Background: Postherpetic neuralgia (PHN) is a complication of herpes zoster characterized by persistent dermatomal pain. It has a negative impact on the quality of life. There is no gold standard therapy for PHN, and various local and systemic treatments have been tried. There are studies reporting the use of combination of steroids and local anesthetics but there is no standardized method. Aim: To evaluate the response of modified Jaipur block with increased concentration of dexamethasone. Methods: We conducted a retrospective study in patients who were given Jaipur block. The patients age, sex, duration of PHN, type and severity of pain were observed. A combination of 2% lignocaine and 0.5% bupivacaine and dexamethasone was injected subcutaneously. The pain was scored using visual analogue scale at the baseline, and 1 month after 1^st, 2^nd, and 3^rd session of block and follow up after 6 months and 1 year. Results: The mean age of our patient was 63.33 ± 9.5 years. The males outnumbered females. Thoracic dermatomes were more commonly involved. The mean duration of PHN was 11.58 ± 12.76 months; stimulus evoked PHN was the commonest type of pain seen. The mean visual analogue score (VAS) decreased progressively after each session of the block. Maximum patients (50%) had excellent response, whereas 1.9% did not respond to the block. Relapse of pain was seen in 5.6% of the patients. There was no significant side effect noted. Limitations: There was no objective method used to assess pain. Conclusion: PHN is chronic neuropathic pain. Response to modified Jaipur block is good, but if the duration of PHN is more, the recurrence rate is higher. Modified Jaipur block is an effective and safe treatment for PHN

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Cutaneous signs in dermatology are pathognomonic or diagnostic for certain conditions. A knowledge of these signs is a useful skill, which must not be forgotten in the recent trend towards relying on molecular biology and other investigative tools including histological findings to make a diagnosis. The aim of this review is to summarize all cutaneous signs in dermatology in a systematic way that would benefit dermatologists, trainee or experienced, in identifying diseases and sharpening their clinical skills. A keyword search for the terms “cutaneous signs,” “sign” AND “dermatology” was conducted through PUBMED, Google, and the major textbooks in dermatology (i.e., Rooks Textbook of Dermatology; Fitzpatrick's Dermatology in General Medicine and Dermatology). References were searched thoroughly for all cutaneous signs described. One hundred and nineteen signs were noted and summarized under the following categories: autoimmune, infective, inflammatory, neoplastic, genetic, trauma/miscellaneous. This review would serve as a good reference for those wanting to improve their clinical acumen in diagnosing dermatological disease.

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Anti-tumor necrosis agents are being increasingly used in the management of moderate to severe psoriasis. Therapy with antitumor necrosis factor alpha (TNF-α) agents is being fraught with reactivation of latent tuberculosis infection (LTBI). This paper addresses the intricate relation between LTBI and anti-TNF-α agents and provides working guidelines for screening of LTBI and its management before prescribing anti-TNF-α therapy in patients with psoriasis.

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Background: Urticaria is an unknown, sudden, and itchy skin disease that is recognized with redness, swelling, and is sometimes seen with angioedema. It is classified as acute or chronic, depending on the duration of symptoms. Thiols in plasma are powerful antioxidants that physiologically eliminate free radicals. The mostly and rapidly affected proteins are thiols that contain the sulfhydryl group. In the present study, the thiol/disulfide homeostasis was investigated as a brand new indicator of oxidative stress in patients who had acute urticaria and presented to the emergency department. Objective: In the present study, the thiol/disulfide homeostasis, ischemia-modified albumin (IMA), and and neutrophil lymphocyte ratio (N/L ratio) were investigated in the etiopathogenesis of acute urticaria. Material and Method: A total of 37 patients and 40 healthy volunteers were included in the study. Thiol/disulfide homeostasis (TDH) [total thiol-native thiol/disulfide changes] was measured in both groups (patient group and control group) using a brand novel method developed by Erel and Neselioglu. Half of the difference between total thiol and native thiol concentrations gives the amount of disulfide bond. Results: Total thiol and native thiol levels in blood were found to be low. The levels of total thiol (P = 0.218) and native thiol (P = 0,001) were significantly lower in patients with acute urticaria than in the control group. At the same time, the level of disulfide was significantly higher in the patient group than in the control group (P = <0.001). The level of IMA was higher in the patient group than in the control group (P < 0.001). Conclusion: While total thiol and native thiol are low in acute urticaria, the levels of disulfide and IMA are high.

