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Background: Cyclosporine (CysA) is effective for psoriasis in adult patients but little data exist about its efficacy and safety in childhood and adolescence psoriasis.Objectives: To assess the effectiveness and safety of CysA for childhood and adolescence psoriasis.Methods: Retrospective analysis of a group of children and adolescents (age < 17 years) with plaque psoriasis treated with CysA at several Italian dermatology clinics.Results: Our study population consisted of 38 patients. The median age at the start of treatment was 12.3 years. Therapy duration varied from one to 36 months. The median maintenance dosage per day was 3.2 mg/kg (range 2–5 mg/kg). Fifteen patients (39,4%) achieved a complete clearance or a good improvement of their psoriasis defined by an improvement from baseline of  ≥75% in the psoriasis area and severity index (PASI) at week 16. Eight patients (21.05%) discontinued the treatment due to laboratory anomalies or adverse events. Serious events were not recorded.Conclusions: In this case series, CysA was effective and well-tolerated treatment in a significant quote of children. CysA, when carefully monitored, may represent a therapeutic alternative to the currently used systemic immunosuppressive agents for severe childhood psoriasis. [ABSTRACT FROM AUTHOR]

Background: Dupilumab has been shown to be a safe and effective drug for the treatment of atopic dermatitis (AD) in children from 6 months to 11 years in randomized clinical trials. Aim: The aim of this real-life study was to determine the effectiveness in disease control and safety of dupilumab at W52 in moderate-to-severe AD children aged 6-11 years. Methods: All data were collected from 36 Italian dermatological or paediatric referral centres. Dupilumab was administered at label dosage with an induction dose of 300 mg on day 1 (D1), followed by 300 mg on D15 and 300 mg every 4 weeks (Q4W). Treatment effect was determined as overall disease severity, using EASI, P-NRS, S-NRS and c-DLQI at baseline, W16, W24, and W52. Ninety-six AD children diagnosed with moderate-to-severe AD and treated with dupilumab were enrolled. Results: Ninety-one (94.8%) patients completed the 52-week treatment period and were included in the study. A significant improvement in EASI score, P-NRS, S-NRS and c-DLQI was observed from baseline to weeks 16, 24 and 52. Conclusions: Our real-life data seem to confirm dupilumab effectiveness and safety in paediatric patients. Moreover, our experience highlighted that patients achieving clinical improvement at W16 preserved this condition over time.

Background: Etanercept is licensed for the treatment of moderate-to-severe plaque psoriasis in children., Objectives: The aim of this analysis was to investigate effectiveness, tolerability, and reasons for discontinuation of etanercept in a real-life cohort of children and adolescents with moderate to severe plaque psoriasis., Methods: Data collected from a number of centers belonging to the 'Pediatric Dermatology Group' of the Italian Society of Dermatology (SIDeMaST) were examined in patients (age ≤17 years) who started treatment with etanercept from 2011 to 2015. A group of 23 patients were identified. Efficacy assessment was defined as the proportion of patients with a ≥50% and ≥75% improvement in Psoriasis Area Severity Index (PASI) at weeks 12, 24, and 52. Safety was evaluated on adverse event reporting. Reasons for discontinuation were classified as ineffectiveness, adverse events, remission, or other reasons., Results: At week 12, 56.5% of patients achieved PASI 75, 86.9% achieved PASI 50. Efficacy was sustained through week 52. In 15 patients etanercept was still ongoing at the time of data collection. In three patients the therapy was suspended due to inefficacy. The medication was overall well tolerated., Conclusions: Etanercept was an effective and well-tolerated treatment in this real-life cohort of patients.

