Background and hypothesis In patients with moderate or severe renal disease, hospitalization is often required because of poorly controlled co-morbidities. We aimed to provide evidence that an outpatient health program involving a close collaboration between nephrologists and General Practitioners can be successful in reducing hospitalizations in non-dialysis chronic kidney disease patients. Methods Observational cohort study on 17,036 stage 1-5 chronic kidney disease patients enrolled in the Emilia-Romagna (Italy) PIRP project between 1st April 2004 and 31st December 2015, and their 70,560 hospitalizations registered in the four years preceding and following their enrolment in the project. Interrupted Time Series analysis was used to estimate hospitalizations' trend summarized on 4-monthly basis. Results Among patients who survived 4 years in non-dialysis chronic kidney disease condition, a 2.9% reduction in hospitalizations was observed in the four years following the enrolment in PIRP compared to the four years previously. The change in hospitalizations' trend was estimated at -8.09 admission per 1,000 patients and 4-month period. This decrease was mainly accountable to hospitalizations whose main diagnoses at discharge were diseases of the circulatory system and the genitourinary system (-2.68 and -4.76 admissions per 1,000 patients respectively). Patients with heart failure and those with coronary artery disease displayed large reductions in hospitalization trend (-17.08 and -9.48 admissions per 1,000 patients respectively). A reduction of hospitalizations with similar magnitude was also observed for the advanced stages of CKD. Conclusion The implementation of an integrated public health project that provides for the early management and continuity of care of CKD patients may be a way to reduce hospitalizations, particularly those related to cardiovascular and genitourinary diagnoses. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement The study was funded by the Italian Ministry of Health, RC-2023-2778789. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: Ethics Committee of Area Vasta Emilia Centro (AVEC) gave ethical approval for this work (identification No. 341/2022/Oss/AOUBo). I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes All data produced in the present study are available upon reasonable request to the authors

Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) vaccination in solid organ transplant (SOT) recipients is associated with suboptimal antibody response (AbR) favouring breakthrough infection (BI). The role of cell-mediated immunity (CMI) remains uncertain. Single-center prospective longitudinal cohort study of adult SOT recipients monitored for both AbR and CMI at 6 ± 2 months after booster dosage of SARS-CoV-2 vaccine. Primary end-point was BI diagnosis and CMI was the main risk factor. Relationship between CMI and BI was investigated by bivariate tests and multivariable logistic regression. CMI was performed in 139 patients. In 66 patients BI was documented before CMI, thus 73 (33 kidney, 24 liver, 14 lung, 2 heart) were analysed. The first 2 vaccine doses consisted of BNT162b2 and mRNA-1273 in 69.1

BackgroundRASopathies, including Noonan syndrome and related disorders, are multisystem conditions caused by mutations in various genes encoding proteins involved in the RAS/MAPK signaling pathway resulting in increased signal flow. They are clinically characterized by failure to thrive, facial dysmorphisms, congenital heart defects, lymphatic malformations, skeletal anomalies, and variable cognitive impairment, with variable prevalence in the different conditions and subtypes. Pubertal development, which affects growth and final height, is often delayed in Noonan syndrome patients, though not universally. This study aimed to evaluate the timing and progression of puberty and its impact on growth and final height in patients with RASopathies.Subjects and methodsA retrospective longitudinal study was conducted involving 103 patients with molecularly confirmed RASopathies. A subgroup of 40 patients who had completed pubertal development was analyzed. Anthropometric, hormonal (FSH, LH, estradiol/testosterone), and radiological data were collected.ResultsAmong the 40 patients who had completed puberty, 75% had a diagnosis of Noonan syndrome. The median age at pubertal onset was 11.8 years in males and 13.2 years in females. Delayed puberty was observed in 27.8% of patients, with a higher incidence in females. Median final height was significantly lower in those with delayed pubertal onset compared to those with normal development (p < 0.01). No significant differences in final height were observed between patients with growth hormone deficiency treated with growth hormone and those who were untreated.ConclusionsDelayed pubertal onset negatively impacts final height in patients with RASopathies, with inadequate pubertal catch-up growth being a common outcome. While most patients initiate puberty spontaneously, careful monitoring of growth and pubertal progression is crucial to optimize therapeutic interventions and improve final height outcomes.

