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Psoriasis is one of the commonest inflammatory skin diseases determining a very high impact on patients' quality of life and daily activities and relationships. Several biologic therapies have been approved through the years for the treatment of moderate‐to‐severe plaque psoriasis, and efficacy and safety profile have been analyzed in clinical trials. Ixekizumab is an immunoglobulin G subclass 4 monoclonal antibody that selectively targets and binds IL‐17A with high specificity and affinity. Inhibiting IL‐17A activity, ixekizumab reduces and turns down levels of inflammation, resulting in the clinical improvement of the disease. Long‐term efficacy and safety profile of ixekizumab have been investigated and reported in the UNCOVER trials, but in literature there are only few studies based on real life experience. We present the efficacy and safety profile of ixekizumab in a cohort of 779 patients affected by moderate‐to‐severe plaque psoriasis and treated with ixekizumab in 11 Italian dermatology hospitals, with a follow‐up of care until 192 weeks. [ABSTRACT FROM AUTHOR]

EffeCtiveness of biologic treAtmeNts for plaque psOriasis in Italy: An obserVAtional (CANOVA) study was aimed at providing real‐world evidence of the effectiveness of biologics in Italian patients with moderate–severe psoriasis. It was an observational, retro‐prospective cohort study conducted in 17 Italian dermatology clinics. Adult patients with moderate–severe plaque psoriasis, who started a biologic treatment between 24 weeks and 24 months before enrolment, were included. With a follow‐up visit at 6 months after enrolment, each patient had at least 12 months of observation. The primary objective was to describe the clinical response rates (PASI 75) after 16/24/52 weeks from biologic treatment start. Secondary outcomes were sustained response, quality of life, and treatment satisfaction. Of the 669 eligible patients (64% males), 52% were naïve to biologics, though a mean duration of psoriasis since first diagnosis of 18.6 years (SD 13.2). The most frequently prescribed biologics were secukinumab (41%), ustekinumab (25%), TNF‐inhibitors (22%) and ixekizumab (12%). PASI 75 was achieved by 86% of patients (95% CI: 82%–89%) at 16 weeks, 90% (87%–93%) at 24 weeks, and 91% (89%–94%) at 52 weeks. Patients achieving PASI 90 and PASI 100 at 52 weeks were 75% (71%–79%) and 53% (49%–57%), respectively. Sustained PASI 75 response after 1 year from treatment start was achieved by 78% (74%–82%) of patients. Mean DLQI total score was 2.3 (SD 3.9) at enrollment and decreased at the final visit to 1.8 (3.6). A high level of treatment satisfaction was expressed by patients over the study period. This large real‐world study confirms in the clinical practice the good effectiveness and acceptability of biologics in psoriasis patients. [ABSTRACT FROM AUTHOR]

Topical treatment is the mainstay for mild or moderate psoriasis, but patients are generally little satisfied. Calcipotriol/betamethasone dipropionate (Cal/BD) cutaneous foam has shown to improve signs and symptoms in plaque psoriasis patients. This study assessed patient's satisfaction with Cal/BD foam in a real‐life Italian dermatological clinical practice. A multicenter, 4‐week observational prospective cohort study enrolled, in 17 Italian dermatology clinics, adult patients with plaque psoriasis on the body and/or scalp. Treatment satisfaction was assessed by 9‐item Treatment Satisfaction Questionnaire for Medication (TSQM‐9), preference over previous treatments by Patient Preference Questionnaire (PPQ), and change in disease state by Psoriasis Area Severity Index (PASI). Overall 256 patients were eligible, with a mean (SD) age of 55.6 (15.4) years, 59.4% were males. Psoriasis severity was mild in 52.0% of patients, moderate in 43.3%, and severe in 4.7%. Scalp involvement was present in 36.7% of patients. Previous antipsoriatic treatments had been received by 80.5% of patients. TSQM‐9 median (25th–75th percentile) scores were 83.3 (66.7–88.9) for effectiveness, 77.8 (66.7–88.9) for convenience, and 78.6 (64.3–92.9) for global satisfaction. Mean (SD) PASI value decreased from 7.3 (4.8) to 2.1 (2.7) after 4 weeks. More than 90% of patients previously treated for psoriasis evaluated the Cal/BD foam more effective, easier to use and better tolerated compared to previous topical treatments at PPQ. This observational study provides real‐life evidence of a high level of satisfaction with effectiveness and convenience of the Cal/BD foam in a cohort of plaque psoriasis patients, with an objective improvement in PASI. [ABSTRACT FROM AUTHOR]

