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The world is on the edge of a new pandemic due to the monkeypox virus, an endemic virus from Africa with occurrences in the western hemisphere due to international travel. Contact with respiratory droplets, skin lesions, or bodily fluids from infected animals, direct or indirect contact with contaminated fomites can lead to transmission. A prolonged close contact is required in order for the infection to be spread. The lesions start as papules or macules, develop into pustules, umbilicated vesicles, ulcers, and, finally, into crusty scabs, similar to smallpox. No specific clinically proven treatments for monkeypox infection are currently available, although there are some preventive measures that can be taken. The present study presented the case of a homosexual man with genital monkeypox infection. Currently, there are five confirmed cases of monkeypox in Romania and its incidence is continuously rising. Therefore, dermatovenerologists all over the world should be prepared to recognize the disease, as well as take preventive measures in order to avoid another global pandemic., Competing Interests: The authors declare that they have no competing interests., (Copyright: © Cutoiu et al.)

Cutaneous lymphomas are a group of rare and distinct diseases that present varying clinical manifestations, histopathology and prognosis. Optimal and early management relies on accurate diagnosis. Unfortunately, clinical diagnosis in early stages is difficult due to the clinical overlap with other dermatologic conditions. In numerous cases, several consultations and multiple biopsies are required. Dermoscopy is frequently used for the evaluation of melanocytic skin tumors, but its value has been recognized for non-melanocytic neoplasms and inflammatory skin diseases, and in the last few years it has assisted with the diagnosis of cutaneous lymphoproliferative disorders (LPD). Studies have shown that dermoscopy may be useful in the evaluation of cutaneous lymphomas, offering a link between clinical and histopathological examination, but the features are not diagnostic and histopathological confirmation is mandatory. However, dermoscopy can raise suspicion of cancer, leading to a skin biopsy. Furthermore, larger and prospective studies are required to define the exact dermoscopic features of every subtype of cutaneous lymphoma., Competing Interests: The authors declare that they have no competing interests., (Copyright: © Ungureanu et al.)

Giant condyloma acuminatum (GCA), or Buschke-Löwenstein tumor (BLT), represents an infrequent sexually transmitted disease (STD), caused by human papillomavirus (HPV), especially genotype 6 or 11. There are numerous risk factors for HPV, such as multiple sexual partners, homosexuality, prostitution, chronic genital infections, as well as the lack of proper hygiene. HPV infection is a field infection, where large areas of cells at a tissue surface are affected by the HPV virus; therefore, once the GCA is excised, treatment of the whole affected genital area needs to be undertaken. The treatment is classified into topical therapy (podophyllin, 5-FU, radiotherapy, topical photodynamic therapy), excisional therapy (CO 2 laser, cryotherapy, electrotherapy, surgery) and immunotherapy (imiquimod). However, the 'gold standard' therapy is represented by wide surgical excision without grafting, since it is considered that healing per secundam is an improved approach, because there is no risk of recurrences on fibrotic tissue. A total of 7 cases of the BLT with comorbidities and particularities are presented and it is recommended that it be taken into consideration that the incidence of the disease is increasing, emphasizing the importance of an early diagnosis, as well as an adequate treatment., Competing Interests: The authors declare that they have no competing interests., (Copyright: © Boda et al.)

