Diagnosis Of Eczema Research Articles

Association between phthalate exposure and rash eczema disease: based on NHANES 2005-2006.

Phthalates are commonly found in plastic products, personal care products, and food packaging. In recent years, the relationship between phthalates and skin diseases such as eczema has been gaining attention. As endocrine disruptors, phthalates may increase the risk of eczema by affecting the immune system or skin barrier function. This study used a cross-sectional design based on data from the 2005-2006 National Health and Nutrition Examination Survey to assess the association between phthalate exposure and eczema in adults using generalized linear models, restricted cubic spline plots and weighted quantile sum regression. Eczema diagnosis was determined by participants' self-report of whether they had ever been diagnosed with eczema by doctors. Phthalate exposure was assessed by urinary concentrations of phthalates. A total of 1203 subjects, aged 18years and over, were recruited for the study, comprising 627 males and 576 females. We found that females had significantly higher phthalate exposure concentrations than males. There was a significant positive correlation between monoisononyl phthalate (MiNP) and eczema. Mixture analysis similarly found a positive correlation between phthalates and rash eczema, and MiNP was the main contributor. Further sex-stratified analyses showed that this association occurred predominantly in females, while no significant association was found in the male population. Phthalates may have adverse effects on skin health, particularly in women. Future studies should further investigate the mechanisms of this association and focus on other types of phthalates and their effects on skin health.

Managing eczema from infancy to adolescence

Eczema (atopic dermatitis) can have a substantial impact on children and young people, and it is important that the condition is well managed to avoid complications. This article provides a quick overview of the symptoms and diagnosis of eczema and looks at its management from infancy to adolescence.

Evaluation of Skin of Color Curricular Content for Physician Assistant Education.

Physician assistants (PAs) are often members of dermatologic care teams. Adequate knowledge of dermatologic conditions in skin of color (SOC) is crucial to proper diagnosis, treatment, and patient satisfaction. The objective of this study was to increase PA students' objective knowledge of and comfort level with evaluating dermatologic conditions in SOC. Eligible participants included 36 PA students at a major metropolitan medical center during the 2022 to 2023 academic year. A preintervention survey, immediate postintervention survey, and 7-month follow-up postintervention survey were administered before and after a SOC lecture. The surveys concluded with a 10-question, image-based, multiple-choice examination. There was a significant increase in accurate diagnoses of acne scarring, eczema, psoriasis, rosacea, and seborrheic dermatitis in SOC (59.4% preintervention to 76.9% postintervention, P = .029). Student confidence, as rated on a scale of 1 (minimally confident) to 5 (extremely confident), in diagnosing these conditions increased from 2.97 to 3.52 (P = .036). Implementation of a SOC-specific dermatology lecture significantly increased the accuracy and confidence with which PA students diagnosed dermatologic conditions.

Emollient application from birth to prevent eczema in high-risk children: the BEEP RCT.

