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Abstract Background and objectives Freckles (ephelides) are small, light brown macules of sun-exposed areas in fair-skinned subjects. On the other hand, freckle-like pigmentation of the axilla is a highly characteristic feature of neurofibromatosis. To what extent (clinically and pathologically) are the two pigmentary defects similar? And to what extent are café-au-lait patches and freckle-like lesions similar pathologically? Subjects and methods Ten cases of neurofibromatosis and 10 cases of freckles were examined clinically. Two biopsies were taken from the former; one obtained from an axillary freckle-like lesion, and the other from a café-au-lait patch. One biopsy only was taken from freckles. The biopsies were processed for haematoxylin and eosin, silver stain and transmission electron microscopy. Results Obvious differences were detected between freckles (ephelides) and freckle-like lesions in cases of neurofibromatosis. Café-au-lait patches and freckle-like lesions showed the same pathological changes of lentigo simplex, with increased melanin pigment from the basal layer up to the stratum corneum, moderate elongation of the rete ridges and mild inflammatory infiltrate intermingled with melanophages. Electron microscopy revealed an increase in melanocyte number and the presence of giant melanin granules in freckle-like pigmentation as well as café-au-lait patches. These ultrastructural freckles (ephelides) showed an increase in activity but not the number of melanocytes. Conclusions The term freckle-like should be changed to lentiginous macules of neurofibromatosis. On the other hand, the café-au-lait patches should be considered as lentiginous patches. Freckles should be restricted to sun-exposed areas in fair-skinned persons only. [ABSTRACT FROM AUTHOR]

Background: Melasma is a chronic acquired focal pigment disorder showing symmetrical hyperpigmentation or hypermelanosis of photoexposed areas on the face. Tranexamic acid (TXA) is a treatment for melasma. The regression of melasma after platelet-rich-plasma (PRP) treatment is an interesting finding., Objective: We investigated the effect of microneedling followed by PRP versus microneedling followed by tranexamic acid in the treatment of patients with melasma., Methods: The study included 26 patients with melasma divided into two groups of 13 patients each. Group 1 was treated with microneedling and PRP, and Group 2 was treated with microneedling and tranexamic acid., Results: The response to treatment was assessed using the Melasma Area and Severity Index scoring system before and after treatment. At the start of the study and at the first session, there were no statistically significant differences ( p >0.05). At the second and third treatment sessions, there were statistically significant differences ( p <0.05). There were no statistically significant differences between the two groups regarding side effects of pain, erythema and postinflammatory hyperpigmentation., Conclusion: Microneedling with PRP offers better results than microneedling with TXA in treating melasma., Competing Interests: DISCLOSURES: The authors report no conflicts of interest relevant to the content of this article., (Copyright © 2021. Matrix Medical Communications. All rights reserved.)

Gold nanoparticles (AuNPs) represent an effective choice for topical drug delivery systems thanks to their small size, general non-toxicity, ease of functionalization and high surface to volume ratio. Even if systemic, methotrexate still plays an important role in psoriasis treatment: its topical use shows insufficient percutaneus penetration owing to limited passive diffusion, high molecular weight and dissociation at physiological pH. The aim of our study was to design a new drug delivery nanocarrier for Methotrexate and to improve its solubility, stability and biodistribution. AuNPs were on purpose prepared with a hydrophilic stabilizing layer, in order to improve the colloidal stability in water. Water-soluble gold nanoparticles functionalized by sodium 3-mercapto-1-propansulfonate (Au-3MPS) were prepared and loaded with methotrexate (MTX). The loading efficiency of MTX on Au-3MPS was assessed in the range 70-80%, with a fast release (80% in one hour). The release was studied up to 24h reaching the value of 95%. The Au-3MPS@MTX conjugate was fully characterized by spectroscopic techniques (UV-vis, FTIR) and DLS. Preliminary toxicity tests in the presence of keratinocytes monolayers allowed to assess that the used Au-3MPS are not toxic. The conjugate was then topically used on C57BL/6 mouse normal skin in order to trace the absorption behavior. STEM images clearly revealed the distribution of gold nanoparticles inside the cells. In vitro studies showed that Methotrexate conjugated with Au-3MPS is much more efficient than Methotrexate alone. Moreover, DL50, based on MTT analysis, is 20 folds reduced at 48 h, by the presence of nanoparticles conjugation. UV-vis spectra for in vivo tracing of the conjugate on bare mouse skin after 24h of application, show increased delivery of Methotrexate in the epidermis and dermis using Au-3MPS@MTX conjugate, compared to MTX alone. Moreover we observed absence of the Au-3MPS in the dermis and in the epidermis, suggesting that these layers of the skin do not retain the nanoparticles. Based on our data, we found that the novel Au-3MPS@MTX conjugate is an effective non-toxic carrier for the satisfactory percutaneous absorption of Methotrexate and could help in possible topical treatment of psoriasis., (Copyright © 2016 Elsevier B.V. All rights reserved.)

