Adherence to the Mediterranean diet model and psoriatic disease (skin, joint and metabolic expression of psoriasis)

Psoriasis is a chronic disease, characterized by systemic inflammation with skin, joint and metabolic involvement. The most common tools to evaluate the severity of each disease is respectively the Psoriasis Area Severity Index (PASI) and the Disease Activity Index for Psoriatic Arthritis (DAPSA). The association between psoriasis and obesity and the role of visceral fat in producing an inflammatory state have been demonstrated. The Mediterranean Diet (MD) has been recommended as a model of healthy diet on the basis of scientific evidence and considered as an adjuvant therapy for all patients affected by chronic inflammatory diseases. Our study evaluated the association between adherence to MD (assessed with the Predimed questionnaire) and psoriatic disease severity. 80 patients (40 with psoriasis and 40 with psoriatic arthritis) were evaluated for disease severity (PASI, DAPSA) and were assessed for Metabolic Syndrome according to the International Diabetes Federation (IDF) definition. To evaluate adherence to the MD, each patient was administered the Predimed questionnaire which includes 14 questions. Our study shows a correlation between low adherence to MD and a high expression of psoriasis, considering cutaneous, joint symptoms and the metabolic profile

Linagliptin-induced bullous pemphigoid

Bullous pemphigoid (BP) is an autoimmune disease that can be induced by several drugs. In the literature 21 cases of BP probably associated to the use of gliptins have been reported. We describe one female patient who developed BP 5 months after the introduction of linagliptin into her anti-diabetic therapy (metformin and repaglinide). Clinical diagnosis of BP was confirmed by histological examination of a lesional skin biopsy and direct immunofluorescence of perilesional skin. Oral anti-diabetic therapy was substituted with subcutaneous injection of insuline. In addition, i.v. methylprednisolone (1mg/kg/day for ten days than tapered) and azathioprine (100mg/day) were administered for 12 weeks achieving complete regression of the cutaneous lesions. Considering the possible relationship between BP and gliptins, a clinical surveillance for cutaneous disorders is advisable in patients undergoing this treatment

Effectiveness of risankizumab in the treatment of palmoplantar psoriasis: a 52-week Italian real-life experience

Background: Data on the treatment of palmoplantar psoriasis (PP) are scarce, representing a therapeutic challenge. This study aims to assess the efficacy and safety of risankizumab in a population of patients with psoriasis with a palmoplantar involvement, over a 52- week treatment period. Methods: We performed a retrospective analysis in a cohort of patients with PP, with or without involvement of other skin sites. Palmoplantar Psoriasis Area and Severity Index (ppPASI) was assessed at baseline and after 4, 16, 28 and 52 weeks, to evaluate the PP severity. Results: Sixteen patients were enrolled. The rates of ppPASI90 responses constantly increased during the period of observation and were 18.7%, 62.2%, 75.0% and 81.2% at weeks 4, 16, 28 and 52, respectively. Only two patients suspended treatment because of ineffectiveness at week 16. Conclusion: Our data from a series of 16 patients reveal that risankizumab could represent an effective and safe therapeutic choice in patients with PP

A strange perianal ulcer

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Linear IgA bullous dermatosis in a two-year-old child: possible association with aspirin

A child with linear IgA bullous dermatosis, appeared after after administration of aspirin, is herein reported

Role of personalized medication training in improving efficacy and adherence to a topical therapy

Poor adherence to topical therapy, defined as the degree to which patients use medication as prescribed by their health-care provider, represents a frequent cause of poor treatment outcomes. OBJECTIVE: To evaluate the impact of individualized medication training on efficacy, adherence and patient satisfaction to 4 weeks of a topical therapy in psoriasis. METHODS: All enrolled psoriatic patients were given a prescription for calcipotriol/bethamethasone dipropionate gel once daily and were randomly assigned to one of the two following groups with a 1:1 allocation ratio. Patients in group 1 and 2 underwent an initial visit, including the physical examination and provision of information by the dermatologist. Patients in group 2 also received an additional 20\u2009minutes of individualized medication training. Efficacy, adherence and patient satisfaction were evaluated after 4 weeks of treatment. RESULTS: We enrolled 104 consecutive patients with psoriasis: patients in group 2, who were trained, had at week 4 a significant improvement in BSA, PASI, and dPGA, higher PPQ score and were more adherent compared to those in group 1 who were not trained. CONCLUSION: Individualized medication training on the correct application of a topical therapy from a healthcare professional may improve patients' adherence, treatment tolerability and clinical outcomes

