Pushing the edge of dermoscopy in new directions: Entomodermoscopy of Trombicula autumnalis

Dermatologists are often faced with the challenge of patients presenting with non specific symptoms such as itching and or erythema. These symptoms may be attributed to a number of diseases, many of which are trivial, and others even life-threatening. In order to establish the correct diagnosis, dermatologists must rely on good diagnostic tools and knowledge. Dermoscopy was introduced mainly for inspection of pigmented lesions, but its use has now also spread to non-melanoma skin cancer, inflammatory diseases, and almost any skin disease. This diagnostic technique also applies to skin infestation today, often offering the opportunity to rapidly identify new hidden features of parasites. This case report describes an unusual but representative case in which entomodermoscopy enabled a rapid diagnosis in a patient with a non specific erythematous patch. Whereas differential diagnosis of such skin manifestations could have been too laborious and misleading, dermoscopy easily allowed us to find a small parasite, later identified as Trombicula autumnalis

Interstitial granulomatous dermatitis due to borreliosis

3Interstitial granulomatous dermatitis (IGD) is a rare dermatosis of unknown cause with characteristic histopathological features and variable clinical expression. [1] It has been associated with systemic diseases which include rheumatoid arthritis, lupus erythematosus, autoimmune thyroiditis, carcinoma, infections and drug intake. It has recently been proposed that interstitial granulomatous dermatitis could be a cutaneous manifestation of Lyme borreliosis in Borrelia burgdorferi endemic areas. [2],[3],[4] We report a similar case below.openopenDI MEO, N.; Stinco, G.; Trevisan, G.DI MEO, Nicola; Stinco, G.; Trevisan, Giust

Customized multichannel measurement system for microbial fuel cell characterization

This work presents the development of an automatic and customized measuring system employing sigma-delta analog-to-digital converters and transimpedance amplifiers for precise mea- surements of voltage and current signals generated by microbial fuel cells (MFCs). The system can perform multi-step discharge protocols to accurately measure the power output of MFCs, and has been calibrated to ensure high precision and low noise measurements. One of the key features of the proposed measuring system is its ability to conduct long-term measurements with variable time steps. Moreover, it is portable and cost-effective, making it ideal for use in laboratories without sophisti- cated bench instrumentation. The system is expandable, ranging from 2 to 12 channels by adding dual-channel boards, which allows for testing of multiple MFCs simultaneously. The functionality of the system was tested using a six-channel setup, and the results demonstrated its ability to detect and distinguish current signals from different MFCs with varying output characteristics. The power measurements obtained using the system also allow for the determination of the output resistance of the MFCs being tested. Overall, the developed measuring system is a useful tool for characterizing the performance of MFCs, and can be helpful in the optimization and development of sustainable energy production technologies

Doxycycline, a widely used antibiotic in dermatology with a possible anti-inflammatory action against IL-6 in COVID-19 outbreak

N/

Management of advanced melanoma in the COVID-19 era

N/

Dermoscopy of Mycobacterium marinum Skin infection: A Challenging Diagnosis

Mycobacterium (M.) marinum is a slow-growing atypical mycobacterium found mainly in saltwater environments. Infection occurs following inoculation of a skin lesion and manifests as a localized granulo-ma; in fact, the most common cause of infection with M. marinum is the exposure of traumatized skin to affected aqueous environments (1), and it most commonly involves individuals with occupational and recreational exposure to non-chlorinated water (2)

Dermoscopy of Mycobacterium marinum Skin infection: A Challenging Diagnosis

Dear Editor, Mycobacterium (M.) marinum is a slow-growing atypical mycobacterium found mainly in saltwater environments. Infection occurs following inoculation of a skin lesion and manifests as a localized granuloma; in fact, the most common cause of infection with M. marinum is the exposure of traumatized skin to affected aqueous environments (1), and it most commonly involves individuals with occupational and recreational exposure to non-chlorinated water (2). An erythematous or bluish 0.5 to 3.0 cm nodule usually develops at the inoculation site, while ulceration can occur later and subsequent lesions may be present along the lymphatic drainage. We present the first case in the literature describing the dermatoscopic characteristics of a microbiologically proven Mycobacterium marinum skin infection, although more cases are certainly needed to identify the main dermatoscopic features of this infection. In January 2019, a 66-year-old patient was referred to our Dermatological Clinic reporting the appearance of two purplish nodules about 2 months earlier, located on the back of the hand and on the left thumb (Figure 1) and of erythematous purplish appearance and quite painful to palpation. Based on the clinical presentation, infection with atypical mycobacteria, botryomycosis, fungal infection (Cryptococcus neoformans, Histoplasma capsulatum) and infection with Francisella tularensis were considered in the differential diagnosis. The patient was asked if he had an aquarium at home and he confirmed this by telling us of his passion for aquariums, which made the diagnosis easier. Dermatoscopic examination performed on the two lesions at the center of the first nodule located on the hand showed a whitish area surrounded by an erythematous background with fine scaling and dotted vessels and orange-whitish central areas with looped concentric monomorphic vessels (Figure 2, a). However, the thumb lesion had a purplish background with multiple structured rounded areas with orangish appearance surrounded by looped vessels arranged in a crown-like shape (Figure 2, b). It is interesting to note the dermoscopic-histological correlation in this disease: the orangish areas in fact correspond to a granulomatous dermatitis, characterized by inflammatory nodular infiltrate within the dermis (tuberculoid granulomas) (3). Clinically and dermoscopically, the nodules had two different sets of features because they were in different stages of development: the nodule of the thumb was older than the other one on the hand, which the patient reported was of recent onset, also confirmed by the presence of suppuration and ulceration. Both lesions had orange areas in the context of an erythematous background which led us to investigate a granulomatous disease. A deep culture examination and a skin biopsy were thus performed, showing Mycobacterium marinum infection. Oral therapy with clarithromycin 500 mg twice daily for 4 weeks was started and healing occurred in about 21 days. We present this case to emphasize the role of dermoscopy in differential diagnosis of granulomatous disease and to show dermoscopic clues that have not yet been described and that can be used in the future to establish very early diagnosis of this infection, reducing the diagnostic delay

Toxic local reaction after phosphatidylcholine mesotherapy

N/

Yellow Plugs: An Additional Dermoscopic Criterion in the Diagnosis of Primary Cutaneous B-Cell Lymphoma

n/