Jarisch-Herxheimer reaction (JHR) is an acute and self-limited condition, which commonly occurs after treatment for spirochetal infections. Probably, it corresponds to a transient immunological reaction to endotoxin-like products released from the microorganism during the therapy. For this reason, JHR may be associated with many other infectious diseases besides syphilis. Here, we report a case of a patient affected by extended cutaneous candidiasis diagnosed by culture examination; a JHR occurred after an accidental overdose of oral fluconazole.

Intralesional steroid injection is a common and highly effective treatment procedure, which can be successfully used for several dermatologic, rheumatologic, and orthopedic disorders. However, it may be associated with various local side effects, such as pain, granulomatous reaction, allergic reactions, hypo or hyperpigmentation and, uncommonly, skin atrophy. A peculiar and rare side effect of steroid injection is linear hypopigmentation and atrophy, which is probably an expression of lymphatic spread of corticosteroid crystals. Here, we report a case of linear hypopigmentation and atrophy in a 26-year-old male patient.

Cutaneous larva migrans (CLM; also called creeping eruption) is a cutaneous ectoparasitosis commonly observed in tropical countries. It is characterized by an erythematous, pruritic, and raised lesion with linear or serpiginous distribution, typically localized at the lower extremities. Oral ivermectin represents the most recommended current treatment, with important adverse effects associated. We report the clinical case of a 52-year old with CLM, successfully treated with topical ivermectin.

Erythema multiforme (EM) is an immune-mediated reaction characterized by target lesions and with possible mucosal involvement. Its most frequent cause is HSV, with HSV-1 more common than -2. It is usually self-limited but it can show recurrences. We report a peculiar case of recurrent herpes-associated erythema multiforme (HAEM) in a 35-year-old man. The patient was affected by both herpes labialis and genitalis, but the typical target lesions were only associated with recurrent herpes labialis. Here, we hypothesize about the pathogenic differences between HSV-1 and HSV-2, and discuss the therapeutic management of HAEM.

Journal of the European Academy of Dermatology and VenereologyVolume 33, Issue 2 p. e58-e59 Letter to the Editor The use of PRP (platelet-rich plasma) in patients affected by genital lichen sclerosus: clinical analysis and results M. Tedesco, M. Tedesco Department of Plastic and Reconstructive Surgery, San Gallicano Dermatologic Institute, IRCCS – IFO, Rome, ItalySearch for more papers by this authorG. Pranteda, Corresponding Author G. Pranteda cpranteda@libero.it orcid.org/0000-0003-1807-8829 Department of Plastic and Reconstructive Surgery, San Gallicano Dermatologic Institute, IRCCS – IFO, Rome, ItalyCorrespondence: G. Pranteda. E-mail: cpranteda@libero.itSearch for more papers by this authorG. Chichierchia, G. Chichierchia Musculo-Skeletal Tissue Bank, Lazio, Rome, Italy Immunohaematology and Transfusion Medicine, IRCCS Regina Elena National Cancer Institute, Rome, ItalySearch for more papers by this authorG. Paolino, G. Paolino Unit of Dermatology, San Raffaele Hospital, Milano, ItalySearch for more papers by this authorA. Latini, A. Latini Infective Dermatologic Department, San Gallicano Institute of Dermatology, IRCCS-IFO, Rome, ItalySearch for more papers by this authorD. Orsini, D. Orsini Infective Dermatologic Department, San Gallicano Institute of Dermatology, IRCCS-IFO, Rome, ItalySearch for more papers by this authorA. Cristaudo, A. Cristaudo Infective Dermatologic Department, San Gallicano Institute of Dermatology, IRCCS-IFO, Rome, ItalySearch for more papers by this authorM.L. Foddai, M.L. Foddai Immunohaematology and Transfusion Medicine, IRCCS Regina Elena National Cancer Institute, Rome, ItalySearch for more papers by this authorE. Migliano, E. Migliano Department of Plastic and Reconstructive Surgery, San Gallicano Dermatologic Institute, IRCCS – IFO, Rome, ItalySearch for more papers by this authorA. Morrone, A. Morrone San Gallicano Institute of Dermatology, IRCCS-IFO, Rome, ItalySearch for more papers by this author M. Tedesco, M. Tedesco Department of Plastic and Reconstructive Surgery, San Gallicano Dermatologic Institute, IRCCS – IFO, Rome, ItalySearch for more papers by this authorG. Pranteda, Corresponding Author G. Pranteda cpranteda@libero.it orcid.org/0000-0003-1807-8829 Department of Plastic and Reconstructive Surgery, San Gallicano Dermatologic Institute, IRCCS – IFO, Rome, ItalyCorrespondence: G. Pranteda. E-mail: cpranteda@libero.itSearch for more papers by this authorG. Chichierchia, G. Chichierchia Musculo-Skeletal Tissue Bank, Lazio, Rome, Italy Immunohaematology and Transfusion Medicine, IRCCS Regina Elena National Cancer Institute, Rome, ItalySearch for more papers by this authorG. Paolino, G. Paolino Unit of Dermatology, San Raffaele Hospital, Milano, ItalySearch for more papers by this authorA. Latini, A. Latini Infective Dermatologic Department, San Gallicano Institute of Dermatology, IRCCS-IFO, Rome, ItalySearch for more papers by this authorD. Orsini, D. Orsini Infective Dermatologic Department, San Gallicano Institute of Dermatology, IRCCS-IFO, Rome, ItalySearch for more papers by this authorA. Cristaudo, A. Cristaudo Infective Dermatologic Department, San Gallicano Institute of Dermatology, IRCCS-IFO, Rome, ItalySearch for more papers by this authorM.L. Foddai, M.L. Foddai Immunohaematology and Transfusion Medicine, IRCCS Regina Elena National Cancer Institute, Rome, ItalySearch for more papers by this authorE. Migliano, E. Migliano Department of Plastic and Reconstructive Surgery, San Gallicano Dermatologic Institute, IRCCS – IFO, Rome, ItalySearch for more papers by this authorA. Morrone, A. Morrone San Gallicano Institute of Dermatology, IRCCS-IFO, Rome, ItalySearch for more papers by this author First published: 27 July 2018 https://doi.org/10.1111/jdv.15190Citations: 13Read 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.Citing Literature Volume33, Issue2February 2019Pages e58-e59 RelatedInformation

