Are Anti-TNF-α Agents Safe for Treating Psoriasis in Hepatitis C Virus Patients with Advanced Liver Disease? Case Reports and Review of the Literature.

Tumor necrosis factor-alpha (TNF-α) inhibitors represent an effective treatment for severe psoriasis in hepatitis C virus (HCV) patients. The literature reports mainly on short-term treatment in patients with chronic hepatitis with minimum-to-moderate activity with an acceptable safety profile. We report the first 2 cases of hepatocellular carcinoma (HCC) arising in HCV psoriatic patients with advanced liver disease during long-term treatment with etanercept. Our first patient, known to have had HCV infection for 41 years, developed an HCC after 21 months of therapy with etanercept (50 mg/week). The second patient, HCV+ for 20 years, was treated for 58 months with the same therapy, and despite no signs of liver function impairment was diagnosed with HCC. Both of them presented with cirrhosis, which was diagnosed 9 and 5 years earlier, respectively. It remains to be clarified whether there is any connection between psoriasis treatment with anti-TNF-α agents and the development of HCC in HCV-infected patients. Further long-term, follow-up studies and registries of HCV patients with mild/moderate activity may contribute to clarify this issue.

Comparative study of trichloroacetic acid vs. photodynamic therapy with topical 5-aminolevulinic acid for actinic keratosis of the scalp.

BACKGROUND: Photodynamic therapy with 5-methyl-aminolevulinate and photodynamic therapy with trichloroacetic acid 50% are the two techniques utilized in the management of actinic keratosis. This study was planned to compare the efficacy, adverse effects, recurrence and cosmetic outcome of these option therapies in patients with multiple actinic keratosis of the scalp. METHODS: Thirteen patients with multiple actinic keratosis were treated with one of the two treatments on half of the scalp at baseline, while the other treatment was performed on the other half 15 days apart, randomly. Efficacy, adverse effects, cosmetic outcome and recurrence were recorded at follow-up visit at 1, 3, 6 and 12 months. RESULTS: Photodynamic therapy with 5 methyl-aminolevulinate was more effective than trichloroacetic acid although less tolerated by patients as it was more painful. Early adverse effects were almost the same even if trichloroacetic acid leads also to crust formation and to a worse cosmetic outcome characterized by hypopigmentation. Recurrence was lower in the area treated with photodynamic therapy. CONCLUSION: Trichloroacetic acid 50% is less effective than photodynamic therapy with 5 methyl-aminolevulinate in the treatment of multiple actinic keratosis of the scalp although better tolerated by patients. As this technique is less painful and less expensive than photodynamic therapy, we hypothesize and suggest that more sequential treatments could lead to better results.

Recessive bullous dermolysis of the newborn in preterm siblings with a missense mutation in type VII collagen.

Bullous dermolysis of the newborn is a dominant or recessive inherited subtype of dystrophic epidermolysis bullosa characterized by the tendency to spontaneously stop blistering within the first months of life. Here we report two siblings with bullous dermolysis of the newborn who were born prematurely and have a novel recessive mutation, p.Pro2259Leu, in the triple helix domain of type VII collagen. We discuss the possible relationship between genotype and prematurity and clinical manifestations in these patients.

Unusual form of cutaneous infiltration by cancer.

Breast cancer is the most common visceral neoplasm which metastatizes in skin. Skin infiltration by breast cancer may appear as various types of neoplastic/inflammatory lesions, including plaques, pigskin-like areas, scirrhous morphea-like lesions, nodules, zosteriform lesions, and papulovescicles. An unusual form of cutaneous infiltration involving a mammary region bearing a post-mastectomy surgical skin scar is herein described: interestingly, such a cutaneous cancer involvement could not be included in the above classification, because it merely consisted of red-purple areas dealing with small telangiectasias, without any sign of inflammation.

Plantar melanoma that mimics melanocytic nevi: a report of 4 cases with lymph node metastases and with review of positive and negative controls.

We report 4 cases of melanoma localized on the sole with some striking histological similarities to the compound nevi. One case showed inguinal lymph node metastases after a diagnosis of compound nevus made 5 years earlier. The other 3 cases were sent to us in consultation as suspected plantar lesions; a diagnosis of melanoma mimicking compound nevus was proposed: the sentinel lymph node technique was accordingly performed and resulted positive. These 4 index cases were compared with 26 cases of ordinary plantar melanoma and with 117 cases of benign compound plantar nevi. Histologically, the similarity of areas of these 4 cases of plantar melanoma to compound plantar nevi (namely Miescher, Clark, or acral lentiginous nevus) is so close that it may prove misleading in the diagnostic pathway. In such cases, an erroneous diagnosis of benign lesion may be made. The correct diagnosis of melanoma can, however, be done by combining the clinical and pathological findings. In fact, this deceptive form of melanoma mimicking a compound nevus is characterized by patients' advanced age (>45 years), large lateral diameters (>10 mm), and significant depth of the lesion (>1 mm). In our 4 cases, such features were combined with one or more of the following histological clues: lentiginous (ie, continuous) proliferation of enlarged and hyperchromatic melanocytes aligned in single units at the dermoepidermal junction; extensive eccrine duct melanocytic infiltration; dermal melanocytes with slight nuclear enlargement, nuclear membrane thickening and folding, and conspicuous central nucleoli; and cellular pleomorphism of the epidermal and dermal component. Moreover, mitotic figures were an inconstant but decisive indication of malignancy. In conclusion, a small group of plantar melanoma has striking similarities with compound nevi. Only the correlation of clinical data (old age of the patient and large size of the lesion) with subtle architectural and cytological alterations (depth of the lesion, lentiginous melanocytic epidermal and eccrine proliferation, and cellular alteration and mitoses) allows a correct diagnosis.

Sclerosing nevus with pseudomelanomatous features.

BACKGROUND: Among the pigmented lesions with a central area of scar, we found a group of cases histologically characterized by striking architectural alteration of the melanocytic component, but with no cytological atypia and mitotically quiescent. The aim of the current study was to assess the biological nature of such lesions. METHODS: We selected 19 of these melanocytic neoplasms that had the following characteristics: (a) a clinically evident whitish central area suggestive of regression (with no history of a previous surgical procedure or trauma), (b) histological features of fibrous scar-like tissue at the center of the lesion, (c) the presence of large, confluent and unusually shaped melanocytic nests at the dermoepidermal junction and in the dermis, (d) a pagetoid spread of melanocytes above the epidermal basal layer and (e) remnants of nevus tissue at the border of the scar. The lesions showed no evidence of cytological atypia, expansive nodules of melanocytes, significant numbers of mitoses or cellular necrosis. RESULTS: All the cases have been followed up and none have recurred or metastasized. Histologically, these neoplasms have important similarities with the so-called recurrent nevus, nevi on lichen sclerosus and nevi developed during or following cutaneous inflammatory and sclerosing processes. The origin of the scar in each case was obscure but was probably related to minor unnoticed trauma or to chronic friction on a nevus. In few cases, the fibrosis was probably the result of partial regression of the nevus or a sequel to folliculitis. The pseudomelanomatous features appear to be related to the presence of the scar, as already reported for nevi that are involved in fibrotic or scarring processes. In our study, the nevi involved in the fibrotic process were congenital nevi and common or dysplastic nevi. One case was a Spitz nevus. CONCLUSIONS: From our data we concluded that, despite their worrisome clinical and histological aspect, the lesions described in this case series were most probably benign melanocytic nevi, involved by a fibrotic process combined with pseudomelanomatous proliferation. The lack of cytological atypia, mitoses and expansive nodules allowed us to differentiate these lesions from regressing melanomas.

Notalgia paresthetica: factors associated with its perceived severity, duration, side, and localization.

BACKGROUND: Notalgia paresthetica (NP) is a disorder characterized by pruritus localized to the patient's back. Little is known about predictors of severity, duration, side, and localization. OBJECTIVE: To identify factors associated with perceived severity, duration, side, and localization of NP. METHODS: In a cross-sectional study, disease severity, duration, side, and localization were compared among the considered variables. Multivariate analysis was used to assess each variable contribution in predicting disease severity and its duration. RESULTS: Sixty-five patients were recruited. Disease involved more female than male patients (Female/Male: 1.6) and after adjusting for all potential confounders, it was perceived as more severe in females (OR = 7.3, 95% CI = 2-26.3, P < 0.01). NP was reported more frequently on the right side among patients sleeping on the left side and conversely (P < 0.05). A higher disease duration was significantly linked to a higher body mass index (OR = 4.8, 95% CI = 1.3-17.1, P < 0.05). CONCLUSION: Our study linked female gender to worse disease severity, a higher body mass index to longer disease duration, and prevailing sleep position to NP side expression. The sleeping position should be considered a possible target for treating the disease.

