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This article provides an overview of tumoural melanosis (TM), a rare condition characterized by the regression of cutaneous melanoma. The authors present four cases of TM from Greece and discuss the clinical, dermatoscopic, and histopathologic characteristics of the condition. They highlight the importance of clinicopathologic correlation in diagnosing TM and recommend aggressive management due to the poor outcomes associated with the condition. Dermatoscopic findings, such as "peppering," whitish or pinkish structureless areas, and blue/grey areas, can assist in the diagnosis of TM. The article includes images to illustrate the cases and provide visual examples of the diagnostic findings. [Extracted from the article]

Alopecia areata is an autoimmune form of non‐scarring hair loss. It is usually characterized by limited areas of hair loss. However, the disease may progress to complete scalp and body hair loss (alopecia totalis, alopecia universalis). In patients with alopecia areata hair loss significantly impacts the quality of life. Children and adolescents with alopecia areata often experience bullying, including physical aggression. The disease severity evaluation tools used in clinical practice are: the Severity of Alopecia Tool (SALT) score and the Alopecia Areata Scale (AAS). A SALT score equal to or greater than 20 constitutes a commonly accepted indication for systemic therapy in alopecia areata. When using the AAS, moderate to severe alopecia areata should be considered a medical indication for systemic treatment. Currently, the only two EMA‐approved medications for alopecia areata are baricitinib (JAK 1/2 inhibitor) for adults and ritlecitinib (JAK 3/TEC inhibitor) for individuals aged 12 and older. Both are EMA‐approved for patients with severe alopecia areata. Other systemic medications used off‐label in alopecia areata include glucocorticosteroids, cyclosporine, methotrexate and azathioprine. Oral minoxidil is considered an adjuvant therapy with limited data confirming its possible efficacy. This consensus statement is to outline a systemic treatment algorithm for alopecia areata, indications for systemic treatment, available therapeutic options, their efficacy and safety, as well as the duration of the therapy. [ABSTRACT FROM AUTHOR]

Background: Real‐world data in patients with moderate psoriasis treated with apremilast is limited. Objectives: To evaluate the effectiveness and safety of apremilast in bio‐naïve patients with moderate psoriasis in real‐world clinical settings. Methods: This was a 52‐week multicenter, observational, prospective study of adult outpatients with moderate psoriasis {[10% < body surface area < 20% or 10 < psoriasis area severity index (PASI) < 20] and 10 < dermatology quality of life index (DLQI) < 20} initiated on apremilast ≤7 days before enrollment. Missing data were imputed using the last observation carried forward method. Results: A total of 287 eligible patients (median age: 54.2 years; median psoriasis duration: 9.8 years) were consecutively enrolled. At baseline, the median DLQI and PASI scores were 12.0 and 11.8, respectively. The 52‐week DLQI ≤ 5 and PASI75 response rates were 68.3% and 61.0%. At 52 weeks, 70.8% and 72.7% of the patients shifted from moderate/severe/very severe to clear/minimal scalp and palmoplantar psoriasis involvement, respectively; the pruritus severity state improved in 67.2%. The 52‐week Kaplan–Meier estimated drug continuation rate was 85.3%. The adverse drug reaction rate was 19.9%. Conclusions: Apremilast is a safe and effective treatment for bio‐naïve patients with moderate psoriasis and specific psoriasis manifestations. [ABSTRACT FROM AUTHOR]

The introduction of immune checkpoint inhibitors (ICIs) opened a new era in oncologic therapy. The favourable profile of ICIs in terms of efficacy and safety can be overshadowed by the development of immune‐related adverse events (irAEs). Dermatologic irAEs (dirAEs) appear in about 40% of patients undergoing immunotherapy and mainly include maculopapular, psoriasiform, lichenoid and eczematous rashes, auto‐immune bullous disorders, pigmentary disorders, pruritus, oral mucosal lesions, hair and nail changes, as well as a few rare and potentially life‐threatening toxicities. The EADV task force Dermatology for Cancer Patients merged the clinical experience of the so‐far published data, incorporated the quantitative and qualitative characteristics of each specific dirAEs, and released dermatology‐derived, phenotype‐specific treatment recommendations for cutaneous toxicities (including levels of evidence and grades of recommendation). The basic principle of management is that the interventions should be tailored to serve the equilibrium between patients' relief from the symptoms and signs of skin toxicity and the preservation of an unimpeded oncologic treatment. [ABSTRACT FROM AUTHOR]

Background: Squamous cell carcinoma of the lip accounts for 20% of all oral carcinomas. Its diagnosis may be challenging because it clinically resembles actinic cheilitis and inflammatory lesions of the lips. Objectives: To determine clinical and dermatoscopic predictors of squamous cell carcinoma of the lip vs. other lip lesions. Methods: Multicentre retrospective morphological study, including histologically confirmed cases of squamous cell carcinoma of the lip and controls consisting of actinic cheilitis and inflammatory lesions of the lips. Clinical and dermatoscopic images were evaluated for the presence of predefined criteria. Crude and adjusted odds ratios and corresponding 95% confidence intervals were calculated by univariate and multivariate logistic regression respectively. Results: A total of 177 lip lesions were evaluated, 107 (60.5%) were squamous cell carcinomas and 70 (39.5%) were controls. The most frequent dermatoscopic criteria of lip squamous cell carcinoma were scales (100%), white halos (87.3%) and ulceration (79.4%). The majority of squamous cell carcinomas displayed polymorphic vessels (60.8%), with linear (68.6%) and hairpin (67.6%) being the most frequent types. Multivariate logistic regression analysis showed that clinical predictors of lip squamous cell carcinoma were exophytic appearance and clinical hyperkeratosis, with 43‐fold and 6‐fold higher probability respectively. White clods and ulceration in dermoscopy presented a 6‐fold and 4‐fold increased risk for squamous cell carcinoma respectively. Conclusions: A scaly lesion with exophytic growth, dermatoscopically displaying white clods, ulceration and linear and hairpin vessels is very likely a squamous cell carcinoma of the lip. [ABSTRACT FROM AUTHOR]

The patients reported that treatment with Cal/BD aerosol foam was "very good" in terms of effectiveness (64.5%), tolerability (59.0%), ease of application (58.8%) and overall treatment satisfaction (64.3%) (Fig. GLO:3NZ/01dec21:jdv17593-fig-0001.jpg PHOTO (COLOR): 1 Satisfaction with previous psoriasis treatments assessed at study enrolment (baseline) and with Cal/BD aerosol foam treatment at the end of week 4. Patient-reported outcomes with calcipotriol/betamethasone aerosol foam in patients with plaque psoriasis in Greece. [Extracted from the article]

Overall, 1221 patients with clinical differential diagnosis of necessarily psoriasis and >=1 of morphologically similar inflammatory and/or cancerous erythematosquamous conditions lacking a definitive clinical diagnosis were included. On the other hand, dermoscopic findings are only relevant within the overall clinical framework of the patient.4,5 Accordingly, our study stresses the importance of integrating dermoscopy in the clinical examination when rendering a diagnosis, particularly when assessing challenging lesions mimicking diverse skin conditions, either malignant or inflammatory. Accurate dermoscopic criteria of various skin diseases exist, but the extent to which they improve diagnosis over the unaided-eye examination in the real clinical setting remains unclear. [Extracted from the article]

