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AbstractBackground Determining tumor necrosis factor-alpha inhibitors (anti-TNF-α) failure is still a challenge in the management of moderate-to-severe psoriasis. Thus, our comprehensive systematic literature review aimed to gather information on the criteria used to define anti-TNF-α failure. We also aimed to discover the main reasons for anti-TNF-α failure and define subsequently administered treatments.Materials and methods We conducted a systematic review following review and reporting guidelines (Cochrane and PRISMA). International (Medline/PubMed and Cochrane Library) and Spanish databases (MEDES, IBECS), and gray literature were consulted to identify publications issued until April 2021 in English or Spanish.Results Our search yielded 58 publications. Of these, 37 (63.8%) described the criteria used to define anti-TNF-α primary or secondary failure. Criteria varied across studies, although around 60% considered Psoriasis Area and Severity Index (PASI)-50 criteria. Nineteen (32.8%) reported the reasons for treatment failure, including the lack or loss of efficacy and safety-related problems, mainly infections. Finally, 29 (50%) publications outlined the treatments administered after anti-TNF-α: 62.5% reported a switch to another anti-TNF-α and 37.5% to interleukin (IL)-inhibitors.Conclusion Our findings suggest a need to standardize the management of anti-TNF-α failure and reflect the incorporation of new targets, such as IL-inhibitors, in the treatment sequence.KEY MESSAGESIn the treatment of psoriasis, the primary and secondary anti-TNF-α failure criteria differ widely in the scientific literature.The strictest efficacy criteria for defining anti-TNF-α failure, or those recommended by guidelines such as PASI75, were underused both in clinical trials and observational studies.Most studies failed to consider patient-reported outcomes in assessing psoriasis treatment efficacy, which contrasts with recent recommendations on the inclusion of patient-reported HRQoL as a supporting criterion when considering clinical outcomes.

Resumen: Objetivo: Los pacientes diagnosticados de cáncer queratinocítico (carcinoma basocelular y carcinoma epidermoide cutáneo) o cáncer cutáneo no melanoma (CCNM) tienen un riesgo aumentado de desarrollar una segunda neoplasia cutánea. Nuestro objetivo es describir la frecuencia, tasa de incidencia y factores de riesgo predisponentes para desarrollar una segunda neoplasia cutánea en una cohorte de pacientes tratados mediante cirugía micrográfica de Mohs (CMM). Material y métodos: Estudio prospectivo de una cohorte nacional de pacientes incluidos para realización de CMM para tratar CCNM en 22 centros españoles (julio 2013-febrero 2020) REGESMOHS. Las variables analizadas incluyen las características demográficas, la frecuencia de aparición de segundas neoplasias cutáneas, sus tasas de incidencia y factores de riesgo, y se estimaron utilizando un modelo de regresión logístico multivariante de efectos mixtos. Resultados: Fueron intervenidos 4.768 pacientes: 4.397 (92%) carcinomas basocelulares, y 371 (8%) carcinomas epidermoides. El tiempo medio de seguimiento fue de 2,4 años. Se diagnosticó un nuevo tumor durante el seguimiento en 1.201 pacientes (25%); 1.013 (21%) fueron carcinomas basocelulares, 154 (3%) carcinomas epidermoides cutáneos, 20 melanomas (0,4%) La tasa de incidencia fue de 107 (101-113) por 1.000 personas/año para cualquier tumor; 90 (85-96) para el carcinoma basocelular, 14 (12-16) para el carcinoma epidermoide cutáneo y 2 (1-3) para el melanoma. El riesgo de nueva neoplasia fue mayor en varones que en mujeres 738 (61%) vs. 463 (39%). Los factores de riesgo más significativos fueron la historia de múltiples tumores previos al diagnóstico (RR: 4,6; IC 95%: 2,9-7,1); la inmunosupresión (RR: 2,1; IC 95%: 1,4-3,1) y paciente varón (RR: 1,6; IC 95%: 1,4-1,9). Conclusión: Los pacientes diagnosticados de cáncer queratinocítico intervenido mediante cirugía de Mohs tienen un riesgo aumentado de aparición de segundas neoplasias, sobre todo en aquellos pacientes con historia de tumores múltiples al diagnóstico, inmunodeprimidos y varones. Abstract: Objective: Patients with nonmelanoma skin cancer (NMSC)—ie, basal cell carcinoma (BCC) or squamous cell carcinoma (SCC)—have an increased risk of developing a second skin cancer. The aim of this study was to describe the frequency, incidence per 1000 person-years, and predictors of a second skin cancer in a cohort of patients with NMSC treated with Mohs micrographic surgery (MMS). Material and methods: Prospective study of a national cohort of patients with NMSC who underwent MMS at 22 Spanish hospitals between July 2013 and February 2020; case data were recorded in the REGESMOHS registry. The study variables included demographic characteristics, frequency and incidence per 1000 person-years of second skin cancers diagnosed during the study period, and risk factors identified using mixed-effects logistic regression. Results: We analyzed data for 4768 patients who underwent MMS; 4397 (92%) had BCC and 371 (8%) had SCC. Mean follow-up was 2.4 years. Overall, 1201 patients (25%) developed a second skin cancer during follow-up; 1013 of the tumors were BCCs (21%), 154 were SCCs (3%), and 20 were melanomas (0.4%). The incidence was 107 per 1000 person-years (95% CI, 101-113) for any cancer, 90 per 1000 person-years (95% CI, 85-96) for BCC, 14 (95% CI, 12-16) per 1000 person-years for SCC, and 2 (95% CI, 1-3) per 1000 person-years for melanoma. More men than women developed a subsequent skin cancer (738 [61%] vs 463 [39%]). The main risk factors were a history of multiple tumors before diagnosis (relative risk [RR], 4.6; 95% CI, 2.9-7.1), immunosuppression (RR, 2.1; 95% CI, 1.4-3.1), and male sex (RR, 1.6; 95% CI, 1.4-1.9). Conclusion: Patients have an increased risk of developing a second tumor after MMS treatment of NMSC. Risk factors are a history of multiple tumors at diagnosis, immunosuppression, and male sex.

