Sara Bellavista

Periungual and subungual pyogenic granuloma

Background  Nail pyogenic granuloma (PG) is common, often seen as an urgent case, given the recent onset as a bleeding nodule. Nail PGs are due to different causes that act through different pathogenetic mechanisms and may be treated in several ways. Both causes and treatments of nail PG have never been classified.

Prevalence and predictors of Lymphogranuloma venereum in a high risk population attending a STD outpatients clinic in Italy

BackgroundWe evaluated LGV prevalence and predictors in a high risk population attending a STI Outpatients Clinic in the North of Italy.MethodsA total of 108 patients (99 MSM and 9 women), with a history of unsafe anal sexual intercourses, were enrolled. Anorectal swabs and urine samples were tested for Chlamydia trachomatis (CT) DNA detection by Versant CT/GC DNA 1.0 Assay (Siemens Healthcare Diagnostics Terrytown, USA). RFLP analysis was used for CT molecular typing.ResultsL2 CT genotype was identified in 13/108 (12%) rectal swabs. All LGV cases were from MSM, declaring high-risk sexual behaviour and complaining anorectal symptoms. Patients first attending the STI Outpatient Clinic received a significant earlier LGV diagnosis than those first seeking care from general practitioners or gastroenterologists (P = 0.0046).LGV prevalence and characteristics found in our population are in agreement with international reports. Statistical analysis showed that LGV positive patients were older (P = 0.0008) and presented more STIs (P = 0.0023) than LGV negative ones, in particular due to syphilis (P < 0.001), HIV (P < 0.001) and HBV (P = 0.001).Multivariate logistic regression analysis revealed that HIV and syphilis infections are strong risk factors for LGV presence (respectively, P = 0.001 and P = 0.010).ConclusionsEven if our results do not provide sufficient evidence to recommend routine screening of anorectal swabs in high-risk population, they strongly suggest to perform CT NAAT tests and genotyping on rectal specimens in presence of ulcerative proctitis in HIV and/or syphilis-positive MSM. In this context, CT DNA detection by Versant CT/GC DNA 1.0 Assay, followed by RFLP analysis for molecular typing demonstrated to be an excellent diagnostic algorithm for LGV identification.

Dermasilk Briefs in Vulvar Lichen Sclerosus: An Adjuvant Tool

Objective: The purpose of our study was to evaluate whether briefs made of Dermasilk fabric could be an adjuvant tool in the management of vulvar lichen sclerosus (LS). Materials and Methods: A controlled, randomized, double-blind study versus placebo was conducted, comparing Dermasilk versus standard cotton briefs in patients affected by LS during treatment with clobetasol propionate 0.05% ointment and vitamin E moisturizer. For each patient, an evaluation of objective genital signs and subjective symptoms typical of LS was recorded before the start of treatment, after 1 month, and after 6 months of the study. Statistical analysis was performed with SPSS 17.0 for Windows. Results: Forty-two women affected by LS were recruited and divided into those wearing Dermasilk or cotton briefs. Patients wearing Dermasilk briefs showed a better improvement in the clinical symptoms of burning sensation, skin irritation, and pain (Fisher test, p < .0001) compared with the cotton placebo group. The improvement in itching was also faster in the Dermasilk group (Fisher exact test, p < .05). Erythema also showed a better improvement in the Dermasilk group (Fisher test, p < 0.05). Conclusions: Dermasilk fabric seems to be a useful adjunct to topical treatment in producing a better and more rapid control of symptoms in patients with LS.

Use of Dermasilk briefs in recurrent vulvovaginal candidosis: safety and effectiveness

Despite the generally excellent results achieved with fluconazole 150 mg weekly in recurrent vulvovaginal candidosis (RVVC), some patients with a long history of disease do not achieve complete resolution of symptoms following antimycotic treatment. It is thought that use of tight synthetic fabric underwear could be a significant factor in causing recurrence. We decided to compare underwear made of Dermasilk®, a pure fibroin fabric impregnated with a permanent antimicrobial protection, with a cotton placebo to see whether it could be a useful adjunctive tool in the management of RVVC. We recruited 96 women who had a long‐term history of RVVC and had not responded to oral antimycotics with complete satisfaction. The patients were randomly divided into two groups and instructed to use either white cotton placebo briefs or Dermasilk® briefs. Both groups were treated with fluconazole 150 mg once weekly for 6 months. After 6 months, the Dermasilk group showed a statistically significant greater decrease of itching, burning, erythema and a smaller number of recurrences than the cotton group. Our work suggests that Dermasilk® briefs could be a useful adjunctive tool in addition to antimycotic treatment to help relieve the discomfort of recurrent vulvovaginitis.

