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Abstract Polypoid melanoma is a variant of nodular melanoma, whose poor prognosis depends on its thickness and the presence of ulceration at the time of diagnosis. The authors report two cases of polypoid melanoma, presenting as broad, cauliflower-like, polypoid masses. Dermoscopy was characterized by a multicolored pattern, atypical polymorphic vessels, and the fiber sign. Clinical and dermoscopic features can help to diagnose polypoid melanoma and exclude other possible differential diagnoses. However, histology remains mandatory to confirm the diagnostic suspicion.

Background: Actinic keratosis (AK) is a form of premalignant keratinocyte dysplasia. Recently, the role of photosensitizing drugs in the development of AK has been postulated. Objective: This study evaluated a possible association between the use of photosensitizing drugs and the development of AK. A secondary aim was to identify a possible association between any medication other than those primarily examined and AK. Methods: A single-center, case-control study assessed the cumulative drug exposure of 90 patients with AK and 90 controls visiting a dermatology service for other skin ailments. Before the visit, patients were interviewed to collect data on daily therapy and the lag-time of discontinued drugs within the last 2 years, and to record the drug’s active ingredient, dosage, and duration of therapy. In addition, sociodemographic characteristics including age, sex, educational level, skin phototype, and cumulative sun exposure habits were gathered. Results: By logistic regression, exposures to angiotensin II receptor blockers (ARBs) and antiplatelet agents were identified as independent risk factors for the development of AK. ARB intake was associated with AK only at high exposure (OR = 13.6; 95% CI, 2.0-93.8). The use of antiplatelet drugs was borderline, yet not significant, at low exposure (OR = 3.31; 95% CI, 0.86-12.7), but increased in a dose-dependent manner. The strongest correlation was found at the highest cumulative dose (>1100 dose unit-years (OR = 4.38; 95% CI, 1.16-16.6). Conclusions: High exposure to ARBs and antiplatelet agents may promote AK carcinogenesis in at-risk patients.

Abstract Koebner phenomenon regards the formation of a psoriatic lesion after a trauma, including tattoo, insect bite or other injuries. Although this manifestation is not specific for psoriasis, physicians should be aware because early recognition may be helpful in making the diagnosis when present.

Byline: Miriam. Leuzzi, Andrea. Sechi, Federica. Filippi, Ambra. Di Altobrando, Carlotta. Gurioli, Iria. Neri Sir, Infantile hemangioma (IH) with minimal or arrested growth (MAG) is a variant of IH increasingly [...]

Thanks to their specificity of action, biologic drugs often lead to complete clearance of psoriatic lesions. In order to maintain its effectiveness, biological therapies cannot be discontinued. The aim of the study was to investigate the effect of widening the administration window of four biologic drugs, thus improving the quality of life of psoriatic patients and satisfying their desire to feel free from the disease, without loss of effectiveness. We performed a multicentric cohort study considering patients with moderate-severe plaque psoriasis and/or arthropathic psoriasis treated with infliximab, adalimumab, etanercept or ustekinumab. The study group included patients with stabilized psoriasis in which the administration regimen of the biologic drug was deferred. The control group included psoriatic patients treated according the product monograph. The percentage of relapses in case of deferred administration intervals was comparable to that of standard administration intervals. The delayed administration modality got a good psychological consensus from the patients themselves, that reported a greater 'perceived satisfaction'. A consistent economic advantage was reported in case of prolonged administration intervals. The administration of biologic drugs with prolonged intervals maintains the same effectiveness as standard administration and produces a 'perceived satisfaction' in psoriatic patients. [ABSTRACT FROM AUTHOR]

The non‐invasive examination of the nail unit using a dermoscope is known as onychoscopy. This technique has become increasingly appreciated to facilitate the clinical diagnosis of nail disorders, opening up a valuable second front with a potential to avoid invasive diagnostic procedures. During a nail consultation, the nail unit should always be examined with the aid of a dermatoscope in all its components. The aim of this paper was to provide practical information about onychoscopy of the nail plate free edge and hyponychium, two components of the nail unit difficult to evaluate at naked eye and often forgotten, but of paramount importance. [ABSTRACT FROM AUTHOR]

