Institute Of Dermatology Research Articles

Molecular characterisation and antibiotic susceptibility of meningococcal isolates from healthy men who have sex with men

ObjectivesTo evaluate and characterise meningococcal carriage among healthy men who have sex with men (MSM) within a screening programme for Neisseria gonorrhoeae infection at the San Gallicano Dermatological Institute, Italy.MethodsA...

1618 Improving the Clinic Experience for Surgical Patients Visiting the Melanoma Multidisciplinary Team Clinic at Guy’s and St Thomas’ NHS Foundation Trust

Abstract Aim The incidence of malignant melanoma has been increasing in the UK over the last decade. Effective melanoma management requires a multidisciplinary team (MDT) approach, often involving dermatologists, oncologists, radiologists, histopathologists, skin cancer nurse specialists and plastic surgeons. Patient waiting times at our melanoma MDT clinic at the St John’s Institute of Dermatology at Guy’s Hospital, London had anecdotally been reported as excessive, specifically for same-day ‘in-clinic referrals’ from dermatology to plastic surgery. We aimed to ascertain the reasons for the delay and implement changes to improve patient satisfaction in the clinic. Method A patient satisfaction questionnaire was devised, measuring satisfaction on a numerical scale of 1 (unsatisfied) to 5 (very satisfied) in addition to a clinic staff perception questionnaire on patient satisfaction. Lack of instruction from staff after the dermatology appointment was identified as the predominant factor contributing towards waiting delays to the plastic surgery clinic. This led us to highlight and educate the issue to all team members involved and create a system whereby patients re-reported to the administrative staff after their dermatology appointment to be re-entered into the system. Results As a result of this, the mean surgical patient satisfaction score, pre-intervention of 3.83, improved to 4.50 post-intervention. Similarly, mean scores from staff assessing perception of how well the clinic ran and patient waiting times also increased. Conclusions The introduction of a new patient in-clinic referral protocol and increased staff education of the issue has improved both patient and staff satisfaction within the clinic’s health care provision.

Angiokeratoma-like Lesions Caused by Posttraumatic Stress May Spontaneously Regress, AK-like lesions Spontaneously Regress

Institute of Dermatology, Chinese Academy of Medical Sciences & Peking Union Medical College, Nanjing, China. Corresponding authors: Wen-Kai Zong, M.Med, Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, Jiangwangmiao Street 12, Nanjing 210042, China. E-mail: [email protected]. Received 14 May, 2020 Revised 3 July, 2021 Accepted 4 July, 2021 Shi-Qi Ling (ORCID: 0000-0003-2862-4299). The authors declare no conflicts of interest. Patient Consent: written informed consent was provided by the patient for the treatment and for publication of the case details. Author Contributions Statement LS: contributed to analyse most of the data, write the initial draft of the paper and finalizing this paper. ZW: helped perform the analysis with constructive discussions. FS: contributed significantly to analysis and manuscript preparation. ZWK: collected data of the case, contributed to refining the ideas, and carrying out additional analyses. CH: contributed to the conception of the study. This is an open access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. http://creativecommons.org/licenses/by-nc-nd/4.0

Living legend in dermatology-Professor Amrinder J Kanwar

Professor (Dr.) Amrinder J Kanwar, MBBS from AIIMS, New Delhi, India, 1995 – Commonwealth fellow at St John’s Institute of Dermatology, London, 2006 – International HIV Training program National Institute of Health (N/H) BETHESDA, May 2006

Abstract 2759: Reprogramming of PD1+ M2-like tumor-associated macrophages with anti-PD-L1 and Lenalidomide in cutaneous T cell lymphoma

