Photoadaptation to ultraviolet B TL01 in psoriatic patients.

BACKGROUND: In the biologic era, narrow-band ultraviolet B (NB-UVB) phototherapy still remains a valuable, effective, inexpensive, safe anti-psoriatic treatment. Patients can lose response to NB-UVB over time due to photoadaptation. This phenomenon is the tendency of the skin to respond to ultraviolet (UV) exposure by undergoing changes that may result in a decreased future response to an equivalent dose of radiation, thus leading to the need for an increased exposure during phototherapy course. AIM: To characterize and quantify the determinants of photoadaptation in NB-UVB treated psoriatic patients. METHODS: We enrolled 57 adult patients with moderate plaque psoriasis. Patients underwent 24 sessions of NB-UVB phototherapy delivered thrice a week. Dosing was started with 70% of the minimal erythema dose (MED) with percentage-based dose increments every two treatments. MED as well as change in the erythema and melanin index (MI) were measured at baseline and at the end of phototherapy course. Moreover, an adaptation factor (AF) was calculated for each patient. RESULTS: Adaptation factor was not influenced by both baseline MED and skin type. We found a weak correlation between higher cumulative dosages and the initial MED (Spearman's rho = 0.32, P = 0.0154) as well as with the mean initial MI (Spearman's rho = 0.25, P = 0.0624, statistically borderline). Clearance and mean number of treatments were correlated (Spearman's rho = 0.48, P < 0.001). CONCLUSION: Photoadaptation is a physiological skin response that negatively influences NB-UVB responsiveness and is not predictable by the baseline MED and skin type. Thus, starting with more aggressive protocols and increasing rapidly dosage progression to prevent AF may increase NB-UVB response.

Italian position paper on urticaria. Italian Board on Urticaria.

The Italian Board on Urticaria has prepared a document focusing on the definition and classification of urticaria, taking into account the recent progress in identifying the causes, eliciting factors, and pathomechanisms of this disease. As urticaria has a profound impact on the quality of life, effective treatment is important. Therefore, specific treatment options for the management of urticaria are evaluated on the basis of the recent literature. Non-sedating H(1) antihistamines are recommended as the first-line treatment as they have proven effective in several randomized double-blind controlled studies. Dosages higher than those recommended may be necessary in some cases. However, additional or alternative therapies may be required for different urticaria subtypes and in view of individual variations in the course of the disease and response to treatment. Immunosuppressive drugs such as corticosteroids are not recommended for long-term treatment due to unavoidable, severe adverse effects.

Efficacy and safety of a topically applied Avène spring water spray in the healing of facial skin after laser resurfacing.

BACKGROUND: Although laser resurfacing is a well-accepted treatment, tolerance problems may preclude patient's acceptance of the procedure. Post-laser protracted erythema is a prime problem, associated with the symptoms of pain, itching, stinging and tightening. OBJECTIVE: The present study was conducted to evaluate a low-salt medical spring water (Avène, Avène-les-Bains, France), in conjunction with the standard use of an emollient, to improve tolerance by hydrating the postlaser skin. METHODS: A controlled, randomized, open-labeled, multicentric and two parallel group study was completed after 84 days in 74 patients, 34 applying a petrolatum ointment alone (control group), and 40 applying petrolatum ointment in association with the Avène spring water spray ad libitum (water group). RESULTS: The water spray showed a pronounced effect on reducing erythema, from the second week of postlaser onwards, with a statistically significant difference in favor of the water group compared with the control group (p < or = 0.04 from day 14 to day 84, except a non-significant trend on day 28). In addition, the water spray was found to significantly reduce itching on day 28 (p < 0.05), and stinging and tightening on day 14 and day 21 (p < 0.05). Pain was not modified by the water. CONCLUSION: Topical water appears to be a helpful adjunctive treatment to petrolatum ointment for counteracting erythema, itching, stinging and tightening during the postlaser treatment period.

Multicentre study of allergic contact cheilitis from toothpastes.

