Claudio Marasca

Acne Smart Club: An Educational Program for Patients with Acne

Objective: To evaluate adherence to therapy in acne patients using mobile phones and Short Message Service (SMS) to communicate. Methods: 160 patients were randomly assigned to two groups: the SMS group received 2 text messages twice a day for a period of 12 weeks; the control group did not receive any messages. Before and after 12 weeks, the following evaluations were performed in all patients: digital photographs, the Global Acne Grading System, the Dermatology Life Quality Index, the Cardiff Acne Disability Index, the doctor-patient relationship evaluated through the Patient-Doctor Depth-of-Relationship Scale, and the adherence to treatment evaluated by asking patients how many days a week they had followed the therapy. For statistical analysis we used Students t test. Results: The SMS group had a better improvement of all parameters compared to the control group. Conclusion: Adherence and compliance are higher for patients who are included in a strategy of control.

Photodynamic Therapy and Skin Appendage Disorders: A Review

Photodynamic therapy (PDT) is a noninvasive treatment that utilizes light treatment along with application of a photosensitizing agent. In dermatology, PDT is commonly used and approved for the treatment of oncological conditions such as actinic keratosis, Bowen disease and superficial basal cell carcinoma. In the last 2 decades however, PDT has also been used for the treatment of several nonneoplastic dermatological diseases. The present review summarizes published data on PDT application in skin appendage disorders. Our literature review shows that: (a) PDT may be a suitable treatment for acne, folliculitis decalvans, hidradenitis suppurativa, nail diseases, and sebaceous hyperplasia; (b) there is a lack of agreement on PDT features (type, concentrations and incubation period of used substances, number and frequency of PDT sessions, optimal parameters of light sources, and patient characteristics [e.g., failure to previous treatments, disease severity, body surface area involved, etc.] which should guide PDT use in these diseases); (c) further research is needed to establish international guidelines helping dermatologists to choose PDT for the right patient at the right time.

Assessment of the Combined Efficacy of Needling and the Use of Silicone Gel in the Treatment of C-Section and Other Surgical Hypertrophic Scars and Keloids.

OBJECTIVE:To evaluate the individual effectiveness of needling therapy using the Dermapen (Dermapen, Salt Lake City, Utah) and topical therapy with silicone gel (Kelo-cote, Sinclair Pharma, London, England), and their combined effectiveness for the treatment of linear surgical scars, hypertrophic scars, and keloids. MATERIALS AND METHODS:Twenty patients were randomly selected and equally divided into 2 groups (A and B), with each group of 10 including 6 patients with keloids and 4 with hypertrophic scars. Treatment assignments were random. In group A, the entire scar was treated by skin needling, with silicone gel applied to half of the scar. Patients in group B were treated with silicone gel on the whole scar, with only half of the scar also treated with skin needling. During follow-up visits, clinical photographs, evaluation of the scars’ thickness, skin ultrasound, and modified Vancouver Scar Scale were performed. RESULTS:Group A showed an average improvement of 68% (P < .01) on the half of the scar with the combination treatment (skin needling plus silicone gel) compared with a 52% improvement on the half of the scar that was treated with only skin needling. Group B showed an average improvement of 63% (P < .01) where the combination treatment was performed, compared with 47% improvement on the area treated with only the silicone gel. CONCLUSIONS:In conclusion, the combination of these 2 treatments is safe and effective for the treatment of hypertrophic scars and keloids. These modalities achieved favorable results with each patient adhering to the study paramenters.

Salicylic acid for the treatment of melasma: new acquisitions for monitoring the clinical improvement

The Melasma Area and Severity Index (MASI) and the Melasma Severity Score (MSS) are calculated on the basis of only a subjective clinical assessment. This raises the need to have an objective score, uniform in the evaluation by different clinicians. The purpose of this study was to establish if the images by Canfield Reveal Imager can be correlated to MASI score to better evaluate the clinical efficacy of salicylic acid 33% peeling in the treatment of melasma respect to the clinical observation.

Sunbathing and sunlamp exposure: awareness and risk among Italian teenagers.

To the Editor, Adolescence represents a critical period of life during which ultraviolet (UV) radiation can increase skin cancer risk. ‘Tanorexia’ is a new term used to describe an intense desire to be tanned, that multiple studies have tried to classify as a dysmorphic disorder, deriving from an obsessive and distressing desire to be suntanned (1).According to Molly M.Warthan et al. (2), we consider tanorexia as the repetitive behavior of an individual with regard to UV exposure.We have analyzed attitudes to indoor tanning among young people aged from 16 to 19, selected from a high school in Naples (Italy) to identify the risk of this disorder among Italian adolescents.

Intralesional Diode Laser 1064 nm for the Treatment of Hidradenitis Suppurativa: A Report of Twenty Patients

AIM: Hidradenitis suppurativa (HS) is a chronic inflammatory disease, commonly characterized by painful, deep dermal abscesses and chronic draining sinus tracts. Recently, laser and light-based therapies have become more commonly used in the management of HS. MATERIAL AND METHODS: We report 20 HS patients treated with a 1064 nm wavelength, emitted from a diode laser, launched in an optical fibre through intracavitary modalities. RESULTS: Each patient underwent four laser sessions, one every two weeks. we recorded a significative reduction (31%) of Sartorius score from 28.55 ± 13.04 to 19.75 ± 12.29 after 4 laser sessions (p < 0.05). No one has had a worsening of the disease. CONCLUSION: Intralesional diode laser 1064 nm can be a good treatment option for patients with moderate and localized hidradenitis suppurativa, because it is minimally invasive, doesn’t have significant complications and provides a rapid post-treatment recovery.

