Background: Hidradenitis suppurativa (HS) is a chronic, inflammatory, recurrent, debilitating skin disease of the hair follicle that usually occurs after puberty with painful, deep-seated, inflamed nodules and sinus tracts in the apocrine gland-bearing areas of the body, most commonly the axillae and inguinal and anogenital regions, with a relevant impact on patients’ quality of life (QoL). Objective: To evaluate how the burden of HS disease impacts on patient well-being and working activities in a large Italian population over a period of 9 months. Methods: A multicenter, prospective, epidemiologic cohort study was conducted in adult Italian patients with HS. HS severity was assessed through Hurley stage and HS Physician’s Global Assessment (HS-PGA), clinical improvement by HS Clinical Response (HiSCR) and partial response, and disease burden through QoL questionnaires (HIDRAdisk, Skindex-16, Dermatology Life Quality Index [DLQI]), and Work Productivity and Activity Impairment – General Health (WPAI:GH). Results: A total of 308 patients (56.2% women; mean age 35.2 ± 12.9 years) were enrolled in 27 dermatologic clinics. Men were older (37.4 years vs. 33.5), more smoking addicted (74.1% vs. 60.1%), and alcohol consumer (34.1% vs. 13.9%), while more women were obese (34.10% vs. 22.22%). At baseline, most patients had a Hurley severity stage of 2 (43.9%), a moderate HS-PGA score (57.1%), and poor QoL (HIDRAdisk: 65.7 ± 23.3, Skindex-16: 60.3 ± 26.9, and DLQI: 10.8 ± 8.1). Patients with more severe disease showed worse QoL. Mean values for the variables related to HS severity decreased during the study period. The achievement of HiSCR and partial response increased during the study. Conclusion: This study offers insight into the disease burden of HS in an Italian population. Our results underline the impact of QoL evaluation, also with the use of the HIDRAdisk, in clinical routine as a support to validated severity clinical and instrumental indexes for a “360-degree” assessment of HS patient’s burden of disease.

Brooke-Spiegler syndrome is a rare disorder, characterized by the development of skin adnexal tumors, including cylindromas, trichoepitheliomas, spiradenomas. Although these neoplasms are benign in most patients, a malignant transformation can rarely occur. Furthermore, an occasional association between cutaneous adnexal tumors and basal cell adenoma as well as adenocarcinoma of the parotid gland has been rarely described, with approximately 20 cases reported. We report a case of BSS presenting with a malignant eccrine spiradenocylindroma, in a patient with previous history of parotid basal cell tumor.

Among solid tumors, melanoma is the most aggressive form of skin cancer, with the highest risk of developing brain metastasis. The central nervous system is the most frequent initial site of treatment failure, both with chemotherapy and with biological therapies. The combination of antiCTLA4 and antiPD1 is superior to single agents alone in terms of rapidity and duration of responses, although its activity is limited in symptomatic patients. Target therapy induces rapid responses in a significant proportion of patients, but these are generally short-lasting. Currently, there is a great interest in evaluating the combination with new immunotherapy and antiangiogenic agents, with sequential or concomitant radiotherapy. Multidisciplinary management of patients with melanoma brain metastasis is crucial to provide the best treatment in the context of a patient-centered approach.

