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The study was carried out in Capri during the summer of 2006. The data concerning UV irradiance were regularly recorded over the entire period of the study describing the numerical index of UV radiation intensity (UVI).5 A total of 450 tourists answered a questionnaire containing personal information regarding sex, age, eye colour, hair colour, phototype, sunscreen used and sunbathing time. The MED was measured by the Skin Analyser Q Tan. After the MED examination, the staff of dermatologists created a card (record) for each volunteer examined, which contained information about their photosensitivity. During sun exposure the volunteers examined at the dermatologic centre were informed directly through their mobile phones by SMSs, about the optimal UV dose for their skin, an estimate of the residual exposure time and the protection factor of the sunscreen they needed according to UVI units registered. The information released by mobile phone was based on the correlation of daily UVI registered by the experimental set-up and the individual photosensitivity, thus obtaining an estimate of the maximum exposure time expressed in minutes to prevent sunburn. These values were reached on the basis of the effective erythemal dose (DE) expressed in MED/h using the following algorithm ST ¼ 60/DE. Therefore, in a typically sunny August day with a UVI equal to 6 (2.6 MED/h), a phototype I or II at his/her first sun exposure would develop a sunburn after about 20 min, while in a moderately pigmented subject, this would take some hours (Table 1). This campaign aimed to capture the attention of young people by an experimental photodermatology service and to promote preventive care through a system of customized UVI teledosimetry using information technology such as mobile phones, keen to young people. This pilot study could represent an example of cooperation between information technology and clinicians using information technology in the field of photoprotection and can suggest further research development to optimize the sun prevention devices

Biologically based agents (biologics) are novel therapeutic options in the treatment of moderate to severe psoriasis. However, the immunosuppressive effects of biologic agents are also a reason to expect higher rates of adverse events, such as infections and malignancies. To date, reactivation of latent tuberculosis infection (LTBI) is a major complication of tumour necrosis factor (TNF)-α antagonists. Until recently, there were no alternatives to the tuberculin skin test (TST) for diagnosing LTBI. However, an alternative has now emerged in the form of a new in vitro test: the interferon (INF)-γ assays. There are at present two commercially available assays, T-SPOT.TBTM (T-SPOT) and QuantiFERON-TB Gold (QFT-G). In this study, a new version of QFT-G has been used, the QuantiFERON TB Gold ‘in tube’ (QFT-GIT), which also included the TB7.7. The aim of our study was to compare IFN-c assays with TST for detection of tuberculosis (TB) infection in patients due to start anti-TNF-a therapy.

A 11-year old girl with solar urticaria and alloalbuminemia is described. The phototests elicited the appearance of an urticarian reaction only in the visible spectrum between 400 and 425 nm. Alloalbuminemia was detected also in the patient's mother who didn't showed any photosensitivity.

OBJECTIVE: We propose a simple cryo-technique for the treatment of cutaneous soft fibromas. METHODS: This method, useful for fibromas larger than 4-5 mm in diameter, allows the freezing of the only soft fibroma without affecting the surrounding skin. RESULTS: The technique shows the following advantages: it is simple to perform, it avoids local anesthesia, and it can be used in pacemaker holders. CONCLUSION: The cosmetic results are very good.

In six healthy volunteers the 8-methoxypsoralen (8-MOP) plasma levels have been determined by high resolution liquid chromatography (HPLC) respectively 15, 30, 60, 90, 120, 150 and 180 minutes after the oral intake of an oral formulation of the drug (0.6 mg/kg b.w.). In order to evaluate the cutaneous photosensitivity, each subject has been exposed to UVA (wavelength 320-400-nm) at 15, 30, 60, 120, 150 minutes intervals from the 8-MOP intake. During each UVA exposure eight areas (1 cm in diameter) received 1, 2, 3, 4, 5, 6, 7 and 8 J/cm2. The results show that the lowest MPD is achieved from 30 and 60 minutes after the highest plasma level of the 8-MOP.

