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Background Lichen planus-like keratosis (LPLK) or benign lichenoid keratosis is an involuting cutaneous entity where regressing features are the histologic hallmark. Most authors consider LPLK as an heterogeneous spectrum of intraepithelial epidermal or melanocytic lesions, mainly pigmented, involuting by inflammatory regression. Objective The authors review the clinico-histologic definition and correlate with the dermoscopic features of LPLK. Methods Sixteen LPLK were clinically distributed into three types: plaque-like (PL), flat erythematous (FE) and flat pigmented (FP) type and evaluated with conventional dermoscopy. Dermoscopic features of regression were recorded as the presence of blue-white structures and vascular structures. The predominant distribution, size and colour of pigmented granules were also recorded. All cases were excised and submitted to histopathologic examination and subdivided into three groups according to the early, classic and atrophic subtypes. Results The FP (44%) and the FE (37%) types are diagnosed more frequently than the PL type (19%). PL type correlates better with the classic type. FE correlates mainly with early/atrophic types, while the FP nearly exclusively with the late atrophic type. Regressive features are present in all but one case with a predominance of blue areas (94%). Localized (55%) and diffuse (37.5%) granular pattern are presenting in all but one case. The diffuse granular pattern correlates with the FP type (5/6 cases), while the localized granular pattern is mainly present (6/9 cases) in the FE type. Vascular structures can be found in half of the cases and white scar-like depigmentation is just present in four cases. BWS and vascular structures present together are observed in four cases (25%). Conclusions Our results show a large correlation among clinical, histologic and dermoscopic aspects of LPLK may be interpreted as a spectrum of cutaneous lesions going into inflammatory regression, showing different clinical and dermoscopic patterns according to the involuting stage. The early type of LPLK (FE) shows a localized granular pattern where regression is at the very early stage. The classic dermoscopic features of regressing lesion for LPLK (pigmented granular pattern) apply to the most frequent encountered pigmented atrophic flat type or classic pigmented type, where sometimes regression is advanced or almost complete and no clear diagnosis of a previous benign/malignant - epithelial or melanocytic lesion can often be given. Regressive dermoscopic features must be evaluated in the context of global and clinical pattern of the lesion. Nonetheless dermoscopy can close correlate with clinical incipient or complete regression and must prompt the need for eventual prophylactic surgical removal. [ABSTRACT FROM AUTHOR]

Background: For centuries, medicated baths have been one of the first lines of treatment for psoriasis. Even today, with sophisticated immunosuppressive treatments available, Dead Sea salts and spa waters are recognized to be beneficial in the management of psoriatic patients. Objective: To assess statistically the efficacy of sodium bicarbonate (NaHCO 3 - ) baths in psoriasis patients. Methods: Thirty-one patients with mild-moderate psoriasis were admitted to this study; Nineteen patients were treated with sodium bicarbonate baths and compared with twelve patients who were administered a placebo. Assessments were made on days 0 and 21. Results: Almost all patients who used NaHCO 3 - reported a statistically valuable improvement. NaHCO 3 - baths reduced itchiness and irritation; in general, the patients themselves recognized a beneficial impact on their psoriasis, so much so that they have continued to bathe in NaHCO 3 - even after the end of the study. Conclusion: We maintain that even with sophisticated immunosuppressive and highly specific anti-cytokine and anti-chemokines treatments available for the treatment of psoriasis, an older and often forgotten treatment can still play a role. [ABSTRACT FROM AUTHOR]

A 71-year-old white woman presented with an 8 month history of a slowly growing painless nodular subcutaneous mass of the left arm. Her past medical history was unremarkable except for a recent onset thrombocytosis. At the beginning she tried to manually extrude the “content” of the growing “cyst”. On examination teleangectatic skin overlying a subcutaneous roundish mass measuring 4 cm in diameter, poorly mobile and of elastic and lipomatous consistency was observed. The skin lesion was surgically removed and the histopathologic examination showed a diffuse infiltrating subcutaneous nodule characterized by a trabecular pattern composed of round to oval monomorphous cells with scant cytoplasm. The nuclei were large and vescicular, with multiple nucleoli. Numerous mitotic and atypical elements were present. Immunohistochemistry revealed diffuse positivity with chromogranin A, synaptophysin and anti-PGP 9.5. A sentinel lymph node biopsy was followed by a left axillary lymph node dissection and postoperative radiation therapy of the scar site in the left arm. After 11 months an osteomedullary biopsy showed a picture consistent with chronic lymphocytic leukaemia. The interest of the present case lies in the atypical clinical presenation of a Merkel cell carcinoma (MCC) and in the simultaneous association with a second neoplasia. Patients with chronic lymphocytic leukaemia (CCL) have a threefold risk of developing a second tumor, and this risk increases to eightfold when considering skin tumors only. In addition a high incidence of second neoplasms in MCC is also reported. Just a small number of cases of MCC arising in patients with CLL could be reviewed and the fact that this is more than coincidental remains to be established. [ABSTRACT FROM AUTHOR]

