Abstract The impact of adverse skin reactions to antitumour therapy (ASR) on psychological characteristics is underinvestigated. We evaluated itch and the psychological status of patients with ASR in comparison with patients with atopic dermatitis (AD) or melanoma. This was a multicentre cross-sectional, observational study of dermatological outpatients from three clinics. Patients with ASR (n = 93), atopic dermatitis (AD) (n = 106) and psoriasis (n = 101) and healthy volunteers (n = 216) were included. Itch intensity was measured with a visual analogue scale (VAS). Psychometric examination comprised scales for anxiety (General Anxiety Disorder-2), depression (Patient Health Questionnaire-2), perceived stress (Perceived Stress Sscale-10, PSS-10), perceived stigmatization (Perceived Stigmatization Questionnaire, PSQ) and quality of life (5-Pruritus Life Quality, 5PLQ). AD and ASR did not differ from each other significantly in itch frequency (71.7% and 66%), VAS itch intensity [median 6.0, interquartile range (IQR) 3.8–8.0 and median 5.0, IQR 4.0–7.0], 5PLQ score (median 7.0, IQR 3.0–9.0 and median 6.00, IQR 3.0–11.0), PSQ score (median 14.0, IQR 10.0–25.0 and median 15.0, IQR 8.0–26.0) or PSS-10 score (median 18.0, IQR 14.0–22.0 and median 18.5, IQR 15.0–23.0). However, both AD and ASR showed significantly higher parameters than melanoma for itch frequency (15.9% for melanoma), VAS itch intensity (median 2.0, IQR 1.0–2.0; P = 0.001), 5PLQ score (median 1.0, IQR 0.0–3.0; P = 0.001), PSQ score (median 11.0, IQR 7.0–17.0; P = 0.006) or PSS-10 score (median 12.0, IQR 8.0–18.0). Anxiety and depression (General Health Questionnaire-4 score) ranged from the highest score (median and IQR) in AD (4.0, 3.0–6.8) to the lowest in skin melanoma (1.0, 0.0–3.0), with an intermediate score for ASR (2.0, 2.0–5.0; P < 0.001). ASR is characterized by a high prevalence and intensity of itch, impact of itch on quality of life, stigmatization and stress, and the increased levels of anxiety and depression. These are comparable with severe pruritic dermatosis such as AD. The management of patients with ASR should address associated psychological issues and itch.

Abstract Alopecias, especially nonscarring forms, are considered dermatological disorders with low subjective symptoms. However, trichodynia – a painful scalp sensation – is common with telogen effluvium and androgenetic alopecia (AGA), often coexisting with psychopathological findings. Scarring alopecias, such as lichen planopilaris (LPP), may present with pruritus. We evaluated the prevalence of subjective scalp sensations in alopecias and examined their associations with psychological distress. Ninety patients were enrolled. Their mean age was 38.3 years; 39 had AGA, 22 had alopecia areata (AA) and 29 had LPP. Scalp sensations were evaluated using the Hair-Specific Skindex-29, which is rated on a five-point Likert scale from 0 = ‘never’ to 4 = ‘all the time’, transformed to a 0–100 scale. Prevalence was defined as the proportion of patients reporting a score > 0 for items 1 (scalp hurting), 7 (burning/stinging) and 10 (itch). Psychological distress was measured with the Hospital Anxiety and Depression Scale. Simple linear regression analyses were performed. Scalp hurting sensation was reported by 56% of patients with AGA (mean score 33.3, SD 34.6), 45% of patients with AA (mean 34.1, SD 40.5) and 55% of patients with LPP (mean 21.6, SD 22.9). Burning/stinging occurred in 33% of patients with AGA (mean 14.7, SD 24.1), 32% with AA (mean 20.5, SD 31.5) and 34% with LPP (mean 11.2, SD 17.1). Itch prevalence was 51% in AGA (mean 25.0, SD 30.9), 45% in AA (mean 23.9, SD 31.3) and 55% in LPP (mean 24.1, SD 27.1). Linear regression analysis showed significant associations between burning sensation and distress in LPP (R2 = 0.18, P = 0.02) and AGA (R2 = 0.11, P = 0.04), but not for scalp hurting or itch. Contrary to the common view that nonscarring alopecias are largely asymptomatic, the prevalence of subjective scalp sensations – particularly hurting and burning – was comparable with that in scarring LPP. The selective link between burning and psychological distress suggests a specific psychoneuroinflammatory pathway, although it explains only part of the symptoms.

