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Brusasco M, Kalaja A, Satolli F, Feliciani C, De Felici Del Giudice MB. A Case of Noonan Syndrome and Kyrle Disease: Casualty or Causality? Acta Dermatovenerol Croat 2023; 31:160-161. [PMID: 38439730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/06/2024]
Abstract
A 39-year-old Caucasian woman affected by Noonan Syndrome (NS) mutated in RAF1 was referred to us with itchy lesions on her limbs that had appeared two months earlier. Clinically, there were multiple umbilicated papules with a hyperkeratotic central plug, localized on the upper and lower limbs (Figure 1, a-b). The patient had no personal history of diabetes mellitus or chronic renal failure, but suffered from hypertrophic cardiomyopathy. Blood tests showed no abnormalities. On histological examination of a skin lesion, an ectatic hair follicle with a hyperkeratotic ostium was observed with fragments of hair, inflammatory cells, and epidermal perforation. A final diagnosis of Kyrle disease (KD) was established. The patient underwent narrowband UVB (NB-UVB) phototherapy with residual atrophic scars (Figure 1, c-d), but with a complete and long-lasting resolution of symptoms. KD belongs to perforating dermatoses (PD), a heterogeneous group of skin diseases characterized by the transepidermal elimination of dermal components. Despite the classification of PD still being under debate, four primary forms are traditionally recognized: reactive perforating collagenosis, elastosis perforans serpiginosum, perforating folliculitis, and KD (1). The typical skin manifestation of KD is an eruption of dome-shaped papules and nodules, with a whitish central keratotic plug, mainly localized on the extremities and the buttocks. Described by Kyrle in 1916, KD is frequently associated with systemic diseases, especially chronic renal failure and diabetes mellitus. Other associated conditions include chronic hepatic disease, internal malignancies, and congestive heart disease (1). Despite the absence of a consensus, the control of the underlying disease remains the first therapeutic target. Both topical (keratolytics, retinoids, and corticosteroids) and systemic treatments (corticosteroids, retinoids, antibiotics, and phototherapy) have been reported to control skin manifestations (2). In our experience, NB-UVB is an effective option as first-line therapy in case of diffuse lesions, both in KD and in other PD (3). NS is a relatively common RASopathy, a heterogenous group of genetic diseases characterized by a defect of the Ras-mitogen-activated protein kinase (Ras-MAPK) pathway, with an estimated prevalence of 1/1000-2500. PTPN11 is the most frequent mutated gene, accounting for 50% of cases, but more than ten genes have been identified as causing NS (4). Classical features include a distinctive facial dysmorphism, short stature, pulmonic stenosis, and other anomalies of different organs. The skin is commonly involved. Keratinization disorders and hair abnormalities such as keratosis pilaris, ulerythema ophryogenes, wavy or curly hair, and scarce scalp hair, are often described. Other cutaneous signs include easy bruising, skin hyperlaxity, multiple lentigines, and café-au-lait spots (5). To the best of our knowledge, no cases of KD in patients with NS have been previously reported to date. The exact etiopathogenesis of KD is not clear, but it has been hypothesized that systemic diseases, such as diabetes and chronic renal failure, can cause a deposit of substances or dermis alterations, which triggers the inflammatory process with subsequent transepidermal extrusion (1). In our patient, we ruled out all the causes commonly associated with KD. It is however possible that this manifestation could be a direct result of the patient's illness. Our patient suffered from diffuse keratosis pilaris, and an abnormal epidermal keratinization with a secondary inflammatory dermic response is among the suggested possible pathogenetic mechanisms of KD (1). On the other hand, the hyperlaxity and fragility of the skin typical of NS suggest the presence of altered connective tissue, which could trigger an abnormal keratinization and, subsequently, the transepidermal extrusion, as well as perforating elastosis, which is associated with genetic connective tissue diseases (1). Moreover, our patient suffered from a cardiac disease, another condition associated with KD (5). Although these explanations have their appeal, there is currently insufficient evidence of a link between KD and NS, and it will be necessary to collect additional data to confirm this hypothesis.
