Topical application of bacteriocins from Bacillus subtilis promotes Staphylococcus aureus decolonization in acneic skin and improves the clinical appearance of mild-to-moderate acne.

Introduction: Patients with mild-to-moderate acne are frequently colonized by Staphylococcus aureus on their skin, which alters microenvironmental skin conditions and exacerbates disease symptoms. Bacteriocins produced by Bacillus subtilis may act as antimicrobial peptides against Gram-positive bacteria. Aim: To investigate whether topical application of bacteriocins from B. subtilis could serve as a potential strategy for promoting S. aureus decolonization from acneic skin. Material and methods: The research product was a cream formulation containing 1% bacteriocins from B. subtilis. First, we conducted a 60-day pilot study on the effect of topically applied bacteriocins from B. subtilis on the absolute abundance of S. aureus in 12 patients with mild-to-moderate acne. Second, we designed an 8-week, uncontrolled, open-label, multicentre clinical study to investigate whether the topical application of bacteriocins from B. subtilis reduces the number of inflammatory and non-inflammatory lesions, as well as Global Acne Grading Scale (GAGS) scores, in 373 patients with mild-to-moderate acne. Results: At the microbiological level, quantitative PCR showed a decrease in the absolute abundance of S. aureus in acne areas after topical application of the research product for 60 days (-38%, p < 0.001). In the clinical study, the number of inflammatory and non-inflammatory lesions was found to decrease at 8 weeks by 59% (p < 0.001) and 58% (p < 0.001), respectively, compared with baseline. A 56% decrease was observed for GAGS scores. Conclusions: Topical bacteriocins from B. subtilis can promote S. aureus decolonization in acneic skin, ultimately improving the clinical appearance of mild-to-moderate acne.

Adalimumab Originator vs. Biosimilar in Hidradenitis Suppurativa: A Multicentric Retrospective Study.

This study aimed to compare adalimumab originator vs. biosimilar in HS patients, and to evaluate the effect of a switch to a biosimilar, or a switch back to the originator, in terms of treatment ineffectiveness. Patients with a diagnosis of HS were enrolled from 14 Italian sites. Treatment ineffectiveness was measured using Hurley score. The major analyses were 1) comparison between the two treatment groups (non-switcher analysis), and 2) the cross-over trend of Hurley score between treatment switchers (switcher analysis). Cox and Poisson regression models were used to compare the treatment ineffectiveness between groups. A total of 326 patients were divided into four groups: 171 (52.5%) taking originator; 61 (18.7%) patients taking biosimilar; 66 (20.2%) switchers; 28 (8.6%) switchers from originator to biosimilar and switched. A greater loss of efficacy was observed in the group allocated to the biosimilar than the originator group. The switcher analysis showed an effectiveness loss in the biosimilar compared to the originator. These results seem to indicate that a switch from one drug to the other may lead to a greater risk of inefficacy. A return to the previous treatment also does not ensure efficaciousness.

Thalidomide and discoid lupus erythematosus: case series and review of literature.

Background: The anti-inflammatory drug, thalidomide, is often administered off-label especially in dermatology patients with diseases refractory to different medications. The drug's mechanism of action is not well understood but clinical evidence suggests an immunomodulatory function. Although this drug is a useful tool for several dermatoses, there are associations between its use and neurotoxic and teratogenic side effects. Consequently, it is reserved only for severe and refractory cases. Methods: Herein, we present a review about thalidomide focusing on its application in dermatology, particularly on discoid lupus erythematosus (DLE) treatment. We analyzed four cases of people who had a regression of DLE with a dosage of 50 mg thalidomide. Patients were followed to determine the conditions treated with thalidomide, dosage, efficacy, duration of treatment, side effects, adverse events and follow-up. A low dose of 50 mg/day induced a notable and rapid improvement within 1-2 months of treatment and no side effects have been reported so far. Results: We report four cases of DLE treated previously with the most common immunomodulatory agents with no results and finally successfully treated with thalidomide. In all four patients, despite a low dose of 50 mg/day, a notable and rapid improvement was obtained within a few months of treatment with no side effects. Conclusions: Notwithstanding the small cohort size, our experience confirms the efficacy of thalidomide for the treatment of DLE.

Dimethyl fumarate titration for the systemic treatment of moderate-to-severe plaque psoriasis.

BACKGROUND: Dimethyl fumarate (DMF) is an oral systemic agent approved for the treatment of moderate-to-severe psoriasis vulgaris. It has a favourable tolerability profile, but it is associated with a high incidence of mild and reversible adverse events. The aim of the article is to describe a clinical experience aimed at increasing tolerability. PATIENTS AND METHODS: A group of patients was treated with DMF with a titration schedule, according to clinical practice, although a personalization of the step-up timing was allowed. The highest dose was the minimal effective dose or the maximal tolerated doses. RESULTS: DMF treatment was effective in reducing the disease severity and improving the quality of life. DMF was well tolerated as only mild, mainly gastrointestinal, adverse events occurred in these patients. In addition, the up-titration schedule seemed to provide a reduced incidence of adverse events compared with the fixed dose. CONCLUSION: Our experience suggested that the recommended up-titration schedule of DMF, adjusted and personalized according to patient needs and physician opinion, provided a relevant clinical benefit and was well tolerated.

