Treatment of Ingrowing Toenails With Phenol 88% or Trichloroacetic Acid 100%: A Comparative, Prospective, Randomized, Double-Blind Study.

BACKGROUND: Phenol is the gold standard for chemical matricectomy in ingrowing toenail. Recently, trichloroacetic acid (TCA) was used as cauterant. Both agents have high success rates but a postoperative healing time claimed to be faster for TCA rather than phenol. OBJECTIVE: Comparing the efficacy, the postoperative oozing time, the inflammatory reaction, and the postoperative pain. MATERIALS AND METHODS: Comparative, prospective, randomized, double-blind study. Eighty-four patients with 96 ingrowing toenails were randomized in 2 groups. Forty-six ingrowing toenails were treated with phenol 88% and 50 with TCA 100% within a 4-month period. Patients were observed 4 times for the presence of oozing and for the degree of inflammation. Patients assessed also oozing and pain on a scale basis during 34 days. RESULTS: Oozing was observed to be less with phenol treatment, as from the second week. Inflammation was also significantly inferior in the phenol group at Week 4. Patients evaluated the incidence of pain below 2/10 for both cauterants, while oozing was higher with TCA during 34 days. The overall success rates of both groups were similar with 100%. CONCLUSION: Phenol and TCA are both effective but TCA does not offer any advantage in terms of postoperative morbidity compared with phenol.

Recent trends in specular light reflectance beyond clinical fluorescence diagnosis.

Under specific light illumination, particularly ultraviolet (UV) and near-UV light stimulation, the skin produces both specular light reflectance and, possibly, specific fluorescent emission. These properties offer diagnostic clues and disclose some peculiar functions of the skin. A series of superficial infections (erythrasma, some tinea capitis types, tinea/pityriasis versicolor, dermatophytoses, etc.) and pilosebaceous follicles enriched in Propionibacterium spp show fluorescence. This latter characteristic is downgraded or lost while on some anti-acne treatments. A quenching effect of fluorescence is observed following the application of sunscreens. The (pre)neoplastic areas prepared for methylaminolevulinate photodynamic therapy (MAL-PDT) show reddish fluorescence following drug metabolisation producing porphyrins by the abnormal activated cells. Of note, when using a recording sensitive CCD camera instead of casual visual observation, skin fluorescence may be superimposed on the specular reflectance of the incident light. With the current technology, these situations are not distinguished with confidence. Any harsh and scaly lesion appears brighter following yellowish specular light reflectance. Stratum corneum samplings collected on clear self-adhesive discs or cyanoacrylate skin surface strippings are conveniently examined ex vivo, taking advantage of the same optical properties.

Severe herpes simplex virus type-I infections after dental procedures.

BACKGROUND: Recurrences of herpes labialis (RHL) may be triggered by systemic factors, including stress, menses, and fever. Local stimuli, such as lip injury or sunlight exposure are also associated to RHL. Dental extraction has also been reported as triggering event. CASE REPORTS: Seven otherwise healthy patients are presented with severe and extensive RHL occurring about 2-3 days after dental extraction under local anaesthesia. Immunohistochemistry on smears and immunofluorescence on cell culture identified herpes simplex virus type I (HSV-I). Five patients reported more severe prodromal signs than usual. Although all the patients suffered from RHL, none had previously experienced RHL after dental care. Two patients required hospitalisation for intravenous acyclovir therapy, whereas the others were successfully treated with oral valaciclovir or acyclovir. CONCLUSION: Severe and extensive RHL can occur soon after dental extraction under local anaesthesia. Patients with a previous history of RHL seem to be at higher risk. It is not clear whether RHL is linked to the procedure itself, to the anaesthetic procedure or both. As the incidence is unknown, more studies are required to recommend prophylactic antiviral treatment in RHL patients who are undergoing extractions. Dentists should be aware of this potentially severe post-extraction complication.

Nail Unit Blue Nevi: A 11-Case Series and Review of the Literature.

