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Background Ketoconazole, an antifungal agent, adversely affects spermatogenesis in rodents, but knowledge on adverse effects of prolonged administration of ketoconazole on the fertility of male dogs is lacking. A case of reversible infertility with azoospermia in a male American Staffordshire terrier treated with ketoconazole is reported here. Case presentation A seven-year old male American Staffordshire terrier treated for 3 months with ketoconazole for a persistent Malassezia dermatitis displayed reduced libido and mating of 3 bitches had been unsuccessful. The dog was presented at the clinic 40 days after the treatment had been stopped. At first presentation, low libido and complete absence of sperm in the ejaculate (azoospermia) associated with low testosterone level were found. Repeated examinations revealed that sperm quality and testosterone level had restored 100 days after ketoconazole had been withdrawn. Thereafter, the dog successfully mated 2 bitches. Conclusion The treatment with ketoconazole for 3 months may have led to reversible infertility characterized by azoospermia. Therefore, owners of stud dogs should be informed of this risk prior to initiating such treatment and in case of infertility, previous treatment with ketoconazole should be considered as a possible cause.

Discharging facial lesions of dental etiology are almost always difficult to diagnose. Due to the lack of dental signs in most patients, these lesions are often misunderstood and overlooked. Such patients often seek cosmetic therapy and end up undergoing unnecessary treatments, if an odontogenic source is not established. To make an accurate diagnosis, a comprehensive medical and dental history, as well as knowledge of the various presentations of facial lesions, is of pivotal importance. The cases identified here were misdiagnosed at first, and they were treated with antibiotics and surgical procedures as a result. Root canal operations were performed after referral to a dental unit, and the sinus tract eventually healed. This emphasizes the significance of taking odontogenic sources into account when treating head and neck lesions.

Background In recent years, the rate of immunosuppressed patients has increased rapidly. Invasive fungal infections usually occur in these patients, especially those who have had hematological malignances and received chemotherapy. Fusariosis is a rare pathogenic fungus, it can lead to severely invasive Fusarium infections. Along with the increased rate of immune compromised patients, the incidence of invasive Fusarium infections has also increased from the past few years. Early diagnosis and therapy are important to prevent further development to a more aggressive or disseminated infection. Case summary We report a case of a 19-year-old male acute B-lymphocytic leukemia patient with fungal infection in the skin, eyeball, and knee joint during the course of chemotherapy. We performed skin biopsy, microbial cultivation, and molecular biological identification, and the pathogenic fungus was finally confirmed to be Fusarium solani. The patient was treated with oral 200 mg voriconazole twice daily intravenous administration of 100 mg liposomal amphotericin B once daily, and surgical debridement. Granulocyte colony-stimulating factor was administered to expedite neutrophil recovery. The disseminated Fusarium solani infection eventually resolved, and there was no recurrence at the 3 mo follow-up. Conclusion Our case illustrates the early detection and successful intervention of a systemic invasive Fusarium infection. These are important to prevent progression to a more aggressive infection. Disseminate Fusarium infection requires the systemic use of antifungal agents and immunotherapy. Localized infection likely benefits from surgical debridement and the use of topical antifungal agents.

BACKGROUND Cutaneous lesions of external ear are quite common in clinical practice. Patients often present with various cutaneous lesions of the external ear to various disciplines. They are often underdiagnosed as many lesions, though commonly diagnosed by our dermatologist colleague are missed by other clinicians. These lesions can be classified in various ways, according to the aetiology, and according to the anatomic sites. In the present study, we tried to assess the prevalence of different skin lesions affecting external ear presenting to an ENT and skin outpatient department of a tertiary care medical college in Eastern part of India. METHODS This is a descriptive observational study, cross sectional in design. 240 patients attended the outpatient department with cutaneous lesions affecting external ear from January 2019 to February 2020. The patients presenting in both ENT and skin outpatient department were chosen randomly. Cases were diagnosed based on history and clinical examination and appropriate investigation as required. All cases were categorised into 5 types (infective, inflammatory, autoimmune, neoplasm & naevi, and reactive & reparative) according to the aetiology. In each category, prevalence of various skin lesions was recorded. RESULTS A total number of 240 cases were detected during the study period. Among them, infective 43.33 %, inflammatory 30.83 %, autoimmune 9.17 %, neoplasm & naevi 4.17 % and reactive & reparative were 12.82 %. Taenia was the most common lesions encountered (20.51 %) followed by keloid (12.5 %). Impetigo and seborrheic dermatitis shared same number of cases (9.4 %). Neoplastic lesions were the least common. CONCLUSIONS With some awareness and basic knowledge, many of the cutaneous lesions of external ear can be diagnosed and treated whenever patients report to a clinician, thus saving valuable time, effort and money of the patient. KEYWORDS Cutaneous Lesions, Skin Lesions, External Ear

We investigated the local and systemic effects of hyperbaric oxygen therapy in BALB/C mice, exposed to two different exposure times, under 2.4 atmosphere (ATM). Fifteen animals were divided into three groups (GI, GII and Control) and underwent a surgical excision of a skin fragment of approximately one square centimeter of the dorsal region. The wounds were treated and monitored for 21 days. In the control group, the wound was cleaned once a day with sterile 0.9% NaCl solution. GI and GII mice were submitted to daily hyperbaric oxygen therapy of 30 or 60minutes sessions, respectively. The wounds were photographed every three days and their surfaces were analyzed by an image analyzer. At 21 days, all animals were euthanatized for histopathological analysis of the skin, lungs and liver in order to identify eventual alterations in wound healing or in the analyzed organs. Animals belonging to GI showed a faster skin wound healing in comparison to the other groups. Animals from GII, however, showed a delayed wound healing process and exhibited lung and microcirculatory alterations. These findings allow us to conclude that the exposure time to the oxygen in hyperbaric environment is crucial and can help or disturb skin wound healing or even be deleterious to other organs. RESUMO Investigaram-se os efeitos locais e sistêmicos da oxigenoterapia hiperbárica em camundongos BALB / C, submetidos a dois tempos de exposição diferentes, sob atmosfera 2,4 (ATM). Quinze animais foram divididos em três grupos (GI, GII e controle) e submetidos à excisão cirúrgica de fragmento de pele de aproximadamente um centímetro quadrado da região dorsal. As feridas foram tratadas e acompanhadas por 21 dias. No grupo controle, a ferida foi limpa uma vez ao dia, com solução estéril de NaCl 0,9%. Camundongos GI e GII foram submetidos à oxigenoterapia hiperbárica diária de 30 ou 60 minutos de sessões, respectivamente. As feridas foram fotografadas a cada três dias, e suas superfícies analisadas por um analisador de imagens. Aos 21 dias, todos os animais foram submetidos à eutanásia para análise histopatológica da pele, do pulmão e do fígado, em busca de eventuais alterações na cicatrização da ferida ou nos órgãos analisados. Animais pertencentes ao GI apresentaram cicatrização mais rápida de feridas cutâneas em comparação aos outros grupos. Já os animais do GII apresentaram retardo na cicatrização da ferida e alterações pulmonares e microcirculatórias. Esses achados permitem concluir que o tempo de exposição ao oxigênio em ambiente hiperbárico é fundamental e pode auxiliar ou atrapalhar a cicatrização de feridas cutâneas ou mesmo ser deletério para outros órgãos.

