Zigzag longitudinal melanonychia: a peculiar dermoscopic pattern.

BACKGROUND: Longitudinal melanonychia (LM) can present a diagnostic challenge and dermoscopy is of utmost importance for its evaluation and differential diagnosis of LM. OBJECTIVE: This report aimed to describe an unusual dermoscopic pattern in a group of patients that presented with LM. METHODS: The clinical course and features of five LM patients that presented with an unusual 'zigzag' dermoscopic pattern were analyzed retrospectively. RESULTS: In all, four of the five patients were children (age range: 10-13years). In all five patients, the thumb nail was affected. A nail matrix biopsy was available for only one patient and was reported as lentigo. In two (one child and one adult) out of the five patients, spontaneous total regression of the LM was observed. CONCLUSIONS: The peculiar 'zigzag' dermoscopic pattern of LM described herein seems to occur primarily in children. Although this pattern is a benign in nature, it is not clear if it is related to trauma. Further investigation is warranted to clarify the association between the histopathological findings and the zigzag pattern observed via dermoscopy.

The combination of tumour necrosis factor-α -308A and interleukin-10 -1082G gene polymorphisms and increased serum levels of related cytokines: susceptibility to vitiligo.

BACKGROUND: The aetiopathogenesis of vitiligo is still under investigation. AIM: To assess the role of single nucleotide polymorphisms (SNPs) of the genes for tumour necrosis factor (TNF)-α, interleukin (IL)-6 and IL-10, as well as the serum levels of these three cytokines in the pathogenesis of vitiligo. METHODS: The study enrolled 105 patients with vitiligo, and 211 age- and sex-matched controls. TNF-α (-308), IL-6 (-174) and IL-10 (-1082) promoter polymorphisms were investigated by LightSNiP assay and analysed by χ(2) test. Subsequently, the serum cytokine levels were assessed by ELISA and evaluated by Mann-Whitney U-test and Kruskal-Wallis test. RESULTS: The frequency of the GG genotype of the IL-10 -1082 polymorphism was significantly higher in the vitiligo group compared with the healthy control group (P = 0.02). Further investigations using combinations of these variant alleles detected a significant risk for vitiligo for individuals carrying both the IL-10 -1082G and TNF-α -308A alleles (OR = 12.57, 95% CI 1.44-110.0, P < 0.01). Serum IL-10 and TNF-α levels were higher in the vitiligo group (P = 0.001). In addition, TNF-α levels in patients with active disease were significantly higher than in patients with stable disease (P < 0.02). CONCLUSIONS: The concomitant presence of IL-10 -1082G and TNF-α -308A alleles significantly raises the risk for vitiligo. Furthermore, in accordance with these findings, serum IL-10 and TNF-α were also increased in this study, confirming the role of these cytokines in the pathogenesis of vitiligo.

Composite haemangioendothelioma with lymph-node metastasis: an unusual presentation at an uncommon site.

A 48-year-old woman presented with red papules on the thigh. Histopathological examination indicated pyogenic granuloma, and the patient was treated with total excision in 2003 and electrocauterization in 2005. Three months later, upon recurrence of the lesions, a diagnosis of composite haemangioendothelioma (CHE) was made. The patient was treated by total excision and lymph-node dissection, which revealed inguinal lymph-node metastasis. Despite the surgery, a further local recurrence occurred, subsequently treated by wide excision en bloc, with adjuvant radiotherapy and chemotherapy. Although CHE is defined as a vascular tumour with low-grade malignancy, the local recurrences and lymph-node metastases resulted in treatment difficulties in this case. Unlike earlier cases, the tumour in our patient presented as localized numerous small papulonodules, and lymph-node metastasis was detected within a relatively short time. Dermatologists and pathologists should be aware of this rare condition and include it in the differential diagnosis of vascular lesions.

Demodex folliculorum in pregnancy.

BACKGROUND: Demodex folliculorum (DF), which is a resident in human pilosebaceous follicles, has been implicated in rosacea, blepharitis, pityriasis folliculorum, pustular folliculitis, and skin lesions of immunosuppressed patients on chemotherapy or with acquired immunodeficiency syndrome (AIDS). OBJECTIVE: We aimed to determine the influence of pregnancy on the carriage of DF. METHODS: Mite density in 40 pregnant women was compared with that of age- and sex-matched controls. Two standardized skin surface biopsies were taken from each subject. Results In pregnant women, DF was found at 0.55/cm2, compared with a mean value of 1.2/ cm2 in nonpregnant controls. The difference between the two groups was not statistically significant (Mann-Whitney test, P = 0.22). CONCLUSIONS: Our findings indicate that pregnancy may not have a direct effect on mite density.

Self-healing juvenile cutaneous mucinosis.

Self-healing juvenile cutaneous mucinosis was encountered in a 15-year-old boy who presented with characteristic cutaneous findings and a clinical course of final spontaneous resolution. The interesting point is the presence of numerous nodules found in unusual locations. To date, nodules occurring on the long axis of the extremities have not been reported.

Demodex folliculorum in renal transplant patients.

BACKGROUND: Demodex folliculorum (DF), which is a resident in human pilosebaceous follicles, has been implicated in infections of patients under cancer chemotherapy and with AIDS. OBJECTIVE: We aimed to determine the influence of immunosuppression on carriage of DF. METHODS: Mite density was compared, of 30 renal transplant (RT) patients under a combination therapy of cyclosporine, azathioprine and prednisolone with that of age- and sex-matched controls. Two samples of standardized skin surface biopsies were taken from each subject. RESULTS: DF was not found in any of the RT patients while a mean density of 0.55 DF/cm2 was present in healthy subjects (Fisher's exact test, p < 0.0001). The relationship between mite density and classic risk factors was not found to be statistically significant (Fisher's exact test, p > 0.05). CONCLUSION: Our findings indicate that there may be other factors than immunosuppressive therapy influencing DF density.