Niniejsza aktualizacja i rewizja międzynarodowych wytycznych dotyczących pokrzywki została opracowana zgodnie z metodami zalecanymi przez Cochrane i grupę roboczą Grading of Recommendations Assessment, Development and Evaluation (GRADE). Jest to wspólna inicjatywa Dermatology Section of the European Academy of Allergology and Clinical Immunology (EAACI), Global Allergy and Asthma European Network (GA2LEN) i jej Urticaria and Angioedema Centers of Reference and Excellence (UCAREs i ACAREs), European Dermatology Forum (EDF; EuroGuiDerm) oraz Asia Pacific Association of Allergy, Asthma and Clinical Immunology z udziałem 64 delegatów z 50 towarzystw krajowych i międzynarodowych z 31 krajów. Konferencja uzgodnieniowa odbyła się 3 grudnia 2020 r. Niniejsze wytyczne zostały uznane i zaakceptowane przez European Union of Medical Specialist s (UEMS). Pokrzywka jest częstą chorobą, w której pośredniczą komórki tuczne, objawiającą się bąblami, obrzękiem naczynioruchowym lub obydwoma tymi objawami. Częstość występowania ostrej pokrzywki w ciągu życia wynosi około 20%. Przewlekła pokrzywka spontaniczna lub indukowalna powoduje niesprawność, pogarsza jakość życia oraz wpływa na aktywność w pracy i w szkole. Ta zaktualizowana wersja międzynarodowych wytycznych dotyczących pokrzywki obejmuje definicję i klasyfikację pokrzywki oraz przedstawia opracowane przez ekspertów i oparte na dowodach metody diagnostyki i leczenia w przypadku różnych podtypów pokrzywki.

The evidence- and consensus-based guideline on atopic eczema, published in JEADV on 18 August 2022 (part 1) and 3 September 2022 (part 2) was developed in accordance with the EuroGuiDerm Guideline and Consensus Statement Development Manual. Four consensus conferences were held between December 2020 and July 2021. Twenty-nine experts (including clinicians and patient representatives) from 12 European countries participated. To reflect the most recent evidence on novel systemic medications, an update was published in October 2022. According to the purpose of the Italian Society of Dermatology and STD (SIDEMAST), the Italian Association of Hospital Dermatologists (ADOI) and the Italian Society of Allergological and Environmental Dermatology (SIDAPA) to adapt the EuroGuiDerm guideline on the treatment of atopic eczema into the Italian Healthcare setting, the original update has been supplemented by inserting notes, well highlighted by the original text, to emphasize the laws, rules, procedures and suggestions of the Italian Ministry of Health and regional Health authorities.

SIDeMaST (Società Italiana di Dermatologia Medica, Chirurgica, Estetica e delle Malattie Sessualmente Trasmesse) contributed to the development of the present guideline on the systemic treatment of chronic plaque psoriasis. With the permission of EuroGuiDerm, SIDeMaST adapted the guideline to the Italian healthcare context to supply a reliable and affordable tool to Italian physicians who take care of patients affected by atopic dermatitis. The evidence- and consensus-based guideline on atopic eczema was developed in accordance with the EuroGuiDerm Guideline and Consensus Statement Development Manual. Four consensus conferences were held between December 2020 and July 2021. Twenty-nine experts (including clinicians and patient representatives) from 12 European countries participated. This first part of the guideline includes general information on its scope and purpose, the health questions covered, target users and a methods section. It also provides guidance on which patients should be treated with systemic therapies, as well as recommendations and detailed information on each systemic drug. The systemic treatment options discussed in the guideline comprise conventional immunosuppressive drugs (azathioprine, ciclosporin, glucocorticosteroids, methotrexate and mycophenolate mofetil), biologics (dupilumab, lebrikizumab, nemolizumab, omalizumab and tralokinumab) and janus kinase inhibitors (abrocitinib, baricitinib and upadacitinib). Part two of the guideline will address avoidance of provocation factors, dietary interventions, immunotherapy, complementary medicine, educational interventions, occupational and psychodermatological aspects, patient perspective and considerations for pediatric, adolescent, pregnant and breastfeeding patients.

