Several treatment options are currently available for the treatment of psoriasis.

Background Though patient needs are key drivers of treatment decisions, they are rarely systematically investigated in routine care. Objective This study aimed at analysing needs and expectations from the patient perspective in the German and Swiss psoriasis registries PsoBest and Swiss Dermatology Network of Targeted Therapies (SDNTT) with respect to treatment choice, age and gender. Methods The German and Swiss psoriasis registries observe patients recruited at first-time use of systemic drugs. Within 10 years, clinical [Psoriasis Area Severity Index (PASI), Body Surface Area (BSA)] and patient-reported outcomes are documented, including the Dermatology Quality of Life Index (DLQI) and the Patient Benefit Index (PBI), characterizing patient needs for treatment. The analysis data set includes n = 4894 patients from PsoBest and n = 449 from SDNTT with mean follow-up time of 7.5 months. Results A total of 5343 patients registered between 2008 and 2016 were included in the analyses (at baseline: 59.6% male, mean age 47.6 years +/- 14.5, PASI 14.2 +/- 9.7, BSA 22.7 +/- 19.7, DLQI 11.3 +/- 7.2). The most important patient needs were to 'get better skin quickly' and to 'be healed of all skin defects'. Subgroup analyses by age revealed significant differences in needs, especially higher needs regarding social impairments in patients younger than 65 years. Patients 65 years or older attributed more importance to sleep quality, less dependency on medical visits, fewer side-effects and confidence in the therapy. Out of 25 items reflecting patient needs, 20 items were rated significantly more important by women than men, with the greatest differences regarding feeling of depression, sleep quality and everyday productivity. Divided by treatment, needs were rated differently, recommending individualized and targeted choice of therapy. Conclusion Age and gender stratify patient needs. Women showed higher expectations and rated specific needs in psoriasis treatment higher than men. Analysing the patient needs on an individual level will facilitate shared decisions by patient and physician in finding the optimal personalized treatment.

Giuseppe Argenziano – Second University of Naples, Naples, Italy Perla Calderón – University of Chile, Santiago, Chile Lars E. French – University Hospital Zurich, Zurich, Switzerland Robert Gniadecki – Bispebjerg University Hospital, Copenhagen, Denmark Qiang Ju – Renji Hospital, Shanghai Jiao Tong University, Shanghai, China Brian Kirby – St. Vincent’s University Hospital, Dublin, Ireland Dan Lipsker – University of Strasbourg, Strasbourg, France Branka Marinović – University Hospital Center Zagreb, Zagreb, Croatia Tetsuo Shiohara – Kyorin University, Tokyo, Japan H. Peter Soyer – The University of Queensland, Woolloongabba, Australia Dae Hun Suh – Seoul National University, Seoul, Republic of Korea Jacek C. Szepietowski – University of Wroclaw, Wroclaw, Poland Christos C. Zouboulis – Dessau City Clinic, Dessau, Germany An International Journal founded as ‘Dermatologische Zeitschrift’ by Oskar Lassar (1893–1907) Continued by Erich Hoffmann (1908–1938), continued as ‘Dermatologica’ (1939–1991), by Wilhelm Lutz (1939–1958), Rudolf Schuppli (1959–1985) and J.-H. Saurat (1986–2015), continued as ‘Dermatology’ since 1992

Rosacea (in German sometimes called 'Kupferfinne', in French 'Couperose' and in Italian 'Copparosa') is a chronic and frequently relapsing inflammatory skin disease primarily affecting the central areas of the face. Its geographic prevalence varies from 1% to 22%. The differential diagnosis is wide, and the treatment is sometimes difficult and varies by stage of rosacea. For erythematous lesions and telangiectasia, intense pulsed light (IPL) therapy and lasers are popular treatment option. In addition, a vasoconstrictor agent, brimonidine, has recently been developed. For papulopustular rosacea, topical antibiotics, topical and systemic retinoids, as well as systemic antibiotics are used. A topical acaricidal agent, ivermectin, has undergone clinical development and is now on the market. In the later stages, hyperplasia of the sebaceous glands develops, resulting in phymatous growths such as the frequently observed bulbous nose or rhinophyma. Ablative laser treatments have largely replaced classical abrasive tools. Here, we reviewed the current evidence on the treatment of rosacea, provide a guideline (S1 level) and discuss the differential diagnosis of rosacea.

BACKGROUND:Eugène Follmann first described syphilitic balanitis as a manifestation of primary syphilis in 1948 and since then it has been known as syphilitic balanitis of Follmann (SBF). So far, SBF has rarely been described in literature.OBJECTIVES:We are reporting five additional cases of SBF considering the broad differential diagnosis of balanitis.METHODS:A review of the available literature of SBF was performed and five additional cases analyzed.RESULTS:In our case series, the clinical appearance of SBF shows a heterogeneous spectrum varying from painful oedematous balanoposthitis with beginning paraphimosis to superficial erosive balanitis and even to painless induration of the glans.CONCLUSIONS:SBF might be seen more frequently than has been described due to misinterpretation. Therefore primary syphilis should be included in the differential diagnosis of balanitis and balanoposthitis.

