Publications by authors named "Nicoletta Bernardini"

56 Publications

Safety and Impact of Anti-COVID-19 Vaccines in Psoriatic Patients Treated with Biologics: A Real Life Experience.

J Clin Med 2021 Jul 29;10(15). Epub 2021 Jul 29.

Dermatology Unit "D. Innocenzi", Sapienza University of Rome, Polo Pontino, 04100 Terracina, Italy.

Since all clinical trials conducted during the development of anti-COVID-19 vaccines have adopted among the exclusion criteria the presence of immunodepression or immunomodulating therapy, to date, the effects of vaccination against the new coronavirus 2 in people under such conditions have yet to be clearly defined. The primary objective of the study is to assess the safety of treatment with biotechnological drugs in patients suffering from moderate-severe psoriasis and subjected to the prophylactic vaccination against SARS-Cov-2. Additionally, the secondary objective of the research is to investigate the existence of a possible impact of anti-COVID-19 vaccination on the natural chronic-relapsing course and the severity of the psoriatic disease. The study included 436 patients with moderate-severe psoriasis, both male and female, in treatment with biologics. The data were collected using the direct interview method. A reduction of 74.13% of average Psoriasis Area Severity Index (PASI )compared to baseline (T0) was found in all subjects; this does not differ significantly from the group that underwent vaccination (73.4%). Moreover; at the end of the study, neither mild nor severe adverse events (ADR) were observed among them. In conclusion, biotechnological drugs used in the management of patients with moderate-severe psoriasis demonstrate a high safety profile also in subjects immunized against SARS-Cov-2.
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http://dx.doi.org/10.3390/jcm10153355DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8347527PMC
July 2021

Long-Term Maintained Response to Selective Internal Radiation Therapy in an Oligometastatic Uveal Melanoma Patient Treated with Concomitant Anti-PD-1 Therapy.

Life (Basel) 2021 Jul 14;11(7). Epub 2021 Jul 14.

Dermatology Unit "Daniele Innocenzi", "A. Fiorini" Hospital, Via Firenze, 1, 04019 Terracina, Italy.

Uveal melanoma (UM) is a primary neoplasm of the eye arising from the melanocytes residing in the iris, ciliary body or choroid. It is the most frequent intraocular malignancy and often determines metastases at distant sites, with a peculiar tropism for the liver. Metastatic UM has a poor prognosis, as any treatment affects the natural course of this fatal disease. Herein, we report a case of a UM metastatic to the liver in a 54 year-old female patient, initially treated with nivolumab without success. The patient was then scheduled for selective internal radiation therapy (SIRT) while continuing immunotherapy. This combination led to a complete and durable response and the patient is currently free of disease, two years after the diagnosis of the hepatic metastases. The association between SIRT and immunotherapy (IT) has very promising perspectives for metastatic UM, especially considering the disappointing or contradictory results of classic chemotherapies, IT alone and targeted therapies. Furthermore, this combination has been shown to have a good security profile. However, further studies are needed to confirm the efficacy of associating SIRT and IT and to clarify some unsolved problems, such as the timing of administration of these two therapies.
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http://dx.doi.org/10.3390/life11070692DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8307638PMC
July 2021

Predictive factors of lack of response to adalimumab among bio-naive patients suffering from moderate-to severe psoriasis: analysis of a multicenter data collection in Italy.

Expert Opin Biol Ther 2021 Sep 18;21(9):1291-1298. Epub 2021 Jul 18.

Department of Dermatology, Università Cattolica Del Sacro Cuore, Rome, Italy.

Introduction: Efficacy of anti-TNF-a agents seems inferior to IL-17 and IL-23 inhibitors. Nevertheless, after biosimilars approval, anti TNF-a agents are recommended as first-line for psoriatic patients, for economic reasons.

Methods: Predictive factors of response or non-response to adalimumab in bionaive patients who started adalimumab (originator or biosimilar) over 12 years in 9 dermatologic centers in Italy. Effectiveness was assessed with Psoriasis Area and Severity Index (PASI75 and PASI90) at weeks 12, 24 and 48. Multiple logistic regressions were used for variables predicting clinical response; Kaplan-Meier survival curves and Cox regression for drug survival.

