Francesco Borgia

Treatment of Psoriatic Nails with Topical Cyclosporin: A Prospective, Randomized Placebo-Controlled Study

Background: Nail involvement is a frequent event in the course of psoriasis causing severe distress. While systemic cyclosporin (CsA) represents a well-established therapy of psoriasis, its topical use is limited by the difficult penetration of the molecule through the skin and the nail because of its highly lipophilic nature. Objectives: We carried out a prospective randomized placebo-controlled study in order to analyze the effectiveness and tolerability of topical oil-dissolved 70% CsA solution in nail psoriasis. Methods: Sixteen adult patients with nail psoriasis, divided randomly into two groups of 8 patients (group A and group B), were treated respectively with a 70% maize-oil-dissolved oral CsA solution and maize oil alone. To compare the therapeutic effectiveness, all patients were evaluated, before starting the treatment and after 12 weeks of therapy, by the same dermatologists. The patients were also asked to assess the severity of their nail involvement at baseline and at the end of the treatment. Results: In group A, 3 patients came to a complete resolution of nail lesions and 5 showed a substantial improvement of the overall severity score. In group B, a slight improvement was noted in only 1 patient. All the patients of group A judged positively the results of the therapy, while in group B only 1 patient reported a moderate improvement. Conclusion: Our results show that topical therapy with oral CsA solution is a safe, effective and cosmetically highly acceptable treatment modality for nail psoriasis. The ability of CsA to influence keratinocyte proliferation and T-cell lymphokine release, reducing the cornification of the upper layers of the epidermis, may prevent the typical alterations observed in nail psoriasis.

Correlation between endocrinological parameters and acne severity in adult women.

Many studies demonstrate increased androgen levels and high prevalence of polycystic ovaries in women affected by acne. We evaluated the relationship between clinical features, ultrasonographic data on polycystic ovaries and hormonal parameters in 129 women >17 years of age with acne. Serum levels of androgens of ovarian and adrenal origin were measured. Menstrual cycle regularity, hirsutism, body mass index and ultrasonographic evaluation of ovaries were recorded. Raised levels of at least one androgen were evident in a majority of our patients. Only 19% of them had polycystic ovary syndrome. Hirsutism and acne severity correlated negatively with serum sex hormone-binding globulin (SHBG) levels (p<0.05). No correlation between acne severity and hirsutism was found. In post-pubertal women, severity of acne seems to depend on peripheral hyperandrogenism, with a negative relationship between the acne severity and serum SHBG levels. We strongly recommend the evaluation of serum SHBG levels in women with acne in order to select patients who can have a better response to appropriate hormonal regimes.

Subcutaneous fat necrosis of the newborn: Be aware of hypercalcaemia

Abstract:  Subcutaneous fat necrosis of the newborn is an uncommon, self‐limiting panniculitis that usually occurs in full‐term infants as a consequence of perinatal asphyxia. The cutaneous involvement may be associated with metabolic complications such as hypoglycaemia, thrombocytopenia, hypertriglyceridemia, anemia and hypercalcaemia. The delayed onset of hypercalcaemia, 1–6 months after the development of the skin manifestations, imposes a prolonged follow‐up to avoid its acute toxic effects on cardiovascular and renal systems and the more durable metastatic calcifications.

Mucosal Leishmaniasis Occurring in a Renal Transplant Recipient

The long-term use of immunosuppressive therapy in transplant recipients causes a well-known high susceptibility to opportunistic infections. Several cases of visceral leishmaniasis have been reported in immunosuppressed patients; cutaneous and, especially, mucosal involvement has rarely been described in the literature. We report a case of mucosal leishmaniasis, occurring in a renal transplant recipient, observed in Sicily, an endemic region for the Leishmania infantum. A 65-year-old white man, a farm labourer, was referred to our department because he had had, for 4 months, a painless, rapidly growing, infiltrating lesion localised in the lower lip. At the age of 59, he had received an orthotopic renal transplant for focal sclerosing glomerulonephritis and was started on cyclosporine A and methylprednisolone for immunosuppression. He had no history of cutaneous disease. He had never travelled out of Italy. Physical examination revealed a hard, diffuse enlargement of the left half of the lower lip, partially covered by small scabs (fig. 1a); granulomatous changes were visible on the internal side of the cheek (fig. 1b). There were no palpable lymph nodes, and no other lesions were noted on the body. Histology of two biopsy specimens, respectively from the vermilion area and the cheek, showed a dense dermal inflammatory cell infiltrate composed of lymphocytes and histiocytes. In the cytoplasm of the latter, numerous Leishman-Donovan bodies were present. Routine laboratory tests were within the normal ranges; human immunodeficiency virus (HIV) 1 and HIV-2 testing, serum venereal disease research laboratory and Leishmania serology performed by immunofluorescence were negative, as well as culture in NovyMcNeal-Nicolle medium. A bone marrow biopsy specimen was negative for Leishmania. The diagnosis of mucosal leishmaniasis was based upon history and histopathological examination, revealing Leishmania amastigotes in the dermis. Differential diagnosis, including trauma, fixed drug eruption, syphilitic chancre, Melkersson-Rosenthal syndrome, granulomatous cheilitis, sarcoidosis and lymphoedema, were excluded on the basis of anamnestic, clinical and laboratory data.

Photodistributed eruptive telangiectasia: an uncommon adverse drug reaction to venlafaxine

cians) and time spent informing patients during dermatologist visits could sustain the increased awareness regarding onychomycoses that the PSA achieved. In addition, studies could be undertaken to compare the television time-rental cost along with the cost of unnecessary consultations vs. the decrease in treatment cost through early diagnosis in order to evaluate the cost-benefit ratio of the onychomycosis PSA campaign.

