Cutaneous Manifestations In Patients Research Articles

Cutaneous Manifestations in Patients with Dermatomyositis, Are They Only Skin Deep?

Dermatomyositis (DM) is a rare and severely debilitating autoimmune disease that can affect children and adults; however, there is little understanding of the patient-reported experience and uncertainty around validated clinical outcomes assessments (COAs) that could measure changes in the condition during clinical trials of new treatments. The aim of this study was to understand the patient experience of DM, with a focus on its cutaneous manifestations, to describe the patient experience and determine the suitability of existing COA measures. Adult (≥ 18 years) patients (N = 28) with severe active cutaneous manifestations of DM were interviewed. In the 90-min interviews, open-ended questions and probes were used to elicit descriptions of key clinical manifestations and patients' experiences of DM, including the symptoms and impacts on their daily lives and wellbeing. Patients reported 13 different skin manifestations of DM. The most common were rash (n = 28, 100%), itch (n = 28, 100%), dry skin (n = 23, 82%), and swelling of the skin (n = 17, 61%). The head and face, followed by hands, were perceived as the most bothersome body areas affected by skin manifestations, because they are exposed and visible to themselves and other people. All patients (n = 28, 100%) reported at least one impact of DM, which varied greatly between patients, but included emotional, psychological, cognitive, and physical impacts, and those affecting daily life, such as work and sleep. Over half of the patients (n = 19, 67%) reported that their daily activities were impacted by DM. The qualitative interviews with patients revealed that the presentation of DM manifestations is highly variable but affects patients' emotional wellbeing, physical activities, and daily life significantly.

Cutaneous Manifestations in Patients on Hemodialysis and Assessment of the Changes in Quality of Life After 12 Weeks of Treatment by a Dermatologist.

Cutaneous manifestations are frequently observed in end-stage kidney disease (ESKD) and affect the quality of life (QoL) of patients undergoing maintenance hemodialysis (HD). Even patients undergoing HD who frequently visit hospitals do not receive active dermatological care. The aims of this study were to assess the cutaneous manifestations of patients undergoing HD and investigate changes in their QoL before and after active treatment by dermatologists. A 12-week prospective study was conducted in two HD centers. Patients in one center received dermatological intervention, while patients in the other center received conservative management by a nephrologist. Patients scored their QoL using the Dermatology Life Quality Index (DLQI) and the Skindex-29 at the start of the study and 12 weeks later. Two matched groups were formed using propensity score matching. Simple and multiple linear regression analyses were used to identify associations between dermatological treatment and the improvement in QoL. In total, 120 patients were included, of whom 65 and 55 were in the intervention and control groups, respectively. Approximately 93.8% of the patients had dermatological manifestations, with pallor and xerosis being the most common. Improvement in QoL, as assessed using the DLQI, was confirmed after 12 weeks in the overall population. However, active intervention by a dermatologist did not significantly improve QoL. Patients treated with dermatological intervention by a dermatologist did not achieve greater improvements in QoL than control patients. Therefore, careful assessment of skin issues in patients with ESKD should be undertaken by nephrologists, and the best possible treatment should be administered.

Anaphylaxis as the only presenting symptom of COVID 19

Most children with SARS-CoV-2 infection are asymptomatic or exhibit only mild symptoms. A varied incidence of cutaneous rashes has been described in different studies.A recent review of the cutaneous manifestations in patients with COVID-19 highlighted that urticarial rash is common at the onset of the disease but very rare cases found to have associated anaphylaxis. With this report, we are describing a 10-year-old child who presented to a tertiary care hospital in Jordan with anaphylaxis as the only presenting symptom of COVID-19.

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.

Cutaneous Manifestations in Patients with Beta-Thalassemia Major.

Beta-thalassemia major is a transfusion-dependent thalassemia. Both ongoing disease-related inflammatory processes and chronic transfusions lead to iron overload, which is depicted by hyperferritinemia. We aimed to report the prevalence of various dermatological manifestations in beta-thalassemia major patients and their relationship with serum ferritin levels. This was a cross-sectional study conducted over a period of six months. Beta-thalassemia major patients were consecutively enrolled and examined by a dermatologist who charted any skin conditions, if present. A blood sample was also taken at the same time to check for the serum ferritin levels. Data was analysed using SPSSv25. A total of 113 patients were included in the study. The mean age of the cohort was 9.32 ± 4.54 years. The mean ferritin level for the cohort was 3334 ± 1676 micrograms per litre. Cutaneous manifestations were seen in 89.4% (n = 101) patients with the common ones namely xerosis (44.2%), freckles (39.8%) and pruritus (44.2%). We noted that serum ferritin levels were significantly higher in those with freckles (p = 0.00288). The cause of pruritus does not appear to be jaundice (p = 0.973). Lastly, number of skin conditions were higher in those with onset of blood transfusions at age less than one year (p = 0.0011). Dermatological manifestations are a frequently encountered problem in beta-thalassemia major patients. It is important to examine these patients for various skin disorders periodically as this can help improve their quality of life and reduce dermatological-associated morbidity.

