BackgroundLichen Sclerosus et Atrophicus (LSA) is a chronic inflammatory dermatosis of multifactorial aetiology, mainly affecting the genital area in both sexes and at any age. First-line therapy involves topical corticosteroids, whilst surgery, particularly circumcision in males, is reserved for non-responders or phimosis cases. Some patients show persistent disease post-surgery. The study aims to compare the effectiveness of circumcision versus topical corticosteroids in improving QoL in men with LSA, assess postoperative recurrence risk.MethodsA retrospective study of consecutive male patients with histological or clinical genital LSA were undergone. We collected clinical, anamnestic, and therapeutic data, including pre- and post-circumcision topical treatments. The DLQI questionnaire assessed quality of life according to treatment type.ResultsFifty-five males were analysed; 40% underwent circumcision. Of these, 83% used topical steroids before surgery and 68% resumed afterward (Steroid-Free Survival: 19 months). Resumption correlated with prior treatment (p = 0.043). QoL improved after circumcision and worsened with active therapy or phimosis (p = 0.002; p = 0.006).ConclusionCircumcision improves QoL, especially in phimosis, though relapses are frequent. Topical therapies are commonly employed but do not appear to significantly impact QoL. The results underline that LSA management should be personalised, combining medical and surgical approaches based on severity and patient response.

Background/Objectives: Psoriasis is a chronic inflammatory skin disease that may have a significant impact on patients’ quality of life. Alongside clinical scores, treatment goals include improvements in patients’ quality of life, divided into its social, working and psychosocial life aspects. Indeed, psychological impairment should always be considered in the management of moderate-to-severe psoriasis. Tildrakizumab, an anti-IL-23, is approved for the management of moderate-to-severe psoriasis. Both clinical trials and real-life studies show its efficacy and safety; however, no studies have evaluated how tildrakizumab may improve different domains of quality of life, including physical, psychological, and social aspects of patients’ quality of life. The objective was to evaluate the effectiveness of tildrakizumab in the management of moderate-to-severe psoriasis, focusing on the impact on all domains of patients’ quality of life. Methods: A 28-week multicenter, real-life, retrospective study was performed enrolling patients affected by moderate-to-severe psoriasis undergoing treatment with tildrakizumab. PASI and DLQI were evaluated at each follow-up (W16, W28). A sub-analysis of each DLQI question evaluated different domains of quality of life, including physical, psychological, and social aspects of patients’ quality-of-life. Results: A total of 62 patients were enrolled. At week 28, 97.1%, 85.7%, and 54.3% of patients achieved PASI75, PASI90, and PASI100, respectively. DLQI showed a significant reduction from baseline (20.3 ± 5.5) to week 28 (0.9 ± 2.2, p < 0.0001), with up to 82.9% achieving DLQI < 1. Sub-analysis of each question (Q1–Q10) showed a reduction in the value of each answer from baseline to week 28. Conclusions: The results confirm tildrakizumab as an effective and safe treatment in real life, positively affecting all domains of quality of life, with significant impact already appreciable at week 16 of follow-up.

Guselkumab has been shown to be safe and effective for the treatment of psoriasis in numerous randomized clinical trials and real-life studies. Real-life data on treatment up to 4 years are lacking. The present study aims to estimate the drug survival, effectiveness and safety of guselkumab over a period of 208 weeks. We included all consecutive patients with psoriasis or psoriatic arthritis receiving at least one dose of guselkumab. Effectiveness was evaluated as achieving 100% or ≥ 90% improvement in the Psoriasis Area and Severity Index (PASI 100 or PASI 90) and absolute PASI ≤ 3. Drug survival was evaluated using the Kaplan–Meyer curves. In total, 202 patients were studied. Their mean PASI decreased from 10.9 (SD 5.76) at baseline to 0.48 at week 208. Rates of PASI 100 response improved over time: the outcome was achieved in 30.0% and 65% of patients at weeks 16 and 208, respectively. For PASI 90 and PASI ≤ 3 we found similar trends. After 208 weeks of treatment, the estimated rate of drug survival was 68.5% in observed cases. Being super responders (SRs) according to our definition (P = 0.005) and the GUIDE definition (P < 0.001) reduced the risk of drug interruption, as did cardiovascular comorbidities. In our population, none of the baseline characteristics showed a clear impact on the effectiveness of guselkumab. Considering both SR definitions, in our cohort, being an SR was associated with a better response in the long term when considering PASI 100 and 90 in both linear and multivariate analyses. Our study confirms the good effectiveness and favourable safety profile of guselkumab in a real-world setting up to 4 years.

