Aim Alopecia areata(AA) is a chronic, non-scarring inflammatory disorder that affects hair follicles on the scalp and body.It is increasingly recognized that AA is not merely a dermatological condition limited to localized hair loss but may also be associated with systemic inflammatory processes. Materials and methods This retrospective study included male and female patients older than 4 years of age who were treated with topical diphenylcyclopropenone(DPCP) for moderate-to-severe AA between August 2023 and August 2024.The study comprised 19 female and 19 male patients.Patients who received topical DPCP treatment for AA and underwent complete blood count(CBC) analysis both before and after treatment were included. Results Of the 38 AA cases included in the study, 19 were female(50.0%).The mean Severity of Alopecia Tool(SALT) score at baseline was 87.76 ± 21.80(range: 25-100), while the mean SALT score at Month 6 was 60.21±41.33(range: 0-100), indicating a significant reduction in disease severity(p < 0.01). Significant changes were observed in lymphocyte counts(p = 0.01) and the platelet-to-lymphocyte ratio(PLR, p = 0.02) following treatment.When evaluating which hematological and inflammatory parameters predicted the SALT score at Month 6, an exploratory regression analysis(Adjusted R2 = 0.101) showed that only the change in lymphocyte levels was associated with treatment response(β = 0.354, p = 0.029). Conclusion Our findings suggest that, based on sixmonth evaluation results,DPCP may be an effective treatment option for AA.While it modulates local inflammation, it appears to have a limited effect on systemic immunity; however, this does not result in any significant adverse alterations in hematological and inflammatory biomarkers.Current data suggest that topical DPCP treatment demonstrated a potentially acceptable hematological safety profile in the short-tomedium term.Furthermore, the change in lymphocyte levels may emerge as a potential biomarker for predicting treatment response.

Benign melanosis of the nipple and areola is a rare pigmentary disorder that may clinically mimic malignant melanoma and pigmented Paget's disease, particularly during pregnancy. We report a 30-year-old woman at 28 weeks' gestation who presented with bilaterally asymmetric, heterogeneously hyperpigmented macules on the nipples and areolae. Dermoscopy revealed a prominent and regular pigment network with heterogeneous light-and dark-brown coloration. Multiple punch biopsies were performed to exclude melanoma in situ. Histopathological examination showed irregular acanthosis and increased basal layer pigmentation without melanocytic atypia. Immunohistochemical staining demonstrated scattered MART-1-and HMB-45-positive melanocytes without an increase in number, supporting the diagnosis of benign melanosis of the nipple and areola. The coexistence of vitiligo represents a rare and noteworthy feature of this case. This report emphasizes the importance of histopathological evaluation in differentiating benign melanosis from malignant pigmented lesions in pregnant patients.

BACKGROUND:Palmoplantar psoriasis exhibits greater treatment resistance compared to other psoriatic plaques and presents clinical and histopathological overlap with palmoplantar eczema. This study aimed to investigate treatment resistance mechanisms in palmoplantar psoriasis and assess the contribution of IL-17, IL-23, and IL-36α to the differential diagnosis of palmoplantar psoriasis and eczema. Immunohistochemical levels of these cytokines were measured in paired acral and non-acral psoriatic samples. METHODS:We retrospectively included 73 patients: 25 with only palmoplantar psoriasis, 25 with palmoplantar eczema, and 23 with both conditions and concurrent plaque psoriasis. Clinical and histopathological diagnoses were confirmed. Immunohistochemical analyses were conducted using preparations stained for IL-17, IL-23, and IL-36α. RESULTS:In psoriasis cases, immunohistochemical examination of biopsies from both body and palmoplantar regions showed lower IL-17 and IL-36α expression in acral regions compared to non-acral regions. In palmoplantar eczema patients, IL-17 and IL-23 expression was higher than in palmoplantar psoriasis patients; however, IL-36α expression was similar in both conditions. CONCLUSIONS:The diminished expression of IL-17 and IL-36α in palmoplantar psoriasis compared to other body sites may contribute to variable responses to targeted treatments. These findings suggest the potential for developing distinct biological treatments for these regions.

