Melanoma Prevention: Comparison of Different Screening Methods for the Selection of a High Risk Population.

BACKGROUND: Guidelines recommend limiting melanoma screening in a population with known risk factors, but none indicates methods for efficient recruitment. The purpose of this study is to compare three different methods of recruiting subjects to be screened for melanoma to detect which, if any, is the most efficient. METHODS: From 2010 to 2019, subjects were recruited as follows: (1) regular skin examinations (RS), mainly conducted through the Associazione Contro il Melanoma network; (2) occasional melanoma screening (OS), during annual public campaigns; (3) and selective screening (SS), where people were invited to undergo a skin check after filling in a risk evaluation questionnaire, in cases where the assigned outcome was intermediate/high risk. Melanoma risk factors were compared across different screening methods. Generalized Linear Mixed Models were used for multivariable analysis. RESULTS: A total of 2238 subjects (62.7% women) were recruited, median age 44 years (2-85), and 1094 (48.9 %) records were collected through RS, 826 (36.9 %) through OS, and 318 (14.2 %) through SS. A total of 131 suspicious non-melanoma skin cancers were clinically diagnosed, 20 pathologically confirmed, and 2 melanomas detected. SS performed significantly better at selecting subjects with a family history of melanoma and I-II phototypes compared to OS. CONCLUSIONS: Prior evaluation of melanoma known risk factors allowed for effective selection of a population to screen at higher risk of developing a melanoma.

Effects of autologous micrografts on stable bilateral vitiligo: A focus on hand lesions.

Vitiligo is an autoimmune skin disorder characterized by depigmented patches of the skin associated with, among several factors, dysregulation and death of melanocytes. Currently, the treatment of vitiligo is based both on the arrest of the progression of active disease and on the stimulation of the skin repigmentation. The aim of this study was to assess the effects of autologous micrografts and narrowband ultraviolet B (NBUVB) phototherapy for skin repigmentation of patients with bilateral stable vitiligo. Autologous micrografts are derived from mechanical disaggregation of small pieces of the patient's own skin, while phototherapy is a strategy treatment already used. Twenty patients with stable bilateral vitiligo were treated, showing a mean percentage rate of 59.1% at baseline. Combined treatment by autologous micrografts and NBUVB was performed only on the lesions of the hands, and the clinical follow up was performed after 3 and 6 months by photographs taken under Wood's light. After 6 months, we classed 100% of patients as responders. We also reported a mean of repigmentation rate of 36.7% after 3 months and 64.6% after 6 months of treatment. In particular, six of the 20 patients reached a marked repigmentation rate (75-100%), four moderate (51-75%) and 10 mild (26-50%). No adverse effects were observed and no drugs were administrated as co-adjuvant therapy. These results are suggestive of a potential wide use of autologous micrografts associated with NBUVB phototherapy for the treatment of stable vitiligo.

Semi-Automatic Tool for Vitiligo Detection and Analysis.

Vitiligo vulgaris is an autoimmune disease which causes a strong reduction of the cells producing melanin, which is the main skin pigment. This results in the growth of white patches on patients' skin, which are more or less visible, depending on the skin phototype. Precise, objective and fast detection of vitiligo patches would be crucial to produce statistically relevant data on huge populations, thus giving an insight on the disease. However, few methods are available in literature. In the present paper, a semi-automatic tool based on image processing to detect facial vitiligo patches is described. The tool requires pictures to be captured under black light illumination, which enhances patches contrast with respect to healthy skin. The user is only required to roughly define the regions of interest and set a global threshold, thus, no specific image-processing skills are required. An adaptive algorithm then automatically discerns between vitiligo and healthy skin pixels. The tools also allow for a statistical data interpretation by overlapping the detected patches of all patients on a face template through an occurrence map. Preliminary results obtained on a small population of 15 patients allowed us to assess the tool's performance. Patch detection was checked by an experienced dermatologist, who confirmed the detection for all the studied patients, thus supporting the effectiveness of the proposed tool.

Depigmentation patterns of nonsegmental vitiligo: a prospective study of macromorphologic changes in lesions.

BACKGROUND: Efforts have been recently made to investigate simple, objective, accurate, and reproducible methods of clinical/noninvasive assessment of nonsegmental vitiligo. However, studies have mostly considered quantitative or semiquantitative parameters, almost neglecting the purely qualitative appearance of vitiligo lesions at a given moment and over time. OBJECTIVE: The objective of this study was to investigate the dynamics of macromorphologic alterations taking place within vitiligo patches. STUDY DESIGN: This was a prospective study of a vitiligo cohort. PATIENT POPULATION: Consecutive patients affected by nonsegmental vitiligo. METHODS: Enrolled patients affected by nonsegmental vitiligo underwent a dermatology visit once monthly for 12 months. Vitiligo lesions were photographed at each visit under both room light and Wood's light, and analyzed via a morphometric, digitalized software capable of detecting quantitative changes of white areas. Pictures depicting changing patches were evaluated in order to assess clinical morphology. RESULTS: Ninety patients were included for the final analysis and 360 lesions were evaluated, 102 of which (28.9 %) showed changes of white areas. Subjective evaluation highlighted two distinct depigmentation patterns, which were present either alone or in combination: (1) a sharply defined band of intermediate color between the depigmented center and the surrounding normal skin, which was defined as 'marginal hypopigmentation;' and (2) pinpoint hypopigmented/depigmented macules centered by a follicle, which we named 'perifollicular depigmentation.' On the other hand, only one repigmentation pattern was detected, the already known 'perifollicular repigmentation.' CONCLUSION: The depigmentation process in vitiligo seems to follow only two specific patterns. This preliminary study represents, in our opinion, a valuable background for future research aiming to investigate the dynamics of vitiligo pathogenesis or assess depigmentation/repigmentation patterns for monitoring treatment response.

