Sex-related Variations in Comorbidities in Lichen Sclerosus: A Systematic Review and Meta-Analysis.

The comorbidities of lichen sclerosus (LS) are presumed but have not been analysed in detail. The purpose of this review was to identify evidence-based associated diseases in patients with LS and explore the potential need for sex-dependent screening protocols. A comprehensive search of the MEDLINE, Embase, and PsycINFO databases from inception to 29 February 2024 was conducted using the key search terms LS and all its synonyms. Pooled odds ratios and 95% confidence intervals of comorbidities were generated using the DerSimonian and Laird random-effects model. A total of 21 case-control studies met the inclusion criteria. Of the 75 comorbidities analysed, only 16 (21.3%) were studied in both sexes, revealing no contrasting associations based on sex. Both female and male LS patients showed significantly increased odds of common dermatological conditions (i.e., lichen planus, vitiligo, alopecia areata, atopic dermatitis, and psoriasis), various cardiovascular risk factors (i.e., essential hypertension, obesity, dyslipidaemia, diabetes mellitus, and diabetes mellitus type 2), genital warts, and hypothyroidism compared with controls. Overall, the scarcity of data currently does not support the implementation of sex-dependent screening strategies. The findings do, however, present significant associations with a range of potentially serious comorbidities, which warrants further elucidation and clinical vigilance.

Inflamed actinic keratoses as a biomarker in repositioning of chemotherapeutics: a systematic review and meta-analysis.

BACKGROUND: Inflammation of actinic keratoses (AK) was originally described with systemic 5-fluorouracil, and led to the development of topical fluorouracil. Similar observations using different chemotherapeutics may point to other drugs with a potential for repositioning. OBJECTIVE: This systematic review aims to evaluate chemotherapeutic agents linked to inflammation-induced cure of AK. METHODS: This systematic review was registered in PROSPERO (CRD42022346168) and followed PRISMA guidelines. A comprehensive literature search for eligible original articles written in English and published in peer-reviewed journals until July 13, 2022 was conducted in MEDLINE and Embase. RESULTS: 28 articles met inclusion criteria accounting for 36 patients (mean age 68.4 ± 8.3 years) with inflamed AK, exposed to 21 different chemotherapeutic agents - 21/36 (58.3%) received monotherapy and 15/36 (41.7%) received multidrug combinations. Regression was complete in 13/28 (46.4%) and partial in 14/28 (50.0%) of inflamed AK. Cure rates of inflamed AK in multidrug combinations were not superior to monotherapies (p = .252), leading to the observation that the majority of the former (14/15; 93.3%) encompassed one of five chemotherapeutic agents linked to AK inflammation also as a monotherapy. CONCLUSION: Overall, inflammation partially/completely cured AK in 96.4% of patients (27/28). Taxanes, pemetrexed, and doxorubicin might have the potential for the management of AK.

Skin and gut microbiota dysbiosis in autoimmune and inflammatory skin diseases.

The human body is inhabited by complex communities of microorganisms. Changes in the composition and function of the skin and gut microbiota are linked to various skin diseases. The microbiota is an important modulator of the immune system and thus maintains homeostasis. Conversely, the immune system can also change the composition of the microorganism community. Thus, it is still unknown whether certain skin diseases are caused by primary changes in the local and/or remote microbiota, or whether dysbiosis is only a secondary consequence of the dermatoses themselves. Expanding knowledge of skin and gut microbiota dysbiosis in skin diseases may possibly lead to better understanding of their pathophysiologies and to the discovery of new molecular markers for their earlier diagnosis and targeted treatment; for example, using specific microbes to replace missing ones. This narrative review provides an overview of current knowledge about skin and gut microbiota dysbiosis in psoriasis, atopic dermatitis, hidradenitis suppurativa, seborrheic dermatitis, acne vulgaris, rosacea, and lichen sclerosus.

Purple-brown coalescing macules on the mandibular area of the face.