1, new recurrences were observed in two out of nine patients (22.2%) that received acitretin and in five out of seven patients (71.4%) that received TCi as maintenance treatment. Acitretin was continued after TS withdrawal as maintenance treatment; (ii) a cycle of TS followed by TCi as maintenance treatment; (iii) TCi in combination with 25 mg of acitretin, both in continuous application. Erosive pustular dermatosis of the scalp (EPDS) is an inflammatory dermatosis, characterized by erosions, pustules and crusts.1-7 Risk factors include elderly age, actinic damage, androgenetic alopecia and preceding trauma.1-7 We retrospectively analysed data of clinically and histologically diagnosed EPDS patients, to assess disease characteristics and efficacy of different therapies and to explore various associations. .000 ht GLO:3NZ/01nov21:jdv17455-fig-0001.jpg PHOTO (COLOR): 1 Treatment flowchart. gl After treatment cessation, 18 out of 23 patients (78.3%) experienced a recurrence/deterioration at a median time of 8 weeks (IQR = 4-12, range = 2-16). [Extracted from the article]

Background: Apremilast is an oral phosphodiesterase‐4 inhibitor indicated for patients with moderate‐to‐severe chronic plaque psoriasis and active psoriatic arthritis. Objectives: To examine the effectiveness of apremilast on Dermatology Life Quality Index (DLQI), Psoriasis Area and Severity Index (PASI) and nail, scalp and palmoplantar involvement, when administered prior to biologics. Methods: This 52‐week real‐world study included biologic‐naive adults with moderate psoriasis (psoriasis‐involved body surface area 10% to <20%, or PASI 10 to <20 and DLQI 10 to <20). Apremilast was initiated ≤7 days before enrolment. Data from the first 100 eligible patients who completed 24 weeks (W24) of observation (or were prematurely withdrawn) are presented in this interim analysis using the last‐observation‐carried‐forward imputation method. Results: Eligible patients (mean age: 49.9 years; 71.0% males; median disease duration: 8.0 years) were consecutively enrolled between April and October 2017, by 18 dermatology specialists practising in hospital outpatient settings in Greece. Baseline DLQI (median: 12.0) and PASI (median: 11.7) scores improved (P < 0.001) at all postbaseline timepoints (Weeks 6, 16 and 24; W24 median decreases: 9.0 and 9.4 points respectively). At W24, DLQI ≤5, DLQI 0 or 1, and PASI‐75 response rates were 63.0%, 25.0% and 48.0% respectively. The Nail Psoriasis Severity Index score in patients with baseline nail involvement (n = 57) decreased at all postbaseline timepoints (P < 0.001; W24 median decrease: 20.0 points). At W24, 50.0% and 51.7% of patients with baseline scalp (n = 76) and palmoplantar (n = 29) involvement respectively achieved postbaseline Physician's Global Assessment (PGA) score of 0 or 1 if baseline score was ≥3, or 0 if baseline score was 1 or 2. The adverse drug reaction rate was 21.0% (serious: 2.0%). Conclusions: These interim results indicate that through 24 weeks, apremilast improved quality of life and reduced disease severity in biologic‐naive patients with moderate plaque psoriasis, while demonstrating safety consistent with the known safety profile. [ABSTRACT FROM AUTHOR]

Fixed combination aerosol foam calcipotriene 0.005% (Cal) plus betamethasone dipropionate 0.064% (BD) is more efficacious than Cal or BD aerosol foam alone for psoriasis vulgaris: a randomized, double-blind, multicenter, three-arm, phase 2 study. Plaque psoriasis (psoriasis) is a chronic, immune-mediated inflammatory disorder, with a prevalence of approximately 2% in Europe and North America.1 Psoriasis is classified as mild, moderate and severe,2 while ~70-80% of patients suffer from mild disease.1 The European S3 Guidelines recommend the use of vitamin D3 derivatives and steroids combination for the first four weeks as induction therapy.2 An innovative Calcipotriol/Betamethasone (Cal/BD) fixed combination aerosol foam formulation has been developed to enhance adherence in the topical treatment.3 This study aimed to provide real-world data on the effectiveness of Cal/BD aerosol foam in treated patients with at least mild psoriasis. Superior efficacy of calcipotriene and betamethasone dipropionate aerosol foam versus ointment in patients with psoriasis vulgaris-a randomized phase II study. [Extracted from the article]

Nevertheless, treatment outcomes have only been reported in case reports and in a few clinical trials.2-4 The current study aimed to evaluate the efficacy and safety profile of peg IFN in the treatment of mycosis fungoides (MF). The only dose-limiting toxicity was a grade 3 elevation of liver enzymes in the 270-mg dose group.3 Overall, peg IFN should be considered as an alternative option in the treatment of MF and its optimal dosing needs to be evaluated in future studies. IFN- with its cytotoxic effects on tumorous T cells was introduced in the treatment of cutaneous T-cell lymphoma in the 1980s and is included as an option in CTCL guidelines.1 However, recombinant IFN a-2a or IFN a-2b interferon regimens are no longer available, and therefore, the pegylated analogue (pegylated IFN a-2a) has been currently used. [Extracted from the article]

European patient perspectives on the impact of psoriasis: the EUROPSO patient membership survey. When the low may still be high: the heavy burden of residual psoriasis in difficult-to-treat areas despite a low DLQI score among patients under biologics or apremilast: a 5-year, prospective, case-control study A total of 318 patients [172 patients with residual psoriasis in difficult-to-treat areas (study group); 146 patients as control group] were included in the analysis. [Extracted from the article]

A total of 40 specimens were collected as follows: thirty (75%) patients had patch type AA, seven (17.5%) had diffuse AA, and three (7.5%) had alopecia totalis. I Editor i Alopecia areata ( ) is an inflammatory disease of the hair follicle unit characterized by non-scarring hair loss. In the acute stage of our AA cases, pDCs were found in 30.8% which implies that the recruitment of pDCs in AA may appear gradually and then subside throughout the chronic stage. [Extracted from the article]

Certain skin conditions are notably amenable to teledermatology.4 Teledermoscopy may surge as a solution to accelerate the diagnosis and shorten treatment delays by bridging the gap between the time a skin lesion appears and the time an experienced dermoscopist is available to evaluate it. The COVID-19 crisis represents a tipping point for teledermatology. It may augment clinical diagnosis, reduce unnecessary biopsies or function as an enhancement to teledermatology consultations for dermatologists and general practitioners. [Extracted from the article]

