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Systemic treatment for metastatic melanoma has advanced dramatically in recent years with an impressive increase in the rate of overall survival. The two main different strategies are targeted therapies (i.e. BRAF and MEK inhibitors) and immunotherapy with monoclonal antibodies against the immune checkpoint proteins programmed death-1 (PD-1) and cytotoxic T-lymphocyte antigen-4 (CTLA-4). Vitiligo often accompanies immunotherapy in melanoma patients and even correlates with tumor regression after checkpoint blockade. At present, a correlation between vitiligo onset and outcome from immunotherapy is acknowledged; however, evidence of a correlation between vitiligo and efficacy of combination-targeted therapy is lacking. We describe our experience in a patient who received dabrafenib and trametinib and developed vitiligo-like depigmentation after treatment cessation.

SARS‐CoV‐2 has been hypothesized as the aetiologic agent of CLL, on the basis of the temporal correlation between the “burst” of skin manifestations and the viral pandemic, even though we have scarce evidence of swab‐confirmed infections. Authors have therefore suggested some pathogenetic mechanisms such as a delayed immune‐mediated reaction to the virus in genetically‐predisposed patients1 or an early IFN‐I response in young patients, muting early viral replication but also inducing microangiopathic changes.

we read with great interest the article entitled “Should SARS‐CoV‐2 influence immunosuppressive therapy for autoimmune blistering diseases?” published by Di Altobrando A. et al. in the JEADV. This is the first report of COronaVIrus DIsease 2019 (COVID‐19) in a patient affected by autoimmune blistering disease (ABD) during immunosuppressive treatment (i.e. azathioprine). The authors conclude that it is crucial to learn of more cases of ABD patients under immunosuppressive treatment who have developed COVID‐19, in order to better quantify the risk of infection under immunosuppressive therapy.

we read with great interest the article entitled “SARS‐CoV‐2 infection in a psoriatic patient treated with IL‐23 inhibitor” published by Messina F. and Piaserico S. in the JEADV.1 This is the first report of COronaVIrus DIsease 2019 (COVID‐19) in a psoriatic patient treated with a biologic. Whilst the authors reported an infection that occurred during therapy with an IL‐23 inhibitor, we would like to briefly report one that occurred during therapy with an IL‐17 inhibitor.

Papular epidermal nevus with "skyline" basal cell layer is a newly described keratinocytic nevus. Recently, papular epidermal nevus with "skyline" basal cell layer has been reported in association with extracutaneous involvement, and the term papular epidermal nevus with "skyline" basal cell layer syndrome is used to indicate a neurocutaneous syndrome characterized by the presence of papular epidermal nevus with "skyline" basal cell layer and different neurologic symptoms that seem to improve during infancy and adolescence. Multiple pilomatricomas have been reported in association with various syndromes. We report herein papular epidermal nevus with "skyline" basal cell layer associated with multiple pilomatricomas in two members of a family with the aim of drawing attention to this peculiar epidermal nevus to improve our knowledge of the syndrome.

Here, we report the case of a patient, diagnosed with BRAFV600E-mutated metastatic malignant melanoma M1a, who achieved a complete metabolic response after 7 months of treatment with the combination of dabrafenib and trametinib. After 31 months, the treatment was interrupted for patient's decision. To date October 2017, 18 months after the interruption of the treatment with the combination of dabrafenib and trametinib, follow-up Positron Emission Tomography (PET) scans are still documenting complete metabolic response.

Acrodermatitis continua of Hallopeau is considered an uncommon variant of pustular psoriasis, characterized by a relapsing, sterile, pustular eruption of hands and feet. It is not easily treated by antipsoriatic therapies, and may progress toward sclerosis and osteolysis. Numerous topical and systemic treatments have been used, with inconsistent results. The therapeutic response of pustular psoriasis to biologics supports the pivotal role of the tumor necrosis factor (TNF)-α/interleukin (IL)-23/IL-17/IL-22 axis in the pathogenesis of the disorder. Based on these data, secukinumab was used in a patient with uncontrolled acrodermatitis continua of Hallopeau. We described a case of secukinumab treated patient with uncontrolled acrodermatitis continua of Hallopeau. Our experience suggests that secukinumab may represent a suitable choice for the management of acrodermatitis continua of Hallopeau resistant to other treatments.

