Publications by authors named "Giampiero Girolomoni"

274 Publications

The safety profile of hydroxychloroquine: major cutaneous and extracutaneous adverse events.

Clin Exp Rheumatol 2021 Feb 15. Epub 2021 Feb 15.

Division of Dermatology, San Bortolo Hospital, Vicenza, and Centro Studi GISED, Bergamo, Italy.

Hydroxychloroquine is an established therapy for several rheumatological disorders, and very recently it has been proposed as a possible treatment for the new coronavirus disease 2019 even if recent randomised trials did not prove any benefit. Notably, hydroxychloroquine has been associated with a heterogeneous range of cutaneous and extra-cutaneous adverse events. We carried out a narrative review of the literature up to November 1st, 2020, related to the safety of hydroxychloroquine. In particular, cutaneous and extra-cutaneous adverse events associated with hydroxychloroquine were reviewed. The following databases were consulted: PubMed, Embase, Google Scholar and ResearchGate. The research of articles was conducted by using the following search terms: ''hydroxychloroquine," ''adverse event/effect,'' "cutaneous", "skin", "cardiotoxicity", "retinopathy", gastrointestinal and neurological toxicity". The main indication for which hydroxychloroquine was used in the reports was an immune mediated disorder. Adverse events were described mostly in females over 50 years of age. The most common cutaneous adverse effect was maculopapular and erythematous rash occurring within 4 weeks of initiating hydroxychloroquine and disappearing within few weeks of discontinuation. Gastrointestinal symptoms and headache were the most frequent extracutaneous manifestations. Rarer cutaneous manifestations include hyperpigmentation, psoriasiform dermatitis, photodermatitis, stomatitis, melanonychia and hair loss. More severe conditions were acute generalised exanthematous pustulosis, drug rash with eosinophilia and systemic symptoms, Stevens-Johnson syndrome/toxic epidermal necrolysis, and among extra-cutaneous adverse events cardiotoxicity and retinopathy. Since hydroxychloroquine is widely prescribed in rheumatology, it is important for rheumatologists to be familiar with its safety profile.
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February 2021

IL-17A inhibitors in patients with chronic plaque psoriasis and history of malignancy: A case series with systematic literature review.

Dermatol Ther 2021 Feb 17:e14889. Epub 2021 Feb 17.

Section of Dermatology and Venereology, Department of Medicine, University of Verona, Verona, Italy.

The treatment of moderate to severe plaque psoriasis in patients with history of malignancy is challenging. To review the studies reporting the experience with IL-17A inhibitors in patients with psoriasis and history of malignancy; secondly, to investigate cancer recurrence in a series of patients with a prior malignancy and plaque psoriasis treated with IL-17A inhibitors. A systematic literature review and an observational retrospective analysis of patients with history of malignancy and plaque psoriasis treated with IL-17A inhibitors was performed. About 5 original articles out of 601 were retrieved, reporting a total of 10 patients with a median age of 59 years, interquartile range (IQR) 50-63. Seven patients were treated with secukinumab, one with ixekizumab and two with both sequentially. Although the stage ranged from in situ to IV stage, most of the cases were early-stage neoplasm. The IL-17A inhibitor was initiated after a median of 10 months, interquartile range (IQR) 5-30 (range 0-144) from the diagnosis of malignancy. In addition, a series of 12 patients with history of malignancy were identified from the University Hospital of Verona, including 9 cases with cancer in clinical remission and 3 with advanced disease at time of initiating IL-17 inhibitor. No malignancy recurrence was reported within a median of 12 (IQR 6-23) and 46 (IQR 36-48) months follow up in case series from literature and our experience, respectively. Data on use of IL-17A inhibitors in patients with chronic plaque psoriasis and history of malignancy are limited. Registries and proactive pharmacovigilance activities are needed to guide clinical practice.
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http://dx.doi.org/10.1111/dth.14889DOI Listing
February 2021

Nodules on the Thigh after Brown Recluse Spider Venom Bite: A Quiz.

Acta Derm Venereol 2021 Feb 16;101(2):adv00400. Epub 2021 Feb 16.

Section of Dermatology, Department of Medicine, University of Verona, IT-37126 Verona, Italy. E-mail:

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http://dx.doi.org/10.2340/00015555-3767DOI Listing
February 2021

Incidence of Adverse Cutaneous Reactions to Epidermal Growth Factor Receptor Inhibitors in Patients with Non-Small-Cell Lung Cancer.

Dermatology 2021 Jan 28:1-5. Epub 2021 Jan 28.

Section of Dermatology and Venereology, Department of Medicine, University of Verona, Verona, Italy.

Background: Epidermal growth factor receptor (EGFR) inhibitors are routinely used in advanced non-small-cell lung cancer (NSCLC) harboring EGFR mutations. However, their use is associated with gastrointestinal and cutaneous toxicities, including acneiform eruptions, pruritus, xerosis, nail and hair changes. Aside from reducing patients' quality of life, such cutaneous reactions have a considerable impact on the oncologic treatment given that dose reduction or even drug discontinuation may be necessary, especially for the severe forms.

