Aims: Psoriasis is an immune-mediated dermatosis with cardio-metabolic comorbidities. The aim of this study was to assess insulin-resistance, lipid abnormalities, and cardiovascular risk biomarkers in psoriatic patients with or without type 2 diabetes mellitus (T2DM).Methods and materials: We enrolled 425 patients: 86 psoriatics, 69 psoriatics with T2DM, 120 T2DM patients, and 150 healthy subjects. We measured the Psoriasis Area and Severity Index (PASI), body mass index (BMI), insulin-resistance parameters [glycosylated hemoglobin (HbA1c), fasting plasma glucose (FPG), fasting plasma insulin (FPI), and with homeostasis model assessment index (HOMA index)], lipidic panel, plasminogen activator inhibitor-1 (PAI-1), homocysteine, soluble adhesion molecules, matrix metalloproteinase, and adipocytokines.Results: FPG, HbA1c, and HOMA-IR were higher in diabetics with psoriasis (p < 0.0001) than in psoriatics. FPI levels were higher in diabetics with psoriasis than in diabetics and psoriatics (p < 0.0001), and higher in psoriatics than controls (p < 0.0001). Psoriatics and diabetics with psoriasis showed higher triglyceride and LDL-C levels (p < 0.0001) than diabetics. Homocysteine was higher in psoriatics and diabetics with psoriasis (p < 0.0001) than in diabetics. PAI-1 was higher in diabetics with psoriasis than diabetics (p < 0.01). sICAM-1 and sVCAM-1 were higher in diabetics with psoriasis than diabetics (p < 0.001 and p < 0.01) and psoriatics (p < 0.001 and p < 0.0001). Visfatin and resistin were lower in psoriatics (p < 0.0001) and in diabetics with psoriasis (p < 0.001 and p < 0.0001, respectively) than diabetics.Conclusions: A limitation of this study is that there is a significant difference in mean age between controls and other study groups: the lack of matching between case and control groups may interfere with the external validity of the study findings. Despite this, the study highlights a pathogenetic link between psoriasis, considered a pre-diabetic condition, and diabetes. Insulin-resistance seems to be the keystone of psoriasis comorbidities. Psoriasis reinforces diabetes, causing a greater cardiometabolic risk.

No abstract

Anti-CD20 monoclonal antibody rituximab is an approved adjuvant treatment, in combination with oral corticosteroids, for patients with pemphigus vulgaris, a severe and potentially life-threatening autoimmune blistering skin disorder. Updated approaches to the management of pemphigus vulgaris support rituximab as a first-line adjuvant treatment to induce remission early in the course of disease; however, its feasibility in the clinical setting is often reduced by a series of limitations, including high cost of this biological drug, physician and patient concern for the risk of adverse reactions, and uncertainty regarding the optimum dosing and schedule of administration. The standard approved rituximab dosages, which are derived from lymphoma protocols, have been recognized to exceed the effective dose required for inducing B cell depletion, since the B cell burden in pemphigus vulgaris is much lower than in lymphoproliferative disorders. To overcome these limitations, recent research has investigated alternative regimens of rituximab, using lower doses of the drug. Moreover, differences in patient and disease characteristics that are highlighted in the literature strongly suggest that therapy should be tailored individually on a case-by-case basis: personalized treatment schedules may be necessary to optimize response to treatment and tolerability in different subjects, with the possibility of repeated infusions for severe forms and in case of relapse. Finally, low-dose regimens of rituximab were suggested to be favorable during the COVID-19 pandemic by providing a lesser degree of immune cell depletion while retaining a sufficient response. In conclusion, the current literature suggests that lower-dose regimens of rituximab are not only tolerable and cost-effective but may also be associated with a positive response in pemphigus vulgaris, comparable to that achieved with higher doses especially in early disease. Further evidence from rigorous clinical trials will be required to optimize lower-dose regimens of RTX and establish their position within the treatment scenario of pemphigus vulgaris.

There is still some concern about the use of biologics for patients with psoriasis and concurrent hepatitis B virus (HBV) or hepatitis C virus (HCV) infection. In particular, there are scarce data regarding the safety of IL-23 inhibitors in this group of patients. We performed a multicentric retrospective cohort study on 26 consecutive psoriasis patients with HBV infection and 23 patients with HCV infection treated with risankizumab. Patients were monitored for liver function tests (LFTs) at baseline and every 3 months thereafter. Liver stiffness measurement (LSM) by FibroScan was performed in 9 HCV patients. Demographic and clinical data on HBV-patients are listed in Table 1. Eleven of the 26 patients (42.3%) had chronic HBV infection, seven (26.9%) had a serology compatible with a previous or an occult HBV infection, and eight (30.8%) had resolved HBV infection.Patients with chronic HBV infection were under antiviral therapy, except for one patient with undetectable HBV-DNA who underwent only strict serological and biochemical follow-up. Serum HBV-DNA load was undetectable in all patients with previous/occult and resolved HBV infection, and in 7/11 patients with chronic HBV infection. During follow-up, all patients showed stable LFTs and HBV-DNA load with respect to baseline levels; no patients developed hepatocellular carcinoma during risankizumab treatment. Demographic and clinical data on HCV patients are listed in Table 2. Thirteen of the 23 patients (56.5%) had a resolved HCV infection with undetectable HCV-RNA after successful treatment with direct-acting antivirals. Ten patients with detectable HCV-RNA at baseline started concomitant treatment with direct-acting antiviral drugs, all achieving sustained virologic response. All patients were stable with regard to their baseline LFTs and HCV-RNA load, and no patients developed hepatocellular carcinoma during risankizumab treatment. Data on liver fibrosis were collected for nine patients, showing a slight but significant decrease of fibrosis after a median time of risankizumab therapy (mean 3.44 ± 0.88 kPa at baseline and 2.89 ± 0.78 kPa at the end of follow-up; p-value = 0.025). According to the World Health Organization's last global report, in 2019 around 296-million people and 58-million C

Molluscum contagiosum is a common childhood condition, and although it is self-limited, treatments are often prescribed.Several medications are available, but there is no consensus regarding the optimal choice in the pediatric population. We report a child who underwent potassium hydroxide 5% treatment resulting in superficial diffuse erosions caused by the inappropriate application. This underlines the importance of parent education before use of this medication with well-known caustic properties. | 225Pediatric Dermatology BRIEF REPORT in domestic accidents. It is capable of deep penetration, and tissue destruction can continue long after the initial contact with the chemical. 5Among topical preparations used to treat MC, keratolytic KOH solutions at different concentrations (5%, 10%, and 15%) are the least expensive and are frequently used in the pediatric population. 6,7 Several studies have reported them to be safe, effective, and well-tolerated in children 2,8,9 Adverse effects include mild-to-moderate stinging and pigmentary changes; rarely, KOH may cause small erosions and scarring. The lower the concentration, the safer the application. 7-9 In our patient, despite the 5% concentration, misuse of the preparation caused a significant irritant and erosive response.Choosing the most appropriate therapy for molluscum contagiosum requires the consideration of physician experience; the number, severity, and anatomic location of the lesions; and the patient's age, skin phototype, and sociocultural background, as well as any parental language barrier or other barriers to comprehension. Specific instructions need to be given and proper parental comprehension of the method and timing of application should be confirmed. Despite its apparent ease in handling, KOH solution must be prescribed cautiously to prevent misuse and adverse reactions.