The keystone flap and its simplified version for malignant skin tumor defects of the lower limbs: A review of 25 cases

BackgroundSkin tumors commonly occur on the legs and are treated in first line by surgery. Several techniques are available to repair lower limb defects: secondary-intention healing, partial closure, primary closure with or without an s-plasty, or a skin graft. The lack of tissue laxity of the surrounding skin does not allow several local flaps (advancement, rotation, or transposition). Closing large skin defects at this site may be challenging.Patients and methodsWe retrospectively reviewed a series of consecutive patients undergoing malignant tumor wide excision on lower limbs, with a keystone flap or its simplified technique (releasing incision) for closure of a skin defect.ResultsTwenty-five patients, 17 women and 8 men, ranging from 19 to 95 years old (mean age: 70 years) were included. Keystone flap reconstruction on the lower limbs was performed in 19 cases and the simplified technique in 6. The excised tumors were as follows: squamous cell carcinoma (n = 6), basal cell carcinoma (n = 9), melanoma (n = 9) and Bowen's disease (n = 1). Three local complications were observed. No cases of recurrence were observed.ConclusionKeystone flap is a reliable surgical method for reconstruction of lower limb skin defects. Aesthetic results are better than when a skin graft is used, complications are uncommon, and prolonged operative time is avoided.     

Pénfigo vulgar: estudio de cohorte retrospectivo de sus características clínicas,tratamientos empleados y evolución

BackgroundPemphigus vulgaris (PV) is an uncommon, serious disease that is treated with systemic corticosteroids and corticosteroid-sparing agents.ObjectivesTo describe and analyze the demographic and clinical characteristics of patients with PV.Material and methodsRetrospective cohort study of adults diagnosed with PV over a period of 12 years.ResultsPV presented with mucosal lesions in 20 of the 32 patients studied (63%); the most common site was the oral mucosa followed by the vulva. Mucosal involvement was more common in women (P = .03). Lesions were found at more than 1 mucosal site in patients whose disease began in the mucosa, independently of age or sex (P = .003). Disease onset before the age of 40 years was associated with generalized skin lesions (P = .003), a need for corticosteroid-sparing therapy (P = .05), and refractory PV (P = .02). Azathioprine was the most widely prescribed corticosteroid-sparing agent (in 22 patients). Eight patients (25%) were dependent on corticosteroids and disease recurred in 26 (81%). Complete remission, with or without treatment, was achieved in 15 patients (47%). Patients remained disease-free for a median of 14 months, and 2 patients died (6%).ConclusionOnset before the age of 40 years could be a sign of poor prognosis in patients with PV, as it was significantly associated with a higher risk of generalized skin involvement, a need for corticosteroid-sparing therapy, and refractory disease.     

A fibre-free alginate dressing in the treatment of split thickness skin graft donor sites

Background Alginate dressings are gaining acceptance in wound management although comparative published data with conventional treatment is inconclusive.
Aims The aim of this randomised controlled study was to compare a fibre-free alginate dressing (Comfeel SeaSorb) with conventional treatment of standardised split-thickness skin graft donor sites in 17 patients regarding initial absorption of blood and healing.
Results The alginate dressing absorbed 40% ( P < 0.05) more blood, measured as total iron content of used dressings, during the first 10 post-wounding minutes than fine mesh gauze, resulting in less subsequent bleeding. Light microscopic examination of punch biopsies obtained from 10 wounds on post-operative day 6 demonstrated that nine wounds treated with the alginate dressing compared with seven wounds treated conventionally with paraffin-impregnated gauze (Jelonet®) were completely epithelialised, a statistically non-significant difference ( P = 0.46).
Conclusions In conclusion, the fibre-free alginate dressing showed increased initial blood absorption resulting in quicker haemostasis but showed no greater beneficial effect on epithelialisation of split-thickness skin graft donor sites compared with conventional topical treatment     

Clinical and economic consequences of discharge from hospital with on-going TNP therapy: A pilot study

