BACKGROUND: Peristomal pyoderma gangrenosum (PPG) is a variant of pyoderma gangrenosum (PG). It results from a pathergy response to trauma from effl uent from the ostomy or secondary to trauma caused by removal of the ostomy appliance adhesive in contact with the skin. Currently, no evidence-based guidelines for the management of PPG exist. This case study reports a dramatic response to crushed corticosteroid tablets in a patient who proved refractory to fi rst-and second-line treatments of her PPG and several surgeries. CASE: Ms T. was a 39-year-old woman with Crohn's disease who underwent several ileostomies, developed PPG, and failed treatment with adalimumab. Her PPG was successfully treated topically with crushed prednisone tablets. CONCLUSION: We found that crushed corticosteroid tablets were an effective treatment of PPG, due to the ability to reduce pain and allow adhesion of the ostomy appliance.

Allergic and immunologic skin diseases negatively impact the quality of life (QoL) of affected patients with detrimental consequences. Nonetheless, in everyday clinical practice the evaluation of QoL is often overlooked. Considering the increasing prevalence of atopic dermatitis, allergic contact dermatitis, hereditary angioedema, cutaneous mastocytosis, and urticaria, it is essential to determine the effects of allergic and immunologic skin diseases on QoL. A joint meeting (GET TOGETHER 2021) of the Italian Society of Allergology, Asthma and Clinical Immunology (SIAAIC) and the Italian Society of Allergological, Occupational and Environmental Dermatology (SIDAPA) aimed to summarize the features of the main QoL tools used in these diseases and to describe the extent of QoL impairment as well as the impact of treatments on QoL, particularly biologic therapies. The assessment of QoL in patients with allergic and immunologic skin diseases relies on generic, organ-specific and disease-specific questionnaires. While generic and organ-specific questionnaires allow comparison between different diseases, disease-specific questionnaires are designed and validated for specific cohorts: the QoL Index for Atopic Dermatitis (QoLIAD) and the Childhood Atopic Dermatitis Impact Scale (CADIS) in atopic dermatitis, the ACD-11 in allergic contact dermatitis, the Angioedema QoL Questionnaire (AE-QoL) and the Hereditary Angioedema QoL questionnaire (HAE-QoL) in hereditary angioedema, the Mastocytosis QoL Questionnaires (MCQoL e MQLQ) in cutaneous mastocytosis, and the Chronic Urticaria QoL questionnaire (CU-Q2oL) in urticaria. Among the many factors that variably contribute to QoL impairment, pruritus can represent the leading cause of patient discomfort. Biologic therapies significantly ameliorate QoL in atopic dermatitis, hereditary angioedema, mastocytosis and chronic urticaria. In general, adequate management strategies are essential for improving QoL in patients with allergic and immunologic skin diseases.

Generalized pustular psoriasis (GPP) is a severe and potentially life-threatening type of psoriasis. We present the case of a patient with severe GPP, at first unsuccessfully treated with cyclosporine. We chose to treat the patient with ixekizumab, an anti-IL-17 antibody known for its rapid action in psoriasis vulgaris, that has also been reported as effective in GPP. The patient improved rapidly, with resolution of the active lesions after the first administration. The treatment has been continued for 2 years, with no adverse events and sustained disease control. Ixekizumab could be considered a safe and effective option in patients with GPP.

Die generalisierte pustuläre Psoriasis (GPP) ist eine schwere und potenziell lebensbedrohliche Art der Psoriasis. Wir stellen den Fall eines Patienten mit schwerer GPP vor, die zunächst erfolglos mit Cyclosporin behandelt wurde. Wir haben uns für die Behandlung des Patienten mit Ixekizumab entschieden, einem Anti-IL-17-Antikörper, der für seine schnelle Wirkung bei Psoriasis vulgaris bekannt ist und auch bei GPP als wirksam beschrieben wurde. Der Zustand des Patienten verbesserte sich schnell, mit Auflösung der aktiven Läsionen nach der ersten Verabreichung. Die Behandlung wird seit 2 Jahren ohne unerwünschte Ereignisse und mit anhaltender Krankheitsüberwachung fortgesetzt. Ixekizumab könnte als sichere und effektive Option bei Patienten mit GPP angesehen werden.