Background Omalizumab, a recombinant anti-IgE antibody, effectively treats chronic spontaneous urticaria. Evidence is lacking in patients with chronic inducible urticarias (CIndUs), which are frequently H 1 -antihistamine resistant. Objective From the current published literature, we aimed to determine the strength of evidence for omalizumab efficacy and safety in the treatment of CIndUs. Methods We performed a PubMed search to identify evidence on omalizumab use in the following 9 CIndU subtypes: symptomatic dermographism, cold urticaria, delayed-pressure urticaria, solar urticaria, heat urticaria, vibratory angioedema, cholinergic urticaria, contact urticaria, and aquagenic urticaria. Results Forty-three trials, case studies, case reports, and analyses were identified. Our review indicates that omalizumab has substantial benefits in patients with various CIndUs. The evidence is strongest for symptomatic dermographism, cold urticaria, and solar urticaria. Little/no evidence was available on vibratory angioedema and aquagenic and contact urticaria. Our review supports rapid onset of action demonstrated through early symptom control in most cases, sometimes within 24 hours. Many patients gained complete/partial symptom relief and substantially improved quality of life. Adverse events were generally low, with omalizumab being well tolerated by most patients, including children. Conclusions A strong body of evidence supports the use of omalizumab in the treatment of patients with therapy-refractory CIndU. More data from randomized controlled studies are warranted.

Omalizumab treatment in patients with chronic inducible urticaria: A systematic review of published evidence

Scleroderma refers to an autoimmune connective tissue fibrosing disease, including three different subsets: localized scleroderma, limited cutaneous systemic sclerosis, and diffuse cutaneous systemic sclerosis with divergent patterns of organ involvement, autoantibody profiles, management, and prognostic implications. Although systemic sclerosis is considered the disease prototype that causes cutaneous sclerosis, there are many other conditions that can mimic and be confused with SSc. They can be classified into immune-mediated/inflammatory, immune-mediated/inflammatory with abnormal deposit (mucinoses), genetic, drug-induced and toxic, metabolic, panniculitis/vascular, and (para)neoplastic disorders according to clinico-pathological and pathogenetic correlations. This article reviews the clinical presentation with emphasis on cutaneous disease, etiopathogenesis, diagnosis, and treatment options available for the different forms of scleroderma firstly and for scleroderma-like disorders, including scleromyxedema, scleredema, nephrogenic systemic fibrosis, eosinophilic fasciitis, chronic graft-versus-host disease, porphyria cutanea tarda, diabetic stiff-hand syndrome (diabetic cheiroartropathy), and other minor forms. This latter group of conditions, termed also scleroderma mimics, sclerodermiform diseases, or pseudosclerodermas, shares the common thread of skin thickening but presents with distinct cutaneous manifestations, skin histology, and systemic implications or disease associations, differentiating each entity from the others and from scleroderma. The lack of Raynaud's phenomenon, capillaroscopic abnormalities, or scleroderma-specific autoantibodies is also important diagnostic clues. As cutaneous involvement is the earliest, most frequent and characteristic manifestation of scleroderma and sclerodermoid disorders, dermatologists are often the first-line doctors who must be able to promptly recognize skin symptoms to provide the affected patient a correct diagnosis and appropriate management.

Cutaneous Manifestations of Scleroderma and Scleroderma-Like Disorders: a Comprehensive Review

The efficient healing of skin wounds is crucial for securing the vital barrier function of the skin, but pathological wound healing and scar formation are major medical problems causing both physiological and psychological challenges for patients. A number of tightly coordinated regenerative responses, including haemostasis, the migration of various cell types into the wound, inflammation, angiogenesis, and the formation of the extracellular matrix, are involved in the healing process. In this article, we summarise the central mechanisms and processes in excessive scarring and acute wound healing, which can lead to the formation of keloids or hypertrophic scars, the two types of fibrotic scars caused by burns or other traumas resulting in significant functional or aesthetic disadvantages. In addition, we discuss recent developments related to the functions of activated fibroblasts, the extracellular matrix and mechanical forces in the wound environment as well as the mechanisms of scarless wound healing. Understanding the different mechanisms of wound healing is pivotal for developing new therapies to prevent the fibrotic scarring of large skin wounds.

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Toward understanding scarless skin wound healing and pathological scarring.