Resumen: Antecedentes y objetivos: El Wound-QoL es un cuestionario validado para medir la calidad de vida en pacientes con heridas crónicas, que fue desarrollado originalmente para su uso en alemán.El objetivo de este estudio fue traducir el cuestionario Wound-QoL para su uso en la práctica clínica y estudios de investigación en España, así como validar esta versión. Materiales y métodos: Se realizaron dos traducciones independientes del Wound-QoL, directa e inversa, a partir de la versión original en alemán, seguidas de un consenso de expertos sobre las versiones resultantes. Después de su perfeccionamiento se realizó un estudio piloto y posteriormente el estudio de validación. Resultados: Se incluyó un total de 115 pacientes. La edad media fue de 69,5 (DE 14,5) años, y el 60,0% eran mujeres. La versión española del Wound-QoL mostró una excelente consistencia interna (índice alfa de Cronbach > 0,8 en todas las escalas). El análisis factorial dio como resultado las mismas escalas que la versión original. Se objetivaron características satisfactorias de la distribución de la puntuación global y de las subescalas. La validez de constructo y la validez convergente con otros resultados (calidad de vida genérica, tasa de curación) fueron satisfactorias. La gran mayoría de los pacientes consideraron que el cuestionario era una herramienta sencilla y factible. El tiempo medio necesario para completar el cuestionario fue de 5 minutos. El 99,1% de los participantes consideraron que las preguntas eran fáciles de entender y el 94,7% declaró que personal. Conclusiones: La versión española del Wound-QoL muestra una excelente validez en la práctica clínica. Por lo tanto, puede ser recomendada para su uso tanto en la rutina clínica como en los ensayos. Abstract: Background and aims: The Wound-QoL is a validated and feasible questionnaire for measuring disease-specific health-related quality of life in chronic wounds, originally developed for use in German.The objective of this study was to translate the Wound-QoL for use in clinical care and in clinical trials in Spain and to validate this version. Materials and methods: Two independent fourth- and back translations of the Wound-QoL from the original German version were conducted, followed by an expert consensus of the resulting versions. After refinement, the final tool was piloted in N = 10 patients and then used in the validation study. Results: A total of 115 patients were recruited. Mean age was 69.5 (SD 14.5) years, 60.0% were female. The Spanish version of Wound-QoL showed high internal consistency (Cronbach's alpha > 0.8 in all scales). Factor analysis resulted in the same scales as the original version. There were satisfactory distribution characteristics of the global score and the subscales. Construct validity and convergent validity with other outcomes (generic QoL, healing rate) were satisfactory. The vast majority of patients considered the Wound-QoL a simple and feasible tool. Mean time needed for completing the questionnaire was 5 minutes. Overall, 99.1% of the participants found it easy to understand the questions and 94.7% stated that the questionnaire suits the personal situation. Conclusions: The Spanish version of the Wound-QoL shows good validity in clinical practice. It can be recommended for use in clinical routine and trials.

