Search

Background: The most common therapeutic approach to acne is a combined treatment of retinoid and benzoyl peroxide, with oral antibiotics recommended for moderate-to-severe cases. These kinds of therapies often lead to adverse reactions, leading to the request for new therapeutic options. Recently, the combined use of three salicylic acid-based products for the topical treatment of acne has been related to a significant improvement in acne lesions., Methods: A multicenter prospective observational study was carried out on patients with a diagnosis of mild comedonal-papular facial acne to provide new evidence on the clinical effectiveness, tolerability and acceptability of three salicylic acid-based products for the topical treatment of acne in the daily clinical practice. Clinical effectiveness on lesions improvement, the evaluation of personal discomfort related to acne and the assessment of overall clinical outcome were the primary endpoints. Treatment acceptability and tolerability were also evaluated., Results: The treatment with the three salicylic acid-based products has been related to a significant improvement on acne lesions over 8 weeks of treatment, along with a reduction of personal discomfort related to acne and an improvement on lesions appearance. The products have also shown good acceptability and tolerability., Conclusions: The results of this observational study support the effective and well-tolerated use of a combined treatment with three salicylic acid-based products for the topical treatment of acne.

Background: Natural antioxidants represent an effective option in the prevention and/or improvement of ultraviolet radiations (UVR)-induced/aggravated skin conditions. UVR cause DNA damage in keratinocytes, directly, in the form of cyclobutane pyrimidine dimers (CPDs), or indirectly, through oxidative stress production. Failure of the repair system can result in genetic mutations primarily responsible for the initiation of NMSCs. The aim of our study was to evaluate the in vitro protective effect of milk thistle and olive purified extracts on cultured keratinocytes after solar simulator irradiations (SSR)., Methods: Immortalized keratinocytes were pre-incubated with different concentrations of milk thistle and olive purified extracts, and irradiated with increasing doses of SSR. Thereafter, CPDs and p53 expression were evaluated to assess DNA damage, whereas cellular antioxidants consumption and lipid membranes peroxidation were measured to analyze oxidative stress., Results: The study substances were well tolerated by cells and displayed good cytoprotective and antioxidant activities, being milk thistle dry extract more effective in limiting the direct DNA damage, and olive extract particularly able to reduce lipid membrane peroxidation and to increase cellular antioxidants., Conclusions: Both study substances can be defined as safe compounds, showing differential cytoprotective and antioxidant activities and might represent interesting options for NMSCs chemoprevention.

Background: 1,2-Decanediol (S-Mal) is an organic compound belonging to the 1,2-alkanediol family, with two hydroxyl groups located on the first and second carbon of the alkane chain, probably responsible for the enhanced anti-bacterial efficacy. The willow bark total extract (W-Mal) has been used since thousands of years as an herbal remedy for its antipyretic, analgesic, anti-inflammatory and anti-microbial activities. S-Mal is used in cosmetic preparations, whether W-Mal can be topically or systemically administered. Aim of our study was to evaluate in vitro the anti-inflammatory and antioxidant properties of S-Mal and W-Mal, singularly or in combination, in LPS-stimulated keratinocytes., Methods: The possible toxic effect of S-Mal and W-Mal was assessed through analysis of cell viability 24 hours after treatment. The anti-inflammatory and antioxidant activities were evaluated by measuring IL-8, TNF-α and IL-1β production as well as cellular antioxidants (GSH and NADPH) consumption, 24 and 48 hours, respectively, after LPS stimulation., Results: Both substances resulted able to: 1) increase cell viability (P<0.05); 2) decrease the release of inflammatory mediators (IL-8, TNF-α and IL-1β) (P<0.05 - P<0.001); and 3) limit the depletion of cellular antioxidants (GSH and NADPH) (P<0.001)., Conclusions: S-Mal and W-Mal have shown a potential cytoprotective activity when used together, and good anti-inflammatory and antioxidant effects when used either singularly or in combination. In light of our results, S-Mal and W-Mal could represent effective and safe options in the management of bacterial-induced or aggravated skin conditions.

