Enzo Berardesca
University of Miami Miller School of Medicine, Dermatology, Faculty Member
- Enzo Berardesca, MD, has been Director of Clinical Dermatology at the San Gallicano Dermatological Institute, Rome, I... moreEnzo Berardesca, MD, has been Director of Clinical Dermatology at the San Gallicano Dermatological Institute, Rome, Italy from 2001 to 2017. Dr. Berardesca, obtained his training at the University of Pavia and received the M.D. degree in 1979. He served as assistant at the Dept. of Dermatology, IRCCS Policlinico S. Matteo, Pavia from 1982 to 1987, as assistant research the Dept. of Dermatology, University of California School of Medicine in San Francisco, USA in 1987. Dr. Berardesca has been Chairman of the International Society for Bioengineering and the Skin from 1990 TO 1996. He has organized several international meetings on skin bioengineering and irritant contact dermatitis in Europe. He is member of the editorial board of Skin Pharmacology, Skin Research and Technology, The American Journal of Clinical Dermatology and the Journal of Cutaneous and Ocular Toxicology. He is member of the European Association of Dermatology (EADV), the Italian Italian Society of Dermatology (SIDEMAST), the International Society for Biophysics and the Skin (ISBS). He is author of 11 books and more than 400 papers and book chapters.edit
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ABSTRACT
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Stratum corneum barrier is commonly described according to the “brick and mortar” model constituted respectively by corneocytes and intercellular lipids; the former are composed mainly of insoluble bundled keratins surrounded by a cell... more
Stratum corneum barrier is commonly described according to the “brick and mortar” model constituted respectively by corneocytes and intercellular lipids; the former are composed mainly of insoluble bundled keratins surrounded by a cell envelope stabilized by cross-linked proteins and covalently bound lipids. Polar structures, such as corneodesmosomes, interconnect corneocytes determining stratum corneum cohesion. Intercorneocytic lipids are primarily generated from exocytosis of lamellar bodies during the keratinocytes’ terminal differentiation and secondarily generated by sebaceous output. Lipids are required for a competent skin barrier and homeostatic control of transcutaneous penetration. 1
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Scientific research in cosmetics is growing, and there is significant interest in new data related to active molecules, basic science, methods, and product development in this field [...]
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The body skin pH can usually vary from 4.0 to 7.0 depending on location. The presence of natural acidic compounds on the skin surface helps maintain the skin's physicochemical properties as well as its protective functions. Since the... more
The body skin pH can usually vary from 4.0 to 7.0 depending on location. The presence of natural acidic compounds on the skin surface helps maintain the skin's physicochemical properties as well as its protective functions. Since the slightly acidic pH of the skin is extremely important for the skin's protective function, the skin is widely known as "acid mantel." Factors such as age, race, gender, body sites, biochemical differences, and even washing affect the pH of the stratum corneum. Recent clinical studies using an emollient-base finish product using the traditional way of measuring skin pH produced results that indicated an apparent increase in skin pH. The apparent pH increase with these products is most probably an artifact of the skin pH measurement technique. Our findings show that certain petrolatum-based emollients and components could create a protective barrier and help maintain the healthy acidity of the skin. Our work provides new evidence of emoll...
The purpose of this study is to evaluate blood cytokines and immunological parameters in psoriatic patients during long-term treatment with etanercept. Forty-five subjects of both sexes affected by psoriasis with or without arthritis... more
The purpose of this study is to evaluate blood cytokines and immunological parameters in psoriatic patients during long-term treatment with etanercept. Forty-five subjects of both sexes affected by psoriasis with or without arthritis entered the study and were treated with etanercept according to international standard protocols. Biochemical blood analysis was carried out at baseline and during follow-up every second month. In particular, the following parameters were kept under control: antinuclear antibodies, anti-nDNA antibodies, anti-histone antibodies, blood cell count, circulating lymphocyte subtypes (CD3, CD4, CD8, CD16, CD19) and IgE. Cytokine profiles (IL-1-α, IL-1-β, IL-6, IL-8, IL-10, IL-12, INF, TNF- α) were also evaluated in blood samples during the treatment up to 1 year of follow-up. A significant decrease in PASI score (p<0.01) and in several cytokine levels was observed, particularly in IL-1, IL-6, IFN-γ (p<0.01) and to a lesser extent in TNF-α (p<0.05). No...
