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Linear immunoglobulin A (IgA) bullous dermatosis (LABD) is characterized by the presence of multiple IgA autoantibodies, and a comparatively lesser number of IgG antibodies, directed against different hemidesmosomal antigens. The main autoantigens are LAD-1, LABD-97, BP180 and BP230, type VII collagen and laminin 332. The serology of 54 Italian patients with LABD was studied retrospectively using enzymelinked immunosorbent assay (ELISA), immunoblotting assay, and indirect immunofluorescence on monkey oesophagus and salt-split skin. Among these, indirect immunofluorescence of salt-split skin elicits the greatest sensitivity. Sixty-three percent of the sera were observed to be positive, with a lamina lucida pattern observed in 48%, a sub-lamina densa pattern in 2% and a mixed pattern in 13% of cases. IgA reactivity to LAD-1 on immunoblotting was found in 52% of sera, to BP180-NC16A by ELISA in 32% and to BP230 in 26%. Only 17% of patients had circulating IgG autoantibodies. LAD-1 was determined to be a major autoantigen of the lamina lucida subtype. Combined serological assays demonstrated a high sensitivity (82%), suggesting that this approach could support diagnosis when a biopsy is not feasible or direct immunofluorescence results are negative. [ABSTRACT FROM AUTHOR]

The article offers information on Xerosis, a very common skin disorder in patients with type 2 diabetes mellitus (T2DM). Topics discussed include relation between xerosis and diabetic hand syndrome and keratosis pilaris; association of xerosis with increased transepidermal water loss, documenting skin barrier damage, correct management; and treatment for xerosis can limit skin complications, such as cracks, fissures, superinfections, and ulcers.

Chronic spontaneous urticaria (CSU) is perceived as a difficult to manage disease with negative impact on quality of life. The aim of this study was to highlight how to improve the care of people with CSU, using the methodology of narrative medicine. From June 2014 to March 2015, CSU-diagnosed patients and their physicians were asked to record their experiences of the condition in writing. Fourteen healthcare teams participated: 41% considered CSU as a challenge to overcome, while 22% experienced CSU as a big commitment. The number of professional involved was evaluated as insufficient in 11 hospitals. Seventy-five percent of the 190 Italian patients had visited 3 or more physicians before receiving a final diagnosis, with a perceived waste of time and resources. The therapeutic pathways were described as unsatisfactory in 83% of cases. As a result, anger and frustration were life-dominant emotions in 92% of patients. The critical points of the care pathway are related to organizational issues and lack of awareness. [ABSTRACT FROM AUTHOR]

Direct diagnosis of mucous membrane pemphigoid (MMP) is not easy. Circulating autoantibodies targeting bullous pemphigoid antigens of 180 kDa and 230 kDa (BP180 and BP230), α6β4 integrin, laminin 332 and type VII collagen (Col VII) are not always present. The aims of this study were to characterize the humoral immune response of a cohort of Italian patients with MMP, its association with clinical involvement and severity, and to design an algorithm for efficient serological diagnosis. Seventy-eight MMP sera were studied retrospectively by indirect immunofluorescence on salt-split skin, enzyme-linked immunosorbent assay (ELISA) and immuno-blotting. Indirect immunofluorescence on salt-split skin resulted in the most sensitive approach for diagnosis of MMP. BP180 was the major autoantigen in MMP patients with oral and cutaneous involvement. Significant associations were found between BP180 reactivity and oral and cutaneous localization of the lesions (p = 0.006), and between Col VII positivity and Setterfield severity score (p = 0.020). [ABSTRACT FROM AUTHOR]

The article comments on research which concluded that erythemato-papular exanthem is related to human herpesvirus (HHV)-7 infection. Topics discussed include infectious exanthems associated with regional/diffuse lymph node enlargement and lesions of the oral mucosa and failure of the research to specific whether the patient had exanthematous diseases during childhood.

The article presents a case study of a 70-year-old White woman presented with a 40-year history of an asymptomatic erythematous, ulcerated nodule on left ankle. Topics include a skin biopsy showed well-defined acanthosis with psoriasiform hyperplasia, rete ridges of varying width, and partial fusion of rete ridges; and the lesion has first appeared as a red, dome-shaped papule has 30 years old.

The article presents a case study of a 24-year-old woman presented with a 2-year history of spontaneous, painful, swollen erythematous lesions, progressing to ecchymosis, on legs. Topics include the first biopsy showed lymphohystiocytic and neutrophilic infiltrate in fat tissue; and the second biopsy, showed oedema, haemorrhage and dense neutrophilic, as well as eosinophilic, infiltrate in upper dermis without vasculitis.

