Dermoscopy and Reflectance Confocal Microscopy for Monitoring the Treatment of Actinic Keratosis with Ingenol Mebutate Gel: Report of Two Cases

Introduction: A relatively novel application for dermoscopy and reflectance confocal microscopy (RCM) is their use in the monitoring of topical treatment response for non-melanoma skin cancer. Actinic keratosis (AK) is the early phase of a multistep biologic continuum leading to invasive squamous cell carcinoma. A number of topical therapies are now available for the treatment of AK but their disadvantages include long treatment duration and prolonged local reactions. Ingenol mebutate is a newer therapy for AK which is only applied for 2 or 3 days. Case Report: Dermoscopy and RCM findings in two patients with AK treated with ingenol mebutate confirm that it induces rapid lesion necrosis and specific neutrophil-mediated, antibody-dependent cellular cytotoxicity. Necrosis occurs via mitochondrial membrane disruption, with subsequent eradication of residual tumor cells via transient inflammation. Local skin reactions to ingenol mebutate should be considered part of the drug’s mechanism of action rather than an adverse effect. Conclusion: Ingenol mebutate is a valuable therapy for the treatment of AK. This case report adds further evidence to the usefulness of dermoscopy and RCM in the assessment and monitoring of treatment outcome

Case of bullous pemphigoid in a 28-year-old woman affected by tuberous sclerosis complex

[No abstract available

Reflectance confocal microscopy and optical coherence tomography for the diagnosis of bullous pemphigoid and pemphigus

Introduction & Objectives: Bullous pemphigoid (BP) and pemphigus (P) are autoimmune diseases characterized by the presence of blisters on the skin and/or the mucous membranes. The diagnosis of these bullous diseases is based on a combination of criteria encompassing clinical features, histology, immunofluorescence and laboratory data. The aim of this study was to evaluate features of BP and P at reflectance confocal microscopy (RCM) and optical coherence tomography (OCT) in order to provide a rapid non-invasive bed-side diagnosis. Secondary objective was to evaluate the detectability of clinically non-visible lesions. Material & Methods: This was an observational, retrospective, multicentre study (University of Modena, Italy and University of Saint-Etienne, France) in which patients with suspicious lesions for BP or P underwent clinical assessment, RCM, OCT, blood tests and skin biopsy for histological and direct immunofluorescence examinations. A total of 72 lesions in 24 patients (16 with PB and 8 with P) were evaluated. Apparently unaffected skin was examined in order to test sub-clinical lesion detectability in all patients. Data analysis was performed from January 2014 to December 2015. Results: RCM was able to detect sub-epidermal and intra-epidermal blisters respectively in 75% and 50% of the patients affected by BP and P. At OCT the exact blister level was identified in all BP and P cases’. Acantholytic cells were observed only at RCM in P (62.5%). Fibrin deposition inside the blisters was only found in PB, evidenced both at RCM and OCT. Subclinical bullae were revealed on clinically healthy skin at OCT in some cases of BP and P. Conclusions: RCM and/or OCT can assist the clinician in providing rapid information through a non-invasive procedure for a rapid diagnosis of BP and P. Combined use of RCM and OCT for a real-time examination of the skin lesions associates the higher resolution of RCM with the greater penetration depth in cross-sectional view of OCT, providing in vivo quasi-histologic information

A solitary pink lesion: dermoscopy and RCM features of lichen planus

We present an unusual onset of cutaneous lichen planus (LP) in a middle-aged patient. The initial presentation as solitary, indolent pink lesion required further investigations to rule out malignancy, especially amelanotic melanoma. Dermoscopy and reflectance confocal microscopy findings were found to be helpful in our case in addressing the correct diagnosis

Comparison of plasma lipids changes after middle-distance running in euglycemic and diabetic subjects

Background: Although regular performance of aerobic physical exercise is pivotal for preserving or improving health and fitness, scarce information is available on plasma lipids changes after middle-distance running in euglycemic and diabetic subjects. Methods: Eleven male euglycemic amateur runners (mean age 41\ub16 years) and 9 male diabetic amateur runners (4 with type 1 and 5 with type 2 diabetes; mean age 55\ub114 years) participated to a 21.1-km running trial. All subjects belonged to an amateur running team, regularly engaged in amateur running. Blood was collected before the start of the trial and immediately after. The lipid profile, encompassing measurement of total cholesterol, triglycerides, low-density lipoprotein cholesterol (LDL-C) and high-density lipoprotein cholesterol (HDL-C), was assayed with Roche Cobas 6000. Results: All athletes successfully completed the 21.1-km running trial, with running pace comprised between 9.6\u201312.8 km/h. In both categories of subjects the values of LDL-C significantly decreased by approximately 6% after the run, whilst HDL-C and triglycerides significantly increased by 6\u20139% and 30\u201336%, respectively. The post-run variations of all lipoprotein fractions after the running trial were virtually identical in diabetic and euglycemic subjects. Conclusions: The results of this study show for the first time that middle-distance running elicits acute favorable changes of lipid profile both in euglycemic and diabetic subjects. This form of endurance exercise shall hence be further fostered for purposes of public health promotion and improvement

