Common Cutaneous Manifestations Research Articles

Dermatologic manifestations of hematologic disorders.

Distinguishing key morphologic features and understanding the pathophysiology of common cutaneous manifestations of hematologic disorders is essential to ensure prompt and appropriate treatment. In fact, classic cutaneous signs may provide the first clue to the diagnosis of an underlying hematologic disease. Disorders of coagulation, vascular abnormalities, or cutaneous infiltration and deposition are responsible for the underlying pathophysiology of cutaneous manifestations in the majority of cases. Hematologists often feel ill-equipped in identifying morphologic changes in the skin. Thus, the purpose of this review is to provide a comprehensive overview of classic cutaneous manifestations and diagnostic considerations of the associated hematologic conditions. Though there is a specific focus on non-malignant disorders, those straddling the spectrum of malignancy are also discussed. In many disease states, the skin may serve as an important marker of an emerging hematologic disorder, so close collaboration and multidisciplinary input remain essential to provide optimal and timely care for these patients.

Obesity-Related Skin Conditions: Exploring the Link.

Background Obesity is a medical condition characterized by the accumulation of excess fat that can negatively impact health, resulting in a decreased life expectancy and heightened health issues. Obese patients experience skin changes caused by skin infections, mechanical friction, and various skin hypertrophic conditions like fibromas and acanthosis nigricans. Approximately 60-70% of patients suffering from obesity exhibit a range of skin changes. Objective The main objective of the present study is to identify the various types of skin conditions linked to obesity and investigate their relationship with body mass index (BMI). Methodology This is a cross-sectional observational study. This study included obese patients with a BMI greater than 30 kg/m2 who visited the dermatology outpatient department at Saveetha Medical College and Hospital in Chennai, India. We enrolled 100 patients in this study. After obtaining consent, demographic information, height, weight, and cutaneous examination were conducted, and the results were documented. Statistical analysis was conducted using the chi-squared test, where P<0.05 was considered significant. The t-test for independent samples was done to analyze quantitative variables. Results The mean age at presentation was 39.3, and the standard deviation was 9.9.The average BMI was 34.3, and the standard deviation was 2.6. Of the total patients, 34% belonged to the 31-40-year age group, which was followed by 30% in the 41-50-year age group, 23% belonged to the 19-30-year age group, 11% belonged to the 51-60-year age group, and 2% belonged to the >60-year age group. Most patients (63%) had Class I obesity (BMI 30.00-34.99), 34% had Class II obesity (BMI 35.00-39.99), and 3% had Class III obesity (BMI >40.00). The most common cutaneous manifestation overall was acrochordons, followed by acanthosis nigricans, striae distensae, infections, and psoriasis. Conclusion Obesity is identified as a significant public health issue, and its association with skin problems is of practical importance for many clinicians.

Cutaneous manifestations of myelodysplastic syndrome: A systematic review.

Myelodysplastic syndrome (MDS) may present with specific skin lesions, such as leukaemia cutis, which is a well known poor prognostic marker of leukaemia with a high risk of acute leukaemic transformation. However, less is known regarding non-specific cutaneous manifestations of MDS including the prevalence, types and their prognostic and therapeutic significance, which we aimed to determine through this systematic review. We searched electronic databases (PubMed, Medline and EMBASE) from inception up to 26 January 2023 for studies reporting cutaneous manifestations of MDS. Eighty eight articles (case reports n=67, case series n=21), consisting of 134 patients were identified. We identified 6 common cutaneous manifestations: neutrophilic dermatoses (n=64), vasculitis (n=21), granulomatous (n=8), connective tissue disease (CTD) (n=7; composed of dermatomyositis (n=5), cutaneous lupus erythematosus (n=1), and systemic sclerosis (n=1)), panniculitis (n=4), immunobullous (n=1), and other (n=29). Cutaneous features either occurred at time of MDS diagnosis in 25.3%, preceding the diagnosis in 34.7% (range 0.5-216months), or after diagnosis in 40.0% (range 1-132months). Prognosis was poor (40.2% death) with 34.1% progressing to acute myeloid leukaemia (AML). 50% of those with MDS who progressed to AML had neutrophilic dermatoses (p=0.21). Myelodysplastic syndrome was fatal in 39.2% of neutrophilic dermatoses (median time from onset of cutaneous manifestation: 12months), 50% of vasculitis (7.5months), 62.5% of granulomatous (15.5months) and 14.3% of CTD (7months). Recognition of patterns of cutaneous features in MDS will improve early diagnosis and risk stratification according to subtype and associated prognosis.

