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Magnaterra E, Mariotti EB, Corrà A, Aimo C, Quintarelli L, Ruffo di Calabria V, Verdelli A, Caproni M. Reply to 'New onset of systemic lupus erythematosus following COVID-19 mRNA vaccination'. J Eur Acad Dermatol Venereol 2024; 38:e366-e367. [PMID: 38069559 DOI: 10.1111/jdv.19693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 11/22/2023] [Indexed: 04/26/2024]
Affiliation(s)
- E Magnaterra
- Section of Dermatology, Department of Health Sciences, University of Florence, Florence, Italy
| | - E B Mariotti
- Section of Dermatology, Department of Health Sciences, University of Florence, Florence, Italy
| | - A Corrà
- Section of Dermatology, Department of Health Sciences, University of Florence, Florence, Italy
| | - C Aimo
- Section of Dermatology, Department of Health Sciences, University of Florence, Florence, Italy
| | - L Quintarelli
- Rare Diseases Unit, Section of Dermatology, Department of Health Sciences, Azienda USL Toscana Centro, European Reference Network-Skin Member, University of Florence, Florence, Italy
| | - V Ruffo di Calabria
- Section of Dermatology, Department of Health Sciences, University of Florence, Florence, Italy
| | - A Verdelli
- Rare Diseases Unit, Section of Dermatology, Department of Health Sciences, Azienda USL Toscana Centro, European Reference Network-Skin Member, University of Florence, Florence, Italy
| | - M Caproni
- Rare Diseases Unit, Section of Dermatology, Department of Health Sciences, Azienda USL Toscana Centro, European Reference Network-Skin Member, University of Florence, Florence, Italy
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Nazzaro G, Carugno A, Bortoluzzi P, Buffon S, Astrua C, Zappia E, Trovato E, Caccavale S, Pellegrino V, Paolino G, Balestri R, Lacava R, Ciccarese G, Verdelli A, Barruscotti S, Valenti M, Toni G, Giacalone S, Zavattaro E, Gironi LC, Mercuri SR, Ribero S, Gisondi P, Sena P, Marzano AV. Efficacy and tolerability of tirbanibulin 1% ointment in the treatment of cancerization field: a real-life Italian multicenter observational study of 250 patients. Int J Dermatol 2024. [PMID: 38605473 DOI: 10.1111/ijd.17168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Revised: 03/16/2024] [Accepted: 03/19/2024] [Indexed: 04/13/2024]
Abstract
BACKGROUND Tirbanibulin 1% ointment is approved for the field treatment of Olsen grade I actinic keratoses (AKs) of the face and scalp. METHODS We performed a multicenter retrospective study involving 15 dermatologic units in Italy to investigate the efficacy and tolerability of tirbanibulin in a real-life setting. 250 patients were enrolled. Tirbanibulin, 1% ointment, was applied daily for five consecutive days. The efficacy of treatment was measured with modifications of the Actinic Keratosis Area and Severity Index (AKASI). A satisfactory response was defined by complete (100% reduction in the number of lesions) or partial clearance (75-99%) of treated AKs. RESULTS Overall, the AKASI score was significantly reduced in the studied population (mean, from 4.1 ± 2.7 to 1.4 ± 1.5; P < 0.001). A satisfactory response was observed in 222 (88.8%) cases. The proportion of satisfactory responses was higher when follow-up was performed after 8 weeks (34/35, 97.1%). The reduction in AKASI was significant in patients with Olsen grade II or III lesions (from 5.3 ± 2.8 to 1.6 ± 1.6; P < 0.001). A satisfactory response was observed in 91/104 (87.5%) cases. AKASI reduction was also significant in patients with trunk or limb AKs (from 7.0 ± 1.3 to 2.0 ± 1.6; P = 0.018) since a satisfactory response was observed in 7/8 (87.5%) cases. Tirbanibulin was well tolerated; all adverse events (AEs) included transient local reactions at the site of treatment. Overall, 231 patients had at least one AE. Only 7 (2.8%) grade 4 AEs were recorded. CONCLUSION Our retrospective study confirmed that tirbanibulin 1% ointment is effective and well tolerated in a real-life setting and is also promising for Olsen grade II and grade III AKs and AKs localized on difficult-to-treat areas.
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Affiliation(s)
- Gianluca Nazzaro
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Andrea Carugno
- Dermatology Unit, ASST Papa Giovanni XXIII, Bergamo, Italy
- University of Milan-Bicocca, Milan, Italy
| | - Paolo Bortoluzzi
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Stefano Buffon
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Physiopathology and Transplantation, University of Milan, Milan, Italy
| | - Chiara Astrua
- Department of Medical Sciences, University of Turin, Dermatology Clinic, Turin, Italy
| | - Elena Zappia
- Department of Medical Sciences, University of Turin, Dermatology Clinic, Turin, Italy
- Magna Graecia University, Catanzaro, Italy
| | - Emanuele Trovato
- Dermatology Unit, Department of Medical, Surgical and Neurological Sciences, University of Siena, Siena, Italy
| | - Stefano Caccavale
- Dermatology Unit, Department of Mental and Physical Health and Preventive Medicine, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Vincenzo Pellegrino
- Dermatology Unit, Department of Mental and Physical Health and Preventive Medicine, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Giovanni Paolino
- Unit of Dermatology, IRCCS Ospedale San Raffaele, Milan, Italy
- Unit of Dermatologic Clinic, Università Vita-Salute, San Raffaele, Milan, Italy
| | - Riccardo Balestri
- Division of Dermatology, Azienda Provinciale per i Servizi Sanitari (APSS), Trento and Rovereto, Italy
| | - Rossella Lacava
- Division of Dermatology, Azienda Provinciale per i Servizi Sanitari (APSS), Trento and Rovereto, Italy
| | - Giulia Ciccarese
- Unit of Dermatology, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Alice Verdelli
- Section of Dermatology, Department of Health Sciences, USL Toscana Centre, European Reference Network-Skin Member, University of Florence, Florence, Italy
| | - Stefania Barruscotti
- Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
- Dermatology Clinic, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Mario Valenti
- Dermatology Unit, IRCCS Humanitas Research Hospital, Rozzano, Italy
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Giulia Toni
- Section of Dermatology and Infectious Diseases, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Serena Giacalone
- Institute of Dermatology, ASST Valle Olona, Ospedale Sant'Antonio Abate, Gallarate, Italy
| | - Elisa Zavattaro
- Department of Health Science, University of Eastern Piedmont, Novara, Italy
| | - Laura C Gironi
- Department of Health Science, University of Eastern Piedmont, Novara, Italy
| | - Santo R Mercuri
- Unit of Dermatology, IRCCS Ospedale San Raffaele, Milan, Italy
- Unit of Dermatologic Clinic, Università Vita-Salute, San Raffaele, Milan, Italy
| | - Simone Ribero
- Department of Medical Sciences, University of Turin, Dermatology Clinic, Turin, Italy
| | - Paolo Gisondi
- Section of Dermatology and Venereology, Department of Medicine, University of Verona, Verona, Italy
| | - Paolo Sena
- Dermatology Unit, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Angelo V Marzano
- Dermatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Physiopathology and Transplantation, University of Milan, Milan, Italy
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3
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Aimo C, Mariotti EB, Corrà A, Quintarelli L, Ruffo DI Calabria V, Bianchi B, Del Bianco E, Verdelli A, Benucci M, Caproni M. A case of dermatomyositis induced by SARS-CoV-2 infection. Ital J Dermatol Venerol 2024; 159:214-215. [PMID: 38436615 DOI: 10.23736/s2784-8671.24.07807-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/05/2024]
Affiliation(s)
- Cristina Aimo
- Section of Dermatology, Department of Health Sciences, University of Florence, Florence, Italy -
| | - Elena B Mariotti
- Section of Dermatology, Department of Health Sciences, University of Florence, Florence, Italy
| | - Alberto Corrà
- Section of Dermatology, Department of Health Sciences, University of Florence, Florence, Italy
| | - Lavinia Quintarelli
- Section of Dermatology, Department of Health Sciences, University of Florence, Florence, Italy
- Unit of Rare Diseases, Section of Dermatology, Department of Health Sciences, AUSL Toscana Centro, University of Florence, Florence, Italy
| | | | - Beatrice Bianchi
- Section of Dermatology, Department of Health Sciences, University of Florence, Florence, Italy
| | - Elena Del Bianco
- Section of Dermatology, Department of Health Sciences, University of Florence, Florence, Italy
| | - Alice Verdelli
- Section of Dermatology, Department of Health Sciences, University of Florence, Florence, Italy
- Unit of Rare Diseases, Section of Dermatology, Department of Health Sciences, AUSL Toscana Centro, University of Florence, Florence, Italy
| | - Maurizio Benucci
- Unit of Rheumatology, S. Giovanni di Dio Hospital, AUSL Toscana Centro, Florence, Italy
| | - Marzia Caproni
- Section of Dermatology, Department of Health Sciences, University of Florence, Florence, Italy
- Unit of Rare Diseases, Section of Dermatology, Department of Health Sciences, AUSL Toscana Centro, University of Florence, Florence, Italy
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Mariotti EB, Corrà A, Aimo C, Ruffo di Calabria V, Quintarelli L, Verdelli A, Caproni M. Exacerbation of clinical manifestations of bullous pemphigoid after treatment with dupilumab. Clin Exp Dermatol 2024; 49:399-400. [PMID: 38011325 DOI: 10.1093/ced/llad412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Revised: 11/14/2023] [Accepted: 11/21/2023] [Indexed: 11/29/2023]
Abstract
The article presents an adverse event that occurred after the induction phase of dupilumab, administered in another country to a patient affected by bullous pemphigoid.
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Affiliation(s)
| | - Alberto Corrà
- Section of Dermatology, Department of Health Sciences, University of Florence, Florence, Italy
| | - Cristina Aimo
- Section of Dermatology, Department of Health Sciences, University of Florence, Florence, Italy
| | | | - Lavinia Quintarelli
- Rare Diseases Unit, Section of Dermatology, Department of Health Sciences, USL Toscana Centre, European Reference Network-Skin Member, University of Florence, Florence, Italy
| | - Alice Verdelli
- Rare Diseases Unit, Section of Dermatology, Department of Health Sciences, USL Toscana Centre, European Reference Network-Skin Member, University of Florence, Florence, Italy
| | - Marzia Caproni
- Rare Diseases Unit, Section of Dermatology, Department of Health Sciences, USL Toscana Centre, European Reference Network-Skin Member, University of Florence, Florence, Italy
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Mariotti EB, Corrà A, Aimo C, Ruffo di Calabria V, Cavazza G, Quintarelli L, Verdelli A, Mariotti F, Di Zenzo G, Caproni M. Linear deposits of IgM along the dermo-epidermal junction possibly associated with non-classical clinical features in bullous pemphigoid. J Eur Acad Dermatol Venereol 2024; 38:e169-e171. [PMID: 37709552 DOI: 10.1111/jdv.19515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 09/08/2023] [Indexed: 09/16/2023]
Affiliation(s)
| | - Alberto Corrà
- Section of Dermatology, Department of Health Sciences, University of Florence, Florence, Italy
| | - Cristina Aimo
- Section of Dermatology, Department of Health Sciences, University of Florence, Florence, Italy
| | | | - Gabriele Cavazza
- Section of Dermatology, Department of Health Sciences, University of Florence, Florence, Italy
| | - Lavinia Quintarelli
- Rare Diseases Unit, Section of Dermatology, Department of Health Sciences, Azienda USL Toscana Centro, European Reference Network-Skin Member, University of Florence, Florence, Italy
| | - Alice Verdelli
- Rare Diseases Unit, Section of Dermatology, Department of Health Sciences, Azienda USL Toscana Centro, European Reference Network-Skin Member, University of Florence, Florence, Italy
| | - Feliciana Mariotti
- Molecular and Cell Biology Laboratory, Istituto Dermopatico dell'Immacolata (IDI)-IRCCS, Rome, Italy
| | - Giovanni Di Zenzo
- Molecular and Cell Biology Laboratory, Istituto Dermopatico dell'Immacolata (IDI)-IRCCS, Rome, Italy
| | - Marzia Caproni
- Rare Diseases Unit, Section of Dermatology, Department of Health Sciences, Azienda USL Toscana Centro, European Reference Network-Skin Member, University of Florence, Florence, Italy
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Ruffo di Calabria V, Verdelli A, Quintarelli L, Corrà A, Mariotti EB, Aimo C, Del Bianco E, Bianchi B, Maio V, Massi D, Caproni M. Case Report: Resolution of Lichen Planus Pemphigoides as an unexpected outcome of SARS-CoV-2 infection. Front Immunol 2023; 14:1222459. [PMID: 37503348 PMCID: PMC10368974 DOI: 10.3389/fimmu.2023.1222459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Accepted: 06/26/2023] [Indexed: 07/29/2023] Open
Abstract
It is well known that viral infections play a relevant role in inducing or protecting from autoimmune diseases, thus representing a major environmental factor in the disruption of the immune system in genetically susceptible individuals. Since the beginning of the Covid-19 pandemic a great number of clinical and epidemiological studies have demonstrated that SARS-CoV-2 infection is no exception to the rule by interfering on many different levels in the normal functioning of our immune system. Even though a growing number of case series and case reports has been cited in the literature linking the infection to the new onset of autoimmune diseases, to date very little has been reported concerning a possible correlation between the virus and the clinical resolution of any kind of autoimmune pathology. Here we describe an interesting case of abrupt and unexpected resolution of Lichen planus pemphigoides mucocutaneous lesions in a fully vaccinated patient after a mildly symptomatic SARS-CoV-2 respiratory infection and we speculate on the possible underlying mechanisms correlating the two events.
