Giuseppe Stinco

A retrospective epidemiological study on the association of bullous pemphigoid and neurological diseases

Bullous pemphigoid is a rare chronic recurrent dermatosis that is often reported in association with various neurological diseases. No investigation involving a large number of patients has ever been carried out to demonstrate such an association. This study was accomplished by analysing the discharge diagnosis of all hospitalized patients, both day-patients and inpatients, during a 5-year period (1995-2000) covering a total population group of 934,023 living in a region of Italy that has approximately 1,200,000 inhabitants. The results support the hypothesis of an association between bullous pemphigoid, multiple sclerosis and Parkinsons disease on a highly significant statistical basis. The aetiopathogenic mechanisms and the causes that induce the loss of immunological tolerance are not yet understood.

Multiple cutaneous neoplasms in a patient with Rothmund-Thomson syndrome : Case report and published work review

Rothmund–Thomson syndrome (RTS) is a rare genodermatosis characterized by early poikilodermatous skin lesions, often combined with juvenile cataracts, photosensitivity and bone defects. Data in the published work indicate that there is an increased risk of RTS patients developing malignant tumors. Herein, we report the multiple skin carcinomas observed in a case of RTS and review the published work on the occurrence of malignant tumors in these patients. We report the case of a 63‐year‐old male with RTS who developed multiple cutaneous neoplasms (three basal cell carcinomas, three squamous cell carcinomas and Bowens disease) over the previous 15 years. A published work review confirmed that RTS is a genetic condition that predisposes subjects to the development of bone tumors, especially at an early age, and skin tumors at an adult age. Therefore, alongside careful osteoarticular monitoring to identify a bone tumor quickly, during the life of a patient suffering from the syndrome, it is just as important to take appropriate preventive action and monitor the possible onset of skin tumors.

A Randomized Double-Blind Study to Investigate the Clinical Efficacy of Adding a Non-Migrating Antimicrobial to a Special Silk Fabric in the Treatment of Atopic Dermatitis

Background: A randomized, double-blind study designed to compare the efficacy of DermaSilk® versus a sleeve of similar structure but minus the AEM 5772/5 antimicrobial finish in the treatment of atopic dermatitis (AD). Objective: To evaluate the clinical effect of adding an antimicrobial finish to knitted silk garments on eczema severity and on pruritus in patients with AD. Methods: Thirty patients aged between 3 and 31 years (mean 14.2 ± 7.7) were enrolled. The inclusion criterion was that the patients presented with active AD with eczematous lesions located on the arms without any sign of infection. Each participant was given a set of 4 pairs of knitted silk tubular sleeves marked with seams of different colours. Only one colour was treated with AEGIS AEM 5772/5. This information was unknown to both the clinicians and the patients/parents. At baseline (T0) and after 7 (T7), 14 (T14), 21 (T21) and 28 (T28) days, the patients were evaluated using the following methods: photographic assessment, local modified SCORAD index adapted for only the arm, and parent/patient assessment of pruritus measured with a visual analogue scale. Results: The mean local SCORAD index of both the DermaSilk- and the unmodified-silk-covered arms decreased significantly between baseline (T0) and the end of study (T28). However, while the Derma-Silk group showed a constant decrease each week, the unmodified-silk group showed a significant decrease only in the first 2 weeks of the study. Also the decrease in pruritus values between T0 and T28 was greater for the DermaSilk group. Conclusions: This study demonstrates the importance of including the AEM 5772/5 finish to the specially knitted silk for a long-term improvement of atopic eczema symptoms.

Dermoscopy in General Dermatology: A Practical Overview.

Over the last few years, dermoscopy has been shown to be a useful tool in assisting the noninvasive diagnosis of various general dermatological disorders. In this article, we sought to provide an up-to-date practical overview on the use of dermoscopy in general dermatology by analysing the dermoscopic differential diagnosis of relatively common dermatological disorders grouped according to their clinical presentation, i.e. dermatoses presenting with erythematous-desquamative patches/plaques (plaque psoriasis, eczematous dermatitis, pityriasis rosea, mycosis fungoides and subacute cutaneous lupus erythematosus), papulosquamous/papulokeratotic dermatoses (lichen planus, pityriasis rosea, papulosquamous sarcoidosis, guttate psoriasis, pityriasis lichenoides chronica, classical pityriasis rubra pilaris, porokeratosis, lymphomatoid papulosis, papulosquamous chronic GVHD, parakeratosis variegata, Grover disease, Darier disease and BRAF-inhibitor-induced acantholytic dyskeratosis), facial inflammatory skin diseases (rosacea, seborrheic dermatitis, discoid lupus erythematosus, sarcoidosis, cutaneous leishmaniasis, lupus vulgaris, granuloma faciale and demodicidosis), acquired keratodermas (chronic hand eczema, palmar psoriasis, keratoderma due to mycosis fungoides, keratoderma resulting from pityriasis rubra pilaris, tinea manuum, palmar lichen planus and aquagenic palmar keratoderma), sclero-atrophic dermatoses (necrobiosis lipoidica, morphea and cutaneous lichen sclerosus), hypopigmented macular diseases (extragenital guttate lichen sclerosus, achromic pityriasis versicolor, guttate vitiligo, idiopathic guttate hypomelanosis, progressive macular hypomelanosis and postinflammatory hypopigmentations), hyperpigmented maculopapular diseases (pityriasis versicolor, lichen planus pigmentosus, Gougerot-Carteaud syndrome, Dowling-Degos disease, erythema ab igne, macular amyloidosis, lichen amyloidosus, friction melanosis, terra firma-forme dermatosis, urticaria pigmentosa and telangiectasia macularis eruptiva perstans), itchy papulonodular dermatoses (hypertrophic lichen planus, prurigo nodularis, nodular scabies and acquired perforating dermatosis), erythrodermas (due to psoriasis, atopic dermatitis, mycosis fungoides, pityriasis rubra pilaris and scabies), noninfectious balanitis (Zoon’s plasma cell balanitis, psoriatic balanitis, seborrheic dermatitis and non-specific balanitis) and erythroplasia of Queyrat, inflammatory cicatricial alopecias (scalp discoid lupus erythematosus, lichen planopilaris, frontal fibrosing alopecia and folliculitis decalvans), nonscarring alopecias (alopecia areata, trichotillomania, androgenetic alopecia and telogen effluvium) and scaling disorders of the scalp (tinea capitis, scalp psoriasis, seborrheic dermatitis and pityriasis amiantacea).

