Auteur(s) : Linda TOGNETTI linda.tognetti@alice.it, Simonetta GIORGINI, Torello LOTTI Dermatologic Clinic II Division of Clinical, Preventive and Oncologic Dermatology, Department of Critical Care Medicine and Surgery, University of Florence, Villa S.Chiara; Piazza indipendenza 11, 50129 Firenze, Italy The wide spectrum of clinical presentations of textile dermatitis includes unusual patterns and atypical localization [1]. These cases may be difficult to diagnose, especially when clinical features [...]

We report a case of a 34-year-old woman presenting with an erythema multiforme (EM)-like eruption. Lesions developed after a 12-day treatment with a slimming drug preparation (food integrator with thermogenic activity) and a herbal remedy (pilosella tincture). Serological investigations excluded viral or bacterial infections. Patch testing with galenic preparations of both drugs demonstrated sensitization to the slimming drug preparation. According to literature reports and immune-chemical properties, those components that are likely to have triggered the skin eruption are clorazepate dipotassium and theobromine. Their interaction with other two constituents such as pseudoephedrine hydrochloride and dehydrocholic acid may have caused the adverse reaction by means of a summation effect. There are no reports specifically about EM caused by a slimming drug preparation and no studies have identified thermogenic pills as cause of EM/EM-like eruption. Weight-loss compounds in slimming preparations should be kept in mind as a possible cause of drug-induced EM-like eruption.

BACKGROUND:The use of antiretroviral drug abacavir (ABC) has been often associated with cutaneous hypersensitivity reactions, the majority being severe.OBJECTIVE:The present study discusses the issues of patch testing associated with pharmacogenetic screening in light of the development of abacavir hypersensitivity reactions (HSRs).METHODS:The present authors classified 100 patients into three groups: 20 patients (group A) had experienced a hypersensitivity reaction when treated with highly active antiretroviral therapy (HAART) including ABC; 60 HIV-positive patients (group B) were receiving HAART scheme including ABC; 20 HIV-negative patients acted as control group (group C). Patients of group A and B were patch tested with ABC as such, then with an ABC extract diluted to 1 and 10% in petrolatum. Group C patients underwent patches with petrolatum only. A biopsy of the lesion was performed in those patients who showed a positive skin reaction. All patients had been tested for HLA-B5701.RESULTS:A correlation between positive ABC-patch testing and HLA-B5701 was found in 50% of patients enrolled in group A, while in group B and C, all patients tested negative for both genetic marker and ABC-patch testing. Histopathology findings confirmed a vigorous CD4+ and CD8+ cellular response that is compatible with HSR.CONCLUSIONS:Patch testing is a safe and sensitive method that can be used for to confirm or exclude any correlation between abacavir and hypersensitivity skin reactions in patients who have been previously treated with abacavir during HAART. Correlation between patch test, immunohistochimical, and genetic tests results shows that genetic testing increases the possibility to identify patients with a true reaction.

Psoriatic arthritis (PsA) is a psoriasis-associated inflammatory disease of the joints and enthuses. The occurrence of PsA is linked to the complex interplay of gene environment, and immune system. Genetic factors have long been recognized to play an important role in PsA. Genes within the major histocompatibility complex (MHC) region have been shown to be associated with PsA. These include genes coded in the HLA region, (especially Class I antigens) and non-HLA genes (i.e., MHC class I chain-related antigen A, MICA, and TNF-α genes). Association studies in PsA have also identified a number of genes outside MHC region, including interleukin-1 (IL-1) gene cluster, killer-cell immunoglobulin-like receptors (KIRs), and IL-23R genes. Established systemic treatments for moderate-severe psoriasis and PsA may be potentially dangerous and usually time consuming for the patient and often expensive for the National Health Systems. Tests which could predict which subset of psoriatic patients could develop the most severe forms of the disease (i.e., PsA) or will respond to well-established (UVB irradiation) or other systemic treatments are now required. The goal of genetic test screening is to rapidly and safely identify subjects for preventive or early treatment or extended surveillance prior to the onset of signs and symptoms. Genetic tests today represent a reliable investigation procedure which could rapidly and consistently improve the diagnostic ability of the dermatologist and contribute to the early and correct treatment of the different subsets of PsA.

