1 Impacts of the COVID-19 Pandemic to the Skin and to Professionals Caring for the Skin View or Download PDF   , Antonio Chuh1,2*
This is a brief review on the impact of Coronavirus disease 2019 (COVID-19) pandemic on the skin and the practice of dermatology.   There are many skin manifestations of COVID-19. The most characteristic one would be multiple acrally-located erythematous perniosis-like swellings occuring in babies and small children [1-4]. These lesions are usually late in presentation. Vesicular eruptions appear early in the phase of the disease [1]. These two types of lesions are the most specific patterns [1].   Non-pitting oedema on the hands and feet can sometimes be seen. Less commonly, lesions are seen on the face, trunk and ears [4]. They are mainly seen in the European countries and Middle East. To the best knowledge of the Editor, no such lesion has yet been reported in infants and young children in Asia, including South-East Asia. Other skin manifestations include a petechial rash on the trunk, non-specific exanthem and acute urticaria [5-8].   The impacts of COVID-19 are beyond cutaneous manifestations for the infected patients. As an example, for children with severe skin diseases, unrelated to COVID-19 and on immunosuppressant therapies, most pediatric dermatologists have paused or reduced the frequency of laboratory monitoring for adverse effects of the medications [9].   The Editor has previously reported on the close interactions of the cutis and the psyche [10]. During the pandemic, people are experiencing fear, distress and helplessness [11]. These can precipitate or perpetuate cutaneous diseases. The use of protective gears can lead to irritant and allergic contact dermatitis, intertrigo, and lichen simplex. People are afraid to attend surgeries and hospitals. Their thresholds for seeking proper medical attention are raised. In the surgery of the Editor, some long-term or new patients are attending with severe psoriasis, nodulocystic acne, generalised dermatophytoses and other severe skin conditions which could have been well controlled if they seek earlier help.
2 Recent Highlights and Expert Opinion on Psoriasis Management View or Download PDF   , Farid Menaa1,2*
Psoriasis is a common chronic inflammatory skin disorder characterized by red, flaky, crusty, scaly, itchy, thickened plaques (Fig. 1), which affects approximately 2% of the population worldwide [1-2]. Increasing evidences supports the recognition of psoriasis as a multisystem chronic inflammatory disorder with multiple associated comorbidities, including myocardial infarction, metabolic syndrome, diabetes (Type 2 diabetes) and/or Crohn’s disease [3-6].
3 Paraneoplastic Bullous Pemphigoid: Myth or Reality? A Case Report , Sara Dahhouki1*, S Mrabat1, Z Douhi1, S Elloudi1, H Baybay1, FZ Mernissi1
Bullous Pemphigoid (BP) is an autoimmune sub epidermal blistering disorder. In the literature, several cases of pemphigoid associated with malignancies were reported. The association of bullous pemphigoid with cancer is still controversial. Moreover, the incidence of paraneoplastic dermatological manifestations is very low, and the incidence of paraneoplastic bullous pemphigoid is even lower. We report a 56-year-old man with paraneoplastic bullous pemphigoid which helps to discover an urothelial malignant tumor.
4 Firm Yellowish Nodule on the Face of a 7-year-Old Child: What is Your Diagnosis? , Dahhouki Sara1, Bennani Mounia1, Douhi Zakia1, Elloudi Sara1, Baybay Hanane1, Mernissi Fatima Zahra1, Fadel Reda2, Kamal Dounia2, Tahiri Layla3, Hammas Naoual3
A 7 year old girl presented at our clinic with a 3 months history of cutanuous nodule on her face, which had gradually increased in size, non painless and pruritic. The dermatological examination revealed a 2 cm size firm erythematosis nodule, yellowish in the center, on the mental region. There was no mucosal involvement. The general physical examination was normal, with no signs of lymph node enlargement. Dermoscopy showed yellowish homogeneous areas in the center of the lesion, whereas, in the outer part, was a milky-red area, traversed by large telangiectatic vessels on a red-orange background. Histology revealed a normal epidermis, in the dermis, a nappe of cellular populations, made up of large, macrophagic-looking cells, with image of phagocytosis of lymphoid cells, was noted. The rest of the dermis showed dense inflammatory infiltrates, composed of neutrophils, plasma cells, lymphocytes and histiocytes. A phenomenon of emperipolesisis was clearly defined. Immunohistochemical staining revealed that the histiocytes were strongly positive for S100 protein, weakly positive for CD68 and negative for CD1a. Cell blood count, liver and kidney function test, chest x-ray and abdominal ultrasonography were all normal.
5 A New Dermatological Research Focus in the Era of COVID-19 Pandemic , Hsuan-Hsiang Chen1*
In the era of COVID-19 pandemic, the significance of skin manifestations is more important than we think. Dermatologists have a unique opportunity to adequately describe skin manifestations of COVID-19, and make our contribution during this pandemic.
6 A Naevus Sebaceous with Tumour of the Follicular Infundibulum, Trichilemmoma, Desmoplastic Trichilemmoma, Apocrine Adenoma and Syringocystadenoma Papilliferum: Report of a Case , Coyne JD1*, Chatzipantelis P2
Nevus Sebaceous of Jadasson (SNJ) has been reported with various coexisting benign and rarely with malignant neoplasms. We present a case of SNJ with five benign epidermal and adnexal neoplasms, some of them with unusual features. Histologically, all of the typical findings of SNJ appear in our case along with a) a focal area of basaloid proliferation (tumour of the follicular infundibulum), b) more desmoplastic area with features of desmoplastic trichilemmoma and c) a nodular area with cytological features of trichilemmoma. In addition d) apocrine adenoma and e) syringocystadenoma papilliferum were present in adjacent areas. There were no features of malignancy. In summary, we report a complex case of SNJ with five unusual and concurrent neoplastic variants.
