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Starace M, Piraccini BM, Evangelista V, Bruni F, Alessandrini A. Acute telogen effluvium due to Dengue fever mimicking androgenetic alopecia. Ital J Dermatol Venerol 2023; 158:66-67. [PMID: 36939507 DOI: 10.23736/s2784-8671.22.07369-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/21/2023]
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de Marsillac PF, Cortez de Almeida RF, Machado CJ, Piraccini BM, Starace M, Tosti A, Vincenzi C, Kobzei K, Iorizzo M, Alves LD, Blanco A, Coelho C, Saceda-Corralo D, D'Atri G, Benez M, Ramos PM, Baja S, Tortelly VD, Frattini S, Melo DF. Clinical, epidemiological, trichoscopic and histopathological features of linear morphea on the scalp. J Eur Acad Dermatol Venereol 2022; 36:e892-e895. [PMID: 35694874 DOI: 10.1111/jdv.18323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 06/03/2022] [Indexed: 11/29/2022]
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Starace M, Alessandrini A, Piraccini BM. Onychodynia: a new term of painful sensation and paresthesia of the nails. J Eur Acad Dermatol Venereol 2022; 36:e809-e810. [PMID: 35648440 DOI: 10.1111/jdv.18286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 05/18/2022] [Indexed: 11/27/2022]
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Starace M, Alessandrini A, Iorizzo M, D'Altobrando A, Ferrari T, Bruni F, Piraccini BM. A pilot study of intralesional methotrexate injections versus triamcinolone acetonide in patients affected by nail matrix psoriasis. Clin Exp Dermatol 2022; 47:1165-1168. [PMID: 35118697 PMCID: PMC9303444 DOI: 10.1111/ced.15110] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Revised: 01/10/2022] [Accepted: 01/17/2022] [Indexed: 11/28/2022]
Abstract
Nail disorders in general are difficult to treat and often frustrating and so it is nail psoriasis, especially when it is limited to the nails. Quality of life of affected patients is remarkably influenced due to the chronic course of the disease and frequent relapses. The purpose of this study was to compare the response to treatment and follow-up of 12 patients with nail matrix psoriasis, limited to few nails, treated with intralesional injections of 25mg/ml methotrexate or 10mg/ml triamcinolone acetonide. Patients were treated every 6 weeks for 24 weeks and followed up for 6 months. A photographic documentation and a NAPSI scoring were taken during each session and at each follow up visit. At the end of the 4 sessions, all patients showed an improvement of their disease and these data were confirmed at follow up especially for the methotrexate treated group.
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Zengarini C, Pileri A, Salamone FP, Piraccini BM, Vitale G, La Placa M. Subacute cutaneous lupus erythematosus induction after SARS-CoV-2 vaccine in a patient with primary biliary cholangitis. J Eur Acad Dermatol Venereol 2021; 36:e179-e180. [PMID: 34807495 PMCID: PMC9011449 DOI: 10.1111/jdv.17827] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 11/17/2021] [Indexed: 11/30/2022]
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Meyer-Gonzalez T, Bacqueville D, Grimalt R, Mengeaud V, Piraccini BM, Rudnicka L, Saceda-Corralo D, Vogt A, Vano-Galvan S. Current controversies in trichology: a European expert consensus statement. J Eur Acad Dermatol Venereol 2021; 35 Suppl 2:3-11. [PMID: 34668238 DOI: 10.1111/jdv.17601] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 08/13/2021] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Hair disorders are one of the most common conditions within dermatology practice but, although new diagnostic tools and therapeutic options have arisen, the management of these patients still represents a major clinical challenge. OBJECTIVE This study aimed at gathering information and achieving consensus on relevant recommendations on the latest advances in alopecia, trichoscopy and hair dermocosmetics. METHODS Experts of the steering committee consulted the available evidence on trichology-related areas from the past 5 years and formulated recommendations based on the evidence and their experience. A modified two-round Delphi procedure was performed among 45 European dermatologists experts in trichology to consult their degree of agreement on twenty recommendations, using a 4-point Likert scale. Consensus was defined as >80% of participants scoring either 1 (totally agree) or 2 (agree). RESULTS In the first round of the Delphi questionnaire, 75% of the recommendations reached consensus. Those that were not agreed upon were reformulated by the steering committee and voted again after an online meeting, where consensus was achieved in all recommendations. CONCLUSIONS All recommendations reached consensus after the two-round Delphi questionnaire and may be useful in clinical practice for dermatologists. The participants agreed that besides this consensus, further clinical studies are needed to assess the benefits of the emerging tools and treatments and to clarify the controversies that still exist in the field, aiming at improving patients' quality of life.
