Drug Survival of Upadacitinib and Predicting Factors of Discontinuation in Adult Patients Affected by Moderate-to-Severe Atopic Dermatitis: An Italian Multicenter Analysis.

Background: Limited real-world data are available on upadacitinib drug survival in patients with atopic dermatitis (AD). Objectives: To investigate upadacitinib drug survival, and the reasons and predictors of drug discontinuation in AD patients. Methods: All consecutive patients aged 18-75 years, affected by moderate-to-severe AD, and treated with upadacitinib for more than 1 month at dermatological clinics were included during November 2020-August 2023. Upadacitinib survival was investigated through Kaplan-Meier survival analysis and the predictors through multivariable logistic regression analysis. Results: Overall, 325 adult AD patients (mean (SD) age, 38.6(15.6) years) had a 1-year and 1.5-year upadacitinib drug survival of 91.5% and 80.2%, respectively. The main reasons for drug discontinuation (25/325, 7.7%) were adverse events (4.9%), including cutaneous or infectious diseases (1.5%), such as acne and herpes zoster; blood test changes (1.2%), including hypercholesterolemia, creatine phosphokinase or liver enzyme elevation, and lymphopenia; urinary or respiratory infections (0.9%); deep venous thrombosis (0.3%); malignancies (0.3%); loss of consciousness (0.3%); and arthralgias (0.3%); followed by ineffectiveness (0.6%). No specific characteristic was significantly associated with an increased risk of upadacitinib discontinuation. Conclusions: Our findings show that upadacitinib was effective in moderate-to-severe AD after more than 1 year of continuous treatment but point to the need for clinical and laboratory monitoring of patients.

An Innovative Dual-Wavelength Laser Technique for Atrophic Acne Scar Management: A Pilot Study.

Background and Objectives: Acne scars are one of the most disturbing and long-term symptoms of acne vulgaris, having a negative impact on a person's physical, emotional, and social well-being. Aim: the purpose of the study was to evaluate the efficacy and post-treatment outcomes of a dual-wavelength system combining the irradiation of two wavelengths at 10,600 nm and 1540 nm in the management of facial atrophic acne scars. Materials and Methods: Four healthy adult volunteers aged 24-53 years were enrolled. The areas treated were the full face (two patients), cheeks (one patient), and forehead (one patient). A dual-wavelength system (1540 nm and 10,600 nm) was used for this study. Patients underwent 2-4 treatment sessions, and the treatments were performed once every 45-90 days. All possible side effects such as burning sensation, dyschromia, mild to moderate post-treatment erythema, bleeding, itching, edema, and crusting were checked. The index to assess edema and erythema was based on a four-point scale (none, mild, moderate, and severe) and was applied before and at 3-month follow-up (3 MFU) after the last treatment session. In addition, a patient assessment was conducted before treatment and at 3 MFU after the last treatment session. Results: For all patients examined, the edema index was mild, while for the erythema index, 3/4 patients experienced moderate and 1/4 patients experienced mild symptoms. The mean patient downtime was 5.8 ± 0.5 days. Concerning the patient assessment, 2/4 subjects showed excellent improvement, 1/4 patients showed good improvement, and 1/4 patients showed slight improvement. As shown by the photographic assessment, a noticeable improvement in skin texture and a substantial reduction in acne scars were observed at the end of treatment. Conclusions: This dual-wavelength laser technology has the potential to be an interesting and safe approach for acne scar treatment, with a low risk of scarring/hypopigmentation and a shorter healing time.

Dupilumab Treatment in Children Aged 6-11 Years With Atopic Dermatitis: A Multicentre, Real-Life Study.

BACKGROUND: The management of paediatric atopic dermatitis (AD) is challenging, mostly relying on emollients and topical corticosteroids. Dupilumab, a fully human monoclonal antibody, has been recently approved for the treatment of children aged 6-11 years with moderate-to-severe AD not adequately controlled with topical therapies or when those therapies are not advisable. OBJECTIVES: The aim of this study was to evaluate in real life the effectiveness and safety of dupilumab in the treatment of children aged from 6 to 11 years. METHODS: Demographic and clinical data of children aged 6-11 years, affected by moderate-to-severe AD and treated with dupilumab, were retrospectively collected from 24 dermatological and paediatric referral centres. Dupilumab was administered subcutaneously at an induction dose of 300 mg on day (D) 1, followed by 300 mg on D15 and 300 mg every 4 weeks. Disease severity was assessed at baseline and after week 2 (W2), W4 and W16 of dupilumab therapy using Eczema Area Severity Index (EASI), Pruritus Numerical Rating Scale (P-NRS) and Sleep NRS (S-NRS) and Children's Dermatology Life Quality Index (c-DLQI) score. RESULTS: A total of 55 AD children (24 males [43.64%], 31 females [56.36%]; mean age 9.35 ± 1.75 years) were included. A significant improvement in EASI score, P-NRS, S-NRS and c-DLQI was observed from baseline to W16 of treatment with dupilumab. In particular, at W16 the proportion of patients achieving EASI75 was 74.54%. Moreover, at the same timepoint a significant mean percentage reduction for P-NRS, S-NRS and c-DLQI was also observed (68.39%, 70.22% and 79.03%, respectively). CONCLUSIONS: Our real-life data seem to confirm the effectiveness of dupilumab in paediatric patients on all disease aspects, including extent and severity of signs, intensity of symptoms, sleep and QoL, with a good safety profile.

