Valiukevičienė, Skaidra
Item type:Publication, preprint[2026][S1][M001][16]; Background: Patch test results obtained with the European Baseline Series (EBS) in its current version serve both contact allergy surveillance and (re-)assessing the diagnostic value of EBS allergens. Objectives: To present results of current EBS patch testing, obtained in 59 departments in 14 European countries during 2021and 2022. Methods: Anonymised or pseudonymised individual data, and partly aggregated results, on demographic/clinical characteris-tics and patch test results with the EBS were prospectively collected, centrally pooled, and retrospectively analysed. Results: In 2021 and 2022, 18 832 patients were patch tested with the EBS. Sensitization to nickel remained most common(18.85 (18.29–19.43)% positivity (95% confidence interval)). Fragrance mix I and Myroxylon pereirae resin yielded very similar results with 6.39 (6.04–6.76)% and 6.5 (6.15–6.87)% positivity, respectively. Concerning preservatives, methylchloroisothiazoli-none/methylisothiazolinone (MCI/MI) 0.02% aq. yielded 5.52 (5.11–5.96)% and MI 0.2% aq. yielded 5.28 (4.94–5.64)% positives. Testing formaldehyde 2% aq. identified almost one percentage point more positive reactions than 1% aq. (2.05 (1.81–2.32)% vs.1.22 (0.99–1.48)). Positive reactions to the recently added allergens were most frequently seen to propolis (5.47 (5.12–5.84)%) and2-hydroxyethyl methacrylate (3.63 (3.32–3.96)%). Conclusions: Compared to the previous reporting period, surveillance results with the EBS were mostly stable. The results re-garding Quaternium 15 (0.4 (0.29–0.53)% positives) justified its exclusion from the 2023 EBS version.
19 Item type:Publication, research article[2026][S1][M001,T007,T001][21]; Applied Sciences, 2026-03-02, vol. 16, no. 5, p. 1-21Psoriasis is a heterogeneous inflammatory skin disease requiring continuous monitoring to assess treatment efficacy. Automated lesion segmentation remains a significant computer vision challenge due to irregular plaque boundaries, variable skin tones, and uncontrolled lighting conditions in clinical photography. This study proposes a robust hybrid deep learning framework for the automated segmentation of psoriatic lesions in unconstrained environments. We constructed a unique dataset utilizing a hierarchical three-class labeling scheme (psoriatic plaque, healthy skin, and background) to mitigate the class imbalance and background noise often found in binary segmentation tasks. Following a systematic hyperparameter optimization using the Optuna framework, three distinct architectures—DeepLabV3+, UperNet, and SegFormer—were identified as optimal. A novel ensemble architecture was then developed to integrate the high sensitivity of DeepLabV3+, the precision of UperNet, and the contextual balance of SegFormer via a conflict-resolution voting algorithm. Experimental results demonstrate that the proposed hybrid model outperforms individual state-of-the-art architectures, achieving a Dice coefficient of 89.3% for lesion segmentation and an F1 score of 90.7% across skin classes. These findings confirm the system’s adaptability to real-world imaging conditions, validating its potential as an objective decision-support tool for dermatological practice.
20 Item type:Publication, preprint[2026][S1][M001][13]; ; Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease associated with significant diagnostic delays and impact on quality of life. Current guidelines prioritize antibiotics as first-line therapy, but experts increasingly recognize the need for earlier targeted therapy intervention to prevent irreversible scarring and tunnel formation. To establish consensus on clinical scenarios during the 14th European Hidradenitis Suppurativa Foundation Conference in February 2025, 54 HS experts participated in a Delphi consensus, using a Likert scale (-5 to +5) to vote on 16 statements concerning first-line therapy criteria with biologics and/or small molecules for eligible patients. Seventy-eight HS experts were invited, and 54 participated via hybrid onsite and electronic voting. Experts rated 16 pre-defined statements regarding first-line use of biologics and/or small molecules for HS using a Likert scale (-5 to +5). Agreement metrics were stratified as majority agreement (≥70%, median 3.0-3.5), consensus (≥75%, median 3.5-4.5), and strong consensus (≥90%, median ≥4.5). Statements were subsequently ranked for clinical relevance. Strong consensus was reached for patients contraindicated for antibiotics, rapid disease progressors and those with severe disease. Consensus also supported upgrading patients with moderate disease (IHS4 ≥ 4), frequent flares (≥3 in 12 weeks), multiple affected areas and specific phenotypes including anogenital involvement. Strong consensus emerged for syndromic HS and for patients with inflammatory comorbidities such as inflammatory bowel disease and arthritis. Paediatric patients with a positive family history and moderate disease were also considered candidates for first-line biologics or small molecules. This consensus provides evidence-based criteria for upgrading HS patients to first-line biologic therapy, reflecting expert practices across Europe aimed at preventing irreversible disease progression. The results support a 'hit hard and early' approach to minimize scarring and tunnel formation, although prospective studies are still needed to validate these expert-driven recommendations.