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Affiliation(s)
| | - Alice Verdelli
- Rare Skin Diseases Unit, Department of Health Sciences, Azienda USL Toscana Centro (ERN-SKIN), University of Florence, Florence, Italy
| | - Lavinia Quintarelli
- Rare Skin Diseases Unit, Department of Health Sciences, Azienda USL Toscana Centro (ERN-SKIN), University of Florence, Florence, Italy
| | - Alberto Corrà
- Section of Dermatology, Department of Health Sciences, University of Florence, Florence, Italy
| | | | - Cristina Aimo
- Section of Dermatology, Department of Health Sciences, University of Florence, Florence, Italy
| | - Elena Del Bianco
- Section of Dermatology, Department of Health Sciences, University of Florence, Florence, Italy
| | - Beatrice Bianchi
- Section of Dermatology, Department of Health Sciences, University of Florence, Florence, Italy
| | - Vincenza Maio
- Section of Anatomic Pathology, Azienda USL Toscana Centro, Florence, Italy
| | - Daniela Massi
- Section of Anatomic Pathology, Department of Health Sciences, University of Florence, Florence, Italy
| | - Marzia Caproni
- Rare Skin Diseases Unit, Department of Health Sciences, Azienda USL Toscana Centro (ERN-SKIN), University of Florence, Florence, Italy
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Verdelli A, Corrà A, Mariotti EB, Aimo C, Quintarelli L, Ruffo di Calabria V, Donati ME, Bonciolini V, Antiga E, Caproni M. Skin gluten-related disorders: new and old cutaneous manifestations to be considered. Front Med (Lausanne) 2023; 10:1155288. [PMID: 37265490 PMCID: PMC10229844 DOI: 10.3389/fmed.2023.1155288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 04/28/2023] [Indexed: 06/03/2023] Open
Abstract
The term gluten-related disorders (GRD) refer to a spectrum of different clinical manifestations triggered by the ingestion of gluten in genetically susceptible individuals, including coeliac disease (CD), wheat allergy and non-celiac gluten sensitivity (NCGS). GRD are characterized by a large variety of clinical presentations with both intestinal and extra-intestinal manifestations. The latter may affect almost every organ of the body, including the skin. Besides the well-known association between CD and dermatitis herpetiformis, considered as the cutaneous specific manifestation of CD, many other muco-cutaneous disorders have been associated to GRD. In this review, we analyzed the main features of dermatological diseases with a proven association with GRD and those that improve after a gluten-free diet, focusing on the newly described cutaneous manifestations associated with NCGS. Our main hypothesis is that a "cutaneous-gluten sensitivity," as specific cutaneous manifestation of NCGS, may exist and could represent a diagnostic marker of NCGS.
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Affiliation(s)
- Alice Verdelli
- Department of Health Sciences, Rare Dermatological Diseases Unit, Azienda USL Toscana Centro, European Reference Network-Skin Member, Florence, Italy
| | - Alberto Corrà
- Section of Dermatology, Department of Health Sciences, University of Florence, Florence, Italy
| | | | - Cristina Aimo
- Section of Dermatology, Department of Health Sciences, University of Florence, Florence, Italy
| | - Lavinia Quintarelli
- Department of Health Sciences, Rare Dermatological Diseases Unit, Azienda USL Toscana Centro, European Reference Network-Skin Member, Florence, Italy
| | | | - Marta Elettra Donati
- Section of Dermatology, Department of Health Sciences, University of Florence, Florence, Italy
| | | | - Emiliano Antiga
- Section of Dermatology, Department of Health Sciences, University of Florence, Florence, Italy
| | - Marzia Caproni
- Department of Health Sciences, Rare Dermatological Diseases Unit, Azienda USL Toscana Centro, European Reference Network-Skin Member, Florence, Italy
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Bonan P, Fusco I, Bruscino N, Madeddu F, Troiano M, Verdelli A, Piccolo D, Rampino G. Laser-assisted blepharoplasty: An innovative safe and effective technique. Skin Res Technol 2023; 29:e13351. [PMID: 37231919 PMCID: PMC10189347 DOI: 10.1111/srt.13351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 05/04/2023] [Indexed: 05/27/2023]
Abstract
BACKGROUND Blepharoplasty is one of the most popular esthetic procedures with an acceptable risk profile and a relatively quick procedure. METHODS The aim was to evaluate the efficacy and safety of a new CO2 and 1540-nm laser-assisted blepharoplasty technique applied to the upper and lower eyelids. A total of 38 patients were enrolled. Photographs were taken before the treatment and at 6-month follow-up. One "blind" observer assessed the performance of this technique by ranking the results in four categories of eyelid esthetic: 1 = no or poor results (0%-25%), 2 = slight improvement (25%-50%), 3 = moderate improvement (50%-75%) and 4 = marked improvement (75%-100%). All possible complications were monitored. RESULTS Thirty-two patients (84 %) achieved marked improvement, four patients (11%) moderate improvement, two patients (5 %) slight improvement, while zero subjects (0%) poor or no improvement. No serious adverse effects were observed. CONCLUSIONS Our results from clinical evaluations suggest that the CO2 and 1540-nm laser assisted blepharoplasty is proved to be a sophisticate intervention efficacious in improving the treatment of patients with various degrees of eyelid and periocular aging and also in reducing downtime.
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Affiliation(s)
- Paolo Bonan
- Laser Cutaneous Cosmetic and Plastic Surgery UnitVilla Donatello ClinicFlorenceItaly
| | | | - Nicola Bruscino
- Laser Cutaneous Cosmetic and Plastic Surgery UnitVilla Donatello ClinicFlorenceItaly
| | | | - Michela Troiano
- Laser Cutaneous Cosmetic and Plastic Surgery UnitVilla Donatello ClinicFlorenceItaly
| | - Alice Verdelli
- Laser Cutaneous Cosmetic and Plastic Surgery UnitVilla Donatello ClinicFlorenceItaly
| | - Domenico Piccolo
- Skin Center – Dermal‐Aesthetic Laser Centres, Avezzano, Pescara and L'AquilaPescaraItaly
| | - Giuseppe Rampino
- Laser Cutaneous Cosmetic and Plastic Surgery UnitVilla Donatello ClinicFlorenceItaly
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Verdelli A, Bonan P, Fusco I, Madeddu F, Piccolo D. Striae Distensae: Clinical Results and Evidence-Based Evaluation of a Novel 675 nm Laser Wavelength. Medicina (Kaunas) 2023; 59:medicina59050841. [PMID: 37241073 DOI: 10.3390/medicina59050841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 03/31/2023] [Accepted: 04/21/2023] [Indexed: 05/28/2023]
Abstract
Background: A current popular aesthetic problem, especially among younger women, is striae distensae (SD), also referred to as "stretch marks.". Aim: The potential use of the 675 nm laser has been investigated in the treatment of SD. Methods: Patients underwent three sessions of the 675 nm laser with a 1-month interval between sessions. A total of three sessions were performed. The Manchester Scar Scale was used to assess stretch mark changes, and the mean scores related to each parameter at baseline and 6M FU after the last treatment session were measured. A clinical photographic evaluation was performed to show the aesthetic improvement of SD. Results: The patients' treated areas were the abdomen, thighs, buttocks, and breasts. Mean scores related to each Manchester Scar Scale parameter, with their relative percentage change, at baseline and 6M FU after the last treatment session were significantly improved. The total mean Manchester Scar Scale score significantly diminished from 14.16 (±1.30) to 10.06 (±1.32) at 6M FU (p < 0.01). The clinical photographs showed promising aesthetic SD improvement. Conclusions: 675 nm laser therapy demonstrated a good tolerance for the treatment of stretch marks applied to various body areas preventing any discomfort for the patient and with a significant improvement in skin texture.
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Affiliation(s)
- Alice Verdelli
- Laser Cutaneous Cosmetic and Plastic Surgery Unit, Villa Donatello Clinic, 50121 Florence, Italy
| | - Paolo Bonan
- Laser Cutaneous Cosmetic and Plastic Surgery Unit, Villa Donatello Clinic, 50121 Florence, Italy
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Magnaterra E, Magliulo M, Mariotti EB, Ruffo DI Calabria V, Quintarelli L, Corrà A, Aimo C, Verdelli A, Caproni M. Subacute cutaneous lupus erythematosus induced by Pfizer COVID-19 vaccine. Ital J Dermatol Venerol 2023:S2784-8671.23.07373-5. [PMID: 36881332 DOI: 10.23736/s2784-8671.23.07373-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2023]
Affiliation(s)
- Elisabetta Magnaterra
- Section of Dermatology, Department of Health Sciences, University of Florence, Florence, Italy -
| | - Manfredi Magliulo
- Section of Dermatology, Department of Health Sciences, University of Florence, Florence, Italy
| | - Elena B Mariotti
- Section of Dermatology, Department of Health Sciences, University of Florence, Florence, Italy
| | | | - Lavinia Quintarelli
- Section of Dermatology, Department of Health Sciences, University of Florence, Florence, Italy
| | - Alberto Corrà
- Section of Dermatology, Department of Health Sciences, University of Florence, Florence, Italy
| | - Cristina Aimo
- Section of Dermatology, Department of Health Sciences, University of Florence, Florence, Italy
| | - Alice Verdelli
- Section of Dermatology, Department of Health Sciences, University of Florence, Florence, Italy
| | - Marzia Caproni
- Unit of Rare Diseases, Department of Health Sciences, P.O. Piero Palagi, AUSL Toscana Centro, University of Florence, Florence, Italy
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Della Bella C, Corrà A, Mantengoli E, Galano A, Benagiano M, Bonciani D, Mariotti EB, Pratesi S, Quintarelli L, Aimo C, Grassi A, D'Elios S, Volpi W, Verdelli A, Bartoloni A, Rossolini GM, D'Elios MM, Caproni M. Skin IL-17A and IFN-γ Production Correlate with Disease Severity in Patients with Psoriasis and Streptococcal Infection. J Invest Dermatol 2023; 143:925-932. [PMID: 36642401 DOI: 10.1016/j.jid.2022.10.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 10/04/2022] [Accepted: 10/06/2022] [Indexed: 01/15/2023]
Abstract
Psoriasis is a multisystemic inflammatory disorder mainly involving the skin and joints, whose etiopathogenesis is still not completely understood. An association with streptococcal throat infection has been suggested. We aim to investigate a correlation between IL-17A and IFN-γ production by T cells infiltrating skin lesions and PASI in 313 patients with psoriasis, compared with that in 252 healthy controls. The phenotype of β-hemolytic Streptococci-specific infiltrating T cells in skin lesions was evaluated and characterized for IFN-γ, IL-4, and IL-17A production. In addition, PBMCs were tested by ELISpot for IFN-γ and IL-17A after streptococcal antigen exposure. A total of 64 of 313 (20.4%) patients with psoriasis had throat streptococcal infection. Of the 3,868 skin-derived T-cell clones from psoriasis with streptococcal infection, 66% proliferated in response to β-hemolytic Streptococci antigens. Most β-hemolytic Streptococci-specific T cells displayed T helper 17 and T helper 1 phenotypes. The levels of IFN-γ and IL-17A secreted by skin-infiltrating T cells of patients with psoriasis significantly correlated with PASI score. In β-hemolytic Streptococci-positive patients, IFN-γ and IL-17A production by peripheral blood T cells after stimulation with streptococcal antigens was quantified by ELISpot. The results obtained may suggest ELISpot as a useful diagnostic tool to identify patients with psoriasis that may deserve antibiotic treatment.
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Affiliation(s)
- Chiara Della Bella
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy; Department of Molecular and Developmental Medicine, University of Siena, Siena, Italy
| | - Alberto Corrà
- Section of Dermatology, Department of Health Sciences, University of Florence, Florence, Italy
| | | | - Angelo Galano
- Microbiology and Virology Unit, Careggi University Hospital, Florence, Italy
| | - Marisa Benagiano
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | | | | | - Sara Pratesi
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Lavinia Quintarelli
- Immunopathology and Rare Skin Diseases Unit, Section of Dermatology, Department of Health Sciences, Azienda Unità Sanitaria Locale Toscana Centro, University of Florence, Florence, Italy
| | - Cristina Aimo
- Section of Dermatology, Department of Health Sciences, University of Florence, Florence, Italy
| | - Alessia Grassi
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Sofia D'Elios
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Walter Volpi
- Immunopathology and Rare Skin Diseases Unit, Section of Dermatology, Department of Health Sciences, Azienda Unità Sanitaria Locale Toscana Centro, University of Florence, Florence, Italy
| | - Alice Verdelli
- Immunopathology and Rare Skin Diseases Unit, Section of Dermatology, Department of Health Sciences, Azienda Unità Sanitaria Locale Toscana Centro, University of Florence, Florence, Italy
| | - Alessandro Bartoloni
- Infectious and Tropical Diseases Unit, Careggi University Hospital, Florence, Italy
| | - Gian Maria Rossolini
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy; Microbiology and Virology Unit, Careggi University Hospital, Florence, Italy
| | - Mario Milco D'Elios
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy; Department of Molecular and Developmental Medicine, University of Siena, Siena, Italy
| | - Marzia Caproni
- Immunopathology and Rare Skin Diseases Unit, Section of Dermatology, Department of Health Sciences, Azienda Unità Sanitaria Locale Toscana Centro, University of Florence, Florence, Italy.
