Tinea manuum: A report of 18 cases observed in the metropolitan area of Milan and review of the literature.

OBJECTIVE: Tinea manuum is considered in Italy as an uncommon infection, although no recent epidemiological data are available. METHODS: In the period 2000-2018, we observed in the metropolitan area of Milan 18 patients with mycologically tinea manuum. RESULTS: The infection was monolateral in all patients and characterised by erythema and scaling; in two patients, each vesicles and pustules were present. Two patients had also onychomycosis of one fingernail. No cases of simultaneous tinea pedis were observed. As far as the job of these patients is concerned, seven of them were masseurs, three barbers, two cattlemen, two masons, one car mechanic, one florist, one maid and one veterinarian. Trichophyton rubrum was isolated in 6 patients, Microsporum canis in 4, Trichophyton gypseum in 3, Trichophyton verrucosum in 3 and Trichophyton violaceum in 2 patients. CONCLUSION: Masseurs were the most affected. Trichophyton rubrum and Microsporum canis were the most frequent isolated dermatophytes.

Necrotic ulcers caused by Loxosceles rufescens bites: a report of seven patients and scanning electron microscopy of the spider.

Loxosceles rufescens is a spider that may bite humans. To describe the clinical manifestations and treatment of patients with bites caused by L. rufescens, and present scanning electron microscopy of the spider. Twelve patients are described, seven with a confirmed aetiological diagnosis as a sample of the spider was captured. In one case, scanning electron microscopy of the spider was performed. Seven patients presented with a single necrotic ulcer of varying morphology, with a purulent-necrotic bed, located on the neck (one patient), buttock (one patient), thigh (one patient), legs (three patients) and foot (one patient). All patients complained of burning and pain. No systemic symptoms were observed. All patients were treated with sodium hypochlorite solution packs, an equine catalase gel, and polyhexamethylene biguanide cream. Oral analgesics were added. In one patient, oral prednisone was prescribed. Two patients with bacterial superinfections were treated with i.v. piperacillin/tazobactam or i.m. ceftriaxone. All patients recovered within eight weeks, however, a scar developed in five of six patients. The sequence of cutaneous manifestations due to L. rufescens bites is typical. At first, erythema and oedema forms, followed by a vesicle, blister or pustule and, finally, an eschar and scar. Systemic symptoms and signs are rare. To consider this spider as an aetiological agent of necrotic ulcers, it is necessary to capture a sample of the spider, dead or alive, which should then be identified by an expert. Corticosteroids, antibiotics and analgesics are frequently used. Surgery is often necessary.

Pseudoresistance to permethrin in scabies.

Reports of permethrin resistance of Sarcoptes scabiei var. hominis are emerging. We propose that this may be pseudoresistance. The resistance is due to inadequate counselling by physicians, incorrect treatment (insufficient quantity of permethrin; too short length of treatment), and poor adherence and compliance by patients. Other reasons include single application of permethrin, suggestion to apply the drug for 6-8 hours, failed application on subungual folds, irritant contact dermatitis, in particular on genitals, for which some patients stop the treatment, and unexplainable use of permethrin in post-scabies prurigo. Thus, we believe that several cases of resistance to permethrin are actually cases of pseudoresistance.

Isoconazole nitrate vs isoconazole nitrate and diflucortolone valerate in the treatment of tinea inguinalis: results of a multicenter retrospective study.

BACKGROUND AND OBJECTIVE: Many tinea inguinalis infections are characterized by pronounced inflammatory lesions and pruritus. Therefore, a therapy with a topical corticosteroid in addition to a topical antimycotic agent might be beneficial. In this multicenter, retrospective study, we compared the mycological and clinical efficacy and tolerability of isoconazole nitrate alone vs isoconazole nitrate and diflucortolone valerate in 58 adult patients with tinea inguinalis. PATIENTS AND METHODS: Treatment duration was three weeks. The efficacy of the treatment was based on the assessment of several signs and symptoms, which were collected on a 4-point scale. All patients were examined clinically before the beginning of the treatment, one week later, two weeks later, and at the end of the treatment. Mycological examinations were performed before the beginning of the treatment and at the end of the study. RESULTS: Treatment results with the combination of isoconazole nitrate and diflucortolone valerate were superior regarding erythema and pruritus. Both erythema and pruritus resolved in a larger percentage of patients and more quickly. Both regimens were well tolerated. Mycological cure rates were similar in both groups of patients. CONCLUSIONS: Combination therapy with isoconazole nitrate and diflucortolone valerate is an effective and well-tolerated regimen in adult patients with tinea inguinalis.