Alopecia areata (AA) is an organ-specific autoimmune disorder that targets anagen phase hair follicles. The course is unpredictable and current available treatments have variable efficacy. Nowadays, there is relatively little evidence on treatment of AA from well-designed clinical trials. Moreover, none of the treatments or devices commonly used to treat AA are specifically approved by the Food and Drug Administration. The Italian Study Group for Cutaneous Annexial Disease of the Italian Society of dermatology proposes these Italian guidelines for diagnosis and treatment of Alopecia Areata deeming useful for the daily management of the disease. This article summarizes evidence-based treatment associated with expert-based recommendations.

The incidence of nonmelanoma skin cancer continues to increase. Surgical excision remains the best choice of treatment but the demand of patients is to have tissue-sparing approaches with good cosmetic results; these aims led to the development of novel therapeutic agents such as topical ingenol mebutate gel. We report the successful treatment with ingenol mebutate gel 0.05% of three pigmented basal cell carcinomas. Lesions were evaluated by dermoscopy and confocal microscopy before, during and after the treatment.

Background: Numerous reports have shown that psoriasis patients are more exposed to lipoprotein peroxidation and to a decrease in the activity of paraoxonase (PON)1, an antioxidant and anti-inflammatory enzyme. Thus, it has been suggested that malfunction of the antioxidant system and an increased production of reactive oxygen species drive immune inflammatory events, that result in progressive skin cell damage in patients with psoriasis. The PON protein family, including PON1, PON2 and PON3, is one of the most important endogenous defense mechanisms against oxidative stress. In the present study, we investigated PON gene expression in psoriasis and in cutaneous oxidative stress., Methods: The study population included 10 patients affected by moderate-to-severe plaque psoriasis and 15 healthy donors who have undergone to plastic surgery, were used as control. Skin punch biopsies of lesional and non lesional psoriatic skin were performed for analysis of PON2 and PON3 gene expression. In addition, oxidation assays in ex vivo full-thickness healthy skin organ cultures were performed., Results: No significant differences were observed between PON2 and PON3 gene expression in psoriatic lesional and non lesional skin compared with healthy controls. H2O2 treatment induced a significant decrease of PON2 and PON3 expression in ex vivo full-thickness healthy skin organ cultures; conversely the pretreatment of samples with the antioxidant reagent N-acetyl-L-cysteine (NAC) induced a significant increase. Interestingly, no significant alterations were reported for PON2 and PON3 expression in ex vivo full-thickness healthy skin organ cultures stimulated with IL-17., Conclusions: Taken together our findings have revealed that a strong pro-oxidative activity is not effectively countered by antioxidant endogenous mechanisms both in psoriatic skin and in ex vivo experimental model.

Background: Many efforts have been spent attempting to define clinical, histopathological and molecular markers for differential diagnosis of Spitz nevus and melanoma. Dermoscopy has been widely used but it may be not always sufficient., Methods: A retrospective study was performed evaluating Spitzoid-looking lesions showing symmetry at clinical and dermoscopic examination in patients ≥12 years attending our Clinic from 2004 to 2014. Demographic, clinical and dermoscopic data were assessed for each lesion in order to highlight the most common characteristics which could help the differential diagnosis between Spitz nevus and melanoma when clinical or dermoscopic asymmetry is lacking., Results: A total of 760 lesions were excised. 690/760 (90.8%), were identified as typical Spitz nevi, whereas 70/760 lesions (9.2%) consisted of malignant melanocytic lesions. Our study showed that almost 9.2% of clinically and dermoscopically symmetric Spitzoid lesions revealed to be malignant melanocytic lesion. For symmetric Spitzoid looking lesions female sex, clinical palpability, the presence of an inverse network at dermoscopic examination and the involvement of lower limbs were observed as the main factors, which were linked to a higher possibility of being malignant lesions., Conclusions: In order to avoid missing diagnoses for malignant melanocytic lesions, this study remarked the importance of preventive excision for all Spitzoid-looking lesions in patients ≥12 years, even if they show symmetry at both clinical and dermoscopic level.