Evaluation of dietary intake of vitamin E in the treatment of atopic dermatitis: a study of the clinical course and evaluation of the immunoglobulin E serum levels.

BACKGROUND: Vitamin E (VE) is a potent antioxidant that can improve the immune macrophage-mediated response, decrease the production and/or release of prostaglandins in humans, and decrease the serum levels of immunoglobulin E (IgE) in atopic subjects. AIM: To compare the effects of placebo (PL) and VE intake (400 IU/day) on subjective symptoms and serum IgE levels in 96 subjects with atopic dermatitis. MATERIALS AND METHODS: A single-blind clinical analysis was performed on 96 subjects randomly divided into two groups. Fifty subjects were given orally 400 IU (268 mg) of VE of natural origin, once a day for 8 months, and 46 took PL for the same period. Complete blood count, serum IgE levels, radioallergosorbent test (RAST) score, antinuclear antibodies (ANA), and biochemical analysis were obtained at the time of enrollment and every 15 days during the 8 months of the study. To evaluate VE therapy, a questionnaire was sent to each subject for completion at the end of the study. RESULTS: The results were as follows: (A) four subjects treated with VE worsened, compared to 36 in the PL group; (B) six subjects in the VE group and five in the PL group showed no change; (C) slight improvement was observed in 10 subjects in the VE group and four in the PL group; (D) 23 of the 50 subjects treated with VE showed great improvement, compared to only one in the PL group; and (E) there was almost complete remission of atopic dermatitis in seven of the 50 subjects in the VE group, but none in the PL group. Females showed less progression of atopic dermatitis than males in both groups and a higher percentage of almost complete remission (five females and two males). The range of serum IgE levels varied markedly from 1005 to 490 IU/mL in the VE group and from 1239 to 812 IU/mL in the PL group over 8 months. Subjects with great improvement and near remission of atopic dermatitis in the VE group demonstrated a decrease of 62% in serum IgE levels based on initial conditions, while, in subjects taking PL, the difference was approximately 34.4%. No complications were observed in either group. A remarkable improvement in facial erythema, lichenification, and the presence of apparently normal skin was reported. Eczematous lesions healed mostly as a result of decreased pruritus. CONCLUSIONS: The correlation between VE intake, IgE levels, and the clinical manifestations of atopy indicates that VE could be an excellent therapeutic tool for atopic dermatitis.

Evaluación de la ingesta dietética de vitaminaE en el tratamiento de la dermatitis atópica:estudio de la evolución clínica y valoraciónde las concentraciones séricasde inmunoglobulina E / Evaluation of dietary intake of vitamin E in the treatment of atopic dermatitis: a study of the clinical course and evaluation of the immunoglobulin E serum levels

Objetivo: La vitamina E (VE) es un potente antioxidante que puede mejorar la respuesta inmune mediada por macrófagos, reducir la producción y/o secreción de prostaglandinas en seres humanos y disminuir las concentraciones séricas de inmunoglobulina E (IgE) en sujetos con dermatitis atópica. Comparar los efectos de la ingesta de placebo (PL) y de VE (400 UI/día) sobre los síntomas subjetivos y las concentraciones séricas de IgE en 96 sujetos con dermatitis atópica. Materiales y métodos: Se realizó un análisis clínico ciego en 96 sujetos divididos aleatoriamente en dos grupos. Cincuenta sujetos recibieron 400 UI (268 mg) de VE de origen natural por vía oral, una vez al día durante 8 meses y 46 recibieron PL durante el mismo período. Al comienzo del estudio y cada 15 días durante los 8 meses del estudio se realizaron: recuento completo de células sanguíneas, determinación de las concentraciones séricas de IgE, test radio-alergosorbente (RAST), determinación de anticuerpos antinucleares (ANA) y análisis bioquímico. Para evaluar el tratamiento con VE se envió un cuestionario a todos los sujetos que debía rellenarse al final del estudio. Resultados: Los resultados fueron los siguientes: a) cuatro sujetos tratados con VE y 36 tratados con PL empeoraron; b) seis sujetos del grupo VE y cinco del grupo PL no experimentaron cambios; c) se observó mejoría en diez sujetos en el grupo VE y en cuatro en el grupo PL; d) 23 de los 50 sujetos tratados con VE experimentaron una mejoría importante y sólo uno del grupo PL; y e) hubo una remisión casi completa de la dermatitis atópica en siete de los 50 sujetos del grupo VE pero en ninguno del grupo PL.La progresión de la dermatitis atópica fue menor en mujeres que en hombres en los dos grupos y el porcentaje de remisión casi completa fue mayor (cinco mujeres y dos hombres). El intervalo de concentraciones séricas de IgE varió desde 1.005 a 490 UI/ml en el grupo VE y 1.239 a 812 UI/ml en el grupo PL durante los 8 meses. Los sujetos con mejoría importante y cercanos a la remisión de la dermatitis atópica del grupo VE mostraron un descenso del 62 por ciento en las concentraciones séricas de IgE, en relación con las condiciones iniciales, mientras que, en los sujetos que recibieron PL, la diferencia fue aproximadamente del 34,4 por ciento. No se observaron complicaciones en ningún grupo. Se observó una mejoría considerable en el eritema facial y en la liquenificación y se describió la presencia de piel aparentemente normal. Las lesiones eccematosas cicatrizaron principalmente como consecuencia del descenso del prurito. Conclusiones: La correlación entre la ingesta de VE, las concentraciones de IgE y las características clínicas de atopia indican que la VE puede ser un instrumento terapéutico excelente para tratar la dermatitis atópica (AU)