Sex-related differences of clinical features in hidradenitis suppurativa: analysis of an Italian-based cohort

The clinical characteristics associated with hidradenitis suppurativa (HS) severity are poorly understood. In this study, 124 patients with HS from 6 Italian dermatology centres participated in this study. Disease severity was assessed using the Hidradenitis Suppurativa Physician's Global Assessment score (HS-PGA) and Hurley score. The impact of clinical characteristics on disease severity was assessed by logistic regression. Clinical characteristics were similar between men (n = 53) and women (n = 71). Disease severity was also similar; 75% of the patients had Hurley stage II or III disease, and > 60% had moderate, severe or very severe HS as judged by HS-PGA. Lesions were more frequent in the gluteal region in men (32.3% in men vs. 8.7% in women, P < 0.001) and more frequent on the breast in women (16.3% in women vs. 4.6% in men, P = 0.02). Obesity was associated with increased disease severity as measured by HS-PGA (OR: 3.28, 95% CI 1.55-6.95, P < 0.01) and Hurley classification (OR: 3.22, 95% CI 1.34-7.31, P < 0.01). Although severity of HS is similar between the sexes, the localization of lesions is different.

Polymorphic light eruption and IL-1 family members: any difference with allergic contact dermatitis?

Polymorphic light eruption (PLE) is described as a delayed-type hypersensitivity reaction (DTHR) toward a de novo light-induced antigen, yet to be identified. In effect, the inflammatory pathways of PLE and allergic contact dermatitis (ACD) share common patterns in terms of the mediators involved from the innate and adaptive immune system participating in the DTHR. As we have previously highlighted the role of interleukin (IL)-1 family members in ACD, we hypothesised that the same mediators could have similar functions in PLE. Our research aimed to assess the expression of certain IL-1family members in PLE patients vs. controls, and to compare it with ACD. The study population comprised 17 patients with PLE, 5 affected by ACD and 10 healthy controls in the same age range. Lesional and healthy skin samples were collected respectively from patients and donors. IL-36α, IL-36β, IL-36γ, IL-36 receptor antagonist (Ra), IL-1β, IL-33 gene and protein expressions were evaluated through RT-PCR and immunohistochemistry. Circulating proteins in the PLE patients were analysed by using western blot. The IL-36γ gene expression was significantly increased in PLE lesions compared to that in healthy controls and ACD lesions (***p < 0.001; ##p < 0.01 respectively), whereas the other analyzed ILs were more expressed in ACD. Immunohistochemical analysis revealed that IL-36α and IL-36γ protein levels were increased in PLE lesions compared to those of the healthy samples (***p < 0.001). Furthermore the IL-36γ plasma level was increased in PLE patients vs. controls (*p < 0.05). Our findings indicate that the IL-1 family pro-inflammatory members are increased in PLE with distinct differences from those in ACD, in particular with regard to IL-36γ mRNA regulation. Their role as activators of the local, and perhaps systemic, immune response, or as inhibitors of the immune tolerance machinery, needs further investigation.

Supplementation with Lactobacillus rhamnosus SP1 normalises skin expression of genes implicated in insulin signalling and improves adult acne

Systemic supplementation with probiotics is increasingly being explored as a potential treatment strategy for skin disorders. Because both the gut-skin axis and dysregulation of insulin signalling have been implicated in the pathogenesis of adult acne, we designed the current study to evaluate the effect of supplementation with the probiotic strain Lactobacillus rhamnosus SP1 (LSP1) on skin expression of genes involved in insulin signalling and acne improvement in adult subjects. A pilot, randomised, double-blinded, placebo-controlled study was conducted with 20 adult subjects (14 females and 6 males; mean age: 33.7±3.3 years) with acne. Over a 12-week period, the probiotic group (n=10) consumed a liquid supplement containing LSP1 at a dose of 3×109 cfu/day (75 mg/day), whereas the placebo group (n=10) received a liquid lacking probiotics. Paired skin biopsies - one obtained before treatment initiation and one obtained at the end of the 12-week treatment period - were analysed for insulin-like growth factor 1 (IGF1) and forkhead box protein O1 (FOXO1) gene expression. The clinical criterion for efficacy was the investigator's global improvement rating on a five-point scale. Compared with baseline, the probiotic group showed a 32% (P<0.001) reduction, as well as a 65% increase (P<0.001) in IGF1 and FOXO1 gene expression in the skin, respectively. No such differences were observed in the placebo group. Patients in the probiotic group had an adjusted odds ratio of 28.4 (95% confidence interval = 2.2-411.1, P<0.05) to be rated by physicians as improved/markedly improved (versus worsened or unchanged) compared with the placebo group. We conclude that supplementation with the probiotic strain LSP1 normalises skin expression of genes involved in insulin signalling and improves the appearance of adult acne.

