We report the case of a 23-year-old woman with an erythematous, crusted patch of the scalp, lacking pustular lesions, with partial hair loss, developed after mechanical scalp trauma. ...Histopathological examination showed a dermal infiltrate, predominantly peri-adnexal and peri-vascular, rich in plasma cells and lymphocytes, but lacking neutrophils, possibly as a consequence of the time elapsed since the onset of the skin disease. Reduction of functional hair follicles was evidenced. Stains for bacterial or fungal infections were negative. Direct immunofluorescence was negative. Erosive pustular dermatosis of the scalp was diagnosed on the basis of clinical-anamnestic findings, supported by histology. Topical clobetasol propionate led to clinical improvement after a couple of weeks. Erosive pustular dermatosis of the scalp was diagnosed and soon after the patient developed also multiple sclerosis. Up to date, the pathogenesis of erosive pustular dermatosis of the scalp remains unknown, though a possible role of immunosenescence and autoimmunity has been suggested. Indeed, high levels of neutrophil-stimulating cytokines and chemokines have been found in erosive pustular dermatosis patients, possibly causing activation of an aberrant systemic neutrophilic reaction. Furthermore, the role of neutrophils has been recently highlighted also in the pathogenesis of multiple sclerosis. Herein we hypothesize a possible common immunological etiology of multiple sclerosis and erosive pustular dermatosis of the scalp, conceivably involving a hyperactivation of neutrophils.
Sensitive scalp is a common condition defined by the presence of erythema and/or subjective symptoms as pain, pricking, burning, pruritus of the scalp elicited by triggering factors. Trichodynia is a ...term that describes a sensation of pain or burning of the scalp and was assumed to be part of sensitive scalp. Main goal of the study was to establish the prevalence of sensitive scalp in patients with trichological disorders. We conducted a retrospective observational study recorded: age, sex, trichological disorder (telogen effluvium, androgenetic alopecia, alopecia areata, scarring alopecia, trichotillomania) and scalp symptoms (pruritus, pain, burning and itching sensation). We studied 317 patients. 102 patients (32%) complained of sensitive scalp. Telogen effluvium patients had a significantly higher prevalence of sensitive scalp (p <0.001), pain (p= 0.028), burning sensation (p=0.018), pruritus (p=0.016) and trichodynia (p<0.001) than other patients with alopecias. Likewise, AA patients had a statistically significant higher prevalence of pruritus (p=0.0256) and trichodynia (p=0.0223) than other alopecias patients. Sensitive scalp is a frequent symptom reported by patients with hair loss. Telogen effluvium and alopecia areata seem to be most associated to sensitive scalp.
Diffuse Melanosis Cutis (DMC) is a rare and late complication of metastatic malignant melanoma (MM) characterized by progressive pigmentation of skin and sometimes mucous membranes. The distinctive ...feature is the widespread and progressive deposition of melanin precursors in the dermis.
The purpose of this review is to define the clinical and demographic features of DMC and to promote a deeper insight into the clinical manifestation, histological findings, and pathophysiology behind DMC.
We have conducted a systematic review of the literature on published DMC in compliance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis. We also reported a case of DMC secondary to low-risk melanoma.
Overall, including our case report, we reported 53 articles described 62 DMC patients. Breslow level of primary melanoma was reported having a mean value of 3.3 mm. The mean survival rate from onset of DMC resulted being 4.36 months.
Among the most widely accepted etiopathogenetic hypotheses are deposition of melanic precursors in the dermis following tumor lysis, melanocyte proliferation induced by neoplastic growth factors, and the presence of diffuse dermal micro-metastases of MM. However, unanimous consensus on the proposed etiopathogenetic models of DMC is still lacking.
Psoriasis largely affects daily activities and social interactions and has a strong impact on patients' quality of life. Psoriatic patients have different attitudes toward their condition. Topical ...medications are essential for the treatment of psoriasis, but the majority of patients do not adhere to these therapies.
The history of treatment success or failure seems to influence patient attitude toward topical therapy. Therefore, it is important to understand the psychological, experiential, and motivational aspects that could be critical for treatment adherence, and to describe the different attitudes toward topical treatment. Furthermore, the physician-patient relationship and the willingness to trust the dermatologist may have a substantial role in encouraging or discouraging patients' attitudes toward topical therapy.