Dermatomyositis: Practical Guidance and Unmet Needs.

Dermatomyositis is a heterogeneous idiopathic inflammatory myopathy associated with various cutaneous manifestations and variable presence of myositis, interstitial lung disease, and other visceral organ involvement. An accurate diagnosis of dermatomyositis requires correlating clinical examination findings with serological and histological findings. Familiarity with pathognomonic and common cutaneous manifestations of dermatomyositis, which are highlighted here, can be especially helpful in making an accurate diagnosis. Additionally, evaluating patients for presence of myositis-specific autoantibodies can further support or refute a dermatomyositis diagnosis. When present, myositis-specific autoantibodies can also help guide workups for various dermatomyositis-associated manifestations, as each is associated with relatively distinct clinical characteristics. Evaluating patients for various systemic manifestations often relies on expert opinion recommendations; however, societal guideline statements concerning the evaluation of some manifestations have recently been described. Although malignancy-associated dermatomyositis is a well-accepted subtype, there is limited evidence to support extensive malignancy screening has a favorable benefit-risk ratio in most dermatomyositis patients. However, recent research has uncovered novel associations between dermatomyositis and malignancy, suggesting the possibility of identifying high-risk subsets of dermatomyositis patients in whom malignancy screening may have a high value. Treatment for dermatomyositis has remained largely unchanged over the past several decades. Although many dermatomyositis patients can be effectively treated with current options, either as monotherapy or with combination regimens, there is a need for more targeted and effective DM therapies, in general, and for MDA5(+) dermatomyositis-associated rapidly progressive interstitial lung disease. Fortunately, significant current and emerging research activities evaluating various novel medications for dermatomyositis provide hope for exciting future advances in patients with this intriguing immune-mediated disease.

Cutaneous vasculitis in autoinflammatory diseases.

Autoinflammatory diseases (AIDs) characterized by recurrent episodes of localized or systemic inflammation are disorders of the innate immune system. Skin lesions are commonly found in AIDs and cutaneous vasculitis can coexist with AIDs and even present as the most striking feature. This review aims to focus on the frequent cutaneous vasculitis association in three monogenic AIDs including familial Mediterranean fever (FMF), deficiency of adenosine deaminase type 2 (DADA2), and the recently identified adult-onset VEXAS (vacuoles, E1 enzyme, X-linked, autoinflammatory, somatic) syndrome. Cutaneous vasculitis in FMF is characterized by: (1) small-vessel vasculitis similar to IgA vasculitis with palpable purpura but increased intussusception complication and less vascular IgA deposit, and (2) cutaneous arteritis-like vasculitis presenting as subcutaneous nodules most often with higher glomerular involvement. DADA2 has a wide spectrum of clinical presentations ranging from fatal systemic vasculitis with multiple strokes, especially in pediatric patients, to limited cutaneous disease in middle-aged patients. DADA2 shares similar clinical and histopathological features with polyarteritis nodosa (PAN). As a result, DADA2 is commonly initially misdiagnosed as childhood PAN. Livedo racemosa reveals the most common cutaneous manifestation of cutaneous vasculitis in patients with DADA2. VEXAS syndrome is a life-threatening disease. A diagnosis of VEXAS syndrome should be strongly considered or could be made in patients with skin lesions characterized by Sweet syndrome-like eruption, livedo racemosa, concomitant relapsing polychondritis, deep venous thrombosis, pulmonary involvement, and progressive hematologic abnormalities such as myelodysplastic syndrome with a unique finding of cytoplasmic vacuoles in myeloid and erythroid precursor cells from bone marrow aspirate smear. As skin involvement is common in AIDs and may present as the most frequent manifestation, especially in DADA2 (70% to 90%) and VEXAS syndrome (83% to 91%), dermatologists play a crucial role in contributing to the early diagnosis of these AIDs with early initiation of the appropriate therapy to avoid progressing fatal outcomes.

