Search Results (193)

Background: Actinic keratosis (AK) is a common premalignant skin disorder associated with chronic ultraviolet exposure and a recognized risk of progression to cutaneous squamous cell carcinoma. Tirbanibulin 1% ointment is an effective short-course field therapy for AK, but its efficacy in hyperkeratotic lesions (Olsen grade II–III) may be limited by reduced drug penetration through a thickened stratum corneum. Keratolytic pretreatment may represent a plausible strategy to improve topical drug delivery in these more challenging lesions. Methods: This retrospective chart review included consecutive adults with Olsen grade II–III AK treated in routine clinical practice with either a bland emollient lead-in followed by tirbanibulin (Group A) or salicylic acid 30% ointment pre-treatment (Decapan, Sanitpharma; Milan, Italy) followed by tirbanibulin (Group B). No study-driven procedures or additional visits were implemented. The 14-day bland emollient lead-in used in Group A was part of the routine clinical management applied during the relevant treatment period and was not introduced or retrospectively constructed for the purposes of the present comparative analysis. Outcomes were extracted from de-identified medical records and photographic documentation obtained as part of standard care. For the purposes of analysis, post-treatment evaluations were grouped into predefined windows of 3–6 weeks (T1), 10–14 weeks (T2), and 22–30 weeks (T3), corresponding approximately to 1, 3, and 6 months after treatment initiation. The primary efficacy endpoints were the Actinic Keratosis Area and Severity Index (AKASI) and Total Lesion Count (TLC). Secondary endpoints included quality of life assessed by the Dermatology Life Quality Index (DLQI). Results: Both treatment regimens were associated with clinically meaningful improvements in AK severity. At T3, mean AKASI was significantly lower in Group B than in Group A (0.86 ± 0.38 vs. 1.35 ± 0.27; p < 0.001), corresponding to reductions from baseline of 60.6% and 36.9%, respectively. Similarly, mean TLC at T3 was significantly lower in Group B than in Group A (4.80 ± 1.5 vs. 6.35 ± 1.6; p < 0.001), corresponding to reductions from baseline of 46.7% and 27.0%, respectively. Quality-of-life outcomes also favored the sequential approach, with lower DLQI scores at T3 in Group B compared with Group A (2.9 ± 1.6 vs. 3.8 ± 1.9; p = 0.006). Both treatments were generally well tolerated. Although the incidence of local skin reactions (LSRs) was similar between groups, Group B showed lower retrospectively documented composite LSR scores and lower patient-reported discomfort (p < 0.001) and lower patient-reported discomfort (p < 0.001). Conclusions: Sequential keratolytic pretreatment followed by tirbanibulin was associated with greater reductions in disease burden and with lower severity of treatment-related local reactions in this retrospective cohort (Olsen grade II–III). This retrospective study suggests that keratolytic pretreatment may represent a useful adjunctive strategy in hyperkeratotic AK treated with tirbanibulin. Prospective randomized studies are warranted to confirm these findings and to define standardized treatment protocols. Full article

Background/Objectives: The management of moderate-to-severe psoriasis in patients with a recent history of internal malignancy is a clinical challenge, as systemic immunosuppressive therapies are often avoided because of concerns about cancer recurrence. While Psoralen and Ultraviolet A (PUVA) photochemotherapy remains a valuable non-immunosuppressive alternative, regional variations in therapeutic response are not well-characterized in this population. This study aimed to evaluate total and segmental Psoriasis Area and Severity Index (PASI) responses to PUVA in patients with chronic plaque psoriasis and recent internal organ malignancy. Methods: This prospective, single-center, real-world cohort study enrolled 20 adults with moderate-to-severe chronic plaque psoriasis and a recent (<5 years) diagnosis of internal organ malignancy in complete remission. Participants received oral PUVA three times weekly for up to 30 sessions. Primary and secondary outcomes included changes in total PASI, segmental PASI (head/neck, trunk, upper limbs, and lower limbs), and Dermatology Life Quality Index (DLQI) at baseline, completion of therapy, and 6 months post-treatment. Results: PUVA led to a significant reduction in mean total PASI from 18.6 ± 3.2 at baseline to 5.7 ± 6.0 at treatment completion (69% reduction; p < 0.001). However, regional responses differed significantly: the head and neck improved the most (80.4%), followed by the trunk (72.2%) and upper limbs (72.3%), while the lower limbs showed the weakest response (59.5%; p < 0.001). At baseline, trunk contributed the most to total PASI (38%), while post-treatment, lower-limb lesions accounted for approximately 47% of the remaining total disease burden, showing the highest contribution to total PASI of all body regions. At 6 months, the lower limbs remained the most affected area, with significantly lower improvement (52.9%) compared to other regions. Mean DLQI also improved significantly from 17.2 ± 2.8 to 5.6 ± 2.6 (p < 0.001). Conclusions: PUVA is an effective and safe treatment for patients with psoriasis and a recent history of malignancy. Nevertheless, lower-limb psoriasis is relatively recalcitrant and contributes disproportionately to residual disease burden and relapse. These findings support the use of regional PASI assessment to guide individualized management and clinical expectations in this complex patient group. Full article

