Fotodermatosi

Le fotodermatosi in età pediatrica rappresentano un vasto capitolo delle patologie dermatologiche. La luce solare è in grado di produrre malattie caratterizzate da fotosensibilità. Il capitolo focalizza l'attezione soprattutto su le fotodermatosi autoimmuni e quelle mediate da sostanze chimiche. Fra le prime vengono trattate soprattutto la dermatite polimorfa solare, l'orticaria solare e l'hydroa vacciniforme; fra le seconde la gran parte è rappresentata da reazioni fototossiche a vegetali (fitofotodermatiti, cosmetici e farmaci sia topici che sistemici

Vitiligo, NB-UVB and tacrolimus: our experience in Naples.

Aim: The aim of the present study was to evaluate the efficacy and safety of narrowband UVB (NB-UVB) compared with tacrolimus ointment 0.1% in patients with bilateral vitiligo. Methods: In this comparative study, four groups of patients were randomized. Each group was composed by 12 patients with bilateral vitiligo; in each group, every patient was irradiated with NB-UVB (length: 311 nm) twice a week for 9 months and applied tacrolimus ointment 0.1% twice a day on the other area in the same period. Before starting therapy and after 3, 6 and 9 months of therapy, a clinical and photographic evaluation of percentage of repigmentation was performed and Dermatology Life Quality Index Questionnaire was fulfilled. Results: A repigmentation at least partial occurred in 71% of patients after 36 weeks of treatment with tacrolimus ointment 0.1%; in the whole sample, 14 patients (29%) showed no repigmentation at all, with 2 of them discontinuing the therapy because of side effects (erythema and folliculitis-like manifestations). A homogeneous repigmentation at least partial occurred in 69% of patients after 36 weeks of treatment with NB-UVB; in the whole sample 15 patients (31%) showed no repigmentation at all, with 1 of them discontinuing the therapy because of side effects. Conclusion: The present study confirmed that the efficacy of NB-UVB phototherapy in vitiligo is comparable to tacrolimus ointment 0.1% therapy. On the basis of our study, we may suggest tacrolimus ointment 0.1% as an alternative to NB-UVB therapy for treating vitiligo

Lichen amyloidosus: a new therapeutic approach.

The result of topical treatment by dimethyl sulphoxide (DMSO) in a patient with lichen amyloidosus is reported. Itching improved within five days of therapy. Remarkable flattening of the papules was obtained within two weeks. The clinical result was confirmed by histological examination which revealed partially disappearance of amyloid deposits

The melanin pigmentation: cellular and biomolecular mechanisms

Several factors are determinant for the color of human skin: the thickness of the stratum corneum, the speed of blood flow, the degree of oxygenation of hemoglobin but the main role is played by the presence of pigments such as carotenoids and, above all, melanin. The amount and the type of melanin is genetically determined, but they are strongly influenced by the other conditions such as hormonal and environmental: age, presence of metal ions, and inflammatory processes, and specifically exposure to sunlight. In vertebrates, melanocytes cells, responsible for the production of melanin, have the main function, but not exclusively, to protect the skin from the genotoxic stress produced by ultraviolet rays (UV); melanin absorbs the UV and neutralizers reactive oxygen species (ROS) they produce. Some studies clarified, at least in part, enzymatic and non enzymatic factors involved in the biosynthesis of melanin and the molecular mechanisms underlying the different responses of skin pigmentation to external stimuli, particularly to solar radiation. In this review we want to revise the cellular and biochemical aspects of skin pigmentation

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

Photodynamic therapy: a treatment tool for hidradenitis suppurativa

Hidradenitis suppurativa (HS) is a chronic, recurrent, debilitating inflammatory disease of unknown aetiology. The current standard of care for HS includes antibiotics (oral/topical), retinoids (oral/topical) and intralesional steroids. However, the recurrence of the disease and the unsuccessful of the different treatments stimulate findings of different therapy using light source. Among these, photodynamic therapy with 5-aminolevulinic acid (ALA-PDT) has been proposed by some authors recently. In this study we report the experience of 15 patients affected by HS resistant to conventional therapy treated with ALA-PDT

Photodynamic therapy and adapalene in dermatology: synergistic effects in immortal human keratinocytes

