Hidradenitis suppurativa is a common inflammatory skin condition which causes recurrent abscesses, sinuses and scarring in the axillae, groin and inframammary areas. As well as causing significant physical distress due to pain and discharge, the condition impacts psychological well-being with markedly impaired quality of life. Patients suffer pain, embarrassment and psychological distress with impairment of their work and intimate relationships marking it as one of the most distressing dermatological conditions. Numerous studies have documented markers of psychological distress encompassing the physical effects such as pain and itch, affects on mood and impaired function.
Background: The burden of illness associated with atopic dermatitis (AD) is significant and multidimensional, especially in those with moderate to severe disease.Objective: Our objective was to evaluate the disease burden of patients with AD in relation to psychological distress, sleep disturbance, and alcohol misuse.Methods: Patients with AD, attending 2 tertiary referral centers in Dublin, Ireland, were recruited. A series of validated questionnaires were used including the Patient-
at a maintenance dosage of 30 mg to 50 mg daily, it is a highly effective treatment. Adverse reactions are dose-related and generally typical of hypervitaminosis A. As acitretin has no immunomodulatory effects in comparison to conventional treatments, it is thus a superior option in conjunction with ongoing treatment with immune checkpoint inhibitors.To date there are no treatment guidelines for this unique patient cohort and often immunotherapy is ceased in the setting of an acute symptomatic cutaneous adverse event. However, in cases of anti-PD-1 induced or exacerbated psoriasis, we recommend a timely dermatological consult with consideration of acitretin alongside ongoing immunotherapy.
which was observed in our patient. Nevertheless, the diagnosis of POEMS syndrome-associated multicentric Castleman disease was not supported by the absence of peripheral neuropathy in our case. 3 Prior to anakinra treatment, we treated the patient with tocilizumab, 4 which only partially improved urticarial rash on the localized erythematous patches. On the other hand, the administration of anakinra demonstrated prompt favourable responses to clinical manifestations. 2 Taken together, although the possibility of Castleman disease and cutaneous plasmacytosis cannot be completely excluded, our case is considered as Schnitzler syndrome.We agree with the insightful notion by Dr Wang that skinassociated lymphoid tissue (SALT) can be formed under the influence of hypercytokinaemia as a sign of systemic disease. Therefore, we termed these lymphoid follicles as inducible SALT (iSALT). It is yet to be elucidated whether iSALT formation is a characteristic of Schnitzler syndrome or a unique phenomenon detected in our patient, who manifested wheals on recurrent localized erythema, which is not commonly observed in Schnitzler syndrome. We believe that further investigation is required to clarify the pathogenesis and the function of iSALT in various skin diseases. Acknowledgments: We thank Dr Prof. H. Kawabata of Kanazawa Medical University for his informative guidance about the diagnosis of Castleman disease.
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