BACKGROUND:Nail squamous cell carcinoma (NSCC) is the most common nail malignancy, yet it is under-recognized because of its variable presentation. OBJECTIVE:Characterize demographic and clinical characteristics associated with in situ (NSCCis) and invasive (iNSCC) NSCC and evaluate treatment outcomes in a multinational cohort. METHODS:Two-hundred-sixty-nine NSCCs (261 patients) were retrospectively reviewed. NSCCis and iNSCC characteristics were compared using t-tests/chi-square and multinomial logistic regression. RESULTS:NSCC mainly affected the right index and middle fingers and bilateral thumbs (62%), predominantly in men (72.4%) in their sixth decade. Koilocytosis, used to determine human papilloma virus (HPV) status, was detected in 32.2% of tumors (15 polymerase chain reaction-confirmed), and this was more common in NSCCis (P = .015). Subungual ooze independently predicted iNSCC (odds ratio = 3.98; 95% CI = 1.19-13.2; P = .025), while pain (P = .022) and nail plate loss (P = .004) were associated with iNSCC on univariate analysis. Mohs micrographic surgery was the most common treatment (39.5%). Overall recurrence was 9.7%, with no difference among treatments (P > .05). LIMITATIONS:Retrospective design and histopathology-based HPV status. CONCLUSIONS:NSCC presents as a periungual papule/plaque with horizontal growth and a warty appearance, or as an oozing subungual ulcerating tumor, dermally invasive. Periungual NSCC is associated with HPV, often sexually transmitted. HPV-related cases are typically NSCCis. Digit-sparing surgery is first-line treatment, with comparable efficacy across modalities.

Secukinumab has demonstrated sustained efficacy and a favorable safety profile in clinical trials, providing relief from psoriatic symptoms. 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 psoriasis (PsO). SERENA (CAIN457A3403) is a longitudinal, observational study conducted at 438 sites and 19 countries for up to 5 years in adult patients with moderate to severe PsO, psoriatic arthritis, and ankylosing spondylitis. Patients received secukinumab treatment for ≥ 16 weeks before enrollment. This manuscript presents the 5-year data from the SERENA study in patients with moderate to severe PsO. Overall, 1740 patients (67.5 Plaque psoriasis is a skin condition that causes red, scaly patches and can greatly affect a person’s quality of life. Secukinumab is a medicine specifically designed to block interleukin-17A, a protein found in high amounts in people with plaque psoriasis. Studies have shown that secukinumab works well and is generally safe, but it is important to understand patients’ experiences with secukinumab in everyday life over time. The SERENA study followed 1740 adults with moderate to severe plaque psoriasis across 19 countries for up to 5 years. All participants had been taking secukinumab for at least 16 weeks before joining the study. This study assessed the number of people who continued using secukinumab over time (retention), its long-term effectiveness in controlling psoriasis symptoms, and its safety. The results showed that almost 60

BACKGROUND:Yellow nail syndrome (YNS) is a rare syndrome with unknown pathogenesis characterized by a clinical triad of respiratory disease, lymphedema, and xanthonychia. Diagnosis is challenging as clinical manifestations often do not occur concurrently. Due to disease rarity, few studies to date have characterized YNS or assessed therapeutics. OBJECTIVE:We aimed to characterize clinical findings of YNS and compare therapeutic regimens to provide diagnostic and management recommendations. METHODS:An international multi-institutional retrospective cohort study of YNS patients was conducted by a panel of nail experts. RESULTS:We included 111 YNS patients. Xanthonychia, increased transverse curvature, thickening, nail growth arrest, and a history of respiratory disease or lymphedema were highly suggestive of YNS. The therapeutic regimen with highest complete response rate was oral vitamin E combined with oral azole antifungals. LIMITATIONS:Limitations include nonrandomized and retrospective design. Clinical details were inconsistently reported. Some treatments discussed are expert opinions and based on hypothetical and/or minimal data. CONCLUSION:We provide the largest study to date characterizing YNS. We suggest that patients with suspected YNS undergo mycologic examination and referral to pulmonology. We recommend oral vitamin E with oral azole antifungal as the first-line therapy for YNS. Reassurance/no treatment could also be considered.

