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This qualitative study describes a visual clue for the diagnosis of psoriasis, in which the sum of the fragmentation and separation of the laminar parakeratotic stratum corneum and hyperplasia with regular elongation of the rete ridges resembles the letter ñ on histopathologic biopsy specimens.

Background Scabies is a neglected tropical disease of the skin, causing severe itching, stigmatizing skin lesions and systemic complications. Since 2015, the DerMalawi project provide an integrated skin diseases clinics and Tele-dermatology care in Malawi. Clinic based data suggested a progressive increase in scabies cases observed. To better identify and treat individuals with scabies in the region, we shifted from a clinic-based model to a community based outreach programme. Methodology/Principal findings From May 2015, DerMalawi project provide integrated skin diseases and Tele-dermatological care in the Nkhotakota and Salima health districts in Malawi. Demographic and clinical data of all patients personally attended are recorded. Due to a progressive increase in the number of cases of scabies the project shifted to a community-based outreach programme. For the community outreach activities, we conducted three visits between 2018 to 2019 and undertook screening in schools and villages of Alinafe Hospital catchment area. Treatment was offered for all the cases and school or household contacts. Scabies increased from 2.9% to 39.2% of all cases seen by the DerMalawi project at clinics between 2015 to 2018. During the community-based activities approximately 50% of the population was assessed in each of three visits. The prevalence of scabies was similar in the first two rounds, 15.4% (2392) at the first visit and 17.2% at the second visit. The prevalence of scabies appeared to be lower (2.4%) at the third visit. The prevalence of impetigo appeared unchanged and was 6.7% at the first visit and 5.2% at the final visit. Conclusions/Significance Prevalence of scabies in our setting was very high suggesting that scabies is a major public health problem in parts of Malawi. Further work is required to more accurately assess the burden of disease and develop appropriate public health strategies for its control., Author summary Scabies is an infestation of the skin caused by a mite. There is limited data on how common scabies is in sub-Saharan Africa, including Malawi. The DerMalawi project has been providing care for dermatological conditions in rural Malawi since 2015. Between 2015 and 2018 we observed an increase in patients with scabies attending for treatment. In response the project shifted from providing care at clinics to an approach using community-based outreach. Between 2018 and 2019 we conducted community-based activities on three occasions in an area of approximately 30,000 individuals. The DerMalawi team visited schools and villages to identify and treat cases of scabies and their contacts. We were able to examine about 50% of the population on each visit. Initially a large proportion of the population had scabies (15%) and this was similar during our second community survey. At our third survey this appeared to have decreased to 2% but it is difficult for us to know if this is because of treatment given in the previous rounds. Scabies is a major problem in rural populations in Malawi and public health strategies are needed to reduce the disease burden.

The novel coronavirus disease (COVID-19) is a rapidly spreading pandemic, secondary to severe acute respiratory syndrome coronavirus 2. The severity and the little knowledge that we have of the disease have made us focus mostly on the respiratory symptoms. As we bend the curve, other findings reported in association with COVID-19 become of importance for specialists to recognize. We describe the spectrum of clinicopathologic lesions in the skin that can be the only symptom or the first manifestation of COVID-19 and demonstrate the origin of the virus. We collected 25 patients with skin lesions in this context. We recognized 5 types of cutaneous manifestations including acute acroischemic or chilblain-like lesions (11), purpura palpable (2), exanthemas (9), urticarial eruptions (1), and other lesions (2) that might appear with more unspecific pictures. Chilblain-like lesions were the most common form of presentation, which tend to appear as self-healing, erythematous-necrotic plaques mostly on the feet, in young patients with no systemic symptoms associated. Importantly, we visualized viral particles with electron microscopy in 5 of 13 cases analyzed. In this study, we seek to draw a picture of the spectrum of clinicopathologic lesions that may appear in the skin in the context of COVID-19. Although apparently skin lesions are not correlated with disease severity, it may help in some cases to recognize and control the spread of the infection sooner.

