Intertriginous Areas Research Articles

719 Decreased Morbidity in Patients with Hidradenitis Suppurativa Insured by Medicaid or Medicare

Abstract Introduction Hidradenitis suppurativa (HS) is a chronic condition that is defined by recurring inflammation and fibrosis of intertriginous areas. Patients with HS have had increasing inpatient hospitalization rates over the years. Our study investigates inpatient mortality and morbidity factors in patients with HS by primary payer status. We hypothesized that patients who are uninsured or insured by Medicaid or Medicare will have worse in-hospital mortality rates when compared to those insured by private insurance. Methods Using a national database, we performed a cross-sectional study of patients hospitalized from 2017-2019 with a primary diagnosis of HS. The sample size included 12,365 patients with HS. The independent variable was primary payer status, and the dependent variables were age, gender, race, and zip code income quartiles. The primary outcome was in-hospital mortality. The secondary outcomes were morbidity factors (infection and wound dehiscence rates, postoperative complications), time from admission to first procedure, and resource utilization (total hospitalization charges and costs, and length of hospitalization). Statistical analyses were performed to determine frequencies, odds ratios, and significance. Statistical significance was set at p< 0.05. We controlled for the above-defined dependent variables in the logistic regression analysis. Results Primary payer status was not associated with inpatient mortality in patients with HS (p=0.092). From 2017-2019, there were a total of five (0.04%) of in-patient mortalities in patients with HS, with all five being insured by Medicaid and occurring in 2017. Compared with private insurance, Medicare was associated with significantly lower incidences of wound dehiscence (aOR=0.21 (0.06-0.70); p=0.011) and longer time from admission to first procedure (mean days=1.85 vs 1.23; p=0.01). Medicaid was associated with significantly lower incidences of infection (aOR=0.21 (0.08-0.58); p=0.002) and longer time from admission to first procedure (mean days=1.73 vs 1.23; p=0.024). The only difference observed in the uninsured, when compared to privately insured, was significantly lower total costs ($10601.78 vs $13658.37; p=0.030). Conclusions Our study demonstrates that in patients with HS, inpatient morbidity factors are overall better in those who are publicly insured over those privately insured. However, publicly insured patients face a longer wait to first procedure from admission over those privately insured. Applicability of Research to Practice By raising awareness in treatment outcomes and resource utilization for patients with HS in inpatient settings, the medical team caring for these patients can begin to identify reasons for the disparities shown by insurance status.

519 Weekend Admission for Patients with Hidradenitis Suppurativa Have Better Outcomes than Weekday Admission

Abstract Introduction Hidradenitis suppurativa (HS) is a condition that involves recurring inflammation and fibrosis of intertriginous areas. With increasing inpatient hospitalization rates in patients with HS, our study sought to examine differences in outcomes between weekend and weekday admission. The authors hypothesized that patients admitted on a weekend will have worse in-hospital mortality rates when compared to those admitted on a weekday. Methods We used a national database to perform a cross-sectional study focusing on 12,365 patients with a primary diagnosis of HS from 2017-2019. The variables measured were weekend or weekday admission, age, gender, race, and zip income quartiles, with the latter four identified as confounding factors controlled for in the logistic regression analysis. Descriptive analyses were performed to determine frequencies, means, and significance. Statistical significance was set at p< 0.05.The multivariate binomial logistic regression was used to calculate the odds ratio (OR) for the identified outcomes. The primary outcome was in-hospital mortality. The secondary outcomes were morbidity factors (infection and wound dehiscence rates, postoperative complications), time from admission to first procedure, and resource utilization (total hospitalization charges and costs, and length of hospitalization). Results Weekend admission is not associated with worse inpatient mortality in patients with HS (p=0.345). From 2017-2019, 5 patients died, all of whom were admitted on a weekday. Compared to weekday, weekend admission had significantly lower incidences of wound dehiscence (0.38% vs 0%; p=0.007) and postoperative complications (0.24% vs 0%; p=0.035). No significant difference was observed for incidence of infection in weekday (0.43%) vs weekend admission (0.27%) (p=0.311). Weekend admission was also not found to have significant difference in the odds of contracting an infection (OR=0.74 (0.29-1.90); p=0.536). Weekend admission had significantly lower length of stay (mean days=6.40 vs 4.94; p=0.001), total charge ($64598.94 vs $44616.44; p< 0.001), and total cost ($14441.22 vs $10082.79; p< 0.001). Conclusions In contrast to previous studies focused on other pathologies that have shown increased morbidity, treatment metrics, and resource utilization on weekend admission, our study demonstrates that specifically for patients with HS, weekend admission is associated with lower rates of morbidity, length of stay, and charge. Applicability of Research to Practice Given that patients with HS who have a weekday admission have worse outcomes than a weekend admission, it is imperative for the medical team providing care to this group of patients on a weekday to be aware of this and begin to identify any potential factors.

