Atypical pediatric presentation of alopecic and aseptic nodules of the scalp with features of dissecting cellulitis.

Alopecic and aseptic nodules of the scalp (AANS) and dissecting cellulitis of the scalp (DCS) are rare, closely related conditions of young men that exclusively affect the hair-bearing scalp. We describe a 9-year-old boy who presented with a 6-year history of chronically relapsing, sterile, partially scarring nodules of the scalp and facial skin. Histopathology revealed mixed inflammatory infiltrates consisting of neutrophils, macrophages, lymphocytes, and plasma cells in the deep dermis, consistent with the morphological pattern of suppurative, partly granulomatous dermatitis. The present atypical case is characterized by prepubertal onset and facial involvement which, to our knowledge, has not yet been described before, may be included in the spectrum of "typical" AANS and "typical" DCS.

Impact of extracorporeal photopheresis on blood and coagulation parameters.

Extracorporeal photopheresis (ECP) is considered a safe treatment modality. We aimed to assess blood parameters including coagulation during ECP over time. We performed a long-term retrospective single-center chart review (laboratory parameters) of adult patients (n = 172) who had received ECP for any indication. We observed a significant decrease (p < 0.05) in erythrocytes, hemoglobin, and leukocytes compared to baseline levels after only one ECP procedure. This decrease persisted after 3-, 6-, 9-, and 12-months of ECP. A significant pathological decline of hemoglobin was observed in a higher proportion (26.4% and 25.2%, respectively) of patients after 6 (p = 0.0007) and 12 (p = 0.012) months of ECP. Mean corpuscular volume as well as hematocrit was significantly decreased at 3-, 6-, 9-, and 12-months of evaluation compared to baseline (p < 0.05). After 9 and 12 months of ECP we observed a further decline in lymphocyte counts (p < 0.05). Various coagulation parameters did not change significantly during ECP treatment. Even though not all alterations observed in peripheral blood of ECP patients in the present study were of clinical significance, risk for developing persistent anemia must be considered in patients undergoing ECP.

Impact of Extracorporeal Photopheresis on Blood Parameters of Atopic Dermatitis Patients.

BACKGROUND: Extracorporeal photopheresis (ECP) is a safe treatment modality with immunomodulatory effects. The latter may also explain efficacy of ECP in patients with atopic dermatitis (AD). OBJECTIVE: We aimed to assess various blood parameters of AD patients who underwent ECP over a maximum 1-year treatment period. METHODS: We performed a retrospective single-center chart review (clinical data, laboratory data) of adult patients with AD who had received for at least 3 ECP cycles, in part combined with other treatment modalities. RESULTS: We studied 60 patients with AD (85% extrinsic type, 15% intrinsic type) who had median number of 14 (4-23) ECP cycles within a maximum 1-year treatment. When compared with baseline, leukocytes and lymphocytes remained significantly decreased after 3-, 6-, 9-, and 12-month ECP ( P = 0.014 and P = 0.0012, respectively). A significant decline of eosinophils, as well as eosinophilic cationic protein levels, was observed after 3-, 6-, 9-, and 12-month ECPs ( P = 0.011 and P = 0.0017, respectively). Total serum immunoglobulin E (IgE), as well as lactate dehydrogenase, were significantly decreased at 3-, 6-, 9-, and 12-month evaluation compared with baseline ( P < 0.00001 and P = 0.00007, respectively). Patients with slight or marked improvement of AD after their ECP treatment period had significantly higher median baseline serum IgE levels than patients who did not respond to ECP ( P = 0.0023). CONCLUSIONS: Several laboratory parameters, including eosinophils, eosinophilic cationic protein, total serum IgE, and lactate dehydrogenase, which declined under ECP, are well-known disease biomarkers for AD patients. With normalization of the abovementioned laboratory parameters, a clinical response to ECP treatment was observed in almost two thirds of patients, confirming that ECP may be an effective combination treatment modality for AD.

Patients with melanoma of unknown primary show better outcome under immune checkpoint inhibitor therapy than patients with known primary: preliminary results.

Background: Melanoma of unknown primary (MUP) is an uncommon clinical subtype of melanoma of known primary (MKP). Objectives: We aimed to compare treatment outcomes of MUP and MKP patients who had undergone therapy with immune checkpoint inhibitors (ICPI). Methods: We studied 41 metastatic melanoma patients (32 with MKP and 9 with MUP) with an indication for ICPI. Results: Clinical characteristics such as age, gender, stage of disease, etc., did not significantly differ (P < .05) between MUP and MKP patients. 20/32 (62.5%) melanoma-specific deaths (MSD) were observed in the MKP group, whereas 2/9 (22.2%) were detected in the MUP group (P = .035). On logistic regression, the MUP status proved to be an independent predictor for a more favorable outcome under immunotherapy when compared to MKP (P = .030). Conclusion: Our preliminary results indicate that MUP patients show better clinical outcome under ICPI when compared to MKP.

A para-canalicular abscess resembling an inflamed chalazion.

Background. Lacrimal infections by Actinomyces are rare and commonly misdiagnosed for long periods of time. They account for 2% of all lacrimal diseases. Case Report. We report a case of a 70-year-old female patient suffering from a para-canalicular abscess in the medial canthus of the left eye, beside the lower punctum lacrimale, resembling a chalazion. Purulence exited from the punctum lacrimale due to inflammation of the inferior canaliculus (canaliculitis). When pressure was applied to the mass, a second exit of purulence was also observed under the palpebral conjunctiva below the lacrimal caruncle. A surgical excision was performed followed by administration of local antibiotic therapy. The histopathological examination of the extracted mass revealed the existence of actinomycosis. Conclusion. Persistent or recurrent infections and lumps of the eyelids should be thoroughly investigated. Actinomyces as a causative agent should be considered. Differential diagnosis is broad and should include canaliculitis, chalazion, and multiple types of neoplasias. For this reason, in nonconclusive cases, a histopathological examination should be performed.