Purpose of the article: Baricitinib, a JAK 1/2 inhibitor, is approved for treating severe alopecia areata (AA). This study aimed to evaluate the long-term effectiveness and safety of baricitinib in a real-world setting over 52 weeks.Materials and methods: This multicenter retrospective study included 96 adult patients diagnosed with severe AA from 11 Italian Dermatology Units. All patients received 4 mg of baricitinib daily. Effectiveness was assessed using the Severity of Alopecia Tool (SALT) score, with the primary endpoint defined as achieving a SALT score <= 20 at week 52. Secondary endpoints included achieving a Clinician-Reported Outcome (ClinRO) score of 0 or 1 for eyebrow (ClinRO EB) and eyelash hair loss (ClinRO EL), with a >= 2-point improvement from baseline.Results: After 52 weeks, 61.5% of patients achieved a SALT score <= 20. Additionally, 67.6% and 69.7% of patients attained ClinRO EB and ClinRO EL scores of 0 or 1, respectively, with a >= 2-point improvement. No significant adverse safety events were reported during the study.Conclusions: The study confirms the long-term effectiveness and safety of baricitinib for severe AA in a real-world setting. These findings align with clinical trial results and reinforce baricitinib's role as a viable treatment option for severe AA.

Cutaneous larva migrans (CLM) is a zoonotic disease endemic in tropical regions. CLM diagnosis mainly relies on the morphology of the skin lesions, however dermoscopy can improve diagnostic accuracy. In this paper, we report two cases of CLM to highlight the importance of dermoscopic follow-up in early identification of treatment failure, as well as the effectiveness of topical ivermectin as a combined medication.

Actinic keratoses (AKs) are common skin lesions found on sun-exposed areas and are considered potential precursors to squamous cell carcinomas (SCCs). This observational case-control study evaluates the efficacy of combining traditional daylight photodynamic therapy (DL-PDT) with pre-treatment using 0.005% calcipotriol (CAL) ointment. Twenty immunocompetent male patients with grade I-II AKs on the scalp and/or face were randomized into two groups: the case group received a 14-day pretreatment with CAL ointment before DL-PDT, while the control group used a moisturizing cream. Both groups underwent a series of three DL-PDT sessions. The study utilized the Actinic Keratosis Area Severity Index (AKASI) scoring system to measure the actinic damage at baseline, 3 months, and 6 months post-treatment. Results showed a significant reduction in AKASI scores in the CAL group compared to controls, indicating that CAL pretreatment enhances the efficacy of DL-PDT. This combination treatment was well tolerated, with minimal discomfort reported. The findings suggest that incorporating CAL into the treatment regimen can improve the clearance of AKs and potentially prevent their progression to SCCs.

INTRODUCTION:Over the few last decades, dermoscopy has become an invaluable and popular imaging technique that complements the diagnostic armamentarium of dermatologists, being employed for both tumors and inflammatory diseases. Whereas distinction between neoplastic and inflammatory lesions is often straightforward based on clinical data, there are some scenarios that may be troublesome, e.g., solitary inflammatory lesions or tumors superimposed to a widespread inflammatory condition that may share macroscopic morphological findings.EVIDENCE ACQUISITION:We reviewed the literature to identify dermoscopic clues to support the differential diagnosis of clinically similar inflammatory and neoplastic skin lesions, also providing the histological background of such dermoscopic points of differentiation.EVIDENCE SYNTHESIS:Dermoscopic differentiating features were identified for 12 relatively common challenging scenarios, including Bowen's disease and basal cell carcinoma vs. psoriasis and dermatitis, erythroplasia of Queyrat vs. inflammatory balanitis, mammary and extramammary Paget's disease vs. inflammatory mimickers, actinic keratoses vs. discoid lupus erythematosus, squamous cell carcinoma vs. hypertrophic lichen planus and lichen simplex chronicus, actinic cheilitis vs. inflammatory cheilitis, keratoacanthomas vs. prurigo nodularis, nodular lymphomas vs. pseudolymphomas and inflammatory mimickers, mycosis fungoides vs. parapsoriasis and inflammatory mimickers, angiosarcoma vs granuloma faciale, and Kaposi sarcoma vs pseudo-Kaposi.CONCLUSIONS:Dermoscopy may be of aid in differentiating clinically similar inflammatory and neoplastic skin lesions.

