Dermatology practical & conceptual最新文献

Introduction: Dermatological conditions affecting the nails can manifest differently in individuals with distinct skin tones. This often leads to difficulty in the recognition of nail diseases, especially in people with skin of color (SoC), who are not well represented in the literature.

Objectives: Our aim was to provide dermatologists with useful clues for prompt recognition and diagnosis of nail psoriasis (NPso) and nail lichen planus (NLP) in people with SoC.

Methods: We described the ungual manifestations of NPso and NLP in a population of 30 patients with SoC. Diagnosis was primarily based on clinical examination; in cases of diagnostic uncertainty, a biopsy of the nail matrix was performed to obtain histological conclusive evidence.

Results: Of the 30 people with SoC in the analysis, 24 patients had NPso with a median Fitzpatrick phototype of 4.77, and six patients had NLP with a median Fitzpatrick phototype of 5. Regarding the 24 patients with NPso, 10 presented with trachyonychia, nine displayed nail pitting, eight showed onycholysis, and 12 had subungual hyperkeratosis, while splinter hemorrhages were visible in two patients, and activation melanonychia was discernible on the nail plates of eight patients. Of the six patients diagnosed with NLP, all had post-inflammatory pigmentation on the proximal nail, with three patients exhibiting trachyonychia and three others having longitudinal fissures; subungual hyperkeratosis was found in five patients, while three patients displayed activated melanonychia.

Conclusion: People with SoC exhibit a peculiar clinical presentation of both NPso and NLP, and a better understanding is essential to providing timely and effective care.

Introduction: Lichen planus pigmentosus (LPP) is an acquired pigmentary disorder affecting the dark-skinned population. There is a wide range of differentials, with substantial clinicopathological overlap. Dermoscopy may contribute to the better characterization of this dermatosis.

Objective: This study aimed to describe dermoscopic features of LPP with a histopathological correlation.

Methods: LPP lesions of 23 patients were studied using a polarized dermoscopy, followed by histological evaluation.

Results: The most common dermoscopic finding was dots and/or globules (n=23) in different patterns: speckled (n=4), dotted (n=2), reticular (n=4), diffuse (n=9), hem-like (n=1), and circular (n=2). Other patterns were exaggerated pseudo-reticular pattern (n=12), sparing of follicular openings (n=23), targetoid appearance (n=3), blue-white veil (n=5), rosettes (n=5), erythema (n=4), and telangiectasia (n=7). Histological findings included pigment incontinence (n=23), the severity being mild (n=8) and severe (n=15). We found a statistically significant association between the intensity of pigmentary incontinence on the histological examination and the presence of blotches in dermoscopy (P=0.046) and between blue-white veil and rosettes in flexural areas (P=0.01). Also, a statistical relationship was found between severe pigment density (reticulated and diffused patterns) and short disease duration (P=0.016).

Conclusion: We describe LPP dermoscopic changes according to disease progression. We found that blotches are indicative of long-duration disease and could be specific dermoscopic features of LPP. We demonstrate that a blue-white veil associated with rosettes could be pathognomonic features of LPP inversus.

Introduction: Tildrakizumab, a humanized monoclonal antibody targeting the p19 subunit of interleukin 23 (IL-23), has shown promise in the management of moderate-to-severe plaque psoriasis, offering potential improvements in clinical outcomes and quality of life.

Objectives: The study aimed to identify patient characteristics that indicate the initiation of a 200 mg dosage of tildrakizumab in a real-world setting, focusing on factors that enhance treatment effectiveness and safety.

Methods: This prospective study included 54 adult patients with moderate-to-severe plaque psoriasis treated with tildrakizumab 200 mg from March 2023 to March 2024 across 13 Italian Dermatology Units. Data collected included demographics, disease duration, comorbidities, and previous treatments. PASI, BSA, and DLQI scores were recorded at baseline and at weeks 4, 16, and 28. Safety was assessed through adverse event reporting. Univariate analysis was performed to identify baseline characteristics significantly associated with achieving PASI ≤ 5 at week 16.

Results: Significant reductions in PASI scores were observed at week 4 (9 ± 6.9, P < 0.001), with further improvements at weeks 16 (3.9 ± 4.2, P < 0.001) and 28 (2.9 ± 4.4, P < 0.001). Univariate analysis showed that obese patients (BMI > 30) had higher odds (OR = 4.333, P < 0.05) of achieving PASI ≤ 5. Longer disease duration and starting with a 100 mg dosage also correlated with better outcomes. The safety profile was favorable, with minimal adverse events reported.

Conclusions: Tildrakizumab 200 mg is effective and safe for moderate-to-severe psoriasis, particularly in obese patients. These findings support its use as a long-term treatment option.