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Hand dermatitis (HD) is a chronic, relapsing, and remitting inflammatory condition that adversely affects the quality of life of the individual and gravely impacts the mental and socioeconomic well-being by causing professional hindrance and often leading to loss of wages. Despite being one of the most common skin conditions seen by dermatologists, it is often underreported. With the coronavirus pandemic ongoing, there is an emphasis on hand hygiene—being a widely publicized and important preventive measure to control the spread of the Coronavirus disease (COVID-19) virus. Emphasis on hand hygiene has led to a surge in HD, and the presence of HD, in turn, leads to compromised hand hygiene practices and this breach in the skin barrier contributes to another portal of entry of infective agents. We undertook a comprehensive English literature search across multiple databases such as PubMed, SCOPUS, EMBASE, MEDLINE, and Cochrane using keywords and MeSH items to obtain and review several relevant articles. Thus, this review focuses on various clinical, diagnostic as well as therapeutic aspects of this much prevalent and debilitating skin condition which deserves more attention especially during the times of the COVID-19 pandemic where the utmost emphasis is being given to handwashing leading to a vicious cycle of a surge in the cases of HD and compromised skin barrier causing increased susceptibility to the COVID-19 infection.

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Introduction: Chronic urticaria is common and distressing dermatosis where the search for newer agents with improved effectiveness and tolerability profile is a felt need. Bepotastine, a second-generation antihistamine, with added effect on suppression of eosinophil migration has a prospect in the management of chronic urticaria. Aims: To assess and compare effectiveness and safety of bepotastine versus levocetirizine in chronic urticaria. Materials and Methods: Single-center, investigator-blind, randomized, active-controlled, parallel-group phase IV trial (CTRI REF/2018/04/019692) conducted on adult patients of chronic urticaria of either sex. Patients were randomized into receiving either bepotastine besilate 10 mg tablet twice daily or levocetirizine 5 mg tablet once daily with fortnightly follow-up for 6 follow-up visits after thebaseline evaluation. The primary outcome measures were Urticaria Activity Score 7 (UAS7) and Urticaria Total Severity Score (TSS). Routine hematological, biochemical tests, treatment-emergent adverse events were monitored for safety. Results: Thirty patients in the bepotastine group and 29 patients in the levocetirizine group were analyzed by modified-intention-to-treat criteria. The study groups were comparable at the baseline with respect to the severity of chronic urticaria. UAS7 and TSS reduced significantly (P < 0.001, Friedman's ANOVA) in both treatment groups from 1^st follow-up visit and 2^nd follow-up visits (P < 0.05, Post Hoc Dunn's test) At the test-of-cure visit, UAS7 (5.13 ± 8.21 vs 7.48 ± 8.96) and TSS (5.10 ± 4.06 vs 7.07 ± 4.48) were less with bepotastine than levocetirizine although not statistically significant (P = 0.188 and 0.073, respectively, Mann–Whitney U test). Sedation during daytime was found to be significantly more (P < 0.001, Fischer's exact test) with levocetirizine than bepotastine (73.3% vs 17.2%). Conclusion: Bepotastine is comparable to levocetirizine with respect to its effectiveness with an edge in terms of side-effect (sedation during day time); thus, it offers a new therapeutic option in chronic urticaria.

