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Background Verrucous carcinoma is a rare mucocutaneous malignancy characterized by slow, relentless growth and a low metastasis rate. Objective Herein we summarize surgical success rates and review newer approaches to the treatment of verrucous carcinomas.Methods & Materials: PubMed electronic searches were performed by B.F. and C.V. using combinations of the following terms: ''verrucous carcinoma,'' ''Ackerman tumor,'' ''Buschke Lowenstein,'' ''epithelioma cuniculatum,'' ''carcinoma cuniculatum,'' ''papillomatosis cutis,'' ''treatment,'' ''therapeutics,'' ''management,'' ''mohs surgery,'' and ''excision.'' A systematic review was conducted on 49 articles in accordance with PRISMA guidelines. Results Surgical management remains first-line therapy. Wide local excision is most commonly utilized, with highly variable margins (0.5-3.0 cm) and recurrence rates (4.6-75.0%). Mohs Micrographic Surgery has also been used, especially for recurrent tumors, with an overall recurrence rate of 12.9%. Conclusion Surgery is the treatment of choice, either by Mohs Micrographic Surgery or wide local excision. However, surgical recurrence rates are high, and tissue-sparing therapies are desirable given the sensitive locations involved. Ultimately, randomized control trials are needed to develop evidence-based guidelines for the management of VCs.

Cutaneous tuberculosis classically presents as Lupus vulgaris, scrofuloderma, tuberculosis verrucose cutis and tubercular abscess. Hypersensitivity reaction to the bacilli leads to Lichen scrofulosorum and papulonecrotic tuberculids. At the same time, it can have myriad of clinical presentations, many of which are still undescribed. It is important to regularly update ourselves with these unusual manifestations so as to ensure early treatment and reduction of overall morbidity. In this case series tuberculosis manifesting as rapidly progressing diffuse facial granulomas, sporotrichoid tuberculosis, tuberculosis mimicking squamous cell carcinoma, scrofuloderma as tubercular ulcer, lupus vulgaris with nasal septal perforation, lupus vulgaris resembling furuncle, psoriasis, dermatitis and BT Hansen are described in immunocompetent individuals. These cases highlight the importance of recognition of atypical forms of cutaneous tuberculosis to minimize scarring and dissemination of bacilli.

Objectives Calcium depositions are frequent in multiple inflammatory dermatosis, they can be explored by ultrasound (US) but the patterns of these depositions have not yet been described. The aim of this study is to describe different patterns of calcium deposition in inflammatory dermatoses. Methods The clinical and US data of 58 patients from 7 different centers with inflammatory dermatosis showing ultrasonography-detected calcium depositions was retrospectively reviewed. Results Dystrophic calcinosis represented 86.2%, calciphylaxis 8.6%, and metastatic calcinosis 5.2%. Three different sonographic patterns of calcium deposition were found: 1) thin hyperechoic bands, parallel to the surface of the epidermis, generating a strong and wide posterior acoustic shadow; 2) hyperechoic spots or lumps with a narrow acoustic shadow; and 3) a linear hyperechoic band parallel to the walls of a blood vessel with also a narrow acoustic shadow. The predominant pattern in metastatic calcifications was type 1, in dystrophic calcifications type 2, and in calciphylaxis type 3. In dystrophic calcinosis, cutis deposits were longer and wider than in calciphylaxis (P Conclusion New data on inflammatory dermatoses with calcium deposition may be useful for the diagnosis and monitoring of calcium deposits and could avoid the performance of more invasive tests, such as a skin biopsy.

Heterozygous variants in TUBB encoding one of β-tubulin isotypes are known to cause two overlapping developmental brain disorders, complex cortical dysplasia with other brain malformations (CDCBM) and congenital symmetric circumferential skin creases (CSCSC). To date, six cases of CSCSC and eight cases of CDCBM caused by nine heterozygous variants have been reported. Here we report two cases with novel de novo missense TUBB variants (NM_178014.4:c.863A>G, p.(Glu288Gly) and c.869C>T, p.(Thr290Ile)). Case 1 presented brain malformations consistent with tubulinopathies including abnormalities in cortex, basal ganglia, corpus callosum, brain stem, and cerebellum along with other systemic features such as coloboma, facial dysmorphisms, vesicoureteral reflux, hypoplastic kidney, and cutis laxa-like mild skin loosening. Another case presented abnormalities of the corpus callosum, brain stem, and cerebellum along with facial dysmorphisms. We reviewed previous literature and suggest the diversity of clinical findings of TUBB-related disorders.

Report of a case, a 7-year-old male patient, with a single neoformation on the back, without a history of trauma or infection, suggestive for a diagnosis of cutis lymphocytoma. This entity is characterized by clinically and histologically simulating cutaneous lymphoma, for this reason, the characteristics that allow us to identify if the clinical picture is of good prognosis or not are described.

