102. Jahresversammlung Der SGDV Réunion Annuelle

AOÛT 2020 VOLUME 32 - N° 6

Zürich Live Stream Podcast

17 - 18 September 2020 Wissenschaftliches Programm SGDV Programme scientifique SSDV 102. Seite/Page 4 Traktandenliste SGDV Jahresversammlung Ordre du jour SSDV der SGDV Seite/Page 22 Freie Mitteilungen 102ème Communications libres Réunion annuelle Seite/Page 24 Posters de la SSDV Seite/Page 30

Dieses Heft wrde für die Fortbildung der Schweizer Dermatologen dank einer Hilfe die folgenden Firmen realisiert: Ce numéro a été réalisé grâce à une aide pour la formation continue des dermatologues suisses des firmes : Jetzt kassen- zulässig!

* bei atopischer Durchbruch Dermatitis**

Doppelt stark.1 Schnell.2 Einfach.3

QRCode scannen und weitere Informationen zu einer Behandlung mit DUPIXENT® erhalten

Doppelt stark. Wirkung auf Juckreiz & Hautbild.1 NEU Schnell. Signifikante Symptombesserung innerhalb 2 Wochen.2 Einfach. Alle 2 Wochen subkutan (s.c.) & ohne Monitoring.3

** DUPIXENT®: Erstes Biologikum bei erwachsenen Patienten mit mittelschwerer bis schwerer atopischer Dermatitis***

1 Simpson EL et al. Two Phase 3 Trials of Dupilumab versus Placebo in Atopic Dermatitis. N Engl J Med 2016; 375: 2335–48; 2 Blauvelt A et al. Long-term management of moderate-to-severe atopic dermatitis with dupilumab and concomitant topical corticosteroids (LIBERTY AD CHRONOS): a 1-year, randomised, double-blinded, placebo-controlled, phase 3 trial. Lancet 2017; 389: 2287–303; 3 DUPIXENT® Fachin- formation, Stand April 2019, www.swissmedicinfo.ch. Dupixent® Injektionslösung (300mg/2ml) W: Dupilumab (aus gentechnisch veränderten Zellen des chinesischen Hamsters). I: Mittelschwerer bis schwerer atopischer Dermatitis (AD) bei erwachsenen Patienten, bei denen die Erkrankung durch verschreibungspflichtige topische Präparate unzureichend kontrolliert ist, oder diese Präparate nicht indiziert sind. Dupixent kann mit oder ohne topische Kortikosteroide angewendet werden. Dosierung: Anfangsdosis von 600 mg als subkutane Injektion (zwei Injektionen zu je 300 mg), danach 300 mg als subkutane Injektion alle zwei Wochen. Niereninsuffizienz gleiche Dosierung. KI: Darf nicht gegeben werden bei Überempfindlichkeit gegen Wirkstoff oder einen Hilfsstoff. Sch/S: Keine Anwendung in der Schwanger- schaft, es sei denn der potenzielle Nutzen übersteigt das potenzielle Risiko für den Fötus. VM: Enthält Natrium. Überempfindlichkeitsreaktionen: Anwendung sofort beenden und eine geeignete Behandlung einleiten. Helminthose: Vorbestehende Helminthose vor Therapie mit Dupixent behandeln, bei Infektion während der Behandlung und Nichtansprechen auf Helminthosebehand- lung Dupixent aussetzen bis Infektion abgeklungen ist. Konjunktivitis und Keratitis: Patienten darauf hinweisen, dass sie das Auftreten oder eine Verschlimmerung von Augensymptomen dem Arzt / der Ärztin mitteilen sollten. Komorbides Asthma: Anpassung der Asthma-Behandlung nicht ohne vorherige Absprache mit Arzt / Ärztin, nach dem Absetzen der Behandlung diese Patienten sorgfältig überwachen. IA: Anwendung von Lebendimpfstoffen vermeiden. UW: Sehr häufig: Reaktionen an der Injektionsstelle (9,6 %). Häufig: Konjunktivitis, Augenjucken; Blepharitis, oraler

151057_DUP_CH_Anzeige_DE_Final.indd 1 04.06.20 17:31 RUBRIKEN DER DERMATOLOGICA HELVETICA – RUBRIQUES DE DERMATOLOGICA HELVETICA Weiterbildung - Formation continue Jetzt DH Redaktionsbüro, Bureau éditorial: JH Saurat: Chefredaktor, Editeur en chef DERMATOLOGICA HELVETICA M Harms: Chefredaktor StV, Editeur en chef adjointe kassen- Août 2020 - Volume 32 - N° 6 A Navarini: Assoziierter Redaktor, Rédacteur associé Carine Herreras ([email protected]): Redaktionsbüro, Bureau éditorial zulässig! Atar Roto Presse SA, Genève: Druck, Impression SOMMAIRE Sektionen, Sections: JH Saurat: Journal Club, Focus * bei atopischer Chefärzte, Médecins chef-de-service/D. Hohl: Case reports, coups d’œil (Koor- ** 5 Grussworte – Messages de bienvenue dination: Redaktionsbüro, Coordination: Bureau rédactionel, C Herreras, derm.helv@ Durchbruch bluewin.ch) Dermatitis 10 Wissenschaftliches Programm SGDV – A Navarini: Peer-reviewed contributions A Navarini: Weiterbildung der Assistenzärzte, Formation post-graduée des Programme scientifique SSDV assistants M Harms/J. Hafner: Das diagnostische Photo, Photo du mois, terminologie 22 Traktandenliste SGDV – C Mainetti/D Hohl: Tribune des Präsidenten, Tribune du président 1 M Tomasik: Neues aus dem Generalsekretariat, Nouvelles du secrétariat général Doppelt stark. N Griesser: Neue Mitglieder, Nouveaux membres 2 3 Ordre du jour SSDV – Neues aus den kantonalen Dermatologengesellschaften, den Kommissionen Schnell. Einfach. und Arbeitsgruppen, Nouvelles des sociétés cantonales de dermatologie et 24 Freie Mitteilungen vénéréologie, des commissions et des groupes de travail (Koordination: Redak- tionsbüro, Coordination: Bureau éditorial, C Herreras, [email protected]) Communications libres J Hafner: Neues aus der Industrie, Nouvelles de l’industrie (Koordination: Redak- tionsbüro, Coordination: Bureau éditorial, C Herreras, [email protected]) 30 Posters Ständige Kommission für Kommunikation, Commission permanente pour la communication: AK Lapointe, AM Skaria: Redaktoren Westschweiz, Editeurs députés pour la Suisse romande E Bianchi, F Pelloni: Redaktoren Tessin, Editeurs députés pour le Tessin B Schlagenhauff, J Hafner: Redaktoren deutsch-sprachige Schweiz, Editeurs députés pour la Suisse alémanique

e-mail: [email protected] Authors instructions (peer reviews) ISSN: 1420-2360 Size: Papers should comprise approximately 700-2000 words including figures, tables and references. Title page: The first page of each paper should indicate the title, the authors’ names, the institute where the work was conducted, and a short title for use as running head. Full address: The exact postal address of the corresponding author complete with postal code must be given. Key words: For indexing purposes, a list of 3–5 key words in English is essential for all papers. Abstract: Normally each paper needs an abstract of not more than 150 words. It should contain the following information: purpose of the study, procedures, results, conclusions and message of the paper. Abstracts submitted for publication in the section Original Papers should be structured as follows: Background: What is the major problem that prompted the study • Objective: What is the purpose of the study? • Methods: How was the study performed? Results: Most important findings? QRCode scannen und • Conclusion: Most important conclusion? weitere Informationen Footnotes: Avoid footnotes. When essential, they are numbered consecutively and typed at the foot of the appropriate page. Formatting rules: ANZEIGENREGIE – RÉGIE DES ANNONCES zu einer Behandlung mit • Do not use any special page layout. If you would like to see what your manuscript looks like with embedded tables and illustrati- ® ons, remember that we need text and illustrations as separate files! DUPIXENT erhalten • Enter your text continuously flush left. Do not use hard returns ("enter") within a paragraph, only at its end. • Do not use footer and header functions. • Use boldface and italics as well as sub- and superscript where appropriate. Carine HERRERAS • Use your word-processing program to insert Greek letters, mathematical symbols, etc. Legends: The legends to your figures are part of the text and should be listed at the end of your text file. Tél. +41 79 667 32 48 Line Drawings Black and White Half-Tone Images, Color Illustrations E-mail: [email protected] Doppelt stark. Wirkung auf Juckreiz & Hautbild.1 Scans • For processing and retouching scanned half-tone images, Photoshop is recommended. Please save the original scan as well as your processed version. 2 • Export black and white half-tones and color illustrations as TIF or EPS format, as close as possible to their anticipated size in print. Schnell. Signifikante Symptombesserung innerhalb 2 Wochen. • Save them as separate files, not embedded in the text. ÉDITION NEU • Scanned line drawings must be digitalized with a resolution of at least 800, better 1000 dpi (dots per inch) after scaling. 3 • Scanned half-tone images should be digitalized with a final resolution of 300 dpi, a 12 bit grayscale accuracy and a density range Dermatologica Helvetica Einfach. Alle 2 Wochen subkutan (s.c.) & ohne Monitoring. of 2.8. Screen values must lie between 5% and 95%. • Scanned color illustrations must be digitalized in RGB mode with a resolution of at least 300 dpi, a 32 bit accuracy and a density JH Saurat range of 2.8. • Summary. 22, rue de l’Athénée Make sure that your original has the resolution values in this table after scaling, otherwise the printing quality may be inadequate. ** ® *** CH-1206 Genève DUPIXENT : Erstes Biologikum bei erwachsenen Patienten mit mittelschwerer bis schwerer atopischer Dermatitis Detailled authors instruction will soon be avaible on our upcoming website.

* FDA Press Release. FDA approves new eczema drug Dupixent. March 28, 2017. www.fda.gov. *** Wenn eine Therapie mit verschreibungspflichtigen topischen Medika menten keine angemessene Krankheitskontrolle ermöglicht oder nicht empfohlen wird. DUPIXENT® kann mit oder ohne topische Kortikosteroide verwendet werden.3 Warnung – Avertissement 1 Simpson EL et al. Two Phase 3 Trials of Dupilumab versus Placebo in Atopic Dermatitis. N Engl J Med 2016; 375: 2335–48; 2 Blauvelt A et al. Long-term management of moderate-to-severe atopic dermatitis with dupilumab and concomitant topical corticosteroids (LIBERTY AD CHRONOS): a 1-year, randomised, double-blinded, placebo-controlled, phase 3 trial. Lancet 2017; 389: 2287–303; 3 DUPIXENT® Fachin- Für den Inhalt ausserhalb des redaktionellen Teils (insbesondere Anzeigen, Industrieinformationen, Pressezitate und Kongressinformationen) übernehmen Redaktion und Verlag keine Ge- formation, Stand April 2019, www.swissmedicinfo.ch. währ. Eine Markenbezeichnung kann warenzeichenrechtlich geschützt sein, auch wenn bei ihrer Verwendung in dieser Zeitschrift das Zeichen® oder ein anderer Hinweis auf etwa bestehende Dupixent® Injektionslösung (300mg/2ml) W: Dupilumab (aus gentechnisch veränderten Zellen des chinesischen Hamsters). I: Mittelschwerer bis schwerer atopischer Dermatitis (AD) bei erwach- Schutzrechte fehlen sollten. senen Patienten, bei denen die Erkrankung durch verschreibungspflichtige topische Präparate unzureichend kontrolliert ist, oder diese Präparate nicht indiziert sind. Dupixent kann mit oder L’éditeur et la rédaction déclinent toute responsabilité concernant le contenu non rédactionel du périodique (en particulier les annonces, les informations émanant de l’industrie, les citations ohne topische Kortikosteroide angewendet werden. Dosierung: Anfangsdosis von 600 mg als subkutane Injektion (zwei Injektionen zu je 300 mg), danach 300 mg als subkutane Injektion alle tirées de la presse et les informations issues de congrès). Une marque déposée peut jouir d’une protection légale même si elle est mentionée dans le périodique sans le symbole ® ou toute zwei Wochen. Niereninsuffizienz gleiche Dosierung. KI: Darf nicht gegeben werden bei Überempfindlichkeit gegen Wirkstoff oder einen Hilfsstoff. Sch/S: Keine Anwendung in der Schwanger- autre marque signalant, le cas échéant, une telle protection juridique. schaft, es sei denn der potenzielle Nutzen übersteigt das potenzielle Risiko für den Fötus. VM: Enthält Natrium. Überempfindlichkeitsreaktionen: Anwendung sofort beenden und eine geeignete Behandlung einleiten. Helminthose: Vorbestehende Helminthose vor Therapie mit Dupixent behandeln, bei Infektion während der Behandlung und Nichtansprechen auf Helminthosebehand- Dosierungsangaben von Medikamenten: lung Dupixent aussetzen bis Infektion abgeklungen ist. Konjunktivitis und Keratitis: Patienten darauf hinweisen, dass sie das Auftreten oder eine Verschlimmerung von Augensymptomen dem Autoren und Verlag haben alle Anstrengungen unternommen, um sicherzustellen, dass Auswahl und Dosierungsangaben von Medikamenten im vorliegenden Text mit den aktuellen Vor- Arzt / der Ärztin mitteilen sollten. Komorbides Asthma: Anpassung der Asthma-Behandlung nicht ohne vorherige Absprache mit Arzt / Ärztin, nach dem Absetzen der Behandlung diese Patienten schriften und der Praxis übereinstimmen. Trotzdem muss der Leser im Hinblick auf den Stand der Forschung, Änderungen staatlicher Gesetzgebungen und den unterbrochenen Fluss neuer sorgfältig überwachen. IA: Anwendung von Lebendimpfstoffen vermeiden. UW: Sehr häufig: Reaktionen an der Injektionsstelle (9,6 %). Häufig: Konjunktivitis, Augenjucken; Blepharitis, oraler Forschungsergeenisse bezüglich Medikamentenwirkung und -nebenwirkungen darauf aufmerksam gemacht werden, dass unbedingt bei jedem Medikament der Packungsprospekt konsul-

Herpes, Eosinophilie, Kopfschmerzen. P: Dupixent 300 mg, Injektionslösung in einer Fertigspritze: Packung mit 2 Fertigspritzen mit Sicherheitssystem. AK: B. ZI: sanofi-aventis (schweiz) ag, MAT-CH-2000940 1214 Vernier/GE (für weitere Informationen vgl. http://www.swissmedicinfo.ch/). Stand der Information: April 2019 (SACH.DUP.19.04.0253(1)). tiert werden muss, um mögliche Änderungen im Hinblick auf Indikation und Dosis nicht zu übersehen. Gleiches gilt für spezielle Warnungen und Vorsichtsmassnahmen. Ganz besonders gilt dieser Hinweis für empfohlene neue und/oder nur selten gebrauchte Wirkstoffe. Sanofi und Regeneron arbeiten gemeinsam an einem globalen Produktentwicklungsprogramm und an der Vermarktung von DUPIXENT® Alle Rechte vorbehalten. Ohne schriftliche Genehmigung des Verlags dürfen diese Publikation oder Teile daraus nicht in andere Sprachen übersetzt oder in irgendeiner Form mit mecha- nischen oder elektronischen Mitteln (einschliesslich Fotokopie, Tonaufnahme und Mikrokopie) reproduziert oder auf einem Datenträger oder einem Computersystem gespeichert werden. Kontakt: Sanofi Genzyme · [email protected] · www.sanofigenzyme.ch Zulassungsinhaberin: sanofi-aventis (schweiz) ag · 3, route de Montfleury · 1214 Vernier Posologie des médicaments: Les auteurs et l’éditeur ont tout mis en œuvre pour s’assurer que le choix des médicaments et la posologie préconisés dans ce texte soient conformes aux recommandations et à la pratique au moment de la publication. Cependant, compte tenu des recherches en cours, des changements dans les législations et de l’afflux constant de données nouvelles concernant la thérapie médicamenteuse et l’effet des médicaments, il est vivement recommandé au lecteur de vérifier sur la notice jointe à chaque emballage si aucune modification n’est intervenue dans la posologie et si aucune nouvelle contre-indication ou précaution à prendre n’a été signalée. Cela est particulièrement important lorsque l’agent recommandé est nouveau ou peu employé. Tous droits de reproduction, même partielle, sous n’importe quelle forme, strictement réservés.

Dermatologica Helvetica - Volume 32(6) - Août 2020 3

151057_DUP_CH_Anzeige_DE_Final.indd 1 04.06.20 17:31 SGDV 2020 goes DIGITAL

LIVE STREAMING VERSION 17./18.9.2020 direkt aus dem Aufnahmestudio (Messe Zürich)

VERSION LIVE STREAMING 17/18.9.2020 directement du studio d‘enregistrement (Messe Zurich)

Spitzenmedizin in der Praxis

4 Dermatologica Helvetica - Volume 32(6) - Août 2020 Dermatologica Helvetica - Volume 32(6) -Août 2020 • opening». «mind durchzuführen. «Streaming-Format» im virtuell einmalig – alle es hoffen esnnrievreato u eii-ihrettcnshnÜelgne itrdem hinter Überlegungen medizin-sicherheitstechnischen aus vorbehaltlos Personenkreise wir – und erst- 2020 SGDV der Jahresversammlung die entschieden, wir haben Herbst den in sKnrse itelstatt. virtuell Kongresses des Beginn zu gleich Donnerstag am Findet Generalversammlung SGDV von Sinne im «Highlights» fachliche versprechen Experten internationalen und namhaften Mit Lectures Key-Note der in heute betreiben Dermatologen wir – Faches unseres Fortschritte enormen die auf Fokus Praxis» der in «Spitzenmedizin Jahressthema September 17./18. geplant Wie Eckdaten wichtigsten den Zu involvierte weitere und Industrie der als aus Sie Partner für unsere Verantwortung selbstredender für Teilnehmer, mit Organisatoren und als Teilnehmerinnen wir können Variante dieser Mit Auf- anders: alles manchmal doch kommt Planung vorausschauender und bestmöglicher Trotz Praxis der in Spitzenmedizin – DIGITAL goes SGDV der Jahresversammlung 102. Die SGDV der Präsidenten des Grusswort rn e ohimrrltvhilnCVD1-iuto n e ezi nihrnAusblick unsicheren derzeit dem und COVID-19-Situation heiklen relativ immer noch der grund IESRAIGVRINa 17./18.9.2020 am VERSION STREAMING LIVE • Jahresver- die Zuversicht und Elan mit wir können dann nur – zentral ist Dies stehen. Kongress • emtoklge e nznlce emtsnudadrnKaketnmdrseSpit- modernste Krankheiten anderen und Dermatosen entzündlichen bei Dermatoonkologie, amugdrSD ndrQaiä,wewre ntee,organisiere n. anstreben, es wir wie Qualität, der in SGDV der sammlung • emdzn–ac ndrtgihnPraxis. täglichen der in auch – zenmedizin Pro h rnltoa aht tpcdraii n beyond and dermatitis atopic to path translational The rf rsinReich, Kristian Prof. h nepa ewe edrseii ifrne ncne ucpiiiyadaging and susceptibility cancer in differences gender-specific between interplay The Dotto, Paolo Prof. paePsoriasis Update erlCetSe el nSi on eln n Cancer and Healing Wound Skin in Cells Stem Crest Neural Sommer, Lukas Prof. .Em Guttman, Emma f. nvriä Lausanne Universität nvriäslnkmHamburg-Eppendorf Universitätsklinikum T Zürich ETH on ia eia etrNwYork New Center Medical Sinai Mount 2

5 SGDV – SSDV 6 SGDV – SSDV bn uamnmtdmVrtn nZrc mAfamsui e es eluemn Ein teilzunehmen. Messe «Reiz». besonderen der seinem Aufnahmestudio mit im Abend unkonventioneller Zürich sicher in Vorstand dem mit zusammen abend ezihrDn eür uhdmSD osadfrdsVrrun n i raiainder Organisation die uns Vertrauen, das für Vorstand SGDV dem auch gebührt Dank Herzlicher zvrrun i runusafze eeceneudspannende und bereichernde zwei auf uns freuen Wir anzuvertrauen. Jahresversammlung 102. i OI-9Stainzlst ae i i ezihena ewrigDne mMittwoch- am Dinner Networking am ein herzlich Sie wir laden zulässt, Situation COVID-19 die ie eea o rf rgrZn,COUZ n o rf hmsKni brdnStellen- den über Kündig Thomas Prof. von und USZ, CEO Zünd, Gregor Prof. von Referat einem Ständeräten und National- mit Wohlstand» und Sicherheit Gesundheit, von Motor als «Medizin Standespolitik und Parlamentarier-Roundtable/Tarif- Highlight Weiteres Don- am ebenfalls wir verleihen Preise gespendeten grosszügig wiederum diesjährigen, Die Preisverleihungen a Ntokn»itfrusal ndee iuto eodr o eetn.Wn me es immer Wenn Bedeutung. von besonders Situation dieser in alle uns für ist «Networking» Das Tagungspräsident Kündig Thomas med. Dr. Prof. SGDV Präsident Hohl Daniel med. Dr. Prof. virtuell-digital! Ihnen mit Kongresstage te ate osligA.Eneettwr rvon er wird Eingeleitet AG. Consulting freut. Partner besonders & Mutter uns Bettina was gebührt statt, hierfür gestreamt» Dank Herzlichen «live ebenfalls findet Gesundheitskommission der e erz schätzen. zu sehr Vertra uen Ihr und ment e GVwrac u ölc,d ieVezh e pnoe n ate a eeKonzept neue das Partner und Sponsoren der Vielzahl eine da Jahresversammlung möglich, diesjährigen nur unserer auch war Umorganisation SGDV herausfordernde der alle uns für Diese Dermatologie. der wert esamre,i ncls ndeGeneralversammlung. die an Anschluss im nerstagmorgen, iazelmtergnhbn ie ezihnDn ü i lxblä i isndsEngage- das wissen wir – Flexibiltät die für Dank herzlichen Einen haben. mitgetragen finanziell Dermatologica Helvetica - Volume 32(6) -Août 2020 3 ꞏ Dualer Wirkmechanismus: antientzündlich und antiparasitär1– 4 ꞏ Überlegen bei Symptomreduktion und Schubfreiheit im Vergleich zu 2 x tgl. Metronidazol (0.75%)1, 5 ꞏ Mehr erscheinungsfreie Patienten im Vergleich zu 2 x tgl. Metronidazol (0.75%)1, 6 *

* Nach 16 Wochen Anwendung. 1. Taieb et al., Superiority of ivermectin 1% cream over metronidazole 0.75% cream in treating inflammatory lesions of rosacea: a randomized, investigator-blinded trial. Br J Dermatol, 2015; 172(4): 1103-10.2. Stein Gold et al., Efficacy and safety of ivermectin 1% cream in treatment of papulopustular rosacea: results of two randomized, double-blind, vehicle-controlled pivotal studies. J Drugs Dermatol, 2014; 13(3): 316-323. 3. Wolstenholme and Rogers, Glutamate-gated chloride channels and the mode of action of the avermectin/milbemycin anthelmintics. Parasitology, 2005; 131 Suppl: S85-95. 4. Schaller, Rosazea – Klinik, Differentialdiagnostik und aktuelle Therapie. Vol. 1. Auflage. 2015: UNI-MED Verlag. 72.5. Taieb et al., Maintenance of remission following successful treatment of papulopustular rosacea with ivermectin 1% cream vs. metronidazole 0.75% cream: 36-week extension of the ATTRACT randomized study. J Eur Acad Dermatol Venereol, 2016; 30(5): 829-36. 6. Webster et al., Defining treatment success in rosacea as 'clear' may provide multiple patient benefits: results of a pooled analysis. J Dermatolog Treat, 2017; 28(5): 469-474. SOOLANTRA® Crème: Z: Ivermectinum 10 mg/g. Hilfsstoffe: E216, E 218, Phenoxyethanol; Propylenglykol; Cetylalkohol; Stearylalkohol; Excipiens ad unguentum. I: Äusserliche Behandlung entzündlicher Läsionen bei mittelschwerer bis schwerer papulopustulöser Rosazea bei Erwachsenen. D: 1 g/Tag gewöhn- lich bis zu 3 Monaten, Wiederholung nach individueller Nutzen-Risiko-Abwägung. KI: Überempfindlichkeit gegenüber einem Inhaltsstoff.VM: Soolantra® wurde bei Patienten mit Nieren- oder Leberfunktionsstörungen nicht untersucht. Enthält Cetylalkohol, Stearylalkohol, Propylenglykol, die lokale Hautreaktionen hervorrufen können, sowie Methyl-4-hydroxybenzoat (E218), Propyl-4-hydroxybenzoat (E216), die zu möglicherweise verspäteten allergischen Reaktionen führen können. Soolantra® sollte nicht mit starken P-gp- und CYP3A4-Inhibitoren (z.B. Ketokonazol, Itraconazol) sowie mit Substanzen mit enger therapeutischer Breite, deren Exkretion wesentlich von P-gp abhängt (z.B. Digoxin, Ciclosporin), verabreicht werden. Vorsicht ist geboten bei Verabreichung zusammen mit moderaten P-gp- und CYP3A4 Inhibitoren. IA: nicht mit starken Inhibitoren des P-gp und CYP3A4 (Ketokonazol, Itraconazol). UAW: Häufig:Gefühl des Brennens auf der Haut. Gelegentlich: Hautreizung, Pruritus, Hauttrockenheit. Selten: Erythema, Kontaktdermatitis. SS/ST: Anwendung in der Schwangerschaft vermeiden. In der Stillzeit nicht anwenden. P: Tube zu 30 g. Liste B, SL. Zulassungsinhaberin: Galderma SA, CH-6330 Cham. Weiterführende Informationen unter www.swissmedicinfo.ch. Stand: September 2017. CH/SOO/0292/1119

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9 SGDV – SSDV 10 SGDV – SSDV 14.10–14.40 13.50–14.10 13.30–13.50 12.10–12.40 11.40–12.10 Sponsoren/Partner der Pause/Präsentationen 11.25–11.40 12.40–13.10 44–50 as/rsnainndrSponsoren/Partner der Pause/Präsentationen 14.40–15.00 Sponsoren/Partner der Pause/Präsentationen 13.10–13.30 10.45–11.05 10.15–10.45 10.05–10.15 09.35–10.05 8.05–09.35 08.00–08.05 Donnerstag/ Dinner Networking 19.00–23.00 15.00–18.30 Kaffeepause/ 14.30–15.00 13.30–14.30 11.00–13.30 Mittwoch/ Programm/Programme 11.05–11.25 Mercredi h rnltoa aht tpcdraii n beyond and dermatitis atopic to path translational The 2: Lecture Note Key par? déclenché polymorphe, peau/Erythème la et Cocaïne l’année de surprises Les Fallvorstellung/ Thematische Vaudois Universitaire Hospitalier Centre Lausanne year the of Case Psoriasis with living Women for choice Treatment Psoriasis: in Pegol Certolizumab Praxis dermatologischen der in HPV-Impfung Perspektiven – Gesundheitswesens des Zukunft hmtsh Fallvorstellung/ Thematische Satellitensymposium/ Satellitensymposium/ Satellitensymposium/ rf maGtmn e York New Guttman, Emma Prof. Genève de Universitaires Hôpitaux AG UCB-Pharma Lausanne Conrad, Curdin Prof. Zürich Maul, Julia-Tatjana Dr. Bern Yawalkar, Nikhil Prof. dermatologique pratique la dans l’HPV contre vaccination La Perspectives – santé de système du Avenir Medizin der Zeitalter digitalen im as/rsnain e sponsors/partenaires des Pause/Présentations rf lxne rue,Oberhausen Kreuter, Alexander Prof. AG Schweiz Pharma Novartis numérique médecine la de l’ère à as/rsnain e sponsors/partenaires des Pause/Présentations sponsors/partenaires des Pause/Présentations AG Dohme & Sharp Merck MSD e ist o uiua brdeaoiceDermatitis atopische die über Dupilumab von Einsatz Der Tests & Clues 1: cas de Présentation Hamburg Reich, Kristan Prof. Psoriasis Update SSDV annuelle réunion la de Ouverture (statutaire) SSDV la de générale Assemblée Zürich Kündig, Thomas Prof. Lausanne Hohl, Daniel Prof. 2020 SSDV annuelle réunion la de ouverture cliniques de directeurs des commission la de Séance hmtsh Fallvorstellung/ Thematische Lecture1 Note Key 2020/ SGDV Jahresversammlung der Eröffnung Preisübergaben/ (statutarisch) Generalversammlung 2020/ SGDV Generalversammlung Eröffnung Vorstands-Sitzung/ Meeting Register Klinikdirektorenkommissions-Sitzung/ hmtsh Fallvorstellung/ Thematische nesia,Uiesttsia Bern Universitätsspital Inselspital, hinaus Basel Universitätsspital Lausanne Hohl, Daniel Prof. Zürich Kündig, Thomas Prof. Jeudi, 17.9.2020 16.9.2020 as café Pause ééoi erms e prix des remise de Cérémonie éned comité du Séance ypsu satellite: Symposium satellite: Symposium ypsu satellite: Symposium rsnaind a 4: cas de Présentation rsnaind a 3: cas de Présentation rsnaind a 2: cas de Présentation Dermatologica Helvetica - Volume 32(6) -Août 2020 ocs/ieStreaming Podcast/Live Podcast Streaming Live Streaming Live Podcast Streaming Live ieStreaming Live Streaming Live 1 Streaming Live Zürich Messe 7, Halle Studio Streaming 5+6 Inn/Raum Holiday Inn Holiday Foyer 7 Inn/Raum Holiday 7 Inn/Raum Holiday Wie/Wo/ ieStreaming Live Streaming Live Streaming Live 2 Streaming Live Comment/où 7 6 COMMENT AI-JE TROUVÉ MON HOBBY? AVEC COSENTYX®.°

De nouveau actif, grâce à Cosentyx®: Dès Avec Cosentyx®, 8 patients sur 10 ressentent à nouveau ce que signifi e maintenant le fait d’être presque asymptomatique*; et de se sentir ainsi à nouveau DONNÉES libre.°, 1, 2 PROBANTES DU MONDE 3 RÉEL Cosentyx®: De Suisse, pour la Suisse# * Réponse PASI-90- à la semaine 16 (critère d’évaluation de l’effi cacité principal CLEAR) | ° Réponse DLQI à la semaine 52: 72% # Cosentyx® est fabriqué en Suisse (Stein/AG) par Novartis Pharma Stein AG. 1 . Thaci D et al., Secukinumab is superior to ustekinumab in clearing skin of subjects with moderate to severe plaque psoriasis: CLEAR, a randomized controlled trial. J Am Acad Dermatol 2015; 73(3): 400–409. 2 . Information professionnelle Cosentyx® (sécukinumab), mise à jour de l’information: Janvier 2018, www.swissmedicinfo.ch. 3. Augustin M. et al, Effectiveness and safety of secukinumab treatment in real-world clinical settings in European countries confi rms its effi cacy and safety from clinical trials: Data from an interim analysis of SERENA study. Poster présenté à: AAD Annual Meeting, du 1er au 5 mars 2019 à Washington D.C. États-Unis.

Information professionnelle abrégée Cosentyx® (sécukinumab): C: Sécukinumab + excipients. I: Psoriasis en plaques: Cosentyx/- SensoReady est indiqué dans le traitement du psoriasis en plaques modéré à sévère chez les patients adultes qui n’ont pas répondu aux autres traitements systémiques (y compris le traitement par ciclosporine ou par méthotrexate, ainsi que la puvathérapie) ou qui ne peuvent pas les suivre en raison de contre-indications ou d’intolérance. Arthrite psoriasique: Cosentyx/- SensoReady, seul ou en association avec le méthotrexate, est indiqué pour le traitement de patients adultes atteints d’arthrite psoriasique active qui ont répondu insuffi samment à un traitement précédent par des antirhumatismaux modifi cateurs de la maladie (DMARD). Spondylite ankylosante (maladie de Bechterew): Cosentyx/- SensoReady est indiqué pour le traitement de patients adultes atteints d’une spondylite ankylosante sévère qui ont répondu insuffi samment à un traitement conventionnel (par exemple des AINS). P: Psoriasis en plaques: La dose recommandée est de 300 mg administrée aux semaines 0, 1, 2, 3 et 4 en traitement d’initiation, puis tous les mois en traitement d’entretien. Chaque dose de 300 mg est administrée en deux injections sous-cutanées de 150 mg. En cas d’effets indésirables graves, une interruption temporaire du traitement doit être envisagée. Dans les cas graves de candidoses mucocutanées, envisager une réduction de dose de 150 mg. Arthrite psoriasique: La dose recommandée est de 150 mg, en injection sous-cutanée, administrée aux semaines 0, 1, 2, 3 et 4 en traitement d’initiation, puis tous les mois en traitement d’entretien. Pour les patients qui répondent insuffi samment aux Anti-TNFα, la dose recommandée est de 300 mg. En cas de psoriasis en plaques concomitant modéré à sévère, voir les recommandations de posologie et d’utilisation pour le psoriasis en plaques. Spondylite ankylosante (maladie de Bechterew): La dose recommandée est de 150 mg, en injection sous-cutanée, administrée aux semaines 0, 1, 2, 3 et 4 en traitement d’initiation, puis tous les mois en traitement d’entretien. CI: Graves réactions d’hypersensibilité au principe actif ou à l’un des excipients. Infections actives sévères.PE: Prudence chez les patients ayant une infection chronique ou des antécédents d’infections récidivantes, en cas de maladies infl ammatoires chroniques intestinales, en cas de vaccination. En cas d’apparition d’une réaction anaphylactique ou autres réactions allergiques graves, interrompre l’administration immédiatement et prendre des mesures thérapeutiques. Prendre en compte le risque d’aggravation du psoriasis en cas d’arrêt du traitement («rebond»). L’administration concomitante avec d’autres biomédicaments n’a pas été étudiée et n’est pas recommandée. Le capuchon de l’aiguille peut contenir du caoutchouc sec (latex). IA: Les vaccins vivants ne doivent pas être administrés de manière concomitante. Les patients prenant des médicaments dont la dose est déterminée de manière individuelle et qui sont

métabolisés par les enzymes CYP450 3A4, 1A2 ou 2C9, doivent faire l’objet d’un contrôle au début et à la fi n d’un traitement par sécukinumab et la dose de ces substances doit être adaptée NO52522 11/2019 au besoin. EI: Infections des voies respiratoires supérieures, herpès oral, rhinorrhée, diarrhée, candidose orale, tinea pedis, candidose de l’œsophage, neutropénie, conjonctivite, enzymes hépatiques élevés, bilirubine élevée, urticaire. Pr: Cosentyx/- SensoReady 150 mg: 1 ou 2 Stylo(s) prérempli(s)/1 ou 2 seringue(s) préremplie(s)/1 fl acon avec poudre pour solution injectable. Catégorie de remise: B. Pour de plus amples informations, veuillez consulter www.swissmedicinfo.ch. Janvier 2018 V4. Novartis Pharma Schweiz AG, Risch; adresse: Suurstoffi 14, 6343 Rotkreuz, tél. 041 763 71 11 12 SGDV – SSDV 11.40–12.10 Sponsoren/Partner der Pause/Präsentationen 11.25–11.40 12.10–12.40 12.40–13.10 14.10–14.40 13.50–14.10 13.30–13.50 44–50 as/rsnainndrSponsoren/Partner der Pause/Präsentationen 14.40–15.00 Sponsoren/Partner der Pause/Präsentationen 13.10–13.30 17.15–17.45 patterns sensitization and signatures immune different for Evidence 17.09–17.15 Body the on Pictures Dermatology Skin of Localization 17.03–17.09 - contagiosum Molluscum to reaction like Gianotti-Crosti 16.57–17.03 differentially affect IL-17A and (IL-25) IL-17E 16.51–16.57 with Patients 61 of Analysis Retrospective Monocentric, A 16.45–16.51 16.45–17.15 16.15–16.45 15.45–16.15 15.00–15.45 Satellitensymposium/ h rnltoa aht tpcdraii n beyond and dermatitis atopic to path translational The par? déclenché polymorphe, peau/Erythème la et Cocaïne l’année de surprises Les Vaudois Universitaire Hospitalier Centre Lausanne year the of Case Psoriasis with living Women for choice Treatment Psoriasis: in Pegol Certolizumab Praxis dermatologischen der in HPV-Impfung Satellitensymposium/ Perspektiven – Gesundheitswesens des Zukunft Satellitensymposium/ e oeLcue2: Lecture Note Key Fallvorstellung/ Thematische Fallvorstellung/ Thematische as/rsnain e sponsors/partenaires des Pause/Présentations rf maGtmn e York New Guttman, Emma Prof. Genève de Universitaires Hôpitaux AG UCB-Pharma Lausanne Conrad, Curdin Prof. Zürich Maul, Julia-Tatjana Dr. Bern Yawalkar, Nikhil Prof. dermatologique pratique la dans l’HPV contre vaccination La Perspectives – santé de système du Avenir Medizin der Zeitalter digitalen im rf lxne rue,Oberhausen Kreuter, Alexander Prof. AG Schweiz Pharma Novartis numérique médecine la de l’ère à as/rsnain e sponsors/partenaires des Pause/Présentations sponsors/partenaires des Pause/Présentations AG Dohme & Sharp Merck MSD FC1–FC5 art the of state the Treatment: Rosacea trials clinical between bridging – AD in Dupixent Schweiz? die steht wo – Psoriasis der in Spitzenmedizin idaiua:DrI-3Atkre ü lnkudPraxis und Klinik für IL-23-Antikörper Der Tildrakizumab: Satellitensymposium/ Mitteilungen/ Freie Satellitensymposium/ Satellitensymposium/ Co-Satellitensymposium/ adraSA Galderma Tübingen Schaller, Martin Prof. (Dermatology) Genzyme Sanofi Basel Häusermann, Peter Prof. York New Guttman, Emma Prof. practice clinical and Suisse?» la est en Où – psoriasis le dans pointe de médecine La idaiua:LatcrsI-3pu aciiu tl cabinet le et clinique la pour IL-23 L’anticorps Tildrakizumab: nsbShrnvru eta uoenAoi emttspatients Dermatitis Atopic European central versus sub-Saharan in Allschwil Amruthalingam, Ludovic Dr. characteristics clinical and Epidemiology keratinocytes human of functions the Zürich Anzengruber, Florian Dr. Annulare Granuloma Generalized me wteln GJnsnClgAG AG/Janssen-Cilag Switzerland Amgen Zürich Plaza, Tobias Dr. Zürich Anzengruber, Florian Dr. Hamburg Reich, Kristian Prof. lialAG Almirall Zürich Maul, Julia-Tatjana Dr. Kiel Mrowietz, Ulrich Prof. r lui ag Zürich Lang, Claudia Dr. Bern Bürgler, Christina Dr. Genève Brembilla, Nicolô Dr. omnctoslibres Communications ypsu satellite: Symposium ypsu satellite: Symposium ypsu satellite: Symposium ypsu satellite: Symposium satellite: Symposium satellite: Symposium oSmoimsatellite: Co-Symposium rsnaind a 4: cas de Présentation 3: cas de Présentation Dermatologica Helvetica - Volume 32(6) -Août 2020 ocs/ieStreaming Podcast/Live Podcast Streaming Live Streaming Live Podcast Streaming Live ieStreaming Live ieStreaming Live Podcast Streaming Live Streaming Podcast/Live 8 7 Dermatologica Helvetica - Volume 32(6) -Août 2020 13–13 ct eeaie xnhmtu utlss- Pustulosis Exanthematous Generalized Acute 11.30–11.36 11.30–12.00 11.00–11.30 10.30–11.00 10.00–10.10 09.50–10.00 09.30–09.50 09.00–09.30 08.00–09.00 18.9.2020 Freitag/Vendredi, 01–03 as/rsnainndrSponsoren/Partner der Pause/Präsentationen 10.10–10.30 18.15 17.45–18.15 16.45–17.15 16.15–16.45 15.45–16.15 15.00–15.45 17.15–17.45 patterns sensitization and signatures immune different for Evidence 17.09–17.15 Body the on Pictures Dermatology Skin of Localization 17.03–17.09 - contagiosum Molluscum to reaction like Gianotti-Crosti 16.57–17.03 differentially affect IL-17A and (IL-25) IL-17E 16.51–16.57 with Patients 61 of Analysis Retrospective Monocentric, A 16.45–16.51 FC6–FC10 suppurativa Hidradenitis Psoriasis, – trois a Ménage » _ _ _ about Talk Let’s Intimität: und «Haut Bellinzona Regionale Ospedale Evil! and Good Imiquimod: Topical Gallen St. cantonal Gallen/Hôpital St. Kantonsspital Year the of Case -infestationen/ und Hautinfektionen Zürich Schmid-Grendelmeier, Peter Prof. Zürich Dummer, Reinhard Prof. Zürich Kündig, Thomas Prof. cliniques pathologiques Corrélations ri Mitteilungen/ Freie Satellitensymposium/ Satellitensymposium/ / Fallvorstellung Thematische Fallvorstellung/ Thematische Fallvorstellung/ Thematische EAACI» ASCO, AAD, – review in Meeting year’s «This Korrelationen/ Klinisch-pathologische bVeAG AbbVie Lenzburg Taskesen, Timur Dr. Lausanne Conrad, Curdin Prof. Dermatitis atopische und SA (Suisse) Lilly Eli Würenlos Moukhtieva, Renata Dr. Gallen St. Cozzio, Antonio Prof. Triemli Triemli/Hôpital Stadspital cutanées infestations et Infections o nyATCl rvnDisease? Driven Cell T A Only Not as/rsnain e sponsors/partenaires des Pause/Présentations r r abr ee-cise,Zürich Meier-Schiesser, Barbara Dr. Dr. rf hmsKni,Zürich Kündig, Thomas Prof. journée la de clôture de Allocation Tages/ des Schlusswort entzündlichen bei Therapie TCS-/TCI-freie Wirksame, Satellitensymposium/ atrrnugn–Wncdne drRealität? oder Wunschdenken – Hauterkrankungen imdAG Biomed Bern Yawalkar, Nikhil Prof. Zürich Schmid-Grendelmeier, Peter Prof. idaiua:DrI-3Atkre ü lnkudPraxis und Klinik für IL-23-Antikörper Der Tildrakizumab: FC1–FC5 Mitteilungen/ Freie art the of state the Treatment: Rosacea Satellitensymposium/ trials clinical between bridging – AD in Dupixent Satellitensymposium/ Schweiz? die steht wo – Psoriasis der in Spitzenmedizin Co-Satellitensymposium/ Satellitensymposium/ idaiua:LatcrsI-3pu aciiu tl cabinet le et clinique la pour IL-23 L’anticorps Tildrakizumab: SA Galderma Tübingen Schaller, Martin Prof. (Dermatology) Genzyme Sanofi Basel Häusermann, Peter Prof. York New Guttman, Emma Prof. practice clinical and Suisse?» la est en Où – psoriasis le dans pointe de médecine La nsbShrnvru eta uoenAoi emttspatients Dermatitis Atopic European central versus sub-Saharan in Allschwil Amruthalingam, Ludovic Dr. characteristics clinical and Epidemiology keratinocytes human of functions the Zürich Anzengruber, Florian Dr. Annulare Granuloma Generalized lialAG Almirall Zürich Maul, Julia-Tatjana Dr. Kiel Mrowietz, Ulrich Prof. AG AG/Janssen-Cilag Switzerland Amgen Zürich Plaza, Tobias Dr. Zürich Anzengruber, Florian Dr. Hamburg Reich, Kristian Prof. r lui ag Zürich Lang, Claudia Dr. Bern Bürgler, Christina Dr. Genève Brembilla, Nicolô Dr. omnctoslibres Communications omnctoslibres Communications ypsu satellite: Symposium satellite: Symposium ypsu satellite: Symposium ypsu satellite: Symposium satellite: Symposium ypsu satellite: Symposium oSmoimsatellite: Co-Symposium rsnaind a 6: cas de Présentation 5: cas de Présentation rsnaind a 7: cas de Présentation ieStreaming Live Presentation Powerpoint Podcast Streaming Live Streaming Live Streaming Live Streaming Live Streaming Live ieStreaming Live Streaming Live ieStreaming Live Podcast Streaming Live Streaming Podcast/Live Streaming Live 10 9 8

13 SGDV – SSDV 11.36–11.42 Papillomatous pedunculated sebaceous naevi – expanding the clinical and genetic spectrum Dr. Martin Theiler Pang, Zürich 11.42–11.48 Gamma-glutamyl transferase: prognostic role at baseline and during therapy as a novel immune-related adverse event in metastatic melanoma patients treated with immune checkpoint inhibitors Dr. Nikolaus Wanger, St. Gallen 11.48–11.54 The Infantile Hemangioma Referral Score (IHReS): A Validated Tool for Physicians PD Dr. Lisa Weibel, Zürich 11.54–12.00 Driving pathways in Pityriasis Rubra Pilaris 11 Dr. Ahmad Yatim, Lausanne

12.00–12.10 Thematische Fallvorstellung/Présentation de cas 8: Live Streaming Case of the year Kantonssspital Aarau/Hôpital cantonal Aarau

12.10–12.20 Thematische Fallvorstellung/Présentation de cas 9: Live Streaming Banale ulcera? Kantonsspital Luzern/Hôpital cantonal Luzern

12.20–12.50 Pause/Präsentationen der Sponsoren/Partner Pause/Présentations des sponsors/partenaires

12.50–13.20 Satellitensymposium/Symposium satellite: Live Streaming Rare but highly malicious – New hope for patients with metastatic squamous cell carcinoma of the skin Dr. Mirjam Nägeli, Zürich Sanofi Genzyme (Oncology)

13.20–13.50 Key Note Lecture 3: Live Streaming The interplay between gender-specific differences in cancer susceptibility and aging Prof. Paolo Dotto, Lausanne

13.50–14.20 Key Note Lecture 4: Live Streaming Neural Crest Stem Cells in Skin Wound Healing and Cancer Prof. Lukas Sommer, Zürich

14.20–14.30 Pause/Präsentationen der Sponsoren/Partner Pause/Présentations des sponsors/partenaires

14.30–16.00 Medizin als Motor für Innovation, Forschung und Live Streaming den Wirtschaftsstandort Schweiz Medizin als Motor für Gesundheit, Sicherheit und Wohlstand La médecine, moteur d’innovation et de recherche au cœur du pôle économique suisse La médecine, moteur pour la santé, la sécurité et le bien-être 14.30–14.40 Input Referat 1: USZ – Planung und Entwicklung 2020–2050 Prof. Gregor Zünd, CEO, Universitätsspital Zürich 14.40–14.50 Input Referat 2: Entzündliche Hauterkrankungen Prof. Thomas Kündig, Klinikdirektor, Dermatologische Klinik, USZ 12 14.50–16.00 Roundtable: Thema: Moderne und sozial finanzierbare Gesundheitspolitik/Table ronde: pour une politique de santé moderne, qui peut être financée sur le plan social Teilnehmer: Nationale Gesundheitspolitiker (Kommission für Soziale Sicherheit und Gesundheit – Nationalrat und Kommission für soziale Sicherheit und Gesundheit – Ständerat) Participants: SGDV – SSDV SGDV Responsables politiques nationaux en matière de santé 14 (Commission de la sécurité sociale et de lasanté publique Dermatologica Helvetica - Volume 32(6) - Août 2020 du conseil national et Commission de la sécurité sociale et de la santé publique du Conseil des Etats) Moderation/Modération: Bettina Mutter (Owner und CEO, Mutter & Partner Consulting AG)

16.00–16.30 Schlusswort, div. Verdankungen/Allocation de clôture Live Streamng Prof. Thomas Kündig, Zürich Dermatologica Helvetica - Volume 32(6) -Août 2020 atuoebiOrgantransplantierten bei Hauttumore • • Teledermatologie CTCL Update Lymphome/ Kutane • Or • Skills Clinical • • Dermato-Onkologie/Dermato-Oncologie Dermato-Allergologie • rpsh Dermatologie/ Tropische Selbststudium/Auto-enseignement 16.00–16.30 14.50–16.00 14.40–14.50 14.30–14.40 14.30–16.00 rsnaindsgopsd rvi SSDV travail de groupes des Présentation Arbeitsgruppen/ SGDV der Präsentationen edraooi kuleEntwicklungen Aktuelle – Teldermatologie Rahmen tarifärer und Juristischer eeemtlgei e älce rxs– Praxis täglichen der in Teledermatologie Raum deutschsprachigen im uznudGrenzen und Nutzen Praxis die für Biologica-Update lnsh tde nZürich in Studien Klinische analysis cohort retrospective a nailbed: the of Melanoma immunotherapy during arising melanoma novo De gantra nsplantation eii l oo ü eudet ihretudWohlstand und Sicherheit Gesundheit, für Motor als Medizin Schweiz Wirtschaftsstandort den rf hmsKni,Zürich Kündig, Thomas Prof. ucnelntoa tCmiso el éuiésociale sécurité la de Commission et national conseil du clswr,dv ednugnAlcto eclôture de Verdankungen/Allocation div. Schlusswort, finanzierbare sozial und Moderne Thema: Roundtable: USZ Klinik, Dermatologische Klinikdirektor, Kündig, Thomas Prof. Hauterkrankungen Entzündliche 2: Referat Input Zürich Universitätsspital CEO, Zünd, Gregor Prof. 2020–2050 Entwicklung und Planung – USZ 1: Referat Input eii l oo ü noain oshn und Forschung Innovation, für Motor als Medizin amdcn,mtu ’noaine ercecea cœur au recherche de et d’innovation moteur médecine, La td asnépbiu uCneldsEtats) des Conseil du publique santé la de et Gesundheitspolitik/ amdcn,mtu orl at,l éuiée ebien-être le et sécurité la santé, la pour moteur médecine, La suisse économique pôle du etn utr(we n E,Mte ate osligAG) Consulting Partner & Mutter CEO, und (Owner Mutter Bettina Moderation/ social plan le sur financée être peut qui moderne, santé ainl eudetpltkr(omsinfrSoziale für (Kommission Gesundheitspolitiker Nationale Teilnehmer: ihretudGsnhi ainla n Kommission und Nationalrat – Gesundheit und Sicherheit ü oil ihretudGsnhi Ständerat) – Gesundheit und Sicherheit soziale für epnalspltqe ainu nmtèed santé de matière en nationaux politiques Responsables Participants: Cmiso el éuiéscaee el de et sociale sécurité la de (Commission ypoecutané Lymphome emtlgetropicale Dermatologie Modération: al od:pu n oiiu de politique une pour ronde: Table r ijmNgl,Zürich Nägeli, Mirjam Dr. r lve ad,Lausanne Gaide, Olivier Dr. Dr. r ui-ajn al Zürich Maul, Julia-Tatjana Dr. Dr. Bern Jafari, Morteza Dr. Dr. Zürich Greis, Christian Dr. as Philp E Jean-Philp g népublique anté l e R a Spring m e l y t e , Gör E , ieStreamng Live Streaming Live Zürich p a ög l i n , g Z e ü s r i c h 12 13

