Search Results (235)

Bullous pemphigoid (BP) is the most common autoimmune subepidermal blistering disease, predominantly affecting elderly patients with multiple comorbidities. This multicentre retrospective cohort study aimed to characterize the clinical profile, treatment patterns, and drug-associated cases of BP in a real-world setting. The study included 156 patients newly diagnosed with BP between 2020 and 2024 in four dermatology departments in Poland. Diagnosis was based on clinical features, and immunological assessment, including direct immunofluorescence (DIF), ELISA, and BIOCHIP-based indirect immunofluorescence. The mean age at diagnosis was 75.5 ± 10.9 years, and 78.85% of patients had at least one comorbidity, most commonly arterial hypertension, type 2 diabetes mellitus, and dyslipidemia. Severe pruritus was reported in 74.14% of evaluated patients. Blisters and erosions were the predominant clinical manifestations. Topical glucocorticosteroids were the most frequently used treatment, followed by systemic glucocorticosteroids and methotrexate. New drug exposure within 6 months before disease onset was identified in 14.74% of patients and was associated with a shorter time to diagnosis. Drug-associated cases showed lower BP180 ELISA positivity, although this did not remain significant after correction for multiple testing. These findings highlight the clinical complexity of BP and the importance of medication review and direct immunofluorescence in diagnostic evaluation. Full article

Background/Objectives: Inflammatory bowel diseases (IBD) including ulcerative colitis and Crohn’s disease can be associated with other immune-mediated inflammatory diseases (IMIDs) and extraintestinal manifestations (EIM) including dermatological manifestations, ophthalmologic manifestations, musculoskeletal manifestations and neurological manifestations. The aim of this narrative review is to discuss the optimal management and treatment strategy of IBD with immune-mediated inflammatory disease and extraintestinal manifestations. Methods: This review is based on published studies searched in PubMed until 31 December 2025. Our search focused on systemic reviews, review articles, randomized trials, cohort studies, guidelines and case series. Results: In IBD, the presence of additional immune-mediated inflammatory diseases (IMIDs) should be considered a poor prognostic factor, prompting closer disease monitoring and earlier escalation to or optimization of advanced therapy. Therapeutic management requires careful consideration including a multidisciplinary approach and a selection of the most appropriate treatment option(s) based on the presence, severity of IBD and/or IMIDs and/or EIM. For patients with refractory disease affecting multiple organs, emerging strategies include dual biologic therapies. Conclusions: The optimal management of IBD with associated IMIDs/EIM should be multidisciplinary in close cooperation among specialists to align treatment goals and management plans. Full article

Chronic hyperglycemia profoundly impairs skin integrity, with dermatological complications affecting up to half of patients with diabetes mellitus. The objective of this study was to describe the spectrum, frequency, and clinical characteristics of skin lesions in patients with diabetes mellitus and to evaluate whether specific cutaneous signs are associated with an increased risk of subsequently developing type 2 diabetes. This retrospective observational study evaluated 960 cases admitted to the Dermatology Clinic of “Sf. Spiridon” Emergency County Clinical Hospital, Iași, between 2017 and 2022, complemented by an 11-year longitudinal follow-up (2011–2016). Ulcerative lesions predominated (85.7%), followed by inflammatory manifestations (12.4%), while classical diabetes-specific dermatoses represented <2% of cases. Poor glycemic control (HbA1c > 7%) was documented in 94.2% of patients, with the most severe lesions occurring in those with HbA1c > 10%. In the longitudinal analysis, patients who later developed diabetes initially presented significantly higher rates of xerosis, pruritus, and callus compared with the controls. Multivariate logistic regression identified xerosis (OR 4.70) and pruritus (OR 3.41) as independent predictors of future diabetes. These findings suggest that certain dermatological signs may serve as early non-invasive markers of metabolic dysfunction and highlight the importance of routine skin examination in diabetes risk stratification. Full article

