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Secukinumab, a fully human monoclonal antibody, neutralizes interleukin-17A, a cornerstone cytokine driving the multiple manifestations of psoriasis. This post-hoc analysis of the SUPREME study was performed to determine the sustainability of response to secukinumab in terms of Psoriasis Area and Severity Index (PASI) 90 in patients with moderate-to-severe plaque psoriasis. Based on PASI 90 response at week 16, patients were stratified as PASI 90 responders (PASI90R, n = 337) or non-responders (PASI90NR, n = 72). At week 20, 94.2% (n = 295/313) achieved PASI 90/100 response in PASI90R, with response maintained through week 48 (89.6%, n = 189/211). An increased proportion of patients achieved PASI 90/100 response in PASI90NR (week 20: 29.9%, n = 20/67; week 48: 57.1%, n = 20/35). Overall, 64.4% patients achieved absolute PASI score = 0 at week 24 with response sustained to week 48 (66.9%). Secukinumab showed sustained and stable efficacy in maintaining PASI 90 response in patients with moderate-to-severe plaque psoriasis up to week 48.

Introduction: Psoriasis is an inflammatory disorder characterized by a deregulation in the Th1/Th17/Treg cells count and function. A plethora of new drugs called “biologicals” have been developed. Beside TNF­α blockers, new drugs interfering with the IL­23 axis have been introduced. Case Report: We present case of: a 59­year­old high­need psoriatic patient hospitalized for acute heart failure. Physicians decided to withdraw anti­TNF­α therapy because of NYHA class III and the need of cardio­surgery. Surgery was delayed for his general conditions. The patient was referred to our department to establish a new therapy. A treatment with anti­IL­12/IL­23p40 was introduced. Ustekinumab was chosen for the high efficacy rates, the high safety profile and for the reported safety in NYHA class III/IV patients. The rapid general condition improvement enabled the patient to undergo surgery. Conclusion: Anti­TNF­α drugs are contraindicated in NYHA class III/IV patients. In those cases drugs interfering with different cytokine patterns could be of interest. Although anti­IL­12/IL­23p40 has been previously addressed as unsafe in NYHA class III/IV, the clinical practice suggests that this drug can be considered quite safe. Currently the role of anti­ IL­12/IL­23p40 on cardiovascular diseases is still an open question and deserves further investigations. Treatment with anti­IL­12/IL­ 23p40 can be considered a good option in NYHA class III/IV patients and in high­ need psoriasis patients.

Introduction: Treat-to-target strategies are used in several chronic diseases to improve outcomes. Treatment goals have also been suggested for psoriasis, but there is currently no consensus on targets, and guidance is needed to implement this strategy in clinical practice. The project ‘Treat to Target Italia’ was launched by a scientific board (SB) of 10 psoriasis experts to generate expert consensus recommendations. Methods: On the basis of the published literature, their clinical experience, and the results of a survey among Italian dermatologists, the SB identified four relevant topics: (1) clinical remission; (2) quality of life; (3) abrogation of systemic inflammation; (4) safety. They drafted 20 statements addressing these four topics and submitted them to a panel of 28 dermatologists, in a Delphi process, to achieve consensus (greater than 80% agreement). Results: Consensus was reached on all statements. Treatment goals defining clinical remission should include a 90% improvement from baseline in the Psoriasis Area and Severity Index (PASI90 response) or an absolute PASI score of less than or equal to 3. Patient’s quality of life and satisfaction are important targets. If PASI targets are achieved, there should be no or very low impact of psoriasis on quality of life [Dermatology Life Quality Index (DLQI) score less than or equal to 3]. If PASI or DLQI goals are not achieved within 3–4months, treatment should be changed. Abrogation of systemic inflammation may be crucial for preventing or delaying inflammatory comorbidities. Safety is an equally important target as efficacy. Conclusion: These 20 consensus statements define the parameters of a treat-to-target strategy for psoriasis in Italy. It is hoped that use of these in the management of patients with psoriasis will improve treatment outcomes and patient health-related quality of life.

Benign skin diseases have seldom been treated with radiotherapy, unless resistant to other treatments. Eccrine syringofibroadenoma (ESFA) is a rare benign eccrine tumor. ESFA very rarely presents bilateral lesions, and seldom a nonsurgical treatment has been proposed. An exceptional case of bilateral ESFA of the foot is presented; radiotherapy was effective in treating both lesions with good cosmetic results. © 2010 Wiley Periodicals, Inc.