Immune checkpoint-mediated psoriasis: A multicenter European study of 115 patients from the European Network for Cutaneous Adverse Event to Oncologic Drugs (ENCADO) group.

BACKGROUND: Immune checkpoint inhibitor (ICI)-mediated psoriasis poses significant diagnostic and therapeutic challenges. OBJECTIVE: To report data on ICI-mediated psoriasis, emerging from the largest cohort to date, to our knowledge, and to propose a step-by-step management algorithm. METHODS: The medical records of all patients with ICI-mediated psoriasis were retrospectively reviewed across 9 institutions. RESULTS: We included a cohort of 115 individuals. Grade 1, 2, and 3 disease severity was reported in 60 of 105 (57.1%, 10 missing data), 34 of 105 (32.4%), and 11 of 105 (10.5%), respectively. The ratio between exacerbation and de novo cases was 1:4.3. The most common systemic therapy was acitretin (23 patients, 20.1%), followed by systemic steroids (8 patients, 7%), apremilast (7 patients, 6.1%), methotrexate (5 patients, 4.3%) and biologics (4 patients, 3.6%). Overall, 29 of 112 patients (25.9%) interrupted and 20 of 111 (18%) permanently discontinued ICIs because of psoriasis. Body surface area of greater than 10% at baseline had a 3.6 increased risk for ICI treatment modification (odds ratio, 3.64; 95% confidence interval, 1.27-10.45; P = .03) and a 6.4 increased risk for permanent discontinuation (odds ratio, 6.41; 95% confidence interval, 2.40-17.11; P < .001). Guttate psoriasis and grade 2 or 3 disease were significant positive predictors for antitumor response of ICI, whereas pruritus was a negative predictor. LIMITATIONS: Retrospective design. CONCLUSION: Acitretin, apremilast, and methotrexate are safe and effective modalities for ICI-mediated psoriasis. In most cases, ICI can be completed unhindered. A therapeutic algorithm is proposed.

Efficacy and safety of oral minoxidil in female androgenetic alopecia.

Oral minoxidil (OM) has been reported to be effective for androgenetic alopecia (AGA). In this retrospective study, we share our experience of using OM for >24 weeks in 12 patients with female AGA (Ludwig scale I-3-III). Twelve women (aged 18-66 years; mean age 36.66 ± 18.79 years) with AGA (Ludwig scale I-3-III) were recruited. The starting dose of minoxidil was 0.50 mg daily; at 3 months, the dose was increased to 1.50 to 2 mg daily. Efficacy outcome measures were evaluated at baseline and after 24 weeks and included global clinical photography, quantitative digital videotrichoscopic assessment and quality-of-life evaluation. An overall improvement of 38% and 23% in hair density in the frontal and vertex area, respectively, was observed after 24 weeks. The quantitative digital videotrichoscopic evaluation highlighted a statistically significant improvement in the frontal area of the total average hair density and of the total number of hairs per unit area at 24 weeks (131.47 ± 36.11 vs 181.40 ± 57.38; P = .025 and 118.72 ± 32.61 vs 163.81 ± 51.82; P = .025, respectively). In conclusion, OM was effective and had an acceptable safety profile in treating female AGA. The low number of patients and retrospective design of this study are limitations.

Psoriasis and skin pain: instrumental and biological evaluations.

The prevalence of skin pain and the molecular mechanisms responsible for pain in psoriasis remain unclear. This study assessed skin pain in 163 patients (98 males, 65 females, range 18-81 years) with plaque psoriasis, evaluating: the subjective/objective features of this symptom compared with clinical severity of the disease; and the role of interleukin (IL)-33, (involved in both psoriasis and pain pathogenesis), in psoriasis-related pain. Clinical measures used were a questionnaire, plaque Physician Global Assessment (PGA) index, pressure algometry to measure pain threshold and tactile/thermal sensitivity test. IL-33 gene expression was examined in vivo (n = 12) in patients skin and through an ex vivo model of nociception using sodium dodecyl sulphate. Of the psoriatic patients 43.6% reported skin pain during the previous week; itchy, unpleasant, aching, sensitive, hot/burning, tender and cramping were the most reported qualities. Patients' pain threshold decreased with increasing PGA index and pain intensity. Sensitivity to touch/heat was reduced in lesional skin, compared with unaffected psoriatic skin. IL-33 expression was increased in lesional skin of patients reporting pain and in the ex vivo system. In conclusion, symptoms of skin pain should be taken into account in the management of psoriasis.

