Publications by authors named "Sara Mazzilli"

48 Publications

The intent of students to vaccinate is influenced by cultural factors, peer network, and knowledge about vaccines.

Hum Vaccin Immunother 2021 Jun 30:1-9. Epub 2021 Jun 30.

University of Antwerp, Antwerp, Belgium.

Young adults are the future vaccine decision-makers as parents or health-care professionals. To understand their attitudes and behaviors toward vaccination, we conducted a cross-sectional survey of 2079 students attending the University of Antwerp, Belgium and the University of Pisa, Italy. Principal component analysis was used to investigate associations between survey responses and the intent to vaccinate. Vaccination knowledge, attitudes, and behaviors among university students in Italy and Belgium were high. However, only one-half of respondents displayed an intent to vaccinate. High levels of knowledge, positive attitudes, and confidence in vaccines were positively associated with age, higher level of study, being a medical student, a recent vaccination experience, and not knowing trusted persons who did not believe in vaccines. Country of origin was highly correlated with the survey responses and was clustered with lifestyle, family, and data source variables, suggesting a strong modifying effect of culture and family attitudes on how vaccines are perceived in this age-group. Recent meningococcal vaccination campaigns and public discussions around mandatory vaccination in Italy may have influenced these results. We show that the intent to vaccinate was correlated with two main clusters of variables linked to culture (country, family, lifestyle), and to scholarship (knowledge, attitudes, data source) that together influence the behavior of students with respect to vaccination. Our study reinforces previous findings that knowledge about vaccines is key to shaping attitudes and behaviors, but also shows that cultural and lifestyle factors are another platform that could be leveraged in promoting vaccination among young people.
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http://dx.doi.org/10.1080/21645515.2021.1938492DOI Listing
June 2021

The epidemic burden on prisons in Lombardy (Italy) during the first wave of the COVID-19 pandemic: the transmission and measures of prevention in detention facilities.

Int J Prison Health 2021 06;ahead-of-print(ahead-of-print)

Welfare General Directorate, Lombardy Regional Health Authority, Milan, Italy.

Purpose: Early on in the COVID-19 pandemic, the scientific community highlighted a potential risk of epidemics occurring inside prisons. Consequently, specific operational guidelines were promptly released, and containment measures were quickly implemented in prisons. This paper aims to describe the spread of COVID-19 in detention facilities within the Lombardy region of Italy during March to July 2020, and the impact of the prevention and control measures implemented.

Design/methodology/approach: A descriptive retrospective analysis of case distribution was performed for all COVID-19 cases identified among people in detention (PiD) and prison officers (POs). A comparison of the epidemic burden affecting different populations and a correlation analysis between the number of cases that occurred and prevention measures implemented were also carried out.

Findings: From this study, it emerged that POs were at a high risk of contracting COVID-19. This study observed a delay in the occurrence of cases among PiD and substantial heterogeneity in the size of outbreaks across different prisons. Correlation between reported cases among PiD and registered sick leave taken by POs suggested the latter contributed to introducing the infection into prison settings. Finally, number of cases among PiD inversely correlated with the capacity of each prison to identify and set up dedicated areas for medical isolation.

Originality/value: Prevention and control measures when adopted in a timely manner were effective in protecting PiD. According to the findings, POs are a population at high risk for acquiring and transmitting COVID-19 and should be prioritized for testing, active case finding and vaccination. This study highlights the critical importance of including prison settings within emergency preparedness plans.
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http://dx.doi.org/10.1108/IJPH-11-2020-0091DOI Listing
June 2021

Combination of Laser Therapy and Photodynamic Therapy with 5-Aminolevulinic Acid Patch for the Treatment of Actinic Cheilitis.

Photobiomodul Photomed Laser Surg 2021 Apr 16;39(4):303-307. Epub 2021 Mar 16.

Department of Dermatology, University of Rome Tor Vergata, Rome, Italy.

