Topical diclofenac 3% gel plus cryotherapy for treatment of multiple and recurrent actinic keratoses.

This paper reviews retrospectively the results obtained in a case series of multiple refractory actinic keratoses (AKs), treated sequentially with topical diclofenac 3% gel followed by cryotherapy. In total, 29 patients were reviewed; all had >or= 5 lesions (mean 8.2; range 5-12) and a long-term history of recurrence after repeated cryotherapy. After a first-line, 12 week treatment phase with diclofenac 3% gel alone, the number of AKs per subject was reduced to an average of 1.5 AKs (range 0-5), with complete clearance of lesions in 21 cases (71%). Patients showing incomplete response to the above treatment (n = 8) then received liquid-nitrogen ablation for all residual lesions. This procedure resulted in complete clearance of all cases. Significantly, during the post-treatment follow-up period, patients had no AK recurrences for an average of 10 months (range 6-20). Sequential treatment with diclofenac 3% gel followed by cryotherapy may therefore represent an effective approach for the management of multiple refractory AKs.

Seborrheic dermatitis, increased sebum excretion, and Parkinson's disease: a survey of (im)possible links.

The concept of skin as a mirror of parkinsonism, dates back at the beginning of the last century. Since then, much evidence has been accumulated supporting a causal association between the neurological disturbance and changes detectable on areas of the integument with the richest sebaceous gland supply, namely seborrheic dermatitis and/or seborrhea. However, the many persisting sources of perplexity weighing on some general aspects of the skin condition itself (lack of standardized diagnostic criteria, high variability of estimates of prevalence, and controversies on etiology and pathomechanisms) must have to date hampered assessment of the real nature, and significance (if any) of the links observed. The three major pathogenical pathways so far conceived in this context will be critically reviewed on the basis of evidences provided in the literature.

Topical immunotherapy with contact sensitizers: a model to study the natural history of delayed hypersensitivity.

So-called 'topical immunotherapy' (TI) is a well-established treatment modality based on the use of potent contact sensitizers, such as squaric acid dibutylester (SADBE), that are not found in the general or occupational environment of man, and do not induce cross-sensitization to other substances. Thus, unlike patients with sensitivity to other more or less commonplace allergens, subjects submitted to this treatment modality might provide useful data for the study of the natural course of contact sensitivity. On the basis of these premises, we have retrospectively reviewed 40 patients who had consecutively received TI with SADBE for severe alopecia areata and viral warts in the period 1993-2001, and returned to visit after a 1-7-year period since the last therapeutic challenge with the sensitizer. The chronological profile of loss of contact sensitization of this case cohort has been evaluated and compared to that of other series available in the literature. Provided more standardized TI application procedures are established, aim-oriented studies of the outcome of this treatment modality may bring useful data to be employed in construction of predictive models of decay of contact sensitization under conditions of antigen avoidance.

Peeling agents: toxicological and allergological aspects.

BACKGROUND: The use of peeling agents is very common in clinical practice. However, despite the overall good safety profile, it is not without any inherent risk; therefore, clinicians should be adequately informed about potential risk in order to avoid or prevent them. OBJECTIVE: This paper reviews toxicological and allergological aspects of peeling agents in general, also beyond their actual use in peeling procedures. Toxic and allergic reactions from peeling agents are rather uncommon and have been rarely reported in association with the medical use of peels. METHODS: Systemic toxic effects may essentially derive from phenol and potentially from two phenol derivatives, resorcinol and salicylic acid. A complete understanding of the toxicological profile of peeling agents, along with a correct execution of the technique and a carefully selection of patients, can help avoid serious side effects. RESULTS: Allergic contact reactions occur most frequently with resorcinol, while most peeling agents are only rare sensitizers or appear to be free of true sensitizing power. Other types of hypersensitivity response seem to be very rare.

Classical Kaposi's sarcoma: a survey of 163 cases observed in Bari, south Italy.

BACKGROUND: Classical Kaposi's sarcoma (KS) is a sporadic disease that is particularly prevalent in Mediterranean countries. OBJECTIVE: The aim of the study was to update clinical information about this rare condition. METHODS: A survey of 163 cases observed in the period 1971-1990 in Bari, South Italy, was carried out. All records were reviewed and, when lost to follow-up for more than 6 months, patients were called back to update personal and family histories. The age at onset averaged 64 years (range 18-85). The male-to-female ratio was 3:1. No familiar occurrence was identified, and no significant association was found with other conditions (i.e. second primary malignancies and diabetes mellitus). Death from KS occurred in 16 cases, at the mean age of 71 years, an average of 5.7 years after the onset of the disease. To assess whether the different clinical patterns of the disease in its earlier stages may give any indication of its subsequent clinical course, all cases were re-classified into three groups (low-, moderate- and high-eruptivity group) on the basis of both the extent and the rate of spread of the disease before first admission; group-stratified survival function was evaluated using Kaplan-Meier's life table method. RESULTS: Highly significant (p < 0.0001) differences were found in survival profiles of the three study groups, also when only deaths due to KS were computed. CONCLUSION: These findings provide some support to the hypothesis that three subsets of classical KS exist that have different prognoses and, consequently, need different therapeutic approaches.

Cutaneous vasculitis as the sole manifestation of disseminated gonococcal infection: case report.

One of the possible systemic complications of gonorrhoea is disseminated gonococcal infection (DGI), which is usually characterised by both skin and joint lesions. While joint involvement ranges from tenosynovitis to suppurative arthritis, cutaneous involvement features varied non-specific patterns often clinically and histologically consistent with vasculitis. We report a case of DGI in which an extensive, vesicobullous, haemorrhagic, and necrotic cutaneous vasculitis was the sole manifestation of the disease.

Idiopathic chronic pigmentary purpura. Findings in 22 cases and proposal of a new classification.

22 cases of Idiopathic Chronic Pigmentary Purpura are described in 9 males and 13 females with an age range from 14 to 66. Clinical picture, morphology and distribution of the lesions varied. Laboratory and instrumental investigations excluded the presence of systemic diseases or toxic/pharmacological factors responsible for the purpuric eruption. On the basis of the clinical aspects and the histopathological results, an exclusively morphological classification of idiopathic purpuras in macular, papular and eczematic forms is proposed, maintaining that the old nosography is not justified and also taking into account the pathogenetic overlapping confirmed by recent immuno-histochemical and ultramicroscopical studies.

Cutaneous sporotrichosis in the period 1978-1992 in the province of Bari, Apulia, Southern Italy.

The authors report 16 cases of cutaneous sporotrichosis observed in the province of Bari, southern Italy, since 1978. While no more than 55 cases have been documented in other European countries in the last 30 years, in Italy 58 cases (present series included) have been recorded in the same time period. Furthermore, 42 of them (73.7%) originated from Apulia. This unexpectedly high incidence rate in Italy, and in Apulia in particular, provides evidence of the important role played by this area in the ecoepidemiology of sporotrichosis in Europe.