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Background: Confirmatory data on long-term effectiveness and safety of ixekizumb in psoriatic patients from real-world studies are needed. Objectives: The primary aim was to evaluate the 3-year drug survival of ixekizumab in the treatment of patients with moderate-to-severe plaque psoriasis, in a multicenter real-world setting. The secondary aim was to assess the influence of predictive factors on the drug survival of ixekizumab. Methods: A retrospective analysis was performed on a cohort of patients with chronic plaque psoriasis, who received at least one dose of ixekizumab before December 2018. The drug survival analysis was performed, descriptively analyzed using Kaplan-Meier survival curves. Multivariable Cox regression analyses were carried out including variables considered of clinical importance. Results: A total of 306 patients was enrolled. The overall drug survival at 12, 24 and 36 months of treatment with ixekizumab was 92.11%, 83.85% and 80.19%, respectively. A higher probability (HR 2.34) of drug withdrawal was found among patients who had already received an anti-IL-17 agent compared with bio-naive patients (p 0.017). Conclusions: We found that ixekizumab is a biological agent characterized by a long term effectiveness, not influenced by several clinical factors and associated with a good safety profile.

Bullous pemphigoid is the most common autoimmune bullous dermatosis. In recent years several studies have tried to identify the main factors of the disease related with an increased risk of death. The aim of this multicenter Italian study was to assess the risk score of death considering epidemiologic, clinical, immunological, and therapeutic factors in a cohort of patients affected by bullous pemphigoid and try to identify the cumulative survival up to 120 months.We retrospectively reviewed the medical records of patients with bullous pemphigoid who were diagnosed between 2005 and 2020 in the 12 Italian centers. Data collected included sex, age at the time of diagnosis, laboratory findings, severity of disease, time at death/censoring, treatment, and multimorbidity.A total of 572 patients were included in the study. The crude mortality rate was 20.6%, with an incidence mortality rate of 5.9 × 100 person/year. The mortality rate at 1, 3, 5, and 10 years was 3.2%, 18.2%, 27.4% and 51.9%, respectively. Multivariate model results showed that the risk of death was significantly higher in patients older than 78 years, in presence of multimorbidity, anti-BP180 autoantibodies72 U/mL, or anti-BP230 3 U/mL at diagnosis. The variables jointly included provided an accuracy (Harrel's Index) of 77% for predicting mortality.This study represents the first nationwide Italian study to have retrospectively investigated the mortality rates and prognostic factors in patients with bullous pemphigoid. A novel finding emerged in our study is that a risk prediction rule based on simple risk factors (age, multimorbidity, steroid-sparing drugs, prednisone use, and disease severity) jointly considered with two biomarkers routinely measured in clinical practice (anti-BP230 and anti-BP180 autoantibodies) provided about 80% accuracy for predicting mortality in large series of patients with this disease.

Most patients with psoriasis present with localized mild-to-moderate disease. In this case, the application of topical treatments in the first-line setting is recommended in most cases. Among different topical options, the fixed-dose combination of betamethasone dipropionate (BD) and vitamin D analogue (Cal) aerosol foam (Enstilar®, Leo Pharma) is approved as first-line topical therapy for the treatment of psoriasis in USA and the EU, due to its high efficacy and its favorable administration scheme. The PSO-LONG was the first trial to report on the long-term efficacy and safety of the Cal/DB foam treatment for the proactive management of psoriasis and now, the indications of Cal/BD foam included its use in the psoriasis maintenance treatment. However, the precise role of this treatment and the potential therapeutic schemes in the long-term management of psoriasis need further clarification. This Position Paper, authored by a group of Italian Expert Dermatologists, critically discusses the long-term management of psoriasis with Cal/BD foam in clinical practice. In particular, the biological rationale in the proactive treatment with Cal/BD foam and current evidence regarding this therapeutic approach are presented, along with its application also in patients with moderate-to-severe disease, difficult-to-treat lesions, or within combination regimens. In addition, strategies to improve adherence to long-term treatment of psoriasis are discussed,.

