Giuseppe Fabrizi

Sclerosing nevus with pseudomelanomatous features..

Background:  Among the pigmented lesions with a central area of scar, we found a group of cases histologically characterized by striking architectural alteration of the melanocytic component, but with no cytological atypia and mitotically quiescent. The aim of the current study was to assess the biological nature of such lesions.

Cryoinsufflation for Hurley Stage II Hidradenitis Suppurativa A Useful Treatment Option When Systemic Therapies Should Be Avoided

Report of a Case A woman in her 30s presented with hidradenitis suppurativa (HS), Hurley stage II. She was treated with oral contraceptives (drospirenone/ethinyl estradiol), spironolactone (50 mg/d), topical clindamycin, andmonthly intralesional corticosteroids (triamcinolone acetonide, 10 mg/mL). Previously, she had received rifampicin (600 mg/d), first with minocycline (100 mg/d), then with clindamycin (300 mg/d), and finally with moxifloxacin (400mg/d). After these treatments failed, she received isotretinoin (0.5 mg/kg/d) for 2 more years to achieve remission, but without success. Because shehaddecided tobecomepregnant, shewas searching for an alternative treatment, devoid of teratogenic effects, to safely replace oral contraceptives. Effective therapy was paramount because theHS seriously interferedwith sexual intercourse and indirectly with her planned pregnancy. Surgical treatmentwas offered (local incision anddrainage, deroofing, limited local orwide excision), which she declined.

Are Anti-TNF-α Agents Safe for Treating Psoriasis in Hepatitis C Virus Patients with Advanced Liver Disease? Case Reports and Review of the Literature

Tumor necrosis factor-alpha (TNF-α) inhibitors represent an effective treatment for severe psoriasis in hepatitis C virus (HCV) patients. The literature reports mainly on short-term treatment in patients with chronic hepatitis with minimum-to-moderate activity with an acceptable safety profile. We report the first 2 cases of hepatocellular carcinoma (HCC) arising in HCV psoriatic patients with advanced liver disease during long-term treatment with etanercept. Our first patient, known to have had HCV infection for 41 years, developed an HCC after 21 months of therapy with etanercept (50 mg/week). The second patient, HCV+ for 20 years, was treated for 58 months with the same therapy, and despite no signs of liver function impairment was diagnosed with HCC. Both of them presented with cirrhosis, which was diagnosed 9 and 5 years earlier, respectively. It remains to be clarified whether there is any connection between psoriasis treatment with anti-TNF-α agents and the development of HCC in HCV-infected patients. Further long-term, follow-up studies and registries of HCV patients with mild/moderate activity may contribute to clarify this issue.

Advances in the treatment options for vitiligo: activated low-dose cytokines-based therapy

Introduction: Vitiligo is a skin disorder characterized by a progressive depigmentation, which is caused by the loss of melanocytes at the cutaneous level. A shift of the immune system with a prevalence of T helper (Th)1/Th17 response instead of a Tregs/Th2 one and may be part of etiology of 10 vitiligo. Areas covered: This review describes the major points of vitiligo onset and shows the cutting-edge results in the field of low-dose medicine in the treatment of dermatologic diseases and, in particular. in vitiligo. In this review on advances in vitiligo pharmacotherapy, the most pertinent recent publications are reported. Electronic databases such as PubMed were searched for terms ‘low-dose medicine’ or ‘low dose and vitiligo’ or ‘low dose and psoriasis.’ Expert opinion: The availability of a systemic treatment for vitiligo, based on the oral administration of low-dose activated signaling molecules represents an opportunity for the dermatologists to overcome some specific pitfalls of currently available therapeutic protocols.

Comparative study of trichloroacetic acid vs. photodynamic therapy with topical 5‐aminolevulinic acid for actinic keratosis of the scalp

Photodynamic therapy with 5‐methyl‐aminolevulinate and photodynamic therapy with trichloroacetic acid 50% are the two techniques utilized in the management of actinic keratosis. This study was planned to compare the efficacy, adverse effects, recurrence and cosmetic outcome of these option therapies in patients with multiple actinic keratosis of the scalp.

Acute generalized exanthematous pustulosis following paracetamol ingestion in a child

Additional Supporting Information may be found in the online version of this article: Figure S1. Upon activation with TLR-agonists or cytokines TLR-receptors and IL-1 receptors (1) form a multimeric complex comprising MyD88 and IRAK4 (2). This complex (‘MyDDosome’) controls the phopshorylation of IRAK-1 which is degraded upon phosphorylation. (3) IRAK-1 degradation leads to the activation of ADAM17, which in turn controls the posttranslational clevage of CD62L from the cell surface on neutrophilic granulocytes. (4) IRAK-1 degradation also leads to the activation of a complex that phosphorylartes inhibitors of NFkB (the IKK) and to the activation of MAP –Kinases (MAPK). Both pathways control the transcription of cytokines or pro.cytokines which spur acute-phase reactions (5). Data S1. Methods.

Calcipotriol/betamethasone dipropionate ointment compared with tacrolimus ointment for the treatment of erosive pustular dermatosis of the scalp: a split-lesion comparison

Erosive pustular dermatosis of the scalp (EPDS) is a rare disorder of uncertain aetiology that mainly occurs on the sun-damaged scalps of elderly patients after trauma.Topical corticosteroids (TCS) have been widely used in the treatment of EPDS; anecdotal reports have described successful results with topical tacrolimus [1], calcipotriol [2] and dapsone [3, 4]. Nevertheless, due to the rarity of the disease, a comparison of topical treatments in terms of effectiveness and rate of clearing is lacking. [...]

