Erythematous Scaly Plaques Research Articles

Unconventional Remedies for Squamous Cell Carcinoma: A Journey into Alternative Treatments.

Squamous cell carcinoma (SCC) is the second most common form of skin cancer and is typically found on sun-exposed skin. Risk factors include ultraviolet radiation exposure, older age, fairer complexion, smoking, and immunosuppression. SCC is a slow-growing tumor with the possibility of metastasis if not treated. The clinical presentation can range from a dry, scaly erythematous patch or plaque to a firm hyperkeratotic papule, plaque, or nodule, depending on the histological type via biopsy. The first-line therapies for SCC removal are standard excision and Mohs microscopic surgery; however, there are novel and alternative non-surgical options being considered for the treatment of SCC. This review summarizes the current guidelines for treating low-risk and high-risk SCC and discusses rare, experimental, and anecdotal non-surgical treatments for SCC in the literature.

An Incidental Finding Of A Tumour In A Case Of Pityriasis Rubra Pilaris- A Case Report

We report a 49-year-old man who had a progressive rash that covered 90% of his total surface area in a period of 5 years. Confluent scaly erythematous plaques, which started on the upper back and spread to involve the scalp, face, chest, and limbs. Notable observations were subungual hyperkeratosis and onychogryphosis in all nails, along with follicular keratotic papules with waxy keratoderma on the palms and soles. Biopsy from skin lesions were suggestive of PRP. A focal hypoechoic thickening at the base of the bladder was found during abdominal ultrasonography, which could indicate edema or a tumor. Histopathological examination of the removed tissue following TURBT revealed cystic urothelial nests that were consistent with Cystitis Cystica Glandularis (CCG), ruling out cancer. This case underscores the importance of a thorough investigation in patients with extensive dermatoses, highlighting a rare association between PRP and cystic bladder lesions

Approach of Shoshan and Sanshaman Chikitsa in Management of Mandal Kushtha w.s.r. to Psoriasis

Psoriasis is a chronic inflammatory, hyperproliferative skin disease. It is characterised by well-defined, erythematous scaly plaques, particularly affecting extensor surfaces, scalp and nails, and usually follows a relapsing and remitting course. Psoriasis affects approximately 1.5%-3% of populations of European ancestry but is less common in Asian, South American and African populations. It occurs equally in both sexes and at any age; although it is uncommon under the age of 5 years, more than 50% of patients present before the age of 30 years. Aims and Objectives: To find out the effect of Ayurvedic medicine and Shodhan chikitsa in the management of Mandal kushtha (psoriasis). Material and Methods: A 53-year-old male patient having complaint of skin lesion on scalp, upper back and abdomen area with red demarcation from last 15 years. Lesion having silvery scales and falling all rubbing with severe itching. This condition clinically correlated to Mandal Kushtha described in Ayurveda. Mandal Kushiha has Shwelam Raklam varna, Sthirar, Styanam and Utsana Mandala (skin begins with special characters. Acharya Charaka mentioned Shodhan Chikitsa for purification of Kushtha Roga. Result and Discussion: Considering The sign and symptoms patient was treated with classical Vamana Karam (therapeutic emesis) and Virechana karma (therapeutic purgation) according in line of treatment of Kushtha (psoriasis). Assessment was done before treatment, after treatment and after follow-up. Pictures were taken before treatment and after treatment. Remarkable improvement was noticed in scaling, induration and itching after Vamana and Virechanа treatment and residue only hyper pigmented pink lesion.

