Gender differences in genital lichen sclerosus: data from a multicenter Italian study on 729 consecutive cases.

BACKGROUND: Studies specifically conducted to assess gender differences in genital lichen sclerosus (GLS) are not available. This multicenter study aimed to identify possible gender-related differences on GLS clinical features, history and course, through collecting data from a large mixed-sex sample of patients. METHODS: This was a cross-sectional study on 729 subjects (53.8% females, 46.2% males) affected with GLS, consecutively observed within a network of 15 Italian dermatology units. The following information was specifically collected: clinical features and severity of symptoms related to GLS, extragenital involvement, previous therapies, diagnostic suspicion at referral, type of referring physicians, development of genital squamous-cell carcinoma (SCC). RESULTS: Females complained of symptoms more frequent and severe than men; pallor and scarring-sclerosis-atrophy were the most frequent features without gender differences; itching-related signs were more frequent in females than in males as well as extragenital involvement; prior to receiving a definitive diagnosis, females received treatment more frequently than males; 40% of patients were referred with a misdiagnosis; the highest rate of correct suspected diagnosis at referral came from dermatologists than from other physicians; duration of the disease was found to predispose to SCC development. CONCLUSIONS: Our findings highlighted several gender differences on clinical presentation and symptom profile of GLS. In spite of some characteristic features, misdiagnosis at referrals was frequent.

Sinecatechins 10% ointment for genital warts: Case report of a beneficial reaction in an HIV-positive woman.

Patients with HIV infection are more likely to develop anogenital warts compared to HIV-negative people and are susceptible to treatment failures and recurrences. We report a case of extensive vulvar warts in an HIV-positive woman successfully treated with sinecatechins ointment. After the failure of a combination of cryotherapy and imiquimod 5% cream, we started therapy with sinecatechins 10% ointment. The patient developed an intense local inflammatory reaction after three weeks that induced the discontinuation of the therapy. After two weeks, we observed a complete regression of inflammation and a reduction of genital warts. The lesions completely regressed within a few weeks, with no relapse after eight months. Sinecatechins is a standardized extract of green tea leaves, effective in the treatment of external genital and perianal warts in immunocompetent patients, but their role has not been yet studied for immunocompromised people. Our case may represent a starting point for further studies, in order to evaluate the relation between treatment dosage, side effects, and drug response in immunocompromised patients.

Non-infectious inflammatory genital lesions.

The genitalia may be the site of non-infectious inflammatory lesions that are generally manifested as balanoposthitis and vulvovaginitis. In men, these forms constitute 50% of all balanoposthitis forms, and in women, vulvovaginitis frequency is even higher. They consist of genital locations of general skin diseases, such as psoriasis, lichen planus, lichen sclerosus, and other clinical entities with their own physiognomy, such as Zoon's balanitis-vulvitis. Diagnosis of genital non-infectious inflammatory lesions is usually made on clinical criteria. A biopsy is only necessary for the identification of clinical conditions that may simulate inflammatory form but are actually premalignant processes.

Granuloma annulare, autoimmune thyroiditis, and lichen sclerosus in a woman: randomness or significant association?

We report a 60-year-old Caucasian female with a 2-year history of diffused granuloma annulare (GA), who presented for the simultaneous occurrence of genital lichen sclerosus (LS) and autoimmune thyroiditis (AT). In our opinion this combination is not just coincidental but may share similar immunopathological mechanisms.

Keratotic horn on left fifth fingertip: congenital ectopic nail misdiagnosed as a common wart.

The term "ectopic nail" refers to nail tissue found in a location other than in the normal nail bed. Here we report a 9-year-old girl with an asymptomatic keratotic "horn" on the tip of her left fifth finger. Present since the age of 1 month, it was misdiagnosed as a common wart and treated using liquid nitrogen cryotherapy without benefit.

[Apheresis in dermatologic diseases]. / Aferesi nelle patologie dermatologiche.

This report discusses the different types of apheresis used to treat skin diseases and focuses specifically on photopheresis or ECP (extracorporeal photochemotherapy). ECP is a systemic immunomodulatory therapy used successfully to treat many different, mainly autoimmune diseases such as cutaneous T-cell lymphomas, graft-versus-host disease, systemic sclerosis, atopic dermatitis, and pemphigus vulgaris. It has also proved effective against graft rejection after transplant. The exact mechanism by which the ECP performs its therapeutic activity is not yet entirely clear. However, at least 2 mechanisms have been identified that may explain the therapeutic effect. Firstly, ECP is able to induce downregulation of the self-allogeneic immune response that occurs in graft-versus-host disease, systemic sclerosis and atopic dermatitis, and secondly, it can stimulate an immune response against the neoplastic clones in patients with cutaneous T-cell lymphomas. At the Dermatology Clinic of the University of Siena, more than 100 patients with different immune-mediated diseases were treated with ECP. The results obtained are very interesting and our 20 years of experience confirm that the treatment is well tolerated. ECP can therefore be considered of great utility in the modulation of the immune system.

Venous ulcers of the lower limbs due to congenital thalidomide-related valve defect.

A 44-year-old woman with fetal thalidomide syndrome and congenital pseudoainhum of the left big toe had a 5-year history of painful nonhealing ulcers in the left malleolar region. Venous Doppler ultrasonography showed hypoagenesis of the valve flaps of the deep and superficial venous circuit. To our knowledge, this is the first description of congenital pseudoainhum associated with fetal thalidomide syndrome. The coexistence of cutaneous ulcers in our case might be coincidental but may be related to a congenital valve defect (hypoagenesis) caused by thalidomide.

Cutaneous metastases from adenocarcinoma of the rete testis.

Adenocarcinoma of the rete testis (ACRT) is extremely rare and has only been the subject of sporadic case reports, in most of which the neoplasm manifested as a scrotal mass with diffuse enlargement of the testis. Only a few cases of scrotal infiltration by a contiguous ACRT have been described. To our knowledge, none have reported distant skin metastases. We report a case of ACRT presenting with suprapubic skin metastases. The diagnosis was based on clinical and histopathological findings and supported by the results of immunohistochemical and ultrastructural studies. We discuss the differential diagnosis to this rare entity, which include metastatic adenocarcinoma, serous tumor of the testis, and mesothelioma of the tunica vaginalis.

Classification and pathophysiology of skin grafts.

Flaps and grafts are the 2 main surgical procedures to repair losses of skin tissue. A flap is a full-thickness portion of skin sectioned and isolated peripherally and in depth from the surrounding skin, except along one side, called the peduncle. A graft is a section of skin, of variable thickness and size, completely detached from its original site and moved to cover the zone to be repaired. According to their thickness, skin grafts are classified as split thickness (or partial) and full thickness. The former is further divided into thin, intermediate and thick. Split-thickness skin grafts usually take well, whereas a full-thickness graft only takes if it is relatively small. Grafts are also divided, on the basis of their origin, into the following: autografts, when the donor and recipient are the same individual; homografts, when the donor and recipient are different subjects belonging to the same species; hetero- or xenografts, when the donor and recipient belong to different species. Only autografts can take, whereas homo- and heterografts are rejected. Homo- and heterografts, however, can be useful in particular conditions, for example, extensive burns, because they temporarily ensure vital skin functions.