Peristomal Skin Complications: Detailed Analysis of a Web-Based Survey and Predictive Risk Factors.

Patients with a stoma are at risk of developing peristomal skin complications (PSCs) that can negatively impact their quality of life. This study aims to identify potential risk factors for dermatitis, pruritis/xerosis, infections, and ulcerations among patients with a stoma and evaluate preventive measures. This cross-sectional study involved data regarding 232 Italian patients with a stoma. A questionnaire was used to collect patient characteristics, comorbidities, and stoma management data. The most frequent PSCs observed were dermatitis and pruritis/xerosis in approximately 60% of patients. Psoriasis was strongly correlated with dermatitis, while being overweight or obese increased the risk of pruritis/xerosis. Class 2 obesity and atopic dermatitis were associated with an increased risk of infections. Being underweight, completely nonautonomous, and having inflammatory bowel disease were associated with a higher risk of ulcerations, while radiotherapy was a strong risk factor for ulceration. Preventive measures such as using hydrocolloid barriers, TNT gauze cleansing, and low pH detergent were effective in preventing dermatitis. Appropriate stoma care and maintenance, including the use of protective film and careful monitoring of weight and comorbidities, are crucial in minimizing the risk of complications associated with a stoma.

Metastatic porocarcinoma achieving complete radiological and clinical response with pembrolizumab.

A 67-year-old woman presented in 2012 with a crusty nodule on the left lower limb. Histopathological examination at this time reported a poorly differentiated squamous cell carcinoma (SCC). Two years later, she underwent lymphadenectomy and radiotherapy due to unilateral inguinal and pelvic sidewall nodal metastases. The following year she required excision of two subcutaneous lesions, reported pathologically to be SCC metastases. Further imaging following cyberknife radiotherapy to new brain metastases demonstrated widespread metastatic visceral disease. Twelve cycles of carboplatin and capecitabine failed to halt disease progression. In February 2017, she commenced pembrolizumab, achieving an excellent response and currently has no clinical or radiological evidence of disease. Given the unusual behaviour of her cancer, a histopathological review was requested. The diagnosis was revised to that of porocarcinoma (PC). This represents the first documented case of PC treated with immunotherapy. As of March 2019, the patient remains free of disease.

The microbiome and its relevance in complex wounds.

Chronic wounds include arterial, venous, diabetic and pressure ulcers. The term "chronic wound" defines wounds that have not healed within three months. The possible causes that transform a simple wound into a chronic one are the object of study, and research has focused on infection as one of the crucial factors in producing and maintaining chronic wounds. In fact, 60% of chronic wounds are colonized by bacteria living in a biofilm. A biofilm is a complex aggregation of microorganisms characterized by the secretion of an adhesive and protective matrix. The two most common biofilm generators are Staphylococcus aureus and Pseudomonas aeruginosa. Several conditions constitute risk factors for the formation of biofilms, such as diabetes mellitus, venous insufficiency, malnutrition, cancer, oedema, and repetitive trauma. There are no standard diagnostic tests to determine the presence of biofilms, but there are several clinical indications which can help, and performing a tissue biopsy is better than a swab. Wound bed preparation is a crucial part of biofilm treatment and surgical or conservative sharp wound debridement are the preferred treatments that are effective in removing or reducing biofilms. We report three cases of complex wounds and their treatment.

The management of autoimmune diseases in preconception, pregnancy and lactation.

Autoimmune skin diseases can occur in pregnancy, and the treatment is often required to control both maternal disease and fetal outcomes. Moreover, the control of mother's diseases and fetal health is a challenge for dermatologists because of the teratogenic effects of many drugs. So it is important to know exactly which drugs can be administrated in the different stages of pregnancy. Authors reviewing the literature and relying on daily dermatological experience agree that during pregnancy effective drug treatment of autoimmune diseases is possible with reasonable safety for the fetus/child and lactation. During pregnancy and lactation patients with autoimmune disorders should be evaluated carefully, and the benefit-risk of continued therapy should be reassessed. The points to consider presented in this review show that, despite limitations, effective drug treatment of autoimmune diseases is possible with reasonable safety for the fetus/child during pregnancy and lactation. Prior to conception it is necessary to explain to the patients what the risks of pregnancy are. It is preferred to avoid a pregnancy in active disease and replace treatment with an allowed therapy. During pregnancy it is necessary to avoid treatment with mycophenolate mofetil, cyclophosphamide and methotrexate. In some very particular cases, as life saver drug, cyclosporine and rituximab can be used. Finally, some drugs can be used monitoring the patient, in particular, systemic corticosteroid at low dosage, dapsone, azathioprine, iloprost and sildenafil.

Acute localized exanthem due to Coxsackievirus A4.

Enteroviruses are the leading cause of exanthems in children, especially during summer and autumn. Enterovirus infections may occur in epidemics or small outbreaks. A 30-year-old woman presented with a three-day history of an erythematous maculopapular skin rash with petechiae localized exclusively under the nipple of the right breast. The skin eruption was associated with an erythematous-petechial enanthem. The patient complained of low-grade fever, headache, asthenia, sore throat and arthromyalgias. IgM (1:128) and IgG (1:640) antibodies against Coxsackievirus A4 were detected by the virus neutralization test. Reverse transcriptase real time polymerase chain reaction (PCR) assay detected enterovirus RNA in the patient's plasma and faeces. Diagnosis of an acute localized exanthem due to Coxsachievirus A4 was performed. Skin lesions improved in seven days and completely cleared in two weeks without any systemic or topical treatment. Physicians should be aware of the possibility that enteroviruses may determine localized skin eruptions in addition to hand-foot-mouth disease and atypical exanthems. Viral infections should be considered in the differential diagnosis of localized dermatitis especially when the skin eruption is associated with enanthems and with systemic symptoms.