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As Sarcoptes scabiei is becoming less sensitive to permethrin, clinicians have started to prescribe oral ivermectin (OI) as a first-line treatment. Guidelines suggest OI 200 µg kg-1 as two doses, 1 week apart. However, the black box of the ivermectin registered in Italy recommends a single dose. To compare these two regimens, we collected 71 cases of scabies and treated them according to this protocol [single-dose group (SDG)]. This population was compared to 68 patients who received two doses 1 week apart [double-dose group (DDG)]. Clearance of the disease was achieved in 98% of DDG patients. In the SDG, treatment was successful in only 58% of patients. This study confirms that the absence of a second intake of OI is one of the main predictors of treatment failure (P < 0.001), which may also increase the likelihood of emerging resistance in S. scabiei., Competing Interests: Conflict of interest: The authors declare that they have no conflicts of interest., (© The Author(s) 2022. Published by Oxford University Press on behalf of British Association of Dermatologists. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Background: As a consequence of the improvement in survival after solid organ transplantation, to visit transplant recipients with neoplastic and non-neoplastic skin disorders due to immunosuppressive treatment has become common for dermatologists., Methods: Our endpoints were: 1) to investigate the most common skin diseases in a population of transplant recipients; 2) their associations with the type of immunosuppressant or transplant received; and 3) to compare our single center 40-year experience with the literature data. We retrospectively analyzed the clinical details of the adult patients transplanted in the years 1974-2014, visited for consultation at the Unit of Dermatology of our hospital., Results: Pathologic conditions were observed in more than 3/4 of 812 adults during the follow-up (mean 12.1 years): nonmelanoma skin cancers or actinic keratoses were seen in 44.0% (N.=357) of patients, non-neoplastic events in 55.2% (N.=448). Heart transplant had the statistically significant highest rate of NMSC and AK (52.6%, P=0.0352). Patients receiving cyclosporine A developed at least one non-melanoma skin cancer or actinic keratosis in 57.7% of cases (P=0.0001), while tacrolimus showed a lower risk (33%, P=0.0001)., Conclusions: As transplant recipients are susceptible to skin changes, especially after immunosuppressant treatments, a dermatological follow-up should be scheduled for each patient.

Background: Atypical lentiginous melanocytic nevi (ALMNs) are atypical pigmented lesions with histopathological features similar to those of dysplastic nevi, with a lentiginous pattern. Variable histopathological features of ALMNs were observed in our practice., Methods: We described the histopathological features of ALMNs diagnosed in the period 2009-2015. Our cases were divided into 2 groups: Group 1: ALMNs showing the same histopathological features as previously described in the literature; Group 2: ALMNs with different features., Results: Twenty-nine ALMNs were diagnosed; 2 groups of ALMNs were identified. Group 1 ALMNs showed a constant, mild epidermal acanthosis; frequently, an inflammatory infiltrate and dermal fibrosis, cytological atypia and mild architectural atypia. Group 2 ALMNs showed a constant psoriasis-like acanthosis with a hypercellularity of the rete ridges; cytological atypia was rare, whereas architectural atypia was constantly observed. Immunohistochemistry (MART-1 staining) revealed that the melanocytes were localized at the dermo-epidermal junction in both groups. ALMNs showed a broad spectrum of histopathological features., Conclusions: Our main finding was a constant architectural atypia in all lesions of Group 2. The identification of a unique type of ALMN seems no longer possible. The correct recognition of such benign, though atypical, melanocytic lesions is important in order to avoid an overdiagnosis of cutaneous melanoma and to prevent their potential evolution to the latter.

