by the hyaline material may all play a role in the development of the lingual ulcer. Corticosteroids inhibit the production of interleukins, cytokines, and chemotactic agents, leading to a decrease in proteolytic and lipolytic enzymes and leukocytes in areas of inflammation caused by mechanical, infectious, and immunological stimuli, among others. 6 In the present case, we believe that the inhibition of all the proinflammatory agents mentioned in and around the lingual ulcer favored its progressive epithelization. We emphasize the importance of knowing the predisposition of patients with lipoid proteinosis to experience oral ulcers and report a case with good evolution after treatment with oral corticosteroids.

Biologics have been shown to constitute a highly effective treatment for patients with psoriasis. However, a significant number of patients treated with biologics will discontinue them due to loss of efficacy over time, a phenomenon known as biologic fatigue or secondary failure. Combination therapy of biologics with other agents can be considered as a treatment option in such cases. Information regarding the efficacy and safety of adding apremilast to biologic therapy in patients with psoriasis is limited. In the present study, we retrospectively evaluated the efficacy and safety of apremilast combined with biologics in 14 patients with psoriasis showing biologic fatigue at a single hospital. Before the addition of apremilast, the mean Psoriasis Area and Severity Index (PASI) score was 3.2 ± 0.4. At week 24 following the addition of apremilast, the mean PASI score decreased to 1.6 ± 0.3, and four (29%) and seven (50%) patients had achieved 75% and 50% reduction in PASI score, respectively. During the 24 weeks of treatment, diarrhea was observed in four patients, and diarrhea and nausea were observed in one patient. Weight loss of more than 5% bodyweight was observed in two patients. None of the patients discontinued therapy because of these side‐effects. These results suggest that the combination therapy of apremilast and biologics could be a safe, effective option for the management of patients with psoriasis showing biologic fatigue.

as we are aware, this is the first case of EPDS reported in a patient receiving nivolumab; interestingly, there have been a few cases of other neutrophilic dermatoses, such as pyoderma gangrenosum and Sweet syndrome, during ICi treatment. 7 We invite clinicians to consider the diagnosis of EPDS when faced with a scalp eruption occurring in a patient receiving this specific class of drugs. Whether this irAE may correlate with the therapeutic outcome needs to be addressed.