7 Locally Aggressive Trichoblastoma or Basal Cell Carcinoma? What is the Benefit of Dermoscopy? A Case Report , S Dahhouki1*, J Ziani1, Z Douhi1, S Elloudi1, H Baybay1, FZ Mernissi1, G Cherkaoui Belmaati2, MA Houssa2, A Oufkir2
Trichoblastoma is a predominantly dermal benign hair follicle tumor, characterized by well-circumscribed nests and cords of bland follicular basaloid cells in close association with stroma. The aggressive form is rare and its diagnosis remains difficult, because of its similarities with basal cell carcinoma. We report a case of an 80 years old male patient and discuss the morphological differences between the two tumors.
8 Atypical Fibroxanthoma of the Scalp in a Young Woman: A Case Report , Khadija Elboukhari1*, Mounia Bennani1, Sara Elloudi1, Zakia Douhi1, Hanane Baybay1, Fatima Zahra Mernissi1, Afaf Amarti2
Atypical fibroxanthoma, is an uncommon tumor of fibrohistiocytic mesenchymal origin that occurs on the sun-damaged skin of elderly men. The clinical presentation is a solitary cutaneous nodule. The diagnosis is made by histology and immunohistochemistry. The large excision is the mainstay therapy and the recurrence is possible. We report a case of atypical Fibroxanthoma occurring in the scalp of a young woman.
9 Bilateral Squamous Cell Carcinoma of the Forehead , Oukarfi Sara1*, Baybay H1, Douhi Z1, Elloudi S1, Mernissi FZ1
Let me present the case of Mr H. aged 70, farmer, with notion of sun exposure since childhood. Who presents in consultation for a neglected right temporal tumor evolving for 18 months with another contralateral tumor of the same aspect evolving for 5 months. Dermatological examination showed two contralateral temporal tumors, the largest measuring approximately 10 cm from long axis to the right and 3 cm to the left. On the right the tumor is bilobed, well limited, of irregular contours, ulcerated with raised edges and budding bottom surmounted by fibrin and hemorrhagic crusts, fixed with pain on palpation. On the left, the tumor is small with the same clinical appearance.
10 The Sinewy Scruff-Nuchal-Type Fibroma , Anubha Bajaj1*
Nuchal-type fibroma is an uncommon, benign, tumour-like, subcutaneous nodule comprised of bundles of thick collagen fibres confined to dermis and subcutaneous tissue of posterior neck. The condition commonly appears within third to fifth decade and demonstrates a male preponderance. Generally, an asymptomatic, superficial, gradually progressive, solitary or multiple, protrusive, firm to hard, solid, inadequately circumscribed tumefaction is denominated. The pauci-cellular neoplasm is composed of collagen fibres, mature adipose tissue and occasional skeletal muscle fibres with infiltration into surrounding cutaneous adnexal articulations.
11 Isolated Eyebrows and Eyelashes Trichoteiromania Mimicking Alopecia Areata , Khadija Elboukhari1*, Hanane Baybay1, Fatima Zahra Mernissi1
A 23-year-old woman, with no pathological history, was treated for alleged alopecia areata of her eyebrows and eyelashes by her usual dermatologist before being referred to our institution after treatment failure. The condition had been endured for almost two years. The affected areas were also itchy. The patient has no history of autoimmune diseases. Our clinical examination found isolated alopecia of the eyebrows and eyelids, with hair rarefaction (Fig. 1). The pull-hair test sign was negative. The rest of the hair examination of the scalp, pubis, armpits, and body duvet was without abnormalities. The nails were respected. For the alopecia, our differential diagnoses included alopecia areata, frontal fibrosing alopecia, and trichotillomania. Dermoscopic examination revealed erythema. There was no cadaveric or vellus hair and we did not find any yellow dot. Further dermoscopic analyses revealed blacks dots of different sizes, with some brushed hairs and one hook-like end hairs (Fig. 2). The patient admitted her habits of rubbing and scratching her eyebrows and eyelashes. Our final diagnosis was trichotillomania. We commenced treatment with N-acetylcysteine and a psychological evaluation.
12 Acral Cutaneous Manifestations during COVID-19 Outbreak   , Ramon Grimalt1*, Mario Cutrone2
We describe a patient with multiple cutaneous lesions resembling chilblains affecting her feet. She was one of 5 patients with these findings that we have seen during the last week, 4 of them in Venice, Italy, one of them in Barcelona, Spain. A 15-year-old girl with no relevant clinical history presented with reddish asymptomatic spots on her feet. No one in her family nor social environment has been diagnosed by COVID-19 since confinement. On examination, we observed the presence of chilblain-like vasculitical aspects such as microtrombotic-like reddish and purpuric macules (Fig. 1). The girl had no symptoms associated with upper respiratory tract infections, nor myalgia, fever nor headache. We performed fast serology PCR testing on the patient, which provided negative results. Four other patients with similar skin findings (and no other symptoms) were seen at the Pediatric Dermatology unit in Venice, Italy. PCR swab tests in these patients were negative for COVID-19 in all cases In the past week, we have seen 5 patients affected by a new dermatological manifestation, all coinciding with the outbreak of COVID-19 infection throughout the world. They were all asymptomatic adolescents from 12 to 16 years of age. But none of them had a positive family history for COVID-19 infection. In most cases the cutaneous vasculitical like eruptions appear in very mild or totally asymptomatic forms of the disease and mostly in adolescents. It seems to appear at the end of the process. They appear on both hands and feet but predominately on feet. The tendency is for spontaneous resolution but we need more time to follow this up. It is rather surprising that the PCR in all these patients was negative but, as onset occurred at the same time as the outbreak of COVID-19 it appears to suggest a clear relationships between the two. Recently one patient with similar clinical findings was biopsied in Switzerland (personal communication) by Prof Daniel Hohl and showed a lividoid occlusive vasculopathy. Other dermatological findings of COVID-19 infection include signs of small blood vessel occlusion. Also petechiae or tiny bruises, transient lividoid eruptions, acrocyanosis and pseudo chilblain lupus have been reported [1-4].
