British Journal of Dermatology

We are pleased to announce that, after a year as editor elect working alongside Dr John Ingram, Professor John McGrath begins his tenure as the 31st Editor-in-Chief of the British Journal of Dermatology. We would like to send an enormous thank you to Dr Ingram for all his work as our outgoing Editor-in-Chief.

Read Professor McGrath’s first editorial in this month’s BJD: https://academic.oup.com/bjd/article/191/1/1/7693614

Check out this news item from to find out more about Professor McGrath: https://www.bad.org.uk/british-journal-of-dermatology-names-new-editor-in-chief/

Atopic dermatitis (AD) is associated with immunological dysfunction, which may influence cancer development.

This cohort study looked at the electronic health records of children and adults with AD in the UK. Their atopic dermatitis was categorised as mild, moderate or severe using treatments and dermatology referrals as proxies. They then assessed overall malignancy risk between atopic dermatitis and any cancer.

https://academic.oup.com/bjd/article-abstract/189/1/53/7221184?redirectedFrom=fulltext&login=false

A 7-year-old Japanese boy was noted to have focal hyperkeratosis on the palms and soles at birth and then developed signs of excessive scaling and peeling from 1 month after birth. On examination (aged 7 years), he had whitish to light-brown scales with mild erythema on his trunk and extremities. Of note, a large hyperkeratotic plaque with light-brown pigmentation and distinct margins was noted on his abdomen. There was mild diffuse palmoplantar keratoderma.

He was found to have autosomal dominant ichthyosiform erythroderma caused by a heterozygous KLK11 variant which lead to this disorder of cornification.

https://academic.oup.com/bjd/article/189/1/134/7175211?login=true

Protection from ultraviolet radiation through the use of sun screen and physical protection is vital to reduce burning, skin aging and skin cancer.

Historically the intensity of ultraviolet (UV) B light was thought to increase until midday, then decrease, while UV A light intensity was thought to be relatively constant.

Is misinformation in UV light exposure influencing sun protection advice?

Read the correspondance through the link in our bio.

https://academic.oup.com/bjd/article/188/4/552/6880690

Atopic eczema is a chronic, systemic inflammatory disease characterised by itchy, inflamed cutaneous lesions.

Recent studies have suggested a potential role for antibiotics in atopic eczema pathogenesis.

This study identified antibiotic exposure during the prenatal period and the increased risk of atopic eczema in adolescence and young adulthood among participants in the Growing Up Today Study (GUTS).

https://academic.oup.com/bjd/article/188/4/561/6961120?login=true

Studies on psoriasis revealed that being female and having psoriatic arthritis increased the risk of depression and anxiety. Interestingly, moderate-to-severe psoriasis was associated with increased anxiety but not with depression.

What factors do you think contribute to anxiety and depression with eczema and psoriasis?

https://academic.oup.com/bjd/article-abstract/188/4/458/7036849

A 47-year-old man presented to the emergency room with 4 days of intense re**al pain and bleeding with associated night sweats and malaise. History was significant for unprotected a**l in*******se with multiple partners.

Physical exam revealed approximately one dozen haemorrhagic vesiculopustules overlying oedematous pink-red patches on his back and arms as well as bilateral massive inguinal lymphadenopathy with petechial patch overlying the left inguinal region. The patient additionally had an oedematous peria**l patch which was studded with vesiculopustules.

What is the diagnosis?

https://academic.oup.com/bjd/article/188/4/574/6951610?login=true

Vitiligo is an autoimmune pigmentary disorder of the skin with varying prevalence across ethnic groups. Studies have suggested an association between systemic lupus erythematosus (SLE) and vitiligo; however, a systematic evaluation of this association and its prevalence across populations are lacking.

This study aims to address this knowledge gap through a systematic review and meta-a**lysis.

https://academic.oup.com/bjd/article-abstract/188/3/440/6773358?redirectedFrom=fulltext

Visible light sensitivity may be a feature of conditions such as solar urticaria, chronic actinic dermatitis and the cutaneous porphyrias.

The mainstay management approach is light avoidance or physical protection from the triggering wavelengths.

Sunscreen is a form of physical protection, although most sunscreens are not formulated to protect against visible wavelengths, which require VL-blocking pigments.

Commercially available visible light sun protection is important for patients with erythropoietic protoporphyria and solar urticaria as they experience intense symptoms of pain, burning, itch and urticarial rash or phototoxic erythema within seconds to minutes of even minor VL exposure.

