A solitary pink lesion: dermoscopy and RCM features of lichen planus

We present an unusual onset of cutaneous lichen planus (LP) in a middle-aged patient. The initial presentation as solitary, indolent pink lesion required further investigations to rule out malignancy, especially amelanotic melanoma. Dermoscopy and reflectance confocal microscopy findings were found to be helpful in our case in addressing the correct diagnosis

Malattia di Kyrle: eccezionale risposta all’isotretinoina orale

Si presenta il caso di una paziente di 51 anni, affetta da sindrome metabolica, spondiloartrite sieronegativa ed insufficienza renale cronica, afferente al servizio di dermatologia per la presenza di lesioni papulo-nodulari ipercheratosiche follicolari diffuse agli arti ed estremamente pruriginose. Tali lesioni, presenti da alcuni anni, erano state dapprima trattate con terapie topiche (steroidi, antibiotici, retinoidi ed emollienti) con scarso beneficio. A scopo diagnostico veniva eseguita una biopsia cutanea per esame istologico con esito di malattia di Kyrle. Veniva iniziato un ciclo di fototerapia con nb-UVB, poi sospeso per inefficacia. Anche la terapia con metotrexato, impostata per insoddisfacente controllo della patologia reumatologica, non mostrava alcun beneficio sulle manifestazioni cutanee. Veniva dunque intrapresa una terapia con isotretinoina orale 0,5 mg/Kg/die la quale dopo circa 1 anno ha permesso di ottenere una eccezionale e pressoché completa remissione del quadro cutaneo, in assenza di rilevanti effetti collaterali

The combination of oral and topical photoprotection with a standardized Polypodium leucotomos extract is beneficial against actinic keratosis

IntroductionThis study describes a prospective, multicentre, randomized controlled, open-label study with three arms aimed at studying the differences between: [Cnt], self-administered sun protection; [T], topical treatment; and [TO], topical + oral treatment; for the management of Actinic Keratosis (AK) in a cohort of subjects of advanced age displaying severe actinic damage (SAD). MethodsTreatments administered to groups [T] and [TO] had a common component, which is a botanical extract, Fernblock, with demonstrated photoprotective activity. ResultsIn total, 131 subjects were distributed randomly in the three groups, and followed up clinically at three separate time points, beginning of the study (t = 0) and after 6 and 12 months. Analysis of clinical data and examination using reflectance confocal microscopy (RCM) revealed that group [T] and [TO] displayed decreased clinical AK and field cancerization parameters, including the number of new lesions, and reduced the need for additional interventions in these patients. RCM revealed normalization of the keratinocyte layer. Improvements in AK and field cancerization parameters were greatest in the group [TO], suggesting that topical and oral photoprotection improves the clinical and anatomical outcome compared to control conditions. ConclusionsThe combination of topical and oral immune photoprotection provides an advantage compared to topical photoprotection alone

Una storia di lesioni bollose di lunga durata

Si presenta il caso di una paziente di 33 anni di origine marocchina che riferiva fin dall’età infantile la comparsa al minimo traumatismo di multiple piccole lesioni bollose prevalentemente agli arti inferiori con saltuario coinvolgimento del cavo orale. In anamnesi ipertensione arteriosa in terapia farmacologica, un fratello di 47 anni con manifestazioni analoghe ed una sorella di 28 anni affetta da vitiligine, entrambi residenti nel paese di origine. All’esame obiettivo si osservavano molteplici esiti ipo- ed iper-pigmentati ed alcune aree disepitelizzate frammiste a lesioni crostose prevalentemente agli arti inferiori. Erano presenti, inoltre, alcune piccole bolle flaccide a contenuto siero-ematico alla pianta dei piedi ed un marcato diradamento dei capelli. Non era documentabile un interessamento delle mucose. Le indagini biochimiche, istologiche, immunologiche ed ultrastrutturali hanno portato ad una inconsueta diagnosi

Seborrheic keratoses mimicking melanoma unveiled by in vivo reflectance confocal microscopy

