Background The multi-morbid burden and use of systemic immunosuppressants in people with psoriasis may confer greater risk of adverse COVID-19 outcomes but data are limited. Objective Characterize the course of COVID-19 in psoriasis and identify factors associated with hospitalization. Methods Clinicians reported psoriasis patients with confirmed/suspected COVID-19 via an international registry, PsoProtect. Multiple logistic regression assessed the association between clinical/demographic characteristics and hospitalization. A separate patient-facing registry characterized risk-mitigating behaviours. Results Of 374 clinician-reported patients from 25 countries, 71% were receiving a biologic, 18% a non-biologic and 10% no systemic treatment for psoriasis. 348 (93%) fully recovered from COVID-19, 77 (21%) were hospitalized and nine (2%) died. Increased hospitalization risk was associated with older age (multivariable-adjusted OR 1.59 per 10 years, 95% CI 1.19-2.13), male sex (OR 2.51, 95% CI 1.23-5.12), non-white ethnicity (OR 3.15, 95% CI 1.24-8.03) and comorbid chronic lung disease (OR 3.87, 95% CI 1.52-9.83). Hospitalization was more frequent in patients using non-biologic systemic therapy than biologics (OR 2.84, 95% CI 1.31-6.18). No significant differences were found between biologic classes. Independent patient-reported data (n=1,626 across 48 countries) suggested lower levels of social isolation in individuals receiving non-biologic systemic therapy compared to biologics (OR 0.68, 95% CI 0.50-0.94). Conclusion In this international moderate-severe psoriasis case series, biologics use was associated with lower risk of COVID-19-related hospitalization than non-biologic systemic therapies, however further investigation is warranted due to potential selection bias and unmeasured confounding. Established risk factors (being older, male, non-white ethnicity, comorbidities) were associated with higher hospitalization rates. Clinical Implications We identify risk factors for COVID-19-related hospitalization in psoriasis patients, including older age, male sex, non-white ethnicity and comorbidities. Use of biologics was associated with lower hospitalization risk than non-biologic systemic therapies.

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Topical rapamycin can be considered a safe option for the treatment and the prevention of facial angiofibromas in younger patients, but the best formulation has not been established. Our review demonstrates that ointment and gel should be preferred, but it is not clear which concentration is optimal. Long-term and comparative studies between topical rapamycin and ablative techniques are required to establish which treatment has a better outcome and lower recurrence rate.

Bullous pemphigoid (BP) is an autoimmune subepidermal blistering disorder that has been reported to be associated with malignancies. Some authors described several cases of pemphigoid associated with malignancies (PAM); however, the evidence of this correlation still remains controversial. Several theories have been postulated to explain the relationship between malignant neoplasms and BP; the main theory suggests that antibodies directed against tumor-specific antigens of malignant cells may cross-react with antigens (like BP antigens) in the basement membrane zone leading to the formation of blisters. We performed an extensive review of the English published work focusing on the epidemiology, the pathogenetic theories and the clinical and histological aspects of the disease. We identified 40 cases of PAM: of these, seven cases were associated with hematological malignancies and 33 with solid tumors. Physicians should be aware of the existence of PAM and we suggest an oncological screening in early-onset pemphigoid, in patients with a former oncological history, in those with signs and symptoms that could be related to a neoplasm and in BP refractory to common immunosuppressive therapy.

SIGNIFICANCENail psoriasis frequently affects patients with skin psoriasis, inducing not only aesthetic problems, but also functional damage. The disease represents a significant burden, impairing patients' quality of life. The treatment of nail psoriasis varies according to disease severity. Topical therapies are used if the nail involvement is mild, but their efficacy is limited and relapses are common. In more serious cases, systemic agents (both traditional and biologic molecules) have shown long-term efficacy. Among biologics, secukinumab is the only agent supported by evidence from a trial specifically conducted in patients with nail psoriasis.Nail psoriasis affects 50-79% of patients with skin psoriasis and up to 80% of patients with psoriatic arthritis, and can also represent a negative prognostic factor in individuals with plaque psoriasis. Treatments for nail psoriasis are limited, as nails are often difficult to treat with topical therapies alone, and relapse is common. Among different systemic agents, secukinumab, a fully human monoclonal antibody targeting interleukin (IL)-17A, is the only antibody supported by a trial specifically conducted in patients with nail psoriasis (the TRANSFIGURE trial) and has the longest follow-up available to date. In this setting, secukinumab is characterized by the highest efficacy at week 16. This review analysed the different therapeutic options for nail psoriasis, focusing on new treatments that have shown promising results in this field.

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same pathogenic pathway and some clinical manifestations, including chilblains and retinal vasculopathy. In addition, this type I IFN response produces microvascular injury, 6 which has already been reported to be related to COVID-19 infection, and it could explain both chilblains and retinal vasculitis. Also, Kawasaki disease can share some similarities with COVID-19 infection. Both cause acral skin lesions, vasculitis and show increased serum interleukin 6 (IL-6) related to the immune response to the disease. 7 Also, there are other viral infections associated with Kawasaki disease, including other species of human coronaviruses. 8 Other types of acral cutaneous lesions apart from chilblains have been reported in patients with COVID-19. This group includes cyanosis, blisters and gangrene in the feet and hands, primarily in adults. Nonetheless, these types of manifestations appear to be related to coagulation disorders in severe cases of COVID-19, and most carry poor prognosis. 9 Our analytical study was rigorously normal, with no poor prognostic data. In summary, special attention should be devoted to children, despite most remaining asymptomatic in the early stages of the infection. Currently, we do not know whether there will be any other complications in the late stages of the disease and what is the real meaning of the described features. However, these types of manifestations in children appear to occur in the convalescence phase of the infection. Further studies are needed to provide more specific preventive measures and to standardize the short-and middle-term follow-up of these patients.

Our study shows that household cleaning products in Italian market contain several allergens, particularly preservatives and fragrances. For consumers, at least in Italy, it may not be easy to retrieve product information from the website for two widely sold brands. The information had to be taken from the actual package.