BackgroundAtopic dermatitis (AD) is a chronic relapsing eczematous dermatitis typically affecting young patients in a percentage from 15 to 20%; although it typically affects young people and adults, recent papers highlighted the emerging of the disease in the elderly population.MethodsThe aim of the study was to identify the clinical criteria and allergic sensitization that may be able to support physicians and dermatologists in making a correct diagnosis of AD in the elderly. The second aim of this study was to investigate the incidence, the main features, the gender prevalence, the immunological profile, and comorbidities characterizing patients older than 65 years affected by AD.ResultsBased on clinical and serological patterns, different phenotypes of AD were identified: generalized AD (55%) characterized by eczematous lesions involving typical areas of the body or prurigo nodularis‐like AD; chronic eczematous hand dermatitis (23%); face and neck involvement (9%); and nummular eczema (13%). Skin prick tests revealed a positivity for aeroallergens in 49.6% of patients, most of them being polysensitized (55%). Additionally, food skin prick tests were positive in 25% of patients. Most of the patients reported comorbidities, particularly IgE‐mediated diseases, such as seasonal rhino‐conjunctivitis, asthma, and chronic obstructive pulmonary disease. Gastrointestinal symptoms such as meteorism, dyspepsia, cramps/abdominal pain, and diarrhea/constipation, were observed in 35% of patients consequent to food allergy.ConclusionIn our study, we suggest clinical and serological criteria that may be able to guide in the diagnosis of AD in Caucasian elderly, and to design an appropriate treatment according to the current standard protocol.
Background Recent studies highlight that high levels of cytokines may precede the onset of many systemic autoimmune disorders and may also be related to chronic spontaneous urticaria (CSU) activity. Methods Eight patients with CSU candidate to omalizumab therapy were enrolled. Four healthy controls were included with the purpose of comparing baseline cytokine levels. We evaluated serum levels of IFN-c, IL-2, 4, 6, 8, and 10, TNF-a, and GM-CSF. For the patient group, venous blood samples were drawn at T0, T1 (1 week after first drug administration), T2 (after 3 months), T3 (after 6 months), and in case of relapse. Cytokine levels were measured using the human cytokines 8-plex kit. Disease activity and effect of therapy were calculated by means of Urticaria Activity Score 7.Results Higher levels of IL-6 and IFN-c were found in patients with CSU compared to those observed in the control group. Moreover, a common trend between these cytokines and the clinical history of disease could be hypothesized, with a decrease in levels of IFN-c and IL-6 following remission of CSU with omalizumab treatment. Levels of other tested cytokines were similar between patients and healthy subjects.Conclusion IFN-c and IL-6 are proinflammatory cytokines that are strongly related to autoimmunity. Despite being limited by the small sample size, our data offer new insight into a better understanding of the pathogenesis of CSU and support the need for further investigations.
SARS-CoV-2 asymptomatic infection in a patient under treatment with dupilumab Dear Editor, We have read with great interest the letter of the European Task Force on Atopic Dermatitis on SARS-CoV-2 infection and atopic dermatitis published in JEADV (March 2020) 1 in which the authors state: 'Targeted treatment selectively interfering with type-2 inflammation such as dupilumab is not considered to increase the risk for viral infections and might thus be preferred. . .in a situation such as COVID-19 pandemic'. 1 We would like to report the case of a 72-year-old man affected by severe atopic dermatitis (histologically ascertained), who is under treatment with dupilumab since November 2019, with excellent clinical results. At the beginning of SARS-CoV-2 pandemic in Italy, although he was totally asymptomatic for COVID-19, as all the other residents in Vo' Euganeo, a small town near Padua, in the so-called 'Vo' Red Zone' (i.e. restricted area), he was tested with nasopharyngeal swab for SARS-CoV-2 detection and resulted positive. After 20 days of isolation period, the nasopharyngeal swab for SARS-CoV-2 resulted again positive. After 20 more days of isolation, he was tested positive for the third time. Three weeks later, the nasopharyngeal swab for SARS-CoV-2 was finally negative. Notwithstanding the risk factors (i.e. age >65 years and male gender), our patient throughout all this period (9 weeks) remained totally asymptomatic for COVID-19, in good general condition and free of atopic dermatitis. It would seem that treatment with dupilumab, similarly to other antibodies targeting pro-inflammatory cytokines (e.g. adalimumab, infliximab, ustekinumab, secukinumab and guselkumab), does not worsen the condition of patients infected by SARS-CoV-2 or increase the risk of infection by SARS-CoV-2, 2-7 possibly because these antibodies neutralize individual mediators of the inflammation cascade rather than leading to broad immunosuppression. 8 However, of course, more robust clinical data are needed in order to evaluate the safety of dupilumab and of other biologics in patients infected by SARS-CoV-2.
Background: Multiparametric MRI (mpMRI) is the "state of the art" management tool for patients with suspicion of prostate cancer (PCa). The role of non-contrast MRI is investigated to move toward a more personalized, less invasive, and highly costeffective PCa diagnostic workup.Objective: To perform a non-systematic review of the existing literature to highlight strength and flaws of performing non-contrast MRI, and to provide a critical overview of the international scientific production on the topic. Materials and Methods:Online databases (Medline, PubMed, and Web of Science) were searched for original articles, systematic review and meta-analysis, and expert opinion papers.Results: Several investigations have shown comparable diagnostic accuracy of biparametric (bpMRI) and mpMRI for the detection of PCa. The advantage of abandoning contrast-enhanced sequences improves operational logistics, lowering costs, acquisition time, and side effects. The main limitations of bpMRI are that most studies comparing non-contrast with contrast MRI come from centers with high expertise that might not be reproducible in the general community setting; besides, reduced protocols might be insufficient for estimation of the intra-and extra-prostatic extension and regional disease. The mentioned observations suggest that low-quality mpMRI for the general population might represent the main shortage to overcome.Discussion: Non-contrast MRI future trends are likely represented by PCa screening and the application of artificial intelligence (AI) tools. PCa screening is still a controversial topic; bpMRI has become one of the most promising diagnostic applications, as it is a more sensitive test for PCa early detection, compared to serum PSA level test. Also, AI applications and radiomic have been the object of several studies investigating PCa detection using bpMRI, showing encouraging results. Conclusion:Today, the accessibility to MRI for early detection of PCa is a priority.Results from prospective, multicenter, multireader, and paired validation studies are needed to provide evidence supporting its role in the clinical practice.
Background: Omalizumab is not considered a disease-modifying drug and, accordingly, a large proportion of patients experience a relapse following withdrawal from treatment. Patients & methods: A total of 42 patients who underwent at least one cycle of treatment with omalizumab were enrolled. Two groups of relapsed and not-relapsed subjects were compared. Then, patients were divided into subgroups. Results: Female patients relapse more frequently than male subjects. Patients who relapsed complained a long duration of disease, while patients who did not relapse had short a history of disease. Very early responders are thought to have a high recurrence rate. Basal IgE levels were increased in early responders and cholesterol levels were high in very early responders, who relapse following withdrawal from omalizumab. High D-dimer levels were observed in late responders. Conclusion: The identification of clinical and serological predictors will play a pivotal role in the future management of patients treated with omalizumab.
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