Cutaneous manifestations in patients with systemic lupus erythematosus: Forms at the beginning of the disease and during follow-up. Retrospective analysis

ObjectivesTo describe skin involvement (SI) in patients with systemic lupus erythematosus (SLE) at onset and during follow-up of the disease and to determine factors associated with SI at lupus diagnosis. Materials and methodsRetrospective, observational, and descriptive study, from a single centre in patients diagnosed with SLE (ACR 1982-97 or SLICC 2012 criteria). The modified Gilliam classification for SI was used. Descriptive statistics and bivariate and multivariate analysis were performed to evaluate the factors associated with SI at diagnosis of the disease. Results149 patients were included, 91.3% women with a median age at diagnosis of 33 years. SI at onset of the disease occurred in 125 patients (83.9%), followed by joint involvement in 120 cases (80.5%). Non-specific skin lesions were more frequent than specific lesions, 92.8% versus 66.4%, respectively. In the bivariate analysis, a longer delay to diagnosis, the presence of joint involvement, a lower presence of thrombocytopenia, and a higher SLEDAI-2K score were associated with the presence of SI at onset of the disease. In the multivariate analysis, the variable that remained independently associated was joint involvement (OR 2.8%–95% CI 1.1–7.5, p: .04). During follow-up, 4/24 patients who had not presented SI at diagnosis and 51/125 patients who had, had at least one new skin flare (range: 1–5 outbreaks). ConclusionsOur study demonstrates the high frequency of skin involvement in SLE, both diagnostically and evolutionarily, and confirms previously reported data regarding the existence of a skin-articular phenotype.

Skin Toxicity After Exposure to Gadolinium-Based Contrast Agents in Normal Renal Function, Using Clinical Approved Doses: Current Status of Preclinical and Clinical Studies.

The aim of this study was to summarize the current preclinical and clinical evidence on the association between exposure to gadolinium (Gd) compounds and skin toxicity in a setting similar to clinical practice. A search of MEDLINE and PubMed references from January 2000 to December 2022 was performed using keywords related to gadolinium deposition and its effects on the skin, such as "gadolinium," "gadolinium-based contrast agents," "skin," "deposition," and "toxicity." In addition, cross-referencing was added when appropriate. For preclinical in vitro studies, we included all the studies that analyzed the response of human dermal fibroblasts to exposure to various gadolinium compounds. For preclinical animal studies and clinical studies, we included only those that analyzed animals or patients with preserved renal function (estimated glomerular filtration rate >30 mL/min/1.73 m2), using a dosage of gadolinium-based contrast agents (GBCAs) similar to that commonly applied (0.1 mmol/kg). Forty studies were selected. Preclinical findings suggest that Gd compounds can produce profibrotic responses in the skin in vitro, through the activation and proliferation of dermal fibroblasts and promoting their myofibroblast differentiation. Gadolinium influences the process of collagen production and the collagen content of skin, by increasing the levels of matrix metalloproteinase-1 and tissue inhibitor of metalloproteinase-1. Preclinical animal studies show that Gd can deposit in the skin with higher concentrations when linear GBCAs are applied. However, these deposits decrease over time and are not associated with obvious macroscopic or histological modifications. The clinical relevance of GBCAs in inducing small fiber neuropathy remains to be determined. Clinical studies show that Gd is detectable in the skin and hair of subjects with normal renal function in higher concentrations after intravenous administration of linear compared with macrocyclic GBCA. However, these deposits decrease over time and are not associated with cutaneous or histological modifications. Also, subclinical dermal involvement related to linear GBCA exposure may be detectable on brain MRI. There is no conclusive evidence to support a causal relationship between GBCA administration at the clinical dose and cutaneous manifestations in patients with normal renal function. Gadolinium can produce profibrotic responses in the skin, especially acting on fibroblasts, as shown by preclinical in vitro studies. Gadolinium deposits are detectable in the skin even in subjects with normal renal function with higher concentrations when linear GBCAs are used, as confirmed by both preclinical animal and human studies. There is no proof to date of a cause-effect relationship between GBCA administration at clinical doses and cutaneous consequences in patients with normal renal function. Multiple factors, yet to be determined, should be considered for sporadic patients with normal renal function who develop clinical skin manifestations temporally related to GBCA administration.

