Introduction: Genital involvement is observed in approximately 60% of patients with psoriasis, presenting clinicians with formidable challenges in treatment. While new biologic drugs have emerged as safe and effective options for managing psoriasis, their efficacy in challenging-to-treat areas remains inadequately explored. Intriguingly, studies have shown that interleukin (IL)-17 inhibitors exhibit effectiveness in addressing genital psoriasis. Objectives: We aimed to determine the effectiveness profile of bimekizumab in patients affected by moderate-to-severe plaque psoriasis with involvement of genitalia. Methods: Bimekizumab, a dual inhibitor of both IL-17A and IL-17F, was the focus of our 16-week study, demonstrating highly favorable outcomes for patients with genital psoriasis. The effectiveness of bimekizumab was evaluated in terms of improvement in Static Physician's Global Assessment of Genitalia (sPGA-G) and Psoriasis Area and Severity Index. Results: Sixty-five adult patients were enrolled. Remarkably, 98.4% of our participants achieved a clear sPGA-G score (s-PGA-g=0) within 16 weeks. Moreover, consistent improvements were observed in PASI scores, accompanied by a significant reduction in the mean Dermatology Life Quality Index (DLQI), signifying enhanced quality of life. Notably, none of the patients reported a severe impairment in their quality of life after 16 weeks of treatment. In our cohort of 65 patients, subgroup analyses unveiled that the effectiveness of bimekizumab remained unaffected by prior exposure to other biologics or by obesity. Conclusions: Our initial findings suggest that bimekizumab may serve as a valuable treatment option for genital psoriasis. Nevertheless, further research with larger sample sizes and longer-term follow-up is imperative to conclusively validate these results.

(1) Background/Objectives: Nail psoriasis (NP) is a chronic and difficult-to-treat disease, which causes significant social stigma and impairs the patients’ quality of life. Moreover, nail psoriasis is a true therapeutic challenge for clinicians. The presence of nail psoriasis can be part of a severe form of psoriasis and can have predictive value for the development of psoriatic arthritis. Our real-world-evidence multicenter study aims to evaluate the efficacy of bimekizumab in nail psoriasis. (2) Methods: A retrospective analysis of a multicenter observational study included 834 patients affected by moderate-to-severe psoriasis, in 33 Dermatologic Units in Italy, treated with bimekizumab from December 2022 to September 2023. Clinimetric assessments were based on Psoriasis Area and Severity Index (PASI), Dermatology Life Quality Index (DLQI), and Physician’s Global Assessment of Fingernail Psoriasis (PGA-F) for the severity of nail psoriasis at 0, 12, 24, and 36 weeks. (3) Results: Psoriatic nail involvement was present in 27.95% of patients. The percentage of patients who achieved a complete clearance of NP in terms of PGA-F 0 was 31.7%, 57%, and 88.5% at week 4, 16, and 36, respectively. PASI 100 was achieved by 32.03% of patients at week 4, by 61.8% at week 16, and by 78.92% of patients at week 36. The mean baseline PASI was 16.24. The mean DLQI values for the entire group of patients at baseline, at week 4, at week 16, and at week 36 were 14.62, 3.02, 0.83, and 0.5, respectively. (4) Conclusions: Therapies that promote the healing of both the skin and nails in a short time can also ensure a lower risk of subsequently developing arthritis which is disabling over time. Bimekizumab proved to be particularly effective to treat NP, with a fast response in terms of complete clearance, with over 88.5% of patients free from NP after 36 weeks. The findings of our real-world study showed that patients with moderate-to-severe PsO and concomitant NP had significantly faster and more substantial improvements in NP up to 36 weeks with respect to previous research findings. Considering the rapid healing of the nail, the dual inhibition of IL17 A and F might have a great value in re-establishing the dysregulation of keratin 17 at the nail level.

