Vito Di Lernia

Infantile Acute Hemorrhagic Edema and Rotavirus Infection

Abstract:  Infantile acute hemorrhagic edema (AHE) is a benign condition characterized by a dramatic onset of inflammatory edema and ecchymotic purpura in a target or cockade pattern. It is considered an uncommon form of cutaneous vasculitis occurring in children younger than 2 years of age. The outbreak is frequently preceded by an immunization or various infections. We describe an 11‐month‐old girl with rosette‐shaped purpuric plaques on the face and limbs, clinically consistent with a diagnosis of AHE of the skin, associated with fever and diarrhea. Laboratory investigations showed a rotavirus infection, which has not previously been reported in association with AHE of the skin. The disease had a benign course without relapses. Appropriate microbiologic investigations are advisable to confirm the possible etiologic role of rotavirus.

Dermoscopy in General Dermatology

In addition to its traditional use for the evaluation of skin tumors, dermoscopy continuously gains appreciation in other fields of dermatology. The patterns of several inflammatory and infectious skin diseases have already been described, and dermoscopy has been shown to improve the clinical diagnostic performance in the daily practice. The increasing use of dermoscopy was significantly enhanced by the development of the new generation hand-held dermatoscopes that can be easily placed in every dermatologists pocket and do not require the use of immersion fluid. In this article, we provide an up-to-date summary of data on dermoscopy in general dermatology.

Early diagnosis of melanoma: what is the impact of dermoscopy?

There are three possible explanations for the improved melanoma recognition when a clinician uses dermoscopy: first, the presence of early dermoscopy signs that become visible in melanoma much before the appearance of the classical clinical features; second, an increased attitude of clinicians to check more closely clinically banal‐looking lesions; and third, an improved attitude of clinicians to monitor their patients. In this review, the light and the dark sides of melanoma screening are briefly discussed, including the need to find better strategies to decrease the number of unnecessary excision of benign lesions on one hand, and to finally decrease melanoma mortality rates on the other.

Impact of body mass index on retention rates of anti-TNF-alfa drugs in daily practice for psoriasis

Abstract Background: Psoriasis is a chronic inflammatory skin disease which often requires life-long treatment. Objective/aim: Our objective was to assess the role of the body mass index (BMI) on the retention rates of anti-TNF-alfa therapies in patients with moderate to severe plaque psoriasis. Material and methods: Retrospective observational study of psoriasis patients included in local databases of three public Italian hospitals. All patients, who received anti-TNF-alfa treatment in referral centers, were included. Only patients with at least 1-year follow-up were considered eligible. The outcome was the conservation of the treatment at 1 and 2 years of follow-up. Results: 194 patients were enrolled. 307 treatment courses with a minimum follow-up of 12 months and 263 with a follow-up of 24 months were analyzed. The proportion of patients receiving the same treatment at months 12 and 24 was 67.43% and 42.21%, respectively. The proportion steadily decreased with increased values of BMI. Conclusions: The overall efficacy of TNF-alfa inhibitors diminishes with time. The BMI affects the long-term survival rate of anti-TNF-alfa in psoriatic patients. A high BMI can be considered a potential predictor of drug discontinuation.

Focal facial dermal dysplasia: Two familial cases

Focal facial dermal dysplasia (or congenital ectodermal dysplasia of the face) is an inherited condition characterized by congenital scarlike lesions on the temples and a wide spectrum of associated facial abnormalities. We report the case of a woman and her son with this disorder. An autosomal dominant inheritance with variable penetrance and expressivity may explain the different clinical expressions of focal facial dermal dysplasia.

