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Background: Numerous reports of resistance to terbinafine in Trichophyton spp. from all over the world are arousing justified attention and concern. Point mutations in the gene that encodes the squalene epoxidase (SQLE) enzyme are responsible for these therapeutic resistances. Objectives: Primary objective of the study was to describe first isolates of Trichophyton spp. resistant to terbinafine among the patients treated between September 2019 and June 2022 at the Dermatology Units of Ospedale Maggiore Policlinico and San Bortolo Hospital. Secondary objective was to study the resistance mechanism. Methods: Patients with confirmed Trichophyton spp. infection has been treated with systemic and topical terbinafine. Patients were then re‐evaluated 12 weeks after the therapy. Patients with incomplete or absent response to terbinafine underwent a new skin scraping for direct mycological examination, new identification of dermatophyte species from culture and MALDI‐TOF, molecular species identification, antifungal susceptibility testing and molecular analysis of SQLE gene. Results: We identified five patients without clinical response to treatment with terbinafine. The DNA sequencing of the ITS region identified one Trichophyton rubrum and four Trichophyton indotineae. The T. rubrum strain showed minimum inhibitory concentration (MIC) (90% growth inhibition) of 4 mg/L for terbinafine. The four T. indotineae strains showed a MICs range of 0.25–4 mg/L for terbinafine. The analysis of the SQLE gene in the T. rubrum strain showed a nucleotide substitution generating a missense mutation (L393F). The SQLE gene sequencing in the T. indotineae strains showed a nucleotide substitution generating a missense mutation (F397L) in two strains, a nucleotide substitution L393S in one strain and a nucleotide substitution F415C in another strain. Conclusions: We report the first cases of terbinafine‐resistant Trichophyton isolates in the Italian population. Solid antifungal management programs will be needed to promote more responsible use of antimycotics and preserve their therapeutic efficacy to control antifungal resistance. [ABSTRACT FROM AUTHOR]

This article discusses a case of blistering skin lesions caused by the sting of a scorpion belonging to the Hottentotta species. The patient, a 53-year-old Italian man, experienced an acute bullous eruption on his right hand after being stung by a scorpion while in Sri Lanka. The initial symptoms included vesicles, blisters, erythema, edema, and pain, which worsened during his flight back to Italy. The patient received treatment, and complete remission of pain and re-epithelialization occurred within a few weeks. The Hottentotta species of scorpions are mainly found in Turkey, Iraq, Iran, Afghanistan, Pakistan, Nepal, India, and Sri Lanka, and their venom can cause a range of symptoms, including severe cardiovascular and respiratory manifestations. [Extracted from the article]

Orcein stain demonstrates the preservation of elastic fibers (c) (Orcein stain, ×4) gl A treatment with twice-daily topical tretinoin was started, leading to significant improvement after one month (Fig. Mild leukocyte infiltrate is distributed on dermo-epidermal junction and collagen bundles appeared basophilic and verticalized (a) (H&E stain, ×4). Dear Editor, Acquired verrucous perforating collagenoma (AVPC) is an extremely rare clinicopathological entity, belonging to the spectrum of acquired perforating dermatoses (APD). [Extracted from the article]

Background: Treatment of unwanted body hair is a challenging area in cosmetic dermatology. Topical soy isoflavones and derivatives or eflornithine have been utilized in dermatocosmetology for their estrogenic and antiandrogenic activity. Aims: To evaluate the efficacy of a formulation containing capryloyl glycine 4% in decreasing hair growth on the forearms after topical application for 120 days vs placebo. Methods: A total of 69 female patients entered the study (age 37 ± 6). Hair growth was quantified using TrichoScan software on both forearms at 20‐fold magnification (analyzed area 0.651 cm2). Hair density (number of hairs/cm2), density vellus hair, density terminal hair, and median length of hairs were evaluated. The data were analyzed using ANOVA for repeated measures to evaluate changes during the treatment (T0, T60, and T120) and Student's t test (placebo vs active). Results: There was a significant decrease on hair density, median, and terminal hair at the end of the treatment in the active‐treated site (P <.001) as measured by TrichoScan software. Direct comparison between active and placebo‐treated sites showed no significant differences at T0, but highly significant differences at T120 (P <.001). Conclusions: The study shows that a cosmetic formulation based on capryloyl glycine 4% is highly effective in reducing several parameters related to hair growth and hair thickness vs placebo, thus showing efficacy in the treatment of hypertrichosis. [ABSTRACT FROM AUTHOR]

