The use of skin needling for the delivery of a eutectic mixture of local anesthetics.

AIM: The use of skin needling is believed to aid the transdermal delivery of drugs, even if it is mostly used for skin collagen induction. The aim of this paper was to use skin needling, combined with a local anesthetic EMLA (eutectic mixture of lidocaine and prilocaine), as a way to enhance transdermal drug penetration and optimize the analgesic effects of common local anesthesia. METHODS: We recruited 15 patients. For each patient of our study we defined a skin area of 3 cm2 from two forearms: on one side, we used skin needling first and immediately thereafter applied the EMLA in occlusion for 60 minutes; on the other one, we only applied EMLA in occlusion for 60 minutes. Then, pain was induced in each patient's forearm by introducing a 27 G needle into the skin 4 mm deep three times. Lastly, pain sensation measures were registered and a middle value was calculated. RESULTS: When skin needling is used in conjunction with EMLA applied in occlusion for 60 minutes on skin forearms, the level of pain sensation registered was significantly reduced on a Visual Analogue Scale compared to the application of EMLA alone. CONCLUSION: The use of skin needling can improve the transdermal delivery of an emulsion-like eutectic mixture of local anesthetics (EMLA) and can introduce the use of this method for delivering topical molecules in dermatology.

Quality of life in alopecia areata: a disease-specific questionnaire.

BACKGROUND: Alopecia areata (AA) is an autoimmune disease affecting about 2% of the population, which has a considerable impact on quality of life (QoL). There are no disease-specific questionnaires to assess QoL in patients suffering from AA. OBJECTIVE: To validate a new disease-specific questionnaire for AA, named AA-QLI, and to compare the consequent Quality of Life Index (QLI) with the commonly known Dermatology Life Quality Index (DLQI) to verify if it can provide a more comprehensive tool for patients. METHODS: A total of 50 patients affected by AA were administered both the AA-QLI, created by us, and the well-known DLQI. With the aim to detect suitable QLI, we propose to use two multivariate analyses: • a principal component analysis approach on the data collected with both questionnaires to compare their capability to measure the QoL; • a structural equation modelling on our AA-QLI to identify which category of symptoms mostly affects the QoL. RESULTS: The scores of both the questionnaires are quite close, except for a few cases. Statistical analysis shows a higher specificity of the AA-QLI for evaluating QoL. Among the three areas in which AA-QLI is divided, 'Relationship' has a major impact on the QLI, followed by 'Subjective symptoms'; 'Objective signs' has a lower weight on the QLI. CONCLUSION: AA-QLI is a good instrument to evaluate the real impact of AA on QoL. It can be helpful both for the physician and for the patient.

The effect of aminolevulinic acid photodynamic therapy on microcomedones and macrocomedones.

BACKGROUND: Photodynamic therapy (PDT) with aminolevulinic acid (ALA) has been shown to be an effective treatment for acne. However, the effect of ALA PDT on comedo formation has never been objectively evaluated. Cyanoacrylate follicular biopsy (CFB), a noninvasive procedure, has been proposed as the most reliable tool for studying follicular casts. OBJECTIVE: To determine the possible effect of ALA and red light (550-700 nm) on macro- and microcomedones in acne patients. PATIENTS AND METHODS: 10 patients with mild-to-moderate facial and/or chest/back acne resistant to conventional therapies received ALA PDT at 2-week intervals in 3 sessions. The severity of acne had been estimated by a system of points, the Global Acne Grading System. The patients underwent PDT utilizing ALA 10% (face) or 15% (back/chest) and red light (15 J/cm(2) each session). CFBs were performed. RESULTS: Four weeks after their last PDT session, the patients showed an average global score reduction of 50%. CFBs demonstrated a reduction in the total area, the average area and the density of macrocomedones. CONCLUSION: The results obtained in this study using CFB evaluation demonstrate that ALA PDT exerts an action on the comedogenic phase as well.

Evidence for a specific seminiferous tubular factor affecting follicle-stimulating hormone secretion in man.

The interaction of the testis and gonadotropin secretion was studied in 15 men surviving chemotherapy for lymphoma. Azoospermia and complete destruction of all testicular germinal elements were present in 10 of the 15 men; however, Sertoli cells and Leydig cells were present. In these 10 men plasma follicle-stimulating hormone (FSH) levels were fourfold higher than in normal men of similar age whereas luteinizing hormone (LH) levels were normal. In contrast, both FSH and LH were normal in the remaining five men. Three had a full complement of spermatogenic tissue on biopsy and normal sperm concentrations. The other two men were azoospermic; one demonstrated full spermatogenesis in 30% of his tubules; the other had only a few spermatogonia in all tubules. In those patients with lower levels of gonadotropins pituitary insufficiency was excluded by the demonstration of appropriate responsiveness of FSH and LH to clomiphene administration. Similarly, Leydig cell function was normal since plasma testosterone was within the normal range in 13 of the 15 men and only slightly decreased in two. Thus, following chemotherapy, testicular damage was restricted to the germinal tissue, and this in turn was associated with a selective increase in FSH. The source of the FSH inhibitor is either the Sertoli cell or early germinal elements. However, since FSH levels are only half as high as those reported for castrate men, other testicular factors may modify FSH secretion.

Treatment of Hodgkin's disease.

