Darren Roche

Little is known about biological outcomes for severe psoriasis in trisomy 21 (T21). Our aim was to review outcomes of patients with T21 and severe psoriasis treated with biologic or Janus kinase inhibitors (JAKi). Information on demographics, co‐morbidities, and therapeutic responses was retrospectively collated. Twenty‐one patients were identified (mean age 24.7 years). Ninety percent (18/20) of TNFα inhibitor trials failed. Almost two‐thirds (7/11) of patients achieved an adequate response with ustekinumab. All three patients treated with tofacitinib achieved an adequate response following at least three biologic failures. The mean number of biologic/JAKi therapies received was 2.1 with overall survival of 36%. Eighty‐one percent (17/21) of patients required conversion from their index biologic treatment due to failure. In patients with T21 and severe psoriasis, failure of TNFα inhibition is common and ustekinumab therapy should be considered as first‐line therapy. The role of JAKi is emerging.

We report a case of symmetrical drug-related intertriginous and flexural exanthema following antiretroviral postexposure prophylactic medications, tenofovir and emtricitabine, commencement of which preceded the onset of the rash. Tenofovir and emtricitabine are both nucleoside reverse transcriptase inhibitor medications, commonly used to prevent development of AIDS.

Psoriasis is a chronic, hereditary disease with a complex immunopathogenesis rendering it susceptible to misinformation. Misinformation related to psoriasis can have negative effects on both the public perception of psoriasis and patients’ knowledge of psoriasis. To characterize misinformation related to psoriasis available online, we performed a formal literature review via PubMed and a thematic review via Google. Key themes of misinformation included ‘victim-blaming’ (hygiene), ‘vector’ (contagion), ‘vaccination’, ‘villification’ of conventional therapy, ‘validation’ of natural treatment and diet, ‘veneration’ of cures, and ‘vocalization’ from celebrities. Misinformation related to psoriasis is pervasive on social media and other websites. Dermatologists, as patient advocates, should be aware of the content of misinformation available online and combat misleading health information to optimize health outcomes for patients with psoriasis.

A 28-year-old farmer with class IV lupus nephritis presented with a two-week history of a right shin lesion. The lesion was purple in color, fungating, and indurated with a focus of deep ulceration at the inferior pole and punctate, bleeding from its surface. Three months earlier, he was started on induction immunosuppression for a relapse of his lupus nephritis. Since the diagnosis of lupus nephritis, nine years previously, he had had six flares of his disease and had been treated at different time points with cyclophosphamide, rituximab, and high-dose corticosteroids, without adverse events. Laboratory investigations showed improving kidney function (chronic kidney disease [CKD] stage IV) with reducing proteinuria, on his current immunosuppressive regimen. The differential diagnosis for this lesion was calciphylaxis, pyoderma gangrenosum, vasculitic lesion, or an infection. Histology and microbiological analysis confirmed the presence of Absidia corymbifera. He was treated with a combination of isavuconazole, reduction of his immunosuppressive agents, excision of the lesion, and skin grafting.

Dear Editor, Misinformation has been a major global challenge in the COVID‐19 pandemic. Several therapies relevant to dermatology have been falsely touted as beneficial, including hydroxychloroquine