Hard to face: cutaneous malignant melanoma

An 88-year-old Caucasian man recently sought medical attention due to recrudescence of skin disease in the area of previously excised nodule (in 2002) on the nose dorsum. The original lesion was clinically considered as a pigmented basal cell carcinoma, after which histological examination revealed a superficial spreading melanoma in vertical growth face (Clark level IV; Breslow thickness 2.1 mm) arising from a pre-existing nevus. The adjacent skin also showed significant actinic damage both in the epidermis and in the dermis. A sentinel node was positive (micrometastases of melanoma) and radical lymph node dissection of the neck was performed. Other lymph nodes did not contain metastasis. Computed tomography scans of brain, chest, abdomen and pelvis performed at that time showed no evidence of systemic disease.

Possible role of Helicobacter pylori in diseases of dermatological interest

Helicobacter pylori is a gram-negative, flagellate, microaerophilic bacterium identified for the first time about 30 years ago, as a pathogenic factor of gastritis and peptic ulcer. Soon after, it was linked to several gastrointestinal and extra-gastrointestinal diseases (hematological, cardiovascular, neurological, pulmonary and ocular diseases, obesity, diabetes mellitus, growth retardation and extragastric MALT lymphoma). Association and possible cause-effect correlation with H. pylori infection were suggested in diseases of dermatological interest such as chronic urticaria, rosacea, Henoch-Schoenleins purpura, idiopathic thrombocytopenic purpura, cutaneous and oral lichen planus, atopic dermatitis, recurrent aphthous stomatitis, systemic sclerosis, psoriasis, Sjögrens syndrome, Behçet's disease, pruritus, alopecia areata, primary cutaneous marginal zone B-cell lymphomas, vitiligo, chronic prurigo, multiformis, prurigo nodularis, leukocytoclastic vasculitis, prurigo pigmentosa, eczema nummulare, primary cutaneous MALT-type lymphoma, sublamina densa-type linear IgA bullous dermatosis, Sweet's syndrome, cutaneous T-cell pseudolymphoma and pemphigus vulgaris. A critical review of the literature up to May 2017 shows clear evidence of H. pylori involvement only for some of the above purported associations, while in the majority of cases data appear contrasting and/or obtained on a not adequately large study population. Further clinical and laboratory research, with more adequate methodological and statistical basis, is required to assess the actual existence and relevance of many purported associations, as well as the possible role of H. pylori and the underlying pathogenic mechanisms.

Unexpected parasitosis

Neotrombicula autumnalis is an arthropod living in the soil and parasitizes animals only in its larval stage. Depending on climatic conditions, one to five life cycles can take place in a single year. Human infestation is probably underestimated and can be easily missed due to non-pathognomonic cutaneous manifestations in absence of systemic signs. We describe a case of human trombiculiasis and discuss the diagnostic and therapeutic management of this ‘synanthropic’ dermatosis.

Bi-layered collagen nano-structured membrane prototype collagen matrix 10826® for soft tissue regeneration in rabbits: an in vivo ultra-structural study of the early healing phase

Collagen Matrix (CM) 10826 is a nanostructured bi-layered collagen membrane obtained from type I and III porcine collagen, which in vitro has shown to have the potential to be a substitute and/or stimulant for soft oral tissue regeneration. The objective of this study was to evaluate the in vivo potential and safety of this membrane for soft tissue regeneration in the early stage of wound healing. Two soft tissue wounds (test and control) were created on the back skin of 5 rabbits (female New Zealand White Rabbits specific pathogen free). All wounds were protected by a special poly-tetra-fluoro-ethylene (PTFE) healing camera. On each rabbit on the test side CM-10826 was used, while on the control side conventional treatment (an autologous pedicle graft) was performed. The healing process was observed clinically after 2 and 6 days, and Magnetic Resonance Imaging (MRI) was performed after this period. After 7 days, animals were sacrificed and specimens were analyzed with light optic microscopy (LM), Transmission Electron Microscopy (TEM) and Scanning Electron Microscopy (SEM). These in vivo trials on rabbits confirmed that CM-10826 is well tolerated, without signs of histological inflammatory reaction and proved to be able to accelerate the spontaneous repair of the skin defect taken as the control. The light-optic and ultra-microscopy of serial biopsies showed that the new matrix is biocompatible and is able to function as a scaffold inducing soft tissue regeneration. In conclusion this study demonstrates that CM-10826 promote early soft tissue regeneration and suggests it is a potential constituent for human autologous keratinocytes seeded derma bioequivalent. It protects the wound from injuries and bacterial contamination accelerating healing process. As a clinical relevance, we consider that the quality of life of patients will be improved avoiding the use of major autologous grafts, reducing the hospitalization time and morbidity.

