Dose tapering of biological therapies in patients with psoriasis in remission and the associated healing sensation: a multicentric study

La psoriasi è una malattia infiammatoria cronica cutanea che, a seconda della gravità, può essere classificata in lieve, moderata e severa. Per le forme severe, sono stati recentemente introdotti i farmaci biologici, che determinano un’ottima clearance delle lesioni cutanee, aumentando quindi la sensazione di guarigione del paziente. Tali farmaci hanno regimi di somministrazione ben stabiiti, tuttavia, alcuni studi hanno proposto schemi di somministrazione dilazionati per migliorare la qualità di vita del paziente psoriasico. Sono stati arruolati soggetti con diagnosi di psoriasi cutanea moderata-grave e/o artropatica in trattamento con uno dei quattro principali farmaci biologico (infliximab, etanercept, adalimumab e ustekinumab), che avessero raggiunto un PASI100, mantenuto per almeno 12 mesi consecutivi, presso 3 centri italiani. Per tali pazienti, è stato allungato il tempo di somministrazione. È stata valutata la percentuale di recidive e l’associazione con ipertensione, diabete mellito, artropatia psoriasica o con l’abitudine al tabagismo. La sensazione di guarigione è misurata con un questionario somministrato a 3 mesi dal baseline. Sono stati analizzati in totale 199 pazienti in terapia con farmaco biologico da gennaio 2005 a giugno 2018. Sono stati confrontati 96 pazienti che hanno effettuato una riduzione della dose con 103 trattati secondo foglietto illustrativo. La differenza nell’incidenza di recidive tra i due gruppi è apparsa essere trascurabile (p-value 0,445). L’ipertensione arteriosa appariva essere correlata a una più alta percentuale di recidive (p-value<0.05). I farmaci biologici determinano un’ottima risposta terapeutica, associata spesso a una completa remissione della malattia. Il nostro studio ha dimostrato come la somministrazione dilazionata dei farmaci biologici mantenga la medesima efficacia della somministrazione standard e trovi anche ampio consenso da parte del paziente stesso. Ulteriori studi su più ampie casistiche per valutare l’efficacia a lungo termine del trattamento con farmaco biologico ad intervalli di tempo dilazionati e per determinare il parametro qui introdotto della “sensazione di guarigione”.Psoriasis is a cutaneous chronic inflammatory disease which can be classified in mild, moderate or severe, according with the skin involvement. For the severe forms, biological therapies have been recently introduced. These therapies often cause a complete clearance of the skin lesions, but they have specific and rigid dose administration regimens. Recently, some studies have proposed a dose tapering to improve the patient's quality of life and reduce the health costs. We considered in this study 199 patients treated with one biological therapy among infliximab, etanercept, adalimumab or ustekinumab, from January 2005 through June 2018. Of them, 96 reached a complete clearance of the lesions (PASI100) maintained for at least 12 months. In this group, we elongated the administration period of the used biologic and we administered a questionnaire about the “healing sensation”. In the other 103 patients, who did not reach the PASI100, we maintained the therapy at the standard dose. We also evaluated the percentage of relapses among the two groups and the association between the incidence of relapses and hypertension, diabetes, psoriatic arthritis or smoking habits. The difference in terms of relapses between the two groups appeared negligible (p-value 0.445) while hypertension has been related to a higher percentage of psoriasis recurrence in both groups. In the group of dose tapering, most patients (61,70%) reported high satisfaction and “healing sensation” after the dose tapering of the biologic. Biological therapies cause often a good therapeutic response or, in most cases, a complete remission of the disease. Our study demonstrated that a dose tapering of biologics maintain good results in terms of efficacy and it is well accepted by the psoriatic patients. More studies are needed to evaluate the long-term efficacy of these new therapeutic regimens of biologics and to study the newly introduced parameter of “healing sensation”

Photodynamic therapy with 5-methylaminolevulinic acid in the treatment of multiple warts of the face.

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3D human foreskin model for testing topical formulations of sildenafil citrate

: Sildenafil citrate is an approved drug used for the treatment of erectile dysfunction and premature ejaculation. Despite a widespread application, sildenafil citrate shows numerous adverse cardiovascular effects in high-risk patients. Local transdermal drug delivery of this drug is therefore being explored as an interesting and noninvasive alternative administration method that avoids adverse effects arised from peak plasma drug concentrations. Although human and animal skin represents the most reliable models to perform penetration studies, they involve a series of ethical issues and restrictions. For these reasons new in vitro approaches based on artificially reconstructed human skin or "human skin equivalents" are being developed as possible alternatives for transdermal testing. There is little information, however, on the efficiency of such new in vitro methods on cutaneous penetration of active ingredients. The objective of the current study was to investigate the sildenafil citrate loaded in three commercial transdermal vehicles using 3D full-thickness skin equivalent and compare the results with the permeability experiments using porcine skin. Our results demonstrated that, while the formulation plays an imperative role in an appropriate dermal uptake of sildenafil citrate, the D coefficient results obtained by using the 3D skin equivalent are comparable to those obtained by using the porcine skin when a simple drug suspension is applied (1.17&nbsp;×&nbsp;10-10&nbsp;±&nbsp;0.92&nbsp;×&nbsp;10-10 cm2/s vs 3.5&nbsp;×&nbsp;102&nbsp;±&nbsp;3.3&nbsp;×&nbsp;102 cm2/s), suggesting that in such case, this 3D skin model can be a valid alternative for ex-vivo skin absorption experiments

Factors associated with adverse COVID-19 outcomes in patients with psoriasis-insights from a global registry-based study.

