Clinical and dermoscopic characteristics of congenital melanocytic naevi.

BACKGROUND: Prompted by the limited data, we conducted this study to gather more information on dermoscopic features of CN in children, in order to optimize clinical care and management. MATERIALS AND METHODS: All children with congenital nevi (CN) attending our Pediatric Pigmented Skin Lesion Unit during a 2-year period were included in the study. Clinical data were collected, and all children underwent clinical and dermoscopic examination. Dermoscopic patterns and specific features were recorded. RESULTS: Three hundred and thirty CN were examined in a population of 276 children, aged from 6 months to 14 years. The majority (85.14%) had only one congenital naevus, and 43.12% had a family history of congenital nevi. Children with multiple congenital nevi were more likely to have a positive family history of a CN (P = 0.012). Only, in 23 children, neurological/developmental abnormalities were reported. Small CN were the commonest in our cohort (167) followed by the medium-sized (160), whereas large CN (>20 cm) were only three. Thirty-eight CN were located on the volar skin. The globular was the commonest dermoscopic pattern, followed by the reticular, whereas the parallel furrow pattern was the commonest pattern on palms and soles. CN on the trunk were more likely to be globular on the limbs, and reticular and homogeneous on the head and neck (P < 0.001). The commonest dermoscopic findings were haloed and target globules, blotches and perifollicular hypopigmentation, whereas globules and dots around cristae on volar skin. CN located on the limbs were more likely to demonstrate an atypical network (P = 0.001) and a target network with globules (P = 0.020), whereas haloed and target globules (P < 0.001), blotches (P = 0.023) and dots (P = 0.004) were found with an increased frequency in CN on the trunk. CONCLUSIONS: Given that there is much controversy on the management and accurate classification of CN, our findings may provide useful information.

Paediatric melanoma.

Paediatric melanoma, although rare, is the most common skin cancer in children. Our current knowledge on paediatric melanoma incidence trends is expanding, as several studies have addressed this issue with conflicting results. Known risk factors for paediatric melanoma include family history of melanoma, a previous history of malignancy, large congenital nevi, numerous melanocytic nevi, sunburns, increased UV exposure and a sun-sensitive phenotype. In younger children, melanoma more often presents with atypical features, such as a changing, amelanotic or uniformly coloured, often bleeding lesion, not fulfilling in most cases the conventional ABCDE criteria. The major differential diagnoses are melanocytic nevi, proliferative nodules in congenital nevi and atypical Spitz tumours. Moreover, in the younger age group non-Caucasian children are over-represented, tumours tend to be thicker and lymph nodes are often involved. Despite the frequent diagnosis at an advanced stage, the overall survival is fair in paediatric melanoma. Specific guidelines for management of melanoma in children do not exist, and most often the disease is treated similarly to melanoma in adults.

Evaluating the role of Mediterranean diet and eating behaviors on the likelihood of having a non-fatal acute coronary syndrome, under the context of stress perception: a case-control study.

BACKGROUND/OBJECTIVES: Mediterranean diet and perceived stress have long been associated with the likelihood of having an acute coronary syndrome (ACS). The aim of this study was to evaluate whether the Mediterranean diet and other eating behaviors mediate and/or moderate the unfavorable impact of perceived stress on the likelihood of having a non-fatal ACS. SUBJECTS/METHODS: This is a case-control study with individuals matched by age and sex. A total of 250 consecutive patients (60±11 years, 78% men) with a first ACS and 250 population-based, control subjects (60±8.6 years, 77.6% men) were enrolled. Perceived stress levels were evaluated with the Perceived Stress Scale (PSS-14; range 0-14), and adherence to the Mediterranean diet was assessed by the MedDietScore (range 0-55). Stress eating, eating heavy meals and eating alone were also evaluated. RESULTS: For each unit increase in the PSS-14, the likelihood of having an ACS increased by 14% (95% confidence interval (CI)=1.10, 1.18). Stratified analysis by Mediterranean diet adherence level revealed a similar association of PSS-14 with ACS likelihood between the low-to-moderate and moderate-to-high adherence groups (that is, odds ratio (OR)=1.15, 95% CI=1.09, 1.21 and OR=1.13, 95% CI=1.07, 1.80, respectively). Stress eating and eating alone were positively associated with the likelihood of having an ACS (OR=1.31, 95% CI=0.97, 1.77 and OR=1.36, 95% CI=1.08, 1.69, respectively). Eating heavy meals was not associated with ACS (OR=1.08, 95% CI=0.82, 1.41); no mediating or moderating effect of these behaviors on perceived stress ACS was observed. CONCLUSIONS: The highly significant impact of perceived stress on ACS likelihood was not mediated or moderated by the level of adherence to the Mediterranean diet or other eating behaviors, underlying the strong effect of this psychological disorder on ACS.

