Pyoderma gangrenosum associated with pseudo-PelgerHuët anomaly in a patient with idiopathic myelofibrosis

Pseudo-Pelger-Huët anomaly is a condition in which almost all the granulocytes are hyposegmented and/or hypogranulated. It is typically recognized in peripheral blood smears and represents a marker of several disorders, such as myeloproliferative diseases and myelodysplasia. The occurrence of the pseudoPelger-Huët anomaly in the cutaneous infiltrate of pyoderma gangrenosum is very rare. We describe the case of a 70-year-old man with idiopathic myelofibrosis who developed pyoderma gangrenosum. Histological examination showed an infiltrate consisting of granulocytic elements with features of dysmaturity and segmentation anomalies (hypo- and hypersegmented forms), suggestive of pseudo-Pelger-Huët anomaly. Methylprednisolone treatment resulted in progressive improvement of pyoderma gangrenosum

Clinical Features and Response to Treatment in Elderly Subjects Affected by Hidradenitis Suppurativa: A Cohort Study

hidradenitis suppurativa (HS) is a chronic-relapsing inflammatory skin disease. It usually appears in the second and third decades, but a smaller proportion of patients develop late-onset HS. geriatric HS, defined as the persistence or the development of HS after the age of 65 years, has been poorly explored. this study aimed to investigate the clinical features, treatment management and response to therapies of HS elderly subjects (>= 65 years old). we designed a multicentric observational study, gathering data from seven Italian university hospitals. demographic and clinical data of HS patients aged over 65 years were collected at baseline, week 12 and week 24. overall, 57 elderly subjects suffering from HS were enrolled. at baseline, disease severity was predominantly moderate-to-severe, with 45.6% of patients classified as hurley III. the gluteal phenotype was the most frequently observed; it also appeared to affect patients' quality of life more than other phenotypes. gluteal involvement was detected in about half (49.1%) of cases and associated with severe stages of the disease. In terms of therapeutic response, hurley III patients showed the persistency of higher values of mean IHS4, DLQI, itch- and pain-NRS scores compared to hurley I/II. In conclusion, disease severity in this subpopulation appears high and treatment is often challenging

Drug Survival of Interleukin (IL)‑17 and IL‑23 Inhibitors for the Treatment of Psoriasis: A Retrospective Multi‑country, Multicentric Cohort Study

Background: Drug survival, defined as the length of time from initiation to discontinuation of a given therapy, allows comparisons between drugs, helps to predict patient's likelihood of remaining on a specific treatment, and achieving the best decision for each patient in daily clinical practice. Objective: The aim of this study was to provide data on drug survival of secukinumab, ixekizumab, brodalumab, guselkumab, tildrakizumab, and risankizumab in a large international cohort, and to identify clinical predictors that might have an impact on the drug survival of these drugs. Methods: This was a retrospective, multicentric, multi-country study that provides data of adult patients with moderate to severe psoriasis who started treatment with an interleukin (IL)-17 or IL-23 inhibitor between 1 February 2015 and 31 October 2021. Data were collected from 19 distinct hospital and non-hospital-based dermatology centers from Canada, Czech Republic, Italy, Greece, Portugal, Spain, and Switzerland. Kaplan-Meier estimator and proportional hazard Cox regression models were used for drug survival analysis. Results: A total of 4866 treatment courses (4178 patients)-overall time of exposure of 9500 patient-years-were included in this study, with 3164 corresponding to an IL-17 inhibitor (secukinumab, ixekizumab, brodalumab) and 1702 corresponding to an IL-23 inhibitor (guselkumab, risankizumab, tildrakizumab). IL-23 inhibitors had the highest drug survival rates during the entire study period. After 24 months of treatment, the cumulative probabilities of drug survival were 0.92 (95% confidence interval [CI] 0.89-0.95) for risankizumab, 0.90 (95% CI 0.88-0.92) for guselkumab, 0.80 (95% CI 0.76-0.84) for brodalumab, 0.79 (95% CI 0.76-0.82) for ixekizumab, and 0.75 (95% CI 0.73-0.77) for secukinumab. At 36 months, only guselkumab [0.88 (95% CI 0.85-0.91)], ixekizumab [0.73 (95% CI 0.70-0.76)], and secukinumab [0.67 (95% CI 0.65-0.70)] had more than 40 patients at risk of drug discontinuation. Only two drugs had more than 40 patients at risk of drug discontinuation at 48 months, with ixekizumab demonstrating to have a higher cumulative probability of drug survival [0.71 (95% CI 0.68-0.75)] when compared with secukinumab [0.63 (95% CI 0.60-0.66)]. Secondary failure was the main cause for drug discontinuation. According to the final multivariable model, patients receiving risankizumab, guselkumab, and ixekizumab were significantly less likely to discontinue treatment than those receiving secukinumab. Previous exposure to biologic agents, absent family history of psoriasis, higher baseline body mass index (BMI), and higher baseline Psoriasis Area and Severity Index (PASI) were identified as predictors of drug discontinuation. Conclusion: The cumulative probability of drug survival of both IL-17 and IL-23 inhibitors was higher than 75% at 24 months, with risankizumab and guselkumab demonstrating to have overall cumulative probabilities ≥ 90%. Biological agent chosen, prior exposure to biologic agents, higher baseline BMI and PASI values, and absence of family history of psoriasis were identified as predictors for drug discontinuation. Risankizumab, guselkumab, and ixekizumab were less likely to be discontinued than secukinumab

