Certainty diagnosis of scabies in vivo by epiluminescence microscopy

Scabies represents a frequent and well-known skin disease provoked by infestation of Sarcoptes scabiei var hominis. It is characterized by severe generalized pruritus and by the presence of pathognomic burrows caused by the female arachnid in the epidermis. Often there are secondary symptoms such as pomphos, papules, vesicles or burrows and nodules. Currently, the diagnosis of scabies is established by optical microscopy identification of the mite, or ova in skin scraping removed from a linear or serpiginous elevation of skin in the form of a ridge 0.5-1 cm in length. Nevertheless occasionally even when numerous characteristic scabies symptoms are present, the scrape of burrow can be negative in optical microscopy. The authors showed a specific epiluminescence microscopic pathognomic picture of scabies, that can attribute a high diagnostic resolution to this technique. In respect to optical microscopy, epiluminescence permits the observation of an extended skin surface and reduces the possibility of false negative tests

UV-selective face cream (Acne RA-1,2) in acne patients: clinical study of effects on epidermal barrier function, sebum production, tolerability and adherence to pharmacological therapy.

BACKGROUND: General skin care recommendations such as the use of moisturisers and products with adequate photoprotection are important components of management for acne patients to complement the medical regimen. This study aimed to evaluate the real-life clinical effects of a novel UV-selective face cream (Acne RA-1,2) on acne, epidermal barrier function, sebum production, adherence and tolerability when used together with pharmacological acne treatment. METHODS: 40 patients receiving pharmacological acne treatment applied Acne RA- 1,2 once-daily for 3 months. Investigator's Global Assessment of acne, trans- epidermal water loss, sebum production and tolerability were assessed after 1 and 3 months. RESULTS: After 3 months, there was a 38% significant clinical improvement in mean Investigator Global Assessment score (3.4 to 2.1), a 29% significant reduction in trans-epidermal water loss (13.2 to 9.4 g/h/m2), and a 17% significant decrease in sebum production vs baseline (234.6 to 195.6 μg/cm2; all p<0.01). 100% of patients reported complete adherence to pharmacological therapy over the summer of the study vs 52.5% in the previous summer. 87.5% considered their acne improved over the summer of the study vs 55.0% in the previous summer. Pruritus, erythema, dryness and total tolerability symptom scores were significantly reduced after 3 months vs baseline (p<0.05). CONCLUSIONS: Acne RA-1,2 is a useful daily adjunct to pharmacological therapy as it helps to mitigate the irritation these therapies cause, increasing adherence to therapy, and leading to a clinical improvement in acne and epidermal barrier function and a decrease in sebum productio

The role of camouflage in the management of skin damages in oncologic patients

Neoplastic disease and its therapeutic options have a huge impact on the patient's quality of life from both the emotional and the working point of view. Sociological research has revealed that gender also plays an important role in the emotional reaction to the disease. When faced with a neoplastic disease, men and women show significantly different reactions: women, as wives and mothers, are more subject and vulnerable to stress and they can have major psychological implications for the severe impact on body image. In 2002, at the Dermatological Clinic of the University of Naples "Federico II", Corrective Dermacosmetological Laboratory was activated to teach the most suitable techniques in order to disguise skin imperfections by means of an easily reproducible maquillage. Since 2010 the Laboratory is activating to help oncologic patients learn the best way of hiding temporary or permanent skin damages that cause serious discomfort because of the aesthetic modifications of their image. The corrective dermacosmetological camouflage is a technique aiming to learn to oncologic patients the best way of hiding temporary or permanent skin damages related to chemotherapy and radiotherapy: it is also important to contain any cicatricial results. At the laboratories of Naples 36 patients have been treated, 31 women and 5 men, aged between 19 and 72 years. The camouflage technique depends basically on the use of a number of opaque covering non irritant, hypoallergenic creams and powders of superior duration if compared to standard cosmetics. Results were supported by photos showing the excellent results achieved with this technique. Furthermore, an improvement in psychological problems caused by skin damages related to chemotherapy, radiotherapy and surgery therapy was observed in all patients

