New insights into potential risk factors and associations in genital lichen sclerosus: Data from a multicentre Italian study on 729 consecutive cases.

BACKGROUND: Limited data are available on risk factors associated with lichen sclerosus and no data are available on gender differences in genital lichen sclerosus (GLS). OBJECTIVE: This multicentre study aimed at identifying potential risk factors for GLS, through data collection from a large, mixed-sex sample of patients comparing gender-related differences in relation to data from the general population. METHODS: This was a cross-sectional study on 729 subjects (53.8% females, 46.2% males) affected with GLS, consecutively observed within a network of 15 Italian dermatology units. The following information was collected: demographic data, anthropometric measures, comorbidities, family history of LS, clinical features and symptoms related to GLS. RESULTS: Overweight and obesity, blood hypertension, hypothyroidism and an educational attainment equal or above upper secondary school level were more frequent among the study patients than among the general Italian population. Moreover, a family history of GLS was reported more frequently than expected among GLS patients. These factors were similar in males and females. The disease tended to occur later in females than in males. CONCLUSIONS: Our findings suggest that metabolic factors, and possibly a sedentary lifestyle, may play a role in GLS pathogenesis in genetically predisposed patients, and that risk profile is similar in males and females despite some difference in the onset of symptoms.

Clinical, ultrasound, and videodermatoscopy monitoring of psoriatic patients following biological treatment.

BACKGROUND AND PURPOSE: Effective non-invasive techniques to monitor plaque psoriasis progression and treatment are desirable. The aim of the study was to evaluate changes in vascular pattern using videodermatoscopy (VD) and in skin thickness by ultrasound (US), along with clinical observation, during treatment with biologicals. METHODS: Forty-two patients with moderate-to-severe plaque psoriasis treated with adalimumab, etanercept, or ustekinumab were evaluated. Following the identification of a 'target' plaque at baseline, lesion changes were monitored at 15, 30 and 60 days by clinical observation using a Target Lesion Score (TLS), and by VD and US. RESULTS: After 60 days, a significant improvement in all three parameters was observed. In adalimumab-treated patients mean values of TLS, VD, and US were reduced by 83.9%, 73.5%, and 90%, respectively; in etanercept-treated patients by 67.9%, 49.7%, and 79.3%; in ustekinumab-treated patients by 80.9%, 66.4%, and 80.1%. Skin thickness was the first parameter to improve. Vascular improvement was slower compared to clinical and US responses. CONCLUSION: VD and US may be useful to monitor psoriasis treatment. Further investigations are warranted to assess if the persistence of an altered vascular pattern despite clinical and US normalization, as observed in 22% of patients, may influence disease progression and/or correlate with rate and severity degree of relapse.

Superficial leiomyosarcoma of the glans: report of a case and literature review.

Primary leiomyosarcomas of the penis are rare. Clinically and pathologically, these tumors fall into two groups: superficial and deep. Superficial lesions usually are low grade and show a limited tendency toward distant metastasis. In contrast, deep-seated tumors usually show a more aggressive behavior associated with a poor prognosis. A 62-year-old man with a superficial leiomyosarcoma of the glans penis is reported.

Disseminated herpes simplex infection in a HIV+ patient.

UNLABELLED: Genital herpes, a viral infection caused by Herpes simplex virus (HSV), is the most common cause of genital ulceration. Patients with a severe decrease in cellular immunity, such as patients positive for Human immunodeficiency virus (HIV) infection, are more likely to develop atypical, severe, disseminated and/or chronic HSV infections. On the other hand, there is an increase incidence of HIV detection among patients positive for HSV infection, as genital ulcers represent a potential portal of entry of HIV into the host. A case of a 52-year-old homosexual man with a two-month history of multiple erythematous ulcerative lesions on the perianal area, the buttocks, and the third left finger is presented. According to the clinical history, the clinical findings and the laboratory results, a diagnosis of HSV infection was made and treatment with valaciclovir was started, which led to complete regression of lesions 30 days later. The atypical features of the herpetic lesions, along with a past history of atypical pneumonitis one year prior to our observation, prompted to a diagnosis of concurrent HIV infection, later confirmed by laboratory RESULTS: Atypical and disseminated HSV infections occur relatively often in HIV+ patients. This article discusses clinical presentation, diagnosis and management of HSV infection in such cases.

Topical immunomodulator therapy with squaric acid dibutylester (SADBE) is effective treatment for severe alopecia areata (AA): results of an open-label, paired-comparison, clinical trial.