Lichen sclerosus is a chronic disease of unknown etiology that can occur in the genital area of both sexes. Balanitis xerotica obliterans (BXO) occurs only in the genital area of men and typically affects the foreskin, penile glans, and/or the meatus. In the present report, an observational, descriptive, and retrospective epidemiological clinical study of available data between January 2006 and December 2020 in patients diagnosed with BXO from the casuistic of CMI DERMAMED (Târgu Mureș, Romania) was performed. During this 15-year period, 164 patients were diagnosed with BXO, of whom 70 (42.8%) were in the 51-60-year-old age group. They presented at the medical consultation at 3-9 months after onset of symptoms, where 124 (75.6%) the patients were found to be with stage III of the disease. The most important comorbidities were found to be diabetes mellitus and obsesity, who were treated with potent steroids (betamethasone and clobetasol) with favorable results, with only nine (5.48%) cases necessitating surgical treatment. In general, BXO is a rare, acquired, non-infectious and chronically inflammatory (autoimmune) skin disease that has an unknown etiology. Although the risk of developing this condition is particularly high in patients in the 40-60-year-old age group, it can occur at any age. In the present report, the majority of the patients presented after a long period of disease development, such that they were already in advanced stages of the condition with clinically subjective symptoms and severe sexual problems. This delay in diagnosis has several causes, including misdiagnosis, psychological issues, and sexual behavior. Diabetes mellitus and overweight/obesity tended to be important comorbidities of BXO since the majority of the patients were also affected by these conditions. These comorbidities can exert an important pathophysiological influence on BXO. The first-line treatment option for this condition is the local application of potent steroids, with favorable effects. Due to the risk of malignant transformation as a result of BXO, it is recommended that these patients should be followed up for a longer period., Competing Interests: The authors declare that they have no competing interests., (Copyright © 2020, Spandidos Publications.)

Acne is a chronic inflammatory condition affecting the pilosebaceous unit that was traditionally viewed as a disease of the adolescence. However, over the past several years, an increasing number of adult women have been reported to suffer from this condition. The prevalence of adult female acne ranges between 12 and 54%. Two clinical types can be distinguished in this population, a 'retentional' and an 'inflammatory' type, which usually tend to overlap. In terms of evolution, three main subtypes can be identified: Persistent acne, which is the most frequent subtype, late-onset acne and recurrent acne. This type of acne is mainly mild-to-moderate in severity and may be refractory to conventional treatment. The etiopathogenesis is complex and has yet to be fully elucidated. It appears to involve an interaction among genetic predisposition, hormonal factors, and chronic activation of the innate immune system overlapping with external factors, such as daily stress, Western-type diet, use of tobacco and cosmetics. The treatment may be challenging and a holistic approach is required, with special attention to the individual needs and particularities of adult women. Both topical and systemic treatments are available, with hormonal therapies being of special value in this population. The aim of the present article was to provide up-to-date, evidence-based information on the clinical presentation, etiopathogenesis and treatment of adult female acne., Competing Interests: The authors declare that they have no competing interests., (Copyright: © Branisteanu et al.)

Atopic dermatitis (AD) represents a chronic inflammatory skin condition in which the skin barrier is impaired; thus, the permeability is increased. Hence, there is a greater risk of allergic sensitization, as well as a higher pH and lower protection against resident microbes. Since this condition is currently increasing among children, it requires further study, as little is known regarding the pathogenesis that makes the skin prone to chronic relapsing inflammation. Trying to standardize the data regarding the use of prebiotics and probiotics in AD, we encountered tremendous variability in the literature data. Literature abounds in conflicting data: studies regarding prophylactic and therapeutic applications, different types of strains and dosages, applications in young children up to 5 years of age and above, usage of probiotics alone, prebiotics alone or synbiotics combined. There are also conflicting data regarding the outcome of these studies; some confirming a positive effect of prebiotics, probiotics or synbiotics and some showing no efficacy at all. The articles were divided into those assessing probiotics or prebiotics alone and a combination of the two, with studies showing a positive effect and studies proving no efficacy at all. We tried to critically analyze those articles showing weak and strong points. In summary, the most studied probiotics were the strains of Lactobacilli and Bifidobacteria . The Severity Scoring of Atopic Dermatitis (SCORAD) index was used to measure the efficacy of the treatment. Most studies compared their results with a placebo group and the efficacy when seen in moderate to severe forms of AD in patients with other allergic diseases present. However, the results are difficult to interpret, as in many studies the authors suggest that the disease may have a tendency to improve in time in some groups of patients., Competing Interests: The authors declare that they have no competing interests., (Copyright: © Fanfaret et al.)