BACKGROUND:Nearly 10% of all cases of cutaneous melanoma (CM) occur in patients with a personal or family history of the disease.OBJECTIVES:To obtain information about genetic predisposition to CM in Ticino, the southern region of Switzerland, a zone with moderate-to-high CM incidence.METHODS:We identified germline mutations in highly CM-associated genes (CDKN2A and CDK4) and low/medium-penetrance variants (MC1R and MITF) in patients with multiple primary CMs or individuals with one or more CM and a positive family history for CM or pancreatic cancer among first- or second-degree relatives. Healthy blood donors (n = 146) were included as a control group.RESULTS:From July 2010 to July 2012, 57 patients (41 pedigrees) were included. Twenty-six were melanoma-prone families (with at least two cases) and 15 had multiple CMs. Pancreatic cancer was found in six families. The CDKN2A mutation p.V126D was identified in seven patients (four families) with a founder effect, whereas CDKN2A A148T was detected in seven cases (five families) and seven healthy donors (odds ratio 2·76, 95% confidence interval 0·83-9·20). At least one MC1R melanoma-associated polymorphism was detected in 32 patients (78%) and 97 healthy donors (66%), with more than one polymorphism in 12 patients (29%) and 25 healthy donors (17%). The MITF variant p.E318K was identified in four patients from three additional pedigrees (7%) and one healthy control (0·7%).CONCLUSIONS:Inclusion criteria for the Ticino population for genetic assessment should follow the rule of two (two affected individuals in a family or a patient with multiple CMs), as we detected a CDKN2A mutation in almost 10% of our pedigrees (four of 41), MITF p.E318K in 7% (three of 41) and a higher number of MC1R variants than in the control population.

Fumaric acid esters (FAEs) are effective in patients with moderate to severe psoriasis. Recent studies also report the efficacy of one FAE component, dimethylfumarate, in relapsing forms of multiple sclerosis (MS). We describe the case of a patient with MS who developed severe plaque psoriasis during interferon--1a treatment for MS. The psoriasis was unresponsive to usual topical treatments and phototherapy. The patient was started on FAE 720mg daily, with complete remission of the psoriatic lesions and neurological stabilization at follow-up at 24months. Our case suggests that FAEs could represent a therapeutic option for patients with MS who develop plaque psoriasis following exposure to immune-modulating agents.

Case Reports Patient 1. A 22-year-old woman, without notable medical history, without current medication, had complained for 1 year of recurrent episodes of erythema, followed by swelling, itching and desquamation to the distal portion of the right thumb ( fig. 1 a–c). The disease lasts about 2 weeks, it is self-remitting, and relapses are observed every month. The patient does not describe any trigger factor, in particular neither infections nor drugs, and does not present any prodromal phase. Blood analysis including white blood cell count, liver and renal function were normal, except a slight elevation of the blood sedimentation rate (38 mm/h). Bacterial culture of the pharyngeal cavity revealed a normal flora. Patient 2. A 66-year-old man was referred in April 2001 to our consultation due to recurrent episodes of erythema, swelling and lamellar peeling of his left thumb for 3 years ( fig. 2 ). He had recently been operated for a tubulovillous adenoma of the ileocaecal valve. These manifestations were just preceded by a slight general malaise, and no clear trigger factor was identified. The patient has presented about 5 episodes per year, and the evolution was spontaneously favourable in each case. Topical treatment with topical corticosteroids, vitamin D derivates or salicylic acid creams did not change the course of the disease. All the laboratory findings (blood count, blood sedimentation rate, liver thyroid and renal function, prostate and bowel tumour markers) and the swab of the pharyngeal cavity were normal. Patient 3. A 65-year-old woman had developed her first episode of erythema, swelling and scarlatiniform peeling of the right thumb ( fig. 3 ) in January 2006, without prodromal phase. No trigger factor was identified except a dental operation 6 weeks before.

We present an unusual case of a nevus of the nipple changing during pregnancy which caused a diagnostic pitfall. Nevi on the nipple and areola are infrequent, and diagnostic criteria for clinical, dermoscopy or reflectance confocal microscopy examination for nevi in this ‘special location’ are still missing. We comment on the literature on dermoscopic findings in mammary lesions and their management during pregnancy, as well as the challenging histopathology of nevi along the milk line. Finally, we focus on two main limitations of reflectance confocal microscopy: the misinterpretation of dendritic cells and the limitation of the imaging depth.

We report 3 cases of otherwise healthy infants with nodules on their soles. The nodules were present at birth or developed in early childhood. This condition has first been described in 1977 and was termed precalcaneal congenital fibrolipomatous hamartoma (PCFH). Since then the same entity has been reported under various denominations. The incidence of PCFH is underestimated, and it is important to recognize the benign nature of this disorder.