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12
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Quintarelli L, Magnaterra E, Maglie R, Corrà A, Ruffo di Calabria V, Aimo C, Mariotti EB, Verdelli A, Maio V, Antiga E, Caproni M. Lepromatous leprosy presenting with erythema nodosum leprosum mimicking Bechet's disease. Travel Med Infect Dis 2022; 52:102521. [PMID: 36528249 DOI: 10.1016/j.tmaid.2022.102521] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Accepted: 12/09/2022] [Indexed: 12/16/2022]
Affiliation(s)
- L Quintarelli
- Rare Diseases Unit, Azienda USL Toscana Centro, European Reference Network-Skin Member, Department of Health Sciences, University of Florence, Florence, Italy
| | - E Magnaterra
- Department of Health Sciences, Section Dermatology, University of Florence, Italy.
| | - R Maglie
- Department of Health Sciences, Section Dermatology, University of Florence, Italy
| | - A Corrà
- Department of Health Sciences, Section Dermatology, University of Florence, Italy
| | - V Ruffo di Calabria
- Department of Health Sciences, Section Dermatology, University of Florence, Italy
| | - C Aimo
- Department of Health Sciences, Section Dermatology, University of Florence, Italy
| | - E B Mariotti
- Department of Health Sciences, Section Dermatology, University of Florence, Italy
| | - A Verdelli
- Rare Diseases Unit, Azienda USL Toscana Centro, European Reference Network-Skin Member, Department of Health Sciences, University of Florence, Florence, Italy
| | - V Maio
- Department of Health Sciences, University of Florence, Florence, Italy
| | - E Antiga
- Department of Health Sciences, Section Dermatology, University of Florence, Italy
| | - M Caproni
- Department of Health Sciences, University of Florence, Florence, Italy
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13
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Corrà A, Verdelli A, Mariotti EB, Ruffo di Calabria V, Quintarelli L, Aimo C, Sunderkötter CH, Caproni M. Cutaneous vasculitis: Lessons from COVID-19 and COVID-19 vaccination. Front Med (Lausanne) 2022; 9:1013846. [PMID: 36569148 PMCID: PMC9780506 DOI: 10.3389/fmed.2022.1013846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Accepted: 10/28/2022] [Indexed: 12/14/2022] Open
Abstract
Cutaneous vasculitis (CV) is an inflammatory skin-limited vascular disease affecting the dermal and/or hypodermal vessel wall. From the pathogenetic point of view, idiopathic forms are described as well as the induction from various triggers, such as drugs, infections, and vaccines. Following SARS-CoV-2 pandemic outbreak, cases of CV induced by both COVID-19 and COVID-19 vaccinations have been reported in literature. The aim of our work was to collect multiple cases available in the literature and analyze the frequency of the different forms of induced vasculitis, as well as their histological and immunopathological features. Although rare, CV induced by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) and vaccines may provide interesting insights into the pathogenesis of these inflammatory processes that may in the future be useful to understand the mechanisms underlying cutaneous and systemic vasculitis.
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Affiliation(s)
- Alberto Corrà
- Section of Dermatology, Department of Health Sciences, University of Florence, Florence, Italy
| | - Alice Verdelli
- Immunopathology and Rare Skin Diseases Unit, Department of Health Sciences, Azienda USL Toscana Centro (ERN-SKIN), University of Florence, Florence, Italy
| | | | | | - Lavinia Quintarelli
- Immunopathology and Rare Skin Diseases Unit, Department of Health Sciences, Azienda USL Toscana Centro (ERN-SKIN), University of Florence, Florence, Italy
| | - Cristina Aimo
- Section of Dermatology, Department of Health Sciences, University of Florence, Florence, Italy
| | - Cord H. Sunderkötter
- Department of Dermatology and Venereology, University Hospital Halle (Saale), Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - Marzia Caproni
- Immunopathology and Rare Skin Diseases Unit, Department of Health Sciences, Azienda USL Toscana Centro (ERN-SKIN), University of Florence, Florence, Italy,*Correspondence: Marzia Caproni ;
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14
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Caproni M, Calabria VRD, Mariotti EB, Verdelli A, Aimo C, Corrà A, Quintarelli L, Volpi W, Alpsoy E, Sunderkötter C. The impact on the scientific community of the 2018 addendum to the CHCC. Front Med (Lausanne) 2022; 9:1081063. [DOI: 10.3389/fmed.2022.1081063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 11/02/2022] [Indexed: 12/02/2022] Open
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15
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Mariotti EB, Corrà A, Lemmi E, Laschi L, Aimo C, Quintarelli L, Volpi W, Nacci F, Verdelli A, Ruffo di Calabria V, Guiducci S, Caproni M. Multicentric Reticulohistiocytosis Associated with an Early Form of Systemic Lupus Erythematosus: A Case Report of a Rare Disease, with Mini Review of the Literature. J Clin Med 2022; 11:6529. [PMID: 36362761 PMCID: PMC9658768 DOI: 10.3390/jcm11216529] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 10/16/2022] [Accepted: 11/01/2022] [Indexed: 08/10/2023] Open
Abstract
Multicentric reticulohistiocytosis (MRH) is the most frequently described form of reticulohistiocytosis (RH), and it is classified as a class IIb non-Langerhans cell histiocytosis. It has been designated as multicentric, being characterized by multisystemic involvement. In fact, although mainly involving the skin, along with the joints, it is a systemic inflammatory condition potentially involving every internal organ. As MRH-related skin findings can mimic rheumatoid nodules or Gottron papules, the histopathology of the cutaneous lesions is often necessary for the correct diagnosis. Approximately one-third of MRH patients have confirmed concomitant autoimmune disorders. A wide variety of autoimmune disorders associated with the disease have been reported in the literature, suggesting immune dysfunction as a factor in the pathophysiology of MRH. A case of MRH associated with autoimmune manifestation is reported in the context of a mini review of the literature, with a focus on clinical presentation, treatments, and treatment outcomes. Moreover, eight cases of MRH associated with autoimmune diseases are briefly discussed.
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Affiliation(s)
| | - Alberto Corrà
- Section of Dermatology, Department of Health Sciences, University of Florence, 50125 Florence, Italy
| | - Elisa Lemmi
- Section of Anatomical Pathology, Department of Health Sciences, University of Florence, 50125 Florence, Italy
| | - Lucrezia Laschi
- Section of Anatomical Pathology, Department of Health Sciences, University of Florence, 50125 Florence, Italy
| | - Cristina Aimo
- Section of Dermatology, Department of Health Sciences, University of Florence, 50125 Florence, Italy
| | - Lavinia Quintarelli
- Rare Disease Skin Unit, Section of Dermatology, Azienda USL Toscana Centro, University of Florence, 50125 Florence, Italy
| | - Walter Volpi
- Section of Dermatology, Azienda USL Toscana Centro, 50125 Florence, Italy
| | - Francesca Nacci
- Section of Rheumatology, Department of Clinical and Experimental Medicine, University of Florence, 50125 Florence, Italy
| | - Alice Verdelli
- Section of Dermatology, Azienda USL Toscana Centro, 50125 Florence, Italy
| | | | - Serena Guiducci
- Section of Rheumatology, Department of Clinical and Experimental Medicine, University of Florence, 50125 Florence, Italy
| | - Marzia Caproni
- Rare Disease Skin Unit, Section of Dermatology, Azienda USL Toscana Centro, University of Florence, 50125 Florence, Italy
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16
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Verdelli A, Caproni M, Coi A, Corrà A, Degl’Innocenti D, Vasarri M, Quintarelli L, Volpi V, Cipollini EM, Barletta E. Neutrophil Gelatinase-Associated Lipocalin as Potential Predictive Biomarker of Melanoma and Non-Melanoma Skin Cancers in Psoriatic Patients: A Pilot Study. Int J Mol Sci 2022; 23:ijms232012291. [PMID: 36293148 PMCID: PMC9603947 DOI: 10.3390/ijms232012291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 09/15/2022] [Accepted: 10/04/2022] [Indexed: 11/07/2022] Open
Abstract
Background: Studies have demonstrated a higher risk of nonmelanoma skin cancers (NMSC) and a modestly increased melanoma risk in patients with psoriasis. To date, no biomarkers predictive of evolution have been identified yet. Methods: The aim of this prospective case-control study was to investigate the potential role of neutrophil gelatinase-associated lipocalin (NGAL) as a predictive biomarker of skin cancers in psoriatic patients. Patients with a diagnosis of psoriasis were enrolled, as well as healthy subjects and patients with skin cancers as controls. Plasma protein expression of NGAL, metalloproteinases (MMP)-2, and MMP-9 was performed by an enzyme-linked immunosorbent assay (ELISA). In all the patients who developed skin cancer at follow-up, NGAL, MMP-2, and MMP-9 serum levels were dosed again. Results: Plasma NGAL levels were significantly higher in psoriatic patients with NMSC than without (182.3 ± 36.6 ng/mL vs. 139.9 ± 39.3 ng/mL) (p < 0.001). Plasma NGAL levels were significantly higher (p < 0.00001) in patients with psoriasis and NMSC than in patients with skin tumors without psoriasis (182.3 vs. 122.9). Patients with psoriasis who developed NMSC at follow-up showed increased plasma MMP-9 levels. Conclusion: NGAL seems to play a role in the pathogenesis of NMSC but not melanoma in patients with psoriasis.
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Affiliation(s)
- Alice Verdelli
- Department of Health Sciences, Section of Dermatology, Rare Dermatological Unit, Azienda USL Toscana Centro, University of Florence, 50125 Florence, Italy
- Correspondence: ; Tel.: +39-055-6939664
| | - Marzia Caproni
- Department of Health Sciences, Section of Dermatology, Rare Dermatological Unit, Azienda USL Toscana Centro, University of Florence, 50125 Florence, Italy
| | - Alessio Coi
- Unit of Epidemiology of Rare Diseases and Congenital Anomalies, Institute of Clinical Physiology, National Research Council, 56127 Pisa, Italy
| | - Alberto Corrà
- Department of Health Sciences, Section of Dermatology, University of Florence, 50125 Florence, Italy
| | - Donatella Degl’Innocenti
- Department of Experimental and Clinical Biomedical Sciences, University of Florence, Viale Morgagni 50, 50134 Florence, Italy
| | - Marzia Vasarri
- Department of Experimental and Clinical Biomedical Sciences, University of Florence, Viale Morgagni 50, 50134 Florence, Italy
| | - Lavinia Quintarelli
- Department of Health Sciences, Section of Dermatology, Rare Dermatological Unit, Azienda USL Toscana Centro, University of Florence, 50125 Florence, Italy
| | - Valter Volpi
- Department of Health Sciences, Section of Dermatology, Rare Dermatological Unit, Azienda USL Toscana Centro, University of Florence, 50125 Florence, Italy
| | - Emanuele Maria Cipollini
- Department of Health Sciences, Section of Dermatology, Rare Dermatological Unit, Azienda USL Toscana Centro, University of Florence, 50125 Florence, Italy
| | - Emanuela Barletta
- Department of Experimental and Clinical Biomedical Sciences, University of Florence, Viale Morgagni 50, 50134 Florence, Italy
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Verdelli A, Corrà A, Mariotti EB, Aimo C, Ruffo di Calabria V, Volpi W, Quintarelli L, Caproni M. An update on the management of refractory cutaneous lupus erythematosus. Front Med (Lausanne) 2022; 9:941003. [PMID: 36213629 PMCID: PMC9537468 DOI: 10.3389/fmed.2022.941003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 08/29/2022] [Indexed: 11/15/2022] Open
Abstract
Management of cutaneous lupus erythematosus (CLE) involves a combination of preventive measures, topical and systemic drugs, fairly similar for the different subtypes. Although guidelines exist, to date, no specific drugs have been specifically licensed for CLE. Antimalarials remain the first-line systemic treatment, but many patients do not respond, making refractory lupus a challenge for clinicians. The choice of alternative medication should be based on effectiveness, safety and cost. Most of the available drugs for CLE have been adapted from systemic lupus erythematosus (SLE) treatment but the existing literature is limited to small studies and evidence often lacks. As knowledge of pathogenesis of both CLE and SLE is improving, promising new therapies are emerging. In this review, we discuss the available medications, focusing on the novelties under development for CLE.
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Affiliation(s)
- Alice Verdelli
- Section of Dermatology, Azienda USL Toscana Centro, Florence, Italy
| | - Alberto Corrà
- Section of Dermatology, University of Florence, Florence, Italy
| | | | - Cristina Aimo
- Section of Dermatology, University of Florence, Florence, Italy
| | | | - Walter Volpi
- Section of Dermatology, Azienda USL Toscana Centro, Florence, Italy
| | - Lavinia Quintarelli
- Rare Dermatological Diseases Unit, Department of Health Sciences, Azienda USL Toscana Centro, University of Florence, Florence, Italy
| | - Marzia Caproni
- Rare Dermatological Diseases Unit, Department of Health Sciences, Azienda USL Toscana Centro, University of Florence, Florence, Italy
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18
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Corrá A, Barei F, Genovese G, Zussino M, Spigariolo CB, Mariotti EB, Quintarelli L, Verdelli A, Caproni M, Marzano AV. Five cases of new-onset pemphigus following vaccinations against coronavirus disease 2019. J Dermatol 2022; 50:229-233. [PMID: 35975548 PMCID: PMC9538601 DOI: 10.1111/1346-8138.16554] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Revised: 07/23/2022] [Accepted: 08/03/2022] [Indexed: 02/04/2023]
Abstract
Pemphigus is a group of blistering disorders characterized by the formation of intraepithelial blisters in skin and mucous membranes induced by the binding of circulating autoantibodies to intercellular adhesion molecules. The pathogenesis is complex and not fully understood; however, genetic predisposition and various triggers are widely accepted as key factors in pemphigus development. A few cases of new-onset pemphigus following coronavirus disease 2019 (COVID-19) vaccination have already been published. The present paper reports a total of two cases of pemphigus foliaceous and three cases of pemphigus vulgaris that occurred following vaccinations against COVID-19, with anamnestic, clinical, and diagnostic data collection suggesting assumptions over a possible causal correlation.
