Skin Erythema Research Articles

Case Report: Diagnosis and treatment of incontinentia pigmenti with central nervous system anomalies in one patient

IntroductionThis article reports a detailed case of a patient with incontinentia pigmenti who exhibited epileptic status and dermatologic symptoms.Case presentationA 5-month-old female patient was brought to our hospital due to status epilepticus, with erythematous vesicular skin lesions on her trunk and extremities. Routine magnetic resonance imaging revealed infarction, ischemia, and encephalomalacia. Skin biopsy pathology indicated pigmentation disorder. Molecular genetic testing was conducted to identify IKBKG mutations, and the case was finally diagnosed with incontinentia pigmenti complicated by central nervous system anomalies. She was treated with oral levetiracetam (10 mg/kg/day, administered every 12 h) to control her recurrent seizures, and prednisone (1 mg/kg/day, once a day) for anti-inflammatory effects.ConclusionAfter nine months, her skin lesions have resolved, with only a few newly developed erythematous papules and areas of hyperpigmentation being evident. There were no recurrent epilepsy symptoms, developmental impairments, or other associated symptoms.

Efficacy of adalimumab in pediatric non-infectious uveitis with and without anterior segment inflammation

BackgroundThis study aimed to identify the clinical characteristics of cases that is related to the response rate of adalimumab (ADA) treatment.MethodsA retrospective review of medical records was conducted for pediatric patients with non-infectious uveitis undergoing ADA treatment for a minimum of six months. The patients were stratified into two groups: those with anterior segment inflammation (ASI+) and those without anterior segment inflammation (ASI-). The primary outcome was treatment success rate. Secondary outcomes including best-corrected visual acuity (BCVA), inflammation parameters [anterior chamber cell (ACC), vitreous haze (VH)], retinal nerve fiber layer (RNFL) thickness, fluorescein angiography (FA) scores, as well as systemic immunosuppression therapy (IMT) and glucocorticoid load, were assessed.ResultsThe study included 59 patients (111 eyes), with 44 patients (83 eyes, 74.58%) falling into the ASI + group and 15 patients (28 eyes, 25.42%) in the ASI- group. The treatment success rate in the ASI + group was significantly higher than in ASI- patients (93.18% vs. 20%, p < 0.001). Following 6-month of ADA treatment in the ASI + group, there was a significant improvement in BCVA (p < 0.001), inflammation parameters (p < 0.001), reduced RNFL thickness and reduced FA scores (p < 0.001). Conversely, no significant differences were observed in BCVA, inflammation parameters, RNFL thickness and FA scores in the ASI- group. There was also a significant decrease in systemic IMT and glucocorticoid dosing, comparing baseline to the 6-month follow-up visit in both the ASI+ (p < 0.001) and ASI- groups (p < 0.05). Adverse events observed during the study period included abdominal pain, skin erythema, articular symptoms and respiratory infections.ConclusionADA demonstrates superior efficacy in the treating pediatric non-infectious uveitis with ASI + compared to ASI-.

Hidden in plain sight: A case of misdiagnosed leprosy mimicking rheumatoid arthritis

&lt;i&gt;Mycobacterium leprae&lt;/i&gt; is a causative agent of leprosy, a chronic granulomatous infection that primarily affects the skin and the peripheral nerves.&lt;b&gt; &lt;/b&gt;Musculoskeletal involvement, including inflammatory arthritis, is quite common despite being under recognized. Leprosy presents protean manifestations, making it a great mimicker. Herein, we report a case of a 41-year-old Indonesian who resided in Malaysia for the past 20 years and presented with chronic joint pain and swelling of hands for a year, along with gradual facial swelling and numbness in the toes. Retrospectively, the patient noticed an erythematous skin lesion over the trunk and lower limbs 6 months before these symptoms, which did not improve with standard treatment for allergic reactions. These spectral manifestations and the subtle signs of leprosy led to a diagnostic delay of more than a year. In this study, we aim to enhance clinical awareness among primary care providers about recognizing, classifying, and appropriately treating the disease to prevent life-long deformity and disability.

