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Background: Urticaria is a disorder affecting skin and mucosal tissues characterized by the occurrence of wheals, angioedema or both, the latter defining the urticaria-angioedema syndrome. It is estimated that 12-22% of the general population has suffered at least one subtype of urticaria during life, but only a small percentage (estimated at 7.6-16%) has acute urticaria, because it is usually self-limited and resolves spontaneously without requiring medical attention. This makes likely that its incidence is underestimated. The epidemiological data currently available on chronic urticaria in many cases are deeply discordant and not univocal, but a recent Italian study, based on the consultation of a national registry, reports a prevalence of chronic spontaneous urticaria of 0.02% to 0.4% and an incidence of 0.1-1.5 cases/1000 inhabitants/year., Methods: We reviewed the recent international guidelines about urticaria and we described a methodologic approach based on classification, pathophysiology, impact on quality of life, diagnosis and prognosis, differential diagnosis and management of all the types of urticaria., Conclusions: The aim of the present document from the Italian Society of Allergology, Asthma and Clinical Immunology (SIAAIC) and the Italian Society of Allergological, Occupational and Environmental Dermatology (SIDAPA) is to provide updated information to all physicians involved in diagnosis and management of urticaria and angioedema., Competing Interests: Competing interestsThe authors declare that they have no competing interests., (© The Author(s) 2020.)

Background: Adverse reactions to hair dyes are frequent and usually caused by sensitization to paraphenylenediamine (PPD). The aim of the study was to evaluate the tolerability of a PPD-free permanent hair dye (Shine On, BioNike, Milan, Italy) containing paratoluenediamine (PTD) in a group of subjects sensitized to PPD., Methods: The trial, which carried out at four dermatology centers, included subjects sensitized to PPD that turned out negative to patch testing to PTD. The subjects underwent to an open test consisting in the application of two hair dye colors of the product under examination. Finally, subjects who were negative upon the open test were offered to undergo the usage test with the dye, with dermatological evaluations carried out 48 and 96 hours after product application., Results: Sixty subjects were enrolled. They underwent the open test with two shades of dyes: "color 1 - black," the dye color with the highest concentration of color intermediates, and "color 7.3 - golden blonde," the dye color with the highest number of chemically different color intermediates. No reactions occurred with "color 7.3 - golden blonde," while 3 cases (3 out of 60) showed erythema and edema reactions to color 1. The hair dye usage test was negative for all the 21 subjects that were enrolled., Conclusions: The hair dye evaluated in this study (Shine On, BioNike) can be a valid alternative for subjects sensitized to PPD.

Background: Lymphogranuloma venereum (LGV) is a sexually transmitted infection caused by L1, L2, L3 serovars of C. trachomatis (CT). Since 2003, LGV cases have been increasing in Europe. Aim of this report is to describe the LGV cases diagnosed in the largest STI center in Rome, Italy, from 2000 to 2016. This report shows that two clinically and epidemiologically different series of cases exist, and that, at present, the ano-rectal LGV represents the clinical variant occurring more frequently among men having sex with men (MSM), particularly those HIV-infected., Case Presentation: Ten cases of LGV were observed. Three were diagnosed in 2009 in HIV-negative heterosexuals patients that presented the classical genito-ulcerative form with lymphadenopathy. Seven cases were observed in 2015-2016 in HIV-infected MSM, that presented the rectal variant and L2b serovar infection; 4 of these had been misclassified as a chronic bowel disease. Chlamydia infection was confirmed by CT-specific PCR (ompA gene nested PCR), followed by sequence analysis to identify the serovar. All the patients were treated with doxycycline for 3 weeks, obtaining a complete response with healing of both clinical symptoms and dermatological lesions., Conclusions: Our findings suggest that, in case of persistent rectal symptoms in HIV-infected MSM, LGV should be taken into account and investigated through molecular analyses, in order to achieve a correct diagnosis and management of the patients.

