San Gallicano Dermatological Institute IRCCS

Rome, Italy

San Gallicano Dermatological Institute IRCCS

Rome, Italy
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Hames S.C.,University of Queensland | Ardigo M.,San Gallicano Dermatological Institute IRCCS | Soyer H.P.,University of Queensland | Bradley A.P.,Queensland University of Technology | Prow T.W.,University of Queensland
PLoS ONE | Year: 2016

Reflectance confocal microscopy (RCM) is a powerful tool for in-vivo examination of a variety of skin diseases. However, current use of RCM depends on qualitative examination by a human expert to look for specific features in the different strata of the skin. Developing approaches to quantify features in RCM imagery requires an automated understanding of what anatomical strata is present in a given en-face section. This work presents an automated approach using a bag of features approach to represent en-face sections and a logistic regression classifier to classify sections into one of four classes (stratum corneum, viable epidermis, dermal-epidermal junction and papillary dermis). This approach was developed and tested using a dataset of 308 depth stacks from 54 volunteers in two age groups (20-30 and 50-70 years of age). The classification accuracy on the test set was 85.6%. The mean absolute error in determining the interface depth for each of the stratum corneum/viable epidermis, viable epidermis/dermal-epidermal junction and dermal-epidermal junction/papillary dermis interfaces were 3.1 μm, 6.0 μm and 5.5 μm respectively. The probabilities predicted by the classifier in the test set showed that the classifier learned an effective model of the anatomy of human skin. © 2016 Hames et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.


PubMed | University of Queensland, San Gallicano Dermatological Institute IRCCS and Queensland University of Technology
Type: Journal Article | Journal: PloS one | Year: 2016

Reflectance confocal microscopy (RCM) is a powerful tool for in-vivo examination of a variety of skin diseases. However, current use of RCM depends on qualitative examination by a human expert to look for specific features in the different strata of the skin. Developing approaches to quantify features in RCM imagery requires an automated understanding of what anatomical strata is present in a given en-face section. This work presents an automated approach using a bag of features approach to represent en-face sections and a logistic regression classifier to classify sections into one of four classes (stratum corneum, viable epidermis, dermal-epidermal junction and papillary dermis). This approach was developed and tested using a dataset of 308 depth stacks from 54 volunteers in two age groups (20-30 and 50-70 years of age). The classification accuracy on the test set was 85.6%. The mean absolute error in determining the interface depth for each of the stratum corneum/viable epidermis, viable epidermis/dermal-epidermal junction and dermal-epidermal junction/papillary dermis interfaces were 3.1 m, 6.0 m and 5.5 m respectively. The probabilities predicted by the classifier in the test set showed that the classifier learned an effective model of the anatomy of human skin.


PubMed | c Circolo Mario Mieli NGO, San Gallicano Dermatological Institute IRCCS and Instituto Superiore Of Sanita
Type: Journal Article | Journal: Human vaccines & immunotherapeutics | Year: 2016

Our aim was to gain a better understanding of the knowledge about Human Papillomavirus (HPV) infection and attitudes toward the HPV vaccine among men at risk for sexually transmitted infections (STI). A self-administered questionnaire was completed by attendees of the largest STI Center in Rome, Italy, from April to June 2013. Determinants of vaccine acceptability were investigated using a Structured Equation Model. A total of 423 males participated in the survey: 296 (70.0%) men who have sex with men (MSM) and 127 (30.0%) men who have sex with women (MSW). Only one half of the participants knew that HPV is the cause of genital warts (56.9% of MSM vs. 49.5% of MSW, p=0.28). Even less were aware that HPV causes cancer in men (37.2% vs. 27.3%, p=0.08). MSW were more likely to indicate HPV as a cause of cervical cancer (80.8% vs. 69.3%, p=0.03) and to have heard about the vaccine (58.3vs. 43.6%, p=0.01). Moreover, 72.1% of MSM and 70.3% of MSW were willing to be vaccinated. A rise of one-unit in the HPV awareness score increased the OR of vaccine acceptability among MSM by 25% (OR 1.25, 95%CI: 1.05-1.49; p=0.013). Differently, only attitudes had a relevant effect on willingness to be vaccinated among MSW (OR 3.32, 95%CI: 1.53-7.17; p=0.002). Efforts should be made to maximize awareness of HPV, especially as a causative agent of genital warts and male cancers, and to reinforce positive attitudes toward vaccination among men visiting STI centers.