15 SGDV – SSDV 16 SGDV – SSDV Tagungspräsident/ Lausanne Hohl, Daniel Prof. SGDV/ Präsident Organisation générales Informations Informationen/ Allgemeine i ketee IA MASTERCARD/ VISA, akzeptieren Wir (Kreditkarten)/ Zahlungsweise Kongresswebseite/ Kongressanmeldung/ vergeben. Version STREAMING LIVE die für auch werden 18, Credits, SGDV vorgesehenen Die Credits/ Simultanübersetzung) (keine Englisch und Französisch Deutsch, Kongresssprachen/ www.ctlag-congress.ch [email protected] email: Te Luzern 6006 10, Oberseeburg AG Lucerne Team Convention Organisation/ Administrative Schmid-Grendelmeier Peter Prof. Hafner, Jürg Prof. Dummer, Reinhard Prof. Braun, Ralph Prof. Komitee/ Wissenschaftliches rf hmsKni,Zürich Kündig, Thomas Prof. Annullierungsbedingungen/ STREAMING. LIVE version la pour attribués également sont 18, prévus, SSDV crédits Les simultanée) traduction de (pas anglais et français Allemand, skne en ükrttugngledgmctwerden. gemacht geltend Rückerstattungen keine können Es uu ebusmn epu teeffectué. être peut ne remboursement Aucun .+14 7 860 18 371 41 +41 l. Crédits rsdn SSDV Président ieweb: Site rsdn el réunion la de Président age ucongrès du Langues Inscription www.sgdv-congress.ch odtosd‘annulation Conditions ertra administratif Secrétariat oiésiniiu ucongrès du scientifique Comité osacposVS,MASTERCARD VISA, acceptons Nous oed aeet(at ecrédit) de (carte Paiement de Mode Dermatologica Helvetica - Volume 32(6) -Août 2020 14 Dermatologica Helvetica - Volume 32(6) -Août 2020 ndrMseZrc,Hle7nc e eeavramugdnGwnenüberreicht. Gewinnern den Generalversammlung der nach 7 Halle Zürich, Messe der an Einreichung digitalen der betreffend persönlich werden Posterautoren Die werden. präsentiert iso e fihsnumériques. affiches des mission ocso el 102 la de l’occasion à récompensés seront suivants posters Les oit used emtlgee ééélge e rxsrn ei u annspnatle pendant gagnants aux remis seront prix Les Vénéréologie. et Dermatologie de Suisse Société catfrDraooi n eeooi egbn i riewre mLv temn Studio Streaming Live im werden Preise Gesell- Die Schweizerischen vergeben. Venerologie der und Jahresversammlung Dermatologie für 102. schaft der anlässlich werden Preise Folgende Posterpreise/ sou- participants la des de zone informés personnellement la sont dans affiches des Internet auteurs site Les passe. le de sur mot présentées par protégée seront affiches les année, Cette Teilnehmerbereich Passwortgeschützen informiert. im Posters der Webseite der auf Jahr dieses werden Poster Die Posterpräsentation/ Digitale opportun. temps en email par l’organisation E-Mail. par per informiert individuellement informés Organisation seront der orateurs von Les individuell Zeitpunkt gegebenen zum werden Redner Die Informationen/ Referenten rn lc otrri:BseAbi u legshnKontaktekzem allergischen zum Arbeit Beste Posterpreis: Bloch Bruno Preis: 3. .Preis: 2. ieSraigdn eSui ’neiteetd es üih al pè l’Assemblée après 7 Salle Zürich, Messe de d’enregistrement Studio le dans Streaming Live 3 2 rxBuoBoh elertaalsrlezm ecnatallergique contact de l’eczéma sur travail Meilleur Bloch: Bruno Prix rf r .Shye-ri:BseAbi u hmtkdrGndraoe H 4000.— CHF Genodermatosen der Thematik zur Arbeit Beste Schnyder-Preis: W. Urs Prof. rxPo.UsW cndr elertaalsrl hm e génodermatoses des thème le sur travail Meilleur Schnyder: W. Urs Prof. Prix .Preis: 1. générale. 1 ws knCne wr Per Fabre/Avène) (Pierre Award Cancer Skin Swiss Awards rjkutrttugLusWde AG Widmer Louis Projektunterstützung il muoemtlg wr EiLilly) (Eli Award Immunodermatology Lilly emtlg u azmHre L Roche-Posay) (La Herzen ganzem aus Dermatologe ème ème er prix: prix: prix: rxdsaffiches des Prix iluepéetto ecas de présentation Meilleure clinique travail Meilleur elertaalscientifique travail Meilleur et Fallpräsentation Beste et lnsh Arbeit klinische Beste et isncatih Arbeit wissenschaftliche Beste nomto orlsorateurs les pour Information rsnaindafce numériques d’affiches Présentation ième éno nuled la de Annuelle Réunion H 500.— CHF H 1000.— CHF H 2000.— CHF H 1500.— CHF 16 15

17 SGDV – SSDV 18 SGDV – SSDV oene i mtnei etme uasn ednwrgreennNtokn bn am Abend Networking einen gerne wir werden zulassen, September im Umstände die es Sofern (Mercredi,16.9.2020) cadre Programme (Mittwoch,16.9.2020)/ Rahmenprogramm 90 h e-oehrAéoi ieSraigSui,MseZürich Messe Studio, Streaming Live im Apéro Get-together Uhr 19.00 Programm/ Nicht-Mitglieder/ Mitglieder, Kosten/ 93 h ewrigNctse ndgtlmAmbiente digitalem in Nachtessen Networking Uhr 19.30 sitnäze tdne,Pflegefachpersonen Studenten, Assistenzärzte, oscu u evuetpss asrd ’setsca ’ncongrès. d’un social l’aspect de passer se pas veulent ne qui ceux tous éeisassat(e) tdat(e) infirmiers(ères) étudiants(tes), assistants(tes), Médecins 30 h ody n ueHeimreise! gute und Goodbye Uhr 23.00 sozialen den die alle, für organisieren, Studio Streaming Live im Geschehen im mitten 16.9.2020 es üih al ,Wlielntae4,85 Zürich 8050 49, Wallisellenstrase 7, Halle Zürich, Messe Ort/ setensKnrse ih azeternmöchten. entbehren ganz nicht Kongresses eines Aspekt ilscrosacsl emtete etmr,nu eoshuexdognsruesoirée une d’organiser heureux serons nous septembre, en permettent le circonstances les Si dol 6spebe22,pour 2020, septembre 16 le udio St Streaming Live le dans l’action de milieu au networking de Lieu: Frais n eLv temn tdo es Zurich Messe Studio, Streaming Live le dans rencontre de Apéro îe entokn asueabac numérique ambiance une dans networking de Dîner ody tbnvyg eretour! de voyage bon et Goodbye Programme: ebe,Non-membres Membres, Dermatologica Helvetica - Volume 32(6) -Août 2020 H 90.— CHF H 50.— CHF 17 Dermatologica Helvetica - Volume 32(6) -Août 2020 drmtdnBsiin6,6 Rctn cwmnigrlt)erreichbar. Schwamendingerplatz) (Richtung 62 61, Buslinien den mit oder elknitdeMseZrc nwngnMntnz us i e rmN.1 Rctn Auzelg) (Richtung 11 Nr. Tram der mit Fuss, zu Minuten wenigen in Zürich Messe die ist Oerlikon int«»zmMseeäd üih akltesee mPrhu es üiha der an Zürich Messe Parkhaus im stehen Parkplätze Zürich. Messegelände zum «Z» Signet iinS,S,S,S,S,S4 1,S6 1 n 2 u ano elkn o Bahnhof Vom Oerlikon. Bahnhof zum S24 und S19 S16, S15, S14, S9, S8, S7, S6, S2, Linien e e nes brdeAtbh o ae,Br,Cu,Lzr n t alnfle i dem Sie folgen Gallen St. und Luzern Chur, Bern, Basel, von Autobahn die über Anreise der Bei Parking/ Auto, les sur minutes 6 les toutes assurée est Oerlikon gare la avec liaison la Zurich, de centrale gare la A S-Bahn den mit Anschluss einen Minuten 6 alle haben Zürich Hauptbahnhof vom Reisende 7) Halle Zürich, Messe Studio, Streaming (Live Informationen/ Anreise niu avi uvejsua acdepstosd uih ospue ae or voiture votre garer pouvez Vous Zurich. de d’expositions parc jusqu’au suivre à voie la indique insS,S,S,S,S,S4 1,S6 1 tS4d éeuepesrgoa SBh) eusla Depuis (S-Bahn). régional express réseau du S24 et S19 S16, S15, S14, S9, S8, S7, S6, S2, lignes ivu rie eBl,Bre or,Lcreo tGl a ’uoot,l inltqe«»vous «Z» signalétique la l’autoroute, par St-Gall ou Lucerne Coire, Berne, Bâle, de arrivez vous Si Verfügung. zur Hagenholzstrasse u,Ta,Bus/ Tram, Zug, uprigMseZrc u etov asl Hagenholzstrasse. la dans trouve se qui Zurich Messe parking au aeOrio,lsvygusacdn aFied uihe ulusmntsàpe,prl tram le par pied, à minutes quelques en Zurich de Foire la à accèdent voyageurs les Oerlikon, gare o1 drcinAzl)o e insd u 1 2(ndrcinSchwamendingerplatz). direction (en 62 61, bus de lignes les ou Auzelg) (direction 11 No

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19 SGDV – SSDV 20 SGDV – SSDV Weitere/ Bronze/ Silber/ Gold/ Platin/ a isncatih n raiaoiceKmtebdntsc e e ahogne Firmen nachfolgenden den Unterstützung finanzielle bei ihre sich für bedankt Komitee organisatorische und wissenschaftliche Das Sponsors Sponsoren/ ecmt cetfqee ’raiainrmri e nrpie uvne elu soutient leur de suivantes entreprises les remercie d’organisation et scientifique comité Le financier. or platine argent bronze nplus en Dermatologica Helvetica - Volume 32(6) -Août 2020 pr30.6.2020) (per 19 Dermatologica Helvetica - Volume 32(6) -Août 2020 Firma/ Beteiligung Ihre und Interesse Ihr für Firmen folgenden danken Wir Partners/ vctu o eeceet u exposants aux remerciements nos tous Avec lrsnAG Ultrasun AG Pharmaceutical Sandoz AG Permamed AG Medical Orcos AG Doctor Online AG (Schweiz) Pharma Merz AG International Mavena SA Widmer Louis AG Lasermed AG Iromedica SA Biochimique Institut IBSA GmbH ibita Basel Haarwerkstatt AG (Switzerland) Kabi Fresenius Frick Haroun Dr. AG derma2go GmbH Switzerland Cutera AG Bencard GmbH Lasers Alma AG Allergopharma AG Allergan Entreprise Partenaires Zürich Rotkreuz Therwil Küsnacht/Biel Gallen St. Allschwil Hünenberg Schlieren Roggwil Gallen St. Pambio-Noranco Oberuzwil Basel Kriens Therwil Zürich Zürich Greifensee (D) Nürnberg Therwil Zürich Ort/ Lieu pr30.6.2020) (per 20

21 SGDV – SSDV Traktandenliste der 102. Generalversammlung der SGDV – Live Streaming Donnerstag, 17. September 2020 von 08.00 bis 09.35 Uhr

Ordre du jour 102ème Assemblée Générale de la SSDV – Live Streaming Jeudi 17 septembre 2020 de 8h00 à 9h35

Messe Zürich, Halle 7 Key notes Key notes

• SGDV Quo Vadis: Audit Rapport (Pr. Daniel Hohl) • SSDV Quo Vadis : Rapport de l’audit (Pr Daniel • Breaking News zu den Tarifen (Dr. Philipp Hohl) Spring) • Breaking News des tarifs (Dr Philipp Spring) • Unser neues Qualitäts-Label (Dr. Tobias Plaza) • Notre nouveau label de qualité (Dr Tobias Plaza) • Erfolgreiche Verhandlungen mit der Strategie • Les négociations réussies avec le groupe de Gruppe (Dr. Pierre de Viragh) stratégie (Dr Pierre de Viragh) • Das neue schriftliche FMH Facharztexamen (Pr. • Le nouvel examen écrit de spécialiste FMH Curdin Conrad) (Pr Curdin Conrad)

Statutarischer Teil / Traktandenliste Partie statutaire / Ordre du jour

1. Genehmigung der Traktandenliste vom 1. Approbation de l’ordre du jour du 17 sep- 17.09.2020 tembre 2020

2. Genehmigung des Protokolls der 101. Gene- 2. Approbation du procès-verbal de la 101ème ralversammlung der SGDV vom 20.09.2019 assemblée générale de la SSDV du 20.09.2019 (Basel) (Bâle)

3. Mitglieder 3. Membres 3.1. Neumitglieder 3.1. Nouveaux membres 3.2. Ehrenmitglieder 3.2. Membres d’honneur 3.3. Mutationen 3.3. Mutations 3.4. Gedenken der verstorbenen Mitglieder 3.4. A la mémoire des membres défunts

4. Wahlen Vorstand, Kommissionen, weitere 4. Elections comité, commissions, autres 4.1. Vorstellung der Ersatz- und Neumitglieder 4.1. Présentation des membres remplaçants et des membres nouveaux 5. Jahresrechnung 2019 5.1. Jahresrechnung SGDV 5. Comptes annuels 2019 5.2. Revisionsbericht 5.1. Comptes annuels SSDV 5.2. Rapport de révision 6. Budget 2021 6.1. Vorstellung Budget 6. Budget 2021 6.2. Mitgliederbeiträge 6.1. Présentation du budget 6.2. Cotisations des membres 7. Statutenrevision 7.1. Vorstellung der Statutenänderungen 7. Révision des statuts 7.1. Présentation des modifications des statuts 8. Abstimmungen / Wahlen / Entlastung des Vor- standes für das Jahr 2019 (elektronisch) 8. Votes / Elections / Décharge du comité pour l’exercice annuel 2019 (électronique) Unterlagen: 4 Wochen vor dem Termin im Mitglie- derbereich der SGDV-Website abrufbar. Documents: disponibles 4 semaines avant la date Zugangsdaten: Bekanntgabe und weitere Informa- dans l’espace membres du site de la SSDV. tionen zum Zeitpunkt der offiziellen Einladung. Données d'accès: Divulgation et informations com- plémentaires au moment de l'invitation officielle. Mit kollegialen Grüssen Avec mes cordiales salutations Pr. Daniel Hohl Präsident SGDV Pr Daniel Hohl Président SSDV

Kontakt: SGDV/SSDV, Generalsekretariat, Dalmazirain 11, 3005 Bern, Tel. 031 352 22 02, [email protected] Contact: SGDV/SSDV, Secrétariat général, Dalmazirain 11,

SGDV – SSDV SGDV 3005 Bern, Tél. 031 352 22 02, [email protected]

22 Dermatologica Helvetica - Volume 32(6) - Août 2020 THE FACULTY OF BIOLOGY AND MEDICINE OF THE UNIVERSITY OF LAUSANNE (FBM), SWITZERLAND, AND THE UNIVERSITY MEDICAL CENTRE OF LAUSANNE (CHUV) INVITE APPLICATIONS FOR A POSITION OF : SENIOR PHYSICIAN AND PROFESSOR IN DERMATO-PATHOLOGY AT THE DIVISION OF DERMATOLOGY AND VENEROLOGY

Starting date : To be agreed Place : Lausanne, Switzerland

Your profile : • MD or MD-PhD degree • Certification in dermatology and venereology (FMH or Mebeko equivalent) • Training in dermatopathology (European or swiss certificate of competence) and extensive experience in cutaneous pathology (>5 years) • Experience in molecular and digital dermatopathology • Academic knowledge of professorial rank with proven practice in post-graduate and pre-graduate teaching • Internationally recognized and externally funded research program • Good knowledge of French or ability to acquire it quickly

Your advantages : We offer a pleasant working atmosphere in a multicultural, diverse and dynamic academic environment. There are possibilities for continuing professional education and a multitude of activities and other benefits to discover.

Your application : Should be in English, and include a motivation letter, a curriculum vitae, a copy of the five most relevant publications, names and contact information of three referees, a brief statement of research interests and teaching experience as well as copies of all diplomas. They should be submitted online to wwwfbm.unil.ch/releve/application as a single PDF file.

The full job description is available on the same link (or QR code).

Deadline: September 13th 2020 (23:59 GMT+1)

Contact : Prof. Michel Gilliet ([email protected]), Head of the Division

Seeking to promote an equitable representation of woman and men among their staff, the University and the University Medical Centre encourage applications from women. FC1 nal psoriatic skin. The aim of this study is to address the in- A Monocentric, Retrospective Analysis of 61 Patients fluence of IL-17E in the maintenance of epidermal homeos- with Generalized Granuloma Annulare tasis and directly compare it with IL-17A. We show here that IL-22 rather than IL-17A enhances IL-17E production in Nordmann TM1,2, KimJR1,2, Dummer R1,2, Anzengruber F1,2 human keratinocytes. Furthermore, keratinocytes display 1) Department of Dermatology, University Hospital Zurich, Zurich, a complete receptor for IL-17A (composed of IL-17RA/RC Switzerland chains) and IL-17E (composed of IL-17RA/RB chains) at their 2) Faculty of Medicine, University of Zurich, Zurich, Switzerland surface. The expression of the IL-17E receptor is further augmented upon keratinocyte differentiation and stimula- Background: Granuloma annulare is a chronic noninfec- tion with inflammatory cytokines, including IL-17A. Given tious granulomatous skin condition with variable clinical that keratinocytes represent a target of these cytokines, we presentations. Generalized granuloma annulare, defined addressed their effects on the functions of human primary as widespread disease with >10 skin lesions, accounts for keratinocytes. The presence of IL-17E, but not IL-17A, signi- 15% of all cases. Numerous associated diseases have been ficantly promoted the proliferation of keratinocytes in both controversially discussed, most importantly diabetes mel- 2D and 3D settings. Surprisingly, IL-17E addition to cultured litus, dyslipidemia, thyroid disease, malignancy and syste- keratinocytes resulted in the concomitant up-regulation of mic infections. differentiation-associated gene transcripts (i.e. keratin 10, Objectives: The objective of our study is to describe disease loricrin) in low calcium concentration conditions, while characteristics, treatment outcome and associated di- their expression was either inhibited or not changed by seases in patients treated at the Department of Dermatolo- IL-17A. Immunohistochemical analysis of in vitro recons- gy of the University Hospital Zurich during the last 20 years. tituted 3D epidermal equivalents confirmed these results. Methods: The hospital database was searched for patients IL-17E, contrary to IL-17A, was not involved in the induction with generalized granuloma annulare in the last 20 years of antimicrobial response. Moreover, time-lapse analysis of (January 1, 1998, to December 31, 2017). Overall, 61 pa- cell movement showed that IL-17E significantly influences tients, 14 males and 47 females, were included in our study. cell motility increasing both cell speed and displacement. The mean age was 58 years at first consultation. The dia- This was associated with specific changes in actin cytoske- gnosis was verified clinically and histologically. leton organization and regulation of proteins involved in Results: Generalized granuloma annulare occurred at a the focal contacts assembly such as vinculin. mean age of 55 years, more commonly in females. Pruritus Our results reveal a novel role of IL-17E, which is inde- was absent in 51% of all patients. Metabolic diseases inclu- pendent from the activation of immune cells and relies on ding diabetes mellitus, hypercholesterinemia and hyper- its ability to directly affect the epidermis. IL-17E is capable triglyceridemia were present in 10.5, 8.2 and 4.9%, respec- of promoting both proliferation and differentiation of kera- tively. Thyroid disease was present in 9.8% and malignant tinocytes, as well as enhancing their migration. This role is disease in 23%, including colorectal cancer, lymphoprolife- clearly distinct from the role of IL-17A. This data points to a rative disease, squamous cell carcinoma of the esophagus, possible effect of IL-17E beyond psoriasis, in disorders cha- basal cell carcinoma and gynecological malignancy. The- racterized by epidermal alterations as well as in the wound rapy was initiated in 92%, while second- and third-line the- healing process. rapy was performed in 70 and 39%, respectively. Benefit during therapy (e.g., full and partial remission) was achieved in 39.3% during first-line, in 39.4% during second-line FC3 and in 33.8% during third-line treatment. Topical corticos- Gianotti-Crosti like reaction to Molluscum contagiosum - teroids were the most commonly prescribed treatment, Epidemiology and clinical characteristics mostly leading to stable disease (46.6%). Combined full and partial remission occurred in a large proportion of pa- Bürgler C1,2, Weibel L1, Schwieger-Briel A1, Knöpfel N1, Luch- tients receiving UVA1 (45%), PUVA (63.6%) and intralesio- singer I1, Theiler M1 nal triamcinolone acetonide (100%). 1) Pediatric Skin Center, Dermatology Department, University Conclusions: Generalized granuloma annulare is a mostly Children's Hospital Zurich, Zurich, Switzerland asymptomatic and benign disease with a strong tendency 2) Department of Dermatology, Inselspital, Bern University Hospi- for treatment resistance. We suggest to screen all patients tal, University of Bern, Bern, Switzerland for dyslipidemia, thyroid disease and malignant disease. While randomized trials are needed, we suggest topical Objective: Molluscum contagiosum (MC) is a common viral corticosteroids as the first-line treatment, intralesional infection. It may lead to hypersensitivity reactions, though triamcinolone acetonide for persistent solitary lesions and, rarely reported in the literature. The term Gianotti-Crosti if further treatment is needed, UVA1 or PUVA. like reaction (GCLR) was proposed for these eruptions. We report a series of patients with GCLR, better delineating its clinical presentation and course. FC2 Method: We performed a retrospective chart review of all IL-17E (IL-25) and IL-17A affect differentially the func- children presenting with GCLR at our Pediatric Skin Center tions of human keratinocytes between 2015 and 2019. Results: 26 children (14 boys/12 girls) with a median age Borowczyk J1, Buerger C2, Tadjrischi N2, Drukala J3, Wnuk D3, of 6.5 (3 to 11.3) years were included. GCLR appeared at a Boehncke WH1,4, Brembilla NC1 median of 8 (1 to 36) months after the onset of MC. It in- 1) Department of Pathology and Immunology, University of Gene- volved the extremities in all patients, often with a predilec- va, Geneva, Switzerland tion for the extensor surfaces. More widespread eruptions 2) Department of Dermatology, Clinic of the Goethe-University, additionally affected the trunk in 7 (27%) and the face in Frankfurt am Main, Germany 6 (23%) children respectively. Involvement of skin over- 3) Cell Bank, Department of Cell Biology, Faculty of Biochemistry, lying the achilles tendons was a peculiar finding in 4 (15%) Biophysics and Biotechnology, Jagiellonian University, Krakow, Poland children. Strong itch was the predominant symptom in 20 4) Division of Dermatology and Venereology, University Hospitals (77%) patients and the acute onset lead to presentation in of Geneva, Geneva, Switzerland the emergency department in 7 (27%) patients. Median duration of symptoms until the diagnosis of GCLR was 9 The balance between basal cell proliferation and supraba- (1-150) days. The rash responded to potent topical steroid sal cell differentiation maintains homeostasis of the epi- treatment and usually resolved within one month after the dermis. A disturbance of this tightly regulated process is initial consultation. The presence of inflamed MC concur- observed in certain skin diseases such as psoriasis. We have rent with onset of GCLR was observed in 21 cases (81%). recently demonstrated that keratinocyte-derived IL-17E GCLR was followed by clearance of MC in all patients. (IL-25), an isoform of IL-17A, is also overexpressed in lesio- Discussion: GCLR often presents as an acute, extensive, FREE COMMUNICATIONS

24 Dermatologica Helvetica - Volume 32(6) - Août 2020 SunsiMed MEDIZINPRODUKT

SONNENSCHUTZ FÜR RISIKOGRUPPEN

ZUR VORBEUGUNG VON:

• AKTINISCHER KERATOSE (1) • HAUTKREBS (ausser Melanome) (2–3) • LICHTBEDINGTER HAUTALTERUNG (4)

▶ Eine patentierte, photostabile Formulierung (5) mit einer breiten Abdeckung des Spektrums(6–7) ▶ Wirkt gegen DNA-Schäden (3) ▶ Präzise Dosierung und eine angenehme Textur

SunsiMed ist bestimmt für überempfindliche Haut auf Sonne und bietet einen sehr hohen Schutz zur Vorbeugung von aktinischer Keratose, Hautkrebs (ausser Melanome), lichtbedingter Hautalterung. Medizinprodukt der Klasse 1. Lesen Sie aufmerksam den Beipackzettel. Nicht auf Schleimhäute oder geschädigte Haut auftragen. Pierre Fabre Medical Device. (1) Darlington S. et al. A randomized controlled trial to assess sunscreen application and beta carotene supplementation in the prevention of solar keratoses. Arch Dermatol. 2003;139(4):451-5. (2) Van der Pols JC. et al. Prolonged prevention of squamous cell carcinoma of the skin by regular sunscreen use. Cancer Epidemiol Biomarkers Prev. 2006;15(12):2546-8. (3) Young AR et al. Sub-optimal Application of a High SPF Sunscreen Prevents Epidermal DNA Damage in Vivo. Acta Derm Venereol. 2018;98(9):880-887. (4) Study report: 2013033PCC: Evaluation of the photoprotection of Avène solar medical RV4842A RP0629 against solar radiation induced oxidative stress and toxicity in reconstructed human epidermis/Pierre Fabre R&D (5) Study report: 30FAB02 IIIIHe006a2799. Photostability evaluation p.8/Pierre Fabre R&D PFDC tests. (6) Study report MS11.SPF.M2658.PFD.INTISO. ST10.REV: Evaluation of sun protection by international standard – ISO 24444 – In vivo determination of the sun protection factor (SPF) – 01.15 – R&D PFDC. SUN-CH-181029-CH-DE (7) Bacqueville D. et al. Evaluation of the largest spectral range photoprotective efficacy against solar radiation-induced oxidative stress. Poster presented at IPCC Singapour 2014. atypical and highly pruritic eruption, leading to parental 4) Dpt of Dermatology, Mount Sinai Hospital New York, New York, anxiety, emergency consultations and diagnostic difficul- USA ties. Our data help to increase the awareness of this fre- 5) Institute for Parasitology, University of Zurich, Switzerland quently underdiagnosed skin rash. While impressive, GCLR 6) Medical Campus Davos, Davos, Switzerland responds to potent topical steroids, has a benign course and heralds the healing of MC. Background: In sub-Saharan Africa, atopic dermatitis (AD) has only recently been recognized as a major public health problem. Very little is known on the clinical and immunological AD phenotypes in this region. FC4 Objectives: In this study, we wanted to address the ques- Localization of Skin Dermatology Pictures on the Body tion whether and how AD patients from sub-Saharan Africa (Tanzania) and Central Europe (Switzerland) differ in their Amruthalingam L1, Gottfrois P1, Koller T2, Pouly M2, Navarini A3 immune phenotypes, sensitization patterns and immuni- 1) Department of Biomedical Engineering, University, Basel zation to parasitic helminths. 2) Department of Information Technology, University of Applied Methods: We collected, both in Moshi (Tanzania) and Zu- Sciences and Arts, Lucerne rich (Switzerland), sera of age- and sex-matched AD pa- 3) Department of Dermatology, University Hospital, Basel tients and healthy controls (HC) (n=10 for each group). To- tal IgE and specific IgEs against a broad range of antigens In clinical practice, the differential diagnosis process of a were measured using an in vitro multiplex allergy test. An skin lesion (SL) is naturally dependent on the SL location ELISA was used to quantify parasite-specific IgGs. Inflam- on the body. However when considering the majority of mation-associated proteins were measured with high- current artificial intelligence (AI) based teledermatology throughput proteomics. (TD) and photo diagnosis models we observe that they do Results: Specific IgE analyses revealed major differences not integrate this information in their analysis. Instead, they between Tanzanian and Swiss AD patients. Only the Swiss usually solely rely on patients photos only. One reason for AD patients showed strong sensitization against Malas- this is that the SL location is not always available and pro- sezia antigens (Mal s1, Mal s5, Mal s11). In contrast, tro- viding this information is an additional step needed in the pomyosin sensitization was a main feature in the Tanzanian TD workflow, which is not necessarily scalable and would AD patients, as evidenced by increased IgE levels against need to be automated. house dust mites (Der p), storage mites (Gly d2) and sea- In this work we develop an AI based classifier model able to food antigens (Hom g, Lit s, Pen m1). The parasite screening automatically localize skin images on arms, legs, feet, hands, turned out negative for all patients and controls. In multi- heads, trunks with high accuracy. The model is trained as plex proteomics, pro-inflammatory and Th17-associated well to recognize non-skin images to make it robust for cytokines were upregulated in the Tanzanian AD sera com- real-world TD applications. It is also able to recognize dis- pared with those from the Swiss AD patients. criminable skin patterns in very small skin images, which Conclusions: Taken together, our study reveals major diffe- otherwise would be too small for dermatologists to reco- rences in the sensitization patterns and the inflammatory gnize manually. This capacity enables the segmentation of protein expression in the blood of sub-Saharan African the different regions of the body present in patients images. (Tanzanian) versus central European (Swiss) AD patient. Our semi-supervised model is trained on 12’000 high resolution patient pictures cut in small square patches of side size 512 pixels. Available labels were unreliable (weak labels): a picture labeled arm could also contain hands and FC6 torso. Therefore we created a strongly labeled (validated Acute Generalized Exanthematous Pustulosis - Not Only manually) dataset from 700 pictures cropped to show ex- A T Cell Driven Disease? clusively a specific body part. Then we follow a cyclic approach where we pre-train our model on the weak labels, Meier-Schiesser B1, Mellett M1, Klug A1, Navarini AA2, French retrain it on the strong labels and then apply the model to LE3, Contasstot E2 correct the weak labels. This procedure is repeated a cer- 1) Department of Dermatology, University Hospital Zurich tain number of times until the accuracy stops improving on 2)Department of Dermatology, University Hospital Basel the validation set. 3)Department of Dermatology, Ludwigs-Maximilians University Our current models achieves a mean precision and recall Munich of 80% (average over all classes) on the test set. These performance imply that there must be some pattern, hardly Acute Generalized Exanthematous Pustulosis (AGEP) is visible to human, which the model is able to pick up to a severe cutaneous adverse drug reaction characterized differentiate between the body parts. by an acute onset of sterile pustules on an erythematous On the application level, our model could be used in sy- background, fever and peripheral blood neutrophilia. Even nergy with existing TD and diagnosis systems to automa- though it is hypothesized that the massive neutrophilic in- tically provide the SL locations. With this information, im- filtration seen in skin lesions is mediated by memory T cells probable diagnosis could be discarded using logical rules via the production of IL-8, little is known about the early from the traditional dermatologists differential diagnosis pathophysiology of AGEP. Our studies could show that the process. This would introduce human verifiable steps in the proinflammatory cytokine Interleukin (IL) -36 and is invol- otherwise opaque procedures of AI models. ved in the pathogenesis of AGEP, and identifies monocytes and keratinocytes as potential key producers of IL-36 in AGEP. The release of IL-36 and other innate cytokines including IL-1β was induced specifically by the culprit drug in a FC5 pure monocyte population in vitro, suggesting a direct ac- Evidence for different immune signatures and sensiti- tivation of innate immune cells without antigen-specific in- zation patterns in sub-Saharan versus central European duction of T cells. Moreover, we could determine elevated Atopic Dermatitis patients production of IL-36γ, IL-1β, IL-6 and IL-8 upon stimulation with lipopolysaccharide (LPS), an agonist to TLR4. Collec- Lang C1,2, Masenga J3, Semango G3, Kaderbai H3, Li N 1,2, Gutt- tively, we provide evidence that innate immune cytokines mann-Yasski E4, Grimm F5, Schmid-Grendelmeier P1,2, Brüggen are involved in the pathogenesis of AGEP, and identify mo- M Ch1,2,6 nocytes and keratinocytes as potential key players in AGEP. 1) Dpt of Dermatology, University Hospital Zurich, Zurich, Switzer- We also identify TLR4 as an essential pattern recognition land receptor involved in the sensing of drug/albumin complex 2) Faculty of Medicine, University Zurich, Zurich, Switzerland as a danger signal in AGEP patients. The study of innate im- 3) Regional Dermatology Training Center (RDTC) at KCMUC Moshi, mune pathways and their effects on immune and non-im-

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26 Dermatologica Helvetica - Volume 32(6) - Août 2020 mune cells of the skin cells may help to further understand rious toxicity that is challenging to treat. In contrast to the the aberrant immune reactions occurring in these patients liver transaminases alanine aminotransferase (ALT) and as- and possibly identify novel therapeutic targets. partate aminotransferase (AST), only little is known about the frequency and impact of gamma-glutamyl transferase (GGT) elevations. FC7 Methods: GGT determined prior to and during therapy of Papillomatous pedunculated sebaceous naevi – expan- metastatic melanoma patients treated with ICPI were re- ding the clinical and genetic spectrum trospectively assessed in two independent cohorts (PD-1 group: n=218, Ipi+Nivo group: n=148). Overall survival (OS) Theiler M1, Weibel L1, Sorlin A2,3, Neuhaus K4, Chevarin M3, Car- and best objective response were analyzed according to mignac V3, Faivre L2,3,5, Vabres P3,5,6, Kuentz P3,5,7 baseline and immune-related GGT (irGGT) elevations du- 1) Pediatric Skin Center, Dermatology Department, University ring treatment. Children's Hospital Zurich, Switzerland Results: In multivariate analysis, OS was reduced in pa- 2) Centre de Génétique et Centre de référence "Anomalies du tients with elevated baseline GGT (PD-1 group: hazard Développement et Syndromes Malformatifs", Hôpital d’Enfants, ratio [HR] 1.76, p=.0073; Ipi+Nivo group: HR 1.77, p=.032). Centre Hospitalier Universitaire de Dijon, France. 3) UMR-Inserm 1231 GAD, Génétique des Anomalies du dévelop- Immune-related GGT elevation was recorded in 17% (PD- pement, Université de Bourgogne Franche-Comté, Dijon, France. 1 group) and 38.5% (Ipi+Nivo group). Of these patients, 4) Pediatric Skin Center, Division of Plastic and Reconstructive Sur- the majority (81% and 68%, respectively) had normal ALT gery, Department of Surgery, University Children's Hospital Zurich, and AST and showed no clinical signs of hepatotoxicity. Pa- Switzerland. tients who experienced irGGT elevation had superior res- 5) Fédération Hospitalo-Universitaire Médecine Translation- ponse (PD-1 group: odds ratio [OR] 3.57, p=.00072; Ipi+Ni- nelle et Anomalies du Développement (FHU TRANSLAD), Centre vo group: OR 1.74, p=.12) and OS (PD-1 group: HR 0.37, Hospitalier Universitaire de Dijon et Université de Bourgogne p=.0016; Ipi+Nivo group: HR 0.33, p=.00050), also when Franche-Comté, Dijon, France. analyzed with time-dependent Cox regression. 6) Service de Dermatologie, Centre Hospitalier Universitaire de Di- jon, France. Conclusions: The frequency of hepatic irAE is currently un- 7) Oncobiologie Génétique Bioinformatique, PCBio, Centre Hospi- derestimated. The addition of the sensitive enzyme GGT to talier Universitaire de Besançon, France. the laboratory panel before and during therapy with ICPI Background: Postzygotic Fibroblast Growth Factor Recep- allows to detect two to three times more patients develo- tor 2 (FGFR2) mutations have been identified in mosaic ping hepatic or hepatobiliary toxicity than known so far. forms of acne, keratinocytic epidermal nevi, and naevoid Immune-related GGT elevations correlate with response acanthosis nigricans. We showed the implication of the and favorable survival. postzygotic FGFR2 p.(Cys382Arg) variation in two foetuses with papillomatous pedunculated sebaceous naevi (PPSN), an uncommon subtype of sebaceous naevus. FC9 Objective: Here, we report the clinical and genetic findings The Infantile Hemangioma Referral Score (IHReS): A Vali- of a series of 7 children with PPSN. Methods: A retrospec- dated Tool for Physicians tive chart review was performed in all children with PPSN at our centres. Targeted deep sequencing of FGFR2 was Weibel L1, Léauté-Labrèze C2, Baselga Torres E3, Boon LM4, El performed on formalin-fixed tissue after excision of the Hachem M5, van der Vleuten C6, Roessler J7, Troilius Rubin A8 lesions. Results: All PPSN were located on the head. No underlying 1)Pediatric Skin Center, Dermatology Department, University abnormalities or syndromic associations were found. Post- Children's Hospital Zurich, Switzerland zygotic mutations in the transmembrane domain of FGFR2 2) Department of Dermatology, Pellegrin Children's Hospital, Bor- were identified in 5 children (71%), with the p.(Cys382Arg) deaux, France mutation present in 4/5 positive cases. Clinical follow-up 3)Department of Dermatology, Hospital de la Santa Creu i Sant up to a median age of 4 (1-11) years was unremarkable in Pau, Universitat Autònoma de Barcelona, Barcelona, Spain all individuals. 4) Center for Vascular Anomalies, Division of Plastic Surgery,Cli- Discussion: There is an intriguing clinical overlap of PPSN niques Universitaires St Luc, Brussels, Belgium 5) Pediatric Dermatology Unit,Bambino Gesù Children's Hospital, with a germline condition, Beare-Stevenson cutis gyra- IRCCS, Rome, Italy ta (BSCG) syndrome. Indeed, cerebriform patterns are 6) Department of Dermatology, Expertise Center for Hemangioma strikingly comparable, although in a different scale. BSCG and Vascular Malformations (HECOVAN),Radboud University, Me- syndrome shows excessive growth of the entire scalp, dical Center, Nijmegn, The Netherlands with the formation of convoluted folds and furrows, and is 7) Center of Pediatrics and Adolescent Medicine, Medical Center caused by germline FGFR2 p.(Tyr375Cys) and p.(Ser372Cys) University Freiburg, Freiburg, Germany variations. PPSN on the contrary is limited to a fraction of 8) Centre for Laser and Vascular Anomalies, Department of Derma- the scalp, where the postzygotic variation is present. Wit- tology, Skane University Hospital, Malmö, Sweden hin the “mosaic signalopathies” group, our ﬁndings confirm a distinct clinical and molecular subgroup of SN related to Objective: Infantile hemangiomas (IH) are very common; FGFR2, without extracutaneous features. some cases require timely referral and treatment to prevent complications. We developed and validated a reliable instrument for timely and adequate referral of patients with IH FC8 to experts by non-expert primary physicians. Gamma-glutamyl transferase: prognostic role at baseline Methods: This multicenter, cross-sectional, observational and during therapy as a novel immune-related adverse study used a three-stage process: 1) development of the event in metastatic melanoma patients treated with im- Infantile Hemangioma Referral Score (IHReS) tool by IH ex- mune checkpoint inhibitors perts who selected a representative set of 42 IH cases com- prising images and short clinical history; 2) definition of the Wagner NB1, Röcken M2, Garbe C2, Eigentler TK2, Winter J2, Len- Gold Standard for the 42 cases by a second independent ders MM2, Gassenmaier M2, Forschner A2, Leiter U2, Weide B2, committee of IH experts; 3) IHReS validation using the 42 Purde MT1, Flatz L1, Cozzio A1 Gold Standard cases by non-expert primary physicians. 1) Department of Dermatology, Kantonsspital St. Gallen Results: A total of 60 primary physicians from seven diffe- 2) Department of Dermatology, University Hospital, Tübingen rent countries evaluated the 42 Gold Standard cases (without reference to the IHReS tool); 45 primary physicians Background: Hepatic immune-related adverse events (irAE) evaluated these cases using the IHReS questionnaire, and including elevated liver function tests (transaminases) oc- 44 completed re-testing using the instrument. IHReS had cur in 1.4-22.3% of melanoma patients receiving immune a sensitivity of 96.9% (95% confidence interval [CI] 96.1 to

checkpoint inhibitors (ICPI) and constitute a potentially se- 97.8) and a specificity of 55.0% (95% CI 51.0 to 59.0). The FREE COMMUNICATIONS

Dermatologica Helvetica - Volume 32(6) - Août 2020 27 PPV and NPV were 40.5% and 98.3%, respectively. Valida- tion by experts and primary physicians showed substantial agreement for inter-rater reliability and intra-rater repeata- bility. Conclusions: IHReS, a two-part algorithm with a total of 12 questions, is an easy-to-use tool for primary physicians with the purpose of facilitating correct and timely referral of patients with IH. IHReS may help practitioners in their decision to refer patients to expert center.

FC10 Driving pathways in Pityriasis Rubra Pilaris

Yatim A1, Di Domizio J1, Schlapbach C2, Gilliet M1, Conrad C1 1) Department of Dermatology and Venereology, University Hos- pital CHUV, Lausanne, Switzerland. 2) Department of Dermatology, Bern University Hospital, Bern, Switzerland.

Pityriasis Rubra Pilaris (PRP) represents a group of rare inflammatory skin disorders of unknown etiopathology. Due to its heterogeneity, PRP diagnosis is often challenging. Moreover, treatment of PRP is mainly empirical and suffers from the lack of controlled trials. PRP share overlapping clinical and histological features with psoriasis, suggesting a common underlying pathophysiology. Based on this resemblance, a role of the IL23–TH17-axis in PRP was proposed, and several case reports of successful treatment of PRP with psoriasis biologics were described. Although encouraging, no solid conclusion can be drawn from isolated case reports, and none of these therapeutic options is based on a valid immunopathological rationale. Therefore, a better understanding of PRP pathophysiology is required to improve PRP diagnosis and management. To this end, we performed transcriptomic analysis of PRP lesional skin using NanoString technology. Results were compared to those obtained from a large cohort of common inflammatory skin diseases. Molecular profiling revealed the presence of a PRP-specific inflammatory signature that accurately discriminate PRP cases from other inflammatory skin disorders, including psoriasis. Ultimately, this signature could serve as a robust disease classifier to establish accurate diagnosis. An important observation from our gene expression profiling is that PRP-associated inflammation did not demonstrate TH1-, TH2-, nor a typical TH17-related signature. Top upregulated cytokines in PRP lesions are not known to be expressed by lymphocytes, but are reported to be mainly produced by keratinocytes. Our data suggest that PRP and psoriasis are driven by distinct immunopa- thogenic pathways. While psoriasis is a TH17-mediated disease, PRP is a rather T-cell independent disorder mediated by keratinocytes. Importantly, our results might explain the variable response of PRP to IL-17 blockage, and should help guiding rational therapeutic choices. FREE COMMUNICATIONS

28 Dermatologica Helvetica - Volume 32(6) - Août 2020 La possibilité d’avoir RIEN sur la peau peut signifier TOUT pour le patient.2,3

59% DES PATIENTS ATTEIGNENT UN PASI 100 ET 84% UN PASI 90 PENDANT 2.5 ANS.1*

SKYRIZI® est indiqué dans le traitement du psoriasis en plaques modéré à sévère chez les patients adultes ayant présenté une réponse insuffisante à d’autres traitements systémiques tels que la ciclosporine, le méthotrexate (MTX) ou la PUVA (psoralène et UV-A) ou présentant une contre-indication ou une intolérance à de tels traitements. * Rémission complète (PASI 100) chez 59% des patients à la semaine 136 (Open-Label Extension LIMMitless).1

1) Papp K et al. Long-term Efficacy and Safety of Continuous Q12W Risankizumab: Results from the Open-Label Extension LIMMitless Trial. Poster 89. Presented at the 28th European Academy of Dermatology and Venereology Congress (EADV),10 October 2019, Madrid, Spain. 2) Blome C et al. Patient-relevant treatment goals in psoriasis. Arch Dermatol Res (2016) 308: 69–78. 3) Maul JT et al. Gender and age significantly determine patient needs and treatment goals in psoriasis - a lesson for practice. J Eur Acad Dermatol Venereol 2019; 33(4): 700–708.

Information professionnelle SKYRIZI® (Risankizumab): I: Traitement du psoriasis en plaques modéré à sévère chez les patients adultes ayant présenté une réponse insuffisante à d‘autres traitements systémiques tels que la ciclosporine, le méthotrexate (MTX) ou la PUVA (psoralène et UV-A) ou présentant une contre-indication ou une intolérance à de tels traitements. PM: Utilisation sous surveillance d’un médecin expérimenté dans le diagnostic et le traitement du psoriasis en plaques. Après une formation adaptée, les patients peuvent s’injecter eux-mêmes. Dose recommandée: 150 mg (deux injections de 75 mg chacune) en injection sous-cutanée les semaines 0 et 4, puis toutes les 12 semaines. Pas de réponse après 16 semaines, envisager l’arrêt. CI: Hypersensibilité au principe actif/excipients. Infection active cliniquement significative (par ex. tuberculose active). M: Chez les patients présentant une infection active cliniquement significative, placer les patients sous surveillance étroite et le traitement ne doit pas être instauré /doit être interrompu tant que l’infection n’a pas régressé. Dépistage de la tuberculose avant l’instauration du traitement, en cas de TB latente, instauration de traitement antituberculeux avant l’administration. Surveillance TB pendant le traitement. Aucun vaccin vivant pendant le traitement. En cas de réactions d‘hypersensibilité graves, interrompre le traitement. IA: Aucune interaction relevante observée. EI: Très fréquents: Infection des voies aériennes supérieures, y compris infection des voies respiratoires (virales, bactériennes ou non spécifiées), sinusite (aiguë également), rhinite, rhinopharyngite, pharyngite (virale également), amygdalite. P: 75 mg / 0,83 ml: 2 seringues prête à l’emploi chaque boîte.

