Patrizia Pepe

Contact sensitization in 1094 children undergoing patch testing over a 7-year period.

Abstract:  Contact sensitization in children is frequent. However, because exposure to sensitizing agents varies rapidly, it is of utmost importance to perform a periodic evaluation of patch test results. Our purpose was to compare our data on contact sensitization in children during the past 7 years to our previous 1988–1994 findings, in order to identify emerging allergens and update our pediatric series. From 1995 to 2001, 1094 consecutive children were examined. Of these, 997 patients were patch tested with our pediatric series, which includes 30 allergens, whereas 97 underwent patch testing with 46 allergens. A total of 570 children proved allergic (52.1%). The highest sensitization rate was observed in children under 3 years of age. No differences between atopic dermatitis patients and nonatopic ones were observed in the sensitization rate. Neomycin, nickel, wool alcohols, thimerosal, and ammoniated mercury gave most of the positive responses. With respect to 1988–1995 data, allergy to substances such as neomycin, nickel, wool alcohols, thimerosal, ammoniated mercury, propolis, potassium dichromate, and thiuram mix proved more frequent. In conclusion, as sensitization rates to different allergens show great variations over time, periodic evaluations of patch test results in children is necessary in order to update the test trays.

Reflectance confocal microscopy as a second-level examination in skin oncology improves diagnostic accuracy and saves unnecessary excisions: a longitudinal prospective study

Dermatoscopy increases both the sensitivity and specificity of melanoma diagnosis. Reflectance confocal microscopy (RCM) is a noninvasive technique that complements dermatoscopy in the evaluation of equivocal lesions at cellular resolution.

Computerized evaluation of pigmented skin lesion images recorded by a videomicroscope: comparison between polarizing mode observation and oil/slide mode observation.

Background/aims: It has now been established that ELM significantly improves the clinical diagnosis of pigmented skin lesions, particularly when associated with image analysis on digital pictures.

Ultrasound B scanning with image analysis for assessment of allergic patch test reactions.

Assessment of patch lest results has been performed visually and using u lira sound in the U mode. A positive test site has a typical ultrasonographic appearance, presenting a uniform hypoechogenic area in the dermis. In this zone, the mean amplitude of ultrasound reflection peaks decreases, and the extension of this area increases, together with the intensity of the eczematous reaction. A close correlation has been shown between visual scoring, amplitude decrease and surface increase of the hypoecbogenic area. This technique seems to provide a reproducible System for the evaluation of patch tests.

Sensitization to propolis in 1255 children undergoing patch testing

To investigate the frequency and the features of contact sensitization to propolis in children, we patch tested 1255 consecutive children suspected of allergic contact dermatitis with propolis 20% petrolatum over an 8‐year period (1995–2002). Positive responses were observed in 5.9% of patch‐tested subjects, with a significantly higher frequency in boys than in girls. The dermatitis was localized mainly on the face, hands and limbs. A significant linear increase in the annual frequency of propolis allergy was noted. Confirming literature data, a significant association with balsam of Peru sensitivity was present in children reacting to propolis, linked to the presence of common constituents in the 2 substances. In conclusion, based on our data, we suggest that propolis should not be used in topical products for children because of its high sensitization rate at the paediatric age.

Confocal microscopy of recurrent naevi and recurrent melanomas: a retrospective morphological study.

Background  Repigmentation within a scar after different procedures (shave biopsy, partial excision, cryotherapy, laser) is a challenging diagnostic situation.

Confocal Microscopy Insights into the Treatment and Cellular Immune Response of Basal Cell Carcinoma to Photodynamic Therapy

Background: Photodynamic therapy (PDT) represents an optimal treatment for basal cell carcinoma (BCC). Reflectance confocal microscopy (RCM) is a noninvasive imaging tool that has been applied in skin oncology and for BCC diagnosis. Moreover, RCM is a useful tool to determine noninvasive treatment efficacy of nonmelanoma skin cancer. Objective: We aimed to investigate the role of RCM in assessing the efficacy of PDT in the treatment of BCC and to evaluate the skin changes following the PDT. Methods: Ten patients with 12 BCCs were treated with PDT. Dermoscopy and RCM imaging were performed at baseline as well as 7 days (T1), 30 days and 18 months after PDT. Cytological examination was taken at baseline and in case of BCC persistence. Results: At T1, RCM showed the presence of several dendritic-shaped cells within the epidermis, corresponding to activated Langerhans cells. After 1 month, RCM showed the persistence of 2 BCCs, which escaped the clinical and dermoscopic diagnosis. At the long-term follow-up, none of the tumors revealed signs of persistence or recurrence. Conclusion: RCM is a valuable noninvasive tool for the diagnosis and treatment monitoring of BCC using PDT.

Pigmented nodular Basal cell carcinomas in differential diagnosis with nodular melanomas: confocal microscopy as a reliable tool for in vivo histologic diagnosis.

Nodular basal cell carcinoma, especially when pigmented, can be in differential diagnosis with nodular melanomas, clinically and dermoscopically. Reflectance confocal microscopy is a relatively new imaging technique that permits to evaluate in vivo skin tumors with a nearly histological resolution. Here, we present four cases of challenging nodular lesions where confocal microscopy was able to clarify the diagnosis.

In Vivo Confocal Microscopic Pattern of Fibroepithelioma of Pinkus

Caterina Longo, MD, PhD; H. Peter Soyer, MD; Patrizia Pepe, MD; Alice Casari, MD; Elisabeth M. T. Wurm, MD; Pascale Guitera, MD; Giovanni Pellacani, MD; Dermatology Unit, Arcispedale Santa Maria Nuova (Drs Longo and Pellacani), and University of Modena and Reggio Emilia (Drs Longo, Pepe, Casari, and Pellacani), Reggio Emilia, Italy; The University of Queensland School of Medicine, Princess Alexandra Hospital, Brisbane, Australia (Drs Soyer and Wurm); and Sydney Melanoma Diagnostic Centre, Royal Prince Alfred Hospital and Melanoma Institute, Sydney, Australia (Dr Guitera)

Echographic evaluation of edema induced by patch test chambers

positive to a glue of bovine origin, which was usually dissolved in a stainless steel receptacle. Nickel was present in this glue at a concentration of 5 f.lgl g (atomic absorption method) and was found to be responsible for the lesions of her upper limb. This particular localization was caused, at least partially, by movements the patient made to wipe away the glue that occasionally trickled down her bare arm in particular positions that she assumed during her work. After preventive measures were taken, the patient no longer had any signs of the disease.