Recalcitrant livedoid vasculopathy associated with hyperhomocysteinaemia responding to folic acid and vitamins B6/B12 supplementation

is missing (Short communication)

Lichen striatus associated with psoriasis vulgaris treated with oral acitretin.

Lichen striatus (LS) is an uncommon dermatosis of unknown etiology that presents as a continuous or interrupted linear band of pink, tan, red or skin-colored papules in a blaschkoid distribution. The lesions are generally solitary and unilateral, but unusual extensive cases with multiple and bilateral lesions have been also described. Albeit LS is typically an asymptomatic and self-limited dermatosis, it may cause a significant psychological distress in some patients, thus requiring an appropriate therapy. Topical steroid is the most commonly used treatment but it is not always effective. We report a case of LS unresponsive to topical steroid therapy associated with psoriasis vulgaris successfully treated with oral acitretin

Plaque-Type Psoriasis Treated with Calcipotriene Plus Betamethasone Dipropionate Aerosol Foam: A Prospective Study on Clinical and Dermoscopic Predictor Factors in Response Achievement and Retention

Introduction: Little information on possible local factors that can influence the achievement and retention of response of plaque-type psoriasis to calcipotriene plus betamethasone dipropionate aerosol foam is available. The aim of this study was to assess possible correlations between baseline clinical/dermoscopic features of psoriatic plaques and therapeutic response, and between residual dermoscopic findings in clinically improved/healed lesions and post-treatment relapse. Methods: For each target lesion, we calculated the local psoriasis severity index and assessed dermoscopic findings at baseline and at the end of a 4-week treatment, correlating the therapeutic outcome with the initial clinical and dermoscopic features. The lesions were also followed for a 4-week post-treatment period, and possible associations between relapse and (1) baseline clinical/dermoscopic features and (2) dermoscopic findings detected at the end of the treatment were assessed. Results: A total of 105 lesions from 35 patients were included in the analysis. After 4\ua0weeks of therapy, 13 lesions showed no/limited improvement, while partial and optimal response were observed in 51 and 41 plaques, respectively. Poor outcomes were correlated with both legs localization\ua0and degree of lesion infiltration at baseline. Similarly, presence of globular vessels at baseline dermoscopy was more commonly associated with no/limited response and lesions on the legs, particularly those showing resistance to treatment. A correlation was also found between dotted vessels on the baseline dermoscopic examination and good outcomes (partial/optimal response). After a 4-week post-treatment follow-up, 58.7% of the lesions achieving improvement at the end of the therapy showed relapse, with a correlation between recurrence and vessel persistence\ua0on dermoscopy at the end of the therapy. Conclusion: Clinical response of plaque-type psoriasis to calcipotriol/betamethasone dipropionate spray foam may be adversely affected by the degree of infiltration of lesions at baseline and by legs\ua0localization, and the presence of globular vessels at the baseline dermoscopic assessment is related to poor outcomes. A significant post-treatment relapse rate was observed, and persistence of vascular changes on dermoscopy seems to play a role in promoting disease recurrence

cutaneous vascular alterations in psoriatic patients treated with cyclosporine

Videocapillaroscopy can be used to assess cutaneous microcirculation modifications in vivo, and therefore allows assessment of variations in the microvascular architecture in psoriatic subjects during treatment. The aim of this study was to observe and quantify the modifications of the superficial capillary bed in psoriatic plaques during treatment with cyclosporin A. Twelve patients with psoriasis vulgaris were treated with an initial dose of 4 mg/kg/day cyclosporin A over a period of 3 months with periodic clinical and capillaroscopic assessments. Clinical resolution of the lesions and a reduction in microcirculatory alterations was observed in 70% of patients, although none returned to a normal capillaroscopic pattern

Parry-Romberg syndrome: A case with a possible association with lyme disease

Parry-Romberg syndrome is an acquired slowly progressive disease characterized by an atrophy mostly involving half of the face. The pathogenesis of this disfiguring condition is still controversial. The relationship between Parry-Romberg syndrome and Lyme disease needs to be considered in depth. A 16-year-old woman from Albania presented with linear depressions of the right side of the face, clinically compatible with Parry-Romberg syndrome. She had a positive history of Lyme disease. Borrelia infection was confirmed by the positivity of PCR and the presence of IgM antibodies. The patient received intravenous penicillin and metronidazole for 14 days. After treatment and during a 2-year follow-up, the clinical disease progression was halted and the serological and microbiological tests for Borrelia burgdorferi sensu lato were negative. We cannot exclude a coincidence, however, of the bacteriological and serological evidence. Moreover, the interruption of the disease progression after the antibiotic therapy is difficult to ignore without claiming that this association is at least suggestive

Autologous micrografts and methotrexate in plantar erosive lichen planus: healing and pain control. A case report