BACKGROUND:Brodalumab is a monoclonal antibody and IL-17 RA inhibitor that is approved for the treatment of moderate-to-severe psoriasis. The present study aims to estimate the drug survival (DS), effectiveness, and safety of brodalumab over a period of 156 weeks. METHODS:The primary objectives were: (i) to determine the treatment response rate at Weeks 16, 28, 52, 78, 104, and 156 as defined by PASI100, PASI90, and an absolute PASI ≤ 3 and (ii) long-term DS. Secondary objectives included the evaluation of possible predictive factors associated with the achievement of response outcomes, and possible predictive factors associated with lower DS. RESULTS:The treatment response was rapid, with 80.3% of patients achieving PASI ≤ 3, 66% PASI90, and 54.3% the complete clearance of disease at Week 16. The response improved at Week 28, when a plateau was achieved with mild loss of response at later time points, in particular for PASI100 and PASI90 in 55.2 and 65.5% of patients, respectively, at Week 156. After 156 weeks of treatment, 66.22% of patients were still on therapy, and the previous use of IL-17 inhibitors appeared to be associated with an increased risk of treatment discontinuation (HR: 2.51, CI: 1.06-5.98, P = 0.037), and achievement of PASI ≤ 3 until Week 16 with less risk (HR: 0.27 CI: 0.14-0.51, P < 0.001). Bio-naïve status was favorably associated with treatment response, while high BMI negatively affected the achievement of outcomes. CONCLUSION:Our study confirms the good effectiveness and favorable safety profile of brodalumab in a real-world setting for up to 3 years of treatment.

Introduction: the selective IL-17 inhibitor secukinumab has demonstrated efficacy and safety in the treatment of moderate–severe psoriasis in recent years. Objective: evaluate effectiveness and drug survival (DS) of secukinumab in patients with psoriasis for up to 5 years. Methods: This is a retrospective study on a monocentric cohort of patients with psoriasis on secukinumab evaluating the achievement of PASI100, PASI90, and PASI ≤ 3 and DS analysis up to 260 weeks. DS multivariate analysis was carried out considering sex, age, age of onset of the disease, obesity, cardiovascular comorbidities, diabetes, involvement of difficult-to-treat sites, psoriatic arthritis, treatment-naïve status, and mean baseline PASI. Results: At baseline, we evaluated 255 patients on secukinumab. PASI100 was reached by 41.7% and 70.6% of patients at weeks 16 and 260, respectively. PASI90 showed a similar trend with 46.5% of patients achieving it at week 16 and 88.2% at week 260. Non-obese patients showed a faster response than patients with obesity in achieving PASI100, PASI90, and PASI ≤ 3, with significant differences at 28 weeks [55% vs. 40% (p = 0.033), 64% vs. 49% (p = 0.038), and 76% vs. 62% (p = 0.036), respectively]. The estimated DS for secukinumab was 84.3% at 12 and 48% at 60 months. Obesity and smoking habits were associated with a higher risk of discontinuation in multivariate models (HR 1.6 CI 1.05–2.45, p = 0.028; HR 1.48 CI 1.01–2.17, p = 0.043, respectively). Conclusions: Secukinumab showed effectiveness for up to 5 years of treatment, with a high DS and achievement of PASI100, PASI90, and PASI < 3 at these time points. Only obesity reduced the response and maintenance of DS.

