Pyoderma gangrenosum (PG) is a rare, noninfectious, neutrophilic dermatosis of unknown origin that is associated with systemic diseases in 50% of cases. The authors present a case of a 54-year-old man patient with refractory to conventional treatment PG associated with ulcerative colitis and psoriasis, which showed a successful response to treatment with infliximab, a chimeric monoclonal antibody that inhibits tumor necrosis factor alpha (TNF-α). This case report shows the frequent difficulty in the therapeutic approach of PG, especially if associated with underlying disease, and necessity to apply new agents, such as a novel application of the TNF-α inhibitors, in relationship to the recent pathogenic knowledge.

Background Psoriasis (Ps) is a chronic systemic autoimmune disease associated with pruritus in 64–98% of patients. However, few modestly sized studies assess factors associated with psoriatic pruritus. Objective To investigate factors associated with Ps pruritus intensity. Methods Psoriasis patients 18 years or older seen in one of 155 centres in Italy between September 2005 and 2009 were identified from the Italian PsoCare registry. Patients without cutaneous psoriasis and those with missed information on pruritus were excluded. Results We identified 10 802 patients, with a mean age 48.8 ± 14.3 years. Mild itch was present in 33.2% of patients, moderate in 34.4%, severe in 18.7% and very severe in 13.7%. Higher itch intensity was associated with female gender, lower educational attainment compared to university degree, pustular psoriasis, psoriasis on the head, face, palmoplantar areas, folds and genitalia, more severe disease, disease duration <15 years, and no or few prior systemic treatments. Limitations Effects of specific medication on itch were not assessed. Conclusions Pruritus should be evaluated during psoriasis visits, and physicians should be aware of patients at higher risk for itch. Further studies are needed to assess the effects of medications on itch, and establish therapy for psoriasis patients with persistent itch.

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Background Although long-term management of psoriasis is paramount, this approach is challenging in clinical practice. In the recent PSO-LONG trial, a fixed-dose combination of betamethasone dipropionate (BD) and calcipotriol (Cal) foam applied twice a week on nonconsecutive days for 52 weeks (proactive treatment) reduced the risk of relapse. However, the role of Cal/BD foam in the long-term management of psoriasis needs further clarifications. The ProActive Management (PAM) program, a nationwide Italian project, aims at reaching a consensus on the role of proactive management of psoriasis.Methods A steering committee generated some statements through the nominal group technique (NGT). The statements were voted by an expert panel in an adapted Delphi voting process.Results Eighteen statements were proposed, and the majority of them (14/18) reached a consensus during the Delphi voting. The need to provide long-term proactive topical treatment to reduce the risk of relapse for the treatment of challenging diseases sites or in patients where phototherapy or systemic therapies are contraindicated/ineffective was widely recognized. A consensus was reached about the possibility to associate the proactive treatment with systemic and biological therapies, without the need for dose intensification, thus favoring a prolonged remission. Moreover, the proactive treatment was recognized as more effective than weekend therapy in increasing time free from relapses.Approaches to improve adherence, on the other hand, need further investigation. ConclusionsThe inclusion in guidelines of a proactive strategy among the effective treatment options will be a fundamental step in the evolution of a mild-moderate psoriasis therapeutic approach.

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