Skin Adverse Reactions to Novel Messenger RNA Coronavirus Vaccination: A Case Series

Vaccines are actually the most effective strategy to control the COVID-19 spread and reduce mortality, but adverse reactions can occur. Skin involvement with novel messenger RNA coronavirus vaccines seems frequent but is not completely characterized. A real-world experience in the recent vaccination campaign among health care workers in Sardinia (Italy) is reported. In over a total of 1577 persons vaccinated, 9 cases of skin adverse reactions were observed (0.5%). All reactions have been reported to the Italian Pharmacovigilance Authority. Eight occurred in women (mean age 46 years), and five were physicians and four nurses. All patients had a significant allergology history but not for the known vaccine excipients. After dose one, no injection site reactions were observed, but widespread pruritus (n = 3), mild facial erythema (n = 1), and maculopapular rash (n = 3) occurred in the following 24-48 h in three patients. These three patients were excluded from the second dose. Of the remaining six patients, one developed mild anaphylaxis within the observation period at the vaccination hub and five delayed facial erythematous edema and maculopapular lesions, requiring antihistamines and short-course corticosteroid treatment. Spontaneous reporting is paramount to adjourning vaccination guidance and preventive measures in order to contribute to the development of a safe vaccine strategy. Dermatologist' expertise might provide better characterization, treatment, and screening of individuals at high risk of skin adverse reactions

A lumpy back: extensive cutaneous collagenomas

A widespread form of eruptive collagenomas in a 12-year-old man is presented for the impressive iconography, challenging differential diagnosis, and histopathological considerations associated with such rare connective tissue disorders. Syndromic forms should be carefully investigated for the different course and prognosis. Treatment is a major unsolved issue as aesthetic concerns are significant, especially in young adults

Glomeruloid reactive angioendotheliomatosis in a woman with systemic lupus erythematosus and antiphospholipid syndrome mimicking reticular erythematous mucinosis

The umbrella term ‘‘cutaneous reactive angioma- toses’’ was introduced in 2003 to include uncommon angioproliferative (capillary) cutaneous conditions, which present with variable clinical features and involve patients with a variety of underlying systemic conditions.1 Histologically, these disorders are char- acterized by different patterns of intravascular or extravascular lobular or diffuse hyperplasia of endo- thelial cells, pericytes, and, sometimes, histiocytes, mostly throughout the dermis.1 The first condition to be described was reactive angioendotheliomatosis (RAE), which is usually associated with prothrom- botic conditions.1 We report a case of RAE in its rare glomeruloid variant, occurring in a woman with systemic lupus erythematosus (SLE) and antiphos- pholipid syndrome (APS), which is notable because it mimics reticular erythematous mucinosis (REM)

Interstitial granulomatous drug reaction due to febuxostat

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Gram-negative bacterial toe web intertrigo

Gram-negative infection of the toe web space is less frequent than dermatophytes and yeasts, but it is more challenging, especially with the involvement of Pseudomonas aeruginosa in relation to antibiotic resistance and the increased risk of potentially lethal complications. Many conditions, other than infections, might initially present with the same clinical features, recognising the common initial damage (intertrigo), due to skin-on-skin rubbing in a moist environment with air entrapment, which is typical of interdigital spaces. Conditions such as contact eczema, atopic dermatitis, and inverse psoriasis, frequently predispose to, and are maintained by, the intertrigo, triggering a vicious circle. The dermatologist is in a lead position to address the correct assessment and management. A careful screening for predisposing factors is necessary: overweight, diabetic, but also athletes or people attending swimming pools, gyms, public showers/dressing rooms, and thermal baths are also at an increased risk of intertrigo of the toe web spaces. Occupational activities other than recreational might be relevant, such as the use of safety shoes or working in wet warm conditions. Incongruous therapy for tinea pedis or contact dermatitis, frequently auto-prescribed, might be among promoting factors altering the microbial ecosystem balance. The aim of this review is to evaluate the main epidemiologic and clinical features of Gram-negative bacteria intertrigo, the role of promoting factors, and the measures taken to treat and prevent this disorder. Appropriate treatment and patient education are crucial to prevent further infection and relapses

A nose for trouble.

