1,721,025 research outputs found
Autoimmune skin disorders
No full textAutoimmune skin disorders include autoimmune bullous diseases, collagen vascular diseases, alopecia areata, and vitiligo. Lupus erythematosus (LE) is a prototypical autoimmune disorder characterized by the inflammation of the skin, sometimes associated with the involvement of several tissues and the production of autoantibodies directed against nuclear antigens. Scleroderma is a disorder of an autoimmune etiology which can be limited to the skin, as in the localized morphea or scleroderma, or be associated with vascular abnormalities, connective tissue sclerosis, and atrophy and autoimmune changes characterizing progressive systemic sclerosis. Alopecia areata (AA) is a skin disease with characteristic symptoms that include sudden hair loss in restricted areas or on the whole body. Psoriasis is a chronic, hyperproliferative disease of the skin with typical symptoms that include thickened, red, and crusty plaques. Treatment of the major part of these autoimmune disorders is commonly based on systemic corticosteroids and immunosuppressive drugs
LEIOMIOSARCOMA EPITELIOIDE DELL’ORECCHIO
No full textIl leiomiosarcoma superficiale è un raro tumore maligno che rappresenta il 4-6,5% di tutti i sarcomi dei tessuti molli. Ancor più rara è la localizzazione al padiglione auricolare, In questa sede, dopo l'asportazione con chiusura della braccia chirurgica con innesto cutaneo libero, si è provveduto ad ulteriore ampia resezione del padiglione auricolare che è stato poi ricostruito
Erythrodermic Psoriasis: Excellent Management Avoiding Hospitalization
No full textErythrodermic psoriasis (EP) is a rare but severe variant of this inflammatory cutaneous disease, occurring in less than 3% of patients with psoriasis. It is characterized by involvement of more than 90% of body surface area (BSA), with diffuse scaling and erythema. Usually, EP develops in subjects with poor control of psoriatic disease (1). EP is considered an emergency condition in dermatology due to extensive skin involvement and systemic symptoms; moreover, it is often resistant to conventional therapies (1,2). While the pathogenesis of plaque psoriasis is well-understood, with a complex interplay between Th1, Th2, and Th17 responses, the inflammatory mechanisms of EP are less known, but the IL-17 pathway seems to play a pivotal role (2). Brodalumab is a fully human monoclonal antibody blocking the interleukin-17 receptor A, thus interfering with different isoforms of IL-17 (A, A/F, F, C, and E) (3). This results in a complete block of the IL-17 response, including IL-17 C and E, which are released by keratinocytes and not directly by the Th17 line. Therefore, brodalumab presents a broader action in comparison with anti-IL-23 and other anti-IL-17 drugs, which act upstream on the Th17 line (4). As shown by Yamasaki et al. in a 52-week open-label study, brodalumab is associated with a rapid response, even in patients with EP, showing a drastic improvement in symptoms after just two weeks (3). Herein we report a case of a 57 -year-old woman with a recent diagnosis of plaque psoriasis, naïve to systemic therapies, who rapidly developed EP. Psoriasis diagnosis was confirmed by skin biopsy. With regard to comorbidities, she presented a history of excessive alcohol use and tested positive for latent tuberculosis. At the first evaluation, the patient presented with BSA involvement of 90%, a PASI score of 42, and a DLQI of 26, without psoriatic arthritis (Figure 1, a). At the examination, a concomitant ocular involvement was particularly evident, with conjunctival redness and a reported burning sensation (Figure 1, b). After receiving prophylactic treatment for latent tuberculosis, brodalumab was initiated at the labeled dosage. A dramatic improvement was observed after just two weeks, with a reduction of erythema and scaliness as well as the itching and burning sensation (Figure 2, a). Furthermore, the conjunctive redness completely disappeared. After 4 weeks, the PASI score was reduced to 2 and BSA decreased to 5%, with a positive impact on quality of life (Figure 2, b). The patient did not report any adverse events. Due to the rarity of this form of psoriasis, international guidelines or recommendations on EP treatment and management are lacking. Several biologic drugs are currently being used off label based on case reports or small case series, with an optimal response and tolerance profile (1). To our knowledge, , there have been only six cases of EP