Francesca Giusti

The prevalence of positive reactions in the atopy patch test with aeroallergens and food allergens in subjects with atopic eczema: a European multicenter study

Background:  The atopy patch test (APT) was proposed to evaluate IgE‐mediated sensitizations in patients with atopic eczema (AE).

ETFAD/EADV eczema task force 2009 position paper on diagnosis and treatment of atopic dermatitis

Background  The diagnosis of atopic dermatitis (AD) is made using evaluated clinical criteria. Management of AD must consider the symptomatic variability of the disease.

Position paper on diagnosis and treatment of atopic dermatitis

The diagnosis of atopic dermatitis (AD) is made using evaluated clinical criteria. Management of AD must consider the symptomatic variability of the disease. It is based on hydrating topical treatment, and avoidance of specific and unspecific provocation factors. Anti‐inflammatory treatment is used for exacerbation management. Topical corticosteroids remain the first choice. Systemic anti‐inflammatory treatment should be kept to a minimum, but may be necessary in rare refractory cases. The new topical calcineurin inhibitors (tacrolimus and pimecrolimus) expand the available choices of topical anti‐inflammatory treatment. Microbial colonization and superinfection (e.g. with Staphylococcus aureus, Malassezia furfur) can have a role in disease exacerbation and can justify the use of antimicrobials in addition to the anti‐inflammatory treatment. Evidence for the efficacy of systemic antihistamines in relieving pruritus is still insufficient, but some patients seem to benefit. Adjuvant therapy includes ultraviolet (UV) irradiation preferably of UVA wavelength; UVB 311 nm has also been used successfully. Dietary recommendations should be specific and only given in diagnosed individual food allergy. Stress‐induced exacerbations may make psychosomatic counselling recommendable. ‘Eczema school’ educational programmes have proved to be helpful.

Contact sensitization in 1094 children undergoing patch testing over a 7-year period.

Abstract:  Contact sensitization in children is frequent. However, because exposure to sensitizing agents varies rapidly, it is of utmost importance to perform a periodic evaluation of patch test results. Our purpose was to compare our data on contact sensitization in children during the past 7 years to our previous 1988–1994 findings, in order to identify emerging allergens and update our pediatric series. From 1995 to 2001, 1094 consecutive children were examined. Of these, 997 patients were patch tested with our pediatric series, which includes 30 allergens, whereas 97 underwent patch testing with 46 allergens. A total of 570 children proved allergic (52.1%). The highest sensitization rate was observed in children under 3 years of age. No differences between atopic dermatitis patients and nonatopic ones were observed in the sensitization rate. Neomycin, nickel, wool alcohols, thimerosal, and ammoniated mercury gave most of the positive responses. With respect to 1988–1995 data, allergy to substances such as neomycin, nickel, wool alcohols, thimerosal, ammoniated mercury, propolis, potassium dichromate, and thiuram mix proved more frequent. In conclusion, as sensitization rates to different allergens show great variations over time, periodic evaluations of patch test results in children is necessary in order to update the test trays.

Instrument-, age- and site-dependent variations of dermoscopic patterns of congenital melanocytic naevi: a multicentre study

Background  Recently, we identified and described dermoscopic aspects, present with a higher frequency in congenital melanocytic lesions with respect to acquired naevi. We also classified small‐ and medium‐sized congenital naevi (CN) into nine subtypes according to their macroscopic and dermoscopic aspects.

Frequency and intensity of responses to mite patch tests are lower in nonatopic subjects with respect to patients with atopic dermatitis

Background: So far the issue of patch tests with mite allergens in subjects not affected by atopic dermatitis (AD) has been poorly investigated. The aim of this study was to assess the frequency and intensity of responses to atopy patch tests with Dermatophagoides in non‐AD subjects, and to compare them to the ones observed in AD patients.

Sensitization to propolis in 1255 children undergoing patch testing

To investigate the frequency and the features of contact sensitization to propolis in children, we patch tested 1255 consecutive children suspected of allergic contact dermatitis with propolis 20% petrolatum over an 8‐year period (1995–2002). Positive responses were observed in 5.9% of patch‐tested subjects, with a significantly higher frequency in boys than in girls. The dermatitis was localized mainly on the face, hands and limbs. A significant linear increase in the annual frequency of propolis allergy was noted. Confirming literature data, a significant association with balsam of Peru sensitivity was present in children reacting to propolis, linked to the presence of common constituents in the 2 substances. In conclusion, based on our data, we suggest that propolis should not be used in topical products for children because of its high sensitization rate at the paediatric age.

Contact sensitization to disperse dyes in children.

Abstract: From January 1996 to December 2000, 1098 children, including 667 subjects with suspected allergic contact dermatitis and 431 patients with atopic dermatitis (AD), were patch tested with seven disperse dyes: disperse blue 124 (DB124), disperse blue 106 (DB106), disperse red 1 (DR1), disperse yellow 3 (DY3), disperse orange 3 (DO3), p‐aminoazobenzene (PAAB), and p‐dimethylaminoazobenzene (PDAAB). Of these, 51 patients (4.6%; 34 girls and 17 boys) proved sensitized to disperse dyes. AD or history of AD was present in 30 patients (59%). The most common sensitizer was DY3 (17 patients), followed by DO3 (15 patients), and DB124 (14 patients). Among dye‐positive patients, about 12% were sensitized to disperse dyes alone and only 14% reacted to para‐phenylenediamine. In disperse dye‐sensitive children not affected by AD, the feet, axillae, and groin appeared to be the most common localizations, whereas in those with AD, involvement of the face and the flexural areas of the limbs was more common. In conclusion, our study showed that in children with suspected contact sensitization, disperse dyes should be regarded as potential triggering allergens.

Combined skin prick and patch testing enhances identification of peanut‐allergic patients with atopic dermatitis

Background:  Food atopy patch tests (APTs) are considered a useful tool for the diagnosis of food allergy. Hypersensitivity to peanuts has not been investigated by means of APTs so far.

Clinical selection of melanocytic lesions for dermoscopy decreases the identification of suspicious lesions in comparison with dermoscopy without clinical preselection

Background  In most cases dermoscopy is performed only on lesions selected by clinical inspection which present worrying clinical features or appear to deviate from the patients average type of naevus. Thus, possible early malignant melanomas (MMs) or MM precursors, lacking typical clinical characteristics, may elude the dermoscopic examination.