Pyoderma gangrenosum--a systemic disease?

Pyoderma gangrenosum (PG) is an orphan disease. It belongs to the group of neutrophilic dermatoses. Four major subtypes and several rare manifestations illustrate the great variety of clinical presentations and clinical course.

Facial rejuvenation starts in the midface: three-dimensional volumetric facial rejuvenation has beneficial effects on nontreated neighboring esthetic units.

Facial aging is a major indication for minimal invasive esthetic procedures. Dermal fillers are a cornerstone in the approach for facial sculpturing. But where to start? Our concept is midfacial volume restoration in first place.

Juxta-articular adiposis dolorosa (Dercum's disease type IV): report of four cases and treatment by dermolipectomy.

Juxta-articular adiposis dolorosa is a rare subtype of Dercum's disease. It manifests mainly on the medial parts of the knees. Pain and impaired mobility are common symptoms.

Vitiligo: successful combination treatment based on oral low dose cytokines and different topical treatments.

The current treatments for Vitiligo are not completely satisfactory in terms of clinical, aesthetic and compliance results for patients. Recently, combination therapies had been introduced with positive results. In this paper the combination between systemic oral treatment with Low Dose Cytokines in association with other topical treatments was evaluated.

Non-healing facial lesions: cutaneous old world leishmaniasis in dresden.

Cutaneous leishmaniasis is a common vector-borne disease world-wide but not in Central Europe. The typical clinical manifestation is an enlarging papule on the site of infection. Vectors are sandflies and reservoirs may be wild animals like rodents, dogs or even humans.

Ulcerated cutaneous myeloid sarcoma associated with myelodysplastic syndrome.

Cutaneous myeloid sarcoma is a rare extramedullary neoplasia of myeloid differentiation. It can be a herald of myelodysplastic syndrome, myeloproliferative disorder and leukemia. We present two cases of ulcerated cutaneous myeloid sarcoma of the aleukemic type, both associated with myelodysplastic syndrome: a male patient of 67 years with multifocal lesions and an 83-year old woman with a chronic foot ulcer.

Nonsyndromic aplasia cutis congenita: a case report.

Aplasia cutis congenita (ACC) is a rare disorder, which is defined by the localized, or less commonly widespread absence of skin involving the epidermis, dermis and subcutaneous tissue with an incidence of 1/10.000 newborns. The underlying bone and dura mater can be also affected, and muscle and bone involvement occur in approximately 20 to 30% of the cases.

Intralymphatic histiocytosis overlying hip implantation treated with pentoxifilline.

Intralymphatic histiocytosis (IH) is a rare condition that presents with livedoid, erythematous to violaceous patches and plaques near affected joints most commonly in patients with rheumatoid arthritis and in at least 8 reports overlying metal implants. We report the case of a 58 year-old Caucasian woman who developed an indurated violaceous reticulated plaque overlying her right hip after placement of a metal hip implant 6 years prior for treatment of osteoarthritis. Histopathology revealed a proliferation of D2-40-positive dilated lymphatic spaces in the dermis and intralymphatic proliferation of CD68-positive histiocytes.

Heel melanoma: the final result of wrong diagnostic and therapeutic approach in another bulgarian patient. First documented case from the board of the “adcrstr-association for dermatohistopathologic control, reevaluation and subsequent therapeutic recomme.

Difficulties with frequent misdiagnoses and incorrectly defined tumor thicknesses applied to the same histopathological preparation occurring among Bulgarian patients, has led to the creation of national and/or international associations or boards for control in problematic circumstances, particularly for patients with melanocytic and non melanocytic cutaneous tumors. Once again we report a problematic case of a patient with acral lentiginous melanomа, localized in the heel area of the right foot, in an otherwise healthy 69-year old woman. A pigmented lesion gradually developed in her heel area, where the patient had been previously treated several times with invasive therapeutic methods (cryosurgery, shave curettage) due to misdiagnosis as a verrucous lesion or as a viral wart in the absence of any prior histopathology report.

Dysplastic nevi, melanoma and pregnancy- where is the relationship?

Dysplastic nevus is a precursor and a risk factor for the development of malignant melanoma, which explains the scientific interest in this field. Its etiology includes various of endogenous and exogenous factors, as we are considering the influence of hormonal status on the possible malignancy of congenital nevi in particular. The occurrence of some typical melanocytic lesions such as chloasma during pregnancy, where the hormone effect is demonstrated, as well as the more frequent changes of the dysplastic nevi namely within the pregnancy, leads to the idea for the endocrine dependence of the malignant transformation of some melanocytic lesions.

Basal cell carcinoma or not Basal cell carcinoma? That is the question!

