Michela Magnano

Contact allergens and irritants in household washing and cleaning products.

Background: Household cleaning products often contain potential allergens and irritants but allergic contact dermatitis from these products in general consumers is rarely reported in the literature.

Analysis of current data on the use of topical rapamycin in the treatment of facial angiofibromas in tuberous sclerosis complex.

Tuberous sclerosis complex (TSC) is an autosomal dominant neurocutaneous syndrome causing hamartomatous growths in multiple organs. Facial angiofibromas occur in up to 80% of patients and can be highly disfiguring. Treatment for these lesions has historically been challenging. Recently, topical rapamycin has been proposed as an effective option to treat angiofibromas but a commercially available compound has not yet been developed.

Malignancies in bullous pemphigoid: A controversial association.

Bullous pemphigoid (BP) is an autoimmune subepidermal blistering disorder that has been reported to be associated with malignancies. Some authors described several cases of pemphigoid associated with malignancies (PAM); however, the evidence of this correlation still remains controversial. Several theories have been postulated to explain the relationship between malignant neoplasms and BP; the main theory suggests that antibodies directed against tumor‐specific antigens of malignant cells may cross‐react with antigens (like BP antigens) in the basement membrane zone leading to the formation of blisters. We performed an extensive review of the English published work focusing on the epidemiology, the pathogenetic theories and the clinical and histological aspects of the disease. We identified 40 cases of PAM: of these, seven cases were associated with hematological malignancies and 33 with solid tumors. Physicians should be aware of the existence of PAM and we suggest an oncological screening in early‐onset pemphigoid, in patients with a former oncological history, in those with signs and symptoms that could be related to a neoplasm and in BP refractory to common immunosuppressive therapy.

Sex and the PASI: patients affected by a mild form of psoriasis are more predisposed to have a more severe form of erectile dysfunction

Psoriasis is a multi‐systemic disease involving the skin and joints, but it is also characterized by endothelial dysfunction, which may cause sexual impotence and erectile dysfunction (ED), an embarrassing disease frequently neglected by dermatologists.

Nail involvement as a negative prognostic factor in biological therapy for psoriasis: a retrospective study.

Psoriasis (Pso) has a strong impact on quality of life and a positive association has been reported between nail psoriasis (NP) and more severe disease, together with a longer duration of skin lesions. The treatment of NP represents a challenge and biological therapy can be recommended for severe disease.

Methyl-aminolevulinic acid photodynamic therapy for actinic keratoses: a useful treatment or a risk factor? A retrospective study.

Abstract Introduction: Photodynamic therapy (PDT) is a non-invasive treatment, used for superficial non-melanoma skin cancer (NMSC) and actinic keratoses (AKs). Although PDT is considered a safe treatment, some authors report that PDT may have carcinogenic risks. We undertook this retrospective study to determine if there is a real risk of carcinogenicity for patients treated with MAL-PDT for AK and which risk factors may increase the rate of the malignant transformation. Methods: We reviewed the records of patients treated with PDT for one or more AKs at the Sant’Orsola-Malpighi Hospital from January 2010 to December 2012. We also considered if patients had one or more risk factors for NMSC. Results: Three hundred fifty-seven patients were treated with PDT for AKs, among them 17 patients developed a squamous cell carcinoma (SCC) in the site of a lesion previously treated with PDT. Comparing these two groups, the group which developed the SCC presented more risk factors for NMSC. Conclusion: PDT is certainly a good method to treat AKs, but it is important also to consider all its side effects. Among them, the carcinogenetic risk is still underestimated. We suggest that patients with multiple risk factors for NMSC treated with PDT should undergo more frequent follow-ups, in order to prevent malignant progression.