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Affiliation(s)
- Marco Brusasco
- Marco Brusasco, MD, Dermatology Section Department of Medicine and Surgery, University of Parma, Via Gramsci, 14, 43126 Parma, Italy;
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Massa A, Macchi S, Manuguerra R, Brusasco M, Aouadi M, Feliciani C, Satolli F. Is tumoral melanosis still a challenge? A case of tumoral melanosis without metastasis. Int J Dermatol 2023; 62:e618-e620. [PMID: 37670681 DOI: 10.1111/ijd.16830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 07/24/2023] [Accepted: 08/23/2023] [Indexed: 09/07/2023]
Affiliation(s)
- Alessandra Massa
- Section of Dermatology, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Stefano Macchi
- Section of Dermatology, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Roberta Manuguerra
- Pathology Unit, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Marco Brusasco
- Section of Dermatology, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Mohamed Aouadi
- Section of Dermatology, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Claudio Feliciani
- Section of Dermatology, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Francesca Satolli
- Section of Dermatology, Department of Medicine and Surgery, University of Parma, Parma, Italy
- Dermatologic Unit, University Hospital of Parma, Parma, Italy
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Medri M, Savoia F, Foca F, Miserocchi A, Quaglino P, Rubatto M, Gullo G, Nardini C, Panasiti V, DE Tursi M, DI Marino P, Brancaccio G, Giunta EF, Napolitano S, Cinotti E, Brusasco M, Stanganelli I. A retrospective observational study on cutaneous adverse events induced by immune checkpoint inhibitors. Ital J Dermatol Venerol 2023; 158:437-444. [PMID: 38015482 DOI: 10.23736/s2784-8671.23.07542-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2023]
Abstract
BACKGROUND Cutaneous adverse events (CAEs) related to oncological therapies are a common scenario in daily clinical practice. METHODS This is a retrospective observational study collecting the data regarding CAEs of patients treated with immune checkpoints inhibitors (ICIs) in four different Italian centers. RESULTS Of 323 patients included, 305 were evaluable for this analysis; 182 patients (59.7%) had metastatic cutaneous melanoma (CM), 99 (32.5%) non-small cell lung cancer (NSCLC) and 24 (7.8%) renal cell carcinoma (RCC). The most frequent CAEs that we found, considering all the 305 patients, were pruriginous maculopapular rash (10.2% of the patients), vitiligo-like areas (7.2% of the patients), psoriasiform rash (6.2% of the patients), asymptomatic maculopapular rash (4.6% of the patients), and lichenoid rash (4.3% of the patients). Vitiligo-like areas occurred more frequently in patients with CM, while a lichenoid rash was more frequently observed in patients with RCC. Treatment interruption was related to drug-induced CAEs in 15.4% of melanoma patients and 0.0% of lung and kidney patients. Patients developing a cutaneous adverse event had better overall response rate and higher progression free survival and overall survival than the patients without CAEs. CONCLUSIONS Our study brings new information on the characteristics of CAEs related to ICIs treatment in three different types of cancers, CM, NSCLC and RCC.
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Affiliation(s)
- Matelda Medri
- Unit of Skin Cancer, IRCCS Istituto Romagnolo per lo Studio dei Tumori Dino Amadori, IRST, Meldola, Forlì-Cesena, Italy
| | - Francesco Savoia
- Unit of Skin Cancer, IRCCS Istituto Romagnolo per lo Studio dei Tumori Dino Amadori, IRST, Meldola, Forlì-Cesena, Italy -
| | - Flavia Foca
- Unit of Biostatistics and Clinical Trials, IRCCS Istituto Romagnolo per lo Studio dei Tumori Dino Amadori, IRST, Meldola, Forlì-Cesena, Italy
| | - Anna Miserocchi
- Unit of Biostatistics and Clinical Trials, IRCCS Istituto Romagnolo per lo Studio dei Tumori Dino Amadori, IRST, Meldola, Forlì-Cesena, Italy
| | - Pietro Quaglino
- Department of Medical Sciences, Dermatologic Clinic, University of Turin Medical School, Turin, Italy
| | - Marco Rubatto
- Department of Medical Sciences, Dermatologic Clinic, University of Turin Medical School, Turin, Italy
| | - Giulia Gullo
- Department of Medical Sciences, Dermatologic Clinic, University of Turin Medical School, Turin, Italy
| | - Chiara Nardini
- Department of Medical Sciences, Dermatologic Clinic, University of Turin Medical School, Turin, Italy
| | - Vincenzo Panasiti
