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BACKGROUND: Studies assessing the association between coeliac disease (CD) and psoriasis show conflicting results. OBJECTIVE: To assess in the primary care setting the prevalence of CD in patients with psoriasis and the response to a gluten-free diet (GFD) in subjects with psoriasis and CD. METHODS: We enrolled 218 patients with psoriasis and 264 controls. Coeliac screening was carried out in all subjects (Eurospital, Trieste, Italy). In subjects with a positive serology, the diagnosis of CD was confirmed histologically. RESULTS: Nine (4.1%) psoriatic patients had positive anti-tissue transglutaminase antibodies compared to only 1 among controls (0.4%, p < 0.05; OR 2.03, 95% CI 1.42-90.11). The diagnosis of CD was confirmed histologically in all 10 subjects. At 6 months GFD was associated with a great improvement of skin lesions in 7 out of 8 patients with psoriasis. CONCLUSION: Our multicentre primary care study showed an high prevalence of CD in psoriasis and an improvement of skin lesions in CD under GFD.
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Enfermedad Celíaca/dietoterapia , Enfermedad Celíaca/epidemiología , Dieta Sin Gluten , Psoriasis/dietoterapia , Adulto , Anciano , Autoanticuerpos/sangre , Estudios de Casos y Controles , Enfermedad Celíaca/diagnóstico , Femenino , Proteínas de Unión al GTP/inmunología , Humanos , Italia/epidemiología , Masculino , Persona de Mediana Edad , Prevalencia , Proteína Glutamina Gamma Glutamiltransferasa 2 , Psoriasis/sangre , Psoriasis/epidemiología , Transglutaminasas/inmunologíaRESUMEN
The aim of this study was to assess quality of life in patients with scalp dermatitis using the Italian version of the Scalpdex, and to validate the instrument in Italian. The survey was conducted in outpatients with psoriasis, seborrhoeic dermatitis, alopecia, or follicular lichen. Data were completed on 194 patients, 78% of whom had psoriasis. Scalpdex scores were always higher in women than in men, and in younger people compared to elderly people. The most frequent items were: being ashamed, embarrassed, bleeding scalp, feeling self-conscious, bothered that the condition is incurable, having the choice of colour of clothes affected, having a negative effect on daily life. The Italian Scalpdex showed good internal consistency, test-retest reliability, convergent validity, and responsiveness. In conclusion, the Italian version of the Scalpdex is a useful instrument to measure quality of life in patients with a scalp condition.
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Alopecia/diagnóstico , Dermatitis Seborreica/diagnóstico , Liquen Plano/diagnóstico , Psoriasis/diagnóstico , Calidad de Vida , Dermatosis del Cuero Cabelludo/diagnóstico , Encuestas y Cuestionarios , Adulto , Alopecia/psicología , Dermatitis Seborreica/psicología , Femenino , Humanos , Italia , Liquen Plano/psicología , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Psoriasis/psicología , Reproducibilidad de los Resultados , Dermatosis del Cuero Cabelludo/psicología , Índice de Severidad de la Enfermedad , Factores de Tiempo , TraducciónRESUMEN
Photodynamic therapy (PDT) with methyl aminolevulinate (MAL) has been suggested as a useful treatment option in a number of skin tumors, other than approved indications, and infections. However, evidence is poor because it is mainly supported by isolated case reports or small case series, often with conflicting results. To assess the effectiveness, tolerability and safety of off-label MAL-PDT in daily clinical practice in 20 Italian hospitals, a retrospective observational study of medical records of patients treated for off-label oncologic and infectious skin conditions was carried out. In all patients standard treatment options had been either ineffective, unacceptably toxic, or medically contraindicated. Clinical data from 145 patients were analyzed. Actinic cheilitis showed a complete remission (CR) in 27 out of 43 treated patients and CR was maintained at follow-up. CR was registered in 3 of 8, 5 of 8 and 10 of 17 treated patients who were affected by extra-mammary Paget's disease (EMPD), erythroplasia of Queyrat (QD), and invasive squamous cell carcinoma (SCC), respectively. Five out of 19 patients with cutaneous T cell lymphoma had a complete remission. Cutaneous B-cell lymphoma, malignant fibrous histiocytoma, mastocytosis and nevus sebaceous were not responsive. Warts were treated in 30 patients and 15 had a complete remission. However, periungueal and plantar lesions were much more responsive than flat and common lesions. Condylomata showed a CR in 2 out of 5 male patients but treatment was painful. Bowenoid papulosis showed only a partial improvement. Atypical mycobacteriosis and chronic cutaneous leishmaniasis were successfully treated. Submammary candidal intertrigo and interdigital intertrigo with Pseudomonas aeruginosa did not improve. Among off-label oncological uses of MAL-PDT, the therapy of actinic cheilitis was the most investigated and showed the best results. In addition, MAL-PDT was used successfully in the majority of patients with QD, EMPD and invasive SCC. Treatment of specific cutaneous infections was well tolerated and gave a good therapeutic result in a few patients, but it does not seem to give substantial advantages over conventional treatment options.
