Psoriasis is an immune system disorder induced by the interaction of the polygenic background and environmental factors. Tumor necrosis factor‐α (TNF‐α)‐induced protein 8‐like 2 (TNFAIP8L2, TIPE2), a regulator of immunity, is differentially expressed in tumors, inflammation, and autoimmune diseases. However, to our knowledge, no study has evaluated TIPE2 expression in patients with psoriasis vulgaris. The present case‐control study aimed to determine the expression levels of TIPE2 mRNA in the peripheral blood mononuclear cells (PBMCs) of patients with psoriasis vulgaris and analyze the correlation between TIPE2 and other inflammatory cytokine variations in the pathogenesis of psoriasis vulgaris. Thirty‐three patients with psoriasis vulgaris and thirty‐one healthy volunteers were enrolled from October 2021 to March 2022. The mRNA expression levels of TIPE2, RELA (NF‐κb p65), TNF‐α, IL‐10, IL‐6, and IL‐1β in PBMCs were determined using qPCR. The severity of psoriasis vulgaris was determined according to the Psoriasis Area and Severity Index (PASI) scores. TIPE2 mRNA expression significantly decreased, while the expression of RELA, TNF‐α, IL‐10, IL‐6, and IL‐1β increased in patients with psoriasis vulgaris compared with that in the healthy control group. In addition, the expression levels of TIPE2, RELA, TNF‐α, and IL‐1β positively correlated with the PASI score. TIPE2 mRNA expression negatively correlated with IL‐6 and positively correlated with TNF‐α. Moreover, TIPE2 mRNA expression was higher in the active stage than that in the stationary stage. Notably, TNF‐α expression levels were higher in patients with psoriasis vulgaris combined with a history of respiratory infection. TIPE2 may contribute to the pathogenesis of psoriasis and be a potential biomarker of psoriasis vulgaris.

Background. The global impact of coronavirus 2019 (COVID‐19) has raised concerns about the management of psoriasis patients, especially among those using biologics. Methods. We conducted a survey‐based research among Omicron‐infected (confirmed, probable, and suspected ones) psoriasis patients in the department of dermatology, West China Hospital, Sichuan University, from January 9th to January 22nd, 2023. We collected demographic and clinical information (psoriasis‐ and COVID‐19‐related) and conducted statistics analysis. Results. Of the 240 patients enrolled, they were classified by the psoriatic treatment, as biologics (n = 138), nonbiological systematic treatment (n = 52), and topical treatment or without pharmacological treatment (n = 50). This study showed the characteristics of Omicron‐related symptoms and cutaneous signs in patients. We observed that patients who received topical treatment or without pharmacological treatment had a lower risk of presenting with COVID‐19 symptoms in the fully adjusted logistic model (OR = 0.40, 95% CI: 0.18–0.90, and P = 0.025). Moreover, in the model for skin manifestations, nonbiological systematic treatment (OR = 2.15, 95% CI: 1.08–4.27, and P = 0.029) and high BMI (OR = 1.10, 95% CI: 1.00–1.20, and P = 0.042) were correlative factors. Conclusions. Our data suggested that differential psoriatic treatment might be a correlative factor in developing symptomatic or asymptomatic Omicron infection and presenting cutaneous signs.

One of the methods used to prevent symptoms of skin aging are chemical peels. Among retinoids, retinol is much less described in the literature than tretinoin as a substance used in the peel procedure. The aim of our study was to determine the efficacy of using a 4% retinol solution product containing novel TGF‐β activators and antioxidants in improving the condition of the skin in patients with facial skin issues caused by aging and skin disorders. Each of 15 patients went through three peel treatment series, with a 30‐day gap between each session and was examined using Multi Skin Test MC 1000 Courage + Khazaka, evaluating hydration, elasticity, and skin pigmentation and Observ 520x. All patients reported overall improvement after the peeling procedure, and most of them reported subjective improvement in the reduction of the facial skin: tone, skin pigmentation, dehydration, dryness, structure, and sebaceous gland activity. An objective evaluation revealed significant clinical improvement in pigmentation in study groups. Elasticity parameters were shown to increase during treatment, with a greater effect occurring in patients with mature skin with first signs of aging and patients with postinflammatory hyperpigmentation, atrophic acne scars, and enlarged pores. Concluding, combined peel therapy of 4% retinol serum product containing novel TGF‐β activators and antioxidants showed good efficacy in reducing facial pigmentation of the skin high patients’ satisfaction with the procedure. The study revealed that the described method is simple to use, has low cost, is with rare adverse events, and has well tolerability.

