Clinical utility of ingenol mebutate in the management of actinic keratosis. Perspectives from clinical practice

Actinic keratoses (AKs) are epidermal cutaneous neoplasia observed predominantly in middle-aged and older subjects with mainly photo type I and photo type II on sun-exposed surfaces as a result of DNA damage. AKs have historically been characterized as being "precancerous"; however, now it is considered by many authors a carcinoma in situ that can persist or progress to invasive squamous cell carcinoma (SCC) with metastatic potential. Despite the advances in the recognition of typical clinic, dermoscopic and histologic patterns, currently it is not yet possible to predict which AKs will progress to SCC. For this reason, early diagnosis and effective therapy are recommended based on cost/risk/benefit analysis. Current treatment consists of lesion-directed or field-directed therapies or a combination of both. Among the topical field therapies, ingenol mebutate stands out for its therapeutic efficacy, both as directed lesion therapy and as field directed therapy. The aim of this review is to demonstrate the utility of ingenol mebutate in the management of AK in daily clinical practice and to highlight data from real world in order to confirm evidence from pivotal studies. In order to explore clinical data from real world, PubMed searches were performed with the search terms "clinical data ingenol mebutate" and "real world ingenol mebutate". The hits were examined for relevant articles using defaults criteria. The timeframe for the sample search started from the first publication on this topic in 2008 up to now. A total of 23 articles were found using the keywords specified above. The overview points out a low number of real-life studies on the effectiveness and tolerability of this novel treatment due to short period of clinical experience for its recent approval. Further real-life studies are required in order to better identify the efficacy, safety and adherence of the drug on a larger population

Facial segmental lipoatrophy effectively treated with a deep priming filler incorporating calcium hydroxyapatite with results sustained for 12 months

Facial segmental lipoatrophy poses a cosmetic challenge for which various interventions have been explored. This study reports the successful treatment of facial segmental lipoatrophy using a deep priming filler formulation containing calcium hydroxyapatite. The treatment demonstrated effectiveness in restoring facial volume, with notable results sustained over a 12-month period. The incorporation of calcium hydroxyapatite in the filler formulation contributed to enhanced longevity and stability of outcomes. This promising approach represents a valuable option for addressing facial segmental lipoatrophy, offering a long-lasting solution with potential implications for cosmetic dermatology practices. Further research and clinical studies are warranted to validate and extend these findings

Efficacy of Cemiplimab in a patient affected by Cutaneous Squamous Cell Carcinoma and Myelodysplastic Syndrome

Cutaneous squamous cell carcinoma (cSCC) is a prevalent skin malignancy, often managed through surgical intervention. However, in certain cases, especially when complicated by concurrent hematologic disorders such as myelodysplastic syndrome (MDS), treatment options become more challenging. This abstract highlights a case study examining the efficacy of cemiplimab, a monoclonal antibody targeting programmed cell death protein 1 (PD-1), in a patient diagnosed with both cSCC and MDS. The patient, initially presenting with an advanced cSCC lesion and underlying MDS, underwent treatment with cemiplimab as a therapeutic approach. Monitoring of the patient's response included clinical evaluation, radiological assessments, and laboratory analyses. Results demonstrated a notable reduction in the size of the cSCC lesion and stabilization of hematologic parameters, suggesting a positive therapeutic effect of cemiplimab in this complex clinical scenario. This case underscores the potential utility of immunotherapeutic agents, specifically PD-1 inhibitors like cemiplimab, in the management of cutaneous malignancies coexisting with hematologic disorders. Further investigations and larger-scale studies are warranted to validate these findings and establish cemiplimab's role as a viable treatment option in similar clinical contexts

Gender matter in isotretinoin therapy for acne vulgaris? A retrospective study

Introduction: Gender differences have been recently highlighted for several aspects of acne vulgaris such as epidemiology, pathogenesis, clinical course, quality of life and treatment outcome. In particular a shorter but more severe clinical course has been reported in males than in females; nevertheless, usually men have their quality of life less affected. Aim: To determine if the response and the adverse events to 1 cycle of oral isotretinoin therapy can be influenced by gender. Methods: A retrospective study was conducted on consecutive patients affected by acne vulgaris and treated with oral isotretinoin. Global acne grading system (GAGS), acne-related quality of life (AQoL) and isotretinoin-related adverse events were considered as outcome measures and were evaluated before (T0), every month during administration and 4 weeks after the withdrawal (T1) of oral isotretinoin therapy. Mann-Whitney U test and Wilcoxon signed-rank test were used for quantitative parameters and Fisher exact test for qualitative ones. Results: Forty-nine acneic patients were retrospectively selected (33 males 67.3% and 16 females -32.7%; median age: 19 years). Patients had received a median dosage of isotretinoin of 0.4 mg/kg/die for a median period of 5 months; no differences in outcome measures among genders were reported. Limitations: The study is retrospective and the sample is small and not homogenously distributed among genders, as males are double in number than females. Conclusions: In our study population gender didn't influence neither the clinical and the quality of life outcome measures nor the occurrence of adverse events to oral isotretinoin therapy for acne

