Psoriasis is a chronic inflammatory cutaneous disease with multifactorial pathogenesis involving both genetic and environmental factors as well as the innate and acquired immune response. Several triggering factors may exacerbate or worsen the disease. In this context, we performed a review manuscript with the aim of investigating current literature on psoriasis risk factors, also showing possible mechanisms by which they act on psoriasis. Globally, risk factors can be divided in classic risk factors (eg, mechanical stress, infections and dysbiosis of the skin, common drugs, environment and pollution, lifestyle, psychological stress, hormonal and metabolic alterations) which have long been known to be responsible for worsening and/or reoccurrence of psoriatic manifestations, and emerging risk factors (eg, biological drugs, immunotherapy for oncologic disease, Covid-19, and vaccines) defined as those newly identified risk factors. Accurate patient information and monitoring of risk factors as well as planned follow-ups may help to prevent and treat the worsening of psoriasis and consequently improve the quality of life of psoriatic patients.

Teledermatology may be defined as the application of telemedicine to dermatology. According to published data, teledermatology is more widespread in Europe and North America, probably where resources for health care are greater than in other areas of the world. Indeed, teledermatology requires advanced technology to be efficient, as high image quality is necessary to allow the dermatologist to make correct diagnoses. Thanks to the recent advances in this field, teledermatology is become routinary in daily clinical practice. However, its use has been improved over time, overcoming several challenges. The aim of this narrative review is to retrace the almost 30-year history of teledermatology, to address the new challenges posed by advancing technologies such as artificial intelligence and the implications it may have on healthcare.

Background: Clinical trials have demonstrated the efficacy of guselkumab in psoriasis, however, limited data are available from real-life studies evaluating the long-term effectiveness and drug survival (DS) of guselkumab. Objective: This multicenter study assessed the 5-year efficacy, DS, and predictors of treatment response in a large cohort of patients with psoriasis. Methods: In this retrospective, longitudinal study, we analyzed data from 1024 patients with moderate-to-severe psoriasis treated with guselkumab between 2019 and 2024. PASI scores were evaluated at baseline, 6 months, and 1– 5 years. DS (ie, duration of continuous treatment with guselkumab without discontinuation) was assessed using Kaplan-Meier analysis, and logistic regression analysis was used to identify predictors of PASI response. Results: Mean PASI decreased from 14.3± 8.8 at baseline to 1.3± 2.4 at 6 months, with sustained improvement from 12– 60 months (PASI values ranging from 1.0± 2.2 to 1.3± 3.5). Bioexperienced (ie having previous biological treatment) patients and obese individuals had lower PASI response. Subgroup analyses revealed significantly lower PASI response rates in obese patients, those previously treated with biologics, and those switched from anti-IL-17 agents (p< 0.05). Multivariate logistic regression analysis revealed that previous biologic exposure and obesity remained significant negative predictors of achieving PASI 75, PASI 90, and PASI 100 across different time points. Cardiovascular disease emerged as a negative predictor for PASI 90 at 3 months (OR 0.64, 95% CI: 0.42– 0.97, p=0.035). The probability of remaining on treatment at 12, 24, 36, 48, and 60 months were 95.85%, 91.73%, 89.74%, 87.08%, and 85.76% respectively. Female sex, ≥ 3 prior biologics, longer disease duration, and previous anti-IL-17 therapy increased the risk of treatment discontinuation. No significant differences in drug discontinuation were noted between patients with or without comorbidities. Conclusion: This real-world study demonstrates the sustained long-term efficacy and DS of guselkumab in patients with psoriasis. Prior biologic exposure, obesity, and patient history are important factors to consider when initiating treatment for long-term management. Plain Language Summary: This study looked at how well guselkumab, a medication for psoriasis, works over five years in real-world patients. Guselkumab is a type of biologic drug (immune-targeted therapy) that blocks a protein called interleukin-23 (IL-23), which plays a key role in causing inflammation and skin symptoms seen in psoriasis. It is administered by injection and used to treat people with moderate-to-severe disease. In this study, over 1,000 people with psoriasis were treated with guselkumab between 2019 and 2024. Most patients saw marked improvements in their skin within six months, and these benefits continued for up to five years. However, people who were obese, had tried other biologic drugs before, or had heart disease did not respond as well. Women and those with longer disease history were more likely to stop treatment. Still, most patients (> 85%), stayed on the drug for the full five years. This study shows that guselkumab can be an effective long-term option for psoriasis, especially when tailored to individual patient needs.

Tildrakizumab is a humanised IgG1/k-type monoclonal antibody that targets the p19 protein subunit of IL23. Despite its effectiveness and safety have been widely reported by clinical trials and real-life experiences, data regarding its use on patients who previously failed anti-IL17 (brodalumab, ixekizumab, bimekizumab and/or secukinumab) are scant. Therefore, further studies on this topic would be beneficial for clinicians in guiding the selection of biologic shifting, considering that anti-IL23, − 12/23, and -IL17 partially share their therapeutic targets. In this context, we performed a 28-week, single-center, real-life, retrospective study, with the aim of assessing the efficacy and safety of tildrakizumab in patients who previously failed anti-IL17, also focusing the attention on psoriasis located in difficult-to-treat areas (scalp, palms or soles, fingernails, genitals). A total of 23 patients (12 male, 52.2%; mean age 52.8 ± 12.4 years) were enrolled. Of these, 11 (47.8%) failed secukinumab, 7 (30.4%) ixekizumab, 3 (13.0%) brodalumab, 1 (4.3%) both secukinumab and ixekizumab and 1 (4.3%) bimekizumab. At baseline, mean PASI and BSA were 12.8 ± 5.9 and 18.7 ± 9.6, respectively. At W16 PASI75 and PASI90 response were achieved by 15 (65.2%), and 9 (39.1%) patients, respectively, whereas 19 (82.6%) and 13 (56.6%) subjects reached these scores at W28. One (4.3%) case of primary inefficacy and 1 (4.3%) case of secondary inefficacy were assessed. Finally, no severe adverse events were collected. Tildrakizumab seems to be a valuable option in selected patients with psoriasis unresponsive to anti-IL17, suggesting that prior exposure to biological therapies seem not directly affect its effectiveness.

Pityriasis rubra pilaris (PRP) is a rare, papulosquamous, inflammatory skin disease. PRP represents a therapeutic challenge. The rarity of this disease and its possible spontaneous remission makes the conduction and interpretation of therapeutic studies particularly difficult. Moreover, PRP not infrequently proves resistant to common topical and conventional systemic therapies. In this context, numerous biologic agents have been reported in PRP treatment. The aim of our manuscript was to review the current literature to evaluate the possible role of biologics targeting the IL17/23 axis in PRP management. Recent cases in the literature have highlighted the use of several promising drugs: IL-17 inhibitors, IL-23 inhibitors, and the IL-12/23p40 inhibitor ustekinumab. However, it should be noted that all these drugs are approved for moderate-to-severe plaque psoriasis and their use in PRP is off label. The treatment of PRP is based on clinical experience, case reports or case series reported in the literature, as randomized controlled trials are difficult to conduct due to the rarity of the condition. Despite data on the efficacy of drugs targeting IL-17 and IL-23 being promising, they are still limited. Certainly, further studies are desirable to better characterize PRP and establish shared guidelines.