Sarcoidosis is a multisystemic granulomatous disease of unknown cause that affects any organ, especially the lungs, eyes, lymph nodes and skin. Skin sarcoidosis occurs in about one-fourth of patients with systemic disease and may also arise in isolation. Skin lesions are divided into two groups, as follows: specific skin lesions where histologic examination shows the typical sarcoid granulomas and non-specific skin lesions. Specific lesions are lupus pernio, infiltrated plaques, maculopapular eruptions, subcutaneous nodules and scars. The most significant non-specific skin lesion seen in sarcoidosis is erythema nodosum. Cutaneous sarcoidosis is known as the 'great imitator' in dermatology, because it can mimic a vast variety of cutaneous lesions. The diagnosis of sarcoidosis is made by exclusion and is supported by the recognition of specific clinical features, the detection of classic histopathologic findings and the exclusion of other granulomatous diseases. We present a case report concerning a single, solitary and asymptomatic lesion on the scalp., Competing Interests: The authors declare that they have no competing interests., (Copyright: © Boda et al.)

Psoriasis is a common long-lasting, inflammatory disease that mainly affects the skin. The incidence of this condition has increased significantly over time and at this point, it affects approximately 1% of children. Psoriasis can appear at any age, including childhood and adolescence, with a higher frequency in girls, an earlier onset being associated with severe psoriasis. The pathology is the result of the interaction between genetics and trigger factors such as infections, stress, diet, obesity, and chemical irritants. Paradoxically, tumor necrosis factor (TNF)-α inhibitors (infliximab, adalimumab) may induce psoriasis in children. Psoriasis is a long-term condition with periods of exacerbation; thus, the quality of life can be affected and patients should receive psychosocial support. Although most children have mild disease and topical treatment is efficient, some cases are challenging to treat. The aim of this review was to provide an overview of the current knowledge concerning the epidemiology, etiology, pathogenesis, clinical features, comorbidities, and treatment of psoriasis in children and also to emphasize the need for a multidisciplinary approach to this complex pathology., Competing Interests: All the authors declare that they have no competing interests., (Copyright: © Branisteanu et al.)

Skin endometriosis is a rare disease with variable clinical and histopathological characteristics that depend on hormonal stimuli. The skin is not a common location, as most cases of endometriosis involve pelvic sites, such as the ovaries, peritoneum and bowel. However, the most common extrapelvic site affected is the abdominal wall and this location of the disease is frequently associated with obstetric and gynecologic surgery. Here we report a case of skin endometriosis emerged as a painful subcutaneous nodule located near to the left side of an obstetrical surgery procedure scar. The patient affected was a woman in her reproductive age, with a history of right ovary endometriotic cyst laparoscopically removed and histologically confirmed as a primary endometriosis. Dermatologists should be aware of this condition in any woman with a painful lump located in the proximity of a pelvic surgery-induced scar. Its non-specific clinical appearance may confuse the clinician and may delay the diagnosis and management., Competing Interests: The authors declare that they have no competing interests., (Copyright © 2021, Spandidos Publications.)

Dual-energy X-ray Absorptiometry (DEXA) determines the mineral contents for the spine, the proximal femur and the entire body. A group of 36 patients with psoriatic arthritis were chosen, with different types of arthropathy, from the total 82 patients with psoriatic arthritis in the study group, for which bone mineral density (BMD) was measured, using the DEXA technique. The chosen study group comprised 12 men, 12 premenopausal women and 12 menopausal women, with psoriatic joint damage and a group of 36 healthy individuals, divided based on the same criteria: Men, premenopausal and menopausal women. This study did not emphasize an association between the patient type and the presented bone demineralization type (χ 2 (2) =4.473, P=0.107) in men. In premenopausal women, there was a significant association between the patient type and the presented bone demineralization type (χ 2 (2) =8.778, P=0.012), as the female patients with psoriatic arthritis presented total and partial demineralization to a larger degree, compared with healthy individuals. In menopausal women, this study did not highlight an association between the patient type and the presented bone demineralization type (χ 2 (2) =4.523, P=0.104). Bone demineralization was significant in all three patient groups, both total and partial, in patients with psoriatic arthritis compared with healthy patients. Bone demineralization manifested as osteopenia, with T-scores ranging from -2.5 to -1, and not as osteoporosis. Determining B MD by DEXA technique revealed osteopenia to a higher degree within the group of patients with psoriatic arthritis compared with the healthy patients, as well as the absence of osteoporosis in psoriatic arthritis., (Copyright © 2020, Spandidos Publications.)

