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Anna Graziella Burroni,1 Mariella Fassino,2 Antonio Torti,3 Elena Visentin4 1IRCCS University Hospital San Martino, IST National Institute for Cancer Research, Genoa, Italy; 2Department of Psychology, Specialization School in Clinical Psychology, University of Turin, Turin, Italy; 3Dermatology practice, Milan, Italy; 4HTA and Scientific Support, CSD Medical Research Srl, Milan, Italy Background: Psoriasis largely affects daily activities and social interactions and has a strong impact on patients’ quality of life. Psoriatic patients have different attitudes toward their condition. Topical medications are essential for the treatment of psoriasis, but the majority of patients do not adhere to these therapies. Objective: The history of treatment success or failure seems to influence patient attitude toward topical therapy. Therefore, it is important to understand the psychological, experiential, and motivational aspects that could be critical for treatment adherence, and to describe the different attitudes toward topical treatment. Furthermore, the physician–patient relationship and the willingness to trust the dermatologist may have a substantial role in encouraging or discouraging patients’ attitudes toward topical therapy. Methods: A survey was designed to collect aspects that could be relevant to understanding different patient attitudes toward psoriasis and its treatments. A total of 495 self-administered questionnaires compiled by psoriatic patients were analyzed from 20 Italian specialized hospital centers in order to provide a nationwide picture. Results: Psoriatic patients have different perceptions and experiences in relation to their condition: half of them consider psoriasis as a disease, while the other half consider psoriasis as a disorder or a nuisance. Topical therapy is the most widely used treatment, even though it is not considered the most effective one and often perceived to be cosmetic. The main findings are: 1) inadequate patient education about this disease, 2) lack of information about topical treatment, and 3) lack of results within the expected time frame. Furthermore, physicians need to build a good relationship with psoriatic patients in order to motivate them, to trust in their care, and to adhere to treatment. Conclusion: This survey adds new and important details about daily life and well-being and the needs of psoriatic patients, providing suggestions for dermatologists to improve patients management. Keywords: psoriasis, topical therapy, survey, dermatologist

Aim: Abrocitinib is a JAK-1 inhibitor approved for the treatment of moderate-to-severe atopic dermatitis (AD). We conducted a 16-week multicenter retrospective study to assess the short-term effectiveness and safety of abrocitinib in patients with moderate-to-severe AD., Our retrospective study included 85 adult patients from 14 Italian Dermatology Units affected by moderate-to-severe AD treated with abrocitinib 100/200 mg., Methods: Effectiveness of abrocitinib at weeks 4 and 16 was assessed by using the Eczema Area and Severity Index (EASI), the Investigator Global Assessment (IGA), the peak pruritus and sleep- Numerical Rating Scale (PP-NRS and S-NRS, respectively)., Results: At week 16, improvement of at least 90% in EASI (EASI90) and IGA 0/1 was observed in 49.4% and 61.2% of patients, respectively. A reduction of at least 4 points in PP-NRS and S-NRS compared with baseline was achieved by 70.6% of patients for both endpoints. No significant safety reports were observed during the study period. Naïve patients had better rates of EASI 90 compared to patients who previously failed dupilumab. Conclusion: Our data confirm the effectiveness of abrocitinib in a real-world setting with better clinical responses at weeks 4 and 16, compared with Phase-III clinical trials. Longer analyses are required to further establish the safety profile of abrocitinib.

Introduction: Several systemic therapies have been approved for the treatment of severe AD. In particular, Janus kinase inhibitors (JAKi), including abrocitinib, baricitinib, and upadacitinib, recently received approval for the treatment of patients with severe AD after being evaluated in several clinical trials. However, a few concerns have been raised regarding their long-term safety and the management of these drugs in real-world clinical practice. In this article we described the results of a Delphi consensus aimed at describing the knowledge on JAKi and focusing, in particular, on providing clinical recommendations for dermatologists in daily practice regarding the use of these drugs., Methods: Twelve Italian dermatologists reviewed the most recent literature regarding the efficacy and safety profiles of JAKi and proposed 24 statements., Results: Agreement was reached for statements focusing on three main topics: (1) place in therapy of JAKi in patients with moderate-to-severe AD; (2) effectiveness and safety of JAK inhibitors in different phenotypes; (3) different approaches to the management of patients treated with JAKi in clinical practice. The panel proposed several recommendations regarding all the statements., Conclusion: Given the wide use of JAKi in clinical practice, it is crucial to establish a specific follow-up for each patient's phenotype in order to achieve the best possible clinical outcome and minimize potential adverse events., (© 2024. The Author(s).)

