This cross-sectional study examines dermoscopic features associated with malignant melanocytic longitudinal melanonychia in patients with skin of color.

Objectives: Female pattern hair loss (FPHL) is a common non-scarring alopecia characterized by progressive follicular miniaturization. The Sinclair scale is widely used for clinical grading but lacks objective quantification. Trichoscopy provides measurable parameters that may improve diagnostic precision. The objectives of the study are to evaluate trichoscopic parameters as indicators of Female pattern hair loss (FPHL) severity and to develop and validate a quantitative trichoscopic grading system in comparison with the Sinclair scale. Material and Methods: This retrospective multicentric study under the aegis of the International Dermoscopy Society included 279 treatment-naïve females (18–50 years) with FPHL. Trichoscopy was performed at standardized frontal scalp points using polarized dermoscopy. Parameters assessed included hair count, shaft diameter, single hair units, terminal-to-intermediate/vellus (T: I–V) ratio, and qualitative features (hair diameter diversity, yellow dots, and peripilar sign). Patients were graded using the Sinclair scale. A novel quantitative grading system (score range 4–20) based on four parameters was applied. Statistical analysis included analysis of variance (ANOVA), Pearson correlation, and Chi-square tests. Results: Most patients were Grade 3 (47%) and Grade 4 (36.6%). Significant progressive decline was observed in hair count (172 ± 10–92 ± 12 hairs/cm 2 ), shaft diameter (66 ± 5–33 ± 3 μm), and T: I–V ratio (3.4 ± 0.6–0.4 ± 0.3) with increasing severity, while single hair units increased (34 ± 5–63 ± 3%). Strong negative correlations were noted between grade and hair count (r = −0.60), diameter (r = −0.65), and T: I–V ratio (r = −0.67) ( p < 0.01). ANOVA showed significant differences across grades for all major quantitative parameters ( p < 0.001), except T: I–V ratio. Qualitative features lacked grading specificity. Conclusion: Trichoscopic quantitative parameters are reliable indicators of FPHL severity. The proposed grading system complements the Sinclair scale by providing an objective, reproducible tool for early diagnosis, severity assessment, and treatment monitoring.

Purpose:This multicentre cross-sectional study aimed to quantify caregiver burden among elderly patients with atopic dermatitis (AD) and to identify its principal clinical, functional, and symptomatic determinants. Specifically, we evaluated the relative contributions of functional impairment, caregiving intensity, and inflammatory severity to overall caregiver burden. Patients and Methods:A total of 213 patient-caregiver dyads were consecutively recruited from four tertiary dermatology centers in Italy. Eligible patients were aged ≥65 years with dermatologist-confirmed AD. Clinical assessments were performed by board-certified dermatologists at each participating centre and included the Eczema Area and Severity Index (EASI), body surface area (BSA), pruritus and sleep disturbance (numeric rating scales), comorbidities, and functional status measured by Activities of Daily Living (ADL) and Instrumental Activities of Daily Living (IADL). Caregivers completed a structured questionnaire on caregiving responsibilities and the Caregiver Burden Inventory (CBI). Associations were examined using Spearman correlation and multivariable linear regression models. Results:Patients had a mean age of 73.3 ± 7.3 years and moderate disease severity (mean EASI 13.3 ± 11.2). Functional impairment was common (median ADL 4.0), and caregivers reported a median of 2.5 daily hours of assistance. Overall burden was moderate (mean CBI 32.0 ± 14.0). CBI correlated most strongly with ADL impairment (ρ = -0.50) and daily caregiving hours (ρ = 0.47), with additional associations for sleep disturbance (ρ = 0.35) and EASI (ρ = 0.31). In multivariable analysis, ADL impairment (p < 0.001), caregiving hours (p = 0.031), sleep disturbance (p < 0.001), and EASI (p = 0.005) remained independently associated with burden; pruritus was not significant after adjustment. Conclusion:Caregiver burden in elderly AD is primarily driven by functional dependence and caregiving intensity, with additional contributions from sleep disturbance and inflammatory severity. Integrating functional assessment and caregiver-focused strategies into routine care may improve outcomes for both patients and caregivers.

