Publications by authors named "Michele Fimiani"

90 Publications

An unusual triple association: Superficial granulomatous pyoderma, subcorneal pustular dermatosis, IgA multiple myeloma.

J Cutan Pathol 2021 Mar 27;48(3):461-463. Epub 2020 Oct 27.

Department of Medical, Surgical and Neurological Science, Section of Dermatology, University of Siena, Siena, Italy.

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http://dx.doi.org/10.1111/cup.13848DOI Listing
March 2021

Effects of psoriasis treatment on genital warts: a case report.

Int J STD AIDS 2019 07 19;30(8):828-830. Epub 2019 May 19.

Dermatology Unit, Department of Medical, Surgical and Neuro-Sciences, University of Siena, Siena, Italy.

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http://dx.doi.org/10.1177/0956462419833218DOI Listing
July 2019

Pyoderma gangrenosum secondary to total hip replacement.

G Ital Dermatol Venereol 2019 Apr 23. Epub 2019 Apr 23.

Dermatology Section, Department of Clinical Medicine and Immunological Science, University of Siena, Siena, Italy.

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http://dx.doi.org/10.23736/S0392-0488.19.06256-4DOI Listing
April 2019

Treatment of resistant granuloma annulare with Rifampin, Norfloxacin, and Minocycline combination therapy.

G Ital Dermatol Venereol 2019 Feb 4. Epub 2019 Feb 4.

Dermatology Section, Department of Medical, Surgical and Neurological Science, S. Maria alle Scotte Hospital, University of Siena, Siena, Italy.

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http://dx.doi.org/10.23736/S0392-0488.19.06270-9DOI Listing
February 2019

Dermoscopic and reflectance microscopy features of primary and metastatic Merkel cell carcinoma: Ten cases.

Skin Res Technol 2019 May 28;25(3):407-409. Epub 2018 Dec 28.

Department of Medical, Surgical and Neurological Science - Dermatology Section, University of Siena, S. Maria alle Scotte Hospital, Siena, Italy.

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http://dx.doi.org/10.1111/srt.12658DOI Listing
May 2019

Preliminary experience of the use of high-resolution skin ultrasound for the evaluation of extrathyroidal manifestations of Graves' disease and response to UVA-1 phototherapy.

Photodermatol Photoimmunol Photomed 2019 03 24;35(2):129-131. Epub 2019 Jan 24.

Dermatology Unit, Department of Medical, Surgical and Neuro-Sciences, University of Siena, Siena, Italy.

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http://dx.doi.org/10.1111/phpp.12442DOI Listing
March 2019

Tuscan consensus on the use of UVBnb phototherapy in the treatment of psoriasis.

G Ital Dermatol Venereol 2019 Apr 29;154(2):99-105. Epub 2018 Oct 29.

Section of Dermatology, Department of Clinical Medicine and Immunological Science, University of Siena, Siena, Italy.

Psoriasis (PSO) is traditionally defined as an immune-mediated, inflammatory dermatological disease characterized by a chronic-relapsing course and associated with multifactorial inheritance (genetic predisposition and influence of various environmental factors). Considered until recently a dermatological disease only, today PSO is correctly known as a systemic one because of the involvement of multiple organs with important impact on social life and relationships. PSO is found in the 0.3-4.6% of the world's population, while its prevalence in the Italian population is estimated at 2.8%. Therefore, if we consider that in Tuscany more than 100,000 people out of 3,672,202 suffer of psoriasis, it is of paramount importance to focus on a shared clinical and therapeutic protocol to manage the disease. With the aim of ensuring diagnostic-therapeutic suitability, high levels of care and standardization of treatment, a unique clinical-therapeutic management model has been developed and validated in Tuscany, involving all accredited regional dermatological centers. Among the possible alternatives to be implemented in the treatment of patients with mild, moderate-severe psoriasis, UVBnb phototherapy is widely used alone or in association with other systemic and non-systemic devices. Despite this, there is still no universally shared therapeutic protocol. In this context the CO.FO.TO working group (Consensus Fototerapia Toscana) is born with the aim of defining and validating the main guidelines in the use of phototherapy with UVBnb in psoriasis; the guidelines are based both on the real-life experience of the different centers of reference in the region and on the revision of the recent literature.
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http://dx.doi.org/10.23736/S0392-0488.18.06223-5DOI Listing
April 2019

Acne mechanica in a child with a motor tic.

G Ital Dermatol Venereol 2020 Aug 20;155(4):514-515. Epub 2018 Sep 20.

Department of Dermatology, University Hospital of St-Etienne, St-Etienne, France.

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http://dx.doi.org/10.23736/S0392-0488.18.06063-7DOI Listing
August 2020

Dermoscopy for the Diagnosis of Conjunctival Lesions.

Dermatol Clin 2018 Oct 16;36(4):439-449. Epub 2018 Aug 16.

Department of Medical, Surgical and Neurological Science, Dermatology Section, University of Siena, S. Maria Alle Scotte Hospital, Viale Bracci 16, Siena 53100, Italy.

