患者女，84岁，右耳部、双手掌、脐部、右乳头红斑痂屑2周余。患者2020年10月16日于血液科化疗期间出现右耳部、双手掌、脐部、右乳头红斑痂屑，轻度瘙痒，皮屑氢氧化钾直接镜检见真菌孢子，真菌培养为白色念珠菌。我科会诊后，予派瑞松外用、二硫化硒洗剂外洗5 d，皮疹进行性加重，表面呈污黑色细软鳞屑。于2020年10月30日再次取皮肤鳞屑行直接镜检，发现大量疥虫虫体及虫卵。既往史：非霍奇金淋巴瘤、弥漫大B细胞淋巴瘤ⅣB期4个月余，于血液科规律化疗，化疗期间出现败血症、骨髓抑制、白色念珠菌感染等。体检：一般情况差，精神欠佳，消瘦面容，全身营养差。皮肤科检查：头皮、胸部、腹部、手掌可见多发暗红色丘疹，上覆痂屑，右耳后、双手掌、脐部、右乳头可见大片灰白色厚积角化鳞屑痂，周围红斑（图1A ~ 1C）。影像学及免疫组化检查结果符合弥漫大B细胞淋巴瘤，起源于非生发中心B细胞（Hans模型）。腹部皮屑行显微镜镜检显示大量疥虫虫体（图1D）及虫卵（图1E）。

Background Drug reaction with eosinophilia and systemic symptoms (DRESS) is a severe multisystem hypersensitivity reaction. While systemic glucocorticoids remain the cornerstone treatment, patients often exhibit resistance, intolerance, or relapse during tapering, highlighting an urgent need for effective strategies. Objective To assess the effectiveness and safety of tofacitinib as an adjunctive therapy in patients with DRESS. Methods We retrospectively analyzed patients with DRESS treated from January 2018 to June 2025, comparing systemic glucocorticoids alone versus glucocorticoids plus tofacitinib. Primary outcome was cumulative glucocorticoid exposure; secondary outcomes included clinical improvement and safety. We used multivariable regression and sensitivity analyses to adjust for potential confounding factors. Results Among 61 patients (37 [60.7%] female; 25 [41.0%] severe DRESS), adjunctive tofacitinib was associated with shorter time to near-complete rash resolution (median, 10.0 vs 13.5 days; p = 0.032), reduced glucocorticoid duration (58.0 vs 88.0 days; p < .001), and lower cumulative dose (1452.0 vs 2145.0 mg; p = 0.019). In adjusted analyses, tofacitinib remained associated with 24.9% reduction in glucocorticoid duration (p = 0.029). Six-month mortality was 0% versus 10.7% (p = 0.091). Conclusion Adjunctive tofacitinib was associated with significant glucocorticoid-sparing effects in DRESS. Prospective randomized controlled trials are needed for validation.

Purpose:Generalized pustular psoriasis (GPP) is a rare, severe, and potentially life-threatening inflammatory skin disease characterized by widespread erythema, pustules and systemic involvement. Evidence-based treatment guidelines for adolescents with GPP remain limited. Spesolimab, a parenteral humanized monoclonal antibody targeting the interleukin-36 receptor, has emerged as a novel therapeutic option; however, data on its use in adolescents are scarce. Here, we aimed to evaluate the effectiveness of spesolimab in treating GPP episodes in adolescents and compared their outcomes with those in adults. Patients and Methods:We analyzed the management of GPP episodes with spesolimab in two adolescent and four adult patients in our unit and conducted a literature review involving 25 patients. Clinical outcomes included response to treatment, pustule resolution, and infection management. Spesolimab achieved rapid and sustained symptom control in all patients, including those with coexisting plaque psoriasis. Results:Twenty-two patients (71.0%) experienced complete pustule resolution within 1 week, and all 31 patients achieved complete pustule resolution by week 4. Treatment responses in adolescents were comparable to those in adults. Infections were identified as key exacerbating factors and managed accordingly. Conclusion:IL-36R inhibitors, such as spesolimab, are potentially effective and safe treatment for both adolescent and adult patients with GPP. Future studies should explore the long-term efficacy of spesolimab and its application strategy of sustained disease control.