SIDeMaST (Societ & agrave; Italiana di Dermatologia Medica, Chirurgica, Estetica e delle Malattie Sessualmente Trasmesse) contributed to the development of the present guideline on the systemic treatment of chronic plaque psoriasis. With the permission of EuroGuiDerm, SIDeMaST adapted the guideline to the Italian healthcare context to supply a reliable and affordable tool to Italian physicians who take care of patients affected by atopic dermatitis. The evidence- and consensus-based guideline on atopic eczema was developed in accordance with the EuroGuiDerm Guideline and Consensus Statement Development Manual. Four consensus conferences were held between December 2020 and July 2021. Twenty-nine experts (including clinicians and patient representatives) from 12 European countries participated. This second part of the guideline includes recommendations and detailed information on basic therapy with emollients and moisturizers, topical anti-inflammatory treatment, antimicrobial and antipruritic treatment and UV phototherapy. Furthermore, this part of the guideline covers techniques for avoiding provocation factors, as well as dietary interventions, immunotherapy, complementary medicine and educational interventions for patients with atopic eczema and deals with occupational and psychodermatological aspects of the disease. It also contains guidance on treatment for pediatric and adolescent patients and pregnant or breastfeeding women, as well as considerations for patients who want to have a child. A chapter on the patient perspective is also provided. The first part of the guideline, published separately, contains recommendations and guidance on systemic treatment with conventional immunosuppressive drugs, biologics and janus kinase (JAK) inhibitors, as well as information on the scope and purpose of the guideline, and a section on guideline methodology.

BACKGROUND:Eyelid dermatitis is a frequent reason of dermatological consultation. Its aetiology is not univocal, being contact dermatitis, both allergic and irritant, the most frequent. The primary sources of allergen exposure include cosmetics, metals, and topical medications, from direct, indirect, or airborne contact.OBJECTIVES:To define the frequency of positive patch test reactions to SIDAPA baseline series allergens, to document positive allergens, and to precise the final diagnosis in patients with eyelid involvement.METHODS:A total of 8557 consecutive patients from 12 Italian Dermatology Clinics underwent patch testing with SIDAPA baseline series in 2018 and 2019. Patients were divided into two groups: (i) with eyelid involvement with or without other involved sites (E-Group) and (ii) without eyelid involvement (NE-Group). The final diagnosis and the frequency of positive relevant patch test reactions were evaluated.RESULTS:E-Group consisted of 688 patients (females 78.6%, mean age 45.3 years), 8.0% of 8557 consecutively patch-tested patients. The final diagnosis in E-Group was ADC in 42.4%, ICD in 34.2%, and AD in 30.5%. The highest reaction rates were elicited by nickel sulphate and methylchloroisothiazolinone/methylisothiazolinone in both E-Group and NE-Group, even if these allergens were significantly more frequently positive in NE-Group patients than in E-Group ones. Positive patch test reactions to fragrance Mix II, dimethylaminopropylamine, and sorbitan sesquiolate were significantly more frequent in E-Group patients than in NE-Group ones.CONCLUSIONS:Eyelid dermatitis is a frequent dermatological complaint. Allergic contact dermatitis is the most frequent diagnosis commonly caused by nickel sulphate, isothiazolinones, and fragrances. The surfactants dimethylaminopropylamine and sorbitan sesquioleate are emerging causes of eyelid allergic contact dermatitis.

After decades of use, methotrexate displays an established safety and efficacy profile in both in-hospital and outpatient settings. Despite its widespread use, there is surprisingly little clinical evidence to guide daily practice with methotrexate in dermatology. To provide guidance for clinicians in daily practice for areas in which there is limited guidance. A Delphi consensus exercise on 23 statements was carried out on the use of methotrexate in dermatological routine settings. Consensus was reached on statements that cover six main areas: (1) pre-screening exams and monitoring of therapy; (2) dosing and administration in patients naïve to methotrexate; (3) optimal strategy for patients in remission; (4) use of folic acid; (5) safety; and (6) predictors of toxicity and efficacy. Specific recommendations are provided for all 23 statements. In order to optimize methotrexate efficacy, it is essential to optimize treatment using appropriate dosages, carrying out a rapid drug-based step-up on a treat-to-target strategy and preferably using the subcutaneous formulation. To manage safety aspects appropriately, it is essential to evaluate patients’ risk factors and carry out proper monitoring during the course of treatment.

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

Despite the well-known cutaneous beneficial effect of thermal water on the skin, no data exist regarding the potential biological effect of orally consumed water on healthy skin. Thus, in this single-center, double-blind, randomized controlled clinical trial conducted on age and menstrual cycle timing-matched healthy female volunteers (24 + 24) consuming water A (oligo-mineral) or water B (medium-mineral) for 1 month (T1), the cutaneous lipidomics were compared. Interestingly, only water A consumers had a statistically significant (p < 0.001) change in cutaneous lipidomics, with 66 lipids different (8 decreased and 58 increased). The cutaneous lipidomics of consumers of water A vs. water B were statistically different (p < 0.05). Twenty cutaneous lipids were necessary to predict the water type previously consumed (AUC ~70). Our study suggests that drinking oligo-mineral water may change skin biology and may influence the cutaneous barrier, so future dermatological clinical trials should also account for the water type consumed to avoid potential confounders.

