Publications by authors named "Giuseppe Micali"

228 Publications

COVID-19: The Italian experience.

Clin Dermatol 2021 May-Jun;39(3):418-423. Epub 2021 Feb 1.

Dermatology Clinic, University of Catania, Catania, Italy. Electronic address:

Italy was among the world's earliest and most affected countries by coronavirus disease 2019 (COVID-19). We report the Italian experience with the pandemic. The dermatologic community immediately reduced any type of activities to 80% to 90% of outpatient consultations, both in public hospitals and in private offices. The Italian Society of Dermatology and Sexually Transmitted Diseases and the Italian Forensic Dermatologic Society supported the dermatologic community by reporting recommendations in newsletters (vademecum) regarding the routine management of dermatologic patients either in the hospital or private setting. We have provided an overview of the skin manifestations from the pandemic, including the consequences of the misuse of safety measures. We also have evaluated the recently developed research projects on patients treated with biologics for psoriasis, atopic dermatitis, and hidradenitis suppurativa, as well as on the registries regarding various skin diseases affected by COVID-19.
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http://dx.doi.org/10.1016/j.clindermatol.2021.01.013DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7849600PMC
February 2021

Bowen's disease of the penile shaft presenting as a pigmented macule: dermoscopy, reflectance confocal microscopy and histopathological correlation.

An Bras Dermatol 2021 Sep-Oct;96(5):609-612. Epub 2021 Jul 18.

Dermatology Clinic, University of Catania, Catania, Italy. Electronic address:

The penile localization of pigmented Bowen's disease has been rarely reported and has been mostly related to human papillomavirus infection. Early diagnosis and treatment are important to prevent progression to invasive squamous cell carcinoma. However, diagnosis can be challenging because it may be difficult to distinguish from melanoma, even using dermoscopy. Reflectance confocal microscopy may be useful in suggesting the bedside diagnosis before the histopathological confirmation. A case of penile pigmented Bowen's disease is described along with its dermoscopy and reflectance confocal microscopy findings and their correlation with histopathology.
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http://dx.doi.org/10.1016/j.abd.2020.10.009DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8441428PMC
September 2021

Management of patients with atopic dermatitis undergoing systemic therapy during COVID-19 pandemic in Italy: Data from the DA-COVID-19 registry.

Allergy 2021 06 9;76(6):1813-1824. Epub 2021 Mar 9.

Dermatology Unit, Department of MedicalSpecialties, Arcispedale Santa Maria Nuova-IRCCS di Reggio Emilia, Reggio Emilia, Italy.

Background: Few and small studies have described the management of immunomodulant/immunosuppressive therapies or phototherapy in atopic dermatitis (AD) patients during coronavirus disease 2019 (COVID-19) pandemic.

Methods: A national registry, named DA-COVID-19 and involving 35 Italian dermatology units, was established in order to evaluate the impact of COVID-19 pandemic on the management of adult AD patients treated with systemic immunomodulant/immunosuppressive medications or phototherapy. Demographic and clinical data were obtained at different timepoints by teledermatology during COVID-19 pandemic, when regular visits were not allowed due to sanitary restrictions. Disease severity was assessed by both physician- and patient-reported assessment scores evaluating itch intensity, sleep disturbances, and AD severity.

Results: A total of 1831 patients were included, with 1580/1831 (86.3%) continuing therapy during pandemic. Most patients were treated with dupilumab (86.1%, 1576/1831) that was interrupted in only 9.9% (156/1576) of cases, while systemic immunosuppressive compounds were more frequently withdrawn. Treatment interruption was due to decision of the patient, general practitioner, or dermatologist in 39.9% (114/286), 5.6% (16/286), and 30.1% (86/286) of cases, respectively. Fear of increased susceptibility to SARS-CoV-2 infection (24.8%, 71/286) was one of the main causes of interruption. Sixteen patients (0.9%) resulted positive to SARS-CoV-2 infection; 3 of them (0.2%) were hospitalized but no cases of COVID-related death occurred.

Conclusions: Most AD patients continued systemic treatments during COVID pandemic and lockdown period, without high impact on disease control, particularly dupilumab-treated patients.
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http://dx.doi.org/10.1111/all.14767DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8014537PMC
June 2021

Line-field confocal optical coherence tomography of xanthogranuloma: Correlation with vertical and horizontal histopathology.

