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Christina Fotiadou, Elizabeth Lazaridou, Eleni Sotiriou, Demetrios Ioannides First Department of Dermatology and Venereology, Aristotle University Medical School, Thessaloniki, Greece Abstract: The recent advances in the understanding of psoriasis pathogenesis have clarified the pivotal role of interleukin (IL)-23. It is a heterodimeric cytokine consisting of two subunits, the unique p19 and the p40, which are shared with IL-12. The basic role of IL-23 in psoriasis is the activation and maintenance of the T-helper 17 pathway. New research findings indicate that IL-23 is more important than IL-12 in the pathogenesis of psoriasis. Based on that background, the selective targeting of the IL-23p19 subunit emerged as an attractive therapeutic option and led to the development of a new category of biologic agents. Three monoclonal antibodies that selectively inhibit the IL-23p19 subunit, guselkumab, tildrakizumab, and risankizumab, are in the pipeline for the treatment of moderate-to-severe psoriasis. In this article, we review the most recent efficacy and safety data regarding these IL-23p19 inhibitors. Keywords: psoriasis, IL-23, treatment, Th17 axis, anti-IL-23p19 monoclonal antibodies

Elizabeth Lazaridou,1 Chrysovalantis Korfitis,2 Christina Kemanetzi,1 Elena Sotiriou,1 Zoe Apalla,1 Efstratios Vakirlis,1 Christina Fotiadou,1 Aimilios Lallas,1 Demetrios Ioannides1 1First Department of Dermatology and Venereology, Aristotle University Medical School, Thessaloniki, Greece; 2Department of Dermatology, 401 General Army Hospital, Athens, Greece Abstract: Rosacea is a chronic skin disease characterized by facial erythema and telangiectasia. Despite the fact that many hypotheses have been proposed, its etiology remains unknown. In the present review, the possible link and clinical significance of Helicobacter pylori in the pathogenesis of rosacea are being sought. A PubMed and Google Scholar search was performed using the terms “rosacea”, “H.pylori”, “gastrointestinal disorders and H.pylori”, “microorganisms and rosacea”, “pathogenesis and treatment of rosacea”, and “risk factors of rosacea”, and selected publications were studied and referenced in text. Although a possible pathogenetic link between H. pylori and rosacea is advocated by many authors, evidence is still interpreted differently by others. We conclude that further studies are needed in order to fully elucidate the pathogenesis of rosacea. Keywords: eradication, Helicobacter pylori, pathogenesis, rosacea

Zoe Apalla,1 Chrysoula Papageorgiou,1 Aimilios Lallas,1 Elena Sotiriou,1 Elizabeth Lazaridou,1 Efstratios Vakirlis,1 Athanassios Kyrgidis,2 Demetrios Ioannides1 1First Department of Dermatology, Aristotle University, 2Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Aristotle University, Thessaloniki, Greece Abstract: Vismodegib is approved for the treatment of adult patients with metastatic (mBCC) or locally advanced basal cell carcinoma (laBCC) that have recurred following surgery or for those who are not good candidates for surgery (risk/benefit ratio is against patient’s benefit, either because of the general condition or because of the expected morbidity from the surgery) or radiation therapy. This article provides an evidence-based review of its current place in therapy. Analytically, the clinical implications in the management of laBCCs and mBCCs and possible new indications, including the neoadjuvant use before surgical excision, are discussed, while in the end, the challenges regarding class-related adverse events and their optimal management are highlighted. Keywords: vismodegib, sonic hedgehog inhibitors, basal cell carcinoma, treatment, review

Efstratios Vakirlis, Grigorios Theodosiou, Zoe Apalla, Michael Arabatzis, Elizabeth Lazaridou, Elena Sotiriou, Aimilios Lallas, Demetrios Ioannides First Department of Dermatology, Aristotle University Medical School, Thessaloniki, Greece Background: The incidence of skin diseases in children is influenced by hereditary, social, and environmental factors. The objective of this study was to determine the incidence of pediatric dermatoses at a University Hospital in Northern Greece. Patients and methods: We reviewed epidemiologic data of 940 patients, aged 0–18 years, who were referred to the outpatient clinic of a University Hospital between January 2013 and December 2015. Demographic data and the frequency of the various diagnoses in various age groups were studied. Results: Nine hundred and forty children and adolescents with 1020 diagnoses were included in the study (52.8% females and 47.2% males). The 10 most frequent diagnoses were: dermatitis/eczema (31.5%), viral infections (12.5%), pigmentary disorders (7.4%), melanocytic nevi (5.8%), alopecia areata (5.8%), acne (5.6%), nail disorders (3.3%), vascular malformations and hemangiomas (2.9%), psoriasis (2.6%), and bacterial infections (2.6%). Atopic dermatitis was the most prevalent dermatosis in all age groups accounting for a total of 20.9% of the study population. A remarkably high incidence of various forms of mastocytosis (2.2%) was seen in our data. Conclusion: Atopic dermatitis is the most frequent pediatric dermatosis in all age groups. Viral infections, pigmentary disorders, and nevi account for a significant proportion of the referrals. The high incidence of mastocytosis in our study may be attributed to overdiagnosis, overestimation due to the relatively small study population, or it may represent the real incidence of mastocytosis in our region. The low incidence of acne in our study may be attributed to the fact that only severe cases are referred to our hospital. Keywords: epidemiology, pediatric dermatology, atopic dermatitis, infection-viral, mastocytosis

