Pruritic Lesions Research Articles

Systemic Medication for the Treatment of Prurigo Nodularis-A Systematic Review.

Prurigo nodularis (PN) is a debilitating inflammatory skin disease characterized by red to violaceous pruritic lesions. The goal of therapy is to break the scratch-itch cycle. Treatment varies and often requires a multimodal approach to target both immune and neural mediated aspects of disease. To review the efficacy of systemic treatment used to treat PN. A systematic search of keywords and Medical Subject Headings was performed in Ovid MEDLINE, Embase, Scopus, and ClinicalTrials.gov. The first 200 results of an abbreviated search in Google Scholar were also included. PRISMA guidelines were followed and the review was registered on PROSPERO (CRD42023412012). GRADE criteria were used to assess articles for quality of evidence. The search resulted in 1153 articles; 382 were duplicates, 643 were irrelevant, 19 were not retrieved, 21 were abstract only, and 88 are included in this review. There were 24 studies on dupilumab, 16 on thalidomide, 8 on cyclosporin, 7 on methotrexate, 3 each on lenalidomide and aprepitant, 2 each on alitretinoin, apremilast, baricitinib, gabapentin, intravenous (IV) immunoglobulins, pregabalin, tofacitinib, and 1 each on amitriptyline, azathioprine, butorphanol, isoquercitin, IV dexamethasone-cyclophosphamide/ oral cyclophosphamide, ketotifen, metronidazole, montelukast, nalbuphine, nemolizumab, serolopitant, tacrolimus, and herose derma zima capsule. Dupilumab reduces pruritus and appearance of lesions and is associated with the fewest number of side effects. Thalidomide and pregabalin are also effective, but their long-term use is limited by muscle and nerve pain. Janus Kinase inhibitors may be beneficial, but large population studies are lacking.

Determining what represents value in the treatment of prurigo nodularis and its key unmet needs in Spain through Multi‐Criteria Decision Analysis

AbstractBackgroundPrurigo nodularis (PN) is a chronic, debilitating dermatologic disease characterised by the presence of highly pruritic nodular lesions. PN highly impacts on patients' quality of life as there are no specific treatments available in Spain.ObjectivesDetermine the main value drivers in the treatment of PN in Spain and its main unmet needs using Multi‐Criteria Decision Analysis (MCDA).MethodsLiterature review to synthesise relevant evidence in an evidence matrix based on the MCDA EVIDEM framework adapted to Spain. A multidisciplinary panel composed of dermatologists, hospital pharmacists and a patient weighted (5‐point scale; 0 minimum importance, 5 maximum importance) and scored each criterion included in the framework (from −5 to 5 or 0 to 5 depending on the criterion). Results were discussed in a reflective group session.ResultsPN was considered a severe (3.3 ± 0.7) and infrequent (2.0 ± 0.7) disease, with high unmet needs (4.2 ± 0.7) mainly due to the lack of available treatments with specific indication for PN. Current off‐label treatments were perceived to have limited efficacy/effectiveness (1.8 ± 1.1), an unfavourable long‐term safety profile (2.1 ± 0.9) and low therapeutic impact (1.7 ± 1.1). The measure of patient‐reported outcomes (2.7 ± 0.9) was perceived as important, but available tools are not specific. Although the cost of available treatments was not considered high (2.4 ± 1.5), experts agreed that PN is associated with moderately high other medical costs (3.6 ± 1.1) and indirect costs (3.1 ± 0.9). Experts considered that current guidelines and consensus (2.6 ± 0.7) are not clear on severity criteria and treatment algorithm. The quality of evidence (1.4 ± 0.5) of currently used off‐label treatments was perceived as low due to a lack of published clinical trials.ConclusionsPN was considered a severe disease associated with relevant unmet needs, including the lack of specific and effective treatments for PN, the lack of consensus on the disease definition, defined severity criteria, prevalence estimations and awareness of PN in Spain.

Demographics and Clinical Insights into Parapsoriasis in Benin City, Nigeria

Parapsoriasis encompasses a rare group of skin conditions characterised by erythematous, scaly, and occasionally pruritic lesions and are known to have malignant associations. Despite its historical presence in medical literature, parapsoriasis classification, aetiology, and management remain subjects of ongoing investigation. Recent disease classification now includes the Small plaque parapsoriasis (SPP) and the Large plaque parapsoriasis (LPP). Notably, these conditions have been associated with a potential for malignant involvement especially the large plaque type, hence the need for early diagnosis, treatment and keen follow up / disease surveillance.

