Emiliano Panconesi

Neuropeptides in skin

Neuropeptides are a heterogeneous group of more than 50 molecules that play a role in various cutaneous functions and diseases; they act as neuromodulators, neurotransmitters, neurohormones, and hormones. In the skin, neuropeptides are synthesized locally (i.e., in keratinocytes and in endothelial cells) and are transported by nerve fibers or immune cells (i.e., lymphocytes, monocytes, and polymorphonuclear cells). Specific receptors and binding sites for neuropeptides have been described in different cell lines in the skin (keratinocytes, endothelial cells, immune cells, fibroblasts). Many different biologic actions of neuropeptides have been demonstrated. Depletion of cutaneous neuropeptides (i.e., with capsaicin cream) or therapeutic use of neuropeptide agonists and/or antagonists may aid in the treatment of skin diseases.

Anaphylactic shock from mustard after ingestion of pizza

A 27-year-old nurse came to us because of itching and the appearance of wheals on her forearms when she prepared injections containing analgesics (unspecified). In the past, from the age of 12 until her first pregnancy at age 23, she had taken analgesics containing phenazonic compounds regularly during her periods. At age 26 she took an unspecified analgesic for back pain and had an immediate reaction of diffuse itching. Approximately 1 year later a tablet of Nisidina® produced anaphylactic shock. Nisidina is a mixture of two antispastic drugs, adiphedrine and ethyl-N-diphenylaminoacetate, an antihistamine, diphenydramine, and the analgesic methamizole (4-methylamino-1.5dimethyl-2-phenyl-3-pyrazolone sodium methanesulfonate) which is sold in Italy under the name Novalgina®. Patch tests with 10 % aminophenazone gave negative immediate and delayed reactions. The prick test with aminophenazone (10 %) and an intradermal test with a 1 % concentration both provoked an immediate wheal reaction. A patch test with Nisidina (saturated solution) also provoked an immediate wheal reaction, but patch tests with the individual ingredients (10 % pet.) were all negative except for methamizole which gave an immediate wheal reaction. Prick tests with methamizole in concentrations of 1, 5, 25, and 50% all provoked immediate reactions. The structural formulas of methamizole and aminophenazone are: Methamizole (Novalgina)

Polycythaemia rubra vera and water‐induced pruritus: blood histamine levels and cutaneous fibrinolytic activity before and after water challenge

We studied blood histamine activity (HA) and cutaneous fibrinolytic activity (CFA) in a patient with polycythaemia rubra vera (PRV) and water‐induced pruritus, before and after water exposure. The results suggest that the water‐induced itching in PRV is associated with an increase in HA. In addition, markedly increased levels of CFA were found both before and after water exposure. These findings have been previously reported in patients with aquagenic pruritus (AP) but not in patients with PRV. As the water‐induced itching in PRV and AP share many common features, these findings suggest that the pathophysiology of the water‐induced pruritus in these two conditions may be similar.

Neuropeptides and skin disorders. The new frontiers of neuro–endocrine–cutaneous immunology

In the past, much work has been devoted to psychosomatic dermatology (or psychodermatology) by well-known pioneers. In recent years, the molecular mechanism by which neuropeptides (NPs) link the neural–immune–endocrine axis has been receiving increasing attention. This bidirectional communication between the immune–endocrine system and the nervous system also involves soluble factors, such as neurotransmitters and cytokines, that are produced by each system. It is also well known that the skin contains numerous NPs released from the sensory nerves and produced by the resident cells of the immune system or by skin cells. Functional dysregulation of NPs has been associated with pathologic cutaneous conditions, such as psoriasis and atopic dermatitis, and the current understanding of the bidirectional loops between the immune–endocrine system and the central and autonomic nervous systems may clarify the pathophysiology of these diseases, thus providing potential targets for therapeutic interventions.

