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Anca E Chiriac,1 Mircea Betiu,2 Piotr Brzezinski,3,4 Beatriz Di Martino Ortiz,5 Anca Chiriac,6– 8 Liliana Foia,9 Doina Azoicai1 1Department of Epidemiology, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, Iași, Romania; 2Department of Dermatovenereology, Faculty of Medicine, “Nicolae Testemitanu” State University of Medicine and Pharmacy, Kishinev, Republic of Moldova; 3Department of Physiology and Cosmetology, Institute of Biology and Environmental Protection, Pomeranian Academy, Slupsk, Poland; 4Department of Dermatology, Provincial Specialist Hospital in Slupsk, Ustka, Poland, Military Support Unit, Ustka, Poland; 5Dermatology Department, Clinicas Hospital, Faculty of Medical Sciences, National University of Ausunción-Paraguay; 6Department of Dermatology, Nicolina Medical Center, Iasi, Romania; 7Department of Dermatophysiology, “Apollonia” University, Iasi, Romania; 8“P.poni” Insitute of Macromolecular Chemistry, Romanian Academy, Iasi, Romania; 9Department of Surgery, Faculty of Dentistry, “Grigore T. Popa” University of Medicine and Pharmacy, Iași, RomaniaCorrespondence: Anca E ChiriacDepartment of Epidemiology, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, Iași, RomaniaEmail chiriancut@yahoo.comAbstract: ”Marjolin’s ulcer” is known as malignant degeneration of ancient burn scars, but both words can induce misdiagnosis. Malignant degeneration of scarring tissue can occur and can vary in its clinical, histological manifestations and its pre-existing skin lesions. We present several cases to substantiate our observations. ”Marjolin’s ulcer” is not synonym to an ulceration appeared on an old burn scar, transformed into squamous cell carcinoma.Keywords: ulcer, Marjolin, malignant degeneration, scar

Anca Chiriac,1–3 Anca E Chiriac,4 Adrian Naznean,5 Cosmin Moldovan,6 Cristian Podoleanu,7 Simona Stolnicu81The Department of Dermato-Physiology, Apollonia University, Iaşi, Romania; 2Department of Dermatology, Nicolina Medical Center, Iaşi, Romania; 3“P. Poni’’ Institute of Macromolecular Chemistry, Iaşi, Romania; 4Department of Epidemiology, University of Medicine and Pharmacy " Grigore T Popa", Iaşi, Romania; 5The Department of Foreign Languages, The University of Medicine and Pharmacy of Tîrgu Mureș, Tîrgu Mureș, , Romania; 6The Department of Applied Simulation in Medicine, The University of Medicine and Pharmacy of Tîrgu Mureș, Tîrgu Mureș, Romania; 7The Department of Cardiology, The University of Medicine and Pharmacy of Tîrgu Mureș, Tîrgu Mureș, Romania; 8The Department of Pathology, The University of Medicine and Pharmacy of Tîrgu Mureș, Tîrgu Mureș, RomaniaAbstract: Herpes zoster usually affects the thoracic and lumbar vertebra (T3–L3), while sacral herpes zoster has been very rarely reported. We present a very rare case of herpes zoster involving S1 dermatome in a 35-year-old healthy man who presented aching pain and typical herpes zoster eruption on the lateral aspect of the calcaneus, lateral plantar area and dorsal aspect of digits III and IV.Keywords: herpes zoster, S1, pain, sacral zoster

Anca Chiriac,1–3 Piotr Brzezinski,4 Tudor Pinteala,5 Anca E Chiriac,5 Liliana Foia5 1Apollonia University, Department of Dermato-Physiology, 2Nicolina Medical Center, Department of Dermatology, 3“P. Poni” Institute of Macromolecular Chemistry, Iaşi, Romania; 4Department of Dermatology, Sixth Military Support Unit, Ustka, Poland; 5Gr T Popa University of Medicine and Pharmacy, Iaşi, Romania Abstract: The prevalence of psychosomatic disorders among dermatological patients is high but frequently unreported because of difficulties in diagnosing and treating this patient group. Psychiatric and psychological factors may play different roles in the pathogenic mechanism of some skin diseases. The mainstay of diagnosis and treatment is the differentiation between skin disorders associated with psychiatric illness and those of a purely psychiatric nature. Dermatologists and psychiatrists should be aware of this pathology and work together as a team to resolve difficult cases, especially in children. The present paper highlights the psychocutaneous diseases most frequently seen by dermatologists in pediatric population. Keywords: psychosomatic disorders, factitial dermatitis, psychodermatology

Cheilitis is a common inflammatory disorder of the vermillion and adjacent skin of the lips. A special type is angular cheilitis. The disease has a mixed etiology, mostly with bacterial and fungal components. Angular cheilitis may be a clinical sign of an underlying disease. It has two age peaks: one during childhood and another in adults. It becomes more frequent with aging. Clinical presentation, differential diagnoses, and treatment are discussed. Angular cheilitis is of importance in primary care of patients, in geriatrics, dentistry, pediatrics, internal medicine, and in dermatology., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Austria, ein Teil von Springer Nature.)

