Publications by authors named "Gabriella Fabbrocini"

325 Publications

Dimethyl fumarate titration for the systemic treatment of moderate-to-severe plaque psoriasis.

Drugs Context 2021 31;10. Epub 2021 May 31.

Dermatology Department, DissaL, Policlinico San Martino IRCCS, Genova, Italy.

Background: Dimethyl fumarate (DMF) is an oral systemic agent approved for the treatment of moderate-to-severe psoriasis vulgaris. It has a favourable tolerability profile, but it is associated with a high incidence of mild and reversible adverse events. The aim of the article is to describe a clinical experience aimed at increasing tolerability.

Patients And Methods: A group of patients was treated with DMF with a titration schedule, according to clinical practice, although a personalization of the step-up timing was allowed. The highest dose was the minimal effective dose or the maximal tolerated doses.

Results: DMF treatment was effective in reducing the disease severity and improving the quality of life. DMF was well tolerated as only mild, mainly gastrointestinal, adverse events occurred in these patients. In addition, the up-titration schedule seemed to provide a reduced incidence of adverse events compared with the fixed dose.

Conclusion: Our experience suggested that the recommended up-titration schedule of DMF, adjusted and personalized according to patient needs and physician opinion, provided a relevant clinical benefit and was well tolerated.
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http://dx.doi.org/10.7573/dic.2020-12-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8177959PMC
May 2021

Bilateral Chilblain-like Lesions of the Toes Characterized by Microvascular Remodeling in Adolescents During the COVID-19 Pandemic.

JAMA Netw Open 2021 06 1;4(6):e2111369. Epub 2021 Jun 1.

Department of Translational Medical Sciences, Section of Pediatrics, University of Naples Federico II, Naples, Italy.

Importance: Chilblain-like lesions have been one of the most frequently described cutaneous manifestations during the COVID-19 pandemic. Their etiopathogenesis, including the role of SARS-CoV-2, remains elusive.

Objective: To examine the association of chilblain-like lesions with SARS-CoV-2 infection.

Design, Setting, And Participants: This prospective case series enrolled 17 adolescents who presented with chilblain-like lesions from April 1 to June 30, 2020, at a tertiary referral academic hospital in Italy.

Main Outcomes And Measures: Macroscopic (clinical and dermoscopic) and microscopic (histopathologic) analysis contributed to a thorough understanding of the lesions. Nasopharyngeal swab, serologic testing, and in situ hybridization of the skin biopsy specimens were performed to test for SARS-CoV-2 infection. Laboratory tests explored signs of systemic inflammation or thrombophilia. Structural changes in peripheral microcirculation were investigated by capillaroscopy.

Results: Of the 17 adolescents (9 [52.9%] male; median [interquartile range] age, 13.2 [12.5-14.3] years) enrolled during the first wave of the COVID-19 pandemic, 16 (94.1%) had bilaterally localized distal erythematous or cyanotic lesions. A triad of red dots (16 [100%]), white rosettes (11 [68.8%]), and white streaks (10 [62.5%]) characterized the dermoscopic picture. Histologic analysis revealed a remodeling of the dermal blood vessels with a lobular arrangement, wall thickening, and a mild perivascular lymphocytic infiltrate. SARS-CoV-2 infection was excluded by molecular and serologic testing. In situ hybridization did not highlight the viral genome in the lesions.

Conclusions And Relevance: This study delineated the clinical, histologic, and laboratory features of chilblain-like lesions that emerged during the COVID-19 pandemic, and its findings do not support their association with SARS-CoV-2 infection. The lesions occurred in otherwise healthy adolescents, had a long but benign course to self-resolution, and were characterized by a microvascular remodeling with perivascular lymphocytic infiltrate but no other signs of vasculitis. These results suggest that chilblain-like lesions do not imply a concomitant SARS-CoV-2 infection. Ongoing studies will help clarify the etiopathogenic mechanisms.
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http://dx.doi.org/10.1001/jamanetworkopen.2021.11369DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8193438PMC
June 2021

Immunological skin signatures in SARS-CoV-2 negative patients with Chilblain-like lesions.

JAAD Int 2021 May 29. Epub 2021 May 29.