Immunoglobulin G4-related disease (IgG4-RD) is an immune-mediated fibroinflammatory condition affecting multiple organs; however, the involvement of skin lesions is rare. We herein report a 65-year-old man who presented with pruritic punctate purpura on both legs and elevated liver enzyme levels. Computed tomography showed enlargement of the pancreas and thickening of the bile duct wall. Magnetic resonance cholangiopancreatography showed diffuse irregular constriction of the main pancreatic duct, stricture of the lower common bile duct, and dilation after confluent stricture. A histopathologic examination of the pancreas and his enlarged salivary gland showed infiltration of IgG4-positive plasma cells. Ultimately, the patient was diagnosed with IgG4-RD.

Background Operation notes often have omissions and are difficult to locate in patients notes despite clear guidance from the Royal College of Surgeons (RCS) 'Good Surgical Practice' 2014 outlining what should be included in operation notes. Procedure-specific proformas are rarely used by Plastic surgeons despite being utilised by other specialities. With an alarming rise of incidence of skin malignancies there has been an increase in the number of skin lesions referred to Plastic surgeons for excision. The need for reliable, reproducible, accurate and easily accessible operating notes for skin lesion excision is pivotal for continuity of care and treatment planning. This study aimed at comparing the quality of skin lesion operation notes prior-to and after implementation of a procedure-specific proforma in relation to RCS recommendations. Methods Fourteen parameters from the recommendations by the RCS ‘Good Surgical Practice’ 2014 guidelines were used to audit skin lesion operation notes. The study consisted of a retrospective audit of 80 operation notes and a prospective audit of 80 operation notes following the development and implementation of a skin lesion procedure-specific proforma. We assessed and compared the operation notes overall compliance with the RCS guidelines. Statistical analysis highlighting the difference between both groups was performed using the independent sample t-test. Results After implementation of the skin lesion procedure-specific proforma, the average compliance with the RCS recommendations increased significantly from 87.5% retrospectively to 98.8% prospectively (p-value 0.0414). In 6 of the 14 parameters assessed significant improvements with regards compliance to the guidelines was demonstrated. Conclusion The development and implementation of a skin lesion procedure-specific proforma has demonstrated a significant improvement in the quality of operation notes within a Plastic surgery department which has the potential to minimise omissions and improve continuity of surgical patient care.

Background and Aim: Zinc has a wide spectrum of biological activities and its deficiency has been related to various dysfunctions. This study aimed to clarify the clinical, hematological, and biochemical changes in Holstein dairy calves with naturally occurring hypozincemia before and after treatment. Materials and Methods: This study was carried out on 25 Holstein dairy calves

Objectives The face aging processes are associated with physiologic and biochemical alteration that produces wrinkles, skin pigmentation and benign growths. The aim of this study was to evaluate the clinical efficacy of voltaic arc dermabrasion with plasma to remove benign facial skin lesions. Study Design Voltaic arc dermabrasion plasma technique was used to remove the facial benign skin lesions. The study involved 45 patients (26 females;19 males) treated for benign facial skin lesions with voltaic arc dermabrasion also called plasma exeresis technique. The subjects age ranged between 43 and 65 years. The clinical observations and comparison of pretreatment and post-treatment photographs of the treated regions were performed by a joint examiner at each follow-up visit. Results During plasma irradiation, the average temperature of the skin was 290.3 ± 21.7 °C, while immediately after it was 90.6 ± 21.8 °C. Overall clinical improvement was 100% in six lesions with complete resolution of all lesions. Three patients observed a transient post-inflammatory pigmentation with a peak at 1 month after VAD treatment, gradually fading spontaneously over 2 to 3 months. Conclusions The voltaic arc dermabrasion technique (atmospheric plasma) should be considered for lesions, especially relatively superficial ones, and small lesions that are located on the face. Level of Evidence IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

Introduction Our previous clinical studies have demonstrated the short-term efficacy and safety of the sirolimus gel for patients with tuberous sclerosis complex (TSC). However, long-term clinical evidence is lacking. Our objective was to assess the safety and efficacy of long-term treatment with the sirolimus gel for the skin lesions of TSC patients. Methods We conducted a multicenter, open-label, uncontrolled clinical trial in 94 Japanese patients with TSC. Patients applied the 0.2% sirolimus gel on their face or head twice daily for > 52 weeks (maximum 136 weeks for safety). The safety endpoints were the rate of adverse event (AE)-caused discontinuation (primary endpoint) and the incidence of AEs. The efficacy endpoint was the response rate of angiofibromas, cephalic plaques, and hypomelanotic macules. Results Among 94 enrolled patients (mean age, 21 years; range 3–53 years), the rate of AE-caused discontinuation was 2.1% (2/94 patients). Although application site irritation and dry skin occurred relatively frequently, none of the drug-related AEs were serious; most of the drug-related AEs resolved rapidly. The major drug-related AEs (≥ 5% in incidence) were application site irritation (30.9%), dry skin (27.7%), acne (20.2%), eye irritation (8.5%), pruritus (8.5%), erythema (7.4%), dermatitis acneiform (6.4%), and dermatitis contact (5.3%). The response rates of angiofibromas, cephalic plaques, and hypomelanotic macules were 78.2% [95% confidence interval (CI) 68.0–86.3%], 66.7% (95% CI 51.1–80.0%), and 72.2% (95% CI 46.5–90.3%), respectively. Conclusions The gel was well tolerated for a long time by patients with TSC involving facial skin lesions and continued to be effective. Trial Registration ClinicalTrials.gov identifier: NCT02634931.

Introduction: The first cases of coronavirus disease 2019 (COVID-19) were noted in December 2019 in Wuhan province, China The World Health Organisation (WHO) announced the pandemic status on March 11, 2020 The manifestations of the disease are as follows: fever, cough, fatigue, anosmia and ageusia, dyspnoea, chest pain, muscle soreness, chills, sore throat, rhinitis, headache, gastrointestinal (GI) symptoms, and dermal lesions Aim: To evaluate the relationship between dermal lesions and GI symptoms in a group of COVID-19 patients Material and methods: A group of 441 COVID-19 patients admitted to the Central Clinical Hospital of the Ministry of the Interior and Administration in Warsaw between March 15th and June 15th, 2020 Results: Of 441 patients with confirmed SARS-CoV-2 infection, 255 (58 5%) experienced gastrointestinal (GI) symptoms: lack of appetite was reported in 124 (48 6%) cases, diarrhoea was noted in 109 (42 7%), abdominal pain in 95 (37 3%), vomiting in 37 (14 5%), and nausea in 32 (12 5%) cases Eight (1 81%) patients had dermal lesions: erythematous macular lesions (2 patients - 25%), erythematous infiltrated lesions (2;25%), erythematous infiltrated and exfoliative lesions (3;37 5%), erythematous papular lesions (3;37 5%), and erythematous oedematous lesions (2;25%) All of those patients reported gastrointestinal symptoms during the hospitalisation Conclusions: The following study analyses possible causes of dermal lesions and their coexistence with GI symptoms Several possible theories were taken into account, including the microbiota alterations and issue of drug-related complications © 2020 Termedia Publishing House Ltd All rights reserved

