Serafinella P. Cannavò

Treatment of Psoriatic Nails with Topical Cyclosporin: A Prospective, Randomized Placebo-Controlled Study

Background: Nail involvement is a frequent event in the course of psoriasis causing severe distress. While systemic cyclosporin (CsA) represents a well-established therapy of psoriasis, its topical use is limited by the difficult penetration of the molecule through the skin and the nail because of its highly lipophilic nature. Objectives: We carried out a prospective randomized placebo-controlled study in order to analyze the effectiveness and tolerability of topical oil-dissolved 70% CsA solution in nail psoriasis. Methods: Sixteen adult patients with nail psoriasis, divided randomly into two groups of 8 patients (group A and group B), were treated respectively with a 70% maize-oil-dissolved oral CsA solution and maize oil alone. To compare the therapeutic effectiveness, all patients were evaluated, before starting the treatment and after 12 weeks of therapy, by the same dermatologists. The patients were also asked to assess the severity of their nail involvement at baseline and at the end of the treatment. Results: In group A, 3 patients came to a complete resolution of nail lesions and 5 showed a substantial improvement of the overall severity score. In group B, a slight improvement was noted in only 1 patient. All the patients of group A judged positively the results of the therapy, while in group B only 1 patient reported a moderate improvement. Conclusion: Our results show that topical therapy with oral CsA solution is a safe, effective and cosmetically highly acceptable treatment modality for nail psoriasis. The ability of CsA to influence keratinocyte proliferation and T-cell lymphokine release, reducing the cornification of the upper layers of the epidermis, may prevent the typical alterations observed in nail psoriasis.

Correlation between endocrinological parameters and acne severity in adult women.

Many studies demonstrate increased androgen levels and high prevalence of polycystic ovaries in women affected by acne. We evaluated the relationship between clinical features, ultrasonographic data on polycystic ovaries and hormonal parameters in 129 women >17 years of age with acne. Serum levels of androgens of ovarian and adrenal origin were measured. Menstrual cycle regularity, hirsutism, body mass index and ultrasonographic evaluation of ovaries were recorded. Raised levels of at least one androgen were evident in a majority of our patients. Only 19% of them had polycystic ovary syndrome. Hirsutism and acne severity correlated negatively with serum sex hormone-binding globulin (SHBG) levels (p<0.05). No correlation between acne severity and hirsutism was found. In post-pubertal women, severity of acne seems to depend on peripheral hyperandrogenism, with a negative relationship between the acne severity and serum SHBG levels. We strongly recommend the evaluation of serum SHBG levels in women with acne in order to select patients who can have a better response to appropriate hormonal regimes.

Serum levels of interleukin‐18 and s‐ICAM‐1 in patients affected by psoriasis: preliminary considerations

Objective To find new aspects of the systemic involvement of the Immune System in psoriasis, we determined serum levels of interleukin‐18 (IL‐18) (Th1‐inducing factor cytokine), CD30 (Th2 marker) and sICAM‐1 (adhesion molecule). In addition we evaluated the correlation between these molecules and psoriasis area and severity index (PASI).

Subcutaneous fat necrosis of the newborn: Be aware of hypercalcaemia

Abstract:  Subcutaneous fat necrosis of the newborn is an uncommon, self‐limiting panniculitis that usually occurs in full‐term infants as a consequence of perinatal asphyxia. The cutaneous involvement may be associated with metabolic complications such as hypoglycaemia, thrombocytopenia, hypertriglyceridemia, anemia and hypercalcaemia. The delayed onset of hypercalcaemia, 1–6 months after the development of the skin manifestations, imposes a prolonged follow‐up to avoid its acute toxic effects on cardiovascular and renal systems and the more durable metastatic calcifications.

Behaviour of laminin 1 and type IV collagen in uninvolved psoriatic skin. Immunohistochemical study using confocal laser scanning microscopy

Previous studies have demonstrated the presence in psoriatic lesions of ultrastructural and molecular alterations of the basement membrane and an altered polarized distribution of the integrins; this latter alteration has also been observed in uninvolved skin. The aim of the present study was to determine, by means of immunolocalization with monoclonal antibodies directed against laminin 1 and type IV collagen and using confocal scanning laser microscopy, whether there are also alterations of the main components of the basement membrane in uninvolved skin. The findings showed a discontinuous and fragmented staining of laminin 1 and a normal distribution of type IV collagen. Taking into account both these results and the results of studies on epithelial cell lines, the authors hypothesize the existence of a functional deficit in psoriatic keratinocytes affecting the synthesis of the α1 subunit of laminin. This deficit would explain: (1) the incapacity to produce mature trimeric laminin; (2) the altered assembly into a distinct basal lamina; (3) the loss of keratinocyte adhesion to the basement membrane; (4) alterations in the polarized distribution of the integrins; and (5) the consequent total or partial block of the cell signals regulating the processes of cytomorphosis. Already present in uninvolved skin, and enhanced by various irritative stimuli, this situation could be decisive for the appearance of psoriatic lesions.