Background: Axillary hidradenitis suppurativa (HS) often requires wide surgical excision and reconstruction. Thoracodorsal artery perforator (TDAP) flaps and split-thickness skin grafts (STSGs) are common options, but comparative long-term data are insufficient. Methods: In this single-center retrospective study, patients aged ≥ 17 years with Hurley stage II–III axillary HS underwent wide excision followed by TDAP flap or STSG reconstruction. Demographic variables, surgical characteristics, complications, recurrence, shoulder mobility, and dermatology-specific quality-of-life outcomes assessed using the Dermatology Life Quality Index (DLQI) were analyzed. Results: In total, 35 reconstructions were reviewed: TDAP (n = 15, 42.9%) and STSG (n = 20, 57.1%). Follow-up was longer for TDAP (28.53 ± 16.38 vs. 19.65 ± 28.06 months; p = 0.014). Mean defect size was 105.47 ± 26.29 cm² (TDAP) vs. 164.65 ± 77.99 cm² (STSG; p = 0.116). Both groups showed significant improvement in DLQI from preoperative to postoperative assessments (TDAP: +20.87; Graft: +18.50; both p < 0.0001), with no significant postoperative difference (p = 0.9608). Smokers had higher preoperative DLQI scores than non-smokers (+5.72; p = 0.0051), but postoperative outcomes were similar (p = 0.5908). Conclusions: Both reconstructions after wide axillary excision provided durable coverage, low complication rates, and significant improvement in quality of life. Incorporating patient-reported and functional outcomes into reconstructive planning may optimize surgical decision-making for axillary HS. Full article

Background/Objectives: Scabies is a contagious dermatological infestation that can cause not only physical symptoms but also considerable psychosocial burden. This study aimed to investigate the relationships between fear of scabies, internalized stigma, and dermatology-related quality of life in patients with scabies. Methods: This cross-sectional study included 131 patients diagnosed with scabies in a dermatology outpatient clinic. Data were collected using a structured questionnaire including sociodemographic and clinical characteristics, the Fear of Scabies Scale (FSS), the Internalized Stigma Scale (ISS), and the Dermatology Life Quality Index (DLQI). Correlation and regression analyses were conducted to examine the associations between fear of scabies, internalized stigma, and quality of life. Results: The mean DLQI score was 15.82 ± 5.69, indicating a considerable impairment in dermatology-related quality of life. Fear of scabies showed a weak but significant positive correlation with DLQI scores (r = 0.326, p < 0.001), whereas internalized stigma demonstrated a stronger correlation (r = 0.484, p < 0.001). Among the stigma subdimensions, social withdrawal showed the strongest association with impaired quality of life (r = 0.622, p < 0.001). Regression analyses revealed that internalized stigma explained 23% of the variance in DLQI scores (R² = 0.234), while fear of scabies explained 10% (R² = 0.106). In addition, longer symptom duration (β = 0.708, p < 0.001), nocturnal pruritus (β = 0.408, p = 0.009), and visible skin lesions (β = 0.263, p = 0.002) were associated with higher levels of fear of scabies. Conclusions: Internalized stigma and disease-related fear were associated with reduced quality of life, with stigma-related mechanisms appearing to play a particularly prominent role. These findings suggest that addressing stigma and providing psychosocial support may be important components of comprehensive scabies management. Full article

