Federico Bardazzi

Treatment of dermatophyte nail infections: An open randomized study comparing intermittent terbinafine therapy with continuous terbinafine treatment and intermittent itraconazole therapy

BACKGROUND terbinafine persists in the nail at effective concentrations for several weeks after discontinuation of treatment. OBJECTIVE Our purpose was to verify whether intermittent terbinafine therapy is effective in dermatophytic onychomycosis and to compare the results of intermittent terbinafine with those of intermittent itraconazole and continuous terbinafine treatment. METHODS An open, randomized study of 63 patients was performed with three treatment regimens: terbinafine, 250 mg daily (21 patients); terbinafine, 500 mg daily for 1 week every month (21 patients); or itraconazole, 400 mg daily for 1 week every month (21 patients). Treatment was continued for 4 months in toenail infections (60 patients) and 2 months in fingernail infections (3 patients). RESULTS At the end of the follow-up period (6 months after discontinuation of treatment) 16 of the 17 patients (94.1%) with toenail onychomycosis were mycologically cured in the terbinafine 250 mg group, 16 of 20 (80%) in the terbinafine 500 mg group, and 15 of 20 (75%) in the itraconazole group. CONCLUSION The percentage of patients who were mycologically cured was higher in the continuous terbinafine group than in the intermittent terbinafine and itraconazole groups, but statistical analysis did not reveal any significant difference between these cure rates.

Drug-induced hair loss and hair growth : incidence, management and avoidance

SummaryA large number of drugs may interfere with the hair cycle and produce hair loss. Drugs may affect anagen follicles through 2 main different modalities: (i) by inducing an abrupt cessation of mitotic activity in rapidly dividing hair matrix cells (anagen effluvium) or (ii) by precipitating the follicles into premature rest (telogen effluvium). In anagen effluvium, hair loss usually occurs within days to weeks of drug administration, whereas in telogen effluvium, hair loss becomes evident 2 to 4 months after starting treatment.Anagen effluvium is a prominent adverse effect of antineoplastic agents, which cause acute damage of rapidly dividing hair matrix cells. Telogen effluvium may be a consequence of a large number of drugs including anticoagulants, retinol (vitamin A) and its derivatives, interferons and antihyperlipidaemic drugs. Drug-induced hair loss is usually reversible after interruption of treatment. The prevalence and severity of alopecia depend on the drug as well as on individual predisposition. Some drugs produce hair loss in most patients receiving appropriate dosages while other drugs are only occasionally responsible for hair abnormalities.Both hirsutism and hypertrichosis may be associated with drug administration. Drugs most commonly responsible for the development of hirsutism include testosterone, danazol, corticotrophin (ACTH), metyrapone, anabolic steroids and glucocorticoids. Hypertrichosis is a common adverse effect of cyclosporin, minoxidil and diazoxide.

Idiopathic trachyonychia (twenty‐nail dystrophy): a pathological study of 23 patients

We report the clinical features and pathological findings in 23 patients with idiopathic trachyonychia (twenty‐nail dystrophy). Clinically, the nail changes in the majority of patients consisted of the typical ‘sandapered’ appearance, with a rough, Iustreless nail plate. In some, however, the nail plate abnormality was less severe, with numerous small, superficial pits, which imparted a shiny appearance to the surface of the nail. Histology of nail biopsy specimens showed spongiotic changes in 19 patients, psoriasiform features in three, and features of lichen planus in one patient. The mean follow‐up of these patients was 2 years, during which time none developed alopecia areata or mucocutaneous lesions.

Trachyonychia associated with alopecia areata : a clinical and pathologic study

Forty of 1095 patients (3.65%) with alopecia areata had severe nail changes that fulfilled the clinical criteria for the diagnosis of trachyonychia. Twelve of these patients had a nail biopsy. A mild to moderately dense lymphocytic infiltrate associated with exocytosis and spongiosis was detected in the proximal nailfold, nail matrix, nail bed, and hyponychium of 11 patients. One patient showed the pathologic changes of lichen planus; lichen planus of the skin developed 6 months after the nail biopsy. Immunohistochemical characterization on paraffin-embedded sections showed that the inflammatory infiltrate consisted of peripheral T lymphocytes. Immunophenotyping on frozen sections was performed in four cases. The results revealed a T4/T8 ratio of 2:1 and the presence of Langerhans cells in the nail matrix. Our results show that trachyonychia is an uncommon nail manifestation of alopecia areata. Distinctive pathologic features of mild to moderately dense lymphocytic infiltrate associated with exocytosis and spongiosis characterize trachyonychia as well as the other nail abnormalities caused by alopecia areata. The clinical association of trachyonychia with alopecia areata does not exclude that the nail abnormality can be due to other diseases such as lichen planus.

