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Background: There are no proper management guidelines for nail apparatus melanoma (NAM)., Objective: This study aimed to describe the clinical features, the presence of locoregional and distant metastases and disease-free and overall survival of NAM treated at our institution., Methods: A retrospective cohort review of patients with single, primary localized histopathologically confirmed NAM was performed. Collected data consisted of patients' characteristics and tumor features. In addition, local recurrence, locoregional metastases, distant metastases, disease-free survival (DFS) and overall survival (OS) were used as the main outcomes in our analysis., Results: Thirty patients with NAM were included. The overall survival (OS) in our patients at 5 and 10 years was 85.6 and 73.4%, respectively. DFS was significantly higher in patients with primary tumor location in the hand and without tumor-infiltrating lymphocytes (p value = 0.01 and 0.04, respectively). The patients with in situ melanoma or Breslow thickness <1 mm had a significantly higher chance of DFS and OS (90.0 and 94.1% at 5 years, respectively) than those with thicker NAM (58.3 and 55.6% at 5 years, respectively). A total of 53.3% of 30 patients underwent primary excision and covering with a full-thickness skin graft, while 13.3% of our 30 patients underwent digit amputation. The patients who underwent excision and covering with a full-thickness skin graft showed a complete overall survival (100% at 5 years)., Conclusion: Primary tumor location in the hand and lower tumor thickness might be correlated with better patients' survival. The study results suggest that total amputation might not be necessary in all NAM cases., (© 2021 S. Karger AG, Basel.)

Background: The skin hyperpigmentation index (SHI), a new objective method for measuring skin hyperpigmentation, needs validation., Objective: To gain evidence of the reliability and validity of the SHI., Methods: Fifteen raters were divided into 3 groups (5 dermatologists, 5 nondermatologist physicians, and 5 nonphysician clinicians). Each rated 5 pigmented mole lesions with mild-to-severe hyperpigmentation to determine intra- and interrater reliability. All raters photographed the lesions and rated them using the subjective Physician Global Assessment (PGA) score. The same photographs were then assessed based on automatic computer measurement software using the online SHI tool (https://shi.skinimageanalysis.com)., Results: The SHI reliability was excellent for all intra- and interrater assessments, while most PGA assessments showed good intra- and interrater agreement. Between-group reliability was excellent for SHI, while moderate-to-good for PGA evaluations. Concordance between the SHI and PGA assessments was strong across all groups of assessors., Conclusion: There is evidence that the SHI is a reliable instrument for measuring skin hyperpigmentation, and can be used by nonexperienced clinicians., (© 2021 S. Karger AG, Basel.)

Background: Actinic keratosis (AK) is the most common precancerous cutaneous lesion, with risk of progression to cutaneous squamous cell carcinoma. In the current study, we evaluated the efficacy of 20-MHz high-intensity focused ultrasound (HIFU), as a new treatment modality for AK., Materials and Methods: Patients with AK lesions (grades I-III) treated with HIFU were included in the study. The clinical assessment was performed 3 months after therapy., Results: Twenty-one patients (14 men, 7 women) with 108 AK lesions (grades I-III) were included in the current study. Ages ranged from 62 to 85 years (mean 72.6 years). Clinically complete resolution of the actinic damage in the treated area was detected in 72.2% of lesions. Furthermore, 28 lesions (26%) showed a reduction of the AK grade, or partial response, after the therapy. Most of the patients experienced annoying but short pain during the procedure. However, late adverse effects of the therapy, such as hypopigmentation, hyperpigmentation and erythema were reported only in a small portion of the lesions., Conclusions: 20-MHz HIFU could be an effective and safe alternative treatment for AK., (© 2021 S. Karger AG, Basel.)

Background: Apremilast is an oral phosphodiesterase 4 (PDE4) inhibitor used for the treatment of moderate to severe psoriasis. Long-term data on the effectiveness and drug survival of patients treated with apremilast are limited., Objective: The aim of this study was to analyze the characteristics, effectiveness, and drug survival of patients treated with apremilast in a real-world setting., Methods: We conducted a retrospective cohort study of patients with psoriasis who received at least 1 dose of apremilast between 2015 and 2018. We documented sex; age; type, duration, and severity (using Psoriasis Area Severity Index [PASI] and Dermatology Life Quality Index [DLQI]) of psoriasis; comorbidities; previous treatment modalities; adverse events; and reasons for therapy discontinuation. For drug survival, estimates and efficacy analysis with Kaplan-Meier statistics were used., Results: The drug survival rate of the 93 reviewed patients was 69.5% at 6 months, 34.7% at 12 months, and 25.8% at 24 months after initiating therapy. The median survival duration was 8.0 months. Therapy was discontinued in 66.6 and 27.8% due to loss of efficacy and adverse events, respectively. At 24 months, 35.9% had achieved PASI75 response and 23.7% had achieved PASI90 response. Most observed adverse events were gastrointestinal issues, weight loss, and headache., Conclusions: Apremilast is an effective and well-tolerated therapy for patients with moderate to severe psoriasis, especially for patients with difficult-to-treat locations and/or contraindications to other biologics. Furthermore, apremilast was used for patients with a history of nonresponse to biologics and was favored for patients with relatively low PASI (<10) and a high DLQI., (© 2021 S. Karger AG, Basel.)

