Recent trends in specular light reflectance beyond clinical fluorescence diagnosis.

in European Journal of Dermatology (2011), 21(2), 157-61

Under specific light illumination, particularly ultraviolet (UV) and near-UV light stimulation, the skin produces both specular light reflectance and, possibly, specific fluorescent emission. These ... [more ▼]

Under specific light illumination, particularly ultraviolet (UV) and near-UV light stimulation, the skin produces both specular light reflectance and, possibly, specific fluorescent emission. These properties offer diagnostic clues and disclose some peculiar functions of the skin. A series of superficial infections (erythrasma, some tinea capitis types, tinea/pityriasis versicolor, dermatophytoses, etc.) and pilosebaceous follicles enriched in Propionibacterium spp show fluorescence. This latter characteristic is downgraded or lost while on some anti-acne treatments. A quenching effect of fluorescence is observed following the application of sunscreens. The (pre)neoplastic areas prepared for methylaminolevulinate photodynamic therapy (MAL-PDT) show reddish fluorescence following drug metabolisation producing porphyrins by the abnormal activated cells. Of note, when using a recording sensitive CCD camera instead of casual visual observation, skin fluorescence may be superimposed on the specular reflectance of the incident light. With the current technology, these situations are not distinguished with confidence. Any harsh and scaly lesion appears brighter following yellowish specular light reflectance. Stratum corneum samplings collected on clear self-adhesive discs or cyanoacrylate skin surface strippings are conveniently examined ex vivo, taking advantage of the same optical properties. [less ▲]

Angiogenic fast-growing melanomas and their micrometastases.

in European Journal of Dermatology (2010), 20(3), 302-7

Malignant melanoma (MM), particularly its fast-growing type, is prone to interstitial, intravascular and extravascular migratory metastases. There is no information linking their growth fraction, the ... [more ▼]

Malignant melanoma (MM), particularly its fast-growing type, is prone to interstitial, intravascular and extravascular migratory metastases. There is no information linking their growth fraction, the configuration of the MM advancing edge, the extent in vascularity and the propensity to metastatic progression. The objective of this study was to determine the growth fraction, the size of vascularity and the contours of the progression border of 32 fast-growing MM with regard to the presence or absence of a micrometastatic spread inside the skin and overt metastases in the sentinel lymph nodes. In vivo high resolution colorimetry was performed as a clinical estimate of MM vascularity. Euclidean geometry and fractal analysis were used on immunohistochemical sections. The relative microvasculature profile area beneath MM, and the fractal dimension D of the MM frontline were assessed. The MIB/Ki-67 index was determined in MM cells. Value a* of colorimetry was similarly increased in the presence or absence of micro-metastases. No difference in growth fraction was revealed between these neoplasms. Correlations were found between vascularity and angiotropism, and between the micrometastatic process and the sentinel lymph node involvement. By contrast, no correlation was shown between vascularity and the fractal D dimension of the MM advancing edge. In sum, this study establishes a link between the extent of MM growth fraction, vascularity and the presence of dermal and nodal micrometastases in fast-growing MM. [less ▲]

Real-life practice study of the clinical outcome and cost-effectiveness of photodynamic therapy using methyl aminolevulinate (MAL-PDT) in the management of actinic keratosis and basal cell carcinoma

in European Journal of Dermatology (2008), 18

Photodynamic therapy with methyl aminolevulinate (MAL-PDT) is a non-invasive therapy for superficial and nodular basal cell carcinoma (BCC). We performed an open-label trial to evaluate efficacy, safety ... [more ▼]

Photodynamic therapy with methyl aminolevulinate (MAL-PDT) is a non-invasive therapy for superficial and nodular basal cell carcinoma (BCC). We performed an open-label trial to evaluate efficacy, safety, tolerability and cosmetic outcome of MAL-PDT in selected patients with superficial and nodular BCCs. Ninety-four superficial and 24 nodular BCCs in 69 patients were treated with 2 to 8 MAL-PDT sessions. Efficacy, safety, tolerability and cosmetic outcome were evaluated at months 1, 3, 6 and 12 after the last MAL-PDT treatment and then every 3 months. One patient discontinued the study for reasons unrelated to study procedures. Complete clinical regression was detected in 84/94 (89.4%) superficial BCCs, and 12/23 (52.2%) nodular BCCs one month after 2 MAL-PDT sessions. No further clinical improvement was observed in either superficial or nodular BCCs with treatment continuation up to a maximum of 8 MAL-PDT sessions. Adverse effects were limited to mild local skin reactions, and cosmetic outcome was rated as excellent or good. Recurrence was observed in 2/84 (2.4%) successfully treated superficial BCCs at 6 and 12 months after treatment discontinuation. Based on the efficacy, tolerability, cosmetic outcome and recurrence rate, our results support the use of MAL-PDT for treatment of superficial BCC and for selected cases of nodular BCC. [less ▲]

Laddering melanotic pattern of Langer's lines in skin of colour.

in European Journal of Dermatology (2008), 18(5), 575-8

Mechanobiological stimulation of the skin influences melanocyte activity. The clinical impact on melanocytes can be perceived by dermoscopy. Our aim was to assess the orientation of Langer's lines using ... [more ▼]