Clinical characteristic and outcomes of psoriasis patients in a multicentre outpatient healthcare institution in Colombia

IntroductionPsoriasis is a chronic inflammatory disease characterized by scaly erythematous plaques, systemic inflammation, and an elevated cardiovascular risk. Due to its complexity in treatment and the frequent occurrence of comorbidities, characterizing patients diagnosed with psoriasis enrolled in care programmes becomes paramount for enhancing health outcomes. ObjectiveTo provide a comprehensive description of the sociodemographic, clinical features, and outcomes of a cohort of patients diagnosed with psoriasis in a multicentre outpatient healthcare institution in Colombia. Materials and methodsA cohort study was conducted involving patients diagnosed with psoriasis. Inclusion criteria required a minimum follow-up duration of three months. Quantitative variables were summarized using the median and interquartile range, while qualitative variables were presented with measures of frequency and 95% confidence interval. Changes in the final values of PASI, DLQI, NAPSI, and BSA from baselines were assessed through percentage comparisons, analysed using chi-square test. ResultsA total of 1155 patients were included, with a median age of 53 years and the majority were men (58%). Plaque psoriasis was the predominant type, observed in 78.7%. Psoriatic arthritis was diagnosed in 18.9%. The most prevalent comorbidity was hypertension, identified in 23.0% (95% CI 20.6 to 25.6%), followed by diabetes at 12.5% (95% CI 10.6 to 14.5%) and cardiovascular disease at 10.6%. A significant proportion of patients were classified as overweight and obese, 43.9% (n=479) and 20.9% (n=228), respectively. Regarding treatment modalities, the majority received biological therapies (39%), followed by systemic therapy (22.2%), and topical therapy (17.5%).During the follow-up period, a considerable percentage of patients experienced some decrease in disease activity. A PASI75 response was achieved by 28.5% (95% CI 25.4% to 31.8%), and PASI90% was achieved by 18% (95% CI 15.4% to 20.9%). A bivariate analysis based on Body Mass Index showed a lower response in patients with overweight or obesity, thought these differences were not statistically significant (p=.937). Notably, a higher percentage of patients with no response were observed among those with hypertension (62.9% p=.123), diabetes mellitus (64.7% p=.393), cardiovascular disease (51.5% p<.001), and chronic kidney disease (55.6% p=.014) when compared with patients who achieved therapeutic goals. ConclusionsWe present the largest psoriasis cohort in Colombia. A majority of our patients showed improvement in disease activity based on clinimetric measures. Nevertheless, the presence of comorbidities significantly reduces the likelihood of achieving a treatment response. A multidisciplinary approach combined with tight follow-up ensures better outcomes, highlighting the importance of implementing real-world, multidisciplinary care programmes.

Periocular Manifestation in Acute Atopic Dermatitis in a Paediatric Patient. A Case Report

Atopic dermatitis is a chronic skin condition characterized by itchy, scaly, and crusted lesions, most commonly affecting infants and children. The condition presents with intense pruritus and a chronic course with exacerbations. Periorbital involvement is expected due to the thin and sensitive skin in this area, and the inflammation can be exacerbated by rubbing or scratching. This case reports a 5-year-old girl with bilateral periorbital inflammation that had been present for 4 hours. She had a history of atopic dermatitis and no known surgical history or medication allergies but was allergic to shellfish. No medication or topical cream was administered for the described episode. Upon waking up, she presented with newly developed periorbital inflammation. She had not consumed any food to which she was known to be allergic, and there had been no increase in eyelid scratching. There was no recollection of contact with any toxic agents. During the physical examination, erythematous scaly plaques were observed on both cheeks, chin, and neck, and periorbital inflammation accompanied by eyelid and periorbital Dennie-Morgan fold. The primary diagnosis was periorbital atopic dermatitis in the context of an acute atopic dermatitis flare-up. The prescribed treatment included prednisolone acetate (Estilsona) for five days and pimecrolimus for the atopic dermatitis. Atopic dermatitis is a complex condition with a multifactorial aetiology, and its management can be challenging. Further research is needed to develop more effective treatments for atopic dermatitis.

Natural Product-Derived Compounds Targeting Keratinocytes and Molecular Pathways in Psoriasis Therapeutics.