Cutaneous Manifestations in Adult Thalassemia Patients

Background: A wide range of cutaneous manifestations have been described in thalassemia patients. No studies have been conducted in Southeast Asia where there is a high prevalence of hemoglobin E (Hb E) thalassemia. Objective: The primary objectives of the present study were to determine the prevalence of cutaneous manifestations among adult thalassemia patients and assess how cutaneous findings differ between patients with and without β-thalassemia (β-thal)/Hb E. Secondary objectives were to determine any associations between cutaneous manifestations and clinical or laboratory findings and to evaluate quality of life (QoL). Materials and Methods: The present study was a cross-sectional descriptive study conducted between April 2021 and December 2022 in Thailand. Adults aged 18 years and older with any type of thalassemia were eligible. The authors collected relevant demographic data, cutaneous and laboratory findings, as well as responses to a validated Thai version of the Dermatology Life Quality Index (DLQI). Results: One hundred patients (37% male) were included, with a median age of 33 (IQR of 24, 41) years. Of these, 76% had β-thal/Hb E. Xerosis was the most common cutaneous manifestation at 69%. Hyperpigmentation was more common in patients with β-thal/Hb E than those without at 41% versus 17% (p=0.031). Extramedullary erythropoiesis, xerosis, and serum ferritin were significantly associated with hyperpigmentation. The overall median DLQI score was 0 (IQR 0, 2). Conclusion: Xerosis was the most common cutaneous findings in adult thalassemia patients, and hyperpigmentation was more common in patients with β-thal/Hb E. However, cutaneous changes had low impact on patients’ QoL. Keywords: Thalassemia; Cutaneous manifestations; Hemoglobin E thalassemia

P92 Cutaneous manifestations of myelodysplastic syndrome: a systematic review

Abstract A variety of associations between cutaneous manifestations and myelodysplastic syndrome (MDS) have been described, but the frequency is unknown. The presence of cutaneous manifestations may have therapeutic and prognostic significance, as the presence thereof has been reported to be associated with poor prognosis or acute myeloid leukaemia (AML) progression, or may precede the diagnosis of MDS [Farah C, Bulai Livideanu C, Jegu J et al. Prevalence and prognostic value of cutaneous manifestations in patients with myelodysplastic syndrome. J Eur Acad Dermatol Venereol 2010; 24:1171–5; Ghoufi L, Ortonne N, Ingen-Housz-Oro S et al. Histiocytoid Sweet syndrome is more frequently associated with myelodysplastic syndromes than the classical neutrophilic variant: a comparative series of 62 patients. Medicine (Baltimore) 2016; 95:e3033]. We aimed to determine the types and prevalence of cutaneous manifestations in MDS, treatment options and prognosis associated with specific cutaneous manifestations and MDS subtypes. PubMed, MEDLINE and Embase were searched from inception up to 26 January 2023 for studies reporting cutaneous manifestations of MDS in adults aged ≥ 18 years, as per the World Health Organization classification. Case reports and case series were included. The review was registered with PROSPERO (CRD42021293140). In total, 92 studies were included (case reports n = 71, case series n = 21), consisting of 140 patients [98 male, mean age 61.0 (SD 15.4)]. We identified six common cutaneous manifestations: neutrophilic, e.g. Sweet syndrome and pyoderma gangrenosum (n = 66); vasculitis, e.g. leucocytoclastic vasculitis and Behçet disease (n = 21); granulomatous, e.g. granuloma annulare and interstitial granulomatous dermatitis (n = 8); connective tissue disease (CTD), e.g. dermatomyositis (n = 7); panniculitis (n = 4); immunobullous (n = 2); and other (n = 30). Sweet syndrome (81.8%) and pyoderma gangrenosum (18.2%) were the commonest presentations of neutrophilic dermatosis. Cutaneous features either occurred at time of MDS diagnosis in 24.7%, preceded the diagnosis in 36.1% (mean 17 months; range 0.5–216), or after diagnosis in 39.2% (mean 20.6 msonths; range 1–132). Prognosis was poor (40.2% death) with 34.1% progressing to acute myeloid leukaemia (AML), 50% of which had neutrophilic dermatosis. Death occurred in 38.5% of neutrophilic dermatoses (median time from onset of cutaneous manifestation: 12 months), 50% of vasculitis (7.5 months), 62.5% of granulomatous (15.5 months), 14.3% of CTD (7 months), and none reported in immunobullous and panniculitis. Granulomatous skin lesions had the poorest prognosis, 60% of which had progressed to AML. This systematic review highlights the range of cutaneous manifestations associated with myelodysplastic syndrome. Of note, we found that the majority of cases progressing to AML were associated with neutrophilic dermatoses overall; however, granulomatous skin lesions had the poorest prognosis with the highest proportion progressing to AML. We speculate that these manifestations may confer an increase in risk of transformation, compared with other cutaneous changes.

