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Cutaneous manifestations related to alcohol intake and abuse are various. Most frequently, there are vascular lesions and cutaneous alterations secondary to hepatic dysfunction. Alcohol consumption represents also a risk factor for many cutaneous diseases, such as psoriasis, where its prevalence is high. Other cutaneous complications associated with alcohol are also discussed.

Skin colour is important for interindividual relationships considerations, as well as for the assessment of some physiopathological aspects. Its subjective assessments varies among observers and according to light. By contrast, an objective approach, both qualitative and quantitative by analytical measurements, has been available for some years. Its application in routine clinical settings is possible. The aspects are dependent on the incident light wavelengths. Accordingly, a series of skin diseases, but also ictera, uremia, anemia and hemochromatosis are possibly assessed in the field of internal medecine according to variations of skin colors.

Skin ageing occasionally manifests itself at long-term by severe atrophoderma. Systemic or topical corticotherapy exerts an atrophic impact mimicking the effects of old age. Such atrophoderma condition has been described as transparent skin about 40 years ago, and it received more recently the new denomination of dermatoporosis. Such condition stands out in the medical history to induce clinical consequences. They are sometimes prominent introducing diverse lesions such as Bateman purpura, stellate scars and wounds following minor trauma.

In the dermatopathology field, some simple available laboratory tests require minimum equipment for establishing a diagnosis. Among them, the cyanoacrylate skin surface stripping (CSSS), formerly named skin surface biopsy or follicular biopsy, represents a convenient low cost procedure. It is a minimally invasive method collecting a continuous sheet of stratum corneum and horny follicular casts. In the vast majority of cases, it is painless and is unassociated with adverse events. CSSS can be performed in subjects of any age. The method has a number of applications in diagnostic dermatopathology and cosmetology, as well as in experimental dermatology settings. A series of derived analytic procedures include xerosis grading, comedometry, corneofungimetry, corneodynamics of stratum corneum renewal, corneomelametry, corneosurfametry, and corneoxenometry.

Some recently introduced targeted treatments in cancerology are responsible for adverse effects on the skin. These events alter the patient well-being. Adequate dermocosmetic management allows to curb the unwanted skin conditions without interfering with the targeted therapeutic effects. However, evidence-based support for using dermocosmetic products as adjunctive cancer treatment remains scarce. It remains nonetheless that the clinical perception is unanimously favourable for such procedure.

Circulating sex hormones follow major fluctuations during the ovarian cycle. The so-called premenstrual syndrome represents a global condition grouping the diversity of catamenial disorders. At the skin level, the sebaceous gland activity is obviously modulated by these endocrine fluctuations. In addition, a series of pathological manifestations take place simultaneously in some women. Among them, the most frequent skin condition is represented by catamenial acne. Concurrently, the autoimmune progesterone dermatitis refers to a diversity of skin alterations resulting from an immune reaction to progesterone. It is present under variable clinical aspects. A series of other recurrent skin conditions are not specifically induced but are merely exacerbated at the end of the ovarian cycle.

In some instances, a dermatosis exhibits a rapid and focal surge of seemingly similar tiny lesions. We report a few typical exemples occurring in adolescents.

Cold application to the skin is commonly used in dermatology. The modalities of application are diversified and condition the temperature reached in the skin and the therapeutic result. Hense, the term cryotherapy without further precision remains little informative. The sensibility to cold of the diverse types of cutaneous cells is heterogeneous, as well as that of healthy and neoplastic tissues.

Under specific light illumination, skin produces peculiar fluorescent aspects. Such property can be used to provide diagnostic arguments or to disclose some peculiar functions of the skin. Some superficial infections (erythrasma, tinea versicolor, dermatophytic tinea,..) reveal fluorescence that may be intense. The pilosebaceous follicles enriched in Propionibacterium spp show fluorescence. Such property is lost during some anti-acne treatments. A quenching effect is observed after application of sunscreens. The (pre)neoplastic areas prepared for dynamic phototherapy become fluorescent. Pyranine labeling of the stratum corneum exhibits fluorescence allowing the assessment of the renewal activity of the epidermis.

