Cardiospermum halicacabum in atopic dermatitis: Clinical evidence based on phytotherapic approach.

Atopic dermatitis is a chronic inflammatory disease that mainly affects children, causing a strong impact on the quality of life. The most affected subjects live in urban areas or in developed countries, with prevalence increased up to 15%-20% in children and from 1% to 3% in adults during the past 30 years. Most adults had the first signs of illness before the age of 5, many of them before the age of 1. Many therapies in use are associated with side effects and often induce intolerance; therefore, many studies are based on the search for topical products that have an effective benefit, are well tolerated and appreciated by patients. Natural products are expected to have promising prospects in the management of atopy. Cardiospermum halicacabum is a member of the Sapindaceae family that seems to express its cortisone-like anti-inflammatory activity by activating phospholipase A2 while maintaining the stability of cell membranes, an effect due to the presence of phytosterols, having an affinity for lipids in the epidermis and cell membranes. We report our experience during a 15 days observational clinical study aimed to demonstrate efficacy and safety of the treatment with HALICAR: a cream containing C. halicacabum. Clinical data indicates that the treatment with HALICAR leads to positive effects in subjects with dermatitis of various degrees, regardless of which concomitant treatment is considered.

Daylight methyl-aminolevulinate photodynamic therapy versus ingenol mebutate for the treatment of actinic keratoses: an intraindividual comparative analysis.

Daylight-photodynamic therapy (D-PDT) and ingenol mebutate (IM) are novel therapies directed to actinic keratoses (AK). The purpose of our study was to compare effectiveness, tolerability, cosmetic outcome and patient preference of D-PDT versus IM in the treatment of grade I and II AK. Twenty-seven patients with AK on the face or scalp were enrolled. Each patient received, in a 25 cm(2) target area, D-PDT on right side and IM on left side. Overall 323 AK were treated. Both target areas achieved complete response in 40.47% of the cases and average AK clearance rate was similar for D-PDT and IM (p=0.74). In D-PDT areas mean grade II AK clearance rate was lower compared with that of grade I AK (p=0.015). In IM areas grade I and II AK average clearance rates were similar (p=0.28). At week 1 and month 1, mean local skin responses (LSR) score were higher in areas treated with IM. IM areas showed more severe pain and cosmetic sequelae. D-PDT had similar effectiveness to IM, even if IM demonstrated higher grade II AK clearance rate. Tolerability profile was superior for D-PDT in terms of LSR and pain. D-PDT was more cosmetically acceptable. Patients preferred D-PDT to IM in most cases.

Daylight photodynamic therapy with methyl aminolaevulinate in patients with actinic keratoses: a preliminary experience in Southern Italy.

BACKGROUND: Daylight photodynamic therapy (D-PDT) is a novel modality of PDT in which the activation of the topical photosensitizer is mediated by the exposure to daylight instead of artificial light sources without the need of preliminary occlusion. This simplified modality has been found to be well tolerated. We report our experience with D-PDT in patients with actinic keratoses (AK). METHODS: The data relative to 53 patients consecutively treated for AK with a single session of D-PDT using methyl aminolaevulinate cream were retrospectively reviewed. Most patients had grade I and/or II AK on the face and/or the scalp. Some patients had additional cutaneous lesions, including non-melanoma skin cancers, in the AK-associated field, that were simultaneously treated with D-PDT. RESULTS: At 3 months, a complete response (AK number=0) was achieved by 54.7% of patients, and the lesion clearance rate was 82.7%. Treatment was more effective in thinner lesions, with complete clearance involving 93% of grade I AK. At 6-9 months after treatment, response was maintained in 85.7% of the lesions previously cleared, and 72.4% of the initial complete responders did not relapse. No relevant effect of D-PDT was instead observed on senile lentigo, nodular basal cell carcinoma and squamous cell carcinoma, whereas a complete response was seen in 7 of the 9 superficial basal cell carcinomas treated. Local skin reactions mostly consisted in slight erythema. Mild symptoms (burning and tingling sensations) were reported by 12 patients. CONCLUSIONS: These preliminary results support the favorable efficacy and tolerability profile of D-PDT, which seems to be an interesting, valid, and convenient therapeutic option for AK, and possibly also for superficial basal cell carcinomas.

