M. Barbareschi

Cutaneous granulomatous reaction to injectable hyaluronic acid gel

Injectable hyaluronic acid (HA) derivatives are the most used reabsorbable dermal fillers for soft tissue augmentation today and their utilization is considered safe. We report a cutaneous granulomatous reaction that developed in a woman 5 weeks after the first treatment with a nonanimal HA derivative for the correction of facial wrinkling. We describe the clinicopathological findings and course of the cutaneous reaction. The adverse reaction showed clinical and histopathological characteristics comparable to the few previously reported cases. All cutaneous lesions spontaneously disappeared without scars within 3 months. We conclude that even nonanimal injectable HA derivatives can be associated with delayed granulomatous reactions. The patient should be informed of this potential long‐term complication.

Rapp-Hodgkin syndrome and AEC syndrome: are they the same entity?

Summary Rapp‐Hodgkin syndrome and AEC syndrome are two disorders in which ectodermal dysplasia and clefting are associated. Rapp‐Hodgkin syndrome is an autosomal dominant condition characterized by cleft lip and palate, peculiar craniofacial features, and ectodermal dysplasia, consisting of abnormalities of teeth, hair, nails and sweating. AEC syndrome manifests the same defects plus ankyloblepharon and a higher frequency of scalp dermatitis. A child affected by ectodermal dysplasia associated with clefting, ankyloblepharon, severe scalp dermatitis, and the characteristic Rapp– Hodgkin fades is reported. The overlap between Rapp–Hodgkin syndrome and AEC syndrome is discussed. Critical review of both disorders suggests that AEC syndrome and Rapp–Hodgkin syndrome represent the same entity.

The treatment of visible signs of senescence : the Italian experience

An Open clinical study was undertaken to evaluate the anti‐photoageing efficacy of topical tretinoin. A length of cream of approximately 1 cm was applied to the face daily in the evening for 6 months: during month 1 of therapy 001%, tretinoin cream was administered; O.O25%, was given during month 2; and 0.05%, was given in months 3–6. The clinical symptoms of photoageing (coarse wrinkling, fine wrinkling, skin thinning, mottled hyperpigmentation, laxity and xerosis) were evaluated before and after therapy. A total of 19–1%, of patients withdrew from the study; only 5–6%, were for treatment‐related reasons. At the end of the treatment period all the clinical parameters, except xerosis, were improved. The amount of improvement varied, but only 42%, of patients failed to show any improvement. Tolerability was excellent in 51.4% of patients, good in 44.4% and fair in 4.2%, and compliance was excellent in 47% of patients, good in 48.5%, and fair in 4.5%. Tolerability and compliance were improved by applying the same amount of cream each day but increasing the concentration of tretinoin over the 6‐month period. Silicone skin replicas of the same area of skin taken before and after treatment, analysed by scanning electron microscopy, profilometry and computer image analysis, showed a decrease in the width of wrinkles, and an improvement in skin texture and follicle density.

Leflunomide-induced subacute cutaneous lupus erythematosus with erythema multiforme-like lesions

Leflunomide is an immunosuppressive agent that acts by inhibiting pyrimidine synthesis in lymphocytes and other rapidly proliferating cells, as well as by suppressing tumor necrosis factor-α–induced cellular responses. A number of leflunomide-related adverse events have been reported. Among cutaneous side effects, a few cases of subacute cutaneous lupus erythematosus have been described. We report a previously undocumented reaction to leflunomide, manifesting as subacute cutaneous lupus erythematosus and erythema multiforme-like lesions, in a young woman treated with this drug for ankylosing spondylitis. Withdrawal of leflunomide combined with a short cycle of systemic corticosteroid led to the resolution of the patient’s rash, indicating this drug as being responsible for the development of the disease. We conclude that leflunomide might have triggered the occurrence of both subacute cutaneous lupus erythematosus and erythema multiforme in a patient with pre-existing autoimmune diathesis. The suppressive effect of this drug on tumor necrosis factor-α–related mechanisms might have played a role in the induction of such a unique reaction to leflunomide.

A Sporadic Case of Congenital Hypotrichosis Simplex of the Scalp: Difficulties in Diagnosis and Classification

Abstract: Hereditary hypotrichosis simplex of the scalp is a genotrichosis characterized by a hair defect limited to the scalp in the absence of other ectodermal or systemic abnormalities. Only large pedigrees consistent with autosomal dominant transmission have been described to date. In this article the clinical and scanning electron microscopy findings of a nonfamilial case of congenital scalp hypotrichosis simplex are reported. In some patients the diagnosis of sporadic hypotrichosis simplex of the scalp should be considered after ruling out all other possible causes of congenital and hereditary hypotrichosis.

