Epiluminescence microscopy: A new approach to in vivo detection of sarcoptes scabiei

Background: The usual methods of scabies diagnosis include microscopic identification of the mites and their eggs and feces in skin scrapings. In many cases, the results of microscopic examination can be negative owing to the low number of parasites present in the cornified layer. Epiluminescence microscopy (ELM) is an in vivo technique that allows a detailed inspection of the skin, from the surface to the superficial papillary dermis. This is where the scabies mite lives. In this study, we evaluate the applicability and the usefulness of ELM for in vivo diagnosis of scabies. Observations: Sixty-five (93%) of 70 cases of scabies showed small, dark, triangular structures at the sites examined with ELM. A subtle linear segment seen below the base of the triangle was made visible by the presence of small air bubbles. Together, both structures re sembled a jet with contrail. On traditional microscopic examination of the scrapings, we verified that the triangular structure corresponded to the pigmented anterior section of the mite in all cases. The linear segment observed on ELM was thought to be the burrow of the mite along with its eggs and fecal pellets. The cases in which the results of a first ELM examination were negative demonstrated positive results on a second ELM examination carried out 20 days later. Conclusion: Epiluminescence microscopy is a very useful tool for in vivo diagnosis of scabies because it permits Sarcoptes scabiei detection in only a few minutes, with no discomfort to the patient and with a very low number of false-negative results

Topical nicotinamide for seborrheic dermatitis: an open randomized study.

Background: Treatment of seborrheic dermatitis (SD) includes various options with different success and safety limitations. Objective: To evaluate the efficacy of topical nicotinamide (NCT) in the treatment of SD. Methods: A total of 48 patients with mild to moderate SD of the face were enrolled in the study (36 males and 12 females; age 20-50 years). Patients were randomized into two groups A and B, who were treated once a day with topical administration of NCT 4% cream and with the vehicle without NCT (placebo), respectively. Clinical measures were assessed by erythema, scaling, and infiltration, which were evaluated using a four-point scale 0-3 before starting treatment and after 2, 6, and 12 weeks' therapy. Results: In comparison with baseline, a reduction of 75% of the total score was observed in patients treated with NCT, whereas for placebo-treated patients the reduction was of 35% (p < 0.05). Conclusion: Topical NCT 4% can have a potential for the treatment of SD

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

Acne Smart Club: An Educational Program for Patients with Acne

Objective: To evaluate adherence to therapy in acne patients using mobile phones and Short Message Service (SMS) to communicate. Methods: 160 patients were randomly assigned to two groups: the SMS group received 2 text messages twice a day for a period of 12 weeks; the control group did not receive any messages. Before and after 12 weeks, the following evaluations were performed in all patients: digital photographs, the Global Acne Grading System, the Dermatology Life Quality Index, the Cardiff Acne Disability Index, the doctor-patient relationship evaluated through the Patient-Doctor Depth-of-Relationship Scale, and the adherence to treatment evaluated by asking patients how many days a week they had followed the therapy. For statistical analysis we used Student's t test. Results: The SMS group had a better improvement of all parameters compared to the control group. Conclusion: Adherence and compliance are higher for patients who are included in a strategy of control. © 2014 S. Karger AG, Basel

A reappraisal of the biological functions of melanins and melanogens: The role of 5,6-dihydroxyindole-2-carboxylic acid (DHICA) in skin (photo)protection

Solar ultraviolet rays (UVR) play an important role in melanoma and non-melanoma skin cancer development while melanins, produced by melanocytes, are involved in photoprotection, control of oxidative stress, regulation of skin homeostasis and immunity. The ratio between the two main groups of melanin, eumelanins and pheomelanins, is regulated by the mc1r gene encoding for melanocortin-1-receptor (MC1R), whose inactivation causes a switch from eumelanin to pheomelanin production. While eumelanins are considered to be photoprotective, pheomelanins are known to be (photo)toxic as they lead to the production of reactive oxygen species in the presence and in the absence of UV radiation. It seems that not only eumelanins but even their precursors can contribute to the (photo)protective action. In particular, 5,6-dihydroxyindole-2-carboxylic acid (DHICA) and its main metabolite 6-hydroxy-5- methoxyindole-2-carboxylic acid (6H5MICA) have antioxidant properties so they could play a critical role in the responses of the melanocyte to oxidative stress and inflammation. Moreover, it has been showed that DHICA is able to act as a chemical messenger inducing antioxidant defense systems and cell differentiation in keratinocytes. On these basis, DHICA and its methylated metabolite could play an important role in chemopreventive strategies of melanoma skin cancer

Epiluminescence microscopy: Criteria of cutaneous melanoma progression

Background: Cutaneous melanoma develops through a series of evolutionary steps (intraepidermal, radial, and vertical growth phases) that are traceable in specific histologic features. Epiluminescence microscopy (ELM) is an in vivo technique that enables the visualization of morphologic structures in pigmented lesions correlated with specific histologic architectural characteristics. Many ELM criteria associated with cutaneous melanoma have been described, but their correlation with tumor progression has not yet been established. Objective: In this preliminary study our purpose was to explore the possibility of recognizing ELM criteria that allow the in vivo detection of the various phases of melanoma progression as well as tumor depth. Methods: Seventy-two cutaneous melanomas (41 'thin' melanomas [TnM], 0.75 mm thickness) were investigated with ELM for the presence of nine standard ELM criteria; their significance was determined by calculating the chi-square test of independence. Results: A significant association is found between the presence of pigment network and TaM and between the presence of gray-blue areas, vascular pattern, and TkM. Moreover, pigment network plus radial streaming is the most significant association of ELM criteria in TnM, whereas gray-blue areas plus vascular pattern is the greatest in TkM. Conclusion: This study shows a good correlation between certain ELM criteria and the histologic architecture of cutaneous melanoma for a preoperative evaluation of the tumor thickness. Further investigation is needed for verifying on a larger number of cases our pilot estimates of sensitivity and specificity of ELM criteria in thin and thick melanomas

Clinical and dermatoscopic criteria for the preoperative evaluation of cutaneous melanoma thickness

Background: Melanoma thickness measured according to the Breslow method is used to determine surgical margin and in patient selection for sentinel node biopsy. Previous studies did not confirm the reliability of melanoma palpability for clinical prediction of tumor thickness. Recently we reported the usefulness of epiluminescence microscopy (dermatoscopy) for in vivo detection of the phases of melanoma progression, as well as tumor depth. Objective: Our purpose was to determine whether the combination of clinical and dermatoscopic criteria could increase the accuracy in preoperative evaluation of melanoma thickness with respect to the clinical elevation and dermatoscopic assessments considered separately. Methods: In a blind retrospective study, 122 cutaneous melanomas were studied to evaluate the presence of several clinical and dermatoscopic criteria and their relation with the histologic thickness. An algorithm of combined criteria was constructed and statistically assessed. Results: Combinations of palpability, diameter of more than 15 mm, pigment network, gray-blue areas, and atypical vascular pattern allowed correct prediction of thickness in 89% of melanomas when categorized in two groups of less than 0.76 mm and more than 0.75 mm thickness, compared with 75% using palpability, and 80% using dermatoscopic criteria. Lower values were obtained in the further subdivision of melanomas into groups of 0.76 to 1.5 mm and more than 1.5 mm thickness. Conclusion: The combination of clinical and dermatoscopic criteria is a more precise guide for the preoperative evaluation of melanoma thickness than either is alone. However, further studies are needed to verify its applicability in establishing the surgical approach to cutaneous melanoma

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