Search

Background: Eyelid dermatitis is a frequent reason of dermatological consultation. Its aetiology is not univocal, being contact dermatitis, both allergic and irritant, the most frequent. The primary sources of allergen exposure include cosmetics, metals, and topical medications, from direct, indirect, or airborne contact. Objectives: To define the frequency of positive patch test reactions to SIDAPA baseline series allergens, to document positive allergens, and to precise the final diagnosis in patients with eyelid involvement. Methods: A total of 8557 consecutive patients from 12 Italian Dermatology Clinics underwent patch testing with SIDAPA baseline series in 2018 and 2019. Patients were divided into two groups: (i) with eyelid involvement with or without other involved sites (E‐Group) and (ii) without eyelid involvement (NE‐Group). The final diagnosis and the frequency of positive relevant patch test reactions were evaluated. Results: E‐Group consisted of 688 patients (females 78.6%, mean age 45.3 years), 8.0% of 8557 consecutively patch‐tested patients. The final diagnosis in E‐Group was ADC in 42.4%, ICD in 34.2%, and AD in 30.5%. The highest reaction rates were elicited by nickel sulphate and methylchloroisothiazolinone/methylisothiazolinone in both E‐Group and NE‐Group, even if these allergens were significantly more frequently positive in NE‐Group patients than in E‐Group ones. Positive patch test reactions to fragrance Mix II, dimethylaminopropylamine, and sorbitan sesquiolate were significantly more frequent in E‐Group patients than in NE‐Group ones. Conclusions: Eyelid dermatitis is a frequent dermatological complaint. Allergic contact dermatitis is the most frequent diagnosis commonly caused by nickel sulphate, isothiazolinones, and fragrances. The surfactants dimethylaminopropylamine and sorbitan sesquioleate are emerging causes of eyelid allergic contact dermatitis. [ABSTRACT FROM AUTHOR]

The European baseline series was last updated in 2019. This article discusses the reasoning behind a further iteration of the series for 2023. [ABSTRACT FROM AUTHOR]

Background: Budesonide was included in the European Baseline Series in 2000 as the most suitable marker forcorticosteroid hypersensitivity. In the last two decades, a decreasing trend of budesonide allergy has been observed. Objectives: To estimate the prevalence of positive patch test reactions to budesonide in a large, Italian patch test population, characterizing patients according to MOAHLFA index and evaluating the benefit with extended readings of budesonide patch test. Methods: Retrospective analysis of patient demographics and patch test results over a 2‐year period (2018–2019) was performed at 14 patch test clinics in Italy. Results: Ninety out of 14 544 (0.6%) patients reacted to budesonide 0.01% pet.. Positive reactions were mild in 54.4% and late readings at day 7 showed new positive reactions in 37.8% of patients. The MOAHLFA index showed a significant positive association with male gender, atopic dermatitis, and age >40 years and a significant negative association with hand and face dermatitis. Conclusions: We documented a low prevalence of budesonide allergy in Italy, confirming its decreasing trend recently reported in the literature. Nevertheless, budesonide needs to be maintained in the baseline series for its good ability to detect corticosteroid sensitization. [ABSTRACT FROM AUTHOR]

Background: Because Myroxylon pereirae (MP), or balsam of Peru, is nowadays almost not used "as such," and fragrance mix 1 (FM1) apparently is more sensitive in detecting fragrance allergy, the usefulness of testing MP in baseline series was recently questioned. Objectives: Identification of the number of clinically relevant patch test reactions to MP not detected by FM1. Methods: Retrospective analysis of 12 030 patients patch tested with MP and FM1 for contact dermatitis between January 2018 and December 2019 in 13 Italian dermatology clinics. Results: Four hundred thirty‐nine patients (3.6%) had a positive patch test reaction to MP; 437 (3.6%) had a positive patch test reaction to FM1. Positive reactions to both MP and FM1 were observed in 119 subjects (1.0%), 310 (2.6%) reacted to MP only, 304 (2.5%) to FM1 only, 5 to MP and sorbitan sesquioleate (SSO), 9 to FM1 and SSO, and 5 to MP, FM1, and SSO. Single sensitizations were clinically relevant in 75.2% of cases for MP (62.9% current, 12.3% past) and 76.3% for FM1 (70.1% current, 6.2% past). Conclusions: Based on our results, MP appears to be still worth testing along with FM1 in baseline series, because it allows detection of a remarkable number of fragrance allergies, often relevant, which would be otherwise missed. [ABSTRACT FROM AUTHOR]

During this pandemic, dermatological infusion centers were partially unavailable, suspended or even reconverted to guest COVID‐19 patients, consequently infliximab (IFX) infusions became challenging for their both logistic arrangement and also for patients' COVID‐19 phobia. This 48 weeks follow‐up retrospective observational study included 37 PsO patients that underwent IFX SB2 during pandemic in two primary dermatological referral centers. In 23 (62.1%) we had to switch from IFX to other biologics, not motivated by adverse reactions, contraindication or even loss of response but only to pandemic related conditions. Nine patients underwent interclass switching and 15 underwent intraclass switching; interestingly 2 patients that underwent adalimumab SB‐5 switched back to IFX. Interclass switching was privileged in elder patients and smokers. All patients at week 48 achieved PASI 100. Intra‐ and interclass switchings are both safe and effective strategies in psoriatic patients with COVID‐19 phobia and/or difficulties to undergo infliximab infusions. [ABSTRACT FROM AUTHOR]

