Background: There is upcoming evidence that dermoscopy facilitates the in vivo diagnosis of skin infections and infestations. As such, dermoscopy connects the research fields of dermatologists and entomologists, opening a new research field of ‘entodermoscopy’. Objective: To provide an overview on the current applications of entodermoscopy. Methods: Systematic review of the English- and German-language literature by searches of Medline, Medscape and abstracts of the 1st World Congress of the International Dermoscopy Society. Results: Dermoscopic patterns have been described for viral warts, molluscum contagiosum, scabies, pediculosis, tinea nigra, tungiasis, cutaneous larva migrans, ticks and reactions to spider leg spines. Besides the diagnostic role of dermoscopy, there is increasing evidence that it can also assist in the monitoring of treatment efficacy for some of these conditions. Conclusion: Although most of the current available literature is based on single observations and small case studies rather than controlled trials, an increasing interest in this field can be observed.
Dermoscopy improves the diagnostic accuracy in the clinical evaluation of pigmented skin lesions, but it is also useful for the assessment of vascular structures that are not visible to the naked eye. As a consequence, dermoscopy has been employed more and more for the differential diagnosis of nonpigmented skin disorders, including tumors but also inflammatory and infectious diseases. This article provides a review of the dermoscopic features seen in various nonpigmented tumoral and nontumoral skin lesions as well as the dermoscopic criteria used for monitoring skin reactions to various treatments.
Importance: Nodular melanoma (NM) is a rapidly progressing potentially lethal skin tumor for which early diagnosis is critical.Objective: To determine the dermoscopy features of NM.Design: Eighty-three cases of NM, 134 of invasive non-NM, 115 of nodular benign melanocytic tumors, and 135 of nodular nonmelanocytic tumors were scored for dermoscopy features using modified and previously described methods. Lesions were separated into amelanotic/ hypomelanotic or pigmented to assess outcomes.Setting: Predominantly hospital-based clinics from 5 continents.Main Outcome Measures: Sensitivity, specificity, and odds ratios for features/models for the diagnosis of melanoma.Results: Nodular melanoma occurred more frequently as amelanotic/hypomelanotic (37.3%) than did invasive non-NM (7.5%). Pigmented NM had a more frequent (compared with invasive non-NM; in descending order of odds ratio) symmetrical pigmentation pattern (5.8% vs 0.8%), large-diameter vessels, areas of homogeneous blue pigmentation, symmetrical shape, predominant peripheral vessels, blue-white veil, pink color, black color, and milky red/pink areas. Pigmented NM less frequently displayed an atypical broadened network, pigment network or pseudonetwork, multiple blue-gray dots, scarlike depigmentation, irregularly distributed and sized brown dots and globules, tan color, irregularly shaped depigmentation, and irregularly distributed and sized dots and globules of any color. The most important positive correlating features of pigmented NM vs nodular nonmelanoma were peripheral black dots/globules, multiple brown dots, irregular black dots/globules, bluewhite veil, homogeneous blue pigmentation, 5 to 6 colors, and black color. A model to classify a lesion as melanocytic gave a high sensitivity (Ͼ98.0%) for both nodular pigmented and nonnodular pigmented melanoma but a lower sensitivity for amelanotic/hypomelanotic NM (84%). A method for diagnosing amelanotic/hypomelanotic malignant lesions (including basal cell carcinoma) gave a 93% sensitivity and 70% specificity for NM.Conclusions and Relevance: When a progressively growing, symmetrically patterned melanocytic nodule is identified, NM needs to be excluded.
A dermoscopic model of 'strawberry' pattern is presented, which may prove helpful in the in vivo diagnosis of nonpigmented, facial AK. A limitation of this study is the lack of testing of the specificity of the described dermoscopic criteria in differentiating nonpigmented AKs from other nonpigmented skin lesions at this site.
The results obtained proved the efficacy of these treatments, and the satisfaction of the patients confirmed the quality of the results.
Background Background: COVID-19 outbreak profoundly affected health systems and people's daily life worldwide. Parkinson's disease (PD) patients lost their normal routine and interrupted regular physical activity, either as physiotherapy or sport, with inevitable consequence on their daily-life and well-being. Objectives Objectives: To evaluate the changes in physical activity due to COVID-19 emergency, including self-management strategies or technology-assisted activities, and the subsequent clinical implications in PD patients. Methods Methods: Seventy-four patients from an Italian center have been remotely examined during the lockdown (April-May 2020) by an e-mail structured survey, including self-administered scales. We collected and analyzed data on changes, modalities and amount of physical active practice, on the use of technology-based tools, and on self-perceived clinical condition. Results Results: Sixty percent of patients reported a significant worsening of their general conditions during the lockdown, the reduction of physical activity being the main risk factor for such change. However, patients found ways to practice physical activity, using satisfactorily technology assistance in 50% of cases (mostly women). Conclusions Conclusions: The COVID-19 emergency has been an ordeal for PD patients. Nevertheless, patients adapted their habits to continue practicing physical activity that resulted a main determinant of their well-being; as well, they successfully approached technology-based assistance. Education, communication, and networking emerge as critical for a constructive reaction to the emergency's challenges.
Parkinson's disease patients benefit from deep brain stimulation (DBS) in subthalamic nucleus (STN), but the basis for this effect is still disputed. In this intraoperative microdialysis study, we found elevated cGMP extracellular concentrations in the internal segment of the globus pallidus, despite negligible changes in glutamate levels, during a clinically effective STN-DBS. This supports the view that a clinically beneficial effect of STN-DBS is paralleled by an augmentation (and not an inactivation) of the STN output onto the GPi.
Background: Dermoscopy of morphea and cutaneous lichen sclerosus (CLS) has been described by various studies, with none of them considering variability according to clinical phases and investigating dermoscopic-histological correlations. Objective: To evaluate dermoscopic features in general and according to clinical stage, identify possible distinctive dermoscopic clues, and assess dermoscopy accuracy in detecting subclinical alterations in morphea and CLS. Methods: A representative dermoscopic image of target lesions was evaluated for the presence of specific features, correlating them with clinical subtype (inflammatory, inflammatory-sclerotic, sclerotic, or sclerotic-atrophic). In case of clinical-dermoscopic discordance (inflammatory, sclerotic, and atrophic findings in noninflammatory, nonsclerotic, and nonatrophic lesions, respectively), dermoscopic-pathological correspondence was assessed. Results: A total of 86 lesions (51 morphea/35 CLS) were analyzed, with most of them displaying an inflammatory-sclerotic or sclerotic clinical pattern. The most common dermoscopic findings of morphea were “fibrotic beams,” while CLS was mainly characterized by bright white/white-yellowish patches and yellowish-white keratotic follicular plugs; all these structures displayed complete specificity for the correspondent dermatosis. Additionally, pigmentary structures were significantly more frequent in morphea and white scaling and hemorrhagic spots in CLS. Only few dermoscopic features reached a statistical significance for a specific clinical stage. Regarding the clinical-dermoscopic discordance rate, it was significantly more common in morphea than CLS; in all cases there was a correspondence between dermoscopic and pathological findings. Conclusion: Dermoscopy of morphea and CLS reveals distinctive dermoscopic clues which are often unrelated to clinical stage but show a constant histological correspondence, thus emphasizing its usefulness in diagnosis and therapeutic management of these conditions.
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