A Retrospective Study on Alopecia Areata in Children: Clinical Characteristics and Treatment Choices.

BACKGROUND: Although children are affected frequently with alopecia areata (AA), data are limited on clinical characteristics and treatment choices. MATERIALS AND METHODS: We retrospectively reviewed the records of the pediatric dermatology department over a 12-year period to identify children with AA. Clinical data were collected. RESULTS: Three hundred and sixty-four children with AA were identified, aged 1-12 years, 214 males and 150 females. The mean age of onset was 6.6 years (±3.3). The disease presented with patches on the scalp in the majority (90.7%), whereas only 6 children had alopecia totalis or universalis. The most commonly prescribed treatment was topical steroids (69.1%), followed by the combination of topical steroids and minoxidil 2% (14.3%). Oral steroids were prescribed in only 16 children. Follow-up at 3 months was available for only 70 children and the majority (84.3%) had some hair regrowth. Hair regrowth was unrelated to the number of plaques (p = 0.257), disease location (p = 0.302), and atopy (p = 0.999). Hair regrowth only correlated with the type of treatment (p = 0.003) with potent topical and intralesional steroids giving the best results. CONCLUSION: AA usually presents with a mild form in children, and potent topical steroids are the mainstay of treatment.

Analysis of Prevalence and Risk Factors of Contact Sensitization with respect to the Occupational Profiles in a Greek Patient Cohort: A Retrospective Analysis of a Greek Referral Centre and Future Perspectives.

Contact dermatitis is a frequent skin disorder related to environmental and occupational etiological factors, which could potentially affect all age groups, as well as both genders. The current study is aimed at exploring the patterns of contact sensitization with respect to the population's occupational patterns in Greece. A retrospective analysis was performed in a cohort of 1978 patients from 2014 to 2016. Patients were divided into two categories; blue collars (BlC) and white collars (WhC), as well as detailed occupation was considered. Separation was performed on the basis of their profession, i.e., labor workers and handicraftsmen were sorted to the BlC group, while office employees were sorted to the WhC group. The common allergen in all occupational subgroups was nickel sulphate. The three most prevalent allergens in both BlC and WhC were nickel sulphate 5%, fragrance mix (I) 8%, and Balsam of Peru 25%. WhC males were uniquely sensitized to colophony 20% and formaldehyde 2%, and WhC females were uniquely sensitized to 5-chloro-2-methyl-4-isothiazolin-3-one (CMIT) and neomycin sulphate 20%. Sensitization to allergens manifested occupation-specific patterns. Allergic contact dermatitis surveillance is of great importance towards the clinical and systematic understanding of the disease, especially with respect to the patient's occupational profile.

Omalizumab in the Treatment of Chronic Urticaria: The Effect of Drug Co-Administration and Co-Morbidities.

BACKGROUND: Chronic Spontaneous Urticaria (CSU) is a disease presenting typical wheals characterized by itching, angioedema or both. Although CU is, by appearance, a relatively "simple" disease, yet it has a devastating effect on those suffering due to its immense social implications. AIMS: The aim of the present study was to investigate the effect of omalizumab in the treatment of CSU. In particular, gender, co-administration of drugs and comorbidities were taken into account. MATERIALS AND METHODS: 108 patients (25 Males/83 Females) admitted to our department were diagnosed with CSU and were treated for 30 months. CSU was estimated on a score basis, which was used in order to define disease severity. The mean total CSU score and the mean CSU score of the first trimester, as well as the first semester, were calculated. Patients were treated with omalizumab, and in several cases, with co-administration of dapsone, cyclosporine and anti-histamines. RESULTS: Females manifested significantly higher scores as compared to males. Further on, patients who relapsed manifested significantly higher scores during the whole time course, as well as at the end of the first semester. CONCLUSION: Females are more prone to CSU. Although CSU scores in patients with remission, relapse and poor response manifested no significant difference at diagnosis, relapsed patients manifested higher CSU scores in the first semester. Therefore, the first semester of treatment is probably critical for the final patient outcome. Further studies are necessary in order to understand the mechanisms of CSU for better treatment and prognosis.

Urticaria from the Neurodermatological Perspective: A Temporal Analysis of Urticaria and Cognition.

