Maria Chiara Mauriello

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.

Chronic Obstructive Pulmonary Disease in Farmers: A Systematic Review

Objective: Chronic obstructive pulmonary disease (COPD) is a significant public health problem but it is unclear whether agricultural work causes an increased risk of disease. The aim of this review was to study COPD risk among farmers and analyze occupational exposures in agricultural workplaces. Methods: A systematic literature search was conducted to identify epidemiological studies investigating COPD prevalence in farmers. Results: In the 14 studies reviewed, COPD prevalence ranged from 3% to 68% due to different characteristics of study population, working activities, case definition/diagnosis. Livestock farmers were at higher risk and significant associations were observed for exposure to organic dusts, endotoxins, mites, ammonia, and hydrogen sulfide. Conclusions: Farming work was associated with greater risk of developing COPD. However, considering the several variables that may influence the disease prevalence in farmers, we suggest the adoption of a standardized research strategy.

Procedure e tecniche diagnostiche in dermatologia

Di fronte a casi dermatologici di difficile risoluzione clinica, ci si puo avvalere di tecniche diagnostiche specifiche per il tipo di patologia in esame. Poiche con il progresso delle conoscenze e delle tecnologie il numero degli esami disponibili e considerevolmente aumentato, sara compito del medico specialista individuare coscienziosamente il percorso diagnostico da consigliare evitando di prescrivere costose e superflue metodiche laboratoristiche. Vengono di seguito descritte le tecniche diagnostiche di uso piu frequente in dermatologia e le loro applicazioni (Tabella 9.1).

Il Corpo Ritrovato: Dermocosmetological Skin Care Project for the Oncologic Patient

Neoplastic disease and its therapeutic options have a huge impact on the patients quality of life from both the emotional and the working point of view. The project “Il Corpo Ritrovato” aims at creating an interdisciplinary network of physicians to improve the quality of life of the oncologic patient, focusing on such important aspects as dermocosmetological skin care but also on the evaluation of new therapeutic and diagnostic algorithms in order to make further progress in the field of prevention.

A New Classification and Clinical Predictivity for Some Naevus Variants

Background. The incidence of cutaneous melanoma is rapidly increasing in Europe. Active research is directed toward the identification of naevi as a risk factor. Objective. The aim of our case-control study was to observe different numbers of moles and different mole typology associations in order to evaluate clinical predictivity and to establish a new classification for some naevus variants. Methods. A case-control study was carried out, enrolling 64 cases affected by melanoma and 183 controls, between October 2009 and February 2011. Each patient was interviewed and subjected to clinical examination. The resulting data were analysed using the statistical elaboration program SPSS 16.0. Results. The association of target naevus with other variants increases the degree of risk (target + small brown Odds Ratio 5.25; confidence interval 1.8–15.4); (target + small brown + small black + large brown odds ratio 5.0; confidence interval 1.1–22.4). Therefore, other variants and/or other variant combinations do not significantly increase risk. Conclusion. People presenting two naevus variants in association with other naevus variants seem to run a major risk. The general nonuniformity of the whole naevus panorama should be carefully considered.