Oscar Muñoz Moreno-Arrones

Frontal fibrosing alopecia: clinical and prognostic classification

Frontal fibrosing alopecia (FFA) is a chronic scarring alopecia with an unpredictable evolution. There are no current classifications of this disease that may predict its prognosis.

In situ production of ROS in the skin by photodynamic therapy as a powerful tool in clinical dermatology.

Photodynamic therapy (PDT) is a clinical modality of photochemotherapy based on the accumulation of a photosensitizer in target cells and subsequent irradiation of the tissue with light of adequate wavelength promoting reactive oxygen species (ROS) formation and cell death. PDT is used in several medical specialties as an organ-specific therapy for different entities. In this review we focus on the current dermatological procedure of PDT. In the most widely used PDT protocol in dermatology, ROS production occurs by accumulation of the endogenous photosensitizer protoporphyrin IX after treatment with the metabolic precursors 5-methylaminolevulinic acid (MAL) or 5-aminolevulinic acid (ALA). To date, current approved dermatological indications of PDT include actinic keratoses (AK), basal cell carcinoma (BCC) and in situ squamous cell carcinoma (SCC) also known as Bowen disease (BD). With regards to AKs, PDT can also treat the cancerization field carrying an oncogenic risk. In addition, an increasing number of pathologies, such as other skin cancers, infectious, inflammatory or pilosebaceous diseases are being considered as potentially treatable entities with PDT. Besides the known therapeutic properties of PDT, there is a modality used for skin rejuvenation and aesthetic purposes defined as photodynamic photorejuvenation. This technique enables the remodelling of collagen, which in turn prevents and treats photoaging stygmata. Finally we explore a new potential treatment field for PDT determined by the activation of follicular bulge stem cells caused by in situ ROS formation.

Frontal fibrosing alopecia and environment: may tobacco be protective?

removes the occluding tissue. My clinical results are excellent. Sexual function is restored, urinary function is ameliorated and not one patient has yet developed penis cancer (maximum published rate 12.5%). I do not undertake female or paediatric clinics, so must leave it to others to translate these fundamental observations in males into clinical research and therapeutic practice in women and children, where the morbidity (and occasionally mortality in the former group) remain unacceptably high. The EDF 2015 guideline has missed the opportunity to be more helpful and influential.

Glomuvenous malformations: dual PDL-Nd:YAG laser approach

Glomuvenous malformations are uncommon simple vascular malformations that might be present at birth or appear during childhood that have been classically classified as a subtype of venous malformations. Sclerotherapy and surgery have been used in the past as treatments for this condition although with disappointing results in large glomangiomas. The treatment of these lesions has still not been standardized. We conducted a retrospective study of 17 patients treated with dual wavelength PDL-Nd:YAG. The majority of the patients experience a reduction of at least a 60% in their glomuvenous malformations. Treatment was well-tolerated, and adverse effects were rare.

Pulsed dye laser on ecchymoses: clinical and histological assessment.

Ecchymoses occur due to local haemorrhages with red blood cell (RBC) extravasation into soft tissues. It can develop after a trauma, a surgical procedure, a cosmetic procedure or even spontaneously, especially in patients taking anticoagulant drugs or with coagulation alterations. Moreover, the prevalence of this condition is on the rise due to the increasing use of chronic anticoagulation therapies. Although ecchymoses resolve spontaneously, the associated discoloration might persist up to 2 weeks in some cases. This situation represents a potential social impairment due to cosmetic concerns, mainly in those patients with extensive bruises affecting non-covered areas. Therefore, the effective and safe treatment of ecchymoses would have an emotionally, socially and even economically positive impact. Many therapeutic approaches have been tried in order to treat or prevent ecchymoses, most of them with poor results. Contradictory results have been found in studies testing the efficacy of topical vitamin K for this purpose [1–3]. A systematic review has not found enough evidence supporting the use of natural alternatives such as arnica or bromelain to prevent or treat ecchymoses [4]. Other approaches have tested vitamin E, primrose oil cold compresses, 3% hydrogen peroxide or even homeopathic alternatives with poor results [5, 6]. Few studies, case series or isolated cases have been already reported about ecchymoses treatment using pulsed dye laser (PDL) [7–9]. Despite their good results in some cases, the parameters used were not optimized, they achieved only partial results or they were focused only on ecchymoses on a specific area (e.g. facial ecchymoses) [7, 9]. The objective of our study was to describe the effectiveness and security of PDL as a potential treatment of cutaneous ecchymoses. In addition, we wanted to describe the histological changes of ecchymoses treated with PDL and the effects of laser in in vitro tests with fresh blood and blood smears.

