Dermoscopic spectrum of mycosis fungoides: a retrospective observational study by the International Dermoscopy Society.

BACKGROUND: The dermoscopic features of classic patch stage mycosis fungoides (MF) have been described, but data on plaque and tumoral stage as well as rarer MF subtypes is limited. OBJECTIVE: To evaluate dermoscopic morphology and dermoscopic-pathological correlations of classic MF stages and investigate dermoscopic features of MF variants. METHODS: Patients with histopathologically confirmed lesions of classic MF (patch, plaque and tumoral stage) or folliculotropic, erythrodermic and poikilodermatous MF were included. Standardized evaluation of dermoscopic pictures of the included MF variants and comparative analysis and dermoscopic-pathological correlation assessment of different stages of classic MF were performed. RESULTS: A total of 118 instances were included (75 classic MF, 26 folliculotropic MF, 9 erythrodermic MF and 8 poikilodermatous MF). Linear/linear-curved vessels and white scales in the skin furrows were significantly associated with patch-stage MF, while clustered dotted vessels were related to plaque-stage MF and peripheral linear vessels with branches, ulceration and red globules separated by white lines to tumour-stage MF. Moreover, patchy white scales were significantly more common in patches and plaques compared to tumours, whereas focal bright white structureless areas were related to plaque and tumoral stage. Vessels histopathologically corresponded to dilated vascular structures in the dermis, orange structureless areas to either dermal hemosiderin (patch/plaque stage) or dense cellular infiltration (tumours), bright white lines/structureless areas to dermal fibrosis and ulceration to loss of epidermis. The main dermoscopic findings of folliculotropic MF were lack of hairs, dilated follicles and follicular plugs, while erythrodermic MF was mainly characterized by linear/dotted vessels, patchy white scales and focal orange structureless areas and poikilodermatous MF by focal white and brown structureless areas, white patchy scales and brown reticular lines. CONCLUSION: Dermoscopy may allow a more precise characterization of classic MF and reveal clues suggestive of the main MF variants.

The role of occlusion and micro-incontinence in the pathogenesis of penile lichen sclerosus: an observational study of pro-inflammatory cytokines' gene expression.

PURPOSE: To assess the expression of selected cytokines in penile lichen sclerosus (PLS) and associate them with the occurrence of micro-incontinence (MI) in different stages of PLS. METHODS: The skin biopsies from 49 PLS affected, and 13 from nonlesional foreskins (healthy control adult males undergoing circumcision due to phimosis caused by short frenulum) were obtained. All specimens were used for RNA extraction and RT-qPCR. Quantitative assessment of the gene expression of interleukin 1-A (IL-1A), interleukin 1-B (IL-1B), interleukin 1 receptor antagonist (IL-1RN), interleukin 6 (IL-6), transforming growth factor ß1 (TGF-ß1), and interferon-gamma (INF-γ) was performed. To determinate the presence of MI, the patients were asked about voiding patterns, especially leaking tiny drops of urine from the urethral meatus after urination. RESULTS: IL-1A, IL-6, and INF-γ mRNA levels were approximately 150, 16, and 59 times higher in PLS than in control samples, respectively. The highest IL-1A mRNA levels were observed in early PLS (n = 13), INF-γ in moderate PLS (n = 32), while IL-6 in severe PLS (n = 4). MI was noted in 45 PLS patients vs. 0 in control (p < 0.0001). IL-1A and IL-6 vs control ratios were concentration (ca.) 400 and 30 times higher, respectively, in MI PLS samples than in PLS without MI. CONCLUSION: Occlusion and irritating urine effect are associated with the clinical progression of penile LS with increased mRNA expression of IL-1A, INF-γ, and IL-6 pro-inflammatory cytokines in the foreskin.

Trichoscopy may enhance the differential diagnosis of erythroderma.

There is a paucity of data concerning the usefulness of trichoscopy in patients with erythroderma. The aim of the study was to compare the trichoscopic features in erythroderma of various aetiologies. In total, 49 patients with a determined cause of erythroderma [including atopic dermatitis (AD), mycosis fungoides (MF), allergic contact eczema (ACE), psoriasis (Pso), Sézary syndrome (SS), drug reaction, pityriasis rubra pilaris (PRP), dermatomyositis (DM), actinic reticuloid (AR), crusted scabies (CS) and pemphigus foliaceus (PF)] were included in the study. Dotted vessels were present in patients with AD, PRP, MF, SS and Pso, and absent in DM, CS and PF (χ², P < 0.02). Spermatozoon-like vessels were observed only in MF and SS (P = 0.001). Whitish-pinkish structureless areas were described in all patients with DM, AR and CS (P < 0.03). The type of vessel and the presence of whitish-pinkish structureless areas under trichoscopy may indicate the cause of erythroderma.

Dermoscopic Features of Leukemia Cutis-Case Series.

Leukemia cutis (LC) is a term describing skin lesions caused by cutaneous infiltration by hematological malignancies (myeloid or lymphoid). To our knowledge, there are no published reports on dermoscopic presentation of LC. The aim of the study was to analyze dermoscopic pattern in series of 5 patients with the diagnosis of LC.

