Background/objective Hidradenitis suppurativa (HS) is a chronic inflammatory disease affecting apocrine gland areas, characterized by painful nodules and abscesses that may result in sinus tracts and scarring. The global prevalence of HS is increasing due to heightened awareness, improved diagnostic methods, rising obesity rates, and higher smoking prevalence. This study aimed to describe the epidemiological, clinical, and comorbid characteristics of HS patients.Methodology This retrospective descriptive cross-sectional study included 193 outpatients aged between 15 and 73 years who visited a tertiary HS clinic between 2017 and 2022. Demographic, clinical, and comorbid characteristics were recorded and analyzed using chi-square and ordinal regression methods.Results The mean age was 34.5 +/- 12.1 years, with a mean disease duration of 5.9 +/- 6.7 years. According to the Hurley classification, 61.1, 24.4, and 14.5% were stages I, II, and III, respectively. Comorbidities were present in 48.2% of patients, with psychiatric disorders (19.2%), diabetes mellitus (14%), and hypertension (9.3%) being most common. Disease duration, smoking, male gender, and atypical localization were associated with increased disease severity.Conclusion Geographic and cultural factors influence the prevalence, severity, and management of HS, necessitating tailored treatment. Effective management requires multidisciplinary screening for early detection and prevention of comorbidities, including psychiatric disorders, cardiovascular conditions, and metabolic syndrome.

Background: Psoriasis is a common, chronic, inflammatory disease. Although it mainly affects the skin, it has been associated with a large number of comorbidities. In addition to comorbidities such as depression and psoriatic arthritis, it is known that there is an increased prevalence of cancer in psoriasis patients. Skin cancers, particularly squamous cell carcinoma, have been associated with psoriasis. However, basal cell carcinoma data are limited. Methods: 346 psoriasis patients and 306 individuals were selected as the control group. There were no differences between the patient and control groups in terms of age and gender. The mean age of the psoriasis patients was 49.9 +/- 15.8 years and the control group was 49.4 +/- 13.4 years. Sociodemographic data of the patients were recorded. Pharmacological agents used in the treatment of psoriasis were included in the analysis. Disease severity was assessed by the psoriasis area severity index (PASI). In the physical examination of the patients, biopsies were taken from lesions suspicious for BCC. BCC diagnosis was made by histopathologically. Results: The frequency of BCC was higher in psoriasis patients than in the control group (6.6% vs. 2.9%, p < .001). Advanced age (p < .001), smoking (p = .003), and arthritis (p < .001) were associated with BCC in psoriasis patients. However, there was no relationship between PASI and BCC (p = .142). Among the psoriasis treatments, only UV therapy was associated with BCC (p = .038). The frequency of PUVA (p < .001) and number of PUVA session (p = .010) was higher in psoriasis patients with BCC rather than NB-UVB. Conclusion: The frequency of BCC is increased in psoriasis patients. Psoriasis is associated with an increased risk of BCC, especially when treated with PUVA therapy for a long time.

[This corrects the article DOI: 10.1016/j.waojou.2022.100724.].

Background and Design: The aim of this study is to enhance the diagnosis and treatment of basal cell carcinoma (BCC) by comparing clinical, dermoscopic, and pathological features. Materials and Methods: This retrospective study included patients from the dermatology clinic between 2012 and 2015 with 111 BCC lesions. Results: The average age for aggressive-type BCC patients was higher. Aggressive-type BCCs were more common on the face. Dermoscopic, gray-blue ovoid nests were more common on the trunk. Pigmented dots were less common on the face, while globules were more frequent on the scalp. Small erosions were more prevalent on the extremities, while shiny white-red structureless areas were more common on the trunk and extremities. Dot vessels were more prevalent on the scalp. Vascular features were more common on the face, whereas pigmented characteristics were less common. Other dermoscopic features were more common on the face and trunk. Arborizing vessels, ulcerations, white crystals, and hairpin vessels were more common in nodular lesions. Other dermoscopic features were more prevalent in nodular lesions. Mixed-type BCCs had more gray-blue ovoid nests and globules, while single-type BCCs had more small erosions. Vascular features were more common in mixed-type BCCs. Ulceration was more common in aggressive BCCs, while small erosions were more prevalent in nonaggressive BCCs. Histopathologically, pigmented BCCs were more common on the scalp and trunk than on the face. Superficial BCCs were more common in trunks and flat lesions. Adenoid BCC was more prevalent in nodular lesions. Scalp mixed-type BCCs were more common and aggressive. Mixed-type BCCs had a higher number of subtypes, including pigmented, infiltrative, adenoid, micronodular, and solid BCCs. Cystic degeneration was more common in mixed-type BCCs. Conclusion: Clinical-pathological correlations and dermoscopic findings improve our understanding of BCC, aiding in accurate diagnosis and management.

