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BACKGROUND Chronic inflammatory vulvar diseases can have a huge detrimental impact on patient welfare. A few studies have addressed this issue so far, mainly measuring patients' quality of life or sexual dysfunction. OBJECTIVE To assess the burden of suffering in patients with chronic inflammatory vulvar diseases using the Pictorial Representation of Illness and Self-Measure (PRISM), a visual, non-verbal instrument. We also assessed (i) the concordance between PRISM and the Dermatology Life Quality Index (DLQI), (ii) whether some variables, both patient-related and disease-related, affect the patient's suffering and quality-of-life impairment. METHODS We evaluated for inclusion in this cross-sectional study all patients who attended our Vulva Unit over a 9-month period with histologically proven lichen sclerosus (LS), lichen planus (LP), lichen simplex chronicus (LSC), eczema, plasma cell vulvitis and psoriasis (at least five for each disease). Demographics and disease-related subjective and objective scores were recorded. The PRISM and DLQI were administered. RESULTS We included 87 patients affected with LS, 13 with LSC and seven with LP. Median PRISM values (0-273 mm) ranged from 95 to 120 mm, depending on the disease, and median DLQI scores (0-30) were five for all three groups. Neither PRISM nor DLQI scores differed significantly among the three groups. Moderate coherence was found between PRISM and DLQI (ρ = 0.5455, P

This paper summarizes the position of the Italian Society of Vulvology on the clinical approach to vulval disease. A thorough history (general medical, gynaecological, and vulval history) is essential for a successful and fruitful vulvological examination. Characteristics of pruritus (itch) and pain, that are the two main vulval symptoms, should be collected and reported with precision, according to duration, temporal course, location, provocation, and intensity. Physical examination must consider both the general condition of the patient and the specific vulval region, that must be examined following a standardized methodology. The physical examination of the vulva is carried out with naked eye and adequate natural or halogen lighting. The subsequent use of instrumental magnification can be considered on particular parts of skin/mucosa, already highlighted with the first inspection. Also, palpation is essential, allowing to appreciate physical features of vulval lesions: consistency, surface, soreness, adherence to underlying plans. Finally, the five-step approach of the International Society for the Study of Vulvo-vaginal Disease about Terminology and Classification of Vulvar Dermatological Disorders (2012) is summarized. A vulval biopsy may be useful in the following situations: when clinical diagnosis is uncertain, lesion not responding to treatment; histologic confirmation for a clinical diagnosis and exclusion or confirmation of a suspected neoplastic intraepithelial or invasive pathology.

Diagnosis of genital inflammatory disorders may be difficult for several reasons, such as their similar appearance, possible misdiagnosis with infectious and malignant conditions, and peculiar anatomic conditions that may lead to modification of clinical features. Dermoscopy could be included as a part of the clinical inspection of genital diseases to support diagnosis, as well as to ideally avoid unnecessary invasive investigation. Practical guidance for the use of dermoscopy in the assessment of the main inflammatory genital diseases is provided, namely for lichen sclerosus, lichen planus, psoriasis, lichen simplex chronicus, and plasma cell mucositis.

The aim of this study was to analyse the impact of socioeconomic status (SES) on the prognosis of patients with invasive malignant melanoma (MM) incident from 1991 to 2011 in the province of Ferrara, northern Italy. A total of 750 patients provided by the Area Vasta Emilia Centrale Cancer Registry were included in this retrospective cohort study. Prognosis was analysed in terms of overall survival and specific survival. The study determinants were the patients' SES and district of residence. The confounding effect of sex, age, period and TNM stage at diagnosis was evaluated. In the study population, neither overall survival nor specific survival showed significant differences among different layers of SES and districts of residence. The risk for death from MM was lower for the female sex [hazard risk (HR)=0.68, 95% confidence interval (CI): 0.50-0.94] and for diagnoses made in the most recent period (2005-2011: HR=0.56, 95% CI: 0.36-0.89 with respect to 1991-1997). A worse prognosis was observed in patients older than 70 years at the time of diagnosis (HR=2.33, 95% CI: 1.39-3.91 with respect to the40-year age group) and in patients with more than pT1 tumours (up to 20 times for pT4 tumours). SES and district of residence did not constitute prognostic factors for MM patients residing in the province of Ferrara. Homogeneity in MM staging, treatment and follow-up strategies due to the relatively small extent of the study area and the presence of a single university hospital of reference, as well as less marked social and economic differences among the study patients in comparison with other previously analysed populations, may account for this finding.

