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Desmoplastic melanoma accounts for 5% of all cases of melanoma, but its diagnosis can be difficult due to its frequent clinical presentation with amelanotic lesions. Histologically, spindled melanocytes surrounded by a collagenous stroma are observed. Compared with other types of melanoma, the desmoplastic types presents greater local aggression, and is more prone to local recurrence, but has a lower risk of lymph node metastasis. Early detection, accurate staging, and proper surgical management are the main factors associated with higher survival rates in melanoma patients. Reflectance confocal microscopy (RCM) has proven to be a valuable imaging tool in the diagnosis of skin neoplasms, being useful for orientating practitioners towards the diagnosis of melanoma and indicating the necessity of performing a diagnostic biopsy. We present the case of 52-year-old woman, who presented to the dermatology department with an irregular, dark-colored plaque in the right deltoid region. Dermoscopy showed asymmetry with an atypical network and some areas of regression. RCM revealed pagetoid cells in the upper epidermis, cell atypia, non-edged papillae, dermal inflammation, and nucleated cells in the dermis, which are highly suggestive of melanoma. A biopsy was also performed. A histopathology exam confirmed the diagnosis of superficially spreading melanoma with a desmoplastic component, and revealed a Breslow index of 0.9 mm, Clark level IV, an absence of mitoses, angiolymphatic invasion and regression, and complete excision. The CT and PET-CT scans were negative. A biopsy of the axillary sentinel lymph node was conducted, with a negative result obtained, establishing the IB stage of the disease. The patient will remain under follow-up to look for a recurrence or a new primary melanoma. [ABSTRACT FROM AUTHOR]

Tinea capitis is a dermatophyte scalp infection with a marked prevalence among the pediatric population. However, in the last few years, its epidemiology has changed due to increasing population migration worldwide. Host-specific and environmental factors contribute to the pathogenesis of tinea capitis. Clinically, tinea capitis may present as a subtle hair loss accompanied by scalp scaling, alopecia with scaly patches, or alopecia with black dots. A more severe form of tinea capitis is represented by kerion celsi, which clinically presents as a tender plaque covered by pustules and crusts. If left untreated, this dermatophytic infection may resolve with permanent scarring and alopecia. The pathological changes found in tinea capitis are reflected by a spectrum of clinical changes. Zoophilic infections typically prompt an extensive inflammatory reaction, while anthropophilic dermatophytoses often lack inflammation and result in more persistent lesions. Tinea capitis typically requires systemic antifungal therapy. Griseofulvin, terbinafine, itraconazole, and fluconazole are the main antifungal agents used. Currently, the duration of antifungal therapy varies based on the clinical presentation and type of dermatophyte involved. Through the reported cases and literature review, we aim to emphasize the importance of the early recognition of atypical variants of tinea capitis in immunocompetent children for the prompt initiation of systemic antifungal therapy, minimizing the need for prolonged treatment. Additionally, we emphasize the importance of regular laboratory testing during systemic antifungal therapy, particularly liver enzyme tests, to prevent adverse events, especially in cases requiring long-term treatment. [ABSTRACT FROM AUTHOR]

Ultrasonography is a well-tolerated procedure that aids in the targeted esthetic therapies of special cutaneous regions, as well as in the prevention (vascular mapping, identification of previous filler, and others) and management of potential complications (vascular occlusion, external vascular compression, product misplacement or migration, inflammatory reactions, and others). It has lately been promoted as the first-line imaging tool to address injectables. In this article, we aim to review the evolving role of ultrasonography in cosmetic filler procedures, from the fundamental ultrasound characterization of cosmetic fillers to the ultrasound-enhanced detection and management of cosmetic filler complications, including ultrasound's role in hyaluronidase-guided injections for cosmetic filler dissolution. Furthermore, the paper explores the integral role played by ultrasound in enhancing the precision, efficacy, and safety of additional minimally invasive aesthetic techniques such as mesotherapy, radiofrequency, cryolipolysis, and polydioxanone procedures. [ABSTRACT FROM AUTHOR]

Choledochal cysts (CCs) are rare occurrences presenting as dilatations of biliary structures, which can present as single or multiple dilatations and can appear as both intra- and extrahepatic anomalies. The most widespread classification of CCs is the Todani classification, but there have been numerous reports of cysts that do not fall into any of the types described. We present such a case—a male patient 36 years of age who underwent preoperative CT, MRCP, and ERCP, which mistakenly indicated a type II Todani CC, and intraoperatively was found to be located at the confluence of the hepatic ducts and encompassed the origin of the common bile duct. Complete resection of the cyst and the proximal segment of the common bile duct was performed, and reconstruction was carried out by Roux-en-Y double-tutorized hepaticojejunostomy. Considering the risk of malignant transformation, the frequent preoperative misdiagnosis, as well as the technically challenging surgery required in such cases, we advocate for a revision of the classification and raise awareness of the need for guidelines regarding the proper short-term and long-term management of this disease to ensure adequate quality of life and disease-free survival for patients. [ABSTRACT FROM AUTHOR]