Actinic cheilitis (AC) is a premalignant lesion of the lips that can evolve into squamous cell carcinoma. Among nonsurgical treatments, photodynamic therapy (PDT) with 5-aminolevulinic acid (ALA) patch might represent a new noninvasive therapeutic approach for AC. We sought to investigate the potential role of fractional CO laser pretreatment in boosting ALA penetration and distribution into AC treated with PDT. We report a case of a woman with AC on the lower lip, treated with ablative fractional CO laser to boost drug delivery of 5-ALA patch before PDT treatment. Reflectance confocal microscopy was performed to assess diagnosis and treatment response. We detected a good clinical and cosmetic outcome after two applications of combined treatment. Erythema, crust, and edema were reported as side effects. This case report shows that ablative fractional CO laser-assisted PDT might be an effective therapeutic alternative for patients with AC who refuse or are contraindicated for surgical procedures.
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http://dx.doi.org/10.1089/photob.2020.4853DOI Listing
April 2021

How reflectance confocal microscopy can be placed in systemic sclerosis skin diagnosis?

Rheumatology (Oxford) 2021 Mar 23. Epub 2021 Mar 23.

Dermatologic unit, University of Tor Vergata, Rome, Italy.

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http://dx.doi.org/10.1093/rheumatology/keab241DOI Listing
March 2021

Knowledge, attitudes and practices concerning pertussis maternal immunization in a sample of Italian gynaecologists.

Hum Vaccin Immunother 2021 06 26;17(6):1681-1685. Epub 2021 Jan 26.

Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy.

Infants are at risk of developing serious diseases as a consequence of pertussis infection. Thus, to protect newborns, many countries, including Italy, have introduced pertussis maternal immunization. However, despite the compelling evidence supporting Tdap vaccinations, the rates of coverage among Italian pregnant women have remained consistently very low. Numerous studies have shown that healthcare providers' recommendations are critical for achieving high maternal vaccination coverages. This study explores Italian gynecologists' knowledge, attitude and practices concerning pertussis maternal immunization. Between July 2018 and September 2018, we performed a national cross-sectional survey administered by e-mail using the mailing list of the Association of Italian Hospital Obstetricians and Gynecologists (AOGOI): the mailing list included more than 3500 members. A total of 451 respondents distributed throughout Italy completed the online survey. Overall, 275 (60.97%) respondents did not routinely recommend pertussis vaccination to pregnant women, mainly for suboptimal knowledge of the maternal pertussis vaccine, protocols, and guidelines: furthermore, 15.44% (69/447) of gynecologists were not aware of the pertussis vaccination program for pregnant women. Gynecologists working in the South or in the Islands of Italy were less aware about the need of administering Tdap in expectant mothers, suggesting that there is a potential risk of health inequalities based on differing levels of vaccine knowledge and recommendations across Italy. In order to enable healthcare professionals to provide accurate and timely information on pertussis immunization to pregnant women, targeted educational programs to improve gynecologists' knowledge on pertussis vaccination are needed.
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http://dx.doi.org/10.1080/21645515.2020.1833580DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8115758PMC
June 2021

Latest Evidence Regarding the Effects of Photosensitive Drugs on the Skin: Pathogenetic Mechanisms and Clinical Manifestations.

Pharmaceutics 2020 Nov 17;12(11). Epub 2020 Nov 17.

Dermatology Unit, Department of Internal Medicine, Tor Vergata University, 00133 Rome, Italy.

Photosensitivity induced by drugs is a widely experienced problem, concerning both molecule design and clinical practice. Indeed, photo-induced cutaneous eruptions represent one of the most common drug adverse events and are frequently an important issue to consider in the therapeutic management of patients. Phototoxicity and photoallergy are the two different pathogenic mechanisms involved in photosensitization. Related cutaneous manifestations are heterogeneous, depending on the culprit drug and subject susceptibility. Here we report an updated review of the literature with respect to pathogenic mechanisms of photosensitivity, clinical manifestations, patient management, and prediction and evaluation of drug-induced photosensitivity. We present and discuss principal groups of photosensitizing drugs (antimicrobials, nonsteroidal anti-inflammatory drugs, anti-hypertensives, anti-arrhythmics, cholesterol, and glycemia-lowering agents, psychotropic drugs, chemotherapeutics, etc.) and their main damage mechanisms according to recent evidence. The link between the drug and the cutaneous manifestation is not always clear; more investigations would be helpful to better predict drug photosensitizing potential, prevent and manage cutaneous adverse events and find the most appropriate alternative therapeutic strategy.
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http://dx.doi.org/10.3390/pharmaceutics12111104DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7698592PMC
November 2020

Overview of the molecular determinants contributing to the expression of Psoriasis and Psoriatic Arthritis phenotypes.

