Nicola Milanesi

Effects of alitretinoin on quality of life of patients having chronic hand eczema: an observational study.

AbstractChronic hand eczema (CHE) is a common disease that has a major impact on patients’ health and on society. AimThe purpose of this observational, open-label study was to assess the efficacy of treatment with 30 mg/d of oral alitretinoin on the quality of life (QoL) in a group of patients affected by CHE. MethodsThis study included 15 patients, all suffering from severe CHE refractory to treatment with potent topical corticosteroids, who underwent treatment with 30 mg/d of alitretinoin for a period of 3 months. At the 1- and 3-month points, together with a clinical evaluation, the QoL of these patients were evaluated by the Dermatology Life Quality Index and visual analog scale (EQ5D-VAS). ResultsThe oral administration of alitretinoin led to a notable QoL improvement among the patients, as shown by the statistically significant improvement in the Dermatology Life Quality Index and in the EQ5D-VAS after 1 and 3 months of therapy.

Treatment of refractory subacute cutaneous lupus erythematosus with oral isotretinoin: A valid therapeutic option

Subacute cutaneous lupus erythematosus (SCLE) is a common manifestation of cutaneous lupus erythematosus(CLE), and its management often involves a combinations of local and systemic treatment (1,2). We present a case of a 26-year-old Caucasian woman with diagnosis of SCLE that was poorly controlled by several therapies. She was treated during the previous 2 years with prednisone (37,5 to 12,5 mg/day for 3 months), hydroxychloroquine (200 mg/day for 4 months), quinacrine (100 mg/ day for 15 days), azathriopine (50 mg/day for 4 months), and topical treatments without a significant improvement of cutaneous lesions. On physical examination she presented several annular, well-demarcated erythematous plaques on the extensor surface of the forearms, upper back, face, V area of the neck, and on the dorsal surface of the feet. Some lesions presented central clearing; others were covered by thin furfuraceous scaling. (FIG. 1a,b). These lesions appeared about 3 years before consultation. She didn’t present or report fever, arthritis or other systemic symptoms. She has had an abnormal development, including verbal and motor skills. Laboratory analysis revealed normal blood count, positive ANA 1:80, positive anti-Ro-SSA antibodies (52 U/mL), and normal complement level. Lesional lupus band test showed deposit of immunoglobulins, complement, and fibrin at the dermo-epidermal junction. A skin biopsy showed hyperkeratosis, vacuolar alteration along the dermoepidermal interface, and a superficial and deep dermal, perivascular and perifollicular lymphocytic infiltrate, confirming the diagnosis of SCLE. We found in the literature only few reports in 1990s and a recent update of therapeutic option describing the possible use of isotretinoin in CLE (1–4). We decided to treat with oral isotretinoin at the dosage of 40 mg/die (i.e., 0.7 mg/kg), and within 1 month a remarkable improvement was observed. At the end of the treatment, started in March and lasted 5 months, only a post-inflammatory Address correspondence and reprint requests to: Angelo Massimiliano D’Erme, MD, Division of Dermatology, Department of Critical Care Medicine and Surgery, Piazza Indipendenza, 11 50129 Florence, Italy, or email: a.m.derme@gmail.com. The authors declare any affiliation or significant financial involvement in any organizations or entity with a direct financial interest in the subject matter or materials discussed in the manuscript on this page.

Allergic contact dermatitis caused by motorcycle heated grips

A 32-year-old non-atopic man presented with a history of pruritic, sharply demarcated erythematous and vesicular eruption of the palms and palmar sides of the fingers. The lesions had started during winter, 2 months after the use of a new motorcycle, equipped with heated grips (Fig. 1). The dermatitis recurred every time that the patient switched on the warm hands controller, and improved with the use of gloves and topical corticosteroids. Patch tests were performed with the Italian Society of Allergological, Occupational and Environmental Dermatology (SIDAPA) baseline patch test series, and read according to ICDRG recommendations. Allergens were provided by F.I.R.M.A. (Florence, Italy), applied on the patient’s back with van der Bend® Square Chambers (van der Bend, Brielle, The Netherlands), and fixed with MediporeTM tape (3M Company, Minneapolis, MN, USA); readings were performed on day (D) 2, D4, and D5. Positive (++) reactions to IPPD 0.1% pet. were observed

Efficacy of treatment with oral alitretinoin in patient suffering from lichen simplex chronicus and severe atopic dermatitis of hands

Lichen simplex chronicus (LSC) is a skin disorder characterized by chronic itching and scratching, which can lead to thick, leathery, brownish skin, sometimes with papules and can be associated with atopic eczema. We report the case of a 52‐year‐old man with a 45‐year atopic condition and presenting LSC in his dorsum. After a 3‐month treatment with alitretinoin at the daily dosage of 30 mg, we have observed a moderate improvement of the hand eczema together with a substantial clinical improvement of LSC and an almost complete resolution of pruritus. We want to report this peculiar case to suggest the use of oral alitretinoin for LSC.

