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Objective: People affected by chronic skin conditions suffer from elevated levels of psychological distress. There is a need for evidence-based treatments that integrate medical care. Mindfulness and Self-compassion programs (MCBPs) have proven effective in chronic diseases. This systematic review aims to narratively synthesize the literature on mindfulness and self-compassion as traits and interventions in chronic skin conditions., Design: We searched four electronic databases for mindfulness and self-compassion trials and correlational studies in chronic skin conditions. We narratively synthetized results regarding the effects of mindfulness and self-compassion, both as traits and as interventions, on psychological and disease outcomes., Results: Thirteen studies were included in our review. Evidence from cross-sectional studies suggest that mindfulness and self-compassion are linked to lower psychological distress and better adjustment to the disease. MCBPs appear feasible for this population and can lower psychological distress, reduce disease severity and improve quality of life. Methodological issues limit conclusions on MCBP efficacy. Based on our analysis, we propose possible mechanisms that future research could explore., Conclusions: The integration of MCBPs in the care process of chronic skin conditions appears promising. Definitive conclusions cannot be drawn due to a lack of strong evidence. Further studies with high methodological standards are needed.

Background: Psoriasis is associated with comorbid psychiatric conditions. However, its relationship with suicidality is not completely understood. The aim of this study was to analyze the prevalence and the correlates of depressive symptoms and suicide risk in patients with psoriasis., Methods: Adult psoriatic patients referring to the Outpatient Service of the Sant'Orsola-Malpighi Polyclinic were enrolled. Depressive symptoms and suicidality were assessed using the Patient Health Questionnaire (PHQ-9) and section C of Mini-International Neuropsychiatric Interview (M.I.N.I. 5.0.0). Psoriasis was evaluated using the Psoriasis Area and Severity Index (PASI), Body Surface Area (BSA) and the Dermatology Life Quality Index (DLQI)., Results: The prevalence of depressive symptoms was 14.9% and that of suicidality 6.3%. PHQ-9 scores were higher in patients with moderate-to-severe psoriasis (PASI≥10, Mann-Whitney U Test=4014.5; P<0.001; BSA≥10, Mann-Whitney Test=3930.5; P<0.001) and poorer quality of life (Mann-Whitney Test=805.5; P=0.024). Moreover, PHQ-9 scores were higher in females (Mann-Whitney Test U=3612.5; P=0.008) and were unrelated to age (rs=-0.056, P=0.423). Conversely, suicide risk was significantly higher in younger patients (Mann-Whitney=744, P=0.013) and females (χ 2 =5.69, P=0.028), and was unrelated to psoriasis severity., Conclusions: Patients with moderate-to-severe psoriasis, especially females, should be screened for depression and suicidal ideation to support them with effective strategies to treat depressive symptoms.

A deeper understanding of how health-related quality of life relates to the clinical and individual characteristics of patients is essential for the delivery of patient-centered dermatological care. The current study aimed to examine the role of individual differences in emotion dysregulation and social anxiety in modulating quality of life in psoriatic patients. A total of 130 patients affected by psoriasis were consecutively enrolled in the study as they approached the Dermatology Unit of Sant'Orsola-Malpighi Hospital of Bologna. Clinical information gathered included illness severity, assessed with the Psoriasis Area and Severity Index (PASI) and the Body Surface Area (BSA); illness onset; familiarity; and prescribed treatment. The patient-reported outcome measures were the Dermatology Life Quality Index (DLQI), measuring the patient's quality of life; the Psoriasis Skin Appearance Bothersomeness scale (PSAB), measuring patient's perception of illness severity; the Difficulties in Emotion Regulation Scale (DERS), assessing emotion dysregulation traits; and the Social Interaction Anxiety Scale (SIAS), measuring anxiety about social interactions. Patients with moderate-to-severe psoriasis reported significantly lower quality of life compared to mildly affected patients. In addition, of the patients affected by mild psoriasis, those characterized by emotion dysregulation and social anxiety traits showed significantly lower levels of quality of life. Our findings suggest that individual differences in emotion dysregulation and social anxiety contribute to health-related quality of life in addition to illness severity. Therapeutic approaches that combine dermatological care with psychological support, especially focused on emotional regulation skills, may be useful to improve clinical outcomes in patients with psoriasis.

