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The spectrum of pustular skin disorders (PSD) is large and particularly challenging, including inflammatory, infectious and amicrobial diseases. Moreover, although pustules represent the unifying clinical feature, they can be absent or not fully developed in the early stage of the disease. The line-field confocal optical coherence tomography (LC-OCT) is a recently developed imaging technique able to perform a non-invasive, in vivo, examination of the epidermis and upper dermis, reaching very high image resolution and virtual histology.We aimed to investigate the potentialities of LC-OCT in the non-invasive differential diagnosis of a series of 11 PSD with different aetiology, microscopic features, body location and incidence rates.Complete LC-OCT imaging (i.e. 2D/3D frames, videos) was performed on a total of 19 patients (10 females and 9 males) aged between 35 and 79 years. Images were blindly evaluated and compared with corresponding histopathologic findings.The LC-OCT imaging was able to detect with high accuracy the pustule structure including shape, margins, morphology and cellular content, along with peculiar epidermal and adnexal alterations in each condition, including: Acute Generalized Exanthematous Pustulosis, Generalized pustular psoriasis, Generalized pustular figurate erythema, Subcorneal Pustular Dermatosis, Intraepidermal IgA pustulosis, Palmoplantar pustulosis, Palmoplantar pustular psoriasis. Herpetic whitlow, Acrodermatitis continua of Hallopeau, Vesicopustular Sweet syndrome and Vesicopustular Eosinophilic cellulitis, with pustular appearance, were also compared.The new LC-OCT can represent a rapid, non-invasive and painless tool which can help differentiating among PSD of different aetiology and microscopic morphology in clinical mimickers in daily practice.

Basosquamous carcinoma (BSC) is a rare and potentially aggressive cutaneous neoplasm combining histopathological features of basal cell carcinoma (BCC) and squamous cell carcinoma (SCC). Line-field confocal optical coherence tomography (LC-OCT) is a new, non-invasive imaging technique featuring excellent resolution and penetration. To date, studies about the use of LC-OCT in the BCC and SCC fields are available, but similar investigations are lacking in the BSC field.The goal of the present study was to identify/describe LC-OCT criteria of BSC.Consecutively enrolled BSCs were imaged with dermoscopy and LC-OCT prior to surgical excision. Dermoscopic and LC-OCT images were evaluated, and histopathological slides were reviewed.Six BSCs from six patients [four (66.7%) males and two (33.3%) females; mean age 76.5 (62-96) years] were included. Identified LC-OCT criteria for BSC included BCC-associated (dermal lobules with millefeuille pattern, dilated vessels, bright cells within the epidermis, bright cells within lobules, stromal stretching, stromal brightness) and SCC-associated features (acanthosis, hyperkeratosis, disarranged epidermal architecture, broad strands, elastosis and glomerular vessels). Interruption of the dermal-epidermal junction and ulceration represented overlapping criteria.Line-field confocal-OCT is a new promising technique that may support the non-invasive recognition of BSC through the simultaneous detection of BCC-associated and SCC-associated features. We hypothesize that the use of LC-OCT might be helpful not only in the diagnostic setting but also in the follow-up surveillance for an early identification of recurrences. Further larger studies are needed to prove this hypothesis.

Tattoos are an increasingly common phenomenon, with a prevalence of around 10-30 % of the population in Western countries. The "Tatou" project assessed the risks of tattooing for patients with psoriasis. The first part revealed strong opposition to tattoos in these patients on the part of dermatologists, despite fewer than a quarter of them having any personal experience of complications. The second part showed a very low rate (6.6 %) of local complications on tattoos in these patients as well as absence of severe complications. These observations led us to assess the reasons for reluctance about tattoos in the 468 dermatologists involved in the first part of the "Tatou" project.We conducted a cross-sectional international study in France, Finland and Italy to evaluate the experience and opinions of dermatologists regarding tattoos in psoriasis patients via an anonymous questionnaire. We then examined the stated reasons for opposition to tattoos in order to establish the profiles of "tattoo-sceptical" dermatologists with regard to 4 different situations: active psoriasis, quiescent psoriasis, treatment with topical steroids and biotherapies.The opinion of dermatologists regarding tattoos was generally unfavourable (3.5±2.8/10), in particular, via multivariate analysis, among older dermatologists (P=0.01), dermatologists in private practice (P=0.04), and non-tattooed dermatologists (P0.0001). In multivariate analysis, the main parameter affecting the position of practitioner with regard to tattoos was their personal opinion of tattoos (P0.0001), regardless of disease activity or type of treatment. Italian, Finnish and female dermatologists exhibited greater reluctance but in a less consistent fashion.This analysis suggests a lack of objectivity among dermatologists opposed to tattoos probably stemming more from a poor opinion of this practice than from any fear of complications in their psoriatic patients.

