Molluscum contagiosum (MC) is a viral skin infection that poses significant physical and psychosocial burdens, particularly in pediatric and immunocompromised populations. Despite the availability of various treatment op...Molluscum contagiosum (MC) is a viral skin infection that poses significant physical and psychosocial burdens, particularly in pediatric and immunocompromised populations. Despite the availability of various treatment options, comparative efficacy and safety data remain limited. This systematic review, conducted in accordance with PRISMA guidelines, evaluates and compares the efficacy, safety, recurrence, and adverse effects of MC treatments. A total of 89 studies encompassing 12,955 participants were analyzed. Curettage, potassium hydroxide (KOH), autoinoculation, and podophyllotoxin demonstrated high clearance rates (97.8%, 73.8%, 79.4%, and 75.0%, respectively) with minimal local side effects. Cryotherapy and laser therapies offered rapid lesion resolution though laser treatment was associated with more discomfort and higher cost. Emerging therapies such as berdazimer gel demonstrated favorable safety profiles, particularly for pediatric patients, while intralesional immunotherapies like Candida and MMR vaccine showed encouraging results in patients with persistent or recurring lesions. The management of MC requires an individualized approach, balancing efficacy, safety, and patient-specific factors such as age, lesion severity, and immune status. Cantharidin, KOH, cryotherapy, autoinoculation, and podophyllotoxin offer high clearance rates, with immunotherapies and lasers offering additional options for resistant cases. Further standardized trials are needed to optimize treatment strategies and long-term recurrence.
BACKGROUND AND OBJECTIVE: Pemphigus treatment has seen significant advancements, yet long-term remission remains a challenge. Comparative data on the long-term effectiveness of available therapies are limited. We compare...BACKGROUND AND OBJECTIVE: Pemphigus treatment has seen significant advancements, yet long-term remission remains a challenge. Comparative data on the long-term effectiveness of available therapies are limited. We compared 10-year relapse rates in pemphigus patients treated with azathioprine or cyclophosphamide plus high-dose IV corticosteroids PATIENTS AND METHODS: In this retrospective single-center cohort study, we analyzed 91 patients with pemphigus vulgaris/foliaceus treated between 1985 and 2022. 43 patients received oral azathioprine, 48 received intermittent intravenous and oral cyclophosphamide. All patients also received intermittent high-dose IV corticosteroids for ≥ 1 year. As rituximab became widely available only after 2019, follow-up was insufficient to include it in this analysis. RESULTS: Remission occurred equally quickly in both groups, but patients treated with cyclophosphamide suffered from significantly fewer relapses: 27% of cyclophosphamide patients had ≥ 1 relapse vs. 80.6% with azathioprine (p < 0.001). 70% of cyclophosphamide patients remained relapse-free and were off therapy for an average of 7 years. CONCLUSIONS: Aggressive initial immunosuppressive therapy with cyclophosphamide is associated with a significantly lower long-term relapse rate in pemphigus. While routine use is limited by its toxicity, these findings underscore the potential for durable remission and the importance of long-term disease control as a treatment goal.
BACKGROUND: Wheat-dependent exercise-induced anaphylaxis (WDEIA) occurs after ingestion of wheat/gluten in the presence of various cofactors. Here, we characterized the sensitization spectrum to various wheat flours, as...BACKGROUND: Wheat-dependent exercise-induced anaphylaxis (WDEIA) occurs after ingestion of wheat/gluten in the presence of various cofactors. Here, we characterized the sensitization spectrum to various wheat flours, as revealed by skin prick test (SPT) and specific IgE (sIgE) against wheat flour, gluten, and various wheat components. The findings were correlated with medical history and oral food challenge (OFC) outcomes in patients with suspected WDEIA. PATIENTS AND METHODS: Retrospectively, 60 patients with specific immunoglobulin E (sIgE) against ω5-gliadin and a history of anaphylaxis after wheat ingestion were analyzed. RESULTS: WDEIA was confirmed after OFC (38/60) in approximately 75 %. With SPT, increased wheal diameters for wheat flours were observed in patients with a history of severe anaphylaxis when compared to patients with milder symptoms of anaphylaxis. Patients with OFC-confirmed WDEIA showed higher SPT wheal diameters for gluten (when compared to patients with negative OFC). OFC outcomes could not be predicted by sIgEs against various wheat components; however, in a subgroup of patients, the values of sIgE against ω5-gliadin and gluten tended to be higher with greater anaphylaxis severity grade. CONCLUSIONS: Thorough medical history taking is crucial for patients with a history of anaphylaxis. Although SPT and sIgE can guide diagnosis, only OFC can confirm the diagnosis of WDEIA.
