Non ti scordar di me

Un uomo di 78 anni giungeva alla nostra osservazione per una lesione della regione temporale destra che riferiva essere presente da pi\uf9 di 1 anno, ma che negli ultimi mesi era aumentata di dimensioni e facilmente andava incontro a sanguinamento. L\u2019esame obiettivo evidenziava una lesione rotondeggiante delle dimensioni di 3 cm con area ulcerata centrale, pigmentazione grigio-blu e bordi lievemente rilevati, eritematosi, con fine desquamazione biancastra. All\u2019esame dermoscopico si osservava un\u2019area centrale ulcerata ed alla periferia aree prive di struttura bianco-rosa, aree irregolari bianco brillante, alcuni vasi dilatati ed aree eccentriche grigio-blu con velo. Veniva, quindi, posta diagnosi differenziale tra melanoma e carcinoma basocellulare pigmentato. La lesione veniva sottoposta ad escissione chirurgica per esame istologico che rivelava proliferazione di cellule squamose atipiche, melanociti, melanofagi e depositi di melanina. Tale quadro risultava compatibile con un carcinoma squamocellulare pigmentato. Si tratta di una variante che, seppur rara (0,01-7% di tutti i carcinomi squamocellulari), dovrebbe essere presa in considerazione nelle diagnosi differenziale di lesioni pigmentate cutanee benigne, come il melanoacantoma, e maligne, quali il melanoma ed il carcinoma basocellulare pigmentato

Baseline biophysical parameters in subjects with sensitive skin

Sensitive skin has been described as a skin type showing higher reactivity than normal skin and developing exaggerated reactions when exposed to external factors. The stinging test, performed by applying lactic acid to the nasolabial fold and evaluating the intensity of subjective symptoms, is widely accepted as a marker of sensitivity and employed for the selection of subjects experiencing invisible cutaneous irritation. However, this test is based on self-perceived assessment and lacks objectivity. In order to contribute to the finding of objective descriptors, we assessed baseline biophysical parameters in subjects with sensitive skin by means of transepidermal water loss (TEWL), capacitance, pH, sebum and skin colour measurements, and compared the data with those obtained in normal subjects, also correlating the results with those of clinical assessments and functional tests. Subjects with sensitive skin showed a trend towards higher scores at all assessment times both for the stinging and the washing test. The skin of sensitive subjects was described as less supple, less hydrated and more erythematous and telangiectatic with respect to the skin of normal subjects. A trend towards an increase in TEWL, pH and colorimetric a* values, and a decrease in capacitance, sebum and colorimetric L* values on the face of subjects with sensitive skin was observable. However, significances were only present for capacitance and a* values. Thus, alterations of baseline capacitance values indicate the tendency to barrier impairment and support the view that skin hyperreactivity to water-soluble irritants is induced by a greater amount of irritants absorbed, whereas the increase in the erythema parameter shows that cutaneous vascular hyperreactivity in subjects with sensitive skin also corresponds to baseline vasodilation

Cicatricial iatrogenic lower eyelid malposition in skin cancer surgery: results of a combined approach

Purpose: Malposition of the lower lid, including rounding of the lateral canthal angle, lower eyelidretraction with inferior scleral show, and ectropion, is a relatively frequent complication in the surgicaltreatment of skin cancer of the cheek and zygomatic areas. The tarsal strip technique, in association witha vertical vector cheek lift, is a reliable method for correcting lower lid malposition.Materials and patients: From January 2008 to January 2010, we treated 19 patients with lower eyelidmalposition after skin cancer surgery of the cheek and zygomatic areas. To correct lower eyelidmalposition, we used the tarsal strip technique and a vertical vector cheek lift in all patients.Results: Eleven patients had scleral show and eight patients had ectropion. Sixteen patients obtainedsatisfactory correction of the eyelid malposition in a single surgical procedure, while three patientsrequired a second surgical step to correct the remaining scleral show. Good esthetic and functionalresults were achieved in all cases.Conclusions: The surgical treatment of skin cancer of the cheek and zygomatic areas has the potential forpostoperative sequelae. The tarsal strip technique, in association with a vertical vector cheek lift, isa relatively simple technique for correcting scleral show and ectropion