Scrub Typhus and Influenza A Co-Infection: A Case Report

Scrub typhus, caused by Orientia tsutsugamushi, is a neglected and reemerging disease that causes considerable morbidity and mortality. It now extends beyond the Tsutsugamushi Triangle, the region wherein it has traditionally been endemic. Influenza has also resurged since the infection control measures against COVID-19 were relaxed. A few cases of scrub typhus and influenza co-infection have been reported. Herein, we report the case of a 74-year-old woman with fever and upper respiratory symptoms diagnosed with influenza A and treated with oseltamivir; however, her fever persisted, and she developed respiratory failure, liver dysfunction, headache, diarrhea, and an erythematous skin rash. She lived in a forested area where scrub typhus was endemic and worked on a farm. Physical examination revealed an eschar on her posterior neck, and she was diagnosed with scrub typhus and influenza A co-infection. After minocycline treatment, her symptoms improved within a few days. This is the first reported case of scrub typhus and influenza A co-infection in Japan. This case illustrates that co-infection should be suspected in patients with fever persisting after their initial infection has been treated and that in patients living in endemic areas, scrub typhus can occur concurrently with influenza. The symptoms of scrub typhus are flu-like and nonspecific, which may delay diagnosis and treatment.

Severe genital cutaneous toxicity with sunitib.

Sunitinib is an oral drug approved for the treatment of metastatic renal cell carcinoma. Serious cutaneous adverse reactions to sunitinib are rare, and when they occur, discontinuation of the treatment may be needed. A 70-year-old male patient was diagnosed with stage IV clear cell renal carcinoma and received treatment with sunitinib. After a second cycle with a 25% dose reduction, the patient was admitted with a diagnosis of grade 3 genital erythema. After ruling out other common causes, sunitinib was considered the cause of genital erythema and was stopped. Treatment with corticosteroids, topical applications, and morphine was started, with resolution after 18 days of evolution. There are only a few published reports that describe erythema and scaling of the genital skin. As in those few cases, for our patient, the first clinical signs appeared on day 28 of sunitinib treatment, and the lesions disappeared after 2 weeks without the use of the drug. Erythema and scaling reappeared when the drug was reintroduced, with greater severity than what was described in some of the other cases, which even included cases for which the lesions did not reappear. Rare instances of severe and limiting skin toxicity may necessitate treatment suspension and compromise survival, as observed in our case. It is crucial to recognize these skin toxicities and understand their appropriate management strategies to initiate treatment as early as possible, thereby avoiding hospitalizations and enabling the resumption of sunitinib therapy.

Moving cupping therapy combined with acupoint bloodletting for plaque psoriasis: A case report.

Psoriasis is a chronic inflammatory skin disease that can present in various phenotypes, with the most common form being plaque psoriasis. Currently, no type of psoriasis can be cured, and existing treatment options are associated with certain safety concerns. In recent years, traditional Chinese medicine has achieved great results in treating psoriasis. Cupping therapy is a widely used method in China. In this case, the combination of moving cupping therapy and acupoint bloodletting has demonstrated a favorable therapeutic effect on plaque psoriasis. A 35-year-old male diagnosed with plaque psoriasis for 20 years, presented with generalized itchy, erythematous, and scaly skin. The patient underwent moving cupping therapy combined with acupoint bloodletting once every other day, three times per week, for a total duration of 8 weeks. After treatment, the erythema, plaques, and scales on the patient's entire body had mostly resolved. The Psoriasis Area and Severity Index (PASI) score decreased from 50 to 5, the Body Surface Area (BSA) improved from 60 % to 4 %, and the Dermatology Life Quality Index (DLQI) decreased from 17 to 2 points. No relapse was observed during the 6-month follow-up. This case demonstrates that moving cupping therapy combined with acupoint bloodletting is well tolerated and effective in relieving skin lesion symptoms and improving the quality of life in patients with plaque psoriasis. As a cost-effective adjunctive therapy, moving cupping therapy combined with acupoint bloodletting holds promise as a non-pharmacological treatment option for plaque psoriasis.

