Italian Journal of Dermatology and Venereology最新文献

Sweet syndrome is a neutrophilic dermatosis characterized by an autoinflammatory nature and a sterile neutrophilic infiltrate. It presents with tender, erythematous, edematous papules or plaques, often accompanied by fever. Aim of this review is to summarize the most meaningful aspects of Sweet syndrome, critically discussing old paradigms and novel findings. A search of the English-language literature was conducted using the terms "Sweet syndrome" and "acute febrile neutrophilic dermatosis." MEDLINE (via PubMed) and Web of Science (WOS) databases were consulted up to June 30, 2024. Since its first identification, new clinical and histopathological variants of Sweet syndrome have been described, highlighting its heterogeneity. Additionally, a multitude of clinical conditions have been increasingly reported in association with Sweet syndrome, ranging from malignancies, autoimmune and infectious disorders. The pathogenesis of the disease is unclear and varies according to the associated conditions. One unifying mechanism is the aberrant activation, proliferation, and skin homing of neutrophils. The mainstay of treatment remains systemic corticosteroids; alternatives include colchicine, dapsone, and potassium iodide. Traditional immunosuppressants, biologic agents, and small molecules have also been described as effective in treating Sweet syndrome. Sweet syndrome is a heterogeneous condition with an elusive pathogenesis. Most cases resolve with corticosteroids, but some remain refractory to various therapies, representing an unmet medical need. Recent evidence on the pathomechanisms underlying Sweet syndrome suggests that not only innate but also adaptive immunity might play roles. Further experimental studies are needed and may help identify new therapeutic targets in the future.

Background: Some people may compulsively desire to suntan despite the negative consequences, exhibiting symptoms similar to addictive disorders. Tanning dependence (TD) should be considered a risk factor leading to excessive sunbathing and thus increasing the risk of skin cancers. The aim of the present study was to investigate the tanning habits of the inhabitants of Trieste, a Northeastern Italian town characterized by high melanoma incidence. Predictors of tanning addiction were searched. The area of Trieste ranks second in Italy (after Turin) for melanoma incidence with standardized incidence rates very high in both sexes.

Methods: This study was based on an anonymous online survey of 520 randomly recruited adults who reported living in Trieste. TD was assessed using the mCAGE (modified Cut down, Annoyed, Guilty, Eye-opener) and the mDSM-IV-TR (modified Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision) questionnaires. Participants were classified as TD if positive on both questionnaires.

Results: Seventy-eight (15%) individuals were classified as TDs. The analyses compared TDs (N.=78, 15%) with non-TDs (N.=285, 55%) on various characteristics and behaviors. Females were significantly more represented in the TD group than males (P=0.03). Contrarily, TD did not vary with respect to age and Fitzpatrick skin type. High-risk tanning behaviors, including sun exposure in the middle hours of the day, long tanning sessions (more than 3 hours), and the use of sunbeds, were significantly related to TD.

Conclusions: Our results show that TD can be predicted by tanning behaviors. Increased knowledge of TD will help design appropriate interventions for different risk subgroups.

Bullous pemphigoid (BP) is considered to be one of the most common autoimmune diseases affecting the skin. Drug associated BP (DABP) is a subset of BP that is caused by the ingestion of specific types of medications. Until this point more than 80 medications have been associated with this condition that only recently has started to be better described. DABP has a better clinical course and prognosis compared to that of idiopathic BP, especially when the suspected inciting medication is discontinued in a timely manner. Therefore, it is very important to obtain detailed medical histories from BP patients especially if they are receiving multiple medications and also to be vigilant for subtle, but important, indications in histopathological, ELISA and immunofluorescence findings as well as in the clinical manifestations of the disorder.

The introduction of systemic biologic therapies marked a significant advancement in the treatment of moderate to severe psoriasis. However, the high cost associated with these treatments has considerably restricted their widespread utilization. The expiration of biologic patents has allowed the development of biosimilars - medications that are highly similar to approved biologics. Biosimilars hold the promise of reducing treatment costs, thereby enhancing patient access to biologic therapies and contributing to the sustainability of healthcare spending. Nonetheless, the unique regulatory pathways for biosimilars introduce uncertainties regarding their application in real-world psoriasis care. Adoption and regulation of biosimilars differ considerably across countries, reflecting diverse approaches and priorities within global healthcare systems. Potential variations between biosimilars and their originator biologics raise questions about their comparative effectiveness and safety. Current evidence supporting biosimilars for psoriasis treatment is largely based on a limited number of randomized controlled trials (RCTs), with a notable lack of robust real-world evidence. As more biosimilars enter the market, evaluating their use in real-world settings is crucial to identify any differences in effectiveness and safety compared to originators or to enhance their uptake by improving the perceptions of physicians and patients. This review explores the opportunities and challenges presented by biosimilars and underscores the existing gaps in evidence regarding their use in psoriasis treatment.

Introduction: Cutaneous infections pose ongoing challenges to standard treatments due to resistance and limited efficacy. Photodynamic therapy (PDT) emerges as a promising supplement or an alternative to address complicated cases. In this review, we comprehensively review PDT's safety and efficacy in treating cutaneous infections.

Evidence acquisition: A PubMed systematic review with search terms for PDT treatment, hair, skin, and nail infections.

Evidence synthesis: There were a total of 43 studies on the use of PDT in cutaneous infections which discussed the treatment of viral (N.=20), bacterial (N.=11), fungal (N.=9), and protozoal (N.=3) infections. There is evidence for using PDT, mostly 5-aminolevulinic acid (5-ALA) and methyl aminolevulinate (MAL), in the treatment of cutaneous infections. Most evidence for viral infections involved treatment with 5-ALA PDT in condyloma acuminatum (CoAc), verruca vulgaris, and molluscum contagiosum. In bacterial infections, 5-ALA and MB PDT have been used to achieve complete remission in refractory Pseudomonas and atypical mycobacteria infections without recurrence. In onychomycosis, MAL PDT achieved a 40.9% cure rate and MB PDT showed a 77.8-100% cure rate with no reports of recurrence. Parasitic infections, such as leishmaniasis have also been successfully treated with both 5-ALA and MAL PDT.

Conclusions: PDT is a promising treatment option for cutaneous infections, with growing evidence for its utility in treating cutaneous bacterial, viral, fungal, and parasitic infections, particularly those that fail standard treatments. Side effects were mostly limited to localized pain with good outcomes and low recurrence rates.