Antioxidants and narrow band-UVB in the treatment of vitiligo: a double-blind placebo controlled trial.

BACKGROUND: Vitiligo is an acquired depigmenting disease with uncertain aetiopathogenesis, possibly associated with oxidative stress. Narrowband ultraviolet B phototherapy (NB-UVB) is the most widely used and effective treatment. AIM: To evaluate the clinical effectiveness of NB-UVB and the repairing of oxidative stress-induced damage, using oral supplementation with an antioxidant pool (AP). METHODS: Patients (n = 35) with nonsegmental vitiligo were enrolled in a randomized, double-blind, placebo-controlled multicentre trial. The treatment group received, for 2 months before and for 6 months during the NB-UVB treatment, a balanced AP containing alpha-lipoic acid, vitamins C and E, and polyunsaturated fatty acids. The area and number of lesions, as well as some parameters of the oxidation-reduction (redox) status of the peripheral blood mononuclear cells (PBMCs) were estimated at the beginning, after 2 months, and at the end of the trial. RESULTS: In total, 28 patients completed the study. After 2 months of AP supplementation, the catalase activity and the production of reactive oxygen species (ROS) were 121% and 57% of the basal values (P < 0.05 and P < 0.02 vs. placebo, respectively). The AP increased the therapeutic success of NB-UVB, with 47% of the patients obtaining > 75% repigmentation vs. 18% in the placebo group (P < 0.05). An increase in catalase activity to 114% (P < 0.05 vs. placebo) and decrease in ROS level of up to 60% (P < 0.02 vs. placebo) of the basal value was observed in PBMCs. Finally, the AP intake maintained the membrane lipid ratio (saturated : unsaturated fatty acids 1.8 : 3.1; P < 0.05), counteracting phototherapy-induced saturation. CONCLUSIONS: Oral supplementation with AP containing alpha-lipoic acid before and during NB-UVB significantly improves the clinical effectiveness of NB-UVB, reducing vitiligo-associated oxidative stress.

[Persistent lymphedema of the penis and scrotum after recurrent episodes of cellulitis and urethritis caused by Chlamydia trachomatis]. / Linfedema persistente del pene e dello scroto successivo ad episodi recidivanti di cellulite ed uretrite da Chlamydia trachomatis.

A 20 year old man affected by a persistent peno-scrotal lymphedema is reported. This condition followed recurrent attacks of cellulitis and a chronic urethritis. From the urethral discharge we isolated Chlamydia trachomatis and, only during the attacks of cellulitis, Group G Streptococcus. This pathogen cannot be isolated from microflora of the normal urethra and rarely cause cellulitis. In our opinion Chlamydial infection favoured the urethral colonization of Group G Streptococci and their passage in the loose connective tissue of the penis and scrotum. Lymphedema, clinically inapparent before the first attack, become progressively more severe and recurrent attacks took place at intervals without obvious re-exposure to an exogenous source of streptococci. The operative treatment of persistent lymphedema is lymphangiectomy and lymphangioplasty.

[Proposal for a therapeutic protocol in Crosti lymphoma]. / Proposta di protocollo terapeutico nel linfoma di Crosti.

Three patients with Crosti's lymphoma were treated with radiotherapy using electron accelerators. The energy radiations ranged from 5 to 9 Mev. with large fields. The total dose was 40 Gy, delivered in 2 Gy fractions daily. The treatment lasted four weeks. No side effects were reported and no recurrence was remarked after 24 months.

[Pemphigus and neoplasia. 2 new clinical cases and a review of the literature]. / Pemfigo e neoplasie. Due nuovi casi clinici e revisione della letteratura.

We report two cases of pemphigus vulgaris associated with internal malignancies. The former was a 56 year-old man who developed pemphigus shortly after non-Hodgkin lymphoma has been formed. The latter was a 69 year-old woman who presented pemphigus and gastric carcinoma in the same time. In order to clarify the relationships between all forms of pemphigus and malignancy or thymoma, a search of the world literature was carried out. We found 44 reports of the association of pemphigus with internal malignancy and with benign or malignant thymoma. The key problem that needs to be resolved is whether there is a causal relationship or whether these are only occasional coincidental findings.

Antinuclear antibodies in psoriatic arthritis and its subgroups.

We tested serum samples from 48 patients with Psoriatic Arthritis (PA) for Antinuclear Antibodies (ANA) using a highly sensitive substrate (Hep-2 cells). We obtained the following results: 1) in PA patients ANA positivity (16.6%) was significantly higher than in age-and sex-matched groups of healthy controls (4.1%; p less than 0.05) and uncomplicated psoriasis (2%; p less than 0.025). 2) ANA were more common in Symmetrical Polyarthritis (37.5%) and Arthritis Mutilans (25%) than in Asymmetrical Oligoarthritis and Spondarthritis (11.8%) and 'Classical' PA (0%). 3) We did not find any positivity for anti-DNA and anti-ENA antibodies among PA patients.

Segmental neurofibromatosis. Case report and review of the literature.

Segmental neurofibromatosis (NF) is characterized by the strictly unilateral occurrence of features that are typical of the more ordinary forms of NF (i.e., NF-1, NF-2), including schwannomas, cutaneous or plexiform neurofibromas, and/or café au lait spots. That is, these features are found in only one or several dermal segments. We describe a case of a 68-year-old woman affected by neurofibromas restricted to the right lumbar region. After extensive investigations, including magnetic resonance imaging, we could rule out the presence of additional, more widespread lesions. Previous reports of segmental NF are reviewed.