Factors influencing response to ingenol mebutate therapy for actinic keratosis of face and scalp

AIM To determine factors independently influencing response to ingenol mebutate therapy and assess efficacy on clinical setting of non-hypertrophic non-hyperkeratotic actinic keratosis (AK). METHODS Consecutive patients affected by non-hypertrophic non-hyperkeratotic AKs of the face or scalp were enrolled to receive ingenol mebutate 0.015% gel on a selected skin area of 25 cm2 for 3 consecutive days. Local skin reactions were calculated at each follow up visit using a validated composite score. Efficacy was evaluated by the comparison of clinical and dermoscopic pictures before the treatment and at day 57, and classified as complete, partial and poor response. RESULTS A number of 130 patients were enrolled, of which 101 (77.7%) were treated on the face, while 29 (22.3%) on the scalp. The great majority of our study population (n = 119, 91.5%) reached at least a 75% clearance of AKs and, in particular, 58 patients (44.6%) achieved a complete response while 61 (46.9%) a partial one. Logistic backward multivariate analysis showed that facial localization, level of local skin reaction (LSR) at day 2, the highest LSR values and level of crusts at day 8 were factors independently associated with the achievement of a complete response. CONCLUSION Ingenol mebutate 0.015% gel, when properly applied, is more effective on the face than on the scalp and efficacy is directly associated to LSR score

Erythrodermic Psoriasis Successfully Treated with Anti IL-17: A Case Series

Erythrodermic psoriasis (EP) is a very rare but extremely severe subtype of chronic plaque psoriasis, affecting 1.00-2.25% of patients with psoriasis (1). Its pathogenesis still remains unknown, and current therapeutic strategies frequently end in failure. In this condition, the skin becomes diffusely red, tending to purple, shiny, with marked desquamation and exudation. Erythema and edema are widespread, covering more than 90% of the body surface and can lead to high risk of multi-organ failure and death (2) due to fluid and protein loss. Predominance of the Th2 immune response and dysregulation of angiogenesis have been proposed to be implicated in the pathogenesis of EP, although this has not yet been fully elucidated (3). Nevertheless, Th17 has been shown to be the second-most predominant T-cell type after Th2 in EP lesions (4,5)

Erythrodermic Psoriasis Successfully Treated with Anti IL-17: A Case Series

Erythrodermic psoriasis (EP) is a very rare but extremely severe subtype of chronic plaque psoriasis, affecting 1.00-2.25% of patients with psoriasis (1). Its pathogenesis still remains unknown, and current therapeutic strategies frequently end in failure. In this condition, the skin becomes diffusely red, tending to purple, shiny, with marked desquamation and exudation. Erythema and edema are widespread, covering more than 90% of the body surface and can lead to high risk of multi-organ failure and death (2) due to fluid and protein loss. Predominance of the Th2 immune response and dysregulation of angiogenesis have been proposed to be implicated in the pathogenesis of EP, although this has not yet been fully elucidated (3). Nevertheless, Th17 has been shown to be the second-most predominant T-cell type after Th2 in EP lesions (4,5)

Herpes zoster ophthalmicus in two women after Pfizer-BioNTech (BNT162b2) vaccine

Varicella‐zostervirus(VZV) isresponsibleforaprimaryinfection (i.e., chickenpox); subsequently, thevirus remains dormant at the level of thespinal dorsal root andcranial ganglia. Inconditionsof stressor immunosuppression, itcanreactivateandcausesecondary herpes zoster (HZ) infection. HZOaccounts for 10%–20%ofHZ casesandischaracterizedbyinvolvementoftheophthalmicbranch ofthefifthcranialnerve. It isconsideredadangerousconditionthat couldleadtosevereconsequencessuchasblindnessin20%–70%of thecases.3Themainriskfactors for thereactivationofVZVarea compromiseofthecell‐mediatedimmunity(CMI)thatpresentsitself inoldage, insomechronicdiseasessuchasdiabetes, autoimmune disease,HIV,andduringimmunosuppressivetherapies.4 Several casesofHZhavebeendescribed inPfizervaccinerecipients,however,onlyoneofthemwithophthalmiclocalization, ina 56‐year‐oldwomanwithrheumatoidarthritis.5 Wereport twocasesofpostvaccineHZOalthoughararelyreportedadverseeventwithpotentiallyseriousconsequences. HZOwasalsodiagnosedinfourpatientssufferingfromamoderateformofCOVID‐19infection6thatwereeffectivelytreatedwith antiviralswithoutanyvisual sequelae. Inthesecases, thetriggering factorforviralreactivationisprobablyduetolymphopeniasecondary to SARS‐CoV‐2

