Cilj: Prikazati slučaj pacijentice s komedonalnim lupusom – izuzetno rijetkim oblikom kroničnog kutanog eritemskog lupusa (engl. chronic cutaneous lupus erythematosus; CCLE). Naglasak je stavljen na specifičnosti kliničke prezentacije i dijagnostičke izazove koji prate ovu bolest. Prikaz slučaja: 37-godišnja pacijentica zaprimljena je u dermatološku ambulantu zbog pojave eritematozne infiltracije na lijevoj strani brade, uz prisutnost otvorenih komedona te atrofičnih ožiljaka i tamnijih komedona periaurikularno. Inicijalno je postavljena dijagnoza subakutnog apscesa brade te je pacijentici propisana antibiotska terapija i planirano daljnje kirurško liječenje, no promjena u izgledu lezije potaknula je sumnju u inicijalnu radnu dijagnozu. Stoga je učinjena incizijska biopsija lezije te je korelacijom kliničke slike, patohistološkog nalaza i rezultata naknadne laboratorijske obrade utvrđeno da pacijentica ima komedonalnu varijantu CCLE-a. Propisana joj je terapija hidroksiklorokinom uz intralezionalnu primjenu triamcinolona. Nakon pojave makularnih promjena terapija hidroksiklorokinom je ukinuta te je uveden metotreksat. Tri mjeseca kasnije doza metotreksata povećana je zbog peristentnog eritema i edema lezije te je intenzivirana terapija intralezionalnim triamcinolonom, što je u periodu od šest mjeseci rezultiralo poboljšanjem kliničke slike. Zaključak: Komedonalni lupus iznimno je rijedak podtip CCLE-a. Do danas ovo je 20. opisani slučaj koji ukazuje na izazove u dijagnostici i terapiji zbog nedostatka tipičnih dermatoloških obilježja i neizvjesnosti prognoze. Patohistološka analiza i korelacija s kliničkom slikom ključne su u potvrdi dijagnoze. Bitna je važnost pravovremenog postavljanja dijagnoze uz individualiziran terapijski pristup te kontinuirano praćenje bolesnika radi mogućnosti progresije u sistemski oblik bolesti.

We present a 70-year-old female patient diagnosed with epidermal growth factor receptor-mutated metastatic non-small cell lung cancer (T4N2M1a), who developed afatinib-induced toxic epidermal necrolysis (TEN). We have also performed a PubMed/Medline literature review to detect other possible cases of TEN/Stevens-Johnson syndrome associated with afatinib treatment and found only 5 other cases reported. To our best knowledge, this is the first case of afatinib-induced TEN successfully treated with cyclosporine.

Artificial intelligence (AI) systems have been shown to help dermatologists diagnose melanoma more accurately, however they lack transparency, hindering user acceptance. Explainable AI (XAI) methods can help to increase transparency, yet often lack precise, domain-specific explanations. Moreover, the impact of XAI methods on dermatologists' decisions has not yet been evaluated. Building upon previous research, we introduce an XAI system that provides precise and domain-specific explanations alongside its differential diagnoses of melanomas and nevi. Through a three-phase study, we assess its impact on dermatologists' diagnostic accuracy, diagnostic confidence, and trust in the XAI-support. Our results show strong alignment between XAI and dermatologist explanations. We also show that dermatologists' confidence in their diagnoses, and their trust in the support system significantly increase with XAI compared to conventional AI. This study highlights dermatologists' willingness to adopt such XAI systems, promoting future use in the clinic.