Basophil activation test (BAT) can tackle multiple mechanisms underlying acute and delayed hypersensitivity to drugs and vaccines and might complement conventional allergy diagnostics but its role in anti-severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccine-related hypersensitivity is ill-defined. Therefore, 89 patients with possible hypersensitivity (56 % with delayed mucocutaneous manifestations) to anti-SARS-CoV-2 vaccines were tested with BAT for Macrogol 3350, DMG-PEG 2000, PEG 20000, polysorbate-80 and trometamol and compared to 156 subjects undergoing pre-vaccine BAT. A positive BAT was associated with delayed reaction onset (p = 0.010) and resolution (p = 0.011). BAT was more frequently positive to DMG-PEG 2000 than to other excipients in both groups (p < 0.001). DMG-PEG 2000 reactivity was less frequent in vaccine-naïve (6 %) than vaccinated subjects (35 %, p < 0.001) and associated with mRNA-1273 vaccination. DMG-PEG 2000 BAT might therefore have a diagnostic role in subjects with delayed hypersensitivity reactions. Natural immunity might be a key player in basophil activation.

AtopyReg® is a multicenter, prospective, observational, non-profit cohort study on moderate-to-severe atopic dermatitis in adults promoted in 2018 by the Italian Society of Dermatology and Venereology (SIDeMaST). We aimed to describe baseline demographics, disease characteristics, comorbidities, and therapeutic data of adult patients affected by moderate-to-severe atopic dermatitis. Patients were selected based on the following inclusion criteria: age ≥ 18 years; Eczema Area and Severity Index score ≥ 16 or localization in visible or sensitive areas (face, neck, hands, or genitalia), or a Numeric Rating Scale itch score ≥ 7 or a Numeric Rating Scale sleep loss score ≥ 7, or a Dermatology Life Quality Index score ≥ 10. Demographic and clinical data at baseline were recorded and analyzed. A total of 1170 patients (male 51.1

BACKGROUND:During the first Italian lockdown period, the imponent amount of hospital COVID-19 patients forced the healthcare system to re-organize visits but no information are available on outpatient ethnical patterns. Here we evaluated healthcare management changes on dermatological outpatient non-surgical settings visits during the SARS-CoV-2 pandemic.METHODS:In this retrospective study we collected data of scheduled, performed and not-performed visits, together with patients' characteristics (i.e., age, gender) with a particular attention for ethnicities among the outpatients accessing during the first Italian lockdown (March 5-April 30, 2020). Then, we compared these data with the corresponding ones in 2019 (before COVID-19 pandemic).RESULTS:During the Italian lockdown the dermatological department registered a great decrement (-83.5%, P<0.001) in visits compared to the corresponding time period in 2019. Performed and scheduled visits to non-oncological stable patients together with emergency accesses to dermatology decreased. Non-Italian patients decreased accesses, especially the South East Asians (-70.4%) and North Africans (-90.0%).CONCLUSIONS:Hospitals policy and mass media deeply condition the public opinion, and this aspect may explain a different access to the hospital among non-Italian patients. Telemedicine should be promoted especially among non-Italian communities in Italy to overgo patients' skepticism and incentivize prevention and early treatment in dermatological conditions.

Omalizumab is a biological drug targeting circulating IgE, approved for use in allergic asthma, chronic spontaneous urticaria, and recently for chronic rhinosinusitis with nasal polyps, with good efficacy in all these settings. Some concerns about omalizumab safety have been raised as its use has been recently linked to potential increased cancer risk. Nevertheless, literature evidence does not support this statement, and clinical studies and evidence from real-world registries and sur-veillance analysis have consistently reported drug safety.

