Sara Cacciapuoti

The effect of aminolevulinic acid photodynamic therapy on microcomedones and macrocomedones.

Background: Photodynamic therapy (PDT) with aminolevulinic acid (ALA) has been shown to be an effective treatment for acne. However, the effect of ALA PDT on comedo formation has never been objectively evaluated. Cyanoacrylate follicular biopsy (CFB), a noninvasive procedure, has been proposed as the most reliable tool for studying follicular casts. Objective: To determine the possible effect of ALA and red light (550–700 nm) on macro- and microcomedones in acne patients. Patients and Methods: 10 patients with mild-to-moderate facial and/or chest/back acne resistant to conventional therapies received ALA PDT at 2-week intervals in 3 sessions. The severity of acne had been estimated by a system of points, the Global Acne Grading System. The patients underwent PDT utilizing ALA 10% (face) or 15% (back/chest) and red light (15 J/cm2 each session). CFBs were performed. Results: Four weeks after their last PDT session, the patients showed an average global score reduction of 50%. CFBs demonstrated a reduction in the total area, the average area and the density of macrocomedones. Conclusion: The results obtained in this study using CFB evaluation demonstrate that ALA PDT exerts an action on the comedogenic phase as well.

CROSS technique: chemical reconstruction of skin scars method

ABSTRACT:  Skin scars remain a therapeutic challenge to dermatologists. Over the past several decades, numerous surgical techniques have been used to improve the appearance of scarring. The objective of this study is to evaluate the efficacy of a local application of a (50%) concentration of trichloroacetic acid (TCA) for the treatment of atrophic acne scars (grade 3 in Goodman classification), as opposed to the higher (90%) TCA concentration used in previous studies, in order to reduce adverse local effects. The primary goal was the resolution of acne or chickenpox scars. Secondary goals were physician and subject assessments of scar improvement. Fifty percent TCA was applied locally to atrophic scars in five patients. Three patients had treated scars on the face and two patients had treated scars on the back. Wooden applicators were used to apply TCA locally and the treatment was repeated at 4‐week intervals for a total of three sessions. Digital photographic analysis of lesions supported clinical observations. Histologic examination was performed only on two samples of patients with treated scars on the back. Clinical examination revealed cosmetic improvements in both depth and appearance of skin scars. We believe that the 50% TCA CROSS can be an effective technique for the treatment of atrophic scars.

Teledermatology: from prevention to diagnosis of nonmelanoma and melanoma skin cancer

Telemedicine is a rapidly developing application of clinical medicine where medical information is transferred through interactive audiovisual media for the purpose of consulting remote medical procedures or examinations, reducing the time of consultation for patients. Teledermatology as an application of telemedicine was developed in 1995: it turns out to be a gradually more ordinary mean of delivering dermatologic healthcare worldwide and will almost certainly have a greater medical function in the future. In particular, teledermatology can aid in the prevention and diagnosis of nonmelanoma and melanoma skin cancer; telemedicine and teledermatology offer the opportunity to make available consultations with experts also by long distance. Overall, patients seem to accept teledermatology, considering it as an excellent mean to obtain healthcare, particularly in those areas with no expert dermatologists available. Clinicians have also generally reported affirmative experiences with teledermatology in the skin cancer field. Further studies focusing on cost effectiveness, patient outcomes, and patient and clinician satisfaction will facilitate to delineate the potential of teledermatology as a mean of prevention and diagnosis of nonmelanoma and melanoma skin cancer.

Automatic Diagnosis of Melanoma Based on the 7-Point Checklist

An image based system implementing a well-known diagnostic method is disclosed for the automatic detection of melanomas as support to clinicians. The software procedure is able to recognize automatically the skin lesion within the digital image, measure morphological and chromatic parameters, carry out a suitable classification for detecting the dermoscopic structures provided by the 7-Point Checklist. Advanced techniques are introduced at different stages of the image processing pipeline, including the border detection, the extraction of low-level features and scoring of high order features.

