IntroductionIxekizumab proved to be effective and safe for psoriasis treatment in several randomized clinical trials and real-life studies. Nevertheless, long-term real-world experiences are still lacking, with little data up to 4 years of treatment.ObjectivesTo analyse survival, effectiveness and safety of ixekizumab in a real-life cohort of patients affected by moderate-to-severe psoriasis or psoriatic arthritis up to 260 weeks (5 years).MethodsWe included all patients treated with ixekizumab from December 2017 to March 2021. Drug survival (DS) was analysed in patients at risk for up to 5 years. Cox analysis was adopted to evaluate possible predictive factors of discontinuation. Psoriasis Area Severity Index (meanPASI and PASI100, 90, and <= 3) was used as outcomes of effectiveness on observed patients at 16, 52, 104, 156, 208 and 260 weeks. Logistic regression was performed to identify possible predictive factors of response.ResultsDS was 65.5% at 260 weeks, with being a super-responder patient (achievement of PASI100 at 16 weeks and maintained at 28 weeks) correlated with less risk of discontinuation. PASI100, 90 and <= 3 was achieved by 54.1%, 60.5% and 73% of observed patients, respectively, at 16 weeks, and by 59.1%, 81.8% and 95.5%, respectively, at 260 weeks. High mean BMI was the only factor strongly associated with less achievement of the outcomes at the earlier time points: PASI100 at 16 weeks (OR 0.93, CI 0.87-0.98, p = 0.014) and at 104 weeks (OR 0.91, CI 0.84-0.98, p = 0.019), PASI90 achievement at 16 weeks (OR 0.94, CI 0.88-0.99, p = 0.028) and 104 weeks (OR 0.91, CI 0.83-0.99, p = 0.027), and PASI <= 3 (OR 0.86, CI 0.76-0.97, p = 0.018) at 104 weeks. No severe adverse events were observed.ConclusionsIxekizumab showed high effectiveness and safety for up to 5 years, with survival of 2/3 of treated patients. Rapid response to treatment is predictive of long-term response.

Interleukin-17 (IL-17) is central in the pathogenesis of psoriasis (1). Brodalumab was approved in Europe in 2017, and its blockade of IL-17 receptor A provides, in clinical trials, quick onset of action and long-term maintenance of treatment response with a favorable safety profile (2,3). Data regarding real-life use are limited (4–6). We retrospectively assessed efficacy and safety of brodalumab in moderate to severe psoriasis patients attending the Dermatology Clinic of the Turin University Hospital for up to 48weeks. Patients received subcutaneous brodalumab 210mg every 2weeks after the administration of 210mg every week for the first 3weeks. Disease severity at baseline was measured by the Psoriasis Area Severity Index (PASI); PASI improvement of 90% (PASI90) and 100% (PASI100) was recorded at 12, 24, and 48weeks. DLQI response rates were collected at baseline and after 48weeks of treatment. Among 1635 patients on biologics attending our clinic, 202 received brodalumab (Table 1). At week 12, 125 (68%) and 97 (53%) patients achieved PASI90 and PASI100, respectively. At week 24, 93 patients (77%) and 111 (65%) achieved PASI90 and PASI100, respectively. At week 48, 32 patients (78%) achieved PASI90 response, while 39 (64%) had complete clearance. Between baseline and week 48, DLQI improved from a mean of 13.8 to 1.3 (p< .001) and PASI improved from 23.3 to 2.2 (p< .001) respectively). Obesity did not seem to reduce the efficacy or time to onset of action of brodalumab since no difference in efficacy was observed between patients with a BMI above or below 30. No significant differences in efficacy were detected at the different time points between patients with and without joint involvement (Figure 1). Bio-naïve patients improved faster than bio-experienced patients in the first weeks of treatment and at every time point. At week 12, the mean PASI in the bio-naïve population was lower than in the bio-experienced (1.56 vs 2.47; p1⁄4 .045), and more patients achieved PASI 90 and PASI <3 (76% vs 56%; p1⁄4 .004 and 86% vs 69%; p1⁄4 .005). At week 24, more bio-naïve patients than bio-experienced patients achieved PASI90 (84% vs 67%, p1⁄4 .021). Forty-nine patients reported side effects, the most frequent of which were arthralgia (15 patients) in patients without joint involvement at baseline and asthenia (10 patients). Two patients discontinued treatment due to reported side effects, one due to joint pain and one due to a major dental abscess resistant to multiple antibiotic therapies. Brodalumab rapidly improves psoriasis in the first few weeks of treatment, particularly in bio-naïve patients, which is in line with the results of registration studies and previous real-life experience (3,5,6). Performance in bio-experienced patients is also good, as previously reported (5,6). Although not approved in the treatment of psoriatic arthritis, joint involvement does not appear to affect the response to therapy.