Background Studies devoted to the assessment of dermatoscopic signs in patients with acneiform rashes and acute exanthematous pustulosis induced by antitumor therapy, as well as acne vulgaris are few and do not evaluate differential diagnostic criteria. There are currently no dermatoscopic algorithms available for the differentiation of these conditions. Aim: To assess the dermatoscopic features specific to acneiform rashes in comparison with acne vulgaris and acute exanthematous pustulosis and to develop an algorithm for differential diagnosis. Methods A multicenter, cross-sectional, observational, prospective study was conducted. Adult patients with acneiform rashes associated with antitumor therapy, acne vulgaris, and acute exanthematous pustulosis were included. Dermatoscopic signs were described according to the recommendations of the International Dermoscopy Society for describing of inflammatory dermatoses. Results Acne vulgaris was characterized by brown-yellow clods on skin-colored areas, white-yellow structureless zones with thin branching vessels, pink structureless zones, white clods surrounded by erythema, white structureless zones (p < 0.001), structureless red-brown zones (p = 0.02), and pink follicular fluorescence in UV light. Acneiform rashes demonstrated erythema with telangiectasia (p = 0.02), purpura (p = 0.001), yellow clods surrounded by erythema, a keratin plug in the center of the pustule, purpura, hemorrhagic spots, keratosis follicularis, yellow crusts, pustules surrounded by erythema with telangiectasia, white scales, and under UV dermatoscopy, keratosis follicularis was observed as white follicular fluorescence (p < 0.001). Acute exanthematous pustulosis showed white clods on structureless erythema without specific fluorescence under UV light, although white clods disappeared under UV light. A Venn diagram was used to develop an algorithm for the differential diagnosis of these three disorders. Conclusion Based on a detailed study of dermatoscopic signs and their analysis using Venn diagrams, we developed an algorithm for the differential diagnosis of acneiform rashes, acute exanthematous pustulosis caused by antitumor therapy, and acne vulgaris. The proposed algorithm may be recommended for clinical use.

ObjectivesThis study aims to update the understanding of Alopecia Areata (AA) in Poland, Czechia, Russia, and Türkiye, focusing on the disease burden, clinical management, and patient journey. It seeks to establish a consensus on optimal management strategies for AA in these regions.MethodsA modified 2-round Delphi panel was conveyed with 23 Dermatologists (Russia; 4, Türkiye; 7, Poland; 6, and Czechia; 6). The Delphi questionnaire consisted of 61 statements and 43 questions designed to obtain an overall understanding of the perception and acceptance of available information regarding the care of patients with alopecia areata.ResultsThe study revealed that moderate-to-severe AA significantly impacts patients’ and their families’ QoL, consistent with previous studies. AA was found to cause more substantial impairment when additional lesions appeared in visible areas besides the scalp. Work and productivity impairment were notably higher in adults with moderate-to-severe AA. Diagnostic consensus highlighted the importance of skin biopsies and trichoscopy, while the need for more practical severity scoring systems was emphasized. Current treatments, including topical therapies, corticosteroids, and systemic immune modifiers, were deemed insufficient, highlighting the unmet medical need.ConclusionThe Delphi study underscores a significant disease burden and unmet medical needs in patients with moderate-to-severe AA. It highlights the necessity of access to novel treatments and further research to develop more effective therapies with a tolerable safety profile. The findings align with global research, emphasizing the psychosocial impact of AA and the need for standardized, effective treatment protocols.

Diagnosing skin diseases in children can be a complex interdisciplinary problem. Incontinentia pigmenti (IP), also known as Bloch-Sulzberger syndrome, is a rare hereditary genodermatosis related to a mutation in the IKBKG gene. We present a family case of IP described from the perspective of various specialists, including dermatologists, oncologists, geneticists, dentists, and trichologists. The peculiarity of this case is the development of squamous cell carcinoma (SCC) on the shin of a 10-year-old female patient with IP. The patient had a positive family history: her mother and two sisters also displayed clinical manifestations of IP with involvement of skin, teeth and hair. The presence of exons 4–10 deletion in the IKBKG gene in all affected females was confirmed by detailed genetic evaluation using long-range PCR, and also high degree of X-chromosome inactivation skewing was demonstrated. The family underwent a comprehensive examination and was followed up for 2 years with successful symptomatic treatment of dermatologic manifestations. Recommendations were also made regarding dental and hair problems. By the end of the follow-up period, patients had stabilized, with the exception of a 36-year-old mother who developed generalized morphea. The study demonstrates the varying expressiveness of clinical symptoms among family members and emphasizes the importance of timely diagnosis for effective management of patients with IP.

BackgroundThere is limited insight into the current disease burden and everyday clinical management of moderate-to- severe AD in Poland, Czechia, Russia, and Turkiye. Therefore, this study aimed to get information-driven insights regarding the current disease burden and clinical management of patients with moderate-to-severe AD with common and differentiating aspects of the patient journey and establish a consensus.MethodsIn this modified 2-round Delphi panel, 133 questions were asked in total to 27 dermatologists. A consensus was achieved when 70% of the panel members strongly agreed or agreed (or strongly disagreed or disagreed) with an item. Statements with <40% agreement dropped from the Delphi rounds and were not repeated.ResultsThe results state that AD has a significant impact on the quality of life for both patients and their families with social and economic consequences in these countries. While there were significant dissimilarities regarding the current treatment approach by preference order and treatment duration among participants, there was also a high percentage of consensus on literature and guideline-based statements. Current topical therapies and the immune response modifiers were not found to be sufficient by panelists to cover the therapeutic needs of patients with moderate-to-severe AD. Moreover, panelists highlighted the significant burden of adverse events with the off-label use of currently available immunosuppressants.ConclusionsThese results underlined that there is a significant disease burden with an unmet treatment need for patients with moderate-to-severe AD in Poland, Czechia, Russia, and Turkiye.

