Probiotics and Prebiotics Orally Assumed as Disease Modifiers for Stable Mild Atopic Dermatitis: An Italian Real-Life, Multicenter, Retrospective, Observational Study.

The role of the skin-gut axis in atopic dermatitis (AD) remains a subject of debate, limiting non-pharmacological interventions such as probiotics and prebiotics. To improve understanding of their potential as a monotherapy for stable mild cases, we conducted a real-life, multicenter, retrospective observational study in Italy. We administered three selected bacteria (Bifidobacterium animalis subsp. lactis BS01, Lactiplantibacillus plantarum LP14, and Lacticaseibacillus rhamnosus LR05) orally to patients with mild atopic dermatitis without a placebo control group, following up for 12 weeks. Clinical assessments using the Scoring Atopic Dermatitis (SCORAD), Eczema Area and Severity Index (EASI), and Three-Item Severity (TIS) score were conducted on 144 enrolled patients (average age: 25.1 ± 17.6 years). Notably, both pruritus and AD-related lesions (erythema, edema/papules, excoriation) exhibited significant clinical and statistical improvement (p < 0.001) after 12 weeks of exclusive probiotic and prebiotic use. These preliminary results suggest a potential link between the skin-gut microbiome and support the rationale for using specific probiotics and prebiotics in mild AD, even for maintenance, to reduce flares and dysbiosis.

Hidradenitis Suppurativa in a Large Cohort of Italian Patients: Evaluation of the Burden of Disease.

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.

Cutaneous carcinogenic risk evaluation in 375 patients treated with narrowband-UVB phototherapy: A 15-year experience from our Institute.

BACKGROUND: Narrowband-ultraviolet B (NB-UVB) is widely used for the treatment of several dermatological diseases. A cutaneous carcinogenic effect has been hypothesized, but not proved. METHODS: We retrospectively reviewed the data of patients treated with NB-UVB between January 1998 and December 2013 at the Dermatology Unit of our University Hospital, to evaluate the cutaneous carcinogenic risk of NB-UVB. RESULTS: In all, 375 patients were included, each receiving a mean follow-up of 6.9 years. Vitiligo and psoriasis were the most common diseases. In total, 19 non-melanoma skin cancers (NMSCs) were diagnosed in eight patients, after a mean latency of 5.2 years after the first radiation. No malignant melanoma (MM) was observed. The incidence rates of basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) were 620.2/100 ̇000 p/y and 116.3/100 ̇000 p/y. NMSCs were more frequent in patients affected by psoriasis (P = .0232), with older age at the first radiation (mean = 68.8 years, P = .0001). CONCLUSION: Despite the small number of patients and limited follow-up, our data suggest that NB-UVB may trigger cutaneous carcinogenesis, mainly in patients at risk for NMSCs, increasing their personal risk for single and multiple neoplasms, usually superficial BCCs. MM risk does not seem to be enhanced.

Safety and Efficacy of Phototherapy in the Management of Eczema.

Atopic Dermatitis (AD), a common skin disease, can occur in patients of all age, gender and ethnicity. It is an inflammatory affection, characterized by chronic and highly debilitating behavior. First-line interventions against AD include environmental measures and topical emollients, corticosteroids or calcineurin inhibitors. When these measures are not sufficient, phototherapy represents an efficient second-line option of treatment; it can be administered on its own, or in the most severe cases combined with systemic medicaments such as corticosteroids.Different types of light therapy, including photochemotherapy, have been tested in the past and in recent years for AD: in particular, ultraviolet A1 (UVA1) and narrow band ultraviolet B (NB-UVB) have been reported in the literature as the most effective resources, respectively for acute and chronic AD. However, to date, no guidelines have been realized concerning the use of phototherapy for AD, as no light form has been defined superior to the others. The most reliable protocols and dosimetry are standardized within the American Academy of Dermatology (AAD) psoriasis guidelines.In adults and children over 12 years (8 years for NB-UVB) phototherapy is recommended with strength B and level of evidence II (excluding home phototherapy, which is recommended with strength C and level of evidence III). It is usually safe and well tolerated; however its short- and long-term adverse effects are the same as those observed when light therapy is performed for other pathologic conditions. Erythema and photodamage are in particular quite frequent; moreover it has not been clarified whether UV radiation may induce neoplastic cellular transformation. For all these reasons, the use of phototherapy must be chosen only after a comprehensive and careful evaluation of the patient's features and compliance, as well as of the limitations of the procedure due to costs and availability.

