Paola Sgubbi

Retronychia in children, adolescents, and young adults: A case series

Turkey, and New Zealand reported an overall survival rate of 56% (25 of 45 patients). Eighty-three percent ofHI neonates treatedwith systemic retinoids survived, whereas the long-term survival was only 24% for those who were not given oral retinoids. Here we report the outcomes for HI in the Japan population. For a clinical survey of HI in Japan, we distributed questionnaires to 904 dermatologic or pediatrics institutes or hospitals throughout Japan in 2010 and received responses from 564 institutes or hospitals (62.4%). Clinical data between 2005 and 2010 were obtained for 16 HI patients. In total, there were 13 survivors (81.3%) and 3 deceased (18.7%). The patient’s sex was reported for 14 patients: 8 male and 6 female. Systemic retinoids were administered to 12 patients, 11 of whom survived (91.7%), whereas only 2 of the 4 patients (50%) who did not receive oral retinoids survived. Ten of 16 patients (62.5%) received intensive care in a neonatal intensive care unit (NICU). Systemic retinoids and administration in the NICU were considered to contribute to relatively good outcomes for HI patients in the Japanese population. The effects of oral retinoids in HI remains unproven, and as suggested in the commentary by Milstone and Choate, the early introduction of overall intensive therapy might have contributed to the better outcomes of the HI babies whowere given oral retinoids. In conclusion, we consider that, due to intensive neonatal care and, probably, to the early introduction of oral retinoids, HI outcomes have improved also in the Japanese population. In long-term HI survivors, epidermal keratinocytes might regain normal differentiation, and this restoration of differentiation is likely to be associated with the improvement of the skin symptoms in HI survivors. From this fact and the results of our clinical survey, we agree with the commentary by Milstone and Choate on the point that recognition of spontaneous improvement of the HI phenotype lowers the psychological hurdle and provides justification for intensive neonatal care that can improve the outcomes of HI patients. Akitaka Shibata, MD, Yasushi Ogawa, MD, PhD, Kazumitsu Sugiura, MD, PhD, Yoshinao Muro, MD, PhD, Riichiro Abe, MD, PhD, Tamio Suzuki, MD, PhD, and Masashi Akiyama, MD, PhD Department of Dermatology, Nagoya University Graduate School of Medicine; Department of Dermatology, Hokkaido University Graduate School of Medicine, Sapporo; Department of Dermatology, Yamagata University Faculty of Medicine, Yamagata, Japan

Carbon dioxide laser: first-line therapy in vulvar inflammatory linear verrucous epidermal nevus

Inflammatory linear verrucous epidermal nevus (ILVEN) is normally associated with the failure of topical and systemic treatments and with recurrences on interruption of therapy. Many physical approaches have been used, but they generally resulted in varying rates of recurrence and unacceptable scarring. We reported a case of ILVEN treated with a single session CO2 laser treatment. In our experience, CO2 laser was quick, easy, effective, and safe; we therefore believe that this approach should be considered as a first‐line surgical option in the treatment of genital ILVEN, particularly in cases of mucosal involvement

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, [...]

Photodynamic therapy: An option in mycosis fungoides

BACKGROUND Photodynamic therapy (PDT) is a well-known and effective treatment for non-melanoma skin-cancer. Numerous studies have also shown its effectiveness in mycosis fungoides. The aim of the study was to analyse MF patients treated with PDT at the Dermatology Unit of Bologna University. METHODS We retrospectively analysed MF patients treated with PDT over the last ten years. Each PDT protocol consisted of the appliance for 3h under an occlusive film dressing on each lesion of a one-mm-thick layer of 16% methyl aminolaevulinate (MAL) 160mg/g cream (Metvix®, Galderma, Paris, France). The cream was then removed and the skin was exposed to 630nm red light from a diode lamp (Aktilite®, Galderma Benelux, Rotterdam, the Netherlands), with a total radiation dose of 37J/cm2 for 9 mins. A protocol of one session every month was scheduled. The treated lesions were clinically examined, before each treatment. RESULTS Four cases, three male and one female, had been treated with PDT. Two patch lesions on the plantar area, one leg and the pubic area were treated. The number of PDT sessions ranged from 4 to 9. Two complete remissions and two partial remissions were observed. A low-to-mild burning sensation was reported during the treatment, and persisted over the next day; no further side effects were observed. CONCLUSIONS Our series shows that PDT can be considered an effective second-line treatment in patients characterised by a disease located in difficult-to-treat anatomical areas such as the feet and the pubic area.

Risk of malignancy in psoriatic patients: Our clinical experience

Dear Editor, Biologic drugs are nowadays widely used for the treatment of several inflammatory diseases, such as psoriasis. These agents are considered highly effective and generally safe, but they have been associated to some adverse effects, particularly the increased risk of infections, while malignancies have been more rarely reported and this link is still debated. We retrospectively reviewed the medical records of patients treated with a biologic agent (infliximab, etanercept, adalimumab, or ustekinumab) or a traditional agent (methotrexate, cyclosporine, or acitretin) and followed by the Severe Psoriasis Outpatient Clinic of Sant’Orsola Malpighi Hospital of Bologna from January 2006 through December 2015. All patients had a clinical diagnosis of severe psoriasis, assessed by Psoriasis Area Severity Index (PASI) and Body Surface Area (BSA), which scored at least 20. Three hundred and fifty-six patients, 214 treated with biologic therapies (32 with infliximab, 68 with adalimumab, 38 with etanercept, and 76 with ustekinumab) and 142 with a traditional agent entered this study. The average treatment time was 28.6 months. Solid malignancies occurred in 9 cases, 7 males and 2 females, with a mean age of 60 years. The mean time interval between the therapy onset and the tumor diagnosis was 48 months. Non-melanoma skin cancers were not considered in this study. Three of the nine patients with solid malignancies had been treated with a traditional agent (one acitretin, one cyclosporine, and one methotrexate) and six with a biologic therapy (three infliximab, two adalimumab, and one etanercept), one of which had been taking also methotrexate (Table 1). Psoriasis itself is considered a risk factor for some cancers such as non-melanoma skin cancer or T cell lymphoma (Wilton, Crowson, & Matteson, 2016), so it is often difficult to determine the real risk of malignancy associated to the use of traditional or biologic treatments for this disease. Moreover, this risk seems to be increased in patients with a more severe psoriasis (Patel, Patel, & Kerdel, 2016), frequently treated for a long period. In our cohort, six of nine patients who developed a malignancy were treated with TNFa-inhibitors (TNFIs), specifically two patients with adalimumab, three with infliximab, and one with etanercept. The