IMPORTANCE:Patients with Gram-negative bloodstream infections (GN-BSI) are classified as non-immunocompromised (n-IC) or immunocompromised (IC). However, immunosuppressive condition should not be considered univocally. OBJECTIVE:To investigate epidemiological characteristics, management and outcome of GN-BSI in IC and non-IC patients. METHODS:Retrospective single-center study of hospitalized patients with GN-BSI conducted over a 7-year period. Patients with GN-BSI were divided in: solid organ transplant (SOT) recipients, patients with hematologic malignancy (HM), patients with metastatic solid cancer (mSC), and non-major IC patients (nm-IC). RESULTS:3544 patients analysed: 76.7% nm-IC, 6.5% SOT, 8.0% HM and 8.8% mSC. SOT and HM patients were younger (SOT: 56.6 ± 13.1 years; HM: 56.4 ± 14.5; nm-IC: 72.4 ± 16.1; mSC: 68.6 ± 13.1, p < 0.001) and had lower CCI value (SOT: 4.5 ± 2.4; HM: 4.1 ± 2.1; nm-IC: 5.5 ± 2.6; mSC: 9.7 ± 2.5, p < 0.001). Urinary tract infection was the most common source of BSI in nm-IC (nm-IC: 50.1%, HM:15%; SOT: 33.3%; mSC: 25.9%, p < 0.001), intra-abdominal infection was the more frequent source among SOT and mSC (SOT:42.3%; mSC: 49.3%, nm-IC: 27.8%, HM:29%; p < 0.001). Primary BSI was the first cause of GN-BSI in HM (HM: 62.1%; SOT: 18.5%; nm-IC: 17.2%; mSC: 10.6%, p < 0.001). The lowest rate of death was observed in SOT and the highest in mSC (SOT 8.2%; nm-IC 13.4%; HM 14.9%; mSC 19.9%, p < 0.001). Relapse rate was highest in SOT (SOT: 18.8%; HM: 11.8%; NMIC: 7.2%; aST: 7.1%, p < 0.001). Follow-up bloodcultures were associated with a lower mortality only among NMIC (HR = 0.317, 95% CI 0.178-0.563, p < 0.001) and aST (HR = 0.198, 95% CI 0.058-0.673, p = 0.010). The role of treatment duration on relapse was not evident in any group, conversely receiving at least 7 days of treatment was associated with a lower risk of 90-day mortality in SOT and HM patients. CONCLUSIONS:The characteristics and outcome of GN-BSI are peculiar between specific IC categories, therefore a personalized management should be implemented.

The PIRP Project (Progressive Renal Insufficiency Prevention), launched in Emilia-Romagna in the early 2000s, was created to establish a network between general practitioners and nephrologists aimed at the early identification of chronic kidney disease (CKD), slowing its progression, and improving clinical outcomes. The project included several phases: a training phase for general practitioners, the establishment of dedicated outpatient clinics, and the creation of a regional electronic registry, which today includes more than 38,000 patients. The results have shown a reduction in CKD progression, fewer urgent dialysis starts, and better control of comorbidities. PIRP differs from the national PDTA for CKD in its operational and regional approach, based on real-world data and multidisciplinary co-management, whereas the PDTA represents a general regulatory framework. The project has developed predictive models (such as CT-PIRP), inspired comparative European studies, and today stands as a model of integrated healthcare, useful for the implementation of nephroprotective drugs and artificial intelligence. Twenty years after its inception, PIRP remains an example of proactive and collaborative medicine, anticipating modern paradigms of population health management.

Itching is an annoying symptom which afflicts patients with chronic renal failure. We aimed to assess the impact and patient’s perception and experience of itching in the dialysis population in Italy. A questionnaire was developed by the National Hemodialysis and Dialysis Association of Italy (ANED) and administered to 996 hemodialysis recipients across 153 Italian dialysis centers. The main outcomes investigated by the questionnaire were patients’ satisfaction on answers regarding the nature of itching; continuing to talk about itching with the nephrologist; beliefs about resolution of itching. A total of 1903 patients from 153 centers responded to the questionnaire. Patients who responded had a mean age of 67.9 ± 13.8 years (63.9

Dietary-Nutritional Therapy (DNT) is an essential component of the conservative management of patients with chronic kidney disease (CKD) as it helps maintain optimal nutritional status, prevent and/or correct symptoms and complications of CKD. Moreover, it allows adherent patients to delay the onset of dialysis, leading to improved quality of life and cost savings for both patients and the community. Through a survey, we aimed to evaluate how personalized diets were assessed, administered, and experienced by CKD patients. A questionnaire was administered to 180 patients from 4 nephrology Centers in Lombardy, (Italy,) regarding their CKD and nutritional therapy. 73% of patients received dietary prescriptions. In 40% of cases, dietary prescriptions were administered in dedicated clinics and were valued as much as pharmacological ones. Most diets prescribed were low-protein (0.8g protein per kg of body weight), although some included very low protein diets supplemented with keto analogs. Unfortunately, post-initial prescription, monitoring adherence to nutritional therapy is not particularly frequent. In conclusion, our survey suggests that while patients in different Nephrology Centers receive proper dietary prescriptions and follow-ups, there are areas for improvement with positive implications for CKD progression and delaying dialysis therapy.