BACKGROUND:Inverse psoriasis (IP) is a variant of plaque psoriasis involving flexor surfaces. A clear definition of IP is still lacking. Therapy is based on topical and systemic treatments, including classic systemic drugs and biologic agents, but a well-defined therapeutic strategy is absent. MATERIALS AND METHODS:This retrospective study investigated the general characteristics of patients with IP or vulgar psoriasis and compared the effectiveness of anti-interleukin-17 or anti-interleukin-23 agents in the same groups. Second, treatment effectiveness and the demographic characteristics of IP patients treated with IL-23 and IL-17 inhibitors were also compared. IP patients were included if they had specific psoriatic involvement of the axillary, inguinal, or submammary lines, breast folds, antecubital and popliteal pits, intergluteal fold, and perianal area. Patients with vulgar plaque psoriasis and concomitant intertriginous involvement were included in the vulgar psoriasis cohort. RESULTS:Patients with IP were prevalently female and treated with IL-17 inhibitors compared to those with vulgar psoriasis. They also had a greater risk of drug discontinuation and subsequent therapeutical switch (32.1% vs. 18.1%, P = 0.002). At later time points, those with IP showed progressively slower achievement of PASI100 and 90 compared to the cohort with vulgar psoriasis. In the IP cohort, there was greater joint involvement in patients treated with an anti-IL-17 agent (P = 0.011), who also had a lower median age of onset (P = 0.011) compared to patients treated with an anti-IL-23 agent. Patients with IP treated with an anti-IL-23 agent initiated with a lower mean PASI and showed a slower response than patients on an anti-IL-17 agent. At later time points, progressively greater effectiveness of IL-23 inhibitors was observed compared to IL-17 inhibitors. CONCLUSIONS:Patients with IP responded less to biologic agents than those with vulgar psoriasis. In the IP cohort, IL-17 inhibitors had a faster onset than IL-23 inhibitors, but long-term anti-IL-23 agents seem to be associated with better outcomes.

ZusammenfassungHintergrundBiologika, die die Interleukine IL‐23 and IL‐17 hemmen, haben sich in der Behandlung der mittelschweren bis schweren Psoriasis als sicher und wirksam erwiesen.StudienzielMedikamenten‐Überleben bei Patienten mit Psoriasis zu untersuchen, die mit Biologika behandelt werden.Patienten und MethodenWir haben die Erreichung des PASI 90 und PASI ≤3 nach 16, 28, and 52 Wochen im Vergleich der IL‐17‐ und IL‐23‐Inhibitoren Brodalumab, Ixekizumab, Secukinumab, Risankizumab, Tildrakizumab und Guselkumab bei insgesamt 1057 Patienten untersucht sowie eine Drug Survival‐Analyse durchgeführt.ErgebnisseUnter IL‐17‐Inhibitoren wurden PASI 90 und PASI ≤3 schneller erreicht; nach 16 Wochen waren sie den IL‐23‐Inhibitoren signifikant überlegen (p <0,001; 56% vs. 42% beziehungsweise 70% vs. 59%). Im Drug Survival zeigte sich allerdings ein Vorteil für die IL‐23‐Inhibitoren; dieses betrug nach 24 Monaten 88% im Gegensatz zu 75% für die IL‐17‐Inhibitoren (p <0,001). In der multivariaten Analyse waren die IL‐23‐Inhibitoren (HR 0,54 CI 0,37–0,78, p = 0,001) sowie männliches Geschlecht (HR 0,57 CI 0,42–0,76, p <0,001) mit einer geringeren Wahrscheinlichkeit des Absetzens der Medikation assoziiert. Risankizumab (HR 0,42 CI 0,26‐0,69, p = 0,001), Guselkumab (HR 0,49 CI 0,24–0,99, p = 0,046) und männliches Geschlecht (HR 0,57 CI 0,43–0,77, p <0,001) waren mit geringerer Wahrscheinlichkeit des Absetzens der Medikation assoziiert als Secukinumab.SchlussfolgerungIL‐23‐Inhibitoren zeigten bezüglich des Drug Survival die besten Ergebnisse. Auf kürzere Sicht waren die IL‐17‐Inhibitoren wirksamer, aber die Langzeitergebnisse sprechen eher für die IL‐23‐Inhibitoren.

