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Fabrizio Martora,1 Claudio Marasca,2 Sara Cacciapuoti,1 Federica Fariello,1 Luca Potestio,1 Teresa Battista,1 Massimiliano Scalvenzi,1 Matteo Megna1 1Section of Dermatology - Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy; 2Dermatology Unit, Medical Department, “Antonio Cardarelli” National Hospital, Naples, ItalyCorrespondence: Fabrizio Martora, Section of Dermatology - Department of Clinical Medicine and Surgery, University of Naples Federico II, Via Pansini 5, Naples, 80131, Italy, Tel +39 - 081 – 7462457, Fax +39 - 081 – 7462442, Email fabriziomartora92@libero.itBackground: The treatment of hidradenitis suppurativa (HS) has always been a real challenge for dermatologists; to date, adalimumab the only biologic drug approved for HS is adalimumab, an anti-tumor necrosis factor (TNF)-α drug, the approval of this drug dates to 2015, data provided by real life show an effectiveness rate of about 60% percent. Recently (31 October 2023) FDA approves secukinumab for moderate-severe HS. The treatment and management of HS is very challenging as available treatments are very limited and show very variable outcomes.Methods: We conducted a prospective monocentric study designed to evaluate the efficacy and safety of secukinumab treatment in HS patients in a real-life setting.Results: The initial cohort of patients recruited included 21 HS patients including 12 females and 9 males. About 57.1% of patients achieved the primary endpoint and recorded significant decrease in all the severity assessment scales (IHS4, DLQI and VAS pain scale) at week 16 and 52, when HiSCR reached 71.4%.Conclusion: The results of our study highlight that treatment with secukinumab in patients with severe HS who failed adalimumab may be a safe and effective therapeutic weapon.Keywords: hidradenitis suppurativa, secukinumab, adalimumab, treatments

Luca Potestio, Matteo Megna, Alessia Villani, Sara Cacciapuoti, Massimiliano Scalvenzi, Fabrizio Martora Section of Dermatology - Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, ItalyCorrespondence: Luca Potestio, Section of Dermatology - Department of Clinical Medicine and Surgery, University of Naples Federico II, Via Pansini 5, Napoli, 80131, Italy, Tel +39 - 081 – 7462457, Fax +39 - 081 – 7462442, Email potestioluca@gmail.comAbstract: COVID-19 was a worldwide emergency, leading to a global health crisis, which completely revolutionized every aspect of human life. Several strategies were adopted to limit the spreading of the infection such as testing and contact tracing, quarantine and isolation, use of face mask, social distancing, lockdowns, travel restrictions, etc. Of these, vaccines were the most important measures to reduce the transmission of the virus and the severity of the infection, in order to overcome the pandemic. Fortunately, vaccination campaign was a success, showing to be efficient in controlling and preventing the COVID-19, reducing the risk of disease progression, hospitalization, and mortality. Monitoring and addressing vaccine-related adverse events have been essential for maintaining public confidence. Indeed, with the increasing number of vaccines administered, various cutaneous reactions have been reported, making dermatologists key players in their recognition and treatment. Particularly, several cutaneous diseases and cutaneous findings have been reported. Of note, also viral reactivations have been described following COVID-19 vaccination. Among these, varicella zoster virus (VZV) reactivation has been collected. Globally, an early diagnosis and an accurate treatment of herpes zoster (HZ) is mandatory to reduce possible complications. In this context, we conducted a review of the current literature investigating cases HZ following COVID-19 vaccination with the aim of understanding the possible causal correlation and underlying pathogenetic mechanisms to offer clinicians a wide perspective on VZV reactivation and COVID-19 vaccines.Keywords: COVID-19, vaccination, herpes zoster, safety

Fabrizio Martora, Massimiliano Scalvenzi, Teresa Battista, Luigi Fornaro, Luca Potestio, Angelo Ruggiero, Matteo Megna Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, ItalyCorrespondence: Fabrizio Martora, Section of Dermatology - Department of Clinical Medicine and Surgery, University of Naples Federico II, Via Pansini 5, Napoli, 80131, Italy, Tel +39-081-7462457, Fax +39-081-7462442, Email fabriziomartora92@libero.itAbstract: The treatment of hidradenitis suppurativa (HS) has always been a real challenge for dermatologists; to date, the only biologic drugs approved for HS are adalimumab, an anti-tumor necrosis factor (TNF)-α drug, authorized in 2015, and secukinumab, recently licensed. The management of this condition is challenging as the available treatments show variable results, and the course of the condition is often chronic-recurrent; therefore, it will be necessary for the future to identify new therapeutic targets for HS. In recent years, studies have focused on the development towards new therapeutic targets. The purpose of our review was to perform a comprehensive literature review of real-life data on anti-IL23 (guselkumab, tildrakizumab, and risankizumab) in HS to summarize the existing evidence on the efficacy and safety of these drugs. We selected 64 articles, among which 32 had the characteristics that we were looking for in our review. To date, the positive data expressed in real-life experiences contrast with the three existing Phase 2 studies conducted so far, where it seems that these drugs may be useful only for a subgroup of patients with HS whose features need to be elucidated. Data from Phase 3 studies and other real-life experiences, perhaps more detailed and with higher numbers, will certainly be needed to fully understand the efficacy and safety of this class of drugs.Keywords: hidradenitis suppurativa, anti-IL23, guselkumab, tildrakizumab, risankizumab, real life evidence

