Angela Antonucci

Onychomatricoma : First description in a child

Abstract:  Onychomatricoma is an uncommon benign tumor of the nail matrix, with peculiar clinical and histologic features and electron microscopic findings. The main clinical signs are longitudinal ridging, yellow coloration along the entire length of the nail plate with splinter hemorrhages in its proximal portion, and a tendency towards transverse overcurvature of the affected nails. We report onychomatricoma associated with onychomycosis in the same nail in a 4‐year‐old girl.

Drug-induced nail abnormalities

A large number of drugs may be responsible for the development of nail changes, including cancer chemotherapeutic agents and retinoids, however, only a few classes of drugs are consistently associated with nail symptoms. Drug-induced nail abnormalities result from toxicity to the matrix, the nail bed, the periungual tissues or the digit blood vessels. The most common symptoms include Beau’s lines, onychomadesis, melanonychia, onycholysis and periungual pyogenic granulomas. Drug-induced nail changes usually involve several or all of the nails. In most cases, nail abnormalities are asymptomatic, but can sometimes cause pain and impair manual activities.

Cutaneous granulomatous reaction to injectable hyaluronic acid gel: Another case

We report a case of a granulomatous reaction in the melolabial folds, occurring 10 days after treatment with Restylane®. The patient, who had previously been treated with the same product in the last 2 years without any adverse effect, developed an unusual early fibrotic reaction that we hypothesized related to hypersensitivity after repeated use. The lesions slowly disappeared with topical steroid therapy. An improved knowledge of the modality of these uncommon adverse effects is necessary to assess the long‐term safety and efficacy of this product.

Treatment of refractory pemphigus vulgaris with anti‐CD20 monoclonal antibody (rituximab): Five cases

Background: Pemphigus vulgaris is an autoimmune disease characterized by blisters and widespread erosions, involving skin and mucous membranes, caused by autoantibodies to desmoglein 1 and 3. This pathology is associated with increased morbidity and mortality if untreated. The treatment of pemphigus vulgaris requires multiple immunosuppressive agents, but often it is particularly resistant. Objective: To evaluate the efficacy and safety of rituximab therapy in refractory pemphigus vulgaris. Methods: Five patients diagnosed as having pemphigus vulgaris were treated with anti‐CD20 monoclonal antibody (rituximab). Each patient was treated with rituximab intravenously at a dosage of 375 mg per square metre of body surface area once weekly for 4 weeks. Results: All the patients presented clinical resolution. No adverse effects were observed. It is important to observe the clinical evolution in the future, but our experience is still limited to a short lifetime and follow‐up. Conclusion: In our experience rituximab has been an effective and safe treatment for refractory pemphigus vulgaris.

Lentigines within Nevus Depigmentosus: A Rare Collateral Effect of UVB Therapy?

Abstract:  Nevus depigmentosus is an uncommon hypopigmented macule or patch that is congenital and stable in its relative size and distribution throughout life; it occurs sporadically and may be localized, segmental or, less often, systematized. We report the case of a 17‐year‐old girl with a segmental achromic nevus of the left leg and a patch on the lower back with late age of onset who developed lentigines after prolonged intense ultraviolet B exposure as a consequence of an incorrect diagnosis of segmental vitiligo.

Two cases of Zoon's balanitis treated with pimecrolimus 1% cream

Background  Plasma cell balanitis is a disorder of the middle‐aged and older uncircumcised male. Several treatments have been proposed to treat this disease, but plasma cell balanitis is often resistant to conventional therapy.