Background: The clinical-epidemiological characteristics and course of bullous pemphigoid in the general population is not clear. Few studies have been performed to date, and only one in the Italian population more than ten years ago. We decided to evaluate the characteristics and outcome of patients admitted for a bullous pemphigoid at our Hospital in the last 4 years., Methods: We retrospectively reviewed the last 4 years' medical records of the Department of Dermatology of the University of Bologna, identifying all patients with histological and immunological data typical for bullous pemphigoid. The patients were contacted and, whenever possible, re-evaluated clinically and serologically. Finally, we made a reviews of therapies administered in these cases., Results: We identified 53 patients with a diagnosis of sub-epidermal autoimmune blistering disease. At re-evaluation, resolution of the disease was observed in 13 cases (24.52%) while the disease persisted in 32 cases. An improvement was observed in 35 (66.03%) patients, a worsening was observed in 3 (5.66%) patients, while the class did not change in 5 (9.43%) patients. All patients received systemic steroids as first line therapy, although most patients underwent more than one therapy. Fifteen patients received systemic steroid therapy alone, 22 patients received azathioprin, 16 patients received methotrexate, all patients received a prescription of topical steroid. Twenty-eight patients had abnormal values of eosinophilia, extremely susceptible to systemic steroid therapy., Conclusions: The findings of our study differ slightly from data collected by other authors in literature. Methotrexate is the drug of choice in terms of efficacy, practicality, cost and tolerability, particularly in the elderly population.

Background: Photodynamic therapy (PDT) is a well-known and effective treatment for non-melanoma skin-cancer. Numerous studies have also shown its effectiveness in mycosis fungoides. The aim of the study was to analyse MF patients treated with PDT at the Dermatology Unit of Bologna University., Methods: We retrospectively analysed MF patients treated with PDT over the last ten years. Each PDT protocol consisted of the appliance for 3h under an occlusive film dressing on each lesion of a one-mm-thick layer of 16% methyl aminolaevulinate (MAL) 160mg/g cream (Metvix ® , Galderma, Paris, France). The cream was then removed and the skin was exposed to 630nm red light from a diode lamp (Aktilite ® , Galderma Benelux, Rotterdam, the Netherlands), with a total radiation dose of 37J/cm2 for 9 mins. A protocol of one session every month was scheduled. The treated lesions were clinically examined, before each treatment., Results: Four cases, three male and one female, had been treated with PDT. Two patch lesions on the plantar area, one leg and the pubic area were treated. The number of PDT sessions ranged from 4 to 9. Two complete remissions and two partial remissions were observed. A low-to-mild burning sensation was reported during the treatment, and persisted over the next day; no further side effects were observed., Conclusions: Our series shows that PDT can be considered an effective second-line treatment in patients characterised by a disease located in difficult-to-treat anatomical areas such as the feet and the pubic area., (Copyright © 2017 Elsevier B.V. All rights reserved.)

Pruritic papular eruption (PPE) is a skin disease characterized by the eruption of itching papules on the extremities, face, and trunk; it is quite frequent in HIV-positive patients especially during the advanced immunosuppressive stage. PPE usually improves or heals when antiretroviral therapy restores the immune system function, but in some cases, it can take several months, and a symptomatic treatment for PPE is required. Systemic antihistamines, topical steroids, topical tacrolimus, itraconazole, pentoxyphilline, and ultraviolet B phototherapy have been proposed in cases of persisting PPE, but an elective treatment has not yet been found. We describe the case of a black patient affected by PPE, nonimproving with antiretroviral treatment, and resistant to topical steroids and oral antihistamines; a satisfactory and speedy result was achieved with narrow-band ultraviolet B phototherapy., (© 2013 Wiley Periodicals, Inc.)

Aim: Superficial acral fibromyxoma (SAFM) is a rare soft tissue tumor, recently delineated and documentated as a separate entity. We report 12 cases of SAFM observed in our department from June 2004 to June 2010 and highlight pathological features and differential diagnosis., Methods: Radiographic examination of the affected digit was performed in all patients. All the tumors were surgically excised under local anesthesia. Follow-up was made every 6-8 months for a maximum period of five years., Results: The patients consisted of 8 men and 4 women, age range 28-76 years (mean 51), presenting with a solitary mass or nodule located in the toes and fingers. Histologically the lesions were well circumscribed dermal nodules composed of stellate and spindle cells, arranged in a myxoid matrix. Very low grade atypia and a few mitotic figures were found in only one case. Neoplastic cells showed immunoreactivity for CD34 (12 patients). In contrast focally positive or negative staining was shown for the epithelial membrane antigen (EMA) and CD 99. Actin, S100 protein, HMB45 and cytokeratin were negative. In three cases marked hyperkeratosis and acanthosis of the epidermis was present. Pathological analysis confirmed the diagnosis of superficial acral fibromyxoma. No recurrences were observed even in a long term, 2-5 year follow-up., Conclusion: Complete surgical excision of the tumors and a careful follow-up is suggested, despite the benign course previously reported.

