Perifolliculitis capitis abscedens et suffodiens in a caucasian: diagnostic and therapeutic challenge.

Perifolliculitis capitis abscedens et suffodiens or dissecting cellulitis of the scalp is a rare, chronic destructive folliculitis of the scalp, characterized by painful nodules, purulent drainage, sinus tracts, keloid formation and cicatricial alopecia. The cause of the disease is unknown, but it is similar in many features to hidradenitis suppurativa and acne conglobata. In our case report, the patient's dermatologic appearance included one slightly erythematous, infiltrated alopecic area with draining lesions in the right parietal part of the scalp with a few alopecic areas in other parts of the scalp. The identification of the infectious agent, repeated swabs and KOH examination/or fungal cultures and tissue sampling for histopathologic analysis were necessary to confirm the diagnosis of perifolliculitis capitis abscedens et suffodiens. The patient received systemic antibiotics (azithromycin and amoxicillin-clavulanate) and oral antimycotic therapy (fluconazole), followed by a long period of oral isotretinoin with local skin care, which led to resolution and thus inhibited the evolution to scarring and nodular stage of the disease. Thus, such combined approach could be useful for other patients with these dermatologic problems.

Prevention of complications in dermatosurgery.

Dermatosurgery has become ever more popular and important in recent years, mostly due to the increasing prevalence of skin malignancies. It also encompasses a wide variety of methods to remove or modify skin tissue for numerous cosmetic reasons. Nowadays, many dermatologists provide complete dermatologic care for their patients, including surgery. Therefore, it is important to be aware of the possible complications and to be able to manage them properly. Complications in cutaneous surgery are not very often, but they can be serious and worrisome including bleeding, infections, allergic reactions, syncope, wound dehiscence, necrosis, and others. In this article special attention is given to bleeding, which is the most common complication in this field. The best way to reduce the number of possible complications is to recognize patients at risk. Thus, complete history and physical examination are required before performing any dermatosurgical operation.

UV damage of the hair.

Hair is a very important for our self-confidence as well as a very important part of appearance and self-concept. It reflects our personality and hair loss or hair damages are considered aesthetic imperfections and social handicap. Outward part of the hair is a "hair shaft" keratin fiber structure sensible to external effects whether they are mechanical, physical or chemical. Excessive sun exposition is the most frequent cause of hair shaft's structural impairment. Photochemical impairment of the hair includes degradation and loss of hair proteins as well as degradation of hair pigment. Hair protein degradation is induced by wavelengths of 254-400 nm. UVB radiation is responsible for hair protein loss and UVA radiation is responsible for color changes. Absorption of radiation in photosensitive amino acids of the hair and their photochemical degradation is producing free radicals. They have adverse impact on hair proteins, especially keratin. Melanin can partially immobilize free radicals and block their entrance in keratin matrix. It also absorbs and filters adverse UV radiations. Therefore melanin is important for direct and indirect protection of hair proteins. Protecting the cuticle is very important for keeping hair shaft's integrity. One can achieve that by avoiding noxious impacts or by implementation of hair care products with UV filters. Nowadays major studies and researches are conducted in order to create hair care products that prevent hair damage.

Acroangiodermatitis (pseudo-Kaposi sarcoma): three case reports.

Acroangiodermatitis (synonym pseudo-Kaposi sarcoma) is a dermatological condition characterized by purple-colored nodules, plaques or patches, mostly on the extensor surfaces of lower extremities, usually in patients with chronic venous insufficiency and arteriovenous malformations of the legs, but also in hemodialysis patients with iatrogenic arteriovenous shunts, paralyzed limbs and amputation stumps. Acroangiodermatitis in patients with chronic venous insufficiency manifests usually as bilateral skin lesions located on the dorsa of the feet, halux and second toe, or on the medial aspect of lower legs. Acroangiodermatitis may look like Kaposi sarcoma, but in contrast to Kaposi sarcoma, acroangiodermatitis is not characterized by progression of changes, and there is a lack of spindle cells and silt-like vessels on histopathologic analysis. Three cases of acroangiodermatitis encountered in our clinical practice are described. The patients presented with livid-erythematous patches on lower legs and skin changes connected with chronic venous insufficiency, treated at the Department Phlebology Unit. Results of the histopathologic analysis indicated acroangiodermatitis. Thus, in clinical practice it is important to recognize acroangiodermatitis and to exclude Kaposi sarcoma, as sometimes there is similarity with this entity. Topical therapy with neutral and local corticosteroid preparations is often useful, however, the use of compressive bandages and dermatologic follow up are recommended.

Results of the determination of serum markers in patients with malignant melanoma.

Although there is no routine procedure for determination of serum markers in patients with malignant melanoma (MM), some markers are being studied as potentially useful prognostic tools. Serum lactate dehydrogenase (LDH), protein S-100B, melanoma-inhibiting activity (MIA) and tyrosinase may correlate with melanoma progression. In this study, the results of determination of S100 protein, LDH, MIA and tyrosinase in the serum of 50 patients with MM (stages I-IV) were determined. The increased values of MIA were found in 26% patients in stage I, while in 50% patients in stage IV Increased S-100 protein was found in 13% patients in stage I while in 50% patients in stage IV. The increased values of LDH were found in 26% patients in stage I, while in 25% patients in stage IV. The positive serum tyrosinase was noticed in 17.3% patients in stage II, while in 25% patients in stage IV. The obtained results have revealed no significant differences between the groups in higher and lower stages of the disease, indicating that blood markers are not reliable prognostic factors for MM progression.