Background: Mammary Paget's disease (MPD) is a rare intraepidermal adenocarcinoma of the nipple‐areola complex, associated with an underlying breast cancer in approximately 90% of cases. Delayed diagnosis of MPD is common. Its dermoscopic features have been ill defined in the literature. Objectives: To determine the clinical and dermoscopic features of MPD versus other dermatologic entities that involve nipple and areola. Methods: Members of the IDS were invited to submit any case of histologically confirmed MPD, as well as other benign and malignant dermatoses that involve the nipple and areola complex. A standardized evaluation of the dermoscopic images was performed and the results were statistically analyzed. Results: Sixty‐five lesions were included in the study, 22 (33.8%) of them MPD and 43 (66.2%) controls. The most frequent dermoscopic criteria of MPD were white scales (86.4%) and pink structureless areas (81.8%), followed by dotted vessels (72.7%), erosion/ulceration (68.2%) and white shiny lines (63.6%). The multivariate analysis showed that white scales and pink structureless areas were significant predictors of MPD, posing a 68‐fold and a 31‐fold probability of MPD, respectively. Split of the population into pigmented and non‐pigmented lesions showed that in pigmented MPD, pink structureless areas, white lines and grey granules and dots are positive predictors of the disease. Among non‐pigmented lesions, pink structureless areas, white lines, erosion/ulceration and white scales served as predictors of MPD. Conclusions: The most frequent profile of an individual with MPD is an elderly female with unilateral, asymptomatic, erythematous plaque of the nipple, dermoscopically displaying pink structureless areas, fine white scales, dotted and a few short linear vessels. In case of pigmentation we may also observe brown structureless areas and pigmented granules. Limitations: Small sample size, retrospective design. [ABSTRACT FROM AUTHOR]

Background: Topical methyl aminolevulinate photodynamic therapy (MAL‐PDT) with 3 h incubation is recommended as a field directed treatment. Skin pretreatment with ablative CO2 fractional laser (AFXL) prior to MAL‐PDT enhances drug penetration and could minimize incubation time. Objectives: To evaluate and compare the safety and the preventive effect in the development of new non‐melanocytic skin cancers (NMSCs) of AFXL‐assisted MAL‐PDT with 1‐h incubation with that of conventional MAL‐PDT in patients with clinical and histological signs of field cancerization. Methods: Forty‐two patients with two mirror cancerized areas of face or scalp were randomized to field treatment with 1‐h incubation AFXL‐assisted PDT or conventional PDT (CPDT). All patients underwent two treatment sessions 1 week apart. Irradiation was performed using a red light‐emitting diode lamp at 37 J/cm2. Patients were followed up at 3, 6, 9 and 12 months for the evaluation of development of new NMSCs lesions. Results: All patients completed the study. There was no statistically significant difference with respect to the total number of new actinic keratoses at any point of follow‐up as well as to the mean time of occurrence of new lesions between treatment fields. Both treatment regimens were safe and well tolerated. Conclusion: Ablative CO2 fractional laser pretreatment may be considered as an option for reducing photosensitizer occlusion time while providing the same preventative efficacy as CPDT in patients with field‐cancerized skin. [ABSTRACT FROM AUTHOR]

Background: Acquired naevi often present in childhood and increase in number and size during early and middle life. As naevi represent potential mimickers of melanoma, the knowledge of their epidemiologic and morphologic characteristics is essential. Objective: In this study, we intend to determine the prevalence of dermoscopic patterns of naevi, as well their association with environmental and constitutional factors. Methods: Cross‐sectional data derived from a population‐based cohort of children and adolescents aged 6–18 years, from 12 different schools in Thessaloniki, Greece. For each participant, a consent form and a questionnaire were completed, which included data on age, sex, phototype, sun sensitivity, sun exposure, sunscreen use and previous sunburn history. All naevi, their body distribution, and their dermoscopic patterns were recorded. Results: Two thousand and five hundred and five (2505) subjects were enrolled into the study (47.8% males and 52.2% females). The mean number of MN counted in a single person was 29.11 (SD = ±23.863). TNC increased continuously with higher age. Males were found to have a significantly increased number on the trunk (11.7 ± 11.2 and 10.0 ± 8.7, respectively, P < 0.001) and face and neck (6.2 ± 5.3 and 5.1 ± 4.3, respectively, P < 0.001) while females on the upper (10.3 ± 10.1 and 9.3 ± 9.4, respectively, P = 0.008) and lower extremities (2.8 ± 3.4 and 2.5 ± 3.2, respectively, P = 0.008). Globular pattern was the most frequent dominant pattern in lower age groups, and its percentage fell as age increased. On the contrary, the reticular pattern was more often documented in individuals in adolescence. Conclusion: This first study of MN in our young population aims to be the basis of further investigation for the MM preventive policy of our state. [ABSTRACT FROM AUTHOR]

Morse code hairs, zigzag hairs and a combination of white and yellow scales are highly suggestive of microsporic infections, whereas corkscrew hairs and black dots typify trichosporic TC. It is likely that this type of hair shaft invasion is dermatoscopically seen as morse code hairs, with the white zones corresponding to the aggregations of hyphae outside the hair and the black zones to non-covered areas of the hair shaft. In summary, the dermatoscopic signs of white and yellow scale, zigzag hair and morse code hair seem as highly suggestive of ectothrix type of hair invasion (probably microspora). [Extracted from the article]

Tinea corporis (TC) is a superficial fungal infection of the glabrous skin of the trunk and extremities, excluding the palmoplantar skin and the folds. The diagnosis of TC is mainly established clinically and is often confirmed by direct microscopy and culture of skin scrapings.[1] Dermatoscopy is a useful diagnostic tool with proven diagnostic value in skin tumours. Of them, 36 were microscopically positive for TC and 40 were negative and finally diagnosed as psoriasis (20), dermatitis (10), pityriasis rosea (5) and lichen planus (5). [Extracted from the article]

Background: The dermoscopic features of superficial basal cell carcinoma (sBCC) and Bowen's disease (BD) have been extensively investigated, and dermoscopy was shown to significantly improve their recognition. However, incorrectly diagnosed cases still exist, with a considerable number of sBCCs dermoscopically interpreted as BD. Our aim was to investigate the dermoscopic variability in sBCC and BD on different anatomic sites, to identify potent dermoscopic predictors for each diagnosis and to investigate the potential source of the inaccurate clinico‐dermoscopic diagnosis of some sBCCs. Methods: Dermoscopic images of histopathologically diagnosed sBCC and BD were evaluated by three independent investigators for the presence of predefined criteria. Subsequently, three independent investigators with expertise in dermoscopy classified the tumours as sBCC or BD based on the dermoscopic image. Diagnostic accuracy scores were calculated and crude and adjusted odds ratios, and 95% confidence intervals were calculated by univariate and conditional multivariate logistic regression, respectively. Results: A total of 283 lesions were included in the study (194 sBCCs and 89 BD). The main dermoscopic predictors of BD were dotted vessels (7.5‐fold) and glomerular vessels (12.7‐fold). The presence of leaf‐like areas/spoke‐wheel areas/concentric structures (OR = 0.027) and arborizing vessels (OR = 0.065) has predicted sBCC. Multivariate risk factors for sBCC misclassification were the location on lower extremities (OR = 5.5), the presence of dotted vessels (OR = 59.5) and the presence of large ulceration (OR = 6.4). In contrast, the presence of brown‐coloured pigmentation was a protective predictor for misdiagnosis (OR = 0.007). Finally, a subgroup analysis of lesions located on lower extremities revealed two additional potent predictors of sBCC: superficial fine telangiectasia (SFT) and whity shiny blotches/strands. Conclusions: Dotted and glomerular vessels are strong predictors of BD. When located on the lower extremities, sBCC may also display dotted vessels, rendering its recognition problematic. On the latter anatomic site, clinicians should consider SFT and whity shiny blotches/strands as additional sBCC predictors. [ABSTRACT FROM AUTHOR]