Journal of the European Academy of Dermatology and VenereologyVolume 36, Issue 10 p. e838-e841 Letter to the Editor Risankizumab shows faster response in bio naïve than in bio-experienced psoriatic patients L. Mastorino, Corresponding Author L. Mastorino [email protected] orcid.org/0000-0001-7386-3219 Department of Medical Sciences, Section of Dermatology, University of Turin, Torino, ItalyCorrespondence: L. Mastorino. E-mail: [email protected]Search for more papers by this authorF. Castelli, F. Castelli Section of Dermatology, Koelliker Hospital, Turin, ItalySearch for more papers by this authorE. Stroppiana, E. Stroppiana Department of Medical Sciences, Section of Dermatology, University of Turin, Torino, ItalySearch for more papers by this authorA. Verrone, A. Verrone Department of Medical Sciences, Section of Dermatology, University of Turin, Torino, ItalySearch for more papers by this authorM. Ortoncelli, M. Ortoncelli Department of Medical Sciences, Section of Dermatology, University of Turin, Torino, ItalySearch for more papers by this authorS. Susca, S. Susca Department of Medical Sciences, Section of Dermatology, University of Turin, Torino, ItalySearch for more papers by this authorS. Boskovic, S. Boskovic Department of Medical Sciences, Section of Dermatology, University of Turin, Torino, ItalySearch for more papers by this authorS.G. Passerini, S.G. Passerini Department of Medical Sciences, Section of Dermatology, University of Turin, Torino, ItalySearch for more papers by this authorN. Macagno, N. Macagno orcid.org/0000-0002-0097-2139 Department of Medical Sciences, Section of Dermatology, University of Turin, Torino, ItalySearch for more papers by this authorC. Cariti, C. Cariti Department of Medical Sciences, Section of Dermatology, University of Turin, Torino, ItalySearch for more papers by this authorM. Licciardello, M. Licciardello Section of Dermatology, Koelliker Hospital, Turin, ItalySearch for more papers by this authorC. Solaroli, C. Solaroli Section of Dermatology, Koelliker Hospital, Turin, ItalySearch for more papers by this authorG. Pertusi, G. Pertusi Outpatient Clinic, Section of Dermatology, ASL VC, Vercelli, ItalySearch for more papers by this authorM.G. Aragone, M.G. Aragone Outpatient Clinic, Section of Dermatology, ASL AL, Alessandria, ItalySearch for more papers by this authorG. Baggini, G. Baggini Outpatient Clinic, Section of Dermatology, ASL AL, Alessandria, ItalySearch for more papers by this authorC. Addese, C. Addese Outpatient Clinic, Section of Dermatology, ASLTO4, Ivrea, ItalySearch for more papers by this authorC. Leporati, C. Leporati Outpatient Clinic, Section of Dermatology, ASLTO4, Ivrea, ItalySearch for more papers by this authorR. Peila, R. Peila Outpatient Clinic, Section of Dermatology, ASLTO4, Ivrea, ItalySearch for more papers by this authorM.T. Giura, M.T. Giura Surgery Department, Section of Dermatology, Cardinal Massaia Hospital, ASL AT, Asti, ItalySearch for more papers by this authorG. Rossotto, G. Rossotto Surgery Department, Section of Dermatology, Cardinal Massaia Hospital, ASL AT, Asti, ItalySearch for more papers by this authorP. Pella, P. Pella Oncology Department, Section of Dermatology, Degli Infermi Hospital, ASL BI, Biella, ItalySearch for more papers by this authorL. Mocci, L. Mocci Section of Dermatology, AO AL Santi Antonio e Biagio e Cesare Arrigo, Alessandria, ItalySearch for more papers by this authorG. Merlo, G. Merlo Section of Dermatology, AO AL Santi Antonio e Biagio e Cesare Arrigo, Alessandria, ItalySearch for more papers by this authorR. Tiberio, R. Tiberio Dermatologic Clinic, AOU Maggiore della Carità Hospital, Novara, ItalySearch for more papers by this authorF. Graziola, F. Graziola Dermatologic Clinic, AOU Maggiore della Carità Hospital, Novara, ItalySearch for more papers by this authorP. Quaglino, P. Quaglino orcid.org/0000-0003-4185-9586 Department of Medical Sciences, Section of Dermatology, University of Turin, Torino, Italy Share last authorship.Search for more papers by this