Carmela C Vittorio

University of Pennsylvania | UP · Department of Dermatology

Mogamulizumab is a novel monoclonal antibody designed to target CC chemokine receptor 4 (CCR4), which is expressed by tumor cells in cutaneous T-cell lymphoma (CTCL). In clinical trials, mogamulizumab monotherapy has demonstrated efficacy in reducing tumor burden in advanced CTCL, particularly in the peripheral blood. In clinical practice at our ce...

With an increase in teledermatology, accelerated by the Covid-19 pandemic, leaders at Penn Medicine recognized a need to improve the value of videoconference-based visits by developing an innovative process to simplify the method by which patients can share photos in advance of the visit while automating instructions and reminders for patients to r...

Dear Editor, Tacrolimus is a calcineurin inhibitor, which in topical formulation is used to treat a variety of skin conditions, including eczema and psoriasis. Tacrolimus has an antiproliferative effect on T lymphocytes, a function that has the potential to treat cutaneous T‐cell lymphoma (CTCL). However, tacrolimus is also immunosuppressive and sy...

Importance Treatment options for Sézary syndrome (SS) are limited and associated with low response rates. Brentuximab vedotin is a CD30-directed antibody-drug conjugate approved for refractory CD30-positive cutaneous T-cell lymphoma. However, limited data exist on its efficacy in SS, including in the pivotal phase 3 ALCANZA (A Phase 3 Trial of Bren...

Background: Lengthy wait times for dermatology appointments in the U.S. limit care access. The University of Pennsylvania's Department of Dermatology has established an urgent care clinic (UCC) and an intermediate care clinic (ICC) to expedite appointments for higher acuity patients. Objective: To describe our rapid access clinics' operations, r...

Loss of CD26 surface expression on the circulating malignant T-cell is the most widely accepted diagnostic marker in patients with leukemic cutaneous T-cell lymphoma (CTCL). CTCL cases with reemergence of CD7 and/or CD26 surface expression are unusual and of uncertain prognosis. We report the case of an erythrodermic leukemic mycosis fungoides pati...

Background: There is a paucity of effective therapies for patients with Sézary syndrome and advanced mycosis fungoides with peripheral blood involvement. Total skin electron beam (TSEB) radiation therapy is an extremely effective skin-directed therapy for these patients, but, until recently, it was thought not to signifcantly affect the peripheral...

Although Sézary syndrome (SS) represents an advanced stage of cutaneous T-cell lymphoma, this diagnosis presents a challenge even for the most experienced dermatologic clinicians. SS is characterized clinically by erythroderma, but can also be identified in the presence of specific histologic and peripheral blood findings. Erythrodermic cutaneous T...

Correspondence: Dr Gelfand, 1471 Penn Tower, 1 Convention Ave, Philadelphia, PA 19104 (joel.gelfand@uphs.upenn.edu). Accepted for Publication: September 12, 2011. Author Contributions: Ms Wan and Dr Vittorio contributed equally to this article as co –first authors. Ms Wan and Dr Gelfand had full access to all of the data in the study and take respo...

Several histone deacetylase inhibitors (HDACi), including vorinostat, have been approved for the therapy of cutaneous T-cell lymphoma (CTCL). Emerging data suggest that HDACi may exert immune suppressive effects which would be disadvantageous for therapy of CTCL. We describe a patient with Sezary syndrome who was monitored for drug-induced immunosu...

Correspondence: Dr Kim, Department of Dermatology, University of Pennsylvania School of Medicine, 14 Penn Tower, Rm 1477, 1 Convention Ave, Philadelphia, PA 19104 (ellen.kim@uphs.upenn.edu).Financial Disclosure: Dr Kim has received investigator funding from TenX, GenMab, Biocryst, Gloucester, Celgene, and Centocor.1 +Tan HH, Goh CL.Viral infections...

Correspondence: Dr Gelfand, 1471 Penn Tower, One Convention Avenue, Philadelphia, PA 19104 (Joel.Gelfand@uphs.upenn.edu). Accepted for Publication: July 10, 2011. Author Contributions: Ms Wan and Dr Gelfand had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. St...

To quantify response rates of Sézary syndrome (SS) to multimodality immunomodulatory therapy and to identify the important prognostic parameters that affect overall response to treatment. Retrospective cohort study. Cutaneous T-cell lymphoma clinic at The Hospital at the University of Pennsylvania. Ninety-eight patients who met the revised Internat...

In choosing the ideal immune modulator, a number of factors should be considered. First, the agent should have the capacity to induce a robust antitumor immune response. The treatment should also directly produce high levels of apoptosis of the tumor cells. Finally, the ability to produce sustained immunologic memory against the tumor cells is of c...

Three months later, she was admitted to the Hospital of the University of Pennsylvania, Philadelphia, with a 2-month history of progressive skin pain, itching, blisters on her buttocks and feet, oral and vaginal erosions, odynophagia, and lower extremity edema for which she was prescribed furosemide at an outside hospital. Initially, the concern wa...

