RESUMEN
Erythroplasia of Queyrat (EQ) is an intraepidermal carcinoma in situ presenting clinically as a sharply demarcated, slightly raised erythematosus plaque on the glans penis or the inner side of the foreskin. Various treatment modalities for EQ have been proposed, including electrocautery and curettage, topical 5-floururacil cream, imiquimod cream, isotretinoin, cryotherapy, laser therapy, radiotherapy, ingenol mebutate gel and Photodynamic Therapy (PDT). Most of these treatments are limited by low clearance rates and frequent relapses. Surgical treatment including local excision, Mohs micrographic surgery and partial or total penectomy, ensures adequate healing rates. However, discomfort consequent to surgical treatment might be unacceptable. Topical PDT using the methyl ester of 5- aminolaevulinic acid (MAL) is an established non-surgical treatment of cutaneous precancerous lesions and skin cancers. We present the case of a 60-year-old uncircumcised man affected by EQ of the penis successfully treated with MAL-PDT, performed five times, two weeks apart, with no recurrences after 6 years.
Asunto(s)
Queilitis/tratamiento farmacológico , Herpes Labial/virología , Linfoma no Hodgkin/complicaciones , Fotoquimioterapia/efectos adversos , Simplexvirus/fisiología , Activación Viral , Anciano , Ácido Aminolevulínico/análogos & derivados , Ácido Aminolevulínico/uso terapéutico , Antivirales/uso terapéutico , Queilitis/complicaciones , Femenino , Herpes Labial/tratamiento farmacológico , Herpes Labial/prevención & control , Humanos , Huésped Inmunocomprometido , Fármacos Fotosensibilizantes/uso terapéutico , Inducción de Remisión , Valaciclovir/uso terapéuticoRESUMEN
Darier's disease (DD) is an autosomal dominant inherited genodermatosis which is often under- or misdiagnosed. In the majority of cases, the disease manifests in adolescents or young adults with small brownish-yellow, warty, hyperkeratotic papules in multiple seborrheic areas of the body. Localized DD (LDD) is a clinical variant, first described by Kreibich in 1906; only a few cases are reported in the literature. We described the case of an aged woman presenting with LDD, and we review the literature on this subject.
Asunto(s)
Dermoscopía , Nevo Pigmentado/patología , Neoplasias Cutáneas/patología , Femenino , Humanos , MasculinoAsunto(s)
Anticuerpos Bloqueadores/uso terapéutico , Efectos Colaterales y Reacciones Adversas Relacionados con Medicamentos/prevención & control , Inmunoterapia/métodos , Lupus Eritematoso Cutáneo/terapia , Factor de Necrosis Tumoral alfa , Animales , Ensayos Clínicos como Asunto , Resistencia a Medicamentos , Efectos Colaterales y Reacciones Adversas Relacionados con Medicamentos/inmunología , Humanos , Interferones/antagonistas & inhibidores , Lenalidomida , Lupus Eritematoso Cutáneo/inmunología , Talidomida/análogos & derivados , Talidomida/farmacología , Talidomida/uso terapéutico , Factor de Necrosis Tumoral alfa/inmunologíaRESUMEN
Only limited data are available on the effects of TNF-alpha inhibitors on dendritic cells. However, TNF-alpha plays a central role in the biology of dendritic cells, both with regard to their maturity process and mobilization to secondary lymphoid organs. In particular, the effects of TNF-alpha inhibitors on Langerhans cells in healthy skin have never been investigated. In this pilot study, we aimed to assess the change of the density of Langerhans cells within the normal, not photo-exposed, skin of 17 psoriatic patients, before and after 16 weeks of treatment with TNF-alpha inhibitors. Most of the patients (88%) showed an increase or a similar density of Langerhans cells after 16 weeks of therapy with TNF-alpha inhibitors compared with baseline values. Only 2 patients (12%) showed a reduction of these cells following therapy with TNF-alpha inhibitors.