P07 Pityriasis amiantacea: a unique presentation of psoriasis associated with tumour necrosis factor-α inhibitor therapy

Abstract Introduction Pityriasis amiantacea (PA) is a rare but distinctive scalp condition. It is characterised by thick, silvery scales that bind together causing matting of multiple hair shafts. This can ultimately result in temporary or permanent hair loss. PA is thought to be a reaction pattern rather than a specific diagnosis and common associated conditions include: scalp psoriasis, seborrhoeic dermatitis, tinea capitis and atopic dermatitis. We report a case of PA presenting in a patient with longstanding rheumatoid arthritis (RA), associated with tumour necrosis factor-α inhibitor (anti-TNF-α) therapy. Case description A 42-year-old was reviewed at her routine rheumatology follow up appointment. She has a 15-year history of seropositive, erosive RA managed with monthly golimumab injections for the last eight years. Prior to this she had been on etanercept for four years, but this lost efficacy. Unfortunately, she had poor disease control on methotrexate, leflunomide and sulphasalazine. She developed a sore area on her scalp nine months previously with accompanying itch. This then spread into an extensive confluent area of redness, associated with soreness, scale, matting onto hair and hair loss. She had been treated unsuccessfully with multiple antibiotic courses, including flucloxacillin, doxycycline and clarithromycin, oral fexofenadine, topical diprosalic and ketoconazole shampoo. The pruritic skin lesions continued to progress and even spread to behind the ears. This had been managed by her general practitioner (GP) as otitis externa. The patient was otherwise well with no joint pains, fever, weight loss or other systemic features. On examination, thickened, hyperkeratotic scaling plaques were seen with clumped hair shafts and underlying erythema of the entire scalp. There were no skin lesions over the rest of the body and nail changes were absent. Swab culture from the scalp was negative for fungal infection but Staphylococcus aureus and Psuedomonas aeruginosa were identified. Dermatology consult was sought, and she was diagnosed with extensive impetiginized pityriasis amiantacea associated with otitis externa. This was thought to be secondary to her anti-TNF-α therapy. Initial management was with scalp oils to soften the scales, Betnovate scalp ointment and a course of antibiotics. However, the mainstay of treatment was stopping the golimumab. Within one month of these interventions she made a dramatic improvement. Discussion The pathogenesis of PA is yet to be definitively established; however, it has been thought that PA may be a manifestation of an underlying inflammatory skin disease. Most commonly, PA is associated with psoriasis and seborrheic dermatitis. Drug induced cases have also been described. There are case reports of PA occurring in patients treated with valproic acid, vemurafenib and minoxidil. The skin symptoms seen in PA are likely a reaction of hair-bearing scalp to various inflammatory and microbial insults. Moreover, a study undertaken in Egypt found that over 96% of patients with PA had Staphylococcus isolates found in skin swabs taken from the affected scalp. Both S. aureus and S.epidermidis were identified; this could suggest incidental colonisation or that these bacteria play a part in development of PA. Multiple studies have looked at distinguishing microbial biofilms and their structure and physical properties. Resilient biological scaffolding of microbial biofilms, rich in polysaccharides, proteins, lipids, and nucleic acids, is triggered by the bacteria and develops on the scalp and hair shafts. As this continues it promotes accumulation of adherent scale and the hair shafts are increasingly bound together and matted to the scalp. TNF-a is an inflammatory cytokine produced by macrophages during acute inflammation. It causes a range of signalling events within cells, leading to necrosis or apoptosis, which contributes to the pathogenesis of many chronic inflammatory diseases, like psoriasis. However, in some cases TNF-a inhibition can paradoxically lead to new psoriasis or worsening of existing psoriasis. This has been observed with the three major anti-TNF-a agents (infliximab, etanercept and adalimumab). Often it is seen in patients receiving treatment for rheumatoid arthritis or inflammatory bowel disease. On average, cutaneous adverse effects are seen approximately 17 months after starting anti-TNF-a therapy. The most frequently seen presentations are of plaque psoriasis and palmoplantar pustulosis. Key learning points Inhibition of TNF-a causes increased production of interferon-a by dendritic cells, which has been associated with induction of psoriasis. Interleukin-1 (IL-1) has also been implicated in the development of psoriasis. Furthermore, TNF-a can activate apoptosis of potentially autoreactive T-cells. Blockade of this action could lead to T-cell mediated tissue and psoriatic pathology. Anti-TNF-a induced PA is a rare adverse reaction that usually requires drug discontinuation. The exact pathogenetic mechanism is unclear but an imbalance of the cytokine environment has been theorised. Our patient highlights the need to stay vigilant for cutaneous adverse reactions and the evolving diverse spectrum of psoriasiform conditions that can be seen secondary to anti-TNF-a therapy.