Background Anti‐tumour necrosis factor (TNF) and anti‐interleukin (IL)‐12/23 biologics revolutionized plaque psoriasis treatment by enabling ≥75% improvement in the Psoriasis Area and Severity Index (PASI 75) in clinical trials. Modern biologics are now reported to achieve PASI 100 (complete skin clearance) in clinical trials. However, real‐world evidence of skin clearance rates with biologics is limited. PSO‐BIO‐REAL was conducted to understand the real‐world burden of plaque psoriasis. Objective The primary objective of this observational study was to estimate the proportion of patients who achieved complete skin clearance at 6 months. Secondary objectives included maintenance of response and evaluation of complete skin clearance at 12 months. Methods PSO‐BIO‐REAL was a multinational, prospective, real‐world, non‐interventional study of skin clearance and patient‐reported outcomes (PROs) with biologics. A total of 846 patients from the United States (32%), France (28%), Italy (22%), the United Kingdom (11%) and Germany (8%) were enrolled and followed for one year. Eligible patients were aged ≥18 years with moderate‐to‐severe plaque psoriasis who had initiated a biologic for plaque psoriasis. Patients could be biologic‐naïve or switching biologics (biologic‐experienced). Assessments were made at baseline and at months 6 and 12. Results At 6 and 12 months, 23% and 26% of patients achieved complete skin clearance, respectively. Prior to study entry, 60% were biologic‐naïve. The proportion of patients achieving complete skin clearance was lower among biologic‐experienced patients (20% at both months 6 and 12) compared with biologic‐naïve patients (25% at month 6, 30% at month 12). The rate of complete skin clearance decreased as the number of prior biologics and baseline comorbidities increased. Conclusion Only one in four patients achieved complete skin clearance after 6 months of treatment with biologics. The study indicates there still is an unmet need for more efficacious biologics for patients with psoriasis.

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Background: Real-life data often highlight the side effects of certain drugs not previously reported in randomized controlled trials (RCTs).Objective: To describe cutaneous inflammatory eruptions i...

Background: Information is limited from real-life studies evaluating the efficacy and safety of brodalumab.Research design and methods: In this real-life study, we retrospectively examined a database of 90 patients with moderate-to-severe psoriasis treated with brodalumab (210 mg, s.c.) and followed for 1 year. Disease severity and treatment response were assessed by the Psoriasis Area and Severity Index (PASI) at baseline and after 4, 12, 24, 36, and 48 weeks. Predictors of a PASI response were evaluated by logistic regression.Results: After 48 weeks, 92.2% of patients (mean age 50.2 ± 15 years) treated with brodalumab achieved a PASI score of

Strabismus is a condition preventing foveal alignment in normal gaze. Its effects can have long-standing impacts on physical, psychological, and social health. Multiple treatment options exist for strabismus such as surgery, optical correction, and vision therapy, however, treatment efficacy remains variable with little consensus on long-term impacts. Diplopia is a common side effect of the ocular misalignment secondary to strabismus and its treatment. When defining long-term success of treating strabismus, it is essential that visual sensory perception and binocular fusion has been integrated and remedied. Strabismus is complex and can be challenging to manage. To illustrate this, we report a 67-year-old female who presented with complications from long-term treatment of infantile strabismus. This case highlights differences in historical and contemporary strabismus treatments.

