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4. Management of patients with atopic dermatitis undergoing systemic therapy during COVID-19 pandemic in Italy: Data from the DA-COVID-19 registry

Author

Chiricozzi, Andrea, Talamonti, Marina, De Simone, Clara, Galluzzo, Marco, Gori, Niccolò, Fabbrocini, Gabriella, Marzano, Angelo Valerio, Girolomoni, Giampiero, Offidani, Annamaria, Rossi, Maria Teresa, Bianchi, Luca, Cristaudo, Antonio, Fierro, Maria Teresa, Stingeni, Luca, Pellacani, Giovanni, Argenziano, Giuseppe, Patrizi, Annalisa, Pigatto, Paolo, Romanelli, Marco, Savoia, Paola, Rubegni, Pietro, Foti, Caterina, Milanesi, Nicola, Belloni Fortina, Anna, Bongiorno, Maria Rita, Grieco, Teresa, Di Nuzzo, Sergio, Fargnoli, Maria Concetta, Carugno, Andrea, Motolese, Alberico, Rongioletti, Franco, Amerio, Paolo, Balestri, Riccardo, Potenza, Concetta, Micali, Giuseppe, Patruno, Cataldo, Zalaudek, Iris, Lombardo, Maurizio, Feliciani, Claudio, Di Nardo, Lucia, Guarneri, Fabrizio, Peris, Ketty, Caldarola, Giacomo, Silvaggio, Dionisio, Dattola, Annunziata, Napolitano, Maddalena, Ferrucci, Silvia Mariel, Dal Bello, Giacomo, Bianchelli, Tommaso, Rovati, Chiara, Pigliacelli, Flavia, Ortoncelli, Michela, Hansel, Katharina, Calabrese, Giulia, Loi, Camilla, Iannone, Michela, Veronese, Federica, Romita, Paolo, Tronconi, Greta, Caroppo, Francesca, Tilotta, Giovanna, Sernicola, Alvise, Esposito, Maria, Raponi, Francesca, Gualdi, Giulio, Rech, Giulia, Musumeci, Maria Letizia, Nisticò, Steven Paul, Campitiello, Alessio, Bonzano, Laura, Piras, Viviana, Chiricozzi, A., Talamonti, M., De Simone, C., Galluzzo, M., Gori, N., Fabbrocini, G., Marzano, A. V., Girolomoni, G., Offidani, A., Rossi, M. T., Bianchi, L., Cristaudo, A., Fierro, M. T., Stingeni, L., Pellacani, G., Argenziano, G., Patrizi, A., Pigatto, P., Romanelli, M., Savoia, P., Rubegni, P., Foti, C., Milanesi, N., Belloni Fortina, A., Bongiorno, M. R., Grieco, T., Di Nuzzo, S., Fargnoli, M. C., Carugno, A., Motolese, A., Rongioletti, F., Amerio, P., Balestri, R., Potenza, C., Micali, G., Patruno, C., Zalaudek, I., Lombardo, M., Feliciani, C., Di Nardo, L., Guarneri, F., Peris, K., Caldarola, G., Silvaggio, D., Dattola, A., Napolitano, M., Ferrucci, S. M., Dal Bello, G., Bianchelli, T., Rovati, C., Pigliacelli, F., Ortoncelli, M., Hansel, K., Calabrese, G., Loi, C., Iannone, M., Veronese, F., Romita, P., Tronconi, G., Caroppo, F., Tilotta, G., Sernicola, A., Esposito, M., Raponi, F., Gualdi, G., Rech, G., Musumeci, M. L., Nistico, S. P., Campitiello, A., Bonzano, L., Piras, V., Chiricozzi, Andrea, Talamonti, Marina, De Simone, Clara, Galluzzo, Marco, Gori, Niccolò, Fabbrocini, Gabriella, Marzano, Angelo Valerio, Girolomoni, Giampiero, Offidani, Annamaria, Rossi, Maria Teresa, Bianchi, Luca, Cristaudo, Antonio, Fierro, Maria Teresa, Stingeni, Luca, Pellacani, Giovanni, Argenziano, Giuseppe, Patrizi, Annalisa, Pigatto, Paolo, Romanelli, Marco, Savoia, Paola, Rubegni, Pietro, Foti, Caterina, Milanesi, Nicola, Belloni Fortina, Anna, Bongiorno, Maria Rita, Grieco, Teresa, Di Nuzzo, Sergio, Fargnoli, Maria Concetta, Carugno, Andrea, Motolese, Alberico, Rongioletti, Franco, Amerio, Paolo, Balestri, Riccardo, Potenza, Concetta, Micali, Giuseppe, Patruno, Cataldo, Zalaudek, Iri, Lombardo, Maurizio, Feliciani, Claudio, Di Nardo, Lucia, Guarneri, Fabrizio, Peris, Ketty, Caldarola, Giacomo, Silvaggio, Dionisio, Dattola, Annunziata, Napolitano, Maddalena, Ferrucci, Silvia Mariel, Dal Bello, Giacomo, Bianchelli, Tommaso, Rovati, Chiara, Pigliacelli, Flavia, Ortoncelli, Michela, Hansel, Katharina, Calabrese, Giulia, Loi, Camilla, Iannone, Michela, Veronese, Federica, Romita, Paolo, Tronconi, Greta, Caroppo, Francesca, Tilotta, Giovanna, Sernicola, Alvise, Esposito, Maria, Raponi, Francesca, Gualdi, Giulio, Rech, Giulia, Musumeci, Maria Letizia, Nisticò, Steven Paul, Campitiello, Alessio, Bonzano, Laura, Piras, Viviana, Chiricozzi, A, Talamonti, M, De Simone, C, Galluzzo, M, Gori, N, Fabbrocini, G, Marzano, A, Girolomoni, G, Offidani, A, Rossi, M, Bianchi, L, Cristaudo, A, Fierro, M, Stingeni, L, Pellacani, G, Argenziano, G, Patrizi, A, Pigatto, P, Romanelli, M, Savoia, P, Rubegni, P, Foti, C, Milanesi, N, Belloni Fortina, A, Bongiorno, M, Grieco, T, Di Nuzzo, S, Fargnoli, M, Carugno, A, Motolese, A, Rongioletti, F, Amerio, P, Balestri, R, Potenza, C, Micali, G, Patruno, C, Zalaudek, I, Lombardo, M, Feliciani, C, Di Nardo, L, Guarneri, F, Peris, K, Caldarola, G, Silvaggio, D, Dattola, A, Napolitano, M, Ferrucci, S, Dal Bello, G, Bianchelli, T, Rovati, C, Pigliacelli, F, Ortoncelli, M, Hansel, K, Calabrese, G, Loi, C, Iannone, M, Veronese, F, Romita, P, Tronconi, G, Caroppo, F, Tilotta, G, Sernicola, A, Esposito, M, Raponi, F, Gualdi, G, Rech, G, Musumeci, M, Nistico, S, Campitiello, A, Bonzano, L, and Piras, V

