Successful use of dupilumab for the treatment of atopic dermatitis on the genitals, a neglected anatomical site.

Atopic dermatitis (AD) is a chronic inflammatory disease that may involve any cutaneous site; involvement of the genital area may greatly impair patients' quality of life but, as the inspection of genitals is not usually conducted during the routine physical examination of patients with AD, the genital presentation of AD is frequently neglected and under-reported. We decided to evaluate the incidence of genital AD in patients with moderate-severe AD and the relative response to anti-interleukin (IL)-4/IL-13 dupilumab. In our study, a high incidence of genital AD emerged but the use of dupilumab allowed a generalized improvement.

Dupilumab therapy of atopic dermatitis of the elderly: a multicentre, real-life study.

BACKGROUND: Treatment of moderate-to-severe atopic dermatitis (AD) in the elderly may be challenging, due to side-effects of traditional anti-inflammatory drugs and to comorbidities often found in this age group. Furthermore, efficacy and safety of innovative drugs such as dupilumab are not yet well known. OBJECTIVES: A multicentre retrospective, observational, real-life study on the efficacy and safety of dupilumab was conducted in a group of patients aged ≥65 years and affected by severe AD. Their main clinical features were also examined. METHODS: Data of elderly patients with severe (EASI ≥24) AD treated with dupilumab at label dosage for 16 weeks were retrospectively collected. Treatment outcome was assessed by comparing objective (EASI) and subjective (P-NRS, S-NRS and DLQI) scores at baseline and after 16 weeks of treatment. RESULTS: Two hundred and seventy-six patients were enrolled in the study. They represented 11.37% of all patients with severe AD. Flexural eczema was the most frequent clinical phenotype, followed by prurigo nodularis. The coexistence of more than one phenotype was found in 63/276 (22.82%) subjects. Data on the 16-week treatment with dupilumab were available for 253 (91.67%) patients. Efficacy of dupilumab was demonstrated by a significant reduction of all the scores. No statistically significant difference regarding efficacy was found in elderly patients when compared to the group of our AD patients aged 18-64 years, treated with dupilumab over the same period. Furthermore, only 18 (6.52%) patients discontinued the drug due to inefficacy. Sixty-one (22.51%) patients reported adverse events, conjunctivitis and flushing being the most frequent. One (0.36%) patient only discontinued dupilumab due to an adverse event. CONCLUSIONS: Therapy with dupilumab led to a significant improvement of AD over a 16-week treatment period, with a good safety profile. Therefore, dupilumab could be considered as an efficacious and safe treatment for AD also in the elderly.

Real-life experience on effectiveness and safety of dupilumab in adult patients with moderate-to-severe atopic dermatitis.

BACKGROUND: Dupilumab, a fully human monoclonal antibody targeting the alpha subunit of IL-4 was recently approved for the treatment of moderate-to-severe atopic dermatitis (AD) in adult patients. OBJECTIVE: To assess dupilumab effectiveness and safety in adults with moderate-to-severe AD in a real-life Italian multicentre retrospective cohort. METHODS: Adult moderate-to-severe AD patients, referring to 39 Italian centers, received dupilumab in the context of a national patient access program. Disease assessment was performed at baseline, after 4 and 16 weeks of treatment using Eczema-Area-and-Severity-Index (EASI) score, itch and sleep numerical-rating-score (itch-NRS, sleep-NRS) and Dermatology-Life-Quality-Index (DLQI). RESULTS: A total of 109 (71 M/38F) patients was studied. There was a significant reduction in EASI score, itch-NRS, sleep-NRS and DLQI from baseline to week 4 and a further significant decline to week 16. EASI 50, EASI75 and EASI90 were achieved by 59.6%, 28.4% and 9.3% of patients at 4 weeks and by 87.2%, 60.6% and 32.4% of them at 16 weeks, respectively. Adverse events were experienced by 19.2% (21/109) of the patients and they were all mild in intensity, being conjunctivitis the most common side effect. CONCLUSIONS: Dupilumab significantly improved disease severity, pruritus, sleep loss and quality of life with an acceptable safety profile.

Eosinophilic panniculitis triggered by arthropod bites in chronic lymphocytic leukemia.

Skin findings are common among patients with hematological malignancies and are thought to be expressions of a reactive spectrum peculiar to immunosuppressed patients with an unclear pathogenesis. Eosinophilic panniculitis is a reaction pattern defined by single or multiple lesions consisting in nodules and plaques, and sometimes in papules and pustules, characteristically associated to hematological neoplasms or to a series of benign conditions such as arthropod bites. We report a case of eosinophilic panniculitis occurring in a 77-year-old woman with chronic lymphocytic leukemia. Our case is remarkable as the histology of panniculitis was associated with a clinical evidence of dermal papules and a history of insect bites.

Late-onset non-familial acrokeratosis verruciformis of Hopf: a case report.

