Dermatology Reports

The top 100 most cited articles in acne vulgaris: a bibliometric analysis

Sapir Itzhaki Gabay — 2024-02-15

A substantial body of literature has been published on acne vulgaris (AV) in the past five decades. Bibliometric analysis (BA) is a scientific, statistical evaluation review of published articles, providing a quantitative assessment of past research. The Web of Science (webOS) citation indexing database was used on 11 June 2023 to identify the top 100 cited articles on AV. Articles were listed in descending order by their annual citation (AC). Data sets were then subdivided into senior author, year and age of publication, journal and its impact factor, the number of total citations according to the webOS, corresponding and senior author’s affiliated institution, country of origin, manuscript type, study design, and research focus. The top 100 most cited articles were published between 1974 and 2020. The mean number of citations ranges between 82 and 688. The most cited paper was Guidelines of care for the management of Acne Vulgaris by Zaenglein, with an AC of 98.2. The largest number of manuscripts was published between 2001 and 2010 (n = 47). The British Journal of Dermatology had the highest number of published manuscripts (15). Of the original research papers, 28% were of a level of evidence 1, 56% focused on treatment, 19.5% on epidemiology, and 16.5% on pathogenesis. This analysis provides detailed bibliometric characteristics, highlighting the worldwide acne burden, with the hope that future researchers will explore the gaps in the AV literature.

Effectiveness and safety of the combination therapy of micro-needling and minoxidil in androgenetic alopecia of Indonesian men: a randomized controlled trial

Kara Adistri — 2024-02-06

Androgenetic alopecia (AGA) is the most common type of hair loss. Treatment options are limited. Microneedling, a minimally invasive technique can enhance hair growth by releasing growth factors. However, no standardized protocol for frequency, depth and duration is available. This study aimed to determine the effectiveness and safety of the combination therapy of microneedling and minoxidil in AGA. This study was a randomized controlled clinical trial conducted over 12 weeks. The intervention group received a 4-weekly combination therapy of microneedling + 5% minoxidil, while the control group got only topical 5% minoxidil. Hair density and diameter were assessed using FotoFinder^® trichoscale (Fotofinder Systems GmBH, Bad Birnbach, Germany) every 4 weeks. A total of 36 male participants, between 26-51 years old, with Hamilton-Norwood type IIIVI AGA were included. At the end of the study, the intervention group had significantly higher hair density (95.6 vs 52.4 hair/cm², p<0.001) and diameter (18 vs 6 μm, p=0.004) than the control group. Side effects, included itching and transient erythema, were well tolerated. The combination of 4-weekly microneedling and topical 5% minoxidil is effective in increasing both hair density and hair diameter, and safe to use in AGA patients.

Platelet-rich plasma for the treatment of scleroderma-associated ulcers: a single-center experience and literature review

Alessandra Grazia Condorelli — 2024-02-21

Systemic sclerosis (SS) is a complex connective tissue disease characterized by vasculopathy and progressive fibrosis, primarily considered an autoimmune disorder. SS can affect multiple organs and tissues, including the skin, respiratory, gastrointestinal, genitourinary, cardiovascular, and musculoskeletal systems. Skin involvement is common, and SS-related ulcers, especially digital ulcers, occur in roughly 50% of patients. These ulcers not only cause pain but also significantly impact patients’ quality of life, and in severe cases, they can lead to infection, gangrene, and amputation. The search for novel therapies for scleroderma-related ulcers remains an ongoing research area. Platelet-rich plasma (PRP) has been investigated as a potential treatment for difficult-to-heal ulcers, including diabetic, pressure, and vascular ulcers. In this study, we share our experience in treating scleroderma ulcers with PRP. Ten patients with confirmed SS and chronic skin ulcers lasting at least six weeks, which had not responded to conventional treatments, were selected for the study. Homologous PRP gel was prepared and applied once a week for up to eight weeks. The ulcers were documented photographically before and after PRP treatment, and pain levels were assessed using a visual analog scale (VAS). We also conducted a systematic review of the literature focusing on the use of PRP in the setting of SS. The results from our casuistry showed that the ten patients, including eight females and two males with a median age of 52.5 years, had ulcer sizes ranging from 0.78 cm² to 28.26 cm². The ulcers were located on fingers, legs, and heels, and they were associated with various forms of SS, including limited and diffuse cutaneous involvement. Raynaud’s phenomenon was prevalent, and two patients exhibited organ involvement. The average ulcer size at the end of PRP treatment decreased significantly, with a 78% reduction in ulcered area. Pain levels also markedly improved, as indicated by a reduction in VAS scores. With regards to systematic revision of literature, we retrieved 45 cases of SS treated with PRP-based therapeutic regimes. However, only a minority of them (n=16) underwent PRP treatment for the treatment of SS-related ulcers. An improvement in wound size and pain has been documented in all cases. Taken together, these data highlight the potential benefits of using homologous PRP in the treatment of scleroderma ulcers, emphasizing its positive impact on ulcer size reduction and pain relief.

