Angelo Piccirillo

Dermoscopy of prurigo nodularis.

The diagnosis of prurigo nodularis is mainly clinical, based on its distinctive features. However, in some cases it may be difficult to differentiate it from other nodular dermatoses only on the clinical basis, thus requiring histopathological examination to reach a definitive diagnosis. The aim of this study was to describe for the first time the dermoscopic features of prurigo nodularis and the useful contribution of dermoscopy in the differential diagnosis of such dermatoses. Fourteen patients with histopathologically proven prurigo nodularis were included in the study. The results of our study suggest that the detection of a “white starburst pattern” surrounding brown‐reddish/brown‐yellowish crust(s), erosion(s) and/or hyperkeratosis/scales is a useful clue to support the clinical diagnosis of prurigo nodularis, distinguishing it from the other main differential diagnoses.

Dermoscopy of subacute cutaneous lupus erythematosus

pruritus on quality of life: the skin equivalent of pain. Arch Dermatol 2011; 147: 1153–1156. 3 Reich A, Heisig M, Phan NQ, et al. Visual analogue scale: evaluation of the instrument for the assessment of pruritus. Acta Derm Venereol 2012; 92: 497–501. 4 Armstrong AW, Kwong MW, Ledo L, et al. Practice models and challenges in teledermatology: a study of collective experiences from teledermatologists. PLoS ONE 2011; 6: e28687. 5 Centers for Medicare and Medicaid Services. Physician Quality Reporting System (PQRS). https://www.cms.gov/ Medicare/Quality-Initiatives-Patient-AssessmentInstruments/PQRS/index.html?redirect=/pqri/. [Accessed February 10, 2016.]

Dermoscopy as an auxiliary tool in the differentiation of the main types of erythroderma due to dermatological disorders.

Dermoscopy as an auxiliary tool in the differentiation of the main types of erythroderma due to dermatological disorders Most cases of erythroderma are due to inflammatory and lymphoproliferative skin disorders, mainly including psoriasis, eczematous diseases, pityriasis rubra pilaris, and mycosis fungoides. Even though the clinical history or presence of specific cutaneous/nail lesions may be useful in assisting the differential diagnosis of erythrodermas caused by the aforementioned dermatoses, their distinction is often challenging for both dermatologists and pathologists. We here report the dermoscopic pattern of four instances of chronic erythroderma in patients with a definitive diagnosis of the above-mentioned dermatological conditions (dermoscopy was always carried out with DermLite DL3; 3Gen, San Juan Capistrano, CA, USA). Case 1 (erythroderma due to psoriasis; Fig. 1a) has a monomorphous pattern with diffusely distributed whitish scales and regularly arranged dotted vessels on a fairly homogeneous reddish background (Fig. 2a). Case 2 (erythroderma due to atopic dermatitis; Fig. 1b) has yellowish scales/serocrusts, sparse whitish scales, and patchily distributed dotted vessels on a pinkish background (Fig. 2b). Case 3 (erythroderma due to mycosis fungoides; Fig. 1c) has a monomorphous aspect consisting of sparse whitish scales ass.ociated with widespread dotted vessels and some peculiar

Latent tuberculosis reactivation in a patient with erythrodermic psoriasis under treatment with ustekinumab and a low dose steroid, despite isoniazid chemoprophylaxis

A 36-year-old healthy man (weight: 78 kg; BMI: 24.6), with a 7-year history of moderate to severe psoriasis, poorly responsive to conventional systemic treatments, was admitted to our clinic for a significant worsening of the disease. Physical examination showed an erythrodermic status with a PASI (psoriasis area severity index) of 44. We started cyclosporine treatment at the dose of 4 mg/kg daily, without any significant results after 6 weeks of therapy. Therefore, we added a systemic steroid (oral [...]

Dermoscopy of nail fold and elbow in the differential diagnosis of early psoriatic arthritis sine psoriasis and early rheumatoid arthritis

Differentiation between psoriatic arthritis (PsA) sine psoriasis and rheumatoid arthritis (RA) may be a challenge, especially in the early stages, hence the need for new instrumental markers to assist their diagnosis. In this study, we investigated possible dermoscopic differences in vascular appearance of nail fold and elbow (a classic site of repeated trauma) in these two conditions. Fifteen patients with PsA sine psoriasis, 12 patients with RA and 12 controls were included in the study. Regarding the nail fold vascular appearance in PsA sine psoriasis and RA cohorts, the presence of diffuse reddish background with or without sparse dotted vessels was significant in the former, whereas the evidence of parallel dotted/short linear vessels (“fish school‐like” pattern) or irregular/ramified, blurry, purple vessels were significant in the latter; none of these patterns were detected in the control group. Regarding the elbow, the pattern significantly associated with PsA sine psoriasis consisted of diffusely distributed, red, dotted vessels. On the other hand, RA patients and controls displayed similar dermoscopic findings, with three possible vascular patterns being observed: (i) irregular, blurry, purple vessels; (ii) avascular appearance; and (iii) sparse, dotted, purple vessels. In conclusion, dermoscopy may be a useful supportive tool for differentiating early PsA sine psoriasis from RA.

Areolar sebaceous hyperplasia associated with oral and genital Fordyce spots.

