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A 57-year-old female presented with a chief complaint of cough, with productive yellow sputum particularly severe in the morning. Bronchoscopy revealed inflammatory changes in both main bronchi, with abundant white purulent secretions and necrotic material adhering to the luminal surface. Histopathological examination showed chronic inflammatory changes in the mucosal tissue, with mild hyperplasia of the local squamous epithelium and evidence of keratinization in the surrounding area, consistent with a diagnosis of tracheal mucosal keratosis. The patient was treated with anti-infection therapy, combined with symptomatic supportive treatments such as cough suppression, expectorants, and bronchodilation, resulting in an improvement of symptoms. Analysis of previous literature revealed that although this condition lacks specific clinical manifestations and signs, it exhibits a typical pattern of tracheal wall lesions, and bronchoscopy and histopathological examination have high diagnostic value for this disease. Due to impaired airway mucosal barrier function, the patient is prone to bacterial infection or colonization in the airways. Symptomatic supportive treatment based on the actual condition can effectively alleviate the patient's clinical symptoms. Currently, there is no definitive curative treatment for tracheal mucosal keratosis. However, treatments such as high-frequency electrocautery, carbon dioxide cryotherapy, and repeated lavage with epidermal growth factors may be helpful in curing this condition., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: Arsenical keratosis is a precancerous dermatosis which could be induced by long-term exposure to arsenic poisoning. Arsenic is often added to traditional Chinese medicine in a non-compliant manner to increase the effectiveness of psoriasis treatment, which is often the main cause of arsenic poisoning in Chinese patients with psoriasis., Objectives: We performed a systemic review of arsenic keratosis during the past 32 years to better understand the sources, treatment, and prognosis of arsenic keratosis in China., Methods: We searched Medline/PubMed, Embase, CNKI, and Wanfang databases for research studies published between 1992 and 2024. A total of 64 papers with 78 individual Chinese of arsenical keratosis were included in this analysis., Results: Of the patients included in the analysis, 92.21% of arsenic poisoning was due to iatrogenic factors: Chinese traditional medicine. Seventy-six patients (98.70%) had skin manifestation of hyperkeratotic papules and plaques, 68 patients (88.31%) had hyperpigmentation, 43 cases (55.84%) had hypopigmentation, and only 4 had a clear indication of Mees' lines in nails. A total of 52.63% of patients presented with tumors, including squamous cell carcinoma, Bowen's disease, and basal cell carcinoma. For patients with tumors, 20 opted for surgery, 6 for radiotherapy, and 3 for PDT. All patients with only cutaneous tumors are currently well-controlled. Death occurred in one patient with metastatic squamous cell carcinoma. Keratinizing papules improved significantly in 70.59% of patients treated with Acitretin Capsules., Conclusions: In this study, arsenic sources in Chinese patients were mainly from traditional Chinese medicine, and there were no reports of exposure to water sources or occupational sources in the past 32 years. Most of the patients showed keratinizing papules and pigmentation, and more than 1/2 of the patients showed skin tumors, mainly squamous cell carcinoma. The treatments of tumors are mainly surgical treatment, PDT and radiotherapy can also be selected. The improvement in keratinizing rash was greater than 70% with acitretin capsules. Patients with this disease should be regularly followed up for early detection and timely treatment of potential malignant tumors., (© 2024 The Author(s). Skin Research and Technology published by John Wiley & Sons Ltd.)

