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Background: Adjuvant treatment of stage II–IV melanoma with PD‐1‐based immune checkpoint inhibitors (ICI) has improved relapse‐free survival (RFS) and has therefore become a standard‐of‐care treatment option. Approximately 25%–30% of patients still recur within 1 year. Predictive biomarkers reflecting real‐world data are desired. The predictive relevance of tumour tissue PD‐L1 expression in the adjuvant setting remains inconclusive. Objectives: This retrospective, observational study was conducted to evaluate the value of PD‐L1 expression scores in different tumour tissue locations in predicting response towards adjuvant immunotherapeutic treatment. Methods: Tumour tissue taken prior to anti‐PD‐1 adjuvant ICI in 243 stage II–IV melanoma patients was collected at University Skin Cancer Center Hamburg. PD‐L1 expression was evaluated on immune cells (ICS), tumour cells (TPS) and combined (CPS). Scores were determined by independent pathological physician quantification and correlated with therapy outcome at different cut‐off (CO) levels (relapse‐free survival, RFS) for different tumour tissue locations (primary tumour, metastases). Results: A total of 104 patients were eligible for analysis. Positivity of ICS, TPS and CPS showed no predictive RFS outcome association at different CO levels when analysed irrespective of tissue origin. In primary tumours, ICS at CO 1% showed a significantly improved RFS upon positivity (HR 0.22). In contrast, positivity to TPS (CO 1%) correlated significantly and independently with improved RFS when evaluated in metastatic tumour tissue specimens (HR 0.37). Conclusions: PD‐L1 tumour tissue expression may serve as a predictive biomarker for adjuvant ICI treatment response stratification in melanoma, but caution should be spent on the origin of tumour tissue analysed. The cell‐type relevant for the predictive value of PD‐L1 expression is tissue‐specific with immune cells being important in primary tumours while tumour cells are key in metastases. The present results should be validated in a multicentre cohort. [ABSTRACT FROM AUTHOR]

Background: Oral finasteride and topical minoxidil are the current standard of care for male androgenetic alopecia and a combination of the two treatments can be considered for greater efficacy. Clinical trials of topical finasteride have also yielded promising results, but routine care data are lacking. Aims: To examine patient‐reported outcomes of men with androgenetic alopecia who received topical finasteride admixed with minoxidil compared to the current standard of care (oral finasteride). Methods: Retrospective, cross‐sectional study with data from a German direct‐to‐consumer teledermatology platform between December 2021 and January 2023. Patient‐reported outcomes were collected through voluntary follow‐up questionnaires provided after 6 weeks on topical finasteride/minoxidil or oral finasteride treatment. Results: A total of 1545 patients who received topical finasteride/minoxidil treatment were included; 238 (15.4%) participated in the follow‐up questionnaire. At week six, 62.2% (148/238) reported positive changes in their hair appearance, and 44.1% (105/238) reported an improvement of self‐esteem. Treatment‐related adverse events were reported in 11.8% (28/238). Full treatment adherence was observed in 74.4% (177/238). Comparing the topical treatment group to those receiving oral finasteride, lower treatment adherence was reported, along with higher rates of local adverse events; no difference was found in the incidence of sexual adverse events. Conclusion: Based on patient‐reported outcomes, topical finasteride/minoxidil seems to be effective and well tolerated, but not superior to oral finasteride. Lower treatment adherence for topical usage must be considered when considering treatment options. Additional real‐world data are needed to further evaluate the efficacy and safety of topical finasteride/minoxidil. [ABSTRACT FROM AUTHOR]

