Mehmet Salih Gurel

Background: Lichen planopilaris (LPP) is an autoimmune cicatricial alopecia leading to irreversible follicular destruction. Interleukin‐31 (IL‐31) and its receptor complex (IL‐31RA/OSMRβ) are implicated in neurogenic inflammation and pruritus in inflammatory dermatoses, including lichen planus. This study aimed to evaluate IL‐31/IL‐31RA expression in LPP and to investigate their associations with disease extent and pruritus. Methods: Thirty patients with classical‐type LPP and 30 age‐ and sex‐matched controls were retrospectively analyzed. Disease extent and pruritus severity were assessed using the scalp involvement score (SALT) and the Numerical Rating Scale (NRS). Immunohistochemical staining was performed on scalp biopsy specimens. Quantitative analysis was conducted using the Sectra UniView digital pathology system and ImageJ/Fiji software. Results: IL‐31/IL‐31RA expression levels were increased in both epidermal and dermal compartments of LPP lesions compared with controls ( p < 0.0001). Strong positive correlations were observed between epidermal and dermal IL‐31/IL‐31RA expression levels ( p < 0.001). No significant associations were detected between IL‐31/IL‐31RA expression and SALT or NRS scores, whereas dermal IL‐31RA levels were higher in patients with perifollicular scaling ( p = 0.039). Conclusion: These findings suggest that increased IL‐31 and IL‐31RA expression in LPP is associated with neuroimmune signaling pathways involved in disease pathophysiology. Rather than indicating a disease‐defining or diagnostic mechanism, IL‐31/IL‐31RA expression may represent an adjunctive immunologic feature within the broader inflammatory milieu of LPP and warrants further investigation in therapeutic and comparative studies.

Background: Tumor necrosis factor‐alpha (TNF‐α) and anti‐BP180‐NC16A immunoglobulin G (IgG) antibodies play roles in the pathogenesis of bullous pemphigoid (BP). However, their correlation with each other, with novel disease severity scales, and their changes in blister fluids during initial therapy have not been well established. Objectives: Objectives: Analyzing TNF‐α and anti‐BP180 antibodies in the blister fluids and sera of BP patients to explore these relationships. Methods: This prospective study included 14 BP patients. We collected blister fluids and sera at baseline and during the initial two weeks of therapy. TNF‐α and anti‐BP180‐NC16A IgG levels were measured by using enzyme‐linked immunosorbent assay. We assessed disease severity using Bullous Pemphigoid Disease Area Index (BPDAI) and BPDAI‐pruritus scores. Results: Our findings showed that TNF‐α levels were significantly higher in blister fluids than in serum ( p = 0.002). In contrast, anti‐BP180‐NC16A IgG levels were significantly higher in serum than in blister fluid ( p = 0.011) and showed a strong correlation ( r = 0.921, p < 0.001). A moderate correlation was found between TNF‐α and anti‐BP180‐NC16A IgG levels in blister fluid ( r = 0.600, p = 0.023), but not in serum. Blister fluid and serum anti‐BP180‐NC16A IgG levels were moderately correlated with BPDAI scores ( r = 0.575, p = 0.032 and r = 0.573, p = 0.032, respectively). However, neither TNF‐α nor anti‐BP180 antibodies correlated with severity subgroups or BPDAI‐pruritus scores. Blister fluid TNF‐α showed a trend toward decreased levels during the first week of therapy. No significant changes were observed in serum samples during the first two weeks of treatment. Conclusion: TNF‐α may be associated with humoral immunity at tissue level and reflect local inflammatory process. TNF‐α levels in new blisters that appear during initial therapy may be affected. While BP180 antibodies seem associated with BPDAI, they do not correlate with severity subgroups or pruritus. Serum markers in the early treatment period may not be useful for predicting disease progression. Trial Registration: ClinicalTrials.gov_identifier: NCT03856840

