Advanced Glycation End Products and Psoriasis

: Advanced glycation end products (AGEs) are biologically active compounds formed physiologically throughout a sequence of chemical reactions, to generate highly oxidant‐reactive aldehydes that combine covalently to proteins. They accumulate slowly in tissues during ageing but also in metabolic and selected inflammatory disorders. Accumulation of AGEs occurs more rapidly and intensely in the skin and serum of patients with type 2 diabetes, obesity, cardiovascular dis‐ eases, chronic renal insufficiency, and non‐alcoholic fatty liver disease and also in the skin of pa‐ tients with psoriasis. All of the above conditions are intimately associated with psoriasis. Interaction of AGEs with their receptors (RAGEs) stimulates cellular signaling with the formation of reactive oxygen species and activation of nuclear factor kappa light chain enhancer of activated B (NF‐kB), which is a key regulator in the expression of inflammatory mediators and the production of oxida‐ tive stress. Thus, AGEs may play an interesting pathogenic role in the intersection of inflammatory and metabolic diseases, may represent a biomarker of inflammation and a potential target for novel therapeutic strategies. This is a narrative review with the objective to summarize current evidence on the role of AGEs in psoriasi

Tailored biological treatment for patients with moderate-to-severe psoriasis

Introduction: Psoriasis is a common, chronic immune-mediated skin disease frequently associated to inflammatory and metabolic comorbidities. About 20–30% of patients are affected by moderate-to- severe psoriasis and require a systemic treatment, which include traditional and biological drugs. The objective of this manuscript is to provide criteria for a personalized biological treatment. Areas covered: Tailoring a biological treatment for patients with moderate-to-severe psoriasis needs to consider several variables related to the disease, the patient and the treatment. It is important to consider the disease severity and activity, the skin areas involved, the frequency of relapses, itch or other symptoms, and foremost the presence of comorbidities. About the patient, is important to consider age, gender, body weight, the occupation, the impact on the quality of life, the likelihood of adherence, patient expectations, the desire for remission, and the fear of side effects. Expert opinion: The presence of comorbidities, which may benefit from or contraindicate a given biologic, is the main driver of a tailored therapy. A personalized treatment associates maximum efficacy and minimal risk of side effects. In addition, there is the possibility of modifying disease-course inducing long-term remission and preventing the development of psoriatic arthritis

A man with a widespread bullous eruption

A man with a widespread bullous eruptio

Eosinophilic annular erythema successfully treated with cyclosporine

Eosinophilic annular erythema (EAE) is a rare, benign eosinophilic dermatosis, first described in infants in 1981 by Peterson and Jarratt as annular erythema of infancy, and in adults in 2000 by Kahofer et al.1 Clinically, EAE is characterized by annular erythematous papules and plaques at the trunk and extremities, with a centrifugal growth pattern and a central area of clearing

Uncommon Non‑Infectious Annular Dermatoses

Several cutaneous diseases can present with annular lesions, making a distinction by physical appearance alone challenging. They can be distinguished into infectious and non‑infectious, and common and uncommon annular dermatoses. Common non‑infectious diseases include granuloma annulare, urticaria, and subacute lupus erythematosus. In addition, there are rare non‑infectious non‑neoplastic annular dermatoses whose nosographic attribution is established, including annually recurring erythema annulare centrifugum (EAC) and annular erythema in Sjögren syndrome and others whose nosographic positioning is still debated. They are neutrophilic figurate erythema, palpable migratory arciform erythema, eosinophilic annular erythema, and annular lichenoid dermatitis of youth. Their etiopathogenesis is largely unknown, although immune‑mediated mechanisms are likely involved. It is difficult to establish if they are variants of reaction patterns or separate clinic‑pathological entities. In fact, EAC and annually recurring EAC may represent different aspects of the same disease. Palpable migratory arciform erythema is hardly distinguishable from EAC deep type, Jessner‑Kanof disease, and lupus tumidus. Neutrophilic figurate erythema and eosinophilic figurate erythema are clinically very similar and differing only in the relative proportion of eosinophils and neutrophils

Atopic Dermatitis in the Elderly Population

Acta DermatoVenereologica Atopic dermatitis is a common inflammatory disease with a chronic and relapsing course. Although considered a childhood disease, it is now evident that atopic dermatitis is also common in adulthood and in the elderly population. Atopic dermatitis typically manifests with bilateral and symmetrical eczematous lesions on the face, trunk and skin folds. Itch is invariably present and may be very severe, markedly affecting daily life and sleep. In older adults, atopic dermatitis may have a high level of impact on quality of life, frequently burdening an already complex comorbid situation. The full assessment of disease burden (localizations, itch severity, sleep alterations, impact on quality of life, disease history, comorbidities) is crucial to identify the most appropriate treatment. In many cases, moderate-to-severe atopic dermatitis in the elderly population can be successfully and safely treated with biological agents inhibiting the interleukin-4/-13 pathway, whereas the use of Janus kinase inhibitors may pose concerns about the safety profile

Cost per responder of Adalimumab biosimilars MSB11022 and ABP 501 versus the originator and methotrexate in chronic plaque psoriasis