Carbon dioxide laser: first-line therapy in vulvar inflammatory linear verrucous epidermal nevus

Inflammatory linear verrucous epidermal nevus (ILVEN) is normally associated with the failure of topical and systemic treatments and with recurrences on interruption of therapy. Many physical approaches have been used, but they generally resulted in varying rates of recurrence and unacceptable scarring. We reported a case of ILVEN treated with a single session CO2 laser treatment. In our experience, CO2 laser was quick, easy, effective, and safe; we therefore believe that this approach should be considered as a first‐line surgical option in the treatment of genital ILVEN, particularly in cases of mucosal involvement

Acute Fitz-Hugh-Curtis Syndrome in a Man due to Gonococcal Infection

BACKGROUND Fitz-Hugh-Curtis syndrome is a rare extra-pelvic complication of genital infection involving the perihepatic capsule. Most cases have been described in women in association with pelvic inflammatory disease; in rare cases it has been reported in men. Because the main symptom is acute abdominal pain, and laboratory and imaging findings are frequently nonspecific, the differential diagnosis, considering other gastrointestinal or renal diseases, can be difficult in the early stage of the syndrome, leading to frequent misdiagnosis and mismanagement. CASE REPORT We report a case of Fitz-Hugh-Curtis syndrome in a 26-year-old man who first presented to the emergency department with acute abdominal pain, vomiting, and fever. Diagnosis was possible on the basis of clinical signs of orchiepididymitis, abnormal ultrasound findings, and specialist consultation with the Sexually Transmitted Infection Clinic. An acute gonoccocal infection was revealed, which was complicated by a collection of free perihepatic fluid and a subcapsular hypoechoic focal lesion. Prompt antibiotic therapy was established, with complete resolution of the symptoms within a few days. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Awareness of the clinical presentation, imaging, and laboratory findings during the acute phase of Fitz-Hugh-Curtis syndrome could help emergency physicians to make an early diagnosis and to correctly manage such patients. Improved diagnostic skills could prevent chronic complications that are especially a risk in the case of delayed or minor genitourinary symptoms.

Pruritic papular eruption in HIV: a case successfully treated with NB-UVB.

Pruritic papular eruption (PPE) is a skin disease characterized by the eruption of itching papules on the extremities, face, and trunk; it is quite frequent in HIV‐positive patients especially during the advanced immunosuppressive stage. PPE usually improves or heals when antiretroviral therapy restores the immune system function, but in some cases, it can take several months, and a symptomatic treatment for PPE is required. Systemic antihistamines, topical steroids, topical tacrolimus, itraconazole, pentoxyphilline, and ultraviolet B phototherapy have been proposed in cases of persisting PPE, but an elective treatment has not yet been found. We describe the case of a black patient affected by PPE, nonimproving with antiretroviral treatment, and resistant to topical steroids and oral antihistamines; a satisfactory and speedy result was achieved with narrow‐band ultraviolet B phototherapy.

Tendency to underestimate the severity of androgenetic alopecia.

between HPV and PPECs. Of these cases, three were found to be infected with HPV 57, while the others were infected with HPV 60. HPV 60 is a distinct skin HPV, and induces unique clinical lesions on the soles and the palms, such as epidermal cysts and ridged warts, which exhibit characteristic histological features such as intracytoplasmic eosinophilic inclusion bodies, vacuolar structures in the cavity and cyst walls, and parakeratotic nuclei. Of these histological changes, intracytoplasmic eosinophilic inclusion bodies and vacuolar structures within the cavity are known to be specific for HPV 60. Several reports have described cases of PPECs infected with HPV 60, but only two have reported HPV 60 in cutaneous lesions in a nonpalmoplantar area as a possible precursor of an NPPEC. However, in these two reports the epidermal cyst was a solitary lesion without any accompanying viral wart above it. To our knowledge, our cases are unique, with findings of a concurrent viral wart and an epidermal cyst on the face, both of which were HPV 60 positive. We report these cases as evidence to support the hypothesis that HPV 60 causes epidermal cysts in human skin.

