Search

A letter to the editor is presented on dermoscopy in patients with Darier's disease.

Comments on several issues related to dermatology. Association of dermatomyositis with acquired ichthyosis; Features of seborrhoeic keratoses; Effects of sclerosis on the dermis.

Since the summer of 1989, Adriatic coastal waters have frequently been cloudy, foamy, creamy, fetid and anomalous in color, owing to amorphous aggregates. These tend to make the bather's skin slimy and greasy. This phenomenon has long been referred to as "dirty sea", indicating increased macroscopic shapeless aggregates of organic and inorganic substances, as well as organisms common in a pelagic ecosystem. The gelatinous component of these aggregates, polysaceharide in nature, is produced during the reproductive period in great quantity, particularly by benthic, tycopelagic or pelagic diatoms.

A letter to the editor is presented which discusses a case report suggesting the utilization of dermoscopy in improving the non-invasive diagnosis of Zoon's plasma cell balanitis (ZPCB).

Competing Interests: The authors report no conflicts of interest in this work.

Competing Interests: The authors report no conflicts of interest in this work.

Background: Facial (FP) and genital psoriasis (GP) significantly affect patients' quality of life. Despite the advances in treatments, limited data on efficacy and safety are available on these difficult-to-treat areas. Guselkumab is an interleukin (IL)-23 inhibitor which has been proven effective in treating patients with moderate-to-severe plaque psoriasis., Objectives: The aim of this interim analysis was to report the efficacy and safety of guselkumab in the treatment of patients with FP and/or GP., Materials and Methods: GULLIVER is a 52-week Italian observational study to evaluate the effectiveness and safety of guselkumab in a real-life setting in patients with FP and/or GP. Adult patients with facial and/or genital moderate-to-severe psoriasis (sPGA score ≥ 3) were included. The primary endpoint of this analysis was the percentage of patients achieving a facial or genital sPGA score of 0 (clear) or 1 (almost clear), at Week 12. The change in the score of the facial or genital sPGA components in patients with a score ≥3 for each sPGA component was assessed. PASI score in patients with a baseline PASI above or below 10 was evaluated., Results: Overall, 351 patients were included in the study; 83.3% of FP and 76.5% of GP patients achieved the primary endpoint. Similar response rates were observed for the facial or genital sPGA components in patients with a baseline facial or genital sPGA score ≥3 in each component. Among patients with a baseline PASI score >10, mean PASI score improved from 19.0 (SD 8.3) to 2.2 (SD 4.8). Forty-four AEs were observed in 32 patients; two mild and transient AEs (fatigue and nausea) were considered treatment related. No SAEs were observed., Conclusions: Guselkumab, showing to be effective and safe in treating FP and GP, may be a valid therapeutic option for patients with psoriasis localized in these difficult-to-treat areas., (© 2024 European Academy of Dermatology and Venereology.)

Background: Dermatophytosis is a prevalent superficial infection caused by filamentous fungi, primarily affecting the skin and/or its appendages. In recent years, there has been a notable increase in mycotic strains resistant to standard antifungal therapies, including Trichophyton indotineae , a dermatophyte of the Trichophyton mentagrophytes complex. This review aims to provide a comprehensive overview of the treatment options for T. indotineae , elucidating their effectiveness in managing this challenging mycotic infection. Methods: For this review, a search was conducted in the PubMed, Scopus, Web of Science, Embase, and Google Scholar databases, encompassing all published data until March 2024. English-language articles detailing therapy outcomes for patients confirmed to be affected by T. indotineae , identified through molecular analysis, were included. Results: Itraconazole was shown to be a good therapeutic choice, particularly when administered at a dosage of 200 mg/day for 1-12 weeks. Voriconazole was also demonstrated to be effective, while terbinafine exhibited a reduced response rate. Griseofulvin and fluconazole, on the other hand, were found to be ineffective. Although topical treatments were mostly ineffective when used alone, they showed promising results when used in combination with systemic therapy. Mutational status was associated with different profiles of treatment response, suggesting the need for a more tailored approach. Conclusions: When managing T. indotineae infections, it is necessary to optimize therapy to mitigate resistances and relapse. Combining in vitro antifungal susceptibility testing with mutational analysis could be a promising strategy in refining treatment selection.

Competing Interests: The authors report no conflicts of interest in this work.