Dermoscopic and trichoscopic features of primary cutaneous lymphomas - systematic review.

Dermoscopy and trichoscopy are non-invasive methods used as auxiliary tools in diagnostics of different dermatoses. To date, no systematic review concerning the utility of dermoscopy and trichoscopy in the diagnostics of primary cutaneous lymphomas has been published. The aim of this study was to summarize the current state of knowledge on this topic based on systematic search of PubMed database and related references published before 8th of August 2020. Besides dermoscopic features, type of dermoscope, polarization mode, magnification, number of cases and histopathological correlation were analysed. A total of 34 records were included into the final analysis, evaluating 141 patients diagnosed with primary cutaneous T-cell lymphomas and 70 patients with primary cutaneous B-cell lymphomas. Most of the analysed records evaluated dermoscopic features (n = 206); trichoscopy was analysed in only 5 cases. Structures most commonly observed in classical mycosis fungoides (n = 108) were fine short linear vessels/linear vessels, spermatozoa-like vessels and orange-yellow patchy areas. In folliculotropic mycosis fungoides (n = 12), most frequently observed were comedonal lesions/comedo openings/central keratotic plugs and white halo around hair follicles/perifollicular accentuation. Primary cutaneous marginal zone B-cell lymphoma (n = 42) and primary cutaneous follicle centre lymphoma (n = 20) most commonly presented with salmon-coloured background and fine short/linear irregular/serpentine vessels. For other PCL, with less than 10 cases reported in the analysed records, details have been provided in the article. Most observations analysed in this systematic review rely on findings from case reports/case series (with the level of evidence V) and lack a control group. A few studies provided information concerning technical aspects of dermoscopic/trichoscopic examination. The role of dermoscopy/trichoscopy in diagnostics of cutaneous lymphomas requires further studies, especially in entities where dermoscopic features have been described in only single or a few cases. However, it seems that this practical, accessory tool in future may provide additional clues during clinical assessment.

The significance of dermoscopy and trichoscopy in differentiation of erythroderma due to various dermatological disorders.

BACKGROUND: The diagnosis of a patient with erythroderma may be difficult and sometimes pose a challenge for both dermatologist and pathologist. The role of dermoscopy in this area seems to be poorly investigated. There are only a few reports, with limited number of patients, describing dermoscopic features in erythroderma of various origins. To the best of our knowledge, none of the previous studies had included trichoscopic examination. OBJECTIVES: Analysis of dermoscopic and trichoscopic patterns in series of patients with erythroderma. METHODS: We retrospectively analysed 28 adult patients who presented with erythroderma between May 2016 and August 2020. Demographic data, disease course and duration, previous treatment, as well as dermoscopic and trichoscopic features were analysed. RESULTS: There were 9 patients (32.1%) with the diagnosis of mycosis fungoides, 8 patients (28.5%) with atopic dermatitis, 3 patients (10.5%) with Sézary syndrome and 3 patients (10.5%) with pityriasis rubra pilaris. The others were diagnosed with allergic eczema (n = 1; 3.6%), dermatomyositis sine myositis (n = 1; 3.6%), psoriasis (n = 1; 3.6%), actinic reticuloid (n = 1; 3.6%) and crusted scabies (n = 1; 3.6%). Characteristic dermoscopic/trichoscopic patterns have been observed in erythroderma due to crusted scabies, psoriasis, dermatomyositis sine myositis, Sézary syndrome and pityriasis rubra pilaris. Differentiation of mycosis fungoides and long-standing atopic dermatitis based on dermoscopy is difficult, as the overlap of vessel morphology, background colour and scale colour exists. Similarly, differentiation between AD and AE based on dermoscopy/trichoscopy seems to be impossible, and clinical background is crucial. CONCLUSION: Dermoscopy and trichoscopy seem to provide additional clues in the assessment of erythrodermic patient. Depending on the underlying cause, trichoscopy or dermoscopy may be more useful.

STAT3, STAT5A, STAT5B and STAT6 proteins are overexpressed in human basal cell carcinoma.

BACKGROUND: The molecular pathogenesis of basal cell carcinoma (BCC) is still not precisely described and is the subject of ongoing studies. The role of signal transducers and activators of transcription (STATs) in human epithelial carcinogenesis has been poorly investigated, but in the era of studies on inhibitors targeting STAT proteins this topic seems worth exploring. Increased expression of STAT3 in human nonmelanoma skin cancer (NMSC) has been confirmed in a few studies, but to our knowledge, expression of STAT5A, STAT5B and STAT6 in BCC has not been previously evaluated. AIM: To measure expression of STAT3, STAT5A, STAT5B and STAT6 expression in different histopathological subtypes of human BCC and its correlation with selected clinical variables. METHODS: Immunohistochemistry was used to assess 60 BCC tumour specimens [20 superficial (s)BCCs, 20 nodular (n)BCCs and 20 infiltrative (i)BCCs] and to compare with specimens of healthy skin. There was no significant difference in age or sex between the three groups of patients with BCC. As many tumours showed heterogeneity of staining, the H-score system was applied to calculate the intensity of immunoexpression. RESULTS: Expression of STAT3, STAT5A, STAT5B and STAT6 was observed in all histopathological subtypes of BCC, and was stronger than the expression within the adjacent epidermis and also stronger than the expression within the epidermis in the healthy control group. Statistical analysis revealed no significant differences in mean H-scores calculated for sBCCs, nBCCs and iBCCs. There were no statistically significant associations between STAT3, STAT5A, STAT5B and STAT6 expression and patient sex/age, and tumour size/site. CONCLUSION: Our results confirm a possible role of STATs in the pathogenesis of BCC and should encourage future investigations on the possible therapeutic implications of this finding.

