Maria Carmela Annunziata

Acne Scars: Pathogenesis, Classification and Treatment

Acne has a prevalence of over 90% among adolescents and persists into adulthood in approximately 12%–14% of cases with psychological and social implications. Possible outcomes of the inflammatory acne lesions are acne scars which, although they can be treated in a number of ways, may have a negative psychological impact on social life and relationships. The main types of acne scars are atrophic and hypertrophic scars. The pathogenesis of acne scarring is still not fully understood, but several hypotheses have been proposed. There are numerous treatments: chemical peels, dermabrasion/microdermabrasion, laser treatment, punch techniques, dermal grafting, needling and combined therapies for atrophic scars: silicone gels, intralesional steroid therapy, cryotherapy, and surgery for hypertrophic and keloidal lesions. This paper summarizes acne scar pathogenesis, classification and treatment options.

Epidemiology of skin cancer: role of some environmental factors.

The incidence rate of melanoma and non-melanoma skin cancer entities is dramatically increasing worldwide. Exposure to UVB radiation is known to induce basal and squamous cell skin cancer in a dose-dependent way and the depletion of stratospheric ozone has implications for increases in biologically damaging solar UVB radiation reaching the earth’s surface. In humans, arsenic is known to cause cancer of the skin, as well as cancer of the lung, bladder, liver, and kidney. Exposure to high levels of arsenic in drinking water has been recognized in some regions of the world. SCC and BCC (squamous and basal cell carcinoma) have been reported to be associated with ingestion of arsenic alone or in combination with other risk factors. The impact of changes in ambient temperature will influence people’s behavior and the time they spend outdoors. Higher temperatures accompanying climate change may lead, among many other effects, to increasing incidence of skin cancer.

Skin Needling to Enhance Depigmenting Serum Penetration in the Treatment of Melasma

Melasma is a common hypermelanotic disorder affecting the facial area which has a considerable psychological impact on the patient. Managing melasma is a difficult challenge that requires long-term treatment with a number of topical agents, such as rucinol and sophora-alpha. Aims. We aim to compare the combined treatment of skin needling and depigmenting serum with that using depigmenting serum alone in the treatment of melasma, in order to evaluate the use of microneedles as a means to enhance the drugs transdermal penetration. Methods. Twenty patients were treated with combined skin needling and depigmenting serum on one side of the face and with depigmenting serum alone on the other side. The outcome was evaluated periodically for up to two months using the Melasma Area Severity Index score and the Spectrocolorimeter X-Rite 968. Results. The side with combined treatment (skin needling + depigmenting serum) presented a statistically significant reduction in MASI score and luminosity index (L) levels compared to the side treated with depigmenting serum alone, and clinical symptoms were significantly improved. Conclusions. Our study suggests the potential use of combining skin needling with rucinol and sophora-alpha compounds to achieve better results in melasma treatment compared to rucinol and sophora-alpha alone.

Teledermatology: from prevention to diagnosis of nonmelanoma and melanoma skin cancer

Telemedicine is a rapidly developing application of clinical medicine where medical information is transferred through interactive audiovisual media for the purpose of consulting remote medical procedures or examinations, reducing the time of consultation for patients. Teledermatology as an application of telemedicine was developed in 1995: it turns out to be a gradually more ordinary mean of delivering dermatologic healthcare worldwide and will almost certainly have a greater medical function in the future. In particular, teledermatology can aid in the prevention and diagnosis of nonmelanoma and melanoma skin cancer; telemedicine and teledermatology offer the opportunity to make available consultations with experts also by long distance. Overall, patients seem to accept teledermatology, considering it as an excellent mean to obtain healthcare, particularly in those areas with no expert dermatologists available. Clinicians have also generally reported affirmative experiences with teledermatology in the skin cancer field. Further studies focusing on cost effectiveness, patient outcomes, and patient and clinician satisfaction will facilitate to delineate the potential of teledermatology as a mean of prevention and diagnosis of nonmelanoma and melanoma skin cancer.

