Manuela Papini

Clinical, Histological and Immunopathological Features of 58 Patients with Subacute Cutaneous Lupus erythematosus

Background: Subacute cutaneous lupus erythematosus (SCLE) is a distinct subset of cutaneous lupus erythematosus clinically characterized by psoriasiform and/or annular lesions and by a mild or absent systemic involvement. Objective: The Italian Group of Immunodermatology of the Italian Society of Dermatology and Venereology reviewed the cases of SCLE seen in 10 years (1987–1996). Patients: Forty-six women and 12 men have been retrospectively studied, 42% had annular lesions, 39% psoriasiform ones and 16% both. Results: Lesions were mainly localized on the neck and face and relapsed in spring and autumn. Seventeen patients had 4 or more American College of Rheumatology criteria and could be classified as having systemic lupus erythematosus. The most frequent histopathological alterations were epidermal atrophy, hydropic degeneration of the basal layer and perivascular lymphocytic infiltrate. Deposits of immunoglobulins and C3 at the dermo-epidermal junction on the clinically involved skin were present in 86% of the patients. Dust-like particles in the epidermis were only found in 3% of cases. Anti-Ro/SSA antibodies were found in 71% of the cases and anti-dsDNA only in 5% of cases. Conclusions: SCLE is a particular subset of cutaneous lupus erythematosus with peculiar clinical and immunopathological features.

Usefulness of Histological Examination for the Diagnosis of Onychomycosis

Background: Direct microscopy and culture tests currently used in the diagnosis of nail mycosis can yield false-negative results, and confirmation of the pathogenic agent, especially in non-dermatophyte infections, is often a lengthy process. Objective: The aim of this study was to investigate the usefulness of the histological examination of nail clipping samples in supplementing the standard microscopic and culture techniques for the diagnosis of onychomycosis. Patients and Methods: One hundred and seventy-two subjects affected by nail alterations suggestive of onychomycosis were evaluated. Nail specimens were studied with 3 different techniques: direct microscopic examination of a 40% KOH clarified preparation, fungal culture and histological examination. Patients positive for fungal infection were re-evaluated with the same techniques after treatment with oral terbinafine, fluconazole or itraconazole and topical application of bifonazole or ciclopirox for 2 months. Results: Direct microscopy was positive in 102 (59.3%) nail specimens. The culture test was positive in 90 cases (52.9%), showing a dermatophyte in 45, a yeast in 23 and a mould in 22 samples. The histological examination was positive in 94 (54.6%) samples. In 4 cases, it was the only investigation confirming the clinical diagnosis of nail mycosis. In most of the cases, the morphological aspect of the hyphae and/or spores suggested also to which group of pathogens (dermatophytes, yeasts or moulds) the mycetes observed in the histological sections could be ascribed. The concurrent presence of a dermatophyte and a mould was evidenced in a few specimens. The control histological examination at the end of the treatment showed negative results or residual non-vital hyphae and/or spores. Conclusions: Results of the present study indicate that the histological examination of nail clipping specimens is a relatively inexpensive, rapid and easily performed procedure. It is useful to confirm or refute the results of routine microscopy and culture tests. Moreover, nail histopathological observation may help in ascribing a pathogenic role of non-dermatophyte isolates and evaluating the effectiveness of antifungal treatment.

Onychomycosis in children: a survey of 46 cases

This is a retrospective study of the agents, clinical aspects, sources of infection and therapy of onychomycosis in children. In the period 1989–2000, we observed 46 consecutive children, until 16 years of age with onychomycosis (29 boys, 17 girls, mean age 10.8 years). Dermatophytes were isolated in 30 cases (Trichophyton rubrum in 22 cases, Trichophyton mentagrophytes in five, Epidermophyton floccosum in two and Trichophyton violaceum in one) and Candida spp. in 16, associated with Trichophyton rubrum in two. Moulds were isolated in three children (Fusarium oxysporum in one, Scopulariopsis brevicaulis in another and Aspergillus fumigatus associated with Trichophyton rubrum in a third). The commonest features were distal and distolateral subungual hyperkeratosis in dermatophyte infections (93%) and onychodystrophy and paronychia in Candida infections (56% and 50% respectively). Forty patients achieved clinical and mycological recovery. It is appropriate to suspect onychomycosis in children, perform microbiological diagnosis and undertake early treatment. An approach of this kind may help to prevent nail dystrophy and the spread of infection.

Nodular secondary syphilis

Nodular secondary syphilis in a 23‐year‐old Indian man was characterized by numerous papular, nodular and plaque skin lesions, without involvement of the mucous membranes. The histopathology showed sarcoid‐like granulomata with lymphocytes, histiocytes, eosinophils, plasma cells and multinucleated giant cells. The differential diagnosis included deep mycoses, leprosy, tuberculosis, sarcoidosis and lymphoma. The results of serological tests and the rapid response to penicillin indicated a correct diagnosis.