11 Item type:Publication, preprint[2025][S1][M001][14]; Chronic skin diseases such as psoriasis (PSO), atopic dermatitis (AD) and hidradenitis suppurativa (HS) are frequently associated with psychological distress, potentially promoting maladaptive coping mechanisms including addictive behaviours. Despite evidence of higher addiction rates among dermatology patients, comprehensive multicenter data across Europe are lacking.
18WOS© Citations 2 Item type:Publication, journal article[2025][S1][M001][19]; Contact allergy is a clinically relevant condition already present in early childhood, yet longitudinal European data remain scarce. This updated ESSCA analysis (2011-2022) offers the most comprehensive pediatric patch test dataset to date, enabling comparison with the previous 2002-2010 ESSCA study.
13 - conference paper[2025][T1e][M001][1]20th BADV Congress "Excellence and Leadership in Dermatology and Medicine" : November 6-7, 2025 Riga, Latvia : Final program and abstract book, 2025-11-06, p. 46-46
Adult atopic dermatitis (AD) is characterized by a chronic and relapsing nature, eczematous morphology, and intense pruritus. AD is driven by proinflammatory mediators, such as IL-4, IL-13, IL-22, IL-31, IFN-, and thymic stromal lymphopoietin, that transduce signals via the signaling pathway JAK1 and JAK2. In addition to gene mutations of filaggrin (FLG), the Th2-deviated microenvironment downregulates FLG expression and disrupts barrier function, resulting in Staphylococcus aureus colonization. In some cases, the management of severe AD requires a multidisciplinary approach not only for the individualized systemic treatment, but also for diagnostics. The AD often deviates from the classic pattern of flexural dermatitis, especially in adults. The several forms of AD for adults exists, such as head-and-neck dermatitis, AD with type I allergies (the facial skin is involved), the AD with chronic hand eczema, the AD with recurrent infections, the AD with multiple areas of lichenification and severe itch, and last least variant – late onset AD with prurigo, and/or alopecia areata. The working diagnosis of AD begins with the evaluation of clinical symptoms, but in some cases we need to perform skin biopsy and histological evaluation to differentiate from cutaneous T cell lymphoma. Nowadays target systemic therapy with dupilumab, JAK1 or JAK 2 inhibitors allows to control moderate and severe AD and does not cause severe adverse reactions even in the long-term perspective of treatment. The interleukin (IL)-4 and IL-13 inhibitor dupilumab for adult patients with severe AD in Lithuania is fully reimbursed by health insurance since 2020. Dupilumab is used when systemic treatment of AD with cyclosporine (CsA) is ineffective or contraindicated. In our centre were treated 45 patients, 10 of them were switch to JAK inhibitors. Upadacitinib is a reversible JAK inhibitor engineered for JAK1 selectivity, correspondingly baricitinib is JAK 1 and JAK 2 inhibitor. In Lithuania since 2023 after reimbursement 6 patients with severe AD were treated using upadacitinib and 4 patients with baricitinib. The treatment with upadacitinb was discontinued for one patient due to severe herpes zoster.
9 Item type:Publication, conference paper[2025][T1e][M001][1]; ; ; ; 20th BADV Congress "Excellence and Leadership in Dermatology and Medicine" : November 6-7, 2025 Riga, Latvia : Final program and abstract book, 2025-11-06, p. 63-63Introduction and Objectives: Granulomatous dermatitis (GD) is a heterogeneous group of chronic granulomatous inflammatory skin disorders characterized by granulomas in the dermis. Although its exact pathogenesis is unclear, GD is increasingly linked to systemic diseases, including hematologic malignancies such as multiple myeloma (MM). Paraproteinemia in MM can cause diverse skin manifestations through immune dysregulation and monoclonal protein deposition, potentially triggering granulomatous inflammation [1, 2]. We present a rare case of an 87- year-old woman with MM in remission who developed extensive, persistent erosive skin lesions histologically confirmed as GD. The objectives of this report are to explore possible pathophysiological links between MMassociated paraproteinemia and granulomatous skin inflammation, highlight the importance of recognizing GD as a potential paraneoplastic cutaneous manifestation in MM patients, and discuss diagnostic and therapeutic challenges in managing GD within the context of hematologic malignancy. Materials and Methods: The patient was admitted with painful, exudative, erosive plaques on the extremities and trunk, histologically confirmed as GD, worsening since initial lesions appeared in 2016. In 2018, a diagnosis of MM was established, stage IA, category/class 2. The patient underwent four cycles of bortezomib combined with dexamethasone, after which the skin lesions regressed. Current evaluation included detailed dermatologic examination, histopathology with direct immunofluorescence, comprehensive blood tests (CBC, inflammatory markers, kidney function), immunologic markers (ANA, ANCA, cryoglobulins), serum protein electrophoresis, immunofixation, and free light chain assay. Imaging comprised chest X-ray, abdominal and peripheral lymph node ultrasound to assess systemic involvement. Consultations with hematologist and rheumatologist were performed. Results: Laboratory tests performed in 2025 revealed elevated ESR (105 mm/h), positive cryoglobulins, monoclonal IgG protein (14.1 g/L), and increased beta-2 microglobulin (4.05 mg/L), indicating active monoclonal gammopathy with hypoalbuminemia, elevated gamma globulins, and signs of renal impairment (reduced GFR, elevated creatinine). ANA and ANCA were negative, excluding systemic autoimmune disease. Histopathology reaffirmed granulomatous dermatitis. Given evidence of active paraproteinemia, therapy was adjusted to pulse methylprednisolone and topical corticosteroids with antiseptics were continued for local wound care. Hematology recommended reassessment for MM progression. Conclusions: This case illustrates GD as a rare cutaneous manifestation associated with MM and paraproteinemia. It underscores the importance of recognizing atypical skin lesions as potential indicators of underlying hematologic disease. Early skin biopsy and multidisciplinary evaluation are key factors to accurate diagnosis and management.