Intralesional Diode Laser 1064 nm for the Treatment of Hidradenitis Suppurativa: A Report of Twenty Patients

AIM: Hidradenitis suppurativa (HS) is a chronic inflammatory disease, commonly characterized by painful, deep dermal abscesses and chronic draining sinus tracts. Recently, laser and light-based therapies have become more commonly used in the management of HS. MATERIAL AND METHODS: We report 20 HS patients treated with a 1064 nm wavelength, emitted from a diode laser, launched in an optical fibre through intracavitary modalities. RESULTS: Each patient underwent four laser sessions, one every two weeks. we recorded a significative reduction (31%) of Sartorius score from 28.55 ± 13.04 to 19.75 ± 12.29 after 4 laser sessions (p < 0.05). No one has had a worsening of the disease. CONCLUSION: Intralesional diode laser 1064 nm can be a good treatment option for patients with moderate and localized hidradenitis suppurativa, because it is minimally invasive, doesn’t have significant complications and provides a rapid post-treatment recovery.

Photodynamic therapy for periungual pyogenic granuloma-like during chemotherapy: our preliminary results

Dear Editor, Patients treated with systemic anticancer drugs often show changes in their nails, which can affect patient’s quality of life causing pain and functional impairment [1]. EGFR inhibitors are used in the treatment of several types of advanced cancer and it is estimated that overall incidence of all-grade nail toxicity during chemotherapy with EGFRIs is 17.2%. These drug class-related adverse events are tumorindependent and have also been reported with the use of the latest ErbB inhibitors, including lapatinib, pertuzumab, and afatinib [2]. The epidermal growth factor receptor (EGFR) is most concentrated in the basal keratinocytes, where it acts as a powerful growth promoter, leading to epidermal hyperplasia and hyperkeratosis. Periungual lesions are the most common and debilitating manifestations in patients treated with targeted anticancer therapies. Pyogenic granuloma-like (PGL) lesions are an excess of friable granulation tissue on proximal or lateral folds of the nail, mimicking ingrown nails. These periungual lesions can affect any digit, but the thumbs and the big toes are the most frequently affected, probably because they are more exposed to microtrauma. Development of EGFR inhibitor-induced nail PGLs is dose-dependent, and the granulomas usually regress spontaneously 1–2 months after stopping the drug [3]. The pathogenic hypothesis is that these lesions result from inhibition of the EGFR and downstream EGFR-dependent pathways in basal and suprabasal keratinocytes. This inhibition leads to growth arrest, apoptosis, and decrease of migration of keratinocytes. Consequentially, the periungual epidermis thins damaging the paronychium by the lateral edges of the nail plate and can induce a similar reaction of secondary inflammation to presence of a foreign body [4]. PGL treatment is based on topical steroids and antiseptics, liquid nitrogen, electrodessication, and silver nitrate, associated with local hygiene and avoidance of friction and pressure by shoes [5]. Lateral matricectomy with phenolization of affected toenails has been reported effective with no recurrence, indicating the predisposing role of trauma and nail morphology [6]. Photodynamic therapy (PDT) is a clinically approved and minimally invasive therapeutic procedure that can exercise a selective cytotoxic activity. PDT is currently indicated for treatment of actinic keratosis, basal cell carcinoma, and squamous cell carcinoma in situ (Bowen’s disease) [7]. PDT has also been proposed for the treatment of several nonneoplastic dermatological diseases like photo-aged skin, leishmaniasis, hidradenitis suppurativa (HS), sebaceous hyperplasia, and acne vulgaris. Moreover, some studies have demonstrated that endothelial cells generate protoporphyrin IX from photosensitizers and PDT has the ability to destroy vascular endothelial cells both in vitro and in vivo [8]. In addition, VEGF expression was downregulated following ALA-PDT treatment in mice [9]. Recently, PDT has been effectively used to treat vascular lesions such as port-wine stains, Kaposi’s sarcoma, and pyogenic granuloma [10]. Because of PDTanti-inflammatory and selective action and modulation on granulomatous process and on vascularization, we decided to utilize this treatment modalities in four patients with PGL induced during anti-EGFR-therapy previously treated with topical high-potency corticosteroides in occlusive, and on phenolization at 16% (two patients in treatment with afatinib, one in treatment with lapatinib, and one with erlotinib). * G. Fabbrocini gafabbro@unina.it

