Publications by authors named "Elisa Cinotti"

100 Publications

Dermoscopy of early melanomas: variation according to the anatomic site.

Arch Dermatol Res 2021 Mar 26. Epub 2021 Mar 26.

Dermatology Unit, Department of Medical, Surgical and Neurosciences, University of Siena, Siena, Italy.

To date, is yet to be elucidated whether the body location of cutaneous melanoma can significantly affect an early dermoscopic diagnosis and, consequently, if it can be regarded as a prognostic factor. To investigate the dermoscopic appearance of early melanomas (EMs) at different body sites; to test the ability of dermoscopists in recognizing specific dermoscopic features in EMs. A pool of 106 experienced dermoscopists evaluated the presence of 10 dermoscopic features assumed as suggestive of malignancy among 268 images of EMs with ambiguous appearance located at 16 body sites. According to 720 evaluations, EMs of the "upper extremities" showed a prevalence of early atypical lentiginous features. EMs of the "anterior trunk" exhibited the lower rate of recognition for all features. EMs of the "rear trunk" can be regarded as an intermediate area, showing high recognition rates of regression-related and chronic-traumatism-related features.
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http://dx.doi.org/10.1007/s00403-021-02226-xDOI Listing
March 2021

Comments on "Differentiating basal cell carcinoma from intradermal nevi along the eyelid margin with dermoscopy".

J Am Acad Dermatol 2021 Feb 27. Epub 2021 Feb 27.

Department of Dermatology, University Hospital of Siena, Siena, Italy.

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http://dx.doi.org/10.1016/j.jaad.2021.02.040DOI Listing
February 2021

Mucous membrane pemphigoid with lichen planus-like features: not only in the oral mucosa.

Eur J Dermatol 2021 Feb;31(1):111-112

Dermatology Unit, Department of Medical, Surgical and Neurosciences, University of Siena, Siena, Italy.

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http://dx.doi.org/10.1684/ejd.2021.3975DOI Listing
February 2021

Localized uncombable hair syndrome: Non-invasive imaging with high-resolution videodermoscopy.

Skin Res Technol 2021 Feb 27. Epub 2021 Feb 27.

Department of Medical, Surgical and Neurological Science, Dermatology Section, University of Siena, S. Maria alle Scotte Hospital, Siena, Italy.

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http://dx.doi.org/10.1111/srt.13016DOI Listing
February 2021

Line field confocal optical coherence tomography: An adjunctive tool in the diagnosis of autoimmune bullous diseases.

J Biophotonics 2021 May 22;14(5):e202000449. Epub 2021 Feb 22.

Dermatology Unit and Skin Bank, Department of Medical, Surgical and Neurosciences, Siena University Hospital, Siena, Italy.

Autoimmune bullous diseases (AIBDs) still represent a considerable a source of morbidity and mortality: early identification of a specific AIBD is often difficult due to overlapping clinical and/or laboratory features and time-consuming invasive laboratory tests. We aimed to investigate the potential role of a new imaging technology, line-field confocal optical coherence tomography (LC-OCT), in the non-invasive diagnosis of AIBDs. LC-OCT was performed at lesional, perilesional and contralateral healthy sites in 30 patients, before histology and direct immunofluorescence. LC-OCT examination was able to identify the level of split (subcorneal/suprabasal/subepidermal/sublamina densa), to provide detailed images of the bulla roof morphology and content (eg, erythrocytes/acantholytic cells/polymorphonucleates). Areas of intra/subepidermal detachment were also detected also at clinically normal perilesional skin sites. LC-OCT can support physicians, real time and at bed-site, in the differential diagnosis of various AIBDs and their mimickers. Moreover, it can be used for the identification of subclinical lesions and therapy tapering.
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http://dx.doi.org/10.1002/jbio.202000449DOI Listing
May 2021

Review of Dermoscopy and Reflectance Confocal Microscopy Features of the Mucosal Melanoma.

Diagnostics (Basel) 2021 Jan 8;11(1). Epub 2021 Jan 8.

Department of Medical, Surgical and Neurological Science, Dermatology Section, University of Siena, S. Maria alle Scotte Hospital, 53100 Siena, Italy.