To the Editor: Pityriasis rosea (PR) is a benign self-limited rash that presents as multiple erythematous patches on the trunk and limbs. 1 Contreras-Ruiz J. Peternel S. Jimenez Gutierrez C. Culav-Koscak I. Reveiz L. Silbermann-Reynoso M.L. Interventions for pityriasis rosea. Cochrane Database Syst Rev. 2019; : 2019https://doi.org/10.1002/14651858.CD005068.pub3 Crossref Scopus (10) Google Scholar While the exact etiology of PR remains unknown, human herpesviruses 6 and 7 have been implicated in its pathogenesis. 1 Contreras-Ruiz J. Peternel S. Jimenez Gutierrez C. Culav-Koscak I. Reveiz L. Silbermann-Reynoso M.L. Interventions for pityriasis rosea. Cochrane Database Syst Rev. 2019; : 2019https://doi.org/10.1002/14651858.CD005068.pub3 Crossref Scopus (10) Google Scholar ,2 Leung A.K.C. Lam J.M. Leong K.F. Hon K.L. Pityriasis rosea: an updated review. Curr Pediatr Rev. 2021; 17: 201-211https://doi.org/10.2174/1573396316666200923161330 Crossref PubMed Scopus (14) Google Scholar PR treatment is centered on relieving symptoms, including topical emollients, topical or oral corticosteroids, antipruritic lotions, and oral antihistamines. However, the effectiveness of these treatments is not fully characterized, and no standardized treatment exists for PR. The unpredictable nature of PR can result in prolonged discomfort, anxiety, and decreased quality of life. Thus, effective treatment options are essential to mitigate the impact of PR on patients' well-being. 3 Chang H.C. Sung C.W. Lin M.H. The efficacy of oral acyclovir during early course of pityriasis rosea: a systematic review and meta-analysis. J Dermatolog Treat. 2019; 30: 288-293https://doi.org/10.1080/09546634.2018.1508820 Crossref PubMed Scopus (9) Google Scholar

Introduction: In addition to preventive measures (wearing masks, hand hygiene, isolation), mass vaccination of the population remains the most effective means of combatting the COVID -19 pandemic. One of the serious hypersensitivity reactions to the vaccine is anaphylaxis. The aim of this study was to present the experience of the Clinical Hospital Center (CHC) Rijeka with screening and vaccination of patients at increased risk for anaphylaxis or similar severe allergic reaction to the SARS-CoV-2 vaccine. Participants and Methods: The study included data from all patients registered in the electronic consultation system of CHC Rijeka in 2021, in whom vaccination in hospital setting was indicated and who had received at least one dose of the vaccine against COVID -19 in the same year. The inquiry about the need for vaccination at the day hospital was made by a general practitioner, and the indication was made by a team of hospital allergologists. Only Pfizer’s vaccine (Comirnaty®) was used for vaccination. Results: In 2021, a total of 451 patients were vaccinated based on the prior e-consultation. Of these, 138 received only the first dose of the vaccine, 308 received both doses, and five patients received three doses. The most common indication for in-hospital vaccination was a history of anaphylaxis or anaphylactoid reaction, in 330 (73.2%) patients. A total of 97 patients (21.5%) were referred for a history of non-anaphylactic allergic reaction, 17 (3.8%) for angioedema, and seven patients (1.6%) for other reasons. None of the patients vaccinated at the day hospital developed an anaphylactic reaction to the SARS-CoV-2 vaccine. A total of six patients reported mild reactions after vaccine administration. Conclusion: In the context of COVID -19 morbidity and mortality, the benefit of vaccination far outweighs the risk of anaphylaxis, which is readily treatable in the hospital setting. However, caution and prolonged monitoring is still warranted when vaccinating individuals with a history of anaphylaxis or allergy to any of the components of the administered vaccine.

Dermatologic TherapyEarly View e15791 LETTERFree Access Pityriasis rubra pilaris following booster dose of mRNA (Pfizer–BioNTech) COVID-19 vaccine Nika Hlaca, Nika Hlaca orcid.org/0000-0002-0517-5462 Department of Dermatovenerology, Clinical Hospital Centre Rijeka, Rijeka, Croatia Faculty of Medicine, University of Rijeka, Rijeka, CroatiaSearch for more papers by this authorTina Zagar, Corresponding Author Tina Zagar tinazagar89@gmail.com orcid.org/0000-0002-0308-4057 Department of Dermatovenerology, Clinical Hospital Centre Rijeka, Rijeka, Croatia Faculty of Medicine, University of Rijeka, Rijeka, Croatia Correspondence Tina Zagar, Department of dermatovenerology, Clinical Hospital Centre Rijeka and Faculty of Medicine, University of Rijeka, Croatia. Email: tinazagar89@gmail.comSearch for more papers by this authorMarija Kastelan, Marija Kastelan orcid.org/0000-0002-8318-8031 Department of Dermatovenerology, Clinical Hospital Centre Rijeka, Rijeka, Croatia Faculty of Medicine, University of Rijeka, Rijeka, CroatiaSearch for more papers by this authorSandra Peternel, Sandra Peternel orcid.org/0000-0001-8590-0451 Department of Dermatovenerology, Clinical Hospital Centre Rijeka, Rijeka, Croatia Faculty of Medicine, University of