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3.
Dermatol Ther ; : e14514, 2020 Nov 09.
Artigo em Inglês | MEDLINE | ID: mdl-33166029

RESUMO

The skin is the most common organ of involvement during the course of lupus erythematosus (LE). The literature data concerning the dermatoscopic patterns of the different clinical variants of cutaneous LE (CLE), namely chronic (CCLE), subacute (SCLE), and acute (ACLE), are scarce. To determine the dermatoscopic spectrum of CLE and to correlate the dermatoscopic features with the histological findings. This was a retrospective, observational, multicenter, cohort study. We evaluated the dermatoscopic features in a cohort of patients diagnosed with CLE. Furthermore, we investigated their frequency per clinical subtype and correlated them with the anatomic alterations. We included 79 patients. The most prevalent dermatoscopic features of CCLE included follicular plugs (86.4%, P < .01), patchy distribution (75%, P = .1) of mostly linear curved vessels (56.8%, P = .8), white scales (68.2%, P < .01), and structureless white color (68.2%, P < .01). The most common criteria of SCLE were patchy distribution (90%, P = .1) of mostly linear curved vessels (53.3%, P = .8) and fine white scales (60%, P < .01), while ACLE was characterized by erythema (100%, P < .05) and patchy distribution (100%, P = .1) of mostly dotted vessels (60%, P = .4). Follicular plugs/rosettes in dermatoscopy strongly correlated with follicular plugs in histology (rho = 0.919). Hyperkeratosis significantly correlated with white (rho = 0.644) and yellow/brown scales (rho = 0.225), telangiectasia with linear curved vessels (rho = 0.321) and white color with dermal fibrosis (rho = 0.623). Depending on CLE subtype, distinct dermatoscopic patterns are recognized. In CLE there is a high correlation between certain dermatoscopic criteria and the underneath anatomic alteration.

4.
Dermatol Ther ; : e14414, 2020 Oct 16.
Artigo em Inglês | MEDLINE | ID: mdl-33064345

RESUMO

Basal cell carcinoma (BCC) is the most common skin cancer in white skin individuals. The treatment of choice is surgical excision, but several other therapeutic choices are available and might also be efficient and cost-effective in selected cases of low-risk BCC or when surgery is complicate or contraindicated. The aim of the current study was to analyze the applied treatments for BCC in the real-life practice of a tertiary hospital, and investigate factors associated to the tumor and the patients that might influence the treatment selection of clinicians. Data on all BCCs treated from 1st January 2018 to 31st December 2019 were extracted. A total of 751 BCCs from 585 patients were included. The baseline characteristics of patients and tumors, the type of applied treatment and the histopathologic report when available were analyzed. Most tumors were located on the head/neck (64.2%). The most frequently applied treatment was surgical excision (580/751, 77.2%). In 22.8% of tumors a nonsurgical treatment was selected. The most frequently selected alternative treatments were, imiquimod, cryosurgery, their combination (immunocryosurgery), and vismodegib. A pretreatment diagnosis of superficial BCC was associated with a 12-fold increased probability of selecting a nonsurgical treatment except of vismodegib. Every added year of age increased the probability of selecting a nonsurgical treatment by 3-fold. Every added mm of diameter increased the possibility of vismodegib use by 4%. Surgery is the most frequently applied BCC treatment, but nonsurgical modalities do also have an essential role in real settings.

5.
Arch Dermatol Res ; 2020 Oct 22.
Artigo em Inglês | MEDLINE | ID: mdl-33094412

RESUMO

Hidradenitis suppurativa (HS) is a difficult-to-treat chronic relapsing skin disease, which greatly impacts the quality of life. To bring forward real-life challenges in the decision-making process regarding HS treatment. A retrospective observational study was performed with treatment-related data derived from the HS archive of tertiary hospital-based First Department of Dermatology and Venereology of Aristotle University, Greece. Data were available for 121 patients, 63 men (52.7%) and 58 women (47.93%) with a mean age of 38 years. Doxycycline 100 mg twice daily for 1-2 weeks and then once daily for up to a total of 12 weeks was the most popular treatment choice (80 patients, 66.12%), administered for mild-to-moderate disease. Biologics were the second most frequently prescribed treatment, reserved for moderate-to-severe disease (adalimumab: 26 patients, 14.88%, infliximab: 2 patients, 1.65%). All in all, a wide variety of treatment regimens were implemented, with various combinations of topical and systemic agents. Real-life practice reflects the relative paucity of high-quality evidence regarding HS treatment and the absence of a unanimously preferable therapeutic option, leaving both dermatologists and patients defenceless against disease progress and sequelae.

