Atypical Manifestations of Syphilis: A 10-Year Retrospective Study.

Background: The incidence of syphilis has increased in high-income countries in the past few decades, especially among men who have sex with men. In the present study, we aimed to analyze the correlations between atypical syphilis manifestations and the demographic, clinical, and laboratory features of patients and to review unusual presentations of syphilis reported in the literature. Methods: We conducted a retrospective analysis of 307 patients with syphilis diagnosed between 1 January 2013 and 31 October 2023 at the sexually transmitted infection (STI) centers of the University of Genoa and University of Foggia with both typical and atypical manifestations of disease. Results: In our series, atypical manifestations were detected in 25.8% of the patients, especially in the secondary stage of the disease. Lesions with annular morphology and lesions presenting as itchy erythematous scaly plaques with a psoriasiform appearance were the most common atypical presentations of secondary syphilis. A statistical analysis revealed that homosexual orientation, syphilis reinfection, and venereal disease research laboratory (VDRL) titers > 1:32 were correlated with atypical manifestations. Conclusions: Our study demonstrates that the spectrum of syphilis manifestations, in all the stages of the disease, is wide; atypical manifestations often pose diagnostic challenges, may delay the provision of appropriate treatment, and facilitate the spread of the infection.

Monkeypox outbreak in Genoa, Italy: Clinical, laboratory, histopathologic features, management, and outcome of the infected patients.

Since May 2022, multiple human Monkeypox cases were identified in nonendemic countries, mainly among men who have sex with men. We aimed to report the features, clinical course, management, and outcome of the Monkeypox cases diagnosed in the Dermatology and Infectious Disease Units of the San Martino Hospital, Genoa, Italy. We performed an observational study of the Monkeypox cases diagnosed from July 1 until August 31, 2022, collecting clinical, laboratory, and histological data. We studied 16 Monkeypox-infected men (14 homosexual, 2 bisexual) with a median age of 37 years. Three were HIV-infected. All patients reported multiple sexual partners and/or unprotected sex in the 2 weeks before the diagnosis. Most patients had prodromal signs/symptoms before the appearance of the skin/mucosal eruption, consisting of erythematous papules/vesicles/pustules in the anogenital area, which tended to erode evolving into crusts and ulcers. Lesions were often associated with local and/or systemic symptoms. Histopathology showed overlapping features in all cases: epidermal ulceration and dermal inflammatory infiltrate consisting of lymphocytes and neutrophils with an interstitial and perivascular/peri-adnexal pattern and endothelial swelling. Concomitant sexually transmitted infections (STIs) (gonococcal/nongonococcal proctitis and anal high-risk human papillomavirus [HR-HPV] infection) were frequent. Four patients were hospitalized, and one received specific treatment. The overall outcome was good. At the follow-up visit, three patients presented skin scars. Our series confirms the features of the current Monkeypox outbreak; however, different from other studies, we found a considerable rate of concomitant STIs, such as anal HR-HPV infection, that should be kept in mind because this persistent infection is the main cause of anal cancers.

Monkeypox virus infection mimicking primary syphilis.

In our case series of monkeypox (MPX) virus infected patients, one had a single genital ulcer as the only cutaneous manifestation of the infection. Physical examination revealed a single, rounded ulcer of the shaft penis characterized by pinkish raised, infiltrated borders and a crusty yellowish bottom associated with bilateral inguinal lymphadenopathies. Serology for Treponema pallidum infection and a complete screening for sexually transmitted infections (STIs) resulted negative except for the detection of Staphylococcus aureus at the cultural examination and MPX DNA at the ulcer bottom. The patient's general conditions were good therefore he remained isolated at home for 3 weeks after the diagnosis. At one month follow up, he presented only a depressed pinkish skin scars on the site of the previous ulcer. The clinical presentation of this patient could easily be misdiagnosed with other sexually transmitted infections (STIs), especially with primary syphilis. MPX infection should be considered in the differential diagnosis of STIs, also in patients with weak and localized manifestations.

Ciprofloxacin induced acute generallised exanthematous pustulosis.

