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Photodynamic therapy (PDT) with topical delta-aminolaevulinic acid (ALA) is considered as a valuable tool for treating non-melanoma skin tumours, but there is no consensus about the methods of treatment, where they should be used and the rates of complete responses. This study reports the treatment of 50 actinic keratoses (AKs), 23 superficial basal cell carcinomas (BCCs), 30 nodular BCCs, 4 pigmented BCCs, 12 superficial squamous cell carcinomas (SCCs), 6 nodular SCCs, 6 Bowen's diseases and 4 keratoacanthomas (KAs). A 20% ALA emulsion was applied under an occlusive dressing for 6-8 h and the skin was then irradiated with 630 nm light from a dye laser. Treatments were delivered every other day until complete clinical disappearance of the lesions was observed. ALA-PDT was interrupted in the case of a partial response if, after two additional treatments, no further improvement was observed. All AKs (50/50), superficial BCCs (23/23), Bowen's diseases (6/6) and KAs (4/4) showed a complete response. In addition, 91.6% (11/12) superficial SCCs, 80.0% (24/30) nodular BCCs and 66.7% (4/6) nodular SCCs responded completely to the treatment. All 4 pigmented BCCs were resistant to the therapy. Some (59) of the treated areas that appeared completely responsive were excised for serial histopathological examination and the remaining 63 were followed-up for 24-36 months (median value, 29 months). Comprehensively, the rates of complete responses decreased after taking into consideration the results of these histological examinations and the long-term follow-up. The final response rates are as follows: 84.0% (42/50) AKs, 86.9% (20/23) superficial BCCs, 50% (15/30) nodular BCCs, 83.3% (10/12) superficial SCCs and 33.3% (2/6) nodular SCCs. The rates of complete responses of Bowen's diseases and KAs remained at 100%.(ABSTRACT TRUNCATED AT 250 WORDS)

We have investigated short- and long-term ocular side effects of psoralen plus UVA (PUVA) therapy in 82 patients who refused to wear UVA blocking sunglasses after the treatments. They had received 321.7 +/- 328.8 J/cm2 of UVA in 148.8 +/- 113.9 exposures over 2-4 years. Results were compared with findings obtained in 749 patients who shielded their eyes. They received 402.6 +/- 302.2. J/cm2 of UVA in 167.8 +/- 136.9 treatments over 2-6 years. 20 patients refusing eye sun protection developed conjunctival hyperemia and 21 patients decreased lacrimation. Among patients who adequately protected the eyes, we observed 5 cases of conjunctival hyperemia and 1 case of decreased lacrimation. Lens opacities did not develop in any patient. Adequate eye sun-protection is thus needed to avoid acute toxicity of cornea and conjunctiva but lens opacities do not appear to be a side effect of long-term PUVA-therapy.

Background: The optimal therapeutic regimen of bath-PUVA therapy of psoriasis is still under debate., Objective: We investigated the safety and efficacy of an aggressive and individualized bath-PUVA regimen., Methods: Two closely matched groups of 22 psoriatic patients were treated either with 30-min baths in 0.0003% 8-methoxypsoralen (8-MOP) aqueous solution or oral administration of the drug. According to the standard European regimen, treatments were delivered 4 times a week starting with the minimal phototoxic dose., Results: Complete clearing or marked improvement was observed in all the patients. However, with bath-PUVA, the same therapeutic effect required smaller cumulative UVA doses (39.3 +/- 15.8 vs. 123.8 +/- 39.9 J/cm2) and lower numbers of exposures (15.2 +/- 4.4 vs. 20.6 +/- 4.2). Both differences were significant at the 0.01 level (Student's t test). Gastro-intestinal side-effects were of course restricted to oral 8-MOP. The incidences of burns and pruritus were similar., Conclusion: Using an aggressive and individualized schedule, bath-PUVA therapy showed a greater efficacy than oral PUVA therapy while being just as safe.

Background: There is a disparity between the absorption spectrum of 8-methoxypsoralen and the action spectrum for psoralen-sensitized erythema. In an action spectrum corrected for unsensitized reaction 313 and 365 nm have similar efficacies., Objective: We evaluated the relative erythemogenic and antipsoriatic efficacy of narrow-band (311 nm) UVB with and without prior psoralen exposure. We also compared the effects of narrow-band UVB and broad-band UVA after oral and bath-water psoralen exposure., Methods: Patients with psoriasis underwent half-side comparison studies. In one group the therapeutic efficacy of 311 nm UVB with and without oral psoralen was assessed. The second group received UVA and 311 nm UVB after oral psoralen. The third group was exposed to both radiation sources after bath-water exposure., Results: The erythemogenic, pigmentogenic, and therapeutic efficacy of 311 nm was increased by oral psoralen. With systemic 8-methoxypsoralen, UVA was comparable to 311 nm UVB. After bath-water exposure, 311 nm was clearly superior to broad-band UVA., Conclusion: The efficacy of narrow-band 311 nm UVB can be enhanced by psoralen. Narrow-band 311 nm UVB is also effective after psoralen bath-water delivery.