Skin capacitance is an electrical property measurable at the level of the stratum corneum. Values are related to the moisture content of the tissue. Using the silicon image sensor technology, it has recently become possible to measure capacitance at 50 microm intervals on the skin surface. The resulting nonoptical picture corresponds to skin capacitance imaging. This novel tool for dermatologists highlights with precision the hollow skin surface patterns, including dermatoglyphics, the patterns of the shallow skin lines, and wrinkles. The topographic heterogeneity in skin surface hydration is made visible. In addition, the sweat gland and follicular openings are disclosed. Skin disorders induced by surfactants or presenting as hyperkeratotic areas, including some neoplasms, may show typical aspects. It is concluded that skin capacitance imaging brings added value to the clinical assessment performed by dermatologists.

Cutaneous pseudolymphomas represent an heterogeneous group of tumours resembling lymphomas by some clinical and histological aspects. They are distinguished, in particular, by their benign evolution. The histological and immunohistological examinations combined with molecular biology help to elucidate any diagnostic uncertainty. In these diseases, monoclonality and pseudoclonality must be distinguished in the lymphoid infiltrates. Searching for any specific etiology is important because removing the cause is likely to clear the lesions.

Targeted therapies are focused on one or a few molecules particularly involved in specific diseases. Some inflammatory dermatoses and cutaneous neoplasia potentially benefit from these approaches. Nine monoclonal antibodies of interest in dermatology are presented according to the disorders where they have proven their efficacy. Biotherapies extend beyond monoclonal antibodies. A given effect, such as TNF-alpha antagonism, is indeed obtained by distinct drug classes. The interindividual differences in the therapeutic responses remain unpredictable, and there is no criteria of selection of patients who could benefit the most from these targeted medications.

Both cocaine and crack exert sympathetic and prothrombotic effects. The induced lesion may affect the skin, as well as other organ systems. Various types of vasculitis and infectious dermatoses are the predominant issues. In addition, tactile and visual hallucinations may occur suggesting insect crawling underneath the skin.

Innate immunity represents a complex biological organization exhibiting some implications in diverse disorders, in particular at the level of the skin. Its functioning relies on two main groups of components encompassing the PRRs (Protein Recognition Receptors) and the antimicrobial peptides. In humans, particularly in the skin, the major PRRs are represented by the Toll-like receptors (TLRs). The main antimicrobial peptides encompass the alpha- and beta-defensins, and cathelicidins. The expression of the innate immunity compounds is modulated by some drugs. This feature represents a mode of action that remained ignored in the past.

Dermatological emergencies encompass a series of distinct diseases of infectious, autoimmune and environmental origins. They account for a number of consultations at the general practitioner's office and in emergency units of medical centers. The concerned first line medical staffs are then facing some conditions with a dramatic potential. We review the most common conditions including urticaria, angioedema, infectious cellulitis, acute photodermatoses, the Lyell syndrome, some other paroxysmal severe adverse drug reactions, burns, erythroderma and the Kaposi-Juliusberg varicelliform eruption.

The clinician is at the crossroad between scientific information and some rubbish presentations of low level communication. In this background, searching for objectivity is mandatory in clinical trials. We summarize the main aspects of assessment on nominal scale, ordinal scale, interval scale as well as on structured and non structured scales.

Contrasting with many animals, the human physiological capacity to resist to cold is quite limited. Severe cold exerts its major physiopathological effects on the skin and the whole body. The skin and body thermoregulations become quite rapidly unsatisfactory. Cold is then responsible for a series of dermatoses which could, however, be often prevented by simple means. The severity and the duration of exposure to cold, combined to wind speed, altitude and environmental hygrometry condition the nature and severity of the potential disorders. Some lesions may remain moderate in severity, self-limited and transitory. Others lead to irreversible damage with necrosis of the skin and the deeper tissues. Death secondary to hypothermia is the risk of performing some outdoor activities in inhospitable and extreme cold conditions.