Risankizumab for the treatment of moderate-to-severe psoriasis: A multicenter, retrospective, 1 year real-life study

Several new biologic agents targeting IL23/Th17 axis, such as risankizumab, have been developed for the treatment of psoriasis. The aim of the present study was to analyze the efficacy and safety of risankizumab in patients with moderate-to-severe psoriasis over a 52-week period. A multicentric retrospective study was conducted in patients who initiated risankizumab between July 2019 and December 2020. Psoriasis Area and Severity Index-PASI was measured at baseline and after 4, 16, 28 and 52 weeks. Clinical responses were evaluated by PASI75, PASI90 and PASI100 at the same timepoints. Potential safety issues and adverse events (AEs) were collected. Univariable and multivariable logistic regressions were performed for variables predicting clinical response. One hundred and twelve patients with psoriasis were included. PASI90 response was achieved by 17.86% of patients at week 4, 72.22% at week 16, 91.0% at week 28 and 95.24% at week 52 (as observed analysis). No associations between the considered variables and the efficacy endpoints were retrieved, influence of variables such as Body Mass Index (BMI), baseline PASI or previous biologics were not shown. No serious safety issues or discontinuations related to adverse events were reported. Risankizumab showed high efficacy and a favorable safety profile, regardless of patient- and disease-related factors

Secukinumab in moderate-to-severe plaque psoriasis: a multi-center, retrospective, real-life study up to 52 weeks observation

Objectives: To evaluate efficacy and safety of the anti-IL-17 drug secukinumab in a real-life large cohort of patients with moderate-to-severe plaque psoriasis in Central Italy. Methods: Multicenter, retrospective study with an observation period of up to 52\ua0weeks. Efficacy was assessed by Psoriasis Area and Severity Index (PASI) score; clinical and laboratory examinations were performed at baseline and at weeks 4, 12, 24, 36, and 52. Results: A 90% and a 100% PASI score reduction (PASI90 and PASI100) were reported in 67.5% and 55% of patients at week 12, respectively. A rapid improvement of skin lesions was observed particularly in young patients and in patients na\uefve to biologics: at week 4, the achievement of PASI90 and PASI100 was higher in younger patients (odds ratio [OR] 0.95, and 0.95; p\ua0=\ua00.003, and 0.005, respectively); PASI90 was achieved by 42.0% of patients na\uefve to biologics and by 17.0% of patients with prior exposure to biologics (PBT) (OR 0.24; p\ua0=\ua00.001); and PASI100 was reached by 25.5% of na\uefve patients and 9.8% of PBT (OR 0.28; p\ua0=\ua00.015).The drug was well tolerated. Conclusion: Secukinumab was effective in this real-life analysis, with rapid clinical improvement and long-term maintenance of results

HLA-Cw6 allele, NFkB1 and NFkBIA polymorphisms play no role in predicting response to etanercept in psoriatic patients

OBJECTIVE: This retrospective study aimed to evaluate the role of NFKB1-94 insertion/deletion ATTG (rs28362491) and NFkBIA 2758 A>G (rs696) polymorphisms and HLA-Cw6 allele in predicting the response to etanercept, a TNF-α blocker, in a population of psoriatic patients naive to biologics. METHODS: Genomic DNA was extracted from whole blood in a series of 96 psoriatic patients who received etanercept for at least 3 months. Patients were classified as responders if they achieved a Psoriasis Area and Severity Index improvement of at least 75% after 12 weeks of etanercept treatment and as nonresponders if Psoriasis Area and Severity Index improvement was less than 75%. Genotyping was performed using the PCR-restriction fragment length polymorphism (PCR-RFLP) method. RESULTS: We did not find any significant role of NFKB1-94 insertion/deletion ATTG (rs28362491) and NFkBIA 2758 A>G (rs696) polymorphisms and the HLA-Cw6 allele in predicting the response to etanercept. CONCLUSION: Our findings suggest that NFKB1 and NFkBIA polymorphisms are not related to the response to etanercept. They also indicate that the therapeutic response to etanercept is not influenced by the presence of the HLA-Cw6 allele, in contrast with previous evidence on ustekinumab, suggesting that such an association is related more to drug than to disease characteristics