Eosinophilic annular erythema in adults: report of two cases and review of the literature.

We herein report two cases of eosinophilic annular erythema in adults, which is rare. In both patients, lesions developed rapidly in few days and were located mainly on the trunk, buttocks, and extremities. Diagnosis was histopathological, with typical features including acute dermal inflammatory infiltrate with abundant eosinophils. One of the patients recurred after treatment on three occasions and finally cured spontaneously. The second patient recurred once and was then successfully treated with topical clobetasol. Clinical and histopathological features of eosinophilic annular erythema in adults have rarely been reported. A review of the literature and discussion of relationship with Wells syndrome are also included.

Melanoma in situ and syringoma: a rare collision tumor. Clinical-pathological report of a case.

Collision or contiguous tumors, defined as two or more distinct tumors occurring at one site, are often an unexpected finding and may represent a diagnostic challenge, as clinical and histological presentations do not always coincide. Various combinations of collision tumors have been described with respect to melanocytic lesions, with the most frequently reported being the combination of nevus and basal cell carcinoma. We present an unusual case on the nose involving a melanoma in situ and a clinically-inapparent syringoma, which, to the best of our knowledge, is the first report of this combination.

Adalimumab-related alopecia in a patient affected by psoriasis.

Alopecia induced by biological therapy is a rare side effect of this type of drugs. A total of 23 patients of psoriasiform eruptions with severe scalp involvement that induced alopecia during anti-tumor necrosis factor (anti-TNF) treatment of non-dermatological conditions have been previously reported. We present a 50-year-old man affected by plaque psoriasis that developed psoriasiform patches with alopecia over his scalp 10 months after initiating treatment with adalimumab. Punch biopsy of the alopecic area on the scalp revealed psoriasiform epidermal changes and alopecia areata-like dermal changes. Along with these findings, there was a dermal inflammatory infiltrate made up of eosinophils and plasma cells. In conclusion, scalp psoriasiform lesions with alopecia in patients treated with anti-TNF agents have been rarely reported. We describe a patient with anti-TNF therapy-related alopecia affected by psoriasis. Our patient has a peculiar histology with features of psoriasis and alopecia areata in addition to eosinophils and plasma cells. This entity may respond to topical treatment. However in patients of severe scalp involvement anti-TNF suspension should be considered.

Eosinophilic annular erythema in adults: report of two cases and review of the literature

Abstract We herein report two cases of eosinophilic annular erythema in adults, which is rare. In both patients, lesions developed rapidly in few days and were located mainly on the trunk, buttocks, and extremities. Diagnosis was histopathological, with typical features including acute dermal inflammatory infiltrate with abundant eosinophils. One of the patients recurred after treatment on three occasions and finally cured spontaneously. The second patient recurred once and was then successfully treated with topical clobetasol. Clinical and histopathological features of eosinophilic annular erythema in adults have rarely been reported. A review of the literature and discussion of relationship with Wells syndrome are also included.

Melanoma in situ and syringoma: a rare collision tumor. Clinical-pathological report of a case

Abstract Collision or contiguous tumors, defined as two or more distinct tumors occurring at one site, are often an unexpected finding and may represent a diagnostic challenge, as clinical and histological presentations do not always coincide. Various combinations of collision tumors have been described with respect to melanocytic lesions, with the most frequently reported being the combination of nevus and basal cell carcinoma. We present an unusual case on the nose involving a melanoma in situ and a clinically-inapparent syringoma, which, to the best of our knowledge, is the first report of this combination.

Agomelatine for Depression in Parkinson Disease: Additional Effect on Sleep and Motor Dysfunction.