Psoriasis is a chronic autoimmune inflammatory skin disorder that affects approximately 2-3% of the global population due to significant genetic predisposition. It is characterized by an uncontrolled growth and differentiation of keratinocytes, leading to the formation of scaly erythematous plaques. Psoriasis extends beyond dermatological manifestations to impact joints and nails and is often associated with systemic disorders. Although traditional treatments provide relief, their use is limited by potential side effects and the chronic nature of the disease. This review aims to discuss the therapeutic potential of keratinocyte-targeting natural products in psoriasis and highlight their efficacy and safety in comparison with conventional treatments. This review comprehensively examines psoriasis pathogenesis within keratinocytes and the various related signaling pathways (such as JAK-STAT and NF-κB) and cytokines. It presents molecular targets such as high-mobility group box-1 (HMGB1), dual-specificity phosphatase-1 (DUSP1), and the aryl hydrocarbon receptor (AhR) for treating psoriasis. It evaluates the ability of natural compounds such as luteolin, piperine, and glycyrrhizin to modulate psoriasis-related pathways. Finally, it offers insights into alternative and sustainable treatment options with fewer side effects.

A Case of Staphylococcus simulans Colonization in a Patient with Psoriasis

A 20-year-old female patient presented with localized erythematous scaly lichenified plaques on her right lower leg. Despite traditional treatments, the lesions consistently recurred in previously affected anatomical locations. Bacterial culture was performed, and Staphylococcus simulans was identified on both lesional and nonlesional skin. Histopathological examination revealed parakeratosis, Munro microabscess, hypogranulosis and regular acanthosis with an elongated rete. Based on clinical and histological findings, the patient was finally diagnosed with possible psoriasis. Although S. simulans is a common livestock colonizer, it rarely colonizes human skin. Herein, we report the first case of S. simulans colonization in a recurrent psoriatic lesion in previously affected anatomical locations.

Atypical Manifestations of Syphilis: A 10-Year Retrospective Study.

Background: The incidence of syphilis has increased in high-income countries in the past few decades, especially among men who have sex with men. In the present study, we aimed to analyze the correlations between atypical syphilis manifestations and the demographic, clinical, and laboratory features of patients and to review unusual presentations of syphilis reported in the literature. Methods: We conducted a retrospective analysis of 307 patients with syphilis diagnosed between 1 January 2013 and 31 October 2023 at the sexually transmitted infection (STI) centers of the University of Genoa and University of Foggia with both typical and atypical manifestations of disease. Results: In our series, atypical manifestations were detected in 25.8% of the patients, especially in the secondary stage of the disease. Lesions with annular morphology and lesions presenting as itchy erythematous scaly plaques with a psoriasiform appearance were the most common atypical presentations of secondary syphilis. A statistical analysis revealed that homosexual orientation, syphilis reinfection, and venereal disease research laboratory (VDRL) titers > 1:32 were correlated with atypical manifestations. Conclusions: Our study demonstrates that the spectrum of syphilis manifestations, in all the stages of the disease, is wide; atypical manifestations often pose diagnostic challenges, may delay the provision of appropriate treatment, and facilitate the spread of the infection.

Magnitude of Psoriasis and Its Associated Factors, and Quality of Life of Psoriasis Patients among Patients Who Attend Dermatology Clinic at Tibebe Ghion Comprehensive Specialized and Addis Alem Primary Hospitals, North West Ethiopia, 2022: Institution-Based Cross-Sectional Study.

Psoriasis is a common immune-mediated papulosquamous inflammatory skin disease characterized by well-demarcated, erythematous silvery scaly plaques. Prevalence rates of psoriasis showed a worldwide variation and have been reported to range between 0.09% and 5.1%. It has been associated with several intrinsic as well as extrinsic factors and has a detrimental effect on health-related quality of life. Studies on the burden, factors associated with it, and quality of life of psoriasis are limited in the study area. To assess the magnitude, factors associated with it, and quality of life of psoriasis patients. Institution-based cross-sectional study was conducted among patients who attend dermatology clinics at Tibebe Ghion comprehensive specialized and Addis Alem primary hospitals from June 8 to September 5, 2022. Systematic random sampling was applied to select study participants until the sample size (318) was fulfilled. A structured interviewer-administered questionnaire was used to collect data. Collected data were coded and entered into EPI data version 3.1 and then exported to SPSS version 27 for analysis. Descriptive statistics and logistic regression analysis were done. The mean age of study participants was 22.5 with a standard deviation (SD) of 18.2 years. The proportion of psoriasis was 5.3% with a 95% CI (3.1%, 8.4%). Stressful life events (AOR = 3.32, 95% CI (1.12, 9.86)) and alcohol consumption (AOR = 3.73, 95% CI (1.03, 13.51)) were significantly associated with psoriasis. Seven (41.2%) psoriasis patients had a large effect on their quality of life. The mean dermatology quality of life index (DLQI) was 9.82. The proportion of psoriasis in this study was comparable to earlier international and Ethiopian studies, but greater than studies from other African countries. Stressful life events and alcohol consumption were significantly associated with psoriasis. The majority of psoriasis patients had a large negative effect on their quality of life.

