Nodular lesions on the breast can be alarming for women and have a negative physical and psychological impact. The lesions might be underdiagnosed as keloid or overdiagnosed as malignancies. To reach an accurate diagnosis, pathological examination is required. We herein present a case of linear keloidal morphea on the breast of a 30-year-old woman who presented with a firm asymptomatic lesion that developed during pregnancy. She had a family history of autoimmune diseases. Careful clinical and dermoscopic investigations with histopathological examination were consistent with nodular morphea. In addition, we analyze reports of nodular morphea from the past 25 years. The most common comorbidities of nodular morphea are systemic sclerosis, systemic lupus erythematosus, and morphea (localized scleroderma). Treatment is a challenge.

The pro-yellow laser (PYL), with a wavelength of 577 nm, is an ideal tool for treating vascular lesions and vascular malformations in the skin, and is also a powerful therapeutic modality that can be applied to non-vascular conditions. By penetrating deeper than standard lasers, it simultaneously targets both prominent lesions and underlying structures. The lesion turns white immediately after exposure to the appropriate dose, serving as a clinical indicator of thermal damage. Results can be obtained more safely, permanently, and with fewer side effects for lighter and darker skin tones. Neither the dye nor the gel used in pulsed dye and Intense Pulsed Light (IPL) laser systems is required with the Pro Yellow Laser (PYL). Likewise, it does not require a heavy and oversized system, as in the copper bromide laser or a cooling apparatus, as in the IPL laser system, which makes PYL superior to these treatment modalities. We reviewed the most recent studies to evaluate the role of PYL in the treatment of vascular and non-vascular skin diseases and the evidence for efficacy or the lack of such evidence. We provided up-to-date details on the use of PYL to treat both vascular and non-vascular skin conditions, including facial telangiectasia, poikiloderma of civatte, facial erythema, keratosis pilaris rubra, port-wine stain, venous lake, spider angioma, cherry angioma, hemangioma, genital angiokeratoma, Becker’s nevus, melasma, rosacea, post-acne erythema, and vulvar syringoma, ephelides, solar lentigines, and onychomycosis.

Lichen planus (LP) is a common inflammatory condition of unknown etiology that commonly affects the skin and mucous membranes. Optical coherence tomography angiography (OCTA) is a noninvasive technique for identifying early retinal vascular impairment in systemic disease without clinical damage by imaging deep and superficial capillary networks. To assess the impacts of LP on the choroid and assess vascular changes in retinal capillary density using OCTA. This single-center prospective case-control study included 30 therapeutic-naïve LP patients and 30 age and sex-matched healthy individuals. All study subjects underwent a complete ophthalmological examination, including best-corrected visual acuity (BCVA) measurement using a Snellen chart, slit-lamp biomicroscopy, intraocular pressure (IOP) measurement, and fundus examination. They were then examined using spectral domain OCT and choroidal thickness was measured. The vessel density of the superficial and deep capillary networks was measured and assessed using OCTA. Patients had significantly thicker choroidal and retinal thickness than controls, with subfoveal, nasal, and temporal areas showing a significant difference. A significantly higher vascular density in the superficial capillary plexus, particularly in the nasal perifoveal area, was found compared to the control group. Significantly, higher vascular density in the deep capillary plexus in the parafoveal area compared to controls was reported. Significant correlations were found between visual acuity and IOP, and age, duration of disease, and severity of disease. This study is the first to reveal that LP patients exhibit choroidal changes and retinal vascular alterations compared to healthy controls.

Lichen planus is a common pruritic inflammatory disorder of the skin with an autoimmune background. It affects < 1

A Yemeni woman in her fifties presented with a 2-year history of progressive disfiguring enlargement of the nose with fleshy lesions on the margin of the nose and the lips. Similar lesions developed slowly on the eyelids and proximal thighs. Clinical examination showed multiple, asymptomatic, smooth, lobulated and indurated violaceous papules and nodules on the nasal alae.