BACKGROUND: Blue nevus of the nail apparatus is a rare entity and only isolated cases are reported in the literature. OBJECTIVE: The aim of this study was to better characterize blue nevus at the nail unit. METHODS: Retrospective analysis of all nail unit blue nevi from the Nail Group of the French Society of Dermatology was compared to the literature. RESULTS: Eleven cases were retrieved from 2002 to 2019 with an average age of 45 years. The majority were women (9/11) and acquired (10/11). Hands were more frequently involved (9/11) with a predilection for the thumb and 2 cases were located on the hallux. Nail unit blue nevus mostly presented as a well-delimited blue spot of the lunula (9/11) and histologically was of the common type (10/11). There was no malignancy. CONCLUSION: Nail unit blue nevus is a rare asymptomatic benign entity, mostly acquired on the thumb or the hallux of women. The most frequent presentation is a painless blue spot on the lunula. Congenital blue nevi seem to only affect the paronychium. Main differential diagnosis is melanoma and histopathological examination is mandatory.

Diagnosis using nail matrix.

Diagnosing nail matrix diseases requires knowledge of the nail matrix function and anatomy. This allows recognition of the clinical manifestations and assessment of potential surgical risk. Nail signs depend on the location within the matrix (proximal or distal) and the intensity, duration, and extent of the insult. Proximal matrix involvement includes nail surface irregularities (longitudinal lines, transverse lines, roughness of the nail surface, pitting, and superficial brittleness), whereas distal matrix insult induces longitudinal or transverse chromonychia. Clinical signs are described and their main causes are listed to enable readers to diagnose matrix disease from the nail's clinical features.

Nail tumors.

Most neoplasms of the nail apparatus have different clinical appearances, courses, and biological behaviors as compared with similar tumors located elsewhere on the skin. Some of these tumors are unique to the nail, such as onychomatricoma. As a general rule, benign lesions respect the general architecture of the nail apparatus, whereas malignant ones are destructive. Our review covers the most common nail tumors, from benign ones to the most frequent nail malignancy, the squamous cell carcinoma, which actually is the greatest simulator. We will also discuss new approaches to the diagnosis and treatment of melanoma of the nail apparatus. Physicians should be aware of these conditions and their management.

Associated pyoderma gangrenosum, erythema elevatum diutinum, and Sweet's syndrome: the concept of neutrophilic disease.

BACKGROUND: The association of three neutrophilic dermatoses supports the concept of "neutrophilic disease" as a syndrome representing a continuous spectrum of clinical entities. RESULTS: This report describes three neutrophilic pathologies arising in the same patient, in association with seronegative rheumatoid arthritis. The successive occurrence of erythema elevatum diutinum, pyoderma gangrenosum, and Sweet's syndrome illustrates the concept of "neutrophilic disease" developed by Wallach et al. in the 1990s. Most authors agree that neutrophilic dermatosis is defined as a cutaneous disease mainly characterized by polymorphonuclear neutrophil infiltration without infectious cause.The assessment of neutrophilic dermatosis includes identification of the type of cutaneous lesion, the existence of possible extracutaneous sites, and a search for associated disease. CONCLUSIONS: The occurrence of three separate neutrophilic dermatoses in a single patient lends further support to the concept that these entities form a spectrum of diseases called neutrophilic disease.

Chronicle of a pigmented superficial Basal cell carcinoma.

Dermoscopic patterns of basal cell carcinoma (BCC) are well defined, but the dynamics of dermoscopic changes in time were apparently never described so far. In this paper, prominent changes were observed over a 8-week period, allowing to establish a close connection between spoke wheel areas and maple leaf-like aspects, through progressive thickening of the former ones. A chronobiological phenomenon ruling synchronous apoptosis in some of the most superficial BCC nests is suggested, leading to a wax and wane process of millimetric crusts, taking part in the spontaneous BCC regression/progression process.

The appearance of angiolipomatosis after using laptop computer on the thighs: a relationship?

A 56-year-old patient developed angiolipomatosis of the anterior part of the thighs after repeated laptop contact localisation. Histological findings exhibit an unusual inflammatory infiltrate. We postulate that the computer could favour lipoma development by a physiopathological mechanism that remains to be clarified.

Vulvar basal cell carcinoma: report of a case involving the mucosa and review of the literature.

