Marco Scarnò

Psoriasis and bone mineral density: Implications for long‐term patients

Psoriasis is a chronic inflammatory disease associated with several comorbidities. Osteoporosis is defined as a reduction in bone mineral density with impaired bone microarchitecture. Several mechanisms may be implicated as a possible cause for the association between psoriasis and osteoporosis, such as systemic inflammation, anti‐psoriatic drug intake and joint dysfunction for psoriatic arthritis (PsA). The aim of the present study was to assess bone mineral density (BMD) in patients with psoriasis, correlating the prevalence of osteopenia/osteoporosis with Psoriasis Area and Severity Index (PASI) score, mean duration of psoriatic disease, PsA and previous treatments for psoriasis. Forty‐three consecutive patients with psoriasis, 19 of whom were affected by the arthropathic form, were enrolled. We evaluated the severity of psoriasis as measured by PASI score, the CASPAR criteria and ultrasounds of the joints to verify the diagnosis of PsA and the age of psoriasis onset to estimate mean disease duration. Patients underwent a bone density scan of the lumbar spine and femoral neck by dual‐energy X‐ray absorptiometry to measure BMD. Patients with osteopenia/osteoporosis showed a statistically significant longer average duration of psoriatic disease (17 years), compared to patients affected by psoriasis with normal T‐score (8.8 years) (P = 0.04). The linear logistic regression confirms a significant relation between mean psoriatic disease duration and BMD alterations (P = 0.04). Our results suggest the necessity of an early diagnostic evaluation of bone metabolism in patients with psoriasis, especially if characterized by longer disease duration.

Finasteride, 1 mg daily administration on male androgenetic alopecia in different age groups: 10‐year follow‐up

Finasteride 1 mg is indicated for the treatment of men with androgenetic alopecia (AGA). However, more than 5 years efficacy and safety has not been previously reported. To assess the efficacy over 10 years in different age groups of men with AGA. 118 men, between 20 and 61 years, with AGA receiving finasteride (1 mg/day), were enrolled in this uncontrolled study. Efficacy evaluation was assessed with standardized global photographs at T0,T1,T2,T5,T10. Statistical analysis was made using frequency tables and evaluating the chi‐square index with its p‐value. Better improvements are observed in patients older than 30 years (42.8% aged between 20 and 30 years did not improve also after 10 years) or with higher AGA grades (58.9% for AGA grade IV and 45.4% for AGA grade V had the first improvement just after 1 year). In 21% of cases, the treatment continuation beyond 5 years provided better results. Side effects were referred by 6% of the patients; nevertheless, some of them went on with treatment because of the great results. In our opinion, the result after the first year can help in predicting the effectiveness of the treatment. Its efficacy was not reduced as time goes on; in fact, a big proportion of subjects unchanged after 1 year, improved later on, maintaining a positive trend.

Homocysteine plasmatic status in patients with psoriasis

ejd.2011.1455 Auteur(s) : Antonio Giovanni Richetta1 antoniorichetta@hotmail.com, Carlo Mattozzi1, Laura Macaluso1, Carmen Cantisani1, Simona Giancristoforo1, Sara D’epiro1, Monica Salvi1, Marco Scarno2, Stefano Calvieri1 1 Department of Dermatology, Policlinico “Umberto I” University of Rome “La Sapienza”, Viale del Policlinico, 155, 00133 Rome, Italy 2 CASPUR Department of medical statistics, Italy Hyperhomocysteinaemia represents an independent risk factor for atherosclerotic cardiovascular [...]