Topical treatment is the mainstay for mild or moderate psoriasis, but patients are generally little satisfied. Calcipotriol/betamethasone dipropionate (Cal/BD) cutaneous foam has shown to improve signs and symptoms in plaque psoriasis patients. This study assessed patient's satisfaction with Cal/BD foam in a real‐life Italian dermatological clinical practice. A multicenter, 4‐week observational prospective cohort study enrolled, in 17 Italian dermatology clinics, adult patients with plaque psoriasis on the body and/or scalp. Treatment satisfaction was assessed by 9‐item Treatment Satisfaction Questionnaire for Medication (TSQM‐9), preference over previous treatments by Patient Preference Questionnaire (PPQ), and change in disease state by Psoriasis Area Severity Index (PASI). Overall 256 patients were eligible, with a mean (SD) age of 55.6 (15.4) years, 59.4% were males. Psoriasis severity was mild in 52.0% of patients, moderate in 43.3%, and severe in 4.7%. Scalp involvement was present in 36.7% of patients. Previous antipsoriatic treatments had been received by 80.5% of patients. TSQM‐9 median (25th–75th percentile) scores were 83.3 (66.7–88.9) for effectiveness, 77.8 (66.7–88.9) for convenience, and 78.6 (64.3–92.9) for global satisfaction. Mean (SD) PASI value decreased from 7.3 (4.8) to 2.1 (2.7) after 4 weeks. More than 90% of patients previously treated for psoriasis evaluated the Cal/BD foam more effective, easier to use and better tolerated compared to previous topical treatments at PPQ. This observational study provides real‐life evidence of a high level of satisfaction with effectiveness and convenience of the Cal/BD foam in a cohort of plaque psoriasis patients, with an objective improvement in PASI. [ABSTRACT FROM AUTHOR]

Background: Few and small studies have described the management of immunomodulant/immunosuppressive therapies or phototherapy in atopic dermatitis (AD) patients during coronavirus disease 2019 (COVID‐19) pandemic. Methods: A national registry, named DA‐COVID‐19 and involving 35 Italian dermatology units, was established in order to evaluate the impact of COVID‐19 pandemic on the management of adult AD patients treated with systemic immunomodulant/immunosuppressive medications or phototherapy. Demographic and clinical data were obtained at different timepoints by teledermatology during COVID‐19 pandemic, when regular visits were not allowed due to sanitary restrictions. Disease severity was assessed by both physician‐ and patient‐reported assessment scores evaluating itch intensity, sleep disturbances, and AD severity. Results: A total of 1831 patients were included, with 1580/1831 (86.3%) continuing therapy during pandemic. Most patients were treated with dupilumab (86.1%, 1576/1831) that was interrupted in only 9.9% (156/1576) of cases, while systemic immunosuppressive compounds were more frequently withdrawn. Treatment interruption was due to decision of the patient, general practitioner, or dermatologist in 39.9% (114/286), 5.6% (16/286), and 30.1% (86/286) of cases, respectively. Fear of increased susceptibility to SARS‐CoV‐2 infection (24.8%, 71/286) was one of the main causes of interruption. Sixteen patients (0.9%) resulted positive to SARS‐CoV‐2 infection; 3 of them (0.2%) were hospitalized but no cases of COVID‐related death occurred. Conclusions: Most AD patients continued systemic treatments during COVID pandemic and lockdown period, without high impact on disease control, particularly dupilumab‐treated patients. [ABSTRACT FROM AUTHOR]

The impact of intermittent circadian fasting (ICF) on skin disorders is far to be plenty deciphered. However, the circadian rhythm seems to exert a modulation on dermatoses severity, drug‐response, and drug‐related side effects. We aimed to evaluate ICF effect in the daily management of dermatological diseases. In this multicenter, prospective observational study we enrolled patients willing to undergo the 2018 ICF (from May 16 to June 14). Dermatoses severity were evaluated at the beginning of ICF (T0) and at the end of ICF (T1) by two independent board‐certified dermatologists. Seventy‐two patients suffering from different dermatoses volunteered to take part into the study. They displayed a mean age of 40.38 ± 12.46 years (median 41.0 years), 25 subjects were males (34.7% of the entire sample). The median weight change was 0 kg. The overall ICF effect size was −0.58 ([95% CI −0.83 to −0.33], P <.0001, medium effect size). Since in the present investigation no weight loss occurred, we could speculate that the impact of fasting in terms of improvements in the clinical symptoms could be rather due to the perturbation of the human biological clock. Despite our data remain preliminary, a chronobiological approach should be incorporated in the dermatological armamentarium. [ABSTRACT FROM AUTHOR]

Alitretinoin is the only systemic agent approved to treat moderate‐severe chronic hand eczema (CHE) unresponsive to potent topical corticosteroids. No nationwide Italian data regarding real‐life efficacy, safety, and tolerability of treatment are available. The DECISA project (DErmatology Clinics in Italy: Survey on Alitretinoin) retrospectively examined data from a registry including 15 Dermatology Clinics authorized to prescription of alitretinoin for CHE patients. Disease severity was assessed at baseline, and after 3 and 6 months of treatment, using the 5‐point Physician Global Assessment (PGA) and the modified Total Lesion‐Symptoms‐Severity (mTLSS) scores. Between November 2010 and July 2018, data of 248 male and 190 female patients (mean age 49.71 ± 13.20 years) treated with alitretinoin were collected. Of them, 43.2% had irritant contact dermatitis, 22.2% allergic contact dermatitis, 18.0% atopic dermatitis, 16.7% mixed (irritant/allergic) type of eczema. At 3 months, the 420 re‐evaluated patients showed significantly reduced mTLSS and PGA (P <.0000001 vs baseline for both); PGA was clear/almost clear in 35.6% of cases. At 6 months, the 341 re‐evaluated patients showed significant (P <.0000001) improvement of mTLSS and PGA vs baseline and 3 months (PGA clear/almost clear: 41.4%). Relapses occurred in 125 patients; 58 underwent an additional course of alitretinoin, with similarly good results. No relevant safety issues were reported; 86 patients experienced adverse effects, which forced 40 to prematurely stop treatment. The DECISA project results confirm the real‐life efficacy, safety and tolerability of alitretinoin in the treatment of moderate to severe CHE refractory to standard topical therapies. [ABSTRACT FROM AUTHOR]

