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In relation to the clinical presentation, the imaging results and histopathological examination, the sample were tested for orthopoxvirus DNA and cowpox virus, which were detected by polymerase chain reaction (PCR). Line-field confocal optical coherence tomography imaging of human cowpox virus skin infection I Editor i , Human cowpox is a rare zoonotic infection that evokes a self-limited disease, except for immunocompromised and eczematous patients, particularly children, where it can become a severe, even fatal infection.1 During the last decade, there has been an increasing number of reports on human cowpox infection in Europe.1 Cowpox virus (CPXV), genus orthopoxvirus, family Poxviridae, is a DNA virus with rodent reservoir being exclusively human pathogen. [Extracted from the article]

Onychomatricoma is a rare tumour that derives from the nail matrix and grows within the nail plate. The clinical presentation can mimic many other tumours and conditions, and surgical biopsy and histopathological examination are necessary to confirm the diagnosis. As nail surgery is a painful experience for the patient and sometimes can leave permanent onychodistrophy, more precise preoperative diagnosis is needed to distinguish onychomatricoma from other nail diseases more accurately and to limit surgical interventions. The objective of this study was to evaluate current literature on imaging techniques for the diagnosis of onychomatricoma in order to understand how this technology can help the presurgical diagnosis of this tumour. We searched in the Cochrane Skin Group Specialised library, Medline, Embase and LILACS databases all studies evaluating imaging technique for the diagnosis of onychomatricoma up to February 2018. We found that not only nail dermoscopy, but also reflectance confocal microscopy, optical coherence tomography, ultrasonography and magnetic resonance can be useful in this field. [ABSTRACT FROM AUTHOR]

Background Spontaneous regression of melanomas is relatively common, its prevalence ranging from 10 to 35%. However, regressing nevi can exhibit worrisome feature and simulate melanoma both clinically and dermoscopically. Thus, the presence of regression can represent a confounding factor. Objective To investigate the frequency of dermoscopic patterns of “regression” in a series of benign and malignant melanocytic skin lesions, and to design an integrated scoring system. Scoring classifiers are very effective in selecting the significant parameters for discriminating two clinical conditions, thus can rapidly calculate a patient’s risk for a given disease. Methods We selected a series of 95 regressing melanocytic lesions, including 50 regressing nevi and 45 melanomas with regression. For each lesion, 12 dermoscopic variables (i.e. five types of regression structures, five atypical pigmentation structures, atypical vascular pattern and pink areas) were examined by three expert in dermoscopy (blinded to the histological diagnosis). The dermoscopic evaluation was then combined with patient age, gender, body site and the maximum diameter of lesion. Concordance analysis with Cohen’s kappa was performed between the three clinicians. A risk scoring system was designed by the leave-one-out cross-validation procedure to ensure model prediction power. Results The predictive score model revealed a sensitivity of 97.8% and a specificity of 75.5% in discriminating nevi and melanomas with regression. Using the score model, the diagnostic performance of the examiners increased by an average of 23.7% in sensitivity and 5.9% in specificity, compared with standard dermoscopic pattern analysis. Conclusions We assessed the validity of an integrated risk scoring model as a new methodological approach that could help the dermatologist in the differentiation between melanoma with regression and regressing nevus. Future studies could test the setting up of a score model over an even more complex pool of data obtained from different skin lesions with various diagnostic devices. [ABSTRACT FROM AUTHOR]

Background Published studies on emergency dermatology consultations are few because there are few dermatology emergency units in the world. No study has yet described the Italian situation. Objectives To quantify and characterize patients evaluated in our dermatology emergency unit from 2006 to 2011. Methods We studied personal details, diagnosis, annual trend of cases, emergency level and hospitalization of dermatology cases over the 6-year period. Results A total of 12 226 patients were evaluated. The most numerous diagnostic group was infections (27.1%), followed by non-specific and descriptive diagnosis (22.5%), skin conditions caused by mechanical or physical agents (13.1%), eczematous diseases (10.5%), insect bites (9.5%) and urticaria/angio-oedema (8.8%). The most common indications for admission to hospital were skin conditions caused by mechanical or physical agents (33.3%), infections (27.5%), drug eruption (15.9%) and autoimmune or inflammatory disorders (7.4%). Emergency dermatology cases followed a variable annual trend, with more consultations in the summer months. Conclusion This is the first long-term retrospective analysis of a large series of dermatology emergency patients. It provides useful quantitative and qualitative information on cases for physicians and the national health system for the purposes of improving patient care and cost-effectiveness. [ABSTRACT FROM AUTHOR]

