Italian Journal of Dermatology and Venereology最新文献

Intravenous immunoglobulin (IVIG) therapy has emerged as a promising treatment option for various dermatological autoimmune diseases due to its immunomodulatory potential and low incidence of severe side effects. Despite its widespread use, the mechanism of action of IVIG in treating autoimmune diseases remains a topic of debate. IVIG is derived from the plasma fractionation of a large pool of donors, primarily consisting of the IgG isotype. Its main mechanisms of action involve neutralizing circulating autoantibodies via the F(ab')2 portion, inhibiting complement-mediated tissue destruction, and reducing the half-life of circulating autoantibodies through the Fc portion. This paper explores the growing utilization of IVIG as an off-label therapy in dermatological autoimmune or immune-mediated diseases, including autoimmune bullous disease (AIBS), dermatomyositis (DM), lupus erythematosus (LE), systemic sclerosis, scleromyxedema, Stevens-Johnson Syndrome (SJS), toxic epidermal necrolysis (TEN), pyoderma gangrenosum (PG), and necrobiotic xanthogranuloma (NXG). In this context, the sole large prospective, randomized trial was the 2022 ProDERM study, which demonstrate efficacy of IVIG in improving cutaneous manifestations among 95 DM patients compared to the placebo group. Moreover, although considered off-label, the use of IVIG is regarded as the first-line therapy for patients with scleromyxedema. As a first line of therapy, IVIg is only approved for Kawasaki Disease (KD) in the setting of vasculitis. The treatment in all other indications is mostly considered as adjuvant therapy only after failure of immunosuppressive therapy or in the presence of contraindications.

Introduction: Lichen striatus (LS) is an acquired blaschkitis, with typical linear and unilateral distribution. It occurs mainly in children and is self-resolving, yet its etiopathogenesis remains widely unknown.

Evidence acquisition: A review of the literature on LS cases was performed using the keyword "lichen striatus" to retrieve all relevant articles through PubMed and Google Scholar.

Evidence synthesis: A total of 27 articles describing 440 LS patients were included in the present review. Mean age of patients was 3.8 years; male: female: ratio was 1:1.9. The present review confirms LS as a primarily pediatric condition, mainly affecting females. Dysregulation of the immune system might be involved in its pathogenesis, with cytotoxic T-cells attacking mosaic keratinocytes after loss of immune tolerance. The review confirms LS is mainly diagnosed clinically (80%) based on its clinical characteristics: erythematous (70%) or hypopigmented (24%) papules, distributed along the lines of Blashko. The benignity of this clinical entity is suggested by the rather short duration of disease (9.5 months on average) and by the uncommonness of therapy, adopted in only 20% of cases, and when needed, administered topically.

Conclusions: This review examines the complexities of LS but acknowledges limitations in data sources and calls for further research.

Background: The incidence of melanoma has been steadily increasing in recent years and remains one of the most frequent cancers in adolescents and young adults. The literature shows how a high percentage of melanoma patients present with high anxiety and depression scores and a correlation between worsening quality of life and impaired body image has been shown. The present study aimed to investigate the relationship between cutaneous and visceral metastasis in a group of 73 patients with advanced melanoma in relation to body image, anxiety, depression, and coping style.

Methods: Hospital Anxiety and Depression Scale, Body Image Scale and Mini-Mac questionnaires were administered to a sample of 73 subjects with advanced melanoma (stage III and IV); Analyses were performed with SPSS version 28.01 and a P value <0.05 was considered significant.

Results: Emerging results indicated greater body image impairment in patients with skin metastasis, no significant difference in anxiety and depression by staging. Patients receiving target therapy showed a reduction in anxiety and depression compared with patients receiving immunotherapy.

Conclusions: In line with the literature, cutaneous metastatic involvement negatively affected body image, a prevalence rate of anxiety and depression of 28,8% and 19.2%, respectively, emerged in the sample, while 17.8% reported significant body image impairment, suggesting how melanoma impacts in patient's quality of life.

Introduction: Nail psoriasis (NP) affects a significant proportion of cutaneous psoriasis patients, often leading to functional impairment and psychosocial distress. Despite available treatment options, challenges persist in achieving efficacy and with drug delivery, prompting investigation into novel therapeutic devices.

Evidence acquisition: A literature search was performed using the PubMed database for devices and lasers for NP on 17 October 2023 using the following search terms: device OR laser AND "nail psoriasis." Twenty-two articles were included describing treatment with pulsed dye laser, fractional carbon dioxide (CO2) laser, long-pulsed Nd:YAG laser, excimer laser, photodynamic therapy, intense pulsed light, and microneedling device.

Evidence synthesis: While some recent studies on use of therapeutic devices have shown promising results for NP treatment, current evidence supports an algorithmic approach including topical therapies, intralesional kenalog injections, and systemic therapies, depending on number of nails affected, presence of psoriatic arthritis, cutaneous psoriasis, comorbidities, and effect on quality of life. Laser therapy, although promising, requires further validation through extensive randomized trials before its inclusion in treatment regimens.

Conclusions: These exploratory findings highlight emerging therapies that may expand the spectrum of options available. Use of lasers for NP treatment could provide dermatologists with a broader arsenal for customizing treatment plans that address individual patient needs, taking into account comfort, cost, and compliance to enhance overall patient outcomes.

Introduction: Despite the promising results in terms of effectiveness of anticancer treatments, a wide range of dermatologic adverse reactions have been reported. Among them, skin photosensitivity, defined as a range of dermatologic conditions caused or exacerbated by sunlight exposure, is an emerging adverse event.

Evidence acquisition: A review of the current literature was performed to report the most characteristic phototoxic and photoallergic reactions associated with anticancer therapies, as well as other characteristic manifestations potentially related to photo-exposure, including UV recall, vitiligo-like reactions, drug-induced cutaneous lupus erythematosus, and UV-induced hyperpigmentation.

Evidence synthesis: A total of 30 manuscripts were collected in the present review, reporting several phototoxic and photoallergic reactions associated with anticancer therapies.

Conclusions: Photosensitivity reactions are an increasing challenge in cancer management. The raising awareness about this adverse event has increased the identification of potential photosensitizing drugs as well as its prevention and the management. However, more studies are required to improve the knowledge of this cutaneous toxicity and to define a personalized treatment strategy.