BACKGROUND:Onycholysis is a common but etiologically heterogeneous nail sign, most frequently due to psoriasis, onychomycosis, and trauma. Since the diagnosis of the underlying cause can be misleading, we investigated whether dermoscopy (onychoscopy) pre- and post-clipping of the onycholytic nail plate can provide reproducible patterns to distinguish these causes without the need for a biopsy. MATERIALS AND METHODS:In a multicenter retrospective image-based study, 60 onycholytic fingernails were examined (20 patients per diagnosis: psoriasis, onychomycosis, trauma). Onychoscopy of the intact plate was followed by clipping of the detached nail plate and dermoscopic assessment of the exposed nail bed under both dry and wet conditions. Color, amount, thickness, adherence, mobility ("wet test"), and distribution of subungual scales were recorded. Multinomial logistic regression assessed independent associations between dermoscopic features and diagnostic categories. RESULTS:After clipping, dermoscopy revealed distinct nail-bed patterns. Psoriasis showed a high scale amount (65%), white color (95%), thick (90%), strongly adherent (95%), and immobile scales (95%). Onychomycosis showed a moderate/high scale amount (95%), yellow/yellow-white color (90%), reduced adherence (80%), and mobility (65); when compared with psoriasis it showed higher odds of moderate-to-low scale amount (odds ratio [OR] 7.19), yellowish color (OR 6.02), reduced adherence (OR 75.19), and wet-test mobility (OR for absence 0.026). Trauma showed a low scale amount (75%), thin (85%), loosely adherent (65%), mobile scales (60%), and showed increased odds of reduced amount (OR 13.34), yellowish color (OR 7.15), and reduced adherence (OR 80.95). CONCLUSIONS:Combining pre- and post-clipping nail dermoscopy improves differentiation of psoriatic, onychomycotic, and traumatic onycholysis, supporting post-clipping nail bed dermoscopy as a simple adjunct that enhances diagnostic accuracy and management.

Background: Mycosis fungoides (MF) is the most common type of T-cell lymphoma and is characterized by the infiltration of the epidermis by small to medium-sized atypical T lymphocytes. Folliculotropic MF (FMF) is a rare clinicopathological variant of MF characterized by preferential infiltration of the follicular epithelium. Clinical presentation of FMF can vary from follicle-based patches to plaques, nodules, and tumors, with cicatricial or not alopecia. The most involved site is the head, especially the face. Objective: The aim of this review was to assess the main trichoscopic findings reported in scalp lesions. Methods: A comprehensive literature search of PubMed was performed. Results: Ten studies were included; the trichoscopic features reported were decreased number of pilosebaceous units, dotted dilated vessels, white/yellow scales, and perifollicular halos. The main clinical presentation reported were patchy alopecia or generalized alopecia. Most of the studies included were case reports, so studies with larger sample sizes are strongly needed to make trichoscopy a complementary diagnostic tool to improve the differential diagnoses between FMF and other scalp disorders. Conclusion: Trichoscopy plays a key role in diagnosing FMF of the scalp, revealing characteristic features such as milky-red globules, orange-yellow patches, comedones, and distinct vascular patterns.

Ritlecitinib, an oral Janus kinase (JAK) 3/tyrosine kinase expressed in hepatocellular carcinoma (TEC) family kinase inhibitor, demonstrated safety in patients aged 12 years and older with alopecia areata (AA) in an initial integrated analysis of 4 clinical studies for up to 2 years. This updated integrated safety analysis evaluated the safety of ritlecitinib up to 5 years in patients aged ≥ 12 years with AA from the ALLEGRO clinical trial program. Safety data were pooled from 4 studies. Two groups were analyzed: patients who received any dose of ritlecitinib (30 mg or 50 mg with or without a 4-week 200 mg loading dose, or 10 mg daily) (“any-ritlecitinib” group) and a subset of the any-ritlecitinib group including only patients who received ritlecitinib 50 mg daily with or without a 4-week 200 mg daily loading dose (ritlecitinib 50 mg ± 200-mg group). Safety data were summarized descriptively. Proportions and incidence rates (IRs; IR/100 patient-years [PYs]) of adverse events (AEs) were evaluated. In the ritlecitinib 50-mg ± 200-mg (N = 1228) and any-ritlecitinib (N = 1294) groups, median duration of exposure was 1197 days (3261.5 PYs) and 1204 days (3539.5 PYs), respectively. AEs occurred in 1070 patients (87.1

Scabies is an increasingly reported parasitic infestation in Europe, with rising clinical and public health relevance due to difficulties in containment and treatment. In October 2024, the Emilia-Romagna Region introduced free access to antiscabies medications for all confirmed cases and their contacts, and using monthly surveillance data from the Bologna metropolitan area (January 2020-August 2025), we assessed its intervention's impact. Forecasts predicted 1427 cases during the postintervention period (November 2024-August 2025), whereas 1030 cases were observed, corresponding to a reduction of nearly 400 cases compared to expectations. The decline was statistically significant and consistently below the model's 95% confidence interval, suggesting that, beyond any other intervention, universal cost coverage facilitates rapid treatment initiation and improved adherence, thereby containing transmission chains. This real-world evaluation provides quantitative evidence that free drug provision represents an effective population-level strategy to control scabies, reinforcing the need for equitable access to first-line therapies.