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We tested an OTC formulation versus placebo in a double-blind trial to evaluate its ability to improve elasticity and firmness of the skin. The clinical non-invasive evaluation in 20 volunteers shows: 1. No adverse reactions such as... more
We tested an OTC formulation versus placebo in a double-blind trial to evaluate its ability to improve elasticity and firmness of the skin. The clinical non-invasive evaluation in 20 volunteers shows: 1. No adverse reactions such as itching or irritation 2. Efficacy and cosmetic acceptibility of the test cream 3. An increase in electrical capacitance (moisture content) even though without statistical significance. This result is not surprising because the patients had healthy skin and were relatively young (aged 20-25) 4. A very significant improvement in the biomechanical properties (extensibility and firmness) of the skin. This increase was statistically significant (P < 0.02) The main components of the cream (boswellic acids, Sylibin and Centella asiatica extracts) were formulated as complexes with lyso-phospholipids and soya bean non-saponifiable lipids.
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Cellulite represents the most common lipodystrophic disease. It affects more likely women than men and it usually develops in particular anatomic sites such as lateral thighs and buttocks. In these areas skin resembles 'orange... more
Cellulite represents the most common lipodystrophic disease. It affects more likely women than men and it usually develops in particular anatomic sites such as lateral thighs and buttocks. In these areas skin resembles 'orange peel' surface. The pathophysiological aspects of cellulite are still not clear. Many predisposing factors seem to influence cellulite onset, including gender, heredity, race, body weight and age. Hormones and impairment of both microvascular and lymphatic circulation are considered the most important etiological factors. The evaluation of cellulite is based principally on clinical observation, thigh circumference measurements, body mass index and thermography but for testing anticellulite products, more objective and non-invasive methods of evaluation are requested.
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Only a limited number of studies on cellulite have been published in the international literature and many of them reach somewhat antithetical conclusions. Consequently, it is not yet possible to reconcile the extreme differences of... more
Only a limited number of studies on cellulite have been published in the international literature and many of them reach somewhat antithetical conclusions. Consequently, it is not yet possible to reconcile the extreme differences of opinion which have lingered on for years concerning the nature of this disorder, as well as its origin and even the most basic aspects of its histopathological classification. It does not even have a recognized name: in fact, the term 'cellulitis' is used in scientific English to indicate a spreading gangrenous infection of the subcutaneous cellular tissue. The other terms used from time to time [panniculitis, lipodystrophy, edematofibrosclerotic panniculitis (EFP), liposclerosis, lipoedema, etc.] have quite different morphological and pathogenetic connotations in general. Over the last few decades, three major conflicting theories have emerged in relation to the ethiopathogenesis of cellulite. These indicate, respectively, the following causes: ...
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The topically applied cosmetic products can be helpful in improving the aged skin condition. The present study shows how oral fish-cartilage food supplementation can be helpful in improving the treatment of ageing skin. A total of 30... more
The topically applied cosmetic products can be helpful in improving the aged skin condition. The present study shows how oral fish-cartilage food supplementation can be helpful in improving the treatment of ageing skin. A total of 30 healthy women with signs of skin ageing were studied. Fifteen of the women were treated with a food supplement based on polysaccharides derived from the fish cartilage and a natural mix of antioxidants for 2 months and the other 15 with a placebo. Clinical evaluation and biophysical parameters related to skin function and wrinkle severity, such as silicone replica, skin thickness, mechanical properties, skin colour and capacitance, were measured. The results showed statistically significant changes in the active-treated group in comparison to the placebo. In particular, dermal thickness (treatment: from 1.13 to 1.23 mm; P < 0.001), skin wrinkling (treatment: from 9.5 to 3.5 R(a); P< 0.002), skin colour (treatment: brighter and less pigmented; P &l...