- Unit of Plastic and Reconstructive Surgery, Campus Bio-Medico University, Rome, Italy
| | - Michele DE Tursi
- Department of Innovative Technologies in Medicine and Dentistry, University G. D'Annunzio of Chieti-Pescara, Chieti, Italy
| | - Pietro DI Marino
- Department of Innovative Technologies in Medicine and Dentistry, University G. D'Annunzio of Chieti-Pescara, Chieti, Italy
| | | | - Emilio F Giunta
- Unit of Oncology, Luigi Vanvitelli University of Campania, Naples, Italy
| | | | - Elisa Cinotti
- Unit of Dermatology, Department of Medical, Surgical and Neurological Sciences, University of Siena, Siena, Italy
| | - Marco Brusasco
- Unit of Dermatology, Department of Clinical and Experimental Medicine, University of Parma, Parma, Italy
| | - Ignazio Stanganelli
- Unit of Skin Cancer, IRCCS Istituto Romagnolo per lo Studio dei Tumori Dino Amadori, IRST, Meldola, Forlì-Cesena, Italy
- Unit of Dermatology, Department of Clinical and Experimental Medicine, University of Parma, Parma, Italy
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Brusasco M, Feliciani C, De Felici del Giudice MB. A case of chronic granulomatous disease and acne: is isotretinoin a safe treatment? Dermatol Reports 2022. [DOI: 10.4081/dr.2023.9631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
We report the case of a patient with chronic granulomatous disease and acne treated with isotretinoin, who developed a diffuse staphylococcal skin infection during the therapy. Chronic granulomatous disease is a rare genetic disorder characterized by an altered innate immunity with an increased risk of potentially lethal bacterial and fungal infections. Although chronic granulomatous disease is rare, acne is a common manifestation in these patients, but there are no data about the gold standard therapy.
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Caini S, Brusasco M, Niero G, De Giorgi V, Lombardo M, Massone C, Medri M, Palmieri G, Pizzichetta M, Quaglino P, Satta R, Feliciani C, Gandini S, Stanganelli I. Health Care and Safety of Patients with Melanoma during the COVID‐19 Pandemic in Italy. J Eur Acad Dermatol Venereol 2022; 36:e510-e512. [PMID: 35278222 PMCID: PMC9115002 DOI: 10.1111/jdv.18056] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- S. Caini
- Cancer Risk Factors and Lifestyle Epidemiology Unit Institute for Cancer Research, Prevention and Clinical Network (ISPRO) Florence Italy
| | - M. Brusasco
- Section of Dermatology Department of Medicine and Surgery University of Parma Parma Italy
| | - G. Niero
- Italian Association of Melanoma Patients (AIMaMe) Rome Italy
| | - V. De Giorgi
- Department of Dermatology University of Florence Florence Italy
| | - M. Lombardo
- Department of Dermatology Ospedale di Circolo e Fondazione Macchi Varese Italy
| | - C. Massone
- Dermatology Unit Galliera Hospital Genoa Italy
| | - M. Medri
- Skin Cancer Unit Istituto Scientifico Romagnolo per lo Studio dei Tumori (IRST) Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Meldola FC Italy
| | - G. Palmieri
- Immuno‐Oncology & Cancer Biotherapies University of Sassari ‐ Unit of Cancer Genetics, Institute for Genetic and Biomedical Research – National Research Council (IRGB‐CNR) Sassari Italy
| | - M.A. Pizzichetta
- Dermatologic Clinic University of Trieste Trieste Italy
- Department of Medical Oncology Centro di Riferimento Oncologico di Aviano (CRO), (IRCCS) Aviano Italy
| | - P. Quaglino
- Dermatologic Clinic Department of Medical Sciences University of Turin Medical School Turin Italy
| | - R. Satta
- Department of Surgical Microsurgical and Medical Sciences Unit of Dermatology University of Sassari Sassari Italy
| | - C. Feliciani
- Section of Dermatology Department of Medicine and Surgery University of Parma Parma Italy
| | - S. Gandini
- Division of Epidemiology and Biostatistics European Institute of Oncology Milan Italy
| | - I. Stanganelli
- Section of Dermatology Department of Medicine and Surgery University of Parma Parma Italy
- Italian Association of Melanoma Patients (AIMaMe) Rome Italy
- Department of Dermatology University of Florence Florence Italy
- Department of Dermatology Ospedale di Circolo e Fondazione Macchi Varese Italy
- Dermatology Unit Galliera Hospital Genoa Italy