Self-assembled hyaluronic acid nanoparticles delivered by polymeric microneedles for targeted and long-acting therapy of psoriasis.

Psoriasis is an autoimmune-driven inflammatory skin disease, clinically characterized by skin thickening, erythema, and scaling, significantly impacting patients' life quality and mental health. Clinically, oral pill or injection of methotrexate (MTX) formulation is a common route for psoriasis therapy, while both methods often cause undesired toxicity due to systemic administration, and limit patient compliance because of the frequent-dosing requirement. Here, we introduce a dissolvable microneedle (MN) patch made of polyvinyl alcohol (PVA) that incorporates self-assembled hyaluronic acid (HA) nanoparticles (NPs) conjugating MTX, which is designed for treating skin diseases, offering reduced adverse effects and improved patient adherence through its targeted and long-acting properties. Upon transdermal delivery via polymeric MNs, the HA-based therapeutic NPs actively target to the inflammatory skin cells via the interaction of HA group with CD44 protein that is highly expressed on the cell membrane in the psoriatic skin. Moreover, the HA-based NPs undergo slow dissociation, thereby achieving sustained release of the MTX drug at the lesion site over 7days. Due to the favorite features, in the imiquimod (IMQ)-induced psoriatic mouse, only one application of the polymeric MN patch achieves diminished epidermal hyperplasia, and reduced inflammatory factors expression, ultimately improving the psoriasis-like skin condition in vivo.

EGFR Mutation in Neonatal Nephrocutaneous Syndrome: Unveiling a Genetic Challenge

AbstractEpidermal growth factor receptor (EGFR) is a transmembrane glycoprotein that exhibits tyrosine kinase signaling activity, playing a pivotal role in various cellular processes. Overexpression or overactivity of EGFR is significantly associated with inflammatory and malignant diseases, particularly lung cancer. Conversely, germline loss-of-function mutations in EGFR have been distinctly linked to a rare condition known as neonatal nephrocutaneous syndrome. We report a case of a preterm female neonate, born to consanguineous parents and from a pregnancy that was complicated by polyhydramnios. From birth, she displayed distinctive clinical features, including fragile skin and widespread erythema, sparse scalp hair, bilateral ankyloblepharon, thick eyebrows, and arachnodactyly. Subsequently, she developed progeroid features marked by skin desquamation, along with failure to thrive, diarrhea, and severe electrolyte and acid–base imbalances. Additional complications comprised anemia, generalized mucocutaneous candidiasis, external otitis, and recurrent septic episodes. Genetic analysis confirmed a homozygous EGFR mutation c.1283G &gt; A p.(Gly428Asp). The infant's neurological status remained stable, albeit requiring pain management through oral morphine and gabapentin. Palliative care became imperative, given the dismal prognosis. The identified mutation is exceedingly rare, with only 24 reported cases known thus far. Each of these instances resulted in a complex multisystemic condition marked by a wide range of challenging symptoms and signs. This clinical journey highlights the intricate interplay among genetic mutations and complex medical conditions, and underscores the critical significance of multidisciplinary care.

Efficacy of Natural β-Carotene Chewable Tablets Derived from Banana (Musa AA) Pulp in Reducing UV-Induced Skin Erythema.

