Michela Castello

Useful treatment of vitiligo in 10 children with UV-B narrowband (311 nm).

Abstract:  We report our experience with UV‐B narrowband (UV‐B–NB) therapy in children affected by vitiligo. We studied 10 Caucasian Italian children (six boys, four girls, mean age 9.7 years ± 2.67). Treatment mean term was 5.6 months; frequency was three times a week on nonconsecutive days or only twice a week, because of school or family duties. The percentage of repigmentation was evaluated by comparing photographs taken before, during, and after the treatment, and showed a repigmentation level higher than 75% in five patients (5/10, 50%) and between 26% and 75% in three patients (3/10, 30%). Of our patients, 80% had a satisfactory response to phototherapy. Adverse events were limited and transient. No significant relationships between repigmentation grades and variables such as skin type, positive family history, and disease extension were observed. Some areas responded better than others; the best results were shown on the face and neck. Perhaps we studied too few patients to be conclusive, but the results obtained so far seem to indicate that children affected by recent vitiligo have a better response to the therapy. We feel that UV‐B–NB therapy is a valuable and safe option for the treatment of pediatric vitiligo, and should be started as soon as possible.

GM-CSF contributes to prompt healing of ecthyma gangrenosum lesions in kidney transplant recipient

BACKGROUND Ecthyma gangrenosum (EG) is an unusual, potentially fatal cutaneous disease, commonly associated with Pseudomonas aeruginosa septicemia. CASE REPORT We report the case of a 61-year-old man admitted to the Nephrology Department for fever, leukopenia and inguinal and scrotal painful lesions. Physical examination revealed inguinal and scrotal macules, nodules, blisters and ulcers with central necrosis. P. aeruginosa was isolated from an ulcer. EG was diagnosed. Because of the severe leukopenia, granulocyte-macrophage colony-stimulating factor (GM-CSF) was administered until the white blood cell count significantly increased. Based on antibiogram, intravenous ceftazidime and teicoplanin were given for 11 days. Cutaneous manifestations were completely healed in about 2 months. CONCLUSION We suggest that the combination of GM-CSF with appropriate antibiotics can resolve EG and avoid or minimize the risk of septicemia in immunosuppressed patients.

Mycosis fungoides in childhood: Description and study of two siblings

Primary cutaneous T-cell lymphomas are exceedingly rare in children and adolescents. However, mycosis fungoides (MF) is the most frequent primary cutaneous lymphoma diagnosed in childhood. Two cases of MF in siblings (a 14-year-old boy and his 10-year-old sister) are reported. On the basis of clinical features (histopathological and immunophenotypical findings) a diagnosis of MF patch lesions was made in both siblings. Since recent data in the literature have underlined a high frequency of the HLA-DQB1*03 allele in patients with familial MF (including child patients), the HLA profile of the patients was analysed, indicating the presence of a haplotype (HLA-DQB1*03,*03 in the girl, HLA-DQB1*02,*03 in the boy) corresponding with that described in recent literature. Two rare and exceptional cases of MF in siblings are reported, highlighting the presence of a peculiar haplotype.

White sponge naevus: una rara patologia del cavo orale

White sponge naevus (WSN) is a rare, benign, autosomal dominant disorder that involves non cornifying stratified squamous epithelia: predominantly the oral mucosa, less frequently nose, oesophagus, anogenital area. This is an inherited condition, but in literature we can find also case report with negative familial background. Clinically it is characterized by asymptomatic, bilateral, white, soft and spongy plaques in the oral mucosa and the onset is usually in early childhood. The histological features include epithelial thickening, parakeratosis and vacuolization of the suprabasal layer of oral epithelial keratinocytes. In 1995 Richard et all and Rugg et all show that mutation in the mucosal K4 and/or K13, the specific keratins of the buccal, nasal, esophageal mucosae and anogenital epithelia, is associated with WSN. Even if it is a benign condition, it is important to make a differential diagnosis from other white lesions of the oral mucosa, that are potentially malignant. No standard treatment exists, although numerous therapies have been tested. We report a case of a young female patient who presents oral WSN, treated successfully with topical tetracycline; in our case we have used tetracycline ophthalmic cream, because in Italy there is no tetracycline solution.

Erythema nodosum in kidney transplant recipient: A rare complication of pneumonia treatment

M. Gregorini, M. Castello, T. Rampino, P. Esposito, R. Rosso, G. Borroni, A. Dal Canton. Erythema nodosum in kidney transplant recipient: a rare complication of pneumonia treatment. Transpl Infect Dis 2011. All rights reserved

Studio retrospettivo di 232 pazienti con orticaria cronica: inquadramento clinico-diagnostico