BACKGROUND:Nail psoriasis (NP) affects up to 90% and 86% of patients with cutaneous psoriasis and psoriatic arthritis, respectively, with a significant impact on quality-of-life. The Nail Psoriasis Severity Index (NAPSI) is infrequently used in clinical practice owing to its labor-intensive nature and variable interobserver reliability. OBJECTIVE:The objective of this study was to assess performance and inter-reader agreement between artificial intelligence (AI)-determined NAPSI scores and dermatologist-assigned scores. METHODS:This cross-sectional study used clinical images of psoriatic fingernails captured retrospectively at a specialized nail clinic in New York City. A convolutional neural network (CNN) model was trained and utilized for NAPSI classification of psoriatic fingernail clinical images, with seven dermatologist nail experts scoring identical images. The primary outcome was the interclass correlation coefficient (ICC), using a one-way analysis of variance (ANOVA) fixed effects model for the single-rater absolute agreement, between the average NAPSI score determined by the dermatologists and the AI. RESULTS:In total, 240 images of psoriatic fingernails were included. The ICC for overall NAPSI, matrix (NAPSIm), and bed (NAPSIb) scores among the dermatologists were 0.43 (95% confidence interval [CI] 0.33-0.55), 0.56 (95% CI 0.46-0.67), and 0.53 (95% CI 0.43-0.65), respectively. Comparing the AI algorithm-assigned NAPSI, NAPSIm, and NAPSIb scores with the average dermatologist-assigned scores, ICCs were 0.81 (95% CI 0.74-0.86), 0.75 (95% CI 0.65-0.82), and 0.81 (95% CI 0.74-0.86), respectively. CONCLUSIONS:We found an excellent correlation between AI-derived NAPSI scores and dermatologist-assigned scores, underscoring the potential of CNNs to improve accuracy and reliability in NAPSI scoring. The limitations of this study include the small sample size, undetermined CNN diagnostic accuracy, incomplete data, and potential racial/ethnic minority group underrepresentation.

Nail psoriasis (NP) is an autoimmune condition that affects approximately 80-90% of individuals with cutaneous plaque psoriasis and 80% of patients with psoriatic arthritis. Though the condition can be challenging to treat, there are several effective conventional treatments including intralesional corticosteroid injections, vitamin D analogues, and biologic medications. Patients may prefer natural remedies for their NP for a holistic healthcare approach, lower cost, or safety profiles. This review explores the existing research on efficacy of oral omega-3 fish oil and vitamin supplementation, as well as topical indigo naturalis for NP. We also discuss data on dietary associations with NP. The data supporting natural treatments for NP is promising, however, further randomized control trials are necessary to establish clinical guidelines. As of now, natural treatments could be considered as adjunct, but not standalone treatments for NP.

Introduction: Rosacea is a common chronic inflammatory dermatosis characterized by erythema, telangiectasia, papules, and pustules on the central face. The frequency of contact sensitization complicating rosacea and its therapy is unknown, with only few studies published in the literature. In the present study, we aimed to evaluate contact sensitivity in patients with rosacea. Methods: A total of 50 rosacea patients and 50 age- and sex-matched healthy controls were enrolled. Both groups were patch tested with the European Baseline Series. Results: A positive reaction to at least one allergen of the European Baseline Series was observed in 15 (30%) of rosacea patients and 10 (20%) of the healthy controls. Although the rate of positive reaction in the rosacea group was higher than in the controls, no statistically significant difference was documented. In addition, the total number of positive reactions to allergens in the rosacea group was higher than the control group, namely, 26 versus 17. Conclusion: Contact hypersensitivity may coexist with rosacea. Its identification holds significant clinical relevance, influencing the long-term management and justifying the application of patch testing in rosacea patients.

Background: Hidradenitis suppurativa (HS) is a chronic inflammatory skin disorder with a significant impact on the quality of life of affected patients. This study aimed to correlate serum inflammatory markers with specific tools assessing quality of life, emotional well-being, and loneliness, such as the Dermatology Life Quality Index (DLQI), Hospital Anxiety and Depression Scale (HADS), and the UCLA Loneliness Scale. Methods: A pilot observational study including 37 patients with HS was conducted. Inflammatory serum markers, including C-reactive protein (CRP) and Erythrocyte Sedimentation Rate (ESR), were evaluated at baseline, 3 months, and 6 months later. Psychometric scores were also evaluated at the same study intervals. Results: DLQI was correlated with ESR at baseline (Spearman’s rho = 0.35, p = 0.03), indicating that poorer quality of life is associated with changes in this serum marker. Disease activity, as reflected by inflammatory markers, was associated with significant psychological burden. Specifically, a worse DLQI score was associated with higher ESR (estimate β = 0.14, 95% confidence interval [CI]: 0.05–0.22; p = 0.001) and higher CRP level (estimate β = 0.25, 95% CI: 0.02–0.48; p = 0.02). Similarly, a worse UCLA score was associated with higher ESR (estimate β = 0.11, 95% CI: 0.02–0.20, p = 0.01). Conclusions: Our study results underline the close relation between systemic inflammatory markers and clinical severity together with psychological burden in HS patients, as indicated by the significant association that was revealed between ESR/CRP and poorer psychometric scores. However, further research is warranted to validate these findings.

