Claudia Abruzzese

Unusual case of linear anetoderma in children.

1 Myers WA. The “nasal crease”: a physical sign of allergic rhinitis. JAMA 1960; 174: 1204–1206. 2 Cornbleet T. Transverse nasal stripe of puberty (stria nasi transversa). AMA Arch Derm Syphilol 1951; 63: 70–72. 3 Moss C, Shahidullah H. Transverse nasal groove. In: Burns T, Breathnach S, Cox N, Griffiths C, eds. Rooks Text Book of Dermatology, Vol. 1, 8th edn. Oxford: Wiley-Blackwell, 2010: Chapters 18: 90. 4 Hosokawa H, Hosokawa K. Two cases of transverse nasal stripe accompanied by comedones and milia [in Japanese]. Jpn J Dermatol 2012; 122: 2669–2673. 5 Sathyanarayana BD, Basavaraj HB, Nischal KC et al. Appraisal of transverse nasal groove: a study. Indian J Dermatol Venereol Leprol 2012; 78: 439–442.

Eosinophilic Dermatosis Associated with Haematological Malignancies: A Report of Two Cases

Hematologic malignancies can be associated to dermatological manifestations, with two possible etiopathogenetic mechanisms: a direct invasion of skin by neoplastic cells or a paraneoplastic phenomenon. The eosinophilic dermatosis can be included in the latter class and arc a group of polymorphous dermatitis, clinically characterized by papules, plaques, nodules or vescico-bullous lesions, mainly involving sun-exposure sites. Clinical pictures are similar to an insect bite reaction, but in most cases the patients deny any arthropod contacts. Therefore, they arc now considered as a hypersensitive reaction to different stimuli induced by lymphoproliferative malignancies and the associated immune-deficient state. Herein, we describe two cases of patients affected by a non-Hodgkin lymphoma (NHL), in whom a diagnosis of insect bite-like reaction (IBLR) was made.

Fingertip Dermatitis: Occupational Acrylate Cross Reaction

Allergic contact dermatitis due to acrylates present in the workplace is a disease frequently reported among dentists, printers, and fiberglass workers.1 Recently, the number of cases of contact allergic dermatitis among beauticians specialized in sculpting artificial nails has increased. The use of sculptured nails (also called acrylic or porcelain nails) is becoming increasingly popular in beauty treatment centers, and they are also available in kits for do-it-yourself applications at home. In recent years we have witnessed an increase in the incidence of allergic contact dermatitis (ACD) caused by the acrylic products used in artificial nails. ACD mostly affects the professional beauticians who handle the product, but can also be observed in end users.2 A 35-year-old woman, economist and manicurist for hobby for 4 years, presented with severe fingertip dermatitis and nail plate dystrophy ( Fig. 1 A, B ) . Eighteen months previously, she had had hair extensions and developed a transient pruritic rash on her arms that cleared after removing the hair extensions. Acrylate adhesive is used to attach hair extensions and may have been applied in this case. A year previously, she began to work with sculptured acrylic nails and shortly thereafter developed severe vesicular dermatitis on her hands and fingers. About two years, the patient also relates to practice decoupage and use acrylic glue. She stopped working with artificial nails because contact with nail-sculpturing materials was suspected as the cause of her dermatitis. A few months later, she applied artificial nails on herself and a day later developed severe fingertip dermatitis, which was present on clinical examination, together with nail plate dystrophy. Patch testing was performed with a European baseline series (TRUE test panels 1 and 2) supplemented with pet.-based selected allergens from a series of adhesive and acrylate chemicals F.I.R.M.A. (Benzoyl peroxide 1%, Methyl methacrylate 2%, Hydroxyethyl methacrylate 2-HEMA 2%, Tripropylene glycol diacrylate 0.1% , Trimethylolpropane triacrylate 0.1% , Urethane diacrylate 0.1%, Urethane diacrylate 0.05%, Ethyl cyanoacrylate [ECA] 10%, Hydroquinone 1%) applied in Finn Chambers on Scanpor tape and read according to the International Contact Dermatitis Research Group scoring scale at D3 and D7. A TRUE patch test was positive to nickel sulphate (D3+++, D7+) and cobalt (D3+, D7 ++). Special series for acrylate chemicals F. I. R. M. A. was positive for ethylcyanoacrylate (ECA) 10% (D3+, D7++). Allergic reactions to sculptured nails can appear within months or years after use by both professional users and end users, because contact with these substances is in both cases protract in time. Symptoms of sensitization to acrylates in professional beauticians―generally women― consist of subacute or chronic eczema located on the pads of the fingers that come into direct contact with the acrylic resin.3 Typically the fingertip of the first, second, and third finger of both hands are affected―the nondominant hand from holding the client’s nail, and the dominant hand from holding the brush. Lesions also frequently occur on the sides of the hands where these rest on work surfaces is likely to carry monomer residues. Typical symptoms are pruritus, fingertip dermatitis and pain once fissures develop. Eczematous lesions frequently occur away from the site of contact as the result of transportation of residues of either the glue monomer or the powder polymer ( which can also contain the monomer) from the hands to more distant areas of skin. Symptoms in end users differ from those in professional users. The first sign is itchiness at the nail base, with paronychia, painful nails, and, occasionally, paresthesia subsequently developing. The nail base often becomes dry and thickened, and Allergology International. 2014;63:609-610

