How to fight SARS-COV-2 vaccine hesitancy in patients suffering from chronic and immune-mediated skin disease: four general rules.

All public health ministries have implemented strategies to contain the spread of COVID-19 worldwide. Vaccines against SARS-CoV-2 still represent the most effective weapon to combat the circulation of the virus, in order to decrease the impact of COVID-19 on the general health of the population, to prevent the emergence of new SARS-CoV-2 variants and avoid excessive hospitalization. However, the success of a vaccination campaign largely depends on the penetrance of the message addressed to general population, which takes on an even more strategic value when vaccine candidates suffer from chronic diseases. In this view, patients suffering from immune-mediated skin diseases could represent a "weak link in the vaccine chain." Our main objective is to focus attention on four main elements in support of vaccination strategy in order to promote the patients' awareness to be at highest risk of negative consequences in case of SARS-Cov-2 infection, and to build, strengthen and maintain trust in vaccines' efficacy and safety.

Clinical and dermoscopic characteristics of congenital melanocytic naevi.

BACKGROUND: Prompted by the limited data, we conducted this study to gather more information on dermoscopic features of CN in children, in order to optimize clinical care and management. MATERIALS AND METHODS: All children with congenital nevi (CN) attending our Pediatric Pigmented Skin Lesion Unit during a 2-year period were included in the study. Clinical data were collected, and all children underwent clinical and dermoscopic examination. Dermoscopic patterns and specific features were recorded. RESULTS: Three hundred and thirty CN were examined in a population of 276 children, aged from 6 months to 14 years. The majority (85.14%) had only one congenital naevus, and 43.12% had a family history of congenital nevi. Children with multiple congenital nevi were more likely to have a positive family history of a CN (P = 0.012). Only, in 23 children, neurological/developmental abnormalities were reported. Small CN were the commonest in our cohort (167) followed by the medium-sized (160), whereas large CN (>20 cm) were only three. Thirty-eight CN were located on the volar skin. The globular was the commonest dermoscopic pattern, followed by the reticular, whereas the parallel furrow pattern was the commonest pattern on palms and soles. CN on the trunk were more likely to be globular on the limbs, and reticular and homogeneous on the head and neck (P < 0.001). The commonest dermoscopic findings were haloed and target globules, blotches and perifollicular hypopigmentation, whereas globules and dots around cristae on volar skin. CN located on the limbs were more likely to demonstrate an atypical network (P = 0.001) and a target network with globules (P = 0.020), whereas haloed and target globules (P < 0.001), blotches (P = 0.023) and dots (P = 0.004) were found with an increased frequency in CN on the trunk. CONCLUSIONS: Given that there is much controversy on the management and accurate classification of CN, our findings may provide useful information.

Psoriasis in children: a retrospective analysis.

BACKGROUND: Few epidemiological studies are available on childhood psoriasis. METHODS: Between 2005 and 2008, information was collected about all children diagnosed with psoriasis in the Pediatric Dermatology Unit of Andreas Sygros Skin Hospital, in Athens, Greece. RESULTS: A total of 125 children with psoriasis were examined, the male to female ratio was 1.4:1 and the peak age of onset was in the 9- to 10-year-old age group. Only 16% of the patients had a positive family history. Plaque type psoriasis was the most prevalent type at presentation with 56.8% of the children affected, followed by scalp involvement (33.6%). The limbs were the most prevalent site of involvement (70 children, 56%), followed by the body (59 children, 47.2%) and scalp (60 children, 48%) equally affected. Most of the children had <5% of their skin affected by psoriasis (53.2%). Age of onset had no influence on the severity of the disease (P=0.107), whereas a positive correlation was found with sex and severity of the disease, with male patients being more severely affected (P=0.008). Family history did not influence the age at presentation (P=0.68). Topical steroids were used in most commonly followed by keratolytics, calcipotriol, topical tacrolimus and topical pimecrolimus. CONCLUSION: Our study reflects the patterns of presentation of childhood psoriasis in sunny countries like Greece.

Treatment of nail psoriasis with a two-compound formulation of calcipotriol plus betamethasone dipropionate ointment.

BACKGROUND: Treatment of nail psoriasis remains a challenge. OBJECTIVE: To evaluate the efficacy of a two-compound product of calcipotriol plus betamethasone dipropionate ointment on nail psoriasis in an open-label study. METHODS: Twenty-five psoriatic patients with nail involvement and mild cutaneous psoriasis were instructed to apply a calcipotriol-betamethasone valerate ointment formulation once daily for 12 weeks on affected nails. Outcome measures were assessed at baseline and at weeks 4, 8 and 12 using the nail psoriasis severity index (NAPSI). RESULTS: Twenty-two patients having 114 nails involved at baseline with a mean NAPSI of 5.8 +/- 1.7 were followed up for 12 weeks. The mean NAPSI at the end of the treatment period was reduced to 1.6 +/- 0.6 presenting a 72% improvement. Significant improvement was observed for hyperkeratosis and onycholysis (reduction of mean hyperkeratosis NAPSI from 2.2 +/- 0.5 to 0.5 +/- 0.1 and mean onycholysis NAPSI from 2.0 +/- 0.6 to 0.4 +/- 0.2), moderate improvement for oil drops (reduction of mean oil drop NAPSI from 1.2 +/- 0.4 to 0.8 +/- 0.3) and slight improvement for pitting (reduction of mean pitting NAPSI from 0.8 +/- 0.2 to 0.6 +/- 0.2). CONCLUSIONS: The calcipotriol plus betamethasone dipropionate two-compound ointment, applied once daily for 12 weeks, was shown to improve nail psoriasis.

