Dermatology Reports

Repair of a medial canthal defect

Alberto Murtas — 2024-07-03

An 87-year-old man presented for treatment of a histology-proven basal cell carcinoma (BCC) involving the left medial canthus. The lesion was successfully resected with adequate margins under local anesthesia and resulted in a defect measuring 2x1.5 cm. How would you repair this defect?

Double-triangular flap for reconstruction of a circular skin defect in the central frontal region

Georgi Tchernev — 2024-09-12

A 75-year-old female presented to the dermatology department with primary complaints of a tumor formation located in the center of the forehead, above the eyebrows. The adjacent skin was slightly sun-damaged, but no signs of surgical scars or malignancy were noted. A clinical diagnosis of basal cell carcinoma was established, and the patient was recommended surgical excision under local anesthesia.

Reconstruction of hand surgical wounds after pseudo-syndactyly correction or squamous cell carcinoma resection in patients affected from epidermolysis bullosa: a monocentric experience with a collagen-elastin dermal matrix substitute

Giulia Bernante — 2024-10-25

In patients with epidermolysis bullosa (EB), surgery may be required to remove squamous cell carcinoma (SCC) of the hands or to correct pseudo-syndactyly. Dermal substitutes may represent a suitable tool to promote the healing of surgical wounds in EB. We review our experience with a collagen-elastin dermal matrix to promote surgical wound healing due to hand surgery to correct pseudo-syndactyly or SCC resection in patients affected by EB. Overall, 12 patients (mean age, 29±11 years, range 13-51; four females) with EB were considered, with a total of 25 different interventions (16 SCC removals; 3 amputations for recurrent infiltrating SCC; 6 pseudo-syndactyly corrections). All patients received a collagen-elastin dermal matrix sheet. Neodermis was achieved in all patients, and no adverse events potentially associated with the graft occurred. No SCC recurrence was reported at sites operated for either SCC resection or amputation. The opening of the first or second commissure appears to be maintained for over 1 year after the procedure, preserving digital function. We believe that the application of a dermal substitute, together with a close dressing protocol, may represent a suitable strategy for obtaining physiological tissue regeneration and maintaining proper hand function in patients with EB.

Lichen planus pigmentosus inversus: case report and systematic review

Fabio Massimo Gavazzoni — 2024-10-11

Lichen planus pigmentosus inversus (LPPI) is a rare variant of lichen planus characterized by well-demarcated, often slight pruritic, dark-gray plaques in intertriginous zones, hence the attribute of “inversus”. It was originally described by Pock et al. in 2001, and less than 100 cases have been reported to date. Here, we present a case of a 52-year-old male with a two-month duration of gray-brownish plaques in bilateral axillary, submammary, antecubital, and inguinal folds. No triggering agent was present, and the biopsy showed an interface/lichenoid dermatitis with plenty of pigment incontinence. Topical tacrolimus 0.1% ointment was administered with moderate improvement at five weeks. A review of the literature showed no significant differences in involved sites and age distribution among genders, with a slightly longer duration of manifestations in females. The most administered therapeutic agents were topical corticosteroids, alone or in combination with other agents, and tacrolimus.

Efficacy of tildrakizumab 200 mg for treating difficult-to-treat patient populations with moderate-to-severe plaque psoriasis

Paolo Dapavo — 2024-08-09

Psoriasis is an inflammatory chronic disease of the skin, typically located on the extensor surfaces of the body and the trunk. Patients with psoriasis can often present multiple characteristics, such as lesions located in difficult-to-treat (DTT) areas or high severity of the disease, which can negatively affect their quality of life. There is a lack of consensus in identifying the best therapy for these complex patient populations, especially after the failure of one or multiple lines of therapy. In this regard, we report a case series describing patients with psoriasis located in different DTT areas or presenting a high Psoriasis Area and Severity Index (PASI) score at baseline and treated ineffectively with prior lines of therapy. Finally, patients achieved complete remission following therapy with tildrakizumab 200 mg (anti-IL-23p19), highlighting its potential efficacy in these patient populations.

Scabies mimicking relapsing atopic dermatitis

Flavia Pigliacelli — 2024-08-09

Atopic dermatitis (AD) is a chronic inflammatory skin disease clinically characterized by eczematous skin manifestations. Sometimes, it can manifest with non-specific clinical features, which are common with other skin conditions, such as infectious and neoplastic diseases. We would like to underline the importance of accurate dermatologic examination and rigorous anamnesis in patients affected by AD to avoid misdiagnosis and delayed treatments.

Cutaneous larva migrans: is dermoscopy useful for the treatment?

