Frontal Fibrosing Alopecia: Role of Dermoscopy in Differential Diagnosis.

Frontal fibrosing alopecia (FFA) is more common in postmenopausal women, but it can occur in younger women. Some authors consider FFA to be a distinct frontal variant of lichen planopilaris. From a clinical point of view, this relatively uncommon condition is characterized by progressive frontotemporal recession due to inflammatory destruction of hair follicles. Dermoscopy can be very useful, as the differential diagnosis between traction alopecia, alopecia areata, FFA and cicatricial marginal alopecia may be difficult. It is not clear whether or not treatment alters the natural history of the disease - the disease stabilized with time in most of the patients with or without continuing treatment. Here we report a case of a 50-year-old woman with FFA and discuss the relevance of dermoscopy in the differential diagnosis of this disease.

A case of transient zinc deficiency in a breast-fed preterm infant successfully treated with oral zinc supplementation: review of zinc metabolism and related diseases.

A 15-week-old baby girl, born at the 29 week of gestation, presented with a four-week history of demarcated, erythematous, erosive and exudative patches on the perianal, perioral and acral areas. A clinical diagnosis of zinc deficiency was considered. Serum zinc level was decreased (0.5 mg/L; normal 0.70-1.50 mg/L), the mother's serum and milk had normal zinc values. The baby was started an empiric trial of oral zinc supplementation (3 mg zinc gluconate/kg body weight/ day) with complete healing of lesions after two weeks. Treatment was gradually withdrawn at six months of age with no relapse. Transient zinc deficiency due to increased zinc requirements in breast-fed mainly preterm infants is a condition similar to acrodermatitis enteropathica, an autosomal recessive disorder of enteric zinc absorption affecting almost exclusively not breast-fed infants. Early recognition of the disorder and introduction of zinc supplementation rapidly reverses transient zinc deficiency, that probably will become more and more frequent, because of the rising rate of premature infants with breast-feeding only.

Terbinafine-induced acute generalized exanthematous pustulosis.

Terbinafine is an allylamine antifungal agent, effective in the treatment of dermatomycoses. Many cutaneous adverse reactions have been reported (in about 3% of treated patients). Furthermore terbinafine has been associated with pustular eruptions, as well as the induction and exacerbation of pre-existing psoriasis and acute generalized exanthematous pustulosis (AGEP). AGEP is an uncommon aseptic pustular eruption, classified for many years as a pustular psoriasis, that usually follows recent administration of oral or parenteral drugs. The disease is most frequently triggered by antibiotics, most of all aminopenicillins and macrolides. Characteristic AGEP features include the sudden onset of fever above 38 C with widespread erythematous eruption, rapidly progressing to a fine, non-follicular, micropustular rash. Leucocytosis is generally present, sometimes associated with eosinophilia. The illness usually resolves spontaneously with the fever and the pustulation clearing within 15 days, sometimes followed by desquamation. Hystopathology shows non-follicular spongiotic pustules in the epidermis filled with neutrophils, a mixed perivascular infiltrate of neutrophils and occasional eosinophils with papillary dermal oedema. On this subject, Sideroff et al. recently elaborated a validation score based on morphology, histological criteria, and disease course. The pathogenetic mechanism which leads to the induction of AGEP by some medicines has still not been clarified, but T cells seem to play a crucial role. The authors report a case of a patient with terbinafine-induced AGEP and a review of the literature about this topic. The case illustrates once again the role of terbinafine in AGEP and reminds us that early diagnosis of AGEP is important to avoid unnecessary investigations and/or the administration of antibiotics.

Malignant nodular hidradenoma of the skin: report of seven cases.

BACKGROUND: Malignant nodular hidradenoma (MNH) is an infrequent, highly malignant, primary skin tumour derived from eccrine sweat glands. Most tumours occur in elderly individuals. MNH has very poor prognosis, high recurrence and a high rate of metastases. The best method of treatment is still unclear: radical surgical excision is widely used, and selective lymph node dissection is also suggested. The value of the adjuvant radiotherapy and chemotherapy has not been confirmed. PATIENTS AND TREATMENT: Seven MNH patients (4 men, 3 women, age 60-87 years) were treated between 1991 and 2007 in the Dermatology Unit of San Donato Hospital of Arezzo and in the Section of Dermatology of University of Siena, Italy. Tumours varied from 0.8 to 4.4 cm in size. All patients underwent local excision; five also had lymph node dissection. One patient underwent adjuvant radiotherapy, and three received chemotherapy. RESULTS: Six of seven patients died, with survival varying from 15 to 45 months. Distant metastases occurred in two patients. Survival time was inversely proportional to the size of the tumour. CONCLUSIONS: MNH is an aggressive tumour and should be diagnosed and excised as early as possible. Histological parameters are paramount, but correct diagnosis also calls for attention to clinical presentation and any history of recurrence or recent enlargement of long-standing lesions. In our experience, radiotherapy and chemotherapy do not seem to prolong survival.