Clinical evaluation of a new cosmetic cream containing PEPHA®-TIGHT on the skin of childbearing women

The purpose of this study is to evaluate the efficacy of daily application of a new cosmetic cream on the skin of childbearing women. Fifty-two childbearing women were evaluated and each subject was initially (T0) prepared using an hydration and sebometry test. A quantity of 50 ml of cosmetic cream was applied for 1 month on each patient. At the end of the month (T1), the tests were repeated. At the end of the study, all enrolled women showed an improvement of facial skin hydration and sebum normalization and reduction of skin aging. The present study shows that the cosmetic preparations containing PEPHA®-TIGHT and other moisturizing agents are able to improve skin hydration and reduce skin aging, according to several published clinical trials. The absence of a control group and the short observation time limits this study.

Between history and gossip: the state of women relative to syphilis, a traditionally male disease

Despite the new World Health Organization data remind us how syphilis is a disease which affects both sexes equally, this pathology has always been mainly considered a male disease. While several famous men are known to be affected by syphilis, there are very few women affected by this pathology of which we have historical records. Through the lives of Mary Todd Lincoln, Catherine of Aragon, Karen Blixen and Florence Foster Jenkins, this article would like to grant dignity to all the women who contracted syphilis in the wrong historical era where, for a woman, admitting to contracting it was shameful. Through the important women who lived their lives fighting against this disease and its complications, we would like to pay tribute to all those women who still today, in an era of antibiotics and where syphilis is a treatable pathology, they cannot be cured because they are both geographically and socially disadvantaged.

Use of platelet rich plasma in human infertility

Successful embryo implantation requires good quality embryo but also needs a receptive endometrium site. In our clinical practice, we daily verify that an adequate endometrial growth is reached for successful implantation. To understand whether platelet rich plasma (PRP) can improve endometrium thickness and performance, PRP treatment was carried out after at least three of the classic medical protocols currently in use had been unsuccessfully adopted. Eight patients with more than 3 cryo-transfers cancelled because of failure of endometrial growth, defined as endometrium less than 6 mm, with negative hysteroscopic screening for endometrial pathology, and with negative bacteriologic screening, before present and all previous treatment, were selected to undergo PRP treatment. In 7 out of 8 treatments, an endometrial thickness greater than 6.5 mm (mean 6.9 mm) was reached, with endometrial three-layer pattern, before progesterone administration and embryo transfer was performed. In 6 out of 7 patients, who underwent embryo transfer, beta-HCG were positive, with 2 biochemical abortions, one miscarriage at 6-week pregnancy, two babies born and one drop-out. In this study, 8 patients had extraordinarily poor endometrial quality, and the endometrium was non-responsive to conventional estrogenic therapy, resulting in cycle cancellation. After application of PRP, the endometrial thickness was satisfactory in all the patients except one. Of these, beta-HCG was positive in 6 women, the pregnancy was progressing normally in 2 women, and one had an early miscarriage. We can suppose that the multiple implantation failures were caused by inefficient expression adhesion molecules, which can hypothetically be more represented after PRP application.

