Bellinato, F

Girolomoni, G

Gisondi, P

English

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This study showed an association between psoriasis and IBDin paediatric patients similar to that in adults. However, the cor-relation was not as prominent as that of adults because of lowprevalence. In addition, a long-term observational study onwhether psoriasis and IBD in paediatrics and adolescent affectcomorbid disease in adults is needed in the future.AcknowledgementThis study was conducted according to the guidelines of theDeclaration of Helsinki and approved by NHISS (No. NHIS-2020-1-570), and the institutional review board of SeoulNational University Hospital with a waiver of informed consent(IRB No. E-2007-106-1141). All provided claim data by NHISSwere de-identified.Conflicts of interestThe authors have nothing to declare.Funding sourceNone.Data availability statementThe data that support the findings of this study are accessiblethrough the National Health Insurance Sharing Service (https://nhiss.nhis.or.kr/) with permission.D. H. Kim,1 S. I. Cho2,*1Department of Pediatrics, Kyung Hee University Medical Center, Seoul,Korea, 2Department of Dermatology, Seoul National University Hospital,Seoul, Korea*Correspondence: S. I. Cho. E-mail: chlroe@hotmail.comReferences1 Korman NJ. Management of psoriasis as a systemic disease: what is theevidence? Br J Dermatol 2020; 182: 840–848.2 Fu Y, Lee CH, Chi CC. Association of psoriasis with inflammatory boweldisease: a systematic review and meta-analysis. JAMA Dermatol 2018;154: 1417–1423.3 Egeberg A, Mallbris L, Warren RB et al. Association between psoriasisand inflammatory bowel disease: a Danish nationwide cohort study. Br JDermatol 2016; 175: 487–492.4 Kwon HH, Na SJ, Jo SJ, Youn JI. Epidemiology and clinical features ofpediatric psoriasis in tertiary referral psoriasis clinic. J Dermatol 2012; 39:260–264.5 Moon JS. Clinical aspects and treatments for pediatric inflammatorybowel diseases. Pediatr Gastroenterol Hepatol Nutr 2019; 22: 50–56.6 W€orns MA, Lohse AW, Neurath MF et al. Five cases of de novo inflam-matory bowel disease after orthotopic liver transplantation. Am J Gastro-enterol 2006; 101: 1931–1937.7 Greuter T, Bertoldo F, Rechner R et al. Extraintestinal manifestations ofpediatric inflammatory bowel disease: prevalence, presentation, and anti-TNF treatment. J Pediatr Gastroenterol Nutr 2017; 65: 200–206.8 Bae JM, Lee HH, Lee B-I et al. Incidence of psoriasiform diseases second-ary to tumour necrosis factor antagonists in patients with inflammatorybowel disease: a nationwide population-based cohort study. AlimentPharmacol Ther 2018; 48: 196–205.9 Ko JM, Gottlieb AB, Kerbleski JF. Induction and exacerbation of psoriasiswith TNF-blockade therapy: a review and analysis of 127 cases. J Derma-tolog Treat 2009; 20: 100–108.10 Cyrenne BM, Parpia AS, Sibbald C. Paradoxical psoriasis in pediatricpatients: a systematic review. Pediatr Dermatol 2021; 38: 1086–1093.DOI: 10.1111/jdv.18121Monkeypox virus infection: whatdermatologist needs to know?Dear Editor,By May 2022, an increasing number of human monkeypoxvirus (MPXV) infections have been reported in Western coun-tries; of these, at least 26 have been confirmed in Europe.1 SinceMPXV isolation in 1958, the disease was mostly endemic in Cen-tral and West Africa, where sporadic cases in humans wereacquired from animals.2,3 A small epidemic of 72 cases in theUnited States in 2003 revealed the MPXV propensity to trans-mission outside the natural ecological niche.4 Most of the recentcases have no relation to travel history to endemic areas.1Although encountering MPXV infection may be a rare occur-rence, dermatologists will be likely called for consultations forpatients with suspected MPXV infection. The aim of this letter isto provide dermatologists the essential notions about this infec-tion that recently drew public attention. To this aim, we summa-rized the principal clinical and epidemiological characteristics ofMPXV infection (Table 1).MPXV is a brick-shaped, enveloped, double-stranded DNAvirus, of the