Background::Generalized pustular psoriasis (GPP), a rare and recurrent autoinflammatory disease, imposes a substantial burden on patients and society. Awareness of GPP in China remains limited.Methods::This cross-sectional survey, conducted between September 2021 and May 2023 across 14 hospitals in China, included GPP patients of all ages and disease phases. Data collected encompassed demographics, clinical characteristics, economic impact, disease severity, quality of life, and treatment-related complications. Risk factors for GPP recurrence were analyzed.Results::Among 127 patients (female/male ratio = 1.35:1), the mean age of disease onset was 25 years (1st quartile [Q1]–3rd quartile [Q3]: 11–44 years); 29.2% had experienced GPP for more than 10 years. Recurrence occurred in 75.6% of patients, and nearly half reported no identifiable triggers. Younger age at disease onset ( P = 0.021) and transitioning to plaque psoriasis ( P = 0.022) were associated with higher recurrence rates. The median diagnostic delay was 8 months (Q1–Q3: 2–41 months), and 32.3% of patients reported misdiagnoses. Comorbidities were present in 53.5% of patients, whereas 51.1% experienced systemic complications during treatment. Depression and anxiety affected 84.5% and 95.6% of patients, respectively. During GPP flares, the median Dermatology Life Quality Index score was 19.0 (Q1–Q3: 13.0–23.5). This score showed significant differences between patients with and without systemic symptoms; it demonstrated correlations with both depression and anxiety scores. Treatment costs caused financial hardship in 55.9% of patients, underscoring the burden associated with GPP. Conclusions::The substantial disease and economic burdens among Chinese GPP patients warrant increased attention. Patients with early onset disease and those transitioning to plaque psoriasis require targeted interventions to mitigate the high recurrence risk.

目的 探讨司库奇尤单抗治疗中重度斑块状银屑病出现应答不良的患者,转换为依奇珠单抗治疗的疗效和安全性.方法 纳入司库奇尤单抗治疗的中重度斑块状银屑病患者,达到PASI50但从未达到PASI90,以及曾达到PASI90后失去PASI75的患者,转换为依奇珠单抗治疗,观察其12周及长期疗效及安全性.结果 共纳入7例患者,男5例,女2例,年龄中位数39.7(34.0,57.3)岁,平均病程(26.7±9.1)年,平均BMI30.6±4.8.PASI评分从基线时(9.8±4.3)分下降至12周时(1.4±1.2)分,平均治疗时间(46.9±11.2)周,末次随访PASI评分(2.5±2.3)分.3例(42.86％)患者出现局限性湿疹,1例(14.29％)出现注射部位反应,1例(14.29％)出现口腔念珠菌病.结论 司库奇尤单抗应答不良的中重度斑块状银屑病患者转换为依奇珠单抗,仍然能获得较好的治疗效果,且其安全性可.

Objective: The ongoing coronavirus disease 2019 (COVID-19) epidemic has caused extensive damage worldwide. We explored whether the medical care conduct of patients with psoriasis has changed and whether the COVID-19 epidemic has placed more psychological pressure on these patients. Methods: A questionnaire survey was administered to patients with psoriasis in the Dermatology Department of Peking University Third Hospital in July 2022. Information about the patients’ general demographics, psoriasis condition, mental state of anxiety (Generalized Anxiety Disorder-7 [GAD-7] score), changes in medical care conduct, and Concerns about COVID-19-Related Risk Score for Psoriasis (CCRSP, a self-designed questionnaire) was collected. Univariate analysis with the Mann–Whitney U test for continuous variables was used in the estimation of statistical differences. Results: A total of 112 patients with psoriasis completed the survey. Purchasing medicine was the factor that added difficulty for most participants (32.1%). Fewer participants (26.8%) encountered medical registration difficulties than economic and transportation difficulties. Nearly three-quarters of participants (73.2%) reported at least one medical care conduct change resulting from the COVID-19 epidemic. A small proportion of participants (12.5%) thought that COVID-19 prevented them from seeking medical services for psoriasis. The top three items that caused the most concern were psoriasis aggravation resulting from drug reduction and withdrawal because of COVID-19 (44.7%), psoriasis aggravation after infection with COVID-19 (38.4%), and psoriasis-related side effects of the COVID-19 vaccine (35.7%). The GAD-7 score of patients with a high CCRSP (score of >10) was significantly higher than that of patients with a low CCRSP (score of ≤10) (nonparametric test, P = 0.047). Conclusion: COVID-19 poses challenges and places a mental burden on patients with psoriasis. Doctors should regulate the medical behavior of patients with psoriasis according to their specific COVID-19 situation and help patients ease their anxiety to maintain the stability of their psoriasis condition.

