Stamatis Gregoriou

Hyperpigmentation and melasma

Facial and neck pigmentations are significant cosmetic problems. They are common in middle‐aged women, related to endogenous (hormones) and exogenous factors (cosmetics, perfumes, sun exposure), and often represent paramount causes of emotional distress. Although melasma is the most common cause of facial pigmentation, there are many other forms including drug‐induced and postinflammatory hyperpigmentation. We review pathogenesis, clinical and histopathological data, effect on quality of life, and treatment options in facial hyperpigmentation disorders.

Evaluation of the efficacy and safety of infliximab on psoriatic nails: an unblinded, nonrandomized, open‐label study

Background  Despite advances in the treatment of skin psoriasis during the last years, therapy of psoriatic nails remains a challenge.

Cytokines and other mediators in alopecia areata.

Alopecia areata, a disease of the hair follicles with multifactorial etiology and a strong component of autoimmune origin, has been extensively studied as far as the role of several cytokines is concerned. So far, IFN-γ, interleukins, TNF-α, are cytokines that are well known to play a major role in the pathogenesis of the disease, while several studies have shown that many more pathways exist. Among them, MIG, IP-10, BAFF, HLA antigens, MIG, as well as stress hormones are implicated in disease onset and activity. Within the scope of this paper, the authors attempt to shed light upon the complexity of alopecia areata underlying mechanisms and indicate pathways that may suggest future treatments.

Treatment of Psoriatic Nails with Tazarotene Cream 0.1% vs. Clobetasol Propionate 0.05% Cream: A Double-blind Study

t azarotene 1.13 (0.88) 0.28 (0.45) 0.97 (0.71) Clobetasol 1.09 (0.99) 0.36 (0.48) 0.97 (0.85) Onycholysis t azarotene 1.97 (1.27) 0.82 (0.73) 1.54 (1.00) Clobetasol 1.90 (1.28) 0.82 (0.62) 1.73 (1.09) Hyperkeratosis t azarotene 1.80 (1.04) 0.36 (0.48) 0.97 (0.80) Clobetasol 1.70 (0.95) 0.58 (0.66) 1.56 (0.83) Salmon patches t azarotene 1.15 (0.89) 0.17 (0.38) 0.69 (0.72) Clobetasol 1.07 (0.78) 0.19 (0.45) 0.85 (0.61)

Treatment of nail psoriasis with adalimumab: an open label unblinded study

Background  Despite numerous advances in the therapeutic management of cutaneous psoriasis, there is a lack of standardized therapeutic regimens for psoriatic nail disease.

Coping with acne: beliefs and perceptions in a sample of secondary school Greek pupils

Background  Information on the understanding of acne in adolescents has only occasionally been reported in the medical literature.

Clinical features and natural history of acquired cold urticaria in a tertiary referral hospital: a 10-year prospective study.

Background  Acquired cold urticaria (ACU) represents a heterogeneous group of disorders that share a common clinical feature: the development of urticaria or angioedema after cold exposure. We present epidemiological and clinical data of subjects with ACU, natural progression and we examine possible parameters that could correlate with disease severity.

Treatment of Pyoderma gangrenosum with Low-Dose Colchicine

Pyoderma gangrenosum (PG) is a neutrophilic dermatosis of unknown origin. Systemic agents occasionally administered provide either incomplete long-term control of the disease or have been associated with serious adverse side effects after chronic administration. We present two patients with PG successfully treated with low-dose colchicine. Antimitotic, anti-inflammatory and immunomodulating properties of colchicine might account for its beneficial effects in PG patients. Colchicine is effective and well tolerated in low doses by most patients. In addition, it is inexpensive and safer for long-term treatment than corticosteroids and other immunosuppressive agents. Colchicine may be proposed either as a single agent or as a corticosteroid-sparing agent for early treatment of PG.