INTRODUCTION:Up to 30% of patients with psoriasis develop psoriatic arthritis (PsA) during their lifetime, which can result in irreversible joint damage. Early identification and interception of PsA could potentially decrease inflammation and progression of structural damage. This review summarizes the state of the art on psoriasis-to-PsA transition and discusses the challenges to prevent and early manage PsA. AREAS COVERED:One primary hurdle clinicians face is their inability to establish an early PsA diagnosis because of the poor specificity of symptoms. Arthralgia, severe psoriasis, a history of uveitis, nail psoriasis, scalp psoriasis, having a first-degree relative with PsA, familial aggregation, genetic factors, specific skin phenotypes, mechanical stress, and obesity confer an increased risk of PsA transition. However, underlying molecular and cellular mechanisms remain poorly defined. EXPERT OPINION:The evolution from cutaneous to synovio-entheseal inflammation in patients with psoriasis presents an opportunity to investigate the critical events linked to arthritis development. Further efforts should be made to clearly define early PsA and identify patients with psoriasis at increased PsA risk. Machine learning and artificial intelligence may analyze and integrate different factors to more objectively estimate the possible risk of psoriasis to PsA transition for each patient.

Lentigo maligna (LM) is a subtype of cutaneous melanoma in situ that develops on chronically sun-damaged skin in elderly individuals. Its diagnosis and management remain challenging due to its slow progression, frequent occurrence on cosmetically sensitive areas in frail individuals, and tendency for subclinical peripheral extension. Despite its potential for invasive transformation, the natural history of LM remains incompletely understood and evidence-based management strategies for this specific entity remain limited. This work aims to bridge the gap between scarce high-quality evidence and the clinicians' need for practical guidance on LM management by formulating evidence-based and expert consensus-driven recommendations for diagnosis, treatment and follow-up. Under the coordination of the International Dermoscopy Society, a global, multidisciplinary consortium of 53 experts-including dermatologists, dermato-oncologists, dermatologic surgeons, radiologists, radiotherapists, pathologists and epidemiologists-formulated recommendations through structured consensus, informed by a comprehensive review of current scientific evidence and clinical practice standards. Optimal management of LM requires accurate diagnosis and individualized treatment planning. Non-invasive skin imaging techniques, especially dermoscopy and reflectance confocal microscopy, aid in diagnosis, biopsy orientation, lesion delineation and post-treatment monitoring. Multiple partial biopsies help confirm diagnosis and rule out invasion. Complete surgical excision remains the first treatment option. No definitive safety margins can be recommended for standard surgery; margin-controlled techniques are preferable for large or ill-defined lesions. Topical imiquimod and radiotherapy are effective alternatives where surgery is unsuitable. Topical imiquimod is useful as primary, adjuvant or neoadjuvant therapy. Blind destructive methods should be avoided. Close clinical and imaging follow-up is needed. Patient-centred care, shared decision-making, and a multidisciplinary approach are critical for optimal outcomes. These international consensus recommendations summarize current best practices for LM management, offering practical, evidence-informed guidance to clinicians while acknowledging the potential of future research in refining these conclusions.

Although recognition of prurigo nodularis (PN) and lichen simplex chronicus (LSC) of the scalp is usually straightforward, they may sometimes pose difficulties in terms of differential diagnosis with other similar dermatoses. The aim of this observational retrospective study was to assess dermoscopic features of PN and LSC of the scalp across fair- and dark-skinned individuals and compare them with those of clinical mimickers. Fair-skinned (Fitzpatrick phototypes I–III) and dark-skinned (Fitzpatrick phototypes IV–VI) patients with a histological diagnosis of PN/LSC of the scalp, along with controls, were considered. All the images were randomly evaluated by two independent investigators to identify findings according to standardized criteria. Interobserver agreement was evaluated through Cohen’s kappa coefficient, while Fisher’s exact test with p value set at 0.01 was used for comparative analyses between cases and controls. The study included 79 cases, including 40 instances of PN/LSC of the scalp (27 with fair skin and 13 with dark skin) and 39 controls. The most common dermoscopic findings (> 1/3 of cases) of PN/LSC in both light and dark phototypes included sparse follicular plugs, broken hairs, purple structureless areas, broom-like hairs, and erosions. Additionally, purple dots, perivascular white halo and dotted vessels with unspecific distribution were also common in fair skin, while white lines (peripheral-radial) and structureless areas turned out to be as frequent in dark skin. Comparative analysis showed that dotted vessels, follicular plugs, broken hairs, broom-like hairs, purple structureless areas, and perivascular white halo were more common compared to control in light phototypes, whereas only erosions, peripheral white lines, and purple structureless areas reached statistical significance in dark-skinned patients (p < 0.01). Kappa values were 0.88 and 0.81 for fair and dark skin, respectively. Dermoscopy is a valuable adjunct in the non-invasive diagnosis of PN and LSC of the scalp, with good reproducibility across skin phototypes.