Una strana placca eritematosa parzialmente ulcerata

Presentiamo il caso di una donna di 38 anni affetta da sclerosi tuberosa ed in terapia immunosoppressiva dal 2006 per trapianto renale. La paziente presentava grave deficit cognitivo e di coordinazione motoria. All’esame obiettivo si rilevava la presenza di una placca eritematosa in regione pretibiale sinistra, parzialmente ulcerata, di cui la paziente riferiva comparsa e persistenza da circa 3 anni. Nel resto del corpo la cute si presentava integra eccetto alcune lesioni da grattamento. In passato erano state eseguite due biopsie cutanee per un miglior inquadramento diagnostico il cui referto istologico era risultato completamente aspecifico. La madre riferiva di aver notato la comparsa talvolta di alcune bolle sul corpo, che si rompevano e guarivano spontaneamente senza lasciare esiti cicatriziali. Nel sospetto di una patologia bollosa si eseguiva un prelievo ematico per immunofluorescenza indiretta e due biopsie cutanee per esame istologico e immunofluorescenza diretta. Al momento della consegna degli esiti degli esami, che deponevano per un quadro di pemfigoide bolloso, si osservava un’intensa area disepitelizzata nella regione pretibiale sinistra e due piccole bolle tese sulla gamba destra. Localmente si applicavano steroide topico sulle lesioni bollose e medicazione a base di idrofibra con argento sull’area pretibiale sinistra con risoluzione del quadro cutaneo

Rôle de la microscopie confocale de réflectance et de tomographie par cohérence optique pour le diagnostic de la pemphigoïde bulleuse et du pemphigus

Introduction: La pemphigoïde bulleuse (PB) et le pemphigus vulgaire (PV) sont des maladies auto-immunes caractérisées par la présence de bulles cutanées et ou muqueuses. Le diagnostic de ces maladies bulleuses repose sur une combinaison de critères cliniques, histologiques, d’immunofluorescence et biologique. L’utilité de la microscopie confocale de réflectance de (MRC) et tomographie par cohérence optique (OCT) pour le diagnostic de BP et de PV a été rapporté dans un petit nombre de cas. Nous rapportons l’examen en MRC et l’examen OCT des caractéristiques de BP et PV. Matériel et méthodes: Il s’agissait d’une étude observationnelle multicentrique dans laquelle les patients présentant des lésions suspectes pour BP ou PV ont eu un examen clinique, en MRC (Vivascope 3000® Caliber) et OCT (Vivosight®, Mickelson) ; de plus étaient réalisés un examen histologique et une immunofluorescence directe et indirecte. Vingt-quatre patients (16 avec PB et 8 avec PV) étaient évalués. Trois zones étaient examinées pour chaque patient : 2 lésions et une zone de peau saine. Résultats: La RCM et l’OCT ont tous deux permis de visualiser un décollement sous-épidermique et bulles intra-épidermiques chez tous les patients atteints de BP et PV. L’OCT était la méthode la plus appropriée pour l’identification du niveau exact de la bulle, alors que la MRC permettait d’observer l’acantholyse de kératinocytes des bulles de PV. Des dépôts de fibrine et des septa à l’intérieur des bulles ne se trouvaient que dans les PB et non dans les PV aussi bien en OCT que MCIV. Discussion: Il est maintenant possible au clinicien de déterminer le type et le niveau de clivage d’une bulle et de différencier PB ou PV de manière non-invasive. Par ailleurs, il est possible d’examiner les bulles sans fixation ce qui permet de visualiser le cloisonnement par des septa de fibrine lors de la PB. Conclusion: La MCIV et l’OCT peuvent aider le clinicien dans le diagnostic de BP et PV au cours d’un examen rapide est simple à réaliser de manière non-invasive. De plus, ces techniques peuvent être utiles pour la sélection du site de biopsie

Uso della microscopia laser confocale e della tomografia a coerenza ottica nella diagnosi del pemfigoide bolloso e del pemfigo

Il pemfigoide bolloso (PB) ed il pemfigo (P) sono malattie autoimmuni caratterizzate dalla formazione di bolle sulla pelle e/o sulle mucose. La diagnosi di queste patologie viene posta sulla base della valutazione clinica, dei dati di laboratorio, dell\u2019istologia, dell\u2019immunofluorescenza diretta ed indiretta. Nel nostro studio osservazionale multicentrico sono stati valutati con la microscopia laser confocale (RCM) e con la tomografia a coerenza ottica (OCT) di 16 pazienti con PB e di 8 con P sia la cute apparentemente sana che tre lesioni bollose. L\u2019OCT \ue8 risultato essere pi\uf9 preciso del RCM nella definizione della localizzazione delle bolle e nell\u2019identificazione delle lesioni subcliniche. Grazie al potere risolutivo maggiore, l\u2019RCM \ue8 in grado di visualizzare strutture a risoluzione quasi istologica e pertanto \ue8 risultato essere capace di valutare pi\uf9 parametri rispetto all\u2019OCT, dimostrando di essere un ottimo strumento nella diagnosi differenziale con altre patologie bollose come ad esempio quelle di natura virale

Quantitative evaluation of healthy epidermis by means of multiphoton microscopy and fluorescence lifetime imaging microscopy

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