Background: Registry studies broadly describing the safety of systemic drugs in psoriasis are needed.Objective: To describe the safety findings of the systemic drugs acitretin, adalimumab, apremilast, cyclosporine, etanercept, infliximab, methotrexate, secukinumab, and ustekinumab used for the treatment of moderate to severe psoriasis in patients included in the Spanish Registry of Adverse Events for Biological Therapy in Dermatological Diseases (BIOBADADERM) Registry. Methods:The incidence rate ratio (IRR) and adjusted IRR (including propensity scores) of identified adverse events for each drug, using methotrexate as reference, were determined by means of a prospective cohort.Results: Our study included 2845 patients (8954 treatment cycles; 9642 patient-years). Ustekinumab and secukinumab had the lowest rate of adverse events for several of the system organ classes, with a statistically significant decreased rate ratio (IRR of \1), whereas cyclosporine and infliximab had the highest, with an increased rate ratio (IRR of $5).

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The effect of sex on systemic therapy for psoriasis has not been well studied. The aim of this study was to determine, in a large group of 2,881 patients followed from January 2008 to November 2018, whether sex influences prescription, effectiveness of therapy, or the risk of adverse events. The results show that women were more likely than men to be prescribed systemic therapy. No differences between men and women were found in the effectiveness of therapy. Women were also more likely to experience adverse events, but the difference in risk is small, and does not justify different management. The effect of sex on systemic therapy for psoria sis has not been well studied. The aim of this study was to analyse a large multicentre Spanish cohort of 2,881 patients with psoriasis (58.3% males), followed from January 2008 to November 2018, to determine whether sex influences prescription, effectiveness of therapy, and the risk of adverse events. The results show that women are more likely than men to be pre scribed biologics. There were no differences between men and women in effectiveness of therapy, measur ed in terms of drug survival. Women were more likely to develop adverse events, but the difference in risk was small and does not justify different management. Study limitations include residual confounding and the use of drug survival as a proxy for effectiveness.

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platelet activation and improves skin vascularization. Moreover, iloprost was efficacious in a case of calciphylaxis. 9 HLU and calciphylaxis share a common increase in local vascular resistance and clinical aspect. 10 In our series, five patients received concomitant skin grafting. Considering that skin grafts were previously unsuccessful in all patients of our series, iloprost may enhance the efficacy of the graft. Our case series suggests that iloprost, alone or as adjuvant treatment to skin grafting, may be a potential and safe therapeutic option in patients with severe HLU with failure of previous skin grafts. Larger series are warranted to confirm our results. Acknowledgement The patients in this manuscript have given written informed consent to the publication of their case details.

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