Scabies is a human ectoparasitosis caused by Sarcoptes scabei var. hominis. World-wide around 300 million patients are affected. Infants and children have the highest incidence rates. Poverty and overcrowding are social factors contributing to a higher risk of transmission and treatment failure. The leading symptom of the infestation is itch. Complications are bacterial infections that are responsible for mortality. Diagnosis is clinical. Non-invasive imaging technologies like dermoscopy can be used. Polymerase chain reaction (PCR) is less sensitive and specific than microscopy of skin scrapings. Treatment of choice is topical permethrin 5%. Ivermectin is the only oral drug FDA-approved for scabies. It should be used in cases non-responsive to topical therapy and in case of high number of infested patients in addition to topical therapy. Pseudo-resistance to treatment is not uncommon. New drugs are on the horizon. What is Known: • Pruritus is the leading symptom causing sleep disturbances and scratching with the risk of secondary bacterial infections. • Treatment failure is related to inappropriate application of topical drugs and asymptomatic family members. What is New: • COVID-19 pandemic and migration are contributing to an increased incidence of scabies. • New compounds to treat scabies are on the horizon., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Borreliosis, also known as Lyme disease, is a vector-borne disease caused by different species of the Borrelia burgdorferi complex. It is frequent in Europe and Northern America. The major vectors are ixodoid ticks. Paediatric borreliosis is common and peaks in children between five to nine years. In Europe, the leading symptom of early infection is erythema migrans, in contrast to Northern America where arthritis is the dominating clinical finding. In this review, we focus on Europe, where cutaneous borreliosis is mainly caused by infection with B. afzelii. The cutaneous symptoms include erythema migrans, lymphocytoma, chronic atrophic dermatitis and juxta-articular nodules. In children, lymphocytoma is very common but chronic atrophic dermatitis is rare. Clinical symptoms, diagnosis, peculiarities of childhood disease and treatment are also reviewed. It is important to note that after haematogeneic spread, signs of infection may be non-specific, and this is a challenge for diagnosis.

Kerion Celsi is an inflammatory, deep fungal infection of the scalp. It is rare in neonates but gets more common in children about 3 years and older. It represents with swelling, boggy lesions, pain, alopecia and purulent secretions. Secondary bacterial infection is not unusual after maceration. Extracutaneous manifestations include regional lymphadenopathy, fever and very rare fungemia. Id-reactions can occur. Diagnosis is based on clinical suspicion, clinical examination and medical history. Diagnosis should be confirmed by microscopy, fungal culture and molecular procedures. The most common isolated fungal species are anthropophilic Trichophyton (T.) tonsurans and zoophilic Microsporum (M.) canis, while geophilic species and moulds rarely cause Kerion Celsi. Treatment is medical with systemic and topical antifungals supplemented by systemic antibiotics when necessary, while surgery needs to be avoided. Early and sufficient treatment prevents scarring alopecia. The most important differential diagnosis is bacterial skin and soft tissue infections., (© 2023 Wiley-VCH GmbH. Published by John Wiley & Sons Ltd.)

Psoriasis is a chronic inflammatory disease associated with immune system dysfunction that can affect nails, with a negative impact on patient life quality. Usually, nail psoriasis is associated with skin psoriasis and is therefore relatively simple to diagnose. However, up to 10% of nail psoriasis occurs isolated and may be difficult to diagnose by means of current methods (nail biopsy, dermoscopy, video dermoscopy, capillaroscopy, ultrasound of the nails, etc.). Since the nail is a complex biological tissue, mainly composes of hard α-keratins, the structural and morphological techniques can be used to analyze the human fingernails. The aim of this study was to corroborate the information obtained using Raman spectroscopy with those obtained by scanning electron microscopy (SEM) and X-ray diffractometry and to assess the potential of these techniques as non-invasive dermatologic diagnostic tools and an alternative to current methods.

Competing Interests: The authors have no conflicts of interest to declare.