Dengue Fever among Patients Visiting the Outpatient Department of Dermatology in a Tertiary Care Centre: A Descriptive Cross-sectional Study.

Dengue is in an increasing trend in our part of the world mostly due to global warming, It can present with various manifestations including cutaneous manifestations. The main objective of our study was to find out the prevalence of dengue fever among patients visiting the Outpatient Department of Dermatology in a tertiary care centre. A descriptive cross-sectional study was conducted among patients visiting the Outpatient Department of Dermatology in a tertiary care centre after taking ethical approval from the Institutional Review Committee (Reference number: 09092022\04). Data from 1 June 2022 to 8 September 2022 were collected between 1 December 2022 to 20 February 2023 from the hospital records. The laboratory data of individuals were analyzed to find out the prevalence of dengue fever. A Visual Analogue Scale was used to assess the severity of pruritus. Convenience sampling method was used. Point estimate and 95% Confidence Interval were calculated. Among 7442 patients, dengue fever was found to be in 202 (2.71%) (2.34-3.08, 95% Confidence Interval) patients. The mean duration of fever was 3.02±2.960 days. The mean duration of onset of rash after having a fever was 2.56±2.032 days. The most common cutaneous manifestation was maculopapular rash 70 (34.65%). The prevalence of dengue fever was found to be lower than in the studies done in similar settings. dengue fever; prevalence; rash.

ERYTHEMA NODOSUM AND PYODERMA GANGRENOSUM IN PEDIATRIC INFLAMMATORY BOWEL DISEASE

Inflammatory Bowel Disease (IBD), including Crohn’s disease (CD), ulcerative colitis (UC), and indeterminate colitis (IC), affects 77/100,000 children in the US. It is estimated that 2-5% of children with UC and 1-10% of children with CD experience a cutaneous manifestation of IBD. The most common cutaneous manifestations of IBD are erythema nodosum (EN) and pyoderma gangrenosum (PG). The purpose of this study was to characterize the relationship between EN and PG and pediatric IBD using the large Improve Care Now network (ICN) database.

Cutaneous Manifestation in COVID-19: A Lesson Over 2 Years Into the Pandemic.

Cutaneous manifestations related to Coronavirus Disease-19 (COVID-19) have been reported over 2 years since the pandemic began. This research aimed to review articles published in English that describe cutaneous manifestations related to COVID-19/SARS-CoV-2. A data search for case reports, original studies, and review articles from the onset of the current COVID-19 pandemic to December 31, 2022, was performed using PUBMED, Cochrane Library, ResearchGate, and Google search engines. Keywords were "coronavirus", "novel coronavirus 2019", "COVID-19", "SARS-CoV-2", and "2019-nCoV" in combination with "cutaneous", "skin" and "dermatology" The extracted data included authors, region, sex, age, number of participants with skin signs, cutaneous signs, its location, symptoms, extracutaneous/associated symptoms, suspected or confirmed status for COVID-19, timeline, and healing duration. Six authors independently reviewed the abstracts and full-texts to identify publications providing these details concerning cutaneous manifestations related to COVID-19. A total of 139 publications with full text (122 case reports, 10 case series, and 7 review articles) that reported cutaneous manifestations were identified, and reviewed from 5 continents. The most common cutaneous manifestations of COVID-19 were maculopapular, followed by chilblain-like lesion, urticarial, livedoid/necrotic, vesicular, and other/non-descript rashes/skin lesions. After 2 years into the COVID-19 pandemic, we can conclude that there is no pathognomonic cutaneous manifestation of COVID-19, since it can be also found in other viral infections.

