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Background: Atopic dermatitis (AD) is a chronic inflammatory skin condition that significantly impairs the quality of life. Recent advancements in systemic therapies, such as Janus kinase (JAK) inhibitors, offer very effective new treatment options. However, concerns regarding potential adverse events, including cardiovascular and thromboembolic risk, have emerged from clinical studies and call for further real-life investigations. This has highlighted the need to establish specific risk categories, such as tobacco smokers., Objective: This study aims to evaluate the safety and effectiveness of upadacitinib, a JAK1 inhibitor, in patients who smoke with moderate-to-severe AD over a 2-year treatment period, comparing outcomes with patients who do not smoke., Patients and Methods: A retrospective multicenter study was conducted across 12 dermatology departments in Italy, including 375 patients treated with upadacitinib. The presence and intensity of smoking habits as well as effectiveness scores and safety data were collected., Results: Patients who smoke accounted for 36.8% of the sample. Two thromboembolic events in patients who do not smoke were recorded in the 2-year (median follow up of 52.6 weeks) observation period. The most common adverse event was acneiform eruption (12.4% of patients after 104 weeks). No significant differences related to safety emerged regarding the presence or absence of a smoking habit. Drug survival was very high with no differences between the two cohorts (83.5% after 104 weeks for patients who smoke)., Conclusions: This study suggests that upadacitinib is a safe and effective treatment for moderate-to-severe AD in presence of tobacco smoke, with no significant differences in safety or effectiveness compared with patients who do not smoke., Competing Interests: Declarations. Funding: This research received no external funding. Conflicts of Interest: Francesca Barei has acted as speaker and/or consultant for LeoPharma and Almirall. Anna Balato has served on scientific boards and/or has received fees for scientific consultations from: Abbvie, Amgen, Boehringer Ingelheim, Janssen, Eli‐Lilly, Novartis, and UCB. Andrea Chiricozzi has served as advisory board member and consultant and has received fees and speaker’s honoraria or has participated in clinical trials for AbbVie, Almirall, Bristol Myers Squibb, LeoPharma, Lilly, Janssen, Novartis, Pfizer, and Sanofi Genzyme. Silvia Mariel Ferrucci was a principal investigator in clinical trials for AbbVie, Almirall, Galderma, Leo Pharma, Sanofi, Amgen, Novartis, and Bayer and received honoraria for lectures from Novartis and Menarini. Caterina Foti has received personal fees from Abbvie, Sanofi, Eli-Lilly, Novartis, LeoPharma, Amgen, Boehringer-Ingelheim, Incyte, Pfizer, and Almirall. Luigi Gargiulo has been a consultant and/or speaker and has participated in advisory boards for Abbvie, Almirall, Eli Lilly, Pfizer, Sanofi, and UCB Pharma. Marco Galluzzo has acted as speaker and/or consultant for AbbVie, Almirall, Eli-Lilly, Janssen-Cilag, LeoPharma, Novartis, and Sanofi, outside of the submitted work. Giampiero Girolomoni has received personal fees from AbbVie, Almirall, Amgen, Boehringer-Ingelheim, Bristol-Myers Squibb, Eli-Lilly, Leo Pharma, Merck Serono, Novartis, Pfizer, Pierre Fabre, Samsung bioepis, and Sanofi. Niccolò Gori has served on advisory boards and received honoraria for speaking engagements for AbbVie, Sanofi, Leo-Pharma, Almirall, Pfizer, and Lilly. Mario Bruno Guanti has acted as speaker and/or consultant for AbbVie, Leopharma, Sanofi, Menarini, Lilly, and Almirall. Francesco Leo has no conflicts of interest to declare. Angelo Valerio Marzano reports consultancy/advisory boards disease-relevant honoraria fees from AbbVie, Amgen, Boehringer-Ingelheim, Bristol Myers Squibb, Incyte, Leopharma, Novartis, Pfizer, Sanofi, and UCB. Luca Mastorino has been a consultant and/or speaker and has participated in advisory boards for Accord, Avène, LeoPharma, and Almirall Maddalena Napolitano reports consulting fees from Abbvie, Lilly, LEO Pharma, Almirall, Sanofi; payment/honoraria from Abbvie, Lilly, LEO Pharma, Almirall, and Sanofi; and participation on data safety monitoring boards/advisory boards from Lilly, Sanofi, LEO Pharma, Abbvie, and Almirall; and support for attending meetings/travel from Lilly. Alessandra Narcisi has served on advisory boards or received honoraria for lectures and research grants from Almirall, Abbvie, Leo Pharma, Celgene, Eli-Lilly, Janssen, Novartis, Sanofi‐Genzyme, Amgen and Boehringer Ingelheim. Michela Ortoncelli has acted as a speaker and/or consultant for AbbVie, Novartis, Sanofi, LeoPharma, Almirall, and Eli-Lilly. Cataldo Patruno has served as an advisory board member and consultant and has received speaker’s honoraria and fees for her participation in clinical trials for Abbvie, Almirall, Eli‐Lilly, LeoPharma, and Novartis. Elena Pezzolo has been a consultant and speaker for Sanofi Genzyme, AbbVie, LeoPharma, Novartis, Janssen, Almirall, Pfizer, Galderma, and Boehringer Ingelheim. Simone Ribero has acted as a speaker and/or consultant for AbbVie, Almirall, Boehringer-Ingelheim, Bristol-Myers Squibb, Eli-Lilly, J&J, L’Oreal, LeoPharma, Novartis, Pfizer, Pierre Fabre, and Sanofi. Mariateresa Rossi has been a consultant and/or speaker, has participated in advisory boards, and received honoraria for lectures for Abbvie, Almirall, Eli Lilly, Pfizer, Sanofi, and LeoPharma. Ethics Approval: The study was conducted in accordance with the Declaration of Helsinki and approved by the Ethics Committee of the Department of Medicine at the University of Turin, with ethics committee approval number: 0006349 (18 January 2024). Consent for Participation and Publication: Informed consent was provided by all subjects and parents involved in the study, for both participation and publication. Data Availability:: Data will be made available on reasonable request. Code Availability:: Not applicable. Author Contributions: All authors contributed to the study conception and design. Material preparation and data collection were performed by all authors. Data analyses were performed by Luca Mastorino. The first draft of the manuscript was written by Francesco Leo, Luca Mastorino, Michela Ortoncelli, and Simone Ribero, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript., (© 2025. The Author(s).)