Background: Seborrheic keratoses (SebK) with atypical dermoscopy presentation are increasingly reported. These lesions do not exhibit typical dermoscopy features of SebK and sometimes mimic melanoma, thus complicating the differential diagnosis. Reflectance confocal microscopy (RCM) is a non-invasive tool, which allows an in vivo imaging of the skin. Objective: To evaluate the agreement between RCM classification and histological diagnoses, and the reliability of well-known RCM criteria for SebK in the identification of SebK with atypical dermoscopy presentation. Methodology: We retrospectively analysed at RCM excised lesions presenting in dermoscopy 651 score at revisited 7-point checklist. The study population consisted of cases showing no melanocytic RCM findings. Lesions were investigated for distinct non-melanocytic RCM features, blinded from histopathology diagnoses. Histopathology matching was then performed before statistical analysis. Results: The study consisted of 117 cases, classified at RCM as SebK (71 cases), dermatofibroma (DF; 18 cases), basal cell carcinoma (BCC; 13 cases), squamous cell carcinoma (SCC; 2 cases), and \u201cnon specific\u201d (13 cases). Overall K strength of agreement at histopathology matching proved 0.76. Of the 71 cases classified at RCM with SebK, agreement was achieved in 97%. Conclusions: RCM classification proved high agreement with histopathology for SebK with atypical dermoscopy presentations, allowing an early differential diagnosis. RCM features in this group of lesions were similar to those described for typical cases of SebK, and may assist clinician therapy decision making, whilst avoiding unnecessary excisions

SAÚDE COLETIVA INFORMA – CARTA DE DIREITO DOS USUÁRIOS DO SUS

A Carta dos Direitos dos Usuários do SUS é fruto de um trabalho cuidadoso, que visa garantir o acesso universal e igualitário às ações e serviços para promoção, proteção e recuperação da saúde. Com tantas mudanças sociais, econômicas e políticas acontecendo nos últimos anos no País, os usuários desconhecem a totalidade de seus direitos para usufruírem corretamente dos benefícios garantidos a eles. O documento, que tem como base seis princípios básicos de cidadania, caracteriza-se como uma importante ferramenta para que o cidadão conheça seus direitos e deveres no momento de procurar atendimento de saúde, tanto público quanto privado. Foi realizada uma pesquisa quantitativa por meio de coleta de dados com questionários nas Cidades de Herval d’Oeste e Joaçaba, entrevistando pessoas nas ruas e também dentro dos postos de saúde das Cidades. Alguns desses entrevistados foram filmados, e, então, foi produzido um vídeo para melhor entendimento do assunto proposto, explanando cada questão colocada na pesquisa em forma de telejornal; em cada questão citava-se um dos direitos contidos na carta para se observar se o usuário conhecia ou não esse direito. Infelizmente, os resultados da pesquisa evidenciaram que a maioria dos entrevistados não conhece todos os direitos oferecidos a eles, porém o ideal seria que a população tivesse plena ciência dessa Carta. Para o Conselho Nacional de Saúde, é importante que todos se apossem do conteúdo da Carta, elaborada com uma linguagem acessível, para, assim, permitir o debate e a apropriação dos direitos e deveres nela contidos por parte dos gestores, trabalhadores e usuários do SUS.Palavras-chave: Saúde pública. Direitos humanos. Sistema Único de Saúde

De Novo Skin Neoplasms in Liver-Transplanted Patients: Single-Center Prospective Evaluation of 105 Cases

Background and Objectives: Solid-organ transplant recipients (SOTRs) are notably considered at risk for developing cutaneous malignancies. However, most of the existing literature is focused on kidney transplant-related non-melanoma skin cancers (NMSCs). Conflicting data have been published so far on NMSC incidence among liver transplant recipients (LTRs), and whether LTRs really should be considered at lower risk remains controversial. The aim of the present study was to prospectively collect data on the incidence of cutaneous neoplasms in an LTR cohort. Materials and Methods: All LTRs transplanted at the Hepato-Pancreato-Biliary Surgery and Liver Transplantation Unit of Modena University Hospital from October 2015 to June 2021 underwent a post-transplant periodic skin check at the Dermatology Unit according to our institutional integrated care pathway. Data on the presence of cutaneous malignant and premalignant lesions were collected at every timepoint. Results: A total of 105 patients were enrolled in the present study. Nearly 15% of the patients developed cutaneous cancerous and/or precancerous lesions during the follow-up period. Almost half of the skin cancerous lesions were basal cell carcinomas. Actinic keratoses (AKs) were observed in six patients. Four patients developed in situ squamous cell carcinomas, and one patient was diagnosed with stage I malignant melanoma. Otherwise, well-established risk factors for the occurrence of skin tumors, such as skin phototype, cumulative sun exposure, and familial history of cutaneous neoplasms, seemed to have no direct impact on skin cancer occurrence in our cohort, as well as an immunosuppressive regimen and the occurrence of non-cutaneous neoplasms. Conclusions: Close dermatological follow-up is crucial for LTRs, and shared protocols of regular skin checks in this particular subset of patients are needed in transplant centers