Atopic eczema is a common childhood skin problem linked with asthma, food allergy and allergic rhinitis that impairs quality of life. To determine whether advising parents to apply daily emollients in the first year can prevent eczema and/or other atopic diseases in high-risk children. A United Kingdom, multicentre, pragmatic, two-arm, parallel-group randomised controlled prevention trial with follow-up to 5 years. Twelve secondary and four primary care centres. Healthy infants (at least 37 weeks' gestation) at high risk of developing eczema, screened and consented during the third trimester or post delivery. Infants were randomised (1 : 1) within 21 days of birth to apply emollient (Doublebase Gel®; Dermal Laboratories Ltd, Hitchin, UK or Diprobase Cream®) daily to the whole body (excluding scalp) for the first year, plus standard skin-care advice (emollient group) or standard skin-care advice only (control group). Families were not blinded to allocation. Primary outcome was eczema diagnosis in the last year at age 2 years, as defined by the UK Working Party refinement of the Hanifin and Rajka diagnostic criteria, assessed by research nurses blinded to allocation. Secondary outcomes up to age 2 years included other eczema definitions, time to onset and severity of eczema, allergic rhinitis, wheezing, allergic sensitisation, food allergy, safety (skin infections and slippages) and cost-effectiveness. One thousand three hundred and ninety-four newborns were randomised between November 2014 and November 2016; 693 emollient and 701 control. Adherence in the emollient group was 88% (466/532), 82% (427/519) and 74% (375/506) at 3, 6 and 12 months. At 2 years, eczema was present in 139/598 (23%) in the emollient group and 150/612 (25%) in controls (adjusted relative risk 0.95, 95% confidence interval 0.78 to 1.16; p = 0.61 and adjusted risk difference -1.2%, 95% confidence interval -5.9% to 3.6%). Other eczema definitions supported the primary analysis. Food allergy (milk, egg, peanut) was present in 41/547 (7.5%) in the emollient group versus 29/568 (5.1%) in controls (adjusted relative risk 1.47, 95% confidence interval 0.93 to 2.33). Mean number of skin infections per child in the first year was 0.23 (standard deviation 0.68) in the emollient group versus 0.15 (standard deviation 0.46) in controls; adjusted incidence rate ratio 1.55, 95% confidence interval 1.15 to 2.09. The adjusted incremental cost per percentage decrease in risk of eczema at 2 years was £5337 (£7281 unadjusted). No difference between the groups in eczema or other atopic diseases was observed during follow-up to age 5 years via parental questionnaires. Two emollient types were used which could have had different effects. The median time for starting emollients was 11 days after birth. Some contamination occurred in the control group (< 20%). Participating families were unblinded and reported on some outcomes. We found no evidence that daily emollient during the first year of life prevents eczema in high-risk children. Emollient use was associated with a higher risk of skin infections and a possible increase in food allergy. Emollient use is unlikely to be considered cost-effective in this context. To pool similar studies in an individual patient data meta-analysis. This trial is registered as ISRCTN21528841. This award was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme (NIHR award ref: 12/67/12) and is published in full in Health Technology Assessment; Vol. 28, No. 29. See the NIHR Funding and Awards website for further award information.

WHAT TO EXPECT FROM MICROBLADING OF THE EYEBROWS

Microblading of the eyebrows, a kind of cosmetic tattooing that has become very popular in the last decade, it can nevertheless cause adverse skin reactions at the tattoo site, including infections, allergic reactions, and even sarcoid reactions. These reactions can lead to a reduction in the quality of life. We report tow cases of adverse reactions following microblading of the eyebrows, the first patient 40-year-old women presenting with a 7 -month history of erythematous lesions on the eyebrow, A biopsy was performed, which came back a sarcoidosis granulomatous reaction, Our patient was put on intralesional corticosteroid and synthetic antimalarials with good improvement, the second patient have 38 year-old women consulting for erythematous, oozing, pruritic lesions after 3 days of application microblading of the eyebrows, . The dermatological examination revealed the presence of edematous erythematous plaques surmounted by vesicles with crumbling contours located on both eyebrows. The diagnosis of contact eczema was retained, and the patients was put on a low-class topical corticosteroid for 10 days with good improvement.

Differential diagnosis of contact dermatitis: A practical-approach review by the EADV Task Force on contact dermatitis.

The diagnosis of eczema ('dermatitis') is mostly clinical and depends on the clinical history and exploratory objective findings (primary lesions, patterns). Contact dermatitis remains as an important condition in the group of eczematous disorders, with important socioeconomic and occupational relevance. Although irritant and allergic contact dermatitis have a different pathogenesis, both are characterized by a rather typical morphology, are triggered by external factors and tend to occur primarily in the area of contact with the exogenous agent. In addition, allergic and irritant dermatitis may also co-exist. The importance of diagnosing contact dermatitis, especially when allergic in nature, is both due to the possibility of avoiding the trigger, and due to its role in aggravating other skin conditions. Nevertheless, the heterogeneity of clinical presentations in daily practice may pose an important challenge for the suspicion and correct diagnosis of contact dermatitis. Furthermore, other conditions, with different pathogenesis and treatment, may clinically simulate contact dermatitis. The Task Force aims to conduct a review of the unifying clinical features of contact dermatitis and characterize its main clinical phenotypes, and its simulators, in order to contribute to an early suspicion or recognition of contact dermatitis and enable a correct differential diagnosis.

