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Background: Disseminated granuloma annulare is a rare clinical variant of granuloma annulare.inflammatory skin condition with unknown etiopathogenesis. Objective: To study clinical aspects of granuloma annulare and its relationship with coexisting pathology and therapeutic options. Methods: We performed a retrospective study in the Craiova Dermatology Clinic on cases of patients hospitalized with disseminated granuloma annulare during 2015-2023. A total of 21 patients were evaluated and monitored for a year after initial diagnosis. Results: We found the following associated pathology: type 2 diabetes mellitus (12 cases), dyslipidaemia (11 cases), overweight and obese (10 cases), hypothyroidism (4 cases), rheumatoid arthritis (1 case) and neoplastic disease in 4 patients. Treatment was complex and effective. Conclusion: Patients with disseminated granuloma annulare should be investigated for internal disease. [ABSTRACT FROM AUTHOR]

Psoriasis is a chronic auto-immune disease that affects 2-3% of the general population. It is associated with a series of conditions such as psoriasis arthritis, metabolic syndrome, cardiovascular disease, inflammatory bowel disease, psychiatric manifestations. This review aims to highlight the common pathogenic pathway of psoriasis and comorbidities, especially metabolic syndrome (MetS) and, according to the literature, their evolution with systemic therapy. We conducted an observational study on 51 patients with psoriasis. The metabolic syndrome defined according to National Cholesterol Education şi ATP III criteria (Adult Treatment Panel guidelines), was seen in 54,90% of cases. The common pathogenic pathway of psoriasis and metabolic syndrome is represented by chronic inflammation and cytokines as TNF a and IL 6, IL17 are seen in both cases. Despite the numerous efforts to elucidate the pathogenesis of MetS, the relation between psoriasis and its different components remains complex and fairly unclear. [ABSTRACT FROM AUTHOR]

Relapsing polychondritis is a rare, autoimmune inflammatory condition that involves cartilaginous structures, predominantly those of the ears, nose, and tracheobronchial tree. Other affected structures may include the cardiovascular system, peripheral joints, skin, middle and inner ear, eyes, and central nervous system. Systemic corticosteroid therapy is the treatment of choice. In recent decades, viral infections have been proposed as environmental factors that trigger autoimmunity in genetically predisposed individuals. Respiratory viruses, especially parainfluenzae and coronaviruses, have been associated with the onset of rheumatoid arthritis, while growing evidence describes the occurrence of autoimmune disorders in COVID-19. Clinical case. A 31-year-old patient presented in October 2020 fur infiltrated erythematous-edematous plaques, highly painful, located in the auricles, bilaterally. The disease started a month ago. The patient applied the antibiotic and dermatocorticoid cream locally, without a favorable evolution. From the medical history we notice that the patient presented 4 months ago pain in the radio-carpal joints, later in the joints of the knees and ankles far which she presented to the Rheumatology department. Two weeks ago, she presented with pain in the nasal pyramid and at the eye level. She was diagnosed with chronic hypertrophic rhinitis and conjunctivitis, respectively. The pharyngeal exudate showed Klebsiella pneumoniae present. The other laboratory tests were within normal limits. The patient had a history of asymptomatic infection with SARS-VOC-2 virus, diagnosed by highlighting specific antibodies during investigations to establish the etiology of polychondritis. We performed a biopsy of a fragment of the skin, along with the underlying cartilage, in the pavilion of the left ear. Based on the clinical examination and the histopathoiogical examination, we specified the diagnosis of relapsing polychondritis. We started treatment with Methylprednisolane 32 mg /day, Famotidine 40 mg / day, Rupatadine 10 mg / day, Levofloxacin 500 mg / day, with a slightly favorable evolution. Methotrexate 10 mg/ week treatment was also initiated in December 2020. Discussions. Relapsing polychondritis is a pro-gressive autoimmune condition that affects several organs and tissues. Early recognition of the signs of this rare disease and prompt initiation of anti-inflammatory and immunosuppressive therapy can relieve symptoms and prevent complications, especially those affecting the respiratory tract and heart. Conclusions. The number of case reports describing autoimmune phenomena in COVID-19 is increasing, and these conditions may involve different organs and systems. Although the chronology of pathologies in our case suggests the possible involvement of SARS-CoV-2 infection in the occurrence of Polychondritis, we mention that so far no cases of relapsing Polychondritis associated with this viral infection have been reported. [ABSTRACT FROM AUTHOR]

