Giulio Gualdi

Cutaneous lesions as initial signs of interferon α-induced sarcoidosis: report of three new cases and review of the literature

Sarcoid reactions are well‐recognized adverse events during interferon (IFN) therapy. They are frequently underdiagnosed because misinterpreted as IFN‐induced side effects. Sarcoid cutaneous lesions may therefore represent useful hints to an early diagnosis, but their incidence is unknown. We report three new cases of mono‐localized, purely cutaneous IFNα‐induced sarcoidosis. In addition, an extensive review of the literature, with special attention to skin involvement, was performed through a PubMed search. The analysis of the retrieved articles showed that cutaneous lesions are frequent signs of IFN‐induced sarcoidosis. Skin involvement is documented in 56% of the reports and it appears among the presenting and diagnostic signs of a sarcoid reaction in 51%. Special attention to dermatologic signs is imperative in the course of IFN therapy because even minimal skin involvement may offer a clue to an early diagnosis of IFN‐induced sarcoidosis.

Metastatic Basal Cell Carcinoma With Squamous Differentiation Report of a Case With Response of Cutaneous Metastases to Electrochemotherapy

BACKGROUNDnMetastatic basal cell carcinoma is a rare disease with poor prognosis. Palliative therapeutic approaches include surgery, radiotherapy, and/or chemotherapy. These treatment modalities are invasive and risky and associated with relevant adverse effects. Electrochemotherapy is a recently described therapy that relies on the permeation of cancer cell membranes by electrical pulses to enhance cytotoxic drug penetration. It has been successfully used in the treatment of primary and metastatic skin cancers. We report a case of metastatic basal cell carcinoma in which electrochemotherapy was effective in inducing local regression of skin metastases.nnnOBSERVATIONSnA 75-year-old man presented with a pigmented, deeply infiltrating nodule in the right axilla manifesting as basal cell carcinoma with squamous differentiation at histopathologic examination. Despite 2 wide surgical resections involving lymphadenectomy with axillary vein substitution and systemic chemotherapy, a progressive metastatic spreading, both cutaneous and visceral, occurred in the following 2 years. Three successive sessions of electrochemotherapy with bleomycin sulfate were then performed on isolated skin metastases. The treatment was well tolerated and led to a rapid clinical and histologic regression of the treated lesions. Conclusion Electrochemotherapy is an effective and well-tolerated adjunct to the therapeutic options in metastatic basal cell carcinoma, characterized by an advantageous risk-benefit ratio and minimal downtime.

Electrochemotherapy-induced virus disappearance in HHV-8-positive skin nodules of Kaposi sarcoma: first histological and immunohistochemical demonstration of efficacy

and rapid resolution of GA following discontinuation of topiramate. Although the temporal relationship between drug discontinuation and skin resolution is evident, further studies and epidemiological data are necessary to support our clinical observation. Based on the T-cell subpopulations identified in GA lesions, we hypothesize that a delayed-type hypersensitivity reaction to topiramate was the involved pathogenetic factor.

Cutaneous neonatal lupus erythematosus in four siblings

sis, syphilis, bronchogenic carcinoma and other systemic mycoses. It has been suggested that co-infection with HIV and P. brasiliensis gives a mixed form of acute and chronic disease which represents a reactivation of a quiescent focus. The diagnosis is confirmed by identification of the typical budding yeast structures in tissue on direct microscopy and by mycological culture when possible. The growth in modified Sabouraud medium can take some weeks. Other tests such as serology and intradermal reaction have a role in the monitoring of the disease during treatment and in epidemiological studies. Detection of antibodies in the serum or antigen in body fluids is also useful in diagnosing the infection. The antibody tests may be less helpful in the immunocompromised. Our patient had the pathognomonic findings of yeasts in lesional skin and bronchoalveolar lavage. His serology has been persistently positive since diagnosis despite clinical and mycological cure, with 6 years of follow-up. The evidence comparing different treatments in the management of paracoccidioidomycosis is very limited. The use of the imidazoles itraconazole and ketoconazole is widely reported. Itraconazole is currently the drug of choice for treating this infection. Amphotericin B, trimethoprim–sulfamethoxazole and terbinafine are also used. Our patient showed a rapid sustained improvement following the use of itraconazole but remains under regular follow-up as relapse occurs in up to 5% of cases. Skin and oral lesions show diffuse staining for the inflammatory cytokine tumour necrosis factor, the expression of which is substantially reduced by day 20 of treatment. The diagnosis of paracoccidioidomycosis must be considered in individuals presenting with respiratory and ⁄or mucocutaneous symptoms and who originate or are returning travellers from areas where P. brasiliensis is endemic.