Introduction: Psoriasis is a chronic, immune-mediated inflammatory disease characterized by erythematous, scaly plaques. Secukinumab is an interleukin-17A inhibitor with proven efficacy in the treatment of moderate-to-severe psoriasis. Objective: The aim of this study was to present a case of papillary thyroid carcinoma occurring in a patient with psoriasis treated with secukinumab. Case report: The patient had previously been treated with methotrexate for 1.5 years and with secukinumab for 2 years and 9 months. In this case, papillary thyroid carcinoma may have developed de novo or in association with secukinumab therapy. Conclusions: The relationship between anti-psoriatic therapies and the development of malignancies remains unclear and requires further physical examination, and appropriate laboratory and radiological evaluation, should be performed before and during treatment with biological agents due to the potential risk of malignancy.

BACKGROUND:Lichen planus (LP) is an idiopathic, chronic, inflammatory dermatosis that can affect the skin, its appendages, and mucous membranes. Chronic inflammatory dermatoses may contribute to metabolic complications and increase cardiovascular risk. This study aimed to evaluate cardiovascular risk in patients with LP by assessing the Plasma Atherogenic Index (PAI) and Epicardial Adipose Tissue (EAT) thickness. METHODS:A case-control study was conducted, including a total of 150 individuals, comprising 75 patients with LP and 75 age-, sex-, and body mass index (BMI)-matched controls. Lipid profiles were analyzed, and the PAI (log10[triglycerides (TG)/high-density lipoprotein cholesterol (HDL-C)]) was calculated. EAT thickness was measured using transthoracic echocardiography. RESULTS:In the study, 40% of participants were male and 60% female in both groups. Dyslipidemia was identified in 66.7% of the case group and 50.7% of the control group, with the presence of dyslipidemia being significantly higher in the LP group (p < 0.05). Among the cases, 82.7% were in the high, 6.7% in the moderate, and 10.7% in the low cardiovascular risk category. PAI values and mean EAT thickness were significantly higher in the LP group than in controls (both p < 0.05). CONCLUSIONS:The findings support an association between LP and markers of increased subclinical cardiovascular risk rather than established cardiovascular disease. Early recognition and regular screening for cardiometabolic risk factors in dermatology practice, as well as multidisciplinary collaboration with cardiologists, may help prevent long-term cardiovascular complications in patients with LP.

OBJECTIVES:Early-stage mycosis fungoides (MF) is diagnostically challenging due to overlap with inflammatory dermatoses. Age-related immunological and cutaneous changes may modify histopathological presentation. We aimed to compare clinical, histopathological and immunophenotypic features of early-stage MF between geriatric and non-geriatric patients. DESIGN:Multicentre retrospective cross-sectional study. SETTING:Dermatology departments of tertiary centres in Türkiye. PARTICIPANTS:A total of 541 patients diagnosed with early-stage MF were included and stratified into geriatric (≥65 years) and non-geriatric (18-64 years) groups. PRIMARY AND SECONDARY OUTCOME MEASURES:The primary outcomes were age-related differences in histopathological and immunohistochemical features. Secondary outcomes included clinical characteristics and quality of life measures. Primary endpoints were prespecified a priori (epidermotropism, basilar lymphocytes, epidermal atrophy, dermal lymphocytic infiltration, papillary dermal fibrosis and CD4-dominant versus CD8(+)/CD4(-) phenotypes); all other comparisons were considered exploratory. RESULTS:The geriatric group had a higher proportion of males (59.5% vs 47.1%; p=0.004), while lesion type, duration, surface involvement and Dermatology Life Quality Index scores did not differ between groups. Histopathologically, epidermotropism (81.3% vs 63.3%), basilar lymphocytes (57.1% vs 45.7%), epidermal atrophy (26.6% vs 13.8%), dermal lymphocytic infiltration (75.8% vs 58.5%) and papillary dermal fibrosis (55.2% vs 38.4%) were more frequent in geriatric patients (all p<0.05). Plasma cells (13.5% vs 6.2%) and eosinophils (21.8% vs 13.8%) were also increased. A CD4-dominant phenotype was more common in geriatric patients (70.2% vs 60.6%; p=0.043), whereas a CD8-positive/CD4-negative phenotype was more frequent in non-geriatric patients (8.5% vs 2.6%; p=0.012). However, histopathological and immunohistochemical variables were extracted from existing routine pathology reports without central slide re-review, harmonised scoring criteria or adjudication; therefore, the reported frequencies may partly reflect intercentre/interobserver reporting practices and temporal changes in diagnostic work-up (eg, immunohistochemistry panels and reporting terminology) in addition to biological differences. CONCLUSIONS:Although clinical characteristics were comparable across age groups, geriatric patients showed differences in reported histopathological and immunophenotypic features; these observations may facilitate clinicopathological recognition of early-stage MF in older individuals. However, some features (particularly epidermal atrophy and superficial/papillary fibrosis) are not MF-specific and may partly reflect background age- and site-related changes.

