Pustule Formation Research Articles

Acne vulgaris in adolescents – the review

Acne vulgaris is one of the most common chronic inflammatory skin disorders that affects almost 90% of the adolescents worldwide. Due to its effect on one’s appearance, it causes not only physical but also psychological consequences. The cause of acne involves increased sebum production, hyperkeratinisation of the follicle, bacterial colonization and inflammation, which result in formation of comedones, papules, pustules and nodules. Diet, Body Mass Index, hyperhidrosis and stress can be triggering factors. The pharmacological treatment of acne involves substances administered topically as well as orally. First line of treatment of mild-to-moderate acne involves topical benzoyl peroxide, retinoids, chemical peels, antibiotics and combinations of those agents. The treatment of moderate-to-severe or inflammatory acne consists of oral antibiotics, isotretinoin, oral contraceptives and spironolactone. New therapies are being investigated and show a great potential, however further research should be pursued in order to achieve long-lasting results of the treatment.

Competitive control of CsNCED1-1 by CsLOB1 and CsbZIP40 triggers susceptibility to citrus canker.

Pustule formation is pivotal for the development of the Xanthomonas citri subsp. citri (Xcc)-induced citrus canker disease (CCD). Although our previous study demonstrated that the exogenous application of abscisic acid (ABA) facilitated pustule formation induced by Xcc, the precise mechanism remains elusive. The 9-cis-epoxycarotenoid dioxygenase (NCED) is a crucial enzyme in ABA biosynthesis. This study explored the role of citrus CsNCED1-1 in CCD resistance through overexpression and RNA interference of CsNCED1-1 in Wanjincheng orange (Citrus sinensis). Our findings indicated that CsNCED1-1 negatively modulated CCD resistance by fostering ABA accumulation, concomitant with an increase in jasmonic acid (JA) and a decrease in salicylic acid (SA). Plants overexpressing CsNCED1-1 displayed shortened leaves with smaller and denser stomata along with irregular and increased palisade cells. CsLOB1 is a known susceptibility gene for CCD, and CsbZIP40 positively influences resistance to this disease. We further confirmed that CsLOB1 promoted and CsbZIP40 suppressed the transcription of CsNCED1-1 by directly binding to the CsNCED1-1 promoter. Notably, CsbZIP40 and CsLOB1 showed a competitive relationship in the regulation of CsNCED1-1 expression, with CsbZIP40 exhibiting greater competitiveness. Overall, our findings highlight that CsNCED1-1 promotes susceptibility to citrus canker by disrupting JA- and SA-mediated defense mechanisms and triggering the proliferation and remodeling of palisade cells, thereby facilitating pathogen colonization and pustule formation. This study offers novel insights into the regulatory mechanisms underlying citrus canker resistance and the role of CsNCED1-1 in citrus.

Hubungan Kualitas Tidur dengan Derajat Keparahan Acne Vulgaris pada Siswa-Siswi Kelas X di Sma Muhammadiyah 2 Bandar Lampung Provinsi Lampung Tahun 2024

Acne vulgaris is a multifactorial chronic skin condition, characterized by inflammation in the pilosebaceous units, such as the formation of comedones, papules, pustules, nodules, and cysts, which typically present on the face, upper body, and upper arms. Sleep quality is defined by an individual's capacity to sleep adequately and achieve the necessary amount of rest. This study aims to identify the correlation between sleep quality and the severity of acne vulgaris among tenth grade students at Muhammadiyah 2 Senior High School of Bandar Lampung, Lampung Province in 2024.The research adopts a quantitative approach and analytical survey method with a cross-sectional design. The study population includes all 285 tenth-grade students at Muhammadiyah 2 Senior High School of Bandar Lampung, Lampung Province in 2024. A total of 74 respondents were selected using the Slovin formula based on inclusion and exclusion criteria, with a purposive sampling technique. The data were collected using the Pittsburgh Sleep Quality Index (PSQI) questionnaire and observations of the severity of acne vulgaris. Data analysis was conducted using univariate and bivariate analyses with the non-parametric chi- square test, utilizing SPSS version 26.The study revealed that 50 respondents (67.6%) had poor sleep quality, while 24 respondents (32.4%) experienced a moderate severity of acne vulgaris. The analysis indicates a significant correlation between sleep quality and the severity of acne vulgaris among tenth-grade students at Muhammadiyah 2 Senior High School in Bandar Lampung, Lampung Province in 2024, with a p-value of 0.000 ≤ 0.05. The results of this research provide useful information and may serve as a supplementary resource for future research.