Cutaneous susceptibility to SARS-CoV-2 infection according to the expression of viral entry factors in the skin

Introduction: Reports of dermatological manifestations in patients with COVID-19 suggest a possible cutaneous tropism of SARS-CoV-2; however, the capacity of this virus to infect the skin is unknown. Objective: To determine the susceptibility of the skin to SARS-CoV-2 infection based on the expression of viral entry factors ACE2 and TMPRSS2 in this organ. Method: A comprehensive analysis of human tissue gene expression databases was carried out looking for the presence of the ACE2 and TMPRSS2 genes in the skin. mRNA expression of these genes in skin-derived human cell lines was also assessed. Results: The analyses showed high co-expression of ACE2 and TMPRSS2 in the gastrointestinal tract and kidney, but not in the skin. Only the human immortalized keratinocyte HaCaT cell line expressed detectable levels of ACE2, and no cell line originating in the skin expressed TMPRSS2. Conclusions: Our results suggest that cutaneous manifestations in patients with COVID-19 cannot be directly attributed to the virus. It is possible that cutaneous blood vessels endothelial damage, as well as the effect of circulating inflammatory mediators produced in response to the virus, are the cause of skin involvement.

Cutaneous manifestations in patients with end-stage renal disease on hemodialysis.

End-stage renal disease (ESRD) is a serious chronic disease that affects many organ systems. Skin manifestations that are commonly seen in ESRD can significantly impair the quality of life in these patients. Early recognition and management of mucocutaneous disorders can improve quality of life and decrease morbidity. This study aimed to evaluate the skin manifestations in ESRD patients undergoing hemodialysis. In this cross-sectional study 150 patients undergoing hemodialysis in the Nephrology Department of Shahid-Beheshti Hospital in Babol were enrolled. The demographic and clinical data were assessed. Analysis was done by SPSS 22 and significance level was under 0.05. The mean duration of hemodialysis was 8.7 months. The most common skin findings in patients include xerosis 84.7%, pallor 82.7%, pruritus 67.3%, hyperpigmentation 40%, purpura 28%. Skin infections were detected in 36% of patients (fungal 28%, bacterial 10.7%, and viral 5.3%). Nail, hair and mucosal changes were observed among 65.3%, 38% and 17.3% of patients respectively. No significant correlation was detected between skin findings and duration of dialysis. The findings of the present study showed that skin manifestations are highly prevalent among patients with ESRD. Prompt diagnosis and management of the dermatological disorders may improve the quality of life in the affected patients.

Cutaneous Manifestations in Patients With COVID-19 Treated at a University Hospital in Southern Brazil.

Objectives The aim of this study was toascertain whether pattern of cutaneous lesions, age, sex, ethnicity, long-term medication use, arterial oxygen saturation at the first examination, setting of care, and number of medications used to treat SARS-CoV-2 infection are associated with mortality in patients with a confirmed diagnosis of coronavirus disease 2019 (COVID-19) and cutaneous manifestations. In addition, to evaluate the occurrence of cutaneous manifestations in patients with a confirmed diagnosis of COVID-19 through a review of medical records and in-person evaluation by a dermatologist. Methods This investigation consisted of two components - (A) a cross-sectional study with a retrospective review of the medical records of all patients with a positive reverse-transcriptase polymerase chain reaction (RT-PCR) test for SARS-CoV-2 treated at Santa Casa de Misericórdia de Porto Alegre between March 2020 and November 2020, and (B) a prospective case series with in-person skin examination by an attending dermatologist of all patients admitted to COVID-19 wards between April 2021 and July 2021. The pattern of skin lesions and other variables were assessed. Results Information from 2968 individuals with COVID-19 was collected (2826 from the medical records and 142 from the in-person examination by a dermatologist). Of these, a total of 51 patients (1.71%) had COVID-19-related cutaneous lesions - 36 from the medical records group (1.27% of cutaneous manifestations) and 15 from the examinated group (10.56% of cutaneous manifestations). Of 51 patients, 15 (29.41%) died. There was no association between mortality and patterns of cutaneous manifestations. The variables male sex (p=0.021), intensive care unit (ICU) admission (p=0.001), and use of three or more antibiotics (p=0.041) were associated with higher mortality. Conclusions The risk factors, proven by our study, for mortality in patients with COVID-19 and cutaneous manifestations were male sex, ICU stays, and use of three or more antibiotics. Using the review of medical records as a tool for evaluating cutaneous manifestations related to COVID-19, there are about 10 times fewer occurrences when compared to in-person evaluation by a dermatologist.