Department of Clinical Medicine and Surgery, Section of Dermatology, University of Naples Federico II, Via Pansini 5, Napoli, Italy.

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http://dx.doi.org/10.1016/j.jdin.2021.05.005DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8164336PMC
May 2021

An open-label, investigator-initiated, single-center, prospective, pilot clinical study to evaluate the efficacy of a skin whitening serum applied twice daily combined with a spot-preventing SPF50+ sunscreen in healthy female subjects with melasma hyperpigmentation.

J Cosmet Dermatol 2021 Jun 4. Epub 2021 Jun 4.

Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy.

Background: Melasma is a common skin disorder characterized by alterations in normal skin pigmentation. The objective was to evaluate the efficacy and safety of a skin whitening serum containing niacinamide, hydroxyphenoxy propionic acid, dipotassium glycyrrhizate, glycolic acid and 4-n-butylresorcinol applied twice daily combined with a spot-preventing SPF50+ sunscreen for treatment of melasma.

Methods: Twelve healthy Caucasian women with melasma (Fitzpatrick skin types II-IV) were enrolled in this pilot clinical study. Efficacy evaluations were performed at baseline and weeks 4, 8, and 12 of treatment, and included clinical and instrumental assessments.

Results: All endpoints for melasma hyperpigmentation showed a statistically significant improvement from baseline to the end of the study. There was only one dropout. No signs of irritation or discomfort were observed at baseline, w4, w8 or w12. An overall improvement in melasma was observed both clinically and on reflectance confocal microscopy (RCM).

Conclusion: This topical skin whitening serum had favorable outcomes for the treatment of melasma hyperpigmentation in adult women, as demonstrated on investigator and instrumental assessments. The results of this pilot study need to be confirmed in randomized, controlled studies with a larger sample size.
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http://dx.doi.org/10.1111/jocd.14271DOI Listing
June 2021

Trotula de Ruggiero and the birth of gender medicine.

Ital J Dermatol Venerol 2021 May 28. Epub 2021 May 28.

Department of Health Sciences Vincenzo Tiberio, University of Molise, Campobasso, Italy -

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http://dx.doi.org/10.23736/S2784-8671.21.06969-3DOI Listing
May 2021

Successful treatment of eruptive pyogenic granuloma (PG) with propranolol.

Dermatol Ther 2021 May 24:e14998. Epub 2021 May 24.

Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy.

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http://dx.doi.org/10.1111/dth.14998DOI Listing
May 2021

A Survey Among Italian Physicians During COVID-19 Outbreak. Could Bacillus Calmette-Guérin Vaccine Be Effective Against SARS-CoV2?

Front Pharmacol 2021 3;12:646570. Epub 2021 May 3.

Division of Allergy and Clinical Immunology, Department of Medicine ASL Salerno, "Santa Maria Della Speranza" Hospital, Salerno, Italy.

Epidemiological studies show that BCG-vaccinated population seems to be more likely protected from COVID-19 infection, but WHO gave a stark warning on use of BCG vaccine without confirmed COVID-19 trials. The aim of the study is to evaluate whether TB vaccination, performed several years earlier, could confer protection against COVID-19. After the Ethical Committee authorization, professional orders were used to contact physicians with an online survey. Specialty, COVID-19 infection and previous BCG vaccination were recorded. Statistical data analysis was performed. 1906 physicians answered the questionnaire, (M = 1068; F = 838; mean age 50.7 ± 13.3 years; range 24-87), more than half (1062; 55.7%) experienced BCG vaccination. Professional activity was recorded, and only 49 subjects (2.6%) of them were infected by SARS-CoV2. Among the group of infected people, asymptomatic form occurred in 12 subjects (24.5%); a pauci-symptomatic form in 24 subjects (49.0%); and a severe form (pneumonia and/or respiratory distress) in 13 (26.5%). Considering only the clinically relevant form of COVID-19, period prevalence was 2.2% (23/1062) in the vaccinated group and 1.7% (14/844) in the unvaccinated group (OR: 1.31, 95% C.I.: 0.68-2.63, = 0.427). Our experience does not confirm the possible protective role of BCG vaccination, performed years earlier, against COVID-19. Although recent epidemiological studies point out in BCG-vaccinated population a lower prevalence of SARS-CoV2 infection, in our cohort of physicians no significant difference was found in terms of prevalence of COVID-19 infection. Our data underline the necessity to follow the WHO warning about the indiscriminate use of BCG vaccine, until clear evidence of protection by BCG vaccination against COVID-19 is fully demonstrated.
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http://dx.doi.org/10.3389/fphar.2021.646570DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8126664PMC
May 2021

Allergic contact dermatitis to Compositae: A possible cause of dupilumab-associated facial and neck dermatitis in atopic dermatitis patients?