Médicament de catégorie B. T: AbbVie AG, Neuhofstrasse 23, 6341 Baar, Suisse, tél. (+41) 41 399 15 00 (V1). Pour informations détaillées voir l’information professionnelle CH-RISN-190031 04/2020 du médicament: www.swissmedicinfo.ch. 30 POSTERS Alvarez Martinez D2 Alvarez Martinez mans A new bornspeciesamongfunguspathogenic to hu- P2 steroids, althoughoral steroids are required inmostcases. ourpatient,leukemia. In thelesionsimproved withtopical bullous pemphigoidassociated to chronic lymphocytic differentialOther diagnoses include Sweet’s syndrome and may asaninfectiouscellulitis. bemisdiagnosed primarily hematologicalof theunderlying disease. lesions These skin tients, butappearsto beindependent ofthediseasecourse and eosinophiliccellulitis are inCLLpa- classicallydescribed cellulitis (Wells’ syndrome). Exaggerated bite reaction insect patient was consistent withthediagnosis ofeosinophilic rance triggered bite by without fever an insect in aCLL Answer: The clinicalpresentation ofcellulitis-like appea- leukemia D. Bullouspemphigoidassociated to chronic lymphocytic C. Sweet’s syndrome B. Wells’syndrome A. Erysipelas What isthediagnosis? figures".sociated with"flame infiltrate richineosinophilsas- disclosed aninflammatory were normal. The histological biopsy examination ofaskin hypereosinophilia (1.2G/L)whileC-reactive protein levels revealed anelevated count (19.8G/L)with lymphocyte lesions.days toBloodanalysis prior theonsetofskin of the4thfinger. several bites Sheinthe insect reported handfollowedpruriginous plaqueontheleft by ablister due to lack of symptoms, was referred for an erythematous chronic lymphoidleukemia(CLL) butwithouttreatment A85-year-old womanQuiz: previously diagnosed with Geneva ofDermatology and Department Venerology, University Hospital, D,Alvarez Laffitte Martinez E A diagnosis notto bemissed P1 detected aPhialemoniopsisdetected sp. gical cultures were negative whilethemycological ones (PAS) stainingwas positive. andmycobacteriolo Bacterial ciated withabscesses inthedermis. Periodic acid–Schiff infiltrate,an inflammatory richinneutrophils andasso The histological biopsy disclosed examination of the skin dischargesero-purulent withgrains. mounted by nodulesonthedorsumofright foot and examination showedSkin painful plaquesur apurplish lesions. to theonsetofskin respectively. Patient’s noticed to atrip Ecuador prior history 40mg/kg, nazole 200 mgoral capsulesbidandosimertinib lutegravir/lamivudine, cotrimoxazole prophylaxis, itraco mosis in2015.Herusualtreatment includedabacavir/do controlled HIVviremia) andhaddisseminated histoplas- followed for AIDS(CD4+ 38/µlandwell T lymphocytes consultation for apersistent wound onthefoot. Shewas A56-year-old woman was referredObservation: at our whose nameisinaconfirmation process. mates. We here describe anewspeciesofPhialemoniopsis air, water, soilandplant materials inwarmandhumidcli- distributed in the environment, having been isolated from worldwide.gus detected ofthisgenusare Members widely fungi which are ubiquitous, fun- emerging opportunistic Phialemoniopsis belongstoIntroduction: dematiaceous Geneva Diseases,4) Division of Infectious University Hospital of Geneva, neva ofBacteriology,3) Laboratory University Ge HospitalofGeneva, Geneva of Geneva, 2) Divisionof Dermatology and Venereology, University Hospital Geneva ofDermatology,1) Laboratory University HospitalofGeneva, Riat A3 Riat , NinetB1 , Toutous Trellu L2 , Alberto C2 , Alberto , Schuhler C2 , Schuhler , Valladares P4 ------, 2) Dermatologie am Rhein, Basel 2) Dermatologie amRhein, ofDermatology,1) Department University HospitalBasel, Basel ring skin eruptions. skin ring rare presentation of WS as a differential diagnosis in bliste in theliterature. Thus, we would liketo call attention to this are onlyafew casesofthebullousvariant of WS reported polizumab (anti-IL-5 antibody) hasbeenreported. There cyclosporine, dapsone, tacrolimus, antihistamines andme mended asfirstlinetreatment. Successful treatment with be present. Systemic ortopical corticosteroids are recom- or itching sensation. Peripheral bloodeosinophiliamay indurated nodules. Patients frequently aburning report edematous plaques and soft to firm with urticarial riable most casesremain idiopathic. Clinicalpresentation isva- hematological malignancies have beendiscussed, though 1971. Triggers bites, suchasinsect drugs, solidtumorsand ofeosinophilicdermatoses, the spectrum in firstdescribed pathogenesis dermatosis within of unknown inflammatory Discussion: Wells Syndrome (Eosinophilic Cellulitis) isarare additional flares withouttherapy. low-up 6months later, thepatent hadnotexperienced any an additionalcourse ofprednisone. As pertelephone fol- experienced aflare-up, which was controlled againwith toms. Uponcessation ofprednisone therapy, thepatient clobetasol and emollients, which led to resolution of symp dose,kg in atapering as well aswith antihistamines, topical was made. The patient was treated withprednisone 1mg/ gative. Thus, thediagnosis ofbullous Wells Syndrome (WS) and antibodies againstBP180/230intheserumwere ne "flame figures".infiltrate and immunofluorescence Direct ficial anddeepinterstitial andperivascular eosinophilic blistering with eosinophils,subepidermal super a marked (122 mg/land346U/l, repectively). Punch biopsyrevealed philia (1.3G/l).CRPandLDHintheserumwere elevated lymphadenopathy. CBCshowed witheosino leukocytosis central blistering. There were nomucosal lesionsandno plaquesonthetrunkandextremities, withpartial urticarial bites ordrugintake.sect Onpresentation, we saw multiple or otherassociated symptoms. There ofin- was nohistory ters 5 days to prior consultation. The patient denied fever quently progressed to thetrunkwithappearance ofblis- onthehandsandfeetweeks andsubse that hadstarted sented to our clinic with intense rash pruritic for about 2 Case: We the case of a 32-year report old patient who pre B VC1 Amann Literature Bullous Wells Syndrome: andReview ofthe Case Report P3 illustrate thiscase. helps to confirm newspeciesand we areto still working gical excision have alsobeenused. technology Genomics 100-200 mgdaily. Amphotericin B, voriconazole andsur relies andocularis onoral itraconazoleas curvata therapy Standard treatment Phialemoniopsis spsuch ofknown nocompromisedpatient. to discovernot surprised insuchdeepimmu- newgerms use of prolonged antifungal prophylaxis. Moreover, we are travelled. Onehypothesis ofitsemergence could bethe mostprobable origin wasIts Ecuador where ourpatient suppression. phaeohyphomycosis onthefoot inacontext ofimmuno was consistent with the diagnosis of a deep cutaneous Discussion: The clinico-microbiological presentation lesions were stableandasymptomatic. ter 5weeks oftopical andoral itraconazole, thecutaneous itraconazole solutionon a compress 10minutes. during Af- improved slowly, we applications thenaddedempirical of 200 mgbidinorder to increase thebiodisponibility. Lesion capsules were switched for anoral itraconazole solution theresultiodine andafter offungalculture, itraconazole Patient was prescribed localdisinfection withpovidone 1 , Rinderknecht T1 , Rinderknecht Dermatologica Helvetica - Volume 32(6) -Août 2020 , Zehnder M1 , Volz A1,2,Muehleisen ------P4 BP180 and BP230, which typically affect the elderly. The Effectiveness of brentuximab vedotin before and after spectrum of clinical presentations is broad with several aty- allogeneic stem cell transplantation in the management pical misleading variants. Some patients develop strictly of transformed mycosis fungoides. localized lesions, which may pose a diagnostic challenge. Case 1: A 55-year-old woman developed recurrent pruritic André R1, Ram-Wolff C1, Battistella M2, Peffault de Latour R3, tense blisters on the lower left limb since approximately Petit A1, Bouaziz JD1, Brice P3, Bagot M1*, de Masson A1* half a year. Her past history was unremarkable except for *share last authorship vitiligo. She did not take any medication. On examination, 1) Department of Dermatology, Saint-Louis Hospital, AP-HP, Paris she had post-bullous erosions and crusted lesions. There University, Inserm U976 was no mucosal involvement. Light microscopy study of a 2) Pathology, Saint-Louis Hospital, AP-HP, Paris University, Inserm skin biopsy showed subepidermal blistering with an eosi- U976 nophilic infiltrate. Direct immunofluorescence microscopy 3) Hematology-Bone marrow Transplantation, Saint-Louis Hospi- tal, AP-HP, Paris University, Inserm U976 (DIF) showed linear deposits of C3 and IgG along the epidermal basement membrane zone (BMZ). Search for circu- Conflicts of interest: Caroline Ram-Wolff was subinvestiga- lating autoantibodies by ELISA BP180, ELISA BP230 as well tor in Takeda protocol, Martine Bagot was principal investi- as by indirect immunofluorescence using salt-split skin re- gator in Alcanza trial and scientific advisor for Takeda mained negative. Introduction: The interest of Brentuximab vedotin(BV) in Case 2: A 70-year-old man had recurrent pruritic blisters on the management of CD30+ mycosis fungoides(MF) and the right foot dorsum during the past half year. He had a primary cutaneous anaplastic large-cell lymphoma(ALCL) history of hypertensive and coronary artery disease, chro- has recently been demonstrated compared with me- nic obstructive pulmonary disease, hypothyroidism and thotrexate or bexarotene. It is not constant in MF and is chronic kidney disease. On examination he showed several more frequent in transformed disease. BV may also be ef- crusts and one small hemorrhagic blister on the right foot ficient in MF without any expression of CD30 and has been dorsum. There was a discrete bilateral leg and foot edema. used in combination with bendamustine in transformed Oral and genital mucosa were not involved. Light micros- Sezary syndrome. Finally, it can be used as a bridge to al- copy study of a skin biopsy revealed a subepidermal clea- logeneic stem-cell transplantation(ASCT) in relapsed or vage with an eosinophil-rich infiltrate. DIF showed linear refractory non- Hodgkin lymphoma. deposits of C3 and IgG along the epidermal BMZ. Search Methods: We describe two patients treated effectively with of circulating autoantibodies by ELISA-BP180 and indirect BV for a MF, before and after ASCT. immunofluorescence using salt-split skin was negative. Results: The first patient was a 40-year-old man with a Localized forms of BP have often been described. Lesions 4-year history of transformed MF stage N3 on the lymph may only involve legs, palms and soles, or occur around a node core(15% of CD30 expression). He had received se- stoma or on a paralyzed limb. Surgery, PUVA, photodyna- veral treatment lines: chemotherapy(CHOP), bexarotene, mic therapy as well as peripheral edema of the lower limbs interferon alpha, methotrexate. A year and a half after may act as local triggers. Our patients presented with a cli- disease onset, it was finally decided to initiate brentuxi- nical history and clinical features typical for a localized BP. mab(six infusions at a dose of 18 mg/kg), which induced The diagnosis was based on the French clinical criteria for a complete clinical response allowing ASCT with a sibling BP, since the negative immunoserological studies did not donor. One week after the transplant, a recurrence of the allow to further characterize the reactivity profile of the au- transformed MF lesions was observed. The resumption of toantibodies. According to a European guideline, the first BV for six infusions (dose decreased to 12 mg/kg due to therapeutic option for localized BP is constituted by high peripheral neuropathy) then allowed complete remission. potency topical corticosteroids. Second options include A relay by liposomal doxorubicin(four infusions) was fi- tetracycline and nicotinamide (nonvalidated), dapsone or nally performed due to the worsening of neuropathy, fol- sulfonamides (nonvalidated), topical immunomodulators lowed by a maintenance treatment with bexarotene. The (e.g. tacrolimus) as well as oral corticosteroids (validated). second patient was a 62-year-old male treated for stage The latter have more side effects and are associated with an IIB, transformed MF over the past 9 years with initial CD30 increased risk of mortality. In elderly patients the diagnosis expression at 5%. He had received several treatment lines: of BP should be considered also in presence of recurrent interferon alpha, phototherapy, bexarotene, methotrexate, localized vesicles and blisters affecting one body region. liposomal doxorubicin, romidepsin, gemcitabine, ifosfa- Proper diagnosis and therapy critically rely on the positive mide/etoposide, vinblastine. Due to progressive disease findings of DIF studies. 8 years after the initial diagnosis with an increase in CD30 expression on the last skin biopsy sample(25% of lymphoid cells), BV was introduced with a very good partial response P6 allowing haploidentic ASCT. One and a half months after Gender Differences in Psoriasis: A Swiss Online Psoriasis the transplant, a recurrence of the transformed MF lesions Survey was observed. A resumption of BV then allowed a complete remission after four infusions, followed by a mainte- Murer C1,2, Sgier D1,2, Kyonhi Mettler S1,2, Guillet C1,2, Maul JT1,2, nance treatment with bexarotene. Djamei V2, Navarini AA3, Anzengruber F1,2 1) Department of Dermatology, University Hospital Zurich, Zurich Conclusion: BV confirms its usefulness as a bridge to ASCT 2) Faculty of Medicine, University of Zurich, Zurich but also as a treatment for recurrences after an ASCT. Its 3) Department of Dermatology, University Hospital Basel, Basel usefulness as a consolidation treatment remains to be determined. Physicians' and patients' perspectives can vary significantly. For a long time, physicians considered psoriasis a non-pruritic dermatosis until a survey found pruritus to be the most P5 bothersome symptom among psoriasis patients. In our stu- A rare misleading presentation of bullous pemphigoid: dy, we wanted to get an insight into the factors that affect the localized variant patients and evaluate whether gender differences exist. A link of an anonymous online survey (www.fightpsoriasis. Angermeier S1, Prenner A1, Galambos J2, Feldmeyer L1, Borra- ch) with 24 questions was placed on the website of the dori L1 Swiss Psoriasis and Vitiligo Patient Association (www.spvg. 1) Department of Dermatology, Inselspital, Bern University Hospi- ch) from May 2016 until June 2017. 3164 persons partici- tal, University of Bern, Bern 2) Kempf & Pfaltz Histology, Zürich pated in this online survey, of which 1979 were diagnosed with psoriasis. Significantly more females than males were Bullous pemphigoid (BP) is an autoimmune blistering di- affected by psoriatic pruritus [713 (36%) vs. 500 (25.3%), p ≤ 0.001] and 756 (39.7%) of all patients identified pruritus as

sease associated with autoantibodies directed against POSTERS

Dermatologica Helvetica - Volume 32(6) - Août 2020 31 the most life quality-limiting factor. Fewer women reported associated with an attributable etiology: allergic lichenoid high satisfaction with their therapy compared to men [96 contact mucositis, oral lichenoid drug reactions, lichenoid (4.9%) vs. 110 (5.6%), p ≤ 0.015]. Pruritus remains the most graft versus host disease, or other lichenoid reactions. bothersome symptom and women were more often affec- Despite the presence of WHO-defined criteria to evaluate ted by it, leading to a lower treatment satisfaction among epithelial dysplasia the assessment and the significance is female patients. frequently subjective (inter-observer variability): some sees them as reactive changes, other as a true sign of (pre-)malignancy. There is also an intra-observer variability, where P7 the same pathologist may have two different opinions Itch reduction using immersive virtual reality - With blue, about the presence of a particular criterion, in this case green or yellow itch becomes mellow dysplasia, assessed at two different times. In the literature, inconsistency in the histological evalua- Baschong A1, Spiess F2, Cattin PC2, Navarini A1, Müller SM1 tion of oral epithelial dysplasia (OED) has been addressed. 1) Department of Dermatology, University Hospital, Basel However, we did not find any study about intra- and in- 2) Department of Biomedical Engineering, University of Basel, Basel ter-observer variability in the specific assessment of dysplasia in OLP in comparison to OLL. Therefore, we evaluated Background: In clinical routine treatment of itch is often dysplasia in 128 OLL/OLP cases to study the inter-observer unsatisfactory. Inspired by the phenomenon of "conta- and the intra-observer variability. gious itch", indicating that itch can be modified by visual In this study, analyzing the amount of variability in the eva- cues, we investigated the effect of colors on itch perception luation of the grade of dysplasia in OLP and OLL, we found in a previous pilot study. Most patients considered red as a significant inconsistency among the experts (inter-ob- a "pruritic" and blue or green as "antipruritic" colors when server variations), and in three of four experts a significant exposed on LED-screens. We hypothesized that the effect intra-observer discrepancy (poor to moderate agreement), might be augmented if patients are exposed in a virtual when examining the same slide at two different times. 3-dimensional "color room" allowing complete immersion. Some experts were more optimistic than others, and this This present study aimed to determine the effect of "anti- persisted in the second evaluation. pruritic" colors using immersive virtual reality (VR) and to We demonstrated that in OLL there is significantly more assess whether itch- and dermatology-related quality of epithelial dysplasia than in OLP. We also showed that the life, anxiety and depression correlate with the response to grading of epithelial dysplasia in OLP/OLL is partly subjec- the color exposure. tive, showing both significant inter-observer and intra-ob- Methods: In this cross-sectional interventional single-cen- server variations. While many authors have stressed the ter study itch patients were exposed to their subjective inter-observer variability, the intra-observer variability also "antipruritic" color (defined on the Manchester Color needs to be taken in account. Solutions to improve the his- Wheel) in a virtual monochromatic room for 10 min. using tological evaluation of such samples are: definition of clear a head-mounted display. Itch intensity rating (0-10 Nume- criteria to be assessed and standardization of their chrono- rical Rating Scale [NRS]) was repeated at 1-min. intervals. logical assessment, and examination through a second pa- The patients completed the ItchyQoL, DLQI and HADS-A/D thologist, finding a consensus in case of discrepancy. questionnaires. Itch intensity after 10 min. was compared to baseline using Wilcoxon signed-rank tests. In addition, the area under the curve (AUC) was compared to the area P9 under the baseline value plotted over 10min. (bAUC). For An atypical case of penile granulomatous dermatitis with correlations Spearman’s Rho were performed. features of pyoderma gangrenosum and IgG mediated Results: Twenty-two patients (mean age 51.9 ± 23 years, 13 vasculitis females) participated in the study. In comparison to baseline NRS (mdn=4.5) a significant itch reduction following Bogiatz Si1, Di DomizioJ1, Kechrid N1, Rakosi A1, Kaparos N1, 10 min. of exposure to the "antipruritic" color (mdn=3) Paul C2, Gilliet M1, Hohl D1 was found (z=-3.025, p=.001). Comparison of the bAUC 1) Department of Dermatology and Venereology, University Hos- (mdn=45) to exposure AUC (mdn=37; z=-3.118, p=.001) pital CHUV, Lausanne confirmed the effect. Effect sizes were r=.64 (NRS values) 2) Paul Sabatier University and Larrey Hospital, Toulouse, France and r=.64 (AUC), corresponding to a strong effect. No significant correlation between itch reduction and question- Non-infectious granulomatous dermatitis comprises a naire results was found (for all questionnaires p> 0.05). spectrum of diseases, the two major forms being the pa- Conclusion: Visual exposure to the “antipruritic” color using lisaded neutrophilic and the interstitial granulomatous immersive VR resulted in a significant decrease in itch in- dermatitis. A significant overlap exists among them, hence tensity. This aligns with our previous findings on the in- the term "reactive granulomatous dermatitis" has been fluence of colors on itch perception. The response of the in- proposed. Pyoderma gangrenosum (PG) is triggered by tervention appeared independent of psychometric values. pathergy and characterized by a massive neutrophilic infil- Color exposure may develop into a promising, low-cost, trate and abscess formation in the absence of infection. A rapidly-acting, easily-applicable, non-pharmacological me- strong correlation with autoimmune, rheumatological, he- thod for the reduction of itch. matologic malignancies and inflammatory bowel diseases (IBD) exists, suggesting a probable underlying autoinflammatory process. P8 We present the case of a 57-year-old man, diabetic, consul- Inter-observer and intra-observer variations assessing ting for progressive lesions on the glans penis over the past epithelial dysplasia in oral lichenoid diseases 3-4 days, described as painful humid irritation with whitish discharge. Persistent edema preceded the appearance of Zohdy M1, Cazzaniga S1,2, Nievergelt H1, Blum R.1, Suter V.3, Feld- the lesions by one month. An initial screen revealed Can- meyer L.1, Beltraminelli H.1 dida albicans colonization. Bacterial, HSV, HPV and STD 1) Department of Dermatology, Inselspital Bern University Hospi- screens were negative. Despite local treatment with eco- tal, University of Bern, Bern nazole, the lesions expanded, becoming nodular. Histolo- 2) Centro Studi GISED, Bergamo, Italy gy showed pseudo-carcinomatous hyperplasia with strong 3) Department of Oral Surgery and Stomatology, School of Dental neutrophilic infiltrate. Direct immunofluorescence showed Medicine, University of Bern, Bern vessel wall deposits for IgG and C3. Clinical correlation retained the diagnosis of neutrophilic dermatosis, PG-type. A Oral lichen planus (OLP) is the oral manifestation of LP (pre- large screening for vasculitis, as well as autoimmune, onco- valence 0.5-2%). Oral lichenoid lesions (OLL) are a group of logic/hematologic and IBD came negative. diseases characterized clinically by a stomatitis, and histo-

POSTERS logically by a lichenoid reaction similar to OLP, but typically 32 Dermatologica Helvetica - Volume 32(6) - Août 2020 STARK1 Von Kopf bis Fuss erscheinungsfrei.2,3

Langanhaltend Schnell Wirksam 6/10 Patienten über Schon ab Auch an heiklen Stellen 2,3 5 Jahre PASI 100 4 Woche 15 und Gelenken 6

TALTZ®: Der IL-17A-Inhibitor mit hoher Affinität und Spezifizität*,7 – bei Plaque-Psoriasis+ und Psoriasis-Arthritis § * Die in-vitro Affinität für Taltz® beträgt 1,8 pM7. Der Zusammenhang zwischen Wirkungsmechanismus und Methotrexat oder PUVA) nicht angesprochen haben, bei denen diese Therapien kontraindiziert sind oder die diese klinischen Ergebnissen wurde nicht untersucht. Unterschiede in der klinischen Pharmakologie können nicht zur Therapien nicht tolerieren. Taltz, alleine oder in Kombination mit konventionellen krankheitsmodifizierenden Erklärung von Unterschieden in der Wirksamkeit oder Sicherheit verwendet werden. + Taltz® ist zur Behandlung Antirheumatika (DMARD), ist zur Behandlung erwachsener Patienten mit aktiver Psoriasis-Arthritis indiziert, erwachsener Patienten mit mittelschwerer bis schwerer Plaque-Psoriasis indiziert, die auf andere systemische die auf eine Behandlung mit einem oder mehreren DMARDs unzureichend angesprochen haben oder diese Therapien (einschliesslich Ciclosporin oder Methotrexat oder PUVA) nicht angesprochen haben, bei denen diese nicht vertragen haben. D: Plaque-Psoriasis: die empfohlene Dosis beträgt 160 mg als subkutane Injektion (zwei Therapien kontraindiziert sind oder die diese Therapien nicht tolerieren. § Taltz®, alleine oder in Kombination mit 80 mg Injektionen) in Woche 0, gefolgt von 80 mg (eine Injektion) in den Wochen 2, 4, 6, 8, 10 und 12, und konventionellen krankheitsmodifizierenden Antirheumatika (DMARD), ist zur Behandlung erwachsener Patienten danach 80 mg (eine Injektion) alle 4 Wochen. Bei Patienten < 100 kg kann ein alternatives Dosisschema mit mit aktiver Psoriasis-Arthritis indiziert, die auf eine Behandlung mit einem oder mehreren DMARDs unzureichend 160 mg in Woche 0 und ab Woche 2 80 mg alle 4 Wochen erwogen werden. Psoriasis-Arthritis: die empfohlene angesprochen haben oder diese nicht vertragen haben. Dosis beträgt 160 mg als subkutane Injektion (zwei 80 mg Injektionen) in Woche 0, gefolgt von 80 mg (eine Injektion) alle 4 Wochen. KI: Schwere Überempfindlichkeit. Schwere aktive Infektionen. W/V: Bei Patienten 1. Gordon KB et al. Phase 3 Trials of Ixekizumab in Moderate-to-Severe Plaque Psoriasis. N Engl J Med 2016; mit chronischer oder aktiver Infektion oder rezidivierenden Infektionen in der Vorgeschichte muss Taltz mit 375:345-356. doi: 10.1056/NEJMoa1512711. 2. Lebwohl MG et al. Ixekizumab sustains high level of efficacy Vorsicht angewendet werden. Bei neu aufgetretenen oder exazerbierten entzündlichen Darmerkrankungen, and favourable safety profile over 4 years in patients with moderate psoriasis: results from UNCOVER-3 study. soll die Therapie mit Taltz sorgfältig reevaluiert werden und ein Therapieabbruch erwogen werden. Taltz darf J Eur Acad Dermatol Venereol. 2020 Feb;34(2):301-309. doi: 10.1111/jdv.15921. Epub 2019 Nov 7. 3. Ryan, C. nicht zusammen mit Lebendimpfstoff verwendet werden. Bei schwerwiegender Überempfindlichkeitsreaktion et al. Efficacy and safety of ixekizumab in a randomized, doubleblinded, placebo-controlled phase IIIb study of soll Taltz umgehend abgebrochen werden und eine geeignete Therapie eingeleitet werden. Die gleichzeitige patients with moderate-to-severe genital psoriasis. Br J Dermatol, 2018, 179: 844-852. doi:10.1111/bjd.16736. Verabreichung von Taltz mit anderen Biologika wurde nicht untersucht und wird nicht empfohlen. IA: Die 4. Leonardi C et al. Ixekizumab Demonstrates High Sustained Efficacy and a Favorable Safety Profile in Patients Sicherheit von Taltz in Kombination mit anderen Immunmodulatoren oder Phototherapie sowie Impfungen mit With Moderate-to-Severe Psoriasis Through Five Years of Treatment, abstract 548, late-breaking abstracts, Lebendimpfstoffen wurde nicht untersucht. Sch/S: Während der Schwangerschaft und bei gebärfähigen Frauen, Poster 548, presented at 24th World Congress of Dermatology (WCD); Milan, Italy; June 10-15, 2019, https:// die keine wirksame Empfängnisverhütung verwenden, darf Taltz nicht verabreicht werden, es sei denn, dies www.wcd2019milan-dl.org/abstract-book/documents/late-breaking-abstracts/35-psoriasis/ixekizumab- ist eindeutig erforderlich. Patientinnen sollen angewiesen werden für mindestens 10 Wochen nach der letzten demonstrates-high-sustainedefficacy-548. pdf (Zugriff: 05.09.2019). 5. Papp KA et al. lxekizumab treatment Gabe von Taltz wirksame Verhütungsmethoden anzuwenden und nicht zu stillen. Eine Entscheidung, entweder for psoriasis: integrated efficacy analysis of three double-blinded, controlled studies (UNCOVER-I, UNCOVER-2, mit dem Stillen aufzuhören oder die Einnahme von Taltz abzubrechen, sollte unter Berücksichtigung der Vor- UNCOVER-3). Br J Dermatol. 2018;178(3):674-681. doi: 10.1111/bjd.16050. 6. Mease PJ et al. A head-to-head

teile des Stillens für das Kind und der Vorteile der Therapie für die Mutter gefällt werden. UAW: Sehr häufig: PP-IX-CH-0395/04.2020 comparison of the efficacy and safety of ixekizumab and adalimumab in biological-na.ve patients with active Infektionen der oberen Atemwege, Reaktionen an der Injektionsstelle. psoriatic arthritis: 24-week results of a randomised, open-label, blinded-assessor trial. Ann Rheum Dis. 2019 Häufig: Tinea Infektion, oropharyngeale Schmerzen, Übel keit, Diarrhö, Sep 28. doi: 10.1136/annrheumdis-2019-215386. 7. In-vitro Studie: Liu L et al. Generation and characterization erhöhte Leberenzyme. Anaphylaktische Reaktionen wurden selten berichtet. of ixekizumab, a humanized monoclonal antibody that neutralizes interleukin-17A. J Inflamm Res. 2016 Apr P: Taltz 80 mg 1 oder 2 Fertigpen / 1 oder 2 Fertig spritze(n). Abgabe- 19;9:39-50. doi: 10.2147/JIR.S100940. kategorie B. Kassenzulässig. Weitere Informationen finden Sie unter www. Taltz® (Ixekizumab) Injektionslösung. I: Taltz ist zur Behandlung erwachsener Patienten mit mittelschwerer swissmedicinfo.ch. Eli Lilly (Suisse) SA, ch. des Coquelicots 16, CP 580, bis schwerer Plaque-Psoriasis indiziert, die auf andere systemische Therapien (einschliesslich Ciclosporin oder 1214 Vernier (GE). V09-2019

200515_RZ_949_052015_Derma_Anzeige_Anpassung_April2020_RA_210x297_D.indd 1 15.05.20 10:07 Topical and systemic corticosteroids achieved a spectacu- and surgical removal, genital warts tend to be recalcitrant. lar improvement, allowing the rapid tapering of oral pre- HPV vaccination is mainly used as a preventive strategy to dnisone and relay with topical tacrolimus. However, over prevent genital warts, cervical and other anogenital cancers. the next 3 months, lesions relapsed with painful nodular However, in a few cases HPV vaccination has been shown to masses covering the glans. A circumcision performed un- be a good treatment alternative for patients with recalcitrant der systemic corticotherapy allowed disease control, cur- skin warts. Here we report five cases of recalcitrant genital rently maintained under infliximab. Histology showed warts that responded well to treatment with the nonavalent pseudo-carcinomatous hyperplasia with massive neutro- HPV vaccine. HPV vaccines could be beneficial as a non-inva- philic infiltrate in the dermis and granulomatous vasculi- sive treatment alternative for recalcitrant genital warts. tis. A new screening, 6 months after the initial skin lesions, revealed a small intestinal bacterial overgrowth. A Nanos- tring transcriptome analysis revealed a dominant Th1-si- P12 gnature, as shown for reactive granulomatous dermati- Treatment of Pityriasis rubra pilaris with risankizumab tides, contrasting with the Th17 profile described for PG. (Skyrizi) Our case illustrates the diagnostic challenge between the granulomatous dermatitis spectrum and neutrophilic der- Brocco E, Laffitte E matoses of PG-type. Novel molecular approaches, such as Department of Dermatology, University Hospitals, Geneva Nanostring, are promising tools for a better understanding, classification and diagnosis of similar atypical manifesta- Introduction: Pityriasis rubra pilaris is a rare dermatological tions. disease which shares similar inflammatory pathway and cytokine activation profile with psoriasis. Hence, in-label psoriasis treatment are being used off-label to treat re- P10 fractory PRP. We report the case of a patient treated with Skin hyperpigmentation index: a new practical method risankizumab. for unbiased automated quantification of skin hyperpig- Case report: A 43 year-old female presented at our clinic mentation with a 10 weeks history of pruritic erythematous eruption which started on the face with descending progression to Bossart S1, Cazzaniga S1,2, Willenberg T3, Ramelet AA1, the body. The patient was known for probably work-ac- Baumgartner M1, Heidemeyer K1, Hunger RE1, Seyed Jafari SM1 quired untreated latent tuberculosis. Cutaneous biopsies 1) Department of Dermatology, Inselspital, Bern University Hospi- showed hyperkeratosis with follicular spongiosis, acantho- tal, Bern sis and hypergranulosis along with alternating orthokera- 2) Centro Studi GISED, Bergamo, Italy tosis and parakeratosis. PRP was diagnosed. Previous treat- 3) Gefässzentrum Bern, VASC, Lindehofspital Bern, Bern ments with moisturizers, topical class III corticosteroids, UV therapy, antihistamines and two intramuscular cortisone Hyperpigmentation is a darkening of the skin, which is injections remained ineffective. Similar roles of the IL-23– mostly caused by increased production of melanin due to Th17-axis in both PRP and psoriasis have been identified, melanocyte activation or hemosiderin deposits in the skin. suggesting this pathway as a reasonable target for PRP. Up to now, there are only a few available methods for its Biologics which target IL-23p19 subunit generally show si- quantification, which could not evaluate the level of hyper- milar safety profile than those which target IL-12/IL-23p40 pigmentation in a proper quantitative way. A newly deve- subunit, and recently, several studies reported that usteki- loped pigmentation measurment method, the “Skin Hy- numab does not increase tuberculosis risk. We initiated a perpigmentation Index” (SHI), enables a fully-automated treatment with risankizumab, an anti-IL23p19 monoclonal and standardized quantification of skin hyperpigmenta- IgG1 antibody. We used the risankizumab dosing regimen tion based on the clinical and/or dermatoscopic images. approved for psoriasis. Regarding the untreated latent tu- The SHI defines the ratio of two hyperpigmentation scores berculosis, we initiated a treatment of Rifampicine 3 weeks from the patients, i.e. hyperpigmented area of interest in prior to starting risankizumab. After the first risankizumab the skin and normal sun protected skin as the refernce injection, a reduction of DLQI from 20 to 13 and decrease in point. This results in a range from 1 (no pigmentation) to the affected body area surface from 84 % to 30 %. 4 (maximum pigmentation). For more practical and easier Discussion: Classic treatments of PRP include oral isotre- evaluation of the hyperpigmentation, a free user-friendly, tinoin, acitretin, methotrexate and anti-TNFα with usual automated, unbiased online SHI-calculator has been de- scarse to moderate response. Recent case reports have veloped, which is accessible to all practitioners (https://shi. been published on the use of IL-12/IL-23p40 inhibitor and skinimageanalysis.com/). The SHI is a fully automated me- IL-23p19 inhibitor for PRP with very rapid dermatological thod for the quantitative assessment of skin pigmentation, response. Regarding their safety for LTBI patients, data which can easily be applied to assess any skin type with any shows no activation of tuberculosis for patients under- type of hyperpigmentation based of images, regardless of going tuberculosis prophylaxis. Moreover, some data show which device or medium used to capture the photos. This the absence of tuberculosis activation in subgroups of LTBI allows a simple, fast and standardized quantification of patients treated with risankizumab even without TB pro- skin hyperpigmentation and is useful for monitoring the phylaxis. progress and planning of whitening therapy. In conclusion, the patient responded rapidly within 4 weeks to risankizumab. Risankizumab and other IL-23–TH17-axis inhibitors seem promising therapies for patients with PRP P11 and are safe options for patients with LTBI. Nonavalent human papillomavirus vaccination as alternative treatment for genital warts P13 Bossart S, Gabutti MP, Seyed Jafari SM, Hunger RE Coexistence of pathologic variants in transglutaminase Department of Dermatology, Inselspital, Bern University Hospital, 1 and activin receptor-like kinase 1 in a patient with University of Bern self-improving collodion ichthyosis and Morbus Osler Genital warts caused by the human papilloma virus (HPV) Burger B1, Ghosh A2, Gouveia C3, Itin PH4, Navarini AA4 are the most common sexually transmitted disease and 1) Department of Biomedicine, University Hospital and University have a negative impact on quality of life. Of the more than of Basel, Basel 200 different types of human papilloma virus, low-risk types 2) Competence Center Personalized Medicine, University of Zurich 6 and 11 are mainly responsible for the development of and ETH Zurich, Zurich condyloma acuminata. Despite a large arsenal of local the- 3) Universitätsklinik für Dermatologie Inselspital, Universitätsspital rapies such as numerous topical agents, CO2 laser ablation Bern, Bern

POSTERS 4) Dermatology, University Hospital Basel, Basel

34 Dermatologica Helvetica - Volume 32(6) - Août 2020 Self-improving collodion ichthyosis (SICI) is a feature that of Pembrozilumab, developed an extensive local/-in transit mostly affects patients with autosomal recessive congeni- recurrence treated with T-VEC, which is still ongoing. For all tal ichthyosis (ARCI). Approximately 10% of ARCI patients them, we did not report toxicity. are born with the clear, shiny, and tight membrane enca- Conclusion: In our experience, T-VEC is an effective and sing the newborn. The phenotype is often accompanied well-tolerated intralesional therapy by elderly patients with by ectropion and eclabium. SICI is mostly related to trans- in-transit melanoma metastases. glutaminase 1 (TGM1) and arachidonate 12-lipoxygenase (ALOX12B) variants. A genotype-phenotype correlation has not yet been identified, even though some variants P15 are correlated with the rare ichthyosis form of bathing-suit Violaceous patches on bilateral axilla ichthyosis. Osler’s disease (also named Rendu-Osler-Weber disease) de Lorenzi C, Mainetti C, Guillod C is a hereditary hemorrhagic teleangiectasia (HHT) (preva- Department of Dermatology, Ente Cantonale Ospedaliero, Bellin- lence about 1:5000) characterized by a variety of clinical zona features, e.g epistaxis, gastrointestinal bleeding, mucocutaneous teleangiectasia, and iron deficiency anaemia. The Introduction: Different etiologies can triggered intertrigi- autosomal-dominant inherited disease is correlated to at nous patches. Here we described the case of a man who least three genes, endoglin (ENG), activin receptor-like ki- presented axillary patches. nase 1 (ACVRL1), SMAD-related protein 4 (SMAD4/MADH4). Case Report: A 73-year-old Caucasian male without past We present the phenotype and genetic analysis of a male medical history presented since ten days asymptomatic patient who was born with a collodion membrane and ad- brown skin lesions on both axillae appearing progressively. ditionally developed Osler’s disease. The patient showed He had no previous personal or familial medical history the typical signs of Osler’s disease (teleangiectasia and concerning skin diseases. He denied application of topical epistaxis), but only mild symptoms of ichthyosis presented products apart from his usual deodorant and soap. He was by a palmar eczema, severe scaling in the auditory canal, not taking any medication. Clinical examination revealed and fissures of the skalp. Interestingly, an onychodystrophy brown-violaceous non-infiltrated and non-scaly macules was identified on one of the toe nails. Whereas Osler’s di- and patches on both axilla. The rest of the skin (including sease is inherited autosomal-dominantly in patient’s family, other skin folds), hair, nails and oral and genital mucosae no other family members were affected by SICI. were normal. We performed a skin biopsy, which revealed Whole exome sequencing of the genomic DNA from blood a lichenoid dermatitis with pigment incontinence. Serolo- revealed an already known heterozygous variant in the gy for hepatitis C virus was negative. We diagnosed lichen ACVRL1 gene as well as compound heterozygous variants planus pigmentosus inversus (LPPI) and introduced mo- in the TGM1 gene. One TGM1 variant is described to cause metasone furoate 0.1% cream with evolution to brown a bathing suit ichthyosis whereas the second variant is not post-infiammatory macules. We excluded a contact der- correlated with SICI. Interestingly, our patient did not pre- matitis after re-exposure to deodorant and soap without sent the phenotype of a bathing suit ichthyosis. recurrence. The patient independently showed the phenotype of Discussion: LPPI is a rare variant of lichen planus. Its etiolo- Osler’s disease and ichthyosis, both based on genetic va- gy is unclear. Caucasians and Asians have been most com- riants in known genes, without obvious mutual influence. monly reported. It seems to predominantly affect women We present the phenotype of the patient and the correla- after the age of 40 years. Its pathogenesis seems to be simi- tion to the identified variants. lar to lichen planus pigmentosus in terms of a cell-mediated immunity playing a role in triggering the disease. Literature reports an association to friction and tight clothing (Koeb- P14 ner phenomenon), hepatitis C and hormonal factors. The Our Experience with Talimogene Laherparepvec (T-VEC) possible role of chemicals in the clothes being responsible Therapy in Five Patients with In-Transit Melanoma Me- for a lichenoid reaction is debatable. Clinically, it presents tastasis with asymptomatic to mildly pruritic, brown-violaceous, and sharply defined macules-patches, in non-sun exposed, Cattrini B1, Espeli V2, Leoni-Parvex S3, Mainetti C1, Mangas C1,2 intertriginous and flexural areas. Lesions outside the inter- 1) Department of Dermatology, Ente Ospedaliero Cantonale, Bel- triginous areas are observed in 10% of cases. Dermoscopy linzona can assist the diagnosis. Histologically it shows an orthoke- 2) Oncology Institute of Southern Switzerland (IOSI), Mendrisio ratotic, atrophic epidermis with variably lichenoid infiltrate 3) Cantonal Institute of Pathology, Locarno of lymphocytes and histiocytes, associated with prominent pigmentary incontinence in the superficial dermis. Cur- Introduction: Talimogene laherparepvec (T-VEC) is an on- rently there is no consensus concerning the treatment. In colytic herpes virus approved in Switzerland as intralesio- most cases, LPPI is resistant to most therapeutic options. nal therapy for patients with unresectable IIIA, IIIB, IIIC, IIID Spontaneous resolution has been reported. Triggers res- and IVM1a melanoma (AJCC 8th edition). ponsible for Koebner phenomenon must be avoided. Clinical cases: We treated at our dermatology department Conclusion: LPPI, a variant of lichen planus mainly located five patients with stage IIIC melanoma with in transit me- in the folds, present unique clinical features. tastasis. All patients were males and over 80 years old, with comorbidities and a good performance status. We treated successfully two patients with melanoma of the scalp: the P16 first one with in transit metastasis had a complete response Dermatophilus congolensis dermatitis: a souvenir of Asia after two administrations of T-VEC, the second one with in transit metastasis and one cervical lymph node metastasis, de Lorenzi C1,2, Quenan S1, Fontao L1 had a complete response after 3 administrations of therapy. 1) Dermatology Department, Geneva University Hospitals, Geneva One patient also with melanoma of the scalp presented 2) Dermatology Department, Ente Ospedaliero Cantonale, Bellin- complete resolution of the in transit metastasis after two zona injections of T-VEC, but later he developed lung metastasis. We proposed immunotherapy but the patient refused any Introduction: Dermatophilus congolensis is an animal treatment. One patient with in transit melanoma metasta- pathogen responsible for dermatophilosis, mainly seen sis of the shoulder had a local and lymph nodal progression in tropical areas. D.congolensis dermatitis is a self-limited after four administrations of T-VEC. He died few months zoonosis, poorly described in Europe, probably because it later due to systemic progression of melanoma. Finally, a is under-diagnosed. patient with unresectable axillary lymph node metastasis Observation: A 28-year-old woman without past medi- in melanoma of the right arm, progressing after six cycles cal history, presented a 4-day history of skin rash on legs POSTERS

Dermatologica Helvetica - Volume 32(6) - Août 2020 35 extending to the flanks. They appeared during a trip to in association with clobetasol proprionate cream was ob- Thailand. Activities in Thailand included swimming in served. In this context, nivolumab was suspended after 6 rivers, riding elephants and sightseeing tours. Another cycles, which allowed resolution of both symptoms and group member had similar lesions. There was no history of skin lesions. However, the follow-up was unfortunate and sexual intercourse. Clinical findings showed papulo-pustu- the patient died of complication of a digestive hemorrhage lar skin lesions distributed on both legs, thighs and flanks. 6 months later. Gram positive branching filaments with septations and Discussion: Bullous lichen planus has rarely been reported coccoid cells which have a "stacked coins" appearance in the context of nivolumab therapy. After a systematic re- were found in skin smear. Beta-hemolytic colonies were view, 20 cases of nivolumab- and pembrolizumab-induced isolated in culture on blood agar and identified as D.congo- lichen planus between 2016 and 2018 have been publi- lensis by 16S rDNA gene sequencing. After a 1-week course shed, whose 6 of them describe a bullous form. Manage- of doxycycline at dosage of 100 mg once daily, associated ment with topical and/or systemic drugs and maintenance with local antiseptic skin care (aqueous chlorexidine), the or discontinuation of anti-PD1 were dependent on the se- skin rash resolved. verity. Discussion: D.congolensis is an unusual aerobic (facultative Conclusion: The onset of cutaneous adverse reactions un- anaerobic) gram positive organism in the order Actinomy- der anti-PD1 immunotherapy can take weeks to months cetales. It has the ability to form filamentous structures and require a regular follow-up. Discontinuation of immu- evolving to coccoid forms. It is mostly found under tropical notherapy must be balanced taking into account the actual areas or humid climates and poor hygiene conditions is a oncological status and the severity of the skin lesion at the risk factor. It is an animal pathogen responsible for derma- presentation. tophilosis, a disease mainly seen in cattle but it also affects other domestic and wild animals. Dermatophilosis can be transmitted to humans after a contact with an infected P18 animal. The human disease has a broad clinical spectrum Acquired Wrinkled Plaques: Think about Mid-Dermal with non-specific lesions. Microscopy examination of clini- Elastolysis cal sample and cultures are useful to confirm diagnosis. The disease seems to be self-limited and can resolve without De Lorenzi C1, Leoni-Parvex S2, Ghitti F1, Mainetti C1 therapy. Different treatment regimens have been reported 1) Dermatology Department, Ente Ospedaliero Cantonale, Bellin- such as topical gentamycin or systemic antibiotics (ampi- zona cillin, intramuscular streptomycin, cefadroxil) but there is 2) Istituto Cantonale di Patologia, Locarno actually no consensus. Conclusion: D.congolensis dermatitis is a spontaneously re- Introduction: Mid-dermal elastolysis (MDE) is a rare ac- solving tropical zoonosis whose clinical presentation may quired elastic tissue disease. Clinically, it predominantly include a wide variety of non-specific tissue lesions and affects the trunk, back, shoulders and upper extremities thus has a high potential for misdiagnosis. Animals contact with a symmetrical distribution. Palms, soles and faces are should be investigated, particularly among travelers, and spared. We report an additional case. microbiological cultures should be made. Case Report: A 38-year-old female was referred to our Dermatology Clinic for a second opinion regarding skin lesion. They first appeared at the age of 34, on the trunk P17 then extended to the back, initially as red papules leaving Bullous lichen planus and anti-programmed cell death-1 wrinkling skin. She was asymptomatic and did not present therapy any other general symptoms. Her medical history was unremarkable outside of an assisted fecundation. She was de Lorenzi C1,2, André R1, Vuilleumier A3 , Kaya G1,Abosaleh M1 no taking medications. She used to go to tanning salons. 1) Department of Dermatology, Geneva University Hospitals, Ge- Familial history was negative for skin conditions. On clini- neva cal examination, she presented widespread papules and 2) Department of Dermatology, Ente Ospedaliero Cantonale, Bel- plaques with wrinkling and mild protrusion from the sur- linzona face of the skin distributed over the trunk, abdomen and 3) Department of Oncology, Geneva University Hospitals, Geneva back. Histologically, Verhoeff-Van Gieson staining revealed mid and profound dermal loss of elastic fibers. Blood tes- Introduction: Cutaneous adverse events of immunothera- ting revealed anti-thyroglobulin antibodies at 6.7 IU/ml (N pies are frequently encountered in the healthcare practice. < 4.1 IU/ml). Other routine analyses (TSH, immunology tes- Among them, anti-PD1 lichenoid reactions are well known, ting, and proteins electrophoresis) were in the range. The whereas few cases of bullous lichen planus have been re- clinical presentation and histology were compatible with a ported in the literature. type II mid-dermal MDE. Observation: A 68-year-old man, followed for metastatic Discussion: Three clinical variants of MED are described: clear cells renal carcinoma, presented at the clinic for pur- type I consists of well-defined patches of fine wrinkles -ar plish papules on limbs that appeared 3 months after the ranged in parallel to the skin cleavage line, type II consists initiation of nivolumab. The biopsy revealed an epidermi- of soft perifollicular papular protrusions. They predomi- dis with focal hypergranulocytosis and hyperkeratosis, va- nantly affect Caucasian females. Type III consists of reticu- cuolar degeneration and keratinocyte necrosis at the base, late erythema on sun-exposed areas and has a male pre- with pigmentary incontinence and perivascular and inters- dominance. Burning symptoms and/or erythema, urticarial titial lymphocitic infiltrate in the superficial dermis, which papules or plaques can precede. The disease is described confirmed the diagnosis of lichen planus. Nivolumab was with different inflammatory and immune diseases sugges- incriminated after excluding other drug-induced and viral ting an immune process against elastic fibers. It is currently disease. Evolution worsened in few weeks with extension not clear if ultraviolet radiation or hormones play a role in of the purplish papules and plaques up to 30% of the body the metalloproteinases alterations. Differential diagnosis surface area, and onset of vesicles and bullae on some of includes anetoderma, cutis laxa, perifollicular elastolysis, them despite clobetasol propionate cream treatment. A pseudoxanthoma elasticum-like papillary dermal elastoly- second biopsy revealed a new sub-epidermal cleavage. sis and annular elastolytic giant cell granuloma. Topical Direct immunofluorescence showed non-linear colloid bo- therapies (steroids, soybean extract and eicosapentanoic dies in IgM and C3 at the dermo-epidermal junction. ELISA acid or tretinoin) and systemic therapies (steroids, colchi- assays for BP-180 and BP-230 antibodies was negative. At cine, chloroquine, clofazimine, dapsone) have been des- this point, an auto-immune bullous disorder was excluded cribed with no clear benefit. Management is nevertheless and the diagnosis of nivolumab-induced secondary bul- challenging, as there is no consensus and due to cosmetic lous lichen planus was retained as the final diagnosis. No implication. responses to triamcinolone (2 injections of a 40-mg dose) POSTERS

36 Dermatologica Helvetica - Volume 32(6) - Août 2020 P19 rentials include granulomatous and infectious diseases. Long – term disease control after allogeneic hemato- Histopathology of the skin biopsy showed increased num- poietic stem cell transplantation in primary cutaneous T ber of small vessels in the upper and mid dermis and mul- – cell lymphoma; results from a single institution analysis tinucleate giant cells. Conclusion: Our case demonstrates a rare cutaneous pa- Dimitriou F1,3, Schanz U2,3, Nair G2,3, Kimeswenger S4,5, Brüggen thology with atypical clinical presentation mimicking gra- MC1,3, Hoetzenecker W4, Maiwald–Urosevic M3, French LE6, nulomatous disease in an atypical anatomical localisation. Dummer R1,3, Cozzio A7,3*, Guenova E1,3,8* Due to the rarity of the disease there is limited data avai- * These authors contributed equally to this work lable for the treatment modalities; some case reports/se- 1) Department of Dermatology, University Hospital Zurich, Zurich ries describe varying response to laser and intense pulsed 2)Department of Medical Oncology and Hematology, University light therapy, intralesional corticosteroid injections, cryo- Hospital Zurich therapy and surgical excision. Although spontaneous re- 3) Faculty of Medicine, University of Zurich, Zurich mission is rarely described, taking into account the benign 4) Department of Dermatology, Kepler University Hospital Linz, Austria and asymptomatic course of disease our patient did not 5) Department of Soft Matter Physics, Institute for Experimental want to receive any treatment. Physics, Johannes Kepler University, Linz/Austria 6) Department of Dermatology, University Hospital Munich (LMU), Munich, Germany P21 7) Department of Dermatology, Kantonsspital St Gallen, St Gallen Ixekizumab is Superior to Placebo for the Treatment of 8) Lausanne University Hospital (CHUV) and Faculty of Biology and Nail, Scalp, and Palmoplantar Psoriasis in Pediatric Pa- Medicine, University of Lausanne, Lausanne tients with Moderate-to-Severe Plaque Psoriasis

Background: Allogeneic hematopoietic stem cell transplan- Paller A1, Magariños GA2, Pinter A3, Cather J4, Keller S5, Rodri- tation (alloHSCT) has been proposed as curative approach guez Capriles C5, Gallo G5, Edson-Heredia E5, Li L5, Papp K6, Duc for advanced cutaneous T – cell lymphomas (CTCL). Cur- Monnerat M (Non-author Presenter)7 rently, there is no established consensus for the manage- 1) Department of Dermatology, Northwestern University, Chicago, ment of disease relapse after alloHSCT. IL, USA Results: Ten patients, previously treated with multiple lines 2) Psoriahue, Buenos Aires, Argentina of systemic treatment, received alloHSCT. Six patients had 3) University Hospital Frankfurt, Frankfurt, Germany achieved partial response (PR, N = 5) and complete res- 4) Mindful Dermatology and Modern Research Associates, Dallas, ponse (CR, N = 1) prior to HSCT. Post – HSCT, seven patients Texas, USA (N = 7) relapsed after a median time of 3.3 months (0.5 – 7.4 5) Eli Lilly and Company, Indianapolis, IN, USA 6) K Papp Clinical Research and Probity Medical Research, Water- months) and were subsequently treated with radiotherapy loo, and Division of Dermatology, Department of Medicine, Uni- (RT, N =1), RT and adoptive T-cell transfer with EBV speci- versity of Toronto, Toronto, ON, Canada fic cells (N =1), R-CHOP (N = 1) and interferon alpha - 2a 7) Eli Lilly and Company, Vernier combined either with donor lymphocyte infusion (N = 1) or with brentuximab – vedotin (N = 1). One patient (N = 1) Introduction: Ixekizumab is approved for moderate-to-se- achieved PR only after reducing the immunosuppression. vere plaque psoriasis in adults. We report efficacy of Two patients relapsed again and received interferon alpha ixekizumab for nail, scalp, and palmoplantar psoriasis, - 2a and brentuximab – vedotin, respectively. After a me- and patient-reported psoriasis severity from IXORA-PEDS dian follow-up time of 12.6 months (3.5 – 73.7 months) six (NCT03073200), investigating efficacy and safety of ixeki- patients were alive (60%) and four had deceased, three (N zumab in pediatric patients with moderate-to-severe = 3) due to CTCL and one (N = 1) due to GVHD. plaque psoriasis. Conclusion: Disease relapse after alloHSCT can be Methods: Patients (N=171, 6 to <18 years old) were rando- controlled with available treatments. For most patients mized (2:1) to ixekizumab or placebo. Patients randomized who ultimately relapsed, reduction of immunosuppression to ixekizumab received 40-mg (<25kg), 80-mg (25-50kg), and interferon alpha - 2a either administered alone or in or 160-mg (>50kg) starting doses (based on body weight), combination with another systemic agent were preferred. then 20-mg, 40-mg, or 80-mg (respectively) every 4 weeks Although interferon alpha – 2a, similarly to immunosup- through Week 12. Outcomes included proportion of pa- pression reduction, may be beneficial for the achievement tients (with presence at baseline) achieving resolution of of graft – versus – lymphoma effect, the risk of simul- nail (Nail Psoriasis Severity Index [NAPSI]=0), scalp (Pso- taneous worsening of GVHD must be carefully evaluated riasis Scalp Severity Index [PSSI]=0), or palmoplantar (Pal- and taken into consideration. moplantar Psoriasis Area and Severity Index [PPASI] 100) psoriasis, and Patient’s Global Assessment of disease activity (PatGA) score 0 or 1 (0,1). Nonresponder imputation P20 was used for missing data; treatment group comparisons Multinucleate cell angiohistiocytoma – a rare entity mi- were analyzed by Fisher’s exact test. micking granulomatous and infectious diseases Results: At baseline, 46, 152, or 26 patients had nail (NAP- SI>0), scalp (PSSI>0), or palmoplantar psoriasis (PPASI>0), Drach M1, Rodriguez R1, Cozzio A1,2, Saulite I1,2 respectively; all 171 patients had PatGA≥1. At Week 12, 1) Dept. of Dermatology, Venerology and Allergology, Kantonsspi- NAPSI=0 (18%, p=0.317), PSSI=0 (69%, p<0.001), and PPASI tal St. Gallen, St. Gallen 100 (47%, p=0.098) responses were greater with ixekizu- 2) Institute of Pathology, Kantonsspital St. Gallen, St. Gallen mab than placebo (0%, 16%, and 11%, respectively). Si- gnificantly more patients receiving ixekizumab achieved Background: Multinucleate cell angiohistiocytoma (MCAH) PatGA 0,1 (79%, p<0.001) versus placebo (16%) at Week 12. is a rare benign vascular or fibrohistiocytic cutaneous en- Conclusions: At Week 12, ixekizumab was superior to place- tity consisting of dermal vessel proliferation, multinucleate bo for patient-reported psoriasis severity and complete re- giant cells and dermal fibrosis. Most prevalent occurrence solution of scalp psoriasis in pediatric patients. Numerically of MCAH is reported on the lower legs in middle-aged and greater response was observed with ixekizumab for nail elderly females. Cutaneous lesions most commonly pre- and palmoplantar psoriasis resolution. senting as erythematous to violaceous papules and evolve Disclosure: Previously presented at the AAD (2020) Ameri- over several months. can Academy of Dermatology - 78th Annual Meeting; Den- Case summary: We report a case of a 57-year-old male pre- ver, CO, USA; March 20-24, 2020. senting with red to violaceous papules slowly evolving in size and number over the period of one year located at his right dorsal hand. The patient`s history revealed no trauma, no travel in tropical countries or contact to animals. Diffe- POSTERS