Las dermatosis ampollosas se definen por la presencia de una ampolla o de una vesicula, que son lesiones cutaneas elementales constituidas por una cavidad de contenido liquido y localizacion epidermica o subepidermica. Los mecanismos fisiopatogenicos de estas dermatosis son muy variados. Pueden estar provocadas por infecciones bacterianas (impetigo, epidermolisis estafilococica aguda, erisipela ampollosa, sifilis congenita) o virales (herpes simple, herpes zoster, enfermedad pie-mano-boca), medicamentos (sindrome de Stevens-Johnson, sindrome de Lyell), factores externos mecanicos, quimicos o termicos, enfermedades hereditarias (epidermolisis ampollosa hereditaria, ictiosis ampollosa, incontinencia pigmentaria, acrodermatitis enteropatica, dermatosis acantolitica familiar de Hailey-Hailey), enfermedades autoinmunitarias (penfigoide ampolloso de la infancia, dermatosis por inmunoglobulina A lineal de la infancia, dermatitis herpetiforme, epidermolisis ampollosa adquirida, penfigo vulgar, penfigo foliaceo) y enfermedades ampollosas autoinmunitarias transmitidas de la madre al nino (penfigoide del embarazo, penfigo neonatal). Tambien existen dermatosis cuyo aspecto ampolloso es inconstante, como las mastocitosis, la vasculitis leucocitoclastica, el lupus eritematoso diseminado agudo y la reaccion injerto contra huesped. Las causas infecciosas y hereditarias son mas frecuentes en el adulto. En este articulo se consideran los aspectos epidemiologico, clinico, diagnostico y terapeutico de estas dermatosis. Al igual que en cualquier patologia dermatologica, la anamnesis y la exploracion fisica son fundamentales para el diagnostico. Si se sospecha una enfermedad ampollosa autoinmunitaria, las pruebas complementarias son necesarias: estudio histopatologico, inmunofluorescencia directa e indirecta. El diagnostico etiologico correcto es fundamental, ya que el pronostico de este grupo de dermatosis es igualmente variable, desde las formas rapidamente resolutivas hasta las enfermedades potencialmente mortales.

We report a case of a nested melanoma of the elderly, a recently described entity, and we describe its aspect under confocal reflectance microscopy.A 70-year-old woman presented a pigmented lesion of the left leg measuring 2 × 2.5 cm in diameter which was increasing in size. Dermatoscopic examination showed a predominantly globular pattern, with globules of irregular color and distribution. Reflectance confocal microscopy revealed the presence of dense nests at the dermo-epidermal junction with cytologic atypia and pagetoid cells. The histological appearance was overlapping and a diagnosis of nested melanoma of the elderly was made.The presence in an older subject of a large pigmented lesion with an irregular globular pattern should be suspected of nested melanoma of the elderly. Reflectance confocal microscopy may be useful in the case of such difficult lesions to proceed with more confidence to surgical excision.

Ink-jet printing is becoming a leading technology for traditional ceramics, due to its capacity of reproducing highly resolved and customized images on tile surfaces. Nano-sized inks, produced by the polyol synthesis route, proved to fulfil the printing requirements, tailoring their chemico-physical properties (e.g. viscosity, surface tension) on industrial ink-jet devices, so representing a major breakthrough in the quadrichromy process.