The adult plant resistance (APR) genes Yr18, Yr29 and Yr46 in spring wheat showed significant effect against important yellow rust races under North-West European field conditions

Yellow rust caused by Puccinia striiformis f. sp. tritici (Pst) is one of the most important wheat diseases. Adult plant resistance (APR) genes have gained the attention of breeders and scientists because they show higher durability compared to major race-specific genes. Here, we determined the effect of the APR genes Yr18, Yr29 and Yr46 in North-West European field conditions against three currently important Pst races. We used three pairs of sibling wheat lines developed at CIMMYT, which consisted of a line with the functional resistance gene and a sibling with its non-functional allele. All APR genes showed significant effects against the Pst races Warrior and Warrior (–), and a race of the highly aggressive strain PstS2. The effects of Yr18 and Yr46 were especially substantial in slowing down disease progress. This effect was apparent in both Denmark, where susceptible controls reached 100 percent disease severity, and in United Kingdom where disease pressure was lower. We further validated field results by quantifying fungal biomass in leaf samples and by micro-phenotyping of samples collected during early disease development. Microscopic image analyses using deep learning allowed us to quantify separately the APR effects on leaf colonization and pustule formation. Our results show that the three APR genes can be used in breeding yellow rust resistant varieties of spring wheat to be grown in North-West European conditions, and that deep learning image analysis can be an effective method to quantify effects of APR on colonisation and pustule formation.

Rare Filaggrin Variants Are Associated with Pustular Skin Diseases in Asians.

Reactive pustular eruptions (RPEs) can manifest in a variety of conditions, including pustular psoriasis (PP) and adult-onset immunodeficiency syndrome due to anti-interferon-γ autoantibody (AOID). These RPEs can be attributed to different causes, one of which is genetic factors. However, the genetic basis for pustular skin diseases remains poorly understood. In our study, we conducted whole-exome sequencing on a cohort of 17 AOID patients with pustular reactions (AOID-PR) and 24 PP patients. We found that 76% and 58% of the AOID-PR and PP patients, respectively, carried rare genetic variations within the filaggrin (FLG) gene family. A total of 12 out of 21 SNPs on FLG had previously received clinical classifications, with only p.Ser2706Ter classified as pathogenic. In contrast, none of the FLG3 SNPs identified in this study had prior clinical classifications. Overall, these variations had not been previously documented in cases of pustular disorders, and two of them were entirely novel discoveries. Immunohistochemical analysis of skin biopsies revealed that FLG variants like p.Ser860Trp, p.Gly3903Ter, p.Gly2440Glu, and p.Glu2133Asp caused reductions in FLG levels similar to the pathogenic FLG p.Ser2706Ter. These results highlight rare FLG variants as potential novel genetic risk factors contributing to pustule formation in both AOID and PP.

Genetic analysis of different subtypes of aseptic pustulosis in the Chinese population.

Aseptic pustulosis involves inflammatory skin conditions with nonbacterial pustules on erythema, accompanied by neutrophil and eosinophil infiltration in the epidermis. Dysregulation of the interleukin (IL)-36 pathway leads to neutrophil aggregation and pustule formation. Variants in IL36RN, CARD14, AP1S3, MPO, SERPINA3 and BTN3A3 have been identified in generalized pustular psoriasis (GPP) in the past. Some patients with acrodermatitis continua of Hallopeau (ACH), palmoplantar pustulosis and acute generalized exanthematous pustulosis (AGEP) also exhibit mutations in IL36RN, CARD14 and AP1S3, albeit with regional and population-specific variations. This study aims to explore a shared genetic foundation among those with aseptic pustulosis. We performed Sanger sequencing on six genes in 126 patients with aseptic pustulosis. Genetic analysis identified IL36RN variants strongly associated with ACH, AGEP and subcorneal pustular dermatosis (SPD). Immunohistochemistry revealed elevated inflammatory cytokines in all subtypes. This study establishes a significant association between IL36RN variants and ACH, AGEP and SPD, emphasizing the IL-1/IL-36-chemokine-neutrophil axis as a common pathogenic mechanism. Targeting this axis holds promise for therapeutic interventions for aseptic pustulosis.

