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Cited by 3Psoriasis: Treatment and PathogenesisDermatology and Skin DiseasesSpondyloarthritis Studies and Treatments

Tildrakizumab in Managing Psoriasis with Involvement of Difficult-to-Treat Areas: A Multicenter Real-Life Retrospective Study

Open access
Cascio Ingurgio, Ruggero, Alfano, Angela, Matteodo, Elena, Ibba, Luciano, Gargiulo, Luigi, Paolino, Giovanni, Mercuri, Santo Raffaele, Carugno, Andrea +5 more·2026·Journal of Clinical Medicine
DOI 10.3390/jcm15020631PMC PMC12841847
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Abstract

Background: Psoriasis involving difficult-to-treat anatomical areas, such as the scalp, genitalia, fingernails, and palmoplantar regions, carries a disproportionate disease burden and often requires systemic therapy. In this context, real-life data comparing the long-term effectiveness of tildrakizumab 100 mg versus 200 mg in patients with difficult-to-treat psoriasis remain limited. Methods: This multicenter retrospective observational study included adult patients in three Italian dermatology centers. Global efficacy endpoints included PASI75, PASI90, PASI100, and absolute PASI ≤ 2 at weeks 16, 32, 52, and 104. Site-specific effectiveness was assessed as complete clearance (PGA = 0) in patients with baseline involvement (PGA ≥ 2) of difficult-to-treat areas. Outcomes were described by dose. Results: 183 patients were included (100 mg: n = 89; 200 mg: n = 94). Patients receiving 200 mg had higher baseline BMI and were more frequently biologic-experienced. At week 104, PASI75 was achieved by 94.2% of patients receiving 100 mg and 94.7% receiving 200 mg, while PASI90 and PASI100 were achieved by 82.7% vs. 57.9% and 48.1% vs. 47.4%, respectively. Clearance of difficult-to-treat areas improved progressively across all sites. Scalp and genital psoriasis showed higher and earlier clearance rates, whereas nail and palmoplantar psoriasis showed slower and more heterogeneous responses. No consistent dose-dependent advantage emerged, despite less favorable baseline characteristics in the 200 mg group. Conclusions: Over 104 weeks, tildrakizumab showed sustained long-term effectiveness in both global disease control and difficult-to-treat areas. The 200 mg dose, used in a more difficult-to-treat population, achieved comparable long-term outcomes, supporting dose optimization in clinical practice.

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  • Cytokine profiling in hidradenitis suppurativa reveals involvement of TNF-α, IL-1, and IL-17 pathways, providing a rationale for targeted therapies.

    “Cytokine profiling reveals involvement of TNF-α, IL-1, and IL-17 pathways, providing a rationale for targeted therapies.”

    From The Cutaneous Immune Microenvironment in Selected Inflammatory Skin Diseases: Linking Histopathology, Mechanisms, and Targeted Therapy (2026) · cites this paper as [37]

    The Introduction (page unavailable) discusses the IL-23/IL-17 axis and targeted biologic therapy in psoriasis, not cytokine profiling in hidradenitis suppurativa. Searches for hidradenitis suppurativa and the combined TNF-α, IL-1, and IL-17 pathways found no passage addressing the attributed claim. (LLM, conf=0.76)

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  • In hidradenitis suppurativa, the morphological spectrum is characterized by follicular occlusion, sinus tract formation, and a dense inflammatory infiltrate rich in neutrophils and macrophages.

    “In hidradenitis suppurativa, the morphological spectrum is characterized by follicular occlusion, sinus tract formation, and a dense inflammatory infiltrate, rich in neutrophils and macrophages.”

    From The Cutaneous Immune Microenvironment in Selected Inflammatory Skin Diseases: Linking Histopathology, Mechanisms, and Targeted Therapy (2026) · cites this paper as [37]

    The Introduction and Materials and Methods discuss psoriasis and its treatment, not the morphology of hidradenitis suppurativa. Searches for follicular occlusion, sinus tracts, neutrophils, and macrophages found no passage addressing the claim in our copy. (LLM, conf=0.78)

    Experimental — accuracy not yet measured

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Authors
Cascio Ingurgio, R., Alfano, A., Matteodo, E., Ibba, L., Gargiulo, L., Paolino, G., Mercuri, S. R., Carugno, A., Zerbinati, N., Bighetti, S., Costanzo, A., Narcisi, A., & Valenti, M.
Affiliations
  • Dermatology Unit, IRCCS Humanitas Research Hospital, 20089 Milan, Italy
  • Humanitas University (IT)
  • IRCCS Ospedale San Raffaele (IT)
  • Vita-Salute San Raffaele University (IT)
  • University of Insubria (IT)
  • Azienda Socio Sanitaria Territoriale degli Spedali Civili di Brescia (IT)
Corresponding author
Valenti, Mario
ORCID
Venue
Journal of Clinical Medicine
Publisher
MDPI AG
Published
2026-01-13
Volume
15
Issue
2
Pages
631
ISSN
2077-0383 (ISSN-L)
DOI
10.3390/jcm15020631
PMC
PMC12841847
OpenAlex
W7123336371
Cited by
3
References
32
Citations by year
2026: 3
FWCI
7.99
Type
journal article
Language
en
Open access
Licence
Locations
  • Journal of Clinical Medicine (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • PubMed Central (publishedVersion, cc-by)
  • IrInSubria (University of Insubria) (submittedVersion, cc-by)
Topics
  • Life Sciences › Immunology and Microbiology › Immunology › Psoriasis: Treatment and Pathogenesis
  • Health Sciences › Medicine › Dermatology › Dermatology and Skin Diseases
  • Health Sciences › Medicine › Rheumatology › Spondyloarthritis Studies and Treatments
Keywords
tildrakizumab, psoriasis, scalp psoriasis, genital psoriasis, nail psoriasis, palmoplantar psoriasis, PASI response, dose comparison, long-term effectiveness, biologic-naive patients, dose optimization

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