PubMed | The Second University of Naples, Dermatology Unit, San Gallicano Dermatological Institute IRCCS and University of Modena and Reggio Emilia
Type: Journal Article | Journal: Journal of the European Academy of Dermatology and Venereology : JEADV | Year: 2016

Psoriasis is a chronic recurrent inflammatory skin disease that affects 2-3% of the world population. Biologics are relatively new systemic treatments that block molecular steps important in the pathogenesis of psoriasis. In vivo Reflectance confocal microscopy (RCM) is a non-invasive, imaging technique already reported to be useful in the evaluation of the follow-up of PP under treatment with topical actives and phototherapy. No reports on systemic treatments have been proposed in literature so far.The aim of this study was to evaluate the feasibility of RCM in the monitoring of microscopic response to a subcutaneous anti-TNF treatment, Adalimumab.One target lesion with typical clinical aspect, from 48 psoriatic patients, was evaluated using RCM at baseline, after 4 and 8 weeks of treatment.Microscopic confocal changes were followed up during treatment. Results disclosed identification of early microscopic evidence of the anti-inflammatory activity of Adalimumab not detected at clinical examination. Confocal feature related to the effect of TNF- on melanocytes activity has been also identified.Early detected RCM parameters related to Adalimumab activity could be used to identify an early response to the treatment. RCM seems to be able to give useful and practical information about follow-up in patients with PP under treatment with Adalimumab.


PubMed | University of Rome Tor Vergata, San Gallicano Dermatological Institute IRCCS, New York University, University of Brasilia and San Gallicano Dermatologic Institute IRCCS
Type: Journal Article | Journal: Archives of dermatological research | Year: 2016

Clinical management of alopecia represents one of the major issues in dermatology. Scalp biopsies are not easily accepted because of the high bleeding and sensitive anatomical area. Trichoscopy is routinely used for diagnosis of alopecia, but in several cases lack to provide sufficient information on the status of the disease. Recently, reflectance confocal microscopy demonstrated its usefulness for the evaluation of several inflammatory skin condition and preliminary reports about alopecia have been proposed in the literature. The aim was to identify the confocal features characterizing scarring and non-scarring alopecia. Reflectance confocal microscopy from 86 patients affected by scarring (28 lichen planopilaris and 9 lupus erythematosus) and non-scarring alopecia (30 androgenic alopecia and 19 alopecia areata), were retrospectively, blinded evaluated. Good concordance between different readers on the confocal criteria has been assessed. Statistical significant features, specific for scarring alopecia and non-scarring alopecia have been identified. In this study, data on reflectance confocal microscopy features useful for the differential diagnosis between scarring and non-scarring alopecia have been identified. Further studies focusing on the use of this non-invasive technique in the therapeutic follow-up and distinction of sub-entities of alopecia are still required.


Agozzino M.,San Gallicano Dermatological Institute IRCCS | Guichard A.,University of Franche Comte | Ardigo M.,San Gallicano Dermatological Institute IRCCS
Expert Review of Dermatology | Year: 2013

Common inflammatory skin diseases can be correctly diagnosed with clinical examination. However, unusual presentations do exist and may cause difficulties in the differentiation among different entities, and histopathology is required for an accurate diagnosis. In this regard, dermoscopy and reflectance confocal microscopy (RCM) can play an important role in increasing the specificity of the diagnosis, offering the possibility of improved management of patients. In this review, the authors have analyzed dermoscopic patterns of lichen planus, discoid lupus erythematosus, psoriasis and alopecias as prototypes of inflammatory skin diseases, and correlated them with RCM microscopical features. RCM, thanks to its correspondence to histology and to the possibility of an immediate correlation to dermoscopy, provides additional information useful for increasing the sensibility and specificity of dermoscopy. © 2013 2013 Expert Reviews Ltd.


Agozzino M.,San Gallicano Dermatological Institute IRCCS | Tosti A.,University of Miami | Barbieri L.,San Gallicano Dermatological Institute IRCCS | Moscarella E.,San Gallicano Dermatological Institute IRCCS | And 3 more authors.
British Journal of Dermatology | Year: 2011

Summary Background Lichen planopilaris (LPP) and discoid lupus erythematosus (DLE) are the most common causes of lymphocytic primary cicatricial alopecia. The management of scarring alopecia can be difficult. The combination of clinical, dermoscopy and reflectance confocal microscopy (RCM), a noninvasive, high-resolution imaging technique, examinations have already been demonstrated to be useful for choosing the correct biopsy site in patients with inflammatory skin disease and obtaining microscopic diagnostic criteria. Objectives We evaluated the usefulness in practice of RCM for the identification of criteria for LPP and DLE involving the scalp and their management during therapeutic follow-up. Methods Seven white patients with a previously established histological diagnosis of DLE (three) and LPP (four), were included in the study. RCM criteria for primary scarring alopecia were selected: epidermal disarray, spongiosis, exocytosis of inflammatory cells in the epidermis, interface dermatitis, peri- and intra-adnexal infiltration of inflammatory cells, dilated vessels in the dermis, dermal infiltration of inflammatory cells and melanophages and dermal sclerosis. All patients were followed up using RCM during the treatment. During follow-up the RCM evolution of the epidermal, junctional and dermal inflammation were evaluated. Results A series of RCM features of scalp LPP and DLE were identified that show correlation with the histopathological evaluation. During the treatment follow-up of the cases RCM was shown to be sensitive for the identification of therapeutic response. Conclusion In our preliminary study the effective usefulness of RCM for the diagnosis of scarring alopecia and follow-up seemed to be evident. Moreover, RCM seems to be also promising for differential diagnosis between the different entities. © 2011 British Association of Dermatologists.


