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Fabrazzo M, Romano F, Arrigo M, Puca RV, Fuschillo A, De Santis V, Sampogna G, Giordano GM, Catapano F, Lo Schiavo A. A Multivariate Analysis of Depression Prevalence in Psoriasis Patients: A Cohort Study. Int J Environ Res Public Health 2022; 19:ijerph19042060. [PMID: 35206248 PMCID: PMC8871876 DOI: 10.3390/ijerph19042060] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 02/07/2022] [Accepted: 02/08/2022] [Indexed: 11/28/2022]
Abstract
The literature reported higher depression rates in psoriasis patients compared to the general population. Our study aimed to verify whether variability in depression prevalence was due to using different diagnostic tools. We also aimed to determine whether dysfunctional coping strategies might increase the depression burden. We assessed psoriasis severity by the Psoriasis Area Severity Index (PASI) and PSOdisk. We analyzed mental alterations of 120 outpatients by Hamilton Depression and Anxiety Rating Scales (HAM-D and HAM-A), Symptom Checklist-90-Revised (SCL-90-R), plus coping strategies and quality of life by Coping Orientation to Problems Experienced (COPE) Inventory and 36-Item Short Form Health Survey (SF-36). We divided our cohort into five subgroups from minimal to severe psoriasis using the PSOdisk total score. Depression prevalence varied according to the assessment criteria for specificity, frequency, and severity. Different mood disorders other than major depression emerged when we used DSM-IV-TR criteria. Correlation analysis of the criteria we used to diagnose depression or depressed mood indicated that a dysfunctional coping strategy was highly and positively correlated only in patients of the severe subgroup. Differently, a negative correlation emerged between the SF-36 Mental Summary Component (MSC) and behavioral disengagement, thus suggesting that psychopathological distress might induce patients with a marked/severe psoriasis to adopt dysfunctional coping strategies. Dermatologists are fundamental in detecting comorbid depression, referring psoriasis patients to mental health specialists to achieve adequate treatments, and preventing suicide risk.
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Affiliation(s)
- Michele Fabrazzo
- Department of Psychiatry, University of Campania “Luigi Vanvitelli”, Largo Madonna delle Grazie 1, 80138 Naples, Italy; (M.A.); (A.F.); (V.D.S.); (G.S.); (G.M.G.); (F.C.)
- Correspondence: ; Tel.: +39-(0)81-566-65-29
| | - Francesca Romano
- Dermatology Unit, University of Campania Luigi Vanvitelli, 80131 Naples, Italy; (F.R.); (R.V.P.); (A.L.S.)
| | - Marzia Arrigo
- Department of Psychiatry, University of Campania “Luigi Vanvitelli”, Largo Madonna delle Grazie 1, 80138 Naples, Italy; (M.A.); (A.F.); (V.D.S.); (G.S.); (G.M.G.); (F.C.)
| | - Rosa Valentina Puca
- Dermatology Unit, University of Campania Luigi Vanvitelli, 80131 Naples, Italy; (F.R.); (R.V.P.); (A.L.S.)
| | - Antonietta Fuschillo
- Department of Psychiatry, University of Campania “Luigi Vanvitelli”, Largo Madonna delle Grazie 1, 80138 Naples, Italy; (M.A.); (A.F.); (V.D.S.); (G.S.); (G.M.G.); (F.C.)
| | - Valeria De Santis
- Department of Psychiatry, University of Campania “Luigi Vanvitelli”, Largo Madonna delle Grazie 1, 80138 Naples, Italy; (M.A.); (A.F.); (V.D.S.); (G.S.); (G.M.G.); (F.C.)
| | - Gaia Sampogna
- Department of Psychiatry, University of Campania “Luigi Vanvitelli”, Largo Madonna delle Grazie 1, 80138 Naples, Italy; (M.A.); (A.F.); (V.D.S.); (G.S.); (G.M.G.); (F.C.)
| | - Giulia Maria Giordano
- Department of Psychiatry, University of Campania “Luigi Vanvitelli”, Largo Madonna delle Grazie 1, 80138 Naples, Italy; (M.A.); (A.F.); (V.D.S.); (G.S.); (G.M.G.); (F.C.)
| | - Francesco Catapano
- Department of Psychiatry, University of Campania “Luigi Vanvitelli”, Largo Madonna delle Grazie 1, 80138 Naples, Italy; (M.A.); (A.F.); (V.D.S.); (G.S.); (G.M.G.); (F.C.)
| | - Ada Lo Schiavo
- Dermatology Unit, University of Campania Luigi Vanvitelli, 80131 Naples, Italy; (F.R.); (R.V.P.); (A.L.S.)
