Combining secukinumab with dimethyl fumarate for treatment of a patient with psoriasis and recent diagnosis of multiple sclerosis

Results We report the case of a 44-year-old male patient referred to our department in 2006 for evaluation and management of psoriasis and psoriatic arthritis not responding to previous topical therapies and to conventional systemic treatments. On initial evaluation, his Psoriasis Area and Severity Index (PASI) was 23 so it was decided to start a biological therapy. Etanercept was firstly introduced with partial control of both cutaneous and articular manifestations and stopped after 2 years due to a loss of efficacy. Then, other different biological drugs were administered but discontinued for loss of efficacy or no clinical response. In 2017, we started a treatment with secukinumab with significant clinical improvement. These results were still maintained after 2 years. In January 2019, due to several episodes of hypoesthesia and paraesthesia, the patient performed a neurological examination and a brain magnetic resonance imaging (MRI) with gadolinium revealing multiple encephalic and spinal hyperintense lesions compatible with focal demyelinated areas. A diagnosis of relapsing-remitting multiple sclerosis was made and therapy with dimethyl fumarate (240 bid) started. Secukinumab therapy was maintained but decreasing the dose to 150 mg/month in order to reduce the immunosuppressive risks. After 12 months of follow-up, the patient tolerates the association of the two therapies and presents good control of both diseases. To the best of our knowledge, this is the first case of a combination of two immunosuppressive drugs, secukinumab and dimethyl fumarate, for the treatment of a patient with concomitant psoriasis and multiple sclerosis. Among the widely different conventional therapies available to treat these two diseases, only dimethyl fumarate has been approved for both conditions. Moreover, interleukin 17 (IL-17) appears to play a key role in the pathogenesis of both diseases; it is produced by lymphocytes Th17, but also by CD8+ cells, Tγδ lymphocytes and some cells of the central nervous system, such as astrocytes and oligodendrocytes, in the context of active lesions of multiple sclerosis. Currently, the efficacy of anti IL-17 has been described only in few cases of multiple sclerosis. In conclusion, our case emphasizes the potential efficacy and safety of combination therapy of secukinumab and dimethyl fumarate, which may be a therapeutic option for such challenging patients

Secukinumab demonstrates improvements in absolute and relative psoriasis area severity indices in moderate-to-severe plaque psoriasis: results from a European, multicentric, retrospective, real-world study

AbstractObjective: This European, multicentric, retrospective study aimed to collect data on secukinumab effectiveness in a real-world setting.Research design and methods: All psoriatic patients st..

Psoriasis With Leg Involvement, a New Difficult-to-Treat Area: A Cohort Study of Patients Treated With Risankizumab

Introduction: Historically, difficult-to-treat areas in psoriasis included face, scalp, folds, genitalia, nails and palmoplantar region. Recent studies have found that lower limbs behave like a “new” difficult-to-treat area, as it can be the only site of residual disease even in patients undergoing biologic therapies. Objectives: We aimed to evaluate whether legs had different response rates and response times to treatment with a new biologic drug, risankizumab, than other body sites. Methods: We conducted a real-life, observational, retrospective, multicentric study, including patients affected by moderate-to-severe psoriasis with legs involvement and undergoing biological therapy with risankizumab for more than 16 weeks. The Psoriasis Area Severity Index (PASI) and Leg-PASI were collected at T0 and at week 16, 28, 40, 52, 64 and 76. Statistical analysis using T student test and linear regression analysis were performed. Results: A total of 124 patients were included. The difference between the improvement percentage respect to baseline was statistically significant at week 16 and 28, demonstrating that Leg-PASI improved less than PASI. From the linear regression it was deduced that the slope is statistically less steep for Leg-PASI than for overall PASI, confirming that this site responds more slowly to the therapy. Conclusions: Leg response to risankizumab appears to differ significantly from other body-sites in the first weeks of treatment, even if after 28 weeks statistical significance is lost. Our preliminary finding suggests that risankizumab can be considered an effective treatment for legs psoriasis, but with longer response times than other areas demonstrating the relative nature of resistance to treatment of this district

Helicobacter Pylori infection in psoriatic patients during biological therapy

Psoriasis is a relapsing inflammatory disease exacerbated by many triggers. Helicobacter Pylori (H. Pylori) is a Gram-negative bacterium causing the liberation of many cytokines and having a role in systemic inflammation. We assessed over a period of 12 months the presence of H. Pylori in psoriatic patients undergoing biologic therapy and how PASI improved after its eradication

Clinical features and in vivo reflectance confocal microscopy of an atypical presentation of Herpesvirus-2 and Cytomegalovirus co-infection of the intergluteal sulcus