Bromoderma is a rare skin disease caused by the ingestion, inhalation, or contact with products containing bromides. We report a case of bromoderma in a 36-year-old farmer, characterized by remission during the spring and exacerbation during the winter. The recognition of the use of products containing bromides during the winter helped us to understand the cause of the clinical condition.

Pseudomyogenic hemangioendothelioma (PMH) is a rare, mostly indolent, endothelial neoplasm of low-grade malignancy, often mimicking myoid and epithelioid tumors histologically. It is more frequent in young adult males and it usually presents with multiple cutaneous nodules, mostly localized at the extremities. It traverses several tissue planes simultaneously and can involve dermis, subcutis, skeletal muscle, and bone. Histologically, it is characterized by plump spindle cells with eosinophilic cytoplasm, often arranged in fascicles and epithelioid cells with "pseudomyogenic" morphology. Immunohistochemically, PMH is positive for Factor VIII, FLI-1, INI-1, vimentin, MDM2, CDK4, CD31, AE1/AE3, EMA, and P63. The efficacy of treatments is only partially known. Because of the frequent multifocal aspect of PMH, which contraindicates surgery, systemic treatments, such as gemcitabine, sirolimus, and everolimus are used. Based on our observation of multifocal PMH of the foot in a 17-year-old male patient, treated with gemcitabine with complete cutaneous response in a 2-year follow-up, we decided to discuss this rare tumor and underline its progression and therapeutic approaches. Thanks to a correct diagnosis, it is possible to avoid aggressive therapeutic approaches, which would be necessary for nonindolent diseases, such as sarcoma, which often needs amputation.