Background Extracorporeal photopheresis ( ECP) has been used successfully to treat severe steroid-refractory acute and chronic graft-versus-host disease ( aGVHD, cGVHD) since the late 1990s. Objectives To evaluate retrospectively the efficacy and safety of ECP in patients with aGVHD. We also assessed whether ECP may play a role in the prevention of cGVHD. Patients and methods Nine consecutive patients with allografts with aGVHD grade II-III, as defined by consensus criteria, and refractory to steroids, were treated with ECP. ECP was started at a median interval of 46·3 days (range 10-70) from aGVHD onset. Patients were treated initially on two consecutive days (one cycle) at 1-week intervals until improvement and then every 2 weeks. Treatment was then tapered off individually. To evaluate statistical relationships with outcome after 30, 60 and 90 days of ECP, all clinical and historical variables of the patients before treatment were analysed. Results All patients survived and responded within 90 days. The average aGVHD score was 1·72 at aGVHD onset, 2·44 when ECP was started and then gradually declined to 0·44 on day 90. At the same time, the average dose of methylprednisolone declined from 2·22 mg kg−1 to 0·27 mg kg−1 (day 90), while the average dose of ciclosporin declined from 2·46 mg kg−1 to 0·77 mg kg−1 (day 90). Six of nine patients showed a complete skin response after 90 days of treatment. All patients with liver and gastrointestinal tract involvement had complete responses after 90 days, apart from one patient. All our patients developed cGVHD, seven of nine while still on maintenance regimen (6-13 months after haematopoietic stem cell transplantation, HSCT) and the other two patients after suspension of ECP (6 and 9 months after HSCT). Conclusions ECP is effective in patients with mild to moderate steroid-refractory aGVHD (grade II-III). On the other hand, ECP did not prevent the development of cGVHD in our patients. [ABSTRACT FROM AUTHOR]

Background Many research groups have recently developed equipments and statistical methods enabling pattern classification of pigmented skin lesions. To differentiate between benign and malignant ones, the mathematical extraction of digital patterns together with the use of appropriate statistical approaches is a challenging task. Objective To design a simple scoring model that provides accurate classification of benign and malignant palmo-plantar pigmented skin lesions, by evaluation of parameters obtained by digital dermoscopy analysis (DDA). Patients and Methods In the present study we used a digital dermoscopy analyser to evaluate a series of 445 palmo-plantar melanocytic skin lesion images (25 melanomas 420 nevi). Area under the receiver operator curve, sensitivity and specificity were calculated to evaluate the diagnostic performance of our scoring model for the differentiation of benign and malignant palmo-plantar melanocytic lesions. Results Model performance reached a very high value (0.983). The DDA parameters selected by the model that proved statistically significant were: area, peripheral dark regions, total imbalance of colours, entropy, dark area and red and blue multicomponent. When all seven model variables were used in a multivariate mode, setting sensitivity at 100% to avoid false negatives, we estimated a minimum specificity of about 80%. Conclusions Simplicity of use and effectiveness of implementation are important requirements for the success of quantitative methods in routine clinical practice. Scoring systems meet these requirements. Their outcomes are accessible in real time without the use of any data processing system, thus allowing decisions to be made quickly and effectively. [ABSTRACT FROM AUTHOR]

Background Telemedicine could be useful in countries like Italy to meet the needs of elderly patients and in particular in those in precarious general conditions, for whom travelling even short distances can pose considerable practical and economical difficulties. Objective The aim of this study was to determine the efficacy of store-and-forward teledermatology vs face-to-face consultations in elderly patients. Methods A total of 130 geriatric patients with skin diseases requiring dermatological examination were enrolled. The patients examined, consisting of 60 men (46.15%) and 70 women (53.85%), were aged between 66 and 97 years (mean age 80.58 years). Three dermatologists of the department, with equal experience took turns in face-to-face examination and teledermatology ( store-and-forward). To compare face-to-face dermatological examinations with the asynchronous store-and-forward approach of teledermatology, we considered diagnostic agreement (ICD-9 code), therapeutic agreement and concordance of diagnostic confidence. Results One hundred and fourteen of 130 patients were diagnosed with the same ICD-9 code, making a total observed agreement of 87.7% with a Cohen's κ estimated of 0.863. Agreement between therapies was 69.6% (Cohen's κ = 0.640). As it concerns diagnostic confidence, dermatologists appeared generally slightly less certain of their diagnosis by telemedicine. Conclusions Store-and-forward teledermatology can improve diagnostic and therapeutic care for skin disease in elderly who lack easy and/or direct access to dermatologists. [ABSTRACT FROM AUTHOR]

Tacrolimus is a macrolide that inhibits T-cell activation. The most extensive experience with topical tacrolimus has been in treating atopic dermatitis but it has been used in various skin diseases, including Hailey–Hailey disease, with encouraging results. We report a case of extensive Darier's disease successfully treated with topical tacrolimus, after suspension of oral isotretrinoin due to major depression. [ABSTRACT FROM AUTHOR]

