Roberta Giuffrida

Rapid response of metastatic cutaneous squamous cell carcinoma to pembrolizumab in a patient with xeroderma pigmentosum: Case report and review of the literature

A 48-year old patient with known xeroderma pigmentosum was referred to our skin cancer unit because of the recent development of histopathologically verified squamous cell carcinoma (SCC) lymph node metastasis on her left supraclavicular region. A whole body PET-CT showed additional abdominal and inguinal lymph node metastases. Her medical history included, in addition to several minimal surgeries of early forms of keratinocyte skin cancer, a poorly differentiated cutaneous SCC (cSCC) with invasion into the lymphatic vessels on her left tight, which was treated with wide surgical excision 5 years before. Moreover, she suffered from an incipient renal insufficiency not requiring current treatment. On whole body examination, multiple pigmented freckles and actinic keratoses but no other forms of skin cancer were detected. The supracervical lymph node metastasis presented as indurated, infiltrating

Photodynamic therapy in lupus miliaris disseminatus faciei's scars

Lupus miliaris disseminatus faciei is an uncommon granulomatous inflammatory disease, characterized by multiple, monomorphic, reddish translucent papules and nodules, mainly located on the face. Several therapeutic options have been employed with variable results, leaving residual disfiguring scars. On this topic, we report a case of significant improvement of red‐atrophic scars in a 54‐year‐old male after three sessions of photodynamic therapy with 10% aminolevulinic acid. Owing to the high safety profile and the excellent cosmetic result, photodynamic therapy may be considered a useful tool to both prevent and treat undesirable scarring.

Early and Late Onset Side Effects of Photodynamic Therapy

Photodynamic Therapy (PDT) is a non-invasive treatment successfully used for neoplastic, inflammatory and infectious skin diseases. One of its strengths is represented by the high safety profile, even in elderly and/or immuno-depressed subjects. PDT, however, may induce early and late onset side effects. Erythema, pain, burns, edema, itching, desquamation, and pustular formation, often in association with each other, are frequently observed in course of exposure to the light source and in the hours/days immediately after the therapy. In particular, pain is a clinically relevant short-term complication that also reduces long-term patient satisfaction. Rare complications are urticaria, contact dermatitis at the site of application of the photosensitizer, and erosive pustular dermatosis. Debated is the relationship between PDT and carcinogenesis: the eruptive appearance of squamous cell carcinoma (SCC) in previously treated areas has been correlated to a condition of local and/or systemic immunosuppression or to the selection of PDT-resistant SCC. Here we review the literature, with particular emphasis to the pathogenic hypotheses underlying these observations.

Thyroid Autoimmunity and Lichen

Lichen planus (LP) and lichen sclerosus (LS) are cutaneous-mucous diseases with uncertain epidemiology. Current data, which are likely to be underestimated, suggest a prevalence in the general population of 0.1–4% for cutaneous LP, 1.27–2.0% for oral LP, and 0.1–3.3% for LS. While etiology of lichen is still unknown, clinical and histological evidence show an (auto)immune pathogenesis. Association of lichen with autoimmune thyroid disease (AITD) has been investigated in few studies. This association appears better defined in the case of LS, while is more controversial for LP. In both situations, the frequency of the association is higher in females. We review the available literature on the correlation between the different types of lichen and AITD, and the literature on the genetic risk factors which are shared by both conditions. Such data suggest that a common pathogenic mechanism could be the cause for co-occurrence of lichen and AITD, at least in some patients. Additionally, analyzing literature data and in continuity with our previous work on other autoimmune diseases, we suggest that molecular mimicry could trigger both diseases, and thus explain their co-occurrence.

Evaluation of cutaneous surface parameters in psoriatic patients

The purpose of this study was to compare cutaneous surface parameters in lesional and non‐lesional skin of psoriatic patients and in corresponding areas of control subjects.