Basal cell carcinoma is the most frequent malignant tumor in mankind. Although diagnosis often is based on clinical signs confirmed by histopathology, there are simulators of this tumor and there are basal cell carcinomas with misleading clinical appearance. Here we present 4 samples that illustrate the challenge in diagnostics.

“Melanoma imitators”- how to prevent the aggressive approach?

Melanoma imitators could be lesions of different genres; vascular, infectious (granulomatous) and non-melanocytic tumors in addition to various skin artifacts. Their early recognition is essential for the subsequent and sometimes invasive diagnostic and therapeutic approach by the clinician. This paper focuses on several unique cases involving patients with clinical signs of advanced stage melanoma that actually had either benign lesions or circumstances where surgical excision could be avoided.

Melanoma of the heel – a case series of a rare melanoma subtype.

Melanoma of the heel is a rare subtype of the disease, which shows some variations of its incidence in different geographic areas as well as atypical clinical manifestations, resembling numerous other dermatologic conditions, which often leads to misdiagnosis at the early stages of the disease. We present a case series of four patients with malignant melanoma of the heel, with delay of diagnosis due to their atypical presentation, which is illustrated by tumor thickness, Clark level (VI and V), and tumor stage. All of the reported cases are from our own files and demonstrate the challenges with melanoma of the heel, with the aim to emphasize the necessity to biopsy all lesions with unknown significance to avoid the delay in diagnosis and prevent wrong subsequential treatments.

Are microscopic satellites in melanoma indicative of lymphovascular invasion? A preliminary case study.

Microscopic satellites (microsatellites) in primary melanoma are defined as one or more discontinuous nests of neoplastic melanocytes measuring more than 0.05 mm in diameter that are clearly separated by normal dermis (i.e.

Desmoplastic malignant melanoma associated with pigmented ocular tumor: second documented problematic case from the board of “adcrstr-association for dermatohistopathologic control, re-evaluation and subsequent therapeutic recommendations”.

Malignant melanoma is the most malignant skin tumor, whose incidence is rising gradually. It usually occurs in pre-existing lesions in photo-exposed areas of the skin, and, despite its occurrence across a broad age range, its appearance prevails among the elderly. It has a tendency to metastasize rapidly.

Treating skin diseases according to the low dose medicine principles. Data and hypotheses.

Cytokines, hormones and growth factors, also defined with the collective name of “signaling molecules” are key regulating agents of physiological (and also pathological) functions according to the principles of Psycho-Neuro-Endocrine-Immunology (P.N.E.

Psycho-neuro-endocrine-immunology and low dose cytokines therapy: principles and evidences for an innovative medical approach in acute and chronic inflammatory diseases.

The development of the Psycho-Neuro-Endocrine-Immunology (P.N.E.

Life-threatening onychomycosis imitator.

Although onychomycosis is one of the most common dermatological conditions, the exact diagnosis should be carefully confirmed, especially in therapy-resistant cases. Considering the potential for development of various nail disorders that could resemble the clinical picture of typical onychomycosis, the performing of a diagnostic biopsy is sometimes of paramount importance, in order to exclude the possibility of a life threatening onychomycosis imitators. Here, we present a case of subungual malignant melanoma, diagnosed by histological examination in a patient who had received long term, ineffective treatment for onychomycosis.

Foot ulcers in klippel-trenaunay syndrome: two case reports and one metatypical Basal cell carcinoma.

Klippel-Trenaunay syndrome (KTS) is a congenital malformation with vascular anomalies of capillaries, veins and lymphatics and hypertrophy of bones and soft tissues, associated with microdeletion of 2q37.3 and upregulation of angiogenic factor AGGF1. Although KTS predisposes to venous thromboembolic diseases and may be associate with potentially life-threatening vascular complications including bleeding, pulmonary embolism, and deep vein thrombosis, the development of leg or foot ulcers is uncommon.

Nodular epitheloid sarcoma of the upper limb. A case report and review of the literature.

Epitheloid sarcoma is a rare malignant soft tissue sarcoma. We present a 36-year-old male patient with a primary tumour on his wrist and subcutaneous spread in a sporotrichoid pattern along the upper extremity. Early surgical treatment with micrographic control of all margins provides best long term outcome as long as a solitary lesion is present.

Schnitzler syndrome responding to interleukin-1 antagonist anakinra.

Since 2005, an 82-year-old female patient suffered from relapsing, generalized urticarial rash with relapsing fever episodes, arthralgias and burning tibial pain sensations. She unintentionally lost about 10 kg of body weight within 9 months. Systemic treatment with desloratadine, ranitidine, prednisolone and later, ciclosporin A was started.

Generalized eruptive histiocytoma in adult patient.

Generalized eruptive histiocytoma is a rare benign skin disorder with less than 50 cases reported world-wide. It belongs to type IIb of histiocytoses. The histiocytic cells are CD68 positive but lack other markers like CD1a or S100.