Prospective study of consecutive patch testing in patients with contact dermatitis using an adapted Latin American baseline series.

Background. Contact dermatitis is characterized by pruritic skin lesions with high prevalence rates. Our objective is to describe the clinical and epidemiological characteristics of a population with suspected contact dermatitis who underwent to a patch testing using an adapted Latin American baseline series.Methods. Observational, descriptive, analytical clinical study with prospective data collection was performed. 208 participants who underwent patch testing using an adapted Latin American baseline series containing 40 allergens were analyzed. The prevalence of contact allergies was compared with data from the literature. Pearson's chi-square test was used for qualitative variables. Quantitative variables were compared using the Mann-Whitney U test. The significance of the regression parameters was tested using the Wald statistical test. Results. A total of 69.7% had one or more positive tests. Among those, 82.8% were women (OR 1.371; p = 0.398). The hands were the most commonly affected site at 43%. An occupational history was detected in 19.2%. The most common allergens were nickel sulfate (32.2%), sodium tetrachloropalladate (19.7%), fragrance mix I (15.4%), and methylisothiazolinone (13.5%). In multivariate logistic regression models, nickel was significantly related to female sex, as well as palladium. Fragrance mix I was related to a family history of allergy (p less than 0.05). Methylisothiazolinone was statistically significantly related to face and hand lesions. Conclusions. This study demonstrated a detailed profile of a population with suspected allergic contact dermatitis. Our patch test results, using an adapted Latin American baseline series, represent a significant update of this important diagnostic tool.

Are Antimicrobial Peptides a 21st-Century Solution for Atopic Dermatitis?

Atopic dermatitis (AD) is a chronic inflammatory skin disorder that is the result of various environmental, bacterial and genetic stimuli, which culminate in the disruption of the skin's barrier function. Characterized by highly pruritic skin lesions, xerosis and an array of comorbidities among which skin infections are the most common, this condition results in both a significant loss of quality of life and in the need for life-long treatments (e.g., corticosteroids, monoclonal antibodies and regular antibiotic intake), all of which may have harmful secondary effects. This, in conjunction with AD's rising prevalence, made the development of alternative treatment strategies the focus of both the scientific community and the pharmaceutical industry. Given their potential to both manage the skin microbiome, fight infections and even modulate the local immune response, the use of antimicrobial peptides (AMPs) from more diverse origins has become one of the most promising alternative solutions for AD management, with some being already used with some success towards this end. However, their production and use also exhibit some limitations. The current work seeks to compile the available information and provide a better understanding of the state of the art in the understanding of AMPs' true potential in addressing AD.

Upadacitinib treatment withdrawal and retreatment in patients with moderate-to-severe atopic dermatitis: Results from a phase 2b, randomized, controlled trial.

Atopic dermatitis (AD) is a chronic inflammatory skin disease characterized by pruritic eczematous lesions. The effect of treatment withdrawal after response to upadacitinib oral treatment is not fully characterized. Assess the effect of upadacitinib withdrawal on skin clearance and itch improvement in adult patients with moderate-to-severe AD and evaluate the kinetics of recovery on rescue treatment. Data from a phase 2b randomized, placebo-controlled trial (NCT02925117) of upadacitinib in patients with moderate-to-severe AD were analysed. Patients were randomized 1:1:1:1 to receive upadacitinib 7.5 mg, 15 mg, 30 mg or placebo, and then at Week 16, patients were re-randomized 1:1 to receive the same dose of upadacitinib (upadacitinib 30 mg for patients initialized to placebo) or placebo. From Week 20, those who experienced loss of response defined as Eczema Area and Severity Index <50% improvement from baseline (EASI 50) received rescue treatment with upadacitinib 30 mg. Patients who withdrew from upadacitinib experienced a rapid loss of skin clearance response, while those who switched from placebo to upadacitinib gained response. Loss of skin clearance response occurred within 4 weeks and worsening of itch occurred within 5 days. In patients who originally received placebo or a lower dose of upadacitinib leading to a loss of EASI response, rescue treatment with upadacitinib 30 mg resulted in rapid recovery or improvement of both skin and itch responses; most patients who were re-randomized to placebo achieved EASI 75 and IGA 0/1 by 8 weeks of rescue treatment. No new safety risks were observed. Continuous treatment with upadacitinib is suggested to maintain skin clearance and antipruritic effects.

