Diego Orsini

Suicide risk and psychiatric comorbidity in patients with psoriasis

Objectives To examine the occurrence of stressful life events, psychological comorbidity and suicide risk in patients with psoriasis or other dermatological conditions. Methods Consecutive adult outpatients with psoriasis or other dermatological conditions completed a sociodemographic questionnaire and the Hamilton scales for depression and anxiety. Results The study included 157 patients (91 with psoriasis; 66 with other conditions [melanoma; allergy]). Patients with psoriasis were significantly more likely to have experienced major life events in the 12 months before diagnosis, have had a psychiatric diagnosis and to have experienced past suicidal ideation than patients with other dermatological conditions. Conclusions Patients with psoriasis have an increased risk of psychiatric comorbidities, suicidal ideation, and long-term course of the disease compared with patients who have other dermatological conditions. Psychiatric assessment is highly recommended in patients with psoriasis.

Psychiatric comorbidity and suicidal ideation in psoriasis, melanoma and allergic disorders

Abstract Objective: Psychiatric disorders and suicide risk (especially in psoriasis) are frequent and disabling conditions in patients with skin diseases. The aim of this study was to examine the risk of suicide and stressful life events in a sample of patients with skin disease. Methods: A sample of 242 dermatological patients (142 women and 100 men), 112 of which had psoriasis, 77 had melanoma, and 53 were suffering with chronic allergic diseases. Patients were administered the MINI International Neuropsychiatric Interview (MINI), Hamilton Depression Rating Scale (HDRS), Hamilton Anxiety Rating Scale (HARS), and the Columbia-Suicide Severity Rating Scale (C-SSRS). Patients were also asked about their experiences with stressful life events. Results: Patients with psoriasis were more likely to have a history of psychiatric disorders (36.6% vs. 13.2% χ2(1) = 9.55; p = 0.002) compared to patients with allergies. Specifically, patients with psoriasis more likely had a diagnosis of a mood disorder (16.1% vs. 3.9% χ2(1) = 6.85; p = 0.009; 16.1% vs. 0% χ2(1) = 9.56; p = 0.002) and reported past suicidal ideation (33.9% vs. 15.6% χ2(1) = 7.89; p = 0.005; 33.9% vs. 18.9% χ2(1) = 3.96; p = 0.047) as compared to those with melanoma and allergy. Conclusions: The results from this study suggest that patients affected by psoriasis have an increased risk of psychiatric comorbidities and suicidal ideation compared to those who have other dermatological disorders.

Eosinophilic Dermatosis Associated with Haematological Malignancies: A Report of Two Cases

Hematologic malignancies can be associated to dermatological manifestations, with two possible etiopathogenetic mechanisms: a direct invasion of skin by neoplastic cells or a paraneoplastic phenomenon. The eosinophilic dermatosis can be included in the latter class and arc a group of polymorphous dermatitis, clinically characterized by papules, plaques, nodules or vescico-bullous lesions, mainly involving sun-exposure sites. Clinical pictures are similar to an insect bite reaction, but in most cases the patients deny any arthropod contacts. Therefore, they arc now considered as a hypersensitive reaction to different stimuli induced by lymphoproliferative malignancies and the associated immune-deficient state. Herein, we describe two cases of patients affected by a non-Hodgkin lymphoma (NHL), in whom a diagnosis of insect bite-like reaction (IBLR) was made.

Angiomatoid lesions (leukocytoclastic vasculitis) as paraneoplastic manifestations of multiple myeloma IgA λ.

ejd.2010.1223 Auteur(s) : Marta CARLESIMO1,a diegoorsini@libero.it, Alessandra NARCISI1, Diego ORSINI1,a, Pier Paolo DI RUSSO1, Giorgia CORTESI1, Giacinto LA VERDE2, Maria GIUBETTINI3, Federica PULCINI3, Germana CAMPLONE1 1 UOC Dermatology, II Unit University of Rome “Sapienza”, via di Grottarossa 1039, 00189 Rome, Italy 2 Department of Hematology, II Unit University of Rome “Sapienza”, via di Grottarossa 1039, 00189 Rome, Italy 3 Department of Histopathology, II Unit University of Rome [...]

Acitretin in management of diffuse common warts: a case report

Warts are among the most commonly observed dermatological diseases, caused by human papilloma virus (HPV), usually HPV1‐2 subtypes; HPV4‐7 are rarely found and mostly related to professional exposure (butchers and dairy workers). Different therapeutical approaches are possible, depending on extension and severity of lesions. The present authors describe the case of 32‐year‐old Caucasian man, who came to our attention for the presence of numerous exophytic papules on the back of both hands and over periungual regions, which appeared about 6 months before. Histological examination confirmed the clinical suspicion of common warts (HPV4). The patient underwent therapy by acitretin for 12 weeks, obtaining during the 8th week of therapy complete resolution of skin lesions. The present authors present this case for the unusual local aggressiveness of viral warts in an immunocompetent patient successfully treated with acitetrin.