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Lo Schiavo A, Puca RV, Romano F, Milani M. WITHDRAWN: Efficacy and local tolerability of different spray products in the treatment of mild to moderate acne of the back and chest. A controlled, 3-arm, assessor-blinded prospective trial. GIORN ITAL DERMAT V 2017:R23Y9999N00A16112301. [PMID: 27879948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
AHEAD OF PRINT ARTICLE WITHDRAWN BY PUBLISHER.
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Affiliation(s)
- Ada Lo Schiavo
- Clinica di Dermatologica SUN, II Università di Napoli, Naples, Italy
| | - Rosa V Puca
- Clinica di Dermatologica SUN, II Università di Napoli, Naples, Italy
| | - Francesca Romano
- Clinica di Dermatologica SUN, II Università di Napoli, Naples, Italy
| | - Massimo Milani
- Medical Direction Difa Cooper IFC Group, Caronno Pertusella, Varese, Italy -
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Abstract
Etanercept is a competitive inhibitor of tumor necrosis factor-alpha (TNF-α) a polypeptide hormone, involved in the development of the immune system, in host defense and immune surveillance. Even if the etanercept mechanism of action is not completely understood, it is supposed that it negatively modulates biological responses mediated by molecules (cytokines, adhesion molecules, or proteinases) induced or regulated by TNF. For this reason, it is widely used in the treatment of immunologicals diseases, such as rheumatoid and psoriatic arthritis, polyarticular juvenile idiopathic active, ankylosing spondylitis, and plaque psoriasis. Etanercept has a good tolerability profile. Adverse events related to skin are rare, arising usually in about 5% of patients treated with anti-TNF α. In this scenario, we describe a case of figurate urticaria arose after the re-administration of etanercept in a patient affected by psoriasis and hepatitis B. A 65-year-old man, affected by psoriasis, was hospitalized in September 2014 to the Regional Center for the treatment of psoriasis and Biological Drugs of Second University of Naples for progressive extension of psoriatic skin lesions. The laboratory analysis detected positivity for hepatitis B virus (HBV) antigens. For this reason, it was administered to him lamivudine 100 mg/die about 30 days before to start etanercept treatment. The etanercept therapy has resulted in a progressive improving of skin manifestations, and the patient decided individually to stop the therapy. Afterwards, for worsening of the psoriatic lesions, he was again hospitalized and treated with the same therapeutic schedule (lamivudine followed by etanercept). Ten days after the start of therapy, the patient showed the onset of urticarial rash. Due to this, the treatment with lamivudine and etanercept was suspended and the patient's clinical conditions improved. It is probably that immunological disorders due to etanercept therapy and HBV infection could explain the onset of figurate urticaria in our patient. In this contest, the post-marketing surveillance confirms its important role in the monitoring of drugs tolerability and effectiveness.
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Affiliation(s)
- Maurizio Sessa
- Department of Experimental Medicine, Pharmacoepidemiology and Pharmacovigilance Centre of the Campania Region, Section of Pharmacology, Second University of Naples, Via Costantinopoli 16, 80138 Naples, Italy
| | - Maria Giuseppa Sullo
- Department of Experimental Medicine, Pharmacoepidemiology and Pharmacovigilance Centre of the Campania Region, Section of Pharmacology, Second University of Naples, Via Costantinopoli 16, 80138 Naples, Italy
| | - Annamaria Mascolo
- Department of Experimental Medicine, Pharmacoepidemiology and Pharmacovigilance Centre of the Campania Region, Section of Pharmacology, Second University of Naples, Via Costantinopoli 16, 80138 Naples, Italy
| | - Daniela Cimmaruta
- Department of Experimental Medicine, Pharmacoepidemiology and Pharmacovigilance Centre of the Campania Region, Section of Pharmacology, Second University of Naples, Via Costantinopoli 16, 80138 Naples, Italy
| | - Francesca Romano
- Department of Dermatology, Second University of Naples, Naples, Italy
| | | | - Annalisa Capuano