Tinea capitis in Infants less than 1 year of age

Tinea capitis is the most frequent manifestation of dermatophyte infection in children, but because it is rare in the first months of life it is often misdiagnosed. Here we report 15 cases of tinea capitis observed in Italy in infants less than 1 year of age. There were 10 boys and 5 girls (mean age 6 months). Diagnosis was confirmed by mycologic examination. Microsporum canis was isolated in nine cases and Trichophyton mentagrophytes in three. These 12 infants were Italian and animals were the source of infection. Trichophyton erinacei was isolated in one Italian infant, and the source was soil. In the other two cases, Trichophyton tonsurans and Trichophyton violaceum were isolated; these infants were from Central America and India, respectively, and had contracted the infection from humans. All achieved clinical and mycologic recovery after systemic and topical antimycotic therapy.

CD4‐negative variant of CD4+/CD56+ hematodermic neoplasm: description of three cases

Background:  CD4+/CD56+ hematodermic neoplasm (HN) (blastic natural killer (NK)‐cell lymphoma) is a rare entity characterized by dense, monomorphous infiltrates of medium‐sized cells with blastic appearance and a characteristic immunophenotype (positivity for CD4, CD56 and CD123). The combination of CD4 and CD56 positivity is thought to be so striking that it has been used to name this entity.

Lysozyme distribution in healthy human skin

Lysozyme is present in human skin as well as in other tissues and secretions [2, 4]. Previous personal investigations [1] demonstrated lysozyme activity of between 85 and 195 lag/g wet weight (average 142 lag/g wet weight) in the skin of clinically healthy subjects. Indirect immunofluorescence studies [3] revealed that lysozyme is mainly located in the cytoplasm of epidermal cells and that only small quantities are present along the dermal collagen bundles. Forty hospitalized volunteers of both sexes, aged between 19 and 71 years, were studied. All were free from clinical infections and had only limited traumatic or proliferative skin lesions. Lysozyme activity was determined in both serum and 0.5 mm thick samples of skin taken from the lumbar region and treated according to Binazzi et al. [1]. Histochemical studies were carried out on fine frozen sections of skin removed from the same area and/or from the internal surface of the forearm in an identical condition. Immunofluorescence was performed by the routine technique using antihuman milk muramidase rabbit IgG (Dakopatts, Denmark) and ITCF-labeled antl-~rabbit IgG swine serum (Dakopatts, Denmark). The peroxidase conjugate method (Table 1) was used for the immunoperoxidase studies. Controls were performed by absorbing the primary anti-human muramidase antiserum on purified human milk lysozyme before immunostaining, thus blocking the reactivity for muramidase. Lysozyme activity was found to be between 1.25 and 18 lag/ml (average 5.15 lag/M) in serum and between 75 and 198 lag/g wet weigth (average 119.5 lag/g wet weight) in skin samples. These results did not show significant differences with respect to those previously reported [1].

Onychomycosis in Cameroon: a clinical and epidemiological study among dermatological patients.

Background There are currently no studies on epidemiology and clinical aspects of nail fungal infections in the general population of Cameroon.

Epidemiology of onychomycosis in Italy: prevalence data and risk factor identification.

The prevalence of onychomycosis differs according to geographic area and over time and is influenced by several factors. The epidemiology of onychomycosis in Italy is still unclear. To evaluate the prevalence of onychomycosis in a representative sample of the Italian population a group of Dermatologists and General Practitioners carried out an observational survey on the patients coming to their office during a 1‐month period. Any patient with skin or systemic disease giving their consent was enrolled. Demographic characteristics, comorbidities, lifestyles, history of previous mycosis, clinical aspects of onychomycosis and mycological evaluation were studied. A total of 8331 patients (56.7% female and 43.3% male) were evaluated. More than half of them were aged ≥46 years. Onychomycosis was diagnosed in 14.2% of patients. Big toe and thumb were the most frequently affected nails. Onychomycosis was moderate‐severe in 74.1% of the cases. Mycological tests were positive in 81.3% of the cases. Dermatophytes were found in 76.6% of the cases, yeasts in 17.2% and moulds in 6.3%. Risk factors and/or comorbidities were present in 68.2% of the cases. This survey showed a 14% prevalence of onychomycosis in the evaluated population. The main risk factors were previous onychomycosis, diabetes, hallux valgus and use of occlusive footwear.

Skin Mycoses—Geographic Distribution and Present‐day Pathomorphosis

The relationship between fungal infections of the skin and environmental, cultural, hygienic, social and economic conditions, are such that the characteristics of these infections, of necessity, vary with the passing of time. We therefore consider a brief survey of this subject across the years, which has the aim of updating the epidemiology and clinical manifestations of these infections and, if possible, offers indications for timely prophylaxis.