Prevalence of nail abnormalities in children with alopecia areata

Abstract: We assessed the prevalence of nail abnormalities in 272 children with alopecia areata who were seen in our department during an eight‐year period. Of these, 126(46%; 50 girls, 76 boys) had nail abnormalities that were related to alopecia areata. Nail pitting was detected in 92 patients, Including 37 with alopecia totalis or alopecia universalis. Three patients experienced an onychomadesis of all 20 nails during the acute onset of alopecia areata universalis. Thirty‐two (11.7%) had nail thinning and severe nail plate surface abnormalities that were consistent with a diagnosis of trachyonychia.

Correlation between BMI and PASI in patients affected by moderate to severe psoriasis undergoing biological therapy.

Obesity is common in psoriatic patients, and it has been shown to be important for many aspects of the condition. In particular, low‐calorie diets can improve the symptoms and response to treatment in pustular psoriasis. The present study investigates the influence of body‐weight alteration on the diseases clinical manifestations in moderate to severe psoriasis patients treated with biological drugs. Finally, the influence of a caloric restriction was assessed. This observational transversal study enrolled 33 patients attending our Severe Psoriasis Outpatient Clinic, who were treated with biological drugs. Body Mass Index (BMI) was used as a diagnostic indicator of being overweight and of obesity. Waist circumference was also measured. Body weight and Psoriasis Area Severity Index (PASI) index were measured at follow‐up visits at 4 and 8 months. Nonparametric test of Mann–Whitney was used to detect the differences between patient groups. Fishers exact test was performed to evaluate the different results depending on the therapeutic changes of BMI. There was a strong prevalence of overweight‐obese individuals in the group with a mean BMI of 30.59 ± 6.94. Waist circumference was also above normal in the majority of the patients. Obese patients had a PASI index higher than the average of the whole group (25.03 ± 12.43), with grade III obese patients having an average PASI of 44 ± 3.37. At the first and second follow‐ups, patients who put on weight did not achieve PASI 50; patients who had a stable weight presented variable response to treatment, while patients who decreased their weight achieved PASI 90 or PASI 75 even when not responding at the first. Further studies are needed to understand if the poor response observed in heavier patients is due to biological drugs pharmacokinetics or because therapy should be BMI based rather than administered in fixed doses, posing then an ethical consideration.

Euxyl K 400: a new sensitizer in cosmetics

Euxyl K 400 is a preservative for cosmetics and toiletries containing 2 active ingredients, 1,2‐dibronio‐2,4‐dtcyynobutitn and 2‐phenoxyethanol. 2057 consecutive patients with contact dermatitis were patch tested with Euxyl K 400 2.5% pet. and ethanol. A positive patch test occurred in 24 patients (1.2%). The source of sensitization was traced in N patients to their cosmetics. Both leave‐on and rinse‐off products were responsible, Further patch tests with Euxyl K 400 0.5% pet. and phenoxyethanol 5% pet. were performed in 11 patients. A positive patch test to phenoxyethanol was detected in 1 of them. Only 3 patients showed to mild reaction to Euxyl K. 400 0.5% A provocative use test with a lotion preserved with Euxyl K 400 0.1% was positive in 5 of these 11 patients. Patients with Euxyl K 400 sensitivity showed a high prevalence of positive patch tests to other common ingredients of cosmetics. Since the use of Euxyl K 400 in cosmetic products is rapidly increasing, it should he included in the patch test series for patients with suspected cosmetic allergy.

Role of foods in the pathogenesis of chronic paronychia

BACKGROUND Chronic paronychia is a condition that is pathologically characterized by spongiotic inflammation; it can be exacerbated by various and concomitant factors. OBJECTIVE The aim of this study was to assess whether chronic paronychia in food handlers may have clinical, pathologic, and immunohistochemical similarities with immediate contact dermatitis caused by foods. METHODS Twenty food handlers affected by chronic paronychia were submitted to patch tests with the fresh foods that were suspected of being the cause of the dermatitis. RESULTS Nine patients had a positive reaction to a 20-minute open patch test with fresh foods applied on the proximal nailfold. In two patients the pathologic study of the positive open patch test site showed acanthosis, exocytosis, and spongiosis of the epidermis and the presence of an inflammatory lymphocytic infiltrate in the dermis. CONCLUSION Our results confirm the view that an immediate hypersensitivity reaction to foods can be responsible for some cases of chronic paronychia in food handlers.

Perianal streptococcal dermatitis in adults

Summary Perianal streptococcal dermatitis is an uncommon superficial cutaneous infection of the perianal area almost exclusively described in children. We report here four adult cases. Beta‐haemolytic streptococcus group A was detected in the perianal areas of all the patients. Systemic erythromycin gave complete resolution. The incidence of perianal streptococcal dermatitis in adults is probably underestimated, and culture from the affected area should always be performed in patients with persistent perianal erythema.

Audiologic abnormalities in cases of vitiligo

The audiologic function in 50 patients affected by vitiligo was studied. Eight patients (16%) had sensorineural hypoacusis when first seen by us. The relationships between melanocytes of the inner ear and auditory function are discussed.