An itchy vesiculobullous eruption in a patient with chronic lymphocytic leukaemia.

Exaggerated reactions to insect bites are characteristic of patients with haemoproliferative disorders, particularly chronic lymphocytic leukaemia (CLL). Skin lesions usually appear after the diagnosis of leukaemia and seem unrelated to laboratory findings, disease course or therapy. Rarely, the eruption may precede the diagnosis of the haematologic malignancy. The patients usually do not recall of insect bites, and the diagnosis may require histological and laboratory investigations to exclude specific lesions or autoimmune bullous diseases. Lesions may run a chronic course and represent a therapeutic challenge. Here, we report an adult patient with CLL who developed itchy recurrent papulovesicular and bullous lesions. Differential diagnosis was made with cutaneous specific lesions of CLL, bullous pemphigoid and pemphigus vulgaris, but laboratory and histological investigations confirmed the diagnosis of an insect bite reaction. The patient was treated with oral H1 anti-histamines and topical corticosteroids under occlusion, with marked improvement after 10 days

Biological drugs targeting the immune response in the therapy of psoriasis

Chronic plaque psoriasis affects more than 2% of world population, has a chronic recurrent behavior, gives a heavy burden to the patients’ quality of life, and hence remains a huge medical and social problem. The clinical results of conventional therapies of psoriasis are not satisfactory. According to the current knowledge of the molecular and cellular basis of psoriasis, it is defined as an immune-mediated chronic inflammatory and hyperproliferative skin disease. A new generation of biological drugs, targeting molecules and cells involved into perturbed pro-inflammatory immune response in the psoriatic skin and joints, has been recently designed and applied clinically. These biological agents are bioengineered proteins such as chimeric and humanized antibodies and fusion proteins. In particular, they comprise the antitumor necrosis factor-α agents etanercept, infliximab, and adalimumab, with clinical efficacy in both moderate-severe psoriasis and psoriatic arthritis, and the anti-CD11a efalizumab with selective therapeutic action exclusively in the skin. Here, we overview recent findings on the molecular pathways relevant to the inflammatory response in psoriasis and present our clinical experience with the drugs currently employed in the dermatologic manifestations, namely etanercept, infliximab, and efalizumab. The growing body of clinical data on the efficacy and safety of antipsoriasis biological drugs is reviewed as well. Particular focus is given to long-term safety concerns and feasibility of combined therapeutic protocols to ameliorate clinical results

Adherence to the Mediterranean diet model and psoriatic disease (skin, joint and metabolic expression of psoriasis)

Psoriasis is a chronic disease, characterized by systemic inflammation with skin, joint and metabolic involvement. The most common tools to evaluate the severity of each disease is respectively the Psoriasis Area Severity Index (PASI) and the Disease Activity Index for Psoriatic Arthritis (DAPSA). The association between psoriasis and obesity and the role of visceral fat in producing an inflammatory state have been demonstrated. The Mediterranean Diet (MD) has been recommended as a model of healthy diet on the basis of scientific evidence and considered as an adjuvant therapy for all patients affected by chronic inflammatory diseases. Our study evaluated the association between adherence to MD (assessed with the Predimed questionnaire) and psoriatic disease severity. 80 patients (40 with psoriasis and 40 with psoriatic arthritis) were evaluated for disease severity (PASI, DAPSA) and were assessed for Metabolic Syndrome according to the International Diabetes Federation (IDF) definition. To evaluate adherence to the MD, each patient was administered the Predimed questionnaire which includes 14 questions. Our study shows a correlation between low adherence to MD and a high expression of psoriasis, considering cutaneous, joint symptoms and the metabolic profile

Localized Cutaneous Hyalohyphomycosis Caused by a Fusarium Species Infection in a Renal Transplant Patient

Fusariosis is a hyalohyphomycosis due to Fusarium species that mainly occurs in immunocompromised hosts. The clinical spectrum of Fusarium infection comprises localized and disseminated forms. A case of localized cutaneous fusariosis caused by Fusarium solani in a renal transplant patient is described, and the skin manifestations of the disease are discussed