Paolo Romita

Transmission of Nonviral Sexually Transmitted Infections and Oral Sex

INTRODUCTION Oral sex is usually considered a lower-risk sexual activity when compared with sex, but it is frequently the cause of sexually transmitted infections (STI). In particular, STI transferred through oral sex might have no visible symptoms, depending on the type of infection. AIMS The aim of this study is to review the literature about the role of oral sex in the transmission of nonviral STI. MAIN OUTCOME MEASURES State-of-the-art information in the area of STI in relation to sexual function and self-care, this last important for development of STI prevention products such as vaginal microbicides. Sexual behaviors assessed focusing on receiving oral sex and giving oral sex. METHODS A search of the main electronic databases including registers of clinical controlled trials was performed in addition to a hand search of the most relevant Journals. The following electronic databases were searched: PubMed, Embase, Google Scholar, literature review of research articles, and public health department Internet Web sites, for the period of 1945-2011. In addition to searching the Clinical Trials Registry at the US National Institutes of Health, we also used the meta Register of Controlled Trials and the Cochrane Central Register of Controlled Trials. RESULTS STI affect the mucous membranes both directly and indirectly producing characteristic diagnostic signs and lesions. Daily dental clinical activity needs an appropriate knowledge of any kind of oral lesions-related STI. The reader is offered a practical approach with clinically relevant recommendations that may prove useful in his/her daily practice when dealing with STI. CONCLUSIONS These data provide a foundation for understanding diverse STI. We advise physicians to be receptive to discuss sexuality issues and provide patients with adequate therapy.

Allergic contact dermatitis caused by argan oil

Argan oil is a substance obtained by heating, roasting and pressing the nuts contained in fruits of Argania spinosa (Sapotaceae), an endemic tree growing in the southwest of Morocco. Argan oil contains tocopherols, phenols, carotenes, squalene, and fatty acids (1, 2). The main natural phenols in argan oil are caffeic acid, oleuropein, vanillic acid, tyrosol, catechol, resorcinol, epicatechin, and catechin. It is becoming increasingly popular for cosmetic use, being used as a moisturizing oil, as a treatment for juvenile acne, and for nourishing the hair. Argan oil may have nutritional and medicinal properties, owing to its high content of unsaturated fatty acids and phytosterols (1).

Contact dermatitis to topical acne drugs: a review of the literature

Acne vulgaris is a chronic dermatological disorder that affects the majority of teenagers in the Western world. Topical therapy is widely used to treat mild‐moderate acne and is known as well‐tolerated thanks to its low systemic toxicity, although associated to skin adverse effects. Acne seems to be associated also to an intrinsic alteration of the epidermal barrier, regarding both the upper and the follicular stratum corneum that promotes the onset of such local side effects. The commonest one is irritant contact dermatitis, an event of frequent observation occurring with erythema, burning, dryness, scaling, and itching, usually characterized by low severity and limited duration. Among topical acne drugs, retinoids are the most irritating ones. Another side effect is allergic contact dermatitis: it is rare and mainly associated to benzoyl peroxide.