Background: In the treatment of various diseases, such as diabetes and arterial hypertension, fixed dose therapies have been reported to offer a method to simplify complex treatment regimens. There are numerous clinical trials proving the efficacy of cyclosporine in psoriasis in inducing remission and maintaining results, although there are few studies about the treatment optimization of cyclosporine., Methods: We performed a 15-year retrospective observational study comparing two groups of psoriatic patients matched for age and sex. We assessed the clinical response, the safety and the compliance who took fixed dose of 200 mg cyclosporine (range 2.2-3.3 mg/kg) compared with a group of patients who took body weight-based dosage. Student's t-test was used to assess the difference in terms of PASI 75 achievement, patient-reported compliance on a five-point scale, DLQI questionnaire, laboratory values and blood pressure., Results: PASI 75 achievement was not statistically different between the two groups. Compliance was good in both groups, and DLQI was also comparable. Laboratory values and blood pressure were not significantly different., Conclusions: Our study showed no statistically significant difference between the two groups in PASI reduction and PASI 75 achievement, even though the fixed dose was often lower (range 2.2-3.3 mg/kg) than the dosage administered depending on weight. Fixed dose cyclosporine is simple and practical to use in specific clinical settings, in particular when the patient's weight ranges from 60 to 90 kg. This approach can result in improved clinical outcomes and a better quality of life for psoriatic patients.

The presence of history of hyperpigmented crust in a patient with a history of adequate hygiene is typical of terra firma-forme dermatosis. The treatment is the rubbing of the skin with isopropyl alcohol (removal of the hyperpigmented brown crust, confirming the diagnosis). Physicians should be aware because early diagnosis avoid unnecessary treatment., Competing Interests: The authors have no conflict of interest to disclose.

Only a limited amount of data is available on the demographic and socio-economic status of psoriasis patients and its correlation with disease severity and impact on quality of life. The aim of this study was to investigate whether the socio-economic status of psoriasis patients is associated with higher PASI (Psoriasis Area Severity Index) and DLQI (Dermatology Life Quality Index) scores and global severity of disease. A total of 300 adults with plaque psoriasis, attending our psoriasis clinic for the first time (January 2015 to April 2018), were included in the study. Severity of psoriasis was defined according to three different definitions: PASI > 10, DLQI >10, and global severity based on the "Rule of tens" > 10%. The three outcomes were compared between patients with mild psoriasis and those with moderate-to-severe psoriasis using the t-test and χ2-test. Multiple logistic regression analyses were used to evaluate the association between each of the three outcomes and clinical and socio-economic features. Patients with lower educational level, employed in manual or office work, and with lower income were more likely to have moderate-to-severe psoriasis, considering the PASI and DLQI scores separately and the global severity of disease. The association between severity of disease and income was also significant based on multiple regression models. This study confirms the negative association between psoriasis severity and socio-economic status and is aimed at raising awareness among health professionals to investigate and consider this aspect in the management and therapeutic decisions in affected patients.

Background: Tuberous sclerosis is an autosomal dominant genodermatosis characterized by nonmalignant hamartomas in multiple organs. Facial angiofibromas are most commonly located on the face and have the potential to cause disfigurement. Facial disfigurement negatively affects the quality of life of patients and their families, often leading to negative psychosocial outcomes. Nowadays there are no treatment guidelines for facial angiofibromas but due to the progressive nature of facial angiofibromas a safe technique offering good results is needed., Objective and Results: We report the case of a 40-year-old female affected by tuberous sclerosis, whose facial angiofibromas were satisfactorily treated by rapamycin 0.05% ointment, and a combined laser therapy., (© 2018 Wiley Periodicals, Inc.)

The presence of history of redness and swelling of toe in an infant without history of trauma is typical of hair threat tourniquet syndrome. The treatment simply involves incision and removal of hair fibers. Physicians should be aware of this syndrome because early diagnosis and treatment avoid serious complications.

An 8-month-old Caucasian infant with neurofibromatosis type 1 presented with a congenital plexiform neurofibroma and multiple café au lait spots. A pale area surrounded one of the café au lait spots located on the left gluteus in the area of dermal melanocytosis. This halolike phenomenon results from the disappearance of the Mongolian spot around the café au lait spots, revealing normal pigmented skin. This sign has been described rarely in the literature and the pathogenic mechanism is unclear., (© 2017 Wiley Periodicals, Inc.)

Background: Cyclosporine is a validated treatment for moderate to severe psoriasis. Long-term cyclosporine administration may induce toxic effects. The duration of treatment usually ranges from 10 to 16 weeks. However, some patients may take cyclosporine for a longer time., Aim: The objective of the present study is to evaluate the dose, efficacy and safety in long-term cyclosporine therapy., Patients and Methods: We studied the hospital records of patients with psoriasis treated with cyclosporine between 1 January 2009, and 30 April 2015. We decided to focus on patients who, for different reasons, have continued cyclosporine for more than 2 years., Results: Five patients (2.69%) had been assuming cyclosporine for up to 62 months and had achieved a substantial response with no toxic effects. All of them were concerned about recurrence and all patients had personal reasons to prefer Cyclosporine over other drugs, including: familiar history of neurodegenerative disease, desire for motherhood, easy availability on prescription, systemic scleroderma, belenophobia., Conclusion: Cyclosporine is an acceptable monotherapy for psoriasis in selected patients. The prompt discontinuation of treatment usually results in resolution of any eventual toxicity.