The Management of Atrophic Acne Scars: Overview and New Tools

Acne is a common disorder with a high prevalence among adolescents. Acne can cause atrophic scars that are a very unpleasant marker and it may have a negative psychological impact on social life and relationships. The distress generated by acne scars is sometimes very strong among adolescents. General dermatologists have, often, the key role to evaluate atrophic scars and to suggest different treatments. The aim of this paper is to review the different therapeutic options for atrophic scars such as chemical peels, tretinoin-iontophoresis, dermabrasion/microdermabrasion, tissue augmentation, laser treatment, punch excision techniques, subcision, and percutaneous collagen induction by skin needling.

Photodynamic therapy for periungual pyogenic granuloma-like during chemotherapy: our preliminary results

Dear Editor, Patients treated with systemic anticancer drugs often show changes in their nails, which can affect patient’s quality of life causing pain and functional impairment [1]. EGFR inhibitors are used in the treatment of several types of advanced cancer and it is estimated that overall incidence of all-grade nail toxicity during chemotherapy with EGFRIs is 17.2%. These drug class-related adverse events are tumorindependent and have also been reported with the use of the latest ErbB inhibitors, including lapatinib, pertuzumab, and afatinib [2]. The epidermal growth factor receptor (EGFR) is most concentrated in the basal keratinocytes, where it acts as a powerful growth promoter, leading to epidermal hyperplasia and hyperkeratosis. Periungual lesions are the most common and debilitating manifestations in patients treated with targeted anticancer therapies. Pyogenic granuloma-like (PGL) lesions are an excess of friable granulation tissue on proximal or lateral folds of the nail, mimicking ingrown nails. These periungual lesions can affect any digit, but the thumbs and the big toes are the most frequently affected, probably because they are more exposed to microtrauma. Development of EGFR inhibitor-induced nail PGLs is dose-dependent, and the granulomas usually regress spontaneously 1–2 months after stopping the drug [3]. The pathogenic hypothesis is that these lesions result from inhibition of the EGFR and downstream EGFR-dependent pathways in basal and suprabasal keratinocytes. This inhibition leads to growth arrest, apoptosis, and decrease of migration of keratinocytes. Consequentially, the periungual epidermis thins damaging the paronychium by the lateral edges of the nail plate and can induce a similar reaction of secondary inflammation to presence of a foreign body [4]. PGL treatment is based on topical steroids and antiseptics, liquid nitrogen, electrodessication, and silver nitrate, associated with local hygiene and avoidance of friction and pressure by shoes [5]. Lateral matricectomy with phenolization of affected toenails has been reported effective with no recurrence, indicating the predisposing role of trauma and nail morphology [6]. Photodynamic therapy (PDT) is a clinically approved and minimally invasive therapeutic procedure that can exercise a selective cytotoxic activity. PDT is currently indicated for treatment of actinic keratosis, basal cell carcinoma, and squamous cell carcinoma in situ (Bowen’s disease) [7]. PDT has also been proposed for the treatment of several nonneoplastic dermatological diseases like photo-aged skin, leishmaniasis, hidradenitis suppurativa (HS), sebaceous hyperplasia, and acne vulgaris. Moreover, some studies have demonstrated that endothelial cells generate protoporphyrin IX from photosensitizers and PDT has the ability to destroy vascular endothelial cells both in vitro and in vivo [8]. In addition, VEGF expression was downregulated following ALA-PDT treatment in mice [9]. Recently, PDT has been effectively used to treat vascular lesions such as port-wine stains, Kaposi’s sarcoma, and pyogenic granuloma [10]. Because of PDTanti-inflammatory and selective action and modulation on granulomatous process and on vascularization, we decided to utilize this treatment modalities in four patients with PGL induced during anti-EGFR-therapy previously treated with topical high-potency corticosteroides in occlusive, and on phenolization at 16% (two patients in treatment with afatinib, one in treatment with lapatinib, and one with erlotinib). * G. Fabbrocini gafabbro@unina.it

A Dermatological Questionnaire for General Practitioners with a Focus on Hidradenitis Suppurativa

BACKGROUND: Hidradenitis suppurativa (HS) is a skin chronic inflammatory disease typically located in several areas such as perianal, inguinal and axillary regions. In 40% to 70% of cases, general practitioners (GPs) are the first health care professionals consulted by patients suffering from HS. The role of GPs in HS management could be more substantial than it has been in the past. AIM: We developed a questionnaire to assess the knowledge of HS by GPs and to evaluate if in their perception the dermatologist is the reference medical doctor for pathology above. METHODS: The data were processed by a univariate descriptive statistical analysis. RESULTS: Our study showed GPs could recognise patients affected by HS. They have proven to know the main features of HS. Nevertheless, the second part of the questionnaire has highlighted the considerable confusion of GPs about who the reference figure is. CONCLUSION: The data registered regarding therapy and follow up too, only show a mild preponderance of dermatologist compared to other professional figures, such as a surgeon, GPs and plastic surgeon.

Anti-TNF-α therapy modulates mTORC1 signalling in hidradenitis suppurativa

Hidradenitis Suppurativa (HS) is a chronic, inflammatory, recurrent and debilitating skin disease of the hair follicle, which usually occurs after puberty with painful, deep-seated, inflammatory lesions in the apocrine gland-bearing areas of the body, most commonly in axillary, inguinal and anogenital regions This article is protected by copyright. All rights reserved.