The authors describe a case of a 79-year-old man admitted to our Department for a three months lasting asymptomatic ecchymotic eruption involving the face, neck and shoulders. Laboratory investigations revealed: IgG=320 mg/dl (751–1550); hypoproteinemia with albumine level=5,50 g/dl (6,00–8,00); urinalysis showed proteinuria and urine immunoelectrophoresis revealed a monoclonal light chain component (k/l=1:3). Echocardiographic examination showed thickness of both left and right ventricular walls and pericardial effusion (consistent with thesaurismotic deposition). Chest X-ray revealed a right basilar nodular opacity. Abdominal CT scan showed hepatomegaly with multiple nodular lesions. An infiltrate of about 30% of atypical plasma cells was detected in the bone marrow aspirate. A cutaneous biopsy of an ecchymotic skin lesion revealed large depositions of amorphous material around the dermal dilated vessels associated with diffuse dermal red blood cell extravasation. Congo red staining showed a positive orange-brown reaction in the upper dermis, confirming the presence of perivascular amyloid deposition. A diagnosis of primary systemic amyloidosis associated with myeloma was done. The patient died two months later for heart failure. The term amyloidosis is referred to several diseases sharing an abnormal deposition of a fibrillar protein in several tissues. Clinically it can be classified into systemic and organ limited. The systemic amyloidosis can be further classified as primary idiopathic, primary multiple myeloma associated, secondary systemic and familial. Skin involvement is common in the primary systemic amyloidosis, but it rarely occurs in the secondary. Patients affected by primary amyloidosis associated with myeloma have a poor prognosis with a mean survival time of 13 months, which is lowered to 6 months when heart involvement occurs. [ABSTRACT FROM AUTHOR]

Summary We report a 22-year-old woman who developed systemic lupus erythematosus (SLE) immediately after an Epstein–Barr virus (EBV)-induced mononucleosis infection. The link between these two conditions has long been suspected. The close temporal relationship, the course of the pathological events and the development of immunological changes in this case provide further evidence supporting the hypothesis that EBV infection could work as a trigger in some cases of SLE, particularly if the patient is genetically susceptible. [ABSTRACT FROM AUTHOR]

Abstract Fatal calciphylaxis (CPX) occurred in two 71-year-old females both requiring haemodialysis for end-stage renal disease. Case 2 also had an associated follicular lymphoplasmocytoid lymphoma. Although laboratory tests disclosed normal coagulation parameters, this woman had a striking cutaneous histological picture of vessel thrombosis and finally died of disseminated intravascular coagulation. CPX is a rare but potentially life-threatening complication of renal failure. The clinical picture is primarily characterized by livedoid purpura with subsequent cutaneous ischaemia and painful ulcerations. Cutaneous ischaemic phenomena are sustained by a progressive process of vascular calcification and thrombosis involving small to medium size arteries of the dermis and subcutis. Although not yet clearly explained, the pathogenetic role of a predisposing hypercoagulability state is currently the most frequently considered hypothesis. [ABSTRACT FROM AUTHOR]

Atypical fibroxanthoma (AFX) is an uncommon, low-grade, malignant, spindle-cell tumour of fibrohistiocytic histogenesis, which can mimic other malignant skin tumours, such as basal and squamous cell carcinoma (CC), melanoma, and Merkel cell carcinoma (MCC). Three cases of AFX were examined by dermatoscopy, which revealed white areas and an atypical polymorphous vascular pattern characterized by the concurrence of different structures: linear, dotted, hairpin, arborescent and highly tortuous vessels, irregularly distributed over the surface. Seborrhoeic elements and photoageing may be accompanying features depending on the anatomical location of the AFX. AFX may be added to the list of slightly pigmented, reddish, malignant cutaneous tumours, such as SCC, MCC, amelanotic/hypomelanotic melanoma and eccrine porocarcinoma, which display prominent and chaotic dermatoscopic neoangiogenetic features in more advanced stages of proliferation. [ABSTRACT FROM AUTHOR]

