Differences in clinicopathological features and distribution of risk factors in Italian melanoma patients.

BACKGROUND: No studies are available in the literature on the distribution of different melanoma features and risk factors in the Italian geographical areas. OBJECTIVE: To identify the differences in clinical-pathological features of melanoma, the distribution of risk factors and sun exposure in various Italian macro-areas. METHODS: Multicentric-observational study involving 1,472 melanoma cases (713 north, 345 centre, 414 south) from 26 referral centres belonging to the Italian Multidisciplinary Group for Melanoma. RESULTS: Melanoma patients in northern regions are younger, with thinner melanoma, multiple primaries, lower-intermediate phototype and higher counts of naevi with respect to southern patients; detection of a primary was mostly connected with a physician examination, while relatives were more involved in the south. Northern patients reported a more frequent use of sunbeds and occurrence of sunburns before melanoma despite sunscreen use and a lower sun exposure during the central hours of the day. CONCLUSIONS: The understanding of differences in risk factors distribution could represent the basis for tailored prevention programmes.

Lyell syndrome due to ticlopidine.

The antiplatelets drug ticlopidine is widely used in patients suffering from cardiomyopathies, coronary cardiopathies and thromboembolic pathologies. The potential and frequently seen side effects are diarrhoea, hematological dyscrasias and rashes. We describe a case in which the use of ticlopidine in the treatment and prophylaxis of transit ischemic attacks triggered the unusual and rare complication of toxic epidermal necrolysis (TEN). We will then go on to analyse the clinical-pathological aspects and therapies through the use of i.v. immunoglobulins at high dosages that led to a full recovery of the patient.

Calciphylaxis: a case report.

Calciphylaxis or calcific uremic arteriolopathy is characterized by the involvement of the tunica elastica of the reticular or deep subcutaneous dermis, with extravascular and vascular thrombosis calcifications that lead to tissular ischemia. The torso muscles, the lumbar region, and lower limbs are more frequently affected. The pathogenesis is unknown. Calciphylaxis is associated to hyperparathyroidism, chronic renal failure, and diabetes mellitus. The best therapy to date is prevention: early treatment of renal failure, performing a partial parathyroidectomy where necessary, surgical debridement of the necrotic tissue, as well as avoiding the trigger factors such as systemic corticosteroids.

Ekbom syndrome: a disease between dermatology and psychiatry.

The Ekbom syndrome or parasitosis delirium represents a rare mono-symptomatic psychosis characterized by the delirious firm belief of the patient, against all evidence, of being infested by cutaneous parasites. The syndrome affects in particular middle-aged women, and can be the single manifestation of psychological uneasiness or represent one of the aspects of a more complex psychiatric case, compromising almost totally any normal daily work and/or social activity. The authors present a recently observed clinical case and discuss the clinical-diagnostic and therapeutic aspects.

Optimization of systemic treatments for chronic plaque psoriasis. Recommendations for switching and transitioning.

AIM: The aim of this study was to provide practical recommendations for optimizing the use of conventional and biological systemic treatments for moderate-severe chronic plaque psoriasis, particularly in case of transitioning and switching. METHODS: A total number of 147 dermatologists from 33 different countries including Italy achieved consensus in providing practical recommendations for the use of conventional and biological treatments for moderate to severe psoriasis based on systematic literature review and/or expert opinion. RESULTS: In general, the continuous treatment regimen should be preferred in order to achieve a complete and long-term control of psoriasis. However, the treatment could be stopped or the dose reduced in case of complete disease clearance. A conventional drug could be associated to biological treatment in selected cases. Transitioning and/or switching could be considered in case of inefficacy or intolerance. A period of wash up is required if transitioning or switching is due to safety issues. CONCLUSION: This study provides practical suggestions for the optimal use of conventional and biological treatments for chronic plaque psoriasis.