Dermatologica Helvetica - Volume 32(6) - Août 2020 37 P22 P24 Eruptive inflammation of actinic keratosis under R-CHOP Travel history rather than gastrointestinal symptoms is therapy risk stratification criterion for the presence of parasites in patients with chronic spontaneous urticaria Emelianov V, Feldmeyer L, Schlapbach C Department of Dermatology, Inselspital, Bern University Hospital, Erhart C1, Wampfler R2, Kocur K2, Neumayr A2, Poppert S2, Ruf University of Bern T2, Bellutti F3, Hartmann K1,4, Steveling-Klein E1,4 1) Division of Allergy, Department of Dermatology, University Hos- Actinic keratoses (AKs) typically develop on sun-exposed pital Basel and University of Basel, Basel skin. A sudden generalized inflammation of AKs is occasio- 2) Swiss Tropical and Public Health Institute, Basel, Basel nally observed during chemotherapy, potentially leading 3) Allergy Unit, University Children’s Hospital Basel, Basel to a clearing of AKs. Specifically, regimens containing fluo- 4) Department of Biomedicine, University Hospital Basel and Uni- rouracil, dactinomycin, dacarbazine, vincristine, or combi- versity of Basel, Basel nations thereof can cause a widepsread inflammation of AKs. Chemotherapy is thought to selectively cause DNA Background: Blastocystis (B.) hominis is one of the most damage in sun-damaged keratinocytes, leading to local common intestinal protozoan and previous studies have cell-death and subsequent inflammation. suggested a possible causal relationship between B. homi- Here, we report the case of a 77-year-old male who received nis and chronic spontaneous urticaria (CSU). Parasite scree- 5 courses of R-CHOP therapy for an aggressive B-cell-lym- ning is not common practice and risk stratification criteria phoma with infiltration of the right kidney and liver. on whom to perform the test are unclear. After the third course, he suddenly had itching and burning Method: We retrospectively analysed data of 57 patients cutaneous lesions on his forearms. On examination, he had with a diagnosis of CSU referred to the Division of Allergy small, hyperkeratotic patches and plaques on an erythe- of the University Hospital Basel and the University Child- matous basis on the extensor surfaces of both forearms. ren’s Hospital Basel from June 2019 until November 2019. Prior chemotherapy, he had asymptomatic AKs. Histopa- Presence of parasites and B. hominis subtypes were deter- thological examination showed proliferative bowenoid mined in stool samples by microscopy, real-time PCR and AKs. The clinical and pathologic features were consistent conventional PCR followed by sequencing. We also re- with a diagnosis of chemotherapy-induced multiple infla- corded the presence of gastrointestinal symptoms, country med AKs. Since the patient had strong itching and burning, of origin and travel history. he was given topical corticosteroids in combination with Results: In total, 57 patients (36 females (63.2%) and 21 skin emollients, which rapid improvement of his condition. males (36.8%)) with the mean age of 44 (SD ± 15, range According to the evolution of the daylight photodynamic 13-79) years were screened for parasites. Presence of B. ho- therapy will be considered. minis was detected in 19 patients (33%). Comparing diffe- Our case confirms previous reports showing that AKs can rent subtypes of B. hominis in these 19 patients, subtype 3 abruptly become inflamed under chemotherapy as well as was found to represent the most common subtype (n=10; lead to an unmasking of subclinical lesions. 55.6%), followed by subtype 1 (n=3; 16.7%), subtype 2 (n=1; 5.6%) and subtype 4 (n=1; 5.6%). Co-infection with other parasites was observed in 9 patients (47.4%). The most fre- P23 quent co-infection was Dientamobea fragilis (n=8; 42.1%). Pitfalls and complications with biologics: widespread Within the group of 19 patients with B. hominis infestation, dermatophyic infection in a psoriasis patient during the majority of patients (n=15; 78.9%) reported a back- ixekizumab therapy ground of migration (Turkey, n=6; Africa, n=3; Italy, n=2; Ko- sovo, n=1; Serbia, n=1; Macedonia, n=1; Brazil, n=1), which Emelianov V, Heidemeyer K, Feldmeyer L, Yawalkar N was higher compared to the B. hominis negative group Department of Dermatology, Inselspital, Bern University Hospital, (n=17; 45%) (p<0.05). Furthermore, recent travel history was University of Bern more frequently reported in the patients tested positive to B. hominis (n=18; 95%) compared to those patients tested Biologics targeting the interleukin (IL)-17 family of negative (n=19; 50%) (p<0.001). No association with gas- cytokines have led to significant advances in the manage- trointestinal symptoms was observed (p=0.40). ment of psoriasis. Ixekizumab is a humanized monoclonal Conclusion: In the present study, we report on a high antibody directed against IL-17A that has been approved prevalence of parasite infestation in our CSU population for the treatment of moderate-to-severe plaque psoriasis from Northwestern Switzerland. B. hominis was the most and psoriatic arthritis. Although ixekizumab exhibits a fa- frequent parasite found, and B. hominis subtype 3 repre- vorable safety profile, vigilance regarding fungal infections, sented the most common subtype. The majority of CSU particularly candidiasis is necessary. We describe a 44-year- patients with B. hominis infestation had a background of old male patient with a history of recalcitrant severe plaque migration and a positive travel history. Of note, we obser- psoriasis, who was successfully treated with ixekizumab ved no association between B. hominis infestation and gas- (PASI 90 response after 3 months). However, one year after trointestinal symptoms. initiating therapy, the patient presented with new widespread erythrosquamous lesions on the abdomen, upper and lower extremities, accompanied with severe itch. Assu- P25 ming a psoriatic flare-up, therapy with topical calcipotriol Efficacy and safety of tralokinumab with concomitant plus betamethasone dipropionate ointment was given topical corticosteroid in adult patients with mode- with no improvement. Subsequently, a further spread of rate-to-severe atopic dermatitis: Results from the 32- the lesions with a centrifugal pattern was noted. Direct my- week Phase 3 ECZTRA 3 trial cological examinations and mycological cultures identified a Trichophyton rubrum. Oral terbinafine 250 mg/day for 6 Weidinger S1, Schmid-Grendelmeier P2, Silverberg JI3, Toth D4, weeks led to complete resolution of the fungal infection. Bieber T5, Alexis AF7, Pink A8 Therapy with ixekizumab was continued with remarkable 1) Department of Dermatology and Allergy, University Hospital clinical response (absolute PASI <1) and no further side ef- Schleswig-Holstein, Campus Kiel, Kiel, Germany 2) Allergy Unit, Department of Dermatology, University of Zuerich, fects for over 1.5 years. Our observation reminds that cli- Zurich, Switzerland nicians must maintain a high index of suspicion for fungal 3) Department of Dermatology, The George Washington Univer- infections including dermatophyte fungi in patients recei- sity School of Medicine and Health Sciences, Washington, DC, USA ving IL-17 antagonists. 4) XLR8 Medical Research and Probity Medical Research, Windsor, ON, Canada 5) Department of Dermatology and Allergy, University Medical Center, Bonn, Germany POSTERS

38 Dermatologica Helvetica - Volume 32(6) - Août 2020 6) Department of Dermatology, Icahn School of Medicine at Method: Patients received Cal/BD aerosol foam 1x/day for Mount Sinai, New York, NY, USA 4 weeks during the open‑label period of this phase III long- 7) Department of Dermatology, University of Alabama, Birmin- term proactive management trial. Patients who achieved gham, AL, USA treatment success (physician’s global assessment (PGA) 8) St. John's Institute of Dermatology, Guy’s and St. Thomas’ Hos- score ‘clear’/‘almost clear’ with ≥2 grade improvement from pitals, London, UK 9) Department of Dermatology, Erasmus University Medical Cen- baseline) were randomised 1:1 in a double-blind fashion to ter, Rotterdam, the Netherlands Cal/BD or vehicle 2x/week for 52 weeks. Patients who did not achieve treatment success were withdrawn from the Background: Atopic dermatitis (AD) is a chronic, heteroge- study. Eligible patients: adult; truncal and/or limb psoriasis neous, inflammatory skin disease characterized by itch at least ‘mild’ by PGA; covering 2–30% of body surface area and eczematous lesions. Interleukin (IL)-13 is a key type-2 (BSA); with a modified psoriasis area and severity index cytokine involved in AD inflammation. Tralokinumab is a (mPASI) of ≥2. Endpoints included: change from baseline in fully human monoclonal antibody that specifically neutra- PGA, mPASI and BSA, and number of adverse events (AEs). lizes IL-13. We report the efficacy and safety of tralokinumab Results: 650 patients entered the open-label phase; 521 + topical corticosteroid (TCS) in moderate-to-severe AD. (80.2%) achieved treatment success at Week (W) 4. More Type of study: Phase 3 than 90% of patients achieving success had PGA score Methods: This was a double-blind, randomized 32-week moderate or severe at baseline (moderate, n=444 [85.2%]; (wk) study (NCT03363854). Patients with moderate-to-se- severe, n=34 [6.5%]). PGA at W4 was ‘clear’ (n=110, 21.1%) vere AD were randomized 2:1 to subcutaneous tralokinu- and ‘almost clear’ (n=411, 78.9%) in those achieving suc- mab 300 mg every 2wks (Q2W)+TCS or control (placebo cess. Mean mPASI (± standard deviation [SD]) and mean Q2W+TCS). Primary endpoints were Investigator’s Global BSA (± SD) at baseline was 7.8 (3.8) and 8.2% (6.2%), respec- Assessment (IGA)-0/1 and Eczema Area and Severity Index tively, in patients achieving treatment success. Change in (EASI)-75. At wk16, tralokinumab responders (IGA-0/1 and/ mean (± SD) mPASI and BSA from baseline to W4 was -0.8% or EASI-75) were re-randomized 1:1 to tralokinumab Q2W (0.2%) and -0.6% (0.4%), respectively, in successful patients. or Q4W+TCS for an additional 16wks. Control responders Of the 650 patients assigned to treatment, 115 (17.7%) continued control, all non-responders received tralokinu- experienced 157 AEs; 5 (0.8%) patients experienced AEs mab Q2W+TCS. possibly or probably related to the study drug; 2 (0.3%) pa- Results: At baseline, 46.3% of 380 randomized patients tients withdrew during the open-label phase due to an AE. had severe AD (IGA-4); mean EASI was 29.4. At wk16, si- Conclusion: Cal/BD aerosol foam was highly efficacious gnificantly more tralokinumab-treated patients achieved and well tolerated; approximately 80% of patients achie- IGA-0/1 (38.9%) and EASI-75 (56.0%) than control patients ved treatment success by PGA following a 4-week, 1x/day, (26.2% and 35.7%; p=0.015 and p<0.001). Rescue treat- open-label treatment regimen. More than 90% of patients ment was reported by 2.8% of tralokinumab and 10.2% of had moderate-to-severe psoriasis at baseline by PGA, control patients. As assessed by IGA-0/1 and EASI-75, 89.6% showing that Cal/BD aerosol foam was effective in this pa- and 92.5% of wk16 tralokinumab responders maintained tient population response at wk32 with tralokinumab Q2W+TCS, 77.6% and 90.8% with tralokinumab Q4W+TCS. Among wk16 tralokinumab nonresponders, 30.5% and 55.8% achieved IGA-0/1 P27 and EASI-75 at wk32. The overall adverse event rate was Safety of long-term proactive management with fixed- similar across treatment groups and did not increase with dose combination calcipotriol 0.005% and betame- prolonged treatment. thasone dipropionate 0.064% foam in patients with Conclusion: Tralokinumab 300 mg Q2W+TCS was effica- psoriasis vulgaris: results of a phase III, multicenter, ran- cious in treating moderate-to-severe AD, with a favorable domized, 52-week, vehicle-controlled trial safety profile. Lebwoh M5, Jalili A7, Lacour JP6, Liljedahl M2, Lynde C1, Holst Mørch M2, Snel-Prentø AM2, Thaçi D4, Warren RB3 P26 1) Lynde Dermatology, Probity Medical Research, Markham, ON, Results from the open-label treatment period of a long- Canada and Department of Medicine, University of Toronto, Toron- to, ON, Canada term proactive management phase III trial using fixed- 2) LEO Pharma A/S Ballerup, Denmark dose combination calcipotriol 0.005% and betametha- 3) Dermatology Centre, Salford Royal NHS Foundation Trust, sone dipropionate 0.064% foam Manchester NIHR Biomedical Research Centre, University of Manchester, Manchester, M6 8HD, UK Lebwohl M5, Jalili A7, Lacour JP6, Liljedahl M2, Lynde C1, Holst 4) Comprehensive Center for Inflammation Medicine, University of Mørch M2, Snel-Prentø AM2, Thaçi D4, Warren RB3 Luebeck, Luebeck, Germany 1) Lynde Dermatology, Probity Medical Research, Markham, ON, 5) Department of Dermatology, Icahn School of Medicine at Canada and Department of Medicine, University of Toronto, Toron- Mount Sinai, New York, NY, USA to, ON, Canada 6) Service de Dermatologie, University Hospital of Nice, Nice, 2) LEO Pharma A/S Ballerup, Denmark France 3) Dermatology Centre, Salford Royal NHS Foundation Trust, 7) Dermatology & Skin Care, Bürgenstock Medical Center, Obbür- Manchester NIHR Biomedical Research Centre, University of gen, Switzerland Manchester, Manchester, M6 8HD, UK 4) Comprehensive Center for Inflammation Medicine, University of Introduction: Phase III study assessing safety and tolera- Luebeck, Luebeck, Germany bility, effects on calcium (Ca) homeostasis, and effects on 5) Department of Dermatology, Icahn School of Medicine at hypothalamic-pituitary-adrenal (HPA) axis of long-term Mount Sinai, New York, NY, USA proactive management with 2x/week fixed combination 6) Service de Dermatologie, University Hospital of Nice, Nice, calcipotriol 0.005% (Cal) and betamethasone dipropionate France 7) Dermatology & Skin Care, Bürgenstock Medical Center, Obbü- 0.064% (BD) aerosol foam vs. vehicle control in adults with rgen psoriasis vulgaris (NCT02899962). Method: Patients achieving treatment success (physician’s Introduction: To assess the efficacy of once-daily, fixed- global assessment [PGA] score ‘clear’/‘almost clear’ with ≥2 dose combination calcipotriol 0.005% (Cal) and betame- pt improvement from baseline (BL)) following 1x/day Cal/ thasone dipropionate 0.064% (BD) aerosol foam in adults BD for 4 weeks, were randomised 1:1 to 2x/week Cal/BD with psoriasis vulgaris, after 4 weeks of open-label treat- or vehicle for 52 weeks. Eligibility criteria: ≥18 years; trun- ment within a Phase III long-term proactive management cal and/or limb psoriasis at least ‘mild’ by PGA; involving trial, with respect to baseline demographics and disease 2–30% body surface area (BSA); modified psoriasis area characteristics of patients achieving treatment success and severity index score (mPASI) ≥2. Criteria for HPA axis (NCT02899962). subgroup: truncal and/or limb psoriasis at least ‘moderate’ POSTERS

Dermatologica Helvetica - Volume 32(6) - Août 2020 39 by PGA; BSA: 10–30%; normal HPA axis function. Safety en- characteristics at randomisation were similar between dpoints: adverse events (AEs); rebounds (mPASI ≥12 and groups; 82% of randomised patients had PGA score ‘mode- increase from BL in mPASI ≥125% or development of more rate’ at baseline. Median time to first relapse was 56 days inflammatory disease); effect on Ca homeostasis and HPA vs 30 days, Cal/BD and vehicle, respectively. Risk of first re- axis. lapse was 43% lower with Cal/BD vs vehicle (HR, 0.57; 95% Results: 545 patients were randomised to Cal/BD (n=272) CI, 0.47–0.69; p <0.0001). Rate of relapse over one year was or vehicle (n=273). Characteristics at randomisation were 46% lower (95% CI, 37–54%; P<0.001), Cal/BD group ver- similar between groups. Rate of (AEs) per 100 patient-years sus vehicle. Predicted mean number of relapses over one (pt-y) was 165.1 and 156.1, Cal/BD and vehicle groups, year was 4.0 vs 7.5, Cal/BD and vehicle, respectively. Cal/ respectively. Rate of serious AEs per 100 pt-y was low and BD group had 11% more days in remission than vehicle comparable (8.2 Cal/BD; 7.8 vehicle), as was rate of treat- (p<0.0001), 41 extra days over one year. Cal/BD was well ment-related AEs (2.7 Cal/BD; 4.5 vehicle). Two AEs (cho- tolerated during the study. rioretinopathy, pain of skin) were adjudicated as related Conclusions: Long-term proactive management over 52 to long-term corticosteroid use. Three patients (2 Cal/BD weeks with fixed combination Cal/BD aerosol foam was su- [0.7%]; 1 vehicle [0.4%]) experienced AEs leading to dis- perior in prolonging time to first relapse, reducing number continuation. Rebound within 2 months of entering the of relapses and increasing days in remission versus vehicle proactive-management phase occurred in 6 Cal/BD and in adults with psoriasis vulgaris. This is the first study of its 7 vehicle patients. Rebound was 4x as likely with vehicle kind to demonstrate long-term proactive management of (n=17) vs. Cal/BD (n=4) following relapse. No clinically re- psoriasis vulgaris with a twice-weekly topical regimen. levant effect on Ca metabolism or HPA axis by subgroup Additional information: This study was funded by LEO analysis was observed. Pharma. Conclusion: The rate of AEs was low and similar across treatment groups; most were mild. Incidence of rebound was higher in the vehicle group vs. Cal/BD with no clinically P29 relevant effects on Ca metabolism or HPA axis. Long-term Multistate modelling of time to response in patients with proactive management over 52 weeks with fixed-dose moderate to severe psoriasis treated with brodalumab or combination Cal/BD foam was well tolerated versus vehicle ustekinumab in the AMAGINE-2 and -3 studies in adults with psoriasis vulgaris. Additional information: This study was funded by LEO Filipe P2, Conrad C4, Andersen JS3, Joly P1 Pharma. 1) Clinique dermatologique, CHU de Rouen, Rouen, France 2) Department of Dermatology, Hospital de Santa Maria, Lisbon, Portugal P28 3) LEO Pharma A/S, Ballerup, Denmark 4) Service de Dermatologie, CHUV, Lausanne Long-term proactive management of psoriasis vulgaris with fixed-dose combination of calcipotriol 0.005% and Introduction: The objectives of this post hoc analysis were to betamethasone dipropionate 0.064% foam: results of a develop and use a methodology to assess sustained psoria- Phase III randomised controlled trial sis area and severity score (PASI) response where variability in the assessment is expected over time. Criteria for sustained Lebwohl M5, Jalili A7, Lacour JP6, Liljedahl M3, Lynde C2, Holst response (response state) were proposed and evaluated by Mørch M3, Snel-Prentø AM3, Thaçi D4, Warren RB1 1) Dermatology Centre, Salford Royal NHS Foundation Trust, estimating the probability to: 1) enter the response state, 2) Manchester NIHR Biomedical Research Centre, University of be in response state over time; and 3) average time spent in Manchester, Manchester, M6 8HD, UK response, for patients treated with brodalumab (Bro) or us- 2) Lynde Dermatology, Probity Medical Research, Markham, ON, tekinumab (Ust). Canada and Department of Medicine, University of Toronto, Toron- Materials and methods: This post hoc pooled analysis of to, ON, Canada the AMAGINE-2 and -3 studies included patients who had 3) LEO Pharma A/S Ballerup, Denmark received Bro of 210 mg every 2 weeks or Ust 45–90 mg 4) Comprehensive Center for Inflammation Medicine, University of (weight-dependent) on Day 1 and Weeks (W) 4, 16, 28 and Luebeck, Luebeck, Germany 40, throughout the 52-week treatment period. Patients swit- 5) Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, NY, USA ching from Ust to Bro following inadequate response to 6) Service de Dermatologie, University Hospital of Nice, Nice, treatment per protocol at W16 were censored. Patients with France inadequate response at other timepoints were included in the 7) Dermatology & Skin Care, Bürgenstock Medical Center, Obbü- analysis. The probability to be in response over time was es- rgen timated assuming that patients were in one of two states: 1) response state (absolute PASI 0 required to enter or re-enter); Introduction: A phase III multicentre, randomised, and 2) non-response (leave response state: PASI >2). PASI >2 vehicle‑controlled study to assess the efficacy of long-term was required to leave the response state since fluctuations in proactive management with 2x/week fixed combination response are observed over time in psoriasis, and variability in calcipotriol 0.064% (Cal) and betamethasone dipropionate the disease-assessment was expected. Also, PASI <2 is a treat- 0.005% (BD) aerosol foam versus vehicle, in patients with ment goal in current guidelines. A multistate model was used psoriasis vulgaris. Safety data are reported separately. to estimate transition probabilities between states. Methods: Patients received 1x/day Cal/BD during the Results: In an analysis of pooled data (Bro n =339, Ust n =590), 4-week open-label phase (NCT02899962). Patients achie- the probability to enter the response state was significantly ving success (physician’s global assessment [PGA] score greater with Bro vs Ust (HR =1.96; 95% CI: 1.66, 2.31, p <0.001). "clear"/"almost clear" with ≥2-grade improvement from The probability to be in response through 52 weeks was hi- baseline) were randomised 1:1 in a double-blind fashion to gher with Bro vs Ust (81% [95% CI: 74%, 89%] vs 60% [95% 2x/week Cal/BD or vehicle for 52 weeks. Eligibility criteria: CI: 54%, 67%]). The estimated difference in probability to be ≥18 years; truncal and/or limb psoriasis, involving 2–30% of in response at W52 was 21% (95% CI: 11%, 30%) in favour of body surface area; PGA ≥‘mild’ and modified psoriasis area Bro. The estimated mean time spent in response state through and severity index score ≥2 at Visit 1. Primary endpoint: 52 weeks was longer with Bro (215 d; 95% CI: 197, 233) vs Ust time to first relapse (PGA ≥‘mild’). Secondary endpoints: (145 d; 95% CI: 130, 160). The estimated difference in length of number of relapses; proportion of days in remission (PGA stay in response between groups was 70 d (95% CI: 46, 94; p "clear"/"almost clear"). <0.001) in favour of Bro. 545 patients were randomised to Cal/BD or vehicle (safety Conclusion: Treatment with Bro was associated with signifi- set); 521 achieved treatment success in the open-label cantly higher probabilities to achieve complete response and phase, (Cal/BD n=256; vehicle n=265 [full analysis set]); 251 to be in response, and a significantly longer time spent in the (46.1%) randomised patients completed the study. Disease response state vs Ust. POSTERS

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Bitte ausgefüllt mit Unterschrift zurückschicken /à renvoyer SVP signé: Fax 043 343 75 70 /E-Mail [email protected] * Ich berechtige LEO Pharma, mir Informationsmaterial zum Thema Dermatologie, Einladungen zu Dermatologie-Fortbildungen und Informationen über Produkte und Dienstleistungen von LEO Pharma an diese E-Mail-Adresse zuzustellen. Eine Entfernung aus diesem E-Mail-Verteiler ist jederzeit mit sofortiger Wirkung durch ein formloses E-Mail an [email protected] möglich. * J’autorise LEO Pharma à me faire parvenir à cette adresse e-mail du matériel d’information sur le thème dermatologie, des invitations à des formations en dermatologie, des informations sur les produits et services de LEO Pharma. Il est possible à tout moment et avec un effet immédiat, d’éliminer cette adresse e-mail de la liste de distribution par une simple demande informelle adressée à [email protected]. Ref: 1. Fachinformation / Information professionnelle Enstilar® (Calcipotriol / Betamethason) www.swissmedicinfo.ch 2. Gerdes S. Prospective, Observational, Non-Interventional, Multicentre Study on the Efficacy and Tolerability of a New Calcipotriol/ Betamethasone Aerosol Foam (Enstilar®) in Patients with Plaque Psoriasis under Daily Practice Conditions. Dermatology. 2017;233(6):425-434. 3. Koo J. et al., Superior efficacy of calcipotriene and betamethasone dipropionate aerosol foam versus ointment in patients with psoriasis vulgaris – A randomized phase II study. J Dermatolog Treat, 2016; 27(2): 120–127. 4. Lebwohl M. et al., Fixed combination aerosol foam calcipotriene 0.005 % (Cal) plus betamethasone dipropionate 0.064 % (BD) is more efficacious than Cal or BD aerosol foam alone for psoriasis vulgaris. A randomized, doubleblind, multicenter, three-arm, phase 2 study. J Clin Aesthet Dermatol. 2016;9(2):34–41. Gekürzte Fachinformation ENSTILAR® SCHAUM Zusammensetzung: 1 g Schaum enthält 0.05 mg Calcipotriol und 0.5 mg Betamethason in Form von Betamethasondipropionat. Indikationen: Psoriasis vulgaris bei Erwachsenen. Dosierung: 1x täglich, max. 100 g/Woche bzw. 15 g/ Tag. Empfohlene Behandlungsdauer: Nicht länger als 4 Wochen. Anwendung: Dose vor Gebrauch schütteln, mindestens 3cm entfernt von der Haut sprühen und sanft in die betroffenen Hautregionen einreiben. Kontraindikationen: Überempfindlichkeit gegen Inhaltsstoffe. Anwendung im Gesicht, insbesondere auf augennahen Hautarealen (Kataraktgefahr). Anwendung mit Okklusiv-Verbänden. Psoriasis guttata, erythrodermische, exfoliative und pustulöse Psoriasis. Bekannte Störungen des Calciumstoffwechsels. Infektionen mit Viren, Pilzen, Bakterien und Parasiten, Hautmanifestationen von Tuberkulose oder Syphilis, periorale Dermatitis, atrophische Haut, Dehnungsstreifen, erhöhte Fragilität der Hautvenen, Ichthyose, Akne vulgaris, Akne rosacea, Rosacea, Hautulzera, Wunden, perianaler und genitaler Pruritus. Schwere Niereninsuffizienz und schwere Leberfunktionsstörungen. Keine Anwendung bei Kindern, da noch keine Erfahrungen. Vorsichtsmassnahmen: Druckbehälter mit hochentzündlichem Inhalt. Explosionsgefahr bei Erhitzung. Von Funken/offenen Flammen fernhalten. Übertragen auf Gesicht, Mund oder Augen vermeiden, Hände nach Anwendung waschen. Behandlung von >30% der Körperoberfläche vermeiden. Bei einer Dosis von mehr als 100 g/Woche können Hypercalcämien nicht ausgeschlossen werden. Bei Dosisüberschreitung Kontrolle des Serumcalcium. Während der Therapie mit Enstilar® wird empfohlen, exzessive Bestrahlung mit natürlichem oder künstlichem Sonnenlicht zu begrenzen oder zu meiden. Eine gleichzeitige Behandlung mit anderen Kortikosteroiden sowie eine grossflächige oder okklusive Anwendung sollten vermieden werden (Suppression endogener Cortisolproduktion). Sorgfältige Therapieüberwachung empfohlen, da die Psoriasistherapie mit Kortikosteroiden ein gewisses Risiko eines Reboundeffektes, einer Toleranzentwicklung und einer Auslösung einer generalisierten Psoriasis pustulosa birgt. Unerwünschte Wirkungen: Gelegentlich: Follikulitis, Überempfindlichkeitsreaktionen (Urtikaria, Ödeme, Lippen- und Zungenschwellung oder Atembeschwerden), Hyperkalzämie, Hyperkalziurie, Hypopigmentierung der Haut, Exazerbation der Psoriasis, Rebound-Effekt, Hautschmerzen, Pruritus und Irritationen. Interaktionen: Nicht mit salicylsäurehaltigen Zubereitungen mischen, die Salicylsäure inaktiviert Calcipotriol. Salicylsäure bleibt auf der Hautoberfläche, so dass auch eine zeitlich versetzte Calcipotriol-Anwendung in der Wirkung vermindert sein kann. Packungen: Enstilar®: 1 Sprühdose (60* g) (Liste B); Stand der Information: April 2016. *Kassenzulässig. Ausführliche Informationen entnehmen Sie bitte der aktuellen Fachinformation auf www.swissmedicinfo.ch LEO Pharmaceutical Products Sarath Ltd., Eichwatt 5, 8105 Regensdorf, Tel: 043 343 75 75 LEO® © LEO 02 2019 D/F - ALL LEO TRADEMARKS BELONG TO THE LEO GROUP - MAT-05596

Enstilar Ad A4 bi 2019-02.indd 1 05.02.19 16:38 P30 dapsone gel, systemic rifampicin combined with clindamy- Management of moderate-to-severe psoriasis with bro- cin, lymecyclin, dapsone, isotretinoin, also photodynamic dalumab in daily practice conditions – first real-wor- light therapy, and last adalimumab, intermittently together ld-evidence (RWE) results from the LIBERO trial with systemic corticosteroids, were ineffective. Apremilast was subsequently initiated as for treatment of psoriasis. A von Kiedrowski R⁵, Hinz T⁷, Mauer G⁶, Schwinn A2, Timmel A1, rapid and continuous improvement of the inflammatory Hutt HJ⁴, Augustin M3 lesions and of the pain was reported within the first few 1) Skin Center Rügen, Bergen, Germany days. Clinical control after three weeks confirmed a nearly 2) Dermatological Practice, Memmingen, Germany complete remission. 3) German Center for Health Services Research in Dermatology As interruption of treatment and resuming therapy re- (CVderm), Institute for Health Services Research in Dermatology sulted in recurrence, respectively remission again, it is likely and Nursing (IVDP), University Medical Center Hamburg-Eppen- dorf (UKE), Germany that apremilast suppressed the inflammatory reaction in 4) LEO Pharma GmbH, Neu-Isenburg, Germany FD. The pathogenesis of this disease is not fully understood. 5) Medical Study & Service Selters GmbH, Selters/ Ww, Germany Staphylococcus is thought to have a direct or indirect pa- 6) Dermatological Practice, Bad Kreuznach, Germany thogenic role in the etiology and may be responsible for 7) Center for Skin Health, Neuwied, Germany the dominant neutrophilic inflammatory infiltrate. A defec- tive immune system also increases the risk of FD, with se- Introduction: Since September 2017 brodalumab 210 mg veral familial cases reported. Mechanical factors and struc- is available for the treatment of moderate-to-severe psoria- tural abnormalities, such as the plicate scalp in this patient, sis in Europe. While in the AMAGINE-program blocking the may play an additional role. IL-17 receptor subunit A has shown a fast onset of action, Apremilast, as a specific PDE4 inhibitor, suppresses innate high complete clearance rates as well as sustained effica- and adaptive immune cells, including neutrophils and T cy up to 5 years, there is only limited real world evidence cells. Reduced generation of spontaneous reactive oxygen (RWE) data available. species and of neutrophilic extracellular traps was obser- Material and Methods: Prospective, multi-center, non-in- ved in rheumatoid arthritis patients treated with apremi- terventional RWE study, assessing the management of mo- last. Since neutrophils are the predominant inflammatory derate-to-severe psoriasis with brodalumab in daily prac- cell in FD, the inhibitory effect of apremilast on neutrophil tice after 12 and 52 weeks (W). Interim-Data on W12 with activity could explain the rapid beneficial effect seen in this special focus on the new therapeutic goal of an absolute case. This introduces new therapeutic options for FD and PASI ≤ 3 is presented. warrants further investigation. Results: Between 11-2017 and 01-2020 516 patients (64.9% male, mean age 50 ± 14 years, weight 90 ± 22 kg, disease P32 duration: 20 ± 15 years) from 216 sites in Germany were Selective inhibition of hdac6 sensitizes cutaneous t-cell enrolled. 57.2% of the patients were biological-naïve. 221 lymphoma to pi3k inhibitors patients had been previously treated with one (64.3%), two (20.8%) or with three or more (14.9%) biologicals, mainly Bobrowicz M1,2, Slusarczyk A1, Domagala J1,3, Dwojak M1,3, with adalimumab (45.3%), secukinumab (44.3%) or usteki- Ignatova D2, Chang Y2, Iselin C2, Miazek-Zapala N1, Marhelava numab (24.3%). At the cut-off date for this analysis (22 JAN K3,4, Fassnacht C2, Guenova E2,5*, Winiarska M3* 2020) PASI values for 502 patients were available at base- * Contributed equally line and for 460 patients at W12. At baseline 27.9% of pa- 1) Department of Immunology, Medical University of Warsaw, Po- tients were classified as mild (PASI < 10), 40.8% as moderate land (PASI 10 - 19) and 31.3% as severe Psoriasis (PASI ≥ 20). Ove- 2) Department of Dermatology, University Hospital Zürich, Univer- rall, the mean PASI was reduced from 16.9 to 9.1 at W2 and sity of Zurich 3) Postgraduate School of Molecular Medicine, Medical University further improved to 2.9 at W12. 77.2% of the patients met of Warsaw, Poland the primary endpoint of an absolute PASI ≤ 3 at W12 (as 4) Department of Clinical Immunology, Transplantation Institute, observed analysis). Results on the total group and relevant Medical University of Warsaw, Poland subgroups were evaluated. 5) Department of Dermatology, CHUV and University of Lausanne Discussion: To date the LIBERO trial represents the largest, prospective, multi-center, non-interventional RWE study Histone deacetylases (HDACs) are key epigenetic modula- assessing the management of moderate-to- (very) severe tors influencing essential cellular processes such as apopto- psoriasis with brodalumab in daily practice conditions. It sis and DNA repair. HDAC inhibitors (HDACis) have recently confirms the fast onset and the high clearance rates of bro- emerged in anti-cancer therapy, also in the treatment of dalumab in daily practice as well as in relevant subgroups. cutaneous T-cell lymphomas (CTCLs). Unfortunately, the Additional information: Encore abstract: This data has been therapeutic efficiency is low and the use of non-specific accepted as poster at FOBI 2020 (FOBI DIGITAL). (pan-) HDACis results in a questionable safety profile with considerable side effects. One strategy to improve the use in cancer treatment is the use of specific HDACis targeting P31 only a single HDAC isoform. In CTCL, HDAC6 is a promising Successful treatment of refractory folliculitis decalvans target, as it has been shown to be overexpressed in primary with apremilast samples from CTCL patients. Another strategy to increase HDACi treatment efficiency is in combination therapies to Fässler M, Radonjic-Hoesli S, Feldmeyer L, Imstepf V, Pelloni L, achieve synergistic effects. A preclinical study using CTCL Yawalkar N, de Viragh PA cell lines showed a combined effect of the pan-HDACi vori- Department of Dermatology, University Hospital of Bern, Inselspi- nostat with inhibition of the phosphatidylinositol 3-kinase tal, Bern (PI3K). However, it remains unclear which HDAC isoform is responsible for this effect. As HDAC6 targets a downstream Folliculitis decalvans (FD) is a rare neutrophilic inflamma- kinase in the PI3k pathway, this isoform is a promising tion of the scalp, characterized by painful follicular papules, candidate. In this study, we explore the synergistic effects pustules, crusting and tufting of hairs. It results in the des- of HDAC6 and PI3K inhibition in CTCL. We find that simul- truction of hair follicles and finally in cicatricial alopecia. taneous inhibition results in decreased cell viability and Unclear etiology makes treatment of refractory FD challen- proliferation in CTCL cell lines and primary patient material. ging. Our results suggest that a combination therapy of HDAC6 We report the case of a 28-year-old male with a 5-year his- and PI3K inhibition can be a suitable treatment for CTCL tory of painful FD. He showed large oval patches of hair patients. Such treatment holds the potential for a more ef- loss with erythema, follicular pustules, crusting and hair ficient therapy with potentially less side effects. tufts distributed along the scalp with a cutis verticis gyra- ta. Treatments with topical corticosteroids, antibiotics and POSTERS

42 Dermatologica Helvetica - Volume 32(6) - Août 2020 P33 gually. None reported a previous trauma. It remains unclear Measles mimicking Stevens-Johnson syndrome whether this specific case is the result of previous trauma or two separate incidents that coincided in time. Fosse N, Zehnder M, Blickenstorfer M University Hospital Basel, Department of Dermatology P35 We report the case of a patient referred to the emergency Global publication productivity in dermatology: a biblio- room of the University Hospital Basel due to progressive metric description of the past and estimation of the fu- sore throat and generalized exanthema with suspected ture Stevens-Johnson syndrome. The patient was a 31-year Gantenbein L, Navarini A, Brandt O, Mueller SM old homeless male. Twelve days prior to presentation, Departement of Dermatology, University Hospital, Basel he was diagnosed with tonsillitis at a peripheral hospital and treated with cefuroxime and ibuprofen. One day la- Background: In the past two centuries generations of der- ter the patient developed a generalized pruritic exanthe- matologists around the world have created an immense ma with very painful oral ulcerations. He was treated with number of publications. To our knowledge, no bibliometric two consecutive courses of high-dose oral steroids for analysis of these publications has been performed so far, a suspected severe adverse drug reaction. Due to lack of nor have registered trials been systematically analysed to clinical improvement, the patient was referred to the Uni- anticipate future publication trends. versity Hospital Basel. The clinical examination revealed Methods: For each of 195 countries the number of publica- multiple ulcerations of the oral and nasal mucosa. Multiple tions for "dermatology" was determined on Scopus (more confluent brown-red papules and plaques without blisters search hits than on PubMed), normalized per 1 Mio inha- were present on the trunk, extremities and palmoplantar bitants and bibliometrically analysed. Dermatology-related region. Further exploration and laboratory tests for EBV, trials registered at clinicaltrials.gov were retrieved for the Coxsackie virus, syphilis, HIV, Hepatitis B and C and au- top-30 countries and specified for the top-10 countries by toimmune bullous diseases were negative. In addition, the the top-10 diagnoses. rapid strep test was negative. The initial presentation with Results: Scopus yielded 1`071`518 search hits for "derma- mucosal ulcerations and exanthema led to the differential tology" between 1832-2019. 72.4% of publications were diagnosis of a severe cutaneous adverse drug reaction articles, 12.2% reviews, 5.9% letters and 11.3 % others. such as a Stevens-Johnson syndrome. Since the SCORTEN The most productive affiliation was the Harvard Medical revealed 0 points and no epidermolysis was found, School, the leading funding source the National Institutes Stevens-Johnson syndrome was considered unlikely. Due of Health. Amongst the analysed 195 countries, 30 had to the hemorrhagic confluent exanthema with upper res- published >5000 publications. The top-3 countries with piratory symptoms and an unclear vaccination status of the highest absolute number of publications were the USA patient, measles serology was performed, which revealed (30.6% of all), Germany (8.1%) and the UK (8.1%), whereas positive anti-IgM antibodies for measles. Thus, we were Switzerland, Denmark and Sweden had the highest norma- able to diagnose an adult measles infection with tonsillitis. lized publication rates. Currently, the most trials are registe- In addition, we found HSV1 (PCR) in an oral swab test as red in the USA (8111), Canada (1368) and France (1543). The a superinfection causing herpetic gingivostomatitis. This top-3 percentages of trials per diagnosis were: Melanoma explains the heavy mucosal involvement, in the sense of in the Netherlands (24.8% of all dermatology-related trials Aphthoid Pospischill-Feyrter, which has been described in this country), psoriasis in Germany (21.7%) and atopic after measles infection, varicella zoster or scarlet fever. This dermatitis in Japan (15.9%). case shows how important it is to include diseases such as Discussion and conclusion: There are marked geographic measles in the differential diagnosis, which have become differences in global dermatology-related publication pro- rare due to widespread vaccination. Especially in patients ductivity. The existing top-10 publication output originates of low socio-economic status, basic vaccinations are more from the USA, Canada, a few European and Asian coun- likely to be incomplete. tries- accounting for >3/4 of all publications. When normalized by inhabitants (normalization by dermatologists impossible due to lacking data) smaller countries such as P34 Switzerland had the highest publication productivity. The Subungual Lipoma USA are undoubtedly in a leader position with the highest absolute numbers of publications, most productive insti- Gabutti M, Haneke E tutional affiliations, funding sources and registered clinical Department of Dermatology, Inselspital, University of Bern trials, the latter indicating that this country is likely to maintain its position in the near future. While some countries Introduction: Subungual soft tissue tumors are rarely such as Germany, the Netherlands and Japan continue to characteristic enough as to allow a clinical diagnosis to focus their research on the top-10 topics, China and India be made with certainty. Insidious nail deformation is a appear to prioritize their scope towards others. frequent sign whereas pain is rare although the leading symptom in glomus tumors. We hereby present a case of subungual lipoma, diagnosed histologically after surgery. P36 Case: A 46-year-old otherwise healthy male patient pre- National publication productivity in dermatology: an ex- sented with an uncommon clinical sign of pincer nail for- ploratory analysis of contributing factors mation of the left thumb, which had developed over the course of 2 years after a pinching trauma. Heart and/or Gantenbein L, Navarini A, Brandt O, Mueller SM lung diseases were denied. Clinically, we observed an over- Departement of Dermatology, University Hospital, Basel curvature of the nail plate and an absent lunula, in addition to idiopathic nail clubbing of all finger and toenails. Background: Publication productivity is essential for the The slightly violaceous hue of the proximal part of the nail progress of dermatology and may on a national level be an evoked the clinical suspect of a subungual myxoid pseudo- indicator for the scientific impact of countries in this field. cyst. Conventional radiography showed osseous changes However, to our knowledge, the factors driving dermatolo- after a processus unguicularis fracture with signs of bone gy-related publication productivity are unknown. resorption and apposition. Study goals: To explore whether the level of expertise, Treatment: Nail avulsion, tumor excision and nail matrix healthcare-related and health-economic factors correlate reconstruction. During surgery, it became evident that the with the national publication productivity. lesion was a solid soft tissue tumor in submatrical localiza- Methods: The 30 countries with the highest absolute nu- tion. Healing was unevently and resulted in a normal nail mbers of publications for "dermatology" listed on Scopus again. (more search hits than on PubMed) were determined, Histology: Adipose tissue without atypia with a relatively normalized by 1 Mio inhabitants (source: United Nations) high proportion of fibrous tissue. and correlated (Spearman`s rho) with relevant information Conclusion: Lipomas of the nail unit have been previously provided by the Organisation for Economic Co-operation reported in eleven patients, either periungually or subun- and Development (OECD). Furthermore, the normalized POSTERS

Dermatologica Helvetica - Volume 32(6) - Août 2020 43 publication productivity was correlated with the Health Introduction: Artificial intelligence is a growing field in Access and Quality (HAQ)-Index, the dermatology-related medicine and several papers showcase possible break- Hirsch (H)-factor and citations retrieved from SCImago throughs, especially for image-related tasks. However, Country Ranking. most of these findings are never translated to the clinic, Results: The Scopus search yielded 1`071`518 hits for "der- usually because the AI is failing to deliver the same results matology". The top-3 countries with the highest absolute in a real-world environment. This is because high quality number of publications were the USA, Germany and the pictures are typically used for training AI models that are UK, the highest normalized publication rate had Switzer- subsequently used to analyze pictures of lower and/or land, Denmark and Sweden. The normalized publication different quality levels. rates of the top-30 countries correlated strongly with Material and methods: To equalize datasets and make sure the physicians per 1000 inhabitants (rho=0.812), health that trained AI are ready to be used on real pictures, we spending per capita (rho=0.791), HAQ-Index (rho=0.784), propose to use a method call Cycle GAN to mitigate the research & development investment (rho=0.735), gross discrepancy of results between two given datasets. We domestic product per capita (rho=0.720) and moderately choose an extreme case, namely training an AI to recognize with the dermatology-related H-factor (rho=0.632) and ci- skin tumors using real dermoscopy images. Subsequently, tations (rho= 0.449). we used this AI on real clinical images of tumors and confir- Discussion: Our analysis revealed that 6/top-7 countries med low success rates. However, when the Cycle GAN me- with the highest absolute publication productivity belong thod was then used on these clinical images, the success to the "G7-nations" ("The Group of Seven") which represent rate was approaching the real dermoscopy images again. the largest advanced economies. This suggests a connec- Discussion: This proof of concept demonstrated that the tion between the publication productivity and econo- use of Cycle GAN can equalize differences between two mic factors, which is supported by the strong correlation distinct datasets. Cycle GAN drastically improved the result between the normalized publication rate and the assessed of the trained AI over the second dataset and could help to health-economic factors. Similarly, the surrogate markers solve the issue of the application of AI models to new data. for the quality of the healthcare system and the level of ex- Project funded by Fondation Botnar. pertise correlated clearly with the publication productivity. Conclusion: Our data suggest that publication productivity in dermatology depends on healthcare system-related-, P39 health-economical factors and publication expertise. Souvenir from the tropics However, correlations do not imply causation, necessitating further studies to draw conclusions. Grizzetti L, Di Lucca J, Gaide O Department of Dermatology, University Hospital CHUV, Lausanne

P37 Case Report: A 28-year-old man consulted our policlinic for A closure option for combination defects of the nasal ulcerative lesions of both inferior limbs. These ulcers were sidewall and paranasal cheek: a case report the result of ruptured pustular lesions acquired during the last days of a 3-week journey to Australia and Samoa. He George K, Zahn C, Kuonen F reported having had multiples mosquito bites on his entire Department of Dermatology and Venereology, Hôpital de Beau- body and a leech bite on the left limb (the leech could be mont, Lausanne University Hospital Center, Lausanne promptly removed) during this trip. He did not complain of fever or any other symptoms before or after the ulcer Background: Surgical removal of cutaneous tumors of the development. Vaccinations were up to date including nasal sidewall and paranasal cheek can lead to major de- a booster dose of diphtheria, tetanus and poliomyelitis fects. Repair challenges in this area consist in preserving vaccination 1.5 years before. Dermatological examination the various subunits texture and thickness, the nasojugal showed ulcerative and crusted lesions with surrounding concavity as well as the lower eyelid outline and functio- erythema on both ankles and feet, with predominant le- nality. sions on the left limb. A pustule was present on the medial Case report: We report a case of a 79-year-old male who aspect of the left ankle and an erythematous plaque with presented for surgical removal of a middle-differentiated central crust was observed on the anterior aspect of the squamous cell carcinoma of the right cheek. Analysis of distal left thigh. An infectious origin was suspected and our the primary defect revealed the cutaneous involvement differential diagnosis included echtyma, leishmaniosis, di- of two distinct aesthetic subunits: the medial and superior phtheria, atypical mycobacterial infection or deep mycosis. part of the right cheek as well as the right nasal sidewall. In We performed a microbiological swab and introduced an this particular case we chose to combine an inferior cheek empirical antibiotic therapy with oral amoxicillin/clavula- advancement flap with a glabellar advancement-rotation nic acid. The bacteriological culture showed the growth of flap. This combined intra-subunit reconstruction allows the Corynebacterium diphtheria and Streptococcus pyogenes; maintenance of the nasojugal fold. The upper glabellar flap diphtheria toxin was not detected. Clinical evolution after 4 relieves the closure-induced tension exerted on the infe- days was already favorable; we repeated an ulcer swab and rior eyelid by the inferior cheek flap and minimizes the risk performed a throat swab, which both resulted negative as of postoperative eyelid ectropion. At 3-month follow-up, for bacterial culture and diphtheria toxin. Until the results both the cheek advancement and glabellar advancement of these swabs, the patient was on respiratory and contact rotation flaps presented excellent viability. Importantly isolation. A 14-day course of Co-Amoxicilline allowed com- the skin texture, the nasojugal fold and the inferior eyelid plete healing of all cutaneous lesions. contour were preserved. Discussion: Cutaneous diphtheria (CD) is endemic in seve- Conclusion: In summary, the authors present a novel tech- ral tropical areas, where 3–5% of the population is reported nique consisting of a combination of an inferior cheek ad- to be nasal carriers of the organism. Ulcers in returning vancement flap and a glabellar advancement-rotation flap travelers should raise suspicion, among other infectious for the reconstruction of a combined paranasal cheek and diseases, for CD, and warrant microbiological analyses on nasal sidewall defect allowing maintenance of the facial swab and/or biopsy of lesions, with search of specific toxin aesthetic units without functional repercussion. in case of CD confirmation. Since vaccination targets the toxin - and not the bacteria - even immunized patients may develop CD infections, as demonstrated here; however, P38 the risk of severe systemic disease is extremely low in this Cycle GAN as a new method to overcome AI-impairing situation. Cutaneous lesions may be co-infected by other differences between datasets bacteria, clinically resembling impetigo. Follow-up cultures should be performed to document clearance before stop- Gottfrois P1,2, Amruthalingam L1,2, Navarini AA1,2 ping isolation. 1) Department of Dermatology, University Hospital of Basel 2) Dept. of Biomedical Engineering, University of Basel