Results: The drug survival analysis showed reduced hazard ratio of overall discontinuation with male gender and scalp localization. In contrast, baseline PASI and genital psoriasis were significantly associated with increased risk of overall discontinuation. Predictive factors of non-response seemed elevated in patients with baseline PASI, older age groups, previously treated patients with phototherapy, females or patients with palmo-plantar while scalp psoriasis, previous cyclosporine and acitretin appeared as a positive predictive factor.

Conclusions: This real-life analysis might be useful for clinicians in case of bio-naive patients with moderate-to-severe psoriasis and various comorbidities.
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http://dx.doi.org/10.1080/14712598.2021.1948530DOI Listing
September 2021

An Open-label Study Comparing Oral Zinc to Lymecycline in the Treatment of Acne Vulgaris.

J Clin Aesthet Dermatol 2021 May 1;14(5):56-58. Epub 2021 May 1.

All authors are with the Dermatology Unit "Daniele Innocenzi", Department of Medical-Surgical Sciences and Biotechnologies, at the Sapienza University of Rome in Polo Pontino, Latina, Italy.

Acne is a chronic multifactorial skin disease with a high prevalence among adolescents. The therapeutic approach for mild to moderate papulopustular acne includes the use of systemic tetracycline. Increased risk of antibiotic resistance necessitates research into alternative therapeutic approaches, such as zinc sulphate. Efficacy of zinc sulphate in acne treatment is widely reported in the literature, but drug comparison studies are lacking. We sought to compare the efficacy and safety of zinc sulphate to lymecycline for the treatment of mild to moderate papulopustular acne. One hundred patients were equally randomized to receive either zinc sulphate or lymecycline. Acne severity was evaluated using the subjective Global Acne Grading System (GAGS) and the Acne-specific Quality of Life (AQoL) questionnaire at baseline and after four and 12 weeks. Both zinc sulphate and lymecycline induced a statistically significant reduction in GAGS scores at four and 12 weeks of treatment. The improvements in AQoL scores in patients treated with zinc sulphate were significantly higher than those in the lymecycline group. Our study suggests that zinc sulphate is a valid alternative therapeutic approach in the treatment of mild to moderate papulopustular acne relative to lymecycline in terms of clinical efficacy, tolerability, and the occurrence of side effects.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8211333PMC
May 2021

Metastatic penile squamous cell carcinoma successfully treated with cemiplimab in an HIV patient.

Dermatol Ther 2021 03 17;34(2):e14744. Epub 2021 Jan 17.

Department of Medical-Surgical Sciences and Biotechnologies, Dermatology Unit "Daniele Innocenzi", Sapienza University of Rome, Rome, Italy.

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http://dx.doi.org/10.1111/dth.14744DOI Listing
March 2021

Do Diet and Lifestyles Play a Role in the Pathogenesis of NMSCs?

Nutrients 2020 Nov 11;12(11). Epub 2020 Nov 11.

Dermatology Unit "Daniele Innocenzi", Department of Medical-Surgical Sciences and Bio-Technologies, Sapienza University of Rome, Fiorini Hospital, Polo Pontino, 04019 Terracina, Italy.

Background And Aims: Literature highlights the role of risk factors like age, body mass index (BMI), tobacco smoking, alcohol intake and diet in the pathogenesis of several cancer types but little is known for non-melanoma skin cancers (NMSC). The aim of this epidemiological study was to evaluate the correlation between modifiable risk factors (BMI, metabolic panel, diet, lifestyle, medical history) and not modifiable risk factors (gender, age) and NMSC development.

Methods: From February 2018 to September 2019, 162 patients affected by NMSC were compared to a group of 167 controls. A univariate and multivariate analysis was conducted to elaborate the data collected through face-to-face interviews.

Results: While our evidence did not always reach statistical significance, NMSC study group patients exhibited high rates of analyzed risk factors (male gender aging over 55 years, high BMI, reduced physical activity) compared to the control group.

Conclusions: Our study indicates that practicing more than 30 min of physical activity daily could be a protective factor against the NMSC onset. Other risk factors were not correlated with NMSC, but more evidence is needed to establish a possible link.
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http://dx.doi.org/10.3390/nu12113459DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7697298PMC
November 2020

Efficacy and safety of systemic isotretinoin treatment for moderate to severe acne (insights from the real-life clinical setting).

Dermatol Ther 2020 11 2;33(6):e14392. Epub 2020 Nov 2.

Dermatology Unit "Daniele Innocenzi", Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Polo Pontino, Terracina, Italy.