Atopic dermatitis (AD) may be complicated by disseminated molluscum contagiosum virus (MOCV) infection, known as eczema molluscatum (EM), particularly in children. Topical treatments are not always effective, and althoug...Atopic dermatitis (AD) may be complicated by disseminated molluscum contagiosum virus (MOCV) infection, known as eczema molluscatum (EM), particularly in children. Topical treatments are not always effective, and although modern systemic immunomodulatory therapies for AD, including use in early childhood, are available, their impact on co-occurring MCV infection is not well documented. We present a 4-year-old child with severe EM that was refractory to conventional topical therapy. She was treated with dupilumab (300 mg subcutaneously every four weeks), which led to a rapid resolution of symptoms and clinical clearance of MOCV-1 infection without adverse events. To contextualize our findings, we performed a systematic literature review, including PubMed, ScienceDirect, Scopus, and Google Scholar, to identify published case descriptions of dupilumab use with co-occurring MOCV infection (PROSPERO ID CRD420251106639). We identified a total of six publications reporting on nine adult patients (mean age: 40 years, range: 21-58 years, 8/9 male). In five of these patients, EM temporarily flared up before resolution. The present report is the first of a child. Our findings, along with existing reports, suggest that dupilumab may be a safe and effective treatment option for AD patients with MOCV infection. Prospective evaluation using standardized outcome measures is warranted.
Blume-Peytavi U, Constantinou A, Tomova-Simitchieva T
… +11 more, Tanew A, Sticherling M, Girschick H, Vogt A, Schwichtenberg U, Gieler U, Märtens A, Zienert K, Stenders C, Werner RN, Wilborn D
This second part of the S3 guideline on the diagnosis and treatment of alopecia areata (AA), presents key recommendations on topical and systemic therapy, quality of life and support services. The first part of the guide...This second part of the S3 guideline on the diagnosis and treatment of alopecia areata (AA), presents key recommendations on topical and systemic therapy, quality of life and support services. The first part of the guideline, published separately, covers the definition and content of epidemiology and diagnosis as well as comorbidities, risk and prognostic factors. The application of corticosteroids is the only topical intervention with a high level of recommendation. All other topical agents that can be offered for the treatment of AA have a low level of recommendation, whereby the recommendation levels for the individual topical agents vary in the age groups of children, adolescents and adults. Of the active substances for systemic treatment of AA, only systemic corticosteroids and Janus kinase inhibitors (JAK) have a high level of recommendation, and they are restricted only to adults. Children and adolescents can be offered corticosteroids, methotrexate or JAK* (*with appropriate authorisation for the age group) for a severe form or higher. All other systemic agents should not be offered to children and adolescents. The expert group recommends that all patients with all forms of AA, regardless of age, should be informed about the possibilities of hair replacement and cosmetic options.
