A. Stratigos

Sunscreens – what's important to know

The popularity of sunscreens dramatically increased since ultraviolet irradiation was implicated in the pathogenesis of skin cancer and skin ageing. The absorption properties, safety, photostability of different organic and inorganic filters are reviewed: para‐aminobenzoic acid, salicylates, cinnamates, benzophenones, butylmethoxydibenzoylmethane (Parsol 1789), drometrizole trisulphonic (Mexoryl XL), terephthalydene dicamphor sulphonic acid (Mexoryl SX), methylene bisbenzotriazol tetramethylbutylphenol (Tinasorb M), anisotriazine (Tinasorb S), titanium dioxide and zinc oxide. Furthermore, this review discusses the optimal methods for measuring the protection that a sunscreen offers, the role of sunscreen use in melanoma prevention and future trends in sunscreen filters development.

Polymorphous light eruption.

Polymorphous light eruption (PLE) is a common idiopathic photosensitivity disorder with an estimated prevalence of 10–20%. It is characterized by an intermittent skin reaction to ultraviolet (UV) radiation exposure, consisting of non‐scarring pruritic erythematous papules, vesicles or plaques that develop on light‐exposed skin. Despite the different morphology in different individuals, the eruption tends to have a monomorphous presentation in any single subject. The histopathological features of PLE are distinct and comprise a perivascular lymphocytic infiltrate in the dermis, subepidermal oedema and variable epidermal changes. The pathogenesis of PLE is not well known, but findings suggest that it is a delayed‐type hypersensitivity reaction to one or more UV‐modified cutaneous antigens. The principal action of PLE is mainly in the UVA region, although some subjects exhibit sensitivity to UVB alone or to both UVA and UVB radiation at the same time. Preventive measures in PLE include the regular use of photoprotective methods combined with graduated exposures to natural sunlight. The induction of immune tolerance by phototherapy and photochemotherapy are useful prophylactic methods in moderate to severe cases. The role of systemic agents in the management of PLE is under investigation. This article reviews the epidemiological, pathogenetic and clinical aspects of PLE and discusses recent advances in the diagnostic approach and management of this condition.

The relevance of peripheral blood T-helper 1 and 2 cytokine pattern in the evaluation of patients with mycosis fungoides and Sézary syndrome.

Summary Background There is evidence that a T‐helper (Th) 2 cytokine pattern dominates in the peripheral blood as well as in tissue of patients with Sézary syndrome (SS), and that the malignant clone is of Th2 phenotype. However, there are conflicting studies on the cytokine pattern in the peripheral blood in different stages of cutaneous T‐cell lymphoma (CTCL).

Evaluation of the efficacy and safety of infliximab on psoriatic nails: an unblinded, nonrandomized, open‐label study

Background  Despite advances in the treatment of skin psoriasis during the last years, therapy of psoriatic nails remains a challenge.

Discoid lupus erythematosus‐like eruption induced by infliximab

Lupus erythematosus‐like syndromes have been reported as an adverse effect of anti‐tumour necrosis factor‐α therapy. We report the case of a patient with rheumatoid arthritis who developed a discoid lupus erythematosus‐like eruption after treatment with infliximab. The rash consisted of diffuse scaly erythematous plaques on the face, trunk and extremities, and occurred in the context of elevated anti‐nuclear and anti‐double‐stranded DNA antibody titres. Direct immunofluorescence of lesional skin showed linear deposition of IgG, IgM and C3. The lesions resolved completely after the discontinuation of infliximab and with the use of anti‐malarial therapy. We discuss the clinical, histological and immunohistochemical features of this case and review the literature with respect to the incidence of lupus erythematosus‐like syndromes in patients receiving tumour necrosis factor‐α antagonists.

Melanoma/skin cancer screening in a Mediterranean country: results of the Euromelanoma Screening Day Campaign in Greece.

Background  Since the year 2000 a melanoma/skin cancer screening campaign has been organized annually in Greece in the context of the Euromelanoma Screening Day Campaign.

Clinical characteristics and course of CD8+ cytotoxic variant of mycosis fungoides: a case series of seven patients

Background  Fewer than 5% of cases of mycosis fungoides (MF) present with a cytotoxic/suppressor CD8+ phenotype which, despite immunophenotypic similarities with CD8+ aggressive lymphomas, is regarded as a phenotypic variant of MF. Poikilodermatous MF showing a CD8+ phenotype has been reported to have a nonaggressive clinical behaviour and a good response to psoralen plus ultraviolet A treatment.

Exacerbation of Psoriasis after Treatment with an EGFR Tyrosine Kinase Inhibitor

Sir, Epidermal growth factor receptor (EGFR), also known as HER-1 or erbB-1, is one of the four members of the erbB/HER EGFR family, located in the cytoplasmatic membrane, which play a key role in the regulation of normal cell growth and differentiation. They consist of an extracellular ligand-binding domain, a transcellular lipophilic segment that anchors the receptor in the cell membrane and an intracellular domain with a tyrosine kinase activity. The binding of the ligand to the extracellular part of the receptor results in the pairing of the receptor with another EGFR (homodimerization) or with another member of erbB family (heterodimerization). Homo- or hetero-dimerization leads to the phosphorylation of the intracellular tyrosine kinase that activates a signal transduction cascade to the nucleus, stimulating cell division, cell proliferation, cell

Photoaging: prevention and topical treatments.

A rapidly increasing number of people visit dermatologists for the prevention and treatment of aging skin. Sun avoidance and sunscreen use are widely accepted strategies of primary prevention against photoaging. Convincing evidence shows that topical application of retinoids has an effect on reversing, at least partially, mild to moderate photodamage. Antioxidants and alpha-hydroxy acids can alter the skin structure and function. Enzymes that repair DNA damage or oligonucleotides that enhance the endogenous capacity for DNA damage repair may prove to be future preventive/therapeutic interventions for aging skin.

Alopecia areata: topical immunotherapy treatment with diphencyprone

Background  Topical immunotherapy with diphencyprone (DPCP) is considered the most effective treatment of alopecia areata (AA).