Scabies and nocturnal pruritus: preliminary observations in a group of African migrants.

INTRODUCTION: Pruritus of scabies is due to a type IV T cell-mediated reaction to the mite's saliva, eggs, excrements and other products released by the mite during its life cycle. Movements of the mite also induce pruritus. According to the literature, scabies pruritus has higher frequency and intensity at night. METHODOLOGY: In this short communication we present the results of a survey on nocturnal pruritus in a group of African migrants with scabies. A questionnaire was given to 36 patients: "Is your pruritus more severe at night?" and "Do you wake up from the sleep because of pruritus?". RESULTS: The answer to the first question was "yes" in 13/18 patients (72.2%) visited from October 2018 to February 2019, and in 6/18 patients (33.3%) visited from May to September 2019. The answer to the second question was "yes" in 11/18 patients (61.1%) of the first group and in 5/18 patients (27.7%) of the second group. CONCLUSIONS: It is possible that nocturnal pruritus in scabies is due to the temperature of the skin surface: when it is high, because of the use of pajamas, heavy sheets and blankets (from October to February), pruritus increases; when the skin's temperature is low, as in the summertime, when people usually sleeps without blankets, with light sheets and pajamas or not having a stitch on, pruritus is less frequent and severe. These conclusions must be confirmed by studies based on larger groups of patients.

Treatment of pruritus in mild-to-moderate atopic dermatitis with a topical non-steroidal agent.

Atopiclair (Zarzenda) is a topical non-steroidal anti-inflammatory agent for the treatment of allergic diseases of the skin. Three main ingredients are contained in this product: glycyrrhetinic acid, telmesteine and Vitis vinifera extracts. Other ingredients include: allantoin, alpha-bisabolol, capryloyl glycine, hyaluronic acid, shea butter and tocopheryl acetate. Two previous randomized, double-blind, vehicle-controlled clinical studies provided evidence that Atopiclair is effective in the treatment of atopic dermatitis. This article presents an open, multicenter, sponsor-free, study on the anti-pruritic activity of this product in adult patients with mild-to-moderate atopic dermatitis. The Median Visual Analogue Scale (VAS) values were: at the start of the study (TO), median VAS was 48.5 mm; three weeks later (T1), median VAS was 34.1 mm (-14.4 mm from baseline); six weeks later (T2), median VAS was 24.6 mm (-23.9 mm from baseline). Statistical analysis revealed that differences between TO versus T1, TO versus T2 and T1 versus T2 were highly significant (p<0.001). Side effects (local burning) were relatively common, although mild in severity. On the basis of the results of this study, Atopiclair showed efficacy in relief of pruritus in adult patients with mild-to-moderate atopic dermatitis.

Treatment of postscabies prurigo with diflucortolone and chlorquinaldol in a group of African refugees.

Postscabies prurigo (PSP) is caused by a delayed hypersensitivity reaction to antigens of the mite. Treatment is based on potent topical or intralesional corticosteroids. We present the results of a study on the effectiveness of a topical combination of diflucortolone and chlorquinaldol. Eighteen African patients who had been previously affected by scabies and treated with permethrin were enrolled. The diagnosis of PSP was made by excluding other causes through microscopic examinations. All patients were treated with the drug combination by two applications daily for two weeks. The primary study objective was to evaluate the itch by a visual analogue scale (VAS) of 0-100. Fifteen patients (83.3%) could be evaluated. All reported improvements: from 86/100 at the start to 29/100 (-57/100) at the end of treatment. Chlorquinaldol, known as an antiseptic agent, demonstrated, according to results of this study, an important anti-itch action.

A new treatment regimen with permethrin in scabies.

