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Background Antibiotic (AB) treatment is one of the first steps in the management of hidradenitis suppurativa (HS). Bacteria, in HS patients, may play a double role, as triggering factors of inflammatory reactions and/or agents of infection. Objectives The aims of this study are as follows: (i) to assess prevalence and AB resistance of bacterial growths in HS patients (ii) assessment of the clinical relevance of obtained data in guiding the selection of the most effective AB therapy. Methods Purulent material from 137 skin lesions of HS patients was collected with swabs. Bacterial flora and AB sensitivity were determined using microbiological cultures for aerobic and anaerobic bacteria. Results A total of 114 samples resulted positive for bacteria. Sample was collected from the axillae, groin and perianal areas. A total of 163 single bacterial growths were observed; 55% were Gram-positive and 44% were Gram-negative. Among them, 18.4% were anaerobic. The most frequent bacterial families included enterobacteriaceae (30.7%), Staphylococcus (25.2%) and Streptococcus (14.1%). The most frequent genus or species were proteus spp. (13.5%) and Escherichia coli (9.8%). The prevalence of AB resistance observed was clindamycin 65.7%, rifampicin 69.3%, penicillin 70.0%, ciprofloxacin 74%, tetracycline 84.7% and erythromycin 89.0%. A limitation of the study is represented the short culture period adopted which may have impaired the isolation of anaerobes. Conclusions Bacterial growth in HS patients has shown a high level of resistance to ABs, including rifampicin, clindamycin and tetracyclines, cited as an empiric choice in HS therapeutic guidelines. A targeted and specific AB therapy, driven by microbiological evaluations with prolonged culture periods, seems more appropriate than empiric, generic, non-specific, therapeutic approaches. Current knowledge regarding HS bacterial AB resistance should be considered in the update of current therapeutic guidelines for HS.

In part I we introduced the class $$\mathcal{E }_2$$ of Lie subgroups of $$Sp(2,\mathbb R )$$ and obtained a classification up to conjugation ( see Theorem 6 below). Here, we determine for which of these groups the restriction of the metaplectic representation gives rise to a reproducing formula. In all the positive cases we characterize the admissible vectors with a generalized Calderon equation. They include products of 1D-wavelets, directional wavelets, shearlets, and many new examples.

The shearlet representation has gained increasingly more prominence in recent years as a flexible and efficient mathematical framework for the analysis of anisotropic phenomena. This is achieved by combining traditional multiscale analysis with a superior ability to handle directional information. In this paper, we introduce a class of shearlet smoothness spaces which is derived from the theory of decomposition spaces recently developed by L. Borup and M. Nielsen. The introduction of these spaces is motivated by recent results in image processing showing the advantage of using smoothness spaces associated with directional multiscale representations for the design and performance analysis of improved image restoration algorithms. In particular, we examine the relationship of the shearlet smoothness spaces with respect to Besov spaces, curvelet-type decomposition spaces and shearlet coorbit spaces. With respect to the theory of shearlet coorbit space, the construction of shearlet smoothness spaces presented in this paper does not require the use of a group structure.

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.

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/aims: Glycolic acid has become a very popular cutaneous improving agent, but, despite its increasing employment, its biophysiological effects on the skin have not been adequately examined. Recently, we described subclinical skin damage induced by a 70% solution of glycolic acid applied on forearm skin by means of non-invasive measuring techniques. In the present study we instrumentally assessed the cutaneous effects induced by a glycolic acid minimal irritant dose on the volar aspect of the right forearm. Methods: Twenty subjects, seventeen women and three men, aged 16 to 56, were tested with 40 nl of a 70% solution of glycolic acid applied on one volar forearm area until a clincally evident cutaneous reaction occurred. Visual scoring, TEWL measurement, skin colour, capacitance and echographic recordings were performed before the beginning of the experiment and 30 min and 3, 24, 48 and 72 h after glycolic acid removal. The echo-graphic recordings were carried out using a 20 MHz B scanner (Dermascan C), and then were processed by dedicated software based on segmentation procedures. Two amplitude intervals were selected for the elaboration of the images, the first marking the hyporeflecting areas of the dermis, the second highlighting both the hyperreflecting parts of the epidermis and the lower dermis, separately. Results: Mean application-time before the appearance of minimal inflammatory skin reactions was 25±7 min. Clinical evaluation was confirmed by the analysis of the colorimetric parameter a*. TEWL and capacitance values showed a marked increase, reaching their maximum at 30 min after solution removal, followed by a progressive decrease. Values of both parameters were statistically significant for up to 48 h. The elaboration of echographic images by a low amplitude interval showed dermal edema more pronounced at 30 min and 24 h, while by highlighting hyperreflecting areas an evident reduction of the entry echo for up to 3 h and a prolonged decrease of the reflectivity of the lower dermis were observable. Conclusion: Our data demonstrate that despite the persistence of higher TEWL values, glycolic acid induced irritation causes a prolonged increase in capacitance that corresponds to modifications in epidermal reflectivity. Epidermal alterations are associated with dermal edema, as evaluated by ultrasound.