Background: Few studies have reported the burden of generalized pustular psoriasis (GPP), a severe and potentially life-threatening skin disease, especially at a national level. Objectives: The aim of this study is to estimate the nationwide burden of GPP in China and make a systemic review of the published data. Methods: We conducted a population-based study using Urban Basic Medical Insurance in China from 2012 to 2016. GPP cases were identified by primary diagnoses including the international classification of Diseases codes (ICD-10: L40.1 and ICD-9: 694.3). A systematic review was conducted using relevant databases up to January 2022. Results: The crude prevalence and incidence of GPP in 2016 were 1.403 (95% confidence interval [CI]: 1.115–1.691) and 0.629 (95% CI: 0.483–0.775) per 100,000 person-years, respectively. The rates were higher in males than in females for both prevalence (1.429 vs. 1.135) and incidence (0.635 vs. 0.520). The prevalence and incidence showed a bimodal age distribution, with the first peak occurring in the 0- to 3-year age-group and the second peak occurring in the 30- to 39-year age-group. The per capita total cost per year for 1 patient with GPP was 609.26 (± 45.77) US dollars. Seven studies were identified in a systematic review, according to which the prevalence (per 100,000) of GPP tended to be higher in Asian countries (0.746–8.178 in Japan and 12.230 in Korea) than in France (0.176), Sweden (6.25), and Brazil (0.7). Conclusions: This is the largest study concerning the disease burden of GPP, and in this study, the prevalence seemed to be higher in Asia. Although the direct economic burden of GPP did not seem high during the study period, the future usage of biologics and the humanistic burden should also be considered for policy-related decision-making.

Background:Netherton syndrome is a rare but severe autosomal recessive disorder with dominant impaired skin barrier function, caused by mutations in the SPINK5 (serine protease inhibitor Kazal-type 5) gene, which encodes LEKTI (lymphoepithelial Kazal-type-related inhibitor).Objectives:To establish a murine model of Netherton syndrome based on CRISPR/Cas9 gene editing technology.Materials & Methods:Spink5-sgRNA was designed to target exon 3 of the mouse Spink5 gene. Cas9 mRNA and sgRNA were microinjected into the zygotes of C57BL/6J mice. Spink5 homozygous knockout mice were born from a heterozygous intercross, and the phenotype of these mice was compared with wild-type regarding gross morphology, histopathology and immunofluorescent detection of LEKTI.Results:Following microinjection of zygotes using the CRISPR/Cas9 system, sequencing demonstrated a 22-bp deletion at exon 3 of the mouse Spink5 gene. Histological investigation revealed complete detachment of the stratum corneum from the underlying granular layer and an absence of LEKTI in skin from Spink5 homozygous knockout mice.Conclusion:The 22-bp deleted Spink5 transgenic mouse model demonstrates the clinical phenotype and genotype of human Netherton syndrome, representing a useful tool for future gene correction and skin barrier/inflammation studies.

目的 了解线上教学对北京大学第三医院八年制学生本科阶段皮肤科学习的影响.方法 对北京大学第三医院2020年应用线上教学及2016至2019年应用线下教学的八年制学生在皮肤科理论授课和见习之前和之后分别进行问卷调查,学习后进行笔试考试,对结果进行分析.采用SPSS 21.0软件进行t检验和Mann-Whitney U检验.结果 线上教学八年制学生总数53人,问卷回收率75.5％(80/106);线下教学八年制学生总数166人,问卷回收率99.1％(329/332).在理论授课和见习之后,线上教学的考试成绩好于线下教学(P<0.001);线上教学的学生对于荨麻疹诊断能力的自我评价低于线下教学(P=0.008);线上教学的学生对于皮肤科在医院中的重要程度评价(P<0.001)和对皮肤科的兴趣(P=0.002)高于线下教学;其他如对皮炎湿疹、痤疮诊断能力的自我评价、以皮肤科为职业的意愿度及皮肤科的难易程度等差异无统计学意义.60.0％(24/40)的学生提交了开放建议,其中最多的建议是希望增加线下见习[22.5％(9/40)].结论 皮肤科线上教学形式的理论授课和见习对于学生知识点的掌握可能优于线下教学,也更能激发学生的学习兴趣,但学生对某些皮肤科常见病的诊治信心可能略低于线下教学.线上与线下结合可能在未来皮肤科教学中能够发挥更大优势,线上教学的形式和内容也亟须在实践中进一步改进.