Photobiomodulation in the treatment of chronic non-responding wounds

We present a protocol of care and therapeutic approach to skin lesions, called AIMED (Anti Inflammatory Regenerative Medicine), which is based on the circularity of its phases and applied therapeutic methodologies. We used photobiomodulation (PBM) for the examination non-responding skin lesions. PBM is an adjuvant treatment for the stimulation of regenerative cellular processes, reduction of inflammation and pain and biochemical modulation of molecular response. We used PBM for the examination of skin lesions, which were not responding to other therapies. LumiHealTM protocol treatment has been applied for 3 months on 8 patients affected by infected vascular ulcers of the lower limbs resistant to previous treatments. Three patients reached positive results immediately, and the remaining 5, at the first follow-up. The use of LumiHealTM in combination with other treatments, method allowed an effective and rapid improvement of the lesions via modulation of the immune response.

History of venous leg ulcers

To retrieve the history of venous ulcers and of skin lesions in general, we must go back to the appearance of human beings on earth. It is interesting to note that cutaneous injuries evolved parallel to human society. An essential first step in the pathogenesis of ulcers was represented by the transition of the quadruped man to Homo Erectus. This condition was characterized by a greater gravitational pressure on the lower limbs, with consequences on the peripheral venous system. Furthermore, human evolution was characterized by an increased risk of traumatic injuries, secondary to his natural need to create fire and hunt (e.g. stones, iron, fire, animal fighting). Humans then began to fight one another until they came to real wars, with increased frequency of wounds and infectious complications. The situation degraded with the introduction of horse riding, introduced by the Scites, who first tamed animals in the 7th century BC. This condition exhibited iliac veins at compression phenomena, favouring the venous stasis. With time, man continued to evolve until the modern age, which is characterized by increased risk factors for venous wounds such as poor physical activity and dietary errors (1, 2).

Electromagnetic field in control tissue regeneration, pelvic pain, neuro-inflammation and modulation of non-neuronal cells

In scientific literature, magnetic fields are used both in basic science and clinical research. They are often used to treat pain and neuro-inflammation disorders thanks to their influence on cellular responses. Our project was born from the regenerative support that we wanted to give to those diseases characterized by neuro-inflammation, nerve lesion, muscles and tissues disorders that can transform the symptom (e.g. neuropathic pelvic pain) in disease. In this study, we examined the action of pulsed electromagnetic fields (PEMFs) on skin lesion regeneration and the repetitive trans-pelvic magnetic stimulation (rTPMS) on patients affected by incontinence and post-surgical problems, sexual dysfunction, and pelvic pain. In rTPMS for post-surgery urinary incontinence, 40 patients affected by post-surgery urinary incontinence were enrolled. Twenty patients (post-prostatectomy) were treated with rTPMS and 20 with conventional therapies. In PEMF for the regeneration of skin tissue, 50 patients affected by various types of skin lesions (70% low legs vascular lesions) were treated with pulsed electromagnetic fields (PEMFs) twice per week and subsequently with home treatment (Home Care device) twice per day. In rTPMS study, results were evaluated after 3 months. In 10 patients (7 post prostatectomy, 3 cystourethrocele) which were submitted to 18 sessions, twice a week, an improvement of incontinence in 75% of cases with patient compliance was recorded and the quality of life up to 100% also improved. Utilizing PEMFs for the regeneration of skin tissue, following 3 months of AIMED protocol treatment, we reached a reduction of 50% of lesion area in the 60% of cases; 35% of cases healed completely. The use of rTPMS allows training muscles to adequately respond to inflammatory stimulus that causes muscle accommodation deficits with altered contractility or spastic painful contracture in pelvic district. It also stimulates a series of regenerative phenomena due to the action of magnetic waves at high intensity on cellular membrane and cytoplasm, especially on mast cells, which seem to have a fundamental role in the determination of the pelvic r egion pain. The magnetic fields for the treatment of cutaneous lesions, which are applied cyclically with other operating methods of AIMED protocol, confirmed the literature data, with a treated group of 50 patients. The use of magnetic fields opens new scenarios for regenerative medicine, since the cell could lend itself to a self-healing process if it receives specific information.