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.

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.

Background: In spite of sporadic data pointing at the role of textile dyes as important contact allergens, only few studies have addressed the issue of the frequency of sensitization to textile dyes in populations of consecutive patients. Objective: The purpose of this study was to evaluate the prevalence of sensitization to disperse dyes, to investigate cross reactivity between azo dyes and para-amino compounds, to describe azo-dye[ndash ]positive patients, and to study the correlation between clinical aspects and sensitization to different disperse dyes. Methods: From January 1996 to December 2000, 6,478 consecutive patients were tested with 7 textile dyes: Disperse Blue 124, Disperse Blue 106, Disperse Red 1, Disperse Yellow 3, Disperse Orange 3 (DO3), para-aminoazobenzene (PAAB), and para-dimethylaminoazobenzene (PDAAB). Results: Of the above, 437 patients were allergic. The most common sensitizers were Disperse Blue (DB) dyes and Disperse Orange 3. Both the clinical aspect and the localization of the lesions were unusual in a fair percentage of cases, especially in DB-positive subjects. Involvement of skin folds was observed in 27% of disperse dye[ndash ]positive patients, mainly comprising DB-sensitive women. Cross-reactivity between azo-dyes and paraphenylenediamine (PPD) was frequent in DO3-, PAAB-, and PDAAB-positive subjects, but not in DB-allergic ones. Moreover, cross reactions between DB106 and DB124 were observed in 59% of DB106- and/or DB124-positive patients. Conclusions: The frequency of disperse dye allergy is higher than generally estimated. Further studies, using routine diagnostic testing with disperse dyes, are needed to investigate whether this increasing trend is present outside of Europe.

The aim of this study was to evaluate disperse dye sensitization in patients with hand dermatitis. From January 1996 to December 2000, we identified 130 patients with hand dermatitis reacting to one of the 7 dyes included in our standard series. In 82 subjects the dermatitis was localized to the hands alone, whereas 48 patients had lesions both on the hands and on other skin sites. Disperse Blue dyes, and Disperse Orange 3 were the most common sensitizers. Among the 13 subjects allergic to disperse dyes alone, we found 3 cases of occupational allergic contact dermatitis, 1 child with atopic dermatitis worsening after the use of synthetic fibre garments, 4 subjects affected by clothing dermatitis, and 5 individuals occupationally exposed to irritants with a dermatitis involving the hands alone. In the latter, the hands may represent a 'locus minoris resistentiae', and both induction and elicitation of contact sensitization could be caused by impaired barrier function at a skin site repeatedly exposed to sensitizing garments.

