Valentina A. Antonucci

Autoantibodies in psoriatic patients treated with anti-TNF-α therapy.

TNF‐α inhibitors have been associated with induction of autoantibodies and autoimmune diseases. We retrospectively evaluated the incidence of autoantibodies ANA, ENA, anti‐dsDNA, the occurrence of clinical symptoms and possibly related treatment failure.

A 36-week retrospective open trial comparing the efficacy of biological therapies in nail psoriasis

Nail psoriasis occurs in about 50% of psoriatic patients and can be psychologically devastating since it appears on visible areas. Up to now there is no evidence about what biological drugs is the most effective on nail psoriasis.

Bullous pemphigoid appearing both on thermal burn scars and split-thickness skin graft donor sites

Bullous pemphigoid (BP) is a common subepidermal autoimmune bullous disease. A number of external agents have been associated with its development, including trauma, thermal burns, skin grafts, radiotherapy, ultraviolet exposure (UVB, PUVA), photodynamic therapy, surgery, vaccination and cutaneous infections. An 85-year-old woman presented with a two-month history of blistering lesions on the back, legs and abdomen (Figure 1). She complained generalized itch and had widespread erosions and crusts on erythematous skin. Remarkably, all the lesions appeared on thermal burn scars (some of which had been covered with meshed split-thickness autografts 20 months before) and on donor sites. Her medical history included hypertension and atrial fibrillation and she had been treated with a calcium channel blocker and warfarin for several years. Skin biopsies from both scar area and donor site revealed a subepidermal detachment and superficial dermal infiltrate consisting of lymphocytes and eosinophils. Direct immunofluorescence showed linear deposits of IgG and C3 at the basement membrane and BP180 ELISA was positive, confirming the diagnosis of localized BP. Clinical Letters The patient was treated topically with clobetasol and with prednisone 50 mg daily, achieving complete resolution of the lesions within two weeks. Prednisone was tapered by halving the dose once every three weeks. No further blistering has occurred since. BP is the most common subepidermal autoimmune blistering disease, classically seen in the elderly. Even though the etiology is still unknown, in some cases skin injuries, including burns [1–4], can trigger BP. Rare cases of BP arising in skin grafts and/or their donor sites have been reported [1–4], with time since onset ranging between a few weeks to 20 years after the skin grafting [4]. Various hypotheses have been proposed to explain the possible trigger mechanisms which lead to trauma-induced BP. A possible scenario is that skin injury causes an alteration of the basement membrane structures, permitting the exposure of BP antigens to the immune system and increasing the likelihood of an autoimmune attack [3–5]. Furthermore the alteration of the skin integrity could promote a rapid blister formation [4]. Also local changes due to the wound healing process may facilitate presentation of the BP antigens [3] perhaps explaining why blistering often occurs some weeks after grafting [2]. Trauma can also modify vascular permeability and stimulate the deposition of autoantibodies at the basement membrane in patients with “sub-clinical BP” [5]. In our case BP was induced by surgical therapy, so we think it can be considered as an example of “immunocompromised district”. This expression implicates heterogeneous clinical conditions (among which areas of thermal burn) characterized by a destabilization of the local immune control system. The involved district may show either reduced or

Multipoint and multilevel injection technique of botulinum toxin A in facial aesthetics.

Botulinum toxin represents one of the most frequently requested cosmetic procedures. We treated 223 patients with facial wrinkles using a new technique of injection of botulinum toxin A (BTA) called multipoint and multilevel injection technique (MMIT). The aim of MMIT was to relax the muscle and not paralyze it. Patient satisfaction was evaluated by Facial Line Treatment Satisfaction Questionnaire (FTSQ). Treatment with botulinum toxin determined a good response in all patients. Facial rhytids were completely resolved in case of young skin and well reduced in case of aged skin, leaving a natural aspect both in static and dynamic wrinkles. Patient mean overall satisfaction evaluated with FTSQ was 6.4 ± 1.1. In our experience, the use of botulin toxin by MMIT consents a better calibration of action with a soft and natural result. This can be achieved by distributing the BTA dose through various injection points for each area (“multipoint injections”). Furthermore, injections can be performed at different levels (“multilevel injections”). The level of injections regulates the potency of effect on the muscle: if the level is deep (intramuscular), the effect will be strong while if it is medium or superficial (subcutaneous and intradermal), the effect will be soft. This consents a fine calibration of action on muscle activity with a personal aesthetic result.