13 An Unusual Skin Manifestation by Mycoplasma Pneumoniae without Pulmonary Infection , Hsuan-Hsiang Chen1*
Pulmonary infections are often caused by Mycoplasma pneumoniae. However, extra pulmonary manifestations are also reported. Mycoplasma pneumonia associated severe mucositis with relative few skin rash has recently been described as a new clinical disease named Mycoplasma Pneumoniae-Induced Rash and Mucositis (MIRM). A 14-year-old girl who developed exuberant mucositis, as well as multiple tense bullae and several targetoid lesions were found on the face, trunk and 4 limbs, but no obvious pulmonary manifestation was found. The laboratory examinations showed elevated M. pneumoniae IgM antibodies. Due to this unique clinical presentation, MIRM was considered and differentiated from Toxic Epidermal Necrolysis (TEN), Stevens-Johnson Syndrome (SJS), or Erythema Multiforme (EM). MIRM may be reconsidered as a specific cutaneous manifestation with or without pulmonary infection.
14 Rheumatoid Vasculitis: Heterogeneous Clinical Presentation , Rebecca Ribeiro Gouvêa1*, Otávio Augusto Gomes da Paz2
Vasculitis is defined as a vascular inflammation which may be localized or systemic and mostly idiopathic. Usually it affects several organs of the body such as skin, kidneys and lungs. Vasculitis is one of the biggest challenges in medical research diagnostics, in nonspecific clinical presentation, as it develops slowly over few weeks to months. In addition, to confirm this, the diagnostic laboratory tests are required and sometimes biopsy is required to be done of the affected artery or serology. To cure this ailment, it is essential to opt for a therapy for symptomatic improvement, induction, remission and decreased mortality.
15 Epidemioclinical Profile of Dermatoses in Children Aged 0 to 18 Years in the Dermatology -Venereology Department of the National Hospital and University Centre - HKM of Cotonou (Benin)   , Fabrice Akpadjan1*, Hugues Adegbidi1, Francis Lalya2, Olivia Yeko2, Bérénice Dégboé2, Marcelline d’Almeida2, Félix Atadokpédé1
Introduction: Skin diseases are a public health problem in all developing countries. In most African countries they are dominated by infectious, immuno-allergic, inflammatory and tumourous skin diseases. So far, no studies have been carried out on paediatric dermatoses in hospitals in our country. Methods: This was a cross-sectional, descriptive study running from July to November 2019 with an exhaustive sampling that included all children aged 0 to 18 years seen during the study period for the first time in the Dermatology-Venereology Department of the NHUC-HKM in Cotonou. EPI data version 3.0 software was used for the statistical analysis. Results: 119 children were included. The sex ratio was 2:1. The age group [0-5] years was the most represented (35.3%). Immuno-Allergic Dermatoses (IADs) predominated (47.1%) followed by infectious dermatoses (40.4%). Atopic eczema (25.2%) and prurigo strophulus (14.3%) were the most frequent IADs, while candidiasis (29.1%) was the most frequent mycotic infection. Conclusion: This study confirms the frequency of skin diseases in children in specialised hospitals in Benin. They are dominated by immuno-allergic dermatoses including atopic dermatitis and prurigo strophulus.
16 The Applications of Fractional Lasers in Taiwan , Hsuan-Hsiang Chen1*
The applications of fractional lasers are enormous. In Taiwan, the most commonly used fractional lasers can be divided into 3 different categories: ablative, non-ablative, and combined hybrid laser. The ablative fractional laser was invented as a new instrument to be used for facial resurfacing initially. On the contrary, the non-ablative fractional laser was introduced primarily to rejuvenate skin with minimal downtime. It produces dermal thermal damage without significantly affecting the overlying epidermal layers of the skin. Both the ablative and non-ablative lasers are applied increasingly to various dermatological conditions. Herein, the author will review the researches and multiple applications of fractional lasers in Taiwan.
17 Endogenous Reactivation rather than Primary Infection of Sexually Transmitted Viruses in the Community during the Early Phase of the COVID-19 Pandemic in Hong Kong , Antonio Chuh1,2*
Aim: We aim to report a retrospective epidemiological study on patients with sexually transmitted infections during the early phase in the COVID-19 pandemic. Methods: Our settings is a primary care genito-urinary medicine clinic with two sessions per week, attached to a major university teaching hospital. We searched and hand-reviewed the medical records of all patients having consulted us during a Pandemic Period of 90 days (1 February to 30 April 2020). We then reviewed records of all patients having consulted us in two Control Periods each of 90 days before the pandemic. We analysed the records with final diagnoses most likely being sexually-transmitted only. Results: During the Pandemic Period, 61 episodes of sexually transmitted infections were diagnosed, significantly less than such in the Control Periods (360 episodes in 180 days; RR: 0.34, 95% CI: 0.25-0.45). The commonest pathogens were Herpes simplex-2 or -1 (recurrent episodes) Human papillomavirus (recurrent episodes) During the Pandemic Period, only one out of 24 patients with herpes simplex-2 or -1 infection was a first attack. This rate was significantly lower than such in Control Period 1 (RR: 0.12, 95% CI: 0.02-0.81), Control Period 2 (RR: 0.13, 95% CI: 0.02-0.93), and both Control Periods combined (RR: 0.12, 95% CI: 0.02-0.86). For human papillomavirus infection, during the Pandemic Period, only one out of 20 patients presented with the first attack. This rate was also significantly lower than such in Control Period 1 (RR: 0.12, 95% CI: 0.02-0.86), Control Period 2 (RR: 0.13, 95% CI: 0.02-0.87), and both Control Periods combined (RR: 0.12, 95% CI: 0.02-0.85). Conclusions: Endogenous reactivations of sexually-transmitted herpes simplex viruses and human papillomaviruses were significantly more frequent than primary infections during the early phase of the COVID-19 pandemic. This may be associated with less sexual exposures and psychosocial stressors compromising cell-mediated immunity.
