Monica Corazza

Eyelid dermatitis: an evaluation of 447 patients.

BACKGROUND Eyelids can be affected by various types of dermatitis that are often difficult to diagnose. OBJECTIVE The aim of the study was to establish some guidelines for a correct diagnosis. METHODS A total of 447 patients treated at 12 research units for eczema or other inflammatory dermatitis located on the eyelids were invited to complete a questionnaire. When necessary, patch tests with haptens of the standard series from Gruppo Italiano di Ricerca sulle Dermatiti da Contatto e Ambientali della Società Italiana di Dermatologia e Venereologia (SIDEV-GIRDCA) were performed. RESULTS Of the subjects studied, 50.2 % were diagnosed with allergic contact dermatitis (ACD); 20.9% were affected by irritant contact dermatitis (ICD), 13.5% by atopic dermatitis, 6.3% by seborrheic dermatitis, 6.5% by aspecific xerotic dermatitis, and 2.3% by psoriasis. Approximately 91% of all subjects reported an absence of familial atopy. A significant statistical association between diagnosis type and a personal history of atopy was evident (p <.000001, chi-square test). The results of gradual logistic regression models showed four-eyelid involvement as the main risk factor for ACD (odds ratio [OR] = 3.0; 95% CI, 1.1-8.1); with ICD, the main risk factor was the onset of symptoms at between 2 and 6 months (OR = 2.1; 95% CI, 1.1-4.0), whereas for atopic dermatitis, the main risk factors were the onset of symptoms later than 6 months and a personal history of atopy (OR = 4.9 and 3.6, respectively). CONCLUSION Results suggest that many characteristics of the patients examined can be used for the differential diagnosis of palpebral eczematous dermatitis.

Primary Cutaneous CD30+ Large T-Cell Lymphoma in a Patient with Psoriasis Treated with Cyclosporine

We report the case of a 61-year-old woman who developed an anaplastic CD30+ cutaneous T-cell lymphoma during oral cyclosporine (CsA) therapy for recalcitrant psoriasis. Two months after CsA discontinuation, clinical and histological resolution of the lymphoma was observed. However, 3 years later extracutaneous involvement of the lymphoma could be detected. The association between CsA administration and the occurrence of the lymphoma may be casual, but a relationship with immunosuppression may also be hypothesized. We have reviewed all relevant data in the literature. To our knowledge, this is the first case of primary cutaneous CD30+ anaplastic large T-cell lymphoma in a patient treated with CsA for psoriasis.

Proactive maintenance therapy with a topical corticosteroid for vulvar lichen sclerosus: preliminary results of a randomized study.

The chronic and relapsing nature of vulvar lichen sclerosus (VLS) represents a challenge for its long‐term management after an effective treatment with topical corticosteroids.

Use of topical herbal remedies and cosmetics: a questionnaire-based investigation in dermatology out-patients.

Background Although topical remedies and cosmetics based on herbal ingredients are becoming increasingly popular with the public due to the perception that botanical compounds are safer and healthier than their synthetic counterparts, a large number of adverse cutaneous effects of plant extracts, notably contact sensitization, have been reported in medical literature.

First randomized trial on clobetasol propionate and mometasone furoate in the treatment of vulvar lichen sclerosus: results of efficacy and tolerability

A 3‐month topical application of clobetasol propionate (CP) represents the recommended and accepted first‐line treatment for vulvar lichen sclerosus (VLS); however, to date, no randomized controlled trials have compared the efficacy and safety of CP with other topical corticosteroids.

Surfactants, skin cleansing protagonists

The correct choice of cosmetic products and cleansers is very important to improve skin hydration, to provide moisturizing benefits and to minimize cutaneous damage caused by surfactants. In fact, surfactants may damage protein structures and solubilize lipids. Soaps, defined as the alkali salts of fatty acids, are the oldest surfactants and are quite aggressive. Syndets (synthetic detergents) vary in composition and surfactant types (anionic, cationic, amphotheric, non‐ionic). These new skin cleansing products also contain preservatives, fragrances, and sometimes emollients, humectants and skin nutrients. We present a revision of the literature and discuss recent findings regarding skin cleansers.