Juvenile xanthogranuloma represents the most common form of non-Langerhans cell histiocytosis. It is tipically a childhood disorder, over 80% of cases developing in the first year of life. Adult onset xanthogranuloma is instead exceedingly rare; our literature research revealed a total number of only 35 cases reported to date. Cases with multiple cutaneous lesions occurring during adulthood are even rarer. The pathogenesis of the disease is incompletely understood and the possibility of extracutaneous involvement is uncertain.Although adult xanthogranulomatosis is not considered a paraneoplastic phenomenon, association with haematological malignancies is very frequent, therefore patients should be thoroughly investigated and closely monitored. We report a case of multiple xanthogranulomas developing in an otherwise healthy adult female patient and review the literature regarding this uncommon disease. [ABSTRACT FROM AUTHOR]

Background: Background atopic dermatitis patients generally respond to conventional therapies. A small proportion of them have severe disease despite intensive treatment. Efficacy of intravenous immunoglobulin (IVIg) in severe, refractory atopic dermatitis has been reported. Materials and methods: We present the cases of five children with severe atopic dermatitis. All patients were previously and/or currently treated with systemic steroids, phototherapy and a large selection of topical agents. Immunosupressive therapy was refused by their legal representatives. Due to financial restraints, low dose IVIg was administered (approximately 0.3 g/kg/month for six months), while the corticosteroid dose was tapered. Disease outcome was measured using the eczema area and severity index (EASI) and the children’s dermatology life quality index (CDLQI). Results: All five patients experienced clinical improvement with significantly reduced EASI and CDLQI scores. No adverse reactions were reported. During the six months follow-up period, no disease flare occured in any of the patients. Conclusions: Adjunctive IVIg is a useful therapeutic approach in selected patients with refractory atopic dermatitis. Even if most of the reported cases refer to high dose IVIg, low dose regimens are not to be discarded, since they can provide satisfactory results with reduced in-patient costs and high compliance. [ABSTRACT FROM AUTHOR]

Intravascular papillary endothelial hyperplasia (IPEH) is an uncommon benign vascular lesion generated by an exaggerated endothelial proliferative response to vascular injury. It represents 2-4% of vascular tumors arising in the skin and soft tissue. Complete surgical excision is curative. Unfortunately, it is frequently confused with other vascular or soft tissue tumors. Therefore, promptly establishing the correct diagnosis helps avoid useless extensive investigations and overtreatment. We report a case of IPEH that developed on the skin of the lower left abdominal area in a 40-year-old female patient in the absence of previous local trauma or vascular anomalies. [ABSTRACT FROM AUTHOR]

Background: Erythroderma may be secondary to several skin diseases, drug reactions, infections, and internal malignancies. Skin lesions usually have an unfavorable course until the underlying disease is treated, therefore a thorough search for the cause of erythroderma is mandatory. Case report: We present the case of a 51-year-old female patient who presented with an erythroderma of unknown etiology of 6 months duration. Extensive screening for the cause of erythroderma lead to the diagnosis of left ovarian papillary serous carcinoma invasive to the epiploon, parietal peritoneum and the wall of the urinary bladder, stage IIC FIGO, pT2c pN0 cM0. The patient underwent surgery, followed by multiple lines of chemotherapy. Whole body computed tomography scan, measurement of serum levels of tumoral markers and dermatologic reevaluation were performed every 3 months. Results: The course of skin lesions paralleled that of the subjacent malignancy and was most favorable under platinum plus gemcitabinum and platinum plus taxanes based chemotherapy that also best controlled the neoplastic process. Conclusion: The parallel evolution of the ovarian carcinoma and cutaneous lesions firmly supports the diagnosis of paraneoplastic erythroderma in our patient. Screening for internal neoplasia should be performed in all cases of erythroderma of unknown etiology. [ABSTRACT FROM AUTHOR]

Sexually transmitted diseases represent a public health problem with extremely diverse clinical, social and economic implications, which is often underestimated by both doctors and patients. The increasing incidence of persistent or recurrent urethritis might be explained by the emergence of microorganisms resistant to the latest treatments available. In this review we aim to provide a general overview of the therapeutic management of persistent and recurrent urethritis, according to the most recent international recommendations. [ABSTRACT FROM AUTHOR]

Intravascular papillary endothelial hyperplasia (IPEH) is an uncommon benign vascular lesion generated by an exaggerated endothelial proliferative response to vascular injury. It represents 2-4% of vascular tumors arising in the skin and soft tissue. Complete surgical excision is curative. Unfortunately, it is frequently confused with other vascular or soft tissue tumors. Therefore, promptly establishing the correct diagnosis helps avoid useless extensive investigations and overtreatment. We report a case of IPEH that developed on the skin of the lower left abdominal area in a 40-year-old female patient in the absence of previous local trauma or vascular anomalies. [ABSTRACT FROM AUTHOR]