Characterization of durum wheat resistance against leaf rust under climate change conditions of increasing temperature and [CO2

Durum wheat cultivation in Mediterranean regions is threatened by abiotic factors, mainly related to the effects of climate change, and biotic factors such as the leaf rust disease. This situation requires an in-depth knowledge of how predicted elevated temperatures and [CO2] will affect durum wheat-leaf rust interactions. Therefore, we have characterised the response of one susceptible and two resistant durum wheat accessions against leaf rust under different environments in greenhouse assays, simulating the predicted conditions of elevated temperature and [CO2] in the far future period of 2070–2099 for the wheat growing region of Cordoba, Spain. Interestingly, high temperature alone or in combination with high [CO2] did not alter the external appearance of the rust lesions. However, through macro and microscopic evaluation, we found some host physiological and molecular responses to infection that would quantitatively reduce not only pustule formation and subsequent infection cycles of this pathogen, but also the host photosynthetic area under these predicted weather conditions, mainly expressed in the susceptible accession. Moreover, our results suggest that durum wheat responses to infection are mainly driven by temperature, being considered the most hampering abiotic stress. In contrast, leaf rust infection was greatly reduced when these weather conditions were also conducted during the inoculation process, resembling the effects of possible heat waves not only in disease development, but also in fungal germination and penetration success. Considering this lack of knowledge in plant-pathogen interactions combined with abiotic stresses, the present study is, to the best of our knowledge, the first to include the effects of the expected diurnal variation of maximum temperature and continuous elevated [CO2] in the durum wheat-leaf rust pathosystem.

Exploring the Quality-of-Life Impact, Disease Burden, and Management Challenges of GPP: The Provider and Patient Perspective [Podcast

Generalized pustular psoriasis (GPP) is a rare, chronic, and debilitating disease characterized by flares of widespread erythema, desquamation, and pustule formation. GPP flares can be accompanied by systemic symptoms including fever, fatigue, malaise, and skin pain; severe cases may be fatal if untreated. Although GPP may occur concurrently with plaque psoriasis, they represent two distinct inflammatory conditions. Patients with GPP experience a substantial burden of disease, and the impact of GPP on an individual's mental health and quality-of-life (QoL) goes far beyond skin pain and discomfort. The rarity of GPP may result in a misdiagnosis, as the sudden onset of skin pustules may be mistaken for a primary infection. Misdiagnosis with a subsequent delay in treatment has tremendous negative consequences for the affected patient. In September 2022, spesolimab became the first FDA-approved medication in the US for the treatment of GPP flares in adults. Spesolimab has since been approved by regulatory agencies in numerous countries, including Japan, Mainland China, and the EU. Prior to spesolimab, the clinical management of GPP relied on the off-label use of systemic or biologic therapies approved for plaque psoriasis or other inflammatory conditions. There is a need for increased education among healthcare providers regarding the clinical diagnosis, risk stratification, and therapeutic management of this rare disease, including the other novel GPP-specific therapies in development. In this podcast, two dermatologists and a patient who has plaque psoriasis and GPP discuss the clinical presentation, symptoms, disease burden, QoL impacts, diagnostic challenges, and therapeutic strategies for the management of GPP.

