Diagnostic Methods and Management Strategies of Herpes Simplex and Herpes Zoster Infections

Herpesviruses are medium-sized double-stranded DNA viruses. Of more than 80 herpesviruses identified, only 9 human herpesviruses have been found to cause infection in humans. These include herpes simplex viruses 1 and 2 (HSV-1 and HSV-2), varicella-zoster virus (VZV), human cyto-megalovirus (HCMV), Epstein-Barr virus (EBV), and human herpesvirus (HHV-6A, HHV-6B, HHV-7, HHV-8). HSV-1, HSV-2, and VZV can be problematic given their characteristic neurotropism which is the ability to invade via fusion of its plasma membrane and reside within neural tissue. HSV and VZV primarily infect mucocutaneous surfaces and remain latent in the dorsal root ganglia for a host's entire life. Reactivation causes either asymptomatic shedding of virus or clinical manifestation of vesicular lesions. The clinical presentation is influenced by the portal of entry, the immune status of the host, and whether the infection is primary or recurrent. Affecting 60% to 95% of adults, herpesvirus-associated infections include gingivostomatitis, orofacial and genital herpes,and primary varicella and herpes zoster. Symptomatology, treatment, and potential complications vary based on primary and recurrent infections as well as the patient's immune status.

Immunotherapy-induced exclusively cutaneous sarcoid-like reaction

Sarcoid-like reactions (SLRs) are rare, granulomatous inflammatory reactions to immune checkpoint inhibitors (ICIs) that can involve any organ but frequently affect the lungs, mediastinal lymph nodes and skin. We present a rare case of an exclusively cutaneous SLR due to pembrolizumab that clinically resembled dermatomyositis. A literature review yielded only 12 previously reported cases of ICI-induced cutaneous SLR without any systemic involvement. Our case highlights the diversity of presentations of cutaneous SLR and emphasises the importance of histological evaluation of new cutaneous eruptions.

Chemotherapy with paclitaxel for recalcitrant molluscum contagiosum in an HIV-infected patient

Molluscum contagiosum (MC) is a viral skin infection seen in children, sexually active adults and immunocompromised populations. It is usually a self-limiting illness that typically spontaneously resolves without therapeutic intervention. However, when the papules are extensive or refractory causing complications or aesthetic issues, multiple treatment modalities exist to relieve symptoms, limit spread and decrease the social stigma associated with visible lesions. Treatment is especially important in HIV/AIDS infected populations, where prevalence is estimated between 5% and 18% and susceptibility to larger, widespread and recalcitrant lesions involving atypical distributions is more common. We evaluated a 38-year-old woman with a history of AIDS (CD4+ T cell count <25 cells/µL) and poor adherence with antiretroviral therapy who presented with a 9-month history of persistent, progressively worsening facial and truncal umbilicated papules consistent with recalcitrant MC refractory to cidofovir injections. She was successfully treated with paclitaxel with complete resolution of the lesions after four cycles without adverse effects.

Cutaneous Bacillary Angiomatosis in a Renal Transplant Patient

A 37-year-old man with a history of renal transplantation in 2013 due to focal segmental glomerulosclerosis presented to the emergency room with a 2-week history of fever, chills, anorexia, weight loss, abdominal pain, diarrhea, and a new asymptomatic lesion on the right side of the neck. The patient worked as a truck driver and frequently traveled to Wisconsin; he had not traveled internationally in the past year. He lived with his brother who had a pet cat. He was compliant with his anti-rejection medication regimen, which included mycophenolate mofetil, tacrolimus, and prednisone. Physical examination of the neck revealed an 8-mm exophytic, friable, red papule with overlying blood crusts (Figure 1). The remainder of the mucocutaneous examination was unremarkable, and there was no palpable lymphadenopathy. The patient was started on empiric intravenous cefepime and metronidazole and admitted to the hospital for further management. A punch biopsy of the lesion was performed.

