Real-World, Retrospective, Multicenter, Observational Study on the Use of the First Liquid AbobotulinumtoxinA in Italy.

INTRODUCTION: Randomized controlled trials (RCTs) suggested that liquid formulation of botulinum toxin type A (aboBoNT-A) is safe and effective, but data confirming these characteristics in a real-life heterogenous set of patients are currently lacking. This study aimed to assess the efficacy and safety of the ready-to-use aboBoNT-A solution in adults with moderate-to-severe glabellar wrinkles. METHODS: In this real-life, multicenter, retrospective, observational study, healthy adults were treated at baseline only with aboBoNT-A solution on the glabellar area and followed up for 24 weeks. Re-treatment after 20-24 weeks could also be combined with other aesthetic procedures. Family history of immune-mediated inflammatory diseases (IMIDs) was not an exclusion criterion. Patient-reported outcomes (patient's satisfaction and injection-related pain) and physician-reported outcomes (Physician Global Assessment, PGA) were collected. RESULTS: Of the 542 patients enrolled in the study, 38 had IMID family history. Injection-related pain was reported in 128 (23.62%) as mild (pain VAS = 1.34 ± 0.87) mainly by non-botulinum toxin treatment-naïve women under 50 years of age. At 48 h, physicians rated the clinical result as "improved" in 64% of patients, conversely 264 patients (48.71%) self-evaluated as "satisfied"/"very satisfied". At 4 weeks a touch-up (< 10 units) was performed in 11 (2.03%) patients and 98.2% were "highly satisfied". Re-treatment was performed in 330 (61.45%) patients, mainly botulinum-experienced, at 20 weeks and in 207 (38.55%), mainly botulinum naïve, at 24 weeks. A total of 403 (74.35%) patients were re-treated with the three-point technique and 201 (37.08%) also received hyaluronic acid filler in the lower central face and middle third. There were no cases of de novo IMIDs. CONCLUSIONS: Real-world data confirmed that aboBoNT-A is a fast, efficient, durable, reproducible, and easy-to-use drug which is also well tolerated in patients with family history of IMID.

Mental Health Consequences of the COVID-19 Pandemic Long-Term Exposure in Italian Dermatologists.

The present study aimed at assessing the consequences of prolonged exposure to COVID-19 distress on mental health in non-frontline health care workers. For this purpose, we have conducted a survey on 425 Italian dermatologists, in the period February-March 2021. The psychopathological symptoms, depression, anxiety, post-traumatic stress symptoms (PTSD), as well as resilience, have been evaluated. The main factors that influence the physician's psychological health have been also investigated. Our study showed that the physicians older than 40 years, as well as those who lived this period in company, reported more personal resources, better managing the distress. Resilience, COVID-19 beliefs, COVID-19 working difficulties, and age were the common predictors of the severe psychopathological symptoms. An interesting result is that the lower level of resilience was the most powerful predictor of a more severe depression, as well as of a higher severity of generalized anxiety disorder, but not of COVID-19 PTSD. The fear of COVID-19 was the most powerful predictor of COVID-19 PTSD. Home conditions and previous SARS-CoV2 infection constituted significant predictors of severe depressive symptoms, but not of anxiety and COVID-19 PTSD. These results are useful in a better understanding of protective and risk factors involved in COVID-19 long-term distress exposure.

Efficacy of botulinum toxin type B for the treatment of primary palmar hyperhidrosis: a prospective, open, single-blind, multi-centre study.

Primary palmar hyperhidrosis is a distressing and disabling condition that can produce social, psychological and occupational problems. Although the use of botulinum toxin type A (BoNT-A) has been reported as an efficacious and safe intervention to improve palmar hyperhidrosis, only one study concerned botulinum toxin type B (BoNT-B) in this disorder. The aim of study was to evaluate the efficacy and safety of BoNT-B in treating primary palmar hyperhidrosis. Participants were injected with 5,000 IU of BoNT-B in each palm. Visual analogue test (VAS) to evaluate the intensity of decrease in sweat production, Minor's iodine starch test and measurement of paper towels' weight were used to ascertain palmar sweating at baseline, 4, 12 and 24 weeks after BoNT-B injections by a blind examiner. Thirty-two subjects (12 males, 20 females, mean age 31 ± 11) were enrolled. Significant reduction of palmar sweating was detected after BoNT-B injection: 2.9 ± 1.4, 0.3 ± 0.4, 0.9 ± 0.8, and 2.1 ± 1.5 g (p < 0.001) of paper towels' weight for the right palm at baseline, 4, 12 and 24 weeks; and 2.8 ± 1.7, 0.5 ± 0.6, 0.8 ± 0.7, and 1.8 ± 1.25 g (p < 0.001) at same time, respectively for the left palm. Significant reduction of mean VAS values were also detected after BoNT-B injections: 8.6 ± 1.1, 0.6 ± 0.8, 3.5 ± 2.5, and 7.1 ± 2.4 (p < 0.0001) at baseline, 4, 12 and 24 weeks, respectively. Mild side effects consisting in local pain and hand weakness were observed in 4 (12.5%) subjects. The findings indicated that the use of 5,000 IU BoNT-B injection in each palm was safe and significantly improved the severity of palmar hyperhidrosis.

Children and sun exposure in the northeast of Italy.

Excessive, incorrect exposure to the sun at a young age can be a risk factor for skin cancer at a later age. In this study we have investigated the exposure and protection habits of a group of children to see whether there are behavioral errors that should and possibly could be corrected. We handed out a multiple-choice questionnaire to 310 subjects, 212 boys and 98 girls between the ages of 6 and 14, all residents in the province of Udine in the northeastern part of Italy. Of these children, 24% had sunburn on several occasions; boys were four times more at risk than girls (OR = 0.4) and the frequency reduced by 30% for each skin phototype class higher. In children between 11 and 14 years of age, exposure was prolonged (43% for 2-4 hours, 38% for 4-8 hours) and 30% preferred peak hours. Eighty percent of the children, mostly girls, younger children (6-10), and the lower skin phototypes used sunscreens, but only 38% used them on a regular basis, whereas 20% applied them after sunbathing and 42% used a single daily application. Two percent of the children used sunglasses and 5% wore a T-shirt regularly. The dermatologist and pediatrician play an important role in advising parents that the sun is good for children, but appropriate measures must be taken to reduce any risks, both immediately and in the long term.

Multiple sclerosis and bullous pemphigoid: a casual association or a pathogenetic correlation?

The literature reports about thirty cases of bullous pemphigoid (BP) which developed in patients affected by multiple sclerosis (MS), although a relationship between these two diseases has not yet been identified. We report two cases of female patients affected by MS who subsequently developed BP. Two women came to our observation because of the presence of a bullous dermatitis. One, aged 54, had been affected by rapidly evolving MS for three years while the other, aged 60, had been suffering from MS since the age of 43. The clinical suspicion of BP was confirmed by cytodiagnostic examination, histology and immunofluorescence. Parenteral steroid therapy produced a rapid improvement of the clinical picture in both cases with a relapse after one year. On the basis of the cases observed, in which BP appeared in the absence of known potential triggering causes, and following a revision of the literature, we agree with those authors who assert that the two diseases could, even though only sporadically, be correlated and we think that the neurological disease could be the cause of the manifestations through immunological pathogenetic mechanisms.