Introduction: Arthralgia is a frequent but often overlooked symptom in patients with psoriasis (PsO) and may represent an early manifestation of psoriatic arthritis (PsA). Objective: To provide a practical overview aiming to support dermatologists in the identification and management of arthralgia in PsO. Methods: An expert panel comprising three dermatologists and two rheumatologists convened to discuss data from a literature search of PubMed/MEDLINE and EMBASE conducted using the terms “arthralgia” and “psoriasis.” Relevant studies were qualitatively analyzed based on clinical relevance and available data on epidemiology, pathophysiology, diagnosis, and management. Results: Predictors of PsA development and distinctions between inflammatory and noninflammatory joint pain are presented, and the main differential diagnoses such as osteoarthritis and fibromyalgia are discussed. The importance of validated screening tools, early imaging, and timely rheumatology referral is emphasized, along with recommendations for patient education and risk factor management. Conclusions: Dermatologists play a central role in the early detection of arthralgia in patients with PsO. Timely rheumatology referral is essential to facilitating early intervention, preventing irreversible joint damage, and improving long-term outcomes.

BACKGROUND:Dermoscopy is a non-invasive technique used to preliminary assess skin lesions in humans and, more recently, in animals. Calcinosis cutis (CC) is an uncommon condition in dogs characterised by cutaneous calcification typically secondary to iatrogenic hyper-glucocorticism or endogenous hyper-adrenocorticism. OBJECTIVES:The aim of this study was to describe and characterise the dermoscopic features of CC in dogs affected by hyper-cortisolism, either iatrogenic or spontaneous, and assess the inter-observer agreement of the dermoscopic parameters. MATERIALS AND METHODS:Twelve lesions from 12 client-owned dogs, histologically diagnosed as CC associated with spontaneous or iatrogenic hyper-cortisolism, were included in this study. Dermoscopic images of the lesions at ×10 magnification were independently evaluated on a computer screen by three ECVD board-certified veterinary specialists and one ECVD resident. RESULTS:At ×10 magnification, all lesions exhibited single or multiple structureless bright white areas and erythema. In eight of the 12 lesions, these white areas surrounded prominent plugs of yellowish-to-brown material emerging from follicular ostia and/or epidermal ulcerations. The main vascular pattern was dominated by a single vessel type (monomorphic pattern), consisting mainly of short, dilated, linear curved vessels (seven of 12), with short linear vessels observed in four lesions. Histopathological results confirmed that the white structures observed dermoscopically corresponded to calcium deposits within the dermis. A specific association was not observed between dermoscopic features and the distribution or localisation of mineralisation described in the histological evaluations. CONCLUSIONS AND CLINICAL RELEVANCE:Dermoscopy represents a useful technique to assess CC in dogs.

Lebrikizumab, a monoclonal antibody targeting interleukin-13, has demonstrated efficacy and safety in adults with moderate-to-severe atopic dermatitis (AD), but data in elderly patients remain limited. We conducted a retrospective multicentre study including 90 patients aged ≥60 years with moderate-to-severe AD treated with lebrikizumab across 23 Italian dermatology centres. Clinical outcomes were assessed at baseline and at weeks (W)16, W24 and W52. Mean EASI decreased from 23.24 ± 7.93 at baseline to 6.33 ± 6.54 at W16, 3.57 ± 3.74 at W24 and 2.70 ± 4.83 at W52 (p < 0.0001). EASI75 was achieved by 58.4%, 82.0% and 87.0% of patients at W16, W24 and W52, respectively. Clinical responses were similar across age groups and independent of prior biologic or JAK inhibitor exposure. Adverse events occurred in 7.8% of patients and were mainly mild. These findings support the effectiveness and safety of lebrikizumab in elderly patients with AD in real-world clinical practice.

