Scurvy as Presenting Sign of Anorexia Nervosa

A 59-year-old woman with history of anorexia nervosa presented with striped purpura and ecchymoses on the legs. Deficiency in serum vitamin C with levels <0.1 mg/dl (N.V. 0.2-2mg/dL) was found

Corymbose Syphilis

A 35-year-old Filipino otherwise healthy women presented with a one-month history of symptomless erythematous papules over the trunk and limbs. Lesions consisted of a large central papule surrounded by satellite papules extended on a rounded diameter measuring 5-15 cm (Figure1A-C). No evidence of mucosal lesions was documented. The patient had fever, fatigue and generalized lymphadenopathy. History of unprotected sexual activity with multiple partners and negative previous syphilis serologies were reported by the patient. Hepatitis B and C and HIV antibodies were negative. Venereal Disease Research Laboratory (VDRL)(1:128), Treponema Pallidum Hemagglutination test (TPHA)(1:2048), total antibodies and IgM anti Treponema Pallidum were positive. Hepatitis B and C and HIV antibodies were negative. Laboratory investigations showed an increased erythrocyte sedimentation rate (34 mm, n.v. 0-15 mm), C reactive protein (13.8 mg/L, n.v. <5 mg/L) and mild monocytosis (1.1×109/L, n.v. 0.2–0.8×109/L). Chest X-ray and abdominal ultrasound did not reveal abnormalities. Histological examination showed a superficial and deep inflammatory infiltrate with sarcoidei-like granulomas characterized by many plasma cells (Figure1D). These findings were consistent with syphilis. She was treated with Benzathine-penicillin, three doses of 2.4 million units intramuscular weekly. A complete resolution of clinical manifestations and a fourfold decrease in VDRL titer was observed after 3 months. Syphilis may rarely have a “corymbo” appearance, i.e. reminiscent of a flat-topped flower cluster in which the individual flower stalks grow upward from various point of the main stem to the same height.1-

Psoriasis: talking points from recent clinical trials

Psoriasis is a chronic inflammatory skin disease that includes a wide spectrum of clinical variants. The most common form of psoriasis is chronic plaque psoriasis, which manifests as well- demarked, erythematous, and scaly plaques. The pathogenic mechanisms underlying either plaque or pustular psoriasis overlap because of the central role of the interleukin-(IL-)23/ IL-17A axis in both conditions, though pustular psoriasis is characterized by a more prominent contribution of the innate immune compartment involving the IL-1 cytokine family [1]. Besides the development of antibodies targeting either solu-ble pathogenic cytokines or their receptor, the inhibition of the intracellular signaling induced by multiple cytokines and chemokines has been proposed as an alternative therapeutic strategy. Nowadays, the therapeutic paradigm for plaque psor-iasis includes topical, phototherapy, conventional systemic treatments, different classes of biological agents, and small molecules. Contrary to plaque psoriasis, only one biologic agent has received approval for the treatment of pustular psoriasis. The pipeline of plaque psoriasis consists of topical and systemic agents that showed promising results in phase II trials, as well as for pustular psoriasis, with one additional IL-36 receptor antagonist under investigation. This editorial aimed to collect and discuss clinical outcomes deriving from the most advanced trials testing promising agents, either topical or systemic. A narrative review for selected agents with a robust clinical trial program was performed

Advanced Glycation End Products and Psoriasis

: Advanced glycation end products (AGEs) are biologically active compounds formed physiologically throughout a sequence of chemical reactions, to generate highly oxidant‐reactive aldehydes that combine covalently to proteins. They accumulate slowly in tissues during ageing but also in metabolic and selected inflammatory disorders. Accumulation of AGEs occurs more rapidly and intensely in the skin and serum of patients with type 2 diabetes, obesity, cardiovascular dis‐ eases, chronic renal insufficiency, and non‐alcoholic fatty liver disease and also in the skin of pa‐ tients with psoriasis. All of the above conditions are intimately associated with psoriasis. Interaction of AGEs with their receptors (RAGEs) stimulates cellular signaling with the formation of reactive oxygen species and activation of nuclear factor kappa light chain enhancer of activated B (NF‐kB), which is a key regulator in the expression of inflammatory mediators and the production of oxida‐ tive stress. Thus, AGEs may play an interesting pathogenic role in the intersection of inflammatory and metabolic diseases, may represent a biomarker of inflammation and a potential target for novel therapeutic strategies. This is a narrative review with the objective to summarize current evidence on the role of AGEs in psoriasi

Clinical Characteristics of Patients with Pustular Psoriasis: A Single-Center Retrospective Observational Study

Clinical and epidemiologic data on pustular psoriasis are scarce. To investigate the phenotypes of pustular psoriasis and the patients’ characteristics observed in a real-life retrospective observational study. The number of incident cases of pustular psoriasis registered in the period 2005–2021 was retrieved from the electronic medical records of the University Hospital of Verona. One hundred and forty cases of pustular psoriasis were collected. Ninety-one out of 140 patients (65%) were females, with a median (IQR) age of 57 (43–66) years. According to the ERASPEN classification criteria, 116 patients (83%) had palmoplantar pustulosis (PPP), 13 (9%) generalized pustular psoriasis (GPP), and 11 (8%) acrodermatitis continua of Hallopeau (ACH). Gender distribution and median age were consistent among the three groups. The prevalence of psoriatic arthritis in GPP, ACH, and PPP was 8%, 36%, and 28%, respectively. During the same period, a total of 4718 cases of plaque psoriasis were retrieved, with a 1:34 ratio of pustular over plaque psoriasis. Pustular psoriasis is much rarer than plaque psoriasis, with PPP being the more common subtype