Mature IL-36γ Induces Stratum Corneum Exfoliation in Generalized Pustular Psoriasis by Suppressing Corneodesmosin

Loss-of-function sequence variations in the IL36RN gene encoding IL-36 receptor antagonist cause familial generalized pustular psoriasis, which begins shortly after birth and is difficult to treat, and its effects on the epidermis are unclear. This study investigated the involvement of IL-36 receptor agonists in the epidermal formation of generalized pustular psoriasis. We found that the IL-36 receptor agonists, especially mature IL-36γ, stimulated IL-8 and pro-IL-36γ production in the epidermis while downregulating the genes encoding epidermal cornified envelope-related proteins, for example, corneodesmosin. IL-36 receptor antagonist and monoclonal anti-IL-36γ antibodies counteracted the effect of mature IL-36γ on corneodesmosin in keratinocytes in a dose-dependent manner. In the epidermis of patients with generalized pustular psoriasis with IL36RN loss-of-function sequence variations, pro-IL-36γ was overproduced in the epidermis, and corneodesmosin protein expression was markedly decreased in the region of giant subcorneal pustules (Kogoj's spongiform pustules), with high neutrophil infiltration. IL-8 induced by mature IL-36γ stimulated the infiltration of several neutrophils in the epidermis. The newly produced pro-IL-36γ is cleaved to the mature form by neutrophil proteases. This newly produced mature IL-36γ was predicted to further suppress the gene expression of corneodesmosin, leading to significant stratum corneum exfoliation and formation of the pustules. Overall, our results elucidate the mechanism underlying the formation of Kogoj's spongiform pustules in generalized pustular psoriasis.

Formate production is dispensable for Haemophilus ducreyi virulence in human volunteers.

Haemophilus ducreyi is a causative agent of cutaneous ulcers in children who live in the tropics and of the genital ulcer disease chancroid in sexually active persons. In the anaerobic environment of abscesses and ulcers, anaerobic respiration and mixed acid fermentation (MAF) can be used to provide cellular energy. In Escherichia coli, MAF produces formate, acetate, lactate, succinate, and ethanol; however, MAF has not been studied in H. ducreyi. In human challenge experiments with H. ducreyi 35000HP, transcripts of the formate transporter FocA and pyruvate formate lyase (PflB) were upregulated in pustules compared to the inocula. We made single and double mutants of focA and pflB in 35000HP. Growth of 35000HPΔfocA was similar to 35000HP, but 35000HPΔpflB and 35000HPΔfocA-pflB had growth defects during both aerobic and anaerobic growth. Mutants lacking pflB did not secrete formate into the media. However, formate was secreted into the media by 35000HPΔfocA, indicating that H. ducreyi has alternative formate transporters. The pH of the media during anaerobic growth decreased for 35000HP and 35000HPΔfocA, but not for 35000HPΔpflB or 35000HPΔfocA-pflB, indicating that pflB is the main contributor to media acidification during anaerobic growth. We tested whether formate production and transport were required for virulence in seven human volunteers in a mutant versus parent trial between 35000HPΔfocA-pflB and 35000HP. The pustule formation rate was similar for 35000HP (42.9%)- and 35000HPΔfocA-pflB (62%)-inoculated sites. Although formate production occurs during in vitro growth and focA-pflB transcripts are upregulated during human infection, focA and pflB are not required for virulence in humans.

COMPLICATIONS OF MONKEYPOX

Introduction: Monkeypox is a rare, viral and emerging disease, although in recent months it has become a growing concern for health professionals and public health authorities around the world. The disease is caused by an orthopoxvirus of the same genus as the human smallpox virus and can cause serious complications in both humans and animals. Objective: To show, through the scientific literature, the complications of monkeypox. Methodology: This is an integrative literature review research, carried out between the months of May and July 2023, through a survey of data in the scientific bases of health: LILACS and SCIELO. Results and Discussion: Through the analysis of the selected studies, the main information for the discussion of this study was evaluated. Scientific evidence has shown that monkeypox complications can vary according to the severity of the patient and can affect different systems of the human body. The scientific literature has pointed out that the main complications of monkeypox include skin infections and skin abscesses. In addition, infection with the virus can provoke the development of cardiac complications, such as myocarditis and heart failure. It can cause abnormal heart rhythms and other cardiovascular problems. Monkeypox develops more severely in people with weakened immune systems because the body has difficulty controlling viral replication. In such cases, the infection can spread quickly and affect various organs and systems in the body. Conclusion: Complications of monkeypox pose significant public health and safety challenges. Although the disease is less lethal than smallpox in humans, it can cause serious complications in infected patients, with localized cutaneous effects such as pustule formation and secondary infections, as well as systemic effects affecting vital organs and body systems.