Background Dyspareunia is a symptom of vulvar lichen sclerosus (VLS). This study specifically addressed prevalence and severity of dyspareunia in patients affected with VLS as well as the factors that can influence its occurrence. Changes in the severity of dyspareunia with treatment were also explored. Methods In this retrospective, cohort study we included VLS patients who had undergone any topical treatment for 12 weeks, between January 2011 and March 2016, at our Vulva Unit; demographics, history and clinical features recorded at baseline and at treatment completion were elaborated. Results The study included 177 patients; among the 90 patients who reported having sexual activity 56.7% complained of dyspareunia; the frequency and severity of dyspareunia was higher among the patients who had not previously been treated with topical corticosteroids than among those who had undergone previous treatments; the patients complaining of dyspareunia reported significantly higher scores for itching and burning compared with those who did not have painful intercourses; after the treatment, 52.5%, 78.4% and 64.3% of the patients reported an improvement ≥75% compared with baseline in dyspareunia, itching and burning scores, respectively. Conclusions Dyspareunia occurred in more than half VLS patients. The patients who complained of dyspareunia had a more severe overall symptom profile than those who did not report having painful intercourses. The objective severity of VLS did not seem to significantly affect dyspareunia occurrence and severity. Dyspareunia was found to be the symptom most resistant to treatment, however early treatment can be expected to reduce its occurrence and severity.

Background The evidence on the safety of topical preparations containing emulsifiers is limited. Objectives The aims of the study were to assess (1) the prevalence of sensitization to some emulsifiers commonly found in topical products, (2) the sensitization to emulsifiers in relation to sex, age, and predisposing factors, and (3) the frequency of concomitant sensitization to other common allergens. Methods All consecutive patients presenting to the Allergy Unit of our Dermatological Department for allergological investigation were enrolled. All patients were patch tested with the Italian Societa Italiana di Dermatologia Allergologica Professionale ed Ambientale baseline series and an additional emulsifiers series. Doubtful patch test reactions were not considered. Results Of 310 patients, 50 (16%) were sensitized to emulsifiers with 72 positive reactions. Lauryl polyethylene glycol/polypropylene glycol-18/18 methicone gave 26 positive reactions, glyceryl oleate 19, myristyl alcohol, and Amerchol L101 11. Concomitant sensitization to emulsifiers was found in 16 patients. Patients allergic to emulsifiers showed concomitant allergic reactions to allergens commonly found in cosmetics. No significant differences by sex, age, atopic diathesis, and clinical pattern at presentation were noticed. Conclusions Contact allergy to emulsifiers is more frequent than reported. Patients allergic to emulsifiers show frequent positive patch tests to other constituents of cosmetics and topical products.

The modern conveniences and enjoyment brought about by electronic devices bring with them some health concerns. In particular, personal electronic devices are responsible for rising cases of several skin disorders, including pressure, friction, contact dermatitis, and other physical dermatitis. The universal use of such devices, either for work or recreational purposes, will probably increase the occurrence of polymorphous skin manifestations over time. It is important for clinicians to consider electronics as potential sources of dermatological ailments, for proper patient management. We performed a literature review on skin disorders associated with the personal use of modern technology, including personal computers and laptops, personal computer accessories, mobile phones, tablets, video games, and consoles.

With the aim to assess changes in both clinical and dermoscopic features of vulvar lichen sclerosus (VLS) after a treatment with topical corticosteroid, 29 VLS patients treated with mometasone furoate 0.1% ointment for 12 weeks were evaluated for symptoms, objective signs and dermoscopic variables at baseline and treatment completion. Numeric scores were assigned to each parameter. Mean itching and burning values had decreased significantly at the 12-week control visit compared with baseline, as well as values referring to pallor, hyperkeratosis and purpuric lesions. Among the dermoscopic variables, the vessel score increased while the scores of patchy, structureless, whitish areas, whitish background, purpuric globules and scales decreased significantly after treatment. Scores referring to gray-blue dots, comedo-like openings and structures like ice slivers did not change significantly throughout the treatment. Based on these findings, dermoscopic features may change, even significantly, with topical corticosteroids and may be useful for monitoring the response to treatment.