The authors report a case of acute eyelid dermatitis, arised during the wintertime, and showing symmetric purpuric erythema of both eyelids along with a moderate infiltration and minimal fine scaling. Clinical history and data highlighted that this dermatitis could be related to the contact with the rubber additives contained in a hot-water bottle. In fact, patch test revealed a sensitization to mercaptobenzothiazole (MBT) and MBT mix.For this reason, the use of hot water bottle was forbidden to the patient and the dermatitis rapidly ended up. The aim was our study is to investigate carefully the cause of dermatitis that is often hidden.

This open-label study takes aim at the valutation of the efficacy and safety of facial injections of an Polyacrilamide Hydrogel (PAIG), in HIV-positive people that showed different level (severe, moderate and mild) of facial lipoatrophy. This is a typical AIDS-related pathology that involve a loss of subcutaneous fat in the face, especially in cheeks, temples and nasolabial folds, and other parts of the body, and often it consequently cause some mental rebound (lack of self-interest or loose of self-esteem). 36 HIV-positive subjects with facial lipoatrophy were enrolled. Every treatment consisted of the injection of 1 to 2 vials of PAIG on the first day, and every 4 weeks for some months, according to the level of facial lipoatrophy. We previously advised each one of the subjects to avoid sunburn in the injection's area. Patient's valuation has been done by facial ecosonography, along with clinical examination. Withal we took standard photographs before and after the treatment, scheduled for successive 12 th , 24 th and 48 th week. 100 percent of our patients have been pleased with the aesthetic result, and they all judged excellent elasticity and consistency in the treated area after twelve months. Pain (scale 0-10) related at moment of the injection was reported in all patients. Excellent results has been obtained in the parietal area and lower third of the face, and also in the upper and lower jaw. The advantage of this hydrogel relates to its non-biodegradability and its important tolerability. Our product does not generally cause allergic reaction or other immunological effect either in animals or in humans; above all it does not migrate.

Airborne allergic contact dermatitis caused by gold is rare, often not even suspected and hence not investigated. Our purpose was to elucidate the clinical relevance of gold-induced airborne contact dermatitis. We analyzed and discussed the occupational dermatitis of two women working as restorers. Both patients' test results showed positive reactions to gold sodium thiosulfate only. The stop-and-relapse test confirmed the diagnostic hypothesis of airborne contact allergy. Our patients turned out to be gold sensitized because of occupational exposure to gold dust and gold leaf.

We report a case of Pyoderma gangrenosum of difficult diagnosis due to its gradual and slow evolution. We believe that cyclosporine A is a valid drug in the management of this strange disease.

Contact DermatitisVolume 58, Issue 3 p. 170-171 Allergic contact dermatitis from 2-ethylhexyl acrylate contained in a wig-fixing adhesive tape and its 'incidental' therapeutic effect on alopecia areata Daniele Torchia, Corresponding Author Daniele Torchia Department of Dermatological Sciences Department of Experimental Pathology and Oncology, University of Florence, 50121 Florence, ItalyDaniele TorchiaDepartment of Dermatological SciencesVia della Pergola, 58/6050121 FlorenceItalyTel: 0039-0552758821Fax: 0039-0552758757e-mail: [email protected]Search for more papers by this authorSimonetta Giorgini, Simonetta Giorgini Department of Dermatological SciencesSearch for more papers by this authorMassimo Gola, Massimo Gola Department of Dermatological SciencesSearch for more papers by this authorStefano Francalanci, Stefano Francalanci Department of Dermatological SciencesSearch for more papers by this author Daniele Torchia, Corresponding Author Daniele Torchia Department of Dermatological Sciences Department of Experimental Pathology and Oncology, University of Florence, 50121 Florence, ItalyDaniele TorchiaDepartment of Dermatological SciencesVia della Pergola, 58/6050121 FlorenceItalyTel: 0039-0552758821Fax: 0039-0552758757e-mail: [email protected]Search for more papers by this authorSimonetta Giorgini, Simonetta Giorgini Department of Dermatological SciencesSearch for more papers by this authorMassimo Gola, Massimo Gola Department of Dermatological SciencesSearch for more papers by this authorStefano Francalanci, Stefano Francalanci Department of Dermatological SciencesSearch for more papers by this author First published: 12 February 2008 https://doi.org/10.1111/j.1600-0536.2007.01212.xCitations: 15Read 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 No abstract is available for this article. References 1 Kanerva L, Jolanki R, Estlander T. 10 years of patch testing with the (meth)acrylate series. Contact Dermatitis 1997: 37: 255– 258. 2 Geukens S, Goossens A. Occupational contact allergy to (meth)acrylates. Contact Dermatitis 2001: 44: 153– 159. 3 Sood A, Taylor J S. Acrylic reactions: a review of 56 cases. Contact Dermatitis 2003: 48: 346– 347. 4 Francalanci S, Giorgini S, Gola M, Sestini S, Moretti S. Occupational allergic contact dermatitis from UV-cured adhesive. Contact Dermatitis 2004: 50: 163– 164. 5 Bjorkner B. The sensitizing capacity of multifunctional acrylates in the guinea pig. Contact Dermatitis 1984: 11: 236– 246. 6 Waegemaekers T H, Van Der Walle H B. The sensitizing potential of 2-ethylhexyl acrylate in the guinea pig. Contact Dermatitis 1983: 9: 372– 376. 7 Mastrolonardo M, Lopalco P L, Diaferio A. Topical immunotherapy with contact sensitizers: a model to study the natural history of delayed hypersensitivity. Contact Dermatitis 2002: 47: 210– 214. Citing Literature Volume58, Issue3March 2008Pages 170-171 ReferencesRelatedInformation

