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Purely cutaneous Rosai–Dorfman disease is a self-limiting and benign histiocytosis; however, some patients may be concerned about the aesthetic appearance, with a negative effect on quality of life. Even though many treatments have been proposed, no specific therapies are available and there is insufficient evidence supporting the superiority of any particular approach. Here we report the improvement of purely cutaneous Rosai–Dorfman disease with topical rapamycin.

As Sarcoptes scabiei is becoming less sensitive to permethrin, clinicians have started to prescribe oral ivermectin (OI) as a first-line treatment. Guidelines suggest OI 200 µg kg–1 as two doses, 1 week apart. However, the black box of the ivermectin registered in Italy recommends a single dose. To compare these two regimens, we collected 71 cases of scabies and treated them according to this protocol [single-dose group (SDG)]. This population was compared to 68 patients who received two doses 1 week apart [double-dose group (DDG)]. Clearance of the disease was achieved in 98% of DDG patients. In the SDG, treatment was successful in only 58% of patients. This study confirms that the absence of a second intake of OI is one of the main predictors of treatment failure (P < 0.001), which may also increase the likelihood of emerging resistance in S. scabiei.

Tuberous sclerosis complex (TSC) is an autosomal dominant neurocutaneous syndrome causing hamartomatous growths in multiple organs. Facial angiofibromas occur in up to 80% of patients and can be highly disfiguring. Treatment for these lesions is challenging. Recently, topical rapamycin has been proposed as an effective option to treat angiofibromas but a commercially available compound has not yet been developed in Europe. We conducted a retrospective review with the aim to update the current data on the use of topical rapamycin in the treatment of angiofibromas in TSC, focusing on the optimal concentration and trying to establish which vehicle should be preferred. Thirty-nine reports describing the use of topical rapamycin in the treatment of angiofibromas in TSC were considered, involving a total of 483 patients. An improvement of the lesions has been shown in over 90% of subjects, particularly if the treatment was started at early stages. Several different formulations (ointment, gel, solution and cream) with a wide range of concentrations (0.003%-1%) were proposed, of which a pharmacological analysis has also been performed. Topical rapamycin can be considered an effective and safe option for the treatment and the prevention of facial angiofibromas in younger patients, but the best formulation has yet to be established. Our review demonstrates that ointment and gel should be preferred, but it is not clear which concentration is optimal. However, according to this study, the 0.1% concentration represents the first choice. Long-term and comparative studies between topical rapamycin formulations are required in order to establish which treatment has a better outcome and lower recurrence rate.

Background The multi-morbid burden and use of systemic immunosuppressants in people with psoriasis may confer greater risk of adverse COVID-19 outcomes but data are limited. Objective Characterize the course of COVID-19 in psoriasis and identify factors associated with hospitalization. Methods Clinicians reported psoriasis patients with confirmed/suspected COVID-19 via an international registry, PsoProtect. Multiple logistic regression assessed the association between clinical/demographic characteristics and hospitalization. A separate patient-facing registry characterized risk-mitigating behaviours. Results Of 374 clinician-reported patients from 25 countries, 71% were receiving a biologic, 18% a non-biologic and 10% no systemic treatment for psoriasis. 348 (93%) fully recovered from COVID-19, 77 (21%) were hospitalized and nine (2%) died. Increased hospitalization risk was associated with older age (multivariable-adjusted OR 1.59 per 10 years, 95% CI 1.19-2.13), male sex (OR 2.51, 95% CI 1.23-5.12), non-white ethnicity (OR 3.15, 95% CI 1.24-8.03) and comorbid chronic lung disease (OR 3.87, 95% CI 1.52-9.83). Hospitalization was more frequent in patients using non-biologic systemic therapy than biologics (OR 2.84, 95% CI 1.31-6.18). No significant differences were found between biologic classes. Independent patient-reported data (n=1,626 across 48 countries) suggested lower levels of social isolation in individuals receiving non-biologic systemic therapy compared to biologics (OR 0.68, 95% CI 0.50-0.94). Conclusion In this international moderate-severe psoriasis case series, biologics use was associated with lower risk of COVID-19-related hospitalization than non-biologic systemic therapies, however further investigation is warranted due to potential selection bias and unmeasured confounding. Established risk factors (being older, male, non-white ethnicity, comorbidities) were associated with higher hospitalization rates. Clinical Implications We identify risk factors for COVID-19-related hospitalization in psoriasis patients, including older age, male sex, non-white ethnicity and comorbidities. Use of biologics was associated with lower hospitalization risk than non-biologic systemic therapies., Capsule summary: In this global registry-based study, risk factors for COVID-19-related hospitalization in psoriasis patients were older age, male sex, non-white ethnicity and comorbidities. Use of biologics was associated with lower hospitalization risk than non-biologic systemic treatment.

