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Background: Genital involvement in atopic dermatitis(AD) can have a significant impact on the patient’s quality of life. However, inspection of genital areas is not usually conducted during routine examination and patients may be reluctant to inform the clinician or show this area. Objective: to evaluate the efficacy of tralokinumab in AD patients with genital involvement. Methods: Adult patients with moderate/severe AD and genital involvement receiving tralokinumab have been analyzed. Primary endpoints were EASI, DLQI, PP-NRS, genital-IGA (g-IGA) and genital itching (GI) at week 16. Results: out of 48 patients with moderate/severe AD under treatment with tralokinumab, 12 patients (25%) showed a genital involvement. Seven patients reported itching in the genital area (58%), while none reported a positive history of genital infections. Median scores at T0 were EASI 17.5, PP-NRS 8 and DLQI 14. After 16weeks of treatment, we observed a median EASI of 3, a median PP-NRS of 1 and a median DLQI of 1. Finally, concerning the genital response, after 16weeks of treatment, we observed a statistically significant decrease in mean GI and g-IGA scores. Conclusion: despite the small size of our sample, tralokinumab can be considered as a valid treatment option for AD with genital involvement. [ABSTRACT FROM AUTHOR]

This article, published in the Journal of Dermatological Treatment, presents a case report on the use of apremilast for the treatment of pustular psoriasis induced by neoadjuvant chemotherapy for Ewing Sarcoma. The patient, a 33-year-old female, developed a cutaneous rash after receiving chemotherapy and was diagnosed with pustular psoriasis. After initial treatment with steroids, the patient experienced a relapse of the rash, and apremilast was initiated, resulting in a rapid response and remission of the psoriasis. The article highlights the importance of managing cutaneous toxicities in oncology patients and suggests that apremilast may be a viable treatment option for psoriasis in patients with a history of cancer. [Extracted from the article]

The management of plaque psoriasis that affects difficult-to-treat areas can be challenging. Biologics have become the treatment of choice for moderate-to-severe plaque psoriasis. However, there are limited data on their efficacy in difficult-to-treat sites (including scalp, palms/soles, nails and genitalia). We conducted a 52-week retrospective study to evaluate the effectiveness of risankizumab in 202 patients with moderate-to-severe involvement of at least one difficult-to-treat area. One hundred and sixty-five patients had scalp psoriasis, 21 had involvement of palms or soles, 72 were affected by genital psoriasis, and 50 patients reported the involvement of the fingernails. After one year of treatment, 97.58% of patients with scalp involvement, 95.28% of patients with palmoplantar psoriasis, 100% of patients with genital psoriasis and 82% of patients with nail involvement achieved a site-specific Physician's Global Assessment of 0 or 1 (clear or almost clear). No serious adverse events were observed during the study. Our study supports the effectiveness of risankizumab in plaque psoriasis involving difficult-to-treat sites. [ABSTRACT FROM AUTHOR]

The R.Evolution project aimed to reach a consensus on the main challenges of conducting clinical research in Italy and possible strategies and approaches to address them and optimize clinical research management. A scientific board of experts initially discussed potentially critical areas in clinical research conduct and further explored them through an online national survey. The survey results were further examined by a group of 35 panelists representing different clinical research stakeholders. A Nominal Group Technique and a Delphi approach (two rounds) were used to generate a consensus on critical factors, tools and strategies in clinical research. Four main critical areas were identified: study feasibility, authorization procedures, operational aspects and patient management. The main issues are scarce awareness of the value of clinical research, lack of trained workforce and excessive complexity of protocols and administrative procedures. The Delphi panel identified six intervention areas: culture and patient involvement; procedures; staff, contracts, training and incentives; organization and infrastructure; administrative procedures; and ethics committee. According to the R.Evolution project, possible strategies to improve clinical research management in Italy include a deeper understanding of the value of clinical research, the creation of long-term plans for hiring, training, organizing and motivating clinical trial staff, the simplification and harmonization of administrative procedures, as well as protocol design, and the development of stronger networks of centers and stakeholders. [ABSTRACT FROM AUTHOR]

Atopic dermatitis (AD) has substantial negative impact on patients' quality of life. Although considerable advances have been made in understanding the pathogenesis and its treatment, there is still limited transfer of this knowledge into daily management. Aiming to identify unmet needs in clinical management of patients with AD, we used a Delphi consensus process. A set of statements regarding diagnosis, management, prognosis, and treatment was identified by five experts (Steering Committee). Then, the Steering Committee and a second group of four clinicians were involved in a Delphi process. Lastly, agreement was assessed in a larger panel of Italian clinicians. Overall, 37 clinicians participated to the process. 17 statements reached strong agreement and 2 reached weak agreement. In general, the statements reflected the need for accurate and effective diagnostic criteria to support clinical experience, especially in the atypical forms of AD. Moreover, prognostic criteria are needed to predict the duration of adult-onset AD. The identification of biomarkers was considered to be useful for clinical management of AD at all stages of disease. Lastly, greater emphasis should be placed on patient education and development of effective tools that can aid informing patients about their disease and its treatment. [ABSTRACT FROM AUTHOR]

