{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,10]],"date-time":"2026-08-10T10:30:47Z","timestamp":1786357847141,"version":"build-2736575974"},"reference-count":29,"publisher":"MDPI AG","issue":"16","license":[{"start":{"date-parts":[[2026,8,8]],"date-time":"2026-08-08T00:00:00Z","timestamp":1786147200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Almirall S.p.A."},{"name":"Content Ed Net S.r.l."}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J. Clin. Med.","JCM"],"abstract":"<jats:p>Background\/Objectives: Patients with a clinical diagnosis of severe psoriasis complicated by comorbidities such as cardiovascular disease, obesity, metabolic syndrome and\/or with the involvement of high-impact areas constitute a clinical challenge. Tildrakizumab is a monoclonal antibody targeting the IL-23\/Th17 axis with a proven record of efficacy and safety in these patients. Methods: Here we present four cases of patients with severe psoriasis and comorbidities including cardiovascular disease (Case 1), obesity (Cases 2 and 3), metabolic syndrome (Case 3), and\/or high-impact areas (Cases 2\u20134). Three patients (Cases 1\u20133) had previously received biologics but developed secondary failure or loss of efficacy; one patient was bio-na\u00efve (Case 4). Results: The treatment with tildrakizumab in all four patients led to a quick onset (by Week 4 in all cases) of complete and lasting (1 year in Case 1, 4 years in Case 2 and 2 years in Cases 3 and 4) remission with no adverse events reported. Conclusions: Tildrakizumab is a valuable therapeutic option for patients with psoriasis and complex clinical situations, and in particular, in cases with obesity and difficult-to-treat lesion locations such as hands, scalp and genitals. Therapeutic success is often linked to an improvement in patients\u2019 quality of life.<\/jats:p>","DOI":"10.3390\/jcm15166161","type":"journal-article","created":{"date-parts":[[2026,8,10]],"date-time":"2026-08-10T09:24:53Z","timestamp":1786353893000},"page":"6161","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Tildrakizumab in the Treatment of Complex and Severe Psoriasis: A Case Series"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8401-5730","authenticated-orcid":false,"given":"Claudio","family":"Marasca","sequence":"first","affiliation":[{"name":"Dermatology Unit, Medical Department, \u201cAntonio Cardarelli\u201d National Hospital, 80131 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0766-8524","authenticated-orcid":false,"given":"Domenico","family":"D\u2019Amico","sequence":"additional","affiliation":[{"name":"U.O.C. Dermatology, A.O.U. \u201cRenato Dulbecco\u201d, 88100 Catanzaro, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0905-0579","authenticated-orcid":false,"given":"Claudia","family":"Giofr\u00e8","sequence":"additional","affiliation":[{"name":"U.O.C. Dermatology, A.O. \u201cPapardo\u201d, 98158 Messina, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3119-6224","authenticated-orcid":false,"given":"Viviana","family":"Lora","sequence":"additional","affiliation":[{"name":"Department of Clinical Dermatology, San Gallicano Dermatological Institute (IRCCS), 00144 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,8,8]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"45","DOI":"10.1038\/s41572-025-00630-5","article-title":"Psoriasis","volume":"11","author":"Armstrong","year":"2025","journal-title":"Nat. Rev. Dis. Primers"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1339","DOI":"10.1038\/jid.2009.59","article-title":"The IL-23\/Th17 axis in the immunopathogenesis of psoriasis","volume":"129","author":"Nestle","year":"2009","journal-title":"J. Investig. 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