Luisa Di Costanzo

Anti-inflammatory properties of low and high doxycycline doses: an in vitro study.

Doxycycline is used to treat infective diseases because of its broadspectrum efficacy. High dose administration (100 or 200 mg/day) is often responsible for development of bacterial resistances and endogenous flora alterations, whereas low doses (20–40 mg/day) do not alter bacteria susceptibility to antibiotics and exert anti-inflammatory activities. In this study, we wanted to assess the efficacy of both low and high doxycycline doses in modulating IL-8, TNF-α, and IL-6 gene expression in HaCaT cells stimulated with LPS. Three experimental settings were used, differing in the timing of doxycycline treatment in respect to the insult induced by LPS: pretreatment, concomitant, and posttreatment. Low doses were more effective than high doses in modulating gene expression of LPS-induced proinflammatory cytokines (IL-8, TNF-α, and IL-6), when added before (pretreatment) or after (posttreatment) LPS stimulation. This effect was not appreciated when LPS and doxycycline were simultaneously added to cell cultures: in this case high doses were more effective. In conclusion, our in vitro study suggests that low doxycycline doses could be safely used in chronic or acute skin diseases in which the inflammatory process, either constantly in progress or periodically recurring, has to be prevented or controlled.

Ischemic cardiovascular involvement in psoriasis: A systematic review

Epidemiologic studies demonstrate that psoriasis is associated with shorter life expectancy, most frequently attributable to cardiovascular (CV) events. Although increased prevalence and incidence of CV risk factors for atherosclerosis have been reported in psoriatic patients, psoriasis likely plays an independent role in the increased cardiovascular risk, presumably linked to the chronic systemic inflammatory state. Consistently, preliminary investigations suggest that anti-inflammatory therapies may improve early subclinical vascular alterations and reduce cardiovascular morbidity and mortality. This review will focus on ischemic CV involvement in psoriatic patients, summarizing the prevalence and incidence of CV risk factors and CV events, as well as evidence on mechanisms of premature atherosclerosis and on effects of systemic anti-inflammatory therapies on CV risk profile. We performed a systematic review using Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) and evaluated the quality of studies comparing drug treatments using Detsky score. Our review documented that psoriatic patients are at increased CV risk, related to raised prevalence and incidence of CV risk factor and to inflammatory status. However, available literature lacks of studies that establish appropriate targets for CV risk factors and assess the clinical value of screening for subclinical organ damage and the impact of disease-modifying therapies on CV risk profile in psoriatic patients. Awareness of raised CV risk in psoriatic patients should foster further research aimed at elucidating these aspects.

Psoriatic Disease and Tuberculosis Nowadays

Psoriasis is a chronic, relapsing and remitting inflammatory skin and joint disease that has a prevalence of 2-3% in the worlds population, whereas of 1–2% in Europe. The traditional concept of psoriasis as the “healthy peoples” disease has been recently revised because of ever-increasing reports of associations with various pathological conditions (hypertension, Crohns disease, type II diabetes mellitus, obesity, dyslipidemia, metabolic syndrome, infectious conditions). Particularly, advances in psoriasis therapies have introduced biologic agents. All the tumor necrosis factor-alpha inhibitors are associated with an increased risk of developing active disease in patients with latent tuberculosis infection, because of TNF-α key role against Mycobacterium tuberculosis. For this reason, exclusion of active tuberculosis and treatment of latent tuberculosis infection are clinical imperatives prior to starting this therapy. Moreover active surveillance for a history of untreated or partially treated tuberculosis or latent form has already been shown to be effective in reducing the number of incident tuberculosis cases.

Effect of weather and environmental factors on the clinical course of psoriasis

Dear Editor, Psoriasis is a chronic disease, the prevalence of which shows geographic variations,1 suggesting that it might be influenced by climatic factors such as sun exposure and humidity.2 ,3 In order to assess the effect of weather and both outdoor and indoor environmental factors on the clinical course of psoriasis, we analysed the answers given to a specific questionnaire administered to 300 consecutive patients attending the psoriasis outpatient clinic of our department. The role of exposure to rainy, windy, muggy, hot, cold and sunny climates, as well as of seasonality in relation to the outdoor environment and the effect of domestic heating and ventilation systems …

Successful management of a delayed and persistent cutaneous reaction to jellyfish with pimecrolimus

The contact with a jellyfish is usually followed by acute inflammatory lesions, characterized by erythema, swelling, vesicles, and bullae, accompanied by burning and pain sensation. The pathogenesis is due to the direct toxic effect of the fluid contained in jellyfish tentacles. Sometimes, jellyfish may induce delayed cutaneous lesions. Delayed cutaneous reaction to jellyfish represents a clinical entity where eczematous lesions develop after days or months after contact with the invertebrate. We report the case of a patient with a delayed and persistent skin reaction due to jellyfish envenomation successfully treated with pimecrolimus.

