We report the case of a 57-year-old male presenting with severe, recurrent perineal angioedema and cutaneous leukocytoclastic vasculitis, both of which manifested shortly after commencing lisdexamfetamine for attention d...We report the case of a 57-year-old male presenting with severe, recurrent perineal angioedema and cutaneous leukocytoclastic vasculitis, both of which manifested shortly after commencing lisdexamfetamine for attention deficit hyperactivity disorder. A positive rechallenge after an extensive workup confirmed a drug-induced reaction. This case highlights lisdexamfetamine as a cause of non-allergic angioedema and leukocytoclastic vasculitis, and demonstrates the diagnostic value of a medication history and rechallenge.
Liu L, La E, Vo T
… +4 more, Chronowski-Wong J, Khamu T, Warren L, Tran A
Australas J Dermatol
· 2025 Nov · PMID 41263764
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Anti-tumour necrosis factor (TNF) agents have improved the quality of life for many individuals with autoimmune conditions such as rheumatoid arthritis, psoriasis, and inflammatory bowel disease. A rarer emerging adverse...Anti-tumour necrosis factor (TNF) agents have improved the quality of life for many individuals with autoimmune conditions such as rheumatoid arthritis, psoriasis, and inflammatory bowel disease. A rarer emerging adverse cutaneous reaction of the drug is the development of psoriasiform alopecia areata, which may present acutely or be delayed for many months to years. This case series will highlight histopathological features pertinent for diagnosis, help distinguish secondary reactions from primary psoriatic alopecia, and help guide management, resulting in less inappropriate discontinuation of therapy.
Sebaceous neoplasms are rare skin tumours linked with Lynch syndrome (LS), particularly the Muir-Torre syndrome (MTS) variant. They present an opportunity for early LS detection due to their association with mismatch rep...Sebaceous neoplasms are rare skin tumours linked with Lynch syndrome (LS), particularly the Muir-Torre syndrome (MTS) variant. They present an opportunity for early LS detection due to their association with mismatch repair (MMR) gene pathogenic variants. This study aims to provide an accurate estimate of LS prevalence among patients with sebaceous adenomas and carcinomas. We performed a systematic review and meta-analysis of studies published between 2005 and 2024. Eligible studies utilised germline testing for MMR mutations. The studies were stratified by diagnostic approach and analysed using proportional meta-analysis to determine LS prevalence. Subgroup analyses were conducted by population characteristics and diagnostic criteria. Lynch Syndrome prevalence among patients with sebaceous neoplasms varied across the 9 studies that met eligibility criteria, ranging from 0.8% to 29.0%. LS among patients with sebaceous carcinomas was 6.6% (95% CI: 3.6%-9.5%). Population-based studies had a higher LS identification rate (10.6%), while multi-centre and single-centre studies reported lower rates. Studies using a history suggestive of MTS or MMR-deficient tumours as criteria showed the highest LS prevalence. Male patients had higher sebaceous neoplasms prevalence, with LS-positive cases presenting at a younger age than typical sporadic cases. Our findings highlight the potential for LS detection in patients with sebaceous neoplasms, particularly those with MMR deficiency or a suggestive MTS history. Increased testing in this group could facilitate early LS detection, improving outcomes through screening and preventive strategies. Universal MMR testing for sebaceous tumours warrants consideration as a strategy to capture at-risk LS patients.
Actinic prurigo (AP) is a rare, idiopathic, acquired photodermatosis predominantly affecting indigenous populations in North, Central and South America. It is characterised by intensely pruritic papules and nodules on su...Actinic prurigo (AP) is a rare, idiopathic, acquired photodermatosis predominantly affecting indigenous populations in North, Central and South America. It is characterised by intensely pruritic papules and nodules on sun-exposed skin, with potential involvement of the lips and conjunctivae. Treatment options are limited and often ineffective or associated with an unacceptable safety profile. This systematic review evaluates the existing evidence on the use of dupilumab and Janus kinase (JAK) inhibitors for AP management. A literature search was performed in MEDLINE, Google Scholar, ScienceDirect and Embase, for English-language publications mentioning the use of dupilumab or JAK inhibitors for AP. Eligible studies included case reports, case series, observational studies, clinical trials, consensus statements and guidelines. Two independent reviewers assessed the manuscripts. The search yielded 125 results, with seven publications meeting eligibility criteria, comprising six case reports and one case series. Four publications described three patients successfully treated with dupilumab, demonstrating significant improvement within weeks of initiation. Three reports detailed the successful use of the JAK inhibitors tofacitinib and baricitinib in three patients, leading to rapid symptom resolution. Emerging evidence suggests that dupilumab and JAK inhibitors may be effective in AP treatment. Evidence is limited to case reports with short follow-up durations. Further studies are necessary to establish the efficacy, safety and long-term outcomes of these novel therapies.
