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Background Cradle cap is a benign and self-limiting variant of seborrheic dermatitis (SD) that can be distressing for parents. Aims To assess by clinical/laboratory/instrumental evaluation the efficacy/tolerability of a gel cream containing piroctone olamine (antifungal), biosaccharide gum-2 (antifungal), stearyl glycyrrhetinate (anti-inflammatory), and zinc l-pyrrolidone carboxylate (zinc-PCA) (antiseborrheic) in the treatment of mild/ moderate cradle cap. Methods In this prospective, open-label trial, 10 infants, with mild/moderate cradle cap enrolled at the Dermatology University Clinic of Catania (Italy) used the tested gel cream twice daily for 30 days. Degree of erythema was evaluated clinically by a 5-point severity scale (from 0=no erythema to 4=severe erythema), at baseline, at 15 and 30 days. Desquamation was rated by dermoscopy evaluation using a 5-point scale (from 0=no desquamation to 4=severe/many large adherent white flakes), at all time points. An Investigator Global Assessment (IGA) using a 6-point scale (from -1=worsening to 4=complete response/clear) was also performed at 30 days. Five subjects, randomly selected, underwent double microbiological evaluation for bacteria and yeasts by cultures of cotton swabs at baseline and at 30 days. Tolerability/acceptability was evaluated on a 4-point scale (from 0=very poor to 3=excellent) at 15 and 30 days. Data were processed using SAS version 9. Results At baseline, a significant colony-forming unit (CFU) count for Malassezia furfur and Staphylococcus aureus was detected in 4 out of 5 selected patients. After 15 and 30 days, a statically significant reduction from baseline in erythema and desquamation severity was observed, along with a reduction in CFU count for Malassezia furfur and Staphylococcus aureus from baseline. No signs of local side effects were documented. Conclusions Our results indicate that the tested gel cream may represent a valid option to treat mild-to-moderate forms of cradle cap and support its antifungal and antibacterial properties.

Urea-based topical compounds at medium concentrations (15%-30%) represent useful dermatological agents for their humectant and keratolytic effects by enhancing stratum corneum hydration and by loosening epidermal keratin, respectively. The aim of this paper is to review the clinical evidences of the use of 15%-30% urea as single topical agent. Although limited evidence supports the use of these concentrations of urea in skin disorders characterised by xerosis and hyperkeratosis, in clinical practice they are largely used especially in xerosis of limited skin areas, in which the side effects are tolerable, or hyperkeratosis involving large or more sensitive (eg, face, genital region, etc) areas, in which higher concentration may be irritant. In addition, urea at medium concentrations is used in combination with other substances including topical antifungals as penetration enhancer.

Federica Dall’Oglio,1 Gabriella Fabbrocini,2 Aurora Tedeschi,1 Marianna Donnarumma,2 Paolo Chiodini,3 Giuseppe Micali1 1Dermatology Clinic, University of Catania, Catania, Italy; 2Section of Dermatology, Department of Clinical Medicine and Surgery, University Federico II of Naples, Naples, Italy; 3Medical Statistics Unit, University of Campania “Luigi Vanvitelli”, Naples, ItalyCorrespondence: Giuseppe MicaliDermatology Clinic, University of Catania, A.O.U. Policlinico -Vittorio Emanuele, via Santa Sofia, 78, Catania 95123, ItalyTel +39 095321705Fax +39 0953782425Email cldermct@gmail.comPurpose: Topical cosmetic agents if correctly prescribed and used may improve outcomes in acne therapy. The aim of this study was to assess the efficacy and tolerability of a new daily cosmetic regimen in the treatment of mild facial acne.Patients and methods: A multicenter, prospective, observational, clinical study was conducted on 91 adult patients with mild acne. Subjects were instructed to apply a fluid containing Licochalcone A/Salicylic acid/L-Carnitine in the morning and a cream with Licochalcone A/Hydroxy-Complex 10% at bedtime for 8 weeks. The efficacy was clinically evaluated by Global Acne Grading System (GAGS) score and by comedones/papules lesions count and by instrumental assessment (SebutapeTMand Reveal Photo Imager/VISIA-CR™ imaging) at baseline, at 4 and 8 weeks.Results: At 4 weeks a statistically significant reduction from baseline of GAGSwas observed. In addition, the mean total count of comedones and papules was significantly reduced by 41% and 45%, respectively, from baseline along with a significant reduction of mean sebum of 47%. At 8 weeks, a further statistically significant reduction from baseline of GAGS, total count of comedones and papules (64% and 71%, respectively), along with an additional sebum reduction of about 52% was also recorded.Conclusion: Our results suggest that the daily regimen based on Licochalcone A with Salicylic acid/L-Carnitine as fluid or with Hydroxy-Complex 10% as cream represent an interesting cosmetic approach for treating mild acne.Keywords: mild acne, topical cosmetic, licochalcone A, salicylic acid, hydroxyl-complex