UV radiation is a primary cause of skin damage and photoaging. β-carotene, a potent antioxidant, aids in mitigating UV-induced oxidative stress and enhancing skin photoprotection. This research aimed to evaluate the efficacy of a nutraceutical product designed to prevent photoaging. The product consists of a blend of hemp seed oil and banana (Musa AA), formulated as a chewable tablet. Healthy male participants aged 35-50 years were enrolled in a randomized, parallel, single-blind, placebo-controlled clinical trial. Participants received either the chewable nutraceutical (five tablets after meals in the morning and evening, equivalent to 8 ± 2 mg/day of β-carotene and 400 mg/day of PUFA) or a chewable placebo for 16 weeks. A total of thirty-six participants successfully completed the entire 16-week study. Administration of the nutraceutical resulted in a significant reduction (p < 0.05) in UV solar light stimulator-induced erythema on the dorsal skin at week 4, with a mean value of 3.76 ± 0.46 AU, compared to the initial value of 4.88 ± 0.62 AU at week 0. Additionally, serum β-carotene concentration significantly increased from 0.45 ± 0.02 µg/mL at week 0 to 0.61 ± 0.06 µg/mL at week 16 (p < 0.05). Moreover, skin intensity in the sun-exposed arm area also significantly improved at week 16, increasing from 71.33 ± 3.50 at week 0 to 81.80 ± 4.45 (p < 0.05). The results indicate that the developed nutraceutical may offer effective protection against erythema, making it a promising option for preventing photoaging.

Pilot Study on the Effects of a Cosmetic Serum Containing Niacinamide, Postbiotics and Peptides on Facial Skin in Healthy Participants: A Randomized Controlled Trial

The literature describes niacinamide, but also postbiotics and peptides, as ingredients that improve skin barrier function, but also affect melanin and sebum levels in individuals. However, the combined effects of these ingredients in a single cosmetic serum have not been sufficiently investigated. Therefore, the aim of this randomized controlled study, conducted at the University of Split School of Medicine (Croatia), was to evaluate the effects of cosmetic products containing these active ingredients. This study was registered with ClinicalTrials.gov (NCT06189105) and has been completed. Primary outcomes were the levels of trans epidermal water loss, skin hydration, erythema, melanin, and sebum, all measured in 25 healthy Caucasian participants. Significant differences between hydration levels were observed at week 4 (61.0 ± 11.2 vs. 68.6 ± 13.3 AU, control and intervention). Moreover, a significant decrease in erythema values from the first to last measurement in the intervention group was observed, (379.9 ± 106.8 vs. 333.6 ± 73.5 AU, baseline values and week 4, intervention group). Interestingly, both the increase in skin hydration levels and the decrease in skin erythema after niacinamide serum application were significant in study participants who did not use sun protection products. It is well known that ultraviolet radiation has detrimental effects on human skin, and our results suggest that niacinamide could help counteract these effects.

Molecular genetic characterization of porcine reproductive and respiratory syndrome virus outbreak in Assam, India and neighbouring regions.

Porcine reproductive and respiratory syndrome (PRRS) is a significant swine disease with no effective vaccine due to high viral mutation rates. This study investigates a natural PRRS outbreak through molecular, pathological, and serological analyses. Nineteen affected pigs were clinically examined, and 10 underwent post-mortem examination. PRRS virus (PRRSV) presence was confirmed in all tissue samples by RT-PCR targeting open reading frame (ORF) 5 and ORF7 genes. Clinical signs, especially in boars and sows, included fever, appetite loss, movement reluctance, erythematous skin patches, vomiting, and abortions in sows. Post-mortem findings highlighted lung consolidation, severe lymph node enlargement, interstitial pneumonia with mononuclear cells, macrophage accumulation and necrotic cells in alveolar spaces. Multifocal myocarditis, lymphoid follicular degeneration, and follicular necrosis were observed in the tonsil, spleen, and lymph nodes. PRRSV-specific antibodies were detected in 32.75% of serum samples, confirming the outbreak. Phylogenetic analysis of the PRRSV-ORF5 and ORF7 genes revealed a close genetic relationship between the outbreak samples from Assam and recent outbreaks in Idukki, Kerala, India (2018), and neighbouring country China, indicating the circulation of Genotype 2 virus in Assam. However, the sequences showed some differences from the isolates of Mizoram, India. In conclusion, this study provides molecular and pathological evidence of a PRRSV outbreak, confirms the presence of PRRSV-specific antibodies and viral RNA, and shed light on the virus's genetic characteristics in India.