EVALUATION OF THE ACCURACY OF USING TOPICAL ANTIBIOTICS IN SELF-MEDICATION FOR ACNE VULGARIS AT THE DENPASAR REGIONAL PHARMACY

Background: One of the skin problems that are often experienced by teenagers today is acne. Acne vulgaris or acne is a chronic inflammatory disease of pilosebaceous follicles which is characterized by the formation of papules, pustules, or nodules. Purpose: This study aims to provide an accurate description of the use of topical antibiotics in acne vulgaris patients and to find out which drugs are often used as self-medication for acne vulgaris. Methods: This research is included in a descriptive research design. Data collection was done by direct observation and recorded on the checklist sheet for Acne Vulgaris patients who did self-medication at the pharmacy. Results: Judging from the evaluation of the accuracy of the use of topical antibiotics in AV patients at the Denpasar Regional Pharmacy, the results obtained were 53 patients, or 92.98% of patients included in the right indication group, 57 patients, or 100%, included in the right dose group, 54 patients or 94.74% included in the right group for the duration of administration, 57 patients or 100% were included in the appropriate time interval group for administration and 100% of patients were included in the side effect alert group. The accuracy of giving antibiotics, which is included in the category of inappropriate indications by 5.71% of respondents, and inappropriate duration of administration by 5.08% of respondents. The drugs used for AV therapy are Topical Retinoids, Mediklin Gel, Mediklin TR, and Erymed. The drug most often given by pharmacists is topical antibiotics, namely Mediklin TR from the Semisynthetic Lincosamide group, as much as 38.57%. Conclusion: There is still suitability for prescribing topical antibiotics in acne vulgaris seen from its severity.Keywords: Acne; Evaluation; Topical antibiotics

Remission of recalcitrant generalized pustular psoriasis under interleukin-36 receptor inhibitor spesolimab

Generalized pustular psoriasis (GPP) is often alife-threatening disease which, in contrast to psoriasis vulgaris, is associated with the formation of sterile pustules on the skin. Until recently, there was no approved treatment in Europe, so that drugs used for psoriasis vulgaris were also frequently used for GPP. However, new studies showed that, in GPP, mutation of the interleukin-36 receptor often leads to increased inflammation and corresponding disease activity. We report acase of GPP with complete remission after two doses of spesolimab, anew interleukin-36 receptor antibody.

Flagging defensive roles of carbohydrate-active enzymes (CAZymes) and carbohydrates during Puccinia triticina-wheat interactions

Puccinia triticina (Pt) infects wheat, leading to colonization of leaf tissues, pustule formation on the leaf and eventually yield loss. Fungicides and breeding techniques are used to manage Pt infection in wheat. However, there is a growing need for biochemical studies to identify critical metabolites and proteins that contribute to plant susceptibility or resistance against Pt. The current study investigated defensive role of non-structural, structural carbohydrates, and CAZymes during Pt-wheat interaction at 1, 7, and 14 days post inoculation (dpi). The results revealed that glucose, total reducing sugars and sucrose were significantly decreased by more than 50% in Pt inoculated susceptible Thatcher (IS) plants. Sucrose concentrations decreased by 0.80 and 0.93 fold in IS compared to control sample (CS) at 1 and 7 dpi. Pt inoculated resistant Thatcher + Lr9 (IR) plants and control (CR) did not display differences in soluble carbohydrate concentrations. In addition, exoglucanase, endoglucanase, pectinase and carbohydrate esterase activities were significantly higher at 1 or 7 dpi in IS compared to IR plants. The cellulose-content was 29% in IR samples compared to 15% in CR samples at 14 dpi. Additionally, hemicellulose increased by 2% in IR at 14 dpi. The cell wall reinforcements in resistant plants were supported by Fourier transformation infrared results that revealed that IR holocellulose content was not affected by Pt infection, but IS samples holocellulose decreased at 7 dpi. In conclusion, increased activities of CAZymes, decreased cell wall holocellulose content, and reduced soluble carbohydrates were susceptibility indicators.