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Starace M, Orlando G, Bruni F, Alessandrini A, Piraccini BM. Anagen effluvium and the role of trichoscopy. Clin Exp Dermatol 2021; 47:589-591. [PMID: 34642956 DOI: 10.1111/ced.14982] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/11/2021] [Indexed: 11/29/2022]
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Piraccini BM, Blume-Peytavi U, Scarci F, Jansat JM, Falqués M, Otero R, Tamarit ML, Galván J, Tebbs V, Massana E. Efficacy and safety of topical finasteride spray solution for male androgenetic alopecia: a phase III, randomized, controlled clinical trial. J Eur Acad Dermatol Venereol 2021; 36:286-294. [PMID: 34634163 PMCID: PMC9297965 DOI: 10.1111/jdv.17738] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 09/29/2021] [Indexed: 01/02/2023]
Abstract
Background Oral finasteride is a well‐established treatment for men with androgenetic alopecia (AGA), but long‐term therapy is not always acceptable to patients. A topical finasteride formulation has been developed to minimize systemic exposure by acting specifically on hair follicles. Objectives To evaluate the efficacy and safety of topical finasteride compared with placebo, and to analyse systemic exposure and overall benefit compared with oral finasteride. Methods This randomized, double‐blind, double dummy, parallel‐group, 24‐week study was conducted in adult male outpatients with AGA at 45 sites in Europe. Efficacy and safety were evaluated. Finasteride, testosterone and dihydrotestosterone (DHT) concentrations were measured. Results Of 458 randomized patients, 323 completed the study and 446 were evaluated for safety. Change from baseline in target area hair count (TAHC) at week 24 (primary efficacy endpoint) was significantly greater with topical finasteride than placebo (adjusted mean change 20.2 vs. 6.7 hairs; P < 0.001), and numerically similar between topical and oral finasteride. Statistically significant differences favouring topical finasteride over placebo were observed for change from baseline in TAHC at week 12 and investigator‐assessed change from baseline in patient hair growth/loss at week 24. Incidence and type of adverse events, and cause of discontinuation, did not differ meaningfully between topical finasteride and placebo. No serious adverse events were treatment related. As maximum plasma finasteride concentrations were >100 times lower, and reduction from baseline in mean serum DHT concentration was lower (34.5 vs. 55.6%), with topical vs. oral finasteride, there is less likelihood of systemic adverse reactions of a sexual nature related to a decrease in DHT with topical finasteride. Conclusion Topical finasteride significantly improves hair count compared to placebo and is well tolerated. Its effect is similar to that of oral finasteride, but with markedly lower systemic exposure and less impact on serum DHT concentrations.
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Starace M, Iorizzo M, Mandel VD, Bruni F, Misciali C, Apalla Z, Silyuk T, Pellacani G, Patrizi A, Piraccini BM, Alessandrini A. Scalp dysaesthesia and lichen simplex chronicus: diagnostic and therapeutic update with literature review. Clin Exp Dermatol 2021; 47:3-8. [PMID: 34137059 PMCID: PMC9290567 DOI: 10.1111/ced.14808] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/14/2021] [Indexed: 11/28/2022]
Abstract
Scalp dysaesthesia, considered a variant of the cutaneous dysaesthesia syndrome, is characterized by chronic sensory symptoms, including pruritus, pain, burning and stinging in a well‐defined location, without objective findings. Its aetiology is not well elucidated and treatment options are limited, thus it can be challenging and frustrating for both patient and physician. It can be associated with lichen simplex chronicus. In this paper, we review the literature on the pathogenetic factors, diagnostic methods and therapeutic options in the management of scalp dysaesthesia. Dissociation, cervical spine disease and muscle tension seem to be the most important pathogenetic factors. Trichoscopy, reflectance confocal microscopy and biopsy are all helpful for the diagnosis of the disease. Therapies include high‐potency topical or intralesional corticosteroids, capsaicin and topical anaesthetics, sedative antihistamines, tricyclic antidepressants, transcutaneous electric nerve stimulation, botulinum toxin and vitamin B12.