Polymorphous light eruption and benign summer light eruption

BACKGROUND/PURPOSE: Polymorphous light eruption (PLE) heterogeneity has been postulated, but the existence of benign summer light eruption (BSLE) is controversial. We studied the prevalence of the clinical patterns, criteria distinguishing BSLE from PLE, and diagnostic usefulness of phototest. METHODS: Five Italian Photodermatology Centres recruited retrospectively 346 patients with typical clinical history and/or presentation of PLE. Age, gender, skin type, family history and presence of atopy were considered. UVA and UVB MEDs and provocative phototests with UVA and UVB were obtained with a standardized procedure. Photopatch tests were applied according to the IRCDG rules. ANA were assessed by indirect immunofluorescence. RESULTS: Four criteria (predominance of women, shorter latency, uninvolvement of the face and absence of relapse during summer) identified BSLE in only 6.1% of cases. All had positive phototests, mostly with UVA. Uninvolvement of face, short latency and no seasonal relapses identified 11.7% patients, mostly with positive phototests to UVA. Short latency and no seasonal relapses in women identified 11.2% patients. Uninvolvement of face and no seasonal relapses in women identified 8.1% of patients. Uninvolvement of face and short latency in women identified 17.6% of patients. CONCLUSION: Criteria diagnosed BSLE in only a minority of patients, who were positive at phototesting, mostly with UVA

A statistical analysis of the characteristics of pigmented skin lesions using epiluminescence microscopy

Due to the fact that not all pigmented skin lesions (PSL) can be diagnosed solely by their clinical appearance, additional criteria are required to optimize the clinical diagnosis of atypical nevus and melanoma. Epiluminescence microscopy is a non-invasive in vivo examination that often helps to improved the accuracy of clinical diagnosis of such lesions. Years of experience have indicated some differential epiluminescent patterns for benign and malignant PSI, but there is some controversy about certain borderline lesions for which histological examination is always necessary. In our study we performed a statistical analysis of data concerning 183 PSI, to determine characteristics significantly associated with these lesions allowing identification of epiluminescent criteria suggestive of atypical nevus and malignant melanoma. Using he chi-quadro test and stepwise regression logistic model, we identified the following epiluminescent pattern as a risk factor for atypical nevus and malignant melanoma: irregular pigment network, presence of capillaries, irregular and abrupt ending of overall pigmentation, irregular brown globules and irregular shape and size of black dots

Statistical image processing for the detection of dermoscopic criteria

An image based system implementing a well-known diagnostic method is disclosed for the automatic detection of melanomas as support to clinicians. The software procedure is able to recognize automatically the skin lesion within the digital image, measure morphological and chromatic feature, carry out a suitable classification for the detection of structural dermoscopic criteria provided by the 7-Point Check List. Experimental results about the adoption of statistical techniques applied to the border detection, feature extraction and classification as well as the resulting diagnostic score are described with reference to a large image set. Copyright © 2011 by the International Measurement Confederation (IMEKO) All rights reserved

Cosmetics for acne: indications and recommendations for an evidence-based approach.

AIM: The aim of this review was to evaluate, by a thorough revision of the literature, the true efficacy of currently available topic and systemic cosmetic acne agents. METHODS: The efficacy of currently available cosmetic acne agents has been retrospectively evaluated via thorough revision of the literature on matched electronic databases (PubMed). All retrieved studies, either randomized clinical trials or clinical trials, controlled or uncontrolled were considered. RESULTS: Scientific evidence suggests that most cosmetic products for acne may enhance the clinical outcome. Cleansers should be indicated to all acne patients; those containing benzoyl peroxide or azelaic/salicylic acid/triclosan show the best efficacy profile. Sebum-controlling agents containing nicotinamide or zinc acetate may minimize excessive sebum production. Cosmetics with antimicrobial and anti-inflammatory substances such as, respectively, ethyl lactate or phytosphingosine and nicotinamide or resveratrol, may speed acne recovery. Topical corneolytics, including retinaldehyde/glycolic acid or lactic acid, induce a comedolytic effect and may also facilitate skin absorption of topical drugs. Finally, the use of specific moisturizers should be strongly recommended in all acne patients. CONCLUSION: Cosmetics, if correctly prescribed, may improve the performance of the therapy, whereas wrong procedures and/or inadequate cosmetics may worsen acne. Cosmetological recommendations may allow clinicians to make informed decisions about the role of various cosmetics and to indentify the appropriate indications and precautions. The choice of the most effective product should take into consideration the ongoing pharmacological therapy and acne type/severity as well

