Acrokeratosis paraneoplastica of Bazex (APB) is a paraneoplastic dermatosis heralding an underlying malignancy, most commonly squamous cell carcinoma of the upper aerodigestive tract.[1] The syndrome is characterized by psoriasiform, violaceous, scaly plaques localized to acral areas and the ears and nose. Involvement of the nails, helical rim and nasal tip are also common. Histologically, APB demonstrates spongiosis, interface dermatitis, and lichenoid inflammation, with direct immunofluorescence revealing variable deposits of immunoglobulins and complement along the basement membrane. While the pathophysiology of APB is unclear, proposed mechanisms include tumor-derived factors, immune-mediated processes, and metabolic deficiencies. Recognizing this syndrome's distinctive cutaneous findings is essential for early cancer detection, as these manifestations often precede the diagnosis of malignancy by months. Management focuses on treating the underlying malignancy, with cutaneous lesions typically resolving upon successful cancer therapy. Symptomatic relief may be achieved with topical or systemic treatments, although these do not address the primary cause.

Topical medications are commonly used to manage mild-to-moderate psoriasis as adjunctive treatments in patients receiving phototherapy, systemic agents or biologic therapies. Amongst available topical options, the fixed-dose combination of calcipotriol (CAL) and betamethasone dipropionate (BDP) has demonstrated efficacy and tolerability in clinical trials, with most adverse events being mild and transient local reactions. CAL/BDP has recently been formulated as a cream using polyaphron dispersion (PAD) technology to improve its rheological behaviour and sensory characteristics. We describe the use of CAL/BDP PAD-based cream specifically in patients with mild-to-moderate psoriasis across four Italian centres. The first case involves a man with mild-to-moderate scalp psoriasis, in whom CAL/BDP PAD-based cream was effective in this high-impact disease location. The second case focuses on a patient with pretibial psoriasis, a difficult-to-treat site. The third case is of a woman with palmoplantar psoriasis who reported clinical improvement in the lesions and increased treatment compliance compared with her previous therapies. The last case describes the concomitant use of CAL/BDP PAD-based cream with a biologic drug, resulting in optimized lesion clearance. CAL/BDP PAD-based cream appears promising for managing psoriasis in specific contexts such as lesions in difficult-to-treat areas or residual disease during biologic therapy. Further real-world data and clinical observations will be important to clarify how this formulation can be integrated into individualized management strategies for mild-to-moderate psoriasis.

Atopic dermatitis (AD) and psoriasis are prevalent chronic inflammatory skin diseases with distinct clinical features and significant impacts on patients' quality of life. AD typically presents as recurrent eczema-like lesions accompanied by intense itching, whereas psoriasis is characterized by well-defined erythematous, scaly epidermal plaques. AD is associated with skin barrier dysfunction, allergen sensitization, and a type 2 immune response, while psoriasis involves hyperproliferation, abnormal differentiation of epidermal keratinocytes, and immune cell infiltration. However, the precise molecular mechanisms underlying AD and psoriasis remain unclear, posing challenges for effective clinical management. MicroRNAs (miRNAs) which are single-stranded RNA molecules that regulate gene expression post-transcriptionally by binding to target mRNAs, have been identified as key players in various inflammatory and immune- mediated skin diseases. In AD and psoriasis, miRNAs influence the progression of diseases by modulating inflammatory responses, keratinocyte hyperproliferation, and aberrant differentiation. Certain miRNAs hold promise as biomarkers for diagnosing and treating AD and psoriasis. This paper examines the roles of specific miRNAs in the pathogenesis of these conditions and provides a systematic overview of their diagnostic and therapeutic potential, offering new directions for clinical research and strategies. Advancements in miRNA research are expected to enhance diagnostic precision and support the development of targeted, personalized therapies, ultimately improving management of these complex dermatologic disorders.

Dear Editor, We report a rare unilateral presentation of pretibial Flegel's disease displaying a folliculocentric dermoscopic pattern not previously described in the literature. A 58-year-old woman presented with a 4-year history of multiple firm, brownish, keratotic papules confined to the right pretibial region, gradually extending toward the knee. The lesions were dome-shaped, rough, and scaly, partially coalescing into small plaques. [...].

