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BACKGROUND: The incidence of skin cancer in patients with systemic lupus erythematosus (SLE) and systemic sclerosis (SSc) has only been investigated with retrospective studies enrolling a low number of patients. The aims of our study were to assess the incidence of skin cancer in two large cohorts of patients, one with SLE and the other with SSc and investigating possible risk factors. METHODS: Ninety SLE, 53 SSc patients and 392 control subjects were enrolled. A questionnaire including personal and medical details was fulfilled. The severity of photoaging, photosensitivity and sun exposure habits was assessed. Skin lesions were evaluated using a video-dermatoscope. Suspicious lesions were surgically removed. RESULTS: The incidence of skin cancer was not different to those of controls. However, a decrease in the incidence of basal cell carcinoma was found in patients with SLE. This finding associated negatively with photosensitivity. SSc patients with skin malignancies did not report photosensitivity and did not adopt a careful photoprotection. A positive association was found between skin cancer and diffuse cutaneous sclerosis, pitting scars, severe photoaging and treatment with Iloprost. CONCLUSIONS: Regular avoidance of sun exposure and photoprotection are effective in reducing the development of skin cancer in patients with autoimmune diseases.
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Lupus Eritematoso Sistémico , Melanoma , Esclerodermia Sistémica , Neoplasias Cutáneas , Humanos , Esclerodermia Sistémica/epidemiología , Esclerodermia Sistémica/complicaciones , Femenino , Neoplasias Cutáneas/epidemiología , Masculino , Persona de Mediana Edad , Lupus Eritematoso Sistémico/complicaciones , Lupus Eritematoso Sistémico/epidemiología , Incidencia , Melanoma/epidemiología , Adulto , Carcinoma Basocelular/epidemiología , Carcinoma Basocelular/etiología , Factores de Riesgo , Anciano , Encuestas y CuestionariosRESUMEN
Nonmelanoma skin cancers (NMSC), comprising basal cell carcinoma (BCC) and squamous cell carcinoma (SCC), are typically encountered on photo-exposed skin. Nevertheless, several cases of NMSC have been described in covered areas such as the genital region; furthermore, some of these lesions may express a variable degree of pigmentation. Due to the existence of mucosal melanoma, an accurate diagnosis is paramount. In this narrative review, we focused our attention on management and - in particular- diagnosis of pigmented NMSC (pNMSC) located in the genital region, emphasizing the features assessed by dermoscopy and reflectance confocal microscopy. As an implementation, we included data on pNMSC from the Dermatology Unit of the University of Campania Vanvitelli. BCC in the genital region represents only 1% of all BCC cases. It has been supposed that the mutation of patched 1 may lead to the development of BCC even without concomitant UV exposure. Pigmented variants on genitals have seldom been described. More prominent dermoscopic features seem to be blue-gray ovoid nests and arborizing vessels associated with whitish structureless areas. SCC and Bowen's disease (BD) - a variant of in situ SCC - may be encountered in the genital area and are sometimes associated with human papillomavirus (HPV) infection. Pigmented SCC is very rare, and most of the literature is focused on pigmented BD (pBD), which is mainly characterized by gray-brown dots in a linear fashion and glomerular vessels without evident scales. In conclusion, pNMSC is rarely encountered on genitals; evaluation with dermoscopy or other ancillary devices like RCM is important both to exclude benign lesions like seborrheic keratosis and lentigo and to rule out melanoma.
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PURPOSE: Tildrakizumab is a selective inhibitor of IL-23 approved for the treatment of moderate-to-severe plaque psoriasis in two dosages. We conducted a 16-week multicenter retrospective study to compare the effectiveness and safety of tildrakizumab 200 mg versus tildrakizumab 100 mg in patients with a high disease burden or high body weight. MATERIALS AND METHODS: Our retrospective study included 134 patients treated with tildrakizumab 200 mg and 364 patients treated with tildrakizumab 100 mg from 28 Italian Dermatology Units affected by moderate-to-severe plaque psoriasis. The patients had a body weight above 90 kg or a high disease burden (Psoriasis Area and Severity Index [PASI] ≥ 16 or the involvement of difficult-to-treat areas). We evaluated the effectiveness of tildrakizumab at the week-16 visit in terms of PASI90, PASI100 and absolute PASI ≤ 2. RESULTS: After 16 weeks of treatment with tildrakizumab 200 mg, PASI90 was reached by 57.5% of patients and PASI100 by 39.6% of patients. At the same time point, 34.3% and 24.2% of patients treated with tildrakizumab 100 mg achieved PASI90 and PASI100, respectively. CONCLUSIONS: Our data suggest that tildrakizumab 200 mg has better effectiveness than tildrakizumab 100 mg in patients with a body weight ≥ 90 kg and a high disease burden.
