Michela Magnano

Background/Objectives: Blood count-derived inflammatory indices have been proposed as accessible biomarkers of systemic inflammation in psoriasis, but their longitudinal behavior during selective interleukin-23 blockade remains uncertain. We evaluated these indices in psoriasis patients treated with risankizumab. Methods: We conducted a multicenter retrospective real-world study (DERMIS), including adults with cutaneous psoriasis, with or without psoriatic arthritis, treated with risankizumab across 10 Italian centers, from national reimbursement up to 1 December 2025. Psoriasis Area and Severity Index (PASI) and complete blood count-derived indices—neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), monocyte-to-lymphocyte ratio (MLR), systemic immune-inflammation index (SII), and systemic inflammation response index (SIRI)—were assessed at baseline and at weeks 12, 24, 52, 104, 156, and 208. Analyses used available data and sensitivity cohorts with follow-up at weeks 52, 104, and 208. Results: Among 250 patients, 43 had data at week 208. PASI scores decreased significantly at all follow-up time points. In contrast, systemic indices showed heterogeneous, non-linear trajectories: NLR, SII, and SIRI fluctuated without consistent sustained reductions, whereas MLR remained broadly stable. PLR showed the most reproducible downward trend, with nominal reductions at weeks 24 and 52; after Bonferroni correction across the six repeated visits within PLR, the reduction at week 52 remained statistically significant, whereas the week-24 reduction did not. Body mass index (BMI)-related differences were inconsistent and did not remain significant after Bonferroni correction. Sex, cardiometabolic comorbidities, and previous biological exposure showed no consistent effect. Conclusions: These findings challenge the use of routine blood count-derived indices as reliable biomarkers of cutaneous response to risankizumab.

Article: Round excision: a new skin sparing technique - Italian Journal of Dermatology and Venereology 2026 May 21 - Minerva Medica - Journals

Historically, psoriasis (Pso) and atopic dermatitis (AD) were considered mutually exclusive diseases due to their activation of opposing immune pathways—Th17 in Pso and Th2 in AD. However, growing clinical evidence and systematic reviews have challenged this dichotomy, demonstrating that both conditions can coexist in the same individual. This paper aims to provide an overview of the nomenclature, epidemiology, genetics, pathogenesis, and clinical features of coexistent psoriasis and atopic dermatitis, whether drug-induced or not. These conditions are also collectively referred to as “PsoDermatitis”.

Background: Alopecia areata (AA) is an autoimmune condition leading to hair loss. Baricitinib, a Janus kinase (JAK) inhibitor, has demonstrated efficacy in controlled clinical trials, but real‐world data on its long‐term effectiveness and safety remain limited. Objectives: This study aimed to assess the real‐life effectiveness and safety of baricitinib 4 mg daily in Italian adult patients with severe AA over a 48‐week treatment period. Methods: We conducted a 48‐week retrospective, observational, multicenter study across 27 Italian university hospitals. Adult patients (18–65 years) with severe AA (Severity of Alopecia Tool [SALT] score ≥ 50) who initiated baricitinib 4 mg daily treatment between November 2022 and October 2023 were included. Effectiveness was measured by the percentage of patients achieving SALT ≤20 at week 48. Secondary outcomes included changes in mean SALT score, trichoscopic findings, patient‐reported quality of life (Skindex‐16, Hospital Anxiety and Depression Scale [HADS]), and Clinician‐Reported Outcomes (ClinRO) for eyebrows and eyelashes. Adverse events were also documented. Results: A total of 253 patients (66.8% females, mean age 40.0 ± 12.6 years) were included. By week 48, 63.2% achieved SALT ≤20, and 75.5% achieved SALT ≤30. The mean SALT score significantly decreased from 93.7 ± 14.1 at baseline to 26.5 ± 33.0 at week 48 ( p < 0.001). Trichoscopic assessment showed a decline in yellow dots (97.6%–50.2%), black dots (43.5%–9.1%), and dystrophic hairs (14.6%–4.3%), whilst regrowing hairs increased (7.1%–80.2%). Skindex‐16 scores improved significantly (57.1 ± 25.0 to 30.0 ± 17.8, p < 0.001), as did HADS Anxiety (8.21 ± 9.38 to 4.62 ± 4.21, p < 0.001) and HADS Depression (6.36 ± 4.55 to 3.70 ± 4.11, p < 0.001). Adverse events were reported in 9.4% of patients. Conclusions: This real‐world study confirms the effectiveness of baricitinib in achieving significant hair regrowth and improving psychological well‐being in severe AA patients.

Article: Tuscany consensus for pediatric scabies: update on clinical management and the urgent need for new guidelines - Italian Journal of Dermatology and Venereology 2024 Nov 19 - Minerva Medica - Journals

Background: 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.Materials and Methods: We conducted a retrospective study involving 23 medical centres across Italy, enrolling patients affected by severe alopecia areata (SALT >50), for more than 6 months. Clinical and trichoscopic assessment was performed at each visit and impact on quality of life, anxiety and depression were evaluated using the Skindex‐16 and the Hospital Anxiety and Depression Scale (HADS), respectively.Results: A total of 118 patients were enrolled, with a mean age of 39 years and a mean SALT >95. The mean value of the SALT score decreased from an average of 96.6 (±8.23 sd) to 48 (±35.2 sd) after 24 weeks of treatment and 42.3% of patients achieved a SALT 30, 31.3% a SALT 20 and 20.3% a SALT 10 by Week 24. Trichoscopic signs showed fewer yellow dots and black dots significantly earlier than hair regrowth. Adverse events during the treatment period (mild laboratory test abnormalities) were reported in 12.7% patients. No drop‐out 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 order to reveal early response to therapy.