Sarcoidosis exclusion criteria: the “simple truth” for a “complicated diagnosis”.

The differentiation between sarcoidosis and sarcoid-type reactions remains a clinical and histopathologic diagnostic dilemma. A definitive distinction is yet to be determined according to the current literature data. Sarcoid-like tissue reactions with identifiable infectious or other immunogenic antigens, should be classified as non-specific clinical manifestations of a specific disease. The current assignment of this type of reaction under the generic umbrella of “sarcoidosis” is incorrect and may result in the subsequent misinterpretation of the definition of the disease in general. On the other hand, this may lead to clinical studies with incorrectly selected inclusion criteria and, therefore, contradictory statements regarding the epidemiology and pathogenesis of the disease. Thus we propose the introduction of new criteria for exclusion of sarcoidosis as an autonomous disease. Recent trials on patients with probable sarcoidosis have focused on ideal criteria, or have provided information about the genetic and immunological profile of patients with specific infections or other diseases, which manifest themself as sarcoidal granulomas. This could explain the heterogeneous clinical and/or genetic profiles of the reported patients, who in fact were not affected by the autonomous disease “sarcoidosis”. The simplification of the current available data regarding this issue will be of fundamental importance for the correct direction of future studies, whose aim is to unravel the pathogenesis of the immunological cascade in patients with sarcoidosis and sarcoid-like type of reaction. It is expected that the introduction of exclusion criteria will inevitably lead to a change in the approach to diagnosis as well as the fundamental understanding of this mysterious disease, known as sarcoidosis.

Polyamide hair implant (biofibre®): evaluation of efficacy and safety in a group of 133 patients.

One of the greatest challenges in medicine is treatment of both feminine and masculine baldness. Among several surgical treatments available, artificial hair implantation has to be listed. We report the efficacy and safety of hair fibre implants, (Biofibre®), through the follow-up of 133 patients in three years. One-hundred-and-thirty-three patients, 98 male and 38 female, with alopecia or baldness, were treated with the hair implant (Biofibre®) which is made from a mixture of polyamides. The patients included had good state of health, healthy scalp and they were diligent in scalp cleaning. Patients with atopic dermatitis, lupus, seborrhoeic dermatitis and other skin diseases were excluded. Patients' scalps had to be normalized in case of local diseases. A clinical evaluation was carried out after 1 month, 4 months, and every other 4 months after the implant. Efficacy and safety of the product were evaluated in each patient. The most represented group consisted of men aged between 30 and 60, belonging to a scale of Hamilton III to IV. They underwent implants of up to 6000 fibres (average of 5-6 implants in three months). The fibre loss was of no more than 10% per year in 91.4% of the cases, 15% in 7.8% of the cases and 20% in 0.8% of the cases. 96.2% of patients declared to be satisfied from the result of the implant while 3.8% declared to not be satisfied. As for post-implantation tolerability and complications, 90.3% of patients recorded no pathology after surgery/ies. The 5.9% presented mild infection pathologies and the 3.8% presented inflammation pathologies (mainly from the use of wrong chemical substances). The resolution of the septic and chemical pathologies occurred in 97.9% of the cases within an average of 15 days with the use of systemic antibiotic and/or steroid local therapy. In 2.1% of the cases it was necessary to remove the fibres which took place without leaving any lasting scar. The implant of polyamide hairs (Biofibre®) can be considered an efficient surgical technique that allows immediate aesthetic results. In our study, hair implant technique demonstrated to be safe and well tolerated by patients.

Clinical efficacy of two topical corticosteroids in the management of chronic hand eczema.

AIM: The aim of this study was to evaluate efficacy, tolerability and safety of a combination treatment with fluticasone propionate 0.05% cream and clobetasole ointment 0.05% in patients suffering from chronic hand eczema. METHODS: The study examined 30 patients with a clinical diagnosis of chronic hand eczema. RESULTS: The treatment with topical corticosteroids resulted effective and topical corticosteroids proved their efficacy in mild and moderate hand eczema. CONCLUSION: In according to the severity of the disease, authors suggest two different clinical strategies in the management of hand eczema.

Gluten-free diet as a therapeutic approach in psoriatic patients: if yes, when.

Since most of the studies are mainly confined to cases reporting coincidence of psoriasis and celiac disease, the authors want to underline the utility of investigating the possible presence of an underlying celiac disease in normal practice for a better approach to the patient. It is necessary to carry out controlled studies on a large number of patients to evaluate the association between these two diseases and the benefits of a gluten-free diet, even when the intestinal symptomatology is not evident.

Nail improvement during alitretinoin treatment: three case reports and review of the literature.

Alitretinoin is an endogenous vitamin A derivative, 9-cis-retinoic acid. Its anti-inflammatory and immunomodulatory efficacy results from controlling leukocyte activity and cytokine production in keratinocytes. We describe three patients with severe chronic hand eczema accompanied by nail dystrophy, which was treated with alitretinoin 30 mg. Clinical evaluation at 6 months showed complete or almost complete clearing of the nail lesions. We also briefly review the literature reporting on nail dystrophy and alitretinoin treatment. There is some evidence of the clinical effect of retinoids on nail formation, owing to the presence of retinoid receptors on the nail matrix. Further studies are required to better understand the impact of alitretinoin in nail diseases. Our observation supports alitretinoin as a treatment option in retinoid-responsive dermatoses associated with nail involvement.

