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Campione E, Wampler M, Bolch CA, Krzak JJ. Barriers and facilitators to implementation of APTA's breast cancer-related lymphedema diagnosis and intervention clinical practice guidelines. J Cancer Surviv 2023:10.1007/s11764-023-01475-1. [PMID: 37853271 DOI: 10.1007/s11764-023-01475-1] [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: 07/17/2023] [Accepted: 09/26/2023] [Indexed: 10/20/2023]
Abstract
PURPOSE The purpose of this study was to identify barriers and facilitators influencing implementation of the diagnosis and intervention clinical practice guidelines (CPGs) related to the management of patients with breast cancer-related lymphedema (BCRL). METHODS A descriptive, cross-sectional web-based survey was conducted. Participants included physical therapists and assistants who were members of the APTA's Academy of Oncologic Physical Therapy and Lymphology Association of North America. Desriptive statisitcs were computed for all demographic and barriers and facilitators data. Individual exploratory factor analyses (EFA) were performed on survey items for both CPGs to identify themes of barriers and facilitators to implementation. RESULTS A total of 180 respondents completed the survey. 34.9% of respondents read the diagnosis CPG and 22.4% read the intervention CPG. A total of 77.8% reported that they did not have issues in changing their clinical routines and 69.5% did not have resistance working according to CPGs. The EFA resulted in 3 themes for each CPG, accounting for 46% of the variance for the diagnostic CPG and 54% of the variance for the intervention CPG. The 3 themes, clinician characteristics, patient demographics, therapist practice setting and beliefs/values, were weighted differently for each EFA. CONCLUSION Most respondents did not read either CPG, however, report a willingness to make changes to clinical practice and utilization of CPGs. For those who have attempted to implement the CPGs, this study was the first to identify the barriers and facilitators impacting the implementation of the CPGs related to the management of BCRL. IMPLICATIONS FOR CANCER SURVIVORS The results will inform the development of targeted implementation strategies to improve access to and adherence to recommendations from the CPGs ultimately improving the efficiency and efficacy of care delivery to patients.
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Affiliation(s)
- Elizabeth Campione
- Physical Therapy Program, Midwestern University, Downers Grove, IL, USA.
| | - Meredith Wampler
- Program in Physical Therapy, Oregon State University - Cascades, Bend, OR, USA
| | - Charlotte A Bolch
- Office of Research and Sponsored Programs, Midwestern University, Glendale, AZ, USA
| | - Joseph J Krzak
- Physical Therapy Program, Midwestern University, Downers Grove, IL, USA
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2
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Doubblestein D, Campione E, Hunley J, Schaverien M. Pre- and Post-Microsurgical Rehabilitation Interventions and Outcomes on Breast Cancer-Related Lymphedema: a Systematic Review. Curr Oncol Rep 2023; 25:1031-1046. [PMID: 37402044 PMCID: PMC10474983 DOI: 10.1007/s11912-023-01439-9] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/19/2023] [Indexed: 07/05/2023]
Abstract
PURPOSE OF REVIEW Breast cancer-related lymphedema (BCRL) is a debilitating progressive disease resulting in various impairments and dysfunctions. Complete decongestive therapy embodies conservative rehabilitation treatments for BCRL. Surgical procedures performed by plastic and reconstructive microsurgeons are available when conservative treatment fails. The purpose of this systematic review was to investigate which rehabilitation interventions contribute to the highest level of pre- and post-microsurgical outcomes. RECENT FINDINGS Studies published between 2002 and 2022 were grouped for analysis. This review was registered with PROSPERO (CRD42022341650) and followed the PRISMA guidelines. Levels of evidence were based upon study design and quality. The initial literature search yielded 296 results, of which, 13 studies met all inclusion criteria. Lymphovenous bypass anastomoses (LVB/A) and vascularized lymph node transplant (VLNT) emerged as dominant surgical procedures. Peri-operative outcome measures varied greatly and were used inconsistently. There is a dearth of high quality literature leading to a gap in knowledge as to how BCRL microsurgical and conservative interventions complement each other. Peri-operative guidelines are needed to bridge the knowledge and care gap between lymphedema surgeons and therapists. A core set of outcome measures for BCRL is vital to unify terminological differences in the multidisciplinary care of BCRL. Complete decongestive therapy embodies conservative rehabilitation treatments for breast cancer-related lymphedema (BCRL). Surgical procedures performed by microsurgeons are available when conservative treatment fails. This systematic review investigated which rehabilitation interventions contribute to the highest level of pre- and post-microsurgical outcomes. Thirteen studies met all inclusion criteria and revealed that there is a dearth of high quality literature leading to a gap in knowledge as to how BCRL microsurgical and conservative interventions complement each other. Furthermore, peri-operative outcome measures were inconsistent. Peri-operative guidelines are needed to bridge the knowledge and care gap between lymphedema surgeons and therapists.
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Affiliation(s)
| | | | - Julie Hunley
- Department of Occupational Therapy, Mount Mary University, Milwaukee, WI, USA
| | - Mark Schaverien
- Department of Plastic Surgery, University of Texas, MD Anderson Cancer Center, Houston, TX, USA
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3
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Karaca-Mandic P, Solid CA, Armer JM, Skoracki R, Campione E, Rockson SG. Lymphedema self-care: economic cost savings and opportunities to improve adherence. Cost Eff Resour Alloc 2023; 21:47. [PMID: 37516870 PMCID: PMC10386258 DOI: 10.1186/s12962-023-00455-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 01/13/2023] [Accepted: 07/20/2023] [Indexed: 07/31/2023] Open
Abstract
BACKGROUND Breast cancer-related lymphedema (BCRL) imposes a significant economic burden on patients, providers, and society. There is no curative therapy for BCRL, but management through self-care can reduce symptoms and lower the risk of adverse events. MAIN BODY The economic burden of BCRL stems from related adverse events, reductions in productivity and employment, and the burden placed on non-medical caregivers. Self-care regimens often include manual lymphatic drainage, compression garments, and meticulous skin care, and may incorporate pneumatic compression devices. These regimens can be effective in managing BCRL, but patients cite inconvenience and interference with daily activities as potential barriers to self-care adherence. As a result, adherence is generally poor and often worsens with time. Because self-care is on-going, poor adherence reduces the effectiveness of regimens and leads to costly treatment of BCRL complications. CONCLUSION Novel self-care solutions that are more convenient and that interfere less with daily activities could increase self-care adherence and ultimately reduce complication-related costs of BCRL.
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Affiliation(s)
- Pinar Karaca-Mandic
- Carlson School of Management, University of Minnesota, Carlson School of Management, 321 19th Avenue South, Minneapolis, MN, 55455, USA.
| | | | - Jane M Armer
- University of Missouri Sinclair School of Nursing, Columbia, MO, USA
| | - Roman Skoracki
- James Cancer Treatment and Research Center, Ohio State University, Columbus, OH, USA
| | | | - Stanley G Rockson
- Stanford Center for Lymphatic and Venous Disorders, Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA, USA
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Wampler M, Campione E, Bolch CA. Practice patterns of physical therapists and physical therapist assistants treating patients with breast cancer related lymphedema. Support Care Cancer 2023; 31:134. [PMID: 36701027 DOI: 10.1007/s00520-023-07589-7] [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: 10/21/2022] [Accepted: 01/11/2023] [Indexed: 01/27/2023]
Abstract
Clinical Practice Guidelines (CPGs) aim to improve patient outcomes through implementation of proven interventions and decrease variation in practices. The relevance of this article is to describe the current state practice of physical therapists who diagnose and treat patients with Breast Cancer Related Lymphedema (BCRL). It also provides a description of physical therapist-reported adherence to the BCRL CPG recommendations which establishes the need for implementation interventions to improve adherence. PURPOSE The purpose of this study is to describe practice patterns of physical therapists (PT) and physical therapist assistants (PTA) who treat patients with breast cancer-related lymphedema and determine if they are adherent to best evidence recommendations for lymphedema diagnosis and intervention. METHODS An electronic survey to collect practice pattern data of PTs and PTAs who treat patients with BCRL was distributed. A descriptive and quantitative statistical analysis was performed. RESULTS Twenty-six percent of respondents read the American Physical Therapy Association sponsored lymphedema diagnosis clinical practice guideline (CPG) and 20% read the lymphedema intervention CPG. Lymphoscintigraphy was the only diagnosis or intervention tool with a significant difference in use between therapists who read versus did not read the CPGs. Adherence to "should do" recommendations was variable: bioimpedance (18.2%), volume calculation (49.3%), ultrasound (0%), patient reported outcome tools (64.9%), compression garments (43.9%), exercise (87.2%), and compression bandaging (56.8%). CONCLUSIONS There is variability in adherence to recommendations for both the lymphedema diagnosis and intervention CPGs. Interventions to improve implementation and adherence to CPG recommendations are warranted.