Autoimmune bullous diseases are a heterogeneous group of diseases characterized by the development of cutaneous and mucosal vesicles, blisters, and finally erosions. The common pathogenetic mechanism is the presence of autoantibodies targeting structural proteins of the skin and mucous membranes (demosomes and hemidesmosomes): in the case of pemphigus, the antigens are intraepidermal, whereas in the case of pemphigoid, dermatitis herpetiformis, and epidermolysis bullosa acquisita they are subepidermal. Mucosal involvement typically affects the oral and ocular mucosa, but in some cases, the upper airways or the upper digestive tract are affected. The burden on patients' lives could be severe due to the impairment of normal feeding or breathing. In other cases, they may represent paraneoplastic syndromes. Since autoimmune bullous diseases may result in significant morbidity and mortality, depending on the grade of cutaneous and mucosal involvement, a prompt therapeutic approach is mandatory and, in recalcitrant cases, may be challenging. The first line therapy consists of corticosteroids, both topical and systemic. Once remission or control of the acute phase is obtained, adjuvant therapies need to be introduced in order to spare the corticosteroid load and minimize side effects such as iatrogenic diabetes or osteoporosis. Herein, we describe all current therapeutic approaches to autoimmune bullous diseases, also including emerging therapies. [ABSTRACT FROM AUTHOR]

Leishmaniasis is emerging as an important problem in immunosuppressed individuals, leading to overt clinical disease, atypical presentation, chronic course, and impaired treatment response. Moreover, it can affect unexposed regions and strikingly mimic other infectious disorders and a variety of neoplastic diseases, thus being easily misdiagnosed. Here, we report the case of an HIV-patient where both clinical picture and histopathological findings were consistent with mucosal leishmaniasis (ML). However, the worsening of the clinical picture after anti-leishmania treatment led to suspect a different diagnosis, and squamous cell carcinoma superimposed on ML and Human Papilloma Virus infection was ultimately diagnosed. [ABSTRACT FROM AUTHOR]

Rituximab, a chimeric monoclonal antibody that targets the CD-20 molecule on B-cells' surface, has led to significant advances in the treatment of autoimmune pemphigus in recent decades. The aim of the study was to assess the clinical efficacy as well as safety data for biosimilar rituximab with emphasis on the treatment of pemphigus vulgaris. A total of 12 individuals with pemphigus vulgaris treated with biosimilar rituximab were followed for at least 1 year. We assessed patient characteristics, disease history, pemphigus disease area index (PDAI) score, anti-desmoglein (Dsg)1 and anti-Dsg3 antibody level, clinical response, and any adverse events during each clinical follow-up visit. We also recorded time to achieve complete remission, duration of complete remission and time to relapse. A consistent decrease in the PDAI score was observed (p<.0001), as well as a significant decrease of anti-Dsg3 values. In addition, the clinical response of this population confirmed that the equivalent is not inferior to Rituximab (p=.521). The introduction or the switch to Rixathon, a rituximab biosimilar, appears to be safe and may provide an opportunity to reduce health system costs because of its similarity to the reference drug in terms of safety and efficacy. [ABSTRACT FROM AUTHOR]

Given the current lack of a therapeutic vaccine for coronavirus disease 2019 (COVID‐19), preventive measures including mask wearing are crucial in slowing the transmission of cases. However, prolonged wearing of protective respirators, medical and fabric masks can easily generate excessive sweating, moisture and friction. Closed and warm environments heighten the skin's permeability and sensitivity to physical or chemical irritants, leading to chronic cumulative irritant contact dermatitis or, rarely, even allergic contact dermatitis. Although not representing a life‐threatening condition, contact dermatitis can have a significant impact on emergency management, as it is potentially able to reduce work performance and create emotional discomfort due to the involvement of evident body areas. To minimize the skin breakdown, adherence to standards on wearing protective and safe equipments and avoidance of overprotection should be performed. At the same time, some measures of skin care are recommended. Here, we offer some tips on how to prevent and manage contact dermatitis due to masks not only in health care workers, but also in the general population during this COVID‐19 outbreak. [ABSTRACT FROM AUTHOR]

This article presents the case of a non-HIV-positive patient who contemporaneously suffered from Kaposi's sarcoma and bullous pemphigoid. Kaposi's sarcoma is a rare low-grade vascular tumour associated with human herpes virus 8 infection, while bullous pemphigoid is the most common autoimmune subepidermal blistering disease in western countries. [ABSTRACT FROM AUTHOR]