- Department of Experimental Medicine, Pharmacoepidemiology and Pharmacovigilance Centre of the Campania Region, Section of Pharmacology, Second University of Naples, Via Costantinopoli 16, 80138 Naples, Italy
| | - Francesco Rossi
- Department of Experimental Medicine, Pharmacoepidemiology and Pharmacovigilance Centre of the Campania Region, Section of Pharmacology, Second University of Naples, Via Costantinopoli 16, 80138 Naples, Italy
| | - Ada Lo Schiavo
- Department of Dermatology, Second University of Naples, Naples, Italy
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Caccavale S, Lo Schiavo A. Psychiatric morbidity and pemphigus: a review of theories and literature on pathogenesis. GIORN ITAL DERMAT V 2016; 151:198-202. [PMID: 25236320] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Skin diseases are very common in the community and a large number of general practice visits are due to dermatological problems. Most dermatologists believe that psychiatric problems are frequent among subjects coming to their attention and several studies on dermatological patients have revealed that they prevalently suffered from psychiatric disorders. However, there are only few articles in the literature dealing with stress-induced pemphigus or psychiatric troubles associated with pemphigus. The relationship between pemphigus and psychiatric disorders is still a matter of debate. The first question is whether the association is circumstantial or causal. Subsequently, it should be clarified if psychogenic factors can be considered an inducing factor for pemphigus onset, or a possible complication of this skin disease, or a comorbidity of it, or, in the end, an adverse reaction to conventional therapy for pemphigus. In any case, further studies are needed to investigate the underlying mechanism linking psychiatric diseases and pemphigus.
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Affiliation(s)
- Stefano Caccavale
- Department of Dermatology, Second University of Naples, Naples, Italy -
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Lo Schiavo A, Tirri R, Peccerillo F, Abbondanza C, Russo B, Caccavale S. Rosacea and abatacept: the first report of a possible correlation. GIORN ITAL DERMAT V 2016; 151:123. [PMID: 26924033] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
- Ada Lo Schiavo
- Department of Dermatology, Second University of Naples, Naples, Italy -
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Ruocco E, Lo Schiavo A, Gambardella A, Ruocco V. Annular Elastolytic Giant Cell Granuloma and Temporal Arteritis Following Herpes Zoster. Skinmed 2015; 13:267-269. [PMID: 26861422] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
- Eleonora Ruocco
- Department of Dermatology, Second University of Naples, Naples, Italy;
| | - Ada Lo Schiavo
- Department of Dermatology, Second University of Naples, Naples, Italy
| | | | - Vincenzo Ruocco
- Department of Dermatology, Second University of Naples, Naples, Italy
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Abstract
Locus minoris resistentiae (lmr) refers to a body region more vulnerable than others. This ancient concept, which is also present in Achilles' and Siegfried's old epic myths, weaves through many fields of medicine. In any internal organ or external body region with a congenital or acquired altered defense capacity, a disease process may occur more easily than elsewhere. Illustrative instances are the appearance of hepatocarcinoma on a cirrhotic liver, the onset of lung carcinoma in a tuberculosis scar, cases of osteosarcoma arising in chronic osteomyelitis, and carcinoma complicating chronic cholelithiasis, just to name a few. In dermatology there are countless reports of privileged localization of cutaneous lesions on injured skin which, therefore, represents a typical condition of lmr. The Köbner phenomenon itself features the oldest, simplest, and most common example of lmr, because it denotes the appearance of new lesions pertaining to a previously present skin disorder at the sites of trauma or other insult. The modern transposition of this old but still valid way of thinking in medicine is the reading key of this issue, devoted to lmr in dermatology.
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Affiliation(s)
- Ada Lo Schiavo
- Department of Dermatology, 2nd University of Naples, via Sergio Pansini, 580131 Napoli, Italy.