Capitanio B.,San Gallicano Dermatological Institute IRCCS | Lora V.,San Gallicano Dermatological Institute IRCCS | Ludovici M.,San Gallicano Dermatological Institute IRCCS | Sinagra J.-L.,San Gallicano Dermatological Institute IRCCS | And 4 more authors.
Journal of the European Academy of Dermatology and Venereology | Year: 2014

Background Sebum plays a key role in the initiation of the acne lesions. Oxidized sebum lipids cause keratynocytes hyperproliferation and inflammatory cytokines release. Association between sebum oxidation and comedogenesis has been little investigated in comedonal acne.Objectives s Evaluation of sebum oxidation parameters and levels of inflammatory cytokines (IL-1α) in patients with mild comedonal acne (MCA) before and after the treatment with a mixed RetinSphere®- vitamin E formulation.Methods Sebum excretion rate (SER), squalene concentration, and oxidation degree of sebum were measured in 18 MCA patients and 10 controls. IL-1α levels in the stratum corneum were measured in both lesional and non-lesional facial areas of MCA patients. Sebum parameters and IL-1α were measured at week 4 of topical treatment. Reflectance confocal microscopy (RCM) was performed in a subset of four patients at the baseline and at week 4 and all patients were assessed clinically before and following the 8 week-treatment.Results Sebum excretion rate and squalene concentration were comparable between MCA patients and healthy controls. Lipid peroxidation (LPO) and the percentage of oxidized squalene (SQOX) were significantly elevated in the sebum of MCA patients. The concentration of the proinflammatory cytokine IL-1α in stratum corneum was significantly higher in the lesional area compared with non-lesional area of the MCA patients at the baseline. At week 4, while SER and squalene concentration did not vary significantly, the LPO levels and the SQOX percentage resulted decreased at a significant extent. Following the treatment, IL-1α concentration in the lesional area reached values comparable to those of unaffected areas. Consistent with the biochemical data, RCM showed the reduction of hyperkeratinization and of inflammatory cells infiltration of the adnexal structures epithelium, significant clinical improvement was recorded at week 8. Conclusion The data further support the involvement of lipid oxidation and particularly by-products of squalene oxidation in comedogenesis. © 2014 European Academy of Dermatology and Venereology.


Donati P.,San Gallicano Dermatological Institute IRCCS | Paolino G.,San Gallicano Dermatological Institute IRCCS | Panetta C.,San Gallicano Dermatological Institute IRCCS | Muscardin L.,San Gallicano Dermatological Institute IRCCS | And 2 more authors.
Infection | Year: 2013

We present a case of visceral leishmaniasis confirmed after the histological investigation of an ulcerate lesion of the scalp in an HIV-1-infected patient receiving highly active antiretroviral therapy (HAART). Histological examination of the skin lesion revealed a squamous cell carcinoma superinfected by amastigotes of Leishmania infantum from the bloodstream. Because HIV-1-infected individuals can harbour parasitic infections in normal and neoplastic tissue, it is necessary to examine carefully any skin lesions, particularly those with uncommon aspects or a worsening course, to exclude superinfections by unsuspected pathogens. © 2013 Springer-Verlag Berlin Heidelberg.


Maresca V.,San Gallicano Dermatological Institute IRCCS | Flori E.,San Gallicano Dermatological Institute IRCCS | Camera E.,San Gallicano Dermatological Institute IRCCS | Bellei B.,San Gallicano Dermatological Institute IRCCS | And 5 more authors.
Pigment Cell and Melanoma Research | Year: 2013

We have discovered a new α-melanocyte stimulating hormone (α-MSH)/peroxisome proliferator activated receptor-γ (PPAR-γ) connection in B16-F10 cells. Both PPAR-γ up-regulation and its induction as an active transcription factor were observed in response to α-MSH. The α-MSH/PPAR-γ connection influenced both pigmentation and proliferation. The forskolin-stimulated cAMP/PKA pathway was not able to induce either PPAR-γ translocation into the nucleus or PPAR-γ transcriptional activity. As the melanocortin-1 receptor, the specific receptor for the α-MSH, is a G-protein coupled receptor, we wondered whether the phosphatidylinositol [PI(4,5)P2/PLCβ] signal pathway was involved in mediating the α-MSH-dependent PPAR-γ activation. Employing inhibitors of PI(4,5)P2/PLCβ pathway, the results of our experiments suggested that this pathway was promoted by α-MSH and that α-MSH played a role in mediating PPAR-γ activation. We have demonstrated, for the first time, that α-MSH induces the PI(4,5)P2/PLCβ pathway, through analysis of the basic steps of the pathway. The α-MSH effect on PPAR-γ was independent of animal species and was not correlated with the physio-pathological status. © 2012 John Wiley & Sons A/S.

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