Background. Freckles and solar lentigines are epidermal pigmentation disorders that affect the face and impact the quality of life of affected individuals. Aims. We aimed to observe and evaluate the clinical effectiveness of a 730 nm picosecond laser for the treatment of freckles and solar lentigines. Methods. We retrospectively collected patient information on freckles and solar lentigines and observed and evaluated the clinical outcome of a 730 nm picosecond laser. These included lesion clearance and recurrence rates, adverse reactions, and patient satisfaction. Results. Fifty cases of freckles and solar lentigines reported between January 1, 2022, and July 1, 2022, were included. All patients received two 730 nm picosecond laser treatments. The lesion clearance rates after one and two treatments were 53.1% and 78.4%, respectively, and the rates after one and six months of treatment were 78.7% and 78.4%, respectively. 90% of the patients reported ≥95% clearance of lesions after six months via a questionnaire survey. Among the patients, 86.0% were satisfied with their treatment. Postinflammatory hyperpigmentation occurred in two patients, both of whom had Fitzpatrick skin type IV. There was no recurrence of lesions. Conclusions. The 730 nm picosecond laser treatment for freckles and solar lentigines has the advantages of a high clearance rate, low recurrence rate, and high patient satisfaction. This trial is registered with ChiCTR2200058573.

Current treatment modalities for postinflammatory hyperpigmentation (PIH) often fall short in delivering satisfactory results for some patients. Therefore, this study aimed to assess the efficacy and tolerability of autologous cell‐free fat extract (CEFFE) in the treatment of PIH. We enrolled 15 patients with PIH and administered them with five intracutaneous CEFFE injections, each at a two‐week interval. Evaluation included efficacy assessment using objective (standard two‐dimensional photos, VISIA®‐photos, brown spot (BS) index, lesion lightness, lesion color, and trans‐epidermal water loss) and subjective (Global Aesthetic Improvement Scale and Likert satisfaction scale) parameters and tolerance assessment. Following CEFFE treatment, significant reductions were observed in the BS index (p < 0.05) and transepidermal water loss (p < 0.05), while skin lightness and lesion color showed significant improvements (p < 0.05) at the 12‐month follow‐up. Subjectively, 93.33% of patients reported improved or greatly improved conditions after 12 months of treatment. Transient local bruising and stinging were the only observed treatment‐related adverse events, with no serious complications reported. These findings demonstrate that intradermal injections of CEFFE are well‐tolerated and effective for the treatment of PIH. This trial is registered with ChiCTR2000039381.

Onychomycosis is a frequent fungal nail disease that is hard to treat and, in most cases, needs long‐term therapy with oral agents. Traditionally, oral agents are favored over topical agents, but it should not be overlooked that they come with broad adverse effects and concomitant drug interactions, which can be unsuitable for many individuals. Therefore, alternative approaches need to be addressed by the medical team for numerous cases. On the other hand, local administration of antimicrobials can come as advantageous because of having a more selective site of activity, avoiding off‐target systemic adverse effects, and rapid administration at the site of infection. In this study, we are evaluating a new topical delivery method of amphotericin B. To investigate the efficacy and safety of topical nanoliposomal amphotericin B 0.4% as a possible therapeutic option, this pilot, single‐group, before‐after clinical study was conducted on 15 onychomycosis patients. The evaluation was processed during 36 weeks of follow‐up and on three endpoints of week 12, week 24, and week 36, for both clinical and mycological responses. Three patients were excluded; of the remaining 12, 50% showed a complete cure, 16.66% had an effective clinical response, 16.66% had a partial clinical response, and 16.66% showed no response at week 12. Mycological cure was calculated as 50% at week 12. At week 24, our measurements were calculated as 91.66% for complete cure, 8.33% for no response, and 91.66% for mycological cure. One patient reported nail plate detachment at week 2 but continued the topical application; follow‐up between weeks 2 and 24 showed a complete cure and regrowth of healthy nails. No other adverse effects were detected. Overall, our study suggests that topical nanoliposomal amphotericin B 0.4% is an effective treatment, which is accessible, affordable, and user‐friendly, has minimum adverse effects, and could be regarded as an alternative treatment for those ineligible for systemic therapy. This trial is registered with IRCT20150101020514N18.