Acne is a chronic inflammatory relapsing disease that affect predominantly adolescents, with scarring as a frequent sequele. Early and appropriate therapy allows better management of the disease, longer remission, scars risk reduction, and improvement of quality of life. According to therapeutic algorithm, systemic isotretinoin can be used in severe acne and also in moderate forms resistant to other systemic treatments. The aims of this real-life observational study were to determine and compare the effectiveness of isotretinoin evaluated by Global Acne Grading System and Acne Quality of Life in moderate and in severe acne, correlation between efficacy and cumulative dose of isotretinoin, tolerability, and recurrence rate. Moreover, the differences in efficacy and tolerability between male and female patients were compared. The treatment with systemic isotretinoin led to an improvement in acne severity and quality of life in all observed subjects.
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http://dx.doi.org/10.1111/dth.14392DOI Listing
November 2020

Mechanisms of Acquired BRAF Inhibitor Resistance in Melanoma: A Systematic Review.

Cancers (Basel) 2020 Sep 29;12(10). Epub 2020 Sep 29.

Dermatology Unit "Daniele Innocenzi", Department of Medical-Surgical Sciences and Bio-Technologies, Sapienza University of Rome, Fiorini Hospital, Polo Pontino, 04019 Terracina, Italy.

This systematic review investigated the literature on acquired v-raf murine sarcoma viral oncogene homolog B1 (BRAF) inhibitor resistance in patients with melanoma. We searched MEDLINE for articles on BRAF inhibitor resistance in patients with melanoma published since January 2010 in the following areas: (1) genetic basis of resistance; (2) epigenetic and transcriptomic mechanisms; (3) influence of the immune system on resistance development; and (4) combination therapy to overcome resistance. Common resistance mutations in melanoma are BRAF splice variants, amplification, neuroblastoma RAS viral oncogene homolog (NRAS) mutations and mitogen-activated protein kinase kinase 1/2 (MEK1/2) mutations. Genetic and epigenetic changes reactivate previously blocked mitogen-activated protein kinase (MAPK) pathways, activate alternative signaling pathways, and cause epithelial-to-mesenchymal transition. Once BRAF inhibitor resistance develops, the tumor microenvironment reverts to a low immunogenic state secondary to the induction of programmed cell death ligand-1. Combining a BRAF inhibitor with a MEK inhibitor delays resistance development and increases duration of response. Multiple other combinations based on known mechanisms of resistance are being investigated. BRAF inhibitor-resistant cells develop a range of 'escape routes', so multiple different treatment targets will probably be required to overcome resistance. In the future, it may be possible to personalize combination therapy towards the specific resistance pathway in individual patients.
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http://dx.doi.org/10.3390/cancers12102801DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7600801PMC
September 2020

Recurrent erythrodermic psoriasis and polycythemia successfully treated with brodalumab.

Dermatol Ther 2020 11 8;33(6):e14338. Epub 2020 Oct 8.

Department of Medical-Surgical Sciences and Biotechnologies, Dermatology Unit "Daniele Innocenzi", Sapienza University of Rome, Polo Pontino, Italy.

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http://dx.doi.org/10.1111/dth.14338DOI Listing
November 2020

Therapeutic Options for the Treatment of Actinic Keratosis with Scalp and Face Localization.

Acta Dermatovenerol Croat 2020 Aug;28(2):93-101

Nicoletta Bernardini, MD, PhD, "Daniele Innocenzi" Dermatology Unit Dept of Medical-Surgical Sciences and Bio-Technologies, Sapienza University of Rome Fiorini Hospital, Via Firenze snc Polo Pontino, 04019 Terracina, Italy;

Actinic keratosis (AK) is a common skin disease related to ultraviolet chronic exposure, that is now considered a squamous cell carcinoma in situ. Primary skin cancer prevention strategies should be recommended for high risk patients. There is a wide spectrum of treatment options available for AKs, and several variables should be taken into account regarding the best therapeutic choice for each patient. The purpose of this article is to review the current treatment strategies for AKs localized on the face and scalp, with a focus on the practical point of view that could be useful for choosing the best therapeutic option. The two main therapeutic approaches will be distinguished first: lesion-directed and field-directed. Afterwards, the treatment based on clinical type and patient comorbidity will be discussed.
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August 2020

Role of CD 20 T cells and related cytokines in mediating retinal microvascular changes and ocular complications in chronic-plaque type psoriasis.

Cytokine 2020 12 25;136:155253. Epub 2020 Aug 25.

Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, C.so della Repubblica, 79, 04100 Latina, Italy; Center for Biophotonics, Sapienza University of Rome, C.so della Repubblica, 79, 04100 Latina, Italy. Electronic address:

Objective: To assess the role of CD3 CD20 CD4 CD8 double-negative (DN) or CD3CD20 CD4/CD8 T cells and the related pro-inflammatory cytokines in the humor aqueous, in mediating retinal microvascular changes in patients with chronic plaque-type moderate to severe psoriasis.

Design: A total of 76 patients (57.6 ± 11.7 years) with chronic plaque-type psoriasis were initially evaluated. Nineteen patients (19 eyes) and 19 healthy volunteers (19 eyes) were subjected to dermatological evaluation with Psoriasis Area Severity Index (PASI) and the Dermatology life quality index (DLQI). Retinal images were processed using an automatized software. On the same day, a venous sample was collected and analyzed using multiparametric flow cytometry. Three out of 6 patients who presented cataract, consented to perform surgery with humor aqueous collection. The samples were analyzed using a Multi-Analyte ELISA kit for the simultaneous quantification of IL1α, IL1β, IL2, IL4, IL6, IL8, IL10, IL12, IL17A, IFNγ, TNF-α, GMCSF.

Results: The CD3CD4/CD8CD20CD56 T cells expression was greater in the psoriatic patients (+73.9%, P < 0.001) compared to controls, but not the DN T cells (-8.2%, P = 0.30). Ocular complications were diagnosed in 61.1% of patients, microvascular parameters including artero-venous ratio (P = 0.04), subfoveal choriocapillaris/Sattler's layer, and choroidal thickness (CT, both P < 0.001) were significantly altered in psoriasis subgroup. The increased circulating levels of the CD3CD4/CD8CD20CD56 T cells were associated with thinning of subfoveal CT (P = 0.03) and Haller's layer (P = 0.01). Instead, the DN T cells presented an inverse relationship with disease duration (P = 0.02), DLQI score (P = 0.02), and the use of biological therapy (P = 0.05). The related cytokine patterns possibly modified in this cellular context have been investigated. No significant differences were observed in cytokines levels between psoriasis and controls, the most significant difference was detected on IL-6, without reaching statistical significance (fold change of 1.4, P = 0.13).

Conclusion: Our findings demonstrated that CD20 T cell subpopulation is highly represented in psoriasis regardless of the use of immunomodulatory therapies, and the diffuse microvascular alterations suggested possible endothelial damage as mainstream for the genesis of psoriatic-mediated complications as further supported by the comparable concentrations of cytokines, at least as humor aqueous content, with respect to healthy eyes.
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http://dx.doi.org/10.1016/j.cyto.2020.155253DOI Listing
December 2020

Long-term safety and efficacy of adalimumab in psoriasis: a multicentric study focused on infections (connecting study).

Postepy Dermatol Alergol 2020 Jun 16;37(3):428-434. Epub 2020 Jul 16.

Infectious Disease Unit, Department of Public Health and Infectious Diseases, University of Rome "Sapienza", Policlinico Umberto I Hospital of Rome, Italy.

Introduction: This Italian multicenter retrospective study evaluated safety and efficacy of the anti-TNF drug, adalimumab, in a cohort of patients affected by tuberculosis (TB), hepatitis B virus (HBV), hepatitis C virus (HCV) or human immunodeficiency virus (HIV). Psoriasis is an autoimmune disease affecting around 3% of the Italian population and associated with several comorbidities, including arthritis, cardio-metabolic diseases and depression. In its moderate-to-severe form, psoriasis profoundly impairs quality of life of patients.

Aim: Therefore, these patients deserve systemic treatments including conventional DMARDS (disease modifying anti-rheumatic drugs) and biologics. Management of moderate and severe psoriasis patients affected by relevant infections such as TB, HBV, HCV and HIV may be difficult because of the toxicity of the conventional systemic treatment.

Material And Methods: The CONNECTING study analysed 28 moderate to severe psoriasis patients infected by TB, HBV, HCV and HIV who were treated with adalimumab for up to 96 weeks together with respective prophylactic treatment.

Results: We observed a rapid decrease in PASI (psoriasis area severity index) reaching a 75% improvement in 91% of patients. Some of these patients ( = 9) were also affected by arthritic comorbidity. The patients experienced a rapid decrease in pain, measured by pain VAS (visual analogic scale) that reached 0 in all of them. Monitoring of the respective infection did not show any worsening or reactivation of infection or any severe adverse events during the entire observation period.