New Insight into the Molecular Pathomechanism and Immunomodulatory Treatments of Hidradenitis Suppurativa.

Hidradenitis suppurativa (HS) is an immune-mediated inflammatory disorder characterized by deep-seated nodules, abscesses, sinus tracts and scars localized in the intertriginous areas. It is accompanied by pain, malodourous secretion and a dramatically decreased quality of life. Although the pathogenesis has not been entirely elucidated, the primary event is follicular hyperkeratosis of the pilosebaceous apocrine unit. Since the registration of the tumor necrosis factor-alpha inhibitor Adalimumab in 2015, several cytokines have been implicated in the pathomechanism of HS and the research of novel therapeutic targets has been intensified. We provide an update on the inflammatory cytokines with a central role in HS pathogenesis and the most promising target molecules of future HS management.

Sex-biased immunological processes drive hidradenitis suppurativa.

Hidradenitis suppurativa (HS) is a chronic inflammatory skin condition that can manifest with abscesses, sinus tracts, and scarring in the intertriginous areas of the body. HS is characterized by immune dysregulation, featuring elevated levels of myeloid cells, T helper (Th) cells, and pro-inflammatory cytokines, particularly those involved in Th1- and Th17-mediated immunity. In most epidemiological studies, HS shows a strong female sex bias, with reported female-to-male ratios estimated at roughly 3:1, suggesting that sex-related factors contribute to HS pathophysiology. In this article, we review the role of intrinsic and extrinsic factors that contribute to immunological differences between the sexes and postulate their role in the female sex bias observed in HS. We discuss the effects of hormones, X chromosome dosage, genetics, the microbiome, and smoking on sex-related differences in immunity to postulate potential immunological mechanisms in HS pathophysiology. Future studies are required to better characterize sex-biased factors that contribute to HS disease presentations.