Imatinib mesylate (IM) represents the first-line treatment of patients with chronic myeloid leukemia (CLM) or gastrointestinal stromal tumor (GIST). It presents several side effects. However, less than 10% are nonhematologic including nausea, vomiting, diarrhea, muscle cramps, and cutaneous reactions. The aim of our study was to identify data regarding IM cutaneous adverse effects (AEs) to improve the clinical diagnosis and management of the more frequent side effects. Skin examination should be done before and during IM treatment so that AEs can be diagnosed and treated early with less impact on chemotherapy treatments and on the quality of life of the patient.

Background: Extracutaneous melanoma (ECM) is a very rare malignancy and its biology differs from that of cutaneous melanoma. Residential studies can offer an important contribution to the study of this disease., Methods: We characterized the distribution of ECM according to residential and demographic baseline characteristics. We computer-searched patients that removed an ECM, and we analyzed all demographic and residential parameters. Disease free survival (DFS), date of death or last follow-ups were evaluated. The same parameters were analyzed using hazards-regression. Finally, we used the multiple regressions between DFS and the predictors., Results: A total of 44 ECM patients were included in our analysis. Median DFS was of 10 months; at Log-Rank Test and Cox-hazard regression, the variable age (P<0.01; P<0.004) and latitude (P<0.02; P<0.006) reached a statistical significance; at multiple logistic regression, the significance was instead maintained only for the variable age. General OS was of 42 months at Log-Rank Test age (P<0.001), as well as latitude (P<0.006) maintained its significance at hazard-regression., Conclusions: Demographic and residential aspects can play an important role in the study of this rare disease, supporting the assumption that ECM are generated by processes actually unknown, as demonstrated in our results compared with those of the literature.

Aim: Xerosis cutis is a frequent condition in the elderly and the topical treatments are aimed to maintain a balance between the physiological components of the epidermis and an optimal moisturization. The aim was to evaluate the efficacy of a dermoprotective cream, glycerol and paraffin-based, in the treatment of individuals affected by senile xerosis., Methods: The patients were recruited at the Professional Dermatology and Allergology Outpatient Clinic of the San Gallicano Dermatological Institute of Rome, between 1st January 2013 and 30th September 2014. To assess the efficacy of the cream, two different areas of treatment were identified in each patient upper the limbs. All patients were staged at baseline (T0) and evaluated after 14 days (T1) and 28 days (T2) of topical treatment, using five clinical parameters: scaling, sensation of skin tightness, presence of fissuring and excoriations from scratching and erythema. The itching degree was also evaluated using a 10-steps analogical scale., Results: Fifty patients with xerosis, 25 with a severe and 25 with a moderate form, over 60 were recruited and evaluated. Median age was 65 years (IQR=61-70). After 28 day of topical administration of the cream, the 54.0% of patients showed the absence of signs of xerosis, the 44.0% a mild form and the 2.0% (one patient) a moderate form. Consistently, a progressive and significative reduction of itching and transepidermal water loss (TEWL), and an improvement in skin hydration was also measured. A good profile of tolerability and no episodes of undesirable side effects, was also observed., Conclusion: The topical daily use of a cream glycerol and paraffin-based, seem to able to control the xerosis in elderly patients, with a significant reduction of all associated signs and symptoms. Further additional data should be collected to better confirm the role of the topical treatment in the control of disease.