Subjects
Registrie, 0301 basic medicine, Dermatitis, Systemic therapy, 0302 clinical medicine, Pandemic, Immunology and Allergy, Medicine, Registries, atopic dermatitis, COVID, SARS‐ CoV, treatment, SARS-CoV, Atopic dermatitis, Dupilumab, Italy, Original Article, Settore MED/35 - MALATTIE CUTANEE E VENEREE, Human, atopic dermatiti, Adult, medicine.medical_specialty, Teledermatology, SARS‐CoV, atopic dermatitis, treatment, Coronavirus disease 2019 (COVID-19), Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), Immunology, Communicable Disease Control, Humans, Pandemics, SARS-CoV-2, COVID-19, Dermatitis, Atopic, Atopic, 03 medical and health sciences, Settore MED/35, Disease severity, Internal medicine, business.industry, medicine.disease, 030104 developmental biology, 030228 respiratory system, atopic dermatitis, COVID, SARS-CoV, business
Abstract

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., Among 1831 studied AD patients, 86.1% were treated with dupilumab. Patients continuing therapy experienced a marked reduction of disease severity during pandemic. The causes of treatment interruption included: fear of increased susceptibility to SARS‐CoV‐2 infection (24.8%), occurrence of comorbidities (5.9%), age above 60 years (5.2%), SARS‐CoV‐2 infection (2.8%), close contact with SARS‐CoV‐2‐positive subject (2.4%), other reasons, for example, inability to maintain drug supply, non‐medical/unspecified causes (58.7%).