JDDG: Journal der Deutschen Dermatologischen GesellschaftVolume 22, Issue 5 p. 707-709 CLINICAL LETTER Omalizumab bei isoliertem idiopathischem Angioödem: Ein Fallbericht und kurze Literaturübersicht Omalizumab for isolated idiopathic angioedema: A case report and short literature review Enrico Zelin, Corresponding Author Enrico Zelin [email protected] orcid.org/0000-0001-9276-3627 Dermatology Clinic, Maggiore Hospital, University of Trieste, Trieste, Italy Korrespondenzanschrift Enrico Zelin, MD, Dermatology Clinic, Maggiore Hospital, Piazza dell'Ospitale 1, 34129, Trieste, Italy. Email: [email protected]Search for more papers by this authorVanessa Mazzoletti, Vanessa Mazzoletti Department of Health Sciences, University of Eastern Piedmont, Novara, ItalySearch for more papers by this authorGiulia Bazzacco, Giulia Bazzacco Dermatology Clinic, Maggiore Hospital, University of Trieste, Trieste, ItalySearch for more papers by this authorLudovica Toffoli, Ludovica Toffoli Dermatology Clinic, Maggiore Hospital, University of Trieste, Trieste, ItalySearch for more papers by this authorClaudio Conforti, Claudio Conforti Dermatology Clinic, Maggiore Hospital, University of Trieste, Trieste, ItalySearch for more papers by this authorNicola Di Meo, Nicola Di Meo Dermatology Clinic, Maggiore Hospital, University of Trieste, Trieste, ItalySearch for more papers by this authorIris Zalaudek, Iris Zalaudek Dermatology Clinic, Maggiore Hospital, University of Trieste, Trieste, ItalySearch for more papers by this author Enrico Zelin, Corresponding Author Enrico Zelin [email protected] orcid.org/0000-0001-9276-3627 Dermatology Clinic, Maggiore Hospital, University of Trieste, Trieste, Italy Korrespondenzanschrift Enrico Zelin, MD, Dermatology Clinic, Maggiore Hospital, Piazza dell'Ospitale 1, 34129, Trieste, Italy. Email: [email protected]Search for more papers by this authorVanessa Mazzoletti, Vanessa Mazzoletti Department of Health Sciences, University of Eastern Piedmont, Novara, ItalySearch for more papers by this authorGiulia Bazzacco, Giulia Bazzacco Dermatology Clinic, Maggiore Hospital, University of Trieste, Trieste, ItalySearch for more papers by this authorLudovica Toffoli, Ludovica Toffoli Dermatology Clinic, Maggiore Hospital, University of Trieste, Trieste, ItalySearch for more papers by this authorClaudio Conforti, Claudio Conforti Dermatology Clinic, Maggiore Hospital, University of Trieste, Trieste, ItalySearch for more papers by this authorNicola Di Meo, Nicola Di Meo Dermatology Clinic, Maggiore Hospital, University of Trieste, Trieste, ItalySearch for more papers by this authorIris Zalaudek, Iris Zalaudek Dermatology Clinic, Maggiore Hospital, University of Trieste, Trieste, ItalySearch for more papers by this author First published: 10 May 2024 https://doi.org/10.1111/ddg.15359_gRead the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onEmailFacebookTwitterLinkedInRedditWechat No abstract is available for this article. LITERATUR 1Belbézier A, Bocquet A, Bouillet L. Idiopathic Angioedema: Current Challenges. J Asthma Allergy. 