Background/Objectives: Patients with treated solid tumors (TST) are a highly heterogeneous and difficult-to-treat population due to the risk of disease progression/recurrence or infection. Methods: We conducted an observational, retrospective, single-center study at the Dermatology Clinic of Turin with a focus on the special population of cancer patients with psoriasis treated with biologics. Results: As of July 2023, 52 psoriatic patients with a prior/concomitant history of malignancy had taken biologic drugs. The median age was 67 years, and the median age of cancer onset was 55 years. The most common tumors were gastrointestinal cancer and melanoma. After the tumor diagnosis, 61% received an anti-IL17 drug; 37 patients continued the initiated biologic therapy, while 12 switched drugs due to secondary inefficacy. The estimated biologic DS was 55.6% at 50 months. Evidence suggests that IL-17 is a key pathogenic factor involved in tumorigenesis, resulting in a lower risk of malignancies in subjects managed with IL-17 inhibitors. Similarly, IL-23 plays a role in suppressing innate immunity and promoting tumor and metastases development. This is a consistent real-life case series that support the use of biologic drugs in patients with TST. Conclusions: IL-23 and IL-17 inhibitors, being immunomodulators rather than immunosuppressants, may be a safe option for patients in an active oncological setting and for immune-correlated adverse events.

Background: Biologics targeting IL-23 and IL-17 show efficacy and safety in the treatment of moderate-to-severe psoriasis. Objective: To investigate drug survival in patients with psoriasis treated with biologics. Patients and methods: We performed a comparative evaluation of the achievement of PASI 90 and PASI <= 3 at 16, 28, and 52 weeks along with a DS (drug survival) analysis with IL-17 and IL-23 inhibitors brodalumab, ixekizumab, secukinumab, risankizumab, tildrakizumab, and guselkumab on 1,057 patients. Results: IL-17 inhibitors showed a faster achievement of PASI 90 and PASI <= 3 with significant superiority over IL-23 inhibitors at week 16 (p < 0.001; 56% vs. 42% and 70% vs. 59%, respectively). A difference was shown in favor of IL-23 inhibitors regarding DS (p < 0.001), which was 88% at 24 months vs. 75% for IL-17 inhibitors. In multivariate analysis, IL-23 inhibitors (HR 0.54 CI 0.37-0.78, p = 0.001), and male sex (HR 0.57 CI 0.42-0.76, p < 0.001) were all associated with a lower probability of drug interruption. Risankizumab (HR 0.42 CI 0.26-0.69, p = 0.001), guselkumab (HR 0.49 CI 0.24-0.99, p = 0.046), and male sex (HR 0.57 CI 0.43-0.77, p < 0.001) were associated with a lower probability of drug interruption than secukinumab. Conclusions: IL-23 inhibitors showed the best performance on DS. Overall, the most effective class was IL-17 inhibitors considering the short-term effectiveness, but long-term effectiveness is in favor of anti-IL-23.

