Introduction: Psoriasis is a chronic, immune-mediated disease that significantly impacts patients’ quality of life. Deucravacitinib, an oral selective TYK2 inhibitor, has shown promising efficacy and safety in phase 3 trials, but real-world evidence remains limited. Objective: To evaluate the effectiveness and safety of deucravacitinib in moderate-to-severe psoriasis in an Italian real-life multicenter cohort. Methods: A retrospective multicenter study was conducted across nine dermatology units in the Lazio region, including 49 adult patients treated with deucravacitinib. Clinical outcomes were assessed using the Psoriasis Area and Severity Index (PASI), Nail Psoriasis Severity Index (NAPSI), Disease Activity index for Psoriatic Arthritis (DAPSA), and Dermatology Life Quality Index (DLQI) at baseline, week 8, and week 16. Results: Mean PASI scores significantly improved, from 11.4 at baseline to 4 at week 8 and to 1.7 at week 16. PASI 75 and PASI 90 responses were achieved by 31 and 13 patients, respectively. DLQI improved from 12 to 1 at week 16, indicating substantial quality-of-life gains. Clinical improvement was consistent in difficult-to-treat areas (scalp, nails, palmoplantar regions) and among patients with psoriatic arthritis. No significant difference emerged between biologic-naïve and biologic-experienced groups. Treatment was well tolerated, with only mild adverse events reported. Conclusion: This real-world study confirms deucravacitinib as an effective and safe oral treatment for moderate-to-severe psoriasis, providing rapid and sustained clinical improvement and enhanced patient quality of life.

Mammary Paget disease (MPD) is a rare cutaneous malignancy associated with underlying ductal carcinoma in situ (DCIS) or invasive ductal carcinoma (IDC). Clinically, it appears as eczematous changes in the nipple and areola complex (NAC), which may include itching, redness, crusting, and ulceration; these symptoms can sometimes mimic benign dermatologic conditions such as nipple eczema, making early diagnosis challenging. A 56-year-old woman presented with persistent erythema and scaling of the left nipple, which did not respond to conventional dermatologic treatments: a high degree of suspicion prompted further investigation. Reflectance confocal microscopy (RCM) revealed atypical, enlarged epidermal cells with irregular boundaries, while line-field confocal–optical coherence tomography (LC-OCT) demonstrated thickening of the epidermis, hypo-reflective vacuous spaces and abnormally large round cells (Paget cells). These non-invasive imaging findings were consistent with an aggressive case of Paget disease despite the absence of clear mammographic evidence of underlying carcinoma: in fact, several biopsies were needed, and at the end, massive surgery was necessary. Non-invasive imaging techniques, such as dermoscopy, RCM, and LC-OCT, offer a valuable diagnostic tool in detecting Paget disease, especially in early stages and atypical forms.

Objectives: To evaluate the impact of non-invasive imaging techniques such as dermoscopy, reflectance confocal microscopy (RCM) and optical coherence tomography (OCT) to monitor the efficacy of risankizumab on plaque psoriasis of the legs by analyzing morpho-histological changes. Materials and Methods: Multicentre, real-world retrospective study involving 37 adults with moderate-to-severe plaque psoriasis. Assessments performed during routine visits at baseline, Week 4 and Week 12 included clinical response, dermoscopy, RCM and OCT. Results: Thirty-seven patients were included (mean age 52.1 years; 54% male; mean BMI 27.0 kg/m²). Dermoscopy showed progressive vascular normalization: at Week 12, 94.29% of lesions had minimal or no vascular pattern. White and yellow scales decreased significantly. On RCM, dilated vessels, inflammatory infiltrate, and papillomatosis progressively normalized. OCT showed reduction in epidermal and stratum corneum thickness and a decline in vascular intensity at multiple depths. Baseline haemorrhagic dots predicted early complete response: 44.8% of lesions with dots achieved complete clearance at Week 4 versus 0% without. Conclusions: Risankizumab induced rapid, significant regression of psoriatic changes, normalizing vascular patterns and skin architecture and reducing epidermal thickness. Findings support its efficacy and rapid onset of action in difficult-to-treat areas and highlight the value of non-invasive imaging for monitoring.

