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Interleukin 17 (IL-17) inhibitors such as secukinumab, ixekizumab, and IL17 receptor (IL17RA) inhibitor brodalumab have proved to be highly effective and safe in psoriasis treatment. Still, a substantial proportion of patients show a primary or secondary inefficacy. When this happens, the clinician can change the therapeutical axis (swap) or perform an intraclass switch among IL-17 inhibitors. The latter option could allow us to address some comorbidity better, spare the other axis in case of the future inefficacy, and avoid interacting with other molecules with a different safety profile. To date, no sufficient data are available on the efficacy of a second IL-17 inhibitor therapy. Our study included 29 patients with moderate to severe psoriasis undergoing an intraclass switch among IL-17 inhibitors. The mean PASI dropped from 11.1 ± 6.1 to 5.2 ± 6.6 at week 16, with response maintained at week 28 and week 52 (3.4 ± 4.2 and 3.0 ± 4.3, respectively) with no occurrence of serious adverse events. Our data support the evidence that intraclass switch among IL-17 inhibitors is a safe and effective therapeutic option in these patients. This trial is registered with SS_DERMO_20.

Systemic retinoids are among the most prescribed drugs in dermatology, thanks to their activity as proliferation modulators and keratinisation normalisers. Common side effects such as blood lipid disorders, xerosis and photosensitivity are well established and usually dose dependent. Conversely, retinoid-associated ocular disturbances have been reported, yet with differences in terms of frequency and manifestations As data regarding a potential correlation with refractive errors are heterogenous and have not been previously thoroughly addressed, we performed a systematic review of the literature with the aim of comprehensively evaluating the current evidence regarding retinoid-associated myopia in dermatologic patients.A systematic review of the literature was carried out according to the PRISMA guidelines. A search on MEDLINE, Pubmed, Scopus, Cochrane Library was conducted using the MeSH terms: retinoid, isotretinoin, acitretin, bexarotene, etretinate, alitretinoin, myopia, refractive errors, via the Boolean term AND. Only manuscripts in English were considered, there was no restriction on type of article. Animal research and in vitro studies were excluded.Six articles were finally included in this systematic review. One well designed prospective study was able to show a slight myopic shift in the first six months, but id did not evaluate further development of the refractive error nor the effects of drug discontinuation. Another prospective study, with a smaller sample size showed no myopic progression at 12 months. Two case reports showed a myopic shift after two weeks from therapy start. Another case report showed a myopic shift associated with narrowing of the anterior chamber after one week from therapy start. Finally a large retrospective study based on spontaneous reporting systems and world's literature classified myopia as a certain side effect.Considering the current literature, it is not possible to define a clear correlation between the use of retinoids and the development or worsening of myopia. Some studies suggest that retinoids may cause a myopic shift and the pathophysiologyical mechanism is supported by some animal and in vitro studies, but there is a lack of large prospective and well-controlled studies. In case of ocular disturbances after retinoid use a prompt ophthalmological referral is advisable and in case of the detection of a myopic refractive error a relationship to retinoids should be ruled out, considering also other possible causes such as age and previous refractive status.

To date, over 250 million people have been reportedly infected by COVID-19 disease, which has spread across the globe and led to approximately 5.1 million fatalities. To prevent both COVID-19 and viral transmission, DNA-based/RNA-based vaccines, non-replicating viral vector vaccines, and inactivated vaccines have been recently developed. However, a precise clinical and histological characterization of SARS-CoV-2 vaccine-related dermatological manifestations is still lacking. A systematic review of 229 articles was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, in order to provide an extensive overview of SARS-CoV-2 vaccine-related skin manifestations. Data on demographics, number of reported cases with cutaneous involvement, vaccine, and rash type (morphology) were extracted from articles and summarized. A total of 5941 SARS-CoV-2 vaccine-related dermatological manifestations were gathered. Local injection-site reactions were the most frequently observed, followed by rash/unspecified cutaneous eruption, urticarial rashes, angioedema, herpes zoster, morbilliform/maculopapular/erythematous macular eruption, pityriasis rosea and pityriasis rosea-like eruptions, and other less common dermatological manifestations. Flares of pre-existing dermatological conditions were also reported. Cutaneous adverse reactions following SARS-CoV-2 vaccine administration seem to be heterogeneous, rather infrequent, and not life-threatening. Vaccinated patients should be monitored for skin manifestations, and dermatological evaluation should be offered, when needed.

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