Search

Caterina Fabroni,1 Angelo Massimiliano D’Erme,2 Torello Lotti3 1Department of Dermatology, Misericordia e Dolce Hospital, Prato, Italy; 2Division of Dermatology, Department of Surgery and Translational Medicine, University of Florence, Florence, Italy; 3Guglielmo Marconi University, Rome, Italy Abstract: Psoriasis is an inflammatory dermatologic disease that can often involve not only the skin and mucosal surfaces but also the bones and joints. It affects approximately 3% of the world’s population, and has a chronic-relapsing course. The management of psoriasis is often difficult and, particularly in the case of moderate to severe forms, the use of systemic therapies is mandatory. The introduction of biologic drugs has greatly improved our ability to treat psoriasis. However, it is necessary to underline that antitumor necrosis factor-α treatments may reactivate latent tuberculosis infection and cause particularly disseminated or extrapulmonary disease. Physicians should carry out proper screening of patients before starting treatment with antitumor necrosis factor-α, in order to identify individuals with latent tuberculosis infection. We report our experience in this field and review the various existing tests to screen for tuberculosis. Keywords: infliximab, adalimumab, tuberculosis, psoriasis

A letter to the editor is presented regarding annular lichenoid dermatitis of youth (ALDY).

The last decades were characterized by a worldwide increasing incidence in melanoma. Almost 35% of diagnosed with melanoma women are in childbearing age. Malignant melanoma is the most common malignancy during pregnancy. Considering this background it is clear how melanoma and pregnancy has becoming one of the main topic of discussion. Current knowledge about pregnancy and melanoma is characterized by many controversies and divergences. The real incidence of melanoma in childbearing and the impact of pregnancy on the prognosis of melanoma is still unclear. There are many uncertainties regarding other aspects of women with melanoma during childbearing, such as the changing in moles, the prognosis and the management. Every changing nevus that would raise concern for malignancy in a pregnant patient should be investigated and surgery should be performed safely using local anesthetic. Pregnancy can affect the staging and treatment of melanoma especially in advanced stage, the decision about introduction or continuation of treatment in the event of pregnancy should be preceded by an analysis of the potential benefits and risks. The role of hormonal changes during pregnancy on melanoma is continually debated. At present, there is a lack of a European guideline on this topic and this review aims to address the most controversial issues such as the roles of hormones, staging and therapeutic difficulties of melanoma during pregnancy. The authors' aim is to help the clinician in the difficult decision-making process concerning the woman suffering from melanoma and her child.

Objectives: The aim of this study was to evaluate the clinical and epidemiological profile of hair and scalp disorders in children referred to the Pediatric Dermatology Outpatient Clinic., Materials and Methods: We performed a retrospective study of children with hair loss problems or scalp diseases who turned to the Pediatric Dermatology Service, Anna Meyer Pediatric Hospital, Florence, Italy, from January 1, 2009, to December 31, 2009. Demographics, personal and familial medical history, laboratory tests, clinical examination, final diagnosis and therapeutic interventions were obtained from the manual chart review., Results: Of the 2,640 children who had access to the Pediatric Dermatology Service, 190 (7.19%) had a hair or scalp disorder. Among the 190 children, 60 (31.57%) presented with nonscarring alopecia, 56 (29.47%) had benign neoplasias, hamartomas or vascular malformations of the scalp, 51 (26.84%) had scalp inflammatory diseases, 14 (7.36%) had scarring alopecia, 5 (2.63%) had infections and 2 (1.05%) had infestation of the scalp. A case of constitutional hypertrichosis (0.52%) and also a case (0.52%) of lamellar ichthyosis were diagnosed., Conclusions: Our results underline that hair and scalp diseases represent an important percentage of admittances to a dermatological pediatric outpatient clinic. The variety and complexity of the diseases observed in this study included diseases commonly found also in adulthood., (© 2015 S. Karger AG, Basel.)

