Acute Pustular Dermatosis, Following Topical Treatment With Pimecrolimus, in a Child Affected With Atopic and Contact Hand Dermatitis

Atopic dermatitis is considered an important risk factor for chronic hand dermatitis, which can be seen in children too. Pimecrolimus cream 1% is approved to treat atopic dermatitis in children aged 2 years or older. In adults, this drug has been used for some clinical indications other than atopic dermatitis, such as chronic hand dermatitis. Here, we describe an adverse drug reaction in a 2-year-old child affected with atopic dermatitis, who was treated with topical pimecrolimus in order to ameliorate her concomitant hand dermatitis. The use of topical pimecrolimus led to a previously undescribed hand pustular dermatosis, being consistent with a form of pustular leukocytoclastic vasculitis, which required the permanent discontinuation of topical pimecrolimus

Recurrence of Mycosis Fungoides on Multiple Melanocytic Nevi: A Case Report and Review of the Literature

Melanocytic nevi represent a widespread cutaneous finding. Nevertheless, the presence of mycosis fungoides and melanocytic nevi in the same location is an extremely rare event. We report the case of a patient affected by mycosis fungoides and treated with PUVA therapy, with complete remission of the disease. Eight years after therapy discontinuation, he presented epidermal scaling and an erythematous perinevic halo on 3 old melanocytic lesions, the clinical aspect of which was highly suggestive for Meyerson nevi. The histological and immunohistochemical examination of an excised melanocytic lesion revealed histological features consistent with the diagnosis of mycosis fungoides superimposed on junctional melanocytic nevi. The finding of patches of mycosis fungoides superimposed on melanocytic nevi is a rare event; the confounding clinical appearance with eczematous changes around a pre-existing nevus may recall the halo dermatitis known as Meyerson phenomenon; this highlights the importance of clinical and histological examination to make the correct diagnosis of dermatological diseases

Non-invasive evaluation of tacalcitol plus puva versus tacalcitol plus UVB-NB in the treatment of psoriasis: "right-left intra-individual pre/post comparison design".

Photochemotherapy with psoralen plus ultraviolet A (PUVA) and phototherapy with UVB narrow band (UVB-NB) are used in the treatment of psoriasis. Numerous studies have shown that the additional administration of either topical or systemic antipsoriatic agents may effectively increase the efficacy of these therapies. This study aimed to compare through objective data the efficacy of topical tacalcitol in combination with PUVA or UVB-NB versus PUVA and UVB-NB monotherapy in the treatment of mild to moderate chronic plaque psoriasis. Modified Psoriasis Area and Severity Index (PASI) score, transepidermal water loss (TEWL) and stratum corneum hydration were used to monitor the restoration of skin barrier in the psoriatic plaques of 40 patients during photochemotherapy. The study was a right-left, intra-individual, pre/post comparison trial. PUVA and UVB-NB treatments were given three times a week. On those plaques localized on the right side of the body tacalcitol ointment was applied once a day, in the evening. Corneometry, TEWL and modified PASI score were used to evaluate the response to the treatment at baseline, one month and two months. Thirty-six of the forty enrolled subjects completed the study. The comparison between combination treatments and the PUVA/UVB-NB monotherapy showed no significant differences with regard to modified PASI index. However, significant differences were recorded with regard to TEWL and corneometry. The combination of tacalcitol plus PUVA or tacalcitol plus UVB-NB restored epidermal barrier functions as well as skin hydration faster than PUVA or UVB-NB monotherapy (TEWL: p=0.0050 and corneometry: p=0.003). The combination of tacalcitol plus UVB-NB allowed a better restoration of skin barrier functions than tacalcitol plus PUVA (p=0.013). In conclusion, the combination of tacalcitol plus PUVA or plus UVB-NB improves the therapeutic result. In addition, the data from TEWL and skin hydration suggest a means in which tacalcitol plus UVB-NB induces a better normalization of skin biophysical parameters