Hyperhidrosis is a disorder of excessive sweating severely impacting on patient's quality of life (Qol). Several studies have been published about oral oxybutynin, but no studies focused on the achievement of complete clinical and Qol response. The aim of this study was to report our real‐life experience with oral oxybutynin in patients with severe hyperhidrosis significantly affecting their Qol. In this cohort retrospective study, we enrolled, in a 3‐year period, patients affected by severe hyperhidrosis with poor Qol, continuously treated with oral oxybutynin. Our outcome was the obtainment of complete clinical and Qol improvement. A systematic review of the literature was also performed reporting efficacy and safety of oral oxybutynin for primary hyperhidrosis. We enrolled 62 patients, of which 53 (85.5%) received a mean daily dose of 10 mg and nine (15.5%) of 5 mg. Complete clinical response was achieved in 77.4% (48/62) of cases, while complete Qol improvement occurred in 51.6% (32/62) of cases. Adverse events were only reported as mild, with dry mouth being the most frequently observed (16.1%). Kaplan‐Meier survival analysis highlighted that both median clinical and Qol complete responses were reached after 1 year of continuous therapy with oral oxybutynin. The main limitation of our study is the small number of patients enrolled. Long‐term therapy with oral oxybutynin for severe hyperhidrosis, continuously administered at a mean daily dosage of 5 to 10 mg, allowed the majority of our patients to reach both clinical and Qol complete improvement, without significant adverse events. [ABSTRACT FROM AUTHOR]

During SARS‐CoV‐2 pandemic, an outbreak of chilblain‐like lesions has been developed, even if the relationship with the virus infection is still debated. We report the good results obtained in 12 patients with chilblain lesions and the use of oral cinnarizine, a piperazine derivative with many pharmacological properties among whom antihistaminic and calcium channel blocking activities. [ABSTRACT FROM AUTHOR]

Two round tables involving experts were organized in order to reach a consensus on the management of patients with actinic keratosis (AK). In the first, seven clinical questions were selected and analyzed by a systematic literature review, using a Population, Intervention, Control, and Outcomes framework; in the second, the experts discussed relevant evidences and a consensus statement for each question was developed. Consensus was reached among experts on how to best treat AK patients with respect to different clinical scenarios and special populations. Lesion‐directed treatments are preferred in patients with few AKs. Patients with multiple AKs are challenging, with more than one treatment usually needed to achieve complete lesion clearance or a high lesion response rate, therapy should be personalized, based on previous treatments, patient, and lesion characteristics. Methyl aminolevulinate‐PDT, DL (day light) PDT, and imiquimod cream were demonstrated to have the lowest percentage of new AKs after post treatment follow‐up. For IMQ 5% and 3.75%, a higher intensity of skin reactions is associated with higher efficacy. Photodynamic therapy (PDT) is the most studied treatment for AKs on the arms. Regular sunscreen use helps preventing new AKs. Oral nicotinamide 500 mg twice daily, systemic retinoids and regular sunscreen use were demonstrated to reduce the number of new squamous cell carcinomas in patients with AKs. Limited evidence is available for the treatment of AKs in organ transplant recipients. There is no evidence in favor or against the use of any of the available treatments in patients suffering from hematological cancer. [ABSTRACT FROM AUTHOR]

Zoon's balanitis (ZB), or balanitis circumscripta plasmacellularis, is a nonvenereal disease, characterized by a chronic, idiopathic, and benign inflammation of genital mucosa. Topical mupirocin 2% ointment for diagnosis of Zoon's balanitis and monotherapy of balanitis circumscripta plasmacellularis. Successful Management of Zoon's balanitis with topical mupirocin ointment: a case report and literature review of mupirocin-responsive balanitis circumscripta plasmacelluaris. [Extracted from the article]

Based on this evidence we decided to use tildrakizumab, an interleukin-23 inhibitor, to treat a patient with therapy-refractory SAPHO syndrome which resulted in a significant improvement of her condition. To our knowledge, this is the first case report of successful treatment of SAPHO syndrome with tildrakizumab, proving that the IL-23 inhibitor tildrakizumab is effective in the treatment of therapy-refractory SAPHO syndrome. [Extracted from the article]