Abstract: Dermoscopy has been documented to increase the diagnostic accuracy of clinicians evaluating skin tumours, improving their ability to detect skin cancer and better recognize benign moles. However, dermoscopically ‘false‐positive’ and ‘false‐negative’ tumours do exist. False‐positive diagnosis usually leads to unnecessary excisions. False‐negative diagnosis is much more dangerous, as it might result in overlooking a cancer, with severe undesirable consequences for the patient and the physician. Therefore, management strategies should mainly focus on addressing the risk of dermoscopically false‐negative tumours. The most frequent benign tumours that might acquire dermatoscopic characteristics suggestive of malignancy are seborrhoeic keratosis (SK), including solar lentigo, melanoacanthoma, irritated, clonal and regressive SK, angioma (mainly thrombosed angioma and angiokeratoma), dermatofibroma, benign adnexal tumours and naevi (Clark, Spitz, recurrent, combined, sclerosing). The most useful clues to recognize these tumours are the following: solar lentigo – broad network; melanoacanthoma – sharp border; irritated SK – regularly distributed white perivascular halos; clonal SK – classic SK criteria; regressive SK – remnants of SK; targetoid haemosiderotic haemangioma – dark centre and reddish periphery; thrombosed angioma – sharp demarcation; angiokeratoma – dark lacunae; atypical dermatofibromas – palpation; follicular tumours – white colour; sebaceous tumours – yellow colour; Clark naevi – clinical context; Spitz/Reed naevi – age; combined naevi – blue central area; recurrent naevi – pigmentation within the scar; sclerosing naevi – age and location on the upper back; blue naevi – history. Malignant tumours that might mimic benign ones and escape detection are melanoma (in situ, nevoid, spitzoid, verrucous, regressive, amelanotic), squamous cell carcinoma (mainly well‐differentiated variants) and rarely basal cell carcinoma (non‐pigmented variants). The most useful clues to recognize the peculiar melanoma subtypes are as follows: melanoma in situ – irregular hyperpigmented areas; nevoid melanoma – history of growth; spitzoid melanoma – age; verrucous melanoma – blue‐black sign; regressive melanoma – peppering or scar‐like depigmentation; amelanotic melanoma – pink colour, linear irregular vessels, dotted vessels. In this article, we summarized the most frequent dermoscopic variations of common skin tumours that are often misinterpreted, aiming to assist clinicians to reduce the number of false diagnoses. [ABSTRACT FROM AUTHOR]

Background Individuals with medical history of non-melanoma skin cancers (NMSCs) usually develop multiple and/or recurrent malignant lesions around the site of the primary neoplasm. The latter represents the clinical expression of the 'field cancerization' theory; supporting the presence of multiple malignant clones of dysplastic keratinocytes over the entire epithelium that potentially can progress into clinical lesions. Taking into consideration that the burden of NMSCs on public health and health-care cost is high, adequate control of recurrences and management of field change is challenging. Objectives To compare the safety and efficacy of daylight photodynamic therapy (DL-PDT) vs. conventional photodynamic therapy (C-PDT) in the prevention of occurrence of new NMSCs in patients with clinical and histological signs of actinic field damage. Methods Twenty-six patients, with personal history of NMSCs on the face or scalp and actinic keratosis (AK) on the same fields, were randomized for DL-PDT on one side and C-PDT on the other. For a 12-month period, individuals were clinically evaluated for development of new NMSCs. Results The total number of new AKs and the mean time of their development did not significantly differ between the treated sides. Local adverse events were more intense with C-PDT, and patients' preference was more for DL-PDT compared to C-PDT. Conclusions The current findings suggest equal preventive potential of DL-PDT vs. C-PDT against the formation of new NMSCs in patients exhibiting actinic field damage. [ABSTRACT FROM AUTHOR]

Background The scalp is a frequent and difficult-to-treat localization of psoriasis. Little evidence exists regarding the use of biologic agents in recalcitrant cases of scalp psoriasis that are resistant to other treatment options. Objectives To evaluate and compare the efficacy of currently available biologic agents (infliximab, etanercept, adalimumab, ustekinumab) in the treatment of scalp symptoms in patients suffering from moderate to severe plaque psoriasis. Materials and methods This retrospective cohort study consisted of a review of the database of all psoriasis patients who suffered from scalp symptoms and received biologic treatment between January 2012 and December 2014. The patients were divided into four groups based on the drug administered. Scalp psoriasis severity was assessed by the Psoriasis Scalp Severity Index (PSSI) at baseline and at weeks 4, 12, 24 and 48. Psoriasis severity was evaluated with the Psoriasis Area and Severity Index (PASI) at the same time points. Results In total, 145 patients were enroled in the study (infliximab n = 35, etanercept n = 30, adalimumab n = 39, ustekinumab n = 41). At week 4, the infliximab group achieved a 74% mean decrease in the PSSI (ΔPSSI), followed by mean decreases of 61.7%, 53.1% and 53.7% in the ustekinumab, etanercept and adalimumab groups respectively. The differences in the ΔPSSI were lower at week 48: ustekinumab 94.9%, infliximab 94.3%, etanercept 83.1% and adalimumab 89.0%. The PASI score improved sufficiently in all treatment groups. Infliximab and ustekinumab exhibited greater efficacy at weeks 4 and 12. This difference was not as prominent as that revealed by the PSSI. At week 48, the differences in the ΔPASI were barely statistically significant ( P = 0.048). Conclusions All four biologic agents yielded significant improvement in both scalp and skin lesions. Ustekinumab and infliximab exhibited the greatest efficacy, which was clinically meaningful from the early stages of the study. Adalimumab and etanercept followed, yielding satisfactory improvement rates. [ABSTRACT FROM AUTHOR]

Background Ultraviolet radiation plays an important role in the pathogenesis of non-melanoma skin cancer. Outdoor workers, including farmers, experience higher exposure levels compared to the general population. Available literature data suggest that occupational ultraviolet exposure represents an independent risk factor for squamous cell carcinoma; whereas for basal cell carcinoma (BCC) this association still remains unclarified. Objectives To analyse the epidemiological, clinical and histological data of patients diagnosed with BCC, and correlate them with outdoor occupation in farmers. Methods Individuals with histologically diagnosed BCCs, between September 2013 and September 2015, were included in the study. Their medical data, including epidemiological, clinical and histological characteristics, were recorded and analysed in conjunction with the occupation. Farmers were identified based on their specific public health insurance. Results Three hundred and forty patients, with 542 BCCs were included in the study. One hundred and twenty (35.3%) were farmers. Mean age of farmers was lower than non-farmers (66.0 ± 9.1 years vs. 75 ± 6.6 years, Mann-Whitney U-test, P < 0.001). Farmers had a sixfold higher probability for exhibiting photodamaged skin ( OR = 6.02, 95% CI: 3.66-9.90, P < 0.001). Farmer workers were more likely to exhibit infiltrative or morpheaform BCC, but less likely to develop superficial BCC. Conclusion Our results indicate a higher risk of earlier development of more aggressive histological subtypes of BCCs in farmers. Photodamage was also more common in this group. Primary and secondary prevention strategies focusing on outdoor workers, including farmers, are mandatory. [ABSTRACT FROM AUTHOR]