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Anticuerpos Monoclonales Humanizados , Peso Corporal , Psoriasis , Índice de Severidad de la Enfermedad , Humanos , Psoriasis/tratamiento farmacológico , Psoriasis/patología , Estudios Retrospectivos , Masculino , Femenino , Anticuerpos Monoclonales Humanizados/administración & dosificación , Persona de Mediana Edad , Adulto , Resultado del Tratamiento , Peso Corporal/efectos de los fármacos , Italia , Fármacos Dermatológicos/administración & dosificación , Fármacos Dermatológicos/uso terapéutico , Relación Dosis-Respuesta a Droga , AncianoRESUMEN
INTRODUCTION: Seborrheic keratoses (SK), are very common benign skin lesions, which may increase in number and size with age. OBJECTIVES: The aim of the study was to assess any differences seen in seborrheic keratoses in relation to different skin types (ST) and lesion location. METHODS: This was a retrospective observational study of 10-months period, based on dermoscopic images of seborrheic keratoses and patient history recorded in database. Patients were categorized according to their age, sex, skin type, and location of SK. RESULTS: The frequency of SK remained high on the back for skin type 1, 2, 3 and 4. This same trend was also seen on the face and chest. In skin type 3 we saw a reversal of distribution of SK, the highest frequency remained on the back, and this was followed by the chest rather than the face. In skin type 5 and 6, the nature of the distribution of SK was more facial, CONCLUSIONS: In summary our study shows that SK are more commonly seen in males than in females, they tend to dominate in sun exposed sites especially the back and the face. Both the smaller and larger sized SK dominated in ST 1 and 2. The lighter to darker shades of color seen in seborrheic keratoses varied in accordance with the skin type, with lighter colored SK being seen more in lighter skin types as compared to darker skin types, whereas bluish colored SK were seen in all skin types except ST 1.
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Cutaneous syncytial myoepithelioma (CSM) is a rare type of cutaneous neoplasm that typically presents as a solitary and well-circumscribed nodule on the skin. It predominantly occurs on the upper and lower extremities of adult patients. Immunohistochemically, CSM is characterized by the co-expression of smooth muscle and epithelial markers. Fluorescence in situ hybridization (FISH) targeting the EWSR1 gene rearrangement is an important diagnostic tool for CSM. In our case report, we found the focal positivity for CD34, which has never been previously observed; this was mostly confined to a central area of the neoplasm.
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BACKGROUND: Little information is available from real-life studies evaluating the efficacy of apremilast in moderate-to-severe psoriasis. METHODS: In this real-life study, we retrospectively examined a database of 231 patients with moderate-to-severe psoriasis treated with apremilast (30 mg twice/day) and followed up for 52 weeks. Disease severity and treatment response were assessed by the Psoriasis Area and Severity Index (PASI) at baseline and after 16, 24, and 52 weeks. Quality of life was assessed by the Dermatology Life Quality Index (DLQI). RESULTS: PASI score decreased from 14.6 at baseline to 4.1 and 1.2 at 16 and 24 weeks. At 24 weeks, 86.7% of patients achieved a PASI score of ≤3 and this improved up to 52 weeks, where all patients had a PASI score of ≤3. At 24 weeks, PASI 75, 90 and 100 responses were achieved in 92%, 83.2% and 36.3% of patients, respectively. At 52 weeks, PASI 75, 90 and 100 response were achieved in 97%, 89.3% and 62% of patients, respectively. DLQI score was 12.4 at baseline and decreased to 2 at week 24, and close to 0 at week 52. No serious adverse event was reported during the treatment with apremilast. CONCLUSIONS: In patients with moderate-severe chronic psoriasis in a real world-setting apremilast was shown to be effective and safe up to 52 weeks.
