Diffuse Pruritic Papular and Nodular Skin Eruption in a Febrile Farmer: A Quiz.

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Dermatoskopisch kontrollierte, schmalere Resektionsränder bei Basalzellkarzinomen an Kopf und Hals: Retrospektive Fallkontrollstudie.

Hintergrund: Unbehandelt kann das Basalzellkarzinom (BCC) erhebliche Gewebezerstörungen verursachen. Die komplette chirurgische Exzision ist die Behandlung der Wahl. Allerdings stellt es besonders im Gesichts- und Halsbereich eine Herausforderung dar, den Tumor vollständig zu entfernen und möglichst viel gesundes Gewebe zu erhalten. Material und Methoden: Bereits exzidierte kleine BCC (≤ 1 cm) von Kopf oder Hals wurden retrospektiv analysiert. Verglichen wurde die histologisch kontrolliert angemessene Breite des Resektionsrandes nach präoperativer dermatoskopischer Untersuchung (Fälle) im Vergleich zur rein klinischen Untersuchung (Kontrollen), sowie die Rezidivrate. Ergebnisse: Bei 281 BCC: 6 % (8/139) der Fälle und 8 % (12/142) der Kontrollen zeigten inadäquate basale Resektionsränder; 4 % (5/139) der Fälle und 20 % (29/142) der Kontrollen zeigten inadäquate laterale Resektionsränder (P < 0.001). Laterale Resektionsränder von 3 mm waren in 0 % (15/66) der Fälle, jedoch in 15 % (10/66) der Kontrollen inadäquat (P >0.005); laterale Resektionsränder von 1-2 mm waren in 7 % (5/73) der Fälle und in 25 % (19/76) der Kontrollen inadäquat (P < 0.01). Rezidive traten in den Fällen mit 3 mm Resektionsrand in 1,5 % auf, in den Fällen mit 1-2 mm Resektionsrand bei 0 %, und bei den Kontrollen bei 7,7 %. Schlussfolgerung: Für BCC im Kopf- und Halsbereich erscheint ein Resektionsrand von 3 mm angemessen, sofern das BCC klein, dermatoskopisch gut definiert und wenig aggressiv ist. Hier zeigten sich operative Heilungsraten von 100 % mit 1,5 % Rezidiven. Resektionsränder von 1-2 mm sollten nur für BCC in sehr schwierig zu behandelnden Bereichen in Betracht gezogen werden, da die Heilungsrate hier nur bei 93 % lag.

Dermatoscopically narrowed surgical margins for head and neck basal cell carcinoma: A retrospective case-control study.

BACKGROUND: Basal cell carcinoma (BCC) can cause extensive tissue damage if untreated. Complete surgical excision is the treatment of choice, but especially in the head-and neck area, defining both radical and healthy skin sparing surgical margins is complex. MATERIALS AND METHODS: Excised, small (≤ 1 cm), BCCs of the head and neck were retrospectively analyzed, comparing histological properness of surgical margins after clinical-dermatoscopical preoperative evaluation (cases), vs. clinical evaluation only (controls) and recurrences. RESULTS: Of 281 BCCs: 6 % (8/139) of cases and 8 % (12/142) of controls had unproper deep margins; 4 % (5/139) of cases, 20 % (29/142) of controls had unproper lateral margins (P < 0.001). Surgical 3 mm lateral margins were unproper in 0 % (15/66) of cases, 15 % (10/66) of controls (P > 0.005); surgical 1-2 mm lateral margins were unproper in 7 % (5/73) of cases, 25 % (19/76) of controls (P < 0.01). Of cases excised at 3 mm, 1-2 mm, and controls, 1.5 %, 0 %, and 7.7 % recurred, respectively. CONCLUSIONS: BCC excision at 3 mm may be appropriate in the head and neck for small, dermatoscopically well-defined and non-aggressive BCCs, attaining surgical cure rates of 100 % and 1.5 % recurrences. Excision at 1-2 mm should be reserved only for BCCs in very difficult-to-treat areas, as the surgical cure rate was only 93 %.