Efficacy of Roflumilast Foam, 0.3%, in Patients With Seborrheic Dermatitis

Current topical treatment options for seborrheic dermatitis are limited by efficacy and/or safety. To assess safety and efficacy of roflumilast foam, 0.3%, in adult patients with seborrheic dermatitis affecting the scalp, face, and/or trunk. This multicenter (24 sites in the US and Canada) phase 2a, parallel group, double-blind, vehicle-controlled clinical trial was conducted between November 12, 2019, and August 21, 2020. Participants were adult (aged ≥18 years) patients with a clinical diagnosis of seborrheic dermatitis for a 3-month or longer duration and Investigator Global Assessment (IGA) score of 3 or greater (at least moderate), affecting 20% or less body surface area, including scalp, face, trunk, and/or intertriginous areas. Data analysis was performed from September to October 2020. Once-daily roflumilast foam, 0.3% (n = 154), or vehicle foam (n = 72) for 8 weeks. The main outcome was IGA success, defined as achievement of IGA score of clear or almost clear plus 2-grade improvement from baseline, at week 8. Secondary outcomes included IGA success at weeks 2 and 4; achievement of erythema score of 0 or 1 plus 2-grade improvement from baseline at weeks 2, 4, and 8; achievement of scaling score of 0 or 1 plus 2-grade improvement from baseline at weeks 2, 4, and 8; change in Worst Itch Numeric Rating Scale (WI-NRS) score from baseline; and WI-NRS success, defined as achievement of 4-point or greater WI-NRS score improvement in patients with baseline WI-NRS score of 4 or greater. Safety and tolerability were also assessed. A total of 226 patients (mean [SD] age, 44.9 [16.8] years; 116 men, 110 women) were randomized to roflumilast foam (n = 154) or vehicle foam (n = 72). At week 8, 104 (73.8%) roflumilast-treated patients achieved IGA success compared with 27 (40.9%) in the vehicle group (P < .001). Roflumilast-treated patients had statistically significantly higher rates of IGA success vs vehicle at week 2, the first time point assessed. Mean (SD) reductions (improvements) on the WI-NRS at week 8 were 59.3% (52.5%) vs 36.6% (42.2%) in the roflumilast and vehicle groups, respectively (P < .001). Roflumilast was well tolerated, with the rate of adverse events similar to that of the vehicle foam. The results from this phase 2a randomized clinical trial of once-daily roflumilast foam, 0.3%, demonstrated favorable efficacy, safety, and local tolerability in the treatment of erythema, scaling, and itch caused by seborrheic dermatitis, supporting further investigation as a nonsteroidal topical treatment. ClinicalTrials.gov Identifier: NCT04091646.

A case report of Hailey-Hailey disease treated with fractional carbon dioxide laser.

Hailey-Hailey disease (HHD), or familial benign pemphigus, is a rare genetic condition characterized by recurrent blisters and erosions with a predilection for intertriginous areas. There is no specific treatment for HHD. Topical and systemic treatments tend to provide temporary remission. Alternative treatment (surgical interventions such as dermabrasion, excision, and laser) has been shown to prolong remission. Considering the risk of complications associated with surgical modalities, laser is often preferred as an alternative for patients failing to respond to first-line therapies. We report a case of recalcitrant HHD successfully treated with a fractional ablative CO2 laser procedure (wavelength of 10600 nm, power of 7-10 W, 2-3 passes) on a 35-year-old female. The patient has a 7-year history of therapy-resistant HHD. A 2-month followup showed substantially resolved lesions, with mild erythema and post-inflammatory hyperpigmentation in treated areas.

Neutrophilic granulocyte-derived B-cell activating factor supports B cells in skin lesions in hidradenitis suppurativa

Hidradenitis suppurativa (HS) is a chronic inflammatory disease characterized by painful inflamed nodules, abscesses, and pus-draining tunnels appearing in axillary, inguinal, and perianal skin areas. HS lesions contain various types of immigrated immune cells. This study aimed to characterize mediators that support lesional B/plasma cell persistence in HS. Skin samples from several cohorts of HS patients and control cohorts were assessed by mRNA sequencing, quantitative PCR on reverse-transcribed RNA, flow cytometry, and immunohistofluorescence. Blood plasma and cultured skin biopsy samples, keratinocytes, dermal fibroblasts, neutrophilic granulocytes (neutrophils), monocytes, and B cells were analyzed. Complex systems biology approaches were used to evaluate bulk and single-cell RNA sequencing data. Proportions of B/plasma cells, neutrophils, CD8+ T cells, and M0 and M1 macrophages were elevated in HS lesions compared to skin of healthy and perilesional intertriginous areas. There was an association between B/plasma cells, neutrophils, and B-cell activating factor (BAFF, aka TNFSF13B). BAFF was abundant in HS lesions, particularly in nodules and abscesses. Among the cell types present in HS lesions, myeloid cells were the main BAFF producers. Mechanistically, granulocyte colony-stimulating factor in the presence of bacterial products was the major stimulus for neutrophils' BAFF secretion. Lesional upregulation of BAFF receptors was attributed to B cells (TNFRSF13C/BAFFR and TNFRSF13B/TACI) and plasma cells (TNFRSF17/BCMA). Characterization of the lesional BAFF pathway revealed molecules involved in migration/adhesion (eg, CXCR4, CD37, CD53, SELL), proliferation/survival (eg, BST2), activation (eg, KLF2, PRKCB), and reactive oxygen species production (eg, NCF1, CYBC1) of B/plasma cells. Neutrophil-derived BAFF supports B/plasma cell persistence and function in HS lesions.