treated with brodalumab in real-life settings (2,4,5). Our experience, in accordance with the cases published in literature, showed a rapid onset of action, without any relevant adverse events. One of the most promising aspects of brodalumab in EP is the reduction in the hospitalization of patients; in fact, thanks to the rapidity of its action it is possible to avoid the administration of systemic steroid therapy, frequently used in the management of EP, and therefore avoid steroid-related AEs. Furthermore, it can be used in monotherapy due to its high efficacy, without conventional immunosuppressive drugs. Finally, its excellent tolerance profile allows its use in a wider patient setting. In conclusion, brodalumab could represent a valid therapeutic option for EP, based on its clinical efficacy, rapid effect, and safety, especially considering the reduction of the clinical burden for both patient and hospital management
Case of large lentigo maligna melanoma of the scalp treated with 5% and 3.75% Imiquimod
No full textThe paper presents a case of lentigo maligna melanoma of the scalp in an elderly patient treated for the nodular part with surgery and the residual melanoma in situ with 5% Imiquimod and subsequently with 3.75% Imiquimod (each concentration for 4 months, 5 times per week), with complete regression of the lesion. 3.75% Imiquimod, which is already used for the treatment of actinic keratosis, could be a useful weapon with the same effectiveness and fewer side effects compared to 5% Imiquimod
Immunofuorescence in Various Skin Diseases
No full textImmunofluorescence (IF) is a technique widely used both to investigate pathophysiology and to help in the accurate diagnosis of various cutaneous disorders, especially bullous diseases and connective tissue diseases. IF testing is invaluable in confirming a diagnosis that is suspected by clinical or histologic examination. Direct immunofluorescence (DIF) is performed on perilesional skin for patients with bullous disease and lesional skin for patients with connective tissue diseases and vasculitis. It helps detect molecules such as immunoglobulins and complement components within biopsy specimen. Indirect immunofluorescence (IIF) is used to detect circulating autoantibodies in patient’s serum. It is helpful in confirming a suspected diagnosis as well as in differentiating among closely related bullous diseases. Many years after the discovery of autoantibodies in autoimmune bullous diseases, direct and indirect immunofluorescence still remain an essential armamentarium for their diagnosis and management. Moreover, thanks to the advent of these techniques and their immunologic and molecular findings, new diseases have been defined and continue to be defined. In conclusion, IF studies have now become an invaluable supplement to clinical and histological examination in a variety of skin diseases and have also enabled the development of new techniques such as immunoblotting, enzyme-linked immunosorbent assay (ELISA), and Biochip method
Quando si dice... è un OSSO DURO!
No full textUn ispessimento del letto subungueale e conseguente deformazione della lamina ungueale può essere causato dalla presenza di una esostosi che si presenta come una placca di consistenza dura che può agevolmente essere evidenziata dall'esame radiografico. Il trattamento chirurgico prevede l'uso di pinza ossivora e della fresa per osso, strumenti chirurgici non comunmente usati dal dermatologo chirurg
Scabies
No full textScabies is a parasitic infestation of the skin caused by the mite Sarcoptes scabiei. It causes a significant disease burden worldwide, especially in residential and nursing care homes and in developing countries where poor access to health care contributes to disease undertreatment and long-term systemic sequelae. Classic scabies typically manifests as an intensely pruritic eruption with characteristic burrows formed as the adult female mites consume their way through the epidermis. Crusted scabies is a rare and severe form of infestation characterized by profuse hyperkeratosis containing over 4000 mites per gram of skin. The diagnosis should be suspected in any patient with a clinical history of itch which is worse at night and affects other family members or close contacts. Nowadays, a variety of noninvasive diagnostic techniques are available. Scabies can be rapidly diagnosed using dermoscopy. The most commonly used treatments are topical 5% permethrin lotion and oral ivermectin
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