We report a patient with cat scratch disease who presented with multiple scattered nodular lesions on the legs. Examination of skin biopsy specimens revealed a granulomatous pattern. In our opinion, this is a previously undescribed secondary cutaneous reaction of cat scratch disease. The pathogenesis of this reaction is unclear but some data suggest that the eruption might be caused by a hematogenous spread of cat scratch disease bacteria to the skin. Pathogenetic relationships with so-called bacillary angiomatosis, recently described in patients with acquired immunodeficiency syndrome, are reviewed here.

Pathogenesis of Granuloma Annulare is not resolved. In some Authors' opinion it is caused by an allergic granulomatous reaction to an unknown dermal antigen. Presence of Granuloma Annulare in patients with Human Immunodeficiency Virus (HIV) infection questions this hypothesis. We present two cases of such association and review eleven patients previously described in the literature. Clinical and histological findings suggest that the cell mediate immune response is not the dominant pathogenetic event, especially in cases of altered cell-mediated immunity.

We report the case of a 62 years-old Italian man affected by crops of pruritic follicular sterile papulo-pustules on the face, trunk and arms. Histopathologic examination revealed a perifollicular inflammatory cell infiltrate composed mostly of eosinophils. These features are characteristic of eosinophilic pustular folliculitis. There is not any uniformly effective treatment for this condition. In our patient the disease did not respond to dapsone, H1 antihistamines and indomethacin. Oral corticosteroids gave good results but were unsuitable for their side effects. The response to PUVA therapy was excellent. In our opinion PUVA therapy is a highly effective and safety treatment for EPF.

A 58-year old male patient was affected by a chronic dermatitis of the hands, forearms and face. Lesions appeared six months before when he started to work as a pizza-maker and worsened when he touched wheat-fluor and when he washed with an oats-derived detergent. He had a familial but not a personal history of atopic diseases. Both the Prick tests and RAST with oats and wheat flour produced positive responses. Protein contact dermatitis is a rare allergic disease caused by the contact with protein substances. It is often seen in patients working in the food industries or in the kitchens. Many of them have no other signs of atopy.

Segmental neurofibromatosis is characterized by the unilateral and segmental appearance of neurofibromas, schwannomas, plexiform neurofibromas and/or café au lait spots and axillary freckling. The aetiology is not clear but the disorder has been postulated to be secondary to a postzygotic (hence non-transmissable) somatic mutational event. In the present study we describe a 43 year old woman affected by neurofibromas on the left forearm. This is our second report of a case of segmental neurofibromatosis and occurs shortly afterwords the first. To the best of our knowledge only 28 additional cases of this very rare disease have been reported in the literature. Their main features are reviewed.

Multinodular Keratoacanthoma is a variant of keratoacanthoma presenting with large annular plaques localized on the photo-exposed surfaces of the aged people. It is characterized by progressive growth of new nodules of keratoacanthoma at the periphery, while partial or complete spontaneous central healing occurs with scar formation. There is no tendency toward spontaneous regression. Multinodular Keratoacanthoma is quite rare. In our opinion only ten cases can be complied from the literature. We report an additional case in a diabetic 87 year old woman. She was previously affected by a vulvar squamous cell carcinoma. No recurrence was observed four months after the surgical excision.

The familial occurrence of lower lip pits (fistulae, sinuses) with or without the cheilo-gnathouranoschisis complex (cleft lip and/or cleft palate) was first described by A. Van der Woude in 1954. The lip pits syndrome is inherited as an autosomal dominant trait with high penetrance (80%), but its clinical expression is variable. Sometimes there may be microforms with only conical elevation and/or surface openings without any deeper sinuses at the typical sites and without cleft lip/palate. We examined 8 members of an Italian family and we observed one member with lip pits and submucous cleft palate and 4 members with only lip pits. Three of these affected members had congenital absence of second premolars too. The presentation, mode of inheritance, aetiology and genetic significance of lip pits syndrome are reviewed. In our opinion this is the first Italian report of the Van der Woude syndrome.