Background:Over recent years, dermoscopy has proven useful not only for diagnosing skin conditions but also as a tool for predicting treatment response in inflammatory dermatoses. However, no data are available on dermoscopic predictors in papulopustular rosacea (PPR). Objective:To evaluate whether certain clinical and dermoscopic findings serve as positive or negative predictors of response to topical ivermectin or metronidazole in PPR. Methods:Twenty-three patients with moderate-to-severe PPR were enrolled. Ten patients received ivermectin 10 mg/g cream and 13 received metronidazole 1% gel (non-randomized, based on physician preference), applied once daily for 8 weeks. Inflammatory lesion counts and key clinical/dermoscopic features were assessed at baseline and after 8 weeks by two independent, blinded physicians. Post-treatment clinical outcomes (optimal response: >75% lesion reduction; partial response: 50-75% reduction) were correlated with baseline features. Results:Both treatments significantly reduced inflammatory lesion counts (p<0.001 for both). Any response (optimal or partial) occurred in 7/10 (70%) ivermectin-treated and 8/13 (62%) metronidazole-treated patients. Optimal response occurred in 5/10 (50%) ivermectin-treated and 4/13 (31%) metronidazole-treated patients. In the ivermectin group, all patients who achieved optimal response had baseline protruding follicular plugs (PFPs) (5/5, 100%) in dermoscopy, which are indicators of demodex tails. Those with partial or minimal/no response in the ivermectin group did not have baseline PFPs (0/5). Baseline PFPs were significantly associated with optimal response to ivermectin (p=0.004). In the metronidazole group, all 4 optimal responders did not have baseline PFPs. All the 4 patients in the metronidazole group with baseline PFPs showed minimal/no response, though this was not statistically significant (p=0.176). No other baseline features significantly predicted response in either treatment group. Conclusion:PFPs in dermoscopy of moderate-to-severe PPR serve as positive predictors for optimal response to topical ivermectin, but not metronidazole. This observation warrants validation in larger controlled trials.

BACKGROUND:Tirbanibulin 1% ointment is a short-course field therapy for actinic keratosis (AK). Real-world data on predictors of response, tolerability, and satisfaction may support patient selection and counselling. The aim was to evaluate effectiveness and tolerability in a large multicenter cohort, identify predictors of high clinical clearance and local skin reactions (LSRs), and describe patient and physician satisfaction. METHODS:This retrospective observational real-life study (33 Italian dermatology centers) included 679 patients. Clinical response was classified as complete (100%), good (75-99%), moderate (50-74%), or <50% clearance; high clearance was defined as ≥75%. AK severity was assessed using AK Area and Severity Index (AKASI). LSRs were graded 0-4, and a total score was calculated. Satisfaction was rated 0-4 (scores 3-4 indicated high satisfaction.) Multivariable logistic regression identified predictors of high clearance, erythema, and vesiculation/pustulation. RESULTS:Patients were predominantly male (70.8%), mean age 74.9±9.7 years; 77.6% were AK-experienced. All patients completed treatment. High clearance occurred in 69.7% and was greater in AK-naïve patients (78.3% vs. 67.1%, P<0.001). Mean AKASI decrease was 63.2%; photodamage improvement was 30.5%. Tolerability was favorable (mean LSR score 0.65±0.90); 11.9% of LSRs were ≥3, with no grade 4 vesiculation/ulceration occurring. Lower Olsen grade independently predicted high clearance. Female sex and age ≥75 years were associated with higher odds of selected LSRs. High satisfaction was reported by 79.4% of patients and 83.1% of physicians. CONCLUSIONS:Tirbanibulin 1% achieved high clearance with favorable tolerability and satisfaction, supporting its use in individualized management of field cancerization.

Topical ruxolitinib 1.5% cream is the first approved therapy for repigmentation in non-segmental vitiligo. However, treatment response varies, and reliable predictors of efficacy remain undefined. This narrative review examined clinical trials and observational studies investigating factors associated with response to ruxolitinib cream. A comprehensive search of MEDLINE, Cochrane CENTRAL and ClinicalTrials.gov (through June 2025) identified 14 eligible studies. Anatomical site was the most consistent predictor, with facial lesions showing the highest repigmentation rates and acral areas demonstrating poor response. Early clinical improvement was associated with better long-term outcomes. Long-term data indicated that repigmentation can persist after treatment discontinuation in a substantial proportion of patients. Demographic and disease-related variables, including age, sex, disease duration and phototype, showed mixed results across studies. Adjunctive narrowband UVB improved repigmentation in initial non-responders but provided limited benefit in early responders. Exploratory biomarker data suggested that Th2 cytokine profiles and reductions in CXCL10 levels may be linked to response, although these findings remain unvalidated. Overall, anatomical location and early clinical response appear to be the most reliable indicators of ruxolitinib efficacy. Further studies with standardized endpoints and predictive modelling are needed to guide individualized treatment strategies in vitiligo.