BackgroundThe recent introduction of biological drugs specifically targeting the interleukins involved in psoriasis pathogenesis revolutionized the therapeutic scenario of moderate to severe forms of psoriasis. Among these, risankizumab, an anti-IL-23, was shown to be effective both in clinical trials and real-life experiences. However, data on its use on very severe forms of psoriasis, defined by a Psoriasis Area Severity Index (PASI) of at least 30, are scant. In this context, our study aimed to investigate the outcomes of patients with very severe psoriasis, and the involvement of difficult-to-treat areas treated with risankizumab for up to 2 years.MethodsA retrospective, observational study enrolled patients with very severe plaque psoriasis and the involvement of difficult-to-treat areas undergoing treatment with risankizumab. Clinical and demographic data were collected at baseline. Moreover, at baseline and each dermatological examination (16, 28, 40 and 104 weeks), clinical improvement was measured using the percentage of patients achieving PASI 75/90/100 response, site-specific Psoriasis Global Assessment and Dermatology Life Quality Index.ResultsAt baseline, the mean PASI was 35.1 +/- 5.1. A significant reduction was observed since week 16 and maintained up to week 104. Moreover, the Psoriasis Global Assessment and Dermatology Life Quality Index improved as well.ConclusionsRisankizumab showed to be effective and safe in patients affected by very severe forms of psoriasis with the involvement of difficult-to-treat areas.

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.

Psoriasis is a chronic inflammatory disease that can affect any part of the body but, when it appears in certain areas, like the face, it can have a very significant psychological impact. Biologics, in particular IL-17 and IL-23 drug inhibitors, have shown relevant clinical efficacy in the management of psoriatic lesions in difficult-to-treat areas. In post hoc analysis of phase III trials in plaque psoriasis, bimekizumab has shown safety and complete clearance of high-impact areas. However, these studies did not focus on the effect of bimekizumab on facial lesions. Therefore, this case series represents the first clinical real-life experience of rapid and successful management of facial psoriasis with bimekizumab in six patients.

Background and Aim Performance assessment of the Stroke Pathway is a key element in healthcare quality. The aim of this study has been to carry out a retrospective assessment of the Stroke Pathway in a first level Stroke Unit in Italy, analyzing the temporal trend of the Stroke Pathway performance and the impact of the COVID-19 pandemic. Methods A retrospective observational study was carried out analyzing data from 1/01/2010 to 31/12/2020. The following parameters were considered: volume and characteristics of patients with ischemic stroke undergoing intravenous thrombolysis, baseline modified Rankin Scale (mRS) and National Institutes of Health Stroke Scale (NIHSS) scores, Onset-to-Door (OTD), Door-To-Imaging (DTI) and Door-To-Needle (DTN) Times, mRS score 3 months after the ischemic event onset (3 m-mRS) and NIHSS score 24 h after the ischemic event onset (24 h-NIHSS). The study also compared the pre-COVID-19 pandemic period (March-December 2019) with the one immediately following it (March-December 2020). Results 418 patients were included. Over time, treatment was extended to older patients (mean age from 66.3 to 75.51 years; p = 0.006 ) and with a higher level of baseline disability (baseline mRS score from 0.22 to 1.22; p = 0.000 ). A statistically significant reduction over the years was found for DTN, going from 90 min to 61 min ( p = 0.000 ) with also an increase in the number of thrombolysis performed within the “golden hour” – more than 50% in 2019 and more of 60% in 2020. Comparing pre- and during COVID-19 pandemic periods, the number of patients remained almost unchanged, but with a significantly higher baseline disability (mRS = 1.18 vs. 0.72, p = 0.048 ). The pre-hospital process indicator OTD increased from 88.13 to 118.48 min, although without a statistically significant difference (p = 0.197). Despite the difficulties for hospitals due to pandemic, the hospital process indicators DTI and DTN remained substantially unchanged, as well as the clinical outcome indicators 3 m-mRS, NHISS and 24 h-NHISS. Conclusions The results of the retrospective assessment of the Stroke Pathway highlighted its positive impact both on hospital processes and patients’ outcomes, even during the COVID-19 pandemic, so that the current performance is aligning itself with international goals. Moreover, the analysis showed the need of improvement actions for both hospital and pre-hospital phases. The Stroke Pathway should be improved with the thrombolysis starting in the diagnostic imaging department in order to further reduce the DTN score. Moreover, health education initiatives involving all the stakeholders should be promoted, also by using social media, to increase population awareness on timely recognition of stroke signs and symptoms and emergence medical services usage.