Enthesitis is a hallmark of psoriatic arthritis (PsA) and echographic ultrasounds (US) represent a support for diagnosis of pre-clinical signs of enthesitis in asymptomatic patients at high risk for advanced forms. Early treatment with anti-TNFα could prevent permanent damage contrasting the degenerative course of the disease. To evaluate the effects of adalimumab on echographic and preclinical enthesitis signs in patients affected by plaque psoriasis. 49 psoriatic patients undergoing adalimumab treatment for plaque-type psoriasis were subjected to echographic screening for identifying pre-clinical signs of enthesitis. Patients underwent clinical and ultrasonographic examination of hands, elbows and knees before starting adalimumab and after 24 and 48 weeks of treatment. We observed a reduction of the total number of echographic abnormalities and a significant decrease of the thickness of quadriceps tendons at week 24 and week 48. Furthermore, there was no evidence of significant articular damage progression during the entire study duration. Entheseal ultrasonography may be used for preclinical diagnosis of PsA. Our study demonstrates that early detection and management with adalimumab leads to a block of articular damage progression. On quadriceps tendon, adalimumab has shown to be effective with a significant thickening reduction at week 24 and 48 [ABSTRACT FROM AUTHOR]

A recent study evaluated the safety and effectiveness of anti-IL-23 drugs in patients with moderate-to-severe plaque psoriasis and previous tuberculosis (TB) infection. The study included 16 patients who received IL-23 inhibitors, such as risankizumab, guselkumab, and tildrakizumab. All patients achieved at least a 75% reduction in Psoriasis Area and Severity Index (PASI) score, with 62.5% achieving complete skin clearance. No evidence of TB reactivation or serious adverse events were observed during the study. Previous clinical trials and real-life experiences also support the safety of IL-23 inhibitors in patients with TB infection. [Extracted from the article]

This letter to the editor discusses the effectiveness and safety of baricitinib, an oral Janus kinase (JAK) inhibitor, in the treatment of severe alopecia areata (AA). The study evaluated the use of baricitinib in 50 patients with severe AA and found that a significant percentage of patients achieved a reduction in hair loss and improvement in their condition. The study also reported that baricitinib was well-tolerated with no serious adverse events. While the study has some limitations, the results support data from previous clinical trials and suggest that baricitinib may be a promising treatment option for severe AA. [Extracted from the article]

This letter to the editor discusses a case of a 46-year-old female patient with hidradenitis suppurativa (HS) who developed paradoxical pustular psoriasis and alopecia after treatment with adalimumab, a tumor necrosis factor-alpha (TNF-alfa) inhibitor. The patient's symptoms improved initially but worsened after 22 weeks of treatment. The authors decided to discontinue adalimumab and prescribed topical therapy with clobetasol propionate. However, due to poor response, they added ixekizumab, an interleukin-17A monoclonal antibody, which resulted in a significant reduction of inflammation and regrowth of hair. The patient completed one year of treatment with ixekizumab without relapse. Paradoxical reactions are unanticipated events that can occur during treatment with biological drugs, and understanding the underlying mechanisms can help in treatment decisions. [Extracted from the article]

This letter to the editor discusses the use of upadacitinib, a selective Janus kinase (JAK) inhibitor, for the treatment of atopic dermatitis (AD) in elderly patients. The authors present a case series of seven elderly patients with adult-onset moderate-to-severe AD who were treated with upadacitinib. The patients showed significant improvement in their Eczema Area and Severity Index (EASI) scores, and the drug was generally well-tolerated with no severe adverse events. The authors suggest that upadacitinib may be a safe alternative for treating moderate-to-severe AD in older adults, but further studies are needed to confirm its safety and effectiveness in this population. [Extracted from the article]

This letter to the editor discusses the use of tralokinumab, a selective inhibitor of interleukin (IL)-13, for the treatment of moderate-to-severe atopic dermatitis (AD). The authors retrospectively analyzed data from 10 patients who were treated with tralokinumab for at least 16 weeks. They found that tralokinumab significantly improved subjective symptoms and quality of life in these patients, with a reduction in itch and improvement in clinical scores. The treatment was generally well-tolerated, with no significant safety concerns. The authors conclude that tralokinumab shows promise for the treatment of AD in real-world patients. [Extracted from the article]