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Ácido Aminolevulínico/análogos & derivados , Fármacos Fotosensibilizantes/uso terapéutico , Enfermedades de la Piel/tratamiento farmacológico , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Ácido Aminolevulínico/uso terapéutico , Femenino , Humanos , Italia , Luz , Masculino , Persona de Mediana Edad , Fotoquimioterapia , Estudios Retrospectivos , Resultado del Tratamiento , Adulto JovenRESUMEN
Experimental investigations have demonstrated that photodynamic therapy (PDT) with methyl aminolevulinate (MAL) may be a useful treatment in several inflammatory skin disorders and aesthetic indications. To assess the effectiveness, tolerability and safety of off-label MAL-PDT in daily clinical practice in 20 Italian hospital centers, a retrospective observational study of medical records of patients treated for off-label inflammatory and aesthetic indications was carried out. In all patients standard treatment options had been either ineffective, unacceptably toxic, or medically contraindicated. Clinical data regarding 221 patients affected by 22 different diseases were collected. The most common off-label indication was acne vulgaris, with >75% improvement in 72.8% of patients. Other disorders of the sebaceous gland, i.e. acne rosacea, hidradenitis suppurativa and sebaceous hyperplasia, were less responsive. Alopecia areata did not show any improvement. Granuloma annulare and necrobiosis lipoidica showed marked or moderate response in the majority of treated patients. The rate of patients with complete remission was lower for inflammatory skin disorders with hyperkeratosis, i.e. psoriasis (6/17) and porokeratosis (3/16). The efficacy for lichenoid dermatoses was dependent on the clinical variant (erosive and scleroatrophic were more responsive than hypertrophic). Only 1 of 6 patients with Zoon balanitis had a marked improvement. MAL-PDT of venous leg ulcers, photo-aging and hypertrophic scars led to a marked remission in 3/5, 3/6 and 5/8 patients, respectively. The treatment had to be interrupted because of strong pain and burning in 24 patients. Long term adverse events were not registered. Most patients with marked improvement had lasting remission with overall excellent cosmetic outcomes. The present findings demonstrate a high interest in off-label uses of MAL-PDT for inflammatory skin disorders. According to the observed clinical responses, safety, and favorable cosmetic results, MAL-PDT seems to have a potential therapeutic role for the treatment of granulomatous dermal disorders and follicular inflammatory diseases whereas results in other conditions are less encouraging.