Multiple primary cancers may occur in the same patient, with a prevalence that follows an ascendant trend. Their development is dictated by a complex interplay between a variety of factors, both patient-dependent and external. The case of a 38-year-old female patient diagnosed and treated for pancreatic cancer (PC) is presented in whom the digital dermoscopic monitoring of melanocytic nevi revealed a marked change of two nevi that acquired rapidly highly atypical features. They were surgically excised and the histopathological examination revealed two completely excised dysplastic compound nevi. Clinicians should be aware of the strong association between dysplastic nevus syndrome and PC, a malignancy associated with an extremely poor prognosis. Familial atypical multiple mole melanoma syndrome (FAMMM) predisposes to the development of melanoma, pancreatic cancer and other neoplasms. The common genetic background of PC and hereditary melanoma is discussed and the importance of regular skin checkup and screening for PC in these patients is underlined. [ABSTRACT FROM AUTHOR]

Background: Erythroderma may be secondary to several skin diseases, drug reactions, infections, and internal malignancies. Skin lesions usually have an unfavorable course until the underlying disease is treated, therefore a thorough search for the cause of erythroderma is mandatory. Case report: We present the case of a 51-year-old female patient who presented with an erythroderma of unknown etiology of 6 months duration. Extensive screening for the cause of erythroderma lead to the diagnosis of left ovarian papillary serous carcinoma invasive to the epiploon, parietal peritoneum and the wall of the urinary bladder, stage IIC FIGO, pT2c pN0 cM0. The patient underwent surgery, followed by multiple lines of chemotherapy. Whole body computed tomography scan, measurement of serum levels of tumoral markers and dermatologic reevaluation were performed every 3 months. Results: The course of skin lesions paralleled that of the subjacent malignancy and was most favorable under platinum plus gemcitabinum and platinum plus taxanes based chemotherapy that also best controlled the neoplastic process. Conclusion: The parallel evolution of the ovarian carcinoma and cutaneous lesions firmly supports the diagnosis of paraneoplastic erythroderma in our patient. Screening for internal neoplasia should be performed in all cases of erythroderma of unknown etiology. [ABSTRACT FROM AUTHOR]

The pathogenesis of chronic wounds (CW) involves a multifaceted interplay of biochemical, immunological, hematological, and microbiological interactions. Biofilm development is a significant virulence trait which enhances microbial survival and pathogenicity and has various implications on the development and management of CW. Biofilms induce a prolonged suboptimal inflammation in the wound microenvironment, associated with delayed healing. The composition of wound fluid (WF) adds more complexity to the subject, with proven pro-inflammatory properties and an intricate crosstalk among cytokines, chemokines, microRNAs, proteases, growth factors, and ECM components. One approach to achieve information on the mechanisms of disease progression and therapeutic response is the use of multiple high-throughput 'OMIC' modalities (genomic, proteomic, lipidomic, metabolomic assays), facilitating the discovery of potential biomarkers for wound healing, which may represent a breakthrough in this field and a major help in addressing delayed wound healing. In this review article, we aim to summarize the current progress achieved in host–microbiome crosstalk in the spectrum of CW healing and highlight future innovative strategies to boost the host immune response against infections, focusing on the interaction between pathogens and their hosts (for instance, by harnessing microorganisms like probiotics), which may serve as the prospective advancement of vaccines and treatments against infections. [ABSTRACT FROM AUTHOR]

Simple Summary: Psoriasis is a chronic multisystem inflammatory disease associated with a wide range of comorbidities including cardiovascular disease, hypertension, diabetes, hyperlipidemia, obesity, metabolic syndrome, anxiety, depression, chronic kidney disease, and malignancy. Currently available novel therapeutic options for moderate-severe psoriasis include tumor necrosis factor alpha inhibitors, inhibitors of the interleukin 17, and inhibitors of the interleukin 23. Apart from the concomitant diseases psoriasis patients may have, biologic therapy may cause significant complications requiring close collaboration between dermatologists and physicians of different specialties. Consequently, it was our main purpose to provide an overview of each class of biologic agents, as well as of the most frequent adverse events they may cause in psoriasis patients with concomitant diseases. Psoriasis is a chronic multisystem inflammatory disease associated with a plethora of comorbidities including metabolic syndrome, cardiovascular disease, hypertension, diabetes, hyperlipidemia, obesity, anxiety, depression, chronic kidney disease, and malignancy. Advancement in unveiling new key elements in the pathophysiology of psoriasis led to significant progress in the development of biologic agents which target different signaling pathways and cytokines involved in the inflammatory cascade responsible for the clinical manifestations found in psoriasis. Currently available novel therapeutic options for moderate-severe psoriasis include tumor necrosis factor alpha inhibitors, inhibitors of the interleukin 17, and inhibitors of the interleukin 23. Nevertheless, concerns have been raised with respect to the possible risks associated with the use of biologic therapy requiring close collaboration between dermatologists and physicians of different specialties. Our aim was to perform an in-depth literature review and discuss the potential risks associated with biologic therapy in patients with psoriasis and concurrent diseases with a focus on the influence of novel therapeutic agents on liver function in the context of hepatopathies, particularly viral hepatitis. A multidisciplinary teamwork and periodic evaluation of psoriasis patients under biologic therapy is highly encouraged to obtain an accurate management for each case. [ABSTRACT FROM AUTHOR]

