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Climate projection studies of future changes in snow conditions and resulting rain-on-snow (ROS) flood events are subject to large uncertainties. Typically, emission scenario uncertainties and climate model uncertainties are included. This is the first study on this topic to also include quantification of natural climate variability, which is the dominant uncertainty for precipitation at local scales with large implications for runoff projections, for example. To quantify natural climate variability, a weather generator was applied to simulate inherently consistent climate variables for multiple realizations of current and future climates at 100 m spatial and hourly temporal resolution over a 12×12 km high-altitude study area in the Swiss Alps. The output of the weather generator was used as input for subsequent simulations with an energy balance snow model. The climate change signal for snow water resources stands out as early as mid-century from the noise originating from the three sources of uncertainty investigated, namely uncertainty in emission scenarios, uncertainty in climate models, and natural climate variability. For ROS events, a climate change signal toward more frequent and intense events was found for an RCP 8.5 scenario at high elevations at the end of the century, consistently with other studies. However, for ROS events with a substantial contribution of snowmelt to runoff (> 20 %), the climate change signal was largely masked by sources of uncertainty. Only those ROS events where snowmelt does not play an important role during the event will occur considerably more frequently in the future, while ROS events with substantial snowmelt contribution will mainly occur earlier in the year but not more frequently. There are two reasons for this: first, although it will rain more frequently in midwinter, the snowpack will typically still be too cold and dry and thus cannot contribute significantly to runoff; second, the very rapid decline in snowpack toward early summer, when conditions typically prevail for substantial contributions from snowmelt, will result in a large decrease in ROS events at that time of the year. Finally, natural climate variability is the primary source of uncertainty in projections of ROS metrics until the end of the century, contributing more than 70 % of the total uncertainty. These results imply that both the inclusion of natural climate variability and the use of a snow model, which includes a physically based process representation of water retention, are important for ROS projections at the local scale.

Alpine grasslands sustain local economy by providing fodder for livestock. Intensive fertilization is common to enhance their yields, thus creating negative externalities on water quality that are difficult to evaluate without reliable estimates of nutrient fluxes. We apply a mechanistic ecosystem model, seamlessly integrating land-surface energy balance, soil hydrology, vegetation dynamics, and soil biogeochemistry, aiming at assessing the grassland response to fertilization. We simulate the major water, carbon, nutrient, and energy fluxes of nine grassland plots across the broad European Alpine region. We provide an interdisciplinary model evaluation by confirming its performance against observed variables from different datasets. Subsequently, we apply the model to test the influence of fertilization practices on grassland yields and nitrate (NO3-) losses through leaching under both current and modified climate scenarios. Despite the generally low NO3- concentration in groundwater recharge, the variability across sites is remarkable, which is mostly (but not exclusively) dictated by elevation. In high-Alpine sites, short growing seasons lead to less efficient nitrogen (N) uptake for biomass production. This combined with lower evapotranspiration rates results in higher amounts of drainage and NO3- leaching to groundwater. Scenarios with increased temperature lead to a longer growing season characterized by higher biomass production and, consequently, to a reduction of water leakage and N leaching. While the intersite variability is maintained, climate change impacts are stronger on sites at higher elevations. The local soil hydrology has a crucial role in driving the NO3- use efficiency. The commonly applied fixed threshold limit on fertilizer N input is suboptimal. We suggest that major hydrological and soil property differences across sites should be considered in the delineation of best practices or regulations for management. Using distributed maps informed with key soil and climatic attributes or systematically implementing integrated ecosystem models as shown here can contribute to achieving more sustainable practices.