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Context: Vitiligo is an acquired pigmentary disorder of the skin that is characterized by circumscribed, depigmented macules, and patches. Aims: To compare the therapeutic efficacy and safety of microneedling combined with topical 5-fluorouracil solution versus microneedling alone on stable patches of vitiligo. Settings and Design: Hospital-based interventional prospective study. Methods and Material: We selected 46 patients in the age group of 10–50 years having patch stability of at least 1-year duration. The patients were randomly assigned into two groups of 23 patients each. Group A was treated with microneedling followed by application of 5-fluorouracil which was available in the form of a solution (50 mg/mL) whereas Group B was treated with microneedling alone. The procedure was repeated after every 15 days up to 4 months and patient follow-up along with the grading of repigmentation was done till 6 months. The side effects were noted. Statistical Analysis Used: Statistical Package for Social Sciences (SPSS) software, version 25.0. The results were analyzed using the Chi-square test and t-test and P < 0.05 was considered significant. Results: At the end of 6 months, excellent response (>75% repigmentation) was reported in 35 patches (48.6%) in Group A treated with microneedling combined with 5-fluorouracil whereas only 12 patches (16.9%) showed an excellent response in Group B treated with microneedling alone. Conclusions: Combining microneedling with 5-fluorouracil is a simple, safe, well tolerable, and effective modality than microneedling alone for treating small localized vitiligo patches.

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Background: Chronic Urticaria (CU) is one of the most common skin diseases, affecting 2–3% of the population. Many studies have demonstrated that plasma D-dimer levels could be considered as a biomarker for disease activity and treatment response in patients with CU. Aim: To evaluate plasma D-dimer levels in patients with CU and their correlation with disease severity. Methods: The present study was a case-controlled study conducted in 97 patients with CU and 40 healthy subjects. Plasma D-dimer levels were measured using the enzyme-linked immunosorbent assay. Results: The mean plasma D-dimer level in patients with CU (807.76 ng/mL) was significantly higher than that in normal subjects (424.63 ng/mL) (P < 0.001). A significant correlation was observed between plasma D-dimer levels and the urticaria active score (P = 0.005, r = 0.28). Our study also suggested a significant difference in plasma D-dimer levels between patients with CU with and without angioedema. Conclusions: Patients with CU had higher plasma D-dimer levels than the control group. A positive statistical correlation was observed between plasma D-dimer levels and severity of CU.

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Background: COVID-19 pandemic has changed the approach of dermatologists, with respect to management of numerous conditions, vitiligo being one of them. However, there is a lack of consensus on how to deal with patients of vitiligo, as we battle this pandemic. Aim: To conduct a questionnaire-based survey, amongst expert dermatologists; in order to understand the impact of COVID-19 on the management of vitiligo. Materials and Methods: An online semi-structured English questionnaire was prepared and the link was circulated among 50 pan-Indian expert dermatologists, through various platforms (snowball sampling). Confidentiality and anonymity were strictly maintained. Responses were analyzed at the end of the study and a consensus statement was generated. Results: 42.22% of the respondents believed that teleconsultation is adequate for the diagnosis and management of most cases of vitiligo. 64.44% were found to be comfortable in prescribing oral medications, even during the COVID-19 pandemic; of which 62% would prefer to prescribe systemic steroids; followed by 17%, 11%, 7%, and 3% who would prefer cyclosporine, azathioprine, mycophenolate mofetil, and methotrexate, respectively. 64.44% respondents would recommend phototherapy in their office and 80% would prefer home-based phototherapy (PUVAsol or handheld NBUVB devices). 86.67% would prefer to stop the oral immunosuppressive drugs, till the COVID-19 RTPCR positive patients are tested negative. Limitations: The results are based on a survey of a small albeit selected group of dermatologists who decided on the currently available information on COVID-19. The same may change depending on the nature of further available information on the virus and its effect on how we manage the patients. Conclusions: Cases for initial consultation may be seen physically, and those for follow-up may be scheduled for teleconsultation. Topical therapy may be used without any hesitation. Phototherapy may be best advised with either PUVAsol or home-based phototherapy units (handheld NBUVB devices). With regards to systemic immunosuppressives, oral minipulse therapy may be preferable in view of lesser requirement of monitoring. Surgery for vitiligo should be performed only if the psychological well-being is severely affected.