Late granuloma formation secondary to hyaluronic acid injection

Hyaluronic acid injection to rejuvenate or to correct defects is a very common practice in aesthetic medicine. Although it is considered highly safe because of biocompatibility and biodegradability, adverse reactions can occur. Herein, we report a patient with foreign body granuloma formation that presented as multiple subcutaneous nodules on both arms, following injections of hyaluronic acid performed about six years earlier. Our case is unique with respect to timing and area of granuloma appearance

Late granuloma formation secondary to hyaluronic acid injection

Hyaluronic acid injection to rejuvenate or to correct defects is a very common practice in aesthetic medicine. Although it is considered highly safe because of biocompatibility and biodegradability, adverse reactions can occur. Herein, we report a patient with foreign body granuloma formation that presented as multiple subcutaneous nodules on both arms, following injections of hyaluronic acid performed about six years earlier. Our case is unique with respect to timing and area of granuloma appearance

A case of nivolumab-induced bullous pemphigoid successfully treated with dupilumab

A 76-year-old man came to our attention for the presence of itchy skin lesions localized on the trunk. The patient had a nodular melanoma removed two years earlier. Because of metastatic pulmonary melanoma, he underwent a lung lobectomy and began adjuvant therapy with nivolumab. After six months of treatment, the patient reported the appearance of itchy lesions on the trunk that were diagnosed as eczema and successfully treated with systemic corticosteroids. Upon corticosteroid discontinuation, the eruption relapsed presenting with erythematous macules, tense blisters, and erosions on the trunk and limbs. The presence of linear deposits of IgG and C3 at the dermo-epidermal junction and high serum levels of anti-BP180 antibodies confirmed the suspicion of nivolumab-induced bullous pemphigoid. Treatment with 0.6mg/kg methylprednisolone and 200mg/day doxycycline as well as nivolumab discontinuation induced temporary remission. After tapering methylprednisolone to 16mg/day, the patient developed new blisters. Therefore, dupilumab 300mg every other week was added with progressive improvement while methylprednisolone was tapered down and withdrawn after four months. After six months the patient was still in full clinical remission. Many cases of conventional bullous pemphigoid have been treated successfully with dupilumab, which can also be used safely in cancer patients without inducing overt immunosuppressio

A case of nivolumab-induced bullous pemphigoid successfully treated with dupilumab