Abstract M2-like tumor-associated macrophages (TAMs) are abundant and influence cutaneous T cell lymphoma (CTCL) development by inducing immunosuppression. Although it is well established that depletion of M2-like TAMs delays CTCL development, little is known about the underlying mechanisms that shape programmed cell death 1+ (PD1+) M2-like TAMs phenotype in CTCL. Here we identified PD1+ M2-like TAMs accumulated in CTCL lesional skin. Moreover, RNA-seq analysis of human CTCL tissues revealed an up-regulation of the TLR/NF-κB and JAK/STAT signaling pathways. In vitro, PD1+ TAMs exhibited an M2-like profile, with a significant increase in the expression of CD163, CD206, and IL-10, and a clear decrease in the expression of CD80, IL-1β, CXCL-10, and CXCL-11, and the activation of TLR/NF-κB and JAK/STAT signaling pathways. To determine whether PD1+ M2-like TAMs could be reprogrammed, anti-PD-L1 (durvalumab) and lenalidomide were used for treatment of MyLa-conditioned media induced human peripheral blood monocyte-derived PD1+ M2-like TAMs. The results show that anti-PD-L1 and lenalidomide synergistically reshaped M2-like TAMs to M1-like TAMs in vitro through ablation of the TLR/NF-κB and JAK/STAT signaling pathways, which was linked with functional changes in phagocytic activity and cell migration. In conclusion, TLR/NF-κB and JAK/STAT signaling pathways may drive PD1+ M2-like TAMs programming in the CTCL tumor microenvironment, anti-PD-L1 and lenalidomide may reshape PD1+ M2-like TAMs and induce functional changes through ablation of these specific pathways in CTCL. Corresponding author: Christiane Querfeld, MD, PhD. Div. of Dermatology and Beckman Research Institute, City of Hope. 1500 E. Duarte Road, Duarte, CA 91010. Email: cquerfeld@coh.org Phone: 626-634-4436 Fax: 626-218-6190 Citation Format: Zhen Han1,5, Chingyu Su1,5, Xiwei Wu2,5, Hanjun Qin2,5, Steven T. Rosen3,5, Christiane Querfeld1,3,4,5. Reprogramming of PD1+ M2-like tumor-associated macrophages with anti-PD-L1 and Lenalidomide in cutaneous T cell lymphoma [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2021; 2021 Apr 10-15 and May 17-21. Philadelphia (PA): AACR; Cancer Res 2021;81(13_Suppl):Abstract nr 2759.

Air pollution and risk of hospital outpatient visits for eczematous skin disorders in metropolitan cities of South Korea

British Journal of DermatologyVolume 185, Issue 3 p. 641-644 Research letter Air pollution and risk of hospital outpatient visits for eczematous skin disorders in metropolitan cities of South Korea S. Park, S. Park orcid.org/0000-0002-7675-4402 Department of Dermatology and Cutaneous Biology Research Institute, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea Contribution: Conceptualization (equal), Methodology (equal), Writing - original draft (equal)Search for more papers by this authorK.H. Ha, K.H. Ha orcid.org/0000-0002-3408-7568 Department of Endocrinology and Metabolism, Ajou University School of Medicine, Suwon, Korea Contribution: Conceptualization (equal), Data curation (equal), ​Investigation (equal), Software (equal), Validation (equal), Visualization (equal), Writing - original draft (equal)Search for more papers by this authorT.-G. Kim, T.-G. Kim orcid.org/0000-0002-2116-4579 Department of Dermatology and Cutaneous Biology Research Institute, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea Contribution: Conceptualization (equal), ​Investigation (equal), Methodology (equal), Validation (equal)Search for more papers by this authorH.C. Kim, H.C. Kim orcid.org/0000-0001-7867-1240 Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Korea Contribution: Conceptualization (equal), Data curation (equal), Validation (equal)Search for more papers by this authorC. Kim, C. Kim orcid.org/0000-0002-5940-5649 Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Korea Contribution: Methodology (equal), Validation (equal), Writing - review & editing (equal)Search for more papers by this authorS.H. Oh, S.H. Oh orcid.org/0000-0002-4477-1400 Department of Dermatology and Cutaneous Biology Research Institute, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea Contribution: Conceptualization (equal), Data curation (equal), Supervision (equal), Writing - review & editing (equal)Search for more papers by this author S. Park, S. Park orcid.org/0000-0002-7675-4402 Department of Dermatology and Cutaneous Biology Research Institute, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea Contribution: Conceptualization (equal), Methodology (equal), Writing - original draft (equal)Search for more papers by this authorK.H. Ha, K.H. Ha orcid.org/0000-0002-3408-7568 Department of Endocrinology and Metabolism, Ajou University School of Medicine, Suwon, Korea Contribution: Conceptualization (equal), Data curation (equal), ​Investigation (equal), Software (equal), Validation (equal), Visualization (equal), Writing - original draft (equal)Search for more papers by this authorT.-G. Kim, T.-G. Kim orcid.org/0000-0002-2116-4579 Department of Dermatology and Cutaneous Biology Research Institute, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea Contribution: Conceptualization (equal), ​Investigation (equal), Methodology (equal), Validation (equal)Search for more papers by this authorH.C. Kim, H.C. Kim orcid.org/0000-0001-7867-1240 Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Korea Contribution: Conceptualization (equal), Data curation (equal), Validation (equal)Search for more papers by this authorC. Kim, C. Kim orcid.org/0000-0002-5940-5649 Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Korea Contribution: Methodology (equal), Validation (equal), Writing - review & editing (equal)Search for more papers by this authorS.H. Oh, S.H. Oh orcid.org/0000-0002-4477-1400 Department of Dermatology and Cutaneous Biology Research Institute, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea Contribution: Conceptualization (equal), Data curation (equal), Supervision (equal), Writing - review & editing (equal)Search for more papers by this author First published: 24 March 2021 https://doi.org/10.1111/bjd.20079 Correspondence: Sang Ho Oh. Email: oddung93@yuhs.ac Funding sources: This study was supported by a Jayjun research grant of Yonsei University College of Medicine (6-2017-0103) and a grant from the Korea Health Technology R&D Project through the Korean Health Industry Development Institute, funded by the Ministry of Health and Welfare, Republic of Korea (grant number: HP20C0019). Conflicts of interest: None to declare. S.P., K.H.H. and S.H.O. contributed equally to this work. Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat Volume185, Issue3September 2021Pages 641-644 RelatedInformation