Patch testing with textile dye mix in Italy: A 2-year multicenter SIDAPA study Azo-dyes, patch test, SIDAPA baseline series, skin tests, textile dye mix Keywords: azo-dyes; patch test; SIDAPA baseline series; skin tests; textile dye mix EN azo-dyes patch test SIDAPA baseline series skin tests textile dye mix 265 268 4 03/22/21 20210401 NES 210401 Disperse dyes (DDs), mostly represented by azo dyes, are small and lipophilic molecules characterized by low cost and simple application on clothing. [Extracted from the article]

Masks are essential for COVID‐19 prevention, but recently they were suggested to modify cutaneous facial microenvironment and trigger facial dermatoses. To evaluate mask‐related rosacea and acne (maskne) in untreated patients during lockdown. In this multi‐center, real‐life, observational prospective study, we enrolled stable, untreated acne and rosacea patients that wore masks during lockdown at least 6 h/day. They underwent two teledermatological consultations, at the baseline and after 6 weeks. Clinical, pharmacological, and psychological data were recorded. A total 66 patients, 30 (median age: 34.0 [30.25‐29.75] yoa) with acne and 36 patients (median age: 48 [43‐54] years) with rosacea, were enrolled in this study. After 6 weeks of mask and quarantine, patients with acne displayed an increased Global Acne Grading Scale (GAGS) score in mask‐related areas (P <.0001). Likewise, after 6 weeks of mask and quarantine, patients with rosacea displayed a worsen in both physican (P <.0001) and patient (P <.0001) reported outcomes. Remarkably, patients reported also a statistically significant decrease in their quality of life (P <.0001). Masks appear to trigger both acne and rosacea flares. Additional studies are needed to generate evidence and inform clinical decision‐making. [ABSTRACT FROM AUTHOR]

During COVID‐19 pandemic, wearing masks for prevention became mandatory but evidence suggest that is also detrimental for skin. Although facial dermatoses due to masks increase in both healthcare workers and general population, a pathogenetic hypothesis remains still elusive. We aimed to evaluate the prevalence of dermatological consultations due to Koebner triggered dermatoses In this prospective, multicenter, real life study carried out in Italy from March 11th to December 11th 2020 during COVID‐19 pandemics, dermatological consultations (in‐person and telemedicine) to study the prevalence of Koebner (KB) phenomenon due to masks were evaluated. Boyd and Nelder classification was adopted for Koebner phenomenon and Bizzozero's for KB intensity. A total of 229/873 (26.2%) dermatological consultations were KB triggered dermatoses and lesions were located in mask‐covered ear area (76 [33.2%]), malar area (73 [31.8%]), perioral area (53 [23.1%]), and nose (27 [11.8%]). The first KB category grouped 142 patients (psoriasis, vitiligo, maskne, and mask rosacea), the second one 24 (warts, molluscum contagiosum, and impetigo), the third one 46 (atopic dermatitis), and the fourth one 17 (eczema). Among previously KB negative psoriatic patients that became KB positive, 9/13 (69.2%) had discontinued or modified the prescribed antipsoriatic treatment. Mask‐related Koebner phenomenon is an important clinical sign to orient clinician's therapeutic protocols during COVID‐19 pandemic, especially in patients with psoriasis. [ABSTRACT FROM AUTHOR]

Tetracyclines (TetraC) are widely used in dermatology for both inflammatory and infectious dermatoses; recently both in vivo and in vitro studies started to suggest also a potential antiviral effect. During COVID‐19 outbreak, several dermatological patients contracted SARS‐CoV‐2 experiencing only mild symptoms, but no protocol were approved. A multicenter prospective observational study that enrolled COVID‐19 patients visited with teledermatology and undergoing TetraC was performed. About 38 adult outpatients (M/F: 20/18, age 42.6 years [21‐67]) were enrolled. During the TetraC treatment, symptoms resolved in all patients within 10 days. Remarkably, ageusia and anosmia disappeared in the first week of TetraC treatment. TetraC seem a promising drug to treat COVID‐19 outpatients with mild symptoms. [ABSTRACT FROM AUTHOR]

