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This article describes an uncommon clinical manifestation of contact dermatitis due to dyed tissues, showing bilateral plaque lesions on the mammary areolas. The clinical history, histological and patch testing examinations confirmed the diagnosis. The possible triggering factors related with this kind of contact dermatitis and possible differential diagnosis are briefly discussed.

Background: Differences in age, site, and histopathologic subtype exist in basal cell carcinoma (BCC)., Objective: To compare the distribution of BCCs in patients younger than 40 with that of those aged 90 and older according to sex, site, and subtype., Methods & Materials: One hundred seventy-five BCCs were examined. The site was classified as head and neck, trunk, or limbs and the subtype as nodular, superficial, or morpheic-infiltrative., Results: Younger exhibited a lower prevalence of BCCs on the head and neck (36.0% vs 57.3%, p<.01) and a higher prevalence on the trunk (59.3% vs 31.5%, p<.01) and of superficial BCCs (43.0% vs 31.5%, p<.05) than older patients. Site was associated with subtype in younger (p<.001) and older (p=.004) patients. Superficial BCCs were mostly on the trunk (p<.001), with a higher prevalence in younger patients (86.5% vs 62.5%, p<.05). Morpheic BCCs were mostly on the head and neck (p<.001), and prevalence did not differ between age groups. Nodular BCCs were mostly on the head and neck in older patients (p=.011). Subtype was independently associated with site (p=.005) but not with age or sex., Conclusion: A different distribution of site and subtype occurs in younger and older patients. Subtype is associated with site independent of age and sex. These findings suggest that, at least in some patients, the anatomic location of BCC may favor the development of a particular subtype.

Epidermal nevus syndromes are a heterogeneous group of genetic disorders characterized by the presence of an epidermal nevus with visceral involvement. Keratinocytic epidermal nevus syndromes are not a clear entity, but all the reported cases showed the presence of a keratinocytic epidermal nevus associated with different systemic lesions. In our report the keratinocytic epidermal nevus syndrome is defined by the presence of the nevus on the face, intraoral lesions and cleft palate in a 1-year-old girl.

Background: A total of 620 healthy term neonates, randomly selected among babies born at the San Paolo Hospital in Milan (Italy), were examined to study the relationship between birthmarks and transient cutaneous lesions in newborns of different ethnic groups., Methods: Information on sociodemographic factors and on physiopathological variables of the pregnancy was collected. Multiple logistic analyses were performed to assess associations between diagnosed skin lesions and various factors. Odds ratios (OR) as a measure of association and the corresponding 95% confidence intervals were estimated., Results: A positive association was found between reduced hypoderm and pregnancy illness (OR = 2.78), hypertrophy genitalia and use of drugs (OR = 1.86) and illnesses in pregnancy (OR = 1.61). Hyperpigmentation in the genital area and Mongolian spot showed significant positive association with geographical area of origin, being systematically more frequent in non-European neonates, while for melanocytic congenital nevi a positive association was observed only for Asiatic newborns (OR = 4.67); salmon patch on the nape showed a significant OR of 1.81 among mothers aged > or = 35., Conclusions: Significant associations between some sociodemographic factors and cutaneous lesions of the newborn and anamnestic data related to the pregnancy were found. Dermatologic conditions are common in the newborns and may justify dermatologic examination., (2007 S. Karger AG, Basel)

We report a case of a 72-year-old woman with a two year history of a plantar lesion. The clinical appearance, a nodular reddish irregular mass about 2 centimeters in diameter, suggested a tumoral lesion. Histologic examination revealed a basal cell carcinoma. The lesion was excised with no recurrence after two years of follow up. The clinical events, and the histological findings are briefly discussed.

Erythema toxic neonatorum (ETN) is a common, self-limiting condition of term infants, appearing particularly within the first 48 hours of life. ETN has a worldwide distribution, with a frequency variable from 19% to 72%. Erythematous macules, wheals, papules and pustules in varying combination occur, with crops of lesions waxing and waning and spontaneous resolution within hours to days. It's important the differential diagnosis from other pustular neonatal conditions, some of which are severe. The etiology of ETN remains unknown. Recent studies reveal an activation of immune cells in the lesions of ETN and a high presence of peptide antibiotics, suggesting that ETN is an inflammatory skin reaction to the microbial colonization at birth.

