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Background: Stiff‐limb syndrome is part of stiff person spectrum, presenting with fluctuating gait disorders attributed to leg stiffness, spasms, and posturing. It could also manifest with anxiety and specific phobias such as pseudoagoraphobia. We aimed to describe the importance of specific gait phobia as a diagnostic clue to anti–glutamic acid decarboxylase stiff‐limb syndrome. Cases: We reported on 2 cases of stiff‐limb syndrome sharing a similar diagnostic path and phenomenology. Both were featured by pseudoagoraphobia, which has documented to typically cover organic conditions, and a remarkable diagnostic delay attributed to misdiagnoses. Presence of pseudoagoraphobia should not point to the diagnosis of a functional disorder—although a negative instrumental workup is documented. Conclusions: Both cases are emblematic of the high misdiagnosis rate affecting stiff person syndrome patients. A proper diagnostic process, including the identification of a pseudoagoraphobia, should help in reaching a diagnosis and providing an early and effective treatment. View Supplementary Video [ABSTRACT FROM AUTHOR]

Psichiatric illness such as depression, schizophrenia and cognitive deficiency are frequently associated with the Darier Disease. Physicians should be aware of such association to allow prompt diagnosis and early interventions of potentially life-threatening psychiatric disorders. [ABSTRACT FROM AUTHOR]

Background To compare the reduction of intraocular pressure (IOP) and glaucoma medications following selective laser trabeculoplasty (SLT) versus stand-alone placement of the Hydrus microstent, a microinvasive glaucoma surgery device. Design Prospective interventional case-series. University practice. Participants Fifty six eyes (56 patients) with uncontrolled primary open-angle glaucoma. Methods Patients received either SLT ( n = 25) or Hydrus implantation ( n = 31) in two centres. Patients were evaluated at baseline and 1, 7 days, 1, 3, 6 and 12 months after surgery. Main Outcome Measures Intraocular pressure and number of glaucoma medications variations inter-groups and intra-groups. Results There were no significant differences at baseline between groups, but the mean deviation was worse in the Hydrus group (−8.43 ± 6.84 dB, confidence limits (CL)−2.8/−3.3 vs.−3.04 ± 0.65 dB, CL−6/−10.8; P < 0.001). After 12 months, there was a significant decrease in IOP and medications in the Hydrus group compared with baseline values. In the SLT group, only the decrease in IOP was significant. There was 3-fold greater reduction in medication use in the Hydrus group compared with SLT (−1.4 ± 0.97 vs.−0.5 ± 1.05, P = 0.001). 47% of patients were medication free at 12 months in the Hydrus group (4% in the SLT group). No complications were recorded in the SLT group. In the Hydrus group, three patients experienced a temporary reduction of visual acuity post-operatively, and two patients had post-operative IOP spikes that resolved within one week. Conclusions Both SLT and Hydrus implantation reduced IOP without serious adverse events. Hydrus implantation led to a significant and further reduction in medication dependence at 12 months. [ABSTRACT FROM AUTHOR]

Pyoderma gangrenosum (PG) is a neutrophilic dermatosis characterised by painful, necrotic ulcerations. PG is described as a rare disease: the world‐wide incidence is estimated to be around 3 to 10 cases per million population per year. These estimations are based mostly on case reports and retrospective case series; there are no prospective, multicentre studies on the matter. The apparent rarity of PG is in contrast with our clinical perception as dermatologists: in our opinion, PG is not so uncommon. Therefore, we decide to investigate the epidemiology of PG in the Italian population and confirm our clinical suspicions that it is not an orphan disease. We enrolled all patients diagnosed with PG in 8 Italian Dermatological Departments from 1st October 2014 to 1st November 2015, and we recorded their features. Our data, collected from 64 patients, are in accordance with those of the published literature regarding the epidemiology and features of PG. In an Italian population of roughly 8 million inhabitants of 7 provinces, we found an incidence of 5.17 new cases per million population per year. Unlike our predictions before the study, we confirmed the world‐wide incidence of PG. To our knowledge, this is the first observational, multicentre study on PG. We hope that it provides a stimulus for further researches on PG and for the creation of an Italian register. [ABSTRACT FROM AUTHOR]