authorP. Dapavo, P. Dapavo Department of Medical Sciences, Section of Dermatology, University of Turin, Torino, Italy Share last authorship.Search for more papers by this authorS. Ribero, S. Ribero orcid.org/0000-0002-0098-1406 Department of Medical Sciences, Section of Dermatology, University of Turin, Torino, Italy Share last authorship.Search for more papers by this author L. Mastorino, Corresponding Author L. Mastorino [email protected] orcid.org/0000-0001-7386-3219 Department of Medical Sciences, Section of Dermatology, University of Turin, Torino, ItalyCorrespondence: L. Mastorino. E-mail: [email protected]Search for more papers by this authorF. Castelli, F. Castelli Section of Dermatology, Koelliker Hospital, Turin, ItalySearch for more papers by this authorE. Stroppiana, E. Stroppiana Department of Medical Sciences, Section of Dermatology, University of Turin, Torino, ItalySearch for more papers by this authorA. Verrone, A. Verrone Department of Medical Sciences, Section of Dermatology, University of Turin, Torino, ItalySearch for more papers by this authorM. Ortoncelli, M. Ortoncelli Department of Medical Sciences, Section of Dermatology, University of Turin, Torino, ItalySearch for more papers by this authorS. Susca, S. Susca Department of Medical Sciences, Section of Dermatology, University of Turin, Torino, ItalySearch for more papers by this authorS. Boskovic, S. Boskovic Department of Medical Sciences, Section of Dermatology, University of Turin, Torino, ItalySearch for more papers by this authorS.G. Passerini, S.G. Passerini Department of Medical Sciences, Section of Dermatology, University of Turin, Torino, ItalySearch for more papers by this authorN. Macagno, N. Macagno orcid.org/0000-0002-0097-2139 Department of Medical Sciences, Section of Dermatology, University of Turin, Torino, ItalySearch for more papers by this authorC. Cariti, C. Cariti Department of Medical Sciences, Section of Dermatology, University of Turin, Torino, ItalySearch for more papers by this authorM. Licciardello, M. Licciardello Section of Dermatology, Koelliker Hospital, Turin, ItalySearch for more papers by this authorC. Solaroli, C. Solaroli Section of Dermatology, Koelliker Hospital, Turin, ItalySearch for more papers by this authorG. Pertusi, G. Pertusi Outpatient Clinic, Section of Dermatology, ASL VC, Vercelli, ItalySearch for more papers by this authorM.G. Aragone, M.G. Aragone Outpatient Clinic, Section of Dermatology, ASL AL, Alessandria, ItalySearch for more papers by this authorG. Baggini, G. Baggini Outpatient Clinic, Section of Dermatology, ASL AL, Alessandria, ItalySearch for more papers by this authorC. Addese, C. Addese Outpatient Clinic, Section of Dermatology, ASLTO4, Ivrea, ItalySearch for more papers by this authorC. Leporati, C. Leporati Outpatient Clinic, Section of Dermatology, ASLTO4, Ivrea, ItalySearch for more papers by this authorR. Peila, R. Peila Outpatient Clinic, Section of Dermatology, ASLTO4, Ivrea, ItalySearch for more papers by this authorM.T. Giura, M.T. Giura Surgery Department, Section of Dermatology, Cardinal Massaia Hospital, ASL AT, Asti, ItalySearch for more papers by this authorG. Rossotto, G. Rossotto Surgery Department, Section of Dermatology, Cardinal Massaia Hospital, ASL AT, Asti, ItalySearch for more papers by this authorP. Pella, P. Pella Oncology Department, Section of Dermatology, Degli Infermi Hospital, ASL BI, Biella, ItalySearch for more papers by this authorL. Mocci, L. Mocci Section of Dermatology, AO AL Santi Antonio e Biagio e Cesare Arrigo, Alessandria, ItalySearch for more papers by this authorG. Merlo, G. Merlo Section of Dermatology, AO AL Santi Antonio e Biagio e Cesare Arrigo, Alessandria, ItalySearch for more papers by this authorR. Tiberio, R. Tiberio Dermatologic Clinic, AOU Maggiore della Carità Hospital, Novara, ItalySearch for more papers by this authorF. Graziola, F. Graziola Dermatologic Clinic, AOU Maggiore della Carità Hospital, Novara, ItalySearch for more papers by this authorP. Quaglino, P. Quaglino orcid.org/0000-0003-4185-9586 