Hidradenitis suppurativa: guidelines of the Italian Society of Dermatology and Venereology (SIDeMaST) for the use of anti-TNF-α agents

Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease characterized by nodules, abscesses and sinus tracts, primarily affecting the intertriginous areas. The occlusion of the upper part of the folliculopilosebaceous unit, leading to rupture of the sebofollicular canal with the consequent development of perifollicular lympho-histiocytic inflammation, is believed to be the initial pathogenic event in HS. Giving the chronic nature of HS, its destructive impact on social, working and daily life of patients, its management is often frustrating both for patients and physicians. The HS treatment choices are influenced by disease severity and its individual subjective impact. In this article, the Board of the Italian Society of Dermatology and Venereology (SIDeMaST) on HS has prepared a document focusing on the role of biologic drugs (anti-TNF-α) in HS management, providing also a flow-chart for HS handling and the inclusion and exclusion criteria for HS treatment with anti-TNF-α.

The use of skin needling for the delivery of a eutectic mixture of local anesthetics

AIM

The use of skin needling is believed to aid the transdermal delivery of drugs, even if it is mostly used for skin collagen induction. The aim of this paper was to use skin needling, combined with a local anesthetic EMLA (eutectic mixture of lidocaine and prilocaine), as a way to enhance transdermal drug penetration and optimize the analgesic effects of common local anesthesia.

METHODS

We recruited 15 patients. For each patient of our study we defined a skin area of 3 cm2 from two forearms: on one side, we used skin needling first and immediately thereafter applied the EMLA in occlusion for 60 minutes; on the other one, we only applied EMLA in occlusion for 60 minutes. Then, pain was induced in each patient's forearm by introducing a 27 G needle into the skin 4 mm deep three times. Lastly, pain sensation measures were registered and a middle value was calculated.

RESULTS

When skin needling is used in conjunction with EMLA applied in occlusion for 60 minutes on skin forearms, the level of pain sensation registered was significantly reduced on a Visual Analogue Scale compared to the application of EMLA alone.

CONCLUSION

The use of skin needling can improve the transdermal delivery of an emulsion-like eutectic mixture of local anesthetics (EMLA) and can introduce the use of this method for delivering topical molecules in dermatology.

A dietary supplement to reduce side effects of oral isotretinoin therapy in acne patients

AIM

The purpose of the study was to analyze the potential capacity of a dietary supplement, based on gamma linolenic acid, vitamin E, vitamin C, beta-carotene, coenzyme Q10 and Vitis Vitifera, to reduce side effects, in particular the dry skin, erythema and desquamation, due to treatment with oral isotretinoin, and evaluate the ability of the product to increase adherence to therapy in patients with acne.

METHODS

Forty-eight patients with nodular acne (32 females and 16 males) were randomly divided into 2 groups: 24 received isotretinoin therapy (20-30 mg/day) for 6 months associated to dietary supplement (twice a day), while the other 24 patients received only isotretinoin (20-30 mg/day) for 6 months. For all patients the degree of acne severity, through GAGS (Global Acne Grading System), the sebum production by Sebutape, the hydration by Corneometer and the erythema by Mexameter, were measured. We have also evaluated the adherence to treatment, asking to patients how many days a week they follow the therapy.

RESULTS

Patients treated with dietary supplement had lower side effects, with a less degree of erythema and dryness, and greater degree of hydration; a greater adherence to therapy was also reported.

CONCLUSION

Thanks to antioxidant and moisturizing properties, the dietary supplement containing gamma linolenic acid, vitamin E, vitamin C, betacarotene, coenzyme Q10 and Vitis Vitifera, can be considered a useful supplement in the treatment and prevention of dry skin associated with the use of oral isotretinoin.