J Cutan Pathol 2021 Sep 10;48(9):1208-1211. Epub 2021 Jun 10.

Dermatology Clinic, University of Catania, Catania, Italy.

Line-field confocal optical coherence tomography (LC-OCT) is a new noninvasive technique for a real-time, vertical, and horizontal imaging of the skin at cellular resolution. A 47-year-old female presented with a 6-month history of an asymptomatic yellowish papule. LC-OCT evaluation was able to show the diagnostic microscopic features of xanthogranuloma and showed an excellent correlation with vertical and horizontal histopathological sections by revealing enlarged dermal papillae containing multiple, bright roundish giant cells, corresponding to foamy histiocytes, and giant cells characterized by a dark center surrounded by a highly hyper-refractile peripheral ring, corresponding to Touton cells. LC-OCT may represent a valid, noninvasive alternative to histopathological examination in clinically atypical cases of xanthogranuloma.
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http://dx.doi.org/10.1111/cup.14067DOI Listing
September 2021

Neurocutaneous syndromes in art and antiquities.

Am J Med Genet C Semin Med Genet 2021 06 20;187(2):224-234. Epub 2021 May 20.

Department of Educational Sciences, Chair of Pediatrics, University of Catania, Catania, Italy.

Neurocutaneous syndromes are a group of genetic disorders affecting the skin, the central and peripheral nervous system, and the eye with congenital abnormalities and/or tumors. Manifestations may also involve the heart, vessels, lungs, kidneys, endocrine glands and bones. When people with these disorders are portrayed in works of art, physicians have speculated on possible diagnoses. In particular, many figures have been labeled as possibly having a neurocutaneous disorder, sometimes distorting the popular conception of these diseases. We review numerous documents, drawings, prints, lithographs, xylographs, and portraits which span the ages from antiquity to the era of the pioneers behind the eponyms, depicting a large spectrum of neurocutaneous disorders.
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http://dx.doi.org/10.1002/ajmg.c.31917DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8252443PMC
June 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

A novel treatment of diaper dermatitis in children and adults.

J Cosmet Dermatol 2021 Apr;20 Suppl 1:1-4

Dermatology Clinic, University of Catania, Catania, Italy.

Background: Diaper dermatitis (DD) is an acute inflammatory reaction, regardless of the cause, of the diaper-covered area. Topical skin barrier repair cosmetic products are the mainstay treatment to cure and/or prevent DD.

Aims: To assess the efficacy/tolerability of a zinc gluconate-taurine/zinc oxide and panthenol/ glycerin/ Butyrospermum parkii butter barrier cream using clinical evaluation.

Methods: In this prospective, open-label trial, 20 patients (10 infants/10 adults), with mild/moderate DD enrolled at the Dermatology University Clinic of Catania (Italy) were instructed to apply the cream twice daily for 30 days. Degree of erythema was performed clinically by a 5-point severity scale (from 0 = no erythema to 4 = severe erythema), at baseline, at 15 and 30 days. An Investigator Global Assessment (IGA) using a 6-point scale (from -1 = worsening to 4 = complete response/clear) along with product tolerability was also performed at 15 and 30 days. Statistical analysis was performed using SAS version 9.

Results: At 15 days, a reduction of clinical erythema assessment (CEA) from baseline was observed (mean from 3.2 ± 0.8 to 2.5 ± 0.3; p < 0.06), that although nonsignificant, showed a significant progressive improvement at 30 days (mean from 3.2 ± 0.8 to 1.1 ± 0.9; p < 0.0001) without any age differences.

Conclusions: Our preliminary results indicate that the tested barrier cream may represent a promising approach in DD rash. It may be used in mild-to-moderate forms in monotherapy without significant side effects or, where required, in association with pharmacological agents. Its long-term use is likely safe.
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http://dx.doi.org/10.1111/jocd.14091DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8252753PMC
April 2021

10% urea cream in senile xerosis: Clinical and instrumental evaluation.

J Cosmet Dermatol 2021 Apr;20 Suppl 1:5-8

Dermatology Clinic, University of Catania, Catania, Italy.

