Aim:

The purpose of this study was to investigate the disease-free time (DFT) and overall survival (OS) of patients with intermediate or high-risk cutaneous melanoma who were treated with conventional surgery alone, and to compare them with that of a second group of patients who were treated with surgery and SLN biopsy.

Methods:

A retrospective, single-centre study was performed at the Department of Dermatology of the "M. Bufalini" Hospital, Cesena, Italy based on data collected between January 1990 and December 2007. A total of 757 consecutive patients with stage I-II melanoma were identified: the former group (control group), treated with conventional surgery, was composed of 224 patients; the latter, treated with surgery and SLN biopsy (SLN biopsy group), was formed of 529 patients.

Results:

The 5-year disease free time (DFT) rate, estimated with Kaplan-Meyer, was 73.9% (95% CI: 67.5-79.2) in the control group, and 82.2% (95% CI: 78.6-85.3) in the SLN biopsy group. Although the DFT rate was significantly higher in the SLN group than in the control group in univariate analyses (P=0.004), this gain was lost in multivariate analysis (P=0.2). The 5-year overall survival (OS) rate was 88.4% (95% CI: 83.2-92.1) for the control group, and 87.9% (95% CI: 84.6-90.4) for the SLN biopsy group. Statistical comparison of specific OS was not statistically significant (P=0.93).

Conclusion:

On the basis of our follow-up data, we found that patients who underwent SLN biopsy technique experienced a reduction in the proportion of lymph nodal relapse, but DFT and OS were statistically equivalent between the two groups.

Aim:

Atopic dermatitis is a chronic inflammatory disease characterized by severe itching, skin dryness, blistering and remittent-relapse course. The critical feature is a skin barrier dysfunction that leads to epidermal inflammation and to bacterial superinfection. The aim of our study is to assess the usefulness of DermaSilk in reducing dermatitis relapses, in infants affected by atopic dermatitis, previously treated with topical corticosteroid and, if needed, with antibiotics.

Methods:

This is a double blind randomized study involving 22 infants, aged 4 to 18 months, affected by atopic dermatitis. Disease severity has been evaluated by the SCORAD Index. To achieve a complete remission, acute phases were managed following international guidelines. Subsequently, infants were randomized to either wear a set of DermaSilk body and tights (group A), or wear clothes in pure cotton (group B) for 24 months with the exception of the warmer months (from mid-May to mid-September).

Results:

The use of topical steroid per month was significantly lower in the DermaSilk group compared to the cotton group (P=0.006). The subjective evaluation reflecting itching reduction was also statistically significant (P=0.014).

Conclusion:

This study shows that DermaSilk products can reduce relapses in infants with eczema during the maintenance phase and play a pivotal role in itching control, improving the quality of life of children and their family.

Aim:

Aim of the study was to assess systemic effects of a cycle of treatment with a topical formulation of l-T4 and escin (Somatoline®) in healthy women based on changes in bioavailability of FT4, FT3, rT3, and TSH.

Methods:

This study enrolled 20 healthy adult women with body mass index <30, not exposed to iodine-containing products. The study called for 28 consecutive days of treatment with Somatoline® followed by a 14-day follow-up period. Blood samples for FT4, FT3 and TSH levels were drawn at baseline, 5 and 24 hours after the first application and thereafter on days 14, 28 and 42. Levels of rT3 were measured during the first 24 hours postapplication.

Results:

Subject mean age was 40.1±8.0 years and BMI from 19.1 to 29.8. Levels of FT4 always remained within normal range and did not change in a clinically relevant way from baseline (11±1.2 pg/dL), with maximum mean change from pretreatment values of 0.4 pg/mL (P=0.87). Likewise, FT3 and TSH levels did not change significantly from baseline (3±0.4 pg/dL and 1.8 ±0.9 µU/mL, respectively). Levels of rT3 behaved in a similar way, with modest changes from baseline (P=0.29). Local tolerability was defined "excellent" for 19 out of 20 women (95%) and "moderate" in one subject who experienced the onset of folliculitis, for which causal correlation with the treatment was considered "possible".

Conclusion:

Used at the posology foreseen for the marketed formulation, Somatoline® does not affect plasma levels of FT4, FT3, rT3 and TSH, either in the short term or after 28 days.