The risk of herpes zoster in the anti-TNF-α era: a case report and review of the literature

BACKGROUND Tumor necrosis factor-α (TNF-α) inhibitors represent efficacious therapeutic agents in many chronic inflammatory diseases such as psoriasis and rheumatoid arthritis. However they have been connected with increased risk of infection and reactivation of a variety of infectious agents, such as viruses. The reactivation of varicella zoster virus infection causes herpes zoster (HZ), a self-limiting, dermatomally localized, vesicular rash that can be accompanied by postherpetic neuralgia and severe neurological complications. MAIN OBSERVATIONS Limited information has been published regarding HZ during therapy with TNF-α inhibitors especially for the occurrence of HZ during adalimumab treatment. We report the case of a 58-year-old immunocompetent man with a 18-year history of plaque psoriasis who develops ophthalmic HZ during treatment with adalimumab. CONCLUSION We report this case to enrich the literature and to highlight the increased risk of HZ infections in patient on anti-TNF-α therapy (incidence of HZ is about 3-fold increased respect to general population). Clinically, these infections often have atypical presentations that may hamper prompt diagnosis. Therefore, it is very important to identify early signs and symptoms of herpes zoster in patients on biologic therapy in order to start prompt efficient antiviral treatment to prevent the development of severe complications.

Acrodermatitis continua of Hallopeau (ACH): two cases successfully treated with adalimumab.

Abstract Acrodermatitis continua of Hallopeau (ACH), also known as dermatitis repens or acrodermatitis perstans, is a rare acropustular eruption, characterized by sterile pustules, paronychia and atrophic skin changes, onychodystrophy and osteolysis of the distal phalanges of the fingers and toes. While some consider ACH a distinct entity, many believe it to be a variant of pustular psoriasis, especially as cases of ACH progressing to generalized pustular psoriasis. The treatment options used are various; however, its typical cyclic recurrences, which induce important physical and psychological morbidity, may render this pathology difficult to treat. Hence, it was considered important to review the evolution of treatment options available thus far including use of biologics. Hereby, we report two patients with ACH who were successfully treated with adalimumab. By analogy to the efficacy of TNF-α antagonists in the treatment of generalized pustular psoriasis, the two patients we report illustrate the long-term efficacy and safety of adalimumab in the treatment of  Hallopeau’s acrodermatitis refractory to therapies.

Polymorphous light eruption and benign summer light eruption in Italy

Background/purpose: Polymorphous light eruption (PLE) heterogeneity has been postulated, but the existence of benign summer light eruption (BSLE) is controversial. We studied the prevalence of the clinical patterns, criteria distinguishing BSLE from PLE, and diagnostic usefulness of phototest.

Differential Diagnosis of Psoriasis

Psoriasis is a common chronic skin disorder estimated to affect about 2% of the Western population. The disease creates a significant stigma for patients and is a major economic burden. Psoriasis has a large spectrum of clinical features and evolution. Clinical features of chronic psoriasis are generally sufficient to make the diagnosis. Diagnostic doubts, however, may arise in several clinical variants and atypical cases or when the psoriatic lesions are localized in particular sites.

Zoon's Balanitis: Benign or Premalignant Lesion?

Zoon’s balanitis or balanitis circumscripta plasmacellularis is a chronic disease of unknown origin.This condition usually manifests in middle-aged or elderly uncircumcised men. Although of unknown etiology, different factors have been reported to be involved in its genesis (local infections, poor hygiene, heat, friction, and constant rubbing). It is generally considered to be a benign condition, and its association with malignancies has been rarely reported. We report the case of an uncircumcised man, who developed clinically and histopathologically evident squamous cell carcinoma of the penis in an area affected by Zoon’s balanitis.