2020; 13: 137-144. 10.2147/JAA.S205709 CASPubMedWeb of Science®Google Scholar 2Brunetta E, Shiffer D, Folci M, et al. Omalizumab for idiopathic nonhistaminergic angioedema: evidence for efficacy in 2 patients. Case Reports Immunol. 2018; 2018: 1-3. 10.1155/2018/8067610 Google Scholar 3Weller K, Groffik A, Magerl M, et al. Development and construct validation of the angioedema quality of life questionnaire. Allergy. 2012; 67(10): 1289-1298. 10.1111/all.12007 CASPubMedWeb of Science®Google Scholar 4Goswamy V, Lee K, McKernan E, et al. A phase IV, Randomized, double-blind, placebo-controlled exploratory study of omalizumab for treatment of idiopathic angioedema in patients who remain symptomatic despite current therapy. J Allergy Clin Immunol. 2022; 149(2):AB166. 10.1016/j.jaci.2021.12.552 Web of Science®Google Scholar 5Bucher MC, Petkovic T, Helbling A, Steiner UC. Idiopathic non-histaminergic acquired angioedema: a case series and discussion of published clinical trials. Clin Transl Allergy. 2017; 7(1): 27. 10.1186/s13601-017-0164-9 PubMedWeb of Science®Google Scholar 6Muñoz JP, Casado AF, Taboada AC, et al. Successful treatment of refractory idiopathic angio-oedema with omalizumab: review of the literature and function of IgE in angio-oedema. Clin Exp Dermatol. 2016; 41(4): 399-402. 10.1111/ced.12779 PubMedWeb of Science®Google Scholar 7Faisant C, Du Thanh A, Mansard C, et al. Idiopathic Non-histaminergic Angioedema: Successful Treatment with Omalizumab in Five Patients. J Clin Immunol. 2017; 37(1): 80-84. 10.1007/s10875-016-0345-7 PubMedWeb of Science®Google Scholar 8Kutlu A, Karabacak E, Aydin E, et al. Efficacy of omalizumab in a patient with angioedema clinically resembling a hereditary angioedema. Ann Dermatol. 2016; 28(3): 381-382. 10.5021/ad.2016.28.3.381 PubMedWeb of Science®Google Scholar 9Azofra J, Díaz C, Antépara I, et al. Positive response to omalizumab in patients with acquired idiopathic nonhistaminergic angioedema. Ann Allergy, Asthma Immunol. 2015; 114(5): 418-419.e1. 10.1016/j.anai.2015.02.007 CASPubMedWeb of Science®Google Scholar 10Ozturk AB, Kocaturk E. Omalizumab in recurring larynx angioedema: a case report. Asia Pac Allergy. 2014; 4(2): 129. 10.5415/apallergy.2014.4.2.129 PubMedGoogle Scholar 11Von Websky A, Reich K, Steinkraus V, Breuer K. Complete remission of severe chronic recurrent angioedema of unknown cause with omalizumab. J Dtsch Dermatol Ges. 2013 Jul; 11(7): 677-678. 10.1111/ddg.12075 PubMedWeb of Science®Google Scholar 12Suna B, Asli G, Ferhan O, et al. Successful treatment of chronic idiopathic angioedema with omalizumab. Allergy. 2010; 65(Suppl 92[Congress abstract]): 459. PubMedGoogle Scholar 13Sands MF, Blume JW, Schwartz SA. Successful treatment of 3 patients with recurrent idiopathic angioedema with omalizumab. J Allergy Clin Immunol. 2007; 120(4): 979-981. 10.1016/j.jaci.2007.07.041 CASPubMedWeb of Science®Google Scholar Volume22, Issue5May 2024Pages 707-709 ReferencesRelatedInformation