The global burden of skin cancer: A longitudinal analysis from the Global Burden of Disease Study, 1990-2017

Background

Despite efforts toward the earlier detection and prevention of skin cancer, the prevalence of skin cancers continues to increase. Identifying trends in skin cancer burdens among populations can lead to impactful and sustainable interventions.

Methods

We assessed the global trends in skin cancer from 1990 to 2017 in 195 countries worldwide through the Global Burden of Disease Study (GBD) 2017 database.

Results

The rate of change in skin cancers between 1990 to 2017 varied among countries. Squamous cell carcinomas increased by 310% during this time, the highest among any neoplasm tracked by the GBD. Men experienced greater age-specific prevalence rates of keratinocyte carcinoma across all ages (P < .05). Women had a greater prevalence of melanoma until approximately age 50 years, after which the trend reversed until age 85 years. Men experienced greater age-specific death rates across all ages. The disability-adjusted life years (DALYs) of melanoma and keratinocyte carcinoma increased exponentially with age (P < .05).

Conclusion

The incidence, prevalence, and DALYs of skin cancers are increasing disproportionately among different demographic groups. As a worldwide epidemiological assessment, the GBD 2017 provides frequently updated measures of the skin cancer burden, which may help to direct resources and allocate funding to close the gap in global skin cancer disparities.

Burden of skin disease and associated socioeconomic status in Asia: A cross-sectional analysis from the Global Burden of Disease Study 1990-2017

Introduction

Skin diseases have a significant global impact on quality of life, mental health, and loss of income. The burden of dermatologic conditions and its relationship with socioeconomic status in Asia is currently not well understood.

Methods

We selected Global Burden of Disease Study datasets to analyze disability-adjusted life years (DALYs) in 50 Asian countries, including Central Asia, northern Asia, eastern Asia, western Asia, southeastern Asia, and southern Asia, between 1990 and 2017. We compared DALYs to the socioeconomic status using the sociodemographic index and gross domestic product per capita of a country. Statistical analysis was performed using Pearson's correlation.

Results

Some countries had higher or lower than expected age-standardized DALY rates of skin diseases. Asian countries, especially high-income countries, had a high burden of inflammatory dermatoses, including acne, alopecia areata, atopic dermatitis, contact dermatitis, decubitus ulcers, psoriasis, pruritus, and seborrheic dermatitis. The burden of infectious dermatoses was greater in low-income Asian countries. The burden of skin cancer in Asia was relatively low.

Conclusion

There is a high burden of skin disease, especially inflammatory conditions, in Asian countries, but the burden of individual dermatoses in Asia varies by country and socioeconomic status. DALYs can potentially serve as a purposeful measure for directing resources to improve the burden of skin disease in Asia.

The global, regional, and national burden of fungal skin diseases in 195 countries and territories: A cross-sectional analysis from the Global Burden of Disease Study 2017

Introduction

Fungal skin diseases are highly prevalent worldwide, but few existing studies focus on the burden of dermatomycoses.

Methods

An analysis of fungal skin disease trends in 2017 in 195 countries worldwide was conducted using the Global Burden of Disease Study database, including prevalence rates, age and sex patterns, and fungal burden, using disability-adjusted life years (DALYs). Age-standardized DALYs were also compared to the sociodemographic index values of all the countries in 2017.

Results

The age-specific fungal skin disease DALYs in 2017 showed a right-skewed distribution, with a peak between 1 and 5 years of age. The world region with the greatest burden of fungal skin disease was sub-Saharan Africa (DALY rate 89.3 per 100,000 males, 78.42 for females), and the individual country with the greatest DALY rate was Mali (122). The Global Burden of Disease super region with the lowest fungal skin disease burden had high incomes (DALY rate 33.12 per 100,000 males, 30.16 for females), which includes southern Latin America, western Europe, high-income North America, Australasia, and high-income southern Pacific.

Conclusion

Skin mycoses place a substantial burden on patients worldwide. This burden is the greatest in resource-poor countries, tropical regions, and children between 1 and 5 years of age. DALYs can potentially serve as a purposeful measure for directing health policy resources to improve the global impact of fungal skin disease.