Mucosal melanoma is a rare tumor with aggressive biological behavior and poor prognosis. Diagnosis is often performed at an advanced stage when the lesions become symptomatic. Although dermoscopy and reflectance confocal microscopy (RCM) are widely used techniques for the diagnosis of cutaneous tumors, their use for mucosal lesions is not well established, probably because the latter are rarer. The objective of this study was to evaluate current literature on these imaging techniques for mucosal melanoma. We searched in PubMed and Cochrane databases all studies up to October 2020 dealing with dermoscopy, RCM, and mucosal melanoma. We found that the most relevant dermoscopic features were structureless pattern and/or the presence of multiple colors. RCM examination mainly showed numerous basal hyper-reflective dendritic cells and loss of normal architecture of the papillae of the lamina propria. Although diagnostic algorithms have been proposed for both techniques, the limit of these methods is the absence of large studies and of standardized and shared diagnostic criteria.
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http://dx.doi.org/10.3390/diagnostics11010091DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7827612PMC
January 2021

A new deep learning approach integrated with clinical data for the dermoscopic differentiation of early melanomas from atypical nevi.

J Dermatol Sci 2021 Feb 2;101(2):115-122. Epub 2020 Dec 2.

Dermatology Unit, Department of Medical, Surgical and Neurosciences, University of Siena, Italy; Bioengineering Unit, Department of Medical Biotechnology, University of Siena, Italy.

Background: Timely recognition of malignant melanoma (MM) is challenging for dermatologists worldwide and represents the main determinant for mortality. Dermoscopic examination is influenced by dermatologists' experience and fails to achieve adequate accuracy and reproducibility in discriminating atypical nevi (AN) from early melanomas (EM).

Objective: We aimed to develop a Deep Convolutional Neural Network (DCNN) model able to support dermatologists in the classification and management of atypical melanocytic skin lesions (aMSL).

Methods: A training set (630 images), a validation set (135) and a testing set (214) were derived from the idScore dataset of 979 challenging aMSL cases in which the dermoscopic image is integrated with clinical data (age, sex, body site and diameter) and associated with histological data. A DCNN_aMSL architecture was designed and then trained on both dermoscopic images of aMSL and the clinical/anamnestic data, resulting in the integrated "iDCNN_aMSL" model. Responses of 111 dermatologists with different experience levels on both aMSL classification (intuitive diagnosis) and management decisions (no/long follow-up; short follow-up; excision/preventive excision) were compared with the DCNNs models.

Results: In the lesion classification study, the iDCNN_aMSL achieved the best accuracy, reaching an AUC = 90.3 %, SE = 86.5 % and SP = 73.6 %, compared to DCNN_aMSL (SE = 89.2 %, SP = 65.7 %) and intuitive diagnosis of dermatologists (SE = 77.0 %; SP = 61.4 %).

Conclusions: The iDCNN_aMSL proved to be the best support tool for management decisions reducing the ratio of inappropriate excision. The proposed iDCNN_aMSL model can represent a valid support for dermatologists in discriminating AN from EM with high accuracy and for medical decision making by reducing their rates of inappropriate excisions.
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http://dx.doi.org/10.1016/j.jdermsci.2020.11.009DOI Listing
February 2021

Dupilumab in Elderly Patients With Severe Atopic Dermatitis.

Dermatitis 2020 Dec 15;Publish Ahead of Print. Epub 2020 Dec 15.

From the Dermatology Section, Department of Medical, Surgical and Neurological Science, University of Siena, S. Maria alle Scotte Hospital, Siena Allergological and Pediatric Dermatology Unit, Department of Health Sciences, University of Florence, Florence Department of Medical Biotechnology, University of Siena, Siena Unit of Dermatology, Livorno Hospital, Livorno, Italy.

Background: Atopic dermatitis (AD) in the elderly has been poorly investigated, although its incidence is gradually increasing mainly in industrialized countries. Age-specific factors in older patients must be considered when selecting treatment options.

Objectives: To evaluate the efficacy and tolerability of dupilumab in treating elderly patients with severe AD.

Methods: This was a retrospective, multicenter study involving 26 elderly patients (age, ≥65 years) with severe AD who were treated with dupilumab for at least 16 weeks. Absolute and percentage frequencies were used to evaluate qualitative variables and mean and SD for quantitative ones. For Eczema Area and Severity Index (EASI), Pruritus Numeric Rating Scale (NRS), and Dermatology Life Quality Index (DLQI), the median was also calculated. Wilcoxon test was used to evaluate the variations in EASI, Pruritus NRS, and DLQI observed between the 2 examinations.