Department of Medical Sciences, Section of Dermatology, University of Turin, Torino, Italy Share last authorship.Search for more papers by this authorP. Dapavo, P. Dapavo Department of Medical Sciences, Section of Dermatology, University of Turin, Torino, Italy Share last authorship.Search for more papers by this authorS. Ribero, S. Ribero orcid.org/0000-0002-0098-1406 Department of Medical Sciences, Section of Dermatology, University of Turin, Torino, Italy Share last authorship.Search for more papers by this author First published: 10 June 2022 https://doi.org/10.1111/jdv.18314Citations: 5 Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onEmailFacebookTwitterLinkedInRedditWechat References 1Mastorino L, Sara S, Megna M et al. Risankizumab shows high efficacy and Maintenance in improvement of response until week 52. Dermatol Ther 2022; 14: e15378. 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Data are available upon reasonable request.

BACKGROUND Recently, Herpes simplex virus (HSV)-1 seroprevalence declined among adolescents, rendering young people lacking HSV-1 antibodies more susceptible to genital HSV-1 acquisition, if sexually exposed. The aim of the present study was to identify the possible risk factors for the development of HSV-1 related herpes genitalis (HG). METHODS From January 2012 to December 2015, patients with HG attending three Sexually Transmitted Infections Units in Northern Italy were recruited. A genital swab on the lesions for the search of HSV-1/2 DNA through Real time polymerase chain reaction (PCR) and a serum sample for HSV-1/2 specific serology were performed. Moreover, patients were asked whether they had personal history of herpes labialis (HL). Patients with PCR proved HSV-1 HG were included as cases; asymptomatic subjects attending STI Units for a blood check were recruited as controls and were checked for HSV-1/2 serology. RESULTS 141 cases and 70 controls were enrolled. Specific HSV-1 antibodies were found in 34.7% of the cases and 67% of the controls. History of recurrent herpes labialis (RHL) was found in 4% of the cases and 31% of the controls. The occurrence of RHL in HSV-1 seropositive patients resulted lower in the case group compared to the control group. CONCLUSIONS We can speculate about a protective role for RHL against the clinical appearance of HSV-1 HG. The clinical usefulness of our study involved especially the counseling in serodiscordant couples. The presence of HSV-1 antibodies in asymptomatic sexual partners does appear protective for HG manifestation only in presence of RHL history.

BackgroundLimited data are available on risk factors associated with lichen sclerosus and no data are available on gender differences in genital lichen sclerosus (GLS).ObjectiveThis multicentre study aimed at identifying potential risk factors for GLS, through data collection from a large, mixed-sex sample of patients comparing gender-related differences in relation to data from the general population.MethodsThis was a cross-sectional study on 729 subjects (53.8% females, 46.2% males) affected with GLS, consecutively observed within a network of 15 Italian dermatology units. The following information was collected: demographic data, anthropometric measures, comorbidities, family history of LS, clinical features and symptoms related to GLS.ResultsOverweight and obesity, blood hypertension, hypothyroidism and an educational attainment equal or above upper secondary school level were more frequent among the study patients than among the general Italian population. Moreover, a family history of GLS was reported more frequently than expected among GLS patients. These factors were similar in males and females. The disease tended to occur later in females than in males.ConclusionsOur findings suggest that metabolic factors, and possibly a sedentary lifestyle, may play a role in GLS pathogenesis in genetically predisposed patients, and that risk profile is similar in males and females despite some difference in the onset of symptoms.