Background: Solar lentigines are common epidermal hyperpigmented macules associated with chronic ultraviolet exposure and photoaging. Objective: To describe a standardized 532 nm green laser protocol for solar lentigines and to place these observations within a narrative review with a structured PubMed/Medline literature search. Methods: Five patients (two women and three men; age range 42–65 years, mean 53.6 years; Fitzpatrick skin phototypes II–III) with solar lentigines underwent treatment with a 532 nm green laser (QuadroStarPRO GREEN, Asclepion) using a standardized, single-session protocol. Outcomes were assessed at the final available follow-up (day 21) by 2 independent dermatologists using a retrospective categorical response classification (complete response/partial response/no response) based on paired baseline and day 21 image documentation only; patient satisfaction was recorded at day 21 on a 0–10 visual analog scale (VAS). A narrative review with a structured PubMed/Medline literature search was conducted to identify clinical studies evaluating 532 nm KTP/green laser devices for lentigines, freckles, and ephelides. Results: All five target lesions were classified as complete response at day 21 (5/5 complete response), with a mean VAS satisfaction score of 8.6/10 (range, 7–10) and no discordance between dermatologists. Mild transient erythema was observed immediately after treatment and improved within the first day; no persistent adverse events, dyschromia, or scarring were observed during the available 21-day follow-up. Conclusions: In this small case series, a single-session millisecond 532 nm green laser protocol was associated with complete-response classification at day 21 in five target lesions. Published clinical studies indicate that outcomes with 532 nm devices vary with device type, pulse structure, and treatment settings; larger comparative studies with objective pigment measures and longer follow-ups are needed.

Background/Objectives: Chronic spontaneous urticaria (CSU) is a mast-cell-driven disease with autoimmune mechanisms and an incompletely clarified aetiology, in which a substantial proportion of patients remain symptomatic despite second-generation H1-antihistamines; until recently, omalizumab was effectively the only targeted option, leaving a considerable non-responder fraction. Between February 2024 and September 2025 the landscape changed: dupilumab (anti-IL-4Rα) and the first oral Bruton tyrosine kinase (BTK) inhibitor, remibrutinib, were approved for CSU; omalizumab biosimilars reached the market; the higher-affinity anti-IgE antibody ligelizumab was discontinued; and the investigational anti-KIT antibody barzolvolimab advanced to phase 3—creating new therapeutic opportunities for non-responders while leaving the choice among these second-line options unresolved by current guidelines. We provide a critical synthesis and propose an evidence-graded process for agent selection, together with a proposed repositioning of the available agents, taking the 2022 EAACI/GA²LEN/EuroGuiDerm/APAAACI guideline as the acknowledged reference. Methods: Critical narrative review with a structured but non-systematic search (PubMed, ClinicalTrials.gov) and a pre-specified evidence hierarchy (guideline to expert opinion); each clinical claim is annotated by its level of evidence. Results: Four agents are appraised in turn—omalizumab (anti-IgE, first-line), dupilumab (anti-IL-4Rα), remibrutinib (oral BTK inhibitor, small-molecule comparator) and barzolvolimab (anti-KIT, investigational). Current evidence appears to support omalizumab as first-line, with mechanism-guided second-line choices conditioned on endotype, comorbidity, prior biologic exposure and safety. Conclusions: The complexity of CSU and the incomplete response to currently available therapies support a patient-tailored approach to treatment selection.

Mammary Paget disease (MPD) is a rare cutaneous malignancy associated with underlying ductal carcinoma in situ (DCIS) or invasive ductal carcinoma (IDC): clinically, it appears as eczematous changes of the nipple and areola complex (NAC), which may include itching, redness, crusting, and ulceration: these symptoms can sometimes mimic benign dermatologic conditions such as nipple eczema, making early diagnosis challenging. A 56-year-old woman presented with persistent erythema and scaling of the left nipple, which did not respond to conventional dermatologic treatments: a high degree of suspicion prompted further investigation. Reflectance confocal microscopy (RCM) revealed atypical, enlarged epidermal cells with irregular boundaries, while line-field confocal-optical coherence tomography (LC-OCT) demonstrated thickening of the epidermis with abnormal tissue inflammation reflectivity at the dermal-epidermal junction. These non-invasive imaging findings were consistent with an aggressive case of Paget disease despite the absence of clear mammographic evidence of underlying carcinoma: in fact, several biopsies were needed and at the end massive surgery was necessary. Non-invasive imaging techniques, such as dermoscopy, RCM and LC-OCT, offer a valuable diagnostic tool in detecting Paget disease, especially in early stages and atypical forms.