Tattooing is the procedure of implanting permanent pigment granules and additives into the dermal layer of the skin, serving various purposes such as decoration, medical identification, or accidental markings. There has been a significant rise in the popularity of decorative tattooing as a form of body art among both teenagers and young adults. Thus, the incidence of tattoos is increasing, with expanding applications such as permanent makeup, scar camouflage, nipple–areola, lips, and eyebrows tattooing, and utilization in oncological radiotherapy such as colon marking. However, there have been reported a broad range of adverse reactions linked to tattooing, encompassing allergic reactions, superficial and deep cutaneous infections, autoimmune disorders induced by the Koebner phenomenon, cutaneous tumors, and others. These reactions exhibit different onset times for symptoms, ranging from immediate manifestations after tattoo application to symptoms emerging several years later. Given the limited information on a tattoo's side effects, this review aims to elucidate the clinical spectrum of cutaneous complications of tattoos in different patients. The analysis will investigate both allergic and nonallergic clinical presentations of tattoo-related side effects, microscopic findings from skin biopsies, and therapeutic outcomes. This exploration is essential to improve our understanding of tattoo-related cutaneous complications and associated differential diagnoses and highlight the significance of patient awareness regarding potential risks before getting a tattoo. [ABSTRACT FROM AUTHOR]

Background: Immunotherapy is currently used to treat multiple types of cancer. While dermatologic toxicity of all grades occur, there are few reports of leukocytoclastic vasculitis induced by immunotherapy. Case report: a 65 years old Romanian man known with chronic lymphatic leukaemia and stage IV non-keratinized squamous cell carcinoma of the lung received second line monotherapy with nivolumab. After the second cycle the patient was referred to our service with general malaise and an eruption of palpable purpuric lesions confluent in plaques with multiple ulcerations disseminated on the thighs and forearms bilaterally, associated with local oedema and pain. A skin biopsy was performed and leukocytoclastic vasculitis was diagnosed. Systemic vasculitis was excluded by extensive investigations. The patient was treated with corticotherapy and hydroxychloroquine, with a favourable evolution of the vasculitis. With maintenance therapy he was able to continue the oncologic treatment. Conclusion: We report a rare case of vascular toxicity of immunotherapy with good response to systemic corticotherapy and hydroxychloroquine. [ABSTRACT FROM AUTHOR]

Psoriasis is a chronic, inflammatory, multisystemic disease which affects approximately 2–3% of the population globally, whose onset is triggered by genetic and environmental factors which activate both dendritic cells and keratinocytes, resulting in the production of proinflammatory cytokines such as tumor necrosis factor alpha, interleukin 17, interleukin 23, interleukin 22, and interleukin 1β. An in-depth understanding of the pathophysiology of psoriasis led to significant advances in the development of safe and efficient novel therapeutic options, with four classes of biologic therapy being approved for the management of moderate to severe psoriasis: tumor necrosis factor alpha inhibitors, interleukin 23 inhibitors, anti-interleukin 12/23 agents, anti-interleukin 17 agents, as well as small-molecule inhibitors, such as apremilast. Psoriasis is associated with comorbid conditions, namely psoriatic arthritis, cardiovascular disease, metabolic syndrome, psychiatric disorders, malignancy, as well as inflammatory bowel disease. For patients affected by both psoriasis and inflammatory bowel disease, there is a strong recommendation to avoid IL-17 inhibitors since they may play a part in the exacerbation of the gastrointestinal disease. Our aim was to perform a thorough literature review regarding the development of inflammatory bowel disease lesions in psoriasis patients treated with IL-17 inhibitors, along with a case presentation to emphasize the need for close follow-up of these patients. [ABSTRACT FROM AUTHOR]

Chronic wounds encompass a myriad of lesions, including venous and arterial leg ulcers, diabetic foot ulcers (DFUs), pressure ulcers, non-healing surgical wounds and others. Despite the etiological differences, chronic wounds share several features at a molecular level. The wound bed is a convenient environment for microbial adherence, colonization and infection, with the initiation of a complex host–microbiome interplay. Chronic wound infections with mono- or poly-microbial biofilms are frequent and their management is challenging due to tolerance and resistance to antimicrobial therapy (systemic antibiotic or antifungal therapy or antiseptic topicals) and to the host's immune defense mechanisms. The ideal dressing should maintain moisture, allow water and gas permeability, absorb wound exudates, protect against bacteria and other infectious agents, be biocompatible, be non-allergenic, be non-toxic and biodegradable, be easy to use and remove and, last but not least, it should be cost-efficient. Although many wound dressings possess intrinsic antimicrobial properties acting as a barrier to pathogen invasion, adding anti-infectious targeted agents to the wound dressing may increase their efficiency. Antimicrobial biomaterials may represent a potential substitute for systemic treatment of chronic wound infections. In this review, we aim to describe the available types of antimicrobial biomaterials for chronic wound care and discuss the host response and the spectrum of pathophysiologic changes resulting from the contact between biomaterials and host tissues. [ABSTRACT FROM AUTHOR]