Novel Quinazoline Derivative Induces Differentiation of Keratinocytes and Enhances Skin Barrier Functions against Th2 Cytokine-Mediated Signaling.

Atopic dermatitis (AD) is a common inflammatory skin disease characterized by pruritic lesions and skin barrier dysfunction. In this study, we evaluated the effect of a quinazoline derivative, SH-340, on TSLP expression and signaling in human primary keratinocytes. Our results demonstrated that SH-340 significantly increased factors for differentiation and skin barrier function including KRT1, KRT2, KRT10, IVL, LOR, CLDN1, OVOL1, and FLG, whereas it inhibited TSLP expression in a dose-dependent manner, both at the mRNA and protein levels. Furthermore, SH-340 was found to inhibit the phosphorylation of STAT6, a downstream signaling molecule of IL-4 and IL-13, in keratinocytes. These findings suggest that SH-340 may suppress TSLP expression by inhibiting the IL-4/IL-13-STAT6 signaling pathway. Finally, SH-340 may potentially contribute to both the alleviation of inflammation and the restoration of skin barrier function.

Dupilumab for patients with photoaggravated dermatoses with skin nodules as main manifestations: A case series

Photoaggravated dermatoses (PD) are diseases that occur without ultraviolet (UV) radiation but are sometimes or frequently exacerbated by UV radiation. The clinical manifestations of PD are varied, some patients may present with pruritic nodular lesions at the site of light exposure, which possibly through a light-induced type 2 inflammatory response. Some cases may be difficult to treat, safe and effective treatment methods are constantly being explored. Here, we reported five patients with moderate to severe PD with skin nodules as main manifestations successfully treated with dupilumab, who were previously resistant to conventional treatment. After the 16-week treatment period, dupilumab showed good efficacy and safety in PD mainly characterized by nodules.

Rapid reduction in Staphylococcus aureus in atopic dermatitis subjects following dupilumab treatment

Atopic dermatitis (AD) is an inflammatory disorder characterized by dominant type 2 inflammation leading to chronic pruritic skin lesions, allergic comorbidities, and Staphylococcus aureus skin colonization and infections. S aureus is thought to play a role in AD severity. This study characterized the changes in the host-microbial interface in subjects with AD following type 2 blockade with dupilumab. Participants (n= 71) with moderate-severe AD were enrolled in a randomized (dupilumab vs placebo; 2:1), double-blind study at Atopic Dermatitis Research Network centers. Bioassays were performed at multiple time points: S aureus and virulence factor quantification, 16s ribosomal RNA microbiome, serum biomarkers, skin transcriptomic analyses, and peripheral blood T-cell phenotyping. At baseline, 100% of participants were S aureus colonized on the skin surface. Dupilumab treatment resulted in significant reductions in S aureus after only 3 days (compared to placebo), which was 11 days before clinical improvement. Participants with the greatest S aureus reductions had the best clinical outcomes, and these reductions correlated with reductions in serum CCL17 and disease severity. Reductions (10-fold) in S aureus cytotoxins (day 7), perturbations in TH17-cell subsets (day 14), and increased expression of genes relevant for IL-17, neutrophil, and complement pathways (day 7) were also observed. Blockade of IL-4 and IL-13 signaling, very rapidly (day 3) reduces S aureus abundance in subjects with AD, and this reduction correlates with reductions in the type 2 biomarker, CCL17, and measures of AD severity (excluding itch). Immunoprofiling and/or transcriptomics suggest a role for TH17 cells, neutrophils, and complement activation as potential mechanisms to explain these findings.

Cutaneous diphtheria most likely due to exposure in a detention camp in Libya.

A 24-year-old male Bangladeshi asylum seeker presented to the emergency department of Policlinico A. Gemelli of Rome, Italy with multiple nodular, pruritic lesions on both lower limbs and both elbows. We present a skin disease typical for persons living in crowded conditions.

