Eleftheria Christofidou

Classic Kaposi's sarcoma in Greece : A clinico-epidemiological profile

Background Classic Kaposis sarcoma (CKS) is not uncommon in Greece with a reported incidence of 0.20 per 100,000 per year.

A randomized trial of amorolfine 5% solution nail lacquer in association with itraconazole pulse therapy compared with itraconazole alone in the treatment of Candida fingernail onychomycosis

Summary Background Treatment failures and relapses are not uncommon in onychomycosis. Therefore, it is worthwhile to consider the combination of systemic and topical antifungals to improve the cure rates further and to reduce the duration of systemic treatment.

Pimecrolimus 1% cream in the treatment of disseminated granuloma annulare

SIR, Generalized granuloma annulare (GA) is an uncommon benign cutaneous disease of unknown origin. The eruption is characterized by numerous skin-coloured to erythematous papules, usually on the trunk and extremities, which demonstrate a tendency to annular grouping and a potential to involve virtually any area of the skin. No consistent association between generalized GA and internal disease has been shown to date, although some reports support an association with diabetes mellitus, malignancies, thyroid disease, drug allergy, hypertension, arthritis, AIDS and other conditions. Generalized GA, although generally considered a disseminated form of localized GA, differs from the localized form by a later age at onset, protracted course, and poor response to therapy. Spontaneous resolution is rare: it has been reported in just two of 100 patients in the largest cohort of patients with generalized GA studied. Therapy has been largely disappointing despite sporadic reports of limited success with topical and intralesional corticosteroids, systemic corticosteroids, potassium iodide, niacinamide, psoralen plus ultraviolet A, systemic retinoids, hydroxychloroquine, dapsone, vitamin E, sulphones and topical tacrolimus. A 37-year-old man developed a disseminated asymptomatic eruption on the trunk, face, neck and extremities. The eruption began 3 years previously on the trunk as small papules, gradually spreading to involve the neck, face, arms and proximal aspects of the lower extremities. Initially the lesions consisted of multiple erythematous papules and nodules, but these gradually became annular with slightly elevated edges in all the body except the face and neck, where they remained papular. His general health remained good. Full blood count, urinalysis, liver function tests, serum proteins, plasma glucose level, chest X-ray and serology were all normal. There was no personal or family history for diabetes mellitus or any other disease. Skin biopsy confirmed the clinical diagnosis, showing foci of degenerated collagen surrounded by histiocytes and a few giant cells admixed with lymphocytes (Fig. 1a). The patient had undergone several treatments with medium to high potency topical corticosteroids, without improvement. Treatment with oral isotretinoin was also attempted a year previously but had to be discontinued because of raised serum lipid levels observed after 1 month of treatment. We began treatment with pimecrolimus 1% cream twice daily for a 3-month period and the patient was re-evaluated after 3 months, both clinically and histologically. The quantity of pimecrolimus 1% cream used by the patient was estimated to be approximately 20 g per week. There was a significant improvement of the eruption (Figs 1b,c). The lesions of the face and neck had undergone complete remission while in the rest of the body significant fading of lesions had occurred. These clinical findings were confirmed by a second skin biopsy that showed mild perivascular inflammation and absence of the histological findings of the previous biopsy that had confirmed the diagnosis of GA. After a 6-month follow-up period without any therapy, the patient remains in a satisfactory clinical condition without relapse of lesions.

Immunophenotypic analysis of the p53 gene in non-melanoma skin cancer and correlation with apoptosis and cell proliferation

Background   Sunlight precipitates a series of genetic events that lead to the development of skin cancers such as basal cell carcinoma (BCC) and squamous cell carcinoma (SCC). The p53 tumour suppressor gene, which plays a pivotal role in cell division and apoptosis, is frequently found mutated in sunlight‐induced skin tumours.

Frontal Fibrosing Alopecia: To Treat or Not to Treat?

Background: Published studies have evaluated a variety of therapeutic agents in frontal fibrosing alopecia (FFA); however, data on whether fibrosis is already established when the patients initially present are scarce. Objective: To identify the prevalence of active disease in patients initially diagnosed with FFA and to evaluate the efficacy of therapeutic agents suggested in the medical literature. Patients/Methods: Eighteen postmenopausal women with FFA presented at the outpatient clinic of our hospital from June 2003 to August 2007. Five patients who also presented with androgenetic alopecia were treated with finasteride 2.5 mg/d plus minoxidil 5% for 12 months. One patient with a rapidly regressing disease received systemic corticosteroids. The remaining 12 patients were divided into two groups: 6 patients received topical clobetasol 0.05% solution once daily for 6 months and the rest received no treatment. Results: Thirteen of 18 patients presented with stable disease. No significant improvement was observed in any of the patients. Conclusion: To date, there is no effective treatment proven with an appropriate level of evidence in the management of FFA. Exclusion criteria in future clinical studies should take into account patients presenting with stable disease. What needs to be established is whether treatment can halt or slow the progression of active disease.