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Affiliation(s)
- Alberto Corrá
- Section of Dermatology, Department of Health ScienceUniversity of Florence ‐ Piero Palagi HospitalFlorenceItaly
| | - Francesca Barei
- Unit of DermatologyFondazione IRCCS Ca’ Granda Ospedale Maggiore PoliclinicoMilanItaly,Department of Pathophysiology and transplantationUniversity of MilanMilanItaly
| | - Giovanni Genovese
- Unit of DermatologyFondazione IRCCS Ca’ Granda Ospedale Maggiore PoliclinicoMilanItaly,Department of Pathophysiology and transplantationUniversity of MilanMilanItaly
| | - Martina Zussino
- Unit of DermatologyFondazione IRCCS Ca’ Granda Ospedale Maggiore PoliclinicoMilanItaly
| | - Cristina B. Spigariolo
- Unit of DermatologyFondazione IRCCS Ca’ Granda Ospedale Maggiore PoliclinicoMilanItaly,Department of Pathophysiology and transplantationUniversity of MilanMilanItaly
| | - Elena B. Mariotti
- Section of Dermatology, Department of Health ScienceUniversity of Florence ‐ Piero Palagi HospitalFlorenceItaly
| | - Lavinia Quintarelli
- Rare Skin Diseases Unit, Azienda USL Toscana Centro, ERN‐SKIN member, Department of Health SciencesUniversity of FlorenceFlorenceItaly
| | - Alice Verdelli
- Rare Skin Diseases Unit, Azienda USL Toscana Centro, ERN‐SKIN member, Department of Health SciencesUniversity of FlorenceFlorenceItaly
| | - Marzia Caproni
- Rare Skin Diseases Unit, Azienda USL Toscana Centro, ERN‐SKIN member, Department of Health SciencesUniversity of FlorenceFlorenceItaly
| | - Angelo V. Marzano
- Unit of DermatologyFondazione IRCCS Ca’ Granda Ospedale Maggiore PoliclinicoMilanItaly,Department of Pathophysiology and transplantationUniversity of MilanMilanItaly
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19
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Aimo C, Mariotti EB, Corrà A, Quintarelli L, Bianchi B, Verdelli A, Ruffo di Calabria V, Caproni M. Lymphedema of the Arm after COVID-19 Vaccination in a Patient with Hidden Breast Cancer and Paraneoplastic Dermatomyositis. Vaccines (Basel) 2022; 10:vaccines10081219. [PMID: 36016107 PMCID: PMC9416749 DOI: 10.3390/vaccines10081219] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 07/23/2022] [Accepted: 07/26/2022] [Indexed: 12/17/2022] Open
Abstract
The pandemic outbreak of Coronavirus Disease 2019 (COVID-19) led to the development of mRNA vaccines. With the extensive vaccination campaign performed worldwide, many adverse reactions to these drugs have been reported in the literature. Although most of them are mild and self-limiting, they may sometimes cause psychological stress and require efforts to make a differential diagnosis with other conditions. This is the case of lymphadenopathies and lymphedema in patients with a history of cancer. Herein we present a case of lymphedema of the arm developed ten days after a VAXZEVRIA COVID-19 vaccine shot in a patient who had concomitant signs and symptoms compatible with a diagnosis of dermatomyositis. It was later classified as paraneoplastic as instrumental investigation revealed a breast carcinoma contralateral to the site of vaccine injection. With this report we ponder an adverse reaction to COVID-19 vaccination with the aim of bringing new data for clinicians who face similar clinical presentations, particularly controversial for radiologists and oncologists.
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Affiliation(s)
- Cristina Aimo
- Section of Dermatology, Department of Health Sciences, University of Florence, 50125 Florence, Italy; (E.B.M.); (A.C.); (L.Q.); (B.B.); (A.V.); (V.R.d.C.); (M.C.)
- Correspondence:
| | - Elena Biancamaria Mariotti
- Section of Dermatology, Department of Health Sciences, University of Florence, 50125 Florence, Italy; (E.B.M.); (A.C.); (L.Q.); (B.B.); (A.V.); (V.R.d.C.); (M.C.)
| | - Alberto Corrà
- Section of Dermatology, Department of Health Sciences, University of Florence, 50125 Florence, Italy; (E.B.M.); (A.C.); (L.Q.); (B.B.); (A.V.); (V.R.d.C.); (M.C.)
| | - Lavinia Quintarelli
- Section of Dermatology, Department of Health Sciences, University of Florence, 50125 Florence, Italy; (E.B.M.); (A.C.); (L.Q.); (B.B.); (A.V.); (V.R.d.C.); (M.C.)
- Rare Diseases Unit, Azienda USL Toscana Centro, Section of Dermatology, Department of Health Sciences, University of Florence, European Reference Network Skin Member, 50125 Florence, Italy
| | - Beatrice Bianchi
- Section of Dermatology, Department of Health Sciences, University of Florence, 50125 Florence, Italy; (E.B.M.); (A.C.); (L.Q.); (B.B.); (A.V.); (V.R.d.C.); (M.C.)
| | - Alice Verdelli
- Section of Dermatology, Department of Health Sciences, University of Florence, 50125 Florence, Italy; (E.B.M.); (A.C.); (L.Q.); (B.B.); (A.V.); (V.R.d.C.); (M.C.)
- Rare Diseases Unit, Azienda USL Toscana Centro, Section of Dermatology, Department of Health Sciences, University of Florence, European Reference Network Skin Member, 50125 Florence, Italy
| | - Valentina Ruffo di Calabria
- Section of Dermatology, Department of Health Sciences, University of Florence, 50125 Florence, Italy; (E.B.M.); (A.C.); (L.Q.); (B.B.); (A.V.); (V.R.d.C.); (M.C.)
| | - Marzia Caproni
- Section of Dermatology, Department of Health Sciences, University of Florence, 50125 Florence, Italy; (E.B.M.); (A.C.); (L.Q.); (B.B.); (A.V.); (V.R.d.C.); (M.C.)
- Rare Diseases Unit, Azienda USL Toscana Centro, Section of Dermatology, Department of Health Sciences, University of Florence, European Reference Network Skin Member, 50125 Florence, Italy
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20
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Quintarelli L, Coi A, Maglie R, Corrà A, Mariotti EB, Aimo C, Ruffo di Calabria V, Verdelli A, Bianchi B, Del Bianco E, Antiga E, Caproni M. Clinical Patterns, Survival, Comorbidities, and Treatment Regimens in 149 Patients With Pemphigus in Tuscany (Italy): A 12-Year Hospital-Based Study. Front Immunol 2022; 13:895490. [PMID: 35880183 PMCID: PMC9307892 DOI: 10.3389/fimmu.2022.895490] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Accepted: 06/08/2022] [Indexed: 11/13/2022] Open
Abstract
IntroductionPemphigus encompasses a group of muco-cutaneous autoimmune bullous diseases characterized by the loss of adhesion between keratinocytes. The disease is associated with increased morbidity and mortality.Materials and MethodsWe characterized clinical patterns, survival, comorbidities, and drug prescriptions in patients with pemphigus referred to the Section of Dermatology of the University of Florence from January 2010 to December 2021.ResultsA total of 149 patients were identified (female/male sex ratio = 2.0). Median age at diagnosis was 57.7 ± 17.2 years; 108 patients were diagnosed with pemphigus vulgaris (PV) (72.5%) and 35 (23.5%) with pemphigus foliaceus (PF). Paraneoplastic pemphigus (PNP) and IgA-pemphigus accounted for three patients each. The overall survival rate was 86.9%. Accordingly, 14 (9%) patients died during the study period. The average age at death was 77.8 ± 9.3. Age at diagnosis was a risk factor for death in patients with pemphigus. Average concentration of Dsg3-IgG and Dsg1-IgG was 85.6 ± 68.8 and 75.9 ± 68.4, respectively. The most serious comorbid diseases included cerebro- and cardiovascular accidents and malignancies. Regarding the treatment regimen, we found a substantially stable use of systemic steroids in the 2010–2018 period; the prevalence of use of mycophenolic acid increased, whereas that of azathioprine decreased. The use of rituximab showed the highest increase in the 2013–2018 period. Proton-pump inhibitors and antibiotics were the most frequently prescribed non-immunomodulating drugs.ConclusionsIn this large series of the patients, patients with pemphigus showed a high incidence of serious comorbid diseases, highlighting the importance of a multidisciplinary approach for a proper management of the patients. Rituximab was the immunomodulating drug showing the highest increase in use over time, reflecting the growing evidence of its efficacy as a first-line treatment in pemphigus.
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Affiliation(s)
- Lavinia Quintarelli
- Rare Skin Diseases Unit, Section of Dermatology, Department of Health Sciences, Unità Sanitaria Locale (USL) Toscana Centro, European Reference Network-Skin Member, University of Florence, Florence, Italy
| | - Alessio Coi
- Unit of Epidemiology of Rare Diseases and Congenital Anomalies, Institute of Clinical Physiology, National Research Council, Pisa, Italy
| | - Roberto Maglie
- Department of Health Sciences, Section of Dermatology, University of Florence, Florence, Italy
| | - Alberto Corrà
- Department of Health Sciences, Section of Dermatology, University of Florence, Florence, Italy
| | | | - Cristina Aimo
- Department of Health Sciences, Section of Dermatology, University of Florence, Florence, Italy
| | | | - Alice Verdelli
- Rare Skin Diseases Unit, Section of Dermatology, Department of Health Sciences, Unità Sanitaria Locale (USL) Toscana Centro, European Reference Network-Skin Member, University of Florence, Florence, Italy
| | - Beatrice Bianchi
- Department of Health Sciences, Section of Dermatology, University of Florence, Florence, Italy
| | - Elena Del Bianco
- Department of Health Sciences, Section of Dermatology, University of Florence, Florence, Italy
| | - Emiliano Antiga
- Department of Health Sciences, Section of Dermatology, University of Florence, Florence, Italy
| | - Marzia Caproni
- Rare Skin Diseases Unit, Section of Dermatology, Department of Health Sciences, Unità Sanitaria Locale (USL) Toscana Centro, European Reference Network-Skin Member, University of Florence, Florence, Italy
- *Correspondence: Marzia Caproni,
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21
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Benucci M, Damiani A, Infantino M, Manfredi M, Lari B, Grossi V, Mariotti EB, Corrà A, Aimo C, Quintarelli L, Verdelli A, Li Gobbi F, Antiga E, Caproni M. Vaccination for SARS-CoV-2 in Patients With Psoriatic Arthritis: Can Therapy Affect the Immunological Response? Front Med (Lausanne) 2022; 9:811829. [PMID: 35295608 PMCID: PMC8918942 DOI: 10.3389/fmed.2022.811829] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 01/25/2022] [Indexed: 12/13/2022] Open
Abstract
Background A few studies on vaccination in patients with rheumatic diseases, including arthritis, connective tissue diseases, vasculitis, and psoriatic arthropathy (PsA), demonstrated reduced production of neutralizing antibodies to SARS-CoV-2 Spike RBD (receptor-binding domain contained in the N-terminal of the S1 globular head region) when compared to the general population. Objective The aim of our study was to observe whether different therapies for PsA [methotrexate, anti-TNF antibodies, soluble TNF receptor (etanercept) or IL-17 inhibitors] have a different impact on SARS-CoV-2 vaccination in a homogeneous population of patients. Methods We enrolled 110 PsA patients in remission, assessed with Disease Activity in PSoriatic Arthritis (DAPSA). Of these: 63 were in treatment with anti-TNF-α therapy (26 etanercept, 15 certolizumab, 5 golimumab, 17 adalimumab); 37 with anti-IL17 secukinumab; 10 with methotrexate. All patients underwent vaccination for SARS-CoV-2 with mRNA BNT162b2 vaccine. Assessment of absolute and percentage lymphocyte subsets and anti-SARS-CoV-2 Spike RBD IgG antibody value 3 weeks after the second vaccine dose were performed. In addition, the serum antibody levels of 96 healthy healthcare workers (HCW) were analyzed. Results The mean disease activity assessed with DAPSA score was 2.96 (SD = 0.60) with no significant differences between patients under different medications (p = 0.779). Median levels of neutralizing antibodies to SARS-CoV-2 Spike RBD were 928.00 binding antibody unit (BAU)/mL [IQR 329.25, 1632.0]; 1068.00 BAU/ml [IQR 475.00, 1632.00] in patients taking MTX, 846.00 BAU/ml [IQR 125.00, 1632.00] in patients taking etanercept, 908.00 BAU/mL [IQR 396.00, 1632.00] in patients taking anti-IL17 and 1148.00 BAU/ml [IQR 327.00, 1632.00] in patients taking TNF-α inhibitors, without statistically significant differences between these groups. Mean serum antibody level of HCW group was 1562.00 BAU/ml [IQR 975.00, 1632.00], being significantly higher than in the patient group (p = 0.000816). Absolute and percentage count of lymphocyte subsets were not statistically different between the subgroups under different treatments and when compared with HCW. Conclusions As for other rheumatic diseases on immunomodulatory treatment, our data showed a reduced humoral response in PsA patients compared to the control group. However, antibody response did not significantly differ between groups treated with different medications.