Prevalence, comorbidities and mortality of generalized pustular psoriasis: A literature review.

Generalized pustular psoriasis (GPP) is a rare auto-inflammatory skin disease characterised by acute episodes of sterile pustule formation. Diagnosis and treatment of the disease have historically been complicated by a lack of awareness, and no consistent global definition or clinical coding standards. Now acknowledged as a distinct clinical entity with a recognised genetic component, GPP can take a serious and life-threatening course due to systemic inflammatory complications and its association with various comorbidities. As with other rare diseases, there are significant challenges to understanding the epidemiology of GPP, notably a small patient population, non-standardised study methodologies and ethnic differences in its presentation. A clearer understanding of GPP is therefore required for clinicians to better manage patients with this rare condition. In this review article, we present an overview of the available data on GPP prevalence estimates in key demographics and report the frequency of genetic mutations associated with the disease. We detail the incidence of known comorbidities and summarise the data on mortality and assigned causes of death. Lastly, we discuss the various factors that impact the collection, interpretation and comparison of these data.

Fatal hydrofluoric acid poisoning: histologic findings and review of the literature.

Hydrofluoric acid (HF), the inorganic acid of elemental fluorine, is a highly dangerous substance and death can result from a very small exposure. In addition to local toxicity, HF can trigger fatal systemic reactions by its high affinity for calcium and magnesium. The authors report the autopsy case of a male worker who was exposed to 50% HF while repairing the leakage from an HF tank valve in a semi-conductor washing factory. His colleagues found blisters on his neck after 6h of work and he was sent to the hospital. However, he expired from cardiac arrest despite an immediate calcium gluconate injection. At autopsy, burns with eschar covering less than 5% of the total body surface were identified on the neck and around both ears, and microscopic examination of the affected skin revealed extensive necrosis of the epidermis and dermis with pustule formation. In chemical analysis, no fluoride ions were detected in blood, vitreous humor, urine, pleural fluid, bile, or skin tissue from the neck. Considering the chemical burns on the neck and the circumstantial information, the cause of death was determined to be HF poisoning. This article presents the clinical manifestations of local and systemic toxicity after the accidental exposure to a high concentration of HF, with histologic demonstrations of chemical burns.

S1.3d The human pathobiont Malassezia furfur secreted protease MfSAP1 regulates cell dispersal and exacerbates skin inflammation

S1.3 Malassezia: genetics, genomics, and biology, September 21, 2022, 11:00 AM - 12:30 PM Objectives Malassezia forms the dominant eukaryotic microbial community on the human skin. The Malassezia genus possesses a repertoire of secretory hydrolytic enzymes involved in protein and lipid metabolism which alter the external cutaneous environment. The exact role of most Malassezia secreted enzymes, including those in interaction with the epithelial surface, is not well characterized.Methods and ResultsIn this study, we compared the expression level of secreted proteases, lipases, phospholipases, and sphingomyelinases of M. globosa in healthy subjects and seborrheic dermatitis or atopic dermatitis patients. We observed upregulated gene expression of the previously characterized secretory aspartyl protease MgSAP1 in both the lesional and non-lesional skin sites of affected compared to healthy subjects. To explore the functional roles of MgSAP1 in skin disease, we generated a knockout mutant of the homologous protease MfSAP1 in the genetically tractable M. furfur. We observed the loss of MfSAP1 resulted in dramatic changes in the cell adhesion and dispersal in both culture and a human 3D reconstituted epidermis model. In a murine model of Malassezia colonization, we further demonstrated MfSAP1 contributes to inflammation as observed by reduced edema and myeloid pustule formation with the knockout mutant versus wildtype.ConclusionTaken together, we show that this dominant secretory M. aspartyl protease has an important role in enabling a planktonic cellular state that can potentially aid in colonization and additionally as a virulence factor in barrier-compromised skin, further highlighting the importance of considering the contextual relevance when evaluating the functions of secreted microbial enzymes.