18 Dermoscope Guided Carbon Dioxide Laser Ablation-The First Report , Antonio Chuh1,2*
We report the first application of dermoscope-guided carbon dioxide laser ablation for a venous lake on the lower lip of an adult patient. The clinical, cosmetic and functional outcomes were excellent after the procedure.
19 Perspectives on the FDA’s Sunscreen Policy: New Aging Theory, Sunlight Benefits, Enhanced Immunity, COVID-19 Mortality, Modelling Analyses, Melanoma Risks and Etiology   , Win L Chiou1*
Currently, the U.S. Food and Drug Administration’s policy on sunscreens assumes that exposure to sunlight, mainly ultraviolet (UV) rays, damages the skin, the damage is cumulative and any sun exposure should be avoided or minimized. Sunscreens are approved to help prevent early skin aging, sunburn and skin cancer. This work presents provocative perspectives on some issues related to use of sunscreens shown below. Skin aging is predominantly caused by the intrinsic nutritional factor. Sunlight damage is unlikely cumulative due to extremely efficient self-repair/self-defense mechanisms of the body. Regular exposure to moderate non-burning sunlight increases immunity and protects against sunburn, melanoma, COVID-19 mortality, high blood pressure, etc. White and non-white populations may need sun protection only when the UV Index is ≥ 5-6 and ≥ 7-8, respectively. Modelling analyses suggest that sunscreens with SPF 8 and 2-6 may be adequate for whites and non-whites, respectively. There are inherent risks of sunburn and melanoma when sunscreen is used intermittently mainly due to unavoidable SPF-independent missing applications and may serve as a false security; this may mainly account for exponential increases in melanoma incidences in recent decades; thus, the more intermittent use of sunscreen, the more incidence of sunburn and skin cancer. 10am-2pm sunlight avoidance guidelines may need modification. Extensive human studies suggest that intense UVB from sunburn, not UVA or sub-erythemal UVB, may cause melanoma; this hypothesis is supported by mouse and fish models. Without exposure to burning sunlight, we may not need to use broad-spectrum sunscreens or UVB-based sunscreens in our daily lives. Potential implications of this work may be immense in terms of saving lives and improving health of consumers, reducing costs associated with marketing and use of sunscreens, as well as reducing environmental pollution.
20 Addressing the Need to Use Psychological Tests in the Field of Dermatology , Charalambos Costeris1,2*, Joshua J Matacotta2
Dermatological patients’ psychological difficulties are one of the many challenges that dermatologists face in their everyday practice. The use of psychological assessment can benefit dermatologists to detect vulnerable patients who lack the opportunity to be referred to mental health professionals. For this reason, if dermatologists collaborate more frequently with clinical health psychologists, dermatological patients would be properly assessed. This would lead in the creation of psychodermatology units in which patients’ emotional difficulties can be treated holistically.
21 Exogenous Ochronosis in Facial Lichen Planus Pigmentosus , Selma El Kadiri1*, Hanane Bay Bay1, Imane Kacimi1, Zakia Douhi1, Sara Elloudi1, Fatima-Zahra Mernissi1, Layla Tahiri2, Nawal Hammas2, Leila Chbani2, Hinde El Fatemi2
Lichen planus pigmentosus is a chronic inflammatory pigmentary dermatosis considered a rare variant of the cutaneous lichen planus. It is characterized by acquired dark brown to gray macular pigmentation involving sun-exposed areas commonly found in dark-skinned patients. Exogenous ochronosis is an acquired cause of blue-gray to black pigmentation involving the skin and mucous tissues. We report a case of exogenous ochronosis occurring in a 45-year-old patient treated for lichen planus pigmentosus. She was treated with Kligman formula containing hydroquinone. The patient presented to our Department for progressive worsening of the malar pigmentation. Dermoscopy revealed gray to black rounded and homogeneous areas with arciform structures obliterating the follicular openings and telangiectasic vessels making us suspecting exogenous ochronosis confirmed by histology.
22 Severe Ulcers in Oral Mucosa Due to Cytomegalovirus in an Immunosuppressed Pediatric Patient , Johanna Peceros-Escalante1*, Katia Henostroza-Inga2, Carlos Gonzales-Saravia3, Roxana Lipa-Chancolla4, Rosalía Ballona-Chambergo3
Cutaneous expressions in cytomegalovirus infection are rare and their clinical manifestations in immunosuppressed patients are diverse; for example, ulcerative forms. Therefore, cytomegalovirus infection should be considered in the differential diagnosis of ulcers in immunosuppressed patients. We reported an immunosuppressed child with severe oral ulcerative lesions of torpid evolution, associated with cytomegalovirus infection, diagnosed by laboratory and histopathological examinations.
23 Cutaneous Drug Eruption after COVID-19 Vaccination , Lauren Schwartzberg1*, Mike´l Muse2, Rene Bermudez2, Blair Harris2, Natalie Depcik-Smith2, Jonathan Crane2
The SARS-CoV-2 virus is a highly transmissible virus that has infected millions of people globally over the past year. In the United States alone, over 400,000 deaths have been reported due to COVID-19 infection [1]. In order to prevent further spread and severe infection, the Food and Drug Administration (FDA) has authorized emergency use of the Moderna COVID-19 vaccine which has demonstrated an efficacy rate of 94.1% in preventing COVID-19 infection [2]. The current recommended administration schedule for the Moderna COVID-19 vaccine is a total of 2 doses, each given at an interval of 28 days apart. Despite its efficacy, adverse events and hypersensitivity reactions are still under evaluation with a few cases reported to date [3]. We report a case of a 40-year-old woman who exhibited a diffuse cutaneous eruption after receiving their first dose of the Moderna vaccine.