Psoriasis in patients with early onset follows an irregular course with tendency to become severe and extensive. The aim of this study was to look for an association between age at onset of psoriasis and use of biologic agents for its treatment. We reviewed the medical records of 350 patients with moderate to severe psoriasis treated with systemic therapies and compared differences in age at disease onset between patients who had received biologics and those who had not. The mean age of our patients was 54.9 ± 15.1 years; 100 of them (28.6%) were currently receiving or had previously received treatment with a biologic agent. For those with biologic use, average age at the time of diagnosis of psoriasis was 28.2 ± 14.7 years, compared with 40.4 ± 18.1 years for those who had not received biologics. A total of 139 patients had psoriasis diagnosed before or at age 30 years. Sixty out of them (43.1%) had used biologics. Forty-four patients had psoriasis diagnosed after age 60 years, but only three out of them (6.8%) had used biologics. Concomitant arthritis was significantly associated with use of biologics. In our patients with psoriasis disease, frequency of treatment with a biologic agent varied inversely with age at disease onset.

Background: Anti-tumor necrosis factor (TNF)-α therapies represent a significant innovation in therapy for psoriasis. However, a significant number of psoriasis patients do not respond well to TNF blockers or show an insufficient control of disease activity on a long-term basis., Objective/aim: The aim of this study was to recognize specific clinical factors that could be associated with a non-response to any available TNF blockers in patients with moderate-to-severe plaque psoriasis., Materials and Methods: The authors reviewed the medical records of all patients who had started etanercept, infliximab, adalimumab and had achieved a minimum of 24 months follow-up. The authors identified subjects who were not responsive to all available anti-TNF agents, whatever the chronology of their use., Results: A total of 110 patients were retrospectively examined. Thirteen patients were identified as "non-responders" to all available TNF-α blockers. Current smoking at the start of anti-TNF therapy was associated with non-response to TNF blockers. The group of "non-responders" presented a high mean body mass index and a high baseline PASI score with respect to the group of responders., Conclusions: The data showed that the majority of non-responder patients were smokers, overweight or obese and had a high baseline PASI score. Concomitant arthritis was not significantly associated with non-response.

Background: Psoriasis is a chronic inflammatory skin disease which often requires life-long treatment., Objective/aim: Our objective was to assess the role of the body mass index (BMI) on the retention rates of anti-TNF-alfa therapies in patients with moderate to severe plaque psoriasis., Material and Methods: Retrospective observational study of psoriasis patients included in local databases of three public Italian hospitals. All patients, who received anti-TNF-alfa treatment in referral centers, were included. Only patients with at least 1-year follow-up were considered eligible. The outcome was the conservation of the treatment at 1 and 2 years of follow-up., Results: 194 patients were enrolled. 307 treatment courses with a minimum follow-up of 12 months and 263 with a follow-up of 24 months were analyzed. The proportion of patients receiving the same treatment at months 12 and 24 was 67.43% and 42.21%, respectively. The proportion steadily decreased with increased values of BMI., Conclusions: The overall efficacy of TNF-alfa inhibitors diminishes with time. The BMI affects the long-term survival rate of anti-TNF-alfa in psoriatic patients. A high BMI can be considered a potential predictor of drug discontinuation.

Some of the traditional psoriasis therapies, such as PUVA therapy and ciclosporin, have been linked to an increased incidence of non-melanoma skin cancer. More recently, an increased risk of cancer has also been a concern with newly introduced biologic agents. The authors report a case of multiple cutaneous squamous cell carcinomas arising on the lower limbs of a patient receiving efalizumab first and subsequently infliximab following many years of treatment with conventional therapies including PUVA and ciclosporin. Both these previous therapies likely contributed to the development of the skin tumors of this patient. Several case reports have documented that the use of tumor necrosis factor (TNF)-α inhibitors may be associated with non-melanoma skin cancer, in particular squamous cell carcinoma. However, case reports, although numerous and well documented, do not fulfil the requirements for testing a cause-effect hypothesis. Since data from animal models indicate that TNF inhibition does not increase the incidence of malignancies, additional longer-term studies are necessary to ascertain whether a link exists between anti-TNF-α and non-melanoma skin cancer above that normally observed in psoriasis patients.