The brown forehead ring: A pattern of facial pigmentation

The brown forehead ring (linea fusca), a distinctive but infrequently recognized pattern of facial pigmentation, is described. The history of this sign is recounted. In modern times it seems to be associated with other well recognized patterns of facial pigmentation, chemical photosensitizers and excessive sun exposure. Three cases in adult males are described and the different aetiologies illustrated.     

The use of cisplatin electrochemotherapy in nonmelanoma skin cancers: A single‐center study

Electrochemotherapy (ECT) is a well‐known nonconventional skin cancer ablative method that was shown to be safe and effective for treating both locoregional disease spreading and disseminated cutaneous and subcutaneous lesions from different types of cancer. The most common medications used are bleomycin and cisplatin. In the last years many studies were performed on ECT, lead it to be a valid therapeutic option in many international guidelines. Nevertheless, there are still no clear indications regarding timing of its use. The main aim of this study was first to assess the safety and effectiveness of intralesional cisplatin ECT for treating different types of nonmelanoma skin cancer in a group of eligible patients. The second endpoint was to assess patients' tolerability and symptoms improvement through the treatment. A single‐center prospective study was performed. Patients with squamous cell carcinoma, basal cell carcinoma, or skin metastases were selected during 1 month. The ideal setting was the presence of two or three lesions with a maximum diameter of 2 cm. Both primary, recurrent, and metastatic lesions were included. Before and 8 weeks after treatment, all patients were evaluated to assess the number, measurement, and anatomical site of skin lesions using photography and metric notation. The medical device for membrane electroporation was the CLINIPORATOR EPS02 model. The cisplatin concentration was at least 1 mg/mL. The dose for each single lesion was calculated based on its volume, as is the standard procedure for ECT. Local or systemic adverse events and changes in symptoms were evaluated with a questionnaire based on a visual analog scale that was administrated before and after ECT. Eight patients with a total of 18 lesions underwent the procedure (six men and two women). Four out of eight (50%) patients had a complete response to the treatment. However, all eight patients had an overall tumor response (100%), experiencing an improvement in symptoms including less pain and bleeding from the tumor. Our study clearly show that ECT with intralesional cisplatin is a valuable and safety procedure for nonmelanoma skin cancer and cutaneous tumor metastasis. ECT with cisplatin was able to achieve a good local disease control leading to complete response in an half of cases. The results were stable after 1 year of follow‐up. The outer ear area displayed a really good response, due to both ear's anatomical configuration and intralesional cisplatin pharmacological characteristics.     

Idiopathic eruptive macular pigmentation in a pediatric patient and a review of the literature

Idiopathic eruptive macular pigmentation (IEMP) is a rare, benign, self-resolving melanosis consisting of hyperpigmented macules typically on the face, trunk, and extremities that can occur in children and adolescents and often presents a diagnostic conundrum. We report a case involving an 8-year-old female whose previous clinical presentation was concerning for an atypical presentation of cutaneous mastocytosis or neurofibromatosis. The clinical and histopathologic evaluation was consistent with the diagnosis of IEMP, and no active intervention was pursued. Our accompanying literature review serves to better characterize this condition, highlight key diagnostic features, and emphasize the tendency for spontaneous resolution to avoid unnecessary treatments with limited clinical efficacy.     

Complete lymph node dissection or observation in melanoma patients with multiple positive sentinel lymph nodes: A single‐center retrospective analysis

Although the role of sentinel lymph node biopsy (SLNB) as a prognostic factor is well established, its consequences for therapy are controversial. The aim of this study was to analyze if complete lymph node dissection (CLND) in patients with more than one positive sentinel lymph node (SLN) significantly improves melanoma‐specific survival (MSS) and progression‐free survival (PFS). Medical records of patients who underwent SLNB between 2001 and 2016 at the University Hospital of Cologne were reviewed, and patients with positive SLN were identified. Patient and tumor characteristics, patterns of recurrence, progression‐free and melanoma‐specific survival were analyzed. Seventy‐eight patients with multiple positive and 197 patients with one positive SLN were included in this study. Patients with multiple positive SLN had significantly more positive non‐SLN compared with patients with only one positive SLN (26.9% vs 8.6%, P = 0.01). However, in the subgroup of patients with multiple positive SLN, CLND did not significantly improve MSS (mean MSS 95 vs 75 months, P = 0.5) and PFS (mean PFS 59 vs 68 months P = 0.167). CLND did not result in a significant improvement in PFS and MSS in patients with multiple positive SLN.     