Contact Dermatitis 2021 May 14. Epub 2021 May 14.

Department of Health Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy.

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http://dx.doi.org/10.1111/cod.13898DOI Listing
May 2021

Ciprofloxacin-induced symmetrical drug-related intertriginous and flexural exanthema (SDRIFE) in a psoriasis patient.

Contact Dermatitis 2021 May 8. Epub 2021 May 8.

Section of Dermatology - Department of Clinical Medicine and Surgery, University of Naples Federico II, Napoli, Italy.

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http://dx.doi.org/10.1111/cod.13882DOI Listing
May 2021

SARS-CoV-2 vaccines and biological treatments: dermatological perspectives.

Ital J Dermatol Venerol 2021 Apr;156(2):118-120

Section of Dermatology, Department of Medicine and Surgery, University of Perugia, Perugia, Italy.

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http://dx.doi.org/10.23736/S2784-8671.21.07055-9DOI Listing
April 2021

Is It Possible to Improve Scabies Diagnosis Performance?

Dermatol Pract Concept 2021 Mar 12;11(2):e2021015. Epub 2021 Apr 12.

Dermatology Unit, Department of Clinical Medicine and Surgery, University of Naples Federico II, Italy.

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http://dx.doi.org/10.5826/dpc.1102a15DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8060016PMC
March 2021

Real-world experience versus clinical trials: pros and cons in psoriasis therapy evaluation.

Int J Dermatol 2021 May 4. Epub 2021 May 4.

Section of Dermatology - Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy.

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http://dx.doi.org/10.1111/ijd.15644DOI Listing
May 2021

A novel azelaic acid formulation for the topical treatment of inflammatory rosacea: A multicentre, prospective clinical trial.

J Cosmet Dermatol 2021 Apr;20 Suppl 1:28-31

Dermatology Clinic, University of Catania, Catania, Italy.

Background: Topical azelaic acid (AzA) is a common treatment for mild/moderate inflammatory rosacea.

Aims: To assess the efficacy and tolerability of a novel formulation cream containing 15% AzA (anti-inflammatory/anti-oxidant/anti-microbial agent) combined with 1% dihydroavenanthramide D (anti-inflammatory/anti-itch) in inflammatory rosacea using clinical/instrumental evaluation.

Methods: In this multicentre, prospective, open-label trial, 45 patients with mild/moderate inflammatory rosacea enrolled at the Dermatology Clinic of the University of Catania, Naples, and Rome (Italy) were instructed to apply the cream twice daily for 8 weeks. Clinical evaluation was performed at baseline (T0) and at 8 weeks (T1) by (1) Investigator Global Assessment (IGA) score based on a 5-point scale (from 0 = clear/no erythema/papules/pustules to 4 = severe erythema/several papules/pustules) and (2) inflammatory lesions count. Instrumental evaluation of erythema degree was performed by erythema-directed digital photography (EDDP) by a 5-point scale (from 0 = no redness to 4 = severe redness) at all time points. Tolerability was assessed by a self-administered questionnaire at 8 weeks. Statistical analysis was performed using SAS version 9.

Results: Forty-four patients completed the study. At week 8, a significant decrease in baseline of IGA scores [median from 3 (T0) to 1 (T1)] and inflammatory lesions count [median from 8 (T0) to 1 (T1)] was recorded along with a significant reduction of erythema scores [median from 2 (T0) to 1 (T1)]. No relevant side effects were recorded.