To assess the effectiveness and safety of a 24-week application of tretinoin 0.025% cream, with an alternate-day regimen, in achieving control of VLS signs and symptoms.17 patients affected with VLS were included. The main efficacy parameters were the response rate, as defined by protocol parameters, the rate of patients achieving an improvement from baseline of ≥75% in the subjective and objective scores, and the mean reduction in subjective and objective scores throughout the treatment. The safety of the treatment was also assessed.By the end of the 24-week treatment, 12 patients (70.6%) experienced a response; 35.3% and 17.6% of patients achieved an improvement of at least 75% in subjective and objective scores, respectively. Mean scores of itching, leukoderma (pallor) and hyperkeratosis decreased significantly in the study patients, and none presented itching-related excoriations. Erythema increased compared with baseline. Six patients (35.29%) experienced some side effects related to tretinoin, mainly mild erythema and burning. None of the subjects discontinued the treatment because of side effects.Tretinoin 0.025% cream applied for 24 weeks may represent a useful alternative option to corticosteroids in the treatment of active VLS, acting particularly on hyperkeratosis and pallor.

Hormonal treatment is indicated in cases of papulopustular, nodular and conglobate acne in females with identified hyperandrogenism, in adult women who have monthly flare-ups and when standard therapeutic options are unsuccessful or inappropriate. This review summarizes the latest information on hormonal therapies including: combined oral contraceptives; anti-androgens, such as cyproterone acetate, spironolactone and flutamide; low-dose glucocorticoids and gonadotropin-releasing hormone agonists. It also shares the authors' recommendations for treatment based on the studies discussed here, and personal experience.

Diagnosis of genital inflammatory disorders may be difficult for several reasons, such as their similar appearance, possible misdiagnosis with infectious and malignant conditions, and peculiar anatomic conditions that may lead to modification of clinical features. Dermoscopy could be included as a part of the clinical inspection of genital diseases to support diagnosis, as well as to ideally avoid unnecessary invasive investigation. Practical guidance for the use of dermoscopy in the assessment of the main inflammatory genital diseases is provided, namely for lichen sclerosus, lichen planus, psoriasis, lichen simplex chronicus, and plasma cell mucositis.

The efficacy and safety of acitretin was evaluated retrospectively in a cohort of 46 patients with moderate to severe plaque psoriasis (Psoriasis Area and Severity Index (PASI) range 10-42). Patients were treated at an initial dose of 10 mg/day acitretin, which was then gradually increased until the best therapeutic effect with the fewest adverse effects was reached (< 50 mg/day) and later decreased and maintained at the lowest effective dosage. Efficacy measures were: (i) PASI75 (75% improvement) and PASI50 between 10 and 16 weeks; and (ii) PASI75 even after 16 weeks of treatment. At weeks 10-16, PASI75 and PASI50 were achieved by 47.8% and 87% of the patients, respectively. Overall, 67.3% reached PASI75. Adverse events occurred in 18 patients (39.1%); among these, 4 (8.7%) discontinued acitretin. Our findings suggest that acitretin at an initial low, gradually escalating dose, and subsequently maintained at the minimal effective dose, is a suitable treatment option for plaque psoriasis as it provides clear-cut improvement in most treated patients while minimizing the risks of side-effects.

To assess the effectiveness, tolerability, and convenience of the cream formulation of mometasone furoate 0.1% (MMF) in the treatment of active vulvar lichen sclerosus (VLS) and to compare the cream with the ointment formulation.The following efficacy parameters were assessed in 27 VLS patients treated with MMF cream for 12 weeks (group A): (i) response rate, (ii) percentage of patients achieving an improvement from baseline of ≥75% in subjective and objective scores, and (iii) mean reduction in subjective and objective scores. These efficacy assessments, as well as those regarding safety and adherence, were compared with the assessments recorded among 37 VLS patients treated with MMF ointment (group B).59.3% (group A) and 78.4% (group B) of patients were considered responders; 44.4% and 40.7% of patients in group A and 54.1% and 45.9% in group B achieved an improvement of at least 75% in subjective and objective scores, respectively. MMF ointment obtained a significantly higher improvement in symptom scores in comparison with the cream formulation.MMF in ointment formulation seems to be more effective in treating active VLS in comparison with MMF cream. Both formulations are well tolerated and there is no difference in patient adherence and satisfaction.