BackgroundPsoriasis (PSO) is a systemic immune-mediated disorder, characterized by inflammation skin and joint manifestations: it is known that up to 30% of PsO patients develop PsA.PsO and PsA share common etiopathogenetic pathways, as IL-23/IL-17 axis. In Italy, Guselkumab (GUS), a selective IL-23 inhibitor, was approved in 2018 for the treatment of PsO, and recently it was also approved for PsA therapy. Today, there are few “real-world” studies regarding the use of GUS in PsA patients.ObjectivesA multicenter Italian study group of dermatologists and rheumatologists aimed at evaluate GUS efficacy and safety in patients with concomitant PsO and PsA in real word setting on both skin and joint domains.MethodsAn observational retrospective, multicentric study was performed in 69 PsO patients with a confirmed diagnosis of moderate to severe PsA. PASI and DLQI were used for the evaluation of skin response, and the number swollen/tender joints, presence or absence of dactylitis or enthesitis or axial involvement and painVAS were evaluated for the articular and periarticular efficacy. These analyses were performed at baseline T0 (beginning of the therapy), T1 (12 weeks) and T2 (24 weeks).Results38/69 patients (55,1%) presented oligoarthritis, 31/69 (44,9%) showed polyarthritis, none of the patients had enthesitis or axial involvement. Moreover, co-morbidities were diagnosed: hypertension (52,2%), hypercholesterolemia (34,8%), Hypertriglyceridemia (29%), diabetes (24,6%), obesity (23,2%), HIV-positive (20,3%), psychiatric disorders (17,4%), cardiopathies (15,9%), inflammatory bowel disease (7,3%), Latent Tubercolosis (4,4%), Chronic B-Hepatitis (2,9%), Chronic C-Hepatitis (1,5%). In all these patients, skin and joint responses were evaluated at week 12 and week 24.Concerning skin efficacy, PASI 90 was achieved at week 24. Concerning Joint response: painVAS progressively improved till T2, tender joint count decreased in patients with oligo and polyarthritis at T1 and maintained at T2, while swollen joint count decreased in polyarthritis patients at T1 and maintained at T2. In oligo-arthritis patients, this parameter was not improved. The number of dactylitis did not decrease during the period of study (see Table 1). No safety concerns were reported in this population.ConclusionEfficacy and safety of GUS was confirmed in this study group of PsO patients with concomitant PsA and several comorbidities in a real-life setting.Disclosure of InterestsNone declared

Background Bariatric surgery (BS) represents the most effective treatment for morbid obesity and its related complications, potentially ameliorating chronic comorbid inflammatory skin conditions, such as psoriasis and hidradenitis suppurativa (HS). Weight-loss interventions are strongly encouraged in patients with HS, but the resulting effect on the course of the disease has been poorly reported. Aim To describe the effect of BS-associated weight-loss on the course of HS. Methods This was a retrospective, descriptive study of a hospital-based patient cohort with HS in order to investigate the relationship between exposure to a BS procedure and the HS disease course. Clinical characteristics and BS-related outcomes were retrospectively analysed by chart review for identified cases. Laboratory parameters for selected micronutrients (levels of vitamin A, D and B12, plus zinc and iron) were re-evaluated at a follow-up visit in each post-BS case. Typical patients with HS from the general cohort served as controls for the comparison of vitamin D and zinc serum levels. Results Of 178 patients with HS, 12 patients with incident HS who had undergone a BS procedure were identified. A subset of patients (n = 10) developed initial signs and symptoms of cutaneous suppuration after experiencing weight loss related to malabsorptive bariatric procedures. Post-BS patients with HS presented multiple micronutritional deficiencies and insufficient responses to standard, first-line antibiotic treatments. Of the micronutrients we selected for analysis, zinc was found to be at significantly lower serum levels in post-BS patients with HS compared with typical patients with HS. Conclusions Post-BS HS may represent a new patient subset, requiring customized clinical management.