Recent studies suggest that extracorporeal photochemotherapy (ECP) may be beneficial in patients with steroid-refractory chronic graft- versus-host disease (cGvHD). However, it is not yet clear whether certain conditions, such as age, mode of onset of cGvHD etc., influence clinical response and whether certain affected organs are more sensitive to ECP than others. We analysed the main clinical and laboratory parameters related to evolution of the disease in 32 steroid-refractory cGvHD patients, to identify any useful response predictors to ECP. ECP affected the course of the disease positively in 78% (25/32) of our cases. [ABSTRACT FROM AUTHOR]

Chronic graft-versus-host disease (cGVHD) is a major complication of allogeneic bone marrow transplantation. Extracorporeal photopheresis (ECP) has recently been introduced as an alternative treatment for cases of cGVHD refractory to conventional immunosuppressive treatment, but its mechanism of action is not yet clear. To investigate in seven patients with cGVHD the effects of ECP on resistance of monocytes to apoptosis and on monocyte cytokine production. We designed an in vitro model that could mimic the potential in vivo effect of reinfusion of peripheral blood mononuclear cells treated by ECP. The model was based on coculture of ECP-treated lymphocytes with untreated monocytes from the same patient. ECP did not accelerate spontaneous apoptosis of monocytes. However, ECP-treated monocytes produced increased amounts of interleukin (IL)-12. In contrast, IL-12 production by monocytes did not increase in cocultures, but IL-10 production was upregulated. These results suggest that reinfusion of large numbers of autologous apoptotic lymphocytes is significant for the therapeutic outcome of ECP through upregulation of IL-10, which is an immunosuppressive cytokine. [ABSTRACT FROM AUTHOR]

Chronic graft-versus-host disease (cGVHD) is a severe and frequent complication of allogenic bone marrow transplantation which is often treated with extracorporeal photochemotherapy (ECP) with a positive clinical outcome in patients resistant to conventional protocols. The mechanism of action of ECP has not been fully elucidated, although several authors have reported that it is able to induce apoptosis. Using samples obtained from ten cGVHD patients, we sought to determine whether lymphocytes treated with ECP underwent apoptosis and, above all, the mechanisms involved. Lymphocytes at four stages were isolated: immediately before ECP, from the last buffy coat collected, after UV irradiation prior to reinfusion, and the day after ECP. When cultured for 48 h, lymphocytes treated with ECP underwent accelerated apoptosis (tested as annexin V binding cells and as intracellular histone-associated DNA fragments) in comparison with lymphocytes from the other samples. This enhanced programmed cell death could not be prevented by IL-2. Immediately after isolation, there was no difference in Bcl-2 or bax expression among the four different samples, or in Fas and FasL mRNA. However, when cultured, lymphocytes treated with ECP showed a rapid downregulation of Bcl-2, an upregulation of bax with an increased bax/Bcl-2 ratio, a decrease in bcl-2 mRNA and an increase in Fas. No changes were detectable in lymphocytes from the other samples. IL-2 and TNF-α production was not significantly different among lymphocytes from the four samples. In conclusion, in patients affected by cGVHD, ECP induced apoptosis of lymphocytes with the involvement of both the Fas/FasL system and the Bcl-2 protein family. [ABSTRACT FROM AUTHOR]

Summary Encephalocraniocutaneous lipomatosis, or Haberland syndrome, is a rare congenital neurocutaneous disease. It is characterized clinically by unilateral lipomatous hamartomata of the scalp, eyelid, and outer globe of the eye, ipsilateral porencephalic cysts with cortical atrophy, cranial asymmetry, marked developmental delay and mental retardation. This syndrome should be distinguished from other mosaic neurocutaneous phenotypes such as as Delleman syndrome, Schimmelpenning syndrome, Goltz syndrome, Goldenhar syndrome and Proteus syndrome. Here we report a case of Haberland syndrome with bilateral involvement which underscores the extreme heterogeneity of clinical presentation of this and related syndromes. [ABSTRACT FROM AUTHOR]