Depression and sleep disorders are among the most prevalent nonmotor symptoms of Parkinson disease (PD). Because agomelatine acts as a MT1 and MT2 agonist and as a 5HT2c antagonist, this study was designed to assess the efficacy of agomelatine in treating depressive symptoms in PD patients, and the potential changes both in sleep quality and motor symptoms. Depressed patients with PD were treated with agomelatine for 6 months, and they were evaluated with an array of scales. Completed nocturnal video-polysomnography was performed at baseline and week 12. The efficacy analysis population included 24 patients (12 men). The mean (SD) age was 75.2 (8.3) years. The mean (SD) daily dose of agomelatine was 25.00 (10.43) mg at 24 weeks. No changes in dopamine replacement therapy were made. There was a significant decrease in the 17-item Hamilton Depression Scale score over the course of the study (P < 0.0005). The Scales for Outcomes in Parkinson disease Sleep Questionnaire showed a statistically significant improvement over time in each of its subscales: nighttime sleep (P < 0.005), last month nighttime sleep (P < 0.0005), and daytime sleepiness (P < 0.0005). Surprisingly, changes over time in the motor subscale of Unified Parkinson Disease Rating Scale were statistically significant (P < 0.0005). Periodic limb movements and awakenings measured by polysomnography improved significantly (P < 0.005 and P < 0.05, respectively). We concluded that the use of agomelatine in PD depressed patients may have a considerable therapeutic potential because of its dual action for treating both symptoms of depression and disturbed sleep given its secondary beneficial effects regarding the reduction of extrapyramidal symptoms.

Efficacy of adalimumab in the treatment of psoriasis: a retrospective study of 15 patients in daily practice.

BACKGROUND: Adalimumab is a fully human IgG1 monoclonal antibody that binds to tumor necrosis factor (TNF), a key proinflammatory cytokine involved in the pathogenesis of psoriasis. OBJECTIVE: A single-center, retrospective study was conducted to assess the efficacy and safety of adalimumab in patients with moderate to severe psoriasis in daily practice. METHODS: The medical records of 15 patients with moderate to severe psoriasis treated with adalimumab during a 1-year period were reviewed. Previous conventional systemic treatments or other biological agents were unsuccessful. All patients received subcutaneous injections of an initial dose of adalimumab (80 mg) at week 0 followed by adalimumab (40 mg) every other week. RESULTS: A 75% improvement in the Psoriasis Area and Severity Index (PASI 75) score was achieved by 80% of patients at week 24 and by 73.3% of patients at week 48. Moreover, 13.3% of patients were almost completely cleared (PASI 90) at week 48. At 24 weeks, adalimumab therapy increased significantly a patient's quality of life as assessed by the Dermatology Life Quality Index (DLQI) (p = 0.001). The Nail Psoriasis Severity Index (NAPSI) decreased from a mean (SD) of 18.9 (12.2) to 8.2 (4.7) (p = 0.001) at week 24. Palmoplantar psoriasis decreased from a mean score of 1.1 (1.3) to 0.5 (0.9) (p = 0.026) and scalp involvement from a mean of 2.5 (1.2) to 1.1 (1.0) (p = 0.002) at week 24. Out of 11 patients with pruritus at the pre-treatment visit, this symptom had completely disappeared in nine of them after 24 weeks of treatment. CONCLUSIONS: Treatment with adalimumab proved to be effective for the management of chronic moderate to severe plaque-type psoriasis in patients whose disease had been refractory to systemic conventional therapies or other biologic agents.

Radiotherapy for extramammary Paget disease of the anogenital region.

Extramammary Paget disease is a rare condition that most commonly affects the anogenital region in the elderly. The treatment of choice has been surgical excision of the affected area with adequate depth and lateral margins, criteria that cannot always be fulfilled, especially when the vulva, anal canal, or penis are involved. More recently radiotherapy has been suggested as a suitable treatment when surgical excision or other modalities are not appropriate. We report a case of anogenital extramammary Paget disease and the clinical response to treatment with radiotherapy. The aim of this article is to review relevant aspects of radiotherapy as a first-choice curative treatment in specific situations of anogenital extramammary Paget disease in situ.

Cobb syndrome: case report and review of the literature.