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Affiliation(s)
- Meredith Wampler
- Program in Physical Therapy, Oregon State University-Cascades, 1500 SW Chandler Ave., Bend, OR, 97702, USA.
| | - Elizabeth Campione
- Physical Therapy Program, Midwestern University, 555 31st St., Downers Grove, IL, 60515, USA
| | - Charlotte A Bolch
- Office of Research and Sponsored Programs, Midwestern University, 19555 N 59th Ave., Glendale, AZ, 85308, USA
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Rockson SG, Karaca-Mandic P, Nguyen M, Shadduck K, Gingerich P, Campione E, Hetrrick H. A non-randomized, open-label study of the safety and effectiveness of a novel non-pneumatic compression device (NPCD) for lower limb lymphedema. Sci Rep 2022; 12:14005. [PMID: 35977981 PMCID: PMC9385615 DOI: 10.1038/s41598-022-17225-9] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 07/21/2022] [Indexed: 01/19/2023] Open
Abstract
Lower extremity lymphedema (LEL) can result in detriments to quality of life (QOL) and impose a significant economic burden on patients and payers. A common component of treatment is pneumatic compression, which requires patients to remain immobile. We investigated a novel non-pneumatic compression device (NPCD) that allows patients to remain active during compression treatment, to see if it reduces swelling and improves QOL. We conducted a non-randomized, open-label, 12-week pilot study of adult patients with primary or secondary unilateral LEL, and measured changes in limb edema and QOL using the Lymphedema Quality of Life Questionnaire (LYMQOL). Twenty-four subjects were enrolled; the majority were female (17) with secondary lymphedema (21). Eighteen completed the study. Statistically significant improvements were observed in overall QOL, aggregated LYMQOL total score, and three of four LYMQOL subscales (Function, Appearance, Mood). The fourth (Symptoms) trended toward significant improvement (p = 0.06). The average reduction in affected limb edema was 39.4%. The novel NPCD produced statistically significant improvements in QOL, functioning, and edema volume of patients with LEL. Innovations in devices to manage LEL can be effective while allowing patients to maintain mobility and physical activity during treatment.
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Affiliation(s)
- Stanley G. Rockson
- grid.168010.e0000000419368956Cardiovascular Medicine, Falk Cardiovascular Research Center, Stanford University, Stanford, CA 94305 USA
| | - Pinar Karaca-Mandic
- grid.17635.360000000419368657Carlson School of Management, University of Minnesota, Minneapolis, MN USA
| | | | | | | | - Elizabeth Campione
- grid.260024.20000 0004 0627 4571Department of Physical Therapy, Midwestern University, Downers Grove, IL USA
| | - Heather Hetrrick
- grid.261241.20000 0001 2168 8324Department of Physical Therapy, Nova Southeastern University, Ft. Lauderdale, FL USA
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Rockson SG, Karaca-Mandic P, Skoracki R, Hock K, Nguyen M, Shadduck K, Gingerich P, Campione E, Leifer A, Armer J. Clinical Evaluation of a Novel Wearable Compression Technology in the Treatment of Lymphedema, an Open-Label Controlled Study. Lymphat Res Biol 2021; 20:125-132. [PMID: 34227842 PMCID: PMC9081034 DOI: 10.1089/lrb.2020.0126] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
A diagnosis of lymphedema comes with a lifetime requirement for careful self-care and treatment to control skin deterioration and the consequences of excessive fluid and protein buildup leading to abnormal limb volume and an increased risk of infection. The burden of care and psychosocial aspects of physical disfiguration and loss of function are associated with compromised quality of life (QoL). The current standard therapeutic intervention is complex decongestive therapy with manual lymph drainage and frequent wearing of compression garments. With insurance limitations on therapy visits and the time and travel required, additional home treatment options are needed. Pneumatic compression pumps that mimic the manual massage pressure and pattern are sometimes prescribed, but these are bulky, difficult to apply, and require immobility during treatment. An open-label pilot study in 40 subjects was performed to evaluate the QoL and limb volume maintenance efficacy of a novel wearable compression system (Dayspring™) that is low profile, easy to use, and allows for mobility during treatment. After 28 days of use, subjects had a statistically significant 18% (p < 0.001) improvement in overall QoL as measured by the Lymphedema Quality-of-Life Questionnaire compared with baseline. Individual QoL domains, and limb volume improved with therapy. Adherence was 98% over the course of the study. Results of the clinical evaluation suggest the Dayspring wearable compression device is safe and effective and improves QoL and limb volume. The novel, low-profile device is easy to use and allows for mobility during treatment, addressing a potential barrier to adherence with pneumatic compression devices.
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Affiliation(s)
- Stanley G Rockson
- Cardiovascular Medicine, Stanford University, Stanford, California, USA
| | - Pinar Karaca-Mandic
- Carlson School of Management, University of Minnesota, Minneapolis, Minnesota, USA
| | - Roman Skoracki
- James Cancer Treatment and Research Center, Ohio State University, Columbus, Ohio, USA
| | - Karen Hock
- James Cancer Treatment and Research Center, Ohio State University, Columbus, Ohio, USA
| | | | | | | | - Elizabeth Campione
- Department of Physical Therapy, Midwestern University, Downers Grove, Illinois, USA
| | | | - Jane Armer
- Ellis Fischel Cancer Center, University of Missouri, Columbia, Missouri, USA
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Gaziano R, Pistoia ES, Campione E, Fontana C, Marino D, Favaro M, Pica F, Di Francesco P. Immunomodulatory agents as potential therapeutic or preventive strategies for COVID-19. Eur Rev Med Pharmacol Sci 2021; 25:4174-4184. [PMID: 34156699 DOI: 10.26355/eurrev_202106_26061] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Currently, the COVID-19 pandemic, caused by the novel SARS-CoV-2 coronavirus, represents the greatest global health threat. Most people infected by the virus present mild to moderate respiratory symptoms and recover with supportive treatments. However, certain susceptible hosts develop an acute respiratory distress syndrome (ARDS), associated with an inflammatory "cytokine storm", leading to lung damage. Despite the current availability of different COVID-19 vaccines, the new emerging SARS-CoV-2 genetic variants represent a major concern worldwide, due to their increased transmissibility and rapid spread. Indeed, it seems that some mutations or combinations of mutations might confer selective advantages to the virus, such as the ability to evade the host immune responses elicited by COVID-19 vaccines. Several therapeutic approaches have been investigated but, to date, a unique and fully effective therapeutic protocol has not yet been achieved. In addition, steroid-based therapies, aimed to reduce inflammation in patients with severe COVID-19 disease, may increase the risk of opportunistic infections, increasing the hospitalization time and mortality rate of these patients. Hence, there is an unmet need to develop more effective therapeutic options. Here, we discuss the potential use of natural immunomodulators such as Thymosin α1 (Tα1), all-trans retinoic acid (ATRA), and lactoferrin (LF), as adjunctive or preventive treatment of severe COVID-19 disease. These agents are considered to be multifunctional molecules because of their ability to enhance antiviral host immunity and restore the immune balance, depending on the host immune status. Furthermore, they are able to exert a broad-spectrum antimicrobial activity by means of direct interactions with cellular or molecular targets of pathogens or indirectly by increasing the host immune response. Thus, due to the aforementioned properties, these agents might have a great potential in a clinical setting, not only to counteract SARS-CoV-2 infection, but also to prevent opportunistic infections in critically ill COVID-19 patients.
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Affiliation(s)
- R Gaziano
- Department of Experimental Medicine, University of Rome Tor Vergata, Rome, Italy.