Psoriasis constitutes a chronic inflammatory disease that affects 0.5-3% of the population with a serious negative impact on patients' quality of life.1 Beyond its correlation with known cardiovascular risk factors, psoriasis is considered an independent risk factor for atherosclerosis and subsequent cardiovascular events. Concerning CAD complexity, patients with SYNTAX score <=22 were classified as low-complexity CAD, while those with SYNTAX >=23 and SYNTAX >=33 as intermediate and high CAD complexity, respectively 4. Additional studies are warranted to confirm the causality between psoriasis severity and CAD complexity with the potential to facilitate interdisciplinary risk stratification and improve patient outcomes. [Extracted from the article]

Background Both chronic plaque psoriasis and periodontitis have an increasing prevalence worldwide and have been associated with the metabolic syndrome; however limited information is available on their association. Objective To evaluate the possible association of severe periodontitis and chronic plaque psoriasis. Methods This was a hospital based case-control study. Chronic plaque psoriasis patients and age- and gender-matched controls have been recruited. Baseline demographic data have been recorded. To explore correlations between different dichotomous variables the Sperman Rho correlation coefficient was used. Correlations were further explored non-parametrically and univariate and multivariate logistic regression was utilized after adjustment for the effect of confounders. Results During the study enrolment period 100 patients with CPP and 100 age- and gender-matched controls were included in this study. Mean age for both groups was 57.2 ± 5.3 years. 43% of patients and controls were males. Significant correlations where noted between psoriasis and 1) periodontitis (rho = 0.219, P = 0.02) and 2) metabolic syndrome (rho = 0.191, P = 0.07) using Spearman's Rho correlation co-efficient. Univariate logistic regression reported significant relations between psoriasis and periodontitis (OR = 3.329, 95%CI: 1.513-7.324, P = 0.003) and psoriasis and metabolic syndrome (OR = 2.293, 95%CI: 1.250-4.207, P = 0.007). On the contrary, a non-significant relation between psoriasis and active smoking status was detected (OR = 1.041, 95%CI: 0.597-1.817, P = 0.887). In a multivariate analysis model we found a significant correlation of psoriasis and periodontitis when controlled for the presence of metabolic syndrome (OR: 2.486, 95%CI: 1.002-5.842, P = 0.049). Conclusion Periodontitis may be associated with psoriasis but further studies are required to elucidate their relationship in the context of the biologic plausibility. [ABSTRACT FROM AUTHOR]

Background Early stage mycosis fungoides (MF) is difficult to be clinically differentiated from chronic dermatitis (CD) in a high proportion of patients. Dermoscopy is a rapid, cheep, non-invasive and widely used method for the evaluation of skin tumours and, recently, of inflammatory skin diseases, as well. Objective To describe the dermoscopic pattern of early stage MF and compare it with the dermoscopic features observed in CD. Methods This was a retrospective study. Dermoscopic images of lesions that were clinically equivocal between MF and CD were evaluated for the presence of predefined morphologic criteria. Diagnosis had been histopathologically and immunohistochemically confirmed in all cases. Sensitivity, specificity, positive predictive value, and negative predictive value were calculated for predefined dermoscopic criteria in relation to the diagnosis of mycosis fungoides. Results A total of 67 dermoscopic images were selected for dermoscopic evaluation. Mycosis fungoides lesions exhibited a characteristic dermoscopic pattern consisting of fine short linear vessels (sensitivity 93.7%, specificity 97.1%) and orange-yellowish patchy areas (sensitivity 90.6%, specificity 99.7%). A characteristic vascular structure resembling spermatozoa was also found to be highly specific for the diagnosis of mycosis fungoides. CD was typified by a different dermoscopic pattern, usually consisting of dotted vessels. Conclusions These observations provide a first indication that early stage MF exhibits a characteristic dermoscopic pattern which is different from CD. Prospective studies with long term follow-up are needed to determine the value of these dermoscopic criteria in the differentiation between the two entities in the daily routine. [ABSTRACT FROM AUTHOR]

Background Adalimumab, a fully human, anti-TNFα monoclonal antibody has been shown to be effective for moderate-to-severe psoriasis in clinical trial setting. However, only a limited number of studies reflect everyday clinical experience with this drug. Objectives To provide evidence on the efficacy, dose optimization and safety of adalimumab based on everyday clinical experience in a tertiary referral centre for psoriasis, in Greece. Methods We retrospectively reviewed the records of all patients with moderate-to-severe psoriasis who received adalimumab, in our referral centre, between January 2008 and October 2010. Results In total, 52 patients were treated with adalimumab for a mean period of 14 months (range 4-30 months). Mean baseline Psoriasis Area and Severity Index (PASI) was 16.7 (range 9-40.3). At 4, 6, 12 and 18 months, PASI75 was attained by 68%, 82%, 89% and 88% of patients respectively. Nineteen of 52 patients (36%) reached a PASI100 at a mean time of 10 months (range 4-18 months). The dose interval between the injections of adalimumab was increased from 2 to 3 weeks for 14 patients (27%) who achieved and sustained a PASI100 after the first year of treatment, without any relapse. The overall rate of adverse events reached 38%, but treatment was discontinued only in two cases (4%). Conclusions Our study demonstrates that adalimumab is effective and safe in patients with moderate-to-severe psoriasis in short- and long-term setting. At the same time, it points out novel and interesting issues for further investigation. [ABSTRACT FROM AUTHOR]

Background Mycophenolate mofetil (MMF) has been lately proposed as one of the most promising steroid-sparing agent in pemphigus. Objective To compare effectiveness and adverse events of two different therapeutic protocols for pemphigus: methylprednisolone alone vs. the combination of methylprednisolone and Mycophenolate mofetil. Methods A randomized prospective non-blinded trial was performed in a tertiary care medical centre. Forty-seven of 52 initially evaluated patients with newly diagnosed pemphigus vulgaris or pemphigus foliaceous that had not previously been treated with systemic corticosteroids or immunosuppressive drugs were randomly assigned to treatment with either methylprednisolone (prednisone equivalent, 1 mg/kg) or methylprednisolone plus mycophenolate mofetil (3 g/day, 1.5 g twice daily). Patients were followed up for clinical outcome based on time required until the achievement of control of disease activity, induction of partial and complete remissions on or off minimal therapy, total amount of corticosteroids administered, frequency of relapses and development of side-effects and complications. Results The two groups were similar in terms of demographics and baseline disease characteristics. There was no difference between groups in any of the variables used to measure response to treatment or total amount of corticosteroids administered. Side-effects did not differ significantly. Conclusion Combination treatment with corticosteroids and mycophenolate mofetil, 3 g/day, offers no advantage over monotherapy treatment with corticosteroids in patients with pemphigus. [ABSTRACT FROM AUTHOR]