Radiation recall dermatitis after docetaxel administration: absolute indication to replace the drug?

permit effective transepidermal absorption of 5-ALA and recommended partial removal of the thickened horny layer to achieve sufficient therapeutic effect. Removal of the stratum corneum before a 16-h occlusion with 2% 5-ALA solution reduced costs and improved therapeutic outcomes for digital BDs. In our case, the considerable 5-ALA uptake, which was confirmed by the production of PpIX detected by steady-state spectroscopy, achieved good clinical results. The concomitance of DEB and the poor healing site was an obstacle to the success of the therapy, which was overcome with PDT, leading to minimal malfunction and scarring. Our experience showed the relevance of PDT as a noninvasive therapy applied under challenging circumstances, which resulted in the faster healing and prevention of wound closure complications and deformities.

Pretibial myxoedema associated with Hashimoto's thyroiditis.

Pretibial myxoedema is a cutaneous mucinosis typically associated with Graves’ disease, although it may also develop in subjects with non‐thyrotoxic thyroid pathologies. This report presents a rare case of pretibial myxoedema occurring in a 58‐year‐old woman with biopsy‐proven Hashimotos thyroiditis. The hypothetical pathogenetic link between the two disorders is discussed with particular attention to the role of thyroid stimulating hormone receptor antibodies.

Multiple Familial Basal Cell Carcinomas Including a Case of Segmental Manifestation

Background: A tendency to develop multiple basal cell carcinomas at an early age is a characteristic feature of some rare hereditary disorders; moreover, multiple basal cell carcinomas are sometimes observed as a corollary of familial basaloid follicular hamartomas or familial multiple trichoepitheliomas. Observation: We report 3 cases of multiple basal cell carcinomas involving 3 successive generations of a family, with a segmental manifestation of lesions in one of these patients. No additional cutaneous or extracutaneous anomalies were found. Conclusions: We hypothesize that a gene mutation may have caused the tumors observed in this family as an autosomal dominant trait. The segmental arrangement of tumors may reflect loss of heterozygosity: at an early stage of embryogenesis, a postzygotic mutation would give rise to a population of cells either homozygous or hemizygous for the underlying gene. The segmental arrangement following the lines of Blaschko would visualize the dorsoventral proliferation of a cell clone characterized by loss of the corresponding normal allele.

Photodistributed telangiectasia following use of cefotaxime.

Sir, Epidermal grafting with suction blisters is used in treatment of stable vitiligo. Previous reports have shown various complications including postinflammatory hyperpigmentation, peripheral hypopigmentation and hypertrophic scarring. However, the risk of infection has not been reported to date. We report an unusual case of verruca vulgaris that appeared after epidermal grafting. It seems likely that virus particles might have been transferred from the operator, who had verruca vulgaris on his hand, to the patient during the surgical procedure. A 12-year-old girl with localized stable vitiligo was treated by epidermal grafting. Blisters on the recipient site formed within 24 h after three freeze±thaw cycles with liquid nitrogen. Blisters on the donor site were made by suction on the inner portion of the thigh. After approximately 3 h of suction at 200 mmHg, large unilocular bullae appeared. After removal of the blisters at the recipient site, the epidermal sheets were grafted to the denuded recipient site and held in place. Two weeks after grafting, once weekly systemic psoralen-ultraviolet A treatment was started. Almost complete repigmentation was observed 3 months after grafting. Four months after grafting, the patient noticed two verrucous plaques in the grafted site (Fig. 1). She denied warts on any other body sites. There was no history of similar lesions in her family or close friends. The operator, who wore gloves, had a verrucous papule on his hand during the surgery. Skin biopsy of two different lesions, on the patients back and the operators hand, demonstrated histological features of verruca vulgaris. Human papillomavirus (HPV) typing was not performed. Although epidermal grafting appears to be an effective and safe method for the treatment of vitiligo, various complications have been reported, of which some are associated with the application of liquid nitrogen, such as postinflammatory hyperpigmentation, hypertrophic scarring, peripheral hypopigmentation and uneven pigmentation. Koebner phenomenon and recurrence have also been considered complications of epidermal grafting. The possibility of transmission of virus from patient to patient or from patient to doctor has been reported. One study showed that virus may survive on a cotton swab dipped into liquid nitrogen and suggested that virus transmission from patient to patient may occur via this route. Charles and Sire reported the possibility of transmission of papovavirus indirectly by cotton-tipped applicators which had been used earlier to treat verruca in other patients. In our case, the same liquid nitrogen and cotton-tipped applicators were not used for multiple patients. Bergbrant et al. reported that there is a risk of contamination of the operator by HPV DNA, during both carbon dioxide laser and electrocoagulation treatment. Once an individual has been infected, new warts may develop in sites of inoculation over a period of weeks to months. After experimental HPV inoculation, it requires from 2 to 9 months for a verruca to become clinically apparent. This observation implies a relatively long period of subclinical infection. In our patient, the verruca appeared 4 months after grafting. It is unclear whether the verruca vulgaris resulted from direct contact with the operators hand during the surgical procedure, or with another person after grafting. However, there are several possible mechanisms of viral transmission from the operator to the patient: the operator may have palpated the lesion with his bare hand immediately after cryosurgery to evaluate the effectiveness of the freezing, or transmission may have occurred during application of a dressing after surgery. We suggest that the risk of transmission of infection from doctor to patient should be considered as a new complication of epidermal grafting.

Confluent and reticulated papillomatosis and acanthosis nigricans in an obese girl: two distinct pathologies with a common pathogenetic pathway or a unique entity dependent on insulin resistance?

478 JEADV 2006, 20, 461–488