1
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Shen S, Feng J, Song X, Xiang W. Reflectance Confocal Microscopy of Adult Periorificial Dermatitis: A Case Report. Clin Cosmet Investig Dermatol 2023; 16:1865-1869. [PMID: 37492464 PMCID: PMC10364813 DOI: 10.2147/ccid.s419756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 07/12/2023] [Indexed: 07/27/2023]
Abstract
Periorificial dermatitis (PD) is an inflammatory disorder of the facial skin that mainly occurs around the mouth and manifests as erythema, papules, pustules, scales and other lesions. Special attention is needed in the clinical diagnosis of PD to distinguish it from acne, seborrheic dermatitis (SD), granulomatous rosacea (GR), sarcoidosis and childhood granulomatous periorificial dermatitis (CGPD). We used reflectance confocal microscopy (RCM) images of a patient with PD to assist in the diagnosis of PD. RCM of PD showed slight oedema of the spinous layer. Numerous dendritic cells, scattered hair follicular keratotic plugging and hair follicle dilatation were observed. The dilation and congestion of superficial dermis blood vessels, an increasing vascular density and accelerated blood flow, and a greater abundance of infiltrated inflammatory cells were also detected.
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Affiliation(s)
- Sihao Shen
- Department of Dermatology, Hangzhou Third People’s Hospital, Zhejiang Chinese Medical University, Hangzhou, People’s Republic of China
| | - Jiangfeng Feng
- Department of Dermatology, Hangzhou Third People’s Hospital, Zhejiang Chinese Medical University, Hangzhou, People’s Republic of China
| | - Xiuzu Song
- Department of Dermatology, Hangzhou Third People’s Hospital, Affiliated Hangzhou Dermatology Hospital, Zhejiang University School of Medicine, Hangzhou, People’s Republic of China
| | - Wenzhong Xiang
- Department of Dermatology, Hangzhou Third People’s Hospital, Affiliated Hangzhou Dermatology Hospital, Zhejiang University School of Medicine, Hangzhou, People’s Republic of China
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2
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Wang ZY, Fei WM, Li CX, Cui Y. Comparison of dermoscopy and reflectance confocal microscopy accuracy for the diagnosis of psoriasis and lichen planus. Skin Res Technol 2022; 28:480-486. [PMID: 35347763 PMCID: PMC9907646 DOI: 10.1111/srt.13158] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 03/09/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Dermoscopy and reflectance confocal microscopy (RCM) as noninvasive tools are gaining increasing importance in the diagnosis of inflammatory skin disorders. The purpose of our study was to calculate and compare the diagnostic accuracy of dermoscopy and RCM in common inflammatory skin diseases. MATERIALS AND METHODS We retrospectively collected clinical, dermoscopic, and RCM images of psoriasis and lichen planuscases from March 2018 to February 2021 in China-Japan Friendship Hospital. There were 10 experts evaluated dermoscopic and RCM images independently. Sensitivity, specificity, positive predict value, and negative predictive value for each and all investigators were calculated. The diagnostic accuracy was also measured by the area under the curve (AUC) for the Receiver Operator Characteristic (ROC) Curves. RESULTS We collected 82 psoriasis and 47 lichen planus cases. Dermoscopy was more sensitive than RCM in the diagnosis of psoriasis, and overall diagnostic accuracy of dermoscopy was also higher than RCM measured by AUC (0.879 vs. 0.835, p = 0.0001). For lichen planus, RCM had higher sensitivity, specificity, positive predictive value, negative predictive value, and overall diagnostic accuracy than dermoscopy (AUC 0.916 vs. 0.813, p<0.0001). CONCLUSION Dermoscopy and RCM play a significant role in assisting the diagnosis of psoriasis and lichens planus. These two noninvasive diagnostic tools have their own advantages and disadvantages for the evaluation of different inflammatory skin diseases, and they can be combined in clinical practice to improve the accuracy of the diagnosis of inflammatory skin diseases.
