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Background: Ultrasound (US) is a real-time non-invasive technique that has been demonstrated to support an early diagnosis and a more precise assessment of hidradenitis suppurativa (HS). Objectives: To compare the clinical and US evaluation of a series of HS patients. Methods: 434 HS patients (259 F, 175 M; mean age 33.82 ±13.31 years) observed across 19 Italian dermatology centres [members of the Italian Ultrasound Working Group (IUWG)] were enrolled in a retrospective study. Clinical staging was obtained by the Hidradenitis Suppurativa Physician's Global Assessment score (HS-PGA), while the ultrasonographic staging was determined by the US HS-PGA, based on the same scores as clinical HS-PGA but performed with the aid of US. Results: At the end of the study, the mean clinical and US HS-PGA scores were 2.70 and 2.92, respectively. Direct comparison of clinical and ultrasonographic assessment revealed that a higher proportion of patients was classified as having moderate and very severe disease by US. In particular, 117 patients (26.96%) had a worse classification by US HS-PGA compared to clinical assessment. Conclusion: Our findings confirm that the use of clinical grading only to assess HS severity may underestimate the real disease severity. US examination can be considered an essential non-invasive imaging tool available to dermatologists for a more accurate diagnosis, staging, treatment planning and monitoring of HS and should be included in the pathway to an optimal standard of care of HS.

Several therapeutic approaches have been described for their treatment of hypertrophic scars and keloids, but to date, the optimal treatment has not been established yet. Our in vivo study was conducted to evaluate the effect of a medical device consisting in an adhesive patch containing onion extract (Allium cepa) 10%, allantoin 1%, and pentaglycan 4% (Kaloidon patch) on hypertrophic scars and keloids. Thirty-nine patients with hypertrophic scars and seven patients with keloids were asked to apply an adhesive patch containing Allium cepa, allantoin, and pentaglycan once/day for at least 8 h consecutively, for 24 weeks. Patients were reevaluated 6 weeks (T6), 12 weeks (T12), and 24 weeks (T24) after starting the treatment through POSAS scale v 2.0, ultrasonographic, and videocapillaroscopic assessment. The investigated medical device was able to induce a significant improvement of POSAS starting from T12, with a positive amelioration trend until T24. However the patient-assessed POSAS sub-items showed improvement already after 6 weeks, whereas a significant improvement of the observer-assessed POSAS sub-items was observed only after 12 weeks (P

The clinical characteristics associated with hidradenitis suppurativa (HS) severity are poorly understood. In this study, 124 patients with HS from 6 Italian dermatology centres participated in this study. Disease severity was assessed using the Hidradenitis Suppurativa Physician's Global Assessment score (HS-PGA) and Hurley score. The impact of clinical characteristics on disease severity was assessed by logistic regression. Clinical characteristics were similar between men (n = 53) and women (n = 71). Disease severity was also similar; 75% of the patients had Hurley stage II or III disease, and > 60% had moderate, severe or very severe HS as judged by HS-PGA. Lesions were more frequent in the gluteal region in men (32.3% in men vs. 8.7% in women, P

Background Phototherapy is a mainstay for the treatment of MF. However, there is scarce evidence for its use, mostly due to the lack of a unified schedule. Aims The primary aim of this study was to establish the first structured, expert-based consensus regarding the indications and technical schedules of NB-UVB and PUVA for MF. The secondary aim was to determine the consensus level for each specific item. Materials & methods E-delphi study. Item-specific expert consensus was defined as the number of "Totally Agree" results to ≥80% of the panelists. Cronbach alpha index ≥0.7 was used as a measure of homogeneity in the responses among questions related to the same topic. Results Overall, there was a high homogeneity among responders (0.78). On specific topics, the highest grade was observed for technical items (0.8) followed by indications for early (0.73) and advanced stages (0.7). Conclusions Items related to the most canonical indications of phototherapy and to treatment schedules showed the highest agreements rates. There is consensus about the use of standardized treatment schedules for the induction and consolidation phases for NB-UVB and PUVA in MF.