Mammalian Target of Rapamycin in Inflammatory Skin Conditions

The conserved serine/threonine kinase mammalian target of rapamycin (mTOR) is a major regulator of survival growth, proliferation and motility, in response to mitogens, energy and nutrient levels. Dysregulation of mTOR pathway has been observed in various inflammatory or neoplastic human diseases. To assess the potential involvement of mTOR in some of the most common inflammatory skin diseases, and its interaction with other inflammatory mediators, we investigated mTOR expression in psoriasis, allergic contact dermatitis (ACD) and atopic dermatitis (AD). mTOR gene expression was assessed in the following conditions: i) skin biopsies from 15 patients affected by psoriasis, 5 patients with ACD, 5 patients with AD and 3 patients with EGFR-inhibitor-induced skin rash; ii) in immortalized keratinocytes HaCaT, primary human keratinocytes (KCs) and full thickness skin organ cultures, incubated with tumor necrosis factor (TNF)-α, interleukin (IL) 17A or their combination; iii) in HaCaT cells stimulated with ultraviolet (UV)B; iv) in skin biopsies from 5 psoriatic patients before and after 16 weeks of anti-TNF-α therapy; mTOR expression was also evaluated through immunohistochemistry in lesional and non-lesional skin samples from 5 psoriatic patients. Moreover, mTOR major up-stream and down-stream regulator gene expression was assessed in skin biopsies from 15 patients affected by psoriasis, 5 patients with ACD, 5 patients with AD and 3 patients with EGFR-inhibitor-induced skin rash. All analyzed skin diseases showed an increase of mTOR gene expression whereas mTOR up-stream negative regulators were reduced or not enhanced in all of them. mTOR was strongly expressed in all epidermal layers of lesional and non-lesional psoriatic skin. Conversely, pro-inflammatory conditions, in vitro, were not able to increase mTOR levels, except for UVB. Similarly, anti-TNF-α therapy was not able to reduce mTOR gene expression in patients with psoriasis. Our study provides evidence that mTOR is involved in cutaneous inflammatory process, but through a signalling not directly dependent from Th1-Th17 pathway.

Vitiligo, NB-UVB and tacrolimus: our experience in Naples

AIM

The aim of the present study was to evaluate the efficacy and safety of narrowband UVB (NB-UVB) compared with tacrolimus ointment 0.1% in patients with bilateral vitiligo.

METHODS

In this comparative study, four groups of patients were randomized. Each group was composed by 12 patients with bilateral vitiligo; in each group, every patient was irradiated with NB-UVB (length: 311 nm) twice a week for 9 months and applied tacrolimus ointment 0.1% twice a day on the other area in the same period. Before starting therapy and after 3, 6 and 9 months of therapy, a clinical and photographic evaluation of percentage of repigmentation was performed and Dermatology Life Quality Index Questionnaire was fulfilled.

RESULTS

A repigmentation at least partial occurred in 71% of patients after 36 weeks of treatment with tacrolimus ointment 0.1%; in the whole sample, 14 patients (29%) showed no repigmentation at all, with 2 of them discontinuing the therapy because of side effects (erythema and folliculitis-like manifestations). A homogeneous repigmentation at least partial occurred in 69% of patients after 36 weeks of treatment with NB-UVB; in the whole sample 15 patients (31%) showed no repigmentation at all, with 1 of them discontinuing the therapy because of side effects.

CONCLUSION

The present study confirmed that the efficacy of NB-UVB phototherapy in vitiligo is comparable to tacrolimus ointment 0.1% therapy. On the basis of our study, we may suggest tacrolimus ointment 0.1% as an alternative to NB-UVB therapy for treating vitiligo.

