Acta Dermatovenerologica Croatica最新文献

The aim of this study was to quantify the effectiveness of intradermal application of autologous fibroblasts on lean tissue structures. The histological sections of the skin were analysed and evaluated for the expansion potential of autologous fibroblasts in the control skin patch area and the nearby pre-treated skin patch into which we had injected expanded autologous fibroblasts nine month earlier. The results show that the pre-injection of fibroblasts into the dermis leads to a long-term rejuvenation of the skin, as evaluated from the histological appearance and from the significantly increased density of fibroblasts in the pre-injected skin vs. controls, from around 60% to over 80%, determined as the percent of lean tissue by a novel image analysis approach. Interestingly, the rate of the in vitro fibroblast expansion from the pre-injected area of the skin was reduced in comparison with the controls, consistent with the view that fibroblasts exhibit a limited cell-division potential and that fibroblasts from the pre-injected skin already experienced expansion nine month earlier prior to the injection into the skin. We conclude that autologous fibroblast application results in a significant long-term augmentation of the lean tissue elements of the skin.

Tests which have proven their efficacy and reliability in the follow-up of pemphigus patients are used only on a limited scale or take time to complete due to a lack of technical facilities in several centers. Therefore, more accessible methods are being considered for monitoring disease activity. We aimed to investigate the relationship between platelet function and disease activity based on the change in proinflammatory cytokine profile in pemphigus pathogenesis. The size of platelets correlates positively with their activity. Platelet sizes can be evaluated by the platelet volume index consisting of mean platelet volume (MPV), platelet-crit (PCT), and platelet distribution width (PDW). These indicators can be easily measured in complete blood count (CBC) with automatic blood counting devices, which do not require additional costs and are readily available. Patients diagnosed with pemphigus between April 2010 and February 2016 (n=18) in our center were retrospectively included in the study. Demographic data, follow-up period, clinical variants of the patients, platelet parameters (MPV, PDW, PCT), and platelet count (PLT) in CBC analysis with concurrent clinical activity, as well as indirect immunofluorescence (IIF) findings (positive highest titer) at the 6th and 12th month were recorded for each patient. MPV changes were consistent with the course of the disease. A statistically significant decrease in PCT levels was observed at the 12th month compared with the baseline levels (P<0.05). According to the baseline measurement, a statistically significant positive correlation (58.9%) was found between the 12-month difference measurements of IIF and PCT. Our data demonstrated that PCT decrease is correlated with IIF values. The significant correlation between PCT and IIF values in our study is important in showing the possible role of platelet index in the measurement of disease activity.

We aimed to investigate the relationship between single nucleotide polymorphism (SNP) in the promoter region of the 5-HT-R2C gene and stress-related disease psoriasis in the Turkish population. The putative association between the 5-HTR2C variant (rs6318 Cys23Ser allele) and patients with psoriasis was investigated. 100 patients with psoriasis and 100 age-sex matched, unrelated healthy subjects representing the control group were included in the study. The PCR-RFLP method was used for genotyping the 5-HTR2C variation. There was no statistically difference in terms of genotype distributions and allele frequencies between the control subjects and patients with psoriasis (P=0.360 and P=0.439, respectively). The comparison between the presence and absence of the 5-HTR2C gene rs6318 G allele within the determined clinical subsets resulted in a significant difference with regard to treatment methodology only when conventional therapy and one or more medical therapy was compared (P=0.021). This study is the first clinical study to investigate the association between 5-HTR2C polymorphism and psoriasis. The role of the 5-HTR2C gene should be examined with more parameters in a larger case series.

The surgical approach to lentigo maligna is a challenge to dermatologists, given its clinical and histopathological particularities. Staged excision with paraffin-embedded, permanent sections for histopathological evaluation of surgical margins is an effective treatment of lentigo maligna because it enables complete excision of the tumor, at the same time preserving maximum amount of healthy tissue. We report a case series of 6 patients diagnosed with lentigo maligna who underwent this procedure in our Institution and we describe the procedure we used. Complete excision of the tumors was achieved with one to three levels, with margins of excision ranging from 2 to 8 mm. There were no local recurrences at the median follow-up of 16 months, obtaining 100% cure rate with this technique. These are comparable with the margins and number of levels of excision described in previous case series reported in the literature. The technique described herein for the treatment of lentigo maligna provides excellent cure rates for this type of cutaneous malignancy notorious for its challenging management.

