BACKGORUND:Atopic dermatitis (AD) can significantly compromise the quality of life (QoL). The aim of our investigation was to evaluate whether QoL correlates with AD severity, evaluated through the physician and the patient perspective, in a sample of Italian children. METHODS:Forty children with AD were evaluated. Disease severity was assessed by the physician and the patients (or their parents) using the SCORAD and the patient-oriented SCORAD (PO-SCORAD) tools, respectively. Patients or their parents completed specific QoL questionnaires (IDQOL/CDLQI). Spearman's correlation coefficient and non-parametric analysis of covariance were used to analyze the data. RESULTS:SCORAD e PO-SCORAD were moderately but significantly correlated (ρ Spearman=0.55, P<0.01). QoL scores ranged from 1 to 23, with a median score of 4.0 (higher scores represent more impaired QoL). After adjustment for age and sex, children with SCORAD>40 had significantly higher QoL scores (more impaired QoL) than those with SCORAD≤40 (median QoL of 5 and 4, respectively, P=0.048). Even higher differences emerged when AD severity was self-assessed (median QoL of 6 and 3.5 for children with PO-SCORAD>40 and PO-SCORAD≤40, respectively, P=0.01). AD children with concomitant food allergy had a significantly more impaired QoL than those with AD only (P=0.040). No significant difference in QoL was observed according to sex or age. CONCLUSIONS:In our sample of AD children, QoL appeared slightly-moderately altered, and increasing disease severity was associated with greater impairment in QoL. SCORAD and PO-SCORAD were fairly correlated and the association of QoL was somewhat stronger with the PO-SCORAD than the SCORAD Index. This supports the usefulness of PO-SCORAD for the self-assessment of AD in children, and suggests the importance to integrate physician and patient perspectives in the management of AD.

BACKGROUND:Vitamin D (vitD) is involved in important regulatory functions of the innate and adaptive immune system. So, it has been hypothesized that vitD might influence the course of atopic dermatitis (AD). Also obesity may have impact on immune system. The aim of our study was to investigate vitamin D status and body mass index (BMI) in urban children with AD.METHODS:52 children with AD and 43 healthy children were enrolled. SCORAD, BMI and serum vitD levels were evaluated.RESULTS:There was an association between vitamin D and the AD occurrence but neither between vitamin D and the AD severity, nor between vitamin D and BMI. A positive correlation was observed between BMI and the AD severity in males.CONCLUSIONS:This study highlights the complex inter-relationships among atopic dermatitis severity, vitamin D and body mass index and suggests the need to investigate the role of genetic factors and/or gender-related differences to possibly identify new prevention strategies.

Venous lakes of the lips (VLL) is a common vascular le-sion caused by a focal dilatation of venules, characterized clinically by soft, compressible, dark-blue to violaceous papules, which occurs most often on the lips of elderly patients. A single layer of flattened endothelial cells and a thick wall of fibrous tissue are observed upon histolo-gical examination (1). VLL persists throughout life. The clinical course of VLL is uncomplicated, apart from occasional associated haemorrhagic and cosmetic problems. Most reports have focused on surgical treatment (2–6), and there are no large published studies on the prevalence of VLL and possible associated factors. The aim of this report is to determine the prevalence of VLL in a general dermatological population and the possible presence of associated factors or risk factors. MATERIALS AND METHODS All adult patients (> 18 years of age) affected by VLL who were examined in the specialized outpatient clinic of our dermatology department from September 2011 to June 2012 were included in the study. Data were collected on age and sex, site and number of VLL. Clinical data included: skin type (according to Fitzpatrick classification), past and present sun-exposure (classified as: outdoor workers; patients having lived in sunny countries for > 6 months; patients seeking suntan; occasional sun-exposed activities; patients having always avoided sun-exposure), the presence of > 20 seborrhoeic keratoses, actinic keratoses, angi-omas, common or atypical naevi, past sunburns at a juvenile or adult age, relevant diseases, past or present known tumours, concomitant therapies, immunosuppressive therapies, or organ grafts. Prevalence was calculated as the percentage of patients with VLL out of all patients observed in the same period at the same outpatient clinic. In order to compare the studied parameters , a case-control study with sex-and age-matched patients without VLL was performed. Control cases were patients admitted to the same outpatient clinic for general dermatological consultation. The patients affected by VLL were referred to our department for general dermatological problems, not for VLL. Student's test was used to compare differences in prevalence of VLL between age groups. χ² test was used to compare percentages differences of the considered parameters. A threshold of 5% was considered statistically significant. RESULTS A total of 1,408 patients were recorded. Of these, 52 (31 men, 21 women, sex ratio M:F = 1.48:1) presented VLL; a prevalence of 3.7%. The mean age of the general study population including VLL patients was 52.6 years, the mean …