Nicotinamide downregulates gene expression of interleukin-6, interleukin-10, monocyte chemoattractant protein-1, and tumour necrosis factor-α gene expression in HaCaT keratinocytes after ultraviolet B irradiation

Ultraviolet (UV) radiation has profound effects on human skin, causing sunburn, inflammation, cellular-tissue injury, cell death, and skin cancer. Most of these effects are mediated by a number of cytokines produced by keratinocytes. In this study we investigated whether nicotinamide (NCT), the amide form of vitamin B3, might have a protective function in reducing the expression of interleukin (IL)-1β, IL-6, IL-8, IL-10, monocyte chemoattractant protein (MCP)-1 and tumour necrosis factor (TNF)-α in UV-irradiated keratinocytes. HaCaT cells were treated with UVB in the presence or absence of NCT, and cytokine mRNA levels were examined by quantitative real-time PCR. NCT significantly downregulated IL-6, IL-10, MCP-1 and TNF-α mRNA expression, whereas it did not exert any significant effect on IL-1β or IL-8 expression. Because of its ability to decrease these cytokine mediators after UV exposure, NCT is a possible therapy to improve or prevent conditions induced or aggravated by UV light.

"Il corpo ritrovato": dermocosmetological skin care project for the oncologic patient

Neoplastic disease and its therapeutic options have a huge impact on the patient's quality of life from both the emotional and the working point of view. The project “Il Corpo Ritrovato” aims at creating an interdisciplinary network of physicians to improve the quality of life of the oncologic patient, focusing on such important aspects as dermocosmetological skin care but also on the evaluation of new therapeutic and diagnostic algorithms in order to make further progress in the field of prevention.

Acne scars: pathogenesis, classification and treatment

Acne has a prevalence of over 90% among adolescents and persists into adulthood in approximately 12%-14% of cases with psychological and social implications. Possible outcomes of the inflammatory acne lesions are acne scars which, although they can be treated in a number of ways, may have a negative psychological impact on social life and relationships. The main types of acne scars are atrophic and hypertrophic scars. The pathogenesis of acne scarring is still not fully understood, but several hypotheses have been proposed. There are numerous treatments: chemical peels, dermabrasion/microdermabrasion, laser treatment, punch techniques, dermal grafting, needling and combined therapies for atrophic scars: silicone gels, intralesional steroid therapy, cryotherapy, and surgery for hypertrophic and keloidal lesions. This paper summarizes acne scar pathogenesis, classification and treatment options.

The Effect of Aminolevulinic Acid Photodynamic Therapy on Microcomedones and Macrocomedones

<i>Background:</i> Photodynamic therapy (PDT) with aminolevulinic acid (ALA) has been shown to be an effective treatment for acne. However, the effect of ALA PDT on comedo formation has never been objectively evaluated. Cyanoacrylate follicular biopsy (CFB), a noninvasive procedure, has been proposed as the most reliable tool for studying follicular casts. <i>Objective:</i> To determine the possible effect of ALA and red light (550–700 nm) on macro- and microcomedones in acne patients. <i>Patients and Methods:</i> 10 patients with mild-to-moderate facial and/or chest/back acne resistant to conventional therapies received ALA PDT at 2-week intervals in 3 sessions. The severity of acne had been estimated by a system of points, the Global Acne Grading System. The patients underwent PDT utilizing ALA 10% (face) or 15% (back/chest) and red light (15 J/cm² each session). CFBs were performed. <i>Results:</i> Four weeks after their last PDT session, the patients showed an average global score reduction of 50%. CFBs demonstrated a reduction in the total area, the average area and the density of macrocomedones. <i>Conclusion:</i> The results obtained in this study using CFB evaluation demonstrate that ALA PDT exerts an action on the comedogenic phase as well.

A case of chronic actinic dermatitis treated with topical tacrolimus

INTRODUCTION

The treatment of chronic actinic dermatitis (CAD), a sun-induced disorder characterized by a persistent eczematous eruption, involves photoprotective measures, topical corticosteroid therapy and, in more severe cases, systemic immunosuppression. The potential side effects of systemic immunosuppressant drugs prompted us to evaluate the efficacy of topical tacrolimus for treatment of CAD. PATIENT AND TREATMENT: A 58-year-old man with CAD, resistant to previous treatment with topical and systemic corticosteroids, oral cyclosporine and PUVA-photochemotherapy, was treated with tacrolimus ointment 0.1% once a day.

RESULTS

Tacrolimus ointment led to significant improvement of pruritus and severe eczematous skin lesions after 20 days of treatment.