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Affiliation(s)
- Maurizio Benucci
- Rheumatology Unit, S. Giovanni di Dio Hospital, Azienda USL-Toscana Centro Florence, Florence, Italy
| | - Arianna Damiani
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Florence, Florence, Italy
| | - Maria Infantino
- Immunology and Allergology Laboratory, S. Giovanni di Dio Hospital, Azienda USL-Toscana Centro, Florence, Italy
| | - Mariangela Manfredi
- Immunology and Allergology Laboratory, S. Giovanni di Dio Hospital, Azienda USL-Toscana Centro, Florence, Italy
| | - Barbara Lari
- Immunology and Allergology Laboratory, S. Giovanni di Dio Hospital, Azienda USL-Toscana Centro, Florence, Italy
| | - Valentina Grossi
- Immunology and Allergology Laboratory, S. Giovanni di Dio Hospital, Azienda USL-Toscana Centro, Florence, Italy
| | | | - Alberto Corrà
- Department of Health Sciences, Section of Dermatology, University of Florence, Florence, Italy
| | - Cristina Aimo
- Department of Health Sciences, Section of Dermatology, University of Florence, Florence, Italy
| | - Lavinia Quintarelli
- Rare Diseases Unit, Azienda USL Toscana Centro, European Reference Network-Skin Member, Department of Health Sciences, University of Florence, Florence, Italy
| | - Alice Verdelli
- Rare Diseases Unit, Azienda USL Toscana Centro, European Reference Network-Skin Member, Department of Health Sciences, University of Florence, Florence, Italy
| | - Francesca Li Gobbi
- Rheumatology Unit, S. Giovanni di Dio Hospital, Azienda USL-Toscana Centro Florence, Florence, Italy
| | - Emiliano Antiga
- Department of Health Sciences, Section of Dermatology, University of Florence, Florence, Italy
| | - Marzia Caproni
- Rare Diseases Unit, Azienda USL Toscana Centro, European Reference Network-Skin Member, Department of Health Sciences, University of Florence, Florence, Italy
- *Correspondence: Marzia Caproni
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22
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Bonan P, Verdelli A, Tognetti L, Guidi I, Sbano P, Rubegni P. Role of microwaves in edematous fibrosclerotic panniculopathy and skin laxity treatment: a preliminary study. Ital J Dermatol Venerol 2022; 156:104-106. [PMID: 35139634 DOI: 10.23736/s2784-8671.19.06497-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Paolo Bonan
- Unit of Laser Cutaneous Cosmetic and Plastic Surgery, Villa Donatello Clinic, Florence, Italy
| | - Alice Verdelli
- Unit of Laser Cutaneous Cosmetic and Plastic Surgery, Villa Donatello Clinic, Florence, Italy
| | - Linda Tognetti
- Unit of Dermatology, Department of Medical, Surgical and Neurosciences, Siena, Italy -
| | - Ivana Guidi
- Unit of Dermatology, Department of Medical, Surgical and Neurosciences, Siena, Italy
| | - Paolo Sbano
- Unit of Dermatology, Department of Medical, Surgical and Neurosciences, Siena, Italy
| | - Pietro Rubegni
- Unit of Dermatology, Department of Medical, Surgical and Neurosciences, Siena, Italy
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23
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Corrà A, Bonciolini V, Quintarelli L, Verdelli A, Caproni M. Linear IGA bullous dermatosis potentially triggered by vaccination. Int J Immunopathol Pharmacol 2022; 36:20587384211021218. [PMID: 35001680 PMCID: PMC8753231 DOI: 10.1177/20587384211021218] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Accepted: 05/06/2021] [Indexed: 11/16/2022] Open
Abstract
Linear IgA bullous dermatosis (LABD) is a mucocutaneous autoimmune blistering disease affecting both adults and children. It is caused by IgA antibodies targeting multiple antigens along the basement membrane zone, leading to disruption of dermoepidermal junction and development of bullous lesions which often presents in characteristic arrangement. Although most LABD cases have been reported to be idiopathic, different triggers have been described, including several drugs and infection. However, the occurrence of vaccine-induced cases of LABD is not widely known and accepted due to the few reports available. We present two cases of LABD occurred following different triggers, rising the suspicion for a possible pathogenetic role of vaccines.
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Affiliation(s)
- Alberto Corrà
- Section of Dermatology, Department of Health Sciences, University of Florence, Florence, Italy
| | - Veronica Bonciolini
- Dermatology Unit, Versilia Hospital, USL Toscana Nord-Ovest, Lido di Camaiore, Lucca, Italy
| | - Lavinia Quintarelli
- Section of Dermatology, Department of Health Sciences, University of Florence, Florence, Italy
| | - Alice Verdelli
- Department of Experimental and Clinical Biomedical Sciences ‘Mario Serio’, University of Florence, Florence, Italy
| | - Marzia Caproni
- Section of Dermatology, Department of Health Sciences, University of Florence, Florence, Italy
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24
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Filippini M, Sozzi J, Farinelli M, Verdelli A. Effects of Fractional CO 2 Laser Treatment on Patients Affected by Vulvar Lichen Sclerosus: A Prospective Study. Photobiomodul Photomed Laser Surg 2021; 39:782-788. [PMID: 34878932 DOI: 10.1089/photob.2021.0053] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: Fractional carbon dioxide (CO2) lasers are today considered the most effective and efficient treatment for many vulvovaginal disorders, providing mini-invasive procedures without side effects. Previous studies demonstrated the efficacy of fractional CO2 lasers in vulvar lichen sclerosus (VLS), a chronic skin disorder characterized by itching and painful lesions. Complications include pain, sexual and/or urinary dysfunction, with a negative quality of life, and an increased risk of squamous cell carcinoma. A definitive VLS treatment is still lacking. Objectives: This is a prospective, single-center study aimed at evaluating the effect of fractional microablative CO2 laser treatment on women affected by VLS. Materials and methods: Patients with histologically confirmed VLS underwent three fractional microablative CO2 laser treatments, 4 weeks apart, on the genital affected areas. Clinical and VLS-related symptoms, side effects, and patient satisfaction index were assessed and recorded for all the patients using the visual analog scale (VAS). Results: Data from a total of 70 patients were included, paired at different time points and analyzed. VLS-related symptoms and other relevant parameters (pH, vaginal introitus discomfort, dyspareunia, vaginal dryness, itching, and burning) showed a statistically significant improvement (p < 0.001) after the first laser treatment and kept improving after second and third sessions. According to VAS, the two most common symptoms, vaginal introitus discomfort and dyspareunia, went from (mean ± standard deviation) 8.2 ± 2.3 and 8.3 ± 2.2, respectively, at baseline, to 3.6 ± 2.6 and 3.8 ± 2.6, respectively, 1 month after the last treatment. Vaginal dryness, itching, and burning were significantly improved as well. Most patients declared to be very satisfied with the results of the treatment. A total of 62.8% of the women expressed a satisfaction score ≥8 on a scale from 0 to 10. Conclusions: Fractional microablative CO2 laser treatment seems to be safe and effective to treat VLS and improve VLS-related symptoms.
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Affiliation(s)
- Maurizio Filippini
- Department of Obstetrics and Gynecology, State Hospital of Republic of San Marino, San Marino, Republic of San Marino
| | - Jessica Sozzi
- Department of Obstetrics and Gynecology, State Hospital of Republic of San Marino, San Marino, Republic of San Marino
| | - Miriam Farinelli
- Department of Obstetrics and Gynecology, State Hospital of Republic of San Marino, San Marino, Republic of San Marino
| | - Alice Verdelli
- Laser Cutaneous Cosmetic and Plastic Surgery Unit, Villa Donatello Clinic, Florence, Italy
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25
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Corrà A, Quintarelli L, Verdelli A, Walter V, Caproni M. Exacerbation of generalized plaque psoriasis after tuberculin test. Dermatol Reports 2021; 13:9019. [PMID: 34880969 PMCID: PMC8611516 DOI: 10.4081/dr.2021.9019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Accepted: 03/17/2021] [Indexed: 11/23/2022] Open
Abstract
Koebner phenomenon, also known as isomorphic response, is the appearance of active skin lesions in sites of epidermal injury. This manifestation is characteristic of different dermatological diseases, such as lichen planus, vitiligo and psoriasis. We present the case of a psoriatic patient who experienced Koebner phenomenon after Mantoux test, followed by eruption of generalized plaque psoriasis.
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Affiliation(s)
- Alberto Corrà
- Section of Dermatology, Department of Health Sciences, University of Florence
| | - Lavinia Quintarelli
- Section of Dermatology, Department of Health Sciences, University of Florence
| | - Alice Verdelli
- Department of Experimental and Clinical Biomedical Sciences "Mario Serio", University of Florence, Italy
| | - Volpi Walter
- Section of Dermatology, Department of Health Sciences, University of Florence
| | - Marzia Caproni
- Section of Dermatology, Department of Health Sciences, University of Florence
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26
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Bonan P, Verdelli A, Pieri L, Fusco I, Linpiyawan R. Facial rejuvenation: A safe and effective treatment with a fractional non-ablative 675 nm laser in Asian population. J Cosmet Dermatol 2021; 20:4070-4072. [PMID: 34655459 DOI: 10.1111/jocd.14529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 09/27/2021] [Accepted: 10/04/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Paolo Bonan
- Laser Cutaneous Cosmetic & Plastic Surgery Unit, Villa Donatello Clinic, Florence, Italy
| | - Alice Verdelli
- Laser Cutaneous Cosmetic & Plastic Surgery Unit, Villa Donatello Clinic, Florence, Italy
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27
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Bonan P, Verdelli A, Pieri L, Fusco I. Could 675-nm Laser Treatment Be Effective for Facial Melasma Even in Darker Phototype? Photobiomodul Photomed Laser Surg 2021; 39:634-636. [PMID: 34597175 DOI: 10.1089/photob.2021.0076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Objective: The study assesses the safety and efficacy of a 675-nm laser source on melasma. Background: Melasma is a frequent acquired skin disease defined by the presence of hyperpigmented macules on the face. Methods: Study protocol included up to three sessions of the 675-nm laser. Objective evaluation was assessed by using a 5-point visual analogue pain scale (VAS) (range, 0-4). Treatment tolerance was assessed using the 5-point VAS. Results: A mean 3.1 ± 0.7 improvement was reached according to photographic evaluation by VAS. Patients treated one time showed mean clearance of 3.3 ± 0.76, patients treated two times showed mean clearance of 3.0 ± 0.71, and patients treated three times showed mean clearance of 3.0 ± 1. Pain score mean was 1.2 ± 0.4. Conclusions: The 675-nm laser system seems to be safe and effective even in the treatment of facial melasma in patients with Fitzpatrick phototypes IV to V.
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Affiliation(s)
- Paolo Bonan
- Laser Cutaneous Cosmetic and Plastic Surgery Unit, Villa Donatello Clinic, Florence, Italy
| | - Alice Verdelli
- Laser Cutaneous Cosmetic and Plastic Surgery Unit, Villa Donatello Clinic, Florence, Italy
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28
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Corrà A, Cammelli F, Quintarelli L, Barbato G, Le Rose O, Salemme A, Di Zenzo G, Coratti F, Verdelli A, Aimo C, Mariotti EB, Bianchi B, Cianchi F, Caproni M. Case Report: Management of Malignancy-Exacerbated Pemphigus Vulgaris During COVID-19 Pandemic. Front Med (Lausanne) 2021; 8:708284. [PMID: 34458285 PMCID: PMC8385714 DOI: 10.3389/fmed.2021.708284] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 07/05/2021] [Indexed: 12/09/2022] Open
Abstract
Pemphigus vulgaris is an intraepidermal autoimmune mucocutaneous blistering disease whose etiopathogenesis includes various trigger factors, i.e., drugs and malignancies. We present a case of malignancy-exacerbated pemphigus vulgaris which required a careful diagnostic process in order to rule out paraneoplastic pemphigus, along with the challenges posed by the need of treating both cutaneous and oncologic diseases. Possible post-operative complications post-poned the start of first-line immunosuppressive treatment of pemphigus. Moreover, the infective risks had to be minimized during the peak of the COVID-19 pandemic in Italy. Intravenous immunoglobulins were chosen as "bridge" therapy before the tumor surgical excision, followed by rituximab in post-operative phase.