患者男,70岁,右眼下方结节1年余.皮损组织病理示:真皮内实性结节状生长的肿瘤,伴显著黏液形成,符合黏液癌.免疫组织化学染色示:P63、SMA、SMMHC、CK7、ER、AR、PR、GATA-3、GCDFP-15、CgA、Syn 均(+);CK5/6、CK20 均(-).PET-CT:右面部术后改变,未见肿瘤残留或转移征象,余未见肿瘤表现.结合临床,组织病理及免疫组织化学结果,且系统检查未发现内脏肿瘤,诊断:原发性皮肤黏液癌.术后随访半年,原皮损部位无复发,未发现内脏肿瘤.

目的 总结斑块型银屑病合并大疱性类天疱疮的临床特点与治疗方法.方法 回顾分析2016年11月-2020年11月在北京大学第三医院皮肤科住院的诊断为斑块型银屑病合并大疱性类天疱疮患者的临床资料.结果 共4例患者,男女各2例,年龄62～86岁,均为银屑病先发病,3例合并高血压,3例合并糖尿病,3例合并甲状腺相关疾病.4例均应用糖皮质激素治疗,其中3例联合丙种球蛋白、免疫抑制剂或生物制剂治疗.结论 斑块型银屑病合并大疱性类天疱疮临床相对少见,有可能与高血压、糖尿病和甲状腺疾病有一定关系,治疗需同时兼顾两种疾病.

角蛋白10(keratin 10,K10)为Ⅰ型角蛋白,由KRT10基因编码,与Ⅱ型角蛋白K1配对组装成角蛋白丝,是表皮的主要结构蛋白.KRT10基因突变可导致表皮松解角化过度症、豪猪状鱼鳞病、雪花状鱼鳞病等多种遗传性皮肤病,K10也参与银屑病、毛发红糠疹、特应性皮炎等炎症性皮肤病的发病机制中.K10的功能远不只是作为细胞骨架抵抗机械应力,在维持皮肤屏障功能、细胞增殖与分化、炎症反应、伤口愈合等过程中都起着非常重要的作用,与代谢之间是否存在关联也值得进一步研究.

银屑病是慢性复发性炎症性皮肤病,经常在原皮损消退的部位复发.组织常驻记忆T细胞(tissue resident memory T cells,TRM)能够长期驻留在皮肤中.近年来许多研究表明TRM是银屑病复发的重要原因,有效地抑制TRM可能是控制银屑病复发的关键.但TRM细胞具有抗损伤和抗凋亡特征,给控制复发带来困难.本文就皮肤TRM的产生、驻留以及TRM与银屑病复发的研究进展进行综述.

目的 探讨在咪喹莫特(IMQ)诱导的银屑病样小鼠模型中再次诱导是否可以模拟复发表型及组织常驻记忆性T细胞(TRM)的变化.方法 将20只C57BL/6小鼠编号后随机等分为两组,每组10只.所有小鼠背部剃毛后,一组小鼠涂抹62.5 mg凡士林(vaseline),另一组小鼠涂抹62.5 mg的5％咪喹莫特乳膏,连续6 d.第6天处死每组小鼠中的5只小鼠(Vaseline组和IMQ组),第36天时两组剩余小鼠背部皮肤均再次涂62.5 mg咪喹莫特(Vaseline-IMQ组和IMQ-IMQ组),连续6 d后处死小鼠.每日记录小鼠背部皮损严重程度指数(PASI),取背部皮肤进行HE染色.取脾脏及皮肤获取单细胞悬液,进行流式细胞检测.结果 在第6天处死时,IMQ组银屑病样皮损典型,PASI评分最高为(9.50±0.58).在第42天处死时,再次诱导的IMQ-IMQ组PASI评分为(10.75±0.50),比单次诱导的IMQ 组(P = 0.03)和 Vaseline-IMQ 组(8.25±1.50,P＜0.0001)PASI 评分高,且比单次诱导的银屑病样皮损出现更快且更重.IMQ-IMQ组病理切片表皮厚度为(85.68±32.83)μm,比 IMQ 组(59.34±19.33)μm 和 Vaseline-IMQ 组(52.04±11.94)μm更厚,差异均有统计学意义(P＜0.000 1).IMQ-IMQ组脾脏Th17细胞比例增高为(5.17±1.94)％,高于 IMQ 组(3.36±0.58)％(P = 0.18)和 Vaseline-IMQ 组(1.87±1.69)％(P=0.006).IMQ-IMQ 组小鼠背部皮肤的 CD8+CD103+TRM比例为(5.29±2.25)％,显著高于IMQ 组(0.63±0.18)％(P= 0.000 1)和Vaseline-IMQ组(1.12±0.61)％(P= 0.000 4).结论 咪喹莫特诱导的银屑病样小鼠模型在间隔1个月后再次诱导,银屑病样皮损更重、反应更快、表皮增厚更多,且存在更多的Th17细胞和CD8+CD103+TRM,有可能作为银屑病研究中的小鼠复发模型.