Orthopoxvirus genus (Poxviridae family), distin-guished into two clades, Western and Central Africa (CongoBasin).5 MPXV is considered a zoonosis acquired via droplets bydifferent reservoirs, such as squirrels, rats and monkeys.6 Recentcases presented with lesions on the genital area, indicating otherpossible routes of transmission, as direct contact with body fluidsor lesion material and prolonged physical contact during sexualintercourses.1,4 Monkeypox shares clinical similarities in theappearance, topography and progression of smallpox, whose pre-sentation nowadays has become anecdotal. After an incubationperiod of 7–17 days, prodromal symptoms (i.e. fever between38.5 and 40.5 °C and fatigue) are followed by the appearance of arash. In such phase, a firm and sometimes painful lymphadenopa-thy involving the maxillary, cervical or inguinal area is an impor-tant clue.4 The smallpox-like rash lasts from 2 to 4 weeks. Lesionsspread centrifugally from the face to the entire body including notonly hands, lower limbs and feet, but also pharyngeal, conjuncti-val and genital mucosae. These are well-defined, progressingthrough macular, papular, vesicular, pustular and crustosephases.4,6,7 Lesions may be hard, deep and sometimes© 2022 European Academy of Dermatology and VenereologyJEADV 2022, 36, e595–e660e656 Letters to the Editorumbilicated. In the pustular stage, a further febrile period maydevelop with severe complications such as vomiting, diarrhoea,pneumonia, encephalitis and sepsis. Superinfections and pittedscars are common sequelae. As opposed to the smallpox, the dis-ease course is usually mild, and most patients self-recover withinfew weeks.4 Higher mortality rate was found among children andimmunocompromised individuals who are at risk of severe dis-ease.1 The main differential diagnosis is with chickenpox. Varicellahowever is not associated with lymphadenopathy, and fever is lessprominent; lesions are more polymorphic, affect almost invariablythe scalp and oral mucosa, and are itchy. To establish the diagno-sis, different laboratory assays can be performed including poly-merase chain reaction (PCR) for viral DNA detection,immunohistochemistry for viral antigen detection, including thepoint-of-care test Tetracore OrthopoxBioThreat, viral isolationand culture from saliva in early phase, lesion exudate on a swabor crust specimens. ELISA for IgM and IgG antibodies detectionmay have cross-reactivity to other Orthopoxviruses.6 Treatment isusually symptomatic, for severe cases antiviral treatments (te-covirimat and brincidofovir) can be considered.6,8 Some studieshave shown that vaccination against smallpox provides cross-pro-tection against other orthopoxviruses, as MPXV.2,4,9 However,more than 40 years have passed from smallpox eradication, and itwas estimated that approximately half of the world’s populationhas no immunity against orthopoxviruses.8 There are some con-cerns for a MPXV outbreak.10 Dermatologists are in a privilegedposition in diagnosing MPXV infection and promoting its aware-ness. From the COVID-19 outbreak, we have learned the impor-tance of case isolation, contact tracing and use of personalprotective equipment, all good hygiene practices that can be trans-lated to MPVX containment.Funding sourceNone.Conflicts of interestNone.Data availability statementNot applicableF. Bellinato, P. Gisondi,* G. GirolomoniDepartment of Medicine, Section of Dermatology and Venereology,University of Verona, Verona, Italy*Correspondence: P. Gisondi. E-mail: paolo.gisondi@univr.itLinked article: N.H. Brockmeyer J Eur Acad Dermatol Venereol 2022;36: 1164–1166. https://doi.org/10.1111/jdv.18301.References1 https://www.ecdc.europa.eu/en/news-events/epidemiological-update-monkeypox-outbreak (last accessed: 24 May 2022).2 Alakunle E, Moens U, Nchinda G, Okeke MI. Monkeypox virus in Nige-ria: infection biology, epidemiology, and evolution. Viruses 2020; 12:1257.3 Kabuga AI, El Zowalaty ME. A review of the monkeypox virus and arecent outbreak of skin rash disease in Nigeria. J Med Virol 2019; 91: 533–540.4 Petersen E, Kantele