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Affiliation(s)
- Zi-Yi Wang
- Department of Dermatology, China-Japan Friendship Hospital, Beijing, China.,Graduate School, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Wen-Min Fei
- Department of Dermatology, China-Japan Friendship Hospital, Beijing, China.,Graduate School, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Cheng-Xu Li
- Department of Dermatology, China-Japan Friendship Hospital, Beijing, China.,Graduate School, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Yong Cui
- Department of Dermatology, China-Japan Friendship Hospital, Beijing, China.,Graduate School, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
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3
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Guida S, Longhitano S, Ardigò M, Pampena R, Ciardo S, Bigi L, Mandel VD, Vaschieri C, Manfredini M, Pezzini C, Arginelli F, Farnetani F, Zerbinati N, Longo C, Pellacani G. Dermoscopy, confocal microscopy and optical coherence tomography features of main inflammatory and autoimmune skin diseases: A systematic review. Australas J Dermatol 2021; 63:15-26. [PMID: 34423852 DOI: 10.1111/ajd.13695] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 07/26/2021] [Accepted: 08/07/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND/OBJECTIVES Non-invasive skin imaging features of main skin inflammatory and autoimmune diseases have been reported, although a comprehensive review of their correlation with histopathologic features is currently lacking. Therefore, the aim of this paper was to review the correlation of dermoscopic, reflectance confocal microscopy (RCM) and optical coherence tomography (OCT) criteria of main inflammatory and autoimmune skin diseases with their corresponding histopathologic criteria correlation. METHODS Studies on human subjects affected by main inflammatory and autoimmune diseases, defining the correlation of dermoscopic, RCM or OCT with histopathologic criteria, were included in the review. Five groups of diseases were identified and described: psoriasiform, spongiotic and interface dermatitis, bullous diseases and scleroderma. RESULTS Psoriasiform dermatitis was typified by white scales, corresponding to hyperkeratosis, and vessels, observed with RCM and OCT. Spongiosis, corresponding to dark areas within the epidermis with RCM and OCT, was the main feature of spongiotic dermatitis. Interface dermatitis was characterised by dermoepidermal junction obscuration. Blisters, typical of bullous diseases, were visualised as dark areas with RCM and OCT while scleroderma lesions were characterised by dermoscopic fibrotic beams, related to dermal thickness variations, with specific OCT and histopathologic correlations. CONCLUSIONS Although the role of RCM and OCT has yet to be defined in clinical practice, non-invasive skin imaging shows promising results on inflammatory and autoimmune skin diseases, due to the correlation with histopathologic features.
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Affiliation(s)
- Stefania Guida
- Dermatology Unit, Department of Surgical, Medical, Dental and Morphological Sciences related to Transplant, Oncology and Regenerative Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - Sabrina Longhitano
- Dermatology Unit, Department of Surgical, Medical, Dental and Morphological Sciences related to Transplant, Oncology and Regenerative Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - Marco Ardigò
- Porphyria and Rare Diseases Unit, San Gallicano Dermatological Institute - IRCCS, Rome, Italy
| | - Riccardo Pampena
- Dermatology and Skin Cancer Unit, First Medical Department, Arcispedale Santa Maria Nuova, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Reggio Emilia, Italy
| | - Silvana Ciardo
- Dermatology Unit, Department of Surgical, Medical, Dental and Morphological Sciences related to Transplant, Oncology and Regenerative Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - Laura Bigi
- Dermatology Unit, Department of Surgical, Medical, Dental and Morphological Sciences related to Transplant, Oncology and Regenerative Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - Victor Desmond Mandel
- Dermatology Unit, Department of Surgical, Medical, Dental and Morphological Sciences related to Transplant, Oncology and Regenerative Medicine, University of Modena and Reggio Emilia, Modena, Italy.,Porphyria and Rare Diseases Unit, San Gallicano Dermatological Institute - IRCCS, Rome, Italy
| | - Cristina Vaschieri
- Dermatology Unit, Department of Surgical, Medical, Dental and Morphological Sciences related to Transplant, Oncology and Regenerative Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - Marco Manfredini
- Dermatology Unit, Department of Surgical, Medical, Dental and Morphological Sciences related to Transplant, Oncology and Regenerative Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - Claudia Pezzini
- Dermatology Unit, Department of Surgical, Medical, Dental and Morphological Sciences related to Transplant, Oncology and Regenerative Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - Federica Arginelli
- Dermatology Unit, Department of Surgical, Medical, Dental and Morphological Sciences related to Transplant, Oncology and Regenerative Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - Francesca Farnetani
- Dermatology Unit, Department of Surgical, Medical, Dental and Morphological Sciences related to Transplant, Oncology and Regenerative Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - Nicola Zerbinati
- Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Caterina Longo
- Dermatology Unit, Department of Surgical, Medical, Dental and Morphological Sciences related to Transplant, Oncology and Regenerative Medicine, University of Modena and Reggio Emilia, Modena, Italy.,Dermatology and Skin Cancer Unit, First Medical Department, Arcispedale Santa Maria Nuova, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Reggio Emilia, Italy
| | - Giovanni Pellacani
- Dermatology Unit, Department of Surgical, Medical, Dental and Morphological Sciences related to Transplant, Oncology and Regenerative Medicine, University of Modena and Reggio Emilia, Modena, Italy.,Dermatology Clinic, Department of Clinical Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
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4
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Csuka EA, Ward SC, Ekelem C, Csuka DA, Ardigò M, Mesinkovska NA. Reflectance Confocal Microscopy, Optical Coherence Tomography, and Multiphoton Microscopy in Inflammatory Skin Disease Diagnosis. Lasers Surg Med 2021; 53:776-797. [PMID: 33527483 DOI: 10.1002/lsm.23386] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 01/13/2021] [Accepted: 01/18/2021] [Indexed: 12/27/2022]
Abstract
BACKGROUND AND OBJECTIVES Technological advances in medicine have brought about many novel skin imaging devices. This review aims to evaluate the scientific evidence supporting the use of noninvasive optical imaging techniques to aid in the diagnosis and prognosis of inflammatory skin diseases. STUDY DESIGN/MATERIALS AND METHODS PubMed and Scopus were searched in September 2020 according to PRISMA guidelines for articles using reflectance confocal microscopy (RCM), optical coherence tomography (OCT), and multiphoton microscopy (MPM) in inflammatory skin diseases, excluding studies monitoring treatment efficacy. RESULTS At the time of the study, there were 66 articles that addressed the utilization of noninvasive imaging in interface, spongiotic, psoriasiform, vesiculobullous, and fibrosing/sclerosing inflammatory skin dermatoses: RCM was utilized in 46, OCT in 16, and MPM in 5 articles. RCM was most investigated in psoriasiform dermatoses, whereas OCT and MPM were both most investigated in spongiotic dermatoses, including atopic dermatitis and allergic contact dermatitis. CONCLUSIONS There is preliminary evidence to support the diagnostic potential of noninvasive optical imaging techniques in inflammatory skin diseases. Improvements in the devices and further correlation with histology will help broaden their utility. Additional studies are needed to determine the parameters for diagnostic features, disease differentiation, and staging of inflammatory skin conditions. Lasers Surg. Med. © 2021 Wiley Periodicals LLC.