BACKGROUND:Non-melanoma skin cancer (NMSC) is a frequent long-term complication in transplant recipients, mainly due to chronic immunosuppression. Its incidence varies by transplant type and regimen, but existing evidence is often fragmented. OBJECTIVE:To assess long-term incidence and risk factors for NMSC, comparing transplant types, immunosuppressive regimens, and tumor subtypes. METHODS:This retrospective cohort comprised 901 transplant recipients (1975-2024) who were under long-term dermatologic follow-up. Data on transplant type, immunosuppressive regimen/duration, and tumor subtype were analyzed. NMSC-free survival was evaluated with Kaplan-Meier curves; Cox regression assessed predictors. RESULTS:Among 901 transplant recipients, 191 (21.2%) developed at least one NMSC during long-term follow-up. Crude incidence rates ranged between 1.88 and 2.68 per 100 person-years across immunosuppressive drug classes and agents. In multivariable Cox models, older age at first transplant was independently associated with higher NMSC risk (HR 1.07 per year, 95% CI 1.06-1.09, p < 0.001). Sex, transplant group, and ever-use of individual immunosuppressive agents were not significantly associated with NMSC risk after adjustment. CONCLUSION:In this long-term cohort, NMSC risk increased with age at first transplant, whereas transplant organ and ever-use of major immunosuppressive agents were not independently associated in adjusted models. Over an extended follow-up, NMSC accumulated steadily, with crude incidence rates around 1.88-2.68 cases per 100 person-years across immunosuppressive classes and agents, underscoring the cumulative nature of skin cancer risk under chronic immunosuppression. Our results reinforce the need for sustained, long-term dermatologic surveillance, particularly in older patients undergoing transplantation.

Introduction: It has been shown that patients with hair loss may experience reduced confidence, increased selfconsciousness, and low self-esteem. However, data concerning patients with lichen planopilaris (LPP) and frontal fibrosing alopecia (FFA) remain limited. Aim: The aim of the study was to assess the quality of life and psychological status of patients with LPP and FFA. Material and methods: In 83 patients with LPP and 79 patients with FFA, we assessed the health-related quality of life, disease perception, depression, anxiety and stress using dedicated questionnaires: DLQI, IPQ-B and DASS-21. Results: In 34% (28/83) of patients with LPP and 19% (15/79) of patients with FFA, the disease had at least a moderate effect on the patient's quality of life. In patients with LPP and FFA, positive correlations were observed between the DLQI and LPPAI (r = 0.406, p < 0.001 and r = 0.317, p < 0.01, respectively). Moderate or high threat was experienced by 59% (49/83) of patients with LPP and 61% (48/79) of patients with FFA. A moderate or severe stress level was noted in 42% (35/83) and 31% (24/79) of patients with LPP and FFA, respectively. In 29% (25/83) of patients with LPP and 20% (17/79) of patients with FFA, at least a mild depression level was observed. Only 10% (8/83) of patients with LPP reported a mild or moderate anxiety level. Stress was considered as the most common cause of the disease by 42% (35/83) of patients with LPP and 42% (33/79) of patients with FFA. Conclusions: Patients with LPP and FFA may experience a substantial impairment of the quality of life and stress, which, in their opinion, is a cause of their condition.

Introduction: Psoriasis is a chronic inflammatory skin disease frequently associated with systemic inflammation. Recently, blood cell-derived markers such as the Systemic Immune Inflammation Index (SII) and Systemic Inflammation Response Index (SIRI) have been proposed as potential biomarkers for disease activity and treatment monitoring. However, their clinical relevance in patients undergoing biological therapy, particularly IL-23 inhibitors, has not been fully explored. Objectives: To evaluate the utility of SII and SIRI in monitoring disease activity in patients with severe psoriasis treated with guselkumab, risankizumab, or tildrakizumab. Methods: This retrospective observational study included 120 patients with moderate-to-severe psoriasis treated with IL-23 inhibitors over 12 months. SII, SIRI, and Psoriasis Area and Severity Index (PASI) were assessed at baseline, six months, and 12 months. Correlations between inflammatory indices and some comorbidities were analyzed. Results: Despite significant PASI improvement across all treatment groups, SII and SIRI values showed inconsistent fluctuations and did not parallel clinical response. While SII decreased slightly in the tildrakizumab group, no consistent trend was observed in guselkumab and risankizumab cohorts. SIRI demonstrated similarly variable behavior. Weak-to-moderate correlations were noted between inflammatory indices and comorbidities such as obesity, diabetes mellitus, and hypertension. Conclusions: SII and SIRI do not reliably reflect treatment response in psoriasis patients receiving IL-23 inhibitors. Their variability and correlation with comorbidities suggest limited value as psoriasis-specific biomarkers. More targeted indicators are needed for accurate monitoring of systemic inflammation in this setting.

Infantile scabies can be challenging to treat because of behavioural and anatomical factors that reduce the efficacy of topical therapies. In this small prospective cohort study, there were 22 neonates and infants with persistent palmoplantar scabies. Patients were treated exclusively with permethrin 5% cream. All patients initially failed the standard regimen consisting of one full-body application, followed by a second -application after 7 days. In 1 group, 11 infants received an intensified regimen with 3 additional nights of targeted application to the hands and feet (intervention group), while in a second group, 11 continued with the standard regimen only (control group). Complete resolution was observed in all 11 patients in the intervention group, compared with none in the control group. Frequent infant behaviours, including spontaneous kicking, leg movements and habitual fist clenching, probably reduced drug contact time on the palms and soles. These findings indicate that standard topical regimens may be insufficient in this population and that targeted reapplication, combined with caregiver education, can optimize treatment outcomes in infants.