Vehicle composition may influence topical corticosteroid performance. In two patients with disseminated granuloma annulare, switching from clobetasol ointment to the same‐strength solution in diethylene glycol monoethyl ether (DEGEE) was followed by complete clearance, suggesting formulation optimization may be considered when topical treatment provides an inadequate response.

Idiopathic normal pressure hydrocephalus (iNPH) is a common condition affecting the elderly. Numerous investigations highlight that its period-prevalence could be underestimated, as well as the economic burden of the missed treatments. The objective of the present investigation is to determine if a cohort of radiologically suspected iNPH patients presents the clinical landmarks of this condition, and to estimate the economic burden of these potentially missed diagnoses. We recorded age, sex, reason to access emergency rooms of our community hospitals, values of Evans' Index, callosal Angle, presence of disproportionately enlarged subarachnoid space hydrocephalus and obvious ventricular enlargement. We telephoned the patients who presented at least two radiological signs of iNPH and administered the idiopathic normal-pressure hydrocephalus grading scale (iNPHGS), to assess the severity of signs and symptoms linked to iNPH, to understand if a strong radiological suspect had a clinical correlation. Among the 308 brain computed tomography scans of a week, a total of 21 agreed to be enrolled in the present investigation. When administering iNPHGS questionnaire to radiologically suspected iNPH, 17/21 patients (80.1%) scored ≥1 in at least two of the three iNPHGS subscales. The scores of the three subscales were strongly associated to each other. The estimated monthly and yearly health-related costs may be EUR 4'799'440 and 57.59 million of Euros, respectively. There is an association between the radiological features of iNPH and the scores of iNPHGS. The period-prevalence could be 5.51%, implying high health care costs, with significant societal impact, and reduced quality of life in patients suffering from undiagnosed iNPH.

Background: Ocular-surface abnormalities are common in patients with moderate-to-severe atopic dermatitis and may predispose to dupilumab-associated ocular surface disease (DAOSD). We investigated early ocular-surface changes during dupilumab treatment and whether baseline-guided hyaluronic acid (HA) eye-drop use was associated with more favorable ocular outcomes. Methods: In this prospective single-center cohort study, patients with moderate-to-severe atopic dermatitis underwent ophthalmologic assessment before dupilumab initiation and after 4 months. HA 0.15% eye drops were prescribed to patients with at least one basal or reflex Schirmer value ≤15 mm and ocular symptoms. Ocular outcomes included tear break-up time (TBUT), basal and reflex Schirmer tests, meibography, and the Ocular Surface Disease Index (OSDI). Follow-up values were compared between HA users and non-users using baseline-adjusted models with false-discovery-rate correction. Results: Thirty-nine patients were included; 18 received HA eye drops and 21 did not. Twenty-seven patients (69.2%) had at least one baseline Schirmer value ≤15 mm. At 4 months, reflex Schirmer values were higher in HA users than in non-users after baseline adjustment (adjusted mean difference, 5.60 mm; 95% CI, 1.64–9.57; p = 0.007; q = 0.035). In the low-Schirmer subgroup, HA use was associated with higher reflex Schirmer (8.50 mm; 95% CI, 4.84–12.17; q < 0.001) and basal Schirmer values (5.07 mm; 95% CI, 1.41–8.73; q = 0.022). Among untreated patients with low baseline Schirmer values, reflex tear production decreased in eight of nine patients, despite OSDI scores remaining within the conventional normal range. Conclusions: HA supplementation at dupilumab initiation was associated with more favorable changes in tear production, particularly among patients with reduced baseline Schirmer measurements. Objective deterioration in tear production despite persistently low OSDI scores highlights the limitations of symptom-based assessment alone. These findings support baseline ophthalmologic evaluation and combined objective and symptom monitoring during dupilumab treatment. Larger controlled studies are needed to determine whether early, targeted HA eye-drop use can prevent clinically relevant dupilumab-associated ocular surface disease.