ABSTRACT Background Eosinophilic fasciitis (EF) is a rare connective tissue disorder characterized clinically by symmetrical swelling, induration and thickening of the skin and histologically by thickening of the fascia with chronic inflammatory infiltrate containing eosinophils. The disease is classified in the spectrum morphea/systemic sclerosis and treated with systemic steroids and other immunosuppressant drugs. Objective The purpose of this study was to use extracorporeal photochemotherapy (ECP) in patients with EF to evaluate the effectiveness of this therapy. Subjects and methods Three patients affected by EF were treated with ECP because they failed to respond or with contraindications to immunosuppressant treatment. The patients underwent ECP with a UVAR XTS apparatus. Subjects were treated on two consecutive days at 2-week intervals for the first 3 months and thereafter every 4 weeks on the basis of clinical response. The patients were assessed before therapy and then monthly by means of a clinical score. Changes in affected areas were evaluated at predetermined points by computerized skin elastometry (Cutometer SEM 474). Result After 1 year of therapy we found considerable improvement of clinical parameters in two cases. There was less striking improvement in the other case. These clinical results were confirmed by the elastometry measurements. All patients reported improved quality of life, which enabled a reduction in the dose of immunosuppressants. Conclusion ECP emerged as a safe and effective therapy in association with low doses of immunosuppressants in our three patients. A randomized comparative multicentre study between ECP as single therapy and ECP plus immunosuppressants and conventional therapies is required to firmly establish photopheresis as a possible basic treatment to combine with conventional therapies for EF. [ABSTRACT FROM AUTHOR]

ABSTRACT Background The term ‘common mole’, often used to describe a subset of benign pigmented skin lesions, is traditionally defined on the basis of morpho-chromatic features. In recent years, certain research groups have developed equipment and methods, such as digital dermoscopy analysis, that enable objective evaluation of pigmented skin lesions. Objective In this study we use a digital dermoscopy analyser trained for the recognition of pigmented skin lesions to compare the subjective definition of ‘common’ and the mathematical concept of ‘close to the mean of measurements’. Methods A subset (100) of digital images of flat pigmented lesions, obtained in daily practice, were classified by trained and non-expert clinicians as common moles (60) or clear-cut melanoma (40), and processed with a DB-Mips analyser. The resulting parameters, validated by a classifier, were used to evaluate Hotelling's T2 multivariate distances from the mean. Results Common’ moles could not be clearly defined in terms of closeness to the means of objectively evaluated parameters. Their diagnosis includes many other evaluations and clusters of variables. Conclusion The clinical semantics of the term ‘common’ does not conform to any unambiguous mathematical definition. [ABSTRACT FROM AUTHOR]

Focuses on a study which evaluated the utility of digital microscopy for analyzing atypical benign and malignant pigmented skin lesions exploiting digital numerical filtering and automatic measurements. Methodology of the study; Discussion of results; Advantage of the combined use of digital dermoscopy and stepwise logistic discriminant analysis.

Background: Line‐field confocal optical coherence tomography (LC‐OCT) is an emerging diagnostic tool with imaging depth reaching ~400 μm and a novel three‐dimensional (3D) cube providing cellular resolution. As far as we are aware, there are only a limited number of papers that have reported diagnostic criteria for melanocytic lesions using this technique, and none of them have been multicentric. Objectives: Our aim was to establish the diagnostic criteria for melanocytic lesions using LC‐OCT and identify the most significant architectural and cytologic features associated with malignancy. Methods: A retrospective evaluation of 80 consecutive melanocytic lesions from a prospective multicentric data set spanning three European centres was conducted. We excluded facial, acral and mucosal lesions from the study. Dermoscopic and LC‐OCT images were evaluated by a consensus of four observers. Multivariate logistic regression with backward elimination was employed. Results: The main melanoma diagnostic criteria include detecting >10 pagetoid cells in 3D acquisition, irregular 3D epidermal architecture, disrupted dermoepidermal junction (DEJ) and clefting. Significant risk factors were irregular 3D epidermal architecture, >10 pagetoid cells, dendritic cells at DEJ without underlying inflammation. Novel malignancy criteria in vertical view were DEJ disruption and clefting around atypical melanocyte nests. Exclusive melanoma features were epidermal nests, epidermal consumption, dense dermal nests with atypia. Protective features in the absence of any malignancy indicators were DEJ ring pattern, cobblestone, elongated rete ridges (vertical), well‐defined DEJ and wave pattern (vertical). Conclusions: A series of diagnostic criteria for the identification of melanocytic lesions with LC‐OCT have been established. Validation of these criteria in clinical practice through future studies is essential to further establish their utility. [ABSTRACT FROM AUTHOR]

Extracorporeal photochemotherapy (ECP) has been shown to be a potent activator of peripheral blood macrophages because it causes a marked release of macrophage-dependent proinflammatory cytokines, and it is therefore currently considered to be a safe and non-toxic immunomodulatory treatment. On this basis we studied the function of peripheral blood mononuclear cells (PBMC) in eight patients with early stage (Ib) cutaneous T-cell lymphoma (CTCL), before and I year after ECP, together with their clinical and histological responses. In particular we evaluated in vitro phytohaemagglutinin (PHA)-stimulated proliferation and production of interleukin-4 (IL-4) and interferon-γ (IFN-γ) as well as lipoopolysaccharide (LPS)-induced production of IL-12. Before treatment we observed that PBMC of patients produced significantly higher levels of IL-4 and lower levels of IFN-γ and IL-12 than those of healthy control subjects. After 1 year of ECP, IL-4, IFN-γ and IL-12 production no longer differed from that of control subjects. Moreover, we observed a good clinical result matched by histological response. Our data confirm that earlystage CTCL patients show a predominantly type-2 immune response that might be responsible for several immunological abnormalities found in this disease. We have demonstrated that ECP reverses the T-helper type 1/T-helper type 2 (Th1/Th2) imbalance and may therefore be considered an efficient biological response modifier. [ABSTRACT FROM AUTHOR]