Chronic spontaneous urticaria (CSU, or CU) is a disease that significantly affects the quality of life of patients. The connection between the cognitive state of an individual and dermatological diseases has been previously reported, and it is known, although not thoroughly investigated, that there is a cognitive and quality of life relation to dermal pathologies. Urticaria is a chronic disease that requires a specialized approach to diagnosis and treatment but also a holistic approach with respect to the consideration of both the pathophysiology of the disease and the cognition status of the patient. The present study aims at analyzing CU score and cognitive indexes with respect to time, as a time series and their subsequent interactions. We have attempted to model the investigated time series in order to unravel possible causative relationships between cognitive/quality of life factors and urticaria. One hundred and eleven patients (29 males/82 females) admitted to our department were diagnosed with CU. CU was estimated on UAS7 score basis, which was used in order to define disease severity. Indexes used for assessing the cognitive and quality of life of patients' status included the Urticaria Control Test (UCT) and Dermatology Life Quality Index (DLQI). Significant correlations were found between UAS7 score and the UCT and DLQI scores, respectively. Interestingly, each score time series was modelled by different sets of equations, indicating the unique effect each one has on the disease, as well as that each score probably is manifested by a different pathophysiological mechanism.

Occupational and non-occupational allergic contact dermatitis to hair dyes in Greece. A 10-year retrospective study.

BACKGROUND: Oxidative hair dyes are an important source of chemical exposure and a major risk factor for the development of occupational and non-occupational allergic contact dermatitis (ACD) worldwide. OBJECTIVE: To identify the frequency of common allergens associated with occupational and non-occupational ACD to hair dyes during the last 10 years, in Greece. METHODS: We retrospectively reviewed the medical records of patients with suspected ACD to hair dyes from 2010-2019. All patients with patch-test-confirmed ACD to hair dyes were evaluated. RESULTS: Out of 501 patients with suspected ACD to hair dyes, 362 had at least one positive reaction to hair dye allergens (62.4% were customers and 37.6% were hairdressers). The mean age of customers and hairdressers was 43.8 years and 30.8 years, respectively. Of the customers, 58.9% were exposed to dyes for >10 years and 61% of hairdressers for <5 years. The most common site of ACD among customers was the scalp (85%) and among hairdressers the hands (90%). p-Phenylenediamine (PPD) was the most common contact allergen (52.2%), followed by toluene-2,5-diamine, p-aminophenol, m-aminophenol, and ammonium persulfate. CONCLUSIONS: Sensitization prevalences for PPD and cross-reacting allergens have increased in Greece during the last decade, regardless of occupational or non-occupational exposure to hair dyes.

Time-Dependent Effects in Chronic Urticaria: A Time-Series Perspective of Omalizumab Treatment.

BACKGROUND: Chronic spontaneous urticaria (CSU, or CU) is a disease that significantly affects the quality of life of patients. It is a chronic disease and requires a specialized approach to diagnosis and treatment. In recent years, the disease has been of great interest due to the existence of new targeted therapeutic approaches. AIM: The present study aims at analyzing CU score concerning time, as a time-series. The authors have attempted to model the investigated time-series to unravel possible causative relationships. METHODS: 108 patients (25Males/83Females) admitted to our department were diagnosed with CU. CU was estimated on a score basis, which was used to define disease severity. Urticaria score was assessed on the basis of Urticaria Activity Score 7 (UAS7). The mean CU score, the mean CU score rate concerning the first month at diagnosis as well as the monthly CU score rate were calculated. RESULTS: Gender is a factor that influences CU score with time. In addition, there was a significant finding that time-series differ with the administration of monotherapy or complementary therapy. CONCLUSION: We have found that females are more prone to CU, while omalizumab monotherapy has more beneficial results as compared to the application of concurrent and maintenance therapies. Further, patients with co-morbidities were more likely to interrupt treatment. Finally, and most significantly, it was shown that monthly CU score rate manifested an oscillatory pattern, which was modelled with the sum of sines functions, highlighting a relative immunological pattern.

The Rising Incidence of Allergic Contact Dermatitis to Acrylates.

BACKGROUND: Allergic contact dermatitis (ACD) caused by (meth)acrylates used in nail products is being increasingly reported in nail technicians and consumers. OBJECTIVES: The aim of the study was to assess the incidence of sensitization to (meth)acrylates in technicians and users of nail products with ACD, referred for patch testing in a tertiary center, during the last 10 years. METHODS: All patients with ACD, who reported a profession associated with cosmetic nail procedures or use of such services and were referred for patch tests in our department between January 2009 and December 2018, were identified. The incidence of positive sensitization to (meth)acrylates was assessed. RESULTS: Contact allergy to 1 or more (meth)acrylates was found in 116 (74.4%) of 156 nail technicians or nail product users, all women. One hundred thirty-eight (88.5%) were occupationally exposed, and 18 (11.5%) were consumers. In addition, there was a statistically significant increase in (meth)acrylate ACD during 2014-2018 (100/127 cases [79%]) when compared with 2009-2013 (16/29 cases [55%]). The most common sensitizer among the 156 allergic individuals was ethylene glycol dimethacrylate, which was positive in 113 cases (72.4%), and among patients with acrylate-positive patch test, the rate was 97.4%. CONCLUSIONS: Our experience confirms the worldwide changing landscape of rising (meth)acrylate sensitization in nail technicians and nail products users with ACD. Efforts to improve prevention are needed, and clinicians should have a high index for suspicion in this occupational group.