Rijeka, Rijeka, CroatiaSearch for more papers by this authorInes Brajac, Ines Brajac orcid.org/0000-0003-1491-7998 Department of Dermatovenerology, Clinical Hospital Centre Rijeka, Rijeka, Croatia Faculty of Medicine, University of Rijeka, Rijeka, CroatiaSearch for more papers by this authorKatarina Dujmovic-Hasanbegovic, Katarina Dujmovic-Hasanbegovic Department of Dermatovenerology, Clinical Hospital Centre Rijeka, Rijeka, Croatia Faculty of Medicine, University of Rijeka, Rijeka, CroatiaSearch for more papers by this authorLarisa Prpic-Massari, Larisa Prpic-Massari orcid.org/0000-0003-3572-6197 Department of Dermatovenerology, Clinical Hospital Centre Rijeka, Rijeka, Croatia Faculty of Medicine, University of Rijeka, Rijeka, CroatiaSearch for more papers by this author Nika Hlaca, Nika Hlaca orcid.org/0000-0002-0517-5462 Department of Dermatovenerology, Clinical Hospital Centre Rijeka, Rijeka, Croatia Faculty of Medicine, University of Rijeka, Rijeka, CroatiaSearch for more papers by this authorTina Zagar, Corresponding Author Tina Zagar tinazagar89@gmail.com orcid.org/0000-0002-0308-4057 Department of Dermatovenerology, Clinical Hospital Centre Rijeka, Rijeka, Croatia Faculty of Medicine, University of Rijeka, Rijeka, Croatia Correspondence Tina Zagar, Department of dermatovenerology, Clinical Hospital Centre Rijeka and Faculty of Medicine, University of Rijeka, Croatia. Email: tinazagar89@gmail.comSearch for more papers by this authorMarija Kastelan, Marija Kastelan orcid.org/0000-0002-8318-8031 Department of Dermatovenerology, Clinical Hospital Centre Rijeka, Rijeka, Croatia Faculty of Medicine, University of Rijeka, Rijeka, CroatiaSearch for more papers by this authorSandra Peternel, Sandra Peternel orcid.org/0000-0001-8590-0451 Department of Dermatovenerology, Clinical Hospital Centre Rijeka, Rijeka, Croatia Faculty of Medicine, University of Rijeka, Rijeka, CroatiaSearch for more papers by this authorInes Brajac, Ines Brajac orcid.org/0000-0003-1491-7998 Department of Dermatovenerology, Clinical Hospital Centre Rijeka, Rijeka, Croatia Faculty of Medicine, University of Rijeka, Rijeka, CroatiaSearch for more papers by this authorKatarina Dujmovic-Hasanbegovic, Katarina Dujmovic-Hasanbegovic Department of Dermatovenerology, Clinical Hospital Centre Rijeka, Rijeka, Croatia Faculty of Medicine, University of Rijeka, Rijeka, CroatiaSearch for more papers by this authorLarisa Prpic-Massari, Larisa Prpic-Massari orcid.org/0000-0003-3572-6197 Department of Dermatovenerology, Clinical Hospital Centre Rijeka, Rijeka, Croatia Faculty of Medicine, University of Rijeka, Rijeka, CroatiaSearch for more papers by this author First published: 27 August 2022 https://doi.org/10.1111/dth.15791AboutSectionsPDF 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 Dear Editor, Data on various cutaneous adverse events as a result of widespread SARS-CoV-2 vaccination is currently accumulating. However, data on cutaneous reactions following booster dose of COVID-19 vaccines are still limited.1, 2 Herein, we present a case of pityriasis rubra pilaris (PRP) following a booster dose of the BNT163b2 (Pfizer–BioNTech) mRNA COVID-19 vaccine. An 85-years-old woman presented to our department with pruritic, erythematous lesions on her scalp, spreading to the trunk and palms, appearing one week after the injection of the booster dose of the Pfizer-BioNTech COVID-19 vaccine. By contrast, the patient reported only mild local tenderness after administration of the first and second dose of the Pfizer-BioNTech COVID-19 vaccine. The patient didn't reveal other possible triggers such as recent infections, changes in her medications, or exposure to UV light preceding the skin eruption. Her medical history was positive for chronic pancreatitis, arrhythmia, and arterial hypertension, and these conditions were well-controlled over a long period. She had no personal or family history of skin diseases. On physical examination, she presented with scaly orange to red plaques on her trunk and waxy yellow palmar keratoderma (Figure 1A–C). Her legs, soles, and nails were not affected at the initial assessment. Our clinical diagnosis of PRP was confirmed by histopathological examination showing irregular epidermal hyperplasia with broad epidermal ridges, hyperkeratosis with alternating orthokeratosis and parakeratosis, follicular plugging and a sparse perivascular lymphocytic infiltrate in the superficial dermis (Figure 1D). The COVID-19 vaccination was the only detectable trigger. Therefore, we started treatment with acitretin 30 mg once daily, along with topical mometasone 0.1% ointment which resulted in complete regression of skin lesions 4 months later. FIGURE 1Open in figure viewerPowerPoint Clinical and histopathological presentation of PRP. Red to orange scaly plaques on the back with orange waxy palmar keratoderma (A–C). A skin biopsy (D) showing irregular epidermal hyperplasia with broad rete ridges, hyperkeratosis with alternating orthokeratosis and parakeratosis and a sparse superficial perivascular lymphocytic infiltrate (H&E, 100× magnification). Inset