24 Immunophenotypes in Atopic Dermatitis , Ana Paula Galli Sanchez1*, Tatiane Éster Aidar Fernandes2, Guilherme de Souza Cabral Muzy3
Atopic Dermatitis is a very heterogeneous and complex disease. Recently, the ethnic background has been reported as a determining factor for a better understanding of genetic differences, clinical phenotypes, and immune activation patterns in patients with AD. In the future, therapeutic interventions should consider these immunophenotypes for individualizing treatment of atopic dermatitis.
25 The Fall of Cryolipolysis Article Info Figures and Data Patsioura Sofia1, Tekeri Maria1, Theodoridis Efstathios2, Papadopoulos Iordanis3*   , Patsioura Sofia1, Tekeri Maria1, Theodoridis Efstathios2, Papadopoulos Iordanis3*
Purpose: The purpose of this study is to examine the impact of cryolipolysis on the general population and its results on those who chose it as a therapeutic tool. The research also investigates the businesses’ satisfaction by the results of the method and the expected profit. Methodology: In this study, the questionnaire was used for data collection by Google Forms and includes questions about the treatment of cryolipolysis. The survey was held during the period April – May 2021. Results: Out of the 300 people who answered the questionnaire, only 62 have tried cryolipolysis, of which 53 are women and 9 are men. The results showed that 30 of the 62 people who underwent cryolipolysis were not satisfied with this treatment. Besides, out of the 80 businesses, only 45 businesses owned the cryolipolysis machine. Finally, the study showed that the businesses are not satisfied with this investment (46.7%) and the results of the treatment (35.5%). Conclusion: The results showed that cryolipolysis is a well-known method but it is not chosen as frequent as in the past by individuals and businesses for localized fat loss.
26 A Case of Pseudochromohidrosis Cured with Oral Erythromycin and Topical Clindamycin , Rashmi Singh1*
Apocrine chromohidrosis and eccrine pseudochromohidrosis are both rare skin presentations. In case of former patient presents with coloured sweats in apocrine distributions usually axilla, breast etc., while later presents with coloured sweat in eccrine distribution. Such cases need to be reported after other possibilities with similar presentations have been ruled, and need special mention in literature as mostly they are misdiagnosed as factitious. Hereby, I am also reporting one such case of pseudochromohidrosis which needed attention as it was causing anxiety to both patient and family members and its proper diagnosis and treatment brought a great relief to them.
27 Synergistic antiaging and Dermal Restorative Effects of an Oral Bioactive Procollagen and Astaxanthin Supplement with A Topical Retinyl Palmitate, Vitamin C, Hyaluronic Acid and Alpha Hidroxy Acid Based Regimen   , S Manzanares1, E Arias1, N Floriach1, Salleras M2, Fernando Alfageme Roldán3*
Aging is a natural process undergone by every organism, with progressive changes that lead to an impairment of many biological processes. The human skin ages through several mechanisms which may cause changes to the morphology of skin leading to its reduced thickness, lower dermis density and to the presence of a subepidermal low echogenic band. These morphological changes are responsible for the visible changes of the skin such as reduced elasticity, firmness, luminosity and hydration. This study was conducted to investigate the anti-ageing effect and to assess the qualities and efficacy of a topical cosmetic products and a nutricosmetic product, after 84 days. Sixty women were divided into three groups and assigned different treatments (Group A: topical treatment, Group B: oral treatment and Group C: combination of topical and oral treatments). The topical treatment consisted in the application of a facial gel with alpha hydroxy acids and a facial cream with retinyl palmitate, hyaluronic acid and Vitamin C, whereas the oral treatment consisted in the daily ingestion of a drinkable solution composed of collagen peptides, astaxanthin, hyaluronic acid, vitamins and active other ingredients. Finally, Group C received a combination of the treatments in Group A and Group B. Different parameters of the skin were assessed such as wrinkles, roughness, firmness, elasticity, hydration, luminosity and spots (brown and visible). Skin morphology was also studied by ultrasonography to analyze the thickness of a Subepidermal Low Echogenic Band (SLEB), skin thickness and dermis density. All parameters were measured at the baseline visit (D0), at day 28 (D28), at day 56 (D56) and at the end point visit (D84). Volunteers had to complete a self-assessment questionnaire at each follow up visit. Results showed that all groups had some anti-aging benefits but the women receiving the combination treatment (Group C) had a faster and synergic effect in comparison to the other two groups with regards to improvements in the markers assessed for skin ageing.