Dermatological conditions associated with HIV medication in a cohort of Greek patients initiating antiretroviral therapy: 1988-2013.

Objectives: Treatment of HIV infection has evolved from a single antiretroviral agent to combination therapy, which has dramatically improved both the quality of life and life expectancy of affected patients. The aim of this study was to review HIV treatment-associated dermatological conditions observed in adult patients receiving antiretroviral therapy (ART) in a single tertiary care referral centre over time. Methods: We reviewed the files of HIV-positive patients seen at the Dermatology Department, AIDS Clinic of the Andreas Syggros Hospital, Athens, Greece who had initiated ART from 1988 to 2013, for evidence of dermatological conditions commonly associated with HIV-related medication. Results: Among a cohort of 1329 HIV-positive patients (1155 men and 174 women), 352 (299 men and 53 women) presented with at least one dermatological condition, with a total of 423 conditions diagnosed that could be attributed to HIV-related medication. Lipodystrophy (47.42%), and maculopapular (MP) rash (40.6%) were most commonly diagnosed. There were three incidence peaks for these reactions, which reflected the different types of ART and HIV-related drugs commonly used at the time. After 2006, the number of these dermatological conditions declined (15.1% of cases) with the availability of newer ART regimens. Conclusions: Early ART was accompanied with a high incidence of adverse skin reactions, which have decreased over time in association with overall better tolerated treatment regimens for HIV infection.

Bevacizumab-associated Sudden Onset of Multiple Monomorphic Comedones on the Scalp Successfully Treated with 30% Salicylic Acid Peels.

Bevacizumab is a humanized monoclonal antibody against vascular endothelial factor (VEGF) that targets tumor cell angiogenesis and proliferation. Although it is usually well tolerated, many side-effects have been reported. These include hypertension, bleeding, and thromboembolic events among others. Drug-associated cutaneous adverse effects are less common and include itching, exfoliative dermatitis, and acneiform eruptions. A man with bevacizumab-associated monomorphic skin eruption successfully was treated with 30% salicylic acid peels. To the author's knowledge, this is the first report of open comedones with no further inflammatory acne lesions that developed in a patient treated with bevacizumab. Complete remission of the rash was achieved after performing 30% salicylic peels, and the patient continued the chemotherapy as planned with no need of either dose reduction or discontinuation of bevacizumab.

Cryotherapy versus imiquimod 5% cream combined with a keratolytic lotion in cutaneous warts in children: A randomized study.

BACKGROUND AND OBJECTIVE: Although cutaneous warts are extremely common in children effective treatment does not exist. We combined imiquimod with a salicylic acid solution 15% (SA) on areas, with thick keratin, like palms and soles to increase its penetration through the epithelium. METHODS: Patients were randomly divided into two groups. The first group was subjected to cryotherapy with liquid nitrogen every two weeks for a maximum of 3 months. The second group was subjected to treatment with imiquimod 5% daily for 6-10 h onto the warts for five consecutive days per week for a maximum of 3 months. RESULTS: Eighty-six children were included, 35 girls and 51 boys, 49 in the cryotherapy group and 37 in the imiquimod and SA group. At the end of the third month no statistically significant difference could be noted between the imiquimod 5% and salicylic acid and cryotherapy groups (p = 0.154). Thirty (81.1%) children treated with imiquimod 5% and salicylic acid were free from their warts in comparison to 33 (67.3%) children treated with cryotherapy. CONCLUSIONS: Imiquimod 5% cream as a monotherapy or in combination with SA can be used safely in children with warts and is equally effective and more effective than cryotherapy in plantar warts. LIMITATIONS: Our study is not placebo controlled and spontaneous resolution cannot be ruled out.

Topical 5% benzoyl peroxide and 3% erythromycin gel: experience with 191 patients with papulopustular acne.