shows additional section with follicular plugging (H&E, 200× magnification) PRP is a rare inflammatory papulosquamous dermatosis, that has recently been linked to the mutations in the caspase recruitment domain-containing protein 14 (CARD14).3 Infections, drugs, malignancies, and rarely vaccines, are all possible PRP triggers.3, 4 Previously, cases of PRP have been observed following vaccination with diphtheria, poliovirus and influenza vaccines.4 SARS-CoV-2 vaccines have recently been recognized as a potential trigger for PRP.5-9 Several cases of PRP have already been reported following the first two doses of SARS-CoV-2 vaccines, however this is the first case to describe PRP after homologous booster dose of Pfizer–BioNTech mRNA COVID-19 vaccine.5-9 Booster doses are given 6 months after the patient's primary vaccine series has been completed. A recent study on cutaneous reactions after booster doses of mRNA COVID-19 vaccines found that urticaria was the most common reaction, followed by local injection site reactions, erythromelalgia, and vesicular reactions.1, 2 In our case, the onset of PRP was 7 days, which is consistent with the study on cutaneous adverse reactions following SARS-CoV-2 vaccine booster.2 Interestingly, and in line with our findings, cutaneous reactions to booster doses might happen even in the absence of reactions to the first and second shots.1, 2 The vaccine-related PRP development may be induced by upregulation of inflammatory immunological pathways, or cross-reactivity between viral or adjuvant molecules and self-antigens.1, 8 It appears that in our patient, repeated exposure to the same mRNA vaccine stimulated the immune system, causing a cytokine imbalance that resulted in the development of PRP. This is, to the best of our knowledge, the first case of PRP following a booster dose of the novel BNT163b2 mRNA COVID-19 vaccine. Currently, cutaneous reactions following the booster dose represent only a small portion of the cutaneous reactions caused by COVID-19 vaccines.1, 2 Nonetheless, as a result of booster vaccination having the potential to trigger immune-mediated skin diseases, it is reasonable to expect more reports on vaccine-induced cutaneous adverse reactions in the future. Finally, our case demonstrates the possibility of developing a cutaneous reaction after receiving a booster dose of mRNA COVID-19 vaccine, even in the absence of a reaction to the first and second doses of the same SARS-CoV-2 vaccine. AUTHOR CONTRIBUTIONS Nika Hlaca conceived the original idea and wrote the original manuscript. Tina Zagar, Sandra Peternel, Katarina Dujmovic-Hasanbegovic and Ines Brajac performed literature research and contributed to the analysis of the data. Marija Kastelan and Larisa Prpic-Massari performed supervision, writing-review and editing. CONFLICT OF INTEREST The authors declare that they have no competing interests. DATA AVAILABILITY STATEMENT The data that support the findings of this study are available from the corresponding author upon reasonable request. INFORMED CONSENT Informed consent was obtained from the patient for publication of this report. Open Research DATA AVAILABILITY STATEMENT The data that support the findings of this study are available from the corresponding author upon reasonable request. REFERENCES 1Prasad S, McMahon DE, Tyagi A, et al. Cutaneous reactions following booster dose administration of COVID-19 mRNA vaccine: A first look from the American Academy of Dermatology/International League of Dermatologic Societies registry. JAAD Int. 2022; 8: 49- 51. CrossrefPubMedGoogle Scholar 2Avallone G, Cavallo F, Astrua C, et al. Cutaneous adverse reactions following SARS-CoV-2 vaccine booster dose: a real-life multicentre experience. J Eur Acad Dermatol Venereol. 2022 Jun 30. [Epub ahead of print]. doi:10.1111/jdv.18386 Wiley Online LibraryWeb of Science®Google Scholar 3Wang D, Chong VC, Chong WS, Oon HH. A Review on Pityriasis Rubra Pilaris. Am J Clin Dermatol. 2018; 19(3): 377- 390. CrossrefPubMedWeb of Science®Google Scholar 4Mohamed M, Belhadjali H, Hammedi F, Ben Meriem C, Zili J. Pityriasis rubra pilaris occurring after vaccination with diphtheria-pertussis-tetanus and oral poliovirus vaccines. Indian J Dermatol Venereol Leprol. 2015; 81(6): 618- 620. CrossrefPubMedGoogle Scholar 5Hunjan MK, Roberts C, Karim S, Hague J. Pityriasis rubra pilaris-like eruption following administration of the BNT163b2 (Pfizer-BioNTech) mRNA COVID-19 vaccine. Clin Exp Dermatol. 2022; 47(1): 188- 190. Wiley Online LibraryCASPubMedWeb of Science®Google Scholar 6Lladó I, Butrón B, Sampedro-Ruiz R, Fraga J, de Argila D. Pityriasis rubra pilaris after Vaxzevria® COVID-19 vaccine. J Eur Acad Dermatol Venereol. 2021; 35(12): e833- e835. Wiley Online LibraryCASPubMedWeb of Science®Google Scholar 7Sechi A, Pierobon E, Pezzolo E, et al. Abrupt onset of Sweet syndrome, pityriasis rubra pilaris, pityriasis lichenoides et varioliformis acuta and erythema multiforme: unravelling a possible common trigger, the COVID-19 vaccine. Clin Exp Dermatol. 2022; 47(2): 437- 440. Wiley Online LibraryCASPubMedWeb of Science®Google Scholar 8Criado PR, Ianhez M, Rocha PS, Miot HA. Pityriasis rubra pilaris (type I) following ChAdOx1 COVID-19 vaccine: A report of two cases with successful treatment with oral isotretinoin. J Eur Acad Dermatol Venereol. 2022; 36(7): e508- e510. Wiley Online LibraryCASPubMedWeb of Science®Google Scholar 9Sahni MK, Roy K, Asati DP, Khurana U. An old entity, a new trigger: Post COVID-19 vaccine pityriasis rubra pilaris. Int J Risk Saf Med. 2021; 32(4): 261- 264. CrossrefPubMedWeb of Science®Google Scholar Early ViewOnline Version of Record before inclusion in an issuee15791 FiguresReferencesRelatedInformation

