Topical Corticosteroid Phobia Among Women Affected With Vulvar Lichen Sclerosus: Results From a Cross-sectional Survey.

OBJECTIVE: Topical corticosteroid (TC) phobia (TCP) is common in subjects affected with chronic inflammatory skin diseases who need prolonged corticosteroid treatments. The aim of this study was to assess TCP in women affected with vulvar lichen sclerosus (VLS). MATERIALS AND METHODS: This observational, cross-sectional study included adult patients with VLS who either started or were undergoing a TC treatment at our vulva unit between May 2022 and May 2023. All patients completed the self-administered TOPICOP questionnaire, which is validated for measuring concerns, worries, and beliefs about TC use. The scores obtained were analyzed in relation to demographic, history, and clinical data. RESULTS: The majority of the 165 (92.1%, 66.5 ± 11.9 years) included patients who had previously undergone TC treatments, mostly for VLS; 81.8% of them had received information about TCs, mainly from dermatologists (86.7%). The median global TOPICOP score was 16.7% (interquartile range. 8.3-30.6), corresponding to a raw median value of 6.0 (interquartile range, 3.0-11.0). The median subscores for the 2 TOPICOP domains, namely, mistaken beliefs and worries about TCs, were equal to each other. At multivariate analysis, none of the collected variables showed a significant association with the degree of TCP. CONCLUSIONS: In our VLS patients, TCP resulted rather low, probably because of the small skin area being treated and the high percentage of women who had already used TCs and who had received information about them from a dermatologist. This latter point suggests that adequate counseling could be a strong basis for greater awareness and serenity in the long-term use of TCs.

Incidence of Vulvar Lichen Sclerosus and of Cancer Among Vulvar Lichen Sclerosus Patients: Does Socioeconomic Status Have a Role?

OBJECTIVE: Socioeconomic status (SES) impacts on the incidence of many inflammatory diseases and cancers, but there is no evidence on its implication in vulvar lichen sclerosus (VLS). The authors aimed to assess possible associations between SES and both occurrence of VLS and cancer occurrence among VLS patients. MATERIALS AND METHODS: A retrospective cohort of women resident in the province of Ferrara, Italy, affected with VLS diagnosed between 2001 and 2020, was investigated for assessing any association of SES with VLS and cancer incidence. The SES was expressed through an ecological-based deprivation index identifying 5 subgroups. RESULT: Four-hundred women were diagnosed with VLS during the study period, with double the number of cases in the second decade (2011-2020) compared with the first (2001-2010). More VLS patients belonged to the high rather than the low SES groups (p = .032). From VLS diagnosis to 2018 (1,958.4 total person*years at risk), 22 patients received their first diagnosis of cancer, mainly the skin, breast, and vulva. No significant differences in cancer incidence were found between high/medium-high and low/medium-low SES subjects. CONCLUSIONS: The fact that more VLS patients belonged to the highest socioeconomic classes may be due to a more frequent diagnosis in those with greater health seeking behavior and resources. An involvement of SES-related factors in VLS pathophysiological background can also be taken into consideration. Both the lack of marked social and economic differences in the study area and the availability of free visits and screening may account for the lack of association between SES and cancer development.

Results from an extended study on the reliability of a questionnaire for the diagnosis of sensitive skin: Confirmations and improvements.

OBJECTIVE: A recently proposed self-assessment questionnaire aimed at diagnosing sensitive skin provided promising results in a relatively small population. The main objectives were: (i) to assess the reliability of the aforementioned questionnaire in a larger population and verify the cut-off score previously found to predict skin sensitivity (defined as positivity to LAST, lactic acid stinging test) and (ii) to define a formula that yields the probability of a positive LAST result. METHODS: Adult volunteers were included in this observational, cross-sectional, extended study. Both LAST-positive subjects, who were considered as having sensitive skin ('patients') and negative ones ('controls') completed the questionnaire, which concerned sensitivity to possible triggers of unpleasant skin sensations in real life. A cumulative score (questionnaire-based skin sensitivity score, 0-10) was calculated from the sum of all items. RESULTS: Three hundred and sixty-four subjects were enrolled, 214 patients and 150 controls. The mean questionnaire-based skin sensitivity score was significantly higher among patients than controls. Using two different methods, cut-off values of 4 and 5 were defined for the identification of LAST-positive subjects, with 76.6% and 72.8% accuracy, respectively. Scores below 4 or above 5 showed a high (80% or better) negative or positive predictive value, respectively. The coefficients found that in multivariate analysis for each questionnaire item, gender and age allowed us to calculate the probability of LAST positivity with higher precision taking into account the 'relative weight' of each factor. CONCLUSION: With small variations in the results, the self-assessment questionnaire confirmed its reliability for diagnosing sensitive skin in clinical practice.

