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1.
Expert Opin Drug Saf ; 2021 Apr 22.
Artigo em Inglês | MEDLINE | ID: mdl-33888008

RESUMO

INTRODUCTION: Hedgehog inhibitors are an alternative treatment option for patients with advanced BCCs not eligible for standard therapies due to the lack of efficacy, the high recurrence risk and the high-rate of morbidity. Sonidegib, an oral smoothened antagonist, has been approved for the treatment of adult patients with locally advanced basal cell carcinoma. Several studies and randomized controlled trials have been conducted to in order to evaluate the efficacy, safety, and tolerability of this new molecule.Areas covered: The aim of this article is to provide a complete overview on the use of sonidegib for the treatment of advanced BCCs describing the efficacy, safety and drug tolerability of this drug.Expert opinion: Sonidegib, with a different pharmacokinetics profile from that of the other SMO-inhibitor vismodegib, demonstrated to be an efficacious and well-tolerated treatment in patients with locally advanced BCC. Although several drug-related adverse events have already been described different strategies should be taken into account to better manage this small molecule avoiding treatment discontinuation. The use of sonidegib as neoadjuvant therapy or combined with other hedgehog pathway inhibitors targeting different sites and to date, only available for pre-clinical studies, should also be considered.

2.
Artigo em Inglês | MEDLINE | ID: mdl-33866515

RESUMO

Even though melanoma represents a small percentage of all cutaneous cancers, it is responsible for most deaths from skin neoplasms. In early stages it can be successfully treated with surgery, but as the disease expands the survival rate drops significantly. For many years the mainstay of treatment for metastatic melanoma was chemotherapeutic agents, even though they failed to prove survival prolongation. After the advent of ipilimumab, a survival benefit and better overall response rate could be offered to the patients. Other new therapies, such as immunotherapies, targeted therapies, vaccines, and small molecules, are currently being studied. Also, combination regimens have demonstrated superiority to some monotherapies. Nowadays, ipilimumab should no longer be considered the first-line therapy given its severe toxicity and lower efficacy, while nivolumab remains efficacious and has a good safety profile. T-VEC as monotherapy has been shown to be an elegant alternative even for the elderly or cases of head and neck melanomas. If the BRAF mutation status is positive, the combination of dabrafenib and trametinib could be an option to consider. Despite the success of the novel treatments, their effectiveness is still limited. New studies have opened up new avenues for future research in melanoma treatment, which is expected to lead to better therapeutic outcomes for our patients. The objective of this review is to discuss the novel therapies for metastatic melanoma that have been tested in humans during the last 3 years to obtain a sharper perspective of the available treatment options for specific patient characteristics.

3.
Artigo em Inglês | MEDLINE | ID: mdl-33913664

RESUMO

BACKGROUND: Psoriasis represents one of the most common skin diseases in Italy, with a prevalence of 2.9%. It has been defined as a noncommunicable disease, due to its high burden and impact on patients' quality of life. AIMS: The aim of our observational study was to assess the actual knowledge and perception of psoriasis in Italian population by administering an online 10-question survey to a representative sample general population. METHODS: An online 10-question survey was administered to a representative sample general population from September 2019 to December 2019. A representative sample of general population (age ≥ 18 years) was enrolled by promoting the online survey through multiple means of communication such as social sites (Facebook, Instagram) or delivering a questionnaire link in public spaces (outpatient clinic, pharmacy). All results were then collected and analyzed in graphs by the Google form platform. RESULTS: 151 individuals participated in the survey. Results showed that 7.3% (n=11) of general population were not familiar with the term psoriasis; 4.6% (n=7) thought to psoriasis as an infectious disease and 6% (n=9) thought that psoriasis was contagious. Interestingly, 39.1% (n=59) of participants have never heard about targeted/biologic therapy. LIMITATIONS: Our study is limited by the small sample size as well as lack of data regarding sex, age and education level of the study participant. CONCLUSIONS: There is still lack of knowledge of psoriasis among general population, representing an obstacle for patients' everyday activities and quality of life. Future studies to investigate the details of this impaired knowledge and new psoriasis campaign on large scale should fill this gap are required.

4.
Artigo em Inglês | MEDLINE | ID: mdl-33856641

RESUMO

Although surgery represents the treatment of choice for the majority of basal cell carcinomas, different therapies are required to treat the advanced ones. Vismodegib and sonidegib are the two oral Smoothened (Smo) inhibitors approved for the treatment of advanced basal cell carcinoma. Clinical detection of subclinical basal cell carcinoma during and after vismodegib treatment could be difficult, requiring the use of dermoscopy and reflectance confocal microscopy as noninvasive diagnostic methods. We report the case of a 62-year-old woman with a locally advanced basal cell carcinoma successfully treated with vismodegib in which dermoscopy and reflectance confocal microscopy showed their superiority in detecting subclinical recurrent basal cell carcinoma developed on scar tissue after complete regression of the tumor.