Occupational contact dermatitis from pyrocatechol in parquet flooring

We describe a case of occupational allergic contact dermatitis due to pyrocatechol. A 55-year-old man reported a 2-year history of very itchy symmetrical eczema on both hands, which was treated with topical emollients and corticosteroids without consistent resolution (figure 1). Histological examination showed features that confirmed a diagnosis of allergic contact dermatitis. The patient was tested with the SIDAPA (Italian Society of Allergological, Professional and Environmental Dermatology) standard series of patch tests, which were negative. The personal history of the patient revealed no significant factors except that he …

Laser removal of tattoos.

In Western countries the phenomenon of “tattooing” is expanding and tattoos are considered a new fashion among young people. In this paper we briefly trace the history of tattooing, the techniques used, the analysis of pigments used, and their possible adverse reactions. We also carried out a review of the international literature on the use of Q-switched laser in tattoo removal and its complications, and we describe our experience in the use of this technique.

Psoriasiform dermatitis in a non-psoriatic patient treated with adalimumab.

Anti-TNF drugs may be associated with various adverse reactions including cutaneous ones. We describe the case of a 45-year-old woman affected by undifferentiated spondylarthritis who presented a localized psoriasiformis dermatitis during treatment with adalimumab, without any medical history of psoriasis.

A Rare Case of Sarcoidosis and Morphea

In the last decades several cases of association between sarcoidosis and various autoimmune diseases have been described, leading us to stress the concept of a possible common genetic “soil” of predisposition. The majority of these cases were association between sarcoidosis and generalized scleroderma, but only one case of localized scleroderma and sarcoidosis. In this report, we describe a case of a female patient in which a diagnosis of pulmonary sarcoidosis and morphea was made.

An interesting case of oedema and ulceration in red areas of tattoo

Dear Editors, We describe the clinical case of a 25-year-old man who presented to our clinic for a granulomatous reaction in the red areas of a tattoo on his right leg (Figure 1). The patient developed oedema and ulceration 3 weeks after undergoing tattoo. The social meaning of the practice of tattooing has evolved over the centuries. The spread of these fads, especially among adolescents, calls for urgent action to provide for health monitoring of the traders who engage in such practices, and to foster self-protection behaviours among young people. If not monitored, these practices may result in both local and systemic complications. Many dermatoses such as psoriasis, systemic lupus erythematosus (SLE), sarcoidosis and lichen planus can be localised in the area of the tattoo (1), probably because of a minor locus resistentiae or the isomorphism of Koebner. We performed a patch test to exclude an allergic reaction, a cutaneous biopsy for histological examination and microbiological cutaneous tests to exclude an infective nature of the reaction. Patch test series SIDAPA, produced by F.I.R.M.A. S.p.A (Firenze, Italy), involve applying patches containing the following haptens on the back of the patient (by a single operator): potassium dichromate, rosin, epoxy resin, formaldeidica resin, Euxil 400, neomycin sulphate, fragrance mix, nickel sulphate, mercaptobenzotiaziolo, paraphenylendiamine, cobalt chloride, balsam of peru, thiuram mix, benzocaine, lanolin alcohols, parabens, Vaseline, scattered yellow, scattered blue and hydroquinone. The patient was asked not to wash his back, and not to take oral cortisone and antihistamines.

