Papular elastolytic giant cell granuloma: report of a case associated with monoclonal gammopathy and responsive to topical tacrolimus.

Papular elastolytic giant cell granuloma is an unusual variant of annular elastolytic giant cell granuloma. Its rarity makes the assessment of the real efficacy of any treatment difficult, as spontaneous remission is possible. We report a case whose interest, besides the rarity of the occurrence, rests in the pure papular expression of the clinical features, the association with a monoclonal gammopathy and the apparent efficacy of topical tacrolimus.

Clinical significance and treatment of skin rash from erlotinib in non-small cell lung cancer patients: results of an Experts Panel Meeting.

Advances in the knowledge of tumor biology and mechanisms of oncogenesis has granted the singling out of several molecular targets for non-small cell lung cancer (NSCLC) treatment. Among these targets, epidermal growth factor receptor (EGFR), or HER1, has received particular attention in lung cancer treatment. Erlotinib, an orally available inhibitor of EGFR tyrosine kinase in a phase III randomized placebo-controlled trial (BR.21), has been proven to prolong survival in NSCLC patients after first or second line chemotherapy. Skin rash is the most common adverse event associated with erlotinib treatment and it is often cause of negative impact on patients' quality of life. There is no specific treatment for this toxicity due to the lack of evidence-based data and recommendations. A panel of Italian oncologists, who had participated to clinical trials and to the Expanded Access Program for erlotinib in NSCLC treatment, and dermatologists with experience with cutaneous toxicity from EGFR inhibitors, attended a Meeting held in Rome on December 2006 to discuss skin rash from erlotinib and to provide suggestions for managing this frequent side-effect.

Contact allergy to cosmetics: the patients' perspective. An interview-based study.

AIM: It is generally agreed that the management of allergic contact dermatitis (ACD) to cosmetic ingredients can be challenging for patients due to the complex names and synonyms of the responsible allergens, but what kind of problems patients actually have in finding safe alternative products has seldom if ever been investigated. METHODS: To identify the major problems experienced by patients allergic to cosmetics, the authors studied 72 ACD patients with clinically relevant positive patch test and/or repeated open application test (ROAT) reactions from cosmetic allergens or from own cosmetic products as is. Two months after patch testing, they were called by phone, and underwent a semi-structured interview focused on the following questions: ''Is your dermatitis better?'', ''Did you find our explanations clear?'', ''Do you remember the name of the substance you are allergic to and which products contained it?'' ''Was it difficult to avoid exposure? If yes, why?'', ''How did you chose alternative products?''. RESULTS: The interview revealed that 63 out of 72 patients were cured or much improved. Of the remaining 9 patients, 6 had not avoided exposure, 3 still suffered from other kinds of dermatitis, but ACD was no longer present. All patients declared themselves satisfied with the explanations received, but half of them could not precisely name the causative allergens/cosmetics and had had problems in finding safe products, especially when preservatives with difficult names were involved. Hypo-allergenic-products were often complained of as expensive. Twenty patients who had been prescribed specific allergens-free products by their dermatologists had overcome their problems more easily. CONCLUSION: Patients' education after patch testing is crucial to achieve quick and stable resolution of ACD from cosmetic products.

Malaria in Maremma, Italy.

BACKGROUND: In August, 1997, a woman with no history of travel to malarious regions developed Plasmodium vivax malaria. She lived in a rural area of Italy where indigenous Anophyles labranchiae mosquitoes were present. METHODS AND FINDINGS: An environmental investigation was done within a 3 km radius of the patient's house. Adult mosquitoes and larvae were collected and examined by PCR with the gene for plasmodium circumsporozoite protein as target. About 200 people living in the area were interviewed to detect possible carriers of P. vivax. FINDINGS: None of the mosquitoes captured were carrying any malarial organisms. The house-to-house investigation identified a 7-year-old girl who had had a feverish illness a few days after her arrival in Italy from India, and who, 3 months later, still had P. vivax in her blood; she and her mother had antimalarial antibodies. INTERPRETATION: These investigations suggest that the index case of malaria was caused by local anopheline mosquitoes infected with exogenous P. vivax.