Objective. Immunohistochemical analysis of podoplanin expression as a pre-operative molecular marker for perineural invasion (PNI) may represent an attractive strategy for surgical management of oral squamous cell cancer (OSCC). We evaluated the relationship between podoplanin expression and PNI in pre-operative incisional biopsies of OSCC. Study Design. After performing pathological staging and histologic and immunohistochemical evaluation of 83 surgical specimens, we performed multivariable logistic regression analysis to examine the relationship between PNI and independent variables. To evaluate the utility of podoplanin immunopositivity for discrimination of PNI status pre-operatively, we calculated the sensitivity, specificity, positive predictive value, and negative predictive value. We performed receiver operating characteristic curve analysis to evaluate the diagnostic accuracy of podoplanin immunopositivity for predicting PNI alone and in combination with age, T stage, N stage, and index site. Results. We observed podoplanin expression in 42 (50.6%) of all the 83 pre-operative incisional biopsies and 29 of the pre-operative biopsies of the 31 (93.5%) postoperative specimens with PNI. The rate of podoplanin expression was significantly higher in patients with pT3 to pT4 stage and pN+ stage disease. Podoplanin positivity in the pre-operative biopsy showed high sensitivity in predicting PNI in the surgical specimen. Conclusion. Podoplanin expression appears to be an independent pre-operative variable significantly related to PNI and a possibly valuable prognostic marker for therapeutical planning and surgical treatment of OSCC. (Oral Surg Oral Med Oral Pathol Oral

Background: Infections of cardiovascular implantable electronic devices (CIED) are mainly due to Gram-positive bacteria (GPB). Data about Gram-negative bacteria CIED (GNB-CIED) infections are limited. This study aimed to investigate risk factors, clinical and diagnostic characteristics, and outcome of patients with GNB-CIED.Methods: A multicentre, international, retrospective, case-control-control study was performed on pa-tients undergoing CIED implantation from 2015 to 2019 in 17 centres across Europe. For each patient diagnosed with GNB-CIED, one matching control with GPB-CIED infection and two matching controls without infection were selected.Results: A total of 236 patients were enrolled: 59 with GNB-CIED infection, 59 with GPB-CIED infec-tion and 118 without infection. No between-group differences were found regarding clinical presen-tation, diagnostic and therapeutic management. A trend toward a higher rate of fluorodeoxyglucose positron emission computed tomography (FDG PET/CT) positivity was observed among patients with GNB than in those with GPB-CIED infection (85.7% vs. 66.7%; P = 0.208). Risk factors for GNB-CIED infec-tion were Charlson Comorbidity Index Score (relative risk reduction, RRR = 1.211; P = 0.011), obesity (RRR = 5.122; P = 0.008), ventricular-pacing ventricular-sensing inhibited-response pacemaker implanta-tion (RRR = 3.027; P = 0.006) and right subclavian vein site of implantation (RRR = 5.014; P = 0.004). At 180-day survival analysis, GNB-CIED infection was associated with increased mortality risk (HR = 1.842; P = 0.067).Conclusions: Obesity, high number of comorbidities and right subclavian vein implantation site were as-sociated with increased risk of GNB-CIED infection. A prompt therapeutic intervention that may be guided using FDG PET/CT is suggested in patients with GNB-CIED infection, considering the poorer outcome ob-served in this group.(c) 2023 The Authors. Published by Elsevier Ltd. This is an open access article under the CC BY-NC-ND license ( http://creativecommons.org/licenses/by-nc-nd/4.0/ )

AIM:People may differ in their vaccine-related beliefs (i.e. efficacy, safety, purpose), with a host of factors influencing these differences. This can produce homogeneous groups of individuals who share certain beliefs, attitudes and opinions not only towards vaccines but science and medicine in general. This study aims to characterise distinct subgroups and identify ideal targets for tailored public health interventions to reinforce favourable vaccine beliefs.METHODS:Latent class analysis was used to derive unique profiles using the 2019 Gallup survey of 140 countries. We modelled a composite of vaccine beliefs and regressed this on class membership and relevant covariates.RESULTS:Patterns of item endorsement indicated a well-fitting five-class model, with classes distinguished based on whether individuals sought personal knowledge about science, medicine and health; trusted science and scientists; and reported confidence in the health care system. The lowest levels of vaccine beliefs were reported by a class lacking trust and confidence and the highest levels were reported by a class endorsing trust, confidence and desiring medical and scientific knowledge. Country-level income was moderately related to class membership, and vaccine beliefs were higher in lower-income countries.CONCLUSIONS:Findings suggest that public health campaigns can focus on improving trust in science and medical providers. Efforts to improve vaccination rates can only be achieved when individuals trust science, view the work of scientists as beneficial and hold favourable views towards health care providers. Individuals will then accrue the necessary wisdom to make good health care decisions that affect not only themselves but also their fellow citizens.

