Sebastián Reyes-García

Introduction: Mortality data in patients with acquired perforating dermatosis (APD) are limited. Objectives: To assess, for the first time, the risk of all-cause mortality in adult patients with APD and to explore associated systemic comorbidities. Methods: This retrospective multicenter case-control study included adult patients diagnosed with APD and age-, sex-, and year-matched controls. We evaluated overall survival and the prevalence of seven major comorbidities: systemic malignancy, chronic obstructive pulmonary disease (COPD), severe liver disease, diabetes mellitus, arterial disease, hypertension, and dyslipidemia. Statistical analyses included univariate comparisons (Fisher’s exact test and logistic regression), Kaplan–Meier survival estimates with log-rank tests, and multivariate Cox proportional hazards models. Results: Fifty-one patients with APD and 102 controls (1:2 ratio) were finally included in this investigation. Patients with APD had a significantly increased risk of mortality compared to controls (log-rank test, P<0.001). In the multivariate Cox regression analysis, arterial disease emerged as the sole independent predictor of mortality (adjusted hazard ratio [HR]:7.716; 95% confidence interval [CI]: 2.774–21.464; P<0.001). Conclusions: This is the first study to identify a potential association between APD and increased all-cause mortality, primarily driven by coexisting arterial disease. These findings highlight the importance of comprehensive management in APD patients and emphasize the dermatologist’s role in multidisciplinary care aimed at improving long-term outcomes.

In routine clinical settings, identifying the factors that influence the persistence of biologic therapies is crucial for tailoring psoriasis management to individual patient profiles. This study aimed to evaluate the real-world drug survival of tildrakizumab in patients diagnosed with plaque psoriasis at the Dermatology Department of HUCA and to explore the clinical predictors of treatment discontinuation. We conducted a retrospective, hospital-based analysis involving 100 patients treated with tildrakizumab (Ilumetri^®) between 1 January 2021 and 30 April 2024. Kaplan–Meier estimates were used to construct survival curves, and multivariate analyses were performed using Cox proportional hazards regression models. Both crude and adjusted hazard ratios (HRs) were calculated to assess potential differences across patient subgroups. The multivariate analysis identified statistically significant associations between reduced drug survival and the presence of psoriatic arthritis (p = 0.02), previous biologic exposure (p = 0.02), and arterial hypertension (p = 0.012). Other comorbidities did not demonstrate significant effects. The most common reasons for treatment discontinuation were primary inefficacy and suboptimal response in patients with arthritis. Overall, tildrakizumab demonstrated robust survival outcomes in this patient population, though diminished persistence was observed in those with prior biologic use, comorbid arthritis, and hypertension.

Cutaneous squamous cell carcinoma (cSCC) is the second most common form of skin cancer. The incidence of metastasis for cSCC is estimated to be around 1.2–5%. Ribosomal protein S6 (p-S6) and the p21 protein (p21) are two proteins that play central roles in other cancers. These proteins may be equally important in cSCC, and together, these could constitute a good candidate for metastasis risk assessment of these patients. We investigate the relationship of p-S6 and p21 expression with the impact on the prognosis of head and neck cSCC (cSCCHN). p-S6 and p21 expression was analyzed by immunohistochemistry on paraffin-embedded tissue samples from 116 patients with cSCCHN and associations sought with clinical characteristics. Kaplan–Meier estimators and Cox proportional hazard regression models were also used. The expression of p-S6 was significantly inversely associated with tumor thickness, tumor size, desmoplastic growth, pathological stage, perineural invasion and tumor buds. p21 expression was significantly inversely correlated with >6 mm tumor thickness, desmoplastic growth, and perineural invasion. p-S6-negative expression significantly predicted an increased risk of nodal metastasis (HR = 2.63, 95% CI 1.51–4.54; p < 0.001). p21 expression was not found to be a significant risk factor for nodal metastasis. These findings demonstrate that p-S6-negative expression is an independent predictor of nodal metastasis. The immunohistochemical expression of p-S6 might aid in better risk stratification and management of patients with cSCCHN.

Biological drugs have prompted a revolution in the treatment of patients with psoriasis because of their favourable efficacy/risk profile. The aims of our study are to determine whether there is any difference in the pattern of use of biological treatments for older (65+ years) and younger patients diagnosed with plaque psoriasis by the Dermatology Service of the Hospital Universitario de Asturias (HUCA), to understand the survival of these drugs, and to identify the factors that predict the discontinuation of treatments. We report a retrospective observational hospital-based study of 300 patients registered at HUCA’s Dermatology Service who were receiving one of the following biological treatments for psoriasis on 30 November 2020: adalimumab, ustekinumab, secukinumab, or ixekizumab. The age groups were compared using Student’s t-test for quantitative variables and the chi-squared test for qualitative variables. We used the Kaplan–Meier estimator to estimate the survival function and the log-rank test to measure differences. No statistically significant differences in the frequency of use were noted between the younger and older groups, for any of the drugs studied. Survival on a drug regime, globally and individually, was similar in the two age groups. Factors predicting lower overall survival were being female, obesity, and having undergone previous biological treatment. The first three factors were influential in the under-65-year-old group, while arthritis was a significant factor for the older group.