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Giuseppe Argenziano,1,* Paolo Amerio,2 Maria Grazia Aragone,3 Ginevra Baggini,4 Manuela Baldari,5 Gianpiero Castelli,6 Simmaco Coppola,7 Antonio Costanzo,8,9 Rocco De Pasquale,10 Maria Concetta Fargnoli,11 Caterina Foti,12 Claudia Giofrè,13 Serena Lembo,14 Claudia Leporati,15,16 Francesco Loconsole,17 Giovanna Malara,18 Ketty Peris,19,20 Antonio Giovanni Richetta,21 Paola Savoia,22 Rossana Tiberio,23 Massimo Travaglini,24 Maria Teresa Uzzauto,25 Luca Bianchi26,* 1Dermatology Unit, University of Campania, Naples, Italy; 2Department of Medicine and Aging Science and Dermatologic Clinic, University “G. d’Annunzio”, Chieti-Pescara, Chieti, Italy; 3ASL AL, Alessandria, Italy; 4Osp. Civile di Varzi, Pavia, Italy; 5ASL4 Liguria, Genova, Italy; 6UOSD of Dermatology, Ospedale Umberto I°, Siracusa, Italy; 7IQVIA, Rome, Italy; 8Department of Biomedical Sciences, Humanitas University, Milano, Italy; 9Skin Pathology Laboratory, Humanitas Research Hospital IRCCS, Milano, Italy; 10UOC Dermatologia, AOU Policlinico “G. Rodolico – San Marco”, Catania, Italy; 11Dermatology, Department of Biotechnological and Applied Clinical Sciences, University of L’Aquila, L’Aquila, Italy; 12Department of Biomedical Science and Human Oncology, Dermatological Clinic, University of Bari, Bari, Italy; 13U.O.C. Dermatologia, A.O. Papardo, Messina, Italy; 14Dipartimento di Medicina, Chirurgia e Odontoiatria Scuola Medica Salernitana, University of Salerno, Fisciano, Italy; 15Dermatology Unit, ASL AL Casale Monferrato, Alessandria, Italy; 16Dermatology Unit, ASL TO4 Ivrea, Torino, Italy; 17Department of Dermatology, University of Bari, Bari, Italy; 18UOC of Dermatology, Grande Ospedale Metropolitano “BMM”, Reggio Calabria, Italy; 19Institute of Dermatology, Catholic University, Rome, Italy; 20Dermatology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; 21Dipartimento di Scienze Cliniche Internistiche e Cardiovascolari Policlinico Umberto I University of Rome “La Sapienza”, Rome, Italy; 22Department of Health Science, Università del Piemonte Orientale, Novara, Italy; 23SCDU Dermatologia, AOU Maggiore della Carità, Novara, Italy; 24U.O.S.D. dermatologica - centro per la cura della psoriasi, Ospedale Perrino, Brindisi, Italy; 25U.O.C. Dermatologia, ASL Salerno, Ospedale “A:Tortora”-Pagani, Salerno, Italy; 26Dermatology Unit, Tor Vergata University Hospital, Rome, Italy*These authors contributed equally to this workCorrespondence: Giuseppe ArgenzianoDermatology Unit, University of Campania “Luigi Vanvitelli”, Via Pansini, 5, Naples, 80131, ItalyTel +39335415093Fax +39 069 762 5822Email g.argenziano@gmail.comLuca BianchiUniversity of Rome “Tor Vergata”, Policlinico Tor Vergata, Viale Oxford 81, Rome, 00133, ItalyTel +39 0620902739Fax +39 0620902742Email luca.bianchi@uniroma2.itPurpose: For patients with psoriasis, treatment adherence and persistence are fundamental if therapeutic goals are to be met. Patient Support Programs (PSPs) may be used as a support tool to assist patients and health care professionals optimize treatment and improve disease management.Patients and Methods: In Italy, the PSP PSOLife CARE, which began on the 9th of February 2017 and is ongoing, aimed to support patients with psoriasis under therapy with secukinumab (Cosentyx®). A team of medical professionals including Dermatologists, Psychologists, Nutritionists, and field Nurses provided outpatient treatment as well as remote support via phone calls. Patients had a standard duration in the Program of 6 months. This report analyzes the data of patients who benefited from the Program from February 2017 to August 2020, for a total observation of 42 months.Results: We provide here a descriptive report on the benefits of participation in the PSOLife CARE Program for patients with psoriasis and medical professionals involved in their care. Throughout their time in the PSOLife CARE Program, patient satisfaction remained consistently high with sustained improvements observed in all aspects of quality of life (ie emotional, social, physical, and economic). Despite exiting from the Program, most patients continued to adhere to secukinumab. Medical professionals also reported positive outcomes on their interactions with patients, with more than half of those surveyed rating the overall quality of the Program as “Outstanding”.Conclusion: By supporting treatment adherence, the PSOLife CARE Program may have empowered patients to better manage their psoriasis, increasing their satisfaction with treatment and quality of life.Keywords: dermatology, PSOLife CARE Program, quality of life, treatment adherence