Objectives: To assess the incidence, impact on treatment and management of EGFR inhibitor-related cutaneous reactions in patients with NSCLC.

Methods: We conducted a prospective observational study on 87 consecutive patients with advanced NSCLC treated with EGFR-tyrosine kinase inhibitors from January to December 2019. Patients who developed mucocutaneous reactions were evaluated and treated by both oncologists and dermatologists, and underwent dermatologic follow-up until resolution of the cutaneous reaction. Demographic and clinical data were collected for each patient, and the severity of the cutaneous reaction was graded using the Common Terminology Criteria for Adverse Events.

Results: Seventy-one patients (81.6%) developed cutaneous reactions. The number of cutaneous reactions per patient was 1 in 37%, 2 in 41% and 3 or more in 22%. The most common cutaneous reactions included acneiform eruptions (56.3%), xerosis ± asteatotic eczema (48.3%), nail changes (39.1%), mucositis (29.9%), pruritus (24.1%) and hair changes (12.6%). Afatinib was associated with a higher rate of nail changes and mucositis (p < 0.01 and p < 0.005, respectively) compared to other agents, while no patient-related predictive factors were identified. Dose reduction was performed in 18% of patients. Multidisciplinary management involving dermatologists allowed to resume the drug in all patients who had discontinued it due to the cutaneous reactions.

Conclusions: A multidisciplinary approach to EGFR inhibitor-related cutaneous reactions is advantageous and can reduce the need to discontinue oncologic treatment.
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http://dx.doi.org/10.1159/000513233DOI Listing
January 2021

Treat-to-Target in Atopic Dermatitis: An International Consensus on a Set of Core Decision Points for Systemic Therapies.

Acta Derm Venereol 2021 Feb 17;101(2):adv00402. Epub 2021 Feb 17.

Department of Dermatology and Allergology, University Medical Center Utrecht, 3584 Utrecht, The Netherlands. E-mail:

Currently no treat-to-target framework to guide systemic treatment in adults with moderate-to-severe atopic dermatitis exists. We sought to reach international consensus through an eDelphi process on a core set of recommendations for such an approach. Recommendations were developed by an international Steering Committee, spanning 3 areas (Guiding Principles, Decision Making, and Outcome Thresholds) and 2 specific time-points; an initial acceptable target at 3 months and an optimal target at 6 months, each based on improvements in patient global assessment plus at least one specific outcome domain. These treat-to-target- orientated recommendations were evaluated by an extended international panel of physicians, nurses and patients. Proposed recommendations were rated using a 9-point Likert scale; for each recommendation, consensus agreement was reached if ≥ 75% of all respondents rated agreement as ≥ 7. Consensus on 16 core recommendations was reached over 2 eDelphi rounds. These provide a framework for shared decision-making on systemic treatment continuation, modification, or discontinuation.
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http://dx.doi.org/10.2340/00015555-3751DOI Listing
February 2021

Klinische Merkmale und Behandlungen der transitorischen akantholytischen Dermatose (Morbus Grover): ein systematischer Review.

J Dtsch Dermatol Ges 2020 Aug;18(8):826-834

Section of Dermatology and Venereology, Department of Medicine, University of Verona, Verona, Italy.

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http://dx.doi.org/10.1111/ddg.14202_gDOI Listing
August 2020

Treat-to-Target Approach for the Management of Patients with Moderate-to-Severe Plaque Psoriasis: Consensus Recommendations.

Dermatol Ther (Heidelb) 2021 Feb 11;11(1):235-252. Epub 2021 Jan 11.

Institute of Dermatology, Catholic University, Largo Francesco Vito, 1, 00168, Rome, Italy.

Introduction: Treat-to-target strategies are used in several chronic diseases to improve outcomes. Treatment goals have also been suggested for psoriasis, but there is currently no consensus on targets, and guidance is needed to implement this strategy in clinical practice. The project 'Treat to Target Italia' was launched by a scientific board (SB) of 10 psoriasis experts to generate expert consensus recommendations.

Methods: On the basis of the published literature, their clinical experience, and the results of a survey among Italian dermatologists, the SB identified four relevant topics: (1) clinical remission; (2) quality of life; (3) abrogation of systemic inflammation; (4) safety. They drafted 20 statements addressing these four topics and submitted them to a panel of 28 dermatologists, in a Delphi process, to achieve consensus (greater than 80% agreement).

Results: Consensus was reached on all statements. Treatment goals defining clinical remission should include a 90% improvement from baseline in the Psoriasis Area and Severity Index (PASI90 response) or an absolute PASI score of less than or equal to 3. Patient's quality of life and satisfaction are important targets. If PASI targets are achieved, there should be no or very low impact of psoriasis on quality of life [Dermatology Life Quality Index (DLQI) score less than or equal to 3]. If PASI or DLQI goals are not achieved within 3-4 months, treatment should be changed. Abrogation of systemic inflammation may be crucial for preventing or delaying inflammatory comorbidities. Safety is an equally important target as efficacy.