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Background: This study evaluated the effect of mycophenolate mofetil, methotrexate, and pimecrolimus on the expression of cdk4 and p16, important proteins implicated in hyperproliferation and arrest in the G1 phase, in oral lichen planus (OLP). Materials and Methods: In this randomized clinical trial, 60 patients were randomly assigned in three equal groups to receive either pimecrolimus cream, or mycophenolate mofetil or methotrexate, both supplemented with pimecrolimus. Pretreatment and post-treatment specimens were immunohistochemically stained for detecting cdk4 and p16. Results: A significant decrease in cdk4 cytoplasmic positivity was noted in all three treatment groups and was especially more significant in the MTX group (P < 0.0001) than in the other two groups (P < .001). However, a significant decrease in the cdk4 nuclear staining was noted with only systemic treatment groups of MMF (P < 0.05) and MTX (P < 0.01), both supplemented with pimecrolimus. No significant decrease in cytoplasmic p16 levels was noted in the MTX group while a significant decrease in cytoplasmic p16 levels was noted in the other two groups; however, no significant decrease in p16 nuclear staining was noted with any treatment. Conclusion: By decreasing the expression of cdk4 and p16, pimecrolimus, methotrexate, and mycophenolate mofetil decrease the malignant potential of OLP lesions. However, methorexate can be a better alternative in cases showing high cdk4 expression.

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Background: The study pertaining to the prevalence of diseases plays a valuable tool in the planning and implementation of health care facilities. The prevalence of skin diseases in Andaman and Nicobar islands, which is rightly called “Little India” considering the heterogeneity of the people living here, will serve as an indispensable tool. Methodology: The data from the outpatient records of the Dermatology Department of 2 consecutive years were collected retrospectively, the study duration being January 2017 to December 2018. The diagnoses were classified as per the International Classification of Diseases (ICD 10). The quantitative variables are expressed as numbers and percentages. Results: Cutaneous infections namely dermatophyte infection, tinea versicolor, impetigo, scabies, molluscum, and warts were the most commonly encountered disorders. Hansen's disease was witnessed in 42 patients. Among the tribals, scabies, dermatophytosis, and pyoderma were the commonly encountered cutaneous disorders. Conclusion: Thus, the data presented in the present study can be extrapolated on the mainland considering the diversity of the population in the Andaman and Nicobar (A and N) Islands.

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Porokeratosis ptychotropica (PP) is a rare variant of porokeratosis characterized by pruritic, symmetrical, red-brown verrucous papules, and plaques most commonly localized within the gluteal fold. Herein, we report the clinical, dermoscopy, and reflectance confocal microscopy (RCM) aspects of a case of PP in a 63-year-old Caucasian woman along with histopathological correlation. Both dermoscopy and RCM were able to recognize the cornoid lamella, the histopathological clue shared by all clinical variants of porokeratosis. These non-invasive techniques may help in the differential diagnosis with other inflammatory/infectious and neoplastic disorders that may clinically resemble PP, but show distinct patterns.

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Introduction: Several modalities are used in the treatment of verrucae vulgaris; however, their side effects are common. Vitamin D3 has been recently used as a treatment in verruca vulgaris. Aim of the Work: We aimed to assess the expression of involucrin in verrucae before and after intralesional injection of vitamin D3 and its correlation with clinical response. Subjects and Methods: This study included 60 patients with verrucae vulgaris. These patients were subjected to intralesional injection of vitamin D3 at 3-week intervals for a maximum of five sessions. The pathological assessment was done by skin biopsies obtained from thirty patients before the first session and after the last session of injection and compared to skin biopsies from 30 healthy individuals. Results: The injected verrucae showed complete response in 39 patients (65%), partial response in 15 patients (25%), and no response in 6 patients (10%). Nonsmoker patients had a better response than smokers. Vitamin D3 injections also resulted in increasing involucrin expression and changing its pattern of expression. Conclusions: Intralesional vitamin D3 is an effective treatment for verrucae vulgaris. Involucrin expression is modified in verrucae.