Conclusions: Our results suggest that this new non-irritating product represents a valid therapeutic option for mild/moderate inflammatory rosacea, and EDDP is able to provide a more defined evaluation of erythema changes.
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http://dx.doi.org/10.1111/jocd.14098DOI Listing
April 2021

Topical oil formulation of plant extracts and vitamins as effective treatment for stretch marks and xerosis-An observational longitudinal study.

J Cosmet Dermatol 2021 Apr;20 Suppl 1:9-13

Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Napoli, Italy.

Background: Stretch marks are linear scars that result from elastic fiber destruction. They usually occur as the consequence of rapid change in the body mass (weight gain and loss, pregnancy, weightlifting), long-term steroid use, or endocrinopathies. Treatment is challenging and mainly based on topical and procedural therapies, although the standard of care is still under debate.

Purpose: To evaluate the efficacy and tolerance of a topical oil formulation of plant extracts and vitamins on the aesthetic improvement of stretch marks and xerosis.

Materials And Methods: Fifty male and female patients, aged between 14 and 45 years, with stretch marks referring at the University Hospital Federico II, Naples, were enrolled between March and November 2019. Topical application of plant extracts and vitamin-rich oil was performed twice daily on affected skin for 4 months. Patients were monitored at baseline (T0), and at two-month (T1) and 4-month (T2) follow-ups, through clinical and dermoscopic assessment, confocal microscopy, cutaneous ultrasound, MoistureMeterEpiD, and X-Rite spectrocolorimeter. Primary endpoints were as follows: 70% clinical improvement of stretch marks and 3-point decrease in clinical score from baseline to T2. Secondary endpoints were as follows: change in the T0 parallel pattern of collagen fibers at confocal microscopy, cutaneous thickness increase at ultrasounds, cutaneous hydration increase at MoistureMeterEpiD, erythema reduction at X-Rite spectrocolorimeter, and safety and adverse events (AEs).

Results: At 4-month follow-up, stretch marks improved objectively and subjectively in all patients (p < 0.001). In detail, there was a 29% and 71% improvement in clinical appearance of stretch marks at T1 and T2, respectively, as documented dermoscopically and by the 3-point reduction in the assessor's mean clinical score at each follow-up visits [from 8.1±0.7 at baseline to 5.7±1.0 at T1 and 2.3 ±0.5 at T2 (p < 0.001)]. Erythema decreased by 15% and 30% and in parallel hydration increased by 25% and 71%, at T1 and T2, respectively (p < 0.001). At T2 confocal microscopy of stretch marks, dermal collagenous fibers assumed casual disposition with reticular pattern and refractivity, as signs of collagen remodeling and neocollagenesis, and also the T2 cutaneous ultrasound revealed increased epidermal thickness and decreased dermal hypoechogenicity as for a higher skin hydration.

Conclusion: Our study showed that a topical oil formulation rich in plant extracts and vitamins appears to be effective and safe in treating stretch marks and xerosis.
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http://dx.doi.org/10.1111/jocd.14094DOI Listing
April 2021

Ultraviolet radiation, vitamin D and COVID-19.

Ital J Dermatol Venerol 2021 Apr 29. Epub 2021 Apr 29.

Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy.

Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), the causative agent of coronavirus disease 2019 (COVID-19), has become pandemic on March 11, 2020. COVID-19 has a range of symptoms that includes fever, fatigue, dry cough, aches, and labored breathing to acute respiratory distress and possibly death. Health systems and hospitals have been completely rearranged since March 2020 in order to limit the high rate of virus spreading. Hence, a great debate on postponable visits and treatments including phototherapy for skin diseases is developing. In particular, as regards phototherapy very few data are currently available regarding the chance to continue it, even if it may be an useful resource for treating numerous dermatological patients. However, phototherapy has an immunosuppressive action possibly facilitating virus infection. In the context of COVID-19 infection risk it is important to pointed out whether sunlight, phototherapy and in particular ultraviolet radiation (UV-R) constitute or not a risk for patients. In this review we aimed to focus on the relationship between UV-R, sunlight, phototherapy, and viral infections particularly focusing on COVID-19.
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http://dx.doi.org/10.23736/S2784-8671.21.06833-4DOI Listing
April 2021

Psoriasis awareness among general population: preliminary results of an online survey.