Diffuse Melanosis Cutis as the First Sign of Recurrence of Low-Risk Melanoma: Case Report and Systematic Review.

INTRODUCTION: Diffuse Melanosis Cutis (DMC) is a rare and late complication of metastatic malignant melanoma (MM) characterized by progressive pigmentation of skin and sometimes mucous membranes. The distinctive feature is the widespread and progressive deposition of melanin precursors in the dermis. OBJECTIVES: The purpose of this review is to define the clinical and demographic features of DMC and to promote a deeper insight into the clinical manifestation, histological findings, and pathophysiology behind DMC. METHODS: We have conducted a systematic review of the literature on published DMC in compliance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis. We also reported a case of DMC secondary to low-risk melanoma. RESULTS: Overall, including our case report, we reported 53 articles described 62 DMC patients. Breslow level of primary melanoma was reported having a mean value of 3.3 mm. The mean survival rate from onset of DMC resulted being 4.36 months. CONCLUSIONS: Among the most widely accepted etiopathogenetic hypotheses are deposition of melanic precursors in the dermis following tumor lysis, melanocyte proliferation induced by neoplastic growth factors, and the presence of diffuse dermal micro-metastases of MM. However, unanimous consensus on the proposed etiopathogenetic models of DMC is still lacking.

Dimethyl fumarate as a safe and effective therapy for recalcitrant psoriasis in comorbid patients.

Psoriasis is a chronic condition for which multiple therapies are currently available. In particular, in cases of moderate- severe psoriasis, traditional systemic drugs or the new biological drugs can be administered. However, the treatment of patients who require systemic therapy and have multiple comorbidities can be particularly complex. Some treatment options may be in fact contraindicated or may lose effectiveness over time, reducing the options available to the dermatologists. In such circumstances, dimethyl fumarate may represent a safe and effective choice, also in patients who have already attempted biological therapies. In this regard, we report the case of a patient with moderate-severe psoriasis treated over time with various therapies (including topicals, phototherapy, traditional and biological drugs) that were discontinued due to ineffectiveness or incompatibility caused by the occurrence of concomitant diseases, who finally achieved clinical remission with dimethyl fumarate.

Erosive pustular dermatosis of the scalp and multiple sclerosis: just a coincidence?

We report the case of a 23-year-old woman with an erythematous, crusted patch of the scalp, lacking pustular lesions, with partial hair loss, developed after mechanical scalp trauma. Histopathological examination showed a dermal infiltrate, predominantly peri-adnexal and peri-vascular, rich in plasma cells and lymphocytes, but lacking neutrophils, possibly as a consequence of the time elapsed since the onset of the skin disease. Reduction of functional hair follicles was evidenced. Stains for bacterial or fungal infections were negative. Direct immunofluorescence was negative. Erosive pustular dermatosis of the scalp was diagnosed on the basis of clinical-anamnestic findings, supported by histology. Topical clobetasol propionate led to clinical improvement after a couple of weeks. Erosive pustular dermatosis of the scalp was diagnosed and soon after the patient developed also multiple sclerosis. Up to date, the pathogenesis of erosive pustular dermatosis of the scalp remains unknown, though a possible role of immunosenescence and autoimmunity has been suggested. Indeed, high levels of neutrophil-stimulating cytokines and chemokines have been found in erosive pustular dermatosis patients, possibly causing activation of an aberrant systemic neutrophilic reaction. Furthermore, the role of neutrophils has been recently highlighted also in the pathogenesis of multiple sclerosis. Herein we hypothesize a possible common immunological etiology of multiple sclerosis and erosive pustular dermatosis of the scalp, conceivably involving a hyperactivation of neutrophils.

Acne Fulminans Induced by Lymecycline in a Patient with Hidradenitis Suppurativa: A Case Report.