Context: Hidradenitis suppurativa is a noncontagious, inflammatory, chronic and recurrent disease. The prevalence of HS is estimated to be between less than 1 and 4%. It is more common in females than males at a 2:1 ratio. Many cases of HS are either misdiagnosed or remain undiagnosed. Aims: To assess knowledge of diagnosing hidradenitis suppurativa by Ministry of Health primary health care physicians in Jeddah city, 2019 and to identify the determinants and knowledge of diagnosing hidradenitis suppurativa. Settings and Design: An analytical cross-sectional study conducted in Jeddah city, 2019, among primary health care physicians of the MOH. Methods and Material: Estimated sample size was 114. The required primary health care centers were 38 centers. The centers were chosen by a simple random sampling technique. A reliable self-administered questionnaire was used. Ethical approval was obtained. Statistical Analysis Used: Descriptive statistics consisted of means, standard deviations, frequency tables, cross tabulation and charts). Categorical variables were compared using the chi–square test to determine significant relationships between variables. Results: 65.4% (68) diagnosed the disease correctly. Most of their knowledge came from clinical practice (39.4%). There was a significant relationship with current job title and medical degree (P-value < 0.0005). Conclusion: The present study showed good knowledge about and ability to diagnose HS. A more advanced medical degree and more years of clinical experience was positively associated with the ability to diagnose HS.

Melanoma is a type of skin cancer with a high mortality rate. The different types of skin lesions result in an inaccurate diagnosis due to their high similarity. Accurate classification of the skin lesions in their early stages enables dermatologists to treat the patients and save their lives. This paper proposes a model for a highly accurate classification of skin lesions. The proposed model utilized the transfer learning and pre-trained model with GoogleNet. The model parameters are used as initial values, and then these parameters will be modified through training. The latest well-known public challenge dataset, ISIC 2019, is used to test the ability of the proposed model to classify different kinds of skin lesions. The proposed model successfully classified the eight different classes of skin lesions, namely, melanoma, melanocytic nevus, basal cell carcinoma, actinic keratosis, benign keratosis, dermatofibroma, vascular lesion, and Squamous cell carcinoma. The achieved classification accuracy, sensitivity, specificity, and precision percentages are 94.92%, 79.8%, 97%, and 80.36%, respectively. The proposed model can detect images that do not belong to any one of the eight classes where these images are classified as unknown images.

Pilomatricomas are rare skin tumors related to hair follicles. They typically present in children, and the most common locations are head and neck. Pilomatricomas are usually painless; however, they can cause cosmetic problems. Treatment is decided on an individual basis and involves local excision. However, caution should be taken if the lesion is malignant, as resection with safe margins (0.5-1.0 cm) is determinant of the overall outcome. Radiotherapy is indicated in cases of residual tumor tissue or recurrence. The role of chemotherapy in pilomatricomas is still undetermined. We report a 55-year-old female with multiple lumps on her shoulder and back. The sonographic features of these lesions were typically consistent with pilomatricomas. The patient decided to opt for excision due to cosmetic reasons and the histopathology features were suggestive of pilomatricoma.

OBJECTIVES The purpose of this cross-sectional study was to prepare a reliable and easy-to-use architectural classification for vulvar lichen sclerosus (VLS) aimed at defining the morphological patterns of this condition. MATERIALS AND METHODS An expert panel composed by 7 physicians with expertise in clinical care of vulvar conditions outlined the architectural criteria for the definition of VLS severity (phimosis of the clitoris, involvement of the interlabial sulci, narrowing of the vulvar introitus), identifying 5 grades to build up a classification. Thirteen physicians with 2-30 years expertise in vulvar diseases (nonexpert group) were asked to evaluate 3-5 pictures from 137 patients. Each physician individually assigned a grade to each case, according to the previously mentioned criteria. Interrater reliability was analyzed by means of intraclass correlation coefficient (ICC). The reliability concerning the 2 classifications of each rater was analyzed by means of κ statistic. Intraobserver and interobserver reliability in vivo was analyzed by means of κ index. RESULTS This study provides a new classification of VLS, based on defined anatomical criteria and graded into mutually exclusive progressive classes.The ICC analysis showed a substantial interrater reliability of the classification, ICC = 0.89 (0.87-0.91), both in the expert panel and in the nonexpert group (ICC = 0.92 and 0.87, respectively). An "almost perfect" intraobserver and interobserver reliability was achieved among physicians in vivo (κ = 0.93). CONCLUSIONS Our classification showed a high reliability. It is easy to use, and it can be applied in clinical practice and eventually, in the evaluation of regenerative and cosmetic surgery.

Producción Científica, Coronavirus disease 2019 (COVID-19) is a multisystem disease caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), that primarily causes respiratory symptoms. However, an increasing number of cutaneous manifestations associated with this disease have been reported. The aim of this study is to analyze the scientific literature on cutaneous manifestations associated with SARS-CoV-2 by means of a narrative literature review until June 2021. The search was conducted in the following electronic databases: Medline (PubMed), SciELO, and Cochrane Library Plus. The most common cutaneous manifestations in patients with COVID-19 are vesicular eruptions, petechial/purpuric rashes, acral lesions, liveoid lesions, urticarial rash, and maculopapular-erythematous rash. These manifestations may be the first presenting symptoms of SARS-CoV-2 infection, as is the case with acral lesions, vesicular eruptions, and urticaria. In relation to severity, the presence of liveoid lesions may be associated with a more severe course of the disease. Treatment used for dermatological lesions includes therapy with anticoagulants, corticosteroids, and antihistamines. Knowledge of the dermatologic manifestations associated with SARS-CoV-2 contributes to the diagnosis of COVID-19 in patients with skin lesions associated with respiratory symptoms or in asymptomatic patients. In addition, understanding the dermatologic lesions associated with COVID-19 could be useful to establish a personalized care plan., Junta de Castilla y León - FEDER (n° 07.04.467804.74011.0)

This study presents the first application of convolutional neural networks to high-frequency ultrasound skin image classification. This type of imaging opens up new opportunities in dermatology, showing inflammatory diseases such as atopic dermatitis, psoriasis, or skin lesions. We collected a database of 631 images with healthy skin and different skin pathologies to train and assess all stages of the methodology. The proposed framework starts with the segmentation of the epidermal layer using a DeepLab v3+ model with a pre-trained Xception backbone. We employ transfer learning to train the segmentation model for two purposes: to extract the region of interest for classification and to prepare the skin layer map for classification confidence estimation. For classification, we train five models in different input data modes and data augmentation setups. We also introduce a classification confidence level to evaluate the deep model’s reliability. The measure combines our skin layer map with the heatmap produced by the Grad-CAM technique designed to indicate image regions used by the deep model to make a classification decision. Moreover, we propose a multicriteria model evaluation measure to select the optimal model in terms of classification accuracy, confidence, and test dataset size. The experiments described in the paper show that the DenseNet-201 model fed with the extracted region of interest produces the most reliable and accurate results.

