Carlotta Gurioli

Childhood lichen sclerosus: a long-term follow-up.

Abstract:  Lichen sclerosus (LS) shows a predilection for the genital area and occurs mostly in postmenopausal women and in prepubertal girls. We conducted a retrospective review of 15 young girls whit genital LS with onset before the menarcheal age and treated with topical clobetasol propionate 0.05%. The mean duration of follow‐up was 4.7 years with relapses in nine patients after approximately 1 year from the first clearing. At the end of the study we observed that (i) potent topical steroids are safe and effective in childhood, (ii) an early aggressive treatment gives the best therapeutic response, (iii) one follow‐up visit a year is required to monitor for relapsing.

Tattoo-associated Pseudolymphomatous Reaction and its Successful Treatment with Hydroxychloroquine

Tattooing has become increasingly popular in today’s society, although it has been practiced for over 8000 years (1). Following this new fashion trend, physicians have documented an increasing number of tattoo-associated skin disorders.The most common dermatological tattoo compli-cations concern hypersensitivity reactions to tattoo pigments, for example, irritant and allergic contact dermatitis (2), development of lichenoid areas (1, 3–5), and granulomatous responses such as sarcoid granulo-mas or foreign body granulomas (1). Less frequently patients developing discoid lupus erythematosus have been reported (2).Pseudolymphoma confined to the tattoo area is an unusual tattoo reaction that, to the best of our knowledge, has been described in only seven cases in the literature (6–10). We report here a new case of pseudolymphoma developing in the green portion of a multicoloured tattoo, which was treated with a systemic anti-malarial drug.CASE REPORT

Plaque stage mycosis fungoides treated with bexarotene at low dosage and UVB-NB

Mycosis fungoides (MF) is the most common form of cutaneous T-cell lymphoma (CTCL), a non-Hodgkin lymphoma characterized by proliferation of atypical epidermotrophic helper/memory T cells in the skin. Therapeutic management includes topical therapy such as topical corticosteroids, topical chemotherapy or phototherapy; or systemic therapy such as photochemotherapy (psoralen and ultraviolet A [PUVA]), extracorporeal phototherapy, radiation, and mono or polychemotherapy. Herein we report one case of MF unresponsive to conventional therapy, subsequently treated with bexarotene and narrow-band ultraviolet B (UVB-NB). Bexarotene belongs to a new subclass of retinoids, binding primarily the nuclear hormone receptors RXRs. Bexarotene has the same effect as its natural counterpart: 9-cis-retinoic acid. Bexarotene may be used alone or in association with interferon alfa, interferon gamma, extracorporeal photophoresis and PUVA. We utilized 75 mg/day of bexarotene associated with 0.3 J/cm2 UVB-NB as an initial dose. The sessions were three times weekly and the irradiation was increased by 30% at each session to reach a maximum of 1.6 J/cm2. After 8 week treatment, clinical lesions markedly improved without recording hypercholesterolemia or hypothyroidism. During the follow-up no relapses were detected. We suggest that the combined therapy UVB-NB and bexarotene may be considered as an alternative treatment to PUVA and bexarotene.

Necrosis of the eyebrow after local injection of lidocaine 2% on the lower eyelid: is a thrombus-embolic mechanism involved?

An 84-year-old woman was referred to us for evaluation of a necrotic skin lesion involving the medial area of the left eyebrow (Figure 1). This lesion appeared 2 days after she had been treated for an ectropion of the lower eyelid with Ziegler cautery puncture. This treatment was performed under local anesthesia obtained with 0.2 mL of lidocaine 2%, which was infiltrated into the border of the lower eyelid. The needle was directed from the lateral to medial cantus, and subsequently, with a flat electrode, a single row of punctures were made through the lower lid, deep inside the tarsus. Immediately after the injection the patient complained, for some minutes, of intense pain on the left eyebrow, in the area where the ulceration developed 48 hours later. Physical examination showed a necrotic area 7 mm in diameter with an erythematous border and an adherent dark crust. No other cutaneous abnormalities were detected. The patient’s personal history was negative for cryoglobulinemia, polyarteritis, macroglobulinemia, polycythemia, severe obliterans arteriosclerosis, hypercalcemia, and diabetes, all diseases that are a risk factor for developing cutaneous ulcers. Cutaneous swabs were taken, and direct microscopic examination and cultures were negative for bacteria and fungi. The complete blood count and blood biochemistry analysis were within normal limits. The patient was treated with an antibiotic ointment, and the eschar was surgically removed. The lesion healed with scarring after 2 weeks.

Randomized, controlled, double-blind clinical study evaluating the safety and efficacy of MD2011001 cream in mild-to-moderate atopic dermatitis of the face and neck in children, adolescents and adults.

Abstract Introduction: This mono-center randomized, controlled, double-blind study evaluates the safety and efficacy of MD2011001 cream versus placebo, in mild-to-moderate atopic dermatitis (AD). MD2011001 is a nonsteroidal topical cream containing vitamin E, epigallocatechin gallate and grape seed procyanidins. Methods: Patients with AD (corresponding to an IGA score of 2 or 3), involving the face, the perioral/periocular area and/or the neck, were enrolled. Patients were randomized 1:1 ratio to receive MD2011001 or placebo before the start of the study (D0), then evaluated after 7 days, and after 28 days. The study was approved by the Local Independent Ethics Committee and conducted according to the Declaration of Helsinki and local regulations. The statistical tests used were the Wilcoxon test and the Mann–Whitney U-test. Results: Forty-four patients (29F and 15M) were enrolled. The IGA values showed a statistically significant reduction during the treatment period obtaining a favorable safety profile and local tolerance for both the products. The reduction in the surface area affected by AD was significantly faster with MD2011001. Discussion: This study focuses on very sensitive areas known to be particularly susceptible to local complications. Conclusions: These results suggest the usefulness of an emollient treatment for mild/moderate AD.