Papular epidermal nevus with skyline basal cell layer (PENS) is a newly described keratinocytic nevus whose dermoscopic characteristics have not been clarified. We used a dermatoscope to investigate the multiple PENSs of a patient with PENS syndrome. All the lesions shared a common dermoscopic homogeneous white pattern surrounded by peripheral, slightly dotted hyperpigmentation. The smallest lesions had no other features, whereas the largest lesions had some scaling, directly proportional to their dimension, and a central, clear, pink discoloration.

none 13 no Psoriasis is a multi-systemic chronic inflammatory disease that affects about 1.5-3% of the general population, of which almost 20% suffer from a moderate-severe form. Those patients can be treated with a systemic agent, and, in case of scarce response or contraindications, they may require a biologic therapy, such as tumor necrosis factor or interleukin-12/23 inhibitors. When also those agents fail, clinicians face a true therapeutic challenge. We report a case series of multi-failure 16 patients, successfully treated with secukinumab, a fully human monoclonal antibody that selectively neutralizes interleukin-17A, recently approved for the treatment of plaque psoriasis, psoriatic arthritis and ankylosing spondylitis. Magnano, M; Loi, C; Patrizi, A; Sgubbi, P; Balestri, R; Rech, G; Tasin, L; Girardelli, C. R; Conti, A; Odorici, G; Campanati, A; Offidani, A. M; Bardazzi, F. Magnano, M; Loi, C; Patrizi, A; Sgubbi, P; Balestri, R; Rech, G; Tasin, L; Girardelli, C. R; Conti, A; Odorici, G; Campanati, A; Offidani, A. M; Bardazzi, F.

Koilonychia describes an altered shape of the nail that is concave and not convex. Physiological in children, in adults it may occur in the fingernails in patients with Plummer.Vinson syndrome, due to the severe iron deficiency, of after severe nail thinning, as in the cases reported.

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Mycosis fungoides and Sézary syndrome represent the most frequent forms of cutaneous T cell lymphoma. Both are characterized by skin infiltrating and/or circulating malignant cells displaying a CD4+CD7– phenotype in the majority of cases. Because an expansion of CD4+CD7– cells may also be found in inflammatory dermatoses or in the aging process, we evaluated, by flow cytometry, the relationship between CD7 expression and the distribution of differentiation/activation or homing antigens on peripheral blood lymphocytes from 36 cutaneous T cell lymphoma patients and from healthy donors. CD4+CD7– cells were increased in all patients with cutaneous T cell lymphoma. As a consequence, the CD7+/– ratio was reduced in stage I–II mycosis fungoides (3.96 vs 6.55 in healthy donors), and inverted in stage III–IV MF and Sézary syndrome (0.28 and 0.12 respectively). In the late stage of disease, the CD7+/– inverted ratio was strictly related to the expression of CD15s, CD60, and CD45R0, and the lack of expression of CD26 and CD49d. Interestingly, in leukemic patients, this phenotype was also associated with peculiar morphologic (large size) or phenotypical (CD3dim expression) characteristics. Furthermore, a progressive reduction of circulating CD8+ cells was also seen throughout all stages of disease. The presence of these populations in cutaneous T cell lymphoma at late phases of disease and Sézary syndrome suggests that all of these molecules may play an important part in the activation pathway and skin homing of circulating T cells in lymphoproliferative disorders. Therefore, this may constitute a distinctive feature in cutaneous T cell lymphoma patients with more aggressive characteristics.