The article presents a study on the possible role of extracorporeal photochemotherapy (ECP) in the long term treatment of the disease in patients with severe chronic atopic dermatitis (SAD) recalcitrant to traditional therapies for more than 6 months. The study used Declaration of Helsinki principles for clinical investigation. It confirms that ECP can be a safe, effective treatment in patients with SAD resistant to previous therapies.

Defibrotide is a drug with an interesting spectrum of pharmacological properties that make it useful for the treatment of arterial and venous thrombotic diseases. These properties include profibrinolytic, antithrombotic -- thrombolytic, anti-ischaemic and antiatherosclerotic activity, as well as protective activity in shock. Like low molecular weight heparins, it also seems to have anti-inflammatory properties. Authors report a 73-year-old man with disseminated granuloma annulare (GA) treated with defibrotide. The lesions had appeared 2 months earlier on the neck and nape of the neck, spreading slowly to the scalp, trunk, back and arms. The patient complained of moderate pruritus. His family history was negative for similar skin diseases and diabetes mellitus. The patient's previous medical history included chronic autoimmune gastritis and deep vein thrombosis of the lower limbs. Skin examination showed large plaques of dermatitis, predominantly on the nape of the neck, back, chest and extensor surface of the arms.

Multiple minute digitate hyperkeratosis (MMDH) is a skin disease of unknown aetiology characterized clinically by multiple minute asymptomatic keratotic lesions with spiky horny projections. The disorder has been classified into early (congenital) and late (acquired) onset forms, the latter occurring as a presenting sign of concomitant inflammatory, metabolic or malignant disease. Here we report two cases of late onset MMDH without any associated pathology. These cases emphasize that some cases of late-onset MMDH may be idiopathic. [ABSTRACT FROM AUTHOR]

Linked article: This article is commented on by S. Caius Silviu et al., pp. e396–e397 in this issue. To view this article visit https://doi.org/10.1111/jdv.15083 [ABSTRACT FROM AUTHOR]

Psoriasis, a chronic inflammatory condition, often presents challenges in treatment, particularly in areas such as nails, palms/soles, scalp/face, and genitalia. Monoclonal antibodies (mAb) like risankizumab targeting interleukin-23 (IL-23) have emerged as promising treatments, yet data on long-term efficacy remain limited. This multicenter retrospective study aimed to evaluate the drug survival at 12 and 36 months of 191 psoriasis patients treated with risankizumab, focusing on critical areas. Patients, previously unresponsive to first-line therapies, were treated according to Italian Guidelines. Survival analysis revealed a 97.6% one-year and 95% three-year drug survival rate. Secondary ineffectiveness was the primary reason for discontinuation, particularly in palmoplantar involvement cases. Factors such as BMI, gender, age, disease duration, baseline severity, and previous biologic exposure did not significantly impact drug survival, except for palmoplantar psoriasis (HR 4.72). Risankizumab demonstrated prolonged response with low treatment switch requirements, especially notable in challenging areas. Understanding such factors can aid in optimizing therapeutic approaches for improved patient care and long-term outcomes in managing psoriasis. Further research is warranted to refine treatment strategies in difficult-to-treat areas. [ABSTRACT FROM AUTHOR]

Background: Early melanoma detection is the main factor affecting prognosis and survival. For that reason, non‐invasive technologies have been developed to provide a more accurate diagnosis. Recently, line‐field confocal optical coherence tomography (LC‐OCT) was developed to provide an in vivo, imaging device, with deep penetration and cellular resolution in three dimensions. Combining the advantages of conventional OCT and reflectance confocal microscopy, this tool seems to be particularly suitable for melanocytic lesions. Objectives: The objective of this study was to identify and describe the correlation between specific dermoscopic criteria and LC‐OCT features in three dimensions associated with melanocytic lesions. Methods: Dermoscopic and LC‐OCT images of 126 melanocytic lesions were acquired in three different centres. The following dermoscopic criteria have been considered: reticular pattern, dots and globules, structureless areas, blue‐whitish veil, regression structures, negative network, homogeneous pattern, streaks and blotches. Results: 69 (55%) benign and 57 (45%) malignant lesions were analysed. A regular reticular pattern was found associated in the 75% of the cases with the presence of elongated rete ridges with pigmented cells along the basal layer, while atypical reticular pattern showed an irregular organization of rete ridges with melanocytic hyperplasia, broadened and fused ridges and elongated nests. Both typical and atypical dots and globules were found associated with melanocytic nests in the dermis or at the dermoepidermal junction (DEJ), as well as with keratin cysts/pseudocysts. Grey globules corresponded to the presence of melanin‐containing dermal inflammatory cells (melanophages) within the papillae. Structureless brown/black areas correlated with alterations of the DEJ. We observed the same DEJ alterations, but with the presence of dermal melanophages, in 36% of the cases of blue/white/grey structureless areas. A description of each LC‐OCT/dermoscopy correlation was made. Conclusions: LC‐OCT permitted for the first time to perform an in vivo, 3D correlation between dermoscopic criteria and pathological‐like features of melanocytic lesions. [ABSTRACT FROM AUTHOR]