Factors Influencing Leprosy Incidence: A Comprehensive Analysis of Observations in Wenshan of China, Nepal, and Other Global Epidemic Areas.

Leprosy remains endemic in some regions and is a global health concern. However, the possible causes and risk factors of the disease remain unclear. Data in Wenshan, China were collected from the Wenshan Institute of Dermatology (1986–2015); data in Nepal were obtained from the Leprosy Control Division, Department of Health Services, Nepal (2011 to 2015); and data from Indonesia, India, and Brazil were collected from WHO records. We assessed the epidemiological trends of leprosy in Wenshan and compared the features of possible causes and risk factors with those of other countries. We then performed a descriptive and statistical analysis to make our study more purposeful and definitive. A total of 3,376 cases were detected in Wenshan from 1986 to 2015. The overall prevalence rate (PR) of leprosy presented a decreasing trend with a peak (4.9/10,000 population) in 1986. The detection of new leprosy cases was higher in males than in females. Visible deformity increased every year since 2005 with a disability of 34.8% in 2015 among new cases. In Nepal, 2,461 leprosy patients received multi-drug therapy (MDT) in 2015 which corresponded to the PR of 0.89/10,000 population. Geographic latitude and socio-economic situations appeared to be the main causes of leprosy, and the healthcare condition was an important factor associated with leprosy incidence. The introduction of MDT effectively reduced leprosy prevalence worldwide. Wenshan (China), Nepal, and other countries share similarities in various aspects with respect to socio-cultural features, geographical distribution, environmental factors, and economic situation, which may contribute to leprosy being endemic in these areas.

Short Communication: HIV Viral Load Trends During the Coronavirus Disease 2019 Pandemic in a Reference Center for HIV in Rome, Italy.

Coronavirus disease 2019 (COVID-19) pandemic has reduced the access of HIV patients to reference centers. However, retention-in-care is critical to maintain adherence to therapy and viral suppression. During lockdown in Italy, our center implemented several measures to ensure HIV-care continuum. To assess whether these efforts were successful, we investigated HIV viral load trend for a 1-year period (September 2019-August 2020), which included lockdown and partial lockdown months in our country. No significant changes overtime in the proportion of undetectable HIV-RNA were observed. Continuity of service made it possible to maintain viral suppression in our patients.

Epicutan allergének változása az Országos Bőr- és Nemikórtani Intézet valamint a Semmelweis Egyetem Bőr-, Nemikórtani és Bőronkológiai Klinika Allergológiai Laboratóriumának környezeti standard rutinsorában

The patch test has been the standard diagnostic tool of verifying contact hypersensitivity for decades. The test’s methodological elements and the tested allergen groups are the achievements of a dynamically changing process of the 20th century. Most commonly, the environmental standard baseline series is used in everyday clinical practice. Te frst environmental series in Hungary, which was recommended for national use, was created in the Allergology Laboratory of the National Dermatological and Venereological Institute in the 1970 years. It consisted of 21 allergens. Afer the Institute’s closure, the Semmelweis University, Department of Dermatology, Venereology and Dermatooncology continued to perform the patch testing. Te number of the baseline series members became more than doubled by now. This review aims to summarise the alterations in the environmental standard baseline series of the Allergology Laboratory of the National Dermatological and Venereological Institute and the Department of Dermatology, Venereology and Dermatooncology of the Semmelweis University and the sensitisation frequencies registered from 1976 to 2016 per 10 year periods.