A survey was designed to collect aspects that could be relevant to understanding different patient attitudes toward psoriasis and its treatments. A total of 495 self-administered questionnaires compiled by psoriatic patients were analyzed from 20 Italian specialized hospital centers in order to provide a nationwide picture.
Psoriatic patients have different perceptions and experiences in relation to their condition: half of them consider psoriasis as a disease, while the other half consider psoriasis as a disorder or a nuisance. Topical therapy is the most widely used treatment, even though it is not considered the most effective one and often perceived to be cosmetic. The main findings are: 1) inadequate patient education about this disease, 2) lack of information about topical treatment, and 3) lack of results within the expected time frame. Furthermore, physicians need to build a good relationship with psoriatic patients in order to motivate them, to trust in their care, and to adhere to treatment.
This survey adds new and important details about daily life and well-being and the needs of psoriatic patients, providing suggestions for dermatologists to improve patients management.
Background
The hygiene hypothesis proposes that reduced exposure to infectious agents in early life would explain the increase of allergic and autoimmune diseases observed over the past decades in ...high‐income countries.
Methods
We conducted a matched case‐control study on incident atopic dermatitis (AD). Cases were 426 outpatient children with a first diagnosis of incident AD. Controls were 426 children attending a pediatric/dermatological visit for nonatopic disorders matched to cases (1:1). Particular attention was paid to the time elapsed between the markers of microbial exposure and disease onset, and we considered for controls the same time window of exposures from birth as his/her matched case. Odds ratios (ORs) were computed using multivariable conditional logistic regression models, according to center, sex, age, and period of enrollment, and including as potential confounders a family history of any allergy in parents, type of delivery, having siblings, keeping pets, age at weaning, and having had ≥4 infections.
Results
The OR of AD first occurrence was 0.35 (P‐value = .039) for children who had experienced ≥4 infections compared with those with no infections. A decreasing trend in risk was observed with increasing number of siblings (P‐value = .023), the protective effect reaching about 40% for children with 2 or more siblings (OR = 0.62; P‐value = .048). Pet keeping, in particular daily contact with dogs, was inversely associated with AD risk (OR = 0.40; P‐value = .004).
Conclusions
These results support the hygiene hypothesis in its broad sense. Early‐life environmental exposures, including pathogens and commensals, act as “microbes contact carriers” influencing immune system balance early in life.
The results of this large case‐control study supported the hygiene hypothesis in atopic dermatitis (AD). The high number of infectious events had a protective effect against AD occurrence. Increasing number of siblings and daily contact with dogs were inversely associated with AD risk.
Background
Epidemiological data on infant feeding practices and allergic diseases are controversial. The purpose of this study was to explore the association of early weaning with the occurrence of ...atopic dermatitis (AD).
Methods
We conducted a matched case–control study on incident physician‐diagnosed AD in early childhood including 451 cases and 451 controls. Data on several factors, including feeding practices, were collected through an interviewer‐administered questionnaire. Odds ratios (OR) and the corresponding 95% confidence intervals (CIs) were estimated through logistic regression models, conditioned on study center, age, sex, and period of interview, and adjusted for potential confounders.
Results
Early weaning, defined as the introduction of solid foods at 4 or 5 months of age, was inversely related to the risk of AD, with children weaned at 4 months having lower AD risk (OR = 0.41, 95% CI, 0.20–0.87) compared to those exclusively breastfed. Similar results were observed for weaning started at 5 months of age (OR = 0.39, 95% CI, 0.18–0.83). This association persisted when children with and without family history of allergy were considered separately. Prolonged partial breastfeeding (breastmilk plus milk formulas) was not associated with AD. Consistently, the introduction of a high number of different solid foods reduced the risk of AD (P trend = 0.02 at 4 months of age and P trend = 0.04 at 5 months).
Conclusion
Our data provide evidence against the preventing role of prolonged exclusive (but not partial) breastfeeding in AD occurrence and confirm recent results indicating a beneficial role of early weaning in AD.
PDF