Introduction: Alopecia areata exhibits diverse clinical forms, encompassing the less common variant, sisaipho. Clinical observations suggest its unique ability to emulate both male and female pattern hair loss, implying a potential androgenic influence akin to androgenetic alopecia. Case Presentations: Herein, we present 3 cases of alopecia areata in adults exhibiting a male or female pattern distribution or accentuation. Conclusion: To improve diagnosis and differential diagnosis of alopecia, the term “alopecia areata in a male or female pattern distribution” may be introduced as a new clinical subtype of alopecia areata. This new subtype could also integrate sisaipho. By introducing this refined terminology, we seek to improve our comprehension of the condition, enabling more precise diagnoses and tailored treatment approaches.

Background: Nail involvement is very frequent in psoriasis and may significantly affect patients’ quality of life due to clinical and functional impairment. In addition, nail psoriasis constitutes a negative prognostic factor for the development of psoriatic arthritis (PsA), even in the absence of cutaneous disease. Summary: Herein we provide an updated review on the diagnostic evaluation of nail psoriasis using clinical assessment and implementation of imaging techniques including dermoscopy, capillaroscopy, ultrasonography, and optical coherence tomography. In addition, we summarize consensus guidelines for the management of nail psoriasis and provide efficacy data on the use of intralesional, topical, and the most recently approved targeted systemic therapies. Key Messages: Physicians should be aware of the importance of prompt diagnosis and management of nail psoriasis, to improve patient outcomes and decrease the risk of PsA development.

Background: Subungual melanoma (SUM) is a rare type of cutaneous malignant melanoma (CMM) associated with poor prognosis, while data regarding its prevalence are scarce. Objectives: We sought to provide a comprehensive systematic review and meta-analysis of the prevalence rates of SUM among all types of CMM, considering certain demographic and clinical characteristics. Methods: The MEDLINE electronic database was searched systematically to identify eligible studies providing prevalence rate estimates of SUM in patients with CMM. Included studies were further analysed to estimate the relative prevalences of SUM according to study design, study years, geographical region and sex distribution. Results: Twenty-eight studies met the inclusion criteria. The overall SUM prevalence was 1.9% (95% CI [1.5%-2.3%]). The prevalence of SUM did not differ significantly between population-and hospital-based studies and remained stable over time. However, it was found to be significantly higher in Asians compared to patients of other geographical regions as well as in studies with more men than women compared to those with female preponderance (p < 0.001). Conclusions: In all, the overall SUM prevalence among all subtypes of CMM was estimated at 1.9%, without significant changes over time, and was found to exhibit significant variability between subgroups of different geographical regions.

Amicrobial pustulosis of the folds: long-term remission achieved with

Le brodalumab est un anti-IL17 indiqué dans le psoriasis modéré à sévère. BrIDGE est une étude observationnelle grecque, prospective, multicentrique dont l'objectif principal était d'évaluer l'efficacité du brodalumab en vraie vie. Le critère d'évaluation principal était la proportion de patient ayant atteint le PASI 100 à la semaine 24. Les critères secondaires principaux d'évaluation étaient le pourcentage de patient ayant atteint un PASI100 à S12/16, 52 et 104. Le maintien de la réponse chez les patients ayant répondu a été évaluée via le pourcentage de patients maintenant un PASI100 à S52 et 104 après avoir atteint un PASI100 à S24 La qualité de vie a également été évaluée à travers le DLQI, et le pourcentage de patient atteignant un DLQI de 0 ou 1 à S12/16, S24, 52, 104. 200 patients atteints de psoriasis en plaques modéré à sévère ont été inclus. À l'inclusion, le score moyen (écart-type [ET]) de l'indice dermatologique de qualité de vie (Dermatology Life Quality Index; DLQI) était de 12,9 (7,3) et le score total moyen (ET) de l'indice de sévérité du psoriasis rapporté aux surfaces atteintes (Psoriasis Area and Severity Index; PASI) était de 17,3 (9,1). En ce qui concerne le critère d'évaluation principal à la semaine 24, 42% (71/169) ont obtenu un score PASI 100. Concernant les critères d'évaluation secondaire, les proportions de patients à S12/16, à S52 et à S104 étaient, respectivement, de 32% des patients (58/181), 51,3% (80/156) et de 65% (89/137). Parmi les patients ayant obtenu un score PASI 100 à S24, 89,6% et 90,2%, respectivement, ont conservé un score PASI 100 à S52 et 104. Le score PASI total moyen (ET) était de 3,9 (7,7) à S12/16, de 1,8 (3,6) à S24 de 1,5 (4,3) à S52 et de 1,0 (2,1) à S104. 44 ont arrêté le traitement par brodalumab. Le délai moyen (ET) avant l'arrêt du traitement était de 36,1 (26,4) semaines. À la fin du traitement, 25 patients sont passés à un autre traitement. Concernant l'évaluation de la qualité de vie, à S12/16, le score DLQI moyen (ET) était de 3,8 (5,3). Les scores respectifs pour à S24, 52 et 104 étaient de 2,2 (3,9), de 1,4 (3,3) et de 0,6 (1,4). Les proportions de patients ayant obtenu un score DLQI 0 ou 1 aux Visites 2, 3 et 4 étaient respectivement de 59,9%, de 71,6% et de 85,4%. L'efficacité d'un traitement utilisé dans la prise en charge du psoriasis modéré à sévère peut être mesurée à travers l'évolution du score PASI chez les patients traités. La mesure du DLQI permet également d'évaluer l'impact d'un traitement sur la qualité de vie des patients. Cette analyse montre des améliorations cliniquement significatives chez les patients atteints de psoriasis en plaques modéré à sévère après un traitement par brodalumab d'une durée moyenne de 86,7 semaines. L'efficacité est évaluée par une réduction du score PASI et du score DLQI.