El síndrome verrugoso tropical comprende condiciones cutáneas infecciosas, crónicas y granulomatosas que cursan con placas, nódulos o úlceras verrugosas, de ahí su nombre. Este síndrome incluye la cromoblastomicosis, la esporotricosis, la paracoccidioidomicosis, la lobomicosis, la leishmaniasis y la tuberculosis cutánea verrugosa, todas ellas enfermedades de amplia distribución en áreas tropicales y subtropicales. Sus diagnósticos pueden ser difíciles y confundirse entre sí, lo cual es más frecuente entre la esporotricosis y la leishmaniasis. Para distinguirlas se recurre a criterios clínicos y epidemiológicos, y a métodos diagnósticos como intradermorreacción, examen directo, biopsia, cultivo, inmunofluorescencia y PCR, algunos de los cuales no son de uso común. El diagnóstico preciso conduce al tratamiento adecuado. Se presenta el caso de un hombre de 18 años con extensas placas verrugosas en una rodilla, inicialmente interpretadas como leishmaniasis verrugosa por la clínica, la epidemiología y la biopsia. Se le trató con Glucantime® durante 20 días, pero no presentó mejoría, por lo que se tomó una nueva biopsia que también se interpretó como leishmaniasis cutánea. La revisión de ambas biopsias evidenció inflamación con granulomas abscedados y presencia de cuerpos asteroides esporotricósicos, que condujeron al diagnóstico de esporotricosis, el cual se confirmó luego con el cultivo del hongo. Las lesiones remitieron con la administración de itraconazol.La clínica y la epidemiología de la leishmaniasis y las de la esporotricosis pueden ser semejantes, por lo que la biopsia y los estudios de laboratorio son esenciales para establecer el diagnóstico. El cuerpo asteroide esporotricósico es patognomónico de esta entidad.

Calcinosis cutis is a rare, benign and usually asymptomatic condition which may involve any part of skin. Characterized histologically by deposition of calcium within the dermis. Can present at variable site with variable pathogenesis. This case series present the rare entity of idiopathic cutaneous calcinosis which can be diagnosed accurately with clinical, pathological and metabolic correlation, is completely curable by surgical excision and has an excellent prognosis. Keywords: Calcinosis cutis, Idiopathic, Histopathology, Dystrophic calcification.

Cutis Vertcis gyrata is an uncommon neurocutaneous syndrome characterized by excessive growth of the skin of the scalp or the face, forming folds of similar aspect to cerebral cortex gyri. Three categories have been individualized: the primary form, essential or non-essential, and the secondary form.

Leukemia cutis [LC] is the infiltration of neoplastic leukocytes or their precursors into the epidermis, the dermis, or the sub cutis, resulting in clinically identifiable cutaneous lesions. LC may follow, precede, or occur concomitantly with the diagnosis of systemic leukemia.Here we present a case report of Chronic Myeloid Leukemia [CML] cutis in a 32-year-old female who was a known case of CML and presented with multiple erythematous nodules all over her body. Cytological study from the aspirates of these nodules revealed MPO [Myeloperoxidase] positive immature cells from myeloid series.

De-differentiated chondrosarcoma (DDCS) is an extremely aggressive tumor of the bone characterized by a high-grade, non-chondroid sarcoma adjacent to a low- or intermediate-grade chondrosarcoma. Adequate tumor sampling demonstrating the biphasic features is necessary to make an accurate diagnosis. The diagnosis may be challanging as histopathology may mimic other neoplasms. We present a case of 76-year-old woman with a history of breast cancer who presented with a pathologic non-displaced fracture. A bone biopsy demonstrated a high-grade neoplasm composed of pleomorphic spindled and epithelioid cells with focal expression of AE1/3 and GATA3, most likely consistent with metastatic breast carcinoma. After a difficult clinical course, the tumor was resected demonstrating a similar morphology to her prior biopsy, as well as an area of a low-grade cartilaginous neoplasm consistent with chondrosarcoma. The biphasic tumor alongside a low-grade chondrosarcoma allowed for a diagnosis of DDCS. Several days after her procedure, the patient developed violaceous nodules overlying and surrounding the surgical site. Skin biopsy demonstrated a malignant epithelioid neoplasm with identical histomorphologic features identical to her prior bone resection. Given the location of the skin lesions directly within the surgical site right after resection, the clinical-pathological picture was that of sarcomatosis cutis by iatrogenic cutaneous implantation. This article is protected by copyright. All rights reserved.

Primary malignant epithelial tumours arising from accessory lacrimal glands (ALGs) are extremely rare, with only few cases reported in literature. They generally appear as gradually increasing masses of the upper or the lower eyelid. Only one case of primary adenocarcinoma or adenocarcinoma not otherwise specified (ACNOS) from ALGs has been reported in literature. Herein, we describe a case of ACNOS arising from ALGs with an atypical clinical presentation and review prior cases of ALGs epithelial malignancies reported in the literature. A 78-year-old man referred to our Ocular Oncology Unit for adjuvant therapy after the excision of a conjunctival tumour of the left eye with a histological diagnosis of squamous cell carcinoma. He underwent topical chemotherapy with MMC and during follow up he presented a multinodular iris mass in his left eye. The MRI of the orbit showed an ocular mass infiltrating orbital soft tissues of the inferior palpebral region with an involvement of the corresponding zygomatic cutis. We performed orbital exenteration and histological studies revealed an epithelial neoplasm with a solido-glandular growth pattern with lumens containing an eosinophilic material positive for PAS and PAS-D. The immunohistochemical findings confirmed the diagnosis of adenocarcinoma NOS from ALGs. Although ALGs epithelial malignancies are extremely uncommon, they should be considered in the differential diagnosis of ocular tumours. A vigilant approach towards these entities is required, since they can be clinically insidious and locally aggressive.