Giulia Bazzacco — 2024-07-08

Cutaneous larva migrans (CLM) is a zoonotic disease endemic in tropical regions. CLM diagnosis mainly relies on the morphology of the skin lesions; however, dermoscopy can improve diagnostic accuracy. In this paper, we report two cases of CLM to highlight the importance of dermoscopic follow-up in the early identification of treatment failure and the effectiveness of topical ivermectin as a combined medication.

Erythrasmoid pityriasis versicolor: three case reports and review of the literature

Stefano Veraldi — 2024-07-08

Pityriasis versicolor is clinically characterized by slightly scaly, hyper- or hypopigmented macules usually located on the chest, shoulders, back, and arms. Rare cases of atypical locations of pityriasis versicolor have been described, such as groins, penis, and perineum. We present three cases of pityriasis versicolor located exclusively on the submammary folds, pubis, and inguinal folds (the latter in an 11-year-old girl), respectively. Considering both the location and clinical presentation of pityriasis versicolor in these three patients, we think the diagnosis of erythrasmoid pityriasis versicolor is acceptable. Differential diagnosis with erythrasma must be taken into consideration. Therefore, mycological and bacteriological examinations are necessary for a correct diagnosis and specific therapy.

A rare case of unilateral nevoid telangiectasia in a Saudi pediatric patient

Almuntsrbellah Almudimeegh — 2024-09-12

Unilateral nevoid telangiectasia (UNT) is a rare congenital or acquired benign cutaneous vascular anomaly first identified by Blaschko in 1899. It is characterized by superficial telangiectasias with a reticular or linear pattern on one side of the body, often following a dermatomal distribution. We present the first case of UNT documented in Saudi Arabia in a 12-year-old girl.

Isolated cutaneous myeloid sarcoma preceding acute myeloid leukemia: a case report and literature review

Konstantina Mavridou — 2024-10-15

Isolated cutaneous myeloid sarcoma (icMS) and aleukemic leukemia cutis (ALC) are cutaneous extramedullary manifestations of leukemia in which leukemic cells infiltrate the skin before they can be identified either in the peripheral blood or in the bone marrow. We report the case of a 67-year-old patient who presented with a rapidly developing cutaneous tumor and scaly, erythematous- squamous plaques. Isolated cutaneous myeloid sarcoma was diagnosed, which rapidly progressed to terminal-stage acute myeloid leukemia (AML). To highlight the disease characteristics of the adult-onset icMS and ALC cases that preceded AML, we additionally compiled the pertinent literature of case reports of these rare conditions. We identified 15 previously published icMS/ALC cases with adequately detailed clinical data descriptions. We could confirm medical experience that icMS/ALC patients have a worse overall prognosis. Moreover, we could identify FAB-M5 AML subtype as a significant adverse prognosticator in these patients.

Bullous pemphigoid with secondary acquired reactive perforating collagenosis: a challenging clinical case report

Valentina Ruffo di Calabria — 2024-10-03

Bullous pemphigoid (BP) is a common autoimmune blistering disorder with unknown aetiology. During the last decades, its association with various common comorbidities, including cardiovascular, metabolic, neuropsychiatric, and neoplastic disorders, has been established. However, in recent years, an increasing number of BP cases have also been reported in association with rarer diseases, including acquired reactive perforating collagenosis (ARPC). Patients with coexisting BP and ARPC have been reported to share common clinical features, including metabolic comorbidities, e.g., diabetes mellitus (DM). As the evolution from ARPC cutaneous involvement to classic BP lesions has been more frequently described, it has been suggested that it may represent a new clinical variant of BP with a specific pathogenetic background. Here is reported a challenging case in which a typical onset of BP was later followed by the eruption of atypical ARPC lesions in a patient with multiple non-compensated metabolic and cardiovascular comorbidities.

An out-of-season cold. Filler-induced vascular occlusion of the columellar artery causing necrosis of the cartilaginous anterior nasal septum: case report and a literature review

Corrado Zengarini — 2024-10-11

Hyaluronic acid fillers are widely employed for aesthetic procedures but can lead to vascular complications, including rare instances of arterial occlusion. We report a case of columellar artery occlusion following a nasal filler injection in a 30-year-old woman. The patient initially presented with subtle symptoms, including persistent rhinorrhoea and an unusual sensation of cold air. Rhinoscopy revealed full-thickness necrosis of the anterior nasal septum, likely due to compression or embolization of the septal branch of the superior labial artery; prompt treatment with hyaluronidase, aspirin, and topical antibiotics resulted in complete resolution. A literature review identified only one similar case, emphasizing this complication’s rarity and potential underreporting. This case underscores the importance of early recognition and intervention in filler-induced vascular events.