Long-term prognosis for advanced stages of cutaneous T-cell lymphoma may be beneficially altered with the use of multimodality therapy. However, refractory disease exists in Which current therapeutic options fail to halt the progression of disease. We present 3 cases of refractory Sezary syndrome in which the combination of vorinostat and interfero...

Most cutaneous T-cell lymphomas demonstrate a malignant population with a CD4(+) phenotype. In rare cases, CD8(+) phenotypes have been described based on immunostaining of skin specimens. Although some CD8(+) lymphomas have an indolent course, others, such as CD8(+) epidermotropic cytotoxic T-cell lymphomas, are typically more aggressive. To our kn...

Total skin electron beam radiation is an effective therapy for palliation of the cutaneous symptoms of the most common types of cutaneous T-cell lymphomas, mycosis fungoides and Sézary syndrome. We report 4 cases of patients with Sézary syndrome who had significant improvement in their blood burden of malignant cells in addition to complete cutaneo...

The goal of this study was to evaluate the clinical response rate of patients with Sézary syndrome (SS) to multimodality immunomodulatory therapy consisting of extracorporeal photopheresis in combination with >/= 2 systemic biologic response modifiers (interferon-, interferon-, retinoids, and/or sargramostim) and psoralen plus UV-A. Twenty-eight pa...

Mycosis fungoides (MF), and the associated leukemic variant Sezary Syndrome (SS), are the most common group of cutaneous T-cell lymphomas. MF/SS is a non-Hodgkin's lymphoma of mature, skin-homing, clonal, malignant T lymphocytes that initially presents in the skin as patches, plaques, tumors, or generalized erythema (erythroderma) and can involve t...

1 +Suchin KRCucchiara AJGottleib SL et al. Treatment of cutaneous T-cell lymphoma with combined immunomodulatory therapy: a 14-year experience at a single institution Arch Dermatol 2002;1381054- 1060PubMed2 +Rook AHKubin MCassin M et al. IL-12 reverses cytokine and immune abnormalities in Sezary syndrome J Immunol 1995;1541491- 1498PubMed3 +Vowels...

Cutaneous T cell lymphomas (CTCLs) are a heterogenous group of lymphoproliferative disorders caused by clonally derived, skin-invasive T cells. Mycosis fungoides (MF) and Sezary syndrome (SS) are the most common types of CTCLs and are characterized by malignant CD4(+)/CLA(+)/CCR4(+) T cells that also lack the usual T cell surface markers CD7 and/or...

For nearly 2 decades clinicians have been treating cutaneous T-cell lymphoma (CTCL) with regimens that combine interferon alfa with retinoid compounds. In December 1999 a new retinoid, bexarotene, was approved by the US Food and Drug Administration for the treatment of CTCL. At the manufacturer's recommended dose of bexarotene (300 mg/m(2) of body...

The use of photochemotherapy for the treatment of cutaneous T-cell lymphoma (CTCL) was first reported by Gilchrest et al. in 1976. 1 Oral 8-methoxypsoralen (8MOP) was administered to patients with early-stage disease, followed by photoactivation with ultraviolet-A irradiation to the skin. This technique, referred to as PUVA, has since become a main...

Although its cell of origin is still controversial, the blastic NK-cell leukemia/lymphoma clearly represents a distinct type of hematopoietic neoplasm that is particularly clinically aggressive when it occurs in elderly patients as a disseminated, multi-organ disease. Consistently effective treatments have not been developed for this malignancy. Th...

Multimodality biological response-modifier therapy that includes photopheresis, interferon, and bexarotene is the standard of care in our institution for advanced cutaneous T-cell lymphoma with peripheral blood involvement. We added psoralen plus long-wave UV-A (PUVA) to this regimen in 5 patients with Sézary syndrome. All patients responded with d...

Laser-assisted hair removal has rapidly emerged as a noninvasive technique for long-term reduction in unwanted hair. This article reviews the pertinent aspects of hair follicle biology, the theoretical aspects of the physics and mechanisms of laser epilation, the different types of lasers available for hair removal, and the practical clinical aspec...

Recent reports indicate that laser hair removal is most effective on anagen hairs. However, no published trials have examined laser epilation after hair cycle synchronization. To evaluate the potential for enhanced laser hair removal after the induction of telogen hairs into anagen by wax epilation. We identified four 2.5-cm square areas with equiv...

BACKGROUND: Recent reports indicate that laser hair removal is most effective on anagen hairs. However, no published trials have examined laser epilation after hair cycle synchronization. OBJECTIVE: To evaluate the potential for enhanced laser hair removal after the induction of telogen hairs into anagen by wax epilation. METHODS: We identified fou...

It has long been known that certain immune augmenting therapeutics, particularly interferon alpha, can exert profound salutary effects on the clinical progress of patients with cutaneous T-cell lymphoma. Emerging evidence that the host immune response may play an important role in the control of this disorder has led to the clinical application of...