CONCLUSIONS

Tacrolimus shows a beneficial effect on CAD; this could be attributed to the fact that CAD is characterized by a lymphohistiocytic infiltrate producing a chronic eczema and that tacrolimus blocks the activation of lymphocytes and other immune system cells, also inhibiting the release of mediators from cutaneous mast cells and basophils.

In vitroeffects of ultraviolet A on histamine release from human basophils

BACKGROUND

As long-wave ultraviolet (UV) radiation penetrates the dermis, connective tissue cellular components and circulating blood cells can be possible targets for solar UVA. Basophils, involved in the effector phase of the inflammatory response, play a part in skin diseases such as chronic urticaria, psoriasis, atopic dermatitis, fixed drug eruption, allergic contact dermatitis, urticaria pigmentosa, systemic sclerosis and bullous pemphigoid.

OBJECTIVE

The evaluation of the in vitro effect of UVA on histamine release from human basophils.

METHODS

Basophils from healthy human volunteers were irradiated, respectively, with UVA at doses of 2.5, 5, 7.5, 10, 20 and 50 J/cm2 and then incubated with an anti-IgE serum. A fluorimetric technique was employed to determine histamine release from samples: (i) incubated with 2% HClO4 (complete lysis of basophils); (ii) irradiated with increasing doses of UVA; and (iii) unirradiated (controls).

RESULTS

Histamine release was: 100% for HClO4 incubated basophils, 30% for unirradiated and anti-IgE incubated cells (controls) and 27%, 24%, 34%, 41%, 60% and 70% for basophils irradiated with UVA doses, respectively, of 2.5, 5, 7.5, 10, 20 and 50 J/cm2 and incubated with anti-IgE. Histamine releasability from irradiated samples was statistically significant (P < 0.05), in comparison with controls, at UVA doses equal to 5, 10, 20 and 50 J/cm2.

CONCLUSIONS

UVA exerts, at least in vitro, a biphasic dose-dependent action on histamine release from human basophils incubated with an anti-IgE serum: at the lowest irradiation doses (< 5 J/cm2) it exerts an inhibitory effect and at the highest doses (> or = 10 J/cm2) histamine release increases significantly.

Non-ionizing electromagnetic radiations, emitted by a cellular phone, modify cutaneous blood flow

BACKGROUND

Our surroundings are full of non-ionizing electromagnetic radiation (EMR) of different frequency and power. The non-ionizing EMRs emitted by television, computer and cellular phone (CF) sets have been increasing over the past few years.

OBJECTIVE

The aim of our study was to assess the effects of non-ionizing EMRs (frequency 3 x 10(8) to 3 x 10(11) Hz), emitted by CFs, on cutaneous blood flow in healthy volunteers.

METHODS

Thirty healthy volunteers (14 male and 16 female; age: 18-53 years) entered the study. Measurements of cutaneous blood flow were taken under standard conditions (temperature and humidity), using a laser Doppler He-Ne flowmeter that was applied to the ear skin by an optical fibre probe. Microflow values were recorded without CF contact with the skin (T0), with the CF turned off but in contact with the ear skin (T1), with CF contact and turned on (T2), with CF contact, turned on and receiving (T3). The microflow values were also recorded backwards: with CF contact and set turned on (T4), with CF contact and turned off (T5), without CF contact (T6).

RESULTS

The mean value of basal microflow (T0), expressed as perfusion units (PU), was 51.26+/-11.93 PU. During the T1 phase, the microflow increase was 61.38%; in T2 it was 131.74%, in T3 157.67%, in T4 139.21% and in T5 122.90%; in T6, the microflow value was 57.58+/-10 PU (similar to the basal microflow). Statistically significant cutaneous microflow values (p<0.050) were observed comparing the T1 to T5 values with basal microflow (T0). Furthermore, in comparison with T1 values (CF turned off in contact with the ear skin), the T2, T3 and T4 data were statistically significant (T2 vs. T1: t=7.763 with p<0.050; T3 vs. T1: t=9.834 with p<0.050; T4 vs. T1: t=8.885 with p<0.050).

