Relapsing polychondritis is an immune-mediated systemic disease characterized by recurrent episodes of inflammation of cartilaginous and proteoglycan-rich tissues, resulting in progressive anatomical deformation and functional impairment of the involved structures. Auricular and nasal chondritis and/or polyarthritis represent the most common clinical features, but potentially all types of cartilage may be involved. Because of the pleomorphic nature of the disease, with non-specific symptoms at the onset, the diagnosis of relapsing polychondritis is often delayed. In this review article we provide a comprehensive look into clinical presentation, laboratory and instrumental investigations, diagnostic criteria, and therapeutic options.
Atopic dermatitis is a common chronic/chronically relapsing inflammatory skin disease, with increasing worldwide prevalence. Etiopathogenesis is complex and multifactorial, with a mix of genetic, immunological and environmental aspects. Like in other chronic inflammatory diseases, oxidative stress plays an important pathogenetic role. We reviewed in vivo research studies on humans about oxidative stress and atopic dermatitis. Although sometimes contrasting, overall, they suggest that oxidative stress may have a significant role in atopic dermatitis, but our understanding is still incomplete, at least concerning in vivo data, because of limitations of available literature. Research consists of 33 papers published in 28 years, was not always performed on large study populations, represents a limited number of countries and ethnicities—not always in proportion to their size—and is scattered over multiple papers that, in the majority of cases, cannot be pooled and/or compared because many biomarkers were studied, in different tissues and with different methods. Further, larger studies appear warranted and necessary to shed more light on this aspect of atopic dermatitis, which is important not only to improve our understanding of this disease, but also for potential clinical and therapeutic implications.
A 9‐year‐old boy was brought by his mother to our department for a follow‐up visit and dermoscopy of melanocytic nevi. During the consultation, she complained of a gradually increasing, asymptomatic, cutaneous discoloration involving the trunk, arms, and lower limbs of her son which had appeared approximately at the end of the summer. The boy was healthy and was not taking any medication or nutritional supplements. Despite good hygiene, including showers and brushings with acid liquid soap at least three to four times per week, he showed no improvement of the condition. Physical examination revealed dirty‐appearing skin, composed of subtle, but clear‐cut, brown to blackish areas with a velvety texture, symmetrically involving the lateral sides of the trunk, umbilical, and periumbilical regions with light scaling, dorsal and volar surfaces of the arms, and posterior parts of the lower limbs (Figs 1 and 2). The neck, dorsum and anterior aspects of the lower limbs were uninvolved. 1 Diffuse brown–blackish hyperpigmentation of the lateral aspect of the trunk and of the dorsal surface of the arm 2 Subtle pigmentation of the abdomen Partial removal of these patches by isopropyl alcohol swabbing (Fig. 3) confirmed the clinical suspicion of terra firma‐forme dermatosis. The boy's mother refused our proposal of dermal scraping and 3‐mm punch biopsy when reassured about the benign nature of the condition and the ease of treatment. 3 Alcohol swabbing reveals a pink linear area of normal skin. The appearance of the alcohol pad after rubbing The patient was seen 24 h later for erythema and burning of lesional areas because of excessively vigorous and extensive rubbing, but with no residual signs of the disease (Fig. 4). 4 Absence of dermatosis after cleansing at home. Notice frictional erythema of the treated areas
Photodynamic Therapy (PDT) is a non-invasive treatment successfully used for neoplastic, inflammatory and infectious skin diseases. One of its strengths is represented by the high safety profile, even in elderly and/or immuno-depressed subjects. PDT, however, may induce early and late onset side effects. Erythema, pain, burns, edema, itching, desquamation, and pustular formation, often in association with each other, are frequently observed in course of exposure to the light source and in the hours/days immediately after the therapy. In particular, pain is a clinically relevant short-term complication that also reduces long-term patient satisfaction. Rare complications are urticaria, contact dermatitis at the site of application of the photosensitizer, and erosive pustular dermatosis. Debated is the relationship between PDT and carcinogenesis: the eruptive appearance of squamous cell carcinoma (SCC) in previously treated areas has been correlated to a condition of local and/or systemic immunosuppression or to the selection of PDT-resistant SCC. Here we review the literature, with particular emphasis to the pathogenic hypotheses underlying these observations.
The 2010 Italian Euromelanoma Day produced good results in terms of melanoma detection/suspicion rates, likely due to the extensive use of full clinical and dermoscopic examinations. The campaign failed to attract many high-risk individuals. Targeted communication strategies are needed to this regard.
People living with HIV (PLWH) are affected by a higher incidence skin disorders, which are often associated with high morbidity and mortality. In particular, psoriasis affects PLWH severely and for a longer time than the general population. Human immunodeficiency virus (HIV) infection is characterized by a progressive decrease in CD4+ T‐cell count, and it could seem paradoxical that psoriasis exacerbations are more frequent in this subset of patients than the general population, even though it is commonly observed at any stage of infection. For a long time, there have been limited therapeutic choices for PLWH affected by psoriasis. The introduction of the combined antiretroviral therapy dramatically changed the natural course of both HIV and psoriasis in PLWH, leading to an improvement of quality and duration of life. However, the clinical severity of psoriasis in PLWH often requires the use of immunosuppressant drugs. Knowledge about their safety and efficacy are limited to case‐reports, small case‐series and studies, therefore their use has not yet entered the routine. Further studies are needed to determine if immunosuppressive drugs can be safely and effectively used in PLWH affected by psoriasis and other autoimmune disorders.
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