A short novel about the spread of two important diseases in history: syphilis and SARS

Throughout the centuries, the undefended nature of man has very often manifested in cases of epidemics, which have determined scenarios of suffering and death. Through “historical” observation lens, it is possible to understand the relationship between the spread of viruses, bacteria and parasites responsible for these epidemics and the displacement of ancient or contemporary travellers. We have analysed two infective diseases, syphilis and SARS, and their role in history and in medicine.

Laser treatment of leg ulcers: selected concepts

An overview on different laser devices, available for the treatment of the different phases of wound healing: debridement, wound repair and scars correction.

Duncan’s dermatosis: from the “terra firma-forme” to a possible syndromic condition. The story of a dirty disease

Since its first description by Duncan, Tschen and Knox in 1987 in the former Archives of Dermatology (1), “Terra firma-forme dermatosis” has been variously described in medical literature, representing a strange, probably underestimated, cutaneous disease. During the last 40 years, the condition has been recorded as an undesirable as well as unexplained event, occurring mainly in childhood, characterized by a brownish-black appearance of the whole skin, resembling dirt. Recently, authors described several cases of atypical patterns of the disease, sometimes with impressing topographic clinical pictures, evocative for syndromic phenotypes. Thanks to more careful examination of the tegument, often with the aid of non-invasive diagnostic tools, attention to this disease is growing. This brief review summarizes the state of the art on the topic, through an historical overview of what is known of this ‘dirty’ dermatosis.

The evolution of artificial hair implantation

From the beginning, artificial hair implantation has aroused a lot of interest, sometimes controversial, in the field of hair restoration. The artificial fiber must be of high quality and biocompatible. Biofibre® is a very fine fiber having diameter of 80 m. The standard length of this fiber is 15 or 30 cm, to satisfy multiple patient requests. They are available in 13 colors and 3 different shapes (straight, wavy and curly). Artificial hair implant is indicated in all (male and female) cases of androgenetic alopecia, especially for those who show dismal response to medical therapies and have poor donor area supply for hair transplantation. It has also shown good results to treat scars. One hundred thirty-three cases of androgenetic alopecia were treated with Biofibre® and followed-up for 3 years. A clinical evaluation was carried out after 1 month, 4 months and every other 4 months after the implant. The fiber loss was no more than 10% per year in 91.4% of the cases, 15% in 7.8% of the cases and 20% in 0.8% of the cases. 96.2% of patients declared themselves to be satisfied with the result of the implant while 3.8% declared to be not satisfied. To conclude, modern artificial hair implantation can be considered a safe and easy mode of hair restoration, for male and female patients, especially in donor depleted cases or when an immediate aesthetic result is required.

Spontaneous retrospective clinical evaluation of a new phytoestrogen-based cosmetic gel cream on postmenopausal women’s skin

The purpose of this study is to evaluate the efficacy of daily application of a new phytoestrogen-based cosmetic gel cream on postmenopausal women’s skin. Sixty postmenopausal women were evaluated. Each subject was initially (T0) submitted to a hydration and sebometry test. A quantity of 50 ml of phytoestrogen-containing gel cream was given for one month to each patient. At the end of the month (T1), the tests were repeated. At the end of the study, 85% of the women showed an improvement of facial skin hydration. All the women who took part in the study had facial skin sebum normalization. The present study confirms that cosmetic preparations containing phytoestrogen are able to reduce skin aging, according to several published clinical trials. Nevertheless, the absence of a control group and the short observation time limited this study.

Cutaneous manifestations in Steinert’s disease. Apropos of four clinical cases

Myotonic dystrophy type 1 (MD1) (OMIM 160900, Steinert disease) is the most common muscular disease, with an estimated worldwide prevalence ranging from 0.5 to 18/10,000 (1). MD1 is an autosomal dominant multisystem disorder that affects skeletal and smooth muscles as well as eyes, heart, endocrine system, and central nervous system. Available data on skin and adnexal involvement that has been demonstrated as a hallmark of the neurological disease are still poor. The aim of this case report-based, mini review on MD1 and skin is to highlight the importance of such superficial signs to be easily detected in the physical examination, and to evaluate the occurrence of these cutaneous manifestations in presence of various degrees of the disease and gene mutations.