Journal of the European Academy of Dermatology and VenereologyVolume 20, Issue 4 p. 484-486 Allergic contact dermatitis from henna temporary tattoo M Stante, Corresponding Author M Stante * Corresponding author, tel./fax +39-055-2758757; E-mail: [email protected]Search for more papers by this authorS Giorgini, S Giorgini University of Florence, Department of Dermatology, Florence, Italy.Search for more papers by this authorT Lotti, T Lotti University of Florence, Department of Dermatology, Florence, Italy.Search for more papers by this author M Stante, Corresponding Author M Stante * Corresponding author, tel./fax +39-055-2758757; E-mail: [email protected]Search for more papers by this authorS Giorgini, S Giorgini University of Florence, Department of Dermatology, Florence, Italy.Search for more papers by this authorT Lotti, T Lotti University of Florence, Department of Dermatology, Florence, Italy.Search for more papers by this author First published: 02 March 2006 https://doi.org/10.1111/j.1468-3083.2006.01483.xCitations: 8Read 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 References 1 Önder M, Atahan ÇA, Öztaş P, Öztaş MO. Temporary henna tattoo reactions in children. Int J Dermatol 2001; 40: 577– 579. 2 Tosti A, Pazzaglia M, Corazza M, Virgili A. Allergic contact dermatitis caused by mehindi. Contact Derm 2000; 42: 356. 3 Gupta BN, Mathur AK, Agarwall C, Singh A. Contact sensitivity to henna. Contact Derm 1986; 15: 303– 304. 4 Öztaş MO, Önder M, Öztaş P, Atahan ÇA. Contact allergy to henna. J Eur Acad Dermatol Venereol 2001; 15: 91– 92. 5 Lyon MJ, Shaw JC, Linder JL. Allergic contact dermatitis reaction to henna. Arch Dermatol 2000; 136: 124– 125. 6 Le Coz CJ, Lefebvre C, Keller F, Grosshans E. Allergic contact dermatitis caused by skin painting (pseudo tattooing) with black henna, a mixture of henna and p-phenylenediamine and its derivates. Arch Dermatol 2000; 136: 1515– 1517. 7 Goon ATJ, Gilmour NJ, Basketter DA, White IR, Rycroft RJG, Mcfadden JP. High frequency of simultaneous sensitivity to Disperse Orange 3 in patients with positive patch tests to para-phenylenediamine. Contact Derm 2003; 48: 248– 250. Citing Literature Volume20, Issue4April 2006Pages 484-486 ReferencesRelatedInformation

Accumulation of calcium in the skin is usually classified as a group of disorders referred to as calcinosis cutis. We report the case of a patient who developed iatrogenic calcinosis at the site of subcutaneous administration of low‐molecular‐weight heparins (LMWH) as nadroparin. This is usually used for the prevention of deep venous thrombosis, especially following renal transplantation. The role of calcium content in nadroparin is discussed.