Suspended sediment load in rivers is highly uncertain because sediment production and transport at catchment scale are strongly variable in space and time, and they are affected by catchment hydrology, topography, and land cover. Among the main sources of this variability are the spatially distributed nature of overland flow as an erosion driver and of surface erodibility given by soil type and vegetation cover distribution. Temporal variability mainly results from the time sequence of rainfall intensity during storms and snowmelt leading to soil saturation and overland flow. We present a new spatially distributed soil erosion and suspended sediment transport module integrated into the computationally efficient physically based hydrological model TOPKAPI-ETH, with which we investigate the effects of the two erosion drivers – precipitation and surface erodibility – on catchment sediment fluxes in a typical pre-Alpine mesoscale catchment. By conducting a series of numerical experiments, we quantify the impact of spatial variability in the two key erosion drivers on erosion–deposition patterns, sediment delivery ratio, and catchment sediment yields. Main findings are that the spatial variability in erosion drivers affects sediment yield by (i) increasing sediment production due to a spatially variable precipitation, while decreasing it due to a spatially variable surface erodibility, (ii) favouring the clustering of sediment source areas in space by surface runoff generation, and (iii) decreasing their connectivity to the river network by magnifying sediment buffers. The results highlight the importance of resolving spatial gradients controlling hydrology and sediment processes when modelling sediment dynamics at the mesoscale, in order to capture the key effects of sediment sources, buffers, and hillslope hydrological pathways in determining the sediment signal.

To make sound decisions in the face of climate change, government agencies, policymakers and private stakeholders require suitable climate information on local to regional scales. In Switzerland, the development of climate change scenarios is strongly linked to the climate adaptation strategy of the Confederation. The current climate scenarios for Switzerland CH2018 - released in form of six user-oriented products - were the result of an intensive collaboration between academia and administration under the umbrella of the National Centre for Climate Services (NCCS), accounting for user needs and stakeholder dialogues from the beginning. A rigorous scientific concept ensured consistency throughout the various analysis steps of the EURO-CORDEX projections and a common procedure on how to extract robust results and deal with associated uncertainties. The main results show that Switzerland’s climate will face dry summers, heavy precipitation, more hot days and snow-scarce winters. Approximately half of these changes could be alleviated by mid-century through strong global mitigation efforts. A comprehensive communication concept ensured that the results were rolled out and distilled in specific user-oriented communication measures to increase their uptake and to make them actionable. A narrative approach with four fictitious persons was used to communicate the key messages to the general public. Three years after the release, the climate scenarios have proven to be an indispensable information basis for users in climate adaptation and for downstream applications. Potential for extensions and updates has been identified since then and will shape the concept and planning of the next scenario generation in Switzerland.

Increasing urbanization is likely to intensify the urban heat island effect, decrease outdoor thermal comfort, and enhance runoff generation in cities. Urban green spaces are often proposed as a mitigation strategy to counteract these adverse effects, and many recent developments of urban climate models focus on the inclusion of green and blue infrastructure to inform urban planning. However, many models still lack the ability to account for different plant types and oversimplify the interactions between the built environment, vegetation, and hydrology. In this study, we present an urban ecohydrological model, Urban Tethys-Chloris (UT&C), that combines principles of ecosystem modelling with an urban canopy scheme accounting for the biophysical and ecophysiological characteristics of roof vegetation, ground vegetation, and urban trees. UT&C is a fully coupled energy and water balance model that calculates 2 m air temperature, 2 m humidity, and surface temperatures based on the infinite urban canyon approach. It further calculates the urban hydrological fluxes in the absence of snow, including transpiration as a function of plant photosynthesis. Hence, UT&C accounts for the effects of different plant types on the urban climate and hydrology, as well as the effects of the urban environment on plant well-being and performance. UT&C performs well when compared against energy flux measurements of eddy-covariance towers located in three cities in different climates (Singapore, Melbourne, and Phoenix). A sensitivity analysis, performed as a proof of concept for the city of Singapore, shows a mean decrease in 2 m air temperature of 1.1 ∘C for fully grass-covered ground, 0.2 ∘C for high values of leaf area index (LAI), and 0.3 ∘C for high values of Vc,max (an expression of photosynthetic capacity). These reductions in temperature were combined with a simultaneous increase in relative humidity by 6.5 %, 2.1 %, and 1.6 %, for fully grass-covered ground, high values of LAI, and high values of Vc,max, respectively. Furthermore, the increase of pervious vegetated ground is able to significantly reduce surface runoff.