La cosmetologia e la scienza che studia le materie prime e il modo di miscelarle tra loro per ottenere un cosmetico. I prodotti cosmetici dovrebbero essere fabbricati, manipolati, confezionati e venduti in modo tale da non arrecare danni alla salute quando applicati sulla cute e/o le mucose. Pertanto, a tutela del singolo consumatore numerosi e complessi sono le leggi e i controlli relativi alla loro immissione sul mercato. In particolare, la normativa dei prodotti cosmetici e disciplinata dalla Legge n. 713 dell’11 ottobre 1986, successivamente modificata da Decreti Legislativi (D.Lgs.) n. 300 del 10 settembre 1991, n. 126 del 24 aprile 1997, n. 50 del 15 febbraio 2005 e n. 194 del 10 aprile 2006, che stabilisce una disciplina organica ai fini della tutela della salute pubblica.

The term “cosmeceuticals”, suggested by Kligman more than 20 years ago, refers to topical products that lie in a gray zone where they are viewed as having both pharmaceutical and cosmetic properties [1]. Although the neologism was innovative and relevant, it was rejected from the US Food, Drug, and Cosmetic Act that, according to the 1938s US Congress, labels as drug every substance for use in the diagnosis, cure, treatment or prevention of disease, and as cosmetic any product intended for beautifying and promoting attractiveness. In spite of this, the term cosmeceuticals has recently been gaining increasing popularity, as the term cosmetic seems to be restrictive for those substances that have druglike beneficial effects. On the other hand, the “cosmeceuticals” concept has caused a lot of confusion, because of similar neologisms such as neutraceuticals and/or neoceuticals. Actually, in USA and Canada, most cosmeceuticals are regulated as over the counter (OTC) products, while in Europe they are considered as cosmetics. Only in Japan, a new class of products, called quasi-drugs, has been created [2].

A 62-year-old woman was admitted to our clinic for the evaluation of 2.5-year history of progressive exertional facial flushing, and swelling of the head, face, and neck. Three years earlier, she had undergone implantation of a definitive pacemaker with an endocardial ventricular lead for a severe bradycardia. Physical examination revealed facial swelling and erythema including the periorbital areas, distended neck and edema of the region above the lower margins of the rib cage. Numerous dilated cutaneous venules were present on the ventral upper thoracic wall interspersed with patches of intense flush and large areas of normally colored skin (Fig. 1). There had been no weight loss within the previous months. History of angioedema, allergic reactions, autoimmune diseases, or medication was negative. Enlarged lymph nodes were not detected. Complete blood cell count, fibrinogen, Quick's test for prothrombin, antithrombin III, C-reactive protein, lipidic profile, renal functions, urinanalysis, and thyroid function test were within normal ranges. Standard X-ray and sectional radiography of the chest revealed no lung diseases or alterations of the mediastinum. Doppler examination of the supraaortic trunks and chest CT scan showed normal findings. A diagnosis of superior vena cava syndrome (SCVS) was suspected and a cavography was performed, by injecting contrast medium simultaneously through the basilic veins, that revealed marked narrowing of the confluence of the two brachiocephalic veins at the junction of the internal jugular and right subclavian veins with a total obliteration of the right brachiocephalic vein (Fig. 2). The diagnosis of pacemaker-induced SVCS was confirmed and the woman was referred for angiosurgery. Figure 1. Presence of edema of the region above the lower margins of the rib cage. Numerous dilated cutaneous venules on the ventral thorax wall interspersed with patches of intense erythema and large areas of normally colored skin were present Figure 2. Cavography showing obliteration of the right brachiocephalic vein at its confluence with the left brachiocephalic vein