Francesca Perino

TNF-alpha gene polymorphisms can help to predict response to etanercept in psoriatic patients

Genetic factors might have a role for lack of therapeutic response to anti‐TNF‐alpha agents, as previously suggested in patients with rheumatoid arthritis and inflammatory bowel disease.

Melanoma and non-melanoma skin cancer in psoriatic patients treated with high-dose phototherapy

Abstract Objectives: The carcinogenic effect of plus ultraviolet A (PUVA)-therapy in psoriatic patients has been widely demonstrated, while data on the safety of narrow band (311 nm) ultraviolet B (nb-UVB) are scarce. We investigated the occurrence of melanoma and non-melanoma skin cancer (NMSC) in psoriatic patients treated with nb-UVB or PUVA-therapy. Methods: This retrospective study included patients affected by psoriasis, who had been treated with nb-UVB or PUVA-therapy. Clinical data and phenotypic risk factors were collected and a total body examination was performed at a routine appointment during the study period. Results: We examined 92 patients (60 males and 32 females; mean age: 53.5 years, range: 20–83 years) treated with PUVA-therapy (42/92, 45%) or with nb-UVB (50/92, 55%) for 1–28 years (mean: 7.1 years). Among patients treated with PUVA, nine skin tumors (one melanoma, seven basal cell carcinoma (BCCs) and one squamous cell carcinoma (SCC)) were detected in 2/42 (4.7%) patients, while in the nb-UVB group, 14 skin tumors including two melanomas, four BCCs, and eight SCCs were diagnosed in 6/50 (12%) patients. Conclusions: A noteworthy number of NMSC were diagnosed in this Mediterranean population of patients exposed to high-dose UV treatment. A thorough risk-benefit evaluation should always be done before UV treatment and patients should be carefully monitored for skin cancer during and after treatment discontinuation.

Enteric-coated mycophenolate sodium as a steroid-sparing agent in pemphigus treatment: a retrospective study

Several immunosuppressive drugs are used as steroid‐sparing agents in pemphigus vulgaris (PV) treatment, with the aim of reducing the cumulative dose of steroids and minimizing the side effects of long‐term steroid treatment. The objective of this study is to evaluate the efficacy and safety of enteric‐coated mycophenolate sodium (EC‐MPS) as a steroid‐sparing agent in PV patients. We performed a retrospective study on PV patients who had attended our dermatology department between October 2004 and December 2010 and who had been treated with a combined therapy of systemic corticosteroids and EC‐MPS. In the 16 enrolled patients, the introduction of EC‐MPS allowed the tapering of systemic corticosteroids, and in 12 of these patients, complete remission was achieved in the time of observation, on average in 4.3 months. Corticosteroid withdrawal was possible in two patients, and EC‐MPS was very well tolerated. No serious adverse events were recorded. EC‐MPS is a valid therapeutic opportunity as a steroid‐sparing agent in PV patients.

Anti-TNF-α-induced psoriasiform lesions in IBD: an abnormal immune activation or a ‘patchy cutaneous’ immune suppression?

We read with interest the original article by Tillack et al who reported the characteristics of psoriasiform skin lesions induced by antitumour necrosis factor (anti-TNF)-α in patients with IBD.1 The authors show by immunohistochemical analysis that cutaneous lesions are characterised by interferon (IFN)α expression, infiltrates of interleukin (IL)-17A/IL-22-secreting T helper (Th)17 cells and IFNγ-secreting Th1 cells. They also demonstrate that therapy with ustekinumab, an anti-IL-12/IL-23 antibody, is highly effective in treating anti-TNF-α antibody-induced psoriasis and psoriasiform lesions. Our group is interested in the pathogenesis of psoriasiform lesions induced by anti-TNF-α antibodies in IBD patients. We found an interesting case of an 18-year-old man diagnosed with ileo-colonic Crohns disease in 2003. In June 2009, the patient presented with back pain and impaired spinal mobility and was diagnosed with ankylosing spondylitis by lumbar MRI. Since symptoms did not improve with steroids and physiotherapy, he switched to adalimumab (40 mg every other week following 160/80 mg induction …

Bioelectrical impedance analysis to define an excess of body fat: evaluation in patients with psoriasis