Background: To date, no study evaluating the knowledge of psoriasis among high school students has been conducted. Thus, we aimed to examine the awareness of such disease among teenagers as well as the possible changes in both the perception of psoriasis and comprehension level after an interactive lesson., Methods: A school-based survey was conducted in March 2016 on 300 high school students aged 14-18 years. The survey followed a three-step process. Initially, the questionnaire was administered to students in a 30 minutes period. Subsequently, a dermatologist held a lesson of 120 minutes on various features of psoriasis. Few hours after the presentation, the same questionnaire was re-administered to the same students in order to assess the degree of learning., Results: Two-hundred and fifty students completed the survey. In the prelesson evaluation, the mean score was 5.9±4.5 (range 0-14). Students improved their baseline scores by an average of 6.3 points in the absolute score in the postlessons questionnaire results (mean value =12.2±1.9). Scores gained in postlesson test were statistically significant improved compared to prelesson examination (P<0.001)., Conclusions: Our study demonstrated that psoriasis awareness among young subjects is very low and needs to be increased, through specific educational programs.

The exact pathogenesis of hidradenitis suppurativa (HS) is still unproven. In the last few years numerous studies hypothesized that the disease is triggered by genetic and environmental factors. Follicular occlusion seems to be central to its development followed by follicular rupture, and immune responses finally leading to the development of clinical HS lesions. Data to date suggest that there is immune dysregulation in both the cutaneous and systemic immune system in patients with HS, but relative contributions from the innate and adaptive immune systems have not been fully elucidated. Furthermore, it can be further assumed that endocrine disorders related to follicular diseases can be implicated in the pathophysiologic pathways of HS. This review focuses on the key role of the immune system and endocrine disorders in the pathogenesis of HS.

Background: General skin care recommendations such as the use of moisturizers and products with adequate photoprotection are important components of management for acne patients to complement the medical regimen. This study aimed to evaluate the real-life clinical effects of a novel UV-selective face cream (Acne RA-1,2, Meda Pharma, Solna, Sweden) on acne, epidermal barrier function, sebum production, adherence and tolerability when used together with pharmacological acne treatment., Methods: Forty patients receiving pharmacological acne treatment applied Acne RA-1,2 once-daily for three months. Investigator's Global Assessment of acne, trans-epidermal water loss, sebum production and tolerability were assessed at one and three months., Results: After 3 months, there was a 38% significant clinical improvement in mean Investigator Global Assessment score (3.4 to 2.1), a 29% significant reduction in trans-epidermal water loss (13.2 to 9.4 g/h/m2), and a 17% significant decrease in sebum production vs. baseline (234.6 to 195.6 µg/cm2; all P<0.01). One hundred percent of patients reported complete adherence to pharmacological therapy over the summer of the study vs. 52.5% in the previous summer. About 87.5% of patients considered their acne improved over the summer of the study, vs. 55.0% in the previous summer. Pruritus, erythema, dryness and total tolerability symptom scores were significantly reduced after 3 months vs. baseline (P<0.05)., Conclusions: Acne RA-1,2 is a useful daily adjunct to pharmacological therapy as it helps to mitigate the irritation these therapies cause, increasing adherence to therapy, and leading to a clinical improvement in acne and epidermal barrier function and a decrease in sebum production.

Ultraviolet (UV) radiation exerts different harmful effects on human health, being the main etiological agent of certain skin cancers and photoaging. In this context, photoprotection, intended as a set of measures adopted to limit and prevent the effects of UV radiation, plays a critical role in avoiding undesired sunlight outcomes. Traditional sunscreens represent a widely used photoprotective approach, even if they exert a "passive photoprotection" and are not effective once damage to skin cells has been generated after sun exposure. Conversely, "active" photoprotection is represented by topical sunscreens including also antioxidants and liposome-containing DNA repair enzymes, which may constitute a photostrategy filling the current gap in sun protection. In the current review, we focused on "active" photoprotection at a topical level, reporting present knowledge and future prospective regarding DNA repair enzymes such as photolyase, endonuclease and 8-oxoguanine glycosylase which are able to enhance the protective power of traditional sunscreens.

Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease characterized by nodules, abscesses and sinus tracts, primarily affecting the intertriginous areas. The occlusion of the upper part of the folliculopilosebaceous unit, leading to rupture of the sebofollicular canal with the consequent development of perifollicular lympho-histiocytic inflammation, is believed to be the initial pathogenic event in HS. Giving the chronic nature of HS, its destructive impact on social, working and daily life of patients, its management is often frustrating both for patients and physicians. The HS treatment choices are influenced by disease severity and its individual subjective impact. In this article, the Board of the Italian Society of Dermatology and Venereology (SIDeMaST) on HS has prepared a document focusing on the role of biologic drugs (anti-TNF-α) in HS management, providing also a flow-chart for HS handling and the inclusion and exclusion criteria for HS treatment with anti-TNF-α.