Dear Editor, Nevoid acanthosis nigricans (AN) is a rare form of benign AN that can be mostly found as a solitary lesion distributed along Blaschko's lines (1). It is not associated with any known syndrome, endocrinopathy, drugs, or internal malignancy. Treatments include retinoid, calcipotriol, and laser treatments (2). Herein we report a case of nevoid AN successfully treated with topical ketoconazole plus urea. A 15-year-old woman presented with a 3-year history of asymptomatic plaques on her abdomen that were increasing in size. She had no medical history and no family history and was not obese. Physical examination revealed dark-brownish pigmented plaques on the midline and right side of her abdomen (Figure 1, a). Potassium hydroxide test was negative. Thyroid function test, antinuclear antibody test, and liver and renal function tests were within normal limits. Histological examination of skin biopsy showed hyperkeratosis and papillomatosis with minimal acanthosis and a mild perivascular lymphocytic infiltration in the superficial dermis (Figure 1, b). Some melanophages were observed in the superficial dermis. Based on the clinical features and these histological findings, a diagnosis of nevoid AN was established. Additionally, there were numerous hyphae and spores in the stratum corneum that were confirmed by Grocott staining (Figure 1, c) and periodic acid-Schiff staining (Figure 1, d). Fungal infection was suggested, and the result of a potassium hydroxide test was considered to be pseudo-negative. Topical ketoconazole cream was initially administrated for one month, and the rough surface was markedly improved (Figure 1, e). Subsequently, topical 20 % urea cream was used and the area of skin lesion decreased in size after 6 months (Figure 1, f). We discontinued ketoconazole cream after 2 months. To the best of our knowledge, this is the first case of nevoid AN successfully treated with topical ketoconazole plus urea. Some cases of AN appear to have an associated endocrinopathy (1). However, genetic factors may also play a role in the pathogenesis of AN. It has been reported that mosaic mutation in fibroblast growth factor 3 (FGFR3) is associated with nevoid AN (3). All known mutations in FGFR3 are gain-of-function mutations, and the activity of the FGFR3 signal correlates with the severity of AN. Involvement of fungal infection has not been reported in the pathogenesis of nevoid AN. We did not identify the fungal species in our patient, but Malassezia infection was suggested. In general, potassium hydroxide test can reveal only yeast forms of Malassezia, and pseudo-negative results may often occur. The abundant hyphae and spores in the stratum corneum are a characteristic pathological feature of Malassezia infection, and the obvious effects of ketoconazole may support the Malassezia infection. Since Malassezia is known to promote cytokine production in human keratinocytes (4), an autocrine FGFR3 signal might accelerate the prolifera

Dear Editor, A 45-year-old man presented with a large, dark, keratotic, warty, and friable plaque on the distal posterior aspect of the left leg (Figure 1, a). The patient reported that the lesion was not present at birth but had appeared approximately at the age of three as an erythematous patch that progressively grew over the time. During adolescence, the surface of the lesion became rough and warty and was easily traumatized due to its location, resulting in recurrent bleeding episodes over a period of years. For this reason, the patient requested lesion removal. The patient did not report any other significant comorbidity, and physical examination revealed no other abnormalities. A shaving biopsy of the lesion was performed, and histopathology highlighted ectatic vascular spaces with some luminal red blood cell beneath a papillomatous and hyperkeratotic epidermis (Figure 1, b). Based on clinical and histopathological features, a diagnosis of angiokeratoma circumscriptum naeviforme (ACN) was established. ACN is one of the five disorders belonging to the group of angiokeratomas (AKs) that also include AK of Mibelli, AK of Fordyce, solitary or multiple AK, and AK corporis diffusum. Among these variants, ACN is the rarest and is seldom studied (1). AKs are benign vascular anomalies of the superficial vascular plexus that appear as dark red papules and plaques arranged either discretely or in clusters. ACN lesions are typically situated unilaterally on the lower limbs, especially on the legs and feet, but can occasionally occur elsewhere. Lesions are generally noted in early childhood. The early lesions are flat and reddish in color, while older lesions become increasingly studded and acquire a verrucous or warty surface. There is no tendency of spontaneous improvement, and minor traumas can easily cause beading and infection (2). While the plaques were linear in disposition in most of the cases reported in the literature, a peculiar feature of our case was the isolated, round, and giant appearance of the plaque. Even though ACN is not typically associated with other abnormalities, coexistence with other vascular malformations has been reported in some cases, including AK of Fordyce, Cobb syndrome, Klippel-Trenaunay syndrome, nevus flammeus, infantile hemangioma, and traumatic arteriovenous fistula (3). From a histological point of view, ACN appears as dilated dermal papillary capillaries drained by dilated venules. The overlying epidermis shows a variable degree of acanthosis, papillomatosis, and compact hyperkeratosis. Typically, the deep dermis and hypodermis are not involved, helping distinguish them from verrucous hemangioma (4). Lichen simplex chronicus, verrucous carcinoma, and verrucous melanoma must also be considered in the differential diagnosis (5). Recurrent bleeding or cosmetic reasons are common indications for treatment. Surgical excision represents the most effective option. Other possibilities include diathermy, electrocau