Some typical distributions of skin lesions represent a helpful sign for the differential diagnosis in dermatology. Indeed, some dermatoses, affecting the skin, nails or mucosae, display an annular or linear disposition. The linear pattern can be explained by several factors. The dermatosis can follow either a nerve traject, vascular or lymphatic vessels, or embryological lines. Exogenous factors, including traumatisms or automutilations, can also contribute to this particular distribution. In this review, the principal linear dermatoses are discussed together with their pathogenesis.

Thanks to the recently introduced silicone image sensor technology, skin capacitance imaging has now been made possible. The dedicated device is called SkinChip. This method is easy to handle and provides information about the skin microrelief, the level of stratum corneum hydration and the sweat gland activity. The apparatus sees and measures these parameters with a 50 microm resolution. A series of conditions have been explored using skin capacitance imaging. This review summarizes relevant findings about regional variability on the body, changes occurring with ageing, effects of a hydrating formulation, reactivity kinetics of corneocytes to surfactants, acne and skin pores characteristics, as well as hyperkeratotic dermatoses and tumours.

Pimecrolimus is an immune downregulator that belongs to the class of calcineurin inhibitors. Its efficacy is recognized for the topical treatment of the mild to moderate types of atopic dermatitis. In addition, the drug shows activity in a series of other dermatitides. We report a review of the international literature about this topic.

Myospherulosis is a rare disorder that may develop in various organs including the skin. It is characterized by a typical histological presentation resulting from the interaction between erythrocytes and lipids. We present a case of cutaneous myospherulosis associated with membranous lipodystrophy. The lesions were supervening on severe steroid-induced skin atrophy upon which ointments had been applied.

So-called dry skin is a quite common and annoying condition. This skin may affect individuals that are otherwise healthy. It may be particularly severe and unpleasant in cases of ichthyosis, atopic dermatitis or psoriasis. The inductive effects of the environment must not be ignored. Emollients and hydrating agents for the stratum corneum can help relieve the clinical manifestations.

Some cutaneous lesions accompany or reveal endocrine disorders. Identifying the endocrinopathy is very important because it sometimes allows corrective rather than symptomatic treatment. The most frequenly involved diseases include thyrotoxicosis, hypothyroidism, the auto-immune disorders of thyroid, Cushing syndrome, Addison disease, acromegaly, androgen-dependent disorders, hypopituitarism, hypoparathyroidism, pseudohypoparathyroidism and diabetes mellitus.

The profound endocrine upheaval of pregnancy is frequently associated with changes in the function and structure of the blood and lymph microvasculature of the skin and mucosae. Palmar erythema is frequent but rarely severe and is associated with burning sensations. Spider telangiectasias develop in the majority of pregnant White women but are less often identified in women with darker skin. Hemangiomas and glomus tumors occur in one-third of women. A firm edema may develop on the face and extremities in the final months of pregnancy. Venous hypertension and varicosities of the lower limbs are common. Gingivitis, gum hypertrophy, and pyogenic granuloma are common in the oral cavity. The vaginal mucosa is also affected, showing a violaceous aspect, at times accompanied by varicosities of the vulva. Many gestational vascular changes regress spontaneously in the postpartum phase. Some vascular tumors may need to be treated with a vascular laser or intense pulsed light.

Pyogenic granuloma is a common vascular tumour that can be treated by various means. However, some large lesions and those located on some difficult-to-treat body sites may represent a difficult challenge to the clinician (residual pain after treatment, difficult to cover with a dressing, or risk of sequelae). We report the successful treatment of such lesions in three patients using the Nd-YAG laser.

Insulin therapy is increasingly used. Hopefully, its complications are steadily decreasing in incidence since the introduction of new generations of insulin. The main cutaneous side effects were varied, including lipoatrophy, lipohypertrophy, allergic reactions, infectious abcesses and some idiosyncratic reactions.