Acne inversa treated with infliximab: different outcomes in 2 patients.

dition usually presents with painful, inflamed lesions in the apocrine-gland-bearing areas of the body, most commonly the axillary, inguinal and anogenital areas. The disease usually occurs after puberty and before the age of 40 years, suggesting a hormonal influence on the pathogenesis of the disease. Occlusion of the apocrine duct by a keratinous plug and defects of the follicular epithelium have usually been considered the aetiology of acne inversa. Contributing factors include friction from axillary adiposity, sweat, heat, stress, tight clothing and genetic and hormonal components (1). Acne inversa can be treated with antibiotics, retinoids, corticosteroids, cyclosporine, incision and drainage, local wound care, local excision, radiation and laser therapy. Although there are a wide range of therapies suggested for the treatment of acne inversa, the disease is often resistant and the psychological impact on the patient can be great (2), encompassing social, personal and occupational challenges. We describe here 2 case reports of patients affected by acne inversa resistant to traditional therapies, who were treated with infliximab.

Pityriasis versicolor during anti-TNF-α monoclonal antibody therapy: therapeutic considerations

Anecdotal reports have shown that tumour necrosis factor (TNF)‐α inhibition may cause unchecked superficial infection with the microorganisms responsible for pityriasis versicolor (PV). We observed several cases of PV, which is frequently resistant to topical therapies, in psoriatic patients undergoing anti‐TNF‐α monoclonal antibody therapy. To evaluate the incidence and the therapeutic management of PV in this group of individuals, between 1 January and 27 December 2010, we examined 153 psoriatic patients for the hypopigmented/hyperpigmented macular and scaling lesions associated with PV. All patients positive for PV were given topical therapy with miconazole nitrate cream twice daily for 28 days, after which they were re‐evaluated. In patients non‐responsive to topical therapy, we started systemic therapy with fluconazole, 300 mg week−1 for 3 weeks. We diagnosed seven cases of PV. At the end of topical treatment, complete healing of lesions was observed in only one patient. In the other six patients, systemic treatment led to complete resolution of the infection. Although the onset of PV during anti‐TNF‐α therapy is seldom reported, it is not likely to be rare, but rather under‐reported because of its limited pathological significance. In our opinion, the therapeutic management of this condition deserves greater consideration, as the use of topical treatments alone is largely ineffective compared with systemic treatment.

Necrotizing vasculitis in a patient affected by autoimmune hyperthyroidism treated with propylthiouracil

Necrotizing vasculitis is a complex phenomenon because of an inflammation of small and larger vessels with polymorph infiltration within the vessel walls and leukocytoclasis, occurring in several autoimmune diseases. Propylthiouracil (PTU) is a medication commonly used to treat hyperthyroidism, but it is associated with various rare side effects, such as antineutrophil cytoplasm antibody‐positive vasculitis. In the last decades, multiple cases of PTU causing antineutrophilic cytoplasmic antibody have been reported, some of them fatal. The present authors report the case of a 34‐year‐old Caucasian female affected by autoimmune hyperthyroidism treated with PTU, presenting an antineutrophil cytoplasm antibody‐positive necrotizing vasculitis, with high levels of anticardiolipin antibodies that involved the upper arms and buttocks. The clinical manifestations improved after discontinuing of PTU and immunosuppressant treatment.

Should ustekinumab really be used as first-line biological therapy in pityriasis rubra pilaris?

tive treatment of severe psoriasis reduces the cardiovascular mortality risk, our study showed that systemic inflammation caused by psoriasis can be suppressed by traditional and new antipsoriatic treatment modalities. A significant correlation between BMI and seCRP levels of patients was found. This supported the findings of Ohtsuka who previously showed a relationship between these parameters in a psoriatic population. Recent studies show that CRP levels rise with increasing BMI in the healthy population. We emphasize that BMI should be taken into consideration when evaluating CRP levels in the psoriatic patient population where obesity is a frequent comorbidity. SAA levels were not related to patients’ BMI so we believe that SAA is a more specific marker than CRP for evaluating systemic inflammation caused purely by psoriasis in psoriatic patients. The negative correlation between BMI and PASI decrease and the significantly higher levels of CRP in obese patients vs. obese controls suggest that obese psoriatic patients have a higher burden of inflammation and elevated inflammatory markers, which cause delay in response to treatment. Considering obesity as a poor prognostic factor for response to treatment, psoriatic patients should be counselled to lose weight and be put on proper diet programmes as part of an efficient antipsoriatic treatment protocol.