Ersilia Tolino

Correlations between Psoriasis and Inflammatory Bowel Diseases

For a long time the relationship between inflammatory bowel diseases (IBDs) and psoriasis has been investigated by epidemiological studies. It is only starting from the 1990s that genetic and immunological aspects have been focused on. Psoriasis and IBD are strictly related inflammatory diseases. Skin and bowel represent, at the same time, barrier and connection between the inner and the outer sides of the body. The most important genetic correlations involve the chromosomal loci 6p22, 16q, 1p31, and 5q33 which map several genes involved in innate and adaptive immunity. The genetic background represents the substrate to the common immune processes involved in psoriasis and IBD. In the past, psoriasis and IBD were considered Th1-related disorders. Nowadays the role of new T cells populations has been highlighted. A key role is played by Th17 and T-regs cells as by the balance between these two cells types. New cytokines and T cells populations, as IL-17A, IL-22, and Th22 cells, could play an important pathogenetic role in psoriasis and IBD. The therapeutic overlaps further support the hypothesis of a common pathogenesis.

Mediterranean diet and familial dysmetabolism as factors influencing the development of acne

Aim: To investigate the effects of adherence to the Mediterranean diet and familial dysmetabolisms on acne development. Methods: A community-based case–control study was carried out in Italy enrolling cases as acneic outpatients of a dermatological ambulatory service and controls as clinically healthy acne-free subjects. Food consumption were evaluated with a validated food-frequency questionnaire, exploring the consumption of pasta, meat, cheese, fish, fruit, vegetables, and olive oil. Adherence to the traditional Mediterranean diet was assessed by a 10-point Mediterranean diet scale that incorporated the main characteristics of this diet. A logistic regression analysis estimated the variables who predicted the odds of being case, using those variables that at the univariate analysis yielded a p-value <0.25. Results are presented as odds ratio (OR) or adjusted OR (AOR). Results: The study included 93 cases (36.6% males, median age 17 years) and 200 controls (32% males, median age 16 years). The Mediterranean diet score ≥6 revealed a protective effect towards acne (crude OR 0.22, 95% CI 0.08–0.64). Logistic regression analysis showed that familial hypercholesterolaemia, diabetes, and hypertension are strong risk factors for acne (AOR 8.79, 95% CI 1.67–46.22; 3.32, 95% CI 1.27–8.63; and 2.73, 95% CI 1.07–6.96, respectively), while the Mediterranean diet represents a protective factor (score ≥6, AOR 0.31, 95% CI 0.11–0.89). Conclusions: The odds for familial dysmetabolisms was higher in cases than in controls, confirming their role in determining or maintaining acne. Moreover, this is the first study demonstrating a protective role of the Mediterranean diet in the pathogenesis of acne.

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.

Isotretinoin for the treatment of squamous cell carcinoma arising on an epidermoid cyst.

A 63‐year‐old man showed multiple concentric erythemato‐nodular lesions of approximately 1.5–3 cm in diameter, located in the parietal and temporal region. The skin biopsy allowed histological diagnosis of infundibular epidermal cyst associated with chronic granulomatous flogosis; in one of these, a well‐differentiated squamous cell carcinoma arising from the cyst wall was found. The patient received isotretinoin at the daily dosage of 0.5 mg/kg/day for 5 months. During 1‐year follow‐up, laboratory tests, computed tomography scans, and control histology were all in the normal range, with a good improvement of the lesions. Epidermal cysts and squamous cell carcinoma are both commonly encountered in practice. However, the association of epidermal inclusion cysts and squamous cell carcinoma in the skin is very rare. In some cases, including the present one, more potent chemopreventive strategies, such as the use of systemic retinoids, must be considered. Systemic retinoids are the most heavily researched chemopreventive agents and have shown promise for multiple types of cancer, including bladder and head and neck carcinomas. We would like to recommend the possibility to administer retinoids in a squamous cell carcinoma, achieving very satisfactory results; in our case, a complete remission of malignant lesion and an improvement of epidermal cysts were made, without the development of side effects associated with retinoids.

Cardiovascular Risk in Psoriatic Patients Detected by Heart Rate Variability (HRV) Analysis

Postmarketing Phase IV

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 [...]

