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Acne is the most common skin disease, with a relative prevalence of 85%-100% among young individuals. It affects the cosmetic appearance of the patients provoking severe distress. A number of different topical treatments have been used for the treatment of acne. In this study, we investigated the efficacy and safety of the topical treatment with 5% benzoyl peroxide and 3% erythromycin gel in patients with papulopustular acne. One hundred and ninety-one patients with inflammatory acne completed the study. The patients included 54 males and 137 females, mean age 22.3 ± 8.1 years. Topical gel was applied on the face once daily for 3 months. The mean number of non-inflammatory and inflammatory lesions after 3 months of therapy decreased significantly with respect to baseline, with a mean percentage reduction of the non-inflammatory and inflammatory lesions by 42.2% and 57.5%, respectively. In conclusion, topical 5% benzoyl peroxide and erythromycin 3% as monotherapy is efficient for the treatment of papulopustular acne.

Background: Psoriasis is a chronic, immune-mediated inflammatory disease estimated approximately in 2% of the European population. Drug abuse is reported in 3-5% of the global population. Main observation: We present a 41-year-old, cocaine-addicted patient male with severe plaque-type psoriasis treated successfully with ustekinumab. The patient received ustekinumab at a dose of 45 mg subcutaneously at weeks 0, 4 and 16 and achieved PASI 75 at week 18. Conclusions: Although several drug-abusers experience psoriasis, literature is very poor regarding the outcome of systemic treatment in those patients. In our patient no adverse effects were seen during the administration period of ustekinumab and no interactions between cocaine and ustekinumab were noticed. Nevertheless, more individuals and further studies are needed to establish the efficacy and safety of ustekinumab in the treatment of psoriasis in drug-abusers. ( J Dermatol Case Rep . 2013; 7(3): 82-83)

Background. A dramatic increase in bacterial resistance as a result of the use of topical antibiotics in acne has been recorded over the past 20 years. Aim. In this study we investigated the efficacy and safety of the topical treatment with 5% benzoyl peroxide and 3% erythromycin gel in patients with inflammatory acne. Materials and Methods. One hundred and ninety one patients with inflammatory acne were evaluated. The patients included 54 males and 137 females with a mean average age being 22.3±8.1 years. The topical gel was applied on the face, once daily, for 3 months.Results. The mean number of non-inflammatory and inflammatory decreased. These findings were statistically significant from baseline with a mean percentage reduction of the non-inflammatory and inflammatory lesions, corresponding to 42.2% and 57.5% respectively. Conclusion. Topical 5% benzoyl peroxide and erythromycin 3% as monotherapy is efficient in the treatment of inflammatory acne.

Hereditary epidermolysis bullosa (HEB) is a group of genetically determined mechanobullous disorders characterized by blister formation following minor trauma. Unusual melanocytic lesions may be a rare feature of all major categories of HEB. We report a large melanocytic nevus, clinically simulating malignant melanoma, which developed at a site of healing blisters in an 8-year-old male with recessive generalized epidermolysis bullosa simplex (EBS). Histological findings were consistent with a compound nevus. This is the third reported case of an eruptive melanocytic nevus developing in EBS. Due to their unique features, it has been suggested that these nevi may represent a distinct variant, referred to as epidermolysis bullosa nevi. Despite the atypical picture, no malignant transformation of HEB nevi has been seen. Therefore, after histologic verification, regular long-term follow-up rather than radical surgery is recommended.

Oral squamous cell carcinoma (OSCC) is the sixth most common cancer in the world. The phosphatidylinositol 3 kinase (PI3K) signalling pathway has been reported to play an important role in OSCC. Since we have previously detected absence of hotspot PIK3CA gene mutations in the Greek population, we hypothesized that BRAF or HRAS may be activated as upstream effectors of the pathway. Furthermore, the status of the HRAS and BRAF mutations in OSCC has never been assessed before in the Greek population. Eighty-six primary paraffin-embedded tumors were screened for BRAF and HRAS hotspot mutations. In HRAS, two hotspot mutations in codon 12 (2.3%) and eight new genetic alterations were detected (8.6% overall). One new missense mutation, Alanine53Valine (Ala53Val), one silent mutation, two mutations in the 5'UTR region and four mutations in intron 1 were detected. No hotspot mutations in Braf were found. A new silent mutation/polymorphism T1803C was detected at a percentage of 30%. This study is the first to report HRAS mutations in the Greek population. The results suggest that RAS is an important member of the PI3K signalling pathway and may play a role in the tumorigenesis of OSCC.