The epidemiology of atopic dermatitis in Italian schoolchildren

BACKGROUND

Atopic dermatitis (AD) is common in children in industrialized countries. Only one large population study on its prevalence has been conducted in Italy, based on self-report questionnaire. The present study was designed to estimate the prevalence of AD in schoolchildren in Italy by dermatologists' assessment and by UK Working Party criteria, and to investigate associated symptoms and factors.

METHODS

Cross-sectional survey on a random sample of 9-year-old schoolchildren from seven Italian cities. Children were examined by experienced dermatologists. Parents and teachers answered standardized questionnaires.

RESULTS

Of the 1369 children examined, 88 had a diagnosis of AD, with an estimated point prevalence of 5.8% (95% CI 4.5-7.1) in the reference population. The reported lifetime prevalence was 15.2 (95% CI 12.2-18.2) for AD, 11.9% (95% CI 9.0-14.8) for asthma, and 17.6% (95% CI 14.6-20.7) for rhino-conjunctivitis. The strongest associated factor was the presence of AD in at least one parent. No association of AD with maternal smoking during pregnancy, birth weight, maternal age at the time of the child birth and breast-feeding was observed. The environmental characteristics of the house and the school did not correlate with the prevalence of AD. Episodes of lower respiratory tract infections were associated with asthma, and to a lower extent also with AD and rhinitis.

CONCLUSIONS

The prevalence of doctor-diagnosed AD in Italian schoolchildren is comparable to those reported for other developed countries. Family history of atopy was the single most important associated factor, while the complex interplay of environmental factors remains to be elucidated.

Epiluminescence microscopy for port-wine stains: pretreatment evaluation

BACKGROUND

Port-wine stains (PWSs) are characterized by an increased number of ectatic vessels. The treatment of choice is the use of some lasers such as pulsed dye lasers. However, some lesions are nonresponsive to laser treatment. Perhaps the vessels' depth and diameter and the thickness of the vessel wall are important factors influencing the effectiveness of the laser treatment.

METHODS

To investigate whether epiluminescence microscopy (ELM) could be useful in determining the effectiveness of laser treatment of PWSs, we studied a group of patients with PWSs using both ELM and histological analysis.

RESULTS

A correlation existed between a gray-whitish veil seen by ELM and the vessel depth judged by histology: when the veil was absent, the vessels were always found to be located only in the upper third of the dermis.

CONCLUSION

We think that the gray-whitish veil is a distinctive dermoscopic feature that is able to differentiate between superficial vessels (absence of veil) and deeper vessels (presence of veil).

The effects of a diode laser (810 nm) on pigmented guinea-pig skin

Various types of lasers, such as the Q-switched ruby laser and the Alexandrite laser, cause selective damage to cutaneous pigmented cells and are currently used in the therapy of pigmented lesions. The aim of this study was to evaluate the effects of a diode laser at a wavelength of 810 nm on pigmented guinea-pig skin. The diode laser was supplied by OcuLight Iris Medical Instruments, Inc. and was used to deliver 0.15, 0.2, 0.3, 0.4, 0.5, 1 and 1.5 J/cm2 laser beams in micropulses of 100 micros. The study was carried out on albino and black-spotted guinea pigs (GP). After irradiation, punch biopsies were taken and analysed by light and electron microscopy. Albino animals developed just a few signs of cutaneous injury. This mostly consisted of spongiotic disarray, after the highest doses were administered (>1 J/cm2). In the black skin of spotted GPs alterations appeared at 0.15 J/cm2 and included melanosome damage and, at doses higher than 0.3 J/cm2, also melanocyte damage. These observations demonstrate that the diode laser at 810 nm selectively affects pigmented structures and that the cellular targets of diode laser radiation are the melanosomes. The diode laser specificity for melanin may provide a biological basis for the treatment of pigmented superficial cutaneous lesions.