SARS‐CoV‐2 become pandemics and there is still a dearth of data about its the potentially among dermatological patients under biologics. We aimed to assess health literacy, disease knowledge, treatment dissatisfaction and biologics attitudes toward COVID‐19. We performed a cross‐sectional, questionnaire‐based survey on 98/105 consecutive dermatological patients treated with biologics—51 suffering from plaque psoriasis, 22 from atopic dermatitis, and 25 from hidradenitis suppurativa. An ad hoc, validated questionnaire has 44 items investigating the following domains: knowledge of COVID‐19 related to (a) epidemiology, (b) pathogenesis, (c) clinical symptoms, (d) preventive measures, and (e) attitudes. Patients data and questionnaires were collected. Despite only 8.1% thought that biologics may increase the risk of COVID‐19, 18.4% and 21.4% of the patients were evaluating the possibility to discontinue or modify the dosage of the current biologic therapy, respectively. Globally, male patients (P =.001) with higher scholarity level (P =.005) displayed higher knowledge of COVID‐19. Patients with lower DLQI (P =.006), longer disease duration (P =.051) and lower scholarity (P =.007) have thought to discontinue/modify autonomously their biologic therapy. At the multivariate logistic regression, only the knowledge of epidemiology and preventive measures resulted independent predictors of continuation vs discontinuation and modification vs no modification, respectively. Dermatologists should promote COVID‐19 knowledge to prevent biologics disruption. [ABSTRACT FROM AUTHOR]

Neutrophilic dermatoses (ND) are a polymorphous group of noncontagious dermatological disorders that share the common histological feature of a sterile cutaneous infiltration of mature neutrophils. Clinical manifestations can vary from nodules, pustules, and bulla to erosions and ulcerations. The etiopathogenesis of neutrophilic dermatoses has continuously evolved. Accumulating genetic, clinical, and histological evidence point to NDs being classified in the spectrum of autoinflammatory conditions. However, unlike the monogenic autoinflammatory syndromes where a clear multiple change in the inflammasome structure/function is demonstrated, NDs display several proinflammatory abnormalities, mainly driven by IL-1, IL-17, and tumor necrosis factor-alpha (TNF-a). Additionally, because of the frequent association with extracutaneous manifestations where neutrophils seem to play a crucial role, it was plausible also to consider NDs as a cutaneous presentation of a systemic neutrophilic condition. Neutrophilic dermatoses are more frequently recognized in association with respiratory disorders than by chance alone. The combination of the two, particularly in the context of their overlapping immune responses mediated primarily by neutrophils, raises the likelihood of a common neutrophilic systemic disease or an aberrant innate immunity disorder. Associated respiratory conditions can serve as a trigger or may develop or be exacerbated secondary to the uncontrolled skin disorder. Physicians should be aware of the possible pulmonary comorbidities and apply this knowledge in the three steps of patients' management, work-up, diagnosis, and treatment. In this review, we attempt to unravel the pathophysiological mechanisms of this association and also present some evidence for the role of targeted therapy in the treatment of both conditions. [ABSTRACT FROM AUTHOR]

Chronic spontaneous urticaria might affect elderly patients, causing a serious impairment of their quality of life. The therapeutic management of the elderly patient is challenging; in fact, the first‐line recommended therapy for symptom control are antihistamines, that may have interactions or increased risk of side effects in patients with comorbidities and poly‐pharmacological regimen. Omalizumab is the first biological drug approved for chronic spontaneous urticaria resistant to antihistamines. Real‐life data focusing on patients >65‐year‐old treated with omalizumab are rare. In our retrospective study, we evaluated the efficacy and safety of this biologic therapy in patients over 65‐year‐old. We performed Urticaria Activity Score‐7 (UAS‐7) in order to evaluate the efficacy of omalizumab and the time of remission. We collected any adverse event related to the treatment. Moreover, we investigated the presence of comorbidities and their impact on the efficacy of omalizumab. Sixty‐threepatients, with a mean age of 72.3 ± 5.6 years, range: 65‐89) were enrolled. Of 63 subjects, 23 (36.5%) had an "early complete response" profile, which means the achievement of a UAS7 score of "0" within the first 7 days of therapy. The most frequent comorbidity was hypertension, which affected 26 of 63 (41.3%) patients; no adverse events were reported. No significant correlations were found between treatment effectiveness and comorbidities. Omalizumab is a safe and effective therapy also in elderly patients with multiple comorbidities. [ABSTRACT FROM AUTHOR]

The article focuses on the European baseline series (EBS) of contact allergens (haptens) which is used in Europe as a patch test screen in the diagnosis of allergic contact dermatitis. It comments on an update of the EBS with the European Society of Contact Dermatitis working group European Surveillance System of Contact Allergy to provide evidence-based changes to the series. It mentions specific haptens that have not been included in the EBS including sodium metabisulfite, and decyl glucoside.

Psoriasis is a chronic inflammatory systemic disease characterized by a wide range of comorbidities. Respiratory comorbidities are currently poorly characterized and with discordant results. The systemic state of inflammation caused by psoriasis acts de novo on respiratory tissues and amplifies preexisting inflammation from asthma or chronic obstructive pulmonary disease. Because the lungs act as a gas exchanger between the internal and external environment, the impact of chronic psoriasis inflammation may be easily assessed through the analysis of exhaled breath. The fraction of exhaled nitric oxide test (FeNO) is a potential noninvasive solution that can provide quantitative and qualitative indices of respiratory airway inflammation. FeNO is routinely used to screen and manage asthmatic patients. Recent pilot studies contain encouraging data that underscore its possible use with systemic inflammatory nonpulmonary diseases, such as psoriasis. FeNO may therefore be a useful tool to evaluate underestimated airway inflammation and at the same time globally evaluate the impact of systemically antipsoriatic therapies. [ABSTRACT FROM AUTHOR]