Melorheostosis (MEL) is a rare benign bone disorder that can be associated with several anomalies, including vascular abnormalities, nevus sebaceus, unilateral nevoid telangiectasia, linear scleroderma and hypertrichosis. We report the case of a 6‐year‐old patient who showed an unusual co‐occurrence of bone hyperostosis and different skin lesions affecting the same side of the body: MEL, verrucous epidermal nevus, connective tissue nevus, linear scleroderma‐like disorder, hyperpigmentation and hypertrichosis. The spatial co‐occurrence of these conditions made us speculate as to whether they originated from a common genetic mechanism or if their co‐occurrence was completely accidental. [ABSTRACT FROM AUTHOR]

In this article, we report the sonographic features of vaccination granulomas in three children sensitized to aluminum. Although the recognition of the vaccination granuloma relies on the clinical examination, misdiagnosis is frequent, leading to distressful procedures or prolonged antibiotic administration. In all our cases, sonography revealed a teardrop‐shaped echogenic central structure, suggesting the deposition of aluminum crystals along the route of administration with consequent subcutaneous degenerative changes, and a surrounding hypoechoic cap, which reflects the changeable inflammatory reaction and the granuloma formation. [ABSTRACT FROM AUTHOR]

Readings on day (D)2 and D4 showed positive reactions to nickel sulfate 5%, tioconazole 1%, and tioconazole 28% nail lacquer "as is" (Figure 2). Keywords: allergic contact dermatitis; case report | fluconazole; tioconazole EN allergic contact dermatitis case report | fluconazole tioconazole 354 356 3 04/07/21 20210501 NES 210501 First-line therapy for both topical and systemic mycosis includes azoles. GLO:FQV/01may21:cod13748-fig-0001.jpg PHOTO (COLOR): 1 Pruriginous cutaneous rash extended to the lower limbs after tioconazole-medicated nail solution and tioconazole cream application and fluconazole systemic assumption gl The patient had no previous history of allergy. [Extracted from the article]

2 Poddighe D, Bruni P. Mycoplasma pneumoniae -induced rash and mucositis (MIRM): an unusual mild skin rash associated with severe mucosal involvement. I Mycoplasma pneumoniae i -induced rash and mucositis (MIRM), proposed as a unique entity apart from erythema multiforme (EM), Steven-Johnson Syndrome (SJS) and toxic epidermal necrolysis (TEN) by Canavan I et al i . in 2015, follows a less severe course and is associated with less morbidity and mortality.1,2 In SJS and TEN, widespread, confluent skin lesions, positive Nikolsky sign and significant epidermal detachment are present.3 In MIRM, mucositis, especially oral, is nearly universal (94%) and predominant over a less marked or absent cutaneous involvement.1,4 It is a major cause of morbidity, may lead to multiple confluent erosions, haemorrhagic crusting and sparse vesiculobullous perilabial eruptions and, rarely, to sequelae such as mucosal synechiae and pigmentary changes. Differently from EM-spectrum disease, lip enlargement in MIRM is persistent and can lead to a swelling of the vermilion borders with a "duck-like lips" appearance, which may be a clue to suspect MIRM in children and to timely begin appropriate treatment strategies. [Extracted from the article]

Congenital fibrous hamartoma of the tip of the tongue, a peculiar and novel entity, consists of one or two asymptomatic pearly or yellowish nodules, not exceeding 0.5 cm in maximum diameter, at the tip of the tongue, ventrally or dorsally. Unlike other localizations, congenital fibrous hamartoma of the tip of the tongue is not associated with cleft lip or palate, or with feeding problems. Surgical excision should be avoided, reserved only for dubious cases, since the lesions are benign and stable over time. [ABSTRACT FROM AUTHOR]

Allergic contact dermatitis to braces containing 4,4'-diaminodiphenylmethane, a previously unreported causative agent Keywords: allergic contact dermatitis; brace; case report; diaminodiphenylmethane; orthopedic support EN allergic contact dermatitis brace case report diaminodiphenylmethane orthopedic support 157 159 3 07/27/20 20200801 NES 200801 4,4'-Diaminodiphenylmethane (4,4'-MDA, CAS no. 101-77-9), an aromatic amine, is the degradation product of 4,4'-methylenebis(phenyl isocyanate) (4,4'-MDI). The patient had had a fracture of the fifth right metatarsal bone 20 days prior and had been wearing a leg brace made of polyurethane ever since (Figure 1A). [Extracted from the article]