Evaluation of a training course for general practitioners within the melanoma multimedia education programme of the Italian Melanoma Intergroup: a study protocol

Ignazio Stanganelli — 2024-02-09

The text discusses the role of general practitioners (GPs) in the prevention and early diagnosis of melanoma, a type of skin cancer. It highlights the need for GPs to be able to recognize suspicious skin lesions and refer patients to specialist dermatology centers. However, many GPs lack comprehensive training in diagnosing melanoma. The text mentions that various training courses have been conducted for GPs, but their impact on clinical practice has been limited. The MelaMEd Programme is an e-learning course developed by the Italian Melanoma Intergroup (IMI). The programme aims to provide GPs with comprehensive knowledge of melanoma prevention, diagnosis, and treatment. It includes an e-learning section, and a dedicated platform called MelaMEd platform, which offers a multimedia atlas of melanoma. The objective of the study is to evaluate the impact of the MelaMEd programme on GPs’ diagnostic accuracy, knowledge of melanoma, and management of suspicious lesions. The methodology involves administering pre-training and post-training questionnaires to participants, assessing their diagnostic skills and evaluating the training course’s effectiveness. The study aims to demonstrate the effectiveness of the MelaMEd programme in improving GPs’ ability to recognize and manage melanoma. It also seeks to identify areas for improvement and recommend interventions to enhance diagnostic accuracy. The results will be analyzed statistically using descriptive, univariate, and multivariate analysed methods.

Preliminary analysis of the melanoma multimedia educational program for general practitioners on behalf of the Italian Melanoma Intergroup

Federica Zamagni — 2024-02-12

According to the National Oncological Plan 2023-2027 on the importance of multidisciplinary and interactive e-learning training, the Italian Melanoma Intergroup (IMI) has developed MelaMEd (Melanoma Multimedia Education), a national project for general practitioners (GPs) on the prevention and detection of cutaneous melanoma through an online platform and an online course. MelaMEd enables participants to i) recognize skin lesions that require specialist dermatological assessment, ii) select patients at high risk of melanoma and iii) be informed of the diagnosis and treatment pathway of patients with melanoma. A free online platform and online course were developed and launched in June 2022. Before starting the course, enrolled participants fill out a pre-training questionnaire concerning the basic knowledge of the disease and the recognition and management of suspicious lesions. After the course, participants will fill out the same questionnaire again. The online course will end in December 2023. Here we present a preliminary analysis of the pre-training results (January 2023-July 2023). The data have been analyzed descriptively. So far, five healthcare centers have participated in the project for a total of 1320 participants. Of these, 298 compiled the pre-training questionnaire. Forty-seven percent of them were aged <40 years. Respondents were almost divided between GPs (47%) and resident GPs (48%). Among the theoretical questions, the ABCDE rule and ugly duckling sign are well known (96% and 91% of correct answers, respectively), but a lower percentage (68%) of respondents knows the EFG rule for the recognition of nodular melanomas and the statement of Breslow thickness (29%). Regarding the series of clinical images of pigmented skin lesions and their management, the percentages rate of accuracy varied from 33% to 87%: melanoma (5 cases) ranges from 36% to 71%, melanocytic nevi (3 cases) from 33% to 84%, whereas the percentages rate of referral for dermatological evaluation varied from 44% to 99%. Melanoma cases referred to dermatologist ranges from 67% to 99%. This preliminary analysis on pre-training questionnaire mainly showed a lack of knowledge of the two major points of melanoma diagnosis (EFG) and management (Breslow thickness), as well as a low rate of participants. We will compare the proportions of correct answers to the questionnaires before and after the course once available.

