Elena Guanziroli

The human hair: from anatomy to physiology

Hair is a unique character of mammals and has several functions, from protection of the skin to sexual and social communication. In literature, there are various studies about hair that take into consideration different aspects within many fields of science, including biology, dermatology, cosmetics, forensic sciences, and medicine.

Role of cleansers in the management of acne: Results of an Italian survey in 786 patients

Abstract Background: Modern therapy of acne is based also on moisturizers, cleansers and sunscreens. However, a few studies have been published on cleansers, and never in Italy. Objective: We decided to carry out an epidemiological study on the knowledge, beliefs and perceptions of acne patients regarding cleansers. Methods: The survey has been carried out in Italy in 2013–2014. A group of patients with acne completed a questionnaire which included 10 questions. Results: One hundred and eighteen dermatologists and 786 evaluable acne patients attended the survey. Approximately 70% of patients use a specific anti-acne cleanser. This cleanser is suggested in 57% of cases by a dermatologist. The patients buy this cleanser at the pharmacy (77% of cases). More than 62% of patients are satisfied about this cleanser. More than 66% of patients use the cleanser twice daily. The length of washing is less than one minute in 48% of patients. More than 66% of patients believe that the cleanser has a therapeutical role. Conclusion: The results of this survey cannot be compared with other studies because of the lack of similar studies about this topic. These results suggest that a sample of Italian acne patients consider cleansers as an important adjuvant treatment in acne.

Onychomycosis caused by Trichosporon mucoides

A case of onychomycosis caused by Trichosporon mucoides in a man with diabetes is presented. The infection was characterized by a brown-black pigmentation of the nail plates and subungual hyperkeratosis of the first three toes of both feet. Onychogryphosis was also visible on the third left toe. Direct microscopic examinations revealed wide and septate hyphae and spores. Three cultures on Sabouraud-gentamicin-chloramphenicol 2 agar and chromID Candida agar produced white, creamy, and smooth colonies that were judged to be morphologically typical of T. mucoides. Microscopic examinations of the colonies showed arthroconidia and blastoconidia. The urease test was positive. A sugar assimilation test on yeast nitrogen base agar showed assimilation of galactitol, sorbitol, and arabinitol. Matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF) confirmed the diagnosis of T. mucoides infection. The patient was treated with topical urea and oral itraconazole. Three months later, a mild improvement was observed. The patient was subsequently lost to follow-up.

Nasal polyps : A predisposing factor for cutaneous leishmaniasis of the lips?

Cutaneous leishmaniasis (CL) of the lips is rare. This study was conducted to investigate findings in patients with this condition.

Allergic contact dermatitis caused by clindamycin

A 58-year-old white woman was admitted with a clinical diagnosis of HS/AI that manifested at the age of 40 years. Dermatological examination showed HS/AI involving both inguinal folds, with inflammatory nodules, fistulae, and sero-purulent discharge. The patient complained of severe pain. The diagnosis of HS/AI (Hurley II stage) was confirmed. Laboratory examinations showed increases in total leukocyte number, erythrocyte sedimentation rate, and C-reactive protein level. Bacteriological examinations gave positive results for Staphylococcus aureus. According to an antibiogram, the patient was treated with amoxicillin (3 g/d for 10 days) and 1% clindamycin phosphate gel (Clindamicina SAME, with 2 applications per day for 10 days). One week later, the patient returned with an acute rash, characterized by erythema and vesicles, in both inguinal folds. She complained of severe pruritus. A diagnosis of contact dermatitis was made, and clindamycin treatment was stopped. The patient was successfully treated with hydrocortisone butyrate cream, and subsequently subjected to patch testing with the Società Italiana di Dermatologia Allergologica, Professionale e Ambientale (SIDAPA) baseline series, Clindamicina SAME gel and Zindaclin gel, both tested “as is”, clindamycin hydrochloride 1% pet., clindamycin phosphate 1% aq., and carbopol, glycerol, propylene glycol, methylparahydroxybenzoate, and propylparahydroxybenzoate, that is, the components of Clindamicina SAME (all of these substances were tested at the same concentrations as present in the gel). The procedure was performed according to ESCD guidelines. Positive reactions (++) to Clindamicina SAME, Zindaclin, clindamycin hydrochloride and clindamycin phosphate were observed on day (D) 2 and D4. Eight healthy volunteers showed negative results with all of the previously mentioned substances.