Treatment options are limited and expensive, and therefore commercially available products with improved VL protection could dramatically improve the lives of patients with these conditions by raising their exposure thresholds, and consequently this is a most exciting development for people living with these challenging diseases.

https://academic.oup.com/bjd/article/188/3/445/6855586

Artificial intelligence (AI) algorithms are increasingly used for clinical tasks within dermatology, with some algorithms having regulatory approval in Europe and Australia.

However, there are concerns about the transparency of these algorithms regarding patient diversity. Recent work showed that Fitzpatrick skin tone information was reported in only 10% of dermatological AI datasets.

A randomized, prospective clinical trial found that an AI algorithm performed poorly on diagnoses it had never encountered during algorithmic training.

This study looks at published algorithms and assesses potential biases against women or patients with skin of colour.

Rosacea can be a distressing condition for many, especially in transgender and gender-diverse (TGD) people who already experience discrimination.

Prior studies in cisgender men and women have demonstrated an improvement in rosacea with oestrogen hormone replacement therapy, combined oral contraceptive (COC) therapy and anti-androgenic medications.

Have you considered the impact of rosacea in gender- diverse populations?

Topical corticosteroid withdrawal syndrome (TSWS), sometimes called ‘steroid addiction’, is of increasing interest to the eczema community.

It can be challenging for patients and clinicians to distinguish TSWS symptoms from eczema that has not been adequately treated by the topical corticosteroids as uncontrolled eczema and TSWS share similar characteristics (e.g. inflamed skin).

British Association of Dermatologists guidelines for the management of cutaneous squamous cell carcinoma in situ (Bowen disease) 2022 .

The overall objective of the guideline is to provide up-to-date, evidence-based recommendations for the management of squamous cell carcinoma (SCC) in situ.

https://academic.oup.com/bjd/advance-article/doi/10.1093/bjd/ljac042/6788751

Psoriasis is an immune-mediated dermatological disease affecting 2–4% of the world’s population.
 
While fatigue is a common symptom in chronic inflammatory diseases, few small observational and cohort studies exist describing fatigue in patients with psoriasis.
 
This nationwide, cross-sectional study aimed to characterize the association between fatigue and psoriasis in patients in the USA.
 
Do you ask your patients about fatigue?

Mendelian disorders of cornification (MeDOC) are a group of heterogeneous genodermatoses with different genetic bases. The pathogenesis of a substantial group of MeDOC remains to be elucidated.

The authors of this study aim to identify a new causative gene and the pathogenesis of a previously undescribed autosomal-dominant cornification disorder.

Whole-exome sequencing was performed in three families with the novel cornification disorder to identify the disease-causing variants.

They identified two heterozygous variants affecting Gly50 in kallikrein-related peptidase (KLK)11 in a familial case and two sporadic cases with the new disorder.

These findings highlight the essential role of KLKs in maintaining homeostasis of skin keratinization and desquamation.

Click the link in our bio to read more!

Checkpoint inhibitor (CPI) therapy has significantly improved overall survival in several cancers including metastatic melanoma (MM).
 
Cutaneous immune-related adverse events (irAEs) secondary to CPIs are commonly observed; however, autoimmune blistering disorders such as bullous pemphigoid (BP) are rare.
 
The authors of this muti-centre observational study review the prevalence, incidence risk, clinicopathological features and management of toxicity in bullous cutaneous irAEs associated with CPI therapy.
 
Have you seen any cases of Checkpoint inhibitor (CPI)-associated bullous pemphigoid ?

A high prevalence of skin sensitization and dermatitis has been reported among workers exposed to epoxy components.
 
The authors of this study aim to estimate the risk of skin sensitization and dermatitis among workers exposed to epoxy components during production of wind turbine blades while using comprehensive safety measures.
 
A cross-sectional study of 180 highly epoxy-exposed production workers and 41 nonexposed office workers was conducted at two wind turbine blade factories in Denmark.
 
Click the link in our bio to read more!

Frontal fibrosing alopecia (FFA) is an immune-mediated cicatricial alopecia, first described in 1994, that has increased in prevalence over the past 30 years.
 
FFA mainly occurs in postmenopausal women and is associated with hormonal, genetic and environmental factors, although a definitive aetiology remains unclear.
 
Alopecia has a negative effect on patients’ quality of life (QoL) and is associated with anxiety and depression.
 
The authors of this study conducted semistructured interviews with 14 patients with a diagnosis of FFA.
 
Participants expressed the devastating effects of this progressive disease on social, professional and psychological aspects of their lives.
 
This further highlights the high disease burden in this patient group.
 
How do you support your patients?

