This study highlights phenotypic features of psoriasis in elderly and in very late onset psoriasis. The management of these fragile patients remains poorly codified and needs further investigation.

it is crucial to ensure good quality, understandability and reliability prior to publication. Patients should be advised to critically evaluate the source and content of a video and not to simply trust the number of likes. Health care providers and authorities should take joint measures to implement quality control of videos on YouTube TM. The results of our study may encourage shared decision-making and be beneficial for both patients and health care providers to recommend appropriate videos to their patients. We thank Heike Weingarten and Cindy G€ orgmayr for their valuable support in evaluating the 49 videos. Funding: None.

JEADV AbstractBackground Three biotherapiesetanercept, adalimumab and ustekinumabare licensed in childhood psoriasis. The few data available on their efficacy and tolerance are mainly derived from industry trials. However, biological drug survival impacts long-term performance in real-life settings.Objective The objective of this study was to evaluate the survival rates of biological therapies in children with psoriasis in real-life conditions. Secondary objectives were to evaluate the factors associated with the choice of the biological therapy and to report severe adverse events. Materials and methodsThis study was an observational retrospective study. Data were extracted from the clinical records of 134 children. Kaplan-Meier estimates were used to analyse drug survival overall and in subgroups of plaque psoriasis, bio-na€ ıve and non-na€ ıve patients. ResultsWe analysed 184 treatment courses: 70 with etanercept, 68 with adalimumab and 46 with ustekinumab.Factors associated with the choice of first-line biological agent were age at initiation (younger for adalimumab, P < 0.0001), age at onset of psoriasis (younger for adalimumab and etanercept, P = 0.03) and baseline Psoriasis Assessment Severity Index and Physician global assessment (both higher for adalimumab, P < 0.001). Drug survival rates were higher for ustekinumab than for adalimumab and etanercept (P < 0.0001) for all treatment and all psoriasis types, plaque-type psoriasis (P = 0.0003), patients na€ ıve for biological agents (P = 0.0007) and non-na€ ıve patients (P = 0.007). We reported eight serious adverse events (SAEs): severe infections (n = 3), significant weight gain (n = 2), psoriasis flare (n = 1) and malaise (n = 1). Biological therapy was discontinued in three children (one with psoriasis flare and two with weight gain). Only the two cases of weight gain resulted in an unfavourable outcome.Conclusions Our real-life comparative study found that ustekinumab had the best drug survival outcome. The profile of SAEs in children was comparable to that in adults. These results will assist dermatologists in the decision-making process when choosing treatment options for children with psoriasis in daily practice.

4 Russo A, Curtis S, Balbuena-Merle R et al. Bullous hemorrhagic dermatosis is an under-recognized side effect of full dose low-molecular weight heparin: a case report and review of the literature.

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