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Median raphe cyst (MRC), also known as genitoperineal cyst of median raphe, mucoid cyst of penis, or apocrine cystadenoma/hydrocystoma of penis, represents a congenital developmental defect of the male genitalia. MRC is an uncommon lesion most commonly observed in the first decade of life. However, being often asymptomatic, it is probably underestimated and may be noticed later, during the second to third decades. MRC reflects a developmental defect in male genitalia during embryogenesis, but the exact mechanism is clear. It might result from tissue trapping during embryonic fusion of urethral folds for development of urethral groove, anomalous developmental of the periurethral glands of Littre, or aberrant blockage of the paraurethral duct. MRC usually appears as a translucent, yellowish, cystic lesion of various sizes that may occur anywhere on the ventral side of the male genital area between urethral meatus, scrotum, perineum, and anus, along the midline/median raphe.

Background Cradle cap is a benign and self-limiting variant of seborrheic dermatitis (SD) that can be distressing for parents. Aims To assess by clinical/laboratory/instrumental evaluation the efficacy/tolerability of a gel cream containing piroctone olamine (antifungal), biosaccharide gum-2 (antifungal), stearyl glycyrrhetinate (anti-inflammatory), and zinc l-pyrrolidone carboxylate (zinc-PCA) (antiseborrheic) in the treatment of mild/ moderate cradle cap. Methods In this prospective, open-label trial, 10 infants, with mild/moderate cradle cap enrolled at the Dermatology University Clinic of Catania (Italy) used the tested gel cream twice daily for 30 days. Degree of erythema was evaluated clinically by a 5-point severity scale (from 0=no erythema to 4=severe erythema), at baseline, at 15 and 30 days. Desquamation was rated by dermoscopy evaluation using a 5-point scale (from 0=no desquamation to 4=severe/many large adherent white flakes), at all time points. An Investigator Global Assessment (IGA) using a 6-point scale (from -1=worsening to 4=complete response/clear) was also performed at 30 days. Five subjects, randomly selected, underwent double microbiological evaluation for bacteria and yeasts by cultures of cotton swabs at baseline and at 30 days. Tolerability/acceptability was evaluated on a 4-point scale (from 0=very poor to 3=excellent) at 15 and 30 days. Data were processed using SAS version 9. Results At baseline, a significant colony-forming unit (CFU) count for Malassezia furfur and Staphylococcus aureus was detected in 4 out of 5 selected patients. After 15 and 30 days, a statically significant reduction from baseline in erythema and desquamation severity was observed, along with a reduction in CFU count for Malassezia furfur and Staphylococcus aureus from baseline. No signs of local side effects were documented. Conclusions Our results indicate that the tested gel cream may represent a valid option to treat mild-to-moderate forms of cradle cap and support its antifungal and antibacterial properties.

Urea-based topical compounds at medium concentrations (15%-30%) represent useful dermatological agents for their humectant and keratolytic effects by enhancing stratum corneum hydration and by loosening epidermal keratin, respectively. The aim of this paper is to review the clinical evidences of the use of 15%-30% urea as single topical agent. Although limited evidence supports the use of these concentrations of urea in skin disorders characterised by xerosis and hyperkeratosis, in clinical practice they are largely used especially in xerosis of limited skin areas, in which the side effects are tolerable, or hyperkeratosis involving large or more sensitive (eg, face, genital region, etc) areas, in which higher concentration may be irritant. In addition, urea at medium concentrations is used in combination with other substances including topical antifungals as penetration enhancer.

Background Acquired lymphangiectasias represent cystic dilatations of the cutaneous lymphatic vessels resulting from damage and/or obstruction of previously normal lymphatics, usually secondary to surgery, radiotherapy, and/or infections. Materials and methods The clinical, dermoscopic, and confocal microscopy features of three cases of acquired lymphangiectasias occurring after breast surgery are described along with histopathological correlations. Results Polarized dermoscopy revealed in all lesions the presence of well-circumscribed, white-yellowish lacunae surrounded by pale septa. In addition, some lesions showed scattered reddish areas and red lacunae. Confocal microscopy showed in the upper dermis numerous, roundish dark cavities separated by thin septa. These features corresponded histopathologically to saccular dilations and ectatic lymphatic vessels lined by a single layer of endothelial cells in the papillary/reticular dermis. Conclusion The use of non-invasive diagnostic techniques may be addressed to an enhanced non-invasive diagnosis of acquired lymphangiectasias by showing peculiar features, thus avoiding the need for skin biopsy.