Competing Interests: Conflicts of interest: S.M.F. is principal investigator in clinical trial to Amgen, Sanofi, Novartis, Lilly, Leo Pharma and AbbVie, and she is advisory board or speaker to Novartis, Menarini, Sanofi, AbbVie and Leo Pharma. F.B. has a conflict of interest with Leo Pharma and Almirall. The other authors declare no conflicts of interest.

Introduction: Currently, limited data are available on long-term use of dupilumab to treat atopic dermatitis (AD) in a multinational real-world setting. The aim of this analysis was to report the interim 1-year data for patients with AD enrolled in the GLOBOSTAD registry, including treatment patterns, dupilumab effectiveness and safety, and healthcare burden., Methods: GLOBOSTAD is an ongoing, 5-year, multinational, prospective, observational study of adult/adolescent (aged ≥ 12 years at baseline) patients with AD who initiated dupilumab in real-world settings according to their local country-specific prescribing guidelines. Outcomes were evaluated at baseline and at 3, 6 and 12 months and included Eczema Area and Severity Index (EASI) total score, SCORing Atopic Dermatitis (SCORAD) total score, percent body surface area (BSA) affected, Patient-Oriented Eczema Measure (POEM), Dermatology Life Quality Index (DLQI) total score for adults or Children's Dermatology Life Quality Index (CDLQI) total score for adolescents and pruritus Numeric Rating Scale (NRS) total score., Results: At the interim 1-year cut-off (March 2023), 955 patients were enrolled in GLOBOSTAD, and follow-up data were obtained from 903 patients. After dupilumab initiation, mean improvements in effectiveness outcome measures from baseline to month 3 were EASI from 25.1 to 6.1, SCORAD 59.3 to 25.3, POEM 19.7 to 8.7, DLQI 13.7 to 5.3, CDLQI 12.2 to 2.7 and pruritus NRS 6.3 to 2.5, with each measure exceeding the minimal clinically important difference. These positive changes in effectiveness outcomes were maintained or further improved through 12 months since treatment initiation. AD-related hospitalizations and emergency room or urgent care facility visits decreased from 11.1% to 1.7% from baseline to month 12., Conclusions: In a multinational real-world setting, dupilumab demonstrated rapid, robust and sustained effectiveness in patients with moderate-to-severe AD across multiple disease domains, including AD signs, symptoms, quality of life and emergency/urgent care visits. Safety was consistent with the known dupilumab safety profile., Clinical Trial Registration: ClinicalTrials.gov Identifier NCT03992417., Competing Interests: Declarations. Conflict of Interest: P. Calzavara-Pinton is an advisory board member for AbbVie, Almirall, Galderma, LEO Pharma, Meda, and Sanofi. C-Y. Chu is an investigator for AbbVie, Dermira, Eli Lilly, Novartis, Oneness Biotech, Pfizer, Regeneron Pharmaceuticals Inc., Roche, and Sanofi; a consultant for AbbVie, Eli Lilly, Novartis, Pfizer, Roche, and Sanofi; a speaker for AbbVie, Eli Lilly, Mylan, Novartis, Pfizer, Roche, Sanofi, and Viatris; and an advisory board member for Mylan, Pfizer, Roche, and Sanofi. Hilde Lapeere is on the advisory boards of AbbVie, LEO Pharma, Eli Lilly, Pfizer, and Sanofi. M. Rossi is a speaker for AbbVie, Galderma, La Roche-Posay, LEO Pharma, Pfizer, and Sanofi. S.M. Ferrucci is an advisory board member for AbbVie, Eli Lilly, and Sanofi; a principal Investigator for Almirall, Menarini, and Pfizer; and reports honoraria for lectures and research grants from Novartis. W-H. Chung has nothing to disclose. A-C. Fougerousse is a consultant for AbbVie, Galderma, LEO Pharma, Lilly, and Sanofi; and a consultant for AbbVie, Eli Lilly, and Sanofi. D.S. Fomina reports honoraria from CSL Behring, Novartis, Sanofi, and Shire. G. Holzer is an advisory board member for AbbVie, Almirall, Eli Lilly, Galderma, LEO Pharma, and Sanofi. J. Čelakovská has nothing to disclose. M. Al-Ahmad is an advisory board member and speaker for AstraZeneca, GSK, and Novartis. T. Tzellos has received honoraria from and is an advisory board member and speaker for AbbVie; and has received honoraria from and is an advisory board member for Boehringer Ingelheim and Sanofi. J. Wu is an employee of Sanofi, and may hold stock and/or stock options in the company. M. Ardeleanu is an employee and shareholder of Regeneron Pharmaceuticals Inc. K. Bosman is an employee and shareholder of Sanofi. Ethical Approval: The study was conducted in accordance with the Declaration of Helsinki, the International Conference on Harmonisation Good Clinical Practice guideline and applicable regulatory requirements. The local institutional review board or ethics committee at each study center oversaw trial conduct and documentation. All patients, or their parents/guardians, provided written informed consent before participating in the trial. Pediatric patients provided assent according to the ethics committee (institutional review board/independent ethics committee)-approved standard practice for pediatric patients at each participating center., (© 2024. The Author(s).)