Background: Cowden's syndrome is a rare, autosomal dominant condition characterized by hamartomas of the gastrointestinal tract and cancer of the breast and thyroid. This study describes the clinical, immunological, and histopathological status of four Cowden's syndrome cases from two different families., Methods: Biopsies were taken from different skin, mucous membrane, and intestinal lesions in all patients. Blood samples from patients and their parents were also examined., Results: Two brothers in the first family had more flexural distribution of papular and warty skin lesions as well as other manifestations of the syndrome, including recurrent pyogenic and fungal infections. Flow cytometric study revealed decreased total T and B-cell percentages and abnormal helper: suppressor ratios in these patients. The other two patients from the second family showed the classical picture of the syndrome and normal immunological parameters. Histopathologically, most skin lesions of the face showed trichilemmomas, and all oral and some of the other skin lesions showed benign fibromas with giant cells (Cowden's fibroma). Examination of intestinal biopsies revealed hamartomatous and hyperplastic polyps., Conclusions: Some cases of Cowden's syndrome may be associated with prominent flexural skin lesions, recurrent pyogenic and fungal skin infections, decreased total T and B-cell counts, and an abnormal helper:suppressor ratio., (© 2011 The International Society of Dermatology.)

Background: Rosacea is a disease of complex pathogenesis and variable response to various therapeutic methods. Aim of the work To evaluate and compare the efficacy, safety and side effects of some topical lines of treatment of rosacea., Patients and Methods: The study included 24 patients (23 females and 1 male) with rosacea on the face. They were classified into three groups--each including eight patients (16 face sides)--and treated with one of three topical agents (azelaic acid 20% cream, metronidazole 0.75% cream or permethrin 5% cream) on one side of the face and another one on the other side twice daily for 15 weeks., Results: There was a significant improvement of lesions after 15 weeks of topical treatment with the three agents. Azelaic acid cream was significantly more effective on inflammatory lesions but not erythema than the other two creams. Side effects--mostly transient--were observed with topical creams with no significant difference. They included itching, burning sensation, oedema and scales. Patients who used azelaic acid 20% cream were more satisfied than with other modalities., Conclusion: Azelaic acid 20% cream provides an effective and safe alternative to metronidazole 0.75% cream or permethrin 5% cream with the added benefit of increased patient satisfaction.

Background and Objectives: The stratum corneum of some of the scaly (parakeratotic) diseases was examined with light and scanning electron microscopy (SEM) with the purpose to reveal the importance of this layer in the diagnosis of some of the diseases associated with the formation of scales., Materials and Methods: Two biopsies of the skin surface were taken: one, obtained from 80 patients with various parakeratotic scaly diseases and from 25 control subjects, was processed for light microscopy; the other biopsy for SEM was taken from 10 control subjects and 25 patients. The diagnoses of these patients were: psoriasis (5 patients), erythrodermic psoriasis (2 subjects), parapsoriasis (5 patients), pityriasis rubra pilaris (5 subjects), pityriasis rosea (3 subjects), and seborrheic dermatitis (5 subjects)., Results: The light microscopic studies showed that normal corneocytes are of polygonal shape with their largest diameter measuring 42 microns; these cells lacked nuclei. All parakeratotic cells appeared bizarre in shape, smaller than normal, and the cells contained a nucleus. With SEM, normal cells appeared relatively regular in size and shape, trabeculated, and had a flat surface. Cells examined in all the diseases revealed various sizes, outlines, and trabeculae. Specific surface patterns (print) of diseased cells were: "fish-scale" in psoriasis; "marbled" in parapsoriasis, "rocky stone" in pityriasis rubra pilaris; "heart-shaped" in seborrheic dermatitis, and semicrystalloid in pityriasis rosea., Conclusions: Parakeratosis is characterized not only by the retention of the nucleus in keratinocytes, but is also characterized by a cell of smaller size. The specific print of a disease helps in the diagnosis. The print will change with different stages of a disease.

Objective: The purpose of this study was to recognize the role of mast cells in the pathogenesis of scabies., Methods: One hundred and fifty patients and 10 controls were included in the study. Group 1 included 20 patients without previous treatment. In group 2, 80 patients were treated with antiscabietic drugs. Group 3 had 50 patients who received an antiscabietic drug followed by 3 days of crotamiton. Diurnal and nocturnal skin biopsies were taken from group 1. In groups 2 and 3, the biopsies were taken after 2 weeks of treatment. Sections were cut and stained by hematoxylin and eosin and Giemsa stains., Results: Mast cells were increased in diurnal and nocturnal biopsies. Evident degranulation of mast cells was detected in nocturnal biopsies. The mast cell number decreased to half its pretreatment number in patients treated with antiscabietic drugs and to its normal number in patients treated with antiscabietic drugs followed by 3 days with crotamiton., Conclusion: The number of mast cells are increased in scabietic lesions. This plays a role in the pathogenesis of the clinical and histologic picture of scabies. We recommend that an antiscabietic drug should be followed by 3 days of crotamiton in the treatment of scabies.