Cutaneous manifestations in celiac disease.

Celiac disease (CD) is an autoimmune gluten-dependent enteropathy characterized by atrophy of intestinal villi that improves after gluten-free diet (GFD). CD is often associated with extra-intestinal manifestations; among them, several skin diseases are described in CD patients. The present review reports all CD-associated skin manifestations described in the literature and tries to analyze the possible mechanisms involved in this association. The opportunity to evaluate the possible presence of CD in patients affected by skin disorders is discussed.

Management and dermoscopy of fast-growing nevi in pregnancy: case report and literature review.

BACKGROUND: The relationship between pregnancy and a change in melanocytic nevi is still controversial. Moreover, management of the rapid evolution of a nevus in an unauspicious melanocytic lesion can be a clinical challenge in pregnancy. METHODS: This article examines a case of a fast-growing deep penetrating nevus in a pregnant woman and provides a literature review of articles relative to pregnancy and nevi change, the management of fast-growing pigmented lesions, and the role and usefulness of dermoscopy in these cases. RESULTS: Recent studies have documented that pregnancy is not associated with any significant change in the size of melanocytic nevi. The management of fast-growing melanocytic lesions during this period compulsorily leans toward excision. Dermoscopy can be useful, providing clinicohistopathologic correlations and a better assignment of the lesion. CONCLUSION: This case report and review provide important management considerations for nevi during pregnancy. Early intervention with aggressive treatment measures is the best management for fast-growing lesions, and epiluminescence dermoscopy can assist the management, although still remaining a second-level examination, useful for documentation and for a better classification of the lesion.

Atypical multifocal cutaneous leishmaniasis in an immunocompetent patient treated by liposomal amphotericin B.

Multifocal cutaneous leishmaniasis (MCL) is an extremely rare disease in South Europe, and it mainly affects immunosuppressed patients. We report a case of MCL in an immunocompetent patient affected by type II diabetes mellitus that clinically presented with three large ulcers on the legs with a non-linear distribution and several months later with an erythematous-crusty lesion on the left cheek. Diagnosis of leishmaniasis due to Leishmania infantum was formulated by PCR analysis. Given the diffuse and wide lesions, the unresponsiveness to previous local and systemic treatments, a parenteral i.v. therapy with liposomal amphotericin B at a dosage of 3mg/kg/day for 5 days was started and then repeated on the 14th and 21st days, leading to a clear improvement in the clinical picture. The different clinical expression and the evolution of leishmaniasis depend on both the parasite subtype and the host's immunity status. L. infantum manifests with an atypical clinical feature more frequently than other species. The differential diagnosis for multiple ulcers must include several skin diseases, such as cutaneous TBC, bacterial ulcers, traumatic ulcers, deep mycoses, and sarcoidosis. However, an MCL should always be considered in subjects coming from endemic areas. In our case, the multifocality, the size of the lesions and the unresponsiveness to other treatment indicate a short course treatment with liposomal B amphotericin that proved to be a suitable alternative to traditional drugs used in MCL.

Atypical mole syndrome and congenital giant naevus in a patient with celiac disease.

We describe a case of a 28-year-old woman affected by celiac disease (CD) associated with rare multiple disorders of the cutaneous pigmentary system: atypical mole syndrome and congenital giant naevus. Some other rare skin lesions have been reported in association with celiac disease such as cutaneous sarcoidosic granuloma, bullous pemphigoid, ichthyosis, alopecia areata, erythema elevatum diutinum, sclero-atrophic lichen and primary cutaneous amyloidosis. This is the 1(st) report concerning celiac disease and congenital disorders of the pigmentary system.

The 72-kDa and the 92-kDa gelatinases, but not their inhibitors TIMP-1 and TIMP-2, are expressed in early psoriatic lesions.

Psoriasis is histologically characterized by hyperkeratosis and papillomatosis with elongated vessels in the upper dermis. In order to evaluate the role of gelatinases in remodelling psoriatic skin in this study we examined the production of the 72-kDa (gelatinase A), 92-kDa collagenase (gelatinase B) and their tissue inhibitors TIMP-2 and TIMP-1. A total of 19 patients affected by different types of psoriasis were included in this study. An immunohistochemical study on cryosections was performed using antibodies to 72-kDa gelatinase, 92-kDa gelatinase, TIMP-1, TIMP-2, laminin, collagen types I, III, IV, VII. mRNA expression for gelatinases and their inhibitors were also analyzed by reverse transcriptase polymerase chain reaction (RT-PCR). In 14 of 19 patients there was a positivity in 92-kDa protein expression in keratinocytes. The 92-kDa gelatinase protein was also present in the upper dermis with prevalence around blood vessels. In 15 of 19 patients the 72-kDa was localized in the upper dermis, almost exclusively in the papillary dermis but absent in epidermis. TIMP-1 and TIMP-2 were both negative in all cases in immunoperoxidase and RT-PCR. Using RT-PCR we show that the 72-kDa mRNA is expressed exclusively in the dermis, on the contrary the 92-kDa was present in epidermis and dermis. Type I, III, IV and VII collagens did not show any alteration or disruption. Overexpression and production of gelatinases without inhibitory effects suggest a role of these proteins in remodelling the psoriatic skin probably inducing the typical histological pattern of papillomatosis.

Rapid perinatal growth mimicking malignant transformation in a giant congenital melanocytic nevus.

Transformation to malignant melanoma in a giant congenital melanocytic nevus observed on the right limb of a 3,300-g newborn boy was strongly suggested by the histologic features of its ulcerated and papular areas: atypical melanocytes, irregular melanin distribution, many mitotic figures, "pagetoid" invasion of the dermis, and destruction of the rete ridges. Electron microscopy, too, showed that the atypical melanocytes had irregularly shaped and folded nuclei, one or more nucleoli, and a cytoplasm rich in organelles and polymorphous melanosomes. Investigation with a panel of monoclonal antibodies, on the other hand, revealed the antigen phenotype of a proliferative melanocytic lesion unaccompanied by the plain expression of antigens usually observed in malignant melanoma. In addition, the clinical picture during a 2-year follow-up has been free from signs of locoregional and systemic progression.