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Olsen EA, Harries M, Tosti A, Bergfeld W, Blume-Peytavi U, Callender V, Chasapi V, Correia O, Cotsarelis G, Dhurat R, Dlova N, Doche I, Enechukwu N, Grimalt R, Itami S, Hordinsky M, Khobzei K, Lee WS, Malakar S, Messenger A, McMichael A, Mirmirani P, Ovcharenko Y, Papanikou S, Pinto GM, Piraccini BM, Pirmez R, Reygagne P, Roberts J, Rudnicka L, Saceda-Corralo D, Shapiro J, Silyuk T, Sinclair R, Soares RO, Souissi A, Vogt A, Washenik K, Zlotogorski A, Canfield D, Vano-Galvan S. Guidelines for clinical trials of frontal fibrosing alopecia: consensus recommendations from the International FFA Cooperative Group (IFFACG). Br J Dermatol 2021; 185:1221-1231. [PMID: 34105768 DOI: 10.1111/bjd.20567] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/07/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Frontal fibrosing alopecia (FFA) has become one of the most common causes of cicatricial alopecia worldwide. However, there is a lack of clear aetiology and robust clinical trial evidence for the efficacy and safety of agents currently used for treatment. OBJECTIVES To enable data to be collected worldwide on FFA using common criteria and assessment methods. METHODS A multicentre, international group of experts in hair loss was convened by email to create consensus recommendations for clinical trials. Consensus was defined at > 90% agreement on each recommended part of these guidelines. RESULTS Standardized diagnostic criteria, severity rating, staging, and investigator and patient assessment of scalp hair loss and other clinical features of FFA were created. CONCLUSIONS These guidelines should allow the collection of reliable aggregate data on FFA and advance efforts in both clinical and basic research to close knowledge gaps in this condition.
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Bruni F, Alessandrini A, Starace M, Orlando G, Piraccini BM. Clinical and trichoscopic features in various forms of scalp psoriasis. J Eur Acad Dermatol Venereol 2021; 35:1830-1837. [PMID: 33991148 DOI: 10.1111/jdv.17354] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Accepted: 04/02/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Scalp psoriasis is often undiagnosed or inadequately treated. The patient himself underestimates the seriousness of this hair disease and consults too late to a dermatologist. OBJECTIVES The aim of our study was to create a correlation between the clinical patterns and trichoscopy of scalp psoriasis such in a way to help the clinician to make the diagnosis and select the appropriate therapy. MATERIAL AND METHODS We gathered all patients affected of scalp psoriasis afferent to Outpatient's hair consultation of the Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, from January 2012 to December 2018. All patients were evaluated through clinical, trichoscopic examination and a skin biopsy only in doubtful cases. We quantified the severity of the disease with several objective and subjective parameters every 4 months, up to 1 year. We recorded therapies, outcome data and quality of life. RESULTS We collected 156 patients affected by scalp psoriasis, identifying seven clinical patterns with specific trichoscopical correlation. In the order of frequency, the clinical patterns were as follows: plaque psoriasis (with a prevalence of erythema, silver-white scales and twisted red loops vessels and red dots); thin scales (with silvery-white scales, simple red lines and signet red ring vessels); sebopsoriasis (with greasy scales, erythema with red dots, globules and twisted and bushy red loops at high magnification); psoriatic cap (with silver-white scales, erythema and polymorphic vascular pattern); pityriasis amiantacea (with yellowish adherent scales, erythema and simple red loops capillaries); cicatricial psoriatic alopecia (with erythema associated with yellowish, silver-white scales with twisted and bushy red loops capillaries) and pustular psoriasis (with 'flower shape' pustular lesions, erythema simple red loops capillaries). CONCLUSIONS The description of different clinical patterns of scalp psoriasis and its trichoscopical correlations may help the clinician to make the diagnosis also in atypical presentations and to prescribe an adequate therapeutic regimen.