Background: Moisturizers represent the mainstay of treatment of xerosis and related pruritus in elderly patients.

Aim: In this study, we evaluated the efficacy and tolerability of a 10% urea cream in patients with senile xerosis.

Methods: Twenty patients affected by moderate-to-severe xerosis of the upper or lower extremities were enrolled and instructed to apply twice daily for 2 weeks a cream containing 10% urea. Evaluation was performed at baseline and after 7 and 14 days by: clinical examination, itch assessment using a Visual Analogue Scale (VAS), and dermoscopy.

Results: After 7 and 14 days of treatment, the tested urea-based cream resulted in a significant, progressive clinical improvement of xerosis and related pruritus in all patients. The clinical results were supported by dermoscopy that showed the reduction/disappearance of scales. The cream, that had a good cosmetological acceptability, was well tolerated with no report of stinging or burning and/or other side effects.

Conclusions: Urea confirms to represent a key molecule for the treatment of senile xerosis.
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http://dx.doi.org/10.1111/jocd.14093DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8251990PMC
April 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
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8252084PMC
April 2021

Treatment of cradle cap in infants with a new cosmetic non-steroidal gel cream: Clinical, laboratory, and instrumental evaluation.

J Cosmet Dermatol 2021 Apr;20 Suppl 1:14-17

Dermatology Clinic, University of Catania, Catania, Italy.

Background: Cradle cap is a benign and self-limiting variant of seborrheic dermatitis (SD) that can be distressing for parents.

Aims: To assess by clinical/laboratory/instrumental evaluation the efficacy/tolerability of a gel cream containing piroctone olamine (antifungal), biosaccharide gum-2 (antifungal), stearyl glycyrrhetinate (anti-inflammatory), and zinc l-pyrrolidone carboxylate (zinc-PCA) (antiseborrheic) in the treatment of mild/ moderate cradle cap.

Methods: In this prospective, open-label trial, 10 infants, with mild/moderate cradle cap enrolled at the Dermatology University Clinic of Catania (Italy) used the tested gel cream twice daily for 30 days. Degree of erythema was evaluated clinically by a 5-point severity scale (from 0=no erythema to 4=severe erythema), at baseline, at 15 and 30 days. Desquamation was rated by dermoscopy evaluation using a 5-point scale (from 0=no desquamation to 4=severe/many large adherent white flakes), at all time points. An Investigator Global Assessment (IGA) using a 6-point scale (from -1=worsening to 4=complete response/clear) was also performed at 30 days. Five subjects, randomly selected, underwent double microbiological evaluation for bacteria and yeasts by cultures of cotton swabs at baseline and at 30 days. Tolerability/acceptability was evaluated on a 4-point scale (from 0=very poor to 3=excellent) at 15 and 30 days. Data were processed using SAS version 9.

Results: At baseline, a significant colony-forming unit (CFU) count for Malassezia furfur and Staphylococcus aureus was detected in 4 out of 5 selected patients. After 15 and 30 days, a statically significant reduction from baseline in erythema and desquamation severity was observed, along with a reduction in CFU count for Malassezia furfur and Staphylococcus aureus from baseline. No signs of local side effects were documented.

Conclusions: Our results indicate that the tested gel cream may represent a valid option to treat mild-to-moderate forms of cradle cap and support its antifungal and antibacterial properties.
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http://dx.doi.org/10.1111/jocd.14095DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8252604PMC
April 2021

A novel treatment of intertrigo in athletes and overweight subjects.

J Cosmet Dermatol 2021 Apr;20 Suppl 1:23-27

Dermatology Clinic, University of Catania, Catania, Italy.

Background: Intertrigo is a recurrent inflammatory dermatosis involving large/small body folds. Skin barrier products represent the mainstay of treatment in uncomplicated mild/moderate intertrigo.

Aims: To assess by clinical and instrumental evaluation the efficacy and tolerability of a new barrier spray containing zinc gluconate-taurine complex and zinc oxide combined with panthenol, glycerin, and Shea (Butyrospermum parkii) butter in mild-to-moderate intertrigo in athletes and overweight subjects.