Background Psoriatic arthritis (PsA) is a chronic inflammatory disease associated with psoriasis (PsO). Early diagnosis and prompt therapeutic intervention are crucial for limiting PsA progression and prevention of disability. Dermatologists are in a privileged position to detect early PsA. The management of patients with PsA in the dermatology setting is widely variable. Objective To provide practical recommendations for the management of patients with PsA in the dermatology setting including early diagnosis and treatment. Methods A consensus document was written by an expert panel composed by dermatologists (n = 12) and rheumatologists (n = 6). Eleven highly relevant questions were selected and elaborated with answers/statements based on a narrative literature review. The resulting document was discussed in a face-to-face meeting adopting a nominal group technique to reach consensus (i.e. 100% agreement) using the Delphi method. Results A consensus was achieved in defining the following: the clinical characteristics differentiating inflammatory and non-inflammatory signs and symptoms of joint disease; the most important differential diagnoses of PsA in clinical practice; the most useful screening questionnaires, serum laboratory tests and imaging techniques for the detection of early PsA; the criteria for dermatologist to refer patients with PsO to rheumatologist; the criteria for the diagnosis of PsA; the selection of the indices that the dermatologist could use for measuring the activity and severity of PsA in clinical practice; when systemic steroids and/or intra-articular steroid injections are indicated in the treatment of PsA. Finally, systemic treatments including synthetic and biologic disease-modifying antirheumatic drugs to be considered for the treatment of PsA have been reported. Conclusions The implementations of these practical recommendations could be very helpful for the management of patients with PsA in the dermatology setting including early diagnosis and treatment.

Linear IgA bullous dermatosis (LABD) is characterized by presence of multiple IgA autoantibodies, and a comparatively lesser number of IgG antibodies, directed against different hemidesmosomal antigens. The main autoantigens are LAD-1, LABD-97, BP180 and BP230, type VII collagen and laminin 332. We retrospectively studied the serology of 54 Italian patients with LABD using enzyme-linked immunosorbent assay (ELISA), immunoblotting assay, and indirect immunofluorescence on monkey oesophagus and salt-split skin. Among these, indirect immunofluorescence of salt-split skin elicits the greatest sensitivity. Sixty-three percent of the sera were observed to be positive, with a lamina lucida pattern observed in 48%, a sub-lamina densa pattern in 2% and a mixed pattern in 13% of the cases. IgA reactivity to LAD-1 on immunoblotting was found in 52% of sera, to BP180-NC16A by ELISA in 32% and to BP230 in 26%. Only 17% of patients possessed circulating IgG autoantibodies. LAD-1 was determined to be a major autoantigen of the lamina lucida subtype. Combined serological assays demonstrated a high sensitivity (82%), suggesting that this approach could support diagnosis when a biopsy is not feasible or direct immunofluorescence results are negative.

The coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, is creating an unprecedented global public health emergency with the continuous growth of infected individuals worldwide. Italy was one of the first European country to face the first wave of infection outside mainland China. The first case of COVID-19 was confirmed in Lombardy on February 20th , 2020, and subsequently, a rapid increase in the number of detected cases was observed, spreading through Italy and the rest of Europe.3 As of April 22nd , confirmed COVID-19 cases in Italy were 183,957.

BACKGROUND: Certolizumab, a pegylated tumour necrosis factor-α inhibitor, reduced disease activity in randomised trials of patients with psoriasis and psoriatic arthritis. Real-life data are missing. OBJECTIVE: To confirm the effectiveness and safety of certolizumab in patients with psoriasis and psoriatic arthritis in routine clinical practice. METHODS: In this retrospective study involving 11 Italian sites, patients with psoriasis and psoriatic arthritis received subcutaneous certolizumab (400 mg loading dose at 0, 2 and 4 weeks, followed by 200 mg every 2 weeks) for up to 52 weeks. Primary outcomes included mean change from baseline in Psoriasis Area and Severity Index (PASI) and modified Nail Psoriasis Severity Index (mNAPSI) scores, and the proportion of patients achieving a 75%, 90% or 100% reduction in PASI score. Other endpoints included Disease Activity Score computed on 44 joints correlated to the erythrocyte sedimentation rate during the first hour (DAS44-ESR), Tender Joint Count (TJC), Swollen Joint Count (SJC), pain (visual analogue scale [VAS] score), inflammatory markers and quality of life (QOL). RESULTS: In the study were enrolled 153 patients (mean age: 55 years). Certolizumab reduced the mean PASI score from baseline by 4.45, 6.30 and 7.58 at weeks 12, 24 and 52, respectively (p

