Viviana Lora

Serum chemerin is increased in patients with chronic plaque psoriasis and normalizes following treatment with infliximab

Background  Chronic plaque psoriasis is associated with obesity, which is a metabolic and inflammatory disorder. Adipokines are involved in the pathogenesis of psoriasis and they are biomarkers of obesity‐related inflammation.

Efficacy of a Single Educative Intervention in Patients with Chronic Plaque Psoriasis

Background: An effective patient-physician relationship is important in the management of psoriatic patients. Objective: Our purpose was to investigate the efficacy of an educational intervention for patients with psoriasis in improving disease knowledge and attitude towards physicians and systemic treatments. Methods: The intervention consisted of a single, 2-hour educational programme conducted either by a dermatologist or by a dermatologist and a psychologist. Information on psoriasis and its treatment was given. A questionnaire concerning knowledge about psoriasis was administered before and after the programme, and after 6 months. Results: 123 patients were enrolled. They reported a high degree of satisfaction with the intervention, improvement in knowledge about the disease and a better attitude towards therapy. After 6 months a better knowledge about the disease and a higher attitude to treatment were retained. Conclusions: A single educational intervention may be helpful in improving psoriasis knowledge and give psychological relief to patients.

The "intraepidermal epithelioma" revisited: immunohistochemical study of the borst-jadassohn phenomenon.

The true nature of the so-called intraepidermal epithelioma of Borst-Jadassohn is poorly understood; whether this represents a distinct tumor or a morphological phenomenon [Borst-Jadassohn phenomenon (BJP)] shared by different entities has been debated. So far, no detailed immunohistochemical studies have been performed to address this issue. The aim of our study was to get further insight into the pathogenesis of the intraepidermal epithelioma of Borst-Jadassohn/BJP. Tumors showing the BJP [mainly clonal seborrheic keratoses (cSK) and clonal Bowen disease (cBD)] were studied and compared with typical (nonclonal) counterparts. Cell nests in cSK, cBD, hidroacanthoma simplex (HS), and porocarcinoma (PC) showed strong expression of epidermal growth factor-receptors (EGF-R), Ki-67, p63, and p53. Cell nests of clonal SK and HS (but not of clonal BD or PC) expressed keratin 5/6. The expression of E-cadherin and the number of CD1a+ Langerhans cells were reduced within the nests of all lesions, whereas melanocytes were increased in all of them. Keratins 7 and 19 were not expressed in any of the lesions. Tumors showing the BJP exhibit some immunohistochemical differences, suggesting that they represent separate entities. However, they all show strong expression of EGF-R within intraepidermal keratinocyte nests, suggesting that the epithelial growth factor pathway plays a role in the development of the BJP.

Lichen striatus associated with etanercept treatment of rheumatoid arthritis

and its protein product SERCA2. Down-regulation of ATP2A2 expression can be counteracted by suppressing the production of prostaglandin E2, which is an effect of the COX-2 inhibitors. Considering that DD is caused by a reduction in the expression of ATP2A2/SERCA2, we propose a new therapeutic approach using COX inhibitors such as diclofenac. Our observation of benefit from application of diclofenac sodium 3% gel in 2 patients with DD seems to support this theory. It would be interesting to ascertain if similar effects can be achieved by systemic administration of the nonsteroidal antiinflammatory agent and to investigate whether it has a therapeutic role in other dermatologic diseases with pathogenesis linked to the COX enzyme pathway.

Early Angiosarcoma of the Scalp: A Clinicopathological Pitfall.

Abstract:Angiosarcoma (AS) is a rare malignant vascular tumor, which affects mainly elderly patients. After the diagnosis, the mean overall survival of patients is 30 months. The variable presentation of the malignancy, the benign appearance of the cutaneous lesions, and the minimal histological changes in early lesions can sometimes delay the correct diagnosis. The authors report a case of an 80-year-old white male patient, with a painless and ecchymotic lesion of the scalp, which histologically showed minimal pathological atypia, conclusive for a diagnosis of AS with minimal histological changes. The authors discuss the main and most emblematic cases of AS initially misdiagnosed for other cutaneous diseases reported in the literature, noting that in some cases, also the histology can be treacherous and a trap for the dermatopathologist. The recent findings on MYC, FLT4 and KDR amplification, and the relative therapeutic perspectives are also discussed. Finally, the authors draw up some pathological cornerstones, which could improve the diagnosis, above all in early lesions with minimal atypia.