Background: Preliminary data support the possible use of ultraviolet-induced fluorescence (UVF) dermoscopy in general dermatology, yet no accuracy analysis has been performed so far., Objective: To evaluate diagnostic accuracy of UVF dermoscopy in clinically similar non-neoplastic conditions as compared to polarized light-based dermoscopy., Methods: Patients with dermatoses potentially showing UV-induced findings were considered; cases were grouped according to clinical patterns and controls were also included. Standardized evaluation of dermoscopic pictures of the target lesion along with comparative and accuracy analysis were performed for polarized and UVF dermoscopic findings., Results: A total of 208 patients were included [31 foot intertrigo (7 due to Pseudomonas, 13 due to Corynebacterium and 11 due to dermatophytes); 57 intertrigo of major creases (18 inverse psoriasis, 13 erythrasma, 15 tinea infections and 11 candidiasis); 16 acne (papulopustular) and 13 Malassezia folliculitis; 46 papulosquamous dermatoses (14 guttate psoriasis, 11 lichen planus, 12 pityriasis rosea and 9 pityriasis lichenoide chronica); and 45 hypopigmented macular dermatoses of the trunk (9 progressive macular hypomelanosis, 9 idiopatic guttate hypomelanosis, 13 vitiligo and 14 achromic pityriasis versicolor)]. Significant (p < 0.01) UVF was seen in several conditions: green in Pseudomonas foot intertrigo; red in Corynebacterium foot intertrigo, inverse and guttate psoriasis (arranged around dermal papillae in the former), progressive macular hypomelanosis (folliculocentric distribution) and erythrasma (showing polygonal or structureless appearance); blue fluorescent concretions along hair shaft in erythrasma; light green in achromic pityriasis versicolor and tinea of major creases; and blue follicular in Malassezia folliculitis. Additionally, both acne and achromic pityriasis versicolor were also associated with interruption of uniform follicular red fluorescence. Notably, polarized and UVF dermoscopy were related to the most accurate feature in nine and eight analysed dermatoses, respectively., Conclusion: UVF dermoscopy improves recognition of non-neoplastic dermatoses, yet it should be considered complimentary to polarized light-based dermoscopy to increase diagnostic performance., (© 2024 European Academy of Dermatology and Venereology.)

Introduction: Atopic dermatitis (AD) is a chronic inflammatory skin disease that negatively impacts the quality of life and work productivity of patients., Objectives: We sought to evaluate the real-world burden of AD patients in Italy., Methods: This sub-analysis of the MEASURE-AD multicountry study conducted between December 2019-2020 included patients diagnosed with moderate-to-severe AD eligible for or receiving systemic therapy in the previous 6 months. During a single visit, physician and patient-reported questionnaires were used., Results: A total of 118 adult patients were enrolled and 57.6% (N = 68) of patients had moderate-to-severe AD at the time of enrolment according to the Eczema Area and Severity Index. Sleep disorders interfered with daily function in the previous week in 58.5% (N = 69) of patients, pruritus was severe in 50% (N = 59) and 42.4% (N = 50) reported a flare lasting >7 days in the previous 6 months. According to the Dermatology Quality of Life Index, 37.3% (N = 44) of patients reported a severe impact of AD and approximately 10% had clinical depression/anxiety. Current drug therapy was considered inadequate in controlling AD in 26.3% (N=31) of patients. Work activity impairment was 38.6±31.7% and monthly AD-related expenses were 148.6±134.6 Euros per patient., Conclusions: This real-life study documents a high burden of disease in patients with moderate-severe AD in Italy.