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44 Dermatologica Helvetica - Volume 32(6) - Août 2020 P40 pies did not show any improvement. Chinese colleagues Basophil activation test to assess autoreactivity in pa- proposed a hospitalization. The patient did not feel reas- tients with chronic spontaneous urticaria sured and returned to Ticino to have our opinion. At the physical examination in our department, she pre- Guillet C1, Sabaté-Brescó M2, Beck N3, Schneider M3, Rosset N1, sented little desquamation on erythematous ground on Schmid-Grendelmeier P1 the tip of her nose with few pustules. We repeated a mi- 1) Allergy Unit, Department of Dermatology, University Hospital crobiological culture, which showed low presence of Sta- Zurich, Zürich phylococcus epidermidis and Bacillus cereus. PCR for HSV 2) Allergy Department, Clínica Universidad de Navarra, Pamplo- I/II resulted negative. Mycological culture revealed finally na (Spain). Spanish Allergy Research Network ARADyAL, Madrid, the presence of Trichophyton (T.) erinacei. We started a sys- Spain temic therapy with Terbinafine for two months. As topical 3) BÜHLMANN Laboratories AG, Schönenbuch therapy, we proposed Clotrimazolum cream. At the end of this period, we obtained a complete resolution of the my- Background: A proportion of chronic spontaneous urtica- cosis. ria (CSU) cases are of autoimmune origin. In vitro basophil Discussion: Skin infections caused by T. erinacei are beco- reactivity assays (basophil activation test (BAT) or basophil ming more common because hedgehogs as exotic pets histamine release assay (BHRA)) are considered as evidence are becoming more popular. Most reported cases cause of serum factors causing histamine release and/or basophil infections of the extremities, especially those exposed to activation and thus, a leading evidence of probable au- direct contact with the animal. In our case, the sting of the toreactive urticaria. In addition, they may help as a tool to hedgehog caused a micro-trauma of the skin and conse- detect autoreactive IgE or FcRI antibodies. Therefore, we in- quently a local infection of the nose. Local therapies are of- vestigated the diagnostic use of BAT in a series of patients ten not sufficient to treat this zoophilic infection. Systemic with CSU of unknown type in Zurich (ZH) and Pamplona Terbinafine or Itraconazole therapies are good options for (P). the treatment of T. erinacei mycoses. Methods/ Materials: We performed retrospective analysis of BAT results obtained from 69 CSU patients from 2 centres (35 patients from ZH and 34 patients from P). Sera P42 from 51 unknown donors was used as negative control. Global Trends in YouTube and Google Search Activity for The BAT protocol was based on Flow CAST® reagents (BÜH- Psoriasis and Atopic Eczema: Detecting Geographic Hot LMANN Laboratories AG) and the use of fresh blood from Spots, Blind Spots and Treatment Strategies three healthy donors. BAT results were expressed as the mean activation of CD63 (%CD63pos) in the three donors Hongler VNS1, Navarini A1, Brandt O1, Goldust M1,2, Mueller (stimulation index, SI). ROC curve analysis revealed an Area SM1 Under the Curve (AUC) of 0.756 and a very good specificity 1) Department of Dermatology, University Hospital Basel, Basel of 96.1% and a sensitivity of 49.1% using a cut-off of 4.9% 2) Department of Dermatology, University of Rome G. Marconi, CD63. The information extracted from the patients’ records Rome, Italy included age, gender, total IgE levels and history of autoimmune disease. Background: In recent years, the Internet and social me- Results: Mean age of patients was 46y [13-76]. Positive dia have become popular sources of information on skin CD63 BAT (Bat+; SI > 4.9%) results were found in 3 of 51 diseases such as psoriasis and atopic eczema. To date, the (5.9%) unknown controls and 34 of 69 (49%) CSU patients geographical distribution and global trends of search ac- (7 Bat+ from ZH and 27 Bat+ from P). Mean total IgE in ZH tivities on psoriasis and atopic eczema on Google and was 548 kU /l (min: 14 kU/l, max 5000 kU/l) and mean total YouTube are widely unknown. The aim of this study was to IgE in Bat+ from ZH was 85kU/l (min: 12 kU/l, max 150 kU/L). identify geographic and temporal trends in YouTube and We found a non-significant negative correlation between Google search activities for psoriasis and atopic eczema. stimulation index value for BAT and total IgE levels (Spear- Methods: We used specific filter settings on Google Trends man’s rank correlation coefficient ρ= -0.136). No other au- to indicate the global search activity for ["Psoriasis"] and toimmune disorders were present in all Bat+ patients. ["Atopic Eczema"] on Google and YouTube between Janua- Conclusion: 49% of patients with CSU tested BAT+, sugges- ry 1st 2008 and August 7th 2019 . The four resulting data ting the presence of autoreactive antibodies. This value is sets were analysed and compared with respect to geogra- higher than previously described but is probably due to phic distribution and temporal trends. partial preselection of patients in P. There was no signifi- Results: The analyses revealed considerable differences in cant correlation between total IgE and BAT % stimulation the global search activity for "Psoriasis"and "Atopic Ecze- index. Five % of healthy samples were BAT+ implying the ma"on YouTube: Apart from a few "blind spots" (e.g. Chad, presence of autoreactive factors without symptoms of CSU. Uzbekistan) the term "Psoriasis" was queried geographi- cally fairly evenly distributed. The opposite was true for "Atopic Eczema", which was predominantly queried from a P41 few "hot spots" (e.g. USA, Commonwealth of Nations and From China with Love: Hedgehog Kiss causes Tinea by Sweden). Since 2008, the search activity on YouTube for Trichophyton erinaceid "Psoriasis" has tripled, while that for "Atopic Eczema" has decreased. On Google, by contrast, search activity has risen Guillod C1, Martinetti G2, Mainetti C1 for both "Psoriasis" and "Atopic Eczema". 1) Department of Dermatology, Bellinzona Regional Hospital, Conclusion: Google Trends can be a useful tool to track Bellinzona people`s/patients' interests and search search behaviour 2) Department of Microbiology, EOLAB, Bellinzona over time, enabling, for instance, regionally tailored information and prevention campaigns. Introduction: Fungal infections caused by Trichophyton erinacei are well known and described in literature. Especially hedgehogs represent reservoirs of this zoophilic fungus. P43 Introduction: Fungal infections caused by Trichophyton eri- Airborne contact dermatitis to artichoke nacei are well known and described in literature. Especially hedgehogs represent reservoirs of this zoophilic fungus. Hsieh A, Piletta P Case report: In October 2019, a 30-year-old southern Swiss Department of Dermatology, University Hospitals, Geneva woman presented to our Dermatology Clinic for evaluation of an inflammation on the tip of her nose since two weeks. Case report: A 46-year-old female patient with a history of Since one year, the patient lived and worked in Shanghai atopy and pressure urticaria present with recurrent pruritic (China) and kept a hedgehog as pet. She referred to kiss it face eruption since 6 years occurring between April and on the tip of its nose now and then. Therefore, sometimes May. The rash occurs usually at work and her condition im- the hedgehog’s spines had stung her. In China, a bacterial proves when she’s on holiday. She had no upper respiratory and mycological sample was performed and it showed the tract symptoms. She’s working since 7 years as a cashier in a presence of Mucor. Local antibiotic and antifungal thera- supermarket and her station is next to flowers. POSTERS

Dermatologica Helvetica - Volume 32(6) - Août 2020 45 The clinical exam reveal a periocular and centrofacial P45 erythematous plaque associated to a diffuse facial swelling. Blockade of CD47 reverses IL-12 failure induced by tumor Bilateral conjunctivitis was also observed. T cells in cutaneous T cell lymphoma Patch test was performed with standard, preservative, emulsifier, plant and personal product series. The results Ignatova D1, Chang YT1,9, Varypataki EM1, Fassnacht C1, Coz- was positive for compositae mix II 5% pet. (++ on D2, ++ on zio A2, Dummer R1, Hoetzenecker W3, French L4, Schäkel K6, D4), sesquiterpene lactone mix 0.1% pet. (++ on D2, ++ on Bobrowicz M6, Mitev V7, Teocharides A8, Pascolo S1, Guenova D4) and parsley (- on D2, ++ on D4). E1,9 Because sesquiterpene lactone can be found in many 1) Department of Dermatology, University Hospital Zurich, Univer- flowers, we proposed to change her cashier station away sity of Zurich, Zurich from the flowers. Despite this intervention, her condition 2)Department of Dermatology, Cantonal Hospital St. Gallen, St. persisted. Therefore, we completed patch tests with perso- Gallen nal product including flowers and vegetables. The results 3)Department of Dermatology, Kepler University Hospital, Linz, came positive for freesia (+ on D2, ++ on D4), peony (- on Austria D2, + on D4), daisy (+ on D2, ++ on D4) and artichoke (++ 4)Department of Dermatology and Allergology, Ludwig-Maximi- on D2, + on D4). lians-University of Munich, Munich Germany Discussion: The final diagnosis was an airborne allergic 5)Department of Dermatology, Heidelberg University, Germany contact dermatitis due to sesquiterpene lactone (SQL), 6)Department of Immunology, Medical University of Warsaw, War- compositae and especially artichoke. This etiology is sup- saw, Poland ported by the seasonal characteristic of the eruption and 7) Department of Biochemistry, Medical University of Sofia, Sofia, flare–up occurring in the vicinity of this vegetable. Howe- Bulgaria ver, airborne allergic contact dermatitis to flowers or other 8) Department of Experimental Hematology, University Hospital vegetables containing SQL cannot be totally ruled out. Zurich We report here a case of allergic contact dermatitis caused 9) Department of Dermatology, Lausanne University Hospital by globe artichoke (Cynara scolymus L.). Only few cases CHUV, University of Lausanne, Lausanne have been described. This plant belongs to the compositae family and is widely cultivated in the Mediterranean. Cutaneous T cell lymphoma (CTCL) is a malignancy of The allergens are thought to be cynaropicrin, grosheimin skin homing CD4+ T lymphocytes. The overall survival of and 8-deoxy-11, 13-dihydroxygrosheimin, which belong late stage patients is only 2 to 5 years. Notably, the advan- to sesquiterpene lactone. They are mainly found in the cing impairment of cellular immunity correlates with the leaves. Classically, plant dermatitis is an airborne eczema disease progression, and is a hallmark of advanced stage. and involve exposed area like the face, the neck, hand and Moreover, the global Th2 bias of the T cells, paralleled by forearms. However, irritant contact dermatitis, urticaria, an- IL-12 silencing in dendritic cells and reduced IFNγ levels, gioedema, allergic rhinitis and systemic allergic dermatitis underlies the major clinical challenge in caring for CTCL pa- have already been described with artichoke. tients: a tendency to develop local and systemic infections In conclusion, artichoke allergy is uncommon but need to and subsequently sepsis with lethal outcome. Therefore, be considered in case of airborne contact dermatitis in par- treatment strategies aiming to restore the Th1 immune ticular in vegetable seller and farmer. responses in CTCL are promising. Accordingly, preliminary data from small clinical studies show the therapeutic efficacy of direct IL-12 and IFNγ application in CTCL patients. P44 Here, we demonstrate a novel role of CD47/SIRPα axis in Artificial Intelligence (AI) in Dermatology: an Application CTCL dendritic cells, which affects the IL-12 production in Sub-Saharan Africa and the polarization of naïve T cells. CD47 has emerged as a suppressor of macrophage-mediated phagocytosis Amruthalingam L1, Gottfrois P1, Andriambololoniaina H5, and promising target for multiple tumor types. In line with ZHAO S2, Philemon R4, Amann V1, XIAO Y2, Rodrigues MA6, the published data for other cancers, we demonstrate that Rapelanoro Rabenja F5, Schmid-Grendelmeier P3, Huang W2,7, CD47 is strongly upregulated in CTCL CD4+ T cells. Interes- Mavura D2,4, CHEN X2, Navarini AA1, Hsu C1 tingly, the expression of CD47 on neoplastic cells hampers 1) University Hospital of Basel - Department of Dermatology, Basel the maturation of the dendritic cells and their capacity to 2) Xiangya Hospital-Department of Dermatology, Changsha, China secrete IL-12 in vitro. Blockade of CD47/SIRPα interaction 3) University Hospital Zurich, Department of Dermatology, Zurich leads to reconstruction of IL-12 signaling and IFNγ secre- 4) Regional Dermatology Training Centre, Dermatology, Moshi, tion in murine lymphoma model and in primary patient - Tanzania derived cell cultures. The improved IL-12 production in DC 5) University of Antananarivo, Madagascar and enhanced Th1 immunity upon α - CD47 treatment cor- 6) Department of Dermatology, Royal Children's Hospital, Mel- relates with delayed tumor growth and prolonged overall bourne, Australia survival in vivo. 7) "Mobile Health" Ministry of Education - China Mobile Joint Labo- ratory, Changsha, China P46 Introduction: There is a shortage of dermatologists wor- Brunsting-Perry pemphigoid: a retrospective case series ldwide. The average is one in 60000. This becomes more of a frequently unrecognized condition severe in rural areas and in parts of the world such as Sub- saharan Africa, the number falls to 10 dermatologists for Imstepf VA1, Borradori L1, Feldmeyer L1, Cazzaniga S2 countries of several tens of millions. 1) Department of Dermatology, University Hospital, Bern Material and Methods: Teledermatology has been around 2) Centro Studi GISED, Bergamo, Italy for quite a while and has been implemented at the Regio- nal Dermatology Training Centre in Moshi, Tanzania 2 de- Background: Brunsting-Perry pemphigoid (BPP) is a rare cades ago. We live in a data rich environment and thanks variant of mucous membrane pemphigoid (MMP). Demo- to an excellent network coverage in Tanzania it becomes graphics and characteristics of affected patients have been possible to use AI techniques integrated with Teledermato- poorly investigated. logy for decision support. Objective: Systematical analysis of the clinicopathologic Discussion: Although AI still remains a subject of research, features of BPP. Methods: Retrospective standardized data it is hoped that it will help HCPs in the clinical setting when analysis of patients diagnosed between 2016 - 2019. safeguards are in place to progressively implement it. This Results: Twelve patients with a mean age of 73 years were presentation aims to present in simple words how can be included. There were 10 men (83%) and two women. All used in Dermatology in resource poor areas and suggest a (100%) patients had pruritic polymorphous lesions affec- potential research project. ting head and neck. Upper trunk and oral involvement was observed in 42% and 33 % of cases, respectively. His- tologically, unspecific erosions or subepidermal blistering were often present. Direct immunofluorescence studies (DIF) disclosed deposits of immunoreactants along the POSTERS

46 Dermatologica Helvetica - Volume 32(6) - Août 2020 Ins_AMELUZ_A4_df.qxp_Layout 1 11.02.19 09:52 Seite 2

AMELUZ® NANO-ÉMULSION

PDT AVEC LUMIÈRE DU JOUR1 Pour le traitement de la kératose actinique et de cancérisation d’une zone1

Référence: 1 Information professionnelle AMELUZ®, www.swissmedicinfo.ch. Information professionnelle abrégée AMELUZ®: C: 1 g de gel contient 78 mg d’acide aminolévulinique. I: Chez les adultes: traitement de la kératose actinique d’intensité légère à modérée du visage et du cuir chevelu (grade Olsen 1 à 2), de cancérisation d’une zone et du carcinome basocellulaire superficiel et/ou nodulaire chez les adultes, qui ne peut être traité par voie chirurgicale en raison d’une morbidité éventuelle due à la maladie et/ou d’un mauvais résultat cosmétique. P/E: Dans le cadre du traitement de la kératose actinique (KA), une séance de PDT avec lumière du jour ou lumière rouge doit être utilisée pour une seule ou plusieurs lésions ou pour des zones cancérisées entières. Deux séances de PDT avec lampe à lumière rouge espacées d’une semaine environ doivent être utilisées dans le cadre du traitement du carcinome basocellulaire (CBC). Les lésions de la KA, les zones (cancérisées) ou les CBC doivent être réévalués trois mois après le traitement. Il faut renouveler le traitement, s’ils ne sont pas totalement guéris. AMELUZ® est utilisé en application sur la peau. Ne doit être administré que sous la surveillance d’un médecin ou d’un/e infirmier/ère expérimenté/e en PDT. Pour la préparation du traitement, dégraisser les lésions, éliminer les squames et les croûtes et rendre rugueuses les surfaces en douceur, en veillant à ne pas les faire saigner. Pour la PDT à la lumière du jour, une protection solaire avec filtres chimiques (LSF ≥30) doit être appliquée 15 minutes avant la préparation au traitement. AMELUZ® doit couvrir les lésions et les zones concernées ainsi qu’une partie d’environ 5 mm tout autour de celles-ci, en formant un film avoisinant 1 mm d’épaisseur. PDT avec une lampe à lumière rouge (KA, zones cancérisées, CBC): Après 3 heures d’incubation, essuyer le gel restant et illuminer la totalité de la zone traitée par une source de lumière rouge (spectre étroit autour de 630 nm et avec une dose de lumière d’environ 37 J/cm2 ou spectre de 570 à 670 nm avec une dose de lumière comprise entre 75 et 200 J/cm2). PDT à la lumière du jour (KA et zones cancérisées): les patients doivent aller à l’extérieur dans un délai de 30 minutes après l’application du gel et s’exposer à la lumière du jour pendant 2 heures consécutives. CI: Hypersensibilité au principe actif, aux porphyrines, à l’arachide ou au soja ou à l’un des excipients; porphyrie; photodermatoses connues. Préc: Ne doit pas être utilisé chez les patients présentant une allergie connue à l’arachide et au soja ou sur des lésions hémorragiques. Il faut veiller à ce qu’AMELUZ® n’entre pas en contact avec les yeux ou les muqueuses. L’utilisation concomitante de médicaments connus pour avoir un potentiel phototoxique ou photoallergique doit être évitée. Éviter toute exposition au soleil des lésions traitées pendant environ 48 heures. La PDT doit être immédiatement stoppée en cas d’observation d’une AGT. Aucune expérience chez les patients sous immunosup- presseurs, présentant des troubles de la coagulation héréditaires ou acquis, ayant une peau de type V ou VI ainsi que sur le traitement de la maladie de Bo wen et des kératoses actiniques sévères ou des lésions pigmentées ou très infiltrées. Aucune expérience si la zone traitée est le siège de maladies de la peau ou si elle porte des tatouages. IA: Aucune étude, aucune connue. EI: Très fréquents au niveau du site d’application: érythème, douleurs, sensations de brûlures, prurit, œdème, formation de croûte, exfoliation, induration, paresthésie. Fréquents: céphalées; au niveau du site d’application: tension de la peau, vésicules, sécrétions, érosion, réaction, gêne, hyperalgésie, hémorragie, sensation de chaleur. Occasionnels: éruption pustuleuse, nervosité, dysesthésie, œdème palpébral, vision trouble, altération de la vue, maux de dos, frissons, sensation de chaleur, pyrexie, douleurs, fatigue, ulcère, échauffement; au niveau du site d’application: pustules, formation de vésicules, peau sèche, pétéchie, hyperkératose, changement de couleur, ulcère, enflure, inflammation, sécrétion des plaies. S: Conserver au réfrigérateur (2–8 °C). P: Tube de 2 g de gel. B. Mise à jour de l’information: Octobre 2018. La version exhaustive de l’information professionnelle est publiée sur www.swissmedicinfo.ch. Louis Widmer SA, Rietbachstrasse 5, 8952 Schlieren-Zurich. epidermal basement membrane. Circulating autoantibo- Results: Thirty patients with NAM were included. Approxi- dies were detected in 6 of 10 tested cases (60%) by ELI- mately half of the cases (52%) underwent primary excision SA-BP180, ELISA-BP230 or indirect immunofluorescence and covering with full-thickness skin graft, while 16% of (IIF) microscopy using split skin. The mean diagnostic delay the patients underwent a finger amputation. Disease free was of 3 years. Topical steroids and systemic therapies were survival was significantly higher in patients with primary given with variable response. Seven patients were either tumor location in the hand. The patients with in situ NAM on dipeptidyl peptidase-4 inhibitors (DPP4is) or on sartans. or Breslow thickness <1mm had a significantly higher Limitations: Retrospective study, patient number and ter- chance of overall survival. Furthermore, the patients, who tiary referral center. underwent excision and covering with full-thickness skin Conclusion: The diagnosis of BPP remains challenging and graft had a complete OS (100% at 5-years). relies on the results of DIF studies. The implication of DPP4i Conclusion: Primary tumor location in the hand and thin- and sartans as triggers should be assessed. ner tumor thickness might be correlated with better DFS Keywords: Brunsting-Perry disease, mucous membrane and OS, respectively. The optimal OS of our patients who pemphigoid, epidermolysis bullosa acquisita, bullous pem- underwent full excision and covering with full-thickness phigoid. skin graft could show that total amputation might not be necessary in most of the NAM.

P47 Enhancement of antibody-dependent cellular cytotoxi- P49 city is associated with treatment response to extracorpo- Patients’ and physicians’ acceptance of and satisfaction real photopheresis for sézary syndrome with teledermatology: A multicenter cross-sectional study in Switzerland Chang YT3, Schläpfer T5, Dimitriou F3, Nägeli M3, Pascolo S3, Hoetzenecker W4, Bobrowicz M2, Guenova E1 Jahn AS1, Müller SM1, Maul TJ2, Navarini AA1, Streit M3, Ganten- 1) Department of Dermatology, Lausanne University Hospital bein L1, Greis C2, Maul LV1,3 CHUV, University of Lausanne, Lausanne 1) Department of Dermatology, University Hospital Basel 2) Department of Immunology, Medical University of Warsaw, War- 2) Department of Dermatology, University Hospital Zürich saw, Poland 3) Department of Dermatology, Cantonal Hospital Aarau 3) Department of Dermatology, University Hospital, Zurich, Zurich 4) Department of Dermatology, Kepler University Hospital, Linz, Background: Teledermatology (TD) has become increa- Austria singly important worldwide in recent years, however, its 5) Department of Dermatology, Kantonal Hospital St. Gallen, St. Gallen acceptance and satisfaction amongst patients and physicians in Switzerland is still unknown. Sézary syndrome (SS) is a rare and highly immune-sup- Material and Methods: This prospective, multicentre, pressive type of cutaneous t cell lymphoma with a low res- cross-sectional study investigated the acceptance of and ponse rate to therapy. The described immunomodulatory satisfaction with TD among dermatology patients and aberrations include increased production of Th2-cytokines physicians of the University Hospitals Basel and Zürich and combined with decreased production of Th1-cytokines the Cantonal Hospital Aarau. From August 2019 to January and a decline in the number of NK cells and their activity le- 2020, a total of 576 patients and physicians completed a vel. Recently published studies examining the potential of newly created questionnaire. The χ2-test was used to com- NK cells modulating IL-2/12 or TRL-7/8 as a new treatment pare means; the confidence interval was 95%. strategy stress the importance of NK cells in SS. Extracor- Results: Among the 512 patients (mean age 49.6±17.9 poreal photopheresis is safely and efficiently used to treat years; 47.1% females; 45.7% urban residents), 24.4% SS and other immunity-altering diseases, but despite more (123/505) had previously used TD. Among the 64 physi- than 30 years since Edelson's ground breaking publication cians (73.4% dermatologists, 26.6% non-dermatologists) remains the exact mechanism of action unclear. In both mean age 35.7±9.5 years; 65.5% females; 85.9% urban resi- grafts vs host disease (GvHD) and SS was an increase in dents), 29.7% (19/64) were TD providers and 17.2% (11/64) NK cells described after ECP and is even perceived as a pa- users as patients themselves. Among all users, 68.8% rameter of response in GvHD. Further exist individual case (75/109) of the patients and 100% (3/3) of the physicians reports of patients in which NK cell activity increased after providing TD themselves and 50% (4/8) of the physicians ECP. To investigate the effect of ECP on NK in SS did we ana- not offering TD rated their experience as good or very lyse blood samples from SS patients before and after ECP good. Whereas amongst non-users, 21.7% (83/383) of the using flow cytometry and an antibody-dependent cellular patients and 41.7% (20/48) of all physicians (28.1% (9/32) cytotoxicity (ADCC) assay and further compared our results in non-providers and 68.8% (11/16) in providers) assumed to the clinical history of the individual patients. We report the quality of TD to be good or very good. Regarding the increased NK cell activity, measured by ADCC after ECP and acceptance, 73.6% (351/477) of patients and 67.2% (43/64) that the quantitative increase is linked to response to the- of physicians preferred a personal medical consultation, rapy in the individual patients. Our findings emphasise the whereas only 5% (24/477) of patients and 10.9% (7/64) of importance of NK cells in ECP, support recently published physicians indicated to prefer telemedicine. 21.4% of pa- results from others on the relevance of NK in ECP and in- tients and 21.9% of dermatologists had no preference. No creases our knowledge of the mechanism of action in ECP. significant differences in the acceptance of TD between men and women (patients: p≤0.97, physicians: p≤0.95), as well as between urban and rural areas (patients: p≤0.62, P48 physicians: p≤0.14) were detected. 73.7% (291/395) of pa- Melanoma of the nail apparatus: an analysis of patients’ tients and 59.7% (37/62) of physicians, would be willing to survival and associated factors spend a maximum of 75 CHF for a TD consultation, 44% (200/455) of patients and 65% (39/60) of physicians would Jafari MS, Lieberherr S, Cazzaniga S, Beltraminelli H, Gabutti be willing to pay a surcharge for an immediately available M, Borradori L, Haneke E, Hunger R TD service. Department of Dermatology, Inselspital, Bern University Hospital, Conclusion: The acceptance of TD is rather low among both Bern patients and physicians as most of them prefer a personal medical consultation. However, the majority of the partici- Background: Proper management of nail apparatus me- pants who has already used TD is satisfied with its quality. lanoma (NAM) is still a matter of controversy and debate. Therefore, we assume that the acceptance of TD has the Objective: This study aims to describe the features, sur- potential to increase over time. vival outcome and associated factors of a cohort of NAM patients. Methods: Retrospective cohort study of patients with NAM evaluated between 2007 and 2017 to assess clinical features, presence of metastases, and disease-free and overall survival. POSTERS

48 Dermatologica Helvetica - Volume 32(6) - Août 2020 P50 A 78-year old male presented with an 8-cm-diameter ne- A mysterious neurocutaneous syndrome with "ga- crotic ulceration involving the right proximal forearm and laxy-like" skin manifestation - a case report the proximal interphalangeal joints. The lesion appeared after gardening, with development of an inflamed ul- Jamiolkowski D1, Burger B3, Müller J2, Bauer A4, Leeb T4, Müh- ceration on the back of his right hand. He was given oral leisen B1, Itin P1, Müller S1 antibiotics with no response. His medical history revealed 1) Department of Dermatology, University Hospital Basel the diagnosis of rheumatoid arthritis, because of which he 2) Department of Neurology, University Hospital Basel received prolonged courses of systemic corticosteroids. 3) Department of Biomedicine, University Hospital Basel and Uni- Extensive microbiological examinations, including wound versity of Basel swabs, tissue biopsy cultures, histological and serological 4) Institute of Genetics, Vetsuisse Faculty, University of Bern investigations confirmed the presence of Cryptococcus neoformans. In addition, cryptoccocal antigen was confir- History and clinical presentation: We present the case of a med in the pleural fluid analysis. Blood and cerebrospinal 48 year-old woman with a history of disseminated telan- fluid cultures remained negative. The patient received giectasia in a livedo racemosa-like distribution interspersed treatment with Amphotericin B, Flucytosin, Fluconazol, as with lesions resembling cherry angiomas and blue-rubber well as antibiotic administration due to suspected bacterial bleb lesions. First skin lesions appeared during adoles- superinfection. He also underwent an extensive wound de- cence with constant progression over time, covering now bridement. The debilitated patient died 25 days after hos- 90 % of her body surface and being most predominant pitalization because of hospital acquired pneumonia with on the breasts and on the abdomen. Elevated lesions are subsequent septic shock. vulnerable to mechanical trauma, bleed easily and already Cryptococcus can present with a variety of skin and soft needed repeated laser treatment, further impairing quality tissue manifestations including papules, plaques, nodules, of life in this patient. The multitude and diversity of lesions granulomas, pustules, abscesses, cellulitis or ulcerations. create a pattern resembling reddish galaxies. In the past Our observation illustrates that cryptococcosis should few years, the patient began to develop bluish nodules always be included in the differential diagnosis of soft tis- resembling venous lakes on her lips and in the oral cavity sue infections, particularly (but not only) in immunocom- without bleeding. promised patients. In addition to the cutaneous involvement, the patient has asymptomatic cerebral cavernomas increasing in size and number. Aged 47, she had an embolic stroke in the territory P52 of the right middle cerebral artery (possibly as a complica- Bart’s Syndrome with α6β4 integrin antibodies tion of a patent foramen ovale). Moreover, she has suffered from unexplained recurrent myelitis causing sensomotoric Jungo P1, Cajacob L1, Volz A1, Häusermann P1, Has C2, Itin P1 hemiparesis on the left side, as well as from recurrent epi- 1) Department of Dermatology, University Hospital, Basel sodes of fever of up to 40 °C without an identifiable under- 2) Department of Dermatology, University Hospital, Freiburg lying focus of infection. Family history is unremarkable. Lesional biopsy revealed an increase in the number of Aplasia cutis congenita type VI, also known as Bart syn- slightly dilated capillaries, small venules and small arte- drome, is a rare inherited disorder characterized by conge- rioles in the upper and lower dermis without signs of in- nital localized absence of skin, associated nail abnormali- flammation and without cytological changes of endothe- ties and epidermolysis bullosa (EB). This type of congenital lial cells. Whole genome sequencing (WGS) performed in absence of skin is regarded now as a manifestation of EB. the patient as well as in her sister and her parents has not Bart’s syndrome is not a disorder but a clinical sign seen yet revealed any gene variant known to cause vascular ab- in many forms of EB. The Koebner, Weber Cockayne and normalities. Dowling Meara forms of EB simplex and dystrophic EB with Discussion: Here we present the unsolved case of a female mutations in COL7A1 have rarely been associated with patient with generalized cutaneous and cerebral vascular Bart's syndrome. In addition, rare cases of junctional EB abnormalities. with pyloric atresia have been reported as Bart’s syndrome The disease shows some similarities to Osler disease and We report a case of a newborn male who had absent skin Fabry disease, but both appear unlikely given the history, over the extremities, temporal and periumbilical region. clinical presentation and lack of identification of correlating The baby was the second child to a consanguineous couple gene variants. In our combined interdisciplinary approach (cousin-cousin). On the first day of life, the boy developed with WGS, extensive study of the literature, evaluation by blisters on the nose and trunk. The skin sample showed mis- experts on genodermatoses, angiology and neurology sing antibodies to adhesion proteins α6β4 integrin of the we have so far not been able to establish the diagnosis. dermal–epidermal junction, which classifies for junctional We present this case in hope to get additional input from EB with pyloric atresia. Furthermore, there was a complex a broader audience that might help to solve this case and systemic involvement with esophageal and pyloric atresia provide evidence for therapeutic approaches such as pro- as well as renal abnormalities. An interdisciplinary ethical pranolol or anti VEGF targeted therapies. consultation revealed an extremely bad prognosis due to a necessity of major gastrointestinal operations and the extensive skin defects. The patient died within 4 days of life P51 following a palliative management. Disseminated cryptoccocosis with cutaneous and pulmonary manifestations in an immunocompromised patient P53 Management of a neonate with a large segmental conge- van Rhyn M, Rammlmair A, Al-Khalil O, Damonti L, Mühle- nital hemangioma causing high-output heart failure thaler K, Beltraminelli H, Borradori L Department of Dermatology, University Hospital, Bern Knöpfel N1, Gnannt R2, Neuhaus K3, Schiestl C3, Hagmann C4, Weber R5, Wisser J6, Theiler M1, Weibel L1 Cryptococcosis is an invasive fungal infection. Cryptococ- 1) Pediatric Skin Center, Department of Dermatology, University cus neoformans is the principal pathogenic member of the Children's Hospital Zurich, Zurich genus. It is found worldwide in decaying woods, fruit and 2) Department of Diagnostic and Interventional Radiology, Univer- bird droppings, particularly from pigeons. The vast majo- sity Children’s Hospital Zurich, Zurich rity of patients with cryptococcosis are immunocompro- 3) Pediatric Skin Center, Department of Plastic and Reconstructive mised. The most common presentations of cryptococcosis Surgery, University Children’s Hospital Zurich, Zurich include pneumonia following the inhalation of spores and 4) Department of Pediatric and Neonatal Intensive Care, University yeast forms as well as meningoencephalitis. Secondary Children’s Hospital Zurich, Zurich cutaneous cryptococcosis by hematogenous fungal disse- 5) Division of Pediatric Cardiology, University Children’s Hospital mination is found in up to 15% of patients with systemic Zurich, Zurich cryptococcosis. A primary cutaneous cryptococcosis as a 6) Department of Obstetrics, University Hospital Zurich, Zurich result of direct local inoculation is rare. 1,2 POSTERS

Dermatologica Helvetica - Volume 32(6) - Août 2020 49 Purpose: To report a challenging case of a large, life-threate- Conclusion: IEMP is a rare benign, self-limiting hyperpig- ning segmental congenital hemangioma (CH) along the mented skin condition of unknown etiology and should scalp, neck and upper trunk associated with congestive be considered in the differential diagnosis for children or heart failure successfully treated with embolization in the young adults with unclear hyperpigmentation disorders. neonatal period. Our personal interpretation is that idiopathic eruptive ma- Case Report: A 36-year-old woman was referred to our Vas- cular pigmentation might be the result of different minimal cular Anomalies Center for evaluation of a large hypervas- inflammatory cutaneous disorders with lesional postin- cular neck mass identified on prenatal ultrasound at gesta- flammatory hyperpigmentation. tional week 20. Fetal MRI showed a large high-flow tumor with multiple feeders supplied by the external carotid artery. Although the fetus developed cardiomegaly, the pre- P55 gnancy was carried to term without further complications Extensive palmoplantar bullae in a 21-month-old infant and caesarean section was performed at gestational age 37 weeks. The newborn presented with a large violaceous Lanz J1, Weibel L1, Knöpfel N1, Farkas A2, Theiler M1 plaque-like tumor with nodular reddish central areas and 1) Pediatric Skin Center, Department of Dermatology, University large pulsating vessels along the right scalp, posterolate- Children’s Hospital Zurich, Zurich ral neck, upper back and shoulder. From day 1 the neonate 2) Dermatology Private Practice, Glattbrugg exhibited respiratory distress and repeat echocardiograms revealed progressive signs of high-output cardiac failure Introduction: Pompholyx is an inflammatory vesiculobul- due to AV-shunt volumes. Complete blood count and lous skin disease of the hands and feet belonging to the coagulation tests including D-dimer levels were normal. A spectrum of eczema. We report a rare case of an impressive lesional skin biopsy showed small to large lobules of GLUT- clinical presentation of pompholyx in a 21-month-old girl 1 negative capillaries embedded in a fibrous stroma and and discuss the main differential diagnoses that should be next generation sequencing revealed a somatic activating considered in infants and toddlers. mutation in GNAQ (p.Q209H), confirming the diagnosis of Case report: A 21-month-old girl was referred for the eva- CH. The cardiac function deteriorated despite ICU mana- luation of a papulovesicular and bullous eruption of 10 gement, thus on day 10 of life percutaneous embolization days duration with predominant palmoplantar involve- using particles was performed with access via the right ment. She had no previous history of skin disease and was common carotid artery, which resulted in an estimated otherwise healthy. She initially presented with mild itchy 30-40% reduction of shunt volume. The infant showed a papules on the abdomen that rapidly spread and later in- favourable course with rapid improvement of cardiac func- volved both palms and soles with the appearance of large tion. Over the following months partial involution of the blisters. Physical examination revealed excoriated erythe- CH occurred and cardiac function normalized completely. matous plaques and papules on the cheeks, lower abdo- Conclusion: Our case adds clinical information to the recent- men, buttocks and limbs. Palms and soles were severely ly described new phenotype of segmental CH. Although affected presenting with multiple vesicles and large bullae. rare in CH, high-output heart failure was severe in this case Mucosal inspection was normal. Further investigations in- and management by early embolization successful. cluded a complete blood count and an autoimmune panel with anti-BP180/230 and indirect immunofluorescence assays, which were unremarkable. A polymerase chain P54 reaction (PCR) for enterovirus was negative. Based on these Idiopathic Eruptive Macular Pigmentation (IEMP) in a findings the diagnosis of pompholyx was made. A short 13-year-old girl - an uncommon pigmentary disorder treatment course of systemic and local corticosteroids as well as application of Tannosynt®-Solution and Dexeryl Koral E1, Itin P2, Volz A2, Häusermann P1,2 , Navarini AA1, Maul Cream lead to complete resolution within two weeks. LV1 Conclusion: Dyshydrotic eczema/Pompholyx is a rare 1) Department of Dermatology, University Hospital Basel condition in small children. Differential diagnoses include 2) Dermatology Practice, Basel hand, foot, and mouth disease, bullous tinea, bullous pemphigoid, and other autoimmune-bullous disorders. Topical Background: Idiopathic Eruptive Macular Pigmentation and systemic corticosteroids are the mainstay of treat- (IEMP) is a rare skin disorder of unknown etiology charac- ment. An underlying allergic contact dermatitis needs to terized by asymptomatic hyperpigmented macules and be considered and addressed. flat plaques. The lesions mainly involve the neck, trunk and proximal extremities of children and young adults. Case: A healthy 13-year-old girl presented to our depart- P56 ment with a two-year history of brownish round macules When the pandemic hides the endemics and flat plaques on the face, trunk and limbs. The lesions were asymptomatic, without preceding inflammatory le- Leuenberger M1, Girard-Srtorhnbach M3, Bonah C2, Toutous sions, gradually progressed and persistent. The past me- Trellu L1 dical and family history was unremarkable. A skin biopsy 1) Department of Dermatology, University Hospital, Geneva revealed an epidermal hypermelanosis with papillomatosis 2) Faculty of Medicine, University of Strasbourg without pigment incontinence in the dermis or a dermal 3) General directorate of Health, Geneva melanocytic proliferation. Based on the clinico-pathological findings, the diagnosis of IEMP was made. Due to the Introduction: The world is currently experiencing a pan- high rate of spontaneous resolution, no treatment was ini- demic related to the coronavirus disease 2019 (COVID-19) tiated. caused by SARS-CoV-2. The Swiss Federal Council decided Discussion: Idiopathic eruptive macular pigmentation to set up a containment system on 16 March 2020. Howe- (IEMP) was first described by Degos et al. in 1978. There ver, the other diseases have not disappeared and we were have been fewer than 60 IEMP cases reported in the Engli- interested to evaluate sexually transmitted infections (STIs). sh literature. The disease is characterized by asymptoma- Method: Communicable diseases notifications are regular- tic pigmented macules predominantly involving the face, ly published on line of the statistics of the Federal Office of trunk, and proximal extremities in children and adoles- Public Health. Four STIs syphilis, gonorrhea, Chlamydia and cents. The cause of IEMP remains unclear and there have HIV infections were observed during the containment pe- been no reported cases of hereditary cases so far. However, riod from 30.03.20 to 28.04.20 and the week 17: 28.04.2020. endocrine factors, inflammatory stimuli, and autoimmune Results: Gonorrhoea: In week 17, 24 infections, compared phenomenon have been adressed as potential triggers. to 78 in 2019 and 61 in 2018, were notified, achieving a The most important differential diagnosis of IEMP includes decrease of 54 cases or 69.2%. From 30 March to 28 April erythema dyschromicum perstans, drug eruption, lichen 2020, 133 infections were notified, compared to 262 in planus pigmentosus, postinflammatory pigmentation and 2019 and 205 in 2018 (a decrease of 49.2% compared to mastocytosis. A therapy of IEMP might not be mandatory, 2019). Early syphilis: 2 cases in week 17, compared to 12 in because IEMP usually shows a tendency towards spon- 2019. From 30 March to 28 April 2020, 10 cases have been taneous resolution over time. reported compared to 38 in 2019 and 54 in 2018 (73% de- POSTERS

50 Dermatologica Helvetica - Volume 32(6) - Août 2020 crease between 2019 and 2020). Chlamydia: 113 cases in P58 week 17 compared to 210 in 2019 and 253 in 2018. In the Nivolumab-Induced Hidradenitis Suppurativa last 4 weeks, 508 Chlamydia were notified compared to 826 in 2019 and 957 in 2018, a decrease of 38.5% compared to Maillard A, Pastor D, Merat R 2019. HIV: In week 17, 7 HIV infections were reported com- Division of Dermatology and Venereology. Geneva University Hos- pared to 33 in 2019 and 36 in 2018 (a decrease of 78.8%). pital Discussion: The figures show a marked decrease in STIs. Containment may have led to a decrease in unsafe sex, Introduction: Mucocutaneous adverse events (AEs) are probably associated to less sexual partners. We also hypo- commonly observed under Immune checkpoint inhibitors thesize that the number of infections may be underesti- therapy (ICIs). Here, we present the first case of anti-PD-1- mated due to a decrease in the number of cases reported induced hidradenitis suppurativa (HS). by health professionals, who were largely mobilized in the Case Report: A 43-y.o. non smoking man with a stage IIIC fight against COVID19. Another hypothesis is the limita- melanoma disease received a 3mg/kg nivolumab adju- tion of outpatient medical consultations suggests that vant therapy. He had no other comorbidities than obesity STIs are currently not yet and/or under-diagnosed. In HIV (BMI 31.9) and severe acne during adolescence, no meta- data, the reported cases do not yet allow precise dating of bolic syndrome, nor personal/familial history of HS. Three the time of infection, most probably prior to the period of months after the beginning of the infusions, he developed containment and some tests may have been performed by painful nodules and aseptic abscess of the axillary folds auto-testing. The current pandemic is motivating preven- and groins but with no subsequent fistula or scars. Most le- tive actions and significant financial means to fight against sions cleared or drained spontaneously but there were new the spread of the virus, leading to the risk of neglecting otA flares every week, requiring sometimes surgical drainage. further increase in STIs is therefore to be feared, amplified A diagnosis of nivolumab-HS, stage Hurley 1 was retained. by the forthcoming deconfinement. The fight against STIs After an unsuccessful course of lymecycline, he gradually must therefore remain a public health priority.her preven- improves under a combination of doxycycline 100mg b.i.d. tive actions. and zinc gluconate 60mg qd followed by zinc gluconate maintenance therapy. Fifteen months after Nivolumab cessation, one or few HS lesions still occasionally occur. The P57 patient remains in remission for melanoma disease. Ipsilateral clubbing of the fingers in an infant with a large Discussion: HS is a common recurrent follicular inflamma- segmental infantile hemangioma tory skin disease in the apocrine gland-bearing areas of the body often associated with obesity, metabolic syndrome, Luchsinger I, Knöpfel N, Theiler M, Weibel L tobacco smoking, inflammatory bowel diseases, psoriasis, Pediatric Skin Center, Dermatology Department, University Child- and inflammatory arthritis. Skin reactions are the most ren's Hospital Zurich common side-effects of anti-PD-1 therapy, among which pruritus, lichenoid dermatitis, eczematous dermatitis, vi- Objectives/Methods: Clubbing represents bulbous enlar- tiligo and maculopapular rash are commonly observed. gement of the distal segment of the fingers/toes usual- Like in our patient, the mean latency period between drug ly associated with hypoxia due to lung or heart disease. initiation and onset of skin eruptions usually observed is Unilateral clubbing is a rare finding described in patients three months. Importantly, improvement after immuno- with underlying venous malformation or hemiplegia. We therapy discontinuation argues strongly in favor of an an- present a toddler girl with a large segmental infantile he- ti-PD-1 induced HS in our patient. Other than worsening of mangioma affecting the upper left extremity and the deve- pre-existing psoriasis, neutrophilic reactions i.e. acute ge- lopment of ipsilateral clubbing. neralized exanthematous pustulosis and Sweet syndrome Results: A monozygotic twin girl was delivered at term have also anecdotally been reported in patients under ICIs. by C-section after an uncomplicated pregnancy. She pre- Anti-PD-1 therapy removes the immune system inhibition sented with widespread telangiectatic precursor features allowing the control of tumor cell progression, but also the of a large, segmental hemangioma extending from the development of T cells-mediated adverse events that may left torso along the arm to the fingers. Additionally, mid- be Th17 mediated as in HS. Our case report indicates that line blanching was observed. PHACE-syndrome was ruled HS, as for other neutrophilic/pustular skin reactions but out (MR-angiography of the head/neck/upper extremities, also neutrophilic response observed in ICIs induced colitis, echocardiography, ophthalmological examination). Due to can be part of the anti-PD-1 mucocutaneous adverse event proliferation, treatment with propranolol was initiated at spectrum. the age of 5 weeks (1mg/kg/day, 2mg/kg/day after 2 months). Propranolol was stopped after continued fading at the age of twenty months. From 7 months of age, marked club- P59 bing of all left fingers was observed as well as some doughy Granulomatous slack skin Mycosis Fungoides and Hodg- hypertrophy of the left hand which felt cooler compared kin's Lymphoma in the same pediatric patient to the right. This finding remained unchanged after stopping propranolol and persisted until the last follow up (age Mainetti C1, Brazzola P2, Mazzucchelli L3, Pesce G4, Belaminelli 24months). No trophic skin changes or functional impair- H1,5 ment was noted. 1) Department of Dermatology, Ente Ospedaliero Cantonale, Bel- Discussion: To the best of our knowledge this is the first linzona report of an infantile hemangioma causing marked club- 2) Istituto Pediatrico della Svizzera Italiana (IPSI), Bellinzona bing of the affected fingers. The development of clubbing 3) Cantonal Institute of Pathology, Locarno is linked to secondary alterations in vascular dynamics and 4) Department of Radio-Oncology, Oncology Institute of Southern hypoxia. Previous reports of acral segmental hemangiomas Switzerland (IOSI), Bellinzona resulting in ulcerations of the fingertips lead to the hypo- 5) Department of Dermatology, Inselspital Bern University Hospi- thesis of relative tissue hypoxia as the underlying cause. We tal, Bern believe the observation of this case underlines this theory which seems particularly true in PHACE type infantile Background: Primary cutaneous lymphomas are rare in hemangiomas. An MR-angiography of the affected arm is childhood and their most common types are mature T-cell planned to be repeated in our patient and the further evo- (CTCL) (type’s mycosis fungoides and CD30+ lymphoproli- lution of clubbing will be monitored. pherative diseases). Granulomatous slack skin (GSS) CTCL variant is very rare at any age. Hodgkin’s lymphoma (HL) is one of the best curable pediatric and adult neoplasm with an incidence in Europa of 2 to 3 cases per 100’000 persons per year. Observation: We report the case of a 12-year-old boy in excellent health. Since 15 months, he complained about a slow and asymptomatic growth of a skin patch on the right iliac crest region. The skin inspection revealed a red-purple POSTERS

Dermatologica Helvetica - Volume 32(6) - Août 2020 51 infiltrated patch. The rest of the skin and the clinical exa- P61 mination of others organs were normal. The histological First case of Tinea capitis due to Arthrographis kalrae examination of the skin biopsy showed a diffuse lymphocytic infiltrate throughout the whole dermis and part of Gaviria Morales E1, Martinetti Lucchini G2, Mainetti C1 the subcutaneous tissue with discrete epidermotropism. 1) Department of Dermatology, Ente Ospedaliero Cantonale, Bel- The CD4/CD8 ratio of more than 10:1 and the presence of linzona the T-cell receptor clonality (TCR-γ) in the molecular pa- 2) Department of Laboratory Medicine, Ente Ospedaliero Canto- thological analysis together with the clinical-pathological nale, Microbiology Division, Bellinzona correlation supported the diagnose of a GSS CTCL variant. A PET-CT showed paratracheal adenopathy and therefore Background: Arthrographis kalrae (A. kalrae) is a slow a thoracotomy lymph node biopsy was performed and the growing hyaline mould with initially yeast-like colonies. It is histology showed a classic stage IIa nodular sclerosing HL. a saprophyte of the environment, mainly found in soil and We treated the HL according to EuroNet-PHL-C2 protocol, compost. In recent years, cases of opportunistic infections TL-1, with two OEPA cycles and one COPDAC cycle, obtai- attributed to this pathogen have been described. ning a complete remission of the HL with a negative PET-CT Case report: A 58-year-old immunocompetent woman, already after the two OEPA cycles. Meanwhile for GSS CTCL presented with a history of itching of the scalp and hair loss we started a local treatment with clobetasol propionate for 12 months with worsening in the last 6 months. She 0.05% cream, getting a minimal improvement. However, declared history of gardening activities with soil exposure during the various cycles of chemotherapy for HL, the skin and she had traveled to Kenya in the past months. Physi- infiltration of the GSS CTCL also improved, but then the be- cal examination exposed a single rounded plaque of hair neficial effect disappeared during the breaks between -cy loss with white scale on the right parietal scalp area with cles. We decided to treat the skin plaque with radiotherapy no erythematous background. Dermoscopic examination (total dose 24 Gy in fractions of 2 Gy) over three weeks. The showed sporadic black dots and hairs with a newly des- result was satisfactory. cribed finding called “Morse code-like hair”. We suspected Discussion: The association CTCL and HL has been reported, alopecia areata, trichotillomania and tinea capitis. The my- as a secondary malignancy in CTCL patients. In the litera- cological culture from scalp samples identified the species ture, the following hypotheses have been proposed as the Arthrographis kalrae. The result was confirmed by sequen- cause of this uncommon association: immunosuppression cing the internal transcribed spacer 1 (ITS1) region of the caused by the treatment or the role of Epstein-Barr virus ribosomal DNA gene using universal primers ITS1 and ITS2. could play a role in the development of HL in these pa- We diagnosed a tinea capitis caused by A. kalrae. The anti- tients. In our case, these two conditions were not present. fungal susceptibility testing showed a minimum inhibitory To our knowledge, we described the first case of associa- concentration (MIC) value for itraconazole of 1 mg/l. We tion between GSS CTCL and HL in a pediatric patient. started a treatment with itraconazole 100mg twice daily for 6 weeks associated with ketoconazole shampoo achieving mycological healing after six weeks. P60 Discussion: Arthrographis is an arthroconidial mould com- Large Mucocutaneous Sarcoidal Granuloma of the Lower prising four species: A. kalrae, A. lignicola, A. pinicola and Lip successful treated with Hydroxychloroquine A. alba. A. kalrae is a saprophytic fungus, distributed worldwide Cattrini B1, Kamarachev J2, Eberhardt A3, Mainetti1 and rarely causes human diseases. The small number of 1) Department of Dermatology, Ente Ospedaliero Cantonale, Bel- case reports of A. kalrae infection are predominately on linzona refractory arthritis, onychomycosis, mycetoma, meningitis 2) Department of Dermatology, University Hospital Zurich, Zurich in immunocompromised, sinusitis and ophthalmitis, vas- 3) Private Practice, Chiasso culitis, endocarditis and lung infections. A. kalrae as well as dermatophytes has ability to utilize keratinous materials as Introduction: Sarcoidosis is a systemic disease of unknown nutritional source. Unlike dermatophytes, A. kalrae occurs etiology characterized by the presence of non-caseating very rarely as keratinophilic pathogen. granulomas. Skin, lungs and eyes are the common target To our knowledge, this is the first isolation from hairs of this organs for sarcoidosis. Mucocutaneous sarcoidal granulo- dimorphic keratinolytic fungus. mas can be the only manifestation of sarcoidosis. Clinical Case: A 65-years old woman, known for a mild psoriasis and arterial hypertension, presented a nodule in P62 her lower lip that has been growing for about six months. Identical transverse nasal crease and milia at homozy- She did not have any benefit either with topical antibiotic gous twins therapy or with topical corticosteroid therapy. The treating dermatologist performed biopsies of both lesions. The his- Zgraggen L1, Mainetti C2 tology showed a granulomatous pattern compatible with 1) Istituto Pediatrico della Svizzera Italiana, Bellinzona sarcoidosis. The colleague referred the patient to us for 2) Department of Dermatology, Ente Ospedaliero Cantonale, Bel- further investigation. On clinical examination, we found a linzona nodulation of about 2 cm in the left half of the lower lip and an infiltrative plaque of right forearm. Laboratory tests such Introduction: Transverse nasal crease is a rare asymptoma- as blood count, liver function, renal function, autoimmune tic skin disease with a line or groove, which extends trans- balance and inflammatory parameters were in the normal versal between the upper two-thirds and the lower third of range. Serology for Quantiferon resulted negative. Serum the nose with or without milia and comedones. angiotensin converting enzyme (ACE) resulted in the nor- Case report: We report a case of two 9 years-old homozy- mal range. Thoracic and abdominal CT-scan showed no pa- gous female twins that presented from many years whiti- thological changes. We diagnosed a mucocutaneous sar- sh belt on the nose. The mother referred that at the level coidosis. At first, we treated the patient with Doxycycline of the lesion appear comedones and milia and during the 100 mg twice daily for three months without benefit. Then summer months, the lesion becomes more prominent. The we started a therapy with Hydroxychloroquine 200 mg girls have no habit of rubbing the nose and do not have al- twice a day with slow but continuous improvement. After 8 lergy and the patients are otherwise healthy. On examina- months, we had a complete regression of the lesions. tion, both the patients presented a linear hypopigmented Conclusion: Sarcoidosis can occur only with mucocu- with transversal distribution across the lower third of the taneous granulomas. Treatment of cutaneous sarcoido- nasal dorsum, featuring some milia at this level. The rest of sis depends on the extension, location, and the type of the dermatologic examination was unremarkable. lesions. Based on our experience, Hydroxychloroquine Discussion: In 1951, Cornbleet first described this kind of remains a good first choice therapy for the treatment of lesion. A transversal nasal crease can present with a wide mucocutaneous sarcoidal granuloma. clinical spectrum ranging from a faint erythematous line to a hypopigmented groove with a depth and width of several millimeter and is a localizing factor for milia, cysts and comedones. Transverse nasal crease is probably an POSTERS

52 Dermatologica Helvetica - Volume 32(6) - Août 2020 Neuer IL-23p19 Inhibitor

ILUMETRI® wird rückerstattet bei schwerer Plaque-Psoriasis* EINFACH** ANHALTEND*** EFFEKTIV***

Nur 1 Mal pro Quartal* Therapiestabilität über Jahre**

* Rückerstattungsinformationen zu Ilumetri® auf http://www.spezialitaetenliste.ch ** Nur eine Anwendung alle 12 Wochen in der Erhaltungstherapie. *** Therapiestabilität über Jahre: Reich K et al., Long-term efficacy and safety of tildrakizumab for moderate-to-severe psoriasis: pooled analyses of two randomised phase III clinical trials (reSURFACE 1 and reSURFACE 2) through 148 weeks., Br J Dermatol. 2019 Jun 19. doi: 10.1111/bjd.18232. [Epub ahead of print].