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8
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Galluzzo M, Caldarola G, De Simone C, Bernardini N, Moretta G, Pallotta S, Botti E, Campione E, Pirro F, Potenza C, Bianchi L, Peris K. Use of brodalumab for the treatment of chronic plaque psoriasis: a one-year real-life study in the Lazio region, Italy. Expert Opin Biol Ther 2021; 21:1299-1310. [PMID: 34114515 DOI: 10.1080/14712598.2021.1941862] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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: 12/17/2022]
Abstract
Background: Information is limited from real-life studies evaluating the efficacy and safety of brodalumab.Research design and methods: In this real-life study, we retrospectively examined a database of 90 patients with moderate-to-severe psoriasis treated with brodalumab (210 mg, s.c.) and followed for 1 year. Disease severity and treatment response were assessed by the Psoriasis Area and Severity Index (PASI) at baseline and after 4, 12, 24, 36, and 48 weeks. Predictors of a PASI response were evaluated by logistic regression.Results: After 48 weeks, 92.2% of patients (mean age 50.2 ± 15 years) treated with brodalumab achieved a PASI score of <3. PASI score decreased from 17.4 ± 10.3 at baseline to 1.7 ± 3.9 and 1.4 ± 3.7 at 12 and 24 weeks, and PASI 75, 90, and 100 response was achieved in 87.3%, 81.8%, and 72.7% of patients, respectively, at 48 weeks.Univariate regression revealed that previous exposure to anti-IL17A treatment was associated with poorer PASI response between 36 and 48 weeks. In difficult-to-treat cases previously having failed with other biologics, brodalumab significantly improved outcome, leading to complete remission.Conclusion: Brodalumab was observed to be effective and safe in patients with moderate-to-severe chronic psoriasis in a real-world setting.
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Affiliation(s)
- M Galluzzo
- Department of Experimental Medicine, University of Rome "Tor Vergata", Rome, Italy.,Dermatology Unit, Fondazione Policlinico Tor Vergata, Rome, Italy
| | - G Caldarola
- Dipartimento Scienze Mediche E Chirurgiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Dermatologia, Rome, Italy.,Dermatologia, Università Cattolica Del Sacro Cuore, Dermatologia, Rome, Italy
| | - C De Simone
- Dipartimento Scienze Mediche E Chirurgiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Dermatologia, Rome, Italy.,Dermatologia, Università Cattolica Del Sacro Cuore, Dermatologia, Rome, Italy
| | - N Bernardini
- Dermatology Unit, Sapienza University of Rome, Latina, Italy
| | - G Moretta
- Dermatology Unit, Istituto Dermopatico dell'Immacolata IDI-IRCCS, Rome, Italy
| | - S Pallotta
- Dermatology Unit, Istituto Dermopatico dell'Immacolata IDI-IRCCS, Rome, Italy
| | - E Botti
- Dermatology Unit, Fondazione Policlinico Tor Vergata, Rome, Italy.,Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy
| | - E Campione
- Dermatology Unit, Fondazione Policlinico Tor Vergata, Rome, Italy.,Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy
| | - F Pirro
- Dipartimento Scienze Mediche E Chirurgiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Dermatologia, Rome, Italy.,Dermatologia, Università Cattolica Del Sacro Cuore, Dermatologia, Rome, Italy
| | - C Potenza
- Dermatology Unit, Sapienza University of Rome, Latina, Italy
| | - L Bianchi
- Dermatology Unit, Fondazione Policlinico Tor Vergata, Rome, Italy.,Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy
| | - K Peris
- Dipartimento Scienze Mediche E Chirurgiche, Fondazione Policlinico Universitario A. Gemelli IRCCS, Dermatologia, Rome, Italy.,Dermatologia, Università Cattolica Del Sacro Cuore, Dermatologia, Rome, Italy
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Gaziano R, Campione E, Iacovelli F, Pistoia ES, Marino D, Milani M, Di Francesco P, Pica F, Bianchi L, Orlandi A, Marsico S, Falconi M, Aquaro S. Antimicrobial properties of the medicinal plant Cardiospermum halicacabum L: new evidence and future perspectives. Eur Rev Med Pharmacol Sci 2020; 23:7135-7143. [PMID: 31486516 DOI: 10.26355/eurrev_201908_18759] [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] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
The emergence and rapid spread of multidrug-resistance in human pathogenic microorganisms urgently require the development of novel therapeutic strategies for the treatment of infectious diseases. From this perspective, the antimicrobial properties of the natural plant-derived products may represent an important alternative therapeutic option to synthetic drugs. Among medicinal plants, the Cardiospermum halicacabum L. (C. halicacabum), belonging to Sapindaceae family, could be a very promising candidate for its antimicrobial activity against a wide range of microorganisms, including both Gram-positive and Gram-negative bacteria, as well as fungal pathogens. Although the antimicrobial properties of C. halicacabum have been intensively studied, the mechanism/s by which it exerts the inhibitory activity towards the pathogenic microbes have not yet been completely understood. This review focuses on the main antimicrobial activities displayed in vitro by the plant extract, with particular attention on our recent advances. We demonstrated that C. halicacabum is able to exert in vitro a dose-dependent fungistatic effect against Trychophyton rubrum (T. rubrum) through molecular interaction with the fungal heat shock protein (Hsp)-90 chaperone. These findings are supported by a growing body of research indicating the crucial role played by the Hsp90 in the virulence of the pathogenic microorganisms, including fungal pathogens. The possible future use of C. halicacabum for treating a wide range of infectious diseases is also discussed.
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Affiliation(s)
- R Gaziano
- Department of Experimental Medicine, University of Rome Tor Vergata, Rome, Italy.
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10
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Lanna C, Cesaroni GM, Mazzilli S, Vollono L, Gaziano R, Marino D, Bianchi L, Campione E. Apremilast as a target therapy for nail psoriasis: a real-life observational study proving its efficacy in restoring the nail unit. J DERMATOL TREAT 2020; 33:1097-1101. [PMID: 32715817 DOI: 10.1080/09546634.2020.1801976] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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: 12/15/2022]
Abstract
PURPOSE Psoriasis, Psoriatic Arthritis and Nail psoriasis are chronic diseases that share a common underlying etiology of immunity dysregulation, enhanced activation of inflammatory pathways and remitting-relapsing course. Although nails represent a small percentage of the body surface involvement of this site can lead to impaired quality of life, severe discomfort and even result in permanent disability. Current therapeutic options for nail psoriasis include a variety of topical and systemic treatments although they are often reported as unsatisfactory from patients either due to their poor effectiveness or disturbing side effects. Recently small molecule drugs such as the PDE4 inhibitors were introduced in clinical practice and specifically apremilast has shown to be an effective new treatment option for psoriasis and psoriatic arthritis. Considering either the specific mechanism of action of apremilast, we performed a real-life observational study of 24 weeks assessing apremilast role in nail psoriasis. MATHERIALS AND METHODS Patients received apremilast 30mg bid, orally. Safety and efficacy were assessed at weeks 0, 4, 8, 12 and 24 using Dermatologic Life Quality Index (DLQI) and Nail Area Psoriasis Severity Index (NAPSI). At T0 we took a nail sample to investigate the presence of onychomycosis. Culture tests were performed in all the patients to search for fungi. RESULTS We recruited a total of 15 patients with nail psoriasis. The analysis of variance (one-way ANOVA) showed the following results: DLQI (F.15.7; p-value < .00001) and NAPSI (F.9.4; p-value < .00001). Three patients (20%) presented also onychomycoses at the beginning of the treatment. CONCLUSIONS Apremilast showed fast and sustained improvement of nail psoriasis over time and a complete resolution of life quality impairment due to the disease.