Methods: In this open-label prospective trial, 20 adult patients, with mild/moderate intertrigo enrolled at the Dermatology University Clinic of Catania (Italy), were instructed to apply the spray twice daily for 30 days. Degree of erythema was performed clinically and by polarized dermoscopy using a 5-point severity scale (from 0=no erythema to 4=severe erythema) at baseline, and at 15 and 30 days. The measurement of pruritus was carried out by a subject-completed visual analog scale (VAS) (from 0 mm=no pruritus to 100 mm=severe pruritus), at all time points. An Investigator Global Assessment (IGA) using a 6-point scale (from -1=worsening to 4=complete response/clear) was also conducted at 30 days, along with a self-administered tolerability questionnaire. Statistical analysis was performed using SAS version 9.

Results: At 15 days, a statically significant reduction from baseline in erythema severity (mean from 3.4 ± 0.3 to 2.5 ± 0.2) along with pruritus intensity (mean from 70 ± 15.4 mm to 40 ± 9.5 mm) was observed. At 30 days, all evaluated parameters showed a further progressive statistically significant reduction from baseline. No relevant side effects were recorded.

Conclusions: Our results suggest that the tested spay containing antiseptic/anti-inflammatory and anti-irritation agents may represent a valid therapeutic option for mild/moderate intertrigo.
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http://dx.doi.org/10.1111/jocd.14097DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8252709PMC
April 2021

Correlation Between Reflectance Confocal Microscopy and Horizontal Histopathology in Skin Cancer: A Review.

Front Oncol 2021 8;11:653140. Epub 2021 Mar 8.

Dermatology Clinic, University of Catania, Catania, Italy.

In dermatopathological daily practice, vertical histopathology sections are classically used to analyze skin biopsies. Conversely, horizontal histopathological sections are currently used for the diagnosis of some types of alopecia. In the last years the morphological findings obtained by horizontal histopathology have been correlated to those obtained by reflectance confocal microscopy which provides the same "point of view" of the skin. This review paper emphasizes the strong matching and correlation between reflectance confocal microscopy images and horizontal histopathology in cutaneous neoplasms, further demonstrating the strong reliability of this innovative, non-invasive technique in the management of skin tumors.
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http://dx.doi.org/10.3389/fonc.2021.653140DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7982596PMC
March 2021

Myroxylon pereirae (balsam of Peru): Still worth testing?

Contact Dermatitis 2021 Sep 3;85(3):269-273. Epub 2021 May 3.

Section of Dermatology, Department of Biomedical Science and Human Oncology, University of Bari, Bari, Italy.

Background: Because Myroxylon pereirae (MP), or balsam of Peru, is nowadays almost not used "as such," and fragrance mix 1 (FM1) apparently is more sensitive in detecting fragrance allergy, the usefulness of testing MP in baseline series was recently questioned.

Objectives: Identification of the number of clinically relevant patch test reactions to MP not detected by FM1.

Methods: Retrospective analysis of 12 030 patients patch tested with MP and FM1 for contact dermatitis between January 2018 and December 2019 in 13 Italian dermatology clinics.

Results: Four hundred thirty-nine patients (3.6%) had a positive patch test reaction to MP; 437 (3.6%) had a positive patch test reaction to FM1. Positive reactions to both MP and FM1 were observed in 119 subjects (1.0%), 310 (2.6%) reacted to MP only, 304 (2.5%) to FM1 only, 5 to MP and sorbitan sesquioleate (SSO), 9 to FM1 and SSO, and 5 to MP, FM1, and SSO. Single sensitizations were clinically relevant in 75.2% of cases for MP (62.9% current, 12.3% past) and 76.3% for FM1 (70.1% current, 6.2% past).

Conclusions: Based on our results, MP appears to be still worth testing along with FM1 in baseline series, because it allows detection of a remarkable number of fragrance allergies, often relevant, which would be otherwise missed.
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http://dx.doi.org/10.1111/cod.13839DOI Listing
September 2021

Evaluation of capillary density in psoriasis: An intrapatient study and literature review.

PLoS One 2021 10;16(3):e0247835. Epub 2021 Mar 10.

Dermatology Clinic, University of Catania, Catania, Italy.

Background: Dilated and tortuous vessels within elongated dermal papillae represent a histopathological clue of psoriasis. However, the number of dilated capillaries (capillary density) in psoriasis remains undefined as the results from the available studies differ significantly.