Journal of the European Academy of Dermatology and VenereologyVolume 36, Issue 10 p. e838-e841 Letter to the Editor Risankizumab shows faster response in bio naïve than in bio-experienced psoriatic patients L. Mastorino, Corresponding Author L. Mastorino [email protected] orcid.org/0000-0001-7386-3219 Department of Medical Sciences, Section of Dermatology, University of Turin, Torino, ItalyCorrespondence: L. Mastorino. E-mail: [email protected]Search for more papers by this authorF. Castelli, F. Castelli Section of Dermatology, Koelliker Hospital, Turin, ItalySearch for more papers by this authorE. Stroppiana, E. Stroppiana Department of Medical Sciences, Section of Dermatology, University of Turin, Torino, ItalySearch for more papers by this authorA. Verrone, A. Verrone Department of Medical Sciences, Section of Dermatology, University of Turin, Torino, ItalySearch for more papers by this authorM. Ortoncelli, M. Ortoncelli Department of Medical Sciences, Section of Dermatology, University of Turin, Torino, ItalySearch for more papers by this authorS. Susca, S. Susca Department of Medical Sciences, Section of Dermatology, University of Turin, Torino, ItalySearch for more papers by this authorS. Boskovic, S. Boskovic Department of Medical Sciences, Section of Dermatology, University of Turin, Torino, ItalySearch for more papers by this authorS.G. Passerini, S.G. Passerini Department of Medical Sciences, Section of Dermatology, University of Turin, Torino, ItalySearch for more papers by this authorN. Macagno, N. Macagno orcid.org/0000-0002-0097-2139 Department of Medical Sciences, Section of Dermatology, University of Turin, Torino, ItalySearch for more papers by this authorC. Cariti, C. Cariti Department of Medical Sciences, Section of Dermatology, University of Turin, Torino, ItalySearch for more papers by this authorM. Licciardello, M. Licciardello Section of Dermatology, Koelliker Hospital, Turin, ItalySearch for more papers by this authorC. Solaroli, C. Solaroli Section of Dermatology, Koelliker Hospital, Turin, ItalySearch for more papers by this authorG. Pertusi, G. Pertusi Outpatient Clinic, Section of Dermatology, ASL VC, Vercelli, ItalySearch for more papers by this authorM.G. Aragone, M.G. Aragone Outpatient Clinic, Section of Dermatology, ASL AL, Alessandria, ItalySearch for more papers by this authorG. Baggini, G. Baggini Outpatient Clinic, Section of Dermatology, ASL AL, Alessandria, ItalySearch for more papers by this authorC. Addese, C. Addese Outpatient Clinic, Section of Dermatology, ASLTO4, Ivrea, ItalySearch for more papers by this authorC. Leporati, C. Leporati Outpatient Clinic, Section of Dermatology, ASLTO4, Ivrea, ItalySearch for more papers by this authorR. Peila, R. Peila Outpatient Clinic, Section of Dermatology, ASLTO4, Ivrea, ItalySearch for more papers by this authorM.T. Giura, M.T. Giura Surgery Department, Section of Dermatology, Cardinal Massaia Hospital, ASL AT, Asti, ItalySearch for more papers by this authorG. Rossotto, G. Rossotto Surgery Department, Section of Dermatology, Cardinal Massaia Hospital, ASL AT, Asti, ItalySearch for more papers by this authorP. Pella, P. Pella Oncology Department, Section of Dermatology, Degli Infermi Hospital, ASL BI, Biella, ItalySearch for more papers by this authorL. Mocci, L. Mocci Section of Dermatology, AO AL Santi Antonio e Biagio e Cesare Arrigo, Alessandria, ItalySearch for more papers by this authorG. Merlo, G. Merlo Section of Dermatology, AO AL Santi Antonio e Biagio e Cesare Arrigo, Alessandria, ItalySearch for more papers by this authorR. Tiberio, R. Tiberio Dermatologic Clinic, AOU Maggiore della Carità Hospital, Novara, ItalySearch for more papers by this authorF. Graziola, F. Graziola Dermatologic Clinic, AOU Maggiore della Carità Hospital, Novara, ItalySearch for more papers by this authorP. Quaglino, P. Quaglino orcid.org/0000-0003-4185-9586 Department