Abstract Background and Aim Performance assessment of the Stroke Pathway is a key element in healthcare quality. The aim of this study has been to carry out a retrospective assessment of the Stroke Pathway in a first level Stroke Unit in Italy, analyzing the temporal trend of the Stroke Pathway performance and the impact of the COVID-19 pandemic. Methods A retrospective observational study was carried out analyzing data from 1/01/2010 to 31/12/2020. The following parameters were considered: volume and characteristics of patients with ischemic stroke undergoing intravenous thrombolysis, baseline modified Rankin Scale (mRS) and National Institutes of Health Stroke Scale (NIHSS) scores, Onset-to-Door (OTD), Door-To-Imaging (DTI) and Door-To-Needle (DTN) Times, mRS score 3 months after the ischemic event onset (3m-mRS) and NIHSS score 24 hours after the ischemic event onset (24h-NIHSS). The study also compared the pre-COVID-19 pandemic period (March-December 2019) with the one immediately following it (March-December 2020). Results 418 patients were included. Over time, treatment was extended to older patients (mean age from 66.3 to 75.51 years; p = 0.006) and with a higher level of baseline disability (baseline mRS score from 0.22 to 1.22; p = 0.000). A statistically significant reduction over the years was found for DTN, going from 90 minutes to 61 minutes (p = 0.000) with also an increase in the number of thrombolysis performed within the “golden hour” – more than 50% in 2019 and more of 60% in 2020. Comparing pre- and during COVID-19 pandemic periods, the number of patients remained almost unchanged, but with a significantly higher baseline disability (mRS = 1.18 vs 0.72, p = 0.048). The pre-hospital process indicator OTD increased from 88.13 to 118.48 minutes, although without a statistically significant difference (p = 0.197). Despite the difficulties for hospitals due to pandemic, the hospital process indicators DTI and DTN remained substantially unchanged, as well as the clinical outcome indicators 3m-mRS, NHISS and 24h-NHISS. Conclusions The results of the retrospective assessment of the Stroke Pathway highlighted its positive impact both on hospital processes and patients’ outcomes, even during the COVID-19 pandemic, so that the current performance is aligning itself with international goals. Moreover, the analysis showed the need of improvement actions for both hospital and pre-hospital phases. The Stroke Pathway should be improved with the thrombolysis starting in the diagnostic imaging department in order to further reduce the DTN score. Moreover, health education initiatives involving all the stakeholders should be promoted, also by using social media, to increase population awareness on timely recognition of stroke signs and symptoms and emergence medical services usage.

Key Clinical Message This clinical case demonstrates quick resolution of nail psoriasis in a patient treated with risankizumab, highlighting the role of IL‐23 in the pathogenesis of nail psoriasis.

Dear Editors, The outbreak of the infection caused by severe acute respiratory syndrome coronavirus (SARS-CoV-2) and the consequent coronavirus disease (COVID-19) has radically changed the way physicians approach outpatient care.1 While writing this article, Italy is one of the European countries with the highest number of cases with almost 220 000 positive subjects since the start of the pandemic. Considering that cutaneous manifestations of COVID-19 have begun to be reported, outpatient dermatology departments are at high risk of admitting coronavirus positive patients. Among the measures suggested for the prevention of the diffusion of the virus, a complete reschedule of dermatological outpatient activity has been undertaken restricting hospital access only to emergent visits and postponing non-urgent consultations. While this approach has been vital in reducing viral spreading, thanks to a drastic reduction in patient flow among the different hospital facilities, it also has its downsides. We report the case of a 26-year-old female who presented for the rapid appearance of a mass on her face. Even though it had grown considerably, the patient had decided to neglect it given the difficulty in acceding to hospital facilities during the COVID-19 pandemic. Upon clinical examination, a nodule of 2 × 1.5 cm2 was noted in the glabellar area. The lesion was slightly tender upon palpation, single, firm, skin-coloured, mobile, and with well-defined borders. The overlying skin showed no relevant change (Figure 1A). Her past medical history was otherwise unremarkable as were her laboratory examinations. Given the rapid volumetric increase, the lesion was excised and pathological examination was performed. Histologically, the biopsy showed a non-encapsulated dermal tumour characterised by a proliferation of polyhedral cells, some arranged in a plexiform pattern. The overlying epidermis appeared to be hyperplastic. The cells presented an abundant eosinophilic granular cytoplasm and exhibited, on immunohistochemistry, strong and specific staining with S100 and CD68. Cytological atypia in the granular cell component was absent as well as the mitotic activity (Figure 1B,C). The patient reported no adverse events during the postoperative recovery and no local recurrence has occurred at the time of writing this paper. A diagnosis of granular cell tumour (GCT), also known as Abrikosoff's tumour,2 was made. This is a rare benign neoplasm of neural sheath origin,3 which generally affects females with Fitzpatrick's skin type V or VI between the second and fifth decades of life.4 GCTs can affect both the mucosa and skin and are commonly located on the tongue (40% of cases), upper respiratory tract, breast, and upper extremities.5 Other affected locations are the gastrointestinal tract, the respiratory tract, the thyroid gland, the urinary bladder, the central nervous system, and the female genitalia.6 They mostly present as an asymptomatic slowly growing nodule. The diagnosis can be made by histopathological examination of the lesion, as the clinical findings are mostly non-specific. For this reason, the differential diagnosis is wide and includes adnexal tumours, lipoma, dermatofibroma, neurofibroma, and schwannoma. Histologically, the tumour is characterised by large eosinophilic cells with a granular cytoplasm—hence, the name GCT. Immunohistochemical stains are generally positive for S100, neuron-specific enolase, and vimentin.7 The COVID-19 pandemic has reduced hospital accesses to only urgent procedures. The risk with this practice lies in the execution of a correct triage. The appearance of a rapidly enlarging nodule should warrant the execution of dermatological examination within reasonable times. Even though the lesion turned out to be benign, GCTs have shown malignant transformation, albeit rarely (1%-2% of cases).8 The use of correct personal protective equipment is fundamental to enable dermatologists to actively participate in the sanitary crises. While colleagues are busy fighting SARS-CoV-2 directly, dermatologists should not stand aside and contribute to the correct and rapid diagnosis of cutaneous disease giving their fundamental support for preventive health care measures. The authors declare no conflicts of interest.