Skin has an integrative role in daily life, being a communication organ between the patient and the world. Skin affection in psoriasis has consequences on the patient's self-esteem, with direct implications on the quality of life. This study focused on the impairment of self-esteem in a group of 110 patients: Patients with severe cutaneous and psoriasis arthritis and patients with mild types of psoriasis, using the Rosenberg Self-Esteem Scale. Patients with severe cutaneous and psoriasis arthritis have a lower self-esteem compared with patients with mild psoriasis. The statistical data of two groups regarding the degree of education (secondary and higher education), in the male patients with severe cutaneous and psoriasis arthritis with higher education showed a lower self-esteem, compared with male patients with severe cutaneous and psoriasis arthritis with secondary education. In mild forms of psoriasis, the self-esteem of women and men is relatively equal, but below the general population average. Male patients with psoriasis arthritis have a much lower self-esteem compared with that of women, looking at life prospects more negatively. Psoriasis has a major impact on self-esteem, which correlates with quality of life in patients with psoriasis arthritis, depending on the skin condition that creates a major visual impact in society., (Copyright © 2020, Spandidos Publications.)

Atopic dermatitis (AD) represents a widespread chronic skin disease associated with different atopic disorders and allergies. These associations, similar to overall AD pathophysiology, are entangled, multifactorial and they are yet to be clarified. IgE and non IgE mediated pathomechanisms appear to be implicated in AD. Allergens constitute key aspects in AD pathogenesis, as they may serve as trigger factors. This review emphasizes mainly house dust mites (HDM), as they are likely the most relevant airborne allergen for AD. Here we review in a concise form the mite allergens, the role of molecular diagnosis and the treatment strategies for HDM. Strategies of avoiding allergens, with a few exceptions, are not enough to control children's AD; recent studies show HDM avoidance procedures in diagnosed AD are insufficient. Regardless, some guidelines acknowledge the benefit of mattress and pillow covers in patients with dust mite sensitization that are unresponsive to optimal AD management. Most clinical trials investigating allergen-specific immunotherapy (AIT) as a potential treatment for AD were done with adult patients; a scarce number of studies looked into the efficacy of AIT as a treatment option in children suffering from AD, with conflicting data among them. One of the most feasible of these studies showed significant improvement of AD outcomes only in the mild/moderate group, but not in the severe group. Uncontrolled studies are hard to interpret, considering the natural history of remitting and relapsing of AD, in many of the patients, without clinical interventions. More AIT studies, especially pediatric studies, are required in order to either prove the reproducibility of positive results or to deny its effectiveness., (Copyright © 2020, Spandidos Publications.)

Toxoplasmosis is a zoonotic infection caused by the obligate intracellular apicomplexan parasite Toxoplasma gondii (T. gondii). T. gondii infection is a cause of congenital infection worldwide. Primary infection or the reactivation of latent infection during pregnancy may lead to fetal infection and to congenital toxoplasmosis syndrome. Seropositive pregnant women are generally protected from maternal-fetal transmission of T. gondii , although exceptions exist. The aim of our study was to analyze the dynamics of T. gondii seroprevalence during a 10-year period and to correlate it with age and demographic features of pregnant women. We tested 6,889 pregnant women in Timisoara, Romania, for IgG-anti- T. gondii antibodies, in two successive periods: i) 2008-2010 (group 1: 1,457 participants); and ii) 2015-2018 (group 2: 5,432 participants). For each participant, data on age and area of residence were collected. Our results showed that in the Western Region of Romania T. gondii seroprevalence in pregnant women declined from 43.79 to 38.81% in the last ten years. This trend was observed in both urban (40.53 vs. 34.85%) and rural areas (52.22 vs. 46.22%). A higher seroprevalence rate was found in rural than in urban areas. In addition, we found an increasing tendency of seroprevalence related to the age of pregnant women., (Copyright: © Motoi et al.)