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Atopic dermatitis is a common, chronically recurrent inflammatory skin disease characterized by a complex etiopathogenesis and a variable clinical phenotype. The clinical presentation is heterogeneous, and the disease is characterized by a recurrent dermatitis, intense itching and a significant impact on the quality of life of patients and their family. The diagnosis is based on the clinical presentation according to the standardized diagnostic criteria, while the assessment of disease severity of the disease is based on the standardized tools for disease severity assessment. Treatment should be tailored to each patient profile, and the goal of the treatment is focused on decreasing symptoms and renewing damaged skin barrier, preventing the exacerbation of the disease and preventing or treating the complications and comorbidities, and decreasing the negative influence of the disease on the patient’s quality of life. Due to progress in understanding the etiopathogenesis, treatment options have significantly expanded in the past years. The Croatian Society of Dermatovenerology of the Croatian Medical Association is presenting guidelines for diagnosis and treatment of atopic dermatitis. These guidelines are the result of consensus of Croatian experts based on critical analysis of relevant, evidence-based scientific literature.

Dear Editor, Owing to the widespread use of COVID-19 vaccines, the number of cutaneous vaccine-related adverse events has recently increased.1 We present two cases of lichen planus in elderly women following COVID-19 mRNA vaccination. The first patient presented with new-onset LP, whereas the second patient experienced an extensive LP flare after a 10-year remission. The first patient was an 82-year-old woman who developed an extensive pruritic rash 14 days after receiving a second dose of the Pfizer-BioNTech COVID-19 vaccine. Other possible triggers such as recent infections, medication changes, or stressful events preceding the eruption were ruled out. The patient had no significant medical history, other than well-controlled arterial hypertension. On physical examination, she had polygonal, purpuric, scaly papules in the axillary region, flexural wrists and forearms, ankles, buttocks, lower back, and abdomen (Figure 1). Mucosal lesions were not observed. Dermoscopy revealed mild desquamation and Wickham's striae. Skin biopsy demonstrated irregular epidermal hyperplasia with hypergranulosis and hyperkeratosis, vacuolar degeneration of the basal layer, and dense lymphocytic infiltrate in the superficial dermis (Figure 1). Considering the clinical presentation, histopathological analysis, and absence of an alternative trigger, we diagnosed LP triggered by the mRNA COVID-19 vaccine. Thus, we began treatment with prednisolone 20 mg daily, tapering the dose over 6 weeks, which resulted in gradual improvement of skin lesions. The second patient was a 68-year-old woman with a 2-week history of an intensely pruritic eruption that occurred 14 days after receiving a second dose of the Moderna COVID-19 (mRNA-1273) vaccine. Her medical history included arterial hypertension, hyperlipidemia, obesity, HLA-B27 spondyloarthritis, and LP, which was histologically confirmed 10 years ago and successfully treated with systemic and topical corticosteroids. During the examination, erythematous to violaceous squamous papules were discovered on the trunk, buttocks, and extremities, as well as around the ankles, flexural wrists, forearms, and axillary folds, with palmar involvement as well (Figure 2). Mucosal or nail lesions were absent. Dermoscopy revealed slight scaling and Wickham's striae, and a skin biopsy confirmed lichen planus. Therefore, we introduced 30 mg prednisolone, and tapered the dose to discontinuation over 6 weeks, which lead to the resolution of skin lesions. LP is a chronic inflammatory T-cell-mediated skin disease caused by various infections, drugs, and, in rare cases, vaccines.1-6 The most common vaccines causing LP are hepatitis B and influenza vaccines. Recently, the new-onset or reactivation of LP has been associated with COVID-19 infection and vaccination. Although most reported cases of LP following COVID vaccination were localized, we observed two cases of widespread LP.2-5 The majority of vaccine-related reactions occur in middle-aged women, implying an increased risk of such reactions in women, even