Piccinno R

Narrowband ultraviolet B phototherapy in childhood vitiligo: evaluation of results in 28 patients.

Abstract:  Phototherapy using narrowband ultraviolet B (UVB) is considered among the treatments of choice in vitiligo, even in childhood. The objective of the current study was to evaluate the profile of safety and effectiveness of such therapy in a group of children. An open, uncontrolled study was performed on 28 children with vitiligo who were receiving narrow band UVB phototherapy. The children were classified according to vitiligo type and phototype. Family history and presence of thyroid disease were investigated. Eighteen patients had received other treatments that was stopped 3 months before starting phototherapy. Phototherapy was administered twice a week. The mean duration of therapy was 10 ± 3.4 months. The mean total dose administered was 156.12 ± 79.4 J/cm2. Photographs of lesions were taken before and at the end of treatment. The response to phototherapy was expressed as percentage of repigmentation. The data were statistically analyzed using SPSS (SPSS Inc., Chicago, IL). Fourteen percent of patients showed excellent response, 28.6% good response, 25% moderate response, and 28.6% mild response; the remaining 3.5% were not responsive. No side effects were observed except mild erythema requiring a decrease in dosage in a few patients. The results of the present study confirm those of other authors, with better results than adults probably related to good adherence of patients and their families. Nevertheless, high cumulative doses are not necessarily related to a good response. Therefore, we suggest stopping treatment after 6 months in nonresponding cases.

Psychological factors involved in prurigo nodularis: A pilot study

Abstract Emotional stresses and psychological disorders seem to be concurrent factors in some cases of prurigo nodularis (PN), a chronic skin condition with a difficult therapeutic approach. In order to improve the therapeutic strategies, we performed a psychometric study on 20 patients affected by generalized and histological proven PN. Specific questionnaires were employed to examine the hypotheses (General Health Questionnaire, State Trait Anxiety Inventory – form Y, Beck Depression Inventory-II, and Eysenck Personality Questionnaire). The results show that symptoms of anxiety and depression associated with PN are more severe than in the control group and that some specific traits of personality are more frequently represented in such subjects. The results of our study represent a first attempt to analyze the psychological problems and the personality dimensions which seem to characterize PN patients. Such evidence supports the importance of a psychological approach in the clinical management of PN, which should always include psychological assessment and treatment together with the other therapeutic options.

Possibility of Treating Basal Cell Carcinomas of Nevoid Basal Cell Carcinoma Syndrome with Superficial X-Ray Therapy

Background: The nevoid basal cell carcinoma syndrome (NBCCS), also known as Gorlin-Goltz syndrome, is a rare dermatological disease inherited according to an autosomal dominant pattern. From the dermatological point of view, the most evident characteristic of the syndrome is the early onset of multiple basal cell carcinomas (BCCs). An ideal treatment of BCCs of the NBCCS does not exist. Objective: To evaluate if in particular cases (e.g. poor general health conditions, previous multiple surgical excisions) radiotherapy may be useful, under the condition that it does not promote the onset of new BCCs and that the healing of irradiated lesions is normal. Methods: A study on 3 patients with 17 BCCs treated with superficial radiotherapy is here reported. Results: Complete remission without carcinogenic effects was reached in all treated lesions, with a mean follow-up of 30.35 months. Conclusion: In our opinion, such results suggest the possibility of a cautious application of superficial radiotherapy in selected cases of NBCCS.

Postoperative radiotherapy of auricular keloids: A 26-year experience

Abstract Background: Auricular keloids are very frequent and often have a peculiar response to therapy. Despite a variety of treatment options, recurrence is the norm. An integrated surgical–radiotherapy approach is suggested to have the most significant effect on recurrence rate, varying from 3.5% to 27%. The aim of this study was to assess, through a retrospective review of our cases, the effectiveness and safety of postoperative radiotherapy performed over 26 years and to observe whether all localizations of auricular keloids behave in the same way. Methods: Sixty patients affected by 76 auricular keloids were included in this study. The median time interval between the surgery and the beginning of radiotherapy was 3 days. The total dose administered ranged from 10 Gy to 45 Gy, by means of weekly fractions of 5 Gy each. Results: The mean follow-up was 47.85 months. In 10 cases (13.2%) a recurrence occurred. The 5-year relapse-free rate from the end of the combined treatment was 79.84%. The cosmetic result was judged as good in all cases. No late stochastic or non-stochastic damages were observed. Conclusion: Our data significantly support the dermatologic postoperative radiotherapy role in the treatment approach of all auricular keloids.