Introduction. Lymphedema is an excessive regional interstitial accumulation of protein-rich fluids. It can be primary, mainly caused by congenital hypoplasia (Meige's disease) or lymphatic vessel agenesis (Milroy's disease). Infections, malignancies, chronic venous stasis, ionizing radiation, obesity, and congestive heart failure are common causes of secondary lymphedema. Although cutaneous tuberculosis may be accompanied by limgangitis, its association with chronic lymphedema is rarely mentioned in the literature. Case report. A 70-year-old man, attended the Dermatology Clinic due to the appearance of permanent, indurated and infiltrated edema of the right lower limb, with translucent papules on the skin The patient also presented at the level of the right calcaneal region a hyperkeratotic lesion, 1.5 cm in diameter, with an ulcerated center (the clinical appearance suggests a tuberculosis verrucosa cutis). From the medical history we highlight that, 7 years ago, after a sting in the right calcaneal region, an abscess formed at the site of the sting which was curetted in the Surgery Department, but which recurred. After about 6 months, the right lower limb began to grow in diameter due to significant edema. For chronic lymphedema, the patient was treated with Detralex, Pentoxi Retard, Vessel Due F prior to hospitalization, with no notable results. The histopathological examination pleaded for the diagnosis of cutaneous tuberculosis. Specific treatment with tuberculostatics (Isoniazid 300 mg, Rifampicin 600 mg, PyrazinamideWOO mg, Ethambutol 1600 mg,7P) was initiated, with a duration of 9 months, the evolution being favorable with the disappearance of the verrucous lesion from the right calcaneus region, with decreased lymphedema and disappearance of papules in the right lower limb. Discussions. Tuberculosis verrucosa cutis (TVC) is the most common form of exogenous paucibacillary tuberculosis. It is the result of primary inoculation in previously tuberculin-sensitive individuals who maintain moderate to high immunity to M. tuberculosis. It is either self-inoculation or heteroinoculation following an accidental or professional contact. Secondary bacterial infection and chronic lymphedema are possible complications of extensive lesions that usually affect the extremities. TVC can persist for many years if not treated properly. Usually, there is a favorable response to antituberculosis therapy, as in our case. Conclusions. Chronic lymphedema associated with tuberculosis verrucosa cutis can be cured by long-term treatment with tuberculostatics. Early diagnosis and treatment of cutaneous tuberculosis are essential to reduce complications. [ABSTRACT FROM AUTHOR]

Introduction. The verrucous carcinoma is a type of squamous carcinoma that is highly differentiated, relatively uncommon, locally aggressive, with slow growth and minimal metastatic potential. Clinical case. A 48-year old man was admitted to the Dermatology department of the Craiova Hospital for a round-oval tumoral mass that was hyperkeratotic, with central ulceration, covered by a hematic crust, approximately 1.5cm in size, localized at the distal phalanx of the third finger left hand, with perilesional edema and erythema. The wart-like lesion appeared 8 months beforehand, which the patient has traumatized repeatedly in the last 2 months. The histopathological examination confirmed the diagnosis of verrucous carcinoma. The X-ray examination revealed external margin osteolysis of the distal epiphysis in the third finger, left hand. The patient was transfered to the Plastic surgery department where the distal phalanx of the third finger, left hand was amputated. Discussions. Risk factors for the development of verrucous carcinoma are HPV infection, carcinogenic chemicals, smoking, chronic inflammation, repeated trauma, etc. Diagnosis is suspected by clinical appearance and confirmed histopathologically. The treatment of choice is surgical excision due to the high risk of recurrence and local invasiveness, and in the case of an advanced tumor with acral localization, amputation is preferred, as is our case. Conclusions. Verrucous carcinoma is a type of squamous carcinoma that is highly differentiated, with slow and continuous invasion of the underlying tissues. In order to establish the diagnosis of verrucous carcinoma, it is necessary to corroborate the clinical examination with histopathological and evolutionary examinations. The treatment of choice is surgical excision, but given the increased risk of recurrence, the patient should be evaluated periodically until complete healing. Our case is interesting by localization and rapid evolution with the invasion of the underlying tissues. [ABSTRACT FROM AUTHOR]