A 76-year-old man came to our attention for the presence of itchy skin lesions localized on the trunk. The patient had a nodular melanoma removed two years earlier. Because of metastatic pulmonary melanoma, he underwent a lung lobectomy and began adjuvant therapy with nivolumab. After six months of treatment, the patient reported the appearance of itchy lesions on the trunk that were diagnosed as eczema and successfully treated with systemic corticosteroids. Upon corticosteroid discontinuation, the eruption relapsed presenting with erythematous macules, tense blisters, and erosions on the trunk and limbs. The presence of linear deposits of IgG and C3 at the dermo-epidermal junction and high serum levels of anti-BP180 antibodies confirmed the suspicion of nivolumab-induced bullous pemphigoid. Treatment with 0.6mg/kg methylprednisolone and 200mg/day doxycycline as well as nivolumab discontinuation induced temporary remission. After tapering methylprednisolone to 16mg/day, the patient developed new blisters. Therefore, dupilumab 300mg every other week was added with progressive improvement while methylprednisolone was tapered down and withdrawn after four months. After six months the patient was still in full clinical remission. Many cases of conventional bullous pemphigoid have been treated successfully with dupilumab, which can also be used safely in cancer patients without inducing overt immunosuppression

Late granuloma formation secondary to hyaluronic acid injection

Hyaluronic acid injection to rejuvenate or to correct defects is a very common practice in aesthetic medicine. Although it is considered highly safe because of biocompatibility and biodegradability, adverse reactions can occur. Herein, we report a patient with foreign body granuloma formation that presented as multiple subcutaneous nodules on both arms, following injections of hyaluronic acid performed about six years earlier. Our case is unique with respect to timing and area of granuloma appearance

Pyoderma gangrenosum associated with pseudo-Pelger-Huet anomaly in a patient with idiopathic myelofibrosis

Pseudo-Pelger-Huët anomaly is a condition in which almost all the granulocytes are hyposegmented and/or hypogranulated. It is typically recognized in peripheral blood smears and represents a marker of several disorders, such as myeloproliferative diseases and myelodysplasia. The occurrence of the pseudo-Pelger-Huët anomaly in the cutaneous infiltrate of pyoderma gangrenosum is very rare. We describe the case of a 70-year-old man with idiopathic myelofibrosis who developed pyoderma gangrenosum. Histological examination showed an infiltrate consisting of granulocytic elements with features of dysmaturity and segmentation anomalies (hypo- and hypersegmented forms), suggestive of pseudo-Pelger-Huët anomaly. Methylprednisolone treatment resulted in progressive improvement of pyoderma gangrenosum

Age affects drug survival rates of interleukin (IL)-17 and IL-23 inhibitors in patients with plaque psoriasis: Results from a retrospective, multicentric, multi-country, cohort study

Background: Scarce data related to the drug survival of biologic agents in psoriasis patients aged >= 65 years is available. Objectives: To evaluate the drug survival of interleukin (IL)-23 or the IL-17 inhibitors approved for the treatment of moderate-to-severe psoriasis in elderly patients (aged >= 65 years), compared with younger adult patients (aged <65 years), and to identify clinical predictors that can influence the drug survival. Methods: This retrospective multicentric cohort study included adult patients with moderate-to-severe psoriasis, dissecting two-patient subcohorts based on age: elderly versus younger adults. Kaplan-Meier estimator and proportional hazard Cox regression models were used for drug survival analysis. Results: We included 4178 patients and 4866 treatment courses; 934 were elderly (1072 treatment courses), and 3244 were younger patients (3794 treatment courses). Drug survival, considering all causes of interruption, was higher in patients aged <65 years than in elderly patients overall (log-rank p < 0.006). This difference was significant for treatment courses involving IL-23 inhibitors (p < 0.001) but not for those with IL-17 inhibitors (p = 0.2). According to both uni- and multi-variable models, elder age was associated with an increased risk of treatment discontinuation (univariable analysis: HR: 1.229, 95% CI 1.062-1.422; p < 0.006; multivariable analysis: HR: 1.199, 95% CI 1.010-1.422; p = 0.0377). Anti-IL-23 agents were associated with a reduced likelihood of treatment discontinuation after adjusting for other variables (HR: 0.520, 95% CI 0.368-0.735; p < 0.001). Being previously treated with IL-17 inhibitors increased the probability of discontinuation. Conclusion: Elderly patients with psoriasis have an increased risk of biologic treatment discontinuation compared with younger adult patients, particularly, if being treated with IL-23 inhibitors. However, in stratified analyses conducted in elderly patients, IL-23 inhibitors showed higher drug survival rates than IL-17 inhibitors