Conclusions: Adalimumab is effective and safe in patients affected by these important infections.
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http://dx.doi.org/10.5114/ada.2020.96910DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7394150PMC
June 2020

Management of psoriatic patients in biologic treatment associated with infectious comorbidities.

Postepy Dermatol Alergol 2020 Jun 16;37(3):417-421. Epub 2020 Jul 16.

Dermatology Unit "Daniele Innocenzi", Department of MEDICO-Surgical Sciences and Bio-Technologies, Sapienza University of Rome, Fiorini Hospital, Polo Pontino, Terracina, Italy.

Introduction: Psoriasis is a chronic inflammatory disease affecting about 2% of population, involving both acquired and innate immunity. Psoriasis affects mainly skin, presenting multiple co-morbidities; among them infective ones. Re-activation of tuberculosis or viral hepatitis (HBV and HCV) still represents a therapeutic challenge in patients receiving treatment with biological drugs, as well as HIV infection. For this reason, a multidisciplinary approach with global treatment resulting from active collaboration of different specialists is highly recommended.

Aim: To investigate the most common infective diseases as co-morbidities associated with psoriasis and to provide algorithms for screening, follow-up and therapeutic management in psoriatic patients.

Material And Methods: We examined the main infectious comorbidities that can affect moderate to severe psoriatic patients, influencing the therapeutic choice as during the biological treatment both viral and tuberculosis re-activation may occur. We have therefore evaluated the main diseases (TB, Hepatitis B and C, HIV) and the monitoring of patients during treatment with biological agents.

Results: Regular monitoring of psoriatic patients is recommended during long-term treatment with biological drugs in order to identify cases of re-activation of the latent infective agent or acquired infection.

Conclusions: Here we report the state of art regarding management of psoriatic patients with these co-morbidities suggesting a specific screening and management for infectious diseases in patients with moderate to severe plaque psoriasis.
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http://dx.doi.org/10.5114/ada.2020.96155DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7394172PMC
June 2020

Polymorphic eruption of pregnancy as a possible COVID-19 manifestation.

Dermatol Ther 2020 11 3;33(6):e14117. Epub 2020 Sep 3.

Department of Medical-Surgical Sciences and Biotechnologies, Dermatology Unit "Daniele Innocenzi", Sapienza University of Rome, Polo Pontino, Italy.

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http://dx.doi.org/10.1111/dth.14117DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7436318PMC
November 2020

Auricle perniosis as a manifestation of Covid-19 infection.

Dermatol Ther 2020 11 16;33(6):e14089. Epub 2020 Aug 16.

Department of Medical-Surgical Sciences and Biotechnologies, Dermatology Unit "Daniele Innocenzi", Sapienza University of Rome Polo Pontino, Rome, Italy.

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http://dx.doi.org/10.1111/dth.14089DOI Listing
November 2020

Urticaria in an infant with SARS-CoV-2 positivity.

Dermatol Ther 2020 11 13;33(6):e14043. Epub 2020 Aug 13.

Department of Medical-Surgical Sciences and Biotechnologies, Dermatology Unit "Daniele Innocenzi", Sapienza University of Rome, Polo Pontino, Terracina, Italy.

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http://dx.doi.org/10.1111/dth.14043DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7404499PMC
November 2020

Evaluation of Cardiovascular Risk in Hidradenitis Suppurativa Patients Using Heart Rate Variability (HRV) Analysis.

Cardiovasc Ther 2020 27;2020:1321782. Epub 2020 Jun 27.

Department of Medical-Surgical Sciences and Biotechnologies, Dermatology Unit "Daniele Innocenzi", Sapienza University of Rome, Polo Pontino, Italy.

Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease associated with elevated prevalence of comorbidities, especially metabolic and cardiovascular diseases. We used a tool called Heart Rate Variability (HRV) in order to assess the correlation between HS and alterations of the sympathetic-vagal equilibrium in the autonomic cardiovascular regulation system. We found increased sympathetic activity, associated with a higher risk of cardiovascular disease. HS, according to our results, is an independent cardiovascular risk factor.
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http://dx.doi.org/10.1155/2020/1321782DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7349464PMC
September 2020

BRAF Inhibitors: Molecular Targeting and Immunomodulatory Actions.