28 Synergistic antiaging and Dermal Restorative Effects of an Oral Bioactive Procollagen and Astaxanthin Supplement with A Topical Retinyl Palmitate, Vitamin C, Hyaluronic Acid and Alpha Hidroxy Acid Based Regimen , S Manzanares1, E Arias1, N Floriach1, Salleras M2, Fernando Alfageme Roldán3*
Aging is a natural process undergone by every organism, with progressive changes that lead to an impairment of many biological processes. The human skin ages through several mechanisms which may cause changes to the morphology of skin leading to its reduced thickness, lower dermis density and to the presence of a subepidermal low echogenic band. These morphological changes are responsible for the visible changes of the skin such as reduced elasticity, firmness, luminosity and hydration. This study was conducted to investigate the anti-ageing effect and to assess the qualities and efficacy of a topical cosmetic products and a nutricosmetic product, after 84 days. Sixty women were divided into three groups and assigned different treatments (Group A: topical treatment, Group B: oral treatment and Group C: combination of topical and oral treatments). The topical treatment consisted in the application of a facial gel with alpha hydroxy acids and a facial cream with retinyl palmitate, hyaluronic acid and Vitamin C, whereas the oral treatment consisted in the daily ingestion of a drinkable solution composed of collagen peptides, astaxanthin, hyaluronic acid, vitamins and active other ingredients. Finally, Group C received a combination of the treatments in Group A and Group B. Different parameters of the skin were assessed such as wrinkles, roughness, firmness, elasticity, hydration, luminosity and spots (brown and visible). Skin morphology was also studied by ultrasonography to analyze the thickness of a Subepidermal Low Echogenic Band (SLEB), skin thickness and dermis density. All parameters were measured at the baseline visit (D0), at day 28 (D28), at day 56 (D56) and at the end point visit (D84). Volunteers had to complete a self-assessment questionnaire at each follow up visit. Results showed that all groups had some anti-aging benefits but the women receiving the combination treatment (Group C) had a faster and synergic effect in comparison to the other two groups with regards to improvements in the markers assessed for skin ageing.
29 The Risk of Creating Difficult-To-Treat Psoriasis by Switching Multiple Biologic Therapies: A Case Report and Relative Considerations , Martina Burlando1*, Ilaria Salvi1, Emanuele Cozzani1, Aurora Parodi1
Despite the revolution represented by biologic drugs, it is safe to say that every dermatologist has known the frustrating experience of treating a “difficult” patient with psoriasis. Such patients may have been treated with numerous drugs, never achieving long-term disease control. We hereby present the case of a patient who, despite having been treated, over the course of 15 years, with 7 biologics and 3 traditional systemic agents, has never experienced lasting remission. We also discuss hypothetical reasons for these repeated treatment failures: while obesity and ANA positivity could have contributed significantly, a third, more complex, factor may be to blame. It is possible that frequently switching to the newest drug available, due to lack of other therapeutic options, interfered with the pathogenetic phenotype of the patient, and, consequently, with the response to other biologics. This disheartening and fascinating hypothesis clearly needs to be investigated, in the hope of finding solutions for all seemingly impossible-to-treat patients.
30 The Influence of Veganism on Acne , Paula Sánchez Niño1, Ramon Grimalt1*
Background: There is an historical controversy regarding the relation of acne and diet. Despite being veganism a current topic, no studies have been yet conducted to assess whether following a vegan diet has a positive or negative effect on acne. Objectives: To assess veganism and acne’s relationship. Methods Cochrane Library and PubMed database were used to search scientific literature. Results: Studies showed a link between milk consumption and acne. Additionally, high glycemic diets were shown to increase acne’s appearance. Some studies suggest that a low intake of vegetables can worsen acne.  Conclusion: There is no scientific evidence assessing whether a vegan diet can affect acne’s appearance on adolescent population.
31 Facial Demodicidosis Revealing HIV , Ryme Dassouli1*, Hanane BayBay1, Imane Kacimi1, Sara Elloudi1, Zakia Douhi1, Fatima Zahra Mernissi1
Demodecidosis is an opportunistic cutaneous ectoparasitosis, common to humans and many mammals, caused by the proliferation of Demodex in the pilosebaceous apparatus. This obligate saprophyte of the skin, ostia-pilosebaceous of seborrheic areas, can become pathogenic in case of cosmetic abuse and debilitated terrain or altered immune status [1] . We report a case of facial demodecia revealing an infection by the human immunodeficiency virus. A 34 years old man with a history of multiple sexual relationships, presented with a pruritic maculo- papular rash of the face that had been evolving for 5 months, unimproved by the application of fusidic acid and exacerbated by dermocorticoids. Clinical examination revealed a pruritic and oedematous erythematous patch on both cheekbones, forehead and chin associated with pustular lesions (Fig. 1). Dermoscopic analysis identified whitish filiform structures corresponding to the Demodex parasite attached to the skin (Fig. 2). The histopathological study confirmed the diagnosis (Fig. 3). The blood count showed a lymphopenia of 520/mm3 with normal eosinophils. HIV serology came back positive (CD4 lymphocytes=120/mm3). The patient noted an improvement under oral erythromycin and local ketokonazole with attenuation of the infiltration and disappearance of pruritus.
32 Chronic Recalcitrant Lesions of an Enlarged Limb: Consider Parkes Weber Syndrome , Ryme Dassouli1*, Hanane BayBay1, Kenza Tahiri Joutei1, Zakia Douhi1, Sara Elloudi1, Fatima Zahra Mernissi1
In this case, we diagnosed the patient with Parkes Weber syndrome. This syndrome is considered by some experts as a sub-form of the Klippel-Trenaunay syndrome. Both syndromes are defined by congenital vascular malformations, which can affect the capillary system as well as the venous or lymphatic system [2]. PWS is a congenital angiodysplastic syndrome combining capillary, venous, lymphatic and arteriovenous shunts in the overgrown limb. It can affect the upper or lower limbs. It can affect the upper or lower limbs, including the pelvic vessels. Most of these patients are already diagnosed in childhood or at puberty [3]. In contrast, in our patient’s case, the disease did not present until he was 36 years old. The abnormal increase in flow in the venous vasculature resulted in venous hypertension. As a result, the patient developed chronic venous insufficiency with increasing age. Simultaneously, the areas located distally around the AV shunts suffered from arterial under excitation. The combination of these two mechanisms resulted in decompensation of the microcirculation, which then led to local hypoxia that subsequently led to chronic leg ulcers that were difficult to treat. Hyperpigmentation, such as yellow ochre purpura, and hypopigmentation, such as white atrophy, developed as typical clinical signs [3,4].