Photodynamic therapy with 5-methylaminolevulinic acid in the treatment of multiple warts of the face

The facial flat wart is caused by human papilloma virus and these lesions may be observed on the face, dorsal hands and shins. Although different therapies, such as keratolytic agents, topical immunomodulators and radical measures, have been used for multiple warts of the face, the results may be troublesome (1). In fact, all these treatments may be painful, not successful and there are numerous relapses. Photodynamic therapy (PDT) with topical photosensitizer application followed by irradiation with red light has been recently proposed for the treatment of viral warts. Side effects of this therapy are few: patients complained of moderate pain or burning sensation, and subsequent scars are usually not observed (2). We describe one case of multiple facial warts successfully treated with this method. A22-year-oldman(Fitzpatrickphototype3) came to our attention for recalcitrant andmultiple viral warts of the face lasting 1 year. He presented multiple warts, most of them situated on the beard area (Figure 1). He had developed few lesions after sun exposure, and subsequently the number of warts had increased. He did not have a history of immunodeficiency. After a month of the use of 80% trichloroacetic acid and 0.05% isotretinoin solution to reduce the thickness of lesions, we used MAL-PDT: we applied the MAL with occlusive dressing technique for 2 h and then used a red light source (630 nm, 37 j/cm – Aktilite CL128 LED) for 8 min. The lamp-to-skin distance was 5 cm. After the first session, the patient showed a clearance of the 60% of warts. The second session of PDT was performed after a month with the same modalities. After two sessions of PDT, the patient achieved a complete clearance of the warts (Figure 2). We did not notice any severe reaction or side effect, except transient local erythema. The patient complained only mild burn sensation, moderate pain and some pustules. A biopsy performed 1 month after this treatment did not show any sign of wart. After a year of follow-up, he did not present recurrences. The PDT consists in the topical application of the 5-aminolevulinic acid (ALA) or its methyl ester (5-methylaminolevulinic acid or MAL), followed by irradiation with red light: this process results in the creation of free radicals able to destroy diseased tissues (2). PDT is a method usually employed for the treatment of non-melanoma skin tumors, in particular actinic keratosis, superficial basal cell carcinoma and Bowen disease, and some inflammatory dermatoses (3). The use of PDT for facial plane warts has been reported in three studies (1,4,5), but in these studies the photosensitizer was ALA and this drug requires a longer incubation period (3–6 h) (1,5) and a longer time exposure (20 min) (5) to red light.

Methyl – aminolevulinic acid photodynamic therapy and topical tretinoin in a patient with vulvar extramammary Paget's disease

Extramammary Pagets disease is a rare neoplasm of apocrine gland‐bearing areas of the skin. The most common site of presentation is the vulva. Surgery is the most frequently reported therapy so far; however, it is invasive and it is complicated by a high rate of recurrence. For this reason, several less‐invasive treatments have been recently proposed, including photodynamic therapy. We describe in this article the case of an 84‐year‐old patient with a noninvasive vulvar extramammary Pagets disease successfully treated with methyl‐aminolevulinic acid photodynamic therapy associated with topical tretinoin.

Lentigines in previous psoriatic plaques in a patient treated with infliximab

ejd.2012.1818 Auteur(s) : Federico Bardazzi, Michela Magnano michela_magnano@virgilio.it, Valentina Angela Antonucci, Riccardo Balestri, Paola Sgubbi, Annalisa Patrizi Division of Dermatology, University of Bologna, via Massarenti 1, 40138, Bologna, Italy Hyperpigmented lesions, confined to a healing psoriatic plaque, have been reported in the literature and are described as lentigines, naevus spilus-like or with speckled pigmentation [1]. These lesions often appeared after the use of phototherapy, [...]

Secukinumab in multi-failure psoriatic patients: the last hope?

Abstract Psoriasis is a multi-systemic chronic inflammatory disease that affects about 1.5–3% of the general population, of which almost 20% suffer from a moderate-severe form. Those patients can be treated with a systemic agent and in case of scarce response or contraindications, they may require a biologic therapy, such as tumor necrosis factor or interleukin-12/23 inhibitors. When also these agents fail, clinicians face a true therapeutic challenge. We report a case series of multi-failure 16 patients, successfully treated with secukinumab, a human monoclonal antibody that selectively neutralizes interleukin-17 A and is recently approved for the treatment of plaque psoriasis, psoriatic arthritis, and ankylosing spondylitis.