Acta Dermatovenerologica Alpina Pannonica et Adriatica最新文献

Biologic therapies have revolutionized psoriasis management, but they have also raised concerns about potential unusual adverse effects. We think this represents the first detailed case of subcutaneous panniculitis-like T-cell lymphoma with hemophagocytic lymphohistiocytosis in a psoriasis patient, confirmed clinically and histopathologically, occurring after 9 months of brodalumab treatment following multiple biologic switches. The patient's development of subcutaneous panniculitis-like T-cell lymphoma during an extended period on brodalumab, compared to other biologics, underscores the need for awareness of potential rare complications associated with this therapy.

Basal cell carcinoma (BCC) of the upper lip poses significant reconstructive challenges due to the need to restore both function and aesthetics in a highly visible area. This case series presents four patients with upper lip BCC that underwent Mohs micrographic surgery followed by individualized local flap reconstruction. Flap selection was tailored to each defect, utilizing rotational, advancement, O-to-Z, and transpositional flaps to address variations in size, location, and tissue availability. All patients experienced satisfactory healing, restoration of lip contour, and preservation of oral competence, with no major complications or recurrences during follow-up. These results highlight the importance of careful preoperative planning and personalized surgical approaches in achieving optimal outcomes for upper lip reconstruction. Our findings support the use of versatile local flaps as effective options for managing complex upper lip defects following BCC excision.

Introduction: Lichen planus (LP) is a chronic T cell-mediated inflammatory disease affecting the skin and mucosa. Interleukin-17 (IL-17), a pro-inflammatory cytokine, has been implicated in LP pathogenesis, but its tissue-level expression across clinical variants remains underexplored. This study compares IL-17 expression in healthy skin and LP lesions and assesses variations based on clinical presentation.

Methods: This cross-sectional retrospective study included 20 LP skin samples and 10 healthy controls. The sample collection spanned a period of 10 years. IL-17 expression was assessed via immunohistochemistry and quantified using a modified Q score. Samples were categorized by mucosal involvement and lesion distribution. Statistical analysis was performed with the Mann-Whitney U test.

Results: IL-17 was absent in healthy skin but present in all LP samples. IL-17 expression was significantly higher in patients with both skin and oral mucosal involvement compared to those with cutaneous LP (p = 0.003). No significant difference was observed between generalized and localized LP.

Conclusions: The results indicate a distinct increase in IL-17 expression in LP lesions, particularly with mucosal involvement, supporting its role in LP pathogenesis. These findings suggest IL-17 as a potential biomarker and therapeutic target, warranting further investigation in larger cohorts.

Introduction: The integration of active ingredients into scientifically backed formulations is an innovative approach to remodeling post-acne atrophic scars, stimulating regenerative processes. Microneedling, a minimally invasive procedure, promotes collagen production and enhances skin penetration of cosmeceutical products such as Pbserum Specific Acne Scars®, which combines collagenases G and H with hyaluronate r-lyase and other ingredients, including allantoin, zinc sulfate, vitamin A, vitamin B3, niacinamide, and melatonin. These components modulate inflammation, fibrosis, oxidative stress, and aging. This study assesses the efficacy and safety of treatment for ameliorating atrophic acne scars.

Methods: Twenty-nine patients were treated with Pbserum Specific Acne Scars® applied by microneedling for 4 months in four sessions on the middle or lower third of the face and/or periocular area. The scar size (according to EvaFace® analysis), deep skin hydration (measured with a Moisturemeter® D device), severity (assessed using the échelle d'évaluation clinique des cicatrices d'acne and Goodman and Baron scales), clinical efficacy (evaluated using Global Aesthetic Improvement Scale), quality of life (measured using Facial Acne Scar Quality of Life questionnaire), and subject satisfaction were analyzed.

Results: Significant improvements were observed in all parameters evaluated, especially after four applications, demonstrating clinical efficacy. Patient satisfaction levels were notably high.

Conclusions: The treatment significantly improved skin texture and scar appearance after four applications over a period of 4 months.

Primary cutaneous CD4-positive small or medium T-cell lymphoproliferative disorder (PCSM-LPD) is characterized by a slow-growing and asymptomatic solitary plaque or tumor, usually involving the head, neck, or upper extremities. The diagnosis is established based on clinical presentation, histopathological features including pleomorphic morphology and CD4-positive immunophenotype of neoplastic T lymphocytes, and molecular analysis showing clonally rearranged T-cell receptor (TCR) genes. Plaques typical of mycosis fungoides are essentially absent. Treatment options include surgical excision, radiotherapy, and topical or intralesional steroids. Because the disease is indolent, aggressive diagnostic tests and systemic treatments are not recommended. We present a case of PCSM-LPD in a previously healthy young man that spontaneously regressed after a biopsy.