Background/Objectives: Palmoplantar psoriasis (PP) is a challenging variant of psoriasis that affects high-impact areas such as palms and soles and significantly impairs quality of life despite often limited body surface involvement. Conventional topical and systemic therapies may be insufficient, and evidence on biologic treatments for this specific phenotype remains limited. Bimekizumab (BKZ), a monoclonal antibody targeting IL-17A and IL-17F, has shown high efficacy in plaque psoriasis. This study aimed to evaluate the real-world effectiveness and rapidity of action of BKZ in patients with palmoplantar psoriasis compared with patients with psoriasis vulgaris (PV). Methods: We conducted a multicenter retrospective cohort study using data from 22 Italian dermatological units within the IL-PSO (Italian Landscape-Psoriasis) database. Adult patients treated with BKZ between November 2022 and October 2024 were included and categorized into three groups: isolated PP, PP associated with PV (PP + PV), and PV without palmoplantar involvement. Clinical outcomes included the Psoriasis Area and Severity Index (PASI), Dermatology Life Quality Index (DLQI), and pruritus Visual Analogue Scale (VAS). Outcomes were assessed at baseline, week 4, and week 16. Results: A total of 47 patients were included. The baseline PASI was lower in the PP group compared with the PP + PV and PV groups, whereas the DLQI was highest in patients with isolated PP. Rapid clinical improvement was observed in all groups. The mean % PASI reduction at week 4 was 60.5%, 65.1%, and 77.0% in the PP, PP + PV, and PV groups, respectively, increasing to 94.8%, 90.4%, and 91.8% at week 16. The proportion of patients achieving complete clearance (PASI = 0) at week 16 was 73.3% (11/15), 68.2% (15/22), and 70.0% (7/10), respectively. Significant improvements were also observed in DLQI and pruritus scores over time. No significant safety concerns emerged. Conclusions: In this real-world multicenter cohort, bimekizumab demonstrated rapid and high efficacy in patients with palmoplantar psoriasis, both isolated and associated with psoriasis vulgaris. These findings support the use of BKZ as an effective therapeutic option for psoriasis involving high-impact areas, as the palmoplantar, although larger studies are needed to confirm these results. Full article

Background and Objectives: Psoriasis is a chronic immune-mediated inflammatory disease characterized by heterogeneous clinical presentation and variable response to biologic therapy. Genetic variation within the IL-23/Th17 inflammatory pathway may influence treatment outcomes. This study evaluated the association between IL12B rs3213094 and IL23R rs11209026 single-nucleotide polymorphisms (SNPs) and response to biologic therapy in patients with moderate-to-severe psoriasis. Materials and Methods: We conducted a multicenter observational study including 92 Romanian patients with moderate-to-severe psoriasis vulgaris receiving their first biologic therapy (anti-TNF, anti-IL-17, or anti-IL-23 monoclonal antibodies). Clinical response was assessed using the Psoriasis Area and Severity Index (PASI) at baseline and weeks 12, 24, 36, and 48. Early response was defined as achieving PASI75 at week 12. Patient-reported disease impact was assessed using the Dermatology Life Quality Index (DLQI) at the same time points. Genotyping of IL12B rs3213094 and IL23R rs11209026 was performed using TaqMan assays. Longitudinal PASI dynamics were analyzed using repeated-measures ANOVA, while multivariable logistic regression was used to identify independent predictors of PASI75 at week 12. Results: A significant reduction in PASI scores over time was observed (p < 0.001). The IL12B rs3213094 genotype was associated with differences in early response kinetics, with T-allele carriers showing significantly greater PASI improvement at week 12 compared with CC homozygotes (90.0% vs. 65.7%, p = 0.003). This effect was limited to early treatment and attenuated at later time points. In multivariable analysis, the IL12B rs3213094 CT + TT genotype was independently associated with PASI75 achievement at week 12 (OR = 4.285, 95% CI 1.500–12.239, p = 0.007). Treatment with anti-IL-17 agents was also an independent predictor of early response (OR = 3.946, 95% CI 1.416–10.998, p = 0.009). No significant association was observed between IL23R rs11209026 and treatment response. DLQI scores improved significantly over time (p < 0.001), without genotype-dependent differences. Conclusions: IL12B rs3213094 SNP is significantly associated with early biologic treatment response in psoriasis, supporting its potential role as a pharmacogenetic biomarker of treatment responsiveness. These findings may inform the integration of genetic markers into personalized therapeutic strategies, particularly in underrepresented populations such as those from Eastern Europe. Further studies in larger cohorts are warranted to validate these results. Full article