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Leukotriene antagonists constitute an important group of drugs in the therapeutic armamentarium of all dermatologists. It has been quite valuable in the management of various types of urticaria and atopic dermatitis. Recently, the role of zileuton in the management of acne has been elaborated, and in the near future it could be used as a first-line agent for the same, thereby preventing adverse effects and antibiotic resistance encountered following antibiotic use. This review will throw light on the dermatologic aspects of leukotriene antagonists.

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Background: Topical antifungals especially azole group of drugs are effective agents in the treatment of dermatophytoses producing 100% clinical and mycological cure. Each of them vary having specific characteristics to tackle several clinical challenges like high relapse rate, recurrences and quality of life. Aims and Objectives: To compare the efficacy and safety of Eberconazole and Sertaconazole in tinea infection. Materials and Methods: This was a randomized, observer-blinded, parallel-group study conducted at a dermatology out-patient department (OPD) of tertiary care teaching hospital in Puducherry. 85 patients with tinea corporis and tinea cruris infections who visited the dermatology OPD were enrolled in this study. The treatment phase involved two groups receiving either Sertaconazole 2% cream or Eberconazole 1% applied topically twice daily for 4 weeks. At the end of treatment phase, there was a 'follow-up phase' at the end of 4 weeks, where the patients were assessed clinically and mycologically. The data were analyzed using descriptive statistics using MS Excel version 2019 and SPSS version 15 for Windows. Results: The primary efficacy variables namely change in pruritus, erythema, induration, scaling and mycological cure significantly improved in both the groups, as compared to baseline (P < 0.001), in the treatment phase and follow-up phase. Intergroup comparison with respect to pruritus and scaling showed significant difference (P < 0.001), suggestive of better reduction of pruritus and scaling scores at 4 weeks with Sertaconazole when compared to Eberconazole. Conclusions: Sertaconazole was better than Eberconazole in relieving signs and symptoms of dermatophytoses, especially pruritus, thereby improving patients' quality of life.

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Background: Frizzled 4 (FZD4) is an important receptor for Wnt proteins that stimulate several downstream signaling pathways. It has been known that the FZD4–Wnt interaction is involved in many types of cancers. However, the role of FZD4 in cutaneous squamous cell carcinoma (CSCC) has not been well studied. Aims: We sought to investigate the association between FZD4 expression level and tumor cell proliferation and apoptosis rates in CSCC. Methods: Expression of FZD4 at mRNA level in CSCC tissues and controls was measured. Colo16 cell proliferation and viability were measured by CCK-8 assay and flow cytometry respectively after siRNA and plasmid transfection. Results: We discovered a significant downregulation of FZD4 expression in CSCC tissues and cell lines compared to controls. Furthermore, our data suggested that over expression of FZD4 inhibited proliferation and promoted apoptosis of Colo16 cells. Conclusion: The results indicated that FZD4 may play as a tumor suppressor gene in the pathogenesis of CSCC.