Summary The outbreak of chilblain‐like lesions (CLL) coincidentally to the COVID‐19 pandemic is a topic of great concern. SARS‐CoV‐2 was initially hypothesized as the etiologic agent of CLL, but, since nasopharyngeal swabs seldom resulted positive, dermatologists’ attention focused on the search for specific SARS‐CoV‐2 antibodies. Many papers were published contemporarily on this topic, reporting limited case series. We reviewed the English literature up to the 1st July 2020 and, excluding single case reports, we considered 13 studies that serologically investigated 220 patients. The presence of specific antibodies was detected in 18 subjects (8,2%): isolated IgA were found in 6 patients, IgA and IgG in 1, isolated IgG in 5, and IgM in 2. In 4 patients, isotypes were not specified. Our review demonstrated a high prevalence of negative serological results in CLL: antibodies were observed only in a few patients, that are even less excluding those with positive IgA, not clearly involved in the pathogenesis of the disease. In conclusion, although it is still uncertain whether CLL are related to SARS‐CoV‐2 infection, patients affected by CLL seem not to be prone to shedding the virus, hence, if they are asymptomatic, we can reassure them, thus avoiding hospital referral This article is protected by copyright. All rights reserved.

The outbreak of chilblain‐like lesions (CLL) coincidentally to the COVID‐19 pandemic is a topic of great concern. SARS‐CoV‐2 has been hypothesized as the etiologic agent of CLL, on the basis of the temporal correlation between the “burst” of skin manifestations and the viral pandemic. However, the relationship between CLL and COVID‐19 remains unclear, since authors failed to confirm the SARS‐CoV‐2 infection in these patients using a real‐time reverse transcription polymerase chain reaction (rt‐PCR) test from nasopharyngeal swabs, which seldom resulted positive. Indeed, the most recent articles on the prevalence of the SARS‐CoV‐2 infection in CLL reported a positive swab test in only about a fifth of these patients.

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.

The coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, is creating an unprecedented global public health emergency with the continuous growth of infected individuals worldwide. Italy was one of the first European country to face the first wave of infection outside mainland China. The first case of COVID-19 was confirmed in Lombardy on February 20th , 2020, and subsequently, a rapid increase in the number of detected cases was observed, spreading through Italy and the rest of Europe.3 As of April 22nd , confirmed COVID-19 cases in Italy were 183,957.

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.

To avoid loss of genetic information in environmental DNA (eDNA) field samples, the preservation of nucleic acids during field sampling is a critical step. In the development of standard operating procedures (SOPs) for eDNA-based compliance monitoring, the effect of different routinely used sediment preservations on biological community structures serving as bioindicators has gone untested. We compared eDNA metabarcoding results of marine bacterial communities from sample aliquots that were treated with a nucleic acid preservation solution (treated samples) and aliquots that were frozen without further treatment (non-treated samples). Sediment samples were obtained from coastal locations subjected to different stressors (aquaculture, urbanization, industry). DNA extraction efficiency, bacterial community profiles, and measures of alpha- and beta-diversity were highly congruent between treated and non-treated samples. As both preservation methods provide the same relevant information to environmental managers and regulators, we recommend the inclusion of both methods into SOPs for biomonitoring in marine coastal environments.

