The recent COVID-19 pandemic has had a significant impact on our lives and has rapidly expanded to reach more than 4 million cases worldwide by May 2020. These cases are characterized by extreme variability, from a mild or asymptomatic form lasting for a few days up to severe forms of interstitial pneumonia that may require ventilatory therapy and can lead to patient death. Several hypotheses have been drawn up to understand the role of the interaction between the infectious agent and the immune system in the development of the disease and the most severe forms; the role of the cytokine storm seems important. Innate immunity, as one of the first elements of guest interaction with different infectious agents, could play an important role in the development of the cytokine storm and be responsible for boosting more severe forms. Therefore, it seems important to study also this important arm of the immune system to adequately understand the pathogenesis of the disease. Research on this topic is also needed to develop therapeutic strategies for treatment of this disease.

Background Drug survival, defined as the length of time from initiation to discontinuation of a given therapy, allows comparisons between drugs, helps to predict patient's likelihood of remaining on a specific treatment, and achieving the best decision for each patient in daily clinical practice. Objective The aim of this study was to provide data on drug survival of secukinumab, ixekizumab, brodalumab, guselkumab, tildrakizumab, and risankizumab in a large international cohort, and to identify clinical predictors that might have an impact on the drug survival of these drugs. Methods This was a retrospective, multicentric, multi-country study that provides data of adult patients with moderate to severe psoriasis who started treatment with an interleukin (IL)-17 or IL-23 inhibitor between 1 February 2015 and 31 October 2021. Data were collected from 19 distinct hospital and non-hospital-based dermatology centers from Canada, Czech Republic, Italy, Greece, Portugal, Spain, and Switzerland. Kaplan-Meier estimator and proportional hazard Cox regression models were used for drug survival analysis. Results A total of 4866 treatment courses (4178 patients)-overall time of exposure of 9500 patient-years-were included in this study, with 3164 corresponding to an IL-17 inhibitor (secukinumab, ixekizumab, brodalumab) and 1702 corresponding to an IL-23 inhibitor (guselkumab, risankizumab, tildrakizumab). IL-23 inhibitors had the highest drug survival rates during the entire study period. After 24 months of treatment, the cumulative probabilities of drug survival were 0.92 (95% confidence interval [CI] 0.89-0.95) for risankizumab, 0.90 (95% CI 0.88-0.92) for guselkumab, 0.80 (95% CI 0.76-0.84) for brodalumab, 0.79 (95% CI 0.76-0.82) for ixekizumab, and 0.75 (95% CI 0.73-0.77) for secukinumab. At 36 months, only guselkumab [0.88 (95% CI 0.85-0.91)], ixekizumab [0.73 (95% CI 0.70-0.76)], and secukinumab [0.67 (95% CI 0.65-0.70)] had more than 40 patients at risk of drug discontinuation. Only two drugs had more than 40 patients at risk of drug discontinuation at 48 months, with ixekizumab demonstrating to have a higher cumulative probability of drug survival [0.71 (95% CI 0.68-0.75)] when compared with secukinumab [0.63 (95% CI 0.60-0.66)]. Secondary failure was the main cause for drug discontinuation. According to the final multivariable model, patients receiving risankizumab, guselkumab, and ixekizumab were significantly less likely to discontinue treatment than those receiving secukinumab. Previous exposure to biologic agents, absent family history of psoriasis, higher baseline body mass index (BMI), and higher baseline Psoriasis Area and Severity Index (PASI) were identified as predictors of drug discontinuation. ConclusionThe cumulative probability of drug survival of both IL-17 and IL-23 inhibitors was higher than 75% at 24 months, with risankizumab and guselkumab demonstrating to have overall cumulative probabilities ≥ 90%. Biological agent chosen, prior exposure to biologic agents, higher baseline BMI and PASI values, an...

Lilly provides access to all individual participant data collected during the trial, after anonymization, with the exception of pharmacokinetic or genetic data. Data are available to request 6 months after the indication studied has been approved in the USA and EU and after primary publication acceptance, whichever occurs later. No expiration date of data requests is currently set once data are made available. Access is provided after a proposal has been approved by an independent review committee identified for this purpose and after receipt of a signed data sharing agreement. Data and documents, including the study protocol, statistical analysis plan, clinical study report and blank or annotated case report forms, will be provided in a secure data sharing environment. For details on submitting a request, see the instructions provided at www.vivli.org.