Background: The treatment of melanoma has been revolutionized by the use of immune checkpoint inhibition (ICI), but many patients do not benefit. Furthermore, immune‐related adverse events may occur during therapy. A predictive biomarker is needed to reliably identify patients benefitting. In lung, renal cell and bladder cancer early C‐reactive protein (CRP) kinetics were shown to be a predictive biomarker for ICI. Objective: Here, we investigate early CRP kinetics as predictive biomarker for ICI in melanoma patients. Methods: Two independent prospectively collected cohorts were analysed: Cohort 1 (n = 87) with advanced and Cohort 2 (n = 99) with completely resected melanoma. Patients were stratified by in the dynamics of CRP after ICI initiation: A doubling of baseline CRP within 30 days followed by at least a 30% drop within 3 months was classified as a CRP flare. If no doubling of CRP was reported, but a 30% drop within 3 months, patients were classified as CRP responders and all others as CRP non‐responders. Analysed factors included clinical characteristics like S100B and LDH. Median follow‐up was 1.5 and 1.7 years for Cohorts 1 and 2. Results: In Cohort 1 CRP flare (n = 12), CRP responders (n = 43) and CRP non‐responders (n = 32) with a progression‐free survival (PFS) of 0.7, 0.6 and 0.2 years (p = 0.017) and an overall survival (OS) of 2.2, 1.5 and 1.0 years (p = 0.014), respectively. Multivariable Cox analysis showed an independent risk reduction of progression for CRP responders by 62% compared to CRP non‐responders (p = 0.001). In Cohort 2 CRP flare (n = 13), CRP responders (n = 70) and CRP non‐responders (n = 16) the log‐rank analysis showed a significant difference between OS and recurrence‐free survival (RFS) curves (p = 0.046 and p = 0.049). Conclusion: Early CRP kinetics could indicate a response to ICI with improved OS and RFS/PFS. CRP flare and CRP response indicating significantly improved outcomes compared to CRP non‐responders. [ABSTRACT FROM AUTHOR]

This article discusses a case study of a 57-year-old female patient with metastasized uveal melanoma who experienced sepsis-like cytokine release syndrome (CRS) after receiving tebentafusp (tebe), a bispecific antibody used to treat this type of cancer. CRS is a common adverse event associated with T-cell-engaging immunotherapeutic drugs like tebe. The patient exhibited symptoms such as hypotension, tachycardia, and fever after the first administration of tebe, and subsequent doses resulted in severe hypotension and tachycardia that required intensive care. The patient's condition stabilized with treatment, but tebe was discontinued due to the severity of the CRS. The article highlights the need for further research to identify biomarkers that can distinguish sepsis-like CRS from an infection. [Extracted from the article]

Background: Adherence to dermatological treatment is described as poor. Empathy and open communication in the physician–patient relationship has been proven to improve adherence. As direct-to-consumer teledermatology enables patients to access dermatological consultations without in-person interactions, we hypothesized treatment adherence in teledermatology to be low. Methods: The objective of the study was to examine treatment adherence in teledermatology. This retrospective cross-sectional study used data from patients treated through a German direct-to-consumer teledermatology platform between July 2021 and April 2022. Additional information was collected through voluntary follow-up questionnaires provided to patients to assess individual treatment success, treatment-related adverse events, and treatment adherence. Results: Data collection included 771 patients; 61.6% (475/771) were women (mean age 35 years). In 46% (355/771), skin disease had been present for <3 months before teleconsultation. Of all patients who answered the follow-up questionnaire (n = 228), 28.5% (65/228) reported treatment-related adverse events, with skin dryness being the most common (56.9%, 37/65). Adverse events resulting in treatment discontinuation were reported in 1.3% (3/228) of all cases. Improvement in skin condition on therapy was described by 75.4% (172/228). In 85.5% (195/228), full treatment adherence was reported. Conclusion: This is the first study worldwide to examine data on treatment adherence in direct-to-consumer-teledermatology. Despite the lack of doctor–patient interaction, the results of our study demonstrate that most patients show high treatment adherence. Possible drivers contributing to high compliance rates could be the high proportion of new-onset skin diseases, the high treatment success of the prescribed therapies, and the low rate of serious adverse events. [ABSTRACT FROM AUTHOR]