Circulating irisin is associated with osteoporotic fractures in postmenopausal women with low bone mass but is not affected by either teriparatide or denosumab treatment for 3 months.

UNLABELLED: In vitro data suggest that myokine irisin may affect bone metabolism by promoting osteoblast differentiation while inhibiting osteoclast differentiation. In this study, circulating irisin levels were associated with previous osteoporotic fractures but not with bone mass and were not affected by denosumab or teriparatide treatment for 3 months. INTRODUCTION: This study aimed to evaluate predictors of circulating irisin in postmenopausal women with low bone mass and to assess a potential effect of denosumab or teriparatide treatment for 3 months. METHODS: Serum samples for irisin measurement were obtained from (a) postmenopausal women with low bone mass (lumbar spinal [LS] or femoral neck [FN] bone mineral density [BMD] T-score ≤-2.0) and their age-matched controls at baseline and 3 months after denosumab (Dmab) injection (Dmab group, n = 50; Dmab control group, n = 25) and (b) women with more severe disease (LS or FN BMD T-score ≤-2.8) and their age-matched controls at the above-mentioned time points after teriparatide (TPTD) initiation (TPTD group, n = 25; TPTD control group, n = 25). RESULTS: At baseline, irisin levels were inversely correlated with age (partial coefficient (r p ) = -0.24; p = 0.009), parathyroid hormone (PTH) (r p = -0.30; p = 0.001), and creatinine (r p = -0.23; p = 0.016) in univariate analysis, and were lower in women with (n = 26; 41.6 ± 2.7 ng/dL) than without previous osteoporotic fracture(s) (n = 99; 51.0 ± 1.6 ng/dL; p = 0.007). In multiple linear regression, previous osteoporotic fracture(s) and PTH were independently negatively associated with irisin [p = 0.04, CI -16.1 to -0.4 and p = 0.002, CI -0.3 to -0.07, respectively], but only the association with PTH remained after controlling for creatinine levels. Serum irisin levels were not different between women with or without low bone mass and were not affected by either Dmab or TPTD treatment for 3 months. CONCLUSIONS: Circulating irisin levels were associated with previous osteoporotic fracture(s); whether this association is independent or is due to confounding by lower muscle mass, potentially reflected by lower creatinine levels, remains to be fully clarified.

Application and evaluation of AERMOD on the assessment of particulate matter pollution caused by industrial activities in the Greater Thessaloniki area.

Industrial activities are sources of high emission rates of particulate matter. The existence of many such industrial plants close to a densely populated area can have a severe effect on human health. The effects can be even worse when these emissions are added to existing background concentration levels. This study deals with the assessment of the primary particulate matter pollution caused by industrial activities close to the city of Thessaloniki in Greece. An atmospheric dispersion and regulatory model was employed, i.e. AERMOD from the US Environmental Pollution Agency. A new PM10 emission sources inventory was prepared for the main industrial plants of the area and the annual and monthly average concentrations from 2003 to 2007 were calculated. The results from AERMOD were validated against data from available monitoring stations and showed reasonably good agreement. It was estimated that industry contributes approximately 30% of primary PM10 on the western suburbs of the city and about 7% in the city centre. The effect of the wind direction was also studied and it was illustrated that the frequent southwest winds present higher concentration levels than the strong north ones.

Psoriasis in children: a retrospective analysis.

BACKGROUND: Few epidemiological studies are available on childhood psoriasis. METHODS: Between 2005 and 2008, information was collected about all children diagnosed with psoriasis in the Pediatric Dermatology Unit of Andreas Sygros Skin Hospital, in Athens, Greece. RESULTS: A total of 125 children with psoriasis were examined, the male to female ratio was 1.4:1 and the peak age of onset was in the 9- to 10-year-old age group. Only 16% of the patients had a positive family history. Plaque type psoriasis was the most prevalent type at presentation with 56.8% of the children affected, followed by scalp involvement (33.6%). The limbs were the most prevalent site of involvement (70 children, 56%), followed by the body (59 children, 47.2%) and scalp (60 children, 48%) equally affected. Most of the children had <5% of their skin affected by psoriasis (53.2%). Age of onset had no influence on the severity of the disease (P=0.107), whereas a positive correlation was found with sex and severity of the disease, with male patients being more severely affected (P=0.008). Family history did not influence the age at presentation (P=0.68). Topical steroids were used in most commonly followed by keratolytics, calcipotriol, topical tacrolimus and topical pimecrolimus. CONCLUSION: Our study reflects the patterns of presentation of childhood psoriasis in sunny countries like Greece.