Lichen planus is a common pruritic inflammatory disorder of the skin with an autoimmune background. It affects < 1% of the general population. The disease has significant comorbidities that must be considered in a holistic approach. Skin and skin adnexa, mucosa, eyes, and the esophagus may be affected. There are various clinical subtypes in addition to classical cutaneous lichen planus. These subtypes depend on age and gender. Nail involvement can result in functional and psychological impairment. Lichen planopilaris in adults leads to irreversible cicatrical alopecia. Erosive and ulcerated lichen planus of the mucosa carries an increased risk of malignant transformation, at least in adults. Treatment must consider the affected area, the severity of disease, age, gender, and comorbidities.

Guttate psoriasis (GP) is a clinical variant of psoriasis defined by morphology, triggers, and course. It is more common among children, adolescents, and young adults. Up to 70% of patients follow a chronic course, some with a switch to plaque psoriasis. Classic treatment for GP consists of topical corticosteroids, anthralin and vitamin-D analogues alone or in combination with ultraviolet B phototherapy. Small molecules and biologics have revolutionized the treatment of moderate to severe chronic plaque psoriasis. In this narrative review their potential in GP therapy is discussed and first clinical data are presented. Inhibition of the interleukin (IL)-23 pathway offers rapid clearance and durable remissions. Further trials are necessary. Possibly, the chronic course and switch to plaque psoriasis may be prevented by early use of IL-23 antagonists.

We present our experience regarding the successful use of isotretinoin as a valuable therapeutic option for lichen myxoedematosus.

A 58-year-old woman presented in 2013 with a 30-year history of psoriasis vulgaris. She had a medical history of mild degree of bronchial asthma (not on any medications) and anxiety disorder for which she was on a course of 30 mg/day mirtazapine. Clinically, the patient had a well-defined, erythematous scaly plaques affecting the scalp, trunk, and extremities (Psoriasis Area and Severity Index (PASI): 16.8). The rest of the examination was regular except for a mild degree of arthralgia affecting small joints of both hands. She had received 15 mg/week of methotrexate and 25 mg/day of acitretin, intermittently over months, with an unsatisfactory response. In 2014, while she was on acitretin, multiple disseminated urticarial wheals were noted but no angioedema (Urticaria Activity Score (UAS7): 35). Urticaria was controlled on antihistaminics; however, no complete remission could be achieved. In October 2020, omalizumab (300 mg/28 days) was started as a second-line due to the poor response to higher doses of antihistaminics. In November 2020, she was switched from methotrexate to secukinumab (300 mg at 0, 1, 2, 3, and 4 weeks, followed by a monthly maintenance dose every 4 weeks) due to a lack of psoriasis improvement by cyclosporin and adalimumab. The patient was kept on omalizumab for 18 months and secukinumab for 20 months. Urticaria went into remission (UAS7:0) while psoriasis achieved nearly complete clearance of lesions (PASI:1) without reporting any side effects (Figure 1). Omalizumab (OMZ) is a recombinant humanized monoclonal anti-IgE antibody approved for managing chronic asthma and chronic spontaneous urticaria (CSU) refractory to high doses of H1-antihistamines. Additionally, OMZ has anti-inflammatory effects beyond anti-IgE activity.1 The treatment of CSU with OMZ results in a normalized IL-31 serum level—a cytokine involved in the initiation of chronic skin inflammation—in both CSU and psoriasis patients.2 Binding of high-affinity IgE to the FceRI receptor of mast cells (MCs) would lead to degranulation and immediate release of the preformed chemical mediators, such as tryptase, and tumor necrosis factor (TNF) from the granules.1 Paolino et al.3 recently reported a possible correlation between serum tryptase, as an inflammatory biomarker, and psoriasis. That supports the role of “activated” MCs in the pathogenesis of psoriasis. Interestingly, increased IgE might be an early parameter of poor/unsatisfactory response of psoriasis patients to biologics.4 Fougerousse et al.5 noted that combination of biologics with OMZ in 10 patients with different inflammatory conditions, 7 of them had psoriasis, was well tolerated, and not associated with adverse events, such as infections, or hospital admission for any reason. Concomitant use of guselkumab and OMZ for psoriasis and CSU showed no clinically significant side effects during an extended treatment course of 21 months.6 OMZ combined with biologics may achieve a better outcome in psoriasis than biologics.6-8 Since all published articles were limited to case reports, the relation between psoriasis and urticaria remains uncertain (Table 1). Based on a single case of psoriasis remission on CSU exacerbation, Magen and Chikovani thought CSU would be found at a lower frequency in patients with psoriasis and vice versa, if more evidence exist.9 However, we think the association of both disorders might be under-reported. Patients with treatment-refractory psoriasis may have, for instance, hyper-IL-23 that would induce concomitant urticarial manifestation.8 Therefore, combined therapy would mutually restore the cytokine imbalance of the two conditions.7, 8 Safety profile of the drug as a potential therapy for psoriasis in-combination with other anti-psoriatic lines, namely biologics, may warrant further studies, particularly for psoriasis with pruritic symptoms. -Diffuse urticarial wheals UAS7:31, -Generalized plaque psoriasis(PASI:32) -Acitretin -Methotrexate -Adalimuma- -Etanercept -Infliximab -Secukinumab -Ustekinumab -Levocetiriz- -Guselkumab -Omalizumab UAS7:0 PASI: ≌ 1 -Diffuse urticarial wheals, -Generalized plaques psoriasis -NBUVB -Cyclosporine -Methotrexate -Adalimumab -Secukinumab -Omalizumab -Diffuse urticarial wheals(UAS7:40) -Generalized plaque psoriasis(PASI:25) -Corticosteroid -NBUVB -Cyclosporine -Methotrexate -Apremilast Tildrakizumab- Omalizumab- -Diffuse urticarial wheals (UAS7:35) -Generalized psoriasis plaques (PASI:16.8) -Cyclosporin -Methotrexate -Adalimumab -Acitretin -Secukinumab Omalizumab- Selami Aykut Temiz, Munise Daye, and Sibel Yavuz managed and followed up the case. Uwe Wollina, Torrllo Lotti, and Recep Dursun shared in literature review. Uwe Wollina reviewed the initial draft. Ayman Abdelmaksoud reviewed the literature, wrote the initial draft, and submitted the final draft. All the authors approved the final draft for submission. An informed consent has been obtained from the patient. The patient agreed for publishing her data in an international journal. The data that support the findings of this study are available from the corresponding author upon reasonable request.