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Sensitive skin is a dermatological problem of increasing incidence in western countries and is sometimes associated with atopic condition and bacterial sovrainfection. The purpose of this study is to evaluate in a double blind,... more
Sensitive skin is a dermatological problem of increasing incidence in western countries and is sometimes associated with atopic condition and bacterial sovrainfection. The purpose of this study is to evaluate in a double blind, randomized, placebo controlled trial the efficacy of gluco-oligosaccharide and collagen tripeptide F in controlling the signs and symptoms of sensitive atopic skin. Forty female subjects (age, 30-59 years) affected by non-lesional atopic sensitive skin entered the study. Skin sensitivity was determined by a dermatologist on the basis of medical history, stinging test, dermatological examination and a questionnaire. A treatment with the test products (active and placebo) was carried out for 4 weeks. Measurements and clinical evaluation were carried out at baseline and at the end of the study. The following objective parameters investigated were bacterial count, skin pH and colour, transepidermal water loss (TEWL), stratum corneum hydration, skin roughness and mechanical properties. Clinical assessment included also a scoring system for dryness, desquamation, irritation, erythema and papules. Significant differences were found in the active treated group when compared with the placebo and in particular for instrumental parameters of roughness (P &lt; 0.02), volume (P &lt; 0.01), TEWL (P &lt; 0.02), erythema (P &lt; 0.0006) and clinical parameters of dryness, desquamation and irritation (P &lt; 0.001). Moisturization levels and skin colour improved significantly in both the active and placebo groups. In conclusion, the study shows that the modulation of bacterial proliferation and normalization of skin barrier properties and stratum corneum moisturization can improve the symptoms of sensitive skin.
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Bullous pemphigoid is an autoimmune disease affecting prevalently the elder. In vivo reflectance confocal microscopy is a non-invasive technique for real-time imaging of the skin with cellular-level resolution. No previous data has been... more
Bullous pemphigoid is an autoimmune disease affecting prevalently the elder. In vivo reflectance confocal microscopy is a non-invasive technique for real-time imaging of the skin with cellular-level resolution. No previous data has been reported about confocal microscopy of bullous pemphigoid. Aim of this preliminary study is the evaluation of the potential of in vivo reflectance confocal microscopy for real-time, microscopical confirmation of clinical bullous pemphigoid diagnosis. A total of nine lesions from patients affected by pemphigoid underwent in vivo reflectance confocal microscopy before histological examination. In our preliminary study, confocal microscopy showed high grade of correspondence to histopathology. In particular, presence of sub-epidermal cleft and variable amount of oedema of the upper dermis associated with inflammatory cells infiltration were seen as prevalent confocal features in the bullous lesions considered. Differently, in urticarial lesions, no specific features could be appreciated at confocal analysis beside the presence of signs of spongiosis and perivascular inflammation. Confocal microscopy seems to be useful for in vivo, microscopical confirmation of the clinical suspect of bullous pemphigoid and for biopsy site selection in urticarial lesions to obtain a more significant specimen for histopathological examination.
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Materials and methods Ten healthy subjects of both sexes (age 26±6 years) entered the study. Three different sites on the volar forearm were irritated by applying 1% sodium lauryl sulphate (SLS) in aqueous solution (Sigma Chemicals, St.... more
Materials and methods Ten healthy subjects of both sexes (age 26±6 years) entered the study. Three different sites on the volar forearm were irritated by applying 1% sodium lauryl sulphate (SLS) in aqueous solution (Sigma Chemicals, St. Louis, USA) under 18 mm ...
Research Interests: Confocal Microscopy, Adolescent, Medicine, Humans, Female, and 7 moreMale, The, Clinical Sciences, Aged, Middle Aged, Adult, and Vitiligo
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The role of race in modulating skin responses has been investigated. Several parameters (skin thickness, transepidermal water loss, water content of the stratum corneum and skin biomechanics) have been measured using noninvasive tools in... more
The role of race in modulating skin responses has been investigated. Several parameters (skin thickness, transepidermal water loss, water content of the stratum corneum and skin biomechanics) have been measured using noninvasive tools in whites, Hispanics and blacks to assess whether the melanin content could induce changes in skin biophysical properties. Marked differences between races appear in stratum corneum water content and in skin extensibility, recovery and elastic modulus. Measurements done in different sun-exposed sites highlight the effects of solar irradiation on the skin and the role of melanin in preventing skin damage. The study shows that racial differences in skin physiology exist and are mainly related to the protective role of melanin present in races with darker skin. Moreover, differences in skin hydration are not fully explained according to the site and presence of hair.