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Purpose To examine the circadian intraocular pressure ( IOP) patterns in healthy subjects, in primary open angle and normal tension glaucoma ( POAG; NTG) using a contact lens sensor ( CLS; Sensimed Triggerfish, Lausanne, Switzerland). Methods This was an observational, nonrandomized study. Ten healthy subjects (Group 1, 10 eyes) and 20 glaucomatous patients [20 eyes, 10 with POAG (Group 2) and 10 with NTG (Group 3)] were enrolled. All patients were controlled with prostaglandin analogues. The 24-hr IOP pattern was the main outcome. The morning (6 AM-11 AM), afternoon/evening (noon-11 PM) and night (midnight-5 AM) subperiod patterns, peaks and prolonged peaks (>1 hr) were secondary outcomes. Results Mean 24-hr IOP pattern showed a nocturnal acrophase in all groups. Patterns were significantly different among groups (p = 0.02), with highest nocturnal IOP values in POAG. Prolonged peaks were more common in patients with glaucoma (70%) than in healthy subjects (33.3%) (p < 0.001). Significant differences were found for Groups 2 and 3 in the morning versus afternoon/evening (p = 0.019 and p = 0.035, Bonferroni correction), morning versus night (p = 0.005 and p < 0.0001) and afternoon/evening versus night periods comparisons (p < 0.0001 for both groups). In Group 1, patterns significantly differed in the morning versus night and afternoon/evening versus night period comparisons (p < 0.0001). Conclusions Continuous 24-hr IOP monitoring with the CLS revealed a nocturnal acrophase in healthy subjects and, more markedly, in glaucoma. Because the diurnal IOP profile seems not to predict the nocturnal rhythm, the circadian IOP pattern should be evaluated in clinical practice. These findings may be worthwhile for the management of glaucoma. [ABSTRACT FROM AUTHOR]

Purpose To evaluate the effects at 1 year of preservative-free timolol gel and preserved timolol eye drops on conjunctiva and tear parameters. Methods Forty patients with primary open-angle glaucoma or ocular hypertension were randomized to the two treatment groups and compared with 20 healthy age-matched controls. Clinical tests ( IOP, Schirmer I test, and lacrimal film break-up time BUT) and in vivo conjunctival confocal microscopy ( IVCM) were performed in all patients at baseline and after 12 months. IVCM ( HRT II Rostock Cornea Module; Heidelberg Engineering Gmb H, Heidelberg, Germany) was performed after topical anaesthesia in the four cardinal locations and at the corresponding limbus to analyse conjunctiva cells. The main IVCM outcomes were goblet cell density and epithelial regularity. Results IVCM and clinical parameters were similar in the three groups at baseline. After 12 months, intra-epithelial goblet cell density was significantly lower in the preserved (48.25 ± 7.70) than in the preservative-free beta-blocker group (86.83 ± 22.17, p < 0.001) and controls (88.9 ± 18.33, p < 0.001). The epithelial layer was significantly more regular in the preserved beta-blocker medication group than in the preservative-free beta-blocker group (p < 0.001) and the control group (p < 0.001). A significant reduction in both Schirmer I and BUT was found in the group of preserved timolol (respectively, 11.3 ± 2.97 and 8.12 ± 0.99) compared with preservative-free timolol (16.8 ± 1.83 and 11.27 ± 1.27, p < 0.001) and controls (17.8 ± 1.87 and 12.10 ± 1.28, p < 0.001). Conclusions Based on our IVCM data, preservative-free beta-blocker gel induces less changes at ocular surface than preserved beta-blockers, a fact that should be considered to obtain less adverse effects and maximal adherence to treatment in a chronic condition such as glaucoma. [ABSTRACT FROM AUTHOR]

Purpose: This prospective study was conducted to evaluate the efficacy and safety of transscleral diode laser cyclophotocoagulation (TDLCP) in advanced refractory glaucoma. Methods: A total of 124 eyes in 121 patients with advanced glaucoma refractory to medical treatment were treated consecutively with TDLCP. Success was defined as final intraocular pressure (IOP) of 5−21 mmHg in eyes with visual acuity (VA) of more than hand movements (HM) and relief of pain in eyes with VA of HM or less, including blind eyes. Results: Mean patient age was 65.6 ± 17.1 years (range 14–91 years). Mean follow-up was 17 ± 14.6 months (range 3–42 months). Mean pretreatment IOP was 29.9 ± 8.4 mmHg (range 17–58 mmHg) and IOP at last follow-up was 20.8 ± 8 mmHg (range 6–45 mmHg) (p < 0.001). The number of laser applications (mean 9.2 ± 2.8, range 4–15) and maximal laser power (mean 2.01 ± 0.22 mW, range 1.3–3.0 mW) were not associated with lower postoperative IOP. Intraocular pressure of ≤ 21 mmHg was recorded in 63.0% of eyes at the last follow-up visit. Overall, 28 (21.7%) eyes required at least one retreatment. No phthisis bulbi or persistent hypotonia developed. Conclusions: TDLCP is an effective and safe method for the treatment of advanced refractory glaucoma, although repeated treatments are often necessary. [ABSTRACT FROM AUTHOR]