Federica Dall’Oglio,1 Gabriella Fabbrocini,2 Aurora Tedeschi,1 Marianna Donnarumma,2 Paolo Chiodini,3 Giuseppe Micali1 1Dermatology Clinic, University of Catania, Catania, Italy; 2Section of Dermatology, Department of Clinical Medicine and Surgery, University Federico II of Naples, Naples, Italy; 3Medical Statistics Unit, University of Campania “Luigi Vanvitelli”, Naples, ItalyCorrespondence: Giuseppe MicaliDermatology Clinic, University of Catania, A.O.U. Policlinico -Vittorio Emanuele, via Santa Sofia, 78, Catania 95123, ItalyTel +39 095321705Fax +39 0953782425Email cldermct@gmail.comPurpose: Topical cosmetic agents if correctly prescribed and used may improve outcomes in acne therapy. The aim of this study was to assess the efficacy and tolerability of a new daily cosmetic regimen in the treatment of mild facial acne.Patients and methods: A multicenter, prospective, observational, clinical study was conducted on 91 adult patients with mild acne. Subjects were instructed to apply a fluid containing Licochalcone A/Salicylic acid/L-Carnitine in the morning and a cream with Licochalcone A/Hydroxy-Complex 10% at bedtime for 8 weeks. The efficacy was clinically evaluated by Global Acne Grading System (GAGS) score and by comedones/papules lesions count and by instrumental assessment (SebutapeTMand Reveal Photo Imager/VISIA-CR™ imaging) at baseline, at 4 and 8 weeks.Results: At 4 weeks a statistically significant reduction from baseline of GAGSwas observed. In addition, the mean total count of comedones and papules was significantly reduced by 41% and 45%, respectively, from baseline along with a significant reduction of mean sebum of 47%. At 8 weeks, a further statistically significant reduction from baseline of GAGS, total count of comedones and papules (64% and 71%, respectively), along with an additional sebum reduction of about 52% was also recorded.Conclusion: Our results suggest that the daily regimen based on Licochalcone A with Salicylic acid/L-Carnitine as fluid or with Hydroxy-Complex 10% as cream represent an interesting cosmetic approach for treating mild acne.Keywords: mild acne, topical cosmetic, licochalcone A, salicylic acid, hydroxyl-complex

Causes of acne scar formation can be broadly categorized as the result of increased tissue formation or, more commonly, loss or damage of local tissue. Clinical manifestations of acne scars and severity of scarring are generally related to the degree of inflammatory reaction, to tissue damage, and to time lapsed since the onset of tissue inflammation. In 1987, D. A. Ellis and M. J. Mitchell proposed an acne scar classification system and first utilized the descriptive terms ice pick, crater, undulation, tunnel, shallow-type, and hypertrophic scars. Acne scars in this system are classified as elevated, dystrophic, or depressed. Other parameters include shape, consistency, color, and distensibility. An accurate evaluation and classification of acne scars is crucial for the selection of the optimal therapeutic approach. Histopathologic examination, which may most precisely depict scar morphology, is not feasible in routine clinical practice, and non-invasive instrumental techniques could be useful for this purpose.