Trichoscopy and LC-OCT findings in sonidegib-induced alopecia in patients with advanced basal cell carcinoma

Irina Ciobotariu — 2024-09-27

Sonidegib is a Hedgehog pathway inhibitor (HHI) used as a first-line systemic treatment for patients with advanced basal cell carcinoma (aBCC). Alopecia is reported as a frequent adverse event (AE), occurring in 49% of patients. Forty-five patients with aBCC were treated with sonidegib between December 2022 and December 2023; among them, 11/45 patients developed alopecia. Trichoscopic features included yellow dots, black dots, exclamation mark hairs, and broken hairs. Upon LC-OCT examination, yellow dots were seen as dilated follicular dark spaces containing malted, nonhomogeneous material and outlined by bright collarets. Black dots corresponded to normal-sized follicular ostia filled with bright, homogeneous material and cadaverized hair. Exclamation mark hairs were short, dark dysmorphic hairs with different sizes of proximal and distal ends, and broken hairs were short dysmorphic hairs. LC-OCT may provide additional insights into early signs and clinical evolution of sonidegib-induced alopecia in patients with aBCC.

New and emerging therapies in cutaneous T-cell lymphoma

Gabriele Roccuzzo — 2024-10-02

Mycosis fungoides (MF) is the most common cutaneous T-cell lymphoma (CTCL) that typically presents in the early phase as inflammatory erythematous patches or plaques, with epidermotropism as the histopathological hallmark of the disease. Traditionally, in the early stages, non-aggressive options represent the first-line strategy: topical corticosteroids, phototherapy, radiotherapy, and occasionally adopting a “wait-and-see” approach for minimally symptomatic patients. In patients with advanced or recurrent disease, good results can be achieved with immune modifiers, chemotherapeutic agents, total skin irradiation, or extracorporeal photochemotherapy, and maintenance therapy is often required. The past decade has seen an expansion of therapies that can be used in this setting by increasing new therapeutic strategies. The key advancements coming from recently published trials are resumed in this article.

Vitiligo in the 19^th-century dermatological works of Vincenzo Chiarugi, Robert Willan, Jean-Louis Alibert, and Ferdinand von Hebra

Flavio Stocco — 2024-07-03

Vitiligo is an iconic dermatological pathology, as its clinical manifestations indelibly mark the patient through the appearance of white spots all over the body. The oldest written testimonies referring to vitiligo are the first texts of Ayurveda, the Ebers Papyrus, and the Leviticus of the Old Testament. During the Roman Empire, the doctors Aulus Cornelius Celsus and Galen, respectively, in the I and II centuries AD, were the first to describe this skin disease, and their statements were used by all subsequent authors. Hieronymus Mercurialis in the XVI century, Joseph Jakob Ritter Plenck in the XVIII century, and Vincenzo Chiarugi again in the XIX century based their writings on the references of the two Roman doctors. After centuries of scientific inaction in the XIX century, there was an exponential increase in dermatological studies, and the medical-scientific works produced in this period laid the foundations of modern dermatology. The nineteenth-century texts of Robert Willan and Thomas Bateman, Jean-Louis Alibert, Ferdinand von Hebra, and Moriz Kaposi proved fundamental for the study of skin pathologies, including vitiligo. The nineteenth-century medical-scientific vision and approach to vitiligo are shown in this work through the presentation of direct quotes extrapolated from the most important works of the authors mentioned above; this served to historically contextualize the gradual progress of medical study regarding this skin pathology.

Face scabies in the elderly: when dermoscopy can be a game changer

Andrea Corio — 2024-10-03

Dear Editor,

Scabies is a common pruritic ectoparasitic infestation of the skin caused by the mite Sarcoptes scabiei. It classically presents as an intensely pruritic eruption that usually involves hands and interdigital folds, wrists, axillae, areolae, abdomen, and genitalia. In immunocompetent adults, mite infestation affecting the face is considered exceptional; accordingly, if topical treatment is chosen, clinicians typically instruct patients to apply the product to the body, excluding the head area. [...]

Scabies clinically diagnosed with eosine 2% magnification dermoscopy

Giulio Cortonesi — 2024-10-04

Dear Editor,

The diagnosis of scabies is primarily clinical; however, the variability in presentation can complicate it. Besides dermoscopy, different non-invasive imaging techniques have been used to assist in scabies diagnosis: 400x magnification, line-field confocal optical coherence tomography (LC-OCT), reflectance confocal microscopy (RCM), and high-frequency ultrasound (HFUS) could be useful for the diagnosis of various diseases such as benign tumors, malignant tumors, and infectious diseases of all types (viral, bacterial, and parasitic). On the other hand, all these techniques are strictly operator- and device-dependent. [...]

