Italian Journal of Dermatology and Venereology最新文献

Background: Inflammation is a common feature of both actinic keratosis and its treatments, so that interventions are often avoided during the summer period, when the sun damage is more likely. 4% 5-fluorouracil cream is known to markedly attenuate local reactions compared to 5% 5-fluorouracil cream. Our aims were to compare the effects of AK treatment in summer and winter months.

Methods: Our trial evaluated the tolerability levels of 4% 5-fluorouracil during the summer and winter periods in two groups of patients affected by actinic keratosis Olsen grade I and II. Evaluation of tolerability was performed by four specific questionnaires after four weeks of treatment with 4% 5-fluorouracil and a specific sunscreen, both once-daily, in summer months, and only 4% 5-fluorouracil once a day in winter months. We also objectively evaluated the effects of treatment with a visual instrument (VISIA) at the end of the treatment and after 3 months.

Results: The main results were an attenuation of the worsening of the quality of life and the perception of the disease during the summer period compared to the winter months. The intensity of the symptoms has not worsened either and, in some cases, has even decreased in the summer group.

Conclusions: Despite several limitations, this trial indicates that the treatment of actinic keratosis with 4% 5-fluorouracil together to the most suitable sunscreen can be performed with confidence even in the summer period.

Janus kinase (JAK) inhibitors are a class of targeted therapies that have revolutionized the management of various inflammatory and autoimmune diseases, including dermatological ones. This narrative review explores their mechanisms, clinical applications, and safety profiles, with a focus on both labeled and off-label uses. JAK inhibitors, such as Baricitinib, Upadacitinib, and Abrocitinib, have shown substantial efficacy in conditions like alopecia areata, atopic dermatitis, and vitiligo. The selective inhibition of specific JAK isoforms underpins their therapeutic effects, with unique profiles influencing both efficacy and safety. Topical JAK inhibitors, such as Ruxolitinib cream, provides a localized approach, minimizing systemic exposure and associated risks. However, the class is not without limitations; adverse effects, including infections and thromboembolic events, necessitate careful patient selection and monitoring. Furthermore, findings from off-label applications often rely on limited evidence, emphasizing the need for robust clinical trials to validate these uses. This review also identifies several limitations, including potential selection bias and a reliance on existing literature, which restrict insights into ongoing and unpublished research. Despite these challenges, JAK inhibitors remain a cornerstone of dermatological treatment, offering new avenues for personalized care. Future research should prioritize biomarker-driven approaches, long-term safety assessments, and the development of agents with reduced off-target effects. As our understanding of JAK-STAT signaling advances, these therapies hold immense promise for expanding the therapeutic landscape in dermatology.

Background: Scorpaenidae are a family of marine venomous fish. Geographical distribution of these fish includes Eastern Pacific Ocean, Western Atlantic Ocean and Mediterranean Sea.

Methods: We observed eight Caucasian, adult patients with skin lesions caused by Scorpaena sp. stings. Five patients were fishermen, two swimmers and one scuba diver. All patients were stung in Italian seas. In four patients it was possible to capture the fish responsible for skin lesions: it was classified as S. scrofa Linnaeus, 1758.

Results: In four patients, hands were involved, in four patients one foot. Two patients developed an erythematous-ulcerated nodule on a hand and one patient developed an ulcer with fibrinous-purulent bed on a toe. All patients complained with local and severe pain. All patients were treated with hot water soaks. The three patients with ulcers were treated with packs of sodium hypochlorite solution, a gel containing equine catalase and a cream with polyhexamethylene biguanide. All patients were treated with oral analgesics. Tetanus prophylaxis were carried out in two patients. In patients with erythematous-edematous lesions, complete remission occurred in 3-7 days. The three patients with ulcers recovered within six weeks. Follow up was negative in all patients.

Conclusions: Although injuries from Scorpaena sp. stings are rare, they can result in significant local symptoms and, in some cases, systemic effects. Awareness of this risk among swimmers, divers, and fishermen is essential for timely diagnosis and treatment.

Background: The differential diagnosis between an early-stage Mycosis Fungoides (MF) and dermatitis may be challenging. Eccrinotropism, the infiltration of eccrine glands by lymphocytes, has been reported in cases of both skin conditions. The aim of the study was to assess the diagnostic and prognostic meanings of eccrinotropism in early-stage MF.

Methods: This retrospective study included 67 patients with histologically confirmed early-stage MF and 34 patients with chronic non-allergic idiopathic dermatitis. Histological and immunohistochemical analyses were conducted to assess the presence and intensity of eccrinotropism. Polymerase chain reaction (PCR) was used to evaluate clonal T-cell receptor (TCR) rearrangements in intraepidermal and eccrinotropic lymphocytes. Statistical analyses were performed to investigate the correlation between eccrinotropism and disease prognosis.