Durability of Efficacy and Safety of Roflumilast Cream 0.3% in Adults With Chronic Plaque Psoriasis From a 52-Week, Phase 2 Open-Label Safety Trial

Background: Roflumilast cream is a potent phosphodiesterase 4 inhibitor recently approved in the United States for treatment of plaque psoriasis with no limitations on duration of use. An open-label trial was conducted to evaluate long-term safety (52 weeks) of once-daily roflumilast cream (NCT03764475). This abstract presents data on durability of response as measured by the percentage of patients with an Investigator Global Assessment (IGA) score of Clear or Almost Clear, percentage improvement in Psoriasis Area Severity Index (PASI) score, and reduction in body surface area (BSA) affected. Methods: Patients who completed a parent, phase 2b, 12-week randomized controlled trial could continue on open-label roflumilast cream 0.3% (Cohort-1, n=230), and patients naïve to roflumilast were also enrolled (Cohort-2, n=102). All psoriasis lesions (except scalp) were treated, including face and intertriginous areas for up to 52 weeks. If affected, palms and soles were treated, but not evaluated towards any efficacy assessments. Median duration of response was determined using the Kaplan-Meier method. Results: With cumulative treatment up to 64 weeks in Cohort-1 and 52 weeks in Cohort-2, long-term safety and tolerability were consistent with the 12-week, phase 2b study. Overall, 73.5% of patients completed the study; 3.9% discontinued due to adverse events (AE) and 0.9% discontinued due to lack of efficacy. Treatment-related AEs were reported in 2.7% patients; none were deemed serious. Investigator tolerability assessments at each visit demonstrated 99% of patients rated “no evidence of irritation.” At Week 52, IGA Success (demonstrating Clear/Almost Clear plus 2-grade improvement from baseline) was achieved by 34.8% of patients in Cohort-1 and 39.5% in Cohort-2. Of patients in Cohort-2, 40% of patients achieved IGA success at week 12. IGA Clear/Almost Clear was achieved by 46.8% of patients across both cohorts at week 12 and consistent through week 52 (44.8%). Similarly, a 60.5% mean PASI improvement and 60.1% mean BSA improvement from baseline were observed at week 12 and consistent through week 52 (59.4% and 63.3%, respectively). Of the 185 patients who achieved IGA Clear/Almost Clear during the open-label trial, the median durability of IGA of Clear/Almost Clear was 10 months (40.1 weeks). Among patients who achieved an IGA of Clear or Almost Clear, 50% maintained Clear or Almost Clear status for at least 10 months. Conclusions: In this long-term safety study, roflumilast cream was well tolerated with a safety profile consistent with the parent Ph2b trial, and effectively maintained clear/almost clear skin with no tachyphylaxis observed. Sponsored by Arcutis Biotherapeutics, Inc.

Perspectives on Pediatric Hidradenitis Suppurativa Care: A Survey of Pediatric Providers

Background: Hidradenitis suppurativa, or HS, is a chronic, inflammatory skin condition characterized by abscesses, nodules, and fistulas typically in intertriginous areas of the body. Pediatric providers are key front-line providers for children and adolescents with HS, yet little is known about their diagnostic and management approach.&#x0D; Objective: In this survey study, we elicited the perspectives and experiences of pediatric providers regarding HS care.&#x0D; Methods: An anonymous survey was distributed to pediatric providers through online pediatric organizational listservs. Survey questions addressed providers’ perspectives on HS diagnosis and management. Comparative statistics between survey responses and provider experience were performed using t-tests and a p-value &lt;0.05 was considered significant.&#x0D; Results: Among the 50 respondents, less than one-half were confident in knowing the available treatment options for HS (46%), managing mild HS (42%) or moderate-severe HS (6%), knowing pediatric HS comorbidities (30%), addressing challenges that HS patients face in school (22%), knowing when to discuss surgical treatments (20%), managing menstrual HS flares (14%), discussing the impact of HS on sexual health (14%), and managing patients with non-prescription therapies (0%). Of the 25 participants who saw patients with HS, less than two-thirds “often/sometimes” screened for substance abuse (64%), polycystic ovarian syndrome (60%), premature adrenarche (28%), and inflammatory bowel disease (20%).&#x0D; Conclusion: Educational resources targeted towards pediatric providers and increased collaboration with dermatologists may improve HS care for children and adolescents.