Riehl’s melanosis (RM) is a pigmentary disorder, more common in individuals with dark skin phototypes, considered a form of pigmented contact dermatitis. In this paper we present a case of RM due to the rubber component of a work facial mask in which dermoscopy and patch test were the most important tools to help physicians in diagnosis. In addition, we reviewed the main dermoscopic clues that may be useful in differential diagnosis with others facial pigmentary disorders.

BACKGROUND:Alopecia areata (AA) is an organ-specific autoimmune disease that affects the hair follicles of the scalp and the rest of the body causing hair loss. Due to the unpredictable course of AA and the different degrees of severity of hair loss, only a few well-designed clinical studies with a low number of patients are available. Also, there is no specific cure, but topical and systemic anti-inflammatory and immune system suppressant drugs are used for treatment. The need to create a global registry of AA, comparable and reproducible in all countries, has recently emerged. An Italian multicentric electronic registry is proposed as a model to facilitate and guide the recording of epidemiological and clinical data and to monitor the introduction of new therapies in patients with AA.METHODS:The aim of this study was to evaluate the epidemiological data of patients with AA by collecting detailed information on the course of the disease, associated diseases, concomitant and previous events, and the clinical response to traditional treatments. Estimate the impact on the quality of life of patients.RESULTS:The creation of the National Register of AA has proven to be a valid tool for recording, with a standardized approach, epidemiological data, the trend of AA, response to therapies and quality of life.CONCLUSIONS:AA is confirmed as a difficult hair disease to manage due to its unpredictable course and, in most cases, its chronic-relapsing course, capable of having a significant impact on the quality of life of patients.

BACKGROUND:Some people may compulsively desire to suntan despite the negative consequences, exhibiting symptoms similar to addictive disorders. Tanning dependence (TD) should be considered a risk factor leading to excessive sunbathing and thus increasing the risk of skin cancers. The aim of the present study was to investigate the tanning habits of the inhabitants of Trieste, a Northeastern Italian town characterized by high melanoma incidence. Predictors of tanning addiction were searched. The area of Trieste ranks second in Italy (after Turin) for melanoma incidence with standardized incidence rates very high in both sexes. METHODS:This study was based on an anonymous online survey of 520 randomly recruited adults who reported living in Trieste. TD was assessed using the mCAGE (modified Cut down, Annoyed, Guilty, Eye-opener) and the mDSM-IV-TR (modified Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision) questionnaires. Participants were classified as TD if positive on both questionnaires. RESULTS:Seventy-eight (15%) individuals were classified as TDs. The analyses compared TDs (N.=78, 15%) with non-TDs (N.=285, 55%) on various characteristics and behaviors. Females were significantly more represented in the TD group than males (P=0.03). Contrarily, TD did not vary with respect to age and Fitzpatrick skin type. High-risk tanning behaviors, including sun exposure in the middle hours of the day, long tanning sessions (more than 3 hours), and the use of sunbeds, were significantly related to TD. CONCLUSIONS:Our results show that TD can be predicted by tanning behaviors. Increased knowledge of TD will help design appropriate interventions for different risk subgroups.

