Genoa and leprosy: from the Middle Ages to the present.

During the Middle Ages, leprosy sufferers could not live in the city and were forced outside the walls. In the centuries, the Genoese area dedicated several hospitals to lepers, such as S. Lazzaro and Pammatone Hospital, a small leprosarium in the Tigullio area and San Martino Hospital from 1935. The first doctor who recognized to cure leprosy in Genoa was Goffredo, who later was also nominated rector of the community. In the early 1900's, Radaeli promoted the construction of a leprosarium behind the San Martino hospital. In 1936 Giuseppe Mariani was known for using the leprosarium to hide Italian Jews during deportation to the extermination camps. Later, Professor Aldo Baccaredda-Boy instituted the graduate school in "Leprosy and Tropical Dermatology", continued by professor Enrico Nunzi until 1990. The leprosarium was then transformed into the Department of Tropical Dermatology and finally into the Operative Unit of Social Dermatology, a national reference center.

Leprosy in Refugees and Migrants in Italy and a Literature Review of Cases Reported in Europe between 2009 and 2018.

Leprosy is a chronic neglected infectious disease that affects over 200,000 people each year and causes disabilities in more than four million people in Asia, Africa, and Latin America. The disease can appear with a wide spectrum of clinical forms, and therefore the clinical suspicion is often difficult. Refugees and migrants from endemic countries affected by leprosy can remain undiagnosed in Europe due to the unpreparedness of clinicians. We retrospectively describe the characteristics of 55 refugees/migrants with a diagnosis of leprosy established in Italy from 2009 to 2018. Continents of origin were Africa (42%), Asia (40%), and South and Central America (18%). The symptoms reported were skin lesions (91%), neuropathy (71%), edema (7%), eye involvement (6%), fever (6%), arthritis (4%), and lymphadenopathy (4%). Seven patients (13%) had irreversible complications. Overall, 35% were relapses and 66% multibacillary leprosy. Furthermore, we conducted a review of 17 case reports or case series and five nationwide reports, published in the same decade, describing 280 migrant patients with leprosy in Europe. In Europe, leprosy is a rare chronic infectious disease, but it has not completely disappeared. Diagnosis and treatment of leprosy in refugees and migrants from endemic countries are a challenge. European guidelines for this neglected disease in this high-risk population would be beneficial.

Long-term ulcerations caused by Mycobacterium lepromatosis.

Patients with leprosy rarely present ulcerated lesions that can appear during reactional states like Lucio's phenomenon (LP), as in our case. LP is a rare complication of multibacillary leprosy due to massive bacilli invasion of endothelial cells causing a thrombotic syndrome. The initial macular lesion is purpuric followed by multiple infiltrated papules and nodules, some of them ulcerated, associated to loss of sensation on lower limbs. The importance of recognizing ulcers as a specific cutaneous manifestation of leprosy allows early diagnosis and treatment, and therefore avoiding the development of disabilities and persistence of illness. Infection by Mycobacterium lepromatosis is associated with LP and it should be especially sought in patients from endemic areas.

Anti-tumor necrosis factor-α treatment with infliximab for disseminated granuloma annulare.

Granuloma annulare (GA) is a chronic inflammatory disease of unknown etiology characterized by the development of plaques preferentially localized to the distal extremities. Spontaneous remission and relapses are quite common and the course of GA is not easy to predict. Moreover, most therapeutic regimens have been used anecdotally and with variable success. We report the case of a 62-year-old White female patient affected by disseminated GA unsuccessfully treated with psoralen plus UVA photochemotherapy, prednisone, and cyclosporine (ciclosporin) who responded to the anti-tumor necrosis factor-α monoclonal antibody infliximab administered intravenously at a dosage of 5 mg/kg at weeks 0, 2, and 6 and thereafter at monthly intervals for 10 additional months. Most of the GA lesions improved within 8 weeks and then slowly resolved within 10 months of treatment. We suggest that infliximab may be proposed as an additional therapeutic option in the treatment of recalcitrant forms of disseminated GA.

A new species, Aspergillus persii, as an agent of onychomycosis.

Onychomycosis due to non-dermatophytic fungi is a well-known and increasingly common infection. For the first time ever, we report two cases of onychomycosis caused by Aspergillus persii, a recently described new Aspergillus species. After ten and three years respectively, both patients showed relapsing nail infections, and mycological tests were still positive for A. persii. In vitro antifungal susceptibility tests demonstrated that both strains were only susceptible to itraconazole, voriconazole, posaconazole and terbinafine of the agents tested.

Prevalence of stratified epithelium-specific antinuclear antibodies in 138 patients with lichen planus.

BACKGROUND: Antibodies to stratified epithelia characterize chronic ulcerative stomatitis, an entity that very closely resembles erosive lichen planus both clinically and histologically. These antibodies are directed against a 70-kd antigen. OBJECTIVE: Our aim was to verify whether antibodies to stratified epithelia are present in patients with common lichen planus. PATIENTS AND METHODS: One hundred thirty-eight patients with various forms of lichen planus were studied. Indirect immunofluorescence was performed on both monkey esophagus and HEp2-2000 cells. Immunoblotting was done with cultured keratinocytes used as the source antigen. RESULTS: Nineteen patients had antibodies to stratified epithelia (in 9 directed against an antigen of 70 kd). Forty-eight patients had circulating antibodies detected by indirect immunofluorescence on both monkey esophagus and HEp2-2000 cells (in 7 directed against an antigen of 70 kd). Indirect immunofluorescence was positive only on HEp2-2000 cells in 21 patients. Indirect immunofluorescence was negative in 50 patients on both HEp2-2000 cells and monkey esophagus. None of the last 71 patients had antibodies directed to an antigen of 70 kd. LIMITATIONS: This is a serological study; results from direct immunofluorescence studies would be interesting. CONCLUSION: Antibodies to stratified epithelia directed to an antigen of 70 kd are not exclusive to chronic ulcerative stomatitis, but are also present in some patients with lichen planus.

Persistent acantholytic dermatosis of the lip related to solar damage.

We describe the case of a 70-year-old woman with persistent acantholytic dermatosis. The peculiarity of the case lies in the unusual localization of this dermatosis on the lower lip. A possible relationship with chronic solar damage is discussed.