Long-term proactive management of psoriasis with calcipotriol and betamethasone dipropionate foam: an Italian consensus through a combined nominal group technique and Delphi approach.

BACKGROUND: Although long-term management of psoriasis is paramount, this approach is challenging in clinical practice. In the recent PSO-LONG trial, a fixed-dose combination of betamethasone dipropionate (BD) and calcipotriol (Cal) foam applied twice a week on non-consecutive days for 52 weeks (proactive treatment) reduced the risk of relapse. However, the role of Cal/BD foam in the long-term management of psoriasis needs further clarifications. The ProActive Management (PAM) program, a nationwide Italian project, aims at reaching a consensus on the role of proactive management of psoriasis. METHODS: A steering committee generated some statements through the nominal group technique (NGT). The statements were voted by an expert panel in an adapted Delphi voting process. RESULTS: Eighteen statements were proposed, and the majority of them (14/18) reached a consensus during the Delphi voting. The need to provide long-term proactive topical treatment to reduce the risk of relapse for the treatment of challenging diseases sites or in patients where phototherapy or systemic therapies are contraindicated/ineffective was widely recognized. A consensus was reached about the possibility to associate the proactive treatment with systemic and biological therapies, without the need for dose intensification, thus favoring a prolonged remission. Moreover, the proactive treatment was recognized as more effective than weekend therapy in increasing time free from relapses. Approaches to improve adherence, on the other hand, need further investigation. CONCLUSIONS: The inclusion in guidelines of a proactive strategy among the effective treatment options will be a fundamental step in the evolution of a mild-moderate psoriasis therapeutic approach.

The Effect of the COVID-19 Lockdown on Melanoma Diagnosis in Italy.

The coronavirus disease 2019 (COVID-19) pandemic has led to lockdowns for much of the world. In Italy, all health procedures not directly related to COVID-19 were reduced or suspended, thus limiting patient access to hospitals. Any delay in cancer treatment presents the additional risk of tumors progressing from being curable to incurable. Specifically, melanoma survival rate strictly depends on tumor thickness, which, in turn, is a function of time. To estimate the impact on melanoma progression caused by the reduction in dermatologic services during the COVID-19 lockdown, a retrospective observational cohort study was conducted. This study was designed to compare the clinical and histologic characteristics of the primary melanomas removed in the first 2 months after the end of the lockdown (May-July 2020) in 12 Italian centers characterized by different COVID-19 case frequencies. The control group was represented by the melanomas removed during the same period in the previous 3 years. Overall, 1,124 melanomas were considered: 237 as part of the study group and 887 from the control group (average, 295), with a 20% reduction. Breslow thickness, as well as high-risk histotypes and melanomas with vertical growth, increased for all melanomas. Ulcerated and high mitotic index melanomas increased, particularly in northern Italy. In Italy, the lockdown led to a significant worsening of melanoma severity, causing a staging jump, with a consequent worsening of outcomes.

Ixekizumab May Improve Renal Function in Psoriasis.

BACKGROUND: Psoriasis is a chronic dermatological condition characterized by lesions on extensor surfaces, hands, feet, and genital areas. Chronic renal failure is often associated with metabolic syndrome and inflammatory conditions, such as psoriasis. CASE REPORT: In this paper, we report a patient with stage-three chronic renal failure that improved his renal condition after treatment with ixekizumab, an anti-IL17A drug used in the treatment of various cutaneous and rheumatological conditions. CONCLUSIONS: IL17A blockage may help to treat various autoimmune and inflammatory conditions, such as psoriasis, that may lead to renal impairment. Further investigation is necessary in order to prove the effectiveness of this drug in renal conditions.

Effectiveness and Safety of Long-Term Dupilumab Treatment in Elderly Patients with Atopic Dermatitis: A Multicenter Real-Life Observational Study.

