Dermasilk® briefs in recurrent vulvovaginal candidosis. An alternative option in long-lasting disease.

AIM: Recurrent vulvovaginal candidosis (RVVC) can be a long-lasting disease; some patients refuse one of the most used treatment based on the assumption of oral fluconazole and resort to self-medication, risking poor control of symptoms and the development of local side effects. The aim of the study is to compare underwear made of Dermasilk®, a pure fibroin fabric bonded with a permanent antimicrobial protection, with cotton placebo briefs to see whether it would be a useful tool in the management of RVVC in patients not receiving oral or topical antimycotic treatment. METHODS: A double-blind, randomized study was carried out on 30 women who had a long-term history of RVVC with mild to moderate symptoms. The patients were randomly divided into two groups and instructed to use either white cotton placebo briefs (CT group) or Dermasilk® briefs (DS group) for 6 months. RESULTS: All vulvovaginal symptoms and signs showed a statistically significant improvement in the DS group compared with the CT group (P<0.001) at the follow-up visits after 3 and 6 months. The number of flares of vulvovaginal symptoms was significantly lower in the DS group compared to the CT group (24 episodes versus 68 episodes during the 6-month study, P<0.001). CONCLUSION: In the absence of both topical and oral antimycotics, Dermasilk® briefs appear to be a useful tool, in reducing the signs and symptoms and the episodes of vulvovaginal discomfort in patients suffering from RVVC.

Prostitution, sexual behavior and STDs.

Prostitution involves the exchange of sexual services for economic compensation. As sexual behaviour is an important determinant in transmitting HIV and sexually transmitted diseases (STDs), sex workers (SWs), transgenders and clients are often labeled as a "high risk group" in the context of HIV and STDs. It has been documented that female sex workers in particular have an increased prevalence of untreated STDs and have been hypothesized to affect the health and HIV incidence of the general population. People involved in prostitution are a cause for concern from both public health and economic perspectives. However, little is known about why they remain in this type of activity given the risks prostitution presents, and even less is known about how to intervene and interrupt the complex cycle of prostitution. The aim of this paper is to provide a clinical and epidemiological analysis of the relationship between prostitution, sexual behavior and outbreaks of STDs; to assess the role that migrants, transgenders and clients of SWs have in prostitution and in the outbreaks of STDs. In addition, we also want to highlight how new sexual networks, like the Internet, have become an increasingly important vehicle to sharing information about prostitution, sexual behavior and STDs. Finally we present what may be the prevention strategies and the goals in order to stem the spread of STDs among these hard-to-access groups.

Evaluation of incidental thyroid nodules in patients with primary melanoma.

AIM: Literature data have suggested an increase of incidental thyroid nodules in patients with malignancies, including melanoma. METHODS: The ultrasound findings of 168 consecutive melanoma patients were revisited in order to evaluate the presence of incidental thyroid nodules and the results were compared with clinical features, Breslow thickness and the rate of malignancy of incidental thyroid nodules. RESULTS: We observed that: 1) incidental thyroid nodules are more frequent in patients affected by melanoma (60.6%) than in the healthy population; 2) no statistically significant difference were found in thyroid involvement on the basis of gender and age; 3) incidental thyroid nodules frequency is increased in patients with thinner melanoma and this increase is more evident if we consider melanoma in situ and female patients; 4) it was not detected malignant incidental thyroid nodules. CONCLUSION: The data revealed a high frequency of incidental thyroid nodules in patients with melanoma, suggesting that it is necessary to study this association in a larger group of patients, also including age/gender matched controls.

Use of Dermasilk briefs in recurrent vulvovaginal candidosis: safety and effectiveness.

Despite the generally excellent results achieved with fluconazole 150 mg weekly in recurrent vulvovaginal candidosis (RVVC), some patients with a long history of disease do not achieve complete resolution of symptoms following antimycotic treatment. It is thought that use of tight synthetic fabric underwear could be a significant factor in causing recurrence. We decided to compare underwear made of Dermasilk®, a pure fibroin fabric impregnated with a permanent antimicrobial protection, with a cotton placebo to see whether it could be a useful adjunctive tool in the management of RVVC. We recruited 96 women who had a long-term history of RVVC and had not responded to oral antimycotics with complete satisfaction. The patients were randomly divided into two groups and instructed to use either white cotton placebo briefs or Dermasilk® briefs. Both groups were treated with fluconazole 150 mg once weekly for 6 months. After 6 months, the Dermasilk group showed a statistically significant greater decrease of itching, burning, erythema and a smaller number of recurrences than the cotton group. Our work suggests that Dermasilk® briefs could be a useful adjunctive tool in addition to antimycotic treatment to help relieve the discomfort of recurrent vulvovaginitis.

Periungual and subungual pyogenic granuloma.

BACKGROUND: Nail pyogenic granuloma (PG) is common, often seen as an urgent case, given the recent onset as a bleeding nodule. Nail PGs are due to different causes that act through different pathogenetic mechanisms and may be treated in several ways. Both causes and treatments of nail PG have never been classified. OBJECTIVES: To classify nail PG according to the pathogenesis, describe the clinical and pathological features and provide guidelines for a correct diagnosis and treatment. METHODS: A retrospective, observational study was performed reviewing epidemiological and clinical features of 58 cases of PG seen at our Departments in the last 5 years. A review of the literature was also carried out, using PubMed database and dermatological textbooks. RESULTS: Nail PG is usually due to the following causes: drugs, local trauma and peripheral nerve injury. Histopathology shows similar features in every type of PG, irrespective of cause and location. CONCLUSIONS: The localization of nail PG, the number of digits involved and clinical history help to identify the cause. When PG is single, especially if it involves the nail bed, histological examination is necessary to rule out malignant melanoma. Treatment must be chosen according to the underlying cause.