Acute generalized exanthematous pustulosis (AGEP) is an uncommon and self-limiting skin rash commonly caused by drugs and is characterized by the acute onset of fever, pustulosis, and neutrophilia from 4 to 10 days after the drug intake. We describe a case of AGEP in a 61-year-old woman that was hospitalized for the acute onset of fever, erythroderma, and pustulosis. Clinical history revealed that she had been treating a bacterial inguinal intertrigo for 4 days with ciprofloxacin 500 mg tablets twice daily and desloratadine 5 mg tablet once daily. To the best of our knowledge, this is the third reported case of AGEP caused by ciprofloxacin, supporting two other previous reports.

Acne and cosmetics: a cross-sectional, web-based questionnaire survey of the views and opinions of Italian dermatologists on the use of camouflage cosmetics in female patients.

BACKGROUND: Unsatisfactory response rates are not rarely observed in the management of acne and seem largely related to poor adherence to treatment. As more specifically regards management of the disease in female patients, available literature provides contradictory indications regarding permissibility of using cosmetics. In this study we aimed to narrow our investigation on the habits of non-academic dermatologists specifically with regards to allowing/not-allowing their female patients to use camouflage cosmetics. METHODS: A Web-based survey was carried out by sending an e-mail containing a brief, aim-oriented questionnaire to a random, nationwide sample of 1508 Italian colleagues. Basic demographic data (sex, age and seniority of specialization), and tick box and open responses to the questionnaire underwent statistical analyses, as appropriate. RESULTS: The response rate was 32.9% (N.=334), this meaning 7.6% of the entire (N.=4390) Italy-based dermatologist population. The outcome between pros-and-cons standpoints was substantially split in half, in that less more than half of interviewees felt "very" or "rather" important to prohibit the use of camouflage cosmetics to their patients and only allowed the use of make-up sporadically, i.e. on "special" occasions. CONCLUSIONS: Camouflage cosmetics in acne patients should not be a sort of taboo for each dermatologist needing to deal with it individually in his/her day-by-day clinical practice. On the other hand, what appears to be still missing is future third-party research on the actual feasibility of cosmetics, and of camouflage products in particular. Large scale, possibly split-face controlled evaluations would be in this view a gold standard to confide in.

Hydradenitis suppurativa and inflammatory bowel disease: An unusual, but existing association.

Inflammatory bowel disease (IBD) could be associated with several extra-intestinal manifestations (EIMs) involving musculoskeletal, hepatopancreatobiliary, ocular, renal, and pulmonary systems, as well as the skin. In the last years, hidradenitis suppurativa (HS) is acquiring an increasing interest. IBD, especially Crohn's disease (CD), is among the most reported associated diseases in HS patients. The aim of this paper is to give a brief overview of data showing a possible epidemiologic and pathogenetic association between IBD and HS. We performed a pooled-data analysis of four studies and pooled prevalence of HS in IBD patients was 12.8%, with a 95%CI of 11.7%-13.9%. HS was present in 17.3% of subjects with CD (95%CI: 15.5%-19.1%) and in 8.5% of UC patients (95%CI: 7.0%-9.9%). Some items, especially altered immune imbalance, are generally involved in IBD pathogenesis as well as invoked by HS. Smoking is one of the most relevant risk factors for both disorders, representing a predictor of their severity, despite, actually, there being a lack of studies analyzing a possible shared pathway. A role for inheritance in HS and CD pathogenesis has been supposed. Despite a genetic susceptibility having been demonstrated for both diseases, further studies are needed to investigate a genetic mutual route. Although the pathogenesis of IBD and HS is generally linked to alterations of the immune response, recent findings suggest a role for intestinal and skin microbiota, respectively. In detail, the frequent finding of Staphylococcus aureus and coagulase-negative staphylococci on HS cutaneous lesions suggests a bacterial involvement in disease pathogenesis. Moreover, microflora varies in the different cutaneous regions of the body and, consequently, two different profiles of HS patients have been identified on these bases. On the other hand, it is well-known that intestinal microbiota may be considered as "the explosive mixture" at the origin of IBD despite the exact relationship having not been completely clarified yet. A better comprehension of the role that some bacterial species play in the IBD pathogenesis may be essential to develop appropriate management strategies in the near future. A final point is represented by some similarities in the therapeutic management of HS and IBD, since they may be controlled by immunomodulatory drugs. In conclusion, an unregulated inflammation may cause the lesions typical of both HS and IBD, particularly when they coexist. However, this is still a largely unexplored field.