The severity and clinical appearance of psoriatic arthritis(PsA) is markedly variable and the dermatologist plays an important role in identifying it at an early stage, before the joint damage becomes irreversible.1 Nail psoriasis(NP) is more frequent in patients with PsA than skin psoriasis2,3: about 50% of patients with NP complain of pain, stiffness or swelling of the interphalangeal joint in the absence of a diagnosis of arthropathy, suggesting that these symptoms may be a manifestation of a subclinical enthesitis potentially preceding PsA.4 This article is protected by copyright. All rights reserved.

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.

A 57‐year‐old woman in good health presented with erythematous plaques that appeared first on the ankles (a, b) and then on the calves (e, f). Dermoscopy of the ankle plaques (c) showed whitish striae (asterisk) and red peripheral globules (arrow) consistent with lichen planus; those on the calves (g) showed translucent yellow–orange areas (asterisk) and branching linear vessels (arrows), suggesting necrobiosis lipoidica. Histology confirmed both diagnoses (d, h). Although we learned that all skin manifestations in one individual should be attributed to the same disease, the coincidental coexistence of different disorders can be observed. Dermoscopy could provide insight into peculiar features, avoiding superficial ‘at‐first‐glance’ diagnoses

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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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Background Distal subungual onychomycosis and traumatic onycholysis are the most common causes of toenail abnormalities, and differential diagnosis is often impossible without mycology. Objectives To identify and describe dermoscopic signs specific for distal subungual onychomycosis that could facilitate its diagnosis and differentiation from traumatic mycologically negative onycholysis and to determine the sensitivity and specificity of these dermoscopic features. Methods We performed a retrospective study at the Outpatient Consultation for Nail Diseases of the Department of Dermatology of the University of Bologna. Dermoscopic digital images of 57 consecutive patients who underwent global photography, videodermoscopy and mycological examination for onycholysis of a single toenail between 1 December, 2010 and 30 June, 2011, were evaluated and compared. Digital dermoscopic images of onycholysis of the great toenail were evaluated for the presence of peculiar dermoscopic features. The presumptive dermoscopic diagnosis was compared with results of mycology. Results Evaluation of videodermoscopic images allowed us to identify three recurring peculiar dermoscopic features, two of which were present only in distal subungual onychomycosis (jagged proximal edge with spikes of the onycholytic area and longitudinal striae) and one only in traumatic onycholysis (linear edge – without spikes – of the onycholytic area). Conclusions We found distinctive dermoscopic signs that are exclusive to distal subungual onychomycosis and to traumatic onycholysis. Detection of these signs is simple and can, in selected cases, help to avoid mycology.

BACKGROUND: Several options for the treatment of ingrowing toenails are available, ranging from simple conservative approaches to extensive surgical procedures. OBJECTIVE: To evaluate in a long-term follow-up (36 months) the efficacy of chemical matricectomy with phenol for the treatment of ingrowing toenails. METHODS AND MATERIALS: A total of 197 phenol ablations were performed in 139 patients with stage 2 and 3 disease. Each patient was examined weekly until full wound healing was achieved and was followed for 36 months to assess the long-term efficacy of the treatment. The healing period after surgery ranged from 2 to 4 weeks; few postoperative complications were seen. RESULTS: Only three recurrences were observed (after 2, 4, and 11 months). Short-term results were excellent. No severe complications occurred during the 36-month follow-up period. Cosmetic results were remarkable. The success rate was 98.5%. CONCLUSIONS: Phenol cauterization is an excellent surgical method for the treatment of ingrowing toenails, being simple and associated with low morbidity and a high success rate, even over the long term (36 months).

Drugs may induce hair loss, stimulate hair growth or, more rarely, induce changes in the hair shape and colour. Drug-induced hair loss is usually completely reversible and is, in most cases, a consequence of a toxic effect of the drug on the hair follicle matrix. In rare cases alopecia may be permanent. Depending on type of drug, dosage and patient susceptibility, hair loss presents as telogen effluvium, anagen effluvium or both. Telogen effluvium is also commonly observed after discontinuation of drugs that prolong anagen, such as topical minoxidil and oral contraceptives. Although a large number of drugs have been occasionally reported to produce hair loss, only for a few drugs the relation between drug intake and hair loss has been proven.