Atopic dermatitis management is challenging and usually requires intermittent or continuous, long-term treatment with topical and/or systemic anti-inflammatory agents and appropriate skin care. Most patients affected by atopic dermatitis improve during sun exposure. It has been reported that the change from a subartic/temperate to a subtropical climate for 4 weeks improved significantly skin symptoms and quality of life in children, even for 3 months after return. However, until now the effect of sun exposure on adult patients with atopic dermatitis has never been investigated.We conducted a retrospective study to assess the short-term effect of sun exposure during summer holidays on skin symptoms of adults affected by AD.One hundred and fourteen patients were enrolled in the study (62 males; aged 18-72 years, mean age 35.3±12.6). Seventy-three out of 114 patients (64%) spent their holidays at the seaside, and 41/114 (36%) in the mountains; 38/41 (92.7%) subjects from the latter group reported that during their holidays they frequented outdoor swimming pools or solariums almost every day of their vacation. The sunlight effect was considered beneficial by 68/114 (59.6%) of patients. In particular, 38/114 patients (33.3%%) reported the improvement of AD and 30/114 (26.3%) the complete resolution of the disease during summer holiday.Our data seem to suggest that sun exposure is beneficial in most patients, but not in all patients. In fact, sun exposure does not appear to improve skin symptoms or even aggravate them in about 4 out of 10 patients. This could be particularly important also considering ongoing climate changes that may affect the clinical history of several skin diseases, among which AD.

Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), the causative agent of coronavirus disease 2019 (COVID-19), has become pandemic on March 11, 2020. COVID-19 has a range of symptoms that includes fever, fatigue, dry cough, aches, and labored breathing to acute respiratory distress and possibly death. Health systems and hospitals have been completely rearranged since March 2020 in order to limit the high rate of virus spreading. Hence, a great debate on postponable visits and treatments including phototherapy for skin diseases is developing. In particular, as regards phototherapy very few data are currently available regarding the chance to continue it, even if it may be an useful resource for treating numerous dermatological patients. However, phototherapy has an immunosuppressive action possibly facilitating virus infection. In the context of COVID-19 infection risk it is important to pointed out whether sunlight, phototherapy and in particular ultraviolet radiation (UV-R) constitute or not a risk for patients. In this review we aimed to focus on the relationship between UV-R, sunlight, phototherapy, and viral infections particularly focusing on COVID-19.

Introduction The negative impact of acne on aspects of health-related quality of life (HRQL) has been demonstrated in many quantitative studies; however, there has been relatively little qualitative research exploring the impact of acne and the use of topical treatment. The study aimed to explore the impact of moderate–severe acne on HRQL in adolescents and adults with inflammatory and non-inflammatory lesions and to develop a conceptual model to illustrate the impact. In addition, the study aimed to identify the attributes of topical acne treatments that are most important for patients. Methods Thirty-four adolescents and 16 adults with moderate–severe acne who were currently/recently prescribed topical treatment were recruited in this cross-sectional qualitative study in the UK, Italy, and Germany. In-depth, semi-structured telephone interviews explored patients’ experiences of acne and the impact it has on their HRQL, and their experience of topical treatments for acne. Data were analyzed using thematic analysis and a conceptual model was developed. Results The analysis identified seven main areas of HRQL that are affected by acne: emotional functioning, social functioning, relationships, leisure activities, daily activities, sleep, and school/work. Also common throughout the interviews was the perception and reaction to acne from others, which potentially had an impact on all areas of HRQL. The conceptual model illustrates the impact on HRQL and the links between HRQL domains. For both adolescents and adults, it was most important for acne treatments to be fast-acting, non-irritating, and non-bleaching. Conclusion The results of this qualitative study demonstrate that moderate–severe acne has an extensive impact on adolescents’ and adults’ HRQL. The conceptual model illustrates the many areas of HRQL that are affected and draws attention to the importance of effective treatments for acne. The study also highlights topical acne treatment attributes that are most important for patients. Funding Meda, a Mylan company.

We present a case of folliculotropic mycosis fungoides (FMF), a variant of cutaneous T-cell lymphoma which particularly affects hair follicles. FMF can imitate a wide variety of otherwise benign dermatoses, so it poses major diagnostic obstacles both for the dermatologist as well as the dermatopathologist. In our case, in vivo reflectance confocal microscopy (RCM) was very important for guiding the skin biopsy site selection. For this reason, RCM can reduce the number of unsuccessful histopathological examinations and increase the diagnostic accuracy for different skin dermatoses.

Interleukin (IL)-36 cytokines are new members of the IL-1 family, which include pro-inflammatory factors, IL-36α, IL-36β and IL-36γ, and a natural receptor antagonist IL-36Ra. Over recent years, much has been learned on their important functions in the regulation of immune response and, especially, on their role in many inflammatory skin diseases. However, to date, no data have been reported on their possible involvement in acne and hidradenitis suppurativa (HS). Here, we have shown that IL-36α, IL-36β, and IL-36γ are increased in lesional skin of acne and HS, highlighting their possible pathogenetic contribution to these two skin conditions. In contrast, IL-36Ra (the anti-inflammatory member of IL-36 sub-family) was increased just in psoriasis, suggesting that an imbalance in IL-36/IL36Ra functions could play a role in the phenotype of skin damage. One of the consequences of this imbalance may be the increased induction of IL-8 that we found higher in acne, HS, and ACD respect to psoriasis.