Presentazione dermoscopica atipica di lesioni non melanocitarie benigne: quale aiuto dal confocale?

Sono sempre più frequenti i report di lesioni cutanee benigne che simulano clinicamente il melanoma; in questi casi spesso mancano i criteri clinico-dermoscopici tipici. Abbiamo analizzato retrospettivamente in microscopia laser confocale (RCM) lesioni che presentassero in dermoscopia punteggio ≥1 alla revisited 7-point checklist, focalizzandoci su quelle prive di criteri melanocitari. Ogni caso è stato indagato quindi per la presenza di caratteristiche RCM non melanocitarie. La selezione ha permesso di raccogliere 117 lesioni a presentazione dermoscopica atipica, classificate al confocale come benigne (71 cheratosi seborroiche e 18 dermatofibromi), maligne (13 basaliomi e 2 spinaliomi), e “non specifiche” (13). Il valore K relativo al matching complessivo con l’istologia è risultato elevato (0.76); per cheratosi seborroiche e dermatofibromi la concordanza è risultata del 97% e 89% rispettivamente. I risultati ottenuti su un gruppo di lesioni di difficile inquadramento clinico, confermano l’utilità del confocale nella diagnosi differenziale non invasiva tra patologie benigne e maligne

Myeloid cell iron uptake pathways and paramagnetic rim formation in multiple sclerosis

In multiple sclerosis (MS), sustained inflammatory activity can be visualized by iron-sensitive magnetic resonance imaging (MRI) at the edges of chronic lesions. These paramagnetic rim lesions (PRLs) are associated with clinical worsening, although the cell type-specific and molecular pathways of iron uptake and metabolism are not well known. We studied two postmortem cohorts: an exploratory formalin-fixed paraffin-embedded (FFPE) tissue cohort of 18 controls and 24 MS cases and a confirmatory snap-frozen cohort of 6 controls and 14 MS cases. Besides myelin and non-heme iron imaging, the haptoglobin-hemoglobin scavenger receptor CD163, the iron-metabolizing markers HMOX1 and HAMP as well as immune-related markers P2RY12, CD68, C1QA and IL10 were visualized in myeloid cell (MC) subtypes at RNA and protein levels across different MS lesion areas. In addition, we studied PRLs in vivo in a cohort of 98 people with MS (pwMS) via iron-sensitive 3 T MRI and haptoglobin genotyping by PCR. CSF samples were available from 38 pwMS for soluble CD163 (sCD163) protein level measurements by ELISA. In postmortem tissues, we observed that iron uptake was linked to rim-associated C1QA-expressing MC subtypes, characterized by upregulation of CD163, HMOX1, HAMP and, conversely, downregulation of P2RY12. We found that pwMS with [Formula: see text] 4 PRLs had higher sCD163 levels in the CSF than pwMS with [Formula: see text] 3 PRLs with sCD163 correlating with the number of PRLs. The number of PRLs was associated with clinical worsening but not with age, sex or haptoglobin genotype of pwMS. However, pwMS with Hp2-1/Hp2-2 haplotypes had higher clinical disability scores than pwMS with Hp1-1. In summary, we observed upregulation of the CD163-HMOX1-HAMP axis in MC subtypes at chronic active lesion rims, suggesting haptoglobin-bound hemoglobin but not transferrin-bound iron as a critical source for MC-associated iron uptake in MS. The correlation of CSF-associated sCD163 with PRL counts in MS highlights the relevance of CD163-mediated iron uptake via haptoglobin-bound hemoglobin. Also, while Hp haplotypes had no noticeable influence on PRL counts, pwMS carriers of a Hp2 allele might have a higher risk to experience clinical worsening