Introduction: In the treatment of hormone receptor-positive (HR+), HER2-negative (HER2−) metastatic breast cancer (MBC), the current guidelines recommend endocrine therapy combined with cyclin-dependent kinase 4/6 (CDK4/6) inhibitors as the preferred first-line treatment to preserve quality of life. Ribociclib is a CDK4/6 inhibitor that has been used in combination with aromatase inhibitors or fulvestrant in patients with HR+, HER2− metastatic breast cancer. Various adverse drug reactions associated with ribociclib have been reported, including cutaneous reactions, hepatotoxicity, and hematologic toxicity. In this study, we aimed to evaluate the clinical manifestations and risk factors of dermatologic toxicities in patients with metastatic breast cancer treated with ribociclib. Methods: This retrospective study included patients with metastatic/recurrent breast cancer who were prescribed ribociclib from April 2021 to December 2024 at a single institution. We retrospectively reviewed the medical records of these patients to identify the frequency of cutaneous adverse events, the time of onset, and the clinical characteristics of skin reactions. Logistic regression analysis was performed on several clinical factors, including body surface area (BSA) and concomitant medications, to identify risk factors associated with the occurrence of cutaneous adverse events. Results: A total of 110 patients with MBC were enrolled during the study period. The median age was 53 years (range, 28–82); all 110 patients (100.0%) were female; the median BSA was 1.56 m² (range, 1.29–2.07); and 32 patients (29.1%) were premenopausal. Ribociclib plus letrozole was administered in 48 patients (43.6%) and ribociclib plus fulvestrant in 29 patients (26.4%). An additional 33 patients (30.0%) received ribociclib plus letrozole with a gonadotropin-releasing hormone (GnRH) agonist. Cutaneous adverse events occurred in 29 patients (26.4%), and the median time to onset was 84 days (range, 3–498). The cutaneous adverse event patterns included pruritus, erythematous macular rash, eczematous rash/contact dermatitis, vitiligo, urticarial reactions, polymorphous light eruption, toxic epidermal necrolysis (TEN), and desquamation. Grade 1 or 2 cutaneous adverse events occurred in 93.1% of patients; Grade 3 toxicity occurred in one patient; and Grade 4 toxicity, namely toxic epidermal necrolysis (TEN), was reported in one patient. Dose reduction was required in three patients (10.3%), and permanent discontinuation of ribociclib occurred in one patient. Clinical improvement was achieved in the majority of patients (86.2%) with cutaneous adverse events following supportive care. Logistic regression analysis revealed that age, Eastern Cooperative Oncology Group (ECOG) performance status, body surface area (BSA), treatment regimen, and use of cholesterol-lowering medications were not independently associated with the development of cutaneous adverse events. Conclusion: CDK4/6 inhibitors represent one of the most important treatment options for HR+/HER2− metastatic breast cancer. Regardless of their clinical efficacy, cutaneous adverse events remain a common source of patient discomfort. Therefore, careful clinical attention and appropriate supportive care are essential to improve patients' quality of life. Full article

Background: Inflammatory bowel disease (IBD), including ulcerative colitis (UC) and Crohn’s disease (CD), represents a chronic immune-mediated disorder frequently associated with extraintestinal manifestations. While musculoskeletal, dermatologic, and ocular complications are well recognized, ear, nose, and throat (ENT) involvement remains underrecognized despite its potential morbidity. Objective: To systematically evaluate the spectrum of ENT manifestations in IBD, focusing on clinical presentation, diagnostic approaches, and outcomes. Methods: A systematic literature search was conducted in PubMed and Scopus in accordance with PRISMA 2020 guidelines. Eligible studies included English-language human studies (2015–2026) reporting ENT manifestations in UC or CD. Following screening, 23 studies were included in the qualitative synthesis. Extracted data comprised study design, IBD subtype, patient demographics, ENT manifestations, diagnostic methods, and clinical outcomes. Results: The majority of studies consisted of case reports and small observational series. Sensorineural hearing loss (SNHL) was the most frequently reported manifestation in both adult and pediatric populations, with evidence suggesting immune-mediated mechanisms and variable responsiveness to corticosteroids. Nasal involvement included pyoderma gangrenosum, pyoderma vegetans, and aseptic nasal septal abscess, occasionally resulting in severe structural complications such as saddle-nose deformity. Laryngeal and airway involvement included dysphonia, tracheitis, and rare but potentially life-threatening inflammatory airway disease. Additional findings included associations with chronic rhinosinusitis. Diagnosis relied on audiometry, imaging, endoscopy, and histopathology. Systemic corticosteroids were frequently effective; however, delayed recognition may lead to irreversible sequelae. Conclusions: ENT manifestations in IBD constitute a clinically heterogeneous but important group of extraintestinal complications. Increased awareness of ENT manifestations may support earlier diagnosis and multidisciplinary management of IBD, potentially reducing irreversible complications. Full article