Cancers (Basel) 2020 Jul 7;12(7). Epub 2020 Jul 7.

Department of Medical-Surgical Sciences and Biotechnologies, Dermatology Unit "Daniele Innocenzi", Sapienza University of Rome, Polo Pontino, 04100 Latina, Italy.

The BRAF inhibitors vemurafenib, dabrafenib and encorafenib are used in the treatment of patients with BRAF-mutant melanoma. They selectively target BRAF kinase and thus interfere with the mitogen-activated protein kinase (MAPK) signalling pathway that regulates the proliferation and survival of melanoma cells. In addition to their molecularly targeted activity, BRAF inhibitors have immunomodulatory effects. The MAPK pathway is involved in T-cell receptor signalling, and interference in the pathway by BRAF inhibitors has beneficial effects on the tumour microenvironment and anti-tumour immune response in BRAF-mutant melanoma, including increased immune-stimulatory cytokine levels, decreased immunosuppressive cytokine levels, enhanced melanoma differentiation antigen expression and presentation of tumour antigens by HLA 1, and increased intra-tumoral T-cell infiltration and activity. These effects promote recognition of the tumour by the immune system and enhance anti-tumour T-cell responses. Combining BRAF inhibitors with MEK inhibitors provides more complete blockade of the MAPK pathway. The immunomodulatory effects of BRAF inhibition alone or in combination with MEK inhibition provide a rationale for combining these targeted therapies with immune checkpoint inhibitors. Available data support the synergy between these treatment approaches, indicating such combinations provide an additional beneficial effect on the tumour microenvironment and immune response in BRAF-mutant melanoma.
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http://dx.doi.org/10.3390/cancers12071823DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7408709PMC
July 2020

Efficacy of nivolumab in HIV patient with melanoma brain metastases.

AIDS 2020 07;34(9):1433-1435

Department of Medical-Surgical Sciences and Biotechnologies, Dermatology Unit 'Daniele Innocenzi', Sapienza University of Rome, Polo Pontino.

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http://dx.doi.org/10.1097/QAD.0000000000002554DOI Listing
July 2020

Melanoma: Double BRAF mutation, double chance to treat?

Dermatol Ther 2020 11 6;33(6):e13820. Epub 2020 Jul 6.

Department of Medical-Surgical Sciences and Biotechnologies, Dermatology Unit "Daniele Innocenzi", Sapienza University of Rome, Polo Pontino, Italy.

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http://dx.doi.org/10.1111/dth.13820DOI Listing
November 2020

A case of hidradenitis suppurativa successfully treated with apremilast in a patient with psoriasis and SAMPUS.

Dermatol Ther 2020 05 8;33(3):e13448. Epub 2020 May 8.

Department of Medical-Surgical Sciences and Biotechnologies, Dermatology Unit "Daniele Innocenzi", Sapienza University of Rome, Polo Pontino, Italy.

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http://dx.doi.org/10.1111/dth.13448DOI Listing
May 2020

Transitory auricular nodules: a peculiar adverse reaction in actinic keratosis field treatment.

Int J Dermatol 2020 Aug 19;59(8):e279-e281. Epub 2020 Apr 19.

Dermatology Unit "Daniele Innocenzi", Department of Medical-Surgical Sciences and Bio-Technologies, Sapienza University of Rome, Polo Pontino, Italy.

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http://dx.doi.org/10.1111/ijd.14882DOI Listing
August 2020

Ingenol mebutate therapy in erythroplasia of Queyrat: a new approach.

Ital J Dermatol Venerol 2021 Jun 4;156(3):388-391. Epub 2019 Dec 4.

Unit of Dermatology Daniele Innocenzi, Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University, Fiorini Hospital - Polo Pontino, Rome, Italy.

Background: Erythroplasia of Queyrat (EQ) is a rare squamous cell carcinoma in situ, usually occurring on the glans penis, the prepuce, or the urethral meatus. Therapy is mandatory because it can progress to invasive carcinoma in up to 30% of cases. Treatment options include 5-fluorouracil, curettage, cryotherapy, radiotherapy, laser, partial or total penectomy, and microsurgery, as also with imiquimod and photodynamic therapies.

Methods: Between 2015 to 2018 we treated five patients, with histologically confirmed EQ, with ingenol mebutate (IM) 0.015% gel applied for 3 days consecutively.