Purpose: SUPREME, a phase IIIb study conducted in Italy, demonstrated safety and high efficacy of secukinumab for up to 72 weeks in patients with moderate-to-severe plaque-type psoriasis. SUPREME 2.0 study aimed to provide real-world data on the long-term drug survival and effectiveness of secukinumab beyond 72 weeks., Patients and Methods: SUPREME 2.0 is a retrospective observational chart review study conducted in patients previously enrolled in SUPREME study. After the end of the SUPREME study, eligible patients continued treatment as per clinical practice, and their effectiveness and drug survival data were retrieved from medical charts., Results: Of the 415 patients enrolled in the SUPREME study, 297 were included in SUPREME 2.0; of which, 210 (70.7%) continued secukinumab treatment throughout the 42-month observation period. Patients in the biologic-naïve cohort had higher drug survival than those in the biologic-experienced cohort (74.9% vs 61.7%), while HLA-Cw6-positive and HLA-Cw6-negative patients showed similar drug survival (69.3% and 71.9%). After 42 months, Psoriasis Area and Severity Index (PASI) 90 was achieved by 79.6% of patients overall; with a similar proportion of biologic-naïve and biologic-experienced patients achieving PASI90 (79.8% and 79.1%). The mean absolute PASI score reduced from 21.94 to 1.38 in the overall population, 21.90 to 1.24 in biologic-naïve and 22.03 to 1.77 in biologic-experienced patients after 42 months. The decrease in the absolute PASI score was comparable between HLA-Cw6-positive and HLA-Cw6-negative patients. The baseline Dermatology Life Quality Index scores also decreased in the overall patients (10.5 to 2.32) and across all study sub-groups after 42 months. Safety was consistent with the known profile of secukinumab, with no new findings., Conclusion: In this real-world cohort study, secukinumab showed consistently high long-term drug survival and effectiveness with a favourable safety profile., Competing Interests: F. Russo has acted as a speaker/consultant for AbbVie, Novartis and Sanofi; M. Galluzzo has acted as a speaker and/or consultant for AbbVie, Almirall, Eli Lilly, Janssen-Cilag, LeoPharma, Novartis and Sanofi; L. Stingeni has acted as a speaker and board member for AbbVie, Almirall, Celgene, Eli Lilly, Janssen, LeoPharma, Novartis and Sanofi; A. Conti has acted as a consultant for AbbVie, Abbott, Amgen, Celgene, Eli Lilly, Janssen Cilag, Leo Pharma, MSD, Novartis, Sandoz, Schering Plough, UCB Pharma and Wyeth; F. Bardazzi has acted as a speaker and/or consultant for Almirall, AbbVie, Celgene, Eli Lilly, Janssen, Leo Pharma and UCB Pharma; G. Girolomoni has received personal fees from AbbVie, Almirall, Amgen, Biogen, Boehringer-Ingelheim, Bristol-Myers Squibb, Eli-Lilly, Fresenius Kabi, Galderma, Genzyme, Leo Pharma, Novartis, Pfizer, Regeneron, Samsung bioepis, Sanofi and UCB; M. Venturini served as a speaker or advisory board member for AbbVie, Almirall, Amgen, Eli Lilly, Galderma, LeoPharma, Novartis, Pierre Fabre and UCB Pharma; M.C. Fargnoli has served on advisory boards, received honoraria for lectures and received research grants from AbbVie, Almirall, Amgen, BMS, Galderma, Janssen, Kyowa Kyrin, Leo Pharma, Lilly, MSD, Novartis, Pfizer, Pierre Fabre, Sanofi-Regeneron, Sunpharma and UCB; M.L. Musumeci has served as a consultant/investigator for AbbVie, Biogen, Eli Lilly, Janssen Cilag and Novartis; P. Malleoli has acted as a consultant or had advisory board agreements for AbbVie, Almirall, Amgen, Eli Lilly, Janssen, Leo Pharma, Novartis and UCB Pharma; F. Loconsole reports no conflicts of interest; A. Offidani has received honoraria as speaker, scientific board member and consultant from AbbVie, Eli Lilly, Galderma, Leo Pharma, Novartis, Pfizer, Sanofi and UCB Pharma; V. Di Lernia has received honoraria as speaker, consultant or advisory board member from AbbVie, Amgen, Janssen and Novartis; Iris Zalaudek has received honoraria for lectures, advisory boards from Almirall, Novartis, MSD, BMS, Philogen, Sunpharma, Sanofi, Celgene, Kyowa Kyrin, Mallinckrodt, Janssen and Eli Lilly; G. Gigante, M. Bartezaghi, P. Ursoleo and E. Aloisi are employees of Novartis. The authors report no other conflicts of interest in this work., (© 2023 Russo et al.)

This comprehensive review offers a detailed look at atopic dermatitis (AD) treatment in Italy, focusing primarily on the use of biologics and small molecules. In response to advancing knowledge of AD's causes and treatments, there's a global need for updated guidelines to provide physicians with a more comprehensive clinical perspective, facilitating personalized treatment strategies. Dupilumab, a groundbreaking biologic, gained approval as a significant milestone. Clinical trials demonstrated its ability to significantly reduce AD severity scores, with an impressive 37% of patients achieving clear or nearly clear skin within just 16 weeks of treatment. Real-world studies further support its efficacy across various age groups, including the elderly, with a safety profile akin to that of younger adults. Tralokinumab, a more recent approval, shows promise in clinical trials, particularly among younger populations. However, its real-world application, especially in older individuals, lacks comprehensive data. Janus Kinases inhibitors like Upadacitinib, Baricitinib, and Abrocitinib hold substantial potential for AD treatment. Nevertheless, data remains limited for patients over 75, with older adults perceived to carry a higher risk profile. Integrated safety analyses revealed individuals aged 60 and above experiencing major adverse cardiovascular events and malignancies, underscoring the need for cautious consideration. While these therapies offer promise, especially among younger patients, further research is essential to determine their safety and efficacy in various populations, including pediatric, geriatric, and those with comorbidities. Biologics and small molecules are improving AD treatment, as shown in this review., Competing Interests: Conflict of interest: the authors declare no potential conflict of interest., (Copyright © 2024, the Author(s).)

