Francesca Gaudiello

Prevention of Tuberculosis in Patients Taking Tumor Necrosis Factor-α, Blockers

Treatment with tumor necrosis factor–α (TNF–α) inhibitors increases the risk of tuberculosis (TB) due to reactivation of latent Mycobacterium tuberculosis infection (LTBI). Screening for LTBI is based mainly on the tuberculin skin test (TST), which has several limitations in any patient who is immunosuppressed due to drugs or autoimmune disease. T cell interferon–γ release assays (IGRA) have been shown to be more specific than TST in immunocompetent patients and potentially represent a new approach for the management of patients taking TNF–α blockers. Even if there is no evidence-based literature of IGRA superiority versus TST in this specific clinical setting, some studies suggest blood assays may be helpful in clinical management of these patients, in addition to currently recommended clinical screening for risk factors for LTBI.

The risk of herpes zoster in the anti-TNF-α era: a case report and review of the literature

BACKGROUND Tumor necrosis factor-α (TNF-α) inhibitors represent efficacious therapeutic agents in many chronic inflammatory diseases such as psoriasis and rheumatoid arthritis. However they have been connected with increased risk of infection and reactivation of a variety of infectious agents, such as viruses. The reactivation of varicella zoster virus infection causes herpes zoster (HZ), a self-limiting, dermatomally localized, vesicular rash that can be accompanied by postherpetic neuralgia and severe neurological complications. MAIN OBSERVATIONS Limited information has been published regarding HZ during therapy with TNF-α inhibitors especially for the occurrence of HZ during adalimumab treatment. We report the case of a 58-year-old immunocompetent man with a 18-year history of plaque psoriasis who develops ophthalmic HZ during treatment with adalimumab. CONCLUSION We report this case to enrich the literature and to highlight the increased risk of HZ infections in patient on anti-TNF-α therapy (incidence of HZ is about 3-fold increased respect to general population). Clinically, these infections often have atypical presentations that may hamper prompt diagnosis. Therefore, it is very important to identify early signs and symptoms of herpes zoster in patients on biologic therapy in order to start prompt efficient antiviral treatment to prevent the development of severe complications.

Efalizumab‐induced guttate psoriasis. Successful management and re‐treatment

Psoriasis is a chronic, immunologically based inflammatory skin disease. Efalizumab (Raptiva®) is a humanized monoclonal immunoglobulin G1 antibody that binds with high specificity and affinity to the alpha subunit of leucocyte function‐asssociated antigen‐1 (LFA‐1) on the surface of T cells. Therefore, efalizumab is an effective biologic therapy for the long‐term treatment of chronic moderate‐to‐severe plaque psoriasis. This drug demonstrated a good safety profile, whereas most adverse events were mild to moderate in severity. During efalizumab treatment, a small percentage of patients experienced protocol‐defined psoriasis adverse events (e.g. worsening of psoriasis or the onset of new psoriasis morphologies). We present the case of a patient who experienced a new onset of guttate psoriasis and a mild worsening of pre‐existing psoriatic lesions during treatment with efalizumab. Restarting with the same drug did not induce any adverse events.

Melanocytic Nevi in Children of Southern Italy: Dermoscopic, Constitutional, and Environmental Factors

The objective was to estimate the prevalence of melanocytic nevi (MN) in children and to determine their dermoscopic characteristics and relationship with anatomic location and environmental and constitutional factors. The population was a randomly selected sample of 144 children who attended primary schools in Naples, Italy. Before physical examination of the children, standardized interviews were conducted with their parents. Follow‐up interviews of both the children and parents were conducted 1 year later. Photographic and dermoscopic images were obtained. Boys had more MN than girls; 465 MN (55.6%) were observed in boys and 371 (44.4%) in girls (p < 0.05). The trunk and neck were the most common locations of MN (p < 0.001). The main dermoscopic feature of all MN observed was a globular pattern (p < 0.001). A significant correlation between duration of sunbathing and MN counts was revealed (p < 0.05). At 1‐year follow‐up, 118 new MN were identified in 66 children. The trunk and neck areas were the most common regions involved in the appearance of new MN (n = 68, 57.6% of all new MN, p < 0.001). The new MN count was significantly higher in children who reported more sunbathing (p < 0.001). Changes in the dermoscopic pattern were observed in 45 persistent MN, demonstrating more MN with a reticular‐globular pattern, especially on the trunk, neck, and upper extremities (p < 0.001). MN development in early life is the result of complicated relationships between nevus evolution, anatomic location, and environmental and constitutional factors.

Excess granulation tissue and hair loss following acitretin

Retinoids are routinely used in dermatology for various clinical entities including acne vulgaris, rosacea, hypertrophic scars, strie distensae, psoriasis, disorders of dyskeratinization, cancer prevention and other chronic hyperkeratotic disorders. Oral acitretin therapy is effective in the treatment of psoriasis normalizing cellular differentiation and maturation but clinical side-effects are reported. We describe the occurrence of excess granulation tissue in the nails sulcus and noncicatricial universal alopecia in a psoriatic patient receiving oral acitretin.

Scratch–patch test for the diagnosis of allergic contact dermatitis to aciclovir

Topical antiviral drugs are frequently used, but although repeated applications can lead to contact reactions (1), adverse cutaneous reactions are not commonly observed. Allergic contact dermatitis caused by aciclovir is rare, with only 20 studies reported (2). We report a patient with acute allergic contact dermatitis of labial and perioral skin following application of a cream containing aciclovir.