Inflammatory reaction to brown pigment in a tattoo

Dear Editors, Tattooing is becoming a common procedure worldwide. This technique was in the past restricted to outlaws, prisoners, sailors or gang members, and it was linked with specific meanings such as religious beliefs, tribal affiliation, loyalty to a leader and that of courage and therapeutic functions. Actually, its incidence is now on the rise compared with that in the past (1), and although it is more frequent among youngsters and young adults, there seems to be no age limit. Both tattooing and removal of tattoos have become a business, with the latter being less successful but more expensive than the former (2). We describe a case of a 31-year-old Caucasian man, presented to our clinic, with ulcerated lesions in the tattoo site on his left forearm, which developed after the application of a tattoo (Figure 1). After the tattooing, the brown part of the tattoo appeared swollen and reddened, with ulcerated lesions that evolved in crusts. We assessed cutaneous sample cultures for microorganisms, which were found to be negative. A diagnosis of inflammatory reaction was considered and a cutaneous biopsy of this reaction was performed. Meanwhile, to exclude an allergic reaction, we performed a patch test series SIDAPA produced by F.I.R.M.A. Spa (Firenze, Italy). The test consists in application of patches containing the following haptens on the back of the patient (by a single operator, Dott. A. Tammaro): potassium dichromate; Rosin; epoxy resin; formaldehyde resin; euxil 400; neomycin sulphate; fragrance mix; nickel sulphate; mercaptobenzothiazole; paraphenylenediamine; cobalt chloride; balsam of Peru; thiuram mix; benzocaine; lanolin alcohols; parabens; Vaseline; scattered yellow; scattered blue and hydroquinone. The patient was asked to refrain from washing his back and taking cortisone and antihistamines by mouth. The patients returned after 48 h from the application for the first reading and 72 h from the application (so 24 h from the first reading) for the second reading. The test is positive if there were any signs such as erythema (+ positive), erythema+ vesicles (+ + positive) and erythema+ vesicles+ oedema (+ + + positive) at the site of contact with the haptens. However, all the patch test results were negative (absence of all signs). Another patch test (F.I.R.M.A. special series) for metal allergens containing the following haptens was performed: copper sulphate, dimetylaminobenzene, aminoazotoluene, dispersed blue, dispersed yellow, scattered orange, dispersed red, gentian violet, cadmium chloride, nickel sulphate, iron chloride, potassium chrome, Chrome Trichloride, aminoazobenzene, cobalt chloride, aluminium chloride, titanium dioxide, zinc, mercury chloride, Kathon, fenolo, ethylenediamine trihydrochloride, phenylenediamine base, formaldehyde, phthalic Figure 1 Photograph of a 31-year-old Caucasian man, presented to our clinic, with ulcerated lesions in the tattoo site on his left forearm.

Localised pseudoepitheliomatous hyperplasia: unusual cutaneous reaction pattern to tattoo.

Dear Editors, Tattoing has been practiced for centuries in many cultures, and has become increasingly popular in Western countries since the 1970s, with a parallel increase in adverse reactions. It is well established that tattooes may be associated not only with different skin diseases, like transient acute inflammatory reactions at the site of needling, but also with serious medical complications such as allergic contact dermatitis, contact urticaria, photodermatitis and other dermatoses like psoriasis, Systemic Lupus Erythematosus (SLE), sarcoidosis, lichen planus or localisation of skin cancer in the area of the tattoo. The reason for this occurrence has not been fully elucidated, but a locus minoris resistentiae or the isomorphism of Koebner has been hypothesised. Herein, we describe a case of a 26-year-old woman who presented to our clinic for an itchy overgrowing reaction at the tattoo site on the posterior side of her right leg. The tattoo had been placed about 6 months prior to spotting the lesion and contained purple, green and blue-black pigment. Cutaneous examination showed a verrucous plaque limited to the purple area of the tattoo, where the patient had applied different topical antibiotic and corticosteroid ointments, without any benefit (Figure 1). Cultural examinations of the lesion were done to exclude an infective pathogenesis and showed negative results. A diagnosis of tattoo granuloma was considered and a cutaneous biopsy was performed. Microscopically, it has: hyperkeratosis, parakeratosis and striking pseudoepitheliomatous hyperplasia (PEH) (Figure 2), with marked perivascular and periadnexial mononuclear inflammatory infiltrate in the dermis and superficial epidermis, composed primarily of lymphocytes and histiocytes (Figure 3A–C). Dermal blackish pigment was also noted (Figure 4A, B). All these findings were consistent with the diagnosis of PEH at the tattoo site. The patient was treated with monthly intralesional triamcinolone injections and she is currently in follow-up. Although inflammatory reactions to tattoos are uncommon, more and more cases are being documented as tattooing becomes increasingly popular in today’s society. Different cutaneous delayed reaction patterns have been described, usually secondary to red pigment injection – the most common are allergic and lichenoid reactions, but granulomatous, pseudolymphomatous and morpheiform reactions can also occur (1,2) The development of cutaneous cancer has been rarely described in the area of a tattoo, but it could be coincidental (3–5). Figure 1 Clinical picture of hyperplastic epidermal reaction localised only to the red pigmented area.