Nicola Balato

Acne and allergic contact dermatitis.

204 patients (43 male and 161 female; average age 19.4 years), under treatment for at least 2 months, entered our study. A special series of allergens was used for patch testing (Table 1), applied with van der Bend square chambers and read at 2 and 3 days. In the case of a positive reaction, patch tests and repeated open application tests (ROAT) were done with each component of the topical product.

IL-33 is secreted by psoriatic keratinocytes and induces pro-inflammatory cytokines via keratinocyte and mast cell activation

IL‐33 is a novel pro‐inflammatory cytokine and ligand for the orphan receptor ST2. Although originally defined as an inducer of Th2‐mediated responses, IL‐33 was recently found to be involved in arthritis, a Th1/Th17‐mediated disease. Here, we assessed the ability of IL‐33 to promote inflammation via mast cells (MCs) and keratinocytes (KCs) activation in psoriasis. IL‐33 resulted elevated in the skin but not in the serum of psoriasis patients. IL‐33 was secreted by psoriasis KCs and HaCaT cells after TNF‐α stimulation. In HMC‐1, TNF‐α, but not IL‐17, could induce a robust increase in IL‐33 expression. In HaCaT cells, TNF‐α was able to induce IL‐6, MCP‐1 and VEGF, and the addition of IL‐33 reinforced these increases. TNF‐α + IL‐33 combination showed similar results in primary KCs and ex vivo skin organ culture. In conclusion, our study suggests that IL‐33 may be involved in psoriasis biology via MCs and KCs.

Educational and motivational support service: a pilot study for mobile‐phone‐based interventions in patients with psoriasis

Background  Psoriasis is a chronic disease which requires long‐term therapy. Therefore, adherence to therapy and patient motivation are key points in controlling the disease. Mobile‐phone‐based interventions, and in particular text messages (TM), have already been used effectively to motivate patients and improve treatment adherence in many different chronic diseases such as diabetes, cardiovascular disease and asthma.

The balance between pro- and anti-inflammatory cytokines is crucial in human allergic contact dermatitis pathogenesis: the role of IL-1 family members.

The interleukin (IL)‐1 family includes 11 members that are important in inflammatory processes. It includes various agonists and two antagonists, IL‐1Ra and IL‐36Ra. Our aim was to investigate whether the IL‐1 family is involved in allergic contact dermatitis (ACD). The expression of IL‐1 family members was evaluated by PCR and immunohistochemistry in the positive patch test reaction site (involved skin) and in the uninvolved skin of ACD patients. We also examined these cytokines in an ex vivo model of ACD. The antagonistic activity of IL‐36Ra was evaluated by injecting recombinant IL‐36Ra in uninvolved skin biopsies of ACD patients. IL‐1Ra and IL‐36Ra expression was quantified in mononuclear cells of nickel‐sensitized patients challenged in vitro with nickel. IL‐33 involvement in ACD was investigated by intra‐dermal injection of anti‐IL‐33 in the uninvolved skin of patients ex vivo. Results showed that IL‐1β, IL‐1Ra, IL‐36α, IL‐36β, IL‐36γ and IL‐33 expression, but not IL‐36Ra expression, was enhanced in ACD‐involved skin. Immunohistochemical analysis and ex vivo skin cultures confirmed these results. Injection of anti‐IL‐33 in ACD‐uninvolved skin inhibited IL‐8 expression, whereas IL‐36Ra inhibited IL‐36α, IL‐36β, IL‐36γ and IL‐8 expression. Nickel induced IL‐1Ra expression in lymphocytes of nickel‐sensitized patients. Hence, various IL‐1 agonists and antagonists may be involved in ACD pathogenesis.

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.

A multicentre study of contact sensitization in children

The results of 7 months of patch testing with a standard series of 26 allergens, in 323 children with eczerematous conditions or itching palmoplantar psoriasis under the age Of 14 years are reported. 114 (35.3%) of the children had 1 or more positive reactions to this standard series. 28 children (8,7%) were poly sensitive. On the basis of personal history, additional series of allergens and/or specific allergens were also tested, 61.7% (90/146) of positive reactions were considered relevant to the current dermatitis. Metals, medicaments, preservatives or fragrances, and shoe components were the major sources of contact sensitization. It is suggested that patch testing he done more frequently in evaluating dermatitis in children.