Профілактика грибкової інфекції стоп

The objective of the work: to study the antifungal activity in vitro and to determine the effectiveness of using the spray containing 0.2% climbazole for the prevention of fungal infections of the feet. Materials and methods. 47 patients were under observation who received treatment at the clinic of the State Establishment «Institute of Dermatology and Venereology of NAMS of Ukraine» for mycosis of the feet and were discharged in a state of recovery, confirmed by mycological negativity. When discharged, patients with a preventive purpose were recommended to apply a spray containing 0.2% climbazole (Mycosan spray) to dry and clean skin twice a day for 30 days with a five-day break for two months. Control of microscopic examination for fungi was carried out once every 2 weeks for two months. To study the protective antifungal activity of the spray in vitro studies were carried out with cultures of yeast-like fungi (Candida spp., strain No. 491) and dermatophytes (Trichophyton rubrum, strain No. 181). Results. The article reveals the relevance of the topic, describes the probable causes of relapses and reinfections of a fungal infection of the feet, indicates ways to prevent these causes. The emphasis is placed on the fact that the main goal of therapeutic and prophylactic measures for fungal infection is the early detection and adequate treatment of patients with mycoses and onychomycosis, as well as the development of fundamentally new means of prevention, one of which is the spray containing 0.2% of climbazole, related to group of azoles which has a fungistatic effect, has a low level of resistance, provides protection and care for the skin of the feet. Conclusions. Studies have shown that Mycosan spray inhibits the growth of pathogenic dermatophytes and yeast-like fungi in vitro. During the observation of 47 patients in the stage of clinical and mycological recovery for two months, infection of the fungal infection of the feet was not observed in a single patient. The spray containing 0.2% of climbazole can be used as an individual prevention of infection and reinfection, as well as an effective addition to the complex therapy of patients with mycoses and onychomycosis of the feet.

PECULIARITIES OF TREATMENT OF PATIENTS WITH ONYCHOMYCOSIS WITH CONTRAINDICATIONS TO SYSTEMIC ANTIMYCOTICS

The aim: To increase the effectiveness of treatment of patients with onychomycosis with contraindications to administration of systemic antifungal therapy. Materials and methods: The study involved 63 patients with onychomycosis of the toes aged 18 to 72 years under supervision at the clinic of the Institute of Dermatology and Venereology of the National Academy of Medical Sciences of Ukraine, who were divided into groups: Group I (30 patients) received naftifine hydrochloride solution and cream; Group II (33 patients) additionally used nail kit mycosan and cytoflavin 2 tablets 2 times a day for 1-1.5 months.The study implied microscopic and molecular genetic examination of nail plates before treatment and starting from the 4th week every 2 weeks. The study included patients with onychomycosis with positive results of both microscopic and PCR studies. Mycological recovery was noted in case of coincidence of results of these studies. Results: Mycological recovery in patients of Group II began in the sixth week in 6.3% and occurred in 100% of cases at the 24th week of treatment, depending on the severity and clinical form. The overall effectiveness of therapy at the 48th week reached 56.7% in Group I and 72.7% in Group II. Conclusions: The developed method of treatment, which includes the use of naftifine hydrochloride solution and cream, nail kit micozan and cytoflavin, allows to achieve clinical and mycological recovery in 72.7% of patients and is a priority in the treatment of patients with onychomycosis with comorbid conditions.

High Prevalence of Rectal <i>Chlamydia trachomatis</i> Infection with the Same Genotype as Urogenital Infection in Female Outpatients in Sexually Transmitted Disease Clinics in China