Immune checkpoint inhibitors (ICIs) have substantially improved outcomes in advanced melanoma but are frequently linked to immune-related adverse events (irAEs). Vitiligo is a common cutaneous irAE and has been consistently associated with improved patient outcome, including prolonged progression-free and overall survival. It also represents significant visual stigma, particularly when the face is involved. Traditional treatment comprises topical steroids, calcineurin inhibitors, laser, and phototherapy which often have insufficient effects. Since 2023, the first approved drug for non-segmental vitiligo (NSV) with facial involvement, the topical Janus kinase inhibitor ruxolitinib, has been available. However, experience with its use in ICI-induced vitiligo remains limited. In this exploratory analysis, three patients who developed facial vitiligo following ICI therapy applied 1.5% ruxolitinib cream to affected facial areas twice daily. After six (two patients), and twelve months (one patient), extensive repigmentation was observed, quantified at 95.7%, 78.9%, and 99.1% using a novel semi-automatic tool. Quality-of-life questionnaires showed mean reductions of 57.6% (Vitiligo DLQI) and 68.2% (Vitiligo-specific Quality of Life) in disease burden. Treatment was associated with substantial repigmentation without observed side effects. Further evaluation in larger, prospective cohorts is warranted to better define treatment effects, clinical applicability, and long-term safety. Full article

Background: Chronic kidney disease-associated pruritus (CKD-aP) is characterised as pruritus in individuals with advanced chronic kidney disease (CKD) without a discernible alternative etiology. This study assessed the prevalence, severity, and effects of CKD-aP on sleep and health-related quality of life (HRQoL) among end-stage kidney disease patients (ESKD) undergoing maintenance hemodialysis (MHD) in an Indian cohort. Methods: This cross-sectional, single-centre study included adults with renal failure undergoing MHD for ≥3 months. The primary outcome was CKD-aP prevalence and its relationship with demographic, clinical, and laboratory variables. Secondary outcomes included CKD-aP severity, characteristics, HRQoL, and sleep quality scores. Statistical analysis was conducted using SPSS v21, with a significance level of p < 0.05. Results: The 12-item Pruritus Severity Scale found mild CKD-aP to be the most common (37% of patients). The 5-D Itch Scale found that patients with moderate-to-severe CKD-aP had longer daily itching (52.9%) with a nonsignificant change over time (p = 0.18), and the back (77.9%) was the most affected site. The Dermatology Life Quality Index revealed that 75.5% of patients had HRQoL impairment. The Skindex-16 found that moderate-to-severe CKD-aP was linked to a greater symptom burden and emotional distress. The Pittsburgh Sleep Quality Index found poorer sleep quality as CKD-aP worsened. Conclusions: CKD-aP is common in patients undergoing hemodialysis and negatively impacts quality of life, emphasizing the need for routine assessment and targeted management. Full article

Background and Objectives: Biological therapy is widely used to treat moderate-to-severe psoriasis. This study aimed to assess the real-world effectiveness and drug survival of biologic treatment in patients with moderate-to-severe psoriasis. Materials and Methods: A retrospective study of 210 patients with moderate-to-severe psoriasis who were treated with biological therapy between 2018 and 2023 was conducted. Baseline data included demographics, comorbidities, prior treatments, Psoriasis Area and Severity Index (PASI) and Dermatology Life Quality Index (DLQI) scores, laboratory results, current psoriasis treatment, and treatment-related adverse events. Results: Of the 210 patients, 60.0% were male (n = 126). The mean age was 48.3 ± 13.6 years in men (range 16–74) and 48.4 ± 13.6 years in women (range 17–79). The mean PASI at initiation of biologic therapy was 15.0 ± 8.1 and decreased to 3.3 ± 4.7 at 1 year, 2.7 ± 4.0 at 3 years, and 2.8 ± 3.3 at 5 years. Drug discontinuation differed between therapies: etanercept had a higher hazard of discontinuation than ustekinumab (hazard ratio (HR) 2.55, 95% confidence interval (CI) 1.17–5.52; p = 0.0179), infliximab (HR 0.36, 95% CI 0.13–0.97; p = 0.0429) and adalimumab (HR 0.47, 95% CI 0.23–0.98; p = 0.0453). Conclusions: In routine clinical practice, biologic therapy was associated with substantial and sustained improvements in the PASI over up to 5 years of follow-up. Drug survival was initially high for all agents but separated over time, with etanercept showing the poorest long-term persistence and a higher hazard of discontinuation compared with other drugs. Full article