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Affiliation(s)
- Ella A Csuka
- Department of Dermatology, University of California, Irvine, Irvine, California, 92697
| | - Suzanne C Ward
- Department of Dermatology, University of California, Irvine, Irvine, California, 92697
| | - Chloe Ekelem
- Department of Dermatology, University of California, Irvine, Irvine, California, 92697
| | - David A Csuka
- Department of Dermatology, University of California, Irvine, Irvine, California, 92697
| | - Marco Ardigò
- San Gallicano Dermatological Institute-IRCCS, Via Chianesi 53, Rome, 00144, Italy
| | - Natasha A Mesinkovska
- Department of Dermatology, University of California, Irvine, Irvine, California, 92697
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5
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Tang Z, Kang L, Zhang Y, Huang J, Tong X, Zhou L, Zeng J. The diagnostic value of in vivo reflectance confocal microscopy in actinic keratosis. Skin Res Technol 2020; 27:80-85. [PMID: 32696993 DOI: 10.1111/srt.12913] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 06/20/2020] [Indexed: 12/20/2022]
Affiliation(s)
- Zhen Tang
- Department of Dermatology Third Xiangya Hospital Central South University Changsha China
| | - Liyang Kang
- Department of Dermatology Third Xiangya Hospital Central South University Changsha China
| | - Yuezhong Zhang
- XiangYa School of Medicine Central South University Changsha China
| | - Jian Huang
- Department of Dermatology Third Xiangya Hospital Central South University Changsha China
| | - Xiaoliang Tong
- Department of Dermatology Third Xiangya Hospital Central South University Changsha China
| | - Lu Zhou
- Department of Dermatology Third Xiangya Hospital Central South University Changsha China
| | - Jinrong Zeng
- Department of Dermatology Third Xiangya Hospital Central South University Changsha China
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6
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Yélamos O, Alejo B, Ertekin SS, Villa-Crespo L, Zamora-Barquero S, Martinez N, Domínguez M, Iglesias P, Herrero A, Malvehy J, Puig S. Non-invasive clinical and microscopic evaluation of the response to treatment with clobetasol cream vs. calcipotriol/betamethasone dipropionate foam in mild to moderate plaque psoriasis: an investigator-initiated, phase IV, unicentric, open, randomized clinical trial. J Eur Acad Dermatol Venereol 2020; 35:143-149. [PMID: 32365242 PMCID: PMC7818495 DOI: 10.1111/jdv.16559] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Accepted: 04/10/2020] [Indexed: 01/07/2023]
Abstract
BACKGROUND Treatment response for psoriasis is typically evaluated using clinical scores. However, patients can relapse after clinical clearance, suggesting persistent inflammation. Dermoscopy, reflectance confocal microscopy (RCM) and optical coherence tomography (OCT) can non-invasively improve treatment response assessment. OBJECTIVES To compare the clinical and non-invasive microscopic features in a psoriatic target lesion treated with clobetasol cream or calcipotriol/betamethasone dipropionate foam (Cal/BD foam). METHODS Prospective, unicentric, open, randomized clinical trial comparing clinical data [total clinical score (TCS)] and microscopic data (dermoscopy, RCM and OCT) in psoriasis patients treated with clobetasol or Cal/BD foam. RESULTS We included 36 adult patients (22 men). At week 4, more patients treated with Cal/BD foam achieved TCS ≤1 than with clobetasol (63.2% vs. 18.8%, P = 0.016). Treatment satisfaction was higher with Cal/BD foam (P < 0.03). Microscopically, Cal/BD foam induced more reduction in epidermal thickness at week 4 (P < 0.049). Dilated horizontal blood vessels were more common with clobetasol than with Cal/BD foam at week 8 (69.2% vs. 31.2%, P = 0.159). If epidermal hyperplasia was noted at baseline, the response was poorer with clobetasol (P = 0.029). LIMITATIONS Small sample size, open study, imaging sampling bias. CONCLUSION Cal/BD foam is more effective than clobetasol, has better patient satisfaction and induces greater reduction in the hyperkeratosis/acanthosis, regardless of baseline epidermal hyperplasia.