Ital J Dermatol Venerol 2021 Apr 29. Epub 2021 Apr 29.

Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy.

Background: Psoriasis represents one of the most common skin diseases in Italy, with a prevalence of 2.9%. It has been defined as a noncommunicable disease, due to its high burden and impact on patients' quality of life.

Aims: The aim of our observational study was to assess the actual knowledge and perception of psoriasis in Italian population by administering an online 10-question survey to a representative sample general population.

Methods: An online 10-question survey was administered to a representative sample general population from September 2019 to December 2019. A representative sample of general population (age ≥ 18 years) was enrolled by promoting the online survey through multiple means of communication such as social sites (Facebook, Instagram) or delivering a questionnaire link in public spaces (outpatient clinic, pharmacy). All results were then collected and analyzed in graphs by the Google form platform.

Results: 151 individuals participated in the survey. Results showed that 7.3% (n=11) of general population were not familiar with the term psoriasis; 4.6% (n=7) thought to psoriasis as an infectious disease and 6% (n=9) thought that psoriasis was contagious. Interestingly, 39.1% (n=59) of participants have never heard about targeted/biologic therapy.

Limitations: Our study is limited by the small sample size as well as lack of data regarding sex, age and education level of the study participant.

Conclusions: There is still lack of knowledge of psoriasis among general population, representing an obstacle for patients' everyday activities and quality of life. Future studies to investigate the details of this impaired knowledge and new psoriasis campaign on large scale should fill this gap are required.
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http://dx.doi.org/10.23736/S2784-8671.21.06822-XDOI Listing
April 2021

Phase angle and Mediterranean diet in patients with acne: Two easy tools for assessing the clinical severity of disease.

J Transl Med 2021 04 26;19(1):171. Epub 2021 Apr 26.

Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy.

Background: Acne is a chronic, inflammatory and debilitating skin disorder. Dietary factors and nutritional status are among the exacerbating factors of acne. Phase angle (PhA), a direct measure of Bioelectrical Impedance Analysis (BIA), represents an indicator of the chronic inflammatory state. The Mediterranean diet (MD) is a healthy dietary pattern that can exert anti-inflammatory effects in several inflammatory diseases. We aimed to investigate the difference in PhA and adherence to the MD and their associations with the severity of acne in a sample of naïve treatment patients with acne compared to control group.

Materials: In this cross-sectional, case-control, observational study, we enrolled 51 patients with acne and 51 control individuals. Body composition was evaluated by a BIA phase-sensitive system (50 kHz BIA 101 RJL, Akern Bioresearch, Florence, Italy, Akern). For adherence to the MD, we have used the PREvención con DIeta MEDiterránea (PREDIMED) questionnaire. The clinical severity of acne was assessed by using the global acne grading system (GAGS), a quantitative scoring system to assess acne severity.

Results: Patients with acne had a worse body composition, in particular smaller PhA (p = 0.003), and a lower adherence to the MD (p < 0.001) than the control group, in spite of no differences in gender, age and BMI between the two groups. Stratifying patients with acne according to GAGS categories, both PhA (p = 0.006) and PREDIMED score (p = 0.007) decreased significantly in severe acne than mild/moderate acne. The GAGS score was negative correlations with PhA (r = - 0.478, p < 0.001) and PREDIMED score (r = - 0.504, p < 0.001). The results of the multivariate analysis showed PhA and PREDIMED score were the major determinants of GAGS score (p < 0.001). The receiver operator characteristic (ROC) analysis reporting a value of PhA of ≤ 6.1° and a PREDIMED score of ≤ 9 identified patients with acne with the highest clinical severity of the disease.

Conclusions: Novel correlations were reported between PhA and the degree of adherence to the MD with acne severity. Of interest, PhA and PREDIMED scores might represent possible markers of the severity of acne in a clinical setting. This study highlights how a cooperation between dermatologist and nutritionists might provide a combination key in the complex management of acne patients.
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http://dx.doi.org/10.1186/s12967-021-02826-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8074493PMC
April 2021

Expert opinion on sonidegib efficacy, safety and tolerability.

Expert Opin Drug Saf 2021 May 12:1-6. Epub 2021 May 12.