Asunto(s)
Fármacos Dermatológicos/uso terapéutico , Células de Langerhans/efectos de los fármacos , Psoriasis/tratamiento farmacológico , Piel/efectos de los fármacos , Factor de Necrosis Tumoral alfa/antagonistas & inhibidores , Adalimumab , Adulto , Anciano , Anticuerpos Monoclonales/uso terapéutico , Anticuerpos Monoclonales Humanizados/uso terapéutico , Recuento de Células , Etanercept , Humanos , Inmunoglobulina G/uso terapéutico , Infliximab , Células de Langerhans/inmunología , Células de Langerhans/patología , Persona de Mediana Edad , Proyectos Piloto , Psoriasis/inmunología , Psoriasis/patología , Receptores del Factor de Necrosis Tumoral/uso terapéutico , Piel/inmunología , Piel/patología , Factor de Necrosis Tumoral alfa/inmunologíaRESUMEN
Topical sunscreens contain molecules or molecular complexes that can absorb, reflect, or scatter UV photons. Evaluation of the efficacy of sunscreen products has been made through the Sun Protection Factor (SPF), a mean of quantitatively assessing in vivo the degree of protection offered by sunscreen products against solar radiation. In vivo evaluation of SPF has several drawbacks. First of all, this evaluation method is expensive in terms of money and time. Moreover, it raises several ethical issues concerning the potential damage to skin volunteers. Several in vitro techniques have been developed, but at present there is no broadly accepted method. In this paper, we will discuss some of the recent advances concerning the in vitro evaluation of sunscreens which would be acceptable for replacing in vivo assays.
Asunto(s)
Anticuerpos Monoclonales Humanizados/uso terapéutico , Inhibición de Migración Celular/efectos de los fármacos , Huésped Inmunocomprometido , Nevo Pigmentado/inmunología , Neoplasias Cutáneas/inmunología , Adulto , Anticuerpos Monoclonales Humanizados/administración & dosificación , Dermoscopía , Femenino , Humanos , Esclerosis Múltiple/tratamiento farmacológico , Natalizumab , TorsoRESUMEN
The aim of this study was to investigate the dermoscopic changes in acquired melanocytic naevi in a large paediatric population over an interval of several years. Images of 717 melanocytic naevi were obtained from 160 consecutive patients. Dermoscopic pigment pattern changes were observed in one of two lesions after a follow-up of one year, in 34 of 295 lesions (11.5%) after 2 years, in 40 of 190 lesions (21.1%) after 3 years, in 40 of 141 lesions (28.4%) after 4 years, in 5 of 37 lesions (13.5%) after 5 years, in 12 of 31 lesions (38.8%) after 6 years, and in 7 of 21 lesions (33.3%) after 7 years. Dermoscopic changes were detected in 25.3% of the lesions in patients aged 3-6 years, in 21% of the lesions in patients aged 7-12 years, and in 15.5% of the lesions in patients over 13 years. Main pattern changes consisted of transition from globular to globular-reticular (35 naevi), from globular to reticular (14 naevi) and from globular-reticular to reticular (24 naevi). These results are consistent with the view that melanocytic naevi generally undergo a characteristic transition from a globular pattern to a reticular pattern. Most of the changes are observed in the 3-6 years age group when hormonal and/or environmental factors are not thought to play a role in pattern alterations.
Asunto(s)
Dermoscopía , Nevo Pigmentado/patología , Neoplasias Cutáneas/patología , Adolescente , Factores de Edad , Niño , Preescolar , Femenino , Estudios de Seguimiento , Humanos , Italia , Masculino , Valor Predictivo de las Pruebas , Pronóstico , Pigmentación de la Piel , Factores de TiempoRESUMEN
Erythroderma is a scaling erythematous dermatitis involving 90% or more of the cutaneous surface. Psoriasis and eczema are the most common dermatoses underlying erythroderma. Cutaneous T cell lymphomas can also cause erythroderma. Differential diagnosis between psoriatic erythroderma and lymphomatous erythroderma is often challenging. Tumour necrosis factor-alpha inhibitors are a new class of drugs used in the treatment of psoriasis, even in erythrodermic psoriasis. The effects of anti-tumour necrosis factor-alpha in cutaneous T cell lymphomas have not yet been established. Consequently, it is mandatory to treat an erythrodermic psoriatic patient with tumour necrosis factor-alpha blockers only if a lymphoproliferative cutaneous disorder has been excluded.
