Tacrolimus in Solution as an Option to Inflammatory Conditions of the Scalp

Introduction: Several dermatological diseases lead to inflammatory conditions of the scalp. Most of these afflictions are recalcitrant and require long term maintenance treatment. Objectives: We present a case series where topical tacrolimus was used in a solution vehicle for these conditions. Methods: A total of 22 patients (aged 24-90 years) with confirmed diagnosis of lichen planus pilaris (LPP),discoid lupus (DL),frontal fibrosing alopecia (FFA),erosive pustulosis of the scalp (EPS) or folliculitis decalvans (FD) were evaluated and treated with tacrolimus solution (0.1%) applied twice daily for 1 month, then once daily for another month and alternate days for 4 months. Efficacy was evaluated by an investigator global assessment,clinical and dermoscopic evaluation at weeks 4,8 and 24.The safety assessment included monitoring of all adverse events. Results: The study included 13 patients with LPP, 2 with DL, 2 with FD, 2 with EPS and 3 with AFF.After 1 month, 14 patients (63.6%) had a good response and 7 (31.8%) had excellent response.After 2 months, 16 patients (72.7%) had excellent response, and this response was persistent after 6 months of treatment. Conclusions: Tacrolimus in solution,even if not yet commercially available,was an effective and well tolerated alternative for the maintenance treatment of inflammatory conditions of the scalp

Real-World Experience with Topical 5-Fluorouracil 4% (40 mg/g) Cream for the Treatment of Actinic Keratosis

Introduction:5-fluorouracil (5-FU) is one of the most effective topical treatments for actinic keratosis (AK). A new 4% formulation of 5-FU was recently approved in Europe. Objectives:This study aimed at evaluating 4% 5-FU cream safety and effectiveness in a real-world setting. Methods:Adult AK patients were retrospectively selected from the University of Campania Dermatology Unit database. Selection criteria included a diagnosis of non-hyperkeratotic, non-hypertrophic AK (Olsen grade I and II) of the face, ears, and/or scalp, treatment with 4% 5-FU once daily for 4 weeks, and at least 3 follow-up visits (4 and 8 weeks after treatment initiation, and 6 months after treatment end). The primary objectives were to evaluate AK lesions improvement at 8 weeks and relapse rate at 6 months. Patient-reported erythema and burning sensation intensity were also assessed at 4 weeks. Results: Ninety-eight patients were included in this analysis (male/female 80/18, mean age 74.7 years). AK lesions improvement at 8 weeks resulted complete or significant in 74.5% and 20.4% of the patients, respectively. At 6 months, 65.3% of the patients did not show AK relapses. Burning sensation at 4 weeks was reported as light, moderate, or absent by 44.9%, 22.4%, and 31.6% of the patients, respectively. Erythema was reported as light, moderate, or absent by 37.8%, 51%, and 10% of the patients, respectively. Burning sensation and erythema disappeared gradually during follow-up. No other side effects were reported. Conclusions:In this real-world study 4% 5-FU proved to be highly effective for AK lesions clearance with a favorable safety profile

Diagnosis and Management of Melanoma of the Scalp: A Review of the Literature

Cutaneous melanoma is a public health issue and the head and neck region is of particular interest, despite accounting for only 9.0% of the total body surface, it harbours 20% of melanoma cases. Data from the literature show that scalp melanomas (SM) carry high mortality rates, with a 10-year survival rate of 60% which lead them to be named as the "invisible killer". Moreover, SMs are more common in the elderly than in young population, and they occur six times more frequently in men than in women. This is probably related to the higher incidence of androgenetic alopecia and a higher cumulative and intermittent ultraviolet damage on the scalp. Histologically, SM is a heterogenous group, including lentiginous melanoma (LM), desmoplastic melanoma, superficial spreading and nodular melanoma. Thin melanomas tend to display an atypical network or pseudo-network and regression in dermoscopy. Blue-white veil, irregular pigmented blotches and an unspecific pattern are most commonly detected in thick lesions. On reflectance confocal microscopy (RCM), the most frequent pattern is irregular meshwork, but also ringed and disarranged pattern have been described. Differential diagnosis includes benign solar lentigo, actinic keratoses, lichen planus like keratosis, melanocytic nevi and blue nevi. All suspicious lesions should be biopsied; therefore, an excisional biopsy with 2 mm margins is usually the best option. The management of SM is the same as for melanoma on other body sites. However, sentinel node biopsy tends to be more challenging, as well as achieving adequate excision margins of the primary tumor. In this review, we summarize clinical, pathologic, dermoscopic and RCM features of SM, and focus on its epidemiology, risk factors and best management options

THE ROLE OF SOCIAL SUPPORT AND EMOTIONAL INTELLIGENCE ON NEGATIVE MOOD STATES AMONG COUPLES DURING PREGNANCY: AN ACTOR-PARTNER INTERDEPENDENCE MODEL APPROACH

Objective: In the eld of perinatal psychology, the majority of studies focused on mothers’ psychological and behavioral states during pregnancy, neglecting the role of their partners. This study used an Actor-Partner Interdependence Model approach to evaluate the role of social support and emotional intelligence in both members of marital couples who were expecting a baby. Method: Forty couples who were waiting for their rst child were asked to complete questionnaires on social support, trait emotional intelligence, anxiety, and depression. Results: Paternal emotional intelligence was related to paternal depression and anxiety, and maternal emotional intelligence was related to maternal depression and anxiety. Anxiety and depression were not predicted by the other partner’s social support and emotional intelligence. However, emotional intelligence in fathers was linked to perceived social support in mothers. Conclusions: Anxiety and depression are serious problems during pregnancy, and high emotional intelligence in fathers can represent an important variable that might indirectly reduce negative mood states in mothers. This consideration may help in the de nition of better preventative actions and psychological interventions during pregnancy