Introduction: Diffuse Melanosis Cutis (DMC) is a rare and late complication of metastatic malignant melanoma (MM) characterized by progressive pigmentation of skin and sometimes mucous membranes. The distinctive feature is the widespread and progressive deposition of melanin precursors in the dermis., Objectives: The purpose of this review is to define the clinical and demographic features of DMC and to promote a deeper insight into the clinical manifestation, histological findings, and pathophysiology behind DMC., Methods: We have conducted a systematic review of the literature on published DMC in compliance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis. We also reported a case of DMC secondary to low-risk melanoma., Results: Overall, including our case report, we reported 53 articles described 62 DMC patients. Breslow level of primary melanoma was reported having a mean value of 3.3 mm. The mean survival rate from onset of DMC resulted being 4.36 months., Conclusions: Among the most widely accepted etiopathogenetic hypotheses are deposition of melanic precursors in the dermis following tumor lysis, melanocyte proliferation induced by neoplastic growth factors, and the presence of diffuse dermal micro-metastases of MM. However, unanimous consensus on the proposed etiopathogenetic models of DMC is still lacking.

We report the case of a 23-year-old woman with an erythematous, crusted patch of the scalp, lacking pustular lesions, with partial hair loss, developed after mechanical scalp trauma. Histopathological examination showed a dermal infiltrate, predominantly peri-adnexal and peri-vascular, rich in plasma cells and lymphocytes, but lacking neutrophils, possibly as a consequence of the time elapsed since the onset of the skin disease. Reduction of functional hair follicles was evidenced. Stains for bacterial or fungal infections were negative. Direct immunofluorescence was negative. Erosive pustular dermatosis of the scalp was diagnosed on the basis of clinical-anamnestic findings, supported by histology. Topical clobetasol propionate led to clinical improvement after a couple of weeks. Erosive pustular dermatosis of the scalp was diagnosed and soon after the patient developed also multiple sclerosis. Up to date, the pathogenesis of erosive pustular dermatosis of the scalp remains unknown, though a possible role of immunosenescence and autoimmunity has been suggested. Indeed, high levels of neutrophil-stimulating cytokines and chemokines have been found in erosive pustular dermatosis patients, possibly causing activation of an aberrant systemic neutrophilic reaction. Furthermore, the role of neutrophils has been recently highlighted also in the pathogenesis of multiple sclerosis. Herein we hypothesize a possible common immunological etiology of multiple sclerosis and erosive pustular dermatosis of the scalp, conceivably involving a hyperactivation of neutrophils., Competing Interests: Conflict of interest: The authors declare no potential conflict of interest., (©Copyright: the Author(s).)

Sensitive scalp is a common condition defined by the presence of erythema and/or subjective symptoms as pain, pricking, burning, pruritus of the scalp elicited by triggering factors. Trichodynia is a term that describes a sensation of pain or burning of the scalp and was assumed to be part of sensitive scalp. Main goal of the study was to establish the prevalence of sensitive scalp in patients with trichological disorders. We conducted a retrospective observational study recorded: age, sex, trichological disorder (telogen effluvium, androgenetic alopecia, alopecia areata, scarring alopecia, trichotillomania) and scalp symptoms (pruritus, pain, burning and itching sensation). We studied 317 patients. 102 patients (32%) complained of sensitive scalp. Telogen effluvium patients had a significantly higher prevalence of sensitive scalp (p <0.001), pain (p= 0.028), burning sensation (p=0.018), pruritus (p=0.016) and trichodynia (p<0.001) than other patients with alopecias. Likewise, AA patients had a statistically significant higher prevalence of pruritus (p=0.0256) and trichodynia (p=0.0223) than other alopecias patients. Sensitive scalp is a frequent symptom reported by patients with hair loss. Telogen effluvium and alopecia areata seem to be most associated to sensitive scalp., Competing Interests: Conflict of interest: The authors declare no potential conflict of interest., (©Copyright: the Author(s).)

Background: There is considerable literature concerning psychological distress and dermatological diseases. Recent studies highlight the role of emotion dysregulation in several skin diseases. Our study sought to explore emotion regulation in patients with chronic skin conditions and the frequency of traumatic experiences they had encountered., Methods: Forty-nine sequential dermatological patients were compared with 49 healthy adults. Both groups were studied by means of validated scales for alexithymia (Toronto Alexithymia Scale [TAS-20]) and dissociation (Dissociation Experiences Scale [DES-II] and they completed a checklist for traumatic events (Traumatic Experiences Checklist [TEC])., Results: Our results indicated that subjects suffering from chronic dermatological diseases presented more severe alexithymic and dissociative traits. Furthermore, they had suffered a greater number of stressful experiences than had individuals in the control group., Conclusions: Our findings appear to be consistent with literature linking skin diseases and emotion regulation, highlighting a psychosomatic specificity in these conditions.