A 76-year-old man came to our attention for the presence of itchy skin lesions localized on the trunk. The patient had a nodular melanoma removed two years earlier. Because of metastatic pulmonary melanoma, he underwent a lung lobectomy and began adjuvant therapy with nivolumab. After six months of treatment, the patient reported the appearance of itchy lesions on the trunk that were diagnosed as eczema and successfully treated with systemic corticosteroids. Upon corticosteroid discontinuation, the eruption relapsed presenting with erythematous macules, tense blisters, and erosions on the trunk and limbs. The presence of linear deposits of IgG and C3 at the dermo-epidermal junction and high serum levels of anti-BP180 antibodies confirmed the suspicion of nivolumab-induced bullous pemphigoid. Treatment with 0.6mg/kg methylprednisolone and 200mg/day doxycycline as well as nivolumab discontinuation induced temporary remission. After tapering methylprednisolone to 16mg/day, the patient developed new blisters. Therefore, dupilumab 300mg every other week was added with progressive improvement while methylprednisolone was tapered down and withdrawn after four months. After six months the patient was still in full clinical remission. Many cases of conventional bullous pemphigoid have been treated successfully with dupilumab, which can also be used safely in cancer patients without inducing overt immunosuppression.

Bowen’s disease represents the in situ form of cutaneous squamous cell carcinoma; although it has an excellent prognosis, 3–5% of lesions progress to invasive cutaneous squamous cell carcinoma, with a higher risk in immunocompromised patients. Treatment is therefore always necessary, and conventional photodynamic therapy is a first-line option. The aim of this review is to provide an overview of the clinical response, recurrence rates, safety, and cosmetic outcome of photodynamic therapy in the treatment of Bowen’s disease, considering different protocols in terms of photosensitizers, light source, and combination treatments. Photodynamic therapy is a valuable option for tumors at sites where wound healing is poor/delayed, in the case of multiple and/or large tumors, and where surgery would be difficult or invasive. Dermoscopy and reflectance confocal microscopy can be used as valuable tools for monitoring the therapeutic response. The treatment is generally well tolerated, with mild side effects, and is associated with a good/excellent cosmetic outcome. Periodic follow-up after photodynamic therapy is essential because of the risk of recurrence and progression to cSCC. As the incidence of keratinocyte tumors increases, the therapeutic space for photodynamic therapy will further increase.

The relationship between psoriasis, immunomodulatory therapies, and the risk of malignancies is complex and still debated. The scarcity of evidence in this field makes clinicians hesitate to prescribe biological therapies for 'difficult-to-treat' patients. Based on a comprehensive MEDLINE/PUBMED search of articles published up to November 2024, this review synthesizes the current evidence on the association between psoriasis and cancer. This review specifically addresses four key aspects: the overall cancer risk in psoriatic patients, the potential role of cytokines involved in psoriasis pathogenesis in tumor development, the association between biological therapies and the incidence of new malignancies in this population, and the risk of cancer recurrence or progression in patients with a history of malignancy who are treated with biologics. Biological therapies do not significantly elevate malignancy risk compared to non-biological treatments or the general population. Evidence is also reassuring for patients with prior malignancy, showing no tumor progression or recurrence. These findings support the timely use of biological treatments in 'difficult-to-treat' patients. Regular cancer screenings and risk-factor minimization should always be recommended for psoriatic patients undergoing immunomodulatory therapies. Multidisciplinary management involving oncologists is suggested, particularly for patients with active and advanced oncological disease.