In November 2000, about 2 months after returning from a trip to southern Italy (Calabria), our 66-year-old patient noticed the onset of a red nodule on the upper side of his right helix. Over the ensuing months the lesion enlarged to cover the entire right auricle. Treatment with topical and systemic steroids and antibiotics failed, so in May 2001 the patient was admitted to Clinical Department of Otorhinolaryngology (ORL) (University of Florence, Florence, Italy). A computed tomography (CT) scan of the skull and neck showed swelling of the soft tissue of the right auricle without bony or vascular lesions. A skin biopsy demonstrated a marked tuberculoid granulomatous cutaneous reaction. Antitubercular treatment (rifampicin and isoniazide) was started without clinical improvement. In December 2001, the patient was admitted to our ward with a progressive, painful, abnormal enlargement of the right auricle (macrotia) with regional lymphadenopathy of 1 year's duration (1, 2). Routine laboratory tests were normal. An HIV test and a Mantoux test were negative. Chest X-rays and abdominal echography were within the normal range. A punch biopsy (performed with a touch preparation from the outer edge of the lesion) was used to make impression smears and to produce cultures on Evans modified Tobie medium (EMTM), and a histological examination was performed. A direct examination of tissue impression smears stained with Giemsa showed numerous amastigotes of Leishmania in the cytoplasma of macrophages and in groups outside the cells (Fig. 3). Histologic examination showed marked granulomatous lymphocytic infiltration and parasite-shaped elements within macrophages. An indirect immunofluorescence test for antibodies IgG anti-Leishmania was positive 1:160. It was not possible to identify species because repeated cultures were contamined by Proteus spp. and Staphylococcus spp. The search for visceral localization of Leishmania and bone marrow biopsy also yielded negative results. A treatment cycle was based on the administration of intramuscolar meglumine antimoniate (Glucantime®, Adventis Pharma S.P.A., Milano, Italy) at a dose of 0.06 g/kg/day.1 For our patient, who weighed 52 kg, we therefore prescribed 3 g/day/15 days/month for 2 months. At the end of the treatment cycle, clinical recovery was almost complete. After 3, 6, 9, 12 and 15 months the search for parasites was negative and the disease did not recur. Extensive cutaneous leishmaniasis of the right auricle (side view) Extensive cutaneous leishmaniasis of the right auricle (rear view) Microscopic examination of tissue impression smears (Giemsa, ×100) Leishmaniasis is the result of infection with intracellular protozoa of the genus Leishmania transmitted to humans by Phlebotomus sandflies. This infection is characterized by a wide spectrum of clinical diseases that include visceral leishmaniasis (VL), mucocutaneous leishmaniasis (MCL) and cutaneous leishmaniasis (CL). The less common forms of CL include recidivans forms, diffuse cutaneous forms and postkala azar dermal leishmaniasis.2 Old World leishmaniasis is caused by Leishmania infantum, Leishmania tropica, Leishmania major and Leishmania aethiopica. In the Mediterranean area, L. infantum causes visceral leishmaniasis, but dermotropic strains may be responsible for cutaneous lesions. In this region, CL has an incidence of approximately 0.16/1000 inhabitants. The vectors are Phlebotomus perniciosus in 80% of cases and Phlebotomus perfiliewi in 20% of cases, and the main reservoir is in dogs, but rodents have also been implicated.3 Transmission occurs when an exposed area of the skin (the face or arms) is bitten by an infected sandfly. The incubation period is usually from 2 to 4 weeks, but is sometimes more than 3 years. In the classic course of the disease, the lesion first appears as a small red papule, progresses to an ulcer, and then spontaneously heals with scarring over months to years; nevertheless, atypical manifestations of CL, protean, and, sometimes, unusual, expecially in AIDS patients, have been reported and can lead to misdiagnosis.4, 5 The auricle is an extremely rare site for CL in Old World leishmaniasis, which tends to be a benign disease with self-healing lesions, with small nodules such as the “oriental sore” generally observed. However, in the New World there is a type of CL of the ear, caused by Leishmania mexicana, that is most prevalent in Mexico and Central America, and is transmitted by the vector Lutzomya olmeca. The pinna of the ear of forest workers who harvest chicle gum from plants is the most common site of infection, which is termed “chicleros’ ulcer”.6 The atypical clinical pattern in our case may have been due to the anatomical site of the lesions (in a region particularly prone to infiltration reactions), the prolonged duration of the lesions or the inappropiate treatments previously applied. Corticosteroids are immunosuppressor drugs which, when given for a prolonged period, can promote the proliferation of Leishmania organisms. In our case the initial diagnosis was tuberculosis. We stress the importance of microscopic examination of tissue impression smears stained with Giemsa, which led us to make a correct diagnosis and treat the cutaneous disease.7