Modern antitumor therapy includes novel targeted and immunotherapeutic options specifically targeting tumor targets. However, many of these targets are also expressed in the constantly proliferating epidermis of the skin, leading to derangement of proliferation and differentiation of keratinocytes, inflammatory responses, skin barrier dysfunction, inhibition of antimicrobial peptides' synthesis, and toxic skin reactions. The article presents an overview of current data on microbiome disorders associated with toxic skin reactions. The potential mechanisms of skin microbiome changes inducing the occurrence and persistence of rashes during anticancer therapy are addressed.

Uremic pruritus is a common symptom in chronic kidney disease and end-stage renal failure. In addition to physical discomfort uremic pruritus disrupts sleep, negatively affects the psycho-emotional state and quality of life. In this group of patients, the association of uremic pruritus with an increase in mortality due to any causes was demonstrated. At the same time, there are no standardized approaches to the treatment of uremic itching. There is also a special category of patients receiving antitumor therapy and developing dermatological adverse events, also potentially accompanied by itching. This article presents a case of uremic pruritus in a patient with papulo-pustular cutaneous reaction (grade II on a Scale Common Terminology Criteria for Adverse Events, CTCAE v 5.0) to the epidermal growth factor (EGFR) inhibitor cetuximab in combination with leucovorin and 5-fluorouracil for rectal cancer. Treatment of uremic pruritus with small doses of gebapentin (300 mg/day) led to complete regression of pruritus. Papulo-pustular rashes completely regressed after recommended systemic and topical therapy according to the severity of rush (doxycycline 100 mg 2 times a day for 5 days, cream with neomycin, natamycin and hydrocortisone 3 times a day for 7 days). Pruritus was absent during the next 6 months of follow-up. Antitumor therapy was not interrupted due to acneiform rush, and following supportive topical therapy allowed to control severity of exacerbations which did not exceed III grade according to CTCAE v 5.0 and did not require the addition of systemic therapy. Thus, therapy of uremic pruritus with gabapentin has shown was effective also in a patient with severe comorbid pathology. Supportive topical therapy consistent with the severity of papulo-pustular rash reduced the severity of exacerbations during following EGFR inhibitor therapy.

Atopic dermatitis is a common chronic dermatosis characterized by a wide variability of endotypes and phenotypes. Approaches to the treatment of atopic dermatitis are currently undergoing significant changes, especially in patients with moderate and severe forms of atopic dermatitis. JAK inhibitors according to the results of numerous studies have shown their efficacy in the treatment of various immune-mediated dermatological diseases such as atopic dermatitis, vitiligo, focal alopecia and psoriasis, etc. The article presents the experience of treating adult patients suffering from a severe form of atopic dermatitis with the selective JAK-1 inhibitor upadacitinib. The observations presented are of particular interest due to the fact that the patients were treated with upadacitinib monotherapy. It should be noted that the drug is highly effective against itching. No adverse events (including the development of infectious diseases, hematological disorders) were registered during dynamic observation (according to the results of laboratory studies).

Pruritus is one of the subjective sensations that significantly reduces the quality of life of patients. In patients with malignancies, itch can be caused by different universal or specific pathophysiological factors. This article discusses disorders that cause pruritus in cancer patients: the tumor growth on its own; pathophysiological changes associated with a number of malignancies, paraneoplastic itch, anticancer therapy, concomitant dermatoses, systemic diseases, psychosomatic disorders. Known or proposed mechanisms of the development of pruritus are presented for each of the mentioned provoking factors, and methods of treatment are described, according to the etiological factor. At the end of the article, universal methods for the correction of itching are presented, applicable in cancer patients, regardless of the pruritogenic factor. Special attention is paid to the correction of xerosis as a universal cause of itching in oncological patients.

The consensus on the prevention and correction of rash in patients with HR+ HER2- metastatic breast cancer treated with alpelisib was developed by the experts of the Russian Society of Clinical Oncology and dermatovenerologists. PIK3CA mutation is a poor prognostic factor for HR+ HER2- metastatic breast cancer. Alpelisib demonstrates efficacy in patients with PIK3CA mutation, but treatment might be associated with adverse events that include rash. All-grade rash was reported in 35.6% patients in SOLAR-1 trial (n=284). According to the published real-world data, for Russian population (n=19) all-grade rash was reported for 37% patients. The consensus contains practical recommendation on management of patients with rash of different grade.