Despite practical advantages (such as exudate management and reduced dressing changes) the adoption of topical negative pressure therapy (TNP) in home care may be restricted through logistical issues and a perception that the intervention is more expensive than the more traditionally utilised wound management products. This pilot study followed the experiences of 20 subjects with a variety of acute and chronic wounds who received TNP either in hospital (n = 10), at home (n = 5) or in both care settings (n = 5). All except one subject showed both reductions in wound surface area and improved appearance of the wound bed during the course of treatment ranging from 2 to 74 days. The single subject, where a deterioration in their wound was noted, had presented with an unclear wound diagnosis thus highlighting the absolute need for accurate diagnosis of wound aetiology prior to commencement of any treatment regime. The cost of treatment was lower where subjects were treated at home (mean cost per day £45.9 SD: 17.0) and highest where care was delivered exclusively in hospital (mean cost per day £259.1 SD: 2.8). Direct comparison of these data with other published studies on the use of TNP therapies is obviously restricted through regional differences in the cost of nursing care, patterns of use of the TNP consumables and the wound outcomes followed in individual cases, however, there would appear to be a qualitative and economic benefit from home care.     

Parche biosintético de colágeno porcino como herramienta coadyuvante o definitiva en el cierre de defectos del cuero cabelludo sin periostio

BackgroundAggressive carcinomas of the scalp usually occur in elderly patients with multiple comorbidities. Complete excision of this type of tumor often involves the removal of periosteum, and the resulting defects can be difficult to reconstruct.ObjectiveTo evaluate the usefulness of porcine type I collagen dressings as adjunct or definitive treatment in the surgical closure of scalp defects without periosteum.Materials and methodsWe performed a prospective study between January 2009 and November 2011 of patients with scalp defects larger than 5 cm resulting from surgery that required the removal of periosteum to obtain tumor-free margins.ResultsThe most prevalent type of tumor was recurrent cutaneous squamous cell carcinoma. The surgical defects ranged in diameter from 5 to 7 cm. In 100% of the patients who received a graft after dressing removal (n = 4), the graft took well. In the patients in whom the biosynthetic dressing was definitive (n = 6), granulation tissue filled the defect and complete closure was achieved in approximately 3.5 months.ConclusionsThe use of porcine type I collagen dressings as an adjunct or definitive tool for the closure of surgical defects on the scalp measuring more than 5 cm in which periosteum has been removed proved to be simple, inexpensive, and effective.     

Effects of local cooling on sacral skin perfusion response to pressure: Implications for pressure ulcer prevention

People with spinal cord injuries are at high risk for developing pressure ulcers. Increased skin temperature is one of the extrinsic causative factors for this multi-factorial disease. Previous animal studies revealed that local skin cooling reduced the severity of ulceration, and cooling is widely used in plastic surgery and organ transplants for tissue preservation. The objectives of this pilot study were to develop test protocols and instrumentation and to investigate the effect of local cooling on skin perfusion response to pressure on young healthy human subjects. Reactive hyperemia was quantified in this study to compare the effects of pressure with and without cooling. Reactive hyperemia is a normal physiological response occurring after vessel occlusion. Laser Doppler flowmetry was used to measure skin blood flow. Time-dependent spectral analysis was used to analyze and decompose the blood flow data into frequency ranges associated with specific blood flow control mechanisms. The study used a repeated measures design with two test conditions: 8 kPa of pressure with and without cooling to 25 °C. We hypothesized that local cooling would reduce the post-ischemic reactive hyperemic response induced by the rigid indenter. Time series results showed that normalized peak perfusion response was significantly lower with cooling (p = 0.019). Time-dependent spectral analysis results suggested that both metabolic and myogenic responses contribute to this protective effect. Findings from our study on humans were consistent with previous animal studies. Additional studies on individuals with spinal cord injury are planned to further evaluate the cooling effect in a high-risk population.     