Published
2021

10. Sunlight-induced Painful Skin (Sun Pain): A New Differential Diagnosis in Photodermatology.

Author

CALZAVARA-PINTON, Piergiacomo, VENTURINI, Marina, ROVATI, Chiara, ARISI, Mariachiara, CALZAVARA-PINTON, Irene, RINALDI, Fabrizio, and ROSSI, Maria Teresa

Subjects
ULTRAVIOLET radiation, VISIBLE spectra, DIFFERENTIAL diagnosis, SKIN cancer, MENTAL depression, FIBROMYALGIA, PATIENTS' attitudes
Abstract

Photodermatoses are characterized by the development of skin eruptions following exposure to ultraviolet radiation or visible light. We report here the clinical findings and results of laboratory investigations and phototesting of 6 patients who experience debilitating and excruciating pain after sun exposure ("sun pain") in the absence of any skin eruption. Phototesting with sub-erythemal doses of ultraviolet A radiation triggered localized pain in 4 patients. At follow-up, 3 female patients were found to have developed fibromyalgia, 2 male patients experienced a major depressive disorder, and another male patient had a conversion disorder. One patient also developed allodynia to tactile stimuli and one developed allodynia to thermal and tactile stimuli. Psychiatric conditions should be taken into consideration in patients presenting with excruciating and debilitating pain on exposure to ultraviolet radiation, but with absence of skin eruption. Further research is needed to evaluate whether it represents a type of allodynia triggered by exposure to ultraviolet radiation. [ABSTRACT FROM AUTHOR]

Published
2021
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12. A Critical Reappraisal of Off-Label Use of Photodynamic Therapy for the Treatment of Non-Neoplastic Skin Conditions.

Author

Monfrecola, Giuseppe, Megna, Matteo, Rovati, Chiara, Arisi, Mariachiara, Rossi, Mariateresa, Calzavara-Pinton, Irene, Fabbrocini, Gabriella, and Calzavara-Pinton, Piergiacomo

Subjects
PHOTODYNAMIC therapy, OFF-label use (Drugs), MEDICAL personnel, LIGHT sources, CLINICAL trials, ACTINIC keratosis
Abstract

Background: In the past 30 years, topical photodynamic therapy (PDT) has been investigated for the treatment of a broad spectrum of cosmetic, inflammatory, and infectious skin conditions with variable, and often contrasting, results. However, the non-expert clinician may be in difficulty evaluating these results because different sensitizers, concentrations, formulations, light sources, and irradiation protocols have been used. In addition, many of these studies have poor quality design being case reports and uncontrolled studies of few cases. Summary: With the aim to clarify the potential usefulness of PDT for the treatment of infectious and inflammatory skin diseases as well as selected cosmetic indications, we searched for randomized controlled clinical trials, non-randomized comparative studies, retrospective studies, and case series studies with a number of at least 10 patients, published since 1990. Later, we reappraised the results in order to give a simple critical overview. Key Messages: Evidence from the literature seems to strongly support the use of ALA- and MAL-PDT for the treatment of common skin diseases such as acne, warts, condylomata, and Leishmania skin infection and for photorejuvenation, i.e., the correction of selected cosmetic changes of aging and photoaging. For other disorders, the level of evidence and strength of recommendation are lower, and controlled randomized studies with prolonged follow-ups are necessary in order to assess the clinical usefulness and other potential advantages over current treatment options. [ABSTRACT FROM AUTHOR]

Published
2021
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13. Application of the 2017 criteria for vascular Ehlers‐Danlos syndrome in 50 patients ascertained according to the Villefranche nosology.

Author

Ritelli, Marco, Rovati, Chiara, Venturini, Marina, Chiarelli, Nicola, Cinquina, Valeria, Castori, Marco, and Colombi, Marina

Subjects
*EHLERS-Danlos syndrome, *PATIENT selection, *CONNECTIVE tissues, *NOSOLOGY, *GENETIC testing
Abstract

Vascular Ehlers‐Danlos syndrome (vEDS) is a rare inherited connective tissue disorder due to heterozygous pathogenic COL3A1 variants. Arterial, intestinal, and/or uterine fragility is the disease hallmark and results in reduced life expectancy. The clinical diagnosis is not always straightforward and patients' selection for molecular confirmation depends on the characteristics of applied criteria, that is, the Villefranche criteria (in use until 2017) and their revision according to the new EDS nosology. Herein, we reassessed the clinical features of 50 molecularly proven vEDS patients, diagnosed according to the Villefranche nosology between 2000 and 2016, using the 2017 classification in order to explore its clinical application. Our findings indicate that the Villefranche criteria were particularly valuable for symptomatic patients, even if with a limited specificity. Our study also suggests that the revised vEDS criteria, although expected to be more specific, might have a poorer accuracy, principally in terms of sensitivity. Both sets of criteria are less effective in presymptomatic young patients, especially in the absence of a clear‐cut family history. For these patients, the careful evaluation of the cutaneous, articular, and dysmorphic features and, above all, genetic testing remain crucial to set‐up proper follow‐up and surveillance before catastrophic vascular and intestinal events. [ABSTRACT FROM AUTHOR]