Human Papillomavirus Infection in Child

Human papilloma viruses (HPV) have been identified as the cause of cutaneous and genital warts. Furthermore, HPV DNA can also be detected in certain malignant epithelial tumors such as cervical carcinoma and cutaneous squamous cell cancer. HPV infections in children, particularly when occurring as condylomata acuminata, present a difficult and often puzzling problem. The modes of viral transmission in child remain controversial, including perinatal transmission, auto- and hetero-inoculation, sexual abuse, and, possibly, indirect transmission via fomites. The treatment of warts and condylomata acuminate in child poses a therapeutic challenge for physicians. No single therapy has been proven effective at achieving complete remission in every patient. As a result, many different approaches to therapy exist. The proper approach to the management of warts depends on the age of the patient, location, size, extent, and type of wart, and duration of lesions. Each treatment decision should be made on a case-by-case basis according to the experience of the physician, patient preference, and the application of evidence-based medicine. In order to modify HPV epidemiology, HPV prophylactic vaccine has been recently proposed for children. The purpose of this review is to update the reader with the latest information on the HPV and its therapeutics in children.

Intralesional Diode Laser 1064 nm for the Treatment of Hidradenitis Suppurativa: A Report of Twenty Patients

AIM: Hidradenitis suppurativa (HS) is a chronic inflammatory disease, commonly characterized by painful, deep dermal abscesses and chronic draining sinus tracts. Recently, laser and light-based therapies have become more commonly used in the management of HS. MATERIAL AND METHODS: We report 20 HS patients treated with a 1064 nm wavelength, emitted from a diode laser, launched in an optical fibre through intracavitary modalities. RESULTS: Each patient underwent four laser sessions, one every two weeks. we recorded a significative reduction (31%) of Sartorius score from 28.55 ± 13.04 to 19.75 ± 12.29 after 4 laser sessions (p < 0.05). No one has had a worsening of the disease. CONCLUSION: Intralesional diode laser 1064 nm can be a good treatment option for patients with moderate and localized hidradenitis suppurativa, because it is minimally invasive, doesn’t have significant complications and provides a rapid post-treatment recovery.

Tolerability and camouflaging effect of corrective makeup for acne: results of a clinical study of a novel face compact cream.

Background A novel face compact cream (FCC) containing a new patented formulation was recently developed to provide acne patients with cosmetic camouflage for their lesions and to have beneficial effects on the multifactorial components of the disease. This pilot investigation aimed to evaluate the real-life tolerability, potential for comedogenicity and covering effect provided by this FCC. Methods This single-center study evaluated the FCC applied once daily for 28 days in 20 females with facial acne. Tolerability was assessed by rating skin reactions on a scale from 1 =absent to 4 =evident. Comedogenicity potential was evaluated by determining the number of facial acne lesions before and after use of the FCC. The covering effect was rated in ten patients 30 minutes after application on a scale from 1 =none to 5 =excellent. Patients rated their opinions on the FCC on day 28 using a questionnaire. Results Assessment of tolerability on days 0, 14, and 28 showed that skin reactions, including erythema, edema, dryness, desquamation, tight feeling, itching, and burning, were absent in all patients. The FCC was noncomedogenic and provided a significant 15.8% reduction in facial acne lesions after 28 days (P<0.001). The FCC provided a good covering effect 30 minutes after application in 80% of patients. All patients (100%) were satisfied with the FCC, with 90% agreeing that the FCC was effective and 80% stating that the FCC improved their skin. Conclusion The FCC was positively perceived, well tolerated, noncomedogenic, and provided an effective covering of acne in this small group of female patients with 1 month of follow-up.

Photodynamic therapy for periungual pyogenic granuloma-like during chemotherapy: our preliminary results

