Tacrolimus not only inhibits T-lymphocyte proliferation and cytokine production, but also plays an important role in the IL-12-induced shift from a T-helper (Th) 2 to a Th1 cytokine profile that characterizes the development of chronic AD. Tacrolimus also demonstrates wider pharmacodynamic effects than hydrocortisone.

Itch is an extremely frequent and enervating symptom of many diseases. Current anti-itch therapy, which is based almost exclusively on an "immunocentric" viewpoint, is often unsatisfactory. Recent studies show that this symptom is in fact the result of a complex interplay among skin, nervous system, endocrine system, and immune system. This explains the frequent failure of therapeutic strategies focused only on a single factor and suggests the usefulness of a polypharmacologic symptomatic treatment, designed on a case-by-case basis as a result of a multidisciplinary approach. We discuss the perspectives of anti-itch therapy in light of the new pathogenetic and pharmacologic acquisitions.

We report a case of a 15-year-old Caucasian female, previously affected by non-segmental vitiligo and psoriasis vulgaris, who developed a psoriatic eruption on sun-exposed skin during the summer. Oral therapy with cyclosporine A achieved a rapid improvement of the clinical picture. The main features of photosensitive psoriasis and the association between psoriasis and vitiligo are discussed herein.

A 71-year-old deaf and mute woman was referred to our clinic for a "bad-smelling eruption of the trunk." On physical examination, the anterolateral portion of the left breast was markedly reduced with respect to the contralateral one, indurated at palpation, and covered by a thick mantle of fibrin and necrotic tissue (Fig. 1a). Moreover, the patient had numerous erythematous plaques, ulcerated nodules, and serohematic blisters localized in a zosteriform pattern on the homolateral aspect of the trunk (Fig. 1b).Incisional biopsy specimens and histologic examination confirmed that the left breast lesion was a carcinoma (ductal type, infiltrating, grade G2) and the other skin lesions were metastases. Cytologic examination and direct immunofluorescence assays performed on a blistering lesion were negative. All the clinical and laboratory assays that we performed in order to rule out any internal involvement were unrevealing except for hypochromic microcytic anemia and hypoalbuminemia. The neoplasm was staged as T4cN0M1 and palliative radiotherapy was started. At the 1 year follow-up, the patient was still alive without any apparent involvement of internal organs.The patient presented when the cancer had already invaded and destroyed the lower portion of the left breast, a "monstre" picture that is uncommon in developed countries. Clinical and laboratory investigations excluded the presence of internal metastases until 1 year after the diagnosis. Such a relatively benign disease course appeared very surprising, considering the local invasivity of the neoplasm. Breast cancer metastasization confined to distant skin areas is relatively rare. The presence of blisters made necessary the exclusion of other dermatoses. In particular, serologic and cytologic assays excluded the coexistence of herpes zoster, while direct immunofluorescence assay excluded localized bullous pemphigoid.Cutaneous metastases featuring a zosteriform pattern are rare in the literature. In these cases, the mechanism of dissemination is very often uncertain, although lymphatic or perineural invasion seems to be the most likely. Figure 1. (a) Ulcerative cancer of the left breast. (b) Plaques, nodules, and blisters localized in the left superior portion of the abdomen.

A 76-year-old woman presented to our department with intense itchiness, begun 3 years earlier, widespread to total body, especially to her limbs. Physical examination of the skin revealed multiple, small, brown, round lesions, with a diameter of about 2-6 mm, and a hyperpigmented, keratotic, slightly raised, palpable border. The skin within the ring was atrophic, hypopigmented, or mildly reddened. The lesions arose into atrophic skin where it was possible to observe some irregular, purpuric macules of variable size (Figures 1 and 2). Due to a previous diagnosis of necrotizing vasculitis of the legs and Sjögren syndrome, the patient was treated from 1999 with 8 mg/d prednisone and topical application of methyl-prednisolone. An incisional biopsy taken from a typical lesion of the right leg was performed.