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Omalizumab (OMZ) is a recombinant, humanized, and monoclonal immunoglobulin G1 (IgG1) anti-IgE antibody approved in patients 12 years of age and older with chronic spontaneous urticaria (CSU) resistant to H1 antihistamines. OMZ blocks IgE binding to its high-affinity FCεRI, resulting in a reduction in free IgE and IgE-mediated reactions. 1 The data on the use of OMZ during the coronavirus disease 19 (COVID-19) pandemic are limited, and our current knowledge is mainly based on case reports. It is recommended to continue OMZ in patients with mild-to-moderate COVID-19, and to prolong the dose intervals or interrupt the treatment according to the patient-based risk-benefit analysis in case of severe disease. 2,3 The aim of this study was to evaluate 1) the prevalence of COVID-19 infection, 2) maintenance of omalizumab treatment, 3) vaccination status, and 4) exacerbation of urticaria symptoms related to COVID-19 infection or vaccination in patients with CSU using omalizumab during the pandemic.

Introduction: Telogen effluvium (TE) is one of the causes of non-scarring hair loss that occurred commonly 2-3 months after a triggering factor. It was reported that the incidence of TE increased during the COVID-19 (coronavirus disease 2019) pandemic.However, to date, there is no study evaluating the status of COVID-19 before the onset of hair loss in patients with TE. The aim of this study is to evaluate the patients with TE whether they had COVID-19 or not before the onset of their hair loss and to compare the demographic and clinical characteristics and laboratory parameters of those with and without a history of COVID-19. Method:We conducted an observational cohort study of TE patients. The diagnosis of TE depended on anamnesis and physical examination of the patients. Also, hair pull test was performed. Demographic data and the results of COVID-19 real-time polymerase chain reaction (RT-PCR) were recorded from the electronic medical records.Results: Totally, 181 patients with TE were included in the study. Sixty-four of patients (35.4%) had been diagnosed with COVID-19 before the hair loss started. The median duration of development of hair loss was 2 months (range 1-11 months, IQR 3) after COVID-19 diagnosis. In this group, 87.5% of patients (n = 56) had acute TE and 12.5% of patients (n = 8) had chronic TE. The rate of acute TE and the use of vitamin supplements were ignificantly higher (p < 0.001 and p = 0.027, respectively) and the monocyte count in peripheral blood was lower (p = 0.041) in the group diagnosed with COVID-19. Discussion and Conclusion:It was stated that monocytes and macrophages infected by SARS-CoV-2 can produce pro-inflammatory cytokines that play a crucial role in the development of COVID-19-related complications. Also, it was suggested that the number of monocytes tends to be lower in the late recovery stage. The lower monocyte count in patients with a history of COVID-19 in our study may be related to evaluating the patients in the late period of recovery and the migration of circulating monocytes to hair follicles. The history of COVID-19 must be questioned in patients with TE. It should be kept in mind that hair loss that develops after COVID-19 may be presented as chronic TE form too. The exact mechanisms of hair loss induced by COVID-19 are not fully explained; the roles of monocytes on the hair follicles may be one of the responsible mechanisms. How to cite this article: Koç Yıldırım S, Erbağcı E, Demirel Öğüt N. Evaluation of patients with telogen effluvium during the pandemic: May the monocytes be responsible for post COVID-19 telogen effluvium?

Background Dupilumab is approved for the treatment of atopic dermatitis (AD). However, there are few studies demonstrating its efficacy and safety, particularly in the treatment of adult‐onset AD. Objective The aim of this study is to evaluate the real‐life experience regarding the efficacy and safety of dupilumab in the treatment of adult‐onset AD. Methods This study is a case series in retrospective design. Patients with the diagnosis of adult‐onset AD, using dupilumab at a standard dose for at least 3 months, were included in the study. Demographic and laboratory data of the cases, data regarding to dupilumab treatment, were recorded. The eczema area severity index (EASI) and the visual analog scale (VAS) for itch were used to evaluate treatment efficacy. Results A total of 16 patients, 6 female and 10 male, were included. The median age was 41 years, the median age of the disease onset was 37.5 years, and the median duration of the disease was 90 months. The median duration of the dupilumab treatment was 10.5 months. The mean percent reduction from baseline in EASI score was 85.8 ± 12.2 at 3 months, 90.7 ± 9.3 at 6 months, and 93.1 ± 5 at 12 months. The mean percent reduction from baseline in VAS itch score was 82.2 ± 8.6 at 3 months. Acute vestibular neuritis was developed in one patient during the dupilumab therapy and resolved with anti‐inflammatory therapy. Conclusion Dupilumab seems to be highly effective and safe in the treatment of adult‐onset AD. The present study is important as it is the first study to evaluate this patient group specifically.

To the Editor, Lipedematous alopecia (LA) is a rare condition of unknown etiology characterized by a localized or diffusely thickened subcutaneous tissue with boggy texture and alopecia. Herein, we present two female siblings who were diagnosed with LA that were not previously described in the literature to the best of our knowledge.