Background Evidence on the treatment of plasma cell vulvitis (PCV) is scarce and comparative studies are lacking. Objective To assess and compare the effectiveness and safety, on a long-term basis, of three topical interventions for the treatment of PCV. Methods Retrospectively collected efficacy and safety data of a cohort of PCV patients treated with fusidic acid 2% and betamethasone valerate 0.1% cream fixed combination (FA/BM, 14 patients), clobetasol propionate 0.05% ointment (CP, six patients) and tacrolimus 0.1% ointment (TC, four patients) at different regimens between January 2000 and June 2013 were analysed. Treatment outcome was assessed according to Investigator Global Assessment (i) symptoms and (ii) signs, at 12, 24 and 52 weeks. Results After 12 weeks, 85% of all patients achieved satisfactory improvement in PCV-related symptoms and maintained the improvement across a 52-week observation period. About 45% achieved a satisfactory result in clinical signs after 12 weeks, without further improvement during the following 9 months. No statistical differences in response were found among treatment groups at 12, 24 and 52 weeks. All study treatments were significantly more effective in improving PCV symptoms rather than clinical signs. With regard to treatment tolerability, one patient (7.1%) in FA/BM group and one (25%) in TC group discontinued the treatment due to local side-effects. Conclusions CP, FA/BM and TC are effective and safe in treating PCV, inducing both a rapid improvement of the disease, notably of symptoms, and stabilizing its control.

Hidradenitis suppurativa–acne inversa (HS-AI) is a chronic inflammatory skin condition that involves the folliculopilosebaceous units. Histopathological studies have suggested that the occlusion of the follicular infundibulum and both innate and adaptive immunity play central roles.1,2 Limited data regarding the clinical aspects and prognosis of HS-AI are available. Patients affected by HS-AI may benefit from early dietary interventions aimed at the metabolic comorbidities that may predispose the patient to HS-AI, reducing weight as a secondary benefit. The rationalization of preventive and therapeutic approaches among centres may help to harmonize the clinical management of HS-AI internationally, with a lasting benefit to patients.

Summary 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.

Glycaemic index (GI) and glycaemic load (GL) are indicators of dietary carbohydrate quantity and quality and have been associated with increased risk of certain cancers and type 2 diabetes. Insulin resistance has been associated with increased melanoma risk. However, GI and GL have not been investigated for melanoma. We present the first study to examine the possible association of GI and GL with melanoma risk. We carried out a population-based, case–control study involving 380 incident cases of cutaneous melanoma and 719 age- and sex-matched controls in a northern Italian region. Dietary GI and GL were computed for each subject using data from a self-administered, semi-quantitative food frequency questionnaire. We computed the odds ratio (OR) for melanoma according to quintiles of distribution of GL and GL among controls. A direct association between melanoma risk and GL emerged in females (OR 2·38; 95 % CI 1·25, 4·52 for the highest v. the lowest quintile of GL score, Pfor trend 0·070) but not in males. The association in females persisted in the multivariable analysis after adjusting for several potential confounders. There was no evidence of an association between GI and melanoma risk. GL might be associated with melanoma risk in females.

Abstrract Purpose: To assess efficacy and safety profile of combining a potent corticosteroid with a retinoid in the treatment of vulvar lichen sclerosus (VLS).We retrospectively compared 21 VLS patients treated with tretinoin (T) in short-contact therapy and mometasone furoate (MMF) (group A) and 20 treated with cold cream (CC) and MMF (group B) for 5 consecutive days/week for 12 weeks. The efficacy parameters were the response rate, the percentage of patients achieving an improvement from baseline of ≥75% in subjective and objective scores and the mean reduction in subjective and objective scores.Thirteen patients (75.2%) were considered as responders in group A and 15 (78.9%) in group B; 50% and 61.1% of patients in group A and 100% and 63.1% in group B achieved an improvement of at least 75% in subjective and objective scores, respectively. The scheme combining MMF and CC was better tolerated than the combination of MMF and T.The combination with a topical retinoid did not enhance the effectiveness of a potent corticosteroid in the treatment of VLS. Either the scarce efficacy of the short-contact therapy regimen or a less favorable safety profile of such combination may account for these findings.