Non ti scordar di me

Un uomo di 78 anni giungeva alla nostra osservazione per una lesione della regione temporale destra che riferiva essere presente da più di 1 anno, ma che negli ultimi mesi era aumentata di dimensioni e facilmente andava incontro a sanguinamento. L’esame obiettivo evidenziava una lesione rotondeggiante delle dimensioni di 3 cm con area ulcerata centrale, pigmentazione grigio-blu e bordi lievemente rilevati, eritematosi, con fine desquamazione biancastra. All’esame dermoscopico si osservava un’area centrale ulcerata ed alla periferia aree prive di struttura bianco-rosa, aree irregolari bianco brillante, alcuni vasi dilatati ed aree eccentriche grigio-blu con velo. Veniva, quindi, posta diagnosi differenziale tra melanoma e carcinoma basocellulare pigmentato. La lesione veniva sottoposta ad escissione chirurgica per esame istologico che rivelava proliferazione di cellule squamose atipiche, melanociti, melanofagi e depositi di melanina. Tale quadro risultava compatibile con un carcinoma squamocellulare pigmentato. Si tratta di una variante che, seppur rara (0,01-7% di tutti i carcinomi squamocellulari), dovrebbe essere presa in considerazione nelle diagnosi differenziale di lesioni pigmentate cutanee benigne, come il melanoacantoma, e maligne, quali il melanoma ed il carcinoma basocellulare pigmentato

The Role of Antioxidants Supplementation in Clinical Practice: Focus on Cardiovascular Risk Factors

Oxidative stress may be defined as an imbalance between reactive oxygen species (ROS) and the antioxidant system to counteract or detoxify these potentially damaging molecules. This phenomenon is a common feature of many human disorders, such as cardiovascular disease. Many of the risk factors, including smoking, hypertension, hypercholesterolemia, diabetes, and obesity, are associated with an increased risk of developing cardiovascular disease, involving an elevated oxidative stress burden (either due to enhanced ROS production or decreased antioxidant protection). There are many therapeutic options to treat oxidative stress-associated cardiovascular diseases. Numerous studies have focused on the utility of antioxidant supplementation. However, whether antioxidant supplementation has any preventive and/or therapeutic value in cardiovascular pathology is still a matter of debate. In this review, we provide a detailed description of oxidative stress biomarkers in several cardiovascular risk factors. We also discuss the clinical implications of the supplementation with several classes of antioxidants, and their potential role for protecting against cardiovascular risk factors

COVID 19-associated chilblain-like acral lesions among children and adolescents: an Italian retrospective, multicenter study

BACKGROUND: Since the COVID-19 pandemic started, great interest has been given to this disease, especially to its possible clinical presentations. Besides classical respiratory symptoms, dermatological manifestations occur quite often among infected and non-infected patients, particularly in children. A prominent IFN-I response, that is generally higher in children compared to adults, may not only cause chilblain lesions, but it could also prevent infection and viral replication, thus justifying the negative swab results, as well as the absence of relevant systemic symptoms in positive cases. Indeed, reports have emerged describing chilblain-like acral lesions in children and adolescents with either proven or suspected infection. METHODS: Patients aged from 1 to 18 years old were enrolled in this study from 23 Italian dermatological units and were observed for an over-all period of 6 months. Clinical pictures were collected along with data on the location and duration of skin lesions, their association with con-comitant local and systemic symptoms, presence of nail and/or mucosal involvement, as well as histological, laboratory and imaging findings. RESULTS: One hundred thirty-seven patients were included, of whom 56.9% were females. Mean age was 11.97 & PLUSMN;3.66 years. The most com-monly affected sites were the feet (77 patients, 56.2%). Lesions (48.5%) featured cyanosis, chilblains, blisters, ecchymosis, bullae, erythema, edema, and papules. Concomitant skin manifestations included maculo-papular rashes (30%), unspecified rashes (25%), vesicular rashes (20%), erythema multiforme (10%), urticaria (10%) and erythema with desquamation (5%). Forty-one patients (29.9%) reported pruritus as the main symptom associated with chilblains, and 56 out of 137 patients also reported systemic symptoms such as respiratory symptoms (33.9%), fever (28%), intestinal (27%), headache (5.5%), asthenia (3.5%), and joint pain (2%). Associated comorbid conditions were observed in 9 patients presenting with skin lesions. Nasopharyngeal swabs turned out positive in 11 patients (8%), whereas the remainder were either negative (101, 73%) or unspecified (25, 18%). CONCLUSIONS: COVID-19 has been credited as the etiology of the recent increase in acro-ischemic lesions. The present study provides a description of pediatric cutaneous manifestations deemed to be potentially associated with COVID-19, revealing a possible association between acral cyanosis and nasopharyngeal swab positivity in children and teenagers. The identification and characterization of newly recognized pat-terns of skin involvement may aid physicians in diagnosing cases of asymptomatic or pauci-symptomatic COVID patients