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Background: As the pathogenesis of keloids is poorly understood, there is no sound biological basis of keloid management. Few controlled therapeutic studies have been published, and recurrences are a major reason for treatment failure. Objective: To detect efficacy and safety of cryosurgery regimens on keloids and the occurring biological changes caused by the treatment. Methods: This prospective randomized study compared efficacy and tolerability as well as histological/immunohistochemical effects of liquid nitrogen contact cryosurgery as a single regimen (group A) and combined with intralesional corticosteroids (group B) on young (<2 years old), small (≤10 cm2) keloids in 40 patients (2-sided effect, α-error 1%, power 95%). Results: Marked flattening of the lesions was achieved by both regimens. Median lesional volumes decreased from 106 to 7 mm3 in group A (p = 0.001) and from 138 to 6 mm3 in group B (p < 0.0001; ns, between groups). Good to excellent responses were registered in 83.3 and 90% of patients in groups A and B, respectively, by evaluating the lesional volume, in 80 and 95% of patients by the physician's evaluation and in 95% of patients in either group by the patient's assessment. Follow-up of 6–36 months revealed no further significant changes. Cryosurgery was generally well tolerated, with minor pain during treatment not requiring (27.5%) or requiring local anaesthesia (5%) – but not analgesics –, and hypopigmentation (25%). Histological examination showed increased vessel number and lumen dilatation after treatment in group B and reduction of rete ridge length in both groups with more prominent changes in group A. Tenascin C staining demarcated keloids from normal skin before therapy, while after therapy the entire treated tissue was labelled. Interferon-γ expression was significantly decreased after therapy both regarding positively stained cells and intensity in both groups. Conclusion: Cryosurgery without and with intralesional corticosteroids is effective and safe on young, small keloids not only as a destructive physical procedure, but also by inducing biochemical and immunological scar rejuvenation. [ABSTRACT FROM AUTHOR]

Aim: Highlighting the diagnostic complexity of skin ulcers. Method: We present a 31-year-old female patient who came to the ulcer unit of "Andreas Syggros" Hospital suffering from a festering necrotic ulcer that appeared a year earlier. She provided a previous punch biopsy result which was compatible with pyoderma gangrenosum. In accordance with the diagnosis, she was already treated with steroids, colchicine, and multiple antibiotics due to positive cultures for E. coli and Pseudomonas aeruginosa. These treatments had little or no response. Due to the atypical clinical presentation of a persistent ulcer and the later appearance of systemic symptoms, we proceeded to do a surgical wedge biopsy and an immunohistochemistry examination. Results / Discussion: The new biopsy was compatible with a diagnosis of T-cell non-Hodgkin lymphoma (ALK+ large cell lymphoma). Conclusion: In some cases, a punch biopsy may lead to a misdiagnosis, so it is useful to perform a surgical wedge biopsy. Physicians should therefore be alert when a skin lesion persists, because it may indicate the presence of a serious underlying systemic disease. [ABSTRACT FROM AUTHOR]

Chronic leg ulcers are a public health problem that can have a significant impact on the patient's physical, socioeconomic and psychological status. The aim of this study is to evaluate the quality of life, anxiety and depression, self-esteem and loneliness in patients suffering from leg ulcers. A total of 102 patients were enrolled in the study. The quality of life, anxiety and depression, self-esteem and loneliness of the patient were assessed using the Dermatology Life Quality Index ( DLQI), Hospital Anxiety and Depression Scale ( HADS), Rosenberg's Self-esteem Scale ( RSES) and the UCLA Loneliness Scale ( UCLA-Version 3), respectively. The mean DLQI score was 13·38 ± 2·59, suggesting a serious effect on the quality of life of patients. Those with leg ulcers had statistically significant higher scores according to the HADS-total scale ( P = 0·031) and HADS-anxiety subscale ( P = 0·015) compared with healthy volunteers. Moreover, a statistically significant difference was found between the two groups concerning the UCLA-scale ( P = 0·029). Female patients presented with a higher score of anxiety ( P = 0·027) and social isolation ( P = 0·048), and worse quality of life ( P = 0·018) than male patients. A severe quality of life impairment was documented, reflecting a significant psychosocial impact on patients with leg ulcers. [ABSTRACT FROM AUTHOR]