Background/Objectives: Alopecia areata is an autoimmune condition characterized by rapid hair loss in the scalp, eyebrows, and eyelashes, for which treatments are limited. Baricitinib, an oral inhibitor of Janus kinases 1 and 2, has been recently approved to treat alopecia areata. Methods: A total of 23 patients affected by severe alopecia areata (SALT > 50) for more than 6 months were enrolled, including 14 with AU, 3 with AT, and 6 with ophiasis, and all of whom were treated with baricitinib for a minimum of 52 weeks. Clinical and trichoscopic assessments were performed at each visit, and the impact on quality of life, anxiety, and depression was evaluated using the Skindex-16 and the Hospital Anxiety and Depression Scale (HADS), respectively. Results: A total of 23 patients were enrolled, with a mean age of 44.62 years and a mean SALT of 83.66. The mean value of the SALT score decreased to 51.23 at 6 months and 42.41 after one year. Psychological well-being and quality of life also improved, as demonstrated by the decrease in Skindex-16 and HADS scores. Trichoscopic signs showed a decrease in yellow dots and black dots and an increase in vellus hairs and hair regrowth. Adverse events during the treatment period were reported in 18.75% patients. No drop-outs were registered. Conclusions: Data on the effectiveness and safety of baricitinib are promising and support the use of this drug in severe forms of AA, also in the early stages. We also suggest performing trichoscopy in response to therapy.

Actinic keratosis (AK) is a precursor to invasive squamous cell carcinoma, making early diagnosis and treatment essential to prevent progression. Among available therapeutic options, nicotinamide (NAM) has shown potential in reducing AK progression. NAM is a precursor of nicotinamide adenine dinucleotide (NAD⁺), which activates sirtuin (SIRT)1, a protein with anti-cancer properties. Although the role of SIRT1 in AK is still debated, no data currently exist on the systemic modulation of this protein in AK. Therefore, this study aims to evaluate whether NAM, by increasing serum NAD+ levels, may promote SIRT1 activation in peripheral blood mononuclear cells (PBMCs) in AK patients. Thirty patients were enrolled and treated with NAM for 24 months. Hematological, biochemical, and skin condition assessments were conducted, alongside the measurement of SIRT1 and NAD⁺ levels. A decrease in basophils, monocytes, total cholesterol, and blood glucose levels was observed in the study group, along with a reduction in AK lesions. Notably, NAM treatment significantly enhanced serum NAD⁺ levels, and nuclear SIRT1 activity in PBMCs. In conclusion, NAM administration significantly reduced AK progression in a NAD⁺/SIRT1-dependent manner, supporting its role as a chemopreventive agent in AK management.

Background: Urticarial vasculitis (UV) is a rare form of small-vessel vasculitis characterized by persistent urticarial lesions and systemic manifestations. It differs from chronic spontaneous urticaria (CSU) both clinically and pathogenetically, often requiring systemic therapy. Despite its complexity, no standardized treatment algorithm exists. Methods: We conducted a retrospective, monocentric, observational study on 11 patients diagnosed with UV at the Dermatology Unit of Tor Vergata University Hospital (Rome) between 2014 and 2024. Demographic, clinical, serological, and therapeutic data were collected from medical records. The therapeutic response was assessed using the Urticaria Control Test (UCT) score. Results: The cohort comprised predominantly women (91%), with a mean age at diagnosis of 52.8 years. Autoimmune thyroiditis was the most frequent comorbidity (64%). Hypocomplementemia was detected in only one patient (9%), who also had systemic lupus erythematosus. Antihistamines, while usually prescribed, showed limited efficacy since none of the patients achieved complete remission with monotherapy. Systemic corticosteroids demonstrated rapid and effective control in acute phases. Omalizumab produced variable responses, with two patients achieving a high response (HR) and one reaching complete remission (CR). Methotrexate and cyclosporine yielded inconsistent outcomes. Due to the heterogeneity and limited sample size, statistical analyses were not performed. Conclusions: UV presents with diverse clinical profiles and therapeutic responses. No treatment proved universally efficacious, but corticosteroids and omalizumab were effective in an acute and maintenance phase, respectively. Our findings underscore the importance of individualized treatment plans and the need for further studies to define predictive biomarkers and therapeutic strategies in UV.

Article: Certolizumab pegol in pregnant and breastfeeding psoriatic patients - Italian Journal of Dermatology and Venereology 2022 Mar 11 - Minerva Medica - Journals

Background/Objectives: Psoriasis is a chronic immune-mediated inflammatory disease associated with a high systemic burden. Inhibition of the IL-23/IL-17 axis is the cornerstone of therapy, although the evaluation of immune-nutritional status in the assessment of psoriatic disease-associated comorbidities is an equally crucial topic. The aim of the study was to document the efficacy, safety and systemic impact of Bimekizumab and Tildrakizumab in patients with chronic plaque psoriasis by analyzing clinimetric indices, atherogenic risk, and immune-nutritional markers. Methods: This was a descriptive real-world clinical study, including 52 psoriasis patients treated with Bimekizumab or Tildrakizumab, who were followed for 52 weeks. In particular, we analyzed the clinimetric (evaluated by PASI and DLQI) and inflammatory (CRP, ESR, NLR, PLR, and LMR ratios; SII) indices, atherogenic risk (by evaluating the lipid profile), and immuno-nutritional markers (HALP score and CONUT score). Assessments were performed at baseline and after 52 weeks. Results: Both treatments led to a significant reduction in the PASI at week 52. The systemic inflammatory marker CRP decreased in both groups. A trend of reduction from baseline to week 52 was reported for both the NLR and PLR. Conversely, a trend of increase was reported for the LMR. The HALP index increased significantly in the Bimekizumab group but not in the Tildrakizumab group, while the CONUT score was significantly lower, suggesting an improvement in the immune-nutritional status. Conclusion: In conclusion, the integrated assessment of hematological ratios, inflammatory indices and immune-nutritional markers provides clinically useful information for a more complete and personalized management of psoriatic patients.

Background/Objectives: psoriasis is a chronic immune-mediated inflammatory dis-ease associated with a high systemic burden. Inhibition of the IL-23/IL-17 axis is the cornerstone of therapy; however, in the assessment of psoriatic disease-associated comorbidities, an equally crucial topic concerns the study of immune-nutritional sta-tus. The aim of the study was to document the efficacy, safety and systemic impact of Bimekizumab and Tildrakizumab in patients with chronic plaque psoriasis by analyz-ing clinimetric and indices, atherogenic risk, and innovatively the immune-nutritional markers. Methods: this is a real world clinical study, including 52 psoriasis patients, treated with Bimekizumab or Tildrakizumab, followed for 52 weeks. In particular, we analized clinimetric (evaluated by PASI and DLQI) and inflammatory (CRP, ESR, NLR, PLR, and LMR ratios, SII) indices, atherogenic risk (by evaluating lipid profile), and im-munonutritional markers (HALP score, and CONUT score). Assessments were per-formed at baseline and after 52 weeks. Results: both treatments resulted in a significant reduction in PASI at week 52. The systemic inflammatory marker CRP decreased in both groups. A trend of reduction from baseline to week 52 was reported for both the NLR, and the PLR. Conversely, a trend of increase were reported for the LMR. The HALP index was significant increase in Bimekizumab group compared to Tildrakizumab group while the CONUT score was significantly lower, suggesting an improvement in the immune-nutritional status. Conclusion: In conclusion, the integrated assessment of hematological ratios, inflam-matory indices and immune-nutritional markers provides clinically useful information for a more complete and personalized management of the psoriatic patients.