Chronic inflammation therapy combined with low dose cytokines in the treatment of chronic ulcers of lower limbs

Prevalence of chronic venous leg ulcers has increased from 55% to 75% in 10 years. We treat chronic vascular lesions according to a cyclic multiphase method that follows the instrumental and differential etiologic diagnosis of ulcers of the lower limbs. The AIMED (Anti Inflammatory Regenerative Medicine) operating model follows the diagnostic phase and is structured in 5 interconnected phases. Mare evaluation, pH control, biofilm removal and prevention and infections are approached according to the International Guidelines. Low-dose cytokine therapy to contrast the inflammatory process are administrated to the patients. Chronic skin lesions of these patients, treated according to the AIMED protocol, have been evaluated twice a week. The clinical evaluation parameters evaluated by us were: reduction of pain at 15 and 30 days, reduction of 50% of the injury at 30 days, characteristics of perilesional skin (edema, erythema) and global profile of the patient. The so-called Low Dose Cytokines therapy is changing the previous therapeutic algorithms thanks to a safe and effective systemic cytokines-receptors interactive physiological process.

Photobiomodulation with polarized light in the treatment of cutaneous and mucosal ulcerative lesions

In recent decades, regenerative medicine has achieved an important evolution at both a conceptual level and scientific production, which explains the current and future possibilities of therapy and daily clinical practice. The main aim of regenerative medicine is the complex system of repair/regeneration. The current literature on the subject demonstrates the advantage of visible light therapy for skin injuries and diseases with the photobiomodulation in which light at low energy levels modulates intra- and extra-cellular photoreceptors by molecular and cellular processes that can stimulate both anti-inflammatory mechanisms and cell proliferative response. The irradiation effects are activated soon after exposure. The anti-inflammatory action on some classes of cytokines and cells (e.g. mast cells and macrophages) is completed with the stimulation of the nitric oxide production, which has an anti-inflammatory and vasodilation action, and gives analgesic relief. Our attention focused on photobiomodulator medical device emitting polarized light. 30 patients (19 women and 11 men) were enrolled in the present study. They were treated for chronic lesions using Bioptron® Light Therapy System device. Patients were initially subjected to Bioptron® light for 20 min after cleansing of the lesion. The operating protocol provides 24 sessions: twice per week for 12 weeks. Twenty patients have been studied for symptoms, histological samples and ulcer characteristics. After 2 months, a reduction of 50% of the lesions was recorded in 18 patients (60%), while in the remaining patients a slower healing was observed. The total wound healing was achieved after 3 months in 13 patients (43%). The examined parameters of the symptom were exudation, pain and signs of infection. Results at 1 and 3 months were, Exudation: at 1 month reduction and positive modulation was observed in 16 patients (53%) and in 25 patients at 3 months; Pain: (evaluated with Vas scale), decreased in 21 patients at 1 month (70%) and in 100% of cases at 3 months; Infections: regressed or disappeared in 100% of cases after the first month. Today, it is no longer time for monotherapy applications, especially in regenerative medicine and the adoption of biophysical therapies can play a positive anti-inflammatory and regenerative role enhancing the function of non-invasive therapies.

Treatment of skin defects with growth factors and biodegradable collagen carrier: histological evaluation in animal model