[Translated article] Association Between Demodex Infestation and Severe Acne Vulgaris: A Cross-Sectional Study of 168 Patients

Background and objectivesInfestation with Demodex mites has been associated with acne vulgaris. The aim of this study was to explore the association between Demodex infestation and severe acne vulgaris in outpatients seen at Hospital Regional Lambayeque in Chiclayo, Peru.Material and methodsWe conducted a cross-sectional study of 46 patients with severe acne and 92 patients with nonsevere acne. Severe acne vulgaris was diagnosed if the score was 3 or more on the Spanish Acne Severity Scale (EGAE, in its Spanish acronym). Demodex infestation was diagnosed when a skin surface biopsy showed more than 5 mites/cm².ResultsThe patients had a median age of 18 years (interquartile range, 15–20 years), 60.9% were male, 81.9% lived in an urban area, and 29.7% were infested with Demodex mites. In the bivariate analysis, severe acne vulgaris was significantly associated with Demodex infestation (P = .001), sex (P = .003), residence (P = .015), a paternal history of acne (P = .045), a maternal history of acne (P = .045), and type of skin (P < .001). In the multivariate analysis, after adjustment for male sex, urban residence, previous treatment, maternal and paternal history of acne vulgaris, and an oily skin type, patients with Demodex infestation were 4.2 times more likely to have severe acne vulgaris (95% CI: 1.6–10.9, P = .003).ConclusionDemodex infestation was associated with severe acne vulgaris in outpatients at our hospital.     

Demodex folliculorum infestations in common facial dermatoses: acne vulgaris,rosacea, seborrheic dermatitis

BackgroundDemodex mites are found on the skin of many healthy individuals. Demodex mites in high densities are considered to play a pathogenic role.ObjectiveTo investigate the association between Demodex infestation and the three most common facial dermatoses: acne vulgaris, rosacea and seborrheic dermatitis.MethodsThis prospective, observational case-control study included 127 patients (43 with acne vulgaris, 43 with rosacea and 41 with seborrheic dermatitis) and 77 healthy controls. The presence of demodicosis was evaluated by standardized skin surface biopsy in both the patient and control groups.ResultsIn terms of gender and age, no significant difference was found between the patients and controls (p > 0.05). Demodex infestation rates were significantly higher in patients than in controls (p = 0.001). Demodex infestation rates were significantly higher in the rosacea group than acne vulgaris and seborrheic dermatitis groups and controls (p = 0.001; p = 0.024; p = 0.001, respectively). Demodex infestation was found to be significantly higher in the acne vulgaris and seborrheic dermatitis groups than in controls (p = 0.001 and p = 0.001, respectively). No difference was observed between the acne vulgaris and seborrheic dermatitis groups in terms of demodicosis (p = 0.294).Study limitationsSmall sample size is a limitation of the study. The lack of an objective scoring system in the diagnosis of Demodex infestation is another limitation.ConclusionThe findings of the present study emphasize that acne vulgaris, rosacea and seborrheic dermatitis are significantly associated with Demodex infestation. Standardized skin surface biopsy is a practical tool in the determination of Demodex infestation.     

A prospective comparative study on the effectiveness of two different non-adherent polyurethane dressings on split-thickness skin graft donor sites

AimTo analyze differences in re-epithelization, exudate absorbency, ease and pain on dressing removal between ALLEVYN? Non-Adhesive and Betaplast? N.MethodologyPatients admitted to the general ward undergoing split skin grafting were recruited. Allevyn and Betaplast were applied on the donor site. Exudate absorption was assessed daily using an absorbency grading chart. Dressing change was done on post-operative day five. Ease of dressing removal and pain score using the Wong-Baker Pain Scale was assessed. The percentage of re-epithelization for each dressing was assessed.Results30 patients were recruited. There was a statistically significant difference in exudate absorption on post-operative day 3 (z = ?2.006, p = 0.045, T = 236) and post-operative day 4 (z = ?2.026, p = 0.0143, T = 188), pain score (z = ?2.861, p = 0.004, T = 180), ease of removal (z = ?2.668, p = 0.008, T = 126) and re-epithelization (z = ?2.566, p = 0.009, T = 336) between Betaplast and Allevyn.ConclusionBetaplast may have faster re-epithelization, better exudate absorption, and is easier to remove while minimizing discomfort as compared to Allevyn.     