Background: The management of acquired hypertrichosis (HT) is based on the search of the causes and subsequent specific treatment. However, simultaneous hair removal is important. No single method for hair removal is appropriate for all patients and skin areas. Treatment options are actually limited and clinical results are often unsatisfactory. Ornithine decarboxylase 1 (ODC1), an enzyme present in hair follicles, is considered as a potential target to inhibit hair growth. Only eflornithine hydrochloride, an inhibitor of ODC1, showed to be partially effective in the management of acquired HT. Aims: The aim of our study was to evaluate the potential inhibition of ODC1 activity by a cream containing 4% capryloyl glycine, an ODC1 inhibitor, and 1% glycine soy‐fermented extract (soy isoflavonoids). Furthermore, we present the results of a placebo‐controlled clinical study that evaluated the efficacy and tolerability of this cream. Methods: The ODC1 activity was detected by measuring absorbance at 340 nm. In the presence of ODC1 inhibitors, absorbance decreases as a function of inhibition. Difluoromethylornithine (DFMO) was provided as an inhibitor control. ODC1 activity inhibition was expressed as percentage of control (untreated sample). All data were presented as mean ± standard deviation of three independent experiments. To determine if statistically significant differences between treatments were present, a t test analysis was performed. The differences between groups were considered significant at p < 0.05. Twelve Caucasian female adult patients, with HT located on the forearms, were enrolled. The study cream (product A) was applied twice/day for four months on the right forearm. A placebo cream (product B) was applied twice/day for four months on the left forearm. Clinical efficacy was evaluated by means of macrophotography. Results: The cream significantly inhibited ODC1 activity (35.1 ± 0.5% inhibition, equivalent to a 64.9 ± 0.5% ODC1 activity). DFMO completely abolished the enzymatic activity (100 ± 5% inhibition, equivalent to 0 ± 5% ODC1 activity). All patients were considered evaluable. In 11 out of 12 patients (91.7%), who were treated with product A, an improvement was observed. No improvement was observed in patients treated with product B. The global assessment showed good efficacy in 7 patients (58.3%) and moderate efficacy in 5 patients (41.7%) treated with the product A. No efficacy was detected in patients treated with product B. Conclusions: The study cream showed to be effective in Caucasian, adult, female patients with hypertrichosis located on the forearms. [ABSTRACT FROM AUTHOR]

Total nail avulsion was performed, and two other nail plates beneath the "old" nail were identified. Dear Editor, A 19-year-old male reported to us with a 4-month history of persistent pain, inflammation, and oozing at the proximal nail fold (PNF) of the left great toe. Physical examination revealed a yellowish thickened nail plate (xantonychia), partial proximal onycholysis, and protruding granulation tissue from the PNF, with associated oozing and periungual inflammation (Fig. [Extracted from the article]

Hyperkeratosis lenticularis perstans (HLP), or Flegel's disease (FD), is a rare disorder of keratinization first described in 1958 by Flegel. HLP is characterized by asymptomatic small papules distributed symmetrically on the dorsal feet and lower part of the legs. It typically presents in the fourth or fifth decade of life. FD has been reported more commonly in women, and little is known about the pathogenesis of this rare dermatosis. Histological examination is mandatory to confirm the diagnosis, and the characteristic features are: focal compact hyperkeratosis, thinned stratum malpighii, epidermal atrophy, and a dense, band‐like lymphocytic infiltrate in the papillary dermis. The treatment of FD is challenging, and a fully effective standard therapy does not exist. We report four cases of HLP that have been diagnosed at the Dermatology Unit of IRCCS Ca' Granda Ospedale Maggiore Policlinico in Milan, Italy, and a literature review is enclosed. [ABSTRACT FROM AUTHOR]

Background: Actinomycoses are rare chronic infections often caused by Actinomyces spp. Cervicofacial actinomycosis (CFA) is caused by primary lesions in the oral cavity and subsequent fistulae, and suppurative and granulomatous lesions on the skin of the face. Methods: We present the results of a retrospective study on 14 patients with CFA, observed in the period 1984–2019 at the Dermatology Unit of the University of Milan. Physical general and dermatologic examinations, instrumental tests, and histopathologic and bacteriologic examinations were carried out in all patients. In three patients, polymerase chain reaction was also carried out. Results: Six patients showed poor oral hygiene; eight patients had been subjected to previous surgical operations in the oral cavity. Histopathologic examination was superimposable in all patients. In four patients, bacteriologic examinations were positive for A. israelii. In three patients, polymerase chain reaction was positive for A. israelii. X‐rays of the bones of the face showed osteolytic lesions in four patients. All patients were successfully treated with benzathine benzylpenicillin followed by amoxicillin or with amoxicillin in monotherapy. In all patients, surgical drainage and debridement of the oral cavity were carried out. Conclusion: CFA is a rare infection caused by primary lesions in the oral cavity and subsequent fistulae, and nodular and ulcerative lesions on the skin of the face. Clinical diagnosis must be confirmed by histopathologic, bacteriologic, and instrumental examinations. Therapy with penicillins is usually very long and must be accompanied by surgical drainage and debridement of the oral cavity. [ABSTRACT FROM AUTHOR]