Acne is the most common skin disease, with a relative prevalence of 85%-100% among young individuals. It affects the cosmetic appearance of the patients provoking severe distress. A number of different topical treatments have been used for the treatment of acne. In this study, we investigated the efficacy and safety of the topical treatment with 5% benzoyl peroxide and 3% erythromycin gel in patients with papulopustular acne. One hundred and ninety-one patients with inflammatory acne completed the study. The patients included 54 males and 137 females, mean age 22.3 ± 8.1 years. Topical gel was applied on the face once daily for 3 months. The mean number of non-inflammatory and inflammatory lesions after 3 months of therapy decreased significantly with respect to baseline, with a mean percentage reduction of the non-inflammatory and inflammatory lesions by 42.2% and 57.5%, respectively. In conclusion, topical 5% benzoyl peroxide and erythromycin 3% as monotherapy is efficient for the treatment of papulopustular acne.

Recommendations for pimecrolimus 1% cream in the treatment of mild-to-moderate atopic dermatitis: from medical needs to a new treatment algorithm.

Pimecrolimus 1% cream is an effective, non-corticosteroid, topical anti-inflammatory treatment for atopic dermatitis (AD). The aim of this article was to review published clinical data that have examined how pimecrolimus can address the medical needs of AD patients. Clinical studies have demonstrated that early treatment with pimecrolimus decreases the progression to disease flares, rapidly improves pruritus and significantly enhances quality of life. Patients find the formulation easy to apply, which may result in improved adherence with the treatment regimen. Pimecrolimus, in contrast to topical corticosteroids (TCSs), does not induce skin atrophy or epidermal barrier dysfunction and is highly effective for the treatment of AD in sensitive skin areas. Furthermore, pimecrolimus reduces the incidence of skin infections compared with TCSs and is not associated with other TCS-related side effects such as striae, telangiectasia and hypothalamic-pituitary-adrenal axis suppression. An additional benefit of pimecrolimus is its substantial steroid sparing effect. On the basis of these data, a new treatment algorithm for patients with mild-to-moderate AD is proposed in which pimecrolimus is recommended as a first line therapy for patients with established mild AD at the first signs and symptoms of disease. Pimecrolimus is also recommended for mild-to-moderate AD after initial treatment with a TCS. After resolution of lesions, maintenance treatment with pimecrolimus may effectively prevent subsequent disease flares. In conclusion, the clinical profile of pimecrolimus suggests that it may be considered the drug of choice for the treatment of mild-to-moderate AD in children as well as adults and particularly in sensitive skin areas.

Psoriasis treated successfully with ustekinumab in a cocaine-addicted patient.

BACKGROUND: Psoriasis is a chronic, immune-mediated inflammatory disease estimated approximately in 2% of the European population. Drug abuse is reported in 3-5% of the global population. MAIN OBSERVATION: We present a 41-year-old, cocaine-addicted patient male with severe plaque-type psoriasis treated successfully with ustekinumab. The patient received ustekinumab at a dose of 45 mg subcutaneously at weeks 0, 4 and 16 and achieved PASI 75 at week 18. CONCLUSIONS: Although several drug-abusers experience psoriasis, literature is very poor regarding the outcome of systemic treatment in those patients. In our patient no adverse effects were seen during the administration period of ustekinumab and no interactions between cocaine and ustekinumab were noticed. Nevertheless, more individuals and further studies are needed to establish the efficacy and safety of ustekinumab in the treatment of psoriasis in drug-abusers.

Tacrolimus 0.1% vs mometasone furoate topical treatment in allergic contact hand eczema: a prospective randomized clinical study.

Tacrolimus is a macrolide immunosuppressant that has been demonstrated to inhibit T-lymphocyte activation without the side-effects of corticosteroids. The safety profile of tacrolimus makes it a promising therapeutic option for dermatitis. To evaluate and compare the therapeutic ability of tacrolimus 0.1% ointment and mometasone furoate 0.1% ointment in patients with chronic hand eczema and positive patch tests. Thirty adults with chronic hand eczema and positive patch test reaction to relevant contact allergens were treated with tacrolimus 0.1% ointment or mometasone furoate 0.1% ointment in a single-centre, randomized comparative study. The scores of the evaluated clinical parameters (erythema, infiltration, vesiculation, desquamation, presence of cracks and itching) did not differ between Groups A and B at any of the four time points (p>0.05).On the other hand, in both groups, a significant difference was detected in all parameters between baseline and Day 90 recorded values. Tacrolimus is a promising alternative therapy for contact dermatitis patients as it is effective from the first month of treatment, well tolerated and offers similar therapeutic results to topical corticosteroid therapy.