Background The prevalence of ophthalmic involvement in rosacea is probably higher than previously presumed and varies considerably among several studies. Objective This study aimed to determine the incidence of ocular disease among a population of rosacea patients in Northern Greece, to objectively determine the presence of eye dryness in rosacea patients with and without clinical ophthalmic involvement and correlate the severity of ocular disease with the severity of cutaneous rosacea. Methods One hundred patients with rosacea were assessed for the stage of their disease and examined for ocular symptoms and signs. In 24 of them the tear break up time (TBUT) and Schirmer test were performed in each eye, along with 24 controls. Results A total of 33 patients (33%) were positive for ophthalmic findings. The most frequent symptoms and signs were burning sensation and tearing, and conjunctivitis and blepharitis, respectively. Eleven patients with ophthalmic manifestations had mild to moderate erythematotelangiectatic rosacea, 17 had moderate papulopustular rosacea and four exhibited findings of phymatous rosacea. The total mean value of patients' Schirmer tests was significantly lower compared with the healthy controls ( P < 0.0001). Mean TBUT was shorter in the rosacea group than that in the age-matched controls ( P < 0.0001). Conclusion Ocular involvement in rosacea is a common phenomenon with eye dryness being an early sign. Tear function tests, like Schirmer test and TBUT, although not specific, could contribute to the screening and early diagnosis of the disease, to prevent the potential development of sight-threatening conditions. [ABSTRACT FROM AUTHOR]

Issues concerning the potential risks of reactivating chronic hepatitis B virus arise when the use of anti-Tumour Necrosis Factor-α (TNFα) agents is imperative in patients with concurrent psoriasis and hepatitis B virus infection. The aim of this study was to report the experience regarding safety in the management of patients with coexisting psoriasis and chronic hepatitis B with the anti-TNFα agents: infliximab, etanercept and adalimumab. The psoriasis outpatient database of our dermatological department was searched for psoriasis and hepatitis B diagnoses and the medical records of these patients were reviewed for use of anti-TNFα agents. Seven cases (four women and three men) were identified, with mean age of 51 years (34-65 years). Three patients received adalimumab, three patients were given etanercept and one infliximab. All patients received lamivudin, 100 mg/day, which started 2 weeks before the initiation of anti-TNFα medication and went on during the whole treatment period. Follow-up period extended from 6-24 months. All patients were inactive HbsAg (+) carriers. Liver function tests - at baseline and at the end of follow-up period - were within the normal range. There was no considerable rise in the viral load in any case, from baseline until the last available measurement, although a patient receiving infliximab showed an increase that reached 600 IU/mL. Successful treatment of psoriasis with anti-TNFα agents in patients who are inactive HBsAg carriers is possible and could be safe under the conditions of concomitant lamivudin administration and intensive monitoring. Larger randomized controlled studies are needed to confirm these findings. [ABSTRACT FROM AUTHOR]

Atopic dermatitis (AD) is a chronic inflammatory skin disease with increasing frequency over the last decades, especially in adults. Cytokines orchestrate atopic skin inflammation. The aim of this study was to compare serum levels of cytokines in adult patients with acute AD (AD1) with other groups of AD patients and controls and investigate the possible association between such cytokines and disease severity. We measured cytokine levels using flow cytometry in 21 adult patients with acute AD, 12 adults with chronic AD, 10 children with acute AD and 10 healthy adults. Flow cytometry analysis of cytokines revealed that interleukin 10 (IL-10), IL-6, interferon γ (IFN-γ) and IL-4 levels were significantly decreased in AD1 group compared with controls, whereas IL-2 and tumour necrosis factor (TNF) did not differ. Comparison of AD1 group with adults chronic phase group showed that IgE, eosinophil and IL-2 levels remained unaltered, whereas IL-10, IL-6, IFN-γ, IL-4 and TNF were significantly decreased. SCORAD and IgE levels were significantly increased, IL-10, IL-6 and IFN-γ were decreased and TNF, IL-2, IL-4 and eosinophil levels remained unchanged in AD1 group compared with children acute phase group. Within AD1 group correlation analysis revealed that IgE and TNF levels were significantly associated with AD severity. Coefficient of determination analysis revealed that TNF and IgE levels could explain 49.14% and 35.28% of the variance of SCORAD. These data indicate that serum IgE and TNF levels correlate with AD severity and that serum cytokines are downregulated in AD1 group. Further studies are clearly needed to elucidate cytokines' role in adults with AD [ABSTRACT FROM AUTHOR]

Background Despite numerous advances in the therapeutic management of cutaneous psoriasis, there is a lack of standardized therapeutic regimens for psoriatic nail disease. Objective An open, non-randomized, unblinded study was designed to evaluate the efficacy and safety of adalimumab in the treatment of nail psoriasis. Patients/methods Seven patients suffering from severe plaque-type psoriasis and 14 with psoriatic arthritis and cutaneous psoriasis with concomitant nail involvement were enrolled into the study. The applied dose regimen of adalimumab was the same as the one recommended for cutaneous psoriasis. Outcome measures were assessed at baseline and at weeks 12 and 24 using the Nail Psoriasis Severity Index (NAPSI). Patients also filled in a Greek translation of the international onychomycosis-specific questionnaire to assess the impact of the nail improvement on their quality of life. Results All 21 patients completed the study and were eligible for statistical analysis. Significant improvement was recorded after the eighth injection. Mean NAPSI (NAPSIm) at baseline was 10.57 ± 1.21 for the fingernails and 14.57 ± 2.50 for the toenails in patients with just cutaneous psoriasis and 23.86 ± 2.00 for the fingernails and 29.29 ± 2.87 for the toenails in patients with psoriatic arthritis. NAPSIm at week 12 was 5.57 ± 0.78 for the fingernails and 9.57 ± 2.17 for the toenails in patients with just cutaneous psoriasis and 12.86 ± 1.05 for the fingernails and 19.21 ± 2.07 for the toenails in patients with psoriatic arthritis. NAPSIm after 24 weeks of treatment was 1.57 ± 0.20 for the fingernails and 4.14 ± 1.58 for the toenails in patients with cutaneous psoriasis and 3.23 ± 0.32 for the figernails and 10.00 ± 1.40 for the toenails in patients with psoriatic arthritis. Treatment was well tolerated with minimal and temporary side-effects limited to the site of injection. All patients were satisfied, while marked improvement in their quality of life was recorded based on the reduction of the scores obtained from the international quality of life questionnaire. Conclusions Despite the lack of a control group, our results demonstrate a beneficial effect of adalimumab on psoriatic nail disease. [ABSTRACT FROM AUTHOR]