Inks for direct ceramic ink-jet printing (DCIJP) are stable suspensions of a pigment dispersed in an organic/inorganic medium. Pigments must penetrate easily the surface of unfired glazes and bodies and must be refractory during firing. Research on ceramic decoration is focussing on nano-sized pigments, due to their stability in a ceramic ink and ability to bestow reliability to the printing system, in order to formulate ceramic inks suitable for DCIJP. In fact, micro-milled pigments cause problems, such as nozzle occlusion and difficult penetration in green ceramic bodies, that can be overcome by using nano-sized pigments, which however are difficult to be wet dispersed once synthesised as nanopowders. This work is aimed at optimising the ink application in DCIJP and its penetration in semi-finished ceramic tiles. Four different ceramic inks, with various pigment concentration, suitable for the four-colour process, were characterized studying both physical and rheological properties; in particular, particle size distribution, density, surface tension, viscosity, electrical conductivity and Z-potential were measured. Moreover, the penetration kinetics into different unfired bodies was experimentally appraised by evaluating the amount of ink absorbed in the unit of time and of surface area by the porous substrate. Results show that all the inks are stable and both surface tension and viscosity fulfil the requirements for DCIJP. Besides ceramic ink viscosity varies of more than one order of magnitude heating the inks from 25 to 85°C. The electrical conductivity is influenced by pigment composition. Concerning the penetration kinetics, it is mostly influenced by pigment concentration and composition, though it changes significantly depending on the substrate composition, microstructure and processing.

Introduction Le gradient veino-arteriel en CO2 (GVACO2) est utilise quotidiennement pour monitorer la microcirculation. En 2011, un travail a montre que les variations de capnie influencaient le gradient [1] . Dans ce travail, les patients avaient beneficie d’une circulation extracorporelle (CEC) pouvant alterer la microcirculation. L’objectif principal de notre etude est de mesurer l’effet des variations de capnies sur le GVACO2 chez des patients a microcirculation saine. L’objectif secondaire est de quantifier l’impact de l’hypocanie et de l’hypercapnie sur le debit microcircualtoire. Materiel et methodes A l’occasion d’un test d’hypercapnie et apres accord du CPP, 15 patients ont ete inclus. Le GVACO2 a ete mesure en normocapnie, hypo- et hypercapnie. L’ordre des mesures a ete randomise. Un retour a l’etat basal a ete respecte entre l’hypo- et l’hypercapnie expliquant la realisation des mesures basales a deux reprises (Basal 1 et 2). L’hypocapnie a ete obtenue par hyperventilation volontaire et l’hypercapnie par inhalation d’un melange enrichi a 7 % en CO2. Le debit microcirculatoire a ete estime au niveau cutane en microscopie confocale (MCF) [2] . Des epreuves d’occlusion vasculaire ont permis de mesurer les pentes de revascularisation (PR) en NIRS, reflets indirects de la microcirculation musculaire. Resultats Notre population est exlusivement masculine âgee de 28,4 ± 5,4 ans. Le GVACO2 augmente fortement en hypocapnie et diminue en hypercapnie. Le debit mesure en MCF baisse d’environ 10 % en hypocapnie. Les PR sont relativement stables en hypocapnie alors qu’elles augmentent significativement en hypercapnie ( Tableau 1 ). Discussion Nous montrons que le GVACO2 est tres influence par les variations de capnie chez des patients ayant une microcirculation saine. Nos resultats sont similaires a ceux retrouves en postoperatoire de chirurgie cardiaque [1] avec une relation inverse entre capnie et GVACO2. Il semble donc que parallelement aux determinants classiques du GAVCO2 (debit cardiaque et etat microcirculatoire), il faille prendre en compte les variations de capnie pour interpreter correctement ce gradient. L’interaction entre la capnie et le GVACO2 peut en partie etre expliquee par l’impact direct que semblent avoir les variations de CO2 sur le debit microcirculatoire. L’hypocapnie s’accompagne d’une diminution moderee du debit estime en MCF alors qu’elle n’a pas d’impact sur les PR en NIRS. Nous sommes interpeles par les faibles variations des marqueurs de debits microcirculatoires mesurees en MCF de l’ordre de 10 %, alors que nous constatons des variations majeures de pres de 300 % du GVACO2. Il existe donc probablement d’autres phenomenes a preciser qui pourraient expliquer les variations du GVACO2 secondaires aux modifications de la capnie.