Atopic dermatitis in older patients: particular points.

We review the particular characteristics of atopic dermatitis (AD) in adult life, and compare findings with those of AD in childhood. AD affects 1-3% of adults world-wide, and can present as adult-onset AD, or as infantile/childhood AD that persists, or recurs after many years. Eczema in adults usually exists for years, compromising quality of life, sex life and occupational choices. The flexural areas, shoulders, head-and-neck, and hands are typically affected. In elderly adults, eczematous erythroderma is common. The intrinsic (non-IgE-allergic) eczema subtype affects 5-15% of cases. Classical food allergy has a low importance, although non-IgE-mediated and pseudoallergic reactions can cause eczema. Sensitivity to aeroallergens, especially dust mite, is demonstrated in the majority of adult AD patients, including elderly adults, by immunoglobulin E-mediated tests and/or atopy patch tests. Occupational allergic and irritant contact dermatitis is increased. In adults, as in children, Staphylococcus aureus colonization is very high, whereas adult skin is more heavily colonized with Malassezia yeasts. Immediate and delayed sensitization to Malassezia sympodialis is specific for intrinsic and extrinsic AD, occurring especially in head-and-neck eczema. Concerning therapy, older patients are prone to certain adverse drug effects. In conclusion, differences exist between childhood and adult disease. As we should be seeing more adults with AD in the future, there is a need for more clinical and immunological studies in older patients.

Tacrolimus ointment 0.1% in the treatment of allergic contact eyelid dermatitis.

BACKGROUND: Tacrolimus inhibits T-lymphocyte activation and dermal Langerhans' cells, without the side-effects of corticosteroids. The safety profile of tacrolimus makes it a promising therapeutic option for dermatitis affecting the delicate periorbital skin. OBJECTIVE: To access the efficacy and tolerability of tacrolimus ointment 0.1% in the treatment of allergic contact eyelid dermatitis. PATIENTS AND METHODS: Twenty adults (16 women, 4 men) with eyelid dermatitis and with at least one positive patch test reaction to relevant contact allergens were treated with topical tacrolimus in a prospective, open-label, non-comparative clinical study. Dermatitis was graded at baseline, at day 30 and day 60, using a 4-point grading system for the following parameters: erythema, oedema, scaling, lichenification, fissuring (investigator assessment) and burning/stinging and pruritus (patient assessment). RESULTS: All patients completed the study. Erythema, oedema, scaling and lichenification showed improvement from baseline to 30 days of treatment ( P < 0.001), but fissuring was not significantly affected. At 60 days, no further improvement of these investigator parameters was observed. Patient parameters improved significantly by day 30 ( P < 0.004) and there was a trend for further improvement at the end of 60 days (for burning, P = 0.046; for pruritus, P = 0.059). Ten per cent of patients mentioned burning and itching, at the application site, during the first days of treatment. No other adverse events were observed. CONCLUSION: Topical tacrolimus is a promising alternative in patients with allergic contact eyelid dermatitis. Therapy was effective by 1 month and was well tolerated. These preliminary results merit a larger, controlled, study.

Photoallergic contact dermatitis: the 15-year experience of a tertiary reference center in a sunny Mediterranean city.

Photoallergic contact dermatitis (PACD) represents an important entity of photodermatoses while photopatch testing is the main diagnostic tool. The main goal of this study is to evaluate retrospectively the prevalence of photoallergic reactions and the offending agents in Athens during a 15-year period. The medical records of all patients with possible PACD between 1992 and 2006 were examined. All patients included in the analysis had undergone patch testing and photo-testing. Contact reactions were detected in 86 out of 207 participants (41.54%), while photocontact reactions were identified in 28/207 (13.52%) patients. The most common offending photoallergen was promethazine (25%), while chlorpromazine and oxybenzone were both detected in 12.5% of cases. PACD represents a unique proportion of photodermatoses in a sunny Mediterranean city such as Athens.

Intracranial primary synovial sarcoma: radiologic-pathologic correlation.