Importance Omalizumab is indicated for the management of chronic idiopathic urticaria (CIU) (also known as chronic spontaneous urticaria) in adolescents and adults with persistent hives not controlled with antihistamines. The effectiveness of omalizumab in the real-world management of CIU is largely unknown. Objective To quantitatively synthesize what is known about the benefits and harms of omalizumab in the real-world clinical management of CIU regarding urticaria activity, treatment response, and adverse events. Data Sources Published observational studies (January 1, 2006, to January 1, 2018) and scientific abstracts on the effectiveness of omalizumab in CIU were identified using PubMed, Embase, Web of Science, and Cochrane search engines; references were searched to identify additional studies. Study Selection Included studies were observational in design and included at least 1 outcome in common with other studies and at a concurrent time point of exposure to omalizumab. A total of 67 articles (35.2% of those screened) were included in the analysis. Data Extraction and Synthesis PRISMA and MOOSE guidelines were followed; independent selection and data extraction were completed by 2 observers. Random-effects meta-analyses were performed. Main Outcomes and Measures Main outcomes were change in weekly Urticaria Activity Score (UAS7; range, 0-42), change in Urticaria Activity Score (UAS; range 0-6) (higher score indicating worse outcome in both scales), complete and partial response rates (percentages), and adverse event rate (percentage). Results Omalizumab therapy was associated with an improvement in UAS7 scores (−25.6 points, 95% CI, −28.2 to −23.0;P  Conclusions and Relevance Benefits and safety of omalizumab in the real-world treatment of CIU meet or exceed results gleaned from clinical trials. These real-world data on omalizumab in CIU may help inform both clinical treatment expectations and policy decision making.

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Benefits and Harms of Omalizumab Treatment in Adolescent and Adult Patients With Chronic Idiopathic (Spontaneous) Urticaria: A Meta-analysis of “Real-world” Evidence

Importance Chronic urticaria (CU) affects 0.1% to 0.3% of children. Most cases have no identifiable trigger and are classified as chronic spontaneous urticaria (CSU). At least half of patients with CSU may have an autoimmune etiology that can be determined in vitro using the basophil activation test (BAT). While 30% to 55% of CU cases resolve spontaneously within 5 years in adults, the natural history and predictors of resolution in children are not known. Objective To assess the comorbidities, natural history of CU, and its subtypes in children and identify predictors of resolution. Design, Setting, and Participants We followed a pediatric cohort with chronic urticaria that presented with hives lasting at least 6 weeks between 2013 and 2015 at a single tertiary care referral center. Exposures Data were collected on disease activity, comorbidities, physical triggers, BAT results, complete blood cell count, C-reactive protein levels, thyroid-stimulating hormone levels, and thyroid peroxidase antibodies. Main Outcomes and Measures We assessed the rate of resolution (defined as absence of hives for at least 1 year with no treatment) and the association with clinical and laboratory markers. Results The cohort comprised 139 children younger than 18 years old. Thirty-one patients (20%) had inducible urticaria, most commonly cold induced. Six children had autoimmune comorbidity, such as thyroiditis and type 1 diabetes. Autoimmune disorders (24 patients [17%]) and CU (17 patients [12%]) were common in family members. Positive BAT results (CD63 levels > 1.8%) were found in 58% of patients. Patients with positive BAT results (CD63 level >1.8%) were twice as likely to resolve after 1 year compared with negative BAT results (hazard ratio [HR], 2.33; 95% CI, 1.08-5.05). In contrast, presence of basophils decreased the likelihood of resolution (HR, 0.40; 95% CI, 0.20-0.99). No correlation with age was found. Chronic urticaria resolved in 43 patients, with a rate of resolution of 10.3% per year. Levels of CD63 higher than 1.8% and absence of basophils were associated with earlier disease resolution. Conclusions and Relevance Resolution rate in children with CU is low. The presence of certain biomarkers (positive BAT result and basophil count) may help to predict the likelihood of resolution.

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Evaluating Comorbidities, Natural History, and Predictors of Early Resolution in a Cohort of Children With Chronic Urticaria

The functional response of natural enemies and their interactions may be affected by host plant characters. Functional response of the adult females of the predatory mite, Typhlodromus bagdasarjani Wainstein and Arutunjan to protonymphs of Eotetranychus frosti (McGregor) on four apple cultivars Imperial Gala, Kohanz Golab, Granny Smith and Lebanon Red was investigated. The protonymphs of E. frosti were offered to the adult female of the predator at densities of 2, 4, 8, 16, 32, 64 and 128 on apple leaf discs (4 cm2). The number and length of trichomes on the lower surface of each apple cultivar were measured. The highest and lowest number of trichomes were observed in Granny Smith and Kohanz Golab, respectively. Typhlodromus bagdasarjani adult females exhibited the type II functional response on E. frosti protonymphs regardless of apple cultivars. Also, the values of attack rate (a) and handling time (Th) were determined using the Rogers's type II model. Adult females of T. bagdasarjani had the highest attack rate (a) (0.0747 h1) and the shortest handling time (0.7005 h) on Kohanz Golab, and the lowest attack rate (0.0334 h1) and the longest handling time (1.1189 h) was on Granny Smith. The theoretical maximum predation rate (T/Th) on Kohanz Golab, Imperial Gala, Lebanon Red and Granny Smith were 34.26, 33.79, 26.85 and 21.45 prey/day, respectively. The estimated value of a/Th indicated that T. bagdasarjani was most effective against E. frosti on Kohanz Golab with lowest number of trichomes. The finding of this study shows that the predation and searching activity of the predator was affected by trichome density and length of the apple leaves.