Ocular cicatricial pemphigoid is a particular form of mucous membrane pemphigoid and it is characterized by a chronic bilateral conjunctivitis with relapsing-remitting periods. Without therapy 75% of the cases develop visual loss due to major ocular complications (e.g. severe dry-eye syndrome, corneal erosions, corneal keratinization, entropion, symblepharon). Pathogenesis remains uncertain and probably linked to an autoimmune type II hypersensitivity response in patients with a genetic predisposition and exposure to different environmental triggers. With a worldwide distribution, no racial predilection and an estimated incidence that largely varies from 1/10,000-1/60,000, ocular cicatricial pemphigoid predominantly affects women aged ~60 years. Conjunctival biopsy with direct immunofluorescence is the gold standard in diagnosis confirmation, but up to 40% of the patients have a negative biopsy result that does not rule out the diagnosis. The skin and many other mucous membranes (e.g. oral, trachea, esophagus, pharynx, larynx, urethra, vagina and anus) may be involved. The disease grading relies on Foster staging system (based on clinical signs) and Mondino and Brown system (based on the inferior fornix depth loss). The differential diagnosis includes atopy, allergies, trauma, chemical burns, radiation, neoplasia, infectious, inflammatory and autoimmune etiologies. The main goals of the treatment are to stop disease progression, to relieve symptoms and to prevent complications. With long-term systemic therapy 90% of the cases can be efficiently controlled. While Dapsone is the first-line treatment in mild to moderate disease in patients without G6PD deficiency, more severe cases require immunosuppressant therapy with azathioprine, mycophenolate mofetil, methotrexate or cyclosporine. Cyclophosphamide, biologics (etanercept or rituximab) and intravenous immunoglobulin therapy are usually reserved for recalcitrant disease and unsatisfactory results to conventional therapy. Dry eye syndrome requires constant lubricating medication and topical steroids, cyclosporine-A and tacrolimus. Surgery should be planed only in quiescent phase as minor conjunctival trauma can significantly worsen the disease., (Copyright: © Branisteanu et al.)

Cytomegalovirus (CMV) infection is the most common congenital infection worldwide, and remains a significant cause of the neurological deficiency and sensory deafness in developed countries. Maternal primary infection, reactivation or reinfection during pregnancy may lead to fetal infection and congenital CMV syndrome. The purpose of this study was to analyze the CMV seroprevalence according to demographic features of pregnant women in western Romania as well as the evolution of CMV immunity in two time intervals. IgG anti-CMV antibodies were tested in sera of 8,951 pregnant women during two successive intervals: 2008-2010 (n=1466) and 2015-2018 (n=7485). The CMV seroprevalence in women of reproductive age decreased from 94.6 to 91.80% in the last decade. The seroprevalence was higher in women from rural areas compared with those from urban areas. These results show that the western region of Romania has a low-risk profile for primary CMV infection during pregnancy due to a large number of seropositive women. However, this risk has increased in the last ten years, from 5.4 to 8.2%, which may show the need to implement a national screening program., (Copyright: © Gorun et al.)

Many diseases that affect physical health can also affect mental health. Many of these diseases are studied in terms of quality of life, depression and suicidal behavior. Dermatological disorders, although having a strong impact on the individual's life, are less studied with regard to suicidal behavior. There is a need to approach several dermatological diseases from the perspective of suicidal behavior in order to intervene early with specific treatment or to prevent suicide. Psoriasis, acne, melanoma, atopic dermatitis and urticaria are scarcely studied from the point of view of suicidal behavior. In addition to these diseases, there are others that require attention in terms of suicidal behavior, such as vitiligo or oculocutaneous albinism, most probably due to a small number of people suffering from these diseases, research is almost non-existent in these cases. We want to draw attention to the importance of early detection of suicidal behavior in dermatological practice and to highlight the need for several studies on this subject., (Copyright © 2020, Spandidos Publications.)