Tuberous sclerosis complex (TSC) is an autosomal dominant disorder with multisystemic involvement usually resulting from mutations in the tuberous sclerosis 1 (TSC1) or TSC2 genes. However, 10 to 25% of patients do not exhibit these mutations. Cerebral cavernous malformations (CCMs) are capillary-venous malformations that can be asymptomatic or cause variable neurological manifestations, including seizures. Familial CCMs are recognized. In both conditions, specific dermatological lesions are associated. We present the case of a 31-year-old female with TSC diagnosed at the age of 18 years who presented with negative genetic testing. She was admitted to our department in 2019 for a sudden increased frequency of focal seizures. Patient examination revealed multiple facial and intraoral angiofibroma, diplopia, right hemihypoesthesia, brisk deep tendon reflexes, and distal leg paresthesia. VideoEEG indicated a frontal paramedian epileptogenic focus. Cerebral magnetic resonance imaging (MRI) and angioMRI identified multiple fronto-parietal cortical tubers, as well as multiple CCMs, with evidence of bleeding in one. Under antiepileptic drug (AED) and mTOR inhibitor treatment, the seizure frequency significantly improved in a short period of time. This is the first reported case of tuberous sclerosis with negative genetic testing associated with multiple cerebral cavernoma. Such complex patients require multidisciplinary management and detailed genetic testing for increasing knowledge on neuro-cutaneous disorders.

Infantile systemic hyalinosis (ISH) is a rare, autosomal recessive disorder characterized by widespread abnormal growth of hyalinized fibrous tissue in skin and mucosae. The typical clinical picture consists of the development of joint contractures, skin lesions, and severe, chronic pain. We report the case of a 2-year-old Pakistani girl, who presented to our clinic with papulonodular lesions, gingival hyperplasia, hypotonia, and joint contractures. Skin biopsy revealed hyaline deposits, and genetic testing revealed a mutation in the protein Anthrax toxin receptor 2 (ANTXR2).

The phases of a cutaneous infection are initially the adhesion of the microorganism to the cells of the host, followed by the invasion of the tissues, than the elaboration of toxins and the escape from the defense systems of the host. The Human Amniotic Membrane (HAM) is extracted from the placenta of donors after caesarean section. The amnios is characterized by a monolayer of epithelial cells, a basement membrane and an avascular stroma of collagen. The HAM showed to promote chronic wound healing. We evaluated the “in vivo” and "in vitro" activity and efficacy of the HAM in subjects with chronic diabetic skin lesion. This clinical case showed that the HAM promote the wound healing of complex chronic skin lesion in a follow-up period of 6 months after the first graft., Highlights • We evaluated the Human Amniotic Membrane (HAM) activity and efficacy in the treatment of diabetic skin lesion. • The Human Amniotic Membrane showed to facilitating cell regeneration in skin lesions. • The Human Amniotic Membrane showed antimicrobial effects, favoring the restoration of skin surface defense systems. • The Human Amniotic Membrane has proved to be an excellent dermal substitute for the treatment of non-healing ulcers.

Dermatofibrosarcoma protuberans is a slowly progressive, locally aggressive fibroblastic tumor which can be misdiagnosed in the early stage. Reflectance confocal microscopic features of dermatofibrosarcoma protuberans has been scarcely described in the literature. We described the dermoscopic and reflectance confocal microscopic findings of 12 × 15 cm sized tumoral lesion of 45-year-old man.

Numerous literature data show the role of mycoplasma infection in the development of non-respiratory lesions of various organs and systems, including the skin. Herpesvirus and mycoplasma infections can trigger the development of immune-mediated inflammatory reactions of the skin and mucous membranes — erythema multiforme exudative, Stevens-Johnson syndrome, vesicular pustular dermatosis — Sneddon-Wilkinson syndrome, etc.In order to study the frequency and nature of skin lesions with mycoplasmosis combined with herpesvirus infection, 45 patients aged 3 to 15 years of life were observed. A comprehensive clinical and laboratory study revealed skin lesions in 27 patients associated with current mycoplasma and herpesvirus infections. Thus, multiforme exudative erythema in the small form variant was diagnosed in 13 patients, skin vasculitis in 4, hemorrhagic purpura in 3, urticaria rash in 3, erythema nodosum in 2, mucositis in 2 children. In 18 children, a combined mycoplasma and herpesvirus infection was established. In 9 children, a mono infection was detected (in 5 — herpes virus and in 4 — mycoplasma).All observed patients showed antibodies to smooth muscle antigens in titers from 1:80 to 1:160 (normal 1:40) and in the vast majority (in 24 patients) — antibodies to vascular endothelial antigens in titers from 1:80 to 1:320 (with the norm of 1:40). Compaction of the intima-media complex was detected in 6 patients with monoinfection and in 16 patients with co-infection, according to ultrasound duplex scanning of the vessels of the brachiocephalic department.Thus, for various immuno-inflammatory, allergic skin diseases, screening for infections, in particular, mycoplasma and herpesvirus, is necessary to optimize treatment.

Lipoid proteinosis is a rare cause of voice problems. Hoarseness is often the first clinical manifestation of this disorder and can present years before any other symptom. Therefore, it is very important as an otorhinolaryngologist to be familiar with the main characteristics of this disease. We present a case report and a review of current literature to provide a concise overview of this frequently missed diagnosis. ispartof: JOURNAL OF VOICE vol:33 issue:2 pages:155-158 ispartof: location:United States status: published

Background: Daclizumab is a humanized monoclonal antibody against the D-subunit (CD25) of the high-affinity interleukin (IL)–2 receptor, used for the treatment of relapsing-remitting multiple sclerosis with a large spectrum of cutaneous adverse reactions. Case presentation: We present the case of a middle-aged man treated with daclizumab for multiple sclerosis, who developed skin reactions difficult to evaluate. A 4 mm punch-biopsy was taken from the plantar area. Histological examination of the biopsy revealed hyperkeratosis and acanthosis but no parakeratosis, while a discrete inflammatory infiltrate was noticed around vessels in the dermis. Treatment with fluconazole 50 mg/day for 10 days, moisturizers, and grade I topical steroids was followed by slight improvement of the clinical picture. Treatment with daclizumab was not discontinued. Conclusion: The clinical efficacy and side effects of daclizumab have to be reported and confirmed in clinical practice in the following years. Any clinical report can contribute to validate the efficacy and risk of the drug’s administration. Any type of adverse skin reaction must be reported for clarifying the diagnosis.

There are various of skin pigmented lesions with high risk. Melanoma is one of the most dangerous forms of skin cancer. It is one of the important research directions of medical artificial intelligence to carry out classification research of skin pigmented lesions based on deep learning. It can assist doctors to make clinical diagnosis and make patients receive treatment as soon as possible to improve survival rate. Aiming at the similar and imbalanced dermoscopic image data of pigmented lesions, this paper proposes a deep residual network improved by Squeeze-and-Excitation module, and dynamic update class-weight, in batches, with model ensemble adjustment strategies to change the attention of imbalanced data. The results show that the above method can increase the average precision by 9.1%, the average recall by 15.3%, and the average F1-score by 12.2%, compared with the multi-class classification using the deep residual network. Thus, the above method is a better classification model and weight adjustment strategy.

