Vasiliki Chasapi

Background/Objectives: Cutaneous melanoma is predominantly sporadic, although a subset of patients presents clinical features suggestive of inherited susceptibility. We introduced the pragmatic concept of genetically enriched (GE) melanoma, defined by the presence of early-onset melanoma, familial melanoma, or multiple primary melanomas. Methods: Its clinicopathological characteristics and prognosis were compared with those of sporadic melanoma. Demographic, clinicopathological, and survival data were analyzed using descriptive statistics, survival analysis, and Cox regression models. Results: In this retrospective single-center study, 1,874 patients were classified as having GE (n = 796, 42.5%) or sporadic melanoma (n = 1,078, 57.5%). Patients with GE melanoma were significantly younger at diagnosis (median age, 37 years [IQR 32–43] vs 57 years [IQR 50–66], p < 0.001) and were more frequently females than those with sporadic melanoma (56.8% vs. 51.4%, p = 0.024). The GE cohort also showed a distinct clinicopathological profile, with a higher proportion of melanoma in situ (20.2% vs. 15.2%), lower proportions of acral lentiginous (3.5% vs. 1.1%) and lentigo maligna (5.2% vs. 1.4%) melanoma, and a lower prevalence of previous malignancies. After a median follow-up of 8 years, disease-free survival did not differ significantly between the two cohorts (log-rank p = 0.23). Within the GE cohort, older age and male sex were associated with a higher risk of recurrence. Conclusions: Overall, patients fulfilling clinical criteria suggestive of inherited melanoma susceptibility appear to represent a distinct clinicopathological subgroup without evidence of poorer prognosis. The concept of GE melanoma may offer a pragmatic framework for identifying patients who may benefit from genetic counseling and tailored surveillance strategies.

Background/Objectives: The treatment landscape of psoriasis has changed dramatically with the emergence of novel biological agents such as those targeting interleukin (IL)-23. Despite their high efficacy, evidence regarding their effectiveness and tolerability in elderly patients is currently limited. The number of older adults living with psoriasis is constantly increasing, highlighting the need for evidence-based guidance focused on this population. The aim of this study was to summarize our center’s experience with the IL-23 inhibitors guselkumab and risankizumab for the treatment of moderate-to-severe psoriasis in patients aged ≥65 years. Methods: We retrospectively reviewed all charts of moderate-to-severe psoriasis patients who received at least one dose of guselkumab or risankizumab (tildrakizumab is not available for use in Greece as of this date) and included those aged ≥65 years at the time of drug initiation. Disease severity was assessed using the Psoriasis Area and Severity Index (PASI), which was calculated at baseline and each subsequent visit up to 156 weeks of treatment. Treatment responses were evaluated with the percentages of patients achieving PASI75/90/100 (reductions from baseline PASI by 75, 90, and 100%, respectively) and absolute PASI ≤ 1 and PASI ≤ 3. All adverse events (AEs) were assessed and documented. The drug survival was estimated using the Kaplan–Meier estimate. Results: In total, 93 elderly patients (64 risankizumab and 29 guselkumab) were included. Regarding risankizumab’s effectiveness, PASI75 response rates increased from 77.4% at week 12 to 90.9% at week 52 and remained stable at 90.5% by week 156. Corresponding PASI100 responses were 67.7%, 81.8%, and 80.9%, respectively. Guselkumab-treated patients exhibited PASI75 response rates of 71.4% at week 12, which improved to 91.3% at week 52 and 100% for those evaluated at week 156, with PASI100 responses of 57.1%, 73.9%, and 83.3%. During observation, 6 (9.4%) risankizumab and 2 (6.9%) guselkumab patients discontinued medication. No statistically significant differences were observed regarding drug survival between patients aged ≥65 vs. <65 years. No serious AEs occurred, and no patient discontinued medication due to AEs. Conclusions: Both guselkumab and risankizumab demonstrated sustained efficacy and persistence along with a favorable safety profile in elderly patients with psoriasis over a three-year period. While our study is limited by its retrospective nature, our findings support the use of IL-23 inhibitors in this growing patient population.

Background: Alopecia areata (AA) is a chronic immune-mediated condition leading to nonscarring hair loss. Its visible nature often leads to stigmatization and bullying, which can negatively affect the mental health and quality of life (QoL) of adolescents. Objectives: To investigate the experiences of bullying, psychosocial challenges and QoL in adolescents with AA. Methods: This cross-sectional study included 417 participants aged between 10 and 17 years, with 156 adolescents diagnosed with AA from 6 European countries and 261 healthy German controls. Data collection involved validated questionnaires. These included the Revised Olweus Bully/Victim Questionnaire for bullying, the Strengths and Difficulties Questionnaire for psychosocial difficulties, and the Pediatric Quality of Life Inventory for QoL. Clinical data, including AA severity score, were also recorded. Statistical analyses employed parametric and nonparametric methods, including multivariate analysis of variance, Mann–Whitney U-tests, t-tests and correlation analyses. Results: Adolescents with AA reported significantly higher rates of general and verbal bullying, with hair loss and nail damage commonly identified as reasons for bullying. Girls experienced more emotional distress and bullying, while boys reported better emotional and social QoL. Physical functioning (i.e. limitations in physical activity, pain or low energy) was significantly lower in the AA group, although overall QoL differences were low. Longer disease duration was associated with greater emotional difficulties and reduced school functioning. No association was found with the age of the participant or the severity of the disease. Conclusions: Adolescents with AA often face significant challenges, including higher rates of bullying and emotional struggles compared with healthy controls. Developing targeted interventions to combat stigma and support mental and emotional wellbeing of paediatric patients with AA, in addition to a collaborative effort involving dermatologists, psychologists and educators could possibly make a meaningful difference in improving the QoL for these young individuals.