A 66-year-old female patient presented with erythematous skin lesions and neuropathic pain on her lower back and left thigh. Initially, the patient was treated for herpes zoster, but her symptoms persisted and she developed leg paresis and hypesthesia. Further examination and testing revealed that the patient had early neuroborreliosis, a neurological manifestation of Lyme borreliosis. Treatment with antibiotics and analgesics led to significant improvement in the patient's symptoms. This case highlights the importance of considering neuroborreliosis in patients with unclear skin lesions and neurological symptoms. [Extracted from the article]

When deciding on systemic therapy for irAE psoriasis, it should be considered that TNF-alpha inhibitors might improve the response to treatment with ICI and thus the prognosis of the tumour disease. Immune checkpoint inhibitors (ICI) have become firmly established in the treatment of malignant melanoma (MM) and have significantly improved prognosis in advanced tumour stages.[[1]] Recently, the anti-programmed death 1 (PD-1) agent Pembrolizumab showed a significant reduction in the risk of disease recurrence for stage IIB or IIC MM.[2] As ICI interferes with immunoregulatory pathways by blocking checkpoints, non-specific activation of the immune system can result in the development of immune-related adverse events (irAE).[3] In patients receiving monotherapy with a PD-1 inhibitor, grade 3 or 4 irAEs occurred in 23% with nivolumab and in 16% with pembrolizumab.[[1]] The spectrum of cutaneous irAE is diverse and most commonly present as maculopapular exanthema with pruritus.[[3]] Another possible manifestation is psoriasis.[5] Treatment with biologics has been established in the therapy of severe psoriasis, one option being tumour necrosis factor (TNF)-alpha inhibitors.[6] Inflammatory signals such as TNF are essential factors that determine the aggressiveness of melanoma cells.[7] There is evidence that concomitant therapy with a TNF-alpha inhibitor may have positive effects on treatment response and thus tumour prognosis.[8] We report on a 67-year-old man with stage IIB MM. In the further course, the psoriasis was progressive; therefore, therapy with Nivolumab was terminated after six times at the patient's request. [Extracted from the article]

Dear Editor, We reported a 25-year-old patient who presented as an emergency case with pustules in the genital area that had been present for a week. An adult patient with suspected of monkeypox infection differential diagnosed to chickenpox. The patient has no steady partner, there was no travelling abroad in the last few months and the recent unprotected sexual intercourse was approximately 2 weeks before the appearance of the skin lesions. [Extracted from the article]

Background: Interferon-alpha is an important therapeutic option for the treatment of the cutaneous T-cell lymphomas (CTCL). Since the approved recombinant interferon-α-2a (IFN-α2a) has no longer been produced since January 2020, pegylated interferon-α2a (pegIFN-α2a) can be used as an alternative treatment, even though it is not approved for the treatment of CTCL. The aim of this multicentre study was to generate comprehensive data on the efficacy and tolerability of pegIFN-α2a in the treatment of CTCL., Patients and Methods: A multicenter retrospective study was conducted with 70 patients with CTCL from twelve German skin centers., Results: In total, 70 patients were included in the study, with 57.2% male and a mean age of 58.8 ± 14.9 years. Mycosis fungoides was present in 71.4% of cases and Sézary Syndrome in 28.6%. An overall response rate of 55.2% was observed with pegIFNα-2a therapy. In 50% of cases, therapy was discontinued after 63.6 ± 33.5 weeks. The most common reason for discontinuation was adverse events, which occurred in 68.6% of cases and which were classified as severe in 29.2%. Blood count changes, fatigue and liver toxicity occurred most frequently., Conclusions: Our analysis provides comprehensive data on the efficacy and tolerability of pegIFNα-2a therapy in patients with CTCL. In terms of response rates and side effect profile, pegIFNα-2a appears to be comparable to IFN-α2a therapy., (© 2024 The Author(s). Journal der Deutschen Dermatologischen Gesellschaft published by Wiley‐VCH GmbH on behalf of Deutsche Dermatologische Gesellschaft.)