Erythrokeratodermia variabilis: report of two cases and a novel missense variant in GJB4 encoding connexin 30.3.

Erythrokeratodermia variabilis (EKV) is characterized by migrating red patches resembling a geographical map, and by localized or generalized hyperkeratosis with scaling of the skin. The onset is usually at birth or during infancy, and the disease persists throughout life. EKV is mainly inherited as an autosomal dominant disease, although recessive transmission has occasionally been reported. Mutations associated with EKV have been identified in the connexin (Cx) genes GJB3 (Cx31) and GJB4 (Cx30.3), however, several cases of EKV have been tested negative for mutations in these two Cx genes. Here, we report our findings of the clinical, histological, and molecular examinations performed in two unrelated sporadic cases of EKV. The molecular screening involved bidirectional sequencing of the coding regions of the GJB3 and GJB4 genes and revealed the existence of a novel c.295G>A missense variant in the GJB4 gene found in homozygosity in one case. The substitution was found to result in a p.E99K change of the Cx30.3 protein, an alteration predicted to have a benign rather than a damaging effect on the protein function.

Skin diseases in Greek and immigrant children in Athens.

OBJECTIVES: This study aimed to characterize the spectrum of skin diseases affecting children in Greece. METHODS: We retrospectively studied data for 4071 children, aged 0-12 years, who were examined and diagnosed with dermatoses at the outpatient clinic of a university dermatological hospital between December 2005 and August 2007. To evaluate changes in disease patterns, these data were compared with data for a cohort of 12,700 children diagnosed with skin diseases at the same clinic two to three decades earlier (in 1977, 1980, and 1983). RESULTS: The most frequent disease was dermatitis/eczema (34.7%), with atopic dermatitis found in 20.7% of children, contact dermatitis in 6.9%, pityriasis alba in 2.1%, and seborrheic dermatitis in 1.8%. Infections (19.3%), nevi (5.6%), scabies (4.8%), and insect bites (4.3%) followed. More viral (12%) than bacterial (3.7%) and fungal (3.6%) infections were noted. Warts constituted 53.2% of viral infections. Immigrants had an increased risk for bacterial infections and scabies. CONCLUSIONS: Children diagnosed with skin diseases 24-30 years earlier were younger; exhibited lower prevalences of dermatitis/eczema (P = 0.01), viral infections (P < 0.001) and nevi (P < 0.001); higher prevalences of bacterial and fungal infections (P < 0.001) and insect bites (P < 0.01); and similar rates of scabies (P = 0.17). This study documents the high prevalence of atopic dermatitis in the region, the increasing incidence of viral infections and nevi, and the continuing problem of scabies, especially in immigrants.

Condylomata acuminata in children.

We describe a study on 38 children from 1 to 11 years of age, with anogenital warts, 25 were girls. The disease was primarily perianal. Sexual abuse was confirmed in one 9-year-old boy. Most responded to monotherapy with podophyllotoxin, imiquimod 5%, or cryotherapy in a 3-month follow-up period.

Treatment of autoimmune urticaria with low-dose cyclosporin A: A one-year follow-up.

Patients with autoimmune urticaria (AIU) and positive autologous serum skin test (ASST) represent a more serious type of chronic urticaria that does not respond to treatment with antihistamines, but responds completely to systemic corticosteroids. Because of the chronic course of the disease, there is a risk of side-effects. Cyclosporin A (CsA) is an alternative treatment for patients with AIU. In order to determine the efficacy of CsA at the lowest possible dose in patients with chronic idiopathic urticaria and positive ASST, 30 patients were included in a 5-month study with a follow-up one year after the end of treatment. All patients had positive ASST before treatment and autoantibodies were present in 73%. Twenty- three patients completed the study and responded to low-dose CsA treatment. Three patients did not respond to a dose of 2.5 mg/kg CsA, and 4 patients dropped-out due to side-effects. After the first month of treatment, an improvement of 31% was noted, reaching 88% after the fifth month of treatment. The mean dose of CsA was 2.16 mg/kg for the first month and 0.55 mg/kg for the fifth month. Three to 6 months after the end of the study, the ASST was repeated and was negative in 78.3% of patients. At the one-year follow-up, 20 patients were symptom-free (87%) and 3 had relapsed (13%). CsA, even in low-doses, can be an effective and short-term treat- ment with minimum side-effects in patients with AIU.