A 43-year-old woman was examined in October 1993 for a widespread, large, ulceronecrotic skin eruption with exception of the mucosa (Fig. 1). The skin lesions were round and regular, varied in size from 0.5 to 2 cm, and were partially covered by a brownish-black crust. The patient had a fever ranging from 38 to 40 °C, always preceded by shivering. She had presented with small exfoliating erythematous patches and itching, 8 months before being admitted to our institute, and was treated with topical corticosteroids. After five and a half months, together with the beginning of fever, the above lesions became wet and were covered with squamous crusts. For 2 years the patient had been affected by perianal fistula, but had not referred to this pathology before. She also reported that she had been treated with antibiotic and corticosterod intravenous therapies. A biopsy specimen from a lesion of the right leg showed a widely ulcerous fragment of the skin, characterized by a strong infiltration of lymphocytes, especially in the upper part of the dermis, with neutrophil granulocytes. The epidermis surrounding the ulcer showed acanthosis, orthokeratosic hyperkeratosis, and spreading lymphocyte exocytosis, with a large number of necrotic keratinocytes and the presence of melanophages (Figs 2 and 3), All the above data suggested a diagnosis of pityriasis lichenoides et varioliformis acuta (PLEVA). Direct immunofluorescence carried out on perllesional skin showed the presence of fluorescent bodies on the superficial dermis using antisera anti-immunoglobulin (anti-IgM) and Ciq. Laboratory tests showed the following values: erythrocyte sedimentation rate (ESR), 55 LVh; C-reactive protein, 85 mg/L; white blood cell (WBC), 9200 g/dL; platelets, 476,000; gamma glutamil transferase, 93 U/L; alkaline phosphatase, 185 IU/L; complement C3 fraction, 70.9 mg/L; CP4/CD8 lymphocyte ratio, 6.5; total IgE, 2493 ku/L. Human immunodeficiency virus (HIV), Epstein-Barr virus (EVB), cytomegalovirus, herpes simplex 1 and 2, toxoplasma, rickettsia, and hepatitis markers A, B, and C gave negative results, while blood cultures were positive for Staphylococcus aureus and Pseudomonas aeruginosa. Circulating immune complexes (as C1 binding system), 80 (im/eq/L (normal value, less than 20). Qhest X-ray and total body computed axial tomography (CAT) scan were negative. Antimicrobial therapy with teicoplanin and trimethoprim + sulfamethoxazole for 15 days resulted in a reduction in microbial count in blood cultures, and therapy with prednisone (60 mg/day) for a further 20 days was started. The patient was discharged from hospital in reasonable physical condition, without fever and with an improvement of the skin lesions. Surgery for the treatment of her perianal fistula was not performed as her general condition had improved- The patient continued therapy at home with 50 mg prednisone and a broad spectrum antimicrobial for a further 20 days. One month later, the patient was admitted to hospital in a poor physical condition with fever (peaks of 40/41 °C), preceded by shivering, relapsing skin ulcers, weak respiration, and polypneia. The laboratory tests showed a serious hypoproteinemia, C-reactive protein concentration of 321 mg/L, and high transaminase levels. Blood analysis was positive for Staphylococcus aureus. Therapy was started with 60 mg prednisone, antimicrobials, and albumin, but 24 h later the patient fell into a coma and died from cardiogenic shock. Upon her family's request, no autopsy was performed.

Dermatomyositis is an inflammatory myopathy characterized by proximal symmetrical muscle weakness with a characteristic cutaneous eruption. Population-based cohort studies provide evidence of an increased frequency of cancer in dermatomyositis patients. Many signs and serology tests have been suggested as markers for malignancy in dermatomyositis. We performed a case-control study on the patients admitted in our institutions for dermatomyositis. Clinical and laboratory data were collected and statistical analysis was performed to reveal important predictive signs of malignancy in dermatomyositis. We found no statistical difference in the clinical or laboratory parameters between the dermatomyositis patients with or without malignancy, with the exception of the erythrocyte sedimentation rate. In our study group an erythrocyte sedimentation rate higher than 35 mm/hr was very strongly associated with the presence or the development of a malignancy. Given the high positive and negative predictive values observed in our study, erythrocyte sedimentation rate evaluation using this cut-off point could be very useful in alerting dermatologists to the need for more in-depth diagnostic procedures in dermatomyositis patients.