Background and Clinical Significance: Dermato-neuro syndrome is a rare, potentially fatal complication of scleromyxedema, characterized by a prodrome of flu-like symptoms, and a triad of fever, confusion, and seizures. Intravenous immunoglobulin (IVIG) has become first-line treatment for both scleromyxedema and dermato-neuro syndrome based on case reports and case series data showing variable treatment responses. Case Presentation: In this report, we describe a Black, female patient with scleromyxedema and lambda-restricted IgG monoclonal gammopathy who developed suspected dermato-neuro syndrome within a week of her first round of IVIG infusions. Conclusions: To our knowledge, this is the second case report of dermato-neuro syndrome temporally linked to a recent IVIG infusion, a paradoxical reaction that may complicate clinical decision making. Furthermore, we highlight the dermatologic manifestations of scleromyxedema in dark skin tones and emphasize the need for heightened clinical suspicion of dermato-neuro syndrome in patients with scleromyxedema presenting with acute neurological symptoms. Full article

Morbid obesity is a chronic condition characterized by metabolic disorders and low-grade chronic inflammation, both of which are closely linked to insulin resistance and adipokine dysregulation. In addition to its systemic effects, obesity also leads to structural and functional changes in the skin, supporting its role as an active metabolic and immunological organ. This study analyzed skin lesions occurring in individuals with morbid obesity and explored their potential relevance in the context of metabolic risk and treatment response rather than establishing clinically validated tools. The focus was on how excess adipose tissue affects the skin through metabolic, hormonal and mechanical mechanisms. Although this review focuses on morbid obesity, many of the included studies examine general obesity without separating its severity. Therefore, the findings may not fully reflect patients with BMI ≥ 40 kg/m² and should be interpreted with caution. Three main areas were considered: the pathophysiological mechanisms underlying obesity-related skin lesions, selected dermatological manifestations as potential markers associated with metabolic risk, and changes in these manifestations during pharmacological, surgical, and lifestyle interventions. Available studies show that acanthosis nigricans and multiple acrochordons are consistently associated with insulin resistance, metabolic syndrome, and metabolic dysfunction-associated steatotic liver disease. An increase in BMI is also associated with impairment of the epidermal barrier, changes in the composition of skin lipids, and modifications of the skin microbiome, while biomechanical factors promote the development of chronic inflammation in the intertriginous areas. It has been shown that normalization of metabolic parameters achieved through GLP-1-based pharmacotherapy, bariatric surgery, or lifestyle changes can improve some skin manifestations, especially acanthosis nigricans. However, it should be emphasized that most available data are based on cross-sectional or observational studies, and validated composite dermatological indices are still unavailable. Skin changes in patients with morbid obesity often reflect underlying metabolic and hormonal disturbances. They may have potential as additional, non-invasive clinical clues, but they should not be treated as independent tools for risk assessment or treatment monitoring. At present, most evidence shows associations only, and it is unclear whether these findings add meaningful predictive value beyond standard metabolic markers. More prospective studies are needed to confirm their clinical usefulness and to define their role in assessing metabolic risk and monitoring treatment over time. Full article