Over the last decade, chronic wounds such as venous or arterial ulcers, diabetic foot ulcers, pressure sores, and nonhealing surgical wounds were brought into the spotlight of the medical community, due to their increasing prevalence and to their significant economic burden. Vascular impairment represents the main cause of chronic ulceration, while the infection is the most frequent complication. Chronic infections persist and progress despite an adequate antimicrobial regimen and are typically caused by mono- or polymicrobial biofilms. The persistent bacterial colonization of the wound, as well as the longterm use of antibiotics predispose to the development of nosocomial infections with resistant strains, with the risk of life-threatening septic complications, especially in immunocompromised individuals. In this article, we perform a thorough literature review, in order to answer the main controversies regarding the involvement of planktonic and/or biofilm bacteria in the healing process of chronic wounds. Furthermore, we aim to analyse the utility of antimicrobial treatment in non-healing wounds, and to establish its main end-points, for the optimal benefit of the patients. [ABSTRACT FROM AUTHOR]

Dermatofibroma (DF) or fibrous histiocytoma is one of the most frequent benign cutaneous soft-tissue lesions, characterized by a post-inflammatory tissue reaction associated with fibrosis of the dermis. Clinically DFs have a polymorphous clinical aspect from the solitary, firm, single nodules to multiple papules with a relatively smooth surface. However, multiple atypical clinicopathological variants of DFs have been reported and, therefore, clinical recognition may become challenging, leading to a more burdensome identification and sometimes to misdiagnosis. Dermoscopy is considered an important tool in DFs diagnosis, as it improves diagnostic accuracy for clinically amelanotic nodules. Although typical dermoscopic patterns are most frequently seen in clinical practice, there have also been some atypical variants described, mimicking some underlying recurrent and sometimes harmful skin afflictions. Usually, no treatment is required, although an appropriate work-up may be necessary in specific cases, such as in the presence of atypical variants or a history of recent changes. This narrative review's aim is to summarize current evidence regarding clinical presentation, positive and differential diagnosis of atypical dermatofibromas and also to raise awareness about the importance of specific characteristics of atypical variants to better differentiate them from malignant conditions. [ABSTRACT FROM AUTHOR]

Hidradenitis suppurativa is a chronic inflammatory skin disease, with a poor therapeutic response and a significant impact on the patient's quality of life. The aim of this review-type article is to assess the role of bacterial infections in both the pathogenesis and evolution of the hidradenitis suppurativa, but also to evaluate the convenience of antibiotherapy in the management of the disease. Antibiotherapy plays an important role in its longterm management, mainly due to the anti-inflammatory action of the frequently recommended agents from the schemes of treatment. The therapy's initiation ought to be consistent with the antibiotic sensitivity profile of microorganisms isolated in the laboratory, personalized depending on the disease’s severity, history of antibiotic use, the risk of drug interactions and the patient's comorbidities. Moreover, the association of antibiotics with anti-TNF-α (tumour necrosis factor) biologic therapy represents a valid therapeutic alternative that can significantly enhance the quality of life, of great utility especially in severe disease stages. In order to elucidate the pathogenesis, we propose two main research directions. Firstly, the profile analysis of virulence of microorganisms and its correlation with the host response to bacterial insult. Secondly, the description of the bacterial biofilm communities, both architecturally and physiologically in-depth analyzes of inter-cellular communication mechanisms. These steps are necessary for the discovery of new therapeutic agents. [ABSTRACT FROM AUTHOR]

Over the last decade, chronic wounds such as venous or arterial ulcers, diabetic foot ulcers, pressure sores, and nonhealing surgical wounds were brought into the spotlight of the medical community, due to their increasing prevalence and to their significant economic burden. Vascular impairment represents the main cause of chronic ulceration, while the infection is the most frequent complication. Chronic infections persist and progress despite an adequate antimicrobial regimen and are typically caused by mono- or polymicrobial biofilms. The persistent bacterial colonization of the wound, as well as the longterm use of antibiotics predispose to the development of nosocomial infections with resistant strains, with the risk of life-threatening septic complications, especially in immunocompromised individuals. In this article, we perform a thorough literature review, in order to answer the main controversies regarding the involvement of planktonic and/or biofilm bacteria in the healing process of chronic wounds. Furthermore, we aim to analyse the utility of antimicrobial treatment in non-healing wounds, and to establish its main end-points, for the optimal benefit of the patients. [ABSTRACT FROM AUTHOR]