The Enigma of a Keratitis-Ichthyosis-Deafness with Silence, Scaling, and Related Syndrome

Abstract Ichthyosis is a group of genetic disorders characterized by generalized dry skin and scaling, and it can be frequently associated with erythroderma. Here, we report a case of ichthyosis associated with a rare syndrome. A 6-year-old congenitally deaf female presented with severe scaling and generalized erythema for 6 months which began with a scaly plaque over the face at the age of 18 months and gradually covered the whole body. Three similar episodes happened after that with a gap of 6 months. There were multiple scaly erythematous plaques present over the trunk and limbs and thick hyperkeratotic plaques were present in axillary and inguinal folds. The scalp hairs were sparse. Histopathology showed psoriasiform changes. Salivary sample sent for genetic analysis revealed an heterozygous mutation c.42C&gt;G (p.Asn14Lys) in GJB2 gene that is known to harbor pathogenic mutations associated with keratitis-ichthyosis-deafness (KID) syndrome. KID syndrome presents with the triad of keratitis, progressive erythrokeratoderma, and hearing loss.

Giant Bowens disease on the anterior abdomen Lull before the storm

Bowens disease is a rare and unusual premalignant skin condition. It commonly present as large scaly erythematous patch or plaque, often giving rise to a large spectrum of differential diagnoses especially in hidden areas.

Pellagra A forgotten sporadic clinical entity in primary health care

A 45- year- old male from an urban community, laborer, heavy alcohol consumer, exclusively on rice diet presented to outpatient department in primary health care centre with chronic diarrhea for three months. He was treated multiple times with antibiotics with no improvement. There was no family history of similar illness. He had normal vital signs and mental state. On general examination, he had typical sharply marginated symmetrical scaly hyperpigmented plaques in sun exposed areas of his forearms and hands and necklace pattern of erythematous scaly plaque around the neck popularly known as Casal’s necklace as described in figure 1. The clinical background and dermatological pattern was sufficient enough to initiate treatment of pellagra with oral Niacin 300 mg daily and vitamin B complex. He had dramatic improvement in his episodes of diarrhea. He had gradual recovery in dermatitis.

Unusual presentation of antisynthetase syndrome: a case series and review of the literature

BackgroundAntisynthetase syndrome is an inflammatory myopathy that is characterized by the presence of anti-aminoacyl-tRNA synthetase antibodies. Only 30% of those who suffer from the disease can be identified. We present three Hispanic cases of antisynthetase syndrome with unusual clinical pictures were extended myositis panel results enable disease diagnosis and treatment.Case presentationA 57-year-old Hispanic/Latino female with an erythematous scaly plaque, unresolved fever and non-immune haemolytic anaemia in whom inpatient work-up for fever of unknown origin was positive for anti-PL12 positive myositis extended panel. A 72-year-old Hispanic/Latino male with amyopathic weakness syndrome and mechanic hands in whom impatient work-up was relevant for proximal muscle uptake and anti-PM75 and AntiPL-12 myositis extended panel. And a 67-year-old Hispanic/Latino male with progressive interstitial lung disease and unresolved fever ended in myositis extended panel positive for antiPL-7. After systemic immunosuppressor treatment, patients had favourable clinical and paraclinical responses during outpatient follow-up.ConclusionsThe high variability of the antisynthetase syndrome in these cases demonstrates the importance of identification through an expanded panel and highlights the probability that this is a variable disease and that we need to include emerging molecular tests to promote the timely treatment of patients.