DermatitisVol. 33, No. 3 LettersFree AccessPatients Withdrawing Dupilumab Monotherapy for COVID-19–Related Reasons Showed Similar Disease Course Compared With Patients Continuing Dupilumab TherapyAndrea Chiricozzi, Lucia Di Nardo, Marina Talamonti, Marco Galluzzo, Clara De Simone, Gabriella Fabbrocini, Angelo Valerio Marzano, Giampiero Girolomoni, Annamaria Offidani, Maria Teresa Rossi, Luca Bianchi, Antonio Cristaudo, Maria Teresa Fierro, Luca Stingeni, Giovanni Pellacani, Giuseppe Argenziano, Annalisa Patrizi, Paolo Pigatto, Marco Romanelli, Paola Savoia, Pietro Rubegni, Caterina Foti, Nicola Milanesi, Anna Belloni Fortina, Maria Rita Bongiorno, Teresa Grieco, Sergio Di Nuzzo, Maria Concetta Fargnoli, Andrea Carugno, Alberico Motolese, Franco Rongioletti, Paolo Amerio, Riccardo Balestri, Concetta Potenza, Giuseppe Micali, Cataldo Patruno, Iris Zalaudek, Maurizio Lombardo, Claudio Feliciani, Flaminia Antonelli, Silvia Mariel Ferrucci, Fabrizio Guarneri, and Ketty PerisAndrea ChiricozziDermatologia, Dipartimento Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, ItalySearch for more papers by this author, Lucia Di NardoDermatologia, Dipartimento Universitario di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Rome, Italy Search for more papers by this authorEmail the corresponding author at [email protected], Marina TalamontiDermatologia, Dipartimento Universitario di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Rome, ItalySearch for more papers by this author, Marco GalluzzoDermatology Unit, Policlinico Tor Vergata, Department of Systems Medicine, Tor Vergata University of Rome, ItalySearch for more papers by this author, Clara De SimoneDermatologia, Dipartimento Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, ItalySearch for more papers by this author, Gabriella FabbrociniDermatologia, Dipartimento Universitario di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, Rome, ItalySearch for more papers by this author, Angelo Valerio MarzanoSection of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, ItalySearch for more papers by this author, Giampiero GirolomoniDermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, ItalySearch for more papers by this author, Annamaria OffidaniDepartment of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, ItalySearch for more papers by this author, Maria Teresa RossiSection of Dermatology and Venereology, Department of Medicine, University of Verona, ItalySearch for more papers by this author, Luca BianchiDermatological Clinic, Department of Clinical and Molecular Sciences, Polytechnic University of the Marche Region, Ancona, ItalySearch for more papers by this author, Antonio CristaudoDepartment of Dermatology, ASST Spedali Civili of Brescia, University of Brescia, ItalySearch for more papers by this author, Maria Teresa FierroDermatology Unit, Policlinico Tor Vergata, Department of Systems Medicine, Tor Vergata University of Rome, ItalySearch for more papers by this author, Luca StingeniClinical Dermatology, San Gallicano Dermatological Institute, Rome, ItalySearch for more papers by this author, Giovanni PellacaniMedical Sciences Department, Dermatologic Clinic, University of Turin, ItalySearch for more papers by this author, Giuseppe ArgenzianoDermatology Section, Department of Medicine, University of Perugia, ItalySearch for more papers by this author, Annalisa PatriziUnit of Dermatology, Department of Clinical Internal, Anesthesiological, and Cardiovascular Sciences, Sapienza University of Rome, ItalySearch for more papers by this author, Paolo PigattoDermatology Unit, University of Campania Luigi Vanvitelli, Naples, ItalySearch for more papers by this author, Marco RomanelliDermatology UOC, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, ItalySearch for more papers by this author, Paola SavoiaDepartment of Biomedical, Surgical and Dental Sciences, Clinical Dermatology, IRCCS Galeazzi Orthopaedic Institute, University of Milan, ItalySearch for more papers by this author, Pietro RubegniDepartment of Dermatology, University of Pisa, ItalySearch for more papers by this author, Caterina FotiDepartment of Health Sciences, Amedeo Avogadro University of Eastern Piedmont, Novara, ItalySearch for more papers by this author, Nicola MilanesiDermatology Unit, Department of Medical, Surgical and Neurosciences, University of Siena, ItalySearch for more papers by this author, Anna Belloni FortinaDepartment of Biomedical Science and Human Oncology, Unit of Dermatology, University of Bari, ItalySearch for more papers by this author, Maria Rita BongiornoDermatology Clinic, Department of Health Sciences, University of Florence, ItalySearch for more papers by this author, Teresa GriecoDermatology Unit, Department of Medicine DIMED, University of Padova, ItalySearch for more papers by this author, Sergio Di NuzzoSection of Dermatology, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, ItalySearch for more papers by this author, Maria Concetta FargnoliUnit of Dermatology, Department of Clinical Internal, Anesthesiological, and Cardiovascular Sciences, Sapienza University of Rome, ItalySearch for more papers by this author, Andrea CarugnoDepartment of Medicine and Surgery, University of Parma, ItalySearch for more papers by this author, Alberico MotoleseDermatology, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, ItalySearch for more papers by this author, Franco RongiolettiDermatology Unit, ASST Papa Giovanni XXIII Hospital, Bergamo, ItalySearch for more papers by this author, Paolo AmerioDermatology Unit, Department of Medical Specialties, Arcispedale Santa Maria Nuova-IRCCS di Reggio Emilia, ItalySearch for more papers by this author, Riccardo BalestriVita-Salute San Raffaele University and IRCCS San Raffaele Hospital, Milan, ItalySearch for more papers by this author, Concetta PotenzaUnit of Dermatology, Department of Medical Sciences and Public Health, University of Cagliari, ItalySearch for more papers by this author, Giuseppe MicaliDepartment of Medicine and Aging Science, Dermatologic Clinic, G. D'Annunzio University, Chieti, ItalySearch for more papers by this author, Cataldo PatrunoDivision of Dermatology, Santa Chiara Hospital, Trento, ItalySearch for more papers by this author, Iris ZalaudekDepartment of Medico-Surgical Sciences and Biotechnologies, Dermatology Unit 'Daniele Innocenzi' Sapienza University of Rome–Polo Pontino, ItalySearch for more papers by this author, Maurizio LombardoDermatology Clinic, University of Catania, ItalySearch for more papers by this author, Claudio FelicianiDermatology Unit, Department of Health Sciences, Università Magna Graecia, Catanzaro, ItalySearch for more papers by this author, Flaminia AntonelliDepartment