We investigated, in patients tested between 1991 and 2004, the patterns of mutually exclusive human immunodeficiency virus-1 thymidine-analogue mutations (TAMs) in 4039 reverse-transcriptase sequences with >/=1 TAM. TAM pattern 1, which included M41L and L210W and excluded K70R and is coupled with more-extensive cross-resistance to drugs, became the most frequent pattern after 1996. In 1465 genotypes from 684 patients in whom highly active antiretroviral therapy (HAART) was unsuccessful, predictors of this pattern were the number of previous HAART regimens undergone (adjusted odds ratio [OR], 1.09 [95% confidence interval {CI}, 1.02-1.16]), use of stavudine/lamivudine (adjusted OR, 1.42 [95% CI, 1.05-1.99]), use of nevirapine (adjusted OR, 1.60 [95% CI, 1.14-2.24]), use of efavirenz (adjusted OR, 1.56 [95% CI, 1.08-2.27]), and use of ritonavir (adjusted OR, 1.35 [95% CI, 1.04-1.75]). Copyright © 2006 Infectious Diseases Society of America [ABSTRACT FROM AUTHOR]

Aim: To analyze the prevalence of anxiety and depression in a large cohort of adults with autoimmune diabetes, identifying sex-driven associated factors., Materials and Methods: In this cross-sectional study, we enrolled 553 consecutive adults with Type 1 diabetes mellitus or latent autoimmune diabetes in adults who came to the Division of Endocrinology of the S.Orsola-Malpighi Polyclinic, Bologna (Italy), to receive their second dose of SARS-CoV-2 vaccine. We administered the questionnaires: Hospital Anxiety and Depression Scale, Diabetes Distress Scale, Diabetes-related Quality of Life, Diabetes Treatment Satisfaction Questionnaire. We collected clinical and biochemical data and 14 days glucose metrics in patients with sensor use > 70% in a time span of ± 4 months from the questionnaires' administration. We excluded 119 patients from our analyses with missing data (final cohort n = 434: 79% of those enrolled)., Results: Anxiety and depression prevalence was respectively 30.4% and 10.8%. According to the multivariate analysis, higher diabete-related emotional burden, lower treatment satisfaction, but not physician-related distress, were risk factors for anxiety and depression; female sex was associated with anxiety (OR 0.51, 95% 0.31-0.81; p = 0.005); in women, depression was associated with increasing age (males vs. females OR 0.96 per 1 year increase, 95% CI 0.92-1.00; p = 0.036), whilst in men with HbA1c (OR 1.08 per 1 mmol/mol increase, 95% CI 1.03-1.13; p = 0.002)., Conclusion: Nearly 1/3 of patients with autoimmune diabetes suffers from anxiety and 1/10 from depression. These conditions are associated with independent modifiable and non-modifiable characteristics. For depression, these characteristics differ between males and females., (© 2024. The Author(s).)

Background: Trypanophobia or "needle phobia" represents a potential hindrance to the effective management of chronic diseases whenever an injectable therapy might be required, especially in case of frequent administrations. Psoriasis, a chronic dermatologic disease, can be effectively treated with biologic drugs administered subcutaneously. Thankfully, anti-IL-23 drugs require few administrations per year and are available in prefilled pens that hide the needle, thus representing a convenient option in patients with trypanophobia., Methods: An observational multicentric study was conducted on patients with moderate-to-severe psoriasis who were treated with 75 mg × 2 risankizumab prefilled syringe therapy for more than 6 months and reported a loss of efficacy measured by the Psoriasis Area and Severity Index (PASI) from PASI 90 to PASI 75 attributed to a reduction of adherence due to trypanophobia. The patients were switched to 1 prefilled pen of risankizumab 150 mg and asked to fill out the Self-Injection Assessment Questionnaire (SIAQ) before and after the injection at week 0 and at the following administration after 12 weeks. Subjects scored each item of the SIAQ on a 5-point scale, scores were later transformed from 0 (worst experience) to 10 (best experience)., Results: Twenty-two patients were enrolled. The mean SIAQ predose domain scores were 5.5 for feelings about injection, 6.2 for self-confidence, and 6.4 for satisfaction with self-injection. After dose scores were higher (> 8.5) for each of the six domains at Week 0 and even higher after 12 weeks (> 9.0)., Conclusions: User-friendly devices, such as prefilled pens, and a lower number of injections improved patient satisfaction in a group of patients with psoriasis on treatment with biologic drugs. We believe that treatment adherence could be positively influenced by such changes in the way of administration of a biologic treatment., (© 2024 The Author(s). Skin Research and Technology published by John Wiley & Sons Ltd.)