Sarcoidosis and atopic dermatitis (AD) are chronic inflammatory conditions with distinct immunologic profiles but overlapping disparities in prevalence and severity among Black Americans populations. We report a rare case of a 58-year-old Black woman with refractory cutaneous sarcoidosis and AD overlap, who presented with severely pruritic, erythematous, scaly lesions primarily on the face, scalp, and neck. Histopathologic examination revealed granulomatous inflammation. Standard topical and systemic therapies were ineffective. Initiation of upadacitinib, a selective Janus kinase (JAK) inhibitor, resulted in dramatic symptom improvement within 1 month, with a pruritus reduction from a peak pruritus Numeric Rating Scale score of 9/10 to 1/10. This case underscores the therapeutic potential of JAK inhibition in addressing convergent inflammatory pathways across traditionally distinct dermatoses, particularly in patients from populations at increased risk for treatment-refractory disease.

Mycosis Fungoides (MF) is characterized by the proliferation of malignant skin-homing memory CD4+ T cells. The disease typically follows an indolent course, progressing from plaques (scaly, erythematous skin lesions) in the early stages (Ia-Ib) to tumors (>IIb) in approximately one-third of cases. Although recent studies have explored cell phenotypes and counts of the tumor microenvironment (TME) in MF progression, spatial interactions between tumor and reactive cells remain poorly understood.

Tinea imbricata is a chronic superficial dermatophytosis caused by the anthropophilic dermatophyte Trichophyton concentricum and is typically characterized by pruritic concentric annular scaly lesions. The disease is endemic to regions of Southeast Asia, the Pacific Islands, and Latin America and remains exceptionally rare in North Africa. We report the first documented case of tinea imbricata diagnosed in Morocco in a 38-year-old Pakistani man residing in Louisiana, USA, who developed characteristic skin lesions while staying in Morocco. The lesions appeared as intensely pruritic concentric plaques involving the inner thighs. Direct microscopic examination and fungal culture findings were highly suggestive of Trichophyton concentricum as the causative organism. Initial treatment with oral terbinafine combined with topical antifungal therapy resulted in only partial clinical improvement. Complete remission was achieved after switching to oral itraconazole associated with topical antifungal treatment. This case highlights the importance of considering imported tropical dermatophytoses even in non-endemic settings.

Discoid lupus erythematosus (DLE) classically affects sun‑exposed areas, such as the face, scalp, and ears. Involvement of the lower extremities is uncommon, and presentation of DLE in association with systemic lupus erythematosus (SLE) in a male patient is relatively rare. This case report describes a 34‑year‑old man who presented with chronic, scaly, dyspigmented plaques confined to both the lower legs, which prompted further evaluation and led to the diagnosis of SLE. Histopathological evaluation supported the diagnosis of DLE, while serologic workup revealed high‑titer antinuclear antibodies (ANAs), anti‑double‑stranded DNA (anti‑dsDNA), anti‑Smith antibodies, and hypocomplementemia, supporting a diagnosis of SLE with chronic cutaneous lupus involvement. Following treatment with strict photoprotection, topical corticosteroids, and weight‑based hydroxychloroquine, the patient showed marked clinical and serologic improvement at the 12‑week and 9‑month follow‑ups. This case highlights the importance of evaluating for systemic involvement in patients with biopsy‑supported DLE, particularly when lesions occur in atypical anatomical locations and in populations traditionally considered at lower risk.

Psoriasis arthropathica, also known as psoriatic arthritis (PsA), is a highly heterogeneous systemic inflammatory disease. In addition to involving the skin with characteristic psoriatic lesions such as erythematous scaly plaques, it may also affect the joints, leading to joint pain, swelling, stiffness, and functional impairment, thereby substantially reducing patients' quality of life. To develop clinical practice guidelines that align with international standards for guideline development while reflecting Chinese clinical practice, the China Dermatologist Association, in collaboration with the Chinese Dermatovenerology Society of Integrative Medicine, initiated a guideline project focusing on 14 key clinical questions in the diagnosis and management of PsA in China. Evidence-based recommendations were formulated accordingly. This guideline systematically reviews recent domestic and international advances in the diagnosis and treatment of PsA, and covers diagnosis, disease activity assessment, therapeutic strategies, comorbidity management, and pharmacotherapy in special populations. The guideline aims to improve the overall standard of PsA diagnosis and management in China and ultimately enhance patient outcomes.

Pityriasis lichenoides (PL) is a benign, self-limiting inflammatory condition, characterized by the appearance of papular, scaly, or necrotic lesions. Despite the rare incidence, clinicians should suspect its diagnosis in the presence of specific skin lesions and epidemiological contexts, as suggested by its association with infections and/or vaccinations.