Cutaneous Manifestations In the Patients With Covid 19: A Prospective Clinical Analysis

Introduction: The COVID-19 pandemic has become a major health care issue worldwide. The surge in cases was seen in the second wave, with more people getting hospital admissions. An accurate and rapid identification of cutaneous manifestations is vital to early diagnosis and better prognosis. The aim of the study was to determine cutaneous manifestations in patients with COVID-19. Materials and Methods: This prospective observational cross-sectional hospital-based study was conducted from June 2021 to September 2021. Patients admitted to the hospital were examined by the dermatologists. All inpatients diagnosed with COVID-19 with RT PCR were included. Types, patterns and how the skin lesions changed its course during illness were recorded. Ethical clearance was taken from IRC. Statistical analysis was done with SPSS Version 20.0. Results: A total of 452 COVID-19 RT-PCR-positive patients were enrolled out of which 97(21.5%) had skin lesions. Out of 131 comorbid patients, 40(30.5%) had skin lesions. Urticarial wheals and erythema nodosum were seen in 21(4.6%) each and were the most common manifestation, followed by exanthema in 17(3.8%). Conclusion: Study showed maximum patients with COVID-19 had urticaria and erythema nodosum. It is important to know the types of skin lesions for early diagnosis. In order to prevent the spread patient can be sent for investigations on time. More elaborate studies with multicenter involvement are recommended.

Rapidly evolving necrotic skin lesions of the face

Rapidly evolving necrotic skin lesions of the face

S5.4a Cutaneous manifestations of deep fungal infections: Aretrospective study from one tertiary hospital

S5.4 Free oral paper session, September 22, 2022, 3:00 PM - 4:30 PM ObjectivesAnalysis of the cutaneous manifestations in patients with deep fungal infections to provide a basis for clinical differentiation and diagnosis.MethodPatients who presented to our hospital from 2016 to 2021, were definitively diagnosed with deep fungal infections by histopathology and mycological detection. Isolates of focal infections were cultured in vitro on SDA or MEA media for 14 days and the species were identified by morphological or molecular analysis. Relevant clinical data on epidemiologic, skin manifestations, underlying disease, causative fungal agent, treatment, and outcomes are collected and analyzed.ResultsA total of 15 patients were diagnosed with deep fungal infections. The respiratory system (7/15) was the most easily involved primary focus of deep fungal infection, digestive system (3/15), and nervous system (2/15) were less common. The mean age of the patients was 50.30 years. Of these, 8 were males. More than half of the cases (7/15) were presented in immunosuppressed patients, including long-term glucocorticoid use, organ transplantation, tuberculosis infection, and malignancy. Skin manifestations were varied, with plaques (5/15) being the most common type of lesion, and then papules (4/15), nodules (2/15), patches (2/15), and ulcers (2/15). Candida spp. (9/15) was the most common pathogens, followed by Talaromyces marneffei (2/15) (Fig. 1a), Cryptococcus spp. (2/15) (Fig. 1b), and Aspergillus spp. (2/15). One case had co-infection with C. albicans and Aspergillus spp.ConclusionsPatients with deep fungal infections are often accompanied by skin manifestations, which vary between patients with deep fungal infections caused by different pathogenic fungi.

Cutaneous manifestations of Coronavirus Disease 2019.

