A Multicentre, Randomised Clinical Trial to Compare a Topical Nitrizinc® Complex Solution Versus Cryotherapy for the Treatment of Anogenital Warts.

INTRODUCTION: Anogenital warts (AGW) are a relevant clinical issue in the field of sexually transmitted disease, and to date no treatment provides a satisfactory clearance rate. Treatment can be both medical and surgical, and be provided by a healthcare provider or by the patient. Cryotherapy (CRYO) is among the most common treatments for AGW. Nitrizinc® Complex solution (NZCS) is a solution containing organic acids, nitric acid and zinc and copper salts that is applied topically to warts, producing mummification of the damaged tissue. It is considered to be an effective and well-tolerated treatment for genital and common warts. The aim of our study was to compare NZCS to CRYO in the treatment of AGW. METHODS: We performed a prospective, multicentre, single-blind, randomised, superiority clinical study involving 120 patients, aged 18-55 years, diagnosed with a first episode of AGW, with each patient having from three to ten AGW. The patients were treated either with NZCS or CRYO for a maximum of four treatments. Primary endpoints were: (1) comparison of the clinical efficacy of CRYO and NZCS, based on response to treatment (clearance of AGW) within four treatment sessions; and (2) tolerability, assessed via a short questionnaire at the end of each treatment session. Secondary endpoints were: (1) number of treatments needed for clearance; and (2) recurrence at 1 and 3e months after confirmed clearance. The results were analysed on an intention-to-treat basis. RESULTS: A complete response was achieved in 89.7% of the NZCS group and in 75.4% of the CRYO group (p = 0.0443). NZCS was found to be better tolerated. There was no difference between the NZCS and CRYO treatment arms in the number of sessions needed to clear the lesions. Recurrence occurred after 1 month in 18.4% of the NZCS group and 38.1% of the CRYO group (p = 0.0356), and after 3 months in 25 and 40.6% of these groups, respectively (p = 0.1479). CONCLUSIONS: Nitrizinc® Complex solution can be considered to be as effective as CRYO for the treatment of small (< 5 mm) external AGW, with a better tolerability profile and lower rate of recurrence. TRIAL REGISTRATION: ISRCTN identifier, ISRCTN36102369.

Pthiriasis of the eyelashes.

Pthirus pubis, popularly known as crab louse, usually infests the pubis, groin, buttocks, intergluteal fold and perianal region. However, it can also infest, in particular in hairy males or when the infestation is longstanding, the thighs, abdomen, chest, axillae and face. The involvement of the scalp is very rare. Eyelashes may also be involved. We present a review of the literature about etiology, epidemiology, clinical features, complications and therapy of Pthiriasis of the eyelashes.

New Developments for Fractional Co2 Resurfacing for Skin Rejuvenation and Scar Reduction.

Fractional CO2 procedures are an established, safe and effective armamentarium for managing skin rejuvenation and scarring. Very short-pulse-duration devices offer a very high ablated volume/ablated surface ratio, inducing a controlled thermal damage. With this kind of device, each procedure can be customized on the features of the skin of each patient. The same device can be used to treat severe burn scars. With a very deep fractional procedure on a scar tissue, immediate relaxation of the tension and retraction forces may be obtained, and downstream, improvements are related more to the activation of a molecular cascade. The authors review the state-of-the-art, in the use of fractioned CO2 laser technology for aesthetic and scar remodelling indications.

Feast of Sacrifice and Orf, Milan, Italy, 2015-2018.

Orf (ecthyma contagiosum) is an infection of the skin caused by a DNA virus belonging to the genus Parapoxvirus. We recently observed 7 cases of orf in Muslim men living in the metropolitan area of Milan, Italy, who acquired the infection after the Feast of Sacrifice.

Treatment of postscabies prurigo with diflucortolone and chlorquinaldol in a group of African refugees.