The aim of the present study is to evaluate the effects on skin regeneration of a new collagen matrix (CM-10826) when used in different combination with or without growth factors, using skin regeneration without membrane as control. An area of 10x15 cm on rabbit back was shaved and three circular wounds on test side were covered with a differently soaked membrane. The first wound was soaked with Epidermal Growth Factor (EGF, 26mg/130mL) (Test EGF), the second with Platelet-Derived Growth Factor (PDGF, 6mg/120mL) (Test PDGF) and the third with EGF (13mg/65mL) and PDGF (3mg/60mL) (Test EGF+PDGF). On the control side, there was a dry membrane. After 7 days, the experiment was concluded. Healing process was evaluated at day 2 and 6 postoperatively. Analysis was made clinically and with light microscopy (LM), transmission electron microscopy (TEM) and scanning electron microscopy (SEM). Analyses with LM of Test EGF showed evidence of neoangiogenesis and good epithelium growth. Test PDGF resulted in moderate angiogenesis, less evident epithelial growth and more evident mesenchymal growth than Test EGF. Test EGF+PDGF showed rich angiogenesis, massive growth of epithelium and mesenchymal tissue. Control side showed weak angiogenesis, regenerating wound margin with normal epithelium and less dense mesenchymal layer. Analysis at TEM and SEM confirmed what was noticed at LM. In vivo studies on rabbits have shown that membrane CM10826 is well tolerated, it gives neither inflammation nor foreign body reactions and does not disturb healing process. CM10826 is safe, modulates angiogenesis and induces migration and proliferation of keratinocytes.

Laser treatment of post-thyroidectomy scar

A good aesthetic result in thyroid surgery is one of the main goals, as this procedure usually involves young women affected in clearly visible anatomical areas. To minimize the detrimental effects of scarring outcome, several therapeutic options have been employed. Lasers may be an alternative choice for prevention and treatment of post-surgical thyroidectomy scar. This paper reviews literature and the current knowledge on this topic. A comprehensive search in the Cochrane Library, MEDLINE and PUBMED databases was performed to identify relevant literature investigating the role of laser therapy in both prevention and treatment of unappealing scarring after thyroid surgery. Laser treatment of post-thyroidectomy scar is emerging with promising clinical outcomes. The greatest efficacy has been seen with vascular-selective and ablative sources. Laser therapy should be taken into account as it represents a valid and safe treatment option.

Stigmata in the history: between faith, mysticism and science

Stigmata are one of the most ancient and fascinating mysteries of the Christian religion. The word “stigmata” derives by the Greek “stigma”, that means sign, mark. Classically, stigmata are the sores inflicted on Jesus Christ during his passion and crucifixion. Today, the term stigmatized has been extended to designate several cases of individuals, who show skin sores similar to those of Christ. The Authors report a brief history of stigmata, trying to give an explanation to such a fascinating phenomenon.

Regenerative medicine in the treatment of gastro-esophageal reflux disease and laryngo-pharyngeal reflux. From research to cure

We present our observational study on 40 patients treated with the medical device containing sodium hyaluronic acid and magnesium alginate, performing a lubricating and hydrating action. This device is in the form of a gel, with topical action to contrast gastroesophageal reflux and to exert a mechanical role of protection of the mucosal tissues (mouth-pharyngo-esophageal mucosa and gastric mucose.). Forty patients were recruited aged between 22- and 72-years-old with painful dyspeptic Gastro Esophageal Reflux Disease (GERD) symptomatology in acute or in clinical phase (25 patients) and with pharyngolaryngo- tracheal symptomatology (15 patients). Patients were divided into two clinical groups: Group A was treated with the medical device, while Group B with conventional treatments without the medical device. Subjects of both groups were also treated with proton pump inhibitors (PPIs). Follow-up was at 10, 20 and 30 days and patients were evaluated for reduction of their subjective symptoms, reduction of symptomatic and occasional therapies, reduction of inflammatory process or disappearance of epithelial lesions of the examined mucosa, healing process. The reduction of subjective symptoms was observed at 10 days in the patient with food bolus (disappearance after 5 days) and in patients with a reduction of 70%. A relevant reduction in the use of symptomatic drugs was noted. Our data are relevant considering symptom relief (heartburn, reflux and dyspepsia). New scenarios for the treatment of inflammatory diseases of the digestive and respiratory tract mucosa are at the horizon. Interdisciplinary translational research brings to the development of novel medical devices (as the one described in this study) with a high safety profile, and extremely active on the inflammation-repair-regeneration complex of different tissues and organs.