Objectives: Little is known about rectal Chlamydia trachomatis (CT) infection in outpatients attending sexually transmitted disease (STD) clinics in China. In this study, we aimed to explore the clinical and epidemiologic features of rectal CT infection in this population. Methods: A cross-sectional study which was conducted among these patients in Tianjin (northern China) and Guangxi (southern China) from June 2018 to August 2020. Bidirectionally sequences were used to analyze CT ompA genotype. Univariate and multivariate logistic regression analysis were developed to explore the association of different risk factors for urogenital and rectal CT infection. Results: A total of 1,382 patients were included in the final analyses. The prevalence of urogenital and rectal CT was 11.2% (154/1374) and 4.9% (68/1377) respectively. The rectal CT prevalence among female and male patients was 7.8% (60/767) and 1.3% (8/610) respectively. The three most common genotypes in urogenital CT samples were genotype E (41/137, 29.9%), J (27/137, 19.7%) and D (21/137, 15.3%), while the most common genotypes among rectal CT positive samples were genotype J (11/47, 23.4%), E (10/47, 21.3%) and D (9/47, 19.2%). More than 85% (52/60) of women infected with rectal CT were co-infected with urogenital CT. About 90.0% (36/40) of women shared the same genotype with urogenital samples. Age under 25 and infected NG were selected as risk factors for urogenital CT, while female patients and patients infected with urogenital CT were the risk factors for rectal CT infection. High proportion of rectal CT infection had concurrent urogenital CT infection especially in women, and most of the co-infections were shared among the same genotypes. Conclusions: It would be prudent to encourage awareness, introduce detections tests and treatment strategies for rectal CT infection particularly in female patients visiting STD clinics in China, irrespective of presence of rectal symptoms and history of anal intercourse. Funding Information: This work was supported by the Chinese Academy of Medical Sciences Initiative for Innovative Medicine (grant 2016-I2M-3-021). Declaration of Interests: The authors report no conflicts of interest in this work. Ethics Approval Statement: This study was conducted in accordance with the Declaration of Helsinki, reviewed and approved by the Institutional Review Board of the Institute of Dermatology, the Chinese Academy of Medical Sciences and Peking Union Medical College (approval number 2017-LS-021).

A retrospective, descriptive study of patients with Mycosis fungoides treated by phototherapy (oral PUVA, NB-UVB) with a twice-weekly regimen at the Institute of Dermatology, Bangkok, Thailand, with an experiential timeline of 13years.

Phototherapy has been a first-line treatment for early-stage mycosis fungoides (MF) since 1976. Oral 8-methoxypsoralen plus ultraviolet A (oral PUVA) and narrow-band ultraviolet B (NB-UVB) are favorable modalities owing to their availability. In previous studies, phototherapy was conducted thrice per week initially, which is not feasible for many patients. To evaluate the initial clinical responses and time to relapse in patients with early-stage MF treated with oral PUVA and NB-UVB at a twice-weekly regimen. We reviewed the records of patients with biopsy-proven MF who received oral PUVA or NB-UVB in 2002-2014. Demographic data, staging, response to initial course of phototherapy, and initial relapse-free interval were collected. Among 70 patients, 14 (20%) and 56 (80%) were treated with oral PUVA and NB-UVB, respectively. The majority had early-stage MF (IA, 22.9%, IB, 57.1%, and IIA, 4.3%). Oral PUVA led to a complete response (CR) in 2 (14.3%) patients and partial response (PR) in 7 (50%) patients; 17 (30.4%) and 25 (44.6%) patients, respectively, achieved CR and PR with NB-UVB. The number of treatments was similar in both groups. The cumulative dose was 520.7J/cm2 for PUVA and 41.6J/cm2 for NB-UVB. There was no initial relapse in the 2 (100%) patients and in 10 (58.8%) patients treated with oral PUVA and NB-UVB at 18months and 9.14months of follow-up, respectively. Patients with early-stage MF can achieve clinical response with oral PUVA and NB-UVB, with a twice per week regimen. The initial relapse-free interval was longer than 1year.

Corrigendum.