Psoriasis is a skin inflammatory disease characterized by an increased body of comorbidities, including parodontopathy. Despite the visibility of skin lesions, prognostic biomarkers, related to disease monitoring and therapeutic effectiveness, are still missing. Although several markers have been studied, none of them has been identified as an independent prognostic factor. This concise review aims to summarize the current knowledge and results in saliva research applied to psoriasis. Combination of different markers could improve the prognostic prediction in patients with psoriasis. Future studies are needed to implement research on salivary biomarkers and their prognostic/therapeutic effects in the management of patients with psoriasis. [ABSTRACT FROM AUTHOR]

We prospectively evaluated 16 dermatological patients with psoriasis (PsO), atopic dermatitis (AD) or pruritus I sine materia i (Psn) who were planned to undergo at least one NB-UVB session (as a monotherapy) before being administered a RNA-based COVID-19 vaccine. While the decision to discontinue NB-UVB is generally motivated by the fear of a potential, not yet fully understood,3 vaccine-related increase of the patients' photosensitivity, those who opt for continuing with UVB-NB act so hoping to prevent possible vaccine-related flares (i.e., psoriasis flares).4 To assess a potential decrease of minimal erythemal dose (MED), causing photosensitivity in NB-UVB patients who were administered a RNA-based COVID-19 vaccine, we performed the multicenter study described underneath. RNA-based COVID-19 vaccine is not a contraindication to phototherapy: Real-life data on minimal erythema dose changes. [Extracted from the article]

Background The prevalence of occupational and non-occupational textile dermatitis seems to be increasing, probably because of changed textile manufacturing techniques. Objective Evaluation of the clinical features and epidemiology of textile contact dermatitis ( TCD) in Italy. Methods Demographic data, clinical history aspects, atopy and positive patch test reactions to occupational and non-occupational allergens were investigated in 277 textile dermatitis patients. Results Contact dermatitis was the most frequent clinical presentation (95.3%). TCD was more common in females, in the fourth to fifth decades of life, and in atopic dermatitis patients. The lesions were prevalently eczematous (74.2%), and mostly located on the trunk and lower limbs in non-occupational cases, and on the hands in textile workers. Allergic TCD (58.3%) was more frequent than irritant TCD. The dyes ( Disperse Blue 124, Disperse Blue 106, and Disperse Yellow 3) were most frequently responsible (79.8%), especially in non-occupational TCD. Formaldehyde and resins were more important in occupational TCD. Concomitant reactions among textile dyes and/or finishing resins were observed in 50.0% of patients. Conclusions Some strategies (sensitization potential of new textile chemicals, more stable dyes, reduced levels of formaldehyde in clothing, and collaboration with textile industry and trade associations) should be adopted to decrease the TCD incidence and update the textile patch testing series. [ABSTRACT FROM AUTHOR]

Background Little is known about the socio-economic burden of severe chronic hand eczema in patients refractory to treatment with potent corticosteroids. Objectives To estimate the socio-economic burden of severe chronic hand eczema refractory to potent topical corticosteroids, and to establish an algorithm for the estimation of the health-related quality of life EuroQol five-dimensional (EQ-5D) utility index from the Dermatology Life Quality Index ( DLQI) summary score. Methods A multicentre cost of illness study was conducted, adopting the societal perspective. Adult patients with severe and refractory chronic hand eczema were enrolled. Direct (e.g. drug treatment and travel) and indirect (i.e. loss of productivity) mean costs/patient-month were estimated. Health-related quality of life was assessed with the EQ-5D and DLQI questionnaires. An ordinary least square regression model was used to investigate relationships between health-related quality of life scores. Results One hundred and four valid patients (mean age 44.5 years, 39.4% male) participated. Overall mean costs were €418.3/patient-month: loss of productivity contributed 43.7%, followed by hospitalization (16.1%) and travel (10.3%). Health-related quality of life scores were, on average, 0.50 ( EQ-5D utility) and 11.3 ( DLQI). Utility and DLQI summary were significantly related to each other. Conclusions Wellbeing and loss of productivity are the most important consequences in these patients. Appropriate treatment is necessary to improve patient health and productivity, which will contribute to reducing societal costs. [ABSTRACT FROM AUTHOR]

Background The evidence on the safety of topical preparations containing botanical extracts is limited. Objectives To assess (i) the use of botanically derived compounds in a large population, (ii) the incidence of cutaneous side-effects, and (iii) the diagnostic usefulness of patch testing. Methods A questionnaire was used in 2661 patients to assess both the prevalence and type of topical botanical preparations used, and the occurrence of adverse skin reactions. Patients declaring adverse reactions were patch tested with (i) the Italian ( SIDAPA) baseline series, (ii) an additional botanical series, and (iii) the patients' own products. Results Of the patients, 1274 (48%) reported the use of topical botanical products; 139 patients (11%) commented on adverse cutaneous reactions; 75 (54%) showed positive reactions with the Italian baseline series. Among the 122 patients tested with the botanical series, 19 (16%) showed positive reactions, in many cases with concomitant relevant positivity to at least one allergen of the Italian series connected with cosmetics. The commonest botanically derived allergens were propolis, Compositae extracts, and Melaleuca alternifolia (tea tree) oil. Conclusions Contact allergy is a possible adverse effect of natural products. Baseline series supplemented with the commonest botanical allergens may be adequate for detecting most of the cases of contact allergy to natural topical products. [ABSTRACT FROM AUTHOR]