Decision-making factors for the long-term topical treatment of mild-to-moderate plaque psoriasis: TEPPSO,a case-vignette study on clinical practice

ObjectivesTopical maintenance therapy strategy with regard to patients with mild-to-moderate plaque psoriasis (PP) continues to be heterogeneous and insufficiently investigated in real-life clinical practice. The objective of this study was to describe the initiation of long-term maintenance treatment and to identify clinical parameters influencing the therapeutic decision.MethodsTEPPSO was a French and Belgian multicentre cross-sectional study based on completion of questionnaires and assessment of credible clinical scenarios of mild-to-moderate PP by physicians using the validated case-vignette method.ResultsMaintenance therapy was recommended by dermatologists (Ds) and by general practitioners (GPs) in 79.1% and 76.8% of cases, respectively. GPs recommended the use of a fixed-dose combination of corticosteroid and vitamin D analogues in only 14.8% of cases, whereas this therapy was recommended by French and Belgian Ds in 54.8% and 39.8% of cases, respectively. In a multivariate analysis, significant determinants of the therapeutic decision were skin lesions impacting quality of life (OR 1.9 [95% CI: 1.1; 3.2] P = 0.01) for Ds, and patient corticophobia (OR 1.7 [95% CI: 1.1; 2.7] P = 0.03) or the presence of skin pruritus (OR 1.8 [95% CI: 1.2; 1.8] P = 0.004) for GPs, respectively.ConclusionsMaintenance treatment with topical agents in patients with mild-to-moderate PP was considered in more than two thirds of cases. Heterogeneity in the choice of topical agents was evidenced particularly between Ds and GPs. Our study is the first to identify significant clinical determinants affecting the therapeutic decision. Updated and validated clinical practice guidelines are needed to ensure uniform therapeutic choices.     

Dermatosis en pacientes con sobrepeso y obesidad y su relación con la insulina

IntroductionThe prevalence of obesity has increased worldwide in recent years. Some authors have described skin conditions associated with obesity, but there is little evidence on the association between insulin levels and such disorders.ObjectiveTo describe the skin disorders present in overweight and obese patients and analyze their association with insulin levels.Material and methodsThe study included nondiabetic male and female patients over 6 years of age who were seen at our hospital between January and April 2011. All the patients were evaluated by a dermatologist, who performed a physical examination, including anthropometry, and reviewed their medical history and medication record; fasting blood glucose and insulin were also measured. The patients were grouped according to degree of overweight or obesity and the data were compared using analysis of variance or the χ² test depending on the type of variable. The independence of the associations was assessed using regression analysis.ResultsIn total, 109 patients (95 adults and 13 children, 83.5% female) were studied. The mean (SD) age was 38 (14) years and the mean body mass index was 39.6 ± 8 kg/m². The skin conditions observed were acanthosis nigricans (AN) (in 97% of patients), skin tags (77%), keratosis pilaris (42%), and plantar hyperkeratosis (38%). Statistically significant associations were found between degree of obesity and AN (P = .003), skin tags (P = .001), and plantar hyperkeratosis. Number of skin tags, AN neck severity score, and AN distribution were significantly and independently associated with insulin levels.ConclusionsAN and skin tags should be considered clinical markers of hyperinsulinemia in nondiabetic, obese patients.     