Non-Melanoma skin cancer is one of the most frequent types of cancer. Early detection is encouraged so as to ensure the best treatment, Hyperspectral imaging is a promising technique for non-invasive inspection of skin lesions, however, the optimal wavelengths for these purposes are yet to be conclusively determined. A visible-near infrared hyperspectral camera with an ad-hoc built platform was used for image acquisition in the present study. Robust statistical techniques were used to conclude an optimal range between 573.45 and 779.88 nm to distinguish between healthy and non-healthy skin. Wavelengths between 429.16 and 520.17 nm were additionally found to be optimal for the differentiation between cancer types., Gerencia Regional de Salud de Castilla y León (GRS 2139/A/20); Spanish Ministry of Science, Innovation and Universities (PRE2019-089411); Instituto de Salud Carlos III (PI18/00587); Ibderdrola Spain; Junta de Castilla y León (GRS 1837/A/18). This project was funded by the Junta de Castilla y Leon, under the title project HYPERSKINCARE (Ref. GRS 1837/A/18). Lloyd Austin Courtenay is funded by the Spanish Ministry of Science, Innovation and Universities with an FPI Predoctoral Grant (Ref. PRE2019-089411) associated to project RTI2018-099850-B-I00 and the University of Salamanca. Susana Lagüela and Susana del Pozo are both funded by the Iberdrola Spain through the initiative Cátedra Iberdrola VIII Centenario of the University of Salamanca. Javier Cañueto is partially supported by the PI18/00587(Instituto de Salud Carlos III cofinanciado con fondos FEDER) and GRS 2139/A/20 (Gerencia Regional de Salud de Castilla y León)

Background A previous study has defined the maculopapular subtype of manifestations of COVID‐19. Objectives To describe and classify maculopapular eruptions associated with COVI‐19. Methods We carried out a subanalysis of the maculopapular cases found in the previous cross‐sectional study. Using a consensus, we defined 7 clinical patterns. We described patient demographics, the therapy received by the patient and the characteristics of each pattern. Results Consensus lead to the description of 7 major maculopapular patterns: Morbilliform (45.5%), Other maculopapular (20.0%), Purpuric (14.2%), Erythema multiforme‐like (9.7%), Pytiriasis rosea‐like (5.7%), Erythema elevatum diutinum‐like (2.3%) and Perifollicular (2.3%). In most cases, maculopapular eruptions were coincident (61.9%) or subsequent (34.1%) to the onset of other COVID‐19 manifestations. The most frequent were cough (76%), dyspnea (72%), fever (88%), and astenia (62%). Hospital admission due to pneumonia was frequent (61%). Drug intake was frequent (78%). Laboratory alterations associated with maculo‐papular eruptions were high C‐reactive protein, high D‐Dimer, lymphopenia, high ferritin, high LDH, and high IL‐6. Limitations The impossibility to define the cause–effect relationship of each pattern. Conclusion We provide a description of the cutaneous maculopapular manifestations associated with COVID‐19. The cutaneous manifestations of COVID‐19 are wide‐ranging and can mimic other dermatoses. This article is protected by copyright. All rights reserved.

Non-melanoma skin cancer, and basal cell carcinoma in particular, is one of the most common types of cancer. Although this type of malignancy has lower metastatic rates than other types of skin cancer, its locally destructive nature and the advantages of its timely treatment make early detection vital. The combination of multispectral imaging and artificial intelligence has arisen as a powerful tool for the detection and classification of skin cancer in a non-invasive manner. The present study uses hyperspectral images to discern between healthy and basal cell carcinoma hyperspectral signatures. Upon the combined use of convolutional neural networks, with a final support vector machine activation layer, the present study reaches up to 90% accuracy, with an area under the receiver operating characteristic curve being calculated at 0.9 as well. While the results are promising, future research should build upon a dataset with a larger number of patients.

