Markers diagnostici e aspetti preventivi-terapeutici delle affezioni cutanee e annessiali dei pazienti in oncoterapia

Negli ultimi decenni lo studio e la conoscenza dei processi alla base di carcinogenesi e metastatizzazione hanno permesso di sviluppare approcci terapeutici nuovi e sempre più mirati. Questo ha portato ad un importante incremento della sopravvivenza dei pazienti oncologici e spesso, ad una minore tossicità delle cure. L’aumento dei long survivor però, ha fatto emergere nuove problematiche e nuove sfide per i medici, relative soprattutto alle conseguenze a lungo termine delle oncoterapie. È chiaro ormai come sia necessaria un’evoluzione del concetto di “curare” verso quello di “prendersi cura”. Tale approccio si focalizza non solo sulla riduzione del carico di malattia, ma anche sul miglioramento della qualità di vita (QoL). Questo approccio non può prescindere dalla presa in carico del paziente nella sua interezza, e quindi non può che essere un approccio multidisciplinare e organizzato in tumor board. Come dermatologi abbiamo sposato in pieno questa visione e abbiamo istituito un ambulatorio di oncodermatologia per la gestione del paziente oncologico dal momento della diagnosi fino alla fine del percorso terapeutico e oltre, stabilendo ed elaborando dei protocolli di prevenzione, diagnosi e terapia per tutti gli effetti collaterali che possono svilupparsi a livello di cute e annessi cutanei in corso di oncoterapia. Questo lavoro di tesi riassume l’esperienza maturata in questi anni e descrive come essa abbia portato all’elaborazione di protocolli preventivi, alla divulgazione scientifica di nuovi approcci diagnostici e allo sviluppo di nuovi schemi terapeutici per diverse reazioni cutanee ed annessiali alle terapie oncologiche. Offre infine spunti di riflessioni e prospettive future che possano sempre dipiù ampliare le nostre conoscenze sui processi patogenetici alla base di questi eventi avversi, su come essi possano agire non solo sulla cute e sugli annessi ma anche su altri organi, ampliando e rafforzando quindi i rapporti con altri specialisti e su come si possa intervenire per prevenirne l’insorgenza e limitarne le conseguenze

Chemotherapy-induced alopecia management: Clinical experience and practical advice

Background: Chemotherapy-induced alopecia (CIA) is probably one of the most shocking aspects for oncological patients and underestimated by physicians. Among hair loss risk factors, there are treatment-related aspects such as drug dose, admin- istration regimen, and exposure to X-rays, but also patient-related characteristics. To the best of our knowledge, no guidelines are available about CIA management. Aims and methods: With this study, based on literature background and our clinical experience, we would like to propose a list of actions in order to estimate the risk of hair loss before starting chemotherapy and to manage this condition before, dur- ing, and after drug administration and to create a sort of practical guide for derma- tologists and oncologists. Results and conclusion: There is an urgent need for prospective studies to clarify the mechanistic basis of alopecia associated with these drugs and consequently to design evidence-based management strategies

Multi-therapies in androgenetic alopecia: review and clinical experiences.

Androgenetic alopecia (AGA) is a genetically determined progressive hair-loss condition which represents the most common cause of hair loss in men. The use of the medical term androgenetic alopecia reflects current knowledge about the important role of androgens and genetic factors in its etiology. In addition to androgen-dependent changes in the hair cycle, sustained microscopic follicular inflammation contributes to its onset. Furthermore, Prostaglandins have been demonstrated to have the ability in modulating hair follicle cycle; in particular, PGD2 inhibits hair growth while PGE2/F2a promote growth. Due to the progressive nature of AGA, the treatment should be started early and continued indefinitely, since the benefit will not be maintained upon ceasing therapy. To date, only two therapeutic agents have been approved by the Food and Drug Administration and European Medicines Agency for the treatment of AGA: topical minoxidil and oral finasteride. Considering the many pathogenetic mechanisms involved in AGA, various treatment options are available: topical and systemic drugs may be used and the choice depends on various factors including grading of AGA, patients’ pathological conditions, practicability, costs and risks. So, the treatment for AGA should be based on personalized therapy and targeted at the different pathophysiological aspects of AG

Realidad Virtual Inmersiva: una oportunidad para el aprendizaje y un desafío para los bibliotecarios