Hand eczema is a chronic disease (1), commonly considered the expression of a contact allergic or irritative dermatitis. However, when the prick/patch tests and laboratory investigations are negative, important diagnostic challenges may arise. Peripheral nerve fibers are in fact capable of releasing neuromediators. Thus, an alteration of the central and/or peripheral nervous system can cause the exacerbation as well as the onset of a cutaneous disease (2). From September 1, 2013 to August 31, 2015, we observed 5 female patients between 20 and 40 years old, with particular hand dermatitis lesions on the volar area, unilateral on the right hand in 3 patients and bilateral in 2 patients. In one case, the dermopathy extended to all the fingers, up to the area of the metacarpophalangeal joints, thenar, and hypothenar eminences. The skin appeared dry (Figure 1), anhidrotic, inelastic, thinned, scaly, and slightly erythematous (Figure 2). In some cases, the fingertips appeared sclerotic, while in other cases the transversal fissures on the flexural joints caused painful and incomplete finger flexion. The dorsal surface was unaffected and the nails healthy. Symptoms were paresthesia and burning sensation. All of the patients were in good general health, with negative routine laboratory investigations, IgE serum levels and prick/patch tests. One patient had just given childbirth three months before the onset of the disease. The patients had been suffering of their hand dermatitis for a duration ranging from 2 months and 2 years and had been treated unsuccessfully with topical and systemic drugs, mainly corticosteroids. We performed a cervical spine X-ray in different projections. In all patients, we observed a degenerative disease of the cervical spine with a reduction of intersomatic discs, primarily C5-C6 (Figure 3). This led us to establish a diagnosis of neurodystrophic hand dermatitis (NHD). Patients started specific treatment programs for the spinal disorder, intake of a vitamin B complex and repairing/soothing skin creams, with a partial improvement. NHD is rarely described in the literature; in 1964 Sannino et al. reported 89 female patients with skin alterations similar to the ones observed in our case series as well as negative patch/prick tests and laboratory investigations, and the main finding was the presence of a cervical spine disease between C5-C7 (3). Recently, Azimi et al. performed a review of skin diseases at sites affected by neurological deficits. They started to collect data from 1966, but did not mention cases attributable to NHD, which is an underestimated and misdiagnosed disorder (2). Cervical spine disease is a predisposing factor for the development of NHD. Additionally, thermoreceptors may be mainly involved, as also reported in brachio-radial pruritus (4-5), explaining the presence of burning sensation. However, in our opinion, NHD should not be classified as a "neurogenic inflammation". This term describes the vasodilation and protein extravasation caused by inflammatory neuropeptides and adrenergic transmitters that influence the antigen presentation, mast-cell degranulation, and cytokine release (2). In fact, corticosteroids and other immunosuppressors are ineffective. Specific treatments for cervical spine disease remain the treatment of choice, as does constant use of repairing/soothing skin creams. Antidepressants, physiotherapy, postural exercises, neuromodulators, and vitamin B complex may be also helpful.

BACKGROUND:Androgenetic alopecia (AGA) is a common form of scalp hair loss that affects up to 50% of males between 18 and 40 years old. Several molecules are commonly used for the treatment of AGA, acting on different steps of its pathogenesis (Minoxidil, Finasteride, Serenoa repens) and show some side effects. In literature, on the basis of hypertrichosis observed in patients treated with analogues of prostaglandin PGF2a, it was supposed that prostaglandins would have an important role in the hair growth: PGE and PGF2a play a positive role, while PGD2 a negative one.OBJECTIVE:We carried out a pilot study to evaluate the efficacy of topical cetirizine versus placebo in patients with AGA.PATIENTS AND METHODS:A sample of 85 patients was recruited, of which 67 were used to assess the effectiveness of the treatment with topical cetirizine, while 18 were control patients.RESULTS:We found that the main effect of cetirizine was an increase in total hair density, terminal hair density and diameter variation from T0 to T1, while the vellus hair density shows an evident decrease. The use of a molecule as cetirizine, with no notable side effects, makes possible a good compliance by patients.CONCLUSION:Our results have shown that topical cetirizine 1% is responsible for a significant improvement of the initial framework of AGA.

Correspondence Gemma Caro, Section of Dermatology, Department of Internal Medicine and Medical Specialties, University La Sapienza, Rome, Viale del Policlinico, 155 00161, Rome, Italy. Email: gemmacaro90@gmail.com Summary Background: Chemotherapy-induced alopecia (CIA) is probably one of the most shocking aspects for oncological patients and underestimated by physicians. Among hair loss risk factors, there are treatment-related aspects such as drug dose, administration regimen, and exposure to X-rays, but also patient-related characteristics. To the best of our knowledge, no guidelines are available about CIA management. Aims and methods: With this study, based on literature background and our clinical experience, we would like to propose a list of actions in order to estimate the risk of hair loss before starting chemotherapy and to manage this condition before, during, and after drug administration and to create a sort of practical guide for dermatologists and oncologists. Results and conclusion: There is an urgent need for prospective studies to clarify the mechanistic basis of alopecia associated with these drugs and consequently to design evidence-based management strategies.

