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Mazzotti E.,IDI IRCCS | Mozzetta A.,Servizio di Psicologia Clinica e Psicoterapia Psicosomatica | Antinone V.,Servizio di Psicologia Clinica e Psicoterapia Psicosomatica | Alfani S.,Laboratorio Of Ricerca Sui Servizi Sanitari | Abeni D.,Laboratorio Of Ricerca Sui Servizi Sanitari
Journal of the European Academy of Dermatology and Venereology | Year: 2011

Background Pemphigus vulgaris is a chronic disease not currently curable. Physical involvement and the impact of chronic therapies can lead patients to changes in psychological and relational areas. Objectives To provide a measure of psychological distress, dysfunctional investment in one's appearance, and their relationship. Methods Self-administered questionnaires (ASI, HADS) were given to 74 pemphigus inpatients. Results Strong associations between psychological distress and dysfunctional investment in one's appearance were observed [adjusted odds ratio (OR) = 7.36, 95% confidence intervals (CI) 1.20-45.11; OR 5.38, 95% CI 0.81-35.87, respectively, for appearance stereotyping and body-image vulnerability], together with a perceived high disease severity (OR 6.03, 95% CI 1.90-23.46). Conclusions Our results are compatible with the idea that some forms of psychological distress could be in part due to one's perception of his/her own body image. © 2010 European Academy of Dermatology and Venereology.

PubMed | Immunology and Allergology Laboratory, Instituto Dermopatico dellImmacolata IDI IRCCS, University College London and IDI IRCCS
Type: Journal Article | Journal: European journal of dermatology : EJD | Year: 2016

Pemphigus vulgaris (PV) is an autoimmune blistering disease mediated by IgG autoantibodies targeting desmogleins (Dsgs). The anti-CD20 monoclonal antibody rituximab is increasingly used in corticosteroid-resistant PV patients. In a subset of rituximab-treated patients in remission, high ELISA index values have been reported; however, their significance remains so far unclear.To address the discrepancy between anti-Dsg3 serum antibody titers and disease severity.6 rituximab-treated PV patients were prospectively followed-up for two years and anti-Dsg3 autoantibodies levels and pathogenic activity were measured.All patients achieved complete remission without any serious side effects. Both anti-Dsg3 autoantibodies (p = 0.031) and their pathogenic activity (p = 0.003) were significantly related to disease severity. However, in selected patients, the dissociation index was a more sensitive indicator for PV clinical activity than the ELISA index.Our findings have demonstrated the existence of non-pathogenic autoantibodies in PV patients in remission, establishing the basis for the design of a system able to precisely monitor the course of disease.

Alfani S.,Laboratory of Health Services Research | Antinone V.,Service of Clinical Psychology and Psychotherapy Psychosomatics | Mozzetta A.,Service of Clinical Psychology and Psychotherapy Psychosomatics | Di Pietro C.,Laboratory of Health Services Research | And 4 more authors.
Acta Dermato-Venereologica | Year: 2012

Alopecia areata is not painful or life-threatening, but its aesthetic repercussions can lead to profound changes in patients' psychological status and relationships. The psychological status and personality traits of 73 patients and 73 controls were evaluated with the Minnesota Multiphasic Personality Inventory (MMPI-2). Analysis of the MMPI-2 profile showed that scores for some scales (i.e. Depression, Anxiety, Family relationships) were higher for patients with alopecia areata than for controls. Patients with alopecia appeared to experience more depressive, hysterical and anxiety feelings, have more hypochondriac tendencies, and to be more in conflict with their social environment. In order to provide more effective management, the psychological status of patients with alopecia areata should be evaluated in dermatological settings. © 2012 The Authors.

Zulian F.,University of Padua | Martini G.,University of Padua | Vallongo C.,University of Padua | Vittadello F.,University of Padua | And 11 more authors.
Arthritis and Rheumatism | Year: 2011

Objective Juvenile localized scleroderma is a chronic progressive fibrotic disorder of the skin that causes permanent disability and aesthetic damage. This study was undertaken to assess the safety and efficacy of methotrexate (MTX) in the treatment of juvenile localized scleroderma. Methods In this double-blind study, patients with active juvenile localized scleroderma were randomized (2:1) to receive oral MTX (15 mg/m2, maximum 20 mg) or placebo once weekly, for 12 months or until treatment failure. Both groups received oral prednisone (1 mg/kg/day, maximum 50 mg) for the first 3 months. A target lesion was evaluated clinically, with infrared thermography and using a computerized scoring system with skin score rate (SSR) evaluation. Response to treatment was defined as the absence of new lesions, SSR â1, and a decrease in lesion temperature of at least 10% compared to baseline. Treatment failure was defined as the occurrence of new lesions, SSR >1, or increased lesion temperature. All analyses were done on the intent-to-treat population. Results Of the 85 patients screened, 70 (ages 6-17 years) were randomized (46 to the MTX group, 24 to the placebo group). The mean disease duration was 2.3 years. After an initial response in all patients, disease relapsed in 15 MTX-treated patients (32.6%) and 17 placebo-treated patients (70.8%) (P ;lt& 0.005). New lesions appeared in 3 MTX-treated patients (6.5%) versus 4 placebo-treated patients (16.7%). The mean SSR decreased from 1 to 0.79 in the MTX group and increased from 1 to 1.1 in the placebo group, and the mean target lesion temperature decreased by 44.4% in the MTX group versus 12.1% in the placebo group. Twenty-six patients in the MTX group (56.5%) and 11 patients in the placebo group (45.8%) developed mild side effects related to treatment. None of the side effects were severe enough to necessitate treatment discontinuation. Conclusion Our findings indicate that MTX is efficacious in the treatment of juvenile localized scleroderma and is well tolerated. Copyright © 2011 by the American College of Rheumatology.