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Di Donato E, Becciolini A, DI Nuzzo S, Chernyschova N, Commisso C, Lamorte S, Brusasco M, Pierobon E, Santilli D, Lucchini G, Riva M, Sverzellati N, Mozzani F, Ariani A. AB0578 SUBCLINICAL ENTHESITIS IN PSORIASIS patiEntS AS prediCtor OF ARTHRITIS (EPESCA STUDY): PRELIMINARY RESULTS. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.3149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background:Enthesitis is one of the typical pathological signs of spondyloarthritis such as psoriatic arthritis (PsA) and it seems to be the Primum movens of the disease. Clinical assessment of enthesitis showed to be less sensitive, compared to ultrasound (US) evaluation, in identifying enthesitis in patients with PsA [1].OMERACT defined US enthesitis as: “hypoechoic and/or thickened insertion of the tendon close to the bone (within 2 mm from the bony cortex), which exhibits Doppler signal if active and that may show erosions, enthesophytes/calcifications as a sign of structural damage” [3]The reported prevalence of subclinical enthesitis in psoriasis (PsO) patients in different countries ranges between 7% and 20% [2].Objectives:The main objective of this study was to estimate, by US evaluation, the prevalence of subclinical enthesitis in PsO patients without any clinical signs of enthesitis. Secondary objectives were to analyze differences, in terms of age, sex, BMI, PsO onset and diagnosis, among patients with enthesitis (active or not active), enthesopathy and without any alteration of enthesis.According to the OMERACT definition of ultrasound enthesitis, patients were divided into 4 groups: patients with active enthesitis (AE) defined as the presence of power-Doppler signal in a hypoechoic and/or thickened insertion of the tendon close to the bone; patient with enthesitis (En) defined as hypoechoic and/or thickened insertion of the tendon close to the bone without PD signal; patients with enthesopathy (Ep) defined as the presence of structural damage (erosions, enthesophytes/calcifications); patients without any alteration of enthesis (WE).Methods:Patients with at least 18 years and a diagnosis of PsO made by a Dermatologist were included. Exclusion criteria were the presence of clinical symptoms or signs of articular or entheseal involvement, diagnosis of arthritis and therapy with bDMARDs or tsDMARDs.All patients underwent US examination on grey scale and Power Doppler (PD) ultrasonography of 6 sites (Achilles, quadriceps, distal and proximal patellar, plantar fascia and triceps enthesis) bilaterally. Ultrasound was performed by an experienced sonographer, using a Logiq P9 equipped with 6-12 MHz broad band linear transducer. Data were reported as frequencies and median with interquartile range. To check differences among these four groups, we used chi-square test or Kruskall-Wallis test. P-value ≤ 0.05 is considered statistically significant.Results:We enrolled 124 consecutive psoriasis patients (47 [37.9%] female) with median age 57.7 (45.3-66.5) years, median disease duration 20.4 (10.1-30.8) years, median BMI 27 [24-29]. Patients with AE, En, Ep were 20.2% (25/124), 49.2% (61/124) and 18.5% (23/124), respectively.Patients WE (12.1%, 15/124) showed significantly lower BMI, younger age and shorter diagnostic delay compared to the other patients.All signs of enthesopathy/enthesitis were more frequently observed at Achilles (33.1%, 41/124), triceps (23.4%, 29/124), quadriceps (20.2%, 25/124), distal patellar (18.5%, 23/124) and proximal patellar (4.8%, 6/124) enthesis.Conclusion:Subclinical enthesitis is quite common in PsO patients, and about 20% showed active enthesitis. The enthesopathy seems to be more frequent in patients with increased delay in PsO diagnosis, older age and higher BMI.References:[1]Bandinelli F. et al. Ultrasound detects occult entheseal involvement in early psoriatic arthritis independently of clinical features and psoriasis severity. Clin Exp Rheumatology. Mar-Apr 2013;31(2):219-24.[2]Zuliani F. et al. Ultrasonographic detection of subclinical enthesitis and synovitis: a possible stratification of psoriatic patients without clinical musculoskeletal involvement. Clin Exp Rheumatol Jul-Aug 2019;37(4):593-599.[3]Balint P. V. et al. Reliability of a consensus-based ultrasound definition and scoring for enthesitis in spondyloarthritis and psoriatic arthritis: an OMERACT US initiative. Ann Rheum Dis 2018 Dec;77(12):1730-1735.Disclosure of Interests:None declared.
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De Felici Del Giudice MB, Brusasco M, Rovesti M, Manuguerra R, Dominici MM, Zucchi A, Feliciani C, Stanganelli I. A Nodular Pink Lesion with an Uncommon Diagnosis: A Quiz. Acta Derm Venereol 2020; 100:adv00236. [PMID: 32618353 PMCID: PMC9207639 DOI: 10.2340/00015555-3590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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