Urticaria and angioedema to rubisco allergen in spinach and tomato

a t i a s l F t p r S A 23-year-old, nonatopic woman presented with severe angioedema of the lips and tongue associated with a choking sensation, which developed soon after the ingestion of spinach leaves. The acute reaction was successfully managed by intramuscular epinephrine and intravenous chlorpheniramine. History revealed previous episodes of urticaria and angioedema after the ingestion of raw and cooked spinach (Spinacia oleracea) and tomato (Solanum lycopersicum). Skin prick tests (SPTs) were performed with common airborne allergens and commercial extracts of several foods (Lofarma,Milan, Italy), using saline solution and histamine (10 mg/mL) as negative and positive controls, respectively. The SPTs produced positive results (defined as a wheal diameter greater than 3 mm over the negative control) to tomato, eliciting a wheal of 11 mm. Prick-byprick test results with raw and boiled spinach were positive, eliciting a wheal of 14 mm for the former and 12 mm for the latter. Proteinswere extracted by spinach leaves as previously described. The protein concentration, determined according to Bradford’s method, proved to be 2.04mg/mL for the spinach extract and 2.45 mg/mL for the tomato extract. The two extracts were stored at –20 C until required. The sodium dodecylsulfate–polyacrylamide gel electrophoresis (SDS-PAGE) (Nupage Bis Tris; Invitrogen,Milan, Italy) profile of spinach and tomato extracts, after staining with 0.1% Coomassie Brilliant Blue, revealed bands with a mass range of approximately 10 to 100 kDa for spinach and 6 to 60 kDa for tomato (Fig 1). The results of SPTs with the spinach extract at both 1:100 and 1:1,000 dilutions were positive, eliciting a wheal of 10 mm for the former and 9 mm for the latter. Ten healthy volunteers were skin prick tested with the same procedures with negative results. Specific IgE to spinach (7.29 kUA/L) and tomato (2.66 kUA/L) were detected by ImmunoCAP. Electrophoresis of tomato and spinach extracts was performed in a 10% polyacrylamide precast gel (Nupage Bis-Tris; Invitrogen) at 180mA for 1 hour. The gel was stained with Colloidal Blue Staining Kit (Invitrogen). Immunoblotting analysis (Quantity One Basic; BioRad, Milan, Italy) showed specific IgE reactivity to a band of approximately 15 kDa present in the spinach extract and to a band of approximately 6 kDa in the tomato extract (Fig 1). The proteomic profiling of such IgE-binding bands was performed to characterize the relevant allergenic proteins. The tryptic digests were obtained following a typical digestion protocol and analyzed by matrix-assisted laser desorption ionization time-offlight mass spectrometry. Protein identification was accomplished searching the Swiss-Prot database using Mascot (Matrix Science Ltd, London, England) database search engines. The 2 examined bands were identified as Rubisco (ribulose-1,5-bisphosphate carboxylase/oxygenase) (EC 4.1.1.39),with 11 identifiedpeptideswith a coverage of 44% for spinach and 10 identified peptides with a

Unusual presentation of carpal tunnel syndrome with cutaneous signs: a case report and review of the literature.

Carpal tunnel syndrome (CTS) is a neurological impairment caused by compression of the median nerve throughout the carpal tunnel, which consequently induces ischemia and mechanical disruption, dysfunctional axonal transport, and epidural blood flow. Most common symptoms include numbness, rather than pain, with a typical night exacerbation, weakness, paresthesia, and loss of sensitive discrimination. In rare cases, such syndrome may present with cutaneous manifestations localized on the distal phalanges of the hands, even without the above mentioned neurological symptoms. We describe a case of a woman who came to our attention complaining of the appearance of recurrent bullous eruptions involving the distal phalanges innervated by the median nerve. She did not report any neurological signs whatsoever. After excluding a bullous disease, we further investigated through additional analysis that revealed a CTS. Hence, physicians should consider CTS as a differential diagnosis when assessing cutaneous lesions of the first three fingers of the hands.

Occupational erythema multiforme-like contact reaction to iodoacetonitrile in a chemistry student

Conflicts of interest: The authors have no conflict of interests to disclose. laboratory and was occupationally exposed to a large number of chemicals, always while wearing protective latex gloves. The patient was hospitalized and treated with systemic corticosteroid therapy for 2 weeks. Skin lesions evolved with severe scaling (Fig. 2), and healed in 1 month without further issues. Three months after the complete resolution of his dermatitis, the patient was patch tested with the baseline Italian Society of Allergological, Occupational and Environmental Dermatology standard series (Firma , Florence, Italy) and with all skinhazardous chemicals that he used before the appearance of such manifestations. Patch tests were applied on the back and left in occlusion for 2 days, using the Finn Chambers (diameter 8 mm; Epitest Ltd, Tuusula,

Isobornyl acrylate : An impurity in alkyl glucosides

Abstract Context: Alkyl glucosides and alkyl poly-glucosides are widely used as wetting agents, surfactants and emulsifiers in several industrial and cosmetic products. They are known as well-tolerated and are usually added to the primary surfactants in order to reduce the irritating potential of the main foaming agents. Objective: Recently, some authors suggested that allergic contact dermatitis to alkyl glucosides might be more frequent than suspected. On the other hand, the chemical structures of glucosides do not show potentially allergenic chemical groups or strongly polarized structures. The aim of our study is to investigate alkyl glucosides carrying out a detailed chemical analysis on samples of raw materials to identify potentially allergenic impurities or by-products contained in commercial samples of alkyl glucosides. Materials and methods: We chemically analyzed samples of cocoyl glucoside, decyl glucoside and lauryl glucoside by three different analytical methods, in order to identify any undesired or polluting substances. Result: In each of the three samples, we detected the presence of isobornyl acrylate. Its approximate content in the tested samples is 500 ng/g of the product. Discussion: Isobornyl acrylate is not used in the synthesis of alkyl glucosides, but as a plasticizer in many plastic materials. It can be easily released to materials flowing over these surfaces when they have high extraction power, as glucosides. Conclusion: Isobornyl acrylate may play a role as hidden allergen, in the form of an impurity collected during the industrial process, explaining some cases of allergic reaction to alkyl glucosides.