The impact of maternal anxiety during pregnancy on children's eczema and allergic rhinitis: The Ma'anshan birth cohort study

ObjectiveThe objective of this study was to investigate the associations between maternal exposure to anxiety during pregnancy and the susceptibility of offspring to eczema and allergic rhinitis and the possibility of sensitivity periods and cumulative effects. MethodsThe study's sample consisted of 3160 mother-child pairs from the Ma'anshan Birth Cohort Study. Maternal anxiety was repeatedly measured in the 1st, 2nd, and 3rd trimesters of pregnancy using the Chinese version of the Pregnancy-Related Anxiety Scale. Information regarding children's eczema and allergic rhinitis diagnoses was collected through parental reports at 12, 24, 36 and 48 months of age. Binary logistic regression models were used for statistical analysis and corrected for multiple comparisons using the false discovery rate (FDR) method. ResultsChildren whose mothers experienced anxiety throughout pregnancy had the highest odds of developing total eczema (aOR 1.45, 95% CI 1.02–2.07) and total allergic rhinitis (aOR 1.67, 95% CI 1.17–2.37) between the ages of 6 and 48 months. The higher the trajectory of the maternal anxiety scores throughout pregnancy, the higher the odds of total eczema (aOR 1.65, 95% CI 1.14–2.40) and allergic rhinitis (aOR 1.84, 95% CI 1.28–2.66) in their offspring. The association between maternal anxiety and children's eczema was mainly concentrated in the first 24 months, whereas the association with allergic rhinitis was mainly concentrated in the 36–48 months. ConclusionMaternal anxiety during any trimester of pregnancy, especially with a consistently high trajectory of anxiety scores, was associated with higher odds of children's eczema and allergic rhinitis.

An Observational Study of Dermoscopic and Histopathological Correlation in Spongiotic Disorders - A Hospital Based Cross Sectional Study.

Spongiosis is defined as intercellular edema and vesicles in the epidermis. Histopathology is the gold standard for the diagnosis of spongiotic disorders. Clinical diagnosis of eczema is sometimes unclear and confused with other dermatoses; histopathology often shows spongiotic tissue reaction patterns; such conditions are called spongiotic disorders. It is challenging for a dermatologist to make the correct diagnosis noninvasively with a dermoscope and thus we have taken up the study to correlate the dermoscopic and histopathological findings in spongiotic disorders to set dermoscopic criteria for the diagnosis. To study the dermoscopic features of spongiotic disorders and correlate clinical, dermoscopic, and histopathological findings. Two hundred fifty two patients, with history and clinical presentation suggesting eczema were enrolled. They were classified as Acute (<6 weeks), Subacute (6 weeks to 3 months), and Chronic (>3 months) eczemas based on duration. Dermoscopy and skin biopsy were performed on representative lesions. Data were compiled and statistically analyzed using frequency distribution and Chi-square test. We correlated the diagnosis based on acute, subacute, and chronic with three modalities, clinical examination, dermoscopy, and histopathology. On clinical examination, acute (27.4%), subacute (42.9%), and chronic (29.7%) dermatitis. On dermoscopy, acute (28.5%), subacute (40.4%), and chronic (31.1%) dermatitis. On histopathology, acute (29.5%), subacute (44.2%), and chronic (26.3%) spongiosis. A positive correlation of 99%, 96.2%, and 95% was observed on dermoscopy and histopathology, in acute, subacute, and chronic eczemas, respectively. Dermoscopy of acute eczemas showed linear vessels (100%) and red background (100%). White-Clods (98.9%) and excoriation marks (70.1%). Dermoscopy of subacute eczemas showed white scales (99.1%), irregular pigment network (98.3%), vascular changes with irregular dots (97.4%), a brown-white background (93.1%), and black/brown/grey dots (91.4%). Dermoscopy of chronic eczema showed brown-white background (100%), irregular pigment network (100%), and black/brown/grey blotches (100%). Definitive dermoscopic patterns are observed consistently with spongiotic diseases and these can be used additionally to set dermoscopic criteria and confirm the diagnosis. Also, dermoscopic findings are well correlated with the already established histopathological features.