The interest to the health related quality of life (HRQoL) in children with dermatologic conditions is growing and it was studied in children with different dermatologic diseases. Generic, dermatology-specific and disease-specific instruments can be used to measure HRQoL in pediatric dermatology. In most cases HRQoL questionnaires to be used in adult population are inappropriate for children. With the help of illustrations and interview forms children are able to assess their HRQoL from the age of 4-5 years. In smaller children proxy ratings can be used. The dermatology-specific instrument Children's Dermatology Life Quality Index (CDLQI) is the most frequently used HRQoL instrument for children with different skin conditions. There is lack of validated dermatology-specific HRQoL proxy instrument to be used in children under 4 years and disease-specific instruments for many skin diseases. Most of the disease-specific HRQoL instruments created especially for children with skin diseases are atopic dermatitis-specific. The assessment of HRQoL in pediatric dermatology helps to assess the impact of single skin disease on child's life, to register patients' view on the efficacy of different treatment methods, educational programs and consultations. It makes possible to compare the impact of skin diseases and results of the treatment in children from different age groups on local, regional, national and international levels. It is used by pharmaceutical industry in clinical trials of new drugs and by health service authorities in national standards.

It is now recognized that therapy should not only seek to cure disease, but also to affect outcomes that matter to the patients the most; those related to their functioning in their everyday life and their overall quality of life. In those situations where elimination of disease/complete cure is not possible for example in chronic conditions, limiting the complications from the illness, so that patients can still maintain a comfortable and satisfying life, becomes the goal of treatment. This coupled with the growing patient rights movement and the need for patients to be a part of treatment decision-making process means that patient's health-related quality of life is no longer just an important consequence of health-care, but it is increasingly regarded as an explicit ultimate goal.

Aim:

Many skin conditions may have a strong impact on quality of life. The impact depends on several factors and in particular on the nature of the disease itself. The aim of the study was to describe the burden of several dermatological conditions on patients and to compare them.

Methods:

Dermatological patients were recruited consecutively during the normal outpatient clinics of a large reference hospital. Quality of life data were collected using the Skindex-29. A short form of the questionnaire, the Skindex-17, was derived in order to simplify the presentation of results. The Skindex-17 has two subscales: symptoms and psychosocial.

Results:

Data were complete for 2478 patients and 2402 patients for the symptomatic and the psychosocial scale of Skindex-17, respectively. The different skin conditions were grouped into 32 categories. Three disease patterns could be recognized, according to quality of life impairment: 1) low symptomatic impairment and low psychosocial impairment: mild conditions such as nevi and benign skin neoplasms, but also melanoma; 2) low symptomatic impairment and high psychosocial impairment: diseases such as alopecia, hirsutism, vitiligo; 3) high symptomatic impairment and high psychosocial impairment: for example, psoriasis, pemphigus, lichen.

Conclusion:

Specialty-specific quality of life questionnaires, such as the Skindex-29 or the Skindex-17, allow to evaluate differences among conditions. Such observations could be used by health policy makers, to show, for example, that some conditions affecting the appearance, even though not clinically severe, may have a strong impact on psychosocial life.

Health-related quality of life issues in patients with cutaneous malignancies is being re-explored. This is motivated by the heavy burden they put on dermatological care, it is more and more considered a chronic disease and new non-invasive therapies are being introduced. The purpose of this review is to identify the relevant quality of life (QOL) issues and to summarize the instruments used for investigating QOL in keratinocyte carcinoma patients. With a systematic literature search in Embase, MEDLINE OvidSP, PubMed publisher and Cochrane Central, 10 questionnaires and 4 studies reporting on quality of life issues were identified. Generic (UK Sickness Impact profile [UKSIP], Short Form 36-item Health Survey [SF-36], Functional Assessment of Cancer Therapy-General [FACT-G]) and dermatology specific (Dermatology Life Quality Index [DLQI] and Skindex-29, -16, -17) instruments demonstrated little to no QOL impairment. This may be explained by failing to capture the relevant domains such as "emotions", "appearance" and "anxiety". Skin cancer specific questionnaires (Skin Cancer Index [SCI], Skin Cancer Quality of Life Impact Tool [SCQOLIT] and Actinic Keratosis Quality of Life [AKQoL]) demonstrated good validity and responsiveness and represent the effect on QOL properly. However, there are some points of critique to these questionnaires. Optimal management of patients with actinic neoplasia syndrome and the selection and evaluation of therapies may benefit from the use of PROs in this ever increasing population.