[No abstract available

A New Hybrid Therapeutic Approach to Solitary Keratoacanthoma: Complete Recovery in Six Patients

Introduction: Solitary keratoacanthoma (SKA) is generally considered as a well-differentiated form of squamous cell carcinoma, but it usually runs a benign course and a not aggressive behavior. Diagnostic criteria, prognosis, and treatment of SKA are not fully defined yet. Surgical treatment with fusiform excision represents the gold standard; nonoperative intralesional therapy of KA is uncommon but may provide a valid option in some categories of patients. Case series presentation: We report our experience regarding the treatment of SKA with a hybrid treatment consisting of a minimally invasive technique such as curettage followed by intralesional corticosteroid administration in the same session. Six patients affected with KA were treated ending in a complete resolution, with good esthetic outcome, no relapse after 1 year, and satisfaction of the patients. Discussion and conclusion: The combined treatment allows us on the one hand to avoid radical surgery in selected patients and particular anatomic areas and on the other the side effects that the use of intralesional chemotherapy/immunosuppressive drugs can entail

Treatment of Netherton syndrome with dupilumab

Background Netherton syndrome (NS) is a rare autosomal recessive skin disease caused by loss of function mutations in SPINK5 gene (serine protease inhibitor of kazal type 5) encoding LEKTI (lymphoepitelial kazal-type-related inhibitor). Its clinical presentation includes congenital ichthosis, hair shaft abnormalities (bamboo hair or trichorrhexis invaginata) and atopic diathesis. No specific therapy for NS has been identified at the moment. Objective To explore the clinical effects that type 2 cytokines blockage with dupilumab has in a patient with NS. Methods A 29-year-old woman with NS and severe atopic manifestations was treated with dupilumab. Clinical monitoring was performed over 6 months. We also reviewed the clinical effects reported by other authors while treating NS patients with dupilumab. Results In our patient, dupilumab induced a rapid and sustained reduction of pruritus, scaling and erythema. Only ten cases of patients with NS treated with dupilumab are reported in the literature, including ours. In general, dupilumab improved most of patients’ clinical manifestation, especially pruritus. Only two adverse events were reported by other authors, namely a case of conjunctivitis and a case of bacterial infection. Conclusion NS is a rare genodermatosis that could cause severe complication and impact patients’ quality of life. In NS patients inhibition of IL-4 and IL-13 signaling was associated with remarkable clinical improvements, especially in controlling pruritus. Our data support the use of dupilumab for controlling skin manifestation and symptoms of NS

Survey of bullous pemphigoid in an Italian University hospital: clinical-epidemiological characteristics and follow-up

The clinical-epidemiological characteristics and course of bullous pemphigoid in the general population is not clear. Few studies have been performed to date, and only one in the Italian population more than ten years ago. We decided to evaluate the characteristics and outcome of patients admitted for a bullous pemphigoid at our Hospital in the last 4 years

Seven years-experience of adalimumab therapy for Hidradenitis Suppurativa in a real-life dermatologic setting

Introduction Hidradenitis Suppurativa (HS) often causes severe impairment of the quality of life of patients affected, as it is characterized by recurrent relapses of inflammation and predisposes to retractive scars, with severe alteration of anatomy of the affected regions. Adalimumab is currently the only approved long-term biological therapy for this disease. Material and method We retrospectively review the data of HS patients treated with Adalimumab at the ‘Hidradenitis Suppurativa Clinic’, University of Ferrara, Italy since the drug was first available to October 2020. The aim is to describe our real-life experience in a clinical outpatient service. We assessed the main demographic features, therapy duration, reasons of suspension and efficacy (evaluated by HiSCR – Hidradenitis Score) in relation to surgical procedures, hospitalization, number of areas involved by the disease and BMI > 30. We also assessed the aspects related to the use of adalimumab’s biosimilar. Results Data on 76 patients, with a mean age of 38.26 ± 14.74 years and mean BMI 28.10 ± 5.92 were collected. Most of the treated patients had Hurley stage III (58/76); mean Sartorius score was 115.5 ± 55.86, mean IHS4 was 76.1 ± 44.3. A statistically significant correlation between hospitalization and cessation of adalimumab, the loss of the achievement of the HiSCR, and surgery was found. No need to do surgery was a protective factor against the failure of adalimumab treatment, meaning that the most severe cases are more likely to fail the biological therapy. Conclusion New scenarios are opening up in clinical practice: the arrival of biosimilars allow greater sustainability of expenditure, while the anti-IL17 allow the patient who has failed therapy with adalimumab a valid and safe therapeutic option to be undertaken. A comprehensive care including hospitalization, a specific antibiotic therapy and surgical treatment is often mandatory to achieve a satisfactory control of the disease