Cobb syndrome is a rare non-inherited neurocutaneous disease, in which there are metameric cutaneous and spinal vascular malformations of the trunk. In cases of segmentally distributed multiple cutaneous vascular lesions, early diagnostic imaging of the spinal cord allows prompt intervention in order to reduce permanent neurological sequelae. We report case of Cobb syndrome in a 12-year-old boy and present a systematic review of the literature.

Tacalcitol ointment for the treatment of nail psoriasis.

Tacalcitol is a vitamin D analog with proven efficacy for the topical treatment of psoriasis, but to date it has not been tested in psoriasis of the nail. However, successful treatment has been reported with other vitamin D derivatives such as topical calcipotriol, and topical calcitriol in one study. The present study aimed to assess the efficacy and tolerability of topical tacalcitol in the treatment of nail psoriasis in a sample of 15 patients over a 6-month period. Treatment with tacalcitol ointment may be useful to treat nail psoriasis as it achieves a significant improvement in all nail parameters, both of the matrix and of the bed.

Is deoxypyridinoline a good resorption marker to detect osteopenia in phenylketonuria?

OBJECTIVES: To evaluate deoxypyridinoline as a resorption marker in phenylketonuria (PKU) and to search for a relationship between deoxypyridinoline, calcium/creatinine index (Ca/Cr I), osteocalcin and bone alkaline phosphatase (BAP). METHODS: This was a transversal analytical study of 46 PKU patients [17.5 (4-38) years]. Deoxypyridinoline and osteocalcin were measured with a chemiluminescent assay and BAP was measured with an immunoradiometric assay. RESULTS: Deoxypyridinoline was significantly increased in patients aged 7-14 and >18 years old, being associated with age (r=-0.724, P<0.001). Adult patients showed significantly higher Ca/Cr I, which correlates with Phe values for the year prior to the study (P=0.014). Serum BAP was significantly increased in pediatric patients (9-13 years), while it was decreased in adult patients (P=0.003). Decreased osteocalcin levels were found in patients>15 years (P=0.028). Altered deoxypyridinoline and BAP values were related (P=0.042). CONCLUSION: PKU patients excreted increased D-Pyr, suggesting high bone resorption. Bone formation seems active in childhood but deteriorates in adult PKU patients. Periodic measurement of D-Pyr and BAP may be useful in the prevention of osteopenia in PKU patients.

Serum levels of parathyroid hormone and parathyroid-related peptide in psoriasis.

Psoriasis is a common skin disorder that may be triggered by hormonal disturbances, among other factors. Some studies have demonstrated an elevation of serum parathyroid hormone (PTH) levels in psoriasis and several other diseases of keratinization of unknown aetiology. PTH-related peptide (PTH-rp), on the other hand, is a potent inhibitor of epidermal cell growth factor and is not expressed in psoriatic skin. Serum levels of this peptide have not been reported in psoriasis. Immunoassay was used to measure serum PTH and PTH-rp in 22 patients with plaque-type psoriasis before and after treatment with mometasone furoate. Results were compared with a group of 20 healthy, non-psoriatic volunteers. Serum PTH levels were significantly elevated in the psoriatic group compared with the control group (p=0.001) and were significantly reduced after treatment (p=0.01). A correlation was found between pretreatment serum PTH levels and psoriasis area and severity scores (PASI) (r=0.42; p=0.01). In contrast, serum PTH-rp levels were not different between psoriatics and controls and were not affected by treatment. These findings indicate that serum PTH concentrations reflect disease activity in patients with psoriasis.

Treatment of nail psoriasis with 8% clobetasol nail lacquer: positive experience in 10 patients.