Blue diode laser as supportive therapy for the management of vulvar lichen sclerosus

Serena Bergamo — 2024-08-09

Vulvar lichen sclerosus is a chronic inflammatory condition characterized by the thinning and atrophy of the skin and mucosa surrounding the vulva and anus. This study evaluates the efficacy of a treatment protocol utilizing blue-diode laser photobiomodulation in managing vulval lichen sclerosus symptoms in a cohort of 12 female patients. The treatment protocol consisted of laser sessions 3 times a week for 2 weeks and follow-up sessions over a 16-week period. Objective and subjective parameters were assessed before treatment, at the end of treatment, and at 4-month follow-up visits. Results demonstrated significant reductions in subjective symptoms, such as itching and pain, as well as improvements in objective signs, including erythema and fissures. No side effects were observed, indicating the safety and tolerability of laser treatment. These findings suggest that photobiomodulation can be an effective therapeutic option for patients with vulval lichen sclerosus, with future research aimed at refining treatment protocols and evaluating its long-term benefits.

“Mosaic graft” technique and surgical dermal glue in Mohs micrographic surgery and general dermatologic surgery

Gian Marco Vezzoni — 2024-07-15

After Mohs micrographic surgery, derm surgeons utilize local flaps, full or partial thickness grafts, with good or acceptable cosmetic results. When we are dealing with older and problematic patients, blood thinner users, and non-collaborative people with large facial neoplasms, using flaps may be very difficult, and grafts become the best choice. Our aim was to assess a technique to graft very easily, quickly, and safely, full-thickness skin grafts in facial wounds, and have good cosmetic results in those older and problematic people. Ten elderly patients who underwent Mohs surgery or other surgical procedures have been grafted with this technique that we called “mosaic graft”, made possible using a dermal glue in a new way. In some cases, for bigger defects, we also assessed the “stripes” variant of this technique. Graft survival was almost always complete in all cases, and after 6 months the cosmetic outcomes were good. This “mosaic graft” technique and its “stripes” variant showed good reliability, fast execution, easy harvesting with tissue saving, and good cosmetic outcomes, making this technique a very good choice for older and problematic patients.

Epidemiological and clinical profiles of cutaneous leishmaniasis cases in Amhara National Regional State, Northwest Ethiopia: a multicenter retrospective study

Bizuayehu Gashaw — 2024-11-04

Cutaneous leishmaniasis (CL) is caused by Leishmania parasites. Ethiopia is one of the top ten countries with a high CL load, and Amhara National Regional State (ANRS) is one of the CL hotspot areas in the country. This study examined cutaneous leishmaniasis’s epidemiology and clinical profiles in the ANRS region. It was conducted from April to October 2023 across eight Leishmaniasis Treatment Centres (LTCs). A data review was done from patients presenting to these centers between June 2018 and July 2023. Chi-square test and logistic regression were performed using SPSS-23. A total of 1729 patients with CL were recorded, resulting in an overall burden of 8.6 cases per 10,000 outpatients. Patients were from 112 districts, and most of them (71.1%) presented with localized cutaneous leishmaniasis (LCL). Approximately 12% of patients lived with the disease for over a year without treatment, while 13.2% of patients were multiple-time comers. Cutaneous leishmaniasis continues to be a significant public health issue in the ANRS region. Approximately onethird of CL patients exhibit the mucocutaneous leishmaniasis (MCL) clinical form. There has been a notable delay among CL patients in seeking diagnosis and treatment. It is essential to conduct large-scale community-based studies and studies focused on both traditional and modern treatment centers to accurately estimate the prevalence of CL in the region. Follow-up and molecular studies are crucial for enhancing our understanding of the clinical features of the disease. Furthermore, raising community awareness about CL prevention and control can help patients obtain early diagnosis and treatment.

Facial wrinkle categorization using convolutional neural network

Čedomir Vasić — 2024-09-12

A tool for detecting and classifying wrinkles on the facial skin is always welcomed in the pursuit of tight and beautiful skin. If this tool involves using a state-of-the-art neural network and high-quality images, it is highly likely to be practical. Five thousand and ninety-eight images were categorized into four classes by a trained expert and prepared for neural network training. The task was to determine whether such prepared data could serve as good material for learning and whether they could provide sufficiently high accuracy in prediction. It was found that the answer to this question is positive.