The authors describe the case of a 64-year old man who presented with an asymptomatic brown macula on his glans penis that had appeared about 18 months earlier. Dermoscopy analysis demonstrated a prominent, wide and irregular pigment network, which stopped abruptly at the periphery of the lesion. A diagnostic biopsy showed the characteristics of a melanoma in situ . The patient was referred for partial surgical excision of the glans. No recurrence or metastasis occurred during the two years after the operation. Melanoma in situ of the penis is very rare in dermatologic literature. Early diagnosis is of paramount importance because its prognosis is very poor. Early systematic use of dermoscopy may be useful for the differential diagnosis of pigmented mucosal lesions, which include mucosal melanosis and other benign melanoses of genitalia.

We examined, retrospectively, 239 patients (113 adults and 126 children) with LS, referred to our department from 1980 up to 2001. Clinical parameters evaluated were age, sex, LS variant, extracutaneous manifestations, duration of disease and follow-up. We also considered laboratory findings, most notably erythrocyte sedimentation rate, blood eosinophilia, antinuclear antibodies (ANA) and various circulating autoantibodies. Plaque morphea was the most common form in both groups (74 adults and 61 children). In contrast, linear scleroderma affected children much more frequently than adults (22 children vs 7 adults). When the limbs were involved, this variant could lead to severe orthopedic complications (10 children vs one adult patient). On the other hand, linear scleroderma of the scalp and face comprising scleroderma en coup de sabre and Parry-Romberg syndrome was also more frequent in children (14 children vs 5 adults) causing ocular (8 cases), oral (7 cases) and neurologic (8 cases) abnormalities. Typical of childhood were mixed forms (18 pediatric patients), characterized by combination of different LS variants, which usually followed a more protracted and complicated course and showed ANA positivity (11 cases). Among adults, Raynaud's phenomenon was found in 8 patients; interestingly, anticentromere antibodies were detected in 4 of these subjects, identifying a subset at risk for progression to systemic disease. Children and adults developed LS with analogous clinical and immunological features. However, the prevalence of LS variants differed between adult and pediatric populations, leading to different extracutaneous complications.

A newborn had 3 blue-black macules on the left side of the dorsal tongue. Clinical diagnosis was difficult. A biopsy specimen showed focal increase of melanin in the basal cells and subepithelial melanophages. The persistence of the lesions was unchanged at the age of 6 months, and the histologic features led to the diagnosis of oral physiologic melanosis.

Seborrheic keratosis can be associated with different neoplasms such as basal cell carcinomas, squamous cell carcinomas and melanomas. We describe an unusual case of a man who presented with a brown plaque on his back. The clinical diagnosis was melanoma. Histopathologic examination of the lesion revealed four neoplasms: a compound nevus, a junctional nevus, a superficial basal cell carcinoma and a seborrheic keratosis. Although this association most likely represents a chance phenomenon, we discuss the possibility that the seborrheic keratosis developed from the nevus, and that subsequently the junctional nevus and the basal cell carcinoma developed from the seborrheic keratosis., (Copyright 2001 S. Karger AG, Basel)

We describe the case of a twenty-nine year-old woman presenting a lamellar desquamation on the abdomen, submammary folds and on the limbs. During recent years the patient suffered neither from bowel disorders, nor from dryness of the skin. Laboratory tests revealed high values of parathormone and a high level of antiendomysial antibodies. The total bone-mineral density was about 78% of normal levels. A duodenal mucous membrane specimen showed total atrophy of the villi. Skin biopsy revealed an acquired ichthyosis mimicking an ichthyosis vulgaris. The patient underwent a gluten-free diet, supported by folic acid and vitamin D and six months later, after the regression of secondary hyperparathyroidism, a remarkable improvement of the cutaneous symptoms was obtained.

We describe a bullous-hemorrhagic reaction of the ear lobes in a child with nephrosis after levamisole intake. This drug is used in children as an alternative treatment of corticosteroid-responsive nephrotic syndrome. Histologic evaluation of a lesion revealed necrotizing vasculitis involving mainly the large vessels of the deep plexus. The lesions disappeared 25 days after discontinuation of treatment.