Skin Barrier-Improving and Skin-Soothing Effects of Autophagy-Activating Peptide on Sensitive Skin

Among the complex and diverse triggering and aggravating factors for sensitive skin syndrome, potential defects in skin barrier function are considered one of the most important ones. Previously, we have reported improvements in skin barrier function thanks to autophagy-activating peptide derivatives. Further investigation revealed that the activation of autophagy signaling in skin cells also attenuated inflammatory responses induced by UV irradiation or exposure to pollution. In this study, in vitro and ex vivo human skin explant models were used to evaluate the potential benefits of the autophagy-activating peptide, pentasodium tetracarboxymethyl palmitoyl didpeptide-12 (PTPD-12), on sensitive skin-related parameters. Clinical efficacy testing was also performed to confirm the skin barrier-improving and skin-soothing activities of the autophagy-activating peptide. As a result, significant reductions in inflammatory cytokine (IL-8 and TNF-α) and enzyme activity (PDE4) were observed in the in vitro system. Increased expression of barrier marker proteins by PTPD-12 in UV-irradiated human skin tissue was observed ex vivo. In a clinical study, delayed response to topical capsaicin-induced vascular activation, which represents enhanced epidermal permeability barrier function, was observed after 4 weeks of application of PTPD-12 in healthy volunteers. In another clinical study with sensitive skin carriers identified via a lactic acid stinging test, a significant reduction in trans-epidermal water loss (TEWL) and skin erythema index was observed after 4 weeks of PTPD-12 usage. These results suggest that the activation of autophagy can be a potential treatment regimen for sensitive skin syndrome, specifically in terms of skin barrier function enhancement and skin soothing.

Efficacy and Safety of Topical Application of Plant-Based Products on Skin Aging in Healthy Individuals: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

Recently, numerous topical products containing plant-based ingredients have been reported to resist skin aging. However, there is a lack of sufficient evidence to substantiate these claims. This paper presents a comprehensive review and meta-analysis to evaluate the efficacy and safety of topical products containing plants or plant extracts in anti-aging. Four databases-PubMed, Embase, Web of Science, and the Cochrane Library (CENTRAL)-were systematically searched for articles related to plant-based interventions and skin aging, covering the period from January 2000 to December 2024. A total of eight randomized controlled trials (RCTs) met the inclusion criteria and were included in the meta-analysis. Products containing plant extracts demonstrated a statistically significant difference in improving skin hydration and skin elasticity, reducing melanin and erythema compared to other products. No significant statistical difference was observed in reducing transepidermal water loss (TEWL). Subgroup analysis revealed a significant statistical difference in improvement overall skin elasticity (R2) during short-term (≤ 8 weeks)treatments, while no statistical difference was observed during long-term (> 8 weeks)treatments. Additionally, no significant difference was observed in the specific measurements of skin elasticity, including R5 (net elasticity) and R7 (the ratio of elastic recovery to total deformation). Regarding safety, no adverse events were reported in six studies, while the remaining two studies did not specify whether adverse events occurred. The meta-analysis results indicated that botanical preparations significantly enhanced skin hydration, reduced melanin levels and erythema, and increased overall skin elasticity. However, the analysis did not provide sufficient evidence to support a reduction in transepidermal water loss (TEWL), or improvements in R5 (net elasticity) and R7 (the ratio of elastic recovery to total deformation). PROSPERO (york.ac.uk) identifier: CRD42023478803.

Anti-inflammatory and antioxidant succinyl-chitosan oligosaccharide protects human epidermal cell and mouse skin against ultraviolet B-induced photodamage

