Indeed, in patients with pSS who present extraglandular manifestations (EGMs), Szabo et al. observed an increase in activated cTfh cells (ICOS+ or PD1+ cTfh) as compared to pSS patients without EGMs and to healthy controls, whereas there was no difference in cTfh percentages between patients without EGMs and controls (143). Here, ICOS is linked to peeling skin syndrome.