J Cell Mol Med 2020 12 31;24(23):13554-13563. Epub 2020 Oct 31.

Medical Genetics Laboratory, Department of Biomedicine and Prevention, Tor Vergata University, Rome, Italy.

Psoriasis and psoriatic arthritis are multifactorial chronic disorders whose etiopathogenesis essentially derives from the alteration of several signalling pathways and the co-occurrence of genetic, epigenetic and non-genetic susceptibility factors that altogether affect the functional and structural property of the skin. Although shared and differential susceptibility genes and molecular pathways are known to contribute to the onset of pathological phenotypes, further research is needed to dissect the molecular causes of psoriatic disease and its progression towards Psoriatic Arthritis. This review will therefore be addressed to explore differences and similarities in the etiopathogenesis and progression of both disorders, with a particular focus on genes involved in the maintenance of the skin structure and integrity (keratins and collagens), modulation of patterns of recognition (through Toll-like receptors and dectin-1) and immuno-inflammatory response (by NLRP3-dependent inflammasome) to microbial pathogens. In addition, special emphasis will be given to the contribution of epigenetic elements (methylation pattern, non-coding RNAs, chromatin modifiers and 3D genome organization) to the etiopathogenesis and progression of psoriasis and psoriatic arthritis. The evidence discussed in this review highlights how the knowledge of patients' clinical and (epi)genomic make-up could be helpful for improving the available therapeutic strategies for psoriasis and psoriatic arthritis treatment.
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http://dx.doi.org/10.1111/jcmm.15742DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7754002PMC
December 2020

Efficacy of Certolizumab Pegol in naïve versus multi-treated patients affected by psoriatic arthritis.

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

Department of Dermatology, University of Rome "Tor Vergata", Rome, Italy.

Background: The efficacy and safety of Certolizumab Pegol over 52 weeks was compared in two groups of patients: Group 1 comprised patients naïve to biologic treatments; Group 2 comprised patients previously treated with one or more anti-Tumor necrosis factor (TNF)-alpha and/or antiinterleukin (IL) agents.

Methods: We reported results in 50 patients affected by both mild psoriasis (PsO) and psoriatic arthritis (PsA). Primary endpoint was a reduction from baseline at week 52 of Disease Activity Score (DAS44-ESR) in both groups of patients. Secondary endpoints were a reduction from baseline at week 52 of Psoriasis Area Severity Index (PASI), Visual Analog Scale for Pain (PAIN VAS), ESR, CRP, and Dermatology life quality index (DLQI).

Results: We observed a statistically significant improvement of both cutaneous and rheumatic disease in all patients, with a consistent reduction of DAS44-ESR, PASI, and PAIN VAS from baseline to week 52. DAS44-ESR decreased from 3.9 at BL to 1.5 at W52 (Group 1), and from 3.8 to 1.7 at W52 (Group 2). Mean PASI score decreased from 3.2 at baseline (BL) to 0.4 at W52 (Group 1), and from 5.4 to 0.7 at W52 (Group 2). Mean PAIN-VAS decreased from a value of 73.5 at BL to 2.5 at W52 (Group 1), and from a value of 62.4 at BL to 9.2 at W52 (Group 2). We also found a reduction in ESR, CRP and DLQI values for each time point.

Conclusions: Our results confirm that CZP can be administered safely and effectively to treat both psoriasis and psoriatic arthritis irrespective of previous treatments with biologic agents.
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http://dx.doi.org/10.23736/S0392-0488.20.06623-7DOI Listing
October 2020

The combined role of clinical, reflectance confocal microscopy and dermoscopy applied to chronic discoid cutaneous lupus and subacutus lupus erythematosus: A case series and literature review.

Lupus 2021 Jan 6;30(1):125-133. Epub 2020 Oct 6.

University of Alcalà, Alcalá, Spain.