JDDG: Journal der Deutschen Dermatologischen GesellschaftEarly View CLINICAL LETTER Omalizumab for isolated idiopathic angioedema: A case report and short literature review Enrico Zelin, Corresponding Author Enrico Zelin [email protected] orcid.org/0000-0001-9276-3627 Dermatology Clinic, Maggiore Hospital, University of Trieste, Trieste, Italy Correspondence Enrico Zelin, MD, Dermatology Clinic, Maggiore Hospital, Piazza dell'Ospitale 1, 34129, Trieste, Italy. Email: [email protected]Search for more papers by this authorVanessa Mazzoletti, Vanessa Mazzoletti Department of Health Sciences, University of Eastern Piedmont, Novara, ItalySearch for more papers by this authorGiulia Bazzacco, Giulia Bazzacco Dermatology Clinic, Maggiore Hospital, University of Trieste, Trieste, ItalySearch for more papers by this authorLudovica Toffoli, Ludovica Toffoli Dermatology Clinic, Maggiore Hospital, University of Trieste, Trieste, ItalySearch for more papers by this authorClaudio Conforti, Claudio Conforti Dermatology Clinic, Maggiore Hospital, University of Trieste, Trieste, ItalySearch for more papers by this authorNicola Di Meo, Nicola Di Meo Dermatology Clinic, Maggiore Hospital, University of Trieste, Trieste, ItalySearch for more papers by this authorIris Zalaudek, Iris Zalaudek Dermatology Clinic, Maggiore Hospital, University of Trieste, Trieste, ItalySearch for more papers by this author Enrico Zelin, Corresponding Author Enrico Zelin [email protected] orcid.org/0000-0001-9276-3627 Dermatology Clinic, Maggiore Hospital, University of Trieste, Trieste, Italy Correspondence Enrico Zelin, MD, Dermatology Clinic, Maggiore Hospital, Piazza dell'Ospitale 1, 34129, Trieste, Italy. Email: [email protected]Search for more papers by this authorVanessa Mazzoletti, Vanessa Mazzoletti Department of Health Sciences, University of Eastern Piedmont, Novara, ItalySearch for more papers by this authorGiulia Bazzacco, Giulia Bazzacco Dermatology Clinic, Maggiore Hospital, University of Trieste, Trieste, ItalySearch for more papers by this authorLudovica Toffoli, Ludovica Toffoli Dermatology Clinic, Maggiore Hospital, University of Trieste, Trieste, ItalySearch for more papers by this authorClaudio Conforti, Claudio Conforti Dermatology Clinic, Maggiore Hospital, University of Trieste, Trieste, ItalySearch for more papers by this authorNicola Di Meo, Nicola Di Meo Dermatology Clinic, Maggiore Hospital, University of Trieste, Trieste, ItalySearch for more papers by this authorIris Zalaudek, Iris Zalaudek Dermatology Clinic, Maggiore Hospital, University of Trieste, Trieste, ItalySearch for more papers by this author First published: 09 April 2024 https://doi.org/10.1111/ddg.15359Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onEmailFacebookTwitterLinkedInRedditWechat No abstract is available for this article. REFERENCES 1Belbézier A, Bocquet A, Bouillet L. Idiopathic Angioedema: Current Challenges. J Asthma Allergy. 2020; 13: 137-144. 10.2147/JAA.S205709 CASPubMedGoogle Scholar 2Brunetta E, Shiffer D, Folci M, et al. Omalizumab for idiopathic nonhistaminergic angioedema: evidence for efficacy in 2 patients. Case Reports Immunol. 2018; 2018: 1-3. 10.1155/2018/8067610 Google Scholar 3Weller K, Groffik A, Magerl M, et al. Development and construct validation of the angioedema quality of life questionnaire. Allergy. 2012; 67(10): 1289-1298. 10.1111/all.12007 CASPubMedWeb of Science®Google Scholar 4Goswamy V, Lee K, McKernan E, et al. A phase IV, Randomized, double-blind, placebo-controlled exploratory study of omalizumab for treatment of idiopathic angioedema in patients who remain symptomatic despite current therapy. J Allergy Clin Immunol. 2022; 149(2):AB166. 10.1016/j.jaci.2021.12.552 Google Scholar 5Bucher MC, Petkovic T, Helbling A, Steiner UC. Idiopathic non-histaminergic acquired angioedema: a case series and discussion of published clinical trials. Clin Transl Allergy. 2017; 7(1): 27. 10.1186/s13601-017-0164-9 PubMedWeb of Science®Google Scholar 6Muñoz JP, Casado AF, Taboada AC, et al. Successful treatment of refractory idiopathic angio-oedema with omalizumab: review of the literature and function of IgE in angio-oedema. Clin Exp Dermatol. 2016; 41(4): 399-402. 10.1111/ced.12779 PubMedGoogle Scholar 7Faisant C, Du Thanh A, Mansard C, et al. Idiopathic Non-histaminergic Angioedema: Successful Treatment with Omalizumab in Five Patients. J Clin Immunol. 2017; 37(1): 80-84. 10.1007/s10875-016-0345-7 PubMedGoogle Scholar 8Kutlu A, Karabacak E, Aydin E, et al. Efficacy of omalizumab in a patient with angioedema clinically resembling a hereditary angioedema. Ann Dermatol. 2016; 28(3): 381-382. 10.5021/ad.2016.28.3.381 PubMedGoogle Scholar 9Azofra J, Díaz C, Antépara I, et al. Positive response to omalizumab in patients with acquired idiopathic nonhistaminergic angioedema. Ann Allergy, Asthma Immunol. 2015; 114(5): 418-419. e1. 10.1016/j.anai.2015.02.007 CASPubMedWeb of Science®Google Scholar 10Ozturk AB, Kocaturk E. Omalizumab in recurring larynx angioedema: a case report. Asia Pac Allergy. 2014; 4(2): 129. 10.5415/apallergy.2014.4.2.129 PubMedGoogle Scholar 11Von Websky A, Reich K, Steinkraus V, Breuer K. Complete remission of severe chronic recurrent angioedema of unknown cause with omalizumab. J Dtsch Dermatol Ges. 2013 Jul; 11(7): 677-678. 10.1111/ddg.12075 PubMedGoogle Scholar 12Suna B, Asli G, Ferhan O, et al. Successful treatment of chronic idiopathic angioedema with omalizumab. Allergy. 2010; 65(Suppl 92[Congress abstract]): 459. PubMedGoogle Scholar 13Sands MF, Blume JW, Schwartz SA. Successful treatment of 3 patients with recurrent idiopathic angioedema with omalizumab. J Allergy Clin Immunol. 2007; 120(4): 979-981. 10.1016/j.jaci.2007.07.041 CASPubMedGoogle Scholar Early ViewOnline Version of Record before inclusion in an issue ReferencesRelatedInformation