Despite the high prevalence of scabies, acute rheumatic fever (ARF) and rheumatic heart disease (RHD) in regions such as Oceania, few studies have addressed the evidence for a causal relationship of scabies with ARF and...Despite the high prevalence of scabies, acute rheumatic fever (ARF) and rheumatic heart disease (RHD) in regions such as Oceania, few studies have addressed the evidence for a causal relationship of scabies with ARF and RHD. In this study, we evaluate the relationship of scabies with GAS and subsequently ARF and RHD, as it could lead to an additional strategy for ARF/RHD prevention. Databases (PubMed, Web of Science and Scopus) were accessed to identify and include studies that investigated the association between scabies, ARF and RHD. Seventy-three articles investigating a potential link between scabies, GAS skin infections and ARF/RHD were included in this review. Most of these studies were from Australasia. Epidemiological and microbiological evidence consistently support the hypothesis that scabies increases the risk of Group A streptococcal (GAS) infection, which, in turn, leads to ARF and RHD. Many studies found shared risk factors and a strong association between scabies and ARF/RHD. The available evidence supports a role of scabies and GAS skin infection in the pathogenesis of ARF/RHD. Large-scale observational studies should be conducted to further define the relationship between these conditions. Based on the evidence presented here, we believe it is likely that improving scabies diagnosis and treatment would reduce the incidence of ARF/RHD.
Teledermatology improves access to care, but its reliability for scoring skin diseases compared with face-to-face assessments remains underexplored. We undertook a systematic review of studies comparing teledermatology a...Teledermatology improves access to care, but its reliability for scoring skin diseases compared with face-to-face assessments remains underexplored. We undertook a systematic review of studies comparing teledermatology and in-person assessments using validated scoring tools. Following PRISMA guidelines, we searched MEDLINE and Embase for English-language studies up to 16 December 2024. Eligible studies reported agreement metrics between photographic and in-person evaluations. Two reviewers independently screened and extracted data. Meta-analysis was performed for EASI and PASI using a random-effects model. Risk of bias was assessed with QUADAS-2. No funding was received. This project was registered on PROSPERO [CRD420251026970]. Sixteen studies involving 927 participants were included: six on atopic dermatitis, five on plaque psoriasis, three on patch testing, and two on acne. Reported reliability metrics included the intraclass correlation coefficient (ICC) and kappa values. These ranged from moderate to excellent. Reliability was influenced by assessor experience, image quality, and disease severity. Nine studies were at risk of bias due to unclear methodology. Pooled ICCs demonstrated excellent reliability for atopic dermatitis (0.90) and good reliability for psoriasis (0.87). These findings suggest that teledermatology appears as reliable as in-person review for atopic dermatitis and psoriasis, supporting its role in clinical practice. Standardisation of image capture and further research across a broader range of dermatological conditions is required.
Su JC, Townsend A, Gibson KA
… +3 more, Kauffman L, Colman S, Newson RS
Australas J Dermatol
· 2025 Dec · PMID 41178170
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BACKGROUND/OBJECTIVES: Atopic dermatitis (AD) affects up to 2.8 million Australians. This study examines the current characteristics of the disease and the burden placed on Australian adults living with moderate-to-sever...BACKGROUND/OBJECTIVES: Atopic dermatitis (AD) affects up to 2.8 million Australians. This study examines the current characteristics of the disease and the burden placed on Australian adults living with moderate-to-severe AD. METHOD: A cross-sectional online survey of persons with moderate to severe AD (n = 300), enrolled in October 2024, was conducted, examining self-reported demographics, AD characteristics and burden of disease, including the Patient Oriented Eczema Measure (POEM) and the Dermatology Life Quality Index (DLQI). All analyses were descriptive and assessed by the following subgroups: moderate AD, severe AD and severe AD on advanced therapy. RESULT: The mean (SD) age of participants was 38.2 (11.87) years, with 53.7% being female and 69.7% Caucasian. AD was active in 92.3% of participants, with a mean of 56.9 (65.9) active flare days in the past 6 months. The mean POEM score was 14.6 (5.90), and 90.7% reported disturbed sleep due to AD. Among employed respondents, the mean number of reduced workdays due to AD in the previous month was 3.2 (3.22). AD significantly impacted 59.0% of respondents' ability to engage in activities of interest. Co-morbidities were common, with 48.3% having at least one; the most prevalent being allergies (29.0%), anxiety (24.0%), and depression (13.7%). CONCLUSION: Nearly all participants experienced sleep disturbances, and the prevalence of anxiety and depression was high. Active flares in AD were frequent. Work and social impairment in moderate-to-severe AD was significant, including for many receiving currently available advanced therapies. There remains a need for new treatments in Australia to alleviate the current AD burden.
Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are rare, severe mucocutaneous diseases associated with high rates of mortality. While the acute complications of SJS and TEN are well documented, it is...Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are rare, severe mucocutaneous diseases associated with high rates of mortality. While the acute complications of SJS and TEN are well documented, it is being increasingly recognised that survivors may develop psychological sequelae that can be associated with significant morbidity. This systematic review and meta-analysis aimed to critically evaluate observational studies of psychiatric complications and quality of life in adults with SJS and TEN. This review was registered with INPLASY and conducted in accordance with the PRISMA reporting guidelines. Potential bias was assessed using the NIH criteria. Ten articles describing results from 1123 cases and 2687 controls were included. The overall quality of the studies was suboptimal, and the level of heterogeneity was very high (I = 96%). Meta-analysis of eight studies with fifteen study groups (n = 2120) showed a prevalence of psychiatric complications of 24.9% in SJS and TEN patients. SJS and TEN survivors appear to suffer a high burden of psychological complications, including post-traumatic stress disorder, depression, anxiety, as well as quality of life impairment. This population would likely benefit from early multidisciplinary input and long-term follow-up; however, additional larger controlled studies are needed.
We describe four cases of iron extravasation injuries presenting to a dermatology clinic, where compression applied post-infusion appeared to reduce or prevent cutaneous siderosis. In each case, distinct patterns of hype...We describe four cases of iron extravasation injuries presenting to a dermatology clinic, where compression applied post-infusion appeared to reduce or prevent cutaneous siderosis. In each case, distinct patterns of hyperpigmentation were observed, with areas of compression from bandages or dressings showing reduced staining. Iron extravasation, a complication of intravenous iron therapy, can cause permanent cosmetic damage and distress. Current treatment options for reversing staining are limited, costly and require multiple sessions. This case series suggests that compression may be a simple, safe and effective measure to minimise cutaneous siderosis and improve patient outcomes.
While allergic contact dermatitis (ACD) to lanolin and its derivatives is well-recognised, its presence in certain wound care products is often not apparent due to the absence of the ingredients list on their packaging....While allergic contact dermatitis (ACD) to lanolin and its derivatives is well-recognised, its presence in certain wound care products is often not apparent due to the absence of the ingredients list on their packaging. This case report describes allergy to Cuticerin dressings in a patient with a history of chronic ulcers, highlighting the presence of lanolin in this particular dressing and the risk of sensitisation in individuals with chronic skin barrier impairment.
Folliculitis decalvans (FD) and Tufted Hair Folliculitis (THF) present with recurrent episodes of follicular inflammation, pustules and crusting, predominantly of the scalp, leading to scarring alopecia. With no specific...Folliculitis decalvans (FD) and Tufted Hair Folliculitis (THF) present with recurrent episodes of follicular inflammation, pustules and crusting, predominantly of the scalp, leading to scarring alopecia. With no specific or optimal treatment available, FD/THF is difficult to treat and significantly impacts patients' quality of life. As new treatments have been reported for FD/THF management in recent years, we conducted a systematic review aiming to identify the types of treatments used in FD/THF, their effect, duration of effect (DoE), impact on patients' quality of life and any adverse effects impacting treatment. Registered with PROSPERO (CRD42023459898), we used PRISMA and SWiM guidelines, and Joanna Briggs Institute Critical Appraisal tools. We found 113 articles involving 728 patients, reporting on 2041 treatment episodes for 246 different treatments. Reported treatment effects were assessed, and descriptive statistics were used to calculate the median DoE for each. A mean age of 38.3 years with predominantly male (3.3:1) and Fitzpatrick I-IV skin type (85.2%) was noted. Reported treatments included systemic and topical antibiotics, corticosteroids, retinoids and ciclosporin, as well as biologic agents, photodynamic therapy, laser therapies, topical calcineurin inhibitors, radiation therapy, surgical procedures, platelet-rich-plasma injections, botulinum toxin A injections, Manuka honey and Ayurvedic treatments with leech therapy. Although limitations exist due to GRADE level of evidence being low to very low, our findings suggest systemic antibiotic monotherapy may not be as beneficial as previously reported. Combination therapy with systemic antibiotics, topical, local and/or other systemic agents may provide the best outcome and longest DoE for FD/THF patients, with a greater role for biologic agents and laser therapy in their management.