article: Hyperbaric oxygen therapy (HBOT )can improve the effectiveness of adalimumab in hidradenitis suppurativa - Giornale Italiano di Dermatologia e Venereologia 2020 April;155(2):234-5 - Minerva Medica - Journals
Schnitzler Syndrome is a rare acquired auto-inflammatory syndrome defined by an urticarial eruption and a monoclonal gammopathy, mainly of the IgM kappa isotype. It shares many clinical and biological features with other autoinflammatory disorders such as NLRP3-auto-inflammatory disorders (NLRP3-AID, formerly cryopyrin associated periodic syndromes or CAPS) or adult-onset Still disease (AOSD). Hence, recurrent fever, urticarial rash with a neutrophilic infiltrate on skin biopsy (i.e. neutrophilic urticarial dermatosis or NUD) and a significant elevation of blood inflammation markers are commonly found in Schnitzler Syndrome as well as in NLRP3-AID or AOSD. IL-1ß plays a crucial role in the pathogenesis and explains the clinical symptoms of Schnitzler Syndrome. This is emphasized by the spectacular effectiveness of IL-1 blocking therapies, especially anakinra. IL-1 blocking therapies are efficient on the inflammation-linked symptoms but not on the monoclonal component. The evolution is chronic and about 15-20% of patients may develop lymphoproliferative disease, in particular Waldenström disease, a proportion similar to patients with IgM monoclonal gammopathy of undetermined significance, and more rarely AA-amyloidosis.
article: Cutaneous relapse after allogenic hematopoietic stem cell transplantation for acute myeloid leukemia: a clinical and immunophenotype study of seven patients - Giornale Italiano di Dermatologia e Venereologia 2020 April;155(2):250-2 - Minerva Medica - Journals
article: “Paradoxical joint inflammation” possibly induced by a tumor necrosis factor antagonist in three patients with psoriasis - Giornale Italiano di Dermatologia e Venereologia 2020 June;155(3):370-1 - Minerva Medica - Journals
Psoriatic arthritis (PsA) is a seronegative inflammatory arthritis often observed in patients with skin psoriasis. Treatment of PsA, especially peripheral PsA, has typically relied on disease-modifying anti-rheumatic agents (DMARDs); however, these agents have limited efficacy and considerable associated toxicity. More recently, monoclonal antibodies (biologic agents) have revolutionized management of immune-mediated diseases; however, these therapies carry a high cost and require parenteral administration. Apremilast, a novel oral DMARD, was approved by the European Union for psoriatic arthritis in 2015. Apremilast inhibits the function of phosphodiesterase-4, a regulator of cyclic adenosine monophosphate, leading to a broad inhibition of proinflammatory mediators and subsequent reduction in tumour necrosis factor-alpha (TNF-α) response. The PALACE and ACTIVE trials, phase III randomized controlled trials for apremilast, showed that apremilast is effective at improving various clinical and patient-reported outcome measures for psoriatic arthritis in both DMARD-naïve and DMARD-experienced PsA patients. Efficacy was limited in patients with previous biologic DMARD failure and the overall efficacy of apremilast appears to be less than biologics agents, though no head-to-head trials exist comparing apremilast to biologic DMARDs. Apremilast is generally well tolerated, with short-lived gastrointestinal side effects being the most commonly reported adverse events. Guidelines suggest a trial of apremilast in patients who have failed traditional oral DMARDs and for whom, biologics are contraindicated. More studies directly comparing apremilast to conventional DMARDs and biologic DMARDs are needed and will be crucial in informing clinical and economic decisions about apremilast role in management of PsA.
Eccrine porocarcinoma is a rare skin cancer that originates from the acrosyringium of eccrine sweat glands. From the clinical point of view the differential diagnosis with other skin cancers such as basal cell carcinoma and squamous cell carcinoma it is often impossible, only the histopathologic features can lead to the definitive diagnosis. Eccrine porocarcinoma can arise from a previous poroma or de novo, it may recur after surgical excision and cause lymph node and visceral metastasis. There are no international guidelines for treatment or follow-up of patients. The aim of this work was to present a rare case of eccrine porocarcinoma of the scalp successfully treated in our clinic and to extrapolate from the international literature the main clinical and histopathological features of eccrine porocarcinoma and the various experiences regarding the types of treatment.
