Samantha Berti

Bacterial skin and soft tissue infections: review of the epidemiology, microbiology, aetiopathogenesis and treatment : A collaboration between dermatologists and infectivologists

Bacterial skin and soft tissues infections (SSTI) often determine acute disease and frequent emergency recovering, and they are one of the most common causes of infection among groups of different ages. Given the variable presentation of SSTI, a thorough assessment of their incidence and prevalence is difficult. The presence of patient‐related (local or systemic) or environmental risk factors, along with the emergence of multi‐drug resistant pathogens, can promote SSTI. These infections may present with a wide spectrum of clinical features and different severity, and can be classified according to various criteria. Many bacterial species can cause SSTI, but Gram‐positive bacteria are the most frequently isolated, with a predominance of Staphylococcus aureus and Streptococcus pyogenes. The diagnosis of SSTI requires an extended clinical history, a thorough physical examination and a high index of suspicion. Early diagnosis is particularly important in complicated infections, which often require laboratory studies, diagnostic imaging and surgical exploration. SSTI management should conform to the epidemiology, the aetiology, the severity and the depth of the infection. Topical, oral or systemic antimicrobial therapy and drainage or debridement could be necessary, along with treatment of a significant underlying disease. This review discusses the epidemiology, the pathogenesis and the classification of bacterial SSTI, describes their associated risk factors and their clinical presentations. The authors provide a rational diagnostic and therapeutic approach to SSTI in respect of antibiotic resistance and currently available antimicrobial agents.

Subacute Cutaneous Lupus Erythematosus in Childhood

Abstract: We report a 7‐year‐old girl who presented with erythematous‐infiltrated, figurate, well‐defined lesions over sun‐exposed skin and antinuclear and Ro/SSA antibodies. Lupus band test revealed granular IgM and microgranular C3 deposits at the dermoepidermal junction. Histopathologic examination of lesional skin showed orthohyperkeratosis, epidermal atrophy, widespread hydropic degeneration of the epidermal basal cell layer, and a dermal perivascular lymphohistiocytic infiltrate. The clinical, immunopathologic, and histopathologic findings were consistent with the diagnosis of annular‐polycyclic variant of subacute cutaneous lupus erythematosus (SCLE). Treatment with hydroxychloroquine cleared the cutaneous lesions. We report this patient because SCLE is extremely rare in childhood, and discuss the two previous cases reported in the literature.

The role of T lymphocytes and cytokines in the pathogenesis of pemphigoid gestationis

Summary Background Pemphigoid gestationis (PG), also known as herpes gestationis, is a rare autoantibody‐mediated bullous disease, usually associated with pregnancy and the postpartum period. However, infiltrating cells have recently been suggested to also contribute to the pathogenesis of cutaneous lesions.

Autoimmune markers in vitiligo patients appear correlated with obsession and phobia.

Background  Current studies have treated a limited portion of the subjective aspects of vitiligo patients and have yet to elucidate possible psychological differences between those with autoimmune markers (AIM) with respect to those without autoimmune markers (NAIM).

Non‐segmental vitiligo and psoriasis comorbidity – a case‐control study in Italian patients

A recent systematic evaluation of vitiligo and psoriasis comorbidity has not yet been reported in a large series of patients with vitiligo.

Stress as a possible mechanism in melanoma progression.

The incidence of melanoma, the most aggressive type of cutaneous malignant tumor, is currently on the rise. Treatment in advanced stages is still unsuccessful compared with other malignant tumors, thus it is important to indentify the key mechanisms responsible for melanoma progression and metastasis. Genetic and molecular components, in particular, that are up- or downregulated in melanoma cells, affect the invasive potential of melanoma. Another possible important cofactor highlighted by recent studies is chronic stress, involving environmental and psychological factors, which can be an important cofactor in not only cancer progression in general but also in melanoma spreading. The negative effects of chronic stress have been evaluated epidemiologically in patients with breast and prostate cancer. In particular, the effects of stress mediators, namely, catecholamines have been studied on various human malignancies, including melanoma and have highlighted a significant increase of progression-related molecules. As such, this could be the starting point for a new approach in the treatment of advanced melanoma, in which the negative effects of stress are reduced or blocked.

Vitiligo in an Italian outpatient center: a clinical and serologic study of 204 patients in Tuscany.

AbstractBackground: Vitiligo is a depigmentation disorder resulting from destruction of cutaneous melanocytes that affects 0.1–2% of the world’s population, irrespective of sex and race. Objective: To investigate the clinical and immunopathologic characteristics of a series of Italian vitiligo patients. Methods: We examined clinical and immunopathologic data of 204 patients affected by vitiligo at a university-based dermatology outpatient hospital (second clinic) between January 1998 and March 2008. In particular, the clinical-epidemiologic characteristics of our patients, serologic parameters suggestive of immune/autoimmune activity (autoantibodies, immune complexes, complement, immunoglobulins), and the association between vitiligo and HLAs were investigated. Results: Upon comparison of our results with control and literature values, the following aspects appeared to be in complete agreement: the frequency of clinical subtypes of vitiligo, an earlier onset of segmental compared with non-segmental vitiligo, the association of familial vitiligo with other autoimmune diseases, the greater association of non-segmental vitiligo than segmental vitiligo with autoimmune diseases, and some features of pediatric vitiligo. Other data were partially consistent with the literature, such as the association between vitiligo and autoimmune diseases/autoantibody activities, and the association between vitiligo and HLAs. Finally, a portion of our data did not concur with the literature, including the sex distribution and mean age of onset, the lack of association between halo nevi and autoimmune diseases, and some aspects of pediatric vitiligo. Conclusions: This study provides novel information regarding clinical features and serologic parameters in different subgroups of vitiligo, namely a significant association between active vitiligo and autoantibody activities, and significant clinical differences (i.e. activity of disease, age of onset, and coexistence of other autoimmune diseases) between vitiligo associated with autoantibodies and vitiligo negative for autoantibodies.

Sequential effects of photodynamic treatment of basal cell carcinoma

Background:  Photodynamic therapy (PDT) of superficial basal cell carcinoma (SBCC) acts as a biological response modifier or killing target cells, but sequential biological effects have not been reported in depth in humans.

Autoimmune signals in non‐segmental vitiligo patients are associated with distinct clinical parameters and toxic exposures

Background  Although non‐segmental vitiligo is commonly considered an autoimmune disease, the possible differences between non‐segmental vitiligo patients with and without autoimmune signals have not been clearly established.

Mast cells do not play a role in vitiligo

ejd.2011.1459 Auteur(s) : Samantha Berti1 s.berti@meyer.it, Laura Amato1, Meena Arunachalam1, Adelina Spallanzani1, Francesca Prignano1, Romina Nassini2, Daniela Massi3, Roberta Colucci1, Silvia Moretti1 1 Departments of Dermatological Sciences 2 Preclinical and Clinical Pharmacology 3 Pathological Anatomy, University of Florence, Piazza Indipendenza 11, 50129 Florence, Italy Stem cell factor (SCF), produced by keratinocytes and endotheliocytes, acts as a ligand for the c-KIT receptor which is expressed [...]