Marco Adriano Chessa

Nail involvement as a negative prognostic factor in biological therapy for psoriasis: a retrospective study.

Psoriasis (Pso) has a strong impact on quality of life and a positive association has been reported between nail psoriasis (NP) and more severe disease, together with a longer duration of skin lesions. The treatment of NP represents a challenge and biological therapy can be recommended for severe disease.

Cutaneous adverse effects during ipilimumab treatment for metastatic melanoma: a prospective study.

BackgroundIpilimumab is an immunomodulatory antibody directed against cytotoxicT-lymphocyte-associated antigen 4 (CTLA-4), which is administered to patients with advanced melanoma, with a proven positive effect on overall survival. The cutaneous adverse effects (AEs) of ipilimumab are relatively frequent, although described as usually mild and rarely life threatening.ObjectivesTo describe a three-year experience of a single institute in detecting and managing cutaneous AEs.Materials & MethodsA cohort of patients (n = 41) treated with ipilimumab (3 mg/kg/three weeks) for metastatic melanoma, from 2013 to 2016,was investigated for adverse cutaneous events.ResultsOn dermatological evaluation, 34.1% of the patients in our series developed cutaneous AEs: rash (7.3%; n = 3), folliculitis (7.3%; n = 3), mucositis (2.4%; n = 1), rosacea (2.4%; n = 1), eczema (2.4%; n = 1), acneiform eruption (2.4%; n = 1), syringometaplasia mucinosa (2.4%; n = 1), Stevens-Johnson syndrome (2.4%; n = 1), and vitiligo (4.9%; n = 2). These were all Grade 1 and 2 AEs, except for the case of Stevens-Johnson syndrome (Grade 4). On a patient-reported scale, 4.9% (n = 2) and 9.8% (n = 4) of the patients complained of severe xerosis and pruritus, respectively.ConclusionIpilimumab was relatively well tolerated in our series, mainly causing mild cutaneous AEs, which, in our experience, responded satisfactorily to conventional therapies. Only in one case was the treatment discontinued, due to Grade 4 side effects.

The Prognosis of Nail Apparatus Melanoma: 20 Years of Experience from a Single Institute

Introduction and Objectives: Nail apparatus melanoma (NAM) is an uncommon tumor, especially in Caucasians. The prognosis of patients affected by NAM was analyzed and correlated with the histopathological criteria and the surgical management of the tumors. Materials and Methods: We collected data regarding NAM referred to the Skin Cancer Unit of the Dermatology Department of the University of Bologna, from 1992 to January 2012. Results: Out of 1,327 melanoma cases diagnosed between 1992 and 2012, 42 patients were affected by NAM (2.93%). All the patients were Caucasian. Two deceased patients with insufficient medical records and 1 woman with a personal history of breast cancer were excluded. Thirty-nine cases entered this study: 24 were women (67%) and 15 men (33%). The mean age at diagnosis of NAM was 57.3 years (range 29-88 years). Statistical analyses showed that prognosis was significantly correlated with the Breslow thickness (≥/<2 mm; p = 0.02), regression (p < 0.0001) and ulceration (p = 0.04). Regarding surgical management, Kaplan-Meiers test pointed out that performing functional surgery compared to disarticulation did not correlate with a better prognosis of patients (p = 0.08). Conclusions: In our experience, the surgical management (disarticulation with respect to functional surgical excision) did not influence the prognosis of NAM patients. The latter was affected by the histopathological characteristics (Breslow thickness, regression and mitoses) and location (fingers vs. foot).

Hand, foot and mouth disease: an overview of clinical features in adult patients.

