Aurora Tedeschi

Management of Cutaneous Warts

Cutaneous warts are benign epidermal proliferations caused by human papillomavirus infection. Treatment aims to cure the patient’s physical and psychological discomfort, and to prevent the spread of infection by contact with other body areas or with other individuals. Among the available medical and destructive therapeutic options for cutaneous warts, none is uniformly effective or virucidal. Moreover, in most cases the safety and efficacy of these treatment options has not been assessed in randomized controlled trials, so that the reproducibility of many of the listed treatments is difficult to evaluate and a possible placebo effect cannot be ruled out.This article provides indications for the management of patients with cutaneous warts through an evidence-based approach, considering a first-, second-, and third-line therapy for each clinical form. The first line includes medical treatments useful to cure single, or few, and/or small common warts of short duration (<1 year). If these treatments have failed or are contraindicated, cryotherapy may be considered as second-line therapy. For recurrent or difficult-to-treat lesions, a third-line of therapy includes a variety of alternative therapeutic options that are in clinical use but are not necessarily approved by the US FDA, and their use may be further limited by adverse effects.

Mesotherapy for skin rejuvenation: assessment of the subepidermal low-echogenic band by ultrasound evaluation with cross-sectional B-mode scanning

ABSTRACT:  Skin‐targeted ultrasound is a noninvasive technique that has been extensively used to evaluate age‐related dermal changes, and the presence of a subepidermal low‐echogenic band (SLEB) has been related to chronic UVR exposure in several studies. Since SLEB echogenicity is photoage‐related, the aim of this study was to evaluate, through ultrasound imaging, the effects on skin photoaging of mesotherapy, a treatment approach currently used in cosmetic dermatology for skin rejuvenation. Twenty women (mean age: 46.7 range 40–60 years) with physical signs of moderate photoaging on the dorsum of the hands were enrolled and treated with multiple microinjections of hyaluronic acid (HA) salts of biotechnological origin (1.000 Kd) every week for 4 weeks. In all subjects, ultrasound evaluation was performed at each visit and 1 week after the last treatment to evaluate SLEB echogenicity changes during treatment. At the end of study, a statistically significant (p < 0.001) increase of SLEB echogenicity (with a mean increase of pixel numbers equal to 31.3%) was observed in 15 of 19 subjects who completed the study. Our preliminary study suggests that mesotherapy with HA may be an effective treatment for skin photoaging, as confirmed by ultrasound. Follow‐up investigations on larger series of patients are necessary to further evaluate the safety, effectiveness, and duration of effect of this possible therapeutic approach to skin photoaging.

Use of squaric acid dibutylester (SADBE) for cutaneous warts in children.

Abstract: We evaluated the efficacy of squaric acid dibutylester (SADBE) contact immunotherapy for the treatment of warts on a series of 188 children. Included in the study were those children who satisfied at least two of the following criteria: single or multiple sites with several warts, warts resistant to repeated medical and/or surgical treatments, recurrent multiple warts, and patient or parent refusal to undergo destructive or surgical treatment. Excluded from the study were children with single warts or with flat warts located exclusively on the face and children less than 2 years of age. Treatment consisted of twice weekly applications of serial dilutions of SADBE (0.03–3%) for no more than 10 weeks. Of the 148 children who completed the study, 124 (84%) showed complete clinical resolution with no significant side effects. Of those with total clinical resolution, 101 completed a 24‐month follow‐up with no relapses. Twenty‐four (16%) children were nonrespondent. No apparent correlation between treatment response and age, gender, anatomic site, lesion type, or atopy was found. Contact immunotherapy with SADBE is a relatively safe and effective alternative treatment in the management of multiple and resistant cutaneous warts in children.

Videodermatoscopy enhances the ability to monitor efficacy of scabies treatment and allows optimal timing of drug application.

Background  Videodermatoscopy (VD) is a noninvasive diagnostic tool that has recently been advanced as an alternative technique for the diagnosis of scabies, based on studies showing its ability to detect mites in vivo with results comparable to those obtained by traditional skin scraping.

The use of videodermatoscopy to monitor treatment of scabies and pediculosis

Abstract A great pitfall for scabies and pediculosis therapeutic studies to date is that primary and secondary study outcomes are indirectly assessed (presence or absence of live parasites, including eggs, determined by gross clinical inspection) and data time points are non-standardized (highly variable) relative to the time of therapeutic application. Videodermatoscopy (VD) is a non-invasive technique that allows a rapid and magnified in vivo observation of the skin up to ×1000 with the visualization of morphologic features invisible to the naked eye. Utilization of VD in establishing highly definitive and precise quantitative data products used in the treatment of scabies and pediculosis provides enormous advantages in the quest to establish reproducible quantitative methodology for efficacy studies in these parasitoses. VD enhances the monitoring of clinical response to treatment in scabies and pediculosis and allows determination of the optimal timing of drug application both in vivo and ex vivo. This may be particularly important in minimizing risk of overtreatment, reducing the potential for side effects, and enhancing patient compliance.

