Urticaria in Pregnancy and Lactation

Chronic urticaria (CU) is a mast cell-driven chronic inflammatory disease with a female predominance. Since CU affects mostly females in reproductive age, pregnancy is an important aspect to consider in the context of this disease. Sex hormones affect mast cell (MC) biology, and the hormonal changes that come with pregnancy can modulate the course of chronic inflammatory conditions, and they often do. Also, pregnancy-associated changes in the immune system, including local adaptation of innate and adaptive immune responses and skewing of adaptive immunity toward a Th2/Treg profile have been linked to changes in the course of inflammatory diseases. As of now, little is known about the effects of pregnancy on CU and the outcomes of pregnancy in CU patients. Also, there are no real-life studies to show the safety of urticaria medications during pregnancy. The recent PREG-CU study provided the first insights on this and showed that CU improves during pregnancy in half of the patients, whereas it worsens in one-third; and two of five CU patients experience flare-ups of their CU during pregnancy. The international EAACI/GA²LEN/EuroGuiDerm/APAAACI guideline for urticaria recommends adopting the samemanagement strategy in pregnant and lactating CU patients; starting treatment with standard doses of second-generation (non-sedative) H1 antihistamines, to increase the dose up to 4-folds in case of no response, and to add omalizumab in antihistamine-refractory patients; but also emphasizes the lack of evidence-based information on the safety and efficacy of urticaria treatments during pregnancy. The PREG-CU study assessed treatments and their outcomes during pregnancy. Here, we review the reported effects of sex hormones and pregnancy-specific immunological changes on urticaria, we discuss the impact of pregnancy on urticaria, and we provide information and guidance on the management of urticaria during pregnancy and lactation

Cancer Incidence, Mortality, Years of Life Lost, Years Lived With Disability, and Disability-Adjusted Life Years for 29 Cancer Groups From 2010 to 2019: A Systematic Analysis for the Global Burden of Disease Study 2019.