SummaryBackground Hyperandrogenism and reduced skin autophagy have been implicated in the pathogenesis of adult female acne (AFA). Here, we tested whether a ready-to-use peel-off facial mask containing myoinositol (an androgen inhibitor) and trehalose-loaded liposomes (as activators of cutaneous autophagy) applied overnight every other day for 60 days can improve AFA. We also sought to investigate the molecular mechanisms underlying the clinical effects. Objectives We conducted an uncontrolled, open-label clinical study in 40 cases of AFA to investigate the effect of the facial mask on lesion count, sebum production (measured with the Sebutape® technique), and Global Acne Grading System (GAGS) scale. We also investigated the changes from baseline to the end of treatment in androgen and beclin-1 levels (as a marker of authophagy) in skin biopsy supernatants. Methods Forty Caucasian patients with AFA were enrolled. Changes in clinical and molecular endpoints before and after treatment were investigated. Results The mean counts of comedones, papules, pustules, and nodular lesions decreased significantly (all P

BACKGROUND 1,2-Decanediol (S-Mal) is an organic compound belonging to the 1,2-alkanediol family, with two hydroxyl groups located on the first and second carbon of the alkane chain, probably responsible for the enhanced anti-bacterial efficacy. The willow bark total extract (W-Mal) has been used since thousands of years as an herbal remedy for its antipyretic, analgesic, anti-inflammatory and anti-microbial activities. S-Mal is used in cosmetic preparations, whether W-Mal can be topically or systemically administered. Aim of our study was to evaluate in vitro the anti-inflammatory and antioxidant properties of S-Mal and W-Mal, singularly or in combination, in LPS-stimulated keratinocytes. METHODS The possible toxic effect of S-Mal and W-Mal was assessed through analysis of cell viability 24 hours after treatment. The anti-inflammatory and antioxidant activities were evaluated by measuring IL-8, TNF-α and IL-1β production as well as cellular antioxidants (GSH and NADPH) consumption, 24 and 48 hours, respectively, after LPS stimulation. RESULTS Both substances resulted able to: 1) increase cell viability (P

The incidence of nonmelanoma skin cancer continues to increase. Surgical excision remains the best choice of treatment but the demand of patients is to have tissue-sparing approaches with good cosmetic results; these aims led to the development of novel therapeutic agents such as topical ingenol mebutate gel. We report the successful treatment with ingenol mebutate gel 0.05% of three pigmented basal cell carcinomas. Lesions were evaluated by dermoscopy and confocal microscopy before, during and after the treatment.

Background Numerous reports have shown that psoriasis patients are more exposed to lipoprotein peroxidation and to a decrease in the activity of paraoxonase (PON)1, an antioxidant and anti-inflammatory enzyme. Thus, it has been suggested that malfunction of the antioxidant system and an increased production of reactive oxygen species drive immune inflammatory events, that result in progressive skin cell damage in patients with psoriasis. The PON protein family, including PON1, PON2 and PON3, is one of the most important endogenous defense mechanisms against oxidative stress. In the present study, we investigated PON gene expression in psoriasis and in cutaneous oxidative stress. Methods The study population included 10 patients affected by moderate-to-severe plaque psoriasis and 15 healthy donors who have undergone to plastic surgery, were used as control. Skin punch biopsies of lesional and non lesional psoriatic skin were performed for analysis of PON2 and PON3 gene expression. In addition, oxidation assays in ex vivo full-thickness healthy skin organ cultures were performed. Results No significant differences were observed between PON2 and PON3 gene expression in psoriatic lesional and non lesional skin compared with healthy controls. H2O2 treatment induced a significant decrease of PON2 and PON3 expression in ex vivo full-thickness healthy skin organ cultures; conversely the pretreatment of samples with the antioxidant reagent N-acetyl-L-cysteine (NAC) induced a significant increase. Interestingly, no significant alterations were reported for PON2 and PON3 expression in ex vivo full-thickness healthy skin organ cultures stimulated with IL-17. Conclusions Taken together our findings have revealed that a strong pro-oxidative activity is not effectively countered by antioxidant endogenous mechanisms both in psoriatic skin and in ex vivo experimental model.