Aim: The use of skin needling is believed to aid the transdermal delivery of drugs, even if it is mostly used for skin collagen induction. The aim of this paper was to use skin needling, combined with a local anesthetic EMLA (eutectic mixture of lidocaine and prilocaine), as a way to enhance transdermal drug penetration and optimize the analgesic effects of common local anesthesia., Methods: We recruited 15 patients. For each patient of our study we defined a skin area of 3 cm2 from two forearms: on one side, we used skin needling first and immediately thereafter applied the EMLA in occlusion for 60 minutes; on the other one, we only applied EMLA in occlusion for 60 minutes. Then, pain was induced in each patient's forearm by introducing a 27 G needle into the skin 4 mm deep three times. Lastly, pain sensation measures were registered and a middle value was calculated., Results: When skin needling is used in conjunction with EMLA applied in occlusion for 60 minutes on skin forearms, the level of pain sensation registered was significantly reduced on a Visual Analogue Scale compared to the application of EMLA alone., Conclusion: The use of skin needling can improve the transdermal delivery of an emulsion-like eutectic mixture of local anesthetics (EMLA) and can introduce the use of this method for delivering topical molecules in dermatology.

Aim: The purpose of the study was to analyze the potential capacity of a dietary supplement, based on gamma linolenic acid, vitamin E, vitamin C, beta-carotene, coenzyme Q10 and Vitis Vitifera, to reduce side effects, in particular the dry skin, erythema and desquamation, due to treatment with oral isotretinoin, and evaluate the ability of the product to increase adherence to therapy in patients with acne., Methods: Forty-eight patients with nodular acne (32 females and 16 males) were randomly divided into 2 groups: 24 received isotretinoin therapy (20-30 mg/day) for 6 months associated to dietary supplement (twice a day), while the other 24 patients received only isotretinoin (20-30 mg/day) for 6 months. For all patients the degree of acne severity, through GAGS (Global Acne Grading System), the sebum production by Sebutape, the hydration by Corneometer and the erythema by Mexameter, were measured. We have also evaluated the adherence to treatment, asking to patients how many days a week they follow the therapy., Results: Patients treated with dietary supplement had lower side effects, with a less degree of erythema and dryness, and greater degree of hydration; a greater adherence to therapy was also reported., Conclusion: Thanks to antioxidant and moisturizing properties, the dietary supplement containing gamma linolenic acid, vitamin E, vitamin C, betacarotene, coenzyme Q10 and Vitis Vitifera, can be considered a useful supplement in the treatment and prevention of dry skin associated with the use of oral isotretinoin.

Aim: The aim of the present study was to evaluate the efficacy and safety of narrowband UVB (NB-UVB) compared with tacrolimus ointment 0.1% in patients with bilateral vitiligo., Methods: In this comparative study, four groups of patients were randomized. Each group was composed by 12 patients with bilateral vitiligo; in each group, every patient was irradiated with NB-UVB (length: 311 nm) twice a week for 9 months and applied tacrolimus ointment 0.1% twice a day on the other area in the same period. Before starting therapy and after 3, 6 and 9 months of therapy, a clinical and photographic evaluation of percentage of repigmentation was performed and Dermatology Life Quality Index Questionnaire was fulfilled., Results: A repigmentation at least partial occurred in 71% of patients after 36 weeks of treatment with tacrolimus ointment 0.1%; in the whole sample, 14 patients (29%) showed no repigmentation at all, with 2 of them discontinuing the therapy because of side effects (erythema and folliculitis-like manifestations). A homogeneous repigmentation at least partial occurred in 69% of patients after 36 weeks of treatment with NB-UVB; in the whole sample 15 patients (31%) showed no repigmentation at all, with 1 of them discontinuing the therapy because of side effects., Conclusion: The present study confirmed that the efficacy of NB-UVB phototherapy in vitiligo is comparable to tacrolimus ointment 0.1% therapy. On the basis of our study, we may suggest tacrolimus ointment 0.1% as an alternative to NB-UVB therapy for treating vitiligo.