Tripe palms (TP) is a rare dermatologic condition. TP alone, or associated with malignant acanthosis nigricans (MAN), in most cases is a cutaneous paraneoplastic disorder and its recognition should prompt a full diagnostic work-up for an underlying malignancy. We report a case of a patient in whom the correct identification of TP and MAN has allowed early diagnosis of gastric cancer. Paraneoplasias are frequently the first sign of an underlying malignant tumor. Although relatively rare, they need to be recognized by dermatologists to make an early diagnosis and improve the prognosis related to the neoplasia.

The antitumor necrosis factor (TNF-alpha) drugs are increasingly used in treating skin diseases such as psoriasis. TNF-alpha is a proinflammatory cytokine with a key role in the pathogenesis of psoriasis but also in host defence against bacterial pathogens, especially against those that multiply inside host cells. The effectiveness of anti-TNF-alpha in the treatment of psoriasis is now widely recognized and has led to their increasingly wide use. Although these drugs are considered relatively safe, their use is associated with an increased incidence of serious infections even in patients treated. Have been described above numerous cases of tuberculosis but has also observed an increased incidence of granulomatous infections by intracellular bacteria such as Legionella pneumophila required. Infections due to this biotic agent, if not diagnosed early, are potentially fatal. We report the case of a patient, heavy smoker, suffering from severe skin psoriasis who after starting treatment with infliximab developed a pneumonia caused by Legionella pneumophila. Our aim is to draw the attention of specialists on increasing risk of granulomatous infections by intracellular agents in patients being treated with anti TNF-alpha.

Infliximab is an anti-TNFalpha chimeric monoclonal antibody, commonly used in the treatment of moderate to severe psoriasis. TNFalpha is a pro-inflammatory cytokine which play a key role in host defense from infections by intracellular bacteria, such as Listeria monocytogenes, Histoplasma Capsulatum and especially Mycobacterium Tuberculosis. Infliximab therapy increases the risk of tuberculosis due mainly to the reactivation of latent TB infection (LTBI) and, therefore, it is mandatory to screen patients for LTBI prior to starting a treatment with anti-TNFalpha agents. We report the case of a psoriatic patient, who, despite a negative screening for infection by M. tuberculosis including both tuberculin skin test (TST) and chest X-ray, developed after 4 months of infliximab treatment, a severe pulmonary, lymphnodal and intestinal tuberculosis during infliximab treatment.

Pimecrolimus is a non-steroidal immunosuppressant derived from ascomycin. This drug inhibits the action of calcineurin phosphatase and blocks the production of inflammatory substances that are thought to be important in causing skin lesions in inflammatory diseases. Pimecrolimus 1% cream (Elidel, Novartis Pharma, East Hanover, NJ, USA) was approved in the European Union, the United States and Japan as second-line therapy for the short- term and non-continuous chronic treatment of mild to moderate atopic dermatitis in non-immunocompromised adults and children aged 2 years and older, who have failed to respond adequately to other topical prescription treatments, or when those treatments are not advisable. This topical immunomodulator has also an enormous potential as topical treatment for numerous inflammatory skin diseases like psoriasis and vitiligo. Recently, some authors reported its efficacy in the treatment of skin manifestations of Lupus erytematosus.

Environmental mycobacteria are the causative factors of an increasing number of infections worldwide. Cutaneous infections as a result of environmental mycobacteria are often misdiagnosed, and their treatment is difficult because these agents can show in vivo and in vitro multidrug resistance. The most common environmental mycobacteria that can cause cutaneous infections are Mycobacterium fortuitum and Mycobacterium marinum. All mycobacteria are characterized by low pathogenicity and they can contaminate affected or traumatized skin only in immunocompetent subjects (mainly in fishermen, swimming-pool attendants, and aquarium owners) whereas medical and esthetic procedures are at risk for the infections because of the quick-growing mycobacteria. Immunocompromised subjects can instead easily develop environmental mycobacterial infections of differing degrees of severity.