Mechanobiological stimulation of the skin influences melanocyte activity. The clinical impact on melanocytes can be perceived by dermoscopy. Our aim was to assess the orientation of Langer's lines using the combination of ultrasound shear wave propagation and dermoscopy in 70 adults of darker skin complexion. On the back, 44/70 patients showed a honeycomb melanotic pattern without any main orientation. By contrast, a streaky parallel pattern of melanotic lines oriented in the direction of Langer's lines was found in 26/70 patients. Indeed, the maximum speed of ultrasound propagation was found parallel to the main orientation of the laddering melanotic pattern. The parallel melanotic pattern probably reflects the main orientation of the epidermal rete ridges aligned in the direction of Langer's lines. This aspect could be ascribed to the deepening of these structures and/or to mechanobiology affecting melanocytes. The aspect is reminiscent of that previously described in striae distensae and atrophic scars. [less ▲]

Skin capacitance imaging, a new technique for investigating the skin surface.

in European Journal of Dermatology (2006), 16(5), 500-6

Thanks to the recently introduced silicone image sensor technology, skin capacitance imaging has now been made possible. The dedicated device is called SkinChip. This method is easy to handle and provides ... [more ▼]

Thanks to the recently introduced silicone image sensor technology, skin capacitance imaging has now been made possible. The dedicated device is called SkinChip. This method is easy to handle and provides information about the skin microrelief, the level of stratum corneum hydration and the sweat gland activity. The apparatus sees and measures these parameters with a 50 microm resolution. A series of conditions have been explored using skin capacitance imaging. This review summarizes relevant findings about regional variability on the body, changes occurring with ageing, effects of a hydrating formulation, reactivity kinetics of corneocytes to surfactants, acne and skin pores characteristics, as well as hyperkeratotic dermatoses and tumours. [less ▲]

Environmental hazards and the skin.

in European Journal of Dermatology (2006), 16(3), 322-4

Comedolysis by a lipohydroxyacid formulation in acne-prone subjects.

in European Journal of Dermatology (2003), 13(1), 65-8

Post-summertime exacerbation of acne is not a rare event. This study was conducted to assess the preventive effect of a proprietary formulation containing 2-hydroxy-5-octanoyl benzoic acid on this ... [more ▼]

Post-summertime exacerbation of acne is not a rare event. This study was conducted to assess the preventive effect of a proprietary formulation containing 2-hydroxy-5-octanoyl benzoic acid on this environmental related disease. This compound is commonly called beta-lipohydroxyacid (LHA). Among a randomized group of 14 acne-prone women, 12 who developed cornified follicular plugs the end of summertime were treated by the LHA formulation twice daily for 2 weeks. Ten of 14 other women who presented the same skin condition remained untreated as controls. The comedolytic effect was assessed using non-invasive ultraviolet-light video recording combined with computerized image analysis. The cornified follicular plugs were progressively cleared in 10/12 LHA-treated women and in 3/10 untreated volunteers. Analytical assessments showed a significant decrease in both the number and total size of microcomedones in the LHA-treated women. By contrast, no quantitative change was disclosed in the untreated group. It is concluded that the tested LHA formulation exerts comedolytic properties that might help in preventing post-summertime acne exacerbations. [less ▲]

Necrotizing varicella zoster virus folliculitis.

in European Journal of Dermatology (2003), 13(6), 587-9

Although the usual clinical features of the varicella zoster virus (VZV)-induced lesions are readily recognized, the same virus is also responsible for a series of atypical lesions. A patient is presented ... [more ▼]

Although the usual clinical features of the varicella zoster virus (VZV)-induced lesions are readily recognized, the same virus is also responsible for a series of atypical lesions. A patient is presented with a single large infiltrated plaque on the abdomen. Although histology showed a necrotizing folliculitis surrounded by a dense perifollicular inflammatory infiltrate, the clinical presentation was not suggestive of folliculitis. Subtle cyto-histological clues for viral infection were suggested. Immunohistochemistry revealed the presence of VZV in the remnants of the follicular structures. This report underlines one of the protean clinical presentations of VZV skin infections and highlights the discreteness of typical VZV-related cyto-histological alterations. Complementary VZV identification methods such as immunohistochemistry, are helpful in order to increase the diagnostic accuracy of unusual VZV lesions. [less ▲]

Update on the histological presentation of facial wrinkles.

in European Journal of Dermatology (2002), 12(6), -

Breaking the Relentless Course of Hallopeau's Acrodermatitis by Dapsone

in European Journal of Dermatology (1999), 9(2), 126-128

We report the case of a 74-year-old man who suffered for four years from recurrent generalized pustular eruptions associated with acrodermatitis continua of Hallopeau (ACH). Initial therapy using topical ... [more ▼]

We report the case of a 74-year-old man who suffered for four years from recurrent generalized pustular eruptions associated with acrodermatitis continua of Hallopeau (ACH). Initial therapy using topical corticosteroids, tars and PUVA failed to improve the acral lesions. The disease was also unresponsive to systemic therapy using corticosteroids, methotrexate, etretinate, acitretine and cyclosporin A. Serious side-effects were experienced with these drugs. A marked improvement of the generalized pustules was observed under treatment combining etretinate and methotrexate, without having any effect on the acropustulosis. During hospitalization, a topical tar therapy cleared the pustular rash. Again no effect was observed on the acral lesions. Disulone (DDS) therapy, initiated at a dose of 200 mg/day, completely cleared ACH after 4 weeks. The disease relapsed when the dose was reduced to 100 mg/day. Increasing the DDS to 150 mg/day was rapidly followed by a new clearance of the acral lesions. After a 3-month treatment, the patient has remained lesion free and no DDS-related side-effects have occurred. In conclusion, sulfones may be considered as an alternative therapeutic option in drug-resistant ACH. [less ▲]