of Dermatology, University of Trieste, ItalySearch for more papers by this author, Silvia Mariel FerrucciUnit of Dermatological Diseases, ASST Sette Laghi, Ospedale di Circolo, Varese, ItalySearch for more papers by this author, Fabrizio GuarneriSection of Dermatology, Department of Medicine and Surgery, University of Parma, ItalySearch for more papers by this author, and Ketty PerisDermatologia, Dipartimento Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, ItalySearch for more papers by this authorPublished Online:1 Jun 2022AboutSectionsPDF/EPUB Permissions & CitationsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookXLinked InRedditEmail To the Editor:Atopic dermatitis (AD) is a chronic inflammatory skin disease that is treated with phototherapy or systemic therapies when the disease is assessed as moderate-severe and unresponsive to topical therapies.During COVID-19 pandemic, a few studies described the therapeutic management of AD.1–3 In Italy, the DA-COVID-19 national registry was created to collect clinical data about the management of moderate-severe AD patients during the lockdown period (starting from February to June 2020). Pandemic-related sanitary restrictions limited the access to hospitals and determined the implementation of regular visits with telemedicine, resulting in a predominant patient-oriented assessment of disease severity.3 Three time points for data collection were considered.3Herein,3 we describe AD course after dupilumab withdrawal. The effectiveness of dupilumab in the treatment of moderate-severe AD has been widely characterized in both real-world and clinical trial settings.4,5 However, there is no evidence about the maintenance of treatment response after withdrawal of dupilumab therapy.Of 1013 patients treated with dupilumab monotherapy, 75 (7.4%) interrupted therapy, with a mean duration of treatment withdrawal of 106.4 days (±75.83 days). Significant differences between the subgroup of patients continuing and patients withdrawing therapy throughout the study period were detected, highlighting a lower degree of disease severity in patients continuing therapy (data not shown). In particular, patient self-reported AD severity status showed significantly higher scores in patients withdrawing treatment, independent of the cause of interruption, at any time point (Table 1). Thirty-six of 75 patients withdrew therapy because of the risk factors related to COVID-19 disease (age >65 years, metabolic and/or cardiovascular comorbidities), SARS-CoV-2 infection, fear of increased susceptibility to SARS-CoV-2 infection, or close contact with SARS-CoV-2+ subjects.TABLE 1 AD Course in Patients Withdrawing Dupilumab Monotherapy Because of Reasons Related or Unrelated to SARS-CoV-2 InfectionChanges in mean scores for Eczema Area and Severity Index (EASI), Itch–Numeric Rating Scale (Itch-NRS), and Sleep–Numeric Rating Scale (Sleep-NRS) from time point 3 and time point 1 were not significantly different in the subcohort of patients withdrawing because of SARS-CoV-2–related reasons versus patients continuing dupilumab therapy (Table 1). In this subcohort of patients, mean dupilumab withdrawal period resulted longer intervals (123.2 ± 11.69 days) compared with patients discontinuing dupilumab because of reasons unrelated to SARS-CoV-2 infection (90.03 ± 12.91 days), although this difference was not statistically significant (P = 0.0615).Of 75 patients, 39 patients withdrew dupilumab therapy because of reasons unrelated to COVID-19 disease, including ineffectiveness, adverse events, patient's decision, and issues with drug supply. In contrast to patients withdrawing therapy because of SARS-CoV-2–related reasons, these patients experienced a significant worsening of AD with greater changes in mean EASI score, Itch-NRS, and Sleep-NRS at time point 3 versus time point 1, compared with patients continuing therapy (Table 1). Thus, this study provides relevant insights for physicians about the management of AD patients after dupilumab suspension or withdrawal during COVID-19 pandemic, because a 16-week interruption due to SARS-CoV-2–related reasons did not cause a significant relapse or worsening of the disease.REFERENCES1. Stingeni L, Hansel K, Antonelli E, et al. Atopic dermatitis in adolescents: effectiveness and safety of dupilumab in a 16-week real-life experience during the COVID-19 pandemic in Italy. Dermatol Ther. 2021;34:e15035. . Epub ahead of print. Crossref, Medline, Google Scholar2. Rossi M, Rovati C, Arisi M, et al. Management of adult patients with severe atopic dermatitis treated with dupilumab during COVID-19 pandemic: a single-center real-life experience. Dermatol Ther 2020;33(4):e13765. Crossref, Medline, Google Scholar3. Chiricozzi A, Talamonti M, De Simone C, et al.DA-COVID-19 study group. Management of patients with atopic dermatitis undergoing systemic therapy during COVID-19 pandemic in Italy: data from the DA-COVID-19 registry. Allergy 2021;76(6):1813–1824. Crossref, Medline, Google Scholar4. Gori N, Chiricozzi A, Malvaso D, et al. Successful combination of systemic agents for the treatment of atopic dermatitis resistant to dupilumab therapy. Dermatology 2021;237(4):535–541. Crossref, Medline, Google Scholar5. Deleuran M, Thaçi D, Beck LA, et al. Dupilumab shows long-term safety and efficacy in patients with moderate to severe atopic dermatitis enrolled in a phase 3 open-label extension study. J Am Acad Dermatol 2020;82(2):377–388. Crossref, Medline, Google ScholarFiguresReferencesRelatedDetails Volume 33Issue 3Jun 2022 Information© 2021 American Contact Dermatitis Society. All Rights Reserved.To cite this article:Andrea Chiricozzi, Lucia Di Nardo, Marina Talamonti, Marco Galluzzo, Clara De Simone, Gabriella Fabbrocini, Angelo Valerio Marzano, Giampiero Girolomoni, Annamaria Offidani, Maria Teresa Rossi, Luca Bianchi, Antonio Cristaudo, Maria Teresa Fierro, Luca Stingeni, Giovanni Pellacani, Giuseppe Argenziano, Annalisa Patrizi, Paolo Pigatto, Marco Romanelli, Paola Savoia, Pietro Rubegni, Caterina Foti, Nicola Milanesi, Anna Belloni Fortina, Maria Rita Bongiorno, Teresa Grieco, Sergio Di Nuzzo, Maria Concetta Fargnoli, Andrea Carugno, Alberico Motolese, Franco Rongioletti, Paolo Amerio, Riccardo Balestri, Concetta Potenza, Giuseppe Micali, Cataldo Patruno, Iris Zalaudek, Maurizio Lombardo, Claudio Feliciani, Flaminia Antonelli, Silvia Mariel Ferrucci, Fabrizio Guarneri, and Ketty Peris.Patients Withdrawing Dupilumab Monotherapy for COVID-19–Related Reasons Showed Similar Disease Course Compared With Patients Continuing Dupilumab Therapy.Dermatitis.Jun 2022.e25-e29.http://doi.org/10.1097/DER.0000000000000814Published in Volume: 33 Issue 3: June 1, 2022 TopicsCOVID-19 PDF download