Hidradenitis suppurativa (HS) is a chronic, recurrent, inflammatory disease associated with a high physical and psychological burden. It is a disorder of the infundibular segment of the pilosebaceous unit, characterized by subcutaneous nodules, abscesses, sinus tracts and scar formation on the intertriginous and apocrine-bearing areas. HS is quite rare in young and prepubertal children. It usually begins after puberty, but several reports of prepubertal HS onset have been described. These cases are strongly linked to hormonal disorders and genetic susceptibility. Specific guidelines for prepubertal patients are still lacking, so further studies are warranted to better delineate a tailored approach. This paper aims to summarize the most significant aspects, as well as the most recent information about the epidemiology, pathogenesis, clinical features, diagnosis, comorbidities and treatment of paediatric HS. In addition, we report our clinical experience in managing HS in a group of eight prepubertal patients based on systemic antibiotics (azithromycin) and zinc oral supplementation.

Hidradenitis suppurativa (HS), is a chronic inflammatory disease affecting the skin-bearing terminal of hair follicles and apocrine glands whose diagnosis and staging are clinical1,2 . Scores mainly rely on physical findings and although easily performed, lack information on disease severity. Ultrasound (US) aids in the diagnosis and assessment of HS disease severity3 . This article is protected by copyright. All rights reserved.

Inhibition of the epidermal growth factor receptor (EGFR) represents one of the most important avenues of research and development in cancer therapy. The cutaneous toxicity [papular–pustular eruption (PPE), seborrheic dermatitis-like erythema, diffuse xerosis, inflammatory paronychia, painful fissures on fingers, hair changes] frequently described with EGFR inhibitors (EGFRI) can result in significant physical discomfort and often lead to interruption or dose modification of EGFRI. Therefore, appropriate management of skin toxicity is mandatory to allow adequate drug administration and to improve health-related quality of life and therapy outcomes. Although the mechanism by which inhibition of EGFR leads to skin toxicity is still largely unknown, EGFR is primarily expressed in undifferentiated proliferating basal and suprabasal keratinocytes both in the epidermis and in the outer layers of hair follicle [1]. The activation of EGFR by its ligand EGF regulates normal keratinocytes proliferation, differentiation, migration, and survival in the skin [1]. Tan et al. [2] demonstrated that MAPK activity shows a trend in association with skin toxicity after tyrosine kinase inhibitors administration and they concluded that by giving an inhibitor of MAPK phosphorylation to patients undergoing treatment with EGFR inhibitors, clinicians could control the skin toxicity. It has recently been demonstrated that topical application of green tea polyphenols in rats prevents the UVB-induced oxidative phosphorylation of MAPK [3] and nicotinamide also inhibits the MAPK pathways in cell cultures and in rats [4, 5]. Starting from these data, we report our experience in the management of EGFR skin toxicity using a new therapeutic approach, based on the use of a combined therapy: topical application of a moisturizer cream containing green tea polyphenols twice a day and oral administration of nicotinamide (1 g/die) for 12 weeks. The moisturizer cream containing green tea was applied on face, hands, neck, back, shoulders, arms, and legs, starting when skin toxicity occurred. Topical application of 1% clindamycin gel and/or systemic administration of minocycline 100 mg/die were provided in case of super bacterial infection, until infection resolved completely. Treatment was variably effective on different aspects of skin toxicity: PPE and itching rapidly improved, with a significant reduction of prevalence and clinical severity in treated patients at week 6. Seborrheic dermatitis erythema improved more slowly after 12 weeks of therapy (Figure 1). Paronychia, xerosis, and fissures were less responsive even if they demonstrated a positive trend to the treatment. Finally, all treated patients reported a significant improvement in life quality, which represents one of the most important goals in the control of EGFR-related skin toxicity. To date, no controlled clinical studies investigating treatment options for EGFRI skin toxicity have been fully reported and as a result, evidence-based treatment recommendations are not yet possible. Our experience showed that in a homogeneous and prospective setting, a simple nicotinamide/green tea polyphenols-based therapy is extremely effective in order to improve skin toxicity due to EGFRI and merits further investigation. In addition, evaluation of patient, nursing, and physician education tools is important and may aid in the promotion of prophylactic intervention, early recognition, and best practices in skin toxicity management, thereby maximizing potential clinical benefit from the EGFRI class of agents, reducing the risk of serious infection, and improving patient quality of life.