Chloracne, first described by Herxheimer in 1899, is a dermatosis consisting of more or less diffuse acneiform lesions distributed prevalently on the face and on body areas not usually affected by acne and caused by chronic or acute exposure to halogenated chemical compounds. Dioxin is the common name for dibenzo-p-dioxins and dibenzofurans, contaminants nearly ubiquitous in the environment and highly resistant to chemical and biological degradation. These compounds can survive for decades in the environment and accumulate in the human and animal food chains. Chloracne is characterized by the onset of numerous comedo-like lesions and yellowish cysts on the face, particularly on the cheeks, that can spread to the trunk and other body regions not usually affected by acne vulgaris, with diffuse grayish skin pigmentation and sometimes associated with hypertrichosis and areas of folliculitis. The lesions may occasionally be accompanied by skin or systemic manifestations. We report 9 cases of chloracne, 8 of them with rapid onset in patients residing in the same building, and 1 in a patient occupationally exposed to halogenated compounds. In our series, the doses of dioxin and polychlorinated biphenyls in the soil, water and plant material, and the serum titer of dioxin were within the normal range. This consideration raises the issue of the need to revise the serum threshold for dioxin poisoning and the environmental threshold. We wish also to underline the value of dermatopathology in the differential diagnosis of chloracne., (Copyright 2010 S. Karger AG, Basel.)

Background: Ulcerous rectocolitis and Crohn's disease are the best known forms of inflammatory bowel disease (IBD). Skin manifestations are not uncommon in IBD and may be divided into specific cutaneous signs, aspecific cutaneous signs, and cutaneous signs caused by drugs used for IBD therapy. The specific signs (fistulas, rhagades and ulcers) are the result of the diffusion of the intestinal inflammatory process into the skin. Aspecific cutaneous signs (stomatic aphthosis, erythema nodosum, pyoderma gangrenosum, Sweet's syndrome, vasculitis, bullous diseases) are quite frequently found in those suffering from IBD, but also in apparently healthy subjects, and may sometimes be the first sign of the intestinal disease. Cutaneous manifestations due to drugs vary in clinical aspect and are the direct consequence of the therapies adopted, which in IBD patients can be quite numerous: steroids, immunosuppressants, 5-aminosalicylic acid, biological agents, antibiotics., Objective and Methods: Due to the frequent finding of cutaneous manifestations in patients affected by IBD, a collaboration was set up between the Dermatological Clinic of the University of Bologna and the Center for the Study of IBD of the same university hospital. The aim was to diagnose the cutaneous signs appearing during IBD and to establish their etiopathogenesis in order to assess whether they were the result of epiphenomena of the IBD or side effects of the therapies adopted., Results: The cutaneous manifestations we observed can be divided into three distinct groups: signs that were specific to the basic disease, aspecific signs and finally signs attributable to the drugs used for therapy. Particular attention was given to the aspecific signs and those consequential to therapy. The aspecific cutaneous signs seen in our clinic generally reflect those reported in the literature. The cutaneous manifestations due to drugs were further divided into three groups: rosacea, acneiform dermatitis and psoriasis-like dermatitis. The most notable aspect of our series is the high number of patients presenting psoriasiform-type dermatitides with a generally widespread diffusion., Conclusion: We would like to draw attention to the fact that all patients with psoriasis had been undergoing treatment with drugs inhibiting tumor necrosis factor alpha (TNF-alpha) as part of IBD therapy. In all cases, the cutaneous reaction started after the third or fourth infusion of the biological drug. Anti-TNF-alpha agents have also been successfully used to treat psoriasis in the last few years. The reason for this apparently paradoxical effect of the therapy is still unclear., (2007 S. Karger AG, Basel)