In order to establish a consensus recommendation for performing photopatch testing, a photopatch test taskforce group was established under the joint umbrella of the European Society for Contact Dermatitis and the European Society for Photodermatology in 2000. After proposing the most adequate methodology in 2004 and completing a European multicentre photopatch test study in 2011, this taskforce is recommending a list of photoallergens that should form part of a baseline series for photopatch testing in Europe. It contains mainly ultraviolet filters and drugs, mostly non-steroidal anti-inflammatory drugs. The choice of chemicals was based on the results of a recent multicentre study, previous published cases of photoallergy, and use of the substances in the European market. It is suggested that an extended list of photoallergens should be photopatch tested in selected cases, along with patients' own products. Two contact allergens, cinnamyl alcohol and decyl glucoside, should be simultaneously patch tested in order to clarify photopatch and patch test reactions, respectively, to ketoprofen and methylene bis-benzotriazolyl tetramethylbutylphenol (Tinosorb M™). [ABSTRACT FROM AUTHOR]

Sensitization to orthopaedic implant materials is an unpredictable event that might affect implant performance. In candidates for hip or knee joint prosthesis implantation, to evaluate preoperative assessments for identifying patients with metal sensitivity, to determine the percentage of patients who developed metal sensitivity at 1 year after prosthesis implantation, and to examine the clinical relevance of patch tests and lymphocyte transformation tests (LTT-MELISA®) for the evaluation of metal sensitization. A total of 100 patients referred for total hip or total knee arthroplasty were assessed preoperatively and then at 1 year post-implantation by means of patch tests with the metals present in the implant alloys. In a pilot study, 20 patients also underwent both patch testing and a lymphocyte transformation test (LTT-MELISA®) for the same metals. Only 72 of 100 patients were patch tested both before and after surgery, and 12 of 20 also underwent LTT-MELISA® before and after surgery. Of 31/100 patients with an apparent history of nickel sensitivity determined during preoperative assessment of subjects, 12 tested negative on both tests, and 4 with a negative history of nickel sensitivity tested positive. One year post-implantation (72 patients), 5 patients who had initially tested negative for a metal allergy became positive for at least one or more metal constituents of the prosthesis on at least one or the other test. Given the discrepancies between the information obtained while taking patient histories and test results, preoperative history-taking alone appears to be insufficient for identifying patients with metal sensitivity. Moreover, the increase in the percentage of patients who tested positive for metal sensitivity 1 year post-implantation suggests the possibility of prosthesis-induced sensitization. Therefore, objective determination of metal sensitivity at preoperative assessment should be considered in planning arthroplasty intervention, as it would help the surgeon in selecting the most appropriate prosthesis for the patient and could benefit implant performance. [ABSTRACT FROM AUTHOR]

Background: Evaluation of possible photoallergic contact dermatitis in at-risk populations is often not undertaken, and an agreed methodology for investigation is uncommonly used. Objectives: We conducted a retrospective multicentre study to determine the prevalence of photoallergic contact dermatitis in Italy. Methods: A total of 1082 patients with histories and clinical features suggestive of photoallergic contact dermatitis were evaluated. All the patients had undergone photopatch testing with allergens proposed for Italy as well as other substances suggested by each patient’s personal history. Results: 234 patients (21.6%) were positive to at least one test substance of the standard photopatch testing series or to added substances. 234 patients (21.6%) were positive to at least one substance with a total of 290 reactions. 204 of the reactions were typically photoallergic; 68 reactions were allergic and within this group 10 were photoaugmented reactions; 18 reactions were considered to be phototoxic. Conclusion: The predominant group of photoallergens was drugs, followed by organic UV filters and antimicrobial agents. [ABSTRACT FROM AUTHOR]

Keywords: 3-dimethylaminopropylamine; allergic contact dermatitis; cosmetic products; patch test; personal care products; baseline series EN 3-dimethylaminopropylamine allergic contact dermatitis cosmetic products patch test personal care products baseline series 240 241 2 03/23/20 20200401 NES 200401 3-Dimethylaminopropylamine (DMAPA) (CAS no. 109-55-7) is an aliphatic amine used for the synthesis of betaines often present in the final product as a contaminant;[1] DMAPA is able to induce contact allergy.[[2], [4]] DMAPA may be contained in personal care products and several industrial products such as agricultural chemicals, fabric softeners, water-resistant textile fibers, synthetic dyes and paints, etc. In this study, the prevalence of positive patch test reactions to DMAPA during 2018 in Italian patients was assessed. DISCUSSION Our data from 5140 consecutively patch tested patients in Italy during a 1-year period showed a prevalence of 1.3% of contact allergy to DMAPA. [Extracted from the article]

The present work reports the results of a multicentre study of toothpaste allergic contact cheilitis (TACC) conducted by GIRDCA (Gruppo Italiano Ricerca Dermatiti da Contatto e Ambientali). The study examined 54 patients with eczematous lesions on the lips, the possible cause of which was suspected to be the use of toothpastes. Patch tests were conducted with a standard series, a specially-targeted series (toothpaste cheilitis series, TCS), and with suspected toothpaste(s). A stop-restart test (SRT) was carried out with these, together with a use test to identify possible alternative products. The TCS produced 17 positive reactions in 13 patients, the most frequent being to spearmint oil. Of the 54 patients, 5 displayed positive reactions only to the TCS. The patch tests with toothpaste produced positive reactions in 11/32 patients, the SRT a positive response in 10/12 cases. The diagnosis of TACC was confirmed in 15/54 patients. Alternative products were identified for 5 patients. In conclusion, the allergens most frequently responsible for TACC were the flavourings, and the additional series proved to be useful in many cases (together with patch tests with toothpastes and the SRT) for correct diagnosis and to initiate effective prevention. [ABSTRACT FROM AUTHOR]