Pustular psoriasis is a chronic inflammatory skin disease characterized by erythematous plaques with sterile pustules. It includes the distinct clinical entities generalized pustular psoriasis (GPP), acrodermatitis continua of Hallopeau (ACH) and palmoplantar pustular psoriasis (PPPP). Recently clarified pathomechanisms of pustular psoriasis indicate that hyperactivation of the skin innate immunity, including of the IL-1/IL-36 axis, plays an important role in the pathogenesis of pustular psoriasis. Autoinflammatory keratinization disease (AiKD) is the umbrella clinical entity for inflammatory keratinization disorders with genetic autoinflammatory pathomechanisms, and pustular psoriasis is a representative AiKD. To date, mutations/variants in five genes-IL36RN, CARD14, AP1S3, MPO and SERPINA3-have been reported to be genetic causative or predisposing factors for pustular psoriasis. The pathogenic mechanisms induced by the mutations/variants in these genes are all closely related to the excessive activation of skin innate immunity and autoinflammation. A number of biologics (e.g., tumor necrosis factor inhibitors, IL-17/IL-17 receptor inhibitors and IL-23 inhibitors) and granulocyte and monocyte adsorption apheresis are used to treat pustular psoriasis. Recently, based on novel information on the pathomechanisms of pustular psoriasis, which are mainly associated with autoinflammation, inhibitors of several pathogenic pathways, including of the IL-1, IL-36, IL-8 and granulocyte colony-stimulating factor signaling pathways, have been studied as emerging treatments., Competing Interests: Declaration of Competing Interest The author declares that he has no competing interests., (Copyright © 2021 Japanese Society for Investigative Dermatology. Published by Elsevier B.V. All rights reserved.)

Background: An intractable plantar keratoma (IPK) is a conical thickening of the epidermis' stratum corneum and a common cause of foot pain which can have a significant, detrimental impact on the mobility, quality of life and independence of individuals. Conservative treatments are currently offered to patients with IPK, but they are unsatisfactory since they do not offer a sufficient or permanent reduction of symptoms. The purpose of this study was the evaluation of the feasibility, safety and effectiveness of innovative treatments for intractable plantar keratoma (IPK)., Methods: A randomized single blind trial with 40 patients divided with block randomization in four parallel groups was conducted to compare treatment combinations: conservative sharp debridement only or sharp debridement with needle insertion, physiological water injection or lidocaine injection. All patients obtained the same treatment four times at a four-week interval. At each visit, visual analog scale (VAS), Foot Function Index (FFI) and IPK size were evaluated. VAS and FFI were also completed at a six and twelve-month follow-up., Results: Our findings in regards to feasibility demonstrated recruitment challenges because of the anticipated pain that would be provoked by needle insertion may not be worth the potential pain relief compared to debridement alone from the patient's perspective. This was also the principal cause of drop out. Our preliminary results show no main effect of group for any of the clinical outcomes: pain felt on VAS, FFI score, IPK's size (p > 0.05). However, the analysis revealed a statistically significant effect of time on VAS (p < 0.001), FFI score (p < 0.001) and IPK's size (width and depth (p < 0.001); length (p = 0.001)), but no group x time interaction was found (p > 0.05)., Conclusions: This study demonstrates that IPK treatment consisting of sharp debridement with needle insertion, physiological saline water injection or lidocaine injection is feasible and safe. There was a non-statistically significant trend toward diminishing pain intensity compared to scalpel debridement alone. The pain provoked by needle insertion and injection treatments must be addressed with a scientifically proven protocol to make it more comfortable for patients before these treatments could be considered in further studies., Trial Registration: ClinicalTrials.gov, NCT04777227 . 2 March, 2021 - Retrospectively registered (All participants were recruited prior to registration).

Hyperkeratosis lenticularis perstans (HLP), or Flegel's disease (FD), is a rare disorder of keratinization first described in 1958 by Flegel. HLP is characterized by asymptomatic small papules distributed symmetrically on the dorsal feet and lower part of the legs. It typically presents in the fourth or fifth decade of life. FD has been reported more commonly in women, and little is known about the pathogenesis of this rare dermatosis. Histological examination is mandatory to confirm the diagnosis, and the characteristic features are: focal compact hyperkeratosis, thinned stratum malpighii, epidermal atrophy, and a dense, band-like lymphocytic infiltrate in the papillary dermis. The treatment of FD is challenging, and a fully effective standard therapy does not exist. We report four cases of HLP that have been diagnosed at the Dermatology Unit of IRCCS Ca' Granda Ospedale Maggiore Policlinico in Milan, Italy, and a literature review is enclosed., (© 2020 the International Society of Dermatology.)