Xerosis is a common skin condition characterized by roughness, scaling, loss of elasticity and often discomforting sensations of itching and burning. Xerosis is a specific component of various dermatological diseases (atopic dermatitis, allergic and irritative contact dermatitis, asteatotic eczema) and/or a consequence of systemic or topical treatments. Xerosis is also a common manifestation of frequent reating washing enhanced by winter weather and represents a "paraphysiological" condition in elderly (>70 years). When one of these conditions is present xerosis can be defined as secondary, while it is defined as "idiopathic" or constitutional when it appears independently of age or any well-know pathological or physiopathological cause. Xerosis is the most common skin manifestation in primary Sjögren syndrome (pSS) (23–67%) [[1]Ueki H. Ingaki Y. Hamasaki Y. Ono M. Dermatologische manifestations des Sjögren-syndrome.Hautarz. 1991; 42: 741-747PubMed Google Scholar]. In our previous study we documented xerosis in 54 of 62 pSS [[2]Bernacchi E. Amato L. Parodi A. Cottoni F. et al.Sjögren's syndrome: a retrospective review of the cutaneous features of 93 patients by the Italian Group of Immunodermatology.Clin Exp Rheumatol. 2004; 22: 55-62PubMed Google Scholar]. Therefore, Sjögren syndrome (SS) may be considered as atopic dermatitis a disease characterized by secondary xerosis. Since the pathogenetic mechanisms of xerosis in pSS patients are not well-known, we conducted a histopatological examination of xerotic skin to evaluate epidermal, dermal, sebaceous and sweat glands alterations and immunohistochemical investigations to evaluate the epidermal expression of specific molecules (cytokeratins, involucrin and loricrin) involved in keratinocyte differentiation and proliferation. Moreover, to study the skin barrier function of xerotic skin in pSS patients, we employed corneometry and evaporimetry as non-invasive methods to detect stratum corneum water content and trans epidermal water loss (TEWL). Thirteen female patients (mean age 55 ± 4 years) affected with pSS were selected. Diagnosis was done on the basis of clinical, histopathological, immunopathological and serological evaluation, according to the European Community Study Group criteria [[3]Vitali C. Bombardieri S. Moutsopoulos M.H. et al.Assesment of the European classification criteria for Sjögren syndrome in a series of clinically defined cases: result of a prospective multicentre study.Ann Rheum Dis. 1996; 55: 116-221Crossref PubMed Scopus (475) Google Scholar]. Cutaneous xerosis present in all 13 patients was defined on the basis of both objective signs, such as roughness, scaling, cracks and fissures using European Group for Efficacy Measurements on Cosmetic and other Topical Products (EEMCO) guidelines [[4]Serup J. EEMCO Guidelines. Evaluation of dry skin (xerosis) and ictyosis. Clinical score systems.Cosm Technol. 1999; 2: 9-13Google Scholar] and subjective symptoms (such as pruritus, dryness and pinprick-like sensation). Xerosis was assessed in the deltoid areas, shoulders and external limbs by two independent observers. The detection of stratum corneum water content was performed by means of a capacitance device (Corneometer, CM 420, Courage and Khazaha, West Germany) [[5]Courage W. Hardware and measuring principle: corneometer.in: Elsner P. Berardesca E. Mailbach H. Bioengeneering of the skin: water and the stratum corneum. CRC Press, Boca Raton1994: 171-175Google Scholar]. We employed an evaporimeter (Servomed-Milano, Italy) for measuring basal TEWL [[7]Ellman P. Weber F.P. Goodier TE.W. A contribution to the patology of Sjögren's disease.Quart J Med. 1951; 20: 33-42PubMed Google Scholar]. These determinations were obtained in the morning, from March to June, after a resting period of 15 min and in presence of standard environmental conditions (room temperature between 19 and 21 °C, relative humidity 40–50%) for each of the 13 pSS patients and relative 11 female healthy controls (mean age 53 ± 6 years). These functional investigations were done at the same time and on pre-estabilished cutaneous areas: deltoid region, dorsal surface of the (right) hand, dorsal surface of the forearm, antero-lateral surface of the thigh and forehead. TEWL was expressed in g/m2 h, stratum corneum water content in Corneometer Units [5Courage W. Hardware and measuring principle: corneometer.in: Elsner P. Berardesca E. Mailbach H. Bioengeneering of the skin: water and the stratum corneum. CRC Press, Boca Raton1994: 171-175Google Scholar, 6Pinnagoda J. Tupker R.A. Agner T. Serup J. Guidelines for transepidermal water loss (TEWL) measurement.Contact Dermatitis. 