The use of dermal templates in dermato-surgery and patient perspectives

Serena Morsia — 2024-02-15

Acellular dermal matrices currently represent a useful reconstructive method in onco-dermatologic surgery. Nevertheless, they have some limitations, especially in terms of costs and outpatient post-operative wound care. While some studies on their cost-tobenefit ratio in breast surgery have already been issued, evidence is currently lacking in onco-dermatological surgery. The aim of this study was to evaluate the clinical outcomes perceived by patients who had undergone onco-dermatologic surgery in which either acellular dermal matrices or skin grafts had been used as reconstructive methods. A study population of 150 patients was identified retrospectively and patients’ degree of satisfaction was assessed through the Global Aesthetic Improvement Scale and the Patient Scar Scale Questionnaire. Despite similar scores among the study groups, slightly better results were appreciable after single- stage grafting. However, to what extent these variations really represent a significant difference from a clinical point of view remains to be determined. Moreover, other potential bias in the interpretation of our results may reside in differences in terms of age, body location and baseline tumor size among the study groups. Therefore, further research is needed.

Histopathologic spectrum of morphea: a single-center retrospective study

Özben Yalçın — 2024-02-06

Morphea is a rare autoimmune disease that often affects skin and subcutaneous tissues. The aim of this study was to determine the association between patient demographic parameters, lesion site, clinical subtype of morphea, and histological findings. Between 2016 and 2022, we investigated 78 patients with morphea at the Department of Pathology, Prof. Dr. Cemil Taşcıoğlu City Hospital in Turkey. Case-specific hematoxylin and eosin stain slides were obtained from the pathology archive and assessed blindly by two pathologists. Flattening of rete ridges, location of inflammatory infiltrate, grade of inflammatory infiltrate, presence of plasma cells, presence of eosinophils, homogenization of dermal collagen, decrease of skin appendages, basal pigmentation and melanin incontinence were evaluated. Statistical analyses were performed using SPSS Statistics v.20 (IBM, Armonk, NY, USA). The most common clinical presentation was plaque type (87.5%), while histopathological findings included homogenization of dermal collagen (100%) and decrease of skin appendages (98.7%). Flattening of the rete ridges was observed in 46.2% of patients. Severity of the inflammatory infiltrate was found to be higher in these patients (p=0.028). Basal pigmentation was observed in 59% of patients. Line sign was more common in lower extremity lesions among all localizations (p=0.015). The histopathologic features of morphea are variable and confusing. Particularly, in cases with collagen homogenization, morphea should be considered in differential diagnosis with clinical correlation. In addition, the line sign could be helpful for identifying lesions located in the lower extremities.