Background Numerous factors have been implicated in the pathogenesis of rosacea, which remains obscure. Objectives To examine the epidemiological characteristics of rosacea patients, the histopathological alterations, the prevalence of gastric Helicobacter pylori infection and the role of ultraviolet radiation, to detect the presence of Demodex folliculorum on affected skin and to elucidate the immunological nature of this disorder. Methods The study included 100 patients with rosacea. Each patient was assessed with a clinical, haematological, biochemical and histological examination; serology test for the detection of antibodies against H. pylori; direct immunofluorescence on perilesional, sun exposed skin and indirect immunofluorescence with monkey oesophagus as a substrate; antinuclear antibody titre and a skin surface biopsy to search for Demodex folliculorum. Results Women were more frequently affected. Half of our patients were 51–70 years old. About two-thirds were phototypes I and II and 73% complained of worsening of conditions after sun exposure. An almost permanent histopathological feature was solar elastosis. Higher prevalence of H. pylori was not established. Prevalence and mean density of Demodex folliculorum were significantly increased in rosacea patients. Direct and indirect immunofluorescence tests were positive in 6.4% and 6.7% respectively. Antinuclear antibody titres were found in 21.1%. Conclusions Our results suggest the pivotal role of chronic sun exposure in the pathogenesis of rosacea. Demodex folliculorum represents a significant cofactor that may contribute to the transition of the disease from a vascular to an inflammatory stage. The low positive results of direct and indirect immunofluorescence do not support a potential autoimmune role in the development of rosacea. [ABSTRACT FROM AUTHOR]

Pemphigus refers to a group of potentially life-threatening autoimmune diseases of the skin and mucous membranes, characterized by the formation of blisters and erosions of the skin. An autoimmune process, directed against keratinocyte desmosomal cadherins, interferes with the adhesive function of these molecules. This results in the separation of keratinocytes and clinical manifestation of blistering. Differences in the particular antigens targeted by the antibodies and in the distribution of these antigens in the different regions of the body and in the separate layers of the epidermis result in different clinical manifestations of the disease. Diagnosis of pemphigus is based on three independent groups of criteria: clinical features (flaccid blisters and erosions on skin and oral mucosa), histologic findings (epidermal acantholysis) and immunological tests (circulating and skin-fixed antibodies against keratinocyte surface antigens). The principle aim of treatment is to reduce inflammatory response and autoantibody production, thereby achieving disease remission. Systemic corticosteroids are still the most useful drugs in the treatment of pemphigus and continue to be the mainstay of therapy for this disease. Adjuvant drugs, such as immunosuppressants, are commonly used in combination, in order to increase efficacy and have a steroid-sparing effect, thereby allowing reduced maintenance doses and less side effects of systemic corticosteroids. Other options include intravenous immunoglobulin and plasmapheresis. However, more research is needed to develop treatments with the least possible toxicity. [ABSTRACT FROM AUTHOR]

The article offers information on real-life efficacy and safety of secukinumab antibody within a cohort of patients with moderate-to-severe plaque psoriasis. It mentions Secukinumab prevents interleukin 17A (IL-17A) from binding to its receptor and limit inflammatory processes ultimately leading to excessive keratinocyte proliferation; clinical trial of Forty-two patients ; and secukinumab proved more efficacious than phase-III clinical-trial and other real-life data.

Linked article: A. Pampín–Franco et al. J Eur Acad Dermatol Venereol 2021; 35: 1133–1142. https://doi.org/10.1111/jdv.17105. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented which discusses the study on the successful treatment of Netherton's syndrome with the use isotretinoin.

A letter to the editor about Halo nevus that manifests as a depigmented halo is presented.

The article presents case studies of a 3-year-old and a 7-year-old boy, who were presented to the hospital because of scalp lesions. Topics discussed include performing dermoscopic examination on both the patients, finding black dots, comma hairs and corkscrew hairs in first patient and identifying presence of prominent scale and broken hairs in second patient.

A letter to the editor is presented referring to a study on the treatment of cutaneous infantile haemangiomas by using calcineurin inhibitors.

A letter to the editor is presented concerning a case of inflammatory linear verrucous epidermal naevus.

Background: Scarce data related to the drug survival of biologic agents in psoriasis patients aged ≥65 years is available., Objectives: To evaluate the drug survival of interleukin (IL)-23 or the IL-17 inhibitors approved for the treatment of moderate-to-severe psoriasis in elderly patients (aged ≥65 years), compared with younger adult patients (aged <65 years), and to identify clinical predictors that can influence the drug survival., Methods: This retrospective multicentric cohort study included adult patients with moderate-to-severe psoriasis, dissecting two-patient subcohorts based on age: elderly versus younger adults. Kaplan-Meier estimator and proportional hazard Cox regression models were used for drug survival analysis., Results: We included 4178 patients and 4866 treatment courses; 934 were elderly (1072 treatment courses), and 3244 were younger patients (3794 treatment courses). Drug survival, considering all causes of interruption, was higher in patients aged <65 years than in elderly patients overall (log-rank p < 0.006). This difference was significant for treatment courses involving IL-23 inhibitors (p < 0.001) but not for those with IL-17 inhibitors (p = 0.2). According to both uni- and multi-variable models, elder age was associated with an increased risk of treatment discontinuation (univariable analysis: HR: 1.229, 95% CI 1.062-1.422; p < 0.006; multivariable analysis: HR: 1.199, 95% CI 1.010-1.422; p = 0.0377). Anti-IL-23 agents were associated with a reduced likelihood of treatment discontinuation after adjusting for other variables (HR: 0.520, 95% CI 0.368-0.735; p < 0.001). Being previously treated with IL-17 inhibitors increased the probability of discontinuation., Conclusions: Elderly patients with psoriasis have an increased risk of biologic treatment discontinuation compared with younger adult patients, particularly, if being treated with IL-23 inhibitors. However, in stratified analyses conducted in elderly patients, IL-23 inhibitors showed higher drug survival rates than IL-17 inhibitors., (© 2024 European Academy of Dermatology and Venereology.)

