A 58-year-old female presented to a lifestyle medicine clinic in 2019 with a one-year history of pemphigus vulgaris (PV) and having itching, burning sensations, and bulla formation all over her body. She further had a recent diagnosis of type 2 diabetes mellitus and also complained of malaise, indigestion, and anxiety due to her skin condition. She was on methyl prednisolone, metformin, and other herbal supplements for 1 year to control her PV and diabetes. Laboratory investigations revealed the presence of autoantibodies Desmoglein 1 and 3 with titers of 3.26 and 3.5, respectively.The patient underwent a yoga & naturopathy-based lifestyle modification program for a period of 53 days in 2019, followed by 10 days in 2020 and 15 days in 2021, and subsequent follow-up measures. This included hydrotherapy, yoga, a vegetarian diet, herbal preparations, massage, etc. By the end of 2020, the patient was tapered from all medications, and there was complete remission from PV. Given the multidimensional impact of PV, a holistic, patient-centered lifestyle approach as described in this case may be beneficial in managing PV. Further research is warranted in this area.

UNASSIGNED: Post-inflammatory hypopigmentation (PIH) is an acquired partial or total loss of pigment that occurs as a result of cutaneous inflammation. Clinically, post-inflammatory hypopigmentation is recognized by a discoloration of the skin; however, proper diagnosis requires a skin biopsy. Although post-inflammatory hypopigmentation is similar in appearance to vitiligo, histopathological evaluation highlights the key differences in the presence of melanocytes and melanophages.
UNASSIGNED: A 28-year-old woman presented with discoloration in the vulvovaginal area. Physical examination was within normal limits; however, a genital exam revealed a large, intensely white discoloration in an hourglass pattern involving the clitoris, labia majora, and perianal area. Pigmentation was observed at the base of the hair follicles, which is not consistent with vitiligo. The patient consented to a skin biopsy, which was performed without complication. The biopsy showed mild chronic vulvitis and pigment incontinence due to post-inflammatory hypopigmentation. The patient was prescribed a high-potency topical steroid and a significant reduction in lesion area was observed at 3-month follow-up.
UNASSIGNED: Proper diagnosis via clinical examination and skin biopsy is essential in the treatment of pigment deficiencies. In cases of post-inflammatory hypopigmentation, the initial cause of inflammation must first be identified in order to provide an effective treatment regimen. When facing uncommon dermatological conditions such as post-inflammatory hypopigmentation, proper histopathological diagnosis, course of treatment, and follow-up are important in order to achieve patient satisfaction.

Patients diagnosed with skin conditions have a higher risk of comorbid psychiatric conditions and suicide-related outcomes such as suicidal ideations and behaviors. There is paucity of evidence in the US general population about the risk of suicide death in patients with dermatologic conditions.
We conducted a retrospective case-control study to investigate the risk of suicide death in patients receiving care for dermatologic conditions. This study involved 8 US health systems. A total of 2674 individuals who died by suicide (cases) were matched with 267,400 general population control individuals.
After adjusting for age, sex, and any mental health or substance use condition, we did not find an association between death by suicide and any skin condition including conditions where clinicians are generally concerned about the risk such as acne (adjusted odds ratio [aOR] = 1.04, p = 0.814), atopic dermatitis (aOR = 0.77, p = 0.28), and psoriasis (aOR = 0.91, p = 0.64).
This case-control study provides no evidence of increased risk of death by suicide in individuals with major skin disorders in the US general population.

OBJECTIVE: To present a new case of adverse cutaneous reaction during lithium treatment and to update the systematic review and meta-analysis of the incidence of this adverse reaction.
METHODS: We conducted a systematic search (performed in September 2016) for peer-reviewed articles in English indexed in Medline (2011-present). Meta-analytical estimates were obtained using the \"Metafor\" package.
METHODS: Ms. H., a 31-year-old Caucasian woman with BD1, was admitted to the inpatient unit for a full-blown psychotic episode and treated with carbamazepine 400 mg q.d., lithium carbonate 450 mg q.d., and risperidone 4 mg q.d. with clinical improvement. After 12 days from the start of psychopharmacological treatment, she manifested a cutaneous reaction that motivated the stop of carbamazepine treatment, as well as the increase in lithium carbonate dose (750 mg q.d.). Risperidone dose remained unvaried. Since the skin lesion persisted after 8 days from withdrawal of carbamazepine, the private practitioner stopped also lithium carbonate treatment (de-challenge), maintaining risperidone treatment. The cutaneous reaction resolved spontaneously after six days from withdrawal of lithium carbonate. Subsequently, the worsening of psychopathological conditions motivated a new admission during which lithium carbonate was reintroduced (16 days after its suspension) (re-challenge). On the following day, we observed an itching erythematous maculopapular rash involving the trunk, the four limbs, and the oral mucosa.
CONCLUSIONS: Our case of an erythematous maculopapular rash during lithium treatment was the first to present a challenge-de-challenge-re-challenge sequence that suggests causality. Although meta-analysis does not point to an increased rate of adverse skin reaction during lithium treatment, clinicians should not neglect to monitor cutaneous symptoms during lithium treatment.

Primary biliary cholangitis (PBC) is a rare autoimmune cholestatic liver disease. It is often associated with extrahepatic autoimmune diseases. Skin disorders are sporadically reported in association with PBC. We report an unusual case of PBC associated with acquired reactive perforating dermatosis (ARPD) and present a review of the literature on skin disorders associated with PBC. Our patient presented to the dermatology department with generalized pruritus associated with nodular perforating skin lesions on the trunk, and cholestatic liver disease of unknown origin. After having established both diagnosis of ARPD and PBC, she was managed in an interdisciplinary manner, and both her skin and liver conditions improved gradually. Only one similar case is reported in the literature, in that case, the liver disease was not treated. By reviewing the literature, we found that lichen planus, vitiligo, and psoriasis are the most frequent skin disorders associated with PBC. However, there is only limited data about specific skin disorders associated with PBC. This case report of a patient with PBC associated with ARPD underlines the importance of interdisciplinary management of patients with rare liver diseases combined with rare skin disorders. The present review of the literature shows that probably, immune-mediated skin conditions are not more frequent in PBC patients than in the general population. However, the available data are scant; there is a need for high-quality data on skin conditions associated with PBC.