in elderly ones, as observed in our cases.1, 6 Both our patients developed LP 14 days after receiving the second dose of mRNA COVID-19 vaccine, which is consistent with vaccine-related LP time onset.6 The immunopathogenesis of vaccine-induced LP likely involves Th1 cell activation with upregulation of proinflammatory cytokines IL-2, TNF-alpha, and IFN-y, which leads to apoptosis of basal keratinocytes, a hallmark of LP. However, the precise mechanism underlying LP (re)activation following vaccination remains unknown. Similarly, immune dysregulation after COVID-19 vaccination may result in the (re)activation of other immune-mediated skin diseases such as psoriasis, vitiligo, acne vulgaris, pemphigus vulgaris, and certain connective tissue diseases.2, 5 Likewise, COVID-19 pandemic has underlined the importance of dermatologists and rheumatologists in providing guidance regarding immunosuppressive and biological therapy considering their extensive experience with such treatments, as well as recognizing the immune-mediated aspects of COVID-19 infection and vaccination.7 Furthermore, as a result of a better understanding of COVID-19 disease mechanisms, novel therapeutic strategies utilizing adipose-derived mesenchymal stem cells (AD-MSCs) are being developed, and given their immuno-modulatory properties, could be employed to combat the disease.8 Finally, dermatologists should be aware of new-onset or flare-ups of LP in older women caused by COVID-19 vaccination as well as the possible (re)activation of other immune-mediated skin diseases. N.H. wrote the original manuscript. T.Z., S.P., and I.B. performed literature research and contributed to the analysis of the data. M.K. and L.P.M. performed supervision, and writing—review and editing. The authors declare no conflicts of interest. Authors declare human ethics approval was not needed for this study. The data that support the findings of this study are available from the corresponding author upon reasonable request. Written informed consent was obtained from the patients for the publication of this case report and accompanying images.

Journal Article Bullous Sweet syndrome following SARS‐CoV‐2 Oxford AstraZeneca vaccine Get access T. Žagar, T. Žagar Department of Dermatovenereology Clinical Hospital Centre Rijeka Rijeka Croatia Search for other works by this author on: Oxford Academic Google Scholar N. Hlača, N. Hlača Department of Dermatovenereology Clinical Hospital Centre Rijeka Rijeka CroatiaFaculty of Medicine University of Rijeka Rijeka Croatia Correspondence: Nika Hlača. Email: nika.hlaca@uniri.hr https://orcid.org/0000-0002-0517-5462 Search for other works by this author on: Oxford Academic Google Scholar I. Brajac, I. Brajac Department of Dermatovenereology Clinical Hospital Centre Rijeka Rijeka CroatiaFaculty of Medicine University of Rijeka Rijeka Croatia Search for other works by this author on: Oxford Academic Google Scholar L. Prpić‐Massari, L. Prpić‐Massari Department of Dermatovenereology Clinical Hospital Centre Rijeka Rijeka CroatiaFaculty of Medicine University of Rijeka Rijeka Croatia Search for other works by this author on: Oxford Academic Google Scholar S. Peternel, S. Peternel Department of Dermatovenereology Clinical Hospital Centre Rijeka Rijeka CroatiaFaculty of Medicine University of Rijeka Rijeka Croatia https://orcid.org/0000-0001-8590-0451 Search for other works by this author on: Oxford Academic Google Scholar M. Kaštelan M. Kaštelan Department of Dermatovenereology Clinical Hospital Centre Rijeka Rijeka CroatiaFaculty of Medicine University of Rijeka Rijeka Croatia Search for other works by this author on: Oxford Academic Google Scholar British Journal of Dermatology, Volume 186, Issue 3, 1 March 2022, Page e110, https://doi.org/10.1111/bjd.20876 Published: 01 March 2022

Artificial exposure to ultraviolet B light (UVB) while soaking in an indoor salt bath, also called balneophototherapy, could simulate the natural exposure to the sun while bathing in the Dead Sea. We aimed to assess the effects of this intervention on patients with chronic plaque psoriasis. We searched CENTRAL, MEDLINE, Embase, and LILACS up to June 2019. We included randomized controlled trials (RCTs). The primary efficacy outcome was psoriasis area and severity index (PASI)-75 to detect people with a 75% or more reduction in the PASI score from baseline. The primary adverse outcome was treatment-related adverse events requiring withdrawal. We included eight RCTs (2105 participants; 1976 analyzed). With respect to PASI-75, two studies found that salt bath + UVB may improve psoriasis when compared to UVB alone (risk ratio 1.71, 95% confidence interval 1.24 to 2.35; 278 participants). With respect to treatment-related adverse events requiring withdrawal, two other studies found little to no difference when compared to UVB alone (risk ratio 0.96, 95% confidence interval 0.35 to 2.64; 404 participants). Salt bath + UVB could improve psoriasis when compared to UVB alone, though, results are based on a limited number of studies and provide low-certainty evidence.