Outpatient pediatric dermatologic surgery: experience in 296 patients.

From January 2010 to December 2012, 296 skin biopsies were performed in pediatric patients using only local anesthesia (cream and infiltration). The biopsies were divided into three groups: biopsies of skin neoplasms, biopsies of skin rashes and biopsies of follicular-centered lesions. Our data demonstrate the possibility of using this procedure, with the dual advantage of eliminating hospitalization and cost savings.

To what extent is quality of life impaired in vitiligo? A multicenter study on Italian patients using the dermatology life quality index.

BACKGROUND: It is believed that vitiligo has an impact on the overall patient quality of life (QoL). OBJECTIVE: To estimate QoL in a fairly large sample of Italian vitiligo patients by using the Dermatology Life Quality Index (DLQI) questionnaire. METHODS: One hundred and sixty-one vitiligo patients referred to 9 dermatological centers were offered to participate by filling in the Italian version of the DLQI questionnaire. RESULTS: The mean total DLQI score was 4.3 (SD ±4.9; range: 0-22). In multivariate analysis, DLQI >5 was associated with female gender, stability of the disease over time and involvement of the face at disease onset. CONCLUSIONS: The impairment of QoL is overall limited in Italian vitiligo patients, especially if it is compared with results from other available studies. This could be due to cultural and ethnic characteristics of the sample.

Circulating autoantibodies and autoimmune comorbidities in vitiligo patients: a multicenter Italian study.

BACKGROUND: Autoimmune comorbidities and circulating autoantibodies have been observed in vitiligo patients, but differences in rate are present according to countries in which the studies were performed, perhaps owing to ethnic diversities or different trigger factors. OBJECTIVE: To estimate the prevalence of circulating autoantibodies and overt autoimmune diseases in a fairly large sample of Italian vitiligo patients. METHODS: 175 outpatients affected by vitiligo and referred to nine dermatological centers were included in the study. Patients were offered routine blood test, serological testing for thyroid function and search for autoantibodies. RESULTS: At least one circulating autoantibody was detected in 61 (41.8%) of 146 subjects who underwent laboratory tests. Anti-thyroperoxidase (25.6%), anti-thyroglobulin (23.4%), antinuclear antibodies (16.8%) and anti-gastric parietal cell antibodies (7.8%) were the most noticed autoantibodies. 74 (41.5%) autoimmune comorbidities, mainly autoimmune thyroiditis (37%), were reported. CONCLUSION: The prevalence of autoimmune comorbidities and circulating autoantibodies in this study was in agreement with other surveys conducted on Caucasian patients.

Transepidermal water loss in newborns within the first 24 hours of life: baseline values and comparison with adults.

The measurement of transepidermal water loss (TEWL) is important for evaluating the integrity of the barrier function of the stratum corneum. Normal TEWL values in healthy adults and in children ages 2 and older are well known, but few studies have been performed in infants and neonates. TEWL in healthy neonates younger than 24 hours old was assessed and compared with that of an adult study population. We also studied possible correlations between this parameter, gestational age, and mode of delivery. A prospective study was conducted in healthy newborns. The areas tested were the volar forearm and the popliteal fossa. Ninety-nine healthy newborns were enrolled and 33 healthy adults were analyzed as controls. Statistically significant differences were noted between newborns and adults in TEWL (p < 0.01). Newborns had a much higher mean TEWL than adults. Differences in the morphology and physiology between newborn and mature skin can explain the higher TEWL in newborns. Higher TEWL could also be due to the sudden functional adaptation of the skin immediately after delivery, when the newborn transits from a liquid to the dry, gaseous extrauterine environment. Functional evaluation of the neonatal skin barrier is important mainly because maintaining skin integrity facilitates cutaneous adaptation.

Salicylic acid peel incorporating triethyl citrate and ethyl linoleate in the treatment of moderate acne: a new therapeutic approach.