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Ácido Aminolevulínico/análogos & derivados , Fármacos Fotosensibilizantes/uso terapéutico , Enfermedades de la Piel/tratamiento farmacológico , Acné Vulgar/tratamiento farmacológico , Acné Vulgar/epidemiología , Adulto , Anciano , Anciano de 80 o más Años , Ácido Aminolevulínico/uso terapéutico , Femenino , Humanos , Italia , Luz , Masculino , Persona de Mediana Edad , Fotoquimioterapia , Estudios Retrospectivos , Enfermedades de la Piel/epidemiología , Resultado del TratamientoRESUMEN
Background: Topical chlormethine (CL) is recommended as a first-line treatment for early-stage mycosis fungoides (MF) and in 2017, the European Medicines Agency approved the CL gel formulation to treat adult patients. More recently, to increase patient compliance and adherence, clinicians have developed flexible protocols that allow the concomitant use of CL gel with topical corticosteroids in daily practice regimens. Therefore, sharing real-life data on CL gel use and side effects management may help improve the use of this agent. Objectives: To expand knowledge about the actual use of CL gel in patients with MF, the present study assessed the improvement of MF skin lesions after CL gel treatment and provided information on the management of cutaneous adverse events (AEs) in a real-life setting. Methods: This was an Italian retrospective study conducted among six dermatology referral centers. Patients ≥18 years affected by MF and in treatment with CL gel (160 µ/g), alone or in combination according to routine clinical practice, between December 2019 and December 2021 were considered. The study's primary aim was to evaluate the effectiveness of CL gel in terms of overall response rate (ORR) after 3 months of treatment. Results: A total of 79 patients (61% male) with different stages of MF (84% early stage) were included. CL gel was prescribed mainly in association with topical corticosteroids (66% of patients). ORR after 3 months of treatment was 42%, with no differences between early- and advanced-stage MF. Response rates improved over time up to 97% after 18 months of treatment. Overall, 66 AEs were reported in 67% of patients; most were hyperpigmentation (45%) and irritant contact dermatitis (37%). Six AEs led to treatment discontinuation, and five out of six (83%) patients who reported these events resumed treatment after interruption. No AEs were classified as severe. Conclusions: Our observations support the use of CL gel in patients with early- and advanced-stage MF, making it a valuable treatment option.
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Previous studies have reported that repeated solar and artificial UVB (280-320 nm) and UVA (320-400 nm) exposures can modify acquired melanocytic nevi (AMN). We therefore investigated the clinical, dermoscopic, histological and immunohistochemical changes in AMN exposed to UVB and UVA radiation. Twenty healthy volunteers with at least three AMN on the trunk were enrolled in the present study and randomized into two groups to receive equally effective doses of narrow-band (NB)-UVB or UVA1. Three exposures per week were delivered for a total of 4 weeks. During exposures, one AMN was left unprotected, a second one was shielded with an opaque adhesive tape and the third nevus was covered with a commercial sunscreen. After the irradiation cycle, the AMN were surgically removed and underwent histological and immunohistochemical assessment of melanocyte/melanogenesis-related proteins (MART-1, tyrosinase, HMB-45), cell cycle activation markers (Ki-67, topoisomerase IIalpha, p53, Cdk2) and transcription factors (microphthalmia-associated transcription factor, STAT3). Nevi that were exposed to NB-UVB or UVA1 also showed statistically significant increase in size and changes in their dermoscopic features, including overall darkening, increased pigment network expression, formation of branched streaks, and increased number and size of brown globules and dots. AMN that had been covered with opaque tape or sunscreen did not show changes in size or dermoscopic features following UVA1 or NB-UVB exposure. Histological and immunohistochemical analysis did not show any significant change in exposed AMN in comparison with AMN shielded with an opaque adhesive tape or covered with the sunscreen.
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Nevo Pigmentado/metabolismo , Nevo Pigmentado/patología , Piel/efectos de la radiación , Rayos Ultravioleta , Adulto , Anciano , Antígenos de Neoplasias/metabolismo , Quinasa 2 Dependiente de la Ciclina/metabolismo , ADN-Topoisomerasas de Tipo II/metabolismo , Proteínas de Unión al ADN/metabolismo , Dermoscopía , Femenino , Técnicas Histológicas , Humanos , Inmunohistoquímica , Antígeno Ki-67/metabolismo , Antígeno MART-1/metabolismo , Masculino , Antígenos Específicos del Melanoma/metabolismo , Factor de Transcripción Asociado a Microftalmía/metabolismo , Persona de Mediana Edad , Monofenol Monooxigenasa/metabolismo , Factor de Transcripción STAT3/metabolismo , Proteína p53 Supresora de Tumor/metabolismo , Antígeno gp100 del MelanomaRESUMEN
BACKGROUND: Narrowband (NB) ultraviolet (UV) B lamps are widely used for treatment and prophylaxis of several skin diseases. OBJECTIVE: We sought to assess the efficacy of two protocols of NB-UVB therapy for the prophylaxis of UVB-sensitive and UVB-insensitive solar urticaria (SU). METHODS: Subjects affected by SU underwent phototesting for assessment of the minimal erythemal dose and minimal urticarial dose. Patients without urticarial response to UVB underwent a single daily exposure every other day for 4 weeks (group A). Patients with a urticarial test response to broadband UVB or NB-UVB (group B) received 3 daily exposures (on working days) for the first week. Afterward, they were treated as the patients of group A for 3 weeks. Follow-up visits took place after 1 and 3 months. RESULTS: A total of 39 patients completed the study. In groups A (29 patients) and B (10 patients), the median total number of exposures was 12 (interquartile range [IQR]: 12; 15) and 25.5 (IQR 24; 27), respectively. The median total NB-UVB dose was 10.3 J/cm(2) (IQR 9.9; 11) for group A and 9.1 J/cm(2) (IQR 8.5; 10.6) for group B. At follow-up visits, patients reported good tolerance to the sun. LIMITATIONS: A direct comparison of NB-UVB with UVA or psoralen plus UVA for the photoprophylaxis of SU is still lacking. CONCLUSION: NB-UVB phototherapy was well-tolerated and effectively prevented SU relapses.