We compared the effects of methyl levulinate (MAL)/photodynamic therapy (PDT) and adapalene, evaluated singly, versus combination therapy on HaCaT keratinocytes. Our aim was to determine whether the additive/synergistic outcomes of combination treatment were such that doses of each component could be reduced without affecting treatment efficacy. The analysis of data from specific PDT/adapalene combinations results indicating effects ranging from additive to clearly synergistic. We first evaluated the effects on cell viability, cell cycle and protein expression profiles of each individual treatment, then we tried to understand the reasons and the mechanisms whereby cells under combined treatment move more efficiently to death. Although we observed therapeutic strengthening by increasing either drug doses or light fluences, reinforcement was particularly marked in combinations in which PDT was predominant. Thus, if PDT is appropriately tuned, the dose of the drug can be reduced without compromising the therapeutic response. As both photodynamic therapy and adapalene have been and are therapeutic approaches to treat different dermatological pathologies such as acne, actinic keratosis etc., our data suggest that the adapalene-PDT combination may have important spin-off in clinical dermatology as a strategy to tackle this nasty condition

Valutazione dell'efficacia di un coadiuvante topico a base di argento micronizzato, zinco acetato e acido laurico nel trattamento dell'acne lieve-moderata

L'acne è una dermatosi ad eziopatogenesi multifattoriale in cui differenti fattori contribuiscono al mantenimento del processo infiammatorio. Il ruolo del P. acnes è stato, infatti, rideterminato in quanto trigger principale della risposta infiammatoria, essendo in grado di attivare la liberazione di numerose citochine proinfiammatorie. Non a caso, gli antibiotici sono tra i farmaci cardine della terapia topica dell'acne. Il loro uso è, tuttavia, limitato dallo sviluppo di resistenze batteriche. Ne deriva la necessità di utilizzare nuove molecole, le cui proprietà antibatteriche non siano suscettibili di fenomeni di resistenza. Tra le molecole che hanno destato maggiore interesse, per l'azione antibatterica non antibiotico-dipendente, e, pertanto, non soggetta allo sviluppo di resistenze, annoveriamo l'acido laurico, l'argento micronizzato e lo zinco acetato. Il nostro studio si propone di valutare l'efficacia nel trattamenti dell'acne lieve-moderata di una terapia topica a base di argento micronizzato, acido laurico e zinco acetato attraverso una valutazione sia oggettiva, mediante GAGS e Sebutape, che soggettiva, mediante l'ausilio di un nuovo strumento di valutazione della componente psicologica del paziente acneico: l'acne radar

Topical tacrolimus and vitiligo: our experience in sixty cases

Aim. Vitiligo is an acquired hypomelanotic disorder characterized by circumscribed depigmented maculae on the skin. Current treatment procedures include narrow band UVB therapy, topical corticosteroids and imunomodulators. Aim of our study was to evaluate the efficacy and safety of topical tacrolimus in the treatment of vitiligo. Methods. Sixty patients (44 females, 22 males) with stable vitiligo were enrolled in our study. They did not show any benefits from topical corticosteroids, PUVA and NB-UVB therapy, so they were administered topical tacrolimus 0.1% twice a day and followed-up for 9 months. Results. At least a partial repigmentation was noticed with tacrolimus ointment in 46 patients after 9 months of therapy. Twenty-three of them obtained a good repigmentation, already evaluable at 3 months from the beginning of therapy and remaining the same at 6 and 9 months, respectively. The other 23 patients obtained an excellent repigmentation, evaluable only at 9 months from the beginning of therapy, while a poor repigmentation was observed at 3 and 6 months. Two patients discontinued therapy because of side effects, while the remaining 12 had no repigmentation at all. Conclusion. Topical tacrolimus could be considered an effective and safe therapy for vitiligo, expecially for patients who had no benefits from corticosteroids and/or phototherapy

TRATTAMENTO ASSOCIATO UVB-DITRANOLO IN PAZIENTI CON PSORIASI A PLACCHE

The purpose of this study was to determine whether the combination of ultraviolet B therapy and anthralin would result in a more rapid resolution of plaque-type psoriasis. Short-contact anthralin (0.5% in petrolatum) was used. Ultraviolet B irradiation was carried out 5 times a week with a bank of 8 Philips TL 40W/12 tubes (irradiance, 1 mW/cm2 30 cm). Out of the 14 patients studied, seven (group I) were given anthralin for 15 days before practicing UVB therapy and seven (group II) carried out phototherapy sessions for 15 days before the combination of both treatments. These results show both a more rapid clearance of psoriatic plaques and lower UVB total dose with anthralin pretreatment