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ÖzAmaç: Psoriatik artrit (PsA), entezit ve/veya yumuşak doku şişliği tüm psoriazisli hastaların yaklaşık %6-30'unda birlikte görülmektedir. Geri dönüşü olmayan komplikasyonlar ile giden sakatlayıcı ciddi bir komorbidite olması nedeniyle PsA'nın erken tanısı önemlidir. Gereç ve Yöntem: Mart 2014-Mart 2015 tarihleri arasında Hacettepe Üniversitesi Tıp Fakültesi, Dermatoloji Anabilim Dalı'na başvuran öncesinde PsA tanısı olmayan plak psoriazisli hastalar çalışmaya dahil edildi. Demografik bilgiler, daha önce alınan tedaviler, laboratuvar parametreler ve muayene bulguları toplandı. Tüm hastalara aynı hekim tarafından eşlik edebilecek romatolojik şikayetler ile ilgili hazırlanmış beş sorudan oluşan romatolojik anket uygulandı. En az bir soruya pozitif yanıt veren hastalar aynı merkezin romatoloji bölümüne konsülte edilerek değerlendirildi. Bulgular: İki yüz yirmi üç hasta çalışmaya dahil edildi, %58'i (n=129) erkek ve %42'si (n=94) kadındı. Hastaların ortalama yaşı 43,46±14,31 yıldı. Ortalama Psoriazis Alan ve Şiddet İndeks skoru 12,66±9,89 idi. Ankette en sık saptanan şikayet istirahatte miyalji/artralji varlığı olarak hastaların %28'inde (n=62) saptandı. Hastalardan ankette en az bir pozitif yanıtı olan %30'u (n=69) romatoloji bölümüne konsülte edildi, bu hastaların %24'ü (n=53) romatoloji tarafından değerlendirildi. Bu hastaların %40'ında (n=21) PsA, %6'sında (n=3) sakroiliit, %4'ünde (n=2) ankilozan spondilit ve bir hastada tanımlanamayan bağ doku hastalığı olmak üzere hastaların %51'i (n=27) hasta romatolojik hastalık tanısı aldı Sonuç: Dermatoloji hekimlerinin PsA semptomlarından şüphelenme, bu belirtileri sorgulama ve muayene yetilerinin geliştirilmesi erken tanının sağlanabilmesi için önemlidir. Bu çalışmada psoriazisli hastalarda standart bir romatolojik anket uygulaması ile verimli biçimde PsA tanısının tahmin edilebileceği sonucuna varılmıştır. Anahtar Kelimeler: Psoriazis, psoriatik artrit, anket Background and Design: Psoriatic arthritis (PsA), enthesitis and/or soft tissue swelling accompany psoriasis in 6-30% of all psoriatic patients. Early recognition of PsA is crucial since it is a serious disabling comorbidity with irreversible complications. Materials and Methods: Patients, who were admitted to the outpatient clinic of Hacettepe University Faculty of Medicine Department of Dermatology between March 2014 and 2015 with plaque psoriasis lacking any prior PsA diagnosis, were enrolled for this study. Demographic data, previous treatment history, laboratory parameters and physical examination of the patients were collected. All patients were examined by the same physician with a rheumatologic questionnaire that consists of five questions about any accompanying rheumatologic complaints. All patients who had at least one positive answer were consulted with the department of rheumatology at the same center. Results: Two hundred and twenty-three patients were included, 58% (n=129) were male and 42% (n=94) were female. The mean age of the patients was 43.46±14.31 years. The mean Psoriasis Area and S...

Background: Chronic spontaneous urticaria (CSU) is a mast cell-mediated disease, which is sometimes associated with various inflammatory disorders.Omalizumab is a commonly used biological agent, which is a recombinant, humanized, monoclonal antibody against human immunoglobulin E. However, there are only few reports about the combination of omalizumab for CSU with any other biologics for accompanying inflammatory diseases in the literature. The aim of this study was to evaluate the patients whose treatment of omalizumab for CSU were combined with any other biologics for associated inflammatory disorders and to describe whether these combinations might have any safety concerns. Methods:We conducted a retrospective cohort study of adult patients with CSU treated with omalizumab concurrently using another biological agent for their other dermatological conditions.Results: Thirty-one patients, 19 women and 12 men, were evaluated. The mean age was 45.13 years. The median duration of omalizumab was 11 months.Biological agents which patients were treated other than omalizumab were as follows: adalimumab biosimilar (n = 3), ustekinumab (n = 4), secukinumab (n = 17) and ixekizumab (n = 7). The median duration of concurrent use of omalizumab and other biologics was 8 months. None of the drug combinations was stopped because of side effects. Conclusion:This observational study demonstrated that omalizumab treatment for CSU in combination with any other biological agents for dermatological disorders appeared to be well tolerated without any major safety concerns.