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Cutaneous changes induced by aging can be quantified and monitored noninvasively by means of bioengineering tools. Skin elasticity, hydration, skin blood flow and skin surface pattern show age-related changes reflecting the damage of... more
Cutaneous changes induced by aging can be quantified and monitored noninvasively by means of bioengineering tools. Skin elasticity, hydration, skin blood flow and skin surface pattern show age-related changes reflecting the damage of cutaneous structures involved. Impairment and degeneration of elastic and collagen networks are responsible for the progressive decrease in skin elasticity recorded during aging. Reduction in blood flow and water supply with probably defective stratum corneum binding result in reduced stratum corneum water content and transepidermal water loss. Morphological changes such as increased skin roughness pigmentation and alteration of skin surface pattern appearing from the age of 30 years onwards may be investigated at a subclinical level allowing the detection of early signs of aging.
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... 3 Review Noninvasive Bioengineering Assessment of Psoriasis ENZO BERARDESGA, MD, AN D HOWAR D I. MAIBAGH, MD ... Page 3. No. 3 NONINVASIVE BIOENGINEERING ASSESSMENT ...
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Dear Readers, As part of a continued effort to improve the quality of our papers and the transparency of the publication process, Cosmetics will introduce in the near future the possibility for the Authors to choose an Open Peer Review... more
Dear Readers, As part of a continued effort to improve the quality of our papers and the transparency of the publication process, Cosmetics will introduce in the near future the possibility for the Authors to choose an Open Peer Review process (OPR). OPR is as a process in which the names of the authors and reviewers may be known to each other, and where review reports are published alongside the final manuscript, with the aim to facilitate discussion and clarity between the authors and the reviewer(s). I think this could be a highly innovative approach for undergoing the reviewing process and improve the interactions between authors and reviewers, leading to a better quality of the final published manuscript. Indeed, the single-blinded system of peer reviewing widely used today can generate serious problems, where the reviewer may be biased against the authors of the paper, and lean toward rejection or acceptance for unscientific reasons. Another drawback of traditional peer review...
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BACKGROUND Pyruvic acid is an α-keto acid that presents keratolytic, antimicrobial, and sebostatic properties as well as the ability to stimulate new collagen production and elastic fibers formation. Because of its low pKa and its small... more
BACKGROUND Pyruvic acid is an α-keto acid that presents keratolytic, antimicrobial, and sebostatic properties as well as the ability to stimulate new collagen production and elastic fibers formation. Because of its low pKa and its small dimension, it penetrates rapidly and deeply through the skin, so far as to be considered a potent chemical peel agent. It has proven its efficacy for the treatment of many dermatological conditions such as acne, superficial scarring, photodamage, and pigmentary disorders. Pyruvic acid application usually induces intense burning, and the postpeeling period is characterized by erythema, desquamation, and, sometimes, crusting. OBJECTIVE The aim of the study is to assess the efficacy and tolerability of 50% pyruvic acid in a new non-erythematogenic formulation (pyruvic acid 50%, dimethyl isosorbide, propylene glycol, ethyl alcohol, dimethyl sulfone, ethyl lactate, water) for the treatment of photodamage, superficial scarring, and melasma. MATERIALS AND M...
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Lichen planopilaris (LPP) and discoid lupus erythematosus (DLE) are the most common causes of lymphocytic primary cicatricial alopecia. The management of scarring alopecia can be difficult. The combination of clinical, dermoscopy and... more
Lichen planopilaris (LPP) and discoid lupus erythematosus (DLE) are the most common causes of lymphocytic primary cicatricial alopecia. The management of scarring alopecia can be difficult. The combination of clinical, dermoscopy and reflectance confocal microscopy (RCM), a noninvasive, high-resolution imaging technique, examinations have already been demonstrated to be useful for choosing the correct biopsy site in patients with inflammatory skin disease and obtaining microscopic diagnostic criteria. We evaluated the usefulness in practice of RCM for the identification of criteria for LPP and DLE involving the scalp and their management during therapeutic follow-up. Seven white patients with a previously established histological diagnosis of DLE (three) and LPP (four), were included in the study. RCM criteria for primary scarring alopecia were selected: epidermal disarray, spongiosis, exocytosis of inflammatory cells in the epidermis, interface dermatitis, peri- and intra-adnexal infiltration of inflammatory cells, dilated vessels in the dermis, dermal infiltration of inflammatory cells and melanophages and dermal sclerosis. All patients were followed up using RCM during the treatment. During follow-up the RCM evolution of the epidermal, junctional and dermal inflammation were evaluated. A series of RCM features of scalp LPP and DLE were identified that show correlation with the histopathological evaluation. During the treatment follow-up of the cases RCM was shown to be sensitive for the identification of therapeutic response. In our preliminary study the effective usefulness of RCM for the diagnosis of scarring alopecia and follow-up seemed to be evident. Moreover, RCM seems to be also promising for differential diagnosis between the different entities.
