Pasquale Ena

Rapid identification of cutaneous infections by nontubercular mycobacteria by polymerase chain reaction-restriction analysis length polymorphism of the hsp65 gene

Background  Nontubercular mycobacteria (NTM) may cause cutaneous infections which are difficult to interpret due to the variability of the clinical manifestations. This study involved eight patients (four men and four women) with primary cutaneous infections caused by NTM; the skin lesions included dermo‐hypodermal abscesses, suppurative granulomas, and papulonodules localized on the legs, arms, hands, and face. The general condition of the patients was relatively good and they were not immunosuppressed.

Lichen planus in children: a case report.

Abstract: Lichen planus (LP) Is rare in children. A review of the literature reveals that it has some peculiarities with respect to sex, localization, clinical aspect, race, and family history. We present an Indian child with the documented peculiarities of infantile LP. A comparison of LP and graft‐versus‐host disease points to the Importance of thymic Involution in the pathogenesis of the former, which could explain the rarity of this disorder In infants.

High Prevalence of Microproteinuria, an Early Index of Renal Impairment, in Patients with Diffuse Psoriasis

Heavy reversible proteinuria induced by antihypertensive treatment with low doses of captopril has recently been reported by our group in psoriatic patients. To ascertain whether an increased permeability of the glomerular basal membrane of psoriatics can lead to an enhanced urinary excretion of albumin independently from the presence or absence of coexisting diabetes or hypertension, the latter parameter was measured in 39 patients affected by diffuse psoriasis. A high prevalence of microalbuminuria was observed in diabetic and hypertensive psoriatics. Moreover, a direct correlation was found between the diastolic blood pressure (BP) values and the urinary excretion of albumin in the entire group of psoriatics, thus suggesting systemic hypertension as one of the factors responsible for proteinuria in these patients. However, more than 50% of normotensive psoriatics showed an enhanced excretion of albumin. Since microalbuminuria has been indicated as a reliable index to predict the development of renal impairment, the finding of an enhanced albumin loss in psoriatics represents a further risk factor in these patients, who are particularly susceptible to experience cardiovascular complications.

Discoid lupus erythematosus of the eyelids associated with staphylococcal blepharitis and Meibomian gland dysfunction.

Lower eyelid involvement occurs in 6% of patients with discoid lupus erythematosus (DLE). Eyelid lesions are rarely the initial manifestation of DLE. We describe a 25‐year‐old woman presenting with discoid lesions of the lower eyelids, staphylococcal blepharitis and Meibomian gland dysfunction, who later developed a discoid lesion on the chin. Histopathological and immunofluorescence studies of a biopsy specimen from this lesion established the diagnosis of DLE. We are unaware of any previously reported cases of DLE presenting with discoid eyelid lesions associated with staphylococcal blepharitis and Meibomian gland dysfunction. DLE should be considered as a differential diagnosis in chronic blepharitis that persists despite usual medical management and eyelid hygiene. Misdiagnosis may lead to eyelid margin deformities, necessitate a complicated full‐thickness biopsy, and delay diagnosis of systemic lupus.

Mycobacterium chelonae I infection mimicking acne conglobata in an immunocompetent host

Mycobacteria are an important cause of cutaneous and soft tissue infections. Mycobacterium chelonae belongs to the nontuberculous mycobacteria that are facultative pathogens in humans.

Sebaceous gland hyperplasia of the foreskin

Two men, aged in their 20s, presented with multiple, soft, rounded papules on the prepuce. The lesions were centrally umbilicated, resembling molluscum contagiosum, but clearly distinct from Tyson’s glands. Surface microscopy showed well‐defined, milky‐white, bag‐shaped structures, which under histological examination were found to be sebaceous glands with various features of hyperplasia. A lymphocytic T‐cell infiltrate, closely associated with progressive degeneration and destruction of the sebocytes, was visible around the glands. In the differential diagnosis of penile papular lesions, this unusual clinical presentation supported by dermatoscopy is consistent with preputial sebaceous gland hyperplasia. As both patients had a prominent T‐cell infiltration, it is possible that under inflammatory stimulation, sebaceous glands undergo hypertrophy and gradual central involution.

Tufted hair folliculitis in a woman treated with lapatinib for breast cancer.

puncture skin test (0%; P < 0.001). The proportion of positive APST was in line with that found in larger groups of patients with CU. One reason why the puncture skin test was negative in all our patients might be that in this technique the concentration of autoantibodies or other histamine-releasing factors is too low to increase the permeability of the capillary wall significantly. Furthermore, Kimura et al. used a serum containing high levels of autoantibodies to perform the puncture skin test, whereas we used plasma, which may not contain autoantibodies but rather other histaminereleasing factors. Irrespective of the possible explanation, our results suggest that (at least in adult patients with CU) the APST remains the best means to detect an autoreactive status in vivo and that the puncture skin test cannot be considered a valid substitute for the intradermal test.

Mucocutaneous leishmaniasis as presentation of HIV infection in Sardinia, insular Italy

Leishmaniasis is endemic in Sardinia but only cutaneous and visceral cases have been reported to date. We report a case of mucocutaneous leishmaniasis as presentation of HIV infection in a Sardinian patient who had never visited endemic areas. Serological and clinical diagnosis was cytologically and histopathologically confirmed. The patient had a good response to treatment with liposomal amphotericin combined with highly active antiretroviral therapy without recurrences after four years. Our case report highlights the need to better assess the circulation of species, risk factors and clinical spectrum of Leishmania infection in the Italian Mediterranean islands.

Hair casts due to a deodorant spray

A 7‐year‐old girl presented with itching and greyish‐white sleeve‐like structures in her hair. After ruling out other possible causes for the symptoms, such as nits and dandruff, it was determined that the patient was affected by hair casts. These are small cylindrical structures resembling louse eggs that encircle individual scalp hairs and are easily movable along the hair shafts. It was concluded that she had induced the condition through misuse of a deodorant body spray. Scanning electron microscopy combined with electron dispersive X‐ray analysis (X‐ray microanalysis) of the hair casts showed the chemical nature of the structures. Some elements present in the composition of the ingredients of the deodorant spray, such as aluminium, chlorine, silicon, magnesium and carbon, were also present in this uncommon type of hair casts.

Eye changes in a patient with lamellar ichthyosis and toe pseudoainhum

Autosomal recessive primary ichthyosis (ARPI) is a rare, genetically heterogeneous skin disease. Several loci of responsible genes have been identified, including 14q11, which controls transglutaminase-1 expression, and 2q33–35. Clinical, biochemical, and histological evidence exists separating ARPI into two distinct diseases: lamellar ichthyosis (LI; the severe phenotype) and congenital ichthyosiform erythroderma (CIE, the milder phenotype). The estimated incidence is 1 : 200 000 to 300 000 live births. Affected babies are called ‘collodion babies,’ because they are embedded in an inelastic membrane that dries soon after birth. Within 2 weeks the collodion membrane spontaneously sheds and the skin develops plate-like scales covering the entire body. In LI the scales are dark, large, polygonal, and tightly adherent and give a typical lifelong disfiguring appearance. Histopathologically, there is marked hyperkeratosis and a prominent granular layer. LI is a retention disorder, with normal epidermal turnover. Pseudoainhum is an affection characterized by the appearance of a constricting band around a digit, which may lead to spontaneous amputation (dactylolysis). This lesion has been observed in vascular, neurological, and skin disorders. Pseudoainhum is very rarely found in patients with LI. We report herein the eye changes in a patient with LI and toe pseudoainhum.