Perception and acceptance of medical photography among Arab dermatology patients: a cross-sectional analysis

Saba AlSuhaymi — 2024-02-06

Medical photography has been utilized in clinical, academic, and research settings. In conservative countries, such as Saudi Arabia, limited data reflect patients’ viewpoints on medical photography. The aim of this paper was to assess patients’ opinions on medical photography and the factors influencing its acceptability. A cross-sectional study utilizing a self-distributed paper-based questionnaire was performed in the dermatology clinics at King Abdulaziz Medical City (Riyadh, Saudi Arabia) between February 2020 and January 2021. The response rate is 100% as only willing participants were handed a hard-copy survey and then retrieved once completed. A total of 414 Saudi adults were enrolled. Medical photography was highly acceptable, fairly acceptable, and poorly acceptable in 36.7%, 11.6%, and 14.3% of the patients, respectively. Females were more accepting of medical photography than males (p=0.041). Physicians were the most preferred choice as photographers (83%). Stating all intended use of the photographs was favored by most patients. Using a departmentowned camera was essential to 84%. Patients who never had their photographs taken previously were more unaccepting of medical photography than those with prior experience (p=0.037). The main limitation of the study was that it was conducted at a single center; therefore, it may not represent the entire population. Medical photography is acceptable to the majority of patients. Meeting popular preferences, including physicians as photographers, using department-owned cameras, and stating all possible uses of the photographs may enhance patients’ experience. The findings offer insight for developing a standardized framework that is suitable for both patients and physicians.

Can hydradenitis suppurativa be associated with inflammatory joint involvement? Report of a case series and review of the literature

Dario Graceffa — 2023-09-11

Dear Editor, Hidradenitis suppurativa (HS) or acne inversus, is a chronic inflammatory cutaneous disease with a significant negative impact on the patient’s quality of life, from a psychological, social and occupational point of view. The disease mainly affects the female sex and occurs between puberty and 40 years of age. It is estimated that in Europe the prevalence of the disease in the general population is 1%. Recent studies have shown a high incidence of inflammatory arthritis, in particular spondyloarthritis, in patients with HS.2 In this report, we present 18 cases of patients with hidradenitis suppurativa, visited at the San Gallicano Dermatological Institute, who presented joint symptoms. [...]

Discoid lupus erythematosus associated with chronic granulomatous disease

Ana Carolina de Almeida Figueiredo — 2023-09-13

To the Editor, Chronic granulomatous disease (CGD) is a primary immunodeficiency disorder in which a reduced activity of nicotinamide dinucleotide phosphate (NAPDH) oxidase leads to defective reactive oxygen intermediates (ROS) and impairs intracellular killing of microorganisms. Patients have recurrent bacterial and fungal infections as well as granuloma formations, and have a higher risk of autoimmune and inflammatory disorders like lupus erythematosus. 1 A 20-year-old caucasian male with a diagnosis of autosomal recessive CGD was referred to our hospital because of a pruritic photosensitive rash on the face and hands, present for more than a year. [...]

Risk factors for fragility fractures in patients with immunobullous diseases on long-term systemic glucocorticoids

Liau MeiQi May — 2024-03-04

Dear Editor, Systemic glucocorticoids remain a cornerstone of therapy in immunobullous diseases. Yet little is known about glucocorticoid-induced osteoporosis (GIOP) in patients with immunobullous diseases. We performed a retrospective review of medical records at an immunodermatology clinic in a Singaporean tertiary centre. Inclusion criteria consisted of patients with a newly diagnosed immunobullous condition between January 2011 and October 2017 who were on long-term (>= 3 months) systemic glucocorticoids at a minimum daily dose of prednisolone 15mg. [...]

Delayed breast cellulitis post nipple-sparing mastectomy surgery

Vittoria Cioppa — 2023-08-29

Not available

Definitive histology control after Mohs micrographic surgery: pleonastic or not?