Ultraviolet B (UVB) irradiation from sunlight is one of the primary environmental factors that causes photodamage to the skin. The aim of this study was to prepare succinyl-chitosan oligosaccharide (SU-COS) and evaluate its protective effects and related molecular mechanisms against UVB-induced photodamage for the first time. SU-COS (substitution degree: 69.26 %, molecular weight: 6400 Da) was shown to have excellent biocompatibility and to effectively promote the migration of human epidermal HaCaT cells. UVB irradiation was used to develop photodamage models in HaCaT cells and murine skin. In vitro, treatment with SU-COS significantly increased the cell survival ratio by >11 % while concurrently reducing reactive oxygen species formation, preserving normal cytoskeletal morphology, stabilizing the cell cycle, and decreasing the apoptosis ratio. The SU-COS intervention also demonstrated a reparative effect on UVB-damaged mouse skin by reducing skin erythema and water loss, relieving crusting, and maintaining the epidermis thickness of the skin and the stability of collagen fibers. The observed changes in both in vitro and in vivo results were accompanied by significant modulation of gene and protein expression associated with the cellular cycle, collagen synthesis, extracellular matrix degradation, antioxidant defense, and inflammation. Overall, SU-COS holds immense promise for applications in repairing photodamage.

Localized inflammation in dengue vaccine-induced skin rash is not associated with continuous presence of dengue virus genome.

Vaccination with the tetravalent live attenuated dengue virus (DENV) vaccines TV003 and TV005 causes a mild, relatively localized erythematous maculopapular skin rash in most dengue-naïve vaccinees. Human challenge model DENV strains, DENV2Δ30 and DENV3Δ30, trigger a confluent skin rash over most of the body in most unvaccinated participants. To determine the etiology of these rashes we performed in situ hybridization for DENV genome and assessed cellular infiltration by hematoxylin/eosin staining in skin biopsies from humans infected with live attenuated dengue vaccine DENV2Δ30 or DENV3Δ30 challenge strains. Sixty-three biopsies from 40 participants were included in the study, of which 43 biopsies from 32 patients contained intact RNA. Of these, one sample taken from a non-erythematous site from a DENV2Δ30-infected participant experiencing a rash, was positive for DENV2 genome. Incidence and severity of lymphocytic infiltration were highest in rash biopsy samples compared to those from non-involved areas in participants experiencing a rash or from those taken from participants not experiencing a rash. These results indicate that the rash associated with infection with live attenuated dengue vaccines or challenge strains is predominantly lymphocyte-driven perivascular dermal inflammation without local concomitant active viral replication.

Oral Intake of Collagen and Collagen Hydrolysate From Takifugu bimaculatus Attenuates Ultraviolet-Induced Skin Photoaging in Mice.

With the rapid emergence of pufferfish aquaculture and processing industries, fish skin is underutilized as a byproduct of processing, leading to resource waste. In this study, Takifugu bimaculatus skin collagen (TBSC) was extracted by acetic acid solubilization and its physicochemical properties were analyzed. The effects of TBSC and the TBSC hydrolysate (TBSCH) on ultraviolet (UV) irradiation-induced photoaging were investigated using a mouse model. The purity of TBSC was 90.02%. Electrophoresis and Fourier infrared spectroscopy characterization of TBSC showed that the type of collagen in TBSC was typical standard type I. The degree of hydrolysis was selected to optimize the hydrolysis conditions for TBSC. The papain enzyme dosage, temperature, pH, and hydrolysis duration of 51,000 U/g, 48.03°C, 5.35, and 4 h have been demonstrated to be the optimum hydrolysis conditions for TBSCH. Oral administration of either TBSC or TBSCH ameliorated UV-induced skin erythema and hyperkeratosis. TBSC and TBSCH treatment increased collagen content and had an inhibitory effect on matrix metalloproteinase (MMP)-2 and MMP-3 expression, whereas MMP-9 expression was significantly reversed only in the TBSCH-treated groups. The expression of the c-Jun protein was much lower in these groups, suggesting that TBSCH had a greater alleviating effect on collagen degradation and extracellular matrix breakdown. Therefore, it is proposed that TBSCH has the potential to be used as a nutricosmetic agent with protective attributes against UV-induced skin damage and concurrent collagen depletion.

Haematogenous seeding in mycosis fungoides and Sézary syndrome: Current evidence and clinical implications.