Objectives: To evaluate the capillary density in psoriasis using dermoscopy and horizontal histopathological sections (HHS), two techniques that share the horizontal view of the skin, and to compare the results with the existing data.

Methods: Twenty adult patients with stable plaque psoriasis were enrolled and, in each patient, a target area of the examined plaque, previously engraved by gently rotating a 5-mm biopsy punch device, underwent dermoscopy and biopsy for HHS. In all examined fields, capillary density was evaluated in a centered 4-mm diameter area, counting the number of red dots at dermoscopy and of dermal papillae at HHS.

Results: A total of 20 target lesions located on the trunk, arms and tights were evaluated. The mean capillary density resulting from dermoscopy was 43.02±6.60/mm 2 whereas that from HHS was 50.30±9.05/mm 2. These data showed a statistically significant difference (p = 0.006), with a strong correlation at Pearson's test (r = 0.88).

Conclusions: Our results when compared with those from the existing literature showed some differences. The peculiarity of our work is represented by the precise measurement and correlation of the capillary density using two different methods, as the preliminary skin engraving allowed a perfect match between the area undergoing dermoscopy and that of skin sampling for HHS. Compared to dermoscopy in which deep-located vessels might have gone undetected, HHS seems to reflect more precisely and reliably the real capillary density showing an average of 50 capillaries/mm 2 that in a common 5x5 cm psoriatic patch corresponds to an average of 125.000 capillaries. These results highlight the extraordinary potential of psoriatic skin to develop such a complex and intricate vascular network.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0247835PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7946227PMC
March 2021

Erythema-directed digital photography and colorimeter scores correlate with rosacea erythema evaluation in patients under treatment with topical ivermectin.

Dermatol Ther 2021 05 13;34(3):e14920. Epub 2021 Mar 13.

Dermatology Clinic, University of Catania, Catania, Italy.

Inflammatory rosacea is clinically characterized by persistent erythema and inflammatory lesions. Its severity is generally based on clinical observation that may be cumbersome. The aim of this study was to assess if erythema-directed digital photography (EEDP) and colorimeter (COL) correlate and are concordant with clinical evaluation of erythema degree of rosacea under topical treatment. Thirty naïve patients with mild/moderate inflammatory rosacea were instructed to apply ivermectin cream for 8 weeks. Erythema degree was performed at baseline, and at 2, 4, 6, and 8 weeks by clinician erythema assessment based on 5-point severity scale (from 0 = no erythema to 4 = fiery redness), and by instrumental evaluation by EDDP using the same 5-point scale of clinical assessment and by COL using a 5-point scale (from 0 = <1 units = no erythema to 4 > 12 units = fiery redness). Concordance and correlation analysis were performed using Cohen's Kappa coefficient and Correlation Coefficient test respectively. At baseline a statistically significant concordance/correlation value between EDDP and COL was observed. At 2 weeks, the statistical concordance/correlation value between instrumentals were both increased, along with a slight significant concordance between clinical assessment and erythema-directed digital photography. At 4, 6 and 8 weeks, a statistically significant increase of concordance/correlation value among all the considered parameters from baseline was found. The results of our study showed that at baseline and during the early treatment stage both EDDP and COL were able to appreciate more accurately the erythema grade compared to clinical observation supporting the use of non-invasive techniques for a more objective evaluation of erythema in rosacea.
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http://dx.doi.org/10.1111/dth.14920DOI Listing
May 2021

DECISA Project (DErmatology Clinics in Italy: Survey on Alitretinoin): A real-life retrospective cohort multicenter study on 438 subjects with chronic hand eczema.

Dermatol Ther 2021 05 9;34(3):e14911. Epub 2021 Mar 9.

Dipartimento di Medicina Clinica e Sperimentale-Dermatologia, Università di Messina, Messina, Italy.