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Background: Rosacea is a chronic inflammatory skin disease whose etiopathogenesis is still unknown. Previous studies have shown a relationship between certain inflammatory disorders and serum endocan levels. Endocan (previously known as endothelial cell-specific molecule 1) might play a role in the pathogenesis of various inflammatory diseases. Aims and Objectives: Our study aimed to evaluate serum endocan levels in patients with rosacea to investigate the association of endocan with the demographic data. Materials and Methods: The study recruited individuals aged ≥18 years who voluntarily agreed to participate in the study. The participants included 37 women (mean age: 48.29 ± 12.08 years) and 13 men (mean age: 52.23 ± 13.34 years) diagnosed with rosacea, and 37 women (mean age: 49.18 ± 16.6 years) and 13 men (mean age: 53.69 ± 11.30 years) selected as controls. Both groups were matched according to age and sex. The rosacea diagnosis was based on clinical examination findings, and serum endocan levels were measured using the method of enzyme-linked immunosorbent assay (ELISA). The statistical significance of the data was determined by the Mann–Whitney U test, and a value of P < 0.05 was considered statistically significant. Results: Serum endocan levels differed significantly between the patients with rosacea and the control group (P < 0.05). Conclusion: Circulating endocan might be a new marker related to disease progression in patients with rosacea. Further investigation is needed to determine whether endocan levels could become a new therapeutic target in rosacea, a disease that still cannot be fully cured.

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Background: Primary hyperhidrosis (PHH) is characterized by idiopathic, focal, bilateral, and symmetrical excessive and exaggerated sweating with a major impact on the quality of life (QoL). To date, there are no studies about the prevalence of PHH in Jordan and in the Arab region. Aim: To assess the prevalence, severity, and characteristics of PHH in the Jordanian population as well as its impact on QoL. Material and Methods: This study was conducted in five hospitals in Jordan and included 4,500 attendants of outpatient clinics who were evaluated for the presence of PHH. To assess the severity of hyperhidrosis (HH), we used the Hyperhidrosis Disease Severity Scale (HDSS). To evaluate the impact of HH on QoL, the Dermatology Life Quality Index (DLQI) questionnaire was answered by our patients, either digitally or on paper. Results: The overall prevalence of PHH in the Jordanian population was 3.2% (n = 144). The most common site was the axillae (63%), either isolated or in association with other sites. Both sexes were affected equally. The overall mean age of onset was 14.7 years. Positive family history was found in 35% of the patients. Nearly two-thirds of the patients presented with HDSS of 3 or 4. The impact on QoL was substantial with a mean DLQI of 12.8. Conclusion: PHH prevalence in the Jordanian population is 3.2%, which has a major impact on QoL. This raises the need for addressing this disease to reduce its burden on patient lives.

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Pilomatricoma is a relatively common benign cutaneous adnexal tumor and a well-recognized entity, while its pigmented variant is far less common and less reported. Its estimated frequency ranges from 11 to 24%, according to a limited number of published case series. This article describes the case of a 42-year-old man presenting a firm subcutaneous nodule of the periareolar region. Histopathologic examination revealed a cystic lesion composed of matrical and supramatrical cells accompanied by a foreign body granulomatous cell reaction. Interestingly, a hyperpigmented area with numerous hyperplastic melanocytes and few mitoses was detectable. In order to assess the cell lineage of the mitotically active component in the hyperpigmented area, double immunohistochemistry with Ki67/Mart1 and p63/SOX10 was performed. Pigmented pilomatricoma is an underrecognized, underreported variant, and double immunohistochemistry stain is an effective tool in providing the correct interpretation of the proliferative activity in the different cellular populations.

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Olmsted syndrome is a rare genodermatosis. Palmoplantar keratoderma and periorificial keratodermic plaques are the most important clinical findings. Additional findings associated with a large number of systems may accompany such as teeth, nail deformities, alopecia, mental retardation, and bone–joint anomalies. Therefore, it is difficult to make a differential diagnosis from other palmoplantar keratodermas. It also needs to be differentiated from acrodermatitis enteropathica because of periorificial plaques. The absence of regression in lesions with zinc treatment excludes this disease. We present here an Olmsted syndrome case with essential thrombocytosis for the first time.