Clinical predictors of non-response to any tumor necrosis factor (TNF) blockers: a retrospective study

Background: Anti-tumor necrosis factor (TNF)-α therapies represent a significant innovation in therapy for psoriasis. However, a significant number of psoriasis patients do not respond well to TNF blockers or show an insufficient control of disease activity on a long-term basis. Objective/aim: The aim of this study was to recognize specific clinical factors that could be associated with a non-response to any available TNF blockers in patients with moderate-to-severe plaque psoriasis. Materials and methods: The authors reviewed the medical records of all patients who had started etanercept, infliximab, adalimumab and had achieved a minimum of 24 months follow-up. The authors identified subjects who were not responsive to all available anti-TNF agents, whatever the chronology of their use. Results: A total of 110 patients were retrospectively examined. Thirteen patients were identified as “non-responders” to all available TNF-α blockers. Current smoking at the start of anti-TNF therapy was associated with non-response to TNF blockers. The group of “non-responders” presented a high mean body mass index and a high baseline PASI score with respect to the group of responders. Conclusions: The data showed that the majority of non-responder patients were smokers, overweight or obese and had a high baseline PASI score. Concomitant arthritis was not significantly associated with non-response.

Psoriasis plaque test with confocal microscopy: evaluation of different microscopic response pathways in NSAID and steroid treated lesions.

Pathophysiology of psoriasis is complex and characterized by microscopic, specific changes. In vivo reflectance confocal microscopy (RCM) provides tissue and cell morphology information in non‐invasive way, generating quasi‐histologic resolution. Concerning plaque psoriasis, confocal criteria have been described disclosing high agreement between RCM and conventional histology.

Circulating Autoantibodies and Autoimmune Comorbidities in Vitiligo Patients: A Multicenter Italian Study

Background: Autoimmune comorbidities and circulating autoantibodies have been observed in vitiligo patients, but differences in rate are present according to countries in which the studies were performed, perhaps owing to ethnic diversities or different trigger factors. Objective: To estimate the prevalence of circulating autoantibodies and overt autoimmune diseases in a fairly large sample of Italian vitiligo patients. Methods: 175 outpatients affected by vitiligo and referred to nine dermatological centers were included in the study. Patients were offered routine blood test, serological testing for thyroid function and search for autoantibodies. Results: At least one circulating autoantibody was detected in 61 (41.8%) of 146 subjects who underwent laboratory tests. Anti-thyroperoxidase (25.6%), anti-thyroglobulin (23.4%), antinuclear antibodies (16.8%) and anti-gastric parietal cell antibodies (7.8%) were the most noticed autoantibodies. 74 (41.5%) autoimmune comorbidities, mainly autoimmune thyroiditis (37%), were reported. Conclusion: The prevalence of autoimmune comorbidities and circulating autoantibodies in this study was in agreement with other surveys conducted on Caucasian patients.

Epstein-Barr virus and skin manifestations in childhood

Epstein–Barr virus (EBV) is a human B‐lymphotropic herpes virus and one of the most common viruses in humans. Specific skin signs related to EBV infection are the exanthem of mononucleosis, which is observed more frequently after ingestion of amoxicillin, and oral hairy leukoplakia, a disease occurring mostly in immunocompromised subjects with HIV infection. Other more uncommon cutaneous disorders that have been associated with EBV infection include virus‐related exanthems or diseases such as Gianotti–Crosti syndrome, erythema multiforme, and acute genital ulcers. Other skin manifestations, not correlated to virus infection, such as hydroa vacciniforme and drug‐induced hypersensitivity syndrome have also been linked to EBV. The putative involvement of EBV in skin diseases is growing similarly to other areas of medicine, where the role of EBV infection is being investigated in potentially debilitating inflammatory diseases. The prognosis of EBV infection in healthy, immunocompetent individuals is excellent. However, lifelong infection, which is kept in check by the host immune system, determines an unpredictable risk of pathologic unpredictable scenarios. In this review, we describe the spectrum of non‐tumoral dermatological manifestations that can follow EBV primary infection or reactivation of EBV in childhood.

Skin eruption associated with Hymenolepis nana infection

A 56‐year‐old man presented with a recurrent cutaneous eruption of the trunk, associated with itching, which had lasted for several months. Antihistamines, such as cetirizine, loratadine, and fexofenadine, and topical steroids had been used with only temporary relief. Recently, the cutaneous manifestations had become continuous and very tedious and had not responded to local or systemic treatments. The patient was a doctor of medicine, was married, and had not been taking any medications. He had travelled for scientific purposes to different areas of Italy and The Netherlands in the last 12 months. He had no animals at home and no history of fever, sweats, arthralgia, cough, dyspnea, or allergic diseases. A history of gastritis and mild hyperglycemia was present.