Ernesto De Piano — 2023-08-29

Not available

Exploring adult-onset actinic prurigo in Thailand

Siripan Sangmala — 2023-09-12

Actinic prurigo (AP) is an uncommon photodermatosis. In European and Native American populations, AP is more common in young women and demonstrates clinical improvement or remission in adulthood. The clinical signs of AP differ in Asians because the disorder typically occurs in adults (adult-onset AP) and is clinically persistent. The objective of this study was to investigate the characteristics and outcomes of patients with AP in Thailand. A total of 15 cases with AP were evaluated. All of them were adultonset AP (mean onset age of 45.5 years). Males predominated (66.7%). The majority of them manifested with papules on the face and upper extremities. Mucositis was present in 2 patients. Phototesting revealed that the minimal erythematous dose (MED) for UVA decreased in 3 subjects and the MED for both UVA and UVB decreased in other 3 patients. A photo-provocation test was performed on 9 patients with normal MED, and 5 of them showed positive UVA photo-provocation, while 4 showed positive UVA and UVB photop-rovocation. A systemic immunosuppressant was prescribed in 60% of patients. Median time for clinical improvement was 8.6 months. Complete clinical remission was found in only 3 patients. Adult-onset AP has different clinical features and responds differently to treatment, compared to classical AP.

Folliculosebaceous cystic hamartoma: an unusual histopathological entity: a case report

Katia Sofía Palomino Aguilar — 2024-01-24

The skin covers our body and exhibits a complex structure that is adapted to the different body areas. The scalp skin is distinctive, and the histopathological alterations in its diseases also present distinctive features. We present the clinical case of a 28-year-old female patient, with no significant medical history. She reported a nodular tumor on the left parietal region of the scalp, which had been present for 10 years and showed slow growth. The patient had no major discomfort other than an occasional discharge of scant whitish material upon applying pressure. Intralesional corticosteroids were administered but had no effect. Over the following year, the discomfort increased, leading to the decision to remove it. The anatomopathological study found dilated follicular hairy structures in the dermis filled with keratin and debris, surrounded by multiple sebaceous glands that flow there, all surrounded by a characteristic mesenchymal cells population, diagnosing a folliculosebaceous cystic hamartoma.

Effectiveness and safety of tuberculin purified protein derivative for the treatment of anogenital warts in patients with human immunodeficiency virus

Pati Aji Achdiat — 2024-01-30

Individuals with human immunodeficiency virus (HIV) infection are prone to developing persistent and unremitting anogenital warts (AGWs). To address this health condition, immunotherapy using tuberculin purified protein derivative (PPD) has been proven to be a promising novel and safe treatment for AGWs in HIV patients. Therefore, this study involved a case of a 21-year-old man with stage I HIV infection, possessing CD4 counts 548 cells/uL and routinely receiving HIV antiretroviral. Patients presented with a condyloma acuminata type AGWs, supported by histopathological results, and tested positive for Human papillomavirus type 11. The treatment approach involved administering 15 tuberculin units of PPD weekly to the largest lesion for 5 weeks. The lesion started to respond two weeks following the first injection and showed a 50% decrease in size after five weeks. There was pain on the site of injection and sub-febrile for a short period. In conclusion, tuberculin PPD is safe and has the potential for the treatment of AGWs in HIV-positive patients for further development.

Gemcitabine, a rare cause of chemotherapy-related reticulate hyperpigmentation

Francesco Savoia — 2024-02-02

Reticulate pigmentary disorders can be classified into inherited or acquired and cutaneous drug-induced reticulate hyperpigmentation belongs to this last group. The list of the drugs involved is constantly increasing and chemotherapy agents are frequently implicated. We report a new case of chemotherapy-related reticulate hyperpigmentation to gemcitabine, even though a previous chemotherapy with nanoparticle, albumin-bound (Nab®) paclitaxel and gemcitabine may have promoted the onset of the disease. Reassurance of the patients is important in these cases, in order to continue the chemotherapy, and gradual fading of the hyperpigmentation is usually observed, as in our case.

