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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. [ABSTRACT FROM AUTHOR]

Patients on DMF had used systemic therapies for psoriasis, including biologics, more frequently than patients under other systemic treatments (73.4% vs. 50.7%, I P i = 0.003). DMF may be the preferred choice for multi-failure psoriasis patients with treatment-emergent side-effects, due to its favourable long-term safety profile. When comparing patients on DMF versus patients under other systemic treatments through cumulative PASI75 up to the first therapy discontinuation, we found, from month 9 onwards, a slightly superior improvement in the DMF group, although without any statistically significant difference (Figure 1). [Extracted from the article]

Background: Since the beginning of the coronavirus disease 2019 (COVID‐19) pandemic, an increasing number of chilblain‐like lesions (ChLL) have been increasingly reported worldwide. To date, the causal link between ChLL and SARS‐CoV‐2 infection has not been unequivocally established. Methods: In this case series, we present demographic, clinical, laboratory, and histopathological information regarding 27 young patients with a clinical diagnosis of ChLL who referred to the Dermatology Unit of Papa Giovanni XXIII Hospital, Bergamo, Italy, from 1 April 2020 to 1 June 2020. Results: The mean age was 14.2 years, and 21 patients (78%) experienced mild systemic symptoms a median of 28 days before the onset of cutaneous lesions. ChLL mostly involved the feet (20 patients – 74%). Among acral lesions, we identified three different clinical patterns: (i) chilblains in 20 patients (74%); (ii) fixed erythematous macules in 4 children (15%); (iii) erythrocyanosis in 3 female patients (11%). Blood examinations and viral serologies, including parvovirus B19, cytomegalovirus (CMV), Epstein‐Barr virus (EBV), and coxsackievirus were normal in all. Three patients (11%) underwent nasopharyngeal swab for RT‐PCR for SARS‐CoV‐2 showing only 1 positive. Histopathological examinations of 7 skin biopsies confirmed the clinical diagnosis of chilblains; vessel thrombi were observed only in 1 case. Our findings failed to demonstrate the direct presence of SARS‐CoV‐2 RNA in skin biopsies, both with real‐time polymerase chain reaction (RT‐PCR) and RNAscope in situ hybridization (ISH). Limitations: Limited number of cases, unavailability of laboratory confirmation of COVID‐19 in all patients, potential methodological weakness, and latency of skin biopsies in comparison to cutaneous lesions onset. Conclusions: These observations may support the hypothesis of an inflammatory pathogenesis rather than the presence of peripheral viral particles. Although, we could not exclude an early phase of viral endothelial damage followed by an IFN‐I or complement‐mediated inflammatory phase. Further observations on a large number of patients are needed to confirm this hypothesis. [ABSTRACT FROM AUTHOR]

Background: Few studies have compared the use of different biologics in a real-life setting in plaque psoriasis patients. Objective: To compare the efficacy of biologics in psoriasis/psoriatic arthritis patients. Methods: Patients treated with adalimumab, etanercept and ustekinumab for at least 16 weeks were included. Achievement of Psoriasis Area Severity Index (PASI), PASI 90/100 response and time taken to achieve PASI 90/100 response were measured. Logistic regression was used to evaluate the effect of psoriasis localization on achievement of PASI 100 response. Results: Two hundred and fifty five patients were included. No difference was observed in PASI 90 response between etanercept and ustekinumab (65.5 vs. 55.4%), while adalimumab-treated patients had a higher response versusustekinumab (71.6 vs. 55.4%, p =.02). More patients achieved complete remission (PASI 100 response) with adalimumab versus etanercept (65.7 vs. 23%, p <.001) or ustekinumab (65.7 vs. 44.6%, p =.003). Adalimumab-treated patients achieving PASI 90 responded more quickly (by three and six months) versus ustekinumab or etanercept. PASI100 response was achieved in ∼43% of adalimumab and ustekinumab treated-patients by three months versus etanercept (14.3%), increasing to 92.5, 85.4 and 35.7%, respectively by six months. PASI100 response was associated with psoriasis nail involvement or genital psoriasis. Conclusion: In the real-life setting, adalimumab was the most effective biological agent for the treatment of plaque psoriasis. [ABSTRACT FROM AUTHOR]