Michelangelo Vestita

Psoriasis and cardiovascular disease.

Current epidemiological data support the association between psoriasis and cardiovascular (CV) risk, in apparent correlation with psoriasis severity. Although less unanimously, evidence of an increased prevalence of CV diseases among psoriasis patients has been reported, including ischemic heart disease, cerebrovascular, peripheral vascular and heart structural disorders. In particular, various studies showed a correlation between psoriasis and major CV events (i.e., myocardial infarction, stroke), while others investigated subclinical changes of blood vessels, such as intima‐media thickness increase, arterial stiffness and coronary artery calcification. A series of different mechanisms, like traditional CV risk or iatrogenic risk factors, inflammation, hemostasis dysregulation, hyperhomocysteinemia, and shared genetic susceptibility, are thought to underlie this epidemiological association. Among these elements, inflammation and its related cytokine milieu, including Th1‐mediated response and Th17/Treg imbalance, C reactive protein and the newly implicated osteopontin are considered to play a primary role, even if yet to be fully understood.

Can early treatment with biologicals modify the natural history of comorbidities

Psoriasis is associated with many burdening comorbidities, which often share similar pathogenic features and follow a progressive pattern. Some of them, such as psoriatic arthritis (PsA) and cardiovascular diseases, are frequently delayed steps of the “psoriatic march,” mostly developing after the appereance of cutaneous lesions. Biological agents targeting tumor necrosis factor (TNF) constitute a relatively new and efficient approach to psoriasis. Enticing but somewhat unclear data are available regarding the effects of anti‐TNFs on psoriasis comorbidities, ranging from pathomechanisms to clinical outcomes. The ability of anti‐TNF drugs to inhibit the structural damage in PsA supports the feasibility of a preventive action on PsA development. In general, effective suppression of inflammation appears to have a key role in preventing some comorbidities. This article briefly reviews the current literature, evaluating possible effects of anti‐TNF drugs on the natural history of psoriasis comorbidities. Although further studies are needed, noteworthy considerations can be drawn.

An overview of delayed pressure urticaria with special emphasis on pathogenesis and treatment

Delayed pressure urticaria (DPU) is a physical urticaria characterized by the development of deep swellings at sites of pressure application on the skin. Etiopathogenesis of DPU is still unknown, although the available evidence suggests the involvement of mast cells through non‐immunologic mechanisms and the role of several mediators beyond histamine, such as proinflammatory cytokines. The management of DPU is complex, also considering that prevention is very difficult and DPU frequently coexists with chronic “idiopathic” urticaria. Moreover, H1‐antihistamines, which are the mainstay of treatment for common urticaria, usually provide less satisfactory results as compared with other urticarias. Therefore, numerous treatment alternatives have been proposed for severe refractory cases, such as oral or topical corticosteroids and various drugs with anti‐inflammatory effects.

Alcohol, psoriasis, liver disease, and anti-psoriasis drugs.

Over the last years, data have been accumulating regarding a possible association between alcohol and psoriasis. While it is still unclear whether alcohol misuse represents a true risk factor or merely an epiphenomenon of the cutaneous disease, a number of studies support the role of ethanol and its metabolites as triggering factors of psoriasis. A drinking habit also appears to exacerbate a preexisting psoriasis, and the magnitude of alcohol consumption may be related to both a higher incidence and severity of psoriasis. Evidence also shows that deaths from alcohol‐related causes are significantly more frequent in patients with psoriasis than in normal controls. Alcohol consumption may adversely affect psoriasis through multiple mechanisms, such as increased susceptibility to infections, stimulation of lymphocyte and keratinocyte proliferation, and production of proinflammatory cytokines. Moreover, alcohol misuse can predispose to a greater risk of liver disease and potential drug interactions. Alcoholic and non‐alcoholic liver diseases have both been found to be common in psoriatic patients. Tumor necrosis factor (TNF)‐alpha, a key cytokine in psoriasis pathogenesis, has been found to have a crucial role in alcoholic hepatitis, and small preliminary studies have evaluated the effect of anti‐TNF therapy in this condition. However, the use of anti‐TNF‐α drugs in alcoholic hepatitis is still controversial and needs to be further investigated. In this review, the relationship between alcohol and psoriasis will be reviewed and discussed, taking also into account recent findings related to liver disease and therapeutic implications.

Noneczematous Contact Dermatitis

Irritant or allergic contact dermatitis usually presents as an eczematous process, clinically characterized by erythematoedematovesicous lesions with intense itching in the acute phase. Such manifestations become erythematous-scaly as the condition progresses to the subacute phase and papular-hyperkeratotic in the chronic phase. Not infrequently, however, contact dermatitis presents with noneczematous features. The reasons underlying this clinical polymorphism lie in the different noxae and contact modalities, as well as in the individual susceptibility and the various targeted cutaneous structures. The most represented forms of non-eczematous contact dermatitis include the erythema multiforme-like, the purpuric, the lichenoid, and the pigmented kinds. These clinical entities must obviously be discerned from the corresponding “pure” dermatitis, which are not associated with contact with exogenous agents.