Efficacy and tolerability of a lotion containing triethyl citrate, ethyl linoleate, and GT peptide-10 in the adjuvant treatment of hidradenitis suppurativa: Real-life data

Hidradenitis suppurativa (HS) is a chronic disorder of terminal follicular epithelium in the apocrine gland‐bearing areas. The long term therapy is based mainly on topical and/or systemic antibiotic use that could result in antibiotic resistance. The aim of our study was to present the real‐life experience based on the efficacy and tolerability of a novel lotion containing triethyl‐citrate, ethyl‐linoleate, and g‐peptide‐10 in the treatment of mild to moderate HS that has already shown effectiveness in acne treatment. This was an open‐label study on 30 patients of both sexes affected by HS. Patients were divided into two groups: 15 with Hurley I and 15 with Hurley II–III. The subjects were treated with the topical lotion, three‐times‐daily for eight weeks, with control at 4 (T1) and eight weeks (T2). Any other concomitant treatment (both topical and/or systemic) was avoided during study period. Improvement was observed in both Sartorius score grading system and inflammatory and noninflammatory lesion counts. The novel lotion has proved to be effective and well‐tolerated topical agent alone or in association with other topical and/or systemic tratments in HS, without side effects

Factors influencing response to ingenol mebutate therapy for actinic keratosis of face and scalp

AIM To determine factors independently influencing response to ingenol mebutate therapy and assess efficacy on clinical setting of non-hypertrophic non-hyperkeratotic actinic keratosis (AK). METHODS Consecutive patients affected by non-hypertrophic non-hyperkeratotic AKs of the face or scalp were enrolled to receive ingenol mebutate 0.015% gel on a selected skin area of 25 cm2 for 3 consecutive days. Local skin reactions were calculated at each follow up visit using a validated composite score. Efficacy was evaluated by the comparison of clinical and dermoscopic pictures before the treatment and at day 57, and classified as complete, partial and poor response. RESULTS A number of 130 patients were enrolled, of which 101 (77.7%) were treated on the face, while 29 (22.3%) on the scalp. The great majority of our study population (n = 119, 91.5%) reached at least a 75% clearance of AKs and, in particular, 58 patients (44.6%) achieved a complete response while 61 (46.9%) a partial one. Logistic backward multivariate analysis showed that facial localization, level of local skin reaction (LSR) at day 2, the highest LSR values and level of crusts at day 8 were factors independently associated with the achievement of a complete response. CONCLUSION Ingenol mebutate 0.015% gel, when properly applied, is more effective on the face than on the scalp and efficacy is directly associated to LSR score.

Association between smoking habits and acne. A case-control study and a systematic review and meta-analysis

Background: Smoke increases the development of many diseases. Previous studies about its role in the pathogenesis of acne shows contradictory results. Methods: A questionnaire was administrated to each participant, to assess the association acne - smoke. For the systematic review, a bibliographic search on electronic databases was performed (Pubmed, Scopus and Google Scholar). Only case-control studies in English-language from 1966 to 2010 were included. All publications were analyzed by two researchers. Data regarded acneic patients in current and never smokers. Quality assessment was performed using a score for observational study. Results: Of 93 cases of the case-control study, 6 patients had severe acne, 19 moderate acne and 68 had a mild acne, according to classification of Global Alliance to improve outcomes in acne. No one of the smokers had severe acne, only one smoker had moderate acne and 11 had mild acne. Systematic review considered five population studies. First meta-analysis, with all investigations, showed a OR=2.03 (95% CI: 0.63–6.58). The sensitivity analyses include meta-analyses stratified by gender, and quality (score>6). Results for males were: OR=1.89 (95%CI:1.25-2.87); for female OR=1.84 (95%CI:0.36-9.51). The analysis using quality score reported OR=3.48, (95%CI: 1.58-7.68). Conclusions: In conclusions, smokers have higher risk to develop acne, especially males. Conclusions are not robust, because of heterogeneity definitions of smokers and acne grading. Keywords: Acne; Smoke; Tobacco; Nicotine; Cigarettes.

A Review of the Literature of Surgical and Nonsurgical Treatments of Invasive Squamous Cells Carcinoma

Cutaneous squamous cell carcinoma (cSCC) is an increasing public health problem. It is a primary malignant skin tumor with Malpighian differentiation and together with basal cell carcinoma is classified among nonmelanoma skin cancers (NMSCs). cSCC usually occurs on photoexposed areas, such as the head, the neck, and the extremities, and its incidence increases with age. Invasive forms of this skin tumor tend to be more aggressive showing a higher metastatic potential, usually regarding regional lymph nodes. Treatment options for invasive cSCCs include both surgical and nonsurgical options. The therapeutic choice depends on several factors, such as anatomic location, risk factors for tumor recurrence, age, and health status of the patient. This review aims to provide an overview of the current evidence on therapeutic surgical and nonsurgical management of invasive cSCC.