The article presents a case study of a 24-year-old man, with neither family nor personal history of AA or psoriasis, presented with severe adult-onset AD duration that was recalcitrant to topical corticosteroids and systemic, ciclosporin. The article discusses that IL-4 is a known negative regulator of Th1- and Th17- mediated inflammation. It has been suggested that its blockade by dupilumab may create a Th2/Th1 imbalance and enhance or promote Th1/Th17.

The article discusses the case of 79-year-old patient with routine mole mapping. He reported no personal or familiar history of melanoma and had recently had a basal cell carcinoma (BCC) excised. Clinical examination revealed that he had skin phototype II. It mentions that all patients with cutaneous melanoma (CM) have synchronous second primaries of patients with multiple primary melanomas present with synchronous lesions.

Serological diagnosis of bullous pemphigoid is based on immunoblotting or indirect immunofluorescence on normal human salt-split skin. These methods are expensive or time-consuming and not available as a routine test in all laboratories. We used rat bladder epithelium as substrate for indirect immunofluorescence and compared it with other substrates and with immunoblotting. Twenty-nine bullous pemphigoid sera were studied on rat bladder epithelium, monkey oesophagus, salt-split skin and with immunoblotting on human keratinocyte cultures. Indirect immunofluorescence on rat bladder epithelium proved to be more sensitive (72%) than on monkey oesophagus alone (45%) and less sensitive than on salt-split skin (97%). Rat bladder epithelium, when tested on 41 sera of a control group, showed a very high specificity: 2/41 (95%). In combination with immunoblotting on keratinocyte extracts, indirect immunofluorescence on rat bladder epithelium allowed 93% of sera to be recognized, a value close to the salt-split skin alone. Rat bladder epithelium appears to be a more sensitive substrate than monkey oesophagus for the diagnosis of bullous pemphigoid and, although less specific, it is easier and faster than using salt-split skin, which remains indispensable to distinguish bullous pemphigoid from epidermolysis bullosa acquisita. [ABSTRACT FROM AUTHOR]

A letter to the editor about a case of bullous lesions in chronic lymphocytic leukemia is presented.

The article presents a study describing histological and immunohistochemical features of penile squamous cell carcinomas (SCC) in cancer patients. The study also examines the modulation of hormonal receptors oestrogen receptors (ERa), androgen receptor (AR), progesterone receptor (PR) and molecular proliferation markers in normal penile epithelium and in SCC. Information on the methods used in the study and results is provided.

The article describes the case of homozygous twins with the first, a 47-year-old verweight male patient with a history of psoriasis and who received the ustekinumab human monoclonal antibody. The variables considered include the presence of the human leukocyte antigen (HLA)-Cw602 allele, the response of the twins to ustekinumab and their personal life profiles. A discussion on the immune response of the first twin is offered.

The article presents a case study of a 70-year-old man who was presented with paraneoplastic pemphigus (PNP) associated with retroperitoneal Kaposi's sarcoma (KS). It mentions the patient's suprabasal intraepidermal blistering skin lesion, the administration of the oral prednisone and treatment with glucocorticoids, and the skin biopsy which revealed lichenoid infiltrate, a histological features of KS.

A letter to the editor is presented related to a case study on the diagnosis and treatment of onchomycosis which is caused by Aspergilllus nomius.

The article presents case studies of 71-year-old and 53-year-old men with psoriatic arthritis. These cases describe the cutaneous adverse events in patients receiving treatment with tumour necrosis factor (TNF)-alpha blocking agents. They show the atypical lichenoid drug eruptions with interface dermatitis histology that occurred during therapy for psoriasis and psoriatic arthritis with the TNF-alpha blocking agents infliximab and etanercept.

A letter to the editor is presented in response to the article "Hydroxychloroquine in Psoriasis: Is it Really Harmful?," that was published in April 20, 2006 issue.

Presents a letter to the editor about a study investigating the presence of immunoglobulinA-antiendomysial antibodies in patients with pemphigus.

The article presents the case of a 34-year-old female patient with a history of hepatitis C virus recurrence, erythematous papulo-squamous lesions on her trunk and limbs and a patch on the right upper arm, which was consistent with the diagnosis of pityriasis rosea (PR). The diagnosis was confirmed after patchy parakeratosis and dyskeratotic cells in the epidermis, edema and perivascular infiltration of lymphocytes and histiocytes in the papillary dermis were discovered using a biopsy specimen.