BACKGROUND: Treatment of nail psoriasis is difficult. Several topical therapies have been employed with poor results because drug penetration is limited in this localization. Recently, a new formulation containing 8% clobetasol-17-propionate in a colourless nail lacquer vehicle has shown good results in the control of nail psoriasis. OBJECTIVE: To determine the efficacy and safety of 8% clobetasol-17-propionate in a lacquer vehicle in nail psoriasis. METHODS: Ten patients with both nail bed and matrix psoriasis were included in the study. They were treated with a colourless nail lacquer containing 8% clobetasol-17-propionate that was applied once daily for 21 days and then twice weekly for 9 months. RESULTS: Within 4 weeks of therapy there was a reduction of all the nail alterations, including nail pain. Therapeutic response was directly related to the length of therapy. The nail parameters that responded best to therapy were onycholysis, pitting and salmon patches. Subungual hyperkeratosis and splinter haemorrhages on the other hand had moderate and poor improvement, respectively. The treatment was well tolerated in all of the patients and there were no local (i.e. atrophy and sobreinfection) or systemic secondary effects. CONCLUSIONS: The formulation containing 8% clobetasol-17-propionate is a safe, effective and cosmetically highly acceptable treatment for nail bed and matrix psoriasis.

El impacto psicosocial de la psoriasis / The psychosocial impact of psoriasis

Introducción: la psoriasis es una dermatosis frecuente que produce un importante impacto psíquico y social entre los pacientes afectados. Asimismo es conocido que el estrés es uno de los factores desencadenantes más frecuente de los brotes. Material y métodos: hemos diseñado un cuestionario anónimo de 30 puntos que recoge datos demográficos, así como los factores desencadenantes de la psoriasis y una serie de preguntas acerca de la repercusión psicosocial generada por la misma en el último mes. La encuesta se envió por correo a 1.500 pacientes, visitados hasta entonces en nuestros departamentos, entre diciembre de 1996 y marzo de 1997. Resultados: fueron contestadas 231 encuestas (16,8%) correspondientes a un 54,1% de hombres y un 45,9% de mujeres, con una edad media de 43 años. Entre los resultados obtenidos destaca que el estrés fue el factor desencadenante más importante de los brotes (43% de los encuestados); dentro de las situaciones desencadenantes de estrés, los conflictos afectivos fueron los más frecuentes (24,2%), especialmente en mujeres. Existe una correlación entre el estrés como factor desencadenante y el sexo femenino. Hay que destacar que un 51,5% de los pacientes se sienten bien informados, especialmente por parte de su dermatólogo (58,9%), y que el nivel de satisfación con su dermatólogo es alto, alcanzando un 47,2% de los casos. Destacamos que un 38,8% de pacientes no acudió muchas veces a baños públicos en el último mes. Conclusión: nuestros resultados confirman una vez más el hecho de que el estrés es uno de los factores desencadenantes más frecuentes de la psoriasis y que esta dermatosis genera un importante impacto psicosocial entre los individuos afectados (AU)

Tratamiento de la psoriasis en placas con propiltiouracilo tópico / Treatment of plaque-type psoriasis with topical propylthiouracil

Introducción: en los últimos años se han publicado varios estudios en los que se demuestra la eficacia de dos fármacos antitiroideos (propiltiouracilo y metimazol) en el tratamiento de la psoriasis tanto por vía oral como tópica. Objetivo: evaluar la eficacia del propiltiouracilo tópico al 5% en comparación con calcipotriol en el tratamiento de la psoriasis en placas. Material y métodos: estudio prospectivo y randomizado sobre 28 pacientes de los que la mitad fueron tratados con propiltiouracilo al 5% en crema tres veces al día y la otra mitad con calcipotriol ungüento 50 µg/g dos veces al día. Resultados: no se observaron diferencias significativas entre el PASI basal y el PASI a las 4 y 8 semanas en los pacientes tratados con propiltiouracilo tópico y sí, en cambio, con los tratados con calcipotriol. Asimismo hay diferencias significativas entre el PASI a las 8 semanas de los pacientes tratados con calcipotriol respecto a los tratados con propiltiouracilo tópico. No se observaron efectos secundarios. Conclusiones: el propiltiouracilo al 5% en crema es ineficaz en el tratamiento de la psoriasis en placas (AU)