Efficacy and safety of roflumilast cream for chronic plaque psoriasis with facial/neck and intertriginous area involvement: a post hoc analysis from a randomized controlled trial.

This post hoc analysis evaluated efficacy and safety of roflumilast cream in patients with psoriasis involving the face/neck or intertriginous areas from a phase IIb trial. Of 331 patients enrolled in the phase IIb trial, 160 had psoriasis involving the face/neck and/or intertriginous areas. Once-daily roflumilast cream was well tolerated with efficacy across multiple endpoints in these patients.

Widespread Erosions in Intertriginous Areas

Widespread Erosions in Intertriginous Areas

Deucravacitinib and psoriasis: a sigh of relief

Introduction and pathophysiology Psoriasis is a chronic inflammatory skin condition linked to numerous other medical disorders, such as cardiometabolic syndrome, depression, and psoriatic arthritis1. Around 125 million individuals on the planet are affected by psoriasis. Genetic factors mostly cause psoriasis, while environmental variables can aggravate the condition2. Moderate-to-severe psoriasis is present in ~25% of affected patients3. Greater than 80% of cases of psoriasis fall within the most frequent subtype, plaque psoriasis. Erythematous scaly plaques, which typically develop on extensor surfaces like the knees and the elbows are the hallmark of this subtype. Gluteal fold, intertriginous areas, soles, palms, and nails may also be impacted. Furthermore, impacted regions are typically clearly defined and frequently symmetrical. A feed-forward mechanism of inflammation, notably the type 17 T-helper cell (TH17) pathway, leads to the development of plaque psoriasis2. Patients with more severe cases of psoriasis experience a stronger psychological impact as a result of the disease. Up to 20% of psoriasis sufferers are more prone to experience depression and have suicidal thoughts that progress to actual suicide4. Treatment options for psoriasis Primary treatment options for psoriasis include phototherapy and topical and systemic treatments which can be utilized singly or in combination. Phototherapy is initiated when the disease is extensive and resistant to other therapies. Two types of phototherapies are used: psoralen combined with ultraviolet A irradiation (PUVA) and UVB irradiation. However, they cost expensive and proper facilities are required. Despite toxicity-reducing strategies such as combination therapy, some individuals experience major adverse effects from traditional psoriasis medicines5. A phosphodiesterase 4 (PDE-4) inhibitor, Apremilast was approved by the Food and Drug Administration (FDA) in 2014 to treat plaque psoriasis6. Inhibition of PDE4 raises intracellular cyclic adenosine monophosphate (cAMP) concentrations. However, Apremilast’s precise therapeutic activity in people with psoriatic arthritis and psoriasis is not fully understood, nor are the mechanisms through which it works7. Apremilast over 16 weeks demonstrated a clinically significant improvement in patients suffering from plaque psoriasis, as determined by the PASI score, according to ESTEEM 1 and ESTEEM 2, two clinical trials8,9. Apremilast was the only oral drug available for plaque psoriasis until now. On September 9, 2022—FDA approved deucravacitinib, as a new and better oral treatment option for adults suffering from moderate to severe plaque psoriasis10,11. Sotyktu (deucravacitinib) Deucravacitinib is a tyrosine kinase 2 (TYK2) inhibitor that is selective and allosteric. It inhibits TYK2 by preferentially attaching to the pseudo kinase or unique regulatory domain instead of the enzyme’s active catalytic site12. The drug’s approval came after encouraging findings from the 2 clinical trials—POETYK PSO-1 and PSO-2, which found that Apremilast and placebo were less effective than deucravacitinib in treating 1684 adult patients with plaque psoriasis. In patients using deucravacitinib, oral ulcers, a rise in blood creatine phosphokinase, upper respiratory infections, pimples, and folliculitis were the most common side effects by the end of week 16 of these clinical studies. Deucravacitinib resulted in a rapid response and consistent trends in enhancements in many efficacy measurements as well as quality of life for those who have moderate to severe plaque psoriasis13. However, as per the manufacturer, Bristol Myers Squibb, combining Sotyktu (deucravacitinib) with other strong immunosuppressants is not advised. Conclusion For patients with psoriasis plaque who are not satisfied with conventional and topical therapies, the approval of deucravacitinib marks an exciting day, as it is the first oral medication authorized after a long time for plaque psoriasis. Given its track record of assisting patients in achieving smoother skin, as shown in the POETYK PSO clinical study, the drug deucravacitinib can change how psoriasis is managed and treated in a better way. Although the drug is contraindicated in pregnancy, information regarding the drug’s presence in human milk is lacking. Further research is required to comprehend better results in lactating women and widen the range as the drug has limitations in severe hepatic impairment10. Ethical approval Not applicable. Source of funding None. Author contributions MS.M. and F.A.: conceptualization. M.S.M., M.M.N.U., and S.T.A.: conducted the literature and drafting of the manuscript. M.A.S.: performed editing and supervision. All authors have read and agreed to the final version of the manuscript. Conflict of interest disclosure The authors declare that they have no financial conflict of interest with regard to the content of this report. Research registration unique identifying number (UIN) Not applicable. Guarantor All authors take responsibility for the work, access to data and decision to publish.