AllergyVolume 75, Issue 9 p. 2428-2428 CORRIGENDUMFree Access Corrigendum This article corrects the following: Dog ownership at three months of age is associated with protection against food allergy Tom Marrs, Kirsty Logan, Joanna Craven, Suzana Radulovic, W.H.A. Irwin McLean, Gideon Lack, Carsten Flohr, Michael R. Perkin, , Louise Young, Victoria Offord, Mary DeSousa, Jason Cullen, Katherine Taylor, Anna Tseng, Bunmi Raji, Sarah Byrom, Gillian Regis, Charlie Bigwood, Charlotte Stedman, Sharon Tonner, Emily Banks, Yasmin Kahnum, Rachel Babic, Ben Stockwell, Erin Thompson, Lorna Wheatley, Devi Patkunam, Kerry Richards, Ewa Pietraszewicz, Alick Stephens, Asha Sudra, Victor Turcanu, Volume 74Issue 11Allergy pages: 2212-2219 First Published online: July 8, 2019 First published: 14 September 2020 https://doi.org/10.1111/all.14249AboutSectionsPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat In the article,1 the following errors were published in the author byline on page 2212, conflicts of interest should have been added to the article. The authors would like to add Ronald van Ree and Serge Versteeg and their affiliations to the author byline and to correct the initial of the author from WHA Irwin McLean to WHI Irwin McLean. The author byline reads. Tom Marrs1,2, Kirsty Logan1, Joanna Craven1, Suzana Radulovic1, WHA Irwin McLean3, Gideon Lack1,2, Carsten Flohr4, Michael R. Perkin5, on behalf of the EAT Study Team†. 1Paediatric Allergy Department, Women and Children's Health, King's College London, London, UK. 2Children's Allergies Department, Evelina London, Guy's and St Thomas’ NHS Foundation Trust, St Thomas’ Hospital, London, UK. 3Division of Molecular Medicine, Centre for Dermatology and Genetic Medicine, University of Dundee, Dundee, UK. 4Unit for Population-Based Dermatology Research, St John's Institute of Dermatology, King's College London and Guy's & St Thomas’ Hospital NHS Foundation Trust, London, UK. 5Population Health Research Institute, St George's, University of London, London, UK. The author byline should read. Tom Marrs1,2, Kirsty Logan1, Joanna Craven1, Suzana Radulovic1, WHI Irwin McLean3, Serge A. Versteeg4, Ronald van Ree5, Gideon Lack1,2, Carsten Flohr6,*, Michael R. Perkin7,*on behalf of the EAT Study Team. 1Department of Paediatric Allergy, Department of Women and Children's Health, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King's College London. Strand, WC2R 2LS. 2Children's Allergies Department, Guy's and St Thomas’ NHS Foundation Trust, St Thomas’ Hospital, Westminster Bridge Road, Lambeth, SE1 7EH. 3Division of Biological Chemistry and Drug Discovery, School of Life Sciences, University of Dundee, Dundee, DD1 5EH, UK. 4Department of Experimental Immunology, Amsterdam University Medical Centers, AMC, Amsterdam, The Netherlands. 5Departments of Experimental Immunology and of Otorhinolaryngology, Amsterdam University Medical Centers, AMC, Amsterdam, The Netherlands. 6Unit for Population-based Dermatology Research, St John's Institute of Dermatology, Guy's and St Thomas’ NHS Foundation Trust and King's College London, UK. 7Population Health Research Institute, St George's, University of London, Cranmer Terrace, London, SW17 0RE. 2. The conflicts of interest should have been added to the article and have read. Conflicts of interest. RvR has provided consultancy for HAL Allergy BV, Citeq BV, Angany Inc and received speaker's fees from HAL Allergy and ThermoFisher Scientific. REFERENCE 1Marrs T, Logan K, Craven J, et al. (2019). Dog ownership at three months of age is associated with protection against food allergy. Allergy. 74(11): 2212- 2219. https://onlinelibrary.wiley.com/doi/10.1111/all.13868. Volume75, Issue9September 2020Pages 2428-2428 ReferencesRelatedInformation

Is COVID-19 affecting the epidemiology of STIs? The experience of syphilis in Rome

Dear Editor, In response to the COVID-19 pandemic, on 9 March 2020, the Italian government announced a nationwide lockdown programme of social distancing, self-isolation for contacts and prohibition of public...

Provisional Amyopathic Dermatomyositis with Penile Squamous Cell Carcinoma

Department of Pathology, Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, Nanjing, 210042, Jiangsu, China Corresponding authors: Jianfang Sun, Department of Pathology, Institute of Dermatology, Chinese Academy of Medical Sciences and Peking Union Medical College, 12 Jiangwangmiao Street, Nanjing, Jiangsu, 210042, China. E-mail: [email protected] Received 6 March, 2020 Revised 10 May, 2020 Accepted 4 June, 2020 Conflicts of interest: None declared This is an open access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. http://creativecommons.org/licenses/by-nc-nd/4.0

Novel education-based intervention to reduce inappropriate antibiotic prescribing for treatment of gonorrhoea in China: protocol for a cluster randomised controlled trial

IntroductionInappropriate use of antibiotics to treat gonorrhoea can lead to antibiotic resistance. Education programmes may be helpful for improving physician prescribing behaviours in accordance with treatment guidelines. As traditional education...

