Carlotta Baraldi

Cutaneous adverse effects during ipilimumab treatment for metastatic melanoma: a prospective study.

BackgroundIpilimumab is an immunomodulatory antibody directed against cytotoxicT-lymphocyte-associated antigen 4 (CTLA-4), which is administered to patients with advanced melanoma, with a proven positive effect on overall survival. The cutaneous adverse effects (AEs) of ipilimumab are relatively frequent, although described as usually mild and rarely life threatening.ObjectivesTo describe a three-year experience of a single institute in detecting and managing cutaneous AEs.Materials & MethodsA cohort of patients (n = 41) treated with ipilimumab (3 mg/kg/three weeks) for metastatic melanoma, from 2013 to 2016,was investigated for adverse cutaneous events.ResultsOn dermatological evaluation, 34.1% of the patients in our series developed cutaneous AEs: rash (7.3%; n = 3), folliculitis (7.3%; n = 3), mucositis (2.4%; n = 1), rosacea (2.4%; n = 1), eczema (2.4%; n = 1), acneiform eruption (2.4%; n = 1), syringometaplasia mucinosa (2.4%; n = 1), Stevens-Johnson syndrome (2.4%; n = 1), and vitiligo (4.9%; n = 2). These were all Grade 1 and 2 AEs, except for the case of Stevens-Johnson syndrome (Grade 4). On a patient-reported scale, 4.9% (n = 2) and 9.8% (n = 4) of the patients complained of severe xerosis and pruritus, respectively.ConclusionIpilimumab was relatively well tolerated in our series, mainly causing mild cutaneous AEs, which, in our experience, responded satisfactorily to conventional therapies. Only in one case was the treatment discontinued, due to Grade 4 side effects.

Oral melanoma and other pigmentations: when to biopsy?

Oral pigmentations (OPs) are often neglected, although a meticulous examination of the oral cavity is important not only in the diagnosis of oral melanoma, but also for the detection of important clinical findings that may indicate the presence of a systemic disease. OPs may be classified into two major groups on the basis of their clinical appearance: focal and diffuse pigmentations, even though this distinction may not appear so limpid in some cases. The former include amalgam tattoo, melanocytic nevi, melanoacanthoma and melanosis, while the latter include physiological/racial pigmentations, smokers melanosis, drug‐induced hyperpigmentations, postinflammatory hyperpigmentations and OPs associated with systemic diseases. We will discuss the most frequent OPs and the differential diagnosis with oral mucosal melanoma (OMM), underlining the most frequent lesions that need to undergo a bioptic examination and lesions that could be proposed for a sequential follow‐up.

Topical 1% propranolol ointment with occlusion in treatment of pyogenic granulomas: An open-label study in 22 children

Pyogenic granuloma (PG) is a common, acquired, benign vascular neoplasm of the skin and mucous membranes. It occurs most often in children and adolescents. First‐line treatment options for PG are based on destructive approaches. Pain, permanent scarring, and pigmentation are potential complications of these therapies.

Oestrogen and progesterone receptors in melanoma and nevi: an immunohistochemical study

BackgroundThe effect of hormonal stimulation and fertility treatments, on the development of malignant melanoma (MM) remains to be determined.ObjectivesThe aim of this study was to investigate the presence of oestrogen receptor alpha (ERα) and progesterone receptor (PR) inMM and nevi after hormonal stimulation.Materials & MethodsImmunohistochemical analyses were performed utilizing antibodies specifically directed against ERα and PR in MM and atypical nevi specimens from patients: (1) diagnosed during pregnancy, (2) diagnosed in the six months following delivery, or (3) who had undergone repetitive cycles of hormonal stimulation for in vitro fertilization (IVF) in the year that preceded MM diagnosis. Controls were atypical nevi and MM specimens of female patients of the same age group who had received no hormonal therapies and reported no pregnancies in the five years before diagnosis.ResultsTwenty-eight female patients at childbearing age were selected for this study. Strong cytoplasmic positivity of ERα and PRwas detected in atypical melanocytes of two MM specimens of patients who had undergone repetitive cycles of hormonal stimulation during IVF procedures. All other specimens showed no expression ofERαor PR.ConclusionSince our results represent preliminary findings, conclusions regarding a possible correlation between IVF therapy and melanoma occurrence cannot be ascertained. Larger laboratory studies should be performed to investigate reproductive hormone receptor expression in MM in women following IVF, pregnancy, prolonged contraceptive use, or hormone replacement therapy.

‘Scaly’ tattoo reactions: is treatment mandatory?

B. Palterer, V. Grandi, E. Antiga, V. Maio, E. Maggi and F. Liotta Department of Clinical and Experimental Medicine, Division of Internal Medicine, University of Florence, Largo Brambilla 3, 50134 Florence, Italy; Department of Surgery and Translational Medicine, Division of Dermatology, University of Florence, Italy; and Department of Human Pathology and Oncology, University of Florence, Florence, Italy E-mail: boaz.palterer@gmail.com Conflict of interest: the authors declare that they have no conflicts of interest. Accepted for publication 5 May 2016

Vascular leg ulcers: histopathologic study of 293 patients.