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There is strong evidence that obesity is closely associated with psoriasis. However, data on body composition are lacking in psoriasis. The purpose of this study were to investigate the body composition in psoriasis patients using bioelectrical impedance analysis and to correlate the bioelectrical impedance data with disease severity and laboratory parameters.Anthropometric measurements and bioelectrical impedance analyses were performed on patients with psoriasis, naïve to any systemic treatment, who attended the outpatient clinics of two University centers.Data of 164 adult patients were analyzed. Compared to men, women had several significantly higher bioelectrical impedance parameters including reactance, fat mass% and adipose tissue%. The values of adipose tissue were positively correlated only with patients age (p = .021) and age at disease onset (p = .0006), but not with disease severity. In addition, we observed that the use of BMI cutoffs allowed to categorize 36.7% of women and 19.2% of men as obese, while fat mass% showed that 53.3% of women and 48.1% of men were obese.In our study, psoriasis is been associated with a high fat mass%. We suggest that screening for body fat distribution in psoriatic patients might be useful to identify early obesity-related disease.

Background The assessment of joint disease in psoriasis (PsO) patients is paramount, particularly where consensus among dermatology and rheumatology specialists is necessary. Objectives To evaluate the prevalence of psoriatic arthritis (PsA) in PsO patients and assess how a novel 16-item visual instrument (PsA-Disk) correlates with the disease and its clinical manifestations. Methods Data were prospectively collected from 8 dermatological/rheumatological centres across Italy. During their first dermatological visit, patients completed both PEST (Psoriasis Epidemiology Screening Tool) and PsA-disk questionnaires. Rheumatological visit was performed in order to confirm presence/absence of PsA. Clinimetric and disease activity variables were recorded. Results From a total of 239 PsO patients, 120 (50.2%) patients were diagnosed with PsA. More PsA-positive patients had nail PsO (54.2% vs. 42%, p=0.05) and a PEST score ≥3 vs. PsA-negative patients (77.5% vs. 37.8%, p Conclusions PsA-Disk is a novel instrument helping both dermatologist and rheumatologist in the rapid assessment PsA, facilitating in the timely therapeutic management of these patients. Disclosure of Interest None declared

Enhanced photoluminescence (PL) in a tellurite glass (TeO2–ZnO) doped with erbium ions (Er3+) and containing silicon nanocrystals (Si-NCs) is reported. The PL increase is mainly attributed to energy transfer from excited Si-NCs to the Er3+ located in the vicinity of the nanocrystals although the contribution of active defects in the glass cannot be completely excluded. Enhancement of ≈300 % was observed in the visible and in the near-infrared regions. In particular, the fourfold enhancement observed for the broad emission centered at ≈1530 nm, corresponding to the Er3+ transition 4I3/2 → 4I15/2, indicates large potential of the composite material for interface with existing telecommunication devices.

Background and Aims Varietal thiols, important odorous molecules in wine, have been identified in Vitis vinifera L. grapes as S-cysteinylated and S-glutathionylated odourless precursors. The aim of this paper is to investigate the presence of these precursor compounds during ripening of two Italian white grape cultivars, Grechetto and Malvasia del Lazio, in comparison with the well-characterised, reference cultivar Sauvignon Blanc. Methods and Results Grapes were sampled and sorted according to density in order to obtain homogeneous samples at the TSS concentration of 16, 19 and 22°Brix, as a synthetic index of ripening stage. After sorting and processing the grapes, the concentration of thiol precursors contained in each sample of juice was determined by liquid chromatography-quadrupole MS. For the first time, S-3-(4-sulfanyl-4-methylpentan-2-ol)-glutathione was identified and quantified in the three cultivars as a glutathione-conjugated precursor. Both S-cysteinylated and S-glutathionylated precursors were ubiquitous in the three cultivars, although their concentration varied significantly. Conclusion Thiol precursors increased with TSS during ripening in Sauvignon Blanc and Grechetto, while no variation of these odourless compounds was observed in Malvasia del Lazio, which also had a lower concentration of these precursors. Significance of the Study This work contributes to defining the significance of these precursors to the varietal attributes of the resulting wines, as well as indicating the optimal harvest time of grapes for maximal expression of thiol varietal attributes in wine.