Background: Spasmodic senile entropion (SE) is characterized by the inward turning of the eyelid. SE typically occurs spontaneously, but sometimes after ocular surgery. As of today, it is still lacking a gold standard technique., Aims: To report the results of 11 cases of involutional entropion of the lower lid successfully treated with an injection of botulinum toxin, to evaluate the clinical results, and to document the duration of relief., Methods: Eleven patients with senile entropion were treated with abobotulinum toxin A. The orbicularis oculi muscle was injected with 35 Su units of botulinum toxin. The procedures required an average of 5 min to complete. The follow-up period was 24 months., Results: The average age of the patients was 68.09 years (ranging between 62 and 75). About 7 days after the treatment, the entropion had resolved and there was only one recurrence at the 3-month visit. The recurrence rate was 27% after 6 months, and 27% after 9 months. Of note, the patients with recurrence repeated the injection and showed an increasingly long wellness period., Conclusions: Injection of botulinum toxin can treat entropion and resulted in a significantly high success rate., (© 2016 Wiley Periodicals, Inc.)

Bullous pemphigoid (BP) is an autoimmune subepidermal blistering disorder that has been reported to be associated with malignancies. Some authors described several cases of pemphigoid associated with malignancies (PAM); however, the evidence of this correlation still remains controversial. Several theories have been postulated to explain the relationship between malignant neoplasms and BP; the main theory suggests that antibodies directed against tumor-specific antigens of malignant cells may cross-react with antigens (like BP antigens) in the basement membrane zone leading to the formation of blisters. We performed an extensive review of the English published work focusing on the epidemiology, the pathogenetic theories and the clinical and histological aspects of the disease. We identified 40 cases of PAM: of these, seven cases were associated with hematological malignancies and 33 with solid tumors. Physicians should be aware of the existence of PAM and we suggest an oncological screening in early-onset pemphigoid, in patients with a former oncological history, in those with signs and symptoms that could be related to a neoplasm and in BP refractory to common immunosuppressive therapy., (© 2015 Japanese Dermatological Association.)

Interstitial granulomatous dermatitis with arthritis (IGDA), also known as Ackerman's syndrome, is a rare cutaneous disease classically characterized by the triad of cutaneous cords, a typical histologic infiltrate mainly constituted by histiocytes and arthritis/connective tissue disease. Here we report the case of IGDA with the typical clinical and histological features in a patient affected by lupus erythematosus. In this article we underline that IGDA may have a variety of different clinical and histological features. The rope sign is typical but infrequent, while histology is usually characteristic and shows a dermal inflammatory infiltrate, with a predominance of histiocytes, localized interstitially and in a palisaded array between collagen fibres, that show signs of degeneration. Clinical and histological differential diagnoses are discussed.

Botulinum toxin represents one of the most frequently requested cosmetic procedures. We treated 223 patients with facial wrinkles using a new technique of injection of botulinum toxin A (BTA) called multipoint and multilevel injection technique (MMIT). The aim of MMIT was to relax the muscle and not paralyze it. Patient satisfaction was evaluated by Facial Line Treatment Satisfaction Questionnaire (FTSQ). Treatment with botulinum toxin determined a good response in all patients. Facial rhytids were completely resolved in case of young skin and well reduced in case of aged skin, leaving a natural aspect both in static and dynamic wrinkles. Patient mean overall satisfaction evaluated with FTSQ was 6.4 ± 1.1. In our experience, the use of botulin toxin by MMIT consents a better calibration of action with a soft and natural result. This can be achieved by distributing the BTA dose through various injection points for each area ("multipoint injections"). Furthermore, injections can be performed at different levels ("multilevel injections"). The level of injections regulates the potency of effect on the muscle: if the level is deep (intramuscular), the effect will be strong while if it is medium or superficial (subcutaneous and intradermal), the effect will be soft. This consents a fine calibration of action on muscle activity with a personal aesthetic result., (© 2014 Wiley Periodicals, Inc.)