Background: Dermatological conditions represent a leading cause of global nonfatal disease burden, accounting for approximately 42.9 million disability-adjusted life years annually. Their complex pathogenesis is increasingly understood through the skin–brain–exposome axis, a bidirectional neuroimmunological and environmental communication network. The study aims to synthesize the neurobiological mechanisms of the skin–brain–exposome axis with macroscopic sociodemographic modifiers, clinical manifestations, and evidence-based psychodermatological interventions. Methods: A narrative review was conducted, following a structured search of PubMed, Scopus, and Web of Science (from inception to February 2026), yielding 54 sources. Mechanistic and interventional data (including randomized controlled trials and meta-analyses) were integrated with large-scale population-based epidemiological findings, anchored by a recent cross-sectional Polish cohort of 27,000 adults. Results: Psychological distress is associated with hyperactivation of the hypothalamic–pituitary–adrenal (HPA) axis and peripheral neurogenic inflammation (e.g., Substance P, corticotropin-releasing hormone), exacerbating stress-sensitive conditions such as atopic dermatitis, psoriasis, acne, and chronic pruritus. External exposome factors (urbanization, pollution) and sociodemographic variables (education, gender) may modify biological risk and diagnostic capture rates, frequently generating an epidemiological diagnostic paradox. Randomized trials support that psychotherapeutic interventions, particularly Cognitive Behavioral Therapy (CBT) and Mindfulness-Based Stress Reduction (MBSR), effectively disrupt the physical itch–scratch–stress cycle and improve disease-specific quality of life, serving as evidence-based adjunctive strategies in comprehensive care. Conclusions: Effective dermatological management requires targeting both the cutaneous barrier and the psychological exposome. Integrating routine psychosocial screening and stratified behavioral interventions into standard clinical care is essential for addressing the neuroimmune chronicity of inflammatory skin diseases. Full article

Diabetes mellitus affects an estimated 589 million adults globally, and cutaneous manifestations occur in up to 70% of affected individuals during the course of the disease. The objective of this narrative review is to examine the intersection of diabetes mellitus, skin aging, cosmetic dermatologic procedures, and regenerative therapies, with an emphasis on evidence-based best practices and clinical considerations. While the impaired wound healing associated with diabetes has been extensively studied, the aesthetic implications of diabetic skin disease remain comparatively underexplored. Individuals with diabetes frequently exhibit features of accelerated cutaneous aging, including premature wrinkling, dyschromia, xerosis, alopecia, and other cosmetically significant dermatoses that may negatively impact quality of life. In parallel, the demand for aesthetic dermatologic procedures among patients with diabetes has increased substantially; however, evidence-based recommendations guiding the safe and effective use of cosmetic interventions in this population remain limited. Diabetic skin demonstrates accelerated biological aging driven by complex pathophysiological mechanisms, including the accumulation of advanced glycation end products, chronic low-grade inflammation, oxidative stress, microvascular dysfunction, and neuropathy. These processes partially overlap with chronological aging and photoaging but are mechanistically distinct and may influence tissue repair, inflammatory responses, and the safety profile of commonly performed aesthetic procedures such as chemical peels, laser resurfacing, dermal fillers, neuromodulators, and microneedling. Emerging regenerative approaches, including platelet-rich plasma, platelet lysate, and mesenchymal stromal cell-derived products such as exosomes and secretomes, have attracted increasing attention as biologically targeted strategies for cutaneous rejuvenation. Nevertheless, clinical evidence specifically addressing aesthetic interventions in diabetic populations remains limited. A diabetes-informed approach to aesthetic dermatology that considers metabolic status, procedure selection, and post-procedural monitoring is therefore essential to optimize safety and therapeutic outcomes. Full article