Somatostatin Treatment of Psoriatic Arthritis

ABSTRACT: Eighteen patients with psoriatic arthritis were treated for 48 hours with an infusion of somatostatin 250 fig/hr diluted in a 5% glucose solution. This therapy led to a reduction of joint pain and satisfactory clearing of cutaneous lesions immediately after treatment in eight patients, less marked results in four, and null in four. Two patients were dropped from the study because of negative side effects during administration of the drug. Fifteen days after treatment, the clearing of lesions and joint pain reduction were even more pronounced. The most encouraging results were obtained on erythrodermic and large plaque psoriasis and on the polyarticular involvement. We suggest that the use of this drug, whose side effects are discussed, should be limited to patients with polyarthritis showing severe cutaneous involvement.

Tinea capitis in the adult: Two case studies

The authors describe two cases of tinea capitis in adults, one due to Microsporum canis and the other to Trichophyton rubrum. The atypical clinical presentation of the dermatophytosis in these two cases is stressed. It is hypothesized that in both cases the disease spread from primary lesions on the face.

Ultrastructural Findings in Bullous Pemphigoid

In four bullous pemphigoid patients electron microscopic and direct immunofluorescence examinations were carried out on sections of the border of a blister, apparently normal skin surrounding the blister, apparently normal skin distant from the blister, and apparently normal skin subjected to the stimulus of a xenon lamp. The bullous pemphigoid blister was formed by cleavage of the basal cells away from the basal lamina which remained intact. The intercellular spaces were widened and the half‐desmosomes reduced in number in the skin surrounding the blister. Xenon lamp irradiation produced a pattern similar to that of the skin surrounding the blister, but without immunoglobulins and complement fixed in vivo.

Increased Cutaneous Fibrinolytic Activity in Aquagenic Pruritus

ABSTRACT: Aquagenic pruritus is a disease in which itchy prickling skin discomfort is evoked by contact with water at any temperature without observable cutaneous lesions. Little is known about its etiology and pathogenesis. Previous reports show that increased levels of blood histamine and cutaneous mast cell degranulation are present before water exposure and that they increase stilt further with water challenge. This paper shows that fibrinolytic activity is markedly increased both before and after water exposure, while circulating fibrinolytic activity is normal before water exposure in three cases of aquagenic pruritus. A patient who was asymptomatic at the time of the study had no observed increase in fibrinolytic activity either before or after water challenge, suggesting that the remission of symptoms of aquagenic pruritus and normalization of cutaneous fibrinolytic activity are interdependent factors.

Purpuras and related conditions

Abstract Purpuras include a wide spectrum of cutaneous disorders characterized by extravasation of red blood cells into the skin with consequent release of hemoglobin. Various other pigments deriving from heme are subsequently found into the skin within 2–3 weeks, accounting for the color changes (purple, orange, brown, yellowish, green-blue) which may occur in most purpuric lesions. Too often the factors leading to these disturbances are obscure. Sometimes they are obscure mainly to the dermato-venereologist as they are generally considered more pertinent to the field of interest of other specialists, i.e. in hematology or internal medicine. The dermato-venereologist should be familiar with these cutaneous conditions and, when necessary, cooperate with the hematologist in order to evaluate the cutaneous and extracutaneous signs and symptoms and to schedule the proper systemic and/or topical therapies. Learning objective. At the conclusion of this learning activity, participants should be able to discuss the clinical and histological presentations of purpuric disorders and know which tests should be done to allow proper diagnosis and treatment. The participants should also be aware of the controversies concerning the pathogenesis of some kinds of purpuras (i.e. palpable purpuras), of the evolution of terminology and finally of the different therapeutic options and regimens.

Erythema elevatum diutinum

A 57‐year‐old woman presented with symmetrical reddish‐brown plaques on the entire skin, especially the extremities. The lesions differed in size and shape, and their consistency ranged from soft to tight‐elastic, to hard in the older lesions (Fig. 1). The forearms and the dorsae of the hands and feet were covered with confluent plaques; some of these had an isolated nodular lesion on top. The lesions on the arms were papular‐nodular, arranged in rows to form “cords” with “pseudokeloid” appearance (Fig. 2). On the face, around the cheeks, the wings of the nose, and the ears, there were purplish nodular lesions and plaques.