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Affiliation(s)
- C Lanna
- Dermatologic Unit, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - G M Cesaroni
- Dermatologic Unit, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - S Mazzilli
- Dermatologic Unit, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - L Vollono
- Dermatologic Unit, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - R Gaziano
- Microbiology Section, Department of Experimental Medicine, University of Rome Tor Vergata, Rome, Italy
| | - D Marino
- Microbiology Section, Department of Experimental Medicine, University of Rome Tor Vergata, Rome, Italy
| | - L Bianchi
- Dermatologic Unit, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - E Campione
- Dermatologic Unit, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
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11
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Dattola A, Balato A, Megna M, Gisondi P, Girolomoni G, De Simone C, Caldarola G, Cama E, Piaserico S, Fargnoli M, Fidanza R, Parodi A, Burlando M, Offidani A, Diotallevi F, Potenza C, Conti A, Chiricozzi A, Campione E, Bianchi L. Certolizumab for the treatment of psoriasis and psoriatic arthritis: a real‐world multicentre Italian study. J Eur Acad Dermatol Venereol 2020; 34:2839-2845. [DOI: 10.1111/jdv.16606] [Citation(s) in RCA: 4] [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] [Received: 02/26/2020] [Accepted: 04/21/2020] [Indexed: 01/11/2023]
Affiliation(s)
- A. Dattola
- Department of Dermatology University of Rome“Tor Vergata” Rome Italy
| | - A. Balato
- Department of Advanced Biomedical Sciences University of Naples Federico II Naples Italy
| | - M. Megna
- Department of Clinical Medicine and Surgery University of Naples Federico II Naples Italy
| | - P. Gisondi
- Section of Dermatology and Venereology Department of Medicine University of Verona Verona Italy
| | - G. Girolomoni
- Section of Dermatology and Venereology Department of Medicine University of Verona Verona Italy
| | - C. De Simone
- Institute of Dermatology Catholic University Rome Italy
- Dermatology Unit Fondazione Policlinico Universitario A. Gemelli IRCCS Rome Italy
| | - G. Caldarola
- Institute of Dermatology Catholic University Rome Italy
| | - E. Cama
- Dermatology Unit Department of Medicine University of Padua Padua Italy
| | - S. Piaserico
- Dermatology Unit Department of Medicine University of Padua Padua Italy
| | - M.C. Fargnoli
- Department Dermatology Department of Biotechnological and Applied Clinical Sciences University of L'Aquila L'Aquila Italy
| | - R. Fidanza
- Department Dermatology San Salvatore HospitalUniversity of L'Aquila L'Aquila Italy
| | - A. Parodi
- Section of Dermatology DISSAL San Martino‐IST Polyclinic HospitalUniversity of Genoa Genoa Italy
| | - M. Burlando
- Section of Dermatology DISSAL San Martino‐IST Polyclinic HospitalUniversity of Genoa Genoa Italy
| | - A. Offidani
- Dermatology Unit Department of Clinical and Molecular Sciences Polytechnic Marche University Ancona Italy
| | - F. Diotallevi
- Dermatology Unit Department of Clinical and Molecular Sciences Polytechnic Marche University Ancona Italy
| | - C. Potenza
- Department of Medical‐Surgical Sciences and Bio‐Technologies Sapienza University of Rome, Polo Pontino Terracina Italy
| | - A. Conti
- Dermatology Unit Surgical, Medical and Dental Department of Morphological Sciences related to Transplant, Oncology and Regenerative Medicine University of Modena and Reggio Emilia Modena Italy
| | - A. Chiricozzi
- Institute of Dermatology Catholic University Rome Italy
- Dermatology Unit Fondazione Policlinico Universitario A. Gemelli IRCCS Rome Italy
- Dermatology Unit Department of Clinical and Experimental Medicine University of Pisa Pisa Italy
| | - E. Campione
- Department of Dermatology University of Rome“Tor Vergata” Rome Italy
| | - L. Bianchi
- Department of Dermatology University of Rome“Tor Vergata” Rome Italy
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Diluvio L, Caporali S, Lozzi F, Campione E, Mazzilli S, Lanna C, Bianchi L, Bernardini S, Minieri M, Mauriello A, Ferlosio A, Candi E, Terrinoni A. Birt-Hogg-Dubé syndrome, from non-invasive dermatologic assessment to gene testing, molecular and ultrastructural histologic analysis. J Eur Acad Dermatol Venereol 2020; 34:e206-e209. [PMID: 31876332 DOI: 10.1111/jdv.16168] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- L Diluvio
- Dermatology Unit of Department of Systems Medicine, University of Rome Tor vergata, Rome, Italy
| | - S Caporali
- Department of Industrial Engineering, University of Rome Tor Vergata, Rome, Italy
| | - F Lozzi
- Dermatology Unit of Department of Systems Medicine, University of Rome Tor vergata, Rome, Italy
| | - E Campione
- Dermatology Unit of Department of Systems Medicine, University of Rome Tor vergata, Rome, Italy
| | - S Mazzilli
- Dermatology Unit of Department of Systems Medicine, University of Rome Tor vergata, Rome, Italy
| | - C Lanna
- Dermatology Unit of Department of Systems Medicine, University of Rome Tor vergata, Rome, Italy
| | - L Bianchi
- Dermatology Unit of Department of Systems Medicine, University of Rome Tor vergata, Rome, Italy
| | - S Bernardini
- Department of Experimental Medicine, University of Rome Tor Vergata, Rome, Italy
| | - M Minieri
- Department of Experimental Medicine, University of Rome Tor Vergata, Rome, Italy
| | - A Mauriello
- Department of Experimental Medicine, University of Rome Tor Vergata, Rome, Italy
| | - A Ferlosio
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - E Candi
- Department of Experimental Medicine, University of Rome Tor Vergata, Rome, Italy.,Biochemistry Laboratory, Fondazione Luigi Maria Monti, IDI-IRCCS, Rome, Italy
| | - A Terrinoni
- Department of Experimental Medicine, University of Rome Tor Vergata, Rome, Italy
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Signa S, Campione E, Rusmini M, Chiesa S, Grossi A, Omenetti A, Caorsi R, Viglizzo GM, Galluzzo M, Bianchi L, Talamonti M, Orlandi A, Martini A, Ceccherini I, Gattorno M. Whole exome sequencing approach to childhood onset familial erythrodermic psoriasis unravels a novel mutation of CARD14 requiring unusual high doses of ustekinumab. Pediatr Rheumatol Online J 2019; 17:38. [PMID: 31286971 PMCID: PMC6615224 DOI: 10.1186/s12969-019-0336-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Accepted: 06/05/2019] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Autosomal dominant gain of function mutations in caspase recruitment domain family member 14 (CARD14) is a rare condition associated with plaque-type psoriasis, generalized pustular psoriasis, palmoplantar pustular psoriasis and pityriasis rubra pilaris. Recently, a new CARD14 -associated phenotype defined as CAPE (CARD14-associated papulosquamous eruption) with clinical features of both psoriasis and pityriasis rubra pilaris was reported. We describe a family carrying a novel heterozygous mutation in CARD14 gene, with childhood-onset erythrodermic psoriasis requiring an unusual extremely high dose (up to 2 mg/kg every 8 weeks) of ustekinumab to achieve disease remission. CASE PRESENTATION We describe a large family with three pairs of twins presenting a clinical phenotype characterized by childhood-onset erythrodermic psoriasis; in some family members is also reported psoriatic arthritis. The two probands presented poor clinical response to topic and systemic therapy with antihistamine, steroid, retinoids, cyclosporine and etanercept. After exclusion of the most common genes associated to autoinflammatory diseases (IL36RN, IL1RN, MVK, TNFRSF1A, NLRP3, NLRP12, MEFV, NOD2, PSMB8, PSTPIP1, LPIN2) we approached a new gene search by subjecting to Whole Exome Sequencing (WES) analysis five members of the family. A novel heterozygous mutation (c.446 T > G, leading to the missense amino acid substitution p.L149R) in the exon 4 of the CARD14 gene was identified in all affected members. Increasing dosages (up to 2 mg/kg every 8 weeks) of ustekinumab, a human monoclonal antibody targeting interleukin-12 (IL-12) and interleukin-23 (IL-23), allowed the complete control of the clinical manifestations, with an evident reduction of circulating Th17 and Th22 CD4+ T cell subsets. CONCLUSIONS We describe the association of mutations of the CARD14 gene with an erythrodermic psoriasis pedigree, underlying the necessity to investigate CARD14 mutations in childhood-onset psoriasis cases and confirming the presence of CARD14 causative mutations also in erythrodermic psoriasis form, as recently reported. Also in pediatric age, ustekinumab represents a powerful therapeutic option for this rare condition, that is usually refractory to other treatments. In young children, high and frequent dosages allowed a complete control of the clinical manifestations without any severe side effects, with a long-term follow-up.
