Management of small wounds: result of an Italian survey.

BACKGROUND: Infection at the surgical site is a frequent complication of office skin procedures, such as electrodesiccation, laser therapy, superficial peelings, curettage, cryotherapy, and incisional or shave biopsies. The use of antibiotic therapy in their prevention is highly controversial due to the raising phenomenon of antibiotic resistance. Italy ranks fifth among high-income countries for resistance to antibiotics, with a rate seven times higher than Scandinavia. In order to raise awareness on this alarming issue, a survey was planned to disclose the misuse of topical antibiotics in the dermatologic practice. METHODS: A specifically designed questionnaire aimed at analyzing the topical management of skin lesions following common office skin procedures was distributed nationwide to physicians engaged in the management of small surgical wounds and then collected for statistical data processing and evaluation. RESULTS: A total of 1500 forms were distributed nationwide, 1340 (89.3%) of which were completed by dermatologists. Analysis of the collected data showed that more than 70% of the respondents always use topical antibiotics in the attempt of preventing possible post-procedure superinfections. CONCLUSIONS: This survey confirms not only an antibiotic misuse by a large part of the respondents, but above all the widespread erroneous belief that such therapeutic approach can be useful in averting the risk of infections postoperatively. These findings may obviously explain the spread of antibiotic resistance in Italy and confirm that there is an absolute need to raise awareness among dermatologists about the damage caused by the misuse of antibiotics in the management of small wounds.

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.

Giant major aphtha.

Major aphthae are usually located on the dorsum of the tongue, the mucosal surface of the lips and the palate. They are large, round or oval ulcers, with a whitish-grey bed, well-defined borders and erythematous halo. They are very often accompanied by severe pain. Major aphthae can take up to four months to heal, often with a scar. Relapses are possible. We present a case of giant major aphtha that was previously diagnosed as squamous cell carcinoma.

A Prospective, Multicenter, Open-label Study to Evaluate the Safety and Efficacy of a Cream Containing Xyloglucan, Pea Protein, and Opuntia ficus-indica Extract Versus Calcipotriol/Betamethasone in Adult Patients with Mild-to-moderate Psoriasis.

Objective: Psoriasis is a chronic, inflammatory skin disease, requiring local and systemic drugs according to disease severity. This study aims to investigate the efficacy and safety of a topical treatment containing xyloglucan, pea proteins and Opuntia ficus-indica extracts (XPO) compared to calcipotriol 50mcg/betamethasone 0.5mg ointment (CB). Methods: Forty-two patients diagnosed with mild-to-moderate plaque psoriasis were assigned 1:1 to XPO treatment or CB for 28 days. Disease status was assessed at baseline (V1), monitored every two weeks (V2, V3), and at follow-up (V4). Disease severity was assessed by PASI (Psoriasis Area and Severity Index), PGA (Physician's Global Assessment), and VAS (Visual Analog Scale for itching). Photos were taken before and after XPO treatment. Treatment efficacy was determined by comparing psoriasis severity at baseline to V3. Tolerability was assessed by monitoring the occurrence of adverse events. Results: Both groups showed a statistically significant difference in PASI score from V1 to V2 (p=0.001, XPO; p=0.008, CB) and to V3 (p=0.001, XPO; p=0.004, CB). XPO achieved a PASI 50 score of 24 percent at V2 and 52 percent at V3 compared to CB (0% at V2 and 19% at V3). At V3, PGA was significantly reduced in both groups (p=0.003, XPO; p=0.001 CB). Both treatments significantly reduced itching at V2 (p=0.001, XPO; p=0.003, CB) and V3 (p=0.001, XPO; p=0.0005, CB). Conclusion: XPO showed similar efficacy to CB, significantly reducing disease severity, erythema, itching, induration, and scaling with an excellent tolerability profile.

Follicular larva migrans.

Follicular larva migrans (FLM) is a rare and atypical clinical presentation of hookworm-related cutaneous larva migrans (HrCLM). FLM is characterized clinically by follicular, round, small, erythematous papules that are sometimes topped by vesicles or pustules. These lesions are usually located on the abdomen, back, buttocks and thighs and are accompanied by more or less severe pruritus. Some typical and/or short and fragmented tracks may also be visible. FLM is more resistant to anti-helminthic drugs than classical HrCLM: this is likely due to the deep location of larvae in hair follicles. We present two cases of FLM and a review of the literature.

Efficacy and Tolerability of a Novel Topical Treatment Containing Pea Protein and Xyloglucan in the Management of Atopic Dermatitis in Children: A Prospective, Multicenter Clinical Study.