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Alessandrini A, Piraccini BM, Veronesi G, Ferrari T, Dika E. A heart-shaped brown lesion. Int J Dermatol 2021; 60:e381. [PMID: 33846969 DOI: 10.1111/ijd.15590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 03/23/2021] [Indexed: 11/29/2022]
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Evangelista V, Vincenzi C, Bruni F, Piraccini BM, Neri I. Contact dermatitis apparently triggered by meningococcal and polyvalent vaccines: A case of allergic contact dermatitis due to chlorhexidine. Contact Dermatitis 2021; 85:354-355. [PMID: 33763887 DOI: 10.1111/cod.13846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 03/19/2021] [Indexed: 11/28/2022]
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Filippi F, Vollono L, Piraccini BM, Misciali C, Tartari F, Neri I. Erytromelanosis faciei successfully treated with low-dose oral isotretinoin. Ital J Dermatol Venerol 2020; 156:620-622. [PMID: 33314900 DOI: 10.23736/s2784-8671.20.06858-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Bruni F, Di Altobrando A, Alessandrini A, Starace M, Piraccini BM, Vincenzi C. Delayed access and provision of dermatological care as a collateral damage of COVID-19-related fear: Allergic contact dermatitis to fluconazole. Contact Dermatitis 2020; 84:354-356. [PMID: 33230852 PMCID: PMC7753396 DOI: 10.1111/cod.13748] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 11/19/2020] [Indexed: 11/30/2022]
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Alessandrini A, Starace M, D'''''Ovidio R, Villa L, Rossi A, Stan TR, Calzavara-Pinton P, Piraccini BM. Androgenetic alopecia in women and men: Italian guidelines adapted from European Dermatology Forum/European Academy of Dermatology and Venereology guidelines. GIORN ITAL DERMAT V 2020; 155:622-631. [PMID: 33295740 DOI: 10.23736/s0392-0488.19.06399-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Androgenetic alopecia (AGA) is the most common form of alopecia, affecting up to 80% of men and 50% of women in the course of their life. AGA is caused by a progressive reduction in the diameter, length and pigmentation of the hair, resulting from the effects of the testosterone metabolite dihydrotestosterone (DHT) on androgen-sensitive hair follicles. Clinical presentation is different in men and women. Trichoscopy is used routinely in patients with androgenetic alopecia, for diagnosis and differential diagnosis with other diseases, allowing staging of severity and monitoring the progress of the disease and the response to treatment. Medical treatment of AGA includes topical minoxidil, antiandrogen agents, 5-alpha reductase inhibitors and many other options. This guideline for the treatment of androgenetic alopecia has been developed by an Italian group of experts taking into account the Italian pharmacological governance. The article is adapted from the original of the European Dermatology Forum (EDF) in collaboration with the European Academy of Dermatology and Venereology (EADV). It summarizes evidence-based and expert-based recommendations (S3 level).
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Dika E, Lambertini M, Misciali C, Fanti PA, Contedini F, Pinto V, Pignatti M, Cipriani F, Corti B, Piraccini BM. Nail-plate dystrophy of the fifth toenail: thinking outside the box. Clin Exp Dermatol 2020; 46:584-587. [PMID: 33231894 DOI: 10.1111/ced.14493] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 09/15/2020] [Accepted: 10/07/2020] [Indexed: 11/30/2022]
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Barbareschi M, Vescovi V, Starace M, Piraccini BM, Milani M. Propylene glycol free 5% minoxidil lotion formulation: cosmetic acceptability, local tolerability, clinical efficacy and in-vitro skin absorption evaluations. GIORN ITAL DERMAT V 2020; 155:341-345. [PMID: 32635707 DOI: 10.23736/s0392-0488.20.06554-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND A new propylene glycol (PG)-free 5% minoxidil (Mnx) lotion has been recently commercialized. Aim of this study was to evaluate the acceptability/tolerability and clinical efficacy of 3-month application of this new PG-free Mnx lotion and the penetration of the active compound in a reconstructed human epidermis (RHE/Episkin) model in comparison with a PG Mnx 5% lotion. METHODS Thirty subjects of both sex with a diagnosis of AGA were enrolled in the trial. Cosmetic acceptability and clinical efficacy were evaluated after 4, 8 and 12 weeks of treatment. Global tolerability was evaluated at week 12. Cosmetic acceptability evaluation was assessed using a 7-item questionnaire using a 10-point scale score. Global Tolerability was evaluated with a 4-grade scale. Clinical efficacy was evaluated with a 5-grade scale. Skin absorption of PG-free Mnx was evaluated and compared with a PG Mnx solution using the Episkin model. RESULTS All subjects concluded the study. The 7-item questionnaire mean values were always <2 at each time-point evaluation, demonstrating high cosmetic acceptability/tolerability. No subjects reported burning, itching or redness sensations. Global Tolerability score mean±SD value was 1.7±0.4. Clinical efficacy scores were 0.4, 0.6 and 1.2 at week 4, 8 and 12, respectively. PG-free Mnx showed similar amount of absorbed dose in comparison with PG Mnx. CONCLUSIONS This new PG-free lotion shows a very good cosmetic acceptability/tolerability profile. Clinical efficacy was also documented. The skin penetration of this formulation is comparable to the PG Mnx lotion, supporting the bioequivalence of the two products.