Results: Three patients showed complete response at one year follow up. Two patients showed partial response after two months, so they received a second course of therapy with IM. At one-year follow-up, one of them showed complete response, the other partial response.

Conclusions: Our experience demonstrated that IM may be considered as an effective and safe treatment option in EQ. IM offers various advantages such as easy and fast application, rapid complete remission, better compliance, few side effects and excellent cosmetical results. The authors call for further exploitation in bigger trials.
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http://dx.doi.org/10.23736/S0392-0488.19.06371-5DOI Listing
June 2021

IL-17 and its role in inflammatory, autoimmune, and oncological skin diseases: state of art.

Int J Dermatol 2020 Apr 30;59(4):406-411. Epub 2019 Oct 30.

Dermatology Unit "Daniele Innocenzi", Department of Medico-Surgical Sciences and Bio-Technologies, Sapienza University of Rome, Fiorini Hospital, Polo Pontino, Teracina, Italy.

Recent data support the theory of the involvement of IL-17 in the pathogenesis of several chronic inflammatory skin diseases (psoriasis, atopic dermatitis, acne, hidradenitis suppurativa) and autoimmune skin diseases (alopecia areata, vitiligo, bullous diseases). Even if the role of IL-17 in inflammatory and autoimmune diseases has been reported extensively, its role in tumor is still controversial. Some reports show that Th17 cells eradicate tumors, while others reveal that they promote the initiation and early growth of tumors. Herein, we review the role of IL-17 in the involvement of some common dermatologic diseases: psoriasis, atopic dermatitis, hidradenitis suppurativa, acne, vitiligo, melanoma, and nonmelanoma skin cancers.
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http://dx.doi.org/10.1111/ijd.14695DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7216999PMC
April 2020

Eruptive Blue Nevi of the Scalp in a Patient with Mayer-Rokitansky-Küster-Hauser Syndrome during Isotretinoin Therapy.

Indian J Dermatol 2019 Jul-Aug;64(4):339

Department of Medical-Surgical Sciences and Bio-Technologies, Dermatology Unit "Daniele Innocenzi", Sapienza University of Rome, Fiorini Hospital, Polo Pontino, Terracina, Italy. E-mail:

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http://dx.doi.org/10.4103/ijd.IJD_188_18DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6714184PMC
September 2019

Interleukin-17A affects extracellular vesicles release and cargo in human keratinocytes.

Exp Dermatol 2019 09;28(9):1066-1073

Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy.

Psoriasis is a chronic inflammatory systemic disease caused by deregulation of the interleukin-23/-17 axis that allows the activation of Th17 lymphocytes and the reprogramming of keratinocytes proliferative response, thereby inducing the secretion of cyto-/chemokines and antimicrobial peptides. Beside cell-to-cell contacts and release of cytokines, hormones and second messengers, cells communicate each other through the release of extracellular vesicles containing DNA, RNA, microRNAs and proteins. It has been reported the alteration of extracellular vesicles trafficking in several diseases, but there is scarce evidence of the involvement of extracellular vesicles trafficking in the pathogenesis of psoriasis. The main goal of the study was to characterize the release, the cargo content and the capacity to transfer bioactive molecules of extracellular vesicles produced by keratinocytes following recombinant IL-17A treatment if compared to untreated keratinocytes. A combined approach of standard ultracentrifugation, RNA isolation and real-time RT-PCR techniques was used to characterize extracellular vesicles cargo. Flow cytometry was used to quantitatively and qualitatively analyse extracellular vesicles and to evaluate cell-to-cell extracellular vesicles transfer. We report that the treatment of human keratinocytes with IL-17A significantly modifies the extracellular vesicles cargo and release. Vesicles from IL-17A-treated cells display a specific pattern of mRNA which is undid by IL-17A neutralization. Extracellular vesicles are taken up by acceptor cells irrespective of their content but only those derived from IL-17A-treated cells enable recipient cells to express psoriasis-associated mRNA. The results imply a role of extracellular vesicles in amplifying the pro-inflammatory cascade induced in keratinocyte by pro-psoriatic cytokines.
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http://dx.doi.org/10.1111/exd.14015DOI Listing
September 2019

Postacne scarring: which factors are involved?

G Ital Dermatol Venereol 2020 Dec 12;155(6):793-794. Epub 2019 Jul 12.

Unit of Dermatology "D. Innocenzi, " Polo Pontino, Sapienza University, Rome, Italy.