This patient presented with a 1-year history of violaceous-brown, coalescing reticulated macules on his face, with no similar lesions in other body areas. Laboratory findings were normal and antinuclear antibody test was negative. Histopathological findings included lichenoid tissue reaction and prominent pigmentary incontinence. Click here for the corresponding questions to this CME article.

Palisaded neutrophilic granulomatous dermatitis in a patient with HLA-B27-negative axial spondyloarthritis: a case report and literature review.

Palisaded neutrophilic granulomatous dermatitis (PNGD) is a rare histopathological pattern belonging to a group of cutaneous granulomatous eruptions that typically manifests with asymptomatic skin-colored, erythematous, or violaceous papules or nodules. PNGD can be triggered by various systemic conditions, including medications and autoimmune and autoinflammatory disorders, as well as malignancies; for example, lymphoproliferative disorders. Therefore, in patients with PNGD an extended diagnostic workup is mandatory as well as follow-up in the case of idiopathic PNGD. To the best of our knowledge, this is the first reported case in the literature of PNGD causally related to a relapse of HLA-B27-negative axial spondyloarthritis.

Inflammation of Actinic Keratoses Induced by Combination of Carboplatin and Paclitaxel: Two Case Reports.

The observations of a beneficial effect of 5-fluorouracil-induced actinic keratoses (AK) inflammation led to the development of topical fluorouracil, a product registered for the management of AK. A conscientious surveillance of AK inflammation during chemotherapy may conceivably lead to the development of further drugs for treatment of AK. A number of other chemotherapeutics have thus been linked to similar reactions without ensuing development. Here, we describe two further cases linking chemotherapy with carboplatin and paclitaxel to possible anti-AK effects, identifying them as potential treatments. Whether multidrug chemotherapy leads to stronger AK inflammation or cure AK more successfully is currently unknown.

Cutaneous adverse effects of biologic drugs in psoriasis: a literature review.

Psoriasis is a chronic immune-mediated skin disease that affects 125 million people worldwide. Over the last two decades, biologic drugs have revolutionized the treatment of moderate to severe plaque psoriasis. They act on one or more molecular targets and thus modify or inhibit signal transduction pathways in the pathophysiological process of the disease. This articles summarizes cutaneous adverse effects to biologic drugs used in the treatment of psoriasis. Because they were on the market first, most of the literature covers cutaneous adverse effects of tumor necrosis factor-α (TNF-α) inhibitors, but increasingly more data are also available for adverse effects caused by newer biologics that inhibit the interleukin (IL)-12/23, IL-17, and IL-23 pathways. Some cutaneous adverse effects are general-for example, injection site reactions-whereas others are more class-specific; namely, Candida infections in IL-17 inhibitors. However, because some biologic drugs used in psoriatic patients are also registered for the treatment of certain other immune-mediated diseases such as rheumatoid arthritis, data regarding cutaneous adverse effects come from various sources that differ in quality and often cannot be interpreted without bias.

Long-Term Efficacy of Treatment with Intravenous Immunoglobulin in Scleromyxedema.

Scleromyxedema or generalized lichen myxedematosus is a rare depositional disorder. Diagnostic criteria encompass a generalized papular and sclerodermoid eruption, monoclonal gammopathy (paraproteinemia), most often with G-lambda type immunoglobulin, a characteristic microscopic triad (mucin deposition, fibroblast proliferation, fibrosis), and absence of thyroid disease. Many internal manifestations of scleromyxedema have been described to date, leading to high mortality and morbidity. Because the disease is rare, the etiology is not fully understood and there is a lack of well-designed studies, so no optimal treatment exists so far. This paper reports the follow-up on a patient in 5.5-year remission after successful intravenous immunoglobulin therapy 10.5 years since initial diagnosis.

Oral manifestations of autoinflammatory and autoimmune diseases.

Autoimmune diseases may also be reflected in changes in the oral cavity that represent the first sign of the disease, or they may occur simultaneously with or later in the course of the disease. Oral findings are mostly non-specific, and therefore further investigations are needed to exclude or confirm possible diagnoses. This article presents the most important diseases in this research area, divides them into meaningful groups, and highlights the importance of examining the oral cavity for possible manifestations.