Mesotherapy with hyaluronic acid (HA) is a treatment approach currently used for skin rejuvenation. High-frequency ultrasound (20–100 MHz) is a non-invasive technique that has been used to evaluate age-related dermal changes. The presence and the degree of a typical subepidermal low-echogenic band (SLEB) are photoaging related: the lower the SLEB echogenicity, the higher the photoaging. The aim of this trial was to evaluate, through ultrasound imaging, the long-term effects of microinjections of HA on SLEB echogenicity. Twenty-two women with clinical and ultrasound signs of moderate photoaging were enrolled in the study. Treatment consisted of multiple microinjections of HA salts of biotechnological origin on the dorsum of one hand, once weekly for 4 weeks and, successively, once monthly for 4 months (group A) or 9 months (group B). The dorsum of the other hand of each subject was injected with saline solution and used as a control. In all subjects, high-frequency ultrasound (22 MHz) was performed to evaluate SLEB echogenicity changes during treatment. Eighteen out of 22 patients completed the study. At the end of 4 weeks, an ultrasound increase of dermal echogenicity was observed in 13 subjects (seven of group A and six of group B), which we considered as “responders”. In these patients, the Student’s t-test showed a significant increase from baseline of SLEB pixel numbers of +24 % (P

Topical cosmetic agents may play a role in the management of facial seborrheic dermatitis by reducing inflammation and scale production. Advanced digital photography, equipped with technology able to provide a detailed evaluation of red skin components corresponding to vascular flare (erythema-directed digital photography), is a useful tool for evaluation of erythema in patients affected by inflammatory dermatoses. The aim of this study was to assess the efficacy and safety of a new cosmetic topical gel containing piroctone olamine, lactoferrin, glycero-phospho-inositol, and Aloe vera for the treatment of facial seborrheic dermatitis by clinical and advanced digital photography evaluation.An open-label, prospective, clinical trial was conducted on 25 patients with mild to moderate facial seborrheic dermatitis. Subjects were instructed to apply the gel twice daily for 45 days. The clinical efficacy was evaluated by measuring at baseline, at day 15 and 45 the degree of desquamation (by clinical examination) and erythema (by digital photography technology via VISIA-CR™ system equipped with RBX™), using a 5-point severity scale, and pruritus (by subject-completed Visual Analogue Scale; scale from 0 to 100 mm). Finally, at baseline and at the end of the study, IGA (Investigator Global Assessment) was performed using a 5-point severity scale (from 0 = worsening to 4 = excellent response).At the end of treatment, a significant reduction (P0.001) of all considered parameters was observed. Moreover, an excellent response (80% improvement) was recorded in 47.9% of patients, with no case of worsening. No signs of local intolerance were documented.The tested cosmetic topical gel was effective in treating mild to moderate seborrheic dermatitis of the face. Erythema-directed digital photography may represent a noteworthy tool for the therapeutic monitoring of facial seborrheic dermatitis and an important adjunct aid in the dermatologic clinical practice.

According to the American Academy of Aesthetic Plastic Surgeons, more than 11 million cosmetic surgical and nonsurgical procedures were performed by board-certified plastic surgeons, dermatologists and otolaryngologists in the United States, totaling more than 12 billion dollars. We performed a retrospective observational multi-centric study on patients treated with a non-animal origin cross-linked hyaluronic acid with different molecular weights for nasolabial folds, evaluating through a new imaging system, profilometric techniques with the confocal microscopy, the durability, the efficacy and the safety of this product. From 25 patients, 150 silicone casts were obtained: 75 casts of the right nasolabial fold and 75 casts of the left nasolabial fold. Roughness arithmetical average of the right fold at T2 decreased by 50% versus T0 and by 40% compared to T1; at T2, it decreased by the 45% versus T0 and by 35% compared to T1. No side effects were reported. Results proved that the analysis of the skin microreliefs through confocal microscopy is a new imaging system that allows to evaluate with precision and safety the results of aesthetic treatments such as fillers objectively.