Videodermoscopy Scalp Psoriasis Severity Index (VSCAPSI): A useful tool for evaluation of scalp psoriasis

The standard methods used to diagnose scalp psoriasis vary in sensitivity, reproducibility, and invasiveness. Videodermoscopy can be used to explore microcirculatory modifications in skin diseases. Psoriasis presents three pathognomonic vascular patterns: red dots, hairpin vessels and red globular rings. Our aim was to create a videodermoscopy scalp psoriasis severity index (VSCAPSI) for evaluation of scalp psoriasis, especially mild and moderate forms that often are not clinically appreciable. VSCAPSI takes into account the area of the scalp affected by psoriasis, the presence and morphology of vascular patterns, the erythema and desquamation. Videodermoscopy images obtained between November 2009 to June 2010 from 900 participants with various scalp and hair disorders were reviewed for distinguishing features. During the 2010 Italian congress on psoriasis, in order to assess the reproducibility and efficacy of the VSCAPSI, 146 dermatologists were asked to evaluate 16 videodermoscopy images of scalp psoriasis using the VSCAPSI. Of the 900 patients, 85 new cases of scalp psoriasis were diagnosed. The other 815 patients were found to be suffering from different scalp and hair diseases. Of 146 dermatologists, 28 did not recognize erythema, 15 desquamation and 7 the vascular patterns. The VSCAPSI provides important evidence for early diagnosis, differential diagnosis, for follow-up and screening.

MAL Daylight Photodynamic Therapy for Actinic Keratosis: Clinical and Imaging Evaluation by 3D Camera.

Non-melanoma skin cancer is the most common skin cancer with an incidence that varies widely worldwide. Among them, actinic keratosis (AK), considered by some authors as in situ squamous cell carcinoma (SCC), are the most common and reflect an abnormal multistep skin cell development due to the chronic ultraviolet (UV) light exposure. No ideal treatment exists, but the potential risk of their development in a more invasive form requires prompt treatment. As patients usually present with multiple AK on fields of actinic damage, there is a need for effective, safe, simple and short treatments which allow the treatment of large areas. To achieve this, daylight photodynamic therapy (DL-PDT) is an innovative treatment for multiple mild actinic keratosis, well tolerated by patients. Patients allocated to the PDT unit, affected by multiple mild−moderate and severe actinic keratosis on sun-exposed areas treated with DL-PDT, were clinically evaluated at baseline and every three months with an Antera 3D, Miravex© camera. Clinical and 3D images were performed at each clinical check almost every three months. In this retrospective study, 331 patients (56.7% male, 43.3% female) were treated with DL-PDT. We observed a full clearance in more than two-thirds of patients with one or two treatments. Different responses depend on the number of lesions and on their severity; for patients with 1–3 lesions and with grade I or II AK, a full clearance was reached in 85% of cases with a maximum of two treatments. DL-PDT in general improved skin tone and erased sun damage. Evaluating each Antera 3D images, hemoglobin concentration and pigmentation, a skin color and tone improvement in 310 patients was observed. DL-PDT appears as a promising, effective, simple, tolerable and practical treatment for actinic damage associated with AK, and even treatment of large areas can be with little or no pain. The 3D imaging allowed for quantifying in real time the aesthetic benefits of DL-PDT’s increasing compliance.

The Sentiment Hidden in Italian Texts Through the Lens of A New Dictionary

The aim of this work is to propose a strategy to classify texts (or parts of them) in an ordinal emotional scale to gauge a sentiment indicator in every domain. In particular, we develop a new dictionary for the Italian language which is built using an objective method where the polarities of synonyms and antonyms are accounted for in an iterative process. To build our sentiment indicator negations and intensifiers are also used, thus considering the context in which the single word is written. We apply our new dictionary to extract the sentiment from a set of around 40 issues of the Bank of Italy quarterly Economic Bulletin. Our results show that our strategy is able to correctly identify the sentiment expressed in the Bulletins, which is correlated to the main macroeconomic variables (such as national GDP, investment, consumption or unemployment rate). Our analysis shows that sentiment represents not only an evaluation of the stylistic way in which texts are written, but also a valid synthesis of all the external factors analysed in the same document.