The Composition of Subgingival Microbiome in Hidradenitis Suppurativa and Periodontitis Patients

Hidradenitis suppurativa (HS) is a chronic inflammatory disorder of the pilosebaceous unit of the intertriginous body areas. Recent findings have suggested the association between periodontitis and HS. This investigation aimed to characterize and compare the composition of subgingival microbiome between HS, periodontitis, and control patients. The nine crucial perio-pathogenic species and total bacteria were analyzed using RT-PCR based tests in samples collected from 30 patients with periodontitis, 30 patients with HS and 30 controls. Patients with HS were excluded if they had periodontitis and patients with periodontitis were excluded if they had HS. The mean total bacteria count was significantly higher in HS and periodontitis samples than in control samples (p < 0.05). The majority of perio-pathogens tested were more frequently detected in HS and periodontitis groups than among controls. Treponema denticola was the most common pathogen in individuals with HS (70%) and periodontitis (86.7%), while among controls Capnocytophyga gingivalis was the most frequently detected isolate (33.2%). The results of the present investigation demonstrated that HS and periodontitis patients share some similarities in their subgingival microbiome composition.

Sustainable patient education in hidradenitis suppurativa

AbstractBackgroundHidradenitis suppurativa (HS) is a chronic inflammatory disease of recurrent painful nodules and sinus tracts mainly located in intertriginous skin areas. HS can cause physical and psychosocial impairments, and patients have a need for information and social support.ObjectivesAn educational event was established to accommodate the aforementioned patient needs. The event presents updated information concerning HS and debates the lived experience of HS. This article outlines our approach to patient education.MethodsThe educational HS‐event has yearly welcomed patients and relatives at Roskilde hospital since 2010—except in year 2020 due to corona‐legislation. The educational content includes information on HS aetiology, epidemiology, treatment, psychosocial aspects of HS and current research. The team of educators is multidisciplinary and includes patients.ResultsTwelve thematic patient reported questions and concerns reoccur at the events. They include: The aetiology of HS and lifestyle, daily life, employment and economy, emotions, locations of lesions, heredity, comorbidities, self‐care to alleviate symptoms, treatment, the healthcare system, prognosis and new research. The participants are satisfied with the arrangement.ConclusionEducational activities such as the one outlined in this manuscript provides requested information, coping strategies social support. Studies are needed to investigate if systematic education of HS patients improves subjective and objectives measures.Plain abstractPatient education is an important part of disease management. It is essential to share different experiences and practices of patient education to optimize and inspire future educational programs. This study presents a decade of experiences from an annual event that has educated patients with the skin disease Hidradenitis suppurativa (HS). HS is a chronic inflammatory disease that causes skin abscess, nodules, and substantial scarring. The abscesses are extremely painful and located in areas of the body with skin‐to‐skin contact. Due to the painful condition the disease can cause both physical as well as psychological and social difficulties, and the patient group have a need for medical information and social support. In 2010 Roskilde hospital established an annual educational