Sara Cacciapuoti,* Luca Potestio,* Gianluca Guerrasio, Gabriella Fabbrocini ,† Massimiliano Scalvenzi, Angelo Ruggiero,* Giuseppina Caiazzo,* Matteo Megna* Section of Dermatology - Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy*These authors contributed equally to this work†Professor Gabriella Fabbrocini passed away on 3rd March 2023Correspondence: Angelo Ruggiero, Section of Dermatology - Department of Clinical Medicine and Surgery, University of Naples Federico II, Via Pansini 5, Napoli, 80131, Italy, Tel +39 - 081 – 7462457, Fax +39 - 081 – 7462442, Email angeloruggiero1993@libero.itBackground: Recent knowledge of psoriasis pathogenesis has led to the development of selective drugs. Among these, brodalumab is a monoclonal antibody targeting the interleukin (IL)-17A receptor approved for the treatment of moderate-to-severe plaque psoriasis. Biologics may be considered in patients with milder diseases in case of active psoriatic arthritis, severe impact on patient’s quality of life, and involvement of sensitive and difficult-to-treat areas. These skin locations commonly require systemic drugs. Recently, psoriasis severity monitoring has also changed. Indeed, the clinical evaluation by means of specific efficacy scores was combined with serological evaluation by means of the assay of specific inflammatory biomarkers.Methods: An observational study enrolled patients affected by moderate-to-severe plaque psoriasis involving difficult-to-treat areas, undergoing treatment with brodalumab to evaluate the effectiveness and safety of brodalumab in patients with psoriasis affecting difficult-to-treat areas (scalp and palmoplantar regions). Secondary outcomes were the assessment of the development of serum markers of inflammation during the treatment period as well as the evaluation of the dermoscopic features of the affected sites to quantify disease activity and response to treatment.Results: Twenty-five patients were included in the study. A statistically significant reduction from baseline in PASI, PSSI, ppPASI and DLQI values as early as week 24 was observed, with further improvement up to week 52. Plasma levels of MMP-3, VEGF-A, and hs-PCR decreased during treatment from week 0 to week 52.Conclusion: Our real-life experience suggests brodalumab as a valuable option for the management of psoriasis located in difficult-to-treat areas. Moreover, our study highlights that the use of brodalumab reduces the plasmatic levels of inflammatory biomarkers (MMP-3, VEGF-A and hs-PCR), showing how the drug modulates the skin inflammatory response by reducing systemic inflammation.Keywords: brodalumab, psoriasis, difficult-to-treat areas, biologic drugs, efficacy

Teresa Battista, Massimiliano Scalvenzi,* Fabrizio Martora,* Luca Potestio, Matteo Megna Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy*These authors contributed equally to this workCorrespondence: Fabrizio Martora, Section of Dermatology - Department of Clinical Medicine and Surgery, University of Naples Federico II, Via Pansini 5, Napoli, 80131, Italy, Tel +39 - 81 – 7462457, Fax +39 - 81 – 7462442, Email fabriziomartora92@libero.itBackground: Nail psoriasis (NP) has a prevalence that ranges from 10 to 82% among patients with psoriasis (PsO) and is one of the most common difficult to treat site of psoriasis. We performed a thorough review of the literature, exploring evidence regarding all available NP systemic treatments, describing also in detail NP dedicated clinical trials.Methods: A literature search was conducted in PubMed and Embase prior to February 2023 using a combination of the terms “nail” AND “psoriasis” AND “systemic therapy” AND/OR “systemic treatment”. A total of 47 original studies and case reports were reviewed in this article.Results: Systemic therapies should be considered when the disorder involves more than 3 nails, has extensive skin and joint involvement, and has a significant impact on QoL, due to their best long-term efficacy. In detail, conventional and biologic systemic drugs demonstrated efficacy in recent trials, including acitretin, methotrexate, cyclosporine, apremilast, adalimumab, infliximab, etanercept, certolizumab, golimumab, ustekinumab, secukinumab, ixekizumab, brodalumab, bimekizumab, guselkumab, risankizumab and tildrakizumab.Conclusion: Several therapies have demonstrated efficacy and safety in the treatment of NP; however, the choice of treatment depends not only on the severity of the nail involvement, but also on whether PsA is present, the patient’s comorbidities other than PsA, previous treatment history, and the patient’s drug preferences.Keywords: nail psoriasis, psoriasis, treatment, biologics

Immunohistochemistry was performed with anti-BRIT-1 (mouse polyclonal antibody, diluted 1: 300 overnight at 4°C, Abcam), anti-PARP-1 and anti-CAF-1/p60 following the previously described methods.2,3 The expression of BRIT-1 was subdivided into "normal" (nuclear) vs "abnormal" (cytoplasmic or negative); nuclear expression of PARP-1 and CAF-1/p60 in >50% of CM cells was labelled as "overexpression". Consistently, most CM metastases (6/8, 75%) showed PARP-1 and CAF-1/p60 overexpression. Defect of BRCA1 C terminus-repeat inhibitor of human telomerase expression-1 (BRIT-1), a protein involved in DNA repair, appears to promote growth and aggressiveness of several human cancers.1 Mutations in the nuclear localization signals within the BRIT-1-encoding gene have been described, which may lead to an aberrant cytoplasmic localization of the protein.1 However, BRIT-1 has not yet been studied in cutaneous melanoma (CM). [Extracted from the article]

Reply to 'New-onset cutaneous lichen planus triggered by COVID-19 vaccination' by Merhy et al References 1 Merhy R, Sarkis AS, Kaikati J, El Khoury L, Ghosn S, Stephan F. New-onset cutaneous lichen planus triggered by COVID-19 vaccination. Lichenoid drug reaction following influenza vaccination in an HIV-positive patient: a case report and literature review. [Extracted from the article]