Results: After 4 months of therapy, the majority of patients showed a significant improvement in EASI (64.4%), Pruritus NRS (58.2%), and DLQI (44.9%). Only 11% of patients reported mild or moderate conjunctivitis.

Conclusions: To the best of our knowledge, this is the first study concerning the use of dupilumab in the elderly with severe AD. Our data show the effectiveness of dupilumab in this particular population with a lower percentage of conjunctivitis than observed in studies on adults and also excellent control of itching. Only larger, controlled case studies will be able to clarify whether the dosage or frequency of administration of dupilumab in these patients should be different from the protocol used for adults.
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http://dx.doi.org/10.1097/DER.0000000000000686DOI Listing
December 2020

An unusual triple association: Superficial granulomatous pyoderma, subcorneal pustular dermatosis, IgA multiple myeloma.

J Cutan Pathol 2021 Mar 27;48(3):461-463. Epub 2020 Oct 27.

Department of Medical, Surgical and Neurological Science, Section of Dermatology, University of Siena, Siena, Italy.

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http://dx.doi.org/10.1111/cup.13848DOI Listing
March 2021

Squamous cell carcinoma arising on acrodermatitis continua of Hallopeau: clinical and noninvasive skin imaging features.

Int J Dermatol 2020 Nov 25. Epub 2020 Nov 25.

Department of Medical, Surgical and Neurological Science, Dermatology Section, University of Siena, S. Maria alle Scotte Hospital, Siena, Italy.

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http://dx.doi.org/10.1111/ijd.15297DOI Listing
November 2020

A strange annular eruption on the back.

G Ital Dermatol Venereol 2020 Nov 12. Epub 2020 Nov 12.

Dermatology Unit, Department of Medical, Surgical and Neurosciences, University of Siena, Siena, Italy.

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http://dx.doi.org/10.23736/S0392-0488.20.06765-6DOI Listing
November 2020

Folliculotropism in head and neck lentigo maligna and lentigo maligna melanoma.

J Dtsch Dermatol Ges 2021 02 9;19(2):223-229. Epub 2020 Nov 9.

Dermatology Department, University of Modena and Reggio Emilia, Modena, Italy.

Background: Lentigo maligna (LM) and lentigo maligna-melanoma (LMM) are histotypes of melanoma arising in skin with cumulative solar radiation damage. The extension of atypical melanocytes to the hair follicle (folliculotropism) is a histopathological feature of LM/LMM. Its role has not been totally clarified, but it may be correlated to treatment response in LM or to progression in LMM.

Objective: This retrospective, multicentric study aims to identify dermatoscopic features associated with folliculotropism in LMs/LMMs.

Patients And Methods: We analyzed cases of head and neck LMs/LMMs diagnosed between 2005-2014 at Melanoma Units, University of Bologna/Modena/Florence/Siena (Italy), Nice (France): 25 LMs and 73 LMMs were included.

Results: Grey circles (44 %) indicated an isthmic/bulb level of involvement, which were completely absent in the infundibular LM lesions (P = 0.041). In the group of LMMs, light/dark brown pseudonetwork and light brown structureless areas were an indicator of diffuse distribution of malignant melanocytes in the follicular units (P < 0.001 and P = 0.001, respectively), while grey circles indicated focal or diffuse distribution (P < 0.001).

Conclusions: A better understanding of the extension of malignant melanocytes is helpful, aiding clinicians in their decision to perform a radical excision or obtaining a biopsy in the most invasive area of the lesion, which includes potential folliculotropism.
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http://dx.doi.org/10.1111/ddg.14311DOI Listing
February 2021

Effectiveness and Safety of Anti-interleukin-17 Therapies in Elderly Patients with Psoriasis.

Acta Derm Venereol 2020 11 4;100(18):adv00316. Epub 2020 Nov 4.

