Psoriasis is a skin disorder characterized by chronic inflammation driven by different immunologic pathways, among which the IL‐23/Th17 axis plays a pivotal role. For this reason, the use of IL23p19 inhibitors in psoriasis treatment has been evaluated over the years. Guselkumab, a totally human IgG1 lambda monoclonal antibody, that selectively blocks the p 19 subunit of IL‐ 23 has demonstrated high efficacy and safety throughout several, randomized, double‐blind phase III trials (VOYAGE 1 and 2, NAVIGATE and ECLIPSE). We designed a single‐center retrospective cohort study in a population consisting of 46 patients followed from December 2018 to April 2021. After a diagnosis of moderate to severe psoriasis, all the patients were considered suitable to receive treatment with Guselkumab. In our population, among those who achieved clinical improvement in terms of Psoriasis Area Severity Index (PASI), PASI 75, 90, and 100 were achieved on average on weeks 14, 19, 21 respectively. We then analyzed a subgroup of our population, consisting of 35 patients, who had an identical follow‐up time of 28 weeks, thus observing the trend in mean PASI at subsequent assessments and the number of patients who had reached PASI 75, PASI 90, and PASI 100 at week 4 (10; 3; 1), week 12 (12; 13; 11), week 20 (7; 6; 2), and week 28 (1; 4; 6), respectively. The results obtained are in line with those obtained from previous studies, thus confirming that Guselkumab is an excellent choice in terms of security, long‐term efficacy, and overall tolerance.

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BackgroundMonoclonal antibodies (mAbs) directed against Tumor Necrosis Factor alpha (TNF‐α) and interleukin (IL)‐17 and 23 represent the ultimate therapeutic strategy in treating psoriasis patients, but scientific literature still does not provide conclusive results regarding the possible influence of previous biological therapies on real‐life therapeutic response.ObjectivesThe objective of our work was to investigate any putative difference in the achievement and maintenance of PASI 75, 90 and 100, as well as the probability to achieve absolute PASI≤1 and ≤ 3, between 305 bio‐naïve and bio‐experienced patients treated with anti‐IL mAbs.MethodsA comparison between previous biologic and clinical factors, including relative and absolute PASI, was carried out through chi square test. Survival curves for the achievement of PASI 75, 90 and 100 and their differences were evaluated, performing a multivariate analysis (Confidence Interval 95%; p‐value <0.0.5).ResultsPrevious biologic therapy resulted associated with a lower rate of PASI 75 (HR 1,339; p‐value 0,034), 90 (HR 1,365; p‐value 0,0031;) and 100 achievement (HR 1,596; p‐value 0,007).The survival curves showed how bio‐experienced patients were less likely to reach and maintain PASI 90 (naïve vs anti‐IL: p = 0.001; naïve vs anti‐TNF + anti‐IL: p <0.001) and PASI 100 (naïve vs anti‐TNF‐α: p = 0.014; naïve vs anti‐IL: p <0.001; naïve vs anti‐TNF‐α + anti‐IL: p < 0.001)]. Moreover, bio‐naïve patients showed a greater probability to achieve both absolute PASI≤3 and ≤ 1 (p<0.001)ConclusionsOur results represent a real‐life analysis on the impact of previous biologic therapy in the clinical efficacy of anti‐IL. Even if further studies with bigger samples are needed to extrapolate absolute considerations, we provided the first evidence on the burden of the bio‐naïve condition for a greater achievement of both PASI 90, 100 and the probability to achieve PASI≤1 and ≤ 3.This article is protected by copyright. All rights reserved.

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Pyoderma gangrenosum (PG) is a neutrophilic inflammatory dermatosis, whose management still represents a clinical challenge due to frequent unresponsive cases. The aim of our study was to evaluate the efficacy of a novel, combined approach including local wound management, based on the principle of PG-TIME and a systemic therapy with an anti interleukin (IL)-17A monoclonal antibody (mAb). We presented a case of a 37-year-old female patient, affected by multi-refractory PG. The patient was treated with a combined approach of both local and systemic therapy. Wound clinical improvement was assessed by Wound Bed Score (WBS), wound size was evaluated through 3D camera laser scanner, and pain was evaluated with visual analog scale (VAS). After 52 weeks of therapy, the association of local wound management with ixekizumab 80 mg [160 mg at time (T) 0; 80 mg every 2 weeks until week 12; 80 mg every 4 weeks] allowed us to perform skin grafting and obtain complete wound healing. Our clinical case demonstrated the efficacy of a novel combination therapy for the treatment of recalcitrant PG based on IL-17 mAbs and local wound management built on the main features of PG-TIME.

Purpose of Review The compression therapy provides valuable support during management of vascular and inflammatory lower leg skin disorders. The review outlines the mechanism of action and the treatment options available with indications for use in wound management and general dermatology. Recent Findings Atypical wounds such as pyoderma gangrenosum, cutaneous vasculitis and other inflammatory skin diseases may benefit from the use of compression therapy. Adherence to treatment is always a challenging aspects for patients and caregiver, but modern technologies and specific materials have improved the compliance during treatment. Summary Compression therapy is a main option in vascular ulcer management. The technology provided by different devices together with new methods of bandaging application have increased the outcomes and acceptability from patients. Physicians should be aware of the advantages provided by compression therapy in skin diseases.

Introduction. Dubowitz syndrome is a rare genetic disease with only a few cases reported in the literature. It is characterized by growth retardation, microcephaly, facial dysmorphism and higher risk of developing cancer and cardiomyopathies. PG is an autoinflammatory disorder that causes painful ulcers to develop on the skin and has not been previously associated with Dubowitz syndrome. Case Presentation. The authors report the case of a 50-year-old female with Dubowitz syndrome who developed painful ulcerative lesions. An incisional biopsy was performed to rule out other diagnoses, and a subsequent clinical diagnosis of PG was made. The patient was treated with specialized wound dressings and oral glucocorticoids. The clinical picture improved consistently after 7 weeks of therapy. Conclusions. This case report, to the authors’ knowledge, is the first to suggest a possible association between Dubowitz syndrome and PG and also to indicate an effective treatment.