The hydrological and biogeochemical response of rivers carries information about solute sources, pathways, and transformations in the catchment. We investigate long-term water quality data of 11 Swiss catchments with the objective to discern the influence of major catchment characteristics and anthropic activities on delivery of solutes in stream water. Magnitude, trends, and seasonality of water quality samplings of different solutes are evaluated and compared across catchments. Subsequently, the empirical dependence between concentration and discharge is used to classify the solute behaviors. While the anthropogenic impacts are clearly detectable in the concentration of certain solutes (i.e., Na+, Cl−, NO3, DRP), the influence of single catchment characteristics such as geology (e.g., on Ca2+ and H4SiO4), topography (e.g., on DOC, TOC, and TP), and size (e.g., on DOC and TOC) is only sometimes visible, which is also because of the limited sample size and the spatial heterogeneity within catchments. Solute variability in time is generally smaller than discharge variability and the most significant trends in time are due to temporal variations of anthropogenic rather than natural forcing. The majority of solutes show dilution with increasing discharge, especially geogenic species, while sediment-bonded solutes (e.g., total phosphorous and organic carbon species) show higher concentrations with increasing discharge. Both natural and anthropogenic factors affect the biogeochemical response of streams, and, while the majority of solutes show identifiable behaviors in individual catchments, only a minority of behaviors can be generalized across the 11 catchments that exhibit different natural, climatic, and anthropogenic features.

Rapid population and economic growth in Southeast Asia has been accompanied by extensive land use change with consequent impacts on catchment hydrology. Modeling methodologies capable of handling changing land use conditions are therefore becoming ever more important and are receiving increasing attention from hydrologists. A recently developed data-assimilation-based framework that allows model parameters to vary through time in response to signals of change in observations is considered for a medium-sized catchment (2880 km2) in northern Vietnam experiencing substantial but gradual land cover change. We investigate the efficacy of the method as well as the importance of the chosen model structure in ensuring the success of a time-varying parameter method. The method was used with two lumped daily conceptual models (HBV and HyMOD) that gave good-quality streamflow predictions during pre-change conditions. Although both time-varying parameter models gave improved streamflow predictions under changed conditions compared to the time-invariant parameter model, persistent biases for low flows were apparent in the HyMOD case. It was found that HyMOD was not suited to representing the modified baseflow conditions, resulting in extreme and unrealistic time-varying parameter estimates. This work shows that the chosen model can be critical for ensuring the time-varying parameter framework successfully models streamflow under changing land cover conditions. It can also be used to determine whether land cover changes (and not just meteorological factors) contribute to the observed hydrologic changes in retrospective studies where the lack of a paired control catchment precludes such an assessment.

Previous estimates of melt and surface sublimation on glaciers of the subtropical semiarid Andes (29–34°S) have been obtained at few specific locations, but it is not clear how ablation components vary across the entire extent of a glacier in this dry environment. Here, we simulate the distributed energy and mass balance of Juncal Norte Glacier (33°S) during a 2-month summer period. Forcing fields of near-surface air temperature and wind speed are generated using two methods accounting for the main physical processes that shape their spatial variations. Simulated meteorological variables and ablation agree well with observations on the glacier tongue and reveal complex patterns of energy and mass fluxes. Ablation decreases from 70 mm w.e. d−1 at the low-albedo glacier terminus (~3000 m), where almost 100% of total ablation corresponds to melt, to 75% of total ablation. Our simulations provide the first glacier-scale estimates of ablation components on a glacier in the study region and better reproduce the observed and expected spatial variations of melt and surface sublimation, in comparison with more simple assumptions, such as linear gradients and uniform wind speeds.

