H Syndrome retrospectively diagnosed: The importance of recognizing cutaneous signs

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Hydroxychloroquine in psoriasis: is it really harmful?

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Serology of Lupus Erythematosus: Correlation between Immunopathological Features and Clinical Aspects

Systemic lupus erythematosus (SLE) is an autoimmune disease characterized by the aberrant production of a broad and heterogenous group of autoantibodies. Even though the presence of autoantibodies in SLE has been known, for more than 60 years, still nowadays a great effort is being made to understand the pathogenetic, diagnostic, and prognostic meaning of such autoantibodies. Antibodies to ds-DNA are useful for the diagnosis of SLE, to monitor the disease activity, and correlate with renal and central nervous involvements. Anti-Sm antibodies are highly specific for SLE. Anti-nucleosome antibodies are an excellent marker for SLE and good predictors of flares in quiescent lupus. Anti-histone antibodies characterize drug-induced lupus, while anti-SSA/Ro and anti-SSB/La antibodies are associated with neonatal lupus erythematosus and photosensitivity. Anti-ribosomal P antibodies play a role in neuropsychiatric lupus, but their association with clinical manifestations is still unclear. Anti-phospholipid antibodies are associated with the anti-phospholipid syndrome, cerebral vascular disease, and neuropsychiatric lupus. Anti-C1q antibodies amplify glomerular injury, and the elevation of their titers may predict renal flares. Anti-RNP antibodies are a marker of Sharp’s syndrome but can be found in SLE as well. Anti-PCNA antibodies are present in 5–10% of SLE patients especially those with arthritis and hypocomplementemia

Results of COVID-19 screening in a dermatologic clinic in northern Italy

Introduction The COVID-19 pandemic has been a social, economic and sanitary challenge, which caused a great slowdown in most clinical activities. At the beginning of 2021, the gradual reopening of outpatient services was threatened by the risk of COVID-19 outbreaks in healthcare facilities. Methods Between January and March 2021, our dermatologic clinic promoted a screening campaign based on rapid antigen-testing: adhering patients were tested for COVID-19 and were visited only after getting a negative result. Results Among 635 recruited subjects, 514 agreed to be enrolled in the study, while 121 refused and were not tested. Only 1 of the 514 tests was positive for COVID-19, thus the incidence of COVID-19 infections was very low (0,002%). A significant percentage of patients (19,1%) refused to be tested. Among those who did not give consent for COVID-19 testing, 52,9% were male, although the total recruited population was prevalently female (56,1%). Discussion and conclusions Screening for COVID-19 in outpatient clinics is a promising tool to prevent virus outbreaks, despite the limitations posed by testing hesitancy. Moreover, the very low incidence of COVID-19 infection we detected could be seen as a sign of hope for the resumption of non-essential clinical activities

A patient with immunological features of paraneoplastic pemphigus in the absence of a detectable malignancy.

3. Yotsumoto S, Setoyama M, Hisadome H, Tashiro M, 9. Yamasaki H, Tada J, Yoshioka T, Arata J. Epidermolysis Murata F. A case of epidermolysis bullosa herediteriabullosa pruriginosa (McGrath) successfully controlled by dominant dystrophic type of Cockayne and Touraine. oral cyclosporin. Br J Dermatol 1997; 137: 308–310. Dermatology 1993; 186: 201–204. 10. del-Rio E. Prevention of blisters in dystrophic recessive 4. Fine J-D, Eady RAJ, Bauer EA, Briggaman RA, Brucknerepidermolysis bullosa with cyclosporine. J Am Acad Tuderman L, Christiano A, et al. Revised classi cation Dermatol 1993; 29: 1038–1039. system for inherited epidermolysis bullosa: report of the 11. White JE. Minocycline for dystrophic epidermolysis bullosa. second international consensus meeting on diagnosis and Lancet 1989; 29; 8644: 966. classi cation of epidermolysis bullosa. J Am Acad Dermatol 12. Talas G, Adams TS, Eastwood M, Rubio G, Brown RA. 2000; 42: 1051–1066. Phenytoin reduces the contraction of recessive dystrophic 5. Burgeson RE. Type VII collagen, anchoring brils, and epidermolysis bullosa broblast populated collagen gels. Int epidermolysis bullosa. J Invest Dermatol 1993; 101: 252–255. J Biochem Cell Biol 1997; 29: 261–270. 6. Smith LT. Ultrastructural ndings in epidermolysis bullosa. 13. Shirakata Y, Shiraishi S, Sayama K, Shinmori H, Miki Y. Arch Dermatol 1993; 129: 1578–1584. High-dose tocopherol acetate therapy in epidermolysis bul7. Hovnanian A, Christiano AM, Uitto J. The molecular losa siblings of the Cockayne-Touraine type. J Dermatol genetics of dystrophic epidermolysis bullosa. Arch Dermatol 1993; 20: 723–725. 1993; 129: 1566–1570. 14. Caroll PB, Rilo HRL, Abu Elmagd K, Jhonson N, Carter 8. Shenefelt PD, Castellano LM, Fenske NA. Successful treatC,WrightH, et al. EVect of tacrolimus (FK506) in dystrophic ment of albopapuloid epidermolysis bullosa (Pasini's variant) epidermolysis bullosa: rationale and preliminary results. Arch with topical pulse corticosteroid therapy. J Am Acad Dermatol 1993; 29: 785–786. Dermatol 1994; 130: 1457–1458