Aims: The systemic and respiratory clinical manifestations of coronavirus disease 2019 (COVID-19) include fever, cough, sneezing, sore throat, rhinitis, dyspnoea, chest pain, malaise, fatigue, anorexia, and headache. Moreover, cutaneous manifestations have been observed in 0.2% to 20.4% of cases. This investigation further explores the dermatological manifestations associated with COVID-19 and reactions induced by its pharmacological treatments. Conducted at a university hospital, the study examined 841 patients and identified skin manifestations in 1.5% of cases. It differentiates between symptoms directly attributed to the viral infection and those arising from treatment, highlighting the need for clinical vigilance and adaptability in managing these manifestations. COVID-19 has been linked to a wide range of clinical symptoms, extending beyond the well-known respiratory effects to include various dermatological manifestations. These manifestations, which range from mild rashes to severe conditions like vasculitis, may complicate diagnosis and management, particularly when similar symptoms are induced by therapeutic drugs used in COVID-19 treatment. Methods: This cross-sectional study included 841 patients treated in the COVID-19 outpatient and inpatient units of the university hospital between March and May 2020. The assessment involved clinical examinations and telemedicine consultations, focusing on differentiating between viral and drug-induced dermatological reactions. Results: Dermatological manifestations were observed in 1.5% of the 841 patients. Direct virus-related skin changes were noted in 1% (n=8) of patients, including maculopapular eruptions (50%, n=4) on the face and trunk, trunk-localized urticaria (25%, n=2), and purpuric lesions (12.5%, n=1) on the lower extremities. Drug-induced dermatological reactions were identified in 0.5% (n=5) of patients, featuring conditions such as bullous drug reactions, psoriasiform drug eruptions, hypertrichosis, and urticaria. Conclusion: These findings highlight the complex interplay between COVID-19 and its treatment, where both the virus and pharmacological agents can trigger significant dermatological reactions. The need for healthcare providers to consider both viral and drug-induced factors in the diagnosis and management of skin manifestations in COVID-19 patients is underscored. Further studies are essential to refine treatment protocols and reduce adverse dermatological outcomes.

Abstract Introduction Topical therapies are used in almost all patients with psoriasis. A novel fixed topical combination cream (GN-037) with a lower concentration (0.0356%) of clobetasol 17-propionate (CP) was developed together with urea, salicylic acid, and retinoic acid to provide a better benefit–risk ratio. The present multicenter randomized double-blind vehicle-controlled parallel group phase 2 study aimed to investigate the efficacy and safety of GN-037 in patients with mild-to-moderate plaque psoriasis (MMPP). Methods Patients (n = 190) were randomized (2:2:1) to receive GN-037 or CP or vehicle (V) cream twice daily to a selected target body lesion for 4 weeks. The primary endpoint was treatment success defined as percentage of patients with at least two-grade improvement in Investigator’s Global Assessment Score (IGA) and IGA score equal to 0 or 1 evaluated at weeks 2, 4, 6, and 8 in each arm compared with baseline. Treatment-emergent adverse events (TEAEs) and safety were evaluated throughout the study. Results GN-037 demonstrated statistically significant superiority over V throughout the study. At week 4, treatment success was achieved in 37.9% of patients in the GN-037 arm compared with 29.2% and 9.1% in the CP and V arms, respectively. At least two-grade improvement compared with baseline was achieved by 57.6%, 72.7%, and 80.3% of the patients in the GN-037 arm for erythema, plaque elevation, and scaling, respectively. The mean changes in affected BSA were −2.1 ± 2.9, −1.8 ± 2.4, and −0.5 ± 1.6 in the GN-037, CP, and V arms, respectively. The TEAEs were similar among the arms and the most frequently observed TEAEs were Psoriasis Area and Severity Index (PASI) increase in all arms. Conclusions GN-037 was more effective than V in achieving primary and all secondary endpoints throughout the study. Safety data did not reveal any new safety concerns with the combination cream product. Therefore, 4 weeks of GN-037 treatment demonstrated an excellent efficacy and safety profile in patients with MMPP. Trial Registration number ClinicalTrials.gov identifier, NCT05706870.