Giant cell tumor of soft tissue (GCTST) is a very rare neoplasm that occurs predominantly in in the fifth decade of life presented as a benign looking painless mass associated with a local recurrence rate of 12% and very rare metastasis. We report a case of this rare entity presented with unusual presentations in a young boy which was diagnosed by histopathological examination and immunohistochemistry after complete excision raising the awareness of diagnosis and management of this unusual entity.

Background: Recurrence of basal cell carcinoma (BCC) after complete surgical excision is rarely reported. Risk factors for this negative outcome are not well-studied. We present the clinical and histological features of recurrent BCCs in our institution.Methods: All patients between January 2016 to December 2020 whose primary BCCs were excised with free surgical margins according to the histopathology report, and represented later with local recurrence were included. The medical files were retrieved to record patient's age, sex, sun exposure, tumor site, size, clinical diagnosis, histopathology variant of primary lesion, least free margin distance of the original lesion, and recurrence time.Results: Eighteen patients (11 males and 7 females ranged between 50 and 75 years old) fulfilled the inclusion criteria; all of their lesions were located in head and neck regions. The mean recurrence time was 31.2 months (11-86) and the histological variant was the same of primary in 17/18 patients. Primary tumors showed nodular subtype in 77.8% of patients and 55.6% of the primary tumors were less than 15 mm in diameter. Sun exposure history was given by 77.8% of patients while the rest of patients had non-significant exposure. All recurrent excised lesions were of free margin less than 4 mm. Conclusion: We found that the primary tumors of all studied recurrent BCCs were excised with surgical margins less than 4 mm. We recommend follow up for all excised BCCs either those of low or high risk histological variants. Tumor size does not appear a considerable risk factor for local recurrence.