Background: An association between autoimmune disease and malignant melanoma (MM) has often been reported in the literature as a positive prognostic factor for MM. Consequently, we evaluated the influence of different autoimmune diseases on the prognosis of MM., Aim: To evaluate the prognosis of patients with MM who also had an autoimmune disorder, whether tumour-associated, paraneoplastic or drug-induced., Methods: Autoimmune diseases were classified and analysed as tumour-associated, paraneoplastic or drug-induced. Patients were enrolled according to their clinicopathological features and matched with control groups. Kaplan-Meier analysis was used to estimate disease-free survival (DFS) and overall survival (OS), and log-rank test was used to evaluate differences between the survival curves., Results: In total, 49 patients with MM and tumour-associated autoimmune disease were included in our analysis. No case of paraneoplastic autoimmune disease was detected. The survival analyses showed a range of results, from a worsening of DFS and OS to a lack of any difference. In a second analysis, we separately analysed patients who developed autoimmune disorders after starting adjuvant therapy with interferon-α; we did not find significant differences between these patients and the untreated patients., Conclusions: Autoimmune disease, whether tumour-associated or drug-induced, was not associated with better prognosis in patients with MM. The results suggest that the reported relationship between autoimmunity and MM may be a result of individual variation in sensitivity to the autoimmune disease, the tumour or the treatments., (© 2014 British Association of Dermatologists.)

Steinert's disease or Myotonic dystrophy type I (DM1) is an autosomal dominant disease characterized by myotonia, muscular dystrophy, cataracts, hypogonadism, frontal balding, and electrocardiographic alterations.Several tumors have been associated with DM1 such as pilomatricoma, thymomas and insulinomas. Herein, we describe the unusual onset of multiple basal cell carcinomas in a young woman with DM1.

Interferon alpha (IFNalpha) is the most used adjuvant treatment in clinical practice for melanoma (MEL) high-medium risk patients; however, the use of IFNalpha has yielded conflicting data on Overall Survival (OS) and disease free survival (DFS) rates. Starting from these considerations, we carried out an analysis on our MEL patients who received adjuvant IFNalpha therapy, in order to identify possible predictors for their outcome. A total of 140 patients were included in our analysis. Patients with Breslow thickness &#8804;2.00 mm presented a significantly longer mean DFS than patients with Breslow &#8805;2.01 mm (p = 0.01). Using non- parametric Spearman’s Coefficient test we found association between DFS and Breslow thickness (p < 0.001) and between DFS and ulceration (p = 0.03). Performing Multiple Regression test, Breslow thickness (p < 0.001) remained the only statistically significant predictor. From the OS analysis we found that patients with lower Breslow values &#8804; 2.00 mm (p < 0.0001), and absence of ulceration (p <0.004) showed a significantly better long-term survival. From the current analysis we found that the use of low dose IFNalpha is justified only for cutaneous melanoma &#8804; 4.01 mm that was not ulcerated; patients with Breslow &#8805; 4.01 mm, in our opinion, should not carry out adjuvant treatment with low dose IFNalpha, because its side effects could be higher than the its benefits.

In the absence of risk factors, thin melanomas (TM) present a long-term survival; however, recurrences may occur. We describe the predictive clinicopathological features of patients with metastatic TM. Kaplan-Meier product was performed for the survival analysis, while Cox proportional hazards regression was used to evaluate the effect of the clinicopathological features on disease-free survival (DFS) and overall survival (OS). Median DFS of the entire cohort was 26 months and three patients developed late metastases. Nine patients developed extra-nodal metastases as first recurrence, while cases of positive sentinel lymph node biopsy (SLNB) were not found. DFS and OS varied according to the clinicopathological features, but only ulceration remained the main statistical significance value. According to our results, a hypothetical use of SLNB in TM without other risk factors is not currently feasible. No consensus exists as to which patients with TM are at risk for metastases or late recurrences.

The term "Glaucoma" is used to describe a number of diseases of the eye characterized by a particular form of optic nerve damage that is often associated with high intraocular pressure (IOP). The open-angle glaucoma is the most common form that is also referred to as chronic glaucoma. This is described as an optic neuropathy with multifactorial nature in which there is a loss of characteristics of the optic nerve fibers. Therapeutic options for the treatment of this disease are different, you can take advantage of eye drops, laser therapy and conventional surgery or more combined treatments. Medicated eye drops are the most common way to treat glaucoma. Although eye drops are widely used, adverse reactions are not frequently observed and described. In particular, the adverse skin reactions are not frequently described in the literature, but often seen in dermatologic clinic, we reported their skin reactions and possible alternative treatments described in literature and their patent applications.