Asunto(s)
Dermatitis Exfoliativa/tratamiento farmacológico , Factor de Necrosis Tumoral alfa/antagonistas & inhibidores , Adalimumab , Antiinflamatorios/uso terapéutico , Anticuerpos Monoclonales/uso terapéutico , Anticuerpos Monoclonales Humanizados/uso terapéutico , Dermatitis Exfoliativa/etiología , Eccema/complicaciones , Etanercept , Humanos , Inmunoglobulina G/uso terapéutico , Infliximab , Linfoma Cutáneo de Células T/complicaciones , Psoriasis/complicaciones , Receptores del Factor de Necrosis Tumoral/uso terapéuticoRESUMEN
Bullous pemphigoid is an autoimmune blistering skin disease characterized by the presence of circulating autoantibodies which recognize specific proteins of the epidermis and dermoepidermal junction. Diagnosis is based on clinical criteria and laboratory investigations, notably histology, direct and indirect immunofluorescence, and ELISA. This study describes a new immunofluorescence assay for parallel determination of anti-BP180 and anti-BP230 based on recombinant antigenic substrates. The aim of the study was to detect BP180 and BP230 autoantibodies by BIOCHIP technology using both a specially designed recombinant BP180-NC16A protein and cells expressing the BP230-gc antigen fragment. 18 patients with bullous pemphigoid were included in the study. Autoantibodies to BP180 were detected by the BIOCHIP technique in 83.33% of patients with clinical, serological, and immunohistological confirmed bullous pemphigoid while autoantibodies against BP230-gC were detected only in 39% of patients. The detection of anti-BP180-NC16A and anti-BP230-gC by a new biochip-based immunoassay is a suitable alternative to indirect immunofluorescence and ELISA. This method has the advantage of easily discriminating the different autoantibody specificities. The BIOCHIP method is faster, cheaper, and easy to use when compared with the ELISA approach. For this reason, the new method could be used as an initial screening test to identify patients with bullous pemphigoid, and doubtful results could then be confirmed by ELISA.
Asunto(s)
Carcinoma Basocelular/diagnóstico , Errores Diagnósticos , Errores de Medicación , Melanoma Amelanótico/tratamiento farmacológico , Neoplasias Cutáneas/tratamiento farmacológico , Adulto , Aminoquinolinas/uso terapéutico , Antineoplásicos/uso terapéutico , Carcinoma Basocelular/tratamiento farmacológico , Femenino , Humanos , Imiquimod , Melanoma Amelanótico/diagnóstico , Neoplasias Cutáneas/diagnósticoRESUMEN
BACKGROUND: The first step in the analysis of a dermatoscopically imaged melanocytic lesion is segmentation--informally, isolating those points in the image belonging to the lesion from those belonging to the surrounding non-lesional skin. Although typically studied in the context of automated analysis, segmentation is a necessary step even for human operators who plan to evaluate quantitative features of a lesion (such as diameter or asymmetry). METHODS: In a double blind evaluation of the segmentation of 77 digital dermatoscopic images, we observed a significant inter-operator variability. RESULTS: The area of the disagreement region was on average 15.28% of the area of the lesion itself, and in 10% of the cases it was more than 28%. More experienced dermatologists showed greater agreement among themselves than with less experienced dermatologists, and a slight tendency toward 'tighter' segmentations. CONCLUSION: The evaluation methodology addresses a number of crucial difficulties encountered in previous studies and may be of independent interest. Our results underscore the necessity of taking into account inter-operator variability in large epidemiological studies, in particular those involving less experienced dermatologists, and of striving toward techniques allowing greater standardization and replicability in the evaluation of the fundamental visual parameters of lesions.