6.
J Dermatolog Treat ; : 1-4, 2020 Aug 20.
Artigo em Inglês | MEDLINE | ID: mdl-32783678

RESUMO

OBJECTIVE: The increasing number of elderly psoriatic patients presents a challenge for dermatologists. Biologicals and small-molecule inhibitors in the general population have demonstrated a sufficient efficacy and safety profile; yet, studies about their use in the geriatric population are lacking. In this study, we evaluated the efficacy and safety of biological and apremilast among psoriatic patients ≥65 years old. MATERIALS AND METHODS: Clinical records of patients over 65 years old receiving biological drugs or apremilast were retrospectively reviewed. Efficacy was evaluated using Psoriasis Area and Severity Index (PASI) score at treatment onset and weeks 12, 24, 52 and 3 years. Adverse events were also recorded. RESULTS: A total of 154 patients with a mean age of 70.7 ± 6.3 years-old were included in our study. Secukinumab, ustekinumab and brodalumab showed fast-acting results, while the sustained efficacy of secukinumab, ustekinumab, infliximab, adalimumab and brodalumab was also notable. Overall, 30 out of 154 (19.5%) patients reported side effects. Lower respiratory system infections (n = 6; 3.9%) and hepatic enzyme elevation (n = 6; 3.9%) were the most frequently observed events. CONCLUSIONS: Biologicals and apremilast demonstrate adequate efficacy in elderly psoriatic patients. Incidence and severity of reported adverse events were similar to those reported among patients of younger age in relevant clinical studies.

9.
Dermatol Ther ; : e13958, 2020 Jul 04.
Artigo em Inglês | MEDLINE | ID: mdl-32621642

RESUMO

Bullous pemphigoid (BP) patients are predominantly above 70 years of age, with limited tolerance to the side effects of the immunosuppressive drugs. Advancements in our understanding of the pathophysiology of BP have led to the development of molecules which target specific pathways involved in induction and perpetuation of disease. Patients with BP Disease Area Index above 60 and less than 100 were split into two groups-one with high and the other with normal levels of IgE. The tested parameters included eosinophils' count, total IgE serum level, and interleukins (IL) 16, 17A, and 23 counts in the peripheral blood and skin bulla serum, before any therapeutic intervention. Thirty individuals fulfilled the criteria for enrollment. Patients with high IgE blood serum levels had significantly higher levels of IL17A and normal IL23 levels in blood and bulla serum. Patients with normal serum IgE levels had slightly higher IL23 levels in blood and bulla serum. The eosinophil count was positively related to IL17 blood serum level and negatively related to IL23. IL16 did not differ in the two groups. BP patients may represent a group of patients benefiting most substantially from the introduction of nonimmunosuppressive therapeutics into the treatment regimens for their disease. Clinical criteria and immune biomarkers are needed for making the best therapeutic choice.

10.
Mediterr J Rheumatol ; 31(Suppl 1): 137-144, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32676572

RESUMO

Molecular targeting therapies represent a new exciting era in dermatology. A promising novel drug class, subject of intense research, is Janus kinase (JAK) inhibitors. Multiple cytokine receptors signal through the Janus kinase and signal transducer and activator of transcription (STAT) pathway. The pathway plays a central role in innate and adaptive immunity, and haematopoiesis. The understanding of the contribution of JAKs to the immunologic processes of inflammatory diseases led to the development of JAK inhibitors, initially for rheumatologic and hematologic diseases. Soon, their efficacy in some dermatologic conditions was also demonstrated, and today their role as therapeutic agents is thoroughly researched, mainly in atopic dermatitis, psoriasis, vitiligo, and alopecia areata. JAK inhibitors can be administered orally or used topically. As they are relatively new treatment modalities in dermatology, many questions concerning their efficacy and safety remain unanswered. Data from ongoing trials are eagerly awaited. Here, we summarize under development JAK inhibitors for dermatologic diseases.