Postscabies prurigo (PSP) is caused by a delayed hypersensitivity reaction to antigens of the mite. Treatment is based on potent topical or intralesional corticosteroids. We present the results of a study on the effectiveness of a topical combination of diflucortolone and chlorquinaldol. Eighteen African patients who had been previously affected by scabies and treated with permethrin were enrolled. The diagnosis of PSP was made by excluding other causes through microscopic examinations. All patients were treated with the drug combination by two applications daily for two weeks. The primary study objective was to evaluate the itch by a visual analogue scale (VAS) of 0-100. Fifteen patients (83.3%) could be evaluated. All reported improvements: from 86/100 at the start to 29/100 (-57/100) at the end of treatment. Chlorquinaldol, known as an antiseptic agent, demonstrated, according to results of this study, an important anti-itch action.

Autoimmune bullous diseases during pregnancy: insight into pathogenetic mechanisms and clinical features.

Pemphigoid gestationis (PG), also known as herpes gestationis, is the prototypic pregnancy-associated autoimmune bullous disease (AIBD), but also the other AIBDs, notably pemphigus vulgaris, may begin or exacerbate during pregnancy. Although the increase in concentration of T and B regulatory cells makes pregnancy a state of increased immunologic tolerance toward the semiallogeneic fetal antigens, a prevalent T helper (Th) 2 profile, that is reported to be associated with pregnancy, may cause exacerbation of pemphigus and AIBDs in general during this period. Active disease may lead to stillbirth, spontaneous abortion, preterm pregnancy, low birthweight, and neonatal pemphigus. PG is a rare AIBD usually starting during the third trimester of pregnancy and healing in the postpartum. It is due to the formation of autoantibodies directed against different epitopes of bullous pemphigoid (BP) 180 as a consequence of the aberrant expression of BP180 in the placental tissue of genetically predisposed women. PG is characterized by vesicles with herpetiform distribution, blisters and urticarial elements typically involving the periumbilical area and the distal portion of the upper limbs. Diagnosis is based on: 1) physical examination; 2) histopathological pattern consisting of a dermal inflammatory infiltrate rich in eosinophils; 3) direct immunofluorescence test demonstrating linear deposits of complement fraction 3 and immunoglobulin G along the basement membrane zone; 4) detection of circulating autoantibodies by means of indirect immunofluorescence or enzyme linked immunosorbent assay. Here, we provide an updated overview on the pathophysiologic mechanisms of pregnancy-associated or pregnancy-exacerbated AIBDs, focusing also on peculiar clinical features of these disorders.

Amputation of a finger in a patient with multidrug-resistant Mycobacterium marinum skin infection.

Mycobacterium marinum is the etiologic agent of fish tank granuloma. The clinical course is usually benign: spontaneous healing is possible within weeks or months. However, fish tank granuloma is sometimes resistant to several antibiotics. We report a case of M. marinum infection of a finger in a 73-year-old cook. The disease was resistant to a number of antibiotics and required the amputation. The history of this patient testifies that M. marinum can be resistant to several antibiotics and that skin infections can be sometimes so severe as to require the amputation of a finger.

Phthirus pubis Infestation of the Scalp: A Case Report and Review of The Literature.

Phthirus pubis usually infests the pubis, groin, buttocks and perianal region. It can sometimes infest the thighs, abdomen, chest, axillae and beard. Eyelashes and eyebrows may be involved in children. The involvement of the scalp is very rare. We describe a case of P. pubis infestation located exclusively on the scalp in an adult woman. Neither lice/nits nor skin lesions were observed elsewhere, including eyebrows, eyelashes, axillae, pubis, buttocks and perianal region (the patient was hairless in the axillae and pubis). A review of the literature is enclosed.

The association of isoconazole-diflucortolone in the treatment of pediatric tinea corporis.

BACKGROUND: Tinea corporis is a common mycotic infection in children. Staphylococcus aureus superinfections may be observed in atopic children with tinea corporis suffering from severe pruritus and consequent scratching. OBJECTIVE: From 2006 to 2011, we observed 288 children with mycologically proven tinea corporis. In 39 of them (13.5%) tinea corporis was superinfected by S. aureus: all these children were affected by atopic dermatitis. We interpreted these bacterial superinfections as the clinical result of scratching due to pruritus. METHODS: In 2012, we decided to treat all children with a single lesion of tinea corporis with a combination of 1% isoconazole nitrate and 0.1% diflucortolone valerate cream (one application/day for 5-7 days), followed by a treatment with isoconazole or clotrimazole or ciclopirox cream (two applications/day for two weeks). RESULTS: From 2012 to 2014, we observed 108 children with tinea corporis confirmed by mycological examinations. Clinical and mycological recovery was observed in 93 of them (86.1%). Only four of these children (3.7%) developed S. aureus superinfections. CONCLUSIONS: Our study in atopic children with tinea corporis superinfected by S. aureus confirms that a topical therapy with the association isoconazole-diflucortolone is useful and safe.