A 6-month-old female baby had, for 2 months, multiple whitish papules of 1–3 mm of diameter, on the dorsal aspect of the hands, and in a less number on the feet and knees (Fig. 1). Blood examination including phosphoremia and parathormone were within normal limits. Echocardiography and computed tomography of the central nervous system were normal. Multiple whitish papules on the dorsal aspect of the hands A papule on the knee was surgically removed. The histological examination showed in the reticular dermis a nodular formation, filled by basophilic material, surrounded by a thin wall of collagen fibers without perilesional infiltrate. A special stain with Von Kossa for the basophilic material showed the presence of calcium inside the nodular lesion (Fig. 2). A diagnosis of milia-like idiopathic calcinosis cutis (MICC) was made. Von Kossa special stain positive reaction for calcium material (×10) At a 2-month follow-up, new lesions were not observed and some lesions healed spontaneously. MICC is considered a nonsyndromic calcinosis.1 Almost all of the described cases in the literature are associated with Down syndrome affecting young patients between 6 and 13 years of age.2 The clinical history reveals a manifestation of multiple whitish papules, ranging from 1 to 4 mm in diameter, mainly localized on the upper and lower limbs and rarely on the face.3 The histologic pattern of these lesions could be represented by a pseudocystic structure full of calcium, with a moderate to absent flogistic reaction. It is also reported as a transepidermal elimination of calcium deposits.4 These histological features could be considered for differentiating other diseases with skin calcium deposition like post-traumatic calcinosis, secondary form after the use of paste for electroencephalography, or for the exclusion of the idiopathic calcinosis of the scrotum of the adult which are associated, histologically, with an intense granulomatous to foreign body reaction.5 The pathogenesis is still unknown. In subjects affected by Down syndrome, there is a higher risk of calcification of the cardiac valves and of cerebral tissue, probably due to an increased synthesis of calcium by the fibroblasts.6 Other hypotheses include that MICC may be an abnormal increased calcium deposition inside the sudoral duct7 or the result of the calcification of pre-existing epithelial cysts.8 In the literature, reports of MICC not associated with Down syndrome are rare. To date, only six cases have been reported.3,9,10 In three cases, only a single lesion of which two had a post-traumatic origin is described. Eng, in his report, described two cases in which the first patient had hundreds of papules in the perigenital area.10 This latter clinical feature is also compatible with the diagnosis of adult scrotal calcinosis, just considering the histological pattern showed. The idiopathic origin seems to be more identifiable in a child described by Bécuwe, showing multiple skin lesions on the limbs and the face.3 To our knowledge, this is the youngest patient affected by MICC not associated with Down syndrome, suggesting that the real idiopathic form of MICC is extremely rare.

Background: A total of 620 healthy term neonates, randomly selected among babies born at the San Paolo Hospital in Milan (Italy), were examined to study the relationship between birthmarks and transient cutaneous lesions in newborns of different ethnic groups. Methods: Information on sociodemographic factors and on physiopathological variables of the pregnancy was collected. Multiple logistic analyses were performed to assess associations between diagnosed skin lesions and various factors. Odds ratios (OR) as a measure of association and the corresponding 95% confidence intervals were estimated. Results: A positive association was found between reduced hypoderm and pregnancy illness (OR = 2.78), hypertrophy genitalia and use of drugs (OR = 1.86) and illnesses in pregnancy (OR = 1.61). Hyperpigmentation in the genital area and Mongolian spot showed significant positive association with geographical area of origin, being systematically more frequent in non-European neonates, while for melanocytic congenital nevi a positive association was observed only for Asiatic newborns (OR = 4.67); salmon patch on the nape showed a significant OR of 1.81 among mothers aged ≧35. Conclusions: Significant associations between some sociodemographic factors and cutaneous lesions of the newborn and anamnestic data related to the pregnancy were found. Dermatologic conditions are common in the newborns and may justify dermatologic examination.