Background: The aim of this study is to find the associations between malignant melanoma (MM) and other non-cutaneous malignancies and to see whether there are possible correlations between them., Methods: We analysed a sample of 1720 patients collected by our melanoma database, to identify patients with both MM and non-cutaneous primary cancer (NCC). The incidence rate (IR) included in our database was calculated as the ratio between the observed patients with NCC and those with MM., Results: A total of 74 patients, with both NCC and MM, were included in our analysis, corresponding to 4.30% of patients with MM present in our melanoma database. After breast cancer (24.3%; IR = 1:4), the most common malignancies were lymphomas (14.8%; IR = 1:4), renal cell carcinoma (13.5%; IR = 1:7), thyroid cancer (9.4%; IR = 1:11), and prostatic carcinoma (8.1%; IR = 1:12), followed by other cancers. Among patients with lymphomas, most patients (72.7%) had a non-Hodgkin lymphoma. Our study shows a high coexistence of multiple malignancies in patients with MM., Conclusion: Although we cannot definitively confirm a true association between non-skin cancers and MM, we believe that there are sufficient links for further investigation in order to identify new aetiological factors and therapeutic targets for these cancers.

Brain metastases (BM) are one of the most frequent neurological complications of cancers. Melanoma is the third most common tumor to metastasize to the brain with a reported incidence of 10-40 %, and many patients have subclinical BM (>73 %). We computer-searched the clinical records of all our patients registered into a database to identify patients that presented or developed BM. A total of 49 patients with melanoma BM were included in our analysis. General time to brain metastases (TTBM) was 23 months. The nonparametric test between TTBM and the single variables showed an association between TTBM and Breslow thickness (p < 0.0076; Spearman's coefficient-0.411), ulceration (p = 0.0656; Spearman's coefficient-0.287) and positive sentinel lymph node (p < 0.0015; Spearman's coefficient-0.475). Performing multiple regression, positive SLN remained the only, statistically significant, predictive variable (p < 0.01). Regarding the first melanoma site, the axial sites were more likely to develop BM than peripheral ones (p < 0.001). The analysis of brain metastasis survival (BMS) with Kaplan-Meier curves has resulted in a median survival rate of 6 months (range 1-134 months) and was strongly related to response to treatment, number of parenchymal lesions, presence or absence of symptoms. The results of the current analysis revealed clinical and primary tumor characteristics associated with the development of BM, TTBM, and BMS. The SNL was found to be the strongest predictor for BM development.

In the literature, there are some papers reporting on patients with metastatic melanoma from an unknown primary lesion (MUP). The pathogenesis of this phenomenon and the prognosis of these patients are still debatable. Therefore, we reviewed our casistics on MUP patients. We identified 24 MUP patients out of all patients registered into a melanoma database from June 1996 to June 2011. The incidence was 1.4%. We compared the survival rate of all patients with MUP stage III-IV with all patients with metastatic melanoma known primary (MMKP) stage III-IV observing a clear survival improvement for MUP patients in front of MMKP patients (p<0.01). In a second instance, we compared stage III MUP patients with only lymph nodal involvement with stage III MMKP patients with only lymph nodal involvement, and again we found statistically significant better survival for MUP patients (p<0.05). In this retrospective study, the number of lymph nodes involved (p=0.8), the sex (p=0.9), and S100 value (p=0.2) were not statistically relevant for prognosis. The better prognosis for these patients is very similar to better survival rate for metastatic melanoma patients and vitiligo. This correlation may be in accord with the hypothesis of a regression of primary lesion by immunological system of the host and also the median age of patients at the time of diagnosis, commonly older than melanoma patients, may correspond to a long period of immunological interferences between the host and the melanoma disease.