Acrokeratosis verruciformis of Hopf is a rare heritable autosomal dominant genodermatosis and keratinization disorder, first described in 1931 by Hopf. It presents with multiple flat skin colored papules, mainly localized at the dorsal region of the hands and feet. AKV is an allelic disorder, associated with heterozygous missense mutation in ATP2A2 gene, which is involved in Darier's disease. Usually, it arises in early life but rare sporadic cases with adult onset have been reported. We report a case of late-onset non-familial AKV in a 52-year old patient.

Omalizumab therapy in a patient with cronic spontaneous urticaria, ulcerative colitis, hypereosinophilia and prurigo Besnier: a case report.

The case of a woman who suffered from CSU and prurigo Besnier, with a history of chronic hyper-eosinophilia, ulcerative colitis and thyroiditis, unresponsive to anti-histamines and steroids is reported. The patient received omalizumab treatment, and obtained resolution of urticaria along with improvement of cutaneous symptoms of prurigo.

Topical promethazine side effects: our experience and review of the literature.

Promethazine hydrochloride is a first-generation H1 receptor antagonist, antihistamine, and antiemetic medication that can also have strong sedative effects. The apparent ability of topical H1r/2r antagonists to target epidermal H1/2r was translated into increased efficacy in the treatment of inflammatory dermatoses, likely due to decreased inflammation and enhanced barrier function.

A case of sensitization to alitretinoin.

Alitretinoin is a unique retinoid authorised for the treatment of adults with severe chronic hand eczema (CHE) refractory to potent topical steroids. The most common adverse events (AEs) were typical class effects of oral retinoids including headache, flushing and skin disorders. To our knowledge, there are no cases of sensitization to alitretinoin reported in literature. We present a case of sensitization to alitretinoin.

Allergic diseases and climate changes: our experience and an update.

AIMS: Recent research has shown that there are many effects of climate change on aeroallergens and thus allergic diseases in humans. It is not easy to evaluate the impact of climate change and air pollution on the prevalence of allergic diseases. The present study is devoted to decipher the possible relationships between climatic changes and allergic diseases, and in particular with atopic dermatitis (AD). MATERIALS AND METHODS: To evaluate the aeroallergens effects on AD, we submitted to an allergological study protocol 59 children patients with AD to study the interaction between aeroallergens-atopy patch test (APT) and skin prick test (SPT). The same tests were performed on to the same patients after 24 months to assess the time trend. RESULTS: We found a high prevalence of house dust mites and grasses pollen APT positivity in AD's and in respiratory patients and we also found an increase in positive results in the same patients after 24 months. However, we observed a variation in the control group, in which in earlier tests all patients had negative results but after 24 months we found some positivity. CONCLUSION: We found a correlation between APT and SPT in AD and we observed a concordance between APT results and the atopy score index, underlying the triggering role of these aereoallergens in the atopic patient's skin reactivity.

Systemic contact dermatitis (SCD) due to dietary nickel.

Systemic contact dermatitis (SCD) can be caused by nickel in sensitized subjects. Nickel allergy is commonly characterized by localized reactions ensuring cutaneous exposure to this element. Systemic reactions can occur after dietary nickel ingestion. We report a case of a woman with Systemic Contact Dermatitis due to nickel.

An atypical cutaneous reaction to rivastigmine transdermal patch.

Rivastigmine is a cholinesterase inhibitor which improves cognitive function and is currently being used in patients with mild to moderate Parkinson's and Alzheimer's dementia. This drug can be given orally or topically, as transdermal patch. The latter form is currently used for most excellent compliance and few side effects. The most common cutaneous side effects are irritative dermatitis. We report the second case of active sensitization by the rivastigmine-patch in a patient suffering from Alzheimer's dementia.

Cranial shape varies along an elevation gradient in Gambel's white-footed mouse (Peromyscus maniculatus gambelii) in the Grinnell Resurvey Yosemite transect.

Environmental variation over a species's range creates differing pressures to which organisms must adjust in order to survive. Taxa can respond to these pressures at population and individual levels, leading to localized phenotypic differentiation. Assessing the spatial distribution of phenotypic variation can illuminate how dramatically varying environmental factors shape phenotypes and may forecast a taxon's ability to adapt should conditions change. We characterized morphological variation along a transect sampled in the Grinnell Resurvey project to determine whether Gambel's white-footed mouse (Peromyscus maniculatus gambelii), a generalist taxon inhabiting the full elevational range of habitats in Yosemite National Park and surrounding areas, has responded morphologically to variation in its environment. We quantified variation in modern P. m. gambelii cranial shape using 2D generalized Procrustes analysis and Euclidean distance matrix-based geometric morphometrics. We performed multivariate regression of shape coordinates on elevation to test for environmental influences on shape within the principal geographic dimension of change along the transect. We observe a statistically significant correlation with shape on elevation for occlusal and lateral views of the cranium, explaining a small percentage of the overall variation in shape. Modern P. m. gambelii crania show a pattern of flexion in which the angle of the cranial base decreases at higher elevations. Results of EDMA parallel these findings, but highlight additional areas of the cranium that vary with elevation. Collectively, the patterns of variation detected suggest a biological response to the environment that warrants further study. This work lays the foundation for comparison with morphological data from historical specimens, which can address evolutionary scenarios generated from our findings, and for investigation of other taxa included in the resurvey project.