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The quantification of allergic patch test reactions to several compounds was evaluated on patients using laser Doppler velocimetry (LDV), transepidermal water loss and colorimetry. The correlation between visual scores and instrumental... more
The quantification of allergic patch test reactions to several compounds was evaluated on patients using laser Doppler velocimetry (LDV), transepidermal water loss and colorimetry. The correlation between visual scores and instrumental measurements was investigated by the implementation of a modern statistical method: a classification tree. The LDV showed the highest correlation with the severity of the reaction. The best prediction
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The aim of this study is showing the filming and skin barrier protective properties of a new ingredient based on ceramides and trehalose and carried in lipophilic vesicles composed of lecithin and cholesterol (or phytosterols). Through an... more
The aim of this study is showing the filming and skin barrier protective properties of a new ingredient based on ceramides and trehalose and carried in lipophilic vesicles composed of lecithin and cholesterol (or phytosterols). Through an in vivo study, the restructuring and hydrating properties of this trehalose and ceramides compound have been evaluated. Furthermore, this new ingredient has been used in a topical formulation for atopic dermatitis, proving to be effective in the alterations of skin barrier. This evidence makes it an interesting ingredient for topical dermatological compositions in the treatment of dermatitis and all manifestations correlated to these skin disorders, such as edema, swelling, rash, redness, and itching. Its soothing and protective action against the painful and annoying symptoms like those given by dermatitis makes this trehalose and ceramides based ingredient for topical use.
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Atopic dermatitis is a chronic, pruritic inflammatory skin disease that adversely affects quality of life. The current study evaluates the efficacy of a shower cream and a lotion, each with skin-identical lipids and emollients, in the... more
Atopic dermatitis is a chronic, pruritic inflammatory skin disease that adversely affects quality of life. The current study evaluates the efficacy of a shower cream and a lotion, each with skin-identical lipids and emollients, in the treatment of atopic dry skin of subjects with a history of atopic condition. In all, 40 healthy females with clinically dry skin on the lower legs were enrolled in the study and underwent 4 weeks of daily use of the shower cream and 2 additional weeks of both the shower cream and the body lotion. Subjects were evaluated at day 0, week 4, and week 6. Skin barrier function was assessed by Tewameter , skin hydration by Corneometer , smoothness and desquamation by Visioscan , and stratum corneum architecture by reflectance confocal microscopy (RCM). The investigator assessed the degree of dryness, roughness, redness, cracks, tingling and itch, and subjective self-assessment evaluated the perception of skin soothing, smoothness, and softness. Skin barrier f...
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Noninvasive quantification of stratum corneum water content is widely used in skin research and topical product development. The original EEMCO guidelines on measurements of skin hydration by electrical methods and transepidermal water... more
Noninvasive quantification of stratum corneum water content is widely used in skin research and topical product development. The original EEMCO guidelines on measurements of skin hydration by electrical methods and transepidermal water loss (TEWL) by evaporimeter published in 1997 and 2001 have been revisited and updated with the incorporation of recently available technologies. Electrical methods and open-chamber evaporimeters for measurement of TEWL are still the preferred techniques to measure the water balance in the stratum corneum. The background technology and biophysics of these instruments remain relevant and valid. However, new methods that can image surface hydration and measure depth profiles of dermal water content now available. Open-chamber measurement of TEWL has been supplemented with semiopen and closed chamber probes, which are more robust to environmental influence and therefore convenient to use and more applicable to field studies. However, closed chamber metho...
