Cutaneous Bowen's Disease: an Analysis of 182 Cases according To Age, Sex, and Anatomical Site from an Italian Center.

Bowen's disease (BD), also known as squamous cell carcinoma in situ, is a type of non-melanocytic intraepidermal malignancy characterised by a slowly enlarging erythematous to pink, scaly patch or plaque with irregular and well-demarcated borders. These lesions are usually persistent and progressive; it has been estimated that in general population around 3% to 5% of Bowen's disease transform into invasive squamous cell carcinoma. This report describes our experience with cutaneous BD and assesses the differences found about age, sex and anatomical site. Bowen's disease was seen more frequently in male patients rather than in female patients in contrast to what confirmed in literature - this difference is probably because being head-neck an exposed region, patients are more easily induced to autoexam and to consult the dermatologist.

Confocal microscopy can assess the efficacy of combined microneedling and skinbooster for striae rubrae.

Striae distensae or stretch marks are dermal scars characterized by flattening and atrophy of the epidermis. They develop particularly during adolescence but they can also appear in other situations such as pregnancy, the use of prolonged therapies with topical or systemic corticosteroids, Cushing's syndrome, Marfan's syndrome, prolonged use of lightening creams, cachexia, rapid weight loss or the use of androgenic and anabolic substances. Treatment options often take a long time, and the results are often disappointing, causing significant psychological distress in patients. We propose a completely innovative approach, combining the skinbooster technique with the microneedling technique. These minivasive methods work by inducing tissue remodeling and stimulating the synthesis of new collagen. Confocal microscopy can show and follow the skin changes made by these therapies, thus becoming an important and valid therapeutic monitoring tool for aesthetic dermatology.

Instrumental, clinical and subjective evaluation of the efficacy of a cosmetic treatment for home use.

Background: In the last few years, there has been increasing demand for aesthetic procedures to improve the effects of skin aging. Aim: To evaluate the anti-aging efficacy, tolerability and skin changes induced by the topical products containing hyaluronic acid, N-acetyl glucosamine and gamma-amino butyric acid through instrumental techniques, clinical and subjective evaluation. Patients/Method: Twenty female enrolled applied a day and night cream after applying a serum, once week applied a mask, for 2 months. A clinical assessment of smoothness, expression wrinkles, fine wrinkles and measurements of the parameters using Reveal Imager, X-Rite, Corneometer, Dermalab, Moisture Meter EpiD were taken at day 0, 15, 30 and 60 of study period. A final assessment questionnaire was submitted. Results: The products were accepted by all the volunteers. The hydration (Corneometer: T0 49.17 vs T60 61.11, average variation 24.28%) (Moisture Meter EpiD: T0 45.73 vs T60 61.10, average variation 33.60%), elasticity (Dermalab: T0 56.06 vs T60 62.78, average variation 11.98%) and lightening of the skin (X-Rite: T0 60.23 vs T60 63.36, average variation 5.26%) improved. All changes were statistically significant (p < 0.05). Conclusion: The efficacy of the topical products is confirmed by subjective, clinical and instrumental assessment. This should be a routine approach in dermatologic practice.

Management of clinical and subclinical actinic keratoses with histological and immunohistochemical assessments by confocal microscopy.

Reflectance confocal microscopy has been used to monitor treatment efficacy in non-melanoma skin cancer, but few studies have compared different therapies using the same confocal criteria. We compare a single score designed in previous study to evaluate confocal, histological, and immunohistochemical results obtained before and after two treatments of actinic keratosis (AK) and in field cancerisation area. Thirty volunteer male patients, aged >50-year old, with at least three clinically visible AKs on the bald scalp, were included in this study: 15 patients were submitted to 3% diclofenac therapy and 15 to 5% fluorouracil therapy. Confocal imaging was performed on a 5 × 5 cm skin area. In five patients of each group we performed cutaneous biopsies. Scaling, upper nucleated cells, and inflammatory cells showed a higher percentage reduction in field cancerisation, especially in diclofenac treatment group, while in AK inflammatory cells showed a greater percentage reduction in 5-fluorouracil treatment group. Both therapies are efficacious, but their effectiveness is different on the single parameters of the confocal, histology, immunohistochemically.

