Dimitrios Sgouros

Palmar and plantar melanomas differ for sex prevalence and tumor thickness but not for dermoscopic patterns.

The specific anatomy of the glabrous skin, characterized by marked orthokeratosis and the presence of furrows and ridges, results in peculiar dermoscopic patterns of acral melanocytic lesions. Most frequently, acral nevi are typified by a parallel furrow pattern and acral melanoma (AM) by a parallel ridge pattern (PRP). Although the dermoscopic patterns of AM have been extensively investigated, little attention has been paid to site-related differences between palmar and plantar AM. The current study aimed to compare patients’ characteristics, melanoma thickness, and the morphologic variability of AM depending on the localization on palms or soles. Patients demographics and dermoscopic images of 118 AM, including 99 (83.9%) plantar and 19 (16.1%) palmar lesions (mean thickness, 2.1 mm), were extracted from the databases of seven pigmented skin lesion clinics and were evaluated for the presence of predefined criteria. Palmar melanomas were remarkably more frequent in women (male-to-female ratio, 1/3.8) and thinner than plantar melanomas (1.3 vs. 2.2 mm). Dermoscopically, no significant differences were found between plantar and palmar melanomas, with PRP scored in 64.6 and 68.4% of plantar and palmar lesions, respectively. Non-site-specific melanoma criteria were detected in 83.9% of lesions and, among melanomas not exhibiting a PRP, 95.1% showed at least one non-site-specific melanoma criterion. In conclusion, plantar and palmar AMs show sex-related and thickness-related differences, but do not differ with respect to their dermoscopic features. For cases lacking the PRP, non-site-specific melanoma criteria may be considered as helpful additional clues for the correct diagnosis.

Frontal Fibrosing Alopecia and Vitiligo: Coexistence or True Association

Frontal fibrosing alopecia (FFA) is a primary lymphocytic cicatricial alopecia characterized by a progressive band-like recession of the frontotemporal hairline and frequent loss of the eyebrows. It predominantly affects postmenopausal women. Coexistence of FFA and vitiligo is rarely reported in the literature. We retrospectively studied 20 cases diagnosed with FFA in a 14-month period in our Department. Among them, there were 2 cases, a 72-year-old woman and a 48-year-old man, who developed FFA on preexisting vitiligo of the forehead. Anatomical colocalization of the two dermatoses supports the notion that a causal link may exist and their association may not be coincidental. We suggest that interrelated immunologic events and pathologic processes may underlie both these skin conditions.

Giant Onychomatricoma of the Great Toenail: Case Report and Review Focusing on Less Common Variants

Onychomatricoma is a rare benign fibroepithelial filamentous tumor originating from the nail matrix. It typically presents with the clinical tetrad of xanthonychia, pachyonychia, proximal splinter hemorrhages and increased transverse overcurvature of the nail plate. The giant variant can easily confuse the clinician due to its extensive nail dystrophy that can mask the characteristic features of this tumor. Benign (fibrokeratoma, ungual fibroma, onycholytic matricoma) and malignant entities (Bowens disease, squamous cell carcinoma, onycholytic carcinoma) are mimics of the disease. Nail surgery can facilitate the diagnosis, which should always be confirmed by histology, as rare variants do exist.

Onychotillomania: A Chameleon-Like Disorder: Case Report and Review of Literature

Onychotillomania, or nail-picking disorder, is an uncommon and misdiagnosed behavioral pattern focused on the nail apparatus. It is demarcated by the compulsive or irresistible urge in patients to constantly injure their own nails, with the fingers or tools, inflicting noticeable or even irreversible self-destruction of the nail unit. Despite its rarity, this self-injurious coercion often poses a diagnostic and therapeutic challenge. Not only do many patients deny nail manipulation, but also the disorder has long been recognized to present itself with a wide range of clinical features, which hampers early and indisputable diagnosis. Furthermore, onychotillomania constitutes a persistent and hardly manageable problem, mostly because of its psychocutaneous nature as well as its high propensity to coexist with underlying neuropsychiatric illnesses or other behavioral disorders. However, the medical literature concerning obsessive nail picking still remains relatively scarce. Herein, we present an extraordinary, yet very intriguing case of a Caucasian patient with onychotillomania and onychophagia coexistence masquerading a weird inflammation-like lesion.

Is there a pathogenetic link between frontal fibrosing alopecia, androgenetic alopecia and fibrosing alopecia in a pattern distribution?

patients. No significant correlation was found between a CD4/ CD8 ratio of more than five and disease progression; only three cases had CD4/CD8 ratios of more than 10 with no evident progression of their disease. Imaging studies were selective in our cohort based solely on clinical suspicion. The vast majority of our imaging studies were normal. In addition, most of the abnormal findings were due to either coincidental unrelated medical disease or non-significant (≤15 mm) vs. reactive lymphadenopathies. Limitations of this study include the retrospective cohort design and the potential for bias in a population referred to a tertiary care centre. In conclusion, extensive screening studies performed in earlystage MF (T1/T2) do not appear to be of high yield and lack a clinical correlation with significant disease progression in a large database. Imaging investigations have a low yield even when restricted on the basis of clinical suspicion in early-stage disease. Negative result of blood film, LDH and flow cytometry in this study can raise the question to extend optional screening from only T1 MF to both T1 and T2 MF. However, screening investigations are indicated if progression is suspected. Due to the rarity of the condition, follow-up in a specialized tertiary care is preferred.