The performance of urban drainage systems is typically examined using hydrological and hydrodynamic models where rainfall input is uniformly distributed, i.e., derived from a single or very few rain gauges. When models are fed with a single uniformly distributed rainfall realization, the response of the urban drainage system to the rainfall variability remains unexplored. The goal of this study was to understand how climate variability and spatial rainfall variability, jointly or individually considered, affect the response of a calibrated hydrodynamic urban drainage model. A stochastic spatially distributed rainfall generator (STREAP – Space-Time Realizations of Areal Precipitation) was used to simulate many realizations of rainfall for a 30-year period, accounting for both climate variability and spatial rainfall variability. The generated rainfall ensemble was used as input into a calibrated hydrodynamic model (EPA SWMM – the US EPA's Storm Water Management Model) to simulate surface runoff and channel flow in a small urban catchment in the city of Lucerne, Switzerland. The variability of peak flows in response to rainfall of different return periods was evaluated at three different locations in the urban drainage network and partitioned among its sources. The main contribution to the total flow variability was found to originate from the natural climate variability (on average over 74 %). In addition, the relative contribution of the spatial rainfall variability to the total flow variability was found to increase with longer return periods. This suggests that while the use of spatially distributed rainfall data can supply valuable information for sewer network design (typically based on rainfall with return periods from 5 to 15 years), there is a more pronounced relevance when conducting flood risk assessments for larger return periods. The results show the importance of using multiple distributed rainfall realizations in urban hydrology studies to capture the total flow variability in the response of the urban drainage systems to heavy rainfall events.

A new particle-based reduced-complexity model to simulate sediment transport and channel morphology in steep streams in presented. The model CAST (Cellular Automaton Sediment Transport) contains phenomenological parameterizations, deterministic or stochastic, of sediment supply, bed load transport, and particle entrainment and deposition in a cellular-automaton space with uniform grain size. The model reproduces a realistic bed morphology and typical fluctuations in transport rates observed in steep channels. Particle hop distances, from entrainment to deposition, are well fitted by exponential distributions, in agreement with field data. The effect of stochasticity in both the entrainment and the input rate is shown. A stochastic parameterization of the entrainment is essential to create and maintain a realistic channel morphology, while the intermittent transport of grains in CAST shreds the input signal and its stochastic variability. A jamming routine has been added to CAST to simulate the grain–grain and grain–bed interactions that lead to particle jamming and step formation in a step-pool stream. The results show that jamming is effective in generating steps in unsteady conditions. Steps are created during high-flow periods and they survive during low flows only in sediment-starved conditions, in agreement with the jammed-state hypothesis of Church and Zimmermann (2007). Reduced-complexity models like CAST give new insights into the dynamics of complex phenomena such as sediment transport and bedform stability and are a useful complement to fully physically based models to test research hypotheses.

The current work addresses one of the key building blocks towards an improved understanding of flood processes and associated changes in flood characteristics and regimes in Europe: the development of a comprehensive, extensive European flood database. The presented work results from ongoing cross-border research collaborations initiated with data collection and joint interpretation in mind. A detailed account of the current state, characteristics and spatial and temporal coverage of the European Flood Database, is presented. At this stage, the hydrological data collection is still growing and consists at this time of annual maximum and daily mean discharge series, from over 7000 hydrometric stations of various data series lengths. Moreover, the database currently comprises data from over 50 different data sources. The time series have been obtained from different national and regional data sources in a collaborative effort of a joint European flood research agreement based on the exchange of data, models and expertise, and from existing international data collections and open source websites. These ongoing efforts are contributing to advancing the understanding of regional flood processes beyond individual country boundaries and to a more coherent flood research in Europe.

