Symmetrical cutaneous rash in two women.

Symmetrical drug-related intertriginous and flexural exanthema, commonly known as "baboon syndrome" due to its typical involvement of the gluteal area, is an erythematous symmetrical rash associated with systemic drug administration.

Suicide risk and depression in patients with psoriasis.

BACKGROUND: Psoriasis is associated with comorbid psychiatric conditions. However, its relationship with suicidality is not completely understood. The aim of this study was to analyze the prevalence and the correlates of depressive symptoms and suicide risk in patients with psoriasis. METHODS: Adult psoriatic patients referring to the Outpatient Service of the Sant'Orsola-Malpighi Polyclinic were enrolled. Depressive symptoms and suicidality were assessed using the Patient Health Questionnaire (PHQ-9) and section C of Mini-International Neuropsychiatric Interview (M.I.N.I. 5.0.0). Psoriasis was evaluated using the Psoriasis Area and Severity Index (PASI), Body Surface Area (BSA) and the Dermatology Life Quality Index (DLQI). RESULTS: The prevalence of depressive symptoms was 14.9% and that of suicidality 6.3%. PHQ-9 scores were higher in patients with moderate-to-severe psoriasis (PASI≥10, Mann-Whitney U Test=4014.5; P<0.001; BSA≥10, Mann-Whitney Test=3930.5; P<0.001) and poorer quality of life (Mann-Whitney Test=805.5; P=0.024). Moreover, PHQ-9 scores were higher in females (Mann-Whitney Test U=3612.5; P=0.008) and were unrelated to age (rs=-0.056, P=0.423). Conversely, suicide risk was significantly higher in younger patients (Mann-Whitney=744, P=0.013) and females (χ2=5.69, P=0.028), and was unrelated to psoriasis severity. CONCLUSIONS: Patients with moderate-to-severe psoriasis, especially females, should be screened for depression and suicidal ideation to support them with effective strategies to treat depressive symptoms.

Individual Differences in Emotion Dysregulation and Social Anxiety Discriminate between High vs. Low Quality of Life in Patients with Mild Psoriasis.

A deeper understanding of how health-related quality of life relates to the clinical and individual characteristics of patients is essential for the delivery of patient-centered dermatological care. The current study aimed to examine the role of individual differences in emotion dysregulation and social anxiety in modulating quality of life in psoriatic patients. A total of 130 patients affected by psoriasis were consecutively enrolled in the study as they approached the Dermatology Unit of Sant'Orsola-Malpighi Hospital of Bologna. Clinical information gathered included illness severity, assessed with the Psoriasis Area and Severity Index (PASI) and the Body Surface Area (BSA); illness onset; familiarity; and prescribed treatment. The patient-reported outcome measures were the Dermatology Life Quality Index (DLQI), measuring the patient's quality of life; the Psoriasis Skin Appearance Bothersomeness scale (PSAB), measuring patient's perception of illness severity; the Difficulties in Emotion Regulation Scale (DERS), assessing emotion dysregulation traits; and the Social Interaction Anxiety Scale (SIAS), measuring anxiety about social interactions. Patients with moderate-to-severe psoriasis reported significantly lower quality of life compared to mildly affected patients. In addition, of the patients affected by mild psoriasis, those characterized by emotion dysregulation and social anxiety traits showed significantly lower levels of quality of life. Our findings suggest that individual differences in emotion dysregulation and social anxiety contribute to health-related quality of life in addition to illness severity. Therapeutic approaches that combine dermatological care with psychological support, especially focused on emotional regulation skills, may be useful to improve clinical outcomes in patients with psoriasis.

Cyclosporine in clinical practice: a retrospective study comparing fixed dose and body weight-based dose regimens in psoriatic patients.

BACKGROUND: In the treatment of various diseases, such as diabetes and arterial hypertension, fixed dose therapies have been reported to offer a method to simplify complex treatment regimens. There are numerous clinical trials proving the efficacy of cyclosporine in psoriasis in inducing remission and maintaining results, although there are few studies about the treatment optimization of cyclosporine. METHODS: We performed a 15-year retrospective observational study comparing two groups of psoriatic patients matched for age and sex. We assessed the clinical response, the safety and the compliance who took fixed dose of 200 mg cyclosporine (range 2.2-3.3 mg/kg) compared with a group of patients who took body weight-based dosage. Student's t-test was used to assess the difference in terms of PASI 75 achievement, patient-reported compliance on a five-point scale, DLQI questionnaire, laboratory values and blood pressure. RESULTS: PASI 75 achievement was not statistically different between the two groups. Compliance was good in both groups, and DLQI was also comparable. Laboratory values and blood pressure were not significantly different. CONCLUSIONS: Our study showed no statistically significant difference between the two groups in PASI reduction and PASI 75 achievement, even though the fixed dose was often lower (range 2.2-3.3 mg/kg) than the dosage administered depending on weight. Fixed dose cyclosporine is simple and practical to use in specific clinical settings, in particular when the patient's weight ranges from 60 to 90 kg. This approach can result in improved clinical outcomes and a better quality of life for psoriatic patients.

A suspicious dark lesion in a boy.