Penile carcinoma is a relatively frequent health issue in the developing countries such as Africa, Asia and South America, usually affecting men aged between 50 and 70 years. It is a highly treatable disease in its early stages, but has serious physical and psychological consequences. Usually, penile carcinoma is located in the penile glans, in approximately half the cases, with the most frequent histological type being squamous cell carcinoma with its microscopic subtypes. A large number of risk factors have been reported for this disease, having a multifactorial etiology, HPV infection being one of the most important factors involved in its appearance. Out of the HPV DNA positive genital cancers HPV-16 is the most frequently found type in men, followed by HPV-18. The evolution of penile cancer includes two independent carcinogenic pathways, related or unrelated to HPV infection. There is limited data available in literature regarding HPV-related neoplasia, as well as on the efficacy of vaccination in men, with studies still ongoing., (Copyright © 2020, Spandidos Publications.)

Angiotensin-converting enzyme inhibitors (ACEIs) represent an important group of pharmacological compounds, largely prescribed for more than 30 years. They have been extensively evaluated in clinical trials, demonstrating significant reduction of morbidity and mortality of patients with cardiovascular diseases, mainly high blood pressure, myocardial infarction, heart failure and stroke. Besides their beneficial effects and a general good safety profile, it was proven that ACEIs might also induce adverse effects in some patients, most notably angioedema (AE) and chronic cough. The occurrence rate of adverse events induced by ACEIs is low, but the number of suffering patients is relatively high, since ACEIs is one of the most frequently prescribed medication worldwide. The aim of our study was to evaluate clinical pattern, risk factors and general management of ACEI-induced angioedema in a cohort of patients addressed for allergist evaluation in one university hospital in Romania, during a period of 32 months. It was found that ACEI-induced angioedema (ACEI-AE) represented more than half of the total number of patients addressed for angioedema without urticaria, with variable clinical and time-patterns. Most of the patients were referred by general practitioners (GPs) with diagnosis of urticaria or other skin allergy and continued to take ACEIs for months and years after onset of angioedema. We concluded that the awareness of acquired, non-allergic angioedema induced by ACEI therapy in medical practice is still low and there is a need for improved knowledge and interdisciplinary collaboration in this field., (Copyright © 2020, Spandidos Publications.)

A variety of medicinal products have been associated with rash and normally this information should be available in the Summary of Product Characteristics (SmPCs). Our study aimed to investigate the frequency of rash as an adverse drug reaction, based on the information provided by SmPCs of 1,048 single active substances (international non-proprietary names) authorized in the United Kingdom. Data on rash frequency was collected from each SmPC using automated searches based on selected keywords. Data analysis was carried out using R, v. 3.4. We found that over 90% of the medicines used orally or by injection may be associated with rash as an adverse event, the most common classes being protein kinase inhibitors, anticancer medicinal products, monoclonal antibodies, biologicals, antivirals and retinoids, with high variations in rash frequency for products within the same class, but also for products with the same active substance. Analysis of SmPCs revealed the need to increase homogeneity in reporting rash frequency, by using Council for International Organizations of Medical Sciences classification, and Medical Dictionary for Regulatory Activities coding in a more standardized manner, and also the need to include more safety endpoints in clinical trials and to use better the safety results for publication and updating the SmPCs., (Copyright: © Ancuceanu et al.)