INTRODUCTION: Un questionnaire d'auto-évaluation récemment proposé visant à diagnostiquer la peau sensible a fourni des résultats prometteurs dans une population relativement petite. Les principaux objectifs étaient: (i) d'évaluer la fiabilité du questionnaire susmentionné dans une population plus large et de vérifier la valeur du cut-off précédemment trouvé pour prédire la sensibilité cutanée (définie comme la positivité au LAST, de l'anglais « test de piqûre d'acide lactique ¼), et (ii) de définir une formule qui donne la probabilité d'un résultat LAST positif. MÉTHODES: Des volontaires adultes ont été inclus dans cette étude observationnelle, transversale et étendue. Les sujets LAST-positifs, qui étaient considérés comme ayant la peau sensible ('patients'), et les sujets négatifs ('témoins') ont rempli le questionnaire, qui concernait la sensibilité aux possibles déclencheurs de sensations cutanées désagréables dans la vie réelle. Un score cumulatif (score de sensibilité cutanée basé sur un questionnaire, 0-10) a été calculé à partir de la somme de tous les éléments. RÉSULTATS: Trois cent soixante-quatre sujets ont été recrutés, 214 patients et 150 témoins. Le résultat moyen de sensibilité cutanée basé sur le questionnaire était significativement plus élevé chez les patients que chez les témoins. En utilisant deux méthodes différentes, des valeurs seuils de 4 et 5 ont été définies pour l'identification des sujets LAST-positifs, avec une précision de 76,6% et 72,8%, respectivement. Les scores inférieurs à 4 ou supérieurs à 5 ont montré une valeur prédictive négative ou positive élevée (80% ou plus), respectivement. Les coefficients trouvés en différentes analyses pour chaque élément du questionnaire, sexe et âge nous ont permis de calculer la probabilité de positivité LAST avec une plus grande précision en tenant compte du « poids relatif ¼ de chaque facteur. CONCLUSIONS: Avec de faibles variations dans les résultats, le questionnaire d'auto-évaluation a confirmé sa fiabilité pour le diagnostic des peaux sensibles dans la pratique clinique.

Assessment of the perceived burden associated with Malignant Melanoma with Pictorial Representation of Illness and Self Measure (PRISM) and Melanoma Concerns Questionnaire (MCQ-28).

PURPOSE: The impact of malignant melanoma (MM) on patients' psychophysical well-being has been poorly addressed. We aimed to assess the perceived burden in patients with a diagnosis of MM, using two different tools, one generic and one specific for MM, such as Pictorial Representation of Illness and Self Measure (PRISM) and Melanoma Concerns Questionnaire (MCQ-28), respectively. The correlation between PRISM and MCQ-28 subscales and the relevance of disease and patient-related variables were also investigated. METHODS: This single-centre, cross-sectional study included all adult consecutive MM patients who attended our Dermatology Unit from December 2020 to June 2021. Demographics and disease-related data were recorded. PRISM and MCQ-28 were administered. RESULTS: One hundred and seventy-one patients were included (mean age: 59.5 ±14.9 years.; 48.0% males). Median time from MM diagnosis to inclusion was 36 months. Nearly 80% of the patients had in situ or stage I MM. Overall, 22.2% of the patients reported a PRISM score <100mm and similar percentages provided scores indicating impaired quality of life, as assessed with MCQ-28 subscales. A weak, albeit significant, correlation was found between PRISM scores and ACP, CON and SOC2 subscales. The most relevant association found was that between lower PRISM scores and higher-stage MM. CONCLUSIONS: In the study population, mostly affected with superficial MM, their perception of the burden associated with MM did not appear either particularly dramatic or disabling. PRISM seems a reliable system for capturing and quantifying the domains correlated with the emotive dimension of MM, especially MM-related concerns and willingness to face life.