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Affiliation(s)
- Alberto Corrà
- Section of Dermatology, Department of Health Sciences, University of Florence, Florence, Italy
| | - Francesca Cammelli
- Division of Gastrointestinal Surgery, Careggi University Hospital, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Lavinia Quintarelli
- Section of Dermatology, Department of Health Sciences, University of Florence, Florence, Italy.,Rare Diseases Unit, Section of Dermatology, Department of Health Sciences, Azienda USL Toscana Centro, University of Florence, European Reference Network-Skin Member, Florence, Italy
| | - Giuseppe Barbato
- Division of Gastrointestinal Surgery, Careggi University Hospital, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Ornella Le Rose
- Section of Radiology, Unità Sanitaria Locale Toscana Centro, "Piero Palagi" Hospital, Florence, Italy
| | - Adele Salemme
- Molecular and Cell Biology Laboratory, Istituto Dermopatico dell'Immacolata - Istituto di Ricovero e Cura a Carattere Scientifico, Rome, Italy
| | - Giovanni Di Zenzo
- Molecular and Cell Biology Laboratory, Istituto Dermopatico dell'Immacolata - Istituto di Ricovero e Cura a Carattere Scientifico, Rome, Italy
| | - Francesco Coratti
- Division of Gastrointestinal Surgery, Careggi University Hospital, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Alice Verdelli
- Section of Dermatology, Department of Health Sciences, University of Florence, Florence, Italy.,Rare Diseases Unit, Section of Dermatology, Department of Health Sciences, Azienda USL Toscana Centro, University of Florence, European Reference Network-Skin Member, Florence, Italy
| | - Cristina Aimo
- Section of Dermatology, Department of Health Sciences, University of Florence, Florence, Italy
| | | | - Beatrice Bianchi
- Section of Dermatology, Department of Health Sciences, University of Florence, Florence, Italy
| | - Fabio Cianchi
- Division of Gastrointestinal Surgery, Careggi University Hospital, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Marzia Caproni
- Section of Dermatology, Department of Health Sciences, University of Florence, Florence, Italy.,Rare Diseases Unit, Section of Dermatology, Department of Health Sciences, Azienda USL Toscana Centro, University of Florence, European Reference Network-Skin Member, Florence, Italy
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29
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Samotij D, Szczęch J, Antiga E, Bonciani D, Caproni M, Chasset F, Dańczak-Pazdrowska A, Furukawa F, Hasegawa M, Hashizume H, Ikeda T, Islam A, Kim HJ, Lesiak A, Misery L, Mowla MR, Polańska A, Szepietowski JC, Tsuruta D, Verdelli A, Werth VP, Reich A. Clinical characteristics of itch in cutaneous lupus erythematosus: A prospective, multicenter, multinational, cross-sectional study. Lupus 2021; 30:1385-1393. [PMID: 34000879 DOI: 10.1177/09612033211016098] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Pruritus is an important symptom frequently accompanying various inflammatory skin conditions and some recent data indicated that it may be associated with autoimmune connective tissue diseases. The aim of this study was to assess the frequency and clinical presentation of itch in CLE. METHODS A multinational, prospective, cross-sectional study was performed to assess the prevalence, intensity and clinical characteristic of pruritus in various subtypes of CLE. A total of 153 patients with active CLE lesions were included. Their age ranged between 17 and 82 years (mean 49.8 ± 15.4 years), and 115 patients (75.2%) were women. The disease activity and damage were assessed according to the Cutaneous Lupus Erythematosus Disease Area and Severity Index (CLASI). Pruritus severity was assessed with Numeric Rating Scale (NRS) and the 12-Item Pruritus Severity Scale. Dermatology Life Quality Index and EQ-5D questionnaire were used to measure quality of life. RESULTS Pruritus was present in 116 (76.8%) of patients of whom half had NRS scoring equal or above 4 points indicating moderate or severe pruritus. Most commonly itch was localized on the scalp, face (excluding ears and nose) and arms (40.5%, 36.2%, 31.9%, respectively). Sensations connected with pruritus were most frequently described as burning, tingling and like ants crawling feeling, but 31.9% patients described it as "pure itch". More than half of patients reported that pruritus was present every day, and it was most frequent during the evenings. The pruritus scoring and the CLASI activity score were significantly correlated (r = 0.42, p = 0.0001), while no correlation was found with the CLASI damage score (p = 0.16). Both the maximum and average itch intensity were correlated with systemic lupus erythematosus (SLE) activity measured with the Systemic Lupus Erythematosus Disease Activity Index. CONCLUSIONS Pruritus is a common, but frequently overlooked symptom of CLE. Its intensity correlates with the activity of CLE, but not with the skin damage. In more than a half of patients it occurs on a daily basis. The correlation between the intensity of pruritus and the activity of the skin lesions and the systemic involvement indicate that pruritus could be an individual indicator of both SLE and CLE activity.
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Affiliation(s)
- Dominik Samotij
- Department of Dermatology, University of Rzeszow, Rzeszow, Poland
| | - Justyna Szczęch
- Department of Dermatology, University of Rzeszow, Rzeszow, Poland
| | - Emiliano Antiga
- Department of Health Sciences, University of Florence, Florence, Italy
| | - Diletta Bonciani
- Department of Health Sciences, University of Florence, Florence, Italy
| | - Marzia Caproni
- Department of Health Sciences, University of Florence, Florence, Italy
| | - François Chasset
- Faculty of Medicine, AP-HP, Dermatology Department, Sorbonne University, Tenon Hospital, Paris, France
| | | | - Fukumi Furukawa
- Department of Dermatology, Wakayama Medical University, Wakayama, Japan
| | - Minoru Hasegawa
- Department of Dermatology, University of Fukui, Fukui, Japan
| | - Hideo Hashizume
- Department of Dermatology, Iwata City Hospital, Iwata, Japan
| | - Takaharu Ikeda
- Department of Dermatology, Wakayama Medical University, Wakayama, Japan
| | - Aminul Islam
- Department of Dermatology and Venereology, Chittagong Medical College, Chittagong, Bangladesh
| | - Hee Joo Kim
- Department of Dermatology, Gachon University College of Medicine, Incheon, South Korea
| | - Aleksandra Lesiak
- Department of Dermatology and Venereology, Medical University of Lodz, Lodz, Poland
| | - Laurent Misery
- Department of Dermatology, University Hospital of Brest, Brest, France
| | - Mohammad Rafiqul Mowla
- Department of Dermatology and Venereology, Chittagong Medical College, Chittagong, Bangladesh
| | - Adriana Polańska
- Department of Dermatology, Poznan University of Medical Sciences, Poznan, Poland
| | - Jacek C Szepietowski
- Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, Wroclaw, Poland
| | - Daisuke Tsuruta
- Department of Dermatology, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Alice Verdelli
- Department of Health Sciences, University of Florence, Florence, Italy
| | - Victoria P Werth
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.,Corporal Michael J. Creszenz VAMC, Philadelphia, PA, USA
| | - Adam Reich
- Department of Dermatology, University of Rzeszow, Rzeszow, Poland
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30
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Bonan P, Troiano M, Bruscino N, Verdelli A. Treatment of benign hyperpigmentations and pigmented scars by 755 alexandrite laser comparing the Single Pass versus MultiPass (MoveoPL) emission in skin types I-IV. Dermatol Ther 2021; 34:e14819. [PMID: 33506629 DOI: 10.1111/dth.14819] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 12/26/2020] [Indexed: 11/28/2022]
Abstract
Lasers are effective treatments for benign hyperpigmentations but may be difficult especially in darker skin type. In this randomized split-face controlled study on benign hyperpigmentations and pigmented scars, we compare the standard Single Pass (SP) emission with the MultiPass emission (MoveoPL) 755 alexandrite laser. Patients, skin types I-IV, with solar lentigines and ephelides of the face, chest, and hands and patients with pigmented scars of the legs, underwent laser treatment, by treating one side of the body or half scar using the SP and the other side using MoveoPL. Improvements according to a grading score system, side effects, and patient satisfaction were recorded. About 63 patients were enrolled. An overall improvement of benign hyperpigmentations and pigmented scars was recorded, with a grading score (±SD) of 2.8 ± 0.8 for SP and 3.6 ± 0.5 for MoveoPL (range, 0-4). SP emission showed best results in skin types I-II whereas MotusPL obtained successfully results in all the phototypes analyzed (types I-IV). Patients preferred MoveoPL as it was associated with fewer side effects. Both standard SP and MoveoPL emission are effective and safe. MoveoPL showed a higher efficacy and safety profile for the treatment of hyperpigmentations.
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Affiliation(s)
- Paolo Bonan
- Laser Cutaneous Cosmetic & Plastic Surgery Unit, Villa Donatello Clinic, Florence, Italy
| | - Michela Troiano
- Laser Cutaneous Cosmetic & Plastic Surgery Unit, Villa Donatello Clinic, Florence, Italy
| | - Nicola Bruscino
- Laser Cutaneous Cosmetic & Plastic Surgery Unit, Villa Donatello Clinic, Florence, Italy
| | - Alice Verdelli
- Laser Cutaneous Cosmetic & Plastic Surgery Unit, Villa Donatello Clinic, Florence, Italy
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Verdelli A, Caproni M. Comment on "Dermatitis herpetiformis in an African woman", the importance of direct immunofluorescence assay. Pan Afr Med J 2020; 36:196. [PMID: 32952840 PMCID: PMC7467610 DOI: 10.11604/pamj.2020.36.196.18397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Accepted: 12/16/2019] [Indexed: 11/24/2022] Open
Affiliation(s)
- Alice Verdelli
- Department of Surgery and Translational Medicine, Section of Dermatology, University of Florence, Florence, Italy
| | - Marzia Caproni
- U.O. Dermatology I, P.O. Piero Palagi, USL Toscana Centro, University of Florence, Florence, Italy
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32
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Bonan P, Troiano M, Verdelli A. Safety and efficacy of single pass vs
multipass
emission with 755 alexandrite laser for
all‐skin‐type
hair removal: A pilot study. Dermatol Ther 2020; 33:e14001. [DOI: 10.1111/dth.14001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 06/23/2020] [Indexed: 12/01/2022]
Affiliation(s)
- Paolo Bonan
- Laser Cutaneous Cosmetic & Plastic Surgery Unit Villa Donatello Clinic Florence Italy
| | - Michela Troiano
- Laser Cutaneous Cosmetic & Plastic Surgery Unit Villa Donatello Clinic Florence Italy
| | - Alice Verdelli
- Laser Cutaneous Cosmetic & Plastic Surgery Unit Villa Donatello Clinic Florence Italy
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Bonan P, Verdelli A. Combined microwaves and fractional microablative CO2 laser treatment for postpartum abdominal laxity. J Cosmet Dermatol 2020; 20:124-131. [PMID: 32463169 DOI: 10.1111/jocd.13510] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 05/11/2020] [Accepted: 05/15/2020] [Indexed: 01/02/2023]
Abstract
BACKGROUND Postpartum abdominal changes represent a major esthetic concern affecting women. As the abdomen stretches during pregnancy and some of the muscles lose tone, there is an increased skin laxity and a loss of abdominal elasticity. As a result, the abdomen becomes saggy. AIMS To evaluate the performance of a combined microwaves and fractional microablative CO2 laser treatment for reshaping and improvement of abdomen texture/laxity and striae distensae in postpartum women. PATIENTS/METHODS Fifteen women (median age 38 years) received three monthly abdomen treatments with a new microwaves platform, the ONDA Coolwaves® (DEKA) system, followed by a treatment with fractional microablative CO2 laser (SmartXide2; DEKA) a month thereafter. We followed up each patient's weight and nutritional habits. Outcome was assessed using reproducible circumference and abdominal measurements, digital and 3D photography, the laxity score as well as patient satisfaction index. RESULTS The overall mean circumferences reduction was 3.6 ± 1.2 cm. Significant improvement in skin laxity and tightening was noted by physicians and patients as well as a reduction of striae distensae. Interestingly, as a result of skin remodeling, repositioning of the umbilicus was also demonstrated. Treatments were well tolerated with no side effects. CONCLUSIONS Our data showed a sustainable reduction in circumference and improvement in appearance of abdomen in postpartum women, without compromising patients' safety.
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Affiliation(s)
- Paolo Bonan
- Laser Cutaneous Cosmetic & Plastic Surgery Unit, Villa Donatello Clinic, Florence, Italy
| | - Alice Verdelli
- Laser Cutaneous Cosmetic & Plastic Surgery Unit, Villa Donatello Clinic, Florence, Italy
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Bonan P, Bassi A, Bruscino N, Schincaglia E, Gavrilova M, Troiano M, Verdelli A. Combined pulsed dye laser and Q-switched Nd:YAG laser intraumatic facial tattoo removal: A case series. Dermatol Ther 2019; 32:e13069. [PMID: 31430015 DOI: 10.1111/dth.13069] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Accepted: 08/15/2019] [Indexed: 11/29/2022]
Abstract
Traumatic tattoos can be treated with several methods, including mechanical and chemical devices. However, they are rarely used due to the high risk of permanent side effects such as scarring and depigmentation. Recently, laser devices, especially the Q-switched (QS) laser and the pulsed dye laser (PDL), applied in combination, have achieved complete clearance of the lesions without any risk of side effects. Herein, we reported three cases of traumatic facial tattoos successfully treated with combined PDL and QS Nd:YAG laser.