Published
2020
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16. Arquitectura sagrada en Burundi

Author

Leoni, Luigi, Rovati, Chiara, Leoni, Luigi, and Rovati, Chiara

Abstract

[Resumen] Una iglesia debe tener el rostro y el corazón de la tierra y del pueblo en el que se destaca. Para proyectar los espacios para el culto, es importante sumergirnos en la vida de las personas, compartir sus visiones y verdaderas aspiraciones y conocer el lenguaje de sus corazones a través de la observación de la naturaleza. La experiencia en África nos ha sugerido la expoliación de cualquier perjuicio para dar la bienvenida a la novedad de un mundo virgen, capaz de inspirar, en su simplicidad, la formas más esenciales y verdaderas, sin artificios y reminiscencias de otros mundos.

17. Arquitectura sagrada en Burundi

Author

Leoni, Luigi, Rovati, Chiara, Leoni, Luigi, and Rovati, Chiara

Abstract

[Resumen] Una iglesia debe tener el rostro y el corazón de la tierra y del pueblo en el que se destaca. Para proyectar los espacios para el culto, es importante sumergirnos en la vida de las personas, compartir sus visiones y verdaderas aspiraciones y conocer el lenguaje de sus corazones a través de la observación de la naturaleza. La experiencia en África nos ha sugerido la expoliación de cualquier perjuicio para dar la bienvenida a la novedad de un mundo virgen, capaz de inspirar, en su simplicidad, la formas más esenciales y verdaderas, sin artificios y reminiscencias de otros mundos.

18. A Critical Reappraisal of Off-Label Use of Photodynamic Therapy for the Treatment of Non-Neoplastic Skin Conditions

Author

Irene Calzavara-Pinton, Mariachiara Arisi, Piergiacomo Calzavara-Pinton, Matteo Megna, Chiara Rovati, Giuseppe Monfrecola, Gabriella Fabbrocini, Mariateresa Rossi, Monfrecola, Giuseppe, Megna, Matteo, Rovati, Chiara, Arisi, Mariachiara, Rossi, Mariateresa, Calzavara-Pinton, Irene, Fabbrocini, Gabriella, and Calzavara-Pinton, Piergiacomo

Subjects
medicine.medical_specialty, Photoaging, medicine.medical_treatment, Photodynamic therapy (PDT), Photodynamic therapy, Dermatology, Cosmetic Techniques, Skin infection, Skin Diseases, Non-neoplastic conditions, 030207 dermatology & venereal diseases, 03 medical and health sciences, 0302 clinical medicine, Acne Vulgaris, Medicine, Humans, Rejuvenation, Off-label PDT, Skin Diseases, Infectious, Acne, Photosensitizing Agents, Photorejuvenation, business.industry, Retrospective cohort study, Evidence-based medicine, Aminolevulinic Acid, Off-Label Use, medicine.disease, Non-neoplastic condition, Clinical trial, Lichen Sclerosus et Atrophicus, Photochemotherapy, 030220 oncology & carcinogenesis, business
Abstract

Background: In the past 30 years, topical photodynamic therapy (PDT) has been investigated for the treatment of a broad spectrum of cosmetic, inflammatory, and infectious skin conditions with variable, and often contrasting, results. However, the non-expert clinician may be in difficulty evaluating these results because different sensitizers, concentrations, formulations, light sources, and irradiation protocols have been used. In addition, many of these studies have poor quality design being case reports and uncontrolled studies of few cases. Summary: With the aim to clarify the potential usefulness of PDT for the treatment of infectious and inflammatory skin diseases as well as selected cosmetic indications, we searched for randomized controlled clinical trials, non-randomized comparative studies, retrospective studies, and case series studies with a number of at least 10 patients, published since 1990. Later, we reappraised the results in order to give a simple critical overview. Key Messages: Evidence from the literature seems to strongly support the use of ALA- and MAL-PDT for the treatment of common skin diseases such as acne, warts, condylomata, and Leishmania skin infection and for photorejuvenation, i.e., the correction of selected cosmetic changes of aging and photoaging. For other disorders, the level of evidence and strength of recommendation are lower, and controlled randomized studies with prolonged follow-ups are necessary in order to assess the clinical usefulness and other potential advantages over current treatment options.

Published
2021

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