Background: Hidradenitis suppurativa (HS) is a debilitating, chronic‐relapsing, inflammatory skin disease of apocrine gland‐bearing skin, presenting with nodules, abscesses, and fistulae. Ultrasound is used to classify HS lesions but evaluation of vascularization, related to tissue inflammation, needs Color Doppler. The aim was to correlate vascularization of HS lesions with patients' reported pain. Methods: Vascularization was assessed with Hitachi Arietta V‐70 sonographer according to a four‐category system ranging from absent (0), minimal (1), moderate (2) vascularization, and detectable vascular flow (3). Pain was scored with Numeric Rating Scale (NRS) from 0 to 10. Results: Twenty‐four patients were included, 13 men (54.2%) and 11 women with mean age of 37.2 (range: 19‐61 years). Sixty‐nine HS lesions were studied: none of the lesions with absence of vascularization was painful. Lesions with minimal vascularization had a mean NRS value of 3.1 (range: 0 to 7; standard deviation [SD]: 1.6). Lesions with moderate vascularization had a mean NRS value of 6.4 (range: 4‐8; SD: 1.4). Lesions with intense vascular flow had a mean NRS value of 7.8 (range: 5‐9; SD: 1.7). Correlation Spearman's rank coefficient calculated between the class of vascularization and the mean NRS value was 0.98, supporting high correlation between intensity of vascularization and local pain. Conclusion: The present study is the first one demonstrating correlation between vascularization of HS lesions assessed with Color Doppler and local pain. Color Doppler may be a dynamic diagnostic tool that can address the therapeutic approach and assess response to treatment in HS. [ABSTRACT FROM AUTHOR]

Background: Hidradenitis suppurativa (HS) is an inflammatory, recurrent and debilitating chronic skin disease that is often worsened by comorbidities, with a destructive impact on the social and working life of the patient. The low awareness of patients and clinicians regarding HS, together with weak coordination between specialists who manage the clinical care of these patients, may result in a burdening diagnostic and therapeutic delay, lowering efficacy of therapies and worsening prognosis and patients' QoL. Objectives: To rule out these critical aspects, a HS‐Multidisciplinary Unit with a hierarchical organization is proposed. Methods: Based on previously published models of a multidisciplinary unit, a hierarchical structure of a HS‐dedicated multidisciplinary unit was designed. Results: In this model, an operational core constituted by four healthcare professionals constantly working as team, is supported by a large panel of consultants, local dermatologists and general practitioners, helping in HS patient management. Conclusions: This standardization would imply an optimization of professional resources, an amelioration of patient's quality of life, and a shortening of patient journey. [ABSTRACT FROM AUTHOR]

Summary: Objective: Tinea manuum is considered in Italy as an uncommon infection, although no recent epidemiological data are available. Methods: In the period 2000‐2018, we observed in the metropolitan area of Milan 18 patients with mycologically tinea manuum. Results: The infection was monolateral in all patients and characterised by erythema and scaling; in two patients, each vesicles and pustules were present. Two patients had also onychomycosis of one fingernail. No cases of simultaneous tinea pedis were observed. As far as the job of these patients is concerned, seven of them were masseurs, three barbers, two cattlemen, two masons, one car mechanic, one florist, one maid and one veterinarian. Trichophyton rubrum was isolated in 6 patients, Microsporum canis in 4, Trichophyton gypseum in 3, Trichophyton verrucosum in 3 and Trichophyton violaceum in 2 patients. Conclusion: Masseurs were the most affected. Trichophyton rubrum and Microsporum canis were the most frequent isolated dermatophytes. [ABSTRACT FROM AUTHOR]

Background: Tungiasis is an infestation caused by the penetration into the skin of the flea Tunga penetrans. Histopathologic studies on imported tungiasis are rare and based on a limited number of cases. Methods: We carried out a review of 39 biopsy specimens collected from 39 patients with imported tungiasis. In all patients, ethnicity, gender, age, location, and clinical features of the lesions, Fortaleza classification and countries of infestation were recorded. Results: Histopathologic study revealed hyper‐ parakeratosis and acanthosis. Fragments of the flea were located in the epidermis and upper dermis and were circumscribed by a pseudo‐cystic cavity. Inside this cavity, we observed: the exoskeleton, made up of a thickened and eosinophilic cuticle; the striated muscle; the tracheal rings and the digestive organs (observed only in some specimens); the ovaries, very rich in eggs, and an inflammatory infiltrate, made up of lymphocytes and neutrophils, with numerous eosinophils. The hypodermic layer was never observed. Conclusion: Histopathologic examination is helpful for the correct diagnosis of tungiasis in travelers returning from tropical and subtropical countries in which the infestation may be characterized by an atypical clinical presentation. [ABSTRACT FROM AUTHOR]