The Global Burden of Diseases, Injuries, and Risk Factors Study 2019 (GBD 2019) provided systematic estimates of incidence, morbidity, and mortality to inform local and international efforts toward reducing cancer burden. To estimate cancer burden and trends globally for 204 countries and territories and by Sociodemographic Index (SDI) quintiles from 2010 to 2019. The GBD 2019 estimation methods were used to describe cancer incidence, mortality, years lived with disability, years of life lost, and disability-adjusted life years (DALYs) in 2019 and over the past decade. Estimates are also provided by quintiles of the SDI, a composite measure of educational attainment, income per capita, and total fertility rate for those younger than 25 years. Estimates include 95% uncertainty intervals (UIs). In 2019, there were an estimated 23.6 million (95% UI, 22.2-24.9 million) new cancer cases (17.2 million when excluding nonmelanoma skin cancer) and 10.0 million (95% UI, 9.36-10.6 million) cancer deaths globally, with an estimated 250 million (235-264 million) DALYs due to cancer. Since 2010, these represented a 26.3% (95% UI, 20.3%-32.3%) increase in new cases, a 20.9% (95% UI, 14.2%-27.6%) increase in deaths, and a 16.0% (95% UI, 9.3%-22.8%) increase in DALYs. Among 22 groups of diseases and injuries in the GBD 2019 study, cancer was second only to cardiovascular diseases for the number of deaths, years of life lost, and DALYs globally in 2019. Cancer burden differed across SDI quintiles. The proportion of years lived with disability that contributed to DALYs increased with SDI, ranging from 1.4% (1.1%-1.8%) in the low SDI quintile to 5.7% (4.2%-7.1%) in the high SDI quintile. While the high SDI quintile had the highest number of new cases in 2019, the middle SDI quintile had the highest number of cancer deaths and DALYs. From 2010 to 2019, the largest percentage increase in the numbers of cases and deaths occurred in the low and low-middle SDI quintiles. The results of this systematic analysis suggest that the global burden of cancer is substantial and growing, with burden differing by SDI. These results provide comprehensive and comparable estimates that can potentially inform efforts toward equitable cancer control around the world.Funding/Support: The Institute for Health Metrics and Evaluation received funding from the Bill & Melinda Gates Foundation and the American Lebanese Syrian Associated Charities. Dr Aljunid acknowledges the Department of Health Policy and Management of Kuwait University and the International Centre for Casemix and Clinical Coding, National University of Malaysia for the approval and support to participate in this research project. Dr Bhaskar acknowledges institutional support from the NSW Ministry of Health and NSW Health Pathology. Dr Bärnighausen was supported by the Alexander von Humboldt Foundation through the Alexander von Humboldt Professor award, which is funded by the German Federal Ministry of Education and Research. Dr Braithwaite acknowledges funding from the National Institutes of Health/ National Cancer Institute. Dr Conde acknowledges financial support from the European Research Council ERC Starting Grant agreement No 848325. Dr Costa acknowledges her grant (SFRH/BHD/110001/2015), received by Portuguese national funds through Fundação para a Ciência e Tecnologia, IP under the Norma Transitória grant DL57/2016/CP1334/CT0006. Dr Ghith acknowledges support from a grant from Novo Nordisk Foundation (NNF16OC0021856). Dr Glasbey is supported by a National Institute of Health Research Doctoral Research Fellowship. Dr Vivek Kumar Gupta acknowledges funding support from National Health and Medical Research Council Australia. Dr Haque thanks Jazan University, Saudi Arabia for providing access to the Saudi Digital Library for this research study. Drs Herteliu, Pana, and Ausloos are partially supported by a grant of the Romanian National Authority for Scientific Research and Innovation, CNDS-UEFISCDI, project number PN-III-P4-ID-PCCF-2016-0084. Dr Hugo received support from the Higher Education Improvement Coordination of the Brazilian Ministry of Education for a sabbatical period at the Institute for Health Metrics and Evaluation, between September 2019 and August 2020. Dr Sheikh Mohammed Shariful Islam acknowledges funding by a National Heart Foundation of Australia Fellowship and National Health and Medical Research Council Emerging Leadership Fellowship. Dr Jakovljevic acknowledges support through grant OI 175014 of the Ministry of Education Science and Technological Development of the Republic of Serbia. Dr Katikireddi acknowledges funding from a NHS Research Scotland Senior Clinical Fellowship (SCAF/15/02), the Medical Research Council (MC_UU_00022/2), and the Scottish Government Chief Scientist Office (SPHSU17). Dr Md Nuruzzaman Khan acknowledges the support of Jatiya Kabi Kazi Nazrul Islam University, Bangladesh. Dr Yun Jin Kim was supported by the Research Management Centre, Xiamen University Malaysia (XMUMRF/2020-C6/ITCM/0004). Dr Koulmane Laxminarayana acknowledges institutional support from Manipal Academy of Higher Education. Dr Landires is a member of the Sistema Nacional de Investigación, which is supported by Panama’s Secretaría Nacional de Ciencia, Tecnología e Innovación. Dr Loureiro was supported by national funds through Fundação para a Ciência e Tecnologia under the Scientific Employment Stimulus–Institutional Call (CEECINST/00049/2018). Dr Molokhia is supported by the National Institute for Health Research Biomedical Research Center at Guy’s and St Thomas’ National Health Service Foundation Trust and King’s College London. Dr Moosavi appreciates NIGEB's support. Dr Pati acknowledges support from the SIAN Institute, Association for Biodiversity Conservation & Research. Dr Rakovac acknowledges a grant from the government of the Russian Federation in the context of World Health Organization Noncommunicable Diseases Office. Dr Samy was supported by a fellowship from the Egyptian Fulbright Mission Program. Dr Sheikh acknowledges support from Health Data Research UK. Drs Adithi Shetty and Unnikrishnan acknowledge support given by Kasturba Medical College, Mangalore, Manipal Academy of Higher Education. Dr Pavanchand H. Shetty acknowledges Manipal Academy of Higher Education for their research support. Dr Diego Augusto Santos Silva was financed in part by the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - Brasil Finance Code 001 and is supported in part by CNPq (302028/2018-8). Dr Zhu acknowledges the Cancer Prevention and Research Institute of Texas grant RP210042

Idiopathic guttate hypomelanosis: An overview

Idiopathic guttate hypomelanosis is a commonly acquired, benign leukoderma characterized by multiple, discrete round or oval, porcelain-white macules on sun-exposed areas, especially the extensor aspect of forearms and shins, sparing the face, neck, and trunk. It usually affects the geriatric population (>50 years); chronic exposure to ultraviolet rays and senile degeneration being the important pathogenic factors. The diagnosis remains essentially clinical, whereas newer confirmatory investigations are emerging. Despite the benign course of progression, many patients seek medical attention owing to cosmetic concerns. Several treatment modalities have been tried over time including topical, physical, and surgical measures, although there is lack of a standard treatment regime. In this article, we have reviewed the different aspects of this condition including treatment, along with the recent updates to create awareness about this dermatological entity

Linear porokeratosis over the face: An unusual presentation

Porokeratosis is a heterogeneous disorder of keratinization usually inherited in an autosomal dominant pattern. It usually affects the trunk and extremities. Lesions exclusively present over face are rare and not well-documented. We present a case of linear porokeratosis along the blaschkoid lines over the face in a 9-year-old girl

Clinical and Histopathological response to multidrug therapy in paucibacillary leprosy at the end of 6 Months: A prospective observational study from eastern India