Mastocytosis is a group of disorders characterized by the accumulation of mast cells in various tissues. In this article we report an interesting case of cutaneous mastocytoma in a 3-month-old infant. We describe two episodes characterized by an exacerbation of the skin lesion with the typical Darier’s sign. Both of them occurred after breastfeeding. In both episodes, the mother had eaten shrimps before the breastfeeding. This peculiar case, difficult to understand regarding its pathogenesis, was successful resolved just with dietary prescription given to the breast feeding mother.

Hintergrund: Blaulichtbestrahlung hemmt die Proliferation von Keratinozyten und moduliert die T-Zell-Immunantwort in vitro. In 2 klinischen Studien bewirkte das Verfahren nachweislich eine Reduzierung des Schweregrads von Psoriasis vulgaris (PsO). Ziel: Beurteilung der Sicherheit und Wirksamkeit der heimischen Langzeitanwendung von UV-freiem Blaulicht bei leichter PsO. Methoden: 47 Patienten mit geringgradiger PsO wurden per Randomisierung der Behandlung einer PsO-Plaque entweder mit Blaulicht hoher Intensität (HI: 453-nm-LED, 200 mW/cm2, n = 24) oder niedriger Intensität (LI: 453-nm-LED, 100 mW/cm2, n = 23) über 12 Wochen zugeteilt. Eine kontralaterale Plaque blieb als Kontrolle unbehandelt. Ergebnisse: Die Patienten-Compliance und -zufriedenheit waren hoch. Der primäre Endpunkt, die Veränderung gegenüber Studienbeginn (change from baseline; CfB) im Local Psoriasis Severity Index, zeigte eine signifikante Verbesserung bei den behandelten im Vergleich zu den Kontrollplaques (ΔCfB in der HI-Gruppe: -0,92 ± 1,10, p = 0,0005; in der LI-Gruppe: -0,74 ± 1,18, p = 0,0064). Schlussfolgerung: Die Behandlung mit UV-freiem Blaulicht ist gut verträglich und bewirkt eine klinische Besserung von PsO-Plaques. Übersetzung aus Dermatology 2015; 231: 24-34 (DOI: 10.1159/000430495)

Actinic keratosis (AK) is a keratinocyte intraepidermal neoplasia UV light–induced that frequently appears in sun-exposed areas of the skin. Although historically AK was defined as "precancerous", actually it is considered as the earliest stage of squamous cell carcinoma (SCC) in situ. Since AKs can progress into invasive SCC, their treatment is recommended. AKs rarely develop as a single lesion; usually multiple lesions commonly affect an entire area of chronically actinic damaged skin. This has led to the concept of "field cancerization", an area chronically sun-exposed that surrounds peripherally visible lesions, in which are individualized subclinical alterations. One of the main principles endpoint in the management of AKs is the evaluation and the treatment of field cancerization. In this view, in order to detect and quantify field cancerization, we employed a method based on the topical application of methyl aminolevulinate (MAL) and the detection of the fluorescence emitted by its metabolite Protoporphyrin IX (PpIX); then, considering the extension and the intensity of measured fluorescence, we create a score of field cancerization. The results show that patients underwent to daylight PDT had a reduction of total score, from T0 to T2. Whereas in the group untreated we observed a stability of total score or a slightly worse. So, the method and the score used allows to evaluate with a good approximation the dimension of field cancerization and show the modification of it after treatment.

Rosacea is a common chronic inflammatory disorder showing a wide range of clinical features such as telangiectasia, erythema, papules, and pustules primarily involving the central part of face (forehead, cheeks and nose) although extra facial manifestation have been described. We describe a case of rosacea with predominant scalp involvement successfully treated with a 8-week-course of doxycycline 40 mg once a day and probiotic therapy twice a day (Bifidobacterium breve BR03, Lactobacillus salivarius LS01 1 × 10(9) UFC/dose).