Objective: Patients with nonmelanoma skin cancer (NMSC)—ie, basal cell carcinoma (BCC) or squamous cell carcinoma (SCC)—have an increased risk of developing a second skin cancer. The aim of this study was to describe the frequency, incidence per 1000 person-years, and predictors of a second skin cancer in a cohort of patients with NMSC treated with Mohs micrographic surgery (MMS). Material and methods: Prospective study of a national cohort of patients with NMSC who underwent MMS at 22 Spanish hospitals between July 2013 and February 2020; case data were recorded in the REGESMOHS registry. The study variables included demographic characteristics, frequency and incidence per 1000 person-years of second skin cancers diagnosed during the study period, and risk factors identified using mixed-effects logistic regression. Results: We analyzed data for 4768 patients who underwent MMS; 4397 (92%) had BCC and 371 (8%) had SCC. Mean follow-up was 2.4 years. Overall, 1201 patients (25%) developed a second skin cancer during follow-up; 1013 of the tumors were BCCs (21%), 154 were SCCs (3%), and 20 were melanomas (0.4%). The incidence was 107 per 1000 person-years (95% CI, 101–113) for any cancer, 90 per 1000 person-years (95% CI, 85–96) for BCC, 14 (95% CI, 12–16) per 1000 person-years for SCC, and 2 (95% CI, 1–3) per 1000 person-years for melanoma. More men than women developed a subsequent skin cancer (738 [61%] vs 463 [39%]). The main risk factors were a history of multiple tumors before diagnosis (relative risk [RR], 4.6; 95% CI, 2.9–7.1), immunosuppression (RR, 2.1; 95% CI, 1.4–3.1), and male sex (RR, 1.6; 95% CI, 1.4–1.9). Conclusion: Patients have an increased risk of developing a second tumor after MMS treatment of NMSC. Risk factors are a history of multiple tumors at diagnosis, immunosuppression, and male sex. Resumen: Objetivo: Los pacientes diagnosticados de cáncer queratinocítico (carcinoma basocelular y carcinoma epidermoide cutáneo) o cáncer cutáneo no melanoma (CCNM) tienen un riesgo aumentado de desarrollar una segunda neoplasia cutánea. Nuestro objetivo es describir la frecuencia, la tasa de incidencia y los factores de riesgo predisponentes para desarrollar una segunda neoplasia cutánea en una cohorte de pacientes tratados mediante cirugía micrográfica de Mohs (CMM). Material y métodos: Estudio prospectivo de una cohorte nacional de pacientes incluidos para realización de CMM para tratar CCNM en 22 centros españoles (julio 2013-febrero 2020) REGESMOHS. Las variables analizadas incluyen las características demográficas, la frecuencia de aparición de segundas neoplasias cutáneas, sus tasas de incidencia y los factores de riesgo, y se estimaron utilizando un modelo de regresión logístico multivariante de efectos mixtos. Resultados: Fueron intervenidos 4.768 pacientes: 4.397 (92%) carcinomas basocelulares y 371 (8%) carcinomas epidermoides. El tiempo medio de seguimiento fue de 2,4 años. Se diagnosticó un nuevo tumor durante el seguimiento en 1.201 pacientes (25%); 1.013 (21%) fueron carcinomas basocelulares, 154 (3%) carcinomas epidermoides cutáneos, 20 melanomas (0,4%) La tasa de incidencia fue de 107 (101-113) por 1.000 personas/año para cualquier tumor; 90 (85-96) para el carcinoma basocelular, 14 (12-16) para el carcinoma epidermoide cutáneo y 2 (1-3) para el melanoma. El riesgo de nueva neoplasia fue mayor en varones que en mujeres 738 (61%) vs. 463 (39%). Los factores de riesgo más significativos fueron la historia de múltiples tumores previos al diagnóstico (RR: 4,6; IC 95%: 2,9-7,1); la inmunosupresión (RR: 2,1; IC 95%: 1,4-3,1) y paciente varón (RR: 1,6; IC 95%: 1,4-1,9). Conclusión: Los pacientes diagnosticados de cáncer queratinocítico intervenido mediante cirugía de Mohs tienen un riesgo aumentado de aparición de segundas neoplasias, sobre todo en aquellos pacientes con historia de tumores múltiples al diagnóstico, inmunodeprimidos y varones.