Mid-dermal elastolysis as a manifestation of immune reconstitution inflammatory syndrome in an HIV-infected patient

Fig 1. Mid-dermal elastolysis: asymptomatic parchmentlike appearance of the skin on the trunk. REFERENCES 1. Bhate C, Schwartz RA. Lyme disease, part I: advances and perspectives. J Am Acad Dermatol 2011;64:619-36. 2. Abele DC, Anders KH. The many faces and phases of borreliosis, I: Lyme disease. J Am Acad Dermatol 1990;23: 167-86. 3. Mullegger RR, Glatz M. Skin manifestations of Lyme borreliosis: diagnosis andmanagement. Am J Clin Dermatol 2008;9:355-68. 4. Goldberg NS, Forseter G, Nadelman RB, Schwartz I, Jorde U, McKenna D, et al. Vesicular erythema migrans. Arch Dermatol 1992;128:1495-8. 5. Wormser GP, Dattwyler RJ, Shapiro ED, Halperin JJ, Steere AC, Klempner MS, et al. The clinical assessment, treatment, and prevention of Lyme disease, human granulocytic anaplasmosis, and babesiosis: clinical practice guidelines by the Infectious Diseases Society of America. Clin Infect Dis 2006;43: 1089-134. 6. Bhate C, Schwartz RA. Lyme disease, part II: management and prevention. J Am Acad Dermatol 2011;64:639-53.

Terra firma-forme dermatosis

To the Editor, We read with great interest the ‘Comment regarding the histopathology of Terra firma-forme dermatosis’ of Berk and Mutizwa1 regarding the Cover Quizlet authored by Dalton and Pride.2 Terra firma-forme dermatosis represents a rare, acquired and dirt-like dermatosis that reflects a disordered and delayed keratinization of unknown etiology.3 First described in 1987 by Duncan,4 terra firma-forme dermatosis is often suspected based upon its distinctive clinical presentation as a hyperpigmented dirt-like skin eruption resistant to

A case of juvenile pityriasis rubra pilaris type III successfully treated with etanercept

Dear Editor, Pityriasis rubra pilaris (PRP) is a chronic papulo-squamous skin disorder of unknown etiology and considerable clinical heterogeneity. Five types of PRP are clinically recognized according to the Griffiths classification (Griffiths, 1980). Among children, the juvenile classical form (type III) is the most common type. It usually runs a benign course with remission in 1–2 years. However, a chronic, resistant course has been reported in some cases (Sehgal & Srivastava, 2006). Several drugs have been used to treat PRP including retinoids, methotrexate, and more recently biologic drugs (Gemmeke, Sch€ onlebe, Koch, & Wollina, 2010; Ross et al., 2016). At present only 3 cases have been reported of PRP patients less than 18 year old treated with biologics (Cox, Lesesky, Garcia, & O’Grady, 2008; G omez, Ruelas, Welsh, Arcaute, & Ocampo-Candiani, 2007; Kim, Chae, Park, Byun, & Youn, 2015). Here we describe a 13 years old patient affected by type III PRP successfully treated with etanercept.

Diffuse dermal angiomatosis of the abdomen.

Diffuse dermal angiomatosis (DDA) is a well-defined clinicopathological entity belonging to the cutaneous reactive angiomatoses, a group of benign vascular disorders characterized by intravascular and extravascular hyperplasia of endothelial cells with or without accompanying pericytes [1]. Clinical hallmarks of DDA are erythemato-violaceous plaques with occasional superficial ulceration, characterized histologically by a diffuse proliferation of CD31-positive endothelial cells arranged between the [...]

Localized post-radiation kaposi sarcoma in a renal transplant immunosuppressed patient

Organ transplant recipients are at high risk to develop secondary cutaneous neoplasms because of immunosuppression. However, little is known about secondary neoplasms developing within a skin area exposed to radiation therapy in these patients. We report a case of a 45-year-old man with history of kidney transplantation in 2005 and rectal adenocarcinoma in 2006 for which he underwent 2 cycles of chemotherapy and a cycle of radiotherapy. In February 2010, he presented with clustered erythematous-violaceous plaques and nodules of 2-month duration, located on the left buttock in the area previously exposed to radiations. Histological examination revealed a poorly demarcated dermal and subcutaneous proliferation of spindle and partly pleomorphic cells, associated with irregularly shaped vessels that dissected through dermal collagen. Immunohistochemistry showed expression of CD31 and podoplanin. Although a moderate expression of the c-Myc protein was found by immunostaining, no amplification of c-myc gene was detected by fluorescence in situ hybridization. Human herpes virus 8 was positive both on immunohistochemistry and PCR. Based on clinicopathologic findings a diagnosis of iatrogenic Kaposi sarcoma localized in the area treated with radiotherapy was made. Clinical and histopathological features of vascular neoplasms may be overlapping, and correct diagnosis may be difficult, particularly in organ transplant recipients. Only the combination of all available information, including histopathological, immunohistochemical, fluorescence in situ hybridization, and PCR data, permit to achieve a correct diagnosis in particularly difficult setting.