A New Case of Trichothiodystrophy Associated with Autism, Seizures, and Mental Retardation

Abstract: We report a patient with trichothiodystrophy associated with autism, mental retardation, and seizures. The diagnosis was based on the presence of brittle hair, with a marked decrease in sulfur‐rich amino acid content, and characteristic features such as “tiger tail” under polarizing microscopy and trichoschisis under scanning electron microscopy. Macroscopic alterations were mostly observed in the frontal and occipital hair, with only microscopic abnormalities in the occipital hair. We consider this an unusual expression of this disease.

Short contact therapy of acne with tretinoin.

The most frequent side effect of topical retinoids is irritant contact dermatitis. It occurs in approximately 85% of patients; the percentage can reach up to 95% in patients treated with tretinoin. Severity of this dermatitis is moderate to severe in approximately 20% of patients. However, 15% of patients stop the treatment with tretinoin because of skin irritation. The authors used tretinoin as short contact therapy (SCT) in mild to moderate acne, in order to try to reduce the incidence and severity of irritant contact dermatitis. They present the final results of a sponsor-free, pilot, open, multicenter study. Seventy-four patients were treated with 0.05% tretinoin cream. It was applied once daily for 30 min. Treatment duration ranged from 8 to 32 weeks (mean duration: 12 weeks). Acne severity and treatment efficacy were evaluated by means of the Global Acne Grading System. A significant clinical improvement (≥50% from baseline) was observed in 41 patients (55.4%). Thirteen patients (17.6%) developed a mild skin irritation. Four patients (5.4%) stopped the treatment because of severe skin irritation. Efficacy of tretinoin used as SCT seems to be superimposable to that of tretinoin used according to standard modality. Tolerability of SCT with tretinoin is very good. This tolerability allows a high adherence of patients to the treatment and it markedly improves compliance.

The anticomedonic activity of azelaic acid investigated by means of scanning electron microscopy on horny layer biopsy

Hyperkeratosis of the follicular channel is the most commonly demonstrated abnormality in comedonic acne. Several reports have shown the effectiveness of azelaic acid against comedoaes in acne. The aim of this study was to investigate the activity against comedones of 20% azelaic acid (AZA) cream compared with 0.05% retinoic acid (RA) cream and placebo cream using clinical and scanning electron microscopy (SEM) evaluation. Skin surface biop sies with cyanoacrylate glue were performed before and at the end of four months of treatment, and SEM was used to count the number of comedones. The placebo group did not show a reduction in the number of comedones, but there was a significant reduction in the AZA and RA groups. AZA induced a reduction in follicular hyperkeratosis of a similar magnitude to that induced by RA.

Role of cleansers in the management of acne: Results of an Italian survey in 786 patients

Abstract Background: Modern therapy of acne is based also on moisturizers, cleansers and sunscreens. However, a few studies have been published on cleansers, and never in Italy. Objective: We decided to carry out an epidemiological study on the knowledge, beliefs and perceptions of acne patients regarding cleansers. Methods: The survey has been carried out in Italy in 2013–2014. A group of patients with acne completed a questionnaire which included 10 questions. Results: One hundred and eighteen dermatologists and 786 evaluable acne patients attended the survey. Approximately 70% of patients use a specific anti-acne cleanser. This cleanser is suggested in 57% of cases by a dermatologist. The patients buy this cleanser at the pharmacy (77% of cases). More than 62% of patients are satisfied about this cleanser. More than 66% of patients use the cleanser twice daily. The length of washing is less than one minute in 48% of patients. More than 66% of patients believe that the cleanser has a therapeutical role. Conclusion: The results of this survey cannot be compared with other studies because of the lack of similar studies about this topic. These results suggest that a sample of Italian acne patients consider cleansers as an important adjuvant treatment in acne.

Citrobacter koseri folliculitis of the face

We report a case of severe Citrobacter koseri folliculitis of the face in a boy with acne. A 15-year-old boy affected by acne was admitted because of a rash located on the face. Dermatological examination revealed two large plaques, with numerous pustules, eschars and crusts, located bilaterally and symmetrically on the cheeks. Three bacteriological examinations were positive for C. koseri. The patient was successfully treated with i.m. ceftriaxone. C. koseri is a Gram-negative, aerobic, mobile, nonsporulating bacillus belonging to the Enterobacteriaceae family. It can cause meningitis, central nervous system abscess and sepsis, almost exclusively in infants and immunocompromised hosts. Respiratory tract and urinary infections have been reported in elderly people. Furthermore, rare cases of skin infections have been described.