[spa] Introducción: Los profesionales que se dedican a los servicios de información en ciencias de la salud asumen día tras día múltiples desafíos, evalúan oportunidades y trabajan para adaptarse a los cambios. Objetivos: En este contexto, la Realidad Virtual Inmersiva (RVI) se presenta como una oportunidad y al mismo tiempo un desafío para ofrecer una herramienta formativa interactiva. Material y método: Las actividades de formación tradicionales, como la modalidad presencial o los talleres prácticos, se han reformulado y se han buscado alternativas en las que la simulación y la realidad virtual toman fuerza y mayor protagonismo. Actualmente, se quiere apostar por la RVI como herramienta para la formación, educación y docencia, así como modelo de distracción para intervenciones asistenciales, campañas de sensibilización o para el bienestar del usuario con productos de relajación. Resultados: La experiencia en productos de RVI, como el “Scape Room” de ORCID o la sesión de mindfulness con “My Moments”, han servido de base para que la biblioteca comience a liderar, cocrear y participar en actividades y proyectos que hacen uso de esta tecnología y se desarrollan en diferentes áreas de la entidad. En esta línea, también se diseñaron una serie de aplicaciones que tienen como objetivo formar en aspectos relacionados con la colocación y retirada de EPIs (CovidCos), el acompañamiento emocional a los profesionales (CovidCor) y la detección precoz del empeoramiento del nuestro paciente (SRR Score). Estos primeros productos se generan íntegramente en la biblioteca (Idea-Presupuesto-Contenidos-Implementación) y cuentan con el valor añadido que aporta el proveedor tecnológico. En este escenario, la Biblioteca no solo presta servicios, sino que en los últimos años ha iniciado una participación activa en proyectos de investigación que se llevan a cabo en la organización. Conclusiones: El bibliotecario se reivindica como un agente activo que interviene en las diferentes partes de un proyecto de RVI, desde la génesis hasta su materialización. Esta es una oportunidad para que los bibliotecarios lideren proyectos de investigación dentro de las organizaciones, en función de su experiencia y actitud.[eng] Introduction: Health information professionals deal with multiple daily challenges, evaluate opportunities, and work to adapt to changes. Objective: In this context, Immersive Virtual Reality (IVR) presents itself as an opportunity and, at the same time, a challenge to offer an interactive educational tool through this technology. Material and method: Traditional training methods, such as in-person training or practical workshops, have been reformulated, and alternatives that prioritize simulation and virtual reality have been sought, gaining strength and greater prominence. IVR is promoted for training, education, and teaching purposes, as well as an entertainment for patients in healthcare interventions, awareness campaigns, or user well-being with relaxation products. Results: Experiences with IVR products, such as the "scape room" by ORCID or the mindfulness session with My Moments, were a basis for the library to begin leading, co-creating, and participating in IVR activities and projects developed in various areas of the organization. In this line, a series of applications were also designed with different content that cater to training in the placement and removal of personal protective equipment (CovidCos), emotional support for professionals (CovidCor), and early detection of our patients' deterioration (SRR Score). These initial products are entirely generated within the library (Idea-Budget-Content-Implementation), along with the technology provider. The library not only provides services but has also taken an active role in research projects carried out within the organization in recent years. Conclusions: Librarians are promoted as active agents involved in different parts of an IVR project, from its inception to becoming an intervention: this is an opportunity to lead research projects within organizations, based on their experience and attitude

Acneiform rash induced by EGFR inhibitors: review of the literature and new insights

Acneiform rash is the most common side effect of epidermal growth factor receptor (EGFR) inhibitors (EGFRis), and it occurs in 50-100% of patients. This condition can affect the quality of life of these patients and can sometimes lead to a discontinuation of the antineoplastic therapy. Several recent prospective studies have addressed and evaluated different interventions to mitigate or reduce the severity of EGFRis-associated skin rash. With this aim, we have established a dermocosmetological outpatient clinic for cancer patients at the Department of Clinical Medicine and Surgery, University of Naples Federico II in collaboration with the Department of Dermatology and Cutaneous Surgery, Miller School of Medicine, University of Miami. An interdisciplinary network of physicians can improve the quality of life of the cancer patients, focusing on such important aspects as dermocosmetological skin care, but also on the evaluation of new therapeutic and diagnostic algorithms in order to make further progress in the field of prevention. In this review, we summarize the state of the art of the epidemiology, pathogenesis, and treatment of EGFRis acneiform rash, and we describe our outpatient clinical experience