Presents a letter to the editor on the histological examination of the skin disease acrokeratoelastoidosis.

A commentary on an article on the implementation of dermoscopy using fluorescence for the diagnosis of melanoma is presented.

Background: Line‐field confocal optical coherence tomography (LC‐OCT) is a new, valid means for a rapid and non‐invasive in vivo examination of the epidermis and upper dermis, allowing digital interpretation and measurement of high‐resolution images on a cellular level. Given these properties, it may represent a valid tool for monitoring psoriasis during treatment, allowing a new method to set a precise objective severity of the disease. Objectives: We aimed to investigate the potentialities of LC‐OCT in the non‐invasive monitoring of microscopical changes associated with moderate–severe plaque psoriasis (PP) during the treatment with the most common biological drugs. Materials and Methods: We performed LC‐OCT imaging of PP lesions from 17 patients before and after 8 weeks of treatment. The clinical severity of the single lesions was evaluated using a lesion score (LS), designed considering three parameters: erythema, desquamation and infiltration. LC‐OCT images were segmented by artificial intelligence and evaluated based on three microscopic criteria: the thickness of the stratum corneum, the thickness of the living epidermis and the undulation of the dermo‐epidermal junction. Results: Line‐field confocal optical coherence tomography digital analysis allowed recognition and quantification of the three microscopic criteria, showing a reduction of all these during the follow‐up. Furthermore, a high correlation between change in LS and the thickness of the stratum corneum and the thickness of the living epidermis was found. Conclusion: Line‐field confocal optical coherence tomography can non‐invasively monitor the response of PP to different treatments. Morphometric changes occurring in the psoriatic lesion during the 8‐week treatment period were identified by in vivo LC‐OCT and measured by using artificial intelligence. Although future studies are required, based on these preliminary results, LC‐OCT may represent a valid potential tool for precise monitoring of therapeutic response. [ABSTRACT FROM AUTHOR]

The article presents a case study of a 75-year-old woman having erythrodermic dermatitis related to eruptive seborrhoeic warts on the face and trunk. Computed tomography of the abdomen and chest revealed a solid mass measuring 23X19 millimeter (mm) located in the left renal cortex. A renal needle biopsy was conducted and histopathological examination revealed renal angiosarcoma.

The article presents a case study of a 13-year-old boy with history of asymptomatic, yellowish-brown papule on the trunk. Clinical findings revealed the presence of circumscribed dermal nodules of intensely eosinophilic histiocytes with glassy cytoplasm and the diagnosis shows solitary reticulohistiocytoma (SRH). It states that SRH is different from multicentric reticulohistiocytomas in the immunophenotypical result affected by granuloma, epithelioid sarcoma and juvenile xanthogranuloma.

The article describes a case of halo melanoma in 35-year-old male patient. The patient presented with a history of achromic halo around a pigmented skin lesion (PSL) on the abdomen and has many naevi on various parts of his body. Physical examination of the patient showed a notably black PSL with irregular borders, surround by a uniform, virtligo-like halo. On dermatoscopy, asymmetry and a pronounced but poorly defined pigmented reticulum and coarse peripheral pseudopods were observed.

The authors report a case of bullous tinea pedis caused by Trichophyton violaceum with dermatophytid reaction in a 26-year-old woman who had been in Africa. Diagnosis was based on mycological examination (direct microscope observation and culture). Recovery was achieved after systemic antimycotic therapy with itraconazole and topical imidazole for a month. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented in response to an article related to dermatology published in a previous issue of the periodical.

Presents a letter to the editor describing the successful treatment of erythema annulare centrifugum with metronidazole.

Reports on the use of extracorporeal photochemotherapy (ECP) for the treatment of fasciitis in chronic graft-versus-host disease (cGVHD). Characterization of cGVHD and its manifestation, fasciitis; Details of treatment with ECP on a patient with diagnosis of cGVHD associated fasciitis; Improvement in fasciitis with ECP alongside immunosuppressive therapy; Consolidation of ECP as a treatment for visceral and cutaneous involvement in chronic GVHD with promising results for cGVHD fasciitis.