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Affiliation(s)
- Paolo Bonan
- Laser Cutaneous Cosmetic & Plastic Surgery Unit, Villa Donatello Clinic, Florence, Italy
| | - Andrea Bassi
- Laser Cutaneous Cosmetic & Plastic Surgery Unit, Villa Donatello Clinic, Florence, Italy
| | - Nicola Bruscino
- Laser Cutaneous Cosmetic & Plastic Surgery Unit, Villa Donatello Clinic, Florence, Italy
| | - Emiliano Schincaglia
- Laser Cutaneous Cosmetic & Plastic Surgery Unit, Villa Donatello Clinic, Florence, Italy
| | - Maria Gavrilova
- Laser Cutaneous Cosmetic & Plastic Surgery Unit, Villa Donatello Clinic, Florence, Italy
| | - Michela Troiano
- Laser Cutaneous Cosmetic & Plastic Surgery Unit, Villa Donatello Clinic, Florence, Italy
| | - Alice Verdelli
- Laser Cutaneous Cosmetic & Plastic Surgery Unit, Villa Donatello Clinic, Florence, Italy
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Antiga E, Maglie R, Quintarelli L, Verdelli A, Bonciani D, Bonciolini V, Caproni M. Dermatitis Herpetiformis: Novel Perspectives. Front Immunol 2019; 10:1290. [PMID: 31244841 PMCID: PMC6579917 DOI: 10.3389/fimmu.2019.01290] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Accepted: 05/21/2019] [Indexed: 02/06/2023] Open
Abstract
Dermatitis herpetiformis (DH) is an inflammatory disease of the skin, considered the specific cutaneous manifestation of celiac disease (CD). Both DH and CD occur in gluten-sensitive individuals, share the same Human Leukocyte Antigen (HLA) haplotypes (DQ2 and DQ8), and improve following the administration of a gluten-free diet. Moreover, almost all DH patients show typical CD alterations at the small bowel biopsy, ranging from villous atrophy to augmented presence of intraepithelial lymphocytes, as well as the generation of circulating autoantibodies against tissue transglutaminase (tTG). Clinically, DH presents with polymorphic lesions, including papules, vesicles, and small blisters, symmetrically distributed in typical anatomical sites including the extensor aspects of the limbs, the elbows, the sacral regions, and the buttocks. Intense pruritus is almost the rule. However, many atypical presentations of DH have also been reported. Moreover, recent evidence suggested that DH is changing. Firstly, some studies reported a reduced incidence of DH, probably due to early recognition of CD, so that there is not enough time for DH to develop. Moreover, data from Japanese literature highlighted the absence of intestinal involvement as well as of the typical serological markers of CD (i.e., anti-tTG antibodies) in Japanese patients with DH. Similar cases may also occur in Caucasian patients, complicating DH diagnosis. The latter relies on the combination of clinical, histopathologic, and immunopathologic findings. Detecting granular IgA deposits at the dermal-epidermal junction by direct immunofluorescence (DIF) from perilesional skin represents the most specific diagnostic tool. Further, assessing serum titers of autoantibodies against epidermal transglutaminase (eTG), the supposed autoantigen of DH, may also serve as a clue for the diagnosis. However, a study from our group has recently demonstrated that granular IgA deposits may also occur in celiac patients with non-DH inflammatory skin diseases, raising questions about the effective role of eTG IgA autoantibodies in DH and suggesting the need of revising diagnostic criteria, conceivably emphasizing clinical aspects of the disease along with DIF. DH usually responds to the gluten-free diet. Topical clobetasol ointment or dapsone may be also applied to favor rapid disease control. Our review will focus on novel pathogenic insights, controversies, and management aspects of DH.
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Affiliation(s)
- Emiliano Antiga
- Section of Dermatology, Department of Health Sciences, University of Florence, Florence, Italy
| | - Roberto Maglie
- Section of Dermatology, Department of Health Sciences, University of Florence, Florence, Italy
| | - Lavinia Quintarelli
- Section of Dermatology, Department of Health Sciences, University of Florence, Florence, Italy
| | - Alice Verdelli
- Section of Dermatology, Department of Health Sciences, University of Florence, Florence, Italy
| | - Diletta Bonciani
- Section of Dermatology, Department of Health Sciences, University of Florence, Florence, Italy
| | - Veronica Bonciolini
- Section of Dermatology, Department of Health Sciences, University of Florence, Florence, Italy
| | - Marzia Caproni
- Section of Dermatology, Department of Health Sciences, University of Florence, Florence, Italy
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Abstract
Ureidopyrimidinone (UPy) is introduced into various polyethylenes (PEs) bearing hydroxyl groups by solution grafting, affording physically cross-linked PE via multiple H-bonding.
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Affiliation(s)
- Arkadiusz Zych
- SABIC Technology & Innovation
- STC Geleen
- Urmonderbaan 22
- Geleen
- The Netherlands
| | - Alice Verdelli
- Department of Chemistry
- Life Sciences and Environmental Sustainability
- University of Parma
- 43124 Parma
- Italy
| | - Maria Soliman
- SABIC Technology & Innovation
- STC Geleen
- Urmonderbaan 22
- Geleen
- The Netherlands
| | - Roberta Pinalli
- Department of Chemistry
- Life Sciences and Environmental Sustainability
- University of Parma
- 43124 Parma
- Italy
| | - Jérôme Vachon
- SABIC Technology & Innovation
- STC Geleen
- Urmonderbaan 22
- Geleen
- The Netherlands
| | - Enrico Dalcanale
- Department of Chemistry
- Life Sciences and Environmental Sustainability
- University of Parma
- 43124 Parma
- Italy
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Maglie R, Quintarelli L, Verdelli A, Fabbri P, Antiga E, Caproni M. Specific dermatoses of pregnancy other than pemphigoid gestationis. GIORN ITAL DERMAT V 2018; 154:286-298. [PMID: 30375214 DOI: 10.23736/s0392-0488.18.06159-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Specific dermatoses of pregnancy are skin disorders that occur specifically during or immediately after pregnancy and cannot be found in non-pregnant patients. According to the current consensus, they include atopic eruption of pregnancy (AEP), polymorphic eruption of pregnancy (PEP), pemphigoid gestationis (PG), and intrahepatic cholestasis of pregnancy (ICP). The diagnosis of specific dermatoses of pregnancy can be challenging due to their variation in clinical presentation; moreover, the tests currently available do not always provide the clue for the diagnosis. However, some distinctive features may be helpful to differentiate between such entities. Accordingly, the knowledge of specific dermatoses of pregnancy and of their management is critical, since their early recognition may allow to provide care for the mother and prevent potential increased fetal risk. In fact, while AEP and PEP do not affect maternal and fetal prognosis, PG and, mainly, ICP are associated to maternal complications as well as the risk of fetal loss. In this paper, the epidemiology, pathogenesis, clinical features as well as management of AEP and PEP are reviewed in detail, while PG is described in another article of this issue. Moreover, the main features of ICP, which cannot be considered a primarily skin disease but may be managed first by dermatologists, are reported.
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Affiliation(s)
- Roberto Maglie
- Section of Dermatology, Department of Surgery and Translational Medicine, University of Florence, Florence, Italy
| | - Lavinia Quintarelli
- Section of Dermatology, Department of Surgery and Translational Medicine, University of Florence, Florence, Italy
| | - Alice Verdelli
- Section of Dermatology, Department of Surgery and Translational Medicine, University of Florence, Florence, Italy
| | - Paolo Fabbri
- Section of Dermatology, Department of Surgery and Translational Medicine, University of Florence, Florence, Italy
| | - Emiliano Antiga
- Section of Dermatology, Department of Surgery and Translational Medicine, University of Florence, Florence, Italy -
| | - Marzia Caproni
- Section of Dermatology, Department of Surgery and Translational Medicine, University of Florence, Florence, Italy
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Verdelli A, Coi A, Marzano AV, Antiga E, Cozzani E, Quaglino P, La Placa M, Benucci M, De Simone C, Papini M, Parodi A, Bianchi F, Caproni M. Autoantibody profile and clinical patterns in 619 Italian patients with cutaneous lupus erythematosus. J Eur Acad Dermatol Venereol 2018; 33:742-752. [PMID: 29924416 DOI: 10.1111/jdv.15147] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Accepted: 05/30/2018] [Indexed: 12/14/2022]
Abstract
BACKGROUND Anti-nuclear antibodies (ANA), anti-extractable nuclear antigens (ENA) and anti-dsDNA antibodies are often associated with cutaneous lupus erythematosus (CLE), with variable frequency depending on skin subtype. However, specific data based on large case-series on the pathogenetic, diagnostic and prognostic meaning of such autoantibodies are still lacking. OBJECTIVE To characterize the correlations between CLE subtypes as well as LE-non-specific skin lesions and their autoantibody pattern. METHODS Epidemiological, clinical and immunopathological data of 619 Italian patients with CLE and LE-non-specific skin lesions were analysed. Differences in age, sex, clinical features and autoantibody profile were evaluated in each LE subgroup. RESULTS Anti-nuclear antibodies (P < 0.0001), anti-dsDNA (P < 0.0001), ENA (P = 0.001), anti-Sm (P = 0.001), anti-RNP (P = 0.004) and anti-histone (P = 0.005) antibodies were associated with SLE. A strong association between ANA (P < 0.0001) and anti-dsDNA (P < 0.0001) and female gender was also found: positive ANA and positive anti-dsDNA had a higher prevalence among females. Chronic CLE resulted to be negatively associated with ENA (OR = 0.51, P < 0.0001), anti-Ro/SSA (OR = 0.49, P < 0.0001) and anti-dsDNA (OR = 0.37, P < 0.0001). Intermittent CLE resulted to be negatively associated with ENA (OR = 0.50, P = 0.007) and ANA (OR = 0.61, P = 0.025). Subacute CLE resulted to be associated with ENA (OR = 5.19, P < 0.0001), anti-Ro/SSA (OR = 3.83, P < 0.0001), anti-Smith (OR = 2.95, P = 0.004) and anti-RNP (OR = 3.18, P = 0.007). Acute CLE resulted to be strongly associated with anti-dsDNA (OR = 6.0, P < 0.0001) and ANA (OR = 18.1, P < 0.0001). LE-non-specific skin lesions resulted to be significantly associated with systemic involvement. Livedo reticularis was significantly associated with ENA (P = 0.007) and anti-Ro/SSA (P = 0.036). Palpable purpura and periungual telangiectasia were significantly associated with ANA. CONCLUSION According to our findings, some well-known associations between CLE subtypes and autoantibody profile were confirmed; moreover, specific association between autoantibodies and LE-non-specific skin lesions was highlighted. A strict association between anti-ENA and anti-Ro/SSA antibodies and livedo reticularis, ANA and palpable purpura, and ANA and periungual telangiectasia was evidenced.
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Affiliation(s)
- A Verdelli
- Department of Surgery and Translational Medicine, Section of Dermatology, University of Florence, Florence, Italy
| | - A Coi
- Institute of Clinical Physiology, National Research Council, Pisa, Italy
| | - A V Marzano
- Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, UOC Dermatologia, IRCCS Fondazione Ca' Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy
| | - E Antiga
- Department of Surgery and Translational Medicine, Section of Dermatology, University of Florence, Florence, Italy
| | - E Cozzani
- IRCCS-AOU San Martino-IST, Dissal, Section of Dermatology, University of Genoa, Genoa, Italy
| | - P Quaglino
- Department of Medical Sciences, Dermatologic Clinic, University of Turin, Turin, Italy
| | - M La Placa
- Dermology Division, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy
| | - M Benucci
- Rheumatology Unit, S. Giovanni di Dio Hospital, Florence, Italy
| | - C De Simone
- Dermatology Department, Policlinico Universitario 'A. Gemelli', Università Cattolica del Sacro Cuore, Rome, Italy
| | - M Papini
- Department of Surgical and Biomedical Sciences, Dermatologic Clinic of Terni, University of Perugia, Perugia, Italy
| | - A Parodi
- IRCCS-AOU San Martino-IST, Dissal, Section of Dermatology, University of Genoa, Genoa, Italy
| | - F Bianchi
- Institute of Clinical Physiology, National Research Council, Pisa, Italy
| | - M Caproni
- Department of Surgery and Translational Medicine, Section of Dermatology, University of Florence, Florence, Italy
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Bonciani D, Antiga E, Bonciolini V, Verdelli A, Del Bianco E, Volpi W, Caproni M. Homocysteine serum levels are increased and correlate with disease severity in patients with lupus erythematosus. Clin Exp Rheumatol 2016; 34:76-81. [PMID: 26742563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Accepted: 08/31/2015] [Indexed: 06/05/2023]
Abstract
OBJECTIVES To determine homocysteine (Hcy) serum levels in patients with cutaneous lupus erythematosus (CLE) and a possible correlation with the disease activity. METHODS Ninety-three patients with LE and 30 healthy controls were included in the study. For each patient, disease activity was calculated and plasma levels of Hcy was measured by enzymatic colorimetric assay. RESULTS Forty-six patients had chronic cutaneous LE (CCLE), 14 had LE tumidus (LET), 17 had subacute CLE (SCLE) and 16 had SLE. Median values [25°-75° percentile] were 7[4-9] for CCLE, 3.5[2.3-4.8] for LET, and 8[7-10] for SCLE; for SLE the RCLASI score was 7.5[4.8-13] and the SELENA/SLEDAI score was 10.5[9-13.3]. HHcy was present in 73.9% of patients with CCLE, 35.7% with LET, 82.4% with SCLE, 81.2% with SLE, 20% of healthy controls. Overall, patients with LE showed a higher median serum Hcy level than the control group (15[13-18.2] vs. 11[8.8-12.2], p<0.001). There was a significant correlation between Hcy serum levels and disease activity, both in patients with CLE and SLE. CONCLUSIONS We demonstrated that Hcy levels were higher in patients with different forms of CLE and correlated with disease activity calculated by CLASI. Therefore, HHcy could be related to LE pathogenesis and might be a triggering factor in predisposed individuals.