Extreme precipitation is thought to increase with warming at rates similar to or greater than the water vapour holding capacity of the air at ~ 7% °C−1, the so-called Clausius–Clapeyron (CC) rate. We present an empirical study of the variability in the rates of increase in precipitation intensity with air temperature using 30 years of 10 min and 1 h data from 59 stations in Switzerland. The analysis is conducted on storm events rather than fixed interval data, and divided into storm type subsets based on the presence of lightning which is expected to indicate convection. The average rates of increase in extremes (95th percentile) of mean event intensity computed from 10 min data are 6.5% °C−1 (no-lightning events), 8.9% °C−1 (lightning events) and 10.7% °C−1 (all events combined). For peak 10 min intensities during an event the rates are 6.9% °C−1 (no-lightning events), 9.3% °C−1 (lightning events) and 13.0% °C−1 (all events combined). Mixing of the two storm types exaggerates the relations to air temperature. Doubled CC rates reported by other studies are an exception in our data set, even in convective rain. The large spatial variability in scaling rates across Switzerland suggests that both local (orographic) and regional effects limit moisture supply and availability in Alpine environments, especially in mountain valleys. The estimated number of convective events has increased across Switzerland in the last 30 years, with 30% of the stations showing statistically significant changes. The changes in intense convective storms with higher temperatures may be relevant for hydrological risk connected with those events in the future.

The spatial distribution of alpine snow covers is characterised by large variability. Taking this variability into account is important for many tasks including hydrology, glaciology, ecology or natural hazards. Statistical modelling is frequently applied to assess the spatial variability of the snow cover. For this study, we assembled seven data sets of high-resolution snow-depth measurements from different mountain regions around the world. All data were obtained from airborne laser scanning near the time of maximum seasonal snow accumulation. Topographic parameters were used to model the snow depth distribution on the catchment-scale by applying multiple linear regressions. We found that by averaging out the substantial spatial heterogeneity at the metre scales, i.e. individual drifts and aggregating snow accumulation at the landscape or hydrological response unit scale (cell size 400 m), that 30 to 91% of the snow depth variability can be explained by models that are calibrated to local conditions at the single study areas. As all sites were sparsely vegetated, only a few topographic variables were included as explanatory variables, including elevation, slope, the deviation of the aspect from north (northing), and a wind sheltering parameter. In most cases, elevation, slope and northing are very good predictors of snow distribution. A comparison of the models showed that importance of parameters and their coefficients differed among the catchments. A "global" model, combining all the data from all areas investigated, could only explain 23% of the variability. It appears that local statistical models cannot be transferred to different regions. However, models developed on one peak snow season are good predictors for other peak snow seasons.

Bedload sediment transport and erosion processes in channels are important components of water induced natural hazards in alpine environments. A raster based distributed hydrological model, TOPKAPI, has been further developed to support continuous simulations of river bed erosion and deposition processes. The hydrological model simulates all relevant components of the water cycle and non-linear reservoir methods are applied for water fluxes in the soil, on the ground surface and in the channel. The sediment transport simulations are performed on a sub-grid level, which allows for a better discretization of the channel geometry, whereas water fluxes are calculated on the grid level in order to be CPU efficient. Several transport equations as well as the effects of an armour layer on the transport threshold discharge are considered. Flow resistance due to macro roughness is also considered. The advantage of this approach is the integrated simulation of the entire basin runoff response combined with hillslope-channel coupled erosion and transport simulation. The comparison with the modelling tool SETRAC demonstrates the reliability of the modelling concept. The devised technique is very fast and of comparable accuracy to the more specialised sediment transport model SETRAC.

The establishment of riparian pioneer vegetation is of crucial importance within river restoration projects. After germination or vegetative reproduction on river bars juvenile plants are often exposed to mortality by uprooting caused by floods. At later stages of root development vegetation uprooting by flow is seen to occur as a consequence of a marked erosion gradually exposing the root system and accordingly reducing the mechanical anchoring. How time scales of flow-induced uprooting do depend on vegetation stages growing in alluvial non-cohesive sediment is currently an open question that we conceptually address in this work. After reviewing vegetation root issues in relation to morphodynamic processes, we then propose two modelling mechanisms (Type I and Type II), respectively concerning the uprooting time scales of early germinated and of mature vegetation. Type I is a purely flow-induced drag mechanism, which causes alone a nearly instantaneous uprooting when exceeding root resistance. Type II arises as a combination of substantial sediment erosion exposing the root system and resulting in a decreased anchoring resistance, eventually degenerating into a Type I mechanism. We support our conceptual models with some preliminary experimental data and discuss the importance of better understanding such mechanisms in order to formulate sounding mathematical models that are suitable to plan and to manage river restoration projects.