Clinical evaluation and assessment of the therapeutic efficacy of alitretinoin in a group of patients with chronic hand eczema refractory to topical steroid therapy.

AIM: We examined and evaluated the clinical characteristics of patients who had come to the Allergological and Occupational Dermatology unit in Florence with severe CHE refractory to potent topical corticosteroids. We evaluated the efficacy and safety of alitretinoin and we analyzed the response in the three months of follow-up in the group of patients who completed the cycle of therapy. Improvement in clinical signs and symptoms was assessed using mTLSS and PGA. METHODS: All patients were treated daily with single 30-mg doses of oral alitretinoin for 3 to 5 months. The study examined 15 patients with a clinical diagnosis of severe CHE. We found the treatment to be efficient in nine of 13 patients (69%) who were assessed as having "clear" or "almost clear" hands according to PGA. RESULTS AND CONCLUSION: Even if the number of patients we analyzed was limited and lacked a control group the study allowed us to confirm the efficacy of alitretinoin used in a "real life" clinical experience. In addition, thanks to the adoption of proper emollient therapy and avoidance of any relevant allergens or irritants, no recurrence of the condition was observed among the patients who completed therapy with a PGA value of "mild", "almost clear", or "clear" during three months after treatment.

Therapeutic implications of adding the psychotropic drug escitalopram in the treatment of patients suffering from moderate-severe psoriasis and psychiatric comorbidity: a retrospective study.

BACKGROUND: It is known that stress and/or psychiatric diseases can play an important role in determining psoriasis, including the well-known negative somato-psychiatric rebound that comes with the disease. METHODS: Samples of 38 subjects suffering from both moderate-severe psoriasis treated with anti-TNFα, and depressive and/or anxious mood disorders were studied. Part of them were additionally treated with escitalopram, whereas the other group only consulted to a dermatological and psychiatric follow-up. The aim of this study was to determine if an improvement in the dermatological manifestation as well as an improvement in the anxious-depressive disorder can be observed. RESULTS: The study revealed that patients treated with escitalopram had a reduction of psycho-diagnostic test scores that measure depression and anxiety levels as well as the values of pruritus. CONCLUSION: Our study suggests that psychological interventions and antidepressant medications may improve perceived symptom severity, quality of life and major compliance to the treatment in selected patients (suffering from psoriasis and mood disturbance), without a clinician necessarily being able to see an impact on psoriasis severity.

The importance of stressful family events in psoriatic patients: a retrospective study.

BACKGROUND: Psychosomatic stress events are believed to play an important role in psoriasis either by inducing or worsening the disease. OBJECTIVE: In this article, we compared the role of family stress events against other types of stress events on the psychological well being of patients and on their skin disease. We used our sample of psoriasis patients with said stress events. METHOD: Patients underwent a dermatological examination which was evaluated through the PASI index. Simultaneously, they underwent interviews for psychological evaluations. The Hamilton scales were administered to assess anxiety and depression (Ham-A scores significant >20, Ham-D >15). RESULTS: It has been demonstrated that family stress influences the psychological well being more than other types of daily stress events. In fact, people with family stress events reported higher value HAM-A (P = 0.03) and HAM-D (P = 0.02) compared with those who reported other types of stress events. Women reported higher values of HAM-A and HAM-D than men. The value of PASI in the two groups (with family stress events and those with other stress events) was not statistically significant. CONCLUSION: Results obtained from this analysis show the importance of family stress events on the quality of life and on psychiatric and dermatological status. For the psychological morbidity, a parallel approach of both bio-psychiatric and skin care is recommended, especially for women.

Erythema multiforme-like irritant contact dermatitis after application of an antiscabies treatment.

We describe the case of an irritant contact dermatitis due to an antiscabies treatment in a man who presented to our clinic with an important cutaneous reaction with many hemorrhagic, "target" erythema multiforme-like lesions, as the result of an acute toxic insult of the skin by permethrin 5%. This is a possible, but very uncommon symptom of non-eczematous contact dermatitis and an unusual drug causing the acute hypersensitivity reaction typical of erythema multiforme.

A case of airborne allergic contact dermatitis by rubber additives.

The authors report a case of acute eyelid dermatitis, arised during the wintertime, and showing symmetric purpuric erythema of both eyelids along with a moderate infiltration and minimal fine scaling. Clinical history and data highlighted that this dermatitis could be related to the contact with the rubber additives contained in a hot-water bottle. In fact, patch test revealed a sensitization to mercaptobenzothiazole (MBT) and MBT mix.For this reason, the use of hot water bottle was forbidden to the patient and the dermatitis rapidly ended up. The aim was our study is to investigate carefully the cause of dermatitis that is often hidden.