Pyogenic granulomas in childhood: New treatment modalities

Wine Lee et al (1) reported seven cases of paediatric cutaneous and mucosal pyogenic granulomas treated with β-adrenergic receptor antagonists (4 females/ 3 males; aged 2-8 yrs). Topical treatment with timolol 0.5 % two times daily was performed in a 32-month-old female presenting a lesion of the cheek and timolol 0.5 % 2 % three times daily on the other patients for 2-6 months, with partial to complete response. Most lesions were located on the face and only one lesion presented on the forearm. One 6-year-old male patient was treated with oral propranolol for a pyogenic granuloma of the buccal mucosa (2 mg/kg/day; twice daily for 6 months) with a complete resolution of the lesion. The authors referred that bleeding was the main concern of patients’ parents and that therapy with β-adrenergic receptor antagonists resolved this symptom at the first two months of treatment leading to high satisfaction.

Cutaneous carcinogenic risk evaluation in 375 patients treated with narrowband-UVB phototherapy

Narrowband‐ultraviolet B (NB‐UVB) is widely used for the treatment of several dermatological diseases. A cutaneous carcinogenic effect has been hypothesized, but not proved.

Living with Chronic Spontaneous Urticaria in Italy: A Narrative Medicine Project to Improve the Pathway of Patient Care

Chronic spontaneous urticaria (CSU) is perceived as a difficult to manage disease with negative impact on quality of life. The aim of this study was to highlight how to improve the care of people with CSU, using the methodology of narrative medicine. From June 2014 to March 2015, CSU-diagnosed patients and their physicians were asked to record their experiences of the condition in writing. Fourteen healthcare teams participated: 41% considered CSU as a challenge to overcome, while 22% experienced CSU as a big commitment. The number of professional involved was evaluated as insufficient in 11 hospitals. Seventy-five percent of the 190 Italian patients had visited 3 or more physicians before receiving a final diagnosis, with a perceived waste of time and resources. The therapeutic pathways were described as unsatisfactory in 83% of cases. As a result, anger and frustration were life-dominant emotions in 92% of patients. The critical points of the care pathway are related to organizational issues and lack of awareness.

Eczema craquelé, an uncommon clinical manifestation of myxedema.

eine 32-jährige Frau stellte sich mit einer einjährigen Vorgeschichte von oberflächlichen Rissen und Fissuren an beiden Beinen vor, ohne Anzeichen einer Veneninsuffizienz (Abbildung 1). Weder lag ein Pruritus noch ein Ödem vor. Sowohl die persönliche als auch familiäre Anamnese war unauffällig, vor allem bezüglich atopischer Erkrankungen. Die Patientin gab darüber hinaus an, keine aggressiven Reinigungsmittel oder Peelings verwendet zu haben. Es gab keine Hinweise auf eine saisonal bedingte Verschlechterung der kutanen Symptome. Die Anwendung verschiedener Feuchtigkeitsund Pflegecremes sowie typischer Kortikosteroide und topischer Anwendung von Tacrolimus brachte klinisch keinerlei Verbesserung. Wir diagnostizierten folglich ein Eczema craquelé. Die Patientin unterzog sich einer 4 mm-Stanzbiopsie an einer ihrer Läsionen des Beines. Der histologische Befund zeigte eine Parakeratose, ein Schachbrettmuster (Abbildung 2), sowie die Homogenisierung von Kollagenbündeln, welche durch Muzin-Depots sowohl in der papillären als auch der retikulären Dermis geteilt wurden. Dies konnte durch Alzianblau-Färbung bestätigt werden (Abbildung 3). Die Laborergebnisse, unter anderem großes Blutbild, klinische Chemie und biochemische Analysen, lagen alle im normalen Bereich. Während Clinical Letter

Primary Cutaneous Large B-Cell Lymphoma, Leg Type, Localized on the Dorsum.

Primary cutaneous large B-cell lymphoma, leg-type (PCLBCL-LT), is a large B-cell lymphoma primarily involving the skin. It is distinguished from the other 3 subsets of this lymphoproliferative disorder by its immunohistopathological features, configuring confluent sheets of medium-sized to large B lymphocytes with round nuclei provided with evident nucleoli, resembling centroblasts or immunoblasts, which express Bcl-6, Bcl-2. Prevalently appearing on the lower limbs, as a single or multicentric and frequently ulcerated skin nodule or plaque, PCLBCL-LT has a worse prognosis than the other large B-cell lymphomas. Moreover, the age of onset is delayed (7th decade) compared to those of the other 3 subtypes (6th decade); it presents a slight female predominance (2:1), and a higher percentage of positivity to Bcl-2. We present a 52-year-old man who showed a 2-year standing, non-ulcerated, round, 4 cm in diameter, red plaque, medially located on the dorsum. After biopsy the diagnosis of PCLBCL-LT was made on histopathological and immunohistochemical studies, the latter showing positivity to CD20, Bcl-2, and Bcl-6. After treatment with radiotherapy the patient has shown a 4.4-year follow-up free of disease.