Daylight photodynamic therapy with methyl-aminolevulinate for the treatment of actinic cheilitis.

Actinic cheilitis (AC) is a common premalignant condition that requires an effective treatment to reduce the risk of malignant transformation. Photodynamic therapy (PDT) has been recently added to the armamentarium available for AC treatment. Daylight PDT (D-PDT) is a novel PDT modality in which the activation of the topical photosensitizer is induced by the exposure to natural daylight instead of artificial light sources without preliminary occlusion. This simplified procedure was found to be more tolerated as compared to conventional PDT. We report our preliminary experience on the use of D-PDT using methyl-aminolevulinate cream in 10 patients with refractory AC of the lower lip. Patients received two consecutive D-PDT sessions with an interval of 7-14 days. At 3 months after therapy, a complete response was observed in seven patients, with sustained results in five patients over an observational period of 6-12 months. Treatment was well tolerated.

To what extent is quality of life impaired in vitiligo? A multicenter study on Italian patients using the dermatology life quality index.

BACKGROUND: It is believed that vitiligo has an impact on the overall patient quality of life (QoL). OBJECTIVE: To estimate QoL in a fairly large sample of Italian vitiligo patients by using the Dermatology Life Quality Index (DLQI) questionnaire. METHODS: One hundred and sixty-one vitiligo patients referred to 9 dermatological centers were offered to participate by filling in the Italian version of the DLQI questionnaire. RESULTS: The mean total DLQI score was 4.3 (SD ±4.9; range: 0-22). In multivariate analysis, DLQI >5 was associated with female gender, stability of the disease over time and involvement of the face at disease onset. CONCLUSIONS: The impairment of QoL is overall limited in Italian vitiligo patients, especially if it is compared with results from other available studies. This could be due to cultural and ethnic characteristics of the sample.

Circulating autoantibodies and autoimmune comorbidities in vitiligo patients: a multicenter Italian study.

BACKGROUND: Autoimmune comorbidities and circulating autoantibodies have been observed in vitiligo patients, but differences in rate are present according to countries in which the studies were performed, perhaps owing to ethnic diversities or different trigger factors. OBJECTIVE: To estimate the prevalence of circulating autoantibodies and overt autoimmune diseases in a fairly large sample of Italian vitiligo patients. METHODS: 175 outpatients affected by vitiligo and referred to nine dermatological centers were included in the study. Patients were offered routine blood test, serological testing for thyroid function and search for autoantibodies. RESULTS: At least one circulating autoantibody was detected in 61 (41.8%) of 146 subjects who underwent laboratory tests. Anti-thyroperoxidase (25.6%), anti-thyroglobulin (23.4%), antinuclear antibodies (16.8%) and anti-gastric parietal cell antibodies (7.8%) were the most noticed autoantibodies. 74 (41.5%) autoimmune comorbidities, mainly autoimmune thyroiditis (37%), were reported. CONCLUSION: The prevalence of autoimmune comorbidities and circulating autoantibodies in this study was in agreement with other surveys conducted on Caucasian patients.

Methyl-aminolevulinate photodynamic therapy for the treatment of erythroplasia of Queyrat in 23 patients.

Erythroplasia of Queyrat (EQ) is an intraepithelial squamous cell carcinoma localized on the mucosal or transitional surfaces. Standard therapy usually consists of the surgical removal of the cancer. The use of non-invasive alternative procedures, such as photodynamic therapy (PDT), has been considered for the treatment of EQ, although only a few reports regarding isolated cases or small series exist. We describe our cumulative experience with PDT, using topical methyl-aminolevulinate (MAL), for the management of 23 male patients with EQ of the glans penis and/or prepuce. Patients underwent two consecutive weekly MAL-PDT sessions, with the second session postponed in seven patients because of an excessive local reaction. Nineteen patients obtained a complete clinical remission without any sign of recurrence over an average post-treatment period of 18 months (range, 8-30 months). Cosmetic outcome was excellent in most patients, while dyschromic changes occurred in four cases. All patients experienced transient local adverse reactions and 22 of them reported severe or very severe symptoms during the session.