An interesting case of oedema and ulceration in red areas of tattoo

Dear Editors, We describe the clinical case of a 25-year-old man who presented to our clinic for a granulomatous reaction in the red areas of a tattoo on his right leg (Figure 1). The patient developed oedema and ulceration 3 weeks after undergoing tattoo. The social meaning of the practice of tattooing has evolved over the centuries. The spread of these fads, especially among adolescents, calls for urgent action to provide for health monitoring of the traders who engage in such practices, and to foster self-protection behaviours among young people. If not monitored, these practices may result in both local and systemic complications. Many dermatoses such as psoriasis, systemic lupus erythematosus (SLE), sarcoidosis and lichen planus can be localised in the area of the tattoo (1), probably because of a minor locus resistentiae or the isomorphism of Koebner. We performed a patch test to exclude an allergic reaction, a cutaneous biopsy for histological examination and microbiological cutaneous tests to exclude an infective nature of the reaction. Patch test series SIDAPA, produced by F.I.R.M.A. S.p.A (Firenze, Italy), involve applying patches containing the following haptens on the back of the patient (by a single operator): potassium dichromate, rosin, epoxy resin, formaldeidica resin, Euxil 400, neomycin sulphate, fragrance mix, nickel sulphate, mercaptobenzotiaziolo, paraphenylendiamine, cobalt chloride, balsam of peru, thiuram mix, benzocaine, lanolin alcohols, parabens, Vaseline, scattered yellow, scattered blue and hydroquinone. The patient was asked not to wash his back, and not to take oral cortisone and antihistamines.

Acitretin for treatment of familial porokeratosis palmaris et plantaris disseminate

ejd.2012.1826 Auteur(s) : Nevena Skrozaa, Ilaria Proiettia proiettilaria@gmail.com, Nicoletta Bernardinia, Francesca Nicoluccia, Ersilia Tolinoa, Giorgio La Violaa, Diego Orsinia, Sara Zubera, Concetta Potenzaa UOC of Dermatology “Daniele Innocenzi”, Faculty of Medicine and Surgery, University of Rome “Sapienza”, Polo Pontino, A.Fiorini Hospital, Via Firenze, 04019, Terracina, Italy a All authors contributed equally to this work A 65-year-old Caucasian man was referred to our department [...]

Black lymph node in tattoo: an easy pitfall.

Systemic Symptoms (DRESS) syndrome could be discussed in the present patient. Indeed, the interval of 5 weeks between onset of the drug and skin reaction is compatible with intervals described in DRESS, i.e. 2–6 weeks. Furthermore, presence of fever, moderate increased eosinophil count onset of symptoms, presence of atypical lymphocytes, rapid improvement after steroid treatment initiation and compatible histology are other arguments in favour of a DRESS syndrome. The REGISCAR DRESS score was 5, which classified the present reaction as probable DRESS syndrome. Alternately, an acute generalized exanthematous pustulosis (AGEP) could also be suspected. All cutaneous symptoms were compatible with this diagnosis, particularly the aspect of pustular rash with secondary erosive desquamation and the absence of internal organ dysfunction. Even though the classical intraepidermal pustule has not been found on skin biopsies, the EUROSCAR calculated AGEP score was 7, meaning a probable AGEP. Ultimately, an overlap drug reaction between DRESS syndrome and AGEP might be evocated in the present observation, in accordance with previously published cases, even if those overlap reactions seem very infrequent. The most frequent adverse events encountered with vemurafenib are mainly cutaneous rash with papulopustular follicular eruption, photosensitivity, cutaneous squamous cell carcinomas or keratoacanthomas, arthralgia and asthenia. Altogether, doselimiting skin toxic effects were mainly grade 3 rash in 7% and 8% of patients in phases 2 and 3 vemurafenib trials respectively. A DRESS syndrome associated with vemurafenib was recently reported with less severe, but very similar symptoms as compared to the present one. This case raised the question of the management of moderate to severe skin reactions associated with BRAF inhibitors therapies. Indeed, it seems that some patient will developed a very severe skin reaction, even though infrequent and eventually after a previous moderate rash. Patients who experienced an initial moderate grade 1 or 2 rash, as observed in this case, should be followed very cautiously if the BRAF inhibitor is re-introduced or carried on. To date, neither guidelines nor recommendations exist for the management and investigations towards immediate or delayed immunoallergic reactions caused by BRAF inhibitors.

Nodular melanoma arising in a patient treated with anti-tumor necrosis factor alpha antagonists.

Figure 1 The neoplasm is asymmetric (a, ·20), with a junctional component (b, ·200) and involvement of the hair follicle (c, ·200). There are dermal mitoses (d, ·400) and confluence of the dermal nests e, ·200). The tumor cell populations are different: some large with abundant cytoplasm while others are small and spindle-shaped with little cytoplasm. Histological examination reveals a brisk tumor infiltrating lymphocytes (f, ·200)

A case of cutaneous large B-cell lymphoma of the legs appearing as chronic venous ulceration

We report here a case of a woman with a cutaneous large B-cell lymphoma of the legs. She had a plaque lesion, superficially ulcerated and necrotized with tumorous borders situated on the posterior side of the right leg and two red or bluish-red nodular lesions. A skin biopsy from both nodular and plaque lesion showed a diffuse infiltrate of atypical large B cells CD20+ and CD79a+, spanning epidermis, dermis and subcutaneous tissue. A therapeutic approach containing anti-CD20 monoclonal antibody (rituximab) was suggested.