Chronic venous leg ulcers (CVLU) account for the final outcome of a far wider disease spectrum referred to as chronic venous disease. Physiological wound healing involves a three-stage process, with the coagulation/ inflammatory, granulation and epithelialization phases occurring successively. In the case of chronic wounds, such as CVLUs, the tissue damage and repair are misbalanced, resulting in the ulcer's lodging in a particular wound stage - the inflammation or granulation stage -, consequently impairing progression towards wound healing. Failure to rebuild the skin integrity may be due to a large number of factors, either endogenous - host factors determining or maintaining breaches in the protective barrier of the skin -, or exogenous, such as microbial biofilm infections. The future research should focus upon the study of wound microenvironment. The detection of specific biomarkers of chronic wound healing, as well as the discovery of therapeutic agents that target molecules involved in the pathogenic cascade would change the course of the disease. [ABSTRACT FROM AUTHOR]

Glucagonomas are neuroendocrine tumors (NETs) that arise from the alpha cells of the pancreatic islets. They are typically slow-growing tumors associated with abnormal glucagon secretion, resulting in one or more non-specific clinical features, such as necrolytic migratory erythema (NME), diabetes, diarrhea, deep vein thrombosis, weight loss, and depression. Here, we report the case of a 44-year-old male with a history of diabetes mellitus, presenting with a pruritic and painful disseminated cutaneous eruption of erythematous plaques, with scales and peripheral pustules, misdiagnosed as disseminated pustular psoriasis and treated for 2 years with oral retinoid and glucocorticoids. During this period, the patient complained of weight loss of 32 kg and diarrhea and developed deep vein thrombosis. These symptoms, together with an inadequate response to therapy of the skin lesions, led to the reassessment of the initial diagnosis. Laboratory tests confirmed elevated plasma glucagon levels (>1000 pg/mL) and computed tomography (CT) scans revealed a 35/44 mm tumor in the pancreatic tail. Due to considerable disease complications and the COVID-19 pandemic, the surgical removal of the tumor was delayed for nearly 2 years. During this time, somatostatin analogue therapy efficiently controlled the glucagonoma syndrome and likely prevented tumor progression. As in other functional pancreatic NETs, the early clinical recognition of hormonal hypersecretion syndrome and the multidisciplinary approach are the keys for best patient management. [ABSTRACT FROM AUTHOR]

Hidradenitis suppurativa (HS) is a chronic inflammatory disease affecting intertriginous skin areas of young adults. Although HS was historically defined as an infectious disease, the role of microorganisms in its pathogenesis is now controversial. We investigated the lesion microbiota of a recently diagnosed 24-year-old male patient with axillary HS, who shared features of the metabolic syndrome. The microbiological analysis of the patient's lesion was indicative of colonization with bacteria including aerobes - Staphylococcus (S.) aureus, S. lugdunensis, S. epidermidis, anaerobes - Anaerococcus (A.) octavius, and microaerophiles - Cutibacterium (C.) acnes; this last one was also isolated in monoculture from a patient's healthy skin control sample. In vitro antibiotic susceptibility evaluation revealed Methicillin-resistant S. aureus (MRSA) and highly susceptible S. lugdunensis and S. epidermidis. Profiles of A. octavius and C. acnes showed that both strains were susceptible to Vancomycin, Clindamycin, Doxycycline and Linezolid; the anaerobe was Benzylpenicillin-resistant and Tetracycline and the microaerophile was intrinsically Metronidazole-resistant. We conclude that the intralesional microbial diversity in this case shows low variety of species and similarities to healthy skin microbiota, although the presence of S. aureus, particularly MRSA, S. lugdunensis or C. acnes - frequently involved in chronic skin pathologies - may be relevant for the disease severity. MRSA carriage in the patient's lesion represents a significant epidemiological risk for the healthcare environment. Antibiotic treatment in the early stages of HS should be administered with caution. Extended studies of HS microbiota could identify relevant colonization patterns for the outcome of the disease and offer important keys for selecting personalised, efficient therapeutic schemes. [ABSTRACT FROM AUTHOR]

Electrochemotherapy (ECT) is an effective bioelectrochemical procedure that uses controlled electrical pulses to facilitate the increase of intracellular concentration of certain substances (electropermeabilization/ reversible electroporation). ECT using antitumor drugs such as bleomycin and cisplatin is a minimally invasive targeted therapy that can be used as an alternative for oncologic patients not eligible for surgery or other standard therapies. Even though ECT is mainly applied as palliative care for metastases, it may also be used for primary tumors that are unresectable due to size and location. Skin neoplasms are the main clinical indication of ECT, the procedure reporting good curative results and high efficiency across all tumor types, including melanoma. In daily practice, there are many cases in which the patient's quality of life can be significantly improved by a safe procedure such as ECT. Its popularity must be increased because it has a safe profile and minor local adverse reactions. The method can be used by dermatologists, oncologists, and surgeons. The aim of this paper is to review recent literature concerning electrochemotherapy and other clinical applications of electroporation for the targeted therapy of metastatic melanoma. [ABSTRACT FROM AUTHOR]