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Neri I, Guglielmo A, Virdi A, Gaspari V, Starace M, Piraccini BM. The red half-moon nail sign: a novel manifestation of coronavirus infection. J Eur Acad Dermatol Venereol 2020; 34:e663-e665. [PMID: 32535979 PMCID: PMC7323324 DOI: 10.1111/jdv.16747] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Accepted: 06/03/2020] [Indexed: 01/17/2023]
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Di Altobrando A, Bruni F, Alessandrini A, Starace M, Misciali C, Piraccini BM. Severe de-novo palmoplantar and nail psoriasis complicating Nivolumab treatment for metastatic melanoma. Dermatol Ther 2020; 33:e13363. [PMID: 32239596 DOI: 10.1111/dth.13363] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2020] [Revised: 03/17/2020] [Accepted: 03/28/2020] [Indexed: 12/18/2022]
Abstract
Nivolumab, a fully human IgG4 immune checkpoint modulator, binds to the programmed cell death 1 (PD-1) receptor on T cells and blocks their inhibition. Thus, it increases the anticancer host immune response by allowing T cells to attack tumor cells. Although anti-PD-1 immunotherapy is typically well accepted, deregulation of immune tolerance caused by nivolumab may determine immune-related adverse events, among which skin toxicities represent the most common. We report a case of severe new-onset palmoplantar and nail psoriasis after receiving nivolumab treatment for metastatic melanoma.
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Starace M, Iorizzo M, Trüeb RM, Piccolo V, Argenziano G, Camacho FM, Gallyamova Y, Rudnicka L, Umbert I, Lyakhovitsky A, Vañó-Galván S, Goren A, Alessandrini A, Bruni F, Piraccini BM. Erosive pustular dermatosis of the scalp: a multicentre study. J Eur Acad Dermatol Venereol 2020; 34:1348-1354. [PMID: 31954062 DOI: 10.1111/jdv.16211] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Accepted: 12/17/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND Erosive pustular dermatosis of the scalp (EPDS) is characterized by crusted erosions or superficial ulcerations that lead to scarring alopecia. OBJECTIVES AND METHODS We performed a multicentre retrospective clinical study including 56 patients (29 females and 27 males, mean age 62.7) with a confirmed EPDS in order to describe epidemiology, clinical findings and therapeutic choices of this disease. RESULTS Mechanical/chemical trauma was reported in 28.6%, a previous infection in 10.7%, a previous cryotherapy in 5.4% androgenetic alopecia in 48.2% and severe actinic damage in 25%. Trichoscopy showed absence of follicular ostia, tufted and broken hair, crusts, serous exudate, dilated vessels, pustules and hyperkeratosis. Histopathology revealed three different features, depending on the disease duration. The most prescribed therapy was topical steroids (62.5%), followed by the combination of topical steroids and topical tacrolimus (8.9%), systemic steroids (7.1%) and topical tacrolimus (5.4%). A reduction of inflammatory signs was observed in 28 patients (50%) treated with topical steroids and in all three patients treated with topical tacrolimus. CONCLUSION The relatively high number of patients collected allowed us to identify a better diagnostic approach, using trichoscopy and a more effective therapeutic strategy, with high-potency steroids or tacrolimus, which should be considered as first-line treatment.