event for patients with HS and their relatives. The educational content includes general information regarding the disease, medical and surgical therapy options, psychosocial aspects of HS, and the latest scientific research concerning HS. The team of educators includes dermatologists, medical and PhD students, experts in psychology, representatives from the HS Patient Association and patients. In this study we outline our approach to patient education for those with HS and their relatives and present the participants' questions and comments as raised at these events. Arrangements such as this can be used to support the patients with the information needed to better understand their disease, but also to facilitate coping strategies and provide a framework for social support. Other studies are needed to investigate if education of patients with HS can improve subjective or objective measures.

Acanthosis Nigricans: An Updated Review.

Early recognition of acanthosis nigricans is important because acanthosis nigricans can be a cutaneous manifestation of a variety of systemic disorders and, rarely, as a sign of internal malignancy. The purpose of this article is to familiarize pediatricians with the clinical manifestations, evaluation, diagnosis, and management of acanthosis nigricans. A search was conducted in November 2021in PubMed Clinical Queries using the key term "acanthosis nigricans". The search strategy included all clinical trials, observational studies, and reviews published within the past 10 years. Only papers published in the English literature were included in this review. The information retrieved from the above search was used in the compilation of the present article. Acanthosis nigricans is characterized by symmetric, hyperpigmented, and velvety plaques with ill-defined borders, typically involving intertriginous areas. Obesity is the most common cause of acanthosis nigricans which is increasingly observed in obese children and adolescents and can serve as a cutaneous marker of insulin resistance. Early recognition of acanthosis nigricans is important because acanthosis nigricans can also be a cutaneous manifestation of a variety of systemic disorders and, rarely, as a sign of internal malignancy. This may consist of weight reduction, discontinuation of causative drugs, treatment of underlying endocrinopathy, or treatment of an underlying malignancy. For patients with isolated acanthosis nigricans and for those whose underlying cause is not amenable to treatment, treatment of the lesion may be considered for cosmetic reasons. Topical retinoids, vitamin D analogs, chemical peels, and other keratolytics are often used for the treatment of localized lesions. Seldom, systemic therapy such as oral retinoids may be considered for extensive or generalized acanthosis nigricans and acanthosis nigricans unresponsive to topical therapy. Other uncommon treatment modalities include dermabrasion, laser therapy, and surgical removal. Although acanthosis nigricans is treatable, a complete cure is difficult to achieve. The underlying cause should be treated, if possible, to resolve and prevent the recurrence of acanthosis nigricans. The diagnosis is mainly clinical, based on the characteristic appearance (symmetrically distributed, hyperpigmented, velvety, papillomatous, hyperkeratotic plaques with ill-defined borders) and the typical sites (intertriginous areas, flexural area, and skin folds) of the lesions. The diagnosis might be difficult for lesions that have atypical morphology or are in an unusual location. Clinicians should be familiar with the clinical signs, evaluation, diagnosis, and therapy of acanthosis nigricans because of the link between it and underlying diseases.