A Clinical Study about the Frequency of Physiological Skin Changes Observed in Pregnant Females

Objective: To find out the frequency of physiological skin changes in pregnant females. Methods: In this descriptive cross-sectional study, 100 pregnant females presenting in outpatient departments of dermatology &amp; gynaecology, obstetrics at Akhtar Saeed Trust Hospital Lahore were enrolled over a period of 1year from June 2020 till June 2021. All consenting pregnant females were enrolled in this study and pregnant females with pre-existing skin diseases and having specific dermatosis of pregnancy were excluded from this study. Detailed history was taken &amp; their complete physical &amp; dermatological examination was carried out and the findings were noted down in pre-designed performa. Results: Physiological skin changes were observed in all the patients in our study. The agr range of patients in this study was 18-35 years, the mean age being 25.06 years. The most common cutaneous manifestation observed was hyperpigmentation out of which linea nigra was commonest finding present in 92% of patients, hyperpigmentation on various parts of body in 16 %, melasma in 12% of patients and 76% of patients showed vascular changes. Practical Implications: The rationale of this study is to assess the frequency of physiological changes occurring in pregnant females. So that they can be promptly and correctly diagnosed and thus reducing the emotional and financial stress on community. Conclusion: Pregnant females suffer from a variety of physiological skin changes. Awareness &amp; recognition of these changes will help in timely diagnosis and treatment. Keywords: Pregnancy, skin physiological changes, hyperpigmentation, melasma, vascular changes

Nirmatrelvir-ritonivir, COVID-19, and possible adverse cutaneous reactions.

Nirmatrelvir-ritonivir (Paxlovid) recently received emergency use authorization for the treatment of coronavirus disease 2019 (COVID-19). Literature has linked numerous cutaneous adverse effects to nirmatrelvir and ritonavir, the copackaged tablets within Paxlovid. A review and comparison of these adverse effects to the common cutaneous manifestations of COVID-19 is provided. Numerous drug-to-drug interactions exist between nirmatrelvir-ritonivir and commonly-used medications within dermatology.

Cutaneous Adverse Reactions Associated with COVID-19 Vaccination

Adverse reactions following COVID-19 vaccination are common. We sought to characterize the most common cutaneous manifestations following COVID-19 vaccine administration and identify potential predictive factors.

Managing Monkeypox Virus: Characterizing Common Cutaneous Manifestations and Antiviral Efficacy.

The Monkeypox virus (MPX) has been detected in multiple non-endemic countries since May 2022. The cutaneous manifestations of MPX can have multiple distinct presentations, including pustular and vesicular. Although there are no approved treatments, three antivirals (brincidofovir, cidofovir, tecovirimat) have been utilized. The objective of our study was to conduct a systematic review to evaluate antiviral efficacy (first aim) and cutaneous manifestations of MPX (second aim). Utilizing PRISMA guidelines, we searched PubMed and SCOPUS databases to identify studies utilizing antiviral treatment in human subjects for MPX and studies reporting cutaneous characteristics of MPX lesions. For our first aim, six articles met inclusion criteria. For our second aim, 27 met inclusion criteria. Eighty-eight percent had complete resolution with tecovirimat (n=28) which was well tolerated, and decreased hospitalization time (10 days) compared to brincidofovir (29 days). Forty-four percent of patients had &lt;10 cutaneous lesions and 36% had 10-100 lesions. The most common lesion type was pustular (32%, n=380). This limited sample of studies suggests that tecovirimat is well tolerated and may be an effective antiviral for MPX treatment. Further studies are required to better understand the role of antivirals for MPX treatment among human patients. J Drugs Dermatol. 2023;22(3): doi:10.36849/JDD.7263.