Background: Interleukin 23 (IL-23) inhibitors, such as guselkumab, risankziumab, and tildrakizumab, have proved to be highly effective and safe for psoriasis treatment either in bio-naïve or bio-experienced patients. A substantial proportion of patients show a primary or secondary inefficacy to IL-17 inhibitors and can benefit from an alternative line of treatment, like IL-23 inhibitors. To date, no sufficient data are available on the effectiveness of IL-23 inhibitors after an anti-IL-17 agent. Methods: Our study includes 48 patients with moderate to severe psoriasis undergoing a switch from IL-17 to IL-23 inhibitors. This trial is registered with SS_DERMO_20. Results: The mean PASI (Psoriasis Area Severity Index) decreases from 11.6 to 3.3 at week 16, with responses maintained at weeks 28 and 52 (2 and 1.4, respectively), and a PASI100 achievement in more than 24% of patients at 16 weeks and 61.9 at 48 weeks, with no occurrence of serious adverse events. However, almost one in six patients interrupted the IL-23 inhibitors mainly due to primary ineffectivenss. Conclusions: Our data support the evidence that an interclass switch among IL-17 inhibitors is a safe and effective therapeutic option for these patients.

Dear Editor, Psoriasis is an inflammatory skin disease with an important impact worldwide; its treatment comprises biological therapies targeting specific immune cytokines, such as interleukin17.1,2 Three molecules targeting this cytokine have been used over the years. Differences in pharmacodynamics and pharmacokinetics are responsible for differences in therapeutic efficacy. Studies directly comparing the longterm efficacy of the three available antiIL17 agents is still lacking.3– 5

A nationwide cross-sectional online survey was administered to dermatologists managing patients with moderate-to-severe plaque psoriasis across Italy to obtain real-world dermatologists’ perspectives on the impact of psoriasis and its treatment on patients’ daily lives and quality of life (QoL). A total of 91 dermatologists (aged 39.1 ± 11.2 years) completed a 31-question survey and workshop sessions were undertaken in order to identify the best management approach to achieve patient wellbeing. Social (4.2 ± 0.1), physical (4.26 ± 0.2) and mental components (4.1 ± 0.3) were rated by dermatologists as contributing to patient wellbeing to similar extents. While a high proportion (85.4%; rating of 4.3 out of 5) of dermatologists felt that they considered the QoL of patients, a lower proportion (69.6%; rating of 3.7 out of 5) felt that patients were satisfied in this regard. The psoriasis area and severity index and body surface area were the instruments most frequently used to assess the physical domain, while interviews/questions and the dermatology life quality index were used to assess social and mental domains, with only 60% of dermatologists following up on these aspects. The importance of investigating the presence of comorbidities was recognized but not always carried out by many dermatologists, (>70%), particularly for obesity and anxiety/depression. This survey identified key components contributing to barriers impacting on the QoL of patients with moderate-to-severe psoriasis from the perspective of the dermatologist.

Introduction. Psoriasis of the scalp, genital areas, and palms and soles represents a treatment challenge in clinical practice. Randomized clinical trials and real-life studies investigating the efficacy of biological drugs in these sites are scarce. The present is a descriptive retrospective real-life study with the aim to evaluate the efficacy and safety of brodalumab in these difficult-to-treat areas. Materials and Methods. 158 psoriatic patients with scalp involvement, 69 with genital involvement, and 54 with palmoplantar involvement being treated with brodalumab were assessed at weeks 16, 28, and 48 using PSSI (Psoriasis Scalp Severity Index), sPGA-G (Physician Global Assessment of Genitalia), and ppPASI (Palmoplantar Psoriasis Area and Severity Index). Results. The achievement of relative PSSIs (75%, 90%, and 100%) was already observed in week 16. 86% achieved PSSI75, 80% PSSI90, and 75% PSSI100. The sPGA-g 0/1 was achieved by 83% of patients at week 16 and 100% at week 24 and 48. At week 16 ppPASI75, 90, and 100 were all reached by 76.9% of patients; at week 24, 84.6% of patients reached all relative ppPASI. Conclusions. Brodalumab proved to be effective and safe in the treatment of scalp, genital, and palmoplantar regions.

