Mpox Virus (MPXV) is a zoonotic infectious disease first identified in 1970 in rural villages in rainforest areas of central and western Africa when smallpox was in the final stages of eradication. Since May 2022, cases and sustained transmission chains of monkeypox have been reported for the first time in countries where the disease is not endemic and without cases having direct or immediate epidemiological links to areas of West or Central Africa (travel, importation of mammals). On 23 July 2022, WHO declared monkeypox a “Public Emergency of International Concern” (PHEIC). In this paper, we report two cases of a Polymerase Chain Reaction (PCR)-confirmed MPXV infection. A 39-year-old Italian male came to our attention for a suspected herpetic infection, fever, headache, and malaise, which were followed by the development of an erythematous plaque covered by vesicles on the chin, an oval ulcer with a white peripheral border on the lower lip, and a central erosive area and three pustules on the arms and trunk. During the physical examination, cervical lymphadenopathy was also detected. PCR investigation of the patient and his partner confirmed the presence of MPXV infection. Our report describes a possible clinical feature of Mpox disease and illustrates the challenge of a disease that seems to present itself in different ways.

Background. Psoriasis is a chronic inflammatory skin disease with an important socio-economic burden. Available therapies include conventional systemic drugs and biological drugs, such as Tumor Necrosis Factor (TNF)-α inhibitors, that are characterized by high costs. Aim. Perform a cost-estimation analysis of conventional treatment vs therapy with biosimilar TNF-α inhibitor between January 2021 and January 2022, according to the Apulia regional cost list. Methods. The average annual expenditure per patient on conventional treatment (cyclosporine and methotrexate) vs therapy with biosimilar TNF-α inhibitor was compared. The 'cost per responder' was determined by analyzing the percentages of 'responders' (patients achieving PASI 75 and PASI 90) and 'non-responders' (PASI <75) after one year of treatment. Results. The annual per capita expenditure with cyclosporin was €3,515.35, with methotrexate was €1,048.87, while for treatment with TNF-α biosimilar inhibitor drug was €3,030.11. The "cost per responder" analysis showed a value of €8,573 for cyclosporine, €2,834 for methotrexate, and €3,564 for TNF-α biosimilar inhibitor. Conclusions. Conventional drugs have a greater impact on healthcare expenditure than TNF-α biosimilar inhibitors.

Tea tree oil is an essential oil obtained by distillation from the leaves and terminal branchlets of Melaleuca alternifolia and is now present in numerous products for body care and self-medication. We report a case of allergic contact dermatitis to tea tree oil in a young man who was applying a lotion containing tea tree oil on a wart localized on the plantar aspect of the right big toe, which had previously been treated with cryotherapy. He developed a severe eczematous eruption on the right foot and the right leg, with subsequent id reactions affecting the right thigh, the contralateral lower limb, the trunk and the upper limbs. The lotion was discontinued, and the dermatitis resolved after topical corticosteroid therapy. Patch testing with the aforementioned lotion 10% pet. and oxidized tea tree oil 5% pet. identified tea tree oil as the culprit agent of the dermatitis. This case report confirms that products made of natural ingredients, often perceived to be harmless, can cause allergic reactions.