Recent findings indicate that fingolimod, the first oral drug approved for the treatment of multiple sclerosis (MS), acts as a direct inhibitor of histone deacetylases (HDACs) and enhances the production of brain-derived neurotrophic factor (BDNF) in the CNS. Both mechanisms are relevant to the pathophysiology and treatment of major depression. We examined the antidepressant activity of fingolimod in mice subjected to chronic unpredictable stress (CUS), a model of reactive depression endowed with face and pharmacological validity. Chronic treatment with fingolimod (3 mg kg-1, i.p., once a day for 4 weeks) reduced the immobility time in the forced swim test (FST) in a large proportion of CUS mice. This treatment also caused anxiogenic-like effects in the social interaction test without affecting anxiety-like behavior in the elevated plus maze or spatial learning in the water maze. CUS mice showed reduced BDNF levels and enhanced HDAC2 levels in the hippocampus. These changes were reversed by fingolimod exclusively in mice that showed a behavioral response to the drug in the FST. Fingolimod treatment also enhanced H3 histone K14-acetylation and adult neurogenesis in the hippocampus of CUS mice. Fingolimod did not affect most of the parameters we have tested in unstressed control mice. The antidepressant-like activity of fingolimod was confirmed in mice chronically treated with corticosterone. These findings show for the first time that fingolimod exerts antidepressant-like effect acting in a "disease-dependent" manner, and raise the interesting possibility that the drug could relieve depressive symptoms in MS patients independently of its disease-modifying effect on MS. [ABSTRACT FROM AUTHOR]

Cultured mouse D3 embryonic stem (ES) cells differentiating into embryoid bodies (EBs) expressed several Wnt isoforms, nearly all isotypes of the Wnt receptor Frizzled and the Wnt/Dickkopf (Dkk) co-receptor low-density lipoprotein receptor-related protein (LRP) type 5. A 4-day treatment with retinoic acid (RA), which promoted neural differentiation of EBs, substantially increased the expression of the Wnt antagonist Dkk-1, and induced the synthesis of the Wnt/Dkk-1 co-receptor LRP6. Recombinant Dkk-1 applied to EBs behaved like RA in inducing the expression of the neural markers nestin and distal-less homeobox gene (Dlx-2). Recombinant Dkk-1 was able to inhibit the Wnt pathway, as shown by a reduction in nuclear β-catenin levels. Remarkably, the antisense- or small interfering RNA-induced knockdown of Dkk-1 largely reduced the expression of Dlx-2, and the neuronal marker β-III tubulin in EBs exposed to RA. These data suggest that induction of Dkk-1 and the ensuing inhibition of the canonical Wnt pathway is required for neural differentiation of ES cells. [ABSTRACT FROM AUTHOR]

We examined the effect of the three human isoforms of apolipoprotein E (ApoE2, ApoE3, and ApoE4) on the canonical Wnt signaling pathway in undifferentiated PC12 cells. Addition of recombinant ApoE4 reduced Wingless-Int7a-stimulated gene expression at concentrations of 80 and 500 nm. Recombinant ApoE2 and ApoE3 were virtually inactive. Recombinant ApoE4 also inhibited Wnt signaling when combined with very low density lipoproteins (VLDLs) or in cells over-expressing the low density lipoprotein receptor-related protein, LRP6. In contrast, the enforced expression of LRP5 unmasked an inhibition by ApoE2 and ApoE3, which, however, were less effective than ApoE4 in inhibiting Wnt signaling. We also transfected PC12 cells with constructs encoding for the three human ApoE isoforms to examine whether endogenously expressed ApoE isoforms could modulate the Wnt pathway. Under these conditions, all three ApoE isoforms were able to inhibit Wnt signaling, although ApoE4 showed the greatest efficacy. Only the conditioned medium collected from cultures transfected with ApoE4 induced a significant inhibition of Wnt7a-stimulated gene expression, confirming that ApoE4 has an extracellular action that is not shared by the other ApoE isoforms. We conclude that ApoE4 behaves as an inhibitor of the canonical Wnt pathway in a context-independent manner. [ABSTRACT FROM AUTHOR]