ENWEndNote BIBJabRef, Mendeley RISPapers, Reference Manager, RefWorks, Zotero AMA Orsini D, D'Arino A, Pigliacelli F, Assorgi C, Latini A, Cristaudo A. Allergic contact dermatitis to dorzolamide and benzalkonium chloride. Advances in Dermatology and Allergology/Postępy Dermatologii i Alergologii. 2018;35(5):538-539. doi:10.5114/ada.2018.73859. APA Orsini, D., D'Arino, A., Pigliacelli, F., Assorgi, C., Latini, A., & Cristaudo, A. (2018). Allergic contact dermatitis to dorzolamide and benzalkonium chloride. Advances in Dermatology and Allergology/Postępy Dermatologii i Alergologii, 35(5), 538-539. https://doi.org/10.5114/ada.2018.73859 Chicago Orsini, Diego, Andrea D'Arino, Flavia Pigliacelli, Chiara Assorgi, Alessandra Latini, and Antonio Cristaudo. 2018. "Allergic contact dermatitis to dorzolamide and benzalkonium chloride". Advances in Dermatology and Allergology/Postępy Dermatologii i Alergologii 35 (5): 538-539. doi:10.5114/ada.2018.73859. Harvard Orsini, D., D'Arino, A., Pigliacelli, F., Assorgi, C., Latini, A., and Cristaudo, A. (2018). Allergic contact dermatitis to dorzolamide and benzalkonium chloride. Advances in Dermatology and Allergology/Postępy Dermatologii i Alergologii, 35(5), pp.538-539. https://doi.org/10.5114/ada.2018.73859 MLA Orsini, Diego et al. "Allergic contact dermatitis to dorzolamide and benzalkonium chloride." Advances in Dermatology and Allergology/Postępy Dermatologii i Alergologii, vol. 35, no. 5, 2018, pp. 538-539. doi:10.5114/ada.2018.73859. Vancouver Orsini D, D'Arino A, Pigliacelli F, Assorgi C, Latini A, Cristaudo A. Allergic contact dermatitis to dorzolamide and benzalkonium chloride. Advances in Dermatology and Allergology/Postępy Dermatologii i Alergologii. 2018;35(5):538-539. doi:10.5114/ada.2018.73859.

Auteur(s) : Guglielmo Pranteda1, Elena Mari1, Diego Orsini2, Giulia Pranteda2, Chiara Assorgi2, Miriam Grimaldi3 1Dermatology Unit, University of Rome “Sapienza”, II School of Medicine, S. Andrea Hospital, Via di Grottarossa 1035, Rome, Italy 2Student of II School of Medicine, S. Andrea Hospital, Via di Grottarossa 1035, Rome, Italy 3Dermatology Unit, Azienda Ospedaliera Matera, Italy A 47-year-old man presented tiny, flat, arch-arranged, flesh-colored papules on the right chest, [...]