AA) is a chronic autoimmune disease often associated with atopy. 1 We report the first 2 cases of severe atopic dermatitis (AD) resistant to dupilumab and concurrent AA successfully treated with upadacitinib. Case 1 is a 30-year-old man with a severe AD and a 5-year history of universal AA resistant to conventional treatment. We observed numerous eczematous and

and busyness level (P = 0.03), and positively associated with stress (P < 0.001) and air pressure (P = 0.05). In addition, POEM was significantly higher in weeks with high Birch (P = 0.018) and Elm pollen (P = 0.008). Daily temperature tended to associate negatively with POEM while daily active time and diurnal temperature range showed no association with POEM. POEM was higher in weeks with shorter sleep duration, however, not significant (P = 0.061). Occasionally, the associations between triggers and POEM indicated opposite responses in the study population (Fig. 2). iSCORAD was positively associated with the self-reported stress levels (P = 0.002) but not with any of the other passive data. iSCORAD was, however, strongly associated with POEM in a linear mixed effect model (P < 0.001). Our findings are in line with previous studies reporting that low humidity decreases skin barrier function and, for most subjects, increases AD symptoms 4 that discrepancies exist with regards to temperature, which may be both protective 3,4 and harmful, 7 and that AD symptoms can be triggered by a variety of pollens. 8,9 Furthermore, stress is a well-known trigger factor which this study also supports. 10 Overall, our data indicate that within AD, the importance of specific trigger factors varies from patient to patient. In conclusion, data collected passively through the smartphone (mainly GPS) is associated with patients' subjective disease severity (POEM). This was shown for air humidity and -pressure, pollen and overall busyness level supporting that lifestyle and environmental factors are linked to AD disease activity.

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undetected primary gonadal GCT which may have regressed spontaneously, especially a testicular tumor. [1][2][3] Primary and metastatic (also called secondary) germ cell tumors account for approximately one quarter of all retroperitoneal tumors. 2,3 For both primary and secondary tumors, serum tumor marker detection could help with diagnosis (e.g., alpha-fetoprotein, human chorionic gonadotropin), as well as they are markers of tumor relapse. 2,3 However, the existence of the so-called primary EGCT of the retroperitoneum is still a matter of debate, 3,4 and they should be considered to be metastases of a viable or burned-out testicular cancer until proven otherwise. 1,3 Both extragonadal and gonadal germ cell tumors involving the skin are extremely rare, and when they occur, most lesions are true mature teratomas. 4 The prognosis is variable according to the disease extension and systemic dissemination. 4 Curative treatment is achieved after wide excision whenever it is possible. Chemotherapy and radiotherapy are recommended as adjuvant to surgery and for metastatic disease. 4 To date, there is one report of malignant primary EGCT located in the scalp in a child and another report of a mixed nonseminomatous germ cell tumor presenting as a subcutaneous tissue mass. 1,5 Cutaneous EGCT can be difficult to differentiate from a primary malignant neoplasm, sarcoma, or a skin metastasis. Dermatologists must be attentive in order to early recognize cutaneous manifestations of EGCT to increase the suspicion of these rare presentations of this life-threatening disease.

Cutaneous melanoma is a public health issue and the head and neck region is of particular interest, despite accounting for only 9.0% of the total body surface, it harbours 20% of melanoma cases. Data from the literature show that scalp melanomas (SM) carry high mortality rates, with a 10-year survival rate of 60% which lead them to be named as the "invisible killer". Moreover, SMs are more common in the elderly than in young population, and they occur six times more frequently in men than in women. This is probably related to the higher incidence of androgenetic alopecia and a higher cumulative and intermittent ultraviolet damage on the scalp. Histologically, SM is a heterogenous group, including lentiginous melanoma (LM), desmoplastic melanoma, superficial spreading and nodular melanoma. Thin melanomas tend to display an atypical network or pseudo-network and regression in dermoscopy. Blue-white veil, irregular pigmented blotches and an unspecific pattern are most commonly detected in thick lesions. On reflectance confocal microscopy (RCM), the most frequent pattern is irregular meshwork, but also ringed and disarranged pattern have been described. Differential diagnosis includes benign solar lentigo, actinic keratoses, lichen planus like keratosis, melanocytic nevi and blue nevi. All suspicious lesions should be biopsied; therefore, an excisional biopsy with 2 mm margins is usually the best option. The management of SM is the same as for melanoma on other body sites. However, sentinel node biopsy tends to be more challenging, as well as achieving adequate excision margins of the primary tumor. In this review, we summarize clinical, pathologic, dermoscopic and RCM features of SM, and focus on its epidemiology, risk factors and best management options.