A number of relationships exist between diabetes mellitus and a series of cuteanous disorders. Skin lesions may reveal diabetes in a more or less specific way. They may also represent complications supervening in an already treated diabetic patient. Some of these dermatoses (acanthosis nigricans, purpuric and pigmented capillaritis) are markers of macrovascular complications. The same disorders and some others (xerosis, Dupuytren's disease) are more frequently associated with microangiopathy in Type II diabetes. Other skin diseases (alopecia areata, vitiligo) are markers of auto-immunity in Type I diabetes.

Background: Skin is enlarged and doughy in acromegaly. Alterations have been reported in the structure of the extracellular matrix (ECM) and in the mechanical properties of the dermis. It is recognized that internal tensions in the dermis give rise to active cell-ECM and cell-cell mechanical interactions. This mechanobiological aspect can lead to functional and conformational changes in the cells. Such alterations in connective tissue cells have not been explored so far in acromegaly. The aim of the study was to assess structural changes in the dermal ECM, and in the number and shape of factor XIIIa-positive type I dermal dendrocytes (DDs) in acromegaly., Materials and Method: A total of 32 patients with acromegaly (three untreated, 17 with active disease under somatostatin analogues and 12 cured) were examined. Both the maximum and the most recent IGF-1 (insulin-like growth factor) dosages recorded in the patients' files were retrieved. Skin biopsies were taken from their forearms. Histochemistry, immunohistochemistry, morphometry and electron microscopy were used., Results: Collagen-bundle coarsening and acidic glycosaminoglycan deposits were found irrespective of the current endocrine status. Dermal dendrocytes were often markedly reduced in numbers, but those present were plump with few dendrites. A negative correlation was found between DD numbers and the maximum IGF-1 dosages recorded in the patients' files. A similar although weaker trend was found with the most recent IGF-1 dosages., Conclusions: Collagen, glycosaminoglycans and DDs appeared affected in acromegaly, even when the hormonal status was controlled after surgery and/or somatostatin analogue treatment. The persisting conformational change of DDs suggests a modification in cellular tensegrity, perhaps initiated by hormonal effects and probably maintained by alterations in the ECM interactions.

Some cutaneous disorders can be treated by light under specific modalities. Balneotherapy, UVA phototherapy, PUVAtherapy, TL 01 phototherapy, extracorporeal photochemotherapy and external photodynamic therapy are representatives of this group of treatment modalities.

The physiological responses to ultraviolet light exposure can be immediate, early or delayed. Typical examples include actinic erythema, suntan, the telogen actinic effluvium, ephelids, lentigines, some melanocytic naevi, and actinic wrinkles.

A series of viral and bacterial diseases are photoaggravated. Some autoimmune connective tissue disorders including lupus erythematosus and dermatomyositis are also affected. This category of photoexacerbated diseases also encompasses some cases of atopic dermatitis, lichen and rosacea.

Numerous types of lasers can exert different and specific effects in the skin. Devices delivering high intensity of pulsed light can exert similar effect.

Genophotodermatoses can result from a defect in melanin synthesis, a defect in DNA repair or a congenital photosensibility.

Dietary deficiencies are multiple and some of them may induce specific changes in the skin biology and structure. Vitamin A deficiency is well identified as a cause of xerosis and follicular keratosis. Skin of the forehead and balding scalp was examined in 3 homeless alcoholic men who suffered from altered liver functions and denutrition including carotene and vitamin A deficiencies. The ultraviolet light-enhanced visualization (ULEV) method was used with a computer-assisted video camera equipped with an internal ultraviolet-emitting unit. Twenty healthy age- and phototype-matched men served as controls. Subclinical alterations of the stratum corneum and tiny follicular horny spikes at the skin surface were disclosed by ULEV. They were consistent with discrete flakiness on the forearms. By contrast, skin of the face and scalp showed follicular horny impactions corresponding to kerosis without any evidence for interfollicular xerosis. The skin condition was markedly improved after a 10-week dietary normalization. It is concluded that the ULEV method reveals some of the mildest and subclinical skin changes secondary to carotene and vitamin A deficiency. It could tentatively be used as a cheap and non-invasive aid in clinical screening programs among populations at risk.