Editor Hand, foot and mouth disease (HFMD) mainly affects children aged <5 years and is caused by several serotypes of enteroviruses, more frequently Enterovirus 71 (EV71) and Coxsackie A16 (CA16). The disease presents with vesicles in the mouth, hands, feet and buttocks. Only 1% of infected adults develop clinical manifestations, probably as a result of immunological memory. Nevertheless, in the atypical HFMD caused by Coxsackie virus A6 (CVA6), the involvement of immunocompetent adults has been recently described. Adult cases (18 years of age and older) of atypical HFMD, referred to the Dermatology Unit in Bologna from October 2014 to January 2016, were enrolled for the study, if they met three inclusion criteria (Table 1). We identified 10 atypical HFMD lesions in immunocompetent adults transmitted by children: seven men and three women with a mean age of 39 12.59 years. Epidemiological, clinical and laboratory findings are summarized in Table 1. Seven of 10 patients presented prodromal symptoms, most frequently fever and sore throat. A similar frequency of prodromal symptoms was reported in a paediatric study. The cutaneous findings of our adult patients were similar to the atypical diffuse vesiculobullous forms of childhood, which is one of the four main patterns of atypical HFMD described in children. In our cluster, the extent of cutaneous lesions was mild in five of 10 patients, moderate in four of 10 patients and severe in one of 10 patients. A severe extension seems more common in children: at least 50% could present an involvement >25% BSA. All patients presented reddish pseudo-purpuric macules on the palms and soles. The lesions were vesiculobullous with an erythematous halo or pseudo-purpuric macules associated with vesicles on the palms and soles (Fig. 1a,b). Similar pseudo-purpuric lesions of palms and soles were reported in 78% and 17% of subjects, respectively, in two recent paediatric studies. The pseudo-purpuric pattern is the clinical expression of vesicles more deeply located in the epidermis and is more frequent in adults, probably due to the greater thickness of the palmoplantar epidermis. In addition, five of 10 patients manifested perioral involvement and four of these also perinasal (Fig. 1c,d). Perianal involvement was absent, this site being more prone to irritation in childhood. The lower limbs were involved in three of 10 patients (Fig. 1e), the upper limbs and abdomen in one of 10 patients and the scalp in three of 10 patients (Fig. 1f). Curiously in one patient affected by psoriasis, the HFMD lesions first appeared on the psoriasis plaques (Fig. 1g). As is known, Coxsackie virus tend to diffuse on areas with an altered cutaneous barrier, such as on eczematous skin (eczema coxsackium), more frequent in paediatric age. One patient presented desquamation of the palms and soles 6 weeks after onset, while another presented orchiepididymitis 7 days after CVA6 infection. Onychomadesis was seen in three of 10 patients within 3–8 weeks after diagnosis and was associated (a) (b)

Nodular scabies in infants: dermoscopic examination may avoid a diagnostic pitfall

infantile scabies sometimes manifests with atypical clinical presentation, leading to misdiagnosis. Monomorphic primary lesions or different coexisting lesions may be present. Specific pediatric localizations are scalp and face1, but in infants the most common are palms, soles and axillae. Irritability and poor feeding are more often referred by parents than itching. This article is protected by copyright. All rights reserved.

The detection of human papillomavirus–16 in squamous cell carcinoma of the nail unit: A case series

Lifetime prevalence values are reported as percentages, with number of self-reported cases in parentheses. To calculate each percentage, the number of cases in an age group was divided by the total number of subjects (cases plus controls) within that age group. Data source: 23andMe (Mountain View, CA) research participants with at least 97% European ancestry. BCC cases, SCC cases, and both sets of controls had 52%, 53%, and 54% males, respectively. Participants provided informed consent to take part in this research, in accord with 23andMe human subjects protocol (reviewed and approved by Ethical and Independent Review Services, an Association for the Accreditation of Human Research Protection Programs, Inceaccredited institutional review board). For more information about this cohort, please contact the corresponding author (ksarin@stanford.edu) or see: a. Pickrell JK, Berisa T, Liu JZ, et al. Detection and interpretation of shared genetic influences on 42 human traits. Nat. Genet. 2016. http://dx. doi.org/10.1038/ng.3570. b. Chahal HS, Lin Y, Ransohoff K, et al. Genome-wide association study identifies novel susceptibility loci for cutaneous squamous cell carcinoma. Nature Commun. 2016;7(12048):1-8. http://dx.doi.org/10.1038/ncomms12048. c. Chahal HS, Wu W, Ransohoff K, et al. Genome-wide association study identifies 14 novel risk alleles associated with basal cell carcinoma. Nature Commun. 2016;7(12510):1-10. http://dx.doi.org/10.1038/ncomms12510. BCC, Basal cell carcinoma; SCC, squamous cell carcinoma. J AM ACAD DERMATOL FEBRUARY 2017 354 Research Letters

‘Scaly’ tattoo reactions: is treatment mandatory?

