ABSTRACT Background Routine collection of patient perspectives about psoriasis and its treatment through patient reported outcome measurements (PROMs), alongside clinician reported outcome measurements (CROMs), may improve clinical outcomes and facilitate shared decision making. Objectives This study aimed to assess the impact of using PROMs on evaluating treatments in patients with moderate to severe psoriasis. Methods The SUMMER Project is a multicenter study examining the characteristics, severity, treatment, healthcare resource use and quality‐of‐life impact of moderate to severe psoriasis patients in Spain. Data extracted from medical records, partly through natural language processing, included demographics, clinical data and CROMs (Psoriasis Area Severity Index‐PASI and body surface area‐BSA). PROMs collected through a platform every 3 months included Dermatology life quality index (DLQI) to assess HRQoL, 10‐point Visual Analogic Scale (VAS) to assess psoriasis global impact, and Treatment Satisfaction Questionnaire for Medication (TSQM‐9). Results Out of 222 patients from 5 hospitals, 147 were analyzed. The mean age was 48.2 years, with 58.5% males. Most (88.9%) were on biologic treatment for psoriasis, while 18.8% were on conventional systemic treatment. At the start, 7.3% had severe psoriasis symptoms (PASI ≥ 5 and/or BSA ≥ 3). The median baseline DLQI was 3.0, with 21.0% scoring ≥ 5. The average VAS score was 2.4, with 12.5% scoring ≥ 7. Mean global TSQM‐9 score was 80.6. During follow‐up, 9.6% changed treatment. At the time of change, 53.8% had mild symptoms (PASI ≤ 3), 30.8% had severe symptoms (PASI ≥ 5), and 68.8% had high DLQI and/or VAS scores. Those who changed treatment showed significant improvement in DQLI and VAS scores. Conclusions Most psoriasis patients maintained stable treatment, with good HRQoL. Few patients reported a significant impact on HRQoL and changed their treatment. PROs can play an important role in shared decision making to change treatment in routine clinical practice, even for patients achieving excellent clinical outcomes.

Chronic spontaneous urticaria (CSU) remains difficult to manage in patients refractory to antihistamines and omalizumab. Although dupilumab has recently been approved and incorporated into international guidelines, real-world evidence remains limited, particularly in treatment-refractory populations. We conducted a multicentre ambispective cohort study across 16 Spanish hospitals including adults with CSU, with or without concomitant chronic inducible urticaria, treated with dupilumab and followed for ≥4 weeks. The primary outcome was well-controlled disease within 24 weeks (Urticaria Control Test ≥12 and Urticaria Activity Score over 7 days≤6). Fiftyone patients were included; 92.0% had previously received omalizumab. At week 24, 69.7% (23/33) achieved well-controlled disease and 39.4% (13/33) complete control. Among patients with available week-52 data, 90.5% (19/21) and 61.9% (13/21), respectively, achieved these outcomes. Concomitant therapy use declined from 94.1% at baseline to 55.6% at week 52. Among omalizumab-experienced patients evaluable at week 24, dupilumab response was lower in prior nonresponders than in those with at least partial response to omalizumab (40% vs 85%, p=0.011). Atopic comorbidities were associated with greater UAS7 reduction (p=0.018). Dupilumab was well tolerated, with mostly mild adverse events. In routine clinical practice, dupilumab provides effective disease control in patients with difficult-totreat CSU, including most omalizumab-experienced individuals.

Chronic actinic dermatitis (CAD) is a rare, immune-mediated photodermatosis that may be severe, generalized, and refractory to conventional therapies. We describe four men (aged 44-65 years) with long-standing, severe CAD unresponsive to multiple systemic treatments, including immunosuppressants, dupilumab, and tofacitinib. All patients presented with marked photosensitivity; two had erythroderma. Extensive investigation excluded cutaneous T-cell lymphoma. Photobiologic testing demonstrated reduced minimal erythema doses to UVB adjusted for phototype, supporting the diagnosis of CAD. Upadacitinib (15-30 mg once daily) was initiated off-label. Clinical improvement occurred within 4 weeks, with complete remission achieved between 4 and 8 weeks in all patients. Remission was sustained for up to 12 months of follow-up. Treatment was well tolerated, with only mild acneiform eruption and transient hypertriglyceridaemia in one case. These findings suggest that selective JAK1 inhibition may represent a therapeutic option in severe, treatment-refractory CAD.