Keywords: unilateral Demodex sp. folliculitis; unilateral demodicidosis; unilateral rosacea EN unilateral Demodex sp. folliculitis unilateral demodicidosis unilateral rosacea 335 336 2 01/23/23 20230101 NES 230101 CONFLICT OF INTEREST None. 10 Turkmen D. A rosacea case involving one side of the face accompanied by Demodex infestation: unilateral rosacea fulminans. To the Editor, Literature data about a clinical entity which was named unilateral rosacea (UR), unilateral demodicidosis (UD), or unilateral I Demodex i sp. folliculitis are poor.[[1], [3], [5], [7], [9], [11]] We report a case of UR (this is the name we prefer). [Extracted from the article]

Mesotherapy is sometimes responsible for dermal and subcutaneous infections caused by nontuberculous mycobacteria. Mycobacterium chelonae, M abscessus, and M fortuitum are usually involved. We present two cases of deep skin infections caused by M chelonae following mesotherapy. A review of the literature is included. [ABSTRACT FROM AUTHOR]

Abstract: While the commensal bacterium Propionibacterium acnes (P. acnes) is involved in the maintenance of a healthy skin, it can also act as an opportunistic pathogen in acne vulgaris. The latest findings on P. acnes shed light on the critical role of a tight equilibrium between members of its phylotypes and within the skin microbiota in the development of this skin disease. Indeed, contrary to what was previously thought, proliferation of P. acnes is not the trigger of acne as patients with acne do not harbour more P. acnes in follicles than normal individuals. Instead, the loss of the skin microbial diversity together with the activation of the innate immunity might lead to this chronic inflammatory condition. This review provides results of the most recent biochemical and genomic investigations that led to the new taxonomic classification of P. acnes renamed Cutibacterium acnes (C. acnes), and to the better characterisation of its phylogenetic cluster groups. Moreover, the latest data on the role of C. acnes and its different phylotypes in acne are presented, providing an overview of the factors that could participate in the virulence and in the antimicrobial resistance of acne‐associated strains. Overall, this emerging key information offers new perspectives in the treatment of acne, with future innovative strategies focusing on C. acnes biofilms and/or on its acne‐associated phylotypes. [ABSTRACT FROM AUTHOR]

Abstract: Background: Acne is common among young people. Objective: To describe the burden, management and sources of advice of acne in a representative sample of young people in Europe. Methods: This cross‐sectional survey was conducted in a representative sample of individuals aged 15–24 years from Belgium, Czech and Slovak Republics, France, Italy, Poland and Spain (n = 3099). Results: Most individuals considered their acne (all severity stages) to be no/minor problem, although 29.7% considered it a major problem/burden. Over‐the‐counter (OTC) topical treatments were used more frequently than prescribed treatments. Acne was diagnosed by physicians in 47.6% of cases; other health professionals (nurses, pharmacists) or patients accounted for the remainder of diagnoses. Physicians were the source of acne information in just over one‐quarter of cases (27.0%). The vast majority of advice was from friends/family and the Internet. Conclusion: Almost one‐third of young people consider acne to be a major problem/burden. Fewer than half of acne diagnoses are made by a physician, and acne is often self‐managed using OTC treatments. [ABSTRACT FROM AUTHOR]

Summary: We describe five cases of acneiform eruption caused by vitamin B12 in five females aged 37, 32, 62, 29, and 21 years, respectively. The eruption appeared from 1 week to 5 months after the beginning of the therapy with i.m. or oral vitamin B12. Clinical picture was characterized by papules and pustules located on the face. In three patients, similar lesions were also present on the neck, shoulders, chest, and upper portion of the back. Comedones and cysts were absent. In two patients, serum vitamin B12 levels were very high. Histopathologic examination in one patient revealed an eosinophilic folliculitis. Spontaneous and complete remission was observed in all patients 3‐6 weeks after vitamin B12 discontinuation. [ABSTRACT FROM AUTHOR]

Abstract: Background & Aims: Treatment with the farnesoid X receptor (FXR) agonist obeticholic acid is ineffective in some patients with non‐alcoholic steatohepatitis (NASH) but the explanation is uncertain. We investigated hepatic FXR expression, and measurements of fibroblast growth factor 19 (FGF19) and bile acids (BAs) in children with NAFLD to investigate relationships with NASH. Methods: 33 children with NAFLD who underwent diagnostic liver biopsy were studied. Hepatic FXR protein levels and circulating FGF19 concentrations were compared with those analysed in five control subjects with proven normal liver histology. NASH was defined by the Paediatric NAFLD Histological Score (PNHS). Binary logistic regression with adjustment for covariates and potential confounders was undertaken to test factors independently associated with: a) NASH and b) hepatic FXR protein levels. Results: Mean ± SD age was 13.7 ± 1.9 years. Nineteen patients had NASH (PNHS ≥ 85) and 14 did not have NASH (PNHS < 85). Hepatic FXR level and plasma FGF19 concentration varied ~10‐fold and 5‐fold, respectively, between groups, and was highest in control subjects, intermediate in NAFLD without NASH, and lowest in NASH (between group differences P < .001 and P < .01 respectively). NASH was independently associated with both FXR protein levels (OR = 0.18, 95% CI 0.09, 0.38) and FGF19 concentration (OR = 0.55, 95% CI 0.20, 0.89). Conclusions: FXR protein levels vary markedly between normal liver, NAFLD without NASH, and NASH. Low levels of FXR are independently associated with NASH. [ABSTRACT FROM AUTHOR]