Journal of the European Academy of Dermatology and VenereologyVolume 37, Issue 4 p. e547-e549 LETTER TO THE EDITOR Dichotomic response patterns to PD-1 blockade with cemiplimab in a patient with multiple squamous cell carcinomas Giulia Bazzacco, Corresponding Author Giulia Bazzacco [email protected] orcid.org/0000-0001-8135-7025 Skin Cancer Unit, Department of Dermatology, University Hospital of Trieste, Trieste, Italy Correspondence Giulia Bazzacco, Dermatology Clinic, Hospital Maggiore, Piazza dell'Ospitale 1, 34129, Trieste, Italy. Email: [email protected]Search for more papers by this authorEnrico Zelin, Enrico Zelin orcid.org/0000-0001-9276-3627 Skin Cancer Unit, Department of Dermatology, University Hospital of Trieste, Trieste, ItalySearch for more papers by this authorLudovica Toffoli, Ludovica Toffoli orcid.org/0000-0003-3319-6604 Skin Cancer Unit, Department of Dermatology, University Hospital of Trieste, Trieste, ItalySearch for more papers by this authorClaudio Conforti, Claudio Conforti orcid.org/0000-0001-5126-8873 Skin Cancer Unit, Department of Dermatology, University Hospital of Trieste, Trieste, ItalySearch for more papers by this authorNicola di Meo, Nicola di Meo Skin Cancer Unit, Department of Dermatology, University Hospital of Trieste, Trieste, ItalySearch for more papers by this authorDahlia Fedele, Dahlia Fedele Skin Cancer Unit, Department of Medical Oncology, Maggiore Hospital of Trieste, Trieste, ItalySearch for more papers by this authorIris Zalaudek, Iris Zalaudek Skin Cancer Unit, Department of Dermatology, University Hospital of Trieste, Trieste, ItalySearch for more papers by this author Giulia Bazzacco, Corresponding Author Giulia Bazzacco [email protected] orcid.org/0000-0001-8135-7025 Skin Cancer Unit, Department of Dermatology, University Hospital of Trieste, Trieste, Italy Correspondence Giulia Bazzacco, Dermatology Clinic, Hospital Maggiore, Piazza dell'Ospitale 1, 34129, Trieste, Italy. Email: [email protected]Search for more papers by this authorEnrico Zelin, Enrico Zelin orcid.org/0000-0001-9276-3627 Skin Cancer Unit, Department of Dermatology, University Hospital of Trieste, Trieste, ItalySearch for more papers by this authorLudovica Toffoli, Ludovica Toffoli orcid.org/0000-0003-3319-6604 Skin Cancer Unit, Department of Dermatology, University Hospital of Trieste, Trieste, ItalySearch for more papers by this authorClaudio Conforti, Claudio Conforti orcid.org/0000-0001-5126-8873 Skin Cancer Unit, Department of Dermatology, University Hospital of Trieste, Trieste, ItalySearch for more papers by this authorNicola di Meo, Nicola di Meo Skin Cancer Unit, Department of Dermatology, University Hospital of Trieste, Trieste, ItalySearch for more papers by this authorDahlia Fedele, Dahlia Fedele Skin Cancer Unit, Department of Medical Oncology, Maggiore Hospital of Trieste, Trieste, ItalySearch for more papers by this authorIris Zalaudek, Iris Zalaudek Skin Cancer Unit, Department of Dermatology, University Hospital of Trieste, Trieste, ItalySearch for more papers by this author First published: 28 October 2022 https://doi.org/10.1111/jdv.18705Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article. Volume37, Issue4April 2023Pages e547-e549 RelatedInformation