BACKGROUND: The multimorbid burden and use of systemic immunosuppressants in people with psoriasis may confer greater risk of adverse outcomes of coronavirus disease 2019 (COVID-19), but the data are limited. OBJECTIVE: Our aim was to characterize the course of COVID-19 in patients with psoriasis and identify factors associated with hospitalization. METHODS: Clinicians reported patients with psoriasis with confirmed/suspected COVID-19 via an international registry, Psoriasis Patient Registry for Outcomes, Therapy and Epidemiology of COVID-19 Infection. Multiple logistic regression was used to assess the association between clinical and/or demographic characteristics and hospitalization. A separate patient-facing registry characterized risk-mitigating behaviors. RESULTS: Of 374 clinician-reported patients from 25 countries, 71% were receiving a biologic, 18% were receiving a nonbiologic, and 10% were not receiving any systemic treatment for psoriasis. In all, 348 patients (93%) were fully recovered from COVID-19, 77 (21%) were hospitalized, and 9 (2%) died. Increased hospitalization risk was associated with older age (multivariable-adjusted odds ratio [OR] = 1.59 per 10 years; 95% CI = 1.19-2.13), male sex (OR = 2.51; 95% CI = 1.23-5.12), nonwhite ethnicity (OR = 3.15; 95% CI = 1.24-8.03), and comorbid chronic lung disease (OR = 3.87; 95% CI = 1.52-9.83). Hospitalization was more frequent in patients using nonbiologic systemic therapy than in those using biologics (OR = 2.84; 95% CI = 1.31-6.18). No significant differences were found between classes of biologics. Independent patient-reported data (n = 1626 across 48 countries) suggested lower levels of social isolation in individuals receiving nonbiologic systemic therapy than in those receiving biologics (OR = 0.68; 95% CI = 0.50-0.94). CONCLUSION: In this international case series of patients with moderate-to-severe psoriasis, biologic use was associated with lower risk of COVID-19-related hospitalization than with use of nonbiologic systemic therapies; however, further investigation is warranted on account of potential selection bias and unmeasured confounding. Established risk factors (being older, being male, being of nonwhite ethnicity, and having comorbidities) were associated with higher hospitalization rates

Pyoderma gangrenosum in the genital area: successful treatment using adalimumab

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Mathematical views: a preliminary analysis on undergraduate mathematics students

International audienceWe investigate the mathematical views of a sample of undergraduate mathematics students in their third year of studies, namely during the semester that precedes the Bachelor degree. We collected data about the students' mathematical views, their personal information and academic achievement, analysing the relationships among them. We also study mathematical views' influence on the appreciation of different aspects of teaching. Finally, we investigate the extent to which undergraduate studies can change a student's view of mathematics. Data are collected by means of multiple-choice demographic questions and Likert-scale affective questions. Results reveal that different views have an impact on third-year undergraduate mathematics students' achievement, as well as on the preference for more transmissive formats of the lesson, or more participative ones, based on different mathematical views

Nail Psoriasis: An Updated Review and Expert Opinion on Available Treatments, Including Biologics

Nail psoriasis affects 50–79% of patients with skin psoriasis and up to 80% of patients with psoriatic arthritis, and can also represent a negative prognostic factor in individuals with plaque psoriasis. Treatments for nail psoriasis are limited, as nails are often difficult to treat with topical therapies alone, and relapse is common. Among different systemic agents, secukinumab, a fully human monoclonal antibody targeting interleukin (IL)-17A, is the only antibody supported by a trial specifically conducted in patients with nail psoriasis (the TRANSFIGURE trial) and has the longest follow-up available to date. In this setting, secukinumab is characterized by the highest efficacy at week 16. This review analysed the different therapeutic options for nail psoriasis, focusing on new treatments that have shown promising results in this field

An erythematous palmoplantar rash due to human parechovirus

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Sudden swelling and redness of the toe

The presence of history of redness and swelling of toe in an infant without history of trauma is typical of hair threat tourniquet syndrome. The treatment simply involves incision and removal of hair fibers. Physicians should be aware of this syndrome because early diagnosis and treatment avoid serious complications

Molluscum contagiosum infection on a congenital intermediate melanocytic naevus

A 2-year-old girl presented with a 3-month history of several small painless papules, growing on the surface of an abdominal congenital melanocytic naevus (MN). Her mother noted that the lesions were significantly increasing in number and size. There was no history of trauma and her medical and family histories were unremarkable. Physical examination revealed multiple skin-coloured, translucent, glossy, dome-shaped papules, ranging from 1 to 3\u2005mm, localised exclusively on the surface of a macular, smooth, light to dark brown, non-hypertrichotic congenital intermediate MN (2 74\u2005cm) (see figure 1). The dermoscopic examination of the papules suggested the diagnosis of molluscum contagiosum (MC), which was histologically confirmed. MC is a common viral skin infection, which is seldom associated with other skin diseases (eg, epidermoid cyst and nevocellular naevus).1 The localisation of MC on an MN is extremely rare, and only a few case reports have been published in the literature until now; in all reported cases, the lesions are strictly confined to the MN and did not affect the remaining skin.2 ,3 A possible explanation of the occurrence of viral lesions on an MN may be represented by the Meyerson\u2019s phenomenon, an eczematous reaction occurring in MN.4 We could hypothesise that this resulted in a barrier dysfunction predisposing the patient to develop MC locally. Even though congenital intermediate MN is recognised to have a low malignancy potential during childhood,5 melanoma can develop. Therefore, the physician should be aware of the appearance of MC superinfection on MN, but the occurrence of new lesions within a congenital MN requires a dermatological evaluatio