Tobacco-induced contact dermatitis.

Tobacco and tobacco smoke are strongly associated with various skin conditions, among which contact dermatitis is of prime importance. The aetiological and clinical aspects vary according to the different tobacco production and processing steps. Contact dermatitis is frequent in tobacco harvesters, curers and cigar makers, whereas it rarely affects smokers and, only exceptionally, cigarette packaging workers. The skin sites involved also vary, according to whether the exposure is occupational or non-occupational. Tobacco contact irritation is far more frequent than contact allergy. The sensitizing compound in tobacco is unknown; nicotine, while highly toxic, does not seem to cause sensitization, except in rare cases. Besides natural substances, several compounds are added to tobacco during processing and manufacturing. For this reason, identifying the aetiological factors is exceedingly difficult. Another important aspect to take into account is the co-causative role of tobacco in eliciting or exacerbating contact dermatitis in response to other agents, occupational or extra-occupational.

Increased prevalence of early repolarization in electrocardiograms of psoriatic patients.

Psoriasis (Ps) is a chronic-relapsing, inflammatory, and proliferative condition of the skin: prior studies hypothesized a link between Ps and anomalies in ß-adrenergic tone. We therefore aimed to ascertain the prevalence of early repolarization pattern (ERP) in resting electrocardiograms (ECGs) of psoriatic patients compared with an appropriate control group. We performed a retrospective study of resting ECGs of 100 consecutive psoriatic patients and 100 healthy controls. The presence of ERP in at least two contiguous leads at rest ECG was recorded, and findings were also categorized according to the lead group where ERP was detected (anterior, lateral, inferior). An ERP in ≥ 2 contiguous leads occurred in 40 % of psoriatic patients, compared with 14 % of control subjects (p < 0.001). (36 vs 10 % in anterior leads, p < 0.001; 6 vs 3 % in inferior leads, p n.s.; 10 vs 2 % in lateral leads). After adjustment for sex, age, heart rate, and level of physical activity, the odds ratios for the presence of ERP were 8.6 (95 % CI, 2.1-35.2, p < 0.01), and 7.1 (95 % CI, 1.6-31.8, p < 0.05) in anterior leads. In a small case/control study, increased rates of ECGs showing ERP have been observed among psoriatic patients. Clinical significance of such finding needs to be assessed in further observational studies.

Endothelial function and cardiovascular risk in active inflammatory bowel diseases.

BACKGROUND: Endothelial dysfunction has been already reported in inflammatory bowel diseases (IBD). However, case series so far examined were rather heterogeneous as for disease severity and subsets investigated. OBJECTIVE: We evaluated endothelial dysfunction by brachial artery flow-mediated vasodilatation (FMD), and subclinical atherosclerosis by assessment of common carotid intima-media thickness (CCA-IMT) in a cohort of patients with Crohn's disease (CD) or Ulcerative colitis (UC) in active phase compared to healthy control subjects. METHODS: Forty-nine patients (mean age 41±16 years), 25 with CD and 23 with UC, and forty controls (mean age 45±15 years) were enrolled. Diagnosis was based on the standard clinical, endoscopic and histological criteria. Disease activity was assessed by Crohn's Disease Activity Index or Disease Activity Index. All patients, were under medical treatment as appropriate. RESULTS: FMD values were lower in IBD patients than controls (6.1±3.0 vs 8.2±3.4. p=0.003); no difference was seen between UC/CD groups (5.9±3.5 vs 6.3±2.6, p=0.67). No changes in statistical differences occurred after adjustment for age, gender, body mass index and family history of cardiovascular disease. Finally, no differences in IMT values were seen between IBD patients and controls. Disease duration and medical treatment did not affect endothelial function. CONCLUSIONS: Our study showed a lower FMD in IBD patients. Inflammation and immune response could explain endothelial dysfunction, which is the earliest stage of atherosclerotic process. IBD patients in active phase might therefore be at higher risk for atherosclerosis progression.

Determinants for acknowledgement of occupational related causes among Italian police officers.