Pancreatic panniculitis: The "bright" side of the moon in solid cancer patients

BackgroundPancreatic panniculitis is a rare complication of pancreas disorders occurring in 0.3–3% of patients, most often accompanied by the pancreatic acinar carcinoma.It presents multiple, painful, deep, ill-defined, red-brown, migratory nodules and plaques of hard elastic consistency; often ulcerated and typically located on the lower proximal and distal extremities.The pathogenesis is not fully understood, but it is thought to result from lipolysis and fat necrosis with secondary tissue inflammation induced by pancreatic enzymes. Histopathology shows subcutaneous lobular fat necrosis with anuclear adipocytes (called ghost cells) surrounded by a mixed inflammatory infiltrate. Focal calcification may also be seen. The treatment is directed to the underlying disorder, which may result in regression of skin lesions.Case presentationWe present two cases of pancreatic panniculitis with similar clinical, laboratory, and histopathological features associated with different internal malignancy. The first case, after extensive investigations showed the presence of a pancreatic carcinoma with multiple liver metastases and a poor prognosis. The second one instead is the first case in literature where painful subcutaneous nodules of the legs were the early manifestation of a neuroendocrine carcinoma of the adrenal gland.ConclusionsAlthough subcutaneous fat necrosis usually occurs late in the course of a malignancy, recognition of the association with pancreatic panniculitis may prevent a long delay in the diagnosis and management of the occult neoplasm. It should be primarily considered when panniculitis is widespread and persistent, and frequent relapses or tendency to ulcerate of the nodules are regarded as red flags.

Neurothekeoma, a hard to diagnose neoplasm among red nodules

basophilic inclusion bodies called Michaelis–Gutmann bodies, which are thought to represent the remnants of bacterial organisms secondary to the inadequate digestion of bacteria and are pathognomonic for malacoplakia. They stain positive with periodic acid–Schiff (for phosphate salt), von Kossa (for calcium), and Perl (for iron) stains. Antibiotics with specific intracellular penetration properties, such as quinolones, are a mainstay of malacoplakia treatment. In addition, surgical treatment may be necessary depending on the organs affected. Decreasing the dose of immunosuppressive agents when possible has been suggested for the treatment of severe, refractory cases of malacoplakia. This case highlights the fact that extensive pelvic malacoplakia can be mistaken for invasive cancer on computed tomography. Therefore, accurate biopsies of the lesion and cultures should be conducted.

Cutaneous metastases of internal malignancies: an experience from a single institution

BackgroundCutaneous metastases represent 2% of all skin tumours. Their recognition can be challenging, as they may present with different clinical features, with consequent frequent delay and failure in diagnosis.ObjectivesTo review our series of cutaneous metastatic lesions, analyse their frequency according to patient gender, histotype, localization of the primary tumour, and site of cutaneous metastasis, and correlate this data with clinicopathological parameters.Materials & methodsWe conducted a retrospective review of all cases of cutaneous metastases from visceral neoplasms diagnosed in our dermatopathology department from July 2003 to February 2017. We registered clinical, histological, and immunohistochemical data. Additional immunohistochemical staining panels were elaborated to confirm or identify the origin of the primary tumour, or at least to specify the histological subtype.ResultsWe identified 45 histological diagnoses of cutaneous and mucocutaneous metastases. The primary tumour that was most likely to metastasize to the skin was breast cancer. Most cases of breast (89%) and lung cancer (86%) metastasized to the trunk. Of the lesions, 57.5% were nodules and 32.5% were plaques, more frequently multiple (64.4%). In 58% of cases, a metastasis was clinically suspected. Histological examination most frequently revealed an adenocarcinoma, sometimes suggestive of the site of origin.ConclusionsCutaneous metastases should be primarily considered when discrete firm painless nodules emerge rapidly. Clinicians should carefully consider infiltrated lesions of the chest in women since scleroderma and erysipelas-like presentation can be a clue for undiagnosed breast cancer.