Platelet-rich plasma (PRP) has emerged as a significant regenerative therapy used alone or combined mainly with stem cells, autologous fat grafts, hyaluronic acid, and biomaterials in a variety of medical fields, especially in hair regrowth, wound healing, and sports and rehabilitation medicine. However, the results obtained with this biologic therapy are heterogeneous and conflicting. The observed disparities in the effectiveness of PRP therapies may be due to a lack of standardization in blood processing and preparation. This article is aimed at reviewing the main biological parameters that need to be documented for a thorough reporting of quantitative and qualitative characteristics of the PRP injected, to allow a comparison between the quality of samples and the clinically obtained results and advance the efforts towards treatment standardization. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic had a great negative impact on nursing homes, with massive outbreaks being reported in care facilities all over the world, affecting not only the residents but also the care workers and visitors. Due to their advanced age and numerous underlying diseases, the inhabitants of long-term care facilities represent a vulnerable population that should benefit from additional protective measures against contamination. Recently, multiple countries such as France, Spain, Belgium, Canada, and the United States of America reported that an important fraction from the total number of deaths due to the SARS-CoV-2 infection emerged from nursing homes. The scope of this paper was to present the latest data regarding the COVID-19 spread in care homes worldwide, identifying causes and possible solutions that would limit the outbreaks in this overlooked category of population. It is the authors' hope that raising awareness on this matter would encourage more studies to be conducted, considering the fact that there is little information available on the impact of the SARS-CoV-2 pandemic on nursing homes. Establishing national databases that would register all nursing home residents and their health status would be of great help in the future not only for managing the ongoing pandemic but also for assessing the level of care that is needed in this particularly fragile setting. [ABSTRACT FROM AUTHOR]

The ongoing coronavirus disease 2019 (COVID-19) outbreak was declared a pandemic by the World Health organization in early March 2020. The disease typically presents with viral respiratory symptoms that could progress to acute respiratory distress syndrome. Emerging evidence suggests different possible dermatologic manifestations of COVID-19, including: acral lesions (pernio-like, pseudo-chillblain), vesicular eruptions, macular and papular exanthema, urticaria, livedoid, purpuric and petechial rashes. However, specific skin manifestations of the COVID-19 disease have not yet been clearly established and the relationship between the appearance of skin lesions and SARS-CoV-2 infection is still unclear. These highly variable skin changes could represent a direct consequence of the viral infection, an immunological response to viral nucleotides, adverse reactions to drugs frequently used for the treatment of COVID-19, or other disorders. In a global effort to comprehend the exact cutaneous features of COVID-19, several international dermatological societies have initiated nationwide studies to analyze COVID-19 cutaneous manifestations during this pandemic. This paper represents a literature review of the scientific data available on the clinical characteristics and symptoms of the cutaneous manifestations associated with COVID-19. Such findings are extremely useful in establishing if dermatological manifestations in COVID-19 patients could harbor a diagnostic significance and subsequently be used as prognostic factors for outcomes of COVID-19. [ABSTRACT FROM AUTHOR]

Background: Primary cutaneous aggressive epidermotropic CD8+ T cell lymphoma is an extremely rare type of cytotoxic lymphoma with increased tendency of spreading to extranodal sites, poor response to conventional therapies for classic CD4+ cutaneous T cell lymphomas, and an unfavorable prognosis. Case report:We present the case of a 40 year old male patient who was referred to our clinic for generalized ulcerated, escharotic, infiltrated papules and plaques and painful ulcerations covered by white deposits on the soft and hard palate of 18 months duration. The unique clinical and histopathological features had posed great diagnostic and therapeutic difficulties. The patient had first been diagnosed with lymphomatoid papulosis, and later with T cell lymphoma and treated with methotrexate, oral retinoids and phototherapy without clinical benefit. During hospitalization in our clinic, the diagnosis of primary cutaneous aggressive epidermotropic CD8+ T cell lymphoma was established and treatment with cyclophosphamide and dexamethasone, associated with local radiation therapy was instituted. Although the cutaneous and oral lesions improved during the first 3 months of treatment, the condition gradually worsened afterwards. Conclusions: Due to the paucity of literature data, frequent atypical presentations, aggressive behavior, and lack of optimal treatment strategies, primary cutaneous aggressive epidermotropic CD8+ T cell lymphoma continues to represent a diagnostic and therapeutic challenge. Further case reports that describe clinical experience and therapeutic outcomes would help clarify its definition, classification and guide the management in this very aggressive cutaneous lymphoma. [ABSTRACT FROM AUTHOR]

Atopic dermatitis is an inflammatory skin disease, characterized by periods of exacerbation and remission, which affects 15-30% of children and 2-10% of adults. It is known that atopic dermatitis is caused by an abnormal skin barrier (physical, chemical and immunological). In addition, new studies have shown that an important role in the pathophysiology of atopic dermatitis is the altered skin microbiota. This review highlights the recent observations regarding the changes of the skin microbiome in atopic dermatitis and possible therapeutic options for this disease. [ABSTRACT FROM AUTHOR]