Background Although acne vulgaris is a common skin disorder, limited epidemiological data exist specifically for European populations. Objective To determine the prevalence of self-reported acne among young people in Europe and evaluate the effect of lifestyle on acne. Methods We conducted a cross-sectional population-based online survey in representative samples of individuals aged 15–24 years in Belgium, Czech and Slovak Republics, France, Italy, Poland and Spain (n = 10 521), identified by a quota sampling method based on age, geographic location and socio-professional category. Results The overall adjusted prevalence of self-reported acne was 57.8% (95% confidence interval 56.9% to 58.7%). The rates per country ranged from 42.2% in Poland to 73.5% in the Czech and Slovak Republics. The prevalence of acne was highest at age 15–17 years and decreased with age. On multivariate analysis, a history of maternal or paternal acne was associated with an increased probability of having acne (odds ratio 3.077, 95% CI 2.743 to 3.451, and 2.700, 95% CI 2.391 to 3.049, respectively; both P < 0.0001), as was the consumption of chocolate (OR 1.276, 95% CI 1.094 to 1.488, for quartile 4 vs. quartile 1). Increasing age (OR 0.728, 95% CI 0.639 to 0.830 for age 21–24 years vs. 15–17 years) and smoking tobacco (OR 0.705, 95% CI 0.616 to 0.807) were associated with a reduced probability of acne. Conclusion The overall prevalence of self-reported acne was high in adolescents/young adults in the European countries investigated. Heredity was the main risk factor for developing acne. [ABSTRACT FROM AUTHOR]

According to the previously cited Chinese study, immunosuppression caused by concomitant diseases or drugs is present in 47.2% of patients.2 These data mean that HZD occurs also in immunocompetent subjects.4 Herpes zoster duplex can be mono- or bilateral, symmetric or asymmetric. Dear Editor, Herpes zoster duplex (HZD) is a rare clinical variety of herpes zoster (HZ) in which at least two noncontiguous dermatomes, mono- or bilaterally, symmetrically or asymmetrically, are involved.1 A review of the literature revealed approximately 50 cases of HZD. However, in patients with previous COVID-19, HZ often develops 8-10 weeks after COVID-19 recovery: this is because of a reactivation of latent VZV infection.5 In our patient, the appearance of HZD can be because of chronic lymphopenia after COVID-19 recovery. [Extracted from the article]

Superficial fungal infections affect 20-25% of people worldwide and can cause considerable morbidity, particularly if an inflammatory component is present. As superficial fungal infections can be diverse, the treatment should be tailored to the individual needs of the patient and several factors should be taken into account when deciding on the most appropriate treatment option. These include the type, location and surface area of the infection, patient age, degree of inflammation and underlying comorbidities. Although several meta-analyses have shown that there are no significant differences between the numerous available topical antifungal agents with regard to mycological cure, agents differ in their specific intrinsic properties, which can affect their clinical use. The addition of a corticosteroid to an antifungal agent at the initiation of treatment can attenuate the inflammatory symptoms of the infection and is thought to increase patient compliance, reduce the risk of bacterial superinfection and enhance the efficacy of the antifungal agent. However, incorrect use of antifungal-corticosteroid therapy may be associated with treatment failure and adverse effects. This review summarises available treatment options for superficial fungal infections and provides general treatment recommendations based on the consensus outcomes of an Expert Panel meeting on the topical treatment of superficial mycoses. [ABSTRACT FROM AUTHOR]