In the last 3 years, we have studied 10 patients with allergic reactions to topical ketoprofen. We have investigated the sensitization and irritant potential of the drug and the possibility of cross-reactivity with other aryl-propionic non-steroidal anti-inflammatory drugs (ibuproxam, ibuprofen, naproxen, fenoprofen, flubiprofen and tiaprofenic acid). 2 of our patients had contact dermatitis, and the other 8 photocontact dermatitis. One of our patients showed cross-reactivity between ketoprofen and ibuproxam on patch testing. In the photopatch tests, we observed cross-reactivity between ketoprofen and tiaprofenic acid in 2 patients, and cross-reaction between ketoprofen and ibuproxam and flurbiprofen in another case. Experimental studies, including human maximization and photomaximization tests, performed in 20 healthy volunteers, showed a complete absence of sensitization. 3 volunteers showed a marked irritant reaction to ketoprofen (20% pet.) during either maximization (2 cases) or photomaximization (1 case) tests. Although ketoprofen appears not to be a sensitizing agent in human volunteers, the fact that photosensitization to this drug seems to be quite common after topical use suggest that there are some local or individual factors, at present unknown, facilitating the development of allergy. [ABSTRACT FROM AUTHOR]

Background. Epidermotropic lymphoid T cell infiltrates are part of a continuous spectrum of lesions ranging from "benign" parapsoriasis to frank cutaneous T cell lymphoma (CTCL, mycosis fungoides). Either the clinical or histologic differentiation between these entities prove often difficult and the prognosis may be difficult to assess. Patients and Methods. We studied 15 patients, men aged 50 to 81 years, mean ± SD 68 ± 12 years, with patch-plaque CTCL. Sections from punch biopsies from active lesions were stained with Feulgen reagent, coupled with a "twin" adjacent hematoxylin and eosin (H&E)-stained section and analyzed with a VIDAS Zeiss-Kontron Image Analyzer. At least 50 dermal infiltrating cells and 50 epidermotropic Pautrierian cells per specimen were counted and the biopsies were repeated periodically. Results. Nine patients with aneuploid Pautrierian cell DNA patterns did well after conventional phototherapy (dermal cell ploidy was irrelevant), whereas six patients with euploid Pautrierian cell DNA patterns had to be treated aggressively (IFN + retinoids, cop). Clinical and histopathologic aspects of the first group were comparable to those of the second group. Conclusions. The classical cytophotometric aphorism seems to be reversed In this sample: "The more abnormal the ploidy of epidermotropic Pautrierian cells, the better the prognosis." Euplold epidermotropic cell prove more efficient in invading the skin and other areas and this efficiency may be reflected in more aggressive trends in the evolution of the lymphoma. Thus, DSM analysis of epidermotropic cells could prove very useful as an inexpensive tool for routine CTCL grading. [ABSTRACT FROM AUTHOR]

Atopic dermatitis (AD) therapeutic approach calls for a long‐term treatment. Treatment options for AD have recently undergone a revolutionary change by the introduction of the first biologic drug. Availability in daily practice of the last version of international AD guidelines, taking peculiarities of the country into account, can contribute to good clinical practice in Italy. To adapt European Dermatology Forum (EDF) guidelines for AD to the Italian medical–legal context, the EDF guidelines were assessed independently by two independent Italian renowned experts in the field and further integrated with articles published and systematically reviewed before May 2019. The first draft was collegially corrected and updated by the members of the SIDEMAST, ADOI, and SIDAPA. Recommendation levels (A; B; C; D) were graded based on the evidence levels (1–4). The adapted guidelines presented here focus on topical and systemic therapies in AD patients, both children and adults. As opposed to previous Italian guidelines, they include indications about biologics. New relevant evidence available from very recent literature and peculiarities of the Italian medical and legal context have been integrated in the revision process. If compared to general guidelines for AD not adapted to a specific national and cultural context, a revision for specific Italian needs is now available: It comprises the option of implementing the new biologic treatments and is likely to provide an important contribution to the improvement of clinical practice in Italy. Cooperation between patients, dermatologists, allergologists, and pediatricians remains mandatory in AD management. The authors of the present revision recommend an update of the Italian guidelines to be performed at least every second year. [ABSTRACT FROM AUTHOR]

Nanodermatology is an emerging, multidisciplinary science, arising from the convergence of nanotechnology, pharmacology, physics/biophysics, chemistry/biochemistry, chemical engineering, material science, and clinical medicine. Nanodermatology deals with (a) skin biology, anatomy, and physiology at the nanoscale ("skin nanobiology"), (b) diagnosis performed by means of novel diagnostic devices, assisted by nanobiotechnologies ("nanodiagnosis"), and (c) treatment through innovative therapeutic agents, including phototherapy ("photonanotherapy"/"photonanodermatology") and systemic/topical drug administration ("nanotherapy") at the nanoscale, and drug delivery—such as transdermal or dermal drug delivery (TDDD/DDD)—enhanced and improved by nanostructures and nanodrugs ("nanodrug delivery"). Nanodermatology, as a super‐specialized branch of dermatology, is a quite recent specialty: the "Nanodermatology Society" founded by the eminent dermatologist Dr. Adnan Nasir, was established in 2010, with the aim of bringing together different stakeholders, including dermatologists, nanotechnology scientists, policy‐makers and regulators, as well as students and medical residents. Psoriasis has a prevalence of 2–3% worldwide and imposes a severe clinical and societal burden. Nanodermatology‐based solutions appear promising for the proper treatment and management of psoriasis, assisting and enhancing different steps of the process of health‐care delivery: from the diagnosis to the therapeutics, paving the way for a personalized approach, based on the specific dysregulated biomarkers. [ABSTRACT FROM AUTHOR]

