What's already known about this topic?

• Actinic keratoses (AKs) are a major public health concern because of their high prevalence, substantial cost and potential for progression to keratinocyte carcinoma, particularly squamous cell carcinoma.

What does this study add?

• Improved agreement among healthcare practitioners on AK definition and classification is needed to improve management.
• More head-to-head comparisons of alternative treatment strategies for AK are needed to determine the best treatment.

What's already known about this topic?

• Nonpurulent leg cellulitis (NPLC) is a major healthcare burden even in areas where community-associated methicillin-resistant Staphylococcus aureus infection is endemic.
• Treatment of risk factors for developing NPLC may promote resolution of the infection and reduce the rate of recurrence.
• There is currently no published systematic review of risk factors for developing NPLC.

What does this study add?

• A comprehensive systematic review and meta-analysis of observational studies examining risk factors for developing leg cellulitis.
• Local (leg) risk factors appear to be more significant than systemic risk factors in the development of cellulitis.
• Previous cellulitis is highly predictive of cellulitis recurrence.
• Treatment of modifiable risk factors, including leg oedema, wounds, ulcers, areas of skin breakdown and toe-web intertrigo, is likely to reduce the recurrence of cellulitis.

What's already known about this topic?

• The impaired skin barrier in atopic dermatitis facilitates the penetration of potential allergens.
• Children with atopic dermatitis are exposed to potential allergens in topical agents and emollients from an early age.

What does this study add?

• Contact allergy is a significant problem in children with atopic dermatitis and should always be considered in cases of recalcitrant atopic dermatitis.
• Children with atopic dermatitis may have unacknowledged contact allergies contributing to their skin symptoms.
• Children with atopic dermatitis seem to be at greater risk of sensitization to certain allergens, especially components of skincare products.

Plain language summary available online

Linked Comment: Vieyra-Garcia and Wolf. Br J Dermatol 2017; 177:336–337

Linked Comment: Dawe. Br J Dermatol 2017; 177:337–338

What's already known about this topic?

• Some patients with plaque psoriasis who achieve an adequate response with a tumour necrosis factor (TNF) inhibitor therapy, such as adalimumab, eventually lose their response.

What does this study add?

• Patients who had lost their response to adalimumab subsequently achieved a clinical response to the TNF inhibitor etanercept, and no new safety signals were observed.
• Response to etanercept was not affected by the presence of antiadalimumab antibodies.

Linked Comment: Albrecht and Gerdes. Br J Dermatol 2017; 177:338–339

What's already known about this topic?

• There are reports suggesting the involvement of T helper 17 cells in the pathogenesis of atopic dermatitis (AD).
• Several case studies have reported therapeutic benefits of ustekinumab in patients with severe AD, while a few studies have failed to show the benefits.

What does this study add?

• Ustekinumab 45 mg and 90 mg did not demonstrate meaningful efficacy in Japanese patients with severe AD.
• Ustekinumab treatment was generally well tolerated in Japanese patients with severe AD.

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Linked Comment: Samuel and Reynolds. Br J Dermatol 2017; 177:339–341

What's already known about this topic?

• Acral lentiginous melanoma (ALM) is a rare histological variant of cutaneous melanoma (CM), arising on the palms, soles and nail beds.
• ALM accounts for a greater proportion of CMs among Hispanics, Asians and African Americans.
• ALMs have a distinct epidemiology and, unlike other CM subtypes, are not associated with personal history of atypical naevi, or sun exposure.
• Additionally, ALMs have a worse prognosis compared with other CMs.

What does this study add?

• Comprehensive evaluation of clinical variables that impact outcomes, including melanoma-specific survival, in a community-based study setting with equal access to care, has been undertaken.
• Melanoma-specific mortality among patients with ALM is associated with increased tumour thickness and more advanced stage at presentation, but not with race/ethnicity.
• Advanced tumour features at presentation and access to care may account for less favourable survival outcomes reported among nonwhite patients.

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Linked Comment: Berk-Krauss and Stein. Br J Dermatol 2017; 177:341–342

Plain language summary available online

What's already known about this topic?