Discusses a case of an 18 year old man diagnosed with reticular erythematous mucinosis (REM) with initial signs of hydroxochloroquine related retinopathy. Determination of the topical tacrolimus suitability on REM; Medical history; Failure of hydroxychloroquine sulphate to improve clinical condition; Tacrolimus effectiveness; Design of the drug to affect cells blocking calcineurin which activates cytokine genes.

Discusses the case of a 68-year-old presenting with a nodule in the umbilicus at week 12 of pregnancy. Eosin-stained biopsy; Disease background of umbilical endometriosis; Comparison with other forms of endometriosis.

Examines the dissociation of human herpesvirus type eight with pyogenic granulomas with satellite recurrence. Amplification of viral sequences by polymerase chain reaction (PCR); Use of proteinase inactivation and centrifugation for PCR; Causes of systemic vascular proliferations.

Scale bar = 100 m. Tumour lobule, defined under LC-OCT as roundish, elongated and hemispheric tumour island corresponds to RCM bright tumour island or dark silhouette. Dear Editor, Reflectance confocal microscopy (RCM) and line-field confocal optical coherence tomography (LC-OCT) are non-invasive imaging techniques that can help the clinical diagnosis of basal cell carcinoma (BCC).[[1], [3], [5]] Although LC-OCT and RCM have been compared for the identification of squamous cell carcinomas,[4] no comparative studies on BCC diagnostic criteria are available. Our results confirm that both RCM and LC-OCT can help in the non-invasive identification of BCC with an excellent agreement for the presence of tumour lobules in all of their characterizations. [Extracted from the article]

In the present study, we tested a new device called skin phototype diagnosis (SPD) built for the purpose of objectively determining skin phototype. We compared its performance with that of phototype determinations according to Fitzpatrick method and on tristimulus colorimetry (Minolta CR-200). Our population consisted of 100 subjects of Caucasian race (60 female, 40 male; mean age 33 years). Skin colour was measured with both devices (SPD and Minolta CR-200) on the medial surface of the arm (constitutional skin colour). Our study showed that the SPD gave a better representation of Fitzpatrick phototype, showing 89% concordance (evaluated by classification matrix) as against the 71% concordance of the L * a * b * and Yxy colorimetric systems. The present results are important because evaluation of phototype with the SPD device is easy, fast, objective and reliable. Moreover, this instrument has potential applications in cosmetology and in photodermatology. [ABSTRACT FROM AUTHOR]

This article discusses the use of line-field confocal optical coherence tomography (LC-OCT) in diagnosing graphite tattoos. Graphite tattoos are exogenous lesions that occur when graphite from a pencil penetrates the skin or mucosa. The diagnosis of graphite tattoos is typically based on patient history and clinical examination, but LC-OCT can provide additional information by showing hyper-reflective particles in the mid dermis. This non-invasive imaging technique could be a useful tool in identifying graphite tattoos, particularly in children, and reducing the need for invasive procedures. [Extracted from the article]

Background: 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. Objectives: 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. Materials and Methods: 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. Results: 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. Conclusions: 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. [ABSTRACT FROM AUTHOR]

Background: 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. Objective: The goal of the present study was to identify/describe LC‐OCT criteria of BSC. Methods: 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. Results: 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. Conclusion: 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. [ABSTRACT FROM AUTHOR]

Rituximab is a human/murine monoclonal antibody targeting the CD20 antigen on B-lymphocytes surface. Although it has been licensed for treatment of non-Hodgkin's lymphoma, nowadays it is also a novel therapy for autoimmune diseases, such as rheumatoid arthritis and systemic lupus erythematosus. Despite the increasing evidence regarding the safety and efficacy of rituximab in these conditions, many cutaneous adverse events have been reported. Here, we describe the case of a 69-year-old patient, affected by rheumatoid arthritis, who developed psoriatic lesions on her trunk and arms, three months after the second course of rituximab. Similar cases appearing in the literature will also be briefly mentioned. [ABSTRACT FROM AUTHOR]

We read with interest the article by Solimani I et al i ,1 who reported a case of pemphigus vulgaris developed 5 days after the first administration of SARS-CoV-2 vaccination with the mRNA vaccine BNT162b2 (Comirnaty", Biontech/Pfizer). Reply to 'development of severe pemphigus vulgaris following SARS-CoV-2 vaccination with BNT162b2' by Solimani F et al References 1 Solimani F, Mansour Y, Didona D, Dilling A, Ghoreschi K, Meier K. Development of severe pemphigus vulgaris following SARS-CoV-2 vaccination with BNT162b2. [Extracted from the article]

The article presents a case study of a healthy 62-year-old man presented with a moderate burning sensation in the mouth and a 6-month history of glossitis. It is stated that with a thick, yellowish- white, nonremovable coating on the dorsal, lateral and ventral sides, the tongue was found to have a cobblestone appearance on physical examintion.

