Chemical characterization of inks in skin reactions to tattoo

Skin reactions are well described complications of tattooing, usually provoked by red inks. Chemical characterizations of these inks are usually based on limited subjects and techniques. This study aimed to determine the organic and inorganic composition of inks using X-ray fluorescence spectroscopy (XRF), X-ray absorption spectroscopy (XANES) and Raman spectroscopy, in a cohort of patients with cutaneous hypersensitivity reactions to tattoo. A retrospective multicenter study was performed, including 15 patients diagnosed with skin reactions to tattoos. Almost half of these patients developed skin reactions on black inks. XRF identified known allergenic metals - titanium, chromium, manganese, nickel and copper - in almost all cases. XANES spectroscopy distinguished zinc and iron present in ink from these elements in endogenous biomolecules. Raman spectroscopy showed the presence of both reported (azo pigments, quinacridone) and unreported (carbon black, phtalocyanine) putative organic sensitizer compounds, and also defined the phase in which Ti was engaged. To the best of the authors' knowledge, this paper reports the largest cohort of skin hypersensitivity reactions analyzed by multiple complementary techniques. With almost half the patients presenting skin reaction on black tattoo, the study suggests that black modern inks should also be considered to provoke skin reactions, probably because of the common association of carbon black with potential allergenic metals within these inks. Analysis of more skin reactions to tattoos is needed to identify the relevant chemical compounds and help render tattoo ink composition safer.Peer reviewe

Pathologies related to abnormal deposits in dermatology : a physico-chemical approach

Although numerous pathologies are associated with abnormal skin deposits, these remain poorly described, as accurate characterization continues to present a challenge for dermatologists. Their submicrometer size as well as their diverse chemistry require various characterization tools. We aim to exemplify characterization of endogenous and exogenous skin deposits in some selected skin diseases using different physico-chemical techniques. We begin with a presentation of selected dis-eases associated with skin deposits. We then present those of our results which show their variety of structure, location and chemical composition, obtained with various tools: Field Emission Scanning Electron Microscopy coupled with Energy Dispersive X-ray Spectroscopy, X-ray fluorescence, vibra-tional spectroscopies, as well as techniques specific to synchrotron radiation. Our results constitute a real opportunity to improve diagnosis, and to understand the pathogenesis of many skin diseases, and opportunities for therapeutic intervention.Peer reviewe

Les dermatoses bulleuses de l'adulte (de la théorie... à la pratique)

Le diagnostic des dermatoses bulleuses de l adulte est souvent difficile. Les étiologies sont nombreuses avec des critères histologiques peu spécifiques, nécessitant une étude en immunopathologie. Une confrontation anatomo-clinique est également indispensable. La connaissance, à l échelle ultrastructurale, des systèmes de jonction cutanés permet une meilleure compréhension de la pathologie bulleuse. L'analyse histologique doit être systématique. Elle doit situer le niveau de clivage, intra ou sous-épidermique, puis analyser le toit, le contenu de la cavité bulleuse, son plancher et les lésions associées. L'immunopathologie, avec principalement l'immunofluorescence, met en évidence les dépôts immuns dans les dermatoses auto-immunes, et l'immunoblot caractérise les anticorps circulants et leurs antigènes cibles. L'objectif de ce travail a été de réaliser un CD-ROM pour faciliter la compréhension, le diagnostic et l'enseignement de la pathologie bulleuse cutanée de l adulte.The diagnosis of bullous dermatoses is often difficult. The etiologics are numerous with histologic criteria being non-specific. Immunopathologic studies are therefore necessary to confirm diagnosis. A collaboration between pathologist and dermatologist is often necessary. Knowledge of the skin's junctional system is important in understanding bullous pathology. Microscopic analysis must be systematic : first, at the level of the blister (intraepidermal or subepidermal), second at the top of the blister, third inside the blister, fourth at the roof and finally at the associated lesions. Immunopathologic studies, principally immunofluorescence, detect the deposition of antibodies within the tissues in the autoimmune blistering skin diseases, and immunoblots assess the specific antigen to whih circulating antibodies blind. A CD-ROM was developped to facilitate the comprehension, diagnosis and teaching of bullous dermatoses.ST QUENTIN EN YVELINES-BU (782972101) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Brain abscess complicating ischemic embolic stroke in a patient with cardiac papillary fibroelastoma – Case report and literature review

International audienc

Mixed Endocrine Somatostatinoma of the Ampulla of Vater Associated with a Neurofibromatosis Type 1: A Case Report and Review of the Literature

Context Mixed endocrine tumors are double neoplasms with both glandular and endocrine components; these tumors are rare, especially those arising in the ampulla of Vater. Ampullary somatostatinomas are classically associated with neurofibromatosis type 1. We herein describe the first reported case of a mixed endocrine somatostatinoma of the ampulla of Vater associated with neurofibromatosis type 1; we also present a review of the literature of the 7 mixed endocrine tumors of the ampulla which have been reported so far. Case report A 49-year-old woman presented with atypical abdominal pain. Endoscopic examination revealed a tumor involving the ampulla of Vater and a CT scan identified stenoses of both the distal common bile duct and the main pancreatic duct. A pancreaticoduodenectomy was performed and pathological examination revealed two tumor components, exocrine (high grade adenoma with infiltrative adenocarcinoma) and endocrine (expressing somatostatin hormone) with lymph node metastases originating from both types. The patient was treated with adjuvant chemotherapy and has had no recurrence for 3 years. Discussion In ampullary somatostatinomas, psammoma bodies are pathognomonic and chromogranin A is rarely expressed: these features should alert the pathologist to an association with neurofibromatosis type 1. The management of patients with mixed tumors is challenging. The treatment of choice is surgery, and adjuvant chemotherapy should be adapted to the most aggressive component, i.e. the exocrine one. Conclusion Because of their rarity, the diagnosis of ampullary mixed endocrine tumors is difficult. Our case points out the characteristic features of these neoplasms and their possible association with neurofibromatosis type 1.Image: Large exophytic duodenal tumor situated in and around the ampulla of Vater

An atypical persistent eruption of adult-onset Still's disease with neutrophilic urticarial dermatosis-like dermal features: A case report and review of the literature

Adult‐onset Still's disease (AOSD) is a rare systemic inflammatory disorder with unknown etiology. Cutaneous manifestations of AOSD could be typical (evanescent maculopapular rash, salmon‐pink, and non‐ or mildly pruriginous) or atypical (persistent lesions with pruritus). In typical AOSD, microscopic assessment shows non‐specific features such as very mild dermal inflammatory infiltrate (lymphocytes and neutrophils), and in atypical AOSD, it shows highly suggestive dyskeratotic/necrotic keratinocytes with neutrophilic and lymphocytic dermal infiltrate.1-3 Neutrophilic urticarial dermatosis (NUD) is an autoinflammatory condition recently described as recurrent urticarial eruption vanishing within 24 hours with histologically marked neutrophilic infiltrate and leukocytoclasia. NUD is a rare cutaneous presentation of AOSD.4 We report two cases of atypical persistent eruption of AOSD with dyskeratotic/necrotic keratinocytes and in one case leukocytoclasia (as an NUD‐like dermal pattern) that has rarely been described previously. Knowledge of the clinico‐pathological spectrum of atypical AOSD should facilitate diagnosis of this rare and severe disease