Dermatomyositis (DM) is a rare, autoimmune inflammatory myopathy characterized by a heterogeneous clinical course and complex etiopathogenesis. Although classically defined by the coexistence of muscle inflammation and distinctive skin lesions, DM frequently presents as a systemic disease, and, in some patients, cutaneous manifestations may precede muscle involvement or represent the sole clinical feature. The spectrum of skin lesions in DM is broad and includes pathognomonic, characteristic, rare, or atypical manifestations, ranging from classic Gottron’s sign and heliotrope rash to uncommon subtypes such as vesiculobullous dermatomyositis, Wong-type dermatomyositis, or flagellate dermatitis. Particular cutaneous phenotypes often correlate with distinct clinical subtypes, autoantibody profiles, systemic involvement, and prognosis. The diversity of dermatological presentations and their resemblance to other dermatoses may delay accurate diagnosis, especially in amyopathic and hypomyopathic forms of the disease. The aim of this review is to comprehensively discuss the wide spectrum of cutaneous manifestations of dermatomyositis, emphasize less recognized and rare dermatological clinical presentations, and highlight their diagnostic and prognostic significance. However, histopathological examination may support the diagnostic process in challenging cases. Early identification of characteristic skin lesions remains crucial for prompt diagnosis, appropriate screening for systemic complications and malignancy, and optimal management. Close interdisciplinary cooperation among dermatologists, rheumatologists, and other specialists is essential to ensure accurate diagnosis and improve outcomes in patients with dermatomyositis. Full article

Background/Objectives: Cutaneous manifestations of inborn errors of immunity (IEI) are among the most common and often early signs of these disorders, estimated to affect about 40% of patients with IEI, and in some cases, they provide the first diagnostic clue. Skin findings in IEI are heterogeneous and include recurrent skin infections, severe atopic dermatitis, autoimmune manifestations, as well as atypical granulomatous dermatoses, neoplastic lesions, pigmentation disorders, and changes involving hair and nails. Early recognition of these manifestations and linking them to the appropriate immunologic defect is crucial for establishing the diagnosis and initiating targeted therapy. Methods: This paper reviews the dermatologic phenotypes associated with IEI, with particular emphasis on a tabular classification of skin lesions corresponding to specific immunologic defects. Relevant literature was analyzed to summarize characteristic cutaneous presentations and current diagnostic approaches, highlighting the importance of interdisciplinary evaluation. Results: Cutaneous findings in IEI encompass a wide spectrum of infectious, inflammatory, autoimmune, and neoplastic manifestations. Systematic classification of these lesions facilitates earlier recognition of underlying immune defects and supports differential diagnosis. Dermatologic signs frequently precede systemic manifestations, making them valuable early clinical indicators of IEI. Conclusions: Recognition of dermatologic manifestations is critical for early diagnosis of IEI. Interdisciplinary collaboration between dermatologists, immunologists, and other specialists improves diagnostic accuracy and patient management. Current therapeutic strategies range from symptomatic treatment to targeted therapies, and personalized approaches improve prognosis and quality of life in patients with IEI. Full article

We present the case of a 25-year-old male who attended a dermatological online consultation due to a whiplash-shaped, pruritic rash. The lesions in the form of well-demarcated linear erythematous papules, located mainly on the trunk and arms, had first appeared four days prior to the consultation. Chronic disease history was negative and similar symptoms never appeared previously. After reviewing the clinical images and excluding dermatographism, flagellate dermatitis was suspected. The diagnosis was subsequently confirmed when the patient reported having consumed undercooked shiitake mushrooms two days prior to the onset of the lesions. Topical corticosteroids and oral antihistamines were recommended, and the patient was informed about the necessity of high-temperature preparation of shiitake mushrooms in the future. Flagellate dermatitis is a rare entity speculated to be a hypersensitivity reaction to lentinan, a heat-labile polysaccharide found in shiitake mushrooms (Lentinus edodes). Symptoms include characteristic papular or vesicular lesions erupting in a linear pattern resembling whiplash marks, usually on the trunk and extremities. While the condition is self-limiting, the awareness of its manifestation is important in order to prevent unnecessary biopsies. Patients should be educated to avoid further exposure to lentinan, as instances of severe reactions following repeated contact have been described. Full article