Difficult to diagnose small cutaneous melanoma metastases mimicking angiomas: utility of dermoscopy.

BACKGROUND: Metastases from melanoma can be found in any organ, while the reported incidence of skin metastases varies between 2 and 20%. Cutaneous melanoma metastases (CMM) can be heterogeneous at clinical examination, and they can simulate other benign and malignant lesions, thus generating major diagnostic troubles for the dermatologist. Dermoscopy is a useful tool that may increase the physician's diagnostic accuracy to this purpose. MATERIALS AND METHODS: Herein, we describe the case of two patients having lesions that can easily be confused with other benign or malignant lesions for their clinical and dermoscopic similarities and for the variability of presentation of skin metastases. The description of the dermoscopy patterns of melanoma metastases may be useful to recognize early metastases, when clinically not suspected, facilitating an early removal and histopathological confirmation. RESULTS: Diagnoses of melanoma metastases and angiomas were confirmed by histological examination. Melanoma metastases show at dermoscopic examination the angioma-like pattern. The ability to detect CMM between other lesions was good taking into consideration that, without the patient's history and with just the dermoscopy image, it could be very difficult to distinguish CMM from other benign or malignant skin lesions. CONCLUSIONS: The present study confirms that dermoscopy is a useful tool to increase the physician's diagnostic accuracy for CMM and allow its differentiation from other cutaneous lesions, always taking into account the patient's medical record.

Reflectance Confocal Microscopy as New Diagnostic Tool in Folliculotropic Mycosis Fungoides.

We present a case of folliculotropic mycosis fungoides (FMF), a variant of cutaneous T-cell lymphoma which particularly affects hair follicles. FMF can imitate a wide variety of otherwise benign dermatoses, so it poses major diagnostic obstacles both for the dermatologist as well as the dermatopathologist. In our case, in vivo reflectance confocal microscopy (RCM) was very important for guiding the skin biopsy site selection. For this reason, RCM can reduce the number of unsuccessful histopathological examinations and increase the diagnostic accuracy for different skin dermatoses.

Skin diseases and tattoos: a five-year experience.

BACKGROUND: Decorative tattooing as a body art form underwent an exponential increase during the last two decades, particularly among teenagers and young adults. Consequently, the number of reported adverse reactions after tattooing has increased. The most frequent reported skin reactions to tattoo include infectious (bacterial, viral, fungal) or inflammatory (allergic contact dermatitis and granulomatous reaction) diseases. Moreover, tattoos can also induce the development of typical skin lesions of pre-existing dermatoses, a phenomenon known as isomorphism reactive or Koëbner phenomenon, which commonly occurs in patients with psoriasis, vitiligo, or lichen planus. METHODS: A retrospective study analyzing records data of patients attending the Department of Dermatology, University of Naples "Federico II" during 2011-2015 was performed. All cases of tattoo-related or closely-located dermatitis were selected. RESULTS: We observed 19 patients (mean age: 26.4 years old) showing cutaneous conditions related to the practice of tattooing. Allergic contact dermatitis was reported as the most common cutaneous disease linked to tattooing (31.6%), followed by granulomatous reactions (26.3%). These data are consistent with those already reported in the literature. CONCLUSIONS: Our results highlight the need to develop detailed regulations regarding tattoos practice, used materials, as well as execution procedures in order to limit the outbreak of tattoo-related skin diseases.

Confocal microscopy and imaging profilometry: A new tool aimed to evaluate aesthetic procedures.

According to the American Academy of Aesthetic Plastic Surgeons, more than 11 million cosmetic surgical and nonsurgical procedures were performed by board-certified plastic surgeons, dermatologists and otolaryngologists in the United States, totaling more than 12 billion dollars. We performed a retrospective observational multi-centric study on patients treated with a non-animal origin cross-linked hyaluronic acid with different molecular weights for nasolabial folds, evaluating through a new imaging system, profilometric techniques with the confocal microscopy, the durability, the efficacy and the safety of this product. From 25 patients, 150 silicone casts were obtained: 75 casts of the right nasolabial fold and 75 casts of the left nasolabial fold. Roughness arithmetical average of the right fold at T2 decreased by 50% versus T0 and by 40% compared to T1; at T2, it decreased by the 45% versus T0 and by 35% compared to T1. No side effects were reported. Results proved that the analysis of the skin microreliefs through confocal microscopy is a new imaging system that allows to evaluate with precision and safety the results of aesthetic treatments such as fillers objectively.