Dear Editor, A 32-year-old man without relevant pathological antecedents presented to our department for evaluation of two asymptomatic skin lesions localized on his areolas. Physical examination revealed several millimeter-sized confluent papules, arranged in yellowish plaques with a papillomatous surface symmetrically surrounding the nipples (Fig. 1a,b). His upper lip and penis shaft exhibited similar papules, diagnosed as Fordyce spots (ectopic sebaceous glands) (Fig. 1c,d). The remaining skin tegument showed no significant lesions. The man reported that the areolar papules appeared approximately 14 months earlier and since then they had increased in number, while the oral and genital lesions were noted for the first time approximately 3 years prior. A skin specimen was taken by a punch biopsy from the plaque of the left areola for histological examination, which showed mature sebaceous glands located immediately below the epidermis. These were aligned in a band-like distribution and opened directly to the skin surface (Fig. 1e,f). On the basis of clinical and histological data, we made a diagnosis of areolar sebaceous hyperplasia (ASH) associated with oral and genital Fordyce spots. Considering the benignity of the conditions, we decided not to perform any treatment. After a 6-month follow up, the lesions remained stable. Areolar sebaceous hyperplasia is a very rare entity described for the first time by Catalano and Ioannides in 1985. They reported a woman who developed asymptomatic yellowish thickening of both areolae histologically consisting of mature sebaceous glands connected to the skin surface through short, hairless hair ducts. In the following years, only 11 cases have been reported, including six women and five men. The disease was found to be bilateral in five women and two men, while in the remaining cases was unilateral. Only two patients also had oral Fordyce spots, while to date there are no reports of ASH associated with genital Fordyce spots. Clinically, ASH may appear as a diffuse yellowish thickening or swelling of areola, yellowish isolated papules or, as in our case, yellowish plaques due to the confluence of minute papules. Generally, the lesions are asymptomatic and need no treatment. The actual origin of ASH is still controversial. Some authors describe it as hyperplasia of the sebaceous glands in the Montgomery’s tubercles; while others have postulated that it involves independent sebaceous glands, unrelated to the Montgomery’s tubercles or the hair follicles. Furthermore, considering that men lack Montgomery tubercles, sometimes ASH in male subjects has been interpreted as a malformation rather than a hyperplasia, hamartoma or adenoma. In this case, we observed the simultaneous presence of ASH, and genital and oral Fordyce spots. A similar association has never been reported in the published work and, in our opinion, provides insight into the true nature of ASH. In particular, although we can not exclude that the coexistence of the three conditions aforementioned in our patient may be casual, we speculate that this finding suggests that ASH could be interpreted as the areolar equivalent of the Fordyce condition involving the mouth or genitals and therefore ectopic sebaceous glands.

Treatment of recalcitrant erythrodermic psoriasis with ustekinumab

Erythrodermic psoriasis (EP) can be challenging to treat since several factors, such as failure or intolerance, limit favourable outcomes with traditional therapies [1]. The conventional treatments recommended for EP are methotrexate, oral retinoids and cyclosporine [2], although systemic steroids are still used, especially in severe and unstable forms, since they usually induce a rapid clinical improvement [2, 3]. Recently, some cases of EP have been successfully treated with biological agents, [...]

Multiple actinic keratoses and squamous carcinomas at the site of prior herpes zoster

base with a CO2 laser (1000U; SNJ, Seoul, Korea) in ultrapulse mode (power, 1.0 W; frequency, 50 Hz; pulse duration, 0.2 msec). Histopathology of the shave biopsy was similar to the previous finding, in addition, Candida albicans was detected with PAS staining and fungal culture. We treated the left-sided lesion by CO2 laser ablation only. Both lesions healed completely and there were no complications or recurrences during 3 months of follow up (Fig. 1c,d). For the characterization of plasmoacanthoma, we have reviewed all the cases previously reported in the published work (Table 1). Our case is similar to the previous reports in terms of morphology and location, but has the unusual clinical feature of a bilateral and symmetrical distribution in both angles of the mouth. We considered differential diagnoses of candida granuloma, angular cheilitis and syphilis. Unlike candida granuloma, our patient was elderly rather than in early childhood. Also, histopathologically, there was no evidence of granuloma and cellular infiltrates were mostly made up of plasma cells, without neutrophils or multinucleated giant cells. Angular cheilitis manifests as a roughly triangular area of erythema with furrows or fissures rather than verrucous plaques, and the histological finding of dense plasmacytic infiltration ruled out the possibility of angular cheilitis in our case. Syphilis can be differentiated from plasmoacanthoma by serological test and Warthin–Starry stain. Because of the recent suggestion that plasma cell cheilitis and plasmoacanthoma are closely related and may belong within the spectrum of the same disease, we tried corticosteroids and calcineurin inhibitor, which had been shown to be effective in plasma cell cheilitis. However, these agents failed to reduce the sizes of the lesions. Subsequently, we removed the protruding masses by CO2 laser ablation on the supposition of benign timorous condition and satisfactory results were achieved. The reduction of the lesions may have resulted not only from vaporization of the epidermis, but also thermal damage to the underlying dermis. Although uncommonly encountered, plasmoacanthoma should be considered in the differential diagnosis of verrucous lesions involving periorificial areas. In addition, our experience suggests that CO2 laser ablation is a useful and effective therapeutic option in the treatment of plasmoacanthoma unresponsive to topical therapy.

Pedunculated and telangiectatic merkel cell carcinoma: an unusual clinical presentation

Merkel cell carcinoma (MCC) is an uncommon aggressive neuroendocrine tumor of the skin that classically presents on chronic sun-damaged skin as a skin-colored, red or violaceous, firm and nontender papule or nodule with a smooth and shiny surface. Ulcerations can be observed very seldom and only in very advanced lesions. We present a unique case of a MCC presenting with two unusual clinical features: The Telangiectatic surface and the pedunculated aspect.

Folliculotropic mycosis fungoides presenting as non‐inflammatory scarring scalp alopecia associated with comedo‐like lesions

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