Massimiliano Nino

Dermoscopy for the diagnosis of porokeratosis

Dermoscopy is a non-invasive diagnostic technique, which is performed by means of different incident light magnification systems using an oil immersion technique. It allows to observe pigmented and vascular structures, from the stratum corneum to the papillary dermis. Dermoscopy is therefore particularly useful in those skin disorders in which the stratum corneum, epidermis and papillary dermis are involved. It is mostly used for the diagnosis of pigmented skin tumours, but its usefulness has also been reported for the in vivo detection of Sarcoptes scabiei. Additionally, this technique may be used for the diagnosis of verrucae vulgaris, psoriasis and other diseases with epidermal involvement. Porokeratoses are a group of disorders of keratinization characterized by annular lesions surrounded by a characteristic keratotic border which corresponds to a typical histopathologic feature, namely, the cornoid lamella. The cornoid lamella is a column of parakeratotic cells placed on a depression of the epidermis where the granular layer is absent. Though nonpathognomonic, the cornoid lamella is the most distinctive feature of the various types of porokeratosis. These varieties include the plaque type originally described by Mibelli (few lesions located on the extremities with a cornoid lamella which could be thick up to 10 mm); the superficial disseminated and superficial actinic forms, the punctate variant of palms and soles and the linear type all sharing similar histopathologic features. We report a case of disseminated superficial porokeratosis and describe the morphologic features that can be evidenced by epiluminescence microscopy examination.

Lupus miliaris disseminatus faciei and its debated link to tuberculosis

This condition is not uncommon and occurs in adults and adolescents of both sexes. 2,3 The cause and pathogenesis are unknown. Originally considered a variant of lupus tuberculosis or a tuberculid, there is doubtful evidence supporting a link to tuberculosis. A 48-year-old Caucasian woman consulted us for the appearance of multiple indolent papules, with smooth surface and brownishred colour, 2–4 mm in diameter, symmetrically distributed in the centrofacial regions (fig. 1). The papules developed quite rapidly. Diascopy revealed an infiltrate similar to the apple-jelly nodules of lupus vulgaris. Biopsy of a lesion revealed well-defined globular masses of tuberculoid structures in the upper dermis (fig. 2). X-rays showed no lung alterations and a Tine test was positive. After a period of 8 months papules involuted spontaneously. The pathogenesis and its link to tuberculosis are not well understood 4 and are debatable: LMDF could represent an allergic reaction due to the antigen diffusion of a deep tuberculous focus, often unknown. Most forms of LMDF exhibit tuberculoid features histologically; however, tuberculoid granulomas are produced by a multitude of conditions, and forms have been described that lacked tuberculoid structures. Therefore, the histological evidence is of questionable value. Culture examination of lesions does not show Koch bacillus. Although polymerase chain reaction may sometimes be positive, 5 usually these are false-positive results. 6

Cutaneous alternariosis in a kidney transplantation recipient: Report of a case

Phaeohyphomycoses are induced by dematiaceous or darkly pigmented fungi. Alternaria species are the most important causative agents. Factors such as immunosuppression, local wounds or systemic disease are generally present. We report a case of phaeohyphomycosis induced by Alternaria alternata in an immunocompromised patient. The main interest in this case is the rareness of the cutaneous alternariosis and of its clinical aspects and the good response to therapy. Recognition of Alternaria spp. as potential opportunistic pathogens is important for the differential diagnosis of dermatological lesions, such as granulomatous or ulcerative lesions in immunocompromised patients.

A long‐term gluten‐free diet as an alternative treatment in severe forms of dermatitis herpetiformis

Background: A long‐term gluten‐free diet (GFD) as a first‐choice treatment for dermatitis herpetiformis (DH) has been used successfully. The aim of the present study is to evaluate the possibility of treating all severe skin manifestations of DH by a GFD only. Methods: Seventy‐two patients with DH were subdivided in two groups: group A (18 patients) underwent a GFD and received dapsone; group B (54 patients) underwent a GFD. Patients were subdivided into slight, moderate and severe forms. Results: A total of 88.9% of patients treated with dapsone and a GFD (group A) had remission of skin manifestations and the remaining 11.1% were improved. In group B, 87% of patients showed complete remission of skin manifestations after 18 months of a GFD; 13% showed improvement. With regard to severe forms, after an 18‐month treatment, 70.4% of patients in group B; 66.6% in group A. Conclusion: Our study shows that a GFD, if administered steadily and for a long period, can be a valid treatment for severe forms of DH. Dapsone can be useful to control the inflammatory phase of the disease.

Trichophyton violaceum infection in an adult black patient in Europe.

References 1 Morelli JG. Cutaneous viral infections. In: Kliegman RM, Behrman RE, Jenson HB, eds. Nelson Textbook of Pediatrics, 18th edn. Philadelphia: WB Saunders, 2007: 2751–2754. 2 Drake LA, Ceilley RI, Cornelison RL, et al. Guidelines of care for warts: human papillomavirus. J Am Acad Dermatol 1995; 32: 98–103. 3 Kuwahara RT, Craig SR, Amonette RA. Forceps and cotton applicator method of freezing benign lesions. Dermatol Surg 2001; 27: 183–184. 4 Ahmed I, Agarwal S, Ilchyshyn A, et al. Liquid nitrogen cryotherapy of common warts: cryo-spray vs. cotton wool bud. Br J Dermatol 2001; 144: 1006–1009. 5 James WD, Berger TG, Elston DM. Andrew’s Diseases of the Skin, 10th edn. Philadelphia: WB Saunders, 2006: 874–876.

Bullous Fixed Drug Eruption Induced by Paracetamol: Report of a Pediatric Case

Drug eruptions are among the most common adverse drug reactions, affecting approximately 3% of hospitalized patients. A fixed drug eruption (FDE) is a distinct drug-induced reaction pattern that characteristically recurs at the same skin or mucosal site. We report a case of a 2-year-old girl with bullous FDE due to Tachipirina syrup, a preparation containing paracetamol, a commonly used nonsteroidal anti-inflammatory drug in Italy.