Squamous cell carcinoma (SCC) can present as a rare complication of longstanding hidradenitis suppurativa (HS) lesions. Limited data exist on characteristics and outcomes of SCC development within HS lesions. The purpose of this review is to conduct a literature review of previously reported cases of SCC development in pre-existing HS lesions.EMBASE and MEDLINE searches were conducted in OVID on June 25, 2020, to yield 59 studies. Of the 95 patients (mean age: 52.9 years) who developed a total of 122 SCCs within HS lesions, the majority were males (77.9%, n = 74/95). The most common sites of SCC were the gluteal region (47.5%, n = 58/122), the perianal region (18.9%, n = 23/122), and the genitals (13.9%, n = 17/122). The mean duration between HS onset and SCC development was 25.5 years. Of the patients that had outcomes reported, 54.0% (n = 34/ 63) experienced SCC metastasis, 43.1% (n = 28/65) experienced SCC recurrences, and 58.7% (n = 44/75) experienced a mortality outcome. The most common documented reasons for death included metastasis (34.1%, n = 15/44) and sepsis (13.6%, n = 6/44).Patients with longstanding HS lesions can develop SCCs with a high rate of metastasis and mortality. Thus, chronic HS lesions, especially in the gluteal, perianal, genital, and perineal regions, should be monitored regularly for timely SCC diagnosis and management.
Patch testing, used in the assessment of allergic contact dermatitis, is ideally avoided in patients receiving immunosuppressive therapy because of concerns with reductions in accuracy; however, this is not well characterized in the literature. This systematic review summarizes patch testing results in patients receiving immunosuppressive therapy. We identified 16 studies, comprising 195 patients with dermatitis or psoriasis, who were patch tested while receiving immunosuppressants. Of these, 7 studies, comprising 85 patients with dermatitis, patch tests were performed before and during immunosuppression. Overall, 67.9% (n = 19) of the dermatitis patients receiving dupilumab maintained positive reactions to an allergen that previously graded as a 2+/3+ reaction. Several immunosuppressants were also associated with positive patch test results for various allergens. These include dupilumab, cyclosporine, and low-dose prednisone (≤10 mg/d) for dermatitis, and tumor necrosis factor α inhibitors, ustekinumab, and methotrexate for psoriasis. Ideally, it is preferable to patch test when patients are not receiving oral immunosuppressants or immunomodulators. However, clinicians may choose to assess the risks and benefits of patch testing for each patient given the impact of allergic contact dermatitis on patient quality of life.
To the Editor: Guselkumab is the first interleukin 23 inhibitor that has been approved for patients with moderate-to-severe plaque psoriasis on the basis of its safety and efficacy reported in phase III trials. [1][2][3] Patients in the real-world practice may have a more recalcitrant disease compared with those in the clinical trials, where medically challenging patients are often excluded. 4 Accordingly, the aim of this retrospective study was to investigate the drug survival of guselkumab in bio-naive compared with bio-experienced patients with plaque psoriasis in a real-world setting at 2 Canadian academic centers.Upon receiving approval by the research ethics board at the Sunnybrook Health Sciences Centre (205-2018) and Women's College Hospital (2018-0079-E), the charts were reviewed for patients with plaque psoriasis treated with subcutaneous injections of guselkumab (100 mg at weeks 0 and 4 and then 100 mg every 8 weeks as maintenance). Retention data and reasons for the discontinuation of guselkumab treatment were collected. Guselkumab survival was calculated using unadjusted KaplaneMeier analysis, where the discontinuation was conservatively defined as the interruption of guselkumab treatment due to any cause (nonresponder imputation). ManteleCox test was used for the comparison of survival curves among patient groups with different number of previously failed biologic agents.Of the 264 included patients (mean age, 50.3 6 14.3 years; 155 males [58.7%]; 109 females [41.3%]; baseline physician global assessment, 2.6 6 0.9), 67 (25.4%) were bio-naive, 114 (43.2%) had previously failed 1 biologic agent, and 83 (31.4%) had previously failed 2 or more biologic agents (Table I). The most commonly failed biologics were interleukin 12/23 inhibitor (ustekinumab, 56.1%), tumor necrosis factor-inhibitors (adalimumab, 21.6%; etanercept, 16.3%; and infliximab, 9.5%), and interleukin 17A inhibitors (secukinumab, 13.3%; and ixekizumab, 11.4%). During the first 104 weeks of treatment, the main reason for
Background Periodic acid‐Shiff (PAS) stain may help to diagnose fungal infection in biopsies from dermatoses of the palms and soles. It is questionable whether PAS stain should be used routinely or only when tinea is suspected clinically. Methods A total of 195 consecutive punch biopsies of dermatoses from the palms (90) or soles (105) were stained with PAS, regardless of the clinical differential diagnosis. Results PAS stain showed fungi in the corneal layer of 6 (3%) of the 195 biopsies. Tinea was included in the differential diagnosis in 48 cases, of which 3 (6%) were PAS positive. PAS stain was also positive in 3 (2%) of 147 cases in which tinea was not suspected clinically. All 6 PAS‐positive cases were detected in reaction patterns not readily classified as particular diagnostic entities: non‐inflammatory keratoderma (2, 11%), chronic lichenified dermatitis (2, 6%), spongiotic psoriasiform dermatitis (1, 2%), and spongiotic dermatitis (1, 4%). Conclusions There is a low concordance rate between the clinical suspicion and the actual demonstration of fungi by PAS stain in dermatoses of the palms and soles. Routine PAS stains in non‐suspected cases have a relatively low yield, which may be improved by limiting the PAS stain to reaction patterns not readily classified as particular diagnostic entities.
A few PLs may evolve into MF. Prolonged clinical course, appearance of patches and larger plaques, markedly increased lymphocytic nuclear atypia, marked diminution of apoptotic keratinocytes and CD7 and CD8 lymphocytes, and clonal T-cell receptor gene rearrangement may serve as clues.
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