Obesity is a chronic multifactorial disease representing a major health problem. Among its consequences, diverse facets of the cutaneous physiology are altered. Some dermatoses are also more prevalent. The most typical ones are acanthosis nigricans, skin tags, signs of hyperandrogeny, striae distensae, stasis acroangiodermatitis, leg ulcers, lymphoedema and intertrigo.

Histiocytes belong to distinct groups of cells. Similarly, histiocytoses represent some pathologic expressions of the various histiocyte lineages recognized by their distinct phenotypes. The recognition of four major histiocytosis types relies on the distinction between monocytes-macrophages, dermal dendrocytes, Langerhans cells and the so-called indeterminate cells. Each of these groups exhibits a distinctive clinical and histological presentation. The risk of internal involvement, the prognosis and therapy are different as well. The diagnostic mainly relies on the clinico-pathologic assessment, and more particularly on the combination of histological, immunohistochemical and ultrastructural examinations.

Alport's syndrome is a severe hereditary renal disease. Type IV collagen is abnormal in its molecular composition both in the kidneys and the skin. Immunohistochemistry performed on a conventional skin biopsy allows to prove the diagnosis in the affected subjects and in healthy women exhibiting the mutation on a single X chromosome.

A series of gastro-intestinal diseases exhibits some connection with various cutaneous lesions. Some skin manifestations are clinically or histologically evocative, while others lack specificity. These manifestations can occur in overt digestive disease or be the clue for a silent one. A careful skin examination can thus reveal some inflammatory or neoplastic diseases of the gastro-intestinal tract, a malabsorption syndrome or food intolerance.

Cutaneous cystic-like lesions do not always correspond to real epithelial cysts. Indeed, the histological examination may identify another benign tumour. But, in some instances, the surprise may be greater. We report three patients in whom lesions suggested clinically small cysts. However, they were malignant neoplasms corresponding to a malignant fibrous histiocytoma, an epithelioid angiosarcoma and a metastatic adenocarcinoma, respectively.

Imiquimod is the first drug of a new therapeutic class encompassing cutaneous immune response modifiers. This molecule induces the synthesis and release of macrophage-related cytokines. It boosts some local immune responses. These properties are used to treat cutaneous viral condylomas. Other prospective therapeutic goals are presently scrutinized.

The alpha, beta and gamma recombinant interferons are indicated in a growing spectrum of therapeutic indications. Some unwanted side effects occur on the skin. The main clinical presentations include vesiculo-bullous sometimes infiltrated dermatitis, vasculitis, necrosis, ulceration and alopecia. Exacerbation of dermatoses such as psoriasis is also possible.

Winter sports are responsible for various dermatoses which could be often avoided by simple preventive procedures. Both the severity and duration of cold exposure combined with wind speed, altitude and environmental hygrometric value govern the potential types of cold injuries.

Several compounds listed as illicit doping agents can express some effects on the skin. The cutaneous signs are diverse. The clue of the intake of such compounds can be supported by objective non-invasive biometrological assessments. However, such evaluations do not bring the irrefutable proof. The skin can also present unwanted reactions indicating intolerance to the doping agent. Such physiopathological manifestations are not limited to the sport competition, but can also affect some groups of the population searching for a look reminiscent of the ideal young and performing athlete.

Cutaneous pseudolymphomas represent an heterogeneous group of tumours resembling true lymphomas by some aspects. Most often, they are and remain benign. For some lesions, the term prelymphoma should be preferred. Searching for an etiology is important because the eradication of the cause can clear the lesion.

Tropical dermatology is rooted in a multi-faceted array of geographic, climatic, ecologic, economic, socio-cultural, demographic and genetic factors. The poor sanitary conditions, the rudimentary dwelling and malnutrition foster especially some infectious and parasitic dermatoses.

Malakoplakia is a rare chronic disease with pleomorphic presentations. It involves many organs, particularly the urinary and gastro-intestinal tracts. It is less common on the skin. Lesions result from impaired phagocytosis of bacteria by macrophages. Malakoplakia is sometimes related to immunodeficiencies. The diagnosis is usually made by histological examination. We report a case associated with a myelodysplastic syndrome.