6.
Dermatol Ther ; 34(2): e14857, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33559275

RESUMO

Scalp psoriasis represents the most common difficult-to-treat area in psoriasis patients. Its presence is linked to severe discomfort and impairment of quality of life given the associated symptoms (most of all, scaling and pruritus) and the location in a highly visible area, thus a prompt treatment is required. Its management may be challenging as the scalp is quite sensitive to long-term treatment with topical corticosteroids and usually resistant to topical and systemic agents. Likely, the currently available therapeutic armamentarium has been enriched with biologicals and small molecules that revolutionized psoriasis treatment and that of scalp psoriasis. Nevertheless, the lack of international dedicated guidelines pushed us to perform a comprehensive review on the efficacy and safety of biologics and small molecules on scalp psoriasis with the aim to put the basis for a therapeutic algorithm. After reviewing all the available evidence on the short-term and long-term efficacy of biologics and small molecules on scalp psoriasis the use of the newest biologics (anti-IL-17 and anti-IL-23) seems to be linked to the highest clinical performances in controlling scalp psoriasis. However, head-to-head comparisons between different biologics or biologics and small molecules are lacking. Hence, treatment selection should always be individualized.

10.
J Community Health ; 2020 Nov 30.
Artigo em Inglês | MEDLINE | ID: mdl-33258051

RESUMO

In Italy, as well as in almost all countries, the use of masks in public with several other measures has been an important health measure during the ongoing COVID-19 pandemic. The correct use of masks is essential, as a wrong use and disposal may increase the rate of contagious. Herein, we report a descriptive study evaluating the knowledge and use, reuse and disposal of masks in community settings. An anonymous questionnaire called MaSK (Mask uSe and Knowledge) questionnaire was developed and offered to patients referring at our dermatologic outpatient clinic. A total of 2562 full complete patients' questionnaires were considered for the study. Our results showed that awareness and information campaigns aimed at the general population are urgently needed in order to implement a correct use of masks and limit as much as possible the infection rate.

11.
Expert Opin Drug Saf ; 19(12): 1585-1594, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33054455

RESUMO

INTRODUCTION: Basal cell carcinoma (BCC) is the most common non-melanoma skin cancer (NMSC). Although surgery is the first-line therapy for BCC, some cases can progress to an advanced or, rarely, a metastatic state and targeted therapy are required. The main pathway involved in BCC tumorigenesis is the Hedgehog (Hh) signaling pathway and its inhibition is among the few treatment options available for patients with advanced BCCs. Recent advances in targeting this pathway have led to the development of two small-molecule oral Hh inhibitors, vismodegib and sonidegib. AREAS COVERED: The aim of this article is to provide a complete overview on the use of HPI for the treatment of advanced BCCs describing the efficacy, the benefits, and risks related to these small molecules. EXPERT OPINION: To date, the class of Hh inhibitors has revolutionized the management of patients with advanced BCCs, even though they are usually related to a toxicity profile that may represent the major cause of treatment discontinuation; an accurate study of the Hh signaling pathway and the development of other small molecules could be useful to enlarge the armamentarium of treatment in order to assure patients a personalized approach to the choice of treatment.

13.
Skin Appendage Disord ; 6(5): 280-282, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-33088812

RESUMO

Locally advanced basal cell carcinoma had always represented a form of skin cancer which had been difficult to treat until the hedgehog inhibitor vismodegib was approved. This small molecule acts by inhibiting the hedgehog signaling pathway that plays a critical role in the process of tumorigenesis. Although several trials have demonstrated the high efficacy of this drug, different adverse events have been described. Muscle spasms, dysgeusia, weight loss, and alopecia are the adverse events most frequently reported. The objective of this study was to report the incidence of alopecia arising in patients treated with vismodegib, assessing its characteristics, grade of severity, and time of onset.

15.
Dermatol Ther ; : e14267, 2020 Sep 03.
Artigo em Inglês | MEDLINE | ID: mdl-32882083

RESUMO

Androgenetic alopecia (AGA) is an androgen-dependent hereditary trait resulting in hair miniaturization. It is the most common type of alopecia in men and women. During the last years, multiple treatment modalities have been studied, but only topical minoxidil and finasteride have been approved by the US Food and Drug Administration. Microneedling (MN) is a minimally invasive technique that induces collagen formation, as well as growth factors production and neovascularization. Even though not many studies of MN in alopecia have been performed, it remains a favorable treatment modality; however, no standardized protocol for MN in hair loss has been proposed yet. Current evidence is not sufficient to allow a direct comparison with other therapies, but it shows promises to increase hair density, thickness, and quality of hair, especially when combined with other treatments or when used as a drug delivery system. This article aims to summarize the available literature regarding the use of MN alone or associated with other therapies for the treatment of androgenetic alopecia.

