Letter to the Editor e561 Table 1 Characteristics of 12 patients with atypical exanthemas and eosinophilia Case

A new outbreak of monkeypox virus (MPXV) infection, a zoonotic infection endemic in Central and West Africa, is spreading throughout the world with new epidemiology and clinical features. Our aim was to characterize patients presenting to Dermatology emergency room with a MPXV infection between 15 May and 30 June 2022 in a tertiary hospital in Madrid, Spain. We collected 53 patients and describe their clinical, demographic and epidemiological characteristics and followed their evolution.Most of the patients were men who had sex with men with high-risk sexual practices and no recent travels abroad. Most of them (91%) had had a sexually transmitted infection before. All patients had typical skin lesions consisting of vesicular-pustular rash with central umbilication which was localized or disseminated. The most frequent extracutaneous symptoms were fever, painful regional lymphadenopathy and asthenia. Proctitis was present in more than one third of patients. All patients were diagnosed by real time polymerase chain reaction of samples obtained from skin lesions. Pharyngeal and/or rectal exudates demonstrated MPXV in 74% of patients. The current worldwide outbreak of MPXV infections shows epidemiological and clinical differences from previous ones. Clinicians should be aware of these characteristics to correctly diagnose this emerging disease.

BACKGROUND Intralesional methotrexate (il-MTX) has been used as neoadjuvant therapy for cutaneous squamous cell carcinoma (cSCC) but studies on its effects on tumor thickness are lacking. OBJECTIVE The objective of this study was to evaluate il-MTX response with ultrasound examination. METHODS The authors conducted a prospective study in 40 patients with histologically confirmed cSCC. Neodjuvant il-MTX therapy was administered before surgery. Ultrasound evaluation was performed before the first infiltration and before surgical treatment. RESULTS Response to neoadjuvant treatment was observed in 92.5% of patients, both clinically and sonographically. There was a good correlation between both types of measurements, with r = 0.892 for the minor diameter and r = 0.944 for the major diameter (p < .001). The authors found an ultrasound overestimation compared to the clinical measurements in 92.5% of patients (mean overestimation: 1.08 mm). There was a good correlation between ultrasound and histological measurements in tumor thickness with r = 0.932 (p < .01), with an ultrasound overestimation in 97.5% of cases (mean overestimation: 0.90 mm). CONCLUSION Neoadjuvant il-MTX can reduce not only surface tumor dimensions but also tumor thickness. Ultrasound improves treatment response control with greater accuracy than clinical assessment alone.

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Bullous pemphigoid (BP) is the most common autoimmune blistering disease of the skin and mucous membranes. 1,2 Although autoantibodies targeting proteins of the dermoepidermal junction (BP antigen 1 (BPAG1/ BP230) and BP antigen 2 (BPAG2/ BP180)) have been demonstrated as the physiopathological bases of BP, 1,3 the exact pathogenesis remains unknown.Reported annual incidence of BP varies 3-5 and ranges from 2.4 to 21.7 per million population. However, the tendency for BP incidence to increase is clear-cut. 4,[6][7][8] This increase has been attributed to population ageing, drug-induced cases and improvement in the diagnosis due to increasing awareness of non-bullous and atypical variants of BP. 1,3,8 Many studies have corroborated the potential association of medication use with BP. 9-12 Dipeptidyl peptidase-4 inhibitors