Italian Journal of Dermatology and Venereology最新文献

Introduction: Hand eczema (HE) is a prevalent inflammatory skin condition, impacting 15-20% of individuals, with a notable incidence rate of approximately 7.3 cases per 1000 person/years. This condition exhibits significant gender-based variability, with a higher prevalence in females. The clinical presentation of HE is characterized by pruritic erythematous, edematous, weeping plaques, vesicles, and/or bullae, showcasing considerable heterogeneity.

Evidence acquisition: A literature search was conducted across multiple databases, including Medline, Pubmed, Scopus, and the Cochrane Library. The search was conducted using the following key words and medical subject heading (MeSH) terms: "hand," "eczema," "dermatitis," "dermoscopy," and "histology," employing the Boolean term "AND" to combine the research terms for optimal search precision. PRISMA algorithm has been used for article screening. The search scope included manuscripts published up to October 1, 2023.

Evidence synthesis: Up to 50% of HE cases are associated with atopic dermatitis, emphasizing the complex interplay between various dermatological conditions. Common subtypes of HE include irritant contact dermatitis (ICD), allergic contact dermatitis (ACD), atopic hand eczema (AHE), and protein contact dermatitis/contact urticaria (PCD). The chronic nature of HE presents a substantial management challenge, often underestimated, leading to delayed treatment and potential progression to chronic hand eczema (CHE). Beyond individual health implications, HE exerts a profound impact on occupational, domestic, social, and psychological aspects, establishing itself as the most prevalent occupation-related skin disease. This paper seeks to establish a comprehensive classification system for HE, integrating clinical, dermoscopic, and histological elements. Dermoscopy, specifically, proves instrumental in distinguishing HE from palmar psoriasis, revealing characteristic features such as yellow scales and irregular vessels. Histopathological findings underscore the dynamic changes observed from acute to chronic stages, while challenges in differentiating hyperkeratotic HE from psoriasis underscore the necessity for a holistic diagnostic approach.

Conclusions: Accurate diagnosis and effective management of HE necessitate a holistic perspective that recognizes the inherent complexities of this inflammatory skin disease. By providing a multidimensional classification system, incorporating clinical, dermoscopic, and histological parameters, this paper aimed to contribute to a more nuanced understanding of HE and facilitate improved approaches to its diagnosis and treatment.

Background: Infection at the surgical site is a frequent complication of office skin procedures, such as electrodesiccation, laser therapy, superficial peelings, curettage, cryotherapy, and incisional or shave biopsies. The use of antibiotic therapy in their prevention is highly controversial due to the raising phenomenon of antibiotic resistance. Italy ranks fifth among high-income countries for resistance to antibiotics, with a rate seven times higher than Scandinavia. In order to raise awareness on this alarming issue, a survey was planned to disclose the misuse of topical antibiotics in the dermatologic practice.

Methods: A specifically designed questionnaire aimed at analyzing the topical management of skin lesions following common office skin procedures was distributed nationwide to physicians engaged in the management of small surgical wounds and then collected for statistical data processing and evaluation.

Results: A total of 1500 forms were distributed nationwide, 1340 (89.3%) of which were completed by dermatologists. Analysis of the collected data showed that more than 70% of the respondents always use topical antibiotics in the attempt of preventing possible post-procedure superinfections.

Conclusions: This survey confirms not only an antibiotic misuse by a large part of the respondents, but above all the widespread erroneous belief that such therapeutic approach can be useful in averting the risk of infections postoperatively. These findings may obviously explain the spread of antibiotic resistance in Italy and confirm that there is an absolute need to raise awareness among dermatologists about the damage caused by the misuse of antibiotics in the management of small wounds.

Background: Prurigo nodularis (PN) is a chronic, inflammatory skin disease characterized by intense itch. Little evidence exists on the burden of PN in Italy. This real-world analysis aimed to investigate the healthcare resource consumption and related direct costs of patients hospitalized for PN.

Methods: The analysis utilized the administrative databases of healthcare units that cover approximately 12 million inhabitants across Italy. Adult patients were included by ICD-9-CM=698.3 (lichen simplex chronicus; neurodermatitis circumscripta; PN) as proxy of PN diagnosis, from 01/2010 to 09/2021, and had 1 year of data availability before (baseline) and after (follow-up) hospitalization (index date). These patients were 1:2 matched by age, sex, and index date (year) to adults without such hospitalization in the baseline period (matched non-PN controls).

Results: The analysis comprised 295 PN-hospitalized patients, matched with 590 non-PN individuals (mean age 63.2 years, 43.7% female). At baseline, patients had a greater comorbidity burden than non-PN controls, including higher prevalence of hypertension (56.6% vs. 36.6%, respectively), dyslipidemia (26.4% vs. 18.0%), diabetes (24.4% vs. 12.5%) and mental health conditions (14.9% vs. 7.8%). During 1-year follow-up, PN-hospitalized patients had significantly higher resource consumption than matched controls, in terms of mean number of prescriptions most commonly prescribed in PN patients (5.1 vs. 1.9, P<0.001), other drugs (11.7 vs. 6.5, P<0.001), all-cause hospitalization (1.4 vs. 0.1, P<0.001) and outpatient services (5.4 vs. 2.5, P<0.001). Mean annual all-cause healthcare costs for patients over 1-year follow-up were € 3847 total (€ 875 drugs, € 2652 hospitalization, € 320 outpatient services), higher than those for the matched controls, of € 711 total (P<0.001) (€ 353 drugs, € 228 hospitalization, € 130 outpatient services).

Conclusions: Patients hospitalized for PN had a higher comorbidity burden at baseline and greater healthcare resource consumption during 1-year follow-up compared to matched controls, with a 5.4-fold increase in all-cause healthcare costs, indicating substantial clinical burden and remaining unmet need in these patients.

Background: This cross-sectional analysis intends to evaluate trend and outlook of industry clinical research in Italy regarding dermatology and its prospects for the next few years.

Methods: A computerized search of ClinicalTrial.gov database was carried out considering the 20-year period 2003-2022 using the following string: "Skin Diseases OR Skin cancer OR Skin Neoplasms OR Skin Infection OR Skin Lesion OR Skin Ulcer OR Skin Laxity OR Skin toxicity OR Dermatologic Complication OR Skin abnormalities".

Results: During the last 20 years 690 Industry Clinical Trials (IndCTs) were conducted in Italy regarding dermatological investigations, almost entirely funded by non-Italian pharmaceutical companies, involving 4497 centers, and recruiting an average of 13.0 subjects per site. The number of controlled and randomized studies has grown quite regularly and in the last 5 years they represented 79.6% of IndCTs initiated. Countries most frequently sharing with Italy international protocols were Spain (75.0%), Germany (71.8%), France (68.5%), the USA (67.4%), and the UK (54.8%). These data point to a historical involvement of Italy in dermatology IndCTs lower than in the major European countries. However, the war in Ukraine has deprived IndCTs of the contribution of Russia, Ukraine, and Belarus, meaning a mean of about 40 new IndCTs per year in a population of 200 million inhabitants. In contrast, many indicators point to Italy as a country with potential in dermatology wider than used in the past: an efficient health care system accessible to any citizen or resident, 4.6 million dermatological interventions per year, low density of IndCTs concerning dermatology, good production of scientific papers in indexed medical journals, relatively low cost of services and labour and geopolitical stability.

Conclusions: The European Clinical Trials Information System's (CTIS), mandatory for the EU member states since early 2023 allows common, simplified, and harmonized regulatory procedures over the life cycle of clinical trials in Europe (EMA, 2023) and plays in favor of Italy's greater competitiveness in clinical research.