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.

Serum tryptase levels in patients with psoriasis: a pilot study for a possible useful biomarker.

In psoriasis, biomarkers for disease prognosis and response to treatment may help clinicians to improve patient management. Hence, we decided to evaluate the role of serum tryptase (ST) in a sample of patients with psoriasis. We found higher levels of ST in patients with scalp psoriasis than in those without (6.1 vs. 4.6 ng/mL), in those with palmoplantar psoriasis than in those without (5.3 vs. 5 ng/mL) and, with less significance, in those with psoriatic arthritis than in those without (6.1 vs. 5.1 ng/mL).

Key to medically relevant Italian spider bites: a practical quick recognition tool for clinicians.

INTRODUCTION: Spider bites are often overestimated because there are no specific clinical or histopathological aspects that characterize them, and skin lesions that resemble a spider bite are often wrongly considered to be a "true spider bite". However, even in case of a true spider bite, it is almost impossible to confirm the biting species, since very often neither physicians nor patients are trained in spider identification. OBJECTIVE: The aim of this report is to provide clinicians with a rapid and simple recognition of the few Italian medically relevant spiders, in order to take relative medical measures in case of spider bites. MATERIALS AND METHODS: We defined spiders of considerable medical relevance the ones that cause local symptoms with possible systemic involvement, while we defined spiders with mild medical relevance the ones whose bite is not a medical emergency but is particularly painful or can cause lasting symptoms. We focused on the identification of the four spider taxa of major clinical interest through a brief descriptive, photographic and graphic guide, in association to dermatological manifestations. RESULTS: Spiders of considerable medical relevance are Loxosceles rufescens and Latrodectus tredecimguttatus, while spiders of less severe medical relevance are Steatoda paykulliana, S. nobilis, S. grossa, Cheiracanthium punctorium, Amblyocarenum spp. and Macrothele calpeiana (the presence of the latter in Italy is only accidental and very sporadic). The only species capable of causing necrosis is Loxo-sceles rufescens, while Latrodectus tredecimguttatus can cause more systemic symptoms. DISCUSSION AND CONCLUSION: With the aim of promoting a first and rapid recognition of the species, we performed a morphological usable aspect for an initial and quick recognition according to an identification key.

Vipera snakebite in Europe: a systematic review of a neglected disease.

In 2009, snakebites were included in the list of the World Health Organization (WHO) neglected diseases. Dermatological literature lacks current and up-to-date articles about snakebites and their management, despite the fact that dermatologists, especially from rural hospitals, can be called into the emergency room to consult the management of suspected snakebites. In this systematic review, we highlighted the main clinical and laboratory aspects of snakebites from Vipera spp. in Europe, by reviewing 3574 studies initially retrieved from PubMed, Embase and Cochrane CENTRAL databases. Of these, 78 were finally included in the systematic review. We found that the most involved taxon was V. berus in 63.3% and the most involved anatomic site of the bite was the upper limbs 53.1% with fang marks reported in 90.5%. The mean age of the patients was 32.9 years, and bites were slightly more common among males (58.2%). A wound washing was performed in 86.9% of cases before the hospitalization. The most frequently reported grade of envenomation was G2 (42.2%). In addition to local dermatological symptoms (extended erythema, oedema, cutaneous necrosis, hives, purpura, petechiae, acute compartment syndrome), numerous systemic symptoms have also been reported, including fatigue (14.4%), pain (75.3%), fever (49.2%), direct anaphylactoid reaction (5.3%), anxiety (60.8%), cranial nerve neurotoxicity (14.8%), dysesthesia/paraesthesia (7.9%), vomiting (33.7%), abdominal pain (23.3%), diarrhoea (15.4%), dyspnoea (6.3%), proteinuria (10.6%) and haematuria (9.3%). Secondary infections were present in 3.5% and disseminated intravascular coagulation in 3.1% of cases, and fasciotomy was performed in 4.2% cases, while an amputation in 6.9%. Only 0.9% of patients died. Antivenom was administered in 3053 cases. In conclusion, there is a pressing need for robust multi-centre randomized control trials, standardized protocol for snakebite management and antivenom administration across Europe and a National snakebite register for each European country.

The Usefulness of Platelet-Rich Plasma (PRP) for the Treatment of Vitiligo: State of the Art and Review.

