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.

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 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.

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.

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.

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.

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.

Chronic hookworm-related cutaneous larva migrans.

OBJECTIVES: The purpose of this study is to present the 'chronic' or 'persistent' form of hookworm-related cutaneous larva migrans. METHODS: From 1998 to 2011, 13 patients were seen in our department with clinically typical hookworm-related cutaneous larva migrans that had been present for more than 5 months and that, because of the absence of pruritus, had never been treated. RESULTS: The duration of hookworm-related cutaneous larva migrans ranged from 5 to 14 months (mean 7.8 months) in these 13 patients (10 males and three females, aged 23-55 years). The infestation was acquired in Brazil (three patients), Jamaica (three patients), Mexico (two patients), Tanzania (two patients), Thailand (two patients), and Martinique (one patient). The infestation was located on the feet in 10 patients; one of these patients also presented tracks on the back and another presented tracks on a knee. The chest (two patients) and thigh (two patients) were also involved. All patients presented with clinically typical hookworm-related cutaneous larva migrans: seven patients had one track and six patients had two tracks. Laboratory and instrumental examinations were within the normal range or negative. Histopathological examination revealed edema in the papillary and upper dermis, and a perivascular and perifollicular infiltrate in the upper dermis, consisting mainly of lymphocytes and eosinophils. No larvae were detected. CONCLUSIONS: This can be considered the 'chronic' or 'persistent' form of hookworm-related cutaneous larva migrans. Some pathogenetic hypotheses are suggested.

Short contact therapy of acne with tretinoin.

The most frequent side effect of topical retinoids is irritant contact dermatitis. It occurs in approximately 85% of patients; the percentage can reach up to 95% in patients treated with tretinoin. Severity of this dermatitis is moderate to severe in approximately 20% of patients. However, 15% of patients stop the treatment with tretinoin because of skin irritation. The authors used tretinoin as short contact therapy (SCT) in mild to moderate acne, in order to try to reduce the incidence and severity of irritant contact dermatitis. They present the final results of a sponsor-free, pilot, open, multicenter study. Seventy-four patients were treated with 0.05% tretinoin cream. It was applied once daily for 30 min. Treatment duration ranged from 8 to 32 weeks (mean duration: 12 weeks). Acne severity and treatment efficacy were evaluated by means of the Global Acne Grading System. A significant clinical improvement (≥50% from baseline) was observed in 41 patients (55.4%). Thirteen patients (17.6%) developed a mild skin irritation. Four patients (5.4%) stopped the treatment because of severe skin irritation. Efficacy of tretinoin used as SCT seems to be superimposable to that of tretinoin used according to standard modality. Tolerability of SCT with tretinoin is very good. This tolerability allows a high adherence of patients to the treatment and it markedly improves compliance.