Recurrent Erythema Annulare Centrifugum due to Influenza Type A.

Erythema annulare centrifugum (EAC) is a rare erythema characterized by erythematous and urticarial papules or annular plaques that enlarges centrifugally. The lesions usually involve the thighs and the legs. Several disorders are occasionally associated with EAC, infections, including mycoses, bacteria, or viruses and drugs have also been regarded as possible causes of this eruption. We present a 42-year-old dark-skinned woman affected by recurrent EAC that appeared secondary to influenza type A (H1N1). Histopathology showed a superficial form of EAC. In our case, a previous cytomegalovirus and Epstein-Barr virus (EBV) infection were identified and no underlying other diseases were found. Clarithromycin with calcipotriol betamethasone treatment was temporarily efficacious. In the last 3 years, the lesions started to appear every 2 weeks and tended to regress with local treatment after a variable period. We believe that the latent cytomegalovirus and the reactivity induced by EBV combined with influenza can determine, in our case, a cell mediate cutaneous immune response, which leads to the peculiar inflammatory disease known as EAC.

Double little toenails: Report of 4 familial cases.

Double little toenails, or accessory nails of the fifth toe, are a rare and particular deformity distinct from other nail dysplasias. We describe 4 cases of female patients, including a 6-year-old girl, experiencing this bilateral condition after birth. The nail anomaly shows an autosomal-dominant type of transmission that affects only female individuals. The subjects examined were from a family without marriages between blood relatives and without neuroectodermal hereditary diseases. The 4 patients had no bone alterations of the terminal phalanges of the fifth toe or alterations of the joints of the toes or hair. One patient had nail deformity associated with epilepsy; another patient, associated with an infection of an accessory nail.

Werner syndrome: quantitative assessment of skin aging.

BACKGROUND: Werner syndrome (WS) is a rare autosomal recessive disorder characterized by premature aging in adults. Although not sufficient to diagnose WS, persistent short stature and alteration of the dentition are among the few early signs that appear at puberty and can lead to a suspected diagnosis. OBJECTIVE: The study aimed at quantifying the signs of WS skin aging through biophysical parameters to find new parameters to be applied together with clinical observations in order to diagnose the disease early. PATIENTS AND METHODS: The skin disorders induced by the disease were studied using noninvasive techniques: Tewameter TM300, Corneometer CM825, Skin-pH-Meter PH900, Mexameter MX16, Visioscan VC98, and Cutometer MPA580. Twenty-four patients divided into young group, WS group, and elderly group were recruited for the study. RESULTS: The WS skin is quite similar to aged skin, with some differences concerning the barrier function and skin elasticity; for instance, a WS patient of 30 years of age has the same skin roughness of a 50/60 years old subject with a more severe skin condition leading to higher dryness, high transepidermal water loss, and less distensibility correlating with skin indurations. CONCLUSION: In patients with WS, the biophysical parameters can quantify the damage induced on the skin by the disease. In order to stage the degree of the disease, biophysical parameters could be used in the future as a diagnostic procedure in the initial stages of the disease as they may reveal lesions not yet clinically perceptible or in advanced stages.

Ectopic Foot Nails: Clinical and Dermoscopic Features, Treatment and Outcome in 20 Cases.

BACKGROUND: Ectopic nail (EN) is an extremely rare condition in which the small nail apparatus grows outside the normal nail unit of the hand and fingertips. Limited data can be found in the literature regarding ectopic nails of the foot and toes (EFN). OBJECTIVE: The study aimed at characterizing the clinical, therapeutic and dermoscopic EFN by a comparison with and differentiation from EN observed on the hands. METHODS: Data on EFN collected during 2004-2014 were analysed. A literature search was performed to evaluate articles for review points on the topic. RESULTS: Characteristics of shape, development, ultrasound aspects, dermoscopy and the response to treatment of 22 EFN were reported. Results from our study were compared with cases reported in the literature. CONCLUSION: In this article, new aspects on EFN from the clinical-morphological and dermoscopic points of view are reported; these may facilitate the diagnosis of an anomaly even without a histological examination.

Mucocutaneous leishmaniasis as presentation of HIV infection in Sardinia, insular Italy.

Leishmaniasis is endemic in Sardinia but only cutaneous and visceral cases have been reported to date. We report a case of mucocutaneous leishmaniasis as presentation of HIV infection in a Sardinian patient who had never visited endemic areas. Serological and clinical diagnosis was cytologically and histopathologically confirmed. The patient had a good response to treatment with liposomal amphotericin combined with highly active antiretroviral therapy without recurrences after four years. Our case report highlights the need to better assess the circulation of species, risk factors and clinical spectrum of Leishmania infection in the Italian Mediterranean islands.

Fibroblast apoptosis in a patient affected by lamellar ichthyosis.

BACKGROUND: Lamellar ichthyosis (LI) is a congenital recessive skin disorder characterized by generalized scaling and hyperkeratosis. The pathology may be caused by mutations in transglutaminase 1 (TGM1) gene that encodes an enzyme critical for terminally differentiating keratinocytes. Because of evidences that transglutaminase enzymes are involved in programmed cell death, we investigated morphological and biochemical apoptotic parameters in cultured skin fibroblasts from a patient with a severe LI and homozygous for the TGM1 R142H mutation. METHOD: The principle apoptotic signals (mitochondrial membrane potential, analysis of oxygen consumption, DNA fragmentation and Bax/Bcl-2 gene expression) were analyzed in cultured fibroblasts from a LI patient, his mother (TGM1 mutation carrier) and a control subject. RESULTS: LI fibroblasts showing a reduction of fibronectin expression evidenced a strong inhibition of oxygen consumption, a dramatic drop in the mitochondrial membrane potential (Delta psi(m)), and a higher apoptotic index. CONCLUSION: The present results suggest a possible connection between the alterations in the keratinization process leading to LI and the observed increased fibroblast apoptosis.