A Dermatological Questionnaire for General Practitioners with a Focus on Hidradenitis Suppurativa

BACKGROUND: Hidradenitis suppurativa (HS) is a skin chronic inflammatory disease typically located in several areas such as perianal, inguinal and axillary regions. In 40% to 70% of cases, general practitioners (GPs) are the first health care professionals consulted by patients suffering from HS. The role of GPs in HS management could be more substantial than it has been in the past. AIM: We developed a questionnaire to assess the knowledge of HS by GPs and to evaluate if in their perception the dermatologist is the reference medical doctor for pathology above. METHODS: The data were processed by a univariate descriptive statistical analysis. RESULTS: Our study showed GPs could recognise patients affected by HS. They have proven to know the main features of HS. Nevertheless, the second part of the questionnaire has highlighted the considerable confusion of GPs about who the reference figure is. CONCLUSION: The data registered regarding therapy and follow up too, only show a mild preponderance of dermatologist compared to other professional figures, such as a surgeon, GPs and plastic surgeon.

Anti-TNF-α therapy modulates mTORC1 signalling in hidradenitis suppurativa

Hidradenitis Suppurativa (HS) is a chronic, inflammatory, recurrent and debilitating skin disease of the hair follicle, which usually occurs after puberty with painful, deep-seated, inflammatory lesions in the apocrine gland-bearing areas of the body, most commonly in axillary, inguinal and anogenital regions This article is protected by copyright. All rights reserved.

Confocal microscopy can assess the efficacy of combined microneedling and skinbooster for striae rubrae

ABSTRACT Striae distensae or stretch marks are dermal scars characterized by flattening and atrophy of the epidermis. They develop particularly during adolescence but they can also appear in other situations such as pregnancy, the use of prolonged therapies with topical or systemic corticosteroids, Cushing’s syndrome, Marfan’s syndrome, prolonged use of lightening creams, cachexia, rapid weight loss or the use of androgenic and anabolic substances. Treatment options often take a long time, and the results are often disappointing, causing significant psychological distress in patients. We propose a completely innovative approach, combining the skinbooster technique with the microneedling technique. These minivasive methods work by inducing tissue remodeling and stimulating the synthesis of new collagen. Confocal microscopy can show and follow the skin changes made by these therapies, thus becoming an important and valid therapeutic monitoring tool for aesthetic dermatology.

Female pattern hair loss: A clinical, pathophysiologic, and therapeutic review

Female pattern hair loss (FPHL) is the most common form of alopecia in women. Affected women may experience psychological distress and impaired social functioning. Early diagnosis and initiation of treatment are desirable because treatments are more effective to avoid the progression of hair loss than stimulating regrowth. Typically, a diagnosis of FPHL can be confirmed by review of a patients medical history and a physical examination alone. Testing a scalp biopsy is diagnostic but usually not required. In women with signs of hyperandrogenism, an investigation for ovarian or adrenal disorders should be performed. Treatment for FPHL is obscured by myths. The aim of FPHL treatment could be two-fold: Reverse or stabilize the process of hair follicle miniaturization. Mild-to-moderate FPHL in women can be treated with oral antiandrogen therapies (cyproterone acetate and spironolactone) and/or topical minoxidil with good results in many cases. If used correctly, available medical treatments arrest the progression of the disease and reverse miniaturization in most patients with mild-to-moderate FPHL. Hair systems and surgery may be considered for selected cases of severe FPHL.