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Trastornos por Fotosensibilidad/radioterapia , Terapia Ultravioleta , Urticaria/radioterapia , Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Dosificación Radioterapéutica , Terapia Ultravioleta/métodos , Urticaria/etiología , Adulto JovenRESUMEN
BACKGROUND/PURPOSE: Polymorphous light eruption (PLE) heterogeneity has been postulated, but the existence of benign summer light eruption (BSLE) is controversial. We studied the prevalence of the clinical patterns, criteria distinguishing BSLE from PLE, and diagnostic usefulness of phototest. METHODS: Five Italian Photodermatology Centres recruited retrospectively 346 patients with typical clinical history and/or presentation of PLE. Age, gender, skin type, family history and presence of atopy were considered. UVA and UVB MEDs and provocative phototests with UVA and UVB were obtained with a standardized procedure. Photopatch tests were applied according to the IRCDG rules. ANA were assessed by indirect immunofluorescence. RESULTS: Four criteria (predominance of women, shorter latency, uninvolvement of the face and absence of relapse during summer) identified BSLE in only 6.1% of cases. All had positive phototests, mostly with UVA. Uninvolvement of face, short latency and no seasonal relapses identified 11.7% patients, mostly with positive phototests to UVA. Short latency and no seasonal relapses in women identified 11.2% patients. Uninvolvement of face and no seasonal relapses in women identified 8.1% of patients. Uninvolvement of face and short latency in women identified 17.6% of patients. CONCLUSION: Criteria diagnosed BSLE in only a minority of patients, who were positive at phototesting, mostly with UVA.
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Trastornos por Fotosensibilidad/diagnóstico , Luz Solar/efectos adversos , Rayos Ultravioleta/efectos adversos , Adulto , Eritema/epidemiología , Femenino , Humanos , Italia/epidemiología , Masculino , Persona de Mediana Edad , Trastornos por Fotosensibilidad/epidemiología , Prevalencia , Dosis de Radiación , Adulto JovenRESUMEN
Angioedema is a hereditary or acquired disease characterized by localized non-pitting swelling of the subcutaneous tissue which can affect either skin or mucous membranes. Acquired angioedema can often be related to a heterogeneous group of etiological factors including physical stimuli, although up to 38% of cases remain idiopathic. We describe 5 patients who developed an angioedema following sun exposures. All patients reported an intensely stinging angioedema strictly limited to face and extremities, when exposed to solar light. Urticarial wheals were never observed or reported by patients, and oral antihistamines proved to be of no help in preventing or improving the condition of lesions. Laboratory and phototesting data allowed ruling out all other acquired or inherited diseases characterized by photosensitivity. We propose that solar angioedema should be considered a novel clinical entity.
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Angioedema/etiología , Trastornos por Fotosensibilidad/fisiopatología , Luz Solar/efectos adversos , Adolescente , Adulto , Edad de Inicio , Niño , Femenino , Humanos , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Trastornos por Fotosensibilidad/terapiaRESUMEN
Merkel cell carcinoma (MCC) is an aggressive neuroendocrine tumour of the skin. Though immunodeficiency is the most relevant risk factor, ultraviolet (UV) radiation is also involved, but as of yet we do not know the action spectrum, pattern or dose which would produce a dangerous exposure. A retrospective study of two immunosuppressed patients who developed MCC during, or soon after a treatment cycle with high dose UVA1 exposures was conducted, in order to understand wether repeated exposures to suberythemogenic UVA1 radiation may have a cancerogenic activity provoking MCC in immunosuppressed patients.