Italian National Registry of Alopecia Areata: an epidemiological study of 699 Italian patients.

BACKGROUND: Alopecia areata (AA) is an organ-specific autoimmune disease that affects the hair follicles of the scalp and the rest of the body causing hair loss. Due to the unpredictable course of AA and the different degrees of severity of hair loss, only a few well-designed clinical studies with a low number of patients are available. Also, there is no specific cure, but topical and systemic anti-inflammatory and immune system suppressant drugs are used for treatment. The need to create a global registry of AA, comparable and reproducible in all countries, has recently emerged. An Italian multicentric electronic registry is proposed as a model to facilitate and guide the recording of epidemiological and clinical data and to monitor the introduction of new therapies in patients with AA. METHODS: The aim of this study was to evaluate the epidemiological data of patients with AA by collecting detailed information on the course of the disease, associated diseases, concomitant and previous events, and the clinical response to traditional treatments. Estimate the impact on the quality of life of patients. RESULTS: The creation of the National Register of AA has proven to be a valid tool for recording, with a standardized approach, epidemiological data, the trend of AA, response to therapies and quality of life. CONCLUSIONS: AA is confirmed as a difficult hair disease to manage due to its unpredictable course and, in most cases, its chronic-relapsing course, capable of having a significant impact on the quality of life of patients.

Alopecia Areata after COVID-19 Vaccines.

Introduction: Alopecia areata (AA) is a common autoimmune disease characterized by non-scarring hair loss. New onsets of AA have been associated with coronavirus disease 2019 (COVID-19). Various skin diseases have already been reported because of the vaccines (the Pfizer-BioNTech COVID-19 vaccine, the Moderna COVID-19 vaccine, the AstraZeneca vaccine) against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Case Presentation: We report 5 cases of AA after COVID-19 vaccination. The trend shown by patients in this study is an initial worsening after the first dose of the vaccine with the stability of the disease even with subsequent doses. However, it is worth highlighting the case reported by one of our patients who suffered a "booster effect" of the disease with progressive and worsening alopecia with each vaccine booster. Discussion: The possible mechanism of action lies in the ability of COVID-19 vaccines to induce spike protein, which can lead to molecular mimicry phenomena. In an organism predisposed to autoimmunity, the mRNA vaccine acts as a trigger. Furthermore, we would like to point out how even cytokine storm and simple oxidative stress from SARS-CoV-2 infection can induce not only AA but also other types of hair loss such as telogen effluvium. Thus, this highlights how complex and multifaceted the phenomenon is.

A Case of Chronic HCV Infection Reactivation in a Psoriasis Patient Treated with Guselkumab.

INTRODUCTION: Psoriasis is a chronic inflammatory skin disease requiring long-term treatment. However, there are approximately 71 million individuals with chronic HCV infection worldwide. In psoriatic patients affected by chronic HCV infection, conventional systemic drugs may be frequently contraindicated, while data on biologics use are limited. CASE PRESENTATION: The case of a 48-year-old Caucasian man suffering from a severe form of plaque psoriasis and affected by a chronic-HCV-infection treated with guselkumab has been reported. Despite a huge improvement of the skin lesions (PASI reduced from 18 to 2), guselkumab was discontinued due to an HCV-infection reactivation after 3 months of treatment. CONCLUSION: To the best of our knowledge, this is the first case report of the use of guselkumab in an HCV psoriatic patient. Further studies are needed to evaluate the safety of guselkumab in chronic HCV patients.

Oral Minoxidil for Chemotherapy-Induced Alopecia.

Introduction: Chemotherapy-induced alopecia (CIA), one of the most dramatic side effects of chemotherapy, occurs in approximately 65% of patients receiving cytotoxic drugs. Case Presentation: We report the case of a patient, 64 years old, affected by chemotherapy-induced alopecia treated with oral minoxidil with good results. Discussion/Conclusion: Our case may be useful in the literature to propose a new therapy for this pathology that is fundamentally very difficult to treat.