11.
Arch Dermatol Res ; 312(10): 731-737, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-32266532

RESUMO

Early identification and adequate treatment of actinic cheilitis (AC), which affects the lower lip vermillion and is considered a precursor of squamous cell carcinoma, is mandatory. Photodynamic therapy (PDT) has been successfully used in AC. PDT with the use of daylight (DLPDT) is equally effective and more convenient than the conventional PDT. Data on short and long-term efficacy of DLPDT in AC are limited. Our primary purpose was to assess efficacy of DLPDT in AC as well as safety and tolerance. Twenty-two individuals with histologically confirmed AC received 2 MAL (5-aminolevulinic acid)-DLPDT sessions 1 week apart. Patients were evaluated clinically 3, 6, and 12 months after treatment. Non-complete responders were biopsied and excluded from the study if histological alterations were indicative of AC. Adverse events were recorded from baseline to the end of the 12-month follow-up period. Twenty patients completed the study. Overall, complete clinical response 12 months after treatment was 80% (16/20), while an association between treatment response and grade of dysplasia was observed (p = 0.016). With respect to response by grade, complete clinical response achieved in grade I AC was 100% (12/12) and 50% (4/8) in grade II AC. Main adverse events included mild erythema, oedema, and scaling, with no pain associated with DLPDT. According to our results, DLPDT seems to be of significant benefit for the treatment of grade I AC. Combination with the other treatment modalities could improve the efficacy in grade II AC. Further studies are needed for the assessment of late recurrences.

13.
J Am Acad Dermatol ; 82(2): 398-406, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31499156

RESUMO

BACKGROUND: In retrospective studies, a second primary melanoma (SPM) develops in 2%-20% of melanoma patients. Scarce evidence exists on the usefulness of total-body photography (TBP) and digital dermatoscopic documentation (DDD) for detecting SPMs. OBJECTIVE: The primary aim was to quantify the risk and investigate the time of occurrence of SPMs. Secondary aims were to identify risk factors for SPM and to assess the usefulness of TBP and DDD for SPM detection. METHODS: This prospective cohort included patients with recently diagnosed melanoma that underwent sequential clinical and dermatoscopic examinations for up to 5 years. Life table analysis and Kaplan-Meier survival analysis were performed. Multivariate Cox models were constructed to identify factors affecting the outcome. RESULTS: An SPM developed in 46 of 977 (4.7%) patients. Life table analysis revealed a 5-year cumulative risk of 8.0% for SPM. High nevus count, fair phototype, and occupational sun exposure were potent predictors of SPM. Of all new melanomas, 17.3% were diagnosed by clinical and dermatoscopic examination, 48.1% by TBP, and 34.6% by DDD. LIMITATIONS: All patients followed the same protocol and diagnostic bias associated with sequential dermatoscopic imaging. CONCLUSION: In this cohort, melanoma patients were at 8% risk of an SPM developing within 5 years. TBP and DDD significantly contributed to the early detection of SPM.


Assuntos
Melanoma/epidemiologia , Segunda Neoplasia Primária/epidemiologia , Neoplasias Cutâneas/epidemiologia , Adulto , Idoso , Dermoscopia , Feminino , Humanos , Masculino , Melanoma/patologia , Pessoa de Meia-Idade , Segunda Neoplasia Primária/patologia , Fotografação , Vigilância da População , Estudos Prospectivos , Medição de Risco , Fatores de Risco , Neoplasias Cutâneas/patologia , Fatores de Tempo
15.
Pediatr Dermatol ; 36(4): 501-504, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30907017

RESUMO

Terra firma-forme dermatosis (TFFD), first described by Duncan in 1987, is a relatively common but probably underdiagnosed condition, characterized by a reticular hyperpigmented dirtlike eruption resistant to washing with common soap but typically removed with rubbing with 70% isopropyl alcohol. We present a case of TFFD in an 8-year-old boy with rapid response to 5% salicylic acid in petrolatum ointment.