Introduction: Cutaneous neoplasms are the most common cancers in the world, and have high morbidity rates. A definitive diagnosis can only be obtained after histopathological evaluation of the lesions. Objective: To develop an artificial intelligence program to establish the histopathological diagnosis of cutaneous lesions. Methodology: A deep learning program was built using three neural network architectures: MobileNet, Inception and convolutional networks. A database was constructed using 2732 images of melanomas, basal and squamous cell carcinomas, and normal skin. The validation set consisted of 284 images from all 4 categories, allowing for the calculation of sensitivity and specificity. All images were provided by the Path Presenter website. Results: The sensitivity and specificity of the MobileNet model were 92% (95%CI, 83-100%) and 97% (95%CI, 90-100%), respectively; corresponding figures for the Inception model were 98.3% (95%CI, 86-100%) and 98.8% (95%CI, 98.2-100%); lastly, the sensitivity and specificity of the convolutional network model were 91.6% (95%CI, 73.8-100%) and 95.7% (95%CI, 94.4-97.2%). The maximum sensitivity for the differentiation of malignant conditions was 91%, and specificity was 95.4%. Conclusion: The program developed in the present study can efficiently distinguish between the main types of skin cancer with high sensitivity and specificity.

Leprosy is an infectious disease that remains endemic in approximately 100 developing countries, where about 200,000 new cases are diagnosed each year. Moreover, multibacillary leprosy, the most contagious form of the disease, has been detected at continuously higher rates among Brazilian elderly people. Due to the so-called immunosenescence, characterized by several alterations in the quality of the immune response during aging, this group is more susceptible to infectious diseases. In view of such data, the purpose of our work was to investigate if age-related alterations in the immune response could influence the pathogenesis of leprosy. As such, we studied 87 individuals, 62 newly diagnosed and untreated leprosy patients distributed according to the age range and to the clinical forms of the disease and 25 healthy volunteers, who were studied as controls. The frequency of senescent and memory CD8+ leukocytes was assessed by immunofluorescence of biopsies from cutaneous lesions, while the serum levels of IgG anti-CMV antibodies were analyzed by chemiluminescence and the gene expression of T cell receptors' inhibitors by RT-qPCR. We noted an accumulation of memory CD8+ T lymphocytes, as well as reduced CD8+CD28+ cell expression in skin lesions from elderly patients, when compared to younger people. Alterations in LAG3 and PDCD1 gene expression in cutaneous lesions of young MB patients were also observed, when compared to elderly patients. Such data suggest that the age-related alterations of T lymphocyte subsets can facilitate the onset of leprosy in elderly patients, not to mention other chronic inflammatory diseases.

Superinfection of skin lesions is quite common, and often delays wound recovery. Infection control plays therefore a key role in the management of skin lesions, requiring the use of specific antimicrobials. Among available agents, topic antiseptic drugs are currently recommended as a first-choice option, to be preferred to antibiotics, given the growing resistance to these drugs. Compared to antibiotics, antiseptic drugs have a wider spectrum of action, including bacteria, fungi, virus, protozoa, and prions. The ideal antiseptic for the management of an infected skin lesion is expected to be both highly effective and well tolerated, in order to promote the physiologic process of tissue restoration. Among available antiseptics, the 0,05% sodium hypochlorite electrolytic solution meets these criteria: the product proved to be effective in vitro and in animal experimental models against a wide range of microorganisms, besides exerting an anti-inflammatory action in the absence of any irritating, cytotoxic or carcinogenic adverse effect, and being useful in biofilm removal. Similarly, in several clinical trials, the 0,05% sodium hypochlorite electrolytic solution was demonstrated to be very effective and safe in the management of infected skin wounds: based on these results, this product should be strongly considered among the first-choice options for the disinfection of skin wounds. The new formulation, developed according to the latest reference standards for wound healing and in agreement with current guidelines, is qualitatively improved, with an expected positive impact in every field of clinical application and a subsequent benefit for treated patients.

Background/aim Dermatological adverse events (DAE) in hepatocellular carcinoma (HCC) patients treated with sorafenib predicts better outcome. Some turn into skin lesions (SL) requiring pathology examination. We describe incidence, characteristics and molecular profile of SL in HCC patients treated with sorafenib. Materials and methods SL were prospectively collected in 311 HCC patients who started sorafenib. SL from sorafenib cohort were compared to those from a control patient group selected to match SL type and demographics. HRAS, KRAS and BRAF mutations were analyzed by CAST-PCR, mutated p53 and MAPK pathway activation by immunohistochemistry and immune infiltration by hematoxylin-eosin staining. Results Eighty-eight out of 311 patients developed DAE and 7.4% SL required histological assessment. Most frequent lesions were keratoacanthomas (n = 4), squamous-cell carcinomas (SCC)(n = 5), basal-cell carcinomas (BCC)(n = 3) and seborrheic keratosis (n = 5). HRAS and KRAS mutations were detected in 4 SL, while no mutations showed in control SL. Nuclear pERK immunostaining was identified in 33.3% of cases versus 5.3% of controls. Most SL (90%) from patients with DAE were proliferative with intense immune infiltration (73%). Conclusions The onset of SL and their molecular profile did not impact negatively on patient's prognosis, but intense proliferation of SL may reflect compensatory activation of MAPK pathway and warrants their close monitoring.

Made available in DSpace on 2022-04-28T19:49:36Z (GMT). No. of bitstreams: 0 Previous issue date: 2021-01-01 Background: Although the etiology of hepatogenous photosensitization has not yet been fully elucidated, it is known that hepatotoxic substances (saponins) present in grasses of the genus Brachiaria spp. are responsible for intoxication of ruminants and horses, causing great economic losses in the whole world. Since this grass is the source of food for the herd in Brazil, and other countries of the world, the aim of this paper is to describe the epidemiological, clinical, laboratory and anatomopathological aspects of a steer with this disease. Case: A 3-year-old Nellore steer was referred to veterinary care at a property in Bahia, with a 3-week history of swelling, loss of cutaneous tissue in the ear and scrotum region, and dry faeces. The animal was raised in pasture with Brachiaria decumbens along with five animals of different age and sex; however, it was the only one to present symptoms. Although the animal had been treated at the farm, there was no clinical improvement. On clinical examination, the steer was apathetic with jaundiced mucous membranes, nasal and ocular discharge, epiphora, and ulcers on the labial and gum commissure. The steer had leukocytosis with neutrophilia, anemia, and hyperfibrinogemia. The body condition score (BCS) was 2 (BCS ranges from 1 to 5), and the skin lesions observed were bedsores, necrosis and scabs in several regions. The increase in liver enzymes (GGT, AST) indicated hepatic impairment, suggesting a case of hepatogenous photosensitization. The therapeutic protocol instituted was enteral hydration, electrolyte replacement, topical application of ointment in the injured areas. In addition, it was recommended to maintain the animal in the shade, supply of good quality grass, and a new clinical evaluation in seven days. On new examination, it was observed that there was no satisfactory clinical improvement of the animal, and persistence of laboratory changes. Despite the poor prognosis, treatment was continued for another month with the same recommendations. However, in view of the severe clinical condition and unfavorable prognosis, the animal was submitted euthanasia. Necropsy revealed extensive areas of bedsores, erythema, severe jaundice in the mucous membranes, eyeballs and opaque corneas. The liver had an enlarged volume with bulging edges and a greenish color. The kidneys had a pale brownish color, with an irregular and mottled subcapsular surface, with blackened and depressed spots. Histologically, the cytoplasm of the hepatocytes was finely vacuolated, sometimes refringent and with an abundant presence of bile pigment. It was also observed in the middle of the liver parenchyma, multiple foci of accumulation of macrophages filled with vacuoles of different sizes containing saponins and crystals of saponins inside bile ducts. Furthermore, it was possible to observe hypertrophy and hyperplasia of Kupffer cells, disarrangement of hepatocytes with individual necrosis of hepatocytes. Discussion: The diagnosis of hepatogenous photosensitization was based on history, clinical, laboratory and anatomopathological findings. Serum biochemistry was important to measure hepatic impairment and possible secondary lesions, which were confirmed by the necropsy. Although hepatogenous photosensitization is less common in adult cattle, it must be considered in the differential diagnosis of skin lesions, reduced appetite, and jaundice. Since it was a sporadic case, individual predisposition is probably a preponderant factor. Centro de Ciências Agrárias Ambientais e Biológicas (CCAAB) Universidade Federal do Recôncavo da Bahia (UFRB), Cruz das Almas, BA Laboratório de Reprodução Animal Universidade Federal da Bahia (UFBA), BA Faculdade de Medicina Veterinária e Zootecnia (FMVZ) Universidade Estadual Paulista “Júlio Mesquita Filho” (UNESP), SP Faculdade de Medicina Veterinária e Zootecnia (FMVZ) Universidade Estadual Paulista “Júlio Mesquita Filho” (UNESP), SP