Methotrexate in the treatment of mycosis fungoides - a multicenter observational study in 79 patients.

OBJECTIVE: The first report concerning methotrexate (MTX) in the treatment of Mycosis fungoides (MF) was published in 1964 by Wright. The mechanism of MTX action in the treatment of primary cutaneous T-cell lymphoma (CTCL) has been not explained in detail yet (the anti-inflammatory, immunomodulating, immunosuppressive, and cytostatic actions have been under discussion). PATIENTS AND METHODS: This is a retrospective analysis of 79 MF patients in 4 dermatology clinical centers in Poland. Data are presented in terms of the duration, use of MTX, the effectiveness of treatment with MTX in terms of time required to achieve remission, the disease stage, route of administration, age at diagnosis and the dosage. Moreover, the occurrence of side effects depending on the route of administration and duration of therapy with MTX was analyzed. RESULTS: The analysis has revealed that 56 patients (70,9%) had achieved remission on the MTX. The remission began in the 1st month of therapy in 20% of patients, lasted 4 to 6 months in 50% of cases. At least 12 months' remission was confirmed in 25% of patients (2-year-long only in 10% and 3-year-long in 5% of patients). The time to remission was related to the stage of disease at diagnosis as well as to minimal and maximal dose of MTX. The total therapeutic dose of MTX was found important for the course of the disease: higher total dose had prolonged the remission. CONCLUSIONS: Despite the common use of MTX in MF patients, relatively few clinical studies have been published. The response of MF subjects to MTX seems to depend on the stage and, more importantly, the dose of MTX treatment. Methotrexate appears to be an effective treatment at every stage of MF; however, it is not devoided of side effects such as infections and elevated level of aminotransferases, which are most common.

Relationship between serum levels of interleukin-18, IgE and disease severity in patients with atopic dermatitis.

BACKGROUND: Interleukin (IL)-18 is a pleiotropic cytokine. Synergistically with IL-12, IL-18 promotes immune responses of the T helper type, by enhancing synthesis of interferon-γ and inhibiting IgE production. IL-18 can also enhance production of IL-4 and IL-13 production, and stimulate synthesis of IgE. Moreover, in the presence of IL-3, IL-18 can directly stimulate basophils and mast cells to produce their mediators in an IgE-independent manner. These results indicate a role for IL-18 in the pathogenesis of atopic dermatitis (AD). AIM: To examine the association of serum IL-18 with IgE levels and disease severity in patients with AD. METHODS: ELISA was used to measure IL-18 and total IgE levels in the sera of 67 patients with AD and 50 healthy volunteers. The SCORing Atopic Dermatitis (SCORAD) tool was used to determine the severity of this disease. RESULTS: The mean serum level of IL-18 in study group (155.68 pg/mL) was significantly higher than that of controls. IL-18 was also significantly higher in the sera of the patients with severe AD than in those with milder disease. There was a correlation with IgE and IL-18 levels, as patients who had high IgE levels also had high IL-18 levels, compared with controls. CONCLUSION: IL-18 seems to play an important role in the pathogenesis of AD, but this requires further study. IL-18 could be a useful clinical marker of disease severity in AD.

Immunoelectron microscopy in mycosis fungoides and benign dermatoses. Expression of CD3, CD4 and CD7 receptors.

UNLABELLED: Mycosis fungoides is an epidermotropic cutaneous T-cell lymphoma (CTCL).Specimens for presented study were taken from sixteen patients with MF confirmed by immunohistochemical methods and PCR and from nine patients with benign dermatoses. To demonstrate CD3, CD4 and CD7 antigens immunogold method was used. We saw morphological differences between lymphocytes from MF and benign dermatoses. In MF, CD3 and CD4 were present rather in form of clusters placed on the surface of cell. On the contrary -CD3 to CD7 distribution analysis showed that these antigens were present rather individually, however there were seen clusters as well. In MF tumor stage labelling decreased in following order: CD7, CD3 and CD4. We also found internalisation of studied antigens via the coated structures of the cell membrane -especially in tumor stage. In benign dermatoses the majority of all receptors was present on the cell membrane. Our work showed differences in localization of studied antigens, between MF stages, what can suggest their possible translocation in cells. We also found loss of CD3 and CD7 antigens in tumor stage what might be use as adiagnosis tool for this disease. KEYWORDS: mycosis fungoides, benign dermatoses, CD3, CD4 and CD7 receptors, immumogold labelling.