A new treatment regimen with permethrin in scabies.

BACKGROUND: Topical permethrin, applied once daily, is considered as the most effective treatment in scabies. METHODS: Eighty-nine adult immunocompetent patients with scabies were treated with 5% permethrin cream: 42 patients were treated with a single application/day (group 1); 47 patients were treated with one application/day for two consecutive days (group 2). Clinical diagnosis of scabies was confirmed by microscopical examinations. The cream was stored in refrigerator and applied cold on the entire skin surface. The cream was left on the skin for 24 hours. No other topical or systemic drugs were allowed, except for a cleanser with chlorhexidine. The treatment was repeated in all patients 7-10 days later. The follow-up was 2 months after the end of the treatment. RESULTS: Twenty-one patients (61.8%) in the group 1 and 34 patients (87.2%) in the group 2 were considered recovered both clinically and microscopically. Three patients (7.1%) in the group 1 and 4 patients (10.2%) in the group 2 developed a mild irritant contact dermatitis. During follow-up, three patients (7.1%) in the group 1 and two patients (4.2%) in the group 2 developed a recurrence or a re-infestation. CONCLUSIONS: Five per cent permethrin, when applied as cold cream, on the entire skin surface, once daily for two consecutive days, is more effective than the single application in adult immunocompetent patients with scabies.

Bullous cutaneous larva migrans: case series and review of atypical clinical presentations.

Hookworm-related cutaneous larva migrans (HRCLM) is caused by the penetration and migration in the epidermis of larvae of Ancylostoma braziliense and Ancylostoma caninum. It is characterized by slightly raised and erythematous tracks, located especially on the feet. These tracks may be single or multiple, serpiginous or linear, ramified and intertwined, accompanied by pruritus. Atypical clinical presentations of HRCLM are currently more frequent than in the past. We present six patients with bullous HRCLM and discuss the possible pathogenetic factors. Furthermore, we present a review of atypical clinical presentations of HRCLM. From 1998 to 2013 we observed approximately 180 patients with HRCLM. In all patients race, nationality, sex, age, country of infestation, location of the disease, clinical picture, laboratory and instrumental examinations and therapy were collected. In six patients (4 males and 2 females), we made a diagnosis, based on the history and clinical picture, of bullous HRCLM. The infestation was characterized by single or multiple blisters, round or oval in shape, of different size, with a clear serous fluid. Some tracks were also visible. All patients complained of pruritus. General physical examination and laboratory and instrumental examinations were normal or negative. Cytological examinations of the blisters showed the presence of lymphocytes and neutrophils, with numerous eosinophils. All patients were successfully treated with oral albendazole. Blisters appear because of the release by the larvae of lytic enzymes (metalloproteases and hyaluronidases). Furthermore, blisters might be the final clinical result of a delayed hypersensitivity reaction due to the release by larvae of unknown antigens. Finally, only in some patients, bullous HRCLM might represent an acute irritant/allergic contact dermatitis caused by topical drugs applied on the lesions. This hypothesis has been excluded in our patients because no topical treatment was made before our observation.

Onychomycosis by Paecilomyces lilacinus.

The authors describe a case of onychomycosis by Paecilomyces lilacinus in an 81-year-old Caucasian woman. The infection was characterized clinically by yellow-brown discoloration of the nail plate, distal-lateral onycholysis and subungual hyperkeratosis of the first left toenail. Microscopic examination showed irregular hyphae. Four cultures showed the development of lilac and powdery colonies. Conidiophores with divergent long narrow terminal phialides were observed at microscopic examination of culture samples. Therapy with amorolofine nail laquer, itraconazole and terbinafine was uneffective. This is the sixth case published in the literature of Paecilomyces lilacinus onychomycosis, and the second Italian case of Paecilomyces lilacinus infection.