Cutaneous T-cell lymphomas (CTCLs) are a heterogeneous group of diseases characterised by abnormal neoplastic T-cell growth in the skin. Mycosis fungoides (MF), the most common CTCL, manifests as erythematous skin patches and/or plaques, tumours or erythroderma. The disease may involve blood, lymph nodes and rarely viscera. Sézary syndrome (SS) is a unique leukaemia/lymphoma syndrome related to MF, which presents with blood and skin involvement at diagnosis. The pathogenesis of MF/SS is not fully elucidated. The presence of skin lesions at distant sites underpins a hypothesis that MF/SS lesions may develop through haematogenous seeding. Phenotypic similarities between malignant and normal T-cells led to the notion that disease-initiating mutations occur in specific subtypes of mature T-cells, which are responsible for most CTCLs. However, this mature T-cell precursor model is not always consistent with clinical observations and research on MF/SS pathogenesis. Here, we review evidence supporting an alternative model of pathogenesis for MF/SS involving haematogenous seeding as a key process responsible for the initiation and progression of the disease. According to this hypothesis, malignant transformation occurs at an early stage of T-cell development (probably in bone marrow or thymus), yielding circulating neoplastic T-cells which colonise the skin where the microenvironment is most permissive for proliferation and evolution. These mutated precursor cells seed the skin where they find a suitable niche to develop into clinically perceptible disease. Subsequently, malignant T-cells can re-enter the bloodstream, re-seed pre-existing lesions and seed new areas of the skin, causing synchronous and convergent changes in the transcriptomic profile of lesions and tumours, and clinical disease progression - 'consecutive haematogenous seeding' captures this temporal phenomenon. This model radically changes the current understanding of CTCL pathogenesis, transforming it from a primarily cutaneous disease with secondary involvement of blood, to a systemic disease, where the spread of malignant cells through the blood to the skin is not a phenomenon of advanced disease but is an essential component of pathogenesis. This understanding of MF/SS could have several clinical implications, including standardising our approach to assessing blood tumour burden, potential advances in prognosis and monitoring, and investigating combination treatments to improve patient outcomes.

Subcutaneous furosemide in heart failure: a systematic review.

Intravenous loop diuretics are the primary treatment for congestion in patients with decompensated heart failure (HF). Furosemide is the most commonly used loop diuretic and is licensed for administration either orally, intramuscularly or intravenously but not subcutaneously. Recently developed, pH-neutral, concentrated, 'skin-friendly' preparations of furosemide have been developed which allow subcutaneous administration. In this systematic review, we summarize and critically appraise the current evidence for subcutaneous furosemide in patients with HF. The electronic databases MEDLINE, EMBASE, the Cochrane Library, and ClinicalTrials.gov registry were searched up to 31 December 2023. Of the 17 studies identified, 5 were randomised controlled trials (RCTs), 2 were non-randomised controlled studies, 3 were prospective observational cohort studies, and 7 were retrospective observational studies.All RCTs utilised novel pH-neutral, subcutaneous preparations of furosemide. Bioavailability of novel subcutaneous preparations were similar to intravenous furosemide 10mg/ml: 99.7% for an 8mg/ml preparation and 112% for a 30mg/ml preparation. Natriuresis and diuresis were also similar with novel subcutaneous and conventional intravenous furosemide. Adverse events of novel preparations included infusion site pain or discomfort, localised skin erythema and minimal swelling. All studies of conventional subcutaneous furosemide were non-randomised with very limited data re bioavailability or diuretic and natriuretic effect. Conventional subcutaneous furosemide was associated with substantial skin irritation (affecting 3-23% of patients), and skin infections requiring treatment with antibiotics (3-17%). Novel, pH-neutral preparations of subcutaneous furosemide achieved similar diuresis, natriuresis, and bioavailability to intravenous furosemide, and were well tolerated. Novel preparations may be a treatment option for patients with HF.