Aesthetic treatments in cancer patients

Cancer patients are experiencing an increase in overall survival as a consequence of earlier diagnosis and newer effective anticancer therapies. However, cancer survivors often face long-term consequences from their original cancer diagnosis and long-term sequelae of anticancer treatment. Maintaining patients' quality of life is of paramount importance and this can be accomplished by a multidisciplinary treatment approach, including aesthetic treatments to improve patients' body image and positively impact their quality of life. In this perspective, we will discuss the importance of aesthetic treatments in cancer patients. In addition, we will summarise the data available regarding the use of several aesthetic treatments such as fillers, botulinum toxin and laser use in cancer patients, their safety, their efficacy, and the specific precautions that need to be implemented in this particular subset of cancer patients

Psoriatic patients with a history of cancer: a real-life experience with Apremilast treatment for 104 weeks

Psoriasis is a multifactorial, chronic, auto- inflammatory disease, with a worldwide prevalence of around 2%, subtended by robust genetic predisposition and autoimmune pathogenic traits. The disease, mainly involving the skin and joints, is featured by erythemato-squamous lesions, with a chronic relapsing course and relevant systemic comorbidities. Apremilast is a novel oral agent that has recently been made available to dermatologists for the treatment of moderate-to-severe plaque psoriasis and psoriatic arthritis. Although it is considered as relatively safe molecule with few contraindications, experience with Apremilast in the real-world setting for cancer patients with moderate-to-severe plaque psoriasis is lacking. Hence, we report the real-life experience in patients with psoriasis and a history of cancer who underwent treatment with Apremilast for 104 weeks

Face and scalp basal cell carcinoma treatment: A review of the literature

Basal cell carcinoma (BCC) is the most frequent skin cancer and is characterized by slow growth, even if it can be locally invasive and rarely metastasizes. Many different phenotypic presentations and histopathologic subtypes have been described, and the current guidelines subdivide BCCs into low-risk (nodular and superficial) and high-risk subtypes (micronodular, infiltrating, and morphoeic BCC and those with squamous differentiation). Dermoscopy allows the identification of the features associated with these different subtypes. Compared with the low-risk forms of BCC, more aggressive ones tend to undergo more frequently incomplete surgical excision and perineural invasion, so the identification of these lesions before surgery is extremely important. The gold standard of treatment is surgery, particularly for the H region of the face and infiltrative lesions, but other options are available and selected according to many variables, including body area, age, comorbidities, and clinical, dermoscopic, and histopathological features of the lesion. Moreover, the possible complications of surgical approaches, namely healing defects, failure of skin grafts, and wound infection, should be considered. In this review we discuss the management of BCC localized on the face and scalp, according to the currently available treatment options. </p

Therapeutic Options for the Treatment of Actinic Keratosis with Scalp and Face Localization

Actinic keratosis (AK) is a common skin disease related to ultraviolet chronic exposure, that is now considered a squamous cell carcinoma in situ. Primary skin cancer prevention strategies should be recommended for high risk patients. There is a wide spectrum of treatment options available for AKs, and several variables should be taken into account regarding the best therapeutic choice for each patient. The purpose of this article is to review the current treatment strategies for AKs localized on the face and scalp, with a focus on the practical point of view that could be useful for choosing the best therapeutic option. The two main therapeutic approaches will be distinguished first: lesiondirected and field-directed. Afterwards, the treatment based on clinical type and patient comorbidity will be discussed

Therapeutic Options for the Treatment of Actinic Keratosis with Scalp and Face Localization

Actinic keratosis (AK) is a common skin disease related to ultraviolet chronic exposure, that is now considered a squamous cell carcinoma in situ. Primary skin cancer prevention strategies should be recommended for high risk patients. There is a wide spectrum of treatment options available for AKs, and several variables should be taken into account regarding the best therapeutic choice for each patient. The purpose of this article is to review the current treatment strategies for AKs localized on the face and scalp, with a focus on the practical point of view that could be useful for choosing the best therapeutic option. The two main therapeutic approaches will be distinguished first: lesiondirected and field-directed. Afterwards, the treatment based on clinical type and patient comorbidity will be discussed