Conor Larney

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.

Real‐world use of dupilumab has unveiled a spectrum of side effects that were not fully appreciated in initial clinical trials. While dupilumab remains a highly effective treatment for atopic dermatitis, clinicians must be aware of real‐world adverse effects including ocular complications, inflammatory arthritis, psoriasiform eruptions and head and neck dermatitis; as well as reported associations including cutaneous T‐cell lymphoma, alopecia areata, vitiligo and weight gain.

Terra firma‐forme dermatosis is a benign condition characterised by asymptomatic hyperkeratotic, dark papules or plaques. The diagnosis may be confirmed by firmly rubbing the lesions with 70% isopropyl alcohol, resulting in resolution of the lesions. Wolf's isotopic response refers to the development of a new dermatosis in the same location that a previous, healed, unrelated skin condition occupied. We report the case of a patient developing Terra firma‐forme dermatosis at the site of resolved psoriatic plaques.

A 73-year-old Indian man with Fitzpatrick skin phototype V presented to the emergency department with a 1-month history of extensive, painful, rapidly progressive ulcerating nodules and plaques on the arms, trunk and thighs and features of leonine facies. The patient had previously been treated with two courses of oral antibiotics and oral corticosteroids in the community for presumed infected eczema. A skin biopsy sent for histopathology showed epidermotropism and sheets of atypical lymphoid infiltrate extending into the subcutis. The cells were positive for CD2, CD5, CD8, BF1, TIA and granzyme B. They were negative for CD4, CD7, CD30, CD56, delta and EBER. Ki-67 showed a proliferative index of almost 100%.

Vaccination plays a critical role in protecting against infectious diseases, particularly in those with compromised immune systems. While traditional recommendations advise against live attenuated vaccination in patients undergoing most biologic therapies due to the potential risk of serious infections (vaccine‐related disease caused by unchecked replication of the live vaccine microorganism), emerging evidence and expert opinion suggest live attenuated vaccines may be safely and effectively administered with appropriate precautions when using certain medications such as dupilumab and apremilast. This systematic review evaluates the administration of live attenuated vaccines in patients receiving these drugs. A search of MEDLINE and Embase identified 12 relevant publications, including 2 case series, 3 clinical trials, and 7 consensus statements, recommendations, or guidelines. The findings suggest that, in certain circumstances, live attenuated vaccines may be safely administered to patients on dupilumab with appropriate precautions. Data on live attenuated vaccination with apremilast remain limited. Current recommendations emphasise shared decision‐making between clinicians and patients, considering individual risk factors. Further evidence is needed to establish definitive guidelines on live attenuated vaccine administration in patients receiving these therapies.

We report a 48-year-old man with a 3-month history of ulceration on his right inner thigh. The lesion began as a firm, painless, indurated nodule following a trip to rural Victoria, Australia. Over the following weeks, the lesion evolved into a painless, necrotic ulcer that continued to increase in size over the subsequent months. At the time of presentation, clinical examination revealed a 3 × 2 cm violaceous, indurated ulcer with undermined edges and a necrotic base.

A 63-year-old man was referred to the dermatology clinic with a 10-month history of progressive erythema, scaling, swelling and pain of his right index finger after a minor gardening injury. This began at the fingertip, extended proximally and led to a reduced range of motion in the distal interphalangeal joint, nail dystrophy and pustulation. What is the most likely diagnosis?