BACKGROUND:Scabies is a neglected tropical disease with a worldwide distribution. Although uncommon in high-income countries, its incidence has increased in recent years, accompanied by growing reports of treatment failure, particularly with topical permethrin. Observational data from high-income settings remain scarce. We aimed to evaluate the effectiveness of first-line scabies treatments and to identify predictors of treatment failure in Italy. METHODS:SCAB-net was a national, prospective, multicentre observational study conducted in 28 Italian dermatology centres between June 20, 2024, and Dec 31, 2025. Index cases were diagnosed according to International Alliance for the Control of Scabies criteria and followed up until recovery. Treatment selection was left to the discretion of clinicians according to routine clinical practice and included permethrin 5% cream, oral ivermectin 200 μg/kg, benzyl benzoate 10-25% lotion, and their combinations. The primary outcome was clinical cure in the index case. Multivariable logistic regression was used to evaluate associations between clinical factors and recovery. FINDINGS:Among the enrolled 1751 index cases, 1640 had complete treatment data. Benzyl benzoate monotherapy achieved the highest cure rate (84·2% [250 of 297]), significantly outperforming permethrin (42·5% [433 of 1019]; odds ratio [OR] for non-cure permethrin vs benzyl benzoate 6·85, 95% CI 4·65-10·09, p<0·0001). Cure rates with ivermectin were similar to benzyl benzoate (81·6% [449 of 550], p=0·35). Combination therapies did not significantly improve outcomes compared with benzyl benzoate alone. Environmental decontamination counselling was associated with reduced odds of treatment failure (OR 0·39; 95% CI 0·26-0·57; p<0·0001), whereas immunosuppression (OR 2·34; 1·22-4·49; p=0·010) and foreign nationality (OR 1·36; 1·05-1·75; p=0·018) were associated with increased risk. INTERPRETATION:In this observational study from a high-income country, permethrin showed substantially reduced effectiveness compared with benzyl benzoate or ivermectin. These findings support reconsideration of current scabies treatment recommendations. FUNDING:None. TRANSLATIONS:For the Italian translation of the abstract see Supplementary Material section.

Hidradenitis suppurativa (HS) is a chronic, recurrent, and debilitating inflammatory dermatosis affecting approximately 1% of the population, with a female predominance and substantial psychosocial burden. Clinically, it presents with painful nodules, abscesses, and draining tunnels that often progress to fibrosis and long-term disability. Pathogenesis is multifactorial, encompassing follicular occlusion and rupture, dysbiosis, neutrophil-rich inflammation, and cytokine networks driven by tumor necrosis factor-alpha and interleukin-17 (IL-17), and despite advances, major challenges persist, including phenotypic heterogeneity, diagnostic delays, and the limited durability of monotherapies. This narrative review critically synthesizes evidence on combination strategies in HS following a systematic search of PubMed, Embase, and Cochrane (2009–July 2025), including randomized and nonrandomized trials, cohorts, and case series (⩾10 patients) that evaluated multimodal approaches (antibiotics plus biologics, biologics within surgical pathways, small molecules in combination, laser/light-based therapies, and structured wound care). Outcomes of interest included Hidradenitis Suppurativa Clinical Response, International Hidradenitis Suppurativa Severity Score System (IHS4)/IHS4-55, tunnel resolution, patient-reported measures (Dermatology Life Quality Index), flare frequency, and safety; qualitative synthesis was performed according to Scale for the Assessment of Narrative Review Articles criteria. Antibiotics remain valuable for induction or bridging: clindamycin–rifampicin and multidrug regimens (rifampin–moxifloxacin–metronidazole, ertapenem) yield meaningful but time-limited benefit, optimally used as preparatory steps toward long-term interventions. Biologics form the backbone of durable disease control (adalimumab, secukinumab, bimekizumab), with enhanced outcomes when initiated alongside antibiotics or integrated perioperatively with surgery for tunnel eradication. Among small molecules, Janus kinase inhibitors (e.g., upadacitinib) show promising efficacy; apremilast and IL-36 blockade are exploratory options; sirolimus and conventional immunosuppressants retain niche utility in syndromic or refractory phenotypes. Adjunctive measures, including laser/light therapies, structured wound care, metabolic interventions (notably glucagon-like peptide-1 receptor agonists), smoking cessation, and psychological support, further consolidate disease control, while multidisciplinary care models optimize sequencing, comorbidity management, and recurrence reduction. In conclusion, combination therapy has emerged as the organizing principle of modern HS management: integrating antibiotic induction, biologics for long-term modification, targeted surgery, and adjunctive measures enables deeper and more durable responses. Future priorities include treat-to-target strategies, biomarker-guided selection, antimicrobial stewardship, and pragmatic real-world evaluations to advance toward near-clearance in a broader patient population.