Tuberculosis (TB) is one of the major public health problem in developing country like India. Cutaneous tuberculosis which is only 1-1.5% of all cases of extra pulmonary TB, is mostly common in the paediatric age group as compared to adults. A rising incidence of cutaneous tuberculosis is seen as a marker of active transmission of the disease in the community. The present study was done on paediatric age group children (upto 13 years) attending Dermatology OPD of Silchar Medical College and Hospital, Assam to report the clinical pattern and types of cutaneous tuberculosis, and atypical presentations if any, for a period of one year. Material and Methods: All the clinically suspected cutaneous tuberculosis in paediatric patients up to 13 years of age attending the Dermatology OPD of Silchar Medical College and Hospital in one year duration were studied to find out the clinical pattern of cutaneous tuberculosis. Selected cases have been subjected to various investigations including histopathological study. Results: A total of 11 cases were selected after fulfilling inclusion and exclusion criteria. Male to female ratio was 4.5:1. Commonest type was scrofuloderma (54.55%), followed by lupus vulgaris (36.36%), and tuberculosis verrucosa cutis (9.09%). In this study most of cases were in the age group 11-13 years, the youngest was 4 year old boy. Lower limb involvement was the commonest presentation, followed by involvement of neck. Only two of the cases had family history of TB. All the cases responded well to standard directly observed treatment short course (DOTS) anti-tubercular treatment. Conclusion: Cutaneous tuberculosis continues to be a significant medical problem even with the advent of highly effective anti-tubercular drugs because it has varied clinical presentations. Therefore high clinical suspicion is required to diagnose the case. Proper and meticulous clinical evaluation with relevant investigation aids early diagnosis and successful ther

Male, 41 years old (yo) had been complaining of severe arthralgia. Past History indicated obstruction of intestinal tract at 12 yo and gastric ulcer at 13 yo. He had been suffered from polyarthralgia especially at PIP and MP joints of both hands from 38 yo. Finally, he complained severe arthralgia at PIP and MP joints with clubbed fingers without swelling. Biochemical finding indicated negative rheumatoid factor and anti-CCP antibody and normal MMP-3 level, but slightly increased CRP and ESR levels. Radiological finding indicated periostosis of long bone without bone erosion and osteoporosis. His facial appearance was acromegalic with cutaneous manifestation of pachydermia and cutis vertices gyrate without abnormal growth hormone response. Histological findings of skin indicated oedema and hyperplasia of sebaceous glands with infiltration of lymphocytes around small blood vessels compatible with pachydermoperiostosis. In this case mutation of SLCO2A1 gene, which coded prostaglandin transport protein, was identified. The mutation c.940 + 1G > A of SLCO2A1 gene results in deletion of exon 7 and truncation of PG transporter (p.Arg288Glyfs*7). We suggest that severe arthralgia was originated from over production of prostaglandin E2. Further studies will be required.

Background: Cutaneous tuberculosis refers to the clinical manifestation of extrapulmonary tuberculosis affecting the skin. Determining the type of cutaneous tuberculosis from a patient afflicted with is challenging because clinical and histopathological similarities exist between types. Moreover, confirming a diagnosis of cutaneous tuberculosis is difficult because of its similarity with other diseases. For instance, typical and atypical cutaneous tuberculosis may have similar manifestations, but each disease is managed by completely different approaches. Microbiological examination with polymerase chain reaction and bacterial culture are the gold standard methods used to confirm a diagnosis of cutaneous tuberculosis. However, results often demonstrate negative findings. Case Illustration: Five cases of cutaneous tuberculosis, which include two cases of tuberculosis verrucosa cutis, two cases of scrofuloderma, and one case of lupus vulgaris were presented in this article. Four of the five cases demonstrated significant improvement after initiation of an antituberculosis drug regimen. Discussion: Diagnosis of cutaneous tuberculosis in these cases was confirmed through clinical findings and histopathological and microbiological examination. Conclusion: A negative result following microbiological examination does not completely exclude the diagnosis of cutaneous tuberculosis. Investigating the pathognomonic findings of cutaneous tuberculosis through histopathological examination is important to differentiate among its types correctly. Therefore, correlations between clinical and histopathological results are essential to establish a diagnosis of cutaneous tuberculosis.

Fibrosarcomas are rare but highly fulminant and aggressively malignant neoplasm whichoccurs as a result of mutated spindle-shaped fibroblasts. According to WHO, they are soft tissuesarcoma commonly present seldom at cutis. The etiology of such a malignancy is obscurednevertheless it has several predisposing factors like pre-existing pathology but the commonest ofthem is radiation. Mesenchymal malignancies were initially over-diagnosed and were the epicenter ofdiagnostic dilemma to the pathologist, but with the advent of Vimentin staining andimmunohistochemistry, the diagnostic front has fairly advanced for fibrosarcomas. Incidence ofFibrosarcoma in Maxilla accounts for less than 0.1%, when compared to other head and neckmalignancies, and is predominantly found between 2nd to 6th decades of life. Various approacheshave been documented in the literature regarding its treatment, but aggressive surgical excisionremains the mainstay of treating Fibrosarcomas. The role of adjuvant medicinal therapies have beenwell debated but do have a conclusive outcome. Through this article, we want to highlight anddocument a case, which occurred at an exceptionally young age, at a site that had no predisposingfactors but has proven immunohistochemical diagnosis and was rapidly fulminating and aggressivelymalignant. The preoperative diagnosis of the patient was inconclusive reporting it to be amesenchymal tumor, therefore, the patient was treated with the intraoral approach for wide surgicalresection. The surgical specimen was subjected to immunohistochemistry with Vimentin stainingwhich reported it to be a Fibrosarcomas, therefore the patient was advised chemotherapy, yet theprognosis is guarded.