AIDS-related Kaposi’s sarcoma involving the genital and inguinal regions

with leukocytoclasis throughout the dermis (Fig. 2). Interestingly, the polymerase chain reaction (PCR) assay for HSV type 2 DNA was positive in the same specimen using Seeplex HSV2 ACE Detection (Seegene, Seoul, Korea). Cutaneous vasculitis is a common diagnosis in routine dermatology practice. Underlying autoimmune diseases, malignancy, drugs, and systemic vasculitis are often found to be etiological factors. Infections also play a major role, including streptococcus, staphylococcus, mycobacterium, and hepatitis B or C. But, with better techniques such as PCR and various immunodiagnostic techniques, looking at the characteristic antibodies for certain infections now offers us the ability to sort out and determine the true incidence of vasculitis related to the myriad infectious agents. As far as we know, leukocytoclastic vasculitis associated with HSV has not been previously reported. Although our patient did not have any history of herpetic infection, an unapparent HSV infection was implicated as the cause associated with vasculitis. This relationship of HSV and vasculitis is supported by an animal study involving ICR strain mice. The mice were inoculated with an HSV-1 solution, and 29.8% of 258 mice showed Behcet’s diseaselike symptoms that revealed vasculitis. Moreover, the unique plantar location of cutaneous vasculitis supports this etiological association, because the plantar area is known as a predilection site of erythema multiforme, in which hematogenous spread of HSV DNA from the infected lesion to the plantar area has already been proven, and the benign course but frequent recurrences in the presented case seem to be consistent with the natural course of mucosal HSV infections. Here we report a case of plantar leukocytoclastic vasculitis associated with HSV-2 infection proven by PCR assay. Although the specificity of a PCR assay is not high enough, HSV seems to be one of various agents that can cause leukocytoclastic vasculitis. We think the causality link has been overlooked by both patients and physicians due to the asymptomatic nature of HSV infection. More sophisticated laboratory techniques and subsequent reports are required to confirm the etiology of plantar leukocytoclastic vasculitis.

P5.086 Diagnosis of Extra-Genital Chlamydia And/Or Gonorrhoea Infections by Versant CT/GC DNA 1.0

Objectives Nucleic acid amplification testing (NAAT) has become the preferred method to detect Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (GC) infections. Anyway, no commercial test has been cleared so far for use with extra-genital swab samples. In this study Versant CT/GC DNA 1.0 (Siemens) performances have been evaluated by testing ocular, rectal or pharyngeal secretions collected by Siemens collection devices. Methods Study group. A prospective study was performed with 7 newborns with conjunctivitis, and 183 subjects attending the STD Outpatients Clinic of St. Orsola Hospital, Bologna. The latter ones were enrolled because having unsafe receptive anal and/or pharyngeal sex intercourses. NAAT methods. All the specimens were tested by Versant CT/GC DNA 1.0. In case of a Versant CT positive result, we collected the corresponding remnant DNA extract and used it as a template for omp1 semi-nested-PCR. RFLP analysis of PCR-positive samples was carried out by using AluI, HinfI and DdeI as restriction enzymes, for genotyping. All the specimens scored GC positive were retested by a “home-made” PCR assay, targeting cppB gene. Results A total of 253 samples were obtained. In particular, we tested 14 conjunctival swabs, 155 pharyngeal swabs and 84 rectal swabs. Versant assay scored as GC positive 13 pharyngeal and 7 rectal samples. All these specimens were confirmed reactive by cppB PCR. Regarding CT infections, Versant assay identified 2 ocular specimens as positive: one was further genotyped as E and the other one as F. Moreover, we found 4 positive pharyngeal specimens (genotypes E, F, J) and 12 rectal samples (genotypes E, H, J, L2). Conclusions Versant CT/GC DNA 1.0 demonstrated to be a very good method to identify extra-genital infections due to chlamydia and/or gonorrhoea. Because of its performances, and the walk-away capability of the system, this assay can be considered an excellent choice for CT/GC diagnosis.