Frontal fibrosing alopecia: is the melanocyte of the upper hair follicle the antigenic target?

and have the advantage of various stem cells with melanogenic properties. However, the repigmentation outcome of FCS is only comparable or slightly inferior to that of ECS. Recently, a newer approach using a combination of ECS and FCS showed better repigmentation outcome compared to ECS even in difficult-totreat vitiligo (Table 1). It is noteworthy that various modifications have simplified the procedure of ECS. Kumar et al. proposed the “four compartment method”, and Gho et al. described the “6-well plate” technique to address the same. Similarly, ReCell (Avita Medical, London, U.K.) is an automated cell harvesting device that obviates the need for a research laboratory for preparation of cell suspension. In summary, contrary to the conclusion drawn by the authors of the review, the evidence for the efficacy and safety of MKTP is robust. It is one of the treatments of choice for stable vitiligo patches that fail to repigment with different medical modalities. The use of various terminologies for the cellular transplantation methods in vitiligo surgery by different authors might have led to the inadvertent omission of the above-mentioned clinical trials in the review. Hence, it is important to enlist these synonyms as key words for PubMed indexing or as search terms for literature search in future clinical studies or literature reviews, respectively.

Novel topical agent containing superoxide dismutase 100 000 IU and 4% of plant extracts as a mono-therapy for atopic dermatitis

Corticosteroids are the mainstay of treatment for the acute phase of atopic dermatitis (AD), whereas topical emollients are mainly used for maintenance of remission. A topical agent that combines emollient and anti‐inflammatory properties would achieve control of all phases of AD, without the need for chronic corticosteroid use.

Contents Vol. 1, 2015

Editorial Board Roberto Arenas – Hospital General Dr Manuel Gea Gonzalez, Mexico City, Mexico Daniel Asz Sigall – Private Practice – Dermatology, Mexico City, Mexico Robert Baran – University of Franche-Comté, Cannes, France Wilma Bergfeld – Cleveland Clinic, Cleveland, USA Vincenzo Bettoli – University of Ferrara, Ferrara, Italy Ulrike Blume-Peytavi – Charité – University Medicine Berlin, Berlin, Germany Anna Campanati – Marche Polytechnic University, Ancona, Italy Ralph Daniel – Private Practice – Dermatology, Jackson, USA David de Berker – Bristol Royal Infirmary, Bristol, UK James Q. Del Rosso – Las Vegas Skin and Cancer Clinics, Henderson, USA Nilton Di Chiacchio – Private Practice – Dermatology, São Paulo, Brazil Zoe Diana Draelos – Dermatology Consulting Services, High Point, USA Boni Elewski – University of Alabama at Birmingham, Birmingham, USA Gabriella Fabbrocini – University of Naples Federico II, Naples, Italy Harold Farber – Center for Dermatology, Laser, and Cosmetic Surgery, Philadelphia, USA Steven Feldman – Wake Forest University, Winston-Salem, USA Stamatis Gregoriou – National and Kapodistrian University of Athens, Athens, Greece Ramon Grimalt – International University of Catalonia, Sant Cugat del Vallès, Spain Aditya K. Gupta – Mediprobe Research Inc, London, Canada Daniela Guzman-Sanchez – d & laser clinic, Guadalajara, Mexico Eckart Haneke – Private Practice – Dermatology, Freiburg, Germany Maria K. Hordinsky – University of Minnesota, Minneapolis, USA Dimitrios Ioannides – Aristotle UniversityMedical School, Thessaloniki, Greece Matilde Iorizzo – Private Practice – Dermatology, Bellinzona, Switzerland Ana Kaminsky – University of Buenos Aires, Buenos Aires, Argentina Alexandros Katoulis – National and Kapodistrian University of Athens, Athens, Greece Dong-Youn Lee – Samsung Medical Center, Seoul, Korea Bryan C. Markinson – Icahn School of Medicine at Mount Sinai, New York, USA Amy McMichael – Wake Forest University, Winston-Salem, USA Andrew G. Messenger – Royal Hallamshire Hospital, Sheffield, UK Giuseppe Micali – University of Catania, Catania, Italy Mariya Miteva – University of Miami, Miami, USA Bianca Maria Piraccini – University of Bologna, Bologna, Italy

Nevi (Benign Melanocytic)

Melanocytic nevi are benign hamartomas of the skin composed of nevus cells. They are almost always present in fair-skinned individuals and can arise in any anatomic site. When present at birth or during the first 2 years of life, they are categorized as congenital nevi. Melanocytic nevi that show up later in life are described as acquired nevi. The latter are further classified into common acquired nevus, dysplastic (atypical) nevus, blue nevus, Spitz nevus, and halo nevus. Their association with melanoma seems to depend on the total number and the specific types of melanocytic nevi. Regarding their benign nature, usually they do not require any therapeutic intervention. However nevi at special anatomic sites, atypical nevi, or nevi with an intriguing clinical-dermoscopic presentation should be followed up with dermoscopy in a more regular basis.

Clinico-epidemiological data on non-melanoma skin cancer in Greece: 5-year experience (2005–2009) in a tertiary referral center

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