A case of rapidly relapsing pyoderma gangrenosum (PG) of the left preauricular area with no undermined borders is described. This might be considered a case of malignant pyoderma (PM), a rare variety of PG. Five months after complete healing obtained with systemic corticosteroids, the preauricular lesion of PG relapsed. As retreatment with oral methylprednisolone induced glucose intolerance and high arterial pressure, sulfa drugs were initially employed with a transitory recovery of the skin lesion. A successive prolonged course with minocycline induced a new complete resolution. To date, at six months' follow-up, the patient is relapse-free. This case confirms that sulfa drugs and minocycline may also be considered alternative therapies in PM. PM is a variety of PG characterized by specific morphological features, a higher tendency to relapse, and poor responsiveness to treatment.

Background: The correct therapeutic management of acne should include a maintenance therapy with topical retinoids to prevent recurrences after discontinuing a successful treatment. Objective: To investigate the efficacy of a 12-month maintenance treatment with adapalene 0.1% and benzoyl peroxide (BPO) 2.5% fixed combination gel to control acne relapse after treatment with oral isotretinoin (OI). Methods: The study consisted of 2 phases, namely an active treatment phase (AP) and a maintenance phase (MP). In the AP, 70 consecutive patients with moderate to severe acne were treated with OI until acne remission. Then, patients entered the MP and were treated with adapalene-BPO fixed combination once daily for 12 months. The primary efficacy parameter was the relapse rate during MP. Results: Sixty-eight patients completed the study. Relapse occurred in 2 patients (2.94%). Conclusions: Comparing our findings with published data, the association of a topical retinoid and BPO seems to provide favorable evidence for this combination as maintenance therapy.

Rosacea fulminans, previously called pyoderma faciale, is an inflammatory disease considered a dramatic form of rosacea rather than of acne. Typical features are: exclusive facial involvement of young women, sudden onset of large nodules without other signs of acne, remission without scarring or with minimal scars, no recurrences or systemic symptoms. Oral isotretinoin associated with a short course of systemic and topical corticosteroids represent the recommended treatment. Personal observation of 5 cases has induced us to make a review of worldwide literature in order to better define this clinical entity. In our opinion, rosacea fulminans is a valid diagnosis, but clinical criteria should be rigorously respected to fully exclude rosacea conglobata and acne fulminans.

Background Acne vulgaris is a common disease of the pilosebaceous unit. The aim of the study was to evaluate compartment-specific treatment action through the microscopic non-invasive imaging of skin changes. Methods Mild-moderate acne patients, that were prescribed a topical anti-acne product, were followed by clinical and reflectance confocal microscopy (RCM) imaging every 14 days to 6 weeks. Mean and standard deviation of the scores were analyzed for each time point. Results After 2 weeks, the RCM count of papules/pustules and the RCM scores of exocytosis and dermal inflammation, decreased substantially. After 4 weeks, the RCM number of comedos was reduced. After 6 weeks, the number of regular follicles increased, while the infundibula with thickened bright border decreased significantly. Conclusion The progressive reduction in the clinical scores was correlated with the improvement of the RCM parameters. RCM study of acne skin showed a different timing for inflammatory and hyperkeratotic components to achieve a significant reduction during topical therapy with the association of retinoid and antibacterial molecules. The microscopic changes observed showed the regularization of the skin and the improvement of acne related features. RCM may represent a useful tool for the objective assessment of treatment efficacy and individual response evaluation.

Background A correct therapeutic management of acne should include a maintenance therapy to prevent recurrences after discontinuing a successful treatment. The aim of this study is to investigate efficacy and safety of a 12-month maintenance treatment with a product, based on Retinsphere technology that combines retinol encapsulated in glycospheres and hydroxypinacolone retinoate (Biretix gel®), to control acne relapse after a treatment with oral isotretinoin (O.I.). Methods The study consisted of 2 phases: active treatment phase (AP) and maintenance phase (MP). In the AP, 40 consecutive patients with moderate facial acne were treated with O.I. until acne remission. Then, the patients entered in the MP and were treated with Biretix gel® once-daily for 12 months. The efficacy parameter was the relapse rate during MP. Results Thirty-nine patients completed the study. Relapse appeared in 6 patients (15.38%). The new product with Retinsphere technology was well tolerated and none of the subjects complained of adverse events. Conclusions Our findings seems to provide favorable evidence of the efficacy and the safety of this new product in the maintenance treatment after O.I. in patient with moderate acne. The efficacy is maintain for a period as long as a year after O.I. suspension.