Abstract Background: There is strong evidence that obesity is closely associated with psoriasis. However, data on body composition are lacking in psoriasis. The purpose of this study were to investigate the body composition in psoriasis patients using bioelectrical impedance analysis and to correlate the bioelectrical impedance data with disease severity and laboratory parameters. Methods: Anthropometric measurements and bioelectrical impedance analyses were performed on patients with psoriasis, naïve to any systemic treatment, who attended the outpatient clinics of two University centers. Results: Data of 164 adult patients were analyzed. Compared to men, women had several significantly higher bioelectrical impedance parameters including reactance, fat mass% and adipose tissue%. The values of adipose tissue were positively correlated only with patients age (p = .021) and age at disease onset (p = .0006), but not with disease severity. In addition, we observed that the use of BMI cutoffs allowed to categorize 36.7% of women and 19.2% of men as obese, while fat mass% showed that 53.3% of women and 48.1% of men were obese. Conclusion: In our study, psoriasis is been associated with a high fat mass%. We suggest that screening for body fat distribution in psoriatic patients might be useful to identify early obesity-related disease.

Treatment of psoriasis with etanercept in immunocompromised patients: Two case reports

Tumour necrosis factor (TNF)-α blocking agents have revolutionized the treatment of psoriasis and psoriatic arthritis. Concerns remain about increased susceptibility to infection and onset of malignancies, and the use of TNF-α agents in patients with HIV infection or undergoing immunosuppressant treatment is debated. We report cases of severe plaque psoriasis in a patient with HIV infection and in a liver transplant recipient who were successfully treated with etanercept, an anti-TNF-α agent, without notable side-effects.

Clinical, histopathological, and immunological evaluation of a series of patients with erythema nodosum.

The pathogenesis of erythema nodosum (EN) is still poorly understood, and studies evaluating the involvement of a cytokine network are very scarce.

Lentigo maligna: diagnosis and treatment

Lentigo maligna (LM) is an in situ subtype of melanoma, clinically presenting as a pigmented, asymmetric macule that originates mostly on the head and neck and spreads slowly. The diagnosis may be challenging both for clinicians and pathologists. Dermatoscopy and reflectance confocal microscopy represent a useful tool in the differentiation of LM from other pigmented lesions, such as pigmented actinic keratosis, solar lentigines, seborrheic keratosis and lichen planus-like keratosis. Moreover, those non-invasive diagnostic technique may be crucial in the selection of optimal biopsy sites in equivocal lesions, in pre-surgical mapping and in evaluating and monitoring response to non-surgical treatments. Histologic examination remains the gold standard for the diagnosis of LM, showing a lentiginous proliferation of basal atypical melanocytes on a severe sun- damaged skin. The management of LM is constantly evolving. Treatments include surgery (the first choice, when available), radiotherapy and imiquimod cream (in patients not candidates to surgery). Many other possible treatments for LM have been tested, but they are not yet supported by strong evidences. We collected current guidelines and PubMed available reviews, studies and case-reports in order to make an overview on diagnosis and treatment of LM.

Sclerosing nevus with pseudomelanomatous features: Dermoscopic and confocal aspects

Sclerosing nevus with pseudomelanomatous features (SNPFs) is a clinical and pathologic entity that mimics melanoma both clinically and histologically.

Use of reflectance confocal microscopy to diagnose occult basal cell carcinoma: 2 case reports

AK: actinic keratosis BCC: basal cell carcinoma RCM: reflectance confocal microscopy INTRODUCTION Clinical and dermoscopic diagnosis of facial pigmented and nonpigmented lesions is sometimes challenging. Face and scalp are chronic sun-exposed sites, and signs of photoaging can be associated with the development of precancerous or malignant lesions. Noninvasive imaging techniques such as reflectance confocal microscopy (RCM) allow us to better diagnose and monitor equivocal melanocytic and nonmelanocytic lesions, particularly on specific sites such as the face. We report 2 cases of facial basal cell carcinoma (BCC) first diagnosed clinically and dermoscopically as actinic keratoses (AKs). These lesions were resistant to topical treatment and therefore were also evaluated with RCM, which showed features of BCC. Histopathologic examination confirmed the diagnosis of BCC.