A multidisciplinary dermatology-gastroenterology-rheumatology (DER.RE.GA) unit for the care of patients with immune-mediated inflammatory diseases: analysis of the first 5 years from the dermatologist’s perspective

Immune-mediated inflammatory diseases (IMIDs) constitute a heterogenous group of chronic and highly disabling conditions. The clinical challenges they often pose led to formation of numerous dermo-rheumatological interdisciplinary units around the world, which are reported to benefit their patients in various ways. The present paper describes our experience with a multidisciplinary dermatology-rheumatology-gastroenterology unit DERREGA at the IRCCS Foundation Policlinico San Matteo of Pavia over a period of 5 years of its activity (2017–2022). A digital database was created, containing the medical records of 146 patients referred to the dermatology unit only by rheumatologists or gastroenterologists belonging to the multidisciplinary unit DERREGA. Then, aspects such as demographics, initial basis of referral and final diagnosis among the patients were analyzed retrospectively. Patients were classified as either gastroenterological or rheumatological, and then categorized according to the specific basis of referral. Most of the gastroenterological patients (97%) were affected by inflammatory bowel diseases (IBDs). Rheumatological patients were divided in three subgroups, including patients referred with vasculitis, arthropathies (undifferentiated arthritis, psoriatic arthritis and other arthritis) and other rheumatological diseases. Then, final diagnoses were evaluated in each group. Almost a third of IBD patients received a diagnosis of paradoxical psoriasis. Dermatological examination allowed diagnosis of minimal psoriasis based on Caspar criteria in over 70% of the patients admitted with undifferentiated arthritis. A multidisciplinary approach is suggested to provide more effective management of IMIDs and, specifically, from a dermatological perspective, allows for the diagnosis of minimal manifestations of psoriasis in patients with a provisional diagnosis of undifferentiated arthritis

exaggerated insect bite like reaction in patients affected by oncohaematological diseases

Sir,Patients affected by chronic B-cell lymphatic leukaemia(CBLL) and, more rarely, other oncohaematologicaldiseases may present with papules, plaques, nodules andvesico-bullous lesions on exposed areas (1–3). Theselesions are usually considered an exaggerated reaction toinsect bites, although the patients not always had ahistory (except for the seasonal presentation of cuta-neous findings), the clinical picture, and response totreatment suggestive of insect bite (3, 4). This phenom-enon has been described in about 40 patients affected bylymphoproliferative disorders, 95% of whom had CBLL(1–7). Weed (1) first gave the definition of 'exaggerateddelayed hypersensitivity to mosquito bites' and reportedthis condition only in patients affected with CBLL.Later, Houston & Keene (2) described a case ofexaggerated insect bite-like reaction also in a patientwith lymphocytic lymphoma. In 1986, Rosen et al. (3)studied 10 patients and suggested that the cutaneouslesions could be linked, in some way, to the onco-haematological conditions, without explaining the exactpathway.Five patients affected by different B lymphoprolifera-tive disorders, who presented with pruritic papules,nodules and vesico-bullous lesions on exposedareas during spring and summer time, are reported.We discuss an immuno-allergic mechanism, involvingboth allergic reaction to insect bite and the impair-ment of the immune response in oncohaematologicalpatients.CASE REPORTSFrom 1995 to 2001, three patients affected by CBLL andtwo by non-Hodgkin B-cell lymphomas attended ourdepartment with polymorphous, erythematous cuta-neous papules and plaques, some of them evolving intobullous lesions. During spring-summer all the patientsdeveloped very itchy lesions, plaques (Fig. 1) andsometimes bullae, mainly localized on upper and/orlower limbs and on the face. Three patients referred tohave been bitten by mosquitoes, the other two deniedthis occurrence. At the time of the clinical examination,all the patients were living in or close to the area ofPavia, Italy, where seasonal infestations of mosquitoes(Aedes) are particularly widespread. All the patientsunderwent a 4-mm punch biopsy, necessary for ahistopathologic evaluation; a direct immunofluores-cence test was carried out for four patients, to excludeautoimmune bullous diseases.At the time of the eruption, one patient was ontreatment with VACOP-B protocol (adriblastina, cyclo-phosphamide, etoposide, vincristine, bleomycin, predni-sone), two patients with chlorambucil and one withcyclophosphamide. An 87-year-old patient was notunder treatment. Blood analysis revealed peripheraleosinophilia in three patients out of five. Stool analysissearching for parasites was carried out in those threepatients and proved negative. IgE was in the normalrange in all the patients. Serum protein electrophoresisrevealed that total immunoglobulins were in the normalrange or little lower in all the patients, while all of thempresented a different degree of decrease of IgG, IgMand/or IgA in sera. The other clinical and serologicalfindings were unremarkable or consistent with theirhaematological condition.The histopathology was characterized by a variety offindings, all of which were consistent with an arthropodbite reaction. In particular, a wedge-shaped, superficialor superficial-deep perivascular and often also inter-stitial infiltrate was present. It was mainly composed ofeosinophils in association with lymphocytes and rarelyneutrophils. The density or the depth of the infiltratevaried from case to case, also according to the age of thelesion. An oedema of the subpapillary dermis wasalways evident. One patient presented a subepidermalvesicle. In another patient spongiosis could be seen an