1990; 22: 164-178Crossref PubMed Scopus (1080) Google Scholar]. Four female pSS patients (mean age 52 ± 3 years) of the previous group with severe xerosis and four healthy female control subjects (mean age 50 ± 5 years) were selected for immunohistochemical investigations. A punch biopsy was performed on the deltoid area of the patients and control subjects after informed consent. Every punch biopsy (5 mm diameter) was subdivided into two parts: one was employed for immunohistochemical investigations the other was used for histological examination (hematoxylin and eosin). Immunohistochemistry was employed to evaluate epidermal cytokeratins, involucrin and loricrin (the major molecules involved in keratinocytes proliferation and differentiation). The following primary antibodies were used: anti-Ki 67 (1:30; DAKO, Glostrup, Denmark) to evaluate the epidermal proliferation rate, anti-MNF 116 (1:50; DAKO, Glostrup, Denmark) directed against epidermal basal cytokeratins 5 for the evaluation of epidermal differentiation, anti-34βE12 (directed against basal (k1–k5) and suprabasal (k10–k14) epidermal cytokeratines (1:50; DAKO, Glostrup, Denmark), anti-involucrin (1:100; Novocastra Laboratories Ltd, Newcastle upon Tyne, UK) and anti-loricrin (1:500; BabCO, Richmond, CA, USA) to evaluate the terminal phase of keratinocytes differentiation. Two independent and "blinded" observers evaluated serial sections. No pathological alterations were detected in the group of the 13 pSS patients studied with corneometry and evaporimetry, because for each pSS cutaneous region examinated the mean values obtained were the same as those registered in our control groups and as those previously reported by other authors for healthy skin. Only in deltoid area TEWL values were significantly (p = 0.037) lower (Fig. 1). Slight epidermal hyper-ortokeratosis and dermal elastosis were noted in the pSS biopsy specimen examined. In particular no morphological alterations or reduction in number of sebaceous and sweat glands were demonstrated. Table 1 demonstrates that all four female pSS patients selected for immunohistochemical investigations showed an intense and marked staining with Ki 67 of the basal and spinous layers. We also demonstrated increased epidermal differentiation, revealed by intense staining of the basal and spinous layers with monoclonal MNF 116 (specific for epidermal basal cytokeratin 5). The expression of 34βE12 (specific for epidermal basal 1–5 and suprabasal 10–14 cytokeratins) was similar both in pSS patients and in the control subjects. The final phase of keratynocytice differentiation also appeared altered in the pSS patients, with involucrin expression not only in the granulous, but also in the highest part of the spinous layer. Loricrin was equally expressed at the level of the granulous layer in pSS patients and in control subjects.Table 1Immunohistochemical characterization of cytokeratins, involucrin and loricrin in pSS patients and control subjects.pSS patientsControl subjects(4 pt.)1234Ki 67BL + SLBL + SLBL + SLBL + SLBLMNF 116BL + SLBL + SLBL + SLBL + SLBL34βE12BL + SLBL + SLBL + SLBL + SLBL + SLInvolucrinSL + GLSL + GLSL + GLSL + GLGLLoricrinGLGLGLGLGLBL: staining of basal layer; SL: staining of spinous layer; GL: staining of granulous layer. Open table in a new tab BL: staining of basal layer; SL: staining of spinous layer; GL: staining of granulous layer. In conclusion our studies demonstrate that xerosis in pSS is not related to a chronic inflammatory atrophy of sweat glands [[7]Ellman P. Weber F.P. Goodier TE.W. A contribution to the patology of Sjögren's disease.Quart J Med. 1951; 20: 33-42PubMed Google Scholar] or their functional alterations with consequent reduction of sweat rate (resulted normal or higher than normal control [8Rees J.I. Pal B. Stimulated eccrine gland function in primary Sjögren syndrome.Clin Exp Dermatol. 1989; 14: 191-193Crossref PubMed Scopus (9) Google Scholar, 9Katayama I. Yokozeka H. Nishioka K. Impaired sweating as an exocrine manifestation in Sjögren's syndrome.Br J Dermatol. 1997; 133: 716-720Crossref Scopus (41) Google Scholar]. Therefore, on the base of our studies cutaneous xerosis in pSS, unlike xerophtalmia and xerostomia, is not a feature of a chronic autoreactive lymphocytic exocrinopathy. Instead xerosis in pSS seems to be related to peculiar biochemical alterations of epidermis (increased epidermal proliferation and perturbation of epidermal differentiation) very similar to those detected by Engelke et al. [[10]Engelke M. Jensen J-M. Ekanayake-Mudiyanselage S. Proksch E. Effects of xerosis and agening on epidermal proliferation and differentiation.Br J Dermatol. 1997; 137: 219-225Crossref PubMed Scopus (125) Google Scholar] in "idiopathic" xerotic skin of the elderly. The alterated expression of cytokeratins and premature demonstration of involucrin, are presumably the biochemical basis of xerosis in pSS able to explain the alterations of epidermal barrier function and consequent decreased TEWL values especially in cutaneous areas (as deltoid surfaces) where the xerosis is more accentuated.