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Affiliation(s)
- S. Signa
- Centro Malattie Autoinfiammatorie e Immunodeficienze- Clinica Pediatrica e Reumatologia, IRCCS Giannina Gaslini, Via Gaslini 5, 16147 Genova, Italy ,0000 0001 2151 3065grid.5606.5Dipartimento di Neuroscienze, Riabilitazione, Oftalmologia, Genetica e Scienze Materno-Infantili (DINOGMI), Università di Genova, Genoa, Italy
| | - E. Campione
- 0000 0001 2300 0941grid.6530.0Dermatology, Department of “Medicina dei Sistemi”, University of Rome Tor Vergata, Rome, Italy
| | - M. Rusmini
- 0000 0004 1760 0109grid.419504.dUO Genetica Medica, IRCCS G. Gaslini, Genoa, Italy
| | - S. Chiesa
- Centro Malattie Autoinfiammatorie e Immunodeficienze- Clinica Pediatrica e Reumatologia, IRCCS Giannina Gaslini, Via Gaslini 5, 16147 Genova, Italy
| | - A. Grossi
- 0000 0004 1760 0109grid.419504.dUO Genetica Medica, IRCCS G. Gaslini, Genoa, Italy
| | - A. Omenetti
- Centro Malattie Autoinfiammatorie e Immunodeficienze- Clinica Pediatrica e Reumatologia, IRCCS Giannina Gaslini, Via Gaslini 5, 16147 Genova, Italy
| | - R. Caorsi
- Centro Malattie Autoinfiammatorie e Immunodeficienze- Clinica Pediatrica e Reumatologia, IRCCS Giannina Gaslini, Via Gaslini 5, 16147 Genova, Italy
| | - G. M. Viglizzo
- 0000 0004 1760 0109grid.419504.dUO Dermatologia , IRCCS G. Gaslini, Genoa, Italy
| | - M. Galluzzo
- 0000 0001 2300 0941grid.6530.0Dermatology, Department of “Medicina dei Sistemi”, University of Rome Tor Vergata, Rome, Italy
| | - L. Bianchi
- 0000 0001 2300 0941grid.6530.0Dermatology, Department of “Medicina dei Sistemi”, University of Rome Tor Vergata, Rome, Italy
| | - M. Talamonti
- 0000 0001 2300 0941grid.6530.0Dermatology, Department of “Medicina dei Sistemi”, University of Rome Tor Vergata, Rome, Italy
| | - A. Orlandi
- 0000 0001 2300 0941grid.6530.0Cattedra di Anatomia Patologica, Policlinico Universitario di Roma “Tor Vergata”, Rome, Italy
| | - A. Martini
- 0000 0004 1760 0109grid.419504.dDirezione Scientifica, IRCCS G. Gaslini, Genoa, Italy
| | - I. Ceccherini
- 0000 0004 1760 0109grid.419504.dUO Genetica Medica, IRCCS G. Gaslini, Genoa, Italy
| | - M. Gattorno
- Centro Malattie Autoinfiammatorie e Immunodeficienze- Clinica Pediatrica e Reumatologia, IRCCS Giannina Gaslini, Via Gaslini 5, 16147 Genova, Italy
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Galluzzo M, D'Adamio S, Campione E, Mazzilli S, Bianchi L, Talamonti M. A clinical case of severe disease burden: an erythrodermic psoriatic patient treated with secukinumab. J DERMATOL TREAT 2018; 29:1-11. [PMID: 30256706 DOI: 10.1080/09546634.2018.1524818] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [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: 04/24/2018] [Accepted: 09/07/2018] [Indexed: 10/28/2022]
Abstract
Erythrodermic psoriasis is a severe variant of psoriasis characterized by prominent erythema, affecting the entire body surface. Management of erythrodermic psoriasis is difficult, not standardized, and often ineffective. As clinical studies are lacking, reporting of clinical experience with secukinumab may help to gather insight in this field. Here, we describe the case of a 55-year-old man, with a 10-year history of moderate-to-severe plaque psoriasis. He presents a flare of erythroderma involving approximately 90% of his body surface area and a Psoriasis Area and Severity Index score of 42, with an important impact on his quality of life (DLQI score was 20.0; Skindex-29 score was 67.2). The patient presented also alexithymic features. Due to severity of clinical features and poor quality of life, the patient started secukinumab treatment; we observed a striking and rapid response to therapy with an excellent safety profile and a satisfactory compliance. Furthermore, therapy with secukinumab considerably enhanced patient's quality of life. Although further studies are needed to better understand the role of the IL-23/Th17 pathway, secukinumab can be an effective therapeutic option for patients affected by erythrodermic psoriasis.
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Affiliation(s)
- M Galluzzo
- a Department of Dermatology , University of Rome "Tor Vergata" , Viale Oxford 81 , 00133 Rome , Italy
| | - S D'Adamio
- a Department of Dermatology , University of Rome "Tor Vergata" , Viale Oxford 81 , 00133 Rome , Italy
| | - E Campione
- a Department of Dermatology , University of Rome "Tor Vergata" , Viale Oxford 81 , 00133 Rome , Italy
| | - S Mazzilli
- a Department of Dermatology , University of Rome "Tor Vergata" , Viale Oxford 81 , 00133 Rome , Italy
| | - L Bianchi
- a Department of Dermatology , University of Rome "Tor Vergata" , Viale Oxford 81 , 00133 Rome , Italy
| | - M Talamonti
- a Department of Dermatology , University of Rome "Tor Vergata" , Viale Oxford 81 , 00133 Rome , Italy
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Galluzzo M, D'Adamio S, Campione E, Bianchi L, Talamonti M. A safety evaluation of guselkumab for the treatment of psoriasis. Expert Opin Drug Saf 2018; 17:741-751. [PMID: 29897790 DOI: 10.1080/14740338.2018.1488963] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [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: 04/16/2018] [Accepted: 06/12/2018] [Indexed: 01/25/2023]
Abstract
INTRODUCTION Guselkumab is a fully human monoclonal IgG1λ antibody for the treatment of plaque psoriasis that inhibits interleukin (IL)-23p19 subunit, reducing the proliferation of type 17 helper T (Th-17) cells and thus production of Th-17-derived pro-inflammatory cytokines, especially IL-17 and IL-22. Areas covered: In the following article, the mechanism of action and mainly the efficacy and safety profile of guselkumab available from results of trials will be discussed. We summarized these data after a literature review including PubMed search, relating proceedings and abstracts from relevant international conferences, assessment reports from European and United States regulatory agencies and treatment guidelines up to April 2018. Expert opinion: The central role of IL-23 in psoriasis pathogenesis is supported by genetic links of IL-23 and IL-23R alleles to psoriasis susceptibility; early clinical trials have demonstrated that sufficient inhibition of IL-23p19 results in rapid resolution of the disease. Targeting IL-23, may be responsible for the high efficacy and durable responses of guselkumab, avoiding some adverse effects of IL-17A blockade, like mucocutaneous candida infections or triggering/worsening of inflammatory bowel disease, experienced with agents acting selectively against this molecule and that seem to be class related.
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Affiliation(s)
- M Galluzzo
- a Dermatology, Department of "Medicina dei Sistemi" , University of Rome Tor Vergata , Rome , Italy
| | - S D'Adamio
- a Dermatology, Department of "Medicina dei Sistemi" , University of Rome Tor Vergata , Rome , Italy
| | - E Campione
- a Dermatology, Department of "Medicina dei Sistemi" , University of Rome Tor Vergata , Rome , Italy
| | - L Bianchi
- a Dermatology, Department of "Medicina dei Sistemi" , University of Rome Tor Vergata , Rome , Italy
| | - M Talamonti
- a Dermatology, Department of "Medicina dei Sistemi" , University of Rome Tor Vergata , Rome , Italy
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Diluvio L, Mazzeo M, Bianchi L, Campione E. Agminated Dermal Melanocytosis in the Territory of Ota's Nevus. Actas Dermosifiliogr (Engl Ed) 2018; 109:653-655. [PMID: 29559081 DOI: 10.1016/j.ad.2017.07.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Revised: 06/30/2017] [Accepted: 07/16/2017] [Indexed: 11/28/2022] Open
Affiliation(s)
- L Diluvio
- Unidad de Dermatología, Universidad de Roma Tor Vergata, Roma, Italia.