Clinical effectiveness of combined topical remedy «Triderm» in treatment of chronic eczema

Objective — evaluation of the effectiveness, safety and tolerability of the local remedy «Triderm» in the treatment of patients with chronic eczema (ChE). Materials and methods. 30 patients with ChE aged from 25 to 47 years were examined. Among the patients, the diagnosis of true eczema (TE) complicated by secondary infection was established in 37.7%, microbial eczema (ME) — in 63.3 % of cases. A mild degree of severity of ChrE was established in 18 (60.0 %) patients (in 6 with TE, 12 with ME), moderate — in 12 (40.0 %) patients (in 5 with TE, in 7 with ME). Patients used the topical combined glucocorticosteroid «Triderm» twice a day for 14 days. The clinical effectiveness of the local drug was evaluated on the 7th and 14th days of treatment and on the 28th day after the start of therapy according to the dynamics of EASI (Eczema Area and Severity Index), visual analog scale (VAS) of itching, numerical rating scale (NRS) and Dermatological Index of Quality of Life (DIQL). Results and discussion. As a result of the use of «Triderm», positive changes in clinical manifestations were achieved in all patients with ChE — clinical remission (decrease in EASI by more than 75 % from the initial state) was determined in 70 % of patients; significant clinical improvement (decrease in EASI by 50—75 %) and improvement of 30 % (decrease of EASI by 25—50 %), disappearance or significant weakening of itching (decrease in intensity of itching by 4.3 times according to VAS and 3.9 times according to NRS), significant improvement of quality of life (absence of disease impact on life in 76.7 % of patients). Faster improvement and regression of dermatosis, recovery of other dermatological indicators occurred with a mild degree, compared to a medium-severe one. Conclusions. The use of the local combined drug «Triderm» which has anti-inflammatory, antibacterial and antimycotic effects, determines the high efficiency of chronic eczema therapy at various stages of the inflammatory process. The clinical effectiveness of «Triderm» allows it to be recommended for the topical therapy of dermatoses in the pathogenesis of which inflammation, bacterial and fungal flora are important (complicated true and microbial eczema, atopic dermatitis, etc.). The use of «Triderm» cream/ointment allows increasing the compliance, reducing the risk of developing unwanted reactions and interactions between active substances. The good tolerability of the drug and the absence of side effects indicate a favorable safety profile of the studied drug.

S2k guideline diagnosis, prevention, and therapy of hand eczema.

The consensus-based guideline "Diagnosis, prevention, and treatment of hand eczema (HE)" provides concrete instructions and recommendations for diagnosis, prevention, and therapy of HE based on an evidence- and consensus-based approach. The guideline was created based on the German guideline "Management von Handekzemen" from 2009 and the current guideline of the European Society of Contact Dermatitis (ESCD) "Guidelines for diagnosis, prevention, and treatment of hand eczema" from 2022. The general goal of the guideline is to provide dermatologists and allergologists in practice and clinics with an accepted, evidence-based decision-making tool for selecting and conducting suitable and sufficient therapy for patients with hand eczema. The guideline is based on two Cochrane reviews of therapeutic and preventive interventions for HE. The remaining chapters were mainly developed and consented based on non-systematic literature research by the expert group. The expert group consisted of members of allergological and occupational dermatological professional associations and working groups, a patient representative, and methodologists. The proposals for recommendations and key statements were consented by using a nominal group process during a consensus conference on September 15, 2022. The structured consensus-building process was professionally moderated. This guideline is valid until February 22, 2028.

44588 Clinical outcomes and characteristics in CTCL patients with a diagnosis of eczema: retrospective review at a single tertiary referral center

44588 Clinical outcomes and characteristics in CTCL patients with a diagnosis of eczema: retrospective review at a single tertiary referral center

Smoke exposure and childhood atopic eczema and food allergy: A systematic review and meta-analysis.

There is no consensus on the effect of timing and type of smoke exposure on early allergy development. This study aimed to determine the relationship between early eczema or food allergy/hypersensitivity development in children by firstly investigating the effect of smoke exposure across critical development periods and secondly by analyzing effects of parental atcive or passive smoking. Four databases (PubMed, Web of Science, Scopus and Embase) were searched in May 2022 and assessed by two independent reviewers. Case-control, cross-sectional or cohort studies reporting on smoke exposure from preconception to postnatal periods and atopic eczema, food allergy and/or hypersensitivity outcomes by age 3 years were included. The Newcastle-Ottawa Scale was used to assess study quality. Random effects model was used to estimate the pooled risk ratios. From 1689 identified records, 32 studies with nearly 190,000 subjects were included. Parental smoking during preconception, pregnancy and postnatal periods was generally not associated with the risk of eczema, food allergy and food sensitisation development by age 3 years. Maternal active smoking during pregnancy was negatively associated with self-reported doctor diagnosis of eczema (RR = 0.87, 95% CI 0.77-0.98; I2 = 50.56) and maternal passive smoking during pregnancy was positively associated with clinician assessment of eczema in one study (RR = 1.38; 95% CI 1.06-1.79). Our findings highlighted the importance of in utero programming in early-life allergy development. Despite the weak evidence, our results suggest pregnant women should minimise their contact with second-hand smoke to prevent offspring eczema development. There is a need for greater utilisation of objective allergy assessments in future studies.