Immunization with the hepatitis B virus (HBV) is effective and safe with an estimated incidence of adverse reactions, either local or systemic, of less than 0.1%. Cutaneous side effects are rare and include lichen planus (LP) and lichenoid reactions. We report the case of a 21-year-old female, in whom a persistent, papulonodular lesion developed at the site of the injection, 6 weeks after the second dose of the HBV. Histological examination revealed lichenoid and pseudolymphomatous features. In addition, sensitization to thiomersal, a vaccine constituent, was documented by patch testing. The association of LP with chronic liver disease is well established. Furthermore, less than 20 cases of lichen or lichenoid reactions, following HBV vaccination, have been reported. Although several arguments have been presented, it is still debated whether there is a causal association or the occurrence of LP following HBV vaccination is a simple coincidence. It has been speculated that a T-cell-mediated, graft-versus-host-like reaction, triggered by a sensitizing protein, is directed against keratinocytes expressing an epitope of hepatitis B surface antigen or a similar epitope. Our case may represent a localized lichenoid reaction to HBV vaccination, a local reactive hyperplasia or a persisting delayed hypersensitivity reaction to a vaccine constituent. This is the first case of a local lichenoid reaction at the injection site of the HBV vaccine, providing further documentation for a causal association linking the HBV vaccine with LP.

We report the case of a 48-year-old, Caucasian female who presented with slowly progressing asymptomatic poikilodermatous changes of the extensor aspects of the forearms. She also had typical Poikiloderma of Civatte on the V of the neck and erythemato-telangiectatic rosacea of the central face. The patient had been practicing aroma-therapy for many years. Histologic examination revealed findings consistent with PC. Patch-testing revealed positive reactions to Fragrance mix and Nickel sulphate. Based on clinical and histological findings, a diagnosis of extracervical PC was suggested. PC with extra-cervical or extra-facial involvement is rare. In addition, this case supports the theory that contact sensitization to fragrances may contribute to the development of PC.

Beekeepers are at increased risk for honeybee (Hb) venom allergy and they represent a unique population for Hymenoptera venom studies. The aim of this was to prospectively examine the pattern of Hb venom sensitization over a 5-year period in new beekeepers and define possible predisposing factors. Thirty-five beekeepers were tested every 6 months for 5 years with in vivo and in vitro methods to detect the possible development of sensitization to Hb and common wasp (Cw) venom. Inclusion criteria included the lack of previous beekeeping activity and absence of sensitization or reported reaction to Hymenoptera stings. Subjects with both in vivo and in vitro tests that were definitely positive or with one definitely positive and the other doubtful were considered sensitized. Ten of 35 new beekeepers (28.6%) and 3 of 36 controls (8.3%) developed sensitivity to Hb venom during the 5-year period. The risk ratio in incidence studies was calculated at 3.43 (SE of log risk ratio = 0.61; 95% CI of risk ratio = 1.03-11.42). All sensitized beekeepers were detected within the first 18 months of occupational exposure; 8 of 10 (80%) beekeepers were detected during the initial 12 months and the 2 remaining beekeepers were detected between 12 and 18 months. One of 35 (2.9%) beekeepers and 1 of 36 controls (2.8%) were sensitized to Cw venom. The number of stings per year and atopy had no effect on sensitization rate. Although predisposing factors to sensitization or anaphylaxis could not be identified, beekeepers developed sensitization to bee venom in

Occupational-related allergic sensitization has been reported in fishery workers. The aim of this study was to investigate the prevalence, work-related symptoms, and possible risk factors in this occupationally exposed population in Greece. Sixty-four fish and seafood processing workers were compared with 60 controls regarding sensitization to seafood allergens. All participants underwent skin-prick tests (SPTs) with cod, sardines, shrimp, spiny lobster, crabs, salmon, mussels, and trout plus negative and positive control. The level of specific IgE (radioallergosorbent test) was evaluated in subjects with positive SPTs. Sensitization criteria were both SPTs and the corresponding positive radioallergosorbent test. Atopic status was tested with SPTs to seven common inhalant allergens. Potential risk factors for IgE sensitization were investigated using logistic regression analysis. Twenty-three of 64 workers (35.9%) were sensitive to at least one of the seafood allergens tested, and the prevalence in the control group was 10% (6/60; odds ratio, 5.049; 95% CI, 1.884-13.533). The prevalence of sensitization in allergen species tested in the fishery workers group was shrimp, 12.5%; spiny lobster, 10.9%; mussels, 7.8%; crabs 3.1%; cod, 3.1%; sardines, 1.6%; salmon, 1.6%; and trout, 1.6%. Presence of atopy (p = 0.02), intensity (p = 0.03), and duration of exposure (p = 0.03) was found as potential risk factors for IgE sensitization. Four of 64 (6.25%) workers reported work-related symptoms. Occupational exposure to fish and seafood significantly increases the likelihood of sensitization in seafood allergens and atopy, duration, and intensity of exposure may represent potential risk factors in seafood processing workers.