Image credit: Lobato-Berezo A, González-Farré M, Pujol RM. Pustular frontal fibrosing alopecia: a new variant within the folliculitis decalvans and lichen planopilaris phenotypic spectrum? Br J Dermatol. 2022 May;186(5):905-907. doi: 10.1111/bjd.20962. Epub 2022 Mar 16.

Lack of widespread adoption of topical treatments for keloids and hypertrophic scars among clinicians stems from a perceived paucity of evidence or poor experiential outcomes.

This paper found evidence that treatment with clobetasol propionate ointment under occlusion with Silicone Gel Sheets led to a 60% reduction in the Vancouver Scar Scale after 6 months, together with a significant reduction of side-effects.

Could this be stimulus to more research in the future?

https://onlinelibrary.wiley.com/doi/10.1111/bjd.21824

Hijab components and styling practices may lead to an increase in certain dermatoses in women wearing the Hijab.

These dermatoses include pressure-induced traction alopecia, allergic contact dermatitis (due to metal pins used to fasten the hijab) and
seborrhoeic dermatitis which can develop from Malassezia furfur overgrowth due to occlusion of hair follicles and increased perspiration of the scalp.

Providers should be aware of patients’ cultural, social or religious identities when considering diagnoses and discussing treatment, as these factors contribute to their overall health.

https://onlinelibrary.wiley.com/doi/full/10.1111/bjd.21795

What is the most important factor in the outcome of a scar?

Is it how effectively and by what means excisional tension is managed, or is it the density and type of closure used.

https://onlinelibrary.wiley.com/doi/10.1111/bjd.21844?af=R

A 44-year-old Ukrainian individual, identifying himself as an MSM, presented to the sexually transmitted diseases outpatient service in a dermatology unit in Milan for an asymptomatic cutaneous eruption that had appeared 5 days before on his external genitalia and the third finger of his right hand.

Prior to the appearance of skin lesions, he had reported low-grade fever, headache and malaise for a week.

https://onlinelibrary.wiley.com/doi/10.1111/bjd.21773

A 42-year-old woman developed erythematous pruritic symmetrical acral plaques 4 weeks after SARS-Cov-2 infection that resolved in 2 months with topical medications.

Three months after full recovery from the infection, she was administered a first dose of recombinant monovalent vaccine. A week later, there was aggravation of erythema, oozing and scaling over the previously healed lesions.

Examination showed hyperkeratotic erythematous acral plaques with a sharp cutoff from palms and soles. Patches of hypopigmentation over the dorsum of the hands were also noted.

Skin biopsy from the left leg a week later showed psoriasiform hyperplasia with keratinocyte necrosis.

The patient was treated for necrolytic acral erythema with oral zinc supplementation (low serum zinc level) and topicals, with gradual response.

https://onlinelibrary.wiley.com/doi/10.1111/bjd.21703

Hidradenitis suppurativa (HS) is associated with psychological comorbidities such as depression and anxiety, which can lead to work disability and impaired quality of life (QoL).

Patients with a high tendency towards social anxiety are prone to notice or fear the consequences of disease symptoms; however, there is very limited literature on how tendency towards social anxiety may impact patients with HS, and its relationship to QoL.

This study measures the tendency of patients with HS towards having social anxiety and assessed its impact on QoL and depression.

https://onlinelibrary.wiley.com/doi/10.1111/bjd.21694

While there are many condition-specific area and severity indices for dermatological diseases, none exist for keloids. Given this, keloids are typically assessed with heterogeneous parameters.

This study aimed to generate and evaluate a keloid-specific metric to objectively evaluate disease in moderately to severely affected patients with multiple keloids.

https://onlinelibrary.wiley.com/doi/10.1111/bjd.21705

Pretibial myxoedema (PTM) is an uncommon extrathyroidal manifestation of autoimmune thyroid disease that is almost always seen in association with thyroid eye disease (TED).

Teprotumumab is an insulin-like growth factor 1 receptor (IGF-1R) inhibitor used to treat thyroid eye disease.

This study suggests that teprotumumab may be an effective new treatment for pretibial myxoedema. It targets the IGF-1R signalling pathway, which is likely to underlie development of PTM.

https://onlinelibrary.wiley.com/doi/10.1111/bjd.21700

This review provides a comprehensive catalogue of investigated biomarkers of systemic treatment response in psoriasis.

https://onlinelibrary.wiley.com/doi/10.1111/bjd.21677

A transgender man with psoriasis receiving treatment at a phototherapy centre was hesitant to allow a nurse to assess his skin. Staff were unaware of his transgender identity and that he sought to avoid disclosing this.

This review provides a pragmatic and compassionate approach to assessing transgender patients in a dermatology setting.

https://onlinelibrary.wiley.com/doi/10.1111/bjd.21646