Christina Fotiadou, Efstratios Vakirlis, Dimitrios Ioannides First Department of Dermatology-Venereology, Aristotle University Medical School, Thessaloniki, Greece Abstract: Hidradenitis suppurativa (HS) is a chronic, recurrent, inflammatory skin disease that affects the hair follicles of the aprocrine gland-bearing anatomical areas of the body. It is characterized by deep painful nodules and abscesses that rupture and contribute to the formation of sinus tracks and scarring. The management of HS is based on the assessment of disease severity and a combination of medical and surgical treatment according to the European Guidelines. Adalimumab, a recombinant, fully humanized, anti-tumor necrosis factor alpha (anti-TNF-α) monoclonal antibody, is the only officially approved treatment for the management of moderate-to-severe HS. Case reports, concerning 42 patients who received adalimumab for severe HS (with the standard dose regimen for psoriasis), reported a cumulative response rate of 58% (≥50% in 23 patients) with a relapse rate of 71% (10 out of 14 patients). The most recent and most well-powered phase III, randomized placebo-controlled trials for the evaluation of the efficacy and safety of adalimumab in treatment of moderate-to-severe HS (PIONEER studies I and II) showed that the Hidradenitis Suppurativa Clinical Response (HiSCR) rate at week 12 was significantly higher for patients randomized to adalimumab compared to placebo. Adverse events were comparable to placebo. In conclusion, adalimumab, to date, holds the most robust data regarding treatment efficacy in HS. Larger, registry-based studies are needed to further establish the efficacy and safety profile of this anti-TNF-α agent in HS. Keywords: hidradenitis suppurativa, adalimumab, treatment

Christina Fotiadou, Elizabeth Lazaridou, Demetrios Ioannides First Department of Dermatology–Venereology, Aristotle University Medical School, Thessaloniki, Greece Abstract: Psoriasis is a chronic inflammatory cutaneous disorder affecting 2%–4% of the world's population. The prevalence of the disease in childhood and adolescence ranges between 0.5% and 2%. The management of psoriasis in adolescence is an intriguing and complicated task. Given the paucity of officially approved therapies, the very limited evidence-based data from randomized controlled trials, and the absence of standardized guidelines, physicians must rely on published experience from case reports both from the field of dermatology as well as from the application of these drugs for other pediatric conditions coming from the disciplines of rheumatology, gastroenterology, and oncology. Psoriatic adolescents deal with a potentially disfiguring and lifelong disease that could permanently impair their psychological development. It must be clarified to them that psoriasis does not have a permanent cure, and therefore the main goal of treatments is to establish disease control and prolonged periods between flares. The majority of adolescents suffer from mild psoriasis, and thus they are treated basically with topical treatment modalities. Phototherapy is reserved for adolescents with mild-to-moderate plaque disease and/or guttate psoriasis when routine visits to specialized centers do not create practical problems. Systemic agents and biologics are administered to patients with moderate-to-severe plaque psoriasis, pustular psoriasis, or erythrodermic psoriasis. Keywords: adolescent psoriasis, pediatric psoriasis, treatment, systemic treatment, biologic agents

Background: Randomized controlled trials of secukinumab have shown sustained efficacy and a favourable safety profile in multiple manifestations of psoriatic disease. Objectives: To assess the long‐term, real‐world retention, effectiveness and safety of secukinumab in routine clinical practice for the treatment of moderate‐to‐severe plaque‐type psoriasis (PsO). Methods: SERENA (CAIN457A3403) is a large, ongoing, longitudinal, observational study conducted at 438 sites and 19 countries for an expected duration of up to 5 years in adult patients with moderate‐to‐severe PsO, psoriatic arthritis and ankylosing spondylitis. Patients received ≥16 weeks of secukinumab treatment before enrolment. This interim analysis presents data from PsO patients, who were enrolled in the study between October‐2016 and October‐2018 and were observed for ≥2 years. Results: In total, 1756 patients (67.3% male) with a mean age of 48.4 years and body mass index of 28.8 kg/m2 were included in the analysis. The secukinumab treatment retention rates after 1, 2 and 3 years in the study were 88.0%, 76.4% and 60.5%, respectively. Of the 648 patients who discontinued the study, the most common reasons included lack of efficacy (42.6%), adverse event (17.4%), physician decision (12.2%) and subject decision (11.6%). Mean ± SD absolute PASI was 21.0 ± 13.0 at the start of treatment (n = 1,564). At baseline, the mean ± SD PASI score reduced to 2.6 ± 4.8 and remained low at Year 1 (2.3 ± 4.3), Year 2 (1.9 ± 3.6) and Year 3 (1.9 ± 3.5). The safety profile of secukinumab during the SERENA study was consistent with its known safety profile, with no new safety signals reported. Particularly, low rates of inflammatory bowel disease (0.3%; Incidence Rate [IR]:0.15), candida infections (3.1%; IR:1.43) and MACE (0.9%; IR:0.37) were observed. Conclusions: Secukinumab showed high treatment persistence, sustained effectiveness and a favourable safety profile up to 3 years of follow‐up in the real‐world population of PsO patients observed in SERENA. [ABSTRACT FROM AUTHOR]