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Pustular and erythrodermic psoriasis are rare and difficult-to-treat conditions. It has recently been shown that interleukin (IL)-17 inhibitors can be very effective among patients with these forms of psoriasis; however, the potential of IL-23 inhibitors is largely unknown. The aim of this multicentre, retrospective study was to compare the safety, effectiveness, and drug survival of IL-17 and IL-23 inhibitors among patients affected by these rare forms of psoriasis. The study involved 27 patients with erythrodermic psoriasis and 59 with pustular psoriasis (36 with generalised pustular psoriasis and 23 with palmoplantar pustular psoriasis) treated with an IL-17 or IL-23 inhibitor. The effectiveness of the two drug classes was assessed using the disease-specific Psoriasis Area Severity Index (PASI) and the Investigator Global Assessment, which were evaluated at different time points. There was a consistent trend towards a higher rate of PASI 100 responses in the patients treated with IL-17 inhibitors compared with those treated with IL-23 inhibitors, and the other efficacy outcomes showed a similar trend. There was no significant between-drug class difference in efficacy at any of the time points in the erythrodermic psoriasis cohort, whereas PASI 90 and PASI 100 response rates were significantly higher among the pustular psoriasis patients receiving IL-17 inhibitors at week 12 (IL-23 19% vs. IL-17 54% and IL-23 6% vs. IL-17 40%, respectively) and the percentage of responders to IL-17 inhibition was significantly higher at week 24 (IL-23 25% vs. IL-17 74%). In conclusion, it is therefore reasonable to assume that IL-17 and IL-23 inhibitors are both effective when treating pustular and erythrodermic psoriasis.

Background Syphilis is known as the “great imitator” because of its polymorphic clinical manifestations. Condyloma lata are an uncommon mucocutaneous manifestation of secondary syphilis, generally localized in intertriginous areas, such as the genitals and anus. Extragenital localization of condyloma lata is considered unusual. Methods A case study of extra-genital condylomata is presented. To contextualise the case, a literature review of extra-genital condylomata lata was subsequently undertaken. The authors searched MEDLINE/PubMed, Scopus and Excerpta Medica/EMBASE English-language sources using the following keywords: “condyloma lata”, “condylomata lata”, and “condyloma latum”. Results Thirty-five papers (from 1940 to 2021) describing an extra-anogenital localization of condyloma lata were found and are summarized in Table 1. Patients were mainly males (82.1%), with a mean age of 31.9 years. Most of them showed other manifestations of secondary syphilis (53.9%). In a minority of cases (39.0%), concomitant anogenital condyloma lata were present, thus making the diagnosis easier. The toe web localization was the most documented (26.2%) followed by the oral cavity (23.8%). Conclusion In the presence of extra-genital condyloma lata, the differential diagnosis is not always clear, especially when no other muco-cutaneous lesions are observed. In the case of eroded or wet lesions involving any cutaneous fold, associated or not with other cutaneous manifestations, a sexual history should be obtained, and syphilis must be considered.

The Authors report the results of a multicenter retrospective study on 32 patients with moderate-to-severe psoriasis switched from ustekinumab to guselkumab, after failure in achieving minimal disease activity 2 within 52 weeks of therapy with the former.Herein, we report our real-life experience with a similarly sized, single-center retrospective cohort, consisting of 30 patients with moderate-to-severe psoriasis switching from ustekinumab to guselkumab.The switch was proposed to patients meeting the following inclusion criteria: significant residual Psoriasis Area and Severity Index (PASI) (i.e., failed PASI75), patient-reported dissatisfaction or residual disease in sensitive areas (e.g., face, scalp, palms, soles, and genitals) despite weight-appropriate treatment with ustekinumab for at least 6 months. Need for dose intensification or escalation to dosing every 8 weeks was considered as an adjunctive inclusion criterion.Patients' characteristics, including demographics, comorbidities, previous treatments, and clinical features are summarized in Table 1.At the baseline, a slight male sex preference (M:F = 3.9:1 vs. 1.5:1), greater representation of cardiovascular comorbidities (7/30 [23.3%] vs. 3/32 [9.3%]) and history of previous treatment with IL-17 inhibitors (4/30 [13.3%] vs. 0) were noted in our cohort. Twenty-nine, 25, and 22 patients reached weeks 12, 24, and 52 of therapy, respectively, counting from the time of switching. Although mean PASI at the time of switching was similar across the two studies (6.45 vs. 7.4), the proportion of patients achieving PASI <1 was lower than that reported by Magdaleno-Tapial et al. both at week 12 (45% vs. 82%), at week 24 (56% vs. 87%) and at week 52 (50% vs. 100%). Nevertheless, the therapeutic target of PASI 75 was achieved by 55% of patients at week 12, by 72% of patients at week 24 and by 82% of patients at week 52; whereas the PASI 90 target Mean duration of ustekinumab treatment (months), mean ± SD 50.4 ± 32.8Giulia Murgia and Carlo Alberto Maronese contributed equally and both qualify as first authors.