Anxiety and Depression in People with Eczema or Psoriasis: A Comparison of Associations in UK Biobank and Linked Primary Care Data.

Previous research has shown associations between eczema and psoriasis and anxiety and depression. We investigated whether associations are consistent across different settings of ascertainment for depression and anxiety, including interview and survey responses from UK Biobank (a large longitudinal cohort recruiting individuals aged 40-69 years between 2006-2010), and linked primary care data, with the aim of drawing more reliable conclusions through triangulation. In cross-sectional studies, we estimated associations between eczema or psoriasis and anxiety or depression, defining anxiety or depression as 1) self-reported previous diagnosis at UK Biobank recruitment interview; 2) PHQ-9/GAD-7 score indicating depression or anxiety from a UK Biobank mental health follow-up survey in 2016; and 3) diagnosis in linked primary care electronic health record data. We analysed 230,047 people with linked Biobank and primary care data. We found poor agreement between the data sources for eczema, psoriasis, anxiety, and depression. Eg, 9474 had a previous eczema diagnosis in primary care data, 4069 self-reported previous eczema diagnosis at the UK biobank interview, and 1536 had eczema in both data sources (for depression 40,455; 13,320; and 9588 respectively). Having eczema or psoriasis (recorded in primary care or baseline interview) was associated with higher odds of anxiety and depression. Eg, the adjusted odds ratio for depression comparing those with eczema to those without was greater than 1 when defining the outcome from 1) the recruitment interview (1.36, 95% confidence interval 1.27-1.45); 2) the follow-up survey (1.24, 1.09-1.39), and 3) primary care records (1.56, 1.50-1.62). Our findings support increased prevalence of mental illness in people with psoriasis and eczema across multiple data sources, which should be considered in planning of mental health services. However, we found poor agreement in disease ascertainment between settings, with implications for data interpretation in electronic health records.

Associations of gestational and early-life exposure to toxic metals and fluoride with a diagnosis of food allergy or atopic eczema at 1 year of age

Studies have indicated that early-life exposure to toxic metals and fluoride affects the immune system, but evidence regarding their role in allergic disease development is scarce. We aimed to evaluate the relations of exposure to such compounds in 482 pregnant women and their infants (4 months of age) with food allergy and atopic eczema diagnosed by a paediatric allergologist at 1 year of age within the Swedish birth-cohort NICE (Nutritional impact on Immunological maturation during Childhood in relation to the Environment). Urinary cadmium and erythrocyte cadmium, lead, and mercury concentrations were measured by inductively coupled plasma mass spectrometry (ICP-MS), urinary inorganic arsenic metabolites by ICP-MS after separation by ion exchange chromatography, and urinary fluoride by an ion-selective electrode. The prevalence of food allergy and atopic eczema was 8 and 7%, respectively. Gestational urinary cadmium, reflecting chronic exposure, was associated with increased odds of infant food allergy (OR [95% CI]: 1.34 [1.09, 1.66] per IQR [0.08 μg/L]). Both gestational and infant urinary fluoride were associated, albeit at a statistically non-significant level, with increased atopic eczema odds (1.48 [0.98, 2.25], 1.36 [0.95, 1.95], per doubling, respectively). By contrast, gestational and infant erythrocyte lead was associated with decreased odds of atopic eczema (0.48 [0.26, 0.87] per IQR [6.6 μg/kg] and 0.38 [0.16, 0.91] per IQR [5.94 μg/kg], respectively), and infant lead with decreased odds of food allergy (0.39 [0.16, 0.93] per IQR [5.94 μg/kg]). Multivariable adjustment had marginal impact on the estimates above. After additional adjustment for fish intake biomarkers, the methylmercury associated atopic-eczema odds were considerably increased (1.29 [0.80, 2.06] per IQR [1.36 μg/kg]). In conclusion, our results indicate that gestational cadmium exposure might be associated with food allergy at 1 year of age and, possibly, early-life exposure to fluoride with atopic eczema. Further prospective and mechanistic studies are needed to establish causality.

