P. COVID-19 vaccination and patients with psoriasis under biologics: real-life evidence on safety and effectiveness from Italian vaccinated healthcare workers.

Spider poisoning is rare in Europe, with very few reported cases in the literature. Recluse spider (genus Loxosceles) bites may lead to cutaneous and systemic manifestations known as loxoscelism. We report the second known case of spider bite poisoning in Malta caused by Loxosceles rufescens (Mediterranean recluse spider). A young adult female presented with localised erythema and pain on her left thigh after a witnessed spider bite. Over a few days, the area developed features of dermonecrosis together with systemic symptoms, including fever, fatigue and a generalised erythematous eruption. She was managed by a multidisciplinary team and the systemic symptoms resolved within 6 days, while the skin lesion healed with scarring within 2 months. A recluse spider bite should be considered in patients with dermonecrosis. Although spider bite poisoning is uncommon in Europe, it is important to diagnose and manage it appropriately since it could lead to potentially serious sequelae.

papules, nodules and erythematous patches can be presenting signs of vaccine-associated cutaneous pseudolymphoma. 4 The patient in this case had received various vaccinations throughout her lifetime, including the influenza vaccine on a yearly basis but had not experienced any localized or systemic side effects. It has been proposed that cutaneous pseudolymphoma may represent a reaction to vaccine adjuvants such as aluminium hydroxide. 1 This adjuvant is not found in the Pfizer-BioNtech SARS-CoV-2 mRNA vaccine. 5 By flagging this unique adverse drug reaction, we hope to broaden physician's repertoire of differential diagnoses when presented with SARS-CoV-2-related injection site reactions.

IntroductionContinuous positive airway pressure (CPAP) is the standard treatment for obstructive sleep apnoea (OSA), with limited data about the prevalence of respiratory infections and microbial colonization in these patients.ObjectivesThe aim of this study was to determine if CPAP use is associated with respiratory infections and to identify the organisms that colonize or infect these patients.MethodA retrospective, case-controlled study in patients diagnosed with OSA was carried out. 137 patients were recruited and interviewed using a questionnaire. A nasal swab was taken from each patient. Patients using CPAP machines had swabs taken from masks and humidifiers.Results66 (48.2%) patients received CPAP treatment with 60.6% of them having a heated humidifier. 78.8% were male, with the majority using a full face mask (63.6%). No significant difference was seen in the prevalence of rhinosinusitis, lower respiratory tract infections and hospital admissions for pneumonia between CPAP and non-CPAP treated patients. The presence of a humidifier did not influence the prevalence of infections. Commensal flora was predominantly cultured from nasal swabs from both patient groups. Coagulase Negative Staphylococci and Diphtheroids were the main organisms cultured from masks and humidifiers respectively.ConclusionsThis study shows that the use of CPAP, choice of mask and humidifier have no significant impact on the prevalence of infections and micro-organisms isolated. This is very reassuring to the physician prescribing CPAP therapy and users.

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A 55-year-old woman presented with an asymptomatic hypopigmented linear atrophic macular lesion extending from the frontal scalp through the mid-forehead to the nasal bridge, over a 6-week period (Fig. 1). Full skin examination including genitalia was unremarkable. She had no relevant medical history and no family history of autoimmune conditions. Clinicopathological case ª 2018 British Association of Dermatologists 666 Clinical and Experimental Dermatology (2019) 44, pp664-666 C P D

Background Netherton syndrome (NS) is a genodermatosis caused by loss‐of‐function mutations in SPINK5, resulting in aberrant LEKTI expression. Method Next‐generation sequencing of SPINK5 (NM_001127698.1) was carried out and functional studies were performed by immunofluorescence microscopy of a lesional skin biopsy using anti‐LEKTI antibodies. Results We describe a novel SPINK5 likely pathogenic donor splice site variant (NM_001127698.1:c.2015+5G>A) in a patient with NS and confirm its functional significance by demonstrating complete loss of LEKTI expression in lesional skin by immunofluorescence analysis. Conclusion The 2015+5G>A is a novel, likely pathogenic variant in NS. Herein we review and assimilate documented SPINK5 pathogenic variants and discuss possible genotype–phenotype associations in NS.