of Medical Sciences, Section of Dermatology, University of Turin, Torino, Italy Share last authorship.Search for more papers by this authorP. Dapavo, P. Dapavo Department of Medical Sciences, Section of Dermatology, University of Turin, Torino, Italy Share last authorship.Search for more papers by this authorS. Ribero, S. Ribero orcid.org/0000-0002-0098-1406 Department of Medical Sciences, Section of Dermatology, University of Turin, Torino, Italy Share last authorship.Search for more papers by this author L. Mastorino, Corresponding Author L. Mastorino [email protected] orcid.org/0000-0001-7386-3219 Department of Medical Sciences, Section of Dermatology, University of Turin, Torino, ItalyCorrespondence: L. Mastorino. E-mail: [email protected]Search for more papers by this authorF. Castelli, F. Castelli Section of Dermatology, Koelliker Hospital, Turin, ItalySearch for more papers by this authorE. Stroppiana, E. Stroppiana Department of Medical Sciences, Section of Dermatology, University of Turin, Torino, ItalySearch for more papers by this authorA. Verrone, A. Verrone Department of Medical Sciences, Section of Dermatology, University of Turin, Torino, ItalySearch for more papers by this authorM. Ortoncelli, M. Ortoncelli Department of Medical Sciences, Section of Dermatology, University of Turin, Torino, ItalySearch for more papers by this authorS. Susca, S. Susca Department of Medical Sciences, Section of Dermatology, University of Turin, Torino, ItalySearch for more papers by this authorS. Boskovic, S. Boskovic Department of Medical Sciences, Section of Dermatology, University of Turin, Torino, ItalySearch for more papers by this authorS.G. Passerini, S.G. Passerini Department of Medical Sciences, Section of Dermatology, University of Turin, Torino, ItalySearch for more papers by this authorN. Macagno, N. Macagno orcid.org/0000-0002-0097-2139 Department of Medical Sciences, Section of Dermatology, University of Turin, Torino, ItalySearch for more papers by this authorC. Cariti, C. Cariti Department of Medical Sciences, Section of Dermatology, University of Turin, Torino, ItalySearch for more papers by this authorM. Licciardello, M. Licciardello Section of Dermatology, Koelliker Hospital, Turin, ItalySearch for more papers by this authorC. Solaroli, C. Solaroli Section of Dermatology, Koelliker Hospital, Turin, ItalySearch for more papers by this authorG. Pertusi, G. Pertusi Outpatient Clinic, Section of Dermatology, ASL VC, Vercelli, ItalySearch for more papers by this authorM.G. Aragone, M.G. Aragone Outpatient Clinic, Section of Dermatology, ASL AL, Alessandria, ItalySearch for more papers by this authorG. Baggini, G. Baggini Outpatient Clinic, Section of Dermatology, ASL AL, Alessandria, ItalySearch for more papers by this authorC. Addese, C. Addese Outpatient Clinic, Section of Dermatology, ASLTO4, Ivrea, ItalySearch for more papers by this authorC. Leporati, C. Leporati Outpatient Clinic, Section of Dermatology, ASLTO4, Ivrea, ItalySearch for more papers by this authorR. Peila, R. Peila Outpatient Clinic, Section of Dermatology, ASLTO4, Ivrea, ItalySearch for more papers by this authorM.T. Giura, M.T. Giura Surgery Department, Section of Dermatology, Cardinal Massaia Hospital, ASL AT, Asti, ItalySearch for more papers by this authorG. Rossotto, G. Rossotto Surgery Department, Section of Dermatology, Cardinal Massaia Hospital, ASL AT, Asti, ItalySearch for more papers by this authorP. Pella, P. Pella Oncology Department, Section of Dermatology, Degli Infermi Hospital, ASL BI, Biella, ItalySearch for more papers by this authorL. Mocci, L. Mocci Section of Dermatology, AO AL Santi Antonio e Biagio e Cesare Arrigo, Alessandria, ItalySearch for more papers by this authorG. Merlo, G. Merlo Section of Dermatology, AO AL Santi Antonio e Biagio e Cesare Arrigo, Alessandria, ItalySearch for more papers by this authorR. Tiberio, R. Tiberio