Atopic dermatitis (AD) is a chronic, relapsing inflammatory skin condition that can have a negative impact on a patient's quality of life. Long-term effectiveness is required to manage the symptoms of AD (skin inflammation, eczematous lesions, and itching). Because some of the systemic immunosuppressants used to treat AD have been associated with serious adverse events (AEs), other safer, more effective options, including dupilumab, have been proven effective long-term for treatment of adult and adolescent patients with moderate-to-severe AD. The long-term safety and effectiveness of a drug are usually confirmed in real-world studies by evaluating its performance over time. Measures such as drug survival, drug retention, drug persistence, or retention rates reflect whether treatment may be considered as satisfactory by both patients and physicians, meeting key clinical needs. This review aimed to describe the survival, retention, or persistence of dupilumab therapy in adults and adolescents with moderate-to-severe AD by conducting a PubMed search in March 2023 and screening for relevant publications. Globally, real-world studies with dupilumab have regularly reported high drug survival rates after 1, 2, and 3 years of observation, being consistently at 80-90%, with low rates of treatment discontinuation due to lack of efficacy or AEs. These findings are notably higher than 1- and 2-year drug survival rates of systemic immunosuppressants (including cyclosporine [37% and 20%, respectively] and methotrexate [41% and 33%, respectively]). Overall, real-world data on drug survival have confirmed that dupilumab provides long-term sustained efficacy and acceptable safety in patients with moderate-to-severe AD., Competing Interests: Declarations. Conflict of Interest: Mariateresa Rossi is a consultant, advisory board member, and speaker for Sanofi, Leo Pharma, AbbVie, Pfizer, and L’Oréal. Silvia M. Ferrucci was a principal investigator in clinical trials for AbbVie, Almirall, Galderma, Leo Pharma, Sanofi, Amgen, Novartis, and Bayer; and received honoraria for lectures from Novartis and Menarini. Piergiacomo Calzavara-Pinton has received personal fees as a consultant, advisory board member, and/or speaker from AbbVie, Boehringer Ingelheim, Leo Pharma, Janssen, Lilly, Novartis, Pfizer, Cantabria, Molteni Farmaceutici, Galderma, La Roche Posay, Naos, Incyte, Celgene, and Sanofi, outside the present work. Angelo V. Marzano is on consultancy/advisory boards and received disease-relevant honoraria from AbbVie, Boehringer Ingelheim, Novartis, Pfizer, Sanofi, and UCB. Ketty Peris has received honoraria for advisory board and grants from AbbVie, Almirall, Biogen Celgene, Galderma, Leo Pharma, Lilly, Janssen, Novartis, Sanofi, and Sun Pharma, outside the submitted work. Elena Nicoli and Devis Moretti are employees of Sanofi and may hold shares and/or stock options in the company. Andrea Chiricozzi has received personal fees as a consultant, advisory board member, and/or speaker from AbbVie, Boehringer Ingelheim, Leo Pharma, Janssen, Lilly, Novartis, Pfizer, and Sanofi. Ethical Approval: This article is based on previously conducted studies and does not contain any new studies with human participants or animals performed by any of the authors., (© 2024. The Author(s).)