Chronic Giardia intestinalis infection presenting with clinical features mimicking lichen planus.

Sir, Human giardiasis, caused by Giardia intestinalis, a agellate protozoan parasite that colonizes the small bowel, is a worldwide infection (1). Giardia infection is usually asymptomatic but intestinal illness may occur (2–5). Several reports describe the association of allergy with increased levels of total serum IgE antibodies and of speci c IgE antibodies against food allergens in patients aVected by giardiasis, and Giardia infection may determine altered absorption of food antigens causing allergic sensitization (6). Cutaneous signs may be virtually indistinguishable from those of atopic dermatitis (7, 8). Acute reactions such as urticaria or asthma have also been described (9–11). We here report a patient aVected by giardiasis, with lichen-planus-like lesions as the sole clinical feature

Chronic graft-versus-host disease and non-melanoma skin cancer in children: report of two cases.

This article does not have an abstrac

Atypical exanthem with acral involvement in adult patients associated with human herpesvirus 7 active replication: A case series

An "atypical exanthem" (AE) is an eruptive skin eruption that differs in morphology and etiology from classical exanthems and is often a reason for urgent medical evaluation. The most frequent cause of AEs is a viral infection, but an accurate etiology cannot be established basing on the sole clinical features. Human herpesviruses (HHV) have been often suspected as etiologic agents or cofactors in atypical rashes. We performed a retrospective analysis of adult patients presenting an atypical exanthem associated with HHV-7 active replication in our center. The charts of patients were reviewed and the demographic, clinical and laboratory data collected. Nine patients (six males and three females) were included in the study, with a mean age of 43 years for men and of 26 years for women. All patients presented active HHV-7 replication in plasma during the rash, which turned negative after the exanthem resolved. The exanthem displayed a maculopapular pattern involving the trunk, limbs and, notably, the acral regions, in six patients. In three cases the exanthem was confined to only the acral sites. In most cases, there was no fever and the inflammatory indices remained unchanged. Antihistamines, topical and systemic corticosteroids were used as treatment, with excellent symptom control. We propose adding skin manifestation associated with HHV-7 to the concept of atypical exanthems, in particular those localized to the acral regions

Bleomycin-induced flagellate dermatitis: report of four paediatric cases.

The reduced concentration of bleomycin hydrolase enzyme in the skin, pruri- tus and the concomitant radiotherapy could have had a synergistic role in the accumulation of the drug and triggered the flagellate dermatitis