Should SARS-CoV-2 influence immunosuppressive therapy for autoimmune blistering diseases? In this dramatic period where the whole world is affected by the outbreak of coronavirus disease 19 (COVID-19), scientific data relating to the causative virus SARS-CoV-2 as well as the subsequent therapeutic repercussions on the management of other diseases should be divulged in order to share as much information as possible among experts in a timely manner. Therefore, it will be crucial for our community to learn of more cases of autoimmune bullous disease patients under immunosuppressive treatment who have developed COVID-19, in order to better quantify the risk of infection under immunosuppressive therapy. [Extracted from the article]

Keywords: benzalkonium chloride; case report; child; contact dermatitis; pediatric EN benzalkonium chloride case report child contact dermatitis pediatric 397 399 3 05/27/20 20200601 NES 200601 CASE REPORT A 2-year-old female infant was referred with a 3-month history of eczema on the buttocks and upper part of the thighs; the patient was otherwise healthy. Despite some uncertainty regarding categorization as allergic or irritant reaction, we have interpreted the result with benzalkonium chloride 0.1% aq. as contact allergic in view of the morphology of the lesions and the appearance of distant lesions. Footnotes 1 Thanks to its biocidal and disinfectant properties, benzalkonium chloride is used as a preservative in several pharmaceutical products and for the sanitization of surfaces, although, rarely, it can cause allergic contact dermatitis. [Extracted from the article]

Nivolumab, a fully human IgG4 immune checkpoint modulator, binds to the programmed cell death 1 (PD‐1) receptor on T cells and blocks their inhibition. Thus, it increases the anticancer host immune response by allowing T cells to attack tumor cells. Although anti‐PD‐1 immunotherapy is typically well accepted, deregulation of immune tolerance caused by nivolumab may determine immune‐related adverse events, among which skin toxicities represent the most common. We report a case of severe new‐onset palmoplantar and nail psoriasis after receiving nivolumab treatment for metastatic melanoma. [ABSTRACT FROM AUTHOR]

Dear Editor, Erosive pustular dermatosis of the leg (EPDL) is a rare inflammatory cutaneous disease characterized by nonfollicular sterile pustules, erosions and crusts on an erythematous background.[1] EPDL generally affects the middle third of the leg, typically in elderly patients. Indeed, 10 out of 23 patients (43%) in the TC-only group relapsed, whereas four out of 28 patients (14%) treated with both TC and topical zinc oxide relapsed. On the basis of our results, topical zinc oxide may represent a valid, easy and cheap therapeutic strategy for maintenance therapy of EPDL, after TCs have achieved their anti-inflammatory role in the acute phase. [Extracted from the article]

Our striking result suggests that topical zinc oxide may not only represent a valid, easy, and cheap therapeutic strategy for the maintenance therapy of EPDS, but it can be capable of breaking the vicious cycle of healing and recurrences of EPDS, minimizing the adverse effects of long-term topical steroid therapy. Dear Editor, Erosive pustular dermatosis of the scalp (EPDS), a rare underdiagnosed inflammatory disease with predilection for elderly patients with androgenetic alopecia, severe actinic damage, and/or a history of trauma to the scalp, is characterized by recurrent small pustules, erosions, and more or less thickened gray-yellowish scales that can lead to scarring alopecia secondary to hair follicle destruction.1-3 An 81-year-old man was referred with a 2-month history of multiple painful thick, yellow-brownish crusts on the bald areas of the scalp (Fig. [Extracted from the article]

Dear Editor, We read with great interest the paper by Liccioli et al1 concerning I Mycoplasma i I pneumoniae i (MP)-associated mucocutaneous disease in children. 4 Meyer Sauteur PM, Theiler M, Buettcher M, Seiler M, Weibel L, Berger C. Frequency and clinical presentation of mucocutaneous disease due to mycoplasma pneumoniae infection in children with community-acquired pneumonia. MP-related mucocutaneous eruptions with prominent mucositis and scarce cutaneous involvement are usually referred to as I Mycoplasma i -induced rash and mucositis (MIRM). [Extracted from the article]

Koebner phenomenon regards the formation of a psoriatic lesion after a trauma, including tattoo, insect bite or other injuries. Although this manifestation is not specific for psoriasis, physicians should be aware because early recognition may be helpful in making the diagnosis when present. [ABSTRACT FROM AUTHOR]