A fair % of patients with a clinical history of nickel allergy show negative patch test results. To improve the response rate to NiSO[Sub4] 5% pet. patch tests, a testing procedure utilizing pre-treatment of the test area by a 24-h application of sodium lauryl sulfate (SLS) was introduced. 46 women with a clinical history of nickel sensitivity who exhibited negative reactions to nickel sulfate 5% pet. patch tests. were studies. Patients underwent 6 patch tests on adjacent sites on the volar surface of the forearms. 4 patch tests were performed with a 72-h application of 40 mg nickel sulfate 5% pet. While 1 of these patch tests served as control, 3 test areas underwent 24-h pretreatment with 40 μl SLS, 1 with 0.1% and 2 with 0.5% solution. To evaluate differences in the reactivity to SLS plus nickel sulfate related to the site on the forearm, 0.5% SLS pre-treatment was performed both on a proximal and on a distal test site. At the 72-h evaluation, 19 subjects out of 46 showed positive reactions to nickel sulfate 5% pet. at skin sites pre-treatment with 0.1% SLS. whereas 23 patients reacted positively at 0.5% SLS pre-treated areas. Echographic values of skin thickness and of hypo-echogenic dermal areas at positive pre-treated nickel test areas were higher than at control test areas, confirming the clinical evidence of an increased response to NiSO[Sub4] after SLS pre-treatment. The inflammatory reaction, as evaluated clinically and echographically, was much higher at distal skin areas (0.1% SLS and distal 0.5% SLS) than at proximal 0.5% SLS ones. [ABSTRACT FROM AUTHOR]

To compare different house-dust-mite-derived allergenic materials and to correlate the presence of IgE to Dermatophagoides with patch test results, 313 atopic dermatitis (AD) patients and 100 healthy volunteers (HV) underwent patch tests with: Dermatophagoides pteronyssinus (DPT) lyophilized purified alpha fraction in buffered saline/glycerol 50% and/or in petrolatum (Bayropharm); 50% DPT and 50% Dermatophagoides farinea (DF) whole bodies in petrolatum and petrolatum oil (Allergopharma-Bracco): DPT and DF whole bodies in petrolatum and petrolatum oil (Lofarma). We found 39% positive reactions among AD subjects and 13% in HV. The presence of serum-specific IgE did not influence the patch test results, 38% of AD patch-test-positive patients and 5 of 13 HV. respectively, showed a positive prick test and or RAST to Dermatophagoides. Similar sensitization rates were observed with the allergenic material from Bayropharm (54% positivities) and Allergopharma-Bracco (51% positivities), whereas the preparations from Lofarma gave a 20% response rate. [ABSTRACT FROM AUTHOR]

126 enamellers and 64 decorators from 5 factories underwent dermatological and allergological examination using occupational test series in order to evaluate the prevalence of dermatitis and contact sensitization, and to identify the most important sensitizing substances. 48 workers (corresponding to 25.26% of the study population) were sensitized, with a total of 55 positive patch tests. Dermatitis was present in 22 workers, whereas 44 subjects claimed to have had skin lesions in the past. We found 17 positivities to specific substances: 7 to red iron oxide; 2 to antimony trioxide, manganese dioxide and maleic anhydride; and 1 to red copper oxide, cadmium chloride, vanadium pentoxide and sodium tripolyphosphate. [ABSTRACT FROM AUTHOR]