Acne Scars: Pathogenesis, Classification and Treatment

Acne has a prevalence of over 90% among adolescents and persists into adulthood in approximately 12%–14% of cases with psychological and social implications. Possible outcomes of the inflammatory acne lesions are acne scars which, although they can be treated in a number of ways, may have a negative psychological impact on social life and relationships. The main types of acne scars are atrophic and hypertrophic scars. The pathogenesis of acne scarring is still not fully understood, but several hypotheses have been proposed. There are numerous treatments: chemical peels, dermabrasion/microdermabrasion, laser treatment, punch techniques, dermal grafting, needling and combined therapies for atrophic scars: silicone gels, intralesional steroid therapy, cryotherapy, and surgery for hypertrophic and keloidal lesions. This paper summarizes acne scar pathogenesis, classification and treatment options

Reliability and inter-observer agreement of dermoscopic diagnosis of melanoma and melanocytic naevi

The aim of this study was to analyse the reliability and the inter- observer agreement of dermoscopy in the diagnosis of melanocytic skin lesions. Nine dermatologists, with a different training experience and who routinely used dermoscopy in different hospitals in Italy, evaluated clinical and dermoscopy photographs of 15 melanocytic lesions (four invasive melanomas, four histologically common naevi, and seven naevi with histological atypia). A further series of dermoscopic photographs of 40 melanocytic lesions was evaluated to quantify inter-observer concordance in recognizing dermoscopic criteria. Compared to the true (histological) diagnosis, clinical diagnosis (categories: melanoma, common naevus, atypical naevus) was correct in 40% of cases (range, 27-53%). The percentage raised to 55% (40-73%) by the use of dermoscopy, with an average improvement of 15.6%. Concerning melanoma, clinical diagnosis resulted in a sensitivity of 41.9%, specificity of 77.8%, positive predictive value (PPV) of 36.1%, negative predictive value (NPV) of 81.8%. By using dermoscopy, an improvement of diagnostic performance was found (sensitivity 75%, specificity 88.8%, VPP 71.0%, VPN 90.7%). The inter-observer agreement in melanoma diagnosis, by using dermoscopy, was similar to that obtained by clinical examination (k statistics = 0.54 and 0.52, respectively). Concerning dermoscopic criteria, the best agreement among observers was found for pseudopods, a dermoscopic parameter related to the radial growth phase of melanoma. We conclude that dermoscopy is an useful tool for a non-invasive diagnosis of melanocytic skin lesions, improving the diagnostic performance compared to clinical examination

Effectiveness and safety of secukinumab in Italian patients with psoriasis: an 84 week, multicenter, retrospective real-world study

Background: Long term data on the real-life use of secukinumab are scant. The aim of this study was to investigate the real-life effectiveness, safety and treatment persistence of secukinumab in patients with moderate-to-severe psoriasis. Research design and methods: This 84-week, multicenter (n = 7) retrospective study analyzed data from patients who initiated and received at least 6 months of secukinumab treatment between June 2016 and June 2018 in the Campania region of Italy. Patient demographic and treatment characteristics, duration of treatment and reasons for discontinuation as well as Psoriasis Area and Severity Index (PASI), Body Surface Area (BSA), and Dermatology Life Quality Index (DLQI) scores were assessed. Results: 324 patients (63% male, mean age 50.2 years) were enrolled and received a mean 11.7 months of secukinumab treatment. Overall, 9.5% discontinued secukinumab, including 5.2% who discontinued due to secondary inefficacy and 1.8% due to adverse events. PASI, BSA and DLQI scores were significantly improved from baseline at every follow-up visit (p < 0.001) and mean PASI decreased from 15.3 ± 6.3 at baseline to 0.5 ± 1.0 at week 84. Secukinumab had comparable effectiveness in biologic naïve and non-naïve patients. Conclusions: This study confirmed the effectiveness and safety of secukinumab in real-world patients with psoriasis