Tabolli S.,Health Services Research Unit | Pagliarello C.,University of Parma | Paradisi A.,Health Services Research Unit | Cianchini G.,IDI IRCCS | And 2 more authors.
British Journal of Dermatology | Year: 2014

Background Studies conducted using different tools have invariably observed that physical and mental components of health status are seriously compromised in patients with pemphigus. An improvement in quality of life (QoL) has been commonly observed over the treatment period. Objectives The aim of the study is to verify whether the patients' wellbeing is affected by pemphigus also in absence of cutaneous and mucosal lesions. Materials and methods The clinical records of 203 patients were analysed. A total of 47 patients were without bullae/erosions and reported a score = 0 for both the Patient Global Assessment and the Ikeda index. In order to assess the QoL we used the Skindex-17 and the 12-item General Health Questionnaire (GHQ-12). Results Patients without bullae/erosions had a better QoL when compared with patients with active lesions. This difference, with a reduction of approximately 30% of the Skindex-17 scores in the patients without lesions, was statistically significant, for both the symptoms and the psychosocial scales. The proportion of patients at risk of anxiety/depression (GHQ-positive cases) was 44% lower in patients without lesions compared with patients with lesions. In a multiple linear regression model the presence of bullae/erosions negatively influences QoL with an average increase of Skindex-17 symptoms and psychosocial scale scores of 11·7 and 10·6 points, respectively. Female patients had a statistically significantly worse QoL than males on the symptoms but not on the psychosocial Skindex-17 scales. Conclusions While patients without lesions reported a better QoL than patients with bullae/erosions, their Skindex-17 scores remained elevated. Dermatologists should be aware that a clearing of the skin manifestations does not mean 'perfect health' for the patient. What's already known about this topic? Pemphigus has a severe impact on quality of life. Patients with pemphigus have an increased risk of anxiety and depression. Following treatment, pemphigus may have long periods of quiescence. What does this study add? Quality of life is significantly impacted also in patients without bullae/erosions, and in women it is worse than in men. High percentages of patients are at risk of anxiety and depression even when the disease is quiescent. The burden of disease continues to be present even during periods of relative wellness. © 2014 British Association of Dermatologists.

Tabolli S.,Health Services Research Unit | Paradisi A.,Health Services Research Unit | Giannantoni P.,Health Services Research Unit | Gubinelli E.,IDI IRCCS | Abeni D.,Health Services Research Unit
Journal of Dermatological Treatment | Year: 2015

The choice of an adequate psoriasis treatment is critical to good disease management and to overall patient health. It is estimated that about 20-30% of patients requires systemic treatment: "traditional" (methotrexate, acitretina and cyclosporin) or "biological" (etanercept, adalimumab and infliximab). Clinical records of 784 outpatients with psoriasis were analyzed. 51.5% received traditional treatments and 48.5% a biological treatment. Males were 67.8% of patients. Psoriatic arthritis was observed in 37.3%. Females and younger patients were more likely to receive biological treatments. No differences were observed for Body Mass Index or for presence of comorbidities. Patients with psoriatic arthritis were also more frequently prescribed biological drug treatment. In a multivariate logistic regression model, only the older age-group (≥60 years) had a statistically significant OR (p=0.001) with a reduction of about 80% the likelihood of receiving biological treatment compared to the younger age-group (<40 years). Patients with a PASI score ≥20 and patients with arthritis have a probability to be prescribed biologics about five times higher than the other patients. In conclusion, younger age, psoriatic arthritis and the previous use of systemic drugs are factors associated with the use of biological treatment rather than the traditional systemic drugs. © 2014 Informa Healthcare USA, Inc.