Abstract Background Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccination in solid organ transplant (SOT) recipients is associated with poorer antibody response (AbR) compared with non-SOT recipients. However, its impact on the risk of breakthrough infection (BI) has yet to be assessed. Methods Single-center prospective longitudinal cohort study enrolling adult SOT recipients who received SARS-CoV-2 vaccination during a 1-year period (February 2021 – January 2022), end of follow-up April 2022. Patients were tested for AbR at multiple time points. The primary end-point was BI (laboratory-confirmed SARS-CoV-2 infection ≥14 days after the second dose). Immunization (positive AbR) was considered an intermediate state between vaccination and BI. Probabilities of being in vaccination, immunization, and BI states were obtained for each type of graft and vaccination sequence using multistate survival analysis. Then, multivariable logistic regression was performed to analyze the risk of BI related to AbR levels. Results 614 SOT (275 kidney, 163 liver, 137 heart, 39 lung) recipients were included. Most patients (84.7%) received 3 vaccine doses. The first 2 consisted of BNT162b2 and mRNA-1273 in 73.5% and 26.5% of cases, respectively. For the third dose, mRNA-1273 was administered in 59.8% of patients. Overall, 75.4% of patients reached immunization and 18.4% developed BI. Heart transplant recipients showed the lowest probability of immunization (0.418) and the highest of BI (0.323); all mRNA-1273 vaccine sequences showed the highest probability of immunization (0.732) and the lowest of BI (0.098). Risk of BI was higher for non–high-level AbR, younger age, and shorter time from transplant. Conclusions SOT patients with non–high-level AbR and shorter time from transplantation and heart recipients are at highest risk of BI.

BackgroundRASopathies are developmental disorders caused by dysregulation of the RAS-MAPK signalling pathway, which contributes to the modulation of multiple extracellular signals, including hormones and growth factors regulating energetic metabolism, including lipid synthesis, storage, and degradation.Subjects and methodsWe evaluated the body composition and lipid profiles of a single-centre cohort of 93 patients with a molecularly confirmed diagnosis of RASopathy by assessing height, BMI, and total cholesterol, HDL, triglycerides, apolipoprotein, fasting glucose, and insulin levels, in the context of a cross sectional and longitudinal study. We specifically investigated and compared anthropometric and haematochemistry data between the Noonan syndrome (NS) and Mazzanti syndrome (NS/LAH) groups.ResultsAt the first evaluation (9.5 ± 6.2 years), reduced growth (-1.80 ± 1.07 DS) was associated with a slightly reduced BMI (-0.34 DS ± 1.15 DS). Lipid profiling documented low total cholesterol levels (< 5th percentile) in 42.2% of the NS group; in particular, in 48.9% of PTPN11 patients and in 28.6% of NS/LAH patients compared to the general population, with a significant difference between males and females. A high proportion of patients had HDL levels lower than the 26th percentile, when compared to the age- and sex-matched general population. Triglycerides showed an increasing trend with age only in NS females. Genotype-phenotype correlations were also evident, with particularly reduced total cholesterol in about 50% of patients with PTPN11 mutations with LDL-C and HDL-C tending to decrease during puberty. Similarly, apolipoprotein A1 and apolipoprotein B deficits were documented, with differences in prevalence associated with the genotype for apolipoprotein A1. Fasting glucose levels and HOMA-IR were within the normal range.ConclusionThe present findings document an unfavourable lipid profile in subjects with NS, in particular PTPN11 mutated patients, and NS/LAH. Further studies are required to delineate the dysregulation of lipid metabolism in RASopathies more systematically and confirm the occurrence of previously unappreciated genotype-phenotype correlations involving the metabolic profile of these disorders.