Scleroderma is a rare, autoimmune, chronic condition that affects the connective tissue by excessive collagen production. If diagnosed before the age of 16, it is referred to as juvenile scleroderma. There are two major types of the condition: localized and generalized scleroderma. Localized scleroderma has a much higher incidence than the generalized type which is extremely rare among children and affects mostly adults. In either case, imaging can prove to be useful in both the diagnosis and monitoring of the disease. In this article, we aim to review the imaging findings that can be present in juvenile scleroderma, focusing on ultrasonography, magnetic resonance imaging, and classic radiography. Ultrasound provides high-resolution images in real-time dynamic examination. With high-frequency transducers, it may provide a considerable input into the imaging of skin and musculoskeletal involvement. Several findings might be present when using B-mode or Doppler modalities such as thickening and hypervascularization of the cutis and subcutaneous tissue, synovitis and tenosynovitis, as well as small calcifications. Magnetic resonance imaging is also useful to evaluate inflammatory skin infiltration or skin atrophy, as well as deeply located structures, including fasciae, muscles and joints that might not be seen on ultrasonography. This modality is, however, expensive and time-consuming, and might require sedition in children. Classic radiology can show soft tissue calcifications, acroosteolysis, contractures, and subluxations. Computed tomography, which requires a high dose of radiation, is generally avoided in children, except in very specific cases.

Introduction: Verrucous lesions present as cauliflower like, slowly growing masses, which may be single, multiple or diffuse involving the broad areas of skin or mucosal surfaces. Clinically these lesions are diagnostic challenges. Histopathology remains the gold standard in diagnosing this diverse group of verrucous lesions. The aim of this study was to understand the microscopy of clinically verrucous lesions. Material and Methods: This is a retrospective data of clinically verrucous lesions over the past five years. Clinical details were obtained from the archives and diagnosis was noted from the pathology records. A total of 116 clinically verrucous lesions were included. Results: Majority of the cases were Verruca vulgaris (37 cases), followed by 33 cases of Seborrheic keratosis. There were 12 cases of verrucous carcinoma, seven cases of tuberculosis verrucosa cutis, six cases of verrucous nevus and one case of verrucous hemangioma. The other cases were of varied histology, inspite of clinically verrucous appearance. All the cases were diagnosed purely based on histopathology findings, which show characteristic morphological features, which help the pathologist in the correct diagnosis. Conclusions: Histopathologic confirmation helps in alleviating the anxiety of the patients and helps us to arrive at a correct diagnosis. Keywords: Carcinoma, Papillomatosis, Seborrheic keratosis, Verrucous, Wart.

Introduction: Proteinuria is a risk factor for the progression of Nephrotic Syndrome. Xerosis cutis is a disorder of the skin due to reduced fluid or oil content in the skin that moisture the surface of the skin layer. The three primary keys that play a role in the incidence of Xerosis Cutis are the lack of moisture-binding substances, lack of skin fat and ceramics and the latter lack of skin moisture wiring in the viable epidermis mediated by the aquaporin water channel. Reduced protein content and impaired collagen maturation, for example due to proteinuria, might influence the mechanism behind preservation skin moisture. This study aimed to determine the relationship between the severity of proteinuria and Xerosis Cutis in children with Nephrotic Syndrome.Method. This is a cross-sectional analytic study involving 50 patients with Xerosis Cutis with Nephrotic Syndrome. Kruskal Wallis test is used to determine the association of proteinuria severity with Xerosis Cutis in children with Nephrotic Syndrome.Result: The median value of age was 8 (3-16) years, with the most range at 6-10 years old (52%). It consists predominantly of male patients (68%). The duration of the Nephrotic Syndrome has a median value of 2 (1-7) years. Subject with +1 proteinuria (36%), +2 (32%), +3 (28%) and +4 (4%). Skin moisture level was dry (Xerosis Cutis) (36%), normal (56%), and moist (8%). Â There was a significant association between skin dryness and the severity of proteinuria (p = 0.002).Conclusion: There is a significant relationship between the severity of proteinuria and Xerosis Cutis. The higher the severity of proteinuria associated with having skin dryness and thus indirectly describing the more protein wasted through urine.

The goal of this paper is to identify risk factors for dry skin in the elderly as well as to outline a treatment approach to xerosis in the elderly population. Females and those with darker skin types are at higher risk for dry skin. Certain medications such as diuretics and statins also are associated with higher incidence of xerosis. Ceramide-containing moisturizers help to play a protective role. A detailed medication review is warranted for all patients with dry skin. In the elderly, xerosis is a result of a complex interplay of genetic, behavioral, and comorbid factors. Prior to treatment for xerosis cutis, evaluation for an underlying primary inflammatory disease of skin should be ruled out.