Androgenetic alopecia: a review

Purpose Androgenetic alopecia, commonly known as male pattern baldness, is the most common type of progressive hair loss disorder in men. The aim of this paper is to review recent advances in understanding the pathophysiology and molecular mechanism of androgenetic alopecia. Methods Using the PubMed database, we conducted a systematic review of the literature, selecting studies pub- lished from 1916 to 2016. Results The occurrence and development of androgenetic alopecia depends on the interaction of endocrine factors and genetic predisposition. Androgenetic alopecia is character- ized by progressive hair follicular miniaturization, caused by the actions of androgens on the epithelial cells of genetically susceptible hair follicles in androgen-dependent areas. Although the exact pathogenesis of androgenetic alopecia remains to be clari fi ed, research has shown that it is a polygenetic condition. Numerous studies have unequi- vocally identi fi ed two major genetic risk loci for androge- netic alopecia, on the X-chromosome AR ⁄ EDA2R locus and the chromosome 20p11 locus. Conclusions Candidate gene and genome-wide association studies have reported that single-nucleotide polymorphisms at different genomic loci are associated with androgenetic alopecia development. A number of genes determine the predisposition for androgenetic alopecia in a polygenic fashion. However, further studies are needed before the specific genetic factors of this polygenic condition can be fully explaine

Chemotherapy-induced alopecia: A novel observation

no abstract avaibl

Monitoring chemotherapy-induced alopecia with trichoscopy

Background: Chemotherapy-induced alopecia (CIA) ranks among the psychologically most devastating effects of cancer treatment for oncological patients, with an overall incidence of 65%. Nowadays trichoscopy is largely employed in the diagnosis of alopecia, but no description of CIA trichoscopic pattern is present in literature. Aims: We want to create an organic description of CIA trichoscopic aspects. Methods: Oncological patients candidate to chemotherapy drugs, afferent to our trichological outpatient were studied. Anamnesis, clinical exam, clinical global photography, pull test, trichogram, and trichoscopy were conducted at the different moments of therapeutic treatment. Results: A definite trichoscopic pattern in the different phases of treatment was observed. After the first 3 weeks of chemotherapy rare and scattered black dots, broken hairs, flame hairs and pohl pinkus appeared. At the end of chemotherapy besides the features described above, numerous thin hair in regrowth were detected, together to rare terminal hair, scattered black dots and circle hair. Three months after chemotherapy a progressive increase of follicular units and elongation of the existing hair were visible. Conclusions: We propose an description of CIA trichoscopic pattern and its evolution during the different phases of chemotherapy

A machine learning algorithm applied to trichoscopy for androgenic alopecia staging and severity assessment

Introduction: Androgenic alopecia (AGA) staging is still based on macroscopic scales, yet the introduction of trichoscopy is gradually bringing an important change, even though it remains an eye-based method. However, recently developed artificial intelligence-assisted programs can execute automated count of trichoscopic patterns. Nevertheless, to interpret data elaborated by these programs can be complex. Machine learning algorithms might represent an innovative solution. Among them, support vector machine (SVM) models are among the best methods for classification. Objectives: Our aim was to develop a SVM algorithm, based on three trichoscopic patterns, able to classify AGA patients and to calculate a severity index. Methods: We retrospectively analyzed trichoscopic images from 200 AGA patients using Trichoscale Pro® software, calculating the number of vellus hair, empty follicles and single hair follicular units. Then, we elaborated a SVM model, based on these three patterns and on sex, able to classify patients as affected by mild AGA or moderate-severe AGA, and able to calculate the probability of the classification being correct, expressed as percentage (from 50% to 100%). This probability estimate is higher in patients with more AGA trichoscopic patterns and, thus, it might serve as a severity index. Results: For training and test datasets, accuracy was 94.3% and 90.0% respectively, while the Area Under the Curve was 0.99 and 0.95 respectively. Conclusions: We believe our SVM model could be of great support for dermatologists in the management of AGA, especially in better assessing disease severity and, thus, in prescribing a more appropriate therapy

Efficacy and tolerability of a spray product containing hydroxypropyl chitosan, Climbazole and Piroctone olamine, applied twice weekly for the treatment of the Pitiriasis Versicolor

The aim of this study was to demonstrate the effectiveness of a product containing hydroxypropyl chitosan, Climbazole and Piroctone olamine, by monitoring the adherence and the penetration of the molecules in the skin. Confocal microscopy led us to show the persistence of the active compound for a long time in the stratum corneum, thanks to the presence of hydroxypropyl chitosan. This evidence suggests a new protocol of application (a biweekly application, rather than daily)