Stevens–Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are examples of severe cutaneous adverse reactions to drugs (SCARs) with several international recommendations for global medical management, ranging from pharmacological systemic therapy to skin wound care. There is no defined best management of the skin wounds in SJS/TEN. The care of wounds is essential to initiate re-epithelialization. Our objective is to improve the cicatrization process, avoiding scarring due to deepening of the wounds, as well as prevent infections, achieve pain control, and avoid loss of serum proteins, fluids, and electrolytes. In this retrospective case series, we highlight the value of systemic therapy and the use of silver nitrate for wound management in four patients with TEN.

Generalized pustular psoriasis (GPP) is a potentially life-threatening rare immune-mediated disease characterized by rapid onset of erythematous plaques, sterile pustules and systemic inflammation. Spesolimab, a monoclonal antibody targeting the interleukin-36 receptor, is a novel treatment for GPP. However, GPP’s low incidence and limited evidence relating to treatment with spesolimab represents a challenge in determining its real-world efficacy. This review explores the clinical use of spesolimab in a real-world setting. We conducted a review on PubMed, SCOPUS, Embase, and ScienceDirect of case series and reports of patients with GPP treated with spesolimab. Review articles and clinical trials were excluded. From 33 articles, 62 patients with GPP were included. Age ranged from 4 to 88 years. Comorbidities were reported in 48 of the 62 patients; of these, 30 had plaque psoriasis. Spesolimab 900 mg intravenous was administered in one to four doses, depending on clinical response. The second dose was administered 1 week after the first, while the additional doses were given at variable intervals. Follow-up periods ranged from 2 weeks to 15 months. Complete GPP remission was observed in 35/62 (56%) patients, 21 of them achieving it within a week. Partial remission was defined in 27 of the 62 patients (44%). GPP recurrence after treatment was observed in seven patients. Among the 30 patients with concomitant plaque psoriasis reported, after spesolimab administration, plaque psoriasis recurrence was reported in 6 (20%) patients, 3 (10%) reported improvement and for 21 (70%), this outcome was not reported. Eight patients reported adverse effects, including laboratory abnormalities, infections and erythema multiforme. Spesolimab demonstrates a low prevalence of adverse events and clinical efficacy for GPP treatment, including in patients with comorbidities, infections and those > 75 years of age. Its effect on plaque psoriasis remains unclear.

Background: The imbalance of skin microbiota in acne can induce changes leading to induction or to aggravation of chronic inflammatory lesions; complex mechanisms are involved. Cutibacterium acnes (C. acnes) ribotypes RT4 and RT5 express more biofilm and are associated with inflammatory acne lesions. C. acnes RT6 is a non-acne ribotype, beneficial for the skin. Objectives: In an open clinical trial, acne adults were included and assessed clinically at baseline and at month 2 using the Investigator Global Assessment of Acne (IGA) score. A topical emulsion was applied twice daily for 2 months (M2) in each included patient. In the same series of acne patients, skin swab samples were collected from acne patients at baseline and M2 from lesional and non-lesional skin; skin swabs were collected for the metagenomic long-read analysis of microbiota. Materials and Methods: Acne patients with a gravity score IGA of >1<3 were included in this pilot study. An emulsion of O/W formulated with vegetal extract of Umbelliferae associated with a polysaccharide at 1% was applied twice daily for 2 months. At baseline and M2 clinical assessments were made; skin swab samples were also taken for microbiota analysis from lesional and non-lesional skin in each included patient. Extractions of genomic DNA (gDNA) from swab samples from baseline and from M2 were made, followed by full-length (V1–V9) amplification of the 16S rDNA and sequencing of amplicon libraries for strain-level bacterial community profiling. Results: In a series of 32 adult acne patients, the mean initial IGA scale was 3.1; at M2 the IGA scale was 1.5 (p < 0.001). The mean decrease in acne lesions was by 63%. Microbiome metagenomic long-read analysis in these series was mainly dominated by C. acnes followed by Staphylococcus epidermidis (S. epidermidis). The density of C. acnes ribotypes RT6 (non-acne strain) was increased at M2 compared to baseline and the density of ribotypes C. acnes RT1 to RT5 was decreased at M2, compared to baseline (p < 0.0001). S. epidermidis ribotypes (1 to 36) were non significantly increased at M2, compared to baseline (p < 0.1). Conclusions: In a series of 32 acne patients that applied an emulsion based on vegetal extract of Umbelliferae and a polysaccharide at 1% twice daily, a significant clinical improvement in IGA scale for acne lesions was seen at M2, compared to baseline (p < 0.0001). The clinical improvement was correlated with an improvement in skin microbiome at M2 compared to baseline, indicated by the increase in the relative abundance of non-acne strain of C. acnes ribotype 6 and of the decrease in the relative abundance of acne strains ribotypes C. acnes RT1 to RT5.