OBJECTIVE: The objective of this study was to assess the effectiveness and safety of dupilumab in treating elderly patients with atopic dermatitis from baseline to 52 weeks. METHODS: A retrospective observational real-life study was conducted in a group of elderly patients with severe atopic dermatitis treated with dupilumab for 52 weeks. Inclusion criteria were: age ≥ 65 years; diagnosis of atopic dermatitis made by an expert dermatologist; Eczema Area and Severity Index ≥ 24; and a contraindication, side effects, or failure to respond to cyclosporine. The primary outcome was the mean percentage reduction in the Eczema Area and Severity Index score from baseline to week 52. Secondary measures included the mean percentage reduction in the Pruritus and Sleep Numerical Rating Scales and the Dermatology Life Quality Index, and the types and rates of adverse events from baseline to week 52. RESULTS: One hundred and five patients were eligible for the study. Flexural dermatitis was the most frequent clinical phenotype (63.8%). The coexistence of more than one clinical phenotype was found in 70/105 (66.6%) patients. We observed a reduction in all disease severity scores from baseline to week 52 (p < 0.001). Adverse events were recorded in 30/105 (28.6%) patients, with conjunctivitis and injection-site reaction the most frequent. CONCLUSIONS: In this study, dupilumab is an effective and safe treatment for the long-term management of atopic dermatitis in patients aged over 65 years.

A New 675 nm Laser Device in the Treatment of Facial Aging: A Prospective Observational Study.

Objective: To evaluate the effectiveness and safety of a 675 nm laser device in the treatment of facial aging. Background: Wrinkles represent a major sign of aging skin and are considered a major topic in cosmetic dermatology, representing a common problem that negatively impacts patients' quality of life. Different types of treatments are currently available. The aim of this study was to assess the efficacy and safety of a new 675 nm laser source system on facial wrinkles. Methods: A total of 22 consecutive female (age 49.36 ± 8.72) patients, with Fitzpatrick skin types II-IV and facial wrinkles, were treated with three sessions of a 675 nm laser system. Efficacy of treatment was assessed using the Modified Fitzpatrick Wrinkles Scale pre and postoperatively before 3 months. Results: All 22 patients treated with the 675 nm laser had a significant improvement of facial wrinkles according to the FWS (from 1.59 ± 0.80 to 1 ± 0.64; p ≤ 0.001). No side effects occurred except a mild erythematous rash in two patients. Conclusions: This novel 675 nm laser system can be considered a promising and effective tool in patients with facial wrinkles, and it involves a simple post-treatment management.

Neurodystrophic Hand Dermatitis: Sannino Barduagni Syndrome.

Hand eczema is a chronic disease (1), commonly considered the expression of a contact allergic or irritative dermatitis. However, when the prick/patch tests and laboratory investigations are negative, important diagnostic challenges may arise. Peripheral nerve fibers are in fact capable of releasing neuromediators. Thus, an alteration of the central and/or peripheral nervous system can cause the exacerbation as well as the onset of a cutaneous disease (2). From September 1, 2013 to August 31, 2015, we observed 5 female patients between 20 and 40 years old, with particular hand dermatitis lesions on the volar area, unilateral on the right hand in 3 patients and bilateral in 2 patients. In one case, the dermopathy extended to all the fingers, up to the area of the metacarpophalangeal joints, thenar, and hypothenar eminences. The skin appeared dry (Figure 1), anhidrotic, inelastic, thinned, scaly, and slightly erythematous (Figure 2). In some cases, the fingertips appeared sclerotic, while in other cases the transversal fissures on the flexural joints caused painful and incomplete finger flexion. The dorsal surface was unaffected and the nails healthy. Symptoms were paresthesia and burning sensation. All of the patients were in good general health, with negative routine laboratory investigations, IgE serum levels and prick/patch tests. One patient had just given childbirth three months before the onset of the disease. The patients had been suffering of their hand dermatitis for a duration ranging from 2 months and 2 years and had been treated unsuccessfully with topical and systemic drugs, mainly corticosteroids. We performed a cervical spine X-ray in different projections. In all patients, we observed a degenerative disease of the cervical spine with a reduction of intersomatic discs, primarily C5-C6 (Figure 3). This led us to establish a diagnosis of neurodystrophic hand dermatitis (NHD). Patients started specific treatment programs for the spinal disorder, intake of a vitamin B complex and repairing/soothing skin creams, with a partial improvement. NHD is rarely described in the literature; in 1964 Sannino et al. reported 89 female patients with skin alterations similar to the ones observed in our case series as well as negative patch/prick tests and laboratory investigations, and the main finding was the presence of a cervical spine disease between C5-C7 (3). Recently, Azimi et al. performed a review of skin diseases at sites affected by neurological deficits. They started to collect data from 1966, but did not mention cases attributable to NHD, which is an underestimated and misdiagnosed disorder (2). Cervical spine disease is a predisposing factor for the development of NHD. Additionally, thermoreceptors may be mainly involved, as also reported in brachio-radial pruritus (4-5), explaining the presence of burning sensation. However, in our opinion, NHD should not be classified as a "neurogenic inflammation". This term describes the vasodilation and protein extravasation caused by inflammatory neuropeptides and adrenergic transmitters that influence the antigen presentation, mast-cell degranulation, and cytokine release (2). In fact, corticosteroids and other immunosuppressors are ineffective. Specific treatments for cervical spine disease remain the treatment of choice, as does constant use of repairing/soothing skin creams. Antidepressants, physiotherapy, postural exercises, neuromodulators, and vitamin B complex may be also helpful.