Acne fulminans (AF) is a rare and severe form of inflammatory acne that typically occurs in male adolescents with acne vulgaris and is characterized by the sudden onset of painful, bleeding, and ulcerated lesions. It has been described very rarely in association with hidradenitis suppurativa (HS). Its onset may be induced by drugs, particularly isotretinoin. We present a case of a 16-year-old patient with HS who developed AF following initiation of antibiotic therapy with lymecycline. In the literature, only 2 patients who developed a coexistence of AF and HS have been reported, and there are only 2 other similar cases of AF induced by doxycycline and lymecycline. We consider our case to be of particular interest not only because of the very rare concomitant presence of AF and HS but also because AF was induced by lymecycline, a drug commonly used to treat both acne and HS, and described only once as a drug responsible for AF, so it is an aspect that deserves to be considered by the clinician dealing with similar conditions.

Bulky Condyloma Acuminata following Ustekinumab Treatment for Plaque Psoriasis: A Case Report.

Ustekinumab is a fully human monoclonal antibody targeting the pro-inflammatory cytokines interleukin (IL)-12 and IL-23 approved for the treatment of psoriasis and psoriatic arthritis. We report a case of a patient treated for chronic plaque psoriasis with ustekinumab who developed bulky condyloma acuminata shortly after initiating the treatment. Although ustekinumab has already been described in literature associated with other forms of human papilloma virus skin infections, this is the first case to our knowledge in which ustekinumab is associated with genital warts.

Reticular Erythematous Mucinosis: Exclusive Involvement of the Axillary Region.

Reticular erythematous mucinosis is a primary cutaneous mucinosis characterized by the presence of erythematous macules, papules, or plaques coalescing into a reticular pattern that typically involves the midline of the chest or back in middle-aged women. Because of this peculiar location, it is also called midline mucinosis. Although atypical disease localizations have been described in the literature, these have always been accompanied by midline involvement. We report a case of reticular erythematous mucinosis with exclusive involvement of the axillary region.

Lichen planus flare following COVID-19 vaccination: A case report.

We report the third case of cutaneous lichen planus (LP) following COVID-19 BNT162b2 vaccination in a 59-year-old woman with previous LP. The reactivation of LP in patients with dormant LP suggests a possible vaccine-induced immune dysregulation. We suggest that the already described vaccine-induced upregulation of Th1 response may play a relevant role in LP reactivation, through an increase in inflammatory cytokines involved in the pathogenesis of LP. Interestingly, LP has already been associated with vaccinations and viral infections including COVID-19 disease. However, the exact mechanism underlying LP (re)activation after Pfizer-BiotNtech COVID-19 vaccination is still widely unknown and needs to be further investigated.

Age at onset in patients with bipolar I and II disorder: a comparison of large sample studies.

BACKGROUND: Bipolar Disorder (BD) is a leading cause of disability worldwide and factors contributing to its burden include chronic relapsing course, comorbidity, suicide risk, and early age at onset (AAO). In particular, recent investigation has shown that BD onset may occur earlier than previously believed, even though whether BDI and II are different in such regard is still debated. Reduced samples may, moreover, limit the confidence in the published studies, with geographic issues, in turn, representing potentially conditioning factors. The present review was aimed to select and analyze large sample studies comparing AAO in BDI vs II patients. METHODS: A PubMed literature search was performed, considering English-written articles published up to December 2015, comparing AAO in BDI vs II patients with sample size≥100 subjects per group. RESULTS: Seventeen studies were considered suitable for revision, with 8 studies reporting statistically significant differences and 9 not. Among studies reporting statistically significant differences, mostly conducted in Europe, 6 showed an earlier AAO in BDI, while 2 in BDII subjects. LIMITATIONS: Only studies with large samples included, considering AAO as a continuous variable, and providing a comparison between the bipolar subtypes. CONCLUSIONS: Our findings suggest that AAO per se does not seem to reliably differentiate BDI from BDII patients and that such variable should likely be investigated in the context of other clinical characteristics, in order to assess its overall influence over BD course. Geographic factors may, in turn, play a potential role with future investigation warranted to further explore this specific issue.