Conclusion: These 20 consensus statements define the parameters of a treat-to-target strategy for psoriasis in Italy. It is hoped that use of these in the management of patients with psoriasis will improve treatment outcomes and patient health-related quality of life.
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http://dx.doi.org/10.1007/s13555-020-00475-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7859133PMC
February 2021

Clinical profile and co-infections of urethritis in males.

G Ital Dermatol Venereol 2021 01 11. Epub 2021 Jan 11.

Section of Dermatology and Venereology, Department of Medicine, University of Verona, Verona, Italy.

Background: Infectious urethritis are classified in N. gonorrhoeae (NG) urethritis and nongonococcal urethritis, caused commonly by C. trachomatis (CT) or M. genitalium (MG) in Western Europe. The primary objective of the study is to evaluate the association between the clinical profile and the pathogens. Secondly, to assess the prevalence of co-infections.

Methods: The clinical profile of urethritis in men caused by NG, CT and MG confirmed by nucleic acid amplification test (NAAT) on first void urine has been retrospectively collected. The clinical profiles comprised the assessment of dysuria and/or discharge and the clinicaldermoscopic examination of the genitalia. Serological tests for syphilis and HIV were also performed.

Results: A total of 101 episodes of NAAT confirmed NG, CT or MG urethritis were identified. The prevalence for each pathogen was 50.60%, 33.73% and 15.66%, respectively. Co-infections were observed in few cases (4 MG+CT, 1 NG+CT, 1 NG+MG), with M. hominis, U. urealitycum and U. parvum positivity found concomitantly in 7-8% cases. The median age of patients was 33 years. Dysuria was reported in 88% cases (95% NG, 79% CT, 78% MG urethritis). Urethral discharge was found in 86% of cases, including purulent discharge in 61% (98% NG, 70% MG) and transparent in 25% (64% CT). Dysuria and purulent discharge were observed in 95% NG, 54% MG and 29% CT cases, whereas dysuria and transparent discharge were observed in 50% CT, 23% MG and in none of NG cases (p<0.01). Balanitis/meatitis was observed in 24% of cases, genital warts in 12% and proctalgia in 4%.

Conclusions: NAAT is crucial for defining urethritis etiology. Dysuria is the most common symptom. Gonococcal urethritis present with purulent discharge, whereas transparent discharge is associated with non-gonococcal pathogens. Co-infections are rare. Clinical exam may detect other infectious diseases, in particular genital warts.
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http://dx.doi.org/10.23736/S0392-0488.20.06773-5DOI Listing
January 2021

Immune Response to Vaccination in Patients with Psoriasis Treated with Systemic Therapies.

Vaccines (Basel) 2020 Dec 16;8(4). Epub 2020 Dec 16.

Section of Dermatology and Venereology, Department of Medicine, University of Verona, 37129 Verona, Italy.

Psoriasis is a chronic inflammatory skin disease usually treated with immunomodulatory/immunosuppressive agents. The use of these agents has been associated with an increased susceptibility to infections. Vaccination might represent a critical aspect in the management of patients with psoriasis treated with immunomodulatory/immunosuppressive therapies. This narrative review aimed to provide an overview on the immune response to vaccines in subjects treated with systemic agents used to treat patients with moderate to severe psoriasis. Publications appearing in PubMed, Scopus, and ISI-Web of Knowledge database were selected using Medical Subject Headings key terms. Overall, published data confirmed that vaccination with attenuated live vaccines during therapy with immunomodulatory/immunosuppressive therapies should be avoided. For nonlive vaccines, a more favorable safety profile of biologic agents compared to conventional systemic agents is described as the humoral response to vaccines is in general well-preserved. Treatment with cyclosporine and methotrexate is associated with lower antibody titers to vaccines, and thus these agents are better discontinued during vaccination. In contrast, treatment with biological agents is not associated with lower antibody response and can thus be continued safely.
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http://dx.doi.org/10.3390/vaccines8040769DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7767096PMC
December 2020

A case of porokeratosis with predominant follicular involvement.

G Ital Dermatol Venereol 2020 Dec 14. Epub 2020 Dec 14.

Department of Medicine, Section of Dermatology, University of Verona, Verona, Italy.

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http://dx.doi.org/10.23736/S0392-0488.20.06819-4DOI Listing
December 2020

Exfoliative cheilitis as a manifestation of factitial cheilitis in a young man.

G Ital Dermatol Venereol 2020 Dec 14. Epub 2020 Dec 14.

Section of Dermatology, Department of Medicine, University of Verona, Verona, Italy.

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http://dx.doi.org/10.23736/S0392-0488.20.06809-1DOI Listing
December 2020

and other HLA-C alleles, as well as and genetic variants associate with optimal response to anti-IL-17A treatment in patients with psoriasis.

Expert Opin Biol Ther 2021 Feb 28;21(2):259-270. Epub 2020 Dec 28.

Laboratory of Experimental Immunology, IDI-IRCCS , Rome, Italy.