Background: Pilomatrix carcinoma (PC) is a rare skin tumor arising from hair follicle matrix cells. It is locally aggressive with a high rate of local recurrence after surgical excision. Few cases in the literature have been described and the management is not well defined. Objectives: The aim of this study was to present two cases of PC located on the head and review the relevant literature about epidemiology, clinical and dermoscopic evaluation, characteristics of local and distant metastases, local recurrence rate and management of this rare skin tumor. Methods: We consulted databases from PubMed, Research Gate and Google Scholar, from January 2012 to November 2022. We reviewed the literature and reported two additional cases. Results: We selected 52 tumors in middle-aged to older patients located mostly on the head. Dermoscopy evaluation was rarely performed in the pre-operative diagnostic setting. The most definitive treatment was wide local excision, but local recurrences were common. In total, we observed 11 cases of recurrences and 9 patients with locoregional or distant metastases. Four patients received adjuvant radiotherapy, two patients needed chemotherapy and local cancer therapy and one patient received radiochemotherapy. Conclusion: Our reports and the review of the literature can provide a better awareness and management of this rare tumor.

Chersi, Filippo; Conforti, Claudio; Zalaudek, Iris; Bazzacco, Giulia; Zelin, Enrico; di Meo, Nicola Author Information

Primary extramammary Paget disease (EMPD) is a rare malignant tumour occurring in apocrine gland-bearing areas, such as the genitals (mean age at diagnosis 60–70 years).1 Clinically, EMPD exhibits well-circumscribed, erythematous and scaly patches or plaques often mimicking inflammatory skin disorders, but occasional pigmentary changes such as hypo- or hyperpigmentation are reported.1, 2 Histologically, Paget cells appear as atypical large round cells with prominent nuclei and abundant pale cytoplasm (usually containing mucin), located within the epidermis in a pagetoid pattern. Immunohistochemical staining is useful and, in general, primary EMPD is typically cytokeratin (CK) 7+ and CK20−.1 We report the case of a 63-year-old male patient who was referred to our clinic for an asymptomatic hypopigmented patch centred by a pinkish area in the right pubic region (Figure 1a). Dermoscopy showed a diffuse white structureless area (with leukotrichia) at the periphery; in the centre, a pinkish/yellowish area associated with branching white reticular lines and dotted vessels (lava-like areas) was objectified (Figure 1b). A biopsy was performed, and the histology revealed an infiltrating primary EMPD (immunohistochemistry: CK7+, CK20-) (Figure 1c,d). Also, the histological examination of an enlarged right inguinal lymph node showed the presence of tumoral cells (Figure 1e,f); therefore, a diagnosis of metastatic EMPD was made. After a multidisciplinary discussion, the patient was treated with wide surgical excision and systemic therapy (docetaxel + trastuzumab). An early diagnosis is extremely important for EMPD, because invasive forms lead to a high incidence of metastases and poor prognosis.1 Recently, new imaging techniques such as Line-field Confocal Optical Coherence Tomography (LC-OCT) have proved to facilitate a prompt diagnosis.3 Moreover, dermoscopy, a highly available technique, can be very useful and typically shows milky-red areas, vascular patterns (particularly dotted and glomerular vessels), surface scales and ulcers or erosions; less frequently, pigmented or white structures may also be observed.4 In addition, ‘lava-like’ structures and ‘cloud-like’ structureless areas have been recently described as new dermoscopic clues for diagnosing EMPD.4 Our paper focuses on an unusual clinical presentation of EMPD, that is the hypopigmented variant. According to the literature (Table 1), this feature can be found both in initial5-8 and advanced metastatic primary EMPD,9 and the prevalence of hypopigmentation in primary EMPD can vary from 30% (6/19 patients)10 to 67.7% (84/124 patients).2 When associated with the typical erythematous lesions of EMPD, hypopigmentation is usually located around the erythematous plaques.10 Furthermore, Choi et al. found an association between hypopigmentation and a worse outcome, being hypopigmented lesions related to a higher recurrence rate.2 75% M 25% F Penile shaft Scrotum Pubis Labia majora Perineum and anus Regarding the possible aetiopathogenesis of hypopigmentation in EMPD, several mechanisms have been proposed, including a tumour-induced dysfunctional melanocyte–keratinocyte interaction,5 physical replacement of basal keratinocytes or melanocytes by Paget cells6, 7 or decrease in melanocyte growth factors induced by the tumour microenvironment.11 In addition, according to Choi et al., depigmented EMPD may be a result of the recruitment of CD8+ T cells, which can destroy melanocytes leading to depigmentation, but have a poor tumour cytotoxic effect. This hypothesis could explain the reported association between hypopigmentation and development of an advanced disease, as in our case.2 In conclusion, our observations suggest that EMPD should be considered in the differential diagnosis of hypopigmented anogenital lesions. Furthermore, hypopigmentation can be associated with advanced EMPD, leading to a worse outcome, although this hypothesis requires further investigations. All authors have made substantial contribution to conception of the work and have approved the final version. None. The authors have no conflict of interest. The research conforms to the ethical standards described by the Declaration of Helsinki. The patient in this manuscript has given written informed consent to publication of their case details and clinical photographs.