Urinary tract infections (UTIs) are among the most common bacterial infections in Germany, both in outpatient and inpatient settings. The clinical spectrum is heterogeneous and ranges from benign, often self-limiting, uncomplicated infections to complicated urinary tract infections (cUTIs) with life-threatening courses. Complicated urinary tract infections have a higher risk of chronicity, recurrence and/or progression than uncomplicated infections and may be associated with severe disease progression. Stratification of patients with urinary tract infections is, therefore, of utmost importance. Host factors rather than pathogen attributes determine the pathophysiology and therapy of complicated urinary tract infections and pyelonephritis. Complicated UTIs and pyelonephritis are also associated with high rates of antimicrobial resistance in the causative pathogens, so they should be given particular emphasis.

Cutis verticis gyrata (CVG) is a rare skin disorder characterised by thick skin folds and grooves, resembling the gyri and sulci of the cerebral cortex. It can be classified as primary essential, primary non-essential and secondary CVG. The rarity of the condition poses a challenge in the diagnosis and ultimately requires good communication between the clinician and the dermatopathologist for diagnosis. Many names have been given to the condition, including Robert-Unna syndrome, cutis verticis plicata, paquidemia verticis gyrata, cutis sulcata, cutis striata or “bulldog” scalp syndrome. To date, the treatment is still limited to plastic surgeons with excision of the folds, scalp reduction and reconstruction. In this article, we are sharing a rare case and the surgical management of a middle age gentleman with cutis verticis gyrata secondary to cerebral intradermal nevus (CIN) over his occipital scalp., {"references":["Larsen F, Birchall N. Cutis verticis gyrata: three cases with different aetiologies that demonstrate the classification system. Australas J Dermatol. 2007;48(2):91-4. doi: 10.1111/j.1440-0960.2007.00343.x.","Tucci A, Pezzani L, Scuvera G, Ronzoni L, Scola E, Esposito S, et al. Is cutis verticis Gyrata-Intellectual Disability syndrome an underdiagnosed condition? A case report and review of 62 cases. Am J Med Genet A. 2017;173(3):638-46. doi: 10.1002/ajmg.a.38054.","El-Husseiny M, Yarrow J, Moiemen N. Primary cutis gyrata: Review of literature and a successful new surgical approach. Eur J Plast Surg. 2010;33(3):153-7. doi: 10.1007/s00238-009-0383-y.","Beier JP, Kneser U, Horch RE. Surgical treatment of facial cutis verticis gyrata with direct excision. J Cutan Med Surg. 2007;11(1):4-8. doi: 10.2310/7750.2007.00003.","Taha HM, Orlando A. Butterfly-shape scalp excision: a single stage surgical technique for cutis verticis gyrata. J Plast Reconstr Aesthet Surg. 2014;67(12):1747-9. doi: 10.1016/j.bjps.2014.07.039.","Zhang MJ, Sun ZY, Liu Y, Wu SM, Lu KH. Rare giant secondary cutis verticis gyrata. J Plast Surg Hand Surg. 2011;45(4-5):212-4. doi: 10.3109/02844311.2010.488883.","Mutlu OO, Colak O, Canli M, Akcay A. Scalp Reconstruction With Free Latissimus Dorsi Flap in a Patient With Giant Cutis Verticis Gyrata. J Craniofac Surg. 2016;27(6):e553-e554. doi: 10.1097/SCS.0000000000002862.","Orkin M, Frichot BC 3rd, Zelickson AS. Cerebriform intradermal nevus. A cause of cutis verticis gyrata. Arch Dermatol. 1974;110(4):575-82. doi: 10.1001/archderm.110.4.575.","Desai SC, Sand JP, Sharon JD, Branham G, Nussenbaum B. Scalp reconstruction: an algorithmic approach and systematic review. JAMA Facial Plast Surg. 2015;17(1):56-66. doi: 10.1001/jamafacial.2014.889.","Moehrle M, Lischner S, Dunsche A, Breuninger H, Hauschild A. Cerebriform giant melanocytic nevus of the scalp: report of two cases with different surgical approaches. Dermatol Surg. 2002;28(1):75-9. doi: 10.1046/j.1524-4725.2002.01105.x."]}

Introduction: In geriatrics, there are changes in structure and function results in histopathological, physiological and clinical skin changes. The conditions can cause morbidity and decreases the quality of life of patients. This study was the first study that provide the characteristics of geriatric skin disorders in Dr. Mohammad Hoesin Hospital Palembang. Methods: This study was descriptive observational with cross-sectional design using total sampling method performed among patients in Geriatric Outpatient Clinic, Dermatology and Venereology Outpatient Clinic and geriatric inpatient room in Dr. Mohammad Hoesin Hospital on July-September 2019. Results: Physiological skin changes in geriatrics include xerosis cutis (13,95%), seborrheic keratosis (13,17%), guttate hypomelanosis (8,5%), senile lentigen (6,97%), freckle (2,32%), periorbital hyperpigmentation (1,55%), senile purpura (0,77%) and poikiloderma civatte (0,77%). The most skin disorder found were lichen simplex chronicus (11,1%), pressure ulcers (9,25%), senile pruritus (8,32%), asteatotic dermatitis (6.47%) and candidiasis (3,7%). The most common comorbid condition were diabetes mellitus in 16 patients (22,5%), CVD in 7 patients (9,9%), hypertension in 6 patients (8,5%), AKI in 6 patients (8,5 %), and HHD in 4 patients (5,6%). Diabetes mellitus was significantly associated with xerosis cutis (p = 0,0007), senile pruritus (p = 0,015), and guttate hypomelanosis (p = 0,016). Conclusion: The most physiological skin changes found in geriatric patients in Dr. Mohammad Hoesin Hospital were xerosis cutis, seborrheic keratosis, and guttate hypomelanosis, while skin disorder were lichen simplex chronicus, pressure ulcer, and senile pruritus. Diabetes mellitus was significantly associated with skin disorders.