BACKGROUND: Anti-nuclear antibodies (ANA), anti-extractable nuclear antigens (ENA) and anti-dsDNA antibodies are often associated with cutaneous lupus erythematosus (CLE), with variable frequency depending on skin subtype. However, specific data based on large case-series on the pathogenetic, diagnostic and prognostic meaning of such autoantibodies are still lacking. OBJECTIVE: To characterize the correlations between CLE subtypes as well as LE-non-specific skin lesions and their autoantibody pattern. METHODS: Epidemiological, clinical and immunopathological data of 619 Italian patients with CLE and LE-non-specific skin lesions were analysed. Differences in age, sex, clinical features and autoantibody profile were evaluated in each LE subgroup. RESULTS: Anti-nuclear antibodies (P < 0.0001), anti-dsDNA (P < 0.0001), ENA (P = 0.001), anti-Sm (P = 0.001), anti-RNP (P = 0.004) and anti-histone (P = 0.005) antibodies were associated with SLE. A strong association between ANA (P < 0.0001) and anti-dsDNA (P < 0.0001) and female gender was also found: positive ANA and positive anti-dsDNA had a higher prevalence among females. Chronic CLE resulted to be negatively associated with ENA (OR = 0.51, P < 0.0001), anti-Ro/SSA (OR = 0.49, P < 0.0001) and anti-dsDNA (OR = 0.37, P < 0.0001). Intermittent CLE resulted to be negatively associated with ENA (OR = 0.50, P = 0.007) and ANA (OR = 0.61, P = 0.025). Subacute CLE resulted to be associated with ENA (OR = 5.19, P < 0.0001), anti-Ro/SSA (OR = 3.83, P < 0.0001), anti-Smith (OR = 2.95, P = 0.004) and anti-RNP (OR = 3.18, P = 0.007). Acute CLE resulted to be strongly associated with anti-dsDNA (OR = 6.0, P < 0.0001) and ANA (OR = 18.1, P < 0.0001). LE-non-specific skin lesions resulted to be significantly associated with systemic involvement. Livedo reticularis was significantly associated with ENA (P = 0.007) and anti-Ro/SSA (P = 0.036). Palpable purpura and periungual telangiectasia were significantly associated with ANA. CONCLUSION: According to our findings, some well-known associations between CLE subtypes and autoantibody profile were confirmed; moreover, specific association between autoantibodies and LE-non-specific skin lesions was highlighted. A strict association between anti-ENA and anti-Ro/SSA antibodies and livedo reticularis, ANA and palpable purpura, and ANA and periungual telangiectasia was evidenced.

We report the case of a 32-year-old male with Chlamydia trachomatis infection and admitted with chest pain, signs of myocardial damage and coronary arteries free from significant atherosclerotic disease. Cardiac magnetic resonance imaging (MRI) documented imaging patterns of myocardial involvement suggestive of acute myocarditis, and repeated cardiac MRI examinations were used to define appropriate clinical management of the patient. In particular, the decision to submit the patient to an additional antibiotic course was based on evidence of persisting myocardial edema, while no further treatments were prescribed once these imaging findings disappeared. The case emphasizes the potential value of cardiac MRI as the only non-invasive modality currently available for evaluating the temporal evolution of myocardial involvement after acute myocarditis.

Summary Background Chronic plaque psoriasis is frequently associated with metabolic disorders including obesity. Antitumour necrosis factor α treatments can induce body-weight increase in patients with psoriasis. Information on the effect of ustekinumab on body weight is not available. Objectives To investigate whether therapy with ustekinumab is associated with changes in body mass index (BMI) in patients with chronic plaque psoriasis. Methods A prospective, multicentre study comparing the changes in BMI in two closed cohorts of patients with psoriasis during 7-month treatment with ustekinumab (n = 79) or infliximab (n = 83). Results Patients treated for 7 months with infliximab showed a significant (P 2%, compared with only 11% of those receiving ustekinumab (P = 0·01). In the multivariate analysis, all other clinical parameters predicted the BMI increase, except for the use of infliximab. At month 7, 96% of patients treated with infliximab and 82% of patients treated with ustekinumab achieved at least a 50% improvement from their baseline psoriasis area and severity index (PASI 50), and 69% of the infliximab group compared with 58% of the ustekinumab group achieved at least PASI 75. There was no difference in the proportion of PASI 50 and PASI 75 responders between the two groups. Conclusions In contrast to infliximab, ustekinumab does not increase BMI in patients with chronic plaque psoriasis. This difference could be taken into account in the selection of biologics when treating patients with psoriasis.