The link between hidradenitis suppurativa and phylloid hypomelanosis in partial trisomy-13 mosaicism: New evidences and further genetic/pathogenetic insights.

Partial trisomy-13 mosaicism (PT13M) is a rare condition. Among its possible associated cutaneous features, phylloid hypomelanosis (PH), characterized by leaf-like macules reminiscent of floral ornaments in the form of round or oval spots and patches and oblong lesions, is typical. Two cases of PH associated with hidradenitis suppurativa (HS) have been already reported in the literature. We report a third child with PH due to PT13M associated with HS-like lesions limited to hypomelanotic regions. We hypothesize that follicular occlusion genes may be located in the duplicated part of chromosome 13.

Self-perceived Burden, Impairment in Quality of Life and Sexual Functioning, and Further Implications in Patients with Vulvar Lichen Sclerosus: A Narrative Review and Personal Experience.

Vulvar lichen sclerosus (VLS) is an inflammatory disease with numerous detrimental characteristics, namely its distressing symptoms, chronic course, sexual dysfunction, disfiguring anatomical changes, only partial response to treatment, and risk of evolution towards cancer. Interest in the burden of VLS on patient quality of life is fairly recent and only relatively few studies have addressed it so far. In order to focus on the impact of VLS in affected women, an electronic search was performed using the National Library of Medicine PubMed database. All the studies assessing VLS-related suffering and quality of life impairment published in the English literature were analyzed, including controlled studies, case series, and guidelines. The available literature shows that VLS can negatively affect patients' daily lives and significantly impair their physical and social activities, mental health, self-esteem, sexual functioning, and satisfaction. Health-related quality of life impairment among women with VLS is defined as moderate to severe, comparable to that of patients affected with other high-impact chronic skin disorders such as atopic dermatitis, psoriasis, and hidradenitis suppurativa. The symptoms are the main causes of the detrimental effect of VLS. By ameliorating symptoms, treatments are expected to highly improve patient quality of life, especially in case of complete clearance. Treating VLS has a beneficial impact on sexual dysfunction as well, even though dyspareunia appears less responsive than the other disease-related symptoms. In conclusion, the emotional and sexual dimensions are strongly impaired by VLS. Both in clinical practice and in clinical trials, quality of life and suffering should be taken into account and considered as strong conditioning factors in patient well-being. They should also become a measure of therapeutic response in treated patients.

The Role of OX40-OX40L Axis in the Pathogenesis of Atopic Dermatitis.

OX40 is a co-stimulatory immune checkpoint molecule that promotes the activation and the effector function of T lymphocytes through interaction with its ligand (OX40L) on antigen-presenting cells. OX40-OX40L axis plays a crucial role in Th1 and Th2 cell expansion, particularly during the late phases or long-lasting response. Atopic dermatitis is characterized by an immune dysregulation of Th2 activity and by an overproduction of proinflammatory cytokines such as interleukin (IL)-4 and IL-13. Other molecules involved in its pathogenesis include thymic stromal lymphopoietin, IL-33, and IL-25, which contribute to the promotion of OX40L expression on dendritic cells. Lesional skin in atopic dermatitis exhibits a higher level of OX40L+-presenting cells compared with other dermatologic diseases or normal skin. Recent clinical trials using antagonizing anti-OX40 or anti-OX40L antibodies have shown symptom improvement and cutaneous manifestation alleviation in patients with atopic dermatitis. These findings suggest the relevance of the OX40-OX40L axis in atopic dermatitis pathogenesis.