ERYTHEMA NODOSUM AND PYODERMA GANGRENOSUM IN PEDIATRIC INFLAMMATORY BOWEL DISEASE

Abstract BACKGROUND Inflammatory Bowel Disease (IBD), including Crohn’s disease (CD), ulcerative colitis (UC), and indeterminate colitis (IC), affects 77/100,000 children in the US. It is estimated that 2-5% of children with UC and 1-10% of children with CD experience a cutaneous manifestation of IBD. The most common cutaneous manifestations of IBD are erythema nodosum (EN) and pyoderma gangrenosum (PG). The purpose of this study was to characterize the relationship between EN and PG and pediatric IBD using the large Improve Care Now network (ICN) database. METHODS This cohort study evaluated 32,497 patients ages ≤ 21 years from the ICN registry database, including longitudinal data. Association of EN and PG with demographics, medical history, IBD diagnosis characteristics, and visit-level co-morbidities and treatments was evaluated using the Chi-square and Wilcoxon rank sum tests, and multivariable logistic regression. RESULTS In the ICN cohort, the overall incidence of EN was 1.57% (95% CI: 1.43% to 1.71%) and PG was 0.90% (95% CI: 0.80% to 1.00%). The incidence of patients that developed both EN and PG was 0.30% (95% CI: 0.25% to 0.37%). Patients with CD had a higher likelihood of developing EN (1.9%) than patients with IC (1%) or UC (1%) (p &amp;lt;.0001). PG was highest for patients who have IC (1.3%), followed by CD (0.96%) and UC (0.72%) (p value &amp;lt;.03). Worse intestinal disease (higher PUCAI and Physicians Global Assessment) was associated with both EN and PG (p &amp;lt;.0002 and p&amp;lt;.0001). Patients in remission had lower rates of EN (0.8% vs 3.5%) and PG (0.5% vs 1.7%) (p&amp;lt;.0001). Inflammatory markers were higher for patients with either skin condition compared to controls. ESR was shown to have higher mean values for those with EN, 29.59 vs 13.76 vs (p&amp;lt;0.0001), and CRP, 9.27 vs 3.2 (p&amp;lt;0.0001), compared to controls without skin findings. Similarly, compared to controls, patients who had PG had higher mean values for both ESR (22.44 vs 13.76, p&amp;lt;0.0001) and CRP (7.18 vs 3.20, p=0.0003). Having EN or PG was significantly associated with having another extra-intestinal manifestation, including arthritis (EN=24%, PG= 32% vs controls=1.9%, p &amp;lt;.0001) and uveitis (EN= 17.5%, PG= 27% vs controls=0.2%, p&amp;lt;.0001). Patients with EN and PG has higher rates of corticosteroids (EN=32%, PG=20% vs controls=8%, p &amp;lt;.0001). Rate of biologics were less in EN compared to controls (49.5% vs 54%, p=0.03), and not associated with PG. Multivariable logistic regression models confirmed association of Physicians Global Assessment, uveitis, arthritis, and corticosteroids with both EN and PG. CONCLUSION This large cohort study confirmed previous reports of EN and PG incidence in pediatric IBD patients. Both EN and PG are associated with more severe IBD disease and there appears to be an association with other non-cutaneous extra-intestinal manifestations, specifically, arthritis and uveitis.