Assuntos
Dermoscopia/métodos , Exantema/diagnóstico , Hiperpigmentação/diagnóstico , Hiperpigmentação/tratamento farmacológico , Ácido Salicílico/uso terapêutico , Dermatopatias Eczematosas/diagnóstico , Administração Tópica , Criança , Diagnóstico Diferencial , Feminino , Humanos , Índice de Gravidade de Doença , Resultado do Tratamento
16.
Dermatol Pract Concept ; 8(4): 306-313, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30479862

RESUMO

Background: In spite of recent advances in the histopathological and molecular diagnosis of melanocytic neoplasms, a certain proportion of these lesions remain a daunting challenge for both the clinician and the pathologist. Objectives: To emphasize the importance of close collaboration between clinicians and pathologists in case of problematic melanocytic lesions. Patients: We report and discuss 5 problematic scenarios of melanocytic lesions, including tumoral melanosis, nevoid melanoma, lentiginous melanoma, spitzoid melanoma and BAPoma that may pose diagnostic difficulties in our practice. Conclusions: Clinico-dermoscopic-pathological correlation, with incorporation of all the available data, in problematic melanocytic skin neoplasms is of paramount importance for accurate diagnosis.

17.
Dermatol Clin ; 36(4): 359-368, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30201145

RESUMO

In addition to its "traditional" application for the early diagnosis of melanoma and nonmelanoma skin cancers, dermoscopy gains appreciation in fields beyond dermato-oncology. Nowadays, dermoscopy has been established as a reliable adjunctive tool to the everyday clinical practice of general dermatology. Morphology and distribution of vascular structures, background colors, follicular abnormalities, and the presence of scales are important features that should be evaluated. Clinical examination remains the undoubted mainstay of diagnosis in inflammatory and infectious diseases.


Assuntos
Dermatite/diagnóstico por imagem , Dermoscopia , Dermatopatias Papuloescamosas/diagnóstico por imagem , Humanos , Ceratose/diagnóstico por imagem , Líquen Escleroso e Atrófico/diagnóstico por imagem , Lúpus Eritematoso Discoide/diagnóstico por imagem , Psoríase/diagnóstico por imagem , Rosácea/diagnóstico por imagem , Esclerodermia Localizada/diagnóstico por imagem
19.
Clin Cosmet Investig Dermatol ; 10: 305-310, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28848358

RESUMO

Rosacea is a chronic skin disease characterized by facial erythema and telangiectasia. Despite the fact that many hypotheses have been proposed, its etiology remains unknown. In the present review, the possible link and clinical significance of Helicobacter pylori in the pathogenesis of rosacea are being sought. A PubMed and Google Scholar search was performed using the terms "rosacea", "H.pylori", "gastrointestinal disorders and H.pylori", "microorganisms and rosacea", "pathogenesis and treatment of rosacea", and "risk factors of rosacea", and selected publications were studied and referenced in text. Although a possible pathogenetic link between H. pylori and rosacea is advocated by many authors, evidence is still interpreted differently by others. We conclude that further studies are needed in order to fully elucidate the pathogenesis of rosacea.

20.
Clin Cosmet Investig Dermatol ; 10: 171-177, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28546761

RESUMO

Vismodegib is approved for the treatment of adult patients with metastatic (mBCC) or locally advanced basal cell carcinoma (laBCC) that have recurred following surgery or for those who are not good candidates for surgery (risk/benefit ratio is against patient's benefit, either because of the general condition or because of the expected morbidity from the surgery) or radiation therapy. This article provides an evidence-based review of its current place in therapy. Analytically, the clinical implications in the management of laBCCs and mBCCs and possible new indications, including the neoadjuvant use before surgical excision, are discussed, while in the end, the challenges regarding class-related adverse events and their optimal management are highlighted.

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