Abstract:Vascular leg ulcers remain a challenge for the modern health care, and a systematic pathological study on this kind of lesions has not been reported so far. A total of 293 consecutive white patients with chronic leg ulcers (present for a minimum of 6 months and up to several years) referred to the Wound Care Unit (Dermatology, University of Bologna) between March 2008 and June 2011. Thirty-four patients affected by other than vascular ulcers, neoplastic or inflammatory conditions, were excluded. The remaining 259 patients affected by vascular leg ulcers were enrolled in this study. Assessment of the patients general health, skin biopsy, and vascular Doppler of the lower limbs were performed to determine the etiology and to formulate an appropriate management plan, whereas 2 punch biopsies of 3 mm were performed on the border and on the bed of each ulcer. Doppler evaluation showed the presence of vascular hemodynamic impairment in 259 patients. Of these, 181 (69.9%) patients were affected by venous insufficiency, 58 (22.4%) by venous and arterial insufficiency, and 20 (7.7%) by arterial insufficiency. Histopathologic features revealed significant differences, thus, reflecting the clinicopathologic correlation with the underlying hemodynamic impairments. In conclusion, histopathologic and hemodynamic data correlation could provide the basis for future analysis of leg ulcers pathogenesis and may improve treatment protocols. We should underline that this observational study represents a single-institute experience and that larger series are needed to confirm our observations.

Leg Ulcers Associated With Giant Cell Arteritis Relapse

Giant cell arteritis (GCA) is a granulomatous vasculitis of the aorta and its major branches, with a predilection for the extracranial branches of the carotid artery. In June 2012, an 81-year-old Caucasian woman was referred to our dermatology service because of nonhealing ulcers on the right leg. The patient has a personal history of GCA diagnosed in 1991 and was treated with methotrexato and prednisone. She did not complain of asthenia, jaw claudication, and headache. On admission, her inflammatory markers were elevated: erythrocyte sedimentation rate was 52 mm/h and C-reactive protein level was 1.16 mg/dL. The rest of the laboratory tests and coagulative screening were within normal limits. On admission, she resumed methotrexate 5 mg/ week, folic acid 5 mg/week, prednisone 5 mg/day, and pantoprazole 40 mg/day. On physical examination, we found 3 crusted leg ulcers surrounded with a zone of erythema (Figure 1). The patient underwent to a 3-mm punch biopsy of the lesions and an arteriovenous echo color Doppler of the leg. After debridement, the wound was dressed with medicated bandage. The histological finding was atypical for leg ulcers (Figure 2). We observed ulceration; granulation tissue; sparse, perivascular, interstitial mixed mostly lymphocytes; neutrophils; intraluminal thrombi; extravasated erythrocytes; and granulomatous infiltrate made up of histiocytes in the mid and reticular dermis. The ultrasonographic examination showed preserved vascular function and atherosclerosis of the right femoropopliteal arteries, even without significant stenosis. We made the diagnosis of leg ulcers associated with GCA relapse. After treatment with higher doses of systemic glucocorticoids, the ulcers improved in about 1 month. The histological features of GCA were first recognized in 1932 by Horton et al, and so is also called “Horton’s giant cell arteritis.” GCA usually occurs in individuals aged 50 years and older, more often in women. Genetic or ambient factors probably contribute to the development of GCA, but the etiology is still unknown. GCA is responsible for a broad spectrum of manifestations due to the inflammatory involvement of vessel wall with lymphocytic and macrophagic infiltrates in the tunica media that can extend from the tunica intima to the avventitia and sometimes involving internal elastic lamina. Giant cells can be present. Granulomas and fibrinoid necrosis are seen infrequently. Acute-phase 476518 IJLXXX10.1177/1534734613476518The International Journal of Lower Extremity WoundsMisciali et al

B-cell lymphoma in a psoriatic patient treated with infliximab

ejd.2013.1925 Auteur(s) : Federico Bardazzi, Valentina Angela Antonucci, Aurora Maria Alessandrini aurora.alessandrini@alice.it, Carlotta Baraldi, Vera Tengattini, Annalisa Patrizi Department of Internal Medicine, Geriatrics and Nephrology, Division of Dermatology, University of Bologna, Via Massarenti 1, 40138 Bologna, Italy Psoriasis is a common and chronic inflammatory disease of the skin and joints. TNF-α inhibitors have been approved for the treatment of psoriasis and psoriasis arthritis by [...]

Erosive lichen planus: beyond the nails

Erosive Lichen Planus (ELP) is an inflammatory disorder clinically characterized by erosions and primary or secondary ulcerations. It may affect cutaneous surface (soles are often involved), the mucous membranes (especially genital-gingival) and the cutaneous appendages (nails and hairs). ELP restricted to the nails seems to be a rare variety of LP that may accompany mucosal and cutaneous disease (above all the soles of the feet); nail ELP(NELP) is characterized by erosions of the nail bed, acute inflammation of nail folds and permanent anonychia. This article is protected by copyright. All rights reserved.

Large plaque-type blue naevus with cellular nodules: a rare unrecognized melanocytic tumour

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