Main subtypes of cutaneous lupus erythematosus are represented by acute, subacute cutaneous, intermittent and chronic cutaneous lupus erythematosus. Discoid lupus erythematosus represents the most common phenotype of chronic cutaneous lupus erythematosus. The spectrum of clinical manifestations mirrors that of several and distinct histopathological features. Such variability among different CLE subtypes is also observed at dermoscopy. Dermoscopy is nowadays considered an additional valuable method for skin lesions assessment in general dermatology, following and completing the well-known clinical diagnostic steps, such as medical history and clinical examination. In vivo reflectance confocal microscopy (RCM) is a non-invasive imaging tool able to assess the epidermis and upper dermis producing high resolution (horizontal ∼1.25 μm, vertical ∼5 μm), tissue sections used for melanocytic and inflammatory evaluation. In this study, we reported dermoscopic and RCM features about 9 patients affected by subacute and chronic lupus erythematosus retrospectively analyzed.
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http://dx.doi.org/10.1177/0961203320958141DOI Listing
January 2021

Reflectance Confocal Microscopy Applied to Folliculitis Decalvans: Preliminary Results of a Multicenter Study.

Skin Appendage Disord 2020 Jul 3;6(4):202-206. Epub 2020 Jun 3.

Dermatology Unit, University of Tor Vergata, Rome, Italy.

Although trichoscopic criteria indicative of disease severity and inflammatory activity have been recently proposed, the potential use of reflectance confocal microscopy (RCM) in the evaluation of the inflammatory stage of FD has never been published to date. Our study investigated RCM features of 14 patients with a histopathological diagnosis of FD, evaluating clinical and trichoscopic findings. RCM findings were divided into 2 main patterns: "follicular" and "interfollicular." Our results suggest a potential role for RCM as a noninvasive, fast technique for a complementary investigation in the diagnostic process, as well as in the therapeutic management decision.
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http://dx.doi.org/10.1159/000507655DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7445553PMC
July 2020

Spotlight HD-OCT accuracy in early detection of basal cell carcinoma.

Skin Res Technol 2021 Jan 3;27(1):118-120. Epub 2020 Aug 3.

Dermatologic Unit, University of Rome Tor Vergata, Rome, Italy.

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http://dx.doi.org/10.1111/srt.12929DOI Listing
January 2021

Reflectance Confocal Microscopy Applied to Linear (en Coup de Sabre) Morphea.

Skin Appendage Disord 2020 Jun 27;6(3):171-174. Epub 2020 Mar 27.

Dermatology Unit, Department of "Medicina dei Sistemi," Tor Vergata University, Rome, Italy.

En coup de sabre morphea is a clinical variant of morphea, presenting as a linear depressed, atrophic area in the paramedian forehead or the frontoparietal scalp, resembling a stroke from a sword. It affects the skin and subcutaneous connective tissues, with possible extension to the underlying musculature, cartilage, and bone and variable association with neurologic symptoms. A 50-year-old woman presented to our clinic for evaluation of an atrophic lesion on her forehead and scalp appearing 1 year before, progressively extending over time. An alopecic atrophic area involving the skin and subcutaneous tissues of her right forehead and scalp arranged in a linear fashion with an "en coup de sabre" appearance was observed in relation with hair loss in the affected area. Reflectance confocal microscopy showed marked hyperreflective areas with severe eccrine gland atrophy. All sebaceous glands had disappeared, with sporadic follicular persistence reduction. Histopathological examination of a punch biopsy specimen taken from a central parietal alopecic area was consistent with a diagnosis of morphea. To our knowledge, this is the first report regarding the use of reflectance confocal microscopy as an ancillary diagnostic technique in linear localized morphea of the scalp and face. This noninvasive technique may represent a useful tool in distinguishing between early stages of the disease, with prevalence of inflammatory lymphocytic infiltrate, and late stages characterized by more prominent sclerosis with mild or absent signs of inflammation.
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http://dx.doi.org/10.1159/000506748DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7325220PMC
June 2020

Predictive role of vitamin A serum concentration in psoriatic patients treated with IL-17 inhibitors to prevent skin and systemic fungal infections.

J Pharmacol Sci 2020 Sep 11;144(1):52-56. Epub 2020 Jun 11.

Dermatologic Unit, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy.

The use of biological drugs in psoriasis is replacing traditional therapies due to their specific mechanism and limited side effects. However, the use of Interleukin 17 inhibitors and the modification of its cytokine pathway could favor the risk of fungal infections. All-trans retinoic acid is an active metabolite of vitamin A with anti-inflammatory and immunoregulatory properties through its capacity to stimulate both innate and adaptive immunity and to its effects on proliferation, differentiation and apoptosis in a variety of immune cells. Furthermore, it has been recently discovered that All-trans retinoic acid has a direct fungistatic effect against Candida and Aspergillus Fumigatus. On the basis of these new insights, in the current review, we suggest that the evaluation of serum level of All-trans retinoic acid or vitamin A should be considered as a predictive marker for the development of fungal infections among psoriatic patients treated with Interleukin 17 inhibitors. In clinical practice, vitamin A test could be added in the routine hospital diagnostic management for a better selection of psoriatic patients eligible to Interleukin 17 inhibitors.
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http://dx.doi.org/10.1016/j.jphs.2020.06.003DOI Listing
September 2020

A Case of Pincer Nail Successfully Treated with Tazarotene 0.1% Gel.

