Pasquale Frascione

Human Papillomaviruses, p16INK4a and Akt expression in basal cell carcinoma

BackgroundThe pathogenic role of beta-HPVs in non melanoma skin cancer (NMSC), is not still completely understood, and literature data indicate that they might be at least cofactors in the development of certain cutaneous squamous cell carcinomas. However, only few reports contain data on basal cell carcinoma (BCC). The HPVs interact with many cellular proteins altering their function or the expression levels, like the p16INK4a and Akt. Our study aimed to determine the presence of different beta -HPV types and the expression of p16INK4a and Akt in BCC, the commonest NMSC, in the normal appearing perilesional skin and in forehead swab of 37 immunocompetent patients.MethodsThe expression of p16INK4a and Akt, by immunohistochemistry, and the HPV DNA, by nested PCR, were investigated in each sample.ResultsNo correspondence of HPV types between BCC and swab samples was found, whereas a correspondence between perilesional skin and BCC was ascertained in the 16,7% of the patients. In BCC, 16 different types of beta HPV were found and the most frequent types were HPV107 (15,4%), HPV100 (11,5%) and HPV15 (11,5%) all belonging to the beta HPV species 2. Immunohistochemistry detected significant p16INK4a expression in almost all tumor samples (94,3%) with the highest percentages (> 30%) of positive cells detected in 8 cases. A statistically significant (p = 0,012) increase of beta HPV presence was detected in p16INK4a strongly positive samples, in particular of species 2. pAkt expression was detected in all tumor samples with only 2 cases showing rare positive cells, whereas Akt2 expression was found in 14 out of 35 BCC (40%); in particular in HPV positive samples over-expressing p16INK4a.ConclusionsOur data show that p16INK4a and pAkt are over-expressed in BCC and that the high expression of p16INK4a and of Akt2 isoform is often associated with the presence of beta-HPV species 2 (i.e. HPV 15). The association of these viruses with the up-regulation of p16INK4a and Akt/PI3K pathway suggests that in a subtype of BCC these viruses may exert a role in the carcinogenesis or in other, still undefined, biological property of these tumors. If this particular type of BCC reflects a different biology it will remain undisclosed until further studies on a larger number of samples will be performed.

Calcipotriene/betamethasone in the treatment of psoriasis: a review article

Plaque-type psoriasis is a chronic and immune-mediated skin disease affecting ∼ 1 – 3% of the Caucasian population. Most cases are of mild or moderate severity and benefit from local treatment that represents the mainstay therapy. Topical corticosteroids and vitamin D3 analogues remain the option of choice. Optimization of these treatments is made by the combination of calcipotriene and betamethasone dipropionate. This formulation combines the keratinocyte differentiation and antiproliferative action of the vitamin D3 analogues with the anti-inflammatory effect of steroids enhancing effectiveness while reducing the side-effect profile of the single topical agent. In this article, we highlight the advantages of the association of calcipotriene and betamethasone in the treatment of localized plaque-type, scalp and nail psoriasis.

Efficacy and maintenance strategies of two-compound formulation calcipotriol and betamethasone dipropionate gel (Xamiol® gel) in the treatment of scalp psoriasis: results from a study in 885 patients

Background: Previous studies showed the efficacy of a formulation containing calcipotriol and betamethasone dipropionate for the treatment of psoriasis. Objective: To investigate maintenance strategies of a formulation containing calcipotriol (50 µg/g) and betamethasone dipropionate (0.5 mg/g) for the treatment of scalp psoriasis. Materials and methods: Nine-hundred and four patients were screened and randomised on a 1:1 basis in two groups: maintenance of two applications per week (group A) versus on-demand therapy (group B). Clinical evaluation was performed at weeks 0, 2, 4, 8 and 12. Results: Eight-hundred and eighty-five patients were randomised: 441 in group A and 444 in group B. From week 2, both groups showed a significant clinical improvement compared with baseline; at weeks 8 and 12, group A demonstrated a higher clinical response compared with group B (p < 0.05). This difference was statistically significant (OR 0.47, 95% CI 0.37, 0.60). Conclusions: The maintenance of twice-weekly application versus on-demand treatment of calcipotriol/betamethasone dipropionate gel is more effective and is associated with a lower rate of relapse.

Efficacy and tolerability of 5-aminolevulinic acid 0.5% liposomal spray and intense pulsed light in wrinkle reduction of photodamaged skin

Abstract Background: Photodynamic therapy (PDT) with 5-aminolevulinic acid (5-ALA) is effective for the treatment of photoaging. Objective: To evaluate the efficacy and safety of PDT using a novel 0.5% liposome-encapsulated 5-ALA spray and an intense pulsed light (IPL) system (Ellipse Flex PPT) in reduction of periorbital and nasolabial wrinkles. Patients and Methods: Thirty healthy volunteers, aged 35–65 years, skin type I–III, with type 2 photoaging underwent a baseline visit, three ALA-IPL treatments once every 3 weeks, an end-of-treatment visit and a final visit 3 months after the end-of-treatment visit. Wrinkle depth was evaluated according to the modified Fitzpatrick wrinkle scale (MFWS). At the final visit, patients rated their degree of overall improvement. Results: For periorbital and nasolabial wrinkles, the differences of the average MFWS evaluation between baseline versus end-of-treatment visit, baseline versus final visit and end-of-treatment visit versus final visit were statistically significant (p < 0.001). The average overall improvement was greater for periorbital than for nasolabial wrinkles (p < 0.001). No side effects were observed during and after treatment. The degree of overall improvement was scored as excellent by 47% of the volunteers. Conclusions: ALA-IPL treatment using 0.5% liposome-encapsulated 5-ALA spray and Ellipse Flex PPT system is effective and safe for the treatment of type 2 photoaging reducing the PDT-associated side effects.