Clinical and Ultrasonographic Correlation of Acne Scars

BACKGROUND Consensus concerning nomenclature and classification of acne scars is lacking. Classification based solely on clinical examination represents an unmet need that could be improved with the use of objective, reproducible assessments. OBJECTIVE To assess clinical and ultrasound morphologic features in 41 patients with scars resulting from moderate to severe acne and to determine whether correlation exists. MATERIALS AND METHODS Eighty‐one lesions clinically identified as boxcar, ice pick, rolling, hypertrophic, or keloidal were evaluated using high‐frequency ultrasound (22 MHz). RESULTS Ultrasound results generally correlated with clinical appearance. Eight scars clinically classified as ice pick showed a typical boxcar morphology upon ultrasound examination. Ultrasound showed that ice pick and boxcar scars were the deepest, with 95.8% between 0.2 and 0.5 mm. CONCLUSIONS High‐frequency ultrasound is a noninvasive technique that is useful in the evaluation and correct classification of acne scars. It represents an important adjunct to clinical examination, because it provides reliable objective and reproducible information useful to the selection of the best treatment option specifically customized to each individual patients needs.

Non malignant superior vena cava syndrome

A 62‐year‐old woman was admitted to our clinic for the evaluation of 2.5‐year history of progressive exertional facial flushing, and swelling of the head, face, and neck. Three years earlier, she had undergone implantation of a definitive pacemaker with an endocardial ventricular lead for a severe bradycardia. Physical examination revealed facial swelling and erythema including the periorbital areas, distended neck and edema of the region above the lower margins of the rib cage. Numerous dilated cutaneous venules were present on the ventral upper thoracic wall interspersed with patches of intense flush and large areas of normally colored skin ( Fig. 1 ). There had been no weight loss within the previous months. History of angioedema, allergic reactions, autoimmune diseases, or medication was negative. Enlarged lymph nodes were not detected. Complete blood cell count, fibrinogen, Quicks test for prothrombin, antithrombin III, C‐reactive protein, lipidic profile, renal functions, urinanalysis, and thyroid function test were within normal ranges. Standard X‐ray and sectional radiography of the chest revealed no lung diseases or alterations of the mediastinum. Doppler examination of the supraaortic trunks and chest CT scan showed normal findings. A diagnosis of superior vena cava syndrome (SCVS) was suspected and a cavography was performed, by injecting contrast medium simultaneously through the basilic veins, that revealed marked narrowing of the confluence of the two brachiocephalic veins at the junction of the internal jugular and right subclavian veins with a total obliteration of the right brachiocephalic vein ( Fig. 2 ). The diagnosis of pacemaker‐induced SVCS was confirmed and the woman was referred for angiosurgery.

Role of cleansers in the management of acne: Results of an Italian survey in 786 patients

Abstract Background: Modern therapy of acne is based also on moisturizers, cleansers and sunscreens. However, a few studies have been published on cleansers, and never in Italy. Objective: We decided to carry out an epidemiological study on the knowledge, beliefs and perceptions of acne patients regarding cleansers. Methods: The survey has been carried out in Italy in 2013–2014. A group of patients with acne completed a questionnaire which included 10 questions. Results: One hundred and eighteen dermatologists and 786 evaluable acne patients attended the survey. Approximately 70% of patients use a specific anti-acne cleanser. This cleanser is suggested in 57% of cases by a dermatologist. The patients buy this cleanser at the pharmacy (77% of cases). More than 62% of patients are satisfied about this cleanser. More than 66% of patients use the cleanser twice daily. The length of washing is less than one minute in 48% of patients. More than 66% of patients believe that the cleanser has a therapeutical role. Conclusion: The results of this survey cannot be compared with other studies because of the lack of similar studies about this topic. These results suggest that a sample of Italian acne patients consider cleansers as an important adjuvant treatment in acne.

Canal versus Cysts of the Penile Median Raphe: Advancing Diagnostic Methods Using Videodermatoscopy

Abstract:  Median raphe cysts represent defects of embryologic development of the male genitalia during fetal life. A clinical variant is represented by raphe canals, which consist of elongated tracts located in the same areas. Videodermatoscopy is a noninvasive technique that may be helpful in the differentiation between cysts and canals of the median raphe of the penis, thus helping to establish the most appropriate therapeutic approach.

Cosmeceuticals in Dermatology

The term “cosmeceuticals”, suggested by Kligman more than 20 years ago, refers to topical products that lie in a gray zone where they are viewed as having both pharmaceutical and cosmetic properties [1]. Although the neologism was innovative and relevant, it was rejected from the US Food, Drug, and Cosmetic Act that, according to the 1938s US Congress, labels as drug every substance for use in the diagnosis, cure, treatment or prevention of disease, and as cosmetic any product intended for beautifying and promoting attractiveness. In spite of this, the term cosmeceuticals has recently been gaining increasing popularity, as the term cosmetic seems to be restrictive for those substances that have druglike beneficial effects. On the other hand, the “cosmeceuticals” concept has caused a lot of confusion, because of similar neologisms such as neutraceuticals and/or neoceuticals. Actually, in USA and Canada, most cosmeceuticals are regulated as over the counter (OTC) products, while in Europe they are considered as cosmetics. Only in Japan, a new class of products, called quasi-drugs, has been created [2].