Este estudo investiga a influencia de um programa de psicomotricidade baseado nos preceitos da formacao pessoal, propostos por Negrine (1998), nas relacoes interpessoais do idoso, na faixa etaria dos 68 aos 78 anos. A abordagem qualitativa foi utilizada com um delineamento do tipo descritivo-exploratorio. Para a coleta das informacoes, foi utilizada a observacao, apoiando-se no recurso do parecer descritivo como um metodo para o registro dos dados, sendo este da forma mais descritiva possivel, sem juizos de valor. As informacoes coletadas respondem aos objetivos especificos da pesquisa, que sao: descrever, analisar e interpretar os sentimentos provocados pela interacao social do idoso; descrever, analisar e interpretar a descoberta corporal do idoso, como um corpo situado no tempo e no espaco; descrever, analisar e interpretar o conhecimento de si, a auto-reflexao acerca do envelhecimento. A analise qualitativa dos resultados evidencia que um programa de psicomotricidade baseado nos preceitos da formacao pessoal propicia melhorias nas relacoes interpessoais do idoso, mostrando-se um instrumento valioso para a satisfacao do idoso nas suas necessidades; proporciona novos referenciais sociais ao grupo participante, pelo oferecimento de oportunidades de trabalho em cooperacao, propiciando diversidade de experiencias que promoveram a aceitacao e a integracao de todos.

We report a case of a 3-month-old female baby showing clinical and hematological signs compatible with Kawasaki disease. A few days after the beginning of the specific therapy, the young patient developed asymptomatic erythematous plaques appearing on the trunk. The histology disclosed a psoriasic pattern. To the best of our knowledge, we describe the youngest baby in the published work developing a psoriasis during the course of Kawasaki disease.

Erythema toxic neonatorum (ETN) is a common, self-limiting condition of term infants, appearing particularly within the first 48 hours of life. ETN has a worldwide distribution, with a frequency variable from 19% to 72%. Erythematous macules, wheals, papules and pustules in varying combination occur, with crops of lesions waxing and waning and spontaneous resolution within hours to days. It's important the differential diagnosis from other pustular neonatal conditions, some of which are severe. The etiology of ETN remains unknown. Recent studies reveal an activation of immune cells in the lesions of ETN and a high presence of peptide antibiotics, suggesting that ETN is an inflammatory skin reaction to the microbial colonization at birth.

Sir, In the past few years several reports of pathologies due to misuse of temazepam, both intravenous and intra-arterial, have been published (1 ^ 3). We describe here a case of skin necrosis caused by intravenous injection of 30 ml £unitrazepam (Darkene, Bayropharm, drops 0.2%), a drug devoid of the well-known euphoriant e¡ect of temazepam. A 35-year-old man was admitted to our ¢rst aid department for an ulcerous, painless lesion that was located on the anthero-lateral aspect of his right leg. The lesion, which was 3.5 cm in diameter, had developed about 10 days earlier. The borders appeared slightly erythematous with a discharge which was not frankly purulent, surrounding a necrotic central mass (Fig. 1). Several cicatricial lesions of 1 ^ 3 cm diameter were observed around the ulcerous area. Numerous other scars were scattered on his legs and thighs. The superior limbs were not marked. Furthermore, a perimalleolar bilateral swelling was evident. Popliteal, posterior tibial and foot-dorsal pulses were palpable. The patient, a drug addict, often overindulged in benzodiazepines. He did not take any other drugs. He worked as a barman and was searching for a vein on an unexposed area, which explains the absence of lesions on his upper limbs. He claimed he often could not ¢nd the vein and the drug over£owed into surrounding tissues. He was HIV-positive and HCV-positive; laboratory tests showed thrombocytopenia and lymphopenia without a CD4/CD8 inverted ratio. His CPK serum level was normal and urinary myoglobin was absent. A lesional cutaneous swab tested positive for Staphylococcus aureus. The lesion healed over after some weeks, following simple cleansing and topical antibiotic therapy. This case, though mild, is similar to those due to misuse of temazepam intravenous injection previously described by Blair et al. (4). In these reports the extent of cutaneous necrosis was wider and muscular involvement was constant. The pathogenetic hypothesis was based on thrombosis related both to temazepam and hyperviscosity of gel formulation. Other e¡ects due to abuse of intravenous and intra-arterial temazepam are well documented (1 ^ 3), i.e. death from pulmonary microembolization and rhabdomyolisis, and partial or complete amputation of the limbs. In the case described here an ischaemia of the dermic microvasculature with subsequent bacterial superinfection is thought to be the most likely pathogenetic mechanism. No complications related to misuse of temazepam have previously been described in Italy. Flunitrazepam is sold on unrepeatable prescription, its cost is low and it is strongly desired by drug abusers. Doctors thus try to avoid prescribing £unitrazepam because they are aware of the illegal market for this drug.