Progressive facial hemiatrophy or Parry-Romberg syndrome is a rare entity characterized by unilateral atrophy of the skin, subcutaneous tissue, and the underlying bony structures. This syndrome has many features of linear scleroderma en coup de sabre but is distinguished by more extensive involvement of the lower face and by only slight cutaneous sclerosis. We describe two unusual children with both atrophic and sclerotic changes of half of the face coexisting with multiple plaques of typical morphea. Both children developed neurologic disturbances with cranial magnetic resonance imaging (MRI) abnormalities 2 years and 15 years, respectively, after the onset of cutaneous lesions. Thus considering that it may not be possible to correlate impairment in neurologic function and cutaneous disease, as illustrated by our patients, we emphasize the importance of an accurate follow-up.

The authors present two clinical cases of epydermolisis bullosa (Hallopeau-Siemens type), to underline characteristic mucous and dental diseases of these types of genodermatosis; they analyze mean diferentiative criteria and the diagnostic possibilities; in the specific treatment of this kind of patient it is important to focus as the therapeutic approach in the different dental fields: so the authors consider therapeutic treatment related to oral and systemic status of the patient examined. From this analysis they give a rational way of approaching this kind of patient both for hygiene and for diet, surgery-prosthetic and restorative treatments.

Introduction: Several drugs can induce lichenoid lesions., Case Report: We observed two cases of lichenoid lesions of the buccal mucosa due to lithium carbonate. Drug withdrawal caused clearing., Discussion: These cases emphasize the rare nature of this complication. To date only one lichenoid stomatitis has been reported in the literature.

Parapsoriasis has been described rarely in childhood; a few reports mention this condition as preceding early mycosis fungoides. We report a boy age 15 and a girl age 8 years with different clinical features of parapsoriasis who were followed clinically and histologically for about four years. Immunophenotyping of the skin infiltrate and a T cell receptor gene rearrangement analysis were performed on each. The infiltrate was composed mainly of CD4+ and CD45+ lymphocytes in the first patient and of CD8+ and CD45+ in the second. No T cell receptor gene rearrangements were found. The paucity of knowledge about the evolution of this entity in childhood and its relationship to mycosis fungoides makes follow-up critical. The importance of immunophenotyping and immunogenotyping is particularly stressed.

A 6-month-old baby had erythema, fissuring of the skin, and craquelé due to prolonged use of a liquid soap mistakenly believed to be a moisturizer. We think these kinds of skin disorders will become increasingly common due to such misunderstandings. The proliferation of cosmetic products for baby skin care, the increasing prescription of cosmetics by dermatologists for skin disease, and the increase in kinds of cosmetics with similar or unusual contents all encourage such accidents.

A child affected by giant recurrent aphthous ulcers was treated successfully over the long term with thalidomide, with no adverse reactions or reduction of therapeutic efficacy. The use of thalidomide in children for serious aphthosis is proposed.

A 2-year-old boy experienced lichen striatus localized to the left half of the body. Some weeks later he developed a peculiar form of eruptive psoriasis limited to the right half of the body. To our knowledge, unilateral eruptive psoriasis has never been described in the literature. The coincidence in this young patient of lichen striatus and this unusual form of psoriasis arising in so short a period of time leads us to hypothesize a common trigger factor.

A variety of skin and oral mucosal lesions appearing in patients after renal transplantation have been reported in the literature. Because most of these data pertain to adults, we studied a group of children with kidney transplants to investigate the occurrence of skin and/or oral mucosal lesions, compare them with those observed in adults, and contribute to the knowledge of the pathogenesis of these disorders. Our series consisted of 32 patients aged 5 to 18 years, all of whom had skin and/or oral mucosal lesions that were classified as being either drug induced, probably related to uremia, or due to other causes. A possible relationship between drug-induced lesions and the therapeutic immunosuppressive regimen in use was investigated. In addition, two formerly unreported lesions were seen in these patients: hypertrophy of lingual fungiform papillae and onychoschizia. The former occurred only in children receiving cyclosporine. Compared with adults, the frequency of gingival hypertrophy was higher and that of infectious disease was lower.

We studied eight patients with incontinentia pigmenti to investigate the possibility of immunologic abnormalities. In six patients a defect of polymorphonuclear chemotaxis was revealed; lymphocyte subpopulations, serum immunoglobulin levels, and peripheral eosinophils were within normal limits. We hope these findings will stimulate further investigations into the mechanisms involved.

The hyperimmunoglobulin E recurrent-infection syndrome is considered a primary immunodeficiency syndrome characterized by recurrent staphylococcal infections both cutaneous and pulmonary, chronic dermatitis, otitis and sinusitis. Our case report can be interesting for the age of the patient (39 years old), for the absence of visceral lesion and for the development of a peculiar gingival hyperplasia. The review of literature has shown that this kind of gingivitis is not usual but not extraordinary.

