Carcinogenic risk in patients treated with UVA-1 phototherapy: A 5-year retrospective study.

BACKGROUND: UVA-1 phototherapy was first used to treat atopic dermatitis and afterwards to several other skin diseases. The contribution of UVA-1 in human photocarcinogenesis, skin photoaging, immune suppression, and hyperpigmentation is now well established. The actual contribution of UVA-1 radiation to the development of malignant melanoma (MM) in humans cannot be excluded. PURPOSE: The aim of the study is to evaluate the risk of developing skin cancers (non-melanoma skin cancers (NMSCs) and MM) in patients treated with UVA-1 phototherapy with a 5-year dermatological follow-up. METHODS: We conducted a retrospective cohort study with 31 patients with morphea and atopic dermatitis treated with medium dose UVA-1 phototherapy (34 J/cm2). All enrolled patients underwent an oncologic prevention visit annually with a 5-year follow-up with clinical evaluation of the entire skin surface. RESULTS: During the 5-year follow-up, we recorded a case of basal cell carcinoma (BCC) in the cervical region and one case of MM on the back (pT1a). In both cases, the patients were female and affected by morphea. The Glogau 3 group is prevalent (42%), which is consistent with moderate to severe aging; the data appear to be compatible with the age. CONCLUSIONS: This study attests that medium-dose UVA-1 phototherapy does not increase the risk of developing skin tumors and that UVA-1 phototherapy is not a worsening factor of facial photoaging. The main limitation of the study is the small sample size, avoiding to obtain statistically significant values. It was not possible to analyze individually the actual daily sun exposure during the 5-year observation period and to correlate it in terms of time and tumor development. Further studies with large sample sizes will be needed to confirm our data. Our study reaffirms how the dermatological examination performed annually is essential in the follow-up of patients undergoing this type of therapy.

Evaluating the Clinical Meaning of Dermatology Life Quality Index Scores Between Different Phenotypes of Atopic Dermatitis in Patients Before and After Biologic Therapy With Dupilumab.

Background and Objective: Atopic Dermatitis (AD) is the most prevalent inflammatory skin disorder resulting in an intense impact on patients quality of life. The aim of this study is to evaluate the clinical meaning of the DLQI scores documented between different phenotypes of AD patients under biologic therapy with Dupilumab. Method: We conducted a retrospective analysis of 209 patients with AD treated with Dupilumab for 2 years. These patients were categorized into different clinical phenotypes. Severity of the disease was assessed by using the Eczema Area and Severity Index (EASI), Numerical Scale Rating (NRS) for sleep (NRS sleep), pruritus (NRS pruritus) and Dermatology Life Quality Index (DLQI) at baseline and subsequently at 4,12 and 24 months. Results: Our results show that the higher DLQI scores (mean: 18.6, range:9-30) achieved at T0 are associated with a prurigo nodularis AD pattern, while after 24 months (T3) of therapy with Dupilumab, the worst quality of life index results were reported in Flexural and Head-Neck combined clinical phenotypes. Conclusions: Quality of life is probably what matters most as an overall endpoint in AD. Assessing the clinical meaning of DLQI scores across different AD phenotypes could be a further aid when considering decision making factors in patient management.

Super-High Magnification Dermoscopy in 190 Clinically Atypical Pigmented Lesions.

Super-high (×400) magnification dermoscopy (D400) is a new non-invasive imaging technique that has been shown to add information for the differential diagnosis of melanocytic lesions in a pilot study. Our study aimed to confirm if D400 can add details for the discrimination of clinically atypical nevus and melanoma. This is a retrospective observational, multicentric study enrolling patients who received ×20 (D20) and ×400 (D400) magnification dermoscopic examinations of pigmented skin lesions. Dermoscopic images were retrospectively evaluated by three observers for the presence/absence of nine D20 and twenty D400 dermoscopic features defined in the previous pilot study. Univariate and multivariate analyses were carried out to find predictors of benign and malignant behaviors. At D20, an atypical pigment network, blue-whitish veil, atypical vascular pattern, regression, and homogenous pattern were more frequent in melanoma than in nevi (p < 0.001). At D400, melanoma showed more frequently than benign lesions, melanocytes with an irregular arrangement and irregular in shape and size (p < 0.001). A network with edged papillae was more frequent in benign lesions than melanomas (p < 0.001). Our study confirms that D400 can identify melanocytes with an irregular arrangement, and irregularities in shape and size in melanomas, adding information to the conventional D20 examination.

Super-High Magnification Dermoscopy Can Help for the Diagnosis of Lentigo Maligna: a Pilot Study on 61 Cases.