Dear Editor: The European Baseline Series (EBS) of contact allergens is used throughout Europe as a screening test to diagnose contact allergy as a proxy for allergy contact dermatitis and other hypersensitivity skin diseases (1). Parabens are alkyl esters of p-hydroxybenzoic acid with antimicrobial effects used as preservatives in cosmetics, foods, and drugs that have been included in the so called "baseline series" (2) for more than 40 years. Parabens, which are considered allergologically safe biocides and are classified as safe by the US Food and Drug Administration (FDA) and the Scientific Committee on Consumer Safety (SCCS) in Europe (2-4), are frequently present in cosmetics (5). Despite extensive and progressively expanding use worldwide, studies confirm that parabens are seldom responsible for allergic contact dermatitis to cosmetics, and the frequency of sensitivity to parabens has been low and stable for many decades (2). The frequency of positive reactions to paraben mix is less than 0.5% in most clinical series, although it seems that when it occurs it is often of high clinical relevance (6). Nevertheless, several authors have stated that these patients rarely or never have to avoid foods or cosmetics that contain parabens to control their dermatitis (2). Paraben allergy most frequently occurs in patients with long-lasting stasis dermatitis or disruption of skin integrity, with high use of topical drugs, and in those who do not get better under normal treatment and/or skin care (5). The EBS has been periodically adapted by the European Environmental and Contact Dermatitis Research Group (EECDRG) and the European Society of Contact Dermatitis (ESCD), according to frequency studies, but ensuring that tested haptens remain relevant (1). Bruze et al. recommend that haptens should be considered for inclusion in a baseline series when the contact allergy prevalence is 0.5-1.0% or above (7). So, why not exclude paraben mix from the EBS? We analysed all the EBS tests performed at our institution in the last 21 years (2000-2020) to evaluate the frequency of positive reactions to paraben mix 16% pet (Chemotechnique diagnostics, Vellinge Sweden). In total, 5885 patients were patch tested (MOAHLFA index - Table 1), of whom 29 (10 men and 19 women) patients presented with a positive reaction (1+ or more according to ESCD guidelines) to paraben mix (0.49%), with positivity rates varying between 1.79% and 0.0% and progressively falling for the past 20 years (Figure 1). Present or past clinical relevance was found in 19/29 (65.5%) patients (6 men and 13 women), and was related to the use of topical drugs in 16 patients (55.2%) and cosmetics in three patients (10.3%). Paraben reactions occurred mostly in patients with history of leg ulcer, leg dermatitis, and/or chronic venous insufficiency, which is in agreement with the overrepresentation of the group of patients with leg dermatitis compared with the whole population tested (Table 1). The pro

Desmoplastic neurotropic melanoma (DNM) is a rare melanoma subtype that shows tropism for the nerves, perineural invasion correlates to higher rate of local recurrence, poorer prognosis and worse morbidity. Given the paucity of typical melanoma features, both clinical and pathological, this confusing skin cancer may act as a pretender, thus leading clinician to misdiagnosis and subsequent inappropriate conservative treatment. Sarcomatoid-like cells rearrangement and absence of pigmentation can lead towards sarcoma diagnosis, so specific skills are required to pathologist to properly recognize this melanoma subtype. In this case report, we present an example of how challenging can be the diagnosis, and how it can affect clinical outcome.

Acute hemorrhagic edema of infancy (AHEI) is a cutaneous leukocytoclastic small vessel vasculitis of unknown incidence. It affects mostly infants aged 4 to 24 months. The distinctive features of AHEI include a generally healthy-appearing child with low-grade or absent fever and rarely painful targetoid purpuric edematous lesions. The disease usually resolves spontaneously within 3 weeks without late sequelae. The main differential diagnosis of AHEI is Henoch-Schönlein purpura (HSP). Initially, purpura fulminans should also be ruled out. We report the case of a 5-year-old girl with low fever and rapidly progressive skin lesions who had been admitted to the pediatric clinic. The child presented with palpable annular targetoid and purpuric plaques of different size predominantly affecting the face and extremities. In addition, there was a painful, hemorrhagic edema on the dorsum of her hands and feet. Based on the course of the disease and the typical clinical presentation, i.e., extensive characteristic skin lesions in a young child in a good general health condition, a diagnosis of AHEI was established. A virus serology test showed increased titers of enterovirus and coxsackievirus. Isolation of virus from feces confirmed an infection with coxsackie B3 virus. To our knowledge, this is the first report linking coxsackie B3 virus infection to AHEI.

A new coronavirus emerged in 2019 in Wuhan, China named Severe Acute Respiratory Syndrome type 2 coronavirus (SARS-CoV-2). Later, this virus spread worldwide, causing a disease called coronavirus disease (COVID-19). To control the outbreak, many countries announced mandatory quarantine; thus, people changed their lifestyles and started engaging in most activities from home. This review explains how some dermatological pathologies may be precipitated by prolonged stays at home, considering that quarantine was a widely used public health measure during 2020. Most of these dermatoses had to be seen, diagnosed, and treated through tele-dermatology, a remote health care system that took force during the COVID-19 pandemic because of its ease and efficiency in connecting health care professionals and their patients; therefore, reducing the risk of contagion and costs associated to medical care. This review of the principal dermatologic conditions during confinement could allow for a better preparation of health professionals.