INTRODUCTION:Psoriasis is an immune-mediated chronic inflammatory skin disease with a prevalence in Spain of between 2.3% and 2.7%. One-third of patients present with moderate to severe psoriasis (Pso). This article aims to retrospectively describe the characteristics of patients with Pso, as well as severity, patterns of treatment, quality of life (QoL), and associated direct healthcare resources utilized in routine clinical practice in Spain. METHODS:The SUMMER project is an ambispective, non-interventional, multicenter study including adult patients with a diagnosis of Pso. In the retrospective phase, data were extracted from patients' electronic medical records. Data on disease severity scores (PASI and BSA) and impact on quality-of-life impact (DLQI) were captured by natural language recognition processors. RESULTS:Of 10,874 patients with a diagnosis of psoriasis identified from five participating sites, 2734 did not meet inclusion criteria; a total of 8140 patients were included. Mean age (SD) was 57.7 (16.1) years and 51.3% were male. Most patients had plaque psoriasis (91.5%) and lesions in visible areas (70.8%). The most common comorbidities were dyslipidemia (32%), hypertension (25.6%), and anxiety (18.5%). On the basis of thresholds of PASI (5%) and BSA (3%), psoriasis was not controlled in 17.1% and 37.2% of the patients, respectively, and 25.1% of patients were receiving biological treatments. Between 2017 and 2022, ustekinumab showed the highest persistence rate, especially when used as first-line treatment. There was a tendency to prescribe guselkumab and risankizumab most commonly as second- and third-line therapies. DLQI scores showed that Pso had a moderate or higher impact on QoL for 38.0% of patients. CONCLUSIONS:The results show how patients with moderate-severe psoriasis are managed in routine clinical practice in Spain. Between 17% and 37% of patients with Pso are not on the appropriate therapeutic target. Almost a quarter of patients required biological treatments to control the disease.

Managing moderate-to-severe psoriasis in patients with current or past malignancy remains a therapeutic challenge. We conducted a multicentre, retrospective real-world study to assess the safety and effectiveness of guselkumab in this complex population. Thirty patients were included, of whom 11 had active cancer at the time of guselkumab initiation. After 52 weeks of follow-up, guselkumab achieved sustained clinical improvement in skin and joint symptoms, with no observed cases of cancer progression or recurrence. Two patients developed new malignancies during treatment, but guselkumab was not discontinued. These findings support the use of IL-23 inhibitors as a safe therapeutic option in this complex patient population.

MPOX is an orthopoxvirus whose infection has been declared a Public Health Emergency of International Concern in 2022 and 2024. It proved to be a virus with markedly heterogeneous and varied clinical presentation. We performed a systematic PubMed review of articles reporting cases of different clinical manifestations of MPOX until October 2024. The infection has mainly affected men who have sex with men. After 4 to 10 days of incubation, it presents with mucocutaneus lesions and systemic symptoms. Some anatomical sites have shown clinical particularities. Genital edema is a potentially serious complication. The ocular and ear/nose/throat area are other infrequent sites with specific manifestations. MPOX whitlow affects the third finger of the dominant hand and may be associated with extensive inflammation and proximal lymphangitis. Bacterial superinfection is a common complication in the genital area with good response to antibiotic treatment. Immunosuppressed patients may develop severe inflammation and necrosis resulting in poor prognosis. Some authors propose ulceronecrotic MPOX as a defining condition of AIDS. The involvement of women has been exceptional in the current outbreak and has predominantly affected the vulva. Some patients such as healthcare workers, atopics, and people who get tattoos are at risk of developing specific lesions via nonsexual routes. Other atypical manifestations include maculopapular rash and inguinal patch. MPOX is a highly relevant and ongoing infection that can present with multiple atypical manifestations, and the knowledge of which is of great importance to the clinician. We present a unique systematic review of atypical presentations of this infection that may be associated with significant morbidity and mortality, especially in the immunocompromised population.

The management of psoriasis in patients with a history of malignancy is challenging. We conducted a multicentre, retrospective study in 17 Spanish centres including 69 patients with moderate-to-severe psoriasis and a previous or current malignancy treated with risankizumab; 94.2% of patients showed no recurrence or progression of cancer, while 5.8% experienced progression during therapy. Risankizumab was associated with substantial improvement in psoriasis, with a mean final PASI score of 0.9 ± 1.7 after a mean exposure time of 72 weeks. Tolerance was favourable, and no tumour recurrence was considered treatment-related. These findings support risankizumab as an effective and safe therapeutic option for this subpopulation.