Modern therapy of acne is based also on moisturizers, cleansers and sunscreens. However, a few studies have been published on cleansers, and never in Italy.We decided to carry out an epidemiological study on the knowledge, beliefs and perceptions of acne patients regarding cleansers.The survey has been carried out in Italy in 2013-2014. A group of patients with acne completed a questionnaire which included 10 questions.One hundred and eighteen dermatologists and 786 evaluable acne patients attended the survey. Approximately 70% of patients use a specific anti-acne cleanser. This cleanser is suggested in 57% of cases by a dermatologist. The patients buy this cleanser at the pharmacy (77% of cases). More than 62% of patients are satisfied about this cleanser. More than 66% of patients use the cleanser twice daily. The length of washing is less than one minute in 48% of patients. More than 66% of patients believe that the cleanser has a therapeutical role.The results of this survey cannot be compared with other studies because of the lack of similar studies about this topic. These results suggest that a sample of Italian acne patients consider cleansers as an important adjuvant treatment in acne.

Chemical peeling, or chemoexfoliation, is a dermatological procedure commonly used for both skin rejuvenation and some cutaneous conditions. It consists of the application of one or more chemical exfoliating compounds to the skin to remove and regenerate part of the epidermis and dermis. This may result in the improvement of the physical appearance of the skin and a decrease in the number of wrinkles, pigmentations (e.g., melasma, lentigo), and inflammatory lesions (e.g., acne, rosacea) [1, 2].

We evaluated the efficacy of squaric acid dibutylester (SADBE) contact immunotherapy for the treatment of warts on a series of 188 children. Included in the study were those children who satisfied at least two of the following criteria: single or multiple sites with several warts, warts resistant to repeated medical and/or surgical treatments, recurrent multiple warts, and patient or parent refusal to undergo destructive or surgical treatment. Excluded from the study were children with single warts or with flat warts located exclusively on the face and children less than 2 years of age. Treatment consisted of twice weekly applications of serial dilutions of SADBE (0.03-3%) for no more than 10 weeks. Of the 148 children who completed the study, 124 (84%) showed complete clinical resolution with no significant side effects. Of those with total clinical resolution, 101 completed a 24-month follow-up with no relapses. Twenty-four (16%) children were nonrespondent. No apparent correlation between treatment response and age, gender, anatomic site, lesion type, or atopy was found. Contact immunotherapy with SADBE is a relatively safe and effective alternative treatment in the management of multiple and resistant cutaneous warts in children.

Hailey-Hailey disease is a rare autosomal dominant acantholytic disorder characterized from late adolescence or adulthood by recurrent eruptions of vesicles and blisters usually located on the neck, axillae and groin. The clinical cases of four unrelated adult male patients with Hailey-Hailey disease are presented. In all patients, a relatively short-course treatment with oral erythromycin (3-4 weeks) induced a longlasting remission (8 months). Since bacteriological investigations excluded local infection, other hypothetical pharmacological effects (anti-inflammatory action and inhibition of cytokine release), besides the antibacterial properties of erythromycin, should be considered to explain such clinical improvement. However, until precise information about the pathogenesis of Hailey-Hailey disease is available, the mechanism of action of erythromycin in this disease remains speculative. Further studies in larger series of patients are needed in order to assess the role of erythromycin, and perhaps ot...

The term “cosmeceuticals”, suggested by Kligman more than 20 years ago, refers to topical products that lie in a gray zone where they are viewed as having both pharmaceutical and cosmetic properties [1]. Although the neologism was innovative and relevant, it was rejected from the US Food, Drug, and Cosmetic Act that, according to the 1938s US Congress, labels as drug every substance for use in the diagnosis, cure, treatment or prevention of disease, and as cosmetic any product intended for beautifying and promoting attractiveness. In spite of this, the term cosmeceuticals has recently been gaining increasing popularity, as the term cosmetic seems to be restrictive for those substances that have druglike beneficial effects. On the other hand, the “cosmeceuticals” concept has caused a lot of confusion, because of similar neologisms such as neutraceuticals and/or neoceuticals. Actually, in USA and Canada, most cosmeceuticals are regulated as over the counter (OTC) products, while in Europe they are considered as cosmetics. Only in Japan, a new class of products, called quasi-drugs, has been created [2].