Combined sensitizations to different azo dyes, probably based both on true cross-sensitization and on simultaneous positive reactions, have frequently been described. However, since azo dyes are included in the standard series in a minority of countries, the case studies considered comprise, with few exceptions, a small number of subjects. The aim of our study was to investigate cross-reactions between different azo dyes and para-amino compounds in azo-dye-sensitive subjects, to study the clinical aspects of azo dye dermatitis, to assess the relevance of sensitization to azo dyes, and to relate the pattern of cross-sensitizations to the chemical structure of the different dyes. Out of 6203 consecutively tested patients, 236 were sensitized to at least 1 of 6 azo compounds employed as textile dyes, included in our standard series. 107 subjects reacted to Disperse Orange 3 (DO3), 104 to Disperse Blue 124 (DB124), 76 to p-aminoazobenzene (PAB), 67 to Disperse Red 1 (DR1), 42 to Disperse Yellow 3 (DY3), and 31 to p-dimethylaminoazobenzene (PDAAB). Co-sensitizations to para-phenylenediamine were present in most subjects sensitized to DO3 (66%) and PAAB (75%), in 27% and 36% of DR1 and DY3-sensitive subjects, and only in 16% of subjects sensitized to DB124. Apart from the hands and the face, the neck and the axillae were the most frequently involved skin sites. Whereas the involvement of flexural areas was mainly connected with sensitization to DB124, in patients with hand dermatitis and in those working as hairdressers, sensitization to DO3 and PAAB was more frequent. Moreover, in the former patient group, a history of textile dye allergy was most frequently obtained. Out of 33 patients tested with an additional textile dye series, only 5 subjects reacted to anthraquinone dyes. Cross-sensitizations between azo dyes and para-amino compounds can partially be explained on the basis of structural affinities.

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.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.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.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.

Summary Well-known topical and systemic treatments for acne have advanced little over the last 10 years. However, many therapeutic approaches are being evaluated both in terms of topical and systemic treatments. The purpose of this paper is to show the progress of innovative drug projects in treating acne. The topical use of new formulations using lipid nanoparticles and microspheres could help for new products based on anti-androgens or retinoids more concentrated and better tolerated. New active agents such as topical antimicrobial peptides, inhibitors of ectopeptidase, omiganan pentahydrochloryde, antisense oligonucleotides, lauric acid are many original ways to explore for the treatment of acne. New treatment regimens for doxycycline and isotretinoin would increase tolerance. Dapsone has been evaluated for isotretinoin-resistant forms. Phototherapy narrowband light (blue or red) can find its place in the strategy for the management of acne. Finally, acne vaccines could be developped too

Background: Plasma cell vulvitis is a clinically and histologically well-characterized chronic disease that usually relapses after various topical therapies. Considering the inflammatory nature of the disease, the new topical calcineurin inhibitors have been also employed successfully in few cases of Zoon’s balanitis, the corresponding male condition. Objective: The aim of our study is to evaluate the effectiveness of tacrolimus ointment in a small group of plasma cell vulvitis sufferers. Methods: 4 women affected by biopsy-proved plasma cell vulvitis were enrolled, after informed consent. The topical drug was applied twice daily for 6 weeks, then tapered on the basis of the clinical results. Symptoms and objective parameters were obtained periodically at the beginning, after 6 weeks and up to the end of the topical treatment. A final biopsy was performed in 3 out of our 4 patients. The follow-up is still ongoing. Results: The comparative analysis of subjective, objective and histopathological data has shown discordant and less encouraging results than those reported for the corresponding male condition. Conclusion: At the moment, topical tacrolimus could be considered an alternative treatment for plasma cell vulvitis only in cases resistant to conventional therapies.

Lichen sclerosus is a chronic relapsing disease, usually treated with ultra-potent corticosteroids. As immunological alterations are considered important aetiopathogenetic factors in lichen sclerosus, the new immunomodulating topical agents, such as tacrolimus and pimecrolimus, have been employed sporadically as alternative therapies. The aim of this study was to evaluate the therapeutic effects of tacrolimus 0.1% ointment in lichen sclerosus in 11 patients unresponsive or poorly responsive to previous treatments. Tacrolimus 0.1% ointment was applied twice daily for 6 weeks, then tapered over a further 6 weeks. Symptoms and objective parameters were evaluated and quantified at the start, after 6 weeks, at the end of the topical treatment, and at follow-up visits. Improvement or remission of symptoms was observed in the patients who completed the study, while objective parameters were poorly influenced and often were not related to symptom behaviour. Topical tacrolimus can be considered an alternative treatment for lichen sclerosus.

