Contrary to data from Northern European countries, melanoma incidence still showed an ascending trend in the Italian population of Emilia Romagna.

Aims and Background In southern European countries, the availability of epidemiologic data on cutaneous malignant melanoma is limited. A descriptive analysis was performed on melanoma cases diagnosed in the Italian region of Romagna (population 600,000), 1986-91. Methods The main end point was the proportion of cases less than 1.5 mm thick by sex, age, and site. Results A total of 297 incident cases was evaluated. The average annual age-standardized (World) incidence rates were 6.2 (95% CI 5.2–7.2) per 100,000 females and 4.5 (95% CI 3.6–5.3) per 100,000 males. Females presented with significantly thinner melanomas than males. The proportion of cases less than 1.5 mm thick decreased significantly with increasing age in both sexes, with the most pronounced decrease (approximately from 2/3 to 1/3) being observed above 60 years for females and above 40 for males. Comparing sexes by 10-year age groups, a significant F:M advantage in thickness distribution was found only at age 40–49 and 50–59 years. Among females under 60, melanomas of the legs and those of the trunk showed no difference in thickness distribution, in both sexes, incidence appeared to increase progressively with age. No apparent elevation in incidence rates was observed in the age groups with the highest frequency of thin melanomas. Conclusions The major implication of these data is that in public education programs specific messages should be aimed at those subgroups that show the poorest levels of self-surveillance.

A 45-year-old non-atopic woman developed pigmented, bullous dermatitis, resembling a partial thickness burn, on her left knee ( Figure 1). She had wrapped walnut (J. regia) leaves soaked in grappa around her left knee for two consecutive nights in order to treat her painful, swollen knee. This "traditional" remedy had been suggested by a friend of hers who had found the information on the internet. Patch tests with the Italian Society of Allergological, Occupational and Environmental Dermatology (SIDAPA) baseline series (Lofarma, Milano, Italy) and with a piece of leaf "as is" were performed. Patch test chambers (Van der Bend, Brielle, The Netherlands) were applied in occlusion on the patient's back for 2 days. Readings were performed on day (D) 2 and D3 according to ESCD guidelines. The patient did not show any positive reactions. Bullous irritant contact dermatitis was diagnosed. DISCUSSIONJ. regia is a common large walnut tree whose parts are used to treat various diseases (eg, diarrhoea, sinusitis, arthritis, skin disorders, and diabetes) in popular medicine. In particular, fresh leaves of J. regia are applied on the forehead and body to alleviate fever, and on the joints to reduce rheumatic pain. 2 Cases of irritant contact dermatitis caused by the juice of green walnut husks have been described. 3,4 The responsible agent is juglone, an aromatic naphthoquinone present in J. regia husks and leaves. Juglone has an exogenous pigmenting action; for this reason, walnut husks are used in the preparation of vegetable hair dyes, similar to henna (Lawsonia inermis). 3 Although juglone is a strong sensitizer in guinea-pigs, few cases of allergic contact dermatitis caused by walnut husks have been described in humans. 3 In 2015,Foti et al described a case of allergic contact dermatitis caused by an unknown allergen contained in walnut husks. 5

We report the case of a 3-year-old boy with classical chronic bullous disease of childhood (CBDC) arising after recent Epstein-Barr virus seroconversion following infectious mononucleosis. The patient also had small red cells and decreased levels of circulating IgA. He received combined treatment with dapsone and prednisone with good results. Our report is the first of CBDC preceded by Epstein-Barr virus seroconversion. The virus may have had an initial immunopathogenic role in the genesis of the bullous eruption.

2] Angelini G, Vena GA, Grandolfo M. Mometasone furoato: attivia farmacologica e clinica. Dermotime 1994;9(Suppl.): 1-8. Bjening P. Comparison of the bioactivity of mometasone furoate 0.1 % fatty cream, betamethasone dipropionate 0.05% cream and betamethasone valerate 0.1% cream in humans. Skin Pharmacol 1993;6: 187-192. Medansky RS, Bressinck R. Cole GW, et al. Mometasone furoate ointment and cream 0.1% in'treatment of psoriasis: comparison with ointment and cream formulations of fluocinolone acetonide 0.025% and triamcinolone acetonide 0.1%. Cutis 1988;42:480-485. Kelly JW, Cains GD, Rallings M. et al. Safety and efficacy of mometasone furoate cream in the treatment of steroid responsive dermatoses. Australasian J Dermatol 1991;32: 85-91. Rafanelli A, Rafanelli S, Stanganelli I, et al. Mometasone furoate in the treatment of atopic dermatitis in children. J Eur Acad Derm Venerol 1993;2:225-230. Giannetti A, Manzini BM, Bianchi B. Randomized, evaluator-blinded, multicenter study on onset of action, efficacy and safety of mometasone furoate 0.1% cream vs clobetasone butyrate 0.05% ointment in the treatment of atopic dermatitis. Annual Meeting of American Academy of Dermatology, New Orleans, February 4-9, 1995. Braga D, De Panfilis G, Bianchi B. A randomized, multicentric, evaluator-blinded study to compare mometasone furoate 0.1 % ointment versus diflucortolone valerate 0.1 ointment in the treatment of psoriasis vulgaris. Annual Meeting of American Academy of Dermatology, New Orleans, February 4-9, 1995. Rajka G, Avrach W, Gartner L, et al. Mometasone furoate 0.1 % fatty cream once daily versus betamethasone valerate 0.1% cream twice-daily in the treatment of patients with atopic and allergic contact dermatitis. Curr "her Res 1993;54:23-29. Vigliola P, Jones MI, Peets FA. Once-daily 0.1% mometasone furoate creak versus twice-daily 0.1% betamethasone valerate cream in the treatment of a variety of dermatoses. J Intern Med Res 1990; 18:460-467. -* Corresponding author.