Eccrine Spiradenoma of the Forehead: A Case Report

Introduction Eccrine spiradenoma (ES) is a rare benign adnexal tumor originating from the eccrine glands that was first described by Kersting and Helwig in 1956.1 ES typically presents as a single, solid, well-defined nodule of less than 1 cm in size, localized within subcutaneous tissue, but it can also present as one large nodule or as multiple nodules, and have a zosteriform, linear, blaschkoid, or nevoid distribution pattern. The tumor can occur in individuals of any age, although it typically affects young adults aged 15–35 years, and does not preferentially affect males or females.2 Most ES cases with multiple tumors have been reported on the scalp, face, or cervical regions.3 However, a solitary lesion occurring on the forehead region is rare. Here, we report such a case in a 38-year-old woman, which may enrich the clincial presentation of this disease of clinician. Case report A 38-year-old woman presented with a 10-year history of a small nodule on her forehead in the Hospital for Skin Diseases (Institute of Dermatology) in May, 2018. The lesion had gradually undergone a mild increase in size over the past 10 years, with the occasional presentation of paroxysmal pain. There were no specific findings in the patient's family history and medical history. Upon examination, a single soft and tender nodule measuring 0.3 cm × 0.4 cm was noted (Fig. 1A). We performed a complete resection of the tumor, and histopathological examination at low power showed a deep, well-defined, and encapsulated tumor nodule in the dermis (Fig. 1B). At higher magnifications, two distinctive cell types were observed: large pale cells with ovoid vesicular nuclei and small, dark, basaloid cells with hyperchromatic nuclei. Moreover, small lymphocytes scattered between tumor cells were observed (Fig. 1C). In the lumina, periodic acid–Schiff stain (PAS)-positive eosinophilic tubular material was noted (Fig. 1D).Figure 1: Clinical and histopathological results of the patient. (A) Image of the solitary, soft nodule on the forehead, measuring 0.3 cm × 0.4 cm. (B–D) Histopathological results. B: The deep, well-defined, encapsulated tumor nodule arising from the dermis (H&E, ×80). (C) The two types of cells (small, dark, basaloid cells with hyperchromatic nuclei, and cells with large, pale, vesicular, and ovoid nuclei) in the nodule (H&E, ×400). (D) Tubular formations with PAS-positive eosinophilic amorphous material in the lumina (PAS, ×600).The diagnosis of ES was made based on the histological results. The patient has been followed up since diagnosis, and no recurrence had been observed at the time of writing this report. Discussion ES is a rare benign soft tissue cancer, typically presenting as a tender, painful, rounded, bluish, dermal nodular lesion. It is usually found in the deep dermal layer and composed of multinodular tumors with basophilic lobules encapsulated by thick connective tissue. The tumor cells can be divided into two types: cells with low-density cytoplasm located at the center of the tumor and small dark cells with high-density cytoplasm in the perimeter of the tumor. Cystic spaces or tubular structures also can be observed.4 ES mainly occurs on the upper ventral aspect of the body and appears as a solitary tumor.2 In recent solitary cases reported, ES occurred more commonly in the upper extremity.2,5,6 However, a solitary lesion occurring on the forehead region, as in this case, is rare presentation. Clinically, an ES tumor often presents with pain, so this type of tumor needs to be differentiated from other painful skin tumors such as glomus tumor, angioleiomyoma, neuroma, dermatofibroma, angiolipoma, neurilemmoma, and granular cell tumor. Additionally, ES should be differentiated from cylindroma using histology. Cylindroma is a benign tumor, also derived from the eccrine glands, composed of small tumor cell aggregations that are differentially polymorphic in shape and arranged in a jigsaw puzzle pattern. Moreover, a cylindroma tumor mass is rimmed by eosinophilic basement membrane-like material. ES is sometimes similar to hemangiomas and glomus tumors; however, these tumors contain blood in the vascular lumen and have no ducts.7,8 Although a few cases of malignant change in ES have been reported, it occurs very rarely, and most patients have a good prognosis. Long-standing ES tumors tend to deteriorate. In contrast, if the tumor suddenly and rapidly increases, hemorrhages, and ulcerates, the possibility of malignant transformation should be considered. Thus, early and complete surgical excision is the preferable diagnostic tool and treatment option for ES.9 In conclusion, we reported a 38-year-old woman with ES on the forehead region, which is a rare presentation. Nowadays, complete resection of the ES should be considered as a preferable option.

SAT0376 DOES SUPPRESSION OF IL-4 AND IL-13 LEAD TO THE DEVELOPMENT OF NEW ONSET SPONDYLO-ARTHRITIS IN SUSCEPTIBLE PATIENTS?