Efficacy and safety of tacrolimus ointment 0.1% vs. betamethasone 17-valerate 0.1% in the treatment of chronic paronychia: an unblinded randomized study.

BACKGROUND: Recent studies have established the pivotal role of irritants and allergens in development of chronic paronychia and the significant improvement with corticosteroid therapy. OBJECTIVES: The objective of this randomized, unblinded, comparative study was to compare the efficacy of tacrolimus ointment 0.1% vs. betamethasone 17-valerate 0.1% in the treatment of chronic paronychia. METHODS: Forty-five patients with chronic paronychia were randomized 1:1:1 to apply twice daily either betamethasone 17-valerate 0.1% or tacrolimus 0.1% ointment or emollient. Protective measures were counselled to all patients. Treatment duration was 3 weeks and patients were followed for an additional 6 weeks. RESULTS: Eight patients in the betamethasone group were considered as cured, two as improved and four as nonresponders at the end of the treatment period. Thirteen patients in the tacrolimus group were considered as cured and one as improved at the end of the treatment period. Nine patients in the emollient group were considered as stable and six failed to respond. Both betamethasone and tacrolimus groups presented statistically significantly greater cure or improvement rates when compared with the emollient group (P<0.001). CONCLUSIONS: Tacrolimus ointment appears to be a more efficacious agent than betamethasone 17-valerate or placebo for the treatment of chronic paronychia.

Flutrimazole shampoo 1% versus ketoconazole shampoo 2% in the treatment of pityriasis versicolor. A randomised double-blind comparative trial.

Flutrimazole is an imidazole derivative that has been proven to be efficient in superficial skin fungal infections. The aim of this randomised double-blind study was to compare for the first time, the efficiency and safety of flutrimazole 1% shampoo versus ketoconazole 2% shampoo in the treatment of tinea versicolor. Study population consisted of 60 patients with pityriasis versicolor diagnosed clinically and through direct microscopy and culture. Patients were randomly assigned to two groups: one instructed to apply flutrimazole shampoo 1% and one instructed to apply ketoconazole shampoo 2% both on head and body for 14 days. Patients were re-evaluated 14 days after the end of treatment clinically and through direct microscopy and culture. Twenty-one of 26 patients (80.8%) in the ketoconazole and 22 of 29 patients (75.9%) in the flutrimazole group had both visual healing and negative mycological evaluation. Comparison of the response between the two groups with the Yates' corrected chi-square was found statistically not significant (chi(2) = 0.19, d.f. = 1, P = 0.91). None of the patients in the two groups reported any adverse effects. Fourteen (53%) patients in the ketoconazole group and 23 (79%) in the flutrimazole group assessed the shampoos as cosmetically acceptable regarding texture, smell and foam properties. Flutrimazole shampoo 1% appears to present efficacy comparable with ketoconazole 2% in the treatment of tinea versicolor.

Superficial chemical peels.

Superficial chemical peeling (SCP) involves the application of a peeling agent to the skin, resulting in destruction of part or all of the epidermis. SCP is mainly recommended for facial rejuvenation, photoaging and superficial rhytides, pigmentary dyschromias and acne. It can be used on all Fitzpatrick skin types, no sedation is needed, and the desquamation is usually well accepted. Overpeel and complications are very rare. The most commonly used SCP agents are glycolic acid 20-70%, trichloroacetic acid 10-35%, Jessner's solution, salicylic acid, pyruvic acid, resorcinol 30-50% preparations, and solid carbon dioxide. The careful selection of patients is critical for the outcome of a SCP and contraindications must be seriously considered. The peel procedure is generally common for all SCP agents but a good knowledge of the specific characters of each agent is of great importance in order to decide which to use for each individual patient.

Tacrolimus ointment 0.1% in pityriasis alba: an open-label, randomized, placebo-controlled study.

BACKGROUND: Pityriasis alba (PA) is a frequent reason for dermatological consultation because of its chronic course, tendency to relapse and aesthetic impact. OBJECTIVES: In view of its strong association with atopic dermatitis, the objective of this open-label study was to assess the efficacy and safety of tacrolimus ointment in the treatment of PA compared with the efficacy of moisturizers. PATIENTS/METHODS: The study population consisted of 60 individuals of phototype III or IV according to Fitzpatrick's classification, aged 6-21 years. Patients were randomly assigned to one of two groups. Subjects in group A were instructed to apply tacrolimus ointment 0.1% twice daily, 12 h apart, on all hypopigmented macules. Standard moisturizers with SPF 20 sunscreen were used on all lesions applied at least 30 min apart from the tacrolimus ointment. Subjects in group B used solely the same moisturizers with sunscreen. Hypopigmented areas were evaluated at baseline and weeks 0, 3, 6 and 9 by investigators for scaling, hypopigmentation and pruritus on a scale of 0-3. Patient satisfaction was also recorded on a scale of 0-3. All adverse effects were recorded. RESULTS: A statistically significant improvement through time, in hypopigmentation, pruritus and scaling was observed in both groups during the course of 9 weeks. Hypopigmentation resolved from a baseline score of 2.38+/-0.64 to 1.15+/-0.54 at week 3, 0.46+/-0.51 at week 6 and 0.00+/-0.00 at week 9 for the group applying tacrolimus ointment 0.1%. The difference in improvement between the two groups was statistically significant on all three assessments for hypopigmentation (P<0.001), and for pruritus on week 6 and 9 assessments (P<0.05). Three patients (11.5%) in the tacrolimus group reported a mild transient sensation of burning. All patients in the tacrolimus group reported they were completely satisfied or just satisfied with the treatment compared with only 50% of patients using the placebo. CONCLUSIONS: Tacrolimus ointment 0.1% appears to be an effective and safe treatment for PA.