Clubbing/Pseudoclubbing only in Fingernails Previously Affected by Psoriasis

We report a case of fingernails clubbing in a 55-year-old man suffered since the age of 40 from cutaneous psoriasis. The patient had no clubbing before and had no familial cases of clubbing. Cardiological and pneumological visits revealed no abnormalities. All laboratory tests were within normal limits and X-rays excluded the presence of pachyodermoperiostosis. We made the diagnosis of atypical clubbing exclusively in the fingernails previously affected by psoriasis. It may be that a common mechanism lies at the root of these two phenomena.

Lentigines in previous psoriatic plaques in a patient treated with infliximab

ejd.2012.1818 Auteur(s) : Federico Bardazzi, Michela Magnano michela_magnano@virgilio.it, Valentina Angela Antonucci, Riccardo Balestri, Paola Sgubbi, Annalisa Patrizi Division of Dermatology, University of Bologna, via Massarenti 1, 40138, Bologna, Italy Hyperpigmented lesions, confined to a healing psoriatic plaque, have been reported in the literature and are described as lentigines, naevus spilus-like or with speckled pigmentation [1]. These lesions often appeared after the use of phototherapy, [...]

Senile lower lid entropion successfully treated with botulinum toxin A

Spasmodic senile entropion (SE) is characterized by the inward turning of the eyelid. SE typically occurs spontaneously, but sometimes after ocular surgery. As of today, it is still lacking a gold standard technique.

B-cell lymphoma in a psoriatic patient treated with infliximab

ejd.2013.1925 Auteur(s) : Federico Bardazzi, Valentina Angela Antonucci, Aurora Maria Alessandrini aurora.alessandrini@alice.it, Carlotta Baraldi, Vera Tengattini, Annalisa Patrizi Department of Internal Medicine, Geriatrics and Nephrology, Division of Dermatology, University of Bologna, Via Massarenti 1, 40138 Bologna, Italy Psoriasis is a common and chronic inflammatory disease of the skin and joints. TNF-α inhibitors have been approved for the treatment of psoriasis and psoriasis arthritis by [...]

36-wöchige retrospektive offene Studie zum Vergleich der Wirksamkeit von Biologika bei Nagelpsoriasis

Zusammenfassung Hintergrund: Die Nagelpsoriasis betrifft etwa 50 % aller Psoriasis-Patienten und kann eine gravierende psychische Belastung darstellen, da sie an sichtbaren Stellen auftritt. Es ist bisher nicht erwiesen, welche Biologika bei Nagelpsoriasis am wirksamsten sind. Ziel: In unserer Studie sollte festgestellt werden, ob von den vier in unserem Land zugelassenen Biologika (Infliximab, Adalimumab, Etanercept, Ustekinumab) ein Medikament bei Nagelpsoriasis besser wirkt als die anderen Präparate. Patienten und Methoden: Es wurde eine monozentrische retrospektive Studie durchgeführt, um die Wirksamkeit biologischer Therapien bei Patienten mit mittelschwerer bis schwerer Psoriasis und Nagelbeteiligung zu untersuchen. Der Nagelpsoriasis-Schweregrad-Index (NAPSI) wurde bei allen Patienten erhoben. Die statistiche Analyse erfolgte mit dem Kruskal-Wallisund dem Fisher’s-Exact-Test. Ergebnisse: Bei allen Patienten war durchgehend eine statistisch signifikante Verbesserung des mittleren NAPSI ab Studienbeginn über 12, 24 und 36 Wochen zu beobachten. Nach 12 Wochen hatten 27,78 % der Patienten NAPSI 75 erreicht, nach 24 Wochen 81,48 % und nach 36 Wochen 88,89 %, wobei zwischen den einzelnen Medikamenten kein signifikanter Unterschied bestand. Eine Verbesserung im mittleren Psoriasis Area and Severity Index (PASI) war ebenfalls zu verzeichnen. Schlussfolgerung: Psoriatische Nagelläsionen bessern sich unter Biologika-Therapie. Wir fanden keine statistisch signifikanten Unterschiede zwischen den vier untersuchten Biologika.