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Affiliation(s)
- O Yélamos
- Dermatology Department, Hospital Clínic, Institut d'Investigacions Biomediques August Pi i Sunyer, Universitat de Barcelona, Barcelona, Spain.,Department of Dermatology, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Spain.,Department of Dermatology, Centro Médico Teknon - Quirónsalud, Barcelona, Spain
| | - B Alejo
- Dermatology Department, Hospital Clínic, Institut d'Investigacions Biomediques August Pi i Sunyer, Universitat de Barcelona, Barcelona, Spain
| | - S S Ertekin
- Dermatology Department, Hospital Clínic, Institut d'Investigacions Biomediques August Pi i Sunyer, Universitat de Barcelona, Barcelona, Spain
| | - L Villa-Crespo
- Dermatology Department, Hospital Clínic, Institut d'Investigacions Biomediques August Pi i Sunyer, Universitat de Barcelona, Barcelona, Spain
| | - S Zamora-Barquero
- Dermatology Department, Hospital Clínic, Institut d'Investigacions Biomediques August Pi i Sunyer, Universitat de Barcelona, Barcelona, Spain
| | - N Martinez
- Dermatology Department, Hospital Clínic, Institut d'Investigacions Biomediques August Pi i Sunyer, Universitat de Barcelona, Barcelona, Spain
| | - M Domínguez
- Dermatology Department, Hospital Clínic, Institut d'Investigacions Biomediques August Pi i Sunyer, Universitat de Barcelona, Barcelona, Spain
| | - P Iglesias
- Dermatology Department, Hospital Clínic, Institut d'Investigacions Biomediques August Pi i Sunyer, Universitat de Barcelona, Barcelona, Spain
| | - A Herrero
- Dermatology Department, Hospital Clínic, Institut d'Investigacions Biomediques August Pi i Sunyer, Universitat de Barcelona, Barcelona, Spain
| | - J Malvehy
- CIBER de Enfermedades Raras, Instituto de Salud Carlos III, Madrid, Spain
| | - S Puig
- CIBER de Enfermedades Raras, Instituto de Salud Carlos III, Madrid, Spain
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7
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Franceschini C, Persechino F, Ardigò M. In Vivo Reflectance Confocal Microscopy in General Dermatology: How to Choose the Right Indication. Dermatol Pract Concept 2020; 10:e2020032. [PMID: 32363095 DOI: 10.5826/dpc.1002a32] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/20/2019] [Indexed: 12/31/2022] Open
Abstract
Reflectance confocal microscopy (RCM) is a high-resolution, noninvasive imaging technique being increasingly used as an aid to diagnosis in the dermatology setting. RCM is applied in the diagnosis of both melanoma and nonmelanoma skin tumors, but also in the interpretation and management of inflammatory skin diseases. Two different devices with different designs for specific indications are available in the market: a static and a handheld probe. Several clinical presentations of the lesion could affect the examination, such as the presence of ulceration or hyperkeratosis; moreover, the anatomical site can drive the probe selection as well as the effective indication to RCM examination. In this review article, indications for the use of RCM are described in detail with a schematic approach for practical purposes.
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Affiliation(s)
- Chiara Franceschini
- Clinical Dermatology Department, San Gallicano Dermatological Institute (IRCCS), Rome, Italy
| | - Flavia Persechino
- Clinical Dermatology Department, San Gallicano Dermatological Institute (IRCCS), Rome, Italy.,Department of Clinical and Molecular Medicine, Sapienza University of Rome, Italy
| | - Marco Ardigò
- Clinical Dermatology Department, San Gallicano Dermatological Institute (IRCCS), Rome, Italy
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8
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Melo DF, De Carvalho N, Ardigò M, Pellacani G, Mota ANCDM, Barreto TDM, Jorge Machado C, Pineiro‐Maceira JM, Barcaui CB. Concordance among in vivo reflectance confocal microscopy, trichoscopy, and histopathology in the evaluation of scalp discoid lupus. Skin Res Technol 2020; 26:675-682. [DOI: 10.1111/srt.12852] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Accepted: 03/02/2020] [Indexed: 12/22/2022]
Affiliation(s)
- Daniel Fernandes Melo
- Dermatology Department University of State of Rio de Janeiro (UERJ) Rio de Janeiro Brazil
- Dermatology Department Marcílio Dias Naval Hospital Rio de Janeiro Brazil
| | | | - Marco Ardigò
- Clinical Dermatology San Galicano Dermatology Institute‐IRCCS Rome Italy
| | - Giovanni Pellacani
- Dermatology Department University of Modena and Reggio Emilia Modena Italy
| | - Amanda Nascimento Cavalleiro de Mac Mota
- Dermatology Department University of State of Rio de Janeiro (UERJ) Rio de Janeiro Brazil
- Dermatology Department Central Aeronautics Hospital Rio de Janeiro Brazil
| | | | - Carla Jorge Machado
- Preventive and Social Medicine Department Federal University of Minas Gerais Belo Horizonte Brazil
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9
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Yap FB. The Role of Combination Calcipotriol plus Betamethasone Dipropionate Gel in the Treatment of Moderate-to-Severe Scalp Seborrhoeic Dermatitis. Sultan Qaboos Univ Med J 2019; 18:e520-e523. [PMID: 30988973 DOI: 10.18295/squmj.2018.18.04.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Revised: 09/04/2018] [Accepted: 09/20/2018] [Indexed: 11/16/2022] Open
Abstract
Objectives This study aimed to investigate the off-label use of a combination calcipotriol plus betamethasone dipropionate (CBD) gel in the treatment of moderate-to-severe scalp seborrhoeic dermatitis (SSD). Methods This retrospective study involved 32 patients with SSD who were prescribed CBD gel at the Subang Jaya Medical Centre, Selangor, Malaysia, between January 2016 and December 2017. The Physician Global Assessment Scale was used to assess disease severity. Itching/discomfort was evaluated using a visual analogue scale. Results The mean age was 35.8 ± 6.9 years. Severe disease was seen in 53.1%. Complete clearance was recorded in 15.6%, 40.6% and 59.4% of patients at weeks two, six and 10, respectively. By week 10, 87.5% had achieved marked improvement. Both mean itching and discomfort scores significantly improved at weeks two, six and 10 (P <0.001). Better outcomes were significantly associated with disease duration and itching intensity and discomfort at presentation (P <0.050). Conclusion CBD gel should be considered as an option for SSD cases not adequately controlled by prior conventional treatment.
