Paolo Taddeucci

A new model of epidermal culture for the surgical treatment of vitiligo.

Background Vitiligo can be successfully treated with grafts of autologous cultured epidermal cells.

Chondrodermatitis nodularis chronica helicis and photodynamic therapy: a new therapeutic option?

Chondrodermatitis nodularis chronica helicis (CNCH) is a fairly frequent disorder of unknown etiology. Although the elective therapy is surgery, local application of topical steroids, antibiotic ointments, intralesional injection of collagen, cryotherapy, curettage followed by diathermy, and CO2 laser treatment have also been proposed. The aim of the study was to test the utility of photodynamic therapy (PDT) for CNCH. Two patients with painful CNCH underwent PDT with a 635 nm light source for 20 minutes (70 J/cm2) after application of cream containing 20% 5‐aminolevulinic acid (5‐ALA) and occlusion for 3 hours. The lesions decreased considerably in size and pain ceased within a few weeks. The results suggest that this method can be useful for treating CNCH, especially in patients with contraindications for surgery.

Half-and-half nail in a patient with Crohn's disease.

expression of E-cadherin is downregulated. Hoot et al. reported a role of transforming growth factor (TGF)-b-Smad2 signalling pathway in the formation and progression of squamous cell carcinoma. Mice with keratinocyte-specific Smad2 deletion exhibited an accelerated formation and malignant progression of chemically induced squamous cell carcinomas compared with wild-type mice. Moreover, they revealed that lack of Smad2 expression in human squamous cell carcinoma was associated with a reduced expression of E-cadherin, a higher expression of Snail1 and a poor differentiation, indicating the involvement of epithelial–mesenchymal transition. The tumour cells in our case expressed both Snail1 and vimentin and failed to express keratins, suggesting that an epithelial–mesenchymal transition played a crucial role in the tumorigenesis. It is likely that this transition underlie the pathogenesis of not only atypical fibroxanthomamimicking squamous cell carcinoma but also spindle cell carcinoma in some cases. As the TGF-b-Smad signalling pathway is a well-known inducer of this transition, it might be a target for the new therapeutic approach of poorly differentiated squamous cell carcinoma in future.

A new surgical approach for the treatment of severe epithelial skin sun‐induced damage

Background  Cutaneous photoageing is a complex biological process affecting all layers of the skin. Skin damage resulting from intrinsic ageing and extrinsic photoageing may trigger skin cancer. In patients with advanced photoageing and/or diffuse actinic damage, local therapy is often inadequate and the possibility of combined therapy needs to be assessed.

Searching Novel Therapeutic Targets for Scleroderma: P2X7-Receptor Is Up-regulated and Promotes a Fibrogenic Phenotype in Systemic Sclerosis Fibroblasts

Objectives: Systemic sclerosis (SSc) is a connective tissue disorder presenting fibrosis of the skin and internal organs, for which no effective treatments are currently available. Increasing evidence indicates that the P2X7 receptor (P2X7R), a nucleotide-gated ionotropic channel primarily involved in the inflammatory response, may also have a key role in the development of tissue fibrosis in different body districts. This study was aimed at investigating P2X7R expression and function in promoting a fibrogenic phenotype in dermal fibroblasts from SSc patients, also analyzing putative underlying mechanistic pathways. Methods: Fibroblasts were isolated by skin biopsy from 9 SSc patients and 8 healthy controls. P2X7R expression, and function (cytosolic free Ca2+ fluxes, α-smooth muscle actin [α-SMA] expression, cell migration, and collagen release) were studied. Moreover, the role of cytokine (interleukin-1β, interleukin-6) and connective tissue growth factor (CTGF) production, and extracellular signal-regulated kinases (ERK) activation in mediating P2X7R-dependent pro-fibrotic effects in SSc fibroblasts was evaluated. Results: P2X7R expression and Ca2+ permeability induced by the selective P2X7R agonist 2′-3′-O-(4-benzoylbenzoyl)ATP (BzATP) were markedly higher in SSc than control fibroblasts. Moreover, increased αSMA expression, cell migration, CTGF, and collagen release were observed in lipopolysaccharides-primed SSc fibroblasts after BzATP stimulation. While P2X7-induced cytokine changes did not affect collagen production, it was completely abrogated by inhibition of the ERK pathway. Conclusion: In SSc fibroblasts, P2X7R is overexpressed and its stimulation induces Ca2+-signaling activation and a fibrogenic phenotype characterized by increased migration and collagen production. These data point to the P2X7R as a potential, novel therapeutic target for controlling exaggerated collagen deposition and tissue fibrosis in patients with SSc.