33 A Strange Umbilical Rash in a Newly Diagnosed HIV-Positive Man: A New Clinical Description of a Trichosporon Spp Dermatosis , Ryme Dassouli1*, Zakia Douhi1, Kenza Tahiri Joutei1, Hanane BayBay1, Sara Elloudi1, Khaoula Abdellaoui2, Laila Tahiri2, Hinde El Fatemi2, Fatima Zahra Mernissi1
Trichosporon is a basidiomycete yeast of tropical origin that is also opportunistic in the immunocompromised. It is characterized by irregular nodules attached to the hair called white piedra. Trichosporon spp has been reported as the 2nd most common agent of disseminated, potentially fatal fungemia [1]. Nevertheless, no pure cutaneous manifestation had been reported. We report a single case of Trichosporon spp causing an umbilical papulonodular rash in a newly diagnosed HIV-positive subject. A 25-year-old patient, with a history of homosexuality and unprotected sexual intercourse, presented with a one-week-old asymptomatic reddish rash associated with umbilicated papular lesions of the trunk and lower back, which were pruritic and concomitant in appearance. Dermatological examination revealed scattered copper-red papules on the face, trunk and limbs, palmo-plantar papular lesions surrounded by a thin circular whitish collar, with large papules and nodules with an umbilicated center, pruritic and eroded, located in the sacral region and pre-pectoral area (Fig. 1 and 2). Demoscopy revealed a star-like appearance with an erythema in the center, whitish lines in a radial arrangement surrounded by a crown of vessels in points (Fig. 3). Mucosal examination revealed a syphilitic chancre on the glans and the lymph nodes were free. The rest of the examination was unremarkable. HIV and syphilitic serology were positive with a VDRL titre of 1/64. The lumbar puncture was sterile. A biopsy of the umbilical lesions was performed, which revealed sheets of inflammatory cells made essentially of macrophages forming nodules around the vascular structures of the superficial and deep dermis, microscopic yeasts were present within the macrophagic cytoplasm. The mycological study on the collected tissue revealed the presence of Trichosporon SPP. The diagnosis of an opportunistic infection with Trichosporon SPP in an HIV-positive and syphilitic subject in the 2nd bloom phase was accepted. The patient was being treated with late penicillin for syphilis and antiretroviral treatment was recommended after a normal pre-treatment workup. Three weeks later, the syphilis disappeared and the nodular lesions subsided. Demoscopy of the lesions revealed the disappearance of the star-like appearance with the presence of vessels in points and the attenuation of the erythema.
34 Nifuroxazide Erythema Pigmented Fixed: A Side Effect to Be Aware Off , Ryme Dassouli1*, Zakia Douhi1, Imane Kacimi1, Kenza Tahiri1, Hanane BayBay1, Sara Elloudi1, Fatima Zahra Mernissi1
Erythema Pigmentum Fixata (EPF) is a delayed-type toxidermia. It manifests itself within 48 h after the re-introduction of a drug by the appearance of a recurrent rash, leaving a residual hyperpigmentation [1]. We report a first case of erythema pigmentosa fixed to Nifuroxazide. A 48-year-old man, chronic smoker, with a history of type 1 diabetes under insulin, having been amputated of the 4 limbs 5 years ago for ischemia of the limbs secondary to shepherd’s disease, suffering from a functional colopathy for which he often received symptomatic treatments includinf Nifuroxazide. The drug investigation revealed the ingestion of Nifuroxazide for a digestive episode after which he presented a rash composed of pruritic erythematous macules of the trunk and limbs with a 48-hour delay, evolving into post-inflammatory hyperpigmentation. The biopsy showed an interface dermatitis consisting of a predominantly lymphocytic infiltrate. The pharmaco-vigilance report accused Nifuroxazide. All the data allowed us to conclude to an erythema pigmentosa fixata. The patient did not present any more recurrence after eviction of the molecule.
35 Severe Sunburn Triggers the Development of Skin Cancers: Non-cumulative/Overwhelming UV Damages, UVA Rays, Human Papillomavirus, Indoor/Outdoor Workers and Animal Models , Win L Chiou1*
Based on analysis of published data of incidence of melanoma, basal cell carcinoma and squamous cell carcinoma from 2 large prospective cohort studies involving about 120,000 health workers in USA, excellent linear relationships between skin cancer incidence and Severe Sunburn (SS) incidence suggesting their causal association were found. It is postulated that the SS-caused UV radiation overwhelms the skin cell’s capacity to repair/remove DNA lesions (about 70,000 non-cumulative lesions per day) and any of these un-repaired/un-removed lesions can eventually become a pre-cancerous tumor or cancer after overcoming numerous barriers of body’s repair/defense mechanisms. The above rationale for cancer etiology seems consistent with the classical wound-to-tumor doctrine. Infection with Human Papillomavirus will reduce the threshold for non-cumulative DNA lesions thereby facilitating cancer initiation. The proposed SS theory may be generally applicable to people with different races, skin types, hair colors and sunlight exposures. The proposed non-cumulative UV damage concept is supported by published data showing parallel first-order aging kinetics of human skin being exposed and un-exposed to sunlight in ordinary people. Solar UVA only plays a minor or insignificant role in skin cancer and premature aging. Prevalence of SS is reviewed. Controversies on skin cancer risks for indoor and outdoor workers such as airplane pilots and crew, health workers, gardeners and truck drivers are discussed. Potential shortcomings of a common practice of using highly unphysiological UV, UVA or UVB doses in animal, cell culture or human skin studies are discussed. Demonstration resembling the reversibility of intrinsic skin aging using a plant deprived of and then replenished with water is presented. It is hoped that this apparently provocative work may stimulate further discussions in the literature.