COVID arm as a common cutaneous manifestation after mRNA-1273 vaccination: a systematic review

BackgroundBy August 2022, CoronaVirus Disease-2019 (COVID-19) had caused 600 million illnesses and 6.5 million fatalities globally. A massive vaccination program is being implemented worldwide to suppress this condition. Several works of literature stated that mRNA COVID-19 vaccination, specifically with the mRNA-1273 vaccine, is followed by clear evidence of the COVID arm effects associated with this vaccine.ObjectiveTo analyze the latest evidence of COVID arm as a common effect of mRNA-1273 vaccination with the ultimate goal of improving vaccine counseling to help healthcare professionals and reassure patients.MethodsA comprehensive search was performed on topics that assess the COVID arm as a cutaneous manifestation following mRNA-1273 vaccination from inception up until July 2022.ResultsEighteen studies with a total of 1129 participants after the first and second dose of mRNA-1273 vaccination reported that most participants had COVID arm following the first dose administration. The characteristics of the patients were a mean age of 43.8 years old, and females represented ≥ 50% in most studies, with a mean onset of 6.9 days after the first dose administration. Symptoms resolved within seven days following the treatment and were harmless.ConclusionsThis study found that the COVID arm condition is most common following the first mRNA-1273 vaccination in the female and middle-aged group. The correlation between demographic variables and COVID arm risk elucidates that the reaction is a type IV allergic skin reaction.

Management of coronavirus disease 2019 vaccine-induced cutaneous complications: A comprehensive literature review.

Despite the numerous reports of cutaneous manifestations associated with vaccines for coronavirus disease 2019 (COVID-19), the relationship between COVID-19 vaccines and cutaneous side effects remains unevaluated. In this review, we examine these manifestations and their management. Reported dermatoses included injection-site reaction (early and delayed), type I allergic reaction, morbilliform eruption, pityriasis rosea, Sweet syndrome, lichen planus, psoriasis, herpes zoster reactivation, erythema multiforme, Stevens-Johnson syndrome, and toxic epidermal necrolysis (TEN). The most common COVID-19 vaccination-related cutaneous manifestations are delayed local reactions, approximately 66% of which are associated with the Moderna vaccine, and 33% with the Pfizer vaccine. Aside from mild injection-site reactions, severe reactions include anaphylaxis and TEN. Most reactions, except for Stevens-Johnson syndrome and anaphylaxis, though unpredictable and unpreventable are mild and can be treated symptomatically. Findings from this review should allow primary care physicians and dermatologists to reach faster diagnosis and initiate prompt intervention.

FUNGUS AMONG US? THE ASSOCIATION BETWEEN FUNGAL DERMATOPHYTES AND ALLERGIC HYPERSENSITIVITY REACTIONS

<h3>Introduction</h3> The dermatophyte <i>Trichophyton rubrum t</i>ypically infects human skin, hair, and nails and causes common cutaneous manifestations such as athlete's foot and fungal nail infections. However, it has been proposed that sensitization, characterized by high levels of circulating IgE, to this allergen is a risk factor for future development of severe asthma. We surveyed the current literature to find clinical associations. <h3>Methods</h3> A systematic review was conducted using PubMed, Embase, and Web of Science using the search terms "<i>Trichophyton rubrum</i> AND rhinosinusitis OR asthma OR rhinitis OR conjunctivitis OR allergic fungal sinusitis OR allergic bronchopulmonary aspergillosis". Only studies with clinical data were used. <h3>Results</h3> Four studies met inclusion criteria with 356 total patients. They consisted of a case report presenting bronchial asthma and dystrophic toenails whose KOH scrapings isolated <i>Trichophyton rubrum</i> (n=1)<i>,</i> a case series of patients with positive skin-prick- tests and bronchial reactivity to <i>Trichophyton</i> with moderately severe asthma (n=11), a cohort which completed allergen sensitization for <i>Trichophyton</i> with high positivity rates associated with moderate asthma (n=258), and a case series investigating the role of inhaling <i>Trichophyton</i> and its association with asthma (n=86). In these studies, patients treated with systemic steroids (n=12) showed minimal change in pulmonary function tests. After treatment with both oral and topical antifungals (n=12), patients reported a resolution of asthma symptoms leading to a concurrent cessation of allergy medications. <h3>Conclusions</h3> This systematic review identified rare but important association of hypersensitivity to <i>Trichophyton rubrum</i> and the development of severe asthma. Treatment with antifungal agents was more effective than allergy medications.