Asunto(s)
Dermoscopía/métodos , Nevo Pigmentado/patología , Procesamiento de Señales Asistido por Computador , Neoplasias Cutáneas/patología , Método Doble Ciego , Femenino , Humanos , Masculino , Variaciones Dependientes del Observador , Reproducibilidad de los Resultados , Sensibilidad y EspecificidadAsunto(s)
Linfoma de Células del Manto/diagnóstico , Neoplasias Cutáneas/diagnóstico , Anciano , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Biopsia , Reordenamiento Génico de Linfocito B , Genes de las Cadenas Pesadas de las Inmunoglobulinas , Humanos , Inmunohistoquímica , Inmunofenotipificación , Linfoma de Células del Manto/tratamiento farmacológico , Linfoma de Células del Manto/inmunología , Linfoma de Células del Manto/patología , Masculino , Piel/inmunología , Piel/patología , Neoplasias Cutáneas/tratamiento farmacológico , Neoplasias Cutáneas/inmunología , Neoplasias Cutáneas/patologíaRESUMEN
BACKGROUND: Scabies is a contagious infestation affecting subjects of all ages, races, and social conditions. OBJECTIVE: We report a case of a 79-year-old man who developed a bullous pemphigoid-like eruption. He presented to our unit 4 months after the onset of symptoms. An autoimmune bullous disease was suspected. Direct immunofluorescence on a skin specimen and anti-desmoglein 1, anti-desmoglein 3, and anti-bullous pemphigoid antigen 180 were negative. Surprisingly, the histology of a skin lesion demonstrated the presence of scabies, which was successfully treated with benzyl benzoate 20%. CONCLUSION: The diagnosis of bullous scabies should be considered for any bullous eruptions accompanied by papules and itching resistant to steroid treatment and with negative immunopathologic findings.
Asunto(s)
Penfigoide Ampolloso/diagnóstico , Escabiosis/diagnóstico , Anciano , Benzoatos/uso terapéutico , Diagnóstico Diferencial , Epidermis/patología , Técnica del Anticuerpo Fluorescente Directa , Humanos , Insecticidas/uso terapéutico , Masculino , Escabiosis/tratamiento farmacológico , Escabiosis/patologíaAsunto(s)
Dermatitis Atópica/tratamiento farmacológico , Inmunosupresores/efectos adversos , Enfermedades de los Labios/inducido químicamente , Melanosis/inducido químicamente , Tacrolimus/efectos adversos , Administración Tópica , Adolescente , Adulto , Dermoscopía , Femenino , Humanos , Inmunosupresores/administración & dosificación , Enfermedades de los Labios/patología , Masculino , Melanosis/patología , Tacrolimus/administración & dosificaciónRESUMEN
BACKGROUND: Nevus spilus is characterized by a pigmented patch with scattered flat or maculopapular speckles. Nevus spilus was first described by Burkley in 1842. Since then, this lesion has been widely debated in the literature, particularly for the possible occurrence of melanoma within the lesion. OBJECTIVE: We describe the case of a 65-year-old female presenting with a nodular achromic melanoma that occurred within a nevus spilus on the left thigh. CONCLUSION: Our observation is consistent with the idea that this entity in some circumstances may have the ability to evolve into a malignant melanoma.
Asunto(s)
Melanoma/patología , Nevo Pigmentado/patología , Neoplasias Cutáneas/patología , Anciano , Femenino , Humanos , Melanoma/cirugía , Nevo Pigmentado/cirugía , Neoplasias Cutáneas/cirugíaRESUMEN
Acrodermatitis continua of Hallopeau (ACH) consists of a relapsing pustular eruption of the distal portions of hands and feet. We described a case of a 9-year-old boy affected by ACH, successfully treated with targeted ultraviolet B 311 nm phototherapy, which seems to be an effective and safe therapy for this condition.