Dermatology Unit, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy.

: Hedgehog inhibitors are an alternative treatment option for patients with advanced BCCs not eligible for standard therapies due to lack of efficacy, high recurrence risk, and high-rate morbidity. Sonidegib, an oral smoothened antagonist, has been approved for the treatment of adult patients with locally advanced basal cell carcinoma. Several studies and randomized controlled trials have been conducted in order to evaluate the efficacy, safety, and tolerability of this new molecule.: The aim of this article is to provide a complete overview on the use of sonidegib for the treatment of advanced BCCs describing the efficacy, safety, and drug tolerability of this drug.: Sonidegib, with a different pharmacokinetics profile from that of the other SMO-inhibitor vismodegib, demonstrated to be an efficacious and well-tolerated treatment in patients with locally advanced BCC. Although several drug-related adverse events have already been described, different strategies should be taken into account to better manage this small molecule while avoiding treatment discontinuation. The use of sonidegib as neoadjuvant therapy or combined with other hedgehog pathway inhibitors targeting different sites and to date, only available for pre-clinical studies, should also be considered.
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http://dx.doi.org/10.1080/14740338.2021.1921734DOI Listing
May 2021

Looking into a Better Future: Novel Therapies for Metastatic Melanoma.

Dermatol Ther (Heidelb) 2021 Jun 17;11(3):751-767. Epub 2021 Apr 17.

Dermatology Unit, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy.

Even though melanoma represents a small percentage of all cutaneous cancers, it is responsible for most deaths from skin neoplasms. In early stages it can be successfully treated with surgery, but as the disease expands the survival rate drops significantly. For many years the mainstay of treatment for metastatic melanoma was chemotherapeutic agents, even though they failed to prove survival prolongation. After the advent of ipilimumab, a survival benefit and better overall response rate could be offered to the patients. Other new therapies, such as immunotherapies, targeted therapies, vaccines, and small molecules, are currently being studied. Also, combination regimens have demonstrated superiority to some monotherapies. Nowadays, ipilimumab should no longer be considered the first-line therapy given its severe toxicity and lower efficacy, while nivolumab remains efficacious and has a good safety profile. T-VEC as monotherapy has been shown to be an elegant alternative even for the elderly or cases of head and neck melanomas. If the BRAF mutation status is positive, the combination of dabrafenib and trametinib could be an option to consider. Despite the success of the novel treatments, their effectiveness is still limited. New studies have opened up new avenues for future research in melanoma treatment, which is expected to lead to better therapeutic outcomes for our patients. The objective of this review is to discuss the novel therapies for metastatic melanoma that have been tested in humans during the last 3 years to obtain a sharper perspective of the available treatment options for specific patient characteristics.
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http://dx.doi.org/10.1007/s13555-021-00525-9DOI Listing
June 2021

Allergic contact dermatitis probably due to brimonidine tartrate in eyedrops.

Contact Dermatitis 2021 Apr 16. Epub 2021 Apr 16.

Department of Health Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy.

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http://dx.doi.org/10.1111/cod.13867DOI Listing
April 2021

Reflectance Confocal Microscopy Identification of Subclinical Basal Cell Carcinoma after Vismodegib Treatment: Report of a Case.

Dermatol Ther (Heidelb) 2021 Jun 15;11(3):1071-1074. Epub 2021 Apr 15.

Dermatology Unit, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy.

Although surgery represents the treatment of choice for the majority of basal cell carcinomas, different therapies are required to treat the advanced ones. Vismodegib and sonidegib are the two oral Smoothened (Smo) inhibitors approved for the treatment of advanced basal cell carcinoma. Clinical detection of subclinical basal cell carcinoma during and after vismodegib treatment could be difficult, requiring the use of dermoscopy and reflectance confocal microscopy as noninvasive diagnostic methods. We report the case of a 62-year-old woman with a locally advanced basal cell carcinoma successfully treated with vismodegib in which dermoscopy and reflectance confocal microscopy showed their superiority in detecting subclinical recurrent basal cell carcinoma developed on scar tissue after complete regression of the tumor.
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http://dx.doi.org/10.1007/s13555-021-00533-9DOI Listing
June 2021

Ocular Manifestations in Psoriasis Screening (OcMaPS) Questionnaire: A Useful Tool to Reveal Misdiagnosed Ocular Involvement in Psoriasis.