Introduction: Chronic hand eczema (CHE) is an inflammatory skin condition characterized by different pathomechanisms, clinical presentations, and prognoses. Treatment is often challenging because of limited approved drugs, and severe CHE is associated with reduced quality of life (QoL) and poor overall health measures in terms of psychological, functional, and occupational challenges. This study aims to describe the real-life management practices of Italian dermatologists who frequently treat patients with CHE, compare these practices with existing guidelines, and propose practical clinical recommendations for the management of these patients., Methods: An 11-question survey was administered to 14 participating dermatologists to gather their insights on the diagnosis, treatment, and management of CHE. Moreover, a comprehensive literature search was conducted over the previous 10 years as a starting point for discussion among experts., Results: CHE was the reason for 6.9% of dermatological consultations by the 14 experts. Median time to CHE diagnosis was 12 (range: 2-24) months. Fissuring and itching (85.7% for both) were the most frequently reported signs and symptoms of CHE. The survey highlighted the need for long-term treatment that is effective and well tolerated, with experts emphasizing the importance of improving disease awareness among physicians and patients. Practical clinical approaches were proposed, emphasizing the significance of a thorough medical history and identification of symptoms in the management of CHE. Experts advocated for specifically developed CHE treatment approaches, concentrating on alleviating symptoms and signs, minimizing adverse events/safety issues, enhancing the QoL of patients, and long-term disease control. Findings from this survey were further discussed and compared to recommendations of the available guidelines for the management of CHE., Conclusions: Managing CHE requires a comprehensive approach that considers both objective clinical factors and subjective patient expectations. Experts emphasized the need for effective and well-tolerated long-term therapies, improved disease awareness, and communication among physicians and patients., Competing Interests: Declarations. Conflict of Interest: The authors disclose the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: Luca Stingeni has acted as Principal Investigator, speaker, and board member for AbbVie, Almirall, Amgen, Bristol Meyer Squibb, Eli Lilly, Janssen, Leo Pharma, Novartis and Sanofi. Maria Concetta Fargnoli has served on advisory boards, received honoraria for lectures and/or research grants from Amgen, Almirall, AbbVie, Boehringer-Ingelheim, BMS, Galderma, Kyowa Kyrin, Incyte, Leo Pharma, Pierre Fabre, UCB, Lilly, Pfizer, Janssen, MSD, Novartis, Sanofi, Regeneron and Sun Pharma. Fabrizio Guarneri has served as advisory board member for Leo Pharma. Anna Balato has served as advisory board member, consultant and/or has received fees, speakers’ honoraria or has participated in clinical trials for AbbVie, Almirall, Amgen, Boehringer-Ingelheim, BMS, LeoPharma, Eli Lilly, Incyte, Janssen, Novartis, Sanofi and UCB. Monica Corazza has acted as Principal Investigator, speaker, and board member for AbbVie, Almirall, Amgen, Janssen, Leo Pharma, Novartis and Sanofi. Anna Belloni Fortina has participated in advisory boards, acted as consultant and/or received fees from AbbVie, Amgen, Almirall, Sanofi Genzyme, Leo Pharma, Eli Lilly, Pfizer, Unifarco and Novartis. Piergiacomo Calzavara-Pinton served as advisory board member and consultant and has received fees and speakers’ honoraria or has participated in clinical trials for AbbVie, Almirall, Leo Pharma, Cantabria, Galderma, Incyte, Janssen, Novartis, Biogen, Sanofi Genzyme, La Roche Posay, Naos, Boehringer-Ingelheim and Sun Pharma. Antonio Castanzo has served as advisory board member and consultant and has received fees and speakers’ honoraria or has participated in clinical trials for AbbVie, Almirall, Amgen Leo Pharma, Lilly, Galderma, Incyte, Janssen, Novartis, Sanofi Genzyme, Boehringer-Ingelheim and UCB. Silvia Mariel Ferrucci has acted as Principal Investigator in clinical trials, Speaker and Member of Advisory board for: AbbVie, Amgen, Almirall, Bayer, Sanofi Genzyme, Leo Pharma, Eli Lilly, Pfizer, Unifarco and Novartis. Luigi Naldi has been consultant and speaker for AbbVie, Almirall, Boheringer Ingelheim, Bristol Myers Squibb, Janssen, Leo Pharma, Novartis and Sanofi. Giovanni Pellacani has served as advisory board member, consultant and investigator for: AbbVie, Allergan, Almirall, Amgen, Beiersdorf, Boheringer, Canfield, Difa-Cooper Ifc, Eli Lilly, Galderma, Janssen-Cilag, Krymi, Kyowa-Kirin, Leo Pharma, L’oreal, Mavig, Menarini, Pfizer, Pierre-Fabre, Sanofi, UCB and Viatris. Ketty Peris received grants from: AbbVie, Almirall, Lilly, Novartis and Sanofi; Advisory Board or consulting fees from: AbbVie, Almirall, Biogen, Galderma, Leo Pharma, Lilly, MSD, Pierre Fabre, Sun Pharma, Janssen and Sanofi. Francesca Prignano has served as advisory board member and consultant and has received fees and speaker's honoraria or has participated in clinical trials for AbbVie, Almirall, Leo Pharma, Lilly, Janssen, Novartis, Biogen, Sanofi Genzyme, UCB and Boehringer-Ingelheim. Giampiero Girolomoni has received personal fees from AbbVie, Almirall, Amgen, Boehringer-Ingelheim, Bristol-Myers Squibb, Eli Lilly, Leo Pharma, Merck Serono, Novartis, Pfizer, Pierre Fabre, Samsung Bioepis and Sanofi. Ethical Approval: This article is based on data derived from a survey conducted among dermatologists and previously conducted studies and does not contain any new studies with human participants or animals performed by any of the authors., (© 2024. The Author(s).)