BACKGROUND: Topical permethrin, applied once daily, is considered as the most effective treatment in scabies. METHODS: Eighty-nine adult immunocompetent patients with scabies were treated with 5% permethrin cream: 42 patients were treated with a single application/day (group 1); 47 patients were treated with one application/day for two consecutive days (group 2). Clinical diagnosis of scabies was confirmed by microscopical examinations. The cream was stored in refrigerator and applied cold on the entire skin surface. The cream was left on the skin for 24 hours. No other topical or systemic drugs were allowed, except for a cleanser with chlorhexidine. The treatment was repeated in all patients 7-10 days later. The follow-up was 2 months after the end of the treatment. RESULTS: Twenty-one patients (61.8%) in the group 1 and 34 patients (87.2%) in the group 2 were considered recovered both clinically and microscopically. Three patients (7.1%) in the group 1 and 4 patients (10.2%) in the group 2 developed a mild irritant contact dermatitis. During follow-up, three patients (7.1%) in the group 1 and two patients (4.2%) in the group 2 developed a recurrence or a re-infestation. CONCLUSIONS: Five per cent permethrin, when applied as cold cream, on the entire skin surface, once daily for two consecutive days, is more effective than the single application in adult immunocompetent patients with scabies.

The association of isoconazole-diflucortolone in the treatment of pediatric tinea corporis.

BACKGROUND: Tinea corporis is a common mycotic infection in children. Staphylococcus aureus superinfections may be observed in atopic children with tinea corporis suffering from severe pruritus and consequent scratching. OBJECTIVE: From 2006 to 2011, we observed 288 children with mycologically proven tinea corporis. In 39 of them (13.5%) tinea corporis was superinfected by S. aureus: all these children were affected by atopic dermatitis. We interpreted these bacterial superinfections as the clinical result of scratching due to pruritus. METHODS: In 2012, we decided to treat all children with a single lesion of tinea corporis with a combination of 1% isoconazole nitrate and 0.1% diflucortolone valerate cream (one application/day for 5-7 days), followed by a treatment with isoconazole or clotrimazole or ciclopirox cream (two applications/day for two weeks). RESULTS: From 2012 to 2014, we observed 108 children with tinea corporis confirmed by mycological examinations. Clinical and mycological recovery was observed in 93 of them (86.1%). Only four of these children (3.7%) developed S. aureus superinfections. CONCLUSIONS: Our study in atopic children with tinea corporis superinfected by S. aureus confirms that a topical therapy with the association isoconazole-diflucortolone is useful and safe.

Role of cleansers in the management of acne: Results of an Italian survey in 786 patients.

BACKGROUND: Modern therapy of acne is based also on moisturizers, cleansers and sunscreens. However, a few studies have been published on cleansers, and never in Italy. OBJECTIVE: We decided to carry out an epidemiological study on the knowledge, beliefs and perceptions of acne patients regarding cleansers. METHODS: The survey has been carried out in Italy in 2013-2014. A group of patients with acne completed a questionnaire which included 10 questions. RESULTS: One hundred and eighteen dermatologists and 786 evaluable acne patients attended the survey. Approximately 70% of patients use a specific anti-acne cleanser. This cleanser is suggested in 57% of cases by a dermatologist. The patients buy this cleanser at the pharmacy (77% of cases). More than 62% of patients are satisfied about this cleanser. More than 66% of patients use the cleanser twice daily. The length of washing is less than one minute in 48% of patients. More than 66% of patients believe that the cleanser has a therapeutical role. CONCLUSION: The results of this survey cannot be compared with other studies because of the lack of similar studies about this topic. These results suggest that a sample of Italian acne patients consider cleansers as an important adjuvant treatment in acne.

Treatment of symptoms of erythemato-telangiectatic rosacea with topical potassium azeloyl diglycinate and hydroxypropyl chitosan: Results of a sponsor-free, multicenter, open study.

Thirty-seven adult Caucasian patients (9 males and 28 females), with erythemato-telangiectatic rosacea accompanied by stinging and burning sensation, were treated with a cream containing 5% potassium azeloyl diglycinate and 1% hydroxypropyl chitosan. All patients were previously treated at other centers with topical azelaic acid and/or metronidazole. The cream was applied twice daily for 12 weeks. The objective of the study was the evaluation of the soothing effect of the cream: stinging and burning sensation were measured by means of a 4-point scale (0 = absent, 1 = mild, 2 = moderate, and 3 = severe). All patients were clinically evaluated every 4 weeks. Of 37 patients (81.1%), 30 were considered evaluable. Before the beginning of the study, the total score of stinging and burning sensation was 66 (mean: 2.2 points/patient); at the end of the study, it was 37 points (-29) (mean: 1.2 points/patient), with a reduction of 56.1%. No side effects were reported or observed. This study shows that the fixed combination potassium azeloyl diglycinate - hydroxypropyl chitosan is effective in reducing stinging and burning sensation in patients with erythemato-telangiectatic rosacea.