Background and Objectives: Artificial intelligence (AI) has transitioned to an integral part of dermatology in only few years, yet perceptions of its use vary widely, reflecting diverse hopes, concerns, and perceived clinical utility. Materials and Methods: In this study, 300 dermatologists from 13 countries, representing a range of experience levels and AI usage statuses, were surveyed regarding the characteristics and applications of AI in dermatology. Results: Among respondents, 61.33% reported having used AI tools in clinical practice. Adoption of AI was observed across all age groups, countries, and experience levels. Analysis of the types of AI tools used revealed a strong reliance on general-purpose large language models (LLMs), with chatbots being the most frequently cited category, utilized by 58.15% of users. Younger clinicians demonstrated a significant preference for chatbots (p < 0.05). Country-specific patterns in AI adoption were also noted. The most highly rated expected benefit of AI in dermatology was improved diagnostic accuracy, while the primary concern centered on regulatory and ethical limitations, suggesting that the “AI revolution” in dermatology is currently constrained less by technical barriers and more by regulation considerations. Use of consent forms when AI use takes place was more frequently reported as mandatory by dermatologists who had never used AI, reflecting heightened caution among non-users (p = 0.03). Additionally, 75% of respondents agreed that formal training in AI is necessary, highlighting a significant gap in traditional medical education regarding emerging technologies.

BACKGROUND:Dermoscopy is a noninvasive imaging technique that is well-established in human dermatology, where it enhances the diagnosis of neoplastic, inflammatory, infectious, and alopecic skin disorders. In veterinary dermatology, its use is expanding yet remains heterogeneous and largely descriptive, despite growing evidence of conserved dermoscopic patterns across species. HYPOTHESIS/OBJECTIVES:To review the applications of dermoscopy in veterinary dermatology, and to provide a comparative analysis of dermoscopic features observed in dogs, cats, and horses in relation to corresponding findings in human dermatology. MATERIALS AND METHODS:A systematic review of the literature reporting dermoscopic findings in veterinary dermatology was conducted in accordance with PRISMA guidelines. PubMed, Scopus and Google Scholar were searched for studies published up to 30 July 2025. Eligible studies included original articles describing dermoscopic features in dogs, cats, or horses. Extracted data included species, dermatological condition, dermoscopic findings, device type and histopathological correlation, when available. Levels of evidence were assessed using the Oxford Centre for Evidence-Based Medicine criteria. RESULTS:Thirty studies met the inclusion criteria. Most were descriptive case reports or case series. Dermoscopy was applied to a wide range of conditions, including alopecias, parasitic infestations, dermatophytosis, neoplastic and sebaceous lesions, inflammatory dermatoses, and congenital vascular anomalies. Recurrent dermoscopic features showed strong similarities to those described in human dermatology, although species-specific anatomical differences influenced interpretation. CONCLUSIONS:Dermoscopy represents a valuable adjunct diagnostic tool in veterinary dermatology, with clear translational relevance. Standardisation of terminology and further prospective studies are required to support its broader clinical integration.

Bimekizumab, a dual interleukin (IL)-17A and IL-17F inhibitor, has demonstrated high efficacy in clinical trials for moderate-to-severe plaque psoriasis. However, real-world evidence regarding its long-term effectiveness, safety, and treatment persistence up to 2 years remains limited. This study evaluates these outcomes in a routine clinical setting. We conducted a retrospective, multicenter, real-world study across three Italian referral centers, including 126 adult patients with moderate-to-severe plaque psoriasis treated with bimekizumab. Efficacy was assessed by the proportion of patients achieving Psoriasis Area and Severity Index (PASI)75, PASI90, and PASI100 up to 104 weeks. Firth’s penalized multivariable logistic regression was utilized to identify independent predictors of PASI100 at weeks 16 and 52. Drug survival was estimated using Kaplan–Meier analysis. Safety was evaluated through the incidence of treatment-emergent adverse events (TEAEs) expressed per 100 patient-years. Bimekizumab demonstrated rapid and sustained effectiveness with complete skin clearance (PASI100) being achieved by 61.5