Background:Enthesitis is a key feature of peripheral Spondyloarthritis (SpA). Several pro-inflammatory cytokines including Interleukin-17 and Interleukin-23 are found within the enthesis (1). Dupilumab is a recombinant human monoclonal antibody that inhibits signalling of Interleukin-4 and Interleukin-13, approved for use in patients with moderate- to –severe atopic eczema. Here we describe a cohort of patients with severe atopic eczema who have developed a new peripheral SpA/ enthesitis after receiving Dupilumab.Objectives:To describe the clinical and imaging details of this cohort.Methods:All patients in St John’s Institute of Dermatology who exhibited new arthralgias on Dupilumab therapy were referred for assessment in Guy’s Rheumatology Department. These patients had a focussed history, examination, ultrasound and/or MRI of affected joints and entheseal sites.Results:To date we have seen 12 patients with a history of new inflammatory peripheral SpA type symptoms following onset of Dupilumab therapy. There were 7 males and 5 females all of whom have longstanding severe atopic Eczema. All patients had raised baseline IgE levels of mainly >10000. All patients exhibited a positive response to Dupilumab with a marked improvement in eczema as measured by the EASI score. All patients had normal inflammatory markers and negative immunological screening bloods. Musculoskeletal symptom onset was between 2 and 20 weeks after starting treatment. Typically, these patients had inflammatory symptoms affecting both the small joints and the entheseal sites. 2/12 patients developed inflammatory sounding spinal pain. 2/12 patients had ultrasound evidence of arthritis. 11/12 patients had radiological findings of enthesitis as seen on MRI or ultrasound (power doppler ultrasound signal). 9/12 patients were treated with non-steroidal anti-inflammatories with variable improvement.1 patient required no treatment and 1 patient received low dose prednisolone.Conclusion:In our centre approximately 200 patients have received Dupilumab. These musculoskeletal findings have not been reported previously in clinical trials. We hypothesise that the profound inhibition of IL- 4/13 may allow an inflammatory response at the enthesis presenting with a peripheral SpA pattern. IL-4 has been shown to suppress delayed type hypersensitivity reactions (DTHRs) and psoriasis in both human and mice studies (2). These findings and the demonstratation that IL-23 transcription and secretion can be suppressed by IL-4 with resultant reduction in Th17 function (3) may be key factors as to why a SpA type response is seen in certain subjects.

GENETIC (RAPD-PCR) VARIABILITY OF STAPHYLOCOCCUS AUREUS STRAINS EXTRACTED FROM LOCUS MORBI AND INTAKT SKIN OF PATIENTS WITH ALLERGODERMATOSIS

The article presents data on the study of genetic relatedness of S. aureus strains growing on the skin and nasal passages of patients with allergodermatoses. A study of the possible correlation between the genotype of the pathogen and the burden of allergodermatoses using the RAPD-PCR method was done. The aim of the research: determination by RAPD-PCR analysis (Random Amplified Polymorphic DNA) of genetic variability and affinity of S. aureus strains extracted from locus morbi, intact areas of skin and nasal mucosa of patients with allergodermatoses (AD and IE). Materials and methods. RAPD-PCR was used to genotype 111 strains of Staphylococcus aureus extracted from the skin and nasal passages of patients with allergodermatoses (AD and IE), as well as 11 strains isolated from the skin of almost healthy individuals to identify genetic links between these strains. These strains were removed from patients with AD and IE who sought medical help in the dermatological department of the State Institution "Institute of Dermatology and Venereology of the National Academy of Medical Sciences of Ukraine" during 2016-2019. Results. When comparing the RAPD spectra of strains extracted from the affected and intact areas of the skin of patients with mild and severe AD, the degree of genetic relatedness of the strains was 75.1±4.4 % and 98.8±0.8 %, (P˂0,001), respectively, indicating a high level of affinity of the strains. Strains of S. aureus removed from the nasal passages of patients with AD had a high level of genetic affinity with strains removed from the affected areas of the skin – 79.5±1.6 %, which indicates the auto-origin of strains growing on the skin of patients. The affinity of strains isolated from patients with IE with the reference culture of S. aureus ATCC 25923 was 27.4±1.8 % and 52.0±5.2 % for strains isolated from patients with AD, indicating their low genetic relatedness. Conclusions. In the study of RAPD spectra of S. aureus strains isolated from patients with both AD and IE, no genotype was identified that would be associated with the disease or its severity. A high level of genetic affinity of strains extracted from locus morbi with strains extracted from the nasal passages of patients with AD, indicating the auto-origin of strains that grow on the skin of patients. It is shown that with increasing severity of AD, the genetic monotype of isolated pathogens increased: in patients with mild AD, 3 genetic clusters of the microorganism were identified, with moderate – 2, and with severe only one.