BACKGROUND Patients with atopic dermatitis (AD) display a defective skin barrier, consequently they may experience inflammatory flares with different exposures, including masks. Actually, beside scattering case reports, no study focused on the possible AD flaring due to masks. METHODS In this multicenter prospective study AD patients with facial manifestation were followed with teledermatology and evaluated by two board-certified dermatologists at the baseline (T0) and after 1 month (T1) in which patients started to wear masks >6 hours per day. Demographics and clinical parameters, included and not limited to Eczema Area and Severity Index (EASI) and Dermatology Life Quality Index (DLQI), were carefully collected and analyzed. RESULTS We enrolled 57 AD patients (M/F 28/29, 33.91 ± 12.26 yoa) that wore surgical masks (38 (66.7%)), community masks (11 (19.3%) and N95 (8 (14.0%)). Both DLQI and EASI increase during the time period (p<0.0001). DLQI variation was not influenced by age, BMI, and gender, mask type used and AD therapy (p=0.99), whilst EASI variation was significantly influenced by BMI, gender, and therapy (p=0.004). CONCLUSIONS Mask wearing may prove detrimental to patients with atopic eczema and the same may not necessarily be the case for asthma patients.

A nationwide survey was conducted in adult patients with psoriasis (PsO) across Italy to obtain their real-world perspective of the impact of PsO on their wellbeing. Patients completed a 26-question survey (based on the patient benefit index; PBI, The Dermatology Life Quality Index; DLQI and the World Health Organization-five; WHO-5 wellbeing index) and workshop discussion sessions were undertaken by dermatologists to interpret results from the survey. 392 patients with PsO completed the survey. Analysis of results was restricted to patients who had moderate-to-severe plaque psoriasis (assessed by patients; n = 252; 64.3%). Dermatologists (n = 32) completed one question from the survey related to wellbeing and rated social, physical and mental domains as contributing to a similar extent, with comparable scores also observed by patients. For treatment, biologics yielded higher scores on average, whereas little difference was observed between topical and conventional systemic treatments. Only 23.8% of patients felt that their dermatologist was taking into consideration their wellbeing and 32.6% of the patients considered their therapy as inadequate in improving signs and symptoms of the disease. This survey identified key factors contributing to barriers impacting on patient wellbeing. Simple, but comprehensive questionnaires can provide important insight to patients' needs that may significantly increase clinician awareness during visits leading to tailored treatment.