BackgroundCOVID‐19 has been linked to a variety of dermatological conditions.ObjectiveTo determine the presence of various cutaneous manifestations in patients with COVID‐19, also to define their features in relation to the systemic symptoms.MethodsThis research enrolled a total of 1206 lab‐confirmed COVID‐19 individuals at a tertiary care hospital in Karachi, Pakistan. Expert dermatologists assessed patients for COVID‐related skin conditions. COVID‐19 severity was categorized as asymptomatic/mild, moderate, or severe.ResultsOf the 102 (85.7%) patients with only one cutaneous sign, 26.5% developed maculo‐papular/morbiliform/erythematous rash; 14.7% urticaria; 9.85% vesicular/pustular exanthem; 14.7% vascular pattern; 12.7% infections, 7.8% miscellaneous and 9.8% late cutaneous findings A longer‐lasting vascular pattern was related with an older age and a fatal COVID‐19 outcomes (P: 0.000) compared to mild/moderate disease. Most of the retiform purpura presented exclusively with thromboembolic episodes. The moderate severity was correlated with maculopapular/morbiliform/exanthematous phenotype (P: 0.009), whereas urticaria was attributed to asymptomatic/mild disease (0.001) compared to moderate/severe infection.LimitationsSingle‐Centre and observational study.ConclusionVascular lesions were correlated with disastrous COVID‐19 outcomes, whereas retiform purpura was linked to adverse outcomes. The maculopapular/morbiliform/erythematous rash was associated with moderate severity, whilst the urticarial rash was linked to milder course compared to moderate/severe severity infection.

CUTANEOUS MANIFESTATIONS OF DIABETES MELLITUS OBSERVED IN URBAN HEALTH CARE

Background: Aim:Skin involvement in Diabetes mellitus is very common and occurs in 43-66% of diabetics. To study the cutaneous manifestation in patients with diabetes mellitus attending Dermatology OPD at Saveetha Medical College. Seventy-ve patients withMethod: diabetes mellitus and having skin problem at Saveetha Medical College were included in this study. Clinical details regarding age, sex, duration of diabetes, mode of treatment for diabetes and detailed dermatological examination were done in all the patients. Patients having skin changes secondary to pregnancy were excluded in this study. An informed consent was taken from all the patients. The most common cutaneousResults: manifestations observed in our study were infections (87%) followed by acanthosis nigricans (42.6%) and skin tags (29.3%). EarlyConclusion: detection of skin manifestations in diabetes mellitus is important as to avoid or properly manage the complications and to prevent disability.

PUVA therapy in persistent cutaneous histiocytosis: Case report and literature review.

Cutaneous and mucocutaneous histiocytosis (group C) comprise a wide variety of entities affecting skin and/or mucosae. Although they are considered as reactive proliferations, their exact pathophysiology remains unknown and, therefore, they lack a specific treatment. The aim of this study is to review the evidence on cases of histiocytosis treated with UVB and/or UVA and to report a new case of relapsing group C histiocytosis that has been successfully treated with PUVA therapy. We have conducted a review of the literature published over the last 40 years on the treatment of histiocytosis with phototherapy in the online PubMed database. We also describe a new case of successful treatment of histiocytosis with PUVA therapy. Our patient was a 27-year-old man with persistent outbreaks of cutaneous histiocytosis over the previous 8 years. He responded successfully to PUVA therapy, and no relapse has been detected after one year of follow-up. Self-involution is usual in group C histiocytosis, so conservative management is usually the first approach. Relapsing cases pose a therapeutic challenge. Reported treatment options for these patients include isotretinoin, cryotherapy, immunosuppressants, low-dose chemotherapy, CO2 laser, radiotherapy, and surgery. Phototherapy and photochemotherapy have been used in a small number of patients with considerable success. The main limitation to provide firm recommendations on histiocytosis therapy is the absence of solid evidence, as the articles published are mainly case reports with a short follow-up. In our patient, despite the short follow-up we have considered photochemotherapy to be effective since no spontaneous remission had been achieved in the previous 8 years. PUVA therapy could be a safe and effective option to treat persistent cutaneous manifestations in patients with histiocytosis, although more evidence is required to support this statement.

Cutaneous manifestations in patients with COVID-19

Cutaneous manifestations in patients with COVID-19

Evaluation of the prevalence and clinical correlation of skin lesions in patients with diabetes mellitus

Background: DM and the prediabetes state are associated with a number of skin manifestations. It has been shown that cutaneous manifestations are seen in a minimum of 30% of diabetics during the course of their illness, and in some patients, it may be the first sign of the disease. Aim of the study: To evaluate the prevalence and clinical correlation of skin lesions in patients with diabetes mellitus. Materials and methods: The present study was conducted in the Department of Dermatology of the Medical institution. For the study, we evaluated a total of 150 patients with confirmed diagnosis of diabetes mellitus reporting to OPD section of the hospital were selected for the study. An informed written consent was obtained from all the participants after explaining them protocol of the study. Results: Table 1 shows the demographic data of the patients. We observed that pruritis (n=62) was most common cutaneous manifestation in patients with DM. Conclusion: Within the limitations of the present study, it can be concluded that cutaneous manifestations are fairly common in patients with diabetes mellitus. The most common cutaneous manifestations in current study group was pruritis. Other common conditions were canthosis nigricans, cutaneous infections and Achordons.