Randomized studies to assess the efficacy of Mohs micrographic surgery in basal cell and squamous cell carcinomas are limited by methodological and ethical issues and a lack of long follow-up periods. This study presents the “real-life” results of a nationwide 7-years cohort on basal cell carcinoma and squamous cell carcinoma treated with Mohs micrographic surgery. A prospective cohort was conducted in 22 Spanish centres (from July 2013 to February 2020) and a multivariate analysis, including characteristics of patients, tumours, surgeries and follow-up, was performed. A total of 4,402 patients followed up for 12,111 patient-years for basal cell carcinoma, and 371 patients with 915 patient-years of follow-up for squamous cell carcinoma were recruited. Risk factors for recurrence included age, non-primary tumours and more stages or unfinished surgeries for both tumours, and immunosuppression for squamous cell carcinoma. Incidence rates of recurrence were 1.3 per 100 person-years for basal cell carcinoma (95% confidence interval 1.1–1.5) and 4.5 for squamous cell carcinoma (95% confidence interval 3.3–6.1), being constant over time (0–5 years). In conclusion, follow-up strategies should be equally intense for at least the first 5 years, with special attention paid to squamous cell carcinoma (especially in immunosuppressed patients), elderly patients, non-primary tumours, and those procedures requiring more stages, or unfinished surgeries.

Objectives To describe demographic, clinical, radiological and laboratory characteristics, as well as outcomes, of patients admitted for COVID-19 in a secondary hospital.Design and setting Retrospective case series of sequentially hospitalised patients with confirmed SARS-CoV-2, at Infanta Leonor University Hospital (ILUH) in Madrid, Spain.Participants All patients attended at ILUH testing positive to reverse transcriptase-PCR on nasopharyngeal swabs and diagnosed with COVID-19 between 1 March 2020 and 28 May 2020.Results A total of 1549 COVID-19 cases were included (median age 69 years (IQR 55.0–81.0), 57.5% men). 78.2% had at least one underlying comorbidity, the most frequent was hypertension (55.8%). Most frequent symptoms at presentation were fever (75.3%), cough (65.7%) and dyspnoea (58.1%). 81 (5.8%) patients were admitted to the intensive care unit (ICU) (median age 62 years (IQR 51–71); 74.1% men; median length of stay 9 days (IQR 5–19)) 82.7% of them needed invasive ventilation support. 1393 patients had an outcome at the end of the study period (case fatality ratio: 21.2% (296/1393)). The independent factors associated with fatality (OR; 95% CI): age (1.07; 1.06 to 1.09), male sex (2.86; 1.85 to 4.50), neurological disease (1.93; 1.19 to 3.13), chronic kidney disease (2.83; 1.40 to 5.71) and neoplasia (4.29; 2.40 to 7.67). The percentage of hospital beds occupied with COVID-19 almost doubled (702/361), with the number of patients in ICU quadrupling its capacity (32/8). Median length of stay was 9 days (IQR 6–14).Conclusions This study provides clinical characteristics, complications and outcomes of patients with COVID-19 admitted to a European secondary hospital. Fatal outcomes were similar to those reported by hospitals with a higher level of complexity.