The Authors describe the case of a woman affected by generalized plane xanthoma and IgG multiple myeloma with k type immunoglobulins. The association between the two affections is well known. The antilipoprotein activity of the paraprotein has been proved in some cases, associated or not to hyperlipemia. The pathogenetic mechanism of plane xanthoma formation is described briefly. The possible occurrence of plane xanthoma with multiple myeloma is stressed, along with the possible association with other systemic diseases.

The authors describe a 12-year-old boy with a peculiar presentation of preputial papular lesions similar to molluscum contagiosum. Histopathologic investigation revealed the presence of a sebaceous gland opening directly onto the surface and hyperplasia of the epithelium.

The authors describe two brothers showing leukonychia totalis in association with deafness, hyperkeratosis palmaris and plantaris, scalp modifications and dental lesions. The onychopathia began during early childhood and was also present in four other members of the same family. All nails of both hands and feet were affected and appeared white, dull and with inconspicuous lunulae. The hair was rough, dark, bristly, looking like steel wire. In particular, the changes of the hair shaft were studied under scanning electron microscope. Hair dysplasia, accompanied by structural changes such as complete and incomplete twistings, longitudinal grooves and modified imbrication, was found. After briefly reviewing the literature on the subject, the authors point out the suggestive hypothesis that all these manifestations might possibly we ascribed to a single genetic defect, in spite of their different clinical features in the various patients.

The authors describe a study of 8 girls suffering from genital and perianal lichen sclerosus et atrophicus. Following the most recent reports in literature, antibodies against Borrelia burgdorferi have been looked for, and the patients have been treated with propicillin. The results are discussed.

Vitamin A is necessary to maintain the integrity and the differentiation of epithelia of the skin and adnexa. Evident deficiency of vitamin A in chronic diseases, malabsorption and liver affections may result in skin xerosis, follicular keratosis, and metaplasia of mucous membranes. The remarkable toxicity of vitamin A in high doses does not recommend its usage in dermatology. On the contrary the employ of retinoids, synthetic derivatives of vitamin A, brings to excellent results. These vitamin A compounds are much more effective, even if they show important side-effects. Etretinate and isotretinoin are widely used in psoriasis, keratinization disorders, and severe acne. Vitamin E functions in skin biology are not totally known. Vitamin E is used in the treatment of dermolytic recessive epidermolysis bullosa, with controversial results.

To evaluate the clinical-effectiveness of etretinate in the treatment of papilloma virus infections, 20 children with extensive warts were given this oral retinoid for a period not exceeding three months at a dosage of 1 mg per kg per day. Sixteen patients showed complete regression of the disease without relapse, while in 4, lesions recurred after partial regression had been obtained. A follow-up of two years confirmed these findings. The results of this preliminary study are encouraging. Additional study is needed to determine the ultimate usefulness of etretinate in the treatment of refractory warts.

Based on clinical features, infantile seborrheic dermatitis (ISD) can be classified as follows: true seborrheic dermatitis (SD), psoriasiform seborrheic dermatitis (Psor SD), and erythrodermic seborrheic dermatitis. We reviewed the records of 72 children who had been affected by ISD several years earlier to investigate the evolution of disease, to evaluate the patients for the presence of new skin lesions, and to study family histories with respect to these conditions. In addition, we attempted to determine if there is any connection among the initial features of ISD and the types of skin lesions, and atopy or psoriasis. On reexamination, our patients previously diagnosed as having SD showed a larger variety of new skin lesions than those who had Psor SD, and 15% had developed atopic dermatitis. Atopic dermatitis was not present at follow-up in the children with previously diagnosed Psor SD. Psoriatic lesions were present in similar percentages in both groups at the time of reevaluation. Investigation of family history was not useful in predicting later development of psoriasis or atopic dermatitis. We conclude that the initial clinical features of ISD may be of prognostic value, and that SD and Psor SD are probably two different clinical entities.

An 11-year-old girl affected by keratosis punctata palmaris et plantaris, histologically showing focal acantholytic dyskeratosis, is described. This case demonstrates that keratosis punctata palmaris et plantaris may represent a new clinical expression of persistent multiple focal acantholytic dyskeratosis.