Aim: Abrocitinib is a JAK-1 inhibitor approved for the treatment of moderate-to-severe atopic dermatitis (AD). We conducted a 16-week multicenter retrospective study to assess the short-term effectiveness and safety of abrocitinib in patients with moderate-to-severe AD., Our retrospective study included 85 adult patients from 14 Italian Dermatology Units affected by moderate-to-severe AD treated with abrocitinib 100/200 mg., Methods: Effectiveness of abrocitinib at weeks 4 and 16 was assessed by using the Eczema Area and Severity Index (EASI), the Investigator Global Assessment (IGA), the peak pruritus and sleep- Numerical Rating Scale (PP-NRS and S-NRS, respectively)., Results: At week 16, improvement of at least 90% in EASI (EASI90) and IGA 0/1 was observed in 49.4% and 61.2% of patients, respectively. A reduction of at least 4 points in PP-NRS and S-NRS compared with baseline was achieved by 70.6% of patients for both endpoints. No significant safety reports were observed during the study period. Naïve patients had better rates of EASI 90 compared to patients who previously failed dupilumab. Conclusion: Our data confirm the effectiveness of abrocitinib in a real-world setting with better clinical responses at weeks 4 and 16, compared with Phase-III clinical trials. Longer analyses are required to further establish the safety profile of abrocitinib.

The definition of paradoxical psoriasis (PP) encompasses 2 main scenarios, namely, (i) new-onset psoriasis in patients treated for a different disease and (ii) worsening as well as phenotypical change of pre-existing psoriasis. Originally restricted to the appearance of an untoward psoriasiform reaction under TNF inhibitors, the term has gained new meaning, with the progressive observation of psoriasis-like eruptions also with other medications. Although the conceptual framework of PP has expanded, a molecular and clinicotherapeutic classification is still lacking. In addition, a certain degree of confusion surrounds the correct terminology to indicate these eruptions. In this paper, evidence on the epidemiology, clinical features, pathogenesis, and treatment of PP is reviewed, providing a perspective on possible pathogenesis-driven therapeutic approaches., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Background : Omalizumab, an anti-IgE monoclonal antibody, is an effective treatment for patients with chronic spontaneous urticaria (CSU) resistant to antihistamines, but about 10% are unresponsive. Our aim was to assess the effectiveness, safety, and drug survival (DS) of omalizumab by considering clinical and laboratory characteristics. Methods : We conducted a retrospective study on 296 patients with severe CSU treated with omalizumab. Disease activity, comorbidities, and serum levels of total IgE and anti-thyroid autoantibodies were evaluated over a period of up to 8 years. DS was analyzed using unadjusted Kaplan-Meier survival curves. When applicable, the risk of discontinuation was assessed using Cox regression analysis. Results : Out of 296 patients, 118 (40.4%) were early responders, 72 (25.0%) were late responders, 76 (26.0%) were partial responders, and 25 (8.6%) were non-responders. Early responders were more likely to be patients without associated inducible urticaria ( p = 0.021, χ 2 = 9.692), without autoimmune thyroiditis ( p = 0.007, χ 2 = 12.037), and those with higher IgE levels ( p = 0.039, χ 2 = 8.385). Overall, DS was 53.5% at 8 years, primarily due to clinical remission. DS due to inefficacy and clinical remission were 83.9% and 62.1%, respectively, at 8 years. No patients discontinued omalizumab due to adverse events. Patients with normal IgE levels ( p = 0.012, HR = 4.639, CI: 1.393-15.445) and those with autoimmune thyroiditis ( p = 0.028, HR = 3.316, CI: 1.128-8.718) had a higher risk of discontinuing omalizumab due to inefficacy. Conclusions : This study confirms the long-term effectiveness and safety of omalizumab in the treatment of CSU over a period of up to 8 years. Most patients discontinued omalizumab due to clinical remission, while only 5.1% discontinued it due to ineffectiveness.

Background: Alopecia areata is an autoimmune condition characterized by rapid hair loss in the scalp, eyebrows and eyelashes, for which treatments are limited. Baricitinib, an oral inhibitor of Janus kinases 1 and 2, has been recently approved to treat alopecia areata., Materials and Methods: We conducted a retrospective study involving 23 medical centres across Italy, enrolling patients affected by severe alopecia areata (SALT >50), for more than 6 months. Clinical and trichoscopic assessment was performed at each visit and impact on quality of life, anxiety and depression were evaluated using the Skindex-16 and the Hospital Anxiety and Depression Scale (HADS), respectively., Results: A total of 118 patients were enrolled, with a mean age of 39 years and a mean SALT >95. The mean value of the SALT score decreased from an average of 96.6 (±8.23 sd) to 48 (±35.2 sd) after 24 weeks of treatment and 42.3% of patients achieved a SALT 30, 31.3% a SALT 20 and 20.3% a SALT 10 by Week 24. Trichoscopic signs showed fewer yellow dots and black dots significantly earlier than hair regrowth. Adverse events during the treatment period (mild laboratory test abnormalities) were reported in 12.7% patients. No drop-out were registered., Conclusion: Data on the effectiveness and safety of baricitinib are promising and support the use of this drug in severe forms of AA, also in the early stages. We also suggest performing trichoscopy in order to reveal early response to therapy., (© 2024 European Academy of Dermatology and Venereology.)