Vulvar lichen sclerosus: 11 women treated with tacrolimus 0.1% ointment.

Lichen sclerosus is a chronic relapsing disease, usually treated with ultra-potent corticosteroids. As immunological alterations are considered important aetiopathogenetic factors in lichen sclerosus, the new immunomodulating topical agents, such as tacrolimus and pimecrolimus, have been employed sporadically as alternative therapies. The aim of this study was to evaluate the therapeutic effects of tacrolimus 0.1% ointment in lichen sclerosus in 11 patients unresponsive or poorly responsive to previous treatments. Tacrolimus 0.1% ointment was applied twice daily for 6 weeks, then tapered over a further 6 weeks. Symptoms and objective parameters were evaluated and quantified at the start, after 6 weeks, at the end of the topical treatment, and at follow-up visits. Improvement or remission of symptoms was observed in the patients who completed the study, while objective parameters were poorly influenced and often were not related to symptom behaviour. Topical tacrolimus can be considered an alternative treatment for lichen sclerosus.

Chemical burns following irritant contact with povidone‐iodine

Povidone-iodine (PI) is a microbiocide active against gram-negative and gram-positive bacteria as well as fungi, protozoa and some viruses. It is constituted by polyvinylpyrrolidone, a polymer similar to dextran, which acts as a hydrophilic carrier, and iodine. The antimicrobial action is due to iodination and oxidation by free iodine of molecules of the membranes and cytoplasm of the infective agents (I, 2).

Prospective Clinical and Epidemiologic Study of Vulvar Lichen Sclerosus: Analysis of Prevalence and Severity of Clinical Features, together with Historical and Demographic Associations

Background: Few reports have addressed the associations between clinical, demographic and historical variables of vulvar lichen sclerosus (VLS). Objective: To elaborate the prevalence and severity of signs and symptoms and to identify potential factors predicting the severity and course of VLS. Methods: A prospective cohort of 225 patients affected by VLS was included. Data were collected by direct interview and clinical examination. Results: 98% of patients complained of symptoms, principally itching. Pallor and scarring-sclerosis-atrophy were the most frequent and severe signs. The severity of VLS signs was not associated with age at onset and duration of the disease. About 70% of the patients had previously undergone treatment. Conclusions: VLS-related symptoms were not associated with the clinical features which resulted less severe. Personal history of autoimmune diseases and familial history of VLS did not influence the age at onset and the severity of VLS. A considerable part of patients had previously received inappropriate treatment.

Lichenoid reaction from a permanent red tattoo: has nickel a possible aetiologic role?

A 27-year-old man had been tattooed by a professional tattooist 8 months before presentation. He had a large polychrome tattoo over his right deltoid, in which numerous purplish pruriginous papules had persisted since a few weeks after tattooing, restricted to the red areas of the tattoo (Fig. 1). Patch tests with the Italian SIDAPA series showed a ππ π D2/ππ π D3 reaction to nickel sulfate. A strong ππ D2/ππ π D3 reaction was also obtained to the original ‘cardinal red’ pigment used to tattoo the red areas. Patch tests with cobalt sulfate 2% pet., cadmium sulfate 2% pet., ammoniated mercury 1% pet. and copper sulfate 1% aqueous were all negative. A skin biopsy of the red papular lesions showed a bandlike dense lymphocytic infiltrate in the superficial dermis, focal liquefaction degeneration in the basal layer, exocytosis and occasional colloid bodies. There were numerous macrophages containing small pigment granules in the infiltrate. The clinical features, patch tests and biopsy led us to diagnose a chronic lichenoid allergic contact dermatitis due to the red pigment of the tattoo. The material safety data sheet of the ‘cardinal red’ dye declared monoazo pigment, cinnabar and traces of the heavy metals lead, mercury, cadmium, chromium and selenium, but no nickel. Further investigation was therefore performed. After microwave acid digestion, graphite furnace atomic absorption spectroscopy of the original red dye was performed on 3 parts of the sample, which demonstrated the presence of nickel at 1.90 ∫ 0.34 ppm in the pigment. Treatment with a potent topical corticosteroid 2¿ daily for 2 months only slightly improved the dermatitis.