Pimecrolimus 1% cream in the treatment of disseminated granuloma annulare

SIR, Generalized granuloma annulare (GA) is an uncommon benign cutaneous disease of unknown origin. The eruption is characterized by numerous skin-coloured to erythematous papules, usually on the trunk and extremities, which demonstrate a tendency to annular grouping and a potential to involve virtually any area of the skin. No consistent association between generalized GA and internal disease has been shown to date, although some reports support an association with diabetes mellitus, malignancies, thyroid disease, drug allergy, hypertension, arthritis, AIDS and other conditions. Generalized GA, although generally considered a disseminated form of localized GA, differs from the localized form by a later age at onset, protracted course, and poor response to therapy. Spontaneous resolution is rare: it has been reported in just two of 100 patients in the largest cohort of patients with generalized GA studied. Therapy has been largely disappointing despite sporadic reports of limited success with topical and intralesional corticosteroids, systemic corticosteroids, potassium iodide, niacinamide, psoralen plus ultraviolet A, systemic retinoids, hydroxychloroquine, dapsone, vitamin E, sulphones and topical tacrolimus. A 37-year-old man developed a disseminated asymptomatic eruption on the trunk, face, neck and extremities. The eruption began 3 years previously on the trunk as small papules, gradually spreading to involve the neck, face, arms and proximal aspects of the lower extremities. Initially the lesions consisted of multiple erythematous papules and nodules, but these gradually became annular with slightly elevated edges in all the body except the face and neck, where they remained papular. His general health remained good. Full blood count, urinalysis, liver function tests, serum proteins, plasma glucose level, chest X-ray and serology were all normal. There was no personal or family history for diabetes mellitus or any other disease. Skin biopsy confirmed the clinical diagnosis, showing foci of degenerated collagen surrounded by histiocytes and a few giant cells admixed with lymphocytes (Fig. 1a). The patient had undergone several treatments with medium to high potency topical corticosteroids, without improvement. Treatment with oral isotretinoin was also attempted a year previously but had to be discontinued because of raised serum lipid levels observed after 1 month of treatment. We began treatment with pimecrolimus 1% cream twice daily for a 3-month period and the patient was re-evaluated after 3 months, both clinically and histologically. The quantity of pimecrolimus 1% cream used by the patient was estimated to be approximately 20 g per week. There was a significant improvement of the eruption (Figs 1b,c). The lesions of the face and neck had undergone complete remission while in the rest of the body significant fading of lesions had occurred. These clinical findings were confirmed by a second skin biopsy that showed mild perivascular inflammation and absence of the histological findings of the previous biopsy that had confirmed the diagnosis of GA. After a 6-month follow-up period without any therapy, the patient remains in a satisfactory clinical condition without relapse of lesions.

Treatment of Nail Psoriasis with a Two-Compound Formulation of Calcipotriol plus Betamethasone Dipropionate Ointment

Background: Treatment of nail psoriasis remains a challenge. Objective: To evaluate the efficacy of a two-compound product of calcipotriol plus betamethasone dipropionate ointment on nail psoriasis in an open-label study. Methods: Twenty-five psoriatic patients with nail involvement and mild cutaneous psoriasis were instructed to apply a calcipotriol-betamethasone valerate ointment formulation once daily for 12 weeks on affected nails. Outcome measures were assessed at baseline and at weeks 4, 8 and 12 using the nail psoriasis severity index (NAPSI). Results: Twenty-two patients having 114 nails involved at baseline with a mean NAPSI of 5.8 ± 1.7 were followed up for 12 weeks. The mean NAPSI at the end of the treatment period was reduced to 1.6 ± 0.6 presenting a 72% improvement. Significant improvement was observed for hyperkeratosis and onycholysis (reduction of mean hyperkeratosis NAPSI from 2.2 ± 0.5 to 0.5 ± 0.1 and mean onycholysis NAPSI from 2.0 ± 0.6 to 0.4 ± 0.2), moderate improvement for oil drops (reduction of mean oil drop NAPSI from 1.2 ± 0.4 to 0.8 ± 0.3) and slight improvement for pitting (reduction of mean pitting NAPSI from 0.8 ± 0.2 to 0.6 ± 0.2). Conclusions: The calcipotriol plus betamethasone dipropionate two-compound ointment, applied once daily for 12 weeks, was shown to improve nail psoriasis.