A 64-year-old Caucasian woman was referred as a result of a 3-year asymptomatic cutaneous pigmented lesion on her genital area. Tumor cells were Ber-Ep4 and p16 negative. GLO:DIF/01mar21:ijd15010-fig-0002.jpg PHOTO (COLOR): 2 (a) A well-circumscribed lesion composed of anastomosing cords of uniform basaloid cells forming sparse duct-like structures and extending from the basal epidermis into the superficial and mid dermis (H&E, ×2). [Extracted from the article]

Vascular findings have rarely been described in the setting of lichen sclerosus. Enlarged vessels within the atrophic plaques have been observed on the free margins of the labia minora and clitoral hood. The enlarged vessels completely remit upon treatment of lichen sclerosus with an ultra‐potent corticosteroid ointment in the acute phase. During maintenance therapy with calcineurin inhibitors, there was no recurrence of the enlarged vessels. [ABSTRACT FROM AUTHOR]

From March 9, 2020, our outpatient service was temporarily suspended and replaced by phone call to patients, asking if they had discontinued therapy and/or had suffered from any COVID-19 related symptoms since February. On the contrary, the prompt discontinuation of immunomodulant/immunosuppressant therapies and rituximab is mandatory in cases of moderate-severe respiratory symptoms or contact history with COVID-19 patients, until swab-confirmed negativity for COVID-19 and complete remission of respiratory symptoms. Dear Editor, There are different opinions about the management of ongoing immunosuppressant/immunomodulant therapies during the COVID-19 outbreak ([[1], [3]]). [Extracted from the article]

Outcomes of various types of therapy in patients with treatment-resistant acrodermatitis continua of Hallopeau. 5 Galluzzo M, D'Adamio S, Teoli M, Bianchi L, Talamonti M. Biologic therapy for acrodermatitis continua of Hallopeau: successful treatment with secukinumab and review of the literature. Brodalumab in the treatment of moderate to severe psoriasis in patients when previous anti-interleukin 17A therapies have failed. [Extracted from the article]

How infodemic during the COVID-19 outbreak influenced common clinical practice in an Outpatient Service of Severe Psoriasis Dear Editor, We conducted a prospective study on adult psoriatic patients referring to the Outpatient Service of Severe Psoriasis after the end of the lockdown due to COVID-19 emergency in Italy (https://www.gazzettaufficiale.it/eli/gu/2020/04/27/108/sg/pdf). After the end of the lockdown, hospital activities resumed but, to comply with social distancing and environmental sanitation rules, the number of patients per day was reduced to an average flow of 45 patients per week, instead of 50 per week as in common practice.1 A total of 178 patients were seen, of which 11 (6%) discontinued their therapy during the lockdown. [Extracted from the article]

GLO:DF2/01jul20:ced14173-fig-0001.jpg PHOTO (COLOR): (a) Clinical presentation in a 68-year-old woman with a 33-year history of Hailey-Hailey disease: infiltrated dark erythematous plaques with erosions localized to the inguinal folds before treatment. Familial benign chronic pemphigus (Hailey-Hailey disease): use of topical immunomodulators as a modern treatment option. [Extracted from the article]

Diagnosis: Congenital hypertrophy of the lateral nail folds of the big toes CLINICAL COURSE Based on the history and clinical examination, the diagnosis of congenital hypertrophy of the lateral nail folds was made. Congenital hypertrophy of the lateral nail folds is a rare condition of the periungual soft tissues of the great toe.2,3 It should be always considered in the differential diagnosis of an ingrown toenail, especially in neonates and infants. Congenital hypertrophy of the lateral nail folds often appears at birth, or shortly after, as a hypertrophic lip, typically at the medial fold of both great toes that partially covers the nail plate. [Extracted from the article]

Moreover, contact dermatitis from diapers due to rubber chemicals (mercaptobenzothiazole) or glues such as PTBFR has been reported. 6 Belhadjali H, Giordano-Labadie F, Rance F, Bazex J. "Lucky Luke" contact dermatitis from diapers: a new allergen?. [Extracted from the article]

The article presents a case study of a 82-year-old immunocompetent man with hemorrhagic and crusted lesions located on his head. Topics discussed hemorrhagic crusted were presented on the scalp; mentions a skin biopsy of lateral cervical region, and histopathological examination revealed in-transit metastases; and highlights the immunologic therapy with ipilimumab and patient's death because of the neoplastic systemic involvement.