Pityriasis rubra pilaris (PRP) is a chronic papulosquamous disorder of unknown etiology, characterized by reddish orange scaly plaques, islands of sparing, palmoplantar keratoderma, and keratotic follicular papules. The disease can be acquired or inherited, being divided into 5 categories: classic adult type, atypical adult type, classic juvenile type, circumscribed juvenile type, and atypical juvenile type. More recently, an HIV-associated type has been added to this classification. The cases of PRP associated with malignancy are unusual. We present a case of a 58-year-old man, with the typical clinical aspect of PRP with a four-month onset of the disease. The histopathological and dermatoscopical findings confirmed the PRP diagnosis. The routine laboratory results were in normal limits, except the number of eosinophils, which was elevated and the number of lymphocytes, which was lower. After a thorough examination within a hematological consultation, the cause of hypereosinophilia remained unknown. An imagistic examination was performed and a prostate hypertrophy was noted. The prostate-specific antigen (PSA) level was found to be increased. The urologic consultation based on clinical, imagistic and microscopic features diagnosed an early stage prostate carcinoma. The conclusion was a paraneoplastic PRP in association with prostate carcinoma. The search in international databases revealed twelve published cases regarding the association of PRP with malignancies. The presented case represents a rare coexistence of PRP with malignancy, particularly with prostate carcinoma, and indicates that PRP can occur as paraneoplastic dermatosis, heralding a malignancy. This case is the first one to present PRP associated with prostate carcinoma. Nonetheless, in the authors' opinion, PRP can be considered a paraneoplastic syndrome; therefore, tumor screening is mandatory in cases presenting this disease., (Copyright: © Fekete et al.)

Capsaicin is a natural protoalkaloid recognized as the main pungent component in hot peppers ( Capsicum annuum L.). The capsaicin receptor is highly expressed in the unmyelinated type C nerve fibers originating from small diameter sensory neurons in dorsal root ganglia and cranial nerve ganglia correspondents. Capsaicin and related vanilloids have a variety of effects on primary sensory neurons function, from sensory neuron excitation characterized by local burning sensation and neurogenic inflammation, followed by conduction blockage accompanied by reversible ultrastructural changes of peripheral nociceptive endings (desensitization), going as far as irreversible degenerative changes (neurotoxicity). The main role in capsaicin-induced neurogenic inflammation relies on the capsaicin sensitive, small diameter primary sensory neurons, therefore its evaluation could be used as a diagnostic instrument in functional alterations of cutaneous sensory nerve fibers. Moreover, capsaicin-induced desensitization and neurotoxicity explain the analgesic/anti-nociceptive and anti-inflammatory effects of topical capsaicin and its potential use in the management of painful and inflammatory conditions. In this study, we describe the effects of capsaicin on neurogenic inflammation and nociception, as well as its potential diagnostic value and therapeutic impact in various conditions involving impairment of sensory nerve fibers.

In vivo confocal laser scanning microscopy (CLSM) is a novel imaging technique that provides noninvasive, morphological characterization of skin structures with a resolution that is very close to that of light microscopy. Moreover, as it allows repeated imaging of the same skin area at different time-points, it is an excellent method for monitoring disease course, response to treatment or specific stimuli and a path to study dynamic phenomena in real-time. To date, two different variants of in vivo CLSM have been authorized in dermatological field, namely the reflectance confocal microscopy predominantly for clinical diagnosis and the fluorescence confocal microscopy mainly for research purposes. This study describes the principles of in vivo CLSM technique, its role in the diagnosis and monitoring of inflammatory skin diseases, as well as some promising research directions to study the dynamics of skin inflammation using this method. In vivo CLSM evaluation of inflammatory dermatoses and of the skin inflammatory component in various diseases has an undoubted potential with broad applications ranging from clinical, morphological to experimental, functional studies involving the skin.