Background. Current psoriasis treatment goals emphasize achieving complete or near‐complete skin clearance while preserving the quality of life, necessitating treatment modification for a suboptimal or inadequate response. Despite risankizumab’s demonstrated efficacy, evidence remains limited for patients switching from ustekinumab, particularly those with suboptimal or inadequate response. Objective. This study assesses risankizumab’s real‐world effectiveness in patients with suboptimal response (PASI 2‐3), inadequate response (PASI 3–5), or failure (PASI >5) to ustekinumab, based on a multicenter retrospective cohort in Spain. Method. A multicenter retrospective study across 24 Spanish hospitals included 102 patients previously treated with ustekinumab and switched to risankizumab. Results. Out of 102 patients, 78 experienced ustekinumab treatment failure (PASI >5), while 24 had an inadequate response (PASI 3–5), including 6 with a suboptimal response (PASI 2‐3). Remarkably, after one year of treatment with risankizumab, all patients demonstrated improvement, achieving near‐complete or complete skin clearance (PASI 0‐1). Conclusion. Risankizumab displayed effectiveness in patients with suboptimal/inadequate response or treatment failure to ustekinumab, aligning with the current treatment goals of complete or near‐complete skin clearance. These real‐world results corroborate clinical trial data, emphasizing risankizumab’s potential as a powerful therapeutic alternative for this patient population. Further prospective studies are essential to validate these findings.

Background. Rapid efficacy is an important item to psoriasis patients. Risankizumab, a humanised immunoglobulin G1 monoclonal antibody that inhibits IL‐23, has demonstrated early and sustained efficacy in patients with moderated‐to‐severe psoriasis. Effectiveness data in real world, particularly regarding short‐term response, however, are scarce. Objective. To explore the short‐term effectiveness of risankizumab in patients with moderate‐severe psoriasis in normal clinical practice. Methods. This was an observational, retrospective, multicentre study carried out at thirteen hospitals in Valencia, Spain. It was conducted on a sample of adult outpatients over 18 years of age, diagnosed with moderate‐to‐severe psoriasis who received at least one subcutaneous injection of 150 mg of risankizumab. Psoriasis Area and Severity Index (PASI) was used to assess the short‐term (4 weeks) effectiveness of risankizumab. Results. One hundred and sixteen patients (63.8% men) with a mean age (standard deviation (SD)) of 50 (16) years were included in the study. 90.6% were overweight or obese, and 22.7% were biologic‐naïve. The mean (SD) PASI score decreased from 11.9 (7.2) at the baseline to 3.3 (2.7) at week 4, with a median (SD) PASI score reduction of 8.6 (2.3) (p < 0.05). The absolute PASI score of <2 was reached by 52.6% of patients. Overall, PASI scores of 75, 90, and 100 were achieved in 56%, 37.1%, and 25.9% of patients, respectively, at week 4. PASI 90 was achieved by a significantly higher proportion of naïve patients than biologic‐experience failure patients (59.3% vs. 30.3%; p = 0.01). Conclusion. This study, which reflects our initial risankizumab experience in a real‐life setting, seems to show quick effectiveness in psoriasis treatment after one single dose. This trial is registered with NCT04862286.

Diagnosis of pityriasis lichenoides et varioliformis acuta (PLEVA) is based on the characteristic pattern of lesions in different stages of development, ranging from erythematous maculopapules to papules with a crusted and/or necrotic centre. However, it may raise the differential diagnosis with other entities. It is therefore not uncommon to have to perform skin biopsies to reach a diagnosis, including in infants. In this study, we report the cases of three patients with PLEVA, highlighting the correlations between the clinical, dermoscopic and histological features. Observation of the dermatoscopic findings described, such as punctate or glomerular vessels and erythematous globules surrounding a homogeneous orange or crusty central area, may allow for a rapid diagnosis, avoiding the need for invasive techniques.