Autologous fat grafting for the treatment of sclerotic lesions and scars

IntroductionMicrofat grafting is a well-known technique that is underutilized in dermatology. Instead of removing sclerotic tissue, microfat grafting preserves the tissue and uses stem cells for remodeling its structure into normal tissue. We performed a retrospective study of patients treated with microfat grafting for sclerotic and atrophic skin lesions and scars.Patients and methodsSeventy-two microfat grafts were performed using the Magalon technique under general anaesthesia for the treatment of sclerotic and atrophic skin lesions. We performed grafts for different indications, such as scars (n = 55) and sclerotic and atrophic skin lesions (n = 17: Parry–Romberg syndrome, morphea). The main outcome was assessed for satisfaction during follow-up. In addition, an independent committee judged the results based on photographs.ResultsSatisfaction levels (e.g. results were judged to be “good”) were almost 91% (n = 50/55) for scars and 100% (n = 17/17) for atrophic and sclerotic skin lesions. Satisfaction levels according to the independent committee were 94.1% for sclerotic and atrophic lesions and nearly 51% for scars.ConclusionSatisfaction was high after microfat grafting for atrophic and sclerotic skin lesions. Microfat grafting enabled restoration of the skin texture by exploiting stem cell properties. It is an efficient dermatological therapy for sclerotic and atrophic lesions, for which there are few alternative treatments.     

Asociación entre la infestación por el Demodex sp. y el acné vulgar grave. Estudio transversal de 168 pacientes

Background and objectivesInfestation with Demodex mites has been associated with acne vulgaris. The aim of this study was to explore the association between Demodex infestation and severe acne vulgaris in outpatients seen at Hospital Regional Lambayeque in Chiclayo, Peru.Material and methodsWe conducted a cross-sectional study of 46 patients with severe acne and 92 patients with nonsevere acne. Severe acne vulgaris was diagnosed if the score was 3 or more on the Spanish Acne Severity Scale (EGAE, in its Spanish acronym). Demodex infestation was diagnosed when a skin surface biopsy showed more than 5 mites/cm².ResultsThe patients had a median age of 18 years (interquartile range, 15-20 years), 60.9% were male, 81.9% lived in an urban area, and 29.7% were infested with Demodex mites. In the bivariate analysis, severe acne vulgaris was significantly associated with Demodex infestation (P = .001), sex (P = .003), residence (P = .015), a paternal history of acne (P = .045), a maternal history of acne (P = .045), and type of skin (P < .001). In the multivariate analysis, after adjustment for male sex, urban residence, previous treatment, maternal and paternal history of acne vulgaris, and an oily skin type, patients with Demodex infestation were 4.2 times more likely to have severe acne vulgaris (95% CI: 1.6-10.9, P = .003).ConclusionDemodex infestation was associated with severe acne vulgaris in outpatients at our hospital.     

Evaluation of timolol maleate gel for management of hard-to-heal chronic venous leg ulcers. Phase II randomised-controlled study

BackgroundVenous leg ulcers (VLUs) often take a very long time to heal. Timolol maleate has been reported as displaying efficacy in healing of VLUs.ObjectivesTo evaluate the efficacy of timolol maleate gel in the management of hard-to-heal VLUs and to assess its safety as a topical agent during 12 weeks of use in combination with conventional treatment.MethodsA prospective, phase-II randomised-controlled trial with a sample size based on Fleming's one-stage design (P0 = 0.25, P1 = 0.45, alpha = 0.1, beta = 0.2) was planned. Patients with VLUs present for ≥ 24 weeks and with ≥ 50% granulation tissue were included. One drop of sustained-release timolol gel (Timoptol® LP 0.5%, Santen, Tampere, Finland) per 6 cm² VLU area was applied every 2 days for 12 weeks in timolol-treated patients, as adjuvant therapy to the standard care protocol (interface dressing and multilayer venous compression). Controls received standard care alone. The primary endpoint was to obtain ≥ 40% reduction in ulcer area at week 12 (W12).ResultsForty-three patients were randomised to the study, with 40 receiving at least one treatment and included in the analysis: 21 timolol-treated patients and 19 controls (females: 70%; median age: 72.5 [range 35–93] years). At W12, ≥ 40% ulcer-area reduction was achieved in 14/21 (67%) timolol-treated patients vs. 6/19 (32%) controls. No serious adverse events occurred. Local wound infections not requiring systemic antibiotics occurred in 5 cases in the timolol group and in one case in the controls.ConclusionsThese results support the benefit and safety of using timolol maleate to manage hard-to-heal VLUs, but confirmation is required in a larger multicentre randomised phase-III study.     

