In vivo reflectance confocal microscopy characterization of silver deposits in localized cutaneous argyria.

Localized cutaneous argyria is a rare condition secondary to skin deposition of silver following exposure to substances containing this metal. The clinical appearance and dermoscopy findings require deep melanocytic lesions and particularly melanoma metastasis to be ruled out. Silver deposits are usually confirmed by scanning electron microscopy and/or energy-dispersive X-ray spectroscopy. Herein we describe the in vivo reflectance confocal microscopy (RCM) features observed in one case of localized cutaneous argyria. These features include the presence of a hyperrefractile network in the papillary dermis and a periadnexal dotted bright pattern. In vivo RCM might be a useful tool for an early diagnosis of this uncommon entity.

Fast itch relief in an experimental model for methylprednisolone aceponate topical corticosteroid activity, based on allergic contact eczema to nickel sulphate.

BACKGROUND: Topical corticosteroids (TC) consistently show effectiveness against itch, a paradigmatic symptom, in various eczemas. Rapid itch relief is a therapeutic goal. The early response of itch to TC has not been adequately studied. OBJECTIVES: To assess the effect on itch of a TC, methylprednisolone aceponate 0.1% ointment (MPA), in induced eczema in volunteers sensitized to nickel sulphate. METHODS: Sixteen volunteers with a late positive patch-test reaction to nickel sulphate entered the study. Eczema was treated once daily with » fingertip unit of MPA for 5 days. Pruritus intensity was assessed with a 10 cm visual analogue scale (VAS). Mean time to itch relief (TR ) defined as the time to reach a 30% decrease in the highest VAS value recorded was assessed, as well as TR-baseline, colorimetry and planimetric morphometry of the reaction. RESULTS: Mean TR was 1.0 days [standard deviation (SD) = 1.1] and mean TR -baseline was 1.6 days (SD = 1.4). Five volunteers reached 100% decrease from itch baseline-VAS in 2.0 ± 1.2 days, whereas a 75% decrease was obtained in 1.7 ± 1.6 days by 16 volunteers. A clinical improvement of patch-test reaction was apparent at day 11, although erythema was still present. CONCLUSION: We present a valid model to assess the efficacy and speed of action of TC treatment to alleviate pruritus and the signs of eczema. The fast effect of MPA against pruritus supports the appropriateness of treating allergic contact eczema with TC.