Background The factors that impact quality of life in acne patient are not fully understood. Objective The purpose of this study was to assess the relationship between quality of life with (i) acne severity; (ii) the duration of this cutaneous disease; and (iii) the gender. Methods Leeds scale to quantify acne severity, and Assessment of the Psychological and Social Effects of Acne (APSEA) score to evaluate quality of life were used. An unselected consecutive group of 50 males and 50 females affected by facial acne filled in the APSEA questionnaire during the first visit and after 3 months of treatment. Results (i) At the beginning of the treatment, APSEA score correlated with acne severity, but at the end of it, the reduction of APSEA score was less marked than the reduction of acne severity. (ii) Acne duration does not significantly influence APSEA score. (iii) Before treatment, acne severity was comparable between females and males, whereas APSEA score was significantly higher in females than in males. Conclusion The quality life of acne patients could be influenced by social and emotional factors. The discrepancy of the results reported in literature regarding the correlation of the quality of life with acne severity and duration probably depends on the sensitivity and specificity of the questionnaire used to assess the quality of life. Among the different available scores to measure quality of life in acne patients, in the authors’ experience, APSEA score is a valuable one.

Background Although long-term cyclosporine administration may induce toxic effects, it may be the only option for the treatment of severe psoriasis. The objective of the present study was to retrospectively evaluate efficacy and safety of long-term cyclosporine treatment in a cohort of patients affected with moderate to severe psoriasis, recalcitrant or unresponsive to other treatments. Possible risk factors predicting an intolerance to cyclosporine were also investigated. Materials and methods Data were collected on psoriatic patients treated with cyclosporine for at least six months at our Psoriasis Outpatient Unit between January 2005 and September 2010. The primary measure for clinical efficacy was the PASI 75 response. Cyclosporine safety was assessed through the review of both laboratory tests and the adverse events registered during the treatment. Results Twenty patients affected with plaque or erythrodermic psoriasis were evaluated. At Week 16, the PASI 75 response was achieved by 85% of patients. Adverse events occurred in eight patients (40%): four experienced an increase in serum creatinine levels to more than 30% of their pre-treatment values and four developed hypertension. Among these patients, five discontinued cyclosporine. Side effects resolved after stopping treatment. Conclusions Our findings suggest that long-term cyclosporine regimen can be justified in severe psoriasis not responsive to other treatments. When cyclosporine administration is required, obesity, pre-treatment controlled hypertension, increased age (>70 years), and metabolic syndrome should be taken into consideration, as a significant correlation with occurrence of cyclosporine-induced side effects has been found.

Vulvar lichen sclerosus (VLS) is a chronic inflammatory disease with a huge impact on a person's quality of life. On the basis of the immunologic changes in VLS, treatment with a high potency topical corticosteroid is recommended. The currently available guidelines identified the ultra-potent corticosteroid clobetasol propionate 0.05% (CP) as the first-line recommended treatment but growing evidence supports the use of the potent corticosteroid mometasone furoate 0.1% (MMF). We reviewed the available studies assessing MMF in the treatment of VLS. Both non comparative and comparative studies were included in this review. Findings from clinical trials indicate that MMF is an effective and safe option in the treatment of VLS both in the active phase and in long-term maintenance treatment. Consistent with the findings from the comparative studies, MMF shows similar efficacy and safety to CP.

BACKGROUND: Few studies have addressed the frequency and the consequences of the appropriateness of referrals for patch testing. OBJECTIVES: To analyse the appropriateness of referrals for patch testing among patients seen in the Allergy Unit, University of Ferrara, and to evaluate whether this selection influences the results of the test. PATIENTS AND METHODS: One thousand six hundred and twenty-seven consecutive patients were enrolled, and 1528 patients were patch tested. On the basis of the history and clinical picture, the appropriateness of referrals for patch testing was judged. RESULTS: Of the patients, 82.30% attended the Allergy Unit with a clinical presentation and/or history considered to be an appropriate indication for patch testing. The rate of appropriate referrals for patch testing from dermatologists was significantly higher (p < 0.001) than that for referrals from other physicians. The sensitization rate was significantly higher among the appropriate referrals than among the inappropriate ones, both in the entire sample (p < 0.001) and in atopic patients (p = 0.012). CONCLUSIONS: Clinical experience was seen to be crucial for the appropriate selection of patients. Furthermore, appropriate referral for patch testing was shown to influence the sensitization rate.