Dear Editor While dupilumab has emerged as an effective treatment for moderate-to-severe atopic dermatitis (AD) since its approval, interleukin (IL)-4 and 13 blockade has also demonstrated efficacy in off-label chronic dermatologic conditions, such as alopecia areata (AA).1,2 Recently, cases of dupilumab-induced phenotype switching from AD to psoriasis have been reported.3,4 Here, we present three cases of new psoriasis onset under dupilumab treatment: two patients affected by AD and one patient affected by AA. As expected, the histopathologic diagnosis confirmed the diagnosis of psoriasis, and a calcipotriene/betamethasone dipropionate foam was administered once daily for 4 weeks on psoriasis lesions with an improvement of her clinical conditions. [Extracted from the article]

Dear Editor, Acrodermatitis continua of Hallopeau (ACH) is a rare, chronic, sterile pustular acrodermatitis, considered as localized form of pustular psoriasis. Further studies are required to evaluate the efficacy and safety of guselkumab in larger cohorts of patients in order to consider this IL-23 inhibitor as a new promising treatment option for ACH. Moreover, no adverse effect events or treatment discontinued were reported with guselkumab.4 In the literature only three cases of ACH treated with guselkumab have been described,4,6 but no cases in which the duration of treatment was longer than 12 months and coincided with a successful therapeutic response. [Extracted from the article]

A case of Melkersson-Rosenthal syndrome successfully treated with hydroxychloroquine Moreover, what captured our attention was that the patient, who worked as a greengrocer, revealed that oedema had appeared for the first time following a prolonged sun exposure. Indeed, few data are available about the use of hydroxychloroquine (HCQ) in MRS.2 Here, we reported a successful use of HCQ in MRS. [Extracted from the article]

See related Reply [ABSTRACT FROM AUTHOR]

In one case, a complete response (CR, evaluated clinically) was achieved after 9 months of therapy, the patient then discontinued treatment and is currently under follow-up; three patients are currently under treatment with partial responses after 6 months and partial response was first achieved 1 month after starting treatment; and one patient is lost to follow-up. All patients had previously experienced surgical excision of their BCCs, and two patients had previously received both surgery and radiotherapy. Hedgehog inhibitors (HHIs) were recently introduced to the market for the treatment of locally advanced basal cell carcinoma (laBCC) and metastatic BCC demonstrating a high response rate in pivotal studies. [Extracted from the article]

There are three possible explanations for the improved melanoma recognition when a clinician uses dermoscopy: first, the presence of early dermoscopy signs that become visible in melanoma much before the appearance of the classical clinical features; second, an increased attitude of clinicians to check more closely clinically banal-looking lesions; and third, an improved attitude of clinicians to monitor their patients. In this review, the light and the dark sides of melanoma screening are briefly discussed, including the need to find better strategies to decrease the number of unnecessary excision of benign lesions on one hand, and to finally decrease melanoma mortality rates on the other. [ABSTRACT FROM AUTHOR]

ABSTRACT Granuloma faciale (GF) is an uncommon, benign form of chronic leukocytoclastic vasculitis, which predominantly affects the face and which is notoriously resistant to several therapies. Besides a range of therapeutic modalities, tacrolimus has been recently reported in the successful treatment of GF. Herein we describe the clinical, dermoscopic and histopathological findings in a patient affected by GF and its response to long-term topical treatment with tacrolimus 0.1% cream. [ABSTRACT FROM AUTHOR]

Psoriasis is a common, chronic, immune‐mediated disease occurring more frequently in association with comorbid metabolic disorders. The management of patients with multiple organ dysfunction is challenging since the use of all conventional systemic agents is limited or contraindicated. In the last two decades, the introduction of biological drugs has revolutionized treatment paradigms of psoriasis and enabled numerous patients to achieve disease control with an acceptable safety profile. We reported for the first time the case of a 66‐year‐old female psoriatic patient affected by myocardial infarction, hypertension, chronic renal failure, hyperthyroidsm and morbid obesity, who experienced remarkable improvement in skin and joint synthoms and metabolic parameters after 48 weeks of secukinumab monotherapy. In our patient, secukinumab was well tolerated and no side effects have been observed. Our observation suggests that secukinumab could be a safe therapeutic option in patients with organ impairment or failure in which the majority of conventional systemic agents are contraindicated. [ABSTRACT FROM AUTHOR]

An introduction is presented in which the editor discusses various reports within the issue on topics including dermoscopic characteristics of pigmented intraepidermal carcinoma, the impact of pregnancy on the recurrence of melanoma, and transition metal complex for dye-sensitized solar cell.