Objective:To investigate the therapeutic effect of human umbilical cord mesenchymal stem cells (MSCs) on psoriasis-like mouse models induced by imiquimod and the underlying mechanisms.Methods:Eighteen C57BL/6 mice were randomly and equally divided into vaseline group, model group and treatment group according to a random number table. The mice in the model group and treatment group received topical treatment with 5% imiquimod cream at a dose of 62.5 mg once a day for 6 consecutive days on the shaved back, and those in the vaseline group received the treatment with the same amount of vaseline ointment; the mice in the treatment group were injected with 1.5×10 6 human umbilical cord MSCs via the caudal vein on days 1 and 4. The severity of skin lesions on the back of the mice was assessed everyday according to the psoriasis area and severity index (PASI) . Twenty-four hours after the last treatment, that is, on day 7, blood samples were taken, and the mice were sacrificed. The dorsal skin tissues were resected and subjected to hematoxylin and eosin (HE) staining. A single cell suspension of the resected spleen was prepared, and flow cytometry was performed to detect the Th1 and Th17 cell subsets in the spleen cells. Enzyme-linked immunosorbent assay was conducted to detect serum levels of cytokines interleukin (IL) -17A and tumor necrosis factor (TNF) -α. One-way analysis of variance was used for comparisons among groups, Tukey test for multiple comparisons, and repeated measures analysis of variance for the analysis of changes in the PASI score over time. Results:On day 7, there was obvious scaly erythema on the back of the mice in the model group, and the skin thickness and number of infiltrating inflammatory cells were significantly higher in the model group (78.73 ± 23.11 μm, 36.16 ± 2.95 cells/mm 2) than in the vaseline group (13.28 ± 4.57 μm, 13.33 ± 1.15 cells/mm 2, q=19.25, 7.21, respectively, both P < 0.001) . The treatment group showed significantly decreased PASI score, epidermal thickness and number of infiltrating inflammatory cells compared with the model group (all P < 0.001) . The percentage of Th17 cell subsets in the spleen cells and serum level of TNF-α were significantly lower in the treatment group than in the model group (both P < 0.05) . There were no significant differences in the spleen weight, spleen index, spleen cell count, Th1 cell percentage or serum IL-17A level between the treatment group and the model group (all P>0.05) . Conclusion:Human umbilical cord MSCs can effectively alleviate skin inflammation induced by imiquimod in the psoriasis-like mouse models, likely by inhibiting Th17 cell formation and TNF-α expression.