Dermatologic radiotherapy in the treatment of extensive basal cell carcinomas: a retrospective study

Abstract Background: The increase of the number of new cases for year of basal cell carcinoma (BCC) has brought also an increase of BCC difficult to treat (extensive, locally advanced and high risk forms). Objective: To evaluate retrospectively the results obtained with dermatologic radiotherapy (RT) for better defining the indications respect to new emerging treatments. Methods: A series of extensive 115 BCC treated with RT from 1977 to 2014 were selected for the study, since endowed with histological diagnosis on the amount of 181 extensive BCC. RT was performed with conventional energies (50–160 kV) administering a total dose ranging from 47 to 85 Gy (median 55 Gy). The mean follow up was 40.66 months (median 21 months). A statistical evaluation was performed with chi-square test to analyse the possible correlations among therapeutic and cosmetic results and size, localisation and clinical type of the lesions. Results: A complete remission (CR) was obtained in 70.43%, a partial remission (PR) in 20% of the lesions treated, while in 9.56% a no response (NR) or not evaluable response (NER) was registered. In 19% of the lesions a relapse was observed, with a five-year cure-rate of 55.13%. Cosmetic results were good in 28%, acceptable in 50% and not acceptable in 22% of the lesions in CR. In six lesions, localised at the trunk region, a chronic radiodermatitis developed. A statistically significative correlation was observed between therapeutic results and size, between cosmetic results and size and between therapeutic results and clinical type of BCC. Conclusion: The treatment of extensive BCC is still a challenge and radiotherapy is one of the possible choices, preferred in the elderly, in relapsing cases, after incomplete excision, and in difficult localisations of the face. Radiotherapy might be included in sequential schedules of treatment to improve final results.

Role of radiotherapy in primary CD30+ and pleomorphic small/medium-sized T-cell lymphomas

Sir, In the treatment of cutaneous T-cell lymphomas, radiotherapy plays a well-known role in the management of mycosis fungoides (MF) and Sezary syndrome, as localized radiotherapy or total skin electron-beam irradiation. Furthermore, radiotherapy has been indicated as first choice treatment in large cell CD30+ lymphomas (LCCD30+L) (1, 2), and in pleomorphic small/medium-sized cells lymphomas (PSMSL) (1, 3, 4). The former is characterized by a single nodularulcerative lesion or grouped nodules, rarely multifocal, sometimes spontaneously regressing, showing histopathologically a diffuse non-epidermotropic infiltrate of large cells expressing CD30 phenotype. The latter is defined by the occurrence of one or several dark red nodules, due to a neoplastic infiltrate of pleomorphic small/medium-sized cells, without clinical evidence of concurrent patches typical for mycosis fungoides. In this short report we update our data on the radiological treatment of LCCD30+L (5), evaluate the results of radiotherapy in the treatment of PSMSL, and compare our findings with those reported in the literature (1–4, 6).

Two cases of lamellar ichthyosis with unusual hair shaft abnormalities.

The authors describe two brothers presenting the clinical picture of lamellar ichthyosis. The scanning electron microscopy and transmission electron microscopy study of their hair demonstrated important recurrent anomalies of the hair shaft.

Radiotherapy of Kaposi’s Sarcoma

Kaposi’s sarcoma is an endothelial neoplasm that presents in different clinical settings with possible skin, mucosa, lymph node and visceral localizations. Treatment requires to be personalized on the basis of clinical picture. Radiotherapy may play a role in the control of the cutaneous and oral mucosa disease, when localized, and in palliation in case of pain or ulcerated lesions. The experience of the authors on a large series of patients confirms that optimal biologic dose of ionizing radiation to be administered is about 30 Gy and that radiotherapy is a therapeutic tool with a favourable benefit/risk ratio.