| | - Eleonora Ruocco
- Department of Dermatology, 2nd University of Naples, via Sergio Pansini, 580131 Napoli, Italy
| | - Teresa Russo
- Department of Dermatology, 2nd University of Naples, via Sergio Pansini, 580131 Napoli, Italy
| | - Gabriella Brancaccio
- Department of Dermatology, 2nd University of Naples, via Sergio Pansini, 580131 Napoli, Italy
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Lo Schiavo A, Ruocco E, Gambardella A, O'Leary RE, Gee S. Granulomatous dysimmune reactions (sarcoidosis, granuloma annulare, and others) on differently injured skin areas. Clin Dermatol 2015; 32:646-53. [PMID: 25160106 DOI: 10.1016/j.clindermatol.2014.04.012] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Granulomatous disorders are chronic cell-mediated immune responses histologically characterized by collections of macrophages, epithelioid cells, and multinucleated giant cells. This disease spectrum often has an infectious origin, but sometimes neither an infective agent nor an inciting antigenic stimulus can be identified. The skin may be a preferential target for these disorders, especially in the areas that have been damaged by various forms of skin injury (eg, herpetic infections, trauma, thermal or solar burns, vaccinations, tattoos). These damaged skin sites frame the new concept of an immunocompromised cutaneous district (ICD), which defines a skin area with acquired immune dysregulation that can pave the way for the local onset of opportunistic disorders, such as infections, tumors, and granulomatous disorders. Sarcoidosis, granuloma annulare (GA), and forms of granulomatous vasculitis, such as Churg-Strauss syndrome (CSS) and Wegener's granulomatosis (WG), are the most common granulomatous disorders that occur in an ICD and may share common pathogenic mechanisms. Recent studies have found clinical and pathologic overlapping features across noninfectious granulomas. Although no unifying etiology exists, the development of granulomatous processes in the ICD has often been reported and the literature contains various hypotheses to explain it: (1) overactive immune response in a previously injured region with or without loss of immune tolerance; (2) overall reduced immune response; (3) retention of an exogeneous antigen or foreign body; (4) altered neural signaling; and (5) a combination of all the aforementioned processes. T helper cells, T regulatory cells, and macrophages, as well as a number of antigenic proteins, have been identified as potential contributing factors. In addition, a genetic predisposition and an intact systemic immune system are both instrumental for the persistence of local granuloma formation in the ICD.
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Affiliation(s)
- Ada Lo Schiavo
- Department of Dermatology, Second University of Naples, via Sergio Pansini, 5, 80131 Naples, Italy.
| | - Eleonora Ruocco
- Department of Dermatology, Second University of Naples, via Sergio Pansini, 5, 80131 Naples, Italy
| | - Alessio Gambardella
- Department of Dermatology, Second University of Naples, via Sergio Pansini, 5, 80131 Naples, Italy
| | - Ryan E O'Leary
- Division of Dermatology, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Sarah Gee
- Division of Dermatology, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
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Ruocco E, Di Maio R, Caccavale S, Siano M, Lo Schiavo A. Radiation dermatitis, burns, and recall phenomena: Meaningful instances of immunocompromised district. Clin Dermatol 2015; 32:660-9. [PMID: 25160108 DOI: 10.1016/j.clindermatol.2014.04.014] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Ionizing and ultraviolet radiations, as well as burns, can selectively damage and immunologically mark the cutaneous area they act on through direct and indirect mechanisms. After the causal event has disappeared, the affected skin district may appear clinically normal, but its immune behavior is often compromised forever. In fact, irradiated or burned skin areas undergo a destabilization of the immune control, which can lead to either a reduction of immunity (as suggested by the facilitated local occurrence of tumors and infections) or an excess of it (as suggested by the possible local onset of disorders with exaggerated immune response). In other words, these areas become typical immunocompromised districts (ICD). Also, in recall phenomena the damaged skin area usually behaves as an ICD with an exaggerated immune response toward a wide range of drugs (especially chemotherapeutic agents) that prove to be harmless on the undamaged skin surface. The occurrence of any skin disorder on an irradiated, photoexposed, or burned skin area can be defined as an isoradiotopic, isophototopic, or isocaumatopic response, respectively; however, the opposite may also occur when elsewhere generalized cutaneous diseases or eruptions selectively spare irradiated, photoexposed, or burned skin sites (isoradiotopic, isophototopic, and isocaumatopic nonresponse, respectively). The pathomechanisms involved in any secondary disorder occurring on irradiated or burned skin areas may be linked to locally decreased or altered lymph flow (with dysfunction of lymph drainage) on the one hand, and to fibrotic throttling or reduction of peptidergic nerve fibers (with dysfunction of neuroimmune signaling) on the other hand, resulting in a significant dysregulation of the local immune response. Future clinical observations and experimental investigations on radiation dermatitis, sunburns, and thermal or chemical skin injuries should shed new light on the mechanisms regulating regional resistance to infectious agents, local oncogenesis, and district propensity to dysimmune reactions.