Glycation is a type of post-translational protein modification that affects antigen self-recognition, cell signaling, the proteasomal degradation of proteins, protein solubility, and the mechanical properties of tissues. Some glycation products are able to cross-link proteins. Serum concentrations of the cross-linking GOLD (glyoxal lysine dimer) and MOLD (methylglyoxal lysine dimer), and the non-cross-linking MG-H1 (methylglyoxal-derived hydroimidazolone isomer 1) in patients with psoriasis (n = 63) and in healthy controls (n = 35) were examined using the LC-Orbitrap-MS/MS (liquid chromatography–Orbitrap tandem mass spectrometry) technique. The following indices were assessed in the patients: BSA (body surface area), PASI (psoriasis area and severity index), and DLQI (Dermatology Life Quality Index). Serum concentrations of GOLD, MOLD, and MG-H1 were found to be significantly lower in psoriasis patients compared with healthy individuals. The concentrations of GOLD, MOLD, and MG-H1 did not correlate with the indices of disease activity and severity. These results may reflect the complexity of metabolic dysregulation accompanying immune-mediated inflammatory diseases such as psoriasis. Full article

Background: Tildrakizumab, an anti-IL-23p19 monoclonal antibody, has demonstrated efficacy in clinical trials, but real-world evidence remains crucial for confirming its profile in diverse populations. Methods: We have conducted a multicenter, retrospective observational study within the Spanish Psoriasis Group (GPS). This study updates previous findings with a larger sample size (n = 372) and longer follow-up. We assessed absolute Psoriasis Area and Severity Index (PASI), Body Surface Area (BSA), and the Dermatology Life Quality Index (DLQI) improvements, as well as safety, in patients with moderate-to-severe plaque psoriasis. Results: The cohort included a large population of patients with a high prevalence of comorbidities and prior biologic exposure. Effectiveness was high, with a significant proportion of patients achieving PASI < 1. Compared to recent real-world data, our cohort demonstrates superior complete clearance rates (PASI < 1) and includes a comprehensive DLQI assessment. Notably, 79 patients were aged ≥65 years, confirming the drug’s utility in the elderly. Safety was consistent with previous reports, with no new signals detected. Conclusions: Tildrakizumab shows robust effectiveness and safety in a complex, bio-experienced real-world population. The lack of clinical predictors of response suggests a need for future pharmacogenetic exploration. Full article

Background: Treatment options for vulvar lichen sclerosus (VLS) remain limited; therefore, therapies that improve quality of life and reduce neoplastic risk are needed. Photodynamic therapy (PDT) is a potential option. This study aimed to evaluate quality of life and sexual function in patients treated according to the protocol used at our institution. Methods: Forty patients with refractory VLS underwent PDT using a 10% 5-aminolevulinic acid nanoemulsion (Ameluz^®) applied to lesions under an occlusive aluminum foil dressing. Patients received 1–6 sessions of 10 min illumination (LED: 37 J/cm², ~77 mW/cm²) at 4–6-week intervals. The Dermatology Life Quality Index (DLQI) and Female Sexual Function Index (FSFI) were used for assessment. Results: Thirty-seven participants answered DLQI, while 20 declared themselves to be sexually active and were included in the analysis. Greater number of PDT sessions was associated with a lower DLQI score (τ = −0.583; adjusted p < 0.001). The number of PDT sessions and the total FSFI score (p = 0.014), as well as desire (p = 0.016), arousal (p = 0.020), orgasm (p = 0.020), and satisfaction (p = 0.016) domains were significantly correlated. Age correlated positively with DLQI scores (p = 0.016), indicating greater disease burden in older patients. Longer disease duration was also associated with poorer quality of life (p = 0.020). Conclusions: PDT can be considered an effective treatment for patients with VLS refractory to standard topical corticosteroid and calcineurin inhibitor therapies when delivered using a refined, patient-centered protocol. This optimized approach used in our institution is based on short irradiation time and precise light delivery, providing a favorable balance between therapeutic efficacy, patient comfort, and treatment feasibility. Our findings also suggest that the cumulative number of PDT sessions is a key factor for clinical response. Further studies should address long-term outcomes. Full article