BACKGROUND:Psoriasis is a chronic systemic inflammatory disease mediated by the immune system. Interleukin-23 (IL-23) plays a key role in its pathogenesis by amplifying inflammation, triggering atherogenic dyslipidemia and insulin resistance, and thereby increasing cardiovascular and cerebrovascular risk. This study aimed to evaluate the effect of the IL-23 inhibitors risankizumab and guselkumab, used in psoriasis treatment, on cardiovascular and cerebrovascular risk through the plasma atherogenic index (PAI) and triglyceride-glucose (TyG) index. METHODS:This retrospective study included 110 patients diagnosed with psoriasis and treated with risankizumab (n = 61) or guselkumab (n = 49). Psoriasis Area and Severity Index (PASI) scores, triglyceride (TG), high-density lipoprotein cholesterol (HDL-C), total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), very low-density lipoprotein cholesterol (VLDL-C) levels and fasting blood glucose (FBG) values at baseline and at 6 months of treatment were obtained from patient records. The plasma atherogenic index (PAI) was calculated as log₁。(TG/HDL-C), and the triglyceride-glucose (TyG) index as log₁。(TG × FBG / 2). RESULTS:In both IL-23 inhibitor groups included in the study, PASI scores, PAI, and TyG index values showed a significant decrease from baseline at the 6th month of treatment (p < 0.05). However, there was no significant difference in the reduction of index levels between the groups (p > 0.05). CONCLUSION:IL-23 inhibitors can reduce atherogenic dyslipidemia and insulin resistance alongside dermatological improvement in the treatment of psoriasis. This suggests a potential role for these agents in reducing the risk of cardiovascular and cerebrovascular disease. However, large-scale, long-term studies are needed to confirm these beneficial effects.

Lichen planus (LP) is a chronic inflammatory disease affecting squamous epithelia, potentially impacting various epithelian surfaces, particularly the skin, oral mucosa, and nails. Mucosal involvement is clinically significant due to its influence on disease course and complications. Mucociliary activity plays a critical role in the defense mechanisms of the respiratory tract, and the potential impact of LP on this activity remains unknown. This study aims to investigate changes in nasal mucociliary activity (NMCT) in patients with LP and to examine the effects of any changes on respiratory health. The study included 30 patients with LP and 31 healthy controls. NMCT was measured using the saccharin transit time test. A 1 mm3 saccharin tablet was placed approximately 1 cm posterior to the anterior edge of the inferior turbinate in the left nasal cavity of each participant. NMCT was measured with a chronometer. NMCT in LP patients was 9.890 ± 1.800 min, while in the control group, it was 7.835 ± 1.530 min (p < 0.001). NMCT was significantly longer in LP patients with oral mucosal involvement compared to those without mucosal involvement (p = 0.044). NMCT tended to be longer in patients with nail involvement, but this difference was not statistically significant (p = 0.096). Prolonged mucociliary clearance in patients with LP (especially those with mucosal involvement) may increase the risk of respiratory tract infections and negatively impact patients’ quality of life. This finding highlights the importance of evaluating NMCT in LP patients and investigating potential therapeutic interventions to improve it.

Purpose/Aim of the study: The efficacy of bimekizumab was shown in moderate to severe plaque psoriasis. The aim of this study was to investigate the early super responder (ESR) profile (at week 4) to bimekizumab.Materials and Methods: We performed a multicenter retrospective study in 20 Dermatology outpatient clinics in Turkey. Adult patients with moderate-to-severe psoriasis who were under bimekizumab for at least 12 weeks were enrolled.Results: A total of 341 adult patients were included. 136 had nail psoriasis (39.9%), 148 had psoriatic arthritis (PsA) (43.4%), 223 (65.4%) had at least one difficult-to-treat area involvement, 155 (45.5%) were bio-naïve, 110 (32.5%) had ≥ 2 biologics history. At week 4, PASI75 was achieved in 144 patients (49.8%), PASI90 was achieved in 88 patients (30.4%), PASI100 was achieved in 51 patients (17.6%). Family history (p = 0.041), palmoplantar involvement (p = 0.008), PsA (p = 0.097), and bio-experienced status (p = 0.060) were associated with lower odds of being an ESR, whereas each 1-point increase in baseline PASI was associated with significantly lower odds of ESR (p < 0.001). Gender, age, disease duration, history of conventional systemic treatment, and presence of any comorbidity were not significantly associated with the likelihood of being an ESR (all p > 0.05).Conclusion: Bimekizumab is the effective treatment in both bio-naïve and bio-experienced patients; however, it may have a more rapid onset of action in bionaive patients. Further studies are needed on the long-term efficacy and safety data of bimekizumab.