Dermatologic Clinic, AOU Maggiore della Carità Hospital, Novara, ItalySearch for more papers by this authorF. Graziola, F. Graziola Dermatologic Clinic, AOU Maggiore della Carità Hospital, Novara, ItalySearch for more papers by this authorP. Quaglino, P. Quaglino orcid.org/0000-0003-4185-9586 Department of Medical Sciences, Section of Dermatology, University of Turin, Torino, Italy Share last authorship.Search for more papers by this authorP. Dapavo, P. Dapavo Department of Medical Sciences, Section of Dermatology, University of Turin, Torino, Italy Share last authorship.Search for more papers by this authorS. Ribero, S. Ribero orcid.org/0000-0002-0098-1406 Department of Medical Sciences, Section of Dermatology, University of Turin, Torino, Italy Share last authorship.Search for more papers by this author First published: 10 June 2022 https://doi.org/10.1111/jdv.18314Citations: 5 Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onEmailFacebookTwitterLinkedInRedditWechat References 1Mastorino L, Sara S, Megna M et al. Risankizumab shows high efficacy and Maintenance in improvement of response until week 52. Dermatol Ther 2022; 14: e15378. Google Scholar 2Gordon KB, Strober B, Lebwohl M et al. Efficacy and safety of risankizumab in moderate-to-severe plaque psoriasis (UltIMMa-1 and UltIMMa-2): results from two double-blind, randomised, placebo-controlled and ustekinumab-controlled phase 3 trials. Lancet 2018; 392: 650–661. 10.1016/S0140-6736(18)31713-6 CASPubMedWeb of Science®Google Scholar 3Warren RB, Blauvelt A, Poulin Y et al. Efficacy and safety of risankizumab vs. secukinumab in patients with moderate-to-severe plaque psoriasis (IMMerge): results from a phase III, randomized, open-label, efficacy-assessor-blinded clinical trial. Br J Dermatol 2021; 184: 50–59. 10.1111/bjd.19341 CASPubMedWeb of Science®Google Scholar 4Gkalpakiotis S, Cetkovska P, Arenberger P et al. Risankizumab for the treatment of moderate-to-severe psoriasis: real-life multicenter experience from The Czech Republic. Dermatol Ther (Heidelb) 2021; 11: 1345–1355. 10.1007/s13555-021-00556-2 PubMedWeb of Science®Google Scholar 5Megna M, Cinelli E, Gallo L, Camela E, Ruggiero A, Fabbrocini G. Risankizumab in real life: preliminary results of efficacy and safety in psoriasis during a 16-week period. Arch Dermatol Res 2022; 314: 619–623. 10.1007/s00403-021-02200-7 CASPubMedWeb of Science®Google Scholar 6Hansel K, Zangrilli A, Bianchi L et al. A 52-week update of a multicentre real-life experience on effectiveness and safety of Risankizumab in psoriasis. J Eur Acad Dermatol Venereol 2021; 35: e169–e170. 10.1111/jdv.17003 CASPubMedWeb of Science®Google Scholar 7Borroni RG, Malagoli P, Gargiulo L et al. Real-life effectiveness and safety of Risankizumab in moderate-to-severe plaque psoriasis: a 40-week multicentric retrospective study. Acta Derm Venereol 2021; 101: adv00605. 10.2340/actadv.v101.283 CASPubMedWeb of Science®Google Scholar 8Augustin M, Lambert J, Zema C et al. Effect of Risankizumab on patient-reported outcomes in moderate to severe psoriasis: the UltIMMa-1 and UltIMMa-2 randomized clinical trials. JAMA Dermatol 2020; 156: 1344–1353. 10.1001/jamadermatol.2020.3617 PubMedWeb of Science®Google Scholar 9Dawoud NM, El Badawy MB, Al Eid HS, Abdel Fattah MM. Risankizumab effectiveness and safety in psoriasis patients who failed other biologics: real-life case series. Indian J Dermatol Venereol Leprol 2021; 88: 1–6. https://doi.org/10.25259/IJDVL_510_2021 10.25259/IJDVL_510_2021 PubMedWeb of Science®Google Scholar 10Mastorino L, Roccuzzo G, Dapavo P et al. Patients with psoriasis resistant to multiple biologic therapies: characteristics and definition of a difficult-to-treat population. Br J Dermatol 2022; 187: 263–265. 10.1111/bjd.21048 PubMedWeb of Science®Google Scholar Citing Literature Volume36, Issue10October 2022Pages e838-e841 ReferencesRelatedInformation