Association of atopic dermatitis (AD) and several mutations of various genes of the immune system, in particular filament-aggregating protein gene (FLG) has been investigated in many studies. The association between defective FLG and AD in the Romanian population has not been assessed or published. The present study focused on the genetic background of AD, aiming to assess the prevalence of FLG mutations in Romanian patients with AD. Genetic background of AD was tested for common FLG-mutations: R501X, 2282del4, S3247X and R2447X. The study involved 48 Romanian Caucasian children aged between two months and six years diagnosed with AD, and 48 healthy volunteers; DNA extraction involved 50% of the patients to give samples by using buccal swabs and 50% by collection of whole blood samples. Genetic predisposition was evaluated based on family history, atopy history and profilaggrin genotyping. DNA extracted from blood samples was adequate to study FLG mutations, although no mutation was identified. Genetic factors do not have a unique critical role in AD; therefore, environmental factors unquestionably play an important role in this disease, but the clear-cut part that these factors trigger toward increasing the risk of AD in childhood is still obscure., (Copyright: © Chiriac et al.)

Background: Alopecia areata (AA) is a T-cell-mediated autoimmune disease and affects up to 2% of the population. There is a need for a more profound and rigorous understanding of the structure and composition of human hair affected by AA in order to manage this disease. The aim of this article is to understand the effects of AA on the structure and composition of human hair., Methods: Several physico-chemical investigation methods, such as Scanning Electron Microscopy (SEM), Transmission Electron Microscopy (TEM), Energy-Dispersive X-ray Spectroscopy (EDX), and microbeam Small Angle X-ray Scattering (SAXS), were used to analyze human hair samples obtained from healthy donors and patients with AA., Results: SEM revealed more severe hair surface defects for the white regrown hair (W-AA) samples. TEM showed the presence of air-like vesicles located in the endocuticle of regrown hair. Analysis of ultrathin sections of W-AA showed the existence of empty vesicles and smaller melanin granules compared to control samples. SAXS demonstrated that unaffected hair of patients with AA (B-AA) and W-AA melanin aggregates are different in their sizes and shapes compared to the control samples. EDX data showed that W-AA elemental composition was significantly different from the other sample groups. Our study showcases promising non-invasive techniques for a better and more accurate understanding of changes in the internal structure and composition of hair affected by AA., Competing Interests: The authors declare that they have no competing interests., (© 2020 Coroaba et al.)

The incidence of basal cell carcinoma (BCC) has been increasing in the last decades due to population aging and precise diagnosis. The difficulty that physicians face frequently is related to the treatment decision for BCC; when treating BCC, correct and personalized choices must be taken into consideration by selecting from a large variety of therapeutic options such as: surgical excision ("the golden standard therapy"), electrodessication, cryosurgery, radiation therapy, laser, photodynamic therapy, curettage, topical treatment (imiquimod, 5-fluorouracil, vismodegib), or combining different treatments. The present authors present series of cases of patients diagnosed with BCC, highlighting that "chemical surgery" using 70% trichloroacetic acid could be a valuable option in the treatment of nonaggressive BCC of the face., (© 2018 Wiley Periodicals, Inc.)

Pachyonychia congenita (PC) is a rare autosomal dominant skin disorder, with unknown prevalence, although it is estimated there are between 2,000 and 10,000 cases of PC worldwide. The International PC Research Registry (IPCRR) has currently identified (as of November 2016) 746 individuals (in 403 families) with genetically confirmed PC. Heterozygous mutations, predominantly missense mutations, in any one of five keratin genes, KRT6A, KRT6B, KRT6C, KRT16, or KRT17 cause PC. The predominant clinical findings include plantar keratoderma, plantar pain and variable dystrophy of some or all toenails and/ or fingernails. Oral leukokeratosis, follicular hyperkeratosis, cysts of various types and natal teeth may also be present. We report the first case of genetically confirmed PC from Romania due to a mutation in KRT6A, p.Arg466Pro.