J Clin Med 2021 Mar 3;10(5). Epub 2021 Mar 3.

Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Via Pansini 5, 80131 Napoli, Italy.

Psoriasis is an immune-mediated, chronic inflammatory disease, which mainly affects the skin, although it has systemic pathological effects. Comorbidities of psoriasis include ocular disorders, which are often nonspecific or mildly symptomatic. The aim of this study was to show the importance of ocular-disease screening in psoriatic patients using the Ocular Manifestations in Psoriasis Screening (OcMaPS) questionnaire. Patients suffering from moderate-to-severe psoriasis referring at our outpatient-clinic were consecutively enrolled. Each patient was asked to complete a screening questionnaire (OcMaPS). Patients reporting ocular symptoms were referred for an ophthalmological examination. A total of 372 patients were enrolled in the study. Ocular symptoms were detected in 39 patients (10.5%), and 37 patients were referred to ophthalmological examination which confirmed the presence of ocular manifestation in 30 patients. There were three cases (10%) of uveitis, 14 (46.6%) of dry eye and 13 (43.3%) of cataract, in progress or already treated with surgery. In the remaining seven patients, no ocular manifestations were found. Ocular manifestations in psoriatic patients are not rare. It is important to be aware of ocular symptoms in psoriatic patients, screening patients (with a consultation or OcMaPS questionnaire), which leads to earlier diagnosis and treatment.
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http://dx.doi.org/10.3390/jcm10051031DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7958956PMC
March 2021

Adalimumab in the Management of Isotretinoin-Induced Acne Fulminans: Report of a Case.

Skin Appendage Disord 2021 Feb 21;7(2):115-119. Epub 2021 Jan 21.

Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy.

Acne fulminans (AF) is a rare, acute, and severe form of acne vulgaris often associated with systemic symptoms. Its treatment is challenging and controversial. We report a case of isotretinoin-induced AF (IIAF) in a 12-year-old boy resistant to traditional therapies (oral steroids and isotretinoin). The patient was successfully treated with adalimumab that can be considered an effective off-label option in the treatment of resistant IIAF in children.
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http://dx.doi.org/10.1159/000512032DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7991494PMC
February 2021

Repigmentation of White Forelock in a Familial Case of Piebaldism Reported via Teledermatology in the COVID-19 Era.

Skin Appendage Disord 2021 Feb 9;7(2):120-122. Epub 2020 Dec 9.

Department of Clinical Medicine and Surgery, Section of Dermatology, University of Naples Federico II, Napoli, Italy.

Piebaldism is a rare autosomal dominant disorder characterized by leucoderma with leucotrichia. We describe a case of white forelock repigmentation in an infant with piebaldism, thanks to a photograph sent by the patient's mother to our dermatology clinic, during COVID-19 pandemic.
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http://dx.doi.org/10.1159/000512033DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7801991PMC
February 2021

The emerging role of dupilumab in dermatological indications.

Expert Opin Biol Ther 2021 Mar 30:1-11. Epub 2021 Mar 30.

Department of Health Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy.

Introduction: Dupilumab represents a breakthrough in the management of atopic dermatitis (AD), thanks to its powerful T-helper (Th)2-mediated immunity modulating activity. It can reduce the atopic skin molecular signature and induce a significant decrease in the clinical signs and symptoms of AD patients.

Areas Covered: Th2 activation has been confirmed or suspected in skin diseases other than AD, and several reports about the treatment with dupilumab in these conditions have been published. In order to review the new indications of dupilumab in dermatology, we performed a search on PubMed, Embase, Cochrane Skin databases, and clinicaltrials.gov.

