Dermatoscopy of nodular/plaque-type primary cutaneous T- and B-cell lymphomas: A retrospective comparative study with pseudolymphomas and tumoral/inflammatory mimickers by the International Dermoscopy Society.

BACKGROUND: Limited data on dermatoscopy of nodular/plaque-type T-/B-cell primary cutaneous lymphomas (PCLs) is available. OBJECTIVE: To describe dermatoscopic features of nodular/plaque-type PCLs, comparing them with those of clinical mimickers (pseudolymphomas, tumors, and inflammatory lesions) and investigating possible differences according to histologic subtypes. METHODS: Participants were invited to join this retrospective, multicenter case-control study by submitting histologically/immunohistochemically confirmed instances of nodular/plaque-type PCLs and controls. Standardized assessments of the dermatoscopic images and comparative analyses were performed. RESULTS: A total of 261 lesions were included (121 PCLs and 140 controls). Orange structureless areas were the strongest PCL dermatoscopic predictor on multivariate analysis compared with tumors and noninfiltrative inflammatory dermatoses. On the other hand, a positive association was found between PCLs and either unfocused linear vessels with branches or focal white structureless areas compared with infiltrative inflammatory dermatoses, whereas white lines were predictive of PCLs over pseudolymphomas. Differences in the vascular pattern were also seen between B- and T-cell PCLs and among B-cell PCL subtypes. LIMITATIONS: Retrospective design and the lack of a dermatoscopic-pathologic correlation analysis. CONCLUSION: Nodular/plaque-type PCLs display dermatoscopic clues, which may partially vary according to histologic subtype and whose diagnostic relevance depends on the considered clinical differential diagnoses.

Altered Levels of Sphingosine, Sphinganine and Their Ceramides in Atopic Dermatitis Are Related to Skin Barrier Function, Disease Severity and Local Cytokine Milieu.

Dysfunctional skin barrier plays a key role in the pathophysiology of atopic dermatitis (AD), a common inflammatory skin disease. Altered composition of ceramides is regarded as a major cause of skin barrier dysfunction, however it is not clear whether these changes are intrinsic or initiated by inflammation and aberrant immune response in AD. This study investigated the levels of free sphingoid bases (SBs) sphingosine and sphinganine and their ceramides and glucosylceramide in the stratum corneum (SC) and related them to skin barrier function, disease severity and local cytokine milieu. Ceramides were measured in healthy skin, and lesional and non-lesional skin of AD patients by a novel method based on deacylation of ceramides which were subsequently determined as corresponding sphingoid bases by using liquid chromatography-tandem mass spectrometry (LC-MS/MS). The cytokine levels were determined by multiplex immunoassay. Atopic skin showed increased levels of most investigated markers, predominantly in lesional skin. The largest difference in respect to healthy skin was found for glucosylceramide with respective median values of 0.23 (IQR 0.18-0.61), 0.56 (IQR 0.32-0.76) and 19.32 (IQR 7.86-27.62) pmol/g protein for healthy, non-lesional and lesional skin. The levels of investigated ceramide markers were correlated with disease severity (scoring atopic dermatitis, SCORAD) and skin barrier function (trans-epidermal water loss, TEWL) and furthermore with cytokines involved in innate, Th-1, and Th-2 immune response. Interestingly, the strongest association with SCORAD was found for sphinganine/sphingosine ratio (r = -0.69, p < 0.001; non-lesional skin), emphasizing the importance of SBs in AD. The highest correlation with TEWL was found for glucosylceramide (r2 = 0.60, p < 0.001), which was investigated for the first time in AD. Findings that the changes in SBs and ceramide levels were predominant in lesional skin and their association with disease severity and cytokine levels suggest an immune-system driven effect. a novel analysis method demonstrates a robust and simple approach that might facilitate wider use of lipid biomarkers in the clinics e.g., to monitor (immune) therapy or dissect disease endotypes.

Descriptive epidemiology of cutaneous squamous cell carcinoma in Croatia.