Chronic oral mucosal lesions can be associated with several mucocutaneous diseases. This article reviews the autoimmune and immune-mediated, reactive, genetic, and infectious diseases that may present with chronic oral and/or cutaneous manifestations and provides a rational approach to diagnosis and management., Competing Interests: Disclosure This article represents an original writing that is not being considered for publication elsewhere. All authors have read and approved the article. The authors report no conflicts of interest related to the content of this article., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Background: Idiopathic calcinosis cutis is an uncommon form of calcinosis cutis. It may present as tumoral calcinosis, subepidermal calcified nodules or scrotal calcinosis. Subepidermal calcified nodules may also present as milia-like lesions commonly seen in children with Down's syndrome in the absence of tissue damage or metabolic disorders, it has been seldom reported in adults. The treatment of choice is surgical excision. However, a surgical approach may not always be beneficial to the patient given the cosmetic outcomes. Here, we describe the successful use of a CO 2 laser in the treatment of milia-like calcinosis cutis of the forehead in an adult without Down's syndrome., Aims: To describe the treatment of Milia-like idiopathic calcinosis cutis of the forehead in an adult without Down's syndrome successfully treated with a CO 2 laser., Methods: We report a case of a 48-year-old man who presented with skin-colored hard asymptomatic papules on the forehead that started about 9 years ago, a biopsy was performed and a diagnosis of milialike calcinosis cutis was made. Surgical excision was discarded regarding the location and the number of lesions, instead, a CO 2 laser was used to treat this condition., Results: Successful laser excision of the lesions with appealing cosmetic results., Conclusions: CO 2 laser seems to be a valuable tool to treat milia-like calcinosis cutis lesions., (© 2019 Wiley Periodicals, Inc.)

In this article, a comprehensive, yet introductory overview on chemexfoliation is given. The molecular mechanisms for selected indications are exemplified and the prerequisites, necessary precautions as well as potential complications are addressed. Finally, selected available superficial peeling substances are presented and the principal peeling procedure is outlined briefly.

Usage of photopneumatic technology has recently increased for treatment of different skin conditions such as acne, keratosis pilaris (KP), and rosacea. Photopneumatic devices combine gentle negative pressure with broad band pulsed light simultaneously to attack multiple targets in the skin for better treatment outcomes. In this literature review, we evaluate the efficacy of photopneumatic therapy on treatment of acne, keratosis pilaris (KP), and rosacea.

Background: Only a few clinical trials on hand eczema have included further classification into subtypes, and there is a need for studies evaluating the present classifications., Objectives: To examine differences in demographic factors, lifestyle factors and severity between subgroups of hand eczema patients, with a focus on hyperkeratotic hand eczema., Methods: This was a retrospective study including hand eczema patients referred to the outpatient dermatological clinic, Bispebjerg Hospital, between January 2013 and July 2014. The study comprises information on subdiagnoses, treatment and foot eczema from patient files, as well as a follow-up questionnaire., Results: A total of 120 patients were included, 10 of whom were diagnosed with hyperkeratotic hand eczema. A significantly higher proportion of the patients with hyperkeratotic hand eczema were male (p = 0.002) and received systemic or ultraviolet (UV) treatment (p = 0.026). The frequency of tobacco smoking was significantly higher in patients with hyperkeratotic hand eczema (p = 0.016), as well as in the other subgroups combined (p = 0.049), than in the background population., Conclusions: Studies evaluating the subdiagnoses of hand eczema are needed, to further validate the classification system, and to provide more detailed information about demographic factors, severity and possible risk factors for different subgroups of hand eczema., (© 2018 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

We report the successful treatment of multiple facial milia with manual extraction and tretinoin in a child with orofaciodigital syndrome type 1. Treatment with topical medications may be insufficient in individuals with orofaciodigital syndrome type 1, and pitted scarring is often a sequala. This case demonstrates that manual extraction is well tolerated and effective in the treatment of multiple milia. In addition, clinicians need to be aware of this rare genetic condition, which commonly presents de novo and can lead to significant morbidity if untreated., (© 2017 Wiley Periodicals, Inc.)