Serum granulysin as a possible key marker of the activity of alopecia areata

BackgroundAlopecia areata (AA) is an organ-restricted autoimmune condition of the hair follicles (HFs) that presents as nonscarring hair loss. A collapse of immunoprivilege for cell-mediated cytotoxicity and following attacks by cytotoxic T cells to anagen HFs are considered to play a major role in the pathogenesis of AA. However, there has been no useful marker for the activity of AA to date.ObjectiveThe aim of this study is to examine whether granulysin, which is known to reflect the activity of cytotoxic immune responses, is related to the disease activity of AA.MethodsWe evaluated serum granulysin levels in acute and chronic AA patients compared to healthy controls in the perspective of bald skin areas, prognosis, and co-existence of other allergic diseases. In addition, immunohistochemical analysis for granulysin-, CD4-, CD8-, and CD56-positive cells in the lesional skin of acute and chronic AA patients was performed.ResultsSerum granulysin levels were significantly elevated in both acute and chronic AA patients (p = 0.00081 and p = 0.0012, respectively). Intriguingly, serum granulysin levels were significantly associated with the broader bald skin areas (Spearman's r = 0.59, p = 0.017), and poorer prognosis in acute AA patients (p = 0.0080). They were also associated with co-existence of allergic disorders in AA patients (p = 0.026). Immunohistochemical staining demonstrated that perifollicular granulysin-bearing cells were mainly detected in acute AA lesions with dense lymphocytic infiltration, and that these granulysin-bearing cells were consistent with CD8⁺ T cells.ConclusionThe serum granulysin level may be a useful and novel marker for the disease activity in the acute phase of AA.     

Spanish Version of Teenagers’ Quality of Life (T-QoL) for Adolescents with Skin Diseases: Translation,Cultural Adaptation and Validation

BackgroundTeenagers’ Quality of Life (T-QoL) is an age-specific measure to assess QoL of teenagers suffering from different skin diseases. A validated Spanish language version is lacking. We present the translation, cultural adaptation and validation of the T-QoL into Spanish.MethodsA prospective study with 133 patients (between 12 and 19 years old), attended at the dermatology department of Toledo University Hospital, Spain (September 2019–May 2020), was carried out for the validation study. The International Society for Pharmacoeconomics and Outcomes Research (ISPOR) guidelines were used for the translation and cultural adaptation. We evaluated the convergent validity with the Dermatology Life Quality Index (DLQI), the Children's Dermatology Life Quality Index (CDLQI) and with a Global Question (GQ) on self-assessed disease severity. We also analysed internal consistency and reliability of the T-QoL tool and confirmed its structure with a factor analysis.ResultsGlobal T-QoL scores significantly correlated with the DLQI and the CDLQI (r = 0.75) and with the GQ (r = 0.63). The confirmatory factor analysis showed optimal fit for the bi-factor model and an adequate fit for the correlated three-factor model. Reliability indicators were high (Cronbach's α = 0.89; Guttman's Lambda 6 index = 0.91; Omega ω = 0.91) and test–retest showed a high stability (ICC = 0.85). The results were consistent with those found by the authors of the original test.ConclusionOur Spanish version of the T-QoL tool is valid and reliable to assess QoL of Spanish-speaking adolescents with skin diseases.     

Complicaciones y secuelas dermatológicas de quemaduras en lactantes y preescolares chilenos

