Antonello Baldo

Polymorphous light eruption and benign summer light eruption in Italy

Background/purpose: Polymorphous light eruption (PLE) heterogeneity has been postulated, but the existence of benign summer light eruption (BSLE) is controversial. We studied the prevalence of the clinical patterns, criteria distinguishing BSLE from PLE, and diagnostic usefulness of phototest.

Retinoids and Phototherapy for Psoriasis

Retinoids are the most widely used agents for systemic treatment of psoriasis; as structural and functional analogs of vitamin A, they are involved in the regulation of several biologic functions. Acitretin is the oral retinoid currently used, alone or in combination with other treatments, for plaque type, erythrodermic, and pustular psoriasis. Due to its high teratogenic effect, therapeutic contraception is required for women taking the drug. Narrowband ultraviolet B (nbUVB, 311 ± 2 nm) is effective for guttate and plaque-type psoriasis. At the molecular level, UV light acts (1) directly (type I reaction) inducing the formation of pyrimidine dimers that, in turn, cause a transient cellular growth arrest; and (2) indirectly (type II reaction) through the generation of reactive oxygen species that act on key molecules such as lipids (in particular lipid membranes), proteins, and nucleic acids. Several studies show that UV rays can cause a transient decrease in DNA, RNA, and protein synthesis. These events are accompanied by a temporary normalization of cell kinetics of psoriatic keratinocytes. Phototherapy is carried out 3 times a week alone or in combination with topical treatments and/or acitretin. Several studies have confirmed that oral retinoids together with nbUVB (ReUVB) reduce the recovery time and also the doses of both acitretin and nbUVB. The regimen is carried out treating the patient with acitretin alone (0.5 mg/kg bw) for 2 weeks, then the dose of acitretin is reduced to 0.3 mg/kg bw, and the nbUVB is added 3 times a week until complete resolution of disease. As retinoids exert an anticarcinogenic effect, the ReUVB regimen could lower skin cancer risk resulting from longterm UVB therapy.

Acute Localized Exanthematous Pustulosis (ALEP): Review of Literature with Report of Case Caused by Amoxicillin-Clavulanic Acid

Acute localized exanthematous pustulosis (ALEP) is a localized form of acute generalized exanthematous pustulosis, characterized by acute onset of multiple nonfollicular, pinhead-sized, sterile pustules following drug administration. Antibiotics, especially β-lactams and macrolides, have been implicated in the majority of cases, although eruption after nonsteroidal antiinflammatory drugs and many other medications has also been reported. Skin reaction arises quickly within a few hours, resolving rapidly within a few days without treatment, and it is usually accompanied by fever and neutrophilic leukocytosis. We report herein all cases of ALEP described in literature, adding the case of a 35-year-old woman admitted to our hospital with outbreak of erythematous pustules on her face, neck, and chest after amoxicillin–clavulanic acid treatment.

Tacrolimus ointment in the management of atopic dermatitis

Atopic dermatitis (AD) is a chronic, relapsing, highly pruritic inflammatory skin disease. AD long-term treatment is usually required to control and prevent flares, and patients need a treatment that is safe and efficacious when applied continuously or intermittently over a prolonged period of time. The treatment options should be chosen according to age, clinical features and severity of the disease in every single patient. For the treatment of a chronic disease like AD, sustained tolerability and efficacy of the applied medications are essential. A topical immunomodulator, tacrolimus ointment, provides an alternative to topical corticosteroids without the associated adverse events. Tacrolimus is a macrolide lactone with unique immunomodulatory properties and strong anti-inflammatory activities and can be used without increasing the risk of infection or other non-application site adverse events, and without loss of effectiveness, in patients with AD.

Reflectance Confocal Microscopy as New Diagnostic Tool in Folliculotropic Mycosis Fungoides

We present a case of folliculotropic mycosis fungoides (FMF), a variant of cutaneous T-cell lymphoma which particularly affects hair follicles. FMF can imitate a wide variety of otherwise benign dermatoses, so it poses major diagnostic obstacles both for the dermatologist as well as the dermatopathologist. In our case, in vivo reflectance confocal microscopy (RCM) was very important for guiding the skin biopsy site selection. For this reason, RCM can reduce the number of unsuccessful histopathological examinations and increase the diagnostic accuracy for different skin dermatoses.

Expression of FK506-binding protein 51 (FKBP51) in Mycosis Fungoides

Mycosis fungoides (MF) is the major subtype of cutaneous T‐cell lymphomas (CTCL). It usually has a prolonged indolent clinical course with a minority of cases acquiring a more aggressive biological profile and resistance to conventional therapies, partially attributed to the persistent activation of nuclear factor‐kappa B (NF‐κB) pathway. In the last decade, several papers suggested an important role for the FK506‐binding protein 51 (FKBP51), an immunophilin initially cloned in lymphocytes, in the control of NF‐κB pathway in different types of human malignancies.

Primary bilateral malignant melanoma of the lower limbs.

Malignant melanoma is the eighth most common cancer in European women. Its incidence is increasing rapidly and it has been demonstrated that this is related to sun exposure. Although few cases of bilateral uveal or choroidal melanoma are described in literature, there are no cases reporting bilateral cutaneous malignant melanoma. We report a singular case of a 43-year-old woman with two primary bilateral melanomas localized on the flexural surface of both legs.