Introduction: Growing evidence points to sympathetic hyperactivity as one critical trigger for life-threatening arrhythmias among postmyocardial infarction patients. Methods and Results: We have evaluated, in a placebo-controlled multicenter study, the efficacy of a β-adrenergic blocking agent (oxprenolol 160 mg) and of a selective left cardiac sympathetic denervation in preventing sudden death in patients with a first and anterior myocardial infarction. Two patient groups were studied. The high-risk group included 144 patients who survived a myocardial infarction complicated by either ventricular tachycardia or fibrillation. The relatively low-risk group included 869 patients whose myocardial infarction did not have these complications; they were allocated only to placebo or oxprenolol. Randomization took place 30 days postmyocardial infarction; mean follow-up was 22 months. In the high-risk group the sudden cardiac death (crude rate) in the placebo subgroup was indeed high (21.3%), and was strikingly reduced to 2.7% and to 3.6% by oxprenolol and by left cardiac sympathetic denervation, respectively (P < 0.05). In the low-risk group the sudden cardiac death (crude rate) in the placebo subgroup was 5.2% and was still reduced by oxprenolol to 1.6% (P < 0.05). The results for total mortality were quite similar to those for sudden death iu both groups. Conclusion: This study, unique for the populations studied and for one of the treatments used, demonstrates that pharmacologic and surgical antiadrenergic interventions significantly reduce sudden cardiac death in postmyocardial infarction patients at high and at low risk. With due consideration to the relatively small size of the high-risk group, it seems reasonable to suggest that left cardiac sympathetic denervatiou may be considered as a possible alternative for high-risk patients with contraindications to beta hlockers. [ABSTRACT FROM AUTHOR]

Numerous studies have focused attention on the influence of various biological and environmental factors on contact hypersensitivity. In order to evaluate the persistence and/or modification of allergic contact sensitivity to a number of common contact sensitizers, the same standardized patch tests were repeated on 174 subjects with contact sensitivity after a time lapse of 5 years (1987 1992). In 18.4% of the cases. 1 or more sensitivities were lost; 28.7% of the patients had a higher number of positive patch tests after 5 years, while the remaining 52.9% of the patients showed no change in the number of positive patch tests. In 88%, the positive allergents were unchanged, whereas in the remaining 12% of the subjects, they showed 1 or more variations. The association between the allergens most often positive was calculated for both the 1st and the 2nd patch test results. Moreover, to evaluate the frequency of an allergen's positivity, we studied the disappearance of old sensitivities and the appearance of new sensitivities by the McNemar test. Cobalt chloride was the only allergen with a significant frequency of new positivities over the period of observation (p<0.01). Logistic regression analysis was performed to evaluate the possible influence of positive tests to other allergens, and of some clinical findings associated with contact dermatitis, on the sensitivity to cobalt chloride in 1987 and in 1992. [ABSTRACT FROM AUTHOR]

5 non-disperse azo dyes, used for colouring natural fibers, were added to the standard patch test series, as 5% pet. preparations. 1814 consecutive patients attending the patch test clinic were patch tested, of whom 16 (0.88%) reacted to the newly added dyes: 8 to Direct Orange 34, 5 to Acid Yellow 61, 2 to Acid Red 359 and 1 to Acid Red 118. On the basis of clinical history and results of patch tests with pieces of fabrics, contact sensitization to non-disperse azo dyes seemed to be related to the appearance of skin lesions at least in 8 subjects. We conclude that systematic exploration of the sensitizing potential of textile dyes, selected after careful investigation, can provide additional information on the frequency of occurrence of textile dye dermatitis, supporting individual investigation in sensitized subjects. [ABSTRACT FROM AUTHOR]

593 recruits selected by the Military Health Service as being healthy and without a history of present or previous dermatitis, or ocular refraction defects, were patch tested with the GIRDCA (Italian Research Group on Contact and Environmental Dermatitis) standard series. Of these, 336 were also patch tested with substances used in the processing and dyeing of textiles and prick tested with 8 major allergens. 74 (12.5%) reacted to 1 or more substances. The most frequent sensitizers were: thimerosal (28 cases), ammoniated mercury (7 cases), phenol-formaldehyde resin (6 cases), parabens, nickel and Disperse Red 17 (4 cases each). 113 recruits reacted to 1 or more prick test allergens. We have demonstrated the importance of establishing such reference values in healthy groups for the correct evaluation of data collected from selected groups. [ABSTRACT FROM AUTHOR]

139 workers from 3 ceramics factories underwent dermatological and allergological examination, using standard and occupational patch test series, in order to evaluate the prevalence of dermatitis and contact sensitization, to identify the most important sensitizing substances in the ceramics industry, and to correlate the results with possible risk factors such as atopy. Hand dermatitis had affected 37% of the subjects examined, 27% of the workers were sensitized to 1 or more allergens. Or 52 subjects with dermatitis, 37% had allergic contact dermatitis and 63% irritant contact dermatitis. 18 subjects were found to he sensitized without showing any previous or present clinical symptoms. Atopy tended towards correlation with the overall incidence of dermatitis, though not with the prevalence of sensitization. [ABSTRACT FROM AUTHOR]