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Context: India accounts for 60% of the global leprosy burden. Deformities lead to a negative impact on the quality of life (QoL). There is a paucity of Indian studies evaluating the QoL in patients with leprosy. Aims: This study was undertaken to assess QoL in leprosy patients with two different questionnaires, correlate QoL with demographic and clinical profile and evaluate the impact on health-related QoL scores. Settings and Design: A cross-sectional study to evaluate the QoL was conducted in the dermatology OPD of a tertiary center in Maharashtra, India. Materials and Methods: Demographic and clinical profile along with evaluation of QoL using DLQI and WHOQOL-BREF questionnaires was conducted in 60 leprosy patients. Statistical Analysis Used: Parametric test, R test, Chi-square test, Z test, Student's t-test (t), and Pearson's correlation coefficient (r) were used. Results: The mean DLQI score was 8.4 ± 4.4 and 40% of patients had moderate impact on QoL, and the mean WHOQOL-BREF score was 3.13 ± 0.9. The demographic profile, type of leprosy and reactions did not have a statistically significant correlation with DLQI. Presence of deformity had significant impact on DLQI and a statistically significant impact on physical, psychological, and environmental domain in WHOQOL-BREF analysis. Conclusions: Deformities have a profound impact on QoL in leprosy patients on evaluation with DLQI and WHOQOL- BREF questionnaires. The social domain was least affected, whereas severe impact was noted in psychological domain. DLQI is a practical and simple questionnaire, whereas WHOQOL- BREF provides a comprehensive approach on all domains.

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Objective: To describe clinical patterns, identify associated drugs, and perform causality assessment of cutaneous adverse drug reactions. Materials and Methods: In this prospective, observational study, patients with signs of cutaneous drug reaction from the department of dermatology of a tertiary teaching hospital were included. Patients with viral exanthemas were excluded. The patterns of cutaneous drug reactions, and associated drugs were noted. Naranjo scale was used for causality assessment of adverse drug reactions. Results: Sixty-five patients (mean age 38.1 years) were included. Skin lesions were seen after 2 days of drug consumption in 25 (38.5%) patients. Pigmentation, fixed drug eruption, and maculo-papular rashes were seen in 13 (20%), 22 (33.8%), and 12 (18.5%) patients, respectively. Thirty-five (53.85%) patients had other associated symptoms. Fever was seen in 22 (33.8%) patients. Thirty-two (49.2%) cases had exposure to antibacterial agents. Most commonly associated drugs with reactions were nonsteroidal anti-inflammatory agents 14 (21.5%) followed by beta-lactam antibiotics 12 (18.5%), and fluroquinolones 7 (10.8%). Fifty-seven (87.7%) adverse drugs reactions had “probable” association with the drug.” Conclusion: Fixed drug eruption is the commonest presentation of cutaneous adverse drug reactions and antimicrobial agents are most commonly associated with it. According to the Naranjo scale, the majority of the cutaneous drug reactions have a “probable” association with the offending drugs.

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Background: Ustekinumab, as a monoclonal antibody against interleukin (IL)-12 and IL-23, gets approved in China since 2019, therefore fewstudies report the application of ustekinumab in treating Chinese psoriasis patients in the real clinical settings until now. Aims: Thus, this study aimed to evaluate treatment efficacy, treatment response–related factors, and safety of ustekinumab in treating Chinese psoriasis patients. Materials and Methods: Totally, 72 moderate-to-severe plaque psoriasis patients who underwent ustekinumab treatment were analyzed. Their clinical data were recorded. Furthermore, improvement of psoriasis area severity index (PASI) score more than 75% (PASI75) and improvement of PASI score more than 90% (PASI90) at week 12 and week 24 were retrieved. Besides, the adverse events were reviewed. Results: There were 72.2% and 37.5% psoriasis patients who achieved PASI75 response and PASI90 response at week 12. Meanwhile, 86.7% and 46.7% psoriasis patients realized PASI75 response and PASI90 response at week 24. Besides, multivariant logistic regression analyses revealed that body mass index (BMI), disease duration, and history of tumor necrosis factor (TNF) inhibitors could independently predict reduced ustekinumab response in psoriasis patients. Additionally, the most common adverse events of ustekinumab treatment in psoriasis patients were infection (12.5%) and nasopharyngitis (9.7%), followed by headache (4.2%), cough (4.2%), abnormal hepatic function (4.2%), injection site reactions (2.8%), and eosinophilia (1.4%), which were all mild and manageable. Conclusions: Ustekinumab is an effective and safe immunotherapy drug for treating Chinese psoriasis patients. Furthermore, BMI, disease duration, and history of TNF inhibitors are predictors of poor ustekinumab response.