Skin signs as early manifestations of Hutchinson-Gilford progeria syndrome

Hutchinson–Gilford progeria syndrome (HGPS) is a rare, sporadic, autosomal dominant genetic disorder with phenotypic features of accelerated ageing due to a mutation of the lamin A (LMNA) gene. It arises in infancy and generally leads to death at approximately the age of 13 years.1,–,5 We report the case of a 7-month-old baby with HGPS …

Successful treatment of rosacea fulminans in a 59-year-old woman with macrolide antibiotics and prednisone.

with Epstein–Barr virus (EBV). Neither antinuclear antibodies nor evidence of thyroid dysfunction were detected. A biopsy taken from a cervical lymph node for histopathology demonstrated necrosis with nuclear debris and a histiocytic cellular infiltrate in paracortical foci (Fig. 1a). The patient was diagnosed with KFD. Although the high fever and tenderness and swelling of the cervical lymph nodes were successfully treated with oral prednisolone therapy, the hair loss did not improve, and the patient was referred to our clinic. Clinical examination revealed irregularly-shaped and pigmented bald patches on lesions behind his ears (Fig. 1b). No HF ostia, yellow dots, or tapering hair were observed on trichoscopic examination. Histological examination using the skin specimens taken from the bald patches revealed the destruction of the HF structures with dense infiltration of inflammatory cells, mainly lymphocytes and histiocytes, particularly around the isthmus area of the HFs (Fig. 1c, d). In addition, few sebaceous glands were present (Figs. 1c and 2a). Although a large amount of nuclear debris was detected, neutrophils were almost absent from the infiltrate (Fig. 1d). Basal vacuolar changes were observed, and some cells with melanin-like granules were detected in the upper dermis (Fig. 1e). Some of these granules were CD68-positive (Fig. 1f), indicating that these cells were melanophages, which could explain the pigmented skin lesions on the bilateral temporal scalp. Immunohistochemistry revealed the infiltrate cells around the HFs to be CD4, CD8or CD68-positive (Fig. 2c–e). We diagnosed the patient with cicatricial alopecia. Kikuchi–Fujimoto disease is a rare and benign condition with a largely unknown etiology. Because several conditions are similar to KFD, including malignant lymphoma, biopsy of the lymph nodes is recommended for an accurate diagnosis. Cutaneous involvement has been reported in 16.6–40.0% of KFD patients. Although the cutaneous manifestations and histopathological findings are variable, no HF involvement has previously been reported in this disease. Kanno et al. recently reported that crusty plaques may be seen on the scalp but did not investigate the HFs. Kim et al. explored pathological findings in previous cases of cutaneous KFD and reported the dermal infiltration of lymphohistiocytes with various quantities of nuclear debris among the characteristic features of the disease and, similarly to the present case, typically no neutrophils. In addition, CD4 and CD8 staining patterns have been reported to be highly variable in cutaneous KFD. CD68 marks histiocytes and plasmacytoid monocytes and can be used to confirm the diagnosis. Although we were unable to find any case reports on the association between KFD and scarring alopecia, our histochemical and immunohistochemical examinations of the cervical lymph node and bald patch strongly suggest that the cicatricial alopecia in the present patient was associated with KFD. Further investigations are necessary to confirm the connection between these diseases.

Nail improvement during alitretinoin treatment: three case reports and review of the literature

Alitretinoin is an endogenous vitamin A derivative, 9‐cis‐retinoic acid. Its anti‐inflammatory and immunomodulatory efficacy results from controlling leukocyte activity and cytokine production in keratinocytes. We describe three patients with severe chronic hand eczema accompanied by nail dystrophy, which was treated with alitretinoin 30 mg. Clinical evaluation at 6 months showed complete or almost complete clearing of the nail lesions. We also briefly review the literature reporting on nail dystrophy and alitretinoin treatment. There is some evidence of the clinical effect of retinoids on nail formation, owing to the presence of retinoid receptors on the nail matrix. Further studies are required to better understand the impact of alitretinoin in nail diseases. Our observation supports alitretinoin as a treatment option in retinoid‐responsive dermatoses associated with nail involvement.

Commission Regulation (EU) No. 412/2012: Is dimethyl fumarate still present in products imported from countries outside the European Union?

Dimethyl fumarate (DMF), the methyl ester form of fumaric acid (DMF) is an effective mold-growth inhibitor. It has a wide-spectrum biocide activity and has been used to protect leather during storage and transport. DMF was first identified as a potent contact sensitizer during a contact dermatitis outbreak that occurred because of its use in Chinese manufactured furniture (1,2). This article is protected by copyright. All rights reserved.

Aspects of contact cheilitis: analysis of 38 cases.

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Allergic contact dermatitis caused by a polyurethane catheter

A 36-year-old non-atopic man presented with itchy dermatitis involving the arm that had appeared 4 months before the visit. From 2014, the patient had required prolonged intravenous antibiotics owing to cystic fibrosis while he was waiting for lung transplantation. Sharply defined, erythematous and oedematous scaly plaques developed at the site of contact with the intravenous catheter (Figure 1); slight improvement was achieved with topical corticosteroids. Patch tests were performed with the SIDAPA baseline series and the patient’s own products, applied on his back with Van der Bend Square Chambers (Van der Bend, Brielle, The Netherlands), and fixed with Medipore tape (3M, Minneapolis, Minnesota); readings were performed on day (D) 2, D4, and D5, according to ICDRG/ESCD recommendations. A strong response (++) was elicited by a fragment of the catheter and by the “T” proximal connector (both tested “as is”), whereas other components of the catheter, including the Grip Lock, metallic stylet, and tapes, did not cause positive reactions. Patch testing with the isocyanate series (Chemotechnique Diagnostics, Vellinge, Sweden) was performed 1 month later, and yielded a ++ reaction to diaminodiphenylmethane (MDA) 0.5% pet., whereas fragments of 2 different silicone catheters gave negative results (Table 1). Considering that isocyanates are important causes of occupation-related asthma, and the risk to the patient of pulmonary complications, IgE specific for isocyanates was investigated, and was in the normal range (0.10 kU/L). The catheter Lifecath PICC Easy (Vygon, Aachen, Germany) was composed of biostable, totally radiopaque polyurethane. According to the manufacturer, there is no detailed information available concerning the composition of the catheter. The dermatitis improved with the