This article describes the present literature on dermoscopy of conjunctiva and shows the results of a dermoscopy study of 147 conjunctival tumors. Melanomas were characterized by a heavy pigmentation, irregular dots, and a higher prevalence of gray color compared with nevi. Squamous cell carcinomas had peculiar hairpin and glomerular vessels. Primary acquired melanoses were characterized by regularly distributed light brown dots. A large part of nevi had small cysts.
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http://dx.doi.org/10.1016/j.det.2018.05.011DOI Listing
October 2018

Meeting a rare disease: bullous ichthyosiform erythroderma.

G Ital Dermatol Venereol 2020 Dec 10;155(6):783-784. Epub 2018 Jul 10.

Division of Medical, Surgical and Neurosciences, Department of Dermatology, University of Siena, Siena, Italy.

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http://dx.doi.org/10.23736/S0392-0488.18.06058-3DOI Listing
December 2020

Rare clinical manifestations of leukemia cutis.

J Cutan Pathol 2018 Oct 13;45(10):799-801. Epub 2018 Aug 13.

Department of Medical, Surgical and Neurological Science, Section of Dermatology, University of Siena, Siena, Italy.

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http://dx.doi.org/10.1111/cup.13321DOI Listing
October 2018

Role of Handheld In Vivo Reflectance Confocal Microscopy for the Diagnosis of Fabry Disease: A Case Report.

Diseases 2018 Jun 27;6(3). Epub 2018 Jun 27.

Department of Medical, Surgical and Neurological Science, Dermatology Section, University of Siena, S. Maria alle Scotte Hospital, Viale Bracci 16, 53100 Siena, Italy.

Fabry disease (FD) is a rare X-linked lysosomal storage disorder caused by the deficient activity of the lysosomal enzyme α-galactosidase that leads to a systemic accumulation of globotriaosylceramide. Handheld in vivo reflectance confocal microscopy (HH-RCM) is a useful modern technique in diagnosis and follow-ups of many skin diseases. This noninvasive device provides high-resolution and high-contrast real-time images to study both the skin and the ocular surface structures that can help clinicians to confirm the diagnosis of FD. HH-RCM could be helpful even for the follow-ups of these patients, enabling us to monitor the effect of enzyme replacement therapy on corneal cells and keratinocytes.
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http://dx.doi.org/10.3390/diseases6030055DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6164009PMC
June 2018

BCC and vismodegib: can we treat and remold at the same time?

G Ital Dermatol Venereol 2020 Feb 16;155(1):119-120. Epub 2018 May 16.

Section of Dermatology, Department of Clinical Medicine and Immunological Science, University of Siena, Siena, Italy.

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http://dx.doi.org/10.23736/S0392-0488.18.06043-1DOI Listing
February 2020

Solitary vulvar neurofibroma in a patient without neurofibromatosis.

G Ital Dermatol Venereol 2018 Aug;153(4):591-593

Dermatology Section, Department of Clinical Medicine and Immunological Science, University of Siena, Siena, Italy.

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http://dx.doi.org/10.23736/S0392-0488.17.05706-6DOI Listing
August 2018

Sinecatechins 10% ointment for genital warts: Case report of a beneficial reaction in an HIV-positive woman.

Int J STD AIDS 2018 09 5;29(10):1033-1035. Epub 2018 Apr 5.

Dermatology Unit, Department of Medical, Surgical and Neuro-Sciences, University of Siena, Siena, Italy.

Patients with HIV infection are more likely to develop anogenital warts compared to HIV-negative people and are susceptible to treatment failures and recurrences. We report a case of extensive vulvar warts in an HIV-positive woman successfully treated with sinecatechins ointment. After the failure of a combination of cryotherapy and imiquimod 5% cream, we started therapy with sinecatechins 10% ointment. The patient developed an intense local inflammatory reaction after three weeks that induced the discontinuation of the therapy. After two weeks, we observed a complete regression of inflammation and a reduction of genital warts. The lesions completely regressed within a few weeks, with no relapse after eight months. Sinecatechins is a standardized extract of green tea leaves, effective in the treatment of external genital and perianal warts in immunocompetent patients, but their role has not been yet studied for immunocompromised people. Our case may represent a starting point for further studies, in order to evaluate the relation between treatment dosage, side effects, and drug response in immunocompromised patients.
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http://dx.doi.org/10.1177/0956462418763888DOI Listing
September 2018

Clinical and histological evaluation in patients with mycosis fungoides treated with UVA1.

G Ital Dermatol Venereol 2020 Jun 24;155(3):306-311. Epub 2018 Jan 24.

Unit of Dermatology, Department of Medical, Surgical and Neurosciences, University of Siena, Siena, Italy.

Background: UVA1 phototherapy is a valid therapeutic alternative for skin lymphoproliferative disorders, although there are few studies concerning its role in mycosis fungoides (MF). Our aim was to evaluate and confirm the effectiveness of UVA1 phototherapy in patients in early stage MF.

Methods: We enrolled 12 patients, 9 males and 3 females (mean age 54.83±9.99, range 36-74) with a histