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Sir, Cutaneous leishmaniasis (CL) is an infection caused by protozoa belonging to the genus Leishmania (L.). The disease is transmitted by sandflies: Phlebotomus (P.) spp. and Lutzomyia spp. are the most frequently involved. Disease reservoirs are represented by dogs, mice, rats, wild rodents and, more rarely, humans. CL is very frequent in the Mediterranean Basin, especially in Sicily. L. infantum, transmitted by P. pappatasi, P. perfiliewi and P. perniciosus, is responsible for all cases observed in Sicily. From the clinical point of view, CL in the Mediterranean Basin is usually characterized by a single, polymorphous lesion located on exposed areas, in particular the face, followed by the upper limbs. In the last few years, we have observed several patients with CL characterized clinically by multiple, monomorphous, slightly inflammatory, papular or papulo-nodular lesions. Some of these lesions appeared as “twin lesions”. We believe that this presentation represents a new clinical variety of CL, which has been called “multifocal CL” by other authors (1–3). The hypothesis of a new carrier involvement is advanced.

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.