Antiphospholipid syndrome (APS) is a hypercoagulable condition associated with antiphospholipid antibodies (LAC, anticardiolipin, and antiA2-glycoprotein) that causes thrombosis and obstetrical complications. Although skin involvement is quite uncommon, it sometimes could be an early sign of
a disease, especially regarding the seronegative subtypes of APS. The most
prevalent form of APS when talking of cutaneous manifestations is livedo reticularis, followed by livedo racemosa, skin ulcers, gangrene, necrosis, purpura, alopecia,acrocianosis, anetoderma, malignant atrophic papulosis, livedoid vasculitis, pseudovasculitic lesions, Raynaud’s Phenomenon, “Antiphospholipid Ras, subungual splinter haemorrhages, cutis marmorata, distal inflammatory oedema, superficial or deep, venous or arterial trombosis.

Collaborating with dermatologists to identify atypical skin damage in APS may be the first step towards establishing the diagnosis and initiating specific treatments as soon as possible.
The cutaneous manifestations of APS can mimic a wide range of pathologies, starting from viral infections to collagen diseases, especially if the patient suffers from systemic lupus erythematosus, vasculitis, chronic kidney disease, immunocompromised patients, patients with hematologic or post-drug abuse disorders.
The requirement for clinical and especially histopathologic diagnosis is essential, good collaboration between clinician and dermatologist, anatomatologist having the role of having a clear diagnosis, supported and the possibility of excluding other possible differential diagnoses.
Starting from the diagnosis and from the assessment of the severity of the cutaneous lesions we can decide the therapeutic conduct, very often the cutaneous lesion being the clinical expression of potential organ manifestations even with vital resonance.
Medication is based on immunosuppressive therapy, ranging from hydroxychloroquine to rituximab, all of having various effects on skin damage control, as well as antiaggregating and oral anticoagulant therapy. All while balancing the risks and advantages and adapting the treatment to the individual's symptoms and general well-being.

The purpose of this special issue is to emphasize the diagnostic challenges experienced primarily by patients and dermatologists, which sometimes take years to establish an accurate diagnosis. Starting from the early diagnosis (strictly cutaneous manifestations) with or without positivity for specific antibodies for antiphospholipid syndrome, we can discuss improving the long-term prognosis and preventing catastrophic effects of the disease.
Starting with a clinical experiences, cases, or case series, physicians are invited to submit their challenging diagnostic experiences in this underexplored disease. Potential publications based on illustrations or even histopathologic findings can have a significant impact on clinical practice and the early initiation of specific therapy, assessing the benefits and depending on professional expertise. Also meta-analyses or reviews can be extremely useful in establishing what is known in this field today . So the general invitation is to submit and expand research in this limited field.

Articles

Journal of Cutaneous Immunology and Allergy