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Chessa MA, Iorizzo M, Richert B, López-Estebaranz JL, Rigopoulos D, Tosti A, Gupta AK, Di Chiacchio N, Di Chiacchio NG, Rubin AI, Baran R, Lipner SR, Daniel R, Chiheb S, Grover C, Starace M, Piraccini BM. Pathogenesis, Clinical Signs and Treatment Recommendations in Brittle Nails: A Review. Dermatol Ther (Heidelb) 2020; 10:15-27. [PMID: 31749091 PMCID: PMC6994568 DOI: 10.1007/s13555-019-00338-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Indexed: 02/06/2023] Open
Abstract
Nail plate brittleness (or fragility) is a common complaint affecting up to 20% of the population, especially women over 50 years of age, with fingernail fragility being more prevalent than toenail fragility. Nail brittleness is characterized by nails that split, flake and crumble, become soft and lose elasticity. The main clinical presentations are: onychoschizia, onychorrhexis, superficial granulation of keratin and worn-down nails. According to causative factors, we can distinguish 2 forms of nail fragility (NF): a primary "idiopathic or brittle nail syndrome" form and NF secondary to different causes such as inflammatory nail disorders, infections, systemic diseases and general conditions, traumas and alteration of the nail hydration. Optimal management requires treatment of the primary cause of brittle nails, when possible. In idiopathic NF oral supplementation, vitamins (especially biotin, also known as vitamin B7), trace elements and amino acids (especially cysteine) have been reported to be useful. In addition, several products, such as topical moisturizers and lacquers could be considered to restructure the affected nail plate and to reduce psychological impacts of this common problem.
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Starace M, Alessandrini A, Bruni F, Piraccini BM. Trachyonychia: a retrospective study of 122 patients in a period of 30 years. J Eur Acad Dermatol Venereol 2020; 34:880-884. [PMID: 31923322 DOI: 10.1111/jdv.16186] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Accepted: 12/17/2019] [Indexed: 02/03/2023]
Abstract
BACKGROUND Trachyonychia is a nail disease characterized by longitudinal striations, ridges, fissures and/or pitting. This condition can be both idiopathic and associated with other dermatologic diseases. OBJECTIVE AND METHODS The aim of this retrospective study was to analyse the clinical features, onychoscopy, therapy efficacy and outcome of 122 patients with trachyonychia visited at the Hair Disease Outpatient Consultations of the Dermatology Unit of the Department of Experimental, Diagnostic and Specialty Medicine of the University of Bologna, from 1988 to 2018. RESULTS Opaque trachyonychia was the most observed type while shiny trachyonychia, less common, was present especially in milder cases. Pitting was the most frequently observed feature (80.3%), followed by koilonychia (45%) and hyperkeratosis (19.6%). Nail matrix longitudinal biopsy was performed for diagnosis confirmation in 29 cases, and spongiotic was the most common pattern. Topical therapy was prescribed in 109 patients while systemic treatments were reserved for severe cases (38 patients); 22 patients did not receive any treatment. A marked improvement in the appearance of the nails or even a total resolution was seen in 63 patients. CONCLUSIONS Trachyonychia can occur at any age but is more frequent in children and often associated with alopecia areata. The pathological diagnosis of trachyonychia is not mandatory as the disease has generally a benign outcome. Considering the absence of pain and the high rate of spontaneous resolution, treatment is often prescribed only for cosmetic reasons or reserved for severe cases.
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Chessa MA, Iorizzo M, Richert B, López-Estebaranz JL, Rigopoulos D, Tosti A, Gupta AK, Di Chiacchio N, Di Chiacchio NG, Rubin AI, Baran R, Lipner SR, Daniel R, Chiheb S, Grover C, Starace M, Piraccini BM. Correction to: Pathogenesis, Clinical Signs and Treatment Recommendations in Brittle Nails: A Review. Dermatol Ther (Heidelb) 2020; 10:231-232. [PMID: 31970705 DOI: 10.1007/s13555-019-00348-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
Unfortunately, the co-author name was incorrectly published as "Jose L. López-Esterbaranz" instead of 'Jose L. López-Estebaranz" in the original article. The correct version of author name is updated here.The original article has been corrected.
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Filippi F, Vincenzi C, Bruni F, Piraccini BM, La Placa M. Methylisothiazolinone is still used and undeclared: A paediatric case of airborne contact dermatitis caused by water-based poster paints for children. Contact Dermatitis 2019; 82:260-261. [PMID: 31872445 DOI: 10.1111/cod.13457] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Accepted: 12/21/2019] [Indexed: 11/30/2022]
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