Isotretinoin for the treatment of squamous cell carcinoma arising on an epidermoid cyst.

A 63-year-old man showed multiple concentric erythemato-nodular lesions of approximately 1.5-3 cm in diameter, located in the parietal and temporal region. The skin biopsy allowed histological diagnosis of infundibular epidermal cyst associated with chronic granulomatous flogosis; in one of these, a well-differentiated squamous cell carcinoma arising from the cyst wall was found. The patient received isotretinoin at the daily dosage of 0.5 mg/kg/day for 5 months. During 1-year follow-up, laboratory tests, computed tomography scans, and control histology were all in the normal range, with a good improvement of the lesions. Epidermal cysts and squamous cell carcinoma are both commonly encountered in practice. However, the association of epidermal inclusion cysts and squamous cell carcinoma in the skin is very rare. In some cases, including the present one, more potent chemopreventive strategies, such as the use of systemic retinoids, must be considered. Systemic retinoids are the most heavily researched chemopreventive agents and have shown promise for multiple types of cancer, including bladder and head and neck carcinomas. We would like to recommend the possibility to administer retinoids in a squamous cell carcinoma, achieving very satisfactory results; in our case, a complete remission of malignant lesion and an improvement of epidermal cysts were made, without the development of side effects associated with retinoids.

Cardiovascular risk in psoriatic patients detected by heart rate variability (HRV) analysis.

Patients affected by severe psoriasis have an increased prevalence of cardiovascular () diseases as documented by several studies. Heart rate variability (HRV) is a noninvasive method to evaluate the autonomic control of the sinus node. In this study, HRV analysis has been used to evaluate whether young patients with moderate cutaneous psoriasis have increased cardiovascular (CV) risk, in absence of CV comorbidities. Our data indicate an imbalance toward the sympathetic arm of the autonomic cardiac modulation. As the increase in sympathetic activity may be associated with a higher CV risk, moderate psoriasis could be considered to be an independent CV risk factor.

Mediterranean diet and familial dysmetabolism as factors influencing the development of acne.

AIM: To investigate the effects of adherence to the Mediterranean diet and familial dysmetabolisms on acne development. METHODS: A community-based case-control study was carried out in Italy enrolling cases as acneic outpatients of a dermatological ambulatory service and controls as clinically healthy acne-free subjects. Food consumption were evaluated with a validated food-frequency questionnaire, exploring the consumption of pasta, meat, cheese, fish, fruit, vegetables, and olive oil. Adherence to the traditional Mediterranean diet was assessed by a 10-point Mediterranean diet scale that incorporated the main characteristics of this diet. A logistic regression analysis estimated the variables who predicted the odds of being case, using those variables that at the univariate analysis yielded a p-value <0.25. Results are presented as odds ratio (OR) or adjusted OR (AOR). RESULTS: The study included 93 cases (36.6% males, median age 17 years) and 200 controls (32% males, median age 16 years). The Mediterranean diet score ≥6 revealed a protective effect towards acne (crude OR 0.22, 95% CI 0.08-0.64). Logistic regression analysis showed that familial hypercholesterolaemia, diabetes, and hypertension are strong risk factors for acne (AOR 8.79, 95% CI 1.67-46.22; 3.32, 95% CI 1.27-8.63; and 2.73, 95% CI 1.07-6.96, respectively), while the Mediterranean diet represents a protective factor (score ≥6, AOR 0.31, 95% CI 0.11-0.89). CONCLUSIONS: The odds for familial dysmetabolisms was higher in cases than in controls, confirming their role in determining or maintaining acne. Moreover, this is the first study demonstrating a protective role of the Mediterranean diet in the pathogenesis of acne.

Severe psoriasis with positive tuberculosis test and treatment with biologic therapy: a case report.

Psoriasis and tuberculosis (TB) are 2 conditions with high prevalence in the general population, often present simultaneously in the same patient. The crucial cytokine involved in the pathogenesis of psoriasis, tumor necrosis factor alpha (TNF-alpha), also is important in defending against mycobacteria. Therefore, it is important to screen patients for a latent TB infection (LTBI) while they are undergoing treatment with TNF-alpha antagonists. We present a case of a patient with psoriasis and LTBI who underwent treatment with etanercept.

Acitretin in management of diffuse common warts: a case report.

Warts are among the most commonly observed dermatological diseases, caused by human papilloma virus (HPV), usually HPV1-2 subtypes; HPV4-7 are rarely found and mostly related to professional exposure (butchers and dairy workers). Different therapeutical approaches are possible, depending on extension and severity of lesions. The present authors describe the case of 32-year-old Caucasian man, who came to our attention for the presence of numerous exophytic papules on the back of both hands and over periungual regions, which appeared about 6 months before. Histological examination confirmed the clinical suspicion of common warts (HPV4). The patient underwent therapy by acitretin for 12 weeks, obtaining during the 8th week of therapy complete resolution of skin lesions. The present authors present this case for the unusual local aggressiveness of viral warts in an immunocompetent patient successfully treated with acitetrin.

Women and acne: any difference from males? A review of the literature.

INTRODUCTION: The attention to the impact of gender differences in acne is needed and, at the moment, lacking. The aim of this paper was to perform a systematic review on gender differences in acne. EVIDENCE ACQUISITION: A review of the literature was performed using the PubMed and Ovid literature search engines , using a variety of combined search terms including "acne", "gender", "sex", "females", "males". The search extended until July 2013. EVIDENCE SYNTESIS: Gender differences in acne highlight hormonal interactions as a major target for which more research is needed to translate current findings to clinically significant diagnostic and therapeutic applications. In addition, female patients are more likely to develop anxiety and depression due to their condition, and acne improvement positively influences quality of life. CONCLUSIONS: The patient's sex should not radically alter diagnostic or therapeutic efforts, although gender differences could be necessary to set up clinical management, monitoring also the psychological aspect.

Skin manifestations in course of celiac disease: case report and review of the literature.

Skin and gut represent physical and immunological barriers between internal and external environment. Some affections involving the intestine, such as celiac disease, are reported to be associated with several different cutaneous diseases, like dermatitis herpetiforme or psoriasis. This could be better explained if gut and skin are taken as complex structures that share physio-pathological and immunological aspects. As a proof, we present the case of a woman affected by celiac disease who presented with three different skin manifestations strongly related in terms of onset, response to therapy and improvement during gluten-free diet.

Correlations between psoriasis and inflammatory bowel diseases.

For a long time the relationship between inflammatory bowel diseases (IBDs) and psoriasis has been investigated by epidemiological studies. It is only starting from the 1990s that genetic and immunological aspects have been focused on. Psoriasis and IBD are strictly related inflammatory diseases. Skin and bowel represent, at the same time, barrier and connection between the inner and the outer sides of the body. The most important genetic correlations involve the chromosomal loci 6p22, 16q, 1p31, and 5q33 which map several genes involved in innate and adaptive immunity. The genetic background represents the substrate to the common immune processes involved in psoriasis and IBD. In the past, psoriasis and IBD were considered Th1-related disorders. Nowadays the role of new T cells populations has been highlighted. A key role is played by Th17 and T-regs cells as by the balance between these two cells types. New cytokines and T cells populations, as IL-17A, IL-22, and Th22 cells, could play an important pathogenetic role in psoriasis and IBD. The therapeutic overlaps further support the hypothesis of a common pathogenesis.