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The starting point of this study described in this paper is the desire to create a model that will be useful in various fields related to mathematical modeling and that will contain a new perspective of what we call and know about feedback. This feedback has appeared in cyber studies. The modeling of this computer system involves the transfer of information from the data of a problem written in a practical language to the language specific to the feedback contained in cellular automata and algebraic fractals. Both cellular automata and algebraic fractals are fundamental in the development of technical solutions used in the fields related to quantum mechanics. The bases of these researches are from the articles conceived by Prof. Dr. Colceag, in which he mentions information fields, structural fractals, but also about modeling and the models that emerge from this modeling. All this complex modeling structure will describe more complex objects with characteristics such as: feedback cycles, projective relationships in the projective space and specific transformations that describe how this model was obtained, these being common features for everything that means description and modeling the phenomena of physics, chemistry, biology, economy etc. At the beginning, such a model focuses on feedback cycles, and will also develop commutative diagrams based on automorphisms. After this first phase, the model is organized on progressive levels where its structure is divided into new and stable structures that self-determine, this leading to a fractalized modeling in which a feedback structure is inserted in the form of a loop.

Despite the presence of this erythema and although the lesions did not respond to treatment, all patients continued with their dupilumab treatment with spontaneous remission of erythema within two to three months. 1 and Table 1) with severe AD treated with dupilumab and with paradoxical head and neck erythema that appeared 8-20 weeks after the start of biological treatment while eczema on other body parts had greatly improved. Dear Editor, Atopic dermatitis (AD) is a chronic inflammatory dermatological disease with multifactorial etiology. [Extracted from the article]

Background: Sleep disturbances are common in patients with atopic dermatitis (AD). Considering their relevant burden on health, routine screening of sleep disturbances seems to be very useful in AD adults' management. However, few studies have evaluated the association between sleep disturbances and AD in adults, and real-life data are lacking. The aim of this study was to assess the effect of treatment with dupilumab on sleep disturbances in adult patients with severe atopic dermatitis., Methods: This is a retrospective, multicenter study including patients (age ≥18 y) with severe atopic dermatitis treated with dupilumab for at least 8 months from January 2019 to January 2020. Patients were evaluated three times: at treatment initiation (T0), at 4 (T4) and 8 months (T8) from the start of treatment. At each visit disease activity was assessed by severity score (Eczema Area and Severity Index [EASI]), patient-reported outcomes (Pruritus Numerical Rating Scale [NRS], Dermatology Life Quality Index [DLQI], and Pittsburgh Sleep Quality Index [PSQI]). Kolmogorov-Smirnov Test was performed to evaluate the normality distribution, Bartlett's Test for homoscedasticity. Since the assumptions were met, ANOVA for repeated measures was performed to evaluate the mean difference of PSQI, EASI, DLQI and pruritus NRS between baseline, the 4 th month and the 8 th month. In addition, χ 2 for Trend Test was performed to evaluate the increasing/decreasing prevalence of poor sleepers., Results: A total of 36 patients (15 females and 21 males) with a mean age of 42.5±14.3 (range 20-67) were included in the study. The mean score for PSQI at TO was 9.0±3.6. At week 16 (T4) the mean score for PSQI was 4.92±2.99 and at week 32 (T8), the mean score for PSQI was 4.3±3.0. EASI, NRS pruritus and DLQI significantly improved during follow-up (P<0.001) whereas PSQI improved significantly at 16 weeks (T4); however, no significant further improvement was observed at 32 weeks. Of the 31 patients (86%) with baseline PSQI≥5, 17 (54%) experienced sleep quality improvement during treatment. Overall, we observed a total of 22 patients (61.1%) having a PSQI<5 at 32 weeks., Conclusions: Our data show effectiveness of dupilumab in improving sleep disturbances in adult patients with severe AD. However, further studies are required to understand if PSQI could serve as useful evaluating tool.

Cyclosporine (CsA) is an effective and safe therapeutic option in various dermatoses in both adults and children. Over the last 25 years, Italian dermatologists have gained relevant experience about the use of CsA in the treatment of psoriasis and atopic dermatitis, and an Italian Consensus Conference has recently provided recommendations in adult patients. A comparison between these real-world indications and current European guidelines is hereby provided.