Background: Trichostasis spinulosa (TS) is a common, underdiagnosed cosmetic skin condition., Objectives: The main objectives of this study were to determine the occurrence of TS relative to age and gender, to analyze its cutaneous distribution, and to investigate any possible familial basis for this condition, its impact on patients, and the types and efficacy of previous treatments., Methods: All patients presenting to the outpatient dermatology clinic at the study institution and their relatives were examined for the presence of TS and were questioned about family history and previous treatment. Photographs and biopsies of suspected cases of TS were obtained., Results: Of 2400 patients seen between August and December 2013, 286 patients were diagnosed with TS (135 males, 151 females; prevalence: 11.9%). Women presented more frequently than men with complaints of TS (6.3 vs. 4.2%), and more women had received prior treatment for TS (10.5 vs. 2.8%). The most commonly affected sites were the face (100%), interscapular area (10.5%), and arms (3.1%). Lesions involved the nasal alae in 96.2%, the nasal tip in 90.9%, the chin in 55.9%, and the cheeks in 52.4% of patients. Only 15.7% of patients had forehead lesions, and only 4.5% had perioral lesions. Among the 38 previously treated patients, 65.8% reported temporary improvement., Conclusions: Trichostasis spinulosa is a common condition that predominantly affects the face in patients of all ages. Additional studies employing larger cohorts from multiple centers will be required to determine the prevalence of TS in the general population., (© 2015 The International Society of Dermatology.)

Keratosis lichenoides chronica (KLC) is a rare dermatological condition characterized by keratotic papules arranged in a parallel linear or reticular pattern and facial lesions resembling seborrheic dermatitis or rosacea. The clinical, histological and therapeutic information on 71 patients with KLC retrieved through a PubMed search plus one our new case were analyzed. KLC affects patients of all ages, with a modest male predominance. Pediatric cases represent about one quarter of patients. Diagnosis is usually delayed and histologically confirmed. All patients have thick, rough and scaly papules and plaques arranged in a linear or reticular pattern, on limbs (>80%) and trunk (about 60%). Face involvement is described in two-thirds of patients. Lesions are usually asymptomatic or mildly pruritic. Other manifestations, such as palmoplantar keratoderma, mucosal involvement, ocular manifestations, nail dystrophy, are reported in 20-30% of patients. Children present more frequently alopecia. No controlled trials are available. Results from small case series or single case reports show that the best treatment options are phototherapy and systemic retinoids, alone or in combination, with nearly half of patients reaching complete remission. Systemic corticosteroids as well as antibiotics and antimalarials are not effective.

Background: Terra firma-forme dermatosis was first described in 1987. It is characterized by the appearance in children or adolescents of dirt-like patches despite normal cleansing. The lesions are removed when the skin is rubbed with a 70°C alcohol swab. This largely unknown condition is of uncertain origin but could be due to a keratinisation disorder., Patients and Methods: Herein we report the case of a 17-year-old male patient who, after seeking the opinions of a number of doctors, consulted in dermatology for multiple pigmented patches on the trunk and limbs that had appeared one year earlier. These lesions had persisted despite appropriate cleansing. He had no history of endocrine disorders and no familial history of pigmentation disorders. A skin biopsy revealed compact orthokeratotic hyperkeratosis resembling a second layer of stratum corneum on top of a normal layer. Very small granules were seen within this layer and PAS staining revealed spores. These skin lesions disappeared when rubbed with an alcohol swab, resulting in a diagnosis of terra firma-forme dermatosis., Discussion: Where a diagnosis of terra firma-forme dermatosis is suspected, confirmation is easy to obtain using an alcohol swab. Nevertheless, the disease is not familiar to dermatologists. The most common differential diagnoses are acanthosis nigricans, reticulate and confluent papillomatosis, and Dowling-Degos disease. Their histopathological appearances are very different and skin biopsy can be useful for diagnosis. These entities belong to a group of disorders involving abnormal keratinisation and pigmentation. Anatomoclinical correlation is essential for optimal management. The appearance of the stratum corneum may play an important role in the diagnosis of terra firma-forme dermatosis., (Copyright © 2016 Elsevier Masson SAS. All rights reserved.)

Scalp hyperkeratosis is common in childhood and adolescence. Diagnosis is affected by age, race, and history of infectious exposure, and associated symptoms including atopic features, alopecia, inflammatory nodules, presence and type of cutaneous lesions outside of the scalp, and nuchal lymphadenopathy. Tinea capitis is common in children with skin of color, especially black and Hispanic children. In adolescents, seborrheic dermatitis predominates as the cause of scalp hyperkeratosis, but tinea is still of concern. This article aims to help the practitioner comfortably diagnose and treat scalp hyperkeratosis in children with skin of color.