We describe two cases of acute myeloid leukemia (AML) who presented with cutaneous manifestations. Leukemia cutis (LC) is the cutaneous presentation of any type of leukemia and occurs in 10% to 15% of patients with AML, but cutaneous infiltration of AML rarely precedes the involvement of the bone marrow or peripheral blood and is called "aleukemia cutis." Our first case presented with facial skin thickening, a manifestation which is known as lionization and his initial clinical diagnosis was nonspecific allergic reaction. Our second case presented with urticaria-like lesions with the initial clinical and histomorphologic diagnoses of leukocytoclastic vasculitis. Histopathologic examination of skin biopsy specimens in both patients showed diffuse infiltration of the dermis with a monotonous population of intermediate-sized mononuclear cells by open chromatin and promonocytic features. Bone marrow aspiration leukocyte karyotyping showed normal cytogenetics, and molecular investigation revealed mutations of NPM1 and FLT3 genes. Somatic CEBPA gene mutation was negative in both patients. LC as the first manifestation of leukemia is very rare and could result in delayed diagnosis and affect patient prognosis.

Introduction: Cutaneous tuberculosis is not a uncommon type of extrapulmonary tuberculosis in India. Our aim was to study the various clinico morphological pattern and epidemiology of cutaneous tuberculosis, and to correlate them with mantoux reactivity and human immunodeficiency virus (HIV) status. Materials and Methods: During the one year newly diagnosed patients of cutaneous tuberculosis were included in this study, attending at Dermatology Outpatient Department. The demographic details, clinical and vaccination history, family history and clinical features were recorded. Monteux test, HIV (ELISA) test and other relevant test done in all cases. Diagnosis was confirmed by clinical, histopathological and microbiological evidences. Results: In our study out of total 34 cases most common morphological variant of cutaneous tuberculosis was lupus vulgaris (LV) (38.23%) followed by Scrofuloderma (SFD) (29.41%) and tuberculois verrucoa cutis (20.59%). In morphologic pattern, plaques were most common lesions in both tuberculois verrucoa cutis and lupus vulgaris while ulcerative lesions were in scrofuloderma. Conclusions: Skin tuberculosis as well as other extra-pulmonary TB is an important issue in the era of HIV-AIDS. As current and newer diagnostic tools are not enough sensitive, specific or cost effective in its diagnosis, knowing its clinical pattern and presentation is important. Keywords: Acid fast bacilli, Cutaneous tuberculosis, HIV, Lupus vulgaris.

Background Epidermolysis bullosa with pyloric atresia (EB-PA), also known as Carmi syndrome, is an uncommon, autosomal recessive genodermatosis that typically affects the skin and gastrointestinal tract. EB-PA is caused by homozygous or compound heterozygous mutations in the integrin alpha 6 (ITGA6) gene on chromosome 2q31.1 or in the integrin beta 4 (ITGB4) gene on 17q25.1. Case presentation A male premature infant was born with aplasia cutis, atresia of the pylorus, and bilateral hydronephrosis. His clinical and imaging findings were compatible with EB-PA. A novel, small deletion of the last two bases in exon 6 and the first two nucleotides of intron 6 (c.565_566+2del) in ITGB4 gene was identified. Conclusion EB-PA-aplasia cutis congenita is known to be a non-treatable condition with a poor prognosis as the reported case. The novel mutation reported in this patient may lead to the lethal form of this disease. Identification of underlying genetic abnormality is critical to give genetic counseling.

Objective Tuberculosis verrucous cutis (TBVC) is a skin infection caused by Mycobacterium tuberculosis, characterized by the presence of a solitaire verrucous plaque, commonly seen on the hands and or feet and could present as a varies of different clinical morphologies. Case report We presented three case report of TBVC. Case 1. A 34-year-old woman, presented with a thickened spot in the right index finger since eight months ago. The first lesion appears as small red spots then progressively bigger until oval-shaped. Case 2. A 48-year-old man came with thickened plaques on the calves for 30 years. The lesion starting as a small red patch on the calves. The edge of the lesion was irregular. Case 3. An 11-year-old boy complained of purple and white plaque-like wounds on the left side of his left hand which had been experienced for approximately 9 years ago. Initially, it started as small reddish nodule appears in the area and expand with time to form purplish and white wide plaques on the border. Results Case 1 showed regression of the lesion and so the verrucosity after one month of therapy, while case 2 showed improvement after the first-month of therapy and case 3 showed improvement in 3 weeks after therapy. Conclusion Tuberculosis verrucous cutis is a disease that should be taken as a health concern in developing countries and remains an issue to the dermatologist as a result of the varieties in its clinical, histopathological, and immunological appearances as well as response to treatment.

