Calogero Pagliarello

Sclerosing nevus with pseudomelanomatous features..

Background:  Among the pigmented lesions with a central area of scar, we found a group of cases histologically characterized by striking architectural alteration of the melanocytic component, but with no cytological atypia and mitotically quiescent. The aim of the current study was to assess the biological nature of such lesions.

Burden of disease during quiescent periods in patients with pemphigus

Studies conducted using different tools have invariably observed that physical and mental components of health status are seriously compromised in patients with pemphigus. An improvement in quality of life (QoL) has been commonly observed over the treatment period.

Family Burden in Epidermolysis Bullosa is High Independent of Disease Type/Subtype

Epidermolysis bullosa is a rare, inherited group of disorders characterized by blistering of the skin following friction or mechanical trauma. The aim of this study was to assess the family burden of epidermolysis bullosa in children aged 0-7 years. A postal survey was conducted. The perceived severity of the disease was evaluated by the caregivers, using the Patient Global Assessment 5-point scale. The caregiver received the Family Strain Questionnaire and the 12-item General Health Questionnaire to assess the probable presence of depression/anxiety. A single-item analysis was also performed for questions related to the burden of disease. Forty-two families were invited to participate. Data from 28 young patients and their caregivers were analysed (response rate 66.7%). The family burden increased with increasing caregivers perceived disease severity, with increasing patients body surface involved, and if parents had depression/anxiety, reaching statistical significance in several Family Strain Questionnaire scales. The family burden due to epidermolysis bullosa is very high independent of disease type/subtype.

Diet Quality and Risk of Melanoma in an Italian Population

BACKGROUND Some results from laboratory and epidemiologic studies suggest that diet may influence the risk of melanoma, but convincing evidence for a role of single nutrients or food items is lacking. Diet quality, which considers the combined effect of multiple food items, may be superior for examining this relation. OBJECTIVE We sought to assess whether diet quality, evaluated with the use of 4 different dietary indexes, is associated with melanoma risk. METHODS In this population-based case-control study, we analyzed the relation between 4 diet quality indexes, the Healthy Eating Index 2010 (HEI-2010), Dietary Approaches to Stop Hypertension (DASH) index, Greek Mediterranean Index (GMI), and Italian Mediterranean Index (IMI), and melanoma risk in a northern Italian community, with the use of data from 380 cases and 719 matched controls who completed a semiquantitative food frequency questionnaire. RESULTS In the overall sample, we found an inverse association between disease risk and the HEI-2010 and DASH index, but not the Mediterranean indexes, adjusting for potential confounders (skin phototype, body mass index, energy intake, sunburn history, skin sun reaction, and education). However, in sex stratified analyses, the association appeared only in women (P-trend: 0.10 and 0.04 for the HEI-2010 and DASH index, respectively). The inverse relations were stronger in women younger than age 50 y than in older women, for whom the GMI and IMI scores also showed an inverse association with disease risk (P-trend: 0.05 and 0.02, respectively). CONCLUSIONS These results suggest that diet quality may play a role in cutaneous melanoma etiology among women.

Field Performance of the Skindex-17 Quality of Life Questionnaire: A Comparison with the Skindex-29 in a Large Sample of Dermatological Outpatients

The utilization of health-related quality of life (HRQoL) questionnaires in routine clinical practice is hampered by several factors, including their length and thus the time needed to complete and score them. For this reason, growing efforts are devoted both to create short questionnaires and to shorten existing ones. The Skindex-17 is a dermatological HRQoL instrument that was derived from the Skindex-29 using Rasch analysis. It consists of 17 items instead of 29, and answers are given on a three-point scale instead of a five-point scale. The aim of this study was to compare information obtained by the Skindex-29 and the Skindex-17 in a large sample of dermatological outpatients. We compared the Skindex-29 with the Skindex-17 scores in 2,487 patients with several dermatological conditions, using intraclass correlation coefficients. The overall correlation was 0.957 for the symptoms scale and 0.940 for the psychosocial scale. The values were very similar for all diseases. The concordance between the levels of severity of the Skindex subscales in the two instruments was also very high. In conclusion, the Skindex-17 provided very similar information compared with the Skindex-29, with the advantage of being shorter and including some important psychometric properties.

Quality of life in patients with pemphigus receiving adjuvant therapy

Background.  Pemphigus has a strong effect on patients’ quality of life (QOL).