Germline PTEN pathogenic variants cause a spectrum of disorders collectively labeled PTEN Hamartoma Tumor Syndrome (PHTS) and featured by hamartomas, developmental anomalies and increased cancer risk. Studies on experimental models provided evidence that PTEN is a “haploinsufficient” tumor-suppressor gene, however, mechanisms involved in the pathogenesis of clinical manifestations in PHTS patients remain elusive. Beyond analyzing clinical and molecular features of a series of 20 Italian PHTS patients, we performed molecular investigations to explore the mechanisms involved in the pathogenesis of PTEN-associated manifestations, with special focus on mucocutaneous manifestations. Typical mucocutaneous features were present in all patients assessed, confirming that these are the most important clue to the diagnosis. The most frequent were papules located in the trunk or extremities (73.7%), oral mucosa papules (68.4%), acral/palmoplantar keratosis and facial papules (both 57.9%), according with literature data. Molecular analyses on one trichilemmoma suggested that the wild-type PTEN allele was retained and expressed, reinforcing the evidence that PTEN does not require a second somatic hit to initiate pathogenic processes. Unexpectedly, one patient also displayed a cutaneous phenotype consistent with atypical mole/melanoma syndrome; no variants were detected in known melanoma genes, but Whole Exome Sequencing showed the rare truncating variant c.495G>A in the CDH13 gene that might have cooperated with PTEN-haploinsufficiency to generate such phenotype. Our findings confirm the reproducibility of known PHTS manifestations in real-world practice, highlighting the role of mucocutaneous manifestations in facilitating prompt diagnosis of the syndrome, and provide some insights into the pathogenic process induced by PTEN alterations, which may contribute to its understanding.

Skin picking disorder, also termed dermatillomania is a condition that leads to repetitive picking of their skin ending up in skin and soft tissue damage. It is classified in Diagnostic and Statistical Manual of Mental Disorder Fifth edition under the "obsessive compulsive and related disorders" section. Often associated with other psychiatric conditions like autism, alcohol abuse, obsessive compulsive, body dysmorphic, mood, anxiety and borderline personality disorders, it is a disorder that is quite often underreported. The patient in this case report is a 58-year-old male with a diagnosis of obsessive compulsive disorder (OCD) who reported severe anxiety and skin picking episodes over several years. He presented to the emergency room with an extensive wound on distal left foot with exposure of the underlying muscle tissue, that resulted from the excessive picking of skin from the left foot. This compulsive behavior started off with picking the skin around his nail beds and slowly got worse. The skin picking would get worse whenever he gets nervous or anxious. The wound was treated with topical wound care and antibiotics. At the time of discharge, he was prescribed oral antibiotics to complete his course of treatment and was referred to the hospital's cognitive behavioral therapy (CBT) program that specializes in treatment of OCD and anxiety disorders. Treatment of dermatillomania is a multipronged approach and should include treatment of the underlying psychiatric illness, the treatment for pruritus and topical treatment of the lesions. Selective serotonin reuptake inhibitors (SSRIs) have proved to be the most effective in treating the psychiatric component of dermatillomania. Non-pharmacological treatments such as behavioral therapy, habit reversal exercises and support groups have also proved to be helpful and are well tolerated amongst patients suffering from dermatillomania.

Feline leishmaniosis (FeL) is increasingly reported throughout the world and skin lesions predominate in the clinical picture. There are, however, few evidence-based data on cutaneous feline leishmaniosis and directions are strongly needed for a better management of the disease. In this study, we systematically reviewed what is currently known about the clinical dermatological presentation of FeL through analysis of the literature and, further, by adding unpublished cases managed by Italian veterinary dermatologists. Sixty-six feline cases of cutaneous leishmaniosis published in 33 articles between 1990 and 2020 met the inclusion criteria and were analyzed. Six unpublished cases of cutaneous FeL managed by Italian dermatologists were also reviewed. The majority of cases were reported from South America, followed by Europe and North America. Nodules were the most frequently reported clinical signs and the presence of Leishmania in lesioned skin was assessed mainly by cytology. A total of six Leishmania species have been identified as being responsible for skin lesions. Coinfections by FIV or FeLV were reported in 12.1% and 9.1% of the cases, respectively. Clinical data including treatment have been analyzed and discussed to provide directives for proper management of the disease for which cats may also serve as domestic reservoirs for human infections.

Background and objective Skin cancer is one of the most common types of cancer and its early diagnosis significantly reduces patient morbidity and mortality. Reflectance confocal microscopy (RCM) is a modern and non-invasive method of diagnosis that is becoming popular amongst clinical dermatologists. The frequent occurrence of artifacts in the images is one of the most challenging factors in making a diagnosis based on RCM. It impedes the diagnosis process for the dermatologist and makes its automation difficult. In this work, we employ artificial neural networks to propose a local quality assessment system. It allows for the detection of artifacts and non-informative component images both retrospectively or in real-time during the examination. Methods In this research we address the quality assessment issue by proposing an artificial intelligence-based solution. 612 RCM mosaics were divided into small component images and manually classified in order to train the ResNeXt model in the quality verification context. A trained network was used to create an application that marks individual classes of the component images on the mosaic. Results We achieved the average classification precision of 0.98 both for the validation and test data sets. In addition, we present local quality assessment statistics of the 1540 cases of skin lesions to show which types of skin lesions most often present with artifacts in their RCM images. Conclusions In this research we investigate the utility of the deep convolution neural networks for the local quality assessment of the RCM images. We propose an AI-based system that may be effectively used as real-time support for the dermatologist during a RCM examination and as a base for the automation of the diagnostic process.

Background The severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) pandemic, causing COVID‐19, is rapidly spread across the world, by posing novel challenges for all physicians. Cutaneous manifestations of COVID‐19 may be present in 20% of patients, but they are still now poorly characterized. Methods We search literature to describe all the various cutaneous manifestation observed during COVID‐19 pandemic. Results Different cutaneous clinical patterns were described, showing a wide polymorphism. Conclusion We provided an overview of all the various cutaneous manifestations of COVID‐19 described in the literature today, to improve our knowledge and lead a more prompt and accurate diagnosis, especially in asymptomatic or paucisymptomatic cases.

