BACKGROUND: Hypersensitivity reactions occurring within minutes after intravascular injection of iodinated radiocontrast media (RCM) are not rare and have been previously considered to be nonallergic. However, in the last decades, evidence is increasing that genuine RCM allergy may present as either full-blown anaphylaxis or delayed exanthematous skin reaction. OBJECTIVES: We aimed to assess whether allergy diagnostics including skin and provocation testing can differentiate between nonallergic and allergic RCM hypersensitivity by identifying the causative RCM as well as tolerated alternative RCM. METHODS: We retrospectively evaluated clinical and diagnostic data from 45 consecutive patients with RCM hypersensitivity. RESULTS: Immediate nonallergic RCM hypersensitivity was diagnosed in 21 patients, immediate-type RCM allergy in 11, delayed-type RCM allergy in 11, and delayed-type iodine allergy in 2. All patients with immediate-type RCM allergy had a history of moderate to severe anaphylaxis. Eleven of 13 patients with delayed-type allergic reactions including the 2 cases of iodine allergy suffered from maculopapular exanthem developing several hours to days after exposure, 1 was a systemic hypersensitivity syndrome, and 1 a fixed drug eruption. Of 18 RCM-allergic patients tested, all tolerated an alternative RCM in the intravenous provocation. CONCLUSIONS: The diagnostic sensitivity of intradermal RCM testing to identify allergic patients is high in both immediate-type and delayed-type RCM allergy. Intravenous provocation with a skin test-negative RCM is safe and enables identification of a tolerated alternative RCM. Additional skin testing of iodine solution is required to identify patients with iodine allergy. (C) 2019 American Academy of Allergy, Asthma & Immunology.

ZusammenfassungKutane Lymphome präsentieren sich klinisch und histologisch oftmals ungewöhnlich und stellen nicht selten eine diagnostische Herausforderung für den Dermatologen dar. In dieser Arbeit werden die vielgestaltigen Präsentationsformen der Mycosis fungoides und anderer kutaner Lymphome anhand von Fallbeispielen aus der Würzburger Spezialsprechstunde für kutane Lymphome vorgestellt und ein Überblick über die Verwechslungsmöglichkeiten mit anderen Dermatosen gegeben.

the anti-programmed death-1 (PD-1) antibody pembrolizumab, routinely used for treatment of metastatic melanoma or non-small cell lung cancer, was recently shown to have clinical meaningful activity in metastatic Merkel cell carcinoma (MCC). Several cases of bullous pemphigoid (BP) induced by PD-1 antibodies in melanoma have been reported so far. Here we report a case of oral mucous membrane pemphigoid (MMP) - a previously unknown, severe immune-related adverse event (irAE) occurring during pembrolizumab therapy. This article is protected by copyright. All rights reserved.

vedotin to 4 weeks, as initial neuropa thy could not be excluded with certainty; otherwise, the patient did not experience any serious (> grade 2) complications like neutropaenia, sensorimotor neuropathy or infections under this treatment and presented with a good quality of life. However, 16 months after the start of brentuximab vedotin and 8 months after initiation of combination therapy, ECP was discontinued due to repetitive failure to achieve sufficient vascular access and further refusal by the patient. After discontinuation of this combined treatment, blood and skin manifestations were rapidly progres - sive and refractory to next-line treatment with bendamustine and the patient died 9 months after discontinuation of brentuximab vedotin/ECP treatment.

Microwaves are tested as a new treatment for human papilloma virus (HPV)-related cutaneous warts in a pilot phase I open label uncontrolled study. Microwaves have been applied to thermally ablate inoperable liver tumours, but have not previously been used on the skin [1]. In this issue of the European Journal of Dermatology, Bristow et al. present a study of 32 adult volunteers who were recruited with 54 refractory plantar warts, present for more than a year, with at least two failed treatments. [...]

Angiosarcoma (AS) is a rare but highly malignant soft tissue sarcoma originating from the vascular endothelium that shows heterogeneous clinical and histopathological features. AS classically develops on sun-exposed skin (idiopathic AS), but may also arise at sites of chronic lymphoedema or previous radiotherapy (secondary AS). AS developing after lymphoedema due to axillary lymph node dissection in breast cancer patients is referred to as Stewart-Treves syndrome.There are three histopathological [...]

