Transplantation is now currently and increasingly performed for the treatment of various acute and chronic diseases. Today the kidney, heart, lung, heart-lung, liver, pancreas, kidney-pancreas, small bowel and bone marrow are being transplanted. The immunological status of patients receiving such transplants exposes them to the risk of developing bacterial, viral and fungal infections. The etiological agents of mycotic diseases involving the skin of transplant recipients range from the common dermatophytes through yeasts such as Candida spp., Malassezia spp. and dimorphic fungi to the emerging molds Fusarium spp. and Pseudallescheria boydii. The very wide spectrum of fungi causing cutaneous disease produces equally varied clinical aspects. Lesions may be typical, but are very often aspecific or ambiguous. Cutaneous lesions may be the sign of a trivial mycotic disease or the marker of a disseminated, potentially lethal fungal illness, so great attention should be given to their early recognition. Cutaneous manifestations due to Candida spp., Aspergillus spp., dematiaceous fungi and Pityrosporum folliculitis are usually observed early after transplant, cryptococcosis more than 6 months later, while the frequency of dermatophytoses increases as time goes by. Coccidioides immitis, Histoplasma capsulatum and Blastomyces dermatitidis may appear any time after transplantation. The management of the more severe forms of cutaneous mycosis in transplant recipients is difficult. Besides the fact that early recognition is not easy, there are also problems regarding the effectiveness and the toxicity of the therapy and drug-drug interactions. Prophylactic measures to avoid fungal contamination must be performed during hospitalization; patients should be taught how to avoid contamination, not only during the first period after transplantation, when high dosage immunosuppressive drugs are given, but also later when a normal lifestyle is resumed.

At the end of pregnancy, both vascular structures and TDS increased. These modifications were transient as the nevi recovered their prior appearance after delivery. The results indicate that an intrinsic influence of pregnancy may induce structural modifications without influencing the size of the nevi. Behavioral factors during the observational period, like a reduced exposure to sunlight reported by most of the women, may have influenced other characteristics, like global pigmentation and pigment network. The authors thank the Fondazione Cassa di Risparmio di Ferrara for its financial support, which enabled them to acquire the instrumentation necessary for this study.

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Background: Because of chronic immunosuppressive therapy, the skin of renal transplant recipients (RTR) is considered more liable to fungal infections. Aim: The aim of the study was to analyze the prevalence of superficial dermatomycoses in a chronically immunosuppressed group of RTR who live in northern Italy and to verify the eventual relationship between the onset of mycoses, the immunosuppressive regimen and the interval of time elapsed after the transplantation. Methods: 73 RTR were submitted to a complete dermatological examination for fungal infection. Skin scrapings were taken from the upper back, from the 4th toe web of all patients and from any suspicious lesion. Results: 31 patients (42.5%) were affected by dermatomycosis. Pityriasis versicolor (PV) was present in 20 RTR (27.4%), fungal infection of the 4th toe web in 10 patients (13.7%) and onychomycosis in 9 RTR (12.3%). Trichophyton mentagrophytes was the most common dermatophyte. The prevalence of dermatomycoses was higher in the group of patients treated with azathioprine-cyclosporine-steroids and in those who had received their renal transplant in the previous 1–5 years. Conclusions: PV was the most frequent dermatomycosis and showed a higher prevalence than in the normal population. The prevalence of fungal infection of the 4th toe web and onychomycosis was similar to that found in the immunocompetent population, but the length of interval after transplantation seemed to increase the probability of their occurrence and of mixed or simultaneous fungal infections in the same patient.

A 79-year-old woman presented with a 1-year history of a pigmented nodular lesion on the left labium minor. Histopathology of the nodule led to a diagnosis of metastatic melanoma. A pigmented flat lesion on the inner side of the left labium major was also biopsied and was found to be a superficial spreading melanoma. The dermoscopic findings of primary and metastatic vulvar melanoma which simultaneously occurred in the same patient are described. Dermoscopy revealed a homogeneous pattern associated with linear irregular vessels in the metastatic nodule, while irregular globules and streaks were seen in the primary melanoma.