Mariarita Rossi

Comparison of diagnostic methods in the diagnosis of dermatomycoses and onychomycoses

Direct microscopic examination of potassium hydroxide (KOH)‐prepared specimens is the simplest, cheapest method used for the diagnosis of mycotic infections of the skin. However, KOH preparations have been reported to have 5–15% of false‐negative results, possibly because of the low visibility of scant, scattered fungal material of the nail scrapings and because the detection of fungal elements depends on the skill of the observer [Arch Dermatol133 (1997) 1317; Clin Microbiol Rev8 (1995) 240]. We compared two different KOH‐based staining methods in order to obtain reliable results in shorter time than expected for cultures. A total of 124 patients with suspect diagnosis of dermatomycosis or onychomycosis were enrolled. Two scrapings from the same lesion of each patient were stained with KOH‐Chlorazole and KOH‐Acridine Orange (AO), respectively; cultural examination of the same specimen was considered as diagnostic gold standard. The two methods showed neither significantly different sensitivity nor specificity; however, for onychomycoses, we observed a slightly higher sensitivity for KOH‐Chlorazole and a higher specificity for KOH‐AO. We suggest the use of both techniques in order to improve detection of fungal infection, especially for onychomycoses.

Erythema annulare centrifugum as the presenting sign of breast carcinoma.

© 2008 The Authors JEADV 2009, 23 , 317–368 Journal compilation

Disseminated superficial actinic porokeratosis diagnosed by dermoscopy

upper or lower dermis. ADM occurs rarely outside Japan and very few cases have been described in non-Asian race people. The ADM in Europeans is a rare manifestation, and only the extrafacial type has been reported in this group of population. The pathogenesis of ADM is currently unknown. Hori et al. speculated that the pathogenesis of ADM may be attributed to the reactivation of pre-existing dermal melanocytes. Dormant dermal melanocytes may be present in the dermis from birth and that their melanin-synthesizing pathway may be activated by locally produced factors like inflammation, local trauma, or sun exposure. Mizushima et al. proposed that there are no triggers but that the melaninsynthesizing ability of the dermal melanocytes may increase more slowly than that of common naevus. Moreover, it is possible that dermal melanocytes may migrate from the basal layer of the epidermis or from hair bulbs. This case represents an unusual acquired pigmentary disorder that appears to be the result of dermal melanocytosis. To our knowledge, the bilateral and symmetrical upper back distribution, with extension to the breast is the first one in the broad spectrum of ADM.

Intralesional interferon alfa-2b as neoadjuvant treatment for perianal extramammary Paget's disease.

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A cutaneous infection caused by Brevundimonas vesicularis: A case report

Brevundimonas vesicularis is a non-fermenting gram-negative bacillus, aerobic and motile. This microrganism is ubiquitous in the environment and has rarely been implicated in human infections. We present the second case of cutaneous infection caused by B. vesicularis in an immunocompetent patient.

Skin diseases in immigrants seen as out-patients in the Institute of Dermatology of the University of Rome 'La Sapienza' from 1989 to 1994

In the Institute of Dermatology of the University of Rome ‘La Sapienza’ (IDURLS) from 1989 to 1994, 2198 immigrants from countries outside the European Community were seen as out-patients. Their personal and pathological data were collected by a particular software ‘Questio’, set up together with colleagues of the Interdepartimental Center for Scientific Calculous (ICSC) of the University of Rome ‘La Sapienza’. The number of patients has been increasing from 326 in 1989 to 436 in 1994. Most of the people were coming from Africa, but from 1989 to 1994 the number of patients from the regions of ex-Yugoslavia has been increasing. About one third of the immigrants were unemployed, whereas 40% of them had a job (worker or employee), and the remaining 20% was composed by students and housewives. Most immigrants (1474 patients) were 20–39-year-old. Their data were compared with those of a control group composed by 2100 Italian people of the same age and sex, seen as out-patients in IDURLS in the same period. The most frequent skin disorders observed in immigrants were skin infectious or parasitic diseases, above all scabies. Excluding people with scabies, both immigrants and Italian patients shared the same skin diseases typical of young adult people: many fungal infections, many contact dermatitis and very few skin malignant tumors.

Predictive factors for false negative sentinel lymph node in melanoma patients.

BACKGROUND Sentinel lymph node biopsy (SLNB) represents a useful tool for staging melanoma patients. However false‐negative SLNB are reported in the literature. OBJECTIVE The aim of our study is to identify predictive factors for false‐negative SLNB in melanoma patients. MATERIALS AND METHODS We conducted a retrospective analysis on 316 melanoma patients who underwent SLNB and were followed up at the Department of Dermatology and Plastic Surgery of University of Rome “Sapienza” from March 1994 to June 2008. RESULTS In our patients, SLNB was positive in 35 cases (11.07%) whereas it was negative in 281 cases (88.93%); 12/316 patients (3.8%) had positive SLNB and positive therapeutic lymph node dissection (TLND); 23/316 (7.28%) patients had positive SLNB and negative TLND; 266/316 (84.18%) patients had negative SLNB but without subsequent metastases in the SLN site; 15/316 (4.74%) patients had negative SLNB, but with subsequent metastases in the same SLN site (false‐negative patients). Among the different prognostic factors, only ulceration was the main predictive factor for false‐negative SLNB, according to statistical analysis (p=.0420). CONCLUSION Our data confirm that SLNB is a useful technique for staging melanoma patients. However, in patients with negative SLNB, a closer follow‐up is recommended when ulceration is present. The authors have indicated no significant interest with commercial supporters.

Amoxicillin–clavulanic acid‐induced linear immunoglobulin A bullous dermatosis: case report and review of the literature

Background  Linear immunoglobulin A bullous dermatosis (LABD) is an autoimmune subepidermal blistering disease, rarely induced by drugs.

Dermoscopy of a Plantar Combined Blue Nevus: A Simulator of Melanoma

Dermoscopy allows early detection of melanoma also on acral volar skin. The majority of melanocytic nevi on palms and soles may show three major dermoscopic patterns: the parallel-furrow pattern, the lattice-like pattern, and the fibrillar pattern. Melanomas at these sites are characterized by the parallel ridge pattern. We present the case of a 59-year-old woman who had an oval papule of bluish color, measuring 0.6 × 0.9 cm, localized on her left sole, that had been present, unchanged, for more than 10 years. Dermoscopy showed a parallel ridge pattern. The histopathological examination revealed a combined blue nevus. We present this case to underline that on acral volar skin also intradermal nevi, such as combined blue nevi, may dermoscopically exhibit a parallel ridge pattern, simulating melanoma.

Cutaneous Cryptococcosis in a Patient Affected by Chronic Lymphocytic Leukaemia: A Case Report

Cryptococcosis is an opportunistic infection, the incidence of which is increased in the immunocompromised patients. Cryptococcus neoformans is an encapsulated fungus that mainly infects the lungs and the central nervous system, possibly involving different organs. Cutaneous cryptococcosis is classified into localized infection, usually occurring after traumatic inoculation (primary cutaneous cryptococcosis) and cutaneous manifestation due to hematogenous dissemination (secondary cutaneous cryptococcosis), mostly in patients with underlying immunosuppression. We report a case of cutaneous cryptococcosis in a patient affected by chronic lymphocytic leukaemia.