background erythema were evident over the nasal bridge, sidewall and ala, clinically in keeping with localized miliaria (Fig. 1), with the differential being an occlusive (infective) folliculitis. Whilst tender on palpation, the area was not overtly cellulitic. Given that the epidermis was intact, and wanting to avoid further compromise to the skin barrier, bacterial swabs were not performed. Dermol â 500 (Dermal Laboratories Ltd, Hertfordshire, UK) lotion was prescribed as an antiseptic soap substitute and emollient. Two weeks later, post-inflammatory hyperpigmentation was apparent in each case, with some residual scaling and dryness. Miliaria, otherwise known as heat rash, is a disorder of eccrine glands due to obstruction and retention of sweat. It is usually associated with immobility, hot/humid environments and improper clothing or bedding which traps heat and perspiration. Within the clinical setting, it is most often seen in febrile inpatients who have been supine for extended periods. There are three subtypesmiliaria crystallina (typically face and trunk), miliaria rubra/pustulosa (most common; typically on the back) and miliaria profunda (rare; trunk and extremities). 5 To our knowledge, this is the first report of a localized facial miliaria secondary to FFP use. It is recognized that epidermal barrier interruption could enhance COVID-19 acquisition 6 and as such, it is fundamental that steps are taken to minimize tissue trauma from PPE use, and to report such cases. Acknowledgement Informed written consent was gained for publication of clinical history and photographs.
Erythrodermic psoriasis is a severe, life‐threatening condition with additional complications, when occurring in hemodialyzed patients, as the majority of treatments are contraindicated. A 44‐years‐old man, of Philippine origins, with a 15‐years‐history of psoriasis treated with cyclosporine developed progressive hypertension and renal insufficiency. Despite drug dismission, renal function worsen to end‐stage, and hemodialysis was necessary three times a week. Phototherapy was not able to control the skin condition, progressing to erythroderma, and after nephrology consultation, the patient consent to the off‐label secukinumab treatment, at the standard regimen (300 mg subcutaneously once weekly at weeks 0‐4 followed by 300 mg every 4 weeks). Seven days after the first injection, a rapid improvement was noted, with the psoriasis area severity index (PASI) score passing from 31.5 to 17.6. At the 52‐week‐follow‐up visit, the patient was completely clarified, without any side effects. The case supports secukinumab effectiveness and safety in difficult patients, including erythrodermic psoriasis with end‐stage renal failure, as drug plasma levels seem not to be affected by hemodialysis. Results are rapidly achieved, and long term maintained, with the additional advantage of a very comfortable monthly administration.
The role of human oncoviruses in melanoma has been poorly investigated. The aim of this study was to investigate the association between oncoviruses and melanomas searching for human papillomavirus (HPV), Epstein Barr virus (EBV), and human herpesvirus 8DNA in melanoma specimens. Formalin‐fixed and paraffin‐embedded tissue specimens of cutaneous, mucosal, and ocular melanomas (OM) were selected from the Pathology Departments of the Galliera Hospital (Genoa) and the University Hospitals of Turin and Cagliari. Cutaneous and mucosal nevi have been collected as controls. The oncoviruses search has been performed with different polymerase chain reaction reagent kits. Fifty‐four melanomas (25 mucosal, 12 ocular, and 17 cutaneous) and 26 nevi (15 cutaneous and 11 mucosal) specimens were selected. The detection rate for one of the investigated oncoviruses was 17% in mucosal, 20% in ocular, and 0% in cutaneous melanomas (CMs). Despite the differences between groups seeming remarkable, there was no statistical significance (
p
> 0.5). Our data do not support a primary role of oncoviruses in melanoma carcinogenesis; however, the finding of HPV and EBV DNA in a considerable fraction of mucosal and OMs suggests that these viruses may act as cofactors in the development of extra‐CMs.
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