Dermatologic TherapyAccepted Articles e15971 CORRESPONDENCE More than a genital psoriasis Riccardo Balestri MD PhD, Riccardo Balestri MD PhD Division of Dermatology, Psoriasis Outpatient Service, Trento, ItalySearch for more papers by this authorGiulia Rech MD PhD, Giulia Rech MD PhD Division of Dermatology, Psoriasis Outpatient Service, Trento, ItalySearch for more papers by this authorCarlo Rene Girardelli MD, Carlo Rene Girardelli MD Division of Dermatology, Psoriasis Outpatient Service, Trento, ItalySearch for more papers by this authorMichela Magnano MD PhD, Corresponding Author Michela Magnano MD PhD michela.magnano@gmail.com orcid.org/0000-0001-9429-9004 Division of Dermatology, Psoriasis Outpatient Service, Trento, Italy Address of Correspondence : Michela Magnano, MD, PhD, Division of Dermatology, Trento Hospital, P.O. Villa Igea, via Malta 16, Trento, Italy 38122 Email: michela.magnano@gmail.comSearch for more papers by this author Riccardo Balestri MD PhD, Riccardo Balestri MD PhD Division of Dermatology, Psoriasis Outpatient Service, Trento, ItalySearch for more papers by this authorGiulia Rech MD PhD, Giulia Rech MD PhD Division of Dermatology, Psoriasis Outpatient Service, Trento, ItalySearch for more papers by this authorCarlo Rene Girardelli MD, Carlo Rene Girardelli MD Division of Dermatology, Psoriasis Outpatient Service, Trento, ItalySearch for more papers by this authorMichela Magnano MD PhD, Corresponding Author Michela Magnano MD PhD michela.magnano@gmail.com orcid.org/0000-0001-9429-9004 Division of Dermatology, Psoriasis Outpatient Service, Trento, Italy Address of Correspondence : Michela Magnano, MD, PhD, Division of Dermatology, Trento Hospital, P.O. Villa Igea, via Malta 16, Trento, Italy 38122 Email: michela.magnano@gmail.comSearch for more papers by this author First published: 08 November 2022 https://doi.org/10.1111/dth.15971 This article has been accepted for publication and undergone full peer review but has not been through the copyediting, typesetting, pagination and proofreading process, which may lead to differences between this version and the Version of Record. Please cite this article as doi: 10.1111/dth.15971. AboutPDF ToolsExport 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 onFacebookTwitterLinked InRedditWechat Accepted ArticlesAccepted, unedited articles published online and citable. The final edited and typeset version of record will appear in the future.e15971 RelatedInformation

Methotrexate (MTX) is a chemotherapeutic agent that acts primarily by inhibiting the folic acid cycle. In addition to its application for treating malignancies, MTX is also used to treat chronic inflammatory diseases including psoriasis. Adverse effects have been reported even at low doses (up to 25 mg/week), and there is risk of toxicity in the form of myelosuppression, hepatotoxicity, or pulmonary fibrosis.Here, we report a case of a 67-year-old male with a past medical history of end stage renal disease on peritoneal dialysis and moderate-to-severe psoriasis with psoriatic arthritis presented with abdominal pain, diarrhea, rash, mucositis, and mucocutaneous ulcers and erosions. The patient was taking methotrexate 10 mg weekly without folic acid supplementation and was found to be pancytopenic. Despite treatment, the patient developed multiorgan failure and passed away after 16 days of hospitalization. Myelosuppression is considered the most serious side effect with the highest risk of mortality. Risk factors for toxicity include renal insufficiency, advanced age, lack of folate supplementation, drug interactions, and medication errors. Importantly, serum levels of MTX do not correlate with toxicity; therefore, folinic acid rescue therapy should be started as soon as MTX toxicity is suspected. MTX toxicity is rare with low dose, proper dose scheduling, and adherence to the recommended guidelines. It is imperative that physicians considering therapy with low dose MTX for dermatologic indications take into consideration a patient's risk factors for toxicity and monitor appropriately.

Topical timolol and lasers are widely used for the treatment of infantile hemangioma (IH), and they can replace propranolol as the first-line treatment of IH. We aimed to investigate the efficacy and safety of topical timolol alone or lasers plus topical timolol versus lasers alone for the treatment of IH using a meta-analysis. We searched the PubMed, Embase, Cochrane Library, China National Knowledge Infrastructure, and Wanfang databases. A more conservative random effect model meta-analysis technique was used to analyze the efficacy and adverse reactions of timolol and lasers. Ten RCTs with a total of 979 patients with IH were included in this meta-analysis. Treatment with topical timolol alone was as effective as lasers in treating IH (risk ratio [RR]=0.99, p= 0.94), with similar adverse events. The difference was not statistically significant (RR=1.67, p= 0.14). Combined treatment with topical timolol and lasers showed a favorable response rate compared with treatment with either lasers (RR=1.23, p= 0.01) or topical timolol (RR=1.35, p= 0.001) alone. Furthermore, compared to topical timolol alone, the combined treatment indicated similar risks of adverse events (RR=0.70, p= 0.38) but fewer risks of adverse events (RR=0.39, p= 0.004) compared to lasers alone. This meta-analysis provided evidences that a combined treatment with topical timolol and lasers might be more effective than a single treatment strategy in infants with IH, and with no significant increase in adverse reactions. The combination of topical timolol and laser therapy might be the preferred choice for the treatment of IHs.