Case Rep Dermatol 2020 May-Aug;12(2):114-118. Epub 2020 May 18.

Dermatology Unit, Department of "Medicina dei Sistemi," University of Rome Tor Vergata, Rome, Italy.

Pincer nail is a common condition characterized by excessive transverse nail curvature, progressively pinching the nail bed distally, resulting in cosmetic discomfort, pain and functional limitation. Treatment is difficult and often unsatisfactory. Surgical treatment performed by experienced physicians provides good outcomes. However, patients usually hesitate to undergo invasive procedures, preferring conservative treatments. Unfortunately, these mainly offer only temporary relief and recurrence rate is high. Topical tazarotene has been used in several nail conditions, but its potential remains not fully elucidated. We herewith present a case of pincer nails in a 35-year-old woman successfully treated with tazarotene 0.1% gel applied topically twice a day for 3 months who did not experience recurrence at 1-year follow-up. At 1-year follow-up, no recurrence has been observed. To our knowledge, this is the first case of pincer nails successfully treated with tazarotene 0.1% gel. With our report, we suggest topical tazarotene as a novel, effective conservative treatment of milder cases of this common, albeit disturbing condition. Although our report may not be sufficient to generalize the results, it paves the way for larger studies investigating the potential of this fast, noninvasive therapeutic agent.
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http://dx.doi.org/10.1159/000507915DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7265718PMC
May 2020

Reflectance Confocal Microscopy of Pigmented Bowen's Disease: A Case Series of Difficult to Diagnose Lesions.

Case Rep Dermatol 2020 May-Aug;12(2):98-106. Epub 2020 May 15.

Department of Medicine and Medical Specialties, University of Alcalá, Madrid, Spain.

Pigmented Bowen's disease is a rare variant of in situ squamous skin cell carcinoma. It mainly affects patients between 60 and 70 years of age. Its clinical features include well-demarcated, pigmented plaque arising in photo-exposed areas of the body. The best-characterized feature of the disease by histological examination is the presence of atypical keratinocytes, hyperpigmentation of the epidermis with trans-epidermal elimination of melanin and dermal melanophages. Precise diagnosis is often difficult, both clinically and dermoscopically, as Bowen's disease is often mistaken with keratinocyte tumors such as solar lentigines, seborrheic keratosis, Bowenoid papulosis, pigmented basal cell carcinoma, pigmented actinic keratosis; or even melanocytic lesions such as melanocytic nevus, pigmented epithelioid melanocytoma, and melanoma. Precise diagnosis often requires biopsy and histopathological examination of the tissue. Reflectance confocal microscopy is a noninvasive technique to diagnose pigmented skin lesions. To date, not much data are available regarding its use in the diagnosis of pigmented Bowen's disease. Herein, we report a well-represented case series of pigmented Bowen's disease imaged using dermoscopy and reflectance confocal microscopy.
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http://dx.doi.org/10.1159/000507916DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7265740PMC
May 2020

Melanocytic lesion in children and adolescents: an Italian observational study.

Sci Rep 2020 05 25;10(1):8594. Epub 2020 May 25.

Dermatologic Unit, University of Rome Tor Vergata, Roma, Italy.