Background Many efforts have been spent attempting to define clinical, histopathological and molecular markers for differential diagnosis of Spitz nevus and melanoma. Dermoscopy has been widely used but it may be not always sufficient. Methods A retrospective study was performed evaluating Spitzoid-looking lesions showing symmetry at clinical and dermoscopic examination in patients ≥12 years attending our Clinic from 2004 to 2014. Demographic, clinical and dermoscopic data were assessed for each lesion in order to highlight the most common characteristics which could help the differential diagnosis between Spitz nevus and melanoma when clinical or dermoscopic asymmetry is lacking. Results A total of 760 lesions were excised. 690/760 (90.8%), were identified as typical Spitz nevi, whereas 70/760 lesions (9.2%) consisted of malignant melanocytic lesions. Our study showed that almost 9.2% of clinically and dermoscopically symmetric Spitzoid lesions revealed to be malignant melanocytic lesion. For symmetric Spitzoid looking lesions female sex, clinical palpability, the presence of an inverse network at dermoscopic examination and the involvement of lower limbs were observed as the main factors, which were linked to a higher possibility of being malignant lesions. Conclusions In order to avoid missing diagnoses for malignant melanocytic lesions, this study remarked the importance of preventive excision for all Spitzoid-looking lesions in patients ≥12 years, even if they show symmetry at both clinical and dermoscopic level.

Systemic supplementation with probiotics is increasingly being explored as a potential treatment strategy for skin disorders. Because both the gut-skin axis and dysregulation of insulin signalling have been implicated in the pathogenesis of adult acne, we designed the current study to evaluate the effect of supplementation with the probiotic strain Lactobacillus rhamnosus SP1 (LSP1) on skin expression of genes involved in insulin signalling and acne improvement in adult subjects. A pilot, randomised, double-blinded, placebo-controlled study was conducted with 20 adult subjects (14 females and 6 males; mean age: 33.7±3.3 years) with acne. Over a 12-week period, the probiotic group (n=10) consumed a liquid supplement containing LSP1 at a dose of 3×109 cfu/day (75 mg/day), whereas the placebo group (n=10) received a liquid lacking probiotics. Paired skin biopsies - one obtained before treatment initiation and one obtained at the end of the 12-week treatment period - were analysed for insulin-like growth factor 1 (IGF1) and forkhead box protein O1 (FOXO1) gene expression. The clinical criterion for efficacy was the investigator's global improvement rating on a five-point scale. Compared with baseline, the probiotic group showed a 32% (P

OBJECTIVE: To evaluate the individual effectiveness of needling therapy using the Dermapen (Dermapen, Salt Lake City, Utah) and topical therapy with silicone gel (Kelo-cote, Sinclair Pharma, London, England), and their combined effectiveness for the treatment of linear surgical scars, hypertrophic scars, and keloids. MATERIALS AND METHODS: Twenty patients were randomly selected and equally divided into 2 groups (A and B), with each group of 10 including 6 patients with keloids and 4 with hypertrophic scars. Treatment assignments were random. In group A, the entire scar was treated by skin needling, with silicone gel applied to half of the scar. Patients in group B were treated with silicone gel on the whole scar, with only half of the scar also treated with skin needling. During follow-up visits, clinical photographs, evaluation of the scars' thickness, skin ultrasound, and modified Vancouver Scar Scale were performed. RESULTS: Group A showed an average improvement of 68% (P < .01) on the half of the scar with the combination treatment (skin needling plus silicone gel) compared with a 52% improvement on the half of the scar that was treated with only skin needling. Group B showed an average improvement of 63% (P < .01) where the combination treatment was performed, compared with 47% improvement on the area treated with only the silicone gel. CONCLUSIONS: In conclusion, the combination of these 2 treatments is safe and effective for the treatment of hypertrophic scars and keloids. These modalities achieved favorable results with each patient adhering to the study paramenters.