Dermatitis Artefacta in a Patient Affected by Impulse Control Disorder: Case Report

Dermatitis artefacta is a disease characterized by self-inflicted skin lesions in fully aware patients. Mechanical and chemical devices are most commonly used to produce such injuries. Several psychological disorders like depression, obsessive compulsive disorders, hysteria, etc. are associated with this kind of disease. Most of the patients are young females aged between 15 and 30, but the diagnosis of dermatitis artefacta may even be made in pediatric patients or elderly people. Because of its rarity and the polymorphism of lesions, dermatitis artefacta is often a challenge for the clinicians. More difficulties might be due to the lack of cooperation in these patients, who usually refuse the dialogue with doctors and deny their primary role in damaging their skin. We present a case of an elderly woman who showed a peculiar pattern of deep excoriating lesions disseminated on the upper part of her body, with an evident state of depression. Diagnostic and therapeutic procedure, that is often long lasting and difficult in such cases, was made by teamwork of dermatologists, psychiatrists and psychologists, leading to steady control of impulses and full remission of cutaneous symptoms

Factors influencing response to ingenol mebutate therapy for actinic keratosis of face and scalp

AIM To determine factors independently influencing response to ingenol mebutate therapy and assess efficacy on clinical setting of non-hypertrophic non-hyperkeratotic actinic keratosis (AK). METHODS Consecutive patients affected by non-hypertrophic non-hyperkeratotic AKs of the face or scalp were enrolled to receive ingenol mebutate 0.015% gel on a selected skin area of 25 cm2 for 3 consecutive days. Local skin reactions were calculated at each follow up visit using a validated composite score. Efficacy was evaluated by the comparison of clinical and dermoscopic pictures before the treatment and at day 57, and classified as complete, partial and poor response. RESULTS A number of 130 patients were enrolled, of which 101 (77.7%) were treated on the face, while 29 (22.3%) on the scalp. The great majority of our study population (n = 119, 91.5%) reached at least a 75% clearance of AKs and, in particular, 58 patients (44.6%) achieved a complete response while 61 (46.9%) a partial one. Logistic backward multivariate analysis showed that facial localization, level of local skin reaction (LSR) at day 2, the highest LSR values and level of crusts at day 8 were factors independently associated with the achievement of a complete response. CONCLUSION Ingenol mebutate 0.015% gel, when properly applied, is more effective on the face than on the scalp and efficacy is directly associated to LSR score

Management of psoriatic patients in biologic treatment associated with infectious comorbidities

Introduction: Psoriasis is a chronic inflammatory disease affecting about 2% of population, involving both acquired and innate immunity. Psoriasis affects mainly skin, presenting multiple co-morbidities; among them infective ones. Re-activation of tuberculosis or viral hepatitis (HBV and HCV) still represents a therapeutic challenge in patients receiving treatment with biological drugs, as well as HIV infection. For this reason, a multidisciplinary approach with global treatment resulting from active collaboration of different specialists is highly recommended.Aim: To investigate the most common infective diseases as co-morbidities associated with psoriasis and to provide algorithms for screening, follow-up and therapeutic management in psoriatic patients.Material and methods: We examined the main infectious comorbidities that can affect moderate to severe psoriatic patients, influencing the therapeutic choice as during the biological treatment both viral and tuberculosis re-activation may occur. We have therefore evaluated the main diseases (TB, Hepatitis B and C, HIV) and the monitoring of patients during treatment with biological agents.Results: Regular monitoring of psoriatic patients is recommended during long-term treatment with biological drugs in order to identify cases of re-activation of the latent infective agent or de novo acquired infection.Conclusions: Here we report the state of art regarding management of psoriatic patients with these co-morbidities suggesting a specific screening and management for infectious diseases in patients with moderate to severe plaque psoriasis

Erythrodermic Psoriasis Successfully Treated with Anti IL-17: A Case Series

Erythrodermic psoriasis (EP) is a very rare but extremely severe subtype of chronic plaque psoriasis, affecting 1.00-2.25% of patients with psoriasis (1). Its pathogenesis still remains unknown, and current therapeutic strategies frequently end in failure. In this condition, the skin becomes diffusely red, tending to purple, shiny, with marked desquamation and exudation. Erythema and edema are widespread, covering more than 90% of the body surface and can lead to high risk of multi-organ failure and death (2) due to fluid and protein loss. Predominance of the Th2 immune response and dysregulation of angiogenesis have been proposed to be implicated in the pathogenesis of EP, although this has not yet been fully elucidated (3). Nevertheless, Th17 has been shown to be the second-most predominant T-cell type after Th2 in EP lesions (4,5)