Cutaneous pigmentation disorders are one of the leading causes of dermatological consultation globally. Hyperpigmentation disorders constitute a group of distinct medical conditions that may be either congenital and associated with various concurrent comorbidities, or acquired due to cutaneous, environmental, or systemic conditions or factors. Due to numerous causes and an often atypical clinical picture, diagnosis can be challenging. Furthermore, although the changes in skin color are not inherently harmful, they can result in significant cosmetic disfigurement and have psychological and social repercussions, particularly given that some hyperpigmentation is irreversible due to the limited effectiveness of current treatments. This article presents two cases exhibiting somewhat similar but different acquired localized hyperpigmentation. We review the current literature with emphasis on the diagnostic approach to this entity and specific acquired hyperpigmentation disorders, in particular drug-induced and paraneoplastic. We emphasize the importance of interdisciplinary cooperation among different specialists, particularly in complicated cases and those that accompany systemic diseases.

Introduction: Granulomas are focal aggregates of inflammatory cells that form in response to a persistent inflammatory stimulus. Available therapies include surgical and nonsurgical management, and current evidence is based on case series or case reports.

Methods: Two case reports of foreign body granulomas treated with a combination of recombinant enzymes (hyaluronidase, collagenase, and lipase of bacterial origin) are presented.

Results: Following three sessions of combined enzyme treatment with a scheduled protocol, both patients showed clinical improvement without any reported adverse events.

Conclusions: Combined enzyme therapy is an effective, safe, minimally invasive, innovative approach for the treatment of foreign body granulomas.

Introduction: Psoriasis is a chronic immune-mediated disorder with a genetic component that primarily affects the skin and has potential systemic involvement. Advances in understanding the interaction between the innate and adaptive immune systems have facilitated improved disease management.

Methods: This study included 25 patients with psoriasis and 20 healthy controls of both sexes. All participants underwent detailed medical history-taking and dermatological examination, including assessment of the body surface area and the Psoriasis Area and Severity Index (PASI). Blood samples (3 ml) were collected from all subjects, and 4 mm lesional skin punch biopsies were obtained from psoriatic patients and healthy controls.

Results: Serum and tissue levels of interleukin 39 (IL-39) were significantly elevated in psoriatic patients compared to healthy individuals. Patients with a positive family history of psoriasis showed higher serum IL-39 levels than those without such a history. In addition, psoriatic individuals with diabetes mellitus or hypertension had higher serum IL-39 levels than those without these comorbidities. A statistically significant correlation was found between disease severity and serum IL-39 concentration.

Conclusions: Elevated serum and tissue IL-39 levels in psoriatic patients suggest a potential role for IL-39 in the pathogenesis of psoriasis, highlighting its possible utility as a biomarker or therapeutic target.

Introduction: Scalp seborrheic dermatitis (SSD) is a prevalent and chronic dermatological condition. Although various mechanisms have been proposed, its precise etiology and exacerbating factors remain unclear. This study aimed to identify the factors influencing clinical severity in individuals with SSD; to assess the associations between severity and variables such as gender, age at disease onset, treatment history, and the presence of comorbid systemic or dermatological conditions; and to determine potential triggering factors.

Methods: A total of 198 adult patients diagnosed with SSD were included in this retrospective study. Collected data included demographic characteristics, smoking and alcohol use, Fitzpatrick skin type, age at disease onset, duration of the most recent flare, frequency of hair washing, and the season during which the patient presented. Clinical severity of SSD was assessed by a dermatologist. In addition, the presence of systemic and dermatological comorbidities, as well as patient-reported triggering factors, was documented.

Results: A statistically significant difference in SSD severity was observed between sexes, with higher severity noted in male patients (p = 0.006). No significant associations were found between SSD severity and age, Fitzpatrick skin type, smoking or alcohol use, season of presentation/flare up, or the presence of systemic diseases. However, SSD severity differed significantly based on the presence of onychomycosis (p = 0.001).

Conclusions: The significant association between the frequency of onychomycosis and the severity of SSD highlights a potential link involving shared immunologic, microbial, and skin barrier dysfunctions underlying both conditions.

Cutaneous tuberculosis (TBC) is rather rare and has diverse clinical presentations relative to host immunity and the number of bacilli present in the tissue. A group of cutaneous lesions called tuberculids represent a strong, delayed-type hypersensitivity reaction to mycobacteria. Among them, erythema induratum of Bazin (EIB) typically presents as tender erythematous nodules that ulcerate and are usually confined to the posterior aspects of the calves. Paradoxical reactions (PRs) to appropriate treatment involving the skin have mostly been described in the setting of miliary tuberculosis. These PRs are encountered in infectious and inflammatory diseases during the institution of appropriate treatment representing a worsening or relapse of disease under treatment or unmasking of subclinical disease. This case report describes a patient with EIB developing a necrotic PR shortly after initiation of antituberculosis therapy. The skin lesions cleared with a topical corticosteroid treatment and continued antituberculosis therapy. It is important to recognize cutaneous PR in the setting of treated cutaneous TBC and to reassure patients about the excellent outcome that can be achieved with continuation of treatment.