Background/aims: The spectrum of dermatological emergencies is broad. Only a few studies have assessed the profile of dermatological conditions resulting in an emergency visit in a referral hospital. We sought to assess the conditions prompting an urgent dermatological visit and to compare the diagnoses with those made during the regular scheduled encounters., Methods: We performed a cross-sectional study of all patients with a cutaneous problem attending our emergency consultation during a 7-month period. The study variables were gender, age, duration of symptoms, diagnosis, need for hospitalization and/or follow-up. We further evaluated patients attending scheduled visits to compare the demographic characteristics and diagnoses between the two groups., Results: Six hundred fifty-two consecutive patients with an urgent dermatological consultation were included. Three hundred sixty (55.2%) were women and 292 (44.8%) were men. Infectious diseases (32.8%) as well as various forms of eczema (24.8%) constituted the most frequent causes for an emergency visit. Approximately 40% of emergency visits took place more than 1 week after the development of the cutaneous manifestations. The most frequent disorders seen in the 1,738 control patients included benign melanocytic and nonmelanocytic tumors (27.2%) and malignant skin lesions (11.5%)., Conclusions: Our study indicates that the dermatological diagnoses in the emergency visits significantly differ from those of the routinely scheduled appointments. In a significant portion of patients, the use of an emergency consultation was not justified. This study provides support to the idea that a specific training is required to manage dermatological emergencies and that efforts should be made to reduce unjustified emergency visit use., (© 2019 S. Karger AG, Basel.)

Background: More epidemiological data about lentigo maligna melanoma (LMM) are required to define follow-up guidelines. The study focused on recurrence, progression, and overall survival of LMM managed with primary wide local excision., Methods: In a 23-year retrospective study (1994 to 2016), a cohort of patients with LMM was evaluated by collecting data about the tumor location, the Breslow depth, the presence of ulceration, and patients' age and sex. Local recurrences, locoregional and distant metastases, and disease-free and overall survival were additionally assessed., Results: Overall, 150 cases (84 male, 66 female, mean age 71.3 ± 11.3 years) of single, localized, primary LMM with a mean follow-up of 6.6 ± 4.4 years were included. A total of 33 (22.2%) patients underwent sentinel lymph node biopsy (SLNB) during surgical excision. However, positive SLNB was detected in none of them. The multivariable Cox analysis indicated that age of diagnosis and male gender significantly influenced the overall survival, while a shorter disease-free survival could be correlated with a greater Breslow thickness. The metastatic potential turned out to be low, entailing 7 deaths in the context of the LMM., Conclusion: Male gender, age over 70 at diagnosis, and a Breslow thickness greater than 0.75 mm were associated with a statistically significant decrease in overall disease-free survival in the current study. The results of the study confirm the favorable outcome of LMM. However, diagnosed patients should undertake regular follow-ups. The intensity of follow-up in these patients can be individualized based on the probability of recurrence/metastasis and overall survival. Furthermore, the study showed that SLNB might not be a necessary staging procedure in patients with LMM., (© 2019 S. Karger AG, Basel.)

Background: Hidradenitis suppurativa (HS) is one of the most distressing conditions observed in dermatology and has a substantial negative effect on the quality of life of affected persons., Objectives: The aim of this study was to evaluate different treatment strategies in patients with HS., Methods: In a retrospective cohort, all patients with HS (July 2015 to March 2017) were reviewed. Collected data consisted of patients' demographics, clinical characteristics, psychosocial situation, and previous and current treatments. In addition, therapy response to the most recent prescribed treatments was assessed., Results: 102 patients (38 females, 64 males; median age 37.5 years) were included in this study. 68.4% of patients had BMI ≥25, and 76.5% of patients were current smokers. Hurley stages I, II, and III were detected in 13.5, 53.1, and 33.3% of patients, respectively. The most commonly administered treatments were surgery (67.6%), nonantibiotic topical therapies (72.5%), antibiotic topical therapies (55.9%), systemic antibiotics (88.2%), and biologics in 11.8% of the patients. 84.6% of the patients showed a response (27.5 and 47.1% partial and complete response, respectively) to the treatments., Conclusion: HS as a chronic, recurrent inflammatory skin disease is associated with smoking and obesity. Application of systemic antibiotics is the most frequent treatment strategy for this disease. However, surgical intervention seems to be the most effective treatment strategy., (© 2018 S. Karger AG, Basel.)