(190) Prescription Patterns in Women with Vulvar Lichen Sclerosus With and Without a Diagnosis of Sexual Dysfunction - A Claims Database Cohort Analysis

Abstract Introduction Vulvar lichen sclerosus (VLS) often presents with intense pruritus and recurrent painful lesions, negatively impacting quality of life and, potentially, the ability to engage in sexual penetration. VLS treatment ranges from topical steroids to systemic antipruritic agents. No studies have yet characterized how concurrent sexual dysfunction impacts VLS treatment. Objective The objective of our study is to assess prescribing patterns in women with VLS with sexual dysfunction compared to women without a diagnosis of sexual dysfunction. Methods A US claims database network (TriNetX Research Network) was queried from 2009 to 2022. We compared women aged ≥18 with VLS (ICD-10: N90.4) and sexual dysfunction (R37 or F52) with women aged ≥18 with VLS but no diagnosis of sexual dysfunction. Outcomes of interest were prescription of opioids (N02A), topical steroids (DE200), vaginal estrogen (GU500), prednisone (8640) or intramuscular (IM) triamcinolone (10759), benzodiazepines (CN302), antifungals (D01) or oral fluconazole (4450), or antipruritic agents including hydroxyzine (5553), amitriptyline (704), gabapentin (25480), or citalopram (2556) within 6 months of the initial diagnosis of VLS. Propensity-matching between the cohorts age, ethnicity, race, type 1 diabetes (E10), vitiligo (L80), autoimmune thyroiditis (E06.3), alopecia areata (L63), pernicious anemia (D51.0), overweight and obesity (E66), type 2 diabetes (E11), hyperlipidemia (E78), essential hypertension (I10), and alcohol abuse (F10.10) was conducted. Results We identified 32,241 women with VLS that did not have concurrent sexual dysfunction (average age 59.5) and 416 women with VLS that had concurrent sexual dysfunction (average age 58.9). After propensity-score matching, the average age of women in each cohort was between 58 and 59 years old (Table 1). Women diagnosed with concurrent sexual dysfunction (n=416) were significantly more likely to receive vaginal estrogen prescriptions (Risk Ratio (RR) 2.00, 95% Confidence Interval (CI) 1.47-2.73), benzodiazepines (RR 1.39, 95% CI 1.00-1.942), and topical anti-inflammatory agents (RR 1.26, 95% CI 1.08-1.47) compared to an equivalent number of propensity-score matched women without a diagnosis of concurrent sexual dysfunction (Table 2). Prescription rates for systemic VLS treatments including oral prednisone or intramuscular triamcinolone (RR 1.06, 95% CI 0.56-1.98), opioids (RR 0.96, 95% CI 0.66-1.40), antifungals (RR 1.35, 95% CI 0.97-1.89), antipruritic agents hydroxyzine, amitriptyline, gabapentin, or citalopram (RR 1.35, 95% CI 0.94-1.93) did not significantly differ between women with or without concurrent sexual dysfunction. Conclusions Our results demonstrate that VLS treatment patterns differ with concurrent sexual dysfunction, with vaginal estrogen, benzodiazepines, and topical anti-inflammatory agents prescribed at higher rates to those with concurrent sexual dysfunction. Rates of prescriptions of opioids, antifungals, oral prednisone, intramuscular triamcinolone, hydroxyzine, amitriptyline, gabapentin, and citalopram were similar between the groups. Given the pruritic vulvar lesions associated with VLS, the low percentage (1.29%) of women with VLS and concurrent sexual dysfunction highlights a potential pattern of underdiagnosis; further study is required to investigate the relationship between VLS and sexual dysfunction. Disclosure No

Epidermolysis Bullosa Pruriginosa Treated with Acitretin

Epidermolysis bullosa pruriginosa (EBP) is a rare inherited and distinctive clinical subtype of dystrophic epidermolysis bullosa. Here is a paediatric case of EBP with extremely pruritic lesions on extensor aspect of limbs and back, where the main modality of treatment given was topical retinoid (tazarotene) and oral retinoid (Acitretin), to which she had responded well clinically as well as symptomatically.

Adult female with a painful and pruritic lower extremity skin lesion.

Adult female with a painful and pruritic lower extremity skin lesion.