Purpose To investigate the impact of diabetes in immigrants on the Italian healthcare system, as well as their compliance with standard protocols of control and treatment. Methods The prevalence of immigrants with diabetes living in the metropolitan area of Bologna (about 1 million inhabitants) in 2019 was investigated using a database containing all subjects in active follow-up for diabetes, based on antidiabetic drug use, disease-specific copayment exemption, ICD-9 codes, continuous care in diabetes units. Country of origin was derived from fiscal code. Results The overall prevalence of diabetes (n = 53,941; 51.8% males, median age 64) was 6.1% in both Italy-born and immigrant cohorts. Immigrant prevalence was 12.4%, moderately higher than that observed in the total population (12.2%). Diabetes risk was increased in the whole immigrant cohort (odds ratio (OR) 1.74; 95% Confidence Interval (CI) 1.69–1.79). Among cases with incident diabetes, the proportion of immigrants (median age, 49 vs. 65 in Italy-born individuals) increased progressively from 11.7% to 26.5% from 2011 to 2019 (males, 8.9–21.0%; females, 14.9–32.8%) in all age groups, particularly in young adults, but also in older subjects. Metabolic control was lower in immigrants, as was adherence to shared diagnostic and therapeutic protocols, without systematic differences in antidiabetic drug use, but much lower use of drugs for comorbid conditions. Conclusions The population with diabetes in the metropolitan area of Bologna is rapidly changing. Quality improvement initiatives are needed to reduce the burden for the universalistic Italian health care system generated by the rapidly-growing high-risk immigrant population.

Rationale & Objective Fabry disease (FD) is an X-linked genetic disorder that causes lysosomal storage of glycosphingolipids, primarily globotryaosilceramide (Gb3) and its derivative globotryaosilsphingosine (Lyso-Gb3), with multiorgan dysfunction including chronic kidney disease. Affected individuals may be carriers of gene variants that are of uncertain significance (GVUS). We described kidney pathology at the early stages of FD-related kidney disease to gain insights into their association with GVUS and sex. Study design Single-center, case series. Setting & Participants Thirty-five consecutively biopsied patients (aged 48.1±15.4 years, 22 females) from among 64 patients, with genetically diagnosed FD. Biopsies were retrospectively screened using the International Study Group of Fabry Nephropathy Scoring System. Observations Genetic mutation type, p.N215S and D313Y, sex, age, eGFR (estimated glomerular filtration rate), plasma Lyso-Gb3 (pLyso-Gb3) levels, and histological parameters, including Gb3 deposits were recorded. Genetic analyses showed mostly missense mutations, p.N215S variant in 15, and the "benign polymorphism" D313Y in 4 of the biopsied patients. Morphological lesions were similar for men and women except for interstitial fibrosis and arteriolar hyalinosis being more common in men. Early in their clinical course, patients with normal/mild albuminuria had podocyte, tubular, and peritubular capillary vacuoles/inclusions, and evidence of chronicity, i.e., glomerulosclerosis, interstitial fibrosis, tubular atrophy. These findings appeared to be associated with pLyso-Gb3, eGFR, and age. Limitations Retrospective design and inclusion of outpatients partially based on family pedigree. Conclusions In early stages of kidney disease in the setting of FD, numerous histological abnormalities are present. These observations suggest that kidney biopsies early in FD may reveal activity of kidney involvement that may inform clinical management.

INTRODUCTION:Late talkers represent a heterogeneous population. We aimed to describe communication profiles of low-risk preterm and full-term late talkers according to their receptive and expressive vocabulary size, considering communicative, linguistic, cognitive, and motor skills, as well as biological and environmental risk factors.METHODS:Sixty-eight late talkers (33 born low-risk preterm and 35 full-term) were identified through a language screening at 30 months. Parents filled out the Italian Short Forms of the MacArthur Bates Communicative Development Inventories and the Socio Conversational Skills Rating Scales. Children were assessed with the Picture Naming Game test and the Bayley Scales of Infant and Toddler Development.RESULTS:A two-step cluster analysis identified three distinct profiles among late talkers according to their receptive and expressive vocabulary size. Severe late talkers (25%) showed less frequent use of pointing, limited verbal imitation, receptive vocabulary size, lexical and sentence production, responsiveness and assertiveness, and lower cognitive scores than mild late talkers (40%). Moderate late talkers (35%) showed less frequent verbal imitation, limited lexical and sentence production and lower cognitive scores than mild late talkers. Male gender was significantly more represented in the severe late profile, whereas other biological and environmental factors did not differ among the three profiles.CONCLUSIONS:Findings highlighted the relevance of assessing communicative, lexical, grammar, pragmatic, and cognitive skills to describe late talkers' profiles. A deeper investigation of phonological skills might also contribute to a further understanding of interindividual variability in this population.