Intraepithelial penile carcinoma (IPC) is an in situ carcinoma of the penis, which can be difficult to diagnose. Current treatments include excisional surgery, Mohs' micrographic surgery, cryotherapy, carbon dioxide laser therapy and topical 5-fluorouracil. We report two cases of men with 12-18 month histories of IPC (Bowen's disease, squamous cell carcinoma in situ) that were previously unsuccessfully treated with antifungals and antibiotics. Treatment with imiquimod 5% cream for 8-10 weeks was effective in both cases with no clinical evidence of relapse at 4 and 6 months. Both patients experienced adverse effects, resulting in temporary discontinuation of treatment.

A great pitfall for scabies and pediculosis therapeutic studies to date is that primary and secondary study outcomes are indirectly assessed (presence or absence of live parasites, including eggs, determined by gross clinical inspection) and data time points are non-standardized (highly variable) relative to the time of therapeutic application. Videodermatoscopy (VD) is a non-invasive technique that allows a rapid and magnified in vivo observation of the skin up to × 1000 with the visualization of morphologic features invisible to the naked eye. Utilization of VD in establishing highly definitive and precise quantitative data products used in the treatment of scabies and pediculosis provides enormous advantages in the quest to establish reproducible quantitative methodology for efficacy studies in these parasitoses. VD enhances the monitoring of clinical response to treatment in scabies and pediculosis and allows determination of the optimal timing of drug application both in vivo and ex vivo. This may be particularly important in minimizing risk of overtreatment, reducing the potential for side effects, and enhancing patient compliance.

Before performing any peeling procedure, an accurate evaluation of the patient is very important. In order to assure a satisfactory outcome and to minimize the risk of scarring and delayed reepithelialization, the appropriate peeling agent for a patient needs to be determined and a period of pretreatment is required [1, 2]. Considerations for the individual choice of peeling agent include: lifestyle, including avoidance of sun exposure and appropriate use of sunscreen, history of perioral herpes simplex virus (HSV) infection, previous or concomitant treatments (oral isotretinoin, contraceptives and other photosensitizing medications such as radiation and laser skin resurfacing), and positive history for abnormal or keloid scarring. For example, patients susceptible to facial herpes simplex virus infection may be treated with antiviral drugs from the pre-peel period until reepithelialization is complete, especially when medium-depth or deep peeling is performed [3–8].

Median raphe cysts represent defects of embryologic development of the male genitalia during fetal life. A clinical variant is represented by raphe canals, which consist of elongated tracts located in the same areas. Videodermatoscopy is a noninvasive technique that may be helpful in the differentiation between cysts and canals of the median raphe of the penis, thus helping to establish the most appropriate therapeutic approach.

A 62-year-old woman was admitted to our clinic for the evaluation of 2.5-year history of progressive exertional facial flushing, and swelling of the head, face, and neck. Three years earlier, she had undergone implantation of a definitive pacemaker with an endocardial ventricular lead for a severe bradycardia. Physical examination revealed facial swelling and erythema including the periorbital areas, distended neck and edema of the region above the lower margins of the rib cage. Numerous dilated cutaneous venules were present on the ventral upper thoracic wall interspersed with patches of intense flush and large areas of normally colored skin (Fig. 1). There had been no weight loss within the previous months. History of angioedema, allergic reactions, autoimmune diseases, or medication was negative. Enlarged lymph nodes were not detected. Complete blood cell count, fibrinogen, Quick's test for prothrombin, antithrombin III, C-reactive protein, lipidic profile, renal functions, urinanalysis, and thyroid function test were within normal ranges. Standard X-ray and sectional radiography of the chest revealed no lung diseases or alterations of the mediastinum. Doppler examination of the supraaortic trunks and chest CT scan showed normal findings. A diagnosis of superior vena cava syndrome (SCVS) was suspected and a cavography was performed, by injecting contrast medium simultaneously through the basilic veins, that revealed marked narrowing of the confluence of the two brachiocephalic veins at the junction of the internal jugular and right subclavian veins with a total obliteration of the right brachiocephalic vein (Fig. 2). The diagnosis of pacemaker-induced SVCS was confirmed and the woman was referred for angiosurgery. Figure 1. Presence of edema of the region above the lower margins of the rib cage. Numerous dilated cutaneous venules on the ventral thorax wall interspersed with patches of intense erythema and large areas of normally colored skin were present Figure 2. Cavography showing obliteration of the right brachiocephalic vein at its confluence with the left brachiocephalic vein