BACKGROUND:Monkeypox (MPOX) caused a public health emergency of international concern (PHEIC) outbreak between 2022 and 2023, with a recent rise in cases that prompted the World Health Organization (WHO) to declare the disease a PHEIC once again. There is little information on its long-term scarring sequelae. OBJECTIVES:The objective of this study was to assess the risk and characteristics of scarring in patients with MPOX in a tertiary hospital. METHODS:This is a prospective cohort study including patients diagnosed using polymerase chain reaction (PCR) tests. Clinical data were collected and followed up at 12-15 months to assess scarring and its impact on quality of life. RESULTS:Of the 40 patients, 19 (47.5%) developed scars, which were more common in those with initial cutaneous manifestations. Scars significantly affected the quality of life, especially in the genital and mucosal areas. The limited sample and loss to follow-up may affect the validity of the results. CONCLUSION:Scarring is a frequent and disfiguring sequela of MPOX, particularly in patients with early skin symptoms. Prevention and close follow-up are crucial in mitigating these complications.

Palmoplantar psoriasis (PP) is a particular type of psoriasis that can justify systemic treatment. Roflumilast is a targeted inhibitor of phosphodiesterase-4 that has been recently approved by the US Food and Drugs Administration as a cream for the treatment of plaque psoriasis. In a small randomized clinical trial and single case reports, oral roflumilast has demonstrated efficacy in the treatment of plaque psoriasis. To the best of our knowledge, we present the first case series of patients with PP treated with oral roflumilast.

Australasian Journal of DermatologyEarly View LETTER Tick bite-induced alopecia areata-like effluvium Rodrigo Peñuelas Leal, Rodrigo Peñuelas Leal orcid.org/0000-0002-9627-780X Consorci Hospital General Universitari de Valencia, Valencia, SpainSearch for more papers by this authorAndrés Grau Echevarría, Andrés Grau Echevarría orcid.org/0000-0003-2557-3107 Consorci Hospital General Universitari de Valencia, Valencia, SpainSearch for more papers by this authorCarolina Labrandero Hoyos, Corresponding Author Carolina Labrandero Hoyos [email protected] orcid.org/0000-0002-3270-7428 Consorci Hospital General Universitari de Valencia, Valencia, Spain Correspondence Carolina Labrandero Hoyos, Department of Dermatology, Hospital General Universitario de Valencia, Av. Tres Creus, 2, Valencia 46014, Spain. Email: [email protected]Search for more papers by this authorJorge Magdaleno Tapial, Jorge Magdaleno Tapial orcid.org/0000-0003-0046-6962 Consorci Hospital General Universitari de Valencia, Valencia, SpainSearch for more papers by this authorAltea Esteve Martínez, Altea Esteve Martínez Consorci Hospital General Universitari de Valencia, Valencia, SpainSearch for more papers by this author Rodrigo Peñuelas Leal, Rodrigo Peñuelas Leal orcid.org/0000-0002-9627-780X Consorci Hospital General Universitari de Valencia, Valencia, SpainSearch for more papers by this authorAndrés Grau Echevarría, Andrés Grau Echevarría orcid.org/0000-0003-2557-3107 Consorci Hospital General Universitari de Valencia, Valencia, SpainSearch for more papers by this authorCarolina Labrandero Hoyos, Corresponding Author Carolina Labrandero Hoyos [email protected] orcid.org/0000-0002-3270-7428 Consorci Hospital General Universitari de Valencia, Valencia, Spain Correspondence Carolina Labrandero Hoyos, Department of Dermatology, Hospital General Universitario de Valencia, Av. Tres Creus, 2, Valencia 46014, Spain. Email: [email protected]Search for more papers by this authorJorge Magdaleno Tapial, Jorge Magdaleno Tapial orcid.org/0000-0003-0046-6962 Consorci Hospital General Universitari de Valencia, Valencia, SpainSearch for more papers by this authorAltea Esteve Martínez, Altea Esteve Martínez Consorci Hospital General Universitari de Valencia, Valencia, SpainSearch for more papers by this author First published: 04 February 2024 https://doi.org/10.1111/ajd.14215Read 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 No abstract is available for this article. REFERENCES 1Trüeb RM, Dias MF. Alopecia areata: a comprehensive review of pathogenesis and management. Clin Rev Allergy Immunol. 2017; 54(1): 68–87. 10.1007/s12016-017-8620-9 Web of Science®Google Scholar 2Rossi A, Magri F, Michelini S, Caro G, Di Fraia M, Fortuna MC, et al. Recurrence of alopecia areata after covid-19 vaccination: a report of three cases in Italy. J Cosmet Dermatol. 2021; 20(12): 3753–3757. 10.1111/jocd.14581 PubMedWeb of Science®Google Scholar 3Castelli E, Caputo V, Morello V, Tomasino RM. Local reactions to tick bites. Am J Dermatopathol. 2008; 30(3): 241–248. 10.1097/DAD.0b013e3181676b60 PubMedWeb of Science®Google Scholar 4Marshall J. Alopecia after tick bite. S Afr Med J. 1966; 40(24): 555–556. CASPubMedGoogle Scholar 5Heyl T. Tick bite alopecia. Clin Exp Dermatol. 1982; 7(5): 537–542. https://doi.org/10.1111/j.1365-2230.1982.tb02472.x 10.1111/j.1365-2230.1982.tb02472.x CASPubMedWeb of Science®Google Scholar Early ViewOnline Version of Record before inclusion in an issue ReferencesRelatedInformation