Androgenetic alopecia (male pattern and female pattern hair loss) is characterized by thinning of the scalp hair. Intradermal injection of autologous platelet‐rich plasma (PRP) might have an effect on hair regrowth.

OBJECTIVE To assess the prevalence of allergic sensitization to titanium and nickel in orthodontic patients and to evaluate alterations of smell and taste. SUBJECTS AND METHODS A total of 250 subjects were invited to participate, 245 accepted. The age range was 11 to 45 years, 68% were females and 52% adolescents. An epicutaneous patch test was performed. Of the positive subjects in the patch test, 26 participated in testing taste and smell and were matched by age and sex with 26 negative subjects. RESULTS The prevalence of hypersensitivity to titanium and/or nickel in orthodontic patients was 15.5%. Taste and smell were more impaired in sensitized subjects (p≤0.025), taste was more affected than smell and the tastes most affected were sour and bitter tastes, while the sweet taste was least impaired. CONCLUSION The allergic sensitization to titanium is more uncommon than to nickel, with altered smell and taste related to those hypersensitivities.

Psoriasis is one of the most common chronic inflammatory skin disorders worldwide with a significant number of patients suffering from moderate to severe disease and requiring systemic therapy. Over the past two decades, better knowledge of disease pathophysiology has translated into treatment advances for both primary disease and its associated comorbidities. However, it is important to review the use of biologic or targeted therapy in a clinical setting in order to understand how to optimize therapeutic results and recognize any unmet needs in this patient subpopulation. We conducted a retrospective study on a cohort of patients diagnosed with psoriasis that had received at least one dose of biologic or targeted therapy for the treatment of psoriasis at the Rijeka Clinical Hospital Center. By documenting treatment trends and specific patient characteristics, we will be able to address any unmet needs in this patient population and provide individualized care strategies.

A subset of Spitz tumors harbor fusions ofNTRK3withETV6,MYO5A, andMYH9. We evaluated a series of 22 melanocytic tumors in which anNTRK3fusion was identified as part of the diagnostic workup. Tumors in whichNTRK3was fused toETV6occurred in younger patients were predominantly composed of epithelioid melanocytes and were classified by their histopathologic features as Spitz tumors. In contrast, those in whichNTRK3was fused toMYO5Awere predominantly composed of spindled melanocytes arrayed in fascicles with neuroid features such as pseudo-Verocay bodies. To further investigate the effects of the fusion kinases ETV6-NTRK3 and MYO5A-NTRK3 in melanocytes, we expressed them in immortalized melanocytes and determined their subcellular localization by immunofluorescence. ETV6-NTRK3 was localized to the nucleus and diffusely within the cytoplasm and caused melanocytes to adopt an epithelioid cytomorphology. In contrast, MYO5A-NTRK3, appeared excluded from the nucleus of melanocytes, was localized to dendrites, and resulted in a highly dendritic cytomorphology. Our findings indicate that ETV6-NTRK3 and MYO5A-NTRK3 have distinct subcellular localizations and effects on cellular morphology.