| | - M Mazzeo
- Unidad de Dermatología, Universidad de Roma Tor Vergata, Roma, Italia
| | - L Bianchi
- Unidad de Dermatología, Universidad de Roma Tor Vergata, Roma, Italia
| | - E Campione
- Unidad de Dermatología, Universidad de Roma Tor Vergata, Roma, Italia
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Signa S, Rusmini M, Campione E, Gueli I, Grossi A, Omenetti A, Bianchi L, Martini A, Ceccherini I, Gattorno M. Severe erytrodermic psoriasis and arthritis as clinical presentation of a CARD14-mediated psoriasis (CAMPS). Pediatr Rheumatol Online J 2015. [PMCID: PMC4599347 DOI: 10.1186/1546-0096-13-s1-p57] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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18
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Signa S, Rusmini M, Campione E, Gueli I, Grossi A, Omenetti A, Bianchi L, Martini A, Ceccherini I, Gattorno M. THU0528 Severe Erytrodermic Psoriasis and Arthritis as Clinical Presentation of a Card14-Mediated Pustular Psoriasis (CAMPS). Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.4904] [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] [Indexed: 11/04/2022]
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Cordiali-Fei P, Bianchi L, Bonifati C, Trento E, Ruzzetti M, Francesconi F, Bultrini S, D'Agosto G, Bordignon V, Francavilla V, Tripiciano A, Chiricozzi A, Campione E, Cavallotti C, Orlandi A, Berardesca E, Di Carlo A, Chimenti S, Ensoli F. Immunologic biomarkers for clinical and therapeutic management of psoriasis. Mediators Inflamm 2014; 2014:236060. [PMID: 25136144 PMCID: PMC4129379 DOI: 10.1155/2014/236060] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [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: 03/06/2014] [Revised: 06/26/2014] [Accepted: 06/26/2014] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND The therapeutic management of psoriasis includes conventional treatments as well as the new generation of highly effective TNF-α inhibitors. However, psoriasis has proven to be a complex therapeutic challenge and treatment failures are not uncommon. Thus, laboratory biomarkers of disease progression/therapeutic efficacy may greatly help in the clinical management of psoriasis. AIMS To identify laboratory biomarkers for clinical management and therapeutic monitoring of psoriasis. METHODS An observational study performed on 59 patients, presenting moderate to severe psoriasis, undergoing treatment with anti-TNF-α agents (etanercept, adalimumab, and infliximab). Soluble and cellular immune/inflammatory parameters were assessed at baseline and after 12 and 24 weeks of treatment. RESULTS Clinical efficacy was achieved in 88% of the subjects at 12 weeks, reaching 90% after 24 weeks. IL-6 and IL-22, which were elevated at baseline, were significantly reduced, in association with a significant decrease of CLA+ T cells and an increase of Treg lymphocytes. T, B, and NK cell subsets and T cell response to recall antigens did not show any evidence of immune suppression. CONCLUSIONS Immune/inflammatory parameters including IL-6 and IL-22, CLA+ T cells, and Treg lymphocytes may prove to be valuable laboratory tools for the clinical and therapeutic monitoring of psoriasis.
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Affiliation(s)
- P. Cordiali-Fei
- Clinical Pathology & Microbiology, San Gallicano Dermatology Institute, Via Elio Chianesi 53, 00144 Rome, Italy
| | - L. Bianchi
- Dermatology, Tor Vergata University, Via Montpellier 1, 00133 Rome, Italy
| | - C. Bonifati
- Clinical Dermatology, San Gallicano Dermatology Institute, Via Elio Chianesi 53, 00144 Rome, Italy
| | - E. Trento
- Clinical Pathology & Microbiology, San Gallicano Dermatology Institute, Via Elio Chianesi 53, 00144 Rome, Italy
| | - M. Ruzzetti
- Dermatology, Tor Vergata University, Via Montpellier 1, 00133 Rome, Italy
| | - F. Francesconi
- Clinical Dermatology, San Gallicano Dermatology Institute, Via Elio Chianesi 53, 00144 Rome, Italy
| | - S. Bultrini
- Clinical Pathology & Microbiology, San Gallicano Dermatology Institute, Via Elio Chianesi 53, 00144 Rome, Italy
| | - G. D'Agosto
- Clinical Pathology & Microbiology, San Gallicano Dermatology Institute, Via Elio Chianesi 53, 00144 Rome, Italy
| | - V. Bordignon
- Clinical Pathology & Microbiology, San Gallicano Dermatology Institute, Via Elio Chianesi 53, 00144 Rome, Italy
| | - V. Francavilla
- Clinical Pathology & Microbiology, San Gallicano Dermatology Institute, Via Elio Chianesi 53, 00144 Rome, Italy
| | - A. Tripiciano
- Clinical Pathology & Microbiology, San Gallicano Dermatology Institute, Via Elio Chianesi 53, 00144 Rome, Italy
| | - A. Chiricozzi
- Dermatology, Tor Vergata University, Via Montpellier 1, 00133 Rome, Italy
| | - E. Campione
- Dermatology, Tor Vergata University, Via Montpellier 1, 00133 Rome, Italy
| | - C. Cavallotti
- Clinical Dermatology, San Gallicano Dermatology Institute, Via Elio Chianesi 53, 00144 Rome, Italy
| | - A. Orlandi
- Anatomic Pathology, Tor Vergata University, Via Montpellier 1, 00133 Rome, Italy
| | - E. Berardesca
- Clinical Dermatology, San Gallicano Dermatology Institute, Via Elio Chianesi 53, 00144 Rome, Italy
| | - A. Di Carlo
- Clinical Dermatology, San Gallicano Dermatology Institute, Via Elio Chianesi 53, 00144 Rome, Italy
| | - S. Chimenti
- Dermatology, Tor Vergata University, Via Montpellier 1, 00133 Rome, Italy
| | - F. Ensoli
- Clinical Pathology & Microbiology, San Gallicano Dermatology Institute, Via Elio Chianesi 53, 00144 Rome, Italy
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Rapanotti MC, Ricozzi I, Campione E, Orlandi A, Bianchi L. Blood MUC-18/MCAM expression in patients with melanoma: a suitable marker of poor outcome. Br J Dermatol 2014; 169:221-2. [PMID: 23448399 DOI: 10.1111/bjd.12295] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Rossi P, Montuori M, Santurro L, Ricciardi E, Feliziani A, De Santis F, Vergati M, Ricozzi I, Campione E, Silvi B, Gaudio D, Petrella G. Electrochemotherapy in head and neck cancer: Our experience in 20 cases. Eur J Surg Oncol 2013. [DOI: 10.1016/j.ejso.2013.07.071] [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] [Indexed: 11/30/2022] Open
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Campione E, Diluvio L, Terrinoni A, Di Stefani A, Orlandi A, Chimenti S, Bianchi L. Progressive late-onset of cutaneous angiomatosis as possible sign of cerebral cavernous malformations. Dermatol Online J 2013; 19:2. [PMID: 23473272] [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: 06/01/2023] Open
Abstract
BACKGROUND Cerebral cavernous malformations (CCM) comprise enlarged capillary cavities in the central nervous system, with possible retinal or cutaneous vascular malformations. This condition is associated with CCM1, CCM2, and CCM3 gene mutations. OBJECTIVE Cutaneous clinical, histological and cerebral MRI findings, including CCM1, CCM2, and CCM3 gene sequencing, of two unrelated, neurological symptom-free patients who consulted for late-onset of deep multiple cutaneous angiomatoid lesions, are described. RESULTS The diagnosis of multiple cutaneous angiomatosis was confirmed and related to CCM as detected by MRI in both cases. Analysis of our patients showed normal nucleotide sequences of the genes proposed. CONCLUSIONS A progressive late-onset of multiple, deep cutaneous venous malformations may indicate the need to investigate a potential coexistence of CCM by MRI. Early diagnosis and prompt treatment is required in these patients. The absence of CCM1, CCM2, and CCM3 mutations might indicate that different genes could be involved in the pathogenesis of these late-onset patients. Careful questioning about family history of CCM is important; our first patient's daughter had a history of cerebral cavernoma.