Sequential methyl-aminolevulinate daylight photodynamic therapy and diclofenac plus hyaluronic acid gel treatment for multiple actinic keratosis evaluation

Actinic keratosis (AK) is a chronic-relapsing skin lesion, considered as an early stage of invasive squamous cell carcinoma (iSCC) on chronically sun damaged skin (Cantisani et al. 2016a; Cantisani et al. 2016b). AK places a significant burden on health care system (Cantisani, Paolino, Bottoni, & Calvieri, 2015; Tolley, Argenziano, CalzavaraPinton, Larsson, & Ryttig, 2017). Consequently, guidelines recommend that all AKs need to be adequately treated (Lucena et al., 2015; Patel & Stockfleth, 2007). The aim of our work was to evaluate the sequential efficacy of diclofenac 3% in 2.5% hyaluronic acid (DHA) and methyl aminolevulinate-daylight photodynamic therapy (MAL-DL-PDT) on multiple AKs on sun exposed areas. Data were derived by randomized controlled monocentric trial from AK patients, who were assigned to MAL-DL-PDT or MAL-DL-PDT plus DHA; DHA have been applied 30 days before or after MAL-DL-PDT. Patients were evaluated by gender, age, anatomic site of the lesion, systemic therapies, medical history, number of the lesions (≤1 or ≥2). An independent investigator, who was blinded to the assigned treatment modality and was not involved in the treatment, evaluated the tumors 3 and 12 months after the last treatment. Treatment failure was defined as residue or recurrence within 1-year post-treatment. Since DHA is an important anti-inflammatory agent, we evaluated the local inflammation in both groups after the treatment with MAL-DL-PDT. The inflammation intensity was staged as follows: 0 (0–19% of inflammation in the treated area), 1 (20–39% of inflammation in the treated area), 2 (40–59% of inflammation in the treated area), 3 (60–79% of inflammation in the treated area), and 4 (80–100% of inflammation in the treated area). The inflammation was evaluated during second or third MAL-DL-PDT session (3–6 months later). Effectiveness was defined as the probability that complete tumor clearance was achieved 12 months after treatment. A total of 125 patients with multiple AK KIN I and II according to Olsen classification on sun exposed areas and treated with MAL-DL-PDT have been included in the analysis. Patients have been evaluated for 12 months. Mean age of the patients was 73 10 years, with 52 females and 73 males. From this sample of patients, we have considered those treated with MAL-DL-PDT or MAL-DL-PDT plus DHA, 30 days later. They were respectively 93 (52 male and 41 female; mean age 72) and 32 (21 male and 11 female; mean age 75) patients (Table 1). T-test on the ages of the two sample did not show significant differences. The main associated internal diseases in MAL-DL-PDT group were arterial hypertension (n = 5), diabetes (n = 2), malignancies (n = 2; 1 breast cancer and 1 prostatic cancer); while in MAL-DL-PDT plus DHA group the main associated disease was arterial hypertension (n = 3). After 12 months, we did not observe a significant difference in resolution of the AK between MAL-DL-PDT and MAL-DL-PDT plus DHA (p = .5). A mean response of 90% in MAL-DL-PDT plus DHA versus 91.2% in MAL-DL-PDT group have been observed (Figure 1). Finally, at each follow-up we evaluated the presence of inflammation between the two groups and we found that MAL-DL-PDT plus DHA showed a reduced inflammation compared to MAL-DL-PDT alone, without any gender variation. Local skin reaction score was between 2 and 3 (40–79%, median 61%) in MAL-DL-PDT group, while in MAL-DLPDT plus DHA group was between 0 and 1 (0-19-39%, median 11%). The score was arbitrarily performed. Mann–Whitney showed a significant result with a p < .0001 (Figure 2). Only 1% of patients showed photoallergic reaction. Since complete lesion clearance is rarely achieved in real-life practice (Faragnoli, in press), the suggested treatment goals are to reduce the number of lesions, to achieve long-term disease control and to prevent disease progression to iSCC (Faragnoli, in press). Our study showed that the sequential treatment may reduce the inflammation rate and number of MAL-DL-PDT session, increasing patients compliance and consequent quality of life.