• There is a low level of consensus between patient and dermatologist perceptions of needs.
• A patient-centred approach in managing psoriasis is increasingly recommended as it encourages patients to participate in treatment and disease management.
• Informed and engaged patients have better clinical outcomes, quality of life and use of healthcare resources.

What does this study add?

• This is the first qualitative study to identify the needs and health perceptions of people with psoriasis in a hospital outpatient clinic.
• Patients have a strong need to be seen as individuals, and the burdens associated with psoriasis that go beyond the skin remain unaddressed in consultations.
• Patients’ need to be cured exceeds perceived side-effect risks and patients need health education to adjust their knowledge and self-management.

What are the clinical implications of this work?

• Consultations with a standardized structure do not match the individual challenges and healthcare needs of patients with psoriasis.
• To achieve a more patient-centred approach health professionals should meet patients’ current needs and talk about the patients’ emotional well-being and concerns that go beyond biomedical factors, as well as offer individualized health education.
• Implementation of minor structural changes may push dermatological services to better meet patient needs.

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Plain language summary available online

What's already known about this topic?

• Only five reports with 10 distinct PNPLA1 mutations causing autosomal recessive congenital ichthyosis (ARCI) have been described.
• Relatively little is known about the type and localization of mutations in PNPLA1 that cause ARCI.

What does this study add?

• This is the first comprehensive series of PNPLA1 mutations, from 18 patients with autosomal recessive congenital ichthyosis.
• The results of this study provide important conclusions about the localization of disease-causing mutations in PNPLA1 and the resulting phenotype, including clinical variations.

What is the translational message?

• Multigene panels and knowledge about causative PNPLA1 mutations will lead to progress in deciphering the function of PNPLA1.
• This might facilitate diagnosis and provide a basis for novel therapeutic strategies in patients with PNPLA1 mutations.

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Linked Comment: Uitto et al. Br J Dermatol 2017; 177:342–343

Plain language summary available online

What's already known about this topic?

• As advanced angiosarcoma is resistant to standard chemotherapy, its prognosis is poor and new therapies are urgently needed.
• Heat shock protein (HSP)90 has been identified as a molecular chaperone that regulates various cancer-related proteins. Numerous clinical trials are currently testing the effectiveness of HSP90 inhibitors in various types of malignancies.

What does this study add?

• HSP90 is overexpressed in angiosarcoma.
• The inhibition of HSP90 is effective in inhibiting the proliferation, migration and invasion of angiosarcoma cells.
• Knock-down of HSP90 did not directly supress vascular endothelial growth factor receptor 2, but selectively suppressed the downstream targets of vascular endothelial growth factor signalling in angiosarcoma cells.

What is the translational message?

• HSP90 could be a novel therapeutic target for angiosarcoma.

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Linked Comment: Spiegelberg. Br J Dermatol 2017; 177:343–344

What's already known about this topic?

• Protein expression level changes, including modulation of keratinocyte differentiation and inflammation markers, can be detected in psoriatic stratum corneum (SC).
• Large-scale protein profiling in SC has been described in atopic dermatitis, but not in psoriasis.

What does this study add?

• Large-scale protein profiling of psoriatic SC detects epidermal differentiation changes and overexpression of adhesion molecules (sICAM1) and chemokines responsible for the recruitment of neutrophils (CXCL1 and CXCL8), T cells (CCL4 and CXCL10) and monocytes and dendritic cells (CCL2, CCL4 and CCL20).
• Cytokines and growth factors involved in the pathophysiology of psoriasis [tumour necrosis factor, interleukin (IL) 12p40, IL17A, IL17F, IL31, transforming growth factor α and vascular endothelial cell growth factor] are upregulated in lesional SC.
• The observed pathophysiological changes are normalized by treatment with calcipotriol–betamethasone.

What is the translational message?

• Noninvasive SC sampling allows protein biomarker quantification in patients with psoriasis, enabling the detection of key pathophysiological mechanisms for the ranking of drugs according to their clinical efficacy.