Background: Despite the widespread use of oral or topical acyclovir, allergic contact dermatitis caused by it has been rarely reported, with fewer than 20 case studies published in the English literature to date., Case Reports: A diagnosis of allergic contact dermatitis from acyclovir cream was established in a 62-year-old female patient who had been continuously using acyclovir cream for 3 weeks after systemic therapy for herpes zoster with acyclovir, and in a 35-year-old female patient, who had undergone liver transplantation in 2008 and subsequently developed a severe form of herpes zoster treated orally with 4 g/day acyclovir and prolonged topical administration of acyclovir cream. In both cases, patch tests were performed with extended European Baseline Series, with the excipients of acyclovir cream (propylene glycol, sodium lauryl sulfate, cetostearyl alcohol, dimethyl sulfoxide) and commercial cream containing acyclovir 2%. Positive reactions were obtained only with the commercial cream with acyclovir 2%. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Allergic contact dermatitis caused by acyclovir is rarely reported and frequently misdiagnosed, despite the wide use of oral or topical acyclovir. Allergic contact dermatitis due to acyclovir applied topically is a clinical problem with which health care providers should be familiar, and which prompts patch testing in suspected patients. Knowledge and education focused on allergens are important to clinicians in daily practice., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Background: Scanning electron microscopy (SEM) and energy dispersive X-ray (EDX) techniques have been used in various fields of medical research, including different pathologies of the nails; however, no studies have focused on obtaining high-resolution microscopic images and elemental analysis of disorders caused by synthetic nails and acrylic adhesives., Methods: Damaged/injured fingernails caused by the use of acrylate glue and synthetic nails were investigated using SEM and EDX methods., Results: SEM and EDX proved that synthetic nails, acrylic glue, and nails damaged by contact with acrylate glue have a different morphology and different composition compared to healthy human nails., Conclusions: SEM and EDX analysis can give useful information about the aspects of topography (surface sample), morphology (shape and size), hardness or reflectivity, and the elemental composition of nails.

We present a diabetic patient with associated two diabetic dermatoses: diabetic dermopathy ("shin spots") and diabetic bullae. A 34-year-old man, with long history of diabetes mellitus, hypertension, and moderate obesity presented to Dermatology Unit for diagnosis of his skin lesions. On clinical examination multiple, light brown, irregular patches, with atrophic scars and crusts over large bullae were observed on the anterior aspect of both legs.

Infantile hemangiomas are reported in 10-12% of children less than 1 year of age, with ulceration in about 5-13% of cases. Little is known about the mechanism of this disease and explanations are still being looked for. We present a 4-month-old female infant with haemangioma on the left buttock; the hemangioma was noticed at 2 weeks of age, progressively enlarging and ulcerated.

Aplasia cutis congenita is a rare malformation characterized by localized congenital absence of the skin. It rarely occurs on the trunk and limbs, and can occur in isolation or as part of a heterogeneous group of syndromes. We report a case of a 4-day-old boy with a 5.6-cm- diameter tumor, with a central crust, non-indurate and no inflammatory rim; localized on the scalp and a small, atrophic hairless scar appeared 6 months later (approximately 5 cm in length) at the site of the previous tumor.

Diaper dermatitis is the most common cutaneous diagnosis in infants. Most cases are associated with the yeast colonisation of Candida or diaper dermatitis candidiasis (DDC). It is an irritating and inflammatory acute dermatitis in the perineal and perianal areas resulting from the occlusion and irritation caused by diapers. Autoeczematization to a distant focus of dermatophyte infection very rarely presents as DDC. We present a 1-month-old boy with lesion on diaper area (gluteal area, perineum, groin and genitalia) and with clusters of pustules and vesicles on a large erythematous base over the dorsal area of both hands.

Objectives: Biologic therapy such as Etanercept, which is a tumor necrosis factor alpha (TNF-α) inhibitor, has been extensively used as election therapy in rheumatoid arthritis. The purpose of this case presentation was to inform about the possibility that lichen planus lesions could potentially become complicated by secondary infections in patients treated with Etanercept. Furthermore, we aimed at analyzing if the complication of the cutaneous lesion was coincidental or it was due to the immunosuppressive systemic therapy, and whether the infected lesion would respond to antibiotic therapy., Case Summary: The patient was a 59-year-old woman with rheumatoid arthritis and that have had lichen planus lesions for approximately 25 years. Only recently, she had been received immunosuppressive therapy (Etanercept and Methotrexate). Further on, the lichen planus flared up with a secondary infection determined by a Methicillin-sensitive Staphylococcus aureus. Uncommon myocardial complications were also characteristic of this case., Results: While a case report described already the appearance of lichen planus following Etanercept therapy (Battistella M et al., 2008), the possibility that the lesion could become secondary complicated following this therapy was never reported before, according to our knowledge. Additionally, we describe in this case the interplay between Etanercept therapy and hypertrophic cardiomyopathy., Conclusions: Our case is not a lichen planus induced by Etanercept, but it is aggravated and secondary infected with Methicillin-sensitive Staphylococcus during the therapy. The additional cardiac complication (hypertrophic cardiomyopathy) may represent solely an evolutive sign of rheumatoid arthritis and therefore not influenced by Etanercept.