Elena Conde-Montero,1 Pablo de la Cueva Dobao,1 José María Martínez González2 1Department of Dermatology, Hospital Universitario Infanta Leonor, 2Faculty of Dentistry, Universidad Complutense de Madrid, Madrid, Spain Abstract: Platelet-rich plasma (PRP) is a widely used throughout diverse fields of medicine for improving tissue regeneration. In dermatology, its main applications in the last few years have mainly been in antiaging treatment and wound healing. PRP contains platelets at higher concentrations than whole blood, and consequently represents a growth-factor pool. Chronic wounds are characterized by a prolonged inflammatory phase, involving a continuous destruction of matrix proteins and growth factors. Growth factors promote cell migration, proliferation, and differentiation, which are essential for wound healing. In this review, we explain the basic principles of PRP in wound healing and aim to offer an updated critical assessment of the available clinical evidence that supports the utility of PRP for the therapeutic challenge that chronic ulcers represent in our daily clinical practice. Keywords: platelet-rich plasma, chronic wounds, growth factors, wound healing, platelet gel

Background Martorell hypertensive ischemic leg ulcers are commonly misdiagnosed, and their prevalence may be underestimated. There are still some aspects to be defined about the aetiopathogenesis of Martorell ulcers and the risk factors that may be involved with them. Methods This is a single-centre retrospective case series study on the demographic characteristics and comorbidities in a series of patients with Martorell ulcer treated at a public university hospital in Madrid. Results Comparing our results to previous studies, which are few and include small samples, the risk factors that we outline are an average age over 70 years and high blood pressure. Only two (5%) participants had poor control of their high blood pressure. Conclusions and Implications for Clinical Practice Defining the epidemiological features of this type of leg ulcer may be very useful in differential diagnosis with other disorders, such as pyoderma gangrenosum. [ABSTRACT FROM AUTHOR]

Incomplete Mohs micrographic surgery (MMS) is the cessation of MMS while the tumour margins remain positive. Zbar retrospectively described a series of 14 incomplete MMS without observing recurrences.1 Madani et al. reported two recurrences among eight cases of incomplete MMS, retrospectively too.2 Neither of these retrospective studies described the rates nor analysed risk factors for recurrence. Incidence rates of tumour recurrence were 12 cases (7.5-19.3) per 100 patient-years after incomplete MMS and 1.4 cases (1.2-1.6) per 100 patient-years after complete MMS (Table 2). [Extracted from the article]

Background: Treatment persistence is becoming a useful measure to evaluate long‐term effectiveness and safety of biological therapies in real‐world settings. Objective: The main objective of this study was to explore the scientific opinion of a panel of dermatologists and hospital pharmacists to reach a consensus about the impact, causes, and best strategies and interventions that might be associated with improved drug persistence in patients with psoriasis in Spain. Methods: This research was conducted using a modified Delphi method organized in two rounds and involving a panel of 90 dermatologists and 34 hospital pharmacists. A questionnaire of 70 items was developed. The items proposed to reach a consensus included topics such as definitions and measures in the treatment of psoriasis, analysis of treatment persistence, factors that may influence treatment persistence, impact of treatment persistence and economic cost of treatment. Results: Dermatologists reached a consensus on 77.1% of the items proposed, and hospital pharmacists reached a consensus on 71.4%. Both groups agreed that it is important to use standardized measures in the evaluation of treatment maintenance over time. Dermatologists agreed that treatment survival, persistence and retention are synonymous, but hospital pharmacists considered only treatment persistence as a valid term. In addition, panelists agreed that drug persistence is an indicator of success in the treatment of psoriasis that may be influenced by a drug's effectiveness and safety profile, as well as by patient satisfaction. They agreed that the different causes of treatment discontinuation should be considered in Kaplan–Meier analysis of treatment persistence. Moreover, treatment persistence was agreed to decrease the cost of therapy. Conclusion: This Delphi consensus highlights the different perspectives of dermatologists and hospital pharmacists regarding the interpretation of treatment persistence, and the challenge of harmonizing the results obtained. [ABSTRACT FROM AUTHOR]