Unusual post-blepharoplasty infection: Gordonia Bronchialis case study

McKenzie E. Maloney — 2024-01-30

Post-procedure infections following in-office blepharoplasty are rare. Gordonia bronchialis is a weakly acid-fast, gram-positive, aerobic Actinomyces that rarely causes infections in humans. A 35-year-old female presented two weeks after an upper blepharoplasty with cyst-like swellings near the incision site. Injection with Kenalog did not resolve the cyst. Histology of the cyst showed benign fibroadipose tissue with noncaseating granulomatous inflammation alongside occasional foreign body giant cells. Anaerobic culture yielded Gordonia Bronchialis. Amoxicillin 750 mg QID was prescribed. The infection regressed but reappeared after tapering. A CT scan showed a small retention cyst in the right sphenoid sinus. The patient was then put on amoxicillin and clavulanic acid combination 875 mg BID and Minocycline 100 mg BID for 3-4 weeks. After two months of treatment, the infection was cleared. Most commonly, post-blepharoplasty infections are due to Mycobacterium. We report a case of G. bronchialis infection following a cutaneous surgery performed in the office.

Diverse clinical manifestations of acquired vulvar lymphangioma: a report of five cases in Vietnamese women

Tho Thi Thanh Nguyen — 2024-01-29

Acquired vulvar lymphangioma (AVL) is a rare but important condition that requires prompt diagnosis and appropriate management to alleviate symptoms and prevent complications. AVL can erupt locally as isolated or clustered lesions which range from translucent, fluid-filled vesicles to smooth, flesh-colored papules or nodules that exude serous or crystalline liquid spontaneously or after trauma. Clinically, it can also be asymptomatic. However, symptoms are commonly accompanied by vulvar itching, burning, soreness, or unpleasant discharge. Here, we report a case series of five Vietnamese patients with AVL with diverse clinical features.

Turnover flap variations in the reconstruction of full-thickness nasal ala defects

Paola Monari — 2023-10-27

The nose is a vital organ and an important aesthetic unit, being placed in the middle of the face. It is also one of the most frequently site involved by skin cancer, and surgical reconstruction can be sometimes challenging. We present two cases of full thickness nasal ala defect, managed with turnover flap with and without earlobe cartilage graft.

Disseminated superficial actinic porokeratosis in an elderly patient undergoing androgen deprivation therapy for advanced prostate cancer: exploring the potential association

Paulus Anthony Halim — 2024-01-24

Porokeratosis is a group of chronic dermatoses characterized by the presence of cornoid lamellae. Disseminated superficial actinic porokeratosis (DSAP) is a common subtype, presenting as multiple small annular scaly lesions primarily in sun-exposed areas. While previous studies have documented DSAP in prostate cancer patients, the association with androgen deprivation therapy (ADT) has not been reported. In this report, we describe an elderly patient with advanced prostate cancer, who developed DSAP subsequent to undergoing ADT. We present the clinical, dermoscopic, and histopathological evaluations, and discuss the potential role of ADT in the pathogenesis of DSAP.

Metronidazole-induced linear immunoglobulin A disease in a patient suffering from ulcerative colitis: a case report and focused review of the literature

Stefano Buffon — 2023-08-29

Linear immunoglobulin (Ig) A disease (LAD) is a rare autoimmune blistering dermatosis caused by linear deposition of IgA1 along the dermoepidermal junction of skin and mucosae. It can affect both children and adults. Although idiopathic in most cases, it can also be associated with infections, malignancies, or drug administration. Among medications, antibiotics are most commonly responsible, particularly vancomycin. We report the case of a 51-year-old female patient who developed mucocutaneous LAD after oral metronidazole administration, which was confirmed by histopathological examination and direct immunofluorescence of one of the bullous lesions. Lesions rapidly cleared after metronidazole discontinuation and a short course of oral methylprednisolone and dapsone. To our knowledge, this is the third reported case of metronidazole-induced LAD and the first in which metronidazole was not administered in combination with other antibiotics such as ceftriaxone.

