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
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.
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.
BACKGROUND:Studies specifically conducted to assess gender differences in genital lichen sclerosus (GLS) are not available. This multicenter study aimed to identify possible gender-related differences on GLS clinical features, history and course, through collecting data from a large mixed-sex sample of patients.METHODS:This was a cross-sectional study on 729 subjects (53.8% females, 46.2% males) affected with GLS, consecutively observed within a network of 15 Italian dermatology units. The following information was specifically collected: clinical features and severity of symptoms related to GLS, extragenital involvement, previous therapies, diagnostic suspicion at referral, type of referring physicians, development of genital squamous-cell carcinoma (SCC).RESULTS:Females complained of symptoms more frequent and severe than men; pallor and scarring-sclerosis-atrophy were the most frequent features without gender differences; itching-related signs were more frequent in females than in males as well as extragenital involvement; prior to receiving a definitive diagnosis, females received treatment more frequently than males; 40% of patients were referred with a misdiagnosis; the highest rate of correct suspected diagnosis at referral came from dermatologists than from other physicians; duration of the disease was found to predispose to SCC development.CONCLUSIONS:Our findings highlighted several gender differences on clinical presentation and symptom profile of GLS. In spite of some characteristic features, misdiagnosis at referrals was frequent.
Xeroderma pigmentosum (XP) is a rare autosomal recessive disease characterized by severe cutaneous and ocular sensitivity to sunlight, leading to skin cancer. Most XP patients belong to the XP complementation groups (XP-A to XP-G), due to mutations in genes involved in nucleotide excision repair (NER). On the other hand, the XP Variant type (XP-V, OMIM#278750), which accounts for about 20% of all XP patients, is associated with normal NER function. The disease gene is POLH, which encodes polymerase η (pol η) allowing translesion synthesis in regions of DNA damage. We observed an Italian family presenting with photosensitivity, freckling since childhood and multiple skin cancers. Complete sequence analysis of XPA, XPC, XPD/ERCC2 genes and exons 1-9 and 11 of POLH gene did not reveal pathological mutations. No PCR product was observed for exon 10 in POLH gene. By RT-PCR analysis followed by POLH exon 10 sequencing, all affected members were found to harbor a homozygous 170-nucleotide deletion. The same deletion was previously described in 3 XP-V families, one of southern Italian descent and two from Algeria, suggesting a possible founder mutation. The deletion determines a severe protein truncation and defective pol η activity. Immunohistochemical study showed markedly reduced pol η expression in skin lesions of the affected siblings compared to the normal control skin.
article: Anti-TNFα-induced psoriasis under treatment of hidradenitis suppurativa: report of 2 cases - Giornale Italiano di Dermatologia e Venereologia 2020 June;155(3):377-9 - Minerva Medica - Journals
BACKGROUND: Mycosis fungoides (MF) is the most common cutaneous T-cell lymphoma, accounting for 54-72% of cases. When it presents as solitary or oligolesional picture, radiotherapy is considered potentially curative. To verify this, we have decided to evaluate the outcome in 15 patients studied in the period 1990-2007 after ten years. METHODS: The files of the patients were revised and they were recalled for a control. Two new cases were added. On the whole 17 patients were studied. All patients underwent histopathological ascertainment and staging investigations. All lesions were treated with conventional radiation therapy with a median dose of 25 Gy. RESULTS: After 1 month from the end of radiotherapy, complete remission (CR) occurred in 22 treatment fields (95.6%) and partial remission (PR) in one (4.4%). Radiotherapy was always well tolerated. At the last recorded visit (median follow up 130 months) 15 patients were alive without disease, and two had localized evidence of MF lesions, with a total 5-year cure-rate of 63.24% and of 66.71% if referred to the original updated series. None of the patients showed progression of the disease. CONCLUSIONS: Our results confirm that radiation therapy in the treatment of minimal stage MF contributes to afford good and durable results with negligible side effects and maintenance of good quality of life over the time.
article: Kaposi’s sarcoma lung metastastis in transplanted patient treatment response with paclitaxel and everolimus - Giornale Italiano di Dermatologia e Venereologia 2020 April;155(2):232-4 - Minerva Medica - Journals
BACKGROUND:The aim of this study was to retrospectively analyze all the cases of BCC histologically diagnosed in the Cutaneous Tumor Center of Dermatology of Bologna University, in a period between 1990 and 2014.METHODS:All the consecutive histopathologically diagnosed BCCs at the Dermatology of the Bologna University from 1990 to 2014 were retrospectively reviewed. We evaluated the absolute number of basal cell carcinoma (BCCs), the demographic features of patients and the characteristics of BCCs with statistically significant correlations.RESULTS:During the investigated 25 years, 8557 BCCs were collected in 7297 patients. We observed that the incidence of this cancer, after stabilizing around a plateau of 400 cases/year in 2005, progressively increased onwards reaching a maximum of cases (821) in 2014 (+105.25%), with an 8.32% mean increase per year in those last 9 years. Moreover, we found a significant correlation (P<0.01%) between gender and the onset of BCC, between the anatomic location and the occurrence of the tumor, between the onset of recurrent or new BCCs and sun exposure.CONCLUSIONS:The present study collects the largest series in the Italian literature focused on demographic features and characteristics of BCC, highlights its higher increasing incidence in Bologna and the need to improve preventive strategies to stem the epidemic diagnosis of BCC.