Background: There is limited epidemiological evidence on outcomes associated with dupilumab exposure during pregnancy; monitoring pregnancy outcomes in large populations is required., Objective: To investigate the potential association between exposure to dupilumab in pregnant women with atopic dermatitis and any adverse pregnancy, neonatal, congenital and post-partum outcomes., Methods: We performed a multicentre retrospective cohort study across 19 Italian tertiary referral hospital. Childbearing women were eligible if aged 18-49 years and carried out the pregnancy between 1 October 2018 and 1 September 2022., Results: We retrospectively screened records of 5062 patients receiving dupilumab regardless of age and gender, identifying 951 female atopic dermatitis patients of childbearing age, 29 of whom had been exposed to the drug during pregnancy (3%). The median duration of dupilumab treatment prior to conception was 22.5 weeks (range: 3-118). The median time of exposure to the drug during pregnancy was 6 weeks (range: 2-24). All the documented pregnancies were unplanned, and the drug was discontinued in all cases once pregnancy status was reported. The comparison of the study cohort and the control group found no significant drug-associated risk for adverse pregnancy, congenital, neonatal or post-partum outcomes. The absence of a statistically significant effect of exposure on the event was confirmed by bivariate analysis and multivariate analysis adjusted for other confounding factors., Conclusions: This cohort of pregnant patients exposed to dupilumab adds to the existing evidence concerning the safety of biologic agents in pregnancy. No safety issues were identified regarding the primary outcome assessed. In clinical practice, these data provide reassurance in case of dupilumab exposure during the first trimester. However, the continuous use of dupilumab throughout pregnancy warrants further research., (© 2024 European Academy of Dermatology and Venereology.)

Background : Dupilumab is a monoclonal antibody used for the treatment of moderate/severe atopic dermatitis (AD). In recent years, several studies have confirmed the positive association between AD and overweight/obesity, and a report demonstrated the effect of weight reduction on the improvement of AD symptoms. Methods : The weight of 170 patients under treatment with dupilumab was recorded at baseline and after 48 weeks (T48). Clinical monitoring was mainly conducted using the Eczema Area and Severity Index (EASI). The study aimed to assess a possible correlation between the clinical outcome of dupilumab therapy and BMI. Results : Although not statistically significant, patients with a BMI < 25 have a higher EASI percentage improvement than patients with a BMI ≥ 25 at any time point, and the percentage of overweight and obese patients that does not reach EASI-75 at T48 is higher compared to normal-weight patients (13.5% vs. 5.9%). Despite this, in the multivariate regression analysis, no baseline characteristic, including BMI, appears to increase the risk of not reaching EASI-75. In addition, the results show no differences in BMI between baseline and T48 in any age/sex group. Conclusions : The results suggest that overweight and obese patients have a lower response to dupilumab when considering the EASI score, but this difference does not appear to be clinically significant. Furthermore, dupilumab treatment does not seem to impact weight.

Atopic dermatitis (AD) is a highly heterogeneous chronic inflammatory skin disorder that is frequently associated with a plethora of comorbidities. AD is, therefore, considered a systemic disease impacted by a considerable burden and leading to poor quality of life, especially in patients with moderate-to-severe disease. Since atopic and non-atopic comorbidities can further worsen the disease course, accurate establishment of the patient's individual intrinsic risk profile and needs is crucial and may help in guiding the selection of the best treatment option. Better quality of care for patients with AD can be delivered through a multidisciplinary team led by a dermatologist, for comprehensive patient management. The implementation of a multidisciplinary approach for AD could enhance the delivery of optimised and safe treatments, improve the standard of care and patient outcomes in the short and long term, and prevent or delay the lifelong impact of uncontrolled AD. Understanding the unmet needs, assessing correctly the patient risk profile and enhancing the shared patient-physician decision-making process can lead to disease control and quality-of-life improvement, especially in the context of the introduction of newer treatment for AD. This narrative review is a call for more data to establish standardised patient profiles and multidisciplinary strategies in AD management. In view on the fast-evolving treatments for AD, this review aims at highlighting the importance of a multidisciplinary approach to a comprehensive assessment and holistic care in patients with moderate-to-severe AD., (© 2024. The Author(s).)

