The SILVER study. Efficacy of topical nitric‐zinc complex solution in the treatment of resistant warts: A postmarketing evaluation

The treatment of cutaneous viral warts caused by human papillomavirus (HPV) infection is often subject to local recurrence and a long clinical and treatment course. Our aim was to analyze real‐life data on the treatment of difficult‐to‐treat warts from a multicenter postmarketing surveillance assessment on the efficacy, tolerability, and safety of a commercially available nitric‐zinc complex solution (NZCS). Dermatologists from 14 Italian centers completed a questionnaire about their clinical experience on treatment of “difficult‐to‐treat” warts, which included warts in the plantar, periungual, anogenital and aesthetically sensitive areas. The questionnaire was designed to obtain detailed information on wart treatment and compare NZCS efficacy with previous treatments. Of 106 questionnaires returned, 83 reported NZCS use; 67 had previous treatments (23 cryotherapy, 2 electrocoagulation, 12 other topical application, and 30 combined treatment, such as laser, cryotherapy, and/or electrocoagulation). NZCS had superior efficacy to that of previous treatments (p < .0001), resulting in 84.1% with a full or partial clearance (vs. 44.8% for previous treatments), and had better local tolerability (p < .0001). NZCS showed better efficacy and tolerability than other previous wart treatments.     

Efficacy and safety of adalimumab in difficult‐to‐treat psoriasis

Psoriasis is a chronic immune‐mediated inflammatory skin disorder, with a prevalence of 2% to 3% worldwide. Psoriatic lesions affecting scalp, nails, palms, and soles are considered difficult‐to‐treat and require specific management. When psoriasis involves these areas, it may be considered more severe even if the lesions are not extensive. Adalimumab (Humira) is a fully human monoclonal antibody against tumor necrosis factor (TNF), administered via subcutaneous injection. It has already been used in the treatment of adults and children with moderate‐to‐severe chronic plaque psoriasis. In literature, few studies investigated its efficacy in difficult‐to‐treat areas, hence we conducted an observational prospective study of 24 weeks to assess its role in patients with difficult to treat psoriasis. We found out a significant improvement in nail and scalp psoriasis, while palmoplantar and genital psoriasis showed an improvement though not statistically significant. Therefore, adalimumab can be used in difficult‐to‐treat areas with great results, also allowing an improvement in the quality of life of affected patients, both adults and children.     

Evidence‐based (S3) guideline for the treatment of psoriasis vulgaris – Update: “Therapeutic options” and “Efalizumab”

In February 2009, the European Medicines Agency's (EMEA) Committee for Medicinal Products for Human Use (CHMP) had recommended the suspension of efalizumab's (Raptiva^®) marketing authorization, because its benefits in the treatment of psoriasis were modest, while there was a risk of serious side effects in patients receiving the medicine, including the occurrence of progressive multifocal leukoencephalopathy (PML). The guideline group has changed the guideline accordingly.     

Plica “Neuropathica” in an 11‐Month‐Old Boy

Plica neuropathica is an acquired, irreversible tangling and matting of scalp hair presenting as discrete masses. Many cases are reported in the literature, but it has never been reported in an infant. Herein we report the first case of plica neuropathica in an 11‐month‐old.     

A “seasonal bromoderma” in a farmer

Bromoderma is a rare skin disease caused by the ingestion, inhalation, or contact with products containing bromides. We report a case of bromoderma in a 36‐year‐old farmer, characterized by remission during the spring and exacerbation during the winter. The recognition of the use of products containing bromides during the winter helped us to understand the cause of the clinical condition.     

“Slime” dermatitis,a fad‐associated chronic hand dermatitis

“Slime” is the colloquial name for a non‐Newtonian viscoelastic putty‐like substance that is currently a popular plaything among pre‐teens and adolescents. Several ingredients in homemade slime recipes may cause irritant or allergic contact dermatitis. We report two children who developed slime‐associated chronic hand dermatitis, more prominently on their dominant hand. We review the potential for irritant and allergic contact dermatoses as the causes of dermatitis associated with homemade slime.     

The “gauntlet” of pellagra

A 48-year-old alcoholic Filipino man presented to the outpatient department with a 2-year history of an eruption in a photosensitive distribution and episodes of mild diarrhea. He was otherwise in good health. Dermatologic examination revealed a browny-red coloration, with a sharply demarcated erythematous border, affecting both hands and lower forearms, where it was striking in its symmetry ( Fig. 1 ). Around the neck, it was typical of a casal's necklace. The fronts and backs of the legs and the dorsa of the feet were also erythematous. The patient showed no evidence of mental confusion.

Figure 1 Open in figure viewer PowerPoint “Gauntlet” of pellagra, showing browny-red discoloration with sharply demarcated erythematous border     

“Retronychia – clinical and pathophysiological aspects”

Retronychia represents proximal ingrowth of the nail that occurs when the nail embeds backwards into the proximal nail fold. It is suspected when there is a persistent paronychia, particularly in the setting of trauma. Important clinical criteria for diagnosis are inflammation of the proximal nail fold, granulation tissue emerging from under the nail fold, thickening of the proximal portion of the nail plate and interruption of nail growth. The condition is rarely diagnosed and often misinterpreted, and is therefore unnecessarily treated with systemic antibiotics and antifungals. Avulsion of the nail confirms the diagnosis and it is the curative treatment. Conservative treatment with an adhesive technique is a valid option in early cases. We report 20 cases of retronychia diagnosed in our department between 2010 and 2013.     

Toward a better understanding of “psychocutaneous disorders”

There is a group of cutaneous disorders for which we have an inadequate understanding of their etiology and which frustrates us as therapists. This includes conditions such as the dynias, neurotic excoriations, postherpetic neuralgia, prurigo nodularis, and others. Herein, we review a recent article in the New Yorker magazine which postulates a new way to look at these puzzling entities.