Pseudolipomatosis cutis is a distinctive artifact characterized by the presence of adipocyte-like vacuoles in the biopsy specimens. We describe this change in a series of skin biopsies clustered over 2 periods, November 2017-December 2017 and February 2019. Hematoxylin and eosin-stained sections from 21 skin biopsies were examined by 2 dermatopathologists. Variable-sized vacuoles were noted in the epidermis, dermis, and/or subcutaneous fat in all biopsies. Vacuoles were seen in the stratum corneum in 2 biopsies, epidermis in 15 biopsies, papillary dermis in 19 biopsies, reticular dermis in 20 biopsies, and subcutis in 9 biopsies. The vacuoles resembled a true histological change in many biopsies: vacuolated keratinocytes (n = 6), basal cell vacuolization (n = 6), foamy histiocytes (n = 12), and adipocytes (n = 20). Other changes included dermal collagen sclerosis and empty ectatic vascular channels. The clustering of this peculiar change in biopsies from patients with unrelated skin diseases that stopped on changing the formalin solution in both instances suggests that it is an artifactual change due to improper tissue fixation.

The skin is the largest organ in the human body; beyond its regulatory and sensory roles, it is meant to protect and act like a barrier against foreign matter. Products intended to restore the skin health should reintegrate the structure of the stratum corneum in which the corneocytes are surrounded by the intercellular lipid lamellae that maintain both corneum integrity and skin permeability barrier. Capilen is a specific liposomal formulation based on a technology through which highly concentrated fresh plant extracts are conveyed into a jelly-like liposomal vehicle and combined with plant-derived omega-3, -6, -7, and -9 fatty acids, phospholipids, and precursors of ceramides. Its components have been widely investigated and produced clinical benefits in atopic dermatitis, bedsores, scars, inflammatory lesions of the skin, and generally whenever signs of xerosis cutis were present. Liposomes contribute to restore the surface lipid layer of the skin and to deliver substances in the activity site. This liposomal cream was proven to limit and delay the occurrence of radiodermatitis in breast cancer patients, and as an add-on provided complete healing of bedsore lesions in geriatric subjects.

Een hemangioma cutis neonatorum (naevus van Unna, ooievaarsbeet, naevus simplex) is een vlak, capillair hemangioom dat gezien wordt in het gelaat, voornamelijk op de neusrug en oogleden, en in de nek van de pasgeborene.

Background: Amyloidosis cutis dyschromica (ACD) is a rare type of primary localized cutaneous amyloidosis. Non-invasive techniques can provide important clues for early diagnosis.Objectives: To highlight the characteristic imaging changes of ACD under dermoscopy and reflectance confocal microscopy (RCM), investigate gene mutations in a Chinese Han pedigree of ACD, and analyze the genotype–phenotype correlation.Methods: Dermoscopy and RCM examinations were completed together for the pedigree, and the imaging characteristics were described. The diagnosis of ACD was confirmed by pathological examination. Sequencing was performed followed by bioinformatics and genotype–phenotype correlation. ACD-related articles published on PubMed between January 1970 and March 2021 were reviewed and summarized.Results: In ACD, dermoscopy showed patchy white hypopigmentation and brownish spots, stripes, or hyperpigmented blotches and patches. RCM showed a highly refractive substance with clumpy, dotted, and linear structures inside the papillary dermis. Sequencing identified glycoprotein non-metastatic melanoma protein B (GPNMB) missense mutations [c.393T>G (p.Y131X; NM_001005340.2)] and a frameshift deletion mutation [c.719_720delTG (p.V240fs; NM_001005340.2)]. The ANNOtate VARiation (ANNOVAR) software predicted that c.393T>G is a pathogenic mutation. The literature review found 14 mutations, namely, 5 (35.7%) frameshift mutations, 4 (28.6%) non-sense mutations, 4 (28.6%) missense mutations, and 1 (7.1%) splice site mutation. Blisters and epidermolysis were observed in several cases, but there was no significant association between clinical manifestations and mutations in ACD.Conclusions: This study was the first to combine dermoscopy and RCM to describe ACD. Two GPNMB gene mutations were reported in a Chinese ACD pedigree. The genotype–phenotype correlation was analyzed for the first time; however, there was no significant correlation.

Aim Traditional approaches to ventral hernia repair involve implantation of synthetic mesh (SM), primary suture (PS) repair, and the use of biologic prostheses (BP). A body mass index (BMI) > 30 increases recurrence rates and complications for such repairs. We have begun to use Autologous Fenestrated Cutis Grafts (CG) as an alternative hernia repair. We investigated the impact of obesity on the recurrence and complication rates of CG compared to traditional repairs. Material and Methods A five-surgeon, retrospective study included all ventral/incisional, epigastric and umbilical hernia repairs (SM, PS, and BP from 2015-2020; CG repairs from 2018-2020). Patients with a BMI ≥ 30 were stratified according to surgical approach. Outcomes included recurrence and complication rates. Descriptive statistics for demographics and outcomes were compared and logistic regression performed with p Results A total of 301 hernia repairs were performed (173 CGs, 54 SM, 59 PS, 15 BS). The groups had similar recurrence rates. A significant difference in complications rates did exist (37% CGs, 48.1% SMs, 15.3% PS, 66.7% BP, p Conclusions CG for abdominal wall hernia repair in patients with BMI ≥ 30 is an acceptable hernia repair in obese patients with similar recurrence rates and an acceptable complication profile compared to traditional repairs.