Effectiveness of Apremilast in Real Life in Patients with Psoriasis: A Longitudinal Study.

Apremilast is an oral selective phosphodiesterase-4 inhibitor developed recently for psoriasis treatment. The aim of this study is to assess the real-life outcomes of use of apremilast in patients with psoriasis in everyday clinical practice. A total of 159 adult patients (90 males) with plaque psoriasis were included in the study. Fifty of the patients (31%) had psoriatic arthritis. All patients started apremilast at the time of enrolment. There was a marked improvement in Psoriasis Area and Severity Index, body surface area and Dermatology Life Quality Index scores across the follow-up period (12 months). The improvements in these scores were also consistent when the patients were stratified according to increasing body mass index. Only 10.6% of the patients discontinued apremilast, because of no response. In conclusion, apremilast is an effective and safe treatment in patients with psoriasis, and its effect is not influenced by body mass index.

A rare skin infection in atopic dermatitis: A case report.

Atopic dermatitis is associated with a susceptibility to infection usually by Staphylococcus spp due to a decrease of AMPs and Th2 cytokines (eg, IL-17). We reported a rare E. faecalis skin contamination in AD patients due to a frequent contact with excrement.

Patients' demographic and socioeconomic characteristics influence the therapeutic decision-making process in psoriasis.

BACKGROUND: Knowledge regarding differences in care for psoriatic patients is limited. The aim of this study was to investigate factors influencing prescription of systemic treatments for patients with psoriasis with a special focus on socioeconomic factors. METHODS AND FINDINGS: This was a non-interventional, cross-sectional study, conducted in 18 Italian University and/or hospital centers with psoriasis-specialized units. Questionnaires evaluating demographic and socioeconomic characteristics were administered to participants. Overall, 1880 consecutive patients affected by mild-to-severe psoriasis were recruited. Univariate and multivariable logistic regression analyses of systemic therapy prescription, with a special focus on biologics, accounting for the above mentioned characteristics were performed. Our analysis showed that all analyzed patients' characteristics were significantly associated with biological therapy compared to non-biological systemic one. Particularly, women were less likely to receive biologics than men (OR = 0.66; 95% CI, 0.57-0.77). Elderly patients (≥65 years) and subjects with a BMI ≥30 had lower odds to receive biologics respect to adults (≥35-64 years) (OR = 0.33; 95% CI, 0.25-0.40), and subjects with BMI≥25<30 (OR = 0.64; 95% CI, 0.53-0.77), respectively. Northern and Southern patients were both less likely to receive biologics than Central patients (OR = 0.75; 95% CI, 0.63-0.89, and OR = 0.56; 95% CI,0.47-0.68, respectively). Lower economic profile and never reading books were both associated with decreased odds of receiving biological therapy. CONCLUSIONS: This study shows that sex, age, comorbidities, and socioeconomic characteristics influence the prescription of systemic treatments in psoriasis, highlighting that there are still unmet needs influencing the therapeutic decision-making process that have to be addressed.

Long-term efficacy and safety of apremilast in psoriatic arthritis: Focus on skin manifestations and special populations.

Few real-life studies evaluated long-term apremilast therapy in the variable spectrum of clinical-anamnestic features which can be found in psoriatic arthritis (PsA) patients. This real-life retrospective observational study aimed to assess long-term efficacy, safety, and tolerability of apremilast among patients with PsA and concomitant cutaneous psoriasis. A stratified analysis was performed on special populations, defined as (a) number (≤1 vs >2) of comorbidities, presence or absence of: (b) history of malignancy, and (c) previous exposure to biologics. Patients attending three Italian University and Hospital centers, who received at least one dose of apremilast and had at least one follow-up visit were included. Ninety-six patients with PsA were identified. Psoriasis Area and Severity Index (PASI), Body Surface Area, 28-joint Disease Activity Score, and Dermatology Life Quality Index scores improved during treatment, already at week 4, relative to baseline. More than 2 comorbidities, history of malignancy and previous biologic treatment negatively influenced PASI responses. At least one adverse event was experienced by 56/96 patients, and 11/56 events required drug withdrawal. In conclusion, this study confirm efficacy and safety of apremilast on joints and skin involvement of PsA, highlighting which patients could have less favorable treatment response.

[Skin and sun exposure]. / Cute e fotoesposizione.

Fisherman commonly experience a significant number of cutaneous problems, related to the exposure to environmental factors due to their working conditions. Among these factors, sun exposure is able to determine both acute and chronic skin damage, mostly linked to the effects of the ultraviolet (UV) radiation on epidermal and dermal structures. In particular, UV-A appears to play a major role in the deterioration of dermal structure leading to the photoaged appearance of the skin, while UV-B is mainly responsible for skin cancers. Peculiar clinical features of skin damage in fishermen include dryness, irregular pigmentation, wrinkling, stellate pseudoscars, elastosis, inelasticity, telangiectasia, comedones and sebaceous hyperplasia. Furtheremore, the high incidence of non-melanoma skin cancers, on sun-exposed areas, confirms the need for occupational health policies focusing on issues such as photoprotection.