Atopic dermatitis (AD) is a chronic relapsing, inflammatory skin disease with a significant impact on the quality of life of patients. The aim of this consensus was to investigate the unmet medical need in the management of adult patients suffering from moderate-to-severe AD in Greece. Initially, an extensive literature review was conducted on diagnosis, epidemiology, disease burden, treatments and AD guidelines to develop preliminary statements. In the second phase, these statements were validated, new ones were added when necessary, and finally, voted through the Delphi method by a consensus panel of medical experts-dermatologists. In the third and final phase, the validated statements were presented to a second consensus group of clinical expert-dermatologists for final vote and strength-ening of the consensus. In total, 15 clinicians participated in the processes of formulation, validation and voting of 35 statements. In the final consensus, agreement rates ranged from 75% to 100% on 97.14% of the total statements. The prevalence and burden of moderate to severe AD is high, necessitating better therapeutic management of the disease. Therefore, there is an emerging need for new, more effective and safer treatment options in moderate to severe AD in Greece. New biological therapies and small molecules are supported by high efficacy and a favorable safety profile. The development of Greek guidelines and a therapeutic protocol, defining the prescribing framework for the new innovative therapies, would significantly contribute to the optimization of the disease management.

Journal of the European Academy of Dermatology and VenereologyVolume 37, Issue 3 p. e350-e351 LETTER TO THE EDITOR Monkeypox virus infection: First reported case in Greece in a patient with a genital rash Vassilios Paparizos, Vassilios Paparizos 1st Department of Dermatology and Venereology, National and Kapodistrian University of Athens Medical School, “Andreas Sygros” Hospital for Skin and Venereal Diseases, Athens, GreeceSearch for more papers by this authorElectra Nicolaidou, Corresponding Author Electra Nicolaidou [email protected] orcid.org/0000-0002-8221-0217 1st Department of Dermatology and Venereology, National and Kapodistrian University of Athens Medical School, “Andreas Sygros” Hospital for Skin and Venereal Diseases, Athens, Greece Correspondence Electra Nicolaidou, 1st Department of Dermatology and Venereology, National and Kapodistrian University of Athens Medical School, “Andreas Sygros” Hospital for Skin and Venereal Diseases, 5 I. Dragoumi str, GR-16121, Athens, Greece. Email: [email protected]Search for more papers by this authorKyriakh Tryfinopoulou, Kyriakh Tryfinopoulou Central Public Health Laboratory, National Public Health Organization, Athens, GreeceSearch for more papers by this authorAnna Papa, Anna Papa Department of Microbiology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, GreeceSearch for more papers by this authorDimitris Rigopoulos, Dimitris Rigopoulos orcid.org/0000-0002-4841-7484 1st Department of Dermatology and Venereology, National and Kapodistrian University of Athens Medical School, “Andreas Sygros” Hospital for Skin and Venereal Diseases, Athens, GreeceSearch for more papers by this authorSotirios Tsiodras, Sotirios Tsiodras 4th Department of Internal Medicine, National and Kapodistrian University of Athens Medical School, Athens, GreeceSearch for more papers by this authorAlexander Stratigos, Alexander Stratigos 1st Department of Dermatology and Venereology, National and Kapodistrian University of Athens Medical School, “Andreas Sygros” Hospital for Skin and Venereal Diseases, Athens, GreeceSearch for more papers by this author Vassilios Paparizos, Vassilios Paparizos 1st Department of Dermatology and Venereology, National and Kapodistrian University of Athens Medical School, “Andreas Sygros” Hospital for Skin and Venereal Diseases, Athens, GreeceSearch for more papers by this authorElectra