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Affiliation(s)
- Felix B Yap
- Department of Medicine, Faculty of Medicine & Health Sciences, Universiti Tunku Abdul Rahman, Kajang, Selangor, Malaysia
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10
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Ianoși SL, Forsea AM, Lupu M, Ilie MA, Zurac S, Boda D, Ianosi G, Neagoe D, Tutunaru C, Popa CM, Caruntu C. Role of modern imaging techniques for the in vivo diagnosis of lichen planus. Exp Ther Med 2018; 17:1052-1060. [PMID: 30679973 PMCID: PMC6327670 DOI: 10.3892/etm.2018.6974] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Accepted: 08/21/2018] [Indexed: 12/21/2022] Open
Abstract
Lichen planus (LP) is a chronic inflammatory skin disease that can sometimes affect mucosal surfaces, with unknown pathogenesis, even though it appears to be an autoimmune disease. The diagnosis of lichen planus is usually based on histopathological examination of the lesions. Nowadays, the classical invasive diagnostic methods are replaced by modern non-invasive techniques. In this review, we present the main non-invasive imaging methods (dermoscopy, reflectance confocal microscopy, optical coherence tomography, ultrasound and diffuse reflection spectrophotometry) used in the diagnosis and therapeutic monitoring of lichen planus. Dermoscopy is a non-invasive method initially used for diagnosis of pigmented tumors but now is used also for inflammatory and infectious skin diseases. In lichen planus, the dermoscopy increases the accuracy of diagnosis, avoids skin biopsies commonly used and can be useful in the therapeutic monitoring by repeated investigation at different stages of treatment. Reflectance confocal microscopy (RCM) is a novel non-invasive imaging technique that is prevalently used for the diagnosis of skin tumors and inflammatory skin diseases. This technology has been mostly employed for bedside, real-time microscopic evaluation of psoriasis, lichen planus, contact dermatitis, revealing specific confocal features to support clinical diagnosis and assist with patient management. Optical coherence tomography (OCT) is an emergent imaging technique, developed over the last decade, based on the interaction of the infrared radiation (900–1,500 nm) and the living tissues. A limited information exists on the benefits of OCT technology for the in vivo diagnosis of LP but could be a useful auxiliary tool in the in vivo differential diagnosis, especially in clinical equivocal settings like mucosal lesions, and in monitoring the response to treatment. Our review shows the possibility of using modern imaging techniques for the in vivo diagnosis and also for evaluation of the treatment response.