A Case of Dissecting Cellulitis of the Scalp, Hidradenitis Suppurativa, and Conglobate Acne Successfully Treated with Secukinumab.

Introduction: Dissecting cellulitis of the scalp (DCS) is a neutrophilic scarring alopecia typically presenting with pustules and fluctuant nodules, followed by suppuration and sinus tract formation. DCS is often associated with other diseases, such as hidradenitis suppurativa (HS) and conglobate acne (CA) which share similar pathogenetic mechanisms. Case Presentation: The authors report the case of a patient affected by a severe form of DCS, HS, and CA of the face. Previous treatments with isotretinoin, antibiotics, and adalimumab did not have a considerable efficacy. Off-label treatment with secukinumab showed a gradual improvement in the clinical presentation bringing to a reduction in the number of HS lesions and to an almost complete resolution of the inflammatory manifestations of DCS. Conclusion: Management of DCS is challenging and is typically based on retinoids which are considered the first line of treatment. The efficacy of biologic drugs, especially TNFα inhibitors, in severe and relapsing forms of DCS has been reported in recent literature. To our knowledge, only one case of isolated DCS treated with secukinumab is reported. No cases of concomitant DCS and HS, treated with this type of IL-17 inhibitor, have been described.

Does sensitive skin lie in epidermal barrier impairment or abnormalities? Results from an observational study assessing biophysical parameters.

BACKGROUND: The pathophysiology of sensitive skin is largely unknown and no univocal data on the role of the epidermal barrier impairment have been identified. The aim of this study was to assess whether subjects with or without sensitive skin differ for some biophysical skin parameters, which reflect skin barrier integrity or skin hyperactivity. METHODS: This observational, cross-sectional study included adult volunteers not affected with chronic inflammatory skin diseases who attended the Unit of Dermatology and the Center of Cosmetology of the University of Ferrara, Ferrara, Italy, between March 2021 and November 2022. All subjects, subdivided into those with or without sensitive skin, based on either Lactic Acid Stinging Test (LAST) result or a questionnaire-based skin sensitivity score ≥4, were tested for transepidermal water loss (TEWL), skin elasticity and hydrations and dermographism. RESULTS: One hundred and eighty-seven subjects were included. No significant differences in terms of TEWL, elasticity and hydration levels were recorded between subjects with sensitive skin and those without, subdivided according to both the LAST result and the questionnaire score. Dermographism was elicited more in subjects with sensitive skin than in the others, although without statistical significance. CONCLUSIONS: The study failed to find significant biophysical differences between sensitive and non-sensitive skin. Therefore, the role of skin barrier impairment does not appear to be a necessary condition in determining an abnormal skin sensitivity to potentially unpleasant and irritating stimuli. These findings indirectly support the relevance of a peripheral sensory neural hyperactivity in the pathophysiology of sensitive skin.

A New Hybrid Therapeutic Approach to Solitary Keratoacanthoma: Complete Recovery in Six Patients.

Introduction: Solitary keratoacanthoma (SKA) is generally considered as a well-differentiated form of squamous cell carcinoma, but it usually runs a benign course and a not aggressive behavior. Diagnostic criteria, prognosis, and treatment of SKA are not fully defined yet. Surgical treatment with fusiform excision represents the gold standard; nonoperative intralesional therapy of KA is uncommon but may provide a valid option in some categories of patients. Case Series Presentation: We report our experience regarding the treatment of SKA with a hybrid treatment consisting of a minimally invasive technique such as curettage followed by intralesional corticosteroid administration in the same session. Six patients affected with KA were treated ending in a complete resolution, with good esthetic outcome, no relapse after 1 year, and satisfaction of the patients. Discussion and Conclusion: The combined treatment allows us on the one hand to avoid radical surgery in selected patients and particular anatomic areas and on the other the side effects that the use of intralesional chemotherapy/immunosuppressive drugs can entail.

Urticaria: A Narrative Overview of Differential Diagnosis.