Pustular psoriasis development after initial ustekinumab administration in chronic plaque psoriasis

Auteur(s) : Stamatis GREGORIOU1 stamgreg@yahoo.gr, Charalambos KAZAKOS1, Eleftheria CHRISTOFIDOU2, George KONTOCHRISTOPOULOS3, George VAKIS4, Dimitrios RIGOPOULOS1 1 University of Athens Medical School, Department of Dermatology, Andreas Sygros Hospital, 5 Ionos Dragoumi Str, 16121 Athens, Greece 2 Pathology Department, Andreas Sygros Hospital, 5 Ionos Dragoumi Str, 16121 Athens, Greece 3 2nd Department of Dermatology, Andreas Sygros Hospital, Athens, Greece 4 Department of Dermatology, Larnaca [...]

Cutaneous metastasis of colon adenocarcinoma: case report and review of the literature

Skin metastases from colorectal carcinoma are rare and signal advanced disease. We present a case of an 80-year-old male with a large skin metastatic focus in the lower abdomen, a year after resection of a colonic adenocarcinoma. The patient had already finished receiving his first cycle of chemotherapy shortly before the discovery of the abdominal nodules and at the same period a chest X-ray, revealed shadows at the base of the right lung.

High-frequency p16INK4A promoter methylation is associated with histone methyltransferase SETDB1 expression in sporadic cutaneous melanoma

Epigenetic mechanisms participate in melanoma development and progression. The effect of histone modifications and their catalysing enzymes over euchromatic promoter DNA methylation in melanoma remains unclear. This study investigated the potential association of p16INK4A promoter methylation with histone methyltransferase SETDB1 expression in Greek patients with sporadic melanoma and their correlation with clinicopathological characteristics. Promoter methylation was detected by methylation‐specific PCR in 100 peripheral blood samples and 58 melanoma tissues from the same patients. Cell proliferation (Ki‐67 index), p16INK4A and SETDB1 expression were evaluated by immunohistochemistry. High‐frequency promoter methylation (25.86%) was observed in tissue samples and correlated with increased cell proliferation (P = 0.0514). p16INK4A promoter methylation was higher in vertical growth‐phase (60%) melanomas than in radial (40%, P = 0.063) and those displaying epidermal involvement (P = 0.046). Importantly, p16INK4A methylation correlated with increased melanoma thickness according to Breslow index (P = 0.0495) and marginally with increased Clark level (I/II vs III/IV/V, P = 0.070). Low (1–30%) p16INK4A expression was detected at the majority (19 of 54) of melanoma cases (35.19%), being marginally correlated with tumor lymphocytic infiltration (P = 0.078). SETDB1 nuclear immunoreactivity was observed in 47 of 57 (82.46%) cases, whereas 27 of 57 (47.37%) showed cytoplasmic immunoexpression. Cytoplasmic SETDB1 expression correlated with higher frequency of p16INK4A methylation and p16INK4A expression (P = 0.033, P = 0.011, respectively). Increased nuclear SETDB1 levels were associated with higher mitotic count (0–5/mm2 vs >5/mm2, P = 0.0869), advanced Clark level (III‐V, P = 0.0380), epidermal involvement (P = 0.0331) and the non‐chronic sun exposure‐associated melanoma type (P = 0.0664). Our data demonstrate for the first time the association of histone methyltransferase SETDB1 with frequent methylation of the euchromatic p16INK4A promoter and several prognostic parameters in melanomas.

CHILD syndrome: the NSDHL gene and its role in CHILD syndrome, a rare hereditary disorder

Background  CHILD syndrome, a rare hereditary disorder of keratinization (MIM 308050, 300275), is the acronym proposed by Happle to name a rare entity, characterized by congenital hemidysplasia, icthyosiform nevus and limb defects, ranging from digital hypoplasia to icthyosiform nevus and ipsilateral limb defects, ranging from digital hypoplasia to complete amelia.

Acanthosis nigricans associated with primary hypogonadism: Successful treatment with topical calcipotriol

Acanthosis nigricans is a mucocutaneous dermatosis characterized by hyperpigmentation and a velvety papillomatous hyperkeratosis. It is frequently associated with systemic diseases including malignancy and endocrinal disorders. We report the beneficial effect of topical calcipotriol ointment 50 mcg/g twice a day in acanthosis nigricans associated with primary hypogonadism.