Introduction. Leukemia cutis is a rare cutaneous leukemia-specific manifestation and is characterized by infiltrates with paraneoplastic leukocytes or their precursors located in the dermis, subcutaneous tissue, cutaneous annexes and blood vessels. Several terms have been used to describe the various leukemia cutis mani-festations in acute myeloblastic leukemia: the granulocytic sarcoma, the monocytic sarcoma, primary extramedullary leukemia and the chloroma. Clinical case. A 65-year old man from the urban area under evidence of the Hematology Department since August 2018 for acute promyelocytic leukemia (AML-M3 in the FAB classification) was consulted in the Craiova Dermatology Department in January 2019 for several nodular tumor masses that were firm, reddish, of 0.2-2 cm, well defined, located in the left inguinal, lumbar, anterior thorax and scalp areas. The tumor masses appeared 3 weeks ago. The patient received remission induction therapy with cytarabine, idarubicin and all-trans retinoic acid (ATRA), obtaining complete remission (blasts 2-3%), then he continued with consolidation treatment with cytarabine, epirubicin and ATRA. The histopathological aspect and the immunohistochemical staining are compatible with a myeloid sarcoma (extramedullary determination of acute myeloblastic leukemia). The immunophenotyping from marrow aspirate, repeated in the Hematology Department in February 2019 suggested a diagnosis of acute promyelocytic leukemia with positive residual disease which means a relapse. The cutaneous lesions have regressed after hematologic retreatment, with some leftover pigmented spots on the torso. The patient is currently under treatment with cytarabine. Discussions. The incidence of cutis leukemia depends on the type of leukemia, with a frequency of 2-18% of cases in acute myeloblastic leukemia. The physiopathology that underlies the leukemic cell migration to the skin is not clear. Most cases of leukemia cutis in acute promyelocytic leukemia that were described in literature were associated with the use of ATRA, that is associated with a high incidence of extramedullary diseases as relapse after complete remission. There is the possibility that ATRA and anthracyclines may not reach the places where extra-medullary infiltrates occur. Clinically, LC can look like erythematous papules or nodules in 60% of cases. Because of the unspecific clinical aspect of the skin lesions, the cutaneous biopsy and the bone marrow biopsy are necessary for establishing the diagnosis. The prognosis of patients with LC is unfavorable, many also having other extramedullary presentations of leukemia. The treatment of leukemia cutis involves the treatment of the underlying disease. Conclusions. Leukemia cutis is a skin marker of hematologic malignant disease but it is a rare manifestation in acute promyelocytic leukemia. Treatment with ATRA can induce leukemia cutis occurrence. The correct diagnosis of leukemia cutis creates the prerequisites for diagnosing the systemic disease and highlights the leukemia relapse, similar to our case. [ABSTRACT FROM AUTHOR]

Clear cell acanthoma is an uncommon, benign lesion, usually present in middle-aged and elderly patients. It looks like an erythematous papule, solitary, with squama at the periphery, regularly located on the lower limbs. We present the case of an 80-year-old female, who was admitted in the Dermatology Clinic of Craiova for an infiltrative plaque, erythematous-squamous-crusty, well delimited, with sizes 1,2/1,5cm, polycyclic shape, located in the right groin. The onset of the condition was 7-8 years ago, with slow growth in size. The excision of the lesion was performed and the histopathological examination confirmed the diagnosis of clear cell acanthoma. Our case is atypical by location. Because clear cell acanthoma is difficult to be clinically diagnosed, with a wide range of lesions that make a differential diagnosis, we highlight the importance of histopathological examination for a positive diagnosis. The treatment depends on the type of lesion and on the patient's preference, usually consisting in surgical excision. [ABSTRACT FROM AUTHOR]

Verrucous carcinoma is a well differentiated type of squamous cells carcinoma, which may interest both the skin and mucous membranes. It is characterized by local invasion with minimal dysplasia and has a reduced metastatic potential. Clinical case. We present the case of an 80-year-old rural patient with verrucous carcinoma, with the objective to highlight the clinical-evolutionary, histopathological and therapeutic aspects of this disorder. The treatment was hemivermillonectomy, and the post-surgical development was favorable. Discussions. Ackerman's verrucous carcinoma is also known as oral florid papillomatosis, a term created by Rock and Fisher in 1960. Wechsler and Fisher have highlighted the aggressive but clinically benign local nature of the disease by using the term "oral florid papillomatosis". Oral verrucous carcinoma may extend to underlying tissue and regional lymph nodes. Therapy for oral verrucous carcinoma is a challenge, because recurrences and anaplastic transformation are frequent after radiotherapy. Surgical treatment is superior, but radiotherapy is generally considered to be a last resort. Conclusion. Patients with verrucous carcinoma should be closely monitored, as they may develop second cancer, an aggressive epidermoid carcinoma, or anaplastic transformation of a pre-existing verrucous carcinoma. [ABSTRACT FROM AUTHOR]

Penile squamous cell carcinoma occurs more frequently after 50 years in uncircumcised men, usually with phimosis. It can develop on the following precancerous lesions: erythroplasia of Queyrat, penile cutaneous horn, genital lichen sclerosus, leukoplakia, pseudoepitheliomatous keratotic and micaceous balanitis, Buschke-Lowenstein condylomatosis, Bowenoid papulosis. It has poor prognosis due to invasion depth and increased risk of metastasis. We present the case of a 56-year-old man who developed an invasive penile squamous-cell carcinoma after a six-year history of Bowenoid papulosis. Circumcision was performed with very good postoperative evolution. The patient has been followed-up for three years with no complications. In conclusion, persistent high-risk human papillomavirus infection in a smoker, uncircumcised man can cause squamous cell carcinoma. [ABSTRACT FROM AUTHOR]