The data that support the findings of this study are available from the corresponding author upon reasonable request.

Globalization entails several medical problems along with economic and social complications. Migrations from other continents, increasing numbers of tourists worldwide, and importation of foreign parasites (eg, Aedes albopictus) have made diseases previously unknown in Europe a reality. The rapid spread of the coronavirus disease 2019 pandemic throughout the world is a warning that other epidemics are still possible. Most, if not all of these diseases, transmitted by viruses or bacteria, present with cutaneous symptoms and signs that are highly important for a speedy diagnosis, a fundamental concept for arresting the diseases and saving lives. Dermatologists play a significant role in delineating cutaneous and mucosal lesions that are often lumped together as dermatitis. We provide a review of many of these cutaneous and mucosal lesions that sometimes are forgotten or even ignored.

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: Psoriasis is an inflammatory disease, that is increasingly being considered as a systemic disorder. Among associated comorbidities, metabolic syndrome plays an important role. The effects of biological therapies on metabolic syndrome is controversial. METHODS: Thirty-one psoriatic patients with metabolic syndrome, eligible to treatment with anti-TNF alpha agents, were enrolled. Metabolic parameters were measured during 4 subsequent visits, one every 40 to 60 days. PASI, BSA and DLQI assessed the severity of psoriasis and the impact on quality of life. RESULTS: We include 31 patients, 18 treated with etanercept and 13 with adalimumab. Metabolic parameters evaluated at V4 in both groups showed different trends in the blood glucose values: a slight decrease in adalimumab group, an increase in etanercept group, with an almost significant comparison test (P=0.073). Similarly, the lipid profile revealed an opposing trend, with an increase in triglycerides in adalimumab patients, and a decrease in the other group, without statistically significant differences. No statistically significant difference was recorded in HDL cholesterol. An improvement in systolic and diastolic pressure was appreciated in both groups, although not significantly. The waist circumference slightly decreased in both groups. PASI 75 score was reached in 60% of the patients. In addition, BSA and DLQI improved. CONCLUSIONS: Our study showed a slight improvement of metabolic parameters. at times with a trend toward significance. Additional long-term studies and a larger number of patients are needed to more clearly define the association between psoriasis and cardiovascular disease and understand the effect of biological therapies on metabolic parameters.

Le dermatofibrosarcome protuberans est une rare tumeur fibreuse de bas grade de la peau et des tissus sous-cutanés, associée à une translocation chromosomique spécifique t(17 ;22). Bien que cette néoplasie métastase rarement à distance, elle est cependant caractérisée par un très haut risque d’infiltration et de récidive locale. Cette tumeur touche surtout les adultes entre 20 et 50 ans, et se localise le plus fréquemment au niveau du tronc (42 % des cas), des extrémités (41 % des cas), de la tête et du cou (16 % des cas). La région génitale est une localisation très rare, décrite par la littérature dans environ 60 cas. Pour ce qui concerne le traitement, la chirurgie tient un rôle majeur ; pour les tumeurs non résécables, en rechute ou métastatique, l’imatinib mésylate est recommandé. Nous présentons ici le cas d’une patiente de 42 ans, atteinte d’un volumineux dermatofibrosarcome à localisation vulvaire, traitée avec bénéfice avec imatinib mésylate pour la réduction tumorale en prévision de la chirurgie. Notre patiente représente le premier cas de dermatofibrosarcome protuberans génitale dans lequel l’imatinib a été utilisé à des fins néo-adjuvants.

Ivermectin is a drug approved for the treatment of papulopustular rosacea (PPR). Although clinical guidelines recommend the use of ivermectin as the first-line treatment in patients with almost clear and mild rosacea, studies concerning its use on them are lacking. This study investigated the effectiveness and the tolerability of ivermectin in almost clear to severe rosacea and assessed the antiparasitic effect on Demodex mites. This is a retrospective study based on 50 patients affected by PPR and treated with topical ivermectin 1% once daily over 16 weeks. The disease severity, the patient-examined improvement, and the safety assessment of patients were evaluated. Demodex mites were studied with the standardized skin surface biopsy. PPR to all severity achieved a therapeutic success. The number of inflammatory lesions was significantly decreased in almost clear (p < .0001), mild, moderate, and severe (p < .001) forms. A complete remission of inflammatory lesions was achieved by almost clear (p < .001) and mild (p = .005) with 82% with none-to-mild cutaneous adverse events. Thirty-two percent were positive for Demodex mites, and all of them turned negative after 16 weeks. Ivermectin is an effective treatment not only in moderate to severe PPR but also in almost clear/mild rosacea.

