Giornale italiano di dermatologia e venereologia : organo ufficiale, Società italiana di dermatologia e sifilografia
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G Ital Dermatol Venereol · Feb 2010
ReviewTopical treatment and combination approaches for vitiligo: new insights, new developments.
Despite much research done involving elucidation of the pathogenesis of vitiligo, a precise cause is still not known. Prevalent hypotheses include the autoimmune, genetic, neural, self-destruction, growth factor deficiency, viral, and convergence theories, which have served as the basis for treatment formulation. Topical therapies have been a mainstay of vitiligo treatment, with or without phototherapy. ⋯ Combinations of vitamin D analogues have varied efficacy based on which type is used and the type of UV light. Efficacy of calcineurin inhibitor combinations also vary based on the type used and UV light combined, with tacrolimus being more effective with excimer laser. Pimecrolimus has been effective with NB-UVB and excimer laser on facial lesions, and microdermabrasion on localized areas.
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Due to the potentially lethal nature of melanoma, prompt diagnosis and timely excision are of paramount importance. The clinical ABCD mnemonic (asymmetry, boarder irregularity, color variegation and diameter greater than 6mm) is one of the first and most widely used methods introduced to teach early melanoma recognition. Unfortunately, some melanomas can evade the clinical ABCD rule and mimic benign melanocytic nevi or mimic benign and/or malignant variants of non-melanocytic lesions. ⋯ Unfortunately, even with dermoscopy, some melanomas remain difficult to diagnose. However, these difficult to diagnose melanomas often reveal subtle dermoscopic clues that allow for their correct identification. In this review, we focus on five variants of melanoma that are challenging to identify and discuss the dermoscopic features that can assist in their diagnosis.
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The authors describe a case of scabies in a 80 year-old woman with a history of intense itching. Lesions were not present in the body parts where they usually occur, but few erythematous and papular lesions were visible on the rear trunk. Diagnosis was not based on the usual clinical features or on the traditional method of microscopic examination but a high magnification videodermatoscopy was performed and, on a burrow-like scabby lesions at the rear trunk, a mite was found. This paper focuses on the importance of the videodermatoscopy, a simple, quick, non-expensive and non-invasive technique, that enhances the diagnostic capability in a case of scabies, which is not localized in the characteristic zones.
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G Ital Dermatol Venereol · Oct 2008
ReviewCardiovascular morbidity in psoriasis: epidemiology, pathomechanisms, and clinical consequences.
Psoriasis is a common inflammatory skin condition. Around 25% of patients develop joint involvement in the form of psoriatic arthritis as well. Recent epidemiologic studies demonstrated an increased cardiovascular morbidity among psoriasis patients. ⋯ The consequences for the management of psoriasis at this point are two-fold: as co-morbidity goes along with co-medication, potential drug interactions need to be kept in mind when choosing a systemic anti-psoriatic therapy. Moreover, as psoriasis itself is a risk factor for cardiovascular morbidity, patients must avoid other known risk factors such as obesity or smoking. Dermatologists need to communicate this additional risk to their patients and support them accordingly.
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Psoriasis is a chronic immune-mediated inflammatory disease, with an estimated prevalence of 1-3% worldwide. It is considered to be a multisystemic disorder, primarily affecting the skin and joints (psoriatic arthritis), and associated with other inflammatory conditions such as inflammatory bowel disease and coronary heart disease among others. ⋯ These agents have gained popularity as safe, effective, and convenient alternatives for the treatment of chronic moderate to severe plaque psoriasis. This review will focus on the main biologics used in the treatment of moderate to severe plaque psoriasis: efalizumab, alefacept, etanercept, infliximab, adalimumab and the new Interleukin (IL) 12/23 inhibitors.