394 Gene expression based molecular test proves clinical validity as diagnostic aid for the differential diagnosis of psoriasis and eczema in formalin fixed and paraffin embedded tissue

Abstract Highly specific and efficient drugs have been developed to treat noncommunicable chronic inflammatory skin diseases (ncISD). Due to their specificity, these drugs require precise diagnostics to attribute the most efficient treatment to each patient. Diagnosis is complicated by the complex pathogenesis of ncISD and their clinical and histological overlap. Especially, precise diagnosis of psoriasis and atopic eczema is difficult in special cases, and molecular tools need to be developed to support gold standard diagnosis. Psoriasis and eczema are among the most prevalent skin diseases worldwide with a combined incidence rate of at least 2%. Although more than a dozen of immune-modulating therapies, particularly monoclonal antibodies targeting specific cytokines or their receptors, have become available over the last decade allowing highly effective treatment, the ultimate breakthrough would include accurate diagnostic tools. Diagnosis of both diseases largely depends on a subjective visual exam and histopathological examination. Due to phenotypical overlaps of both diseases, up to 50% of cases with a palmoplantar localization are misdiagnosed. To close this diagnostic gap, a gene expression-based classifier using NOS2 and CCL27 has been proposed and its clinical validity examined and proven in various patient cohorts. This study aims to develop a real-time based molecular classifier (MC) to distinguish psoriasis from atopic eczema in formalin-fixed, paraffin-embedded (FFPE)-fixed skin samples for diagnostic measures and to evaluate the potential of minimally invasive microbiopsies and noninvasive tape strips or sampling disks for molecular diagnosis. The FFPE, micro-(Ø1mm) and macrobiopsies (Ø4–6 mm), and tape strips were collected from psoriasis and eczema lesions and analysed by real-time polymerase chain reaction (PCR) for the expression of NOS2 and CCL27. A molecular classifier (MC) was established using a linear regression model. We transferred the RNAprotect-based molecular classifier to FFPE samples and were able to produce comparable results. Whereas the RNAprotect based MC distinguished psoriasis from eczema with a sensitivity and specificity for psoriasis of 97.7% and 100%, respectively, and an AUC of 0.99, the FFPE-based classifier determined probabilities for psoriasis with a sensitivity and specificity and of 92% and 100%, respectively, and an AUC of 0.97. To test if microbiopsies are also adequate tissue samples for the MC, we analysed gene expression in 83 pairs of macro- and microbiopsies by real-time quantitative-PCR. Delta-CT values showed no significant difference between macro- and microbiopsies. The MC led to reliable results in the vast majority of samples (91.57%) independent of biopsy size, with a small increase of misclassification (4.98%). The FFPE-based molecular classifier (MC) precisely separates eczema from psoriasis and efficiently identifies subtypes of both diseases. The reliability of the two markers NOS2 and CCL27 has been shown in FFPE tissue facilitating a possible implementation of this molecular diagnostic aid in routine clinical pathological practice. We further show that the gene expression profile of RNA later fixed microbiopsies is comparable to standard 4–6 mm biopsies and that microbiopsies are equally suited for the MC. We demonstrate the potential of tape strips of inflamed epidermis for molecular diagnostics of ncISD. Due to the minimally invasive sampling procedure, tape stripping may be particularly useful for the testing of visible and sensitive skin areas and in children as well as for repetitive sampling procedures necessary to monitor treatment responses over time. In summary, the MC discriminates psoriasis from eczema producing meaningful results in a broad range of skin tissue derived from invasive to minimally invasive sampling techniques. Further efforts are required to simplify and shorten the labor- and cost-intensive procedures of RNA isolation and real-time PCR. One possible solution is a fully automated and closed system, which would allow the integration of molecular diagnostics into the routine patient management at the point of care.