: Our pharmacogenomic study evaluated the influence of the presence/absence of genetic variants of psoriasis-risk loci on the clinical response to secukinumab. Differences in the single-nucleotide polymorphism (SNP) pattern characterizing HLA-Cw6 or HLA-Cw6 patient subpopulations, showing high or low responses to secukinumab, were also analyzed. : 417 SNPs were analyzed by Next-Generation Sequencing technology, in a cohort of 62 psoriatic patients and undergone secukinumab treatment. Univariate regression analysis was employed to examine the association between SNP and clinical response to secukinumab. Multivariate analysis was also performed to assess multivariate differences in SNP pattern of HLA-Cw6 or HLA-Cw6 patients showing high or low responses to secukinumab. : Eight SNPs in and upstream region (rs13207315, rs6900444, rs12189871, rs12191877, rs4406273, and rs10484554), including classical allele (rs1131118), and three in (rs9267325), (rs34085293) and (rs2304255) genes, associating with excellent response to secukinumab were identified. Importantly, rs34085293 or s2304255 SNP status defined a subgroup of super-responder patients. We also found that HLA-Cw6 and HLA-Cw6 patients carried out specific patterns of SNPs associating with different responses to secukinumab. : Assessment of , together with other allelic variants of genes, could be helpful to define patients which better benefit from anti-IL-17 therapy. PASI: Psoriasis Area and Severity Index; SNP: Single-Nucleotide Polymorphism Rs: Reference SNP; PASI75: 75% reduction in Psoriasis Area and Severity Index; PASI90: 90% reduction in Psoriasis Area and Severity Index; PASI100: 100% reduction in Psoriasis Area and Severity Index; NGS: Next-Generation Sequencing; OR: Odds Ratio; CAP: Canonical Analysis of Principal coordinates; BMI: Body Mass Index; LD: Linkage Disequilibrium.
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http://dx.doi.org/10.1080/14712598.2021.1862082DOI Listing
February 2021

The Risk of COVID-19 Pandemic in Patients with Moderate to Severe Plaque Psoriasis Receiving Systemic Treatments.

Vaccines (Basel) 2020 Dec 2;8(4). Epub 2020 Dec 2.

Section of Dermatology and Venereology, Department of Medicine, University of Verona, 37126 Verona, Italy.

Chronic plaque psoriasis is an inflammatory skin disease affecting 2-3% of the general population. Approximately one-third of patients are candidates for systemic immunosuppressive treatments, such as synthetic or biological disease-modifying antirheumatic drugs, because of disease extensions, localization in sensitive or visible areas and/or resistance to topical treatments. These therapies have been associated with increased risk of infection, including upper respiratory tract viral infection. Psoriasis is frequently associated with cardio-metabolic comorbidities, such as obesity and diabetes, that are risk factors for poor prognosis in the case of coronavirus disease (COVID-19) pneumonia. A narrative review of the literature based on an electronic search of the PubMed database was undertaken with the objective of investigating whether there is an increased risk of COVID-19 infection in psoriasis patients on systemic treatment. Original articles, such as case reports, published up to 1 November 2020 were included. There is no evidence that patients with moderate-to-severe psoriasis receiving systemic treatments, including biologics, have higher risk of SARS-CoV-2 infection and/or increased hospitalization and death related to COVID-19 compared to the general population. Several case reports described full recovery from COVID-19 with favorable outcomes in psoriasis patients who were being treated with synthetics or biologicals. Nonetheless, caution should be maintained in this setting, and more data are needed to draw definitive conclusions.
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http://dx.doi.org/10.3390/vaccines8040728DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7761600PMC
December 2020

Therapeutic management of chronic spontaneous urticaria in clinical practice: results from a pilot survey.

G Ital Dermatol Venereol 2020 Nov 23. Epub 2020 Nov 23.

Dermatology Private Practice, Bari and Barletta, Italy.

Background: The therapeutic approaches to patients with chronic spontaneous urticaria (CSU) differ among health care professionals and may be influenced by many factors.

Objectives: This cross-sectional survey was aimed at evaluating physicians' attitudes regarding therapeutic management of CSU on clinical practice.

Methods: A study-specific questionnaire was administered to a group of physicians (n=21) with a specialist interest in CSU from different areas of Italy (Group A) and also to other physicians (n=25) who manage CSU only occasionally in their clinical activity (Group B).

Results: In case of ineffectiveness of second-generation antihistamines at standard doses, higher doses of the same drug were always or frequently prescribed by most physicians in both groups, and 64% in group B and one third in group A usually increased the dose up to twice. Old-generation antihistamines were never used in clinical practice by 14% of survey participants in group A and 24% in group B, with the remaining physicians reporting rare or occasional uses. The prescription of systemic corticosteroids appeared to be more common among physicians in group B. The question concerning the use of alternative drugs in refractory CSU produced different answers between the two groups. Costs and access to specialist reference centers were indicated as the most important barriers to the use of medications different from antihistamines.