BACKGROUND: Acne affects many adolescents. Conventional therapy often results in side effects and poor adherence, and the treatment does not consider the psychological effect of acne on patients, which is comparable with that of disabling diseases. OBJECTIVES: To evaluate the efficacy and tolerability of a peel (30% salicylic acid, triethyl citrate and ethyl linoleate) combined with a home therapy with three topical agents (triethyl citrate, ethyl linoleate and salicylic acid 0.5% cream, lotion) in moderate acne of the face. DESIGN: Prospective, observational, multicenter, open-label, postmarketing, phase IV study. METHODS: Patients were assessed by comparing Global Acne Grading System (GAGS) score and total lesion count from 15 days before the first peel (T-15 ), after four salicylic peels (every 10 ± 2 days (T0 , T10 , T20 , T30 ), and 20 days after of the end of the study (T50 ). This treatment was associated to a home therapy. RESULTS: Fifty-three patients completed the study. The average GAGS score fell 49% between T-15 and T50 (p < .001). No patient withdrew for adverse events. CONCLUSIONS: This therapy was effective and well-tolerated in all cases. Chemo-exfoliation sessions ensured the continuous monitoring of clinical results and improved patient quality of life.

Should idiopathic facial aseptic granuloma be considered granulomatous rosacea? Report of three pediatric cases.

Idiopathic facial aseptic granuloma (IFAG), or pyodermite froide du visage, is a skin disease reported only in children and characterized by painless red nodules usually located on the cheeks. Its etiology is still unclear, but some authors considered the possibility that IFAG might be included in the spectrum of granulomatous rosacea (GR). The histopathological features of IFAG and GR are quite similar, showing perifolliculitis, granulomas, folliculitis, and lymphocytes and plasmacells around epithelioid histiocytes. In the present article, we discuss three cases in which an association between a facial nodule, compatible with both IFAG and GR, and recurrent chalazia make us support the hypothesis that IFAG should be considered as GR.

Clinical characteristics of Becker's nevus in children: report of 118 cases from Italy.

We performed a retrospective study covering a 10-year period (January 1997-January 2007) on children referred to our unit or followed up for Becker's nevus (BN). The aim of this study was to better define the characteristics of BN in childhood, when this hypermelanosis is more frequent than the limited number of studies might suggest. Our data show that BN in children has predilection sites similar to those in adults, but hypertrichosis is rarer. Sun exposure does not appear to play an etiopathogenetic role. The higher incidence in men reported in adult case studies was not found in children. During and after puberty, androgenic stimulation is known to play a pathogenetic role in BN, especially in men, but our cases were mostly younger than 6 years old.

Angiokeratoma Circumscriptum Naeviforme Presenting as a Dark Warty Plaque on the Leg.

