Kyrle's Disease in a Patient with Delusions of Parasitosis

Acquired perforating disorders are a group of uncommon skin conditions characterized by transepidermal extrusion of altered dermal material, most often associated with diabetes mellitus and chronic kidney failure. Delusional parasitosis is a primary psychiatric disorder in which affected patients have fixed, false beliefs that their skin is infested by parasites, in the absence of any evidence supporting their statements. A 69 year old malepatient addressed the Dermatology Department for a skin eruption consisting of multiple umbilicated keratotic papules with a generalized distribution. The patient believed that the lesions were produced by small parasites entering and exiting his skin. The histopathological examination confirmed the clinical diagnosis of Kyrle's disease. The psychiatric examination established the diagnosis of delusions of parasitosis. This is the first reported case of Kyrle's disease associated with delusions of parasitosis. There is no evidence supporting the hypothesis that delusions of parasitosis might be a predisposing factor for Kyrle's disease. However, we believe that the pruritic dermatosis might have triggered the delusions of parasitosis due to the associated pruritus. On the other hand the constant excoriations and traumatizing of a skin prone to develop idiopathic Kyrle's disease in the attempt to remove the parasites prevented the complete resolution of the lesions.

THE ROLE OF ESTROGENS AND ESTROGEN RECEPTORS IN MELANOMA DEVELOPMENT AND PROGRESSION

Melanoma has a significant mortality and its growing incidence is associated with important social and health care costs. Thus, investigation of the complex mechanisms contributing to emergence and development of melanoma are of real interest both in scientific research and clinical practice. Estrogens play an important role in the emergence and development of certain types of cancer, such as breast cancer, endometrial cancer and ovarian cancer, but their role in development of cutaneous melanoma is still a matter of debate. Various data suggest that increased levels of endogenous estrogens during pregnancy or exposure to exogenous estrogens by use of oral contraceptives (OCs) and hormone replacement therapy (HRT) may have a potential role in melanoma development and progression. Moreover, there were revealed several intracellular pathways which can support the connection between estrogens, estrogen receptors (ER) and melanoma. While ER-β plays an antiproliferative role, ER-α promotes cell growth and cellular atypia. Thus, inhibition of ER-β activity in the skin can increase the risk for development of cutaneous melanoma and spread of metastatic cells. However, despite recent advances in this area, the exact role and clinical implications of estrogens and estrogen receptors in melanoma are still not entirely understood and require further investigations.

Brief history of syphilis

Before the discovery of Treponema pallidum as the etiologic agent, the origins of syphilis have been the subject of several debates. Diverse therapeutic agents were employed in an attempt to cure the disease. Examining the milestones in the history of syphilis, the present article reviews the existing theories that tried to explain the origins of the disease, the approach in art, the cultural and the evolution of the treatments from the empiric means to the discovery of penicillin.

Photodynamic therapy in the treatment of basal cell carcinoma

Photodynamic therapy (PDT) is a medical procedure based on the activation of the molecules of various exogenous or endogenous chemical substances called photosensitizers by a light source emitting radiation of an adequate wavelength, usually situated in the visible spectrum; photosensitizers are chemical compounds bearing the capacity to selectively concentrate in the neoplastic cells. The energy captured by the molecules of these substances pervaded in the tumor cells is subsequently discharged in the surrounding tissue, triggering certain photodynamic reactions that result in the destruction of the tumor. The procedure is applicable in numerous medical fields. Skin basal cell carcinoma (BCC), the most frequent type of cancer of the human species, is a cutaneous tumor that responds very well to this innovative treatment method. By reviewing numerous recent studies in the field, this article aims to present the role and the indications of photodynamic therapy in the management of basal cell carcinoma, as well as the most important results achieved so far by this therapy in the field of dermato-oncology.

Axillary basal cell carcinoma--a rare form of a frequent kind of carcinoma

Basal cell carcinoma (BCC) is the most common cutaneous cancer. It seems that the most important prognostic factor is exposure to ultraviolet radiation (solar and artificial), correlated with other factors as well. In this article, we aimed to review basal cell carcinoma located in the axilla, referring to cases from our hospital. Axillary location of BCC is rare, with a very low number of cases quoted in the literature, compared to the high prevalence of basal cell carcinoma in the general population. During a period of two years, we detected only four cases of axillary basal cell carcinoma out of a total number of 921 cases diagnosed as BCC. We were interested in identifying certain factors involved in causing BCC, post-excision clinical evolution, histological type and aggressiveness of axillary basal cell carcinoma. Therefore, we quantified objectively the tumor and stromal expression of some immunological markers like: metalloproteinases MMP1, 3, 11, Ber-EP4 and Ki67. Histological types of tumors investigated here belong to the category of non-aggressive BCC, namely as nodular and superficial, although Ki67 index is greater than the average reported in the literature for this type of tumor. MMPs exhibited increased expression in tumors and stromal compartments, especially at the tumor invasion front, and was not associated with tumor ulceration or surrounding tissue remodeling-related changes. Our results confirm the literature data concerning the involvement of MMPs in BCC progression, whatever the tumor location is.