Gianluca Nazzaro

Paederus fuscipes dermatitis: a report of nine cases observed in Italy and review of the literature

Paederus sp. is a beetle belonging to Staphylinidae family and Coleoptera order. Its distribution is worldwide, especially in hot climates. Over 600 species of Paederus are known, approximately 50 are able to cause an irritant contact dermatitis. When the beetle is accidentally crushed on the skin, it releases pederin, a potent toxin with vesicating action. In Europe, only anecdotical cases of Paederus sp. dermatitis have been reported. Since 1993, we have observed approximately 25 patients with suspected Paederus sp. dermatitis. In 9 the clinical diagnosis was confirmed because Paederus fuscipes were found. The case list includes 6 males and 3 females, ages ranging from 6 to 53 years (mean age: 26.3 years). Six patients presented with one lesion and 3 with 2 lesions. Eyelids (3 patients), shoulders (3), neck (2), cheek (1), breast (1), back (1) and calf (1) were involved. All patients showed erythema, 2 oedema, 2 blisters, 1 vesicles, 1 pustules and 1 crusts. In the patient with pustules, bacteriological examinations were negative. A biopsy was carried out in 4 patients. In the early stages, spongiosis with exocytosis of neutrophils was observed. Vesicles with neutrophils and necrosis of the epidermis were typical of the advanced stage. Oedema of the dermis and a mixed infiltrate, with eosinophils, neutrophils and lymphocytes, in the papillary and upper reticular dermis, were also observed. Direct immunofluorescence was negative in all patients. Paederus sp. should also be considered in temperate climates as a possible aetiological agent in cases of acute dermatitis.

A Short History of Tattoo

Tattoo is a permanent pigmentation of the skin resulting from the introduction of exogenous substances. If this happens unintentionally—for example, after road injuries—it is called traumatic tattoo. However, the most common tattoos are decorative, related to current fashion or to a symbolic meaning. The etymological origin of the word tattoo is believed to have 2 major derivations: the first is from the Polynesian word “ta” which means “striking something,” and the second is the Tahitian word “tatau” which means “to mark something.” This word was introduced in Europe by the English explorer James Cook, who described the Polynesian technique of “tattaw” in his narrative of the voyage. The oldest example of tattoo dates back to 3000 BC and is represented by a mummy called “Ötzi the Iceman” discovered from the area of the Italian-Austrian border in 1991. Radiological examination of his bones showed osteochondrosis in areas where tattoos had been present. It has been speculated that these tattoos may have been related to pain relief treatments similar to acupuncture. If so, this practice may have existed at least 2000 years before its previously known earliest use in China. In ancient times the tattoo spread throughout Egypt and Rome until it was banned by the Emperor Constantine after his conversion to Christianity. Constantine believed that the human image was a representation of God and should not be disfigured or defiled. The practice of tattooing the body was never fully accepted by any of the 3 great monotheistic religions (Christianity, Judaism, and Islam). Although tattoos were forbidden among Christians by Pope Hadrian I in 787, the habit of tattooing the body survived secretly, especially in some places of Christian worship, like the Sanctuary of Loreto, where the “Friars-Tattooist” (“Frati-marcatori”) tattoo, a small devotional sign to the pilgrims, was used. The reintroduction of the tattoo in the Western world occurred after the ocean expeditions of the 18th century. At the end of the 19th century the use of tattooing spread among highest European social classes: famous “celebrity” tattoos included those of Tsar Nicholas II and Sir Winston Churchill. In recent decades the practice of tattoo has widely spread in the Western world to all social classes, with an increase of complications related to it, such as allergic, lichenoid, granulomatous, and pseudolymphomatous reactions or induction of skin diseases.

Syphilis with a lichen planus-like pattern (hypertrophic syphilis)

To the Editor, A 52-year-old Caucasian man presented with a 1-month history of a widespread pruritic cutaneous eruption. Physical examination revealed multiple violaceous plaques with verrucous surfaces asymmetrically distributed on the trunk and upper limbs, thus resembling hypertrophic lichen planus (Fig. 1). A centrally eroded nodule was also present on the scalp, while the interdigital spaces were involved by serous crusted lesions with fissures (Fig. 2). No mucosal lesions, genital ulcers, alopecia or lymphadenopathy was found. The patient denied the use of drugs. Histopathologic examination with hematoxylin– eosin staining showed irregular psoriasiform hyperplasia of epidermis with wedge-shaped hypergranulosis (Fig. 3). The dermis contained a lichenoid infiltrate composed of lymphocytes and plasma cells, and the latter were numerous around vessels (Fig. 4). Polymerase chain reaction and immunohistochemistry (Fig. 5) revealed the presence of Treponema pallidum in the epidermis and papillary dermis. Additionally, venereal disease research laboratory titers were

A 26-year-old man with an eczematous lesion on the nipple.

