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Lichenoid keratosis, also defined as benign lichenoid keratosis, was reclassified as lichen planus-like keratosis by Shapiro and Ackerman. Clinical and dermoscopic features of lichen planus-like keratosis can vary, often not providing useful and necessary information to perform an accurate diagnosis without performing a biopsy or histological examination. We describe 2 difficult to detect lichen planus-like keratosis cases in which we performed reflectance confocal microscopy. We underline the usefulness of this noninvasive diagnostic tool in the unclear cases of lichen planus-like keratosis.

The emergence and rapid spread of multidrug-resistance in human pathogenic microorganisms urgently require the development of novel therapeutic strategies for the treatment of infectious diseases. From this perspective, the antimicrobial properties of the natural plant-derived products may represent an important alternative therapeutic option to synthetic drugs. Among medicinal plants, the Cardiospermum halicacabum L. (C. halicacabum), belonging to Sapindaceae family, could be a very promising candidate for its antimicrobial activity against a wide range of microorganisms, including both Gram-positive and Gram-negative bacteria, as well as fungal pathogens. Although the antimicrobial properties of C. halicacabum have been intensively studied, the mechanism/s by which it exerts the inhibitory activity towards the pathogenic microbes have not yet been completely understood. This review focuses on the main antimicrobial activities displayed in vitro by the plant extract, with particular attention on our recent advances. We demonstrated that C. halicacabum is able to exert in vitro a dose-dependent fungistatic effect against Trychophyton rubrum (T. rubrum) through molecular interaction with the fungal heat shock protein (Hsp)-90 chaperone. These findings are supported by a growing body of research indicating the crucial role played by the Hsp90 in the virulence of the pathogenic microorganisms, including fungal pathogens. The possible future use of C. halicacabum for treating a wide range of infectious diseases is also discussed.

BACKGROUND: The reasons for the appearance of acne in adulthood are largely unknown. OBJECTIVE: We explored the role of personal and environmental factors in adult female acne. METHODS: We conducted a multicenter case-control study in the outpatient departments of 12 Italian cities. Cases (n = 248) were consecutive women ≥25 years of age with newly diagnosed acne of any grade. Controls (n = 270) were females diagnosed with conditions other than acne. RESULTS: In multivariate analysis, a history of acne in parents (odds ratio [OR] = 3.02) or siblings (OR = 2.40), history of acne during adolescence (OR = 5.44), having no previous pregnancies (OR = 1.71), having hirsutism (OR = 3.50), being an office worker versus being unemployed or being a housewife (OR = 2.24), and having a high level of reported psychological stress (OR = 2.95) were all associated with acne. A low weekly intake of fruits or vegetables (OR = 2.33) and low consumption of fresh fish (OR = 2.76) were also associated with acne. LIMITATIONS: We did not establish an onset date for acne. Some of our associations may reflect consequences of established acne. CONCLUSION: Lifestyle factors may play an important role for acne development in adulthood, but their role should be further assessed in prospective studies.

Background: Few data are available on the prevalence of common skin disorders like actinic keratoses in the general population. Such data are mostly needed to better define health needs and to organize medical services. The Prevalence of Actinic Keratoses in the Italian Population Study (PraKtis) was designed to estimate the point prevalence of actinic keratoses and related disorders, e.g. photoaging, in a representative sample of the Italian population. Within the study, information on the history of relevant dermatological diagnoses was also collected. Methods: The study was conducted in collaboration with DOXA, the Italian branch of the Gallup International Association. A representative sample of people aged 45 years or older was selected by picking them from the electoral rolls according to a stratified random sampling design involving a replacement procedure. A total of 180 interviewers specifically trained to collect data on skin diseases and to take photographs of representative lesions on the face and upper limbs, contacted and interviewed the sampled subjects and performed a face-to-face computer-assisted interview. A final sample of about 12,000 subjects was foreseen. Results: The pilot phase of the study was conducted between January 1 and June 30, 2003. A total of 3,660 subjects were recruited and interviewed. Overall, an estimated 37% of Italian people reported having ever undergone a dermatological consultation in the past. An estimated 29% reported having ever received a specific dermatological diagnosis by a physician. The frequency of specifically enquired diagnoses, weighted according to the distribution of the Italian population, was as follows: atopic dermatitis 4.7%, other eczematous dermatitides 4.3%, urticaria 4.3%, psoriasis 3.1%, skin tumors 1.6%, vitiligo 0.7% and actinic keratoses 0.3%. Conclusion: Skin diseases are frequently reported. The prevalence of actinic keratoses according to self-reported diagnoses was lower than expected based on prevalence data obtained by directly examining people. These discrepancies may be due to underreporting and/or unawareness of lesions by affected people. More precise estimates will be obtained by direct examination of sampled people.

Autosomal dominant gain of function mutations in caspase recruitment domain family member 14 (CARD14) were found to cause plaque psoriasis in two families and severe generalized pustular psoriasis as a monogenic form of childhood (CARD14-mediated psoriasis, CAMPS) [1]. CARD14 mutations have also been implicated in plaque-type psoriasis and pityriasis rubra pilaris [2].

Psoriasis is a chronic inflammatory disorder of the skin characterized by epidermal hyperplasia and infiltration of leukocytes into the dermis and epidermis. T cell-derived cytokines, such as IFN-γ and IL-17A, play a major role in the psoriasis-associated epidermal hyperplasia, even though factors/mechanisms that regulate the production of these cytokines are not fully understood. We have recently shown that IL-21 is synthesized in excess in psoriatic skin lesions and causes epidermal hyperplasia when injected intradermally in mice. Moreover, in the human psoriasis SCID mouse model, neutralization of IL-21 reduces both skin thickening and expression of inflammatory molecules, thus supporting the pathogenic role of IL-21 in psoriasis. However, the basic mechanism by which IL-21 promotes skin pathology remains unknown. In this study, we show that CD4+ cells accumulate early in the dermis of IL-21–treated mice and mediate the development of epidermal hyperplasia. Indeed, IL-21 fails to induce skin damage in RAG1-deficient mice and CD4+ cell-depleted wild-type mice. The majority of CD4+ cells infiltrating the dermis of IL-21–treated mice express IFN-γ and, to a lesser extent, IL-17A. Studies in cytokine knockout mice show that IFN-γ, but not IL-17A, is necessary for IL-21–induced epidermal hyperplasia. Finally, we demonstrate that IFN-γ–producing CD4+ cells infiltrating the human psoriatic plaque express IL-21R, and abrogation of IL-21 signals reduces IFN-γ expression in cultures of psoriatic CD4+ cells. Data indicate that IL-21 induces an IFN-γ–dependent pathogenic response in vivo, thus contributing to elucidate a mechanism by which IL-21 sustains skin-damaging inflammation.

Case 1. A 54 year old woman affected by chronic asthmatic bronchitis from the age of 11 years and ulcerous recto-colitis from 15 years, presented several erythematous-violaceous macules from the trunk including abdominal region to all skin surface except the face. Case 2. A 17 year old woman presented a similar hyperpigmentation in the same areas. In both patients histology showed a thin epidermis with vacuolar changes of basal layer and apoptotic bodies and melanophages rich in melanosomes in the papillary dermis. Our diagnosis was Ashy dermatitis. Clinico-pathological correlations and treatment options are discussed.