Expert Opinion: The analysis of available literature suggests that dupilumab may have a large application in dermatology, besides AD. Clinical trials are underway on some widespread disease (i.e. chronic urticaria, bullous pemphigoid, alopecia areata, or allergic contact dermatitis). The data are still partial, but they seem to indicate that dupilumab is efficacious and safe. On the other hand, the dupilumab use in some rare skin diseases remains only hypothetical or linked to few case reports. Dupilumab could have a prominent position in the therapeutic algorithm of chronic skin diseases that significantly affect the quality of life of patients, require long-term treatment, or lacking effective therapies.
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http://dx.doi.org/10.1080/14712598.2021.1907341DOI Listing
March 2021

Possible role of neuropilins in dermatological manifestations of SARS-CoV-2 infection.

Int J Dermatol 2021 Mar 24. Epub 2021 Mar 24.

Department of Clinical Medicine and Surgery, Section of Dermatology, University of Naples Federico II, Napoli, Italy.

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http://dx.doi.org/10.1111/ijd.15546DOI Listing
March 2021

Guselkumab and risankizumab for psoriasis: a 44-week indirect real-life comparison.

J Am Acad Dermatol 2021 Mar 21. Epub 2021 Mar 21.

Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Napoli, Italy.

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http://dx.doi.org/10.1016/j.jaad.2021.01.025DOI Listing
March 2021

The Efficacy and Safety of Abrocitinib as a Treatment Option for Atopic Dermatitis: A Short Report of the Clinical Data.

Drug Des Devel Ther 2021 10;15:1135-1147. Epub 2021 Mar 10.

Department of Health Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy.

Atopic dermatitis (AD) is a chronic, pruritic, inflammatory skin disease that predominantly affects children. However, it can persist in adulthood and/or start at older ages. Both dysfunction of the epidermal barrier and immune dysregulation are known to play a role in the pathogenesis of AD. In the last years, numerous studies showed that Janus kinase (JAK) enzymes have a key role in AD pathogenesis. Therefore, oral and topical JAK inhibitors are new emerging treatments for AD. We report the data relating to abrocitinib, an oral JAK1 inhibitor. For this purpose, we examined articles already published concerning, in particular, concluded clinical trials. Furthermore, we also report the design of current ongoing clinical trials. The search was carried out considering the main search engines relating to medical literature and clinical trials. From all the data we collected, abrocitinib proved to be an effective drug in significantly reducing the severity of moderate-to-severe AD when compared to placebo. Furthermore, the efficacy was similar to other well-established treatment for AD, such as dupilumab. Adverse events were generally mild; indeed, the drug was definitively suspended only in few patients.
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http://dx.doi.org/10.2147/DDDT.S240866DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7956861PMC
March 2021

Effectiveness and Safety of Long-Term Dupilumab Treatment in Elderly Patients with Atopic Dermatitis: A Multicenter Real-Life Observational Study.

Am J Clin Dermatol 2021 Jul;22(4):581-586

Department of Medicine and Health Sciences Vincenzo Tiberio, University of Molise, Via Francesco De Santis, snc., 86100, Campobasso, Italy.

Objective: The objective of this study was to assess the effectiveness and safety of dupilumab in treating elderly patients with atopic dermatitis from baseline to 52 weeks.

Methods: A retrospective observational real-life study was conducted in a group of elderly patients with severe atopic dermatitis treated with dupilumab for 52 weeks. Inclusion criteria were: age ≥ 65 years; diagnosis of atopic dermatitis made by an expert dermatologist; Eczema Area and Severity Index ≥ 24; and a contraindication, side effects, or failure to respond to cyclosporine. The primary outcome was the mean percentage reduction in the Eczema Area and Severity Index score from baseline to week 52. Secondary measures included the mean percentage reduction in the Pruritus and Sleep Numerical Rating Scales and the Dermatology Life Quality Index, and the types and rates of adverse events from baseline to week 52.

Results: One hundred and five patients were eligible for the study. Flexural dermatitis was the most frequent clinical phenotype (63.8%). The coexistence of more than one clinical phenotype was found in 70/105 (66.6%) patients. We observed a reduction in all disease severity scores from baseline to week 52 (p < 0.001). Adverse events were recorded in 30/105 (28.6%) patients, with conjunctivitis and injection-site reaction the most frequent.

Conclusions: In this study, dupilumab is an effective and safe treatment for the long-term management of atopic dermatitis in patients aged over 65 years.
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http://dx.doi.org/10.1007/s40257-021-00597-5DOI Listing
July 2021