Apremilast is a small-molecule inhibitor of phosphodiesterase 4 with an intracellular mechanism of action that increases levels of cyclic adenosine monophosphate (cAMP) indicated for the oral treatment of moderate to severe plaque psoriasis and for the treatment of psoriatic arthritis. Efficacy of apremilast in moderate-to-severe psoriasis has been demonstrated in the pivotal trials, with a 30% PASI-75 response rate at week 16, an efficacy that was maintained through week 52. Apremilast also achieved significant responses in disease involving specific sites, such as palmoplantar, nail and scalp psoriasis, improved patient quality of life, and achieved rapid improvements in pruritus. The findings of some of the real world series indicate that the PASI-75 response may be higher in patients with a lower baseline PASI than that observed in the pivotal trials, enhancing the importance of using the absolute PASI score as a marker of therapeutic success rather than a relative PASI index in this setting. Apremilast has demonstrated good safety and tolerability in both clinical trials and clinical practice series. The most frequent adverse effects were diarrhea (17.3%), nausea (15.7%), upper respiratory tract infections (15.5%), nasopharyngitis (14.4%), tension headache (9.0%) and headache (6.3%). The rate of adverse events recorded in the clinical practice series has been lower compared to the clinical trials.
Hidradenitis Suppurativa (HS) is a severe inflammatory pathology of the skin characterized by chronic recurrent inflamed lesions, nodules, sinus tracts and abscesses usually manifests after puberty, which involves scalp, neck, axillae, perineum and infra-mammary areas.Nowadays treatment options range from short or long courses of antibiotics, anti-inflammatory and biologic drugs, to surgery.Other suggested treatments consider the employment of laser devices, mainly microsurgical lasers (such as CO2 and intense pulsed lasers) and photodynamic therapy.This review explores the potential use of photobiomodulation (PBM), already used for the treatment of other skin conditions, such as acne, hypertrophic scars, wrinkles, and burns, as potential novel therapy for HS.PBM has been reported to have beneficial effects on promoting wound healing, angiogenesis, vasodilation, and relieving from pain and inflammation, as recently demonstrated in an in vitro model mimicking HS disease.In addition, PBM, specifically set at the blue wavelength, has been recently reported as exerting an anti-bacterial activity.Therefore, considering all these PBM features especially its ability to decrease pain and inflammation and to lead to faster wound healing, thus improving patients' quality of life, we hypothesize its employment as adjuvant third line treatment for the management of HS both in young and adult patients.
BACKGROUND:The purpose of this study was to determine and evaluate sun safety knowledge, attitudes and practices (KAP) among agricultural workers (AWs) in the Autonomous Province of Trento (North-Eastern Italy).METHODS:A cross sectional study was performed among AWs who attended pesticide training courses (2016). Participants received a structured questionnaire focusing on KAP towards sun protective behaviors. Synthetic scores for knowledge (GKS), risk perception (RPS), behavioral adaptation and use of personal protective equipment (SPPS) were calculated. Regression analysis was modelled in order to assess GKS, RPS and individual factors as predictors of SPPS.RESULTS:The sample included 204 AWs (89.7% males, 10.3% females, mean age 43.9±15.9 years). Sun protective behaviors were irregularly referred by participants, in particular receiving medical skin assessment by a dermatologist (33.8%), avoiding sun radiations at noon and taking rest breaks in shady areas (30.9%), and wearing sunscreen (13.3%). GKS was correlated with RPS, and RPS was characterized as a significant predictor of SPPS (B=0.307; 95% CI 0.224-0.389, P<0.001), alongside increased seniority (B=4.957: 95% CI 3.064-6.851, P<0.001) and previous history of sunburns (B=5.829; 95% CI 1.520-10.139, P=0.008).CONCLUSIONS:Our findings indicate that AWs are not appropriately aware of the risks associated with occupational exposure to solar radiation, and eventually report inadequate skin cancer prevention practices. Since SPPS found significant predictors in individual factors, tailored interventions and training may contribute to fill knowledge gaps and raise the concerns of AWs towards occupational dermatological disorders.