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Psoriasis , Calidad de Vida , Humanos , Satisfacción del Paciente , Estudios Retrospectivos , Índice de Severidad de la Enfermedad , Psoriasis/tratamiento farmacológico , Italia/epidemiologíaRESUMEN
BACKGROUND: Extra facial lentigo maligna (EF-LM) arises outside the head and neck area. EF-LM presents the classic histological features of lentigo maligna. The dermoscopic aspects of EF-LM have been poorly studied. OBJECTIVE: The primary aims of our study were to analyse and describe the clinical, dermoscopic and confocal microscopy features of a series of histologically confirmed EF-LM. METHOD: We conducted a retrospective and multicentric study. From our database, we selected 48 cases of thin melanomas on photodamaged skin with histological features of EF-LM of which clinical, dermoscopic and confocal microscopy images were available, and a control group of 45 lesions, that can be subjected to differential diagnosis such as solar lentigo, lichenoid keratosis, seborrheic keratosis and melanocytic nevi, of which dermoscopic and confocal microscope images were available. RESULTS: Extra facial lentigo maligna had a higher prevalence of lentigo-like pigment patterns, angulated lines and zigzag structures. At confocal microscopy, LM-EF cases showed a higher prevalence of pagetoid spreading, round cells, dendritic cells in the epidermis, atypical cells at the dermo-epidermal junction, dendritic cells at the junction, meshwork pattern and elastosis. Our study shows that reflectance confocal microscopy (RCM) has a sensitivity of 90% and a specificity of 97% for the differential diagnosis of this type of melanoma. CONCLUSIONS: Extra facial lentigo maligna does not have the classic dermoscopic features of superficial spreading melanoma, the most observed dermoscopic criteria are angulated lines and lentigo-like pigment patterns without lentigo-like border. RCM can be a valuable imaging tool for the evaluation of all those suspicion skin lesions at dermoscopy highlighting cellular atypia suggestive for melanoma.
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Peca Melanótica de Hutchinson , Lentigo , Melanoma , Neoplasias Cutáneas , Humanos , Peca Melanótica de Hutchinson/diagnóstico por imagen , Peca Melanótica de Hutchinson/patología , Estudios Retrospectivos , Estudios de Casos y Controles , Diagnóstico Diferencial , Dermoscopía/métodos , Melanoma/diagnóstico por imagen , Melanoma/patología , Neoplasias Cutáneas/diagnóstico por imagen , Neoplasias Cutáneas/patología , Microscopía Confocal/métodosRESUMEN
INTRODUCTION: Several dermatological diseases lead to inflammatory conditions of the scalp. Most of these afflictions are recalcitrant and require long term maintenance treatment. OBJECTIVES: We present a case series where topical tacrolimus was used in a solution vehicle for these conditions. METHODS: A total of 22 patients (aged 24-90 years) with confirmed diagnosis of lichen planus pilaris (LPP), discoid lupus (DL), frontal fibrosing alopecia (FFA), erosive pustulosis of the scalp (EPS) or folliculitis decalvans (FD) were evaluated and treated with tacrolimus solution (0.1%) applied twice daily for 1 month, then once daily for another month and alternate days for 4 months. Efficacy was evaluated by an investigator global assessment, clinical and dermoscopic evaluation at weeks 4, 8 and 24. The safety assessment included monitoring of all adverse events. RESULTS: The study included 13 patients with LPP, 2 with DL, 2 with FD, 2 with EPS and 3 with AFF. After 1 month, 14 patients (63.6%) had a good response and 7 (31.8%) had excellent response. After 2 months, 16 patients (72.7%) had excellent response, and this response was persistent after 6 months of treatment. CONCLUSIONS: Tacrolimus in solution, even if not yet commercially available, was an effective and well tolerated alternative for the maintenance treatment of inflammatory conditions of the scalp.