In the literature no specific dermoscopic criteria have been described for the diagnosis of Bowen's disease (BD). To assess the morphological findings of BD seen under dermoscopic observation. Clinical and dermoscopic images of 14 patients affected by BD with various amount of pigmentation were obtained by means of Heine Dermaphot. Dermoscopic images were analysed by experienced observers applying the modified pattern analysis. The most frequently occurring dermoscopic features were found to be: multicomponent pattern (100%); atypical vascular structures (86.6%); absence of pigmented network (64.3%) or presence of pseudo-network (35.7%); irregular diffuse pigmentation or blotches of pigment (64.2%); irregularly distributed dots and globules (64.2%); focal/multifocal hypopigmentation (78.5%), scaly surface (64.2%) and haemorrages (26.6%). Dermoscopically, BD is mainly characterized by a multicomponent global pattern associated with a prominent vascular pattern (mainly dotted vessels) and a scaly surface. Although no specific dermoscopic criteria can be given for BD, epiluminescence can be a valuable aid in the diagnosis of such a mimicker lesion. [ABSTRACT FROM AUTHOR]

The article provides information on the east-west advancement flap process for nasal reconstruction. It states that the descriptive term refers to the prevalent horizontal movement of a tissue flap to close a defect, in order to prevent distortion of the surrounding structures. Meanwhile, the procedure requires reconstructing small to-medium defects located on the lateral supratip region of the dorsum of the nose.

A letter to the editor is presented in response to the article "Dermoscopical observation of Bowen's disease" that was published previously.

A letter to the editor which describes the performance of the comet flap under local anesthesia on 20 selected patients with reconstructive purposes after the removal of cutaneous malignancies is presented.

Presents a letter to the editor regarding birhombic transposition flap repairment.

A letter to the editor is presented which describes the development and pilot-testing of the Simple Psoriatic Arthritis Screening (SiPAS) questionnaire tool to screen psoriasis patients with psoriatic arthritis.

Background Excision of large tumours, particularly of the limbs, can be challenging because of problems related to wound repair. This is especially true of the lower legs, where skin is often tight and difficult to mobilize. Closure by flap, which would represent the first choice for defects usually between 12–15 mm to 38–40 mm diameter, is at risk of developing complications, such as end-flap necrosis or dehiscence due to skin tension. For larger defects, usually more than 40 to 45 mm diameter, grafting still remains the only realistic option in the majority of cases, with all the various problems associated with this procedure, such as lengthy healing times and the risk of developing leg ulcers, above all in elderly patients with impaired blood circulation. Second intention healing implies extraordinarily long healing times with often unacceptable delays in normal ambulation and activity. Objective To find an alternative to the usual repair techniques and to try to reduce the risk of complications. Conclusions We developed a relatively simple but effective technique for the closure of large wounds resulting from the excision of tumours. Our technique consists of two longitudinal, parallel, transposition flaps obtained from two opposite sides of the wound, with major axes orientated in the cephalic-caudal direction. The two flaps are then rotated around two fulcra placed at two extremes of the wound by approximately 90°. This relatively simple technique has never caused any of the ordinarily associated problems in terms of necrosis or ulcer development. In addition, dehiscence of sutures never occurred, given the fact that suture tension is minimal. Quick healing has resulted in the majority of cases, avoiding all the problems associated with grafting or other traditional flap techniques. [ABSTRACT FROM AUTHOR]

Thysanoptera dermatitis is caused by the bite of small (1–2 mm) insects (generally thrips). Thrips usually feed on the juices of vegetables but if they reach human skin they can suck the epidermal lymph after biting. The cutaneous lesions formed are small pink and itchy papules localized mainly on the trunk and the arms. Diagnosis is only possible by demonstrating that the insect is present inside one of the lesions of the skin. Thysanoptera dermatitis is often misdiagnosed as mosquito bites. Although self-resolving in a few days, Thysanoptera dermatitis should be known not only for the cultural and scientific training of the dermatologist but also to add more detailed diagnostic information to the generic diagnosis of ‘entomodermatosis’ and to confirm the benign evolution of the bites. [ABSTRACT FROM AUTHOR]