Aim: To analyze sleep quality and its relationships with clinical and biochemical features in a large cohort of adults with autoimmune diabetes., Methods: We administered to 553 patients with autoimmune diabetes the questionnaires: Pittsburgh Sleep Quality Index (PSQI), diabetes distress scale, diabetes-related quality of life and diabetes treatment satisfaction questionnaire. We excluded patients with missing HbA1c ± 4 months from PSQI administration or incorrect PSQI compilation (n = 110)., Results: Altered sleep quality was recorded in 142/443 subjects (32%), insufficient total sleep time in 177/443 (40%). The altered sleep quality group had higher HbA1c (median 56 mmol/mol [interquartile range-IQR 49-62] vs 59 [IQR 52-68]; P < 0.001), higher average HbA1c in the previous 36 months (59 mmol/mol [IQR 54-68] vs 56 [IQR 51-62]; P < 0.001), and more individuals with HbA1c > 53 mmol/mol (74.6% vs 62.8%; P = 0.014). Diabetes duration (P = 0.63), type of insulin delivery (P = 0.48) and glucose monitoring (P = 0.35) were uninfluential. Patients with altered sleep quality showed higher prevalence of autoimmune (42 vs 28%; P = 0.005) and mental diseases (12 vs 4%; P = 0.002); there were greater emotional distress, and lower quality of life and treatment satisfaction (P < 0.001 for all), irrespective of sex. Men with altered sleep quality had higher HbA1c and prevalence of autoimmune diseases. Women showed greater prevalence of psychiatric disorders. Average HbA1c of the previous 36 months, autoimmune or psychiatric disorders were independent predictive factors for altered sleep quality., Conclusion: One-third of the patients with autoimmune diabetes showed altered sleep quality, which associates with worse glycemic control, and autoimmune and mental disorders, with sex-specific differences., (© 2023. The Author(s).)

Background: Clinical performance measurements often employ outcome indicators to express the extent to which health services achieve a given clinical result., Objective: The objective of our study was to develop an outcome indicator of patch testing. We identified and measured as a possible indicator the ratio of patients with allergic and/or photo-allergic contact dermatitis clinically cured/improved as a result of identification of relevant allergens., Patients/methods: Patients with positive reactions considered relevant to their current dermatitis were interviewed by telephone 2 months after patch/photo-patch testing in order to assess their clinical outcome in relation to the recommended elimination of supposedly relevant allergens., Results: Over a 4-year period positive reactions were seen in 1397 out of 2857 tested patients. Relevance was considered current in 578 subjects, and 506 of them were interviewed. Remission/significant improvement following allergen(s) contact avoidance was reported by 431 patients, the outcome indicator (431/506) thus scoring 85.2%. Among the 75 patients who reported no improvement, 41 had not avoided contact with the offending substance(s), 17 had other persistent concomitant skin conditions, and 17 were unchanged despite elimination of the alleged relevant allergens., Conclusions: The ratio of relevantly patch-test-positive patients resolved/improved after allergen avoidance is a useful patch-testing outcome indicator.