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Carcinoma de Células de Merkel/etiología , Huésped Inmunocomprometido/efectos de la radiación , Neoplasias Cutáneas/etiología , Rayos Ultravioleta/efectos adversos , Terapia Ultravioleta/efectos adversos , Anciano , Carcinoma de Células de Merkel/patología , Carcinoma de Células de Merkel/cirugía , Femenino , Humanos , Persona de Mediana Edad , Neoplasias Cutáneas/patología , Neoplasias Cutáneas/cirugíaRESUMEN
BACKGROUND: Secondary syphilis is a diagnostic challenge that relies on microscopic and laboratory tests. OBJECTIVE: We sought to assess the usefulness of in vivo reflectance confocal microscopy (RCM) to detect Treponema pallidum in lesions suggestive of secondary syphilis. METHODS: Macular and papular skin lesions from 3 patients clinically suggestive of secondary syphilis were imaged by RCM and confirmed by skin punch biopsy. RESULTS: In all lesions RCM demonstrated elongated small bright particles with a spiral shape intermingled with the keratinocytes. These features corresponded with immunohistochemical findings that revealed several spirochetes infiltrating the epidermis. LIMITATIONS: Unlike immunohistochemistry, RCM did not visualize T pallidum in the dermis and vascular walls because of limited imaging depth. The specificity and sensitivity of this technique need to be assessed. CONCLUSION: RCM may be an effective diagnostic tool for in vivo real-time imaging of T pallidum in skin lesions of secondary syphilis, and seems to correlate well with immunohistochemistry.
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Microscopía Confocal/métodos , Sífilis Cutánea/microbiología , Sífilis Cutánea/patología , Treponema pallidum/aislamiento & purificación , Adulto , Femenino , Humanos , MasculinoRESUMEN
BACKGROUND: Efalizumab, albeit highly efficient in psoriasis treatment, displays a slower rate of clearance when compared to anti-tumor-necrosis-factor-alpha drugs. It has been suggested that a combination of treatments might accelerate efalizumab response. OBJECTIVE: To determine whether the combination of narrow-band ultraviolet B (NB-UVB) phototherapy and efalizumab could improve the therapeutic efficacy of efalizumab alone in moderate to severe psoriasis. methods: Ten patients underwent a treatment cycle with a whole-body NB-UVB phototherapy (3 sessions a week) during the first 4 weeks of a 6-month treatment with efalizumab at 1 mg/kg body weight/week. In addition, one of two similar plaques, selected for each patient, was shielded during phototherapy. RESULTS: A statistically significant reduction of the psoriasis severity index score was observed at 4 weeks in the irradiated plaque. A Psoriasis Area and Severity Index 75 was achieved by 70% of patients by week 12 as compared to 22-39% reported in the literature. CONCLUSION: This pilot study indicates that the combination with NB-UVB improves the efficacy of efalizumab monotherapy in the treatment of moderate to severe psoriasis.
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Anticuerpos Monoclonales/administración & dosificación , Psoriasis/terapia , Terapia Ultravioleta , Adulto , Anticuerpos Monoclonales Humanizados , Antígenos CD11 , Terapia Combinada , Femenino , Humanos , Inyecciones Subcutáneas , Masculino , Persona de Mediana Edad , Proyectos Piloto , Psoriasis/patologíaRESUMEN
Reflectance confocal microscopy (RCM) is a novel noninvasive technique for "in vivo" examination of the skin. In a confocal microscope, near- infrared light from a diode laser is focused on a microscopic skin target. As this light passes between cellular structures having different refraction indexes, it is naturally reflected, and this reflected light is then captured and recomposed into a two-dimensional gray scale image by computer software. Focusing the microscope (adjusting the focal point on the z-axis) allows images to be obtained of different levels within the skin. Commercially available microscope systems of this type can create images with enough detail for use in histological analysis. The first investigations using these microscopes served to identify the appearance of the various cell populations living in the different layers of normal skin. Today, the main interest has become focused on the use of these microscopes as a diagnostic tool: a means of investigating benign and malignant tumors of melanocytes and keratinocytes, and, more importantly, the findings of this field of study can be used to develop a diagnostic algorithm which would be not only highly sensitive but specific as well. The aim of the paper is to provide an updated literature review and an in-depth critique of the state-of-the-art of RCM for skin cancer imaging with a critical discussion of the possibilities and limitations for clinical use.