Neuroblastoma-like neurilemoma: An additional case

Dear Editor, A 38-year-old woman visited our hospital complaining about a nodule on her right flank. The patient recalled suffering a trauma at the same site 7 years prior, with consequent formation of a hematoma which disappeared within a couple of months. Since then, she had noticed a painless nodule, that grew slowly over the years. In the prior 2 years, however, the nodule became slightly painful leading the patient to have it surgically removed. The initial clinical hypothesis was that of a lipoma. A marginal excision was performed, revealing a 4 cm × 2.5 cm × 2 cm, well-demarcated, multilobulated, solid, nodular lesion, having a whitish cut surface with calcified areas, intermingled with fat. Histopathologically, in the subcutis there was a well-circumscribed, encapsulated, multinodular lesion, consisting of small, round-to-oval tumor cells, with scant cytoplasm, surrounding amorphous, hyalinized areas, forming giant rosettes (Fig. 1). Tumor cells showed blunt nuclei, and mitotic figures were absent and no necrosis was seen. Moreover, there were areas with markedly myxoid stroma and microcalcifications. Immunohistochemical staining (Fig. 2) showed a diffuse, strong nucleocytoplasmic positivity for S100 protein, as well as positivity for synaptophysin in some areas. Glial fibrillary acidic protein (GFAP) intensely stained tumor cells, mostly at the periphery of hyalinized rosettes, with almost completely positive cellular rosettes. Immunostaining was negative for currently used neuronal markers (neurofilaments [neuN]), chromogranin, CD99, neuro-specific enolase (NSE), as well as CD34. The capsule was positive to epithelial membrane antigen. The diagnosis of neuroblastoma-like neurilemoma was made. Neurilemoma with giant rosettes (neuroblastomalike neurilemoma), is a rare entity. To our knowledge, so far, only 10 such cases have been reported in the published work, with Goldblum being the first to have described it in 1994. All have been painless or almost painless subcutaneous nodules involving the neck, knee, palm, vulva, thigh, and rarely the

Intraoperative skin expansion in emergency repair of the scalp.

We report the case of a road accident victim who sustained fracture of the frontal bone and extensive skin loss. Immediate repair of the skin breach was necessary to protect the set bone fragments. Intraoperative skin expansion provided an immediate gain in tissue and avoided the waiting period required with traditional expansion methods. Besides an excellent immediate functional result, acceptable aesthetic results, confirmed 6 months later, were also obtained. ( J Dermatol Treat (2001) 12: 25-28)

Skin biopsy leading to diagnosis of diffuse intravascular B‐cell lymphoma presenting as a fever of unknown origin

