Background: Dermatophytosis is a prevalent superficial infection caused by filamentous fungi, primarily affecting the skin and/or its appendages. In recent years, there has been a notable increase in mycotic strains resistant to standard antifungal therapies, including Trichophyton indotineae, a dermatophyte of the Trichophyton mentagrophytes complex. This review aims to provide a comprehensive overview of the treatment options for T. indotineae, elucidating their effectiveness in managing this challenging mycotic infection. Methods: For this review, a search was conducted in the PubMed, Scopus, Web of Science, Embase, and Google Scholar databases, encompassing all published data until March 2024. English-language articles detailing therapy outcomes for patients confirmed to be affected by T. indotineae, identified through molecular analysis, were included. Results: Itraconazole was shown to be a good therapeutic choice, particularly when administered at a dosage of 200 mg/day for 1–12 weeks. Voriconazole was also demonstrated to be effective, while terbinafine exhibited a reduced response rate. Griseofulvin and fluconazole, on the other hand, were found to be ineffective. Although topical treatments were mostly ineffective when used alone, they showed promising results when used in combination with systemic therapy. Mutational status was associated with different profiles of treatment response, suggesting the need for a more tailored approach. Conclusions: When managing T. indotineae infections, it is necessary to optimize therapy to mitigate resistances and relapse. Combining in vitro antifungal susceptibility testing with mutational analysis could be a promising strategy in refining treatment selection.

Melanocytic lesions with peripheral globules (MLPGs) usually represent lesions in an active growth phase and should be carefully evaluated in adults and the elderly, since melanoma can rarely present with this pattern. The primary aim of this study was to identify anamnestic, clinical, and dermoscopic features associated with malignancy (histologic outcome of melanoma) in MLPGs. The secondary aim was to describe the frequency of these features. We conducted a retrospective cross-sectional observational study, evaluating anamnestic, clinical, and dermoscopic features of MLPGs excised at the Dermatology Clinic of Trieste, Italy (January 2019-June 2023). The association between each variable and the histologic outcome (nevus or melanoma) was assessed using Fisher’s exact test. Differences in age and lesion diameter distribution between nevi and melanomas were analyzed using Student’s t-test for independent variables. Several lesion characteristics were associated with malignancy, including a personal history of melanoma (p=0.0069), localization on the lower limbs (p=0.0215), and lesion diameter ≥6 mm (p=0.0025). Several dermoscopic features were also associated with malignancy, namely non-circumferential peripheral globules (PGs; p=0.0406), regression (p=0.0042), evident vascular pattern/pink areas (p=0.0007), inverse network (p=0.0243), and asymmetric central globules (p=0.0057). Additionally, the comparison between melanoma and nevi groups confirmed that malignant lesions were characterized by a higher mean age at diagnosis (p=0.0237) and a larger mean diameter (p=0.000112). This study provides practical guidance for the management of MLPGs, highlighting that several anamnestic, clinical, and dermoscopic features are suggestive of malignancy.

Actinic keratoses (AKs) are common skin lesions found on sun-exposed areas and are considered potential precursors to squamous cell carcinomas (SCCs). This observational case-control study evaluates the efficacy of combining traditional daylight photodynamic therapy (DL-PDT) with pre-treatment using 0.005% calcipotriol (CAL) ointment. Twenty immunocompetent male patients with grade I-II AKs on the scalp and/or face were randomized into two groups: the case group received a 14-day pretreatment with CAL ointment before DL-PDT, while the control group used a moisturizing cream. Both groups underwent a series of three DL-PDT sessions. The study utilized the Actinic Keratosis Area Severity Index (AKASI) scoring system to measure the actinic damage at baseline, 3 months, and 6 months post-treatment. Results showed a significant reduction in AKASI scores in the CAL group compared to controls, indicating that CAL pretreatment enhances the efficacy of DL-PDT. This combination treatment was well tolerated, with minimal discomfort reported. The findings suggest that incorporating CAL into the treatment regimen can improve the clearance of AKs and potentially prevent their progression to SCCs.

Dear Editor, Scabies is a common pruritic ectoparasitic infestation of the skin caused by the mite Sarcoptes scabiei. It classically presents as an intensely pruritic eruption that usually involves hands and interdigital folds, wrists, axillae, areolae, abdomen, and genitalia. In immunocompetent adults, mite infestation affecting the face is considered exceptional; accordingly, if topical treatment is chosen, clinicians typically instruct patients to apply the product to the body, excluding the head area.