IntroductionBurns are injuries that compromise skin or other organic tissues, caused by different mechanisms. The paediatric population is especially susceptible to accidental burns and their subsequent sequelae. This study aimed to characterise the burns suffered by infants and pre-school children, with emphasis on the development and evolution of complications and cutaneous sequelae.MethodologyA retrospective cohort study based on clinical records of children under 6 years old who suffered skin burns, in whom 1 to 2 years of follow-up was completed.ResultsThe study included 59.2% males, and the mean age was 25.7 ± 6.2 months. Most (64.8%) burns occur in autumn and winter. The most frequent sources of burns were: hot liquids (63.4%) and hot objects (31%). The large majority (88.7%) of the burns were of partial thickness, and covered a mean of 2.4 ± 1.1% of body surface. The hands and upper extremities were the most affected locations, and 42.3% of patients required surgery in the acute period. Of the total burned body locations, 73.7% had one or more complications or cutaneous sequelae. The lower extremities were the most affected by complications. The frequency of complications was: keloids and hypertrophic scars (22%), hyperpigmentation (18%), hypopigmentation (14%), pruritus (14%), wounds and excoriations (12%), and infections (1%).ConclusionsThis series constitutes one of the first studies on the paediatric population affected by burns focused from a perspective on complications. Knowledge of this information is essential for the development of prevention and management strategies.     

Differential expression of BAFF and its receptors in discoid lupus erythematosus patients

BackgroundB-cell activating factor of the TNF family (BAFF) promotes the maturation and survival of B cells. Because BAFF levels are elevated in systemic lupus erythematosus (SLE) patients, BAFF has been the target of emerging therapies for SLE, such as belimumab. Levels of BAFF and its receptors in discoid lupus erythematosus (DLE) patients are unknown.ObjectiveTo compare skin and blood mRNA and protein levels of BAFF and its receptors BAFF-R, TACI, and BCMA in DLE subjects with (DLE+/SLE+ (N = 28)) and without SLE (DLE+/SLE− (N = 35)), psoriasis subjects (N = 11), and normal subjects (N = 42).MethodsWe used quantitative real-time PCR to measure blood and skin BAFF, BAFF-R, TACI, and BCMA mRNA, sandwich ELISAs to measure sera BAFF, and immunohistochemistry to evaluate BAFF and BAFF-R skin protein expression.ResultsBAFF mRNA and protein levels were highest in DLE+/SLE+blood, followed by DLE+/SLE−, psoriasis, and normal blood. BAFF protein also correlated with anti-nuclear antibodies, and autoantibodies against double-stranded DNA, single-stranded DNA, and ribonucleoprotein, and Systemic Lupus Erythematosus Disease Activity Index scores in DLE patients. While showing no difference between DLE+/SLE+ and DLE+/SLE− skin, BAFF and its receptors mRNA were up-regulated in DLE skin vs. normal and psoriasis skin. DLE skin had higher percentages of BAFF-R⁺ inflammatory cells, likely T cells and macrophages, than psoriasis and normal skin.ConclusionsBAFF may be a serologic marker of systemic disease in DLE patients. BAFF and its receptors are elevated in DLE skin, suggesting that targeted therapies against these proteins could treat refractory DLE patients.     

Histopathologic and immunohistochemical distinction of condyloma and seborrheic keratosis in the genitofemoral area

BackgroundMaking a clinical and histological distinction between condyloma and seborrheic keratosis in the genitofemoral area can be difficult. This study aimed to find reliable histological and immunohistological criteria to diagnose these entities.MethodsWe retrospectively studied genitofemoral skin biopsy specimens obtained between January 2004 and December 2007 that had been diagnosed as showing condyloma or seborrheic keratosis. The histological findings were assessed and immunohistochemical stains were performed for human papillomavirus, Ki-67, and p21. DNA was extracted from paraffin sections and amplified by polymerase chain reaction to detect the presence and type of human papillomavirus.ResultsDNA extraction was successfully performed for 58 lesions. The final diagnoses were condyloma in 41 and seborrheic keratosis in 17. The diagnosis of condyloma rather than seborrheic keratosis was likely in the presence of broad, evenly distributed reticulated acanthosis (p < 0.0001), koilocytosis (p < 0.001), a fascicular arrangement of keratinocytes (p < 0.01), and an absence of horn cysts (p < 0.01). Immunohistochemical staining supported the diagnosis of condyloma when positive for human papillomavirus (p < 0.0001), Ki-67 (p < 0.0001), and p21 (p < 0.0001).ConclusionA combination of histological and immunohistochemical findings is useful to distinguish condyloma from seborrheic keratosis in the genitofemoral area.