Topical Diphencyprone Immunotherapy for Painful Nodular Acral Recurrence of Kaposi Sarcoma

Topical Diphencyprone Immunotherapy for Painful Nodular Acral Recurrence of Kaposi Sarcoma Goals of classic treatment of Kaposi sarcoma (KS) without visceral involvement are to control symptoms and improve function. Localized lesions are managed by surgical excision, cryotherapy, intralesional chemotherapy, or radiotherapy, which can be painful and are physician-applied treatments. Recently, less demanding treatments based on topical drugs have been proposed.1-4 We describe 2 patients who underwent successful topical immunotherapy with diphencyprone (DPCP), each for a single painful nodular localization of KS, histologically confirmed and without visceral localization, that had recurred after surgical excision. The patients were both HIV-negative, and their CD4positive lymphocyte counts were greater than 200/μL. After signing an informed consent form, patients were sensitized in the physician’s office by application of a 2% DPCP solution, and the area was then occluded for 48 hours. Thereafter, the patients self-treated once weekly at home by applying a 0.2% solution and occluding the area for the following 24 hours.

An under-recognized, life-threatening complication of atopic dermatitis

A 17-year-old boy was referred from the cardiac surgical ward with lesions on his face, antecubital area and neck. He had undergone cardiac surgery for a large vegetation in the left mitral valve from an infection with methicillin-resistant Staphylococcus aureus. Because the patient was otherwise well and other known cardiac risk factors for developing infective endocarditis (IE) had been excluded, the cardiac surgeon believed that endocarditis represented a complication of his skin condition. The skin condition had been present for some time, and had been variously diagnosed as psoriasis, seborrhoeic dermatitis, rosacea and atopic dermatitis (AD). The patient acknowledged that for this reason, he had not adhered to the prescribed topical treatments and had given up searching for a more feasible and effective therapy, in essence disregarding his problem. On physical examination, an erythematous oozing lesion was seen on the patient’s face, with further lesions on the antecubital area and neck folds with honey-coloured crusting (Figure 1a,b). The patient reported unbearable itching. The clinical findings suggested a diagnosis of impetiginized AD. A culture sample from the skin grew S. aureus, showing the same antimicrobial susceptibilities as the blood culture isolate. The patient was prescribed intravenous antihistamines and broad-spectrum antibiotics because his clinical condition contraindicated the use of steroids, and was instructed to apply emollients. The treatment resulted in marked improvement. We carried out a review of the literature about AD complications, using the following search terms: “dermatitis, atopic” [MeSH terms] OR “dermatitis” [All Fields] AND “atopic” [All Fields] OR “atopic dermatitis” [All Fields] OR “atopic” [All Fields] AND “dermatitis” [All Fields] AND “endocarditis”[MeSH terms] OR “endocarditis”[All Fields]. We found that only a limited number of papers have been published about IE in patients with AD, most often in general medicine or cardiac surgery journals. Moreover, there is no mention of a link between AD and IE in authoritative dermatology textbooks. In most cases, a link between IE and AD has been primarily reported by Japanese authors, but this association is under-reported in Europe and the USA, with two outdated case reports and a single retrospective study by Konstantinou et al. In the most comprehensive review involving serious complications from S. aureus in AD, no further cases were described and the authors referred to the aforementioned Japanese studies. It should be noted that dermatologists sometimes have the potential to avoid painful and costly treatments, as it has been reported that a patient underwent cardiac surgery four times before the medical staff recognized uncontrolled AD as the source of the recurrent IE. In conclusion, we report a patient with IE presenting with impetiginized AD. Although Japanese cardiac surgeons have repeatedly warned about AD as a risk factor for IE, this relationship is largely under-recognized in western countries. It is well known that a lack of time for doctors to educate patients about the correct application of topical treatment and corticophobia cause patients to be noncompliant with treatment, and hence treatment fails. Although the exact incidence of IE among AD patients is unknown, dermatologists should be aware that uncontrolled AD can cause IE, and we think this is a valuable reason to persuade patients to continue the search for a feasible tailored therapy.

Side predominance of squamous cell carcinoma: further evidence

lesion size, and the pulmonary nodule disappeared. No adverse events were noted. Nine months after treatment commencement, no lesions have recurred (Fig 2). Clinical appearance of the lesion was consistent with a cutaneous metastasis. Melanoma was favoured, but a primary lesion was not found. Regarding MPNST, half of the cases occur in patients with personal or family history of NF1, neither of which was present in our patient. Histopathologic findings were consistent either with MM or MPNST and immunohistochemical stains were not helpful. Approximately 60% of melanomas have BRAF mutations. A study by Cipriani et al. suggests that BRAF mutations in poorly differentiated spindle cell malignancies may represent melanoma. Serrano et al. looked for mutated BRAF in MPNST with the hypothesis that both melanocytes and Schwann cells are derived from the neural crest. Although they found BRAF mutations in a small subset of MPNST, the percentage was markedly lower than that of MM. Therefore, an activating mutation in BRAF more likely points towards MM. Targeting BRAF mutation with agents like Dabrafenib has been associated with prolonged survival in randomized trials. Its combined use with Trametinib, which blocks MEK, has become an important strategy to overcome BRAF resistance with no increase in adverse events. This case highlights the difficult differential diagnosis between MM and MPNST in cases that present as dedifferentiated spindled amelanotic lesions. Even if melanosomes have not been found, the presence of BRAF mutations supports dedifferentiated melanoma, and targeted therapy may be considered. We encourage clinicians to search for BRAF mutations in poorly differentiated spindled cell tumours because of its diagnostic and therapeutic implications.