Background: Despite that brodalumab's efficacy and safety have been assessed in randomized clinical trials, real-life data remain scarce. BrIDGE was an observational, prospective, single-cohort, multicentre study that recruited patients with moderate-to severe plaque psoriasis in Greece., Objectives: The primary objective was to assess the proportion of patients who achieved Psoriasis Area and Severity Index (PASI)100 after 24 weeks. Other endpoints included: the maintenance of PASI90/100 through to 104 weeks, the short-term response [PASI75/90/100 and static Physician's Global Assessment (sPGA) 0/1] to brodalumab at 12-16 weeks and time to complete clearance. Moreover, we explored the change in quality of life [Dermatology Life Quality Index (DLQI) 0/1] and adherence to brodalumab., Methods: Two hundred patients who were initiating treatment with or switching to brodalumab, were recruited. Analyses were conducted using the as observed data and three imputation approaches were also applied for the missing data (last observation carried forward, 'worst case' and 'best case' scenario). Continuous variables were reported using summary statistics, whereas categorical variables were reported in frequency tables., Results: Based on the 'as observed data', 42.0% of patients achieved PASI100 at Week 24 after 25.9 ± 3.5 weeks and 65% of patients attained PASI100 at Week 104. In total, 70.2%, 47.5% and 32.0% achieved PASI75/90/100, respectively, whereas 72.6% of patients achieved sPGA 0/1, at Weeks 12-16. With respect to sPGA status 82.8%, 89.2% and 92.5% of patients achieved sPGA 0/1 at Weeks 24, 52 and 104, respectively. The time to achieve PASI100 at Weeks 12-16 was 13.7 ± 1.3, 52.1 ± 3.4 weeks at Week 52 and 105.5 ± 4.8 weeks at Week 104. Mean DLQI and Psoriasis Symptom Inventory (PSI) scores decreased by 11.4 ± 7.0 and 15.4 ± 6.5 points from baseline to Week 104, respectively. Adherence to treatment was equal to 98.9%., Conclusions: Brodalumab confers rapid and durable responses, as well as improvements in the quality of life of moderate-to-severe psoriasis patients., (© 2024 European Academy of Dermatology and Venereology.)

Brodalumab's clinical efficacy and favorable safety profile have been demonstrated during controlled clinical trials, but real-world data remain scarce. BrIDGE, an ongoing 104 week, observational, prospective, multicenter study conducted in Greece, enrolled moderate-to-severe plaque psoriasis patients, with body surface area (BSA) > 10 or psoriasis area severity index score (PASI) > 10 and dermatology life quality index (DLQI) > 10, based on European consensus, initiating brodalumab treatment as per routine clinical practice. This interim analysis includes evaluations 12-16 weeks following treatment initiation. Key efficacy endpoints included proportion of patients achieving static Physician's Global Assessment (sPGA) score of "clear/almost clear" (0/1) and a reduction ≥75%, 90%, 100% from baseline in PASI (PASI75, PASI90, and PASI100) at weeks 12-16. Other endpoints included time to achieve PASI100, changes in self-reported DLQI and psoriasis symptom inventory (PSI) at weeks 12-16. From 200 patients (mean age 51.4 years, 70% male, mean disease duration 13.8 years) enrolled, 72.8% achieved sPGA of 0/1, whereas 70.2%, 47.5%, and 32.0% achieved corresponding PASI75, PASI90, and PASI100 responses following 12-16 weeks of brodalumab treatment, according to the "as-observed" analysis. The mean time to achieve PASI100 was 13.7 ± 1.2 weeks for the 32% who achieved PASI100. Concurrent decreases in mean DLQI and PSI were observed. Furthermore, 90% adherence to brodalumab was noted and nine adverse events were reported. Brodalumab confers substantial clinical improvements short-term as reflected by high levels of skin clearance in moderate-to-severe plaque psoriasis patients within 12-16 weeks of treatment under everyday clinical conditions, followed by improvements in symptoms and quality of life and a favorable safety profile., (© 2022 Wiley Periodicals LLC.)

Treatment of alopecia areata is often challenging, especially for patients with extended disease. Contact immunotherapy with diphenylcyclopropenone (DPCP) has been reported as an effective topical treatment but the exact immunologic mechanism of diverting the immune response is still unknown. We investigated the efficacy of topical immunotherapy with DPCD in acute, intermediate, and chronic lesions of AA and the response rate was associated with perifollicular infiltrate of T regulatory cells. Approximately two-thirds of our patients (67.5%) had a response rate > 50% after 6 months of DPCP therapy. Patients with acute and intermediate onset of the disease were more likely to respond to the therapy. Although responders demonstrated FOXP3+ positive lymphocytes in immunohistochemistry, this association could not be confirmed by statistical significance (p = 0.052). In patients with multiple lesions, that had different chronological onset, the lesions with more recent onset responded faster than lesions of longer duration., (© 2022 Wiley Periodicals LLC.)

Fixed combination calcipotriol/betamethasone (Cal/BD) aerosol foam has been shown to be effective in psoriasis treatment in clinical trials, but real-world evidence is currently sparse. The real-world CELSUS study in Greece found that Cal/BD aerosol foam treatment was effective and associated with satisfaction in psoriasis patients. Patients from the CELSUS study (N = 400) were stratified by baseline disease severity according to physician's global assessment (PGA) score (mild vs. moderate vs. severe) and by previous psoriasis treatment (naïve vs. treatment-experienced). Proportions of patients achieving treatment success (clear/almost clear [PGA 0/1]) after 4 weeks' treatment with Cal/BD aerosol foam were reported for each subgroup. Psoriasis area and severity index (PASI) and patient-reported itch, itch-related sleep loss, scaling, dry skin, and erythema numerical rating scores were reported by subgroup. At baseline, 216 (54%) patients were systemic-or-topical psoriasis treatment-naïve and 184 (46%) were treatment experienced. By disease severity, there were 135 versus 89 patients with mild, 69 versus 83 with moderate and 12 versus 12 with severe disease in the treatment-naïve versus treatment-experienced groups, respectively. In the treatment-naïve group, treatment success was achieved by 72.6%, 56.5%, and 66.7% of patients with mild, moderate, and severe disease, respectively, while the proportions in the treatment-experienced group were 60.7%, 42.2%, and 25%, respectively. Reduction from baseline in psoriasis symptoms was observed in all patient groups. The greatest reductions were observed in treatment-naïve patients with severe disease. Clinically relevant benefits were observed with Cal/BD aerosol foam in psoriasis patients, regardless of prior treatment-experience and disease severity at baseline., (© 2022 Wiley Periodicals LLC.)

Introduction: The COVID-19 pandemic dramatically disrupts health care around the globe. The impact of the pandemic on chronic urticaria (CU) and its management are largely unknown., Aim: To understand how CU patients are affected by the COVID-19 pandemic; how specialists alter CU patient management; and the course of CU in patients with COVID-19., Materials and Methods: Our cross-sectional, international, questionnaire-based, multicenter UCARE COVID-CU study assessed the impact of the pandemic on patient consultations, remote treatment, changes in medications, and clinical consequences., Results: The COVID-19 pandemic severely impairs CU patient care, with less than 50% of the weekly numbers of patients treated as compared to before the pandemic. Reduced patient referrals and clinic hours were the major reasons. Almost half of responding UCARE physicians were involved in COVID-19 patient care, which negatively impacted on the care of urticaria patients. The rate of face-to-face consultations decreased by 62%, from 90% to less than half, whereas the rate of remote consultations increased by more than 600%, from one in 10 to more than two thirds. Cyclosporine and systemic corticosteroids, but not antihistamines or omalizumab, are used less during the pandemic. CU does not affect the course of COVID-19, but COVID-19 results in CU exacerbation in one of three patients, with higher rates in patients with severe COVID-19., Conclusions: The COVID-19 pandemic brings major changes and challenges for CU patients and their physicians. The long-term consequences of these changes, especially the increased use of remote consultations, require careful evaluation., (© 2020 The Authors. Allergy published by European Academy of Allergy and Clinical Immunology and John Wiley & Sons Ltd.)