To the Editor: Psoriasis is a chronic, recurrent, systemic, immune-mediated inflammatory disease that mainly affects the skin, nails, and joints. Plaque psoriasis is the most common type of psoriasis, accounting for more than 80% to 90% of all cases. Secukinumab, a human IgG monoclonal antibody that antagonizes interleukin 17A (IL-17A), was approved by the US Food and Drug Administration in 2015 to treat moderate-to-severe plaque psoriasis. A Chinese multicenter, double-blind, placebo-controlled phase III randomized clinical trial (RCT) demonstrated excellent efficacy and safety.[1] Secukinumab has been available on the Chinese market since May 2019, with a recommended dose of 300 mg. It is well-known that RCTs, due to their rigorous, normalized design schemes, cannot fully reflect what happens in clinical practice settings. The concept of the “efficacy-effectiveness gap” was also introduced,[2] which supports the importance of real-world study. Here, we retrospectively summarized all the inpatients with plaque psoriasis who were treated with secukinumab at Peking University Third Hospital from June to December 2019. General information (sex, age, weight, body mass index, etc.) and clinical features (disease duration, family history, comorbidities, laboratory tests, previous treatments, concomitant treatments, etc.) were collected from clinical records. The psoriasis area severity index (PASI), body surface area (BSA), dermatology life quality index (DLQI), psoriasis scalp severity index (PSSI), nail psoriasis severity index (NAPSI), and palmoplantar psoriasis area and severity index (ppPASI) were also recorded. Safety was assessed by adverse events, and special cases that met the exclusion criteria of clinical trials were monitored accordingly. Statistical analysis was performed with SPSS 26.0 software (IBM Corp, Armonk, NY, USA). This study was approved by the Ethical Committee of Peking University Third Hospital (No. 329-01). Twenty inpatients started secukinumab treatment during the half-year study period. Twelve (60.0%) did not meet the eligibility criteria for the phase III RCT: ten patients (10/20) did not meet the inclusion criteria, one patient had concurrent hepatitis B virus (HBV)/hepatitis C virus (HCV) infection, and one patient had pre-existing idiopathic thrombocytopenia. General patient characteristics were summarized and compared with those in the phase III RCT,[1] and a lower severity was noted in our patients [Supplementary Table 1, https://links.lww.com/CM9/A403]. All patients followed the standard regimen with secukinumab (300 mg) administered subcutaneously once weekly for four weeks and then once every four weeks. During the treatment, four patients used concomitant topical treatments intermittently; two used calcipotriol, and two used calcipotriol betamethasone ointment. The percentages of PASI 75/90/100 responders, BSA involvement ≤ 3%, and BSA involvement ≤ 1% responders, and DLQI <5 and DLQI 0/1 responders are shown in Figure 1A–C. The PASI scores were 8.40 (3.25–11.85), 3.65 (1.38–5.75), and 0.50 (0–1.50) at weeks 2, 4, and 12, respectively. All reached statistical significance compared with the baseline PASI of 11.10 (6.00–17.03) (Zweek 2 = −3.622, P < 0.001; Zweek 4 = −2.803, P = 0.005; Zweek 12 = −3.464, P = 0.001). At week 2, the PASI 75/90/100 responses were 11.8%/5.9%/0%. At week 12, they reached 87.5%, 68.8%, and 43.8%, respectively. The median time to achieve a PASI 75 response was 8 weeks. Considering all patients, 87.5% achieved an absolute PASI ≤ 3, and the PASI score improvement was 95.74% (84.63–100.00%) at week 12.Figure 1: Percentages of PASI 75/90/100 responders (A), BSA 3% and BSA 1% responders (B), DLQI <5 and DLQI 0/1 responders (C) and PSSI 75/90/100 responders (D). Fingernail NAPSI change in patients with fingernail psoriasis (E). Platelet counts of the patient with idiopathic thrombocytopenia (F). Representative pictures of psoriasis on scalp (G) and fingernails (H). PASI: Psoriasis area severity index; BSA: Body surface area; DLQI: Dermatology life quality index; NAPSI: Nail psoriasis severity index; PSSI: Psoriasis scalp severity index.There was no data available concerning BSA or DLQI in the Chinese phase III RCT. An acceptable response of BSA ≤ 3% or a target response of BSA ≤ 1% was considered to be a more practical instrument for real-world application. In our study, the BSA values were 21.5% (6.3%–32.8%), 10.3% (6.1%–17.1%), and 1.0% (0.0%–2.8%) at weeks 2, 4, and 12, respectively. BSA slightly improved at week 2 but did not reach statistical significance (Zweek 2 = −1.663, P = 0.096); however, at weeks 4 and 12, BSA was significantly reduced compared with the baseline BSA of 20.3% (7.6–31.3%) (Zweek 4 = −2.810, P = 0.005; Zweek 12 = −3.408, P = 0.001). At week 2, the BSA ≤ 3%/BSA ≤ 1% responses were 11.8%/5.9%. At week 12, they reached 81.3%, and 62.5%, respectively. Achieving an improvement of 4 points or more in the DLQI was proposed as an assessment