A study of efficacy and safety of newer chemical peels for acne vulgaris grade 1 to grade 3

Acne is a common and complex and multifactorial skin disease that affects individuals of all ages. It commonly presents as Seborrhoea and formation of comedones, papules and pustules. Aim of our study is to evaluate various new chemical peeling agent for search of treatment which stand out with maximum efficacy and least side effect.A total 120 patients were included in our study. Grading of acne was done according to Pillsbury classification and divided into five Treatment groups: Group A: Azelaic peel (20% Azelaic acid peel) Group B: Black peel (8% Acetic acid peel) Group C: Kojic acid peel (12% kojic acid peel) Group D: Lactic acid peel (90% lactic acid peel) Group E: Mandelic acid peel (35% mandelic acid peel). Patients in each arm were subjected to respective chemical peels at an interval of 15 days for a total of 6 sessions. Last visit was done at 12th week. Evaluation done by dermatological examination for acne including counting the number of comedones, papules and pustules.Patients with improvement at the end of 12 weeks the overall reduction rate was 60.4%, 72.4%, 24.1%, 35.2% and 50.1% with Azelaic peel, Black peel, Kojic acid peel, Lactic acid peel and Mandelic acid peel respectively.Our study thus concluded that the efficacy of Black peel is highest in the treatment of acne vulgaris grade I to III in Indian patients. The resolution was also observed good with Azelaic acid and Mandelic acid while response was not up to the mark by Lactic acid and Kojic acid peel. However, immediate erythema and burning sensations were more common side effects with black peel. Though the side effects observed with these peels reduced by itself, application of emollients, mild steroids and sun screeners hastened the recovery.

34888 Refractory pustular psoriasis treated successfully with IL-23 inhibitors. Report of 1 patient with generalized pustular psoriasis and 4 patients with palmoplantar pustulosis

Introduction: It is known that the key inflammatory cytokines in plaque psoriasis are TNF-a/IL-23/IL-17/IL-22. Conversely, recent data demonstrate that pustular psoriasis is mainly characterized by a neutrophil-driven inflammatory response following “hyperactivation” of the IL-36 axis. However, it appears that these 2 pathways cross-talk to each other and act synergistically in the pathophysiologic mechanism of pustule formation. In terms of guidance to treatment, no robust data exist. Considering the advances into the pathophysiology, arises the question whether the novel IL-23 antagonists could lead to clinical improvement. Methods: We present a 75-year-old female patient with generalized-pustular-psoriasis for 10 years and 4 patients (2 females and 2 males) 53, 58, 60, and 62 years old with palmoplantar-pustulosis for 3, 5, 5, and 6 years, respectively. The former had unsuccessfully undergone every available at that point systemic therapy (both conventional and biologic) whereas the laters had failed acitretin, MTX/acitretin, apremilast/acitretin, acitretin/MTX/apremilast respectively. All five had PGA score >3. We initiated an IL-23 inhibitor. Patient with the generalized-pustular form and 2 patients with the palmoplantar form received risankizumab whereas the other 2 guselkumab. Results: All 4 had reached PPPGA 0/1 by week 12, whereas the patient with generalized pustular form had reached PGA 1 by week 16. Formers are currently undergoing the sixth month of therapy, whereas the later the eighteenth month and still present great response. Conclusions: Il-23 might be a key operator in the interconnection of the complex pathogenetic pathways in pustular psoriasis. Therefore, IL-23 inhibition could be a therapeutic option. More data are required.

Dispensability of Ascorbic Acid Uptake and Utilization Encoded by ulaABCD for the Virulence of Haemophilus ducreyi in Humans.

Compared with wounded skin, ascorbic acid is enriched in pustules of humans experimentally infected with Haemophilus ducreyi. Compared with the broth-grown inocula, transcription of the H. ducreyi ulaABCD operon, which encodes genes for ascorbic acid uptake, is increased in pustules. We hypothesized that ascorbic acid uptake plays a role in H. ducreyi virulence. Five volunteers were infected with both H. ducreyi strain 35000HP and its isogenic ulaABCD deletion mutant at multiple sites; the papule and pustule formation rates of the mutant and parent strains were similar. Thus, ascorbic acid uptake is not essential for H. ducreyi virulence in humans.