Epidemiology of pyoderma gangrenosum: Results from an Italian prospective multicentre study

Pyoderma gangrenosum (PG) is a neutrophilic dermatosis characterised by painful, necrotic ulcerations. PG is described as a rare disease: the world‐wide incidence is estimated to be around 3 to 10 cases per million population per year. These estimations are based mostly on case reports and retrospective case series; there are no prospective, multicentre studies on the matter. The apparent rarity of PG is in contrast with our clinical perception as dermatologists: in our opinion, PG is not so uncommon. Therefore, we decide to investigate the epidemiology of PG in the Italian population and confirm our clinical suspicions that it is not an orphan disease. We enrolled all patients diagnosed with PG in 8 Italian Dermatological Departments from 1st October 2014 to 1st November 2015, and we recorded their features. Our data, collected from 64 patients, are in accordance with those of the published literature regarding the epidemiology and features of PG. In an Italian population of roughly 8 million inhabitants of 7 provinces, we found an incidence of 5.17 new cases per million population per year. Unlike our predictions before the study, we confirmed the world‐wide incidence of PG. To our knowledge, this is the first observational, multicentre study on PG. We hope that it provides a stimulus for further researches on PG and for the creation of an Italian register.

Nested Graft for Acral Lichen Sclerosus of the Feet: A Surgical Treatment for an Inflammatory Disease.

Summary: The “nested graft” is an innovative and well-defined surgical technique used for chronic wound healing that induces the de-senescence of fibroblasts in the wound bed. We report a case of a 76-year-old man affected by plantar chronic wounds because of acral lichen sclerosus and atrophicus localized at both feet and treated for many years successfully with immunosuppressive agents. For cardiological dysfunction, systemic therapy was reduced to low dosage of steroids with an increase of ulcerations (5 × 2 cm). So we decided to perform the nested graft on the plantar region. After the surgical procedure, all the grafted ulcers healed, and at a 4-month follow-up, no signs of lichen sclerosus were present.

The Use of PRISM (Pictorial Representation of Illness and Self Measure) in Patients Affected by Chronic Cutaneous Ulcers.

OBJECTIVE: PRISM (Pictorial Representation of Illness and Self Measure) is a nonverbal visualization instrument. The authors chose to use this tool to avoid the limitation of the other tests for the assessment of quality of life by using interview methods that depend on the cognitive and cultural level of the patient. The aim of the study was to assess the impact on the quality of life of different types of chronic wounds using the PRISM test. SETTING: The PRISM test was administered by the same medical student to each patient visiting the dermatology department for a routine visit and medication. PARTICIPANTS: The PRISM test was administered to 77 patients with chronic cutaneous ulcers referred to the Dermatology Department of the Spedali Civili of Brescia, Italy. MATERIALS AND METHODS: The authors analyzed the “Self-llness-Separation” (SIS) value, which resulted from the PRISM test, and related it to sex, age, and ulcer etiology. RESULTS: Considering all categories, the mean SIS was 9.58 cm; a different perception of the disease between the sexes was noted and also in the subgroups based on the ulcer’s different etiology. In addition, the age of the affected patients influenced the SIS value. CONCLUSIONS: PRISM is an easy and sensitive instrument to record information about the patient’s expectations and suffering in order to improve the overall physician-patient relationship.