Dupilumab aggravates Sézary syndrome: The importance of accurate pathological diagnosis

We report a case of Sézary syndrome aggravated by dupilumab. Although a diagnosis of atopic dermatitis was made previously, our retrospective diagnosis was cutaneous T-cell lymphoma. A 72-year-old woman was referred for evaluation of erythema over her entire body. She had received a diagnosis of atopic dermatitis (AD) based on skin biopsy elsewhere 7 years earlier. Since her symptoms were resistant to topical corticosteroids and oral antihistamines, dupilumab was started. She noticed peripheral lymph node enlargement 11 months after the commencement of dupilumab. Physical examination revealed generalized erythroderma with desquamation (Figure 1A,B) and lymphadenopathy in the neck, axilla, and inguinal region. A biopsy from her abdomen showed dense infiltrations of atypical lymphoid cells in the upper dermis with epidermotropism (Figure 1C,D). Immunohistochemically, the infiltrating cells were positive for CD3 and CD4; CD8 was almost negative. There was a 50% deletion of CD7 (Figure 1E–H). Her peripheral blood (PB) white blood cell count was 7660/μL, with 35% abnormal lymphocytes (2681/μL). Although CD4+/CD26− or CD4+/CD7− cells were not assessed, CD4/CD8 ratio was 10.59.1, 2 Human T-lymphotropic virus-1 antibody was negative. Monoclonal gene rearrangement of T-cell receptor β-chain was identified in her PB by Southern blot analysis. Inguinal lymph node biopsy showed partial effacement by atypical lymphocytes. The diagnosis was Sézary syndrome (SS), stage IVA2 (T4N3MXB2). Taking into account the risk of tumor lysis syndrome due to high tumor burden, we selected conventional multiagent chemotherapy as an initial therapy before using a molecular-targeted drug. Dupilumab was discontinued; cyclophosphamide, doxorubicin, vincristine, and prednisolone (CHOP) were started. After two cycles of CHOP, biweekly intravenous mogamulizumab was introduced. Her skin lesions gradually improved. The PB abnormal lymphocyte count decreased. Her disease was well controlled with mogamulizumab for 17 months. We reviewed the previous biopsy specimen. Dense dermal infiltrates with atypical cells and epidermotropism were seen (Figure 1I,J). These infiltrates were positive for CD3 and CD4. CD8-positive cells were sparse. There was a 30% deletion of CD7 (Figure 1K–N). The atypical cells were CCR4+ and CD68−. Although a diagnosis of AD was made previously, our retrospective diagnosis was cutaneous T-cell lymphoma (CTCL). Dupilumab is a monoclonal antibody which inhibits both IL-4 and IL-13 signaling pathways by binding specifically to the α subunit of the IL-4 receptor. Several cases of CTCL that developed or worsened after dupilumab use have been reported. A proposed mechanism of CTCL due to dupilumab is the involvement of IL-13 receptor α2 (IL-13Rα2), which is expressed on CTCL cells and promotes tumor progression. When dupilumab blocks IL-4 and IL-13 receptors, serum IL-13 levels increase. Because dupilumab inhibits IL-13Rα1 but not IL-13Rα2 signaling, increased IL-13 levels due to dupilumab stimulate IL-13Rα2, leading to the activation and proliferation of lymphoma cells.3 To our knowledge, there are 36 cases3-19 of CTCL worsened by dupilumab based on the diagnosis of AD or eczema have been reported. Of these 36 patients, 18 underwent skin biopsy prior to dupilumab therapy; no evidence of CTCL was described in 16 patients.3-10 In one remaining patient, the authors re-evaluated the biopsy specimen taken before dupilumab treatment and revised the diagnosis to early CTCL-not otherwise specified.10 In another patient, the first skin biopsy taken before dupilumab was compatible with AD; however, the diagnosis of mycosis fungoides was made by the second biopsy taken on the first day of dupilumab treatment. After 6 months of dupilumab treatment, the third biopsy turned out CD30-positive anaplastic large-cell lymphoma.11 When using dupilumab for AD, clinicians should be alert to the development or worsening of CTCL. Skin biopsy with immunohistochemical examination is strongly recommended before dupilumab therapy, especially in patients with erythroderma and elderly patients. The authors declare no conflict of interest. Approval of the research protocol: N/A. Informed Consent: N/A. Registry and the Registration No.: N/A. Animal Studies: N/A.