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Affiliation(s)
- Simona Laura Ianoși
- Department of Dermatology, University of Medicine and Pharmacy of Craiova, Emergency County Hospital, 200349 Craiova, Romania
| | - Ana Maria Forsea
- Department of Dermatology, 'Carol Davila' University of Medicine and Pharmacy, Elias Emergency University Hospital, 011461 Bucharest, Romania
| | - Mihai Lupu
- Department of Dermatology, 'Carol Davila' University of Medicine and Pharmacy, Elias Emergency University Hospital, 011461 Bucharest, Romania
| | - Mihaela Adriana Ilie
- Department of Biochemistry, 'Carol Davila' University of Medicine and Pharmacy, 050474 Bucharest, Romania.,Dermatology Research Laboratory, 'Carol Davila' University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | - Sabina Zurac
- Department of Pathology, 'Carol Davila' University of Medicine and Pharmacy, 050474 Bucharest, Romania.,Department of Pathology, 'Colentina' University Hospital, 020125 Bucharest, Romania
| | - Daniel Boda
- Dermatology Research Laboratory, 'Carol Davila' University of Medicine and Pharmacy, 050474 Bucharest, Romania.,Carol Medical Center, 010626 Bucharest, Romania
| | - Gabriel Ianosi
- Department of Surgery, University of Medicine and Pharmacy of Craiova, Military Hospital, 200349 Craiova, Romania
| | - Daniela Neagoe
- Department of Internal Medicine, University of Medicine and Pharmacy of Craiova, Emergency County Hospital, 200349 Craiova, Romania
| | - Cristina Tutunaru
- Department of Dermatology, University of Medicine and Pharmacy of Craiova, Emergency County Hospital, 200349 Craiova, Romania
| | - Cristina Maria Popa
- Department of Dermatology, University of Medicine and Pharmacy of Craiova, Emergency County Hospital, 200349 Craiova, Romania
| | - Constantin Caruntu
- Department of Physiology, 'Carol Davila' University of Medicine and Pharmacy, 050474 Bucharest, Romania.,Department of Dermatology, 'Prof. N. Paulescu' National Institute of Diabetes, Nutrition and Metabolic Diseases, 011233 Bucharest, Romania
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11
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Lacarrubba F, Ardigò M, Di Stefani A, Verzì AE, Micali G. Dermatoscopy and Reflectance Confocal Microscopy Correlations in Nonmelanocytic Disorders. Dermatol Clin 2018; 36:487-501. [PMID: 30201157 DOI: 10.1016/j.det.2018.05.015] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Dermatoscopy and in vivo reflectance confocal microscopy are noninvasive techniques that provide a horizontal approach, with an en face view of the skin structures. Both techniques assist in the clinical diagnosis of a variety of inflammatory and infectious cutaneous disorders. In many cases, they have shown concordance. Their combined use represents, in several instances, a promising option to reach the final diagnosis without the need for invasive procedures.
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Affiliation(s)
- Francesco Lacarrubba
- Dermatology Clinic, University of Catania, Via Santa Sofia 78, Catania 95123, Italy.
| | - Marco Ardigò
- Department of Clinical Dermatology, San Gallicano Dermatological Institute, Rome, Italy
| | | | - Anna Elisa Verzì
- Dermatology Clinic, University of Catania, Via Santa Sofia 78, Catania 95123, Italy
| | - Giuseppe Micali
- Dermatology Clinic, University of Catania, Via Santa Sofia 78, Catania 95123, Italy
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Batani A, Brănișteanu DE, Ilie MA, Boda D, Ianosi S, Ianosi G, Caruntu C. Assessment of dermal papillary and microvascular parameters in psoriasis vulgaris using in vivo reflectance confocal microscopy. Exp Ther Med 2017; 15:1241-1246. [PMID: 29434710 PMCID: PMC5774437 DOI: 10.3892/etm.2017.5542] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Accepted: 09/06/2017] [Indexed: 11/05/2022] Open
Abstract
In vivo reflectance confocal microscopy (RCM) is a modern, non-invasive imaging technique, which allows for real-time examination of the upper layers of the skin at a resolution similar to that of classic microscopy. In addition, it has the advantage of real-time evaluation of blood flow and dynamic monitoring of cutaneous changes while preserving tissue integrity. The present study reported on the in vivo RCM technique as an objective method for the noninvasive assessment of psoriasis vulgaris that is potentially applicable in clinical studies and in monitoring the evolution of lesions under treatment. In psoriasis lesions, RCM virtual horizontal sections at the level of the dermo-epidermal junction featured numerous and prominent dermal papillae that were not surrounded by bright rings of basal cells. Micromorphological examination of the lesions using this technique revealed that mean values of the section area, the perimeter and the Feret's diameter of the dermal papillae were significantly higher in psoriatic lesions than in normal skin. An increased number of capillary vessels per lesional dermal papilla as compared to healthy skin was observed. Furthermore, micromorphological parameters of dermal capillaries were increased in psoriatic skin. These observations point to the utility of in vivo RCM as a promising technique for the non-invasive diagnosis of psoriasis vulgaris, for monitoring the evolution of lesions at a micromorphological level under various treatments and for gaining a better understanding of the pathophysiological processes that occur in the evolution of this disease.
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Affiliation(s)
- Alexandra Batani
- Dermatology Research Laboratory, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | - Daciana Elena Brănișteanu
- Department of Dermatology, 'Grigore T. Popa' University of Medicine and Pharmacy, 700115 Iassy, Romania
| | - Mihaela Adriana Ilie
- Dermatology Research Laboratory, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | - Daniel Boda
- Dermatology Research Laboratory, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | - Simona Ianosi
- Department of Dermatology, University of Medicine and Pharmacy, 200349 Craiova, Romania
| | - Gabriel Ianosi
- Department of Surgery, Clinical Military Hospital, University of Medicine and Pharmacy, 200349 Craiova, Romania
| | - Constantin Caruntu
- Physiology Department, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania.,Department of Dermatology, N. Paulescu National Institute of Diabetes, Nutrition and Metabolic Diseases, 011233 Bucharest, Romania
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14
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Agozzino M, Noal C, Lacarrubba F, Ardigò M. Monitoring treatment response in psoriasis: current perspectives on the clinical utility of reflectance confocal microscopy. PSORIASIS-TARGETS AND THERAPY 2017; 7:27-34. [PMID: 29387605 PMCID: PMC5774604 DOI: 10.2147/ptt.s107514] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Reflectance confocal microscopy (RCM) evaluation of inflammatory skin diseases represents a relatively new technique that, during the past 5 years, has attracted increasing interest, with consequent progressive increment of publications in literature. The success of RCM is directly related to the high need for noninvasive techniques able to both reduce the number of skin biopsies and support clinical diagnosis and patient management. RCM helps to visualize microscopic descriptors of plaque psoriasis (PP) with good reproducibility between observers and a high grade of correspondence with histopathology. Several clinical tests are used for the therapeutic management of PP, but they are limited by subjective interpretation. Skin biopsy presents objective interpretation, but the procedure is invasive and not repeatable. RCM has been used not only for the evaluation of skin cancer or inflammatory skin diseases, but also for monitoring the efficacy of different treatments in PP. In this review, we present some examples of RCM applications in therapeutic psoriasis follow-up.