Confirmed efficacy of topical nifedipine in the treatment of facial wrinkles.

INTRODUCTION: Over the past two decades, there has been increasing demand for aesthetic procedures to reverse the effects of aging, particularly in the facial area. Recently, topical nifedipine has been proposed for its anti-wrinkle efficacy. OBJECTIVE: To confirm the anti-wrinkle efficacy of a 0.5% nifedipine-based topical formulation. MATERIALS AND METHODS: A randomized study was conducted in 20 healthy female volunteers, aged between 45 and 60 years, with moderate to moderately severe facial wrinkles. 10 volunteers applied a 0.5% nifedipine cream and 10 volunteers applied a good moisturizer twice daily for 90 days. The aesthetic improvement was evaluated by a blinded investigator using the Wrinkle Severity Rating Scale (WSRS). Anti-wrinkles effectiveness was also objectively assessed by measuring transepidermal water loss (TEWL), moisture levels of the stratum corneum, skin viscoelasticity and skin folding capacity by instrumental analysis. RESULTS: Post-treatment WSRS score was significantly lower than the baseline WSRS score only in the nifedipine group. The mean WSRS score at T0 was 3.85 and at T3 1.84 in the nifedipine group, while the mean WSRS score at T0 was 3.78 and at T3 3.36 in the control group. Corneometry showed significant increases in measures of skin hydration and TEWL values decreased in all the patients of both groups, indicating a trend toward improved integrity of skin. Dermolab® recorded significant increases in measures of skin hydration in the nifedipine group and a lower increase in the control group. The colorimetric evaluation showed that use of the tested product resulted in significant overall lightening of the skin during use compared with baseline, while the moisturizer didn't produce any change of skin lightening parameters. CONCLUSION: The tested topical preparation is effective in reducing facial wrinkles' depth and in increasing skin hydration and elasticity.

Enhanced antioxidant effect of trans-resveratrol: potential of binary systems with polyethylene glycol and cyclodextrin.

Trans-resveratrol, a polyphenol extracted from Vitis vinifera, has different beneficial effects following its administration on the skin. Here the potential use of binary systems to enhance in vitro and in vivo activity of trans-resveratrol was investigated. Thus the aqueous solubility of trans-resveratrol was investigated in the presence of growing concentrations of polyethylene glycol (PEG) or ß-cyclodextrin (ßCD) as solubilizing excipients. Then, the solid dispersion of trans-resveratrol with PEG or inclusion complexes trans-resveratrol/ßCD were prepared and characterised by different methods. Cytotoxicity and inhibition of reactive oxygen species (ROS) following H2O2 challenge in the presence of trans-resveratrol, alone or associated to the excipients, was evaluated on human keratinocyte HaCaT cell line. Both the trans-resveratrol-containing binary systems induced significant reduction of H2O2-induced ROS production, especially in the case of ßCD that was selected for the following phase of the study. Thus, the effect of a cream containing trans-resveratrol, alone or associated to ßCD, on different skin parameters such as corneometry, colorimetry and elastometry, was evaluated on human volunteers. All patients showed a visible improvement of clinical conditions with a remarkable decrease of aging signs, but this effect was higher of the hemi face treated with the ßCD-containing formulation versus formulation containing trans-resveratrol alone.

Angiosarcoma mimicking rhinophyma.

We report the case of a 61-year-old man showing persistent erythematous macules, plaques, and partially confluent nodules with irregular borders, developed on his nose for one year. During that time the patient underwent several dermatological consultations, and all produced the same diagnosis: rhinophyma. So antibiotic and steroid treatment was carried out without any improvement while the lesions kept growing. When the patient came to our observation, physical examination revealed large, infiltrative, oedematous, erythematous plaques and rare nodules, with superficial telangiectatic vessels. Cervical lymphadenopathy was not detectable. Routine laboratory analysis was normal. Punch biopsy was performed, and histopathology and immunohistochemical studies were consistent with cutaneous angiosarcoma. This is the report of a face angiosarcoma with an unusual and very deceptive clinical presentation.