Background: Exposure to high arsenic concentrations in drinking water has been associated with skin lesions. Our goal was to conduct a systematic review of studies on skin lesions and arsenic exposure, with emphasis on results at low level of exposure. Methods: We conducted a systematic review of studies reporting estimates of either prevalence or risk of skin lesions associated with exposure to more than 2 levels of arsenic in drinking water. We reviewed and abstracted the relevant results, with the aim of conducting a dose-response meta-analysis. Results: Nine studies of skin lesions were reviewed. Strong heterogeneity in the results did not meet the criteria for performing a meta-analysis. The relative risks for an increase of 10 μg/L arsenic in drinking water ranged from 1.002 to 1.140 (p-value of heterogeneity < 0.0001). Protection from bias and confounding was inadequate in most studies. Conclusion: Current studies are inadequate to conduct meta-analysis on dose-response relationship between exposure to arsenic in drinking water and skin lesions. Studies with complete exposure histories indicate skin lesions are associated with arsenic exposure in excess of 50 µg/L or higher.

Background During the outbreak of COVID‐19 many pernio‐like lesions have been increasingly reported. The aim of the study is to describe our management of these skin manifestations and to evaluate a possible correlation to SARS‐CoV‐2 infection. Methods All patients underwent clinical and laboratory tests to detect a possible underlying connective disease and also to specific SARS‐CoV‐2 investigations such as oropharyngeal swab and IgG‐IgM serology. Results Nine patients aged between five and fifteen years old were evaluated. Skin lesions observed were purplish, erythematous and oedematous, in some cases painful and itchy. Six out of nine had respiratory and systemic symptoms (cough, nasal congestion, chills, fever, asthenia) that preceded cutaneous findings of approximately two weeks. Concerning blood exams, three out of nine had D‐dimer weakly increased, four had ANA positivity: two with a title 1:160, one with 1:320 and one with 1:5120 and a speckled pattern. The latter patient had also ENA SS‐A positive and RF positivity, confirmed at a second check, so as to allow us to make a diagnosis of connective tissue disease. Four out of nine had aPL positivity (IgM). Reactants acute phase were all negative. Oropharyngeal swabs and serology tests for SARS‐CoV‐2 was negative (borderline in one patient for IgM). No treatment was needed. Conclusions Even if we do not have enough data to prove it, we hypothesize a correlation between pernio‐like lesions and SARS‐CoV‐2 infection for an increased number of these lesions described during the pandemic and also because such manifestations appeared when temperatures were mild and patients were at home in isolation for the lockdown. Many questions remain open about interaction host‐virus. This article is protected by copyright. All rights reserved.

COVID‐19 is a disease caused by severe acute respiratory syndrome coronavirus 2 of the genus Betacoronavirus (SARS‐CoV‐2). It was first described in Wuhan (China) on December 2019 and has spread to become a pandemic. Its clinical presentation is mainly characterized by cough, fever and dyspnea, although many other symptoms have been described within its presentation pattern. In some cases, it causes an acute respiratory distress that has lead to the death of thousands of people around the world. Furthermore, different types of skin lesions have been described during the infection period of illness.1 In this exceptional situation of global health emergency, physicians are undertaking research work in order to achieve notions on the etiopathogenesis of these skin lesions. The first report of cutaneous manifestations described different forms of skin lesions such as erythematous rash, urticaria and chicken‐pox‐like vesicles.2 Further studies have classified 5 different type of skin lesions, and associated them with patient demographics, timing in relation to symptoms of the disease, severity and prognosis.

In recent weeks, several reports have emerged of skin lesions with different clinical presentations in COVID-19 cases. All dermatologists should be aware of these cutaneous lesions, which may be early clinical symptoms of infection. We reviewed the literature on cutaneous manifestations in the PubMed database from December 2019 and June 2020. From the cases described as case reports or series in 57 recent articles, it appears that skin lesions (i) are highly varied, (ii) may not be related to the severity of the condition and (iii) resolve spontaneously in a few days. The frequency of these lesions in COVID-19 patients varies between 1.8% and 20.4%. The major clinical forms described were maculopapular eruptions, acral areas of erythema with vesicles or pustules (pseudochilblain), urticarial lesions, other vesicular eruptions and livedo or necrosis. The lesions were mainly localized in the trunk and extremities. The majority of patients were male, aged between 4.5 and 89 years. A minority of the patients were children presenting with acral, chilblain-like lesions, papulo-vesicular eruptions or Kawasaki disease-like pediatric inflammatory multisystem syndrome. The mean duration of the lesions was a few days, but some lasting as little as 20 min and others as long as four weeks have been reported. The mean latency time in the majority of cases was between 1 and 14 days; however, in some patients, lesions appeared 2 to 5 days before the onset of COVID-19 symptoms. The histopathological features of these lesions also vary, corresponding to the diversity of clinical manifestations. These features underline the nature of epidermal and dermal vascular lesions—and in severe cases, microvascular injury and thrombosis—associated with COVID-19, and provide important clues to their pathological mechanisms.

Paraneoplastic disorders are rare multiorgan diseases associated with hematological malignancies such as chronic lymphocytic leukemia (CLL). Some of these paraneoplasms manifest as cutaneous lesions, appearing as a simple rash, ulcers or skin thickening. The pathogenesis for this process has been described as development of certain autoimmune reactions against cell wall antigens and proteins. An example is paraneoplastic pemphigus (PNP) which manifests as cutaneous bullae. Bullae may occur anytime during the course of the malignancy i.e. acute phase or remission. Diagnosis involves evaluation of clinical findings, serology and presence of characteristic histological findings. Its pathogenesis is described as development of auto-antibodies against cell junctional and basement membrane proteins. Presence of paraneoplasms has been associated with poorer prognosis and increased mortality in hematological malignancies including CLL. Currently, there are established indications for the treatment of CLL; however, presence of paraneoplasms as an indication for treatment is unclear. Patients with paraneoplasms who underwent expeditious treatment have exhibited better clinical outcomes. Herein we describe a case of a CLL patient in remission presenting with PNP and its response to treatment.

Ultraviolet B (UVB) radiation has recently been recognized as a major stressor for marine vertebrates, particularly fish confined to aquaculture cages. Here, the harmful effects of UVB radiation on gilthead seabream (Sparus aurata), which is a widely cultured species, were investigated. Seabream juveniles were exposed to three UVB conditions (UVB-H – high UVB, 12 kJ m−2 d−1; UVB-M - moderate UVB, 6 kJ m−2 d−1; UVB-L – low UVB, 2.4 kJ m−2 d−1) that are representative of natural underwater UVB levels throughout the water column in the Red Sea. One experimental treatment without UVB exposure was used as a control. The adverse effects of UVB were evaluated after short- (10 days) and long-term (43 days) exposure. The results indicated that short- and long-term exposure to UVB retarded growth and decreased survival rates. UVB exposure resulted in behavioral changes, mainly in UVB-H and UVB-M exposed fish. Swimming activity was reduced; most of the fish tried to avoid exposure and showed a stationary behavior with slow caudal and dorsal fins movements (UVB-H), or a slow displacement behavior (UVB-M). Moreover, a reduction in appetite, reflected by a remarkable increase in the time required to consume the food was observed. Lesions on the skin occurred in the three UVB treatments, and the incidence and severity increased under long-term UVB exposure. Also, physiological changes were observed, including a decrease in total protein and total cholesterol concentrations (all UVB treatments). A potential modulation of the innate immune system (reduction of total anti-protease and total peroxidase activities) was observed (UVB-M, UVB-L). The present results suggest that exposure to solar underwater UVB radiation levels has the potential to interfere and affect the health of S. aurata. Indeed, aquaculture fish species growing at locations where water transparency and UVB incidence is as high as the Mediterranean in summer, and the Red Sea year-round, may be affected, and their welfare, resistance to pathogens, and survival may be compromised. Strategies should be considered to mitigate the adverse effects of UVB exposure, such as deeper and more-shaded cages, or the development of functional foods.

