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Introduction Treatment with biologics often leads to clearance of psoriasis. However, some patients do repeatedly fail to respond and/or lose an achieved response (treatment refractory) to the biologic, whereas other patients achieve excellent response to one biologic and remain clear of psoriasis for several years (super-responders). Objective To identify and characterize patients with treatment refractory psoriasis and patients who are super-responders to biologic treatment. Material and methods Patients registered in DERMBIO between January 2007 and November 2019 were included. Patients were categorized as being treatment refractory if they had had treatment failure to >= 3 biologics targeting >= 2 different pathways. Super-responders were patients treated with their first biologic for minimum 5 years without an absolute psoriasis area and severity index (PASI) > 3 between 6 months and 5 years of treatment. All remaining patients from DERMBIO served as comparators. Results In total, 3280 patients were included with a mean age of 45.0 years. 1221 (37%) of the patients were females. Of the included patients, 214 (6.5%) were categorized as treatment refractory and 207 (6.3%) were categorized as super-responders. Treatment refractory patients had higher mean body weight (100.6 kg vs. 90.6 kg, P < 0.0001) and higher mean BMI (32.2 vs. 29.4, P < 0.0001) compared with the rest of patients in DERMBIO. Super-responders had higher socioeconomic status and fewer comorbidities compared with the comparator group (P < 0.0001). Conclusion A small proportion of patients with psoriasis treated with biologics are either super-responders or treatment refractory. Treatment refractory patients have higher body weight, whereas super-responders have fewer comorbidities and higher socioeconomic status.

is missing (Short communication).

On the occasion of the 70th annual meeting of the American Academy of Dermatology in San Diego the ILDS Executive Committee hosted a cocktail reception in the evening of 18 March. The reception, held at the Marriott Hotel on an evening of several competing attractions, was well attended by friends of the ILDS, who stopped by for a drink and a chat. Jean Bolognia and Chris Griffiths acted as official ILDS meeters and greeters for the guests. Our president, Wolfram Sterry gave a short speech of welcome and provided an update for those present on the recent achievements of and plans for the ILDS. The announcement of the Berlin summit was particularly well received by our member societies. Jerry Shapiro then took the floor to apprise us of the arrangements for the Vancouver World Congress, these too were greeted with enthusiasm...

Background: Large disease registries are the preferred method to assess long-term treatment safety. If psoriasis registries collaborate in a network, their power to assess safety is increased. Objective: To identify heterogeneity in psoriasis registries and methodological challenges for synthesising the data they provide. Methods: We surveyed the registries in PSONET and identified and addressed the challenges to collaborative analysis for the network in several round table meetings. Results: Eight out of 10 registries had a prospective comparator cohort with similar disease characteristics but not on biologics. Registries differed in the coding and validation or follow-up of adverse events and in the way they sampled their population. Fifteen challenges to registries collaborating were identified in the areas of operational governance, structural conduct, bias and analysis. Conclusions: Participation in PSONET, a network of psoriasis registries, helps identify and solve common issues, enhancing the individual registries, and provides larger sets of more powerful safety data in a diverse population. Challenges to interpreting data collectively include heterogeneity in sampling, variable penetration of biologics and compatibility of different datasets.

Quantitative morphological studies of the healthy epidermis are essential in providing a range of parameter estimates that can be considered within the range of normality. Stereology is a set of statistical tools that provides potentially unbiased and precise estimates of 3-dimensional tissue characteristics from 2-dimensional sections. We set out to establish reference values for the volume of the viable epidermis contained within a four-millimetre punch biopsy (Vepi), the volume of the stratum corneum (VSC) and the surface area of the dermo-epidermal junction(ADEJ) in 4 predetermined body regions by use of stereology. Four-millimetre punch biopsies were taken from 20 freshly diseased corpses, fixed in formalin and embedded in paraffin. Vepi, VSC and ADEJ were established stereologically for all 4 body locations followed by pairwise comparison of means after Bonferroni correction. Vepi was significantly larger in the sole compared to all other body locations (p < 0.01). Furthermore, linear regression analysis showed a strong linear relationship between Vepi and VSC in the sole (r = 0.70). Our results suggest that the viable layers of the epidermis might also serve a mechanical function, either directly or by providing the stratum corneum with keratinocytes to support the hyperkeratosis in the weight-bearing parts of the skin.

Background Telemedicine is an increasingly suggested answer to the problem of providing high-class medical service to rural and remote areas in a modern society. Dermatology is a promising candidate for telemedical service, because it is well suited for clinical questions forwarded together with photographs. Objectives To describe the patient population of the Faroe Islands dermatology clinic with respect to distribution of diagnoses, treatment, duration, response time and patient flow. Methods Case notes were drawn from all dermatology consultations managed during 2003–2009 through the national teledermatology system. These were compared with case notes drawn from the same journal system from the regular outpatient clinic. Results Over the last 7 years, a total of 9161 consultations in 7.7% of the population have been performed. The demography of the patient population reflects the underlying population apart for an over-representation of the female gender in younger years. The disease spectrum is comparable with what has been reported in other outpatient clinics, except for the relative absence of skin cancer and pigmented lesions, for which regular outpatient consultation is reserved. Limitations The study is descriptive. Conclusions The experience derived suggests that teledermatology may serve as a near-adequate alternative to a regular private practice, if abstaining from treating minor common skin conditions and purely cosmetic conditions is acceptable.

It is beneficial if teledermatology is integrated in an existing structure for optimum utilisation of resources. Teledermatology has been used to redistribute the workload of specialists. Teledermatology provides continuous access to specialist assessment of patients in collaboration with local physicians. Simple store-and-forward teledermatology is well suited for follow-up of patients initially seen by a specialist. Milder cases of some clinically characteristic diseases such as acne are well suited to management through teledermatology. Teledermatology offers the possibility of case-based continued medical education of non-specialists. Teledermatology generally follows the life curve of other successful new organisational models and does not affect demand for health services.

Stereology is a set of mathematical and statistical tools to estimate three-dimensional (3-D) characteristics of objects from regular two-dimensional (2-D) sections. In medicine and biology, it can be used to estimate features such as cell volume, cell membrane surface area, total length of blood vessels per volume tissue and total number of cells. The unbiased quantification of these 3-D features allows for a better understanding of morphology in vivo compared with 2-D methods. This review provides an introduction to the field of stereology with specific emphasis on the application of stereology to dermatological research by supplying a short insight into the theoretical basis behind the technique and presenting previous dermatological studies in which stereology was an integral part. Both the theory supporting stereology and a practical approach in a dermatological setting are reviewed with the aim to provide the reader with the capability to better assess papers employing stereological estimators and to design stereological studies independently.

The use of teledermatology as an adjunct to conventional clinical dermatology on the Faroe Islands is described. The service is based on a nurse-led dermatological clinic, and teledermatology is combined with specialist visits for more complex diagnosis or procedures.