Immunohistochemical study of epidermal nerve fibres in involved and uninvolved psoriatic skin using confocal laser scanning microscopy.

Abstract Psoriasis is a typical hyperproliferative epidermal disease whose aetiopathogenesis is still to be defined. One of the most likely hypotheses is that it has a neurogenic origin correlated with an altered release of some neuropeptides by sensitive cutaneous nerves via antidromic pathways. As there are conflicting reports about the existence of cutaneous nerve alterations in psoriasis, we carried out an immunolocalization study using the protein gene product 9.5 as a marker for neuronal structures observed by confocal laser scanning microscopy in order to determine the pattern of sensory nerves in psoriatic skin. The investigation was carried out on cutaneous biopsies taken from involved (mature and long-established lesions) and uninvolved skin of ten patients with extensive chronic plaque psoriasis. In uninvolved psoriatic skin a significant decrease in epidermal nerve fibres was found, a further decrease was observed in mature lesions and almost a complete lack of epidermal nerve fibres in long-established psoriatic lesions. The reduction in epidermal nerve fibres and the consequent loss of relationship between these nerve structures and the skin immunocompetent cells (antigen-presenting cells, Langerhans cells, keratinocytes) might be a factor of fundamental importance in the self-maintenance of the disease.

Cost and quality of life in patients with severe chronic hand eczema refractory to standard therapy with topical potent corticosteroids

Little is known about the socio‐economic burden of severe chronic hand eczema in patients refractory to treatment with potent corticosteroids.

Mucosal Leishmaniasis Occurring in a Renal Transplant Recipient

The long-term use of immunosuppressive therapy in transplant recipients causes a well-known high susceptibility to opportunistic infections. Several cases of visceral leishmaniasis have been reported in immunosuppressed patients; cutaneous and, especially, mucosal involvement has rarely been described in the literature. We report a case of mucosal leishmaniasis, occurring in a renal transplant recipient, observed in Sicily, an endemic region for the Leishmania infantum. A 65-year-old white man, a farm labourer, was referred to our department because he had had, for 4 months, a painless, rapidly growing, infiltrating lesion localised in the lower lip. At the age of 59, he had received an orthotopic renal transplant for focal sclerosing glomerulonephritis and was started on cyclosporine A and methylprednisolone for immunosuppression. He had no history of cutaneous disease. He had never travelled out of Italy. Physical examination revealed a hard, diffuse enlargement of the left half of the lower lip, partially covered by small scabs (fig. 1a); granulomatous changes were visible on the internal side of the cheek (fig. 1b). There were no palpable lymph nodes, and no other lesions were noted on the body. Histology of two biopsy specimens, respectively from the vermilion area and the cheek, showed a dense dermal inflammatory cell infiltrate composed of lymphocytes and histiocytes. In the cytoplasm of the latter, numerous Leishman-Donovan bodies were present. Routine laboratory tests were within the normal ranges; human immunodeficiency virus (HIV) 1 and HIV-2 testing, serum venereal disease research laboratory and Leishmania serology performed by immunofluorescence were negative, as well as culture in NovyMcNeal-Nicolle medium. A bone marrow biopsy specimen was negative for Leishmania. The diagnosis of mucosal leishmaniasis was based upon history and histopathological examination, revealing Leishmania amastigotes in the dermis. Differential diagnosis, including trauma, fixed drug eruption, syphilitic chancre, Melkersson-Rosenthal syndrome, granulomatous cheilitis, sarcoidosis and lymphoedema, were excluded on the basis of anamnestic, clinical and laboratory data.

Cutaneous angiosarcoma of the face

Cutaneous angiosarcoma is a rare tumour of vascular origin, which has a poor prognosis because of its high potential for metastasis. We report the case of a 57‐year‐old man with an 8‐month history of a progressively enlarging, asymptomatic red patch over the left periorbital region of the face, previously diagnosed as angiolupoid leishmaniasis, insect‐bites, ‘cellulitis’ and treated with several topical antibiotic and steroid therapy, without any improvement. A skin biopsy of the lesion was performed and histological and immunohistochemical examination revealed a pattern of poorly differentiated angiosarcoma. The peculiarity of the localization at the periorbital area and the particular clinical presentation are emphasized.

Pretibial myxoedema associated with Hashimoto's thyroiditis.

Pretibial myxoedema is a cutaneous mucinosis typically associated with Graves’ disease, although it may also develop in subjects with non‐thyrotoxic thyroid pathologies. This report presents a rare case of pretibial myxoedema occurring in a 58‐year‐old woman with biopsy‐proven Hashimotos thyroiditis. The hypothetical pathogenetic link between the two disorders is discussed with particular attention to the role of thyroid stimulating hormone receptor antibodies.