35 Item type:Publication, conference paper[2025][T1e][M001][1]; ; ; Gollnick, Harald20th BADV Congress "Excellence and Leadership in Dermatology and Medicine" : November 6-7, 2025 Riga, Latvia : Final program and abstract book, 2025-11-06, p. 29-29Introduction & Objectives: Morphoea linearis is the predominant subtype of localised scleroderma, presenting as an inflammatory connective tissue pathology with cutaneous sclerosis and involvement of underlying tissues. Linear scleroderma might extend to dermis, hypodermis, muscle and respective bone. The treatment course is gradual: originally treated with topical corticosteroids and phototherapy, if unresponsive, treatment continues with immunosuppressive medication. This case report aims to outline clinically atypical case of linear scleroderma with probable medium-sized arteriole vasculitis and pulmonary changes, primarily suggesting systemic involvement and posing diagnostic challenges. This case report also highlights a distinct treatment strategy, initially beginning with immunosuppressants, followed by a planned reconstructive surgery to address facial atrophy. Materials & Methods: Case report. Results: The 37-year-old female presented with stiffening and hollowing of the skin on the right cheek, dermatoscopically thinning of hypodermis is noted. Patient has been consulted by rheumatologist, who concluded no systemic involvement, recording only episodic headaches and GERD. Excisional biopsy was performed, concluding non-specific lesions and probable medium-sized arteriole vasculitis in hypodermis. Laboratory findings revealed borderline anti-RP11, and ANA 1:100 yielded fine-speckled nuclear fluorescence with 2+ intensity, blurring the line between purely localised disease and systemic autoimmune involvement. Serological tests also demonstrated negativity for HIV, p24 antigen and Lyme disease. Chest X-ray pointed out significant perivascular changes, again suggesting systemic impact. Vascular changes aided in differentiating linear scleroderma from Hortons’ disease and deep scleroderma, establishing the diagnosis. Distinctly tailored treatment strategy was then adopted, excluding therapy with corticosteroids: initial medication with immunosuppresants aimed at mitigation of the inflammatory process, followed by planned esthetic reconstruction with adipose tissue autotransplantation. Prior to surgical intervention, further evaluation with angio-MRI, chest and head CT as well as additional biopsies with DIF were recommended. Conclusion:This case report highlights the critical importance of a comprehensive, multidisciplinary approach in evaluating localized scleroderma with atypical vascular and systemic features. Careful clinical and histological assessment is essential for establishing an accurate diagnosis and developing an individualized treatment plan.