Conclusions: These preliminary results suggest that therapeutic approaches to CSU seem to be heterogeneous in clinical practice and could be at least in part conditioned by the different medical settings where physicians usually work.
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http://dx.doi.org/10.23736/S0392-0488.20.06761-9DOI Listing
November 2020

Chronic spontaneous urticaria in clinical practice: a pilot survey about attitudes and perceptions on assessment, diagnostic work-up and dietary management.

G Ital Dermatol Venereol 2020 Nov 23. Epub 2020 Nov 23.

Dermatology Private Practice, Bari and Barletta, Italy.

Background: Chronic spontaneous urticaria (CSU) is a heterogeneous condition whose management can be complex and challenging. The 0bjectives is to evaluate physicians' attitudes regarding practical aspects of CSU management, including adherence to international guidelines, criteria and instruments for CSU assessment, prescription of laboratory investigations and role of dietary measures.

Methods: A cross-sectional survey was conducted using a study-specific questionnaire. It was administered to a group of physicians with a specialist interest in CSU from different areas of Italy definable as "CSU experts" (Group A; n=21) and subsequently to other physicians who managed CSU only occasionally in their clinical activity (Group B; n=25).

Results: The EAACI/GA²LEN/EDF/WAO guidelines were considered very or moderately useful by the majority of participants. Significantly more physicians in group A reported that such guidelines were always followed in clinical practice (P=0.0008). Instruments for the assessment of CSU severity/activity and quality of life were used in clinical practice significantly more often by CSU experts as compared to group B. Dietary measures were frequently suggested for CSU patients by nearly three quarters of group B members and by only 5% of CSU experts (P<0.00001). When physicians were asked to indicate the type of laboratory examinations that were commonly performed in patients with longstanding and/or uncontrolled CSU, regardless of history, the investigations most frequently reported were full blood count and thyroid autoantibodies, followed by erythrosedimentation rate and/or C-reactive protein and thyroid function tests.

Conclusions: The results of the present pilot survey seem to suggest the heterogeneity of the approaches used for CSU management in clinical practice.
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http://dx.doi.org/10.23736/S0392-0488.20.06760-7DOI Listing
November 2020

The Economic and Psychosocial Comorbidity Burden Among Adults with Moderate-to-Severe Atopic Dermatitis in Europe: Analysis of a Cross-Sectional Survey.

Dermatol Ther (Heidelb) 2021 Feb 12;11(1):117-130. Epub 2020 Nov 12.

Pfizer Inc., New York, NY, USA.

Introduction: Atopic dermatitis (AD) is a common inflammatory disease of the skin, which may have a substantial impact on patients' health-related quality of life (HRQoL). The aim of this study was to quantify the economic burden (direct and indirect costs) of moderate-to-severe AD and evaluate the prevalence and impact of psychosocial comorbidities among patients in the European Union-5 (France, Germany, Italy, Spain, and the UK).

Methods: Data were analyzed from the 2017 EU5 National Health and Wellness Survey. Respondents with a physician diagnosis of AD/eczema who were considered to have moderate-to-severe AD based on a Dermatology Life Quality Index (DLQI) score  ≥ 6 were included. Direct costs, indirect costs, and psychosocial comorbidities (sleep difficulties and anxiety based on self-report, depression based on the Patient Health Questionnaire-9) were reported descriptively. Generalized linear models were used to examine the relationship between psychosocial comorbidities and health outcomes (the Short Form-36 version 2 [SF-36v2], EuroQoL 5-dimension 5-level, Work Productivity and Activity Impairment questionnaire, and healthcare resource utilization).

Results: Overall, 1014 patients were included in the analysis. Total annual direct costs ranged from €2242 to €6924 and total annual indirect costs ranged from €7277 to €14,236, depending on the level of disease severity. Sleep difficulties, anxiety, and depression were reported by 61.6%, 52.7%, and 75.8% of patients, respectively. These comorbidities were significantly associated with reduced physical and mental component summary scores from SF-36v2 and increased overall work impairment (p < 0.05 for all).

Conclusions: A significant economic burden was observed for patients with moderate-to-severe AD. Sleep difficulties, depression, and anxiety were observed in more than half of moderate-to-severe AD patients and were significantly associated with decrements in HRQoL and with work-related impairment. Reducing the burden of these psychosocial comorbidities in AD could have significant benefit to patients and society.
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http://dx.doi.org/10.1007/s13555-020-00459-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7858996PMC
February 2021

Topographic Differential Diagnosis of Chronic Plaque Psoriasis: Challenges and Tricks.

J Clin Med 2020 Nov 8;9(11). Epub 2020 Nov 8.

Section of Dermatology and Venereology, Department of Medicine, University of Verona, 37129 Verona, Italy.

Background: Psoriasis is an inflammatory skin disease presenting with erythematous and desquamative plaques with sharply demarcated margins, usually localized on extensor surface areas.

Objective: To describe the common differential diagnosis of plaque psoriasis classified according to its topography in the scalp, trunk, extremities, folds (i.e., inverse), genital, palmoplantar, nail, and erythrodermic psoriasis.