Alitretinoin is the only systemic agent approved to treat moderate-severe chronic hand eczema (CHE) unresponsive to potent topical corticosteroids. No nationwide Italian data regarding real-life efficacy, safety, and tolerability of treatment are available. The DECISA project (DErmatology Clinics in Italy: Survey on Alitretinoin) retrospectively examined data from a registry including 15 Dermatology Clinics authorized to prescription of alitretinoin for CHE patients. Disease severity was assessed at baseline, and after 3 and 6 months of treatment, using the 5-point Physician Global Assessment (PGA) and the modified Total Lesion-Symptoms-Severity (mTLSS) scores. Between November 2010 and July 2018, data of 248 male and 190 female patients (mean age 49.71 ± 13.20 years) treated with alitretinoin were collected. Of them, 43.2% had irritant contact dermatitis, 22.2% allergic contact dermatitis, 18.0% atopic dermatitis, 16.7% mixed (irritant/allergic) type of eczema. At 3 months, the 420 re-evaluated patients showed significantly reduced mTLSS and PGA (P < .0000001 vs baseline for both); PGA was clear/almost clear in 35.6% of cases. At 6 months, the 341 re-evaluated patients showed significant (P < .0000001) improvement of mTLSS and PGA vs baseline and 3 months (PGA clear/almost clear: 41.4%). Relapses occurred in 125 patients; 58 underwent an additional course of alitretinoin, with similarly good results. No relevant safety issues were reported; 86 patients experienced adverse effects, which forced 40 to prematurely stop treatment. The DECISA project results confirm the real-life efficacy, safety and tolerability of alitretinoin in the treatment of moderate to severe CHE refractory to standard topical therapies.
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http://dx.doi.org/10.1111/dth.14911DOI Listing
May 2021

Emerging topical drugs for the treatment of rosacea.

Expert Opin Emerg Drugs 2021 03 18;26(1):27-38. Epub 2021 Feb 18.

Dermatology Clinic, University of Catania, Catania, Italy.

: Rosacea is a common, chronic and relapsing inflammatory skin disease of the centrofacial area. Despite advancing knowledge on its pathogenesis, diagnosis, and treatment, some major unknowns still remain, including systematic evidence-based guidelines useful both for clinical assessment and therapeutic management. Topical treatment is regarded as a first-line option for mild to moderate rosacea and includes traditional and new FDA-approved prescription drugs, as well as off-label alternative topical agents.: Since improved awareness of rosacea pathogenetic mechanisms has led to the development of new potential therapeutic agents, a search was performed on the registry. The results identified several investigational topical drugs able to target one or more of the pathogenetic factors of rosacea.: The main unmet needs in the topical treatment of rosacea remain the management of vasomotor flushes and telangiectasias, as well as of troublesome symptoms such as burning and/or stinging. No single agent effective on all rosacea phenotypes is available so far, and preventive treatments capable of halting disease progression have not been identified yet. Finally, data on long-term efficacy and tolerability are still incomplete, especially for drugs more recently introduced in the market.
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http://dx.doi.org/10.1080/14728214.2021.1887138DOI Listing
March 2021

Kaposi's Sarcoma-Related Lymphedema Treated by a Nd:YAG Laser.

Dermatol Surg 2021 Aug;47(8):1139-1140

Dermatology Clinic, University of Catania, Catania, Italy.

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http://dx.doi.org/10.1097/DSS.0000000000002904DOI Listing
August 2021

A Poultry Disease Mimicking Pediculosis Corporis Diagnosed By Dermoscopy: A Quiz.

Acta Derm Venereol 2021 Mar 18;101(3):adv00417. Epub 2021 Mar 18.

Dermatology Clinic, University of Catania, IT-95123 Catania, Italy.

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http://dx.doi.org/10.2340/00015555-3768DOI Listing
March 2021

Retinal Vascular Assessment in Psoriasis: A Multicenter Study.

Front Neurosci 2021 25;15:629401. Epub 2021 Jan 25.

Department of Surgical Science, Eye Clinic, University of Turin, Turin, Italy.

Purpose: To investigate the vascular status of the macula in psoriasis patients without history of ocular inflammation by Optical Coherence Tomography Angiography (OCTA).

Methods: This prospective cross-sectional multicenter study included 55 psoriasis patients and 55 control healthy subjects. A complete eye examination and 6 mm × 6 mm OCTA imaging were performed. Retinal vascular status was evaluated by analyzing vascular density (VD) of superficial vascular plexus (superficial wVD) and deep vascular plexuses (deep wVD) in a 6 mm × 6 mm area and in foveal (superficial fVD and deep fVD) and parafoveal sectors (superficial pVD and deep pVD). In addition, foveal thickness (FT) and foveal avascular zone (FAZ) and clinical variables, including best corrected visual acuity (BCVA), intraocular pressure and refractive condition, were collected.

