Non-scarring patchy alopecia: What else, apart from alopecia areata?

A 67-year-old woman presented with a 3-month history of patchy alopecia areata (AA)-like hair loss and multiple painful enlarged lymph nodes at cervical, nuchal, and left axillary site. The patient was on follow-up for IgM monoclonal gammopathy of undetermined significance, stable for many years. A punch biopsy from a patch of the temporal scalp revealed the presence of B-cell lymphoid infiltrates consistent with marginal zone B-cell lymphoma (MZL). Other staging examinations were conducted to make a definitive diagnosis of nodal MZL with secondary cutaneous involvement. The patient showed a complete remission of the alopecia, without evidence of scarring, after immunochemotherapy for lymphoma.

The Italian Mastocytosis Registry: 6-year experience from a hospital-based registry.

AIM: We collected 'real-life' data on the management of patients with mastocytosis in the Italian Mastocytosis Registry. METHODS: Six hundred patients diagnosed with mastocytosis between 1974 and 2014 were included from 19 centers. RESULTS: Among adults (n = 401); 156 (38.9%) patients were diagnosed with systemic mastocytosis. In 212 adults, no bone marrow studies were performed resulting in a provisional diagnosis of mastocytosis of the skin. This diagnosis was most frequently established in nonhematologic centers. In total, 182/184 pediatric patients had cutaneous mastocytosis. We confirmed that in the most patients with systemic mastocytosis, serum tryptase levels were >20 ng/ml and KIT D816V was detectable. CONCLUSION: The Italian Mastocytosis Registry revealed some center-specific approaches for diagnosis and therapy. Epidemiological evidence on this condition is provided.

New formulation for topical treatment of onychomycoses.

BACKGROUND: In order to treat onychomycosis, topical and systemic medications are available. The choice of a systemic or topic treatment depends on numerous factors, such as patient's age, the presence of comorbidity, responsible fungal species, the clinical form of onychomycosis, its location (fingernails or toenails), the number of nails affected and the percentage of the nail plate infected. As for topical medications, given that nail plate has an insufficiently permeable structure, it is necessary to use appropriate formulae that create in the surface of the nail plate a film able, in turn, to function both as an active ingredient's deposit and moisturising agent in nail's superficial layers in order to facilitate the spread of the active ingredient. In this manuscript, we wanted to evaluate the effectiveness and tolerability rate of a new topical formulation (Miconal Nails®, Morgan srl, Vicenza, Italy) composed of hydrogenated castor oil, hydroxyethyl cellulose, and other ingredients (urea, climbazole, piroctone olamine, undecylenic acid). METHODS: We selected 25 patients of both sexes whose median age was between 20 and 70 years, and were affected by onychomycosis in a single toe. Their onychomycosis was a distolateral subungual type (with a <50% invasion of nail plate and sparing of lunula) and white superficial. The treatment was evaluated with the following possible outcomes: complete healing, improvement, stationarity, worsening. RESULTS: Patients were 11 female subjects and 14 male subjects, whose median age was 45. A complete healing was achieved in 15 patients. In 3 cases the clinical presentation appeared unchanged with a persistence of mycological evidence. The response to the treatment was assessed as improvement in 7 patients. CONCLUSIONS: In our experience, this new product is an effective weapon that enhances the therapeutic selection of topical formulae for treating onychomycosis. If used alone in the cases that meet inclusion criteria for topical treatment, it allowed us to achieve a complete healing just with a 5-month treatment in 60% of cases, data that reached 76% on the follow-up visit.

Epidemiology of onychomycosis in Italy: prevalence data and risk factor identification.

The prevalence of onychomycosis differs according to geographic area and over time and is influenced by several factors. The epidemiology of onychomycosis in Italy is still unclear. To evaluate the prevalence of onychomycosis in a representative sample of the Italian population a group of Dermatologists and General Practitioners carried out an observational survey on the patients coming to their office during a 1-month period. Any patient with skin or systemic disease giving their consent was enrolled. Demographic characteristics, comorbidities, lifestyles, history of previous mycosis, clinical aspects of onychomycosis and mycological evaluation were studied. A total of 8331 patients (56.7% female and 43.3% male) were evaluated. More than half of them were aged ≥46 years. Onychomycosis was diagnosed in 14.2% of patients. Big toe and thumb were the most frequently affected nails. Onychomycosis was moderate-severe in 74.1% of the cases. Mycological tests were positive in 81.3% of the cases. Dermatophytes were found in 76.6% of the cases, yeasts in 17.2% and moulds in 6.3%. Risk factors and/or comorbidities were present in 68.2% of the cases. This survey showed a 14% prevalence of onychomycosis in the evaluated population. The main risk factors were previous onychomycosis, diabetes, hallux valgus and use of occlusive footwear.

Is lipoatrophia semicircularis a rare disease? Report of three cases.

Lipoatrophia semicircularis is characterised by band-like horizontal skin depressions involving the anterior and lateral sides of the lower limbs. Whether this occurrence is rare or is just not well known or simply underreported because it does not cause patient distress is still under discussion. In a 1-year period we observed three cases due to local, mechanical pressure in an Italian dermatology outpatient clinic. However, other factors described in current literature may contribute to this phenomenon. More large-scale studies are needed to clearly assess the origin of this condition.