Relationship between sebostatic activity, tolerability and efficacy of three topical drugs to treat mild to moderate acne.

Background  Acne is a multifactorial disorder in which the sebum plays an important pathogenetic role.

Hypertriglyceridaemia during treatment with adalimumab in psoriatic arthritis

associated with rituximab therapy. Br J Haematol 2003; 121:913–18. 12 Micallef IN, Kahl BS, Maurer MJ et al. A pilot study of epratuzumab and rituximab in combination with cyclophosphamide, doxorubicin, vincristine, and prednisone chemotherapy in patients with previously untreated, diffuse large B-cell lymphoma. Cancer 2006; 107:2826–32. 13 Voog E, Morschhauser F, Solal-Celigny P. Neutropenia in patients treated with rituximab. N Engl J Med 2003; 348:2691–4. 14 Terrier B, Ittah M, Tourneur L et al. Late-onset neutropenia following rituximab results from a hematopoietic lineage competition due to an excessive BAFF-induced B-cell recovery. Haematologica 2007; 92(Suppl. 3):ECR10.

Cutaneous Vascular Alterations in Psoriatic Patients Treated with Cyclosporine

Videocapillaroscopy can be used to assess cutaneous microcirculation modifications in vivo, and therefore allows assessment of variations in the microvascular architecture in psoriatic subjects during treatment. The aim of this study was to observe and quantify the modifications of the superficial capillary bed in psoriatic plaques during treatment with cyclosporin A. Twelve patients with psoriasis vulgaris were treated with an initial dose of 4 mg/kg/day cyclosporin A over a period of 3 months with periodic clinical and capillaroscopic assessments. Clinical resolution of the lesions and a reduction in microcirculatory alterations was observed in 70% of patients, although none returned to a normal capillaroscopic pattern.

Differentiation of pityriasis lichenoides chronica from guttate psoriasis by dermoscopy

Clinical differentiation between pityriasis lichenoides chronica (PLC) and guttate psoriasis (GP) may sometimes be a difficult task, which often requires histological analysis to reach a definitive diagnosis. In this study, PLC and GP lesions were examined using dermoscopy, and the significance of specific dermoscopic findings was investigated in order to facilitate their differentiation and decrease the number of cases requiring biopsy. We found that the incidence of orange–yellowish structureless areas, focal dotted vessels and nondotted vessels was statistically significant in PLC, while the incidence of diffuse dotted vessels was statistically significant in GP.

Dermoscopy in differential diagnosis of palmar psoriasis and chronic hand eczema.

Clinical differentiation between palmar psoriasis and chronic hand eczema may sometimes be a diagnostic challenge; in such cases histopathological analysis helps to differentiate the two conditions. In the present study, palmar psoriasis and chronic hand eczema were investigated using dermoscopy and the significance of specific dermoscopic features was assessed in order to improve their non‐invasive differentiation. Ten patients with biopsy‐proven palmar psoriasis and 11 patients with biopsy‐proven chronic hand eczema were included in the study. We found that the presence of diffuse white scales was significant in palmar psoriasis whereas the presence of yellowish scales, brownish‐orange dots/globules and yellowish‐orange crusts was significant in chronic hand eczema.

Immunohistochemical study before and after narrow band (311 nm) UVB treatment in vitiligo

The present study was aimed at evaluating correlations between clinical response and the histochemical and immunohistochemical changes in vitiligo patches treated with narrow-band UVB phototherapy. Eighteen patients, 13 females and 5 males, aged between 15 and 67 years, affected by vitiligo were recruited and 14 patients completed the study. Before starting the narrow-band UVB treatment three biopsies were carried out on the lesional, perilesional and healthy skin of each patient, excluding the face. After 9 months treatment an additional biopsy was performed on repigmented skin areas adjacent to the lesional biopsy site. For the histochemical evaluation, the Masson-Fontana argentaffin reaction was carried out; for the immunohistochemical study, two antigens were studied: tyrosinase and HMB 45. Clinical improvement was assessed by evaluating the repigmented surfaces, expressed in percentages of the respective vitiligo areas. The results obtained confirm the effectiveness and safety of narrow-band UVB phototherapy for vitiligo, in terms of both good clinical-histological results and absence of important side effects. In addition to attesting the efficacy of narrow-band UVB phototherapy, immunohistochemical tests also appeared to have a potential interest for prognostic purposes.