16.
G Ital Dermatol Venereol ; 155(5): 676-679, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32869963

RESUMO

BACKGROUND: Acne vulgaris is a common and chronic skin disease that impacts on physical and psychological perceptions. Combination therapy with topical retinoids and antimicrobial agent is considered the preferred approach for most of the subjects affected by mild-to-moderate acne. A correct therapeutic management should include a prolonged treatment to ensure therapeutic success and to prevent recurrences. The aim of this study was to evaluate the efficacy and tolerability of a new topical gel formulation that combines retinol encapsulated in glycospheres and hydroxypinacolone retinoate, associated with an anti-microbial peptide (BIOPEP-15) salicylic acid, glycolic acid, and niacinamide as monotherapy in mild acne vulgaris. METHODS: A 2-month prospective study was conducted at the Unit of Dermatology of the Federico II University. Twenty-five patients aged from 14 to 30 years with mild acne of the face (GAGS score ≤ 18) were consecutively enrolled. Each patient was asked to apply the gel formulation once daily in the evening for 8 weeks. The number of acne lesions with VISIA camera system, the global acne grading system (GAGS) score, trans epidermal water loss (TEWL), skin colorimetry (X-rite Spectrocolorimeter), reflectance confocal microscopy exam were evaluated at baseline, after 4 and 8 weeks of treatment for each patient. Tolerability and safety of the product were also evaluated. RESULTS: Twenty-five female patients with a median age of 23.4 were enrolled. Twenty-two (88%) completed the 2-month treatment period visits. At baseline the total acne lesion number, mean (SD), was 5.5 (4) and the GAG score 9 (4). A significant (P=0.001) reduction in number of total acne lesions was observed at week 4 (-57%) and at week 8 (-80%). All patients presented a significant reduction of the GAGS score values: -42% at week 4 and -78% at week 8, confirming the clinical efficacy of the product. At baseline TEWL was 10.2 g/m2/h (1.3) and 10.7 (1.4) at week 8, thus showing that the gel did not impair the skin barrier function. Skin colorimetry was significantly (P=0.0015) reduced by the treatment in comparison with baseline (62 vs. 58). Efficacy of the gel formulation was also confirmed with RCM exams, showing a reduction of dermal inflammation and exocytosis, and an improvement of infundibular hyperkeratinization. We observed that adherence to treatment correlated positively with the improvement of the single parameters. Moreover, side effects such as erythema, dryness, and excessive xerosis were not reported, resulting in a complete adherence to the treatment. CONCLUSIONS: Our findings provide favorable evidences of the efficacy and safety of this new product as a first line treatment in patients with mild acne, or, as a maintenance therapy for prolonged periods after the suspension of a systemic treatment. Furthermore, the tolerability of this topical product and the absence of any side effects increased the adherence to the therapy.

19.
Australas J Dermatol ; 2020 Jul 27.
Artigo em Inglês | MEDLINE | ID: mdl-32715462

RESUMO

BACKGROUND: Intradermal naevi represent a benign histopathological variant of common melanocytic naevi. Studies describing dermoscopic criteria of dermal naevi are very limited. OBJECTIVES: To identify dermoscopic features of dermal naevi in order to facilitate differential diagnosis from malignant lesions. METHODS: A 15-year retrospective study was performed to evaluate the dermoscopic characteristics of 202 dermal naevi, histopathologically diagnosed through the analysis of digital dermoscopic images performed with polarised light dermoscopy. For each lesion, vascular pattern, pigment pattern and other dermoscopic clues were evaluated. RESULTS: 147 Unna naevi and 55 Miescher naevi were included in the study. Brown pigment (37.1%) was the pigment pattern most frequently observed in both Unna and Miescher naevi, followed by cobblestone pattern (30.6%) in Unna naevi and white areas (23.6%) and dotted/globule pattern (20%) in Miescher naevi. As regards the vascular patterns, the polymorphic one was the most frequently observed (34.6%). The combination between comma-shaped and arborising vessels was the most common among all naevi. CONCLUSIONS: Our study describes the dermoscopic features of dermal naevi that may help to differentiate them from malignant lesions such as basal cell carcinoma, amelanotic melanoma and Spitz naevi.

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