Dermato

There has recently been an increased interest in the use of novel automated technologies for the early detection of skin malignancies. We performed a retrospective analysis of the clinical effectiveness of electrical impedance spectroscopy (EIS) in detecting malignancies in an everyday clinical setting. After a thorough visual examination and dermoscopy, 909 abnormal lesions suspicious for malignancy were detected in 481 patients who presented in a private dermatology practice between 2015 and 2017 and evaluated with the EIS system. The histopathological results of the excised lesions were compared to the Neviscore, the output of the device. In total, 443 lesions (49%) received a negative Neviscore and were thus benign. On the other hand, 466 lesions received a positive Neviscore, indicating aberrations of the physiological cell structure. Of the 909 lesions, 45% were excised after visual and EIS examination. Of the excised lesions, 16% were diagnosed histopathologically as malignant. The EIS detected melanomas with 100% accuracy. The number needed to excise decreased from 17.5 to 7.8. The predictive value for a negative Neviscore was 98.9% (true negative results). EIS was found to be a valuable adjunct support tool when making clinical assessments of potentially malignant lesions. Full article

The purpose was to evaluate the prognostic performance of the derived neutrophil–to-lymphocyte ratio (dNLR) in patients with metastatic cutaneous melanoma (CM) treated with immune checkpoint inhibitors (ICI). We retrospectively investigated 41 CM patients with stage IV disease who had the indication for treatment with ICI. dNLR as well as NLR were routinely determined prior to the start of ICI treatment. The dNLR and NLR were calculated as follows: dNLR = absolute neutrophil counts (ANC)/white blood cell count −ANC and NRL = ANC/absolute lymphocyte counts, respectively. Follow-up of the patients was performed in line with current guidelines. In univariate analysis, dNLR (p = 0.027 and p = 0.032) as well as NLR (p = 0.0023 and p = 0.0036) were the only parameters which were significantly associated with the best overall response (BOR) and disease control rate (DCR) on ROC curve analyses. NLR negatively correlated with CM-specific survival (r = −0.32, p = 0.043). CM-specific deaths were significantly associated with the absence of immune-related adverse events (p = 0.043), elevated S100 calcium-binding protein B (S100B) at baseline (p = 0.0006), and dNLR (p = 0.024). In multivariate analyses, NLR was the only significant independent predictor for BOR (p = 0.014; odds ratio: 1.7; and 95% CI 1.11 to 2.61) and DCR (p = 0.019; odds ratio: 1.5; and 95% CI 1.07 to 2.19). Regarding CM-specific death, however, normal baseline S100B was the only significant independent predictor (p = 0.0020; odds ratio: 0.074; and 95% CI 0.014 to 0.38) for survival. Our data demonstrate that baseline NLR seems to be superior to dNLR in the prediction of ICI response in CM patients. Full article

Immune checkpoint inhibitors (ICI) and other antineoplastic treatment regimens can trigger cutaneous immune-related adverse events (irAEs). There is a tendency for underreporting of such cases, as cutaneous irAEs are typically perceived as mild and transient. However, more serious cutaneous irAEs can occur which, despite their lower frequency, deserve attention and require specific care. Here, we report a case of extensive hyperpigmented scleroderma-like lesions (SLL) on the lower extremities under combination treatment with pembrolizumab and pemetrexed in a patient with metastatic non-small cell lung cancer. The present case in conjunction with a review of the current literature underscores the potential risk of developing SLL under treatment with anti-PD-1 antibody and/or pemetrexed. Moreover, it is possible that this particular combination treatment synergistically increases the risk of SLL. As a result, more such cases may arise in the future, as ICI/pemetrexed combination treatment might be employed more often. As drug-induced SLL usually require systemic treatment with high dose-corticosteroids, physicians should be aware of SLL as an irAE when cancer patients present with sclerotic and/or fibrotic skin lesions. Full article

As the skin is an accessible organ and many dermatological diagnostics still rely on the visual examination and palpation of the lesions, dermatology could be dramatically impacted by augmented and virtual reality technologies. If the emergence of such tools raised enormous interest in the dermatological community, we must admit that augmented and virtual reality have not experienced the same breakthrough in dermatology as they have in surgery. In this article, we investigate the status of such technologies in dermatology and review their current use in education, diagnostics, and dermatologic surgery; additionally, we try to predict how it might evolve in the near future. Full article

About 20% of patients with systemic sclerosis have symptoms of another connective tissue disease (CTD). Interstitial lung disease (ILD) is one of the most common organ manifestations in systemic sclerosis (SSc) as well as viral illnesses, such as COVID-19, and can lead not only to diffuse alveolar damage, but also trigger an exacerbation of fibrosis among patients with preexisting ILD. It is also associated with substantial morbidity and mortality. According to the World Scleroderma Foundation, SSc-ILD can mask or mimic early COVID-19 lesions and there are no available computed tomography guidelines on how to discern those two conditions. We present a case of systemic sclerosis exacerbation after COVID-19 in a patient with SSc-Lupus Overlap Syndrome. Full article

Skin-barrier restoration following abrasive trauma is facilitated by mediator release from skin-resident cells, a process that has been investigated primarily in mice or simplified human systems with previous studies focusing on a limited number of biomarkers. Here, we demonstrate how early events caused by skin-barrier disruption can be studied in a human ex vivo skin model. Ten relevant biomarkers were recovered from the interstitial fluid by skin microdialysis with subsequent sample analysis using a multiplex platform. As a control, the biomarker profiles obtained from microdialysis sampling were compared to profiles of skin biopsy homogenates. We found that nine (GM-CSF, CXCL1/GROα, CXCL8/IL-8 CXCL10/IP-10, IL-1α, IL-6, MIF, TNF-α, and VEGF) of the 10 biomarkers were significantly upregulated in response to abrasive trauma. Only dialysate levels of CCL27/CTACK were unaffected by skin abrasion. Biomarker levels in the homogenates corresponded to dialysate levels for CCL27/CTACK, CXCL1/GROα, CXCL8/IL-8, and IL-6. However, IL-1α showed an inverse trend in response to trauma, and biopsy levels of MIF were unchanged. GM-CSF, CXCL10/IP-10, TNF-α, and VEGF were not detected in the biopsy homogenates. Our results suggest that the human ex vivo skin model is a reliable approach to study early events after disruption of the skin barrier. Full article