Malignant melanoma is a rare neoplasm in the pediatric age group. One of the main risks factors is represented by the presence of a high number of melanocytic nevi. Sun exposure in pediatric age represents a predictor of melanocytic nevi number in the adult age and there is a direct correlation between the presence of melanocytic moles in early childhood and the development of many nevi in adults, suggesting that a high number of nevi in childhood should be considered as a predictor of melanoma development during adult life. The predominance of dermoscopic types of melanocytic nevi varies according to the individual's age and depends on endogenous or exogenous signaling, suggesting different pathways of nevogenesis. We evaluated the total amount of melanocytic nevi of pediatric patients and their prevalent dermoscopic pattern. We investigated the reasons for dermatological examination, pointing out the role of older parents' populations in the decision to refer to a dermatological consultant. We performed a prospective observational study on 295 pediatric outpatients consecutively enrolled from July 2018 to July 2019. Descriptive and inferential statistical analyses were performed using logistic and linear regression. 49% of children were characterized by less than 10 nevi, 45% of children by a number of nevi between 10 and 30, whilst 17 patients (5%) had a number of nevi between 30 and 50. The most prevalent dermoscopic pattern was the globular one. An older parenting age was correlated with an autonomous reason for referral and a later first visit. Our data agreed with previous suggestions demonstrating a strong influence of latitude, sun exposure and ethnic background in the development of the number of nevi. To our knowledge, this is the first study, which evaluated the reasons for dermatological examination and the role of older parents' populations in the decision to refer to a dermatological consultant.
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http://dx.doi.org/10.1038/s41598-020-65690-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7248059PMC
May 2020

Dimethylfumarate efficacy and safety in palmoplantar psoriasis patient affected by hepatitis b and depression: A case report.

Dermatol Ther 2020 07 24;33(4):e13659. Epub 2020 Jun 24.

Dermatologic Unit, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy.

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http://dx.doi.org/10.1111/dth.13659DOI Listing
July 2020

Good things come to those who wait: Successful response of solar urticaria to omalizumab after 1 year of treatment.

Photodermatol Photoimmunol Photomed 2020 Sep 1;36(5):408-411. Epub 2020 Jun 1.

Dermatology Unit, University of Rome Tor Vergata, Rome, Italy.

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http://dx.doi.org/10.1111/phpp.12577DOI Listing
September 2020

Factors Affecting the Implementation Process of Pertussis [Tdap] Immunization in Pregnant Women in an Italian Region: A Qualitative Study.

Front Public Health 2020 22;8:120. Epub 2020 Apr 22.

Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy.

Whooping cough (pertussis) represents one of the most prevalent vaccine-preventable diseases in Western countries, capable of causing disease in infants, with a high risk of severe complications. To protect new-borns from pertussis, many countries have introduced the acellular pertussis adult vaccine in combination with tetanus and diphtheria toxoids for women in the third trimester of pregnancy. Thanks to the approval of the new National Immunization Prevention Plan 2017-2019: Italy is among those countries. The Italian health-care system is a regionally based National Health Service, therefore, regions organize and implement new vaccination strategy on their own. This study focuses on Tuscany's experience in implementing the maternal pertussis vaccination. The present study had a qualitative design: we obtained information about the implementation process through interviews with relevant stakeholders involved in the planning or implementation of vaccination programme at different levels. We noticed heterogeneous implementation's status between Tuscan Health Care Departments. The most frequently reported barriers influencing the success of the implementation process of this prevention strategy included: lack of accountability, lack of enabling instruments, financial constraints, logistics barriers, training deficiencies, attitudes of health care workers, and lack of communication experts. The implementation of new vaccination programs is complex and challenging. Often the importance of education and information activities targeting health professionals are underestimated and underfunded. These elements would need to be carefully considered and adequate provisions should be made to address them when designing and implementing effective vaccine interventions.
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http://dx.doi.org/10.3389/fpubh.2020.00120DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7212430PMC
May 2021

Clinical efficacy and reflectance confocal microscopy monitoring in moderate-severe skin aging treated with a polyvinyl gel containing retinoic and glycolic acid: An assessor-blinded 1-month study proof-of-concept trial.

J Cosmet Dermatol 2021 Jan 29;20(1):310-315. Epub 2020 Jun 29.

Dermatology Clinic, University of Rome Tor Vergata Rome, Rome, Italy.

Background: Retinoids and alpha-hydroxy acids are commonly used topically as anti-aging substances. Current medical devices contain retinoic acid (0.02%) and glycolic acid (4%) in a polyvinyl gel vehicle (R-G gel). There are still no clinical data nor objective evaluation of the anti-aging effect this product has in the short term.

Aims: To assess in a prospective 1-month, noncomparative, primary outcome assessor-blinded proof-of-concept trial the clinical efficacy, tolerability, and the skin cells modification (evaluated through reflectance confocal microscopy; RCM), of R-G gel in skin aging treatment.