Background Telemedicine involves distant exchange of medical information between health providers and patientsviaa telecommunication device with/without the aid of an audiovisual interactive assistance. The current COVID 19 pandemic impact on health services mandated an utmost readiness to implement telemedicine which in part is dependent on health care providers willingness to adopt such platforms. Aim The aim of this cross sectional study was to assess knowledge and attitude toward telemedicine Egyptian dermatologists amidst the COVID 19 pandemic. Patients and methods A cross sectional study was designed and data were collected using structured self-administered online questionnaires. Results Dermatologists had a good knowledge about telemedicine (mean 4.17 +/- 1.63;p < .05). Of those completing the questionnaire, 193 (68.9%) were familiar with the term 'telemedicine' and 164 (58.6%) were familiar with tools like teleconferencing. The majority of responding dermatologists 227 (81.1%) were confident that the COVID 19 pandemic is a good opportunity to start applying telemedicine protocols however the majority 234 (83.6%) preferred using it on trial basis at first before full implementation. Conclusion In conclusion an overall good attitude toward telemedicine was reported with a mean of 3.39 (p < .05). Further large scale studies are required to verify such findings.

Currently the most powerful tool in combating the COVID-19 pandemic is vaccination against SARS-CoV-2. A growing percentage of the world's population is being vaccinated. Various vaccines are worldwide on the market. Several adverse reactions have been reported as a part of post-marketing surveillance of COVID-19 vaccines. Among the possible adverse events, cutaneous vasculitis has occasionally been reported. We present a narrative review on cutaneous vasculitis related to COVID-19-vaccination to summarize clinical findings, histopathology, treatment and outcome. We searched for "COVID vaccine", "COVID vaccination" AND "cutaneous vasculitis" in PUBMED. Articles in English have been selected, from inception to December 2021, and analyzed for patient's characteristics, type of vaccine, time of appearance of cutaneous vasculitis and clinico-histopathologic type. Treatment and outcome have also been considered in this narrative review. Two new unpublished cases of ours were added. Cutaneous vasculitis is a rare adverse event to COVID-19 vaccination. It has been observed with mRNA and adenovirus-vector vaccines. IgA vasculitis, lymphocytic and ANCA-associated vasculitis, leukocytoclastic and urticarial vasculitis have been reported. This adverse event can occur after first or second shot. Most cases run a mild to moderate course. Cornerstone of medical treatment are systemic corticosteroids. Complete remission could be achieved in most patients. Vasculitis may not be considered as a contraindication of vaccination, being uncommonly reported and shows a favorable prognosis. The benefit of the vaccination remains high especially for immunocompromised patients. COVID-vaccine induced vasculitis is important in the differential diagnosis of purpuric and vasculitis disorders.

. 3 Singh et al. treated a 13-year-old boy with generalized idiopathic CC by diltiazem over a year with dramatic improvement. 4 We suggest geographic, ethnic, or genetic factors may be related to the rare reports of ICCU in