Annular elastolytic giant cell granuloma after COVID-19 vaccination

Viviana Lora — 2023-09-12

The pandemic of SARS-CoV-2 during the first years of the 2020s led to a great commitment to develop effective vaccines. Despite the good safety and tolerability profile, vaccines may trigger a broad spectrum of cutaneous side effects. Granulomatous dermatitis has been rarely reported after SARS-CoV-2 mRNA vaccines, but no cases of annular elastolytic giant cell granuloma have been described. Moreover, in our case, it was also associated with a central area of mid-dermal elastolysis, confirming the strong association between these two diseases already reported in the literature. The observation of occasional eosinophils within the infiltrate and the presentation of the cutaneous eruption a few days after the administration of the second dose of the Pfizer/BioNTech (BNT162b2) vaccine are highly suggestive of a drug-related eruption. To our knowledge, this is the first report in the literature of an annular elastolytic giant cell granuloma as an adverse effect of the SARS-CoV-2 vaccination.

Extraocular cutaneous sebaceous carcinoma in a patient with Muir-Torre syndrome: special emphasis on histologic and dermoscopic features

Francesco Savoia — 2023-09-13

Cutaneous sebaceous carcinoma (CSC) can be classified into periocular and extraocular and can occur as part of Muir-Torre syndrome. It is usually a pink-red or yellow solitary nodule, mainly located in the head and neck region. According to the literature, dermoscopy is characterized in most cases by a yellow color, polymorphic vessels, and ulceration. We performed a review of the literature, and we found 14 papers describing the dermoscopic features of 33 sebaceous carcinomas, to which we added a case that we have recently observed. Compared to the data of the literature and in particular to the latest published reviews, we found that milky-red areas are frequently observed in CSC (47% of the cases) and can be added to the main dermoscopic features for the diagnosis. In our case, histology showed some features that were consistent with a CSC with a secretory pattern, and other features that were instead consistent with a non-secretory pattern. This was probably due to the fact that the lesion we observed was a moderately differentiated and not well-differentiated CSC. The presence of a CSC should always alert the clinician to the possible association with Muir-Torre syndrome, and immunohistochemistry for mismatch repair gene defects can help in the diagnostic pathway.

Linear immunoglobulin A bullous dermatosis induced by atezolizumab

Seba Almutairi — 2024-02-08

Linear immunoglobulin A bullous dermatosis (LABD) is a rare immune-mediated vesiculobullous disease that is reported to be induced by infections or medications. Atezolizumab is a monoclonal antibody that targets programmed cell death ligand-1 and has been used to treat multiple cancers. Here, we report a case of drug induced LABD following the administration of atezolizumab.

Klinefelter syndrome and cutaneous localization of diffuse large B cell lymphoma: a real connection or a casual association?

Federica Scarfì — 2023-08-29

Diffuse large B cell lymphoma (DLBCL) is a common aggressive subtype of non-Hodgkin lymphoma, accounting for nearly 30-40% of all cases. This condition can affect the skin both primarily and secondarily. Herein we report a clinical and dermoscopic case of skin metastasis of DLBCL in a patient with Klinefelter syndrome.

Heparin-induced thrombocytopenia: a rare presentation with skin necrosis

Filipa David — 2023-10-16

Heparin-induced thrombocytopenia is the most clinically relevant non-hemorrhagic complication of heparin and is characterized by the presence of anti-platelet factor 4 (PF4)/heparinimmunoglobulin G (IgG) antibodies. The circulating PF4/heparin- IgG immune complex binds to platelets via their FcyIIa receptors, activating them and promoting their aggregation, with consequent platelet consumption, thrombocytopenia, and thrombotic phenomena. Despite thrombocytopenia, this condition is not typically associated with bleeding complications. Instead, thrombosis is the most serious complication of heparin-induced thrombocytopenia, contributing to increased morbidity and mortality. Thrombotic events can be venous and arterial, such as deep vein thrombosis, pulmonary embolism, myocardial infarction, and thrombotic stroke. Skin necrosis at the site of heparin injections is a rare but well-described manifestation of heparin-induced thrombocytopenia. We report a case of heparin-induced thrombocytopenia presented as skin necrosis, highlighting the importance of recognizing this potentially fatal condition and the need for an immediate cessation of all sources of heparin and its replacement by other anticoagulants.