Background: Diagnosis of bullous pemphigoid (BP) and pemphigus is based on clinical features, histology, immunofluorescence and laboratory data.
Objectives: To evaluate features of BP and pemphigus at reflectance confocal microscopy (RCM) and optical coherence tomography (OCT) in order to provide a rapid non-invasive bed-side diagnosis. Secondary objective was to evaluate the detectability of clinically non-visible lesions.
Methods: This was an observational, retrospective, multicentre study in which patients with suspicious lesions for BP or pemphigus underwent clinical assessment, RCM, OCT, blood tests and skin biopsy for histological and direct immunofluorescence examinations from January 2014 to December 2015. A total of 72 lesions in 24 selected patients were evaluated. Additionally, apparently unaffected skin at two different distances [near (1-2 cm) and far (2-3 cm)] from each lesion was examined to test subclinical lesion detectability.
Results: RCM was able to detect subepidermal and intra-epidermal blisters, respectively, in 75% and 50% of the patients affected by BP and pemphigus. At OCT, the exact blister level was identified in all patients. Acantholytic cells were observed only at RCM in pemphigus (62.5%). Fibrin deposition inside the blisters was only found in BP, evidenced both at RCM and OCT. Among patients with BP, subclinical blisters were detected in nine (9.4%) clinically healthy skin, while among patients with pemphigus were observed in 10 (20.8%) apparently unaffected skin.
Conclusion: RCM and/or OCT provide useful information for a rapid diagnosis of BP and pemphigus and for the identification of biopsy site. Combined use of RCM and OCT is optimal because associates the higher resolution of RCM with the greater penetration depth of OCT. OCT could be an optimal tool for treatment monitoring, especially in the cases of subclinical lesions. However, histopathologic and immunologic examinations remain the gold standard for establishing the final diagnosis.
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http://dx.doi.org/10.1111/jdv.14795 | DOI Listing |
ASAIO J
October 2024
From the Division of Cardiovascular Critical Care, Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts.
Patients with restrictive cardiomyopathy (RCM) and hypertrophic cardiomyopathy (HCM) were previously considered poor candidates for mechanical circulatory support due to technical limitations related to restrictive ventricular physiology and small ventricular size, limiting the ability to provide adequate flows and decompress the heart. Literature examining use of extracorporeal membrane oxygenation (ECMO) in this population consists of a single case series reporting no survivors. We report our experience providing ECMO in children with RCM or HCM at a large pediatric quaternary cardiac center.
View Article and Find Full Text PDFDiagnostics (Basel)
December 2024
UOC of Dermatology, Policlinico Umberto I Hospital, Sapienza Medical School of Rome, 00161 Rome, Italy.
Early detection and comprehensive diagnostic approaches for breast cancer are essential for improving prognosis. When it comes to changes in the skin of the breast or the nipple-areola complex (NAC), particularly if they are unilateral, it is essential to be vigilant, as these changes could be an early sign of underlying malignancy or other pathologies. Primary breast malignancies, such as mammary Paget's disease (MPD), can manifest as erythema, scaling, or ulceration of the NAC, while secondary cutaneous metastases from other breast carcinomas may present as nodules, erythematous plaques, or inflammatory reactions.
View Article and Find Full Text PDFDiagnostics (Basel)
November 2024
Dermatology Unit, Department of Medical, Surgical, and Neurological Sciences, University of Siena, 51300 Siena, Italy.
Background/objectives: Hidrocystomas, eccrine and apocrine, are rare cystic lesions that form benign tumors of the sweat glands. This study aimed to describe the clinical features of hidrocystomas and evaluate the role of non-invasive imaging techniques, including dermoscopy, Line-field Confocal Optical Coherence Tomography (LC-OCT), Reflectance Confocal Microscopy (RCM), and Ultra-High-Frequency Ultrasound (UHFUS), in their diagnosis.
Methods: In total, seven cases of hidrocystomas were collected from the Dermatologic Clinic of the University of Siena, Italy.
J Dtsch Dermatol Ges
December 2024
Department of Dermatology and Allergy, LMU University Hospital, LMU Munich, Munich, Germany.
Background And Objectives: Lichen planopilaris (LPP) and frontal fibrosing alopecia (FFA) are common causes of cicatricial alopecia. While several studies have demonstrated the usefulness of non-invasive imaging methods such as reflectance confocal microscopy (RCM) and optical coherence tomography (OCT) for the diagnosis of scarring alopecia, this study aimed to identify characteristic features of cicatricial alopecia in LPP/FFA using line-field confocal OCT (LC-OCT).
Patients And Methods: Fifty-one patients (26 LPP, 24 FFA, 1 LPP and FFA) were prospectively analyzed with LC-OCT at three defined locations on the scalp: (1) scarring area = lesion, (2) scar-hair boundary = transition zone and (3) healthy area for the presence of the following pre-defined criteria: no hair follicles left, destructed hair follicles, dermal sclerosis, no rimming of the dermal papillae, epidermal and dermal inflammatory infiltrate, infundibular hyperkeratosis, dilated blood vessels, hypervascularization, melanophages, epidermal pigment incontinence.
Dermatol Pract Concept
October 2024
Dermatology Unit, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy.
Objectives: Alopecia areata incognita is a non-scarring autoimmune hair loss condition primarily affecting women aged 20 to 40. It is often misdiagnosed due to its resemblance to other conditions. Diagnosis relies on clinical suspicion, trichoscopic findings, and histological features.
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