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Affiliation(s)
- E Campione
- Department of Dermatology, University of Rome Tor Vergata
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Campione E, Diluvio L, Terrinoni A, Stefani AD, Orlandi A, Chimenti S, Bianchi L. Progressive late-onset of cutaneous angiomatosis as possible sign of cerebral cavernous malformations. Dermatol Online J 2013. [DOI: 10.5070/d353f3132m] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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Carboni I, Campione E, Specchio F, Chimenti S. [New functions and applications of vitamin D in internal medicine]. Clin Ter 2012; 163:e441-e444. [PMID: 23306760] [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] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
The role of vitamin D (Vit. D) in bone metabolism is well known. It has recently been described that Vit. D exerts immunoregulatory activity, anti-proliferative and pro-differentiation mediated by intracellular receptors of the vitamin (VDR), so it seems to prevent the onset of some cancers (colon, prostate, etc.) and finally has a role in the evolution of some skin dermatoses such as psoriasis and atopic dermatitis. It well known that the presence of low blood levels of Vit. D, associated with the polymorphism of the VDR gene, may correlate with some inflammatory diseases such as also indicated by some authors, according to which the metabolites of Vit. D would be the clinical markers of certain diseases chronic and autoimmune diseases.
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Affiliation(s)
- I Carboni
- Dipartimento Medicina dei Sistemi, Dermatologia, Università Tor Vergata, Roma, Italia.
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Terrinoni A, Serra V, Codispoti A, Talamonti E, Bui L, Palombo R, Sette M, Campione E, Didona B, Annicchiarico-Petruzzelli M, Zambruno G, Melino G, Candi E. Novel transglutaminase 1 mutations in patients affected by lamellar ichthyosis. Cell Death Dis 2012; 3:e416. [PMID: 23096117 PMCID: PMC3481139 DOI: 10.1038/cddis.2012.152] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [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] [Indexed: 01/14/2023]
Abstract
Lamellar Ichthyosis (LI) is a form of congenital ichthyosis that is caused by mutations in the TGM1 gene that encodes for the transglutaminase 1 (TG1) enzyme. Functional inactivation of TG1 could be due to mutations, deletion or insertions. In this study, we have screened 16 patients affected by LI and found six new mutations: two transition/transversion (R37G, V112A), two nonsense mutations and two putative splice site both leading to a premature stop codon. The mutations are localized in exons 2 (N-terminal domain), 5, 11 (central catalytic domain), and none is located in the two beta-barrel C-terminal domains. In conclusion, this study expands the current knowledge on TGM1 mutation spectrum, increasing the characterization of mutations would provide more accurate prenatal genetic counselling for parents at-risk individuals.
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Affiliation(s)
- A Terrinoni
- IDI-IRCCS c/o Department of Experimental Medicine and Surgery, University of Tor Vergata, Rome, Italy
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Diluvio L, Romiti ML, Angelini F, Campione E, Rossi P, Prinz JC, Chimenti S, Lamioni A. Infliximab therapy induces increased polyclonality of CD4+CD25+ regulatory T cells in psoriasis. Br J Dermatol 2010; 162:895-7. [PMID: 20199542 DOI: 10.1111/j.1365-2133.2010.09650.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Giunta A, Demin F, Campione E, Chimenti S, Bianchi L. Dermatitis artefacta in sporadic sclerodermoid hepatitis C virus-associated porphyria cutanea tarda. J Eur Acad Dermatol Venereol 2009; 23:849-50. [DOI: 10.1111/j.1468-3083.2008.03049.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Rapanotti MC, Bianchi L, Ricozzi I, Campione E, Pierantozzi A, Orlandi A, Chimenti S, Federici G, Bernardini S. Melanoma-associated markers expression in blood: MUC-18 is associated with advanced stages in melanoma patients. Br J Dermatol 2008; 160:338-44. [PMID: 19067715 DOI: 10.1111/j.1365-2133.2008.08929.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Multimarker reverse transcriptase-polymerase chain reaction (RT-PCR) was originally reported to reveal melanoma-associated mRNAs (MAMs) in melanoma cells but not in the peripheral blood of healthy individuals. OBJECTIVES To evaluate the expression of MAMs in the peripheral blood of melanoma patients at different American Joint Committee on Cancer (AJCC) stages, and to correlate their presence with early and/or advanced stages of the disease. MATERIALS AND METHODS One hundred blood samples of melanoma patients (AJCC I-IV) were analysed using multimarker RT-PCR to assess the co-expression of Tyr-OH, MART-1, MAGE-3, MUC-18/MCAM and p97. Patients were stratified into two disease categories: early and advanced stages. The former includes in situ and melanoma stages AJCC I-II, the latter AJCC III-IV. chi(2) and Fisher's exact tests were used to statistically evaluate the association between each MAM and disease categories. The recognized significant associations were subsequently resubmitted to univariate logistic regression. Furthermore, sensitivity and specificity were established. RESULTS At least one MAM could be detected in 24% of our series. Tyr-OH was the most common marker (14%), followed by MUC-18 (12%), MART-1 (5%), MAGE-3 (4%) and p97 (3%). No significant association among Tyr-OH, MART-1, MAGE-3, p97 and disease stages were evidenced. Only MUC-18 was statistically associated (P < 0.009) with advanced stages alone or co-expressed with other MAMs. According to logistic regression univariate analysis, MUC-18 increases the probability (odds ratio: 33) being in advanced stages and the incidence of recurrences (95% CI 2.9-374). CONCLUSIONS MUC-18 RT-PCR assay could be proposed as an adjunctive molecular method in the management of melanoma patients and is useful in the monitoring of study protocols.
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Affiliation(s)
- M C Rapanotti
- Department of Internal Medicine, Policlinico di Tor Vergata (PTV), Rome, Italy
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Carboni I, Costanzo A, Campione E, Paternò EJ, Chimenti S. [Ashy dermatosis: clinico-pathological associations in two cases]. Clin Ter 2008; 159:321-323. [PMID: 18998034] [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] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Case 1. A 54 year old woman affected by chronic asthmatic bronchitis from the age of 11 years and ulcerous recto-colitis from 15 years, presented several erythematous-violaceous macules from the trunk including abdominal region to all skin surface except the face. Case 2. A 17 year old woman presented a similar hyperpigmentation in the same areas. In both patients histology showed a thin epidermis with vacuolar changes of basal layer and apoptotic bodies and melanophages rich in melanosomes in the papillary dermis. Our diagnosis was Ashy dermatitis. Clinico-pathological correlations and treatment options are discussed.
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Affiliation(s)
- I Carboni
- Clinica Dermatologica Università di Roma Tor Vergata, Roma, Italia.
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Campione E, Paternò EJ, Diluvio L, Bianchi L, Giorgetti G, Chimenti S. Combination of Low-dosage Cyclosporine and Topical Pimecrolimus in Severe Atopic Dermatitis with Chronic Hepatitis B. Acta Derm Venereol 2008; 88:74-5. [DOI: 10.2340/00015555-0327] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Bianchi L, Orlandi A, Campione E, Angeloni C, Costanzo A, Spagnoli LG, Chimenti S. Topical treatment of basal cell carcinoma with tazarotene: a clinicopathological study on a large series of cases. Br J Dermatol 2004; 151:148-56. [PMID: 15270884 DOI: 10.1111/j.1365-2133.2004.06044.x] [Citation(s) in RCA: 299] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Basal cell carcinoma (BCC) is the most common cancer in humans. Medical treatment modalities offer cost reductions and clinical advantages in selected cases such as low-risk areas, surgically inaccessible sites, patients with multiple neoplasms, and older, infirm or anticoagulated subjects. Tazarotene has been proposed for the treatment of BCC; however, data on its efficacy are lacking. OBJECTIVES To investigate the efficacy of tazarotene in a large series of BCCs, better to define the clinical advantages and the mechanisms of action in vivo. METHODS Tazarotene 0.1% gel was applied daily for 24 weeks to 154 small superficial and nodular BBCs. Clinicopathological changes were followed during the therapy by dermoscopic and histological examination. Proliferation, retinoic acid receptors and apoptosis were investigated by immunohistochemistry and terminal deoxynucleotidyl transferase-mediated deoxyuridine triphosphate-biotin nick-end labelling on biopsies. RESULTS At 24 weeks of therapy, 70.8% of the BCCs showed > 50% clinical and dermoscopic regression, and 30.5% healed without recurrences after 3 years of follow-up. At 12 weeks, biopsies showed that regression was associated with reduced proliferation and increased apoptosis of basaliomatous cells. Most unresponsive tumours displayed a keratotic differentiation. CONCLUSIONS Tazarotene was effective in the majority of superficial and nodular undifferentiated BCCs treated, possibly by antiproliferative and proapoptotic actions in vivo. Keratotic BCCs were the major type among the unresponsive tumours, and were characterized by overexpression of p53 and cellular retinol binding protein-1 in comparison with undifferentiated tumours. Topical tazarotene represents an alternative medical choice for selected cases of BCC.