Atopic dermatitis (AD) is an inflammatory skin disease. Patients with AD are prone to develop anxiety and mood disorders. Aim of this study is to investigate if treatment with dupilumab may improve mental health status of patients affected by AD. A total of 66 patients with severe AD were included: 24 subjects were candidate or have just started (one month) treatment with dupilumab, and 42 have been in treatment for one year. 25.8%, 30.3%, and 45.5% of the total sample showed, respectively, clinically significant anxiety, depression, and symptoms of Internet addiction. Patients with anxiety symptoms resulted to have more severe AD, more sleep problems ( P  = 0.028), less quality of life ( P  = 0.001), more severe depressive symptoms ( P  < 0.001), to be more frequently women ( P  = 0.016), to be less frequently treated with dupilumab for one year ( P  = 0.025). Similarly, patients with clinically significant depressive symptoms resulted to have more severe AD, more sleep problems ( P  = 0.003), less quality of life ( P  < 0.001), more severe anxiety symptoms ( P  < 0.001), to be less frequently treated with dupilumab for one year ( P  = 0.008). Patients with AD treated for one year with dupilumab showed a better mental health profile in terms of less severe anxiety and depression with respect to their counterparts., (Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc.)

Background: Eyelid dermatitis is a frequent reason of dermatological consultation. Its aetiology is not univocal, being contact dermatitis, both allergic and irritant, the most frequent. The primary sources of allergen exposure include cosmetics, metals, and topical medications, from direct, indirect, or airborne contact., Objectives: To define the frequency of positive patch test reactions to SIDAPA baseline series allergens, to document positive allergens, and to precise the final diagnosis in patients with eyelid involvement., Methods: A total of 8557 consecutive patients from 12 Italian Dermatology Clinics underwent patch testing with SIDAPA baseline series in 2018 and 2019. Patients were divided into two groups: (i) with eyelid involvement with or without other involved sites (E-Group) and (ii) without eyelid involvement (NE-Group). The final diagnosis and the frequency of positive relevant patch test reactions were evaluated., Results: E-Group consisted of 688 patients (females 78.6%, mean age 45.3 years), 8.0% of 8557 consecutively patch-tested patients. The final diagnosis in E-Group was ADC in 42.4%, ICD in 34.2%, and AD in 30.5%. The highest reaction rates were elicited by nickel sulphate and methylchloroisothiazolinone/methylisothiazolinone in both E-Group and NE-Group, even if these allergens were significantly more frequently positive in NE-Group patients than in E-Group ones. Positive patch test reactions to fragrance Mix II, dimethylaminopropylamine, and sorbitan sesquiolate were significantly more frequent in E-Group patients than in NE-Group ones., Conclusions: Eyelid dermatitis is a frequent dermatological complaint. Allergic contact dermatitis is the most frequent diagnosis commonly caused by nickel sulphate, isothiazolinones, and fragrances. The surfactants dimethylaminopropylamine and sorbitan sesquioleate are emerging causes of eyelid allergic contact dermatitis., (© 2024 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Competing Interests: Conflicts of interest None disclosed.

Allergic contact dermatitis (ACD) is a common inflammatory skin disease caused by delayed hypersensitivity to chemical and biotic contact allergens. ACD significantly affects the patients' quality of life negatively impacting both occupational and non-occupational settings. Patch testing is the gold standard diagnostic in vivo test to precise the ACD etiology and to correctly perform prevention. According to the Italian Medicines Agency (AIFA) legislative decree no. 178 of 29 th May 1991, allergens are defined as medicines and therefore they are subject to strict regulation. In 2017, AIFA (decree no. 2130/2017) started a procedure to regulate contact allergens on the Italian market and actually the contact allergens temporarily authorized are reported in AIFA decree no. 98/2022, valid until November 2023. The availability on the market of contact allergens to diagnose ACD and continuous updating on the basis of new epidemiological trends are mandatory, jointly with the continuous update of the baseline and integrative series for patch testing. For this reason, the scientific community represented in Italy by the Skin Allergies Study Group of SIDeMaST (Italian Society of Dermatology and Venereology) and SIDAPA (Italian Society of Allergological, Occupational and Environmental Dermatology) are constantly working, in close relationship with the European scientific communities with large expertise in this important sector of the modern Dermatology. Herein, we report the setting up of regulatory legislation by AIFA and the new Italian Adult Baseline Series for patch testing.

Introduction: Several systemic therapies have been approved for the treatment of severe AD. In particular, Janus kinase inhibitors (JAKi), including abrocitinib, baricitinib, and upadacitinib, recently received approval for the treatment of patients with severe AD after being evaluated in several clinical trials. However, a few concerns have been raised regarding their long-term safety and the management of these drugs in real-world clinical practice. In this article we described the results of a Delphi consensus aimed at describing the knowledge on JAKi and focusing, in particular, on providing clinical recommendations for dermatologists in daily practice regarding the use of these drugs., Methods: Twelve Italian dermatologists reviewed the most recent literature regarding the efficacy and safety profiles of JAKi and proposed 24 statements., Results: Agreement was reached for statements focusing on three main topics: (1) place in therapy of JAKi in patients with moderate-to-severe AD; (2) effectiveness and safety of JAK inhibitors in different phenotypes; (3) different approaches to the management of patients treated with JAKi in clinical practice. The panel proposed several recommendations regarding all the statements., Conclusion: Given the wide use of JAKi in clinical practice, it is crucial to establish a specific follow-up for each patient's phenotype in order to achieve the best possible clinical outcome and minimize potential adverse events., (© 2024. The Author(s).)