[EN] Background. Psoriasis is a chronic inflammatory disease characterized histologically by hyperproliferation and aberrant differentiation of epidermal keratinocytes . Keratinocytes undergo alterations in cell cycle regulation may be demonstrable by studying their expression regulatory proteins. The expression patterns of these proteins could be used as a diagnostic tool in cases where the clinical , histopathology and clinicopathologic correlation is not enough. Objective . To evaluate the immunohistochemical expression of 11 cell cycle proteins in skin samples from patients with psoriasis and other inflammatory dermatoses compare . Methods . By using the technique of tissue arrays cyclin E expression , cyclin D1 , cyclin A, p63 , p53 , p27 , p21 , CDK1 , CDK2, Ki67 and Bcl-2 in 70 samples from patients with psoriasis ( cases ) was evaluated and compared 63 biopsies from other skin diseases : lupus erythematosus , pityriasis rosea, pityriasis lichenoides and eczema ( controls). Results . Ten of the eleven cell cycle proteins studied in our series showed statistically significant differences between cases (psoriasis ) and controls ( no psoriasis) . These associations are listed in the accompanying table. p21 , p53 and cyclin D1 revealed inverse association , ie positivity was more frequent in the control group. The remaining proteins studied showed a pattern of more frequent in cases ( psoriasis) positivity , with p63 , cyclin E, CDK2 and p27 proteins with greater intensity of association with the case group. Conclusions . Psoriasis presents immunohistochemical expression patterns of the studied cell cycle proteins different from other skin inflammatory diseases. These findings support the theory of the abnormal regulation of the cell cycle of keratinocytes in psoriasis affected . These differences in the patterns of immunohistochemical expression could be used as a diagnostic tool in cases where the clinicopathological correlation is not enough., [ES] Antecedentes. La psoriasis es una enfermedad inflamatoria crónica caracterizada histológicamente por la hiperproliferación y la diferenciación anómala de los queratinocitos epidérmicos. Los queratinocitos sufren alteraciones en la regulación del ciclo celular que pueden ser demostrables mediante el estudio de expresión de sus proteínas reguladoras. Los patrones de expresión de estas proteínas podrían ser empleados como herramienta diagnóstica en casos donde la clínica, la histopatología y la correlación clinicopatológica no sea suficiente. Objetivo. Evaluar la expresión inmunohistoquímica de 11 proteínas del ciclo celular en muestras cutáneas de pacientes con psoriasis y comparar con otras dermatosis inflamatorias. Métodos. Empleando la técnica de matrices tisulares se valoró la expresión de ciclina E, ciclina D1, ciclina A, p63, p53, p27, p21, CDK1, CDK2, ki67 y bcl-2 en 70 muestras de pacientes con psoriasis (casos) y se comparó con 63 biopsias de otras enfermedades cutáneas: lupus eritematoso, pitiriasis rosada, pitiriasis liquenoide y eccema (controles). Resultados. Diez de las once proteínas del ciclo celular estudiadas en nuestra serie mostraron diferencias estadísticamente significativas entre los casos (psoriasis) y controles (no psoriasis). Estas asociaciones se detallan en la tabla adjunta . p21, p53 y ciclina D1 revelaron asociación inversa, es decir, su positividad resultó más frecuente en el grupo control. El resto de proteínas estudiadas mostraron un patrón de positividad más frecuente en los casos (psoriasis), siendo p63, ciclina E, p27 y CDK2 las proteínas con mayor intensidad de asociación con el grupo casos. Conclusiones. La psoriasis presenta patrones de expresión inmunohistoquímica de las proteínas del ciclo celular estudiadas diferentes a los de otras enfermedades inflamatorias cutáneas. Estos hallazgos apoyan la teoría de la regulación anómala del ciclo celular en los queratinocitos afectados de psoriasis. Estas diferencias en los patrones de expresión inmunohistoquímica podría emplearse como herramienta diagnóstica en aquellos casos donde la correlación clinicopatológica no es suficiente.

Cutaneous collagenous vasculopathy is a rare clinicopathological entity, first described in 2000. Cutaneous collagenous vasculopathy has been considered a form of microangiopathy of superficial dermal vessels and produce lesions that appear as telangiectasia. We present a patient with histopathologic features of cutaneous collagenous vasculopathy and scattered erythematous papules on the trunk with a striking dermatoscopic finding. We propose the term of 'cutaneous papular collagenous vasculopathy' as a new clinical manifestation of this disease.