18F-Fluorodeoxyglucose (FDG)-positron emission tomography (PET) is a unique functional/metabolic imaging modality that is efficacious in nodal staging and detection of extranodal involvement for a variety of lymphomas. We report its novel use in evaluating tumor burden and response to therapy in two patients with cutaneous lymphomas. A 24-year-old...

Objective: To determine the efficacy of multimodality biologic response therapy for patients with cutaneous T-cell lymphoma (CTCL). Design: Retrospective cohort study over a 14-year period. Setting: Tertiary care university hospital. Patients: A consecutive sample of patients was studied, all 47 of whom carried the clinical and laboratory di...

Cutaneous T-cell lymphomas (CTCLs) are a group of skin-invasive malignancies of clonally derived T lymphocytes. Mycosis fungoides and Sézary syndrome, characterized by the proliferation of CD4+ T cells, are the most common forms of CTCL. Among these latter disorders, the host antitumor response appears to play an important role in disease control....

Cutaneous T-cell lymphoma (CTCL) is typically a skin-infiltrating malignancy of clonally derived CD4+ T lymphocytes. Because the host antitumor response appears to play an important role in disease control, systemic therapeutic agents are used in such a manner as to preserve the integrity of the host antitumor response while selectively targeting t...

We report the case of a 43-year-old male patient with persistent multifocal, skin-restricted, CD30-positive, large T-cell lymphoma. Combination therapy of systemic interferon alfa and oral bexarotene was initiated on an experimental basis in the hope of circumventing therapies such as methotrexate, radiotherapy, or multiple-agent chemotherapy that...

Several papulosquamous skin conditions occur in the elderly, including inherited and acquired ichthyoses, psoriasis, cutaneous lymphoma, and cutaneous connective tissue diseases. The clinical presentations can be quite helpful in diagnosing these conditions, and confirmatory histology and immunologic testing can often better define the specific ent...

Dermatologic surgeons frequently see patients with body dysmorphic disorder, a distressing or impairing preoccupation with a nonexistent or slight defect in appearance. Recognition of this disorder is essential to avoid unnecessary and generally unsatisfying surgical outcomes, but no screening tools are available for use in a dermatology setting. T...

We report a case of an aggressive digital papillary adenocarcinoma (ADPA) on the right thumb of a 48-year-old white man. Histologic evaluation of the initial biopsy demonstrated features consistent with those proposed for aggressive digital papillary adenoma; however, re-excision of the remaining lesion revealed histologic features consistent with...

We report a case of an aggressive digital papillary adenocarcinoma (ADPA) on the right thumb of a 48-year-old white man. Histologic evaluation of the initial biopsy demonstrated features consistent with those proposed for aggressive digital papillary adenoma; however, re-excision of the remaining lesion revealed histologic features consistent with...

Cutaneous T-cell lymphoma (CTCL) is most often a skin-infiltrating malignancy of clonal CD4+ T-cells. Therapy is based on staging and the likelihood of progression. Biological response modifiers and chemotherapeutic agents are used to preserve the integrity of the host antitumour response while selectively targeting the malignant cells. The biologi...

Dermatologists appear to be the physicians most often seen by patients with the psychiatric condition body dysmorphic disorder (BDD), a distressing or impairing preoccupation with a nonexistent or slight defect in appearance. The frequency of BDD among patients seeking dermatologic treatment is unknown, however. This study determined the percentage...

To describe the laboratory and physical manifestations of lamotrigine toxicity presenting as anticonvulsant hypersensitivity syndrome. A 49-year-old white man presented to our institution with a two-day history of low-grade fever, erythema, and edema involving the periorbital area. Five days earlier, he had been placed on lamotrigine treatment for...

A 70-year-old immunocompetent man with a more than forty-year history of tinea corporis unresponsive to multiple systemic and topical antifungal agents, including systemic terbinafine, is described. The literature with respect to persistent dermatophyte infection is reviewed.

A 45-year-old white man with no significant medical or psychiatric history complained of a 20-year history of ec- zema on his fingers. Previous treatment included appli- cation of 1% ciclopirox olamine lotion twice daily. This resulted in no significant improvement. On physical examination, several of his fingernails showed loss of the cuticles, pa...

Anticonvulsant hypersensitivity syndrome is a potentially fatal drug reaction with cutaneous and systemic reactions (incidence, one in 1000 to one in 10,000 exposures) to the arene oxide-producing anticonvulsants--phenytoin, carbamazepine, and phenobarbital sodium. In most cases, the hallmark features of fever, rash, and lymphadenopathy are accompa...

The inherent difficulties in the study of HPV infection have made the epidemiology of this common infection complex. The early natural history of HPV infection is similar for all genital and nongenital tissues. Genital HPV infection, however, especially cervical infection, is strongly linked to carcinoma. With the advent of molecular diagnosis of i...