Results: Eccrinotropism was identified in 71% of early-stage MF cases compared to 32% of dermatitis cases, with a statistically significant difference (P=0.008). Eccrinotropism ≥30% was correlated with early-stage MF and correlated with a relapsing-remitting clinical course (P=0.001). Phenotypic abnormalities and clonal TCR rearrangements were consistent between intraepidermal and eccrinotropic lymphocytes, confirming their shared malignant origin.

Conclusions: Eccrinotropism is a valuable diagnostic feature distinguishing early-stage MF from dermatitis. Furthermore, a high degree of eccrinotropism correlates with a more severe, relapsing-remitting clinical course, underlining its prognostic importance. These findings support the inclusion of eccrinotropism as a diagnostic and prognostic marker in the clinical management of early-stage MF.

Background: Lichen planopilaris (LPP) is a rare inflammatory disorder affecting hair follicles primarily on the scalp. It results in permanent hair loss and scarring, which can significantly impact individuals' mental well-being. This study aims to determine the frequency and autoimmune association of LPP to advance understanding and management strategies.

Methods: The study took place from January 1, 2014, to June 1, 2021. Data extraction was facilitated through the Mass General Brigham Enterprise Data Warehouse utilizing the Research Patient Data Registry (RPDR) system. Data extraction included age, gender, race, and autoimmune diseases associated with LPP.

Results: Of the charts screened (24,711), 1549 patients with LPP were identified, resulting in an overall registered prevalence of 0.02581%. Most patients were female (87.1%) and aged over 60 years (33.2%). Analysis of racial distribution revealed a heterogeneous sample, with the highest representation of white patients (80.2%), followed by Black patients (6.7%). Notably, 72 (4.64%) patients were identified with concurrent autoimmune diseases, with most patients having more than one at a time and females comprising the majority (94.4%). Among the observed autoimmune diseases, systemic lupus erythematosus (SLE) was the most prevalent, affecting 40 (55.55%) patients. Dermatomyositis was discerned in 6 (8.33%), systemic sclerosis in 4 (5.55%), and Sjogren syndrome in 40 (55.55%) patients.

Conclusions: This study revealed that LPP affects mainly females aged over 60 years (registered prevalence rate of 0.02581%). Many patients also had autoimmune diseases, notably SLE. This highlights the need for further research to improve management strategies.

Background: Upadacitinib has proven to be well tolerated and provided superior efficacy compared to dupilumab after 16 weeks of treatment in adult patients with moderate-to-severe atopic dermatitis (AD) in randomized clinical trials.

Methods: This multicentric, prospective, observational, real-life study included 120 adult patients with moderate-to-severe AD treated with Upadacitinib at 10 Italian hospitals. We examined both physician-reported outcome measures (EASI), patient-reported outcome measures (itch, sleep and pain score [NRS], Dermatology Life Quality Index [DLQI], alexithymia [TAS-20 score]), and serological markers after 16 weeks.

Results: A statistically significant reduction was recorded in all the scores analyzed, including the TAS-20 score (P<0.0001). The median (IQR) change from baseline to 16 weeks of treatment in the EASI score was 90.1 (11.3) (P<0.0001). The EASI50, EASI75 and EASI90 response rates were 95.8%, 82.5%, 50.8% (P<0.0001).

Conclusions: This is the broadest multicenter real-life study in AD patients treated with upadacitinib, analyzing the reduction of the TAS-20 score. Noteworthy is the rapidity of drug effectiveness in reducing the extension of lesions and itching after just four weeks.

Vitiligo presents a therapeutic challenge due to its unpredictable course and limited treatment options for achieving repigmentation. Trichloroacetic acid (TCA), known for its keratolytic and caustic properties, has emerged as a potential adjunctive therapy in vitiligo management. This review explores the role of TCA alongside established treatment modalities, including phototherapy, topical corticosteroids, and surgical interventions. Mechanisms of action, clinical applications, safety considerations, and future research directions are discussed. TCA acts by inducing controlled chemical injury to the epidermis, facilitating exfoliation and stimulating re-epithelialization. It may also enhance melanocyte migration, proliferation, and pigment production. Combining TCA with phototherapy has shown promise in improving repigmentation rates, while adjunctive use with topical corticosteroids may augment treatment efficacy. In surgical interventions, TCA aids in preparing recipient sites and optimizing graft survival. Adverse effects of TCA include hyperpigmentation and scarring, necessitating careful patient selection and monitoring. Future research should focus on optimizing TCA protocols, conducting large-scale clinical trials, and exploring novel therapeutic combinations. Overall, TCA holds potential as a valuable adjunctive therapy in the multifaceted approach to vitiligo treatment, offering hope for improved outcomes in affected individuals.