Deflazacort-induced Steven-Johnson syndrome: a case report and literature review

Objective: To summarize the clinical features and outcomes of deflazacort-induced Steven Johnson syndrome (SJS)-toxic epidermal necrolysis (TEN) to raise awareness among patients with Duchenne muscular dystrophy (DMD), neurologists as well as other deflazacort users. Methods: The clinical data of a boy with DMD who had SJS induced by deflazacort treated at the Department of Rheumatology & Clinical Immunology of Tianjin Children's Hospital in July 2024 was analyzed retrospectively. Taking "deflazacort" "Steven-Johnson syndrome" "toxic epidermal necrolysis" in Chinese or English as the keywords, literature was searched at CNKI, Wanfang, China Biomedical Literature Database and PubMed up to July 2024. The clinical characteristics, treatment and outcomes of deflazacort-induced SJS-TEN were summarized. Results: A 12-year-old boy was admitted with a 3-day history of rash. He was diagnosed with DMD at the age of 3 and had been treated with prednisolone since the age of 8. Forty-four days before admission, the patient started deflazacort to replace prednisolone. Three days before admission, progressively worsening erythematous maculopapular rashes, blisters and skin peeling (8% body surface area), oral mucosal erosion, and exudative conjunctivitis occurred, thus deflazacort was discontinued. Complete remission of SJS was achieved after treatment with intravenous immunoglobulin (IVIG, total 1.4 g/kg), 2 doses of etanercept (0.9 mg/kg, once), subcutaneous injection and intravenous methylprednisolone (0.7 mg/(kg·d)). Based on the literature, there were 5 reports in English while none in Chinese, altogether 7 cases were reported. All the patients were male, aged 3-45 years. Duration of deflazacort exposure was 2-8 weeks. Dermatology diagnosis of our case was SJS, and 5 cases were TEN. One patient was diagnosed with exudative erythema multiforme, and subsequent deflazacort oral challenge test was positive. Treatment included methylprednisolone or dexamethasone in 5 cases, IVIG in 6 cases, etanercept in 3 cases and cyclosporine in 1 case. All patients recovered completely. Conclusion: The synthetic corticosteroid deflazacort can cause rare but severe adverse reactions such as SJS-TEN, which needs close monitoring and prompt recognition and management.

Performance and safety of transparent postoperative dressings with silicone adhesive in daily practice on fragile skin.

Currently there is limited real-world research on the adhesion qualities, pain and clinical performance of specific silicone adhesives products, and their role in maintaining skin integrity and preventing medical adhesive-related skin injuries (MARSI). This paper presents a clinical evaluation of performance and safety parameters of two silicone adhesive dressings on lacerations or surgical wounds and the surrounding skin in daily practice on fragile skin. An observational, prospective, multicentre, uncontrolled post-market clinical observational study with Leukomed T skin sensitive and Leukomed T plus skin sensitive (both BSN medical GmbH, Essity Group) was undertaken at three sites across Germany between June 2021 to November 2022. Inclusion parameters were acute wounds (surgical or laceration) in patients with at least one fragile skin condition. Endpoints included: the percentage of adhered dressing area seven days after application of the dressings; and evaluation of any signs of skin damage and erythema following dressing removal. Furthermore, self-reported patient pain, comfort during dressing wear, and the health professionals' ease of dressing handling with gloves were assessed. A total of 42 patients with fragile skin and surgical wounds (35 patients) or lacerations (7 patients) were recruited. Mean age was 78 years. There were no signs of erythema following dressing removal and no MARSI (skin stripping, blister, skin tears, maceration, irritant contact dermatitis or allergic dermatitis) occurred at removal after seven days of wear time. Data demonstrated a reliable wound coverage with sufficient adhesion without negatively affecting the periwound skin and wound improvement was observed in 94% of patients. The vast majority of patients reported minimal pain at removal, reduced wound pain and high satisfaction with wearing comfort. Health professionals found the dressings easy to apply and remove, even with gloved hands. The results of this real-world evidence showed effective and well-tolerated use of transparent dressings with silicone adhesive in patients with fragile skin. The dressings may reduce the risk of skin damage including MARSI, while providing patients a high wearing comfort and allowing an almost pain-free dressing change.