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Affiliation(s)
| | - Cecilia Noal
- Dermatology Unit, University of Trieste, Trieste
| | | | - Marco Ardigò
- Clinical Dermatology Department, San Gallicano Dermatological Institute, Istituto di Ricovero e Cura a Carattere Scientifico, Rome, Italy
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Ma YF, Yuan C, Jiang WC, Wang XL, Humbert P. Reflectance confocal microscopy for the evaluation of sensitive skin. Skin Res Technol 2016; 23:227-234. [PMID: 27782310 DOI: 10.1111/srt.12327] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/23/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND Nowadays, the diagnosis for sensitive skin relies on subjective assessment or on the combination of subjective and objective evaluation. No quantitative evaluation is available. It could be expected that confocal microscopy imaging could be of interest to better define the condition. METHODS Total 166 healthy female subjects were recruited in this study. Firstly, all subjects completed the sensitive questionnaire. Then, the cutaneous structures were measured by the reflectance confocal microscopy (RCM) on the face and fossa cubitalia. The lactic acid sting test was conducted finally. According to the results of self-perception sensitive skin questionnaire and lactic acid stinging test to evaluate facial skin sensitivity the both positive subjects were regarded as sensitive skin group and both negative group as healthy control group. RESULT The results of RCM indicating that the proportion of 'disarranged honeycomb pattern' and 'spongiform edema' in the sensitive group and healthy control group were statistically different (P < 0.05), respectively; The following report 'damaged dermal papilla rings' was not a distinctive pattern, with no significant statistical difference (P > 0.05). The epidermal thickness was 38.88 ± 6.81 μm, healthy control group was 40.31 ± 9.37 μm in, respectively, sensitive skin group and healthy control group, there was no significant statistical difference between the two groups (P > 0.05). The honeycomb structure depth of sensitive group was 20.57 ± 4.86 μm. It was for 23.27 ± 6.38 μm, healthy control group the difference being statistically different between the two groups (P < 0.05). CONCLUSION Based on the RCM results, 'epidermal honeycomb structure' and 'spongiform edema' may be used as new skin signs of RCM evaluation of sensitive skin effectively. Indeed, sensitive skin honeycomb structure depth was thinner compared with healthy control group. Such a specific pattern has good clinical and monitoring value for the further exploration. RCM could provide new data and patterns for the evaluation of sensitive skin.
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Affiliation(s)
- Y-F Ma
- Department of Skin and Cosmetic Research, Shanghai Skin Disease Hospital, Shanghai, China
| | - C Yuan
- Department of Skin and Cosmetic Research, Shanghai Skin Disease Hospital, Shanghai, China
| | - W-C Jiang
- Department of Skin and Cosmetic Research, Shanghai Skin Disease Hospital, Shanghai, China
| | - X-L Wang
- Department of Phototherapy, Shanghai Skin Disease Hospital, Shanghai, China
| | - P Humbert
- Research and Studies Center on the Integument (CERT), Department of Dermatology, Clinical Investigation Center (CIC INSERM 1431), Besançon University Hospital, Besançon, France.,INSERM UMR1098, FED4234 IBCT, University of Franche-Comté, Besançon, France
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Agozzino M, Gonzalez S, Ardigò M. Reflectance Confocal Microscopy for Inflammatory Skin Diseases. ACTAS DERMO-SIFILIOGRAFICAS 2016. [DOI: 10.1016/j.adengl.2016.01.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Reflectance Confocal Microscopy for Inflammatory Skin Diseases. ACTAS DERMO-SIFILIOGRAFICAS 2016; 107:631-9. [DOI: 10.1016/j.ad.2016.01.010] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Revised: 01/10/2016] [Accepted: 01/28/2016] [Indexed: 11/23/2022] Open
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Ardigo M, Agozzino M, Franceschini C, Lacarrubba F. Reflectance Confocal Microscopy Algorithms for Inflammatory and Hair Diseases. Dermatol Clin 2016; 34:487-496. [DOI: 10.1016/j.det.2016.05.011] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Ardigò M, Agozzino M, Franceschini C, Donadio C, Abraham LS, Barbieri L, Sperduti I, Berardesca E, González S. Reflectance confocal microscopy for scarring and non-scarring alopecia real-time assessment. Arch Dermatol Res 2016; 308:309-18. [DOI: 10.1007/s00403-016-1657-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Revised: 03/21/2016] [Accepted: 05/17/2016] [Indexed: 10/21/2022]
