Vito Ingordo

Results of atopy patch tests with house dust mites in adults with 'intrinsic' and'extrinsic' atopic dermatitis.

Background The most frequently employed diagnostic criteria of atopic dermatitis (AD) can be fulfilled in the absence of elevated total circulating IgE or specific IgE to food allergens or environmental aeroallergens and/or in the absence of personal or familial history of atopy as well. Therefore a distinction between ‘extrinsic’ or ‘allergic’ and ‘intrinsic’ or ‘non‐allergic’ AD has been suggested. Recently, a patch test with environmental aeroallergens, named atopy patch test (APT), has been proposed for use in the study of AD.

Adult-Onset Atopic Dermatitis in a Patch Test Population

Background: Epidemiological studies about atopic dermatitis (AD) almost exclusively relate to childhood disease with little mention of adult-onset disease. In clinical practice, however, patients who have AD and in whom the onset of disease occurs in adult life are sometimes seen. Objective: Because the subjects with a chronic and recalcitrant eczema are frequently patch tested, the aim of this study was to evaluate the prevalence of adult-onset AD in a patch test population and the differences existing between the early- and adult-onset subsets. Methods: This retrospective analysis was performed on 502 adults (458 males, 44 females) affected by eczematous dermatitis, consecutively examined in the Department of Dermatology of the Italian Navy Hospital in Taranto. In this department, all the eczematous subjects are routinely submitted to the following tests: standard series (GIRDCA or SIDAPA with integrative haptens), prick test with environmental aeroallergens and common food allergens and dosage of total serum IgE. If it is required, additional series of patch tests are also applied. Many patients are also submitted to the atopy patch test (APT) with whole bodies of house dust mites at a concentration of 20%. In the AD patients, diagnosed according to the criteria of Hanifin and Rajka, the ages of onset were subdivided into the following categories: infancy (0–3 years); childhood (4–11 years); adolescence (≧12 years). We arbitrarily also used the age of 18 years as the cut-off mark to allocate the patients to the adult-onset group (AOG) and defined as early-onset group (EOG) the cases encompassed in the aforesaid categories (i.e. onset ≤17 years). Results: 8.8% of all eczemas were adult-onset ADs. 28 (5.6% of all eczemas) adult-onset ADs were ‘sole’ ADs, while 22 cases (3.2% of all eczemas) were adult-onset ADs in which a contact sensitization was detected. The mean SCORAD indexes, according to the age-of-onset groups, decreased when the age of onset increased. No statistical difference was detected between the EOG and AOG with regard to true contact sensitization, clinically relevant or non-relevant contact sensitization, prevalence of ‘pure’ AD and ‘mixed’ AD, and outcome of the APT. The hands were the most frequently affected site in the AOG. Conclusion: A small but significant number of patch-test-negative eczematous cases could be adult-onset ADs and, in this instance, the other two allergological tests (i.e. prick tests and dosage of total serum IgE) and an accurate evaluation according to stated clinical criteria should be performed. However, other studies on large series of patients are required to confirm our observation.

Medical History, Drug Exposure and the Risk of Psoriasis

Background/Aims: To evaluate the association of psoriasis with selected medical conditions and a number of drugs used before diagnosis. Methods: Multicenter case-control study involving outpatient services of 20 general and teaching hospitals. Entry criteria for cases were a first diagnosis of psoriasis made by a dermatologist and a history of skin manifestations of no more than 2 years after the reported onset of the disease. Controls were the first eligible dermatological patients observed on randomly selected days in the same centers as cases. A total of 560 cases and 690 controls were recruited. Results: The odds ratio (OR) of psoriasis was 0.8 (95% confidence interval, CI, 0.5–1.3) in hypertensive subjects, 1.1 (95% CI 0.6–2.0) in diabetics and 1.1 (95% CI 0.7–1.7) in hyperlipidemic subjects. Histamine 2 receptor antagonist exposure was negatively associated with psoriasis: OR 0.3 (95% CI 0.1–0.8). Conclusion: Our study rules out a strong association of psoriasis at its first ever diagnosis with common chronic conditions. The reported associations of psoriasis with relatively common conditions such as diabetes mellitus, hypertension and hyperlipidemia may represent a late effect of well-known risk factors for psoriasis such as smoking and overweight or reflect factors related to the long course of psoriasis itself.