This document is a letter to the editor published in the Journal of Dermatological Treatment. The letter discusses the treatment of palmoplantar psoriasis, a subtype of psoriasis that affects the palms or soles of the feet. The authors conducted a retrospective study to compare the effectiveness of anti-interleukin (IL)-23 drugs and anti-IL-17 drugs in psoriatic patients with palmoplantar involvement. They found that both types of drugs were effective in achieving clear or almost clear skin at palmoplantar regions, with no significant differences between the two. However, the authors note that larger and longer studies are needed to further investigate the role of these treatments in severe palmoplantar psoriasis. [Extracted from the article]

This letter to the editor discusses the effectiveness and safety of dupilumab, a medication used to treat atopic dermatitis (AD), in adolescents. AD is a chronic inflammatory skin disease that commonly affects children and adolescents. The study evaluated the effectiveness of dupilumab in reducing symptoms such as itch and sleep loss, as well as its safety profile. The results showed that dupilumab was effective in reducing symptoms and had a good safety profile. However, larger studies are needed to confirm these findings. [Extracted from the article]

Psoriasis in pediatric patients is uncommon and the management of moderate-to-severe cases can be challenging. We report the case of a 17-year-old girl who presented with severe plaque psoriasis unresponsive to UVB phototherapy. The Psoriasis Area Severity Index (PASI) was 18 and the Dermatology Life Quality Index was 24. We decided to prescribe ixekizumab, observing complete skin clearance after only 8 weeks. The patient is still on treatment with no reported adverse events after two years. [ABSTRACT FROM AUTHOR]

This letter to the editor of the Journal of Dermatological Treatment presents a case series of 28 patients who experienced psoriasis flares or new-onset psoriasis after COVID-19 infection or vaccination. The patients were treated with biologic drugs and followed for at least 16 weeks. The results showed that the biologics were effective in reducing psoriasis symptoms, with most patients experiencing significant improvement. The authors recommend continuing biologic treatment during COVID-19 vaccination and emphasize the safety of these treatments during the pandemic. The study was conducted ethically and in compliance with patient privacy regulations. [Extracted from the article]

This letter to the editor discusses the treatment of atopic dermatitis (AD) in elderly patients. The authors report their experience with 40 patients aged 65 and older who were treated with dupilumab, a monoclonal antibody. The patients showed significant improvement in their symptoms, with a decrease in the Eczema Area and Severity Index (EASI) score and a reduction in pruritus. The treatment was well-tolerated, and no serious adverse events were reported. The authors suggest that dupilumab may be an effective and safe option for elderly patients with AD, but further studies are needed to confirm these findings. [Extracted from the article]

Purpose: The overlap of psoriasis and atopic dermatitis (AD) is rare and treating moderate-to-severe cases can be challenging. Conventional immune-suppressive drugs cannot be used long-term, and no biological drugs are currently approved for treating both conditions. Method: We report the cases of four patients with overlapping features of both psoriasis and AD. Result: After being treated with several systemic drugs, including gold-standard treatments for both psoriasis and AD, they received upadacitinib 15 or 30 mg, achieving complete remission. Upadacitinib is an inhibitor of Janus Kinase 1, currently approved for treating moderate-to-severe AD. Conclusion: To date, very limited data are available regarding the efficacy of upadacitinib in psoriasis. In a phase-3 trial on the efficacy of upadacitinib 15 mg in patients affected by psoriatic arthritis, 52.3% of patients achieved a 75% improvement in Psoriasis Area and Severity Index (PASI75) after one year. Currently, no clinical trials are evaluating the efficacy of upadacitinib in plaque psoriasis. [ABSTRACT FROM AUTHOR]

To the editor Targeted biologic agents have improved the outlook for patients with moderate-to-severe psoriasis, enabling greater disease control ([1]). Duration of response was defined as the time from initial response to first loss of response and could not be longer than 52 weeks due to the study design. Treatment responses were calculated for all four response criteria and plotted over 52 weeks among patients receiving ixekizumab versus ustekinumab. [Extracted from the article]

Biologics have revolutionized the therapy of moderate-to-severe plaque psoriasis. Despite their greater efficacy over conventional systemic therapies their high cost has represented a burden for health-care systems, which limited their use. The availability of biosimilars at low cost is changing the place in therapy of biologics for psoriasis. The role of TNF- α inhibitors in the management of plaque psoriasis, their efficacy and safety profile are presented. Phase 3 clinical trials and real-life data from the use of TNF- α inhibitor biosimilars in the treatment of plaque psoriasis are also reviewed in detail. Furthermore, arguments in favor of the use of TNF- α inhibitor biosimilars as a first-line therapy in moderate-to-severe plaque psoriasis are discussed. An increasing amount of data show that biosimilars represent a safe and effective alternative to the originator biologics. In the face of ever-increasing health-care costs, switching to biosimilars and starting naïve patients on the best-value biologic can reduce expenditure for patients and payers while maintaining a high-quality care. Moreover, as the cost of biosimilars is approaching the cost of conventional systemic treatments, TNF-α inhibitors biosimilars may represent a first-line systemic treatment for psoriasis patients because they are effective and safe. [ABSTRACT FROM AUTHOR]