ABSTRACT Mycobacterium haemophilum, a strongly acid‐ and alcohol‐fast bacillus belonging to the group of non‐tuberculous mycobacteria was first described in 1978 as the cause of cutaneous ulcerating lesions in a woman with Hodgkin's disease. Infection due to M. haemophilum is rare but increasing in prevalence in immnunosuppressed subjects, particularly in patients with acquired immunodeficiency syndrome (AIDS) patients. The skin is the most common site of infection with erythematous or violaceous papules and/or nodules that are usually painless at first, but some elements develop into abscesses or ulcers that can become very painful. The incidence of M. haemophilum is unknown, but cases of infection have been reported in Australia, Canada, the United States, France, Israel, the United Kingdom and Taiwan; to date no cases have been reported in Italy, thus the case reported here is apparently the first one observed in our country.

A 35‐year‐old woman presented with a 8‐month history of scaling, hyperkeratotic and fissured lesions of the fingertips of the first three fingers of both the hands. She referred the healing of the dermatitis during the summer holidays. She was employed in a small firm where she was used to glue together silver components with glass ones of decorative pieces. For this aim, she applied a glue (Loxeal UV 30–20) cured by exposition to UV light coming from a proper lamp. The material safety data sheet (MSDS) indicated that the glue contained hydroxyethyl methacrylate (HEMA) and hydroxypropyl methacrylate (HPMA). Patch tests performed with the standard SIDAPA series gave negative results; patch tests carried out with an additional one (acrylic adhesive series) showed positive reactions towards glue components (HEMA,HPMA) and towards other acrylates (possible cross‐reacting). An inspection performed in the work‐place showed that the patient was in contact with the glue not only when she applied it on the components, but particularly when she handled the bottle cap (splashed with the glue) in its opening and closing. After the changing of her occupation, the patient has not presented relapse of the dermatitis. The UV‐cured acrylic resins are known for some time to be a frequent cause of occupational allergic contact dermatitis in dentists and in printing industry. The case reported shows a different exposition source towards these resins, i.e. from UV‐cured acrylate adhesive employed for sticking metal pieces with glass ones.