Vulvar lichen sclerosus: A single‐center retrospective study in China

Vulvar lichen sclerosus (VLS) is an uncommon, chronic inflammatory skin disease lacking clinical data of large sample size in China. This study was intended to provide missing data on this condition through investigating the clinical characteristics of Chinese VLS patients. The medical records of 129 VLS patients from our vulvar outpatient clinic were analyzed with SPSS version 18.0 software. The age of onset followed a normal distribution, with the peak at 25–30 years. Of all cases, the incidence rate during the postmenopausal period was 14.0% with an average duration of 9.22 years. The most frequently involved site was the bilateral labia minora (71.3%). Itching was the principal symptom (94.6%); meanwhile, patients with severe itching more commonly experienced longer duration, flaring at night, hyperkeratotic lesions or rashes on the posterior commissure than those with mild to moderate itching (P < 0.05). Furthermore, 60% of the enrolled patients suffered from sexual dysfunction. The major sign was pallor (92.2%), followed by hyperkeratosis (55.0%) and atrophy (40.3%). The patients with atrophy had a significantly longer duration of the disease, and the older patients presented more frequently with edema in the area of lesions (both P < 0.05). Of our patients, 9.3% suffered concomitantly from autoimmune diseases, mostly thyroid with one case being complicated by vulvar squamous cell carcinoma (SCC). In our study, the severity of pruritus was partly related to clinical manifestations. Moreover, Chinese patients could have developed VLS mostly in the reproductive period, with less complications of autoimmune diseases or SCC.     

20甲色素沉着为首发表现的Laugier-Hunziker综合征一例

患者女,34岁,因指、趾甲出现棕黑色色素沉着28年就诊。28年前患者无明显诱因发现右拇指指甲出现一纵形色素条,渐扩展为弥漫均匀褐黑色色素沉着,其余9指甲相继也出现同样的色素沉着,4年前趾甲开始出现类似改变,并逐渐累及其余趾甲,半年前发现舌尖、牙龈及唇部出现点片状色素斑（图1 ~ 4）……     

人工紫外线诱导正常皮肤色素斑的初步研究

目的:建立人工紫外线诱导正常皮肤色素斑的模型。方法:采用日光模拟器人工光源,以连续紫外线(波段290～400nm)照射健康受试者上臂内侧皮肤,观察不同照射剂量及照射后不同测量时间局部皮肤黑素测量值的变化。结果:照射后1周,2.0倍最小红斑量(MED)照射剂量组产生黑素的强度高于1.5MED组(P<0.05),与2.5MED组的差异无统计学意义(P>0.05);2.0MED组红斑消退及表面光滑度较2.5MED组轻(P<0.05),与1.5MED组差异无统计学意义(P>0.05)。紫外线照射后1周,各剂量组黑素测量值(L值)均达到高峰,其后随时间延长迅速下降(P<0.05),在第4、5周下降趋势变缓(P>0.05);而红斑测量值(a值)在紫外线照射1周时达到高峰后呈持续递减趋势(P<0.05)。结论:2.0MED照射剂量是紫外线在正常皮肤诱导色素斑的最佳剂量,照射后1～4周是观察色素变化的最佳时机。     

Black veins: a case of minocycline‐induced pigmentation post‐sclerotherapy and a review of literature

Minocycline‐induced pigmentation (MIP) is an uncommon but well‐described adverse effect of oral minocycline treatment. MIP is clinically and histopathologically distinct from post‐sclerotherapy pigmentation. We report a case of a patient presenting with blackened skin overlying veins recently treated with endovenous laser and foam sclerotherapy. The patient was a 44‐year‐old male with systemic sclerosis who commenced minocycline for the treatment of rosacea 5 months prior. Histological examination of the discolored tissue and underlying vein revealed hemosiderin deposition in the dermis and pigmented macrophages within the sub‐endothelial layer of the vein wall with a staining pattern consistent with MIP. Venous tissue has not previously been reported in the literature as a target of minocycline pigmentation. Our patient preferred to control his rosacea by continuing to take minocycline. Follow‐up ultrasound examinations revealed the treated vessels to be fully occluded with no evidence of recanalization, residual flow or ongoing thrombophlebitis. Despite a good sclerotherapy outcome, the pigmentation did not subside over 2 years. This case demonstrates that oral minocycline may induce significant and potentially long‐term pigmentation in predisposed patients undergoing sclerotherapy.     