Photodynamic therapy with topical delta-aminolaevulinic acid for the treatment of plantar warts

Treatments currently employed for plantar warts are often painful (electrosurgery, cryotherapy) and not always effective (keratolytic agents). In this paper we investigate the effect of photodynamic therapy (PDT) with topical delta-aminolaevulinic acid (ALA) on plantar warts. In order to remove the superficial hyperkeratotic layer of the warts an ointment containing 10% urea and 10% salicylic acid was applied for 7 days. After gentle curettage, a cream containing 20% ALA was applied under an occlusive dressing for 5 h on 64 warts, while 57 warts (controls) received only the vehicle. Both the ALA-treated warts and the controls were irradiated using a visible light lamp (with a range of 400-700 nm, peaking at 630 nm). The light dose was 50 J/cm(2). Patients were followed-up for 22 months. Two months after the last irradiation session 48 (75.0%) out of 64 ALA-PDT treated warts had resolved. By contrast only 13 (22.8%) of the 57 control warts had done so. During the treatment a few patients complained of a mild burning sensation. The absorption of ALA by the verrucous tissue was demonstrated by in vivo fluorescence spectroscopy. This study shows that topical ALA-PDT can be an alternative treatment for plantar warts. Further studies will be necessary in order to optimize the concentration of ALA and duration of treatment.

Microanalysis of melanins in mammalian hair by alkaline hydrogen peroxide degradation: identification of a new structural marker of pheomelanins

A highly sensitive, easy-to-perform method for melanin analysis in pigmented tissues based on alkaline hydrogen peroxide degradation has been developed and accomplishes simultaneous determination of eumelanins and pheomelanins. Pyrrole-2,3,5- tricarboxylic acid, the typical eumelanin marker, was obtained in higher yields than in previous procedures. A benzothiazole acid, 6-(2-amino-2-carboxyethyl)-2-carboxy-4-hydroxybenzothiazole, characterized in our previous studies as a specific marker of pheomelanins, and the newly identified 1,3-thiazole-2,4, 5-tricarboxylic acid were also used for pigment analysis. Optimal yields of the pigment markers were obtained at 24 h reaction time. Pyrrole-2,3,5-tricarboxylic acid, 6-(2-amino-2-carboxyethyl)-2-carboxy-4-hydroxybenzothiazole, and 1, 3-thiazole-2,4,5- tricarboxylic acid were quantified in a single chromatographic analysis without fractionation or work up of the degradation mixture. The linearity (linearity coefficient from 0.997 to 0.999) was excellent and the inter-assay (percentage coefficient of variation values in the range 0.2-2, n = 6) and intra-assay (percentage coefficient of variation values </= 0.4) reproducibility of the method was very satisfactory. A variety of mammalian hairs including coat color mutant mice and human hairs were used to evaluate the method. All the phenotypically pheomelanic hairs gave 1, 3-thiazole-2,4,5-tricarboxylic acid in variable yields, whereas 6-(2-amino-2-carboxyethyl)-2-carboxy-4-hydroxybenzothiazole was obtained only from some of the red hair samples examined. Notably, a marked tendency to actinic damage, as evidenced by determination of the minimal erythema dose, was exhibited by those subjects whose hair afforded the highest 6-(2-amino-2-carboxyethyl)-2-carboxy-4-hydroxybenzothiazole yields. This suggests that 6-(2-amino-2-carboxyethyl)-2-carboxy-4-hydroxybenzothiazole represents a new biogenetic marker for predicting individuals at high risk for skin cancer and melanoma.

Solar urticaria: a report on 57 cases

BACKGROUND

Solar urticaria (SU) represents an uncommon skin disorder, characterized by pruritic erythema and wheals after sun exposure, that sometimes restricts normal daily life.

OBJECTIVE

To evaluate data concerning sex, age, natural history, associated diseases, and eliciting wavebands of 57 SU cases.

METHODS

Questionnaire for anamnestic data, laboratory examinations, phototesting.

RESULTS

Sex: 25 (44%) males, 32 (56%) females. Age: The peak age was between 20 and 30 years. Skin type (ST): 12 (21%) ST II, 39 (68%) ST III, and 6 (11%) ST IV. Time between onset and complete disappearance of SU was from 2 to more than 6 years; the main peak (37 patients) between 4 and 6 years. There were histories of atopic dermatitis 12 (21%) and asthma or rhinitis 15 (26%). Association with other urticarias (U): 13 (21%) dermographic U, 2 food U, 3 heat U. Increased immunoglobin E (IgE): 19 (33%). Eliciting wavebands: 38 (67%) visible light (VIS), 16 (28%) long ultraviolet (UVA), 3 natural sunlight. Minimal urticarial dose (MUD): 20-37.5 J/cm2 for VIS-sensitive patients, 5-10 J/cm2 for UVA.