Biological agents (BAs) have been prescribed for inflammatory dermatoses for the past two decades. The most frequent side effects (infections) are now very well documented, but rare side effects are sometimes difficult to characterise. Clinical reports of monoclonal gammopathy of undetermined significance (MGUS) while being treated with a BA (notably TNFα-inhibitors) have been reported [1], however, the involvement of BAs continues to be a matter of debate [2]. In this issue of the European Journal [...]

Immunotherapy for melanoma patients is a promising treatment option, as clinical evidence of the use of systemic CTLA4- and PD1-antibodies has demonstrated. With the exception of unresectable melanoma patients, there is a great need for an adequate therapeutic option for patients with locally advanced melanoma (stage III). In this issue of the European Journal of Dermatology, Seledtsova et al.[1] report their investigations on the treatment of stage III melanoma patients with a xenogeneic cell-based [...]

1 Dermatology Department, Box 46, Addenbrooke’s Hospital, Hills road, Cambridge, CB2 0QQ, UK e-mail: alanadurack@yahoo.com 2 Dermatology Department, Hospital de Santo António dos Capuchos, Centro Hospitalar de Lisboa Central, Alameda Santo António dos Capuchos 1169-050, Lisbon, Portugal e-mail: joanacabete@gmail.com 3 Department of Dermatology, Venereology and Allergology, University Hospital Wuerzburg, Josef-Schneider-Str. 2, 97080 Wuerzburg, Germany e-mail: Behle_V@ukw.de 4 Dermatology Department, Hôpital Edouard Herriot, Lyon, France e-mail: axel.villani@gmail.com 5 Department of Dermatology and Venereology, Hôpital de Beaumont, Lausanne University Hospital Center, Av. de Beaumont 29, CH-1011 Lausanne, Switzerland e-mail: Francois.Kuonen@chuv.ch 6 Dermatology Department, General University Hospital “Gregorio Marañon”, C/ Doctor Esquerdo 46, 28007 Madrid, Spain and Dermatology Department, Clinica Dermatologica Internacional and Clinica Ruber, Madrid, Spain e-mail: alejandromartingorgojo@aedv.es

A 24-year-old male presented with a subcutaneous tumour measuring approximately 10 cm in diameter on his left thigh. The tumour appeared firm on palpation and did not show epidermal alterations (figure 1A). The patient reported that the lesion had been slowly growing in size over a period of a few months. He denied symptoms such as pain, itching or bleeding. Since the patient had already been diagnosed with neurofibromatosis type 1 (NF1) several years before, and since he suffered from multiple [...]

Fingolimod-related viral infections have been described on several occasions since its introduction in 2010. We hereby add a report on an otherwise immunocompetent, 18-year old Caucasian man with relapsing-remitting multiple sclerosis who developed a protracted and extensive molluscum contagiosum (MC) virus infection shortly after being started on fingolimod. Wide-spread cutaneous MC infections in adult patients are considered indicative of underlying immunosuppression. Neurologists prescribing fingolimod ought to be aware of a possibly increased risk of MC, but also need to know about its relative benignity, lack of extra-cutaneous complications, and adequate treatment options.

Introducing the new subsection: Seriously saRComa! Cutaneous sarcomas are a heterogenous group of tumours with multifaceted clinical features. Although rare, their malignant potency underlines the importance of recognizing them at an early stage to ensure that treatment can be successful. In order to sensitize residents to these comparatively rare entities, we introduce this new subsection in the Residents’ Corner of the European Journal of Dermatology. Seriously saRComa! Dermatofibrosarcoma [...]

A 79-year-old female presented with multiple, red to skin-coloured, firm papules on the dorsum of her nose, spread over an area of 3.0 × 2.5 cm. The diameter of single papules was between 3 and 5 mm (figure 1). She reported that a skin tumour had been excised on her nose 4 months before and that it had been histologically diagnosed as an atypical fibroxanthoma (AFX). In the light of this diagnosis and the suspicion of a rapid and extensive relapse, wide local excision was performed. Due to anatomical [...]