This article aims to present current COVID-19 vaccination considerations for patients on immunotherapeutics for the management of immune-mediated dermatological diseases and summarize the recommendations relevant to clinical practice in Taiwan. These Taiwan Dermatological Association (TDA) recommendations are intended to be dynamic in nature and serve as an interim guide to optimize patient care at this current juncture. It is expected that our clinical practice would continually evolve and be informed by new evidence that emerges in this pandemic.

Background: Plasmacytoid dendritic cells (pDCs) are implicated in the reactivation of human herpesvirus 6 (HHV-6) in drug reaction with eosinophilia and systemic symptoms (DRESS). Objectives: We aimed at identifying the alterations of circulating pDCs, basophils, and myeloid dendritic cells (mDCs) during the active stage of drug eruptions and the relationship between pDC alteration and HHV-6 reactivation in DRESS patients. Methods: Nine DRESS patients and twelve patients of other drug eruptions (ODE, including five cases of maculopapular eruptions (MPEs), five cases of Stevens–Johnson syndrome, and two cases of fixed drug eruption) were prospectively recruited. Blood samples were collected weekly for 2 consecutive weeks for flow cytometry of pDC, basophil, mDC, and detection of HHV-6 reactivation by serum anti-HHV-6 immunoglobulin G, or whole blood HHV-6 viral DNA by quantitative polymerase chain reaction. Results: The HHV-6 reactivation was exclusively seen in DRESS, and the pDC levels decreased in DRESS compared with ODE (P = 0.002) and (MPE, P = 0.021), with the timing of such decrease preceding HHV-6 reactivation. Conclusion: The decrease of pDC levels is significantly more common in DRESS patients and occurs before HHV-6 reactivation. The chronological sequence implies that the decrease of pDC may be crucial in the pathogenesis of viral reactivation.

Background: Although increased aortic stiffness has been observed in chronic inflammatory skin diseases, it has not been examined in patients with hidradenitis suppurativa (HS). Objectives: This study aimed to compare aortic stiffness among HS patients and non-HS controls and to investigate the relation between aortic stiffness and disease severity in HS. Methods: Thirty-eight HS patients, and 76 age- and sex-matched controls were studied. Patients who had diabetes, cardiovascular diseases, chronic kidney disease, or other inflammatory conditions were excluded. Aortic stiffness was measured by transthoracic echocardiography. Disease severity and activity were assessed using Hurley stage, and physician global assessment (PGA) score, respectively. Severe disease was defined as Hurley stage III, or PGA scores ≥3. Results: The patients with HS had increased aortic stiffness determined by decreased strain and distensibility compared to control group patients. A significant negative correlation was found between aortic stiffness indices and high-sensitivity C-reactive protein, duration of the disease, Hurley stage, and PGA score. Multivariate analysis revealed the aortic strain and aortic distensibility were predictors of severe disease for Hurley stage III. Conclusion: Aortic stiffness is increased and associated with the severity of the disease in patients with HS.

Background: Nonablative lasers are popular alternatives for atrophic acne scar treatment in Asia. Objectives: We aimed to compare the efficacy and safety between 1550-nm nonablative fractional laser (NAFL) and 755-nm picosecond laser with diffractive lens array (DLA) in Asian patients. Methods: Twenty-three patients with atrophic acne scars received three sessions of split-face treatment with 1550-nm NAFL on one side and 755-nm picosecond laser with DLA on the other side. Sessions were applied at 8-week interval. Blinded dermatologists assessed efficacy through baseline and follow-up photographs. Results: A greater improvement in atrophic facial acne scars was observed on the 1550-nm NAFL side than on the 755-nm picosecond laser side (P < 0.05). Pain was significantly more severe on the 1550-nm NAFL side than the 755-nm picosecond laser side (P < 0.05). Adverse effects on the 1550-nm NAFL side included prolonged erythema, acneiform eruptions, superficial crusting, and postinflammatory hyperpigmentation. Only transient erythema was observed on the 755-nm picosecond laser side. Conclusion: Although the 1550-nm NAFL showed superior efficacy to the 755-nm picosecond laser with DLA for the treatment of atrophic facial acne scars, the latter was associated with fewer adverse effects and may be the best choice for those who request “little-to-no down-time” treatments.

Background: Autoimmunity is a key player in nonsegmental vitiligo (NSV). Interleukin-9 (IL-9) and tumor necrosis factor-like weak inducer of apoptosis (TWEAK) are pleiotropic cytokines that are involved in many chronic autoimmune diseases. Objectives: To measure IL-9 and TWEAK in serum and suction blister fluid of NSV patients and study their relation to vitiligo. Methods: Thirty NSV patients and thirty controls were recruited. Following detailed history and clinical examination, the vitiligo area scoring index (VASI) and the vitiligo disease activity score (VIDA) of the patients were calculated. IL-9 and TWEAK were measured in serum of patients and controls and in suction blister fluid of patients. Results: Serum levels of IL-9 and TWEAK were significantly higher in patients than in controls (P < 0.001). Meanwhile, in patients, IL-9 and TWEAK were significantly higher in serum than in blister fluid (P < 0.001). A significant positive correlation of serum IL-9 (P < 0.001) and serum TWEAK (P < 0.001) with VASI was detected. A significant positive correlation between serum IL-9 and TWEAK in patients was also detected (P < 0.001). Blister fluid levels of both cytokines showed no significant correlation with any of the studied parameters. Conclusion: The elevated serum IL-9 and TWEAK in NSV possibly contributes to disease development and influences disease severity. Exploring their potential as possible therapeutic targets is, therefore, recommended.

Vitiligo is a common depigmenting dermatosis with an autoimmune background. Circulating T-follicular helper (Tfh) cells are reported to increase and correlate with disease activity and autoantibody production in several human autoimmune diseases. The potential contribution of Tfh cells in vitiligo pathogenesis has not been well elucidated yet. Hence, this study aimed to evaluate the frequency of circulating Tfh cells in patients with nonsegmental vitiligo (NSV) in comparison to normal healthy subjects to detect their possible role in vitiligo pathogenesis. Venous blood samples were obtained from 25 patients with NSV and 20 age- and sex-matched healthy controls to determine the level of circulating Tfh cells (CD3⁺ CD4⁺ CXCR5⁺ PD-1⁺ T cell population), by flowcytometry. The frequency of peripheral CXCR5⁺ PD-1⁺ lymphocytes which are CD3⁺ CD4⁺ was significantly augmented in vitiligo patients than controls. It showed a significant positive correlation with vitiligo disease severity and activity estimated by Vitiligo Area Scoring Index and Vitiligo Disease Activity scores, respectively. These results emphasize on the potential role of Tfh cells in the pathogenesis, extent, and severity of NSV. Antagonizing the autoimmune initiating action of Tfh cells population or targeting their cytokine secretion might offer a helpful future tool for the treatment of patients with NSV particularly in active cases.

Historically, angioleiomyoma is a subtype of leiomyoma that comprises about 4%–5% of all benign soft tissue tumors, and calcifications occur in 2%–3% of them. Because of the very low incidence of calcifications, their mechanism of formation is still unknown. In this article, we present the five cases of angioleiomyomas with calcification and discuss the ultrasonographic features in three of those cases. In general, from the aspect of ultrasonography, angioleiomyomas are recognized as hypoechogenic homogenous structures with peritumoral or intratumoral vascularity. However, our cases revealed heterogeneity or hyperechogenicity in inclusions, which has never been reported before. Histologically, calcifications were found not only under the dystrophic pathway which were considered in the past literature but also have the possibility under the metastatic pathway. According to our findings, we also classified the ultrasonographic patterns into three patterns according to the progression and distribution of calcifications. This is the first report to identify the location and possible pathways of calcifications and to classify the ultrasonographic features of calcified angioleiomyomas.