BACKGROUND:Patch testing with additional series (AS) of allergens may be a useful tool in diagnosing allergic contact dermatitis (ACD).OBJECTIVE:Aim of the study was to verify the usefulness, to check the reliability in clinical practice and to evaluate the economic costs of AS previously built up.METHODS:A total of 281 patients with suspicious ACD underwent patch test with the standard series (SS) and with one or more AS (51 among 71 built up).RESULTS:A total of 170 patients (60.5%) showed positive reactions to SS; 116 (41.3%) to AS. Among 582 nonstandard allergens used, 113 (19.4%) elicited 1 or more positive reactions: out of 10,916 patch tests carried out, 260 (2.4%) positive reactions were observed. The correlation between SS and AS indicated that 8.2% patients resulted SS-/AS+, 27.7% SS+/AS-, 32.7% SS+/AS+, 31.3% SS-/AS-. The most frequently used AS showed the following percentages of patients with 1 or more positive reactions: clothes 41.4%, building industry 51.8%, hairdressers 77.3%, textile industry 42.1%, shoes 36.8%. Positive reactions to the most frequently used nonstandard allergens resulted: propylene glycol 0.4%, cobalt chloride 12.6%, phenylmercuric nitrate 2.2%, p-aminophenol 4.5%. The approximate economic cost of patch testing with AS has been evaluated in 1.3 euro per single patch test.CONCLUSION:The cost of patch testing AS is not irrelevant, but it can be compensated by the advantages deriving from the increase of data concerning ACD etiology. A reduction in the number of allergens included in single AS should be performed. Cobalt chloride, taking into account the high percentage of positive reactions observed and its presence in a large number of AS, could be (re)introduced in the standard series.

Anogenital condylomata acuminata are the most frequent clinical manifestation of genital human papillomavirus (HPV) infection. Association between human immunodeficiency virus (HIV) and HPV infections is frequent (range: 26-60% in males). Topical cidofovir (a nucleotide analogue antiviral drug active against a broad range of DNA viruses) is a potential treatment for anogenital warts in immunocompromised patients. We treated three HIV-infected patients with HPV perianal condylomas with topical 1% cidofovir in flexible collodion once a day for 2 weeks. The treatment resulted in complete clearance of the HPV lesions. The patients experienced mild transient erythema without any other side-effects. None of the patients relapsed during the 10-14-month follow-up period.

The present work reports the results of a multicentre study of toothpaste allergic contact cheilitis (TACC) conducted by GIRDCA (Gruppo Italiano Ricerca Dermatiti da Contatto e Ambientali). The study examined 54 patients with eczematous lesions on the lips, the possible cause of which was suspected to be the use of toothpastes. Patch tests were conducted with a standard series, a specially‐targeted series (toothpaste cheilitis series, TCS), and with suspected toothpaste(s). A stop‐restart test (SRT) was carried out with these, together with a use test to identify possible alternative products. The TCS produced 17 positive reactions in 13 patients, the most frequent being to spearmint oil. Of the 54 patients, 5 displayed positive reactions only to the TCS. The patch tests with toothpaste produced positive reactions in 11/32 patients, the SRT a positive response in 10/12 cases. The diagnosis of TACC was confirmed in 15/54 patients. Alternative products were identified for 5 patients. In conclusion, the allergens most frequently responsible for TACC were the flavourings, and the additional series proved to be useful in many cases (together with patch tests with toothpastes and the SRT) for correct diagnosis and to initiate effective prevention.

Background/aims: The aim is to evaluate, using evaporimetry, the possibility of getting further information supporting clinical reading of allergic, irritant reactions and doubtful patch test reactions.Methods: The investigation was carried out on 204 patients (182 female and 22 male, mean age 31.6 years), patch tested routinely as suspects of allergic contact dermatitis. We evaluated 326 reactions (203 allergic, 123 irritant or doubtful).Results: Mean values pf TEWL were: for the positive allergic reactions, 7.21 (SD, 2.26) at 48 h, 15.77 (SD, 5.50) at 72 h; and for the irritant or doubtful reactions, 7.55 (SD, 1.72) at 48 h, and 5.77 (SD, 1.41) at 72 h. TEWL in the 2 reactions groups at 72 h was significantly different (p<0.01).Conclusions: The study shows (i) concordance between the evaporimeter values and the visual score; (ii) at 72 h, the evaporimeter values are increased in the allergic reactions but not in irritant or doubtful reactions; (iii) evaporimetry in the differential diagnoses of patch test reactions was deemed useful.