Citation: Bazzacco G, Conforti C, Toffoli L, Zelin E, Zalaudek I, di Meo N. Dermoscopic Features of Herpes Zoster: Case Series and Review of the Literature. Dermatol Pract Concept. 2023;13(3):e2023149. DOI: https://doi.org/10.5826/dpc.1303a149

Citation: Bazzacco G, Zelin E, Maronese CA, et al. Rosette-like structure: a main dermoscopic feature in a small trichilemmal cyst. Dermatol Pract Concept. 2022;12(1):e2022021. DOI: https://doi.org/10.5826/dpc.1201a21

Nocardia is a genus of aerobic actinomycetes that are usually responsible for opportunistic infection in immunocompromised patients. Less frequently nocardiosis can interest immunocompetent population, causing especially primary cutaneous infections. Cutaneous involvement by Nocardia spp. may occur mostly as one of four clinical manifestations: superficial cellulitis or abscess, mycetoma, lymphocutaneous (also defined "sporotrichoid") infection and secondary cutaneous involvement from systemic disease. Infections usually present after minor local injury, especially in traumatic outdoor activities (e.g. gardeners, farmers, road accidents), with subsequent environmental contamination of the wound. In sporadic cases cutaneous infection follows an insect bite. Microbiological diagnosis is often difficult to obtain and N. brasiliensis is the species isolated in most cases (80%). We present the case of a 45-year-old female with fever and a painful and necrotizing lesion on her right leg with secondary ascending lesions occurred on the homolateral knee and consensual groin lymphadenopathy after insect sting (maybe a spider bite). Cultures on skin biopsy identified Nocardia brasiliensis. Infection was completely healed after 5 months of targeted antibiotic therapy. In addition, we performed a literature review of all cutaneous nocardiosis cases in immunocompetent individuals, finding that only in 22 cases the infection presented after insect bite; in most of these cases lymphocutaneous manifestation was seen and N. brasiliensis was the Nocardia species isolated. Our case, along with others in literature, reveals that the real burden of soft-tissues nocardiosis seems low but probably many cases might go undiagnosed because of difficulties in microbiology diagnosis. Primary cutaneous nocardiosis should be included in the diagnostic pathway in cases of cellulitis following insect bite or sting, especially when localized to extremities.