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Functional response of the predatory mite, Typhlodromus bagdasarjani (Acari: Phytoseiidae) to protonymphs of Eotetranychus frosti (Acari: Tetranychidae) on four apple cultivars

CsA: cyclosporine A SJS: Stevens-Johnson syndrome TEN: toxic epidermal necrolysis INTRODUCTION Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are dermatologic medical emergencies characterized by rapidly progressive diffuse cutaneous necrosis most commonly caused by acute exposure tomedications. These infrequent and unexpected reactions lead to significant morbidity and mortality. Both conditions typically begin with a prodrome of fever and malaise followed by the progressive development of cutaneous and mucosal lesions. Ocular and urogenital lesions are also common. The affected body surface area differentiates pure SJS (\\10%) from pure TEN ([30%). Complications and death typically arise from infections caused by a lack of intact skin barriers. The prevailing understanding of the pathophysiology is that an immune reaction mediates the apoptosis of keratinocytes. As such, immunosuppressants are the hallmark of treatment beyond supportive care. However, conflicting bodies of evidence support their use, and no gold standard exists. Older treatment options include intravenous immunoglobulins and steroids, and one emerging treatment is cyclosporine A (CsA). The existing literature on the benefits of CsA in adults is conflicting given that several studies support its use and others show no benefit. There is thus a need for larger cohort studies, particularly with randomization. In children, the literature on SJS/TEN in general is sparse. Regarding CsA use specifically, there are only several case reports. We thus present our experience with a pediatric SJS/TEN patient that responded rapidly to a high dose of intravenous CsA.

A pediatric case of Stevens-Johnson syndrome/toxic epidermal necrolysis with rapid response to intravenous cyclosporine.

Corresponding Author: Fatemeh Jafarian, Division Dermatology, Department of Medicine, 1001 Decarie Blvd., Montréal, Québec, H4A 3J1, Canada. Email: fatemeh. jafarian@ mcgill. ca Journal of Cutaneous Medicine and Surgery 2020, Vol. 24(6) 642–643 © The Author(s) 2020 Article reuse guidelines: sagepub. com/ journalspermissions DOI: 10. 1177/ 1203 4754 20936649 journals. sagepub. com/ home/ cms Confusion Among Different Forms of Vitamin B3

Confusion Among Different Forms of Vitamin B3.

AVF: arteriovenous fistula or graft CT: computed tomography KC: keratinocyte carcinoma MRI: magnetic resonance imaging SCC: squamous cell carcinomas INTRODUCTION The prevalence of end-stage renal disease and renal transplants has risen dramatically over the past decade. Patient populations with these conditions are of particular concern to dermatologists, given the increased risk for cutaneous malignancy in patients on dialysis and those with a kidney transplant. After renal transplantation, a functioning arteriovenous fistula or graft (AVF) is often maintained for potential future use. Ten-year renal transplantation graft failure rates have been reported as high as 36%. AVFs are usually placed on the upper extremity, positioning a high-pressure circulatory network near the dermis in an area with ultraviolet exposure, which can present a problematic milieu for malignancies. Transplant patients are often immunosuppressed through endogenous and exogenous means with immunomodulatory agents that can be carcinogenic, further raising skin cancer risk. Long-term AVFs might predispose patients to malignancy, considering that increased lymphatic workload with the potential for focal immunosuppression and frequent iatrogenic trauma both accelerate

Keratinocyte carcinomas arising near arteriovenous fistulas: Case series and safety considerations for dermatologic surgery: A report of the International Transplant Skin Cancer Collaborative.

Fatemeh Jafarian

Papers

Functional response of the predatory mite, Typhlodromus bagdasarjani (Acari: Phytoseiidae) to protonymphs of Eotetranychus frosti (Acari: Tetranychidae) on four apple cultivars

A pediatric case of Stevens-Johnson syndrome/toxic epidermal necrolysis with rapid response to intravenous cyclosporine.

Confusion Among Different Forms of Vitamin B3.

Keratinocyte carcinomas arising near arteriovenous fistulas: Case series and safety considerations for dermatologic surgery: A report of the International Transplant Skin Cancer Collaborative.

Growing Role of Telemedicine in Dermatology: A Practical, Timely Application for Skin Cancer Screening in Organ Transplant Recipients.