Angelo Massimiliano D’Erme

The importance of stressful family events in psoriatic patients: a retrospective study

Background  Psychosomatic stress events are believed to play an important role in psoriasis either by inducing or worsening the disease.

Therapeutic implications of adding the psychotropic drug escitalopram in the treatment of patients suffering from moderate–severe psoriasis and psychiatric comorbidity: a retrospective study

Background  It is known that stress and/or psychiatric diseases can play an important role in determining psoriasis, including the well‐known negative somato–psychiatric rebound that comes with the disease.

Dimethyl fumarate contact dermatitis of the foot: an increasingly widespread disease

Background  Dimethyl fumarate (DMF) has been recognized as an extremely potent irritant and sensitizer found in sachets inside furniture. The first skin manifestations were correlated to contact with sofas, chairs, and other furniture. In these last years, some papers have reported a development of allergic contact dermatitis on the foot caused by DMF present in high concentration in shoes made in China.

The role of neuropeptides in the control of regional immunity

Neuropeptides (NPs) and neurotransmitters are a heterogeneous group of soluble factors that make connections within the neuroendocrine and immune systems. NPs, including substance P (SP), vasoactive intestinal peptide (VIP), α melanocyte-stimulating hormone (α-MSH), and calcitonin gene-related peptide (CGRP), released by nerves that innervate the skin, can modulate the action of innate and adaptive skin immunity as well as the skin cells functions. Their role in several inflammatory skin diseases, such as atopic dermatitis, psoriasis, and vitiligo, and in the isotopic response has been reported. Further progress in understanding the various processes that modulate the interactions of the nervous and the skin immune system is essential to develop effective treatment for inflammatory skin conditions with neurogenic components and for understanding signs and symptoms in the isotopic response and, in general, in the control of global and regional immunity.

Why is Kikuchi-Fujimoto disease misleading?

Background  Kikuchi–Fujimoto disease (KFD) or histiocytic necrotizing lymphadenitis is a rare, benign, autoimmune condition characterized by lymphadenopathy, fever, and neutropenia. KFD has also been frequently reported in association with systemic lupus erythematosus (SLE).

Association between isotretinoin and mood changes: myth or reality? An updated overview.

Angelo Massimiliano D’Erme, MD, Sara Pinelli, MD, Alberto Cossidente, MD, Eleonora Campolmi, PhD, Torello Lotti, MD, and Massimo Gola, MD Department of Dermatological Sciences and Centro Interuniversitario di Dermatologia Biologica Psicosomatica (CIDEBIP; Interuniversity Centre for Biological and Psychosomatic Dermatology), University of Florence, Florence, Italy. E-mail: a.m.derme@gmail.com. doi: 10.1111/j.1365-4632.2011.05182.x

Lichen striatus and nail involvement: truly rare or question of time?

References 1 Kostovic K, Pasic A. New treatment modalities for vitiligo focus on topical immunomodulators. Drugs 2005; 65: 447–459. 2 Czajkowski R, Placek W, Drewa T, et al. Autologous cultured melanocytes in vitiligo treatment. Dermatol Surg 2007; 33: 1027–1036; discussion 1035–6. 3 Rusfianti M, Wirohadidjodjo YW. Dermatosurgical techniques for repigmentation of vitiligo. Int J Dermatol 2006; 45: 411–417. 4 Guerra L, Primavera G, Raskovic D, et al. Permanent repigmentation of piebaldism by erbium: YAG laser and autologous cultured epidermis. Br J Dermatol 2004; 150: 715–721. 5 Guerra L, Primavera G, Raskovic D, et al. Erbium:YAG laser and cultured epidermis in the surgical therapy of stable vitiligo. Arch Dermatol 2003; 139: 1303–1310. 6 Chen YF, Yang PY, Hu DN, et al. Treatment of vitiligo by transplantation of cultured pure melanocyte suspension: analysis of 120 cases. J Am Acad Dermatol 2004; 51: 68–74. 7 Lee DY. The use of suction blisters for recipient site in epidermal grafting: the implications for vitiligo. J Eur Acad Dermatol Venereol 2009; 23: 241–242.

Vitiligo: what’s new in the psycho-neuro-endocrine-immune connection and related treatments

SummaryVitiligo is an acquired depigmentary skin disorder of unknown origin characterized by well-demarcated, white macules of varying size and distribution. Despite relevant new research and progresses, why melanocytes disappear to induce the characteristic achromic lesions of vitiligo is not fully understood. In spite of recent findings implicating genetic, immune and oxidative stress factors, the exact pathogenesis of vitiligo remains obscure. An innovative concept based on a functional cross-talk between the nervous and immune system is emerging. Neuropeptides released from peripheral nerve endings could synergize with new cytokines to adversely affect melanocyte function and viability. Evidence is increasing regarding the role of neuropeptides in the pathogenesis of vitiligo and a new winning approach to vitiligo therapy based on neuropeptides regulation is at the horizon.ZusammenfassungDie Vitiligo ist eine erworbene pigmentäre Hauterkrankung unbekannter ätiologie, welche von gut abgegrenzten weißen Hautflecken unterschiedlicher Größe und Verteilung gekennzeichnet ist. Ungeachtet neuer, relevanter Forschungen und Erkenntnisfortschritte ist der Grund für das Abnehmen von Melanozyten und die Induktion der charakteristischen pigmentarmen Läsionen der Vitiligo nicht hinreichend geklärt. Trotz rezenter Erkenntnisse im Bezug auf genetische, immunologische und oxidative Stressfaktoren ist die genaue Pathogenese der Vitiligo unklar. Im Entstehen begriffen ist ein innovatives Konzept, das auf die gegenseitige funktionelle Beeinflussung zwischen dem Nerven- und Immunsystem aufbaut. So könnten von peripheren Nervenenden ausgehende Neuropeptide mit neuen Zytokinen synergieren und sich negativ auf die melanozytische Funktions- und Entwicklungsfähigkeit auswirken. Die wachsende Evidenz im Hinblick auf die Bedeutung von Neuropeptiden bei der Pathogenese der Vitiligo geht mit einem neuen, gewinnbringenden Ansatz in der Vitiligotherapie auf der Basis der Neuropeptidenregulation einher.

