Elisa Varotti

Syringoma : A review of twenty-nine cases

The purpose of our study was to identify the clinical characteristics, epidemiologic data and histologic features in 29 cases of syringoma with a duration of lesions prior to the observation between 1 and 25 years. Only one patient complained of moderate itching. In two cases the lesion was solitary, in another the papules formed a lichenified plaque. In six patients only the eyelids were involved and in two patients a symmetrical localization on the forearms was observed. The other 18 patients showed generalized syringoma, 16 with an eruptive onset, 6 of which were familial. One of our cases showed lesions mimicking urticaria pigmentosa and two patients were affected by Downs syndrome. In two cases, histopathology showed association between syringoma and a melanocytic naevus and in one patient with a solitary lesion a clear cell syringoma was observed.

Clinical effectiveness of a silk fabric in the treatment of atopic dermatitis

Background  In children with atopic dermatitis (AD), eczema is easily aggravated by contact with irritant factors (e.g. aggressive detergents, synthetic and woollen clothes, climatic factors).

Cutaneous manifestations in inflammatory bowel diseases: eight cases of psoriasis induced by anti-tumor-necrosis-factor antibody therapy.

Background: Ulcerous rectocolitis and Crohn’s disease are the best known forms of inflammatory bowel disease (IBD). Skin manifestations are not uncommon in IBD and may be divided into specific cutaneous signs, aspecific cutaneous signs, and cutaneous signs caused by drugs used for IBD therapy. The specific signs (fistulas, rhagades and ulcers) are the result of the diffusion of the intestinal inflammatory process into the skin. Aspecific cutaneous signs (stomatic aphthosis, erythema nodosum, pyoderma gangrenosum, Sweet’s syndrome, vasculitis, bullous diseases) are quite frequently found in those suffering from IBD, but also in apparently healthy subjects, and may sometimes be the first sign of the intestinal disease. Cutaneous manifestations due to drugs vary in clinical aspect and are the direct consequence of the therapies adopted, which in IBD patients can be quite numerous: steroids, immunosuppressants, 5-aminosalicylic acid, biological agents, antibiotics. Objective and Methods:Due to the frequent finding of cutaneous manifestations in patients affected by IBD, a collaboration was set up between the Dermatological Clinic of the University of Bologna and the Center for the Study of IBD of the same university hospital. The aim was to diagnose the cutaneous signs appearing during IBD and to establish their etiopathogenesis in order to assess whether they were the result of epiphenomena of the IBD or side effects of the therapies adopted. Results: The cutaneous manifestations we observed can be divided into three distinct groups: signs that were specific to the basic disease, aspecific signs and finally signs attributable to the drugs used for therapy. Particular attention was given to the aspecific signs and those consequential to therapy. The aspecific cutaneous signs seen in our clinic generally reflect those reported in the literature. The cutaneous manifestations due to drugs were further divided into three groups: rosacea, acneiform dermatitis and psoriasis-like dermatitis. The most notable aspect of our series is the high number of patients presenting psoriasiform-type dermatitides with a generally widespread diffusion. Conclusion: We would like to draw attention to the fact that all patients with psoriasis had been undergoing treatment with drugs inhibiting tumor necrosis factor α (TNF-α) as part of IBD therapy. In all cases, the cutaneous reaction started after the third or fourth infusion of the biological drug. Anti-TNF-α agents have also been successfully used to treat psoriasis in the last few years. The reason for this apparently paradoxical effect of the therapy is still unclear.

Neutrophilic Figurate Erythema of Infancy

Abstract:  We report here a new case of neutrophilic figurate erythema of infancy in a 1‐year and 9‐month‐old white boy. Neutrophilic figurate erythema of infancy is a rare inflammatory dermatosis which is part of the figurate inflammatory dermatoses of infancy and is considered a variant of annular erythema of infancy. The disease is clinically characterized by annular erythematous lesions, sometimes with a polycyclic configuration, and histologically by a dermal neutrophilic infiltration with leukocytoclasia. Differential diagnosis mainly includes clear‐cut severe diseases with a well‐known etiology, such as neonatal lupus erythematosus and its variant erythema gyratum atrophicans transiens neonatale, erythema chronicum migrans and erythema marginatum rheumaticum, and diseases of unknown origin and with less clear limits, such as erythema annulare centrifugum and its variant familial annular erythema. Anamnesis, laboratory findings, clinical features, and histology allow the correct diagnosis and therefore, having excluded severe diseases, parents should be reassured as neutrophilic figurate erythema of infancy, as the annular erythema of infancy, is a benign disease, in most cases unassociated with other conditions and usually self‐limiting over a few months, even though a chronic course may rarely occur. Our case was characterized by a chronic persistent course and by a complete resolution of the lesions only during febrile episodes.

Keratosis lichenoides chronica with an atypical clinical presentation and variable histopathological features.

A 44-year-old, otherwise healthy, Moroccan man was referred to us because of rapid onset of erythematous, scaly, raised, slightly pruritic plaques on the trunk, extremities (Figure 1a–c), face, and scalp (Figure 1d). He showed neither nail changes nor mucosal (oral or genital) involvement. His medical history was unremarkable, and he denied any drug intake. A complete blood cell count, liver and kidney function tests, thyroid parameters, and urinalysis were within normal limits. Syphilis screening, hepatitis B, C, and HIV serology, as well as a QuantiFERON-TB test were negative. A chest X-ray and abdominal ultrasound were normal. Multiple skin biopsies were performed. Those taken from the trunk and extremities showed extensive epidermal hyperparakeratosis, psoriasis-like acanthosis, hypogranulosis (Figure 2a–c) as well as neutrophilic microabscesses (Figure 2c). Other findings included necrotic keratinocytes surrounded by lymphocytes (satellite cell necrosis) and a band-like inflammatory infiltrate associated with melanophages (Figure 2d). Periodic acid-Schiff (PAS) staining was negative. Immunocytochemistry showed a reactive inflammatory infiltrate (the makeup of the lymphoid population was as follows: CD3+/–, CD4–/+, CD8+/–, CD20 rare; “+/–” signified 50–75 % of the population; “–/+”, 25–50 %; and “rare”, 10–25 %). Based on these findings, lymphoma was ruled out. Direct immunofluorescence was negative. By contrast, the biopsies taken from the face showed focal hyperparakeratosis, irregular acanthosis, vasodilation, edema (Figure 3a, b), as well as a dermal – predominantly lymphocytic – inflammatory infiltrate (Figure 3b, c) with admixed melanophages (Figure 3b) and “satellite cell necrosis” (Figure 3d). Except for hyperparakeratosis, these findings (in particular the inflammatory infiltrate with melanophages, and the necrotic keratinocytes) were more suggestive of lupus erythematosus. Antinuclear antibodies, anti-extractable nuclear antigen antibodies, anti-DNA antibodies, antiphospholipid antibodies, antineutrophil cytoplasmic antibodies, rheumatoid factor, as well as complement component 3 and 4 were all negative. Therapy with systemic corticosteroids resulted in a good response, however, there was a rebound following treatment discontinuation. Subsequently, many different therapeutic approaches were attempted, including cyclosporine, methotrexate, acitretin, PUVA therapy, topical calcipotriol, and topical corticosteroids. However, they all proved to be ineffective. Despite their variability, the histopathological features showed a certain degree of repetitiveness, which is characteristic of our eventual diagnosis: keratosis lichenoides chronica (KLC). Systemic corticosteroids were the only effective treatment.

Keratosis lichenoides chronica mit untypischer klinischer Präsentation und variblen histopathologischen Merkmalen

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