The present work reports the results of a multicentre study of toothpaste allergic contact cheilitis (TACC) conducted by GIRDCA (Gruppo Italiano Ricerca Dermatiti da Contatto e Ambientali). The study examined 54 patients with eczematous lesions on the lips, the possible cause of which was suspected to be the use of toothpastes. Patch tests were conducted with a standard series, a specially-targeted series (toothpaste cheilitis series, TCS), and with suspected toothpaste(s). A stop-restart test (SRT) was carried out with these, together with a use test to identify possible alternative products. The TCS produced 17 positive reactions in 13 patients, the most frequent being to spearmint oil. Of the 54 patients, 5 displayed positive reactions only to the TCS. The patch tests with toothpaste produced positive reactions in 11/32 patients, the SRT a positive response in 10/12 cases. The diagnosis of TACC was confirmed in 15/54 patients. Alternative products were identified for 5 patients. In conclusion, the allergens most frequently responsible for TACC were the flavourings, and the additional series proved to be useful in many cases (together with patch tests with toothpastes and the SRT) for correct diagnosis and to initiate effective prevention.

Densitometry of Pautrier's microabscess cells in cutaneous T cell lymphoma.

BACKGROUND: Epidermotropic lymphoid T cell infiltrates are part of a continuous spectrum of lesions ranging from "benign" parapsoriasis to frank cutaneous T cell lymphoma (CTCL, mycosis fungoides). Either the clinical or histologic differentiation between these entities prove often difficult and the prognosis may be difficult to assess. PATIENTS AND METHODS: We studied 15 patients, men aged 50 to 81 years, mean +/- SD 68 +/- 12 years, with patch-plague CTCL. Sections from punch biopsies from active lesions were stained with Feulgen reagent, coupled with a "twin" adjacent hematoxylin and eosin (H&E)-stained section and analyzed with a VIDAS Zeiss-Kontron Image Analyzer. At least 50 dermal infiltrating cells and 50 epidermotropic Pautrierian cells per specimen were counted and the biopsies were repeated periodically. RESULTS: Nine patients with aneuploid Pautrierian cell DNA patterns dis well after conventional phototherapy (dermal cell ploidy was irrelevant), whereas six patients with euploid Pautrierian cell DNA patterns had to be treated aggressively (IFN + retinoids, COP). Clinical and histopathologic aspects of the first group were comparable to those of the second group. CONCLUSIONS: The classical cytophotometric aphorism seems to be reversed in this sample: "The more abnormal the ploidy of epidermotropic Pautrierian cells, the better the prognosis." Euploid epidermotropic cell prove more efficient in invading the skin and other areas and this efficiency may be reflected in more aggressive trends in the evolution of the lymphoma. Thus, DSM analysis of epidermotropic cells could prove very useful as an inexpensive tool for routine CTCL grading.

Nimodipine versus terfenadine in the treatment of physical stimulus-induced urticaria.

Basophil and mastocyte degranulation is calcium-dependent. Calcium-antagonists can inhibit synthesis of and release in vitro some mediators in various types of cells. Both immunologically stimulated and non-immunologically stimulated release of material from basophils isolated from normal and allergic subjects can be antagonized by calcium blockers. The present study was aimed at testing the therapeutic effects and side effects of nimodipine therapy, a new dihydropyridine anti-calcium derivative for physical stimulus-induced urticaria, in comparison with a standard H1-antihistamine therapy. The study was done in 32 outpatients who had physical stimulus-induced urticaria: 20 patients received nimodipine three times a day in a daily dose of 180 mg, 12 patients were treated with terfenadine in a dose of 120 mg. In the majority of patients treated with both nimodipine and terfenadine, satisfactory clinical results were obtained after 3 weeks of therapy. There were, however significant (P less than 0.05) differences in responses. Complete clearance after 3 weeks was noted in 50% patients treated with nimodipine, whereas only 16% of patients on terfenadine were completely clear, and some showed only slight improvement. The treatment was easily manageable, and with few side effects.