Methods: A narrative review based on an electronic database was performed including reviews and original articles published until 1 September 2020, assessing the clinical presentations and differential diagnosis for psoriasis.

Results: Several differential diagnoses could be considered with other inflammatory, infectious, and/or neoplastic disorders. Topographical differential diagnosis may include seborrheic dermatitis, tinea capitis, lichen planopilaris in the scalp; lupus erythematosus, dermatomyositis, cutaneous T-cell lymphomas, atopic dermatitis, syphilis, tinea corporis, pityriasis rubra pilaris in the trunk and arms; infectious intertrigo in the inguinal and intergluteal folds and eczema and palmoplantar keratoderma in the palms and soles.

Conclusions: Diagnosis of psoriasis is usually straightforward but may at times be difficult and challenging. Skin cultures for dermatophytes and/or skin biopsy for histological examination could be required for diagnostic confirmation of plaque psoriasis.
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http://dx.doi.org/10.3390/jcm9113594DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7695211PMC
November 2020

Targeting IL-4 for the Treatment of Atopic Dermatitis.

Immunotargets Ther 2020 29;9:151-156. Epub 2020 Sep 29.

Department of Medicine, Section of Dermatology, University of Verona, Verona, Italy.

Atopic dermatitis (AD) is an immune-mediated inflammatory skin disease characterized by a predominant type 2 immune response. Type 2 immunity is driven by multiple cytokines, including interleukin (IL)‑4 and IL-13 that are considered central to AD pathogenesis and key therapeutic targets. The dual inhibition of these two cytokines or the selective inhibition of IL-13 proved elevated efficacy in treating AD, whereas the selective inhibition of IL-4 has been poorly investigated as IL-4 inhibiting agents did not show any advance in clinical development programs. This review describes the pathogenic role of IL-4 in AD and briefly resumes the main features of compounds selectively blocking IL-4.
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http://dx.doi.org/10.2147/ITT.S260370DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7532907PMC
September 2020

Pseudoepitheliomatous, keratotic, and micaceous balanitis mimicking lichen sclerosus et atrophicus.

Dermatol Online J 2020 Sep 15;26(9). Epub 2020 Sep 15.

Section of Dermatology, Department of Medicine, University of Verona, Verona.

We present a man in his 70s with a hyperkeratotic whitish plaque over the internal prepuce and glans. The lesion was slowly growing for four years prior to presentation and was resistant to several topical treatments. The histological examination of the lesion revealed marked hyperkeratosis and pseudoepitheliomatous hyperplasia, supporting the diagnosis of pseudoepitheliomatous, keratotic, and micaceous balanitis. It is important to be aware of this uncommon but potentially malignant condition affecting elderly men.
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September 2020

Immunomodulatory Role of the Antimicrobial LL-37 Peptide in Autoimmune Diseases and Viral Infections.

Vaccines (Basel) 2020 Sep 10;8(3). Epub 2020 Sep 10.

Section of Dermatology, Department of Medicine, University of Verona, 37126 Verona, Italy.

Antimicrobial peptides (AMPs) are produced by neutrophils, monocytes, and macrophages, as well as epithelial cells, and are an essential component of innate immunity system against infection, including several viral infections. AMPs, in particular the cathelicidin LL-37, also exert numerous immunomodulatory activities by inducing cytokine production and attracting and regulating the activity of immune cells. AMPs are scarcely expressed in normal skin, but their expression increases when skin is injured by external factors, such as trauma, inflammation, or infection. LL-37 complexed to self-DNA acts as autoantigen in psoriasis and lupus erythematosus (LE), where it also induces production of interferon by plasmocytoid dendritic cells and thus initiates a cascade of autocrine and paracrine processes, leading to a disease state. In these disorders, epidermal keratinocytes express high amounts of AMPs, which can lead to uncontrolled inflammation. Similarly, LL-37 had several favorable and unfavorable roles in virus replication and disease pathogenesis. Targeting the antiviral and immunomodulatory functions of LL-37 opens a new approach to limit virus dissemination and the progression of disease.
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http://dx.doi.org/10.3390/vaccines8030517DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7565865PMC
September 2020

Late granuloma formation secondary to hyaluronic acid injection.

Dermatol Online J 2020 Jul 15;26(7). Epub 2020 Jul 15.

Section of Dermatology, Department of Medicine, University of Verona, Verona.

Hyaluronic acid injection to rejuvenate or to correct defects is a very common practice in aesthetic medicine. Although it is considered highly safe because of biocompatibility and biodegradability, adverse reactions can occur. Herein, we report a patient with foreign body granuloma formation that presented as multiple subcutaneous nodules on both arms, following injections of hyaluronic acid performed about six years earlier. Our case is unique with respect to timing and area of granuloma appearance.
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July 2020

Methotrexate vs secukinumab safety in psoriasis patients with metabolic syndrome.

Dermatol Ther 2020 11 15;33(6):e14281. Epub 2020 Sep 15.