Questionario realizzato da ANED che è stato distribuito ai pazienti in vari centri dialisi italiani. Il fine di questa inchiesta era di far emergere tutti quegli aspetti che fanno del prurito uno stato di sofferenza cronica, che mina ed altera, giornalmente, la qualità di vita dei pazienti con malattia renale cronica.The objective of this Italian survey was to comprehensively evaluate the real-life impact of pruritus on individuals undergoing dialysis, directly from the patients' perspective. To achieve this, ANED (Associazione Nazionale Emodializzati e Dializzati) developed a questionnaire distributed to patients across multiple dialysis centers in Italy.Included in the project are three files:the .csv raw dataset; most labels here are in Italian, a translation can be requested to the authors.The original questionnaire in Italian (.pdf); the translations of the questionnaire's items (.docx)

Journal of the European Academy of Dermatology and VenereologyEarly View LETTER TO THE EDITOR PsoBioVax: A multicentric Italian case–control study of the immunological response to anti-SARS-CoV-2 vaccine among psoriatic patients under biological therapy L. Sacchelli, Corresponding Author L. Sacchelli [email protected] orcid.org/0000-0003-4388-4523 Dermatology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Policlinico S. Orsola-Malpighi, Bologna, Italy Department of Medical and Surgical Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy Correspondence M. A. Chessa and L. Sacchelli, Via G. Massarenti, 1, 40138 Bologna, Italy. Email: [email protected]; [email protected]Search for more papers by this authorF. Filippi, F. Filippi orcid.org/0000-0001-8173-4257 Dermatology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Policlinico S. Orsola-Malpighi, Bologna, Italy Department of Medical and Surgical Sciences, Alma Mater Studiorum, University of Bologna, Bologna, ItalySearch for more papers by this authorA. Balato, A. Balato orcid.org/0000-0001-5485-0172 Unit of Dermatology, University of Campania Luigi Vanvitelli, Naples, ItalySearch for more papers by this authorR. Balestri, R. Balestri orcid.org/0000-0002-0885-054X Division of Dermatology, Psoriasis Outpatient Service, APSS, Trento, ItalySearch for more papers by this authorF. Bellinato, F. Bellinato orcid.org/0000-0002-6163-6921 Dipartimento di Medicina Sezione Di Dermatologia Università di Verona, Verona, ItalySearch for more papers by this authorN. Bernardini, N. Bernardini orcid.org/0000-0002-6295-3574 Department of Medico-Surgical Sciences and Biotechnologies Faculty of Pharmacy and Medicine Sapienza University of Rome – Polo Pontino (ASL Latina), Latina, ItalySearch for more papers by this authorL. Bianchi, L. Bianchi Dermatology, University of Rome Tor Vergata, Rome, ItalySearch for more papers by this authorM. Burlando, M. Burlando orcid.org/0000-0002-4381-6718 Department of Dermatology, DISSAL University of Genoa, IRCCS Ospedale Policlinico San Martino, Genova, ItalySearch for more papers by this authorA. Campanati, A. Campanati orcid.org/0000-0002-3740-0839 Dermatological Clinic, Department of Clinical and Molecular Sciences, Polytechnic Marche University, Ancona, ItalySearch for more papers by this authorM. A. Chessa, Corresponding Author M. A. Chessa [email protected] orcid.org/0000-0002-0149-8870 Dermatology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Policlinico S. Orsola-Malpighi, Bologna, Italy Department of Medical and Surgical Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy Correspondence M. A. Chessa and L. Sacchelli, Via G. Massarenti, 1, 40138 Bologna, Italy. Email: [email protected]; [email protected]Search for more papers by this authorM. Corazza, M. Corazza Department of Medical Sciences, Section of Dermatology and Infectious Diseases, University of Ferrara, Ferrara, ItalySearch for more papers by this authorA. Di Cesare, A. Di Cesare orcid.org/0000-0002-1001-4604 Department of Health Sciences, Section of Dermatology, University of Florence, Florence, ItalySearch for more papers by this authorV. Di Lernia, V. Di Lernia Dermatology Unit, Arcispedale Santa Maria Nuova, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, ItalySearch for more papers by this authorF. Diotallevi, F. Diotallevi Dermatological Clinic, Department of Clinical and Molecular Sciences, Polytechnic Marche University, Ancona, ItalySearch for more papers by this authorM. Esposito, M. Esposito orcid.org/0000-0002-4773-6993 Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy Dermatology Unit, Ospedale San Salvatore, L'Aquila, ItalySearch for more papers by this authorM. C. Fargnoli, M. C. Fargnoli orcid.org/0000-0002-7249-2556 Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy Dermatology Unit, Ospedale San Salvatore, L'Aquila, ItalySearch for more papers by this authorP. Gisondi, P. Gisondi orcid.org/0000-0002-1777-9001 Dipartimento di Medicina Sezione Di Dermatologia Università di Verona, Verona, ItalySearch for more papers by this authorA. Giunta, A. Giunta orcid.org/0000-0003-3589-9346 Dermatology, Fondazione PTV Policlinico Tor Vergata, Rome, ItalySearch for more papers by this authorK. Hansel, K. Hansel orcid.org/0000-0002-6674-4278 Dermatology Section, Department of Medicine and Surgery, University of Perugia, Perugia, ItalySearch for more papers by this authorM. Magnano, M. Magnano orcid.org/0000-0001-9429-9004 Division of Dermatology, Psoriasis Outpatient Service, APSS, Trento, ItalySearch for more papers by this authorM. Megna, M. Megna orcid.org/0000-0003-1803-2046 Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Napoli, ItalySearch for more papers by this authorG. Odorici, G. Odorici orcid.org/0000-0002-5910-8994 Department of Medical Sciences, Section of Dermatology and Infectious Diseases, University of Ferrara, Ferrara, ItalySearch for more papers by this authorF. Prignano, F. Prignano orcid.org/0000-0002-5997-2045 Department of Health Sciences, Section of Dermatology, University of Florence, Florence, ItalySearch for more papers by this authorC. Potenza, C. Potenza Department of Medico-Surgical Sciences and Biotechnologies Faculty of Pharmacy and Medicine Sapienza University of Rome – Polo Pontino (ASL Latina), Latina, ItalySearch for more papers by this authorG. Rech, G. Rech Division of Dermatology, Psoriasis Outpatient Service, APSS, Trento, ItalySearch for more papers by this authorM. Rovesti, M. Rovesti Dermatologic Unit, Ospedale “Guglielmo da Saliceto”, Piacenza, PC, ItalySearch for more papers by this authorA. Ruggiero, A. Ruggiero orcid.org/0000-0002-4658-7391 Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Napoli, ItalySearch for more papers by this authorF. Satolli, F. Satolli UOC Dermatologia, University of Parma, Parma, ItalySearch for more papers by this authorL. Stingeni, L. Stingeni orcid.org/0000-0001-7919-8141 Dermatology Section, Department of Medicine and Surgery, University of Perugia, Perugia, ItalySearch for more papers by this authorD. Gibertoni, D. Gibertoni orcid.org/0000-0002-1722-3724 Research and Innovation Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, ItalySearch for more papers by this authorF. Bardazzi, F. Bardazzi Dermatology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Policlinico S. Orsola-Malpighi, Bologna, Italy Department of Medical and Surgical Sciences, Alma Mater Studiorum, University of Bologna, Bologna, ItalySearch for more papers by this author L. Sacchelli, Corresponding Author L. Sacchelli [email protected] orcid.org/0000-0003-4388-4523 Dermatology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Policlinico S. Orsola-Malpighi, Bologna, Italy Department of Medical and Surgical Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy Correspondence M. A. Chessa and L. Sacchelli, Via G. Massarenti, 1, 40138 Bologna, Italy. Email: [email protected]; [email protected]Search for more papers by this authorF. Filippi, F. Filippi orcid.org/0000-0001-8173-4257 Dermatology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Policlinico S. Orsola-Malpighi, Bologna, Italy Department of Medical and Surgical Sciences, Alma Mater Studiorum, University of Bologna, Bologna, ItalySearch for more papers by this authorA. Balato, A. Balato orcid.org/0000-0001-5485-0172 Unit of Dermatology, University of Campania Luigi Vanvitelli, Naples, ItalySearch for more papers by this authorR. Balestri, R. Balestri orcid.org/0000-0002-0885-054X Division of Dermatology, Psoriasis Outpatient Service, APSS, Trento, ItalySearch for more papers by this authorF. Bellinato, F. Bellinato orcid.org/0000-0002-6163-6921 Dipartimento di Medicina Sezione Di Dermatologia Università di Verona, Verona, ItalySearch for more papers by this authorN. Bernardini, N. Bernardini orcid.org/0000-0002-6295-3574 Department of Medico-Surgical Sciences and Biotechnologies Faculty of Pharmacy and Medicine Sapienza University of Rome – Polo Pontino (ASL Latina), Latina, ItalySearch for more papers by this authorL. Bianchi, L. Bianchi Dermatology, University of Rome Tor Vergata, Rome, ItalySearch for more papers by this authorM. Burlando, M. Burlando orcid.org/0000-0002-4381-6718 Department of Dermatology, DISSAL University of Genoa, IRCCS Ospedale Policlinico San Martino, Genova, ItalySearch for more papers by this authorA. Campanati, A. Campanati orcid.org/0000-0002-3740-0839 Dermatological Clinic, Department of Clinical