Abstract: Background: The elderly population is increasing and more patients in this group undergo Mohs micrographic surgery (MMS). The few publications investigating MMS in elderly people conclude that it is a safe procedure; however, these are single‐centre studies without a comparison group. Objective: To compare the characteristics of patients, tumours, MMS and 1‐year follow‐up in patients younger than 80 years, with patients older than 80 years at the time of surgery. Methods: Data was analysed from REGESMOHS, a prospective cohort study of patients treated with MMS. The participating centres were 19 Spanish hospitals where at least one MMS is performed per week. Data on characteristics of the patient, tumour and surgery were recorded. Follow‐up data were collected from two visits; the first within 1 month postsurgery and the second within the first year. Results: From July 2013 to October 2016, 2575 patients that underwent MMS were included in the registry. Of them, 1942 (75.4%) were aged <80 years and 633 (24.6%) were ≥80 years old. In the elderly, the tumour size was significantly higher with a higher proportion of squamous cell carcinoma. Regarding surgery, elderly more commonly had tumours with deeper invasion and required a higher number of Mohs surgery stages, leaving larger defects and requiring more time in the operating room. Despite this, the incidence of postoperative complications was the same in both groups (7%) and there were no significant differences in proportion of relapses in the first‐year follow‐up. Conclusion: The risk of short‐term complications and relapses were similar in elderly and younger groups. MMS is a safe procedure in the elderly. [ABSTRACT FROM AUTHOR]

Background There are a limited number of studies comparing psoriasis patients without psoriatic arthritis (PsA) to those with arthritis. Previous results are controversial. Objectives To perform a comparative analysis of the phenotype, baseline comorbidities, therapeutic profile and incidence of adverse events (particularly overall adverse events, infections and infestations, malignancies and psychiatric disorders) among psoriatic patients with/without PsA. Methods All the patients on the Biobadaderm registry, a prospective inception cohort of psoriasis patients on systemic therapy, were included. Patients were divided into two groups: those with psoriasis without arthritis at the time of entry into the cohort (Pso group) and those with psoriasis and psoriatic arthritis (PsA group) at entry. Patients were followed until the censorship date (last visit in a lost-to-follow-up patient, or 10 November 2015, whichever occurred first). We excluded all the patients who developed any kind of signs and/or symptoms of joint involvement during the follow-up. A descriptive analysis was performed. We estimated incidence ratios ( IRR) of adverse events during systemic treatment using a mixed-effects Poisson regression. Results We included 2120 patients: 1871 (88%) patients with psoriasis without arthritis and 249 (12%) with psoriasis and PsA. The follow-up time was 5020 patients-year in the Pso group and 762 patients-year in the PsA group. Patients with PsA had more comorbidities, particularly hypertension and liver disease; used a higher number of systemic therapies, particularly anti- TNFα drugs and combination therapy; and presented more adverse events ( IRR adjusted = 1.29; 95% CI: [1.05-1.58]), particularly serious adverse events ( IRR adjusted = 1.51; 95% CI: [1.01-2.26]) and infections/infestations ( IRR adjusted = 1.88; 95% CI: [1.27-2.79]), independently of the associated comorbidities and present/past therapies. Conclusions Given the differences between patients with psoriasis alone or with psoriasis associated with PsA, patients with psoriasis and PsA should be followed and managed more closely and with specific attention. [ABSTRACT FROM AUTHOR]