BACKGROUND:Development of more than one primary melanoma in a sole patient is frequent, accounting for 1.2-8.2% of melanoma patients in most recent series. OBJECTIVE AND METHODS:Clinical, histological and epidemiological characteristics of 270 multiple primary melanomas patients were reviewed. RESULTS:Two-hundred and seven patients (76.7%) had two melanomas, whereas in the remaining 63 the number of primary ranged from three to eight; on the whole, 639 multiple primary melanomas were identified. Synchronous melanomas developed more frequently in patients with three or more lesions; median age was significantly lower in the group of patients with more than three melanomas than in the others. Mean Breslow's thickness significantly decreases (P<0.001) from the first (1.77±1.76 mm) to subsequent primaries (0.85±1.25 mm for the second and 0.66±0.48 mm for the third melanoma). Percentage of 'in situ' melanomas was 5.6% as first diagnosis, but increased to 24.8% for the second melanoma; number of nodular melanomas was significantly lower for succeeding diagnosis. AJCC stage at diagnosis showed a statistical prognostic significance, whereas outcome and survival did not depend on the number of primary lesions. Multivariate analysis confirmed the prognostic role of Breslow's thickness, ulceration, gender and patient age, and the better prognosis of patients with multiple melanomas, respect to those with single primary melanoma. CONCLUSIONS:Skin examination and long-term follow-up are mandatory for patients affected by melanoma, with the intent to promptly diagnose not only a disease progression but also possible new primary melanomas.

Editor Imatinib mesylate is a selective inhibitor of PDGFbeta and BcrAbl oncogene, indicated in the treatment of chronic myelogenous leukaemia (CML), gastro-intestinal stromal tumours (GIST), gliomas and small cell carcinomas, but also of unresectable or relapsed dermatofibrosarcoma protuberans (DFSP). This rare fibrohistiocytic tumour shows frequently chromosomal abnormalities; in particular, the translocation leading to the fusion of the 17q22 and 22q13 results in the expression of a COLIA1-PDGFbeta protein, that is processed into mature PDGF and interacts with the PDGFbeta receptor exposed on the DFSP cell surface. Imatinib treatment is generally well-tolerated, with mild to moderate haematological and gastrointestinal toxicity. Oedema is a common drug-related reaction and cutaneous adverse effects such as dose-dependent rash, pruritus, maculopapular eruptions and exfoliative dermatitis have been recently described. Treatment related hypoand hyper-pigmentation are infrequent and have been reported mainly in ethnically pigmented patients. Herein, we report our experience regarding the treatment with imatinib of a Caucasian male 46-year-old patient with multiple papulo-nodular lesions merging into a wide plaque at left groin. DFSP diagnosis was confirmed by histology and immunohistochemistry; surgical approach was excluded because of tumour extension and risk of unacceptable aesthetic defects without effective chances of cure. Imatinib mesylate was started at 400 mg ⁄ m (a)

Background Primary cutaneous T-cell lymphomas (CTCLs) are a heterogeneous group of lymphomas where the tumour population emerges within a multiple subclone pattern. Mycosis fungoides (MF) and Sézary syndrome (SS) are characterized by the expansion of clonal CD4+/CD45RO+ memory T cells. Lymphomatoid papulosis (LyP) is a chronic, lymphoproliferative disorder included in the CD30+ primary CTCL spectrum. Several studies have suggested a role of viral infection for super-antigenic activation of T lymphocytes; however, evidence of their association with CTCLs is still lacking. Human herpesvirus (HHV) 7 is a CD4+ T-lymphotropic herpesvirus; its restricted cellular tropism and the ability to induce cytokine production in infected cells could make it an important pathogenic cofactor in lymphoproliferative disorders. Objectives To investigate the presence of HHV7 DNA on CTCL and healthy skin donors (HD). Methods We used quantitative real time polymerase chain reaction to evaluate the potential pathogenic role of HHV7. Results Twenty-seven of 84 (32·1%) HD were positive for HHV7 DNA. Twenty-one of 148 (14·2%) patients with CTCLs were positive for HHV7 DNA: nine of 39 (23·1%) SS, six of 14 (42·9%) CD30+ CTCLs and six of 24 (25·0%) LyP, and HHV7 DNA was negative in all 71 patients with MF. Conclusions These results seem to exclude a pathogenic role of HHV7 in CTCLs, suggesting the possibility of skin as a latency site.