Moderate-to-severe atopic dermatitis (AD) requires safe, long-term management strategies to complement conventional pharmacotherapy. This study evaluated the efficacy and safety of VGH4, a standardized multi-herb traditional Chinese medicine (TCM) formula, as an adjunct to standard care. In a randomized, double-blind, placebo-controlled crossover pilot trial, 19 patients with moderate-to-severe AD (SCOring Atopic Dermatitis Index (SCORAD) ≥ 25) received VGH4 or placebo for 6 weeks, separated by a 2-week washout. Primary outcomes assessed disease severity (SCORAD), while secondary outcomes included quality of life (DLQI/CDLQI) and safety. Eighteen patients completed the study. VGH4 yielded a median within-patient SCORAD reduction 10.2 points greater than placebo (p = 0.054). The primary endpoint did not reach statistical significance at the α = 0.05 level (p = 0.054); nevertheless, the observed magnitude of improvement exceeded the established minimal clinically important differences (MCIDs). The subjective SCORAD component showed a significant between-treatment difference favoring VGH4 (p = 0.015), and a statistically significant improvement in quality of life was also observed in adult patients (p = 0.023). In conclusion, VGH4 was generally well tolerated in this short-term pilot trial, with no serious adverse events, and showed preliminary signals of possible benefits in patient-reported outcomes as an adjunct therapy. These exploratory findings warrant confirmation in larger, adequately powered trials. Full article

Background: Atopic dermatitis (AD) is a chronic inflammatory skin disease that is often associated with cutaneous pain. The objective of this study was to evaluate the impact of cutaneous pain on the prevalence of anxiety, depression, quality of life (QoL) and stigmatization in patients with AD. Methods: A cross-sectional study was conducted on a group of 113 adults with AD (61% females; mean age 34.48 ± 13.20 years). The severity of AD was evaluated using the Eczema Area and Severity Index (EASI). The intensity of cutaneous pain in the past week was measured using a Numerical Rating Scale (NRS), a Short Form McGill Pain Questionnaire (SF-MPQ) and a Visual Analogue Scale (VAS). Psychosocial burden was evaluated using the Hospital Anxiety and Depression Scale (HADS), the Anxiety Generalized Disorder-7 (GAD-7), the Patient Health Questionnaire-9 (PHQ-9), the Dermatology Life Quality Index (DLQI) and the 6-Item Stigmatization Scale (6-ISS). Results: Individuals with AD who reported cutaneous pain in the past week scored significantly higher in HADS (p < 0.001), HADS-A (p < 0.001), HADS-D (p = 0.002), GAD-7 (p < 0.001), PHQ-9 (p < 0.001), DLQI (p < 0.001) and 6-ISS (p < 0.001) than the rest of the cohort. More individuals with cutaneous pain had anxiety (36 (48.0%) vs. 7 (18.4%), p = 0.002), depression (21 (28.0%) vs. 2 (5.3%), p = 0.006) and abnormal HADS scores (46 (61.3%) vs. 9 (23.7%), p < 0.001) compared to the rest of participants. Significant correlations were observed between all studied pain assessment tools and all studied psychometric assessments. Conclusions: The prevalence and severity of anxiety, depression, stigmatization, and impaired QoL are higher in adults with AD suffering from cutaneous pain compared to those without pain. This symptom is significantly associated with disease burden. Full article

Dercum’s disease (DD) is a rare chronic disorder characterized by painful subcutaneous lipomas, mostly affecting overweight or obese middle-aged women. The etiology remains unclear, and evidence for medical treatments is limited. Surgical approaches may reduce pain but are associated with frequent relapses and are difficult to implement in extensive clinical pictures. We investigated the outcomes of multiple medical and surgical therapeutic strategies. Particularly, we explored immunomodulators (methotrexate and infliximab), used alone or combined with glucagon-like peptide-1 receptor agonists (GLP-1 RAs) such as semaglutide, as well as the dual GIP (glucose-dependent insulinotropic polypeptide)/GLP-1 RAs tirzepatide. Five patients with DD were included in this retrospective single-center case series. Baseline clinical data, medical history, and longitudinal information on Dermatology Life Quality Index (DLQI), Visual Analogue Scale (VAS) for pain, and body mass index (BMI) were collected from existing medical records and scheduled follow-up visits conducted since 2021. Clinical trajectories differed across patients and regimens. Methotrexate and infliximab coincided with variable and often transient improvements in pain and quality of life. Combination regimens including GLP-1 RAs were accompanied by weight reduction and, in selected patients, by sustained improvements in pain and DLQI. In other cases, the benefit was limited or absent. Adverse events were manageable and consistent with the known safety profiles of these drugs. In this small real-world case series, therapeutic responses in DD were highly individualized, underscoring the absence of standardized medical treatment and the need for patient-tailored strategies. The observed patterns suggest that immunomodulatory and incretin-based therapies may represent exploratory options in selected patients, especially when surgery is not feasible. However, controlled studies are needed to clarify their role. Full article