Non-scarring patchy alopecia: What else, apart from alopecia areata?

A 67-year-old woman presented with a 3-month history of patchy alopecia areata (AA)-like hair loss and multiple painful enlarged lymph nodes at cervical, nuchal, and left axillary site. The patient was on follow-up for IgM monoclonal gammopathy of undetermined significance, stable for many years. A punch biopsy from a patch of the temporal scalp revealed the presence of B-cell lymphoid infiltrates consistent with marginal zone B-cell lymphoma (MZL). Other staging examinations were conducted to make a definitive diagnosis of nodal MZL with secondary cutaneous involvement. The patient showed a complete remission of the alopecia, without evidence of scarring, after immunochemotherapy for lymphoma.

The Italian Mastocytosis Registry: 6-year experience from a hospital-based registry.

AIM: We collected 'real-life' data on the management of patients with mastocytosis in the Italian Mastocytosis Registry. METHODS: Six hundred patients diagnosed with mastocytosis between 1974 and 2014 were included from 19 centers. RESULTS: Among adults (n = 401); 156 (38.9%) patients were diagnosed with systemic mastocytosis. In 212 adults, no bone marrow studies were performed resulting in a provisional diagnosis of mastocytosis of the skin. This diagnosis was most frequently established in nonhematologic centers. In total, 182/184 pediatric patients had cutaneous mastocytosis. We confirmed that in the most patients with systemic mastocytosis, serum tryptase levels were >20 ng/ml and KIT D816V was detectable. CONCLUSION: The Italian Mastocytosis Registry revealed some center-specific approaches for diagnosis and therapy. Epidemiological evidence on this condition is provided.

Epidemiology of onychomycosis in Italy: prevalence data and risk factor identification.

The prevalence of onychomycosis differs according to geographic area and over time and is influenced by several factors. The epidemiology of onychomycosis in Italy is still unclear. To evaluate the prevalence of onychomycosis in a representative sample of the Italian population a group of Dermatologists and General Practitioners carried out an observational survey on the patients coming to their office during a 1-month period. Any patient with skin or systemic disease giving their consent was enrolled. Demographic characteristics, comorbidities, lifestyles, history of previous mycosis, clinical aspects of onychomycosis and mycological evaluation were studied. A total of 8331 patients (56.7% female and 43.3% male) were evaluated. More than half of them were aged ≥46 years. Onychomycosis was diagnosed in 14.2% of patients. Big toe and thumb were the most frequently affected nails. Onychomycosis was moderate-severe in 74.1% of the cases. Mycological tests were positive in 81.3% of the cases. Dermatophytes were found in 76.6% of the cases, yeasts in 17.2% and moulds in 6.3%. Risk factors and/or comorbidities were present in 68.2% of the cases. This survey showed a 14% prevalence of onychomycosis in the evaluated population. The main risk factors were previous onychomycosis, diabetes, hallux valgus and use of occlusive footwear.

Is lipoatrophia semicircularis a rare disease? Report of three cases.

Lipoatrophia semicircularis is characterised by band-like horizontal skin depressions involving the anterior and lateral sides of the lower limbs. Whether this occurrence is rare or is just not well known or simply underreported because it does not cause patient distress is still under discussion. In a 1-year period we observed three cases due to local, mechanical pressure in an Italian dermatology outpatient clinic. However, other factors described in current literature may contribute to this phenomenon. More large-scale studies are needed to clearly assess the origin of this condition.

Exploring the Co-occurrence of dermatophyte infection and ichthyosis: A report of 3 cases.

Dermatophyte infections frequently pose diagnostic challenges, especially when occurring alongside ichthyosis, a genetic skin disorder characterized by dry, thickened, scaly skin. This case series outlines three cases where dermatophyte infections overlapped with ichthyosis, emphasizing the complexities in clinical identification and differential diagnosis. Atypical clinical presentations in these cases led to initial misdiagnoses. Ichthyosis, a genetic skin disorder characterized by thickened and scaly skin, creates an environment conducive to dermatophyte settlement, complicating the diagnostic process. The cases highlight the importance of considering fungal infections, even when clinical features deviate from the expected course. A vigilant diagnostic approach, including mycological examinations, is crucial for accurate identification and timely management.

A case of perianal Crohn disease misdiagnosed as condylomata acuminata.