Abstract: Background: Skin bacterial colonizations and superinfections are well‐known complications of scabies, in particular, in tropical and subtropical countries. However, only very rare studies on skin bacterial colonizations and superinfections have been carried out in immunocompetent patients with scabies living in Western countries. Methods: Eighty‐nine Caucasian adult immunocompetent patients with scabies living in Milan, Italy, were subjected to bacteriologic examinations of the skin. Clinical diagnosis of scabies was confirmed in all patients by means of microscopic examinations: they were considered positive when adults or eggs or feces of Sarcoptes scabiei var. hominis were visible. In all patients, six skin swabs (three for aerobic and three for anaerobic bacteria) were taken in three different areas before the beginning of the treatment. Results: No clinical manifestations of pyoderma were observed. Bacteriologic examinations were positive in 5/89 patients (5.6%). Bacteriologic cultures were positive for Staphylococcus aureus in all five patients; in one patient, they were also positive for Escherichia coli. No growth of anaerobic bacteria was recorded. Conclusions: According to the results of this study, skin bacterial colonizations and superinfections in immunocompetent adult patients with scabies living in Milan are uncommon. Bacteriologic examinations may therefore be considered as an unnecessary routine procedure. [ABSTRACT FROM AUTHOR]

Background Centipedes are arthropods belonging to the class Chilopoda. Approximately 3000 species have been described. Centipedes are found more commonly in tropical and subtropical countries. Centipedes possess venomous fangs. The Scolopendra represent the best-known genus of centipede. Methods We describe two cases of severe skin reactions caused by Scolopendra subspinipes bites. Results Both patients were bitten on the hand. The clinical picture was characterized by severe erythematous edema. In addition, one patient presented with a blister. Both patients complained of severe pain. Laboratory examinations showed leukocytosis and an increase in erythrocyte sedimentation rate ( ESR). Complete remission was achieved within two weeks by means of paracetamol and oral prednisone. Conclusions Western dermatologists should be aware of the possibility of severe skin reactions caused by centipede bites. [ABSTRACT FROM AUTHOR]

One week later, the patient returned with a widespread erythematous-squamous rash on the chest and back, with lesions of different morphology and size (Fig. Pityriasis rosea is an acute, exanthematous disease likely caused by human herpesvirus HHV-6 and/or HHV-7.1,2 It mainly affects young adults. Pityriasis rosea-like eruption revealing COVID-19. [Extracted from the article]

Keywords: aminophylline, case report, ethylenediamine, mesotherapy, urticaria, urticarial reaction EN aminophylline, case report, ethylenediamine, mesotherapy, urticaria, urticarial reaction 59 60 2 12/11/20 20210101 NES 210101 Mesotherapy can cause mycobacterial infections, mainly by I Mycobacterium chelonae i , I M. abscessus i , and I M. fortuitum i .1 Cases of sterile suppurative and granulomatous lesions have been reported following mesotherapy.2 In 2005, in the District of Columbia area of United States, an outbreak of skin manifestations (erythema, swelling, ulcers and drainage) occurred in 20 patients after mesotherapy.3 Urticarial reactions are extremely rare.4-6 We describe a case of urticarial reaction to ethylenediamine in an aminophylline compound used for mesotherapy. To our knowledge, only four cases, including a case of angioedema-like contact dermatitis caused by mesotherapy with dutasteride, have been reported.4- B 7 b One case was very similar to ours, being caused by ethylenediamine contained in an aminophylline compound. [Extracted from the article]

Fungal skin infections, or dermatomycoses, are associated with a broad range of pathogens. Involvement of gram-positive bacteria is often suspected in dermatomycoses. Inflammation plays an important role in dermatomycoses, displaying a close association between frequent inflammation and reduced skin-related quality of life. Isoconazole nitrate ( ISN) is a broad-spectrum antimicrobial agent with a highly effective antimycotic and gram-positive antibacterial activity, a rapid rate of absorption and low systemic exposure potential. ISN is effective against pathogens involved in dermatomycoses, with minimum inhibitory concentrations well below the concentration of ISN in skin and hair follicles. The combination of the corticosteroid diflucortolone valerate with ISN (Travocort®) increases the local bioavailability of ISN. Compared with ISN monotherapy, Travocort has a faster onset of antimycotic action, faster relief of itch and other inflammatory symptoms, improved overall therapeutic benefits and earlier mycological cure rate. Travocort is effective in the treatment of inflammatory mycotic infections, and also in the eradication of accompanied gram-positive bacterial infections. The rapid improvement observed with Travocort treatment, combined with favourable safety and tolerability, results in higher patient satisfaction, and therefore, can be an effective tool to increase treatment adherence in patients with dermatomycoses accompanied by inflammatory signs and symptoms. [ABSTRACT FROM AUTHOR]

Background Hookworm-related cutaneous larva migrans ( CLM) is characterized clinically by erythematous and slightly raised tracks, located especially on the feet. These tracks may be single or multiple, linear or serpiginous, more or less ramified and intertwined. The length is variable (up to many cm); the width ranges from 1 mm to 4 mm. Tracks are often accompanied by severe pruritus. Methods Three adult Caucasian patients recently returned from trips to Malaysia and Thailand, presented with follicular CLM. The disease was characterized clinically by follicular, erythematous, small papules that were sometimes topped with vesicles or pustules, located on the buttocks. Pruritus was severe. Results Histopathological examinations revealed a perifollicular infiltrate predominantly consisting of lymphocytes and eosinophils. All patients were successfully treated with oral albendazole (400 mg/day for seven days). In the first patient, two courses were necessary. Conclusions Dermatologists should be aware of the existence of this rare and atypical, although emerging, clinical presentation of hookworm-related CLM. [ABSTRACT FROM AUTHOR]