Nicolaidou, Corresponding Author Electra Nicolaidou [email protected] orcid.org/0000-0002-8221-0217 1st Department of Dermatology and Venereology, National and Kapodistrian University of Athens Medical School, “Andreas Sygros” Hospital for Skin and Venereal Diseases, Athens, Greece Correspondence Electra Nicolaidou, 1st Department of Dermatology and Venereology, National and Kapodistrian University of Athens Medical School, “Andreas Sygros” Hospital for Skin and Venereal Diseases, 5 I. Dragoumi str, GR-16121, Athens, Greece. Email: [email protected]Search for more papers by this authorKyriakh Tryfinopoulou, Kyriakh Tryfinopoulou Central Public Health Laboratory, National Public Health Organization, Athens, GreeceSearch for more papers by this authorAnna Papa, Anna Papa Department of Microbiology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, GreeceSearch for more papers by this authorDimitris Rigopoulos, Dimitris Rigopoulos orcid.org/0000-0002-4841-7484 1st Department of Dermatology and Venereology, National and Kapodistrian University of Athens Medical School, “Andreas Sygros” Hospital for Skin and Venereal Diseases, Athens, GreeceSearch for more papers by this authorSotirios Tsiodras, Sotirios Tsiodras 4th Department of Internal Medicine, National and Kapodistrian University of Athens Medical School, Athens, GreeceSearch for more papers by this authorAlexander Stratigos, Alexander Stratigos 1st Department of Dermatology and Venereology, National and Kapodistrian University of Athens Medical School, “Andreas Sygros” Hospital for Skin and Venereal Diseases, Athens, GreeceSearch for more papers by this author First published: 14 August 2022 https://doi.org/10.1111/jdv.18521Citations: 5Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onEmailFacebookTwitterLinkedInRedditWechat No abstract is available for this article. REFERENCES 1 Monkeypox multi-country outbreak, 2022. URL https://www.ecdc.europa.eu/en/monkeypox-outbreak, assessed on June 15th. Google Scholar 2Hughes AL, Irausquin S, Friedman R. The evolutionary biology of poxviruses. Infect Genet Evol. 2010; 10: 50–9. 10.1016/j.meegid.2009.10.001 CASPubMedWeb of Science®Google Scholar 3Di Giulio DB, Eckberg PB. Human monkeypox: an emerging zoonosis. Lancet Infect Dis. 2004; 4: 15–25. 10.1016/S1473-3099(03)00856-9 PubMedWeb of Science®Google Scholar 4Bragazzi NL, Kong JD, Mahroum N, Tsigalou C, Khamisy-Farah R, Converti M, et al. Epidemiological trends and clinical features of the ongoing monkeypox epidemic: a preliminary pooled data analysis and literature review. 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Background Real-world data in patients with moderate psoriasis treated with apremilast is limited. Objectives To evaluate the effectiveness and safety of apremilast in bio-naive patients with moderate psoriasis in real-world clinical settings. Methods This was a 52-week multicenter, observational, prospective study of adult outpatients with moderate psoriasis {[10% < body surface area < 20% or 10 < psoriasis area severity index (PASI) < 20] and 10 < dermatology quality of life index (DLQI) < 20} initiated on apremilast <= 7 days before enrollment. Missing data were imputed using the last observation carried forward method. Results A total of 287 eligible patients (median age: 54.2 years; median psoriasis duration: 9.8 years) were consecutively enrolled. At baseline, the median DLQI and PASI scores were 12.0 and 11.8, respectively. The 52-week DLQI <= 5 and PASI75 response rates were 68.3% and 61.0%. At 52 weeks, 70.8% and 72.7% of the patients shifted from moderate/severe/very severe to clear/minimal scalp and palmoplantar psoriasis involvement, respectively; the pruritus severity state improved in 67.2%. The 52-week Kaplan-Meier estimated drug continuation rate was 85.3%. The adverse drug reaction rate was 19.9%. Conclusions Apremilast is a safe and effective treatment for bio-naive patients with moderate psoriasis and specific psoriasis manifestations.