UNLABELLED: Severe alopecia areata (AA) may have a chronic relapsing course and is often resistant to current treatments. OBJECTIVES: The aim of our study was to evaluate whether topical immunotherapy with squaric acid dibutylester (SADBE) is able to improve the course of severe AA and to reduce the severity of relapses. METHODS: Fifty-four patients affected by severe AA treated with SADBE who were followed for a period of at least 2 years were selected as the study group. Data collected were compared with those of a matched control group of 54 patients who did not receive any treatment. Student's t-test, analysis of variance (ANOVA) and Pearson's chi-squared test were utilized for data analysis. RESULTS: At the end of therapy, in comparison with the control group, the treatment group showed a statistically significant (p < 0.001) improvement. At follow-up, there was no significant change in relapse rate (treated 44% vs control 52%). However, relapses in the treated group were significantly less severe compared with the control group (p < 0.001). CONCLUSIONS: Our data suggest that topical SADBE represents a valid therapeutic option in severe AA, and may prove to be disease modifying.

Treatment of an extensive superficial basal cell carcinoma of the face with imiquimod 5% cream.

The efficacy and safety of imiquimod, an immune-response modifier approved for the treatment of anogenital warts that has antiviral and antitumor activity, in the management of an extensive superficial basal cell carcinoma (sBCC) of the face as an alternative to surgical treatment was evaluated in a 75-year-old male with a 4-year history of a progressively enlarging lesion located on the right temporal region. Imiquimod 5% cream was applied daily until clinical resolution. Histopathological confirmation of clinical diagnosis and of tumor clearance were performed before starting treatment and at the end of treatment, respectively. Moreover, monthly post-treatment follow-up visits were planned. At physical examination, an ovalar, erythematous and slightly infiltrated plaque of 5 x 4 cm in size (approximately 20 cm2), partly eroded and crusted, with a sharp, raised, pearly edge, was evident on the right temporal region of the patient. Histopathological examination of a biopsy specimen showed the typical features of sBCC. Imiquimod 5% cream applied daily for 5 months produced complete clinical and histological clearance. No adverse events but considerable irritation were reported during treatment and no relapses were clinically observed at the 6-month follow-up visit. Our findings confirm current reports from the literature showing imiquimod 5% cream to be an effective treatment for sBCC that is especially valuable in avoiding disfigurement in cases of single large lesions located on the face or in those patients who may not be surgical candidates.

Thalidomide increases human keratinocyte migration and proliferation.

Thalidomide is reported to have therapeutic utility in the treatment of pyoderma gangrenosum, Behçet's disease, aphthous ulcers, and skin wounds. We investigated the effect of thalidomide on human keratinocyte proliferation and migration, two early and critical events in the re-epithelialization of skin wounds. Thalidomide at concentrations less than 1 microM did not affect keratinocyte viability. Using a thymidine incorporation assay, we found that thalidomide, at therapeutic concentrations, induced more than a 2. 5-fold increase in the proliferative potential of the cells. Keratinocyte migration was assessed by two independent motility assays: a colloidal gold assay and an in vitro scratch assay. At optimal concentrations, thalidomide increased keratinocyte migration on a collagen matrix more than 2-fold in the colloidal gold assay and more than 3-fold in the scratch assay over control. Although pro-migratory, thalidomide did not alter the level of metalloproteinase-9 secreted into culture medium. Thalidomide did, however, induce a 2-4-fold increase in keratinocyte-derived interleukin-8, a pro-migratory cellular autocrine factor. Human keratinocyte migration and proliferation are essential for re-epithelialization of skin wounds. Interleukin-8 increases human keratinocyte migration and proliferation and is chemotactic for keratinocytes. Therefore, thalidomide may modulate keratinocyte proliferation and motility by a chemokine-dependent pathway.

Transient leucoderma appearing in an untreated area following contact immunotherapy for alopecia areata.

One of the possible unwanted side effects following contact immunotherapy of alopecia areata is skin hypopigmentation, either in the form of a transient, post-inflammatory hypopigmentation or as the development of a persistent, depigmented patch. A case of leucoderma occurring on the forehead of a 16-year-old girl following application of squaric acid dibutylester to the scalp for the treatment of alopecia areata is described. Past medical and family history were negative for vitiligo and autoimmune disorders. The hypopigmented patch was distant from the scalp area where squaric acid dibutylester had been applied, and it was not preceded by any sign of eczema, erythema or itch in the same area. Moreover, it faded as soon as treatment was discontinued. A 4-year follow-up revealed no evidence of vitiligo. In conclusion, the possible occurrence of a transient leucoderma in untreated areas should be included among the side effects of contact immunotherapy of alopecia areata with squaric acid dibutylester.