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Microscopía Confocal/instrumentación , Microscopía Confocal/métodos , Piel/citología , Humanos , Melanoma/patología , Neoplasias Cutáneas/patologíaRESUMEN
PURPOSE:: To analyze clinical outcome, local response, survival and toxicity in patients with primary cutaneous lymphoma (PCL) treated with radiotherapy. METHODS:: From 1995 to 2014, 112 patients were treated. B-cell lymphomas (CBCLs; n = 86) and T-cell lymphomas (CTCLs; n = 23) were analyzed separately. Clinical and therapeutic characteristics (age, sex, histology, primary treatment and radiotherapy modality) were related to response to treatment, survival and toxicity. RESULTS:: CBCLs were divided into 4 subgroups: marginal-zone lymphoma (n = 20), follicle center lymphoma (n = 32), diffuse large-cell lymphoma (DLBCL; n = 22) and DLBCL-leg type (n = 12). No significant correlation was found between doses and systemic treatments, extent of biopsy and number of lesions. DLBCL-leg type patients were older (p = 0.05), had disseminated disease (p = 0.034), and more frequently had local (p = 0.01) or systemic recurrence (p = 0.05). CTCLs were divided into 4 subgroups: α/ß CTCL (n = 3), nasal type CTCL (n = 0), γ/δ CTCL (n = 10) and mycosis fungoides (n = 10). Longer disease-free survival was observed in patients obtaining complete remission (p<0.001). CONCLUSIONS:: Radiotherapy is feasible, safe and effective for localized PCLs. The choice of dose is related to histological subgroups and the related prognoses. Survival results are very good also in relapsing disease. In advanced cutaneous lymphoma radiotherapy alone has mainly a role in symptom palliation.
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Linfoma de Células B/patología , Linfoma de Células B Grandes Difuso/patología , Linfoma de Células T/patología , Guías de Práctica Clínica como Asunto/normas , Neoplasias Cutáneas/patología , Anciano , Femenino , Estudios de Seguimiento , Humanos , Linfoma de Células B/terapia , Linfoma de Células B Grandes Difuso/terapia , Linfoma de Células T/terapia , Masculino , Estudios Retrospectivos , Neoplasias Cutáneas/terapia , Tasa de Supervivencia , Resultado del TratamientoAsunto(s)
Eosinofilia/inducido químicamente , Fascitis/inducido químicamente , Factores Inmunológicos/efectos adversos , Natalizumab/efectos adversos , Eosinofilia/diagnóstico por imagen , Eosinofilia/patología , Fascitis/diagnóstico por imagen , Fascitis/patología , Humanos , Masculino , Persona de Mediana Edad , Esclerosis Múltiple/tratamiento farmacológico , UltrasonografíaRESUMEN
We describe the case of a young male affected by chronic pustular psoriasis of the lips that remained the only manifestation of acrodermatitis continua of Hallopeau (ACH) for years before the onset of the characteristic hand lesions.
RESUMEN
Sequential therapy may improve the efficacy and safety of single treatments for severe psoriasis. We compared sequential Cyclosporin A and narrow-band UVB phototherapy versus narrow-band UVB phototherapy alone. A group of 30 patients with severe psoriasis received 3 mg/kg/day Cyclosporin A for 4 weeks. Afterwards, Cyclosporin A was rapidly tapered and phototherapy begun. An additional 30 patients received phototherapy alone. Treatments were given until psoriasis cleared or until partial improvement was achieved without further amelioration despite another week of treatment. Both treatments were highly effective and well tolerated but sequential therapy was more effective in lesions of UV-shielded body areas; itching disappeared more quickly. The cumulative narrow-band UVB dosages and number of exposures were lower. No difference was seen at follow-up extended up to 9 months. Sequential therapy was well tolerated and allowed for the reduction of narrow-band UVB dosage and exposures, quick relief of itching and improvement of UV-shielded lesions.