ABSTRACT Steatocystoma multiplex (SM) is a hamartomatous malformation of the pilosebaceous duct consisting of dermal cysts filled with a sebum-like material. SM lesions are typically located in areas with sebaceous follicles, although atypical presentations involving sites lacking sebaceous follicles have exceptionally been described. We reviewed retrospectively a series of 32 histologically diagnosed SM observed in our department in the period 2006-2010, evaluating the kinds of lesions and their locations, and family history of SM and associated disorders, to focus on the clinical features of the acral subcutaneous variety of SM and to estimate its prevalence. We found five patients (four women and one man) with asymptomatic deep, skin-colored nodules on the flexor surfaces of distal upper extremities with a mean age at diagnosis and at disease onset of 32.5 and 26 years, respectively. The prevalence was 15%. All five cases were sporadic. The male patient had eruptive syringomas as an associated condition, together with a family history of this tumour. Acral subcutaneous SM may represent a distinct disease variety by virtue of its distinctive clinical features. Dermatologists should be aware of this form, which has to be included in the wide panel of diseases involving subcutaneous tissue. [ABSTRACT FROM AUTHOR]

Objective To determine the role of insulin-like growth factor binding protein 3 (IGFBP-3) in mediating the effects of transforming growth factor β (TGFβ) on tenascin-C (TN-C) production and to assess the levels of TN-C in vivo in patients with systemic sclerosis (SSc)-associated pulmonary fibrosis. Methods Human primary lung fibroblasts were stimulated with TGFβ or IGFBP-3 in the presence or absence of specific small interfering RNAs and chemical inhibitors of the signaling cascade. TN-C levels in lung tissue specimens obtained from patients with SSc-associated pulmonary fibrosis were assessed using immunohistochemical analysis and were compared with the levels in specimens obtained from normal donors. TN-C levels were quantified in sera from normal donors and patients with SSc with or without pulmonary fibrosis, using an enzyme-linked immunosorbent assay. Results IGFBP-3 mediated the induction of TN-C by TGFβ. Direct induction of TN-C by IGFBP-3 occurred in a p38 MAP kinase-dependent manner. TN-C levels were abundant in lung tissues from patients with SSc and were localized to subepithelial layers of the distal airways. No TN-C was detectable around the proximal airways. Patients with SSc-associated pulmonary fibrosis had significantly higher levels of circulating TN-C compared with SSc patients without pulmonary fibrosis. Longitudinal samples obtained from patients with SSc before and after the onset of pulmonary fibrosis showed increased levels of TN-C after the onset of pulmonary fibrosis. Conclusion IGFBP-3, which is overexpressed in fibrotic lungs, induces production of TN-C by subepithelial fibroblasts. The increased lung tissue levels of TN-C parallel the levels detected in the sera of SSc patients with pulmonary fibrosis, suggesting that TN-C may be a useful biomarker for SSc-related pulmonary fibrosis. [ABSTRACT FROM AUTHOR]

Objectives Cutaneous leishmaniasis ( CL) of the lips is rare. This study was conducted to investigate findings in patients with this condition. Methods From 2007 to date, we observed 10 patients (nine males and one female), with a median age of 45.2 years (range: 8-77 years), with CL of the lips. Results Six of the 10 patients suffered from nasal polyps, three from bronchial asthma, and one from chronic obstructive pulmonary disease ( COPD). Three of the patients with nasal polyps also had asthma. Three patients had none of nasal polyps, asthma, or COPD. In all patients with nasal polyps, diagnosis was confirmed by anterior rhinoscopy and nasal endoscopy. Conclusions It is possible that, in patients with nasal polyps, asthma, and COPD, the need to breathe through the mouth rather than the nose facilitates the sting by sandflies. Subjects with nasal polyps living in areas endemic for CL should be warned about the risk for being stung by sandflies on the lips, in addition to other uncovered areas. [ABSTRACT FROM AUTHOR]

