Publications by authors named "Zoe Apalla"

Alopecia areata (AA) is an autoimmune disease that is characterized by nonscarring hair loss of the scalp, face, and/or body. Three therapies have been approved for the treatment of severe AA; however, there are several different approaches for defining disease severity. Therefore, severity assessment tools are helpful in determining the appropriate treatment approach and evaluating treatment response in patients with AA.

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Background: The differential diagnosis of early nail unit melanoma can be challenging.

Objective: This retrospective cross-sectional study aimed to characterize the clinical and dermoscopic changes in a series of cases of longitudinal melanonychia that underwent clinical and dermoscopic sequential digital monitoring.

Methods: All patients were adults presenting with a single acquired pigmented nail band and were monitored over time.

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Multinucleate cell angiohistiocytoma (MCAH) is a rarely reported and likely underdiagnosed cutaneous entity with benign biological behavior. MCAH is described as a solitary or multiple proliferation of vascular and fibrohistiocytic origin, with largely unknown etiopathogenesis. It presents as red-brown to violaceous papules or nodules, mainly on the extremities, and is usually asymptomatic.

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Introduction: Treatments such as 4% 5-fluorouracil (5-FU) cream have demonstrated strong efficacy in lesion clearance of actinic keratosis; however, local skin reactions (LSR) during treatment remain a significant challenge, potentially affecting patient adherence.

Objective: We sought to build consensus on management of LSR associated with 4% 5-FU using the Delphi methodology.

Methods: Twenty-eight expert dermatologists participated in a 3-round Delphi process.

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Introduction: Bullous pemphigoid (BP) is an autoimmune disorder causing tense blisters on the skin and sometimes mucous membranes, primarily affecting older adults. It results from autoantibodies attacking the epidermal basement membrane. The incidence of BP is rising globally, particularly due to drug-induced cases.

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Purpose: The dermatological management of cancer patients with cutaneous adverse events occurring during and after oncologic treatment is known as supportive oncodermatology. This includes prevention, early identification, and mitigation of dermatologic toxicities. The aim of the international RESCUE (Residents' survey on training of dermatology residents in supportive oncodermatology) study was to ascertain the current level of expertise in supportive oncodermatology among dermatology residents.

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Folliculitis decalvans is the most common form of primary neutrophilic scarring alopecia, which is diagnosed in 2.8% of patients with hair loss. The course of the disease is typically chronic and relapsing.

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Background: Frontal fibrosing alopecia (FFA) has been defined as a lichen planopilaris (LPP) variant, and both are characterized by lymphocytic scarring alopecia. Despite histopathological similarities, they differ clinically, suggesting potentially different pathogenetic factors. This Delphi study aimed to collect expert opinions to clarify the relationship between FFA and LPP.

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Introduction: Onychomycosis is one of the most common nail diseases. Fingernail onychomycosis is significantly less frequent than toenail onychomycosis and it is often misdiagnosed due to its subtle clinical presentations.

Objectives: We sought to analyze the clinical and onychoscopic features of culture-proven cases of fingernail onychomycosis in adult and pediatric patients.

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Background: Despite durable responses achieved with Immune Checkpoint Inhibitors (ICIs), data about optimal duration of treatment, especially in the context of adverse events, remain scarce.

Objective: To systematically review the evidence concerning the impact of treatment discontinuation with ICIs for reasons other than progressive disease (PD) on relapse rates and survival of melanoma patients.

Methods: A systematic literature search was conducted in three electronic databases until July 2024.

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Multiple parameters define the treatment course with biologics for a psoriatic patient while treatment switches are often associated with worse prognosis. The purpose of this study was to describe the switching patterns of biologics for psoriasis in the Greek market landscape and to detect associated factors that may impact the evolvement of selected therapy. This is a retrospective cohort study using data recorded in the nationwide digital prescription database of Greece.

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This literature review aims to comprehensively evaluate the clinical and dermoscopic presentations of common pediatric diseases among children with skin of color (SoC) while also addressing potential variations based on racial backgrounds. This review encompasses various conditions, such as nevi subtypes, viral infections, infestations, and inflammatory dermatoses, as well as hair diseases and abnormal vascular formations, occurring in pediatric populations. Overall, we identified 7 studies on nevi subtypes, 24 studies on skin infections, 6 on inflammatory dermatoses, 10 on hair diseases and disorders, and 14 on miscellaneous disorders that also satisfied our SoC- and race-specific criteria.

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The dermoscopic rainbow pattern (RP), also known as polychromatic pattern, is characterized by a multicolored appearance, resulting from the dispersion of polarized light as it penetrates various tissue components. Its separation into different wavelengths occurs according to the physics principles of scattering, absorption, and interference of light, creating the optical effect of RP. Even though the RP is regarded as a highly specific dermoscopic indicator of Kaposi's sarcoma, in the medical literature, it has also been documented as an atypical dermoscopic finding of other non-Kaposi skin entities.

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Article Synopsis
  • Diagnosing acral melanocytic lesions, like acral nevi and melanoma, can be difficult, and the BRAAFF checklist was developed to assist in this process but hasn't been validated yet.
  • In a study, varying experts diagnosed images of nevi and melanomas using the BRAAFF checklist online, yielding a sensitivity of 92.5% and a specificity of 65.0%, comparable to traditional pattern recognition.
  • The checklist showed varying levels of agreement among raters based on experience, and a simplified version achieved similar sensitivity with slightly lower specificity, suggesting that the BRAAFF checklist is a helpful but not superior diagnostic tool.
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Article Synopsis
  • Diagnosing basal cell carcinoma (BCC) in individuals with darker skin tones (dark phototypes IV-VI) is difficult due to varied presentations and fewer identifiable clues; dermoscopy can aid in identifying BCC in these patients.
  • This review provides a comparison of BCC's clinical and dermoscopic patterns in people of color to those in lighter-skinned individuals, identifying common mimickers like squamous cell carcinoma and melanoma.
  • Key dermoscopic features of BCC in darker skin include blue, black, and gray dots, with arborizing vessels being the primary indicator, while unique conditions in darker skin such as dermatosis papulosa nigra are also considered in differential diagnosis.
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Background: Dermoscopy is a valuable tool in the diagnosis of various skin conditions. It increases sensitivity and specificity in skin cancer diagnosis, as well as in infectious, inflammatory and hair diseases. However, mastering the intricacies of dermoscopy can be challenging.

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