BACKGROUND:Chronic plaque psoriasis is an immune-mediated, chronic, inflammatory skin disease, which can impair quality of life and social interaction. Disease severity can be classified by the psoriasis area and severity index (PASI) score ranging from 0 to 72 points. Indoor artificial salt bath with or without artificial ultraviolet B (UVB) light is used to treat psoriasis, simulating sea bathing and sunlight exposure; however, the evidence base needs clear evaluation.OBJECTIVES:To assess the effects of indoor (artificial) salt water baths followed by exposure to artificial UVB for treating chronic plaque psoriasis in adults.SEARCH METHODS:We searched the following databases up to June 2019: the Cochrane Skin Group Specialised Register, CENTRAL, MEDLINE, Embase, and LILACS. We also searched five trial registers, and checked the reference lists of included studies, recent reviews, and relevant papers for further references to relevant trials.SELECTION CRITERIA:Randomised controlled trials (RCTs) of salt bath indoors followed by exposure to artificial UVB in adults who have been diagnosed with chronic plaque type psoriasis. We included studies reporting between-participant data and within-participant data. We evaluated two different comparisons: 1) salt bath + UVB versus other treatment without UVB; eligible comparators were exposure to psoralen bath, psoralen bath + artificial ultraviolet A UVA) light, topical treatment, systemic treatment, or placebo, and 2) salt bath + UVB versus other treatment + UVB or UVB only; eligible comparators were exposure to bath containing other compositions or concentrations + UVB or UVB only.DATA COLLECTION AND ANALYSIS:We used standard methodological procedures expected by Cochrane. We used GRADE to assess the certainty of the evidence. The primary efficacy outcome was PASI-75, to detect people with a 75% or more reduction in PASI score from baseline. The primary adverse outcome was treatment-related adverse events requiring withdrawal. For the dichotomous variables PASI-75 and treatment-related adverse events requiring withdrawal, we estimated the proportion of events among the assessed participants. The secondary outcomes were health-related quality of life using the Dermatology Life Quality Index, (DLQI) pruritus severity measured using a visual analogue scale, time to relapse, and secondary malignancies.MAIN RESULTS:We included eight RCTs: six reported between-participant data (2035 participants; 1908 analysed), and two reported within-participant data (70 participants, 68 analysed; 140 limbs; 136 analysed). One study reported data for the comparison salt bath with UVB versus other treatment without UVB; and eight studies reported data for salt bath with UVB versus other treatment with UVB or UVB only. Of these eight studies, only five reported any of our pre-specified outcomes and assessed the comparison of salt bath with UVB versus UVB only. The one included trial that assessed salt bath plus UVB versus other treatment without UVB (psoralen bath + UVA) did not report any of our primary outcomes. The mean age of the participants ranged from 41 to 50 years of age in 75% of the studies. None of the included studies reported on the predefined secondary outcomes of this review. We judged seven of the eight studies as at high risk of bias in at least one domain, most commonly performance bias. Total trial duration ranged between at least two months and up to 13 months. In five studies, the median participant PASI score at baseline ranged from 15 to 18 and was balanced between treatment arms. Three studies did not report PASI score. Most studies were conducted in Germany; all were set in Europe. Half of the studies were multi-centred (set in spa centres or outpatient clinics); half were set in a single centre in either an unspecified settings, a psoriasis daycare centre, or a spa centre. Commercial spa or salt companies sponsored three of eight studies, health insurance companies funded another, the association of dermatologists funded another, and three did not report on funding. When comparing salt bath plus UVB versus UVB only, two between-participant studies found that salt bath plus UVB may improve psoriasis when measured using PASI 75 (achieving a 75% or more reduction in PASI score from baseline) (risk ratio (RR) 1.71, 95% confidence interval (CI) 1.24 to 2.35; 278 participants; low-certainty evidence). Assessment was conducted at the end of treatment, which was equivalent to six to eight weeks after start of treatment. The two trials which contributed data for the primary efficacy outcome were conducted by the same group, and did not blind outcome assessors. The German Spas Association funded one of the trials and the funding source was not stated for the other trial. Two other between-participant studies found salt bath plus UVB may make little to no difference to outcome treatment-related adverse events requiring withdrawal compared with UVB only (RR 0.96, 95% CI 0.35 to 2.64; 404 participants; low-certainty evidence). One of the studies reported adverse events, but did not specify the type of events; the other study reported skin irritation. One within-participant study found similar results, with one participant reporting severe itch immediately after Dead Sea salt soak in the salt bath and UVB group and two instances of inadequate response to phototherapy and conversion to psoralen bath + UVA reported in the UVB only group (low-certainty evidence).AUTHORS' CONCLUSIONS:Salt bath with artificial ultraviolet B (UVB) light may improve psoriasis in people with chronic plaque psoriasis compared with UVB light treatment alone, and there may be no difference in the occurrence of treatment-related adverse events requiring withdrawal. Both results are based on data from a limited number of studies, which provided low-certainty evidence, so we cannot draw any clear conclusions. The reporting of our pre-specified outcomes was either non-existent or limited, with a maximum of two studies reporting a given outcome. The same group conducted the two trials which contributed data for the primary efficacy outcome, and the German Spas Association funded one of these trials. We recommend further RCTs that assess PASI-75, with detailed reporting of the outcome and time point, as well as treatment-related adverse events. Risk of bias was an issue; future studies should ensure blinding of outcome assessors and full reporting.