Superficial radiotherapy for multiple keratoacanthomas.

We report the case of a 76-year-old Caucasian woman who attended our clinic with multiple keratoacanthomas. Radiotherapy was considered a viable and effective option in such an old patient, who could not be a good surgical candidate for number and distribution of the lesions, and for the age. After a 12-month follow-up, we observed the complete and global disappearance of the lesions; the patient was therefore very satisfied especially in view of the clinical outcome. According to our point of view, radiotherapy allows the physician to obtain a good oncological radicality and excellent cosmetic results too.

Fibrillar pattern of a plantar acquired melanocytic naevus: correspondence between epiluminescence microscopy and transverse section histology.

The main epiluminescence microscopy (ELM) patterns observed on volar acquired melanocytic naevi are the parallel-furrow, the lattice-like and the fibrillar patterns. Because of the peculiar arrangement and configuration of epidermal rete ridges in the glabrous skin, the traditional histological picture does not provide an exact correlation with ELM features. In particular, the fibrillar pattern lacks a histopathological correlate. To clarify the microscopic features of the fibrillar pattern, we used transverse histological sectioning to study an acquired compound melanocytic naevus of the sole, characterized by a mixed parallel-furrow/fibrillar pattern on ELM. Low-magnification images of transverse sections allowed us to highlight the typical anatomical arrangement of the volar skin clearly, while high-magnification images demonstrated that the fibrillar pattern corresponded to parallel striae of intensely pigmented corneocytes arranged obliquely to the cutaneous surface.

Development of oesophageal involvement in a subject with pemphigus vulgaris: a case report and review of the literature.

We present the case of a 50-year-old-man with pemphigus vulgaris involving the oropharyngolaryngeal mucosa and oesophagus. Oesophageal involvement of pemphigus vulgaris is relatively uncommon, especially in subjects in clinical remission, and has been rarely described in the literature. Endoscopic examination should be performed to avoid inappropriate therapy due to misdiagnosis of steroid-induced oesophagitis and peptic ulcers.

A case of vesiculo-bullous Darier's disease associated with bipolar psychiatric disorder.

We describe the case of a 71-year-old men suffering from Darier's disease since his youth and presenting with intensely itching, vesicular and pustular lesions, localized on his arms, legs and on the ulnar side of his right hand. The patient also had a 30 year-history of bipolar psychiatric disorders. The histopathological examination of lesional skin showed suprabasal acantholytic clefting, hyperparakeratosis, and dyskeratosis. Histopathological and immunopathological (direct and indirect immunofluorescence) results, were consistent with vesiculo-bullous Darier's disease. Corticosteroid therapy with methylprednisolone at low dosage (0.2 mg/kg/day) was started with a quick resolution of the vesicular lesions on his arms and legs.

Pharmacologic modulation by cetirizine of some adhesion molecules expression in psoriatic skin lesions.

BACKGROUND: Adhesion molecules play a major role in the pathogenesis of inflammatory skin diseases by regulating lymphocyte trafficking and homing in an inflamed area. METHODS: The expression of the lymphocyte function-associated antigen-1 (LFA-1) and of its ligand, the intercellular adhesion molecule-1 (ICAM-1) has been studied in psoriatic skin lesions of 10 patients with guttate, nummular, and palmoplantar psoriasis. In addition, the peculiar immunophenotype of infiltrating cells (CD3, CD4, CD8, CD25) and their correlation with HLA-DR expression before and after treatment with oral cetirizine, a highly selective, third generation H1-receptor antagonist has been examined using the labeled avidin biotin (LAB) system. RESULTS: Cetirizine treatment modulated in vivo the expression of adhesion molecules LFA-1/CAM-1 as shown in all cases by decreased levels of their expression on keratinocytes and on dermal endothelial cells (P < 0.001). The expression of HLA-DR on keratinocytes and endothelial cells was also inhibited after treatment. The numbers of infiltrating CD3-, CD4-, CD8-positive cells were reduced, whereas there was no significant modification of CD25-positive cells within the epidermis and the dermis. CONCLUSION: This open clinical trial suggests that cetirizine could be effective in treating psoriasis: (1) for its symptomatic control on itching; (2) for its immunopharmacologic modulation of leukocyte integrins and on the immunophenotype pattern of infiltrating and resident cells, and (3) for contributing to the clearing of the lesions clinically.