Palmar hyperhidrosis is a potentially disabling condition for which management remains a therapeutic challenge. Given the significant impact on quality of life, various treatment options are available, ranging from topical agents and medical devices to systemic therapies and surgical interventions. Nonsurgical approaches, i.e. topical antiperspirants, botulinum toxin injections, iontophoresis, and systemic agents, are all supported by the current literature. Patients with mild-to-moderate disease can often benefit from topical therapies only. As disease severity progresses, systemic oral medication, such as anticholinergic drugs, usually becomes necessary. Last-line surgical approaches (sympathetic denervation) should be reserved for severe refractory cases. Recently, therapeutic strategies have been evolving with several new agents emerging as promising alternatives in clinical trials. In practice, however, each modality comes with its own benefits and risks. An individual therapeutic ladder is generally recommended, taking into account disease severity, benefit-to-risk profile, treatment cost, patient preference, and clinician expertise. This review will provide an update on current and emerging concepts of management for excessive hand sweating to help clinicians optimize therapeutic decision-making.

The diagnosis remains probable despite the strong temporal relationship because after literature review with the keywords 'SARS-CoV-2', 'Vaccine', 'COVID-19', 'Angiomatosis', 'Haemangiomatosis', 'Cherry' and/or 'Angiomas', no other articles describe true eruptive angiomas after any SARS-CoV-2 vaccine.The pathogenesis of this skin disorder remains unclear. Among the various possibilities, we proposed an HVV-8 reactivation elicited by the vaccination, 1,5 but a real-time PCR requested to search for herpesvirus DNA on cutaneous samples resulted negative.Cells exposing angiotensin-converting enzyme 2 (ACE2) could be altered by circulating spike proteins, probably affecting the ACE2 pathway. 6 Inflammation or increased angiotensin II levels could stimulate the proliferation of predisposed endothelial cells of the skin, causing angiomas; the latter mechanism is also proposed in infantile haemangiomas. 7 Still, experimental studies have not shown significant alterations in the angiotensin II pathway in patients with COVID-19. 8 We believe in a dysregulation of the neuropilin-1 (NRP-1) proteins cascade 9 as a plausible mechanism. Spike protein portions could bind to the NRP-1 and interfere with the VEFG-R, which has been already described to cause cherry angiomas proliferation when dysregulated. This interaction could recall the side effects produced by ramucirumab and other VEGF-R inhibitors. 10 In conclusion, in this case report, we aimed to raise awareness of the increasing variety and complexity of viral, paraviral and vaccine skin reactions induced by the immune response to the genetic material related to the SARS-CoV-2. By sharing this case, we hope that physicians can be aware of the increasing spectrum of AEDs related to these vaccines skin manifestations, however harmless and self-limiting.

Background Few studies have investigated the long-term outcomes of secukinumab in real-life psoriasis treatment where diverse patient profiles require a personalized approach. Objectives To determine long-term performance of secukinumab in moderate-to-severe plaque psoriasis, and identify potential clinical factors predictive of sustained optimal response under real-world conditions. Methods In this 78-week, single-centre, retrospective study, effectiveness, safety and drug survival of secukinumab were evaluated. Effectiveness data are reported as observed. Co-primary endpoints were absolute Psoriasis Area and Severity Index (PASI) ≤3 at week 4, 16, 52, 78, and clinical predictors of PASI ≤3 and PASI100 responses at week 52 and 78. Results A total of 85 patients (75.3% male; mean age 48.6 years) were included. Absolute PASI ≤3 was achieved in 73% and 83% of patients at week 52 and 78, respectively. PASI 75/90/100 responses at week 52 (71.6%, 50.8%, and 40.3%, respectively) were sustained at week 78 (73.6%, 64.2%, and 45.3%, respectively). Median absolute PASI remained low at week 52/78 (0.9/0.6, respectively), while mean absolute PGA also sustained low (0-1) values after 16-78 weeks. Investigator's Global Assessment 0/1 response rate was maintained by week 52/78 (72/83%, respectively). The drug survival rate of secukinumab at week 78 was 79.1%. Treatment was discontinued in 17.9% of patients after an average of 41.7 weeks, mainly due to loss of effectiveness (10.4%). A total of 27% experienced adverse events, without critical safety concerns. Based on multivariate analysis, advanced body mass index (BMI) and presence of ≥3 comorbidities decreased the chance of achieving PASI ≤3 at week 78 [OR (95% CI) 0.78 (0.64-0.97); P = 0.024, and OR (95% CI) 0.045 (0.002-0.83); P = 0.037, respectively]. Conclusions Secukinumab showed consistently high effectiveness in this real-life cohort, with an acceptable safety profile. Over time, persistence of PASI ≤3 response appears to be lower in patients with high BMI or multiple comorbidities.