Background: The incidence of syphilis has increased in high-income countries in the past few decades, especially among men who have sex with men. In the present study, we aimed to analyze the correlations between atypical syphilis manifestations and the demographic, clinical, and laboratory features of patients and to review unusual presentations of syphilis reported in the literature. Methods: We conducted a retrospective analysis of 307 patients with syphilis diagnosed between 1 January 2013 and 31 October 2023 at the sexually transmitted infection (STI) centers of the University of Genoa and University of Foggia with both typical and atypical manifestations of disease. Results: In our series, atypical manifestations were detected in 25.8% of the patients, especially in the secondary stage of the disease. Lesions with annular morphology and lesions presenting as itchy erythematous scaly plaques with a psoriasiform appearance were the most common atypical presentations of secondary syphilis. A statistical analysis revealed that homosexual orientation, syphilis reinfection, and venereal disease research laboratory (VDRL) titers > 1:32 were correlated with atypical manifestations. Conclusions: Our study demonstrates that the spectrum of syphilis manifestations, in all the stages of the disease, is wide; atypical manifestations often pose diagnostic challenges, may delay the provision of appropriate treatment, and facilitate the spread of the infection.

Background/Objectives: The advent of combination antiretroviral therapy has led to significant reductions in HIV-related morbidity and mortality and, conversely, an increasing incidence of chronic diseases, such as cancer. This study aimed to assess the incidence of skin malignancies in a cohort of people living with HIV (PLWH) compared to HIV-uninfected individuals (HUPs). Methods: Between April 2023 and April 2025, PLWH attending the Infectious Disease Unit at Policlinico of Foggia, Italy, were invited for skin cancer screening (cases). During the same period, patients visiting the Dermatology Unit were asked to undergo skin cancer screening and a rapid HIV test. Those who tested negative were included as controls. Suspicious lesions were surgically excised at the Plastic Surgery University Unit and examined by a dermatopathologist. Results: We enrolled 91 cases and 91 controls. Precancerous and cancerous skin lesions were detected at similar rates in PLWH and HUPs (12% vs. 13.2% and 7.6% vs. 8.7%). The total number of cancerous and precancerous lesions was higher in the PLWH group. In both groups, basal cell carcinoma was the most common tumor. Squamous cell carcinoma, basosquamous carcinoma, and dermatofibrosarcoma protuberans were found only in PLWH. Conclusions: The higher risk of multiple and rare skin cancers in PLWH should be recognized by healthcare providers and patients. PLWH should have regular skin cancer screenings, especially if they have additional risk factors such as a history of extensive ultraviolet radiation exposure.

Background/Objectives: Pityriasis rosea (PR) is a self-limiting exanthematous disease associated with the endogenous reactivation of human herpesviruses (HHV)-6 and HHV-7. Classically, the lesions gradually resolve, leaving no sequelae. Therefore, the best treatment is reassuring the patient and suggesting a resting period. However, atypical PR cases characterized by extensive, persistent lesions and systemic symptoms may impact the patient’s quality of life, and, therefore, a treatment can be prescribed. There is limited evidence on the comparative effectiveness of pharmacological treatments for PR; therefore, we performed a network meta-analysis to compare these interventions. Methods: Overall, 12 randomized control trials (RCTs) were identified. The outcomes were itch resolution and rash improvement. Results were expressed as risk ratio (RR) and 95% confidence interval (CI). We also calculated the relative ranking of the interventions for achieving the aforementioned outcomes as their surface under the cumulative ranking (SUCRA). Results: On network meta-analysis, only oral steroids and the combination of oral steroids+antihistamine resulted significantly superior to the placebo in terms of itch resolution (RR 0.44, CI 0.27–0.72 and RR 0.47, CI 0.22–0.99). Oral steroids resulted in the best treatment (SUCRA 0.90) for itch resolution. In terms of rash improvement, only acyclovir and erythromycin resulted significantly superior to placebo (RR 2.55, CI 1.81–3.58; and RR 1.69, CI 1.23–2.33), and acyclovir outperformed all the other tested interventions. Consequently, acyclovir ranked as the best intervention (SUCRA score 0.92). Conclusions: Acyclovir represents the best option for patients with PR that have extensive, persistent lesions or systemic symptoms. Steroids and antihistamines seemed the best treatment for itch resolution.

Background/Objectives: Pityriasis rosea (PR) is a self-limiting exanthematous disease associated with the endogenous reactivation of human herpesvirus (HHV)-6 and HHV-7. Classically, the lesions gradually resolve leaving no sequelae. Therefore, the best treatment is reassuring the patient and suggesting a resting period. However, atypical PR cases characterized by extensive, persistent lesions and systemic symptoms may impact the patient’s quality of life, and, therefore, a treatment can be prescribed. There is limited evidence on the comparative effectiveness of pharmacological treatments for PR, therefore we performed a network meta-analysis to compare these interventions. Methods: Overall, 12 randomized control trials (RCTs) were identified. The outcomes were itch resolution and rash improvement. Results were expressed as risk ratio (RR) and 95% confidence interval (CI). We also calculated the relative ranking of the interventions for achieving the aforementioned outcomes as their surface under the cumulative ranking (SUCRA). Results: On network meta-analysis, only oral steroids and the combination of oral steroids+antihistamine resulted significantly superior to the placebo in terms of itch resolution (RR 0.44, CI 0.27-0.72 and RR 0.47, CI 0.22-0.99). Oral steroids resulted as the best treatment (SUCRA 0.90) for itch resolution. In terms of rash improvement, only acyclovir and erythromycin resulted significantly superior to placebo (RR 2.55, CI 1.81-3.58 and RR 1.69, CI 1.23-2.33), and acyclovir outperformed all the other tested interventions. Consequently, acyclovir ranked as the best intervention (SUCRA score 0.92). Conclusions: Acyclovir represents the best option in PR patients with extensive, persistent lesions or systemic symptoms. Steroids and antihistamines seemed the best treatment for itch resolution.

Dear Editor, Dermatitis factitia (DF), also known as dermatitis artefacta, is a rare condition characterized by self-inflicted skin lesions. These lesions can be a result of compulsive habits driven by emotional distress, serving as a means of emotional release during episodes of anxiety. Alternatively, they may be deliberately induced by the patient with the intention of gaining medical attention. DF is essentially the physical manifestation of underlying psychiatric disorders, making it a particularly challenging condition within the realm of medical practice. Being a diagnosis primarily based on the exclusion of an underlying disorder often requires multiple investigations that can impose a significant economic burden.