Background: Pharmacoeconomic studies comparing the cost of adalimumab biosimilars versus the originator and conventional drugs in psoriasis are lacking. Research design and methods: To assess the cost per responder of adalimumab biosimilars versus the originator and methotrexate for psoriasis treatment. A cost per responder analysis comparing adalimumab biosimilars MSB11022 (Idacio®) and ABP 501 (Amgevita®), and methotrexate to the originator (Humira®) was performed. The incremental cost per responder was calculated by multiplying the cost of treatment based on the perspective of the National Healthcare System and number needed to treat for each therapy. Results: Considering the PASI75 response rate at 16 weeks, the cost per responder for MSB11022 and ABP 501 compared to the originator was € 500 versus 1,831 and € 968 versus 1,949, respectively. For the same endpoint, the cost per responder for subcutaneous or oral methotrexate was € 543 or 34 compared to 2,117 for adalimumab originator. At an indirect comparison among methotrexate, MSB11022 and ABP 501, the costs per PASI75 responder at week 16 were 2%, 26%, 27% and 50% of that of the originator, respectively. Conclusions: The use of biosimilars was confirmed as a valuable pharmacoeconomic strategy to lower healthcare cost in patients with psoriasis

Real-Life Effectiveness of Adalimumab Biosimilars in Patients with Chronic Plaque Psoriasis

Introduction The real-life effectiveness of adalimumab biosimilars in patients with psoriasis has rarely been investigated. Objective To investigate drug survival of adalimumab biosimilars in patients with chronic plaque psoriasis and factors associated with its discontinuation. Methods We carried out a retrospective observational study including all consecutive patients with chronic plaque psoriasis who initiated adalimumab biosimilar MSB11022 (Idacio), ABP501 (Amgevita), or SB5 (Imraldi) between 1 January 2018 and 1 January 2021. The 1-year drug survival of adalimumab biosimilar and independent factors associated with its discontinuation were investigated. Cox regression models were fit to estimate adjusted hazard ratios (aHRs) with 95% confidence intervals (CIs) for the risk of adalimumab discontinuation. A propensity score matching (PSM) model was adopted as sensitivity analysis. Results The study involved a total of 410 patients with follow-up of 549.84 person-years, 271 (66.1%) men, a mean (SD) age of 51.8 (14.5) years, and a baseline PASI of 14.54 (5.02). Among adalimumab biosimilars, 250 (61%) patients received MSB11022, 98 (24%) received ABP501, and 62 (15%) received SB5. Drug survival of adalimumab biosimilars at 1 year was 81.5% in the overall study population. Obesity was associated with increased risk of adalimumab discontinuation (HR = 2.01; 95% CI 1.33-3.03), whereas psoriatic arthritis (aHR = 0.32; 95% CI 0.16-0.64) and receiving adalimumab as first systemic treatment (aHR = 0.44; 95% CI 0.27-0.70) were associated with lower risk. Conclusion The real-life effectiveness of adalimumab biosimilars in patients with psoriasis is consistent with that previously reported for the originator

Annually Recurring Erythema Annulare Centrifugum: A New Case Series with Review of the Literature

Annually recurring erythema annulare centrifugum (AR-EAC) is a rare variant, characterized by typical annular plaques recurring in the same period of the year. We describe 5 new cases and present a review of the literature. Patients were 3 females and 2 males with an age range of 25–55 years. Multiple annular plaques were located at the thighs in 4 patients and the neck in one patient. In 1 patient, a single lesion was present. Plaques were recurring in summer in 3 cases; in 1 case, in spring; and another patient, in winter since 3–4 years. Lesions were self-healing in few days or weeks. Histologically, the epidermis presented mild acanthosis with patchy spongiosis, slight parakeratosis, and mild exocytosis. There was a perivascular lympho-histiocytic infiltrate of variable intensity in the superficial dermis, with occasional eosinophils. In 1 case, the inflammatory infiltrate reached the deep dermis. Mucin deposition was absent. Phenotyping studies in 1 case revealed a predominance of T cells, with a small B-cell component. Moreover, a moderate number of CD123+ plasmacytoid dendritic cells and CD1a+ dendritic cells were noted. Fourteen cases of AR-EAC have been published previously. Collectively, patients’ age ranged from 16 to 83 years, with a mean age of 47 years and a disease duration of 1–30 years. Lesions affected more frequently extremities and recurred most commonly in summer. Patients were all in good general health. Topical corticosteroids were the mainstay of treatment. AR-EAC is a benign disorder, the nature of which remains enigmatic

Dupilumab improves clinical manifestations, symptoms, and quality of life in adult patients with chronic nodular prurigo

Background: Chronic nodular prurigo (CNPG) is a multifactorial skin disease characterized by itchy papules and nodules, usually resistant to standard treatment and associated with markedly impaired quality of life. Objective: To describe dupilumab effectiveness and tolerability in treating adult patients with CNPG refractory to both topical and systemic therapies. Methods: Retrospective, multicenter study including adult patients affected by CNPG, who were treated with dupilumab for at least 16 weeks. Results: Twenty-seven CNPG patients showed clinical improvement in terms of skin lesions, itch, sleeplessness, and quality of life. A consistent proportion of patients (24/27; 88.9%) had at least 16-week continuous treatment and achieved Investigator Global Assessment score 1 (11/24; 45.8%). An increased number of patients achieved at least a 2-grade reduction in Investigator Global Assessment score (19/24; 79.2%). Numeric rating scale values for itch and sleeplessness decreased from 8.9 to 2.7 and from 8.2 to 1.7, respectively (P .001) after 16-week therapy. Ten patients achieved 36 weeks of continuous treatment while maintaining clinical efficacy. Limitations: Major limitations included lack of validated assessment tools at the initial data collection, a limited cohort of treated patients, and a short-term observation period. Conclusion: Dupilumab was proven effective in reducing itch and improving CNPG skin lesions