CONCLUSIONS

In our series: 1. SU affects both sexes usually when they are under 30 years of age; 2. nearly half the patients are free of disease within 5 years; 3. in about one fourth of cases SU is associated with dermographic urticaria or displays a history of atopic dermatitis; 4. the wheals are elicited mainly by VIS or UVA; 5. SU can be prevented, at least in part, by antihistamines or by PUVA therapy.

What do young people think about the dangers of sunbathing, skin cancer and sunbeds? A questionnaire survey among Italians

Previous experience in Australia and Sweden showed that public education programs produced substantial changes in people's opinions, attitudes and perceptions about melanoma, non-melanoma skin cancer, sunlight, sunbeds and suntanning. In order to organize effective prevention campaigns, more must be known about the sunbathing habits of children and adolescents. The aim of our study was to assess the knowledge that young people in a southern European country have about sun exposure. A total of 764 young people ranging from 16 to 22 years old (mean age: 19.3+/-1.2 years) responded to a questionnaire. Our study indicates that young people are very aware of the risks associated with sunbathing but that they continue to expose themselves without taking precautions. This suggests that: a) the majority of young Italians are reasonably well-informed but they do not take preventative measures; b) one effective measure could be promotion of the idea that an untanned body is more esthetically pleasing than a tanned one; c) a crucial point in the programming of future safety measures in suntan centers involves rigorous and regular controls.

Thirty hours' evaluation of UVB-induced erythema by chromometry and microflowmetry

BACKGROUND

Individual UVB photosensitivity is usually investigated by determining the minimal erythemal dose (MED). Nevertheless, factors such as room light intensity and subjective experience of the observer can influence the erythema perception and, therefore, the MED assessment.

OBJECTIVE

To evaluate the relationship between the clinical and the chromometric and microflowmetric analyses of the UVB-induced erythema in 2 healthy volunteers.

METHODS

A bank of 6 fluorescent mercury vapor tubes (Philips TL 12/20 W) was utilized as a source of UVB light. Three skin areas (4 cm2), from the dorsal region of each subject, were irradiated with 3 different UVB doses corresponding to: (1) MED; (2) 0.7 MED, and (3) 1.3 MED.

RESULTS

(1) both microflowmetric and chromometric parameters reached a maximum peak 10-12 h after irradiation and maintained high values also 30 h after irradiation; (2) both microflowmetric and chromometric values were directly related to the UVB doses; (3) in some cases the microflowmetric values started to increase when the chromatic changes were still undetectable.

CONCLUSION

These preliminary data confirm that the visual determination of MED performed 24 h after irradiation is a correct procedure. Nevertheless, the microflowmetric may precede the chromatic changes suggesting that vasodilatation follows irradiation without a latent period.

Phaeomelanin versus eumelanin as a chemical indicator of ultraviolet sensitivity in fair-skinned subjects at high risk for melanoma: a pilot study

It is now generally agreed that solar exposure is a major external factor in the causation of cutaneous melanoma in light skinned populations with red hair and a marked susceptibility to the acute effects of ultraviolet (UV) radiation. In the present study, we investigated the existence of a possible relationship between hair melanin composition and minimal erythema dose (MED), as an indicator of UV sensitivity, in a group of 15 healthy red-haired subjects aged 20-46 years. In spite of comparable skin and hair colour, marked variations were observed in the MED values as well as in the hair melanin composition. Phaeomelanin levels varied in the range 0.026-0.53% w/w and were generally comparable to or higher than eumelanin levels (0.042-0.17% w/w). No significant relationship was found between MED values and phaeomelanin, eumelanin or total melanin (eumelanin plus phaeomelanin) content. Notably, however, a gross positive correlation was found between the eumelanin/phaeomelanin ratio and the MED values. These results would suggest that a high UV sensitivity is associated with high phaeomelanin and low eumelanin levels, and point to the eumelanin/phaeomelanin ratio as a novel chemical parameter that could be used for predicting individuals at high risk for skin cancer and melanoma.