Plasma cell vulvitis is a clinically and histologically well-characterized chronic disease that usually relapses after various topical therapies. Considering the inflammatory nature of the disease, the new topical calcineurin inhibitors have been also employed successfully in few cases of Zoon's balanitis, the corresponding male condition.The aim of our study is to evaluate the effectiveness of tacrolimus ointment in a small group of plasma cell vulvitis sufferers.4 women affected by biopsy-proved plasma cell vulvitis were enrolled, after informed consent. The topical drug was applied twice daily for 6 weeks, then tapered on the basis of the clinical results. Symptoms and objective parameters were obtained periodically at the beginning, after 6 weeks and up to the end of the topical treatment. A final biopsy was performed in 3 out of our 4 patients. The follow-up is still ongoing.The comparative analysis of subjective, objective and histopathological data has shown discordant and less encouraging results than those reported for the corresponding male condition.At the moment, topical tacrolimus could be considered an alternative treatment for plasma cell vulvitis only in cases resistant to conventional therapies.

Contact sensitization in children is frequent. However, because exposure to sensitizing agents varies rapidly, it is of utmost importance to perform a periodic evaluation of patch test results. Our purpose was to compare our data on contact sensitization in children during the past 7 years to our previous 1988-1994 findings, in order to identify emerging allergens and update our pediatric series. From 1995 to 2001, 1094 consecutive children were examined. Of these, 997 patients were patch tested with our pediatric series, which includes 30 allergens, whereas 97 underwent patch testing with 46 allergens. A total of 570 children proved allergic (52.1%). The highest sensitization rate was observed in children under 3 years of age. No differences between atopic dermatitis patients and nonatopic ones were observed in the sensitization rate. Neomycin, nickel, wool alcohols, thimerosal, and ammoniated mercury gave most of the positive responses. With respect to 1988-1995 data, allergy to substances such as neomycin, nickel, wool alcohols, thimerosal, ammoniated mercury, propolis, potassium dichromate, and thiuram mix proved more frequent. In conclusion, as sensitization rates to different allergens show great variations over time, periodic evaluations of patch test results in children is necessary in order to update the test trays.

Background: Food atopy patch tests (APTs) are considered a useful tool for the diagnosis of food allergy. Hypersensitivity to peanuts has not been investigated by means of APTs so far. Methods: APTs and skin prick tests (SPTs) with peanuts were performed in 136 atopic dermatitis (AD) patients. Relevance of positive and negative responses to these tests was assessed by repeated open challenges with peanuts. Results: Nine percent of our AD patients reacted to the challenge. Positive responses to APTs were recorded in 19% of the patients, whereas in 12% positive SPTs were observed. APTs were more frequently positive in subjects with eczematous responses after challenge with respect to those with urticarial reactions. SPT reactivity proved to be higher in patients above 12 years of age, whereas APT positivity was more frequent in children under 6 years. APT sensitivity proved significantly higher than SPT sensitivity, in particular in children under 12 years of age. On the contrary, SPT specificity and positive predictive value were significantly higher with respect to those of APT in the age group of subjects under 6 years of age. Conclusions: Our data suggest that APTs with peanuts may represent a useful integration to standard testing modalities employed for the diagnosis of peanut allergy in AD patients.

About 20% of patients using transdermal estradiol complain of adverse local side effects.A 47-year-old, postmenopausal woman developed eczematous lesions at the sites of application of a estradiol therapeutic transdermal system and successively at the sites of application of a gel containing estradiol. Due to the topical intolerance, the therapy was switched to oral estrogen, which caused a systemic pruritic rash. Positive patch tests with estradiol led to the diagnosis of type IV allergic dermatitis due to transdermal estradiol and to a gel containing estradiol. Systemic contact dermatitis due to oral estradiol was also diagnosed.Even though allergic contact dermatitis from estradiol is extremely rare, local side effects from estradiol systems must be kept in mind and correctly diagnosed. Patch tests allow identification of the causative agent. In the case of primary sensitization to topical estradiol, oral estrogens must be prescribed cautiously to avoid systemic reactions.