Ilumetri 100 mg/1 ml, Injektionslösung Z: Jede Fertigspritze enthält 100 mg Tildrakizumab. I: Behandlung erwachsener Patienten mit mittelschwerer bis schwerer Plaque-Psoriasis, die auf eine vorgängige konventionelle systemische Therapie und / oder PUVA unzureichend angesprochen haben oder bei denen eine Kontraindikation oder Unverträglichkeit gegenüber solchen Therapien besteht. D/A: Anwendung unter Anleitung und Aufsicht eines mit Psoriasis erfahrenen Arztes. Eine subkutane Injektion in den Wochen 0, 4 und danach alle 12 Wochen unter Beachtung der Hinweise in der Packungsbeilage. Dokumentation der verabreichten Chargennummer. KI: Überempfindlichkeit gegenüber Wirk- oder einem der Hilfsstoffe gemäss Zusammensetzung, bei klinisch relevanten aktiven Infektionen (z. B. aktive Tuberkulose). VM: Tildrakizumab kann das Risiko für Infektionen erhöhen, bei Patienten unter immunsuppressiver Therapie kann es zur Reaktivierung von latenten Infektionen kommen, bei Anwendung bei Patienten mit einer chronischen Infektion oder einer rezidivierenden oder kürzlich aufgetreten schweren Infektion in der Anamnese ist Vorsicht geboten. Ilumetri darf nicht angewendet werden bei Patienten mit einer aktiven Tuberkulose; vor Einleitung der Behandlung Patienten bezüglich einer Tuberkulose-Infektion beurteilen und während und nach der Behandlung auf Anzeichen und Symptome einer aktiven Tuberkulose überwachen. Ggf. ist vor Einleiten der Behandlung mit Ilumetri eine Anti-Tuberkulose-Therapie erforderlich. Psoriasis-Patienten, die zuvor eine UV-Therapie erhalten haben, sollten vor und während der Behandlung mit Ilumetri gründlich auf das Vorliegen von Hauttumoren untersucht werden. Komedikation mit anderen systemischen Immunsuppressiva, einschliesslich Biologika ist nicht zu empfehlen, Lebendimpfstoffe sollen nicht zeitgleich verabreicht werden. Vor Beginn der Behandlung mit Ilumetri ist die Vervollständigung aller gemäss aktueller Impfrichtlinien angezeigter Immunisierungen zu erwägen. SS/ SZ: Frauen im gebärfähigen Alter sollen während und für mindestens 17 Wochen nach der Behandlung eine zuverlässige Verhütungsmethode anwenden, als Vorsichtsmassnahme sollte die Anwendung von Ilumetri in der Schwangerschaft vermieden werden, während der Stillzeit kann ein Risiko für das Kind nicht ausgeschlossen werden. Ein Unterbrechen des Stillens oder der Behandlung mit Ilumetri muss evaluiert werden. UW: Sehr häufig: Infektion der oberen Atemwege, einschliesslich Nasopharyngitis, häufig: Kopfschmerzen, Gastroenteritis, Übelkeit, Diarrhoe, Schmerzen an der Injektionsstelle, Rückenschmerzen, UW < 1 % siehe www.swissmedicinfo.ch. P: 1 oder 2 Fertigspritzen mit 1 ml Injektionslösung à 100 mg. Abgabekategorie: B. Zulassungsinhaberin: Almirall AG, Alte Winterthurerstr. 14, 8304 Wallisellen. Ausführliche Informationen siehe Packungsbeilage oder www.swissmedicinfo.ch, Stand der Information:

CHTIL0463aDeSept2019 November 2018. Almirall AG, Alte Winterthurerstrasse 14, 8304 Wallisellen, Mail: [email protected]

almirall.ch underreported entity that often appears during childhood. Background: Facial moisturizers are commonly used by Familial cases have been reported, but not in twins, sug- healthy women and increasingly men of all age groups. gesting a genetic predisposition. Shelley et al. postulated Moisturizer use usually begins at puberty and is continued an embryological origin. It most likely occurs at the site indefinitely due to various factors, including the subjective of fusion of the frontonasal prominence and medial pro- perception of dry skin if moisturizers are not applied. minence, which represents an embryologic fault line. The Objectives: To investigate the effects of moisturizer dis- lesion is not associated with any other symptoms and ge- continuation and the temporal evolution of symptoms ari- nerally does not require any treatment. Our case of homo- sing subsequently. zygous twins with the identical transverse nasal crease and Methods: Two prospective observational split-face compa- milia support a genetic predisposition for embryological rison studies in Switzerland were performed and enrolled: development. (I) in winter 20 healthy females aged 17-25 years; and (II) in summer 36 females 15-20 and 40-55 years of age. All participants used facial moisturizers for at least 2 weeks. Moistu- P63 rizer treatment was stopped on the investigational half of Urticarial rash responding to nonsteroidal anti-inflam- the face. On the control side, the usual skin care regiment matory drugs (NSAID) - A clue to diagnose Schnitzler with the participants’ own moisturizer was continued. Daily Syndrome (SchS) subjective (I/II) and objective (I) skin assessments for the occurrence of typical symptoms of dry skin (dryness, it- Marbet C1, Junker T2, Blickenstorfer M1 ching, dandruff, redness, wrinkles) were collected. 1) Department of Dermatology, University Hospital Basel, Basel Results: In the winter study (I) in both, the subjective and ob- 2) Division of Hematology, University Hospital Basel, Basel jective assessment, a significant increase in all skin changes occurred within 1 day after discontinuation of moisturizer Case: A 59-year-old male was referred to our clinic with application. On day 7, dryness (p<0.001), itching (p<0.025), history of recurrent episodes of urticarial rashes for 5 years, redness (p<0.001) and sheds (p<0.049) were significantly lasting less than 24h. His medical history was notable for different in the subjective assessment and in the objective diabetes mellitus type 2; no known allergies. Evaluation of assessment redness (p<0.004) and sheds (p<0.001). Skin the skin showed multiple erythematous urticarial plaques dryness reverted to baseline levels after 6 days in the ob- on the patient’s trunk and extremities, no lymphadeno- jective and after 10 days in the subjective assessment. The pathy or mucosal involvement. He denied B symptoms and control side's condition was reached after 6 days. felt healthy, therefore chronic spontaneous urticaria was In the summer study (II), only among the 15-20-year-olds, diagnosed and treatment with increased antihistamine dryness was significantly higher on the intervention side dose up to 4x/day initiated. At follow-up, he reported no from day 1 (p<0.028) to day 14 (p<0.009). Their recovery improvement, but rather a worsening of symptoms. time was 11 days until dryness intensity scores comparable A thorough patient history was taken, fever and other sys- to baseline were reached, and a total of 21 days until the temic symptoms were denied, though he did experience control side’s values were matched. Over a 7-day period, malaise and developed ankle pains over time. He had the overall mean dryness score was significantly different also noted an improvement of symptoms after intake of between the interventional and control sides for both NSAID when suffering from intense rashes and increase of young and old participants. episodes when exposed to stress. Skin biopsy was taken, Conclusions: Both healthy young and aging persons react showing a dermal perivascular neutrophilic infiltrate wi- with typical symptoms of temporary dryness to a sudden thout vasculitis. Extensive bloodwork showed increased stop of a previous long-term moisturizer treatment but baseline CRP of 60mg/l, other laboratory test results, such regain normal levels quickly without continuation of mois- as blood count were negative. Immunoelectrophoresis re- turizers. The skin recovery time for skin dehydration is 1-3 vealed elevated kappa light chain M-Protein in serum and weeks in young females, with varying intensities depen- urine. Other immunoglobulins were normal, signifying a ding on the season. monoclonal IgM gammopathy. Based on his chronic urticarial rash, IgM kappa monoclonal gammopathy, neutrophilic infiltrate on skin biopsy and P65 elevated CRP, a diagnosis of SchS was made. Further hae- Canakinumab Lacks Efficacy in Treating Adult Patients matological investigation, including bone marrow biopsy with Moderate to Severe Chronic Spontaneous Urti- revealed a lymphoproliferative clone, consistent with caria in a Phase II Randomized Double-blind Place- Waldenstrom disease. Start of systemic treatment of SchS bo-controlled Single Centre Study with interleukin-1 antagonist anakinra is intended, accompanied by regular haematological controls. Maul JT1, Distler M1, Kolios A1, Maul LV2, Guillet C1, Graf N1, Discussion: SchS is a rare acquired autoinflammatory disor- Imhof L1, Lang C1, Navarini A2, Schmid P2 der with an average delay to diagnosis of 5-6 years. Urtica- 1) Department of Dermatology, University Hospital of Zürich rial rash is often the first symptom to appear. The overall 2) Department of Dermatology, University Hospital of Basel prognosis for the disease is dependent on the underlying lymphoproliferative disorder, occurring in 15-20%. While Introduction: Chronic spontaneous urticaria (CSU) is a com- antagonists of the interleukin-1 pathway such as anakinra mon disease with a significant proportion of patients that or canakinumab are considered first line treatment, NSAID do not respond to standard therapy with antihistamines can be given as symptomatic treatment for flares in lightly and optionally corticosteroids/immunosuppressants. The affected cases or as add-on to systemic therapy. IL-1β antagonist canakinumab is effective in cryopyrin as- In summary a positive response to the intake of NSAID in sociated periodic syndromes (CAPS) associated with urtica- urticarial rashes can be a clue for the presence of a SchS rial symptoms and urticarial vasculitis, so it was suspected rather than chronic spontaneous urticaria especially if that it could also be effective in patients with CSU. lacking response to antihistamines was reported. Methods: The effect of canakinumab was investigated in 20 patients with moderate to severe CSU in a 1:1 randomization to either canakinumab or placebo in a double-blind P64 single-dose crossover design. The verum group received Skin recovery after discontinuation of long-term moistu- 150 mg canakinumab subcutaneously once at baseline. rizer application: A split-face comparison study Patients who had received placebo were able to switch to canakinumab at week 4 if they did not improve. Primary Maul LV1*, Maul JT2*, Kägi M3, Cheng P2, von Laue M3, Chen endpoint was clinical UAS7 improvement at week 4 com- YY4, Kägi M5, Navarini AA1 pared to baseline. Secondary endpoints were the clinical *equal contributions UAS7 improvement at week 8 and the clinical improve- 1) Department of Dermatology University Hospital of Basel ment measured by the physician score and DLQI at week 2) Department of Dermatology University Hospital of Zurich 1, 2, 4, and 8. 3) University of Zurich, Faculty of Medicine, Zurich Results: At week 4 two patients with canakinumab and 4) University of Bern, Faculty of Medicine, Bern three with placebo met the primary endpoint so that ca- 5) Hautzentrum Zurich AG, Zurich nakinumab failed the significant superiority to the placebo POSTERS

54 Dermatologica Helvetica - Volume 32(6) - Août 2020 (p=1.0). An inclusion of the patients who switched to ca- mutation have been associated with AGEP, recently also IL nakinumab after four weeks did not alter the result. There 17 pathway has been postulated in the pathomechanism was also no significant difference between the verum and of AGEP. some published paper has supported this theory placebo groups for all secondary endpoints. The therapy with a responding cases to a biologic IL 17 inhibitor the- was well tolerated, and mild AEs were equally distributed rapy. between verum and placebo. We present a case of a 76 year-old patient, who developed Discussion: Due to this clinical trial with 20 patients, it must a severe a exanthematous sterile pustulosis after using an- be assumed that canakinumab has no effect on lesions of ti-malarial therapy hydroxychloroquine for his well known CSU. In conclusion, this suggests that IL1β may not play a disease Pseudo gout (CPPD) , we have admitted him to crucial role in pathology of CSU patients, unlike e.g. in he- our Ward , a skin biopsy supported our clinical diagnosis reditary fevers or urticarial vasculitis, where targeting IL 1 is (AGEP)and intensive local therapy wit cortisone has been a main treatment option. However, the good tolerability of initiated without response , followed with a systemic corti- canakinumab could be confirmed. sone therapy up to 80 mg /day , although the patient has slightly improved but the symptoms were not completely relieved. the patient has been discharged to be seen him in P66 outpatient clinic , in the same time the biologic IL 17 bloc- The Patient-Reported Burden of Atopic Dermatitis and ker (off label use) has been discussed with the patient . Its Association with Itch: Observations from the Upada- 13 days after discharge the patient came with again worse- citinib Phase 2b Randomized, Placebo-Controlled Trial in ning exanthematous pustulosis symptoms particularly af- Moderate-to-Severe Atopic Dermatitis ter discontinued systemic cortisone , we have started ixekizumab ( Tlatz) biologic initial dose 160 mg injection then Silverberg JI1, Calimlim B2, Teixeira HD2, Wu M2, Simpson EL3 after 2 weeks 80 mg injection , surprisingly the symptoms 1) George Washington University School of Medicine, Washington, were totally relieved after the second injection , we have DC, USA stopped Ixekizmab , at the follow-up the pat have been 2) AbbVie Inc., North Chicago, IL, USA seen which was satisfied and the symptoms are resolved . 3) Department of Dermatology, Oregon Health & Science Univer- As a supportive evidence we have back to our dermatopa- sity, Portland, OR, USA thology laboratory and we observed increased expression of IL 17 by immunohisochmeichal staning at the epidermis Introduction: Atopic dermatitis (AD) is a chronic, inflamma- of pre-treatment biopsy . tory skin disease that imposes a substantial patient-bur- To our knowledge and searching in literature IL 17 inhi- den. We characterize this patient-burden and its associa- bitors have been reported in treatment of a few cases of tion with itch. AGEP with secukinumab (cosentyx) , treatment with Ixeki- Methods: Data were analyzed from a phase-2b place- zumab is not mentioned . bo-controlled upadacitinib (UPA) trial in adults with moderate-to-severe AD (EASI≥16, BSA≥10%, IGA≥3; inadequately controlled by topical treatments or topical treatments P68 were medically inadvisable; n=167). Burden was charac- Pre-ulcerative leishmaniasis mimicking chilblains in a re- terized by standard and novel validated baseline outco- turning traveler me measures, including the ADerm-SS and ADerm-IS (11 symptom and 10 impact items, respectively; item score Nasri J, Cajacob L, Wirz E, Navarini AA, Maul LV ranges 0-10 with higher scores indicating worst symptoms/ Department of Dermatology, University Hospital Basel impact; n=45 at baseline). Pruritus NRS correlations and descriptive statistics within severity strata were assessed at Background: Cutaneous leishmaniasis (CL) is caused by Week 16. Missing data were excluded. protozoa of the genus Leishmania and typically manifested Results: At baseline, 41.9% (IGA=4) and 59.9% (EASI≥23) as multiple or single ulcers. Atypical lesions are rare, but were severe by clinician-reported outcomes; 79.4% can simulate a large variety of dermatological disorders. (POEM≥17) and 52.5% (pruritus NRS≥7) were severe by Case: A 65-year-old traveler returning from Spain and Por- patient-reported outcomes. Nearly all experienced itch tugal presented in winter to our department with a 6-week daily (95.2%); mean average pruritus NRS was 6.5. Non-it- history of acral, non-ulcerative, livid erythema on his right ch symptoms were also common and burdensome, with foot. Previously, three different doctors had diagnosed a high scores for Rash (97.8%, mean=6.1), Dry Skin (100%, bacterial soft-tissue infection, which did not respond to mean=6.0), Skin Flaking (93.3%, mean=5.6), and Skin topical and systemic antibiotics. Subsequently, a diagno- Pain (93.2%, mean=5.2). Many reported nightly sleep dis- sis of chilblains was made, which also did not respond to turbances (55.8%), with high scores for Difficulty Falling adequate treatment. Indeed, a punch biopsy taken at our Asleep (mean=5.6), Sleep Impact (mean=5.6), and Waking department demonstrated histological features that were Up At Night (mean=5.5). Patients experienced considerable compatible with chronic chilblains, namely papillar oe- emotional burden (Self-Consciousness [93.3%, mean=5.9]; dema and perivascular and eccrine-bound lymphocytic Embarrassment [91.1%, mean=5.8]; Sadness [84.4%, infiltrates. However, when the lesions developed ulcera- mean=5.3]). Itch was significantly correlated with ADerm- tion after 3 weeks, we reviewed the diagnosis and found SS/IS items (r≥0.80), Objective SCORAD (r=0.61), and EASI Leishmania amastigotes in a second biopsy. Leishmania (r=0.59), with positive relationships observed with higher major was confirmed by PCR. The patient then received a severity levels at Week 16. 28-day-therapy with 100 mg oral miltefosine and is reco- Conclusion: The extensive patient-burden of AD includes vering slowly. multiple symptoms impacting many different aspects of Discussion: Leishmaniasis is transmitted by the bite of in- day-to-day life. fected sandflies belonging to either Phlebotomus spp. (Old World) or Lutzomyia spp. (New World). The subspecies of the Old World (e.g. L. major, L. tropica) are typically located in P67 Central Asia, the Middle East and North Africa, but due to cli- Interleukin 17 Inhibitor (Ixekizumab) as therapeutic tar- mate change have spread northward. As the most common get of therapy resistant acute generalized exanthema- clinical manifestation of CL is the ulcero-crusted type (40%), tous pustulosis (AGEP) most clinicians are considering CL when presented with ulcerated papules. However, because the temporal evolution Munshi M, Heidemeyer K, Gadaldi K, Yawalkar N of CL skin changes includes a pre- or non-ulcerative form Department of Dermatology, Bern University Hospital, Bern that presents as pink papules, nodules and plaques with central softening, CL must be considered in patients with Acute generalized exanthematous pustulosis (AGEP) a po- potential exposure. Less common are mucocutaneous, tentially life threatening drug reacting ,the culprit medica- lupoid, and sporotricoid types. The differential diagnoses tion such as anti-microbial , calcium channel blocker and include insect bites, mycobacteriosis, granuloma annulare, anti-malarial has been documented. chilblain-lupus and cutaneous lymphoma. PCR from a skin The pathophysiological mechanism still not clear so far, biopsy is the current gold standard for the diagnosis of CL genetically HLA-B5, -DR11 and -DQ3 and IL 36 RN gene with a 100% specificity and a sensitivity of above 92%. POSTERS

Dermatologica Helvetica - Volume 32(6) - Août 2020 55 Conclusion: CL has become one of the neglected tropical cutaneous anaplastic large cell lymphoma was made. diseases. The large clinical polymorphism of CL may result Ciclosporin was stopped and a treatment with me- in delayed diagnosis. We suggest that cutaneous leishma- thotrexate 7.5mg sc /week, in combination with superficial niasis should be considered in the differential diagnosis of radiotherapy for the right foot (3x4 and 3x2 Grey) was ini- chilblains in patients returning from Southern Europe. tiated. Discussion: Primary cutaneous anaplastic large cell lymphoma (pcALCL) is a CD30+ lymphoproliferative disorder, P69 which usually affects elderly patients and has a good pro- Linear IgA bullous dermatosis of childhood gnosis. Typically, pcALCL presents as isolated, reddish, rapid growing nodules, with a tendency for ulceration, but Nasri J, Schellin D, Jungo P, Blickenstorfer B, Mühleisen B, Na- the clinical diagnosis may be challenging, when solitary varini AA, Roider E ulcerated lesions are the leading presentation. The etiolo- Department of Dermatology, University Hospital Basel gy of pcALCL is unclear; some drugs, such as ciclosporin, seem to provoke disease progression. Spontaneous hea- Background: Linear IgA bullous dermatosis of childhood ling can occur in up to a fifth of the cases, however treat- (LABDC), also known as benign chronic bullous childhood ment with excision or radiotherapy is recommended for dermatosis, is a rare chronic autoimmune disease, charac- solitary lesions and systemic therapy is recommended for terized by linear deposits of IgA autoantibodies against advanced disease. For multifocal or systemic disease, the different antigens of the basement membrane. recommended first-line-treatment is methotrexate. The Case: A 4-year-old boy presented with a 5-week history of antibody-drug conjungate Brentuximab vedotin (BV) is ap- blistering on his face, hands, knees and feet. Prior, he had proved for refractory pcACLC, still, the observed response been treated with antibiotics for bullous impetigo without in pcACLC patients was 43.8% better with BV than treat- improvement. Examination revealed multiple erythema- ment of physicians’ choice, and thus should be considered tous, partly crusted nodules, bullae and plaques on the as first line therapy in advanced cases [1-6]. dorsum of his hands and feet, knees, perioral and the gluteal region. Further differential diagnoses included bullous hand-foot-and-mouth disease and linear IgA dermato- P71 sis. Histology showed subepidermal blisters containing Retrospective analysis of blood parameters in psoriasis neutrophils and eosinophils, supporting the clinical dia- patients under different classes of biologics as compared gnosis of LABDC. While DIF confirmed the diagnosis, revea- to Methotrexate ling linear IgA deposition at the dermoepidermal junction, serology for IgA was negative. Most recently, treatment Nidegger A, Conrad C was initiated with dapsone at 0.5 mg/kg bodyweight. Department of Dermatology and Venereology, University Hospital Discussion: LABDC is a rare dermatosis with an incidence CHUV, Lausanne of 1:500’000 and mainly occurs in children aged between 2-5 years. The dermatosis presents with vesicles and firm Background: Over the past two decades, the management blisters in an annular distribution, which may arise on the of psoriasis has fundamentally changed. Thanks to the in- margin of former lesions. Other clinical signs are erythe- creasing knowledge of its pathogenesis, more targeted matous papules and excoriated plaques. Typically, the treatments have been developed. These biologics, most- lesions are located on the abdomen, the gluteal region ly antibodies targeting the pathogenic TNF/IL-23/IL-17- and the face, sometimes also the oral mucosa and extre- pathway, were shown to be highly effective. The long-term mities. Histopathology shows subepidermal bullae with a side effects of biologic drugs are still unknown, however neutrophilic infiltrate in the dermis. Linear IgA deposition their safety and tolerability appears to be remarkable along the basement membrane can be detected by DIF in across the years. However, evidence-based guidelines have normal and perilesional skin. Serology is negative in about still not been clearly defined with regard to laboratory mo- two thirds of the children. Although considered idiopathic, nitoring of treated patients and only few studies have been LABDC may be triggered by antibiotics and anti-inflam- conducted in real-life patients. matory drugs. Dapsone is the treatment of choice and is Objective: To collect data on psoriasis patients receiving sufficient as monotherapy in most cases. Due to potential biologics and to compare trends over time in hematology side effects, combination therapy is frequently needed. An and blood chemistry. Representative antibodies of all three average treatment duration of 4 years has been reported. biological classes were chosen, specifically Adalimumab Conclusion: LABDC is a rare autoimmune bullous disease, (Humira®, anti-TNF), Ustekinumab (Stelara®, anti-IL-12/23), often confused with similar diseases, which may lead to a and Secukinumab (Cosentyx®, anti-IL-17). Results were delay in diagnosis and treatment. LABDC should be consi- compared to patients receiving methotrexate. The rele- dered in the differential diagnosis of children with symp- vance and necessity of frequent laboratory investigations toms of hand-foot-mouth disease and bullous impetigo. in monitoring patients with psoriasis are evaluated. Methods: Retrospective analysis of blood values, which were measured before treatment initiation, after 3, 6, 12, P70 18, and 24 months (depending on availability). A total of The truth behind Pyoderma gangrenosum 351 patients suffering from psoriasis were enrolled. Results: These analyses revealed no worrying shifts of Neff A, Ramelyte E, Kolm I, Messerli O, Dummer R, Hafner J blood values among patients receiving biologics over time, Department of Dermatology, University Hospital Zürich abnormal values were mostly self-limiting, and no cases of severe laboratory abnormalities were detected in the bio- Case-Report: A 69-year-old male was referred to our depart- logics group. The changes in mean values remained within ment with a progressive ulceration on the arch of his right the normal reference range. foot, which started one month ago. Due to Pseudomonas Conclusion: The long-term side effects of biologic drugs aeruginosa in the superficial swab, systemic and topical an- remain unknown. However, there is little evidence for an tibiotic treatment was conducted. As the ulceration did not accumulation of side effects with increasing treatment improve, a biopsy was taken, which showed an unspecific duration. Our results are reassuring in regard to the safety inflammation. Based on clinical presentation and unspeci- profiles of biologic drugs in real-life patients. Reducing fre- fic histology, a diagnosis of pyoderma gangrenosum was quent laboratory analyses to 6 or even 12 months intervals made. Systemic treatment with ciclosporin at 3mg/kg was are sufficient and cost-saving when following psoriasis pa- initiated, under which, the lesion on the right food pro- tients receiving biologics. gressed and new erythematous nodules developed on the right shin, scrotum, palmar and pectoral areas. Extensive blood work-up did not show abnormalities. Biop- sies from newly developed lesions demonstrated a dense, dermal syringotropic lymphocytic infiltrate of large atypical CD30+ lymphocytes. FDG-PET/CT revealed metaboli- cally active lymph nodes in the right groin. Diagnosis of a POSTERS

56 Dermatologica Helvetica - Volume 32(6) - Août 2020 P72 3) Department of Dermatology, Icahn School of Medicine at Treatment strategies for patients with plaque psoriasis Mount Sinai, New York, USA who respond inadequately to certolizumab pegol during 4) Oregon Medical Research Center, Portland, Oregon, USA the first 16 weeks of treatment 5) Institute and Comprehensive Center for Inflammation Medicine, University of Lübeck, Lübeck, Germany Warren RB1, Lebwohl M2, Piguet V3, Sofen H4, Blauvelt A5, Brock 6) Centre de Recherche Dermatologique du Québec Métropoli- F6, Arendt C7, Boehnlein M8, Augustin M9 tain, Québec, Canada 1) The Dermatology Centre, Salford Royal NHS Foundation Trust, 7) UCB Pharma, Monheim, Germany University of Manchester, Manchester, UK 8) UCB Pharma, Slough, UK 2) Icahn School of Medicine at Mount Sinai, New York, USA 9) UCB Pharma, Brussels, Belgium 3) Cardiff University and University Hospital of Wales, Cardiff, UK 10) Translational Research in Inflammatory Skin Diseases, Institute 4) David Geffen School of Medicine at UCLA, Los Angeles, Califor- for Health Services Research in Dermatology and Nursing, Univer- nia, USA sity Medical Center Hamburg-Eppendorf, and Skinflammation® 5) Oregon Medical Research Center, Portland, Oregon, USA Center, Hamburg, Germany 6) UCB Pharma, Slough, UK 7) UCB Pharma, Brussels, Belgium Background: The Fc-free, PEGylated anti-tumour necrosis 8) UCB Pharma, Monheim, Germany factor certolizumab pegol (CZP) has demonstrated effi- 9) Institute for Health Services Research in Dermatology and Nur- cacy and safety in moderate-to-severe plaque psoriasis sing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), (PSO).1,2 Here, we report long-term response in patients Hamburg, Germany with PSO receiving CZP 400 mg every two weeks (Q2W) for up to 128 weeks. Background: Certolizumab pegol (CZP) is an Fc-free, PEGy- Data were pooled from the CIMPASI-1 (NCT02326298), lated, anti-tumour necrosis factor agent approved by the CIMPASI-2 (NCT02326272) and CIMPACT (NCT02346240) EMA for moderate-to-severe plaque psoriasis (PSO). It is im- phase 3 trials in adults with PSO ≥6 months (PASI portant to understand long-term PSO treatment strategies. ≥12/≥10% BSA-affected/PGA ≥3); study designs have been We present clinical responses over three years’ CZP treat- reported.1,2 This analysis includes patients randomised to ment in patients with PSO who showed inadequate res- placebo at Week 0 who did not achieve Week 16 PASI50 ponses (<75% improvement from baseline in PASI [PASI75]) and entered an open-label CZP 400 mg Q2W escape arm after 16 weeks’ (wks’) CZP treatment. for up to 128 weeks. Dosing adjustment to CZP 200 mg Methods: The phase 3 CIMPACT trial (NCT02346240) en- Q2W was permitted from Week 48 based on PASI response rolled adult patients with PSO ≥6 months (PASI ≥12, BSA and Investigator discretion. We report PASI75, PASI90, ≥10%, PGA ≥3 on a 5-point scale). Patients were rando- PGA0/1, and DLQI0/1 through 128 weeks’ CZP treatment. mised 3:3:1:3 to double-blinded CZP 200mg every 2 wks Responder rates are based on a logistic regression model, (Q2W) (400mg at Wks0/2/4), CZP 400mg Q2W, placebo with missing data imputed using Markov Chain Monte Car- Q2W for 16 wks, or etanercept 50mg twice per wk for 12 lo methodology. wks. At Wk16, PASI75 non-responders entered an open-la- Results: 116 placebo-randomised patients entered the CZP bel escape arm receiving CZP 400mg Q2W to Wk144. 400 mg Q2W escape arm. Following 16 weeks’ CZP 400 mg Between Wks48–144, dose adjustment to CZP 200mg Q2W treatment, 76.7%/48.6% achieved PASI75/PASI90; Q2W was permitted based on PASI response/Investigator after 128 weeks’ CZP, responder rates were 75.0%/58.1%. discretion. Patients who did not achieve PASI50 after ≥12 Of the patients who achieved PASI75 after 16 weeks’ CZP wks’ open‑label CZP treatment were withdrawn. We report treatment, 64.7% also achieved PASI90; 80.6% of these pa- PASI75 and PASI90 responder rates for patients initially ran- tients still achieved PASI75 after 128 weeks’ CZP, and 65.7% domised to CZP 200mg Q2W or 400mg Q2W who entered achieved PASI90. Similar trends were reported for DLQI0/1 the escape arm at Wk16. Responder rates were estimated and PGA0/1. using a logistic regression model, and missing data im- Conclusions: Response to CZP 400 mg Q2W was durable puted using the Markov Chain Monte Carlo method. over 128 weeks. Results: 48/159 (30.2%) CZP 200mg Q2W-randomised patients who reached Wk16 did not achieve PASI75 and entered the escape arm. At Wk48 (32 wks’ open-label CZP 400mg P74 Q2W treatment), 58.7% of these achieved PASI75, rising Durability of response with bimekizumab, a selective in- to 72.5% at Wk144 (128 wks’ CZP 400mg Q2W treatment); terleukin-17A and -17F dual inhibitor, in moderate-to-se- 26.0% achieved PASI90 at Wk48 and 38.0% at Wk144. 38/162 vere chronic plaque psoriasis: a 60-week phase 2b study (23.5%) CZP 400mg Q2W-randomised patients who reached (BE ABLE 2) Wk16 did not achieve PASI75; 36 (22.2%) entered the escape arm. At Wk48 (48 wks’ continuous CZP 400mg Q2W treat- Blauvelt A1, Merola JF2, Papp KA3, Gooderham M4, Gottlieb AB5, ment), 78.6% of these achieved PASI75, rising to 79.3% at Cioffi C6, Peterson L7, Cross N7, Griffiths CEM8, Thaçi D9 Wk144; 36.2% achieved PASI90 at Wk48 and 41.6% at Wk144. 1) Oregon Medical Research Center, Portland, Oregon, USA Conclusions: These data support dose escalation as an 2) Department of Dermatology and Department of Medicine, Di- effective treatment strategy for patients displaying an vision of Rheumatology, Brigham and Women's Hospital, and Har- inadequate response after 16 wks’ initial CZP 200mg vard Medical School, Boston, Massachusetts, USA Q2W treatment, with positive mid- and long-term outco- 3) Probity Medical Research, K. Papp Clinical Research, Waterloo, mes. For patients showing inadequate initial responses and University of Toronto, Toronto, Ontario, Canada 4) Skin Centre for Dermatology, Probity Medical Research, Peterbo- to CZP 400mg Q2W, continuation at the same dose may rough, and Queen’s University, Kingston, Ontario, Canada lead to durable PASI75 and PASI90 responses over time. 5) Department of Dermatology, Icahn School of Medicine at Acknowledgements: This study was funded by Dermira Inc. Mount Sinai, New York, USA in collaboration with UCB Pharma. Medical writing support 6) UCB Pharma, Brussels, Belgium was provided by Costello Medical, funded by UCB Pharma. 7) UCB Pharma, Raleigh, North Carolina, USA 8) Dermatology Centre, Salford Royal Hospital, University of Manchester, Manchester, UK P73 9) Comprehensive Center for Inflammation Medicine, University of Durable efficacy of certolizumab pegol dosed at 400 mg Lübeck, Lübeck, Germany every two weeks over 128 weeks in patients with plaque psoriasis enrolled in three phase 3 trials (CIMPASI-1/-2 Background: Bimekizumab provided substantial clinical and CIMPACT) improvements and was generally well tolerated in patients with moderate-to-severe plaque psoriasis in the 12-week K. Gordon,1 R.B. Warren,2 A.B. Gottlieb,3 A. Blauvelt,4 D. Thaçi,5 randomised, double-blinded phase 2b BE ABLE 1 study Y. Poulin,6 M. Boehnlein,7 F. Brock,8 C. Arendt,9 K. Reich10 (NCT02905006); responses were maintained for 48 additio- 1) Department of Dermatology, Medical College of Wisconsin, nal weeks (60 weeks’ total exposure) in the BE ABLE 2 exten- Milwaukee, Wisconsin, USA sion study (NCT03010527).1,2 We report post-hoc analyses 2) Dermatology Centre, Salford Royal NHS Foundation Trust, of response durability with bimekizumab. Manchester NIHR Biomedical Research Centre, The University of Methods: BE ABLE 1 PASI90 responders (≥90% reduction in Manchester, UK POSTERS

Dermatologica Helvetica - Volume 32(6) - Août 2020 57 Psoriasis Area Severity Index at Week 12) receiving bimeki- of PP, although genetic predisposing factors have also been zumab Q4W 64 mg or 160 mg (±320 mg loading dose [LD]) discussed. Although light microscopy findings have been continued the same treatment in BE ABLE 2. All patients often incorrectly interpreted as being nonspecific and not previously receiving bimekizumab Q4W 320 mg or 480 diagnostic, clinical features, the chronological sequence of mg received Q4W 320 mg. Sustained PASI90 and PASI100 the lesions, the course of the disease are strikingly similar responses, defined as PASI90/PASI100 response observed and unique. Therefore, proper clinicopathological correla- at all study visits from Week 12 through Week 60 (non-res- tion is crucial to make the diagnosis of PP. Oral administra- ponder imputation), were assessed in Week 12 PASI90/ tion of doxycycline often yields an PASI100 responders, respectively. Intent-to-treat analyses excellent response. were conducted for PASI90. Results: At Week 12 (BE ABLE 2 baseline), 133/180 (73.9%) bimekizumab-treated patients were PASI90 responders. P76 At Week 60, 80.5% (107/133) of these responders had sus- Acquired Epidermodysplasia Verruciformis in a Lung tained PASI90 responses. The results for individual dose Transplanted Patient groups were: bimekizumab 64 mg à 64 mg 14/15, 93.3%; 160±320 mg LD à 160 mg 41/55, 74.5%; 320 mg à 320 mg Papageorgiou K, Nägeli M 26/33, 78.8%; and 480 mg à 320 mg 26/30, 86.7%. Among Department of Dermatology, University Hospital Zürich Week 12 PASI100 responders (86/180, 47.8%), 54/86 (62.8%) patients sustained PASI100 responses through Week 60, Background: Epidermodysplasia verruciformis (EV) is a with a response pattern across dose groups consistent with rare genodermatosis characterized by depressed cell-me- PASI90. Intent-to-treat analyses showed higher responses diated immunity and a highly susceptibility to infection with bimekizumab 320 mg versus 160 mg. with certain human papillomavirus, called EV-HPV, with a Conclusions: Across dose groups, PASI90 responses were consequent high risk for early development of skin can- sustained to Week 60 in 80.5% of patients who achieved cers. Recently, the term "Acquired Epidermodysplasia PASI90 at Week 12, demonstrating high-level, durable effi- Verruciformis" is used in the Literature to describe EV-like cacy with bimekizumab treatment. Lesions in immunosuppressed Patients mostly with HIV, or- References: 1. Papp K et al. J Am Acad Dermatol gan-transplantation and in the setting of graft-versus-host 2018;79:279–286. 2. Blauvelt A et al. Oral presentation at disease. AAD 2019, 1–5 March 2019, Washington DC, USA. Case Report: A 42 years old immunosuppressed, since 20 Acknowledgments: The study was funded by UCB Pharma. years lung transplanted patient presents with polymorphic The authors would like to acknowledge Jessica Gamage cutaneous lesion, including red, squamous pityriasis-versi- PhD CMPP, of iMed Comms, an Ashfield Company, part of color like macules and flat wart-like papules on the upper UDG Healthcare plc, for medical writing support that was dorsal trunk, neck, face, arms and thorax; and elevated, red funded by UCB Pharma in accordance with Good Publica- verrucous papules on dorsal hands and knees. The clinical tion Practice (GPP3) guidelines. The authors thank the pa- manifestation exists with different expansion since 14 years. tients and their caregivers who contributed to this study, as Clinical course: The initial manifestation was 20 years be- well as the investigators, their teams and the UCB Pharma fore with pityriasis-versicolor like macules on the neck, up- BE ABLE 2 clinical team. per trunk and erythematous macules on the arms, as well verrucae vulgare on the dorsal hands and erythematous papules on the knees. During the treating-process were ap- P75 plied different therapies with only partial response, recur- Prurigo pigmentosa in Switzerland: demographics and rence or new lesions. In 2007 was diagnosed a HPV-asso- characteristics of 14 patients ciated M. Bowen on the right upper arm; HPV-PCR was not performed. In the clinical course there was an expansion of Page G, Page B, Beltraminelli H, Schlapbach C, Borradori L the clinical manifestation on the upper trunk, neck, thorax Department of Dermatology Inselspital, Bern University Hospital, and face. A biopsy from a neck lesion was typical for epi- University of Bern dermodysplasia verruciformis. In PCR was detected HPV 5. Discussion: Background: Prurigo pigmentosa (PP) is a rare acquired in- • Immunosuppressed patients are more susceptible to flammatory skin disease characterized by recurrent crops HPV types that cause EV and are considered to be non of pruritic papulovesicles that resolve with a reticulated pathogenic to the general. This emphasize the impor- pattern of hyperpigmentation. Various factors may play a tance of cell-mediated immunity in resistance to the triggering role, including dietary regimen. Most cases have HPVs that cause EV. The most common HPVs subtypes been reported in young Asian women. Nevertheless, a nu- found in acquired EV, are HPVs 5 and 8 like in inherited mber of PP cases have been also described in Caucasian EV. patients. Here we report 14 Swiss cases of PP observed in • The inherited and acquired EV show similarities in clini- our tertiary referral center. cal and histopathological findings. The histopathologi- Methods: We identified 14 patients with PP, which were cal features include hyperkeratosis, mild acanthosis, and evaluated in our tertiary referral center between 2013 to vacuolated cells in the upper epidermis and demonstra- 2020. The clinical information was retrospectively collected tion of HPV in the skin lesion. from medical records. Results of light microscopy studies of • There is no standardized therapy. Several approaches skin biopsy specimen were available in 10 patients. with topical and systemic agents have been tried. The Results: The age at the time of diagnosis ranged from 17 to clinical outcome was variable. After a regression of the 43 years (mean age: 29.4 years), while the female to male ra- lesion, came oft to recurrence or growth of new lesions. tio was 13:1. The cutaneous eruption was almost invariably • Most used therapies are: topical: retinoid, steroid, im- characterized by recurrent pruritic erythematous-brown munomodulators (imiquimod), cryotherapie and elec- papules, sometimes with vesicles and pustules. Lesions trosurgery; Systemic: Retinoid, Interferon a; combined progressively resolved and resulted in a reticulated pattern therapies: IFN-a with zidovudine, Imiquimod with oral of postinflammatory hyperpigmentation. The most com- isotretinoin, photodynamic therapy with oral retinoids. monly affected parts of the body included the back and the • Better Results are shown with combined approaches. breast area. In 7 (50%) of 14 cases there was a chronological There is only a case report of a renal transplantated relationship between initiation of a new diet plan and the patient with acquired epidermodysplasia verruciformis first cutaneous flares. Histopathological analyses predomi- with response after combined therapy with Gardasil nantly showed a perivascular inflammatory infiltration of vaccination, topical imiquimod 5%, topical tretinoin the upper dermis, variably composed of neutrophils and 0.05% and oral acitretin at 10mg daily. eosinophils. In 10 (71%) of 14 patients, the introduction of • The main aim of EV treatment is to avoid the malignant oral doxycycline resulted in a complete control of the cu- transformation of the lesions. The use of sunscreen and taneous lesions. consequent skin examination is recommended for all Conclusions: Based on our observations, PP is most likely patients. The risk of progression to malignancy in the underdiagnosed in Caucasian patients. Ketosis caused by immunosuppressed patient remains unknown, al- fasting or dieting has been implicated in the pathogenesis though likely. POSTERS

58 Dermatologica Helvetica - Volume 32(6) - Août 2020 BEHANDLUNG TROCKENER HAUT BEI GEWISSEN DERMATOSEN wie z.B. Ichthyosis 1, atopische Dermatitis 2, Altershaut 3, diabetischer Fuss 4, urämische Xerosis 5

Wiederherstellung der Hautbarriere 1 Ausgezeichnete Verträglichkeit und kosmetische Akzeptanz 5 Sicher und an eine Langzeitbehandlung angepasst 1 Ohne Lanolin, ohne Duftsto e

Kurzfachinformation DEXERYL® Creme Z: Glycerolum, Vaselinum album, Para num liquidum. I: Trockene Haut bei gewissen Dermatosen, z.B. Ichthyose. D: Zweimal täglich oder bei Bedarf öfter. KI: Überempfi ndlichkeit gegen einen der Inhaltssto e. VM: Nicht schlucken. Nicht auf infi zierten Wunden anwenden. Beim Stillen wird empfohlen, die Brust auszulassen. IA: Es liegen keine Studien vor. UAW: Gelegentlich: Urtikaria, Rötung, Juckreiz. Vereinzelt Ekzeme. Liste D, 50 g SL (LIM 10), 250 g SL (LIM 30). Ausführliche Informationen unter www.swissmedicinfo.ch. Pierre Fabre (Suisse) SA, 4123 Allschwil. 03/2017 vs.02 (1) C Blanchet-Bardon et al. Association of glycerol and para n in the treatment of ichthyosis in children: an international, multicentric, randomized, controlled, double-blind study. J Eur Acad Dermatol Venereol. 2012; 26(8): 1014-9. (2) GS Tiplica et al. Prevention of fl ares in children with atopic dermatitis with regular use of an emollient containing glycerol and para n: a randomized controlled study. Pediatr Dermatol. 2017; 34(3): 282-89. (3) A Cristaudo et al. E cacy of an emollient dermoprotective cream in the treatment of elderly skin a ected by xerosis. G Ital Dermatol Venereol. 2015; 150(3): 297-302. (4) J Martini et al. E cacy of an emollient cream in the treatment of xerosis in diabetic foot: a double-blind, randomized, vehicle-controlled clinical trial. J Eur Acad Dermatol Venereol. 2017; 31(4): 743-47. (5) E Balaskas et al. Randomized, double-blind study with glycerol and para n in uremic xerosis. Clin J Am Soc Nephrol. 2011; 6(4): 748-52.