Squamomelanocytic tumor is an uncommon cutaneous neoplasm composed of an admixture of melanocytic and squamous cellular phenotypes. We describe a case of this tumor in a 94-year-old man who presented with a nodule on the back. Histologically, a well-demarcated expansive dermal nodule was composed of anastomosing epithelial strands with focal formation of squamous pearls and ductal structures commixed with elongated spindle cells with clear cytoplasm grouped in nests. The two cell types were diffusely admixed or clustered in groups within the nodule. Immunohistochemical studies showed that the spindle cells grouped in nests expressed S-100 and HMB-45 antigens, and the squamoid cells expressed cytokeratins and carcinoembrionic antigen (CEA) protein only in the inner layer of the ducts and the cystic space. Atypical features and high mitotic activity was observed in the melanocytic cells but slight atypia, mild dyskeratosis and mitotic figures were observed also in the squamoid component. This tumor represents a proliferation of two phenotypic cells that are distinctive for their intimate admixture and singular immunohistochemical profile. The authors discuss the histogenesis of this tumor, suggesting that it could represent an atypical solid-cystic hidradenoma colonized by a melanocytic malignant component. The biological behavior of this neoplasm remains currently uncertain.

Aim: It is generally agreed that the management of allergic contact dermatitis (ACD) to cosmetic ingredients can be challenging for patients due to the complex names and synonyms of the responsible allergens, but what kind of problems patients actually have in finding safe alternative products has seldom if ever been investigated., Methods: To identify the major problems experienced by patients allergic to cosmetics, the authors studied 72 ACD patients with clinically relevant positive patch test and/or repeated open application test (ROAT) reactions from cosmetic allergens or from own cosmetic products as is. Two months after patch testing, they were called by phone, and underwent a semi-structured interview focused on the following questions: ''Is your dermatitis better?'', ''Did you find our explanations clear?'', ''Do you remember the name of the substance you are allergic to and which products contained it?'' ''Was it difficult to avoid exposure? If yes, why?'', ''How did you chose alternative products?''., Results: The interview revealed that 63 out of 72 patients were cured or much improved. Of the remaining 9 patients, 6 had not avoided exposure, 3 still suffered from other kinds of dermatitis, but ACD was no longer present. All patients declared themselves satisfied with the explanations received, but half of them could not precisely name the causative allergens/cosmetics and had had problems in finding safe products, especially when preservatives with difficult names were involved. Hypo-allergenic-products were often complained of as expensive. Twenty patients who had been prescribed specific allergens-free products by their dermatologists had overcome their problems more easily., Conclusion: Patients' education after patch testing is crucial to achieve quick and stable resolution of ACD from cosmetic products.

Background: Distinguishing chronic telogen effluvium (CTE) from androgenetic alopecia (AGA) may be difficult especially when associated in the same patient., Observations: One hundred consecutive patients with hair loss who were clinically diagnosed as having CTE, AGA, AGA + CTE, or remitting CTE. Patients washed their hair in the sink in a standardized way. All shed hairs were counted and divided "blindly" into 5 cm or longer, intermediate length (>3 to <5 cm), and 3 cm or shorter. The latter were considered telogen vellus hairs, and patients having at least 10% of them were classified as having AGA. We assumed that patients shedding 200 hairs or more had CTE. The kappa statistic revealed, however, that the best concordance between clinical and numerical diagnosis (kappa = 0.527) was obtained by setting the cutoff shedding value at 100 hairs or more. Of the 100 patients, 18 with 10% or more of hairs that were 3 cm or shorter and who shed fewer than 100 hairs were diagnosed as having AGA; 34 with fewer than 10% of hairs that were 3 cm or shorter and who shed at least 100 hairs were diagnosed as having CTE; 34 with 10% or more of hairs that were 3 cm or shorter and who shed at least 100 hairs were diagnosed as having AGA + CTE; and 14 with fewer than 10% of hairs that were 3 cm or shorter and who shed fewer than 100 hairs were diagnosed as having CTE in remission., Conclusion: This method is simple, noninvasive, and suitable for office evaluation.

Background: In August, 1997, a woman with no history of travel to malarious regions developed Plasmodium vivax malaria. She lived in a rural area of Italy where indigenous Anophyles labranchiae mosquitoes were present., Methods and Findings: An environmental investigation was done within a 3 km radius of the patient's house. Adult mosquitoes and larvae were collected and examined by PCR with the gene for plasmodium circumsporozoite protein as target. About 200 people living in the area were interviewed to detect possible carriers of P. vivax., Findings: None of the mosquitoes captured were carrying any malarial organisms. The house-to-house investigation identified a 7-year-old girl who had had a feverish illness a few days after her arrival in Italy from India, and who, 3 months later, still had P. vivax in her blood; she and her mother had antimalarial antibodies., Interpretation: These investigations suggest that the index case of malaria was caused by local anopheline mosquitoes infected with exogenous P. vivax.