A survey of stream fish communities was conducted in the upper Des Plaines River watershed in Illinois and Wisconsin to determine the distribution of fish species and to evaluate the effects of tributary spatial position, urbanization, and multiple low-head dams on fish species diversity and species composition. Forty-eight sites upstream of Salt Creek in Illinois to the headwaters in Wisconsin were surveyed between 2002 and 2004. We found that fish species diversity decreased as agricultural land was replaced by urban land. In addition, tributary position within the drainage network caused significant differences in fish species diversity; specifically, we found significantly less fish species diversity in main-stem tributary streams located lower in the drainage network than in similarly sized streams located in the headwaters of the drainage area. Fish species composition, determined by multivariate principal components analysis, also showed significant differences among stream position within the drainage network. Increases in urbanization did not have a significant effect on fish species diversity within undammed tributary sites, but it did have a strong influence on fish species composition. Hence, as urbanization increased in these undammed tributaries, the fish species composition changed from coolwater-riverine specialist to warmwater-riverine generalist assemblages. In contrast, for tributary streams with low-head dams, the presence of dams had a greater effect on fish species composition than urbanization. In addition, the presence of multiple low-head dams on the main stem had a cumulative detrimental effect on fish species diversity, which decreased along an upstream-to-downstream gradient. Consequently, it is important to consider tributary spatial position within the drainage network, the amount of urbanization, and the number and locations of dams when characterizing the structure of warmwater fish communities, especially in relation to the development of restoration plans in highly urbanized or urbanizing watersheds. [ABSTRACT FROM AUTHOR]

Aim MAS064D (Sebclair®) is a novel steroid-free cream containing multiple active ingredients. Objective of this pilot study was to evaluate the efficacy and safety of MAS064D in the treatment of mild to moderate SD of the face. Methods Patients ( n = 60) with SD were randomized to receive MAS064D ( n = 40) or a matching vehicle ( n = 20). The primary study endpoint was investigators’ global assessment (IGA) score at day 28, compared with baseline. Secondary endpoints included: IGA score at day 14; investigators’ assessment of erythema and scaling; patients’ assessment of burning/stinging, pruritus and global response to MAS064D; resort to rescue medication; quality of life. Results Use of MAS064D for 4 weeks was associated with a higher percentage of success in the MAS064D group than in the vehicle group (~68% vs 11%, P < 0.0001). The effects of MAS064D were significantly better than those of vehicle for investigator-assessed erythema and scaling, and patients’ assessed pruritus and global response to MAS064D ( P  0.01). No patient in the MAS064D group required rescue medication, compared with two patients in the vehicle group. Four patients (two each in the MAS064D and vehicle groups) reported a total of six non-serious adverse events. Conclusions MAS064D appears to be an effective and well tolerated cream for the treatment of mild to moderate SD of the face. Further clinical evaluation of MAS064D in SD is warranted. [ABSTRACT FROM AUTHOR]

Tungiasis is an infestation caused by penetration in the skin of the gravid female of the flea Tunga penetrans. In the period 1991–2006, 19 patients with imported tungiasis were observed at our Institute. All patients were subjected to general and dermatological examination, laboratory tests (including bacteriological examinations) and surgical excision of the lesions with histopathological examination. In all patients tetanus prophylaxis was made. All patients were followed up for at least six weeks. Thirteen patients were males (68.4%) and 6 females (31.6%). The age ranged from 3 to 71 years (average age: 37.8 years). Eleven patients (57.9%) contracted the infestation in Central and South America and 8 (42.1%) in Africa. In 17 patients (89.5%) tungiasis was localized to the feet, in one to the hands and in one to a thigh. In 13 patients (68.4%) the infestation was characterized by a single lesion; in the other 6 patients (31.6%) the lesions were two. In 15 patients (78.9%) tungiasis was characterized by a papular or nodular lesion. Crusted (2 patients), pustular (2 patients) and bullous (1 patient) lesions were also observed; furthermore, one patient presented with a plantar wart-like lesion. In only one patient bacteriological examinations showed the growth of Staphylococcus aureus and Escherichia coli. All patients healed without complications. [ABSTRACT FROM AUTHOR]

Paromomycin, previously named aminosidine, is an aminoglycoside that was isolated in the 1950s from I Streptomyces krestomuceticus i . Finally, two patients with CL by I L. infantum/donovani i , observed in Switzerland, were cured with 15% paromomycin and 12% methylbenzethonium ointment.[5] It is difficult to explain the reasons for which topical paromomycin showed to be ineffective in several of our patients. Although the low number of patients and lack of a control group are limitations of this study, we decided to stop the use of paromomycin in CL leishmaniasis caused by I L. infantum i . [Extracted from the article]

Serology for Herpes virus revealed positivity for HHV-6 (2960 genomes/mL serum, 902 759 genomes/mL in whole blood [<250 copies], IgG anti-HHV-6 was 1.3). Since IgG against HHV-6 was negative and HHV-6 DNA blood level was still high in the blood, HHV-6 DNA was quantified in hair follicles (846 295 copies/100 000 cells), proving HHV-6 chromosomal integration. Second, these patients have unusually high viral loads of HHV-6 in biological samples which can lead to possible erroneous diagnosis of active infection.[2] This is what happened to our patients with consequent administration of unnecessary antiviral therapies. [Extracted from the article]