Hereditary angioedema (HAE), a rare and debilitating disease characterized by recurrent and spontaneous attacks of tissue swelling, has a high unmet therapeutic need, with many patients experiencing insufficient disease...Hereditary angioedema (HAE), a rare and debilitating disease characterized by recurrent and spontaneous attacks of tissue swelling, has a high unmet therapeutic need, with many patients experiencing insufficient disease control with current prophylactic treatments. The goal of HAE treatment as per guidelines is to achieve total disease control and to normalize patients' lives. Factor XII (FXII), the principal initiator of the contact system, ultimately regulates the kallikrein-kinin system. Activated FXII (FXIIa) converts plasma prekallikrein to plasma kallikrein, which cleaves high-molecular-weight kininogen to produce the vasoactive peptide bradykinin. In HAE pathophysiology, kallikrein-kinin system dysregulation results in excessive bradykinin production. The anti-FXIIa monoclonal antibody garadacimab is approved for long-term prophylaxis against HAE attacks. In the pivotal phase III (VANGUARD) and ongoing phase III open-label extension studies, garadacimab administered subcutaneously (2 × 200 mg loading dose followed by 200 mg once monthly) demonstrated durable efficacy with early onset of protection and a favorable long-term safety profile. Based on this and earlier clinical data, garadacimab has the potential to bring patients closer to achieving the guideline-recommended goals of disease control and normalization of life. Here, we provide an overview of the results from the garadacimab clinical development program.
BACKGROUND AND OBJECTIVES: Oral lichen planus (OLP) is a chronic autoimmune mucosal disease with malignant potential and limited treatment options. This study evaluated the long-term efficacy and safety of cold atmospher...BACKGROUND AND OBJECTIVES: Oral lichen planus (OLP) is a chronic autoimmune mucosal disease with malignant potential and limited treatment options. This study evaluated the long-term efficacy and safety of cold atmospheric plasma (CAP) therapy in therapy-refractory OLP and introduced the novel Lichen Planus Severity Score (LPSS). PATIENTS AND METHODS: Between 2016 and 2019, four patients with histologically confirmed erosive or reticular OLP unresponsive to standard treatments received intraoral CAP therapy using an Argon-based plasma device. Disease activity and symptoms were systematically assessed using the LPSS, integrating clinician-rated (inflammation, ulceration) and patient-reported (pain, function) parameters. Follow-up extended up to 9 years. RESULTS: All patients achieved significant clinical improvement, with LPSS grades decreasing from II-III to I post-therapy. CAP treatment showed a strong, statistically significant correlation with reduced inflammation, ulceration, symptoms, and total LPSS (p < 0.001; ρ = -0.34 to -0.96), indicating sustained remission. No adverse effects or malignant transformations occurred during follow-up. CONCLUSIONS: This first long-term evaluation demonstrates that CAP therapy provides durable remission and excellent safety in refractory OLP. The LPSS proved practical for standardized monitoring. CAP represents a promising non-immunosuppressive therapeutic option warranting validation in larger controlled studies.
BACKGROUND: To improve dermatological care in underserved rural regions, the "Teledermatology in Styria" project launched on January 1, 2020. General practitioners (GP) were digitally connected with dermatologists (DERM)...BACKGROUND: To improve dermatological care in underserved rural regions, the "Teledermatology in Styria" project launched on January 1, 2020. General practitioners (GP) were digitally connected with dermatologists (DERM), supported by Styrian Health Fund, Styrian Medical Association, Austrian Health Insurance Fund Styria, Universities' Department of Dermatology, and e-derm-consult GesmbH. PATIENTS AND METHODS: GPs submit clinical information and images (clinical, dermoscopic) of patient's skin conditions, via a "store-and-forward" service to DERM, who responded with diagnosis and treatment recommendations. The descriptive statistical analysis covered cases from five years without reference region and assessed patient and doctor acceptance through questionnaires. RESULTS: From 5,119 cases DERM changed GPs diagnosis in 51%, no diagnosis was provided by GPs in 23% and only in 25% DERM confirmed GPs diagnosis. While 19% of all cases required no therapy, most cases (61%) were managed by their GPs following teledermatological consultation. Referrals included 12% routine dermatological appointments, 3% urgent appointments, and 2% hospital visits. The case spectrum covered all dermato-venereological conditions, with only 34% neoplasms. Patient satisfaction exceeded 95%, based on 692 returned questionnaires. CONCLUSIONS: Only 17% of patients required additional dermatological examination after teledermatology. The months faster diagnosis and the high level of patient satisfaction highlight the benefits of teledermatological consultations.