Congenital melanocytic nevus: an epidemiologic study in Italy.

Background: The prevalence of congenital melanocytic nevi (CMN) among newborns ranges between 0.2 and 6% in the worldwide literature. In the only available study from Italy the rate was 1% at birth and 1.4% at 2 years of age. Some surveys performed among samples of children and adolescents in other countries showed a prevalence which ranged from 1.4 to 4.4%. Additional data on the frequency in adults are not available. Objective: The aim of this study was to estimate the prevalence of CMN in a large sample of a young male Italian population, which is deemed to be representative of the general population of the same age and sex. Methods: The potential conscripts resident in the coastal regions of southern Italy, enlisted for the compulsory service in the Italian Navy, were called at the age of 18 to the Draft’s Council Medical Unit of the Italian Navy in Taranto to evaluate their psychophysical fitness to recruitment. All the subjects examined from September 2002 to March 2004 showing skin lesions evocative of CMN were referred by general practitioners of the Draft’s Council Medical Unit to the Department of Dermatology of the Italian Navy Hospital for confirming the diagnosis, which was based on the clinical features and the personal history. The confirmed cases were recorded in a predefined patient card, containing the main anamnestic and clinical data. Since the screening of small CMN in such a large sample of subjects was believed to be difficult, only CMN with a diameter ≧1.5 cm were recorded. Results: In 23,354 examined persons 157 CMN were diagnosed, with a prevalence of 0.67% (Bayesian 95% confidence interval 0.57–0.79); 126 (80.3%) CMN were medium-sized (≧1.5 and ≤19.9 cm in diameter), and 31 (19.7%) were large (≧20 cm in diameter). Three CMN (1.9%) were located on the face, 23 (14.6%) on the chest, 24 (15.2%) on the abdomen, 36 (22.9%) on the back, 48 (30.5%) on the lumbar area, 15 (9.5%) on the upper limb, 19 (12.1%) on the lower limb and 15 (9.5%) on the shoulder. No CMN was located on the head. In 19 cases (12.1%) ≧2 adjacent anatomical sites (shoulder/chest, shoulder/arm, etc.) were involved. In 73 moles (46.4%) terminal hairs were present. Eight CMN (5.1%) showed a zosteriform (i.e. segmental) feature. None of the examined subjects reported a personal history of malignant melanoma (MM), and no person with a history of MM was observed among all the enlisted men referred to the Department of Dermatology during the time of the study. Conclusion: The prevalence of CMN in the Italian young male general population is roughly in agreement with the rates detected in general populations from other European studies. The observations of this study also suggest that the risk of appearance of MM, at least in childhood and adolescence, is limited for medium-sized CMN.

Prevalence and Risk Factors for Superficial Fungal Infections among Italian Navy Cadets

Background: Limited studies on the prevalence and risk factors for superficial mycoses are available. Objective: The aim of this paper was to evaluate the prevalence and risk factors for superficial mycoses (dermatophytes and Candida spp.) in a sample of young Italian people resident at a military school. Methods: A total of 1,024 young cadets from the Italian Navy Petty Officers School in Taranto, including 975 (95.21%) males and 49 (4.79%) females, mean age 22.5 ± 3.0 years (range 18–30), were consecutively examined by the same observer. A complete dermatological examination was performed on all the subjects, and skin scrapings for microscopy and fungal culture were obtained from suspected lesions. All the subjects completed a questionnaire providing information on sports practice, swimming-pool attendance, marching, wearing shower sandals, frequent use of ‘gummed’ shoes, history of severe traumas to the nails, presence of hyperhidrosis and history of superficial mycoses. The affected subjects were also asked if they were aware of their condition. Data were analysed by the Statistical Analysis System, version 8.0. The Fisher exact test and odds ratios were calculated. Results: A total of 33 subjects (3.2%) were found to suffer from a mycologically confirmed fungal infection (3% by dermatophytes and 0.2% by Candida albicans): tinea pedis/Candida intertrigo of the feet was suspected in 126 (12.1%) subjects and confirmed in 30 (2.9%), including 28 cases of tinea pedis and 2 cases of Candida intertrigo; tinea cruris/Candida intertrigo of the groin was suspected in 28 (2.7%) subjects, but confirmed in only 1 case (0.1%); onychomycosis was suspected in 64 (6.1%) subjects and confirmed in 2 cases (0.2%). The organism most frequently responsible in tinea pedis was Trichophyton mentagrophytes var. interdigitale (82.1%). The same species (50%) and T. mentagrophytes var. mentagrophytes (50%) were associated with tinea unguium, Epidermophyton floccosum was the only species detected in tinea cruris. Non-dermatophytic filamentous fungi (Penicillium spp., Fusarium spp., Aspergillus spp. and Paecilomyces spp.), not considered pathogenic, were isolated in 48 samples. None of the risk factors analysed were significantly associated with fungal infection. Only 2 subjects out of the 33 people affected were aware of their condition. They both had tinea pedis. Conclusion: The prevalence of mycoses in sailors living in an Italian military school was lower than rates detected in other military populations. This may be due to the cadets’ lifestyle and environmental conditions. The most frequent infection was tinea pedis, mainly caused by T. interdigitale. None of the investigated risk factors were significantly associated with the disease, and most of the affected individuals were not aware of their condition.