BACKGROUND: The spiders of the Loxosceles genus, commonly denoted as “brown spiders” or “Mediterranean recluse” or “brown recluse,” belong to the spider family Sicariidae, suborder Labidognatha, order Araneida, class Arachnida, and phylum Arthropoda. This spider is widespread in Africa and South/Central America, but it is also distributed in North America, in the West Indies, in the Mediterranean Europe, and in China. CASE REPORT: Here, we report the case of a severe dermonecrotic loxoscelism identified in Southern Italy, probably due to the bite of Loxosceles rufescens. The patient was a women admitted at hospital ER because of a little skin erythema that evolved toward a severe necrosis and ulceration within 20 days. After clinical and laboratory data excluded other local and systemic diseases, she was treated with a systemic and local therapy using corticosteroids and antibiotics with the diagnosis of loxoscelism. The healing from the local skin lesion occurred within 2 months, but the local pain, weakness, and discomfort lasted for a long time. CONCLUSION: It is the fisrt time that a possible case of systemic loxoscelism with skin generalized urticaria is reported in Italy.

PURPOSE: Gel pad is an aqueous, flexible, easy available, disposable spacer used for the ultrasound (US) scan of superficial or difficult-to-visualize areas. In clinical practice, it is widely used in B-mode US approach of superficial lesions but, to date, no data have been provided as to its efficacy in the Doppler detection of superficial flows. The aim of our study was to demonstrate the role of stand-off gel pad in the detection of the otherwise-missed peri- or intra-lesional flow signals on Doppler imaging. MATERIALS AND METHODS: A total of 100 superficial lesions undergone to an US evaluation using a 7.5–12-MHz linear probe were evaluated prospectively with and without interposition of a gel stand-off pad to detect the presence or absence of vascularization and to classify the vascular pattern. RESULTS: Peri- or intra-lesional flow was demonstrated in 56% of cases without and in 84% of cases with interposition of a gel stand-off pad; moreover, a statistically significant difference (p value

Background: Data on the clinical patterns and histopathology of SARS-CoV-2 related skin lesions, as well as on their relationship with the severity of COVID-19 are limited. Methods and Materials: Retrospective analysis of a prospectively collected cohort of patients with SARS-CoV-2 infection in a teaching hospital in Barcelona, Spain, from 1 April to 1 May 2020. Clinical, microbiological and therapeutic characteristics, clinicopathological patterns of skin lesions, and direct immunofluorescence and immunohistochemical findings in skin biopsies were analyzed. Results: Fifty-eight out of the 2761 patients (2.1%) either consulting to the emergency room or admitted to the hospital for COVID-19 suspicion during the study period presented COVID-19 related skin lesions. Cutaneous lesions could be categorized into six patterns represented by the acronym &ldquo, GROUCH&rdquo, Generalized maculo-papular (20.7%), Grover&rsquo, s disease and other papulo-vesicular eruptions (13.8%), livedo Reticularis (6.9%), Other eruptions (22.4%), Urticarial (6.9%), and CHilblain-like (29.3%). Skin biopsies were performed in 72.4%, including direct immunofluorescence in 71.4% and immunohistochemistry in 28.6%. Patients with chilblain-like lesions exhibited a characteristic histology and were significantly younger and presented lower rates of systemic symptoms, radiological lung infiltrates and analytical abnormalities, and hospital and ICU admission compared to the rest of patients. Conclusion: Cutaneous lesions in patients with COVID-19 appear to be relatively rare and varied. Patients with chilblain-like lesions have a characteristic clinicopathological pattern and a less severe presentation of COVID-19.

Skin diseases in pigs can negatively impact the production. They cause losses related to the death of the affected pigs, to the cost with the treatment, growth retardation and condemnations in the slaughterhouses. This study was developed to determine the frequency and describe the histopathological findings of skin diseases in pigs in different age groups through a retrospective study from 2006 to 2018. A total of 154 conclusive cases were analyzed, including skin restricted diseases (allergic dermatitis, exudative epidermitis, vesicular dermatitis, pityriasis rosea, swinepox, follicular cyst, papilloma and scrotal hemangioma) or skin lesions secondary to systemic diseases (erysipelas, porcine dermatitis and nephropathy syndrome (PDNS), bacterial septicemia and multiple hemorrhages without definite cause). The skin lesions were classified as bacterial (46.1%), viral (26.6%), allergic (12.3%), neoplastic (1.3%) and others (13.6%). Swine erysipelas was the most frequent diagnosis (47/154), followed by PDNS (23/154), allergic dermatitis (19/154) and exudative epidermitis (15/154). Vesicular dermatitis (9/154), pityriasis rosea (9/154), septicemia with cutaneous manifestations (9/154), swinepox (9/154) and multiple hemorrhages without definite cause (7/154) were also observed. Follicular cyst (3/154), hyperkeratosis without definite cause (2/154), papilloma (1/154), and scrotal hemangioma (1/154) were less frequently described. Of the conclusive diagnosis, age was reported in 138 cases, with the highest frequency of skin lesions observed at the inspection process during slaughter (56/138). RESUMO: As doenças de pele em suínos podem impactar negativamente a produção. Estas causam perdas relacionadas à morte dos acometidos, a custo com tratamentos, atraso no crescimento e condenações nos frigoríficos. Este trabalho foi desenvolvido para determinar a frequência e descrever os achados histopatológicos das doenças de pele em suínos nas diferentes faixas etárias, através de um estudo retrospectivo no período de 2006 a 2018. Foram analisados 154 casos conclusivos incluindo as doenças restritas a pele (dermatites alérgicas, epidermite exsudativa, dermatite vesicular, pitiríase rósea, varíola suína, cisto folicular, papiloma e hemangioma escrotal) e as secundárias a doenças sistêmicas (erisipela, síndrome dermatite nefropatia suína (SDNS), septicemia bacteriana e hemorragias múltiplas de causa não determinada). Estas foram classificadas em bacterianas (46,1%), virais (26,6%), alérgicas (12,3%), neoplásicas (1,3%) e outras (13,6%). A erisipela suína foi a enfermidade mais diagnosticada (47/154), seguida por SDNS (23/154), dermatite alérgica (19/154) e epidermite exsudativa (15/154). Observamos ainda dermatite vesicular (9/154), pitiríase rósea (9/154), septicemia bacteriana com manifestações cutâneas (9/154), varíola suína (9/154) e hemorragias múltiplas de causa não determinada (7/154). Em menor número, cisto folicular (3/154), hiperqueratose sem causa definida (2/154), papiloma (1/154) e hemangioma escrotal (1/154). Dos casos conclusivos, a idade foi informada em 138 casos, sendo a maior frequência das lesões de pele observadas na linha de inspeção, durante o abate (56/138).