Cutaneous

Malignant melanoma is an extremely aggressive and metastatic cancer, highly resistant to conventional treatment modalities. Understanding of fundamental mechanisms responsible for its genesis and progression is critical for development of successful chemotherapeutic treatment. It is becoming clear that melanoma results from complex changes in multiple signaling pathways that control cell proliferation and ability to evade the cell death processes. Impairment or hyper-activation of some components of these pathways may lead to malignant transformation and cancer development. In the present review we consider the current data on involvement of such signaling pathways as cyclin/CDK, Ras/Raf/MEK/MAPK, JNK/c-Jun/AP-1, PI3K/Akt/PTEN/mTOR, IKK/I-κB/NF-κB, Wnt/β-catenin, Notch, Jak/STAT, MITF and some growth factors in regulation of the cell cycle progression, apoptosis and development of human cutaneous melanoma. Understanding of molecular aberrations that underlie melanoma oncogenesis is essential for improvement of diagnosis, accurate prognosis assessment, and rational design of effective therapeutics. Inhibitors of these pathways may serve as promising tools for anti-melanoma targeted therapy. Some novel anti-melanoma target drugs are characterized.

Cigarette smoking is the single biggest preventable cause of death and disability in developed countries and is a significant public health concern. While known to be strongly associated with a number of cardiovascular and pulmonary diseases and cancers, smoking also leads to a variety of cutaneous manifestations. This article reviews the effects of cigarette smoking on the skin and its appendages. A literature review was based on a MEDLINE search (1966-2004) for English-language articles using the MeSH terms cutaneous, dermatology, tobacco, skin, and smoking. An additional search was subsequently undertaken for articles related to smoking and associated mucocutanous diseases, with the focus on pathogenesis and epidemiologic data. Articles presenting the highest level of evidence and latest reports were preferentially selected. Smoking is strongly associated with numerous dermatologic conditions including poor wound healing, wrinkling and premature skin aging, squamous cell carcinom...

Se describe un caso clínico en el que se realizó el tratamiento de un mastocitoma  en un canino mediante  quimioterapeútica con prednisolona  y posterior congelamiento con nitrógeno . Se establece tratamiento con curación del paciente , no se reporta reincidencia .

Report of a clinical case in which a mastocytoma in a canine patient was treated  with liquid nitrogen cryosurgery  after a short chemotherapy course with prednisolone. Treatment therapy was stablished to cure the patient ; no tumor reincidence was reported

Dermatofibrosarcoma protuberans (DFSP) is a very rare cutaneous neoplasm which usually affects the torso. The clinical presentation is nonspecific and can mimic many benign as well as malignant skin lesions. We present a case with clinical diagnostic dilemma which was located over an unusual site to be suspected as DFSP with deceiving feature of cookie cutter sign. Moreover, the skin colored lesion was above a superficial bone, nearly immobile and hard in consistency; which even was mimicking underlying bony lesion on first impression. We have also reviewed the recently published DFSP case presentations and discussed with context to the mimicking nature of the disease.

The detectability and discriminability of virtual haptic gratings were analyzed in the frequency domain. Detection (Exp. 1) and discrimination (Exp. 2) thresholds for virtual haptic gratings were estimated using a force-feedback device that simulated sinusoidal and square-wave gratings with spatial periods from 0.2 to 38.4 mm. The detection threshold results indicated that for spatial periods up to 6.4 mm (i.e., spatial frequencies >0.156 cycle/mm), the detectability of square-wave gratings could be predicted quantitatively from the detection thresholds of their corresponding fundamental components. The discrimination experiment confirmed that at higher spatial frequencies, the square-wave gratings were initially indistinguishable from the corresponding fundamental components until the third harmonics were detectable. At lower spatial frequencies, the third harmonic components of square-wave gratings had lower detection thresholds than the corresponding fundamental components. Therefore, the square-wave gratings were detectable as soon as the third harmonic components were detectable. Results from a third experiment where gratings consisting of two superimposed sinusoidal components were compared (Exp. 3) showed that people were insensitive to the relative phase between the two components. Our results have important implications for engineering applications, where complex haptic signals are transmitted at high update rates over networks with limited bandwidths.