International Journal of DermatologyVolume 62, Issue 4 p. e255-e256 Correspondence Isotretinoin and pregnancy termination: an overview Ayman Abdelmaksoud MSc, Corresponding Author Ayman Abdelmaksoud MSc [email protected] orcid.org/0000-0003-4848-959X Mansoura Dermatology, Venerology and Leprology Hospital, Mansoura, Egypt Department of Dermatology, University of Studies Guglielmo Marconi, Rome, ItalySearch for more papers by this authorUwe Wollina MD, Uwe Wollina MD Department of Dermatology and Allergology, Städtisches Klinikum Dresden, Academic Teaching Hospital, Dresden, GermanySearch for more papers by this authorTorello Lotti MD, Torello Lotti MD University of Rome G. Marconi, Rome, Italy Department of Dermatology and Communicable Diseases, First Medical State Moscow University I. M. Sechenev, Moscow, RussiaSearch for more papers by this authorSelami A. Temiz MD, Selami A. Temiz MD orcid.org/0000-0003-4878-0045 Department of Dermatology, Necmettin Erbakan University Meram Medical Faculty, Konya, TurkeySearch for more papers by this author Ayman Abdelmaksoud MSc, Corresponding Author Ayman Abdelmaksoud MSc [email protected] orcid.org/0000-0003-4848-959X Mansoura Dermatology, Venerology and Leprology Hospital, Mansoura, Egypt Department of Dermatology, University of Studies Guglielmo Marconi, Rome, ItalySearch for more papers by this authorUwe Wollina MD, Uwe Wollina MD Department of Dermatology and Allergology, Städtisches Klinikum Dresden, Academic Teaching Hospital, Dresden, GermanySearch for more papers by this authorTorello Lotti MD, Torello Lotti MD University of Rome G. Marconi, Rome, Italy Department of Dermatology and Communicable Diseases, First Medical State Moscow University I. M. Sechenev, Moscow, RussiaSearch for more papers by this authorSelami A. Temiz MD, Selami A. Temiz MD orcid.org/0000-0003-4878-0045 Department of Dermatology, Necmettin Erbakan University Meram Medical Faculty, Konya, TurkeySearch for more papers by this author First published: 29 December 2022 https://doi.org/10.1111/ijd.16570 Conflict of interest: None. Funding source: None. Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onEmailFacebookTwitterLinkedInRedditWechat No abstract is available for this article. References 1Altıntaş Aykan D, Ergün Y. Isotretinoin: still the cause of anxiety for teratogenicity. Dermatol Ther. 2020; 33(1):e13192. https://doi.org/10.1111/dth.13192 2Yousif J, Adlam T, Grant-Kels JM, Farshchian M. The Supreme Court abortion ban impact on dermatology. J Am Acad Dermatol. 2022; 87(5): 1225–6. https://doi.org/10.1016/j.jaad.2022.07.026 3Cha EH, Kim N, Kwak HS, Han HJ, Joo SH, Choi JS, et al. Pregnancy and neonatal outcomes after periconceptional exposure to isotretinoin in Koreans. Obstet Gynecol Sci. 2022; 65(2): 166–75. https://doi.org/10.5468/ogs.21354 4Choi EJ, Kim N, Kwak HS, Han HJ, Chun KC, Kim YA, et al. The rates of major malformations after gestational exposure to isotretinoin: a systematic review and meta-analysis. Obstet Gynecol Sci. 2021; 64(4): 364–73. https://doi.org/10.5468/ogs.20373 5Yook JH, Han JY, Choi JS, Ahn HK, Lee SW, Kim MY, et al. Pregnancy outcomes and factors associated with voluntary pregnancy termination in women who had been treated for acne with isotretinoin. Clin Toxicol (Phila). 2012; 50(10): 896–901. https://doi.org/10.3109/15563650.2012.739287 6Brzezinski P, Zonda GI, Hincu MA, Vasilache IA, Chiriac A, Ciuhodaru MI, et al. A multicenter cohort study evaluating the teratogenic effects of isotretinoin on neonates. Children (Basel). 2022; 9(11): 1612. https://doi.org/10.3390/children9111612 7Sander M, Sander M. The human chorionic gonadotropin diet: elevated pregnancy markers in patients on isotretinoin. J Cutan Med Surg. 2020; 24(2): 193–4. https://doi.org/10.1177/1203475419888865 8Mitchell AA, Van Bennekom CM, Louik C. A pregnancy-prevention program in women of childbearing age receiving isotretinoin. N Engl J Med. 1995; 333: 101–6. 9Bérard A, Azoulay L, Koren G, Blais L, Perreault S, Oraichi D. Isotretinoin, pregnancies, abortions and birth defects: a population-based perspective. Br J Clin Pharmacol. 2007; 63: 196–205. Volume62, Issue4April 2023Pages e255-e256 ReferencesRelatedInformation