DE X-181115 - CH - DE

SKIN EXPERTISE IN OUR DNA P77 Background: Mycetoma is a chronic subcutaneous granu- Mucosal side effects in patients treated with topical imi- lomatous infection caused by fungi or aerobic bacteria. quimod – a case report and review of the literature Neoscytalidium dimidiatum is a saprophytic dematiaceous fungus, which can be isolated from soil and plant tissues Parlar B, Hammerl V, Navarini A, Mueller S and is predominantly found in tropical and subtropical en- Department of Dermatology, University Hospital Basel vironments worldwide. This fungus has been described as an agent causing chronic superficial infection in skin and Imiquimod 5% is approved for topical treatment of actinic nails, with the soles as the most frequent sites of invasion. keratosis (AKs), superficial basal cell carcinoma and condy- On rare occasions, N. dimidiatum may result in deep or in- lomata acuminata, the 3.75% formulation only for the vasive infections. treatment of AKs. Furthermore, imiquimod has also been Case description: A 53-year-old woman with a previous li- used off-label in various other skin conditions (e.g. Bowen`s ver transplant and immunosuppressioned with tacrolimus disease, lentigo maligna, vulvar intraepithelial neopla- presented with a painful, violaceous nodular lesion on the sia) including pediatric patients. As a toll-like receptor 7/8 plantar aspect of the right foot which appeared 2 weeks af- (TLR7/8) agonist imiquimod induces a local inflammato- ter a trip to Sri Lanka. Light microscopy analysis of a biopsy ry response through increased production of cytokines, specimen showed massive granulomatous and partially co-stimulatory molecules, by activation of Nk-cells and an- abscessing inflammatory infiltrates as well as compact ac- tigen-specific T-cells. In addition to imiquimod-associated cumulations of numerous fungal hyphae which were po- adverse effects at non-application sites such as fever, verti- sitive in the periodic acid–Schiff (PAS) stain. A PCR analysis go or myalgia there have been anecdotal reports of distant of the skin biopsy tissue showed amplification of N. dimi- inflammatory mucosal reactions - a side effect not declared diatum DNA. The patient was given oral voriconazole for 4 in the medicinal product information. We present the case months, with complete regression of symptoms. of a 87-year old female patient with severe oral and la- Discussion / Conclusion: Our patient presented with a bial reactions following application of imiquimod 3.75% plantar mycetoma caused by N. dimidiatum, a very rare for treatment of AKs. She denied accidental transferral of and diagnostically challenging infection in Switzerland. For imiquimod for example by licking fingers following appli- the purpose of rapid diagnosis and initiation of appropriate cation, lesional PCR for herpes simplex and bacteria was therapy, clinicians should be aware of this disease, particu- negative. The patient was treated with rituximab for chro- larly in immunosuppressed patients who have recently tra- nic lymphatic leukemia (CLL). Histological findings showed veled to tropical and subtropical areas. a cutaneous vascular inflammatory reaction without evidence of CLL infiltrates. The lesions resolved with topical hydrocortisone acetate 0.5% suspension. Our case report P80 is complemented with a pathophysiological rational that Novel mutation in mccune-albright syndrome – a case is based on a comprehensible review of the literature that report yielded a total of 8 additional cases. Pelzer C, Saulite I,CozzioA Department of Dermatology, Venerology and Allergology, Kan- P78 tonsspital St. Gallen, St. Gallen Homeodomain only protein X (HOPX) has an oncogenic activity during squamous skin carcinogenesis. A 40 year old woman was admitted to the dermatology department for skin screening to check for psoriasis of the skin Pavlova O1, Lefort K2, Huber M1, Hohl D1* due to joint pain with MCP III synovitis classified as possible 1) Department of Dermatology and Venereology, University Hos- psoriatic arthritis. Up on clinical examination no psoriatic le- pital Centre (CHUV), Lausanne sions were found, but the patient had a striking discoloration 2) Department of Biochemistry, University of Lausanne (UNIL), of her torso and arms (coast of Maine café au lait macules), as Lausanne well as oral lentiginosis. Further investigation showed a history of precocious puberty at the age of 7 and the previous Background: Cutaneous squamous cell carcinomas removal of a “mandibular cyst” which histologically proofed (cSCC) are frequent heterogeneous tumours, arising from to be fibrous dysplasia. McCune Albright Syndrome (MAS) sun-exposed regions of the skin and characterized by was suspected and genetic testing was performed. complex pathogenesis. HOPX is a member of the homeo- MAS is characterized by a somatic mutation of the GNAS1 domain-containing superfamily of proteins, holding an aty- gene coding for a G-protein, which is then constitutively pical homeodomain unable to bind DNA. First discovered active. The most frequent mutation is R201 (R/C). Here we in the heart as a regulator of cardiac development, in skin present a novel mutation of the GNAS gene that to our HOPX modulates terminal differentiation of keratinocytes. knowledge, has not yet been reported. Genetic testing of There is a particular interest in studying HOPX in squamous the GNAS gene showed two novel mutations (c.1406C>A skin carcinogenesis since it has the atypical structure and p.(Pro469Gln) and c.2005A>C p.(Ile669Leu)), one of which the functional duality as an oncogene and a tumour sup- is present as a mosaic in 12% of the tested cells (skin pressor gene, reported in different malignancies. biopsy). Due to the associated pathological conditions the Methods: we analysed the effects of HOPX-knockdown and patient was screened and breast cancer (unilateral, Her-2 overexpression on SCC tumorigenicity in vitro and in vivo. negative, ER 100%, PR 80%) as well as pituitary adenoma Results: our data demonstrate that HOPX-knockdown in were found. We therefore emphasize the importance of SCC cells inhibits their proliferative and invasive activity diagnostic steps when recognizing a “Coast of Maine” pig- through the acceleration of apoptosis. We established that mentation pattern, even in older adults. methylation of two alternative HOPX-promoters leads to differential expression of HOPX-transcripts in normal keratinocytes and SCC cells. P81 Conclusions: we report that HOPX acts as an oncogene in Rapid progression of a transformed mycosis fungoides the pathogenesis of SCC probably via activation of the second alternative promoter, and modulation of apoptosis. Punchera J, Wuthrich H, Bogiatzi S, Gilliet M, Hohl D, Gaide O, Guenova E Department of Dermatology and Venereology, University Hospital CHUV, Lausanne P79 Mycetoma caused by Neoscytalidium dimidiatum: suc- Cutaneous T-cell lymphomas (CTCLs) are a heterogeneous cessful outcome with voriconazole therapy group of non-Hodgkin lymphomas arising from the malignant proliferation of skin-homing or skin resident T-cells. Pelloni LS, Schlapbach C, Feldmeyer L Mycosis fungoides (MF) represents the most common sub- Department of Dermatology, Inselspital, Bern University Hospital, type of CTCL and accounts for approximately 60% of all University of Bern CTCL cases. POSTERS

60 Dermatologica Helvetica - Volume 32(6) - Août 2020 Large cell transformation (LCT) in MF is defined by the his- and less frequently as an allergen. The results of our obser- tological presence of at least 25% large (at least four times vation during the time of covid 19 support the diagnosis of larger than a normal lymphocyte), atypical often CD30+ ICD in HCW using these hand sanitizers. ICD has an impor- tumor lymphocytes. LCT is associated with an aggressive tant impact on the hygiene regimen. In a French study, 52% clinical course and poor prognosis of MF. of the HCW with hand dermatitis stopped or decreased Here we present a patient with aggressive and rapidly the use of hand sanitizers to limit the irritation. Multiple progressing MF stage IIB with LCT. The disease manifested consensus and tips for prevention of the skin and mucous initially with limited skin involvement encompassing a few membranes barrier were published to help HCW fighting superficial annular plaques on the flanks. However, only against covid 19. within a few months, a foudroyant evolution and sudden Conclusion: During this pandemic, the risk of hand derma- development of multiple infiltrated and ulcerated tumor titis was aggravated, since the recommendation of hygiene plaques and nodules resulted in 70% disease affected body to fight against the viral infection propagation was unavoi- surface area and an mSWAT score of 107 points. Histologi- dable. This occupational dermatosis is the most seen at the cal analysis revealed LCT and a CD30+ expression in >30% HCW, and have a significant impact since it can reduce the of the lymphocytic infiltrate. Following treatment recom- effective workforce, and lack of adherence in some cases. mendations of the European guidelines we initiated subcu- This observation recall us for the important role of derma- taneous injections of interferon-α2a as a first line tologist in the primary prevention and the treatment of this treatment. This remaining ineffective, the patient was skin problem in HCW. started on an intravenous therapy with brentuximab vedotin. Data from a recent phase 3 trial of brentuximab vedotin P83 versus physician's choice (methotrexate or bexarotene) Ulcus cruris as a rare skin manifestation of a classical en- for CD30+ MF or primary cutaneous anaplastic large-cell teropathy-associated T-cell lymphoma (EATCL) lymphoma clearly demonstrated the superiority of brentuximab vedotin over standard treatments. After a median Rakosi A, Bogiatzi S, Kaparos N, Gilliet M, Hohl D, Guenova E follow-up of 22.9 months, 56.3% of patients treated with Department of Dermatology, CHUV, Lausanne brentuximab vedotin achieved an objective response lasting at least 4 months (compared to 12.5% of patients in Background: Enteropathy-associated T-cell lymphoma the control group; p-value 0.0001). The median progres- (EATCL) is the most common type of primary gastrointes- sion-free survival (by EMA criteria) was 16.7 months in the tinal T-cell lymphoma and, derived from intraepithelial brentuximab group and 3.5 months in the control group lymphocytes and a rare, but well-known complication of (p-value <0.0001; adjusted p-value <0.0001). Overall severe celiac disease. The majority of de novo EATCL manifest in adverse events were comparable in both groups, with a hi- the small intestine, manifestation at extraintestinal sites gher proportion of patients with peripheral neuropathy in has been rarely reported. the brentuximab group. Case report: We report the case of a 51 year old woman dia- Our patient showed the first signs of improvement with a gnosed with celiac disease in 2005 and necrobiosis lipoi- reduction of > 15 points in the mSWAT score already after dica since 2006 presenting as recurrent lower leg ulcer. In the first injection of brentuximab-vedotin. October 2019, she displayed a rapidly growing right lower Regarding the safety profile, the efficacy, the lack of limi- leg ulcer and a severe right iliac fossa pain associated with tation of cumulative dosing and the reimbursement of an inflammatory syndrome. Histology of the cutaneous brentuximab vedotin (Swiss list of specialties), we consider biopsies showed mixed features of both necrobiosis lipoi- it as the treatment of choice for CD30+ cutaneous T-cell dica and atypical lymphohistiocytic infiltrate suggestive of lymphomas. lymphoma involvement. PET-CT revealed hypermetabo- lism in the ileo-cecal region, the left colic angle, right inguinal and mesenteric lymph nodes. Beside H. pylori gastritis, P82 endoscopy remained unremarkable. In December 2019, Hand dermatitis in health care workers during the time the patient presented an ileal perforation requiring surgi- of covid-19 at the university hospital of Geneva cal resection. Pathological analysis of the resected tissue and lymph nodes revealed the presence of CD30+ atypical Quénan S, Piletta P T cells. In this context, cutaneous biopsies categorized as Department of Dermatology, University Hospital of Geneva a rare cutaneous manifestation of EATCL. The patient was referred for systemic hematological treatment. Introduction: Hand dermatitis is common among health- Discussion: EATL most commonly occurs in 60-70 year old care workers (HCW) although its frequency is probably un- patients. Almost 90% of the patients have the celiac disease derestimated. The prevalence of occupational dermatitis in associated HLA-DQ2/DQ8 phenotype. The diagnosis of ce- the general population ranges from 2% to 15% whereas in liac disease may be established before (20-73%) or occur HCWs it has been reported in around 25%. This is mainly simultaneously with the diagnosis of EATCL 10-58%). Ex- due to frequent hand washing and regular use of hand sa- traintestinal cutaneous manifestation of EATCL is reported nitizers. to occur in no more than 5% of all cases. CD30 expression Description: From 1st till 30 of April 2020, we saw a total varies, however almost all EATLs with large cell morpho- of 73 HCW suffering from skin problem at the unit of der- logy are CD30+, which renders the differential diagnosis matology of the university hospital of Geneva. From the to the much more common primary cutaneous large cell 59 who had hand dermatitis, 31 are nurses (and auxiliary anaplastic T cell lymphoma difficult. nurse), and 28 have a related health work. 49 of them are female and 10 are male. We found personal atopy over 66% of the HCW, and familial atopy over 49% of them. P84 We diagnosed irritant contact dermatitis (ICD) for 81%, Neonatal Lupus Erythematosus with Hydrocephalus allergic contact dermatitis (ACD) for 3.3%, eczema flare- up for 8.4%, and 6.7% had a concomitant ICD and eczema Fässler M3, Rammlmair A3, Scherer C5, Liniger B5, Steinlin M4, flare-up. 52 HCW were used a hand sanitizers containing Bolt I2, Pospieszny K1, Feldmeyer L3, Gouveia C3 chlorhexidine, and 7 were used a free-chlorhexidine hand 1) Department of Radiology, University Hospital, Bern sanitizers (Sterilium). We prescribe topical corticosteroid for 2) Department of Pediatric Rheumatology, University Hospital, 43 HCW, topical calcineurin inhibitor for 14, and only emol- Bern lient for 2 HCW. We recommend them to use hand cream 3) Department of Dermatology, University Hospital, Bern regularly and to reduce home cleaning-tasks. With this ma- 4) Department of Neuropediatrics, University Hospital, Bern nagement, HCW keep doing their job. 5) Department of Pediatric Surgery, University Hospital, Bern Discussion: Since 2005, two alcohol-based sanitizers, a solution and gel both containing Chlorhexidine digluconate, Background: Neonatal Lupus Erythematosus (NLE) is a dis- are proposed to HCW of our institution. Only the one al- tinct clinical entity caused by transplacental passage of lergic to chlorhexidine were used Sterilium. Chlorhexidine, maternal anti-SSA/Ro antibodies and/or, less commonly, used as an antiseptic agent, was reported to be an irritant, anti-SSB/La and/or anti-U1RNP. NLE includes several clini- POSTERS

Dermatologica Helvetica - Volume 32(6) - Août 2020 61 cal manifestations: complete congenital heart block and Introduction: Risankizumab, a humanized IgG1 monoclo- cutaneous lupus are the most common known, while he- nal antibody, selectively inhibits interleukin-23 through patobiliary disease, hematological manifestations and cen- p19 binding. Risankizumab demonstrated superior effi- tral nervous system involvement may occur. cacy compared with adalimumab and ustekinumab out Case description: A 4-week-old boy from a Pakistani family to weeks 44 and 52, respectively, in patients with mode- was hospitalized for progressive macrocephaly and disse- rate-to-severe plaque psoriasis. Here, we evaluated the minated annular non-scaly plaques. The typical skin lesions long-term efficacy and safety of continuous risankizumab led to suspicion of neonatal lupus. Mother’s history was ne- treatment using data from the ongoing Phase 3, multicen- gative for autoimmune diseases. Highly positive anti-SS-A/ ter, international, and open-label extension trial, LIMMitless SS-B antibodies and antinuclear antibodies were found in (NCT03047395). the newborn and the mother. Hydrocephalus was confir- Materials and Methods: This analysis included 897 patients med by sonography and magnetic resonance imaging. enrolled in LIMMitless that, in their base studies, were ini- Thrombocytopenia and elevated liver enzymes were de- tially randomized to 150mg risankizumab. The base stu- tected. The baby had a known atrial septal defect. dies, UltIMMa-1/2, IMMvent, SustaIMM, and NCT03255382, Discussion: Infants born to mothers with anti-SSA/Ro anti- enrolled adults with moderate-to-severe plaque psoriasis. bodies should be monitored for all NLE features at birth, es- Further inclusion criteria for LIMMitless required patients to pecially complete congenital heart block, which frequently complete their base study and be candidates for long-term requires pacemaker implantation. Skin manifestations, if risankizumab. In LIMMitless, all patients received open-la- present, are an invaluable clue for the diagnosis. Hydroce- bel 150mg risankizumab every 12 weeks. From an interim phalus is an uncommon complication of NLS. analysis after 136 total weeks of risankizumab treatment, efficacy was assessed for 90%/100% improvement in Pso- riasis Area Severity Index (PASI) using as observed analyses. P85 Safety was assessed for all patients. Treatment of alopecia areata with tofacitinib Results: Among those patients who have reached 136 total weeks of risankizumab treatment, the proportion Rinderknecht T, Amann VC, Blickenstorfer M, Navarini AA of patients who had PASI 90/100 response were 86.8% Department of Dermatology, University Hospital Basel (506/583)/61.4% (358/583). With 2296.5 patient years of exposure, there was no disproportionate increase in adverse Background: Janus kinase inhibitors (JAK inhibitors) are a events (AEs) compared with rates reported in the base stu- promising novel treatment for alopecia areata. We present dies. Rates of serious AEs, AEs leading to discontinuation, the case of a 32-year old patient with long-standing alope- and AEs of safety interest were low and remained stable; no cia areata of the scalp who experienced nearly complete active TB infections were reported. hair regrowth after 6 months of treatment with tofacitinib Conclusions: Long-term risankizumab treatment demons- (Xeljanz®). trated durability of efficacy and favorable tolerability as Case: A 32-year old woman presented with the third epi- observed in the base studies. sode of alopecia areata, which was first diagnosed 17 years Acknowledgments: AbbVie funded the base studies (UltIM- prior. The duration of the current episode was two years. Ma-1/2, IMMvent, SustaIMM, and NCT03255382) and LIM- Hair loss included at least 75% of the scalp. Eyebrows, la- MITLESS study (NCT03047395), contributed to their design, shes and body hair were still present. Treatments with to- and participated in data collection. AbbVie participated in pical steroids and topical diphenylcyclopropenon were un- data analysis and interpretation of the data, and in writing, successful. Oral treatment with tofacitinib (Xeljanz®) 5 mg review, and approval of the abstract. AbbVie and the au- twice daily was initiated. Hair regrowth started about two thors thank all study investigators for their contributions months later and was present in about 90% of the scalp and the patients who participated in this study. Medical area six months later. Treatment was well tolerated. Apart writing support was provided by Daniel O’Brien, Ph.D., of from a first episode of herpes simplex on the back and mild AbbVie, Inc. acne there were no side effects. Repeated laboratory tests showed no abnormalities. Discussion: We present the case of a woman with alope- P87 cia areata of the scalp in which treatment with tofacitinib Efficacy and Safety Results From the SHARPS Study: resulted in almost complete hair regrowth within six mon- Phase 4, Randomized, Controlled Trial of Adalimumab ths without major side effects. Oral tofacitinib is the most Plus Surgery in Moderate-to-Severe Hidradenitis Suppu- studied JAK inhibitor for the treatment of alopecia areata. rativa Patients are typically treated with 5 to 10 mg twice daily although there is concern for an increased risk for pulmo- Bechara FG1, Horváth B2, Jemec GBE3, Podda M4, Prens EP5, nary embolism with a dose of 10 mg twice daily. Patient Geng Z6, Jean C6, Zouboulis CC7 with longer duration of the current episode (especially > 1) Department of Dermatology, Venereology, and Allergology, Ru- 10 years) and universalis type alopecia appear less likely hr-University Bochum, Bochum, Germany to respond to treatment. The annual costs are 20’000 swiss 2) University of Groningen, University Medical Center Groningen, francs for the dose of 5 mg twice daily. Department of Dermatology, The Netherlands Conclusion: Tofacitinib has demonstrated efficacy in the 3) Department of Dermatology, Zealand University Hospital, treatment of alopecia areata. There are no long-term safety Health Sciences Faculty University of Copenhagen, Roskilde, Den- data and therapy remains off-label. Patients should be edu- mark cated that hair loss is expected to recur within a few weeks 4) Department of Dermatology, Klinikum Darmstadt, Darmstadt, after stopping treatment. Germany 5) Erasmus University Medical Center, Rotterdam, Netherlands; or CHU de Reims, Hôpital Robert Debré, Service de Dermatologie, Reims Cedex, France P86 6) AbbVie Inc, North Chicago, IL USA Long-term Efficacy and Safety of Continuous Q12W Ri- 7) Departments of Dermatology, Venereology, Allergology and Im- sankizumab: Results from the Open-Label Extension munololgy, Dessau Medical Center, Brandenburg Medical School LIMMitless Theodor Fontane, Dessau, Germany

Papp K1, Lebwohl M2, Ohtsuki M3, Puig L4, Zeng J5, Rubant S5, Objective: Surgery for hidradenitis suppurativa (HS) is ad- Valdes J5, Leonardi C6 ministered to remove refractory lesions and scarring. In the 1) K Papp Clinical Research and Probity Medical Research, Water- first prospective, randomized, controlled trial of origina- loo, ON, Canada tor-adalimumab in conjunction with surgery in moderate 2) Icahn School of Medicine at Mount Sinai, New York, NY, United to severe HS (SHARPS), we assessed the efficacy and safety States of the combined regimen. 3) Jichi Medical University, Shimotsuke, Japan Methods: Patients had moderate-to-severe HS (required 4) Hospital de la Santa Creu i Sant Pau, Barcelona, Spain 5) AbbVie Inc., North Chicago, IL, USA radical surgery in an axillary or inguinal region and had 2 6) Central Dermatology, Richmond Heights, Missouri, US other anatomical regions affected with ≥1 at Hurley stage

POSTERS II/III). Enrolled patients (N=206) were randomized 1:1 to

62 Dermatologica Helvetica - Volume 32(6) - Août 2020 receive continuous adalimumab 40 mg or placebo (pre-, The development of NDDH in the presented case could be during-, post-surgery), stratified by baseline Hurley stage (II associated with the acute pulmonary infection as well as vs III) and anatomical region of the surgical site. the underlying malignancy. Prompt treatment with corti- Results: The primary endpoint was met (HS Clinical Res- costeroids and/or steroid-sparing agents is almost always ponse [HiSCR] across all body regions at Week12, adalimu- curative. mab vs placebo). Better outcomes were observed when excluding patients not meeting the lesion entry criterion (sensitivity analysis). P89 Conclusions: Adalimumab prior to surgery was efficacious Blockade of programmed cell death protein 1 (PD-1) in in the treatment of moderate-to-severe HS patients who Sézary syndrome reduces Th2 phenotype of non-tumo- were surgical candidates. Continuation of adalimumab ral T lymphocytes but may enhance tumor proliferation after surgery increased the efficacy on the non-operated HS-involved areas. No safety findings new to adalimu- Saulite I1,2*, Ignatova D1*, Chang YT1, Fassnacht C1, Dimitrou F1, mab were reported during the study; no increase risk of Varypataki E1, Anzengruber F1, Nägeli M1, Cozzio A2, Dummer post-operative wound infection or complication was seen R1, Scarisbrick J3, Pascolo S1, Hoetzenecker W4, Bobrowicz M5, with adalimumab. Guenova E1,6 Disclosure: (AbbVie will collect conflict of interest disclo- 1) Department of Dermatology, University Hospital Zurich, Univer- sure information along with acknowledgments and fun- sity of Zurich, Zurich ding information. If the abstract is accepted, all information 2)Department of Dermatology, Cantonal Hospital St. Gallen, St. will be shown on the presentation.) Gallen AbbVie Inc. Funded this study and participated in the study 3)Department of Dermatology, University Hospitals Birmingham, design; study research; collection, analysis and interpreta- Birmingham, UK tion of data; and writing, reviewing and approving of this 4)Department of Dermatology, Kepler University Hospital, Linz, publication. All authors had access to the data, and partici- Austria pated in the development, review, and approval, and in the 5)Department of Immunology, Medical University of Warsaw, War- saw, Poland decision to submit this publication. 6)Department of Dermatology, Lausanne University Hospital The authors wish to acknowledge Jody Bennett of AbbVie CHUV, University of Lausanne, Lausanne who provided medical writing support for this publication. Sézary syndrome (SS) is an aggressive leukemic variant of cutaneous T-cell lymphoma (L-CTCL) that arises from mali- P88 gnant clonally derived skin-homing CD4+ T cells. Based on Neutrophilic dermatosis of the dorsal hands: an under re- advancements in our under-standing of the mechanisms cognized condition with association to various systemic underlying L-CTCL, boosting the suppressed immune res- and neoplastic disorders ponse emerges as a promising strategy in SS management. Immune checkpoint inhibitory molecules have already de- Rosset NR, Nägeli MN mon-strated efficacy in a wide spectrum of malignancies. Department of Dermatology, University Hospital, Zurich Currently, agents targeting the programmed death-1 (PD- 1) axis are under evaluation in L-CTCL. Here we investigated A 66-year-old male patient, suffering from a recently dia- the expression of PD-1 and its ligands, PD-L1 and PD-L2 in gnosed anaplastic astrocytoma, was hospitalized due to blood and skin from patients with L-CTCL. We demonstrate deteriorating general condition, fever and dyspnea. Anti- that PD-1 expression is markedly increased on tumor T cells biotic treatment with ceftriaxone (2g/24h) was initiated compared to non-tumor CD4+ T cells from SS patients and for suspected pneumonia. The further course was compli- to CD4+ cells from healthy individuals. In contrast, PD-L1 cated by the development of erythematous pruritic, pain- shows decreased expression on tumor T cells, while PD-L2 ful papules and nodules on the dorsa of both hands with expression is low without significant differences between persisting fever. these groups. Functional PD-1 blockade in vitro resulted Laboratory testing was significant for C-reactive protein in reduced Th2 phenotype of non-tumor T lymphocytes, elevation as well as neutrophilic leukocytosis but was but enhanced the proliferation of tumor T cells from SS pa- otherwise unremarkable. Skin biopsy specimen showed tients. Our study sheds some light on the PD-1 axis in both spongiotic changes in the epidermis and a distinct edema peripheral blood and skin compartments in SS patients, in the papillary dermis with a dense interstitial infiltrate of which may be relevant for the treatment of L-CTCL with im- neutrophils. mune checkpoint inhibitor. After exclusion of an infectious cause, histology was compatible with neutrophilic dermatosis of the dorsal hands (NDDH), a variant of acute febrile neutrophilic dermatosis P90 (Sweet’s syndrome). After the diagnosis was established, Klinischer Fall "Photoaggravierte, therapieresistente Su- the patient was started on topical corticosteroids and berythrodermie" emollients, however, without clinical improvement. Conse- quently, therapy was escalated to oral prednisone with a Scherrer E, Messerli-Odermatt O maximal dose of 60mg per day leading to a complete reso- Department of Dermatology, University Hospital Zurich lution of the skin lesions. Unfortunately, 5 days after stopping oral prednisone, rebound of the skin eruptions oc- Anamnese und Klinik: Eine 71-jährige Patientin präsen- curred, leading to a re-initiation of prednisone in the same tierte sich bei seit drei Wochen bestehender erythematos- dose. This time, prednisone was slowly tapered, resulting in quamösen Plaques im Bereich der seborrhoischen Areale, a complete and permanent resolution of the skin lesions. mit flächiger palmoplantarer Beteiligung. Wiederholte ex- NDDH is an under recognized localized variant of Sweet´s terne Biopsien zeigten das Bild einer psoriasiformen Der- syndrome. It is characterized by tender erythematous pa- matitis. Eine topische Steroidtherapie der Klasse III und IV pules, pustules and plaques on the dorsa of the hands, that sowie Rückfettung führte zu keiner Besserung. may ulcerate. Clinical findings can imitate an infectious Befunde: Im Differentialblutbild zeigte sich keine Eosino- process and therefore mislead to unnecessary antibiotic philie oder Hinweise für eine Atopie. Laborchemische Ab- treatments and potentially aggressive surgical manage- klärungen ergaben keine Hinweise auf einen subakuten ment strategies. Therefore a timely biopsy is of utmost Lupus erythematodes oder eine bullöse Autoimmunder- importance for an accurate diagnosis, typically showing matose, weiter wurde mittels Bildgebung ein paraneoplas- edema in the papillary dermis with neutrophilic infiltrates. tisches Geschehen ausgeschlossen. Vascular damage may be observed, but is argued to be a Therapie und Verlauf: Unter UVBnb-Lichttherapie bei ini- secondary phenomenon related to the intensity of neutro- tialer psoriasiformer Dermatitis zeigte sich eine deutliche philic infiltrates. Verschlechterung des Hautbildes mit raschem Auftre- Moreover, recognition of NDDH is important because of ten einer orange-rot betonten Suberythrodermie und its association to systemic and neoplastic disorders and Nappes claires. Eine Re-Biopsie bestätigte den Verdacht should therefore trigger a search for an underlying condi- auf eine Pityriasis Rubra Pilaris. Eine Systemtherapie mit tion. POSTERS

Dermatologica Helvetica - Volume 32(6) - Août 2020 63 Methotrexat und im Verlauf kombiniert mit Infliximab er- The Coronavirus Disease 2019 (COVID-19) is mainly known brachte im Verlauf den erwünschten Erfolg mit zunehmend for respiratory symptoms and acute respiratory distress gebessertem Hautbild. syndrome. Skin manifestations have been reported later. Diskussion: Eine Abgrenzung der Pityriasis rubra pilaris In Geneva, 5121 patients infected with coronavirus were (PRP) gegenüber der Psoriasis vulgaris kann sehr schwierig reported, among which 904 were hospitalized. sein. Histologisch besteht als Abgrenzung zur Psoriasis vul- All patients seen at the special COVID Unit had a nasopha- garis das typische «Schachbrettmuster» mit alternierender ryngeal Real time Reverse Transcriptase Polymerase chain Ortho-/Parakeratose, sowie den Erhalt des Stratum granu- reaction (rRT-PCR) positive for SARS-CoV-2. 3% of hospi- losums und Fehlen von neutrophilen Granulozyten in der talized patients (28 patients) presented with a cutaneous Epidermis. Eine Therapie ist insgesamt oft frustrierend und eruption, with 3 types of eruption: similar eruptions to a besteht in schweren Verläufen immunsupprimierend mit classical viral exanthema, vesicular eruptions and vasculi- Methotrexat. Weiter können TNFα-Antagonisten alleine tic eruptions. 2 patients had an erythematous maculopa- oder in Kombination mit low-dose-MTX oder Retinoide pular eruption and 2 a generalized urticaria. 10 patients eingesetzt werden. Eine Lichttherapie führt in der Regel presented with a monomorphic papulovesicular eruption, zu keinem Erfolg bzw. eher zu einer Verschlechterung des evolving in papules with microcrusts, localized mostly on Hautbildes wie in unserem Fall berichtet. antero-posterior trunk which were asymptomatic or with mild itching. Median duration of skin manifestations was 15 days for varicella-like exanthema. Differential diagnosis P91 of herpes simplex/varicella zoster was ruled out with ne- Serological immune signature changes in SJS/TEN pa- gative PCR performed in vesicles. rRT-PCR in cutaneous tients during IVIG treatment vesicular lesions was negative. 2 cases were vasculitic eruptions with a petechial rash, 3 were acro-ischemic le- Schmidt V1, Contassot E4,2, Li N4,2, Hasler S4,2, Schmid-Gren- sions resembling to chilblains and 9 were transient livedo delmeier P4,2, Nägeli M4,2, French LE3, Brüggen MC4,2,1 reticularis on the legs and palmo-plantar surfaces without 1) Hochgebirgsklinik Davos, Davos argument for vasculitis or thrombotic vasculopathy, with a 2) University Zurich, Faculty of Medicine, Zurich median duration of 21 days. 8 biopsies were obtained in 3) University Hospital Munich (LMU), Department of Dermatology our patients and histological analysis showed typical viral and Allergology, Munich, Germany features. In several cases, dermal vessels displayed a slight 4) University Hospital Zurich, Department of Dermatology, Zurich endothelial swelling, and despite the absence of fibrinoid necrosis or thrombosis, early stage vasculitic alterations, in Introduction & Objectives: Steven Johnson Syndrome (SJS) the form of endotheliitis were observed. In one patient, an and Toxic epidermal necrolysis (TEN) are rare severe cu- acantholysis and large multinucleated keratinocytes with taneous adverse reactions with high morbidity and morta- ballooning degeneration was observed. lity. There is still no consensus on the use of adjuvant treat- All our patients developed systemic symptoms before ments such as intravenous immunglobulines (IVIG), TNF the skin lesions. Classical viral eruption appeared early in inhibitors and systemic glucocorticosteroids for SJS/TEN the disease, 1 or 2 days after the onset of other systemic and little is known about their effects on a cellular/ mole- symptoms, supporting the physiopathology of an immune cular level. Our aim was to explore the effects of IVIG on response to viral particles. Meanwhile vesicular rash and the inflammatory response in SJS/TEN and correlate these vasculitic lesions appeared around 10 days after the be- findings to the clinical outcome. ginning of the disease, which could be linked to a systemic Material & Methods: In this prospective study, we included dissemination of the virus causing endotheliitis as already 3 patients with SJS and 5 patients with TEN treated at the described for other organs. University Hospital Zurich between 2014 and 2020 with high-dose IVIG (1g per day) for 3 days. Serum samples were collected from prior (day 0) and 4-5 days after IVIG adminis- P93 tration. Serum levels of inflammation-associated proteins Efficacy and safety of baricitinib in combination with were measured with high-throughput proteomics (Olink). topical corticosteroids in moderate to severe atopic der- Results: Our comparative analyses of immune response matitis: results of a Phase 3 randomized, double-blind, protein expression prior vs. after IVIG revealed major placebo-controlled 16-week trial (BREEZE-AD7) changes: Interferon gamma levels were most substantially decreased in serum. This was paralleled by a major decrease Reich K1, Kabashima K2, Peris K3, Kolodsick J4, Yang FE4, Gama- of factors and mediators of a Th1- and cytotoxic immune lo M4, Brinker DR4, DeLozier AM4, Janes JM4, Nunes FP4, Thys- response: The Th1 chemokine ligands CXCL9, CXCL10, sen JP5, Simpson EL6, Spina L (Non-Author Presenter)7 CXCL11 and CX3CL1, T cell-activation and -differentiation 1) Translational Research in Inflammatory Skin Diseases, Institute proteins (PD-L1, IL7) and the Natural Killer Cell Receptor for Health Services Research in Dermatology and Nursing, Univer- 2B4 (CD244). Surprisingly, the Th2-inducing cytokine IL33 sity Medical Center Hamburg-Eppendorf, and Skinflammation® was also decreased. In contrast, there was an increase in eo- Center, Hamburg, Germany sinophil chemotactic protein CCL11, the sulfate conjuga- 2) Kyoto University, Kyoto, Japan tion-catalyzing enzyme SULT1A1 and the neurotropic fac- 3) Institute of Dermatology, Università Cattolica, Roma and Policli- tor artemin. There were no significant differences in protein nico Universitario Agostino Gemelli, Rome, Italy expression prior/post IVIG between SJS and TEN patients. 4) Eli Lilly and Company, Indianapolis, IN, USA Clinically, all patients showed an improvement in terms of 5) Department of Dermatology and Allergy, Herlev and Gentofte skin detachment and no additional blisters appeared. Hospital, University of Copenhagen, Copenhagen, Hellerup, Den- Conclusion: Our study shows that IVIG administration in mark SJS/TEN patients is associated with major changes in in- 6) Oregon Health and Science University, Portland, OR, USA flammatory mediators in an early phase (day 4-5). The 7) Eli Lilly and Company, Switzerland presented data indicate an effect mostly on the Th1- / cytotoxic immune response-related factors. Future studies Introduction: Baricitinib (BARI), an oral selective JAK1 and comparing the molecular effects of IVIG to other adjuvant 2 inhibitor, reduced disease severity of moderate-to-severe treatments will enhance our understanding of these thera- AD in BREEZE-AD1 and BREEZE-AD2. Efficacy and safety of pies in SJS/TEN. BARI in combination with topical corticosteroid (TCS) therapy were assessed in adults with moderate-to-severe AD P92 in BREEZE-AD7. Clinico-pathological features of skin lesions associated Methods: BREEZE-AD7 was a randomized, double-blind, to coronavirus disease 2019 (COVID-19): Geneva expe- PBO-controlled phase 3 trial (randomization: 1:1:1 to PBO:- rience BARI 2-mg:4-mg daily; 16 weeks). Use of low-to-moderate potency TCS was allowed. Primary endpoint was propor- Schuhler C1, Kaya G1,2, Toutous-Trellu L1, Alberto C1 tion of patients achieving vIGA-AD™ score 0 (clear)/1 (al- 1) Department of Dermatology and Venereology, University Hos- most clear) with a ≥2-point improvement from baseline pital of Geneva (Week 16). 2) Department of Clinical Pathology, University Hospital of Geneva POSTERS

64 Dermatologica Helvetica - Volume 32(6) - Août 2020 Results: 329 patients were enrolled in BREEZE-AD7. The Conclusion: Baricitinib demonstrated rapid onset of im- proportion achieving vIGA-AD 0/1 was significantly higher provements in AD skin and pruritus severity and clinically in BARI 4-mg+TCS than in PBO+TCS (30.6% versus 14.7%, meaningful improvements in QOL. p≤0.01). There was improvement in primary outcome for BARI 2-mg (23.9%, p=0.08), though not statistically significant. Significantly more patients achieved EASI-75 on P95 4-mg (47.7%, p≤0.01) and 2-mg (43.1%, p≤0.01) than PBO From panniculitis to systemic large B-cell lymphoma (22.9%); Week 16. Significant improvement in itch was detected by Week 2 (4-mg) and Week 3 (2-mg; Table, Figure). Tonellotto L4, Mainetti C4, MichalopoulusP6, Beltraminelli H4,5, Improvements in night-time awakenings, skin pain, DLQI, Spina P1,2, Mangas C4 and POEM were observed by Week 1 (4-mg) and Weeks 1 to 1) Department of Health Sciences, University of Eastern Piedmont, 3 (2-mg); maintained through Week 16. On post-hoc ana- Novara, Italy lysis, patients on BARI had statistically significant increase 2) Cantonal Institute of Pathology, Locarno in number of TCS-free days compared to PBO (4-mg 33% 3) Oncology Institute of Southern Switzerland (IOSI), Bellinzona [p≤0.01], 2-mg 25% [p≤0.05], PBO 17%). BARI treatment 4) Department of Dermatology, Ente Ospedaliero Cantonale, Bel- also resulted in significant reduction in amount of mode- linzona rate-potency TCS used during study (4-mg: 39% 2-mg: and 5) Department of Dermatology, Inselspital Bern University Hospi- 28%; p≤0.01, compared to PBO). Treatment-emergent AEs tal, Bern were reported in 38%, 56%, and 58% patients, and serious 6) Private practice, Lugano AEs in 3.7%, 1.8%, and 3.6% patients, on PBO, 2-mg, and 4-mg, respectively. The most common AEs were nasopha- Introduction: Panniculitis has a large differential diagnosis ryngitis, upper respiratory tract infections, and folliculitis. and malignancy could be one of these. We present a case One pulmonary embolism was reported in the 4-mg group, of panniculitis due to local intravascular infiltration of a sys- and one opportunistic infection (ocular toxoplasmosis) in temic diffuse large B-cell lymphoma. the PBO group. There were no malignancies, major adverse Case report: A 79 year-old woman developed a hyperther- cardiovascular events, or deaths. mic erythema and cutaneous thickening of the abdominal Discussion: BARI in combination with background TCS the- skin. Fourteen days treatment with amoxicillin/clavulanic rapy significantly improved signs and symptoms of mode- acid, followed by 10 days of Cefpodoxim led to moderate rate-to-severe AD compared to PBO, with a safety profile improvement. A first skin biopsy showed lobar panniculi- consistent with prior findings from BARI clinical develop- tis without signs of malignancy. The patient reported 20 ment in AD. BARI may represent a potential novel treat- kg weight loss during the previous 3 months, night swea- ment option for patients with moderate-to-severe AD with ting, itch, fatigue and loss of appetite. Clinically, we found rapid onset of action. thickened, erythematous, tender nodules and plaques on abdominal skin and inner thighs. Laboratory findings showed a small increase in the inflammatory parameters, P94 an increase in Beta2-microglobulin and LDH, and anemia Impact of Baricitinib on Patient-Reported Skin Symp- (Hb 10.5 g/L). During the second day of admission, she de- toms, Itch, and Quality of Life in Adult Patients with veloped left abducens nerve palsy. A PET/CT scan showed Moderate-to-Severe Atopic Dermatitis and an Inade- a metabolic activity of multiple lymphadenopathies invol- quate Response to Topical Therapies from Phase 3 Trials, ving mediastinum, abdomen and retroperitoneum and a BREEZE-AD1 and BREEZE-AD2 cerebral MRI showed a retro-bulbar mass. A second abdominal skin biopsy and a biopsy of the para-renal mass were Lio P1, Nosbaum A2, Cardillo T3, DeLozier A3, Gamalo M3, Ball S3, both histologically consistent with a large B-cell lymphoma Bieber T4, Spina L (Non-Author Presenter)5 with intravascular infiltration seen in the abdominal speci- 1) Northwestern University, Evanston, IL, USA men. Immunohistochemistry showed positivity for BCL6 2) Université Claude Bernard Lyon 1, Villeurbanne, France with corresponding rearrangement at FISH analysis, BCL2 3) Eli Lilly and Company, Indianapolis, IN, USA was negative, MYC could not be assessed. A treatment with 4) Department of Dermatology and Allergy, University of Bonn, high dose systemic steroids led to the normalization of eye Bonn, Germany movements and sight and improvement of panniculitis. In 5) Eli Lilly and Company, Switzerland the Oncology Department, she received 4 cycles of R-CHOP and intrathecal Methotrexate. We obtained a complete cli- Background: Baricitinib is an oral, selective inhibitor of Ja- nical and imaging (PET/CT) response (9 months follow-up). nus kinase (JAK)1 and JAK2 under investigation for treat- Discussion: Lobar panniculitis as a first presentation of a ment of adult patients with moderate-to-severe atopic large diffuse B-cell lymphoma is exceptional. As panniculi- dermatitis (AD). Primary results of 2 Phase 3 trials were dis- tis is caused by multiple entities, it is important to rebiopsy closed elsewhere; the objective here is to report the trials’ in order to look for a potential life-threatening etiology that patient-reported secondary measures of skin symptoms, may require prompt therapeutic intervention. itch, and quality of life (QOL). Methods: In identical, independent 16-week trials (BREEZE- AD1/BREEZE-AD2), patients were randomized (2:1:1:1) to P96 placebo (AD1/AD2, N, respectively, 249/244), baricitinib Allergy to cannabis sativa – allergic or high? Two illustra- 1-mg (127/125), 2-mg (123/123), or 4-mg daily (125/123). tive case reports Measurements included the SCORing Atopic Dermatitis (SCORAD), Patient Global Impression of Severity (PGI-S- Trachsel T1, Manjaly Thomas Z1,2, Chantraine S1, Jamiolkowski AD), and Dermatology Life Quality Index (DLQI). Outco- D1, Link S2,3, Heijnen I3, Scherer Hofmeier K1,2, Hartmann K1,2 mes were analyzed by logistic regression (categorical) and 1) Division of Allergy, Department of Dermatology, University Hos- mixed model repeated measures (continuous). pital Basel Results: Baseline characteristics were similar between stu- 2) Department of Biomedicine, University Hospital and University dies. At Week 16, baricitinib-treated patients were signifi- Basel cantly more likely than placebo-treated patients to improve 3) Medical Immunology, Laboratory Medicine, University Hospital by the SCORAD75 (AD1/AD2 respectively, placebo: 1%/2%; and University Basel 1-mg: 6%/5%; 2-mg: 7%/7%; 4-mg: 10%/11%; p<=.01, for 2- and 4-mg, both studies) and mean change in PGI-S-AD Background: The use of cannabis as a recreational drug, as a (p<=.001, for 2-mg in AD2, and p<=.001, for 4-mg, both nutritional supplement and as a therapeutic agent for pain studies). Baricitinib, versus placebo, resulted in significantly and neurological disorders is gaining increasing popularity. greater improvements in SCORAD pruritus scores at Week 1 Concordant with its increased use, more unwanted side ef- (p<=.01 for 2- and 4-mg, both studies) and Week 16 (p<=.01 fects are being reported. While the psychoactive properties for 2-mg in AD2 and 4-mg, both studies), and greater likeli- have been well described, the immunomodulatory and al- hood to have DLQI 0/1 at Week 16 (AD1/AD2 respectively, lergic potential of cannabis is less well known. Sensitisation placebo: 5%/3%, 1-mg: 8%/10%; 2-mg: 11%/11%; 4-mg: can occur by the inhaled, ingested or cutaneous route. The 17%/15%; p<.05, for 2- and 4-mg, both studies). main allergen attributed to cannabis allergy is Can s 3, a

non-specific lipid transfer protein. We present two cases of POSTERS Dermatologica Helvetica - Volume 32(6) - Août 2020 65 cannabis allergy highlighting the diverse clinical range of with an acceptable safety profile even in elderly patients. symptoms and illustrating the diagnostic challenges. We report here our own experience of use of the anti-PD-1 Method: Both patients were evaluated with a clinical his- Cemiplimab in two elderly patient who alternatively would tory, skin prick testing and serological profiling as well as have undergone palliative care and nevertheless suffered basophil activation testing as an in vitro functional assay. a devastating outcome. In both patients, the complete or Results: A 21-year-old patient, who regularly smokes partial response allowed the cessation of opioids and/or a cannabis, presented with recurrent urticaria. On further return to a normal life. questioning she also reported rhinoconjunctivitis when handling cannabis plants. Skin prick test with cannabis flowers revealed specific sensitisation. Laboratory findings demonstrated neither evidence of specific IgE to Canna- P98 bis sativa, nor any other sensitisations. A 25-year-old ato- Clinical polymorphism of tinea due to Trichophyton pic patient presented with abdominal cramps, dyspnoea, mentagrophytes in children urticaria and dizziness after consuming an almond milk shake with a powdered cannabis supplement. Skin prick Rakosi A1, George K1,2, Hohl D3, Christen-Zaech S1, Bontems O4, test revealed sensitisation to the cannabis powder as well Guenova E4, Monod M4, Morren MA1, Ventéjou S1 1) Pediatric Dermatology unit, Department of Pediatrics and Der- as concurrent sensitisation to birch pollen. Consistent with mato-Venereology, University Hospital Lausanne and University of atopy, the patient had a grossly elevated level of total IgE, Lausanne together with sensitisations to Bet v 1 and Pru p 3, but not 2) Department of Dermato-Venereology, University Hospital Lau- to Cannabis sativa. Basophil activation testing revealed ac- sanne and University of Lausanne tivation and degranulation upon stimulation with cannabis 3) Laboratory of Dermato-Pathology, Department of Dermato-Ve- flowers in the 1st patient and cannabis powder in the 2nd nereology, University Hospital Lausanne and University of Lau- patient. sanne Conclusion: Here, we have presented two patients with 4) Laboratory of Dermato-Mycology, Department of Dermato-Ve- clinically relevant cannabis sensitisation acquired by diffe- nereology, University Hospital Lausanne and University of Lau- rent routes. Both patients tested positive on skin testing, sanne but serological testing was inconclusive. However, in vitro functional testing by BAT supports the clinical working dia- Introduction: Trichophyton mentagrophytes (T.m.) is a zoo- gnosis of cannabis allergy. The pathomechanism is either philic dermatophyte. Cutaneous infection with it usually a primary cannabis allergy or a crossreactivity, for instance manifests with inflammatory lesions. Different animals, through sensitisation to LTP. More widely available stan- most commonly hamsters, dogs, cats, rabbits, and mices, dardised molecular allergy testing for cannabis allergen represent a natural reservoir of this fungi. In order to avoid components will ultimately lead to increased diagnostic recurrence it is necessary to look for and treat a causal ani- certainty of cannabis allergy. mal. Observation: Over the period of March 2019 to March 2020 we saw seven patients with T. mentagrophytes infections P97 showing a wide spectrum of clinical presentations. Cemiplimab for locally advanced and metastatic cu- Patients had a median age of nine years, five of seven were taneous squamous cell carcinoma in elderly patients: a male (table). Source of infection were a hamster in 3 pa- case series tients, a cat in 3 others and a rabbit in the last patient. The clinical presentations were: Merat R, Tzika E - cases 1 to 4 had tinea corporis (Fig 1) with a Majocchi Gra- Department of Dermatology, University Hospital, Geneva nuloma (MG) in case 2 (Fig 2). Of note case 4 was immunocompromised due to chemotherapy for acute lymphoblas- Introduction: Cemiplimab is an anti-PD-1 monoclonal an- tic leukemia. tibody. Based on two early-phase II clinical trials, both FDA - case 5 had tinea manuum and onychomycosis and EMA have approved this drug for patients with local- - cases 6 and 7 had a kerion (tinea capitis). ly advanced cutaneous SCC (lacSCC) and metastatic cu- The clinical picture was remarkable in two siblings, one taneous SCC (mcSCC) who are not candidates for surgery (case 2) presented a MG and the other one (case 1) a very or radiotherapy. We report our experience with the use of inflammatory (oozing) lesion in both likely caused by Cemiplimab in two elderly patients who had either lacSCC contact with an infected hamster. Histopathology of case or mcSCC. 2 showed a deep peri-follicular granulomatous inflamma- Case series: 1-A 91-year-old patient diagnosed with a trans- tion, however as PAS stain and culture of skin biopsy were fixing lacSCC of the right ear involving the external audito- negative, the diagnosis was not immediately clear. Finally ry canal and the mastoid cortex was treated with radiation T. mentagrophytes was cultured from a pustule and MG therapy that resulted in a transient stable disease. Seven could be confirmed on histopathology. Further investiga- months after the initial diagnosis, intense pain and insom- tions ruled out an underlying acquired immunodeficiency. nia was attributed to local progression. Subsequent stan- Application of topical corticosteroids, prior to the first visit, dard combination chemotherapy had to be interrupted for probably has influenced the clinical picture in this case. thrombocytopenia. He then received 18 cycles of Cemipli- Most of patients (5 of 7) were treated for four to twelve mab therapy. After 9 cycles, the patient was released from weeks with oral terbinafine, in combination with topical pain and opioid treatment could be stopped. A complete azole (ketoconazole or econazole) in four patients and response was observed after the 11th cycle. No adverse with topical terbinafine in one. One of the tinea corporis events other than reversible asthenia occurred. The patient patients were treated with itraconazole in addition to to- remains disease free at 6 month follow-up. 2-One year after pical terbinafine for 2 weeks. However, the immunocom- the removal of a pT2 cSCC on his right chest, a 83-year old promised patient was solely treated with fluconazole for 8 patient was diagnosed with metastatic disease involving weeks. bilateral axillary lymph nodes. Surgery was recused and Discussion: Since 2016, the nomenclature of T. menta- despite radiation therapy, rapid progression occured in soft grophytes has changed thanks to molecular analysis of and muscular tissues with subsequent fistulisation of the T. mentagrophytes species complex. Arthroderma van- right axillary mass to the skin. After 6 cycles of Cemiplimab breuseghemii and Microides mentragrophytes become T. therapy, a complete regression of the right axillary mass mentagrophytes and Arthroderma benhamiae becomes and skin closure were observed, followed by a remarkable Trychophyton benhamiae. improvement of his general condition that allowed the pa- Our series demonstrates the variety of clinical presenta- tient to resume a normal life despite a dissociated response tions induced by a single dermatophyte. When the infec- of the left axillary mass that has meanwhile continued to tion extends beyond the superficial epidermis it requires shrink. Up to now, he has received 19 cycles. So far, the only the investigation of predisposing factors such as: immu- adverse event has been an asymptomatic thyroiditis. nosuppression, shaving, epilation, friction, or use of topi- Discussion: As an ultra-violet-induced malignancy, carrying cal steroids. As shown by case 2, histological diagnosis of a high rate of somatic mutations, lacSCC and mcSCC have MG is not always straightforward. In case of granulomatous shown to be remarkably sensitive to anti-PD-1 therapies histology, mycological culture is advisable even if PAS stain POSTERS

66 Dermatologica Helvetica - Volume 32(6) - Août 2020 5,10, 20, 40mg

Schwere Akne*

Individuelle Behandlung dank vier verschiedenen Dosierungsstufen. Hohe Sicherheit durch unterschiedlich beschriftete und gefärbte Kapseln. Vereinbar mit verschiedenen Intoleranzen: ohne Laktose, Gluten oder Fruktose. Gute Verträglichkeit: ohne Sorbitol oder Cochenillerot (Azofarbstoff E124).