Department of Dermatology, CH Victor Dupouy, FR-95100 Argenteuil, France. E-mail:

Anti-interleukin-17 agents have recently been developed for the treatment of psoriasis. This study evaluated the tolerance and effectiveness of anti-interleukin-17 agents for psoriasis in elderly patients in daily practice. A multicentre, retrospective study was performed, involving psoriatic patients aged ≥65 years who had received an anti-interleukin-17 agent, including secukinumab, ixekizumab or brodalumab. A total of 114 patients were included: 72 received secukinumab, 35 ixekizumab, and 7 brodalumab. Treatment was stopped in 32 patients (28.9%), because of relapses in 14 patients (41.2%), primary failures in 11 patients (32.4%), or adverse events in 7 patients (20.6%). The 3 most frequently reported adverse events were injection site reactions (n = 4), oral candidiasis (n = 3), and influenza-like illness (n = 3). Regarding effectiveness, 80 patients (70%) reached a Physician Global Assessment score of 0/1, 6 months after treatment initiation. In conclusion, anti-interleukin-17 therapy appears to be an effective and safe therapeutic option for psoriasis treatment in patients aged ≥ 65 years.
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http://dx.doi.org/10.2340/00015555-3678DOI Listing
November 2020

Extrapalmoplantar pustolosis in Sonozaki syndrome.

G Ital Dermatol Venereol 2020 Oct 9. Epub 2020 Oct 9.

Department of Medical, Surgical and Neurological Science, Dermatology Section, S. Maria alle Scotte Hospital, University of Siena, Siena, Italy.

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http://dx.doi.org/10.23736/S0392-0488.20.06635-3DOI Listing
October 2020

Anetoderma observed with reflectance confocal microscopy.

G Ital Dermatol Venereol 2020 Oct 9. Epub 2020 Oct 9.

Dermatology Section, Department of Medical, Surgical and Neurological Science, S. Maria alle Scotte Hospital, University of Siena, Siena, Italy.

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http://dx.doi.org/10.23736/S0392-0488.20.06627-4DOI Listing
October 2020

Sézary syndrome during anti-IL17 treatment.

Dermatol Ther 2020 11 28;33(6):e14321. Epub 2020 Sep 28.

Dermatology Section, Department of Medical, Surgical, and Neurological Sciences, Santa Maria Alle Scotte Hospital, Siena, Italy.

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http://dx.doi.org/10.1111/dth.14321DOI Listing
November 2020

Superhigh magnification dermoscopy and management of a pediatric Spitz nevus mimicking melanoma.

Ital J Dermatol Venerol 2021 Feb 17;156(1):111-112. Epub 2020 Sep 17.

Section of Dermatology, Department of Medical, Surgical and Neurological Science, S. Maria alle Scotte Hospital, University of Siena, Siena, Italy.

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http://dx.doi.org/10.23736/S0392-0488.20.06573-6DOI Listing
February 2021

A new clinical and dermoscopic monitoring of infantile hemangiomas treated with oral propranolol.

Dermatol Ther 2020 11 18;33(6):e14283. Epub 2020 Sep 18.

Dermatology Unit and Skin Bank, Department of Medical, Surgical and Neuro-Sciences, University of Siena, Siena, Italy.

Oral propranolol (OP) demonstrated high efficacy and safety profile for treatment of critical infantile hemangiomas (IHs). Our aim was to assess the morphologic changes of IHs with standard and high-resolution video dermoscopy (HRVD) from baseline to 18 months either in presence or absence of OP therapy; to investigate if extended anamnestic perinatal data and clinical-dermoscopic characteristics of the IHs can correlate with therapeutic outcome. We enrolled 94 patients (112 IHs): 58 were treated with OP, 35 (42 IHs) for 6 months (group 1), and 23 (25 IHs) for 12-months (group 2); 36 (45 IHs) were followed-up. Clinical-dermoscopic examinations were performed every 3 months during therapy and follow-up. Among 67 treated IHs, superficial and deep IHs with homogenous clinical-dermoscopic aspect developed after the 2 weeks of life achieved the better outcome, stable at 9-month follow-up, independently form treatment duration. Under HRVD, glomerular vessels were prevalent at baseline; corckscrew, comma, and linear-irregular vessels were the prevalent pattern at 1, 3, and 6 months of therapy, respectively. At 12-month follow-up, adequate healing was achieved by 96% of IHs in group 2 and by 78% in group 1, showing dotted vessels. Persistent IHs displayed a reticulated aspect and linear irregular vessels, while arborizing vessels characterized relapsed IHs. A 12-month OP therapy can be considered for newborns presenting with nonhomogenous mixed IHs >3 cm on the perineal area/lower extremities. In conclusion, HRVD allows a real time monitoring of vascular changes in IHs treated with OP and can support physicians in identifying relapses before they become clinically evident.
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http://dx.doi.org/10.1111/dth.14283DOI Listing
November 2020

A novel mutation in LMX1B gene in a newborn with nail-patella syndrome: Clinical and dermoscopic findings.

