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Kristine Heidemeyer,1,2 Marco May Lee,3 Simone Cazzaniga,1,2 Nikhil Yawalkar,1 Luigi Naldi2,4 1Department of Dermatology, Inselspital University Hospital of Bern, Bern, Switzerland; 2Centro Studi GISED, Bergamo, Italy; 3Section of Dermatology, Department of Clinical and Experimental Medicine, University of Parma, Parma, Italy; 4Dermatology Department, S. Bortolo Hospital, Vicenza, ItalyCorrespondence: Kristine Heidemeyer, Department of Dermatology, Inselspital University Hospital of Bern, Freiburgstrasse 34, Bern, CH-3010, Switzerland, Tel +41 31 632 20 94, Email kristine.heidemeyer@insel.chAbstract: Palmoplantar pustulosis (PPP) is a chronic, relapsing, inflammatory disease that can occur alone or in association with arthritis. There is still controversy about whether it should be separated from psoriasis or classified as pustular psoriasis. Furthermore, drug-induced paradoxical PPP is a special variant of PPP that differs from classic PPP in several ways. Treatment of PPP is still challenging, and there are a number of treatment-resistant cases. This review summarizes the risk factors for the development of PPP and the currently available treatment modalities. Female sex, smokers or ex-smokers, obesity, thyroid dysfunction, and treatment with a tumor necrosis factor (TNF)-α inhibitor have been identified as risk factors for the disease’s development, severity, and course. Topical treatments and phototherapy are effective for some patients and are used as a first-line or adjuvant treatment modality. Conventional treatments including retinoids and fumaric acid show good effects and can increase the efficacy of treatment with psoralen + ultraviolet light therapy (PUVA). Ciclosporin is fast acting, but relapse mostly occurs immediately after cessation. TNF-α inhibitors are efficient, and an even better response can be achieved with IL-17 and IL-23 blockers as well as apremilast. The effect of Janus kinase inhibitors seems to be promising according to case reports

Smartphone apps may help promoting the early diagnosis of melanoma. The reliability of specialist judgment on lesions should be assessed. Hereby, we evaluated the agreement of 6 young dermatologists, after a specific training. Clinical judgment was evaluated during 2 online sessions, 1 month apart, on a series of 45 pigmentary lesions. Lesions were classified as highly suspicious, suspicious, non-suspicious or not assessable. Cohen s and Fleiss kappa were used to calculate intra-and inter-rater agreement. The overall intra-rater agreement was 0.42 (95% confidence interval-CI: 0.33-0.50), varying between 0.12-0.59 on single raters. The inter-rater agreement during the first phase was 0.29 (95% CI: 0.24-0.34). When considering the agreement for each category of judgment, kappa varied from 0.19 for not assessable to 0.48 for highly suspicious lesions. Similar results were obtained in the second exercise. The study showed a less than satisfactory agreement among young dermatologists. Our data point to the need for improving the reliability of the clinical diagnoses of melanoma especially when assessing small lesions and when dealing with thin melanomas at a population level.