A, Koopmans M et al. Human monkeypox: epidemi-ologic and clinical characteristics, diagnosis, and prevention. Infect DisClin North Am 2019; 33: 1027–1043.5 Hughes AL, Irausquin S, Friedman R. The evolutionary biology of pox-viruses. Infect Genet Evol 2010; 10: 50–59.6 McCollum AM, Damon IK. Human monkeypox. Clin Infect Dis 2014; 58:260–267.7 Di Giulio DB, Eckburg PB. Human monkeypox: an emerging zoonosis.Lancet Infect Dis 2004; 4: 15–25.Table 1 Main characteristics of Monkeypox infectionTaxonomy Genus: OrthopoxvirusFamily: PoxviridaeGenome Double-stranded-DNASuspected reservoirs Rope squirrel (Funisciurus sp.)Gambian pouched rat (Cricetomys gambianus)Sooty mangabey monkey (Cercocebus atys)Transmission Animal-to-human via dropletsHuman-to-human via droplets, fomites or sexually transmittedIncubation time 7–17 daysProdromal period 1–4 daysCutaneous manifestations Smallpox-like rash of hard, deep, well-circumscribed, umbilicated lesions evolving from macular, papular,vesicular and pustular phasesExtra-cutaneous manifestations Fever, fatigue and lymphadenopathyComplications Pitted scars, vomiting, diarrhoea, pneumonia, encephalitis, ocular infection and sepsisDiagnosis PCR, immunohistochemistry, rapid point-of-care tests (i.e. Tetracore OrthopoxBioThreat), viral culture andelectronic microscopy; ELISA for anti-OPXV IgM and IgGDifferential diagnosis Chickenpox, molluscum contagiosum, measles, syphilis, yaws, scabies, rickettsialpox, drug reactionsTherapy Antipyretic, antibiotics for secondary bacterial infections, tecovirimatPCR, polymerase chain reaction.© 2022 European Academy of Dermatology and VenereologyJEADV 2022, 36, e595–e660Letters to the Editor e6578 Brown K, Leggat PA. Human monkeypox: current state of knowledge andimplications for the future. Trop Med Infect Dis 2016; 1: 8.9 Simpson K, Heymann D, Brown CS et al. Human monkeypox – after40 years, an unintended consequence of smallpox eradication. Vaccine2020; 38: 5077–5081.10 The lancet monkeypox contacts: a puzzling problem. Lancet 2018; 392:986.DOI: 10.1111/jdv.18299Monkeypox virus case withmaculopapular exanthem andproctitis during the Spanishoutbreak in 2022Dear Editor,A 30-year-old male patient visited the Emergency Room (ER)on the 16th May 2022 complaining of a new-onset skin rashassociated with systemic symptoms. He had not travelled abroadduring the previous months. He was diagnosed with HIV infec-tion 9 years prior and maintained a good immune-virologiccontrol under antiretroviral therapy. He also presented pastmedical history of syphilis, hepatitis B and had been treated forhepatitis C virus. He recognized himself as MSM with high-risksexual practices1 such as multiple sexual partners, use of recre-ational drugs and unprotected sexual intercourse 2 weeks priorhis admission to the ER.The patient first presented with symptoms of proctitis (rectalbleeding, mucopurulent discharge and tenesmus). Four dayslater, he experienced a sudden onset of systemic symptoms withfever up to 39.3°C, headache, lymphadenopathy, generalizedarthralgia and myalgia. The skin rash began 2 days later, on botharms and dorsum of hands and then spread to the trunk, legs,face and, lastly, genitalia, sparing palms and soles. Physicalexamination revealed a maculopapular pinkish exanthem associ-ated with numerous flat-topped umbilicated pustules (Fig. 1a–c) with a necrotic centre and surrounded by an erythemato-ede-matous plaque (Fig. 2). In the genitalia, one single pustule in the(a) (b)(c)(d)Figure 1 (a, b, c) Maculopapular exanthem with isolated small pustules over erythematous-edematous plaques are observed, affectingmostly the trunk and proximal limbs. (d) The patient presented as well a non-umbilicated pustule located in the penis body.© 2022 European Academy of Dermatology and VenereologyJEADV 2022, 36, e595–e660e658 Letters to the Editor

Monkeypox virus infection: what dermatologist needs to know?

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Monkeypox virus infection: what dermatologist needs to know?

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