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Background: Patients with multiple actinic keratoses (AKs) should be treated with field-directed therapy. Such treatments challenge patients’ adherence due to out-of-pocket costs, length of treatment and severity of local skin reactions (LSRs). Effective physician–patient communication (PPC) may buffer therapy-related distress, thus improving quality of life, treatment satisfaction and adherence. Objectives: We evaluated the interplay between PPC, LSR intensity (safety) and lesion clearance rates (effectiveness) on treatment satisfaction, quality of life and treatment adherence among patients with multiple AKs receiving topical field-directed therapies. Methods: In this observational, multicentre, longitudinal, cohort study, we included 1136 adult patients with discrete, clinically detectable, visible, multiple (three or more lesions in a 25cm2 area), Grade I/II AKs, for whom the attending dermatologist has prescribed treatment with a topical field-directed therapy. We matched self-reported data and medical information recorded by dermatologists in standard clinical forms. Patients were followed up at two time points (T1: 8days; T2: 25–30days). Results: Most patients were elderly, married, men with poor socio-economic status and multiple lesions of the scalp or face. The majority (n=961) had a prescription of ingenol mebutate (IMB) and 175 received either diclofenac 3% in hyaluronic acid (DHA) or imiquimod 5% (IMQ). Clearance rate at 1month was 84%. Most patients felt very supported (n=819, 73%) and rated dermatologist's explanations very clear (n=608, 54%). Treatment satisfaction (effectiveness and convenience scales) increased along the follow-up, especially for those on IMB (Δpre-post=−4.00; other: Δpre-post=−0.25; interaction P&nbsp

Scarring after a burn injury remains the greatest unmet challenge in the treatment of functional and psychosocial sequelae of burns. The hypertrophic scar represents the most common type of cicatrix after burns, and it has a prevalence of up to 70%. We present a case of upper and lower extremity partial-thickness burns in a female patient treated in two different modalities. Superficial seconddegree burns on the upper extremities were treated with conservative dressing with fairly early wound closure but they developed hypertrophic scars. Deeper, lower extremity burns were debrided with a new bromelain-based debriding agent, resulting in scar-free healing. The pathophysiology of hypertrophic scar formation is based on the perturbation of collagen production or degradation or both. The duration and magnitude of the inflammatory phase of wound healing also appears to play a role in hypertrophic scarring. Bromelain has demonstrated an anti-angiogenic effect in various cancer cell lines and it has been shown to regulate a variety of pro-angiogenic growth factors. This case raises the classical question of the relationship between time to healing and formation of hypertrophic scars after burn injury, pointing to other potential factors that may play an important role in burn healing.La cicatrisation après une brûlure reste le plus grand défi du traitement des séquelles à la fois sur le plan fonctionnel et sur le plan psychologique. La cicatrisation hypertrophique représente l’évolution la plus fréquente après brûlure et sa prévalence est supérieure à 70 %. Nous présentons une observation de brûlures du 2e degré au niveau du membre supérieur et du membre inférieur chez une patiente traitée suivant deux modalités différentes. Les brûlures du second degré superficiel du membre supérieur furent traitées par un pansement classique avec une cicatrisation précoce, mais suivie de cicatrices hypertrophiques. Les brûlures plus profondes du membre inférieur furent détergées avec le nouvel agent à base de bromelaïne, et permirent une guérison sans cicatrice. La physiopathologie de la cicatrisation hypertrophique est basée sur les troubles de production des fibres de collagène, ou de leur dégradation, ou des deux. La durée et l’amplitude de la phase inflammatoire de la cicatrisation paraît aussi jouer un rôle dans l’hypertrophie cicatricielle. La bromelaïne a démontré son effet anti-angiogénique dans plusieurs lignées cellulaires cancéreuses ; elle a montré aussi son aptitude à réguler les divers facteurs de croissance pro-angiogéniques. Cette observation soulève la question classique de la relation entre le temps de cicatrisation et l’apparition de cicatrices hypertrophiques après brûlure, en soulignant les autres facteurs potentiels jouant un rôle important dans la cicatrisation des brûlures.

Background: Non-occupational cases of contact dermatitis to finished wood are occasionally reported from contact with wooden jewellery, musical instruments, knife handles and wooden footwear. Two female patients, 26 and 34 years old, developed acute eczema on the wrists after they worn in the summer a kind of catholic bracelet called “memorabilia” made by single wooden chunks with over-impressed iconic religious images. Objectives: To identify the culprit photoallergen responsible for the reported adverse reactions suspected to be a compound of the wooden bracelets. Methods: Three months after the resolution of the dermatitis, patch test and photo-patch tests were performed with the S.I.D.A.P.A. (Italian Society of Allergic, Occupational and Environmental Dermatology) standard series, and with wood sawdust obtained from both bracelets and tested at 5% in pet. A thin-layer chromatogram (TLC) strip and an extract made from the bracelets were tested in both the patients as patch test and photo-patch test. The extracts of the wooden bracelets were analyzed by gas chromatography – mass spectrometry (GC-MS). Results: Patch tests and photo-patch test with standard series turned out negative. Photo-patch tests with wood sawdust in pet. 5% evidenced a positive reaction (++) in both patients. Two chemicals were detected in the wooden bracelets with GC-MS: dibutylphthalate, commonly used as plasticizer, and 8,8-dimethyl-2H,8H-benzo[1,2-b:3,4-b']dipyran-2-one, a coumarin. Patch test with TLC did not elicit positive reactions but the photo-patch test with TLC gave positive reactions in both the patients to the same invisible spot on the strips. Two coumarins (8,8-dimethyl-2H,8H-benzo[1,2-b:3,4-b']dipyran-2-one and 8,8-dimethyl-2H,8H-benzo[1,2-b:5,4-b']dipyran-2-one) were detected in the spot with GC-MS. Conclusion: Coumarins are chemicals found in many plants with a known photo-allergic potential. They are probably the main photo-allergens in religious wooden bracelets instead of quinones and psoralens hypothesized in previous reports.