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Affiliation(s)
- Diletta Bonciani
- Department of Surgery and Translational Medicine, Section of Dermatology, University of Florence, Italy.
| | - Emiliano Antiga
- Department of Surgery and Translational Medicine, Section of Dermatology, University of Florence, Italy
| | - Veronica Bonciolini
- Department of Surgery and Translational Medicine, Section of Dermatology, University of Florence, Italy
| | - Alice Verdelli
- Department of Surgery and Translational Medicine, Section of Dermatology, University of Florence, Italy
| | - Elena Del Bianco
- Department of Surgery and Translational Medicine, Section of Dermatology, University of Florence, Italy
| | - Walter Volpi
- Department of Surgery and Translational Medicine, Section of Dermatology, University of Florence, Italy
| | - Marzia Caproni
- Department of Surgery and Translational Medicine, Section of Dermatology, University of Florence, Italy
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Verdelli A, Antiga E, Bonciani D, Bonciolini V, Volpi W, Caproni M. A fatal case of hidradenitis suppurativa associated with sepsis and squamous cell carcinoma. Int J Dermatol 2015; 55:e52-3. [DOI: 10.1111/ijd.13006] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2014] [Revised: 01/19/2015] [Accepted: 02/12/2015] [Indexed: 12/31/2022]
Affiliation(s)
- Alice Verdelli
- Dermatology Section; Department of Surgery and Translational Medicine; University of Florence; Florence Italy
| | - Emiliano Antiga
- Dermatology Section; Department of Surgery and Translational Medicine; University of Florence; Florence Italy
| | - Diletta Bonciani
- Dermatology Section; Department of Surgery and Translational Medicine; University of Florence; Florence Italy
| | - Veronica Bonciolini
- Dermatology Section; Department of Surgery and Translational Medicine; University of Florence; Florence Italy
| | - Walter Volpi
- Dermatology Section; Department of Surgery and Translational Medicine; University of Florence; Florence Italy
| | - Marzia Caproni
- Dermatology Section; Department of Surgery and Translational Medicine; University of Florence; Florence Italy
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Bonciolini V, Bianchi B, Del Bianco E, Verdelli A, Caproni M. Cutaneous Manifestations of Non-Celiac Gluten Sensitivity: Clinical Histological and Immunopathological Features. Nutrients 2015; 7:7798-805. [PMID: 26389946 PMCID: PMC4586563 DOI: 10.3390/nu7095368] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2015] [Revised: 09/03/2015] [Accepted: 09/08/2015] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND The dermatological manifestations associated with intestinal diseases are becoming more frequent, especially now when new clinical entities, such as Non-Celiac Gluten Sensitivity (NCGS), are identified. The existence of this new entity is still debated. However, many patients with diagnosed NCGS that present intestinal manifestations have skin lesions that need appropriate characterization. METHODS We involved 17 patients affected by NCGS with non-specific cutaneous manifestations who got much better after a gluten free diet. For a histopathological and immunopathological evaluation, two skin samples from each patient and their clinical data were collected. RESULTS The median age of the 17 enrolled patients affected by NCGS was 36 years and 76% of them were females. On the extensor surfaces of upper and lower limbs in particular, they all presented very itchy dermatological manifestations morphologically similar to eczema, psoriasis or dermatitis herpetiformis. This similarity was also confirmed histologically, but the immunopathological analysis showed the prevalence of deposits of C3 along the dermo-epidermal junction with a microgranular/granular pattern (82%). CONCLUSIONS The exact characterization of new clinical entities such as Cutaneous Gluten Sensitivity and NCGS is an important objective both for diagnostic and therapeutic purposes, since these are patients who actually benefit from a GFD (Gluten Free Diet) and who do not adopt it only for fashion.
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Affiliation(s)
- Veronica Bonciolini
- Department of Surgery and Translational Medicine, Section of Dermatology, University of Florence, Viale Michelangiolo 41, Florence 50125, Italy.
| | - Beatrice Bianchi
- Department of Surgery and Translational Medicine, Section of Dermatology, University of Florence, Viale Michelangiolo 41, Florence 50125, Italy.
| | - Elena Del Bianco
- Department of Surgery and Translational Medicine, Section of Dermatology, University of Florence, Viale Michelangiolo 41, Florence 50125, Italy.
| | - Alice Verdelli
- Department of Surgery and Translational Medicine, Section of Dermatology, University of Florence, Viale Michelangiolo 41, Florence 50125, Italy.
| | - Marzia Caproni
- Director SOS Skin Immunopathology and Rare Dermatological Diseases Unit, 1st Dermatological Clinic ASF-Piero Palagi, Department of Medical and Surgical Critical Care, Section of Dermatology, University of Florence, Viale Michelangiolo 41, Florence 50125, Italy.
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Verdelli A, Antiga E, Bonciani D, Bonciolini V, Volpi W, Maio E, Caproni M. Docetaxel-induced-like subacute cutaneous lupus erythematosus. Clin Exp Dermatol 2015; 41:318-9. [PMID: 26350359 DOI: 10.1111/ced.12756] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/24/2015] [Indexed: 11/26/2022]
Affiliation(s)
- A Verdelli
- Department of Surgery and Translational Medicine, Section of Dermatology, University of Florence, Viale Michelangiolo, 41, 50125, Florence, Italy.
| | - E Antiga
- Department of Surgery and Translational Medicine, Section of Dermatology, University of Florence, Viale Michelangiolo, 41, 50125, Florence, Italy
| | - D Bonciani
- Department of Surgery and Translational Medicine, Section of Dermatology, University of Florence, Viale Michelangiolo, 41, 50125, Florence, Italy
| | - V Bonciolini
- Department of Surgery and Translational Medicine, Section of Dermatology, University of Florence, Viale Michelangiolo, 41, 50125, Florence, Italy
| | - W Volpi
- Department of Surgery and Translational Medicine, Section of Dermatology, University of Florence, Viale Michelangiolo, 41, 50125, Florence, Italy
| | - E Maio
- Department of Surgery and Translational Medicine, Division of Pathological Anatomy, University of Florence
| | - M Caproni
- Department of Surgery and Translational Medicine, Section of Dermatology, University of Florence, Viale Michelangiolo, 41, 50125, Florence, Italy
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Caproni M, Antiga E, Volpi W, Verdelli A, Venegoni L, Quaglino P, Fabbri P, Marzano A. The Treg/Th17 cell ratio is reduced in the skin lesions of patients with pyoderma gangrenosum. Br J Dermatol 2015; 173:275-8. [DOI: 10.1111/bjd.13670] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Affiliation(s)
- M. Caproni
- Department of Surgery and Translational Medicine; Section of Dermatology; University of Florence; Viale Michelangelo 41 50125 Florence Italy
| | - E. Antiga
- Department of Surgery and Translational Medicine; Section of Dermatology; University of Florence; Viale Michelangelo 41 50125 Florence Italy
| | - W. Volpi
- Department of Surgery and Translational Medicine; Section of Dermatology; University of Florence; Viale Michelangelo 41 50125 Florence Italy
| | - A. Verdelli
- Department of Surgery and Translational Medicine; Section of Dermatology; University of Florence; Viale Michelangelo 41 50125 Florence Italy
| | - L. Venegoni
- Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti; Unità Operativa di Dermatologia; IRCCS Fondazione Ca’ Granda; Ospedale Maggiore Policlinico; Università degli Studi di Milano; Milan Italy
| | - P. Quaglino
- Department of Biomedical Sciences and Human Oncology; 1st Dermatologic Clinic; University of Turin; Turin Italy
| | - P. Fabbri
- Department of Surgery and Translational Medicine; Section of Dermatology; University of Florence; Viale Michelangelo 41 50125 Florence Italy
| | - A.V. Marzano
- Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti; Unità Operativa di Dermatologia; IRCCS Fondazione Ca’ Granda; Ospedale Maggiore Policlinico; Università degli Studi di Milano; Milan Italy
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Antiga E, Verdelli A, Bonciani D, Bonciolini V, Quintarelli L, Volpi W, Fabbri P, Caproni M. Drug-induced cutaneous vasculitides. GIORN ITAL DERMAT V 2015; 150:203-210. [PMID: 25776141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Cutaneous vasculitides (CV) can be idiopathic or secondary to several triggers, including drugs, which account for up to 30% of all the cases of CV. Several drugs can induce CV, including some medications commonly used in dermatology, including minocycline, and several new drugs, such as anti-TNF agents. Different pathomecanisms are involved in the development of drug-induced CV, including the formation and deposition of immune complexes, the induction of neutrophil apoptosis, the formation of neoantigens between the drugs and proteins from the host, the shift of the immune response, and others. Although the diagnosis is difficult, because the clinical picture of drug-induced CV is in general indistinguishable from that of other forms of CV, it is important to recognize such entities in order to correctly manage the patient. Anamnesis, diagnostic algorithms to assess the likelihood of the association between a drug and a cutaneous reaction, skin biopsy and laboratory testing (including the search for antineutrophil cytoplasmic antibodies) are useful tools to make a diagnosis of drug-induced CV. About the therapy, while in idiopathic vasculitides the treatment is usually more aggressive and long-lasting, very often requiring a maintenance therapy with immunosuppressive drugs, in drug-induced CV the discontinuation of the suspected drug alone is usually enough to achieve complete remission, making the prognosis usually very good.
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Affiliation(s)
- E Antiga
- Section of Dermatology, Department of Surgery and Translational Medicine, University of Florence, Florence, Italy -
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Filosa A, Verdelli A, Bianchi B, Del Bianco E, Bugatti L, Filosa G, Caproni M. Cutaneous vasculitidis: histology and immunofluorescence. GIORN ITAL DERMAT V 2015; 150:183-191. [PMID: 25776140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Cutaneous vasculitis comprises a wide spectrum of diseases that involve predominantly the blood vessels and surrounding tissues of the skin. Few vasculitic syndromes have pathognomonic clinical, radiographic and/or laboratory findings; thus, confident and accurate diagnosis of vasculitis requires histological confirmation. Skin biopsy should be done, optimally within 24 to 48 hours after vasculitic lesions appear. Deep excision biopsy must be preferred. Direct immunofluorescence of lesional skin is helpful in the diagnosis of vasculitides in the light of a proper clinico-pathological setting and diagnostic in some peculiarly forms. Cutaneous histological patterns can be used to generate relevant clinical differential diagnoses, and, when coupled with patient's history, clinical and laboratory data, allow more precise and accurate diagnosis of vasculitic syndromes. This review will focus on histopathological and immunologic pattern of the more common cutaneous vasculitis syndromes, based on the 2012 Revised International CHCC.
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Affiliation(s)
- A Filosa
- Operative Unit of Pathological Anatomy, ASUR Marche AV3 Macerata, Italy -
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Antiga E, Verdelli A, Bonciani D, Bonciolini V, Caproni M, Fabbri P. Acne: a new model of immune-mediated chronic inflammatory skin disease. GIORN ITAL DERMAT V 2015; 150:247-254. [PMID: 25876146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Acne is a chronic inflammatory disease of the sebaceous-pilosebaceous unit. Interestingly, inflammation can be detected by histopathological examination and immuohistochemical analysis even in the apparently non-inflammatory acneic lesions, such as comedones. In the last years, it has been clearly demonstrated that acne development is linked to the combination of predisposing genetic factors and environmental triggers, among which a prominent role is played by the follicular colonization by Propionibacterium acnes (P. acnes). P. acnes displays several activities able to promote the development of acne skin lesions, including the promotion of follicular hyperkeratinisation, the induction of sebogenesis, and the stimulation of an inflammatory response by the secretion of proinflammatory molecules and by the activation of innate immunity, that is followed by a P. acnes-specific adaptive immune response. In addition, P. acnes-independent inflammation mediated by androgens or by a neurogenic activation, followed by the secretion in the skin of pro-inflammatory neuropeptides, can occur in acne lesions. In conclusion, acne can be considered as a model of immune-mediated chronic inflammatory skin disease, characterized by an innate immune response that is not able to control P. acnes followed by a Th1-mediated adaptive immune response, that becomes self-maintaining independently from P. acnes itself.
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Affiliation(s)
- E Antiga
- Department of Surgery and Translational Medicine, Section of Dermatology, University of Florence Florence, Italy -
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Affiliation(s)
- N Milanesi
- Allergological and Occupational Dermatology Unit, Department of Surgery and Translational Medicine, University of Florence, Florence, Italy
| | - M Gola
- Allergological and Occupational Dermatology Unit, Department of Surgery and Translational Medicine, University of Florence, Florence, Italy
| | - A Verdelli
- Allergological and Occupational Dermatology Unit, Department of Surgery and Translational Medicine, University of Florence, Florence, Italy
| | - S Francalanci
- Allergological and Occupational Dermatology Unit, Department of Surgery and Translational Medicine, University of Florence, Florence, Italy
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Bonciani D, Bonciolini V, Antiga E, Verdelli A, Caproni M, Senetta R. A case of rupioid psoriasis exacerbated by systemic glucocorticosteroids. Int J Dermatol 2015; 54:e100-2. [PMID: 25601211 DOI: 10.1111/ijd.12755] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Diletta Bonciani
- Section of Dermatology, Department of Surgery and Translational Medicine, University of Florence, Florence, Italy.
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Bonciani D, Bonciolini V, Verdelli A, D'Errico A, Antiga E, Volpi W, Fabbri P, Caproni M. Pseudoxanthoma elasticum: a rare cause of erectile dysfunction. GIORN ITAL DERMAT V 2014; 149:728-729. [PMID: 25664826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Affiliation(s)
- D Bonciani
- Section of Dermatology, Department of Medical and Surgical Clinical Care University of Florence, Florence, Italy -
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Verdelli A, Antiga E, Bonciolini V, Bonciani D, Volpi W, Caproni M. Drug induction in connective tissue diseases. GIORN ITAL DERMAT V 2014; 149:573-580. [PMID: 24975950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Connective tissue diseases (CTDs) are defined as a group of acquired disorders resulting from persistent immuno-mediated inflammation. Several classes of drugs seem to be capable of inducing or exacerbating CTDs. A drug-induced (DI) syndrome is defined as a condition temporally related to continuous drug exposure, which resolves upon drug discontinuation. Among CTDs, lupus erythematosus is the most widely known and investigated DI syndrome. However, in recent years, the association between the onset of other CTDs, such as dermatomyositis (DM) and morphea/systemic sclerosis (SSc) has increased in patients with preceding exposure to particular substances. Herein, we conducted a review of published case reports including DM and morphea/SSc, evaluating the real causality among drugs and these syndromes.
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Affiliation(s)
- A Verdelli
- Department of Surgery and Translational Medicine, Section of Dermatology, Section of Dermatology University of Florence, Florence, Italy -
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