Volume 5, Issue 1, February 2025

The ATHENA study is the largest study in the world to investigate whether prophylactic low-dose amitriptyline prevents post herpetic neuralgia, the most common complication of herpes zoster (shingles). This protocol paper describes the design and conduct of this multi-centre, individually randomized, pragmatic, placebo-controlled superiority trial in primary care with health economic analysis and nested qualitative study.

Physicians-in-training report inadequate education in skin of colour (SOC) dermatology during residency. Although dermatology programmes have made progress in teaching SOC dermatology, the status of SOC dermatology education in primary care residency programmes remains unclear. This study aims to characterize the SOC didactic and clinical training opportunities available to primary care residents, laying the groundwork for future curriculum development.

ChatGPT-4 and its dermatology-specific plugins were used to generate patient information leaflets (PILs) to see if they meet UK readability recommendations. Subsequently, they were compared with existing British Association of Dermatologists (BAD) PILs. While some ChatGPT-generated PILs demonstrated better readability than BAD PILs, they still failed to meet the recommended readability level and lacked content usually present in BAD PILs. Therefore, ChatGPT has the potential to serve as a valuable supplementary tool in the creation of PILs but should not fully replace conventional methods.

In our paper, the Active Oligo Skin complex™, processed from sea water and possessing specific mineral composition, was developed and included in a balm. The effects of solution and balm containing the complex were evaluated in vitro on bacteria growth and biofilm formation of S. aureus and S. epidermidis, on different skin models, and in vivo on adult and young volunteers. In summary, the Active Oligo Skin complex™ appears to display in vitro and in vivo potent antipruritic and anti-inflammatory activities.

The wellbeing of the gut barrier is very important for the prevention of the passage of harmful substances into the systemic circulation. Changes in the gut microbial composition may lead to disruption of this barrier with release of the intestinal microbes and toxins into the circulation which may trigger diseases like atopic dermatitis. The serum levels of two components of the gut barrier, claudin 3 and intestinal fatty acid-binding protein, were measured in a group of atopic dermatitis patients and healthy control. There was no difference in the level of the two markers in either of the studied groups. Further studies are still needed.

Line-field confocal optical coherence tomography is a new non-invasive imaging technique that proved to be useful in the longitudinal monitoring of advanced basal cell carcinoma on sonidegib therapy.

WHIM syndrome (warts, hypogammaglobulinaemia, infections and myelokathexis) is a rare primary immunodeficiency associated with increased risk of viral and bacterial skin infections. Here we report a case of recalcitrant tinea capitis in a patient with WHIM syndrome that was unresponsive to multiple treatments for over 10 years. These findings suggest that WHIM syndrome may also confer a previously unrecognized susceptibility to dermatophyte skin infections.

A boy presented with a rare combination of pyoderma gangrenosum and epidermodysplasia verruciformis in an unprecedented co-occurrence.

Fixed drug eruption (FDE) is a distinct adverse drug reaction characterized by a well-defined, dusky, violaceous to erythematous patch that recurs at the same site upon re-exposure to causative drugs and resolves with hyperpigmentation. This unique reaction is a type IV hypersensitivity reaction mediated by memory CD8⁺ T-cells that reside in the basal layer of the epidermis of the resting FDE lesion. Variants of FDE described in the literature include bullous, generalized bullous, non-pigmenting, linear, papular, erythema multiforme-like, transitory giant, annular, psoriasiform, erythema dyschromicum perstans-like and cellulitis-like. We present the case of a 12-year-old male with FDE in a cribriform pattern that has not been defined so far.

We present a rare case of recalcitrant ocular linear IgA bullous dermatosis associated with a programmed death inhibitor. Awareness of this entity is critical for more rapid recognition and initiation of appropriate management and treatment, which would reduce the morbidity and/or mortality associated with these serious adverse reactions.

Shiitake mushroom dermatitis is a toxic dermal reaction characterized by flagellate erythema appearing within 24–72 h following raw or undercooked shiitake mushroom (Lentinus edodes) consumption. It is a benign, self-limiting disease. We report a rare and unusually severe case of shiitake mushroom dermatitis in a 51-year-old man with features of drug reaction, eosinophilia and systemic symptoms.

Mycetoma is a chronic suppurative granulomatous infection of the deep dermis and subcutaneous tissue prevalent in tropical and subtropical regions and is caused by filamentous aerobic bacteria (actinomycetoma) or true fungi (eumycetoma), representing 60% and 40% of cases worldwide respectively. Differentiating eumycetoma from actinomycetoma can be challenging but is required before starting prolonged treatment. Early diagnosis of actinomycetoma is mandatory to prevent tissue destruction, bone invasion and ultimate loss of function by proper investigative work-up, histopathology and direct microscopy of discharge. We here report three cases of actinomycetoma with clinical and microbiology profiles treated with tablets of trimethoprim-sulfamethoxazole, amoxicillin–clavulanic acid.

A 56-year-old male with history of AA, ITP and vitiligo presented to clinic for relapse of his steroid-resistant hair loss which was previously treated with tofacitinib. After initiating baricitinib monotherapy, sustained improvement in hair growth and platelet counts were observed. While history of haematologic comorbidities may raise concern for many clinicians when considering treatment with a JAK inhibitor, this clinical vignette suggests that baricitinib may be considered and safely administered in those with concomitant AA and ITP.

A clinical case showing the efficacy of dupilumab on pembrolizumab-induced bullous pemphigoid.

Pyoderma gangrenosum can occur in Cogan’s syndrome. This case highlights its association in skin of colour.

There is concern that increased surveillance is leading to the overdiagnosis of indolent melanomas that are not destined to be lethal. As overdiagnosis can only be appreciated at a population level, we analysed current and historical population trends of melanoma incidence and mortality worldwide. Epidemiological trends from GLOBOCAN data show signatures typical of overdiagnosis, with the magnitude of increased diagnoses far outpacing mortality for melanoma in most countries.

Patients taking oral EGFR inhibitors should be alert to the risk of TEN if they suddenly develop widespread rash.