Dear Editor, Patients treated with systemic anticancer drugs often show changes in their nails, which can affect patient’s quality of life causing pain and functional impairment [1]. EGFR inhibitors are used in the treatment of several types of advanced cancer and it is estimated that overall incidence of all-grade nail toxicity during chemotherapy with EGFRIs is 17.2%. These drug class-related adverse events are tumorindependent and have also been reported with the use of the latest ErbB inhibitors, including lapatinib, pertuzumab, and afatinib [2]. The epidermal growth factor receptor (EGFR) is most concentrated in the basal keratinocytes, where it acts as a powerful growth promoter, leading to epidermal hyperplasia and hyperkeratosis. Periungual lesions are the most common and debilitating manifestations in patients treated with targeted anticancer therapies. Pyogenic granuloma-like (PGL) lesions are an excess of friable granulation tissue on proximal or lateral folds of the nail, mimicking ingrown nails. These periungual lesions can affect any digit, but the thumbs and the big toes are the most frequently affected, probably because they are more exposed to microtrauma. Development of EGFR inhibitor-induced nail PGLs is dose-dependent, and the granulomas usually regress spontaneously 1–2 months after stopping the drug [3]. The pathogenic hypothesis is that these lesions result from inhibition of the EGFR and downstream EGFR-dependent pathways in basal and suprabasal keratinocytes. This inhibition leads to growth arrest, apoptosis, and decrease of migration of keratinocytes. Consequentially, the periungual epidermis thins damaging the paronychium by the lateral edges of the nail plate and can induce a similar reaction of secondary inflammation to presence of a foreign body [4]. PGL treatment is based on topical steroids and antiseptics, liquid nitrogen, electrodessication, and silver nitrate, associated with local hygiene and avoidance of friction and pressure by shoes [5]. Lateral matricectomy with phenolization of affected toenails has been reported effective with no recurrence, indicating the predisposing role of trauma and nail morphology [6]. Photodynamic therapy (PDT) is a clinically approved and minimally invasive therapeutic procedure that can exercise a selective cytotoxic activity. PDT is currently indicated for treatment of actinic keratosis, basal cell carcinoma, and squamous cell carcinoma in situ (Bowen’s disease) [7]. PDT has also been proposed for the treatment of several nonneoplastic dermatological diseases like photo-aged skin, leishmaniasis, hidradenitis suppurativa (HS), sebaceous hyperplasia, and acne vulgaris. Moreover, some studies have demonstrated that endothelial cells generate protoporphyrin IX from photosensitizers and PDT has the ability to destroy vascular endothelial cells both in vitro and in vivo [8]. In addition, VEGF expression was downregulated following ALA-PDT treatment in mice [9]. Recently, PDT has been effectively used to treat vascular lesions such as port-wine stains, Kaposi’s sarcoma, and pyogenic granuloma [10]. Because of PDTanti-inflammatory and selective action and modulation on granulomatous process and on vascularization, we decided to utilize this treatment modalities in four patients with PGL induced during anti-EGFR-therapy previously treated with topical high-potency corticosteroides in occlusive, and on phenolization at 16% (two patients in treatment with afatinib, one in treatment with lapatinib, and one with erlotinib). * G. Fabbrocini gafabbro@unina.it

A Dermatological Questionnaire for General Practitioners with a Focus on Hidradenitis Suppurativa

BACKGROUND: Hidradenitis suppurativa (HS) is a skin chronic inflammatory disease typically located in several areas such as perianal, inguinal and axillary regions. In 40% to 70% of cases, general practitioners (GPs) are the first health care professionals consulted by patients suffering from HS. The role of GPs in HS management could be more substantial than it has been in the past. AIM: We developed a questionnaire to assess the knowledge of HS by GPs and to evaluate if in their perception the dermatologist is the reference medical doctor for pathology above. METHODS: The data were processed by a univariate descriptive statistical analysis. RESULTS: Our study showed GPs could recognise patients affected by HS. They have proven to know the main features of HS. Nevertheless, the second part of the questionnaire has highlighted the considerable confusion of GPs about who the reference figure is. CONCLUSION: The data registered regarding therapy and follow up too, only show a mild preponderance of dermatologist compared to other professional figures, such as a surgeon, GPs and plastic surgeon.

Anti-TNF-α therapy modulates mTORC1 signalling in hidradenitis suppurativa

Hidradenitis Suppurativa (HS) is a chronic, inflammatory, recurrent and debilitating skin disease of the hair follicle, which usually occurs after puberty with painful, deep-seated, inflammatory lesions in the apocrine gland-bearing areas of the body, most commonly in axillary, inguinal and anogenital regions This article is protected by copyright. All rights reserved.