Advances in the treatment options for vitiligo: activated low-dose cytokines-based therapy.

INTRODUCTION: Vitiligo is a skin disorder characterized by a progressive depigmentation, which is caused by the loss of melanocytes at the cutaneous level. A shift of the immune system with a prevalence of T helper (Th)1/Th17 response instead of a Tregs/Th2 one and may be part of etiology of 10 vitiligo. AREAS COVERED: This review describes the major points of vitiligo onset and shows the cutting-edge results in the field of low-dose medicine in the treatment of dermatologic diseases and, in particular. in vitiligo. In this review on advances in vitiligo pharmacotherapy, the most pertinent recent publications are reported. Electronic databases such as PubMed were searched for terms 'low-dose medicine' or 'low dose and vitiligo' or 'low dose and psoriasis.' EXPERT OPINION: The availability of a systemic treatment for vitiligo, based on the oral administration of low-dose activated signaling molecules represents an opportunity for the dermatologists to overcome some specific pitfalls of currently available therapeutic protocols.

Protective effects of oral antioxidants on skin and eye function.

BACKGROUND: Antioxidants applied topically and/or taken systemically may play an important role in counteracting the oxidative injury to lipids and proteins on the skin and eye that are provoked by radical oxygen species. OBJECTIVE: The aim of the study was to control photoprotective activity of the skin and eye through the use of oral antioxidants in 50 smoker volunteers (10 cigarettes/d) aged between 25-36 years and affected by dry skin. METHODS: Oxidative stress was assessed by a randomized double-blind study, and the ROS-Meter System (Dermotech, Rome, Italy). Global visual function was determined by the use of different visual surveillance tests. RESULTS: A 40% decrease of oxidative stress in blood serum was verified, with a clear relationship between global visual function and the oral intake of an oxygenated carotenoid (lutein). CONCLUSIONS: Carotenoids used as nutritional supplements seem to play an interesting photoprotective role for both skin and eyes, eventually increasing the activity of topical sunscreens.

Pigmented epithelioid melanocytoma: report of a case with favourable outcome after a 4-year follow-up period.

BACKGROUND: Pigmented epitheliod melanocytoma (PEM) is a uncommon melanocytoma with unique histopathological features and possibly with a favourable prognosis, because, although sentinel lymph-node metastases may occur, in the great majority of cases described up to now there is no spread beyond regional lymph-nodes. The nature of PEM, its biologic behaviour and its relationships to naevi and melanoma, however, remain to be clearly established, and several Authors suggest that further cases of PEM with long follow-up should be published, in order to better assess the biologic/prognostic characteristics of PEM. METHODS AND RESULTS: We report a new case of PEM, dealing with an oval, regularly marginated, darkly pigmented, asymptomatic nodule. The dermoscopic pattern showed a homogeneous blue-black pigmentation, without any other dermoscopic sign. The histopathologic analysis showed both isolated and nested oval melanocytes at the junctional level, and a mixture of epitheliod and spindle melanocytes, heavily pigmented, together with numerous melanophages in the dermis, with tendency to periadnexal distribution; cellular atypia was pronounced, but only occasional mitoses were identified in the superficial dermis. After a 4-year follow-up period after excision, no persistent lesion or metastases occurred. CONCLUSIONS: The present case suggests that PEM has a distinct histopathologic/diagnostic identity among melanocytic tumours. Although the up-to-now favourable outcome, however, our patient needs a large period of observation, and further studies with long follow-up are needed to better define the biologic/prognostic identity of PEM.

A phosphatidylcholine hyaluronic acid chitin-nanofibrils complex for a fast skin remodeling and a rejuvenating look.

BACKGROUND: The reduction of mortality worldwide has led older individuals to seek intervention modalities to improve their appearance and reverse signs of aging. OBJECTIVE: We formulated a medical device as innovative block-polymer nanoparticles based on phosphatidylcholine, hyaluronan, and chitin nanofibrils entrapping amino acids, vitamins, and melatonin. METHODS: Viability and collagen synthesis were controlled on fibroblasts ex vivo culture while adenosine triphosphate production was evaluated on keratinocytes culture. Subjective and objective evaluations were performed in vivo on selected volunteer patients. RESULTS: In accordance with our previous studies, both the in vitro and in vivo obtained results demonstrate the efficacy of the injected block-polymer nanoparticles in reducing skin wrinkling and ameliorating the signs of aging.