Hidradenitis suppurativa represents a chronic, recurrent inflammatory disease, characterized by the formation of painful abscesses, sinuous tracts, foul smelling secretions, vicious scaring, with a severe reduction of the patients' quality of life. The pathophysiology of hidradenitis suppurativa is complex, follicular hyperkeratosis being regarded as the main pathogenetic mechanism. Bacterial colonization and follicular dysbiosis are of secondary importance in the pathogenesis of the disease, by triggering immunemediated inflammation. The formation of bacterial biofilms in sinuous tracts inhibits the efficacy of antibiotics, thus inducing chronic lesions. This article aims to highlight the role of bacterial colonization in the pathophysiology of hidradenitis suppurativa, as well as therapeutic options that act by regulating follicular dysbiosis. [ABSTRACT FROM AUTHOR]

Background: Primary cutaneous aggressive epidermotropic CD8+ T cell lymphoma is an extremely rare type of cytotoxic lymphoma with increased tendency of spreading to extranodal sites, poor response to conventional therapies for classic CD4+ cutaneous T cell lymphomas, and an unfavorable prognosis. Case report: We present the case of a 40 year old male patient who was referred to our clinic for generalized ulcerated, escharotic, infiltrated papules and plaques and painful ulcerations covered by white deposits on the soft and hard palate of 18 months duration. The unique clinical and histopathological features had posed great diagnostic and therapeutic difficulties. The patient had first been diagnosed with lymphomatoid papulosis, and later with T cell lymphoma and treated with methotrexate, oral retinoids and phototherapy without clinical benefit. During hospitalization in our clinic, the diagnosis of primary cutaneous aggressive epidermotropic CD8+ T cell lymphoma was established and treatment with cyclophosphamide and dexamethasone, associated with local radiation therapy was instituted. Although the cutaneous and oral lesions improved during the first 3 months of treatment, the condition gradually worsened afterwards. Conclusions: Due to the paucity of literature data, frequent atypical presentations, aggressive behavior, and lack of optimal treatment strategies, primary cutaneous aggressive epidermotropic CD8+ T cell lymphoma continues to represent a diagnostic and therapeutic challenge. Further case reports that describe clinical experience and therapeutic outcomes would help clarify its definition, classification and guide the management in this very aggressive cutaneous lymphoma. [ABSTRACT FROM AUTHOR]

Colorectal cancer (CRC) is an important public health issue, in terms of incidence and mortality, with approximately 1.8 million new cases reported worldwide in 2018. Advancements in understanding pathophysiological key steps in CRC tumorigenesis have led to the development of new targeted therapies such as those based on epidermal growth factor receptor inhibitors (EGFR inhibitors). The cutaneous adverse reactions induced by EGFR inhibitors, particularly papulopustular rash, often require long-term antibiotic treatment with tetracycline agents (mostly minocycline and doxycycline). However, this raises several issues of concern: possible occurrence of gut dysbiosis in already vulnerable CRC patients, selection of highly antibiotic resistant and/or virulent clones, development of adverse reactions related to tetracyclines, interference of antibiotics with the response to oncologic therapy, with a negative impact on disease prognosis etc. In the context of scarce information regarding these issues and controversial opinions regarding the role of tetracyclines in patients under EGFR inhibitors, our aim was to perform a thorough literature review and discuss the main challenges raised by long-term use of tetracyclines in advanced CRC patients receiving this targeted therapy. [ABSTRACT FROM AUTHOR]

Seasonal allergic rhinitis (SAR) is one of the most frequent chronic conditions of the modern world. Pollen carried by the wind from pollinated trees is a major source of SAR. Betulaceae, Oleaceae and Platanus are the most important sources of airway sensitization with regard to tree pollen and, therefore, they are included in the official recommendations of skin prick testing by different official societies. Salicaceae pollen is a moderate source of pollen sensitization. Conversely, large areas are covered with poplars and willows around the world. A number of studies from many countries showed that in some particular situations (large and compacted areas covered by Salicaceae, weather conditions, air pollution, urban ornamental vegetation), poplar and willow pollens may become of local importance in producing SAR. The aim of this review was to present a synthesis of information regarding Salicaceae pollen allergy showing that, if various unfavorable aspects are brought together, a minor problem (Salicaceae sensitization) can became a public health problem. [ABSTRACT FROM AUTHOR]

Melanoma is one of the most aggressive forms of skin cancer, with limited therapeutic options. Since its incidence has been rapidly rising in recent years, the study of new targeted therapeutic strategies has increased. The implication of nanoscience in the development of alternative targeted therapies for melanoma has multiple benefits and could significantly improve the outcome of melanoma patients. In this paper, we review the most recent progress in the field of targeted therapies, emphasizing the impact of nanoscale materials on the targeting and controlled release of anti-tumor drugs. The applications of nanomedicine in the management of melanoma are extensive and refer to sentinel lymph node mapping, chemotherapy, and RNA interference; each of these applications harboring the potential to develop efficient and personalized diagnostic techniques and therapies. Further research, especially in clinical trials, is needed to establish whether fighting melanoma on the nanoscale level represents the key to reaching a critical inflection point in mankind's battle with metastatic melanoma. [ABSTRACT FROM AUTHOR]