L’orticaria cronica e una forma di orticaria che persiste per piu di sei settimane. In questo termine vengono incluse l’orticaria fisica, l’orticaria cronica idiopatica e l’orticaria vasculite. L’orticaria fisica rappresenta il 35%, e l’orticaria vasculite rappresenta il 5%; la maggior parte dei casi (60%) non riconosce una causa scatenante evidenziabile ed e tradizionalmente definita idiopatica. Di questa forma circa il 45% e risultata essere autoimmune. Lo scopo dello studio e quello di individuare le migliori procedure clinico-diagnostiche per identificare i meccanismi scatenanti un’orticaria cronica. Abbiamo sottoposto 232 paziente a test di screening allergologici e ne e emerso che il 45% delle forme di orticaria sono IgE mediate, mentre il restante 55% include le forme di orticaria non IgE mediate. Nei pazienti affetti da forme non IgE mediate e stata valutata la risposta ad una dieta priva di additivi alimentari per un periodo di due mesi, e sono stati valutati gli esami di screening per l’orticaria. Ne e emerso che circa il 46% dei pazienti risponde positivamente alla dieta. Dagli esami screening, invece, sono risultati di particolare rilevanza i dati laboratoristici riguardanti l’autoimmunita. Quindi, i risultati ottenuti indicano che lo screening generale deve essere riservato ad un gruppo selezionato di pazienti, sulla base dei dati clinico-anamnestici e dei risultati ai principali test allergologici. E necessario ricordare l’importanza di una dieta priva di additivi prima di sottoporre i pazienti ad indagini di screening.

Intolleranze alimentari: tra mito e realtà

Le intolleranze alimentari si possono definire come reazioni alimentari ritardate, il cui meccanismo non e ancora completamente noto. La diagnosi puo essere fatta attraverso diverse metodiche. Lo scopo del nostro studio e quello di valutare il test Alcat nelle intolleranze alimentari, e l’efficacia della dieta che ne consegue in termini di miglioramento della sintomatologia. I pazienti testati sono stati suddivisi in due gruppi sulla base della sintomatologia riferita: di tipo gastrointe-stinale o cutanea. Sono stati esclusi pazienti con positivita ai test allergologici alimentari, e quelli in trattamento con farmaci che possono alterare il risultato del test (antistaminici, cortisonici sistemici, anticoagulanti). Una volta ottenuto il referto abbiamo impostato una dieta di eliminazione da seguire per un mese. Nel primo gruppo, formato da 33 pazienti affetti da disturbi gastrointestinali, il 58% ha riferito un migliora-mento della sintomatologia. Mentre nel secondo gruppo, a cui appartengono 20 pazienti affetti da manifestazioni cutanee, l’86% ha riferito un miglioramento. Sulla base dei nostri dati preliminari sembra che l’Alcat test abbia una discreta capacita nell’individuare alimenti non tollerati, con la conseguente possibilita di impostare una dieta corretta. Tuttavia, dallo studio non emerge se il miglioramento e stato duraturo, o se i disturbi di cui soffriva il paziente si sono ripresentati.

Allergeni emergenti nella dermatite allergica da contatto

La dermatite allergica da contatto (DAC) e una patologia infiammatoria della cute; e una reazione di ipersensibilita cellulo-mediata (tipo IV) verso antigeni esogeni. La diagnosi viene fatta tramite i patch test; in particolare, presso il nostro ambulatorio viene utilizzata la serie Sidapa aggiornata annualmente. La letteratura riporta l’occasionale positivita dei test ad allergeni “emergenti”, importanti per la loro diffusione d’uso. Presentiamo, quindi, una revisione della letteratura su tali allergeni che normalmente non vengono testati negli amubulatori di Allergologia Dermatologica. Quello che emerge e che questi allergeni andrebbero testati in modo routinario; comunque, andrebbero testati in tutti quei casi in cui i dati anamnestici possano indicarci una loro importanza nel determinare la patologia. Inoltre, risulta che antigeni gia noti, e attualmente testati in modo routinario, sempre piu frequentemente si ritrovano in numerosi prodotti rappresentando un problema per i pazienti con allergia gia nota.

Studio preliminare sull’utilizzo degli Atopy Patch Test nella diagnosi della dermatite atopica

Atopic dermatitis is a chronic relapsing dermatitis evolving, with clinical, morphological and topographical characteristics for each age, due to the interaction between genetic factors (predisposing) and environmental factors (triggers). The pathogenesis of the disease is not yet known; unlike previously believed, has now been shown that in the pathogenesis, in addition to the known type I immunological reaction, comes in an immune cell-mediated type IV. For this reason it has become increasingly common practice of testing epicutaneous, using as allergens substances known to be held liable for allergic reactions of type I, the Atopy Patch Test. Our study aims to assess the utility, reproducibility and safety in using these tests for diagnostic analysis of atopic dermatitis. The results obtained confirm the usefulness of this test in understanding the mechanism of allergy in atopic subjects and to define the clinical relevance of allergens in triggering atopic dermatitis. By the results obtained we can say that the usefulness of this test seems more obvious to environmental allergens that food allergens, according to reports in the literature.

Eruzione vescicolo-bollosa in un bambino

We report the case of a 3 years old man who presented vesiculobullous lesion localized on the arms, on the legs and on the palmar region. Laboratory findings (Ab antigliadina, BP180, BP230, indirect immunofluorescence), RAST and IgE were done. Antibody assay and indirect immunofluorescence were negatives; IgE were elevated, some allergens were positives, stings of some insect were markedly positives. Clinical laboratory data, familiary anamnesis for atopia and the stagionality of the lesions has make possible diagnosis of stings insect ipersensibility.