27 - conference paper[2025][T1e][M001][1]
; ; ; ; 20th BADV Congress "Excellence and Leadership in Dermatology and Medicine" : November 6-7, 2025 Riga, Latvia : Final program and abstract book, 2025-11-06, p. 67-67Introduction and Objectives: Hidradenitis suppurativa (HS) is a chronic, relapsing inflammatory dermatosis primarily involving apocrine gland-rich intertriginous regions. However, atypical localizations of disease, including the lower abdomen, chest, thighs, and scalp, have also been reported [1]. Such clinical presentations may lead to diagnostic delays and inappropriate management. The pathogenesis of HS is closely linked to follicular occlusion and mechanical friction, with obesity and smoking recognized as significant modifiable risk factors. We present a case of HS affecting the lower abdominal fold, initially misinterpreted as pyoderma gangrenosum (PG), to highlight the importance of clinical awareness in atypical presentations. Materials and Methods: A 27-year-old male with BMI of 38.8 kg/m² was admitted with a one-year history of recurrent, painful, exudative lesions involving the groins and lower abdominal region. On examination, draining fistulas in the inguinal folds were consistent with HS. However, sharply demarcated ulcers in the suprapubic area raised suspicion of PG. The lesions were concealed beneath the abdominal skin fold, contributing to initial diagnostic uncertainty. The diagnostic workup included suprapubic punch biopsies for histopathological analysis, bacterial cultures, and inflammatory marker testing. Results: Clinically, HS was classified as Hurley Stage III with an IHS4 score of 30 and a PGA score of 5. Histopathological analysis confirmed chronic inflammation consistent with HS, without neutrophilic infiltrates characteristic of PG. Laboratory tests revealed mild leukocytosis and moderately elevated C-reactive protein levels. Clindamycin was administered intravenously (600 mg for 5 days), resulting in partial clinical improvement. Subsequently, oral doxycycline was continued (100 mg for 8 weeks). Cultures from the suppurative lesions identified Enterobacter hormaechei and Pseudomonas aeruginosa, for which ceftazidime was given intravenously (2 g for 14 days). The overall response to antibiotic therapy remained insufficient, and treatment with the TNF-α inhibitor adalimumab was initiated (160 mg as an induction dose, followed by 80 mg after two weeks and 40 mg weekly thereafter). The endocrinologist diagnosed grade III obesity and prescribed tirzepatide, a GLP-1 receptor agonist. After a 4-week follow-up, HS activity improved (IHS4 score 10, PGA score 3), and BMI decreased to 37.0 kg/m². Conclusions: This case underscores the diagnostic complexity of HS presenting in an atypical anatomical site. In obese patients, HS lesions may remain concealed beneath skin folds, delaying accurate diagnosis. Careful clinical assessment, including thorough examination, is crucial for timely recognition of such lesions. Furthermore, combined therapy addressing both inflammatory activity and metabolic dysfunction appears to be effective in severe, treatment-resistant HS.
16 - conference paper[2025][T1e][M001][1]
; ; ; ; Introduction and objectives: Ocular cicatricial pemphigoid is a recurring autoimmune disorder classified as a type of mucous membrane pemphigoid (MMP) [1]. Without treatment, ocular cicatricial pemphigoid can cause progressive scarring and damage to the conjunctiva, severe dry-eye syndrome, corneal keratinization, and symblepharon, which may result in blindness [2]. This condition is rare, affecting about 1 in 10,000 to 60,000 people, especially older individuals, and it occurs more often in women than in men [3,4]. Diagnosing the disease can be challenging. About 30% of all direct immunofluorescence (DIF) negative (DIF (-)) patients had either ocular-only MMP or ocular involvement in multisite disease. Serum pemphigoid autoantibodies were detected in 38.2% of patients compared with 6.7% of healthy controls. For this reason, false-negative DIF or serum antibody test results do not rule out the diagnosis [5]. Materials and Methods: We report a case of a 46-year-old woman with a 14-year history of recurring conjunctival lesions. Results: During the clinical examination, membranous lesions were observed in the palpebral, forniceal, and bulbar conjunctiva of the left eye. Serum ELISA tests were performed for bullous disease antibodies, including BP180, BP230, desmoglein 1 and 3, envoplakin, and collagen VII, as well as ANA serum tests and antibodies against herpes simplex virus, which yielded negative results. Patch testing was performed to differentiate contact allergy. Although sensitisation to methylchloroisothiazolinone and methylisothiazolinone – common preservatives found in personal care products and household cleaners – was detected, the diagnosis was ruled out due to the absence of palpebral skin involvement. Two conjunctival biopsies were taken. The histopathological evaluation revealed conjunctival leukoplakic lesions. To remove scarred tissue, excision of the conjunctival lesion was performed. Shortly after surgery, the lesions recurred, resulting in symblepharon formation on the bulbar and palpebral conjunctiva. Throughout the treatment period, the patient was using dexamethasone eye gel and eye drops with no significant clinical improvement. Eventually, new membranous lesions appeared in the right eye, indicating bilateral and ocular-only involvement. Histopathological assessment of the new membranous ocular lesions revealed a tissue fragment covered by hyperkeratotic epidermis with impaired epithelial maturation and noticeable subepithelial lymphocytic infiltration. DIF showed no staining for IgA, IgM, IgG, fibrinogen, or complement antibodies despite clinical progression, development of symblepharon, and eventual involvement of the right eye. The diagnosis of ocular cicatricial pemphigoid was based on bilateral disease progression, exclusion of other causes for scarring conjunctivitis, and lack of response to topical and surgical treatments.
28