Cryoinsufflation for Hurley Stage II Hidradenitis Suppurativa A Useful Treatment Option When Systemic Therapies Should Be Avoided

Report of a Case A woman in her 30s presented with hidradenitis suppurativa (HS), Hurley stage II. She was treated with oral contraceptives (drospirenone/ethinyl estradiol), spironolactone (50 mg/d), topical clindamycin, andmonthly intralesional corticosteroids (triamcinolone acetonide, 10 mg/mL). Previously, she had received rifampicin (600 mg/d), first with minocycline (100 mg/d), then with clindamycin (300 mg/d), and finally with moxifloxacin (400mg/d). After these treatments failed, she received isotretinoin (0.5 mg/kg/d) for 2 more years to achieve remission, but without success. Because shehaddecided tobecomepregnant, shewas searching for an alternative treatment, devoid of teratogenic effects, to safely replace oral contraceptives. Effective therapy was paramount because theHS seriously interferedwith sexual intercourse and indirectly with her planned pregnancy. Surgical treatmentwas offered (local incision anddrainage, deroofing, limited local orwide excision), which she declined.

Factors affecting quality of life in epidermolysis bullosa

Epidermolysis bullosa is a rare group of inherited disorders that manifests as blistering or erosion of the skin in response to little or no apparent trauma. Patients suffer from long-term physical, social and economic consequences. Despite the fact that quality of life assessment has rapidly become a significant outcome variable in dermatology research, only a few studies regarding epidermolysis bullosa patients are available. This paper reviews studies evaluating the effect of epidermolysis bullosa on quality of life in patients and caregivers in order to assess which factors can best describe their health-related quality of life. Currently, considerable deficits prevail in both the diagnosis and treatment of rare skin diseases. Moreover, the psychological and social morbidities very easily evade the eyes of clinicians. Comparison of the impact of epidermolysis bullosa with that of other conditions is clearly valuable for making public policy decisions. This review indicates the need for more rigorous exploration of the impact of such diseases to further guide treatment and to monitor quality of care.

Association Between Dietary Vitamin C and Risk of Cutaneous Melanoma in a Population of Northern Italy

Cutaneous melanoma incidence has been increasing during the last few years, and diet has been suggested as one of the lifestyle factors responsible for this increase. Since antioxidant nutrients such as ascorbic acid might prevent skin carcinogenesis, we investigated the risk of cutaneous melanoma related to vitamin C intake in a population-based case-control study in Northern Italy based on 380 melanoma patients and 719 matched controls, to whom we administered a semiquantitative food-frequency questionnaire. After adjusting for potential confounders, odds ratio of melanoma were 0.86 (95 % confidence interval 0.65 - 1.15) and 0.59 (95 % confidence interval 0.37 - 0.94) in the intermediate and highest categories of vitamin C dietary intake respectively, compared with the bottom one. The association between vitamin C and decreased risk persisted after adjustment for some potential confounders. In age- and gender-stratified analyses, this association was seen in young females (< 60 years old), and was found to be enhanced in subjects with phototypes II and III. These results suggest a possible protective activity of vitamin C intake against cutaneous melanoma in specific subgroups of this population of Northern Italy.

Measuring empowerment in patients with psoriasis: the psoriasis empowerment enquiry in the routine practice (PEER) questionnaire

While empowerment is an outcome pursued by advocacy groups and health care providers, no data are yet available about empowerment in patients with psoriasis in the literature. Our aim was to develop a tool for measuring levels of empowerment in psoriatic patients, and to assess its validity and reliability. A cross-sectional study among outpatients with psoriasis was carried out. Principal component analysis was performed to validate the questionnaire and to measure any associations with demographic and clinical data. The 12-item questionnaire (Psoriasis Empowerment Enquiry in the Routine practice, or PEER) showed acceptable consistency and reliability, and three distinct and interpretable factors have been identified: Knowledge, Experience, Skills. Patients older than 44 years and patients with psoriasis for more than one year showed statistically significantly higher levels of empowerment. Neither educational level nor the number of consultations influenced the global empowerment score (GES). A link between GES and prescribed therapy was found, suggesting that patients receiving systemic drugs have better knowledge, more insight and superior skills to manage their psoriasis. We conclude that PEER is an appropriate tool to assess empowerment among patients with psoriasis and may be used to evaluate the efficacy of educational interventions. Further studies are needed to assess its convergent validity and to improve its reliability.