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Ardigo M, Longo C, Gonzalez S. Multicentre study on inflammatory skin diseases from The International Confocal Working Group: specific confocal microscopy features and an algorithmic method of diagnosis. Br J Dermatol 2016; 175:364-74. [DOI: 10.1111/bjd.14516] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/29/2016] [Indexed: 11/28/2022]
Affiliation(s)
- M. Ardigo
- San Gallicano Dermatological Institute-IRCCS; Via Chianesi 53 00144 Rome Italy
| | - C. Longo
- Dermatology Unit; Arcispedale ASMN-IRCCS; Reggio Emilia Italy
| | - S. Gonzalez
- Department of Medicine and Medical Specialties; University de Alcalà; Madrid Spain
- Memorial Sloan Kettering Cancer Center; New York NY U.S.A
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Hoogedoorn L, Gerritsen MJP, Wolberink EAW, Peppelman M, van de Kerkhof PCM, van Erp PEJ. A four-phase strategy for the implementation of reflectance confocal microscopy in dermatology. J Eur Acad Dermatol Venereol 2016; 30:1308-14. [PMID: 27038136 DOI: 10.1111/jdv.13627] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Accepted: 01/14/2016] [Indexed: 12/31/2022]
Abstract
BACKGROUND Reflectance confocal microscopy (RCM) is gradually implemented in dermatology. Strategies for further implementation and practical 'hands on' guidelines are lacking. OBJECTIVE The primary outcome was to conduct a general strategy for further implementation of RCM. The secondary outcome was the diagnosis of psoriasis and differentiation of stable from unstable psoriatic plaques by means of the 'hands on' protocol, derived from the strategy. METHODS We used a four-phased model; an exploring phase, a systematic literature search, a clinical approach and, finally, an integration phase to develop a clinical guideline for RCM in psoriasis. Receiver operating characteristic curve statistics was applied to define the accuracy for the diagnosis of unstable psoriasis. RESULTS A general strategy for further implementation of RCM and practical approach was developed to examine psoriasis by RCM and to distinguish stable from unstable psoriasis. Unstable psoriasis was diagnosed by epidermal inflammatory cell counts with a sensitivity and specificity of 91.7% and 98.3%, respectively, and with an accuracy of 0.92 (area under the curve). In addition, a monitoring model was proposed. CONCLUSION This is the first study that shows a method for implementation of RCM in dermatology. The strategy and hands on protocol for psoriasis may serve as a model for other dermatological entities and additionally may lead to specialized ready-to-use RCM protocols for clinical dermatological practice.
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Affiliation(s)
- L Hoogedoorn
- Department of Dermatology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - M J P Gerritsen
- Department of Dermatology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - E A W Wolberink
- Department of Dermatology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - M Peppelman
- Department of Dermatology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - P C M van de Kerkhof
- Department of Dermatology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - P E J van Erp
- Department of Dermatology, Radboud University Medical Center, Nijmegen, The Netherlands
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Ardigò M, Agozzino M, Longo C, Lallas A, Di Lernia V, Fabiano A, Conti A, Sperduti I, Argenziano G, Berardesca E, Pellacani G. Reflectance confocal microscopy for plaque psoriasis therapeutic follow-up during an anti-TNF-α monoclonal antibody: an observational multicenter study. J Eur Acad Dermatol Venereol 2015; 29:2363-8. [DOI: 10.1111/jdv.13235] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2015] [Accepted: 05/21/2015] [Indexed: 11/29/2022]
Affiliation(s)
- M. Ardigò
- Department of Clinical Dermatology; San Gallicano Dermatological Institute-IRCCS; Rome Italy
| | - M. Agozzino
- Department of Clinical Dermatology; San Gallicano Dermatological Institute-IRCCS; Rome Italy
| | - C. Longo
- Dermatology Unit; Arcispedale ASMN; Reggio Emilia Italy
| | - A. Lallas
- Dermatology Unit; Arcispedale ASMN; Reggio Emilia Italy
| | - V. Di Lernia
- Dermatology Unit; Arcispedale ASMN; Reggio Emilia Italy
| | - A. Fabiano
- Dermatology Department; University of Modena and Reggio Emilia; Modena Italy
| | - A. Conti
- Dermatology Department; University of Modena and Reggio Emilia; Modena Italy
| | - I. Sperduti
- Biostatistical Unit; Scientific Direction; San Gallicano Dermatological Institute-IRCCS; Rome Italy
| | - G. Argenziano
- Dermatology Unit; Second University of Naples; Naples Italy
| | - E. Berardesca
- Department of Clinical Dermatology; San Gallicano Dermatological Institute-IRCCS; Rome Italy
| | - G. Pellacani
- Dermatology Department; University of Modena and Reggio Emilia; Modena Italy
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