An open label evaluation of the efficacy of imiquimod 5% cream in the treatment of recalcitrant subungual and periungual cutaneous warts.

BACKGROUND: Periungual and subungual warts are very difficult to eradicate with current therapies. Most are destructive in nature (liquid nitrogen, cantharidin, vascular lesion laser) and inflammation, pain and pigment dyschromia are common side effects. Furthermore, failure to respond or appearance of new lesions often leads to even more destructive treatments (CO(2) laser, excisional surgery) and can lead to more pain and scarring. METHODS: In an open trial, the efficacy, safety, and tolerability of topical imiquimod 5% cream was assessed in 15 patients with resistant and recurrent periungual and subungual warts over a 16 week period. RESULTS: Twelve patients (80%) completed therapy, showing complete resolution after a mean time of three weeks (range 1-6 weeks), with the remaining three patients (20%) being classified as non-responders. Local side effects (erythema, pruritus, burning and pain) were generally mild and well-tolerated. No relapses occurred during a 6-month follow-up. CONCLUSION: Topical imiquimod is an interesting novel treatment for multiple periungual and subungual warts. Tolerability is excellent when compared to other commonly used modalities and there are few side effects. This trial suggests a high clinical response rate. This treatment is applicable to patients who have failed conventional therapies before embarking on potentially scarring approaches such as excisional surgery.

Topical treatment of intraepithelial penile carcinoma with imiquimod.

Intraepithelial penile carcinoma (IPC) is an in situ carcinoma of the penis, which can be difficult to diagnose. Current treatments include excisional surgery, Mohs' micrographic surgery, cryotherapy, carbon dioxide laser therapy and topical 5-fluorouracil. We report two cases of men with 12-18 month histories of IPC (Bowen's disease, squamous cell carcinoma in situ) that were previously unsuccessfully treated with antifungals and antibiotics. Treatment with imiquimod 5% cream for 8-10 weeks was effective in both cases with no clinical evidence of relapse at 4 and 6 months. Both patients experienced adverse effects, resulting in temporary discontinuation of treatment.

Agminated lentiginosis: case report and review of the literature.

Agminated lentiginosis (AL) is characterized by numerous lentigines confined to a body segment, with a sharp demarcation at the midline. So far, only 13 cases have been reported in the literature. We report a 30-year-old woman with a multifocal AL. The cutaneous lesions first appeared at 5 years of age and gradually increased in number with time. Clinically, they appeared as numerous brown macules, ranging in size from 1 to 5 mm in diameter, in a peppered distribution over an area extending bilaterally on the neck, chin, and cheeks. On the trunk the lesions were localized to the left shoulder and breast, involving the axilla and upper part of the abdomen down to the umbilicus. Four café au lait macules ranging in diameter from 10 to 15 mm were present, with no evidence of neurofibromas. Histopathology of a macule showed the features of lentigo; in addition, groupings of melanocytes were observed at the dermoepidermal junction. The differential diagnosis of AL includes speckled lentiginous nevus and segmental neurofibromatosis.

Cellular blue nevus of the scalp infiltrating the underlying bone: case report and review.

Cellular blue nevi (CBN) are benign tumors of the skin derived from dermal melanocytes histologically characterized by increased cellularity and often by a dual cell population of nevoid cells. CBN rarely tend to invade the underlying tissues. Only six cases of CBN of the scalp invading the skull have been reported. A new case of a CBN infiltrating the underlying bone is presented. The patient, a 23-year-old woman, had a large hairless area on her right parietal scalp, present since the early months of life. Her past medical history included, on the same site, the presence, at birth, of a raised, dark, soft and hairless mass that was subsequently electrodesiccated. Radiographs of the skull showed an area of osteolysis underlying the cutaneous lesion. Histologic examination of a biopsy specimen revealed a CBN of the scalp infiltrating the underlying bone. Surgical resection of the entire lesion was planned. There were no other anomalies or malignancies. The patient is currently being followed in our clinic.

Microinvasive squamous cell carcinoma arising on lichen sclerosus of the penis.

The case of a 70-year-old white man with a 10-year history of penile lichen sclerosus (LS) who developed microinvasive squamous cell carcinoma on LS is described. A high incidence of penile cancer arising on genital LS has recently been observed. The authors stress the importance of an adequate diagnosis and long-term follow-up in patients with penile LS because of the malignant potential of the disease.