We present a very rare case of spontaneous intracranial synovial sarcoma. A 15-year-old female was admitted to our institution for a cervical spine MRI, reporting a gradual pain of the dorsal neck after an injury three months previously. After obtaining the first sequence we discovered a large skull base mass. We immediately performed a skull base MRI. MR arteriography, MR venography, CT and DSA were also performed. A large space-occupying lesion was demonstrated, extending from the right petrous bone to the occipital bone at the level of the foramen magnum and the right atlantooccipital junction. CT revealed calcifications. The MR venography demonstrated diminished flow in the right transverse and sigmoid sinus, as well in the right internal jugular vein. Otorhinolaryngological evaluation revealed a slight ipsilateral conductive hearing loss. The whole mass was macroscopically removed via a retrosigmoid, transmastoid, infratemporal approach. Postoperative course was uneventful, except for complete palsy of the ipsilateral hypoglossal nerve. The final pathological examination including immunohistochemical picture, showed findings consistent with synovial sarcoma (monophasic spindle-cell type).

Human ORF (ecthyma contagiosum).

Orf is a viral cutaneous infection typically seen on the hands of people involved in sheep and goat farming. We report 31 cases of orf and consider its pathology, characteristic appearance, diagnosis, treatment and complications.

Evaluation of the role of contact sensitization and photosensitivity in the pathogenesis of poikiloderma of Civatte.

BACKGROUND: Poikiloderma of the face and neck (Civatte) is a rather common, indolent, chronic dermatosis, most often affecting menopausal females. Cumulative excessive sun exposure, a phototoxic or a photoallergic reaction, hormonal changes of menopause and genetic factors have all been incriminated in its obscure aetiopathogenesis. OBJECTIVE: To evaluate the role of contact sensitization and photosensitivity in the pathogenesis of poikiloderma of Civatte (PC). METHODS: Thirty-two patients (24 females and eight males, age range 38-74 years) with PC were patch tested with the European standard series and the fragrance series, and were photopatch tested with the photoallergens series. Additionally, photo-testing with a monochromator was performed. RESULTS: Thirteen of 32 patients (40.62%) had one or more positive reactions to allergens of the standard series. Eight patients (25%) had positive reactions to fragrance mix and/or Balsam of Peru, which are included in the standard series, or to allergens of the fragrance series. Nickel sulphate was the single most common cause of contact sensitization (18.75%) among our patients. Ninety-seven subjects, who were patch tested with the standard series for suspected allergic contact dermatitis of the face and/or neck, served as age, sex and site controls. Of these, nine (9.27%) had one or more positive reactions to fragrance compounds. Statistical analysis showed a statistically significant difference in the frequency of positive reactions to fragrances between the PC group and the control group (chi2 value = 3.91, P < 0.05). In contrast, none of the PC patients had a positive photopatch test for the allergens included in the photoallergens series. The estimated minimal erythemal dose for the PC group was in all cases within normal limits for all wavelengths of ultraviolet (UV) radiation examined. CONCLUSIONS: Contact sensitization, mostly to perfume ingredients, may develop in PC, possibly playing a pathogenetic part, at least in a subset of patients. Despite negative results of photopatch testing, an allergic photo-contact reaction cannot be definitely excluded. PC seems not to be a photosensitivity disorder of the type of chronic actinic dermatitis. UV radiation-induced dermal connective tissue changes are the predominant histological feature of PC, leading to telangiectasia due to loss of vascular support. Reticular pigmentation may result from a delayed hypersensitivity reaction to perfume and/or cosmetic ingredients. Patch testing with the standard series and avoidance of documented allergens may be of value in patients with PC.

Allergy to olive pollen: a study of four family members.

We describe four family members with respiratory and dermatological manifestations of olive pollen allergy. The purpose of this study was 1) to investigate whether these patients' sera react to the same or different olive allergens, and 2) to identify common HLA class II antigens.

Homocysteine and C-reactive protein levels in haemodialysis patients.