Eine Erkrankung, die sich auf die Lebensqualität auswirkt, bEhAnDELn

Jeden Arzt mit Unterstützungsmaterialien bei der Verschreibung bEGLEITEn

Und die betreuung jedes Patienten dadurch SIChERSTELLEn

kurzfachinformation cUrAkne®. Dieses Arzneimittel ist teratogen. eine wirksame und sichere Schwangerschaftsverhütung ist von daher zwingend erforderlich. Z: Isotretinoin. l: Schwere Formen der Akne, die sich gegenüber adäquaten Standardtherapiezyklen mit systemischen Antibiotika und topischer Therapie als resistent erwiesen haben. D: 1-2x täglich mit einer Mahl- zeit. Initialdosis: 0.5 mg/kg/Tag. Erhaltungsdosis: 0.5-1.0 mg/kg/Tag; sehr schwere Akne: Bis zu 2.0 mg/kg/Tag. Empfohlene kumulierte Dosis: 120 mg/kg. Vollständige Remission normalerweise nach 16-24 Wochen. kI: Schwangerschaft, Stillzeit. Frauen im gebärfähigen Alter, ausser alle Bedingungen des Schwangerschaftsverhütungsprogramms werden eingehalten. Überempfindlichkeit gegenüber dem Wirkstoff oder einem der Hilfsstoffe, Leberinsuffizienz, Hypervitaminose A, schwere Hyperlipidämie, gleichzeitige Behandlung mit Tetrazyklinen. VM: Psychische Störungen (z.B. Depressionen), intensive Sonnenlichtexposition, chemische Dermabrasion und kutane Laserbehandlung, keratolytisch oder exfoliativ wirkende Aknemittel, schwerwiegende Hautreaktionen, Augenleiden, Funktionsstörungen des Bewegungsapparates, des Bindegewebes und der Knochen, benigne Erhöhung des Schädelinnendrucks, Überwachung der Leberenzyme und Serumlipide, gastrointestinale Beschwerden, allergische Reaktionen. IA: Vitamin A, Tetrazykline, niedrigdosierte Gestagenpräparate. UAw: Sehr häufig: Anämie, erhöhte Sedimentationsrate der roten Blutkörperchen, Thrombozytopenie, Thrombozytose, Blepharitis, Konjunktivitis, trockenes Auge, Augenirritation, erhöhte Transaminasen, Cheilitis, Dermatitis, trockene Haut, lokalisierte Exfoliation, Pruritus, erythematöser Hautausschlag, Hautverletzlichkeit, Arthralgie, Myalgie, Rückenschmerzen, Erhöhung der Triglyceride, Vermin- derung von HDL. Postmarketing: Einzelne Fälle von EM, SJS und TEN, schwerwiegende Rhabdomyolyse-Fälle. Liste A, SL. Ausführliche Informationen unter www.swissmedicinfo.ch. Pierre Fabre (Suisse) SA, 4123 Allschwil. 03/2018 vs.01 * Schwere Formen der Akne, die sich gegenüber adäquaten Standardtherapiezyklen mit systemischen Antibiotika und topischer Therapie als resistent erwiesen haben. CUR-190816-Ch-DE

SKIN EXPERTISE IN OUR DNA is negative. Case 5 is unusual as fingernail onychomycosis Introduction: The ear lobe is the most frequent location of in immunocompetent children is extremely rare, especially borrelial lymphocytoma in children. We report a series of 4 before 6 years of age. It is to be noted that MG and ony- cases of atypical borrelial lympocytoma involving the ear. chomycosis are most often due to T. rubrum. Case repots: We have seen 4 cases of children presenting Conclusion: We report several cases of tinea due to T. men- a swelling with erythematous to violaceous hue localized tagrophytes, emphasizing the frequently inflammatory at the helix and/or anthelix, present for 2 to 6 months, presentation, as well as misleading pictures clinically and caused by Lyme disease (figure 1). In all children, swelling histologically, underlying the need of direct preparation, was recurrent and in two children the ear was painful on mycological cultures or PCR even if PAS coloration is nega- pressure. A history of a tick bite was present in 2 patients. tive. One of them had erythema migrans one year before onset * siblings and was treated for it during 15 days. Lyme serology was performed. IgM and IgG antibodies were positive in 2 cases and IgG in the other 2 cases. All patients were treated either P99 with amoxicillin or cefaclor for 21 days with complete re- Tocilizumab: effective in pansclerotic morphea? solution of the swelling, which confirmed the diagnosis (figure 2). Ventéjou S1, Christen-Zaech S1, Schwieger-Briel A2, De Benedet- Discussion: Borrelial lympocytoma is a benign polyclonal ti F3, Schnider C4, Hofer M4, Bogiatzi S5, Hohl D5, Morren MA1 B-cell lymphoproliferative process and a rare subacute 1) University Hospital Lausanne and University of Lausanne, Pedia- cutaneous manifestation of Lyme disease seen almost ex- tric Dermatology Unit, Department of Pediatrics and Dermato-Ve- clusively in Europe. The most frequent location in children nereology, Lausanne are the ear lobe (>80%) followed by the nipple. The cases 2) Kinderspital Zürich, Department of Pediatric Dermatology, Zü- presented illustrate an atypical clinical presentation of bor- rich relial lymphocytoma: involving the helix. Only a few simi- 3) Bambino Gesu Hospital, Department of Pediatric Rheumatolo- lar cases have been reported in the literature. It has to be gy, Rome, Italy differentiated from cellulitis and from relapsing polychon- 4) University Hospital Lausanne and University of Lausanne, De- dritis, which may start as a recurrent unilateral ear swelling partment of Pediatric Rheumatology, Lausanne Switzerand in children. 5) University Hospital Lausanne and University of Lausanne, Labo- ratory of Dermato- Histopathology, Department of Dermato-Ve- nereology, Lausanne P101 Objective: Pansclerotic morphea (PSM) is a rare skin di- Hyperhidrosis of the forearm : a case report of eccrine sease, often resulting in severe sclerosis of the skin and nevus secondary contractures even when under standard treatment with corticosteroids, methotrexate, mycophenolate Ventéjou S1, Hohl D2, Bogiatzi S2, Christen-Zaech S1, Morren mofetil. Little is known about the effect of newer biologi- MA1 cals such as tocilizumab, an antagonist of IL6R. IL6 is one 1) Pediatric Dermatology unit, Department of Pediatrics and Der- mato-Venereology, CHUV and University of Lausanne of the factors inducing collagen production by fibroblasts. 2) Laboratory of Histopathology, Department of Dermato-Vene- Method: A female 8 year-old patient with progressive stiffe- reology, CHUV and University of Lausanne ning of the skin and impaired joint mobility presented to our clinic. On palpation her skin was diffusely infiltrated. Introduction: Eccrine nevi (EN) are rare skin lesions, cha- There were however no superficially infiltrated plaques, racterized by an increase in number and/or size of eccrine no involvement of hands, feet and face and no systemic glands. They usually occur during childhood and adoles- symptoms. Blood investigations excluded auto-antibodies cence. We report a case with typical features of EN. or systemic inflammation. Skin histology showed a sparse Case report: In July, a 6 year-old, right-handed girl, in good inflammatory lympho-histiocytic infiltration in the upper general health, presented with a 1-month history of hype- dermis and broad collagen fibers in the dermis, replacing rhidrosis of the right forearm. This occurred daily and lasted the upper part of the hypodermis with sparse mucin depo- 15 minutes. Temperature, emotion and exercise did not in- sition. The preferential diagnosis was PSM. Treatment with duce hyperhidrosis. Her major complaint was that these at- systemic corticosteroids and methotrexate as well as tocili- tacks caused limitation in writing and wetting of the sleeve zumab was started. of her clothes. No previous trauma or skin anomalies were Results: Starting two months after initiation and more reported. The mother described a slightly erythematous clearly visible after 4 months of treatment, skin became plaque where hyperhidrosis occurred. On examination, progressively less infiltrated and joint mobility improved there was a well limited are with moist, but otherwise nor- drastically. mal looking skin. On dermoscopy sweat pores were bigger Discussion: According to the literature, treatment of PSM and more visible compared to normal adjacent skin. The is difficult. New drugs targeting pathways stimulating col- diagnosis of eccrine nevus was confirmed by histology lagen production, have been evaluated especially in syste- showing an isolated increased number of eccrine sweat mic sclerosis. Although the role of tocilizumab is difficult ducts in comparison with normal skin. Eccrine coils were on to evaluate in our case, because all three medications were average 16% increased after a count at 3 different depths. started simultaneously. It seems probable that tocilizumab We treated the lesion with topical 20% aluminium chloride was important in reducing skin tightness. Until now, only with a satisfying response. seven pediatric cases of treatment with tocilizumab, all af- Discussion: Only 33 cases of pure EN were reported until ter failure of standard treatments have been reported with now. This diagnosis has to be differentiated from: i)idiopa- partial response in all but one. It is however possible that thic hyperhidrosis, which however has a normal distribu- early treatment with tocilizumab is more effective and can tion of the sweat glands on histology, ii)Eccrine Angioma- prevent irreversible damage. It seems worthwhile to eva- tous Hamartoma (EAH) or sudoriparous angioma, which luate this in a trial. presents with increased eccrine glands associated with vascular proliferation. EN is usually unilateral, typically located on the limbs, preferentially on the forearm. Clinical presentation may vary from isolated hyperhidrosis to linear papules or, brownish patches whether or not with hype- P100 rhidrosis. EAH was previously described with a spitzoid An atypical presentation of borrelial lymphocytoma in or a popcorn pattern on dermoscopy. As far as we know four children this is the first description of an EN in dermoscopy where we could visualize bigger sweat pores compared with the Koulouri A1, Ventéjou S1, Bourban-Jirounek C2, Christen-Zaech healthy skin. S1, Morren MA1,2 1) Pediatric dermatology unit, Department of Pediatrics and Der- mato-Venereology, CHUV and University of Lausanne 2) Pediatric practice surgery, Neuchâtel POSTERS

68 Dermatologica Helvetica - Volume 32(6) - Août 2020 P102 P104 Light-based therapies and scar sarcoidosis Nannizzia persicolor – a rare causative agent of dermato- phytosis Walther M1,2, Dummer R1, Imhof L1 1) Department of Dermatology, University Hospital, Zurich Wüthrich H1, Roosje P2, Fratti M1, Bontems O1, Salamin K1, Mo- 2) Skinmed, Clinic for Dermatology, Aarau nod M1, Guenova E1 1) Department of Dermatology and Venerology, University Hospi- Scar sarcoidosis is a rare cutaneous form of sarcoidosis that tal CHUV, Lausanne appears in previous scar areas sometimes in combination 2) Division of Clinical Dermatology, Department of Clinical Veteri- with systemic disease. We report the case of an 86-year old nary Science, Vetsuisse Faculty, University of Bern, Bern woman with impressive red-brown colored atrophic scars in the face and red papules on the forearms who underwent Superficial fungal infections of skin, hair and nails are a intense abrasive skin treatment of her face followed by a common global problem (more than 20-25% of the world photodynamic therapy (PDT) for actinic keratosis. population are infected. The tree most frequent pathogens Development of scar sarcoidosis is associated with preexis- are dermatophytes, yeasts and molds. Further, fungal pa- ting scars and might be triggered by external physical thogens are classified according to their habitat into an- treatment (abrasion, PDT, laser). Photodynamic therapy is thropophlic, zoophilic or geophilic organisms. The precise normally used to treat cutaneous field cancerization (pre- identification of the fungal species is important for accu- vention of white skin cancer). rate and successful treatment. Species identification can On the other hand light-based treatments (laser, PDT) can be challenging due to morphologic variations in the same be a valid therapeutic option (off-label use) in cases where species and DNA sequence analysis offers an opportunity standard treatment for cutaneous sarcoidosis (intralesional, for precise diagnosis in rare, difficult or ambiguous cases. topical or oral corticosteroid, antimalarials, methotrexate) Here we present a case of a dog with inflammatory skin is ineffective or not possible. reaction due to infection with N. persicolor. Fungal infection was first detected in the direct mycological examination, and N. persicolor was identified morphologically in P103 the primary culture and unequivocally confirmed by DNA Reconstruction of nasal dorsum defect with pro- sequence analysis. cerus-based propeller flap Superficial fungal infections are predominantly caused by dermatophytes. Nannizzia (N.) persicolor (old name Wirz EG1, Läuchli S2,3, Navarini AA1, Kunz M1 Microsporum persicolor) is a zoophilic and geophilic or- 1) Department of Dermatology, University Hospital, Basel ganism that can rarely infected animals or humans. Due 2) Department of Dermatology, University Hospital, Zurich to its resemblance to Trichophyton (T.) mentagrophytes, 3) Dermatologisches Zentrum, Zurich N. persicolor is often underdiagnosed as causative fungal agent. Skin infection due N. persicolor should be ruled out An 82-year-old Caucasian woman presented with a recur- especially in patients with contact to dogs, cats and ro- rent sclerosing basal cell carcinoma on her central nasal dents. In the rare cases of identification of N. persicolor as dorsum. After 3 stages of Mohs micrographic surgery, the a pathogen, topical azoles, terbinafine or ciclopiroxolamin cancer was cleared. The resulting defect measured 4.1x1.8 can be considered as a first-line treatment option. cm with extension to the periosteum. Resolution: The centrally located defect extends from be- neath the glabella to the border of the nasal tip, involving P105 almost the entire anatomical subunit of the nasal dorsum. Deep breathing reduces intraoperative anxiety and pain Linear closure of the defect is impossible due to the width perception in patients undergoing dermatosurgery of its upper portion. A full-thickness skin graft would likely cause an unfavorable cosmetic result because of skin level Zahn CA, Kuonen F differences and the potential for color and texture mis- Departement of Dermatology, University Hospital CHUV, Lau- match. Healing by secondary intention similarly would im- sanne pact cosmesis with the additional risk of scar contraction. Interpolation and transposition flaps, using the skin reser- Background: Patients undergoing skin surgery can expe- voir of the forehead and glabella, likely offer the best alter- rience intraoperative anxiety and pain. To date, intraope- natives for a good functional and cosmetic outcome. The rative relaxation methods have shown variable efficiency. reliable blood supply of a paramedian forehead flap is de- Even if deep breathing is a long known relaxation tech- sirable in a defect reaching the periosteum. Disadvantages nique, to date no experience was reported in the field of are a two-staged procedure and the risk of brow position dermatosurgery. alteration due to closure of the secondary defect. The latter Objetive: To evaluate the effect of deep breathing instruc- holds true for otherwise viable reconstructive alternatives tion on intraoperative anxiety and pain experienced during such as rhombic and note flaps. dermatosurgery under local anesthesia. A propeller flap centered in the glabellar region transfers Methods and materials: We conducted a one-blinded ran- skin from the forehead to the nasal dorsum in a single domized controlled study to assess the effect of pre-opera- procedure without leading to eyebrow asymmetry. It can tive deep breathing instruction on intraoperative anxiety be designed as a myocutaneous flap based on the well and pain. Subjects were randomly allocated to either deep perfused procerus muscle. Advantages of a myocutaneous breathing instruction group (DBI, n = 76) or no instruction pedicle include improved flap survival, supply of extra pad- group (NI, n = 76). Anxiety was measured using the State- ding and coverage of bone and cartilage in deep defects. Trait Anxiety Inventory (STAI), the Amsterdam Preoperative The Procedure: We performed a linear closure of the lower Anxiety and Information Scale (APAIS) and a Visual Analog portion of the defect. For the upper portion, a triangular Scale (VAS). Pain was measured using as well the Visual myocutaneous propeller flap was designed, incised, and Analog Scale (VAS). mobilized while keeping attachment to the procerus mus- Results: STAI and APAIS revealed similar levels of pre-opera- cle on its base. Then it was rotated clockwise for 150 de- tive anxiety, but significantly reduced levels of intraopera- grees and transposed into the defect. tive anxiety in DBI compared to NI patients. VAS for anxiety The flap was secured in place under minimal tension with did not reveal any difference between NI and DBI patients. subcutaneous interrupted 5-0 polydioxanone sutures. Su- VAS for pain revealed significantly reduced intraoperative perficial running 5-0 polybutester sutures were used to ap- pain in DBI compared to NI patients. proximate epidermal edges. Conclusion: DBI significantly reduced intraoperative an- Conclusion: The procerus-based propeller flap is a useful xiety and pain, supporting the efficiency of a simple relaxa- technique to repair large defects on the central nasal dor- tion technique for dermatosurgical procedures performed sum. The skin laxity on the glabella and lower forehead can under local anesthesia. Patients may benefit from this ex- be used to restore both natural width and thickness of the perience for further dermatological procedures. nasal dorsum in a single surgical session. POSTERS

Dermatologica Helvetica - Volume 32(6) - Août 2020 69 P106 vere plaque psoriasis.1,2 Here, efficacy results following up Guselkumab more effective than secukinumab in pa- to 4 years of continuous GUS treatment are presented. tients with psoriasis and self-reported psoriatic arthritis: Methods: In VOYAGE 1 (n=837), patients were randomized randomized, double-blind, head-to-head comparison to GUS 100 mg at Weeks 0, 4, and 12, then every 8 weeks over 1 year (ECLIPSE) [q8wk]; placebo at Weeks 0, 4, 12, followed by GUS 100 mg at Weeks 16 and 20, then q8wk; or adalimumab 80 mg at Merola JF3, Li S4, Hsu MC4, Karyekar C3, Flavin S4, Randazzo B4, Week 0, 40 mg at Week 1, then 40 mg q2wk through Week Coates LC1 47. Starting at Week 52, all patients continued open-label 1) Oxford University, Oxford, UK GUS treatment through Week 204. Efficacy assessments 2) Brigham and Women's Hospital, Harvard Med School, Boston, included proportions of patients achieving Psoriasis Area Mass, USA and Severity Index (PASI) 90, PASI 100, Investigator Global 3) Janssen Med Affairs, Horsham, PA, USA Assessment (IGA) of 0/1, and IGA of 0. Patient-reported 4) Janssen Research & Development, LLC, Spring House, PA, USA outcomes included proportions of patients achieving a Dermatology Life Quality Index (DLQI) score=0 or 1 (no ef- Background: Guselkumab (GUS; antibody against IL-23) fect on patient’s health-related quality of life) and Psoria- and secukinumab (SEC; antibody against IL-17A) are appro- sis Symptoms and Signs Diary (PSSD) summary scores=0 ved for the treatment of psoriasis (PsO). Up to 30% of PsO (no symptoms or signs of psoriasis). Efficacy was analyzed patients may have psoriatic arthritis (PsA). using prespecified treatment failure rules (TFR), nonres- Objective: ECLIPSE compared efficacy and safety of GUS vs ponder imputation (NRI), and As Observed (OBS) metho- SEC in patients with plaque PsO. Post hoc analyses in the dology. For TFR, patients who discontinued due to lack of subgroup of patients with self-reported PsA are reported. efficacy, worsening of psoriasis, or use of a protocol-prohi- Methods: ECLIPSE was a randomized, double-blind trial of bited psoriasis treatment were considered nonresponders. adults with moderate-to-severe plaque PsO who received For NRI, patients with missing efficacy data (regardless GUS 100 mg at Weeks 0, 4, then every 8 weeks or SEC 300 of the reason) after application of TFR were counted as mg at Weeks 0, 1, 2, 3, 4, then every 4 weeks through Week nonresponders. For OBS, patient data from each visit were 44. Primary endpoint was proportion of patients achieving used; missing data were not imputed. ≥90% improvement compared to baseline in Psoriasis Area Results: PASI 90 responses were well-maintained with up and Severity Index (PASI) score [PASI 90] at Week 48. Se- to 4 years of continuous GUS treatment. At Week 204, PASI condary endpoint was proportion of patients with PASI 75 90 response rates were 82.2%, 68.4%, and 84.3%, respec- response at both Week 12 and 48. Cochran-Mantel Haens- tively, based on TFR, NRI, and OBS analyses. Similarly, PASI zel chi-square test, stratified by investigator, compared 100, IGA 0/1, and IGA 0 responses were stably maintained treatment-group responses. from Week 52 through Week 204. Proportions of patients Results: Among 1048 patients randomized [GUS (n=534), with PSSD summary scores=0 and DLQI score=0/1 were SEC (n=514)], baseline characteristics were comparable sustained from Week 76 through Week 204. No new safety between the 2 groups: body surface area PsO: 24%, Inves- signals were identified. tigator Global Assessment [IGA] moderate [76%] or severe Conclusions: High efficacy response rates were maintained [24%]), and were similar to subgroups with self-reported with up to 4 years of continuous GUS treatment in VOYAGE PsA [GUS (n=97), SEC (n=79)]. Primary endpoint of PASI 1, regardless of the analysis method (TFR, NRI, OBS). 90 response at Week 48 was achieved by 84.5% of GUS vs 70.0% of SEC patients (treatment difference [TD], 14.2 [95% CI:9.2%,19.2%], p<0.001). Among patients with PsA, pri- P108 mary endpoint was achieved by 82.5% of GUS vs 63.3% of Guselkumab demonstrates greater efficacy compared SEC patients (TD, 19.2% [95% CI:5.0%, 33.4%]). PASI 90 res- to secukinumab across body weight quartiles and body ponse was maintained in both the overall population (OP) mass index categories: week 48 results from the ECLIPSE and PsA subpopulation beyond Week 20 in GUS treated pa- trial tients, while a reduction in response through Week 48 was observed in SEC-treated patients (Figure). In the OP, PASI Armstrong A4, Flavin S5, Randazzo B2, Langley RG3, Blauvelt A6, 75 response showed non-inferiority of GUS vs SEC (84.6% Hsu MC5, Reich K1 vs 80.2%, p<0.001), but superiority was not demonstrated 1) Dermatologikum Berlin and SCIderm Research Institute, Ham- (p=0.062). Adverse events (AEs) observed in all groups burg, Germany were generally consistent with the established safety pro- 2) Janssen Research & Development, LLC, Spring House, PA/Uni- files for GUS and SEC. versity of Pennsylvania, Philadelphia, PA, USA Conclusions: In the subset of patients with self-reported 3) Dalhouise University, Halifax, NS, Canada PsA in the ECLIPSE study, GUS demonstrated better main- 4) Keck School of Medicine, University of Southern California, Los tenance of skin response and higher efficacy at approxi- Angeles, CA, USA mately one year, compared with SEC in the treatment of 5) Janssen Research & Development, LLC, Spring House, PA, USA moderate to severe plaque PsO, consistent with results of 6) Oregon Medical Research Center, Portland, OR, USA patients with plaque PsO in the overall study population. AEs were generally consistent with the established safety Objective: ECLIPSE is a Phase 3, randomized, controlled profiles for GUS and SEC. trial comparing the long-term efficacy of guselkumab versus secukinumab for the treatment of moderate to severe plaque psoriasis. This post-hoc analysis evaluated efficacy P107 by baseline body weight quartiles and body mass index Maintenance of response with up to 4 years of conti- (BMI) categories. There were no body weight restrictions nuous guselkumab treatment: results from the VOYAGE for enrollment in the study. 1 phase 3 trial Methods: Patients were randomized to receive guselkumab 100 mg at Weeks 0/4/12, then every 8 weeks (n=534), Kimball AB4, Shen YK2, Song M2, Griffiths CEM3, Han C2, Miller or secukinumab 300 mg at Weeks 0/1/2/3/4, then every 4 M2, Blauvelt A1, Papp KA5, You Y2 weeks (n=514), both through Week 44. Efficacy endpoints 1) Oregon Medical Research Center, Portland, OR, USA included the proportions of patients achieving ≥90% im- 2) Janssen Research & Development, LLC, Spring House, PA, USA provement compared to baseline in Psoriasis Area and 3) Dermatology Centre, University of Manchester, Manchester, UK Severity Index (PASI) score (PASI 90), PASI 100, Investiga- 4) Harvard Medical School, Boston, MA, USA tor Global Assessment (IGA) 0, and IGA 0/1 responses at 5) K. Papp Clinical Research and Probity Research Inc., Waterloo, Week 48. Data were analyzed by baseline body weight Ontario, Canada quartiles (Q1, ≤74 kg; Q2, >74 to ≤87 kg; Q3, >87 to ≤100 kg; Q4, >100 kg) and BMI categories (normal, <25 kg/m2; Objective: Guselkumab (GUS) is a fully human monoclonal overweight, ≥25 to <30 kg/m2; obese, ≥30 kg/m2). Missing antibody that binds and blocks interleukin (IL)-23 function. data were imputed as non-response after applying treat- VOYAGE 1 is an ongoing, Phase 3, double-blinded, placebo- ment failure rules. and active comparator-controlled study that evaluates the Results: The proportions of patients achieving a PASI 90 efficacy and safety of GUS in patients with moderate-to-se- response at Week 48 in the guselkumab and secukinu- POSTERS

70 Dermatologica Helvetica - Volume 32(6) - Août 2020 mab groups, respectively, were as follows: by baseline Research & Development and may be shareholders in the body weight quartiles—Q1, 86.7% vs 75.6% (11.1% [0.9%- parent company (Johnson & Johnson). 21.3%]); Q2, 89.1% vs 73.0% (16.0% [6.0%-26.0%]); Q3, 80.3% vs 71.0% (9.3% [–1.9%-20.6%]); Q4, 82.1% vs 61.3% (20.9% [9.4%-32.3%]); by BMI categories—normal, 88.1% P110 vs 75.2% (12.8% [2.2%-23.5%]); overweight, 84.1% vs 73.4% Multiple clustered dermatofibroma: a clinical variant of (10.6% [1.6%-19.7%]); obese, 82.5% vs 65.3% (17.2% [8.8%- dermatofibroma 25.6%]) (percent difference [95% CI]). These results are consistent with the primary endpoint of PASI 90 response Zürcher S, Hunger RE, Feldmeyer L at Week 48 in the overall study population (guselkumab, Department of Dermatology, Inselspital, Bern University Hospital, 84.5% vs secukinumab, 70.0% [14.2% (9.2%-19.2%)]). Simi- University of Bern lar results were observed across all body weight quartiles and BMI categories for PASI 100, IGA 0, and IGA 0/1 res- Background: Dermatofibromas (DFs), also called benign ponses, with all between-treatment differences numerical- fibrous histiocytomas, are neoplastic mesenchymal soft tis- ly favoring guselkumab. sue lesions with fibroblastic and histiocytic differentiation. Conclusions: Across baseline body weight quartiles and The presence of multiple DFs is rare. The multiple eruptive BMI categories, efficacy response rates at Week 48 were DF variant describes the sudden appearance of diffuse DFs. consistently numerically greater for guselkumab com- When they appear in a localised anatomical region, they pared to secukinumab in the treatment of moderate to represent an entity called multiple clustered DFs, of which severe psoriasis. only about 20 cases have been reported so far. Case description: A 49-year-old woman was evaluated for skin lesions on her left breast, which first developed 25 P109 years ago. During menopause, the lesions increased in size Three-year clinical efficacy of guselkumab and ixeki- and became mildly painful. She had a history of anxiety zumab in moderate-to-severe plaque psoriasis: a and depression, which were treated with lorazepam. Phy- matching-adjusted indirect comparison sical examination revealed small papules on the left breast, showing sometimes a clear central area. Some lesions Diels J2, Van Sanden S2, Schubert A3, Thilakarathne P2, Hassan coalesced to form partially atrophic plaques. Light micros- F4, Villacorta R1 copy studies of three biopsy specimens showed the cha- 1) Janssen Research & Development LLC, Horsham, PA, USA racteristic histological criteria for a DF. The DF cells showed 2) Janssen Pharmaceutica NV, Beerse, Belgium a weak positivity for CD34. The latter finding is found only 3) Janssen-Cilag, Warsaw, Poland in a minority of DFs. 4) Janssen-Cilag Ltd, High Wycombe, Buckinghamshire, UK Discussion: Multiple eruptive DFs, diffusely distributed, are frequently associated with autoimmune diseases, haema- Introduction: Given the lack of long-term, head-to-head tologic neoplasia, or HIV infection. Conversely, our case efficacy comparisons between guselkumab (GUS) and illustrates a multiple clustered DF, the features of which ixekizumab (IXE), the study aimed to compare PASI90 (90% were very similar or even identical to a plaque-like DF, two reduction in Psoriasis Area and Severity Index score) res- entities only exceptionally associated with systemic di- ponse rates between the two treatments over three years, seases. No malignant transformation or metastatic disease using data from pivotal Phase 3 randomized control trials has been described. The treatment options for this entity (RCTs) and adjusting for differences in study patient popu- are very limited; a large excision is generally not recom- lations. mended because of the benignity of the condition. Methods: To identify published long-term data from RCTs in moderate-to-severe psoriasis for GUS and IXE, a systematic literature review was performed up to January 2019 P111 using EMBASE, MEDLINE, Cochrane Central, and Clinical- Successful treatment of eosinophilic pustular folliculitis Trials.gov. Unanchored matching-adjusted indirect com- with benralizumab in a 13-year-old girl parison (MAIC) was conducted using individual patient data for GUS (156-week data from VOYAGE 1 and 2 trials) Bürgler C1,5, Guillet C2, Kolm I 2, Theiler M1, and summary-level data for IXE (156-week data from UN- Schmid-Grendelmeier P 2,3, Kroiss S 4, Weibel L 1 COVER-3 trial). Matching was based on propensity score 1) Pediatric Skin Center, Dermatology Department, University weighting methods where GUS patients were re-weighted Children's Hospital Zurich, Zurich such that patient baseline characteristics matched those in 2) Department of Dermatology, University Hospital Zurich, Zurich the IXE arm of UNCOVER 3. The primary outcome assessed 3) Christine Kühne Center for Allergy Research and Education CK- was PASI90 response, in line with the primary outcome CARE, Davos of VOYAGE 1 and 2, up to week 156 (3 years). Modified 4) Division of Oncology and Hematology, University Children's non-responder imputation (mNRI) was applied to handle Hospital Zurich, Zurich missing data resulting from patient discontinuations; NRI 5) Department of Dermatology, Inselspital, Bern University Hospi- and multiple imputation (MI) were used in sensitivity ana- tal, University of Bern, Bern lyses. Odds ratios (OR) with 95% confidence intervals (CI) were calculated at timepoints which overlapped across the Introduction: IL-5 plays a crucial role in regulating the trials. differentiation, proliferation and survival of eosinophils. Results: At weeks 12, fewer patients in the GUS arm achie- Anti-IL5 and -IL5 receptor targeted therapies are licensed ved a PASI90 response versus the IXE arm (58.8% vs 69.3%, for the treatment of severe eosinophilic asthma and have OR 0.63, 95% CI 0.47-0.86, p=0.003). From week 16 to week been proposed to be effective for corticosteroid-resistant 84, PASI90 response rates were similar between the GUS hypereosinophilic syndrome (HES). and IXE arms. From week 108 onwards, PASI90 response Case report: We report the case of a 13year-old girl suffering rates were significantly higher for the GUS arm versus the from an extensively pruritic dermatosis since preschool IXE arm, respectively: at week 108, 77.8% vs 69.3% (OR age. She presented with disseminated papulopustules 1.55, 95% CI 1.12-2.16, p=0.0091); at week 132, 77.3% vs predominantly at the neck and upper trunk. Previous the- 68.5% (OR 1.56, 95% CI 1.13-2.17, p=0.0072); and at week rapies under the diagnosis of atopic eczema,urticaria and 156, 75.4% vs 66.0% (OR 1.58, 95% CI 1.14-2.18, p=0.0055). acne were ineffective. Histology of a skin biopsy revealed Results were consistent using the NRI and MI approaches. an interstitial and periadnexial eosinophilic infiltrate. The Conclusions: Current MAIC analyses suggest higher short- pustules were sterile on microbiology. Full blood count term PASI90 response rates for IXE, but higher long-term revealed persistent eosinophilia with a maximum of 3.03 PASI90 response rates for GUS beyond two years of fol- G/l and increased eosinophilic cationic protein (ECP). In- low-up. These analyses further illustrate the importance of vestigations for further organ involvement of eosinophilia assessing responses to treatment over the long-term given were negative. Total IgE was highly elevated (>1000 kU/l) the chronic nature of plaque psoriasis. without fulfillment of the Hyper-IgE syndrome NIH criteria. Funding: This study was funded by Janssen Inc. Bone marrow aspirate was normal apart from increased eo- Financial Disclosures: All authors are employees of Janssen sinophils, no genetic re-arrangement for myeloic neopla- POSTERS

Dermatologica Helvetica - Volume 32(6) - Août 2020 71 sia detected. Potential triggers of eosinophilia such as daily to target areas and cyclosporine at 3 mg/kg/day for 3 parasitosis,drugs, allergies and immunodeficiency were ex- weeks followed by 1.5 mg/kg/day for 6 weeks. The assess- cluded. We diagnosed idiopathic eosinophilic pustular fol- ment was performed one month following each treatment, liculitis (EPF). Treatment with oral corticosteroids (1mg/kg/ 3 and 6 months post treatment. day) resulted in good improvement but rapid recurrence Results: At 6 months follow-up, mean repigmentation by at lower doses. A single subcutaneous dose of 30mg ben- area method in tofacitinib group was 82.6 ± 28 % SD and ralizumab (Fasenra®) was administered. Within 48 hours in cyclosporine group was 62 ± 18% SD (P = 0.014). Pa- the patient experienced a marked decrease of pruritus. tient satisfaction by visual analogue scale at 6 months also After three weeks, she was completely free of symptoms, showed significant difference (P = 0.024). There was statis- her blood eosinophil count was zero and ECP normalized. tically significant difference between two groups regarding Initial IL-5 levels in our patient were low, however we found Dermatology life Quality Index (DLQI) score after operation an increased IL-5 level of 4.8pg/ml (norm <1) after the in- (p value = 0.036). Treatment was generally well tolerated jection of benralizumab. This excellent response was sus- without any side effects in two groups. tained for 24 weeks, then the disease was slowly relapsing, Discussion: This study demonstrated that topical adminis- benralizumab was once more injected leading again to si- tration of tofacitinib is safe and efficacious treatment in re- gnificant improvement within 2 weeks. fractory vitiligo. Discussion: The delineation EPF from HES remains difficult, however on the basis of the characteristic clinical picture we here favor the diagnosis of EPF. To our knowledge, this is P114 the first report of successful treatment of refractory EPF in Omenn syndrome with striking skin peeling mimicking a child with an anti-IL5 receptor antagonist. Larger studies epidermolytic ichthyosis are needed to determine the benefit and long-term effect of anti-IL5 targeted therapy in eosinophilic dermatoses. Smith A1, Theiler M2, Prader S3, Kamarachev J4, Knöpfel N2, Bürgler C2, Hägi L5, Weibel L2, Pachlopnik-Schmid J3, Schwie- ger-Briel A2 P112 1) Paediatric Dermatology, Department of Paediatrics, Kantonss- Comparing the efficacy of tacrolimus 0.03% cream vs. pital Winterthur low-dose oral isotretinoin in the treatment of moderate 2) Paediatric Skin Center, Dermatology Department, University to severe seborrheic dermatitis Children's Hospital Zurich, Zurich 3) Division of Paediatric Immunology, University Children’s Hospi- Goldust M1, Rokni R2 tal Zürich 1) University Hospital Basel, Basel 4) Dermatopathology, Department of Dermatology, University 2) Mazandaran University of Medical Sciences, Sari, Iran Hospital Zürich 5) Neonatology, Dept. of Paediatrics, Kantonsspital Winterthur Introduction: Seborrheic dermatitis (SD) is a chronic mild skin disorder with high prevalence. Multiple treatment Background: Extensive skin peeling at birth is suggestive of options are available with variable efficacy and safety. This epidermolytic ichthyosis due to KRT1 or KRT10 mutations. study aimed at comparing the efficacy of tacrolimus 0.03% However, the presentation of skin diseases in neonates can cream vs. low-dose oral isotretinoin in the treatment of mo- be misleading necessitating daily re-evaluation and- if dia- derate to severe seborrheic dermatitis. gnosis is in question- early and broad investigations. Material and Methods: In this randomized, controlled clini- Case: We present the case of a term born male neonate with cal trial study, 136 patients suffering from moderate to se- extensive epidermal maceration and striking desquama- vere SD were studied. The patients were randomly divided tion exposing large denuded areas. The working diagnosis into two groups. First group received topical tacrolimus of epidermolytic ichthyosis was made and a biopsy was 0.03% cream twice daily for four weeks. In control group, taken. Due to an evolving picture of scaling and erythema sixty-six patients were treated with isotretinoin 10 mg eve- over the following days, lymphocyte subsets were analysed ry other day. At the beginning of referring and also 2 and 4 as part of a neonatal erythroderma work-up. Histology re- weeks after first visit, the patients were examined to control vealed spongiotic dermatitis with acanthosis, parakera- improvement of clinical symptoms. Patient opinion, inves- tosis, lymphocytic infiltration and numerous eosinophils, tigator assessment, scalp pruritus, sebum production, and suggesting a differential diagnosis of Netherton syndrome quality of life (QoL) comprised the efficacy outcomes. or primary immunodeficiency. Lymphocyte typing showed Results: The highest level of satisfaction (80.3%) was ob- a normal amount of T and NK cells but no naïve CD4 T cells served 28 days after isotretinoin consumption since it was and no B cells. At the same time the recently established 72.7% in tacrolimus group. Relationship between patients’ neonatal SCID screening was analysed with a finding of satisfaction and isotretinoin receiving in 28th day was si- no TRECs (T-cell receptor excision circles), consolidating gnificant (P=0.03). The rate of sebum production signifi- the diagnosis of severe combined immunodeficiency syn- cantly decreased in isotretinoin group. Investigator, and drome (SCID) at one week of age with Omenn syndrome QoL assessments improved in both groups. There were no due to expansion of autoreactive T cells. Maternal engraft- adverse events related to treatment for either group. ment was ruled out by FISH analysis. The result of the muta- Disussion: The treatment with either group had a beneficial tion analysis showing bi-allelic RAG-1 mutations confirmed effect on the clinical condition of the skin of the patients. the diagnosis of T-B-NK+ SCID. Low-dose oral isotretinoin can be a therapeutic modality While high IgE and eosinophilia were present, lymphade- for moderate to severe seborrheic dermatitis. nopathy, organomegaly or other systemic symptoms remained absent. Progressive ichthyosiform erythroderma and alopecia became evident within week one. Leucocy- P113 tosis peaked at 44 G/l on day 8, thus topical steroids and Evaluation of Tofacitinib 2% Cream versus Oral Cyclos- a combination of systemic prednisolone and cyclosporine porine in the Treatment of Refractory Vitiligo were introduced leading to significant improvement of skin changes and complete blood cell count. At the age of Goldust M1, Rokni R2 4 months the patient underwent stem cell transplantation 1) University Hospital Basel, Basel with good success. 2) Mazandaran University of Medical Sciences, Sari, Iran Discussion: Erythroderma in SCID usually occurs within the Background: Vitiligo is a common depigmenting skin disor- first months of life. This unique clinical presentation mi- der, characterized by patchy loss of skin color and finding micking epidermolytic ichthyosis has not previously been effective treatment has remained a challenging issue. This described. This case highlights the importance of not de- study aimed at comparing the efficacy and safety of tofaci- laying immunological work-up in infants with erythroder- tinib 2% cream versus oral cyclosporine in the treatment of ma even with atypical findings, since an early diagnosis of refractory vitiligo. SCID reduces mortality. In the future, results of newborn Methods: In this randomized clinical trial study, 36 patients screenings for SCID, as recently introduced. with multiple, progressive, refractory, vitiligo lesions were randomized to receive either tofacitinib 2% cream twice POSTERS

72 Dermatologica Helvetica - Volume 32(6) - Août 2020 P115 Results: The mean propranolol dose was 1.9 ±0.4mg/kg/ Extensive periocular pustules in a neonate- something day at 3 and 1.9 ± 0.3mg/kg/day at 6 months. The mean wild or rather mild? HAS reduced from 4.3 ±1 at baseline to 2.2 ±1 at 6 months (p<0.0001). 3-month measurements (n=20 in each group, Schwieger-Briel A*, Bürgler C, Knöpfel N, Brändli R, Luchsinger 6 male; mean age: Propranolol = 2.9 ±0.2, Control 3.0 ±0.2 I, Theiler M, Weibel L months): Mean daily sleep duration was 13.3 (9.6 during Pediatric Skin center, Division of Pediatric Dermatology, University night time) hours in the propranolol group vs. 13.6 (9.3 Children's Hospital Zurich, Zurich during night time) hours in untreated infants (p>0.30). The mean number of awakenings per hour of night time sleep Objective: Neonatal cephalic pustulosis (NCP) is a common was 0.33 vs. 0.28 (p=0.21). 6-month measurements (n=24 dermatosis, appearing in 10-66% of neonates(1). It was in each group, 5 male; mean age: Propranolol = 5.9 ±0.3, first described by Aractingi in 1991(2). The diagnostic cri- Control 5.8 ±0.3 months): Mean daily sleep duration was teria were defined by Rapelanoro(3) as affecting neonates 13.1 (9.9 during night time) vs. 13.0 (9.9 during night time) in the first month of life, cephalic localisation, microscopic hours (p>0.70). The mean number of awakenings per hour evidence of malassezia species, absence of other causes of night time sleep was 0.23 vs. 0.22 (p=0.86). Based on the for pustules, and rapid response to ketoconazole cream. BISQ, there were no statistically significant differences in However, the role of malassezia has repeatedly been terms of parent-reported sleep problems, sleep regularity, challenged(4,5). Rarely, NCP can present with extensive and frequency and duration of night time awakenings (all pustules, leading to concerns of parents and pediatricians p>0.09). alike. Conclusions: We did not find statistically significant alte- Method: We performed a retrospective chart review of all rations in the objectively measured and subjectively re- children presenting with extensive or unusual NCP at our ported sleep pattern of propranolol-treated infants at 3 Pediatric Skin Center between 2014 and 2019. and 6 months of age as compared to untreated controls. Results: 11 infants (1 boys/10 girls/ 1 without information) with a median age of 13.6 days (12- 16 days) were included. 9 children were healthy, one suffered from a traumatic de- P117 livery and an-other had been diagnosed with primary im- Favorable response to pulsed dye laser treatment in ca- munodeficiency. The paediatric dermatologist was contac- pillary malformation-arteriovenous malformation (CM- ted through a tele-dermatology mail address (n=4), the AVM) emergency department (n=5), or during inpatient consults (n=2). The main concern of the attending physicians was to Theiler M1, Eisenring D2, Luchsinger I1, Weibel L1 rule out HSV or bacterial infection. All children presented 1) Pediatric Skin Center, Dermatology Department, University with pronounced periocular pustules. Three children had Children's Hospital Zurich also multiple pus-tules on the forehead, the cheeks (n=1) 2) Pediatric Skin Center, Skin and wound treatment, University and the whole face (n=1). In 9 of the 11 children, the pus- Children's Hospital Zurich, Zurich tules cleared quickly with an Azole (ketoconazole, clotri- mazole) anti-fungal with or without addition of topical Objectives: Capillary malformation-arteriovenous malfor- steroids. Swabs had been taken in 4 cases, none of which mation (CM-AVM) is a rare syndrome due to autosomal showed relevant growth of bacteria or funghi (including dominant mutations in RASA1 or EPHB4 and characterized malassezia species). by multiple high-flow cutaneous vascular stains and a risk Discussion: NCP can in rare cases present with extensive for extracutaneous AVMs. Experience with pulsed dye laser pustules of the periocular region and the forehead leading (PDL) treatment of cutaneous lesions is very limited in CM- to parental anxiety and emergency consultations. Our data AVM. We report our findings of a series of CM-AVM patients help to increase the awareness of this particular form of treated with PDL. NCP, which responds well to topical steroids in combina- Methods: The charts of all patients with CM-AVM treated tion with Azole anti-fungals and has a benign course. with PDL (Candela Vbeam perfecta™, 595nm) at our institution were retrospectively analyzed. Results: 5 patients were included in this study. The median P116 age at first laser treatment was 4.3 years (range 2.0 – 10.5). Sleep behavior during propranolol treatment for infan- Reasons for treatment included aesthetic impairment (5 tile hemangioma – a prospective, controlled study. patients), bleeding (1 patient), and soft tissue hypertrophy (1 patient). 4 patients were treated in the head/neck area. Theiler M1*, Schoch SF2*, Weibel L1, von der Heydt S3, Schwie- The median number of treatments was 3 (range 1-4) and ger-Briel A1, Smith A4, Luchsinger I1, Kernland-Lang K5, Waelchli therapy was performed under general anesthesia in 4 pa- R1, Neuhaus K6, Gnannt R7, Knoepfel N1*, Kurth S2,8* tients. 2 patients had concomitant treatment with topical *equally contributing first and last authors sirolimus 0.25% between the laser sessions. All patients 1) Division of Pediatric Dermatology, Pediatric Skin Center, Univer- had moderate to good response to PDL with 40-90% im- sity Children’s Hospital Zurich, Zurich provement of color and there was cessation of bleeding in 2) Department of Pulmonology, University Hospital Zurich, Zurich one patient. Compared to classical port-wine stains mar- 3) Department of Pediatric Surgery, Charité University Medicine, kedly higher fluencies were required to achieve adequate Virchow Medical Center, Berlin, Germany bruising and consecutive lightening. No re-darkening was 4) Division of Pediatric Dermatology, Kantonsspital Winterthur, noted at last follow-up after a median of 3.6 months (range Winterthur 3.0 – 21.3). PDL therapy was well tolerated in all patients. 5) Division of Pediatric Dermatology, Kantonsspital Baden, Baden Apart from transient hyperpigmentation in 1 case, no side 6) Division of Plastic and Reconstructive Surgery, Pediatric Skin effects occurred. Center, University Children’s Hospital Zurich, Zurich Discussion: PDL seems to be effective and safe in cu- 7) Division of Pediatric Interventional Radiology, Department of Diagnostic Imaging, University Children's Hospital Zurich, Zurich taneous high-flow vascular stains of CM-AVM. Of note we 8) Department of Psychology, University of Fribourg, 1700 Fribourg did not observe any tendency for crusting or ulceration. Further studies and longer follow-up periods are required Purpose: Sleep disturbances are reported by parents in up to determine the true value of PDL in this syndrome. to 30% of infants with infantile hemangiomas (IH) treated with propranolol. This is the first prospective, controlled study assessing the sleep behavior in propranolol treated infants based on objective measures. Methods: Sleep parameters of infants treated with propranolol for IH and an age- and sex-matched cohort of healthy untreated infants were assessed over a period of 7 days at age 3 and 6 months using actigraphy, sleep diaries, and the Brief Infant Sleep Questionnaire (BISQ). Treatment response was assessed using the Hemangioma Activity

Score (HAS). POSTERS

Dermatologica Helvetica - Volume 32(6) - Août 2020 73 P118 reactivations (for maculopapular eruptions) might provide Sinus pericranii - a great mimicker mechanistic explanations. It can also be postulated that viral dissemination and infection of blood vessels might Weibel L2, Knoepfel N2, Gnannt R4, Altermatt S3, Nieman E1, lead to a vasculitis and/or perivascular skin inflammation. Theiler M2, Bayliss S1 A better understanding of which subsets of patients deve- 1) Division of Dermatology, St. Louis Children's Hospital, St. Louis, lop skin lesions and which pathways drive COVID-19 skin USA inflammation should provide important clues into SARS- 2) Pediatric Skin Center, Dermatology Department, University CoV2 protective immunity and pathological inflammation. Children's Hospital Zurich To gain insights into the pathophysiology of COVID-19 cu- 3) Pediatric Neurosurgery, University Children's Hospital Zurich taneous manifestations, we are performing an integrated 4) Interventional Radiology, University Children's Hospital Zurich analysis of lesional skin that included NanoString gene expression profiling, H&E-stained histopathology, IHC- and IF- Purpose: Sinus pericranii (SP) is a rare vascular anomaly staining. Moreover, search for evidence of viral replication characterized by an epicranial venous malformation of in the skin is performed using RT-PCR, NanoString and elec- the scalp communicating with an intracranial dural sinus tronic microscopy. All patients presenting skin lesions with through dilated diploic cranial veins. The diagnosis is often documented or suspected SARS-CoV2 infection (either di- difficult to make clinically, because cutaneous features are rectly presenting or referred to our clinic) are included. Re- highly variable. We report 3 cases of SP involving the mid- sults are compared to those obtain from lupus lesions, viral line forehead and nose, emphasizing its cutaneous presen- exanthemas and pityriasis rosea before the pandemic. The tation with diagnostic pitfalls. study is currently on ongoing and should provide, by the Methods: Three patients presented at birth with a vascular time of the conference, high-quality detailed information forehead lesion who subsequently underwent magnetic related to the cells and inflammatory pathways associated resonance angiography (MRA). with distinct clinical patterns of COVID-19 lesional skin. Results: Three female patients with a median age of 9 months (6 months - 14 years) at presentation were investigated for a congenital vascular midline forehead lesion. The referral diagnoses were infantile hemangioma, vascular anomaly and localized scleroderma en coup de sabre. They all presented with erythematous telangiectatic to bluish discoloration of the skin involving the midline forehead and nose. In one patient, there was localized alopecia on the scalp and atrophic changes of the skin with indenta- tion noted in two. The 3 year old patient showed a bluish nodule on the nose that increased in size with crying. Two children were asymptomatic whereas the 16-year-old patient reported headaches and vertigo. In all of them radio- logical studies (MRA) showed a prominent forehead vein with abnormal venous drainage, with suspected intracranial communication in one and increased intraosseous vas- cularization in another patient. They were managed by a multidisciplinary vascular anomalies board. The 3 year old patient underwent neurosurgical removal of communicating veins without improvement of the cutaneous presentation. Conclusion: SP involving the midline forehead-nose may not only mimic other vascular anomalies such as arteriovenous malformations, infantile hemangioma but also morphea en coup de sabre. Physicians should be aware of the cutaneous manifestation of SP and perform cerebral MRA for appropriate diagnosis.

P119 Insights into the immunopathology of COVID-19 cutaneous manifestations

Yatim A, Di Domizio J, Bogiatzi S, Guenova E, Hohl D, Conrad C, Gilliet M Department of Dermatology and Venereology, University Hospital CHUV, Lausanne

SARS-CoV2 is a novel RNA coronavirus that emerged in De- cember 2019 in China, and is the etiological agent of the COVID-19 pandemic. The most frequent clinical presentation of COVID-19 is upper respiratory tract syndrome. Acute respiratory distress syndrome is a common complication of SARS-CoV2 pneumonia. Additional severe complications include coagulopathy and systemic Kawasaki-like vasculitis. Cutaneous manifestations have been uncommonly described in COVID-19. At least four clinical patterns are reported and associated with different patient demographics, timing and severity. Acral chilblain-like lesions affect younger patients and are seen in mild diseases or asymptomatic patients. Maculopapular and vesicular eruptions are concomitant with other symptoms, and do not correlate with disease severity. Finally, necrotic/livedoid lesions are reported in older patients with more severe disease. The immunological mechanisms that trigger COVID-19 skin lesions remain unclear. Excessive type I interferon (for chilblain-like lesions), coagulopathy or vasculitis (for necrotic/ livedoid lesions), and cross-reactive T cells or herpesvirus POSTERS

74 Dermatologica Helvetica - Volume 32(6) - Août 2020 ADVANCED SWISS SUNCARE Made in Switzerland

Protection solaire dermatologique SANS compromis

Haute tolérance Légèreté inégalée Disponible Tous les produits Ultrasun sont formulés SANS parfum, huiles minérales, silicones, émulsifiants PEG/PPG, filtres Gels lamellaires en pharmacies irritants ou perturbateurs endocriniens, enrobage aluminium ou conservateurs. légers et drogueries EcoSun Pass is either a registered trademark or a trademark of BASF SE in the European Union and/or other countries. aktive Tuberkulose). VM:Beieinerklinischbedeutsamenoderschwerwiegenden Infektion,istderPatientsorgfältigzuüberwachenundTREMFYA 17.-20.10.2019. LasVegas, USA.2. FachinformationTREMFYA als s.c.InjektioninWoche 0und4,dannalle8Wochen. KeinAnsprechennach16Wochen, Abbrucherwägen. D: AnwendungsollteunterAnleitungundAufsichteines inderDiagnoseundBehandlungPlaque-PsoriasiserfahrenenArzteserfolgen,nachsachgemässerSchulungauchSelbstadministration. DieempfohleneDosisbeträgt100 mg Therapien wie beispielsweise Cyclosporin, Methotrexat (MTX) oder PUVA (Psoralen und UV-A) unzureichend angesprochen haben oder bei denen eine Kontraindikation oder Unverträglichkeit gegenüber solchen Therapien besteht. GEKÜRZTE FACHINFORMATIONGEKÜRZTE TR TREMFYA b a PASI 100Ansprechen:55,7 % zuWoche 204(TRF) Zulassungsinhaberin: Janssen-CilagAG,Gubelstrasse 34,6300Zug(CP-126337) Compendium. abbrechen. Therapiestart, beilatenterTBzunächstantituberkulöse Therapieeinleiten.ÜberwachungaufTBwährendderTherapie.KeineLebendimpfstoffegebenBehandlung.Bei schwerenÜberemp ndlichkeitsreaktionenTherapie REFERENZEN: * KonfektioniertinSchaffhausen denen eineKontraindikationoderUnverträglichkeitgegenübersolchenTherapienbesteht. TREMFYA BEI PLAQUE PSORIASIS BEI • Jeder2.Patient symptomfreiüber4Jahre • DereinzigvollhumaneIL-23 Hemmer ® UAW: istindiziertzurBehandlung mittelschwerer bisschwererPlaque-PsoriasisbeierwachsenenPatienten,dieaufanderesystemischeTherapienoderPUVA (PsoralenundUV-A) unzureichendangesprochenhabenoderbei IA: bisherkeinerelevantenInteraktionenbeobachtet. Packungen:InjektionslösunginFertigspritzeoderFertigpen(100 mg/ml). Abgabekat.:B.AusführlicheInformationen:www.swissmedic.ch oderwww.swissmedicinfo.ch; 1. Grif ths CEMetal.MaintenanceofResponsewithupto4Years ofcontinuousGuselkumabtreatment:ResultsfromtheVOYAGE 1Phase3Trial. Posterpresentedat:9 Sehrhäu g: InfektionderoberenAtemwege;Häu g: Gastroenteritis, Herpes-simplex-Infektionen,Dermatophytosen,Kopfschmerzen,Diarrhö,Urtikaria, Arthralgie,ErythemanderInjektionsstelle;weitereUAW s. Made in Schahausen* EMFYA ® : STARK &STABIL ® : TREMFYA ® ( Guselkumab, ® , 09/2019unterwww.swissmedicinfo.ch (aufgerufenam23.12.19). humaner IgG1λ-mA 1a,b ) ALS FERTIGPENALS NEU AUCH I: TREMFYA ® istindiziertzurBehandlungmittelschwererbisschwererPlaque-PsoriasisbeierwachsenenPatienten, dieaufanderesystemische KI: 2 SchwerwiegendeÜberemp ndlichkeit aufWirkstoff odereinenderHilfsstoffe.KlinischrelevanteaktiveInfektionen(z. B. 1 ® istabzusetzen,bisdieInfektionabgeklungenist. Abklärung aufTuberkulose-Infektion vor th Fall Clinical Dermatology Conference,

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