INTRODUCTION: Facial lentigo maligna/lentigo maligna melanoma (LM/LMM) is a significant diagnostic clinical challenge and dermoscopy can help its diagnosis. OBJECTIVES: The following study aimed to evaluate if super-high magnification dermoscopy at 400x can add further details for the diagnosis of the LM/LMM. METHODS: This is a retrospective observational, multicentric study enrolling patients who received a 20x and 400x (D400) magnification dermoscopic examination of facial skin lesions in clinical differential diagnosis with LM/LMM. Dermoscopic images were retrospectively evaluated by four observers for the presence/absence of nine 20x and ten 400x dermoscopic features. Univariate and multivariate analyses were carried out to find predictors of LM/LMM. RESULTS: We enrolled 61 patients with a single atypical skin lesion of the face, including 23 LMs and 3 LMMs. The presence of roundish and/or dendritic melanocytes (P < 0.001), irregular arrangement of melanocytes (P <0.001), irregular in shape and size melanocytes (P = 0.002), and folliculotropism of melanocytes (P <0.001) at D400 were more frequent in LM/LMM than other facial lesions. According to the multivariate analysis, roundish melanocytes at 400x dermoscopy were more indicative of LM/ LMM (Odds Ratio-OR 49.25, 95% CI 8.75-513.2, P < 0.001), and sharply demarcated borders at 20x dermoscopy were more indicative of not-LM/LMM (OR 0.1, 95% CI 0.01-0.79, P = 0.038). CONCLUSIONS: D400 can identify atypical melanocyte proliferation and folliculotropism that can help to identify LM/LMM together with conventional dermoscopy data. Our preliminary observations should be confirmed by larger studies.

Association between psoriasis, sleep, and dermatological quality of life: results of a cross-sectional study.

BACKGROUND: Psoriasis is a chronic relapsing inflammatory T-cell mediated disease who affects patients' daily activities and life quality. The association between sleep quality, dermatological quality of life (QoL) and psoriasis severity has been poorly investigated to date. The aim of this study is to investigate how sleep quality impacts on the severity of psoriasis, and to assess whether the different therapies used for psoriasis affect the dermatological QoL. METHODS: We conducted a cross-sectional study on 152 adult patients based on specific questionnaires about the sleep quality (PSQI) and the dermatological quality of life (DLQI). Patients were divides into three groups according to severity (mild, moderate and severe) and therapy (group 1: no current therapy or exclusive use of topical drugs, group 2: use of conventional systemic drugs and group 3: biologics). The outcomes were expressed in the form of an Odd Ratio (OR) and for each variable it was commented whether the OR obtained was statistically significant or not. RESULTS: Inferential statistics comparing patients' DLQI showed that patients in group 3 and group 1 had comparable results. The OR obtained allowed us to state that those not taking biological drugs have a 4-fold higher risk of developing severe psoriasis than those taking them as therapy. No statistical difference was highlighted about sleep quality. CONCLUSIONS: This emphasizes that adequate therapy with biologic drugs allows patients with severe psoriasis to have a comparable QoL to those who are not impaired enough to require systemic or biologic therapy.

Exploring the Relationship Between Dermatology Life Quality Index, Eczema Area and Severity Index, and Sleep Numerical Rating Scale and Pruritus Numerical Rating Scale in Patients with Atopic Dermatitis Treated with Dupilumab.

Objective: Patients with atopic dermatitis (AD) experience decreased quality of life (QoL). Here we describe the relationship between severity and QoL-related scores in patients with moderate-to-severe AD treated with dupilumab. Patients and Methods: This was a real-life, retrospective, and observational study involving patients with AD treated with dupilumab. Treatment effectiveness was evaluated based on the changes in the eczema area and severity index (EASI), sleep quality numerical rating scale ,and pruritus numerical rating scale (PNRS), as well as the dermatology life quality index (DLQI). The relationship between each of them was analyzed. After the first data collection at baseline, patients were re-evaluated at 3 subsequent follow-ups (4, 8, and 12 months). Results: A total of 52 patients were enrolled in the study. At 4 months, the change in DLQI is more correlated with PNRSs (r = 0.643, P < 0.001) than the other scores considered. At 8 months, however, the change in DLQIs correlates similarly both with PNRSs (r = 0.644, P < 0.001) and with the change in EASIs (r = 0.633, P < 0.001). At 12 months of treatments, however, the trend reverses and the correlation with EASIs becomes higher (r = 0.735, P < 0.001) than PNRSs (r = 0.0.659, P < 0.001). Conclusions: The results of our study show that the reduction in the impact on QoL for AD patients in the first months of therapy with dupilumab correlates more with the control of pruritus than with the disappearance of skin lesions.