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This Italian multicenter retrospective study compared the drug survival and efficacy of different anti-TNF agents in psoriasis (PsO) and psoriatic arthritis (PsA) patients. A database of PsO/PsA patients treated with adalimumab,... more
This Italian multicenter retrospective study compared the drug survival and efficacy of different anti-TNF agents in psoriasis (PsO) and psoriatic arthritis (PsA) patients. A database of PsO/PsA patients treated with adalimumab, etanercept, and infliximab from May 2013 to May 2014 was analyzed. PASI 75, 90, and 100 was calculated at each time point to evaluate efficacy. Drug survival rate and probability of maintaining PASI response were evaluated. The impact of dependent variables on probability of PASI 75 loss was evaluated by logistic regression. 1,235 patients were included, 577 with PsO and 658 with PsA. Highest survival rates were observed with adalimumab followed by etanercept and infliximab in PsO and PsA patients. The probability of maintaining PASI response was significantly higher for adalimumab followed by infliximab. For PsO patients, the odds of losing PASI 75 was higher in etanercept-treated patients (OR: 8.1; 95% CI: 4.2-15.6, p < .001) or infliximab (OR: 6.6; 95%...
Research Interests: Treatment Outcome, Linear models, Multivariate Analysis, Italy, Humans, and 15 moreFemale, Male, Psoriasis, Clinical Sciences, Middle Aged, Longitudinal Studies, Time Factors, Odds ratio, Retrospective Studies, Chi Square Distribution, Logistic Models, Adalimumab, Etanercept, Health Care Surveys, and Infliximab
To instrumentally evaluate the efficacy and the safety of a new ternary system chemo exfoliating formulation (water-dimethyl isosorbide-acid) vs traditional binary systems (water and acid) where the acid is maintained in both the systems... more
To instrumentally evaluate the efficacy and the safety of a new ternary system chemo exfoliating formulation (water-dimethyl isosorbide-acid) vs traditional binary systems (water and acid) where the acid is maintained in both the systems at the same concentration. Different peelings (binary system pyruvic acid and trichloroacetic acid-TCA, and ternary system pyruvic acid and TCA) were tested on the volar forearm of 20 volunteers of both sexes between 28 and 50 years old. The outcomes were evaluated at the baseline, 10 minutes, 24 hours, and 1 week after the peeling by means of noninvasive skin diagnosis techniques. In vivo reflectance confocal microscopy was used for stratum corneum evaluation, transepidermal waterloss, and Corneometry for skin barrier and hydration, Laser Doppler velocimetry in association with colorimetry for irritation and erythema analysis. The instrumental data obtained showed that the efficacy and safety of the new ternary system peel compounds were significantly higher compared with the binary system formulations tested. The new formulation peels improved chemexfoliation and reduced complications such as irritation, redness, and postinflammatory pigmentation compared to the traditional aqueous solutions. The study showed that ternary system chemexfoliation, using a controlled delivery technology, was able to provide the same clinical effects in term of stratum corneum reduction with a significantly reduced barrier alteration, water loss, and irritation/erythema compared to traditional binary system peels.
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Female sex has been shown to be a risk factor for the development of adverse drug reactions; however, this has not been studied for cyclosporine (CsA). The aim of this study was to investigate, in Italian dermatological practice, the... more
Female sex has been shown to be a risk factor for the development of adverse drug reactions; however, this has not been studied for cyclosporine (CsA). The aim of this study was to investigate, in Italian dermatological practice, the influence of gender and menopause and related hormones on the incidence of adverse events (AEs) during CsA treatment in psoriatic patients. Multicenter, prospective, observational study conducted from May 2011 to June 2013. Patients with plaque psoriasis, undergoing a new CsA administration course, or about to start it, were enrolled in the outpatient clinics of Italian dermatological centers. During the 2-6 months of study duration, patients had to note all AEs that occurred in a diary that was reviewed by the investigators at the follow-up visit. Sex hormone levels were measured within 7 days from the start date of a menstrual cycle. A total of 969 adult psoriatic patients were enrolled in the study, divided into four cohorts: fertile women and corres...
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ABSTRACT