Dear Editor, Eccrine poroma stands as a benign adnexal neoplasm that originates from the acrosyringium. It typically emerges as solitary, flesh-colored, or erythematous papules, plaques, or nodules, primarily appearing in areas with sweat glands. As well as pigmented lesions, dermoscopy has proven to enhance the clinical diagnosis of numerous non-pigmented skin tumors, including eccrine poroma. Herein we present a case of eccrine poroma located on the dorsal aspect of the left foot, with characteristic dermoscopic features. A 60-year-old woman was admitted with an asymptomatic lesion on the dorsum of her left foot, which had manifested approximately four years before. Clinically, the lesion presented as a well-circumscribed, violaceous, 0.9x0.9 cm papule (Figure 1a). Dermoscopic examination revealed flower-like and leaf-like vascular patterns, white interlacing areas, glomerular vessels, and milky red globules (Figures 1c-d). The lesion was excised and histopathologic findings were consistent with eccrine poroma (Figure 1b). Eccrine poroma (EP) is an adnexal tumor originating in the intraepidermal part of the eccrine sweat gland duct. Dermoscopy and histopathology help to differentiate EP from pyogenic granuloma, seborrheic keratosis, verruca vulgaris, basal cell carcinoma, squamous cell carcinoma, and amelanotic melanoma. Well-defined dermoscopic features in EP are: White interlacing areas around vessels, milky-red globules, flower-like and leaf-like vascular patterns, glomerular vessels, hairpin vessels, yellow structureless areas, poorly visualized vessels, and well-circumscribed globular or lacuna-like structures separated by white to pink mesh bands [1-3]. Histologically, EP manifests as a well-contained tumor constituted of proliferative cuboidal or poroid cells, often extending from the basal epidermis into the dermal layer. Shave, electrosurgical destruction or simple excision may be the treatment of lesions, depending on the depth of the lesion. Kind Regards

Background: Due to the chronic, recurrent nature of Psoriasis vulgaris (PV) and lack of definitive treatment for the disease, patients often resort to alternative treatments. Physicians seem to have low awareness of this issue. Objectives: To elicit the perceptions of 1,621 PV patients on complementary and alternative medicine (CAM) and examine factors reported to worsen PV. Methods: The patients’ sociodemographic characteristics, Psoriasis Area Severity Index (PASI), Dermatology Life Quality Index (DLQI), disease duration, and severity were recorded, and the patients’ CAM use was questioned in detail. The patients were also asked about factors that worsened PV and their experiences with a gluten-free diet. Results: Of the patients, 56.51% had used CAM. The mean age, illness duration, PASI score,s and DLQI of those using CAM were significantly higher. CAM use were significantly higher in those with facial, genital involvement, and arthralgia/arthritis. The patients mostly referred to CAM when PV became severe (46.4%). Of the CAM users, 45.52% used herbal topicals. The physicians of 67.03% did not inquire whether they used CAM. Of the participants, 37.73% considered that stress worsened their disease. Gluten-free diet did not affect PV symptoms in 52.22%. Conclusions: Patients’ CAM use is often overlooked by dermatologists. Our results showed that more than half the patients used CAM and did not share this information with their physicians. Therefore, the awareness of physicians should be increased and patients should be asked about the use of CAM and directed to the appropriate medical treatment options by physicians.

There are safety concerns in the treatment of pemphigus patients with immunosuppressants, particularly rituximab (RTX), in times of the COVID‐19 pandemic. In the beginning, the reports were more pessimistic. However, few reports have recently pointed to manageable courses in this patient group. Therefore, we investigated the disease characteristics and demographic features of pemphigus patients in the period of the COVID‐19 pandemic. We aimed to investigate the impact of immunosuppressants on the course of COVID‐19 in pemphigus patients. Also, we tried to find out the rate of flares due to COVID‐19 and SARS‐Cov‐2 vaccines. This multicenter study included 247 patients with pemphigus from three tertiary dermatology clinics with the specialized outpatient clinic for autoimmune blistering diseases. Patients were asked standardized questions in person or via telephone calls. Also, demographic data were collected from patients' files. Two hundred forty‐four of 247 patients took the survey between August and September 2021. The data of three patients were obtained from the National Health System. We collected the data of all pemphigus patients who visited the clinics at least once in the past 3 years. Among 51 patients having COVID‐19, 40 had a non‐serious disease, whereas 11 required hospitalization. One patient died because of COVID‐19 infection. The number of patients is limited, and data depends mainly on patients' statements. RTX treatment does not require additional safety cautions than other immunosuppressives.