Background/aims: Rubbing the skin may influence the persistence of pustulosis over time. The aim of this study was to assess the impact of a new fabric made with fluorine-synthetic fiber in improving plantar pustulosis., Methods: A total of 17 patients were randomized to receive on one side a sock made of fluorine-synthetic fiber and on the other a sock made of cotton fabric for 4 weeks. The main outcome was the percentage reduction of lesional area at week 4., Results: The median lesion reduction at week 4 was 42.6% in the fluorine-synthetic fiber arm and 2.7% in the cotton arm (p = 0.148). Among secondary outcomes, the overall reduction over time in the treated areas was significantly in favor of the fluorine-synthetic fiber arm (p = 0.045) as well as the perception of the disease by the patient (p = 0.025)., Conclusion: Despite the fact that the primary outcome was not reached, there was a tangible reduction in the extension of the treated areas and in the perception of the disease by the patient., (© 2014 S. Karger AG, Basel.)

Background: Autoimmune comorbidities and circulating autoantibodies have been observed in vitiligo patients, but differences in rate are present according to countries in which the studies were performed, perhaps owing to ethnic diversities or different trigger factors., Objective: To estimate the prevalence of circulating autoantibodies and overt autoimmune diseases in a fairly large sample of Italian vitiligo patients., Methods: 175 outpatients affected by vitiligo and referred to nine dermatological centers were included in the study. Patients were offered routine blood test, serological testing for thyroid function and search for autoantibodies., Results: At least one circulating autoantibody was detected in 61 (41.8%) of 146 subjects who underwent laboratory tests. Anti-thyroperoxidase (25.6%), anti-thyroglobulin (23.4%), antinuclear antibodies (16.8%) and anti-gastric parietal cell antibodies (7.8%) were the most noticed autoantibodies. 74 (41.5%) autoimmune comorbidities, mainly autoimmune thyroiditis (37%), were reported., Conclusion: The prevalence of autoimmune comorbidities and circulating autoantibodies in this study was in agreement with other surveys conducted on Caucasian patients., (© 2014 S. Karger AG, Basel.)

Background: It is believed that vitiligo has an impact on the overall patient quality of life (QoL)., Objective: To estimate QoL in a fairly large sample of Italian vitiligo patients by using the Dermatology Life Quality Index (DLQI) questionnaire., Methods: One hundred and sixty-one vitiligo patients referred to 9 dermatological centers were offered to participate by filling in the Italian version of the DLQI questionnaire., Results: The mean total DLQI score was 4.3 (SD ±4.9; range: 0-22). In multivariate analysis, DLQI >5 was associated with female gender, stability of the disease over time and involvement of the face at disease onset., Conclusions: The impairment of QoL is overall limited in Italian vitiligo patients, especially if it is compared with results from other available studies. This could be due to cultural and ethnic characteristics of the sample.

Background: A predictive model may help to select likely responders and to anticipate treatment duration in vitiligo., Methods: We aimed to develop a predictive rule based on data from a randomized trial of excimer laser in vitiligo. Information on 325 treated patches was available. The degree of repigmentation was assessed by digital image analysis of UVB-reflected photographs. Since no strong relationship between any single predictive parameter and outcome was initially documented, we relied on artificial neural networks., Results: Using a time-response optimal threshold model, data were divided into 2 groups of responders and nonresponders. A discriminant network was trained in order to detect responders versus nonresponders. A regression network was subsequently used to compute repigmentation time in responders. The neural network discriminator achieved 66.46 +/- 5.37% (95% CI) overall accuracy. The mean absolute error of the neural network regressor was 19.5843 +/- 2.0930 with a root mean square error of 23.7156 +/- 2.2225., Conclusion: Our study offers insight into the difficulty of clinical prediction in vitiligo and presents a way to develop an instrument with which to predict the clinical time response in patients treated by excimer laser., (Copyright 2009 S. Karger AG, Basel.)