Background Aimed at the reduction of post-treatment relapse of severe acne, the cumulative dose of oral isotretinoin should be ≥120 mg/kg. However, data on the appropriate oral isotretinoin treatment regimen in mild and moderate acne are lacking. Objective The purpose of this study was to determine the efficacy of an isotretinoin-sparing protocol in inducing permanent remission of mild and moderate acne. Methods In this open, prospective, non-comparative study, 150 patients affected with mild-to-moderate acne were treated with isotretinoin until complete recovery and for a further month of treatment, independent of the total cumulative dose reached. Patients then underwent a 1-year maintenance therapy with adapalene 0.1% cream. Patients were followed up for a further year, without any treatment. Results A total of 139 patients completed the study. Overall, patients received a mean of 80.92 mg/kg cumulative dose of isotretinoin. In the 2-year follow-up, relapse only appeared in 13 patients (9.35%). Conclusion Comparing our findings with published data, this isotretinoin-sparing regimen was shown to be effective in inducing stable remission and preventing acne relapses in patients with mild-to-moderate acne. Low-cumulative dose regimens may potentially lead to a lower incidence of side-effects and to lower costs than higher doses.

Resume Les traitements topiques et systemiques de l’acne bien connus des dermatologues ont peu evolue au cours des 10 dernieres annees. Cependant, de nombreuses pistes therapeutiques sont en cours d’evaluation aussi bien sur le plan des traitements topiques que systemiques. L’objet de cet article est de faire decouvrir l’etat d’avancement des projets therapeutiques novateurs dans le traitement de l’acne. Sur le plan topique, l’utilisation de nouvelles galeniques contenant des nanoparticules lipidiques ou des microspheres pourrait permettre d’evaluer de nouveaux produits a base d’anti-androgenes ou de retinoides plus fortement concentres et mieux toleres. De nouveaux agents actifs topiques comme les peptides anti-bacteriens, les inhibiteurs des ectopeptidases, l’omiganan pentahydrochloryde, les oligonucleotides antisens, l’acide laurique sont autant de pistes a explorer pour le traitement de l’acne. Sur le plan systemique de nouveaux schemas therapeutiques pour les doxycyclines et l’isotretinoine permettraient d’augmenter la tolerance. La dapsone dans les formes resistantes a l’isotretinoine a ete evaluee. La phototherapie a bande etroite en lumiere bleue ou rouge peut trouver sa place dans la strategie de la prise en charge de l’acne. Des vaccins sont egalement en cours d’etude.

The correct choice of cosmetic products and cleansers is very important to improve skin hydration, to provide moisturizing benefits and to minimize cutaneous damage caused by surfactants. In fact, surfactants may damage protein structures and solubilize lipids. Soaps, defined as the alkali salts of fatty acids, are the oldest surfactants and are quite aggressive. Syndets (synthetic detergents) vary in composition and surfactant types (anionic, cationic, amphotheric, non-ionic). These new skin cleansing products also contain preservatives, fragrances, and sometimes emollients, humectants and skin nutrients. We present a revision of the literature and discuss recent findings regarding skin cleansers.

Summary: The antifungal activity of chlorpromazine, an antispychotic phenothiazine, was evaluated in vitro in Candida albicans blastospores and Trichophyton mentagrophytes hyphae. The minimal inhibitory concentrations (MIC) were 40 μg/ml for the yeast and 20 μg/ml for the dermatophyte. The most striking ultrastructural changes following treatment with the MIC consisted in the deterioration of organelles membranes, disorganization of cytoplasmic structures and autolysis. It seems plausible that the fungal toxicity of chlorpromazine depends on its direct interaction with the membranes. Zusammenfassung Die antifungale Aktivitat von Chlorpromazin, einem antipsychotischen Phenothiazin, wurde in vitro an Candida albicans-Blastosporen und an Hyphen von Trichophyton mentagrophytes untersucht. Die minimale Hemmkonzentration (MHK) betrug 40 μg/ml fur die Hefe und 20 μg/ml fur den Dermatophyten. Die eindrucksvollen Ultrastrukturveranderungen durch die Behandlung mit der MHK bestanden in der Entartung der Organellenmembranen, im Abbau der cytoplasmatischen Strukturen und in Autolyse. Die Annahme, das die Toxizitat des Chlorpromazins auf seiner direkten Einwirkung auf die Membranen beruht, erscheint plausibel.