INTRODUCTION: Atopic dermatitis (AD) is a chronic disease that occurs mainly in children. Topical corticosteroids are the main treatment for mild to moderate AD, although they can induce side effects. The efficacy and tolerability of xyloglucan and pea protein (XG-PP) was compared with hydrocortisone in pediatric patients with AD as a steroid-sparing solution. METHODS: A prospective, multicenter, comparative study enrolled 42 patients (age 0.5-12 years) with mild-to-moderate AD, assigned 1:1 to XG-PP or hydrocortisone ointment. Treatments were applied twice daily for 14 consecutive days and assessed at baseline, day 8, and day 15. Efficacy endpoints were AD Severity Index (ADSI) score, Scoring Atopic Dermatitis (SCORAD) index, and Patient-Oriented Eczema Measure (POEM). Tolerability was assessed by the occurrence of adverse events (AEs). RESULTS: Both treatments significantly improved ADSI mean score from baseline to day 15; in the XG-PP arm, ADSI score decreased from 10.55 to 4.15 (p = 0.00001), and in the hydrocortisone arm, from 10.65 to 4.30 (p = 0.0001). In the XG-PP arm, the mean SCORAD score decreased from 65.86 to 30.26 (p = 0.00001) and in the hydrocortisone arm from 68.84 to 31.19 (p = 0.0001) at day 15. An overall decrease from moderate to mild AD for both arms (p = 0.0001) was observed with POEM. For all the three indexes evaluated, no statistical significant differences between the study arms evolution from baseline to day 8 or to day 15 were found. No AEs were reported. CONCLUSION: XG-PP provided a comparable efficacy to hydrocortisone ointment in managing AD, thus representing a safe and effective steroid-sparing alternative in pediatric patients with AD. TRIAL REGISTRATION: Retrospectively registered on 24 November 2021 in the ISRCTN registry: 11118799.

Topical Application of a Formulation Containing Pea Proteins and Xyloglucan in Adult Patients with Atopic Dermatitis: A Double-blind, Parallel, Randomized, Placebo-controlled, Multicenter Study.

Objective: Atopic dermatitis (AD) management requires long-term use of drugs that come with side effects. Compounds such as xyloglucan (XG) and pea proteins (PP) are emerging alternatives to corticosteroids that have shown to restore skin barrier function in preclinical studies. This double-blind, parallel, randomized, placebo-controlled clinical trial investigated the efficacy and safety of XG and PP, in adult AD patients. Methods: Fourty-two patients with AD were randomly assigned 1:1 to receive a XG+PP treatment or the vehicle without XG+PP twice/day for 14 consecutive days for assessment at baseline, Day 8 and Day 15; follow-up visit was 14 days after the end of treatment (Day 28). Efficacy was evaluated using the Scoring Atopic Dermatitis (SCORAD) index, AD severity index (ADSI) score and patient-oriented eczema measure (POEM). Safety and tolerability were monitored as the occurrence of Adverse Events (AEs). Results: At baseline, both groups exclusively included moderate/severe AD cases. At Day 8, six patients treated with XG+PP displayed complete resolution of AD, while 15 patients had mild AD. At Day 28, 16 patients no longer had eczema, whereas five patients displayed mild AD. Notably, 21 patients in the vehicle group still displayed moderate/severe AD. Conclusion: XG and PP promote rapid and long-lasting relief, supporting its use as a safe alternative to mainstay corticosteroid treatments for AD management. The study protocol has been registered in the ISRCTN registry (TN66879853).

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.

Pityriasis rosea and pityriasis rosea-like eruption after anti-SARS-CoV-2 vaccination: a report of five cases and review of the literature.

Only a few cases of pityriasis rosea (PR)/pityriasis rosea-like eruption (PRLE) after anti-SARS-CoV-2 vaccination have been reported. In the period May 2021- February 2022 we observed five cases of clinically typical PR that appeared 2 to 3 weeks after anti-SARS-CoV-2 vaccination with BNT162b2 (3 patients) or mRNA- 1273 (2 patients). In 4 patients PR appeared after the first vaccination; in one patient after the second one. In 3 patients a biopsy for histopathological examinations was carried out. Results were typical for PR. In all patients laboratory examinations were within normal ranges. All patients were treated with cetirizine. Complete remission was observed within 14-30 days. Four patients were subjected to the second vaccination, but no skin lesions appeared. All patients are currently in good general health. It is possible that a relationship between anti- Sars-CoV-2 vaccination and PR/PRLE exists; however, it is very rare, in consideration of millions of vaccinated subjects and the low number of reported cases of PR/PRLE. The pathogenesis of this relationship is unknown. However, some hypotheses may be advanced: PR/PRLE following anti-Sars-CoV-2 vaccination may be just a coincidence; anti-Sars-CoV-2 vaccines cause a reactivation of HHV-6 and/or HHV-7; vaccines can induce a delayed hypersensitivity response clinically similar to drug-induced PRLE.