Anastasia Trigoni

The potential role of microorganisms in the development of rosacea.

Rosacea is a chronic cutaneous disorder characterized by centrofacial persisting erythema, telangiectases, papules, pustules, edema, phymas and ocular involvement. Despite being one of the most common skin disorders, its pathogenesis remains unclear and controversial. Although the disease triggering factors are well recognized, the underlying causes of rosacea have not yet been identified. Several different postulates about its pathogenesis can be found in the medical literature. Abnormalities of the pilosebaceous unit, as well as genetic, vascular, inflammatory, environmental and microbial factors have been described. The microorganisms that have been associated include Helicobacter pylori, Demodex folliculorum, Staphylococcus epidermidis, and Chlamydia pneumonia; all the studies have been inconclusive. We review currently available scientific data on the potential pathogenetic role of microorganisms in the development of rosacea.

Single vs. fractionated photodynamic therapy for face and scalp actinic keratoses: a randomized, intraindividual comparison trial with 12‐month follow‐up

Objective  To compare the efficacy and tolerability of a single ALA‐PDT illumination scheme with that of a fractionated ALA‐PDT illumination scheme in face and scalp actinic keratoses (AKs).

Does halo nevus without halo exist

1394 JEADV 2006, 20, 1328–1399

Resistant pityriasis lichenoides et varioliformis acuta in a 3-year-old boy: successful treatment with methotrexate.

Pityriasis lichenoides et varioliformis acuta (PLEVA) represents the acute clinical subtype of pityriasis lichenoides (PL) and its occurrence is relatively common during childhood. Diagnosis and treatment may sometimes pose certain difficulties. We present the recalcitrant case of a 3‐year‐old boy with an asymptomatic polymorphic eruption consisting of multiple, scattered, 0.5 cm, round to ovoid, erythematous papules covered in places with a fine scale, vesicles and superficial erosions with thick hemorrhagic crusts. The correlation of the clinical features with the lesional histopathology favored the diagnosis of PLEVA. No first‐line treatment scheme succeeded in controlling the eruption of new lesions. The only therapeutic approach that eventually managed to cease the disease evolution was the combination of prednisolone and methotrexate.

Pemphigus vegetans of the tongue: a diagnostic and therapeutic challenge

A 68-year-old woman presented with a large, painful, hypertrophic plaque of the buccal cavity, mimicking cerebriform tongue. The lesion had appeared eight months previously and, under the diagnosis of candidiasis, the patient had been treated ineffectively with nystatin and oral fluconazole. Physical examination revealed a partially eroded, grayish-white, exophytic plaque at the dorsum of the tongue, as well as a whitish hypertrophic rim at the edge of the tongue (Fig. 1). The rest of the oral mucosa, the genital mucosa, and the skin were uninvolved. The presence of angular cheilitis, as seen in Figure 1, was the result of chronic mechanical irritation caused by the impaired adhesion of a denture. Our clinical diagnoses ranged between infectious and neoplastic etiologies and involved the vegetative type of pemphigus vulgaris and pyodermatitis-pyostomatitis vegetans (PPV). Direct microscopic examination and cultures obtained from the exudate were negative. A Tzanck smear revealed numerous acantholytic cells. Histologic examination showed marked acanthosis with microabscess formation, intraepithelial clefting, acantholytic cells, and some eosinophils (Fig. 2). The findings were in keeping with the diagnosis of pemphigus vegetans. However, PPV could not be entirely excluded. Direct immunofluorescence demonstrated intercellular deposits of immunoglobulin G (IgG). Indirect immunofluorescence was also positive. Antibodies to desmoglein 3 were detected using an enzyme-linked immunosorbent assay (ELISA). Further workup in order to exclude inflammatory bowel disease was unremarkable. Pemphigus vegetans was diagnosed according to clinical, histologic, immunofluorescence, and ELISA findings. The patient was started on oral prednisone (1.0 mg/kg/d). At the 4-week follow-up, the initial plaques were seen to have been unresponsive, and the patient’s discomfort was intense. Dapsone at 100 mg/d was introduced, with minimal response, and a concurrent cycle of 400 mg/kg/d of human intravenous immunoglobulin (IVIG) was administered for five days. The treatment resulted in gradual improvement and significant pain relief. Tapering of steroid was started. The patient experienced a flare-up when the dose reached 15 mg, and the dose was increased to 30 mg. Currently, one year after the initiation of treatment, the patient continues to use 5 mg of systemic prednisone every other day in combination with 50 mg/d of dapsone and demonstrates adequate disease control. 350

Efficacy of adalimumab in moderate to severe hidradenitis suppurativa: Real life data

Hidradenitis suppurativa (HS) is a relapsing, inflammatory disease characterized by painful nodules, abscesses, sinuses track formation and scarring. HS has a great impact on patients’ quality of life and its treatment may be really challenging. Adalimumab provides a new therapeutic option for HS. Our aim was to assess the therapeutic potential of adalimumab on patients with HS based on the data from the daily clinical practice of an HS Outpatient Clinic. 19 patients with clinically evident moderate to severe HS, under adalimumab treatment for at least 24 week, participated in this observational, retrospective study. The Hidradenitis Suppurativa Physician’s Global Assessment scale, Modified Santorius scale and Dermatology Life Quality Index (DLQI) at baseline, week 4, week 12 and week 24 were retrieved from the records. Both Modified Santorius score and DLQI were significantly decreased during the weeks of evaluation (Friedman’s test; P < 0.001). The proportion of patients who achieved clinical response was 10.5% (n = 2) at week 4, 42.1% (n = 8) at week 12 and 63.2% (n = 12) at week 24. Treatment with adalimumab was linked with both clinical remission of HS and improvement of patients’ quality of life.