Eyelid involvement of primary cutaneous lymphomas: A clinical perspective.

Eyelids may be affected in systemic, ocular adnexal and primary cutaneous lymphomas (PCLs). The frequency of eyelid involvement in PCLs is still not well known and it is not a predilection site for any type. While primary cutaneous T-cell lymphomas (CTCLs) are more commonly seen than primary cutaneous B-cell lymphomas (CBCLs), especially mycosis fungoides (MF) as by far the most frequent type, B cell lymphomas are reported to be the commonest type in eyelid localization on the contrary. PCLs may be located on the eyelids, as the sole manifestation or in association with the involvement of other parts of the eye and elsewhere of the body. MF may present with a rich spectrum of clinical features on the eyelids mostly seen in folliculotropic subtype and advanced-stage disease. Erythematous scaly patches or plaques representing the most commonly encountered eyelid MF lesions may mimic many other dermatological conditions. Diffuse thickening, oedema, poikilodermic changes, atrophy and wrinkling are other suggestive findings of eyelid MF. Milia-like papules, madarosis and ectropion are also seen in the folliculotropic variant of MF, as ectropion is more typical for Sezary syndrome. Eyelids are also a typical location for tumoural MF which has been suggested as a poor prognostic indicator in MF. Papulonodular lesions, large tumours, ulceration, diffuse infiltration, oedema and subcutaneous atrophy on the eyelids may also be seen in other types of PCLs. Keep in mind, the rich clinical spectrum of PCLs on the eyelids may be crucial in early diagnosis in this special localization.

Photogallery. Rare dermatoses. Part II

In continuation of orphan dermatosis, I would also like to say about diseases such as lichen planus ― which is an autoimmune disease in which the expression of an antigen that has not yet been identified by keratinocytes of the basal layer leads to the activation and migration of T-lymphocytes into the skin with the formation of an immune response and an inflammatory reaction.&#x0D; BournevillePringle syndrome (tuberous sclerosis complex) is a rare genetic disease that is part of the group of phakomatoses, characterized by a polysystemic lesion involving the skin, central nervous system, organs of vision, etc. in the pathological process.&#x0D; Bullous scleroderma is a rare type of localized scleroderma with a predominant skin lesion in the form of foci of induration and sclerosis, subepidermal blisters with serous contents.&#x0D; Trichoadenoma is a rare skin tumor belonging to the group of benign follicular tumors. Consists of numerous, relatively large, round or oval funnel-shaped structures separated by an underdeveloped fibrous stroma.&#x0D; Pseudolymphoma is a reactive polyclonal T- or B-cell lymphoproliferative process that can manifest as both localized and disseminated skin lesions.&#x0D; Giant flaming nevus of the skin of the face is usually a benign disease, but in some cases malignancy is possible.&#x0D; T-cell anaplastic lymphoma associated with sarcoidosis is characterized by lymphadenopathy, lesions, circulating abnormal lymphocytes, and hypercalcemia leading to the sarcoidosis-lymphoma syndrome.&#x0D; Devergy's disease is caused by a violation of keratinization and the appearance of follicular hyperkeratotic papules, palmoplantar hyperkeratosis and erythematous scaly plaques with an orange tint.&#x0D; FavreShay ocher yellow dermatitis occurs in patients with varicose ulcers on the inner surface of the lower third of the legs, which it either precedes or accompanies.&#x0D; Sweet's febrile neutrophilic dermatosis manifests itself in three clinical cases: classical (the disease is preceded by an infectious disease), malignant (occurs as a paraneoplastic syndrome), medicinal (most often occurs in patients treated with G-CSF).&#x0D; Lipodermatosclerosis is manifested by induration and hyperpigmentation of the skin, affecting one or both legs, in a characteristic "upside down champagne bottle" appearance.

Comparative Analysis of the Therapeutic Effects of Fresh and Cryopreserved Human Umbilical Cord Derived Mesenchymal Stem Cells in the Treatment of Psoriasis.