SummaryBackground Treatment failures and relapses are not uncommon in onychomycosis. Therefore, it is worthwhile to consider the combination of systemic and topical antifungals to improve the cure rates further and to reduce the duration of systemic treatment. Objectives To evaluate and compare itraconazole pulse therapy combined with amorolfine with itraconazole alone in the treatment of Candida fingernail onychomycosis. Methods Ninety patients with moderate to severe Candida fingernail onychomycosis were randomized into two treatment groups of 45 subjects each. Group 1 received itraconazole pulse therapy for 2 months and applied amorolfine 5% solution nail lacquer for 6 months, while group 2 received monotherapy with three pulses of itraconazole. The primary efficacy criterion was the result of mycological examination at 3 months. The secondary criterion was the combined mycological and clinical response at 9 months. A pharmacoeconomic analysis was also performed to compare the cost-effectiveness of combined therapy vs. monotherapy. Results Eighty-five patients were analysed (73 women and 12 men, mean ± SD age 44·2 ± 12·9 years). Patients had a mean ± SD of 3·64 ± 2·0 nails involved and 228·6 ± 148·0 mm2 of their nail surface diseased. The mean duration of onychomycosis was 11 months. Paronychial involvement was evident in 71 patients. C. albicans was isolated in 85 cases, C. parapsilosis in three and other Candida species in two cases. Side-effects were uncommon and in only one case led to withdrawal. At the 3-month visit, mycological cure was seen in 32 (74%) of 43 patients in group 1 and in 25 (60%) of 42 patients in group 2. At the 9-month visit, a global cure was seen in 40 patients (93%) in group 1 and in 34 patients (81%) in group 2. Statistical analysis showed no statistically significant difference (P > 0·1) between the two treatment groups. The cost per cure ratio was 1·63 and 1·70€ for groups 1 and 2, respectively. Conclusions The combination of amorolfine and oral itraconazole, which interfere with different steps of ergosterol synthesis, exhibited substantial synergy. Compared with oral itraconazole alone, the combination achieved greater mycological cure and increased total cure rate. However, no statistically significant difference was documented for this number of observations. Combination treatment with amorolfine and two pulses of itraconazole is at least as safe and effective as three pulses of itraconazole, with a lower cost per patient. In our opinion, the addition of amorolfine to oral itraconazole pulse therapy is of value in the treatment of moderate to severe Candida fingernail onychomycosis.

Angioimmunoblastic T-cell lymphoma (AITL) is an aggressive non-Hodgkin′s nodal peripheral T-cell lymphoma characterized by general lymphadenopathy, night sweats, fever, hepatosplenomegaly, polyclonal hypergammaglobulinemia, and cutaneous involvement. We present a rare case of AITL cutaneous involvement mimicking toxic erythema recurring with AITL relapse and suggesting a precursor of disease progression.

Aging of the skin is a complex phenomenon resulting from the interaction of several intrinsic and extrinsic factors [1]. Due to the cosmetic disfigurement it produces and its psychological impact, especially to women, aging of the skin has become an issue of great social significance and concern. Intrinsic aging is an inevitable, genetically programmed process, the underlying mechanisms of which remain largely unknown. No prevention or effective treatment is currently available [1]. Among extrinsic influences (wind, heat, cigarette smoke, chemicals, etc.), ultraviolet radiation appears to be the single most important factor associated with aging of the skin [2]. Photoaging refers to gross and microscopic cutaneous changes induced by cumulative exposure to ultraviolet radiation (UVR). These changes are superimposed on the background of intrinsic aging [2]. Increased recreational sun exposure, including excessive sunbathing, the depletion of stratospheric ozone, the use of UVR in the treatment of various skin diseases, are some of the causes that have led to increased prevalence of photoaging during the last decades. The clinical importance of photoaging lies mostly on the potential for the development of precancerous lesions or skin cancer [3]. In contrast to intrinsic aging, photodamage can be prevented by sun avoidance and proper sun protection [2]. Furthermore, overwhelming clinical and histological evidence indicate that skin changes of photoaging can be reversed by the use of topical retinoids [4].