Editor Intravascular large B-cell lymphoma (IVLBCL) is a rare type of malignant lymphoma, characterized by the selective growth of lymphoma cells within the lumina of vessels. Originally, most IVLBCL cases were only diagnosed postmortem; however, it is now possible to diagnose and treat some cases ante-mortem. Minimally invasive and highly sensitive procedures are required for accurate and quick diagnosis. The most common clinical manifestations are fever of unknown origin, deteriorating mental status change or rapidly progressive neurologic signs and skin rash. Cutaneous lesions, which are found in approximately 40% of cases, include macules, nodules, plaques, ulcer, telangiectases, reticulated livedoid erythema or infiltrative ‘peau d’orange’ and favour the trunk, thighs and legs. Here, we report a case, in which a diagnosis of IVLBCL on the base of a skin biopsy has been formulated. A 65-year-old man presented to geriatric department with a 1-month history of fever of unknown origin, haematuria and rash all over his trunk. He also reported general malaise, weight loss, anorexia and night sweats. Because the patient became rapidly and increasingly unwell and confused, the patient was transferred to the neurosurgical unit, the vital signs were monitored and a diuretic therapy with furosemide and broad-spectrum antibiotic was prepared, even though no focus of infection was identified. Blood tests showed anaemia, leukopenia and thrombocytopenia associated with high serum LDH level. Due to the presence of skin lesions on the trunk, a dermatological opinion was sought. There were confluent erythematous patches on the trunk and almost uniformly on the back, associated with oedema and erythema, and signs of venous stasis (Fig. 1). A skin biopsy was performed and the histological examination showed atypical lymphocytes within blood vessels (Fig. 2). Immunohistochemistry showed the atypical lymphoid cells to be positive for B-cell markers CD20 and negative for CK, CD3, CD30, CD45RO and CD10. They were also positive for BCL-2. On this basis, a diagnosis of IVLBCL was made and a septic condition was excluded. Moreover, a bone marrow sampling was performed. However, no neoplastic infiltration was found. Finally, an ultrasound examination of the abdomen showed the presence of pathological retroperitoneal tissue. An ultrasoundguided needle biopsy of the retroperitoneal mass confirmed the diagnosis of IVLBCL. It is not known if there was a primary retroperitoneal lesion with subsequent cutaneous localization or if there was instead a cutaneous form of IVLBCL with subsequent retroperitoneal localization. The hypothesis of an aggressive chemotherapy was evaluated. However, on the ninth day, a rapid worsening of the patient occurred, with progressive haemodynamic deterioration until death. The autopsy also showed the presence of neoplastic tissue at a neurological level.

The 'common mole' from the point of view of digital dermoscopy analysis: subjective vs. objective evaluation of easy pigmented skin lesions

Background The term ‘common mole’, often used to describe a subset of benign pigmented skin lesions, is traditionally defined on the basis of morpho‐chromatic features. In recent years, certain research groups have developed equipment and methods, such as digital dermoscopy analysis, that enable objective evaluation of pigmented skin lesions.

A case of inflammatory myofibroblastic tumour of the right labium majus.

Editor Inflammatory myofibroblastic tumour (IMT) is a rare massforming lesion characterized by fibroblastic or myofibroblastic spindle cell proliferations with varying degrees of inflammatory cell infiltration, prevalent lymphocytes, plasma cells and histiocytes. The tumour occurs most commonly in the lungs, where it presents genuinely benign behaviour. Even though rare, extrapulmonary IMTs have been reported mostly in the bladder, mesenteric and mediastinum areas, and is characterized by different, more aggressive behaviour. Yet only 18 cases of cutaneous IMT have been reported in the literature. The clinical presentation of cutaneous IMT is not specific and it varies in size and shape. Patients generally present with a mass but without specific symptoms, so it seldom enters differential diagnosis at the time of the initial evaluation. Recently, we observed a case of cutaneous IMT of the vulva. A 38-year-old woman presented with a small vulvar nodular lesion of the right labium majus. The lesion was reported to have been present for more than 3 years, with asymptomatic growth during this time up to its actual size. On physical examination, the lesion was not visible, whereas it was evidenced by palpation examination. It presented as a round, hard, not pulsating mass of 2 cm diameter, fixed at the near tissues, with the over skin normal for colour and aspect. There were no lymphadenopathies or constitutional symptoms, and the laboratory findings were unremarkable. The preoperative ultrasound examination was not exhaustive, showing a mild vascularized homogeneous and