and Molecular Sciences, Polytechnic Marche University, Ancona, ItalySearch for more papers by this authorM. A. Chessa, Corresponding Author M. A. Chessa [email protected] orcid.org/0000-0002-0149-8870 Dermatology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Policlinico S. Orsola-Malpighi, Bologna, Italy Department of Medical and Surgical Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy Correspondence M. A. Chessa and L. Sacchelli, Via G. Massarenti, 1, 40138 Bologna, Italy. Email: [email protected]; [email protected]Search for more papers by this authorM. Corazza, M. Corazza Department of Medical Sciences, Section of Dermatology and Infectious Diseases, University of Ferrara, Ferrara, ItalySearch for more papers by this authorA. Di Cesare, A. Di Cesare orcid.org/0000-0002-1001-4604 Department of Health Sciences, Section of Dermatology, University of Florence, Florence, ItalySearch for more papers by this authorV. Di Lernia, V. Di Lernia Dermatology Unit, Arcispedale Santa Maria Nuova, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, ItalySearch for more papers by this authorF. Diotallevi, F. Diotallevi Dermatological Clinic, Department of Clinical and Molecular Sciences, Polytechnic Marche University, Ancona, ItalySearch for more papers by this authorM. Esposito, M. Esposito orcid.org/0000-0002-4773-6993 Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy Dermatology Unit, Ospedale San Salvatore, L'Aquila, ItalySearch for more papers by this authorM. C. Fargnoli, M. C. Fargnoli orcid.org/0000-0002-7249-2556 Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy Dermatology Unit, Ospedale San Salvatore, L'Aquila, ItalySearch for more papers by this authorP. Gisondi, P. Gisondi orcid.org/0000-0002-1777-9001 Dipartimento di Medicina Sezione Di Dermatologia Università di Verona, Verona, ItalySearch for more papers by this authorA. Giunta, A. Giunta orcid.org/0000-0003-3589-9346 Dermatology, Fondazione PTV Policlinico Tor Vergata, Rome, ItalySearch for more papers by this authorK. Hansel, K. Hansel orcid.org/0000-0002-6674-4278 Dermatology Section, Department of Medicine and Surgery, University of Perugia, Perugia, ItalySearch for more papers by this authorM. Magnano, M. Magnano orcid.org/0000-0001-9429-9004 Division of Dermatology, Psoriasis Outpatient Service, APSS, Trento, ItalySearch for more papers by this authorM. Megna, M. Megna orcid.org/0000-0003-1803-2046 Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Napoli, ItalySearch for more papers by this authorG. Odorici, G. Odorici orcid.org/0000-0002-5910-8994 Department of Medical Sciences, Section of Dermatology and Infectious Diseases, University of Ferrara, Ferrara, ItalySearch for more papers by this authorF. Prignano, F. Prignano orcid.org/0000-0002-5997-2045 Department of Health Sciences, Section of Dermatology, University of Florence, Florence, ItalySearch for more papers by this authorC. Potenza, C. Potenza Department of Medico-Surgical Sciences and Biotechnologies Faculty of Pharmacy and Medicine Sapienza University of Rome – Polo Pontino (ASL Latina), Latina, ItalySearch for more papers by this authorG. Rech, G. Rech Division of Dermatology, Psoriasis Outpatient Service, APSS, Trento, ItalySearch for more papers by this authorM. Rovesti, M. Rovesti Dermatologic Unit, Ospedale “Guglielmo da Saliceto”, Piacenza, PC, ItalySearch for more papers by this authorA. Ruggiero, A. Ruggiero orcid.org/0000-0002-4658-7391 Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Napoli, ItalySearch for more papers by this authorF. Satolli, F. Satolli UOC Dermatologia, University of Parma, Parma, ItalySearch for more papers by this authorL. Stingeni, L. Stingeni orcid.org/0000-0001-7919-8141 Dermatology Section, Department of Medicine and Surgery, University of Perugia, Perugia, ItalySearch for more papers by this authorD. Gibertoni, D. Gibertoni orcid.org/0000-0002-1722-3724 Research and Innovation Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, ItalySearch for more papers by this authorF. Bardazzi, F. Bardazzi Dermatology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Policlinico S. Orsola-Malpighi, Bologna, Italy Department of Medical and Surgical Sciences, Alma Mater Studiorum, University of Bologna, Bologna, ItalySearch for more papers by this author First published: 07 December 2023 https://doi.org/10.1111/jdv.19662 L. Sacchelli and F. Filippi contributed equally. 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 Open Research DATA AVAILABILITY STATEMENT The data that support the findings of this study are available on request from the corresponding author, MAC. 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