Videodermoscopy and Doppler-ultrasound in spider naevi: towards a new classification?

Spider naevi (SN) are considered a subtype of telangiectasias, currently classified as low‐flow vascular malformations.

Steroid-Induced Changes Noted On Trichoscopy Of Patients With Frontal Fibrosing Alopecia

In summary, both apremilast monotherapy and combination therapy result in favorable 52-week maintenance of therapeutic response in approximately two thirds of patients, with minimal mild-to-moderate AEs during weeks 16-52 of treatment. As such, physicians can consider using apremilast in combination with biologic or systemic agents for long-term maintenance of disease control in patients presenting with challenging psoriasis that cannot be controlled with 1 agent alone.

Das primäre kutane angiomatöse Melanom

Eine 63-jährige Frau ohne relevante Anamnese stellte sich in unserer Klinik mit einer chronischen Hautläsion vor, die sich in Morphologie und Farbe veränderte. Zwei Wochen vor der ärztlichen Beratung hatte die Läsion stark geblutet und anschließend erheblich an Größe abgenommen. Die dermatologische Untersuchung ergab einen purpurfarbenen Tumor (mit dem Durchmesser von 1,5 cm) am rechten Schulterbereich, der aus einer leicht erhöhten braunen Papel hervorging. Es gab Anzeichen einer kürzlichen Blutung und etwas Krustenbildung. Die Dermatoskopie zeigte ein violett-schwarzes homogenes Muster und einen blau-weißen Schleier mit weißen Fasertrakten und ungewöhnlichen Gefäßen im Inneren. Darunter ließ sich eine braune melanozytäre Läsion mit einem regelmäßigen Pflastersteinmuster feststellen (Abbildung 1). Die übrige klinische Untersuchung war unauffällig. Eine Exzisionsbiopsie wurde durchgeführt. Die histopathologische Untersuchung ergab eine gut verschachtelte melanozytäre Läsion mit einer weitreichenden intradermalen Komponente, eine progrediente tiefgehende Reifung und keine Anzeichen einer Atypie. Ein nodulärer Tumor, dessen Clinical Letter größter Durchmesser 0,7 cm betrug, wuchs neben dem oben genannten Nävus; er bestand aus mittelgroßen Zellen mit ausgeprägtem Pleomorphismus, übersichtlichen Kernen und auffälligen Nukleoli mit häufigen Mitosen. Im gesamten Neoplasma war keine Reifung vorhanden. Entlang der Basalzellschicht lagen atypische melanozytäre Zellen vor, die in einem lentiginösem Muster ohne Nestbildung angeordnet waren. Es gab vereinzelte tubuläre Strukturen, die an Gefäßkanäle erinnerten und zahlreiche Erythrozyten enthielten. Diese Kanäle wurden von neoplastischen Zellen ausgekleidet, die negativ für die Endothelmarker D2-40 und CD-31 waren. Eine weitere immunhistochemische Färbung ergab durchweg positive Ergebnisse für melanozytäre Marker (S-100, SOX-9 und HMB-45) und war negativ für die Zytokeratine A1–A3 (Abbildung 2). Angesichts der klinischen und histologischen Befunde wurde eine Diagnose des primären angiomatösen Melanoms gestellt (Clark-Level III, Tumordicke nach Breslow 5,2 mm mit Anzeichen einer Ulzeration zwischen 3–5 mm). Ganzkörper-Positronen-Emissions-Tomographie/Computertomographie (PET/CT) zeigte Metastasen in den Lungen, in der Leber und in den Nodi lymphatici coeliaci. Die genetische Untersuchung bezüglich der Mutationen V600E und V600K des BRAF-Gens mit der Echtzeit-PCR (THxID-BRAF AMP, bioMérieux, Frankreich) offenbarte eine V600E-Mutation. Nach der Diagnose wurde die Patientin in die Onkologie-Abteilung überwiesen und erhielt Vemurafenib (zweimal täglich 960 mg). Nach einer Verlaufsuntersuchung von sechs Monaten gab es keinen Hinweis auf eine Progredienz der Erkrankung. Das kutane Melanom zeichnet sich durch klinische und histopathologische Varianten aus. Die letzteren umfassen eine zunehmende Anzahl von unterschiedlichen Bezeichnungen [1] (darunter das naevoide, follikuläre, Animal-type, spitzoide Melanom). Das angiomatöse Muster wurde in der

