Italian Journal of Dermatology and Venereology最新文献

Pediatric psoriasis is a chronic inflammatory skin disorder which impacts lifetime health and is associated with potentially long-lasting morbidities. While the association between psoriasis and metabolic syndrome has been extensively studied, including in children, a comprehensive understanding of other comorbidities in the pediatric population remains limited. This paper aims to provide an updated review of pediatric psoriasis-associated comorbidities, extending beyond the scope of metabolic syndrome. The primary objective of this review is to elucidate the diverse spectrum of comorbidities linked to pediatric psoriasis, highlighting emerging research and identifying gaps in current knowledge. The multifaceted nature of pediatric psoriasis-associated comorbidities rationalizes a holistic approach for clinical management. The identified gaps in current knowledge warrant further investigation to enhance our understanding of the relationships between pediatric psoriasis and associated health outcomes.

Background: Hereditary hemorrhagic telangiectasia (HHT) is a genetic vascular disorder characterized by epistaxis, mucocutaneous telangiectasias, and visceral arteriovenous malformations (AVMs). Despite the central role of dermatologic manifestations in diagnosis, there is a lack of comprehensive studies examining these features in large HHT populations. The aim of this paper is to describe the clinical and dermatologic features of a cohort of HHT patients, focusing on the prevalence, distribution, and morphology of mucocutaneous telangiectasias using videodermatoscopy, and to analyze their correlations with systemic manifestations such as epistaxis and visceral AVMs. In addition, the study examines genetic profiles and introduces the HHT Skin Score, a tool to quantify cutaneous involvement.

Methods: From March 2018 to March 2022, we enrolled a cohort of 62 HHT patients who met the Curaçao diagnostic criteria for definite HHT. Dermatologic assessments included comprehensive examinations, including videodermatoscopic evaluation of cutaneous telangiectasia morphology. Statistical analyses examined associations between telangiectasia distribution, epistaxis severity, presence of pulmonary and hepatic AVMs, and genetic mutations.

Results: Sixty-two patients were evaluated. The areas affected by cutaneous telangiectasias in at least 60% of the patients were the lips (79%), tongue (75.8%), ears (61.3%), and fingertips (71%). Videodermatoscopic image analysis revealed three distinct morphologic variants of telangiectasias: macular/papular, papular, and arborizing. Papular telangiectasias on the lips and tongue were strongly associated with pulmonary AVMs, whereas oral telangiectasias correlated with hepatic AVMs. The HHT Skin Score, developed to quantify the severity of the dermatologic manifestations, showed a significant correlation with the severity of epistaxis.

Conclusions: This study highlights the importance of dermatologic evaluation in HHT and provides a detailed characterization of the patient population. Mucocutaneous telangiectasias and genetics have a predictive value and may help to tailor clinical surveillance. The HHT Skin Score emerged as a collateral outcome, offering a quantitative framework for evaluating cutaneous involvement and its clinical significance.

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.

Background: Social media has transformed medical communication, providing dermatologists with opportunities for public education, professional visibility, and patient engagement. However, ethical and professional concerns arise due to the lack of dermatology-specific guidelines in Italy. While the National Federation of Orders of Physicians and Dentists (FNOMCeO) offers general recommendations, no targeted framework exists to regulate dermatologists' digital presence.

Methods: During the 32nd Annual AIDA Congress in May 2024, a working group of 23 dermatologists with active online engagement was formed. Existing ethical frameworks, including the Code of Medical Ethics, were reviewed to identify regulatory gaps. A core team drafted 12 statements, which were refined through a structured discussion and a vote to reach consensus.

Results: The working group developed 12 best practice statements covering key aspects of ethical online engagement, including responsible social media use, conflict-of-interest disclosures, adherence to scientific evidence, patient privacy, and the fight against misinformation. These statements establish clear principles to guide dermatologists in their digital communication.

Conclusions: This is the first dermatology-specific digital communication consensus in Italy, addressing an urgent need for ethical regulation. These recommendations provide a structured framework for dermatologists, ensuring responsible online engagement while maximizing public health impact. Further regulatory efforts are essential to maintain high professional and ethical standards in the digital era.