Human leukocyte antigen (HLA)-G is a non-classical HLA class I molecule that exerts a generalized immunosuppressive action. A deficit in membrane bound and soluble HLA-G levels seems to cause a defective control on immune responses and trigger off several autoimmune diseases. As psoriasis is considered an autoimmune disease, lower levels of soluble HLA-G (sHLA-G) might be expected in psoriatic patients than in healthy controls. The aims of this descriptive study were: (1) to evaluate whether sHLA-G levels are different in psoriatic patients compared to controls; (2) to compare sHLA-G levels between groups of patients treated with different therapies; (3) to evaluate whether any differences found in HLA-G expression could be related to a genetic control. Peripheral blood samples were investigated for sHLA-G and IL-10 levels and for HLA-G 14 bp polymorphism in 65 patients with moderate-to-severe plaque psoriasis treated with systemic drugs or with topical or physical treatments and in controls. Significantly lower plasma levels of both sHLA-G and IL-10 were found in psoriatic group compared to controls and in local treated patients in comparison with systemic treated patients. These findings could indicate that low sHLA-G levels may contribute to susceptibility to psoriasis. Absence of differences in HLA-G 14 bp allele and genotype frequencies between psoriatic patients and controls and between patients following different treatments seems to exclude genetic bases of sHLA-G levels. It could be speculated that therapeutics antagonizing systemic T helper 1 activation may induce sHLA-G secretion via an IL-10-dependent pathway.

Human herpesvirus 8 (HHV8) has been hypothesized to be a potential cofactor for the development of diverse cutaneous vascular proliferative lesions, including eruptive cherry angiomas. Recent reports evidenced the influence of killer cell immunoglobulin-like receptor (KIR) gene diversity in defining the susceptibility to symptomatic herpesvirus infections. In this study, skin samples from vascular lesions and healthy controls were characterized simultaneously for the presence of HHV8 and for the KIR genotype, focusing upon the presence of the KIR2DL2/DS2 and KIR2DL3 genes, which have been associated to herpesvirus susceptibility. The results showed that about 64 % of the vascular lesions resulted positive for the presence of HHV8, whereas no control healthy skin samples harbored HHV8 DNA. HHV8-positive patients had a significantly increased frequency of KIR2DL2/DS2 homozigosity and a concomitant decrease of the homozygous KIR2DL3 genotype, compared to healthy controls or HHV8-negative patients. Notably, the simultaneous presence of KIR2DL2/DS2 homozygosity and HHV8 infection resulted in a significantly increased risk to develop cutaneous lesions (OR 5.7) compared to the individual factors alone, suggesting that specific KIR genotypes might predispose to HHV8 symptomatic infection, allowing the virus to exert its angioproliferative activity at skin level.

Objective: Dermoscopic features of vulvar lichen sclerosus (VLS) were investigated in order to determine both vascular and non-vascular features of this disease. Materials and Methods: Dermoscopic images of 35 patients affected with histopathologically confirmed VLS were evaluated for the presence of predefined morphological criteria. Results: On dermoscopy, VLS lesions exhibited very sparse vessels, mainly linear, without a specific arrangement. Dotted vessels were observed mostly in the early stage of the disease. Patchy, structureless areas, whitish to white-yellowish to pink-whitish in colour over a diffuse whitish background, were a distinctive and constant dermoscopic feature. Grey-blue dots, usually with a characteristic peppered arrangement, corresponding to dermal melanophages, were also frequently seen. Comedo-like openings and scales were observed, as well as peculiar structures like ice slivers, not identified by histological examination. Conclusion: Our findings show that VLS exhibits characteristic dermoscopic patterns that can aid in its clinical diagnosis.