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http://dx.doi.org/10.23736/S0392-0488.19.06154-6DOI Listing
December 2020

PsA-Disk, a novel visual instrument to evaluate psoriatic arthritis in psoriatic patients: an Italian derma-rheuma multicentre study.

Ther Adv Chronic Dis 2019 14;10:2040622319847056. Epub 2019 May 14.

Department of Systems Medicine, Rheumatology, Allergology and Clinical Immunology, University of Rome 'Tor Vergata', Rome, Italy.

Background: Consensus among dermatologists and rheumatologists in the diagnosis and assessment of musculoskeletal diseases in psoriasis (PsO) patients is needed. This study assesses characteristics of musculoskeletal pain in patients with PsO for the presence of psoriatic arthritis (PsA) and evaluation of a novel 16-item visual instrument (PsA-Disk).

Methods: Data were collected from eight dermatological/rheumatological centres across Italy. Patients with PsO completed PEST (Psoriasis Epidemiology Screening Tool) and PsA-Disk questionnaires during the first visit. A rheumatological visit was performed to confirm the presence of PsA. Both validity and reliability of PsA-Disk were assessed.

Results: A total of 573 patients with PsO were examined at the first visit, and 120 (21%) were diagnosed with PsA. Patients with PsA compared with patients with PsO ( = 119) presented statistically significant differences for: nail involvement, PEST score ⩾3, higher erythrocyte sedimentation rate (ESR), Nail Psoriasis Severity Index (NAPSI)-feet, NAPSI-(hands + feet) and PsA-Disk scores (73.9 ± 32.1 58.1 ± 39.8, < 0.001). Patients with PsA with knee arthritis had higher PsA-Disk scores (98.4 ± 26 71.5 ± 31.9, = 0.006) that were also correlated with number of swollen (= 0.2, < 0.05) and tender joints ( = 0.24, = 0.021), patient ( = 0.4, < 0.001) and physician-pain-visual analogue scale (VAS; = 0.33, < 0.001), patient global assessment (PGA)-VAS ( = 0.23, = 0.025), physician-health assessment questionnaire (HAQ; = 0.38, = 0.011), Disease Activity Score (DAS)-44 ( = 0.25, = 0.023) and Disease Activity in Psoriatic Arthritis (DAPSA; = 0.31, = 0.005). The instrument had excellent reliability in terms of internal consistency (Cronbach's alpha = 0.90) and stability (intraclass correlation = 0.98). Moderate agreement between PsA-Disk and PEST (Cohen's kappa = 0.46) was observed, while construct validity appeared appropriate [PsA + patients: PsA-Disk score (interquartile range; IQR) =71 (50-96); PsA-patients: PsA-Disk score (IQR)=50 (20-90); < 0.001].

Conclusion: PsA-Disk may be considered a valid novel instrument aiding both dermatologists and rheumatologists in the rapid detection and assessment of musculoskeletal disease characteristics.
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http://dx.doi.org/10.1177/2040622319847056DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6535736PMC
May 2019

Face and Scalp Basal Cell Carcinoma Treatment: A Review of the Literature.

Acta Dermatovenerol Croat 2019 Mar;27(1):22-27

Prof. Nevena Skroza, MD, PhD, Dermatology Unit "Daniele Innocenzi", Department of Medical-Surgical Sciences and Bio-Technologies, Sapienza University of Rome, Polo Pontino, 04019 Terracina, Italy;

Basal cell carcinoma (BCC) is the most frequent skin cancer and is characterized by slow growth, even if it can be locally invasive and rarely metastasizes. Many different phenotypic presentations and histopathologic subtypes have been described, and the current guidelines subdivide BCCs into low-risk (nodular and superficial) and high-risk subtypes (micronodular, infiltrating, and morphoeic BCC and those with squamous differentiation). Dermoscopy allows the identification of the features associated with these different subtypes. Compared with the low-risk forms of BCC, more aggressive ones tend to undergo more frequently incomplete surgical excision and perineural invasion, so the identification of these lesions before surgery is extremely important. The gold standard of treatment is surgery, particularly for the H region of the face and infiltrative lesions, but other options are available and selected according to many variables, including body area, age, comorbidities, and clinical, dermoscopic, and histopathological features of the lesion. Moreover, the possible complications of surgical approaches, namely healing defects, failure of skin grafts, and wound infection, should be considered. In this review we discuss the management of BCC localized on the face and scalp, according to the currently available treatment options.
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March 2019
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