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Affiliation(s)
- Eleonora Ruocco
- Department of Dermatology, Second University of Naples, via Sergio Pansini, 5, 80131 Naples, Italy.
| | - Rosa Di Maio
- Department of Dermatology, Second University of Naples, via Sergio Pansini, 5, 80131 Naples, Italy
| | - Stefano Caccavale
- Department of Dermatology, Second University of Naples, via Sergio Pansini, 5, 80131 Naples, Italy
| | - Maria Siano
- Department of Advanced Biomedical Sciences, Section of Surgical Pathology, University Federico II of Naples, Naples, Italy
| | - Ada Lo Schiavo
- Department of Dermatology, Second University of Naples, via Sergio Pansini, 5, 80131 Naples, Italy
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Ruocco E, Ruocco V, Lo Schiavo A, Brunetti G, Wolf R. Viruses and pemphigus: an intriguing never-ending story. Dermatology 2014; 229:310-5. [PMID: 25413257 DOI: 10.1159/000365845] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2014] [Accepted: 07/09/2014] [Indexed: 11/19/2022] Open
Abstract
Virus infections and autoimmunity have long been linked. As to pemphigus, many studies have been directed to prove or rule out the possibility of viral induction. Herpesviruses have often been related to the onset or reactivation of pemphigus. The association may be (i) casual, (ii) due to the iatrogenic immunosuppression facilitating opportunistic viral infections or (iii) based on a pathogenic link between the viral presence and the host's dysregulated immune response leading to autoimmunity. Japanese researchers, using real-time polymerase chain reaction, lately detected herpes simplex virus DNA in the saliva from pemphigus patients at the earliest stage of the disease and with no signs or history of herpetic infection, thus confirming the possible existence of cases of pemphigus induced by herpesviruses. These selected cases could be included into the innovative concept of 'paraviral eruptions', where an inciting role for induction may be played by the concomitant intake of certain drugs.
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Affiliation(s)
- Eleonora Ruocco
- Department of Dermatology, Second University of Naples, Naples, Italy
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Lo Schiavo A, Peccerillo F, Mascolo M, La Montagna M, Caccavale T, Gambardella A, Caccavale S. Inverse notalgia paresthetica: a strange case of professional disease. Int J Dermatol 2014; 54:e49-51. [DOI: 10.1111/ijd.12604] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Ada Lo Schiavo
- Department of Dermatology; Second University of Naples; Naples Italy
| | | | - Massimo Mascolo
- Department of Advanced Biomedical Sciences; University of Naples Federico II; Naples Italy
| | | | - Tobia Caccavale
- Department of Cardiovascular Surgery & Transplant; Monaldi Hospital; Second University of Naples; Naples Italy
| | | | - Stefano Caccavale
- Department of Dermatology; Second University of Naples; Naples Italy
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Abstract
Sarcoidosis is a systemic granulomatous disease characterized by the presence of non-caseating granulomas. Its etiology remains obscure. A plausible hypothesis suggests that a complex interplay of host factors, infectious processes, and non-infectious environmental factors, matched with a susceptible genetic background, results in a pathway that leads to systemic granulomatous inflammation. Although presentations of sarcoidosis vary enormously, multi-organ involvement is a common feature. Cutaneous involvement occurs in about 25% of patients with protean manifestations and variable prognoses. Skin manifestations are divided into specific lesions with histopathologically evident non-caseating granulomas and nonspecific lesions arising from a reactive process that does not form granulomas. A peculiar form of cutaneous sarcoidosis is represented by sarcoidal lesions at sites of trauma that has caused scarring. The pathogenesis of scar sarcoidosis remains unknown. Scar sarcoidosis is also associated with herpes zoster infection, surgery, and tattooing. Such heterogeneous events, along with those at the sites of chronic lymphedema, thermal burns, radiation dermatitis, and vaccinations, occur on areas of vulnerable skin labeled "immunocompromised districts". Numerous options are available for the treatment of cutaneous sarcoidosis. Although corticosteroids remain the treatment of choice for initial systemic therapy, other nonsteroidal agents have proven effective and therefore useful for long-term management. Tumor necrosis factor-α antagonists such as infliximab may have a role in the treatment of cutaneous sarcoidosis, especially in refractory cases that are resistant to standard regimens. Elucidation of the relationship of sarcoidal granulomas with malignancy and immunity may facilitate a better understanding of some pathomechanisms operating in neoplastic and immunity-related disorders.