Primary cutaneous angiomatoid melanoma: Correspondence

A 63-year-old woman with no relevant medical history presented to our hospital with changes in the morphology and color of a chronic cutaneous lesion. Two weeks prior to consultation, the lesion had bled profusely, subsequently decreasing significantly in size. Dermatological examination revealed a purplish tumor (1.5 cm in diameter) in the right scapular region, arising from a slightly raised brown papule. There were signs of recent bleeding and some crusting. Dermatoscopy showed a violaceous-black homogeneous pattern and a blue white veil, with white fibrous tracts and irregular vessels inside. Beneath, a brown melanocytic lesion with a regular cobblestone pattern was observed (Figure 1). The remainder of the clinical exam was unremarkable. An excisional biopsy was performed. Histopathological examination revealed a well-nested melanocytic lesion with an extensive intradermal component, progressive in-depth maturation, and no signs of atypia. A nodular tumor whose largest diameter was 0.7 cm grew adjacent to the aforementioned nevus; it was composed of medium-sized cells with marked pleomorphism, clear nuclei, and prominent nucleoli with frequent mitoses. There was a lack of maturation throughout the neoplasm. Atypical melanocytic cells arranged in a lentiginous pattern without nest formation were present along the basal layer. There were scattered tubular structures resembling vascular channels containing numerous erythrocytes. These channels were lined by neoplastic cells that were negative for endothelial markers D2-40 and CD31. Further immunohistochemical staining showed consistent positivity for melanocytic markers (S-100, SOX-9, and HMB-45) and negativity for cytokeratins A1–A3 (Figure 2). Given the clinical and histological findings, a diagnosis of primary angiomatoid melanoma (Clark level III, Breslow thickness 5.2 mm, with evidence of ulceration between 3–5 mm) was established. Whole-body positron emission tomography-computed tomography (PET-CT) was performed, revealing metastatic disease in the lungs, liver, and celiac lymph nodes. Genetic testing for both V600E and V600K mutations of the BRAF gene was performed using real-time PCR (THxID-BRAF AMP, bioMérieux, France), revealing a V600E mutation. Following the diagnosis, the patient was referred to the oncology department and started on vemurafenib (960 mg BID). After six months of follow-up, there was no evidence of disease progression. Cutaneous melanoma is characterized by clinical and histopathological variants, the latter including an increasing number of different designations [1] (including nevoid, follicular, animal, spitzoid). Rarely reported in the literature, angiomatoid pattern is an extremely uncommon histological melanoma variant [2, 3]. It was first described by Adler et al. in 1997 in a patient with cutaneous metastatic melanoma of unknown origin [4]. As in our case, the lesion on the forehead showed clusters of HMB-45 and S-100-positive cells forming vascular channels [4]. Since then, four more cases with similar histopathology have been published [2, 3]. A vessel-like morphology with pseudovascular channels has also been described in other melanocytic neoplasms [5, 6]; here, due to the lack of tissue resistance to traction, vascular spaces may be formed as a result of the biopsy procedure. In addition, these vessel-like formations can be induced by tumor cell vasculogenic mimicry, a phenomenon observed in a

Penile Mycobacterium avium complex spindle cell pseudotumor

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