Background: Combination treatments for acne vulgaris, such as Benzamycin® (3% erythromycin/5% benzoyl peroxide) and Stievamycin® (0.025% tretinoin/erythromycin 4%), reduce bacterial growth, which contributes to the inflammatory lesions typical of adolescent acne, and also decrease the epidermal cell compaction which may form the characteristic noninflammatory comedone. Both agents contain erythromycin to reduce the growth of Propionibacterium acnes in skin. Benzoyl peroxide has antibiotic activity as well as anticomedogenic properties. Tretinoin may increase the turnover of epidermal cells and loosen the cells compacted to form comedones. A combination preparation containing the two antibiotics may reduce the development of resistance; the combination preparation containing tretinoin and erythromycin will have an antibiotic effect as well as acting on differentiation. Patients and Methods: This multicenter, randomized, double-blind, parallel group study compared the effectiveness of 3% erythromycin/5% benzoyl peroxide and 0.025% tretinoin/erythromycin 4%, each applied twice daily in patients with moderate acne vulgaris. Overall physician and patient ratings of severity of acne symptoms were performed at baseline and at weeks 2, 4, 8, and 12. Results: At baseline the two treatment groups had similar disease severity. The number of papules, pustules, and comedones was reduced in both treatment groups at week 12, and the reductions were not significantly different between the two comparators. Global physician rating of improvement was significantly higher in the 3% erythromycin/5% benzoyl peroxide group compared with the 0.025% tretinoin/erythromycin 4% group; however, there was no significant difference in global patient ratings between the two treatment groups. An aggregate score was produced, for both physician rating and patient rating, by adding up individual symptom severity ratings. Compared with 0.025% tretinoin/erythromycin 4%, 3% erythromycin/5% benzoyl peroxide provided significantly greater reduction in both physician- and patient-rated severity of acne symptoms; there was a significant difference between the two groups as early as week 2. The 3% erythromycin/5% benzoyl peroxide demonstrated significantly greater reduction of erythema and scaling, as evaluated by the study physician, compared with tretinoin 0.025%/erythromycin 4%. Patients judged 3% erythromycin/5% benzoyl peroxide to have a significantly greater effect on redness, dryness, oiliness, and burning. Conclusion: In moderate acne vulgaris, 3% erythromycin/5% benzoyl peroxide may provide a greater beneficial effect than 0.025% tretinoin/erythromycin 4%.

A case of febrile ulceronecrotic Mucha-Habermann's is presented. This disorder is a severe form of pityriasis lichenoides et varioliformis acuta (PLEVA) characterized by the sudden eruption of diffuse coalescent ulcerations associated with high fever. In the present case the disease was preceded by the milder typical form of PLEVA. Histologically a leukocytoclastic vasculitis was seen in addition to the usual lymphocytic perivascular and lichenoid infiltrate. During the course of the disease the patient developed an interstitial pneumonitis which resolved concomitantly with the cutaneous lesions. Adenovirus type II recovered at the height of the illness from the patient's urine may have etiologic implications in the pathogenesis of the disease.

Background: As the use of the newer oral antifungal agents for the treatment of superficial fungal infections becomes more widespread, the issue of safety surrounding their use is becoming an increasingly important consideration. Itraconazole is effective and well tolerated, with most side effects being minor and reversible. The most common adverse events are gastrointestinal upset, headache, and transient skin reaction. There have also been rare reports of hepatitis. Objective: To assess the hepatic safety of pulse and continuous itraconazole in the treatment of onychomycosis. Methods: An analysis was performed on all itraconazole clinical trials sponsored by Janssen Research Foundation in the treatment of onychomycosis, where there was an assessment of laboratory safety. A review of the published literature was also undertaken to assess the hepatic safety of itraconazole in common practice. Results: The data indicate that itraconazole pulse treatment is safe, with no significant differences in the number of code 4 abnormalities (baseline value is in the normal range and at least two values, or the last testing in the observation period, exceed twice the upper limit of normal) in the liver function parameters studied: alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase, and total bilirubin. The incidence of all the code 4 abnormalities was below 2%. In the literature there are reports of symptomatic hepatitis with itraconazole continuous therapy but no published report of symptomatic hepatotoxicity using the pulse regimen. Conclusions: Itraconazole pulse therapy for onychomycosis appears to be safe, especially from the perspective of potential liver damage. In the itraconazole package insert liver function tests are recommended for patients receiving continuous itraconazole for periods of time exceeding 1 month. There is no such monitoring requirement for the pulse regimen unless the patient has a history of underlying hepatic disease, the liver function tests are abnormal at baseline, or at any time that there is the development of signs or symptoms suggestive of liver dysfunction.

Reactive angioendotheliomatosis (RA) is a rare, benign disease. Affected patients present with self-limited, erythematous to violaceous plaques. The clinical lesions are due to intravascular hyperplasia of cytologically banal endothelial cells in the dermis. We report 2 patients who presented with ulcerated, violaceous plaques on the lower extremities. Both had severe peripheral vascular atherosclerotic disease requiring bypass grafts. Unlike previously described cases of RA, our patient's lesions were due to a diffuse proliferation of endothelial cells in the reticular dermis with only minimal, focal intravascular proliferation of these cells. Positive immunostaining with antibodies to Factor VIII-related and CD34 antigens adds evidence that the proliferated cells in the dermis were endothelial cells.

Pancreatic cancer account for less than 5% of human malignant neoplasms but represents the fourth leading cause of cancer death. Currently, there is no early diagnostic test or effective treatment for this disease once it is locally advanced. Cutaneous metastases from pancreatic cancer are relatively rare. The most common site of cutaneous metastasis is the umbilicus, and this is known as Sister Mary Joseph's nodule. A site other than umbilicus is rare. Very few patients have been reported with non-umbilical metastasis and only a handful with scalp lesion.  This is a case report of a patient who presented with a scalp lesion as the first clinical manifestation of a pancreatic carcinoma and a brief review of reported non-umbilical cutaneous metastases in the literature.