Aim: Tzanck smear is a diagnostic tool where the structural characteristics of cells are examined under microscope after undergoing various staining procedures. It is a cost-effective and reliable application that aids clinicians in the diagnostic process in many fields, particularly dermatology. Bibliometric analysis is an methodology that visualizes study topics, authors, countries, and trends in a scientific field, accompanied by numerical data. This study presents a bibliometric analysis of the Tzanck smear literature. Materials and Methods: Web of Science database was used for literature search; VOSviewer and Biblioshiny software were preferred for bibliometric analysis. Results: According to the bibliometric data obtained, herpes and pemphigus group diseases have been the central focus of Tzanck smear studies. Recently, while these two topics have maintained their trend, there has been an increase in Tzanck smear publications related to the Monkeypox virus. The leading authors in terms of publication count are Durdu M, Seckin D, and Folkers E, while the most cited authors are Durdu M, Leonardi CL, and Nahass GT. The leading countries in publishing studies on Tzanck smear are the United States, India, and T & uuml;rkiye. Journals receiving the most publications and citations on Tzanck smear include the Journal of the American Academy of Dermatology, International Journal of Dermatology, Indian Journal of Dermatology, Venereology and Leprosy, Journal of the American Medical Association, and Archives of Dermatology. Conclusion: In this study, an attempt was made to create quantitative maps of studies conducted on the topic of Tzanck smear. This study fills an important gap in the literature by representing the first comprehensive bibliometric analysis specifically focused on the topic of Tzanck smear. A review of the literature shows that researchers, countries, and journals have demonstrated varying trends regarding Tzanck smear over the years. The statistical evaluation of these trends through bibliometric analysis can provide a roadmap for researchers planning to work on this topic when designing their studies.

Methotrexate (MTX) is commonly used as first-line systemic treatment agent in psoriasis. We aimed to evaluate the clinical characteristics and treatment responses of patients with psoriasis undergoing MTX monotherapy. Data from adult patients with plaque psoriasis who received MTX monotherapy for at least 3 months between April 2012 and April 2022 were retrospectively evaluated in 19 tertiary care centers. Our study included 722 female and 799 male patients, a total of 1521 participants. The average age of the patients was 44.3 ± 15.5 years. Mode of treatment was oral in 20.4

Introduction: Pemphigus vulgaris (PV) is an autoimmune disease that mostly affects the oral mucosa. Objectives: This study aimed to determine the demographic, clinical and treatment characteristics as well as the quality of life of patients with PV and oral mucosal involvement. Methods: We conducted a prospective observational study among 106 patients with PV and oral mucosal involvement. Demographic data, clinical and treatment characteristics, and quality of life questionnaires were recorded. Results: Of the 106 patients, 51.89% were males. Mucocutaneous subtype was found in 78.38% of the patients. The initial localization of 41.51% of the patients was only the oral mucosa. Involvement of the bilateral buccal mucosa was observed most frequently in the patients and burning was the most common symptom (85.85%). Oral mucosal examination revealed erosions in 85.85% of the patients. The most frequently used treatment agent in the patients was a systemic steroid, and rituximab used in 16.98% patients. A positive and significant correlation was found between pemphigus severity and OHIP14-TR, DLQI, and DYQS scores (p < 0.05). The quality of life was more significantly adversely affected in those with superficial ulcers, loose bullae, lesion diameter of 1 cm and above, and the number of lesions above 10 in the oral mucosa. Complet response was observed in all patients using rituximab. Conclusions: The most common area of involvement was bilateral buccal mucosa, and the quality of life was affected in correlation with the severity of the disease.

ABSTRACT:68 Ga-prostate-specific membrane antigen (PSMA) PET/CT scan for restaging revealed increased 68 Ga-PSMA uptake in cutis verticis gyrata (CVG) in a patient with prostate cancer. Cutis verticis gyrata is an uncommon disorder in which the scalp thickens and mimics the cerebral cortex with deep grooves and folds. Several studies have demonstrated 68 Ga-PSMA uptake in noncancerous conditions. This case illustrates another instance of a benign illness accompanied by increased 68 Ga-PSMA uptake.