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Background: Acute photodamage is an acute inflammatory reaction of the skin after ultraviolet (UV) irradiation. Many drugs have been successfully used for the treatment and prevention of photodamage. Aims: To evaluate the molecular mechanism of N-terminal 5-mer peptide analog P165 of amyloid precursor protein in repairing photodamaged rat skin. Materials and Methods: We establish a rat model of acute UVB photodamage. The ratskin was treated with or without 250, 500, and, 1000 μM P165. Histological analysis was performed by hematoxylin and eosin staining. Apoptotic cells were analyzed by terminal deoxynucleotidyl transferase dUTP nick end labeling (TUNEL) staining. The kits were used to measure the levels of protein carbonyl (PC), malondialdehyde (MDA), 8-hydroxydeoxyguanosine (8-OHdG), superoxide dismutase (SOD), catalase (CAT), glutathione peroxidase (GPx), and glutathione (GSH). Western blotting was used to measure Nrf2. Results: P165 repaired UVB-induced cutaneous erythema and edema, and reduced apoptosis of skin cells. The levels of PC, MDA, and 8-OHdG in 250 and 500 μM P165 groups were all lower than those in the solvent group. Activities of SOD, CAT, and GPx, and the level of GSH in P165 groups were higher than those in the solvent group. Nrf2 expression in the solvent group was higher than that in the negative group, whereas in the 500 μM P165 group was higher than in the solvent group. Conclusions: Our findings suggest that P165 repairs the rat skin with acute photodamage by reducing oxidative stress. These activities may be mediated by promoting the Nrf2 signaling pathway. Thus, P165 may be a promising agent for the treatment of acute photodamage, which may be used in cosmetics and postsun repair.

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Background: In spite of the skin being the largest organ of the body, cutaneous malignancies are uncommon especially in people of color as compared to the white population. The incidence of cutaneous metastases of visceral malignancies is further low and accounts for 0.5% to 10% of cancer cases as per written literature. Cutaneous metastasis as the presenting sign of underlying internal malignancy is extremely rare and is a marker of poor prognosis. Limited data is available in written literature about the frequency and spectrum of metastatic skin lesions in the Asian population. Objective: 1) To find the frequency of metastasis of visceral malignancies in skin biopsies. 2) To evaluate the clinicopathological presentation and immunohistochemistry (IHC) profile of cutaneous metastases. Subjects and Methods: It is a retrospective analysis of all the skin biopsies received in our department of Pathology for HPE from 01 Jan 2017 till 31 Dec 2019. Cases of cutaneous malignancy were segregated into primary and metastatic categories. Clinical details of the cases of cutaneous metastases were retrieved and analyzed. All the cases of cutaneous metastases were studied in detail for their clinical presentation, histomorphological features, and findings on IHC. Results: Out of a total of 484 skin biopsies in 3 years, 9.7% showed features of malignancy. Total ten cases of cutaneous metastases (2%) were found, out of which three were the primary presentation of silent visceral malignancy. The lung, breast, colon, and ovary were the common primary sites to manifest as cutaneous metastases with the abdominal wall being the commonest site. Histomorphological features aided by the IHC panel helped in diagnosing the cutaneous metastases and site of the primary malignancy. Conclusion: Cutaneous metastasis as the primary presentation of visceral malignancy is rare and should not be missed as it indicates a poor prognosis. Clinico-pathological correlation and histomorphological features assisted by IHC markers help pathologists in diagnosing the site of primary malignancy in cases of cutaneous metastases.

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