Ultrasound anatomy of normal nails unit with 18 mhz linear transducer.

Interest is growing in non-invasive diagnostic methods for nails in dermatological pathology. Currently, nail disease diagnosis is based mostly on clinical evaluation; instrumental examination, traditionally, has been performed by magnetic resonance. Ultrasound (US) can be proposed as an easier and more available method for the study of the nail apparatus. In this study, the nail unit normal ultrasound anatomy was investigated to obtain data on adult normal parameters. On 35 healthy volunteers (20 women and 15 men--average age of 27 years) we performed an ultrasonographic study on the nail plate (dorsal and ventral), nail matrix and nail bed of all fingers of the hands using a 18 MHz linear transducer with Esaote Mylab 50. A thick gel layer allowed for appropriate transmission of ultrasound without any additional device. Macroscopic nail features were studied by clinical examination and photographic analysis. The following ultrasound parameters were investigated: nail thickness; nail bed thickness; matrix lenght; matrix-bone distance. Blood flow was studied with the use of colour and power colour Doppler. The nail apparatus echographic anatomy consists in: (a) nail plate, represented by two hyperechoic bands (dorsal and ventral) with an hypoechoic or anechoic space between them; (b) nail bed, represented by an area of dys-homogeneous hypo-echogeneity; (c) nail matrix, represented by a markedly hypoechoic area corresponding to the region under the nail sulcus; (d) ligaments, sometimes well detectable and formed by a specialized connective tissue; and (e) vessels, well evaluable through doppler examination.

Melanoma versus dysplastic naevi: microtopographic skin study with noninvasive method.

Malignant melanoma (MM) is a cutaneous tumour that originates from the epidermal melanocytes, and whose prognosis is strongly determined by tumour vertical thickness. ABCDE system is currently used for the clinical diagnosis of MM: lesion asymmetry, border irregularity, change or variegation in colour, diameter > 6mm and rapid evolution. Different methods have been used to improve the diagnosis of MM, but the results have not been convincing. Our work investigates the differences between MM and atypical naevi through skin surface analysis, using scanning electron microscopy (SEM): in fact ABCDE classical criteria are often insufficient for differential diagnosis of melanoma. In our study, we analysed 15 malignant melanomas surfaces from 15 patients and of 15 atypical naevi from 10 patients. On histological examination five superficial spreading melanoma (SSM) and 10 nodular melanoma (NMM) were found. Inclusion criteria used for selection were clinical diagnosis of SSM or clinical doubt between MM and atypical naevi (dysplastic naevi). Superficial skin texture was analysed using the silicone replica technique. The replica material is a polyvinylsiloxane derivative for dental application. Our results show that the melanoma has a very irregular surface, with a marked reduction or disappearance of cutaneous furrows, and formation of new lines with varying direction. In conclusion, the method above based on skin surface analysis, may be of help in diagnosis of early stage MM and in differentiating from atypical naevi.

Hair casts due to a deodorant spray.

A 7-year-old girl presented with itching and greyish-white sleeve-like structures in her hair. After ruling out other possible causes for the symptoms, such as nits and dandruff, it was determined that the patient was affected by hair casts. These are small cylindrical structures resembling louse eggs that encircle individual scalp hairs and are easily movable along the hair shafts. It was concluded that she had induced the condition through misuse of a deodorant body spray. Scanning electron microscopy combined with electron dispersive X-ray analysis (X-ray microanalysis) of the hair casts showed the chemical nature of the structures. Some elements present in the composition of the ingredients of the deodorant spray, such as aluminium, chlorine, silicon, magnesium and carbon, were also present in this uncommon type of hair casts.

A morphological study of ectopic plantar nail.

Ectopic nails are rare. Four adult patients presented to us, affected by true ectopic nails of the foot, sole, and toes, occurring bilaterally in one case. Full documentation of these anomalies was collected. The aim of this study was to better describe the morphologic features of ectopic plantar nails by using, besides histologic evaluation, transmission and scanning electron microscopy. New morphologic criteria were identified to determine if ectopic plantar nail differed from normal and ectopic hand nails. Morphologically, ectopic plantar nails are smaller than normal ones, but still form cuticles, nail grooves and nail folds, and periungual wrinkles. Furthermore, they form with a flat angle between the nail matrix and proximal nail fold, and have a nail plate interrupted by several transverse nails grooves.

Microscopic and immunohistochemical analysis of the skin changes of free forearm flaps in intraoral reconstruction.

In the literature, few studies based on clinical and histological evaluation analyze skin structural changes after transplantation to the oral cavity. Ten patients affected by squamous cell carcinoma of the oral cavity who were reconstructed with a free forearm flap were included in the current study to analyze skin alterations. The authors performed a histological and ultrastructural evaluation of skin samples from the free forearm flap before transplantation and 18 months after intraoral reconstruction. They analyzed cytokeratin and involucrin distribution, which represent markers of maturation and differentiation of epithelia. The aim of this study was to demonstrate whether skin "mucosalization" occurs. They found that the skin undergoes some morphological changes induced by the intraoral environment. Cytokeratin and involucrin distribution is mostly unchanged. This aspect is in favor of skin structure preservation. Thus, they found that "mucosalization" of the skin is not evident after 18 months.