Background CD4+CD25+FOXP3+ regulatory T cells (Tregs) are thought to induce immunotolerance in melanoma. They have not yet been investigated in the entire spectrum of melanocytic cutaneous lesions within a tumour site. Objectives To evaluate CD4+CD25+FOXP3+ Tregs among tumour-infiltrating lymphocytes in cutaneous melanocytic lesions. Methods We analysed 128 lesions (10 benign junctional common naevi, 10 benign compound common naevi, 10 compound Spitz naevi, 10 junctional atypical naevi, 20 compound atypical naevi, 20 radial growth phase melanomas, 30 vertical growth phase melanomas and 18 melanoma metastases). Tregs were identified by CD25-FOXP3 double immunostains. Results This study indicates that CD4+/CD25+FOXP3+ Tregs are present in all groups of lesions. Junctional atypical naevi, compound atypical naevi and radial growth phase melanomas showed the highest percentages of CD4+CD25+FOXP3+ Tregs (junctional atypical naevi vs. junctional common naevi, compound common naevi, compound Spitz naevi, melanoma metastases: P < 0·0001; junctional atypical naevi vs. vertical growth phase melanomas: P = 0·001; compound atypical naevi vs. junctional common naevi, compound common naevi: P < 0·0001; compound atypical naevi vs. compound Spitz naevi, melanoma metastases: P = 0·002; compound atypical naevi vs. vertical growth phase melanomas: P = 0·02; radial growth phase melanomas vs. junctional common naevi, compound common naevi, compound Spitz naevi, melanoma metastases: P < 0·0001; radial growth phase melanomas vs. vertical growth phase melanomas: P = 0·008). Conclusions The strong prevalence of CD25+FOXP3+ Tregs both in junctional andcompound atypical naevi and radial growth phase melanomas, suggests that they induce immunotolerance early during melanoma genesis, favouring melanoma growth. Their evaluation within a tumour site could be useful for prognostic and therapeutic purposes. [ABSTRACT FROM AUTHOR]

.ASA-Chronic graft-versus-host disease (GvHD) affects 50% of long-term bone marrow transplant survivors and remains a cause of major long-term morbidity in these patients despite aggressive therapy. Extracorporeal photochemotherapy (ECP), considered as an effective treatment for patients with erythrodermic cutaneous T-cell lymphoma (CTCL), has recently been used successfully in the treatment of GvHD. One of the most intriguing aspects of ECP is its ability to induce two apparently opposite effects: activation of the immune system against neoplastic cells (as in CTCL) and downregulation of the activity of T-cell clones in autoimmune diseases (as in systemic sclerosis, systemic lupus erythematosus and pemphigus vulgaris) and autoallogeneic immune responses (as in GvHD and allograft rejection). Only a better and more complete understanding of the various mechanisms involved will enable this interesting new therapy to be made more effective and selective. [ABSTRACT FROM AUTHOR]

Summary: Background: Early and accurate diagnosis of cutaneous squamous cell carcinomas (SCCs) and actinic keratoses (AK) is fundamental to reduce their associated morbidity and to select the correct treatment. Line‐field confocal optical coherence tomography (LC‐OCT) is a new imaging device that can characterize healthy skin and basal cell carcinoma, but no large studies on keratinocyte cell tumours have yet been published. Aim: To identify and describe LC‐OCT criteria associated with SCC and AK, and to compare LC‐OCT findings in these tumours. Methods: A retrospective observational multicentre study was conducted. Lesions were imaged with the LC‐OCT device before surgery and examined histologically. LC‐OCT criteria for AK/SCC were identified and their presence was evaluated in all study lesions. Univariate and multivariate analyses were performed to compare AK and SCCs, and to investigate differences between in situ and invasive tumours. Results: In total, 158 patients with 50 AK and 108 SCCs (62 in situ and 46 invasive) were included. Cytological and architectural alterations were found in most lesions, and differences were found between AK and SCCs. Although the visualization of the dermoepidermal junction (DEJ) was often hampered by hyperkeratosis and acanthosis, an outlined DEJ without broad strands was observed in almost all AK and almost all in situ SCCs, but in only three invasive SCCs (P < 0.001) when the DEJ was detectable. Conclusion: Our results suggest that LC‐OCT can help clinicians in the identification of AK and SCC and their differentiation, providing a real‐time and noninvasive examination. Further studies are needed to confirm our data. [ABSTRACT FROM AUTHOR]