Defining Fistular Patterns in Hidradenitis Suppurativa: Impact on the Management.

BACKGROUND: Recent studies suggest that there are different fistular subtypes in hidradenitis suppurativa (HS) patients who are associated with variable therapeutic outcomes. OBJECTIVE: To describe clinical and ultrasound features that characterize the different fistular patterns in HS and to evaluate the response to medical therapies. METHODS: A retrospective study developed by a well-recognized center specialized in HS analyzing both clinical and ultrasound (US) aspects of fistular structures in HS patients was performed. Medical therapy response was evaluated through follow-up visits at Week 24. RESULTS: A total of 117 fistulas detected in the skin of 40 patients were evaluated. Four different types of fistulas were described: dermal fistula (Type A), dermoepidermal fistula (Type B), complex fistula (Type C), and subcutaneous fistula (Type D). Fistulas Type A and B showed a complete resolution after 6 months of different medical therapies in up to 95% and 65% of cases, respectively. Contrary to this, fistulas Type C and D showed no significant response after a medical intervention. CONCLUSION: The US evaluation seems to play an important role to define these important structures that will help the clinician in elaborating a personalized combined medical and surgical management of the HS patient.

Diffuse dermal angiomatosis of the breast: clinical and histopathological features.

INTRODUCTION: Diffuse dermal angiomatosis is an entity in the spectrum of reactive angiomatoses characterized by erythematous plaques that mainly affect the lower extremities of patients with a personal history of peripheral vascular disease. Involvement of the breast is a rare event that has only been described as single cases in women with large breasts. OBJECTIVE: Our main aim is to report three rare cases of diffuse dermal angiomatosis of the breast and to better define their clinical, histopathological, and immunohistochemical characteristics. Comorbidities and management will also be discussed. METHODS: A retrospective search of patients with the diagnosis of diffuse dermal angiomatosis of the breast was made. Databases of three hospitals, Hospital 12 de Octubre (Madrid, Spain), Hospital La Fe (Valencia, Spain), and Clinica Dermatologica, University of Genoa (Italy), were included in the analysis. RESULTS: Three middle-aged women who were heavy smokers were found. Physical examination revealed several livedoid plaques on both breasts. Painful ulceration over the violaceous lesions was observed in two cases. Histological features included a diffuse proliferation of spindle-shaped endothelial cells with focal small vessel formation occupying the full thickness of the dermis with scanty extravasated erythrocytes, showing positivity for CD31, CD34, and SMA-α and negativity for D2-40. Management was focused on a strict control of comorbidities, especially on the cessation of smoking habit that led to a conspicuous improvement in all patients. CONCLUSIONS: We describe all those clinicopathologic features that define diffuse dermal angiomatosis of the breast, which should be considered a distinctive variant into the group of cutaneous angiomatoses. In our experience, a strict control of smoking habit must be the first step in the management of this entity.

Dermatologic adverse events to targeted therapies in lower GI cancers: clinical presentation and management.

OPINION STATEMENT: Rapid advances in drug discovery and the regulatory approval of a number of novel anticancer agents during the past decade pose unique challenges to the oncology community. While the benefits of such therapies receive most attention, adverse events (AEs), especially those pertaining to subspecialties (e.g., dermatology), often are underemphasized. To ensure best clinical outcomes, it would be important to bridge the gap between approval of a new drug and devising effective management strategies for the AEs. With the incorporation of targeted therapies to the treatment paradigm of gastrointestinal malignancies, there has been a significant rise in dermatologic AEs among those treated. In addition to significantly affecting patients' quality of life, these AEs represent a growing problem and are relatively unfamiliar to many oncologists. The issue is further complicated by the lack of evidence-based management guidelines for such AEs in the oncology setting, the "generalizing" of terminology (e.g., rash) for some AEs, as well as an insufficient number of oncodermatologists for assistance with their management. It is important for the oncologist to gain familiarity with the most common, manageable and predictable AEs. Their identification is usually based on medical history, clinical features, and full-body skin examination (FBSE) and at times by obtaining a skin biopsy to aid in diagnosis. Although efforts are underway, presently, there is a paucity of biomarkers (e.g., serologic, genetic) to predict dermatologic AEs. Management often requires a multifaceted approach and includes topical, systemic, surgical, and physical (e.g., cryotherapy) modalities of treatment. Unfortunately, very few clinical trials have focused on this aspect of supportive care; therefore, most data on management derives from anecdotal data. Patients should be encouraged to actively report skin problems, while oncologists should play a vital role in addressing these AEs in their patients. Lastly, further research at the molecular and cellular level may assist in the elucidation of the mechanisms underlying these AEs and their clinical correlates, paving way for the design of effective therapies in this subset of patients.

[Rosacea fulminans: report of two cases]. / Rosácea fulminans inducida por corticoides tópicos. Casos clínicos.

BACKGROUND: Rosacea fulminans is a rare condition, characterized by a sudden onset of papulopustules, cysts, edema, and draining sinuses usually confined to the facial area. It is often accompanied by low-grade fever, myalgias and leukocytosis. Patients usually have a background of mild rosacea. We report two male patients aged 29 and 54 years, presenting with rosacea fulminans and ocular involvement, triggered by the use of topical steroids. Both responded to systemic treatment with corticosteroids, isotretinoin and metronidazole. Rosacea fulminans should be considered as a variant of rosacea that includes papulopustular, ocular, phymatous and erythematotelangiectatic types.

Non-steroidal anti-inflammatory drugs and melanoma.

Inflammation is an important contributor to the development and progression of all human cancers. Inflammatory lipid metabolites, prostaglandins, formed from arachidonic acid by prostaglandin H synthases commonly called cyclooxygenases (COXs), bind to specific receptors that activate signaling pathways driving to the development and progression of tumors. Inhibitors of prostaglandin formation, COX inhibitors, including non-steroidal anti-inflammatory drugs (NSAIDs), are well documented agents that inhibit tumor growth and prevent tumor development specially due to long-term use. NSAIDs also alter gene expression independently of COX inhibition which also appear to contribute to the anti-tumorigenic activity of these drugs. In a dermatologic point of view, most investigations are oriented to improve the current knowledge related to the pathogenesis of malignant melanoma, a prevalent skin cancer characterized by a rapid progression with frequent metastases and a poor response to the different available treatments. In the present issue we review the role of inflammation in cutaneous malignant melanoma and its impact on cancer pathogenesis. This topic represents an exciting new area of research, and could potentially result in new targets for melanoma therapy in the future.

Rosácea fulminans inducida por corticoides tópicos: Casos clínicos / Rosacea fulminans: report of two cases

Background: Rosacea fulminans is a rare condition, characterized by a sudden onset of papulopustules, cysts, edema, and draining sinuses usually confined to the facial area. It is often accompanied by low-grade fever, myalgias and leukocytosis. Patients usually have a background of mild rosacea. We report two male patients aged 29 and 54 years, presenting with rosacea fulminans and ocular involvement, triggered by the use of topical steroids. Both responded to systemic treatment with corticosteroids, isotretinoin and metronidazole. Rosacea fulminans should be considered as a variant of rosacea that includes papulopustular, ocular, phymatous and erythematotelangiectatic types.

Linear syringocystadenoma papilliferum: an uncommon event with a favorable prognosis.

Syringocystadenoma papilliferum (SCAP) is an uncommon cutaneous adnexal tumor of uncertain histogenesis. Various authors have postulated that the tumor differentiates toward apocrine gland, eccrine gland, or the apo-eccrine gland. We present a patient with an unusual linear form.