Urticaria is an inflammatory skin disorder that may occur in isolation or associated with angioedema and/or anaphylaxis. Clinically, it is characterized by the presence of smooth, erythematous or blanching, itchy swelling, called wheals or hives, which greatly vary in size and shape and last less than 24 h before fading to leave normal skin. Urticaria is the consequence of mast-cell degranulation that can be caused by immunological or non-immunological mechanisms. From a clinical point of view, many skin conditions can mimic urticaria and their recognition is mandatory for a correct management and therapeutic approach. We have reviewed all of the main relevant studies which addressed differential diagnosis of urticarial, published until December 2022. The National Library of Medicine PubMed database was used for the electronic research. The present review offers a clinical narrative overview, based on the available literature, of the principal skin disorders that can be misdiagnosed as urticaria (mainly autoinflammatory or autoimmune disorders, drug-induced reactions, and hyperproliferative diseases). The aim of this review is to provide clinicians a useful tool for correctly suspecting and identifying all of these conditions.

Visits to Sexually Transmitted Infection Clinics in Italy from January 2016 to November 2021: A Multicenter, Retrospective Study.

There is no evidence of seasonal variation in visits to clinics dedicated to sexually transmitted infections (STIs) in Italy, nor of changes after the advent of the COVID-19 pandemic. An observational, retrospective, multicentric study was conducted to record and analyze all the visits to the STI clinics of the Dermatology Units of the University Hospitals of Ferrara and Bologna and of the Infectious Disease Unit of Ferrara, Italy, between January 2016 and November 2021. Overall, 11.733 visits were registered over a 70-month study period (63.7% males, mean age 34.5 ± 12.8 yrs). The mean number of monthly visits significantly decreased from the advent of the pandemic (136) compared to before (177). In the pre-pandemic period, visits to STI clinics increased in the autumn/winter months when compared to spring/summer, while the trend was the opposite in the pandemic period. Thus, during the pandemic, both an overall significant reduction in visits to STI clinics and a reversal in their seasonality were observed. These trends affected males and females equally. The marked decrease, mostly found in the pandemic winter months, can be linked to the "lockdown"/self-isolation ordinances and social distancing measures during the colder months, coinciding with the spread of the COVID-19 infection, which limited the opportunities for meeting and socializing.

Seven years-experience of adalimumab therapy for Hidradenitis Suppurativa in a real-life dermatologic setting.

INTRODUCTION: Hidradenitis Suppurativa (HS) often causes severe impairment of the quality of life of patients affected, as it is characterized by recurrent relapses of inflammation and predisposes to retractive scars, with severe alteration of anatomy of the affected regions. Adalimumab is currently the only approved long-term biological therapy for this disease. MATERIAL AND METHOD: We retrospectively review the data of HS patients treated with Adalimumab at the 'Hidradenitis Suppurativa Clinic', University of Ferrara, Italy since the drug was first available to October 2020. The aim is to describe our real-life experience in a clinical outpatient service. We assessed the main demographic features, therapy duration, reasons of suspension and efficacy (evaluated by HiSCR - Hidradenitis Score) in relation to surgical procedures, hospitalization, number of areas involved by the disease and BMI > 30. We also assessed the aspects related to the use of adalimumab's biosimilar. RESULTS: Data on 76 patients, with a mean age of 38.26 ± 14.74 years and mean BMI 28.10 ± 5.92 were collected. Most of the treated patients had Hurley stage III (58/76); mean Sartorius score was 115.5 ± 55.86, mean IHS4 was 76.1 ± 44.3. A statistically significant correlation between hospitalization and cessation of adalimumab, the loss of the achievement of the HiSCR, and surgery was found. No need to do surgery was a protective factor against the failure of adalimumab treatment, meaning that the most severe cases are more likely to fail the biological therapy. CONCLUSION: New scenarios are opening up in clinical practice: the arrival of biosimilars allow greater sustainability of expenditure, while the anti-IL17 allow the patient who has failed therapy with adalimumab a valid and safe therapeutic option to be undertaken. A comprehensive care including hospitalization, a specific antibiotic therapy and surgical treatment is often mandatory to achieve a satisfactory control of the disease.