Intestinal inflammation alters the antigen-specific immune response to a skin commensal.

SUMMARYResident microbes in skin and gut predominantly impact local immune cell function during homeostasis. However, colitis-associated neutrophilic skin disorders suggest possible breakdown of this compartmentalization with disease. Using a model wherein neonatal skin colonization by Staphylococcus epidermidis facilitates generation of commensal-specific tolerance and CD4+ regulatory T cells (Tregs), we ask whether this response is perturbed by gut inflammation. Chemically induced colitis is accompanied by intestinal expansion of S. epidermidis and reduces gut-draining lymph node (dLN) commensal-specific Tregs. It also results in reduced commensal-specific Tregs in skin and skin-dLNs and increased skin neutrophils. Increased CD4+ circulation between gut and skin dLN suggests that the altered cutaneous response is initiated in the colon, and resistance to colitis-induced effects in Cd4creIl1r1fl/fl mice implicate interleukin (IL)-1 in mediating the altered commensal-specific response. These findings provide mechanistic insight into observed connections between inflammatory skin and intestinal diseases.

Cutaneous Manifestations of HIV/AIDS in the Era of Highly Active Antiretroviral Therapy: Evidence from Bangladesh

Abstract Objective: Skin diseases are common and striking features of patients with human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) and may vary considerably by ethnic and geographic regions and by the influence of highly active antiretroviral therapy (HAART). However, little information exists regarding the cutaneous manifestations of patients with HIV/AIDS in Bangladesh. This study was performed to elucidate the spectrum of cutaneous disorders in patients with HIV/AIDS in the era of HAART. Materials: This descriptive cross-sectional study was carried out in Chittagong Medical College Hospital, Bangladesh from January 2017 and December 2020. Diagnosed case of HIV/AIDS for HAART therapy and all cases of HIV/AIDS who are already on HAART therapy were included in this study. Descriptive statistical analysis was carried out by using frequencies and percentages. Results: Of 40 patients with HIV/AIDS, 22 (55.0%) were male and 18 (45.0%) were female. The patients ranged in age from 8 to 60years, with a mean age of 38 ± 0.966years. Among all age groups, the highest 19 (47.5%) patients were in the 31- to 40-year age group. Most of the patients were migrant workers [22/40 (55.0%)] with low socioeconomic status [32/40 (80.0%)], and the most common transmission mode was heterosexual activity [36/40 (90.0%)]. Most of the patients [32/40 (80.0%)] had mucocutaneous disorders, 30/40 (75.0%) had infective dermatoses, and 21/40 (52.5%) had non-infective inflammatory dermatoses. Eight of forty (20.0%) patients presented with three or more skin disorders. The most common infective dermatoses were fungal infections [15/40 (37.5%)], followed by viral infections [8/40 (20.0%)], bacterial infections [4/40 (10.0%)], and scabies [3/40 (7.5%)]. The most common noninfective dermatosis was generalized pruritus [6/40 (15.0%)], followed by prurigo simplex [4/40 (10.0%)], psoriasis [4/40 (10.0%)], eczema [3/40 (7.5%)], pruritic papular eruption [1/40 (2.5%)], seborrheic dermatitis [1/40 (2.5%)], urticaria [1/40 (2.5%)], and xerosis [1/40 (2.5%)]. Patients treated with HAART had decreased rates of oral candidiasis and herpes simplex but increased rates of drug reactions [19/40 (47.5%)]. The most common drug eruption following HAART was a morbilliform rash [11/40 (27.5%)], and the most common offending agent was nevirapine. The prevalence of mucocutaneous disorders was higher in patients with a CD4 cell count of <200cells/mm3. Conclusions: A wide range of mucocutaneous disorders is observed in Bangladeshi patients with HIV/AIDS, and HAART has an impact on the spectrum of HIV/AIDS-associated mucocutaneous disorders. Skin and mucocutaneous disorders are seen at every stage of HIV/AIDS and are the initial presentation in most patients in Bangladesh. There is a need for increased attention to the diagnosis and treatment of skin diseases affecting the quality of life of patients with HIV/AIDS.