Results: BCVA, intraocular pressure and refractive condition were comparable between cases and controls. OCTA imaging showed that superficial wVD and superficial pVD were lower in the psoriasis group in comparison with controls ( = 0.009 and = 0.01, respectively). Similarly, deep wVD and pVD were lower in the psoriasis group in comparison with control subjects ( = 0.03 and = 0.01, respectively). In a sub-analysis of 47 patients affected by psoriasis without psoriatic arthritis, lower values of wVD and pVD in both superficial and deep capillary plexuses were registered.

Conclusion: OCTA is a useful tool which provides data on vascular status of the retina in psoriasis with no ocular involvement. VD data may suggest that vascular changes may occur earlier than clinical onset of posterior inflammation.
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http://dx.doi.org/10.3389/fnins.2021.629401DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7868328PMC
January 2021

Diet and acne: review of the evidence from 2009 to 2020.

Int J Dermatol 2021 Jun 18;60(6):672-685. Epub 2021 Jan 18.

Dermatology Clinic, University of Catania, Catania, Italy.

Background: Dietary habits may play a non-negligible role in the development, duration, and severity of acne, as shown in past critical review articles on such association.

Methods: The aim of this systematic review is to supplement data available on scientific literature spanning the last 10 years by inserting the keywords "acne" or "acne vulgaris" and "diet", "nutrition", "food", "chocolate", "dairy", "whey protein", "fatty acid", or "drink" in the timeframe "January 2009-April 2020" within the PubMed database.

Results: Fifty-three reviewed articles met eligibility criteria. They included 11 interventional clinical trials (seven randomized controlled trials and four uncontrolled open label studies) and 42 observational studies (17 case-control and 22 cross-sectional studies, and three descriptive studies).

Conclusions: This review reinforces the notion of a rapidly growing exponential trend of interest in this subject by the scientific community. Acne-promoting factors include high GI/GL food, dairy products, fat food, and chocolate, whereas acne-protective factors include fatty acids, fruit, and vegetable intake. The role played by specific dietary components pertaining to different foods, as done for milk (full-fat/whole, reduced-fat, low-fat/skim milk), dairy products (milk cream, ice cream, yogurt, cheese, etc.), or chocolate (cocoa, dark/milk chocolate), remains an unsolved issue and objective of future research.
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http://dx.doi.org/10.1111/ijd.15390DOI Listing
June 2021

Association of Frontal Fibrosing Alopecia with Facial Papules and Lichen Planus Pigmentosus in a Caucasian Woman.

Skin Appendage Disord 2020 Nov 31;6(6):379-383. Epub 2020 Aug 31.

Dermatology Clinic, University of Catania, Catania, Italy.

Introduction: Frontal fibrosing alopecia (FFA) is a lymphocytic primary cicatricial alopecia typically involving the frontotemporal hairline. It may be associated with the presence of facial papules (FP) that clinically appear as noninflammatory, monomorphic, white-yellowish papules. Lichen planus pigmentosus (LPPigm) is characterized by the presence of asymptomatic grayish pigmented macules, predominantly in sun-exposed and flexural areas.

Case Report: A 58-year-old, Caucasian, phototype III woman presented with a symmetrical, band-like, frontotemporal alopecia with regression of the hairline; bilateral eyebrow loss; diffuse, symmetrical hyperpigmentation of the face; and some asymptomatic, flesh-colored, monomorphic papules on the chin. Based on clinical, dermoscopic, and histological findings, the diagnosis of FFA associated with FP and LPPigm was established.

Discussion/conclusion: The peculiarity of our report is represented by the triple association of FFA, FP, and LPPigm in a Caucasian skin type III woman, as it has been rarely reported. Clinicians should be aware of this association also in subjects with phototype ≤III, as its recognition may be useful for diagnostic and prognostic purposes: the observation of LPPigm of the face may suggest to check for early FFA, and in case of FFA associated with FP, a poorer FFA prognosis may likely be expected.
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http://dx.doi.org/10.1159/000509407DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7706508PMC
November 2020

Field cancerization in clinically solitary actinic keratosis: A pilot study.

