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Background: IL‐23 inhibitors were recently approved for the treatment of skin psoriasis and psoriatic arthritis (PsA). Risankizumab, a humanized monoclonal antibody that specifically binds the p19 subunit of IL‐23, has proven effective on PsA in two randomized controlled trials. To date, only a few real‐world data are available on this topic. Methods: Our study aimed to prospectively evaluate the effectiveness of risankizumab in patients with PsA in a real‐world setting. For this purpose, both rheumatologic and dermatologic assessments were performed at baseline and after 28–40 weeks of continuous risankizumab administration. Moreover, joint and entheses ultrasound assessment was performed at the mentioned time points. The rheumatologic assessment was carried out by means of the following scores: (i) clinical Disease Activity Index for Psoriatic Arthritis (cDAPSA); (ii) Leeds Enthesitis Index (LEI); (iii) Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and (iii) Bath Ankylosing Spondylitis Functional Index (BASFI). The degree of skin involvement was measured by both the Psoriasis Area and Severity Index (PASI) and Physician Global Assessment (PGA). Quality of life was assessed by the Health Assessment Questionnaire (HAQ) and Dermatology Life Quality Index (DLQI). Ultrasound assessment of joints and entheses was performed on the basis of the EULAR‐OMERACT score. Results: After treatment, cDAPSA decreased from a mean value of 12.9 ± 7.6 to 7.0 ± 6.1 (P < 0.001), and the median PD score significantly decreased from baseline (3; range 1–8) to TP1 (1; range 0–7) (P < 0.001). PASI score also decreased from 8.4 ± 4.9 to 0.3 ± 0.5 (P < 0.001), and PGA from 3.1 ± 1.0 to 0.4 ± 0.5 (P < 0.001). Conclusion: We can conclude that risankizumab led to substantial improvement in both skin and joint involvement. [ABSTRACT FROM AUTHOR]

Biological drugs have dramatically changed the approach to treating moderate‐to‐severe plaque psoriasis, achieving excellent skin clearance and safety outcomes. However, the management of difficult‐to‐treat areas (e.g., scalp, palms/soles, nails, and genitalia) still represents a challenge in psoriasis treatment. Data in the literature on difficult‐to‐treat sites are limited and, frequently, no specific analysis is performed during clinical trials. We conducted a 52‐week, retrospective study to evaluate the effectiveness of ixekizumab in 120 patients with moderate‐to‐severe plaque psoriasis of at least one difficult‐to‐treat area (scalp, palmoplantar surfaces, nails, and genitalia). Ninety‐nine patients had scalp psoriasis, 35 had involvement of the palms or soles, 27 were affected by genital psoriasis, and 22 patients reported involvement of the nails. After 1 year of treatment, 96% of patients with scalp involvement, 95.6% of patients with palmoplantar psoriasis, 95.2% of patients with genital psoriasis, and 85% of patients with nail involvement achieved a site‐specific Physician's Global Assessment of 0 or 1 (clear or almost clear). No serious adverse events were observed during the study. Our study supports the effectiveness of ixekizumab in plaque psoriasis involving difficult‐to‐treat sites. [ABSTRACT FROM AUTHOR]

Cutaneous pseudolymphomas are a wide group of diseases mimicking cutaneous lymphoma. They comprise several skin conditions with different etiopathogenesis, clinical–pathological features, and prognosis, which may occur in the absence of an identifiable trigger factor or after administration of medications or vaccinations, tattoos, infections, or arthropod bites. They present with different manifestations: from solitary to regionally clustered lesions, up to generalized distribution and, in rare cases, erythroderma. They persist variably, from weeks to years, and resolve spontaneously or after antibiotics, but may recur in some cases. CD30+ T‐cell pseudolymphomas are characterized by the presence of large, activated lymphoid cells, generally in response to viral infections, arthropod assault reactions, and drug eruptions. Stenotrophomonas maltophilia is a ubiquitous Gram‐negative bacillus responsible for opportunistic infections in immunocompromised patients. Infection of intact skin in immunocompetent patients is particularly rare. Here, we report a case of a man presenting an isolated nodule histopathologically mimicking a primary cutaneous CD30+ T‐cell lymphoproliferative disorder. [ABSTRACT FROM AUTHOR]

The Wolf’s isotopic phenomenon corresponds to the occurrence of a skin disease at a body site affected previously by a different, already healed dermatosis. We report a 74-year-old man who presented with a zosteriform eruption consisting of erythematous-scaly, slightly pruritic papules on the right flank some weeks after herpes zoster (HZ) had healed on the same area. Histologic examination showed typical changes of lichen planus, confirming the diagnosis of post-HZ zosteriform lichen planus (ZLP). The lesions regressed with topical steroid treatment. Zosteriform lichen planus (ZLP) is one example of Wolf’s isotopic phenomenon appearing after HZ. So far, only 17 cases have been reported in the literature. The precise pathogenesis of ZLP is not well known, although persisting viral proteins could be responsible for the hypersensitivity reaction. We review and discuss the salient clinicopathologic features of this rare entity based on a thorough literature review.