Tailored biological treatment for patients with moderate-to-severe psoriasis

Introduction: Psoriasis is a common, chronic immune-mediated skin disease frequently associated to inflammatory and metabolic comorbidities. About 20–30% of patients are affected by moderate-to- severe psoriasis and require a systemic treatment, which include traditional and biological drugs. The objective of this manuscript is to provide criteria for a personalized biological treatment. Areas covered: Tailoring a biological treatment for patients with moderate-to-severe psoriasis needs to consider several variables related to the disease, the patient and the treatment. It is important to consider the disease severity and activity, the skin areas involved, the frequency of relapses, itch or other symptoms, and foremost the presence of comorbidities. About the patient, is important to consider age, gender, body weight, the occupation, the impact on the quality of life, the likelihood of adherence, patient expectations, the desire for remission, and the fear of side effects. Expert opinion: The presence of comorbidities, which may benefit from or contraindicate a given biologic, is the main driver of a tailored therapy. A personalized treatment associates maximum efficacy and minimal risk of side effects. In addition, there is the possibility of modifying disease-course inducing long-term remission and preventing the development of psoriatic arthritis

Dermoscopic features of nevoid melanoma: a retrospective study

BACKGROUND: Nevoid melanoma (NeM) is a rare variant of melanoma resembling melanocytic nevus. The aim of the study was to systemati- cally review the dermoscopic features of NeM. METHODS: A hospital-based retrospective study was conducted. Dermoscopic features of NeMs diagnosed through excisional biopsy between January 2015 1, and March 1, 2021, were compared to superficial spreading melanomas (SSMs) matched by Breslow’s thickness. Then, a litera- ture search was performed. Electronic searches on PubMed database via Medline were conducted to retrieve any manuscript reporting detailed dermoscopic features of histopathologically confirmed NeM. RESULTS: A total of 60 malignant melanomas (MM) comprising 20 NeM and 40 SSM were collected. Twelve out of 20 (60%) NeM showed a nevus-like appearance, including reticular and globular patterns, and in 35% of these cases it was detected because of dermoscopic changes. Then, a total of seven original manuscripts were retrieved from the literature review, comprising 56 cases overall. NeM showed nevus-like pat- tern in 53% of the cases, multicomponent pattern in 21% and amelanotic in 9%. Enlargement, irregularly distributed dots/globules, irregular pigmentation, and atypical vascular pattern were found in NeM with nevus-like appearance. NeM with multicomponent pattern were character- ized by irregular pigmentation, blue-white veil, irregular dots and atypical vascular pattern. Amelanotic NeM is rare and show atypical vascular pattern and milia-like cysts. CONCLUSIONS: Dermoscopy of NeM is challenging as it frequently shows a nevus-like pattern, but clues and detection of dermoscopic changes may help to identify it

Comparative dermoscopy assessment of nevus-associated versus de novo in situ melanoma

Background: Dermoscopic features differentiating in situ nevus-associated melanoma (NAM) versus in situ de novo melanoma (DNM) are inconclusive. Objectives: The aim of the study was to investigate the dermoscopic features associated with in situ NAM versus DNM. Materials & methods: This was a retrospective observational study. All consecutive in situ melanomas diagnosed in adult patients were retrieved and stratified as NAM vs DNM, and clinical and dermoscopic data were compared between the two. Results: A total of 183 patients with in situ melanoma were collected, of whom 98 (54%) were male with a mean age of 64±14 years. For 129 patients, standardized dermoscopic images were collected (51 for NAM and 78 for de novo MM). The most common dermoscopic features were an atypical pigment network (85%), atypical globules (63%) and regression (42%). No significant differences were found except for regression, which was detected in 54.9% NAM vs 33.3% DNM (p=0.016). Multivariate logistic regression confirmed the association between dermoscopic regression and NAM (OR=2.34, 95% CI: 1.15-4.91). Conclusion: Currently, the use of dermoscopy to determine whether a melanoma is associated with a nevus is unreliable, however, the presence of regression adjacent to atypical lesions may raise suspicion of in situ NAM

Acneiform Eruption Induced by Cetuximab

Cetuximab is a recombinant human/mouse chimeric monoclonal antibody that targets the extracellular domain of the epidermal growth factor receptor (EGFR). Cetuximab is approved by the US Food and Drug Administration for the treatment of EGFR-expressing metastatic colorectal cancer as monotherapy in patients who are intolerant to irinotecan-based chemotherapy, or in combination with irinotecan in patients who are refractory to irinotecan-based chemotherapy. Due to the important role of the EGFR in skin homeostasis, cutaneous reactions are a common adverse effect of cetuximab, mainly as acneiform follicular eruption seen in almost 85% of patients. We report on a 46-year-old female Caucasian patient with metastatic colorectal cancer, referred to our department for acneiform eruption induced by cetuximab in combination with irinotecan. Four days after the first infusion the patient developed intense acneiform eruption consisting of erythematous follicular papules and pustules spread to the face, neck and upper part of the trunk, accompanied by intense pruritus and fever (38.0 degrees C). There were no comeclones. Biopsy specimen revealed superficial and florid neutrophilic suppurative folliculitis. She was treated with erythromycin tablet 600 mg, three times a day for 1 month, and topical clindamycin solution 3%. After 1 month of treatment, the lesions consistently faded, and the patient continued receiving immunochemotherapy