Section of Dermatology and Venereology, Department of Medicine, University of Verona, Verona, Italy.

The safety of methotrexate in psoriasis patients with metabolic syndrome could be argued because of increased risk of liver toxicity. The aim of the study was to investigate the safety of methotrexate compared with secukinumab in psoriasis patients with metabolic syndrome. A controlled, open trial in psoriasis patients with metabolic syndrome, candidate to methotrexate, or secukinumab. Primary end point of the study was investigating any variations in waist circumference, body mass index, blood pressure, fasting glucose, total cholesterol, low density lipoprotein cholesterol, high density lipoprotein cholesterol, triglycerides, aspartate aminotransferase, alanine aminotransferase, creatinine levels between baseline and month-6 and 12 of follow-up in the two treatment cohorts. A total of 130 (110 male and 20 female) patients were consecutively assigned in a 1:1 ratio to treatment with methotrexate (n = 64) dosed 15 mg weekly or secukinumab (n = 66) at standard dose. At month-6 and month-12 serum levels of liver enzymes were significantly increased only in patients treated with methotrexate (P < .01). Three times elevation of liver enzymes was reported in 4 of 64 patients receiving methotrexate, causing drug withdrawal. No significant changes in other parameters were observed. Methotrexate could induce a liver enzyme increase whereas secukinumab has a neutral effect.
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http://dx.doi.org/10.1111/dth.14281DOI Listing
November 2020

Mortality from cancer is not increased in elderly kidney transplant recipients compared to the general population: a competing risk analysis.

J Nephrol 2020 Dec 3;33(6):1309-1319. Epub 2020 Sep 3.

Section of Dermatology, Dermatology Unit, Department of Medicine, University of Verona, Ospedale Civile Maggiore, Piazzale Stefani 1, 37126, Verona, VR, Italy.

Background: The impact of cancer on death of elderly kidney transplant recipients has been extensively investigated, but with conflicting results. Unlike their younger counterparts, in elderly kidney transplant recipients cardiovascular and infectious disease may outweigh cancer in causing the patient's death.

Methods: Using competing risk analysis on a large retrospective cohort of kidney transplant recipients, we estimated the cause-specific cumulative incidence and hazard of death in different age categories and calculated standardized mortality ratios (SMRs) to compare mortality rates with the general population.

Results: Six thousand seven hundred eighty-nine kidney transplant recipients were followed-up for a median of 9 years. Ten years after transplantation, in transplant recipients aged 20-39, 40-59, and 60+, the cumulative incidence of cancer-related death was 0.6 (95% confidence interval [CI]: 0.3-1.0), 2.9 (2.3-3.6) and 5.3% (3.5-7.5), whereas the SMR was 9.1 (5.5-15.0), 2.0 (1.6-2.5), and 0.8 (0.6-1.0), respectively. At variance with young recipients, the hazard and the cumulative incidence of cardiovascular-related death in elderly recipients was well above that of cancer-related death.

Conclusions: Relative to the general population, cancer-related death is increased in young but not in elderly kidney transplant recipients because of the more marked increased incidence of competing cause of death in the latter category.
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http://dx.doi.org/10.1007/s40620-020-00847-5DOI Listing
December 2020

A case of kerion celsi caused by Trichophyton tonsurans.

Pediatr Int 2020 Aug;62(8):1007-1008

Section of Dermatology, Department of Medicine, University of Verona, Verona, Italy.

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http://dx.doi.org/10.1111/ped.14279DOI Listing
August 2020

Amicrobial Pustulosis of the Folds: Report of Three New Cases.

Indian J Dermatol 2020 Jul-Aug;65(4):323-324

Section of Dermatology and Venereology, Department of Medicine, University of Verona, Verona, Italy. E-mail:

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http://dx.doi.org/10.4103/ijd.IJD_120_19DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7423227PMC
August 2020

Clinical features and treatments of transient acantholytic dermatosis (Grover's disease): a systematic review.

J Dtsch Dermatol Ges 2020 08 7;18(8):826-833. Epub 2020 Aug 7.

Section of Dermatology and Venereology, Department of Medicine, University of Verona, Verona, Italy.

Grover's disease (GD) is an itchy acantholytic disorder occurring on the trunk of middle-aged men. Based on the best evidence, this study aimed to provide a summary of the clinical characteristics, disease course and treatments of GD. A systematic review was performed according to PRISMA guidelines for original articles published between 01.01.1970-08.15.2019, assessing clinical features and/or any type of intervention for GD. A total of 263 articles were retrieved, and 116 original reports that were deemed relevant and satisfied the inclusion criteria were included in the analysis (88 case reports, 26 case series and two retrospective reviews). From these articles, 317 patients were identified, with a male-to-female ratio of 3.95. The mean age was 59 years (range 11-92). Typical lesions were itchy papules and vesicle-papules, generally located on the trunk. Spontaneous resolution within one week to eight months was described in 42 % of cases. Topical corticosteroids (TCSs) were the most frequent treatment (response rate of 70 %) followed by systemic retinoids and corticosteroids with response rates of 86 % and 64 %, respectively. According to the results of this review, TCS appears to be the most frequently employed treatment, and we suggest TCS as first-line therapy. Second-line treatments could include systemic retinoids or systemic corticosteroids.
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http://dx.doi.org/10.1111/ddg.14202DOI Listing
August 2020

Drug survival of dupilumab compared to cyclosporin in moderate-to-severe atopic dermatitis patients.