Purpose To evaluate the efficacy of UVA collagen cross linking (CXL) on thin keratoconic corneas with previous application of hypoosmolar riboflavin solution. Methods Twelve eyes of 12 patients with progressive keratoconus and a corneal thickness of less than 400 µm without the epithelium, were submitted to collagen cross‐linking after the application of an hypoosmolar riboflavin solution. We instilled one drop every 5 seconds for 2 or 4 minutes to increase corneal thickness up to a minimum value of 400 µm. Pachimetry measurements were taken every 30 seconds to verify the effect on corneal stroma. Results Mean corneal thickness improved in most cases with reduction of the mean K‐value of the keratoconus and no progression was observed at six and twelve months after CXL. One year after treatment no scarring lesions in the stroma were observed and all corneas were transparent. Improvement of visual acuity was significant in three patients (25%), low but detectable in seven patients (51%) and no modifications of visual acuity were observed in two patients (24%). Conclusion Hypoosmolar riboflavin solution showed to be useful to allow CXL procedure in keratoconic corneas with low stromal thickness. No progression of keratoconus was observed six months and one year afer CXL., no developing of stromal scars and patients showed good stability of visual acuity delaying time of surgery. [ABSTRACT FROM AUTHOR]

Purpose In‐the‐bag posterior chamber intraocular lens (PC‐IOL) dislocation is an unusual late complication of cataract surgery that can be managed either by exchange with a scleral fixated intraocular lens or by PC‐IOL repositioning with scleral fixation. In the presence of mild subluxation, in older patients, we prefer to suture the fibrotic capsular bag to the sclera without opening the anterior chamber. Methods 5 patients (mean age 80 y.o.) who had uncomplicated phacoemulsification with implantation of a posterior chamber intraocular lens (IOL) into the continuous capsulorhexis several years before (4‐12 years), suffered from PC‐IOL subluxation secondary to dehiscence of the zonules supporting the capsular bag. All capsular bags were fibrotic and previously received yag capsulotomy for PCO. Using two self sealing side ports the capsular bag was successfully sutured to the sclera at 12' by introducing a double‐armed polypropylene suture through a scleral flap. Results The final postoperative visual acuity was 20/30 or better with no complications during the surgical procedure. Patients discomfort was minimum and no endothelial cell loss was reported. Conclusion Scleral fixation by single suture can be a useful and low‐complication rate procedure for late in‐the‐bag PC‐IOL subluxation in older patients. Use of This procedure in selected cases, can avoid whole capsular bag extraction and replacement with scleral fixated sulcus IOL, with minimal stress for the ocular structures. [ABSTRACT FROM AUTHOR]

This article discusses echographic evaluation of patch test inhibition by oral antihistamine. 18 eczernatous patients (3 male and 15 female, aged 18 to 55 years) contact sensitized to nickel sulfate (+ + or + + + reactions) entered the study. A 1st series of patch tests was carried out using 40 mg of nickel sulfate 5% pet. arm. Patch tests were removed after 72 h and evaluated clinically and echographically 3 h later. The correlation coefficient between clinical scoring and echographic measurements was high (r=O.7626).

Patients with suspected contact dermatitis usually undergo 2-day patch testing, with a 1st reading at 2 days and a 2nd at 3-4 days. This procedure requires a 3-fold check of patients. The results of the 2 different series present only slight variations, regarding thimerosal, potassium dichromate, fragrance mix and epoxy resin, to which more patients were sensitized as evaluated by the 2nd series. Irritant reactions as scored with the alternative testing procedure were no more numerous than those found using the normal procedure finally, more intense allergic responses to some allergens, which did not modify the final reading, were also noted.

The relationship between contact dermatitis sensitization to nickel and atopy has long been discussed. Some authors suggest a preferential connection between nickel sensitization and the atopic state and believe that nickel allergy may be a marker of latent atopy. In this article, 447 nickel-sensitive patients, aged between 6 to 78 years, with dermatitis were studied. All the patients previously tested with GIRDCA standard series, underwent prick tests and RAST for pollens, inhalants, moulds and food allergens.

Yellow or white petrolatum is a mixture of semisolid hydrocarbons of the methane series: the difference between the two arises in the purification process, extension of which is necessary to remove the yellow color. Contact sensitization to white petrolatum is rarely reported. A young woman with eczema was observed, in whom all the allergens, diluted in white petrolatum, were positive, while those diluted in water or propylene glycol were negative. Two months later, she was re-tested with eight brands of white petrolatum. Four kinds of white petrolatum were positive, while eucerin and the metal salts were negative.