Interleukin-1 family members are enhanced in psoriasis and suppressed by vitamin D and retinoic acid

Interleukin (IL)-1 family comprise 11 members that play an important role in immune regulation and inflammatory process. Retinoids exert complex effects on the immune system, having anti-inflammatory effects in chronic dermatological diseases. Vitamin D (vitD) and analogs have been shown to suppress TNF-α-induced IL-1α in human keratinocytes (KCs). In the present study, we investigated IL-1 family members in psoriasis and the effects of vitD and retinoic acid (RA) on these members. We analyzed IL-1 family members gene expression in psoriatic skin and in ex vivo skin organ culture exposed to TNF-α, IL-17 or broadband UVB; afterwards, treatment with vitD or RA was performed and IL-1 family members mRNA was evaluated. Similarly, KCs were stimulated with IL-17 and subsequently treated with vitD. IL-1 family members were enhanced in psoriatic skin and in ex vivo skin organ cultures after pro-inflammatory stimuli (TNF-α, IL-17 and UVB). RA and vitD were able to suppress this enhancement.

Patch testing in children

We looked through our records of patients with ulcers on the legs who had g1ven positive patch test reactions and found that the most frequent allergens were lanolin, the para group and balsam of Peru (Table 2). Our patients had positive reactions Similar to the adults. Th1s report IS of mterest because of the extreme rarity of the congemtal coagulation defect, and because 1t IS a umque expenmental model for studymg topical sensitization of chrome ulcers. Our cases show that only the zone of ulcerated skm and the Circulatory abnormalities are the major predisposmg factors for sensitizatiOn. Age and skm atrophy do not seem to be Implicated.

Nutrition and psoriasis: is there any association between the severity of the disease and adherence to the Mediterranean diet?

BackgroundMany studies have evaluated the role of individual nutrients on the development of psoriasis. However, only few studies have investigated the effect of a healthy eating pattern, such as the Mediterranean diet. In this study, we aimed to investigate the relationship between adherence to the Mediterranean diet, the body composition and the severity of psoriasis in a group of naïve-treatment patients with psoriasis.MethodsThis is a cross-sectional case–control observational study. Sixty-two patients (49 males and 13 females, mean age: 50.2±10.5yrs) affected with mild-to-severe psoriasis were consecutively enrolled. Sixty-two age-, sex- and body mass index (BMI)-matched healthy subjects served as control group. A validated 14-item questionnaire (PREDIMED: PREvención con DIeta MEDiterránea) was used for the assessment of adherence to the Mediterranean diet. The severity of psoriasis was by assessed by standardized Psoriasis Area and Severity Index (PASI) score and C-reactive protein (CRP) levels. Body composition was analyzed with bioelectrical impedance analysis.ResultsA higher percentage of psoriatic patients had a lower PREDIMED score compared to the control group (30.6% vs 4.8%). PASI score was significantly associated with the percentage of fat mass (FM%) and CRP levels. PASI score and CRP levels were significantly associated with the dietary components included in the PREDIMED questionnaire or with the PREDIMED score. At multiple regression analysis, the major predictor of PASI score were FM among BIA parameters, (r2=0.537, β=0.740, p<0.001), and FM (r2=0.537, β=0.603, p<0.001) and PREDIMED score (r2=0.599, β=−0.296, p=0.007) among anthropometric measures, FM and PREDIMED score. Finally, among all items of the PREDIMED questionnaire, EVOO (r2=0.548, β=−0.741, p<0.001), and fish consumption (r2=0.139, β=−0.372, p=0.005) have an independent predictive value for PASI score and CRP levels.ConclusionsThis is the first study to evaluate the association between adherence to the Mediterranean diet and the severity of psoriasis. Moreover, our study highlights the usefulness of the assessment of body composition by bioelectrical impedance analysis in the evaluation of the psoriatic patients.

Effects of adalimumab therapy in adult subjects with moderate-to-severe psoriasis on Th17 pathway

Until relatively recently, psoriasis has been considered to be a mainly T helper (Th)1‐driven inflammatory disease; however, several findings have now assessed a major role for Th17 cells in its pathogenesis. Adalimumab is a biological agent that inhibits TNF‐α, a pro‐inflammatory cytokine with a pivotal role in the mechanisms of the disease.