Background/Objectives: Opportunistic fungal infections are common among people living with HIV (PLHIV) and contribute substantially to morbidity, mortality, and hospitalization rates in this population. This study aimed to determine the prevalence of dermatological manifestations of fungal infections in HIV-positive patients and examine their association with demographic, clinical, and immunological characteristics. Methods: A retrospective review of medical records from 2500 PLHIV treated at the Infectious Diseases Unit of “Andreas Syggros” Hospital for Skin and Venereal Diseases between 1988 and 2017. Data from patients diagnosed with opportunistic fungal infections were analyzed. Participants were classified as either antiretroviral therapy (ART)-naïve or already receiving treatment. Recorded fungal infections were correlated with epidemiological variables and CD4+ T-cell counts. Results: Opportunistic fungal infections were identified in 859 patients (34.36%), with a marked male predominance. Candidiasis was the most frequently reported condition, with a higher prevalence among female patients. Lower CD4+ counts were significantly associated with an increased risk of cryptococcal meningitis, esophageal candidiasis, Pneumocystis jirovecii pneumonia (PJP), and oral candidiasis, whereas higher CD4+ counts were more common in patients with dermatophytosis, onychomycosis, and pityriasis/tinea versicolor. Conclusions: Opportunistic fungal infections remain highly prevalent in PLHIV, particularly among those with advanced immunosuppression. CD4+ T-cell counts are key diagnostic and prognostic markers, reinforcing their importance in monitoring disease progression and guiding clinical management.

Background/Objectives Opportunistic fungal infections are frequently observed in patients living with HIV and contribute significantly to morbidity, mortality, and hospitalization rates within this population. The aim of this study is to note the prevalence of dermatological manifestations related to fungal infections among HIV-positive patients and its correlation with demographic, other clinical characteristics and immune status of the participants. Methods A retrospective review was conducted on a cohort of 2,500 patients living with HIV that have been treated at the Infectious Diseases Unit of "Andreas Syggros" Hospital for Skin and Venereal Diseases from 1988 to 2017. Data from patients diagnosed with opportunistic fungal infections were analyzed. Patients were either antiretroviral therapy (ART)-naïve or already under treatment. Recorded fungal infections were correlated with epidemiological data and CD4+ cell counts. Results Opportunistic fungal infections were documented in 859 patients (34.36%), with a male predominance. Candidiasis was the most frequently reported condition, with higher prevalence among female patients. Lower CD4+ counts were significantly associated with increased risk of cryptococcal meningitis, esophageal candidiasis, Pneumocystis jirovecii pneumonia (PJP), and oral candidiasis, whereas higher CD4+ counts were observed in individuals with dermatophytosis, onychomycosis, and pityriasis/tinea versicolor. Conclusions Opportunistic fungal infections remain prevalent among HIV-positive individuals, particularly in immunocompromised patients. CD4+ cell counts serve as crucial diagnostic and prognostic markers for clinical outcomes in HIV patients, underscoring their role in disease monitoring and management.

Background: Moderate to severe (M2S) atopic dermatitis (AD) is a chronic condition impacting individuals, society, and healthcare systems. Considering the changing M2S-AD treatment landscape, this study assesses the M2S-AD burden in patients reaching referral centers in Greece. Methods: This was a multicenter, cross-sectional study. Patients aged 12 years or older with clinically diagnosed M2S-AD were enrolled. Data collected included clinical practice assessments and the following validated patient-reported instruments: Dermatology Life Quality Index (DLQI); EuroQol-5 Dimensions-3 Level scale (EQ-5D-3L); Patient Oriented Eczema Measure (POEM); Peak Pruritus Numerical Rating Scale (PP-NRS); and Work Productivity and Activity Impairment: General Health (WPAI:GH). A pain frequency/intensity/cause questionnaire and a sleep disturbance scale were also used. Results: Outcomes of 184 adults (51.1% female) with M2S-AD based on the Eczema Area and Severity Index (EASI) are presented (n = 117 moderate; n = 67 severe). Among the patients, 14.8% were obese, 59.2% had allergic comorbidities, and 88.0% were receiving AD-specific therapy (systemic: 38.6%). The median age, disease duration, body surface area, and total EASI scores were 38.8 years, 11.8 years, 30.0%, and 16.9, respectively. The median DLQI score was 12.0, with ‘symptoms/feelings’ being the most affected domain. EQ-5D dimensions ‘anxiety/depression’ and ‘pain/discomfort’ were also affected (65.2% and 64.1% reporting problems, respectively). The median POEM score was 17.0. Pain, severe pruritus (PP-NRS ≥ 7), and sleep disturbance were reported by 80.4%, 62.0%, and 88.5%, respectively. The median WPAI:GH ‘work productivity loss’ and ‘activity impairment’ scores were 23.8% and 30.0%, respectively. Conclusions: Both moderate and severe AD patients reaching Greek specialized centers experience significant symptom burden and impairments in quality of life, sleep, work, and daily activities.

Reported cases of linear lichen planus following multiple Blaschko’s lines are rare. Herein, we present a middle-aged female patient who had unilateral lesions of linear lichen planus that followed Blaschko’s lines in three different sites of the body. The only history given was previous triple immunization against COVID-19 with the Pfizer vaccine and backache with right-sided trochanteric pain over the past year. Interestingly enough, during the diagnostic process, raised serum angiotensin-converting enzyme (SACE) was revealed along with signs of sacroiliitis and trochanteric bursitis. Key words: Linear lichen planus, Blaschko lines, SACE, COVID-19 immunization

Epidermal naevi are hamartomas that are characterized by hyperplasia of the epidermis and adnexal st...