criterion in the British guidelines. A DLQI score of less than 5 (DLQI < 5) was one of the parameters in the decision algorithms for treatment in the French guidelines, and a DLQI of 0/1 was considered to indicate that there was no impact of psoriasis on quality of life. In our study, the DLQI scores were 7.0 (4.3–10.8), 4.0 (2.0–9.0), and 0 (0–4.0) at weeks 2, 4, and 12, respectively. All improved significantly compared with the baseline DLQI of 11.0 (8.0–21.0) (Zweek2 = −2.425, P = 0.015, Zweek4 = −2.197, P = 0.028, Zweek12 = −3.063, P = 0.002). At week 2, 50% of patients had a reduction of ≥ 4 points compared to the baseline DLQI scores, and 25% and 12.5% of patients achieved a DLQI < 5 and DLQI of 0/1, respectively. At week 12, a reduction of ≥ 4 points, DLQI < 5, and DLQI 0/1 were achieved in 60%, 80%, and 66.7% of patients, respectively. The results were comparable to those of the phase III RCT in China.[1] In addition, in line with the superior efficacy demonstrated in Chinese patients in clinical trials, our data also supported superior effectiveness in a real-life clinical setting (PASI 75/90/100: 87.5%/68.8%/43.8% vs. 72%/50%/36%, DLQI 0/1: 66.7% vs. 57%, compared with the results of a meta-analysis including 43 studies conducted in other countries and regions[3]). In the Chinese results, the lower proportion of overweight or obese patients and the higher proportion of biologic-naïve patients might be the reasons for the superior efficacy and effectiveness. The efficacy of secukinumab in difficult-to-treat locations, such as the scalp, nail, and palmoplantar regions, was not reported in the Chinese phase III RCT. In our study, 13 patients had scalp psoriasis. The PSSI scores were 1.5 (0–8.0), 2.0 (0–21.0), and 0(0–3.3) at weeks 2, 4, and 12, respectively. All reached statistical significance compared with the baseline PSSI of 5.0 (3.0, 12.5) (Zweek 2 = −2.692, P = 0.007; Zweek 4 = −2.032, P = 0.042; Zweek 12 = −2.913, P = 0.004). At week 12, the PSSI 75/90/100 responses were 83.3%, 75.0%, and 66.7%, respectively [Figure 1D and 1G]. In three patients with fingernail psoriasis, NAPSI improved by 100.0%, 53.3%, and 28.6% [Figure 1E and 1H]. Only one patient had toenail psoriasis, and achieved a 45.0% improvement in NAPSI. Only one patient had hyperkeratotic palmoplantar psoriasis, with a baseline ppPASI of 16.6, and this was completely cleared at week 8 (ppPASI 100). During the 12-week secukinumab treatment schedule, nine patients (45.0%) had at least one adverse event. The most common adverse events were upper respiratory tract infections (four cases), tinea pedis (two cases), and facial dermatitis (two cases). No serious adverse events occurred, and no patient had to discontinue drug treatment due to adverse events. One special case was a patient with a concurrent HBV/HCV infection. He was positive for hepatitis C virus antibody (HCV-IgM) and hepatitis B virus core antibody (HBcAb) at baseline, and HBsAg, HBV-DNA, and HCV-RNA were negative. He did not show virus reactivation during the 48 weeks of secukinumab treatment without antiviral prophylaxis. Although virus reactivation was not found in our patient, it has been reported that without antiviral prophylaxis, 1 of 11 HBsAg-negative/HBcAb-positive/HBsAb-negative patients, and one of nine patients with HCV infection developed HBV reactivation and enhanced replication of HCV with hepatitis after three months of secukinumab therapy, and both were clinically asymptomatic at the time of reactivation.[4] The viral load and transaminase should be closely monitored. Another special case was a patient with idiopathic thrombocytopenia. The platelet counts increased from 52 × 109/L at baseline to 84 × 109/L at week 12, and remained at 82 × 109/L at week 32 [Figure 1F]. To our knowledge, there have been no previous reports concerning secukinumab (or any other biologic) treatment in patients with psoriasis and pre-existing idiopathic thrombocytopenia. Other occurrences of transient thrombocytopenia during biologic treatment with normal platelet count at baseline were reported,[5] with adalimumab as the probable cause. In this case, considering that the face and nails were affected, and taking into account obesity (body mass index = 30 kg/m2), hypertension, and the patient's intentions and expectations, the decision to initiate secukinumab treatment was made after discussion with the patient and consultation with hematologists. PASI 100 was achieved at week 8 and was sustained during the 32-week follow-up. A slightly increasing platelet count over time even suggested a possible co-benefit. Fully understanding the effect of secukinumab on platelet count in patients with idiopathic thrombocytopenia requires long-term follow-up studies with larger sample sizes. Funding This work was supported by grants from the National Natural Science Foundation of China (No. 81972560) and Beijing Municipal Natural Science Foundation (No. 7202231). Conflicts of interest None.