The article presents a case of pigmented contact dermatitis. Pigmented lesions are not unusual in contact allergy and have been observed with para-phenylenediamines and other allergens. They have frequently been reported as associated with histological changes reminiscent of lichen planus pigmentosus. A 66-year-old woman, with no previous history of atopy or allergy, presented with very pronounced, reticulate, violet-brown pigmented macules surrounding a smooth, greyish, atrophic area in the axillae. Patches had begun 2 years earlier, with no preceding eczema, and were not pruritic. The patient had been using various brands of deodorants for many years.

Among 250 craftsmen working in a field, 50 subjects were selected among those usually handling enamels and lacquers for on-glaze firing. They underwent dermatological examination and patch testing with an occupational series. 24 craftsmen were either mono- or polysensitized, with a total of 32 positive patch tests. 14 of the sensitized subjects had a history of contact dermatitis, mostly metal-induced. Dermatitis of the hands and forearms was present only in 3 subjects, who were found to be positive respectively.

The article presents a case report related to echographic evaluation of edema induced by patch test chambers. Experimental irritant patch testing is generally performed by applying substances on healthy skin of the volar surface of the forearm or of the back, using various types of rigid or flexible chambers or other units. One of the most widely used are Finn Chambers, which have the advantage of exposing the skin to a well defined quantity of a chemical and at the same time providing good adhesion to the test area.

The article presents information about three case reports related to contact sensitization in infants. A 12 month old male baby was admitted with an exacerbation of atopic dermatitis which had started at the age of 4 months. Arms and legs were particularly involved. Neither respiratory symptoms nor seasonal exacerbation of the dermatitis had been reported. During hospitalization, prick tests for food, inhalants, pollens and moulds showed positively to cow's milk. casein and peanut. Sensitization to milk proteins were confirmed on tests.

593 recruits, selected by the Italy's Military Health Authorities as healthy subjects, without dermatitis or ocular defects, underwent patch testing with Italian Research Group into Contact and Environmental Dermatitis (GIRDCA) series, as of October 1, 1990. 336 of them were also tested with 34 haptens, including dyes and ether substances used in textile manufacture. Finally, 351 recruits underwent a prick test with 8 major allergens. 52 subjects were found to sensitized to the GIRDCA series haptens. 72 positive results were observed.

The article presents a study that investigates contact allergy in patients with leg ulcers. The study shows that there were 13 reactions to allergens on the leg ulcer series and 191 in the baseline series. It reveals that three patients who were positive to hydrocolloid gel, but only two wee positive to propylene glycol in the product used for the wound debridement. In addition, no sensitizations were discovered to alginates or polyurethane foams.

This article presents information about Euxyl K 400. Euxyl K 400, a new preservative in toiletries, detergents and cosmetics, has been considered to have a low sensitizing potential. Researcher M. Bruze and other using the guinea pig maximization test on its 2 active ingredients, did not show any sensitizing capacity. He underlined the need for larger test populations to confirm this finding. Since then, there have been 2 reports of allergic contact dermatitis from its active ingredients and the author's report of allergic contact dermatitis twin Euxyl K 400 (4).

"Fiddler's neck" is a condition affecting violin players and consists of an area of erythema, pigmentation, lichenification, acne-like changes sych as papules, pustules and even cysts usually localized below the jaw, where the instrument is in close apposition to the skin. A 16-year old girl had been playing violin since she was 11 years old and developed erythema, mild pigmentation and papules just below the angle of her right mundible about 1 year previously. 5 cm below it, there was a patch of acute eczema just where the skin rubbed the metal fixture which clamps the chin rest to the violin.

This article presents information on contact dermatitis from propolis. Propolis has been used since ancient times for medical and cosmetic purposes. Its use is becoming more and more widespread in Italy and the number of patients with contact dermatitis from it is increasing. A 32 year old coloured man with incense aedema, erythema and vesciculation of the penis after applying a 10% alcoholic solution of propolis for herpes genitalis. Standard patch tests were negative, including balsam of Peru, colophony, cinnamic acid and aldehyde.