Tear film and ocular surface assessment in psoriasis

Background Psoriasis is a skin disease with also systemic involvement: its impact on the eye is not well established and often clinically underestimated. Aim of this study was to investigate the presence of ocular discomfort symptoms and of ocular surface changes in a population of patients with psoriasis. Methods For this cross-sectional, comparative study, 66 patients with psoriasis were subdivided according to the presence of arthritis and to the use of biological therapy. All patients underwent clinical evaluation with the following tests: Ocular Surface Disease Index Questionnaire, Tearscope examination, meibometry, tear film breakup time, corneal and conjunctival fluorescein staining, Schirmer I test, corneal aesthesiometry, meibomian gland dysfunction (MGD) assessment and conjunctival impression cytology. 28 healthy subjects were also enrolled and treated with the same clinical tests. A statistical analysis of the results was performed. Results Patients with psoriasis showed a significant deterioration of the ocular surface tests, if compared with healthy subjects, demonstrated by tear film lipid layer alteration, tear film instability, corneal and conjunctival epithelial suffering and mild squamous metaplasia at impression cytology. No differences were found in ocular surface test results of the psoriatic group when patients were divided according to the presence of arthritis, whereas the anti-inflammatory treatment with biological drugs demonstrated a significant improvement of corneal stain and MGD. Conclusions Our findings suggest that the ocular surface involvement in patients with psoriasis indicates the need of periodic ophthalmological examinations to diagnose the condition and allow a proper treatment, so contributing to the amelioration of patients’ quality of life.

Dermoscopy of a single plaque on the face: an uncommon presentation of cutaneous sarcoidosis

Sarcoidosis is a multisystemic granulomatous disease of unknown causes, and cutaneous sarcoidosis (CS) is an early manifestation of the disease. Dermoscopy has gained increasing interest in the past few years as an aid in the clinical diagnosis of inflammatory and infectious skin manifestations. We present a case report about a single, erythematous, and asymptomatic plaque on the face with unexpected dermoscopy characteristics of CS. Learning points: CS on the face of a therapy-resistant actinic keratosis should be considered a differential diagnosis. Dermoscopy can change the diagnosis and lead to the correct management.

Two cases of erosive pustular dermatosis of the scalp occurring after topical 3,75% imiquimod for actinic keratoses

To the Editor, Erosive pustular dermatosis of the scalp (EPDS) is a rare skin disorder occurring mainly in elderly with atrophic sun-damaged skin and characterized by pustular and crusted lesions of the scalp evolving toward scarring alopecia (Corradin et al., 2012; Vaccaro, Barbuzza, & Guarneri, 2009). We report two cases of EPDS arising after treatment with topical 3.75% imiquimod for actinic keratoses (AKs) of the scalp. The cream was applied once daily for two treatment cycles of 2 weeks each separated by 2 weeks without therapy. Patient 1. A 82-years-old man with history of multiple AKs previously treated with cryotherapy and surgery, referred to our clinic for a burning and painful pustular and erosive skin eruption of the scalp, developed 4 days after stopping the second cycle of 3.75% imiquimod cream. Physical examination revealed erythema, erosions, crusts, and pustules involving the bald scalp (Figure 1a). Patient 2. A 74-years-old man with history of multiple skin cancers previously treated with surgery and diffuse solar damage and AKs unresponsive to previous criotherapy and photodynamic therapy came to our department for a burning pustular and crusted reaction of the scalp, occurred 5 days after stopping the second cycle of 3.75% imiquimod treatment. On physical examination erythema, confluent crusts, small eroded, and pustular lesions of the fronto-parietal area were observed (Figure 2a). In both cases laboratory tests, including autoimmunity, bacteriologic, and mycologic exams, were negative. Dermoscopy showed linear irregular vessels, skin atrophy, and erythema with crusts and yellow pustules. A scalp biopsy was performed and revealed ulcerated atrophic epidermis, subcorneal sterile pustules, and an inflammatory infiltrate mainly consisting in neutrophils and lymphocytes. PAS stain and immunofluorescence were negative.

Clinical and dermoscopic features of genital pigmented Bowen disease

Pigmented Bowen disease (pBD) is an uncommon variant of squamous cell carcinoma in situ. Sometimes it can show clinical and dermoscopic features that are seen in other pigmented lesions of the skin and mucosa, making the diagnosis difficult. We report six cases of pBD occurring on the anogenital area, and discuss the importance of dermoscopy for improving the diagnostic accuracy in pBD.

Relapsing Polychondritis: An Updated Review

Relapsing polychondritis is an immune-mediated systemic disease characterized by recurrent episodes of inflammation of cartilaginous and proteoglycan-rich tissues, resulting in progressive anatomical deformation and functional impairment of the involved structures. Auricular and nasal chondritis and/or polyarthritis represent the most common clinical features, but potentially all types of cartilage may be involved. Because of the pleomorphic nature of the disease, with non-specific symptoms at the onset, the diagnosis of relapsing polychondritis is often delayed. In this review article we provide a comprehensive look into clinical presentation, laboratory and instrumental investigations, diagnostic criteria, and therapeutic options.