A 63‑year‑old Caucasian non‑smoker presented with purplish, firm, slowly growing plaques on the nose, of 20 years duration. The bigger one involved the upper part of the nose in its entirety [Figure 1], while there were smaller ones on the left and right cheek. All the plaques were asymptomatic and did not worsen after sunlight exposure. His past medical history was unremarkable. Hematological and biochemical parameters were within normal limits. Histological examination revealed a diffuse mid‑dermal cellular infiltrate composed of neutrophils, eosinophils, plasma cells, and lymphocytes. A narrow Grenz zone was present. In the lower part of the reticular dermis, the mixed infiltrate was intermingled with a massive deposition of fascicled pattern collagen fibers and spindle cell

Pseudoepitheliomatous keratotic and micaceous balanitis: low-risk human papilloma virus detection in two further cases

We report two cases of histologically documented pseudoepitheliomatous keratotic and micaceous balanitis in middle-aged male patients, which showed positivity for low-risk serotype human papillomavirus DNA. To our knowledge, only one other case has been documented. Further immunohistochemical proliferative markers were performed and compared to literature findings in penile epithelial proliferations. Evolution to invasive verrucous carcinoma has been associated with absence of HPV DNA. Thus, if confirmed by further studies, HPV testing should be included in pseudoepitheliomatous keratotic and micaceous balanitis assessment to address prognosis, and management

Leg ulcer in Werner syndrome (adult progeria): a case report

Werner syndrome (WS; MIM#277700) or adult progeria, is a rare disease, associated with mutations of a single gene (RECQL2 or WRN), located on chromosome 8 (8p12). It codes a DNA-helicase, whose defects cause genomic instability. The highest incidences are reported in Japan and Sardinia (Italy). On this major island of the Mediterranean Basin, the WS cases have been observed in the northern areas. The authors describe the apparently first case reported in southern Sardinia, a 51-year-old woman, who was born in and resides in the province of Cagliari. She presented with a 9-year history of an intractable leg ulcer and other characteristic symptoms, including "bird-like" face, high-pitched voice, premature greying, short stature, abdominal obesity in contrast with thin body type, scleroderma-like legs, decreased muscle mass, diabetes, atherosclerosis, and premature menopause. A specialized genetic Institute of Research (IRCCS-IDI, Rome) confirmed the clinical diagnosis. There is no cure or specific treatment and patients must be periodically screened for an increased risk of cardiovascular and cerebrovascular disease and malignancies. Among the many findings, leg ulcers significantly affect the patient's quality of life. This problem may send the patient to the dermatologist, who finally suspects the diagnosis. Poor response to medical treatment may require aggressive repeated surgery, with poor or temporary results

a nose for trouble

As clinicians we work in a world of evidence- based care, making diagnoses using history taking and examination skills. In his William Pickles lecture at the 2011 Spring General Meeting, Dr Terry Davies asked whether GPs sometimes put too much emphasis on the 'straight line science approach in their diagnoses' when often their initial 'hunch' is the correct one. I suggest that experienced clinicians sometimes make their judgements based not only on experience, but using all their senses including olfaction; they literally develop a 'nose for trouble'. In our everyday life we take our sense of smell for granted. In cities we are overwhelmed by sensory overload as we walk past fast-food outlets, coffee shops, bakeries, through throngs of shoppers smelling of soap, shampoo, aftershave, and perfume, and the ever-present smell of vehicle exhaust. There are many human smells that we simply do not register in our perfumed and deodorised world such as ear wax, sebum, menstrual blood, and even breath, while other smells we note and find offensive, such as stale sweat, flatus, and teenage boys' feet. However, which mother has not lingered over the head of her new baby, breathing in the very special smell of baby and milk? Sheep and cattle recognise their offspring by scent and I am certain that humans are able

Atypical fibroxanthoma/pleomorphic dermal sarcoma of the scalp with aberrant expression of HMB-45: a pitfall in dermatopathology

Atypical fibroxanthoma (AFX) has been considered as the non-infiltrating precursor lesion of pleomorphic dermal sarcoma (PDS), which shows an aggressive clinical behavior, because of its extensive invasion of the deeper skin layers. Although these two tumors may represent two stages of the same disease, it can be difficult to differentiate between them, because of their similar clinical and histological features 1. Furthermore, they must be distinguished from a spindled variant of squamous carcinoma, melanoma and leiomyosarcoma 2. AFX/PDS still remains a diagnosis of exclusion, that needs to combine immunohistochemical markers for a definitive diagnosis. Usually AFX/PDS shows positivity for CD10, CD99, CD68, vimentin and lysozyme, while S100, HMB45, MART-1, cytokeratins, CD34, CD31, desmin and h-caldesmon are absent