The global, regional, and national burden of atopic dermatitis in 195 countries and territories: An ecological study from the Global Burden of Disease Study 2017

Introduction

Numerous population-based studies have focused on the global prevalence of atopic dermatitis (AD), but there are few studies on the global trends of the burden associated with AD.

Methods

We analyzed the global AD trends in 2017 in 195 countries worldwide using the Global Burden of Disease (GBD) Study database, including prevalence rates, age and sex patterns, and AD burden, using disability-adjusted life years (DALYs). Age-standardized DALYs were also compared to the sociodemographic index values of all the countries in 2017.

Results

The age-specific DALYs in 2017 showed a right-skewed distribution, with the highest DALYs between 1 and 5 years of age. Females had a higher burden of AD throughout all age groups and geographic regions. The GBD super region with the greatest burden of DALYs caused by AD was high income (178.63 DALYs per 100,000 males, 231.8 for females), and the country with the highest DALYs was Sweden (326.91). The GBD super region with the lowest age-standardized DALY burden caused by AD was south Asia (84.51 DALYs per 100,000 males, 100.54 for females).

Conclusion

There is a large GBD caused by AD. The observed burden is the greatest in resource-rich countries, females, and young children.

Burden of skin disease and associated socioeconomic status in Europe: An ecologic study from the Global Burden of Disease Study 2017

Introduction

Dermatoses contribute to a large burden of global disease, but the relationship between socioeconomic status and the effect of dermatologic conditions in Europe is not well understood.

Methods

We selected Global Burden of Disease Study data sets to analyze disability-adjusted life-years (DALYs) and the annual rate of change of dermatoses between 1990 and 2017 in 43 European countries. The principal country-level economic factor used was gross domestic product per capita from the World Bank. Statistical analysis was performed with Spearman ρ correlation.

Results

Wealthier European countries had higher DALYs for melanoma, basal cell carcinoma, psoriasis, atopic dermatitis, acne, seborrheic dermatitis, alopecia, asthma, contact dermatitis, and viral skin disease. Poorer countries had higher DALYs of squamous cell carcinoma, urticaria, decubitus ulcers, pruritus, scabies, tuberculosis, and syphilis. Thirteen European countries were in the top 10th percentile globally for annual increase in skin and subcutaneous disease burden.

Conclusion

The majority of European countries have experienced an increase in skin and subcutaneous diseases in recent decades relative to the rest of the world, but the burden of individual dermatoses in Europe varies by country and socioeconomic status. DALYs can potentially serve as a purposeful measure for directing resources to improve the burden of skin disease in Europe.

The global, regional, and national burden of psoriasis in 195 countries and territories, 1990 to 2017: A systematic analysis from the Global Burden of Disease Study 2017

BACKGROUND

Few existing studies on the global incidence, prevalence, and burden of disease from psoriasis are of high quality, making reliable data and comparisons difficult to find.

METHODS

We analyzed global psoriasis trends from 1990 to 2017 in 195 countries worldwide through the Global Burden of Disease Study database, including age-standardized prevalence rates, percent change in age-standardized prevalence rates, age and sex patterns, and psoriasis burden using disability-adjusted life years.

RESULTS

The age-specific prevalence rate in 2017 showed a left-skewed distribution with a peak between 60 and 70 years of age and a roughly equal male-to-female ratio across all ages. Psoriasis burden was greatest in countries with high income and high sociodemographic index. A positive linear relationship between psoriasis prevalence and comorbidities is seen with cardiovascular disease (R = .67), mental health (R = .63), type 2 diabetes mellitus (R = .55), stroke (R = .51), non-Hodgkin lymphoma (R = .84), Hodgkin lymphoma (R = .77), nonmelanoma skin cancer (R = .68), and inflammatory bowel disease (R = .55) across all countries in 2017.

CONCLUSION

There is increasing prevalence, burden, and associated comorbidities of psoriasis on a global scale and the need for support to reduce this important global health disparity.