Molecular diagnosis of hand eczema

Because hand eczema is adiagnostic challenge even for experienced dermatologists, acorrect diagnosis is essential to ensure success of specific therapies. Prerequisites for successful molecular diagnostics in general and in hand eczema in particular are discussed. Basic research and opinion statement on new developments in molecular diagnostics are considered with aspecial focus on hand eczema. The first molecular classifier to distinguish psoriasis from (hand) eczema signature has been introduced as CE-marked in vitro diagnostics (CE-IVD); many more biomarkers associated with diagnostics, theranostics, or natural course of the disease are currently being investigated. Diagnosis of hand eczema will be supported by molecular diagnostics in the near future; we are at the beginning of the molecular era in dermatology.

Diagnosis and Management of Pediatric Chronic Hand Eczema: The PeDRA CACHES Survey.

Chronic hand eczema (CHE) significantly impacts quality of life. Published literature on pediatric CHE (P-CHE) in North America including knowledge on epidemiology and standard evaluation and management is limited. Our objective was to assess diagnostic practices when evaluating patients with P-CHE in the US and Canada, produce data on therapeutic agent prescribing practices for the disorder, and lay the foundation for future studies. We surveyed pediatric dermatologists to collect data on clinician and patient population demographics, diagnostic methods, therapeutic agent selection, among other statistics. From June 2021 to January 2022, a survey was distributed to members of the Pediatric Dermatology Research Alliance (PeDRA). Fifty PeDRA members responded stating that they would be interested in participating, and 21 surveys were completed. For patients with P-CHE, providers most often utilize the diagnoses of irritant contact dermatitis, allergic contact dermatitis, dyshidrotic hand eczema, and atopic dermatitis. Contact allergy patch testing and bacterial hand culture are the most used tests for workup. Nearly all utilize topical corticosteroids as first line therapy. Most responders report that they have treated fewer than six patients with systemic agents and prefer dupilumab as first-line systemic therapy. This is the first characterization of P-CHE among pediatric dermatologists in the United States and Canada. This assessment may prove useful in designing further investigations including prospective studies of P-CHE epidemiology, morphology, nomenclature, and management.

New guideline and treatment options for hand eczema

Due to its high prevalence and associated socioeconomic consequences, hand eczema is aburden for those affected and for society. The various hand eczema subtypes must be differentiated from each other through structured anamnesis and diagnostics in order to initiate cause-related preventive measures in addition to symptomatic therapy. There are new developments in the diagnosis, prevention, and treatment of hand eczema. The diagnostic possibilities are being expanded through molecular methods. Modern topical and systemic therapies offer promising treatment options for patients with atopic but also chronic hand eczema regardless of the underlying etiology.

Gene Expression–Based Molecular Test as Diagnostic Aid for the Differential Diagnosis of Psoriasis and Eczema in Formalin-Fixed and Paraffin-Embedded Tissue, Microbiopsies, and Tape Strips

Highly effective targeted therapies are available to treat noncommunicable chronic inflammatory skin diseases. In contrast, the exact diagnosis of noncommunicable chronic inflammatory skin diseases is complicated by its complex pathogenesis and clinical and histological overlap. Particularly, the differential diagnosis of psoriasis and eczema can be challenging in some cases, and molecular diagnostic tools need to be developed to support a gold standard diagnosis. The aim of this work was to develop a real-time PCR-based molecular classifier to distinguish psoriasis from eczema in formalin-fixed and paraffin-embedded-fixed skin samples and to evaluate the use of minimally invasive microbiopsies and tape strips for molecular diagnosis. In this study, we present a formalin-fixed and paraffin-embedded-based molecular classifier that determines the probability for psoriasis with a sensitivity/specificity of 92%/100%, respectively, and an area under the curve of 0.97, delivering comparable results to our previous published RNAprotect-based molecular classifier. The psoriasis probability, as well as levels of NOS2 expression, positively correlated with the disease hallmarks of psoriasis and negatively with eczema hallmarks. Furthermore, minimally invasive tape strips and microbiopsies were effectively used to differentiate psoriasis from eczema. In summary, the molecular classifier offers broad usage in pathology laboratories as well as outpatient settings and can support the differential diagnosis of noncommunicable chronic inflammatory skin diseases on a molecular level using formalin-fixed and paraffin-embedded tissue, microbiopsies, and tape strips.