The article reports of 312 consecutive patients, admitted for suspected allergic contact dermatitis, who underwent patch tests with reactive dyes. No positive allergic or irritant reactions were observed in all the tested patients, both at 5% and 10% concentrations. Allergic contact dermatitis due to non-disperse textile dyes in order to identify. It has been previously investigated, contact sensitization to reactive textile dies, mostly used for colouring cotton, silk and wool garments employing an initial series of 12 colours.

Dimethyl fumarate (DMF) is a fumaric acid esters derivate approved for plaque psoriasis as first-line systemic therapy. It has been available in Italy since 2017 and an increasing number of patients are treated with this drug. To evaluate DMF effectiveness, side effects and drug survival in a dermatological real-life setting. We performed a retrospective multi-center study in five dermatologic clinics in Emilia-Romagna, Northern Italy, which included all consecutive patients affected by moderate-severe psoriasis treated with DMF. We assessed effectiveness (in terms of PASI50 and PASI75 in an intention to treat observation) and safety (occurrence of side effects) of DMF and their association with demographic and disease characteristics, mean daily dose taken and treatment discontinuation. We included 103 patients, 78 (75.72%) had at least one comorbidity including 19 (18.44%) with a history of cancer; the mean treatment duration was 23.61 ± 17.99 weeks (min 4, max 130) and the mean daily dose was 262.13 ± 190.94 mg. Twenty-four patients (23.30%) reached PASI75 at week 12, while a further 18 patients (17.47%) reached it at week 26. Side effects occurred in 63 patients (61.16%), the most frequent were diarrhea, epigastric discomfort, nausea, and flushing. Sixteen patients (15.53%) showed an alteration of laboratory tests. In some cases side effects were transitory, while in 53 patients (51.45%) they led to cessation of therapy. The median daily dose showed a direct association with PASI50 achievement and an indirect association with treatment discontinuation. Our study shows the peculiarities of DMF in a real-world setting: effectiveness is often reached after 12 weeks of treatment and side effects could limit the continuation of the therapy but, at the same time, DMF has no major contraindications and, due to the wide range of dosage, it can allow both to manage side effects and to personalize the prescription for each patient., (© 2021 The Authors. Dermatologic Therapy published by Wiley Periodicals LLC.)

Background: Few and small studies have described the management of immunomodulant/immunosuppressive therapies or phototherapy in atopic dermatitis (AD) patients during coronavirus disease 2019 (COVID-19) pandemic., Methods: A national registry, named DA-COVID-19 and involving 35 Italian dermatology units, was established in order to evaluate the impact of COVID-19 pandemic on the management of adult AD patients treated with systemic immunomodulant/immunosuppressive medications or phototherapy. Demographic and clinical data were obtained at different timepoints by teledermatology during COVID-19 pandemic, when regular visits were not allowed due to sanitary restrictions. Disease severity was assessed by both physician- and patient-reported assessment scores evaluating itch intensity, sleep disturbances, and AD severity., Results: A total of 1831 patients were included, with 1580/1831 (86.3%) continuing therapy during pandemic. Most patients were treated with dupilumab (86.1%, 1576/1831) that was interrupted in only 9.9% (156/1576) of cases, while systemic immunosuppressive compounds were more frequently withdrawn. Treatment interruption was due to decision of the patient, general practitioner, or dermatologist in 39.9% (114/286), 5.6% (16/286), and 30.1% (86/286) of cases, respectively. Fear of increased susceptibility to SARS-CoV-2 infection (24.8%, 71/286) was one of the main causes of interruption. Sixteen patients (0.9%) resulted positive to SARS-CoV-2 infection; 3 of them (0.2%) were hospitalized but no cases of COVID-related death occurred., Conclusions: Most AD patients continued systemic treatments during COVID pandemic and lockdown period, without high impact on disease control, particularly dupilumab-treated patients., (© 2021 EAACI and John Wiley and Sons A/S. Published by John Wiley and Sons Ltd.)

Calciphylaxis or calcific uremic arteriolopathy is characterized by the involvement of the tunica elastica of the reticular or deep subcutaneous dermis, with extravascular and vascular thrombosis calcifications that lead to tissular ischemia. The torso muscles, the lumbar region, and lower limbs are more frequently affected. The pathogenesis is unknown. Calciphylaxis is associated to hyperparathyroidism, chronic renal failure, and diabetes mellitus. The best therapy to date is prevention: early treatment of renal failure, performing a partial parathyroidectomy where necessary, surgical debridement of the necrotic tissue, as well as avoiding the trigger factors such as systemic corticosteroids.