The presence of history of hyperpigmented crust in a patient with a history of adequate hygiene is typical of terra firma-forme dermatosis. The treatment is the rubbing of the skin with isopropyl alcohol (removal of the hyperpigmented brown crust, confirming the diagnosis). Physicians should be aware because early diagnosis avoid unnecessary treatment.

Socio-economic status and severity of plaque psoriasis: a cross-sectional study in the metropolitan city of Bologna.

Only a limited amount of data is available on the demographic and socio-economic status of psoriasis patients and its correlation with disease severity and impact on quality of life. The aim of this study was to investigate whether the socio-economic status of psoriasis patients is associated with higher PASI (Psoriasis Area Severity Index) and DLQI (Dermatology Life Quality Index) scores and global severity of disease. A total of 300 adults with plaque psoriasis, attending our psoriasis clinic for the first time (January 2015 to April 2018), were included in the study. Severity of psoriasis was defined according to three different definitions: PASI > 10, DLQI >10, and global severity based on the "Rule of tens" > 10%. The three outcomes were compared between patients with mild psoriasis and those with moderate-to-severe psoriasis using the t-test and χ2-test. Multiple logistic regression analyses were used to evaluate the association between each of the three outcomes and clinical and socio-economic features. Patients with lower educational level, employed in manual or office work, and with lower income were more likely to have moderate-to-severe psoriasis, considering the PASI and DLQI scores separately and the global severity of disease. The association between severity of disease and income was also significant based on multiple regression models. This study confirms the negative association between psoriasis severity and socio-economic status and is aimed at raising awareness among health professionals to investigate and consider this aspect in the management and therapeutic decisions in affected patients.

Facial angiofibromas treated by rapamycin 0.05% ointment and a combined laser therapy.

BACKGROUND: Tuberous sclerosis is an autosomal dominant genodermatosis characterized by nonmalignant hamartomas in multiple organs. Facial angiofibromas are most commonly located on the face and have the potential to cause disfigurement. Facial disfigurement negatively affects the quality of life of patients and their families, often leading to negative psychosocial outcomes. Nowadays there are no treatment guidelines for facial angiofibromas but due to the progressive nature of facial angiofibromas a safe technique offering good results is needed. OBJECTIVE AND RESULTS: We report the case of a 40-year-old female affected by tuberous sclerosis, whose facial angiofibromas were satisfactorily treated by rapamycin 0.05% ointment, and a combined laser therapy.

Sudden swelling and redness of the toe.

The presence of history of redness and swelling of toe in an infant without history of trauma is typical of hair threat tourniquet syndrome. The treatment simply involves incision and removal of hair fibers. Physicians should be aware of this syndrome because early diagnosis and treatment avoid serious complications.

Halolike Phenomenon Around a Café au Lait Spot Superimposed on a Mongolian Spot.

An 8-month-old Caucasian infant with neurofibromatosis type 1 presented with a congenital plexiform neurofibroma and multiple café au lait spots. A pale area surrounded one of the café au lait spots located on the left gluteus in the area of dermal melanocytosis. This halolike phenomenon results from the disappearance of the Mongolian spot around the café au lait spots, revealing normal pigmented skin. This sign has been described rarely in the literature and the pathogenic mechanism is unclear.

The rope sign: a case of interstitial granulomatous dermatitis with arthritis.

Interstitial granulomatous dermatitis with arthritis (IGDA), also known as Ackerman's syndrome, is a rare cutaneous disease classically characterized by the triad of cutaneous cords, a typical histologic infiltrate mainly constituted by histiocytes and arthritis/connective tissue disease. Here we report the case of IGDA with the typical clinical and histological features in a patient affected by lupus erythematosus. In this article we underline that IGDA may have a variety of different clinical and histological features. The rope sign is typical but infrequent, while histology is usually characteristic and shows a dermal inflammatory infiltrate, with a predominance of histiocytes, localized interstitially and in a palisaded array between collagen fibres, that show signs of degeneration. Clinical and histological differential diagnoses are discussed.

Senile lower lid entropion successfully treated with botulinum toxin A.

BACKGROUND: Spasmodic senile entropion (SE) is characterized by the inward turning of the eyelid. SE typically occurs spontaneously, but sometimes after ocular surgery. As of today, it is still lacking a gold standard technique. AIMS: To report the results of 11 cases of involutional entropion of the lower lid successfully treated with an injection of botulinum toxin, to evaluate the clinical results, and to document the duration of relief. METHODS: Eleven patients with senile entropion were treated with abobotulinum toxin A. The orbicularis oculi muscle was injected with 35 Su units of botulinum toxin. The procedures required an average of 5 min to complete. The follow-up period was 24 months. RESULTS: The average age of the patients was 68.09 years (ranging between 62 and 75). About 7 days after the treatment, the entropion had resolved and there was only one recurrence at the 3-month visit. The recurrence rate was 27% after 6 months, and 27% after 9 months. Of note, the patients with recurrence repeated the injection and showed an increasingly long wellness period. CONCLUSIONS: Injection of botulinum toxin can treat entropion and resulted in a significantly high success rate.