Background: There is a high demand for dermatological care in Germany. As use of teledermatology has increased significantly, this study aimed to investigate the impact of teledermatology on patient care. Methods: This retrospective cross-sectional study used data from a direct-to-consumer teledermatology platform using store-and-forward technology available in Germany between July 2021 and April 2022. Additional patient characteristics were collected using a voluntary follow-up questionnaire, 28 days after teleconsultation. Results: Data of 1,999 enrolled patients were evaluated. Patients had a mean age of 36 years, and 61.2% (1,223/1,999) lived in a rural residence. The most common diagnoses included eczema (36.0%, 701/1,946), fungal diseases (15.4%, 299/1,946), and acne (12.5%, 243/1,946). The follow-up questionnaire was answered by 166 patients (8.3%, 166/1,999). In total, 42.8% (71/166) of patients had undergone no previous medical consultation. The most frequent reason for using teledermatology was the waiting time for a dermatology outpatient appointment (62.0%, 103/166). A total of 62.0% (103/166) participants rated the treatment success as good or very good, while 86.1% (143/166) rated the quality of telemedical care as equal or better to that of an outpatient visit. Conclusion: This study showed that patients often use teledermatology because of functional barriers (waiting times). In this cohort, the diagnoses strongly corresponded to reasons for outpatient presentation. Most patients rated the quality of teledermatology service as at least equivalent to that of outpatient physician visits and reported treatment success. Thus, teledermatology can relieve the burden of outpatient care while providing high benefits from the patient's perspective.

Background : Adherence to dermatological treatment is described as poor. Empathy and open communication in the physician-patient relationship has been proven to improve adherence. As direct-to-consumer teledermatology enables patients to access dermatological consultations without in-person interactions, we hypothesized treatment adherence in teledermatology to be low. Methods : The objective of the study was to examine treatment adherence in teledermatology. This retrospective cross-sectional study used data from patients treated through a German direct-to-consumer teledermatology platform between July 2021 and April 2022. Additional information was collected through voluntary follow-up questionnaires provided to patients to assess individual treatment success, treatment-related adverse events, and treatment adherence. Results : Data collection included 771 patients; 61.6% (475/771) were women (mean age 35 years). In 46% (355/771), skin disease had been present for <3 months before teleconsultation. Of all patients who answered the follow-up questionnaire ( n  = 228), 28.5% (65/228) reported treatment-related adverse events, with skin dryness being the most common (56.9%, 37/65). Adverse events resulting in treatment discontinuation were reported in 1.3% (3/228) of all cases. Improvement in skin condition on therapy was described by 75.4% (172/228). In 85.5% (195/228), full treatment adherence was reported. Conclusion : This is the first study worldwide to examine data on treatment adherence in direct-to-consumer-teledermatology. Despite the lack of doctor-patient interaction, the results of our study demonstrate that most patients show high treatment adherence. Possible drivers contributing to high compliance rates could be the high proportion of new-onset skin diseases, the high treatment success of the prescribed therapies, and the low rate of serious adverse events.

Background and Objectives: Skin diseases are a common reason for consultations in pediatric practice. The present study aims to characterize the dermatological requests of resident pediatric specialists using teledermatology in Germany., Patients and Methods: This analysis of consultation requests, submitted by pediatricians to a designated pediatric dermatologist via a telemedical consultation system (PädExpert) using the store-and-forward technology, was performed between February 2021 and December 2021., Results: The study analysis included 504 telemedical consultation requests. The mean age of the patients was 6.5 ± 5.0 years with 45.5% of the patients being female. Telemedicine was useful in providing a definite diagnosis in 88.3%. The diagnoses were most frequently assigned to the group of infectious skin diseases (28.8%). Referral to a dermatologist was recommended in 11.5%. The requests were answered on the same day in 63.8% of the cases., Conclusions: The study data shows the great potential of teledermatology to improve access for children with skin diseases to specialized dermatological care. Another advantage is its function as a triage instrument. Since most cases could be managed by teledermatology only, it is possible to reduce the need for an in-person visit to the dermatologist, thus saving resources., (© 2023 The Authors. Journal der Deutschen Dermatologischen Gesellschaft published by John Wiley & Sons Ltd on behalf of Deutsche Dermatologische Gesellschaft.)