Skin-targeted ultrasound is a noninvasive technique that has been extensively used to evaluate age-related dermal changes, and the presence of a subepidermal low-echogenic band (SLEB) has been related to chronic UVR exposure in several studies. Since SLEB echogenicity is photoage-related, the aim of this study was to evaluate, through ultrasound imaging, the effects on skin photoaging of mesotherapy, a treatment approach currently used in cosmetic dermatology for skin rejuvenation. Twenty women (mean age: 46.7 range 40-60 years) with physical signs of moderate photoaging on the dorsum of the hands were enrolled and treated with multiple microinjections of hyaluronic acid (HA) salts of biotechnological origin (1.000 Kd) every week for 4 weeks. In all subjects, ultrasound evaluation was performed at each visit and 1 week after the last treatment to evaluate SLEB echogenicity changes during treatment. At the end of study, a statistically significant (p < 0.001) increase of SLEB echogenicity (with a mean increase of pixel numbers equal to 31.3%) was observed in 15 of 19 subjects who completed the study. Our preliminary study suggests that mesotherapy with HA may be an effective treatment for skin photoaging, as confirmed by ultrasound. Follow-up investigations on larger series of patients are necessary to further evaluate the safety, effectiveness, and duration of effect of this possible therapeutic approach to skin photoaging.

Cutaneous warts are benign epidermal proliferations caused by human papillomavirus infection. Treatment aims to cure the patient's physical and psychological discomfort, and to prevent the spread of infection by contact with other body areas or with other individuals. Among the available medical and destructive therapeutic options for cutaneous warts, none is uniformly effective or virucidal. Moreover, in most cases the safety and efficacy of these treatment options has not been assessed in randomized controlled trials, so that the reproducibility of many of the listed treatments is difficult to evaluate and a possible placebo effect cannot be ruled out. This article provides indications for the management of patients with cutaneous warts through an evidence-based approach, considering a first-, second-, and third-line therapy for each clinical form. The first line includes medical treatments useful to cure single, or few, and/or small common warts of short duration (

Background Videodermatoscopy (VD) is a noninvasive diagnostic tool that has recently been advanced as an alternative technique for the diagnosis of scabies, based on studies showing its ability to detect mites in vivo with results comparable to those obtained by traditional skin scraping. Objective In this study we evaluated a group of patients undergoing topical treatment with a thermosensible foam containing 0.165% pyrethrins and 1.65% piperonyl butoxide to determine whether VD would enhance monitoring of the clinical response to treatment and indicate the optimal timing of drug application. Materials and methods Twenty patients (12 M, 8 F; age 1–65 years) affected by scabies (diagnosis confirmed by VD), and who were treatment naive, were included in the study. The foam was applied to the entire body once a day at bedtime for two consecutive days. To detect treatment response, VD evaluation of two targeted skin sites for each patient was performed at baseline and at 12, 24, 36 and 48 h. A video microscope system equipped with a zoom lens that allowed skin observation with incident light at magnifications ranging from × 20 to × 600 was used. Results In all patients, VD showed active mite migration within burrows at 12 h. At 24 h, there was no evidence of active mite migration, and a majority of patients reported that itching had subsided. At 48 h, the mites were no longer visible in appreciable amounts by VD, and an amorphous material, probably resulting from mite decomposition, was detectable at one end of an empty burrow in the majority of patients. Skin scraping at 48 h, followed by standard microscopic observation, also showed only mite remnants in all patients. None of the 20 patients showed signs of infestation by VD at targeted skin sites at a 2-week post baseline follow-up visit. Conclusions VD enhances the monitoring of clinical response to treatment and allows optimal timing of drug application. This may be particularly important in minimizing risk of overtreatment, reducing the potential for side-effects, and enhancing patient compliance.