Lucia Mantovani

Baseline biophysical parameters in subjects with sensitive skin

Sensitive skin has been described as a skin type showing higher reactivity than normal skin and developing exaggerated reactions when exposed to external factors. The stinging test, performed by applying lactic acid to the nasolabial fold and evaluating the intensity of subjective symptoms, is widely accepted as a marker of sensitivity and employed for the selection of subjects experiencing invisible cutaneous irritation. However, this test is based on self‐perceived assessment and lacks objectivity. In order to contribute to the finding of objective descriptors, we assessed baseline biophysical parameters in subjects with sensitive skin by means of transepidermal water loss (TEWL), capacitance, pH, sebum and skin colour measurements, and compared the data with those obtained in normal subjects, also correlating the results with those of clinical assessments and functional tests. Subjects with sensitive skin showed a trend towards higher scores at all assessment times both for the stinging and the washing test. The skin of sensitive subjects was described as less supple, less hydrated and more erythematous and telangiectatic with respect to the skin of normal subjects. A trend towards an increase in TEWL, pH and colorimetric a* values, and a decrease in capacitance, sebum and colorimetric L* values on the face of subjects with sensitive skin was observable. However, significances were only present for capacitance and a* values. Thus, alterations of baseline capacitance values indicate the tendency to barrier impairment and support the view that skin hyperreactivity to water‐soluble irritants is induced by a greater amount of irritants absorbed, whereas the increase in the erythema parameter shows that cutaneous vascular hyperreactivity in subjects with sensitive skin also corresponds to baseline vasodilation.

Cross-sensitizations between azo dyes and para-amino compound. A study of 236 azo-dye-sensitive subjects.

Combined sensitizations to different azo dyes, probably based both on true cross‐sensitization and on simultaneous positive reactions, have frequently been described. However, since azo dyes are included in the standard series in a minority of countries, the case studies considered comprise, with few exceptions, a small number of subjects. The aim of our study was to investigate cross‐reactions between different azo dyes and para‐amino compounds in azo‐dye‐sensitive subjects, to study the clinical aspects of azo dye dermatitis, to assess the relevance of sensitization to azo dyes, and to relate the pattern of cross‐sensitizations to the chemical structure of the different dyes. Out of 6203 consecutively tested patients, 236 were sensitized to at least 1 of 6 azo compounds employed as textile dyes, included in our standard series. 107 subjects reacted to Disperse Orange 3 (DO3), 104 to Disperse Blue 124 (DB124), 76 to p‐aminoazobenzene (PAB), 67 to Disperse Red 1 (DR1), 42 to Disperse Yellow 3 (DY3), and 31 to p‐dimethylaminoazobenzene (PDAAB). Co‐sensitizations to para‐phenylenediamine were present in most subjects sensitized to DO3 (66%) and PAAB (75%), in 27% and 36% of DR1 and DY3‐sensitive subjects, and only in 16% of subjects sensitized to DB124. Apart from the hands and the face, the neck and the axillae were the most frequently involved skin sites. Whereas the involvement of flexural areas was mainly connected with sensitization to DB124, in patients with hand dermatitis and in those working as hairdressers, sensitization to DO3 and PAAB was more frequent. Moreover, in the former patient group, a history of textile dye allergy was most frequently obtained. Out of 33 patients tested with an additional textile dye series, only 5 subjects reacted to anthraquinone dyes. Cross‐sensitizations between azo dyes and para‐amino compounds can partially be explained on the basis of structural affinities.

Fungal Skin Infections in Organ Transplant Recipients

Transplantation is now currently and increasingly performed for the treatment of various acute and chronic diseases. Today the kidney, heart, lung, heart-lung, liver, pancreas, kidney-pancreas, small bowel and bone marrow are being transplanted. The immunological status of patients receiving such transplants exposes them to the risk of developing bacterial, viral and fungal infections.The etiological agents of mycotic diseases involving the skin of transplant recipients range from the common dermatophytes through yeasts such as Candida spp., Malassezia spp. and dimorphic fungi to the emerging molds Fusarium spp. and Pseudallescheria boydii.The very wide spectrum of fungi causing cutaneous disease produces equally varied clinical aspects. Lesions may be typical, but are very often aspecific or ambiguous.Cutaneous lesions may be the sign of a trivial mycotic disease or the marker of a disseminated, potentially lethal fungal illness, so great attention should be given to their early recognition.Cutaneous manifestations due to Candida spp., Aspergillus spp., dematiaceous fungi and Pityrosporum folliculitis are usually observed early after transplant, cryptococcosis more than 6 months later, while the frequency of dermatophytoses increases as time goes by. Coccidioides immitis, Histoplasma capsulatum and Blastomyces dermatitidis may appear any time after transplantation.The management of the more severe forms of cutaneous mycosis in transplant recipients is difficult. Besides the fact that early recognition is not easy, there are also problems regarding the effectiveness and the toxicity of the therapy and drug-drug interactions.Prophylactic measures to avoid fungal contamination must be performed during hospitalization; patients should be taught how to avoid contamination, not only during the first period after transplantation, when high dosage immunosuppressive drugs are given, but also later when a normal lifestyle is resumed.

Vulvar lichen sclerosus: 11 women treated with tacrolimus 0.1% ointment.