Maria Gavrilova, MD; Alejandro Martin-Gorgojo, MD; Carmen Ruiz-Domenech, MD; Maria-Dolores Alonso-Salvador, MD; Maria del Carmen Gomez-Mateo, MD; Esperanza Jorda-Cuevas, MD, PhD; Departments of Dermatology (Drs Gavrilova, Martin-Gorgojo, Ruiz-Domenech, and Jorda-Cuevas), Neurology (Dr Alonso-Salvador), and Anatomy Pathology (Dr Gomez-Mateo), Clinical University Hospital of Valencia, Valencia, Spain

A case of tinea imbricata in an Italian woman.

© 2015 The Authors. doi: 10.2340/00015555-1887 Journal Compilation

Treatment of Sporotrichoid Fish Tank Granuloma with Pulsed Clarithromycin

Background: There is no established therapy of choice for Mycobacterium marinum skin infections; clarithromycin monotherapy was used in some anecdotical cases at changeable daily doses and length. Objective: To evaluate the efficacy and safety of pulsed clarithromycin monotherapy. Methods: 29 patients with a clinical diagnosis of sporotrichoid fish tank granuloma were admitted from 2002 to 2013. In 14 patients, the clinical diagnosis was confirmed by history, histopathology and bacteriological examinations. All patients were treated with clarithromycin (500 mg/day for 10 consecutive days/month for 5 months). Results: In 12 out of 14 patients (85.7%) complete clinical remission was recorded. Two patients showed partial remission after 3 months of therapy, but they were lost to follow-up and were therefore not considered evaluable. Conclusion: Our study suggests that pulsed clarithromycin monotherapy is effective and safe in sporotrichoid M. marinum skin infections.

Follicular cutaneous larva migrans: a report of three cases and review of the literature

Hookworm‐related cutaneous larva migrans (CLM) is characterized clinically by erythematous and slightly raised tracks, located especially on the feet. These tracks may be single or multiple, linear or serpiginous, more or less ramified and intertwined. The length is variable (up to many cm); the width ranges from 1 mm to 4 mm. Tracks are often accompanied by severe pruritus.

Clinical and dermoscopic characterization of pediatric and adolescent melanomas: Multicenter study of 52 cases

Background Knowledge regarding the morphologic spectrum of pediatric melanoma (PM) is sparse, and this may in part contribute to delay in detection and thicker tumors. Objective To analyze the clinicodermoscopic characteristics of PM. Methods Retrospective study of 52 melanomas diagnosed in patients before the age of 20 years. Results On the basis of its clinical, dermoscopic, and histopathologic characteristics, PM can be classified as spitzoid or nonspitzoid. The nonspitzoid melanomas (n = 37 [72.3%]) presented in patients with a mean age of 16.3 years (range, 8‐20) and were associated with a high‐risk phenotype and a pre‐existing nevus (62.2%). The spitzoid melanomas (n = 15 [27.7%]) were diagnosed in patients at a mean age of 12.5 years (range, 2‐19) and were mostly de novo lesions (73.3%) located on the limbs (73.3%). Whereas less than 25% of PMs fulfilled the modified clinical ABCD criteria (amelanotic, bleeding bump, color uniformity, de novo at any diameter), 40% of spitzoid melanomas did. Dermoscopic melanoma criteria were found in all cases. Nonspitzoid melanomas tended to be multicomponent (58.3%) or have nevus‐like (25%) dermoscopic patterns. Spitzoid melanomas revealed atypical vascular patterns with shiny white lines (46.2%) or an atypical pigmented spitzoid pattern (30.8%). There was good correlation between spitzoid subtype histopathologically and dermoscopically (&kgr; = 0.66). Limitations A retrospective study without re‐review of pathologic findings. Conclusion Dermoscopy in addition to conventional and modified clinical ABCD criteria helps in detecting PM. Dermoscopy assists in differentiating spitzoid from nonspitzoid melanomas. Graphical abstract Schematics with the main dermoscopic features of the 4 patterns. Dermoscopic patterns found in pediatric melanoma: Pattern 1, Multicomponent pattern, mostly found in non‐Spitzoid melanomas associated with nevus. Asymmetric polychromic multicomponent pattern, with irregular globules, negative network and structureless areas and some regression features. Pattern 2, Nevus‐like; only found in adolescents with non‐Spitzoid melanomas. Symmetric 1 or 2 patterns, with a few melanoma local features. Pattern 3, Pink vascular Spitzoid pattern. Polymorphic vascular pattern and shiny white structures. Pattern 4, Atypical pigmented Spitzoid pattern. Asymmetrical distributed starburst or globular pattern with pseudopods at the periphery. Figure. No Caption available.

Dermoscopic features and patterns of poromas: A multicentre observational case-control study conducted by the International Dermoscopy Society

Poromas are benign cutaneous sweat gland tumours that are challenging to identify. The dermoscopic features of poromas are not well characterized.

Dermoscopy features of atypical fibroxanthoma: A multicenter study of the International Dermoscopy Society

Little is known about the dermoscopic features of atypical fibroxanthoma.