Elena Pérez Zafrilla’s research while affiliated with Consorcio Hospital General Universitario de Valencia and other places

MPOX is an orthopoxvirus whose infection has been declared a Public Health Emergency of International Concern in 2022 and 2024. It proved to be a virus with markedly heterogeneous and varied clinical presentation. We performed a systematic PubMed review of articles reporting cases of different clinical manifestations of MPOX until October 2024. The infection has mainly affected men who have sex with men. After 4 to 10 days of incubation, it presents with mucocutaneus lesions and systemic symptoms. Some anatomical sites have shown clinical particularities. Genital edema is a potentially serious complication. The ocular and ear/nose/throat area are other infrequent sites with specific manifestations. MPOX whitlow affects the third finger of the dominant hand and may be associated with extensive inflammation and proximal lymphangitis. Bacterial superinfection is a common complication in the genital area with good response to antibiotic treatment. Immunosuppressed patients may develop severe inflammation and necrosis resulting in poor prognosis. Some authors propose ulceronecrotic MPOX as a defining condition of AIDS. The involvement of women has been exceptional in the current outbreak and has predominantly affected the vulva. Some patients such as healthcare workers, atopics, and people who get tattoos are at risk of developing specific lesions via nonsexual routes. Other atypical manifestations include maculopapular rash and inguinal patch. MPOX is a highly relevant and ongoing infection that can present with multiple atypical manifestations, and the knowledge of which is of great importance to the clinician. We present a unique systematic review of atypical presentations of this infection that may be associated with significant morbidity and mortality, especially in the immunocompromised population.

Background Monkeypox (MPOX) caused a public health emergency of international concern (PHEIC) outbreak between 2022 and 2023, with a recent rise in cases that prompted the World Health Organization (WHO) to declare the disease a PHEIC once again. There is little information on its long‐term scarring sequelae. Objectives The objective of this study was to assess the risk and characteristics of scarring in patients with MPOX in a tertiary hospital. Methods This is a prospective cohort study including patients diagnosed using polymerase chain reaction (PCR) tests. Clinical data were collected and followed up at 12–15 months to assess scarring and its impact on quality of life. Results Of the 40 patients, 19 (47.5%) developed scars, which were more common in those with initial cutaneous manifestations. Scars significantly affected the quality of life, especially in the genital and mucosal areas. The limited sample and loss to follow‐up may affect the validity of the results. Conclusion Scarring is a frequent and disfiguring sequela of MPOX, particularly in patients with early skin symptoms. Prevention and close follow‐up are crucial in mitigating these complications.

Introduction Severe recurrent aphthous stomatitis (RAS) represents a therapeutic challenge because of its impact on the patient's quality of life. Additionally, no approved systemic therapies are available. Roflumilast, a phosphodiesterase‐4 inhibitor, has shown promise in other inflammatory dermatological conditions. This study aimed to assess the characteristics, effectiveness, and safety of roflumilast in treating RAS in routine clinical practice. Methods This is a single cohort ambispective observational study conducted in five Spanish centers. Twenty‐two patients with RAS treated with roflumilast participated. Data collection included demographic, clinical, and outcome variables. Statistical analysis compared the outcomes of 12 weeks of roflumilast treatment with a similar prior period without treatment. Results During treatment with roflumilast, a significant reduction in flare‐ups (88%) and oral ulcers (94%) was observed compared to the untreated period. A reduction in pain (66%) and ulcer duration (63%) was observed. Adverse effects (AEs) occurred in 13 patients, predominantly headache and gastrointestinal disturbances. Most of these were self‐limiting or manageable with dose adjustment. Treatment was withdrawn in three cases, mainly because of AEs. Conclusions This study suggests that roflumilast may effectively treat RAS by reducing the number of flare‐ups and ulcers, their duration, and the symptomatology produced by the ulcers. In addition, roflumilast has a good safety profile, is well tolerated at low doses, and does not require close monitoring. These characteristics and its favorable economic profile make roflumilast a promising therapeutic option in this pathology.

Clinical findings A 63-year-old man presented to the emergency department with skin lesions that had persisted for 4 days. His medical history comprised multiple cardiovascular risk factors, Buerger disease, chronic kidney disease and antisynthetase syndrome with pulmonary hypertension. The patient reported the initial emergence of a nasal lesion, which subsequently generalized. Physical examination identified an erosive plaque on the dorsum of the nose. Numerous ulcers with a necrotic centre were observed in the beard and neck area. Some lesions featured a pearly white border with a central necrotic crust and mild perilesional erythema. Vesicles with a perilesional erythematopurpuric hue and a darker grey centre were observed on his trunk (Figure 1a, b). Some of these lesions presented central ulceration. The patient exhibited multiple white papules on the penis, with a central brownish, necrotic-appearing area (Figure 2). He had no pharyngitis or proctitis symptoms, but he complained of dyspnoea, fever and general malaise, and presented bilateral crackles upon auscultation and an interstitial pattern on chest X-ray (Figure 3). He denied any recent engagement in unprotected sexual intercourse. Skin lesion samples were collected for polymerase chain reaction (PCR) and culture tests.