Dupilumab therapy reduces urinary biopyrrin levels in atopic patients: a new possible biomarker of oxidative status in atopic dermatitis.

BACKGROUND: Accumulating evidence suggests that oxidative stress is involved in the inflammatory process of atopic dermatitis (AD). Biopyrrins are the end products of the oxidative reaction of bilirubin with reactive oxygen species. The aim of our study was to explore the correlation between urinary biopyrrin levels and AD severity as well as to assess the possible modification of them in AD patients during biologic therapy with human monoclonal antibody dupilumab. METHODS: For this purpose, 25 adult patients with moderate-severe AD who were candidates for dupilumab therapy independently from the study, and 15 healthy control subjects, matched by sex and age, were enrolled. Morning urine samples were collected from all study participants. For AD patients, a collection was planned before starting therapy with dupilumab (WO), after 8, 16, 52 weeks (W8, W16, W52, respectively), and two years (Y2) of treatment. The analysis of urinary levels of biopyrrins was performed by ELISA assay. RESULTS: Our results demonstrated that urinary biopyrrin levels were significantly augmented in AD patients, and interestingly they correlated with disease severity. Furthermore, dupilumab therapy decreased levels of urinary biopyrrins in AD patients after eight and 16 weeks, maintaining the result after 52 weeks as well as after two years of treatment. The correlation analysis showed a statistically significant positive correlation between the urinary concentration of biopyrrins and EASI Index, circulating total IgE as well as plasma C reactive protein levels. CONCLUSIONS: Dupilumab therapy was able to ameliorate oxidative state in AD patients.

Efficacy, tolerability and patient's satisfaction for the treatment of moderate to severe plaque psoriasis with apremilast in the real-life setting of Campania region, Italy.

BACKGROUND: Little information is available from real-life studies evaluating the efficacy of apremilast in moderate-to-severe psoriasis. METHODS: In this real-life study, we retrospectively examined a database of 231 patients with moderate-to-severe psoriasis treated with apremilast (30 mg twice/day) and followed up for 52 weeks. Disease severity and treatment response were assessed by the Psoriasis Area and Severity Index (PASI) at baseline and after 16, 24, and 52 weeks. Quality of life was assessed by the Dermatology Life Quality Index (DLQI). RESULTS: PASI score decreased from 14.6 at baseline to 4.1 and 1.2 at 16 and 24 weeks. At 24 weeks, 86.7% of patients achieved a PASI score of ≤3 and this improved up to 52 weeks, where all patients had a PASI score of ≤3. At 24 weeks, PASI 75, 90 and 100 responses were achieved in 92%, 83.2% and 36.3% of patients, respectively. At 52 weeks, PASI 75, 90 and 100 response were achieved in 97%, 89.3% and 62% of patients, respectively. DLQI score was 12.4 at baseline and decreased to 2 at week 24, and close to 0 at week 52. No serious adverse event was reported during the treatment with apremilast. CONCLUSIONS: In patients with moderate-severe chronic psoriasis in a real world-setting apremilast was shown to be effective and safe up to 52 weeks.

Lentigo maligna in a young adult.

BACKGROUND: Lentigo maligna is mainly diagnosed in the elderly with severely sun-damaged skin. OBSERVATION: We describe a case of lentigo maligna in a 51-year-old woman with Fitzpatrick skin type III. Based on private photographs of the patient, we were able to ascertain that the lesion was already present at the age of 22 years. Despite the 29-year clinical history, the lesion was still entirely intraepidermal on histologic examination. CONCLUSION: Lentigo maligna in young adults is extremely rare, and therefore represents a diagnostic challenge for both clinicians and histopathologists.