Pediatr Dermatol 2020 Nov 6;37(6):1205-1206. Epub 2020 Sep 6.

Dermatology Unit, Department of Medical, Surgical and Neurosciences, Siena University Hospital, Italy.

We report on a 3-month-old female patient presenting with bilateral anonychia of the thumbnails and hyponychia of the index nails. Clinico-dermoscopic examination revealed triangular lunulae in all fingernails. Sequence analysis of LMX1B gene identified a novel heterozygous de novo mutation within exon 2, pathogenetic for a nail-patella syndrome.
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http://dx.doi.org/10.1111/pde.14337DOI Listing
November 2020

Tridimensional skin imaging in aquagenic keratoderma: virtual histology by line-field confocal optical coherence tomography.

Int J Dermatol 2021 Feb 29;60(2):e52-e54. Epub 2020 Aug 29.

Dermatology Unit, Department of Medical, Surgical and Neurosciences, University of Siena, Siena, Italy.

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http://dx.doi.org/10.1111/ijd.15169DOI Listing
February 2021

The Comparative Use of Multiple Electronic Devices in the Teledermoscopic Diagnosis of Early Melanoma.

Telemed J E Health 2020 Aug 14. Epub 2020 Aug 14.

Bioengineering and Biomedical Data Science Lab, Department of Medical Biotechnologies, University of Siena, Siena, Italy.

The use of mobile electronic devices as support to medical activity was largely implemented in the past decade. Our first aim was to evaluate the frequency of use of different electronic devices, that is, personal computer (PC), notebook, tablet, smartphone, in a pool of dermatologists recruited to perform multiple online testing session on difficult melanocytic skin lesions (MSLs) cases. The second aim was to evaluate the feasibility of each device in terms of teledermatologic diagnostic performance; the use of four different diagnostic methods, that is, intuitive diagnosis and three dermoscopic algorithms, was also investigated. A total of 111 dermatologists with 4 different levels of experience in dermoscopy, performed 4 tests (intuitive diagnosis and iDScore, ABCD rule, 7-point-checklist-based diagnosis) on 979 MSLs blinded cases. Each testing session was performed with a preferred device. The overall highest areas under the receiver operating characteristic (AUROC) (82%) was obtained by young generation dermoscopists 1-4 years experience) when using an integrated clinical dermoscopic algorithm (iDScore) on a notebook. The average dermatologist using the iDScore obtained AUROC 77.40% with large screen devices (PC and notebook) 77.6% with small screen (tablet, smartphone) and 78.2% by combining the two. Young generation of dermoscopists alternately use different devices, whereas elderly generation still prefer to use the PC. The diagnostic performances obtained with small/large screen were not statistically different from those obtained with fixed/mobile devices. Mobile devices were feasible tools to achieve adequate diagnostic accuracy in difficult MSLs, on a teledermatology setting, independently from participant skill level/age.
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http://dx.doi.org/10.1089/tmj.2020.0057DOI Listing
August 2020

New findings in non-invasive imaging of aquagenic keratoderma: Line-field optical coherence tomography, dermoscopy and reflectance confocal microscopy.

Skin Res Technol 2020 Nov 9;26(6):956-959. Epub 2020 Aug 9.

Dermatology Unit, Department of Medical, Surgical and Neurosciences, University of Siena, Siena, Italy.

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http://dx.doi.org/10.1111/srt.12882DOI Listing
November 2020

In vivo and ex vivo confocal microscopy for the evaluation of surgical margins of melanoma.

J Biophotonics 2020 11 13;13(11):e202000179. Epub 2020 Aug 13.

Department of Medical, Surgical and Neurological Science, Dermatology Section, University of Siena, S. Maria alle Scotte Hospital, Siena, Italy.