Immune-Checkpoint Induced Skin Toxicity Masked as Squamous Cell Carcinoma: Case Report on Mimickers of Dermatological Toxicity with PD-1 Inhibition

Immune checkpoint inhibitors (ICI) are increasingly the mainstay of oncology treatment. Immune-related adverse events (irAEs) from ICI therapy differ from cytotoxic adverse events. Cutaneous irAEs are one of the most common irAEs and require careful attention to optimize the quality of life for oncology patients. These are two cases of patients with advanced solid-tumour malignancies treated with PD-1 inhibitor therapy. Both patients developed multiple pruritic hyperkeratotic lesions, which were initially diagnosed as squamous cell carcinoma from skin biopsies. The presentation as squamous cell carcinoma was atypical and, upon further pathology review, the lesions were more in keeping with a lichenoid immune reaction stemming from the immune checkpoint blockade. With the use of oral or topical steroids and immunomodulators, the lesions resolved. These cases emphasize that patients on PD-1 inhibitor therapy who develop lesions resembling squamous cell carcinoma on initial pathology may require an additional pathology review to assess for immune-mediated reactions, allowing appropriate immunosuppressive therapy to be initiated.

P026 Chronic chilblain like lesions associated with the COVID-19 pandemic

Abstract Background/Aims We report the features of chronic chilblain-like digital lesions newly presenting since the start of the covid-19 pandemic. Comparison with primary perniosis and acrocyanosis, reveals a unique phenotype which appears to be a long-covid phenomenon. Methods The case records of 26 patients with new onset persistent chilblain-like lesions presenting to the Rheumatology service of St George’s University Hospital, London between Autumn 2020 and Spring 2022 were reviewed. Demographic and clinical features, serology, imaging, treatment response and outcome up to Summer 2022 were collated retrospectively. Results Chilblain-like lesions first occurred between September and March; 2019/2020 6 cases, 2020/2021 18 cases and 2021/2022 2 cases. Mean age 35.4 (17-60) years, 88% female, 85% white, all non-smokers. Median body mass index (BMI) 20.2, range 17.0 - 33.2. BMI underweight (&amp;lt;18.5) in 27%. All cases reported new red-purple-blue colour changes of the fingers, some with pain, swelling and pruritis, affecting both hands in 12, one hand in 6, and both hands and feet in 8 cases. There was a past history of cold sensitivity or primary Raynaud’s in 54%. Covid was confirmed in 3 cases, 2 - 8 months prior to onset of chilblain-like symptoms. Possible covid, unconfirmed, was suspected in 5 cases, 1 - 11 months earlier. Affected digits appeared diffusely erythro-cyanotic in 81%, with blotchy discrete maculo-papular erythematous lesions in 42%, some with both features. Involvement was asymmetric in 54%, thumbs spared in 69%. Complement was low in 50% (8/16), ANA positive in 26% (6/23). MRI of hands showed phalangeal bone marrow oedema in keeping with osteitis in 4 of 7 cases. More severe signs and symptoms were associated with low BMI, low C3/4 and a past history of cold sensitivity or Raynauds. Cold avoidance strategies were sufficient for 58%. Pain prompted a trial of NSAIDs, aspirin, nitrates, calcium channel blockers, hydroxychloroquine, oral or topical corticosteroid or topical tacrolimus in 42%. In general, these were minimally effective or not tolerated. 4 severe cases received sildenafil or tadalafil, effective in 2. In 27% complete remission occurred during the first summer season after symptoms commenced, median duration 6 (range 2 - 10) months. In the remaining 19 cases, chilblain-like symptoms returned or worsened in the subsequent second winter period, with 6 of 19 entering remission the following summer. For the remaining 13 persistent cases the total duration of symptoms spans more than a year, and in four cases more than 2 years. Conclusion This series illustrates a distinct chronic chilblain-like condition. Features similar to primary perniosis include female predominance, middle age, pruritic painful blotchy lesions, asymmetry and low BMI. Features in keeping with acrocyanosis include chronicity, extensive diffuse erythro-cyanotic discoloration, relative improvement in warm weather and lack of association with smoking. Disclosure J.A. Nathan: None. P. Kiely: None.