Paradisi A.,Health Services Research Unit | Abeni D.,Health Services Research Unit | Bergamo F.,IDI IRCCS | Ricci F.,Catholic University of the Sacred Heart | And 2 more authors.
Journal of the American Academy of Dermatology | Year: 2014

Background Toxic epidermal necrolysis (TEN) is a severe and potentially lethal drug reaction for which no standard treatment is available. Objective To describe a case series of patients with TEN treated with a single dose of etanercept. Methods We observed 10 consecutive patients with TEN. For each patient, we recorded the presence of comorbidities and all the drugs recently started (ie, in the last month). In all cases, 50 mg of etanercept was administered in a single subcutaneous injection. The clinical severity of disease was computed using the SCORe of Toxic Epidermal Necrosis (SCORTEN) scale. Using the probabilities of death linked to each level of SCORTEN score, we calculated the expected probability of death in our patients. Healing was defined as complete reepithelialization, and a time to healing curve was then obtained using the Kaplan-Meier method. Results All patients promptly responded to treatment, reaching complete reepithelialization without complications or side effects. The median time to healing was 8.5 days. Limitations This is a small, uncontrolled case series. Conclusion These preliminary results suggest the possibility that tumor necrosis factor-alfa may be an effective target for control of TEN, a dangerous skin condition for which no effective cure has yet been found. © 2014 by the American Academy of Dermatology, Inc.

Deeva I.,Laboratory of Tissue Engineering and Cutaneous Physiopathology | Mariani S.,Laboratory of Tissue Engineering and Cutaneous Physiopathology | De Luca C.,Laboratory of Tissue Engineering and Cutaneous Physiopathology | Pacifico V.,IDI IRCCS | And 5 more authors.
Cytokine | Year: 2010

Psoriasis is a chronic recurrent inflammatory disorder of the skin. Clinical subtypes include psoriasis vulgaris (PV), psoriatic arthropathy, and erythrodermic psoriasis. Aim of this study was to analyse relevant inflammatory mediators in the plasma of patients with distinct subtypes of active psoriasis, and in the scales of mild-to-moderate PV patients, and correlation to disease severity. Compared to healthy controls (n = 10), patients affected by very severe forms of psoriasis (n = 30) were characterized by increased plasma levels of IL-4, IL-6, MCP-1, VEGF and in particular PDGFbb. Each group with severe psoriasis had distinct characteristic features of plasma cytokine profile. Mild-to-moderate PV patients (n = 35) showed higher levels of IL-4, IL-6, IL-10, and IL-13 when compared to healthy controls. No correlation was found between PV severity assessed by PASI (Psoriasis Area and Severity Index) and levels of these mediators. By contrast, disease severity correlated to scale levels of IP-10. For the first time, we found exaggerated circulating levels of the pro-angiogenic PDGFbb and VEGF in severe psoriasis. Evidence that the severity of skin symptoms correlated exclusively with scale levels of IP-10, but not with any up-regulated inflammatory mediator in plasma, suggests that distinct skin-independent processes contribute to the circulating cytokine profile in psoriasis. © 2009 Elsevier Ltd. All rights reserved.

Mazzotti E.,IDI IRCCS | Mastroeni S.,Clinical Epidemiology Unit | Lindau J.,University of Rome La Sapienza | Lombardo G.,IDI IRCCS | And 2 more authors.
Journal of the European Academy of Dermatology and Venereology | Year: 2012

Background Psychological distress is frequent among dermatological patients. The development of a positive attitude toward diagnosis and treatment is thought to be critical for successful coping and mental health outcomes. Objective The aim of this study was to assess the coping strategies and the psychological distress, due to anxiety and depression, in an unselected sample of dermatological patients. Methods Self-administered questionnaires (HADS, COPE) were given to 603 dermatological patients. Results Out of 567 participants, 149 (26.2%) scored positive for Anxiety, and 52 (9.2%) scored positive for Depression. Multivariate analysis, adjusting for gender, age, socio-economic status, and disease, showed that both Anxiety and Depression are associated with a less frequent use of Positive attitude coping. Conclusion Our results reinforce the notion that while planning the treatment of dermatological patients, evaluating their mental health might help to provide optimal treatment. Since coping ability was found to be important for mental health status, policy implications could include emphasis on social programs to assist individuals to manage stress, as well as psychological support. © 2011 European Academy of Dermatology and Venereology.

PubMed | University of Rome Tor Vergata and IDI IRCCS
Type: Case Reports | Journal: Journal of the European Academy of Dermatology and Venereology : JEADV | Year: 2016

Epidermolytic ichthyosis (BCIE, OMIM 113800), is an autosomal dominant disorder of the skin caused by mutations in keratin genes KRT1 and KRT10. We present two sporadic patients showing a mild diffuse ichthyosis with palmoplantar keratoderma. Interestingly, one of them shows a significant hyperkeratosis of palms and soles similar to those present in the Meleda disease (OMIM 248300).In this paper we would clarify the genetic difference between the two patients, giving rise to the different phenotype.Clinical evaluation, followed by histological and molecular analysis has been established for these patients.We demonstrated the presence of a genetic cutaneous mosaicism. Both patients carry the KRT1 pI479T substitution, but in the palmoplantar areas of one of them, only the mutated allele is expressed (hemizygous). This leads to highlight a new type of cutaneous mosaic, the palmoplantar mosaicism.

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