Methods: Twelve women with moderate-severe skin aging (Glogau score ≥ 3) were enrolled. The product was applied on the face three times a week for 4 weeks. Study visits were performed at baseline and after 2 and 4 weeks. RCM evaluation was performed openly at each visit using Viva Scope 1500 to evaluate the left cheek (5 mm below the zygomatic process).

Results: Eleven subjects concluded the trial. At baseline, the Glogau score was 3.4 ± 0.5 and decreased significantly at week 4 (P = .0001; ANOVA test) to 2.7 ± 0.6. Significant reductions of dark spots (-40%) and severity of wrinkles (-12%) were observed at week 4 compared to baseline. The RCM score improved significantly at week 4 with the recovery of the polygonal keratinocytes pattern as the central aspect observed.

Conclusion: The gel containing retinoic acid and glycolic acid showed significant improvements of the clinical signs of severe skin aging with a concomitant improvement of epidermal and dermal structures evaluated via RCM.
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http://dx.doi.org/10.1111/jocd.13463DOI Listing
January 2021

Dermoscopy and Reflectance Confocal Microscopy in the Diagnosis and Management of Nail Fold Squamous Cell Carcinoma.

J Med Life 2020 Jan-Mar;13(1):107-111

Dermatologic Unit, University of Rome Tor Vergata, Rome, Italy.

The management and prognosis of squamous cell carcinoma largely depend on its invasiveness and grade of differentiation. Pigmented nail fold squamous cell carcinoma represents a therapeutic challenge, needing careful treatment to preserve nail function. Here, we report the use of dermoscopy and Reflectance Confocal Microscopy to monitor nail fold squamous cell carcinoma in situ and its response to treatment with topical imiquimod.
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http://dx.doi.org/10.25122/jml-2019-0129DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7175428PMC
June 2020

Lichenoid Keratosis: A Clinical Trap without Secrets for Reflectance Confocal Microscopy.

Case Rep Dermatol 2020 Jan-Apr;12(1):47-51. Epub 2020 Mar 20.

Dermatologic Unit, University of Rome Tor Vergata, Rome, Italy.

Lichenoid keratosis, also defined as benign lichenoid keratosis, was reclassified as lichen planus-like keratosis by Shapiro and Ackerman. Clinical and dermoscopic features of lichen planus-like keratosis can vary, often not providing useful and necessary information to perform an accurate diagnosis without performing a biopsy or histological examination. We describe 2 difficult to detect lichen planus-like keratosis cases in which we performed reflectance confocal microscopy. We underline the usefulness of this noninvasive diagnostic tool in the unclear cases of lichen planus-like keratosis.
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http://dx.doi.org/10.1159/000506669DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7154274PMC
March 2020

Real life experience of apremilast in psoriasis and arthritis psoriatic patients: Preliminary results on metabolic biomarkers.

J Dermatol 2020 Jun 1;47(6):578-582. Epub 2020 Apr 1.

Dermatology Unit, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy.

Psoriasis is a common inflammatory skin condition, affecting 2-4% of the worldwide population. Psoriasis remains an important public health challenge because there are many clinical forms of psoriasis in particular sites, probably related to the dysregulation of different cytokines. Therefore, there is a continuous need to improve treatment options with mechanisms of action different from those of the currently known therapies. Advances in knowledge of the molecular bases of pathogenesis lead to a better understanding of the disease, thus influencing the development and management of effective treatments. Moreover, data from recent published work indicate that psoriasis coexists with cardiovascular diseases, metabolic syndrome, diabetes mellitus and psychiatric disorders. We present results from our 52-week open-label trial in a cohort of psoriatic and psoriatic arthritis patients treated with daily p.o. doses of apremilast 60 mg. We confirmed the efficacy and safety of the drug in favoring the improvement of skin and joint disease as well as the modulation of metabolic biomarkers in diabetic and non-diabetic psoriatic patients. Apremilast could be used successfully in psoriatic patients affected by cardiometabolic comorbidities, ensuring an improvement in both diseases.
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http://dx.doi.org/10.1111/1346-8138.15293DOI Listing
June 2020

Ixekizumab in nail psoriasis.

Dermatol Ther 2020 05 9;33(3):e13352. Epub 2020 Apr 9.

Department of Dermatology, University of Rome "Tor Vergata", Rome, Italy.