Dabigatran-associated Acute Generalized Exanthematous Pustulosis (AGEP) in a psoriatic patient undergoing Ixekizumab and its pathogenetic mechanism Within 2 weeks of stopping DAB consume, the patient's AGEP resolved completely, and in accord with Naranjo's criteria, AGEP was depicted as a "probable" DAB related side-effect. Ethanol and cocaine metabolites increase skin lipid peroxidation and at the same time slow down skin lipidic esters metabolism resulting in possible skin inflammation and AGEP. [Extracted from the article]

Interleukin(IL)‐17 inhibitors display higher efficacy than both TNFi and IL‐12/23i, which increased the goal psoriasis area severity index (PASI) from 75 to PASI 90 or even PASI 100. Ixekizumab, a recombinant, humanized IgG4 monoclonal antibody targeting IL‐17A displayed a high efficacy and safety in RCTs, namely UNCOVER‐2 and UNCOVER‐3. However, few studies examined real‐life data for these medications, and those which exist highlight discrepancies in efficacy and safety between RCTs and real‐life data, likely due to the heterogeneity of patients treated outside of trials. Thus, we performed a single center large prospective observational study (RLSD) that enrolled 47 psoriatic patients followed for 20 weeks and we compared the obtained data with the UNCOVER studies. At week 20 in RLSD versus UNCOVER‐3 both PASI‐90 and PASI‐100 results were similar, whilst at week 12, the RLSD cohort obtained higher PASI 90 (76 vs 69,3%) and PASI‐100 (55 vs 39%) than UNCOVER cohorts. Interestingly we also reported higher injection‐site related pain that disappeared after week 12. In conclusion, real‐life data together with RCTs contribute to enrich the information background available to dermatologists in daily practice. [ABSTRACT FROM AUTHOR]

The article describes the case of an 83-year-old male with psoriasis and psoriatic arthritis. The patient experienced symptoms such as severe plaques anddactylitis of the second finger of his right hand. He reported bitter taste after receiving apremilast, a small-molecule inhibitor of phosphodiesterase-4(PDE-4), to treat his psoriasis and psoriatic arthritis.

Psoriasis is a chronic, systemic inflammatory disease that in the moderate to severe forms may benefit of biologics, namely TNF and IL‐12/23 and IL‐17 inhibitors. Loss of response, lack of response, or discontinuation due to adverse events represent a concrete therapeutic challenge for dermatologists that have to switch patients to other treatments. Although some evidences already exist toward the switch from IL‐12/23 and TNF inhibitors to IL‐17 inhibitors, conversely nothing is present toward the switch from IL‐17 inhibitors to IL‐12/23 and TNF inhibitors. We performed a real‐life study enrolling 50 patients randomly switched to adalimuamb, a TNF inhibitor, or ustekinumab, an IL‐12/23 inhibitor. Our observational study suggests that switching from IL‐17i to TNFi and IL‐12/23i is a safe and effective therapeutic strategy. [ABSTRACT FROM AUTHOR]

Cosmetic tattooing involves implantation of pigments into the dermis in order to create a permanent makeup. Here, we report a case of sarcoidal granulomatous reaction to old cosmetic tattoos after an intense pulsed light (IPL) treatment for facial skin rejuvenation. We consider this case as a peculiar example of photo-induced reaction to tattoo. In addition, we hypothesize that an underlying immune dysfunction was present, and acted as a predisposing factor for this unusual response, as the patient had suffered from an episode of acute pulmonary sarcoidosis 15 years before. Overall, our observation suggests that IPL treatment should be used cautiously in patients with tattoos, especially when a history of autoimmune disease is present. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented in response to the article "Removal of an Amalgam Tattoo Using a Subepithelial Connective Tissue Graft and Laser Deepithelialization," by C. M. Campbell and D. E. Deas.

A letter to the editor is presented in response to the article "Migration of mercury from dental amalgam through human teeth," by Hugh H. Harris and colleagues in the 2008 issue.

A letter to the editor is presented on the measurement of mercury exposure in children.

Frequent applications of allergens to the same target seem to reduce skin reactivity. This article investigates the maintenance of specific contact sensitivity in 66 patients. Patch tests were performed and results were read using international standards. 47 out of 66 patients showed positive reactions. A comparison between clinical response and repatch tests showed that 35 had obtained clinical results and positive repatch tests. It shows that approximately half of these patients previously sensitized lost the original sensitivity, which does not seem to be time-dependent.

This article presents a case of occupational allergic contact dermatitis that has occurred from the use of minoxidil. A 45-year old hairdresser was referred with an erythematous, oedematous desquamative dermatitis localized to the fingers of both hands, accompanied by pruitus and burning. He was advised to suspend any contact with minoxidil; the clinical picture completely regressed without any therapy in about 15 days. Only 35 cases of allergic contact dermatitis have been reported with the use of minoxidil since 1984, says the article.

A letter to the editor is presented in response to an article on the relationship between serum heavy metals and childhood skin diseases.

A letter to the editor is presented in response to the article "Titanium Allergy in Dental Implant Patients: A Clinical Study on 1500 Consecutive Patients," by A. Sicilia and colleagues published in a previous issue of the journal.

A letter to the editor is presented in response to the article "Mercury intoxication and neuropathic pain," by N. Celebi and colleagues, in a 2008 issue.