Tacrolimus in Solution as an Option to Inflammatory Conditions of the Scalp

Introduction: Several dermatological diseases lead to inflammatory conditions of the scalp. Most of these afflictions are recalcitrant and require long term maintenance treatment. Objectives: We present a case series where topical tacrolimus was used in a solution vehicle for these conditions. Methods: A total of 22 patients (aged 24-90 years) with confirmed diagnosis of lichen planus pilaris (LPP),discoid lupus (DL),frontal fibrosing alopecia (FFA),erosive pustulosis of the scalp (EPS) or folliculitis decalvans (FD) were evaluated and treated with tacrolimus solution (0.1%) applied twice daily for 1 month, then once daily for another month and alternate days for 4 months. Efficacy was evaluated by an investigator global assessment,clinical and dermoscopic evaluation at weeks 4,8 and 24.The safety assessment included monitoring of all adverse events. Results: The study included 13 patients with LPP, 2 with DL, 2 with FD, 2 with EPS and 3 with AFF.After 1 month, 14 patients (63.6%) had a good response and 7 (31.8%) had excellent response.After 2 months, 16 patients (72.7%) had excellent response, and this response was persistent after 6 months of treatment. Conclusions: Tacrolimus in solution,even if not yet commercially available,was an effective and well tolerated alternative for the maintenance treatment of inflammatory conditions of the scalp

Junctional Nevus and Early Melanoma on Sun-Damaged Skin of the Head/Neck: A Clinico-Pathologic Challenge

Introduction: Melanoma on the head/neck area can show subtle clinical, dermoscopic and histologic features at early stages, being difficult to differentiate from junctional nevi. Objectives: This case series aims to raise awareness on the topic of misdiagnosis of early lentigo maligna as junctional nevi. Methods: From the databases of three pigmented lesion clinics in Italy, Australia, and France, we retrieved all cases of lesions of the head/neck area with an initial histopathologic diagnosis of junctional nevus (JN) or dysplastic junctional nevus (DJN) which subsequently recurred and were ultimately diagnosed as melanoma. Moreover, we also retrieved those cases with an initial diagnosis of JN/DJN made on a partial biopsy that were diagnosed as melanoma after complete surgical removal. Results: Here we report 14 cases in which the initial histologic diagnosis was junctional nevus or dysplastic junctional nevus. The lesions recurred over time with a final diagnosis of lentigo maligna. Conclusions: Clinicians should critically question a given histologic diagnosis of junctional or dysplastic junctional nevus on the head/neck area if the clinical or dermoscopic features are discordant. Clinico-pathologic correlation is the best way to increase diagnostic accuracy and optimize management for the patient

Real-World Experience with Topical 5-Fluorouracil 4% (40 mg/g) Cream for the Treatment of Actinic Keratosis

Introduction:5-fluorouracil (5-FU) is one of the most effective topical treatments for actinic keratosis (AK). A new 4% formulation of 5-FU was recently approved in Europe. Objectives:This study aimed at evaluating 4% 5-FU cream safety and effectiveness in a real-world setting. Methods:Adult AK patients were retrospectively selected from the University of Campania Dermatology Unit database. Selection criteria included a diagnosis of non-hyperkeratotic, non-hypertrophic AK (Olsen grade I and II) of the face, ears, and/or scalp, treatment with 4% 5-FU once daily for 4 weeks, and at least 3 follow-up visits (4 and 8 weeks after treatment initiation, and 6 months after treatment end). The primary objectives were to evaluate AK lesions improvement at 8 weeks and relapse rate at 6 months. Patient-reported erythema and burning sensation intensity were also assessed at 4 weeks. Results: Ninety-eight patients were included in this analysis (male/female 80/18, mean age 74.7 years). AK lesions improvement at 8 weeks resulted complete or significant in 74.5% and 20.4% of the patients, respectively. At 6 months, 65.3% of the patients did not show AK relapses. Burning sensation at 4 weeks was reported as light, moderate, or absent by 44.9%, 22.4%, and 31.6% of the patients, respectively. Erythema was reported as light, moderate, or absent by 37.8%, 51%, and 10% of the patients, respectively. Burning sensation and erythema disappeared gradually during follow-up. No other side effects were reported. Conclusions:In this real-world study 4% 5-FU proved to be highly effective for AK lesions clearance with a favorable safety profile