Lichen planus (LP) is a chronic inflammatory skin disease that can sometimes affect mucosal surfaces, with unknown pathogenesis, even though it appears to be an autoimmune disease. The diagnosis of lichen planus is usually based on histopathological examination of the lesions. Nowadays, the classical invasive diagnostic methods are replaced by modern non-invasive techniques. In this review, we present the main non-invasive imaging methods (dermoscopy, reflectance confocal microscopy, optical coherence tomography, ultrasound and diffuse reflection spectrophotometry) used in the diagnosis and therapeutic monitoring of lichen planus. Dermoscopy is a non-invasive method initially used for diagnosis of pigmented tumors but now is used also for inflammatory and infectious skin diseases. In lichen planus, the dermoscopy increases the accuracy of diagnosis, avoids skin biopsies commonly used and can be useful in the therapeutic monitoring by repeated investigation at different stages of treatment. Reflectance confocal microscopy (RCM) is a novel non-invasive imaging technique that is prevalently used for the diagnosis of skin tumors and inflammatory skin diseases. This technology has been mostly employed for bedside, real-time microscopic evaluation of psoriasis, lichen planus, contact dermatitis, revealing specific confocal features to support clinical diagnosis and assist with patient management. Optical coherence tomography (OCT) is an emergent imaging technique, developed over the last decade, based on the interaction of the infrared radiation (900-1,500 nm) and the living tissues. A limited information exists on the benefits of OCT technology for the in vivo diagnosis of LP but could be a useful auxiliary tool in the in vivo differential diagnosis, especially in clinical equivocal settings like mucosal lesions, and in monitoring the response to treatment. Our review shows the possibility of using modern imaging techniques for the in vivo diagnosis and also for evaluation of the treatment response.

There are complex interconnections between the nervous system and the skin highlighted by the impact of stress and neuroendocrine factors on various dermatological conditions. We investigated the influence of stress on skin neurogenic inflammation induced by capsaicin. A total of 31 healthy subjects were randomized into two groups: subjects in the stress group underwent a stress-inducing protocol and those in the control group were exposed to indifferent conditions. Subsequently, topical capsaicin cream was administered on the non-dominant anterior forearm of each subject from the two groups. The assessment of the local inflammatory reaction induced by capsaicin was performed by thermography at 25 and 40 min post-application. In both groups the inflammatory reaction induced by capsaicin was evidenced at 25 min and was maintained at 40 min post-application. However, at 40 min post-application the hyperthermal area was larger in subjects from the stress group, suggesting that stress exposure is associated with an amplification of the mechanisms involved in capsaicin-induced skin neurogenic inflammation.

Atopic dermatitis (AD) is a multifactorial chronic inflammatory disease with an incompletely understood etiopathogenesis. With a significant impact on the quality of life of patients, AD has attracted the interest of many research studies aiming to investigate the complex cellular and molecular mechanisms and to identify new therapeutic pathways. Various studies have focused on psycho-immunology, emphasizing the involvement of stress, defined as a general response of the body to external or internal challenges to the AD pathology. Factors like lifestyle and leisure activities may change the behavior of immune cells in AD with a strong impact on the evolution of the disease. Moreover, the poor adherence of AD patient to standard treatment approach has led to the necessity to combine different therapies in the field of complementary and alternative medicine. Although there are still not enough data to conclude that adjuvant therapies are effective in a conventional sense, there are already promising results suggesting that alternative therapeutic strategies could be a main subject of further research.

In vivo reflectance confocal microscopy (RCM) is a modern, non-invasive imaging technique, which allows for real-time examination of the upper layers of the skin at a resolution similar to that of classic microscopy. In addition, it has the advantage of real-time evaluation of blood flow and dynamic monitoring of cutaneous changes while preserving tissue integrity. The present study reported on the in vivo RCM technique as an objective method for the noninvasive assessment of psoriasis vulgaris that is potentially applicable in clinical studies and in monitoring the evolution of lesions under treatment. In psoriasis lesions, RCM virtual horizontal sections at the level of the dermo-epidermal junction featured numerous and prominent dermal papillae that were not surrounded by bright rings of basal cells. Micromorphological examination of the lesions using this technique revealed that mean values of the section area, the perimeter and the Feret's diameter of the dermal papillae were significantly higher in psoriatic lesions than in normal skin. An increased number of capillary vessels per lesional dermal papilla as compared to healthy skin was observed. Furthermore, micromorphological parameters of dermal capillaries were increased in psoriatic skin. These observations point to the utility of in vivo RCM as a promising technique for the non-invasive diagnosis of psoriasis vulgaris, for monitoring the evolution of lesions at a micromorphological level under various treatments and for gaining a better understanding of the pathophysiological processes that occur in the evolution of this disease.