The aim of the study was to investigate the squamous cell carcinoma (SCC) incidence in Croatia in the 2003-2005 period. The cases of SCC were retrospectively studied. Data were collected from University Department of Dermatology and Venereology, Zagreb University Hospital Center and National Cancer Registry. In the study period, there were 1,860 cases of SCC (934 men and 926 women). The crude incidence rate for the Croatian population of 100,000 was 14.6 for men and 13.4 for women. The age-standardized incidence rate (adjusted for the world standard population) was 8.9 for men and 5.2 for women. The head was almost exclusive localization of SCC in both sexes. The highest SCC incidence was recorded in Zadar County. These results will serve for the SCC trend monitoring in Croatia and Europe in the forthcoming years.

[Atopy patch test--when is it useful?]. / Atopijski patch test--kada je koristan?

The aim of the article is to introduce the atopy patch test (APT) as a model of cellular immunity reaction. APT is epicutaneous test performed with food and aeroallergens, and represents a good model for T lymphocyte hypersensitivity. It is compared with skin prick test (SPT). Its value is supported by the fact that atopic dermatitis is the result of complex immune interactions and involves both Coombs and Gell reactions type IV and I. In this review, we shortly discuss the etiopathogenesis of atopic dermatitis, distinction of extrinsic and intrinsic issues, and compare the value of APT with SPT and IgE determination. APT includes epicutaneous application of type I allergens known to elicit IgE mediated reactions, followed by evaluation of eczematous skin reaction after 48 and 72 hours. The limitations of ATP include the lack of test standardization, but there also are comparative advantages over SPT and specific IgE determination. We also briefly discuss the most important food and aeroallergens. APT has been recognized as a diagnostic tool in the evaluation of food allergy and aeroallergens such as house dust mite, pollen and animal dander. APT is a useful diagnostic procedure in patients with atopic dermatitis allergic to inhalant allergens and in children with food allergy younger than 2 years. The sensitivity and specificity of the test greatly depend on the allergen tested and patient age.

Skin cancers in Croatia, 2003-2005: epidemiological study.

This study presents the incidence of major nonmelanoma skin cancers (major NMSCs), other nonmelanoma skin cancers (other NMSCs) and malignant melanoma (MM) in Croatia. The skin cancers recorded between 1 January 2003 and 31 December 2005 were retrospectively analyzed. Until 2003, the incidence of major NMSCs and other NMSCs was not estimated in Croatia. Incident cases of NMSCs were identified by the use of a questionnaire distributed to dermatology departments in Croatia and then collected at the University Department of Dermatology and Venereology, Zagreb University Hospital Center, and from the records kept at the National Cancer Registry. Incident cases of MM were extracted from the National Cancer Registry. During the 3-year period, 9,479 cases of major NMSCs are recorded, 4,622 (49%) in male and 4,857 (51%) in female patients. The crude incidence rate was 72.1/100,000 for males and 70.3/100,000 for females. Basal cell carcinoma (BCC) was the most common major NMSC in both sexes. In the total number of major NMSCs, there were 7,244 cases of BCC. Squamous cell carcinoma (SCC) was the second most common major NMSC. There were 1,860 SCC cases. The crude incidence rate was 54.9/100,000 for BCC in males, 53.9/100,000 in females, and 14.6/100,000 for SCC in male and 13.4/100,000 in female patients. Other NMSCs were registered in 119 cases (53% male and 47% female). The crude incidence rate was 0.9/100,000 for male and 0.8/100,000 for female patients. MM was registered in 1,427 cases (48% male and 52% female.) The crude incidence rate was 10.7/100,000 for males and females. These results will serve as reference for studying the patterns of descriptive epidemiology of major NMSCs, other NMSCs and MM in Croatia and Europe in the forthcoming years.

Skin barrier and dry skin in the mature patient.

Dry skin is the most common clinical manifestation of dermatologic diseases, and it presents with itching, redness, and desquamation-signs and clinical manifestations that are not only physically uncomfortable but also affect patients psychologically. The water content in the stratum corneum is largely dependent on the composition and amount of the intercellular lipids, which regulate the loss of water from the skin, and on the levels of hygroscopic substances of the natural moisturizing factors, which are responsible for retention of water in the stratum corneum. Prevention of water loss and penetration of potentially toxic substances and microorganisms into the body are the most important functions of the skin, which acts as a natural frontier between the inner organism and the environment. Skin barrier defects occur in several skin diseases, but the influence of aging on the skin barrier function is largely unknown and conflicting results have been reported. In this review, the structure and function of the barrier in relation to the aging process are discussed.