Two cases of epidermoid carcinoma in situ of the skin, one with mucinous metaplasia and the other with sebaceous metaplasia, are reported. These unique cases suggest a spectrum of differentiation possible by neoplastic epidermal keratinocytes, which may help in the understanding of the histogenesis of certain skin neoplasms.

We report on a case of the collision of a desmoplastic-neurotropic melanoma and a squamous cell carcinoma on the lip. A 46-year-old male developed a multifocal infiltrative squamous cell carcinoma of the lower lip, which also showed sparse melanocyte atypia within the epidermis and an extensive spindle cell proliferation within the dermis, subcutaneous tissues and nerves. An immunohistochemical panel showed that the spindle cells were melanocytes, not derived from the squamous cell carcinoma. Double labeling with AE1/AE3 and S100 showed striking localized proximity of the spindle-cell melanocytic and keratinocyte components in some areas of this tumor. To our knowledge, this is the first report of the collision of a squamous cell carcinoma and desmoplastic-neurotropic melanoma.

Objectives: Leishmaniasis is quite commonly encountered in Balochistan. Of all the known treatment modalities, only a few are available at our hospital. We carried out this study in search of an effective and easily available agent.
Methodology:This quasi-experimental study was carried out at Combined Military Hospital Sibi in Balochistan from May to Nov 2010. The gross appearance of non healing ulcers and demonstration of parasite in Giemsa stained smears were used to confirm the diagnosis. Thirty nine patients were enrolled and divided into two groups by non- probability convenience sampling. Eighteen patients (having 30 ulcers) received meglumine antimoniate and 21 patients (having 32 ulcers) received 0.2% ciprofloxacin intralesionally every fifth day till re-epithelialization started, up to a maximum of five doses. Side effects of therapy were checked at every visit. Patients were followed up at one week and subsequently one month after completion of treatment to assess complete clinical healing and regression in size of the scar.
Results:Two ulcers in meglumine antimoniate and five ulcers in ciprofloxacin group did not heal (response rate 93.33% vs. 84.38%, p: 0.273). Those treated with meglumine antimoniate required a lesser number of doses (mean 3.83 and 4.27; p: 0.039). Reduction in scar size was equal in both groups (58.46% and 57.21%; p: 0.087).
Conclusions: Intralesional ciprofloxacin is an effective, cheap and safe treatment for cutaneous leishmaniasis.

Cutaneous malignant melanoma is the most fatal skin cancer and although improved comprehension of its pathogenic pathways allowed to realize some effective molecular targeted therapies, novel targets and drugs are still needed. Aiming to add genetic information potentially useful for novel targets discovery, we performed an extensive genomic characterization by whole-exome sequencing and SNP array profiling of six cutaneous melanoma cell lines derived from metastatic patients. We obtained a total of 3,325 novel coding single nucleotide variants, including 2,172 non-synonymous variants. We catalogued the coding mutations according to Sanger COSMIC database and to a manually curated list including genes involved in melanoma pathways identified by mining recent literature. Besides confirming the presence of known melanoma driver mutations (BRAF(V600E), NRAS(Q61R) ), we identified novel mutated genes involved in signalling pathways crucial for melanoma pathogenesis and already addressed...

Major gaps remain regarding pathogenetic mechanisms underlying clinical heterogeneity in lupus erythematosus (LE). As systemic changes are likely to underlie skin specific manifestation, we analyzed global gene expression in peripheral blood of a small cohort of chronic cutaneous LE (CCLE) patients and healthy individuals. Unbiased hierarchical clustering distinguished patients from controls revealing a "disease" based signature. Functional annotation of the differentially expressed genes (DEGs) highlight enrichment of interferon related immune response and apoptosis signatures, along with other key pathways. There is a 26% overlap of the blood and lesional skin transcriptional profile from a previous analysis by our group. We identified four transcriptional "hot spots" at chromosomal regions harboring statistically increased numbers of DEGs which offer prioritized potential loci for downstream fine mapping studies in the search for CCLE specific susceptibility l...

Solitary myxomas without other manifestations of Carney’s complex usually arise within the skeletal or cardiac muscles, and less commonly in the intestine, pelvis and subcutis, and very rarely in the skin. Solitary cutaneous myxomas (SCM), more descriptively called solitary superficial angiomyxomas, are uncommon tumours having characteristic histological findings. They occur most commonly on the trunk, leg, head and neck, and more rarely at acral sites of adults. They are characterized
histologically by a well-defined, hypocellular, myxoid tumour with many vascular components in the dermis or subcutaneous fat. We report a case of solitary skin myxoma sitting on the scalp of a young child.

Trichofolliculomas are benign hamartomas of the hair follicles. Usually seen around the nose, they present as small skin-coloured papules or nodules. We present a patient who presented with a cutaneous horn on the pinna developing over a trichofolliculoma, something not described in literature in the past. The growth was excised and the diagnosis was established on histopathological examination.