Background: TNF-α inhibitors have been associated with induction of autoantibodies and autoimmune diseases. We retrospectively evaluated the incidence of autoantibodies ANA, ENA, anti-dsDNA, the occurrence of clinical symptoms and possibly related treatment failure., Patients and Methods: The titers of ANA, ENA and anti-dsDNA were evaluated from blood samples every six months in 128 patients receiving a TNF-α inhibitor (adalimumab, etanercept, infliximab)., Results: Overall 37% of 128 patients treated with anti-TNF-α drug developed autoantibodies, mostly induced by infliximab; 48.48 % of patients who received infliximab presented autoantibodies. One patient developed a drug-induced lupus erythematosus. Forty-five patients were switched to one or more additional TNF-α inhibitors and 25 developed autoantibodies., Conclusions: An increased autoantibody titer is not predictive of treatment failure; particular attention to all phenomena suggestive for autoimmunity is needed in patients with a positive autoantibody titer. Further studies are needed to clarify the role of autoantibodies during anti-TNF- α therapy., (© 2014 Deutsche Dermatologische Gesellschaft (DDG). Published by John Wiley & Sons Ltd.)

Background: Recent findings have shown that psoriasis is frequently associated with atherosclerosis. Intima-media thickness (IMT) is a surrogate marker of atherosclerosis damage. Psoriasis patients had impaired endothelial function and thicker IMT of the carotid artery, compared with the healthy control subjects., Objectives: The aim of our study is to evaluate the prevalence of subclinical atherosclerosis in patients affected by cutaneous psoriasis without arthritis, considering the IMT as a subclinical feature of atherosclerosis., Methods: Intima-media thickness of the common carotid artery was measured using High-resolution B-mode ultrasound in 40 psoriasis patients and 40 control patients matched for age and gender. We also measured triglycerides, PASI, total cholesterol, LDL cholesterol and BMI. Pearson's partial correlation test was used to determine the correlation between each variable., Results: Intima-media thickness in subjects with psoriasis was statistically higher than those in the control subjects (1.465 mm, P value < 0.001). A positive strong correlation between IMT and age (r = 0.464 P < 0.01), total cholesterol (r = 0.466 P < 0.01), LDL cholesterol (r = 0.518 P < 0.01), triglycerides (r = 0.285 P = 0.01) and PASI (r = 0.515 P < 0.01) was observed. There was no statistically significant correlation between IMT and BMI (r = 0.132 P = 0.244)., Conclusions: Our study showed a significant increase in IMT in cutaneous psoriatic patients with moderate to severe psoriasis compared with a control group. IMT seems to be uncorrelated with BMI value. It can be assumed that the assessment of IMT, through a reliable and non-invasive technique such as ultrasound, appears particularly useful in the clinical evaluation of patients with psoriasis who may benefit from early intervention., (© 2012 The Authors. Journal of the European Academy of Dermatology and Venereology © 2012 European Academy of Dermatology and Venereology.)

Background: Nail psoriasis occurs in about 50% of psoriatic patients and can be psychologically devastating since it appears on visible areas. Up to now there is no evidence about what biological drugs is the most effective on nail psoriasis., Objectives: The aim of our study was to determine if one of the four biological drugs approved in our country (infliximab, adalimumab, etanercept, ustekinumab) is more effective than the others for nail psoriasis., Materials and Methods: A single-center, retrospective study was conducted to assess the efficacy of biological therapies in patients with moderate to severe psoriasis with nail involvement. NAPSI was evaluated in all psoriatic patients. Kruskal-Wallis and Fisher's exact tests were used to analyze the data., Results: A global statistically significant improvement in mean NAPSI from baseline to 12, 24 and 36 weeks was observed in all patients. At 12 weeks 27.78% of the patients reach NAPSI 75, at 24 weeks 81.48% and at 36 weeks 88.89%. The improvement in nail psoriasis is not significantly different between groups. An improvement in the mean Psoriasis Area and Severity Index score was also achieved, Conclusions: Biological therapies have shown to ameliorate psoriatic nail lesions. We did not find any statistically significant differences between the four biological drugs investigated., (© The Authors • Journal compilation © Blackwell Verlag GmbH, Berlin.)

Background: Interdigital psoriasis (IP) of the feet is often missed and is commonly mistaken for interdigital fungal infection., Objective: To assess the characteristics and the clinical presentation of IP, in order to better understand if IP should be considered a distinct form of psoriasis or not., Methods: We performed a 1-year observational study on 164 psoriatic patients, affected by moderate to severe cutaneous psoriasis and undergoing systemic therapy, examining each patient between the digits of both feet. In every suspected case of IP, differential diagnosis with interdigital fungal infection was excluded by direct microscopic examination of skin scrapings, by culture and by skin biopsy., Results: We suspected IP in 7 of the 164 patients. IP was confirmed in 6 patients and in the other one a diagnosis of tinea pedis was made., Conclusion: IP proved to be not rare or atypical since IP localized between the toes usually presents as characteristic whitish and sodden plaques or patches. Such a diagnosis should be considered in all patients presenting characteristic lesions especially if these have a negative fungal culture, are resistant to antimycotic treatment and involve patients with a history of psoriasis., (Copyright © 2013 S. Karger AG, Basel.)