Dermatol Ther 2020 11 27;33(6):e13979. Epub 2020 Jul 27.

Section of Dermatology, Department of Medicine, University of Verona, Verona, Italy.

Dupilumab and cyclosporin are recommended treatments for moderate-to-severe atopic dermatitis (AD). The objective of this study was to investigate drug survival of dupilumab in comparison with CsA, reasons of drug discontinuation, and predictive parameters of drug survival in daily practice. Retrospective study including patients with moderate-to-severe AD treated with dupilumab or cyclosporin (CsA) from January 1, 2019 to April 30, 2020. Drug survival analysis was performed using the Kaplan-Meier method and predictive factors were analyzed using multivariate Cox regression analyses. Adult patients with AD (n = 251) treated with dupilumab (n = 149) or CsA (n = 102) were included. Sixteen months from baseline, 82% of patients receiving dupilumab were still on treatment vs 11% of those treated with CsA. Reason for withdrawing dupilumab were primary inefficacy in 4.7% of patients, persistent clinical remission in 7.4%, and cutaneous adverse effects in 2.0%. Older age at diagnosis and shorter AD duration predicted shorter dupilumab survival. Reasons for CsA withdrawal included adverse effects in 23.5% of patients, persistent clinical remission in 15.6%, and a minimal or absent improvement in 11.7%. Dupilumab has a longer drug survival compared to CsA. Only a limited number of dupilumab patients discontinued treatment due to adverse effects and/or ineffectiveness.
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http://dx.doi.org/10.1111/dth.13979DOI Listing
November 2020

Lichen planopilaris coexisting with plaque psoriasis effectively treated with brodalumab.

Dermatol Ther 2020 11 14;33(6):e13967. Epub 2020 Jul 14.

Section of Dermatology and Venereology, Department of Medicine, University of Verona, Verona, Italy.

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http://dx.doi.org/10.1111/dth.13967DOI Listing
November 2020

Real World SB4 (Etanercept Biosimilar) Use in Patients With Psoriasis: Data from the British Association of Dermatologists Biologic Interventions Register (BADBIR).

J Drugs Dermatol 2020 Mar;19(3):316-318

Psoriasis is a chronic, systemic, inflammatory skin disease with a risk of comorbidities and a potential high impact on patients’ quality of life.
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March 2020

Clinical and immunological profile of patients with dipeptidyl peptidase-4 inhibitor-associated bullous pemphigoid.

G Ital Dermatol Venereol 2020 Jun 15. Epub 2020 Jun 15.

Section of Dermatology and Venereology, Department of Medicine, University of Verona, Verona, Italy.

Background: Bullous pemphigoid (BP) is an autoimmune blistering disease caused by antibodies against the hemidemosomal BP180 and/or BP230 proteins. There is an increasing evidence that the use of dipeptidyl peptidase-4 inhibitors, also known as gliptins, increases the risk for BP. The gliptins more frequently associated with BP are vildagliptin and sitagliptin. Clinical, immunological and pathological features of gliptin-associated BP have been reported to be distinct, compared to classic BP.

Methods: In this study, 15 gliptin-associated BP (g-BP) cases have been compared with 16 consecutive idiopathic BP (i-BP) to clarify whether g-BP has distinctive clinical and immunopathological characteristics. Comorbidities, concomitant treatments, latency of the onset of the disease and the time to achieve the remission were also considered.

Results: The mean latency from drug intake to g-BP appearance was 9.4 months (median 10, inter-quartile range (IQR) 6-12). There were no differences in sex and age prevalence between the two groups (g-BP median age 77 years, IQR 70-84; i-BP 81 years, IQR 72-86). There were no differences as far clinical presentation including disease severity, lesions types (urticarial and bullous) or mucosal involvement between g-BP and i-BP cases. The median antibody anti-BP180 and anti-BP230 titres was also similar between the two groups with 29.1 UI/mL (IQR 12.9-65.3) and 11.8 UI/mL (IQR 1.7-26.3), respectively. Gliptins were withdrawn in ten out of 15 patients and remission was achieved with systemic corticosteroids (0.3-0.7 mg/Kg daily) alone or in association with doxycycline (100-200 mg daily) within a mean of 8 months.

Conclusions: A non-inflammatory phenotype with less erythema, fewer urticarial lesions and fewer eosinophils in skin lesions has been associated with gliptins in selected Japanese BP populations. As reported in European studies, no significant differences among the considered variables in the g-BP and i-BP cases have been found in our study.
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http://dx.doi.org/10.23736/S0392-0488.20.06562-1DOI Listing
June 2020