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Affiliation(s)
- L Bianchi
- Department of Dermatology, Tor Vergata University of Rome, Policlinico Tor Vergata, Viale Oxford 81, 00133 Rome, Italy.
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Bianchi L, Campione E, Marulli GC, Costanzo A, Chimenti S. Actinic keratosis treated with an immune response modifier: a case report of six patients. Clin Exp Dermatol 2003; 28 Suppl 1:39-41. [PMID: 14616813 DOI: 10.1046/j.1365-2230.28.s1.13.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Actinic keratoses (AKs) are intraepidermal tumours, which result from the proliferation of transformed neoplastic keratinocytes. They are typically induced by chronic exposure to ultraviolet radiation, and can often develop into squamous cell carcinoma (SCC). Six patients, who presented with AKs located on the head, face and chest, were treated with the immune response modifier, imiquimod, as a 5% cream five times per week for up to 8 weeks. The majority of patients experienced mild to moderate side-effects, consisting of erythema, itching and burning. Topical application of imiquimod for 4-8 weeks resulted in complete clearance in all patients. No new or recurrent lesions were observed during a 6-8 month follow-up period.
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Affiliation(s)
- L Bianchi
- Department of Dermatology, Tor Vergata Universtiy of Rome, Rome, Italy.
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Bianchi L, Costanzo A, Campione E, Nisticò S, Chimenti S. Superficial and nodular basal cell carcinomas treated with an immune response modifier: a report of seven patients. Clin Exp Dermatol 2003; 28 Suppl 1:24-6. [PMID: 14616808 DOI: 10.1046/j.1365-2230.28.s1.8.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Skin cancer is the most common malignancy in humans and accounts for one-third of newly diagnosed cancers. Basal cell carcinoma (BCC) is one of the most prevalent and persistent types, and appears in two main histological forms, superficial and nodular. Typical treatments include surgery; however, this may leave scarring, which is undesirable, especially in facial lesions. We report the results of seven individual patients with one or more BCCs (both nodular and superficial) treated with imiquimod 5% cream. Eleven of 13 lesions cleared following daily topical treatment for 10-18 weeks. Any local skin reactions resolved at the end of treatment.
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Affiliation(s)
- L Bianchi
- Department of Dermatology, Tor Vergata University of Rome, Italy.
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Abstract
The efficacy of tazarotene 0.1% gel in a 30-year-old woman with type I lamellar ichthyosis is reported. The drug was applied to 15% of the total body surface area as follows: once daily for 2 weeks, three times a week for further 2 weeks, followed by a once weekly maintenance application. During the first week of treatment there was partial improvement obtained and in the next 14 days further reduction of scaling within the tazarotene-treated areas was observed. After 4 months of maintenance application, there was a marked overall improvement in the treated areas. Side-effects consisted only of mild pruritus, slight burning and irritation. In essence, the therapeutic benefit obtained was comparable with that of systemic retinoids but without the adverse systemic side-effects. As noted in other reports, tazarotene 0.1% gel seems to be a valuable and safe therapeutic option for this severe genodermatosis.
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Affiliation(s)
- G C Marulli
- Department of Dermatology, Tor Vergata University of Rome, Rome, Italy
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Pagnanelli G, Soyer HP, Argenziano G, Talamini R, Barbati R, Bianchi L, Campione E, Carboni I, Carrozzo AM, Chimenti MS, de Simoni I, Falcomatà V, Filipe Neto I, Francesconi F, Ginebri A, Hagman J, Marulli GC, Palamara F, Vidolin AP, Piemonte P, Soda R, Chimenti S. Diagnosis of pigmented skin lesions by dermoscopy: web-based training improves diagnostic performance of non-experts. Br J Dermatol 2003; 148:698-702. [PMID: 12752126 DOI: 10.1046/j.1365-2133.2003.05168.x] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Dermoscopy has been shown to enhance the diagnosis of melanoma. However, use of dermoscopy requires training and expertise to be effective. OBJECTIVES To determine whether an Internet-based course is a suitable tool in teaching dermoscopy, and to evaluate the diagnostic value of pattern analysis and diagnostic algorithms in colleagues not yet familiar with this technique. METHODS Sixteen colleagues who were not experts in dermoscopy were asked to evaluate the dermoscopic images of 20 pigmented skin lesions using different diagnostic methods (i.e. pattern analysis, ABCD rule, seven-point checklist and Menzies' method), before and after an Internet-based training course on dermoscopy. Mean +/- SEM sensitivity, specificity and diagnostic accuracy, and kappa (kappa) intraobserver agreement were evaluated for each diagnostic method before and after training for the 16 participants. Differences between mean values were assessed by means of two-tailed Wilcoxon rank-sum tests. RESULTS There was a considerable improvement in the dermoscopic melanoma diagnosis after the Web-based training vs. before. Improvements in sensitivity and diagnostic accuracy were significant for the ABCD rule and Menzies' method. Improvements in sensitivity were also significant for pattern analysis, whereas the sensitivity values were high for the seven-point checklist in evaluations both before and after training. No significant difference was found for specificity before and after training for any method. There was a significant improvement in the kappa intraobserver agreement after training for pattern analysis and the ABCD rule. For the seven-point checklist and Menzies' method there was already good agreement before training, with no significant improvement after training. CONCLUSIONS We demonstrated that Web-based training is an effective tool for teaching dermoscopy.
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Affiliation(s)
- G Pagnanelli
- Department of Dermatology, University of Rome Tor Vergata, P.le dell'Umanesimo 10, 00144 Rome, Italy
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Hagman JH, Bianchi L, Campione E, Vidolin AP, Chimenti S. Dermatomyositis associated with ovarian transitional cell carcinoma. J Am Acad Dermatol 2001; 45:642-4. [PMID: 11568769 DOI: 10.1067/mjd.2001.114744] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Abstract
Pyoderma vegetans (PV) is a chronic, vegetating pustular disorder characterized clinically by erythematous vesiculopustular vegetating cutaneous plaques. Marked epidermal hyperplasia, intraepidermal and subepidermal neutrophilic microabscesses and a dermal inflammatory infiltrate are the prominent histopathological findings. We describe a patient with PV associated with ulcerative colitis and mammary Paget's disease. Pustular eruptions associated with ulcerative colitis are reviewed.
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Affiliation(s)
- L Bianchi
- Institute of Dermatology, University of Rome Tor Vergata, Ospedale S.Eugenio, Piazzale dell'Umanesimo 10, 00144 Rome, Italy.
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Abstract
BACKGROUND Immunosuppressive medications such as corticosteroids and cyclosporin are the most commonly employed therapies in pyoderma gangrenosum. We describe a patient with multiple ulcers of pyoderma gangrenosum on the lower extremities in whom immunosuppressive therapy caused serious side effects and had to be discontinued but who was subsequently treated successfully with high dose intravenous immunoglobulin (IVIG). METHODS IVIG was given intravenously at a dose of 400 mg/kg per day for 5 consecutive days. After 1 week there was an arrest in the progression of the ulcers and a marked reduction in pain. Two weeks later clinical improvement of the ulcers was observed. Subsequently, IVIG was given at a dose of 1 g/kg per day for 2 consecutive days. RESULTS The treatment induced a dramatic clinical improvement of one ulcer and healing of the others. Side effects were minimal and well tolerated, and consisted of chills and a slight fever, which resolved with the administration of acetaminophen. CONCLUSION We feel that IVIG can be used in patients with pyoderma gangrenosum in whom conventional therapies are ineffective or produce serious side effects.
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Affiliation(s)
- J H Hagman
- University of Rome 'Tor Vergata', Department of Dermatology, Rome, Italy
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