Cutaneous Manifestations of Chronic Renal Disease among Patients of Combined Military Hospital, Dhaka

Introduction: Chronic renal or kidney disease (CKD) presents with a range of cutaneous manifestation. Many New changes have been described since the advancement of hemodialysis, which prolonged the life expectancy, providing sufficient time for these changes to manifest. Objective: To observe the cutaneous changes in chronic kidney patients. Methods: This descriptive cross sectional study was conducted at Dermatology and Venereology department, Combined Military Hospital (CMH) Dhaka from July 2019 to June 2020. A total 100 CKD patients were recruited through purposive random sampling technique and observed for cutaneous changes. Results: Among the total, 88% study population had some form of skin disorders, pallor 65(65%) was found to be the most common cutaneous manifestation, while xerosis 61(61%), pruritus (53%), hyperpigmentation 37(37%) and bacterial infection 28(28%) were other common features. Prevalence of purpura was 29(29%) and fungal infection was 24(24%). Conclusion: CKD is associated with a broad spectrum of skin manifestations caused by the disease or by the treatment. The more commonly with pallor, xerosis and pruritus proper recognition of cutaneous signs and symptoms can relieve sufferings and reduce morbidity of the CKD patients. JAFMC Bangladesh. Vol 18, No 1 (June) 2022: 71-74

Demographic Study of Dermatological Manifestations of DM Patients Attending in a Medical College Hospital

Introduction: Diabetes mellitus (DM) is a common metabolic disorder and is significant for its ability to adverse effect of various organs. Skin manifestations in this condition are due to metabolic derangements, chronic complications and infections, which are commonly observed after developing clinical diabetes mellitus, but may also precede the disease. Aim: The aim of this study was to understand dermatological manifestations in diabetes mellitus relation with demographic parameters. Materials and Methods: It was a hospital based cross sectional study carried out among 80 randomly selected diabetic patients with/without skin lesions. Patients were then asked for their willingness to participate in the study. Skin examination was carried out and skin lesions were identified. All data was recorded in the pre-designed, pre-tested, and semi-structured questionnaire developed for the study. Data was analyzed using SPSS version 26. Frequencies and percentages were calculated for the necessary data. Result: : Mean age of the subjects was 51.0±13.2 years, minimum age 25 and maximum 80 years. It was observed that, out of 80 patients, 52 (65.0%) were aged between 41–60 years. 52 (65%) were female and 28(35%) were male patients. 46(57.5%) were housewives and 16(20.0%) were service holders, 10(12.5%) were farmers and other 8(10%). 41(51.2%) from middle class, 38(47.5%) from lower class and 1(1.3%) were from upper class. 61.2% patients came from rural area and 38.8% patients from urban area. The mean duration of diabetes mellitus was 6.6±5.1 years, 42.5% patients duration had 5-10 years followed by 36.3% below 5 years and 21.3% patients had DM more than 10 years. Out of 80 patients, a total of 39(48.8%) DM patients had skin manifestations and 41(51.2%) had no skin manifestations. Among 39 DM patients with skin disease, 19(48.7%) having a single, while 8(25.5%) had two and 13(30.8%) patients had three or more skin lesions. 22(56.4%) patients found diabetic dermopathy, diabetic foot ulcer 12(30.8%), fungal infections 9(23.1%), bullous lesions 7(17.9%), diabetic foot gangrene 5(12.8%), lypodystrophy 5(12.8%), pruritus 5(12.8%), xerosis 5(12.8%) cases, scleredema 3(7.7%), ichthyosis 2(5.1%) and bacterial infections 2(5.1%). Age, sex, educational level, socioeconomic status, residence found no significant association (p&gt;0.05), but duration of diabetes mellitus was significantly associated with the presence of dermatological manifestations (p=0.001). Conclusion: The spectrum of skin manifestations due to DM in this study population is similar to that in other parts of the world. Diabetic dermopathy, Pruritus and fungal infections are the most common cutaneous manifestations in DM patients. The presence of skin manifestations can highlighten the suspicion for DM enabling early diagnosis and management and thereby can be helpful for preventing complications. Medicine Today 2022 Vol.34(2): 145-149