B. Palterer, V. Grandi, E. Antiga, V. Maio, E. Maggi and F. Liotta Department of Clinical and Experimental Medicine, Division of Internal Medicine, University of Florence, Largo Brambilla 3, 50134 Florence, Italy; Department of Surgery and Translational Medicine, Division of Dermatology, University of Florence, Italy; and Department of Human Pathology and Oncology, University of Florence, Florence, Italy E-mail: boaz.palterer@gmail.com Conflict of interest: the authors declare that they have no conflicts of interest. Accepted for publication 5 May 2016

Comment on “Scabies in babies”

To the Editor, We read with great interest the article by Hill and colleagues, which confirms that infantile scabies sometimes manifests with atypical clinical presentation, leading to misdiagnosis. We would like to comment on four issues. All infants included in this study initially presented with polymorphic scabies; intensely inflammatory papulovesicles and nodules, pustules, hemorrhagic crusting, and serpiginous or J-shaped burrows were described. In contrast, in our case series, nodular scabies was the primary and monomorphic presentation in nine of 15 infants. In our group, the most commonly involved body area in infants (≤2 years old) was the armpits, confirming the results reported by Boralevi et al. Urticaria pigmentosa could be considered in the differential diagnosis, although the Darier sign may be positive also in scabietic nodules because of a local increase in mast cells. The recognition of age-related variations in morphology and clinical pattern is important to diagnose scabies, although in doubtful cases, dermatoscopy permits a rapid, noninvasive examination of many suspicious sites, differentiating reactive from active nodules with sensitivity of 91% and specificity of 86%. These levels of accuracy are comparable with those of microscopic examination, but dermoscopy is a more-rapid, noninvasive examination, especially in infants. A handheld dermatoscope, at a magnification of 910, shows mites as typical small, brown pigmented triangular structures (hang-glider sign), as well as S-shaped white burrows or jet-liner sign (Figure 1). In conclusion, in infants, a careful family history and a precise clinical examination are useful for the diagnosis of typical scabies. In the case of atypical monomorphic nodular eruption, more frequent in infants, handheld dermatoscopy is a rapid, noninvasive tool for diagnosis and to facilitate the differential diagnosis with urticaria pigmentosa, Langerhans and non-Langerhans cell histiocytosis, juvenile xanthogranuloma, and leukemia cutis.

Hand, foot and mouth disease in adult patients

occurrence of keratoacanthomatous proliferations in these cases may be analogous to the reports of keratoacanthomatous proliferations arising in other forms of lichenoid dermatitis such as verrucous lupus erythematosus or hypertrophic lichen planus, or in areas of trauma, in which the wound healing process is stereotypically associated with a lichenoid host response. It is possible that the lichenoid inflammatory milieu is conducive to the development KAs in certain predisposed individuals, and that increased immune system activation from PD1 inhibition may augment this response. Due to the large number of lesions, a nonsurgical approach, such as topical therapy, may be preferable for eruptive keratoacanthomatous proliferations. Treatment with other agents shown to have success with reactive KAs, such as oral retinoids, may also prove beneficial.

Pigmented fungiform lingual papillae: dermoscopic and clinical features

The tongue is covered by fungiform, filiform and circumvallate papillae. Fungiform papillae may be mainly pigmented in dark‐skinned individuals. A single‐centre study aimed to examine the clinical and dermoscopic features of pigmented fungiform papulae of the tongue (PFPT) in children, and a concise review of the literature has been performed. The clinical and anamnestic data of eight children affected by PFPT visited at the Pediatric Dermatology Unit of Bologna between 2010 and 2017, and a systemic review of all studies of PFPT published on PubMed up to 31 August 2017 has been collected and analysed. The results of our data were consistent with the literature review: dark brown to black coloured pinhead papules or bumps were observed in all cases of PFPT, and three types of clinical patterns have been detected. Moreover, the dermoscopic examination showed a cobblestone‐like distribution and rose petal pattern. PFPT could be associated with hyperpigmentation of other sites such as the proximal nail folds and gums, and an intrafamiliar transmission is also possible. Clinical and dermoscopic features of PFPT may help clinicians to recognize this ethnic, acquired and benign condition.