Erosive lichen planus is an uncommon variant of lichen planus. We report a case of long-standing and refractory plantar ELPs causing disabling and opiate-resistant pain treated with 'classic' meshed skin graft combined with RigeneraVR micrografts. After approximately 9 months follow-up, no clinical recurrence or pain were observed. Erosive lichen planus (ELP) is an uncommon variant of lichen planus, involving oral cavity and genitalia and, less often plantar areas, where it usually presents with chronic erosions of the soles, along with intense, disabling pain and progressive loss of toenails. An abnormal immune cellular response (CD8+ lymphocytes and macrophages) and the consequent altered production of multiple mediators (interleukin-12, interferon-gamma, tumor necrosis factor-alpha, RANTES and MMP-9), seem to play a crucial role in the pathogenesis, although the etiology remains uncertain. From a histological point of view, ELP shows keratinocyte apoptosis, intense inflammatory response and basal epithelial keratinocytes TNF-alpha overexpression. Several therapies have been proposed, with variable and controversial results. While topical corticosteroids and topical calcineurin inhibitors are the treatments of choice for localized forms, short pulses of systemic glucocorticoids, phototherapy, and systemic immunosuppressants are recommended for generalized cases. Surgery has been reported as a possible therapeutic option in refractory and stable cases with localized lesions, either alone or with cyclosporine. Herein, we report a case of longstanding and refractory plantar ELPS causing disabling and opiate-resistant pain treated with 'classic' meshed skin graft combined with RigeneraVR micrografts

Dermoscopic and Clinical Response Predictor Factors in Nonsegmental Vitiligo Treated with Narrowband Ultraviolet B Phototherapy: A Prospective Observational Study

Introduction: Few data on possible local factors that can influence the achievement of response in nonsegmental vitiligo (NSV) treated with narrowband ultraviolet B (Nb-UVB) phototherapy are available. Our objective is to evaluate possible correlations between therapeutic outcomes and dermoscopic and local (lesional) clinical findings of vitiligous lesions undergoing Nb-UVB phototherapy to find positive and/or negative response predictor factors to such treatment. Methods: For each target patch, we calculated the extension area using a computer-aided method and assessed dermoscopic and local (lesional) clinical findings at baseline. After 30 phototherapy sessions (twice weekly), surface area of the lesions was reevaluated to assess clinical improvement, correlating the therapeutic outcome with initial clinical and dermoscopic features. Results: A total of 70 lesions were finally included in the study. At the end of therapy, 18 patches (25.7%) achieved improvement, and the presence of perifollicular pigmentation on baseline dermoscopic examination was found to be associated with a 12-fold higher probability of having a positive therapeutic outcome. Similarly, face localization was also correlated with clinical amelioration, with a sevenfold higher probability for improvement. No association (p > 0.05) between therapeutic outcomes (either good or poor) and other dermoscopic or local clinical variables (including leukotrichia) was observed. Conclusions: Therapeutic response of vitiligo to Nb-UVB phototherapy may be positively affected by local features of the lesions, i.e., face localization and presence of perifollicular pigmentation on baseline dermoscopic examination, which might be considered as positive response predictor factors to optimize treatment of vitiligo

Sporotrichoid Mycobacterium marinum infection in an elderly woman

We describe the case of an elderly woman who acquired a Mycobacterium marinum infection following skin exposure to the bacteria through a small wound on her right ring finger, obtained while preparing fish. The resultant sporotrichoid nodules of the right hand and the distal forearm, refractory to the initial therapy with doxycycline and rifampicin, were successfully treated with oral regimen of clarithromycin. \ua9 2015 by the article author(s)

Giant melanoma of the abdomen: case report and revision of the published cases.

Malignant melanoma presenting as a giant cutaneous mass is rarely observed in clinical practice. A few patients with giant melanoma have been reported, Herein, we document our experience with a patient with giant cutaneous melanoma of the abdomen and review the features of previously reported individuals

Cutaneous melanoma frequencies and seasonal trend in 20 years of observation of a population characterised by excessive sun exposure

Background. Cutaneous melanoma is an aggressive form of skin cancer. It has become an increasingly common neoplasm in the most developed countries, especially among individuals of European origin. Patients and methods. Anonymous data of patients with cutaneous melanoma were collected from the diagnostic database of the University Hospital of Trieste from 1 January 1990 to 10 December 2013. Our study is based on a population which was constant over the period of observation; it was also well-defined and characterised by unrestrained sun exposure. Results. The number of cutaneous melanomas increased during the period of observation with a seasonality trend and gender related differences both for anatomical sites distribution and stage of the disease. Moreover, 6% of our cohort developed multiple melanomas. Conclusions. In a well-defined population devoted to excessive sun exposure the frequencies of skin melanomas roughly doubled from 1990 to 2013 following a seasonal trend. In that population, prevention efforts according to gender specific risk behaviour, as well as follow-up programmes both for evaluation of metastatic spreading and for early diagnosis of additional skin melanomas, are crucial due to gender specific differences and to the occurrence of multiple melanomas. \ua9 2015 Serena Bonin et al., published by De Gruyter Open