Aquarium-borne Mycobacterium marinum skin infection. Report of 15 cases and review of the literature

Mycobacterium marinum is a non-tuberculous photochromogenic mycobacterium, commonly responsible for fish and amphibious infections world-wide. Contagion in humans typically follows minor hand trauma from aquarium keeping and manifests as a granulomatous infection of the skin. Dissemination is rare and almost exclusive to immunosuppressed hosts. 15 cases of M. marinum fish tank related infection are hereby reported. The site of infection was the upper limbs in all cases. 3 patients presented a single papulo-verrucous lesion, while the remaining 12 showed a sporotrichoid clinical pattern. Diagnosis was reached by history and clinical examination and further supported by one or more of the following criteria: histology, culture, acid fast bacilli identification from histologic specimen and PCR. 2 to 3 months minocycline treatment showed efficacy in 13 individuals, another case was treated with rifampicin-isoniazid association, yet another showed spontaneous regression over a 3 month period.

Skin Reactions to Pine Processionary Caterpillar Thaumetopoea pityocampa Schiff

Pine caterpillar, Thaumetopoea pityocampa Schiff, is a phyto- and xylophagous lepidopteran, responsible for the delay in the growth or the death of various types of pines. Besides nature damage, pine caterpillar causes dermatological reactions in humans by contact with its irritating larvae hairs. Although the dermatitis occurs among outdoor professionals, it is primarily extraprofessional. Contamination generally occurs in pinewoods, rarely in cities. Means of contamination comprise direct contact with the nest or the processional caterpillar and indirect contact with air dispersed hairs. The dermatitis is generally observed in late spring and particularly from April to June, among campers and tourers. The eruption has its onset 1–12 hours after contact with the hairs and presents with intense and continuous itching. Morphologically, it is strophulus-like and consists of papulous, excoriated, and pinkish lesions on an oedematous base. Diagnosis is usually straightforward. The pathogenetic mechanism of the affection is mechanical, pharmacological, and allergic in nature. Besides skin, T. pityocampa Schiff can involve the eyes and rarely the airways. Despite the considerable damages to humans and nature, pine caterpillar infestation is an underestimated problem; medical literature lists few studies, and often relevant information is referred to local media and popular wisdom.

Nummular eczema and contact allergy: a retrospective study.

BackgroundEtiopathogenesis of nummular eczema is obscure; many causative factors have been proposed. Only a few studies investigated the relevance of contact allergy. ObjectiveThis retrospective study aimed to investigate the role of contact allergy in the underlying mechanism of nummular eczema. MethodsFrom the 29,323 consecutive patients, we patch-tested for eczematous dermatitis of various type, 1022 (3.5%) with nummular eczema were enrolled. Data were collected for each patient, including age, sex, occupation, symptoms onset and duration, onset and spread sites, and clinical evidence or history of atopy. Histological analyses of acute phase lesions were carried out in some patients. ResultsPeak incidence of age at disease onset was found in the third decade of life. Predominant sites of lesions were upper (75.8%) and lower (64.5%) limbs, followed by trunk, dorsum of the hands, and face and neck. Three hundred thirty-two (32.5%) of 1022 patients showed positive reactions to 1 or more allergens. Highest sensitization rates were found with nickel sulfate (10.2%), potassium dichromate (7.3%), and cobalt chloride (6.1%). Histopathology showed less pronounced spongiosis in atopic subjects and the elderly. ConclusionsBecause this study demonstrates that contact allergy is common with nummular eczema, patch testing is strongly advisable in every patient with persistent nummular dermatitis.

Vitamin D and Atopic Dermatitis in Childhood

Vitamin D features immunomodulatory effects on both the innate and adaptive immune systems, which may explain the growing evidence connecting vitamin D to allergic diseases. A wealth of studies describing a beneficial effect of vitamin D on atopic dermatitis (AD) prevalence and severity are known. However, observations linking high vitamin D levels to an increased risk of developing AD have also been published, effectively creating a controversy. In this paper, we review the existing literature on the association between AD and vitamin D levels, focusing on childhood. As of today, the role of vitamin D in AD is far from clear; additional studies are particularly needed in order to confirm the promising therapeutic role of vitamin D supplementation in childhood AD.

In situ melanoma of the nail unit presenting as a rapid growing longitudinal melanonychia in a 9-year-old white boy.

Longitudinal melanonychia (LM) is a pigmented longitudinal band of the nail unit, which results from pigment deposition, generally melanin, in the nail plate. Such lesion is frequently observed in specific ethnic groups, such as Asians and African Americans, typically affecting multiple nails. When LM involves a single nail plate, it may be the sign of a benign lesion within the matrix, such as a melanocytic nevus, simple lentigo, or nail matrix melanocyte activation. However, the possibility of melanoma must be considered. Nail melanoma in children is exceptionally rare and only 2 cases have been reported in fairskinned Caucasian individuals.