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Background: The presence of Actinic Keratoses (AKs) represent the most important warning sign of subclinical ultraviolet radiation. Currently, the regular use of sunscreens is considered essential for the prevention of the development of AKs. Aim: We evaluated the effectiveness of a new class I Medical Device (MD) for the prevention and treatment of AKs vs traditional sunscreen alone (SPF 100þ). Methods: We conducted a randomized controlled prospective study in 90 Caucasian patients: 62 immunocompetent and 28 Organ Transplant Recipients (OTRs). We randomly assigned subjects to the MD group or sunscreen alone in a 1:1 assignment ratio. The patients have been reevaluated after three and six months. Results: In immunocompetent patients treated with MD, at the end of the study the reduction of the mean number of AKs was 54.7 vs. 9.43% with photoprotector. In OTRs, the global reduction was of 36.7% after MD use compared to 14.3% with the sunscreen. The prevalence of NMSCs, in the patients treated with MD, was 11.11 and 17.18 with sunscreen; the incidence was 19.7 in patients treated with MD and 32.1 in those treated with sunscreen. Conclusion:The MD has demonstrated good efficacy in the reduction of visible AKs, encouraging its use also in high-risk category, like OTRs.

Background: Actinic keratoses (AK) represent common cutaneous lesions, appearing in 'Field cancerization areas' and potentially evolving toward invasive neoplasm. Immunosuppressed patients frequently develop numerous and aggressive AKs. Aim: In this observational study, we report our experience with topical Imiquimod 3.75% as 'Fielddirected therapy' in a cohort of immunosuppressed patients. Methods: A group of 13 immunosuppressed patients presenting multiple AKs of the balding scalp was treated with topical Imiquimod 3.75%. Each patient underwent clinical examination at fixed timepoints during the treatment (T0, T14, T28, T42) and eight weeks after the end. Results: In our cohort, the treatment was well tolerated, with minimal local adverse events. We observed a good clinical response, in terms of Lmax lesions (maximum lesion count during the course of therapy) and of AK clearance. In our group, 46% of patients showed no detectable lesions at the end of the observation period, and this result was maintained up to 1 year after the end of treatment. Conclusion: Topical Imiquimod 3.75% represents an effective and safe treatment for multiple AK of the scalp also in immunosuppressed patients. To the best of our knowledge, this is the first report on the use of this drug in this category of subjects. ARTICLE HISTORY

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Cryptococcus neoformans is opportunistic encapsulated yeast that represents the most frequent cryptococcal species found in humans. It can cause three types of infections: pulmonary cryptococcosis, cryptococcal meningitis and cutaneous cryptococcosis. Cutaneous cryptococcosis may represent the dissemination of a systemic infection (especially from nervous or pulmonary primary site of infection) or may be the only localization, due to a direct inoculation into the skin, because of a traumatic injury. Primary cutaneous cryptococcosis (PCC) is rare and mainly affects elderly patients, from rural areas, with history of cutaneous injuries and activities predisposing wounds or exposure to bird droppings. Immunosuppression may be a predisponing factor. The most utilized treatment is fluconazole, but often, especially for ulcers or deep wounds; surgery is required for complete tissues repair. Herein, we present a case of PCC in an immunosuppressed patient, with destroying ulcers involving deep tissues, completely resolved after fluconazole treatment, without surgical intervention.