The ‘EpiEnlist’ project: a dermo‐epidemiologic study on a representative sample of young Italian males. Prevalence of selected pigmentary lesions

Background  Few studies on the prevalence and incidence of many skin conditions in the general population are available because it is difficult to submit to dermatologic examination large samples of seemingly healthy population.

Dermoscopic features of congenital melanocytic nevus and becker nevus in an adult male population : An analysis with a 10-fold magnification

Background: Dermoscopic features of congenital melanocytic nevi (CMN) have been mostly assessed by high-resolution videodermoscopy. However, optical dermoscopy with the 10-fold magnification is largely available. In some instances, the differential diagnosis between large CMN and Becker nevus (BN) may be difficult. Objective: The aims of this work were: (1) to assess by dermoscopy with the 10-fold magnification the morphological features which have been previously suggested as useful for the identification of CMN in high-resolution videodermoscopy; (2) to search and point out the dermoscopic features of BN; (3) to explore dermoscopic differences between CMN and BN. Methods: The subjects were observed among about 23,000 consecutive young men assessed at the Draft Council’s Medical Unit of the Italian Navy in Taranto for compulsory recruitment and referred to the Department of Dermatology of the Italian Navy Hospital for dermatological examination. Lesions were examined by the same observer using a dermatoscope with a 10-fold magnification, and both the dermoscopic criteria stated by the international Consensus Net Meeting on Dermoscopy and dermoscopic features previously suggested as useful for the identification of CMN by videodermoscopy were recorded in a predisposed patient’s card. Results: There were 127 male subjects, median age 19 years, with 127 CMN, measuring ≧1.5 to ≤19.9 cm in 78% and ≧20 cm in 22% of cases, and 64 male subjects, median age 19 years, with 64 BN. In the sample of medium-sized and large CMN, dermoscopic features previously identified as characteristic of congenital lesions (i.e. target network, focal thickening of network lines, target globules, skin furrow hypopigmentation, focal hypopigmentation, hair follicles, perifollicular hypopigmentation, vessels and target vessels) were observed in sufficiently high rates. In the BN group, network, focal hypopigmentation, skin furrow hypopigmentation, hair follicles, perifollicular hypopigmentation and vessels were the main dermoscopic features. Focal thickening of network lines, globules, target globules, homogeneous diffuse pigmentation, hyperpigmented areas, blotches and target vessels were more frequently observed in CMN than in BN. Conclusions: (1) The same dermoscopic features observed in small and medium-sized CMN by videodermoscopy with high magnifications are also detectable in medium-sized and large CMN, employing the dermoscopy with the 10-fold magnification. (2) Network, focal, skin furrow and perifollicular hypopigmentation, hair follicles and vessels could be considered as peculiar dermoscopic features of BN. (3) Major differences in the frequency of dermoscopic characteristics were detected between CMN and BN, and dermoscopy seems to provide some diagnostic aid in differentiating CMN from BN in equivocal cases.

Prevalence of pityriasis versicolor in young Italian sailors

Background  Pityriasis versicolor is a superficial fungal disease with a world‐wide distribution, but there are few available studies on its prevalence in the general population.

The constellation of dietary factors in adolescent acne: a semantic connectivity map approach

Different lifestyle and dietetic factors have been linked with the onset and severity of acne.

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.