This article discusses a case of granulomatous secondary syphilis, a rare manifestation of the disease. The patient presented with a diffuse rash and a biopsy revealed granulomatous inflammation in the skin. Despite negative results from immunohistochemistry and serological tests, the diagnosis was confirmed through a PCR assay. The article highlights the challenges in diagnosing syphilis and emphasizes the importance of histology and PCR testing in these cases. It also mentions the "prozone phenomenon," which can lead to false negative serological results. [Extracted from the article]

Byline: Dario. Graceffa, Claudio. Bonifati, Viviana. Lora, Pier. Saraceni, Catia. De Felice, Maria. Chimenti, Roberto. Perricone, Aldo. MorroneBackground: The inflammatory involvement of the enthesis in the course of psoriasis is [...]

Background: Preliminary in vitro and in vivo studies have supported the efficacy of the peroxisome proliferator‐activated receptor‐γ (PPARγ) modulator N‐acetyl‐GED‐0507‐34‐LEVO (NAC‐GED) for the treatment of acne‐inducing sebocyte differentiation, improving sebum composition and controlling the inflammatory process. Objectives: To evaluate the efficacy and safety of NAC‐GED (5% and 2%) in patients with moderate‐to‐severe facial acne vulgaris. Methods: This double‐blind phase II randomized controlled clinical trial was conducted at 36 sites in Germany, Italy and Poland. Patients aged 12–30 years with facial acne, an Investigator Global Assessment (IGA) score of 3–4, and an inflammatory and noninflammatory lesion count of 20–100 were randomized to topical application of the study drug (2% or 5%) or placebo (vehicle), once daily for 12 weeks. The co‐primary efficacy endpoints were percentage change from baseline in total lesion count (TLC) and IGA success at week 12; the safety endpoints were adverse events (AEs) and serious AEs. This study was registered with EudraCT (2018‐003307‐19). Results: Between Q1 in 2019 and Q1 in 2020 450 patients [n = 418 (92·9%) IGA 3; n = 32 (7·1%) IGA 4] were randomly assigned to NAC‐GED 5% (n = 150), NAC‐GED 2% (n = 150) or vehicle (n = 150). The percentage change in TLC reduction was statistically significantly higher in both the NAC‐GED 5% [–57·1%, 95% confidence interval (CI) –60·8 to –53·4; P < 0·001] and NAC‐GED 2% (–44·7%, 95% CI –49·1 to –40·1; P < 0·001) groups compared with vehicle (–33·9%, 95% CI –37·6 to –30·2). A higher proportion of patients treated with NAC‐GED 5% experienced IGA success (45%, 95% CI 38–53) vs. the vehicle group (24%, 95% CI 18–31; P < 0·001). The IGA success rate was 33% in the NAC‐GED 2% group (P = not significant vs. vehicle). The percentage of patients who had one or more AEs was 19%, 16% and 19% in the NAC‐GED 5%, NAC‐GED 2% and vehicle groups, respectively. Conclusions: The topical application of NAC‐GED 5% reduced TLC, increased the IGA success rate and was safe for use in patients with acne vulgaris. Thus, NAC‐GED, a new PPARγ modulator, showed an effective clinical response. What is already known about this topic?Acne vulgaris, one of the most common dermatological diseases, affects more than 85% of adolescents.There is a medical need for innovative and safe treatment of acne vulgaris.The peroxisome proliferator‐activated receptor‐γ (PPARγ) is involved in lipid metabolism and specifically in cell differentiation, sebum production and the inflammatory reaction. What does this study add?N‐acetyl‐GED‐0507‐34‐LEVO (NAC‐GED 5%), a PPARγ modulator, significantly improves acne manifestations in patients with moderate‐to‐severe acne and is safe and well tolerated.The results suggest that the PPARγ receptor is a novel therapeutic target for acne.The results provide a basis for a large phase III trial to assess the effectiveness and safety profile of NAC‐GED in combating a disease that afflicts 80–90% of adolescents. [ABSTRACT FROM AUTHOR]

Psoriasis has been reported to be rare in people with skin of color. However, the actual prevalence is probably underestimated by the lack of wide epidemiological studies. The aim of the study is to present our experience in Tigray, Ethiopia, focusing on the issues related to diagnosis, clinical features and therapies. A total of 1288 people affected by psoriasis were visited and 954 were included in a retrospective analysis through the review of medical records of patients attending at three Dermatologic Centers in Ethiopia from 2005 to 2016. The most common clinical form is plaque psoriasis (62.9%), followed by guttate (13.9%), pustular (9.5%), inverse (7.5%), and erythrodermic (6.1%) ones. The prevalence of psoriatic arthritis is 17%. It is often diagnosed late resulting in particularly deforming and debilitating disease. Patients with severe psoriasis often require hospitalization due to the reduced availability of effective treatments and appropriate skin care, resulting in a prolonged recurrence rate or decreased disease‐free interval. In poorer rural areas, patients use some traditional African plants such as Kigelia africana which have been shown to have partial benefits in the treatment of psoriasis. Unfortunately, the only available conventional therapies are topical steroids, salicylic acid, methotrexate, and the sun. More studies concerning the appropriate management of people with psoriasis in low income countries, including standardization of indigenous therapies and a reduction of costs of conventional drugs, could help the care of people with psoriasis. [ABSTRACT FROM AUTHOR]