Survey of the impact of BOLT-trial data on oncologists’ and dermatologists’ decision-making in treating patients with locally advanced basal cell carcinoma

Luigi Scarpato — 2024-07-03

Basal cell carcinoma (BCC) is the most common malignant tumor in white populations. Multiple studies demonstrated that the aberrant activation of Hedgehog signaling is a driver of BCC development, and its blockade represents a potential therapeutic target. In Italy, clinicians can prescribe Hedgehog inhibitors (HhIs) vismodegib and sonidegib. To highlight the treatment choice of clinicians, we conducted an online survey between November 1 and November 18, 2020, with 33 Italian clinicians from 27 reference hospitals, in which each participant received an anonymous survey consisting of two multiple-choice questions on the clinical efficacy and safety profile of sonidegib and vismodegib. Respondents reported their opinions on which efficacy and tolerability data of the pivotal phase-II BOLT trial were more relevant in patients’ treatment choices with locally advanced BCC (laBCC). This survey shows that the overall response rate (ORR) and the duration of response (DoR) are the most expected across dermatologists and oncologists. The different pharmacokinetic profiles of the two HhIs are behind their diverse toxicity spectrum; dose and schedule modification seem to address the choice between vismodegib and sonidegib among dermato-oncology prescribers.

Treatment of keloids with pulsed dye laser in a pediatric population

Riccardo Cavalli — 2024-10-15

Several studies confirmed the role of pulsed dye laser (PDL) in successfully treating keloids. To our knowledge, this is the first study conducted entirely in children (<14 years old). Case notes and photographic records of 16 pediatric patients with keloids treated with PDL at our center between 2012 and 2019 were reviewed. The red tone of the lesion before the first treatment, number of sessions, clinical improvement, and the evaluation of the satisfaction of patients have been reported. An excellent clearance has been achieved in 7 out of 16 (43.8%) cases, a good-moderate clearance in 7 patients (43.8%), and a slight clearance in 2 patients (12.4%). No patients detected absent or low results. A total of 13 out of 16 patients (81.2%) were satisfied. Lesions with higher red-tone grades could benefit from multiple treatment sessions. PDL is an effective treatment of keloids in the pediatric population, characterized by a good safety profile and high satisfaction. We observed good results treating the active remodeling lesions with a higher red tone. These data need to be confirmed with further studies in a larger set of pediatric patients.

Calcipotriol as a daylight photodynamic therapy enhancer: a case-control study

Benedetta Sonego — 2024-10-01

Actinic keratoses (AKs) are common skin lesions found on sun-exposed areas and are considered potential precursors to squamous cell carcinomas (SCCs). This observational case-control study evaluates the efficacy of combining traditional daylight photodynamic therapy (DL-PDT) with pre-treatment using 0.005% calcipotriol (CAL) ointment. Twenty immunocompetent male patients with grade I-II AKs on the scalp and/or face were randomized into two groups: the case group received a 14-day pre-treatment with CAL ointment before DL-PDT, while the control group used a moisturizing cream. Both groups underwent a series of three DL-PDT sessions. The study utilized the Actinic Keratosis Area Severity Index (AKASI) scoring system to measure the actinic damage at baseline, 3 months, and 6 months post-treatment. Results showed a significant reduction in AKASI scores in the CAL group compared to controls, indicating that CAL pretreatment enhances the efficacy of DL-PDT. This combination treatment was well tolerated, with minimal discomfort reported. The findings suggest that incorporating CAL into the treatment regimen can improve the clearance of AKs and potentially prevent their progression to SCCs.

Erythema multiforme following Orf viral infection: a comprehensive review of the literature with a case report highlight

Mona Alkallabi — 2024-09-13

Orf, also known as ecthyma contagiosum, is a highly contagious zoonotic infection linked to direct contact with infected sheep, goats, or reindeer, posing a significant risk to farmers, veterinarians, shepherds, and butchers. This study presents a case of a 41-year-old female who developed Orf, complicated by the rare occurrence of erythema multiforme (EM), after handling sheep meat. The patient initially presented with a progressive, painful skin eruption on the left dorsum of the little finger, which subsequently worsened and led to the development of generalized painful and itchy skin lesions, including target lesions typical of EM, on the palms, soles, and extremities. The diagnosis was confirmed through clinical examination and skin biopsy. The patient was treated with antihistamines and topical corticosteroids, resulting in a complete resolution of symptoms within three weeks. We underscore the importance of recognizing EM as a potential complication of Orf infection, particularly in individuals with occupational animal exposure.