Lichen sclerosus is a chronic relapsing disease, usually treated with ultra-potent corticosteroids. As immunological alterations are considered important aetiopathogenetic factors in lichen sclerosus, the new immunomodulating topical agents, such as tacrolimus and pimecrolimus, have been employed sporadically as alternative therapies. The aim of this study was to evaluate the therapeutic effects of tacrolimus 0.1% ointment in lichen sclerosus in 11 patients unresponsive or poorly responsive to previous treatments. Tacrolimus 0.1% ointment was applied twice daily for 6 weeks, then tapered over a further 6 weeks. Symptoms and objective parameters were evaluated and quantified at the start, after 6 weeks, at the end of the topical treatment, and at follow-up visits. Improvement or remission of symptoms was observed in the patients who completed the study, while objective parameters were poorly influenced and often were not related to symptom behaviour. Topical tacrolimus can be considered an alternative treatment for lichen sclerosus.

Low-cumulative dose isotretinoin treatment in mild-to-moderate acne: efficacy in achieving stable remission

Background  Aimed at the reduction of post‐treatment relapse of severe acne, the cumulative dose of oral isotretinoin should be ≥120 mg/kg. However, data on the appropriate oral isotretinoin treatment regimen in mild and moderate acne are lacking.

Propylene glycol allergy from acyclovir cream with cross‐reactivity to hydroxypropyl cellulose in a transdermal estradiol system?

patient, who was a farmers wife, was mostly exposed to phenylmercuric acetate during contact with pesticides and herbicides used on farm crops. The patient has been asked to avoid further contact with such products. Finally, since the open test represents a crucial investigation in the diagnosis of CUS, one is tempted to propose its introduction into the diagnostic protocol for urticarias. Further efforts could lead to the development of a specific series of allergens for standard investigation protocols.

Frequency of sensitization to Euxyl K 400 in 889 cases

and finger pulps. 4 months before, she had started to help a friend sporadically with the painting of cigarette lighters with a transparent varnish that they applied with a syringe. They used the same products as patient no. 2. She was treated in the same way as the previous patient and her lesions disappeared in 5 days. Patch testing was positive to nickel sulfate ( + + ), standard epoxy resin ( + +) and Esmaltex® epoxy resin ( + +) (Table 1).

Acute Acne Flare following Isotretinoin Administration: Potential Protective Role of Low Starting Dose

E-Mail karger@karger.ch www.karger.com flammatory flares may occur during the first 3–5 weeks of treatment [5] . The flares manifest by paradoxical aggravation of acne, notably of the inflammatory component. As a rule, mild forms of flare resolve spontaneously and do not require change or discontinuation of treatment. Sometimes, inflammatory flare-up can be particularly severe and may distress the patient. These severe flares must be distinguished from acne fulminans, which is accompanied by systemic signs, articular symptoms and biochemical signs of inflammation [6] . Severe inflammatory acne deterioration may lead to scar development. In severe cases, systemic steroid therapy and either reduction or discontinuation of isotretinoin are necessary. The actual responsibility of oral isotretinoin in the extent of these flares is not proven. However, improvements usually occur upon discontinuation of isotretinoin, while increases in dosage can aggravate the inflammation. In order to avoid acne flares, many authors suggest to start oral isotretinoin treatment with a dose of no more than 0.5 mg/kg/ day for the first month, and then to increase the daily dosage to 1 mg/kg [7] . With the present observational study, we wanted to assess whether initial daily doses ! 0.5 mg/kg can further reduce the occurrence of flares during the first month of isotretinoin administration. Between October 2002 and October 2007, 132 acne patients (67 males and 65 females, mean age 20.3 years) whose clinical features are reported in table 1 , group 1, were treated with oral isotretinoin at an initial daily dose ̂ 0.2 mg/kg. The dosage was subsequently increased by 5 mg every 2 weeks, until the maximum tolerated dose (between 0.5 and 1 mg/kg of body weight) was reached. All patients were treated until acne clearing, without exceeding a total cumulative dose of 150 mg/kg. With the aim of

Ofuji Papuloerythroderma: Report of a European Case

The trunk and the limbs of an 82-year-old man were covered with large sheets of flat-topped erythematous papules arranged in a reticulate pattern which suddenly coalesced assuming erythroderma-like aspects. Body and positional folds were characteristically spared (deck chair sign). Mild eosinophilia was present. The histological and immunohistochemical examinations revealed an unspecific eczematous pattern. After systemic steroids and PUVA treatment the patient recovered from the dermatosis. Papuloerythroderma is a distinctive clinical entity, but it is not clear whether the dermatosis is the skin marker of systemic pathological conditions or a precursor of cutaneous lymphomas.

Tacrolimus 0.1% Ointment: Is It Really Effective in Plasma Cell Vulvitis?

Background: Plasma cell vulvitis is a clinically and histologically well-characterized chronic disease that usually relapses after various topical therapies. Considering the inflammatory nature of the disease, the new topical calcineurin inhibitors have been also employed successfully in few cases of Zoon’s balanitis, the corresponding male condition. Objective: The aim of our study is to evaluate the effectiveness of tacrolimus ointment in a small group of plasma cell vulvitis sufferers. Methods: 4 women affected by biopsy-proved plasma cell vulvitis were enrolled, after informed consent. The topical drug was applied twice daily for 6 weeks, then tapered on the basis of the clinical results. Symptoms and objective parameters were obtained periodically at the beginning, after 6 weeks and up to the end of the topical treatment. A final biopsy was performed in 3 out of our 4 patients. The follow-up is still ongoing. Results: The comparative analysis of subjective, objective and histopathological data has shown discordant and less encouraging results than those reported for the corresponding male condition. Conclusion: At the moment, topical tacrolimus could be considered an alternative treatment for plasma cell vulvitis only in cases resistant to conventional therapies.