Introduction: In patients with plaque type psoriasis (PSO), the progression to psoriatic arthritis (PsA) exacerbates the disease's impact and increases disability risk. Nail psoriasis (NP) affects up to 90% of PSO patients with a wide spectrum of clinical features and is a significant predictor of enthesitis, often associated with early PsA stages. Objective: This study aimed to clinically and ultrasonographically evaluate nail units in PSO patients, focusing on differences between those with/without PsA and those with/without onychopathy. Methods: Sixty patients were enrolled (23/60 PSO-37/60 PSO and PsA). PSO and PsA patients were evaluated and compared as well as patients with/without diagnosis of nail psoriasis in this cross-sectional single-center study. Nail abnormalities were evaluated by high frequency ultrasound (HFUS) using high frequency probes (27 MHz). After a descriptive assessment, the Nail Psoriasis Severity Index (NAPSI) and the Brown University Nail Enthesis Scale (BUNES) were used to clinically and ultrasonographically assess nails. Results: HFUS evaluation identified a spectrum of nail and blood flow alterations. Nail disease was characterized by median NAPSI 16 (range 28), median BUNES morphometry 1.5 (range 0.9), and median BUNES power Doppler (PD) 2.2 (range 4.03). Among the studied sample, 43/60 (71.7%) presented nail psoriasis, with 69.7% presenting coexisting PsA as compared to PSO patients (30.3%) (p = 0.04). Conclusion: Our findings highlight the importance of close collaboration between dermatologists and rheumatologists in the evaluation of PSO patients, taking advantage of both clinical and ultrasonographic assessment of nail damage.

Hidradenitis suppurativa (HS) is a chronic-relapsing inflammatory skin disease. It usually appears in the second and third decades, but a smaller proportion of patients develop late-onset HS. Geriatric HS, defined as the persistence or the development of HS after the age of 65 years, has been poorly explored. This study aimed to investigate the clinical features, treatment management and response to therapies of HS elderly subjects (≥65 years old). We designed a multicentric observational study, gathering data from seven Italian university hospitals. Demographic and clinical data of HS patients aged over 65 years were collected at baseline, week 12 and week 24. Overall, 57 elderly subjects suffering from HS were enrolled. At baseline, disease severity was predominantly moderate-to-severe, with 45.6% of patients classified as Hurley III. The gluteal phenotype was the most frequently observed; it also appeared to affect patients’ quality of life more than other phenotypes. Gluteal involvement was detected in about half (49.1%) of cases and associated with severe stages of the disease. In terms of therapeutic response, Hurley III patients showed the persistency of higher values of mean IHS4, DLQI, itch- and pain-NRS scores compared to Hurley I/II. In conclusion, disease severity in this subpopulation appears high and treatment is often challenging.

Background: Dupilumab, a monoclonal antibody targeting the interleukin-4 receptor α, is approved for moderate-to-severe atopic dermatitis (AD). However, its safety profile in patients with concomitant hematologic disorders remains unclear, as such populations were excluded from pivotal trials. Objective: To evaluate the safety and effectiveness of dupilumab in adolescents and adults with AD and underlying hematologic comorbidities. Methods: This retrospective, multicenter study included 139 patients aged ≥15 years with moderate-to-severe AD and at least one hematologic disorder, treated with dupilumab across 21 dermatology centers. Data on disease severity, laboratory markers, and hematologic outcomes were collected over a median follow-up of 52 weeks (range 4–156). Results: The most common hematologic conditions included monoclonal gammopathies, leukemias, lymphomas, myeloproliferative neoplasms, and immune cytopenias. Clinical response to dupilumab was sustained across all endpoints, with median EASI scores decreasing from 26.0 at the baseline to 1.0 at week 52. NRS pruritus and sleep scores similarly declined to 0.0 by week 52. Serum IgE levels and eosinophil counts progressively decreased. The clinical response to dupilumab was sustained across all endpoints, with significant and progressive improvements in EASI, pruritus NRS, and sleep NRS observed up to week 52, followed by long-term stability through week 156. Serum IgE levels decreased steadily at all timepoints, while eosinophil counts declined after week 4 and stabilized beyond week 52. Hematologic conditions remained stable in 82.7% of patients, resolved in 16.5%, and progressed in only one case. Twelve patients (8.6%) received a new hematologic diagnosis during follow-up; no causal relationship could be established due to the retrospective design and absence of systematic screening, and these findings should be interpreted as descriptive associations only. Conclusions: Dupilumab appears to be safe and effective in AD patients with a broad range of hematologic comorbidities, including malignancies. These findings support its use in real-world settings, though prospective studies are warranted to further assess long-term safety in this population.