After primary infection, varicella zoster virus (VZV) causes prolonged latent infections that may reactivate, depending on the immunologic status of the host. We present a case of VZV reactivation in a 10-year-old male patient that underwent unrelated peripheral blood stem cell transplantation (uPBSCT) for T-lymphoblastic lymphoma with lymphoma cutis lesions. This patient had a history of herpes zoster involving the right L2-5 dermatome and trigeminal V1 dermatome prior to uPBSCT. Three months post-uPBSCT, the patient’s underlying disease relapsed, and the patient presented with lymphoma cutis lesions. A few days after a skin biopsy was performed to pathologically confirm skin relapse, vesicles appeared only involving the skin areas with lymphoma cutis. This case illustrates how decreased areas of epidermal immune mechanisms may cause atypical presentations of varicella infection.

Background: Exogenous factors (such as sun exposure, smoking habits, and diet) and endogenous (inflammatory status, general diseases) have a direct influence on skin and soft tissue characteristics. The study’s objective was to assess the impact of metabolic syndrome (MS) on characteristics of skin layers in sun-exposed and non-exposed maxillofacial tissues evaluated by high-frequency ultrasound (HFU), as a potential diagnosis and monitoring tool for the aging process. Material and methods: The present study included 102 subjects (24 with MS, 78 without MS). Anthropometric parameters and disease history were recorded, and blood samples were harvested in order to assess biochemical parameters of MS. Sun-exposed skin (zygomatic region) and non-exposed oral mucosa of the lower lip were assessed using HFU (DUB® cutis, Taberna Pro Medicum) with a 22 MHz probe. Results: Patients with cardiac disease had significantly lower values for epidermis density (p = 0.002). Gender was independently linked to the aged dermis depth (p &lt, 0.001), aged dermis no. of px (pixels) (p &lt, 0.001), dermis depth (p &lt, 0.001), dermis no. of px (p &lt, 0.001), and subcutaneous tissue density (p &lt, 0.001). Patients with MS had thinner epidermis (p = 0.008) and thinner aged dermis (p = 0.037) when compared to non-MS subjects. Conclusion: Patients with MS had thinner epidermis and a lower epidermis number of pixels in sun-exposed skin. Women had lower epidermis density and thicker dermis in sun-exposed skin. Our study showed that HFU, as a non-invasive investigation approach, is useful to diagnose and monitor the aging process in skin and oral mucosa, correlated with skin phenotype pathological conditions.

BACKGROUND Xerosis cutis is recognized as a burdensome and stressful condition of the skin, resulting in impaired health-related quality of life (HRQoL). Therefore, it should be treated as a relevant skin disease with detailed care and treatment recommendations. METHODS This cross-sectional, exploratory study aimed to examine xerosis cutis-related burden from patient's perspective and compare it with individuals without xerosis cutis. Within-group comparisons were also performed among patients with xerosis cutis associated with atopic dermatitis (AD) or not. The second aim was to assess the effect of a routinely applied basic skin care therapy in terms of burden release. RESULTS Overall, 127 participants were included in the study. Patients with xerosis cutis reported a lower quality of life (p = .041), more dysmorphic concerns (p

We report an 11-year-old girl who presented with white papules on the dorsal and palmar region of the hands bilaterally. The parents reported that the lesions had appeared four months before and some had resolved spontaneously. The girl was suffering from celiac disease, Down syndrome, and alopecia areata treated with topical corticosteroids. At the first visit, the girl presented with alopecia areata, corticosteroid acne, and a dozen white papules located on the hands. On dermoscopy, a whitish structureless area was seen. Histological examination showed the presence of calcium deposits without tissue damage, thus confirming the diagnosis of milia-like idiopathic calcinosis cutis. At 6-month follow up, the lesions had completely disappeared. Milia-like idiopathic calcinosis cutis is a benign cutaneous disorder consisting of calcium deposits in an apparently undamaged dermis and is typically associated with Down syndrome. Up to a quarter of patients have coexisting syringomas. The milia-like papules tend to self-resolve as patients reach adulthood, so a wait-and-see approach is recommended.

Applying next-generation sequencing to paired skin and marrow biopsies, Delaleu et al describe an entity they term “myelodysplasia cutis,” comprising histologic features of histiocytoid Sweet syndrome in the skin and a clonally related myelodysplasia in the bone marrow. This can be distinguished from forms of histiocytoid Sweet syndrome not associated with myelodysplastic syndromes, as well as classical neutrophilic Sweet syndrome associated with various malignant and nonmalignant diseases and leukemia cutis where the infiltrating cells are myeloblasts.

A dystrophic nail is an alteration of the physical appearance and structural properties of the nail from its shape, color, and texture, which can result from multiple etiologies. Calcinosis cutis is a condition that refers to the calcium deposition in the skin and underlying tissue. A 55-year-old man who presented with a split right thumbnail associated with subungual calcinosis cutis affecting the same digit for a duration of nine years is described. He did not recall trauma to the affected area. Microscopic evaluation of the tissue specimen obtained following a biopsy of the affected digit's nail matrix showed foci of calcium in the dermis. The correlation of his clinical presentation and biopsy findings established a diagnosis of subungual calcinosis cutis. Subungual calcification has been observed in several clinical settings. In addition to subungual calcinosis cutis, it has been noted as a normal finding in elderly individuals. In addition, it has been observed in patients with scleroderma or following trauma to the site. Less commonly, subungual calcification can be associated with idiopathic conditions: calcifying aponeurotic fibroma, digital calcinosis circumscripta, subepidermal calcified nodule, and calcified subungual epidermoid inclusion.