BACKGROUND: General skin care recommendations such as the use of moisturizers 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, Meda Pharma, Solna, Sweden) on acne, epidermal barrier function, sebum production, adherence and tolerability when used together with pharmacological acne treatment. METHODS: Forty patients receiving pharmacological acne treatment applied Acne RA-1,2 once-daily for three months. Investigator's Global Assessment of acne, trans-epidermal water loss, sebum production and tolerability were assessed at one and three 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

Acne is a common and complex skin disease, with a very complex pathogenesis. Although in women the relationship between acne and insulin resistance is well known, in particular in women with PCOS, in males this relationship has been poorly investigated. In total, 20 subjects with an altered metabolic profile were considered for this study and randomized as follows: 10 patients were treated with metformin plus a hypocaloric diet for 6 months (group A), while 10 patients did not receive any treatment with metformin and were only followed up (group B). All patients of group A, after 6 months of metformin therapy, had a statistically significant improvement compared with patients in group B. Our study reveals the importance of diet and insulin resistance in acne pathogenesis, and underlines the possible use of metformin and diet as possible adjuvant therapy for male patients with acne.

The list of comorbidities and complications associated with hidradenitis suppurativa is extensive. Among the complications of hidradenitis suppurativa, squamous cell carcinoma is considered the most severe. After a meticulous literature research starting from the 1950s, we were able to identify over 90 cases of patients with hidradenitis suppurativa developing squamous cell carcinoma. Most squamous cell carcinomas appear on the perineal or buttock areas. We believe that the development of squamous cell carcinoma in longstanding hidradenitis suppurativa is a typical condition of an immunocompromised district. The "immunocompromised cutaneous district" is a novel concept that applies to an area of diseased or injured skin where local immune control has been altered, thereby permitting the development of a dysimmune reaction, infection, or tumor confined to the diseased or injured site.

We evaluated the impact of regular agonistic physical activity on psoriasis in soccer players of the Italian second league. Particularly, an observational cross‐sectional investigation was conducted by analysing a group of 323 Italian second league soccer players (consecutively enrolled during medical check‐up at training sessions) and 357 sex, age and body mass index matched controls (chaperones of patients attending the outpatient clinic of Department of Dermatology and Department of Allergy and Clinical Immunology, University of Naples Federico II) from July 2015 to May 2016. Our data may suggest that regular and intense sport activity might be an environmental factor which can positively influence psoriasis pathogenesis, thus limiting its outbreak.

Background: Hidradenitis suppurativa (HS) is a chronic inflammatory skin condition that involves the terminal hair follicles of apocrine gland-bearing skin areas. Objective: To evaluate the relationship between HS and systemic medical conditions, such as overweight/obesity during adolescence. Methods: Epidemiologic data was collected from January 2014 up to December 2015 from 27 patients affected by HS, outpatients of the Dermatology Department of University of Naples Federico II, to examine the correlation between HS and overweight/obesity. Results: 70.4% of the patients were female and 29.6% were male. The mean age at onset of the disease was 18.1 ± 5.99 years, while the mean age at first diagnosis by the physician was 21.77 ± 6.61 years. A mean Sartorius score of 50.26 ± 21.75 was registered. Body mass index of HS patients was positively correlated with Sartorius score. Conclusion: Our study underlines the fact that particular attention to metabolic alteration in adolescence can lead to a correct diagnosis with less delay in HS.

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. The project “Il Corpo Ritrovato” aims at creating an interdisciplinary network of physicians to improve the quality of life of the oncologic patient, focusing on such important aspects as dermocosmetological skin care but also on the evaluation of new therapeutic and diagnostic algorithms in order to make further progress in the field of prevention.

The incidence rate of melanoma and non-melanoma skin cancer entities is dramatically increasing worldwide. Exposure to UVB radiation is known to induce basal and squamous cell skin cancer in a dose-dependent way and the depletion of stratospheric ozone has implications for increases in biologically damaging solar UVB radiation reaching the earth’s surface. In humans, arsenic is known to cause cancer of the skin, as well as cancer of the lung, bladder, liver, and kidney. Exposure to high levels of arsenic in drinking water has been recognized in some regions of the world. SCC and BCC (squamous and basal cell carcinoma) have been reported to be associated with ingestion of arsenic alone or in combination with other risk factors. The impact of changes in ambient temperature will influence people’s behavior and the time they spend outdoors. Higher temperatures accompanying climate change may lead, among many other effects, to increasing incidence of skin cancer.

Background: Photodynamic therapy (PDT) with aminolevulinic acid (ALA) has been shown to be an effective treatment for acne. However, the effect of ALA PDT on comedo formation has never been objectively evaluated. Cyanoacrylate follicular biopsy (CFB), a noninvasive procedure, has been proposed as the most reliable tool for studying follicular casts. Objective: To determine the possible effect of ALA and red light (550–700 nm) on macro- and microcomedones in acne patients. Patients and Methods: 10 patients with mild-to-moderate facial and/or chest/back acne resistant to conventional therapies received ALA PDT at 2-week intervals in 3 sessions. The severity of acne had been estimated by a system of points, the Global Acne Grading System. The patients underwent PDT utilizing ALA 10% (face) or 15% (back/chest) and red light (15 J/cm2 each session). CFBs were performed. Results: Four weeks after their last PDT session, the patients showed an average global score reduction of 50%. CFBs demonstrated a reduction in the total area, the average area and the density of macrocomedones. Conclusion: The results obtained in this study using CFB evaluation demonstrate that ALA PDT exerts an action on the comedogenic phase as well.