Transplantation is now currently and increasingly performed for the treatment of various acute and chronic diseases. Today the kidney, heart, lung, heart-lung, liver, pancreas, kidney-pancreas, small bowel and bone marrow are being transplanted. The immunological status of patients receiving such transplants exposes them to the risk of developing bacterial, viral and fungal infections. The etiological agents of mycotic diseases involving the skin of transplant recipients range from the common dermatophytes through yeasts such as Candida spp., Malassezia spp. and dimorphic fungi to the emerging molds Fusarium spp. and Pseudallescheria boydii. The very wide spectrum of fungi causing cutaneous disease produces equally varied clinical aspects. Lesions may be typical, but are very often aspecific or ambiguous. Cutaneous lesions may be the sign of a trivial mycotic disease or the marker of a disseminated, potentially lethal fungal illness, so great attention should be given to their early recognition. Cutaneous manifestations due to Candida spp., Aspergillus spp., dematiaceous fungi and Pityrosporum folliculitis are usually observed early after transplant, cryptococcosis more than 6 months later, while the frequency of dermatophytoses increases as time goes by. Coccidioides immitis, Histoplasma capsulatum and Blastomyces dermatitidis may appear any time after transplantation. The management of the more severe forms of cutaneous mycosis in transplant recipients is difficult. Besides the fact that early recognition is not easy, there are also problems regarding the effectiveness and the toxicity of the therapy and drug-drug interactions. Prophylactic measures to avoid fungal contamination must be performed during hospitalization; patients should be taught how to avoid contamination, not only during the first period after transplantation, when high dosage immunosuppressive drugs are given, but also later when a normal lifestyle is resumed.

ejd.2011.1545 Auteur(s) : Vincenzo Bettoli1 vincenzo.bettoli@fastwebnet.it, Alessandro Borghi1, Lucia Mantovani1, Rita Scorrano2, Sara Minghetti1, Giulia Toni1, Oriele Sarno1, Stefania Zauli1, Annarosa Virgili1 1 Department of Dermatology 2 Section of Ophthalmology, Azienda Ospedaliera Universitaria di Ferrara, Corso Giovecca 203, 44100 Ferrara, Italy A 17-year-old girl, followed for moderate acne vulgaris without endocrinological abnormalities, complained of headache, nausea, vomiting, irritability [...]

Sir, In vivo diagnostic tests may cause side-effects. The well-known, typical side-effects of patch testing are active sensitization, irritant reactions, scars, alteration of pigmentation, pustular or microbial infection, reaction to plaster or test devices, and “angry back syndrome” (1). Systemic symptoms are not unusual among patients undergoing patch tests; 5% of tested patients complain of rashes, high temperature and flare-up reactions (2). A particular patch test side-effect, the “edge-effect”, is reported for irritant substances. A similar reaction is also described sporadically for different allergens using Finn Chambers on Scanpor; test substances, not evenly dispersed under the Finn Chamber accumulate around the perimeter of the chamber, causing a stronger allergic reaction at the rim (3, 4). Another peculiar “edge-effect” has been observed testing potent corticosteroids: at the 48-h control the eczematous reaction is evident only on the outer edge of the patch test site, while at the later readings, the entire patch test site becomes eczematous. This phenomenon may be explained by the anti-inflammatory effect of the corticosteroid reinforced by the patch test occlusion during the first 48 h (5). In the case presented here, a strange patch test sideeffect was observed, characterized by an allergic skin reaction localized on the external edge of some patch test cells.

Sensitive skin has been described as a skin type showing higher reactivity than normal skin and developing exaggerated reactions when exposed to external factors. The stinging test, performed by applying lactic acid to the nasolabial fold and evaluating the intensity of subjective symptoms, is widely accepted as a marker of sensitivity and employed for the selection of subjects experiencing invisible cutaneous irritation. However, this test is based on self-perceived assessment and lacks objectivity. In order to contribute to the finding of objective descriptors, we assessed baseline biophysical parameters in subjects with sensitive skin by means of transepidermal water loss (TEWL), capacitance, pH, sebum and skin colour measurements, and compared the data with those obtained in normal subjects, also correlating the results with those of clinical assessments and functional tests. Subjects with sensitive skin showed a trend towards higher scores at all assessment times both for the stinging and the washing test. The skin of sensitive subjects was described as less supple, less hydrated and more erythematous and telangiectatic with respect to the skin of normal subjects. A trend towards an increase in TEWL, pH and colorimetric a* values, and a decrease in capacitance, sebum and colorimetric L* values on the face of subjects with sensitive skin was observable. However, significances were only present for capacitance and a* values. Thus, alterations of baseline capacitance values indicate the tendency to barrier impairment and support the view that skin hyperreactivity to water-soluble irritants is induced by a greater amount of irritants absorbed, whereas the increase in the erythema parameter shows that cutaneous vascular hyperreactivity in subjects with sensitive skin also corresponds to baseline vasodilation.