Dear Editor. Biologics over the past 20 years have changed the treatment of psoriasis.1, 2 The need to switch biologics due to failure after prolonged use, or adverse events (AEs), has increased the proportion of patients with histories of biological failure or biologic-experienced.1, 3 Nevertheless, patients showing a rapid response are becoming increasingly common.4 The latter can be called super responders (SR).4 There is no consensus on the definition of SR concerning psoriasis.4 Reich et al.5 in the sub-analysis of Voyage 1 and 2 studies defined SRs as patients that achieved a PASI (psoriasis area severity index) 100 response at either week 20 or 28. Feldman et al.6 refer SR to patients that reach PASI100 at Weeks 12 and 24, and Eyerich et al.5 to patients that reach PASI100 by week 20 and maintain it at 28 weeks. Loft et al.7 defined SRs were patients treated with their first biologic for a minimum of 5 years PASI < 3 maintained between 6 months and 5 years of treatment. On the base of our real-life experience, we have defined SR as a patient who presents a fast and exceptional improvement with the first biological treatment: bio-naïve patients that reached PASI100 by the 16th week and maintained at 28th. We conducted a retrospective study on psoriatic patients treated with Il17 and Il23 inhibitors at the dermatology clinic of the Turin University Hospital to better characterize this population. Out of 1053 patients with the initial response to treatment with anti-IL17 and anti-Il23, 283 patients fell within our definition of SRs. Some demographic and disease patterns that might be more frequently associated with SRs than non-SRs were then analysed (table 1). Superresponder patients were found to be younger (mean age 52.2 SD 15.9 vs. 55.6 SD 15.4 p < 0.001) with lower BMI (25.9 SD 4.6 vs. 27.5 SD 5.8 p < 0.001) and with earlier onset of psoriasis (age 32.6 SD 17.6 vs. 35.9 SD 17.5 p < 0.001), than non-SR, no differences in disease duration were observed. Concerning comorbidities, lower rates of obesity and diabetes mellitus were observed (16.2% vs. 25.7% p < 0.001, and 7.4% vs. 13.8% p = 0.008). No significant differences were found for joint involvement and difficult sites (scalp, nails, folds, palms and soles). Superresponders have a higher initial PASI than non-SRs (15.3 vs. 14.4 p = 0.037), but not mean Dermatology Life Quality Index (DLQI) at baseline. Concerning biologic therapies SRs are more likely to be treated with anti-IL17 (p < 0.001), with ixekizumab and brodalumab being the drugs with the highest number of SRs (35.5% and 30.5%). Superresponders had a lower frequency of drug discontinuation (11.7% vs. 22% p < 0.001). In the literature, the patterns associated with the various definitions of SR were low body weight and BMI, lower obesity rate, less traditional systemic drugs used before the first biologic, and lower disease severity at baseline.5, 7 Talamonti et al.8 showed a faster response in patients with HLA-C*06:02 positive, generally younger and with lower disease severity at baseline. Feldman et al. showed a correlation between rapid reduction in the DLQI and Visual Analogue Scale for pain and SR status. Our results are in line with what has been reported in the literature, despite the slightly different definition. Superresponders are younger patients, with lower rates of obesity, diabetes mellitus and lower weight, and have an earlier development of disease than non-SRs. The higher initial mean PASI is related to the bio-naive condition. The higher rate of anti-Il17 gives reason for the higher frequency of SRs being treated with these biologics.9 The monocentric and retrospective nature are the main limitations of this study, highlighting the need for dedicated studies, clinical and translational, to arrive at a shared definition of this special population. LM wrote the paper, performed the research, designed the research study and analysed the data. SS, CC, GA, AV, ES and MO performed the research. PQ contributed essential reagent tools. PD contributed essential reagent tools and performed the research. SR designed the research study, analysed the data and contributed essential reagent tools. None. None.