Surveillance of psoriatic patients on biologic treatment during the COVID‐19 pandemic: A single‐center experience

There are few studies on how patients with psoriasis who are on biologic therapy are affected by the COVID‐19 pandemic. We analyzed the impact of the COVID‐19 pandemic on patients with psoriasis receiving biologic therapy, patients' current status at a single center in Turkey. A total of 133 patients (mean age; 44.6 ± 13.5 years) were on maintenance biological treatment for moderate‐to‐severe psoriasis during the pandemic. A standardized questionnaire was administered by phone interviews to determine patients' perceptions, attitudes, and adherence to therapy and identify the frequency of COVID‐19 infection, psoriasis status, and new comorbidities during the pandemic. All patients had been receiving a biological agent including ustekinumab, etanercept, adalimumab, secukinumab, infliximab, ixekizumab, or certolizumab pegol. Ninety‐one patients (68.4%) had at least one comorbid condition, including psoriatic arthritis (35.3%), hypertension (19.5%), diabetes mellitus (16.5%), obesity, coronary artery disease, and dyslipidemia. During the first 3 months of the pandemic, 52 patients (39%) suspended their biological therapies for short (n = 33) or long (n = 19) periods without medical advice for reasons of fear, worry, and anxiety. All but one patient restarted their medications as a result of therapeutic counseling. Five patients reported suspicious symptoms, but only one had PCR‐confirmed COVID‐19. Our findings suggest that biologic treatment for moderate‐to‐severe psoriasis would not pose an additional risk for COVID‐19 infection and its life‐threatening complications, even in the presence of a high frequency of cardiometabolic comorbidities, provided that all patients are informed and necessary pandemic‐directed precautions are well adopted by the patients.     

Relationship between the efficacy of biologics and clinical plaque psoriasis subtypes in Japanese patients: A single‐center pilot study

Although biologics for plaque psoriasis brought epoch‐making efficacy, not all patients achieve treatment success with all reagents. The aim of this study was to clarify the correlation between clinical plaque psoriasis subtypes, age at onset, and the efficacy of biologics. Clinical records for patients with plaque psoriasis at Fukuoka University Hospital were reviewed retrospectively. The efficacy of biologics was compared using the survival of the first biologics administered in treatment‐naïve patients. The survival of infliximab, adalimumab, and ustekinumab were followed until December 2016. The patients were clinically classified into three subtypes: small, large, or gigantic plaques using the size of the plaques on the back; early onset psoriasis (EOP, onset <40 years); or late‐onset psoriasis (LOP, ≥40 years). Eighty‐seven patients were enrolled. The survival of biologics was significantly better in large plaques compared with small or gigantic plaques (P = 0.0007). In patients treated with tumor necrosis factor (TNF) inhibitors, large plaques had significantly better survival than did the other types (P = 0.0122), while ustekinumab showed good survival in all three subtypes. The survival of biologics was numerically better in EOP than in LOP, but this was not significant. The efficacy of TNF inhibitors was different among clinical subtypes. Psoriatic patients with small plaques may be less responsive to TNF inhibitors. Further studies are needed.     

In vivo measurement of skin erythema and pigmentation: new means of implementation of diffuse reflectance spectroscopy with a commercial instrument

Background Various physical, chemical and biological insults, including exposure to ultraviolet (UV) radiation, cause erythema and change in pigmentation in human skin. These reactions provide an important measure of the cutaneous response to the insult. Objectives To present a new implementation of a method for objective in vivo measurement of erythema and pigmentation. Methods The method is based on acquisition of reflectance spectra in the visible range using a commercially available spectrophotometer. The probe of this instrument incorporates an integrating sphere that captures the light remitted from the skin in a wide range of angles. We corrected the acquired reflectance spectra for the contribution of specular reflections by an amount given by the Fresnel equation and verified this correction experimentally. This correction is particularly important when measurements are performed on heavily pigmented skin. The corrected reflectance spectra are then transformed into absorbance spectra. To analyse these spectra, we developed an algorithm which can be used to calculate apparent concentrations of oxyhaemoglobin, deoxyhaemoglobin and melanin. This method was tested in clinical studies of skin reactions induced by exposure to UV radiation. These experiments involved three groups of subjects with progressively darker complexion (constitutive pigmentation). Each group consisted of 10 subjects. Erythema was measured 1 day after UV exposure, and pigmentation (melanin content) 1 week later. Results Distinct apparent absorbance spectra were obtained for dark, intermediate and fair skin. There was good agreement between reconstructed spectra and experimental data at relevant wavelengths. Difference absorption spectra were able to show the dose dependence of UV‐induced responses, and erythema and pigmentation values obtained by the spectroscopic method showed good correlation with those derived by subjective visual grading. Conclusions The results demonstrate that the presented methodology provides an objective noninvasive way of measuring UV‐induced reactions independently of the level of constitutive pigmentation.