Mukozayı da etkileyen bir generalize subkorneal püstüler dermatozun siklosporin ile başarılı tedavisi: Bir olgu sunumu

Subcorneal pustular dermatosis (SPD), is rare, chronic, and relapsing pustuler eruption. Mostly, it affects middle-aged and elderly women. Mucosal involvement is extremely rare. Here we report a 31-year-old woman with generalized SPD with lip involvement. The patient had annular or serpiginous patterned well-demarcated plaques on the trunk, intertriginous areas and flexor aspects of the limbs, palmoplantar areas, face, and lip mucosa. The bullous lesions exhibited the typical half and half sign. The patient was treated successfully with systemic steroids and cyclosporine.

Celecoxib and Bullous Symmetrical Drug-Related Intertriginous and Flexural Exanthem (SDRIFE)

Symmetrical drug-related intertriginous and flexural exanthema (SDRIFE) is a nonimmediate, T-cell–mediated hypersensitivity drug reaction, characterized by symmetrical erythema involving the gluteal and intertriginous areas without systemic involvement. It occurs after systemic administration of a drug in an individual with/without prior sensitization.1 We report a case of celecoxib-induced bullous SDRIFE. Informed consent was obtained from the patient to publish the case report along with accompanying images.

Acral Acanthosis Nigricans with Concurrent Vitamin B12 Deficiency in an Indian Patient: An Atypical Presentation

Acanthosis Nigricans (AN) is characterised by velvety, papillomatous, brownish-black, hyperkeratotic plaques, typically on the intertriginous areas and neck. It is more commonly seen in the African American descent, rarely occurs in the Indian population. The present case includes 28-year-old male, who presented to the Outpatient Department with asymptomatic hyperpigmention over skin of both feet and knuckles of both hands since three months. The distribution pattern over the knuckles was suggestive of vitamin B12 deficiency however the atypical distribution over the feet leads to suspicion of a differential diagnosis of lichen planopigmentosus, vitamin B12 deficiency and acral AN. Dermoscopy was done to aid in the diagnosis and revealed linear crista cutis and sulcus cutis which are features suggestive of AN. On investigation, serum vitamin B12 levels were below 100 µg/mL and histologic sections showed hyperkeratosis with papillomatosis and mild acanthosis. The patient was treated solely with 1500 mcg mecobalamine daily for 10 days and followed-up. The dermoscopic and histopathological findings were consistent with the diagnosis of acral AN and thus a final diagnosis of acral AN superimposed with vitamin B12 deficiency was made. This case is being reported due to its rare occurrence in the Indian population, the atypical clinical presentation of AN in form of macules and to highlight dermoscopy as an essential non invasive tool aiding in the diagnosis. The diagnosis of acral AN should not be overlooked despite the finding of low serum vitamin B12 levels in such a case and the authors wish to create awareness among the clinicians to investigate the patient further.

Hailey-Hailey disease misdiagnosed as candidal intertrigo: Case report of a rare skin disease

Hailey–Hailey disease (HHD) is a rare autosomal-dominant blistering disorder characterized by macerated velvety, fissured, hypertrophic plaques with characteristic involvement of the intertriginous areas. The diagnosis is often suspected by the clinical appearance of the lesions in intertriginous areas as well as positive family history and confirmed by histological analysis of the lesional skin biopsy. A diagnosis of HHD is rarely made in this environment due to its resemblance to other dermatoses of the intertriginous areas and the rarity of the condition itself. We present a case report of HHD, a rare hereditary disease, involving two unrelated Nigerians seen in our dermatology clinic, who were diagnosed and successfully managed at our centre.

A Case Study of Hidradenitis Suppurativa.

Hidradenitis suppurativa (HS) is a complex, chronic, inflammatory skin disease that is often unrecognized or misdiagnosed. Patients frequently present to with painful nodules, inflammatory papules, sinus tracts, and scarring to intertriginous areas seeking care to alleviate symptoms. There is a paucity of information available specifically aimed to educate emergency nurse practitioners on how to recognize, diagnose, and treat this population. The article highlights the main diagnostic criteria and treatment options available for HS patients to help expand disease awareness.