Background: There are gaps in our understanding of the epidemiology of atopic dermatitis (AD) in adults. Objective: To evaluate the prevalence and severity of AD in adults from countries/regions within Asia, Eurasia, Latin America, Middle East, and Russia. Methods: This international, web-based survey was performed in Argentina, Brazil, China, Colombia, Egypt, Hong Kong, Israel, Malaysia, Mexico, Russia, Kingdom of Saudi Arabia (KSA), Singapore, Taiwan, Thailand, Turkey, and United Arab Emirates. Questionnaires were sent to adult members of online respondent panels for determination of AD and assessment of severity. A diagnosis of AD required respondents to meet the modified United Kingdom (UK) Working Party criteria and to self-report they had a physician diagnosis of AD. Severity of AD was determined using Patient-Oriented Scoring of Atopic Dermatitis (PO-SCORAD), Patient-Oriented Eczema Measure (POEM), and Patient Global Assessment (PGA). Results: Among respondents by country/region the prevalence of AD ranged from 3.4% in Israel to 33.7% in Thailand. The prevalence was generally higher in females versus males. Severity varied by scale, although regardless of scale the proportion of respondents with mild and moderate disease was higher than severe disease. PGA consistently resulted in the lowest proportion of severe AD (range 2.4% China - 10.8% Turkey) relative to PO-SCORAD (range 13.4% China - 41.6% KSA) and POEM (range 5.1% China - 16.6% Israel). Conclusions: This survey highlights the importance of AD in adults, with high prevalence and high morbidity among respondents and emphasizes that AD is not just a disease of childhood- there is disease persistence and chronicity in adults.

Pemphigus vulgaris is a life-threatening bullous disease characterized by acantholysis resulting in the formation of intraepithelial blebs in the mucous membranes and skin. It is a chronic autoimmune bullous dermatosis caused by the production of autoantibodies against desmoglein 1 and 3. It often begins with blisters and erosions on the oral mucosa, followed by lesions on other mucous membranes and drooping blisters that may spread to the skin. If there is clinical suspicion, the diagnosis can be confirmed by cytological examination, histopathological examination, direct and indirect immunofluorescence tests. Before the introduction of corticosteroids, PV was fatal due to dehydration or secondary systemic infections. The mainstay of treatment is still systemic steroids. Immunosuppressants such as azathioprine, mycophenolate mofetil and methotrexate, high-dose intravenous immunoglobulins, CD20 monoclonal antibody Rituximab treatments are used as an adjuvant with steroids in suitable patients and successful results are obtained.

Merkel cell carcinoma (MCC) is a rare tumor that arises from mechanoreceptor Merkel cells. Ultraviolet exposure, immunosuppression and Merkel cell polyoma virus play a significant role in tumor pathogenesis. Although it typically presents as an initially indolent growing, painless solitary lesion, the course of MCC may be aggressive due to the nodal invasion, distant metastasis and high recurrence rates. We presented a case of MCC with a background history of rheumatoid arthritis treated with immunosuppressive therapy for many years who had necrotizing granulomatous lymphadenitis.