Psoriasis, an inflammatory autoimmune skin disease, is characterized by scaly white or erythematous plaques, which severely influence patients' quality of life and social activities. Mesenchymal stem cells derived from the human umbilical cord (UCMSCs) represent a promising therapeutic approach for psoriasis because of its unique superiority in ethical agreeableness, abundant source, high proliferation capacity, and immunosuppression. Although cryopreservation provided multiple benefits to the cell therapy, it also greatly compromised clinical benefits of MSCs due to impaired cell functions. The current study aims to evaluate the therapeutic efficacy of cryopreserved UCMSCs in a mouse model of psoriasis as well as in patients with psoriasis. Our results showed that cryopreserved and fresh UCMSCs have comparable effects on the suppression of psoriasis-like symptoms such as thickening, erythema, and scaling, and serum IL-17A secretion in mice model of psoriasis. Moreover, psoriatic patients injected with cryopreserved UCMSCs had a significant improvement in the Psoriasis Area and Severity Index (PASI), Physician Global Assessment (PGA), and Patient Global Assessments (PtGAs) scores compared to baseline values. Mechanically, cryopreserved UCMSCs markedly inhibit the proliferation of PHA-activated PBMCs, type 1 T helper (Th1) and type 17 T helper (Th17) cell differentiation and secretion of inflammatory cytokines including IFN-γ, TNF-a and IL-17A in PBMCs stimulated by anti-CD3/CD28 beads. Taken together, these data indicated that cryopreserved UCMSCs exhibited great beneficial effect on psoriasis. Thus, cryopreserved UCMSCs can be systemically administered as ''off-the-shelf'' cell product for psoriasis therapy.Trial Registration ChiCTR1800019509. Registered on November 15, 2018-Retrospectively registered, http://www.chictr.org.cn/ .

Comparative study of topical 0.1% tazarotene cream versus calcipotriol 0.005% ointment in the treatment of palmoplantar psoriasis

Palmoplantar psoriasis is classified into two types based on morphology- hyperkeratotic palmoplantar psoriasis and pustular palmoplantar psoriasis. Hyperkeratotic palmoplantar psoriasis presents with well defined erythematous scaly plaques with overlying hyperkeratosis without the presence of sterile pustules, predominantly at the palms and/or soles. There is greater physical and functional disability in patients of palmoplantar psoriasis. Patients with palmoplantar disease are more likely to suffer from a significant impact on skin-related QoL, have problems with activities of daily living, and rely on topical prescription medications than patients with moderate-to-severe plaque psoriasis. These differences are important while creating therapeutic strategies and in understanding patients’ expectations of the treatment. Objective: To compare the clinical efficacy and study the adverse effects of topical 0.1% tazarotene cream and 0.005% calcipotriol ointment in the treatment of palmoplantar psoriasis.A total of 82 palmoplantar psoriasis cases who attended the OPD of a tertiary care hospital in Northern India for a period of two years formed the study group. The study group was randomized into Group A and Group B. Group A participants were instructed to apply a liquid paraffin-based emollient in night, followed by 0.1 % tazarotene cream under occlusion for 12 weeks. Group B patients were instructed to apply calcipotriol ointment 0.005% twice daily on lesions and a liquid-paraffin based emollient in night daily for 12 weeks. The response to treatment was evaluated by improvement in PPPASI at 2-week interval up to 12 weeks.At 12 weeks of follow-up 42.9% patients showed an excellent response, 31.4% showed a clear response in group A. In group B 25% patients had an excellent response and 10% patients showed complete clearance. Adverse effects were seen more in group A.Topical treatment modalities for palmoplantar psoriasis are effective and have a low risk for adverse effects. Both topical calcipotriol 0.005% and tazarotene 0.1% cream are effective in the treatment of palmoplantar psoriasis. While topical tazarotene 0.1% cream showed an excellent clinical response among patients, it was associated commonly with adverse effects such as local irritation and itching in initial weeks of the treatment. Usage of topical 0.005% calcipotriol ointment showed a good clinical response among the patients, with mild side effects of local irritation and itching which resolved on subsequent treatment.

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.