Lyme borreliosis (LB) is the most common vector-borne zoonotic inflammatory disease in the Northern Hemisphere. In Italy, the first case was diagnosed in 1985 in a woman in Liguria, while the second, in 1986 in Friuli-Venezia Giulia, documenting the infection in northern Italy. Both diagnoses were confirmed by serological assessment by an indirect immunofluorescence (IFI) technique. Borrelia cultivation from both Ixodes ricinus ticks and human lesions in Trieste (Friuli-Venezia Giulia) identified Borrelia afzelii as the prevalent genospecies; nevertheless, Borrelia garinii , Borrelia burgdorferi ( sensu stricto ), and Borrelia valaisiana (VS116 Group) were also detected, although less frequently. LB was also documented in other Italian regions: in Tuscany (1991), Trentino-Alto Adige (1995-1996), Emilia-Romagna (1998), Abruzzo (1998), and more recently, Lombardy. Nevertheless, data on LB in other Italian regions, especially in southern Italy and islands, are poor. The aim of this study is to document the spread of LB in Italy through the collection of data from LB patients in eight Italian hospitals located in different Italian regions. Diagnostic criteria for LB diagnosis are as follows: i) the presence of erythema migrans (EM) or ii) a clinical picture suggestive of LB, confirmed by serological tests and/or PCR positivity for Borrelia detection. In addition, data also included the place of residence (town and region) and the place where patients became infected. During the observation period, 1,260 cases were gathered from the participating centers. Although different in extent from northern Italy to central/southern Italy, this study shows that LB is widespread throughout Italy., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Trevisan, Ruscio, Cinco, Nan, Forgione, Di Meo, Tranchini, Nacca, Trincone, Rimoldi, Giacomet, Ricci, Melandri, Artioli, Monteforte, Stinco and Bonin.)

Purpose of Review: Skin rashes seen during COVID-19 usually feature maculopapular or vesicular morphology, thus mimicking cutaneous eruptions occurring in other common infectious dermatoses, such as mononucleosis, chickenpox, sixth disease and measles, with possible diagnostic mistakes. In this review article, we sought to provide a practical overview about clinical appearance of skin rashes related to SARS-CoV-2 infection., Recent Findings: The study summarizes literature evidence on clinical patterns of COVID-19-associated maculopapular or vesicular rash, with a particular emphasis on the principal points of differentiation with possible mimickers., Summary: Several differences do exist between rashes due to SARS-CoV-2 infection and other viral eruptions, mainly including lesions morphology, spreading pattern, symptoms and mucosal involvement. The increase of awareness of such features among clinicians may help promptly recognize COVID-19-related exanthemas in order to take proper action to manage the infection., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)

Background: Since the COVID-19 pandemic started, great interest has been given to this disease, especially to its possible clinical presentations. Besides classical respiratory symptoms, dermatological manifestations occur quite often among infected and non-infected patients, particularly in children. A prominent IFN-I response, that is generally higher in children compared to adults, may not only cause chilblain lesions, but it could also prevent infection and viral replication, thus justifying the negative swab results, as well as the absence of relevant systemic symptoms in positive cases. Indeed, reports have emerged describing chilblain-like acral lesions in children and adolescents with either proven or suspected infection., Methods: Patients aged from 1 to 18 years old were enrolled in this study from 23 Italian dermatological units and were observed for an overall period of 6 months. Clinical pictures were collected along with data on the location and duration of skin lesions, their association with concomitant local and systemic symptoms, presence of nail and/or mucosal involvement, as well as histological, laboratory and imaging findings., Results: One hundred thirty-seven patients were included, of whom 56.9% were females. Mean age was 11.97±3.66 years. The most commonly affected sites were the feet (77 patients, 56.2%). Lesions (48.5%) featured cyanosis, chilblains, blisters, ecchymosis, bullae, erythema, edema, and papules. Concomitant skin manifestations included maculo-papular rashes (30%), unspecified rashes (25%), vesicular rashes (20%), erythema multiforme (10%), urticaria (10%) and erythema with desquamation (5%). Forty-one patients (29.9%) reported pruritus as the main symptom associated with chilblains, and 56 out of 137 patients also reported systemic symptoms such as respiratory symptoms (33.9%), fever (28%), intestinal (27%), headache (5.5%), asthenia (3.5%), and joint pain (2%). Associated comorbid conditions were observed in 9 patients presenting with skin lesions. Nasopharyngeal swabs turned out positive in 11 patients (8%), whereas the remainder were either negative (101, 73%) or unspecified (25, 18%)., Conclusions: COVID-19 has been credited as the etiology of the recent increase in acro-ischemic lesions. The present study provides a description of pediatric cutaneous manifestations deemed to be potentially associated with COVID-19, revealing a possible association between acral cyanosis and nasopharyngeal swab positivity in children and teenagers. The identification and characterization of newly recognized patterns of skin involvement may aid physicians in diagnosing cases of asymptomatic or pauci-symptomatic COVID patients.