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Affiliation(s)
- Eleonora Ruocco
- Department of Dermatology, Second University of Naples, Naples, Italy
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Abstract
Statins, also known as 3-hydroxy-3-methylglutaril-CoA reductase inhibitors, are well-tolerated drugs used for prevention of atherosclerosis and cardiovascular events. Although they are generally considered safe, some serious adverse effects, such as myositis, myopathy, and rhabdomyolysis can rarely occur. Furthermore, recent data from long-term follow-up on patients who have been taking statins for a long period of time suggest that prolonged exposure to statins may trigger autoimmune reactions. The exact mechanism of statin-induced autoimmune reactions is unclear. Statins, as proapoptotic agents, release nuclear antigen into the circulation and may induce the production of pathogenic autoantibodies. Herein we report the case of a 70 year-old man who developed a relapse of pemphigus erythematosus, a syndrome with features of both lupus erythematosus and pemphigus, after atorvastatin intake.
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Affiliation(s)
- Ada Lo Schiavo
- Department of Dermatology, Second University of Naples, Naples, Italy
| | | | - Francesca Romano
- Department of Dermatology, Second University of Naples, Naples, Italy
| | - Roberto Cozzi
- Department of Dermatology, AORN "A Cardarelli", Naples, Italy
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Ruocco E, Caccavale S, Siano M, Lo Schiavo A. Radiation port cutaneous metastases: a further example of immunocompromised district. Indian J Dermatol 2014; 59:302-3. [PMID: 24891670 PMCID: PMC4037960 DOI: 10.4103/0019-5154.131420] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Eleonora Ruocco
- Department of Dermatology, Second University of Naples, Naples, Italy
| | - Stefano Caccavale
- Department of Dermatology, Second University of Naples, Naples, Italy
| | - Maria Siano
- Department of Advanced Biomedical Sciences, Section of Anatomical Pathology, University Federico II of Naples, Naples, Italy. E-mail:
| | - Ada Lo Schiavo
- Department of Dermatology, Second University of Naples, Naples, Italy
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Lo Schiavo A, Caccavale S, Alfano R, Gambardella A, Cozzi R. Bullous pemphigoid initially localized around the surgical wound of an arthroprothesis for coxarthrosis. Int J Dermatol 2014; 53:e289-90. [PMID: 24261580 DOI: 10.1111/ijd.12222] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [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] [Indexed: 11/29/2022]
Affiliation(s)
- Ada Lo Schiavo
- Department of Dermatology, Second University of Naples, Naples, Italy
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Lo Schiavo A, Caccavale S, Brancaccio G, Ruocco E. Multiple symmetric lipomatosis: an unusual case. Int J Dermatol 2014; 53:e144-5. [DOI: 10.1111/j.1365-4632.2012.05712.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Ada Lo Schiavo
- Department of Dermatology; Second University of Naples; Naples Italy
| | - Stefano Caccavale
- Department of Dermatology; Second University of Naples; Naples Italy
| | | | - Eleonora Ruocco
- Department of Dermatology; Second University of Naples; Naples Italy
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Lo Schiavo A, Cozzi R, Alfano R, Romano F, La Montagna M, Caccavale T, Capasso R, Mea EE, Caccavale S. A case of tuberculosis cutis colliquativa treated with rifampicin and isoniazid. Acta Dermatovenerol Croat 2014; 22:160-161. [PMID: 25102805] [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] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Affiliation(s)
| | | | | | | | | | | | | | | | - Stefano Caccavale
- Stefano Caccavale, MD, Department of Dermatology, Second University of Naples Via Sergio Pansini, 5, 80131 Napoli, Italy;
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Lo Schiavo A, Caccavale S, Del Vecchio M, Schiavone M, Alfano R, Bombace F, Iovene MR. Sporotrichoid cutaneous infection by Mycobacterium abscessus. Int J Dermatol 2013; 53:e291-2. [PMID: 24261556 DOI: 10.1111/ijd.12215] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Ada Lo Schiavo
- Department of Dermatology, Second University of Naples, Naples, Italy
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Abstract