BACKGROUND: The therapeutic approaches to patients with chronic spontaneous urticaria (CSU) differ among health care professionals and may be influenced by many factors.OBJECTIVES: This cross-sectional survey was aimed at evaluating physicians’ attitudes regarding therapeutic management of CSU on clinical practice.METHODS: A study-specific questionnaire was administered to a group of physicians (n=21) with a specialist interest in CSU from different areas of Italy (Group A) and also to other physicians (n=25) who manage CSU only occasionally in their clinical activity (Group B).RESULTS: In case of ineffectiveness of second-generation antihistamines at standard doses, higher doses of the same drug were always or frequently prescribed by most physicians in both groups, and 64% in group B and one third in group A usually increased the dose up to twice. Old-generation antihistamines were never used in clinical practice by 14% of survey participants in group A and 24% in group B, with the remaining physicians reporting rare or occasional uses. The prescription of systemic corticosteroids appeared to be more common among physicians in group B. The question concerning the use of alternative drugs in refractory CSU produced different answers between the two groups. Costs and access to specialist reference centers were indicated as the most important barriers to the use of medications different from antihistamines.CONCLUSIONS: These preliminary results suggest that therapeutic approaches to CSU seem to be heterogeneous in clinical practice and could be at least in part conditioned by the different medical settings where physicians usually work.

After onset of the COVID-19 pandemics, the use of phototherapy for dermatological conditions became, as most systemic treatments in dermatology, a subject of debate; finally, several centers all over the world increased their COVID-19-preventive strategies to guarantee narrow band-UVB (NB-UVB) treatments to chronic patients.1 Nicastro et al. demonstrated that not only UV-C but also UV-B and UV-A have a powerful virucidal effect against SARS-CoV-2.2 Currently, it is not known whether the use of phototherapy during RNA-based COVID-19 vaccine is appropriate. Phototherapists may arbitrarily decide to discontinue NB-UVB when a COVID-19 vaccination is planned or has been administered. While the decision to discontinue NB-UVB is generally motivated by the fear of a potential, not yet fully understood,3 vaccine-related increase of the patients' photosensitivity, those who opt for continuing with UVB-NB act so hoping to prevent possible vaccine-related flares (i.e., psoriasis flares).4 To assess a potential decrease of minimal erythemal dose (MED), causing photosensitivity in NB-UVB patients who were administered a RNA-based COVID-19 vaccine, we performed the multicenter study described underneath. We prospectively evaluated 16 dermatological patients with psoriasis (PsO), atopic dermatitis (AD) or pruritus sine materia (Psn) who were planned to undergo at least one NB-UVB session (as a monotherapy) before being administered a RNA-based COVID-19 vaccine. The enrolled patients did not present relevant comorbidities in their medical history (in particular actinic keratosis, alcohol or tobacco addiction or porphyriae), did not take NB- UVB contraindicated prescription drugs (e.g., retinoids), did not follow a specific diet (such as a vegan or a vegetarian diet).5 All recruited patients had completed in the past NB-UVB cycles without complications, showing high compliance (<2 session skipped and <2 rescheduled); also, they did not practice phytotherapy or any other alternative/complementary medicine practice. All patients underwent Minimal Erythemal Dose (MED) evaluation with Multiport UV Solar Simulator 601 (Solar Light CO.INC: Philadelphia, PA) at baseline (T0), 3 days after the first dose of vaccine (T1) and 3 days after the second dose of vaccine. In order to avoid systemic UVB-induced immunosuppression, NB-UVB was delivered three times a week by a Waldmann ramp equipped with 13 Philips® TL100 W/01 fluorescent tubes (Waldmann Medizintechnik GmbH, Villingen-Schwenningen, Germany) emitting 15 mW/cm2 at a distance of 20 cm as measured by a Waldmann UV meter dosimeter and was performed on a body surface area <80%. In line with clinical protocols to avoid photoadaptation phenomena, patients started with 70% of the MED with a session increase of 40% in absence of erythema—otherwise 10%—until a dose of 3.00 J/cm2 was reached. The dose was maintained constant in the following sessions. The sessions and the vaccinations were planned so that all patients would undergo a phototherapeutic session 2–5 h before vaccination and one session 3 days after vaccination. Patients' demographics and clinical characteristics are displayed in detail in Table 1. We enrolled five PsO patients (age: 37 [35–42] years), 3 AD patients (age: 53 [48.5–57] years) and 8 Psn patients (age: 44.5 [37.75–49.5]) with a Fitzpatrick skin type higher than II. In the recruited patient group, we assessed with Wilcoxon paired rank test MED oscillations which were neither statistically significant (p > 0.05) nor clinically meaningful; our results suggest that RNA-based COVID-19-vaccines do not increase photosensitivity and may rather induce photoadaptative phenomena; the latter could prove, however, detrimental for a proper phototherapeutic response.6 We suggest that upon a planned administration of a COVID-19-RNA-Vaccine neither a discontinuation nor a dose modification of a NB-UVB treatment is needed. Also, all patients in our study displayed adequate levels of anti SARS-CoV-2 S1-Receptor Binding Domain (RBD) antibodies (test performed 15 days after vaccination). The authors declare no conflict of interest. Conceptualization: Alessia Pacifico and Giovanni Damiani. Methodology: Alessia Pacifico, Alessandra Buja, Dennis Linder, and Giovanni Damiani. Software: Diego Orsini and Giovanni Damiani. Validation: Alessia Pacifico and Giovanni Damiani. Formal analysis: Alessandra Buja and Giovanni Damiani. Investigation: Alessia Pacifico. Resources: Giovanni Damiani, Alessandra Buja, Paolo D. M. Pigatto, and Alessia Pacifico. Data curation: Giovanni Damiani, Ayman Grada. Writing—original draft preparation: Alessia Pacifico and Giovanni Damiani. Writing—review and editing: Alessia Pacifico, Paolo D. M. Pigatto, Antonio Cristaudo, Diego Orsini, Alessandra Buja, Dennis Linder, Ayman Grada, and Giovanni Damiani. Visualization: Antonio Cristaudo and Diego Orsini. Supervision: Alessia Pacifico and Giovanni Damiani. Project administration: Alessia Pacifico, Paolo D. M. Pigatto, Antonio Cristaudo, Diego Orsini, and Giovanni Damiani. Funding acquisition: Giovanni Damiani. All authors have read and agreed to the published version of the manuscript. The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions.