Dermatol Ther 2021 01 9;34(1):e14607. Epub 2020 Dec 9.

Dermatology Clinic, University of Catania, Catania, Italy.

Clinical studies have demonstrated that subclinical actinic keratoses (AKs) may be clinically evidenced following treatment of multiple AKs with a topical immunotherapy agent known to reveal a "field cancerization". The aim of our study was to investigate if subclinical AKs may be evidenced also in case of single AKs. Ten patients with single, solitary AKs were treated with IQ 3.75% cream applied on the lesion and on a 5 × 5 cm surrounding area once daily for two 2-week treatment cycles separated by a 2-week treatment-free period. Lesions were evaluated by clinical, dermoscopic and RCM examination. At the end of treatment, subclinical lesions were evidenced in 8 of 10 patients revealing the presence of a field cancerization. If larger studies will confirm these results, field cancerization could likely be considered also in case of solitary AKs, resulting in a different approach in terms of disease evolution and treatment.
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http://dx.doi.org/10.1111/dth.14607DOI Listing
January 2021

Clinical evidences of urea at medium concentration.

Int J Clin Pract 2020 Dec;74 Suppl 187:e13815

Dermatology Clinic, University of Catania, Catania, Italy.

Urea-based topical compounds at medium concentrations (15%-30%) represent useful dermatological agents for their humectant and keratolytic effects by enhancing stratum corneum hydration and by loosening epidermal keratin, respectively. The aim of this paper is to review the clinical evidences of the use of 15%-30% urea as single topical agent. Although limited evidence supports the use of these concentrations of urea in skin disorders characterised by xerosis and hyperkeratosis, in clinical practice they are largely used especially in xerosis of limited skin areas, in which the side effects are tolerable, or hyperkeratosis involving large or more sensitive (eg, face, genital region, etc) areas, in which higher concentration may be irritant. In addition, urea at medium concentrations is used in combination with other substances including topical antifungals as penetration enhancer.
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http://dx.doi.org/10.1111/ijcp.13815DOI Listing
December 2020

History of urea as a dermatological agent in clinical practice.

Int J Clin Pract 2020 Dec;74 Suppl 187:e13621

Dermatology Clinic, University of Catania, Catania, Italy.

Urea, also known as carbamide, is a polar, hygroscopic molecule produced by the human body that was first discovered in urine in 1773 by the French chemist Hilaire Rouelle and was artificially synthesised from inorganic precursors in 1828 by the German chemist Friedrich Wöhler. The importance of urea in dermatology is twofold: it primarily has a physiological key role for the maintenance of skin hydration, and it secondarily has been used for more than a century in different topical preparation and concentration in various skin conditions. One of the first uses of urea was the topical treatment of wounds because of its antibacterial and proteolytic properties. Since the second part of the 20th century, urea became one of the most common moisturisers and keratolytic agents, useful for the treatment of xerosis, atopic dermatitis, ichthyosis and psoriasis.
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http://dx.doi.org/10.1111/ijcp.13621DOI Listing
December 2020

Clinical evidences of urea at low concentration.

Int J Clin Pract 2020 Dec;74 Suppl 187:e13626

Dermatology Clinic, University of Catania, Italy.

Urea is a hygroscopic molecule that, because of its moisturising properties, is topically used for the treatment of skin dryness at concentrations ranging from 2% to 12% in different formulations. Based on existing literature, low-concentration urea-containing products are effective in the treatment and/or prevention of xerosis in some skin disorders such as ichthyosis, atopic dermatitis and psoriasis, or unrelated to specific skin diseases. Generally, urea formulations at low concentration are well-tolerated and suited for the treatment of large skin areas, once or twice daily, even for a long period of time. At low concentrations stinging and burning sensation is rare and transient, whit no reported sensitisation despite its widespread use.
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http://dx.doi.org/10.1111/ijcp.13626DOI Listing
December 2020

Optimising the use of urea in dermatology.

Int J Clin Pract 2020 12;74 Suppl 187:e13570

Dermatology Clinic, University of Catania, Catania, Italy.

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http://dx.doi.org/10.1111/ijcp.13570DOI Listing
December 2020
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