article: Prolonged survival of a patient with brain melanoma metastasis treated with BRAF and MEK inhibitors combination therapy - Giornale Italiano di Dermatologia e Venereologia 2020 April;155(2):245-7 - Minerva Medica - Journals
BACKGROUND:Hidradenitis suppurativa (HS) is a chronic, disabling, inflammatory skin disorder that primarily affects the hair follicle localized at the apocrine-gland-bearing areas of the body, including axillary, inguinal, buttocks, and anogenital areas, and it may be associated with a wide array of comorbid conditions. This study aimed to described comorbid conditions affecting HS patients and to detect any correlation with disease severity.METHODS:Analyzing clinic database, we included all charts of patients visited at the HS outpatient clinic of three University Dermatologic Departments in order to describe demographic data, anthropometric measures, disease features, personal habits, clinical history, and presence of comorbidities.RESULTS:Two hundred thirty-four patients, mostly females (62%), were enrolled in this study. Based on Hurley staging classification 41% of patients were classified as Hurley Stage I, 43.0% as Hurley II, and 16% Hurley III, with a mean mSartorius Score value of 24.7 (SD: ±19.39) and a mean AISI score value of 12.5 (SD: ±11.93). The most frequently observed comorbidities were: obesity (26.1%), polycystic ovary syndrome (PCOS) (13.8% of the overall study population and 22.3% of females), hypertension (11.9%), dyslipidemia (9.9%), type II diabetes (9.5%), thyroid disorders (9.1%), nervous system disorders (7.1%), acne (6.7%), metabolic syndrome (4.4%), and Crohn's disease (3.6%). Obesity represented a key-comorbid condition increasing the likelihood of having more severe HS and PCOS (odds ratio 3.35 and 3.74, respectively).CONCLUSIONS:HS is associated with a variety of comorbid conditions that should be considered to perform targeted routine screening and to improve HS management.
BACKGROUND: Psoriatic arthritis (PsA) is an inflammatory arthritis associated with psoriasis in up to one third of psoriatic patients. Clinically it's characterized from an insidious onset. To help clinicians screen for PsA, several screening tools have been developed. The psoriatic arthritis screening and evaluation questionnaire (PASE) is one of the most used in the Psocare units. The sensibility of PASE is of 83% with a cut off of 47 or greater. The aim of our study is to create an Italian self-administered questionnaire, lighter than the PASE, able to identify patients who need a rheumatologic consultation.METHODS: Between April and June 2016 an Italian group of dermatologists and rheumatologists from north Italy developed a new questionnaire called Screening Tool for Rheumatologic Investigation in Psoriatic Patient (STRIPP). Two hundred and twelve patients with the diagnosis of psoriasis, were screened with STRIPP by dermatologists and all of them sent to the rheumatologist.RESULTS: Forty seven out of 212 patients received the diagnosis of early psoriatic arthritis. Statistical analysis (Spearman Rank correlation Test, Mann Whitney Test) showed a specificity of 93.3% and a sensibility of 91.5% taking a point of 3.5 as a cut-off.CONCLUSIONS: The STRIPP is a very easy questionnaire, quick to fill out and has a very high sensitivity and specificity, higher than the PASE. Our future goal will be to screen more patients for validating the STRIPP questionnaire.
INTRODUCTION:Treatment with antihypertensive drugs may be associated with different dermatological adverse reactions.EVIDENCE ACQUISITION:We systematically reviewed the literature available on the MEDLINE (PubMED) databases, up to July 2018. We searched for the terms "calcium-channel blockers" or "angiotensin-converting enzyme inhibitors" or "angiotensin II receptors blockers" or "diuretics" or "beta blockers" AND "dermatological effects" or "skin disease."EVIDENCE SYNTHESIS:The most important cutaneous events occurring during treatment with calcium-channel blockers are represented by pedal edema and photosensitivity with consequent increased risk of skin cancer. Moreover, other adverse reactions are eczematous and psoriasiform dermatitis, subacute cutaneous lupus erythematosus, and rarely toxic epidermal necrolysis. In patients taking angiotensin-converting enzyme inhibitors or angiotensin II receptors blockers, angioedema, psoriasis and pemphigus can be exacerbated. Furthermore, some authors associated the use of these medications with the onset of skin neoplasms. As for diuretics, the most relevant cutaneous reactions are represented by subacute cutaneous lupus erythematosus and leukocytoclastic vasculitis. Photosensitivity is another important event related to diuretics use. Eventually, itching is often related to the use of thiazides, particularly in elderly patients. With regards to beta blockers, we should remember a significant association with psoriasis, lichen planus, subacute cutaneous lupus erythematosus, and an increased risk of skin cancer.CONCLUSIONS:During antihypertensive treatment, several dermatological reactions may occur. Clinicians should inform their patients of the increased risk of cutaneous lesions associated with the use of these drugs, and perform periodic examination of the skin.