INTRODUCTION: Vitiligo is an acquired, idiopathic disorder clinically characterized by amelanotic lesions on the skin which cause significant impairment of patients' quality of life. A variety of treatments have been proposed, with inconsistent results. In the last decades, the use of platelet-rich plasma (PRP) is receiving increasing interest as a potential effective technique in the treatment of several dermatological diseases, including vitiligo. OBJECTIVE: We conducted a review with the aim to identify studies that documented the use of PRP for vitiligo. MATERIALS AND METHODS: Electronic databases of MEDLINE, EMBASE and Cochrane Central Register of Controlled Trials (CENTRAL) from inception to November 2019 have been searched using different combinations of the following terms: "platelet-rich plasma", "platelet gel", "platelet-rich fibrin", "PRP" and "vitiligo". RESULTS: We identified 6 clinical studies consistent with our research, with a total of 253 patients, listing and discussing the obtained results. In all reports, all treated patients showed a stable vitiligo, and a significantly higher improvement in the PRP groups was always observed compared to control groups. Regarding the side effects, PRP in vitiligo patients is useful and without important side effects. CONCLUSION: PRP is a promising treatment for stable vitiligo lesions in different body sites. The possible use of PRP in combination with traditional therapeutic options and the standardization of processing protocols represents a very fertile field for future research. Larger clinical trials with longer time of observation would provide solid evidence regarding the effectiveness of PRP for the treatment of vitiligo.

Alopecia neoplastica as a sign of visceral malignancies: a systematic review.

Alopecia neoplastica (AN) from visceral tumours is a rare form of cutaneous metastasis in which internal malignancies spread to the scalp. The diagnosis of AN may be very challenging, especially when its onset precedes the diagnosis of the primary tumour. We aimed to improve the knowledge on AN, highlighting that in case of scarring localized alopecia, a differential diagnosis with metastasis should always be considered. We performed a systematic review to describe the main demographic and clinical features associated with AN from visceral malignancies; a survival analysis was also performed. In 118 reports, accounting for 123 patients, we found that women were more affected by AN than men (53.7% vs. 46.3%). The most frequent site of the primary tumour was the gastrointestinal tract (24.4%), followed by breast (17.9%), kidney (8.1%), lung (7.3%), thyroid (7.3%), uterus (6.5%), central nervous system (6.5%), liver (3.3%) and other anatomic areas for 18.7% of cases. Furthermore, in more than half of the cases (66.1%), AN lesions were single and were mainly diagnosed after the primary visceral tumour (71.5%). Finally, survival analysis highlighted a lower progression-free survival in men; while, no significant differences in overall survival were reported among genders. In conclusion, metastatic skin disease should always be taken into consideration when dealing with patients with localized scarring alopecia.

Granulomatous reactions after injections of multiple aesthetic micro-implants in temporal combinations: a complication of filler addiction.

BACKGROUND: Granulomatous reaction is a well-known complication following soft filler procedures. However, the diagnosis of filler-induced granulomas may be challenging because of the occasional reluctance of patients to report the previously performed aesthetic procedure. OBJECTIVE: To describe a new clinical situation in which some patients, in the quest for physical perfection, become addicted to multiple sequential cosmetic injections, increasing the risk of adverse reactions. METHODS: We describe three women who developed diffuse facial nodular tumefaction after multiple procedures of filler injections into their face that occurred at different times in the previous years. RESULTS: Histopathology showed a granulomatous reaction including different combined substances that were identified with different types of micro-implants in the same biopsy. CONCLUSIONS: Excessive demand of multiple cosmetic injections may increase the frequency of skin granulomatous reactions and can be included in the spectrum of similar addictive dysmorphophobic behaviours. Histopathology is the best mean to achieve the diagnosis.

Treatment of nodular facial angiofibromas in tuberous sclerosis, using ultrapulse carbon dioxide laser.

Tuberous sclerosis (TS) is a genodermatosis characterized by facial angiofibromas (FAs). These tumours cause aesthetic disfigurement and obstruction of vision, and haemorrhage when traumatized, which can lead to emotional distress and relationship difficulties. We report the case of a 35-year-old patient with extensive TS-associated FAs that were treated with an ultrapulse carbon dioxide laser (UPCDL). UPCDL laser seems to be a easy, useful and convenient tool for the treatment of nodular FAs, which provides good aesthetic results, and a positive response from patients, who report high levels of satisfaction with the results. Minimal recurrence of the tumours occurred during long-term follow-up, and these were successfully treated with UPCDL. It is not yet possible to correct the genetic alterations underlying TS, but UPCDL treatment is a convenient tool to improve the facial appearance of patients with severe FAs.