Mucosal psoriasis: a new insight toward a systemic inflammatory disease

Psoriasis is a chronic disease of the immune system affecting the skin, usually in the form of thick, red, scaly, and inflammatory patches. It affects both sexes and occurs in about 1–3% of the general population. Mucosae are also affected in a reasonable number of patients. In the past, the presence of specific oral manifestations in psoriasis has been the subject of controversy. In recent years, the literature has provided more evidence for defining psoriasis as a systemic disease. For many years mucosal psoriasis lesions were not considered part of the disease; at the moment, more studies are necessary to define the degree of mucosal involvement in psoriasis. Notwithstanding, the cause of this disorder remains largely unknown. The prevalence of psoriasis lesions in the mucosae is highly variable, being between 2 and 30%. Data are heterogeneous because often lesions are asymptomatic and patients do not report them. There is another reason for underestimating mucosal involvement in psoriasis, which is linked to the fact that a histological distinction between psoriasis and some common inflammatory entities of the oral mucosa cannot be made, or at least not in the early phase. Psoriasis affects several mucosae; mainly oral but also genital, ocular, and gastrointestinal (Table 1). The most involved areas are the tongue, cheeks, and gums. In general, mucosal lesions are associated with skin lesions, but some patients only present mucosal involvement at the beginning. In general, oral lesions in psoriasis can be divided into two major categories. The first one includes mucosal psoriasis lesions with a standard histopathological pattern of psoriasis, such as edema and acute inflammatory infiltrate in the epithelium and mixed in the lamina propria with neutrophils and lymphocytes, organized neutrophils ‘‘microabscesses’’ (Fig. 1). Some patients

Eyelid contact dermatitis caused by unusual allergens in hair dye: the importance of testing with additional series.

hair dye: the importance of testing with additional series Editor, Hairdressing chemicals may be associated with allergic contact dermatitis. Usually, the first step to diagnosing a possible allergic contact dermatitis involves patch testing the patient with a standard series of haptens. This provokes positive reactions in 40–65% of cases. We report a 33-year-old woman who presented with eyelid dermatitis. The patient manifested edema associated with pruritus and burning on both upper and lower eyelids. All the periorbital tissue showed slight desquamation (Fig. 1). The patient also demonstrated pruritus on the scalp, face, and neck. The symptoms had appeared three days after the subject had applied a hair dye at her own home. Her history revealed two episodes of eczematous rash on the trunk which had occurred four to five days after using the same hair dye the previous year. An allergological investigation conducted at the time using a standard SIDAPA (Società Italiana di Dermatologia Allergologica, Professionale e Ambientale Italian Society of Allergological, Occupational and Environmental Dermatology) series showed positive results only for nickel sulfate. A brief cycle of topical and systemic corticosteroids was administered to resolve the symptoms and the patient was tested again with a standard series. Additional patch testing with our specific hairdressing series showed a positive reaction to hexyl cinnamal (2% in pet.) and phenoxyethanol (1% in pet.), a preservative for personal care products that is a component of Euxyl K400 (Schülke & Mayr Italia S.r.l., Milano). Lastly, a patch test using the patient’s hair coloring (50% in pet.) was performed, revealing a positive reaction. The condition did not recur after the patient stopped using this particular hair dye. We report this unusual case because neither the allergens nor the localization of the dermatitis (eyelids) are common in dermatitis related to hairdressing chemicals. We also wish to emphasize the importance of testing with specific additional series when the patient’s history leads to a reasonable diagnostic hypothesis, and when testing the products used by the patient is possible. Francalanci et al. demonstrated the importance of using additional series in a study in which a small group (8.2%) of patients undergoing patch testing were negative to a standard series but positive to additional series. In addition, Wang et al. showed that 6.4% of allergies to hairdressing products were not detectable using the standard allergen series alone. Although the prevalence of contact allergy to Euxyl K400 is increasing, the Italian standard series does not include the substance in this form, but as methyldibromoglutaronitrile, which is considered a major sensitizer. Phenoxyethanol is included only in the additional series. In other countries, hexyl cinnamal is included in standard series, such as in Germany since 2005 and in the UK since 2007. Hexyl cinnamal (which is included in fragrance mix II) is not included in the SIDAPA standard series used at the time of this investigation. It is very important that a detailed patient history is obtained and a specific allergological investigation conducted in order to ascertain the most likely suspect allergen and, thereby, establish the cause of a diagnosis of eyelid contact dermatitis. Figure 1 Erythematous and edematous lesions on both eyelids