We report a case of a 30-year-old woman with vegetative lesions in the perianal area to highlight the importance of considering perianal Crohn disease in the differential diagnosis of a resistant condylomata acuminata that does not improve after treatment.

Tumour suppressor gene TP53 mutations in atypical vascular lesions of breast skin following radiotherapy.

AIMS: Atypical vascular lesions (AVL) occurring at the site of radiotherapy represent an uncommon but well-documented complication in the setting of breast-conserving therapy for breast carcinoma. Although the biological behaviour of AVL has been regarded as benign, it has been suggested that AVL may represent a precursor of angiosarcoma. A better understanding of the biology of AVL is essential in order to assess appropriate patient management. The aim of the present study was to investigate alterations of tumour suppressor gene TP53 in a series of radiation-induced AVL and angiosarcomas (AS). METHODS AND RESULTS: Direct sequencing analysis of the TP53 gene showed the presence of at least one variation in 10 of 12 (83.3%) AVL and in seven of eight (87.5%) AS. The most common alteration in both categories was the P72R polymorphism in exon 4. One angiosarcoma sample carried a pathogenetically relevant disruptive mutation c.592delG, a frameshift deletion in exon 6, causing a premature stop codon. CONCLUSIONS: The presence of TP53 alterations suggests that its mutational inactivation may be implicated in the pathogenesis of radiation-associated vascular proliferations. The common mutational pathway suggested by our data supports the hypothesis that AVL and AS are biologically related entities, most probably representing the extremes of a morphological continuum.

Papules arising after radiotherapy for rhabdomyosarcoma.

Radiation therapy, even at low doses, can induce a wide spectrum of vascular skin proliferations ranging from nonmalignant ones, such as benign lymphangiomatous papules (BLAP), to frankly malignant pathologies, such as angiosarcoma. We describe a 50-year-old Caucasian woman with a past history of uterine rhabdomyosarcoma, treated 22 years prior with surgical excision, chemotherapy, and radiotherapy. She presented with a few skin-colored papules and a clear discharge located in the previously irradiated area (right inguinal region). Histopathology showed a proliferation of irregular, interanastomosing vascular channels, thin walled and lined by prominent endothelial cells with focally hobnail features. Cytological atypia of endothelial cells, mitotic figures, hemorrhagic areas, and necrosis were not observed. The endothelial cells expressed D2-40 and CD31. A diagnosis of BLAP following radiotherapy for uterine rhabdomyosarcoma was made. The patient was treated with complete excision using electrodessication. At the 20-month follow-up visit the patient was still free of recurrence.

New formulation for topical treatment of onychomycoses.

BACKGROUND: In order to treat onychomycosis, topical and systemic medications are available. The choice of a systemic or topic treatment depends on numerous factors, such as patient's age, the presence of comorbidity, responsible fungal species, the clinical form of onychomycosis, its location (fingernails or toenails), the number of nails affected and the percentage of the nail plate infected. As for topical medications, given that nail plate has an insufficiently permeable structure, it is necessary to use appropriate formulae that create in the surface of the nail plate a film able, in turn, to function both as an active ingredient's deposit and moisturising agent in nail's superficial layers in order to facilitate the spread of the active ingredient. In this manuscript, we wanted to evaluate the effectiveness and tolerability rate of a new topical formulation (Miconal Nails®, Morgan srl, Vicenza, Italy) composed of hydrogenated castor oil, hydroxyethyl cellulose, and other ingredients (urea, climbazole, piroctone olamine, undecylenic acid). METHODS: We selected 25 patients of both sexes whose median age was between 20 and 70 years, and were affected by onychomycosis in a single toe. Their onychomycosis was a distolateral subungual type (with a <50% invasion of nail plate and sparing of lunula) and white superficial. The treatment was evaluated with the following possible outcomes: complete healing, improvement, stationarity, worsening. RESULTS: Patients were 11 female subjects and 14 male subjects, whose median age was 45. A complete healing was achieved in 15 patients. In 3 cases the clinical presentation appeared unchanged with a persistence of mycological evidence. The response to the treatment was assessed as improvement in 7 patients. CONCLUSIONS: In our experience, this new product is an effective weapon that enhances the therapeutic selection of topical formulae for treating onychomycosis. If used alone in the cases that meet inclusion criteria for topical treatment, it allowed us to achieve a complete healing just with a 5-month treatment in 60% of cases, data that reached 76% on the follow-up visit.