Merlo, Giulia MD; Cozzani, Emanuele MD, PhD; Russo, Roberto MD; Parodi, Aurora MD, PhD Author Information

In recent years, dermatologic manifestations in oncohematologic patients have become more common. The aim of our study was to determine the incidence and heterogeneity of skin manifestations in patients followed at our Hematology Department. This observational monocentrical study was conducted on 60 patients. We divided the observed conditions in exanthematous, purpuric, vesicular-bullous, papulonodular, urticarial, and eczematous manifestations. Moreover, all lesions were classified according to pathogenesis, in (a) specific skin manifestations, caused by neoplastic skin infiltration; (b) immune-mediated manifestations, based on immunological mechanisms; and (c) skin lesions due to immunodeficiency. Altogether, 73 clinical manifestations were reported. Specific manifestations (a) were detected in 15.1% of the cases, mainly with papulonodular appearance. Immune-mediated manifestations (b) were found in 37 cases (50.7%), particularly with eczematous or exanthematous appearance, and leukemia was the malignancy most frequently reported in these patients. Eventually, lesions due to immunosuppression (c) were reported in 34.2% of the cases. They were represented by infections and cutaneous malignancies, and usually manifested with papulonodular lesions. Skin lesions in oncohematologic patients are a common event. A multidisciplinary approach based on the collaboration between the hematologist and the dermatologist is crucial to achieve a proper diagnosis, and correctly manage these manifestations.

Pemphigus is a life threatening autoimmune epidermal blistering disease involving skin and mucous membranes. Pemphigus usually affects middle age men and women involving oral mucosa first and then spreading on the skin. It is caused by the presence of autoantibodies (IgG and less frequently by IgA) directed against desmogleins, and/or other glycoproteins that plays a critical role in cell-cell attachment. Upon a predisposing genetic background, different agents have been shown to act as triggers for the pathogenesis of pemphigus. This guideline for the diagnosis and treatment of pemphigus has been developed by an Italian group of experts taking in account the Italian legislation and local pharmacological governance. Guidelines are adapted from the original article under the guidance of the European Dermatology Forum in collaboration with the European Academy of Dermatology and Venereology. It summarizes evidence-based and expert-based recommendations (S2 level).

INTRODUCTION Aortitis is a well-recognized manifestation of the tertiary stage of syphilis. EVIDENCE ACQUISITION Although often regarded as an unexpected diagnosis, actually new cases of cardiovascular syphilis continue to be reported. Presumably, Treponema pallidum invades the aortic wall and the inflammatory response progresses towards obliterative endarteritis and necrosis of the muscular and elastic fibers in the aortic media. The consequent weakening of the aortic wall can lead to severe complications, represented by aortic aneurysm, aortic valvular insufficiency, aortic root dilation and coronary ostial stenosis. We perused the literature of the last 6 years to assess the prevalence and possible changes over time of syphilis cardiovascular manifestations. EVIDENCE SYNTHESIS Forty four articles were collected, reporting on 66 patients. Many patients presented more than one complication. Aortic aneurysm was the most frequent involvement, detected in 71% of patients. Fusiform or saccular aneurysms often interested the thoracic aorta, primarily located on the ascending segment. The second most common complication was the aortic valvular insufficiency, found in 47% of patients. Coronary ostial stenosis and dilation of the aortic root were less frequent. CONCLUSIONS Comparing our study with the previous ones, the cardiovascular involvement appeared roughly constant over time. Although many articles fail to provide useful information, such as a detailed history and the presence of risk factors, we must note that most patients had no predisposing factors and denied a primary infection. Cardiovascular syphilis is still present nowadays and it is important not to forget the "great imitator" in the event of its characteristic symptoms.

Autoantibodies are important in the diagnosis of dermatomyositis. They can be divided in two different groups: myositis-associated autoantibodies (MAA) prevailing in overlap syndromes, and myositis-specific autoantibodies (MSA), with diagnostic specificity exceeding 90%. Our purpose was to detect retrospectively the prevalence of the most common MSAs in a group of 19 adult DM patients (13 women, 6 men). A severe DM (SDM), with extensive cutaneous and muscular manifestations, dysphagia, and sometimes pneumopathy, was detected in ten cases. Three patients had a mild DM (MDM), with little muscle and skin impairment, and a short course. Four patients suffered from amyopathic DM (ADM), two from paraneoplastic DM (PDM). Each serum was tested for ANA, ENA, MAAs, MSAs. Myositis-specific autoantibodies were detected in 15 cases. The most frequent was anti-TIF1γ, associated with SDM or PDM in four out of seven cases. Anti-MDA5 antibodies were recorded in a SDM and in a ADM with lung fibrosis. Anti-Mi2 and anti-SRP antibodies were both detected in a MDM and in a SDM, whereas anti-SAE1 in a amyopathic form. Other antibodies (anti-NXP2, -Jo1, -PL7, -PL12, -OJ) were found in single patients with SDM. Our series confirmed that specific autoantibodies could be helpful to classify different clinical subsets, particularly in the case of paraneoplastic forms or association with pneumopathy. Moreover, they can help in predicting the disease evolution and influence therapeutic strategies. A greater number of cases should be useful to highlight the clinical and pathogenic role of these antibodies, and develop a homogeneous protocol for diagnosis and treatment.

