The authors aim to present the butterfly effect, a concept based on the theory that small changes might have a powerful effect, as an example of the important connection between diet and acne. Western diet is currently a well-known environmental factor which, mainly via the overstimulation of mTORC1 (mammalian target of rapamycin complex 1), is responsible for the development and aggravation of acne and other age-related diseases of civilization. From the authors' point of view, "the butterfly effect" extrapolated to acne and diet depicts the importance of dietary interventions in acne so as to prevent more serious mTORC1-driven diseases of civilization like obesity, diabetes, and cancer.

No abstract

FeP) is an uncommon subtype of basal cell carcinoma (BCC) with a particular growth pattern, first described by Hermann Pinkus in 1953. 1 This tumor is slow growing and commonly found on the trunk or extremities of persons in the fifth and sixth decades of life. 2 Although its etiopathogenesis is not fully understood, chronic ultraviolet damage seems to be a lesser factor than it is in BCC. 3,4 Mutations in the PTCH gene of the Hedgehog signaling pathway could be involved in its development. 5 FeP arising after radiation therapy has been reported, although a direct link is yet to be defined. 6 FeP is a rare neoplasm that is often difficult to diagnose, as it simulates other skin tumors. As the diagnosis determines therapy, it is important that the tumor is identified correctly.We report the case of a 67-year-old Caucasian female who presented to the Victoria Medical Center in Bucharest, for a routine skin examination. Upon physical examination, numerous, well defined, light brown papules were found scattered over the upper and mid posterior trunk, clinically favoring the diagnosis of seborrheic keratoses.Additionally, a round, 7 mm flesh colored, asymptomatic, slightly raised lesion was observed on the left flank (Figure 1A,B). Personal medical history included a superficial BCC on the trunk, surgically treated approximately 4 years prior to presentation.

Laser hair removal became a very popular intervention, with a permanently increasing number of procedures being performed worldwide. The procedure is often performed by nonmedical personnel, and even by untrained personnel, that could be associated with different kind of adverse events, from mild to serious. The complications associated could be lower if the operators understand the basic of laser physics and the working principles of devices. We propose a simple acronym, WATCH, in order to increase the safety and efficiency of laser interventions.

We have read with interest the article written by Bonan et al. 1 Given our interest in the subject, we also recently published a paper 2 regarding the complications associated with laser hair removal (LHR) and proposed the acronym, WATCH, in order to reduce the frequency and severity of complications associated with this procedure. "Primum non nocere" meaning "First, do no harm" must be applied in every aspect of our practice, including in LHR, and the most practical way is to prevent complications. This could be achieved by knowing and understanding basic laser principles of action, and by a personalized patient approach and selection.