A melanoma immune response signature including Human Leukocyte Antigen-E

Paired cultures of early‐passage melanoma cells and melanocytes were established from metastatic lesions and the uninvolved skin of five patients. In this stringent autologous setting, cDNA profiling was used to analyze a subset of 1477 genes selected by the Gene Ontology term ‘immune response’. Human Leukocyte Antigen E (HLA‐E) was ranked 19th among melanoma‐overexpressed genes and was embedded in a transformation signature including its preferred peptide ligand donors HLA‐A, HLA‐B, HLA‐C, and HLA‐G. Mostly undetectable in normal skin and 39 nevi (including rare and atypical lesions), HLA‐E was detected by immunohistochemistry in 17/30 (57%) and 32/48 (67%) primary and metastatic lesions, respectively. Accordingly, surface HLA‐E was higher on melanoma cells than on melanocytes and protected the former (6/6 cell lines) from lysis by natural killer (NK) cells, functionally counteracting co‐expressed triggering ligands. Although lacking HLA‐E, melanocytes (4/4 cultures) were nevertheless (and surprisingly) fully protected from NK cell lysis.

The Italian Euromelanoma Day: evaluation of results and implications for future prevention campaigns

Melanoma incidence/mortality is increasing worldwide. “Euromelanoma Day” is a pan‐European campaign for skin cancer prevention. Results of the 2010 Euromelanoma Day in Italy are reported herein.

Acute Papulopustular Rosacea-like Eruption from Oral Parabens

Sir, Rosacea is a common chronic cutaneous disorder of unknown aetiology that affects approximately 10% of the population (1). The prevalence of rosacea is highest among fair-skinned 20-60-year-old individuals., particularly those of Celtic and northern European descent (I). Cutaneous manifestations include transient or persistent facial erythema, telangiectasia. oedema, papules and pustules that are usually confined to the central portion of the face (2). Rosacea can also be associated with ocular symptoms of redness. Itching, tearing, dryness and eyelid fullness or swelling (3). Rosacea actually represents a spectrum of diseases, ranging from chronic skin hypersensitivity and flushing to rhinophyma. The National Rosacea Societys Expert Committee on the Classification and Staging of Rosacea identified 4 subtypes of rosacea: erythematotelangiectatic, papulopustular. phymatous and ocular (4). Differential diagnosis with 3 other acneiform facia! eruptions (acne vulgaris, folliculitis, and perioral dermatitis) should be considered when assessing patients. Although the clinical features of the disease are well-recognized, the pathogenesis of rosacea is still poorly understood.

Psoriasis, Kaposi's sarcoma and Hodgkin's disease in a patient with Down's syndrome

Psoriasis, Kaposi’s Sarcoma and Hodgkin’s Disease in a Patient with Down’s Syndrome Maria Concetta Fargnoli a, Ketty Peris a, Pasquale Frascione b, Rosanna Barbati c, Lucia Anemona d, Stefania Uccini e, Francesca Francesconi c, Sergio Chimenti c aDepartment of Dermatology, University of L’Aquila, L’Aquila, bDepartment of Dermatology, Ospedale Regina Elena, Departments of c Dermatology and dPathology, University of Rome ‘Tor Vergata’, and e Department of Experimental Medicine and Pathology, University of Rome ‘La Sapienza’, Rome, Italy

The first skin cancer screening day at the Italian parliament: a Euromelanoma initiative

The effort to decrease incidence/mortality of skin cancer should target not only the general public but also politicians and decision makers, to create a proper health policy. We report the results of the first Skin Cancer Screening Day at the Italian Parliament, organized to draw politicians’ attention on skin cancer.

Successfully treated superficial basal cell carcinomas with ingenol mebutate 0.05% gel: Report of twenty cases.

Surgery is the therapy of choice in the guidelines to treat basal cell carcinomas (BCCs) but a variety of non‐surgical options are available. The objective of this study is to evaluate the efficacy and safety of ingenol mebutate 0.05% gel for the treatment of superficial BCCs. We accepted twenty patients with superficial BCCs on the body and we treated them once daily for two consecutive days with ingenol mebutate 0.05% gel. We examined the lesions at the screening visit and after four days from the gel application to describe the local skin reaction due to the therapy. Then we followed the patients after two and six months from the first visit. All the lesions were clinically and dermoscopically documented with a digital camera and we used the LSR (local skin reaction) grading scale based on a 0–4 numerical index of severity with specific clinical parameters and a characteristic photographic image for each rating, to assess the local side effects related to the therapy.