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What's already known about this topic

• Advances in knowledge of psoriasis pathogenesis have led to identification of new therapeutic targets and the development of biological drugs.
• Nevertheless, severe psoriasis can still be extremely difficult to treat in some patients, even with the advanced biological therapies available today.
• Several studies have focused on the HLA-C*06 allele and investigated correlations between the genetic risk factors of psoriasis and clinical parameters.
• Few studies have investigated the genetic predictors for response to biologics.

What does this study add?

• This study, involving four European centres, aimed to confirm the role of HLA-C*06 in a large cohort of patients as a pharmacogenetic marker of anti-interleukin-12/23 treatment response.
• Considering the high cost of biological therapies, the identification of a range of molecular markers used to predict drug response in long-term treatment would be highly desirable.

What is the translational message?

• Genetic polymorphisms could in future be used not only to predict response to biological therapy in patients with psoriasis but also to improve resource allocation and reduce exposure of patients to unnecessary toxicity.

Linked Comment: Foulkes and Brown. Br J Dermatol 2017; 177:344–345

What's already known about this topic?

• Methotrexate (MTX) is a widely used treatment for moderate-to-severe plaque psoriasis.
• Drug survival of methotrexate for psoriasis has not been studied in detail.

What does this study add?

• This is the first study to describe the long-term drug survival of MTX in patients with plaque psoriasis in daily practice, split according to side-effects and ineffectiveness.
• This is the first study to identify the determinants for drug survival, split according to reasons for discontinuation.
• A high baseline score on the visual analogue scale for disease severity assessed by the patient may play an important role in short drug survival.

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Linked Comment: Kirby. Br J Dermatol 2017; 177:345–346

What's already known about this topic?

• Fatigue is prevalent in patients with chronic inflammatory diseases, cancer and some neurological diseases.
• Depressive mood and pain are strong factors influencing fatigue.
• Emerging evidence points to genes and molecular signalling pathways as important contributors to fatigue.

What does this study add?

• Clinically significant fatigue occurs in nearly 50% of patients with psoriasis.
• Objective measures of psoriasis disease activity do not correlate with fatigue severity.
• There is a need for more research to understand the factors that generate and regulate fatigue in psoriasis.

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Linked Comment: Rosen. Br J Dermatol 2017; 177:346–347

What's already known about this topic?

• The association between atopic dermatitis (AD) and Staphylococcus aureus carriage is well established, and increasing attention has been given to the presence and impact of S. aureus biofilms in AD.
• Bleach baths are a commonly used treatment of infected AD; however, the effect of this treatment on biofilms formed by isolates from patients with AD is sparsely investigated.

What does this study add?

• This study revealed biofilm at the skin surface of a patient with infected AD.
• The current results show that sodium hypochlorite has both inhibitory effects on biofilm formation and the capacity to eradicate established biofilms of S. aureus isolates derived from the skin of patients with AD.

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Linked Comment: Harris and Smith. Br J Dermatol 2017; 177:347–348

Plain language summary available online

What's already known about this topic?

• Organic thioureas are the main culprit behind contact allergy to chloroprene rubber.
• Diethylthiourea is the prevalent thiourea in chloroprene rubber products.
• Organic thioureas are non- or weak sensitizers.
• Organic thioureas decompose to strongly sensitizing isothiocyanates at skin-like temperatures.
• Diphenylthiourea has been shown to be bioactivated in vitro to phenyl isothiocyanate and phenyl isocyanate.

What does this study add?

• Patients with former positive patch-test reactions to diphenylthiourea exhibited a stronger reaction to the degradation product phenyl isothiocyanate than to diphenylthiourea. Positive patch-test reactions to phenyl isocyanate were detected for the first time in patients allergic to diphenylthiourea.
• Diethylthiourea was the only thiourea detected in products used by patients allergic to chloroprene rubber allergic.
• Isothiocyanates are formed in patch-test preparations of diethylthiourea, diphenylthiourea and dibutylthiourea under patch-testing conditions.

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What's already known about this topic?

• The aetiology of Cronkhite–Canada syndrome and the mechanism of hair loss in this syndrome are not known.

What does this study add?

• We present a case of Cronkhite–Canada syndrome and propose alopecia areata incognita as a possible pathological mechanism of hair loss.

Linked Comment: Stefanaki and Stratigos. Br J Dermatol 2017; 177:348–349