BACKGROUND: Wearing masks is an optimal preventive strategy during COVID-19 pandemic, but it may increase facial sebum production. However, few case reports have described seborrheic dermatitis (SeBD) and psoriasis (PsO) flares due to masks. Hence, we conducted a mul-ticenter study to clarify the possibility of increased SeBD and PsO flares in association with mask wearing during the COVID-19 pandemic.METHODS: This multicenter study enrolled patients with a diagnosis of facial SeBD and PsO. All dermatological consultations were conducted in teledermatology at baseline (T0) and after 1 month (T1) Of >6 hours/day wearing mask. PsO patients were assessed using PsO Area and Severity Index (PASI) and self-administered PASI (SAPASI), whilst SeBD patients with symptom scale of seborrheic dermatitis' (SSSD) and seborrheic dermatitis area and severity index (SEDASI).RESULTS: A total of 33 (20 males, 13 females, average age 43.61 +/- 9.86) patients with PsO and 33 (20 males, 13 females, average age 44.00 +/- 8.58) with SeBD were enrolled. After 1 month, PsO patients displayed higher values of both PASI and SAPASI (P<0.0001), while SeBD patients experienced a flare, as testified by the increment of both SSSD and SEDASI (P<0.0001). Mask type did not seem to influence the flare severity.CONCLUSIONS: Masks remain an optimal preventive strategy during COVID-19 pandemic, but patients with PsO and SeBD may experience facial flares. Thus, therapeutic approach should be more aggressive in these groups of patients to counteract the triggering effect of masks.

Since psoriasis (PsO) is a chronic inflammatory disease, patients may experience a drug failure also with very effective drugs (i.e., secukinumab) and, consequently, dermatologists have two therapeutic options: switching or perform a combination therapy (rescue therapy) to save the drug that had decreased its efficacy. At the moment no studies focused on combination/rescue therapy of secukinumab, so we performed a 52-weeks multicenter retrospective observational study that involved 40 subjects with plaque psoriasis that experienced a secondary failure and were treated with combination therapy (ciclosporin (n = 11), MTX (n = 15), NB-UVB (n = 7) and apremilast (n = 7)). After 16 weeks of rescue/combination therapy, PASI and a DLQI varied respectively from 8 [7.0–9.0] and 13 [12.0–15.0], to 3 [2.8–4.0] and 3 [2.0–3.3]), suggesting a significant improvement of daily functionality and quality of life. Results were maintained at 52 weeks. No side effects were experienced during the study. Secukinumab remains a safety and effective drug for PsO patients also in the IL-23 and JAK inhibitors era. The rescue therapy is a valid therapeutic option in case of secukinumab secondary failure.

Tetracyclines (TetraC) are widely used in dermatology for both inflammatory and infectious dermatoses; recently both in vivo and in vitro studies started to suggest also a potential antiviral effect. During COVID-19 outbreak, several dermatological patients contracted SARS-CoV-2 experiencing only mild symptoms, but no protocol were approved. A multicenter prospective observational study that enrolled COVID-19 patients visited with teledermatology and undergoing TetraC was performed. About 38 adult outpatients (M/F: 20/18, age 42.6 years [21-67]) were enrolled. During the TetraC treatment, symptoms resolved in all patients within 10 days. Remarkably, ageusia and anosmia disappeared in the first week of TetraC treatment. TetraC seem a promising drug to treat COVID-19 outpatients with mild symptoms.