River restoration has become a common measure to repair anthropogenically-induced alteration of fluvial ecosystems. The inherent complexity of ecohydrologic systems leads to limitations in understanding the response of such systems to restoration over time. Therefore, a significant effort has been dedicated in the recent years worldwide to document the efficiency of restoration actions and to produce new effective guidelines that may help overcoming existing deficiencies. At the same time little attention was paid to illustrate the reasons and the use of certain monitoring and experimental techniques in spite of others, or in relation to the specific ecohydrologic process being investigated. The purpose of this paper is to enrich efforts in this direction by presenting the framework of experimental activities and the related experimental setup that we designed and installed in order to accomplish some of the research tasks of the multidisciplinary scientific project RECORD (Restored Corridor Dynamics). Therein, we studied the morphodynamic evolution of the restored reach of the River Thur near Niederneunforn (Switzerland), also in relation to the role of pioneer vegetation roots in stabilizing the alluvial sediment. In this work we describe the methodology chosen for monitoring the river morphodynamics, the dynamics of riparian and of in-bed vegetation and their mutual interactions, as well as the need of complementing such observations with experiments and with the hydraulic modeling of the site. We also discuss how the designed installation and the experiments integrate with the needs of other research groups within the project, in particular providing data for a number of investigations thereby including surface water and groundwater interactions, soil moisture and vegetation dynamics.

A review of the literature reveals conflicting results regarding the existence and inherent nature of chaos in hydrological processes such as precipitation and streamflow, i.e. whether they are low dimensional chaotic or stochastic. This issue is examined further in this paper, particularly the effect that certain types of transformations, such as aggregation and sampling, may have on the identification of the dynamics of the underlying system. First, we investigate the dynamics of daily streamflows for two rivers in Florida, one with strong surface and groundwater storage contributions and the other with a lesser basin storage contribution. Based on estimates of the delay time, the delay time window, and the correlation integral, our results suggest that the river with the stronger basin storage contribution departs significantly from the behavior of a chaotic system, while the departure is less significant for the river with the smaller basin storage contribution. We pose the hypothesis that the chaotic behavior depicted on continuous precipitation fields or small time-step precipitation series becomes less identifiable as the aggregation (or sampling) time step increases. Similarly, because streamflows result from a complex transformation of precipitation that involves accumulating and routing excess rainfall throughout the basin and adding surface and groundwater flows, the end result may be that streamflows at the outlet of the basin depart from low dimensional chaotic behavior. We also investigate the effect of aggregation and sampling using series derived from the Lorenz equations and show that, as the aggregation and sampling scales increase, the chaotic behavior deteriorates and eventually ceases to show evidence of low dimensional determinism.

Since the beginning of the coronavirus disease 2019 (COVID-19) pandemic, health care professionals have made swift accommodations to provide consistent and safe care, including emphasizing remote access to allow physical distancing. Depot medroxyprogesterone acetate intramuscular injection (DMPA-IM) prescription is typically administered by a health care professional, whereas DMPA-subcutaneous has the potential to be safely self-injected by patients, avoiding contact with a health care professional. However, DMPA-subcutaneous is rarely prescribed despite its U.S. Food and Drug Administration approval in 2004 and widespread coverage by both state Medicaid providers and many private insurers. Depot medroxyprogesterone acetate users are disproportionately non-White, and thus the restriction in DMPA-subcutaneous prescribing may both stem from and contribute to systemic racial health disparities. We review evidence on acceptability, safety, and continuation rates of DMPA-subcutaneous, consider sources of implicit bias that may impede prescription of this contraceptive method, and provide recommendations for implementing DMPA-subcutaneous prescribing.