The influence of halogen atom substitution (Br and I), in different amounts and positions in an aza-BODIPY skeleton, on the photophysical properties of some aza-BODIPY derivatives has been investigated by using density functional theory and its time-dependent extension. The heavy atom effect on excitation energies, singlet–triplet energy gaps and spin–orbit matrix elements has been considered. The maximum absorption within the therapeutic window has been confirmed for all the aza-BODIPY derivatives. The feasible intersystem spin crossing pathways for the population of the lowest triplet state, that will depend on the values of the spin–orbit matrix elements, the energy gap as well as the orbital composition of the involved states have been found to most likely involve the S1 and T1 or T2 states. The outcomes of computations support the potential therapeutic use of these compounds as photosensitizers in photodynamic therapy.

Psoriasis is a common disease, which has a considerable impact on the healthcare system. Therefore, appropriate use of therapeutic resources is very important. Management of psoriasis in daily clinical practice is highly variable because many issues are still debated and not definitely addressed by the evidence-based medicine. Moreover, the different availability and reimbursability of drugs in each country justifies national guidelines. Expert consensus can provide helpful guidelines for optimizing patient care. A total of 20 dermatologists from different areas of Italy and with large experience in the treatment of psoriasis agreed to participate in the guidelines expert panel who aimed to reach consensus on the factors influencing psoriasis severity, the indications for systemic treatments, the parameters to be considered in the choice of treatment, and the factors to be considered in the choice of biological treatment. The recommendations for the use, screening and monitoring of systemic therapies were based on the 2015 S3 European Dermatology Forum/European Academy of Dermatology and Venereology psoriasis guidelines. Recommendations on the treatment of psoriasis in special patient populations were also agreed. The final document was discussed in a meeting moderated by a facilitator with participation of the entire group and adopting a nominal group technique to reach consensus. A statement was regarded as consented when agreement was achieved by at least 75% of the voting experts according to the Delphi procedure.

Background Despite recent advances in the treatment of psoriasis, the therapeutic options for nail psoriasis are very limited, particularly when this is the only manifestation of the disease. Objective We performed a randomized controlled open-label study to assess the efficacy and safety of a topical treatment with tacrolimus 0.1% ointment in nail psoriasis. Methods In each patient, tacrolimus 0.1% ointment was prescribed for application only on the affected nails of a randomly selected hand for 12 weeks, whereas nails of the other hand did not receive any treatment. Severity of nail psoriasis was evaluated using the Nail Psoriasis Severity Index (NAPSI) score. Results We enrolled 21 consecutive psoriatic patients. At week 12, a statistically significant (P

Etanercept is a fusion protein of soluble TNF receptor type II with human IgG Fc fragment, whose use was approved for psoriasis by the FDA and by the EMEA. It neutralizes the proinflammatory effects of TNF-α, a cytokine with a pivotal role in the pathogenesis of psoriasis, preventing binding to its receptors. The aim of our study was to review the emerging evidence of the therapeutic value of etanercept in the treatment of psoriasis. We found that since its approval, several randomised clinical trials have shown its efficacy in the short and long-term, both in a continuous and interrupted course of therapy. Data deriving from these studies have also suggested an acceptable safety profile, as found also in studies conducted on its use in other autoimmune diseases. Etanercept also seems to be efficacious and safe when administered in a combined treatment with other traditional medications and after switching from another biological drug. Moreover, despite its high costs it does seem to be a cost-effective treatment.