The available data support the hypothesis proposed by Smithers that Hodgkin's disease appears to be a systemic disorder of the lymphatic system. Standard treatments have been developed that cure approximately 70% of all patients who present to most institutions. Physicians should know the treatment approaches before proceeding with staging, because intelligent use of the best available treatment often obviates the need for staging laparotomy. At present, it is best that either chemotherapy or radiotherapy be used alone, except in patients who have massive mediastinal disease and for whom combinations of radiotherapy and combination chemotherapy are superior. Despite the long series of clinical trials conducted over the past two decades, no combination of four drugs has improved the results obtained with the original mechlorethamine-vincristine-procarbazine-prednisone program, when it is given in sufficient doses. It has been assumed that drug resistance of a specific type was the major reason for treatment failure. Attempts by physicians to overcome drug resistance, using alternating cyclical non-cross-resistant combination chemotherapy, have thus far not proved this approach to be superior to the use of a four-drug combination in full doses, and call into question this approach to testing the Goldie-Coldman hypothesis. Dose intensity has been a poorly controlled variable in virtually all clinical trials in Hodgkin's disease, and inadequate dosing may be the prime reason for treatment failure. This point has been highlighted by recent excellent results with marrow-ablative, high-dose chemotherapy and autologous bone marrow transplantation support for patients with very advanced "drug-resistant" disease. Investigators are now attempting to improve dose intensity by using more concentrated versions of standard drug combinations with colony-stimulating factors for support.

[Bromocryptin + gonadotropin vs. goserelin + gonadotropin in ovulation induction in patients with polycystic ovaries]. / Bromocriptina + gonadotropine vs goserelin + gonadotropine nell'induzione dell'ovulazione in pazienti con policistosi ovarica.

OBJECTIVE: To evaluate the efficacy and tolerability of treatment with goserelin + HMG vs bromocriptine + FSH + HMG in the induction of ovulation in patients with ovarian polycystosis. EXPERIMENTAL DESIGN: A randomized prospective study. PATIENTS: Sterile women with ovarian polycystosis of the first type not responding to clomiphene citrate. TREATMENT: Group A: bomocriptine + FSH + HMG (10 patients); Group B: goserelin depot (Zoladex) + HMG (18 patients). RESULTS: A greater percentage of ovulations, pregnancies and a higher success rate were obtained in Group B. The percentage of hyperstimulation was similar in both groups; there was a higher percentage of abortion in Group A. Cycle duration and the number of phials of gonadotropin were greater in Group B. CONCLUSIONS: Treatment with bromocriptine + gonadotropin remains the simplest; the treatment protocol based on geserelin depot + gonadotropin proved to be more efficacious.

Skin needling to enhance depigmenting serum penetration in the treatment of melasma.

Melasma is a common hypermelanotic disorder affecting the facial area which has a considerable psychological impact on the patient. Managing melasma is a difficult challenge that requires long-term treatment with a number of topical agents, such as rucinol and sophora-alpha. Aims. We aim to compare the combined treatment of skin needling and depigmenting serum with that using depigmenting serum alone in the treatment of melasma, in order to evaluate the use of microneedles as a means to enhance the drug's transdermal penetration. Methods. Twenty patients were treated with combined skin needling and depigmenting serum on one side of the face and with depigmenting serum alone on the other side. The outcome was evaluated periodically for up to two months using the Melasma Area Severity Index score and the Spectrocolorimeter X-Rite 968. Results. The side with combined treatment (skin needling + depigmenting serum) presented a statistically significant reduction in MASI score and luminosity index (L) levels compared to the side treated with depigmenting serum alone, and clinical symptoms were significantly improved. Conclusions. Our study suggests the potential use of combining skin needling with rucinol and sophora-alpha compounds to achieve better results in melasma treatment compared to rucinol and sophora-alpha alone.

Teledermatology: from prevention to diagnosis of nonmelanoma and melanoma skin cancer.

Telemedicine is a rapidly developing application of clinical medicine where medical information is transferred through interactive audiovisual media for the purpose of consulting remote medical procedures or examinations, reducing the time of consultation for patients. Teledermatology as an application of telemedicine was developed in 1995: it turns out to be a gradually more ordinary mean of delivering dermatologic healthcare worldwide and will almost certainly have a greater medical function in the future. In particular, teledermatology can aid in the prevention and diagnosis of nonmelanoma and melanoma skin cancer; telemedicine and teledermatology offer the opportunity to make available consultations with experts also by long distance. Overall, patients seem to accept teledermatology, considering it as an excellent mean to obtain healthcare, particularly in those areas with no expert dermatologists available. Clinicians have also generally reported affirmative experiences with teledermatology in the skin cancer field. Further studies focusing on cost effectiveness, patient outcomes, and patient and clinician satisfaction will facilitate to delineate the potential of teledermatology as a mean of prevention and diagnosis of nonmelanoma and melanoma skin cancer.

A new classification and clinical predictivity for some naevus variants.

Background. The incidence of cutaneous melanoma is rapidly increasing in Europe. Active research is directed toward the identification of naevi as a risk factor. Objective. The aim of our case-control study was to observe different numbers of moles and different mole typology associations in order to evaluate clinical predictivity and to establish a new classification for some naevus variants. Methods. A case-control study was carried out, enrolling 64 cases affected by melanoma and 183 controls, between October 2009 and February 2011. Each patient was interviewed and subjected to clinical examination. The resulting data were analysed using the statistical elaboration program SPSS 16.0. Results. The association of target naevus with other variants increases the degree of risk (target + small brown Odds Ratio 5.25; confidence interval 1.8-15.4); (target + small brown + small black + large brown odds ratio 5.0; confidence interval 1.1-22.4). Therefore, other variants and/or other variant combinations do not significantly increase risk. Conclusion. People presenting two naevus variants in association with other naevus variants seem to run a major risk. The general nonuniformity of the whole naevus panorama should be carefully considered.