Klippel-Trenaunay syndrome (KTS) is a rare complex vascular syndrome with limb hypertrophy. KTS is diagnosed if at least two of the three features of capillary malformation, venous malformation, and soft tissue and/or bone overgrowth are present. Of these, capillary malformation (i.e., port-wine stain) is the most commonly observed feature but may be absent in atypical KTS. We herein report a case of atypical KTS with venous malformation and unilateral soft tissue hypertrophy. Full article

Dermal melanocytic disorders present as bluish pigmentation on the skin. Several entities including Mongolian spot, aberrant Mongolian spot, nevus of Ota, and nevus of Ito have been reported. It is often difficult to distinguish between the different entities from their overlapping features. Although they share similar etiologies and histologic findings, their co-morbidities and prognosis differ. In this paper, we report four cases of dermal melanocytic disorders of which we were not able to make a clear-cut diagnosis. Also, we briefly review the dermal melanocytic disorders. Full article

Primary cutaneous amyloidoses (PCA) are a group of conditions characterized by deposition of amyloid in previously normal skin, without association with other skin or systemic diseases. We describe a Kazakhstani female with a 30-year history of increasingly spreading hyperpigmented macular as well papular skin lesions on her upper trunk accompanied by pruritus. Moreover, her medical history included intensely rubbing her skin with a cotton towel following bathing and showering. On the basis of the clinical and histopathological findings, the diagnosis of biphasic cutaneous amyloidosis was made. The present unusual case of biphasic cutaneous amyloidosis can be subsumed under mechanically-induced forms of cutaneous amyloidosis. In conclusion, the present case underscores the necessity to explore carefully the patient’s history in order to discover the cause of PCA. Full article

Phytophotodermatitis is a cutaneous phototoxic reaction resulting from contact with plant compounds such as furocoumarin in citrus fruits, followed by exposure to ultraviolet light. Erythema and vesicles appear on the contact area, followed by hyperpigmented lesions. Hyperpigmentation may exist for weeks to months before fading but can remain up to several years. Diagnosis is often challenging due to the variety of clinical presentations, and it is not always easy to identify trigger exposures. A detailed history is key to diagnosis. We herein report a case of lime-induced phytophotodermatitis which was initially mistaken for unilateral lentiginosis. The patient underwent Q-switched Nd:YAG laser and intense pulsed light (IPL) treatment with immediate improvement. Full article

Mutations in the promoter of the telomerase reverse transcriptase (TERT) gene have been described as the most common hot-spot mutations in different solid tumors. High frequencies of TERT promoter mutations have been reported to occur in tumors arising in tissues with low rates of self-renewal. For cutaneous vascular tumors, the prevalence of TERT promoter mutations has not yet been investigated in larger mixed cohorts. With targeted next-generation sequencing (NGS), we screened for different known recurrent TERT promoter mutations in various cutaneous vascular proliferations. In our cohort of 104 representative cutaneous vascular proliferations, we identified 7 TERT promoter mutations. We could show that 4 of 64 (6.3%) hemangiomas and vascular malformations harbored TERT promoter mutations (1 Chr.5:1295228 C > T mutations, 1 Chr.5:1295228_9 CC > TT mutation, and 2 Chr.5:1295250 C > T mutations), 1 of 19 (5.3%) angiosarcomas harbored a Chr.5:1295250 C > T TERT promoter mutation, and 2 of 21 (9.5%) Kaposi’s sarcomas harbored TERT promoter mutations (2 Chr.5:1295250 C > T mutations). To our knowledge, this is the first general description of the distribution of TERT promoter mutations in a mixed cohort of cutaneous vascular tumors, revealing that TERT promoter mutations seem to occur with low prevalence in both benign and malignant cutaneous vascular proliferations. Full article

(1) Background: Titanium dioxide (TiO₂) consists of three polymorphs, including anatase, rutile and brookite. This work aimed to elucidate the influence of rutile and anatase forms in the performance of sunscreens formulated with green coffee oil (GCO) from coffee beans discarded in the agri-food industry. (2) Methods: TiO₂ particles were characterized in terms of size and wettability. The sunscreens formulated with GCO were characterized regarding the droplet size, rheology, texture profile analysis (TPA), in vitro Sun Protection Factor and Water Resistance Retention. Topical delivery and permeation studies were performed to confirm caffeine release and skin penetration. (3) Results: Particle size distributions of rutile and anatase TiO₂ particles were similar, however, smaller droplets as well as decreased viscosity and increased thixotropy were obtained for anatase TiO₂ and GCO formulation compared to rutile form formulations. Notwithstanding, all formulations exhibited linear viscoelastic behavior. Regarding the TPA, a wide range of mechanical properties improved mainly by GCO rather than TiO₂ form has been demonstrated. The influence of TiO₂ form on UV protection was better evidenced in absence of GCO. The sunscreen formulations containing GCO presented a favorable topical delivery as confirmed by caffeine release and permeation. (4) Conclusions: Both TiO₂ forms combined with GCO provided suitable properties including an effective ultraviolet (UV)-light protection. Full article