BACKGROUND Mpox is a rare zoonotic disease with a progressive increase in cases among men who have sex with men (MSM) worldwide in the last months. New complications of this infection have been described. OBJECTIVES AND METHODS To describe this new pattern of presentation of Mpox at the level of the finger. RESULTS We present 3 cases of Mpox whitlow, a new clinical presentation of Mpox. The patients were 3 MSM with ages ranging from 32 to 49 years. All three had involvement of the third finger of the dominant hand as well as skin lesions at other sites. Two of the three patients had severe inflammation in the digit and proximal arm and were treated with systemic corticosteroids with significant improvement. In 2 of the 3 cases we observed onychodystrophy as a complication. All patients reported sexual intercourse with previous digital anal penetration with the affected finger, which may be the mode of transmission. CONCLUSIONS We describe three cases of this Mpox clinical presentation with some distinguishing features that need to be considered.

fossa, and, remotely, in the palpebral area (Figure 1A,B). The lesions disappeared in less than 24 h, with no skin sequelae, including desquamation. An open test was performed with each ingredient separately (provided by the patient after obtaining from the pharmacy where the master formula was prepared), being negative on early reading (20 min) (Figure 1C), although the patient reported the reaction seen in Figure 1D at 4 h. An exclusively positive reaction to lipoic acid was demonstrated both in the area of application of the open test and in distant lesions on forearm (Figure 1D, black arrows). This case concerns contact urticaria, probably allergic in nature, which, given the occurrence of a systemic reaction as well, can be classified as contact urticaria syndrome caused by alpha-lipoic acid. Complete clearance of the eruption was visible after stopping applying the serum.

Morphea is a connective tissue disease causing skin thickening and fibrosis that impact patients' quality of life. Standard immunosup-pressant treatments have limited efficacy. We present a case of the successful treatment of generalized morphea with baricitinib. A 68- year-old woman presented with progressive skin thickening on the trunk and limbs. The skin appeared tight, shiny, and non-compressible (Figure 1a– c). No other symptoms were observed such as Raynaud's phenomenon, reflux, or digital involvement. Her eosinophil count and autoimmune markers were within normal range. A diagnosis of generalized morphea was confirmed through a skin biopsy. Initial treatment with prednisone and methotrexate showed no response. Infliximab was administered but had limited tolerability and efficacy. A regimen of prednisone (30 mg/day), mycophenolate mofetil (MMF) (2 g/day)

Monkeypox is a rare zoonotic disease with a progressive increase in cases among men who have sex with men (MSM) worldwide in recent months. New complications of this infection have been described. The aim of the study was to describe this new pattern of presentation of monkeypox at the level of the finger. We present the cases of three patients with monkeypox whitlow, a new clinical presentation of monkeypox. The patients were three MSM with ages ranging from 32 to 49 years. All three had involvement of the third finger of the dominant hand as well as skin lesions at other sites. Two of the three patients had severe inflammation in the digit and proximal arm and were treated with systemic corticosteroids with significant improvement. In two of the three cases we observed onychodystrophy as a complication. All patients reported sexual intercourse with previous digital-anal penetration with the affected finger, which may be the mode of transmission. Distinguishing features that need to be considered are discussed. We describe the clinical course of monkeypox whitlow in three patients. Whitlow is a new complication of this emerging viral disease.