Marta Tramontana

Indoor dermatitis due to Aeroglyphus robustus.

DEAR EDITOR, Aeroglyphus robustus is an astigmatid mite described initially by Banks in 1906 and called Glycyphagus robustus. In 1941 Zachvatkin described and called the subfamily Aeroglyphinae and the genus Aeroglyphus. He considered this mite of Canadian origin to be the same as the European species A. peregrinans (Berlese, 1892), and he upgraded the subfamily Aeroglyphinae to family Aeroglyphidae. It was only in 1959 that Cooreman described A. robustus in detail, distinguishing it morphologically from A. peregrinans. At present, in the Italian acarofauna, A. robustus is not present in the family Aeroglyphidae, and its pathogenic role in humans has never been described before. The taxonomy of A. robustus is order Astigmata, suborder Acaridia, superfamily Glycyphagoidea, family Aeroglyphidae. A 57-year-old nonatopic healthy man was referred for an itchy rash with small and isolated erythematous papules, some with pinhead-shaped central tense vesicles and some excoriated and covered by small crusts. The lesions initially involved the extensor surface of the forearms and the sides of the trunk (Fig. 1); after 1 week they spread to the upper and lower limbs. The patient’s wife showed similar skin lesions. They had no other systemic symptoms, and physical examination was otherwise unremarkable. The patient was a farmer, and 1 5 months earlier he had brought home two large bags of grain, cramming them in at the entrance. The grain, of unknown origin, had been collected from a container located near the patient’s house. The patient and his wife were treated with oral cetirizine (10 mg per day) and desoximetasone ointment, with partial reduction of itching and skin lesions within 10 days. Domestic ectoparasitosis was suspected. In order to verify it, sawdust collected from all of the rooms and the grain bags was examined with E.D.P.A. (Esame Diretto Polveri Ambientali), patented by one of the authors. Briefly, dust samples were collected by broom and dustpan from the floor of the home’s rooms and labelled in small containers. After microsieving, sedimentation or flotation, pathogen arthropods and their specific traces (fragments, exuviae, bristles, faeces) were observed with a stereomicroscope and prepared and mounted on slides in warm Berlese solution for direct observation by optical microscope. The dust sample collected from the grain bags was twice as rich in weeds/pests as those collected from the rooms of the house. However, in both samples A. robustus was identified, with several adults (Fig. 2a) and immature forms (protonymphs, nymphs, larvae). Aeroglyphus robustus is morphologically characterized by dorsally tuberculate idiosoma covered by numerous idiosomal multibranched bristles shaped like wheat plugs and, in particular, by two very long opisthosomal bristles in the female (Fig. 2b). The so-called hypopial deutonymphs of A. robustus were also identified (Fig. 2c); they are typical forms of resistance to untoward environmental conditions. Inspection of the house showed the presence of moulds of the genera Penicillium and Aspergillus, in a high relative humidity (85%), on some north-facing walls. The patient tried to eliminate the house infestation using an aerosol automatic spray insecticide based on cyfluthrin. This approach turned out to be ineffective because the mites hide where the insecticide does not reach them and because of the presence of the resistant form (hypopial deutonymph). In fact, a new E.D.P.A. examination showed vital adults and immature forms of A. robustus. Intervention by a pest-control company was then required and the domestic environment was fumigated with cyphenothrin. Immediately the patients’ skin lesions improved, but after 2 weeks similar new skin lesions in the farmer and his wife appeared again. Probably, hypopial

Pyodermatitis-pyostomatitis vegetans and antibullous pemphigoid antigen 180 autoantibodies: a casual association?

cases of HS, including in an open-label pilot study with six patients. Only one recent article has reported its failure (in a patient with a stage III Hurley disease). In conclusion, we have presented two cases of severe HS without response to, and, indeed, worsening with, anakinra treatment. In our opinion, further clinical trials are necessary to evaluate the efficacy profile of anakinra in patients with HS.

The role of personalized Interventional Radiotherapy (brachytherapy) in the management of older patients with non-melanoma skin cancer

OBJECTIVE Non-melanoma skin cancer (NMSC) has been rapidly increasing in incidence over the past 30 years. Mainstays of treatment remain surgery and radiotherapy, particularly in older and/or frail patients (≥75 years old) that often require a personalized treatment strategy using innovative biotechnologies. High-dose-rate interventional radiotherapy (HDR-IRT) seems to be an excellent option for NMSC. MATERIAL AND METHODS Nineteen aged patients with advanced, biopsy proven NMSC were treated with exclusively HDR-IRT. A personalized double-layer mould of thermoplastic mask material was applied to the skin surface. Plastic tubes were fixed on the mould in appropriate geometry over the target area. Planning computed tomography (CT) images were acquired with 2.5 mm slice thickness and transmitted to the planning system. Treatment intention was to deliver ≥95% of the prescribed dose to the Planning Target Volume (PTV), accepting 90% as satisfactory. Toxicities were assessed using the Common Terminology Criteria for Adverse Events scale (CTCAE) v. 4.0. RESULTS Median age was 86 years. Acute toxicity: Grade 2 erythema appeared in all 19 patients. Towards the end of each treatment schedule, epidermolysis developed which was resolved within 6 weeks of completing HDR-IRT. Late toxicity: Grade 1 skin atrophy, pigmentation changes and alopecia in field were observed in all patients. At last follow-up, all patients were disease free. CONCLUSIONS Personalized HDR-IRT appears to be safe and effective for frail older patients and a valid alternative to supportive care for those with contraindication to surgery. Future investigations using also large database analysis seem to be advisory.

Flare-up of previously negative patch test and intradermal test with amoxicillin after oral provocation

Section of Clinical, Allergological and Venereological Dermatology, Department of Medicine, University of Perugia, Perugia, Italy Correspondence Dr Luca Stingeni, Department of Medicine, Section of Clinical, Allergological and Venereological Dermatology, University of Perugia, 06156 Perugia, Italy. Email: luca.stingeni@unipg.it

Systemic delayed hypersensitivity reaction to chlorambucil: a case report and literature review: DELAYED HYPERSENSITIVITY TO CHLORAMBUCIL

Conflict of interest: The authors declare no conflict of interests. Chlorambucil is an alkylating agent and a stable derivative of nitrogen mustard. It is primarily used for the treatment of several chronic lymphoproliferative diseases. The drug is generally well tolerated. Significant acute toxicities are dose-related bone marrow depression (leukopenia and thrombocytopenia), gastrointestinal tract symptoms (anorexia, nausea, and vomiting), and neurotoxic manifestations. Cutaneous adverse drug

Occupational allergic contact dermatitis with secondary spreading from vitamin k3 sodium bisulphite in a pig farmer.

1. Thyssen JP, Linnebery A, Menné T, et al. The epidemiology of contact allergy in the general populationYprevalence and main findings. Contact Dermatitis 2007;57(5):287Y299. 2. Leis Dosil VM, Cabeza Martinez R, Suarez Fernandez RM, et al. Allergic contact dermatitis due to manganese in an aluminum alloy. Contact Dermatitis 2006;54(1):67Y68. 3. Tuchinda P, Liu Y, Tammaro A, et al. Resolution of occupational dermatitis related to manganese exposures. Dermatitis 2014;25(5): 280Y281. 4. Takazawa K, Ishikawa N, Miyagawa H, et al. Metal allergy to stainless steel wire after coronary artery bypass grafting. J Artif Organs 2003;6 (1):71Y72. 5. Santucci B, Cannistraci C, Cristaudo A, et al. Multiple sensitivities to transition metals: the nickel palladium reactions. Contact Dermatitis 1996;35(5):283Y286.