Eosinophilic Annular Erythema as a Subset of Wells Syndrome or a Distinct Entity: Report of Two Cases

Eosinophilic annular erythema (EAE) is an uncommon acute eosinophilic dermatosis of unknown etiology. Urticarial papules and plaques as pruritic lesions appear in annular and arcuate forms on the trunk and proximal limbs and rarely affect the face. In histopathological diagnosis, EAE has typical features, including acute dermal inflammatory infiltrate with abundant eosinophils and lymphocytes around arteries. In spite of no clear treatment, the findings indicated the positive effects of systemic corticosteroid, hydroxychloroquine, and Ultraviolet B therapy along with recurrences. Two patients have been elected in the present study. The first patient was a middle-aged diabetic female with urticarial papules and plaques around the pelvis and proximal thighs that had active borders with improved centers. We started with 400 mg of hydroxychloroquine and 25 mg of prednisone for the patient whose lesions were subsided during the first week. The second consulted patient was a 41-year-old female without a history of previous illness with four months of painful, pruritic, and violaceous plaques on the back of the trunk. In histopathology, dermal inflammatory infiltrate with abundant eosinophils was observed in the dermis. Corticosteroids and hydroxychloroquine were prescribed with the diagnosis of EAE for this patient as well.

Linear and zosteriform lichen planus in a tertiary care centre: a case series

Lichen planus (LP) is a common mucocutaneous condition, but its distribution in a zosteriform and linear pattern is rare. Zosteriform LP is a rare variant with dermatomal distribution and can occur at trauma prone sites. Linear distribution of the disease has been described in less than 1% of patients. Treatment options are topical corticosteroids and systemic antihistamines. We hereby present a case series of four cases with linear and zosteriform patterns in which the biopsy findings were corroborative of lichen planus. In the first case report of a 25-year-old female presented to dermatology OPD of tertiary health Centre with hyperpigmented patches confined to left half of trunk, left arm and left leg for 6 months. Brownish black macules involving left breast and adjoining back and abdomen were seen in zosteriform pattern. In the second case report, a 25-year-old male presented for evaluation of hyperpigmented raised and pruritic lesion over the right axilla of 5 months’ duration Third case was of a 26-year-old female patient who presented with pruritic violaceous macules on left leg extending from mid part of leg to medial aspect of knee and medial side of thigh in a discontinuous pattern for last 3 years. A 34-year-old female presented with history of pruritic rash over the left side of trunk in the fourth case report. The case series is rare and hence being reported.

Coexistence of psoriasiform stratum corneum and underlying lichenoid features in skin biopsies of cutaneous reactions to anti-PD1.

Coexistence of psoriasiform stratum corneum and underlying lichenoid features in skin biopsies of cutaneous reactions to anti-PD1.

A New Moisturiser Improves DNCB-induced Atopic Dermatitis-like Symptoms and Restores Skin Barrier Function in BALB/c Mice.

Atopic dermatitis (AD) is a chronic, inflammatory skin disorder with eczematous and pruritic lesions. Topical moisturisers and either topical corticosteroids or calcineurin inhibitors are usually recommended. Restoring the skin barrier function alleviates AD symptoms. To evaluate the efficacy of a new moisturiser compared to commercially available products in an AD murine model. Experimental AD was induced with topical applications of 2,4-DiNitroChloroBenzene (DNCB) on the shaved back skin of BALB/c mice from Day 1 to Day 38. Mice were randomized to either Vehicle/-, DNCB/-, or DNCB/Eczekalm (test product), DNCB/Atopiclair®, or DNCB/Lipikar (reference products) groups. Once daily application of either Eczekalm or Atopiclair® or Lipikar on the AD lesion was performed from Day 32 to Day 38. The AD severity index (ADSI) and animal behaviour were monitored throughout the study. The trans-epidermal water loss (TEWL) was measured on the sacrifice day (Day 39). At Day39, ADSI in the DNCB/Eczekalm, DNCB/Lipikar, and DNCB/Atopiclair® groups were significantly lower by -70%, -68%, and -57%, respectively, as compared to DNCB/- (p < 0.001). No sign of erythema was observed in the DNCB/Eczekalm group. Mean scores of skin oedema, excoriation, and dryness in the DNCB/Eczekalm, DNCB/Lipikar, and DNCB/Atopiclair® groups were significantly lower than in the DNCB/-. No significant difference was observed between DNCB/Eczekalm and DNCB/Lipikar groups. Mean TEWL in DNCB/Eczekalm group was significantly lower than the ones of DNCB/Atopiclair® (-43%, p < 0.001) and DNCB/Lipikar (-15%, p < 0.05). Eczekalm treatment significantly reduced the inflammatory effects due to AD and itching episodes and restored the skin barrier function.