Antonello Tulli

Epidemiology and clinical and pathologic characteristics of cutaneous malignant melanoma in Abruzzo (Italy)

Background  Malignant melanoma incidence has increased worldwide in recent decades. Cancer registry‐derived epidemiologic data on malignant melanoma in Italy are available only in some northern regions of the country.

Coexisting pemphigus vulgaris and pemphigus foliaceus in the same patient

A 79-year-old man was admitted to our clinic with a 3-month history of diffuse scaly and bullous lesions. Skin examination revealed multiple blisters with an annular shape on the lower dorsum and abdominal areas (Fig. 1), while on the scalp and in the retroauricolar area lesions appeared as erythematous scales and crusts (Fig. 2). Symptoms referred were burning and itching. Past medical history of the patient revealed that he was affected by prostate cancer, treated with ormonal therapy. Chest X-ray and routine laboratory investigations were within normal limits. A TC scan and total body scintigraphy excluded distant metastasis. A paraneoplastic pemphigus was suspected and skin samples from scaly eythematous and bullous lesions were taken for histopathological examination and direct immunofluorescence. Indirect immunofluorescence on

Skin Toxicity from Glyphosate‐Surfactant Formulation

Glyphosate (N‐[phosphonomethyl]glycine) is a nonselective herbicide used in agriculture as a foliage spray for the control and the destruction of herbaceous plants. Adverse skin reactions due to contact with this compound have been rarely described. We report a case of a 78‐year‐old woman presenting with extensive chemical burns on her trunk and legs caused by accidental contact with a glyphosate‐surfactant formulation. The lesions healed in four weeks without scarring.

Topical preparations for the treatment of psoriasis: Results of a retrospective study over 15 years

Background: Psoriasis requires lifelong treatments that depend on the extent, clinical forms and associated conditions. Objective: To retrospectively analyze which topical treatments were used, their efficacy, and potential advantages and disadvantages. Methods: A total of 666 patients admitted for the first time over 15 years who were topically treated were retrospectively reviewed and subdivided using clinical forms and PASI into four groups and four subgroups for the applied treatments. For each treatment the mean PASI was calculated daily: on the first, third and sixth day. An X sample statistical analysis and Mann‐‐Whitney U‐test were performed. The hospitalization time and correlation with the response to treatment were analyzed. Results: A statistically significant response was recorded for every regimen. The best combination was clobetasol propionate plus eosin on alternate days with eosin plus cade oil. The highest score was recorded for the ‘en plaques’ psoriasis. The average length of treatment was of 7.5 days in the best combination. No statistically significant difference among the groups was recorded with respect to the length of hospitalization and PASI. Conclusion: The statistically significant response for all the topical treatments analyzed and recorded in this study does not exclude a potential benefit due to hospitalization per se.

UV Induced Skin Immunosuppression

It is well estabilished that ultraviolet radiations from sunlight are carcinogenetic for skin cells. These radiations at different wavelength induce damage in the skin manly through two mechanisms : direct DNA alteration and alteration of the immune system. The skin immune system is composed by a complex network of cells and soluble mediators that help to maintain the homeostasis of the skin. UV induced immunosuppression is mediated through different photoreceptors present in the skin that lead to either: the production of immunosuppressive cytokines such as IL-10, TNF-α and TGF-β or the development of suppressive T regulatory cells or to the migration in the skin of CD11+ leukocytes in the skin that ultimately lead to the suppression of immune responses. The aim of this short review is to summarize the general knowledge in the field of UV-induced immunosuppression. The knowledge of the exact mechanism involved in this mechanism is important in order to develop strategies aimed at reducing skin cancer induction.

Updated review of the pathogenesis and management of Merkel cell carcinoma

Background: Merkel cell carcinoma is a rare, aggressive, malignant cutaneous tumor of the elderly or immunosuppressed individuals that usually appears on sun-exposed areas of the body. Its pathogenesis is still debated, and, currently, no standardized treatment exists. Objective: To provide a current updated review of the most relevant data concerning the pathogenesis and management of Merkel cell carcinoma. Methods: Using relevant MeSH terms, we performed a review of the literature on these subjects from 1980 to June 2009. Results and Conclusion: The current management of Merkel cell carcinoma is based on surgical excision as the majority of patients present with localized disease, whereas up to 30% have regional lymph node metastases. In these cases, the best outcome is achieved with multidisciplinary management that includes radiotherapy. Chemotherapy is part of the treatment in advanced cases and is mandatory for distant metastatis. Given that a recent work showed the presence of a previously unknown polyomavirus, which the authors called Merkel cell polyomavirus, the therapeutical approach to Merkel cell carcinoma could be reconsidered in the future.

The Antinflammatory Effect of Alpha-MSH in Skin: A Promise for New Treatment Strategies

MCs are peptide hormones involved in the regulation of an increasing list of processes: pigmentation, cortisol production, food intake, energy and metabolism homeostasis, sexual behaviour, exocrine gland function and inflammation. One of the most important players of this system is αMSH, a neuroimmunomodulatory tri-decapeptide derived from POMC; while it has been demonstrated in melanocytes, monocytes, B-cells, NK, a subset of cytotoxic T-cells, epithelial cells and in keratinocytes, the skin is one of the most relevant extrapituitary sources of αMSH expression and secretion. The key role of MCs in skin/hair colour regulation has been widely figured out in man and animal models. UV-light induces the production of MCs; additionally other skins produced cytokines and parakrine factors (CRH, IL-1, TNF-α, and TGF-β) regulate MC production and MC-1R activity. Moreover MCs and their autoAbs are involved in grooming behaviour, antipyretic and antinflammatory responses, learning, reproductive function, appetite regulation, eating disorders, energy homeostasis, ethanol consumption and violent conduct. A strong and not well understood association between skin malignancies and the CRH-POMC axis has been shown. The MCs bind to five MC-Rs. Each MC-R binds several MCs with the exception of MC-2R, strongly selective for ACTH, unlike the expression of MC-R which is tissue specific, MC-5R being the most widespread. The discovery of the influence of MC in the inflammation modulation, food intake behaviour, lipid metabolism, sex activities, neoplasm development and autoimmune diseases is attracting more and more attention to define new therapeutic strategies and drugs like αMSH and the related tripeptide KPV and K(D)PT.

Pharmacotherapy of Inflammatory and Pruritic Manifestations of Corticosteroid-Responsive Dermatoses Focus on Clobetasol Propionate:

Clobetasol-17 propionate is a dihalogenated corticosteroid which, on the basis of the vasoconstrictor assay, is classified as the most potent of all topical steroids. Since 1973 it has been marketed specifically for the short term topical treatment of moderate and severe cortico-responsive dermatoses for its antinflammatory, immunosuppressive and antimitotic effects. Psoriasis, atopic dermatitis, chronic eczema, boullous disorders and itching dermatosis of the genital area are usually well controlled by clobetasol with a great improvement of quality of life in patients.In this manuscript, we reviewed data concerning pharmacology, efficacy and safety profile of clobetasol-17 proprionate, updated studies on its use, efficacy of different formulations and impact on quality of life in corticosteroid-responsive dermatoses.