Background : Atopic Dermatitis (AD) is a prevalent inflammatory skin disease whose course is often complicated by the presence of concomitant anxiety and depressive disorders. Dupilumab has been demonstrated to be largely effective in AD. The aims of the present study were to (1) to verify the effectiveness of 2-year dupilumab treatment on the depressive and anxiety symptoms of patients affected by AD and (2) to identify predictors of the persistence of psychiatric symptoms despite maintenance treatment with dupilumab. Methods : A total of 331 patients with severe AD were assessed at baseline and at different times over 2 years by a large set of rating scales, including the Eczema Area and Severity Index (EASI), the Hospital Anxiety and Depression Scale (HADS), and the Dermatology Life Quality Index (DLQI). Paired sample t -tests were performed to verify the effectiveness of dupilumab on the severity of AD and mental health items. Two binary logistic regression models were then used to identify the predictors of the persistence of clinically significant depression and anxiety, defined by a score ≥ 8 on each sub-scale of the HADS. Results : After 2 years of treatment with dupilumab, the patients benefited, showing a significant improvement in both the dermatological disease and comorbid depression/anxiety ( p < 0.001 for all scales). Overall, 17.5% and 13% of patients, respectively, reported residual depressive and anxiety symptoms after the 2-year treatment with dupilumab. The baseline predictors of the persistence of clinically significant depressive symptoms after the 2-year treatment with dupilumab were found to be a higher body mass index (BMI) ( p = 0.012), a lower impact of dermatological disease on quality of life ( p = 0.015), and more severe depressive symptoms ( p < 0.01), while for anxiety, the only predictor was found to be female gender ( p = 0.03). Conclusions : Using a multidisciplinary approach, at baseline, dermatologists should more closely monitor patients who are at a greater risk of maintaining residual psychiatric symptoms despite therapy, such as those with more severe depressive symptoms and those who are overweight.

Background: Atopic dermatitis (AD) is a common inflammatory skin disease that affects both children and adults. However, limited research has been conducted on gender differences in AD., Objectives: This study aimed to assess gender differences in adult AD patients, focusing on demographic and clinical features, comorbidities and treatment approaches., Methods: In this multicentre, observational, cross-sectional study, we enrolled 686 adult patients with AD (357 males and 329 females). For each patient, we collected demographic data (age and sex), anthropometric measurements (weight, height, hip circumference, waist circumference and waist-to-hip ratio), clinical information (onset age, disease duration, severity, itching intensity, impact on quality of life) and noted comorbidities (metabolic, atopic and other). We recorded past and current topical and systemic treatments. We analysed all collected data using statistical techniques appropriate for both quantitative and qualitative variables. Multiple correspondence analysis (MCA) was employed to evaluate the relationships among all clinical characteristics of the patients., Results: We found no differences in age at onset, disease duration, severity and quality of life impact between males and females. Males exhibited higher rates of hypertriglyceridaemia and hypertension. No significant gender differences were observed in atopic or other comorbidities. Treatment approaches were overlapping, except for greater methotrexate use in males. MCA revealed distinct patterns based on gender, disease severity, age of onset, treatment and quality of life. Adult males with AD had severe disease, extensive treatments and poorer quality of life, while adult females had milder disease, fewer treatments and moderate quality of life impact., Conclusions: Our study reveals that gender differences in adult AD patients are largely due to inherent population variations rather than disease-related disparities. However, it highlights potential undertreatment of females with moderate AD and quality of life impact, emphasizing the need for equitable AD treatment. JAK inhibitors may offer a solution for gender-based therapeutic parity., (© 2023 European Academy of Dermatology and Venereology.)

Background: Limited real-world data are available on upadacitinib drug survival in patients with atopic dermatitis (AD). Objectives: To investigate upadacitinib drug survival, and the reasons and predictors of drug discontinuation in AD patients. Methods: All consecutive patients aged 18-75 years, affected by moderate-to-severe AD, and treated with upadacitinib for more than 1 month at dermatological clinics were included during November 2020-August 2023. Upadacitinib survival was investigated through Kaplan-Meier survival analysis and the predictors through multivariable logistic regression analysis. Results: Overall, 325 adult AD patients (mean (SD) age, 38.6(15.6) years) had a 1-year and 1.5-year upadacitinib drug survival of 91.5% and 80.2%, respectively. The main reasons for drug discontinuation (25/325, 7.7%) were adverse events (4.9%), including cutaneous or infectious diseases (1.5%), such as acne and herpes zoster; blood test changes (1.2%), including hypercholesterolemia, creatine phosphokinase or liver enzyme elevation, and lymphopenia; urinary or respiratory infections (0.9%); deep venous thrombosis (0.3%); malignancies (0.3%); loss of consciousness (0.3%); and arthralgias (0.3%); followed by ineffectiveness (0.6%). No specific characteristic was significantly associated with an increased risk of upadacitinib discontinuation. Conclusions: Our findings show that upadacitinib was effective in moderate-to-severe AD after more than 1 year of continuous treatment but point to the need for clinical and laboratory monitoring of patients.