Digital loans are a source of fast short-term credit for millions of people. While digital credit broadens market access and reduces frictions, default rates are high. We study the role of the speed of delivery of digital loans on repayment. Our study uses unique administrative data from a digital lender in Mexico and a regression-discontinuity design. We show that reducing loan speed by doubling the delivery time from ten to twenty hours decreases the likelihood of default by 21%. Our finding hints at waiting periods as a potential consumer protection measure for digital credit.

Elevated atmospheric CO2 concentrations are expected to enhance photosynthesis and reduce stomatal conductance, thus increasing plant water use efficiency. A recent study based on eddy covariance flux observations from Northern Hemisphere forests showed a large increase in inherent water use efficiency (IWUE). Here we used an updated version of the same data set and robust uncertainty quantification to revisit these contemporary IWUE trends. We tested the hypothesis that the observed IWUE increase could be attributed to interannual trends in plant functional traits, potentially triggered by environmental change. We found that IWUE increased by ~1.3% yr−1, which is less than previously reported but still larger than theoretical expectations. Numerical simulations with the Tethys-Chloris ecosystem model using temporally static plant functional traits cannot explain this increase. Simulations with plant functional trait plasticity, i.e., temporal changes in model parameters such as specific leaf area and maximum Rubisco capacity, match the observed trends in IWUE. Our results show that trends in plant functional traits, equal to 1.0% yr−1, can explain the observed IWUE trends. Thus, at decadal or longer time scales, trait plasticity could potentially influence forest water, carbon, and energy fluxes with profound implications for both the monitoring of temporal changes in plant functional traits and their representation in Earth system models.

OBJECTIVE: The use of biologic agents, mainly tumor necrosis factor (TNF)-a and interleukin (IL)-17A inhibitors, was associated with cutaneous side effects, but the factors associated with eczematous reactions occurring during biologic treatments are not completely known. PATIENTS AND METHODS: An observational, retrospective, multicentre Italian study evaluated the clinical features and the management of eczematous eruptions in 54 patients with chronic plaque psoriasis who developed eczema after treatment with biological agents (anti-IL-17 or 23). RESULTS: Many of these patients had personal and family history of atopy. Eczematous reactions developed between a few days and 3 years after initiation of the biologic drug. The highest proportion of cases associated with eczematous reactions during biologic treatments was seen in patients on anti-IL-17 agents, including brodalumab. We observed that eczema rapidly remitted without relapse in all patients who switched to anti-IL-23 agents. Among our cases, fast responders to psoriasis therapy seem to have more persistent eczematous reactions. CONCLUSIONS: Patients with psoriasis and a history of atopic dermatitis should be treated with an IL-23 inhibitor due to its efficacy in psoriasis and the rarely reported eczematous reaction. [ABSTRACT FROM AUTHOR]

OBJECTIVE: While clinical trials provide invaluable evidence, real-world data can offer further insight on the efficacy and safety of biologic drugs. This report aims to analyze the long-term efficacy and safety of ixekizumab in real-world clinical practice in our facility. PATIENTS AND METHODS: Patients with a diagnosis of psoriasis and who started treatment with ixekizumab were included in this retrospective study and followed for 156 weeks. The severity of cutaneous manifestations was evaluated using the PASI score at several time points and clinical efficacy was evaluated using PASI 75, -90 and -100 responses. RESULTS: Not only PASI 75, but also PASI 90 and 100 responses showed a favorable outcome after treatment with ixekizumab. Responses at week 12 were sustained through the following three years in the majority of patients. No statistically significant difference was found between bio-naive and bioswitch patients and weight and disease duration had no impact on the efficacy of the drug. Ixekizumab had a favorable safety profile, as we observed no major adverse events. Two cases of eczema were observed and led to drug discontinuation. CONCLUSIONS: This study confirms the efficacy and safety of ixekizumab in real-world clinical practice. [ABSTRACT FROM AUTHOR]