Photosensitization is a clinically significant dermatological and systemic disorder affecting grazing livestock worldwide. The condition arises following the ingestion or dermal exposure to photodynamic compounds that, upon activation by ultraviolet (UV) or visible light, induce tissue injury. Plant-associated photosensitization remains one of the most important aetiological categories in veterinary toxicology and may occur via primary (direct phototoxic) or secondary (hepatogenous) mechanisms. This review synthesizes current knowledge on the occurrence of photosensitizing compounds in plants, their biochemical and toxicodynamic properties, and their clinical relevance in livestock species. Emphasis is placed on major primary photosensitizing taxa, including Heracleum spp. and Hypericum perforatum, as well as hepatotoxic pyrrolizidine alkaloid-containing plants such as Senecio spp. Mechanistic pathways, plant metabolite ecology, and toxicopathological outcomes are discussed alongside illustrative case material. Plant-associated photosensitization also carries substantial economic consequences through decreased productivity, increased treatment costs and culling losses in affected herds and flocks. This condition represents a significant animal welfare concern in pasture-based production systems, where prolonged sunlight exposure, limited shade availability, and variable botanical composition of grazing areas can exacerbate both the incidence and severity of clinical manifestations. This review may provide a consolidated veterinary toxicology framework for understanding plant-associated photosensitization in grazing systems. Full article

Food allergy is an exaggerated immune response, mediated by Immunoglobulin E (IgE) or by cells, to food antigens. Dogs and cats may present with both dermatological and gastrointestinal manifestations, although non-seasonal pruritus is the most common clinical sign. Despite advances in understanding the immunopathogenesis of this condition, the elimination–provocation test remains the gold standard for diagnosis. However, new diagnostic approaches, like molecular allergen macroarrays and lymphocyte proliferation assays, may complement traditional strategies, opening new perspectives for accurate diagnosis. For long-term management, strict avoidance of offending allergens is essential, but emerging therapeutic interventions, including immunotherapy using food components and targeted modulation of the gut–skin axis, are promising for improving clinical outcomes. This review summarizes current knowledge and highlights innovative approaches that can transform the diagnosis and management of food allergy in companion animals. Full article

Mycoplasma pneumoniae is traditionally recognized as a leading cause of community-acquired pneumonia, yet growing evidence demonstrates that its clinical impact extends far beyond the respiratory tract. Increasing reports of neurologic, cardiac, hematologic, dermatologic, renal, gastrointestinal, and thrombotic complications indicate that M. pneumoniae should be viewed as a systemic pathogen capable of inducing multisystem disease. Extrapulmonary manifestations may arise through three major mechanisms: direct bacterial invasion of tissues, immune-mediated injury driven by molecular mimicry or immune complexes, and vascular or thrombotic events related to endothelial dysfunction. These processes frequently occur independently of, or temporally dissociated from, respiratory symptoms, complicating early diagnosis. The diagnostic approach remains challenging because respiratory PCR may reflect colonization, serology is delayed, and pathogen detection in sterile sites is uncommon. Consequently, diagnosis often depends on the integration of clinical features, laboratory markers, and organ-specific imaging. Management requires a combined strategy: antimicrobial therapy to reduce bacterial load, organ-targeted supportive measures, and immunomodulatory interventions such as corticosteroids, IVIG, or plasma exchange for severe immune-mediated complications. The emergence of macrolide-resistant strains further underscores the need for tailored antimicrobial strategies and close clinical monitoring. Although many extrapulmonary complications are reversible, severe forms—including encephalitis, ADEM, myocarditis, Stevens–Johnson syndrome, and major thromboses—can lead to lasting morbidity or death. Significant knowledge gaps persist, including determinants of host susceptibility, mechanisms linking CARDS toxin to systemic inflammation, the impact of macrolide resistance on disease severity, and the absence of standardized diagnostic criteria. Advances in molecular immunology, multicenter registries, and development of targeted therapies or vaccines represent crucial next steps. Overall, the breadth and clinical relevance of extrapulmonary involvement support a paradigm shift: Mycoplasma pneumoniae infection should be regarded and managed as a systemic disease rather than a purely respiratory pathogen. Full article