BACKGROUND:Concern about disease exacerbations and fear of reactions after coronavirus disease 2019 (COVID-19) vaccinations are common in chronic urticaria (CU) patients and may lead to vaccine hesitancy. OBJECTIVE:We assessed the frequency and risk factors of CU exacerbation and adverse reactions in CU patients after COVID-19 vaccination. METHODS:COVAC-CU is an international multicenter study of Urticaria Centers of Reference and Excellence (UCAREs) that retrospectively evaluated the effects of COVID-19 vaccination in CU patients aged ≥18 years and vaccinated with ≥1 dose of any COVID-19 vaccine. We evaluated CU exacerbations and severe allergic reactions as well as other adverse events associated with COVID-19 vaccinations and their association with various CU parameters. RESULTS:Across 2769 COVID-19-vaccinated CU patients, most (90%) received at least 2 COVID-19 vaccine doses, and most patients received CU treatment and had well-controlled disease. The rate of COVID-19 vaccination-induced CU exacerbation was 9%. Of 223 patients with CU exacerbation after the first dose, 53.4% experienced recurrence of CU exacerbation after the second dose. CU exacerbation most often started <48 hours after vaccination (59.2%), lasted for a few weeks or less (70%), and was treated mainly with antihistamines (70.3%). Factors that increased the risk for COVID-19 vaccination-induced CU exacerbation included female sex, disease duration shorter than 24 months, having chronic spontaneous versus inducible urticaria, receipt of adenovirus viral vector vaccine, having nonsteroidal anti-inflammatory drug/aspirin intolerance, and having concerns about getting vaccinated; receiving omalizumab treatment and Latino/Hispanic ethnicity lowered the risk. First-dose vaccine-related adverse effects, most commonly local reactions, fever, fatigue, and muscle pain, were reported by 43.5% of CU patients. Seven patients reported severe allergic reactions. CONCLUSIONS:COVID-19 vaccination leads to disease exacerbation in only a small number of CU patients and is generally well tolerated.

Merkel cell carcinoma (MCC) is a rare tumor that arises from mechanoreceptor Merkel cells. Ultraviolet exposure, immunosuppression and Merkel cell polyoma virus play a significant role in tumor pathogenesis. Although it typically presents as an initially indolent growing, painless solitary lesion, the course of MCC may be aggressive due to the nodal invasion, distant metastasis and high recurrence rates. We presented a case of MCC with a background history of rheumatoid arthritis treated with immunosuppressive therapy for many years who had necrotizing granulomatous lymphadenitis.

OBJECTIVE:Teledermatology is the use of communications technology to enable the remote evaluation of skin lesions. Dermatological complaints are common among pediatric patients and should be handled differently than adults. The aim of this study is to group the dermatological lesions of pediatric patients who visited a dermatology outpatient clinic and to investigate in which groups the teledermatology method is more effective. METHODS:This is a prospective observational study. Images of skin lesions, which were examined face-to-face in a dermatology outpatient clinic, were transmitted to another dermatologist via telecommunication. The diagnoses by the physician who examined patients face-to-face were compared with the diagnoses by the teledermatologist. Informed consent was obtained from the parents or legal representatives of all patients participating in this study. RESULTS:A total of 93 pediatric patients were evaluated. In our study, the diagnoses by a dermatologist who evaluated patients face-to-face and the diagnoses by a teledermatologist were in agreement with 74.2% of the time. There was 100% agreement between both dermatologists for the diagnosis of acne and scabies. The diagnosis for verruca was consistent with 91.7% of the time, and for atopic dermatitis, it was 72.7%. There was a 25% consistency between both dermatologists on the diagnosis of contact dermatitis. The diagnostic consistency between both physicians was 53% in the erythematous disease group, 89% in the papulopustular group, and 70% in the pigmented group. CONCLUSION:Teledermatology is a reliable diagnostic method that shortens the waiting time of patients and provides a quick consultation with a dermatologist. When using the teledermatology method, it is important to know which skin lesions or disease groups are more accurately diagnosed.

Atopic dermatitis (AD) is a chronic, itchy, and recurrent inflammatory skin disease.AD, which is known as a childhood disease because of its common occurrence, is also an important health problem in adults.With increasing prevalence rates throughout each year, particularly in developed countries, AD has a heterogeneous clinical presentation that varies with age and different degrees of severity.The treatment includes the use of topical or systemic agents after identifying the needs of the patients.Especially, the identification of molecules responsible for pathogenesis recently has allowed the development of tailored treatments.With a better understanding of both the disease and the economic burden of AD recently, studies have gained momentum on diagnosis, treatment, and quality of life.Guidelines and consensus reports addressing diagnostic and therapeutic approaches have been published in our country, too, in parallel to publications in various countries.In this age of rapid information sharing, all kinds of information need to be updated frequently and become further useful.For this purpose, it is planned to develop a current consensus guideline under the leadership of the Dermatoimmunology and Allergy Association, with the contributions of the Cosmetology and the Dermatology Academy Association, Kayseri Dermatology and the Venereal Diseases Association, and Manisa Dermatology and the Venereal Diseases Association, and through the participation of faculty members experienced in the diagnosis and treatment of AD.The topics and the authors were chosen in December 2020.All Medline data published in the years between 1980 and 2021, current AD diagnosis and treatment guidelines, meta-analytical studies, and expert opinions and experiences were reviewed, and section drafts were developed.Literature data and section drafts were assessed and discussed during a meeting held in March 2021 with the participation of all authors.Then, the sections were finalized via e-mail correspondences and submitted as a final consensus report.

