The advent of biologic agents within the past two decades has dramatically improved the treatment of psoriasis and psoriatic arthritis. Given that there now exists 11 FDA approved biologic options available for psoriasis, with more in the pipeline, the therapeutic armamentarium has been greatly enhanced. However, the fact that there are so many available options has also caused confusion for providers. Therefore, this manuscript deliberately focuses on the most clinically useful facts (such as efficacy and safety data) about each and every FDA approved biologic agent (including pipeline agents) for psoriasis. Moreover, among the clinically relevant facts, this manuscript purposely emphasizes the unique merits and demerits of each agent to make it easier for the provider to select which one of these many options is the best for the particular patient on hand. The goal of this manuscript is to aid the busy practicing dermatologist in becoming more adept at using these agents with the ultimate aim of improving patient care.

Remote consultations likely will grow in importance if the COVID-19 pandemic continues. This review analyzes which methods of teledermatology patients prefer by categorizing how recent studies have defined satisfaction, conducted surveys and concluded patients respond to the different modalities of teledermatology. Using PubMed and Cochrane databases, we reviewed studies from April 5th, 2010 to April 5th, 2020 that included the search terms patient satisfaction and teledermatology. All studies that included patient satisfaction as an outcome were included, but studies not published in English were excluded. We examined domains of satisfaction, survey method, study characteristics (including patient population, country, age, study design and evidence score), findings and statistical comparisons. We thoroughly reviewed 23 studies. Definitions of satisfaction varied, but all concluded patients were satisfied with the live-interactive and store-and-forward modalities. The studies reveal that store-and-forward is appropriate for clinicians with established patients who require regular followup. Verified areas of care include treatment of chronic conditions, topical skin cancer therapy, wound monitoring, and postprocedural follow-up. Only four studies conducted statistical analyses. One of those studies compared patient preference for each modality of teledermatology with face-to-face dermatology. While this study reported high satisfaction with each mode of teledermatology, patients still preferred face-to-face. Favorable responses to remote diagnostic capabilities suggest that these offerings improve preference for teledermatology. With only one study evaluating preference between each modality and face-to-face dermatology, more studies should address the discrepancy. Surveys that cover all domains of satisfaction may improve assessments and identify where gaps in preference exist.

Telemedicine is one of the most consequential technologies in modern healthcare. In certain situations, it allows for the delivery of care with high quality and minimal difficulty. This is particularly true in dermatology, in which many dermatological conditions can be treated remotely. The burden on dermatology patients has been greatly reduced for certain pathologies due to telemedicine. Health care providers also achieve improved job satisfaction following the convenience of meeting their patients. This paper details select dermatological conditions, and subsequently divides them into those treatable by telemedicine appointments, and those requiring face to face appointments.

According to recent data, up to 20% of patients with COVID-19 have cutaneous manifestations. Nails can also develop abnormalities during and after infection. In this article, we review the nail findings observed in patients with COVID-19.We reviewed the PubMed and Embase databases to identify all articles up to May 2021 that have described nail findings in association with COVID-19.A total of 70 studies were reviewed including 61 studies on chilblain-like lesions, which are one of the most widely identified cutaneous findings associated with the COVID-19 pandemic.Nine studies described specific nail findings (Table 1). Three of these findings [Beau lines, 1 transverse leukonychia, 1,2 and onychomadesis (Figure 1a)] are commonly seen with other systemic disease, including viral infection, and are likely the consequence of high fever and/or severe illness. One finding, paronychia, was seen in association with chilblain-like lesions, 3 and three nail findings (the red half-moon sign 4,5 (Figure 1d), the transverse orange discoloration 6 and the diffuse red-white nail bed discoloration 7 ) are novel and potentially related to the microvascular injury due to COVID-19. Of note, an orange-brownish discoloration of the nail in a transverse pattern, the most similar finding to date, has been described in patients with Kawasaki disease, which shares a similar inflammatory response component to COVID-19.COVID-19's effects on the nail blood vessels were documented by Navarro et al. in 12 pediatric patients with COVID-19-related chilblains, described in Table 1. 8 At dermoscopy of the nail fold and hyponychium, they found a red background with globules, indicative of vascular damage.We also documented dilated and tortuous capillaries at dermoscopy in a patient with transverse leukonychia after COVID-19 infection (Figure 1c).The presence of microvascular abnormalities was confirmed by a capillaroscopy study of the nails of 82 patients, enrolled during hospitalization for , or shortly after discharge. 9 Using nail video capillaroscopy (NVC), the authors observed microvascular abnormalities in all patients, which are described in detail in Table 1. Findings varied between acutely ill and discharged patients, providing visual evidence of a vascular pathogenic component to COVID-19 infection.Chilblain-like lesions are a commonly reported manifestation involving the digits. They are also known as 'COVID toes,' even

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The scalp is one of the most commonly affected regions in psoriasis. However, scalp psoriasis can be difficult to treat because of challenges in the delivery of therapy. Effective therapeutic regimens for scalp psoriasis are essential to improving the quality of life of patients. Recent data on topical therapies, phototherapy, systemic agents, and complementary therapy have demonstrated that it is possible to achieve and maintain significant improvement in scalp psoriasis. In this review, efficacy data for these modalities and an algorithm for the practical management of scalp psoriasis are presented.

Teledermoscopy is a novel diagnostic tool for the prevention, diagnosis, and treatment of skin disease when direct visualization of lesions is difficult. It is an economically viable option that can complement telehealth visits and that providers can utilize to identify melanocytic lesions and optimize care with diagnostic accuracy comparable to face-to-face (FTF) diagnosis. Teledermoscopy is invaluable in monitoring chronic conditions that require frequent follow-up and treatment optimization.Inclusion of clinical and dermoscopic images has been shown to improve the diagnostic accuracy of teledermatology services, thereby reducing healthcare costs.Teledermoscopy is also non-discriminatory, as diagnostic accuracy is similar in lighter and darker skin types. It has been shown to improve patient access to specialty services and reduce the number of "no-shows" at FTF clinics and length of surgery

Nail psoriasis has a prevalence that ranges from 10 to 82% and can significantly impact the quality of life of patients. Nail psoriasis is one of the most challenging areas to treat, and multiple therapies have been explored. Topical and injectable therapies are recommended for fewnail disease. Systemic therapies, including biologics, can be considered for patients with multiple and resistant nail disease, impaired quality of life, and severe skin and joint involvement, due to their long-term efficacy. Although outcome data are difficult to compare, interleukin (IL)-17 inhibitors may have superior short-term efficacy when compared to IL-23 inhibitors and tumor necrosis factor (TNF)-alpha inhibitors, although long-term efficacy is similar to TNF-alpha inhibitors. IL-23 inhibitors and TNF-alpha inhibitors have a similar efficacy for nail psoriasis.