Abstract Background: Linear IgA bullous dermatosis (LABD) is an uncommon disease with only a few reported studies in large series with long follow-up periods. Objectives: To evaluate the clinical presentation, immunopathological features, management, and disease course in LABD patients. Methods: Data including demographics, clinical features, histopathological and immunofluorescence findings of LABD patients, in addition to the preferred treatments and responses to treatments were evaluated. Results: Among 26 patients diagnosed with LABD, 17 (65.4%) were female. The mean age was 40.3 ± 22.4 (6-80) years of whom 21 were adults. The most common mucosal involvement was oral (n = 9, 34.6%). Continuous linear IgA deposition was present on the basement membrane zone of all patients in addition to C3 (n = 13), IgG (n = 9), IgM (n = 4), and fibrinogen (n = 4). Three patients were lost to follow-up without any treatment. Dapsone was the treatment of choice in most (n = 21, 91.3%) patients in addition to systemic corticosteroids (n = 17), azathioprine (n = 3), tetracycline and nicotinamide (n = 2). Complete and partial remissions were achieved in 11 (47.8%) and 12 (52.2%) patients, respectively, in a mean follow-up period of 45.9 ± 43.9 (3-158) months. Furthermore, 17 patients were still under treatment at the end of the follow-up period. Study limitations: Retrospective study conducted in a single center. Conclusions: LABD may occur at two separate peaks, one in the second and the other in the sixth decade of life with a female predominance. Other immunoglobulins may be associated with dominant IgA antibody deposition and the most commonly used therapeutic option for LABD patients was oral dapsone.

Abstract Background: Psoriasis is a chronic inflammatory skin disease with a genetic predisposition and autoimmune component, often treated with immunomodulators such as biologic therapies. Objectives: In this study, the authors evaluated the effectiveness and safety of two of these over a 52-week treatment period. Methods: A double-center retrospective cohort study was conducted, enrolling patients with moderate to severe psoriasis who received either guselkumab or risankizumab at dermatology clinics for a minimum of 52-weeks. Result: Out of the 90 patients enrolled in the study, 49 (54.4%) received guselkumab, while 41 (45.6%) received risankizumab. Regarding therapy efficiency, there was no statistically significant difference in PASI90 and PASI100 at week 4 between the two groups (p = 0.428, p = 0.750, respectively). By week 16, PASI90 responses were higher in the guselkumab group (p = 0.039). However, there was no difference in PASI100 response at week 16 (p = 0.957). At weeks 24 and 52, PASI90 and PASI100 responses were similar in both groups. Our results demonstrated that both guselkumab and risankizumab were effective in patients who had previously failed other biologics. Clinical outcomes in both the guselkumab and risankizumab groups had remained unaffected during prior biologic treatments, including anti-TNF, anti-IL17, and/or anti-IL12/23. Treatments yielded consistent outcomes regardless of factors such as obesity, gender, and comorbidities. Study limitations: The small sample size. Conclusions: Our results demonstrated that both guselkumab and risankizumab were effective in patients who had previously failed other biologics. Clinical outcomes in both the guselkumab and risankizumab groups had remained unaffected during prior biologic treatments, including anti-TNF, anti-IL17, and/or anti-IL12/23. Treatments yielded consistent outcomes regardless of factors such as obesity, gender, and comorbidities.

Abstract Keloid is a common fibrotic disease, which is difficult to treat. It often causes itching and pain, which greatly disturbs patients in their work and daily life and causing difficulties in social interaction. Its pathogenesis is not clear, but may be related to several aspects: genetic susceptibility, environmental, immunological and endocrine factors, trauma and tension. The central point of its pathogenesis is the excessive proliferation of fibroblasts, with excessive synthesis and secretion of extracellular matrix such as collagen. However, the cause of fibroblast excessive proliferation and differentiation is not clear. Immune abnormalities may play an important role, with cytokines, chemokines, growth factors, and other important immune molecules acting on fibroblasts. This paper presents a detailed and comprehensive literature review on this subject.

Abstract Background: Conventional systemic corticosteroid therapy for bullous pemphigoid (BP) has been challenged due to severe adverse events. Dupilumab has emerged as an alternative therapeutical option of BP patients. Objectives: To evaluate the efficacy of dupilumab monotherapy and the combination with medium/low-dose corticosteroids for BP treatment. Methods: Thirteen, twenty-four and thirty-two BP patients treated with Dupilumab monotherapy (Dupi group), dupilumab combined with corticosteroids (Dupi + CS group), and corticosteroid monotherapy (CS group), respectively, were retrospectively analyzed for various clinical and laboratory parameters. Results: In the Dupi group, the total Bullous Pemphigoid Disease Area Index (BPDAI) Total, Erosion/Blister, Urticaria/Erythema and Itching NRS scores were all reduced significantly after 2-4 weeks of treatment, but the BPDAI Mucosal Score was not changed significantly at the end of the overextended time of treatment. All the above clinical parameters and many laboratory parameters (including the serum anti-BP180 autoantibodies [IgG] level, blood eosinophil count, and percentage) were significantly reduced in both Dupi + CS and CS groups after treatment, but no statistical differences were found in the reduction rates of these parameters between the two groups. However, the Dupi + CS group had less baseline dose and cumulative dosage of prednisone at the time of disease control, and fewer adverse effects were reported than the CS group. Study limitations: The retrospective design and small clinical sample size of the Dupi group. Conclusions: For BP patients, dupilumab monotherapy based on the treatment of atopic dermatitis can significantly improve skin lesions and pruritus symptoms but may be ineffective for oral mucosal lesions. The combination of dupilumab and medium/low-dose corticosteroids can achieve the same effect of corticosteroid therapy with superior safety.

Abstract Ischemic ulcers due to compromised microcirculation of the lower limbs cause painful ulcers that represent a challenge for the correct diagnosis and treatment. Livedoid vasculopathy, calciphylaxis, and Martorell’s hypertensive ischemic ulcer are part of this group and present some similarities due to microvascular occlusive impairment. They are often misdiagnosed as inflammatory ulcers such as pyoderma gangrenosum and vasculitis. This review discusses the pathophysiology, risk factors, clinical aspects, differential diagnoses, histopathology, and presents a therapeutic update of livedoid vasculopathy, calciphylaxis, and Martorell’s ulcer. Although they are less frequent causes of chronic ulcers, a correct diagnosis is essential to reduce the chance of erroneous therapies that may impact morbidity and mortality related to these conditions.

Abstract Male androgenetic alopecia (MAA) is quite common and worsens with age, with a significant impact on quality of life, and is increasingly a reason for consultation with a dermatologist. The etiopathogenesis of MAA is multifactorial and genetic and hormonal influences stand out. MAA starts with the process of follicular miniaturization in diverse phenotypic patterns. The diagnosis of MAA is basically clinical and currently corroborated by well-established trichoscopic findings. Despite this, therapeutic options are limited, especially when one considers medications with a high level of scientific evidence. This review aims to help the general dermatologist towards a better understanding of MAA providing a basis for good individualized and judicious therapeutic decisions.