The advent of novel targeted chemotherapeutic agents and immunotherapies has dramatically changed the arena of cancer treatment in recent years. BRAF inhibitors, MEK inhibitors, and ipilimumab are among the newer chemotherapy drugs that are being used at an increasing rate. Dermatologic adverse events to these medications are common, and it is important for dermatologists and oncologists alike to learn to recognize and treat such side effects in order to maintain both patients' quality of life and their anticancer treatment. This review describes the cutaneous side effects seen with BRAF inhibitors (eg, maculopapular eruption, photosensitivity, squamoproliferative growths, melanocytic proliferations), MEK inhibitors (eg, papulopustular eruption), and ipilimumab (eg, maculopapular eruption, vitiligo), with a mention of vismodegib and anti-PD-1 agents.

Keratosis pilaris (KP) has beenpresented as small keratotic follicular papules with or without surrounding erythema. Various treatments with laser or light therapy have been used for the management of KP with various clinical outcomes. In the present study, we investigated the efficacy and safety of a combination therapy for KP. A total of 29 anatomical sites with KP in 26 patients were treated using a 595-nm pulsed dye laser (PDL) with nonpurpuragenic fluences, a long-pulsed 755-nm alexandrite laser, and microdermabrasion. Clinical improvement was assessed by comparing preand posttreatment clinical photographs and patient satisfaction rates. Evaluation of the clinical results three months after the treatments showed that 12 of the 29 anatomical sites (41.4%) demonstrated Grade 3 clinical improvement, ten (34.5%) had Grade 2 clinical improvement, four (13.8%) showed Grade 1 improvement, and three (10.3%) showed Grade 4 improvement. We observed that KP lesions improved not only in erythema and skin texture, but also in brownish dyschromias. Potential adverse events were not observed, except prolonged posttherapy scaling. Our observations demonstrate that combination therapy using a 595-nm PDL, a long-pulsed 755-nm alexandrite laser, and microdermabrasion can have a positive therapeutic effect on KP.

The RAF inhibitors vemurafenib and dabrafenib are emerging as the standard of care for Val600 BRAF-mutant metastatic melanoma. These drugs have shown clinical benefit over the standard care (dacarbazine); however, they are associated with frequent cutaneous adverse events, which can be concerning to the patient and their physician. Herein, we review the range of cutaneous disorders that seem to be induced by RAF inhibitors, including cutaneous squamous-cell carcinoma, hyperkeratotic lesions, Grover's disease, keratosis pilaris-like reactions, and photosensitivity. These disorders often affect patients' quality of life; therefore, dermatological assessment and timely management is essential to ensure that patients continue to use RAF inhibitors., (Copyright © 2013 Elsevier Ltd. All rights reserved.)

Terra firma-forme dermatosis is characterized by 'dirty' brown-grey cutaneous patches and plaques that can simply be eradicated by forceful swabbing with alcohol pads. The pathogenesis has been attributed to abnormal and delayed keratinization. Although affected patients present with typical lesions, the disorder is not well-known by dermatologists. In this report, we describe two patients with terra firma-forme dermatosis in the setting of xerosis cutis and atopic dermatitis. From a clinical point of view, we lay emphasis on its unique expression and diagnosis/treatment. From a histological perspective, we highlight its resemblance to dermatosis neglecta and speculate on the role of 'neglect' in a patient with seemingly adequate hygiene. The role of urea containing emollients in the development of this disorder remains to be determined.

Keratosis lichenoides chronica (KLC) is a rare chronic hyperkeratotic disorder that typically affects patients aged 20 to 50 years. Its distinct clinical presentation in the pediatric population has raised speculation that the adult and pediatric variants of this disorder may be entirely separate disease entities. We present a case of adult-type KLC manifesting during childhood in a 14-year-old adolescent girl. We also review the literature on this rare disorder.

Background: Keratosis pilaris atrophicans (KPA) is a group of disorders characterized by erythematous keratotic papules followed by atrophy on the face. The treatment is often unsatisfactory., Methods: Four white women, with ages ranging from 14 to 20 years, were treated with an intense pulsed light (IPL) system with a cut filter of 570 nm. The power density was between 40 and 47 J/cm(2), divided into two pulses of 3 ms, with a delay between both of 20 ms. Patients received five to nine sessions., Results: Clinical improvement was noted in all patients, with a reduction of erythema in treated areas of between 75% and 100%. Treatment was well tolerated and no adverse reactions were observed. After a follow-up of 10 months no recurrence was observed. In addition, in parallel mode to erythema improvement, a reduction of roughness was observed., Conclusion: Our results suggest IPL should be considered as a safe treatment option in patients with KPA.

Overweight and obesity is a public health problem in Hungary and in the Western world. It is important to underline that obesity is an illness and an important risk factor for several skin and other diseases. An overview of skin diseases caused or aggravated by obesity (acanthosis nigricans, acrochordons, keratosis pilaris, hyperandrogenism, stria, adiposis dolorosa, lymphoedema, chronic venous insufficiency, plantar hyperkeratosis, lipoedema, skin infections, acne inversa, psoriasis, tophi) helps us to look and see as well. Look for the possibility of skin infections as it helps the early diagnosis and to avoid complications. Draw patients' attention to the preventive importance of skin care. In case of an obese patient the usual dosage of most local and systemic drugs should be modified. It must be kept in mind that obesity directly or indirectly starts unfavorable processes in almost all organ systems. Therefore, only a multidisciplinary care may secure treatment and rehabilitation of obese patients. Dermatological and lymphological care is often part of the rehabilitation.

Background: Keratosis lichenoides chronica (KLC) is a rare chronic keratinisation disorder. Out of almost 60 published cases of KLC, only two report its occurrence in siblings. We report a new case in which a brother and sister present KLC that improved markedly with UVB phototherapy., Patients and Methods: A 10-year-old girl presented with hyperkeratotic papules symmetrically arranged in a reticular pattern on the face and the extremities. Onset occurred at the age of six months. For a number of years, minimum sunlight was allowed owing to a diagnosis of lupus. However, KLC was our first diagnostic assumption, confirmed by an elbow lesion biopsy sample. The patient's brother, one and a half years old, had been presenting similar lesions since the age of two months. Sibship was demonstrated by DNA analysis using short tandem repeat markers. No consanguinity was found. After one month of narrow-band UVB phototherapy, most of the papules had flattened., Discussion: KLC is uncommon in childhood and familial occurrence is very rare. Clinically, thick keratotic papules arranged in parallel lines or small networks cover the dorsal aspects of the limbs symmetrically. The face may be affected by a seborrhoea-like dermatitis. Histology typically shows alternating acanthosis and atrophy, with focal parakeratosis. An extensive lichenoid lymphohistiocytic and plasmocytic infiltrate is demonstrated in the dermis. The course is chronic. Spontaneous resolution may occur. Sunlight has been shown to be effective in the few paediatric cases reported. Narrow-band UVB phototherapy appears to be an effective therapeutic option.

Skin cancers are the most frequent malignancies in organ transplant recipients (OTR), with 95% being nonmelanoma skin cancers (NMSC), especially squamous (SCC) and basal cell carcinomas. Most OTR with a first SCC subsequently develop multiple NMSC within 5 years, highlighting the concept of 'field cancerization', and are also at high risk for noncutaneous cancers. In order to reduce the tumor burden in these patients, their management requires an interdisciplinary approach including revision of immunosuppression, new dermatological treatments and adequate education about photoprotection in specialized dermatology clinics for OTR. Whereas surgery remains the gold-standard therapy for NMSC, noninvasive methods have shown promising results to treat superficial keratoses and subclinical lesions on large body areas. Although the threshold of skin cancer necessitating revision of immunosuppression is debated, this measure should be envisaged at the occurrence of the first SCC, or in case of multiple non-SCC NMSC. While the role of immunosuppressants in the occurrence of NMSC is widely recognized, the best immunosuppressive strategies remain to be defined. Presently, randomized prospective studies assess the burden of new skin tumors, as well as graft and patient survival, in patients with one or several NMSC after the introduction of mTOR (mammalian target of rapamycin) inhibitors.