Tattoos have been used for over 2000 years. Nowadays, the frequency of tattoos has been growing, especially among young people. In many countries, more than 25% of the population has a tattoo. Lately, the medical world is trying to increase the awareness concerning tattoos and the multiple risks they carry, like allergic reactions, lichenoid reactions, sarcoidosis, scleroderma-like reactions, viral, bacterial and fungal infections, benign tumors, pseudolymphomas, chronic lymphoid hyperplasia. Rarely, malignant tumor can develop on the tattoo surface. Clinical case: A 25 year old male has been admitted in our clinic presenting infi ltrative, erythematous, scaly plaques, with yellow crusts on the surface, placed on the left arm and right leg, on the surface of two tattoos, only on the areas with red pigment. The patient had these symptoms for over one year. The tattoos were made two years before coming to the hospital. The cutaneous lesions were surgically removed and a histopathological exam was performed, revealing chronic granulomatous infl ammatory infi ltrate, with giant cells and eosinophilic necrosis areas. Discussions: In order to make a tattoo, body artists use multiple pigments, by themselves or in different combinations. The red pigment used in tattoos can be organic (santal wood, Caesalpinia echinata – both vegetal dyes) or inorganic (cadmium, mercury, selenium, sienna, the last one is an iron hydrate). There are several cutaneous reactions to the pigments found in tattoos: infl ammatory reactions, allergic reactions, granulomatous reactions, lichenoid reactions and pseudolymphomatous reactions. Conclusions: 1) The granulomatous reaction is a complication that occurs frequently after red pigment tattoos; and 2) The patients need to be thoroughly investigated in order to rule out a foreign body reaction, sarcoidosis, an infectious disease (tuberculosis, mycobacteria infections, leprosy, leishmaniasis, and fungal infections), granuloma annulare, and iatrogenic granulomatous disease after the use of ribavirin, interferon, anti-TNF  medication, ipilimumab. [ABSTRACT FROM AUTHOR]

Granuloma annulare and necrobiosis lipoidica are granulomatous diseases with an unclear etiology. The presence of both pathologies in the same patient is quite rarely reported. Clinical case: We present a 75-year-old patient, from urban environment, with disseminated granuloma annulare and necrobiosis lipoidica, and we aim to point out the clinical progress as well as the histopathological and therapeutic aspects of both diseases. After paraclinical investigations, the patient was also diagnosed with diabetes mellitus. The recommended treatment was Ofl oxacin 400 mg/day, Doxycycline 100 mg/day and Rifampicin 150 mg (2 cps. every 12 h) for three consecutive days/month over a period of four months, and 0.1% Tacrolimus (one application/day in the evening). The 4-month evolution since the beginning of the treatment has been favorable only for the granuloma annulare lesions. Discussions: Granuloma annulare and necrobiosis lipoidica can be associated with diabetes mellitus and more frequently affect women. The concurrent occurrence of both diseases has been rarely reported, only 11 cases presenting this association. There is no standard treatment for the two diseases. The favorable result of the therapy using cyclins is due to the anti-infectious, anti-infl ammatory and immunomodulatory actions of these agents. Conclusion: The association of the two diseases is very rare and we require further investigations to elucidate common pathogenic mechanisms and establish optimal therapy. [ABSTRACT FROM AUTHOR]

Angiolymphoid hyperplasia with eosinophilia is a benign vasculo-proliferative disease, predominantly found in middle-aged women (20-50 years old) and with exceptionally cases reported in children or elderly. We report the case of a male patient who developed multiple lesions of angiolymphoid hyperplasia with eosinophilia in the seventh decade of life. A 63-year-old man, without pathological antecedents presents with 6 nodular reddish lesions, 2-4 mm in size, moderately itchy, located in the left retroauricular region. Based on anamnesis, clinical examination, histopathological exam and other laboratory tests, we established the diagnosis of Angiolymphoid hyperplasia with eosinophilia. After complete excision, immediate repair of the defect was performed using advancement flaps from the declive aria. After a 9-months follow-up there was no evidence of recurrence. Considering the possible internal organ involvement, we recommend a quarterly follow-up of the patient for an early diagnosis of other pathological conditions that can lead to a poor vital prognosis. [ABSTRACT FROM AUTHOR]