Alessia Lozito

Adalimumab, a tumor necrosis factor-alpha inhibitor, is widely used for chronic plaque psoriasis and psoriatic arthritis. While cutaneous adverse effects are known, perforating dermatosis is rare and poorly understood. A 34-year-old woman with psoriasis and psoriatic arthritis developed acquired perforating dermatosis after switching from adalimumab biosimilar GP2017–CTP17. She presented painful, ulcerated plaques on the thighs, gluteal area, and elbows. Histopathology confirmed the diagnosis. The biosimilar drug was discontinued and a 4-week course of systemic corticosteroids led to complete resolution. Both conditions were later managed with methotrexate and ixekizumab. Perforating dermatosis following anti-tumor necrosis factor is rare and underreported with adalimumab. No other known triggers (e.g., diabetes and renal failure) were present. Hypothesized mechanisms include fibronectin dysregulation and advanced glycation end accumulation, disrupting keratinocyte function. Perforating dermatosis should be recognized as a rare adverse effect of tumor necrosis factor-alpha inhibitors. Early recognition and discontinuation may prevent progression. Further studies are needed to clarify pathogenesis.

Background: Macromastia is a well-known issue in breast reconstruction. Skin-reducing mastectomy (SRM) was introduced as a skin-sparing mastectomy that utilizes a skin reduction pattern similar to breast reduction or breast lift surgery, specifically to manage hypertrophic and pendulous breasts. Over time, numerous authors have contributed to refining the SRM technique, leading to the development of various technical variants. However, the diversity of approaches inspired by SRM has created confusion, and clear surgical indications are lacking. Methods: We propose a unifying concept called breast reshaping mastectomy (BRM), which encompasses all techniques based on SRM principles. The BRM aims not only to preserve and reduce the breast skin envelope but also to immediately reshape it for a more aesthetic outcome. This approach is applicable to all mastectomies where skin envelope preservation (with or without the nipple-areola complex) is oncologically safe, a modification of breast skin coverage is needed for better aesthetic results, and an implant-based reconstruction is planned. Results: To define the BRM concept, we reviewed the existing literature on SRM and its related techniques. Our analysis focused on four key elements: skin incision pattern, implant coverage strategy, nipple-areola complex (NAC) management, and the choice between two-stage and direct-to-implant reconstruction. Conclusions: By integrating these four components into a single surgical framework, BRM provides a structured approach to breast reconstruction that enhances both oncologic safety and aesthetic outcomes. Standardizing these techniques could help clarify surgical indications and improve reconstructive planning for patients undergoing skin-sparing mastectomy.