First Terbinafine-Resistant Trichophyton indotineae Isolates with Phe397Leu and/or Thr414His Mutations in Turkey

Fungal infections of the skin, nails, and hair caused by dermatophyte species continue to be a worldwide concern. The increase in terbinafine-resistant superficial dermatophytosis has become a major concern over the last decade. In this report, we presented two cases of infection with terbinafine-resistant Trichophyton indotineae, the first diagnosis of this species in Turkey. One patient exhibited erythematous pruritic patches and plaques in the inguinal and gluteal regions, while the other patient showed annular erythematous scaly plaques in the bilateral posterior thigh and gluteal regions. One patient harbored a CD36 mutation. Both strains harbored the same amino acid substitution in the squalene epoxidase gene, whereas one isolate had another unknown mutation. Clinical improvement was observed with resveratrol treatment in the patient with the CD36 mutation but not in the other patient.

OA09 Challenging case of psoriatic arthritis: what should we do next?

Introduction/BackgroundPsoriatic arthritis (PsA) is a chronic inflammatory enthesoarthro-osteopathy associated with extra-articular manifestations and several co-morbidities occurring in up to 42% of patients with psoriasis. The heterogeneity of PsA is the reason why the term ‘Psoriatic Disease’ (PsoD) has been proposed to reveal more precisely how the PsA patients suffer.Description/MethodWe report a case of refractory PsA presenting with a flare raising therapeutic challenges.In 2019, a 27-year-old man who was diagnosed since 2014 with PsA and psoriasis presented with flare up of psoriasis affecting almost all of his body and peripheral joints mainly MCPs. There was no uveitis or IBD history.PsArc score: Tender joint count (TJC)=5, swollen joint count (SJC)=4 and VAS= 4/5He was on methotrexate 10 mg orally once weekly that was increased to 15 mg with folic acid once weekly. Unremarkable other medical history.Drug history included: Phototherapy without response (2007), then cyclosporine 100mg BD for six weeks which stopped due to severe mood changes.Unsuccessful trials of 20 mg oral methotrexate once weekly because of elevated liver enzymes, subcutaneous form causing significant neurapraxia, adalimumab (2010-2013) stopped due to secondary failure, ustekinumab (2013-2014) stopped after three injections (primary failure), Infliximab (2014-2015) stopped due to throat swelling during transfusion, apremilast 30mg BD stopped due to complete inefficacy. Secukinumab was started by another trust for one year that helped his condition but he lost follow up, we arranged secukinumab continuation that was very effective for only six months and the patient presented severe flare of his skin in the form of widespread different sized erythematous indurated scaly plaques affecting all his body with PsArc score TJC=10 SJC=6, VAS was 5/5. PASI score 14.In 2020 ixecuzimaub was started by the dermatologists that show dramatic improvement in his skin, PASI score became 1.6 but unfortunately not working for joints with 12 tender joints and evidence of tenosynovitis in almost all small joints of hands. He tried leflunomide 20 mg orally daily but stopped due to deranged liver functions.Investigations showed fluctuating CRP levels (3-87 mg/l), normal blood counts and negative RF.Discussion/ResultsWe present a case of PsA that was treated by almost all synthetic and biologic DMARDS that show high efficacy in most of cases of PsA patients. Certolizumab or golimumab were suggested by Guys and St Thomas hospital to start on. Dual biologic therapy is recently reported in the psoriatic literature including ustekinumab plus etanercept, secukinumab plus etanercept, and apremilast with all biologic agents in patients with plaque psoriasis or psoriatic arthritis not responding adequately to single biologics alone. But there was an increased incidence of urinary tract and upper respiratory infections, including a hospitalization for H2N1 flu in the ustekinumab plus etanercept case.Key learning points/ConclusionMost physicians are often reluctant to prescribe dual biologic therapy because of safety concerns. Very little data exist regarding the safety of dual biologic medications for concomitant psoriasis and psoriatic arthritis. Additionally, the possibility of a major adverse cardiovascular event related to combined biologic therapy has been reported. More research is warranted to explore dual therapy in refractory patients.