Anecdotal reports have shown that tumour necrosis factor (TNF)-α inhibition may cause unchecked superficial infection with the microorganisms responsible for pityriasis versicolor (PV). We observed several cases of PV, which is frequently resistant to topical therapies, in psoriatic patients undergoing anti-TNF-α monoclonal antibody therapy. To evaluate the incidence and the therapeutic management of PV in this group of individuals, between 1 January and 27 December 2010, we examined 153 psoriatic patients for the hypopigmented/hyperpigmented macular and scaling lesions associated with PV. All patients positive for PV were given topical therapy with miconazole nitrate cream twice daily for 28 days, after which they were re-evaluated. In patients non-responsive to topical therapy, we started systemic therapy with fluconazole, 300 mg week(-1) for 3 weeks. We diagnosed seven cases of PV. At the end of topical treatment, complete healing of lesions was observed in only one patient. In the other six patients, systemic treatment led to complete resolution of the infection. Although the onset of PV during anti-TNF-α therapy is seldom reported, it is not likely to be rare, but rather under-reported because of its limited pathological significance. In our opinion, the therapeutic management of this condition deserves greater consideration, as the use of topical treatments alone is largely ineffective compared with systemic treatment.

Le alterazioni delle unghie, così come le patologie dei capelli, possono rappresentare in molti casi un importante ausilio diagnostico sia per il riconoscimento di malattie dermatologiche, sia per l’individuazione di malattie sistemiche. Il nostro lavoro è rivolto in primo luogo allo specialista in pediatria e consiste in una guida rapida che riassume tutti gli elementi utili alla veloce identificazione delle più comuni alterazioni ungueali e delle malattie del capello nel bambino, fornendo inoltre le indicazioni sintetiche sul loro possibile trattamento.

Onychomatricoma is an uncommon benign tumor of the nail matrix, with peculiar clinical and histologic features and electron microscopic findings. The main clinical signs are longitudinal ridging, yellow coloration along the entire length of the nail plate with splinter hemorrhages in its proximal portion, and a tendency towards transverse overcurvature of the affected nails. We report onychomatricoma associated with onychomycosis in the same nail in a 4-year-old girl.

the Divisions of Dermatology at the Dipartimento di edicina Specialistica, Diagnostica e Sperimentale, Universit a Bologna, and the Ospedale Santa Chiara, Trento, Italy. ing sources: None. licts of interest: None declared. ints not available from the authors. spondence to: Riccardo Balestri, MD, Dipartimento di edicina Specialistica, Diagnostica e Sperimentale, Universit a di Bologna, Clinica Dermatologica, Via Massarenti 1, 40138 Bologna, Italy. E-mail: ilsabo@libero.it. J Am Acad Dermatol 2013;69:e217-8. 0190-9622/$36.00 a 2013 by the American Academy of Dermatology, Inc. http://dx.doi.org/10.1016/j.jaad.2013.03.030

As far as we know, our case is the first pellagroid skin eruption related to a vitamin PP deficit due to the stopping of supplements during ketogenic diet and anti-epileptic therapy, and emphasizes that an appropriate supplementation of vitamins and oligoelements is mandatory in such cases.

A combination of topical and oral antifungals is widely used to treat onychomycosis, but treatment failure is common and oral drugs may cause toxicity and potential drug interactions. For this reason, new approaches and strategies should be considered. The following case shows that photodynamic therapy (PDT) may represent an alternative noninvasive approach to treatment of onychomycosis.

Onychomatricoma is an uncommon benign tumor of the nail matrix, with peculiar clinical and histologic features and electron microscopic findings. The main clinical signs are longitudinal ridging, yellow coloration along the entire length of the nail plate with splinter hemorrhages in its proximal portion, and a tendency towards transverse overcurvature of the affected nails. We report onychomatricoma associated with onychomycosis in the same nail in a 4-year-old girl.