Sexually transmitted rectal infections in a cohort of ‘men having sex with men’

Purpose. We assessed the prevalence and predictors of Chlamydia trachomatis, Neisseriagonorrhoeae and Mycoplasmagenitalium rectal infections in a population of ‘men having sex with men’ (MSM). Methodology. From January to November 2017, 165 MSM attending a STI outpatients clinic in Bologna (Italy) and reporting unsafe anal intercourses were enrolled. An ano‐rectal swab was collected from each patient: chlamydial and gonococcal infections were diagnosed by a commercial NAAT, whereas an in‐house quantitative PCR was used for M. genitalium detection. In addition, 131 urine samples and 84 pharyngeal swabs underwent testing for C. trachomatis and N. gonorrhoeae. A molecular C. trachomatis typing, a serological screening for anti‐Chlamydia IgG and IgA, as well as the assessment of HIV, HCV and syphilis infections, were performed. Results/Key findings. The prevalence of C. trachomatis, N. gonorrhoeae and M. genitalium rectal infections was 27.2, 25.4 and 4.8 %, respectively. Globally, 63.1 % of cases were asymptomatic and up to 80 % of chlamydial and gonococcal infections would have been missed if the rectal site had not been tested. All the patients with rectal M. genitalium carriage were asymptomatic and characterized by low bacterial loads (<2500 DNA copies/reaction). Lymphogranuloma venereum (LGV) prevalence was 12.1 % with a considerable proportion of asymptomatic infections (35 %). The presence of symptoms, age >30, HIV‐positivity and elevated levels of anti‐Chlamydia antibodies were the most significant predictors of LGV. Conclusions. Sexually transmitted rectal infections are frequent and often asymptomatic among MSM. LGV prevalence is high in our country and there is increasing evidence of symptomless cases.

Keratosis lichenoides chronica with an atypical clinical presentation and variable histopathological features.

A 44-year-old, otherwise healthy, Moroccan man was referred to us because of rapid onset of erythematous, scaly, raised, slightly pruritic plaques on the trunk, extremities (Figure 1a–c), face, and scalp (Figure 1d). He showed neither nail changes nor mucosal (oral or genital) involvement. His medical history was unremarkable, and he denied any drug intake. A complete blood cell count, liver and kidney function tests, thyroid parameters, and urinalysis were within normal limits. Syphilis screening, hepatitis B, C, and HIV serology, as well as a QuantiFERON-TB test were negative. A chest X-ray and abdominal ultrasound were normal. Multiple skin biopsies were performed. Those taken from the trunk and extremities showed extensive epidermal hyperparakeratosis, psoriasis-like acanthosis, hypogranulosis (Figure 2a–c) as well as neutrophilic microabscesses (Figure 2c). Other findings included necrotic keratinocytes surrounded by lymphocytes (satellite cell necrosis) and a band-like inflammatory infiltrate associated with melanophages (Figure 2d). Periodic acid-Schiff (PAS) staining was negative. Immunocytochemistry showed a reactive inflammatory infiltrate (the makeup of the lymphoid population was as follows: CD3+/–, CD4–/+, CD8+/–, CD20 rare; “+/–” signified 50–75 % of the population; “–/+”, 25–50 %; and “rare”, 10–25 %). Based on these findings, lymphoma was ruled out. Direct immunofluorescence was negative. By contrast, the biopsies taken from the face showed focal hyperparakeratosis, irregular acanthosis, vasodilation, edema (Figure 3a, b), as well as a dermal – predominantly lymphocytic – inflammatory infiltrate (Figure 3b, c) with admixed melanophages (Figure 3b) and “satellite cell necrosis” (Figure 3d). Except for hyperparakeratosis, these findings (in particular the inflammatory infiltrate with melanophages, and the necrotic keratinocytes) were more suggestive of lupus erythematosus. Antinuclear antibodies, anti-extractable nuclear antigen antibodies, anti-DNA antibodies, antiphospholipid antibodies, antineutrophil cytoplasmic antibodies, rheumatoid factor, as well as complement component 3 and 4 were all negative. Therapy with systemic corticosteroids resulted in a good response, however, there was a rebound following treatment discontinuation. Subsequently, many different therapeutic approaches were attempted, including cyclosporine, methotrexate, acitretin, PUVA therapy, topical calcipotriol, and topical corticosteroids. However, they all proved to be ineffective. Despite their variability, the histopathological features showed a certain degree of repetitiveness, which is characteristic of our eventual diagnosis: keratosis lichenoides chronica (KLC). Systemic corticosteroids were the only effective treatment.

Keratosis lichenoides chronica mit untypischer klinischer Präsentation und variblen histopathologischen Merkmalen

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