We report the first series of melanomas (MMs) where the surgical margins were evaluated both by ex vivo confocal microscopy (EVCM) and in vivo reflectance confocal microscopy (RCM). We evaluated the surgical margins of 42 cutaneous MMs of lentigo maligna/lentigo maligna melanoma type and 2 mucosal MMs with EVCM. Cutaneous MMs also underwent RCM mapping. Imaging results were compared with histopathology. The rate of correct identification of the tumor margins (invaded or not invaded) was 97.6% for RCM (evaluations of cutaneous MMs) and 95.5% for EVCM (evaluations of both cutaneous and mucosal MMs). Our study showed that the MM extension is visible under EVCM and that the combination of in vivo RCM and EVCM can be a new strategy for the evaluation of surgical margins of MMs.
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http://dx.doi.org/10.1002/jbio.202000179DOI Listing
November 2020

Kaposi sarcoma of the glans: New findings by line field confocal optical coherence tomography examination.

Skin Res Technol 2021 Mar 23;27(2):285-287. Epub 2020 Jul 23.

Dermatology Unit, Department of Medical, Surgical and Neurosciences, University of Siena, Siena, Italy.

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http://dx.doi.org/10.1111/srt.12938DOI Listing
March 2021

Real-World Effectiveness and Safety of Apremilast in Older Patients with Psoriasis.

Drugs Aging 2020 09;37(9):657-663

Service de Dermatologie, Hôpital Victor Dupouy, 69 rue du Lieutenant-Colonel Prud'hon, 95100, Argenteuil, France.

Introduction: Apremilast is a drug recently developed for psoriasis. Few data are available on its use in the elderly. We evaluated the tolerance and effectiveness of apremilast used in daily practice for psoriasis treatment in older patients.

Methods: We performed a multicenter, retrospective study involving patients aged ≥ 65 years who had received apremilast as a psoriasis treatment. Demographic data and details regarding psoriasis and adverse events (AEs) were collected from patient medical records.

Results: 135 patients were included (mean age: 73.5 years). Treatment was stopped in 74 patients (54.8%) for AEs (n = 43, 56.6%), primary failures (n = 18, 23.4%), and relapses (n = 7, 9.2%). When patients were stratified by age at treatment initiation, the main cause of discontinuation in patients ≥ 75 years was AEs, whereas in patients aged 65-74 years it was primary failures (28.3%). Sixty-one patients reported AEs, mainly digestive (n = 49). Regarding effectiveness, 45.2% of patients reached PGA 0/1 between 3 and 6 months after treatment initiation. One-year apremilast continuation rates were better in the 65-74 and 75-84 years subgroups than in the > 85 years subgroup (p = 0.01).

Conclusion: Apremilast seems to be an effective and safe therapeutic option for psoriasis in the elderly. The main AEs reported by patients did not seem to differ from those reported previously in younger populations. However, AEs were more frequent in patients > 75 years old leading to more frequent discontinuation of apremilast compared with younger patients, suggesting a higher level of vigilance is needed in the elderly.
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http://dx.doi.org/10.1007/s40266-020-00781-yDOI Listing
September 2020

Acanthosis nigricans monstre successfully treated with topical tacalcitol, metformin, and oral contraceptives.

Dermatol Ther 2020 07 24;33(4):e13660. Epub 2020 Jun 24.

Dermatology Unit and Skin Bank, Department of Medical, Surgical and Neuro-Sciences, University of Siena, Siena, Italy.

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http://dx.doi.org/10.1111/dth.13660DOI Listing
July 2020

High magnification and fluorescence advanced videodermoscopy for hypomelanotic melanoma.

Skin Res Technol 2020 09 16;26(5):766-768. Epub 2020 Mar 16.

Department of Medical, Surgical and Neurological Science, Dermatology Section, University of Siena, S. Maria alle Scotte Hospital, Siena, Italy.

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http://dx.doi.org/10.1111/srt.12855DOI Listing
September 2020

Hematoma-like metastases in melanoma: Ultrasound findings.

Skin Res Technol 2020 09 16;26(5):757-758. Epub 2020 Mar 16.

Department of Medical, Surgical and Neurological Science, Dermatology Section, University of Siena, S. Maria alle Scotte Hospital, Siena, Italy.

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http://dx.doi.org/10.1111/srt.12845DOI Listing
September 2020