Journal Article Allergic and cutaneous reactions following inactivated SARS‐CoV‐2 vaccine (CoronaVac®) in healthcare workers Get access K. Durmaz, K. Durmaz Department of Dermatology Bilecik Bozuyuk State Hospital Bozuyuk, Bilecik Turkey https://orcid.org/0000-0002-8636-9866 Search for other works by this author on: Oxford Academic Google Scholar S. Aykut Temiz, S. Aykut Temiz Department of Dermatology Konya Ereğli State Hospital Konya Turkey https://orcid.org/0000-0003-4878-0045 Search for other works by this author on: Oxford Academic Google Scholar Z. Metin, Z. Metin Department of Dermatology Zonguldak Ataturk State Hospital Zonguldak Turkey Search for other works by this author on: Oxford Academic Google Scholar R. Dursun, R. Dursun Department of Dermatology Necmettin Erbakan University Meram Medical Faculty Konya Turkey Search for other works by this author on: Oxford Academic Google Scholar A. Abdelmaksoud A. Abdelmaksoud Mansoura Dermatology, Venerology and Leprology Hospital Mansoura Egypt https://orcid.org/0000-0003-4848-959X Search for other works by this author on: Oxford Academic Google Scholar Clinical and Experimental Dermatology, Volume 47, Issue 1, 1 January 2022, Pages 171–173, https://doi.org/10.1111/ced.14896 Published: 01 January 2022

Dermatologic TherapyEarly View e15493 LETTER Topical Timolol for ingrown nail post-avulsion refractory wound Dharmendra Dineshchandra Dave, Dharmendra Dineshchandra Dave Consultant Dermatologist at Dave Skin & Laser Clinic, Patan, IndiaSearch for more papers by this authorAyman Abdelmaksoud, Corresponding Author Ayman Abdelmaksoud behcet.behcet@yahoo.com orcid.org/0000-0003-4848-959X Mansoura Dermatology, Venereology and Leprology Hospital, Mansoura, Egypt Department of Dermatology, University of Studies Guglielmo Marconi, Rome, Italy Correspondence Ayman Abdelmaksoud, Mansoura Dermatology, Venereology and Leprology Hospital, Mansoura, Egypt. Department of Dermatology, University of Studies Guglielmo Marconi, Rome, Italy, Email: behcet.behcet@yahoo.comSearch for more papers by this authorUwe Wollina, Uwe Wollina orcid.org/0000-0001-5933-2913 Department of Dermatology and Allergology, StädtischesKlinikum Dresden, Academic Teaching Hospital, Dresden, GermanySearch for more papers by this authorSelami Aykut Temiz, Selami Aykut Temiz orcid.org/0000-0003-4878-0045 Necmettin Erbakan University Meram Medical Faculty, Department of Dermatology, Konya, TurkeySearch for more papers by this authorMichelangelo Vestita, Michelangelo Vestita orcid.org/0000-0002-2203-0353 Unit of Plastic and Reconstructive Surgery, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USASearch for more papers by this author Dharmendra Dineshchandra Dave, Dharmendra Dineshchandra Dave Consultant Dermatologist at Dave Skin & Laser Clinic, Patan, IndiaSearch for more papers by this authorAyman Abdelmaksoud, Corresponding Author Ayman Abdelmaksoud behcet.behcet@yahoo.com orcid.org/0000-0003-4848-959X Mansoura Dermatology, Venereology and Leprology Hospital, Mansoura, Egypt Department of Dermatology, University of Studies Guglielmo Marconi, Rome, Italy Correspondence Ayman Abdelmaksoud, Mansoura Dermatology, Venereology and Leprology Hospital, Mansoura, Egypt. Department of Dermatology, University of Studies Guglielmo Marconi, Rome, Italy, Email: behcet.behcet@yahoo.comSearch for more papers by this authorUwe Wollina, Uwe Wollina orcid.org/0000-0001-5933-2913 Department of Dermatology and Allergology, StädtischesKlinikum Dresden, Academic Teaching Hospital, Dresden, GermanySearch for more papers by this authorSelami Aykut Temiz, Selami Aykut Temiz orcid.org/0000-0003-4878-0045 Necmettin Erbakan University Meram Medical Faculty, Department of Dermatology, Konya, TurkeySearch for more papers by this authorMichelangelo Vestita, Michelangelo Vestita orcid.org/0000-0002-2203-0353 Unit of Plastic and Reconstructive Surgery, Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USASearch for more papers by this author First published: 05 April 2022 https://doi.org/10.1111/dth.15493Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article. Early ViewOnline Version of Record before inclusion in an issuee15493 RelatedInformation