Dear Editor, A 45-year-old man presented with a large, dark, keratotic, warty, and friable plaque on the distal posterior aspect of the left leg (Figure 1, a). The patient reported that the lesion was not present at birth but had appeared approximately at the age of three as an erythematous patch that progressively grew over the time. During adolescence, the surface of the lesion became rough and warty and was easily traumatized due to its location, resulting in recurrent bleeding episodes over a period of years. For this reason, the patient requested lesion removal. The patient did not report any other significant comorbidity, and physical examination revealed no other abnormalities. A shaving biopsy of the lesion was performed, and histopathology highlighted ectatic vascular spaces with some luminal red blood cell beneath a papillomatous and hyperkeratotic epidermis (Figure 1, b). Based on clinical and histopathological features, a diagnosis of angiokeratoma circumscriptum naeviforme (ACN) was established. ACN is one of the five disorders belonging to the group of angiokeratomas (AKs) that also include AK of Mibelli, AK of Fordyce, solitary or multiple AK, and AK corporis diffusum. Among these variants, ACN is the rarest and is seldom studied (1). AKs are benign vascular anomalies of the superficial vascular plexus that appear as dark red papules and plaques arranged either discretely or in clusters. ACN lesions are typically situated unilaterally on the lower limbs, especially on the legs and feet, but can occasionally occur elsewhere. Lesions are generally noted in early childhood. The early lesions are flat and reddish in color, while older lesions become increasingly studded and acquire a verrucous or warty surface. There is no tendency of spontaneous improvement, and minor traumas can easily cause beading and infection (2). While the plaques were linear in disposition in most of the cases reported in the literature, a peculiar feature of our case was the isolated, round, and giant appearance of the plaque. Even though ACN is not typically associated with other abnormalities, coexistence with other vascular malformations has been reported in some cases, including AK of Fordyce, Cobb syndrome, Klippel-Trenaunay syndrome, nevus flammeus, infantile hemangioma, and traumatic arteriovenous fistula (3). From a histological point of view, ACN appears as dilated dermal papillary capillaries drained by dilated venules. The overlying epidermis shows a variable degree of acanthosis, papillomatosis, and compact hyperkeratosis. Typically, the deep dermis and hypodermis are not involved, helping distinguish them from verrucous hemangioma (4). Lichen simplex chronicus, verrucous carcinoma, and verrucous melanoma must also be considered in the differential diagnosis (5). Recurrent bleeding or cosmetic reasons are common indications for treatment. Surgical excision represents the most effective option. Other possibilities include diathermy, electrocautery, cryosurgery, or laser (6). In our case, there was no macroscopic residual disease after the shaving biopsy. A collagen dressing was applied, and the wound underwent second intention healing in three weeks. There was no evidence of local recurrence after 18 months. References: Das A, Mondal AK, Saha A, Chowdhury SN, Gharami RC. Angiokeratoma circumscriptum neviforme: An entity, few and far between. Indian Dermatol Online J. 2014;5:472-4. Mittal R, Aggarwal A, Srivastava G. Angiokeratoma circumscriptum: a case report and review of the literature. Int J Dermatol. 2005;44:1031-4. Wankhade V, Singh R, Sadhwani V, Kodate P, Disawal A. Angiokeratoma circumscriptum naeviforme with soft tissue hypertrophy and deep venous malformation: A variant of Klippel-Trenaunay syndrome? Indian Dermatol Online J. 2014;5(Suppl 2):S109-S112. Oppermann K, Boff AL, Bonamigo RR. Verrucous hemangioma and histopathological differential diagnosis with angiokeratoma circumscriptum neviforme. An Bras Dermatol. 2018;93:712-5. Goldman L, Gibson SH, Richfield DF. Thrombotic angiokeratoma circumscriptum simulating melanoma. Arch Dermatol. 1981;117:138-9. del Pozo J, Fonseca E. Angiokeratoma circumscriptum naeviforme: successful treatment with carbon-dioxide laser vaporization. Dermatol Surg. 2005;31:232-6.

Case Report: Cutaneous Leishmaniasis Misdiagnosed as Pyoderma Gangrenosum.

With an estimated prevalence of 0.7%, pyoderma gangrenosum (PG) is the most frequent type of reactive skin lesions seen in the setting of inflammatory bowel disease, together with metastatic Crohn's disease. However, in the case of persistent cutaneous ulcerations in patients with Crohn's disease under biologic and/or immunosuppressive therapy, infectious or malignant etiologies should be excluded. We report a case of multiple difficult-to-treat skin ulcerations due to Leishmania in a patient with Crohn's disease treated with antitumor necrosis factor-alpha drugs, misinterpreted for a long time as PG.

Syphilis as osteomyelitis of the fifth metatarsal of the left foot: the great imitator hits once again.

INTRODUCTION: We report an unusual case of osteomyelitis of the left foot due to syphilitic bone involvement. CASE PRESENTATION: A 73-year-old man came to our attention with a four-month history of fever and a hypertrophic ulceration of the fifth metatarsal of the left foot. He had a history of syphilis treated years before. The CT scan showed an evident osteolytic area of the metatarsal phalangeal joint of the fifth left toe. The serological tests demonstrated a syphilitic reinfection. On suspicion of a bone localization of syphilis, an US-guided bone biopsy was performed. The histological examination with silver impregnation confirmed the diagnosis. The patient was treated with the traditional treatment of syphilis using penicillin, obtaining the complete resolution of the radiological and cutaneous alterations. CONCLUSIONS: The aim of this work is to sensitize clinicians to suspect syphilis in case of osteolytic lesions in patients with a history of this disease.