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Bianca Maria Piraccini

Full Professor

Department of Medical and Surgical Sciences

Academic discipline: MED/35 Dermatology and Venereal Diseases

Head of Scuola di Specializzazione Dermatologia e Venereologia (DI 68/2015)

Coordinator of PhD Programme in Surgical Sciences

Research

Keywords: children alopecia nails fungi tumors melanoma drugs hair onychomycosis chemotherapy

    1. Nail diseases: clinical and epidemiological aspects. Nail diseases affect more than 50% of the population and include traumatic, inflammatory and neoplastic diseases. About 1500 patients with nail diseases are visited annually at the Dermatology Outpatient Diseases Outpatient Clinic. It is therefore possible to evaluate the prevalence of different diseases, study their clinical aspects, and the response to treatments. Nail diseases are studied clinically, with computer-assisted dermatoscopy and with more or less invasive methods such as mycological examination, histopathological examination and cytological examination.
    2. Onychomycosis (fungal nail infection): identification of the pathogens responsible and the validity of medical and surgical therapeutic options. Onychomycosis (fungal nail infection) affects 30% of the general population: the identification of the responsible pathogens is fundamental for setting the correct treatment.
    3. Treatment of inflammatory nail diseases, such as psoriasis and lichen planus, with the possible use of biological agents. Treatment of inflammatory nail diseases, such as psoriasis and lichen planus, is often unsuccessful, or punctuated by relapses after therapy. The use of different drugs, also experimentally, including biological drugs, can allow to identify the most useful treatment in these patients.
    4. Identification of the cutaneous and nail side effects of drugs such as chemotherapy, EGF inhibitors, VEGF and HAART therapy and their treatment. Numerous chronic therapies, such as chemotherapy or antiviral therapies, produce skin and nail side effects which reduce the quality of life of the patients and which are difficult to manage because the therapy that causes them cannot be suspended. The research is aimed at identifying side effects and studying their pathogenesis as well as identifying treatment. The side effects of the various drugs will be 'cataloged' from a clinical point of view. A histological and immunohistochemical study on sick and healthy nails will be carried out in collaboration with European and American centers (with the support of the ENS-European Nail Society and CND-Council for Nail Disorders) of receptors of epithelial and vascular growth factors in the nail tissues.
    5. Clinical, dermatoscopic, histopathological and immunohistochemical study of nail tumors, including melanoma. Management of nail pigmentation bands in childhood: identification of non-invasive diagnostic parameters to exclude nail melanoma.
    6. The appearance of a pigmentation in black-brown band of the nail (melanonichia striata) can be due to a simple activation of the melanocytes of the matrix of the nail, to a nevus, or even to a melanoma of the nail. In children aged 0-3 years, the appearance of a band of longitudinal melanonychia, usually attributable to a nevus, is not uncommon. Diagnosis occurs only after surgical removal and histological examination of the band, which is not easy in children. In collaboration with fellow nail experts from the International Melanonychia Group, we are evaluating whether there are clinical and dermatoscopic criteria that can avoid nail surgery in children with melanonychia striata.
    7. Nail surgery. Surgery of the nail apparatus is not easy and requires a good knowledge of the nail anatomy. The advanced surgical techniques, such as Mohs surgery or the tangential biopsy of the matrix, allow the removal of neoplastic pathologies of the nails with minimal scarring. In the case of invasive tumors, the choice is between the removal of the entire nail system or the complete removal of the distal part of the finger, including the bone phalanx. The phenolization of the lateral horns of the nail matrix in the treatment of the ingrown nail is the cure with the greatest success and the least morbidity.
    8. Microscopic and cultural identification of the most important fungi that can parasitize hair, nails and skin.
    9. Clinic and epidemiology of the most frequent hair diseases. About 2000 patients per year with hair and scalp diseases are visited in the Dermatology Outpatient Diseases Outpatient Clinic. The patients are studied from a clinical point of view and with invasive methods (biopsy for histological examination) and not (pull test, videodermatoscopy). The most advanced therapies are prescribed and clinical trials with new drugs are carried out.
    10. Identification of the causes and treatment of cicatricial alopecia. Hair loss is permanent in cicatricial alopecia, and identifying the cause of the pathological process allows to stop the evolution of the disease. The research is also aimed at understanding the epidemiological modifications of some pathologies, such as frontal fibrosing alopecia, for which an Italian registry has been prepared in order to collect clinical, laboratory, histopathological, dermatoscopic data, to be put together with the data from countries around the world to study this emerging pathology.
    11. Identification of allergens that commonly cause contact dermatitis.
    12. Study of temporary and permanent alopecia by chemotherapy. Identification of risk factors and therapies. 30% of patients subject to anticancer chemotherapy (taxanes, busulfan and others) no longer regrow all hair after stopping treatment. This possibility unknown to the scientific population until 10 years ago, is now being studied: In collaboration with the Italian Society of Dermatology and Venereology (SIDeMaST) we are doing a multicenter study to evaluate patients before and after therapy to identify those who develop permanent alopecia from chemotherapy and find out the risk factors and possible treatments.

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