We read the study from Roberts et al 1 Roberts W.C. Barbin C.M. Weissenborn M.R. Ko J.M. Henry A.C. Syphilis as a cause of thoracic aortic aneurysm. Am J Cardiol. 2015; 116: 1298-1303 Abstract Full Text Full Text PDF PubMed Scopus (37) Google Scholar about syphilis as a cause of thoracic aortic aneurysm that prompted us to make some considerations. We agree that syphilitic aortitis, far from disappeared, remains a major cause of thoracic aortic aneurism. Besides, coronary artery ostial stenosis, a less common manifestation of syphilitic aortitis, is still described in the study. 2 Tewari S. Moorthy N. Cardiovascular syphilis with coronary stenosis and aneurysm. Indian Heart J. 2014; 66: 735-736 Abstract Full Text Full Text PDF PubMed Scopus (12) Google Scholar Recently, we conducted a survey of the report of the last 5 years on the clinical presentation of neurosyphilis founding 286 affected patients (unpublished data). Regrettably, however, such cases are incompletely reported. In particular, most studies do not inform how early the patients did show cutaneous or mucosal symptoms of early infection, whether they had undergone a standard therapy nor the time elapsed before developing late complications. However, according to the study by Zhou et al and Drago et al 3 Zhou P. Gu X. Lu H. Guan Z. Qian Y. Re-evaluation of serological criteria for early syphilis treatment efficacy: progression to neurosyphilis despite therapy. Sex Transm Infect. 2012; 88: 342-345 Crossref PubMed Scopus (39) Google Scholar , 4 Drago F. Parodi A. Rebora A.E. Re-evaluation of serological criteria for early syphilis treatment efficacy: progression to neurosyphilis despite therapy: a reply. Sex Transm Infect. 2012; 88: 509 Crossref PubMed Scopus (7) Google Scholar and evidence that up to 5% of immunocompetent patients treated with benzathine penicillin G (BPG) experience treatment failure 5 Ghanem K.G. Erbelding E.J. Cheng W.W. Rompalo A.M. Doxycycline compared with benzathine penicillin for the treatment of early syphilis. Clin Infect Dis. 2006; 42: e45-49 Crossref PubMed Scopus (96) Google Scholar has wavered our confidence in BPG as the gold standard therapy for early and late latent syphilis. Trying to prevent long-term complications, we adopted in the last 5 years an enhanced therapy for early syphilis that uses doxycycline and ceftriaxone in addition to BPG. In fact, these treponemicidal antibiotics can penetrate all tissues more effectively than BPG 6 Nau R. Sörgel F. Eiffert H. Penetration of drugs through the blood-cerebrospinal fluid/blood-brain barrier for treatment of central nervous system infections. Clin Microbiol Rev. 2010; 23: 858-883 Crossref PubMed Scopus (671) Google Scholar and might be considered as a completion of the standard BPG therapy. Syphilis as a Cause of Thoracic Aortic AneurysmAmerican Journal of CardiologyVol. 116Issue 8PreviewIn 2009, we described morphologic findings in 22 patients having resection of an ascending aortic aneurysm in the previous 11 years at the Baylor University Medical Center, and histologic examination of the aneurysmal wall disclosed classic findings of syphilitic aortitis. The major purpose of that extensively illustrated report was to describe the characteristic gross features of the aneurysm such that syphilitic aortitis might be better recognized at operation and appropriate antibiotics administered postoperatively. Full-Text PDF