Marta Muscianese

Pitted keratolysis, erythromycin, and hyperhidrosis

Pitted keratolysis (PK) is a plantar skin disorder mainly caused by coryneform bacteria. A common treatment consists of the topical use of erythromycin. Hyperhidrosis is considered a predisposing factor for bacterial proliferation and, consequently, for the onset of PK. The aim of this study was to evaluate the relationship between PK erythromycin and hyperhidrosis. All patients with PK seen in SantAndrea Hospital, between January 2009 and December 2011, were collected. PK was clinically and microscopically diagnosed. All patients underwent only topical treatment with erythromycin 3% gel twice daily. At the beginning of the study and after 5 and 10 days of treatment, a clinical evaluation and a gravimetric measurement of plantar sweating were assessed. A total of 97 patients were diagnosed as PK and were included in the study. Gravimetric measurements showed that in 94 of 97 examined patients (96.90%) at the time of the diagnosis, there was a bilateral excessive sweating occurring specifically in the areas affected by PK. After 10 days of antibiotic therapy, hyperhidrosis regressed together with the clinical manifestations. According to these data, we hypothesize that hyperhidrosis is due to an eccrine sweat gland hyperfunction, probably secondary to bacterial infection.

Lichen sclerosus et atrophicus induced by carbamazepine: a case report.

We report a case of Lichen Sclerosus in a 73-year-old man who had been treated for epilepsy with carbamazepine. Lichen sclerosus et atrophicus (LSA), also called lichen sclerosus (LS), is a chronic inflammatory cutaneous condition characterized by white plaques with epidermal atrophy and scarring. To date no cases of LSA has been linked to carbamazepine, although in a few cases lichenoid eruptions but without sclero-atrophy have been described after exposure to this drug. Therefore, to our knowledge, this is the first report of a Lichen sclerosus et atrophicus induced by carbamazepine

Role of Steroid Therapy in Pseudoxanthoma Elasticum-like Papillary Dermal Elastolysis

Pseudoxanthoma Elasticum-like Papillary Dermal Elastolysis (PXE-PDE) is a peculiar idiopathic elastolytic disorder that clinically resembles Psudoxanthoma elasticum (PXE). It is histologically characterized by a total or partial loss of elastic fibers in the papillary dermis. It more often affects elderly women and is characterized by asymptomatic and symmetrical yellowish papules localized predominantly on the neck, supraclavicular regions, and flexural areas. After analyzing a series of cases and the recent literature suggesting that glucocorticoids may down-regulate the elastin gene expression and elastin mRNA, in cultured human skin fibroblasts, we think that high dose and prolonged steroid therapy may contribute to the appearance of PXE-PDE lesions.

Systemic mastocytosis presenting with gastrointestinal, bone and skin involvement

Ultrasonography (US) is often the first imaging study performed in patient with abdominal pain or vague symptoms related to the gastrointestinal tract. To this end, it has been demonstrated that transabdominal sonography achieves good to excellent results in potential bowel disorders; especially, if ultrasonography findings are framed in the context of clinical information. Systemic mastocytosis is not a common disease and it usually involves skin, gastrointestinal tract and bone. It results from a clonal neoplastic proliferation of abnormal mast cells and clinically it can ranges from ‘asymptomatic’ with normal life expectancy to ‘highly aggressive’. Symptoms are caused by the release of mast cells mediators, such as histamine, and by the increase bulk of mast cells in the tissue. We present herein a case of systemic mastocytosis presenting with abdominal symptomatology due to thickened colonic involvement showed by US associated with bone and skin involvement.RiassuntoL’ecografia è spesso considerata l’indagine di primo livello nei pazienti con dolore addominale o con altra sintomatologia aspecifica del tratto gastrointestinale. A tal proposito, è stato dimostrato che l’ecografia transaddominale è in grado di raggiungere anche eccellenti risultati nello studio dei disturbi intestinali, soprattutto se inquadrata nel contesto di specifiche informazioni cliniche. La mastocitosi sistemica è una rara patologia che generalmente coinvolge cute, tratto gastrointestinale e osso. Si tratta di proliferazione neoplastica di tipo clonale di mastociti, che clinicamente può variare da una sintomatologia lieve con normale aspettativa di vita fino ad un quadro altamente aggressivo. I sintomi sono causati dal rilascio dei mediatori contenuti nei mastociti, tra i quali l’istamina, e dall’incremento dei mastociti nei tessuti. Presentiamo qui un caso di mastocitosi sistemica caratterizzato dalla comparsa di sintomatologia addominale dovuta a ispessimento del grosso intestino identificato all’esame ecografico, associato a interessamento osseo e cutaneo della patologia.