Background: At present, the WHO recommends fixed duration multidrug therapy (FD-MDT) for the treatment of leprosy, in which treatment is provided for a fixed duration regardless of clearance of skin lesions or bacterial status of the patient. There is divided opinion regarding the efficacy of FD-MDT; especially for paucibacillary Hansen's disease, in which treatment is provided for 6 months. In addition, there is a paucity of literature on clinical and histopathological features of treated leprosy. Objectives: The objectives of this study were to prospectively observe the effects of MDT on clinical and histopathological features in paucibacillary leprosy and to assess the efficacy, safety and tolerability of MDT-paucibacillary (PB) regimen. Materials and Methods: A total of 52 new cases of PB leprosy diagnosed by clinicopathological correlation and slit skin smear were administered standard WHO PB-MDT for 6 months. Patients were reviewed at 3rd month and 6th month of therapy and 3 months posttherapy for their clinical and histopathological assessment. Results: Among 52 new cases of PB-leprosy 43 patients (mean age 31.74 ± 12.2 years, m:f 1.53:1) completed the study as per protocol. Fourteen percent patients recovered completely, 76.7% patients had a residual patch at the end. Number of lesions reduced significantly 2nd follow-up onwards while the lesional size showed significant decrease 1st follow-up onward. Nerve palpability also reduced significantly at treatment completion. Histological improvement was appreciable; lymphocytic infiltration reduced significantly 2nd follow-up onward and presence of granuloma 1st FU onward. Only four patients complained of occasional, uneventful epigastric pain during the study. Conclusion: Although the frequency of persistence of lesions after completion of therapy was high, histological evidence of activity was present in a minority (7%). Thus, the standard WHO MDT-PB regimen was found to be effective, safe and well-tolerated

Using ChatGPT for writing articles for patients' education for dermatological diseases: A pilot study

Background: Patients' education is a vital strategy for understanding a disease by patients and proper management of the condition. Physicians and academicians frequently make customized education materials for their patients. An artificial intelligence (AI)-based writer can help them write an article. Chat Generative Pre-Trained Transformer (ChatGPT) is a conversational language model developed by OpenAI (openai.com). The model can generate human-like responses. Objective: We aimed to evaluate the generated text from ChatGPT for its suitability in patients' education. Materials and Methods: We asked the ChatGPT to list common dermatological diseases. It provided a list of 14 diseases. We used the disease names to converse with the application with disease-specific input (e.g., write a patient education guide on acne). The text was copied for checking the number of words, readability, and text similarity by software. The text's accuracy was checked by a dermatologist following the structure of observed learning outcomes (SOLO) taxonomy. For the readability ease score, we compared the observed value with a score of 30. For the similarity index, we compared the observed value with 15% and tested it with a one-sample t-test. Results: The ChatGPT generated a paragraph of text of 377.43 ± 60.85 words for a patient education guide on skin diseases. The average text reading ease score was 46.94 ± 8.23 (P < 0.0001), and it indicates that this level of text can easily be understood by a high-school student to a newly joined college student. The text similarity index was higher (27.07 ± 11.46%, P = 0.002) than the expected limit of 15%. The text had a “relational” level of accuracy according to the SOLO taxonomy. Conclusion: In its current form, ChatGPT can generate a paragraph of text for patients' educational purposes that can be easily understood. However, the similarity index is high. Hence, doctors should be cautious when using the text generated by ChatGPT and must check for text similarity before using it

Global research trend on allergic skin disorders: A bibliometric analysis from 2001 to 2020

Background: Allergic skin disorders constitute a variety of inflammatory skin disorders with increasing incidence. Bibliometric studies involve a statistical analysis of academic literature to assess the current research trend and identify knowledge gaps. There is a dearth of such studies concerning allergic skin disorders. Aim: To perform a bibliometric analysis of global research concerning allergic skin disorders from 2001 to 2020. Materials and Methods: We obtained all data from the Web of Science using the keywords “atopic dermatitis,” “contact dermatitis,” “skin allergy,” “urticaria,” “food allergy,” and “drug allergy.” Only articles in English language were included. Subsequent analysis revealed the total number of publications, top journals, institutions, and countries, thus highlighting the overall research trend. Results: Overall 76,764 articles were published on allergic skin disorders from 2001 to 2020 (original articles > review articles). The United States of America (USA) contributed maximum publications (26.1%) followed by Germany (9.6%), Japan (8.2%), and England (8.1%). The Allergy is the most preferred journal for publishing skin allergy research. Most research concentrated on atopic dermatitis, pathomechanisms of allergic disorders, and their primary prevention. Conclusion: This study evaluates the current landscape of skin allergy research. There has been a consistent increase in the number of publications concerning allergic skin disorders over the years. However, majority of the research publications are from developed countries. Hence, skin allergy-related research publication should be increased for diverse and enriched literary evidences