Background Few reported studies compare drug survival in moderate-to-severe psoriasis vulgaris. Objectives To describe and compare drug survival of systemic drugs, including biologic agents (infliximab, etanercept, adalimumab and ustekinumab) and classical drugs (acitretin, ciclosporin and methotrexate) in moderate-to-severe psoriasis. Methods This was a multicenter, prospective, cohort study of patients receiving systemic therapies between 2008 and 2013 in 12 hospitals in Spain. Baseline data and drug discontinuation were collected. Drug survival is presented using Kaplan-Meier survival curves. We compared adjusted risk ratios of serious adverse events (AEs) with results of survival analysis for AEs. Results A total of 1956 patients were included for analysis (1240 exposed to biologics during follow-up and 1076 to classic therapies). Median follow-up time was 3.3 years (0.0-5.1 years). There were 2209 discontinuations out of 3640 therapy cycles started. The main reason for discontinuation was lack of efficacy (36.4%) and remission (27.2%). Biologics showed a higher drug survival than classics and the pattern of survival results for all outcomes (positive or negative) were very similar. Adjusted risk ratios of serious AEs did not agree with results of survival analysis. Limitations A limitation is that this is an observational study with potential selection bias. Conclusion Survival as a proxy measure of drug safety in psoriasis is inadequate. [ABSTRACT FROM AUTHOR]

Background: Increasing evidence indicates a relationship between psoriasis and metabolic syndrome (MS). We evaluated the prevalence of MS in patients receiving systemic treatment for psoriasis in Spain, and its relationship to cardiovascular disease (CVD). Methods: This cross-sectional, multicenter, non-interventional study enrolled 368 patients with moderate-to-severe psoriasis requiring systemic treatment. Clinical parameters for psoriasis, CV risk factors, MS and CVD were assessed. Descriptive and logistic regression analyses were performed. Results: 352 patients were included (median psoriasis duration: 18 years, plaque psoriasis [95.7%], psoriatic arthritis [22.8%]). Overall, 132 patients (37.5%) fulfilled diagnostic criteria for MS; the most prevalent MS components were high blood pressure and increased waist circumference. Patients with MS were older, more likely to be obese and to have a sedentary lifestyle and hypercholesterolemia than those without MS. CVD was more prevalent in patients with MS than in those without (29.5% versus 15.9%,p = 0.002), particularly coronary heart disease (CHD), myocardial infarction and heart failure. MS was independently associated with CVD (OR 1.98,p = 0.018) and CHD (OR 2.02,p = 0.044). Conclusion: The prevalence of MS was high among patients with moderate-to-severe psoriasis requiring systemic treatment, and was associated with a higher prevalence of CVD. Dermatologists should consider implementing simple screening protocols. [ABSTRACT FROM PUBLISHER]

Background: Few treatments for alopecia areata (AA) have demonstrated sustained efficacy., Objective: Evaluate the efficacy and safety of continued ritlecitinib treatment to Week 48 in patients with AA with or without target efficacy responses at Week 24., Methods: Patients aged ≥12 years received daily ritlecitinib (± 4-week loading dose): 200/50 mg, 200/30 mg, 50 mg, or 30 mg. Patients with clinical response at Week 24, based on a Severity of Alopecia Tool (SALT) score ≤20 and ≤10 were evaluated for sustained response through Week 48. Nonresponders at Week 24 were assessed for response through Week 48., Results: Among ritlecitinib-treated patients with SALT score ≤20 and ≤10 responses at Week 24, ≥85% and ≥68%, respectively, sustained these responses through Week 48. Of those with SALT score >20 at Week 24, 22%-34% achieved SALT score ≤20 at Week 48. Of those with a SALT score >10 at Week 24, 20%-26% achieved SALT score ≤10 at Week 48. Safety was similar across subgroups., Limitations: Small sample size., Conclusion: Hair regrowth was sustained through Week 48 in patients with response at Week 24. Up to one-third of patients who did not meet target efficacy at Week 24 achieved response with continued ritlecitinib treatment., (Copyright © 2024. Published by Elsevier Inc.)