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.

Introduction There is evidence that exercises that work the facial and neck muscles that create facial expressions and facilitate lymph circulation with their movements are effective in facial rejuvenation and keeping facial youthfulness. This study aims to determine the awareness of facial aging and the methods affecting this process, especially facial exercises/facial yoga. Materials and Methods A 15-question survey was created to question awareness and preferences for facial aging, protecting facial youth and facial rejuvenation methods. The survey was shared online on social media apps. Statistical analyzes were performed. Results The majority of volunteers were female (85.1%), between 25-34 years of age (32%), university graduates (44%), with income equal to expenditure (77%), and healthcare workers (26%). Individuals were most disturbed by the changes around the eyes (34%). Most of the participants had heard of facial rejuvenation (82%) and facial exercises (86%) before, but very few (23%) had applied them. Conclusions It was determined that individuals were aware that facial exercises were effective in facial rejuvenation, but they did not apply them. Making a habit of facial exercises at a young age and adding them to other non-invasive methods can delay the aging of the face and the transition to some costly invasive procedure.

Abstract Diagnosis of early-stage MF, there are molecular studies that include Bcl-2 and ki-67, but there is no study showing that mast cells can be used both in the diagnosis of early-stage MF and in the etiopathogenesis of MF. In our study, we aimed to show that Ki-67, Bcl-2 and mast cell staining, which can be easily obtained in every laboratory, are helpful markers in the diagnosis of early-stage MF. Methods: A total of 81 cases, including 27 Mycosis Fungoides, 27 benign inflammatory dermatoses (psoriasis, lichen planus, eczema) and 27 patients without any disease, were included in the study retrospectively. Ki-67, Bcl-2 and mast cell counts were made under a light microscope with stained slides. Results: Mast cells were found to be significantly higher in cases of mycosis fungoides compared to cases of benign inflammatory dermatosis (p>0.001). In mycosis fungoides cases, ki-67, Bcl-2 and mast cells were significantly higher compared to the control group (p>0.001). In benign inflammatory dermatosis cases, ki-67 and Bcl-2 were found to be significantly higher than the control group (p>0.001). Conclusion: MF lesions are initially included in the differential diagnosis of many diseases including eczema, psoriasis, and lichen planus. In this case, histopathological examination is used in order to reach a clear diagnosis. Ki-67, Bcl-2 and mast cells were found significantly higher in MF patients compared to the control group. However, no difference was found between MF and benign inflammatory dermatoses in ki-67 and Bcl-2 staining.

Acute generalized exanthematous pustulosis (AGEP) is a severe cutaneous adverse reaction characterized by the rapid development of nonfollicular, sterile pustules on an erythematous base.AGEP is mainly caused by drugs in most cases, there have been few reports of AGEP associated with viral infections. 1,2Several drugs such as antimalarials (chloroquine and hydroxychloroquine), lopinavir/ritonavir, ribavirin, interferon, oseltamivir, remdesivir, favipiravir, darunavir and so on are prescribed for the treatment of COVID-19.AGEP, morbilliform drug eruptions, vasculitis, DRESS syndrome, urticarial vasculitis, and others have been reported due to these drugs.4][5][6] There are no adverse cutaneous events that have been reported to date caused by favipiravir. 7Here, we report an AGEP case due to favipiravir COVID-19 because of its rarity.A 54-year-old man referred to our clinic with widespread extremely pruritic pustular lesions 2 weeks after recovering from COVID-19.He had a history of COVID-19, 1 month before these skin lesions.At that time, his PCR was positive, he was treated with oral favipiravir, enoxaparin for 7 days, and he was symptom-free for 2 weeks.The pustular lesions first appeared on his face and neck and then spread to his trunk and other parts of the body with an erythematous base, and he has no mucosal involvement.In his laboratory tests, leucocyte:13.940,aspartate aminotransferase (AST):57, alanine aminotransferase (ALT):42.3,C-reactive protein:109 were high.He was febrile for a short period.So, he did not use an antiinflammatory agent or antipyretic agent.He had no history of other diseases and pustular psoriasis, psoriasis, or psoriatic arthritis.He had no other medications.The histopathological examination of punch biopsy specimen from trunk lesion showed linear neutrophilic parakeratosis with crust, focal hypergranulosis, acanthosis, and mild spongiosis of epidermis.There was papillary edema and subcorneal