Pemphigus, a prototypical organ-specific human autoimmune disease, may be associated with other immunity-related disorders, viral infections, and different types of tumors. Coexistence with immune diseases is fairly frequent and, for some of them (eg, myasthenia gravis, Basedow's disease, rheumatoid arthritis, or lupus erythematosus), common pathogenic mechanisms can be considered. The association with viral infections (mainly herpesvirus infections) raises the question of whether the virus triggers the outbreak of the disease or simply complicates its clinical course. Neoplastic proliferations coexisting with pemphigus have a different histogenesis and the pathogenic link may vary according to the associated tumor (thymoma, lymphoma, carcinoma, or sarcoma). A subset of pemphigus-neoplasia association is represented by Anhalt's paraneoplastic pemphigus, with peculiar clinical, histologic, and immunologic features characterizing it. Coexistence of pemphigus with Kaposi's sarcoma, albeit not frequent, offers an intriguing speculative interest. The cornerstone of management in pemphigus is the combination of systemic corticosteroids and immunosuppressants. The conventional treatment used in most cases is based on oral administration of deflazacort and azathioprine. In selected cases, mycophenolate mofetil is preferred to azathioprine. Severe forms of pemphigus require intravenous pulse therapy with dexamethasone (or methylprednisolone) and cyclophosphamide. In the recent years, the use of high-dose intravenous immunoglobulin therapy has gained several consents. Rituximab, a monoclonal anti-CD 20 antibody, which affects both the humoral and cell-mediated responses, has proved to give a good clinical response, often paralleled by decrease of pathogenic autoantibodies. The combination with intravenous immunoglobulin offers the double advantage of better clinical results and a reduced incidence of infection. Interventional treatments, such as plasmapheresis and extracorporeal immunoadsorption, are aimed at patients with life-threatening forms of pemphigus and high levels of circulating autoantibodies, a circumstance where the medical therapy alone risks failing. Second-line treatments include gold salts (which we do not favor because of the acantholytic potential inherent in thiol structure) and the association of oral tetracyclines with nicotinamide, which is rather safe. Local treatments, supplementary to the systemic therapy, are aimed at preventing infections and stimulating reepithelialization of eroded areas. Innovative topical treatments are epidermal growth factor, nicotinamide gel, pimecrolimus, and a proteomics-derived desmoglein peptide. Pemphigus patients should be warned against over-indulging in unnecessary drug intake, prolonged exposure to ultraviolet rays, intense emotional stress, and too spiced or too hot foods. Cigarette smoking is not contraindicated in pemphigus patients because of the nicotine anti-acantholytic properties.
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Affiliation(s)
- Eleonora Ruocco
- Department of Dermatology, Second University of Naples, via S. Pansini, 5 - 80131 Naples, Italy
| | - Ronni Wolf
- Dermatology Unit, Kaplan Medical Center, Rehovot 76100 Israel; The School of Medicine, Hebrew University and Hadassah Medical Center, Jerusalem, Israel
| | - Vincenzo Ruocco
- Department of Dermatology, Second University of Naples, via S. Pansini, 5 - 80131 Naples, Italy.
| | - Giampiero Brunetti
- Department of Dermatology, Second University of Naples, via S. Pansini, 5 - 80131 Naples, Italy
| | - Francesca Romano
- Department of Dermatology, Second University of Naples, via S. Pansini, 5 - 80131 Naples, Italy
| | - Ada Lo Schiavo
- Department of Dermatology, Second University of Naples, via S. Pansini, 5 - 80131 Naples, Italy
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Ruocco V, Ruocco E, Lo Schiavo A, Brunetti G, Guerrera LP, Wolf R. Pemphigus: Etiology, pathogenesis, and inducing or triggering factors: Facts and controversies. Clin Dermatol 2013; 31:374-381. [DOI: 10.1016/j.clindermatol.2013.01.004] [Citation(s) in RCA: 75] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Ruocco E, Wolf R, Caccavale S, Brancaccio G, Ruocco V, Lo Schiavo A. RETRACTED: Bullous pemphigoid: Associations and management guidelines. Clin Dermatol 2013; 31:400-412. [DOI: 10.1016/j.clindermatol.2013.01.007] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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Affiliation(s)
- Ada Lo Schiavo
- Department of Dermatology; Second University of Naples; Naples; Italy
| | - Rossella Alfano
- Department of Dermatology; Second University of Naples; Naples; Italy
| | - Stefano Caccavale
- Department of Dermatology; Second University of Naples; Naples; Italy
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Affiliation(s)
- Ada Lo Schiavo
- Department of Dermatology, Second University of Naples, Naples, Italy E-mail:
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Lo Schiavo A, Caccavale S, Alfano R, Puca RV, Cozzi R. Elephantiasis nostras verrucosa: a rare case of thyroid dermopathy. Indian J Dermatol Venereol Leprol 2012; 78:650-2. [PMID: 22960831 DOI: 10.4103/0378-6323.100578] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Lo Schiavo A, Brancaccio G, Romano F, Caccavale S. Nerve injury and localized skin lesions: an instance of immunocompromised district. Skinmed 2012; 10:260-261. [PMID: 23008949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
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Lo Schiavo A, Brancaccio G, Puca RV, Caccavale S. Etanercept in the treatment of generalized annular pustular psoriasis. Ann Dermatol 2012; 24:233-4. [PMID: 22577283 PMCID: PMC3346923 DOI: 10.5021/ad.2012.24.2.233] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2011] [Revised: 07/18/2011] [Accepted: 08/08/2011] [Indexed: 11/08/2022] Open
Affiliation(s)
- Ada Lo Schiavo
- Department of Dermatology, Second University of Naples, Naples, Italy
| | | | | | - Stefano Caccavale
- Department of Dermatology, Second University of Naples, Naples, Italy
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Lo Schiavo A, Caccavale S, Orlando I, Tirri R. Erythema gyratum repens and rheumatoid arthritis: an unrecognized association? Indian J Dermatol Venereol Leprol 2011; 78:122. [PMID: 22199086 DOI: 10.4103/0378-6323.90974] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Abstract
Human skin is continuously exposed to internal and external influences that may alter its condition and functioning. As a consequence, the skin may undergo alterations leading to immune dysfunction, imbalanced epidermal homeostasis, or other skin disorders. New theories are developing that link food intake and health. The objective of this review is to evaluate current knowledge about the interrelation of food and skin, particularly the effect of nutrients on some cutaneous immune disorders and therapeutic actions of nutrients in skin disorders.
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Affiliation(s)
- Ada Lo Schiavo
- Department of Dermatology, School of Medicine and Surgery, Second University of Naples, Via S. Pansini no. 5, 80131 Naples, Italy.
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Abstract
BACKGROUND In earlier papers, we suggested that the aggravation of psoriasis by antimalarial drugs (analogous to hypolipidemic drugs) could be initiated by a break in the epidermal barrier. We suggested that these drugs exerted their effect by inhibiting epidermal transglutaminase activity, and supported this hypothesis by demonstrating the effect of hydroxychloroquine sulfate (HCQS) on the morphology of cultured skin and on liver transglutaminase activity. In the present article, we describe, for the first time, the morphologic changes induced by HCQS on cultured skin of psoriatic patients. METHODS Uninvolved (apparently normal) skin explanted from the back of two psoriatic patients was cultured in the presence of 9.2 and 13.8 mM of HCQS for 3 days. The morphologic changes were evaluated in a blind manner. The experiment was repeated twice. RESULTS Significant changes in the epidermal morphology of psoriatic skin cultured in the presence of HCQS, compared with skin cultured without the presence of the drug, were observed. The most striking changes were enhanced and irregular keratinization and dermo-epidermal detachment and cleft formation. No parakeratosis or other characteristics of psoriasis were observed. CONCLUSIONS The first changes caused by HCQS on the cultured skin of psoriatic patients are not characteristic of psoriasis, and include hyperproliferation and enhanced and irregular keratinization. The present experimental study gives further support to the hypothesis that HCQS causes an initial break in the barrier function of the epidermis (probably by inhibiting transglutaminase activity), which is followed by a physiologic response of the epidermis aimed at barrier restoration. This rather nonspecific stimulus to epidermal proliferation is probably sufficient to trigger psoriasis, in vivo, among genetically predisposed patients.
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Affiliation(s)
- R Wolf
- Macabbi Health Care Outpatient Clinic, and the Sackler Faculty of Medicine, Tel-Aviv University, Israel
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Schiavo AL, Ruocco V, Marino F, Ferraiolo S, Pinto F, Orlando G. Tommaso de Amicis, Augusto Ducrey, Lodovico Tommasi: three Neapolitan stars in the dermatovenereology firmament. Int J Dermatol 1996; 35:57-62. [PMID: 8838933 DOI: 10.1111/j.1365-4362.1996.tb01619.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [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] [Indexed: 02/02/2023]
Affiliation(s)
- A L Schiavo
- Department of Dermatology and Venereology, Second University of Naples School of Medicine and Surgery, Italy
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