We report the case of woman who presented a vulvar basal cell carcinoma (BCC) on the inner part of the labium majus, treated with local resection. Vulvar BCC is a rare cancer but can be long misdiagnosed due to a non-specific presentation. Though even rarer, BCC involving the mucosal side of the labium majus has to be considered in the differential diagnosis of the vulvar tumors. A complete excision with free margins is the treatment most recommended. Other recommendations include the early identification of aggressive subtypes, which carry a greater risk of recurrence and spreading potential as well as a long-term follow-up with exhaustive muco-cutaneous examination.

Dynamics of skin barrier repair following preconditioning by a biotechnology-driven extract from samphire (Crithmum maritimum) stem cells.

BACKGROUND: With aging, the barrier repair kinetics following any weakening of the epidermal permeability barrier function is commonly slowed down. OBJECTIVE: To assess the recovery rate of the epidermal permeability barrier function following controlled stripping and applications of samphire and control formulations. METHOD: In 12 healthy subjects older than 50 years, controlled stratum corneum (SC) strippings were used to increase the transepidermal water loss (TEWL) just above 15 g/m(2) /h. This procedure followed a 14-day skin preconditioning by daily applications of formulations enriched or not with a samphire (Crithmum maritimum) biomass. An untreated skin site served as control. The epidermal permeability repair kinetics was assessed for 14 days by daily measurements of both TEWL and the colorimetric value a*. RESULTS: A rapid (96 h) recovery to lower TEWL values was obtained at each of the samphire-preconditioned sites (0.1% serum, 0.05% cream, the serum-cream association, and 0.5% silicone oil). This process was significantly (P < 0.001) faster than that on both the placebo-preconditioned (silicone oil) and the untreated sites. No adverse inflammatory and sensory reactions were recorded. At the sites preconditioned by samphire formulations, the SC moisture (capacitance) was higher at completion of the study compared to inclusion. CONCLUSIONS: The present experimental pilot study brings some clues supporting a beneficial boosting effect of samphire cell biomass on the kinetics of epidermal permeability barrier repair.

Intense pulsed-light therapy for proliferative haemangiomas of infancy.

Infantile haemangioma therapy has long been a wait-and-see policy. Since recent development of laser and light therapy, pulsed dye laser has been successfully used for treating superficial haemangiomas. Few studies have been published about treatment with intense pulsed light (IPL) to assess the risk/benefit of IPL in the treatment of infantile haemangiomas during their early proliferative phase. In the present retrospective cohort study, we retrieved data about a series of 14 Caucasian children (median age: 4.8 months) with infantile haemangiomas treated with Photoderm Vasculight flash lamp. All patients experienced a rapid regression of the haemangiomas after 3 treatments on average. Few adverse events were noted, including ulceration and crusts. No residual scarring and cosmetic damages were noticed. Fast growing haemangiomas should be treated with light therapy as soon as possible. This technology is safe, efficient, inducing regression, and preventing any further functional and aesthetic complications. The benefit-risk ratio favours the treatment of most types of haemangiomas which are out of the scope of betablocker administration.

Photodynamic therapy for multi-resistant cutaneous Langerhans cell histiocytosis.

Langerhans cell histiocytosis is a rare group of proliferative disorders. Beside cutaneous involvement, other internal organs can be affected. The treatment of cutaneous lesions is difficult and relies on topical corticosteroids, carmustine, nitrogen mustard, and photochemotherapy. Systemic steroids and vinblastine are used for recalcitrant skin lesions. However, some cases fail to respond. An 18-month old boy presented a CD1a(+), S100a(+) Langerhans cell histocytosis with cutaneous and severe scalp involvement. Topical corticosteroids and nitrogen mustard failed to improve the skin lesions. Systemic corticosteroids and vinblastine improved the truncal involvement but had no effect on the scalp lesions. Methylaminolevulinate (MAL) based photodynamic therapy (PDT) resulted in a significant regression of the scalp lesions. Control histology revealed an almost complete clearance of the tumor infiltrate. Clinical follow-up after six months showed no recurrence.Although spontaneous regression of cutaneous Langerhans cell histiocytosis is observed, the rapid effect of photodynamic therapy after several failures of other treatment suggests that photodynamic therapy was successful. As far as we know this is the first report of photodynamic therapy for refractory skin lesions. Larger series are needed to determine whether photodynamic therapy deserves a place in the treatment of multiresistant cutaneous Langerhans cell histiocytosis.