Background: Chronic Spontaneous Urticaria (CSU) is characterized by recurrent wheals and/or angioedema for longer than 6-weeks. Guidelines recommend Omalizumab (Oma) as first-line and Cyclosporine-A (Cs-A) as second-line treatment in antihistamine resistant CSU. This step-wise algorithm might be time-consuming and costly. Objective: To determine indicators of response to Oma or Cs-A in CSU patients. Methods: We retrospectively analyzed data from seven centers in Turkey; the inclusion criteria for patients were to receive both Oma and Cs-A treatment (not concurrently) at some point in time during their follow-up. Clinical and laboratory features were compared between groups. Results: Among 110 CSU patients; 47 (42.7%) were Oma-responders, 15 (13.6%) were Cs-A-responders, and 24 (21.8%) were both Oma and Cs-A responders and 24 (21.8%) were non-responders to either drug. High CRP levels were more frequent in Cs-A-responders (72.7% vs. 40.3%; p = 0.055). Oma-responders had higher baseline UCT (Urticaria Control Test) scores (6 vs. 4.5; p = 0.045). Responders to both drugs had less angioedema and higher baseline UCT scores compared to other groups (33.3% vs. 62.8%; p = 0.01 and 8 vs. 5; p = 0.017). Non-responders to both drugs had an increased frequency in the female gender and lower baseline UCT scores compared to other groups (87.5% vs. 61.6%; p = 0.017 and 5 vs. 7; p = 0.06). Study Limitations: Retrospective nature, limited number of patients, no control group, the lack of the basophil activation (BAT) or BHRA (basophil histamine release assay) tests. Conclusions: Baseline disease activity assessment, which considers the presence of angioedema and disease activity scores, gender, and CRP levels might be helpful to predict treatment outcomes in CSU patients and to choose the right treatment for each patient. Categorizing patients into particular endotypes could provide treatment optimization and increase treatment success. (C) 2022 Published by Elsevier Espana, S.L.U. on behalf of Sociedade Brasileira de Dermatologia.

Scabies is a highly contagious, parasitic infestation caused by Sarcoptes scabiei var. hominis. There are some reports which claim the incidence of scabies has increased during COVID-19 lockdown. In this study, we aimed to compare the prevalence of scabies between March to September 2020 - the first six months of the COVID-19 outbreak in Turkey - and March to September 2019 - the same period in the previous year. Case number percentages were compared month-over-month and by total numbers for each specified period. Pearson's chi-squared test was the comparison tool used. We checked the records of 36,469 patients who were admitted to Bezmialem Vakif University, Faculty of Medicine, Dermatology Department, a tertiary healthcare center, between March and September 2019, and out of this number, 258 patients had been diagnosed with scabies. The overall scabies case percentage was 0.71% and the range of monthly prevalence was 0.57%-0.83%. During the corresponding period in 2020, 26,219 dermatology patients were admitted, and 465 of those patients were diagnosed with scabies. The overall scabies case percentage was 1.77% and the range of monthly prevalence was 1.37%-3.46%. Scabies prevalence percentages were statistically significantly higher in all months and in the overall total in 2020 (P<0.001). Our nine patients, who admitted in 2020, did not respond to permethrin treatment but responded well to an ivermectin and permethrin combination. Scabies incidence has increased during the COVID-19 pandemic according to our study. We believe there may be an underreported resistance to permethrin and that starting treatment with oral ivermectin in combination with topical permethrin in extraordinary times, such as a pandemic, may help to control outbreaks.