Background: Immunosuppressed (IS) patients, particularly solid organ transplant recipients and those on immunosuppressive therapy, face a higher incidence and recurrence of nonmelanoma skin cancers (NMSC), including basal cell carcinoma (BCC) and squamous cell carcinoma (SCC). Mohs micrographic surgery (MMS) is the preferred treatment for high-risk NMSC due to its high cure rate and margin examination capabilities. However, IS patients may experience more complications, such as surgical site infections, and a greater risk of recurrence, making their outcomes a subject of interest., Objectives: This study aimed to compare IS and immunocompetent (IC) patients undergoing MMS for NMSC in terms of baseline characteristics, intra- and post-surgical complications, and postoperative recurrence rates., Methods: The study utilized data from the REGESMOHS registry, a 7-year prospective cohort study in Spain. It included 5226 patients, categorizing them into IC (5069) and IS (157) groups. IS patients included solid organ transplant recipients, those on immunosuppressive treatments, individuals with haematological tumours and HIV-positive patients. Patient data, tumour characteristics, surgical details and outcomes were collected and analysed., Results: IS patients demonstrated a higher proportion of SCC, multiple synchronous tumours and tumours invading deeper structures. Complex closures, unfinished MMS and more surgical sections were observed in the IS group. Although intra-operative morbidity was higher among IS patients, this difference became non-significant when adjusted for other variables such as year of surgery, antiplatelet/anticoagulant treatment or type of closure. Importantly, IS patients had a substantially higher recurrence rate (IRR 2.79) compared to IC patients., Conclusions: This study suggests that IS patients may be at a higher risk of development of AE such as bleeding or tumour necrosis and are at a higher risk of tumour recurrence. Close follow-up and consideration of the specific characteristics of NMSC in IS patients are crucial. Further research with extended follow-up is needed to better understand the long-term outcomes for this patient group., (© 2024 European Academy of Dermatology and Venereology.)

Background and Objective: A significant proportion of women of childbearing age have psoriasis. The aim of this study was to examine family planning concerns in this population., Material and Methods: Observational, descriptive, cross-sectional, multicenter study conducted between March 2020 and October 2021. We collected sociodemographic data and analyzed responses to a family planning questionnaire administered to women aged 18 to 45 years with plaque psoriasis who were candidates for systemic treatment., Results: We studied 153 patients (mean [SD] age, 35.4 [8.0] years; mean disease duration, 16.7 years) being treated at 11 Spanish hospitals. Overall, 38.4% of women were considered to have moderate to severe psoriasis by their physicians; perceived severity ratings were significantly higher among women. Psoriasis affected the women's desire to become pregnant or led to their delaying pregnancy in 1 in 3 respondents. They were concerned that their condition might worsen if they had to discontinue or switch treatment or that the treatment might harm the baby. Approximately half of the women had not received family planning counseling from their physicians, and this was more likely to be the case among never-pregnant women. Women on biologic therapy (58.7%) had better psoriasis control and a better quality of life than women on other treatments. Their sexual health was also less affected., Conclusions: Women with psoriasis have numerous family planning concerns, which in some cases can lead them to delay pregnancy or affect their desire to become pregnant. Dermatologists need to receive better training regarding family planning in women with psoriasis so that they can provide their patients with more and better information., (Copyright © 2023 AEDV. Publicado por Elsevier España, S.L.U. All rights reserved.)

Background: In recent years, remarkable improvements in our understanding of atopic dermatitis (AD) have revolutionized treatment perspectives, but access to reliable data from clinical practice is essential., Materials and Method: The Spanish Atopic Dermatitis Registry, BIOBADATOP, is a prospective, multicenter database that collects information on patients of all ages with AD requiring systemic therapy with conventional or novel drugs. We analyzed the registry to describe patient characteristics, diagnoses, treatments, and adverse events (AEs)., Results: We studied data entries for 258 patients who had received 347 systemic treatments for AD. Treatment was discontinued in 29.4% of cases, mostly due to a lack of effectiveness (in 10.7% of cases). A total of 132 AEs were described during follow-up. Eighty-six AEs (65%) were linked to a systemic treatment, most commonly dupilumab (39AEs) and cyclosporine (38AEs). The most common AEs were conjunctivitis (11patients), headache (6), hypertrichosis (5), and nausea (4). There was 1severe AE (acute mastoiditis) associated with cyclosporine., Conclusions: Initial findings on AEs from the Spanish BIOBADATOP registry are limited by short follow-up times precluding comparisons or calculation of crude and adjusted incidence rates. At the time of our analysis, no severe AEs had been reported for novel systemic therapies. BIOBADATOP will help answer questions on the effectiveness and safety of conventional and novel systemic therapies in AD., (Copyright © 2023 AEDV. Publicado por Elsevier España, S.L.U. All rights reserved.)