Objective:Psychiatric disorders and suicide risk (especially in psoriasis) are frequent and disabling conditions in patients with skin diseases. The aim of this study was to examine the risk of suicide and stressful life events in a sample of patients with skin disease. Methods:A sample of 242 dermatological patients (142 women and 100 men), 112 of which had psoriasis, 77 had melanoma, and 53 were suffering with chronic allergic diseases. Patients were administered the MINI International Neuropsychiatric Interview (MINI), Hamilton Depression Rating Scale (HDRS), Hamilton Anxiety Rating Scale (HARS), and the Columbia-Suicide Severity Rating Scale (C-SSRS). Patients were also asked about their experiences with stressful life events. Results:Patients with psoriasis were more likely to have a history of psychiatric disorders (36.6% vs. 13.2%χ2(1) = 9.55;p = 0.002) compared to patients with allergies. Specifically, patients with psoriasis more likely had a diagnosis of a mood disorder (16.1% vs. 3.9%χ2(1) = 6.85;p = 0.009; 16.1% vs. 0%χ2(1) = 9.56;p = 0.002) and reported past suicidal ideation (33.9% vs. 15.6%χ2(1) = 7.89;p = 0.005; 33.9% vs. 18.9%χ2(1) = 3.96;p = 0.047) as compared to those with melanoma and allergy. Conclusions:The results from this study suggest that patients affected by psoriasis have an increased risk of psychiatric comorbidities and suicidal ideation compared to those who have other dermatological disorders. [ABSTRACT FROM PUBLISHER]

Introduction: Skin manifestations are common in patients with inflammatory bowel diseases (IBD) and can be part of a concomitant illness with a shared genetic background, an extra-intestinal manifestation of the disease, or a drug side-effect. Areas covered: We provide a practical overview of the epidemiology, pathogenesis, diagnosis, therapeutic approach and prognosis of the most frequent disease-related and drug-induced cutaneous manifestations in IBD, illustrated by cases encountered in our clinical practice. Among the most frequently encountered IBD-related lesions are erythema nodosum, pyoderma gangrenosum and Sweet’s syndrome. Common skin manifestations with a strong association to TNF antagonists are local injection site reactions, psoriasiform lesions, cutaneous infections, vasculitides and lupus-like syndromes. In addition, we discuss the relation of thiopurines and TNF antagonists with the risk of skin cancer. Expert commentary: We hope this review will help caretakers involved in the management of IBD patients to recognize the lesions and to manage them in close collaboration with a dedicated dermatologist. [ABSTRACT FROM PUBLISHER]

Introduction: Psoriasis is a chronic skin disorder associated with several comorbid conditions. In psoriasis pathogenesis, the role of some cytokines, including TNF-α and IL-17, has been elucidated. Beside their pro-inflammatory activity, they may also affect glucose and lipid metabolism, possibly promoting insulin resistance and obesity. On the other hand, adipose tissue, secreting adipokines such as chemerin, visfatin, leptin, and adiponectin, not only regulates glucose and lipid metabolism, and endothelial cell function regulation, but it may contribute to inflammation. Areas covered: This review provides an updated ‘state-of-the-art’ about the reciprocal contribution of a small subset of conventional cytokines and adipokines involved in chronic inflammatory pathways, upregulated in both psoriasis and increased adiposity. A systematic search was conducted using the PubMed Medline database for primary articles. Expert commentary: Because psoriasis is associated with increased adiposity, it would be important to define the contribution of chronic skin inflammation to the onset of obesity and vice versa. Clarifying the pathogenic mechanism underlying this association, a therapeutic strategy having favorable effects on both psoriasis and increased adiposity could be identified. [ABSTRACT FROM PUBLISHER]

In this paper, the non-invasive system MASSIMO is presented for the monitoring and the seismic vulnerability mitigation of the cultural heritage. It integrates ground-based, airborne and spaceborne remote sensing tools with geophysical and in situ surveys to provide the multi-spatial (regional, urban and building scales) and multi-temporal (long-term, short-term, near-real-time and real-time scales) monitoring of test areas and buildings. The measurements are integrated through web-based GIS and 3D visual platforms to support decision-making stakeholders involved in urban planning and structural requalification. An application of this system is presented over the Calabria region for the town of Cosenza and a test historical complex. [ABSTRACT FROM AUTHOR]