Frequency of IgA antibodies in pemphigus, bullous pemphigoid and mucous membrane pemphigoid

Circulating and bound IgA antibodies can be found in the autoimmune blistering diseases, but their prevalence, clinical relevance and target antigens remain unknown. Thirty-two patients with pemphigus, 73 with bullous pemphigoid and 28 with mucous membrane pemphigoid were studied retrospectively. Direct immunofluorescence (DIF) analysis of IgG, IgA, IgM and C3 was carried out for all cases. Sera were studied by standard indirect immunofluorescence, indirect immunofluorescence on salt-split skin, immunoblotting for bullous pemphigoid and mucous membrane pemphigoid and ELISA for pemphigus. With DIF, we found IgA autoantibodies in 22 of all 133 cases. Circulating IgA antibodies to skin were detected in 2 of 3 IgA-DIF-positive patients with pemphigus, in 3 of 6 with bullous pemphigoid, and in 6 of 13 with mucous membrane pemphigoid. We confirm that the IgA reactivity is more frequently associated with mucous membrane involvement, especially in cases without critical involvement (5/8). The role of IgA and its antigenic specificity in these diseases remain unclear

Management and antisepsis in wound care: The experience of an Italian region (Liguria) in the treatment of older people affected by chronic ulcers

Liguria is one of the Italian regions with the highest percentage of elderly people. The European Union declared the region as a "reference site", for experimenting cutting-edge solutions and assistance models in health management of elderly people. Chronic ulcers become a problem of considerable importance looking at the number of involved elderly patients and of the necessary resources for their care, as well for the impact on the patient's quality of life, due to the painful and limiting nature of the pathology. This study aims to evaluate the appropriate wound management in older people affected by chronic ulcers. A group of wound care experts operating in the Liguria region met with the aim of reviewing the epidemiology of chronic skin lesions, analyzing the diagnostic/therapeutic approach currently in use, focusing on the importance of the antisepsis in wound management. In Liguria region general practitioners reported a 3.9% prevalence of chronic skin lesions in 2018, and up to 7.35% in women over 85 years; about 90% of the lesions managed at home were pressure lesions. An overall assessment of the patient and the lesion, appropriate cleansing and antisepsis phases and a multidisciplinary management are essential to facilitate the wound's healing process among the elderly

Autoimmune bullous dermatoses in cancer patients treated by immunotherapy: a literature review and Italian multicentric experience

Cutaneous immune-related adverse events are frequently associated with immune checkpoint inhibitors (ICIs) administration in cancer patients. In fact, these monoclonal antibodies bind the cytotoxic T-lymphocyte antigen-4 and programmed cell death-1/ligand 1 leading to a non-specific activation of the immune system against both tumoral cells and self-antigens. The skin is the most frequently affected organ system appearing involved especially by inflammatory manifestations such as maculopapular, lichenoid, psoriatic, and eczematous eruptions. Although less common, ICI-induced autoimmune blistering diseases have also been reported, with an estimated overall incidence of less than 5%. Bullous pemphigoid-like eruption is the predominant phenotype, while lichen planus pemphigoides, pemphigus vulgaris, and mucous membrane pemphigoid have been described anecdotally. Overall, they have a wide range of clinical presentations and often overlap with each other leading to a delayed diagnosis. Achieving adequate control of skin toxicity in these cases often requires immunosuppressive systemic therapies and/or interruption of ICI treatment, presenting a therapeutic challenge in the context of cancer management. In this study, we present a case series from Italy based on a multicenter, retrospective, observational study, which included 45 patients treated with ICIs who developed ICI-induced bullous pemphigoid. In addition, we performed a comprehensive review to identify the cases reported in the literature on ICI-induced autoimmune bullous diseases. Several theories seeking their underlying pathogenesis have been reported and this work aims to better understand what is known so far on this issue