The aim of this work was to evaluate associations between invalidating health problems and the main demographic and professional determinants among the employees of the Police Headquarter of the Province of Foggia (South Italy). Personal records of the employees on active service between November 2009 and May 2010 (N. 798 files) have been analysed. 241 personal service records reporting at least an acknowledged occupational related cause were examined. Low educational level increases the risk of occupational related causes (OR = 2.03; 95% Cl = 1.03-3.2; p < 0.002). Traumatisms (49.4%) and osteoarticular system diseases (23.6%) were the most frequent reasons for acknowledgement of work-related causes. The risk of causes related to traumatism was lower among employees with lower educational level (OR = 0.59; 95% CI = 0.36-0.97; p = 0.0038) and higher length of service (OR = 0.83; 95% Cl = 0.79-0.87; p < 0.001). Occupational-health physician knowledgeable about police work plays an important role by screening for specific conditions and educating the Police Officers about increased risks.

Effect of psychological stress on salivary interleukin-1beta in psoriasis.

BACKGROUND: Psoriasis is a chronic inflammatory skin disease in which several Th1 cytokines such as interleukin-1 beta (IL-beta) have been shown to play a pivotal role. Psychological stress has also been implicated in triggering or exacerbating the disease. METHODS: Salivary IL-1beta and cortisol levels of 25 patients with psoriasis were compared with those of 50 age- and sex-matched healthy controls under basal conditions and after a standardized stressful procedure including mental arithmetics and the Stroop Color-Word Naming Test. RESULTS: At baseline, mean IL-1beta levels were higher in patients with psoriasis than controls (p <0.001), whereas mean cortisol levels did not differ significantly between groups. Although IL-1beta levels increased after stress among controls, they did not increase among patients with psoriasis, with a significant group-by-time interaction (p <0.01). After stress, cortisol levels were significantly increased in both groups as compared with baseline (p < or =0.001), without any group-by-time interaction. Perceived stress was similar among psoriatic patients and controls. There was no significant correlation between changes in IL-1beta and changes in cortisol. CONCLUSIONS: The higher basal IL-1beta levels among psoriatic patients suggest that its production is increased. Changes in proinflammatory cytokine activity in psoriatic skin may play an important role in propagating inflammation. The blunted response of IL-1beta to stress observed in psoriatic patients may reflect a "ceiling effect", or be ascribed to a defective response of the immune system to adrenergic stimuli.

Cardiovascular reactivity to experimental stress in psoriasis: a controlled investigation.

A defective response of psoriatic skin to beta-adrenergic stimulation has been implicated in the pathophysiology of psoriasis. A psychophysiological study was planned to investigate whether the beta-adrenergic receptor hyporesponsiveness found in psoriatic skin can also be detected in other systems. Twenty-five psoriatic patients and 50 healthy controls were submitted to a standardized stressful procedure (mental arithmetic and the Stroop Colour-Word Naming Test) to trigger the activation of the sympathetic nervous system, and their haemodynamic responses were compared. While there were no differences between groups in perceived stress, a blunted increase in heart rate and a sharper increase in diastolic blood pressure was observed in psoriasis patients compared with controls. The psychophysiological reaction pattern observed in psoriatic patients might be explained by lower reactivity of heart beta1-adrenergic receptors and arteriolar walls beta2-adrenergic receptors. While this study suggests that beta-adrenergic receptor hyporesponsiveness might have a systemic expression in psoriatic patients, it needs support from future studies exploring beta-adrenergic function in psoriatic patients more directly.

Seborrhoeic dermatitis in the elderly: inferences on the possible role of disability and loss of self-sufficiency.

The constant increase of life expectancy in countries with high standards of living raises growing concern about many aspects of skin morbidity in the elderly. As regards seborrhoeic dermatitis, literature yields prevalence estimates for elderly people that are consistently higher than those reported from the general population. This prompts speculations on whether factors inherently involved in senescence might have some role in the course of seborrhoeic dermatitis. In a series of 186 subjects, aged > or =65, strength of association of the skin disorder with age, sex, coexisting non-cutaneous conditions, and degree of loss of self-sufficiency in activities of daily living (ADL index) was evaluated by univariate and multivariate analysis. We found that age (OR: 1.14; p<0.001) and, more importantly, dependency in more than one ADL (OR: 30.2; p<0.0001) were independent explanatory variables of seborrhoeic dermatitis. These findings suggest that senescence per se might have some significance in the natural history of this type of eczema.