Allergic contact dermatitis caused by Helichrysum italicum contained in an emollient cream.

A 69-year-old non-atopic woman presented with eczematous lesions on her legs, trunk, and upper limbs. The history revealed that, one month before the development of the eczema, she had been applying an emollient cream to her legs (BioEulen Pediatric Cream, Aboca, Sansepolcro, Italy) based on natural ingredients to treat a moderate xerosis. She was treated with topical corticosteroids (mometasone furoate) with a once-daily application for 2 weeks, and instructed to avoid further contact with the suspected topical product. Three months after the complete resolution of the lesions, she was patch tested with the Italian Society of Allergological, Occupational and Environmental Dermatology (SIDAPA) standard baseline series (Euromedical®, Calolziocorte, LC, Italy), with our ‘natural ingredients’ series (Firma®, Florence, Italy) (Table 1), and with the emollient cream ‘as is’. Patch tests were applied on the back, and left in place for 2 days with Finn Chambers® (diameter 8 mm; SmartPractice®, Phoenix, AZ, USA) on Scanpor® tape (Norgesplaster A/S, Vennesla, Norway). Readings were performed at D2 and D4. The reactions were classified according to the International Contact Dermatitis Research Group guidelines. Readings showed positive reactions (++) to Myroxylon pereirae and to the cream ‘as is’. Hence, we performed patch tests with the ingredients of the cream (Table 2), kindly provided by the manufacturer (Aboca). Patch tests gave positive reactions (++), at both D2 and D4, for the hydrophilic fraction and the lipophilic fraction of flowering tops of Helichrysum (Helydol®), both at 3% pet. Ten healthy volunteers were patch tested with both substances, with negative results.

Drug reaction with eosinophilia and systemic symptoms caused by lenalidomide.

ejd.2012.1853 Auteur(s) : Caterina Foti1 c.foti@dermatologia.uniba.it, Annarita Antelmi1, Antonio Mazzocca2, Francesco Saverio Vella2, Paolo Romita1, Stefania Pugliese3, Daniela Lomazzo3, Piero Portincasa3, Giuseppe Palasciano3 1 Section of Dermatology, Department of Biomedical Sciences and Human Oncology, 2 Department of Emergency and Organ Transplantation, 3 Clinica Medica Augusto Murri, Department of Biomedical Sciences and Human Oncology University of Bari Medical School, 70124 Bari, Italy Drug [...]

Management of Chronic Spontaneous Urticaria in the Elderly

The guidelines for the management of urticaria in adults and children have been revised and updated recently. However, there are few data in the literature concerning several aspects of this disease in the elderly (e.g., epidemiology, etiopathogenesis, clinical aspects, association with co-morbidities, efficacy and safety profiles of treatments, and management strategies). This is an obvious deficiency in the data, as this disease causes a deterioration in quality of life, affecting the quality of sleep, everyday life habits and activities, and inducing severe disability. Chronic spontaneous urticaria (CSU) can also be associated with internal, infectious, autoimmune, or neoplastic diseases. It is therefore necessary to pay particular attention to these clinical issues through appropriate clinical examinations. At the same time, the specific features of medications used to treat CSU in the elderly should be carefully evaluated, as its pharmacological treatment raises a number of problems related both to the clinical condition of the patient and to concomitant diseases, as well as to the polypharmacotherapy, which is common in older subjects and may cause safety problems because of the drug interactions. Non-sedating new-generation antihistamines are the mainstay treatment of CSU for the elderly. The efficacy and safety of alternative treatment options have not been assessed in the geriatric population with CSU; corticosteroids and cyclosporine (ciclosporin) should be used by this population with extreme caution. Similarly, there are no data regarding the actual safety profile of the new-generation antihistamines at higher doses than those recommended in elderly patients.