Topical tacrolimus during systemic therapy for severe atopic dermatitis in the clinical practice.

OBJECTIVE: To evaluate the role of tacrolimus ointment in the management of patients on dupilumab therapy for severe atopic dermatitis, in a real-life setting. PATIENTS AND METHODS: Consecutive patients with severe AD treated with dupilumab were enrolled. Topical treatment was associated according to the clinical practice. Eczema Area and Severity Index (EASI), itching and sleep Numerical Rating Scale (NRS) and Dermatologic quality of Life (DLQI) were recorded at baseline and after 4, 16 and 52 weeks of treatment with dupilumab. RESULTS: Overall, 342 patients were enrolled, and 307 were evaluable. Tacrolimus was used by 6.5% (n=20) of patients at baseline, 11%, 13.5%, and 11.3% after 1, 4 and 12 months, respectively; the mean time to introduce tacrolimus after initiation of dupilumab was 8.3 ± 0.3 months. Low EASI score (<7; mild disease) after 1 month of systemic therapy was more frequent in patients who applied tacrolimus at baseline than in patients who did not (72.2% vs. 55.8%, p=0.027). Female sex, low DLQI scores, low age at dupilumab initiation, and non-generalized AD were correlated with an increased probability to start tacrolimus at any time during the study. CONCLUSIONS: Data suggested that early treatment of localized areas with tacrolimus improves systemic treatment efficacy.

Dupilumab and prurigo nodularis-like phenotype in atopic dermatitis: our experience of efficacy.

BACKGROUND: Atopic dermatitis (AD) is a common chronic multifactorial dermatosis that can occur through different clinical phenotypes although all exhibit identical pathogenetic mechanisms such as the prurigo nodularis (PN)-like phenotype. CASE REPORT: Here, we described 11 patients with PN-like AD treated with dupilumab, a human monoclonal IgG4 antibody that inhibits interleukin-4 (IL-4) and interleukin-13 (IL-13). Efficacy outcomes were performed at baseline, at first and fourth month after starting treatment. We collected different scores such as NRSi as well as IGA. At the same time, patient subjective benefits were analyzed through DLQI, POEM, and HADS scores. Quality of sleep was also recorded by NRSS. All patients showed rapid clinical improvement of cutaneous lesions and no other new lesions were reported during treatment. Reduction of daily itching was referred already after the first month of treatment. CONCLUSION: These results show the effectiveness of dupilumab in this clinical setting of AD, supporting this treatment as a valid therapeutic approach in difficult-to-treat-PN-like clinical presentation of AD.

Rosacea fulminans: two case reports and review of the literature.

Rosacea fulminans is a rare and severe inflammatory dermatosis which affects predominantly childbearing women. It is characterized by sudden onset and it usually localizes exclusively on the centrofacial areas, presenting with numerous fluctuant inflammatory nodules and papules which may coalesce. Treatment with isotretinoin in combination with topical and systemic corticosteroids is successful. Clearance of lesions may be obtained under systemic treatment with no or minimal scarring outcomes. Due to rare incidence its pathophysiological mechanisms, diagnosis and management remain controversial. We report two cases of rosacea fulminans arisen in otherwise healthy people and completely healed after treatment. Our aim is to share our experience about this disease in order to increase knowledge about its diagnosis, management and its treatment. We also make a review of the literature of this peculiar dermatosis.

Analysis of current data on the use of topical rapamycin in the treatment of facial angiofibromas in tuberous sclerosis complex.

BACKGROUND: Tuberous sclerosis complex (TSC) is an autosomal dominant neurocutaneous syndrome causing hamartomatous growths in multiple organs. Facial angiofibromas occur in up to 80% of patients and can be highly disfiguring. Treatment for these lesions has historically been challenging. Recently, topical rapamycin has been proposed as an effective option to treat angiofibromas but a commercially available compound has not yet been developed. OBJECTIVES: The aim of this review is to analyse the current data on the use of topical rapamycin in the treatment of angiofibromas in TSC, focusing on the risk-benefit profile. METHODS: A retrospective review of the English-language literature was conducted. RESULTS: Sixteen reports describing the use of topical rapamycin in the treatment of angiofibromas in TSC were considered, involving a total of 84 patients. An improvement of the lesions has been shown in 94% of subjects, particularly if the treatment was started at early stages. Several different formulations (ointment, gel, solution and cream) with a wide range of concentrations (0.003%-1%) were proposed. Only 4 local adverse side-effects were reported after the use of rapamycin solution. CONCLUSION: Topical rapamycin can be considered a safe option for the treatment and the prevention of facial angiofibromas in younger patients, but the best formulation has not been established. Our review demonstrates that ointment and gel should be preferred, but it is not clear which concentration is optimal. Long-term and comparative studies between topical rapamycin and ablative techniques are required to establish which treatment has a better outcome and lower recurrence rate.