Human papilloma viruses (HPV) have been identified as the cause of cutaneous and genital warts. Furthermore, HPV DNA can also be detected in certain malignant epithelial tumors such as cervical carcinoma and cutaneous squamous cell cancer. HPV infections in children, particularly when occurring as condylomata acuminata, present a difficult and often puzzling problem. The modes of viral transmission in child remain controversial, including perinatal transmission, auto- and hetero-inoculation, sexual abuse, and, possibly, indirect transmission via fomites. The treatment of warts and condylomata acuminate in child poses a therapeutic challenge for physicians. No single therapy has been proven effective at achieving complete remission in every patient. As a result, many different approaches to therapy exist. The proper approach to the management of warts depends on the age of the patient, location, size, extent, and type of wart, and duration of lesions. Each treatment decision should be made on a case-by-case basis according to the experience of the physician, patient preference, and the application of evidence-based medicine. In order to modify HPV epidemiology, HPV prophylactic vaccine has been recently proposed for children. The purpose of this review is to update the reader with the latest information on the HPV and its therapeutics in children.

Skin cancer represents an increasingly worldwide public health problem. Because an estimated 50% to 80% of the skin's lifetime sun damage is thought to occur in childhood, it is during this critical period that excessive sun exposure is considered a risk factor for later development of skin cancer. Our objective was to investigate sun habits of children of Southern Italy. The population was a randomly selected sample of 800 parents of children who attended primary schools in Campania between December 2005 and September 2006. Interviews were conducted using a questionnaire, which provided information about sociodemographic characteristics, parents' knowledge about the risk of skin cancer, their level of education, and their and their children's sun-protection and sun-exposure habits. Our results show that 45% of the children were exposed to the sun less than 2 hours a day; it is important to notice that 71.2% often stayed in the sun from 11 am to 4 pm. About 40% of children had sunburns during holidays. These data show that prevention should imperatively be emphasized for improving sun-protection and sun-exposure habits.

Background: The currently adopted method for predicting sun sensitivity is Fitzpatrick’s classification which however is based on self-reported burning tendency and tanning ability. Objective: Determination of the individual UV susceptibility based on non-subjective parameters. Method: Minimal erythema dose (MED), intensity and duration of pigmentation on days 5, 9 and 16 following 1 MED and the levels of the melanin marker pyrrole-2,3,5-tricarboxylic acid (PTCA) were analysed in non-red-haired subjects (50, aged 20–46 years). Results: Phenotype groups or phototypes showed a good correlation with PTCA yields and the persistence of pigmentation on day 16, but not with MED values. MED values did not show a significant correlation with PTCA yields. On the other hand, high values on day 16 were exhibited only by subjects having PTCA values higher than 200 ng/mg. Conclusions: Measurement persistence of pigmentation on day 16 represents a non-invasive and easy-to-perform method to evaluate photoprotection in those individuals escaping straightforward classification based on phenotype or anamnesis.

Introduction: The treatment of chronic actinic dermatitis (CAD), a sun-induced disorder characterized by a persistent eczematous eruption, involves photoprotective measures, topical corticosteroid therapy and, in more severe cases, systemic immunosuppression. The potential side effects of systemic immunosuppressant drugs prompted us to evaluate the efficacy of topical tacrolimus for treatment of CAD. Patient and treatment: A 58-year-old man with CAD, resistant to previous treatment with topical and systemic corticosteroids, oral cyclosporine and PUVA-photochemotherapy, was treated with tacrolimus ointment 0.1% once a day. Results: Tacrolimus ointment led to significant improvement of pruritus and severe eczematous skin lesions after 20 days of treatment. Conclusions: Tacrolimus shows a beneficial effect on CAD; this could be attributed to the fact that CAD is characterized by a lymphohistiocytic infiltrate producing a chronic eczema and that tacrolimus blocks the activation of lymphocytes and other immune system cells, also inhibiting the release of mediators from cutaneous mast cells and basophils.