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http://dx.doi.org/10.1111/dth.13352DOI Listing
May 2020

The Dark Side of Gefitinib: Reflectance Confocal Microscopy Applied to Hair Hyperpigmentation.

Skin Appendage Disord 2020 Jan 25;6(1):44-47. Epub 2019 Oct 25.

Dermatologic Unit, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy.

Gefitinib is a multi-target tyrosine kinase inhibitor used for the treatment of non-small cell lung cancer. Papulo-pustular and/or paronychia, abnormalities in hair growth, itching, and dryness due to epidermal growth factor inhibitors - i.e., PRIDE Complex - are a common effect of tyrosine kinase inhibitors. We report a case of hair and eyebrow hyperpigmentation after 7 months of treatment with gefitinib. In the literature, we found no data regarding rapid pigmentation of hair due to treatment with any multi-target tyrosine kinase inhibitors. To our knowledge, this is the first case reporting both hair and eyebrow hyperpigmentation. We hypothesize the role of different mechanisms linked to rapid hair hyperpigmentation.
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http://dx.doi.org/10.1159/000503758DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6995969PMC
January 2020

The Effectiveness of a New Topical Formulation Containing GSH-C4 and Hyaluronic Acid in Seborrheic Dermatitis: Preliminary Results of an Exploratory Pilot Study.

Clin Cosmet Investig Dermatol 2019 16;12:881-885. Epub 2019 Dec 16.

Dermatologic Unit, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy.

Introduction: Seborrheic dermatitis is a common skin disease with clinical aspects similar to those of psoriasis, eczema or allergic reactions, appearing on the sebum-rich areas of the scalp, face, and trunk. Yeast like Malassezia species, immunologic abnormalities and activation of complement are recognized as a crucial pathogen for the onset of seborrheic dermatitis. Intermittent and active phases are characterized by burning, scaling and itching, then followed by inactive periods. The disease is sometimes severe up to the erythrodermia; thus, it has a great influence on the patient's quality of life. In vitro and vivo studies have shown that the exogenous intake of glutathione-GSH-C4 and tocopherol inhibits lipid peroxidation and effectively fights and reduces oxidative stress in inflammatory disorders.

Methods: We have carried out a study enrolling 20 patients affected by SD to evaluate the effectiveness and tolerability of a new topical formulation in cream (hereinafter SEB) containing GSH-C4 0.4% in hyaluronic acid 0.25% - a new synthetic glutathione derivate called INCI (butyroyl glutathione)-assigned by the Personal Care Council. Investigator Global Assessment score and Patient Global Assessment of Treatment scales were used to test the efficacy of this new formulation.

Results: All patients showed a good clinical response to the treatment with topical SEB demonstrated by the gradual reduction in inflammatory skin lesions.

Discussion: The results of our pilot study confirm the efficacy and tolerability of this new topical formulation in a real-life assessment and patients showed strong adherence to therapy. These promising results - still to be confirmed on a larger number of patients - emphasize the potential SEB has in controlling the chronic inflammation of seborrheic dermatitis.
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http://dx.doi.org/10.2147/CCID.S231313DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6930516PMC
December 2019

Small Molecules, Big Promises: Improvement of Psoriasis Severity and Glucidic Markers with Apremilast: A Case Report.

Diabetes Metab Syndr Obes 2019 17;12:2685-2688. Epub 2019 Dec 17.

Dermatologic Unit, University of Rome Tor Vergata, Rome, Italy.

Psoriasis is a common inflammatory skin condition frequently associated with cardiometabolic diseases such as diabetes. Indeed, the state of systemic inflammation typical of psoriasis leads to an increase in the level of IL-1, IL-6 and TNF-alpha which may cause a reduced sensitivity to insulin and, ultimately, can lead to type 2 diabetes mellitus. Particularly, the derangement of PDE4-cAMP signaling has a critical role in disordered glucose and lipid metabolism. Apremilast, as a selective inhibitor of PDE4-cAMP signalling, represents an innovative therapeutic strategy for psoriasis. Here, we report a case of a patient affected by psoriasis and diabetes, who - after using Apremilast - improved his glucose metabolism as well as his need of anti-diabetic drugs and his psoriasis. This suggests that, in addition to its role against psoriasis, Apremilast may even act as a metabolic modulator.
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http://dx.doi.org/10.2147/DMSO.S229549DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6925552PMC
December 2019
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