Keratosis pilaris (KP) is a common inherited disorder of follicular hyperkeratosis It is characterized by small, folliculocentric keratotic papules that may have surrounding erythema. The small papules impart a stippled appearance to the skin resembling gooseflesh. The disorder most commonly affects the extensor aspects of the upper arms, upper legs, and buttocks. Patients with KP usually are asymptomatic, with complaints limited to cosmetic appearance or mild pruritus. When diagnosing KP, the clinician should be aware that a number of diseases are associated with KP such as keratosis pilaris atrophicans, erythromelanosis follicularis faciei et colli, and ichthyosis vulgaris. Treatment options vary, focusing on avoiding skin dryness, using emollients, and adding keratolytic agents or topical steroids when necessary.

Background: Recently, a wide range of new noninvasive therapies has been introduced for the treatment of actinic keratoses. As these treatment options do not provide tissue for histopathologic examination, in vivo confocal laser scanning microscopy may become an important method for obtaining a reliable diagnosis., Objective: The objective was to validate the diagnostic confocal examination of actinic keratoses., Methods: Thirty actinic keratoses and skin fields from the contralateral sides of the patients were consecutively sampled and examined using a confocal microscope. Stored images were rated by four independent observers., Results: Distinct diagnostic morphologic features could be visualized. Overall, sensitivity of 93.34% and specificity of 88.34% could be achieved by two clinical dermatooncologists (positive predictive value 88.94%, negative predictive value 93.15%). Assessment of distinct confocal microscopy features showed a moderate interobserver correlation (kappa= 0.4-0.6 in five of seven criteria). Classification and regression tree analysis yielded a one-step algorithm based on only one criterion (irregular keratinocyte cell borders), facilitating a correct classification in 86.67% of actinic keratoses and 85% of normal skin., Limitations: Hyperkeratotic actinic keratoses were excluded from the study set., Conclusions: This study provides a set of morphologic confocal microscopy criteria showing promise as a noninvasive monitoring tool in the treatment of actinic keratoses.

Actinic keratosis (AK) is common and lesions may progress to squamous cell carcinoma. The choice of therapy depends mainly on 2 factors: the efficacy of therapeutic options and the number of lesions present. Cryotherapy alone is suitable for treating a few lesions, whereas topical medications, photodynamic therapy (PDT) with 5-aminolevulinic acid (ALA), or either in combination with cryotherapy are appropriate for treating multiple (>15) lesions. When combinations are necessary, the total cost to treat multiple AKs to 100% clearance becomes important. This report provides a simple pharmacoeconomic analysis of 4 FDA-cleared therapies (imiquimod, diclofenac, 5-fluorouacil [5-FU], and ALA PDT) for AK given in combination with cryotherapy. This analysis assumes standard costs of procedures and office visits (based on April 2007 reimbursement data) and 2 treatment courses (medications: imiquimod, diclofenac, 5-FU) or sessions (ALA PDT) of each modality followed by cryotherapy to 100% clearance. The total cost of each combination is $725.17 for ALA PDT, $845.07 for diclofenac, $942.13 for 5-FU, and $1,473.39 for imiquimod. When phase III trial efficacies of the 4 modalities are considered, the actual cost of using imiquimod or diclofenac increases because additional treatments may be required. Among these 4 FDA-cleared therapies for multiple AK lesions, ALA PDT is the least expensive treatment and imiquimod is the most expensive treatment under the stated assumptions.

Controversy exists on whether or not the epidermal keratinizing squamous epithelium of skin grafts and flaps applied to line a neovagina changes histologically to a nonkeratinizing mucosal type squamous epithelium after vaginoplasty in male-to-female transsexuals. To end this discussion, the aim of this study was to objectify the short-term and long-term histologic aspect of this neovaginal epithelial lining. Biopsies were taken from the epithelium lining of the neovagina of 9 male-to-female transsexuals, from the moment of vaginoplasty up to 14 years after. These were stained with hematoxylin-eosin and periodic acid-Schiff stain for histologic comparison to normal vaginal biopsies. Because no changes that might have been induced by local influences or hormonal therapy were found, we concluded that short-term and long-term changes in the histologic aspect of inverted skin flaps do not occur after penile and scrotal skin vaginoplasty in male-to-female transsexuals.