36 Radiofrequency Current at 448 Khz For Female Pattern Hair Loss: Cellular Bases For Redensification Improvement , Naranjo Pablo1,2*, Martínez-Pascual María Antonia3, López Andrino Rodolfo1, Zarza Luciañez Daniel2, Hernández-Bule María Luisa3
Objective: Capacitive-Resistive Electrothermal Therapies (CRET) have proven effective in tissue regeneration. This study analyzes the response to 448-kHz CRET treatment in 20 patients with Female Pattern Hair Loss (FPHL) and in woman’s Dermal Papilla Cells (DPC). Methods: Patients received ten 20-minute CRET sessions over an 8-week interval. Three months after the last session, the effects of the treatment were trichoscopically analysed. DPC were CRET stimulated intermittently for 12, 24 or 48 h and the effects on cell proliferation and expression of several proteins involved in cell proliferation were analysed. Results: Trichoscopic data revealed generalized, statistically significant hair redensification (10 – 15 % over pre-treatment values) in all the treated scalp areas. In-vitro electrostimulation significantly increased DPC proliferation and expression of the proteins involved in cell proliferation. Since dysregulation of DPC proliferation is the main factor underlying abnormal hair loss, it is likely that electrically-induced DPC proliferation is involved in the redensifying effects obtained in the trichological study. Conclusion: The results of the trichological study in FPHL patients and those of the experimental study in woman’s DPC are consistent with each other and suggest that 448-kHz CRET could be effective both for hair redensification and hair loss prevention.
37 Clinicopathological Correlation in Dermatopathology , Safa Suleman El Faituri1*
Introduction and aim: Getting an accurate diagnosis in dermatopathology requires a combination of clinical and pathological information. Our aim was to assess the importance of the correlation between clinical and histopathological diagnosis in various cutaneous diseases. Materials and Methods: One-hundred cases of variable skin diseases were studied clinically by dermatologist and histopathologically by general pathologists. Cliniopathological correlation was done by direct communication between the dermatologist and the pathologist. Results: Concordance between pathological and clinical diagnoses was seen in 84%, a new pathological diagnosis was issued in 3% and non-diagnostic report in 13 %. After clinicopathological correlation; out of 84%, we accept only 65% as final diagnosis. In addition, the correlation was helpful and provide a diagnosis in another 20% of cases. One new pathological diagnosis was accepted whereas in the remaining cases (14%) further workup were required. Conclusions: Accurate diagnosis of cutaneous disorders depends on clinical skills as well as careful histopathological assessment and best results can be obtained if the patient and biopsy sections are viewed together. Electron microscopy, immunofluorescence assay, immunohistochemistry techniques and molecular pathology are important adjuncts for definite diagnosis of many skin diseases.
38 Histoplasmosis Due to Histoplasma Capsulatum Var. Duboisii: Diagnostic Difficulties in Decentralized Areas, H Dione1*, P Dioussé1, ATD Lawson1, PS Touré¹, M Bammo1, F Seck1, SA Diop1
Introduction: Histoplasmosis caused by Histoplasma capsulatum var. duboisii is a deep mycosis that is rampant in Africa. Clinical manifestations are dominated by skin involvement. It is a condition that sometimes poses diagnostic and therapeutic problems. Observation: We report the case of an 81-year-old non-smoking, non-alcoholic patient who presented with polymorphic cutaneous lesions in the form of gums of variable size disseminated on the trunk and the limbs at the stage of rawness or softening, an ulcerative lesion crusty measuring 5 cm on its longest axis sitting at the level of the abdomen and an ulceration measuring 6 cm on its longest axis with purulent and hemorrhagic background with raised edges and indurated base at the level of the right subclavicular region. This picture had been evolving for 9 months in a context of impaired general condition and exertional dyspnoea at stage IV. Pulmonary examination revealed bilateral pleural effusion syndrome. Examination of the lymph nodes revealed no superficial adenopathy. African histoplasmosis was suggested. Retroviral serology and syphilitic serology were negative. The thoraco-abdomino-pelvic computed tomography showed a tumoral process at the apical level of the right lung at the level of the ventral segment of the upper lobe and multiple secondary localizations in the right mediastino-hilar lymph nodes under the skin and bone. The diagnosis of histoplasmosis was retained by the pathological examination of the skin biopsy, which was in favor of histoplasmosis and mycology confirmed histoplasmosis due to Histoplasma capsulatum var. dubosii. The evolution was marked by the death of the patient before the treatment. Conclusion: African histoplasmosis remains a rare condition although a few cases are reported in the literature. Its clinical polymorphism often confuses practitioners.
39 Sealant Penetration into Occlusal Fissures: An In-Vitro Optical Coherence Tomography Study, Noor Hanisah Rahim1, Nurul Izyani Johari1, Maria Angela Gonzalez2, Prema Sukumaran3*
Objective: This study was designed to use Optical Coherence Tomography (OCT) to quantify depth of occlusal fissures on premolar teeth and to quantitatively evaluate the penetration of pit and fissures sealants relative to fissure depth. The study aimed to evaluate the penetrability of Pit and Fissure Sealant (PFS) in covering the full-depth of different occlusal fissure depths using Swept-Source Optical Coherence Tomography (SS-OCT). Methods: Ninety-seven investigation sites on f occlusal fissures of fifteen premolar teeth with International Caries Detection and Assessment System (ICDAS) scores of 01 or 02 were categorized using SS-OCT into four groups (smooth, shallow, intermediate, and deep fissures). After PFS placement, cross-sectional images of these fissures were observed again with SS-OCT. Results: The result of this study shows that PFS can fully penetrate the smooth fissures (100%) followed by shallow fissures (94.2%) and intermediate fissures (47.6%). Incomplete full depth PFS penetration can be seen in all deep fissures (100%). Conclusion: The depth of the fissure will largely affect the penetrability of PFS into the fissure.