BACKGROUND: Mild to moderate hyperhomocysteinemia is very common among patients undergoing haemodialysis. There is sufficient evidence that hyperhomocysteinemia is an independent risk factor for cardiovascular and or atheromatous disease in end stage renal failure patients. Vitamin supplementation such as vitamin B6, B12 or folate has been proposed to correct this metabolic disturbance and it is to be proved if this intervention benefit these patients, but there is no agreement whether oral folate supplementation is capable to normalize homocysteine levels in end stage renal failure patients. METHODS: In 53 patients, undergoing haemodialysis, homocysteine levels (Hcy), folate, vitamin B12, ferritin and C-reactive protein (CRP) were estimated before and after dialysis, without folate supplementation. Thirty voluntary blood donors were used as controls to compare homocysteine levels. After four weeks of oral folate supplementation (10 mg/24 hours) the levels of homocysteine, serum folate and intra-erythrocyte folate were estimated again. Eighteen months later the survival rate of our patients was recorded and analyzed in relation to Hcy and CRP levels. RESULTS: The results showed that haemodialysis patients exhibited, almost, fourfold higher homocysteine levels than controls (27.39 +/- 11.54 vs 7.38 +/- 3.5, t = -8.2, p = 0.000000). Folate levels, vitamin B12 and CRP increase significantly after haemodialysis where as homocysteine levels decrease (Hcy1 vs. Hcy2: z = 2.08, p = 0.03). Fourteen (14) patients suffered from coronary heart disease (CHD) and they exhibited the higher levels of homocysteine (Hcy1 vs. CHD: z = -3.4, p = 0.0006). All estimations performed revealed a negative correlation between homocysteine levels and plasma or intra-erythrocyte folate. No other variable exhibited any significant influence upon homocysteine levels. After folate supplementation homocysteine levels in the whole number of patients were unchanged (Hcy(before) vs. Hcy(after): 27.39 +/- 11.54 vs. 26.95 +/- 8.22, z = 0.3, p = 0.7, NS). When patients with homocysteine levels higher than 24 micromol/L were selected, a significant decrease was observed (34.77 +/- 9.32 vs. 30.0 +/- 8.05, z = 2.09, p = 0.02). Forty-two patients were treated with erythropoietin for their anemia and we found a positive correlation between C-reactive protein levels and rhu-Epo dose (CRP vs. Epo: r = 0.45, p = 0.002). Homocysteine levels did not exhibit any significant influence upon short-term survival (U = -0.37, p = 0.3, NS) where as CRP levels exhibit a significant influence upon short-term survival (U = 2.15, p = 0.005). CONCLUSIONS: Homocysteine levels in haemodialysis patients are fourfold higher than healthy controls. Folate, vitamin B12 and CRP increases significantly after dialysis. Patients with coronary heart disease exhibit the highest levels of homocysteine. The homocysteine levels are inversely related with the folate levels. The exogenous folate supplementation increase the serum folate levels but decreases homocysteine only in patients with higher than mild hyperhomocysteinemia. Hcy doesn't exert any significant effect upon the short-term survival of the haemodialysis patients but CRP level is a god predictor of the short-term survival of these patients.

Darier's disease complicated by Kaposi's varicelliform eruption due to herpes simplex virus.

Darier's disease is an autosomal dominant dermatosis. It may rarely be complicated by localized or widespread cutaneous viral infections. We describe a case of Kaposi's varicelliform eruption due to herpes simplex virus type 1 presenting in a patient with Darier's disease.

Effect of an antioxidant (quercetin) on sodium-lauryl-sulfate-induced skin irritation.

Quercetin is a bioflavonoid with antioxidant and anti-inflammatory activity. The purpose of this study was to examine the effect of quercetin on acute skin irritation, with special interest in the skin barrier function recovery. Acute irritant contact dermatitis was induced in 15 patients by 24-h occlusion of 2% sodium lauryl sulfate (SLS) (day (D) 1). The influence of application on SLS-irritated skin of topical quercetin for 5 consecutive Ds, compared to vehicle and controls, was studied. Parameters measured were transepidermal water loss (TEWL) and erythema index. Final measurements were taken on D 7 after a 1-D rest period. TEWL and the erythema index continued to rise 2 D after application of SLS and 1 D after treatment with quercetin, vehicle or controls. Both TEWL and erythema values at D 7 did not return to values before the SLS barrier disruption at all the test sites. Therefore, quercetin topically applied after induction of irritant contact dermatitis does not appear to increase the recovery of barrier function and erythema caused by SLS.

Frequency of immediate reactions to the European standard series.

Immediate contact reactions (contact urticaria) can occur after skin contact with a wide range of substances. We studied the incidence of immediate contact reactions (wheal and flare) to the European standard series allergens in 664 patients. Patch tests were first examined at 30 min for immediate patch test (IPT) reactions, and again at D2 and D4 for delayed patch test (DPT) reactions. Almost all the allergens of the European standard series caused IPT reactions. IPT reactions were most commonly seen with Myroxylon Pereirae (balsam of Peru) (113 reactions), fragrance mix (112 reactions), paraben mix (30 reactions) and clioquinol (13 reactions); these reactions were followed by DPT reactions to the same substance in 13.4%, 8.8%, 10% and 7.7%, respectively. For certain substances, patients with (+) IPT reactions had a significantly higher incidence of DPT reactions to the same allergen, as compared to patients with (-) IPT reactions (fragrance compounds p<0.001, formaldehyde p<0.005, thiuram mix p<0.01, paraben mix p<0.05). Thus, perhaps the mechanisms involved in IPT reactions are not the same for all substances. At least for certain substances, an IPT reaction may be related to the development of a DPT reaction.