An incomplete form of childhood Behçet's disease treated with infliximab.

Behçets disease (BD) is a multi-systemic vasculitis characterized by the possible presence of cutaneous, ocular, articular and neurological manifestations. In this report, we examine the case of a fifteen-year-old boy with an incomplete form of juvenile Behcets disease which began with joint involvement and developed into a complete form only after several years. The patient showed a rapid response to anti-TNF-alpha (infliximab) with an improvement of mucocutaneous lesions (oral and genital ulcers, pseudofolliculitis) and arthritis.

Pharmacological management of pediatric Kerion celsi.

We report a case of severe tinea capitis, treated successfully with griseofulvin. In our opinion, the treatment of this severe dermatophytosis with griseofulvin is safe and effective. Other treatments, such as itraconazole pulsed therapy, failed, despite an initial improvement, leading to an aggressive recurrence of the lesion. We chose griseofulvin for its well-known large spectrum activity, also against uncommon species, like Microsporum Gypseum, which are responsible for the most severe cases.

The management of pseudomyogenic hemangioendothelioma of the foot: A case report and review of the literature

Pseudomyogenic hemangioendothelioma (PMH) is a rare, mostly indolent, endothelial neoplasm of low‐grade malignancy, often mimicking myoid and epithelioid tumors histologically. It is more frequent in young adult males and it usually presents with multiple cutaneous nodules, mostly localized at the extremities. It traverses several tissue planes simultaneously and can involve dermis, subcutis, skeletal muscle, and bone. Histologically, it is characterized by plump spindle cells with eosinophilic cytoplasm, often arranged in fascicles and epithelioid cells with “pseudomyogenic” morphology. Immunohistochemically, PMH is positive for Factor VIII, FLI‐1, INI‐1, vimentin, MDM2, CDK4, CD31, AE1/AE3, EMA, and P63. The efficacy of treatments is only partially known. Because of the frequent multifocal aspect of PMH, which contraindicates surgery, systemic treatments, such as gemcitabine, sirolimus, and everolimus are used. Based on our observation of multifocal PMH of the foot in a 17‐year‐old male patient, treated with gemcitabine with complete cutaneous response in a 2‐year follow‐up, we decided to discuss this rare tumor and underline its progression and therapeutic approaches. Thanks to a correct diagnosis, it is possible to avoid aggressive therapeutic approaches, which would be necessary for nonindolent diseases, such as sarcoma, which often needs amputation.

A “seasonal bromoderma” in a farmer

Bromoderma is a rare skin disease caused by the ingestion, inhalation, or contact with products containing bromides. We report a case of bromoderma in a 36‐year‐old farmer, characterized by remission during the spring and exacerbation during the winter. The recognition of the use of products containing bromides during the winter helped us to understand the cause of the clinical condition.

Transitory Acquired Flagellate Ictyosis, an Easy Treatment

We described the case of 45 years-old woman affected by a flagellate dermatitis arisen immediately after having a bath in sulfurous thermal water. Such dermopathy resolved after a common scratching of the lesions by the patient, so that the possible pathogenetic mechanism to explain the resolution of the lesions is the mechanical removal of cornified cell layer. After six months follow-up, the patient is in good conditions, without relapses of the flagellate dermatitis.

Granuloma annularis revealing Wegener's granulomatosis.

Skin manifestations are often associated with systemic autoimmune diseases (SAD). Some SAD, such as systemic lupus erythematosus, psoriatic arthritis and scleroderma display pathognomonic dermatological features, whereas other systemic diseases such as sarcoidosis, vasculitis and rheumatoid arthritis can present with non-specific skin manifestations that range from erythema nodosum to necrotic lesions. Here we report the case of a 25-year-old man with uveitis, polyarthrirtis, pulmonary involvement, nephrotic syndrome, cutaneous granuloma and pneumonia by E. coli.