IntroductionPsoriasis affecting the genital, palmoplantar, and scalp regions is recognized as difficult-to-treat, and data on the efficacy of biologics in these areas remains limited.Research design and methodsThis single-center study evaluated the efficacy of anti-IL-17 and anti-IL-23 agents on scalp, genital, and palmoplantar psoriasis. We retrospectively analyzed data from all patients with psoriasis being treated with IL inhibitors at our clinic. Efficacy was evaluated at 16, 28, and 52 weeks, according to the achievement of relative and mean PSSI, PGA-G, and ppPASI.ResultsIn all, 308 patients showed involvement of the scalp, 136 in the genital area, and 94 in the palmoplantar regions. On scalp psoriasis, anti-IL-17 agents demonstrated superiority in disease control compared to anti-IL-23 agents. PSSI100 at week 16 was reached by 59% of patients on an anti-IL17 vs 39.8% on an anti-IL-23 (p < 0.003). At genital sites, no significant differences between anti-IL-17 and anti-IL-23 agents were observed, and all classes achieved PGA-G 0/1. No significant differences between anti-IL-17 and anti-IL-23 agents were observed in palmoplantar areas.ConclusionsThe present data support the utility of both anti-IL-17 and anti-IL-23 agents for the treatment of difficult-to-treat areas in patients with psoriasis. Anti-IL-17 agents achieved better control of scalp psoriasis.

The emergence of Neisseria gonorrhoeae isolates displaying resistance to antimicrobials, in particular to ceftriaxone monotherapy or ceftriaxone plus azithromycin, represents a global public health concern. This study aimed to analyze the trend of antimicrobial resistance in a 7-year isolate collection retrospective analysis in Italy. Molecular typing on a subsample of gonococci was also included. A total of 1,810 culture-positive gonorrhea cases, collected from 2013 to 2019, were investigated by antimicrobial susceptibility, using gradient diffusion method, and by the N. gonorrhoeae multiantigen sequence typing (NG-MAST). The majority of infections occurred among men with urogenital infections and 57.9% of male patients were men who have sex with men. Overall, the cefixime resistance remained stable during the time. An increase of azithromycin resistance was observed until 2018 (26.5%) with a slight decrease in the last year. In 2019, gonococci showing azithromycin minimum inhibitory concentration above the EUCAST epidemiological cutoff value (ECOFF) accounted for 9.9%. Ciprofloxacin resistance and penicillinase-producing N. gonorrhoeae (PPNG) percentages increased reaching 79.1% and 18.7% in 2019, respectively. The most common sequence types identified were 5,441, 1,407, 6,360, and 5,624. The predominant genogroup (G) was the 1,407; moreover, a new genogroup G13070 was also detected. A variation in the antimicrobial resistance rates and high genetic variability were observed in this study. The main phenotypic and genotypic characteristics of N. gonorrhoeae isolates were described to monitor the spread of drug-resistant gonorrhea.

BACKGROUND:Although long-term management of psoriasis is paramount, this approach is challenging in clinical practice. In the recent PSO-LONG trial, a fixed-dose combination of betamethasone dipropionate (BD) and calcipotriol (Cal) foam applied twice a week on non-consecutive days for 52 weeks (proactive treatment) reduced the risk of relapse. However, the role of Cal/BD foam in the long-term management of psoriasis needs further clarifications. The ProActive Management (PAM) program, a nationwide Italian project, aims at reaching a consensus on the role of proactive management of psoriasis. METHODS:A steering committee generated some statements through the nominal group technique (NGT). The statements were voted by an expert panel in an adapted Delphi voting process. RESULTS:Eighteen statements were proposed, and the majority of them (14/18) reached a consensus during the Delphi voting. The need to provide long-term proactive topical treatment to reduce the risk of relapse for the treatment of challenging diseases sites or in patients where phototherapy or systemic therapies are contraindicated/ineffective was widely recognized. A consensus was reached about the possibility to associate the proactive treatment with systemic and biological therapies, without the need for dose intensification, thus favoring a prolonged remission. Moreover, the proactive treatment was recognized as more effective than weekend therapy in increasing time free from relapses. Approaches to improve adherence, on the other hand, need further investigation. CONCLUSIONS:The inclusion in guidelines of a proactive strategy among the effective treatment options will be a fundamental step in the evolution of a mild-moderate psoriasis therapeutic approach.

Dear Editor, Tildrakizumab was approved in Europe in 2018 for the treatment of moderate-to-severe psoriasis, and its blockade of the p19 subunit of the IL23 provides efficacy and long-term maintenance, of treatment response, with a favorable safety profile in several phase III trials. Although registration studies and recent meta-analyses show a lower efficacy of tildrakizumab compared to other IL23 inhibitors, real-life evidence appears more promising, even in the management of obese patients and with the involvement of difficult sites. We conducted a retrospective study at the dermatology clinic of the University Hospital in Turin on patients treated with tildrakizumab over the last 2 years, with a maximum follow-up of 52 weeks, evaluating the response in terms of PASI (psoriasis-area-severity-index), absolute (mean and <3) and relative (PASI75, 90, and 100) and the impact on quality of life (via DLQI dermatology-life-quality-index). Among 1635 psoriatic patients on biologics attending our clinic, 129 received tildrakizumab. 120 patients reached 16 weeks of treatment, 102, 80, and 42 reached weeks 28, 40, and 52, respectively. Characteristics of general populations were summarized in table 1. Mean initial PASI was 9.7 (±3.4) and DLQI was 26.53 (±2.47). Mean PASI fell to 2.58 (±2.16) at 16 weeks, 1.76 (±1.83), 1.61 (±1.88), and 1.25 (±1.79) at weeks 28, 40, and 52, respectively. DLQI fell to 2.52 at week 40 (±4.62) and 2.58 (±5.17) at week 52, with a DLQI 0/1 reached by 46 patients (58%) and 34 (62%) at week 40 and 52. The percentage of patients achieving PASI100 progressively increased at various time points from 20% at week 16 to 48% at week 52. Similar observations are possible for PASI90 which increased from 28% to 53% in the same time interval, PASI75 from 55% to 76%, and PASI<3 from 64% to 71%. In Figure 1, it can be observed that for PASI100 at week 52 a plateau is not yet. Relative to previous use of biological drugs, bio-naive patients did not show a significant advantage over bio-experienced patients with tildrakizumab. Similar observations can be made in the case of joint involvement or not. Involvement of difficult sites results in significant differences in the attainment of PASI100 at weeks 16, 28, and 40 (11% vs. 30% p = 0.034, 16% vs. 42% p = 0.042, and 21% vs. 55%, p = 0.01), PASI75 and 90 and mean PASI at week 40 (59% vs. 95% p = 0.004, 35% vs. 75% p = 0.01, and 2.1 vs. 0.75 p = 0.005). Tildrakizumab showed to be effective and safe in the treatment of moderate–severe psoriasis in line with previous real-life studies and clinical trials, it does not appear to be influenced by the arthritic component or previous treatment failures, unlike risankizumab which showed less efficacy. Overall, our population showed less efficacy in achieving PASI75, 90, and <3 than was reported by Caldarola et al. at week 28 (81.40% vs. 75%, 64.4% vs. 48%, and 79.7% vs. 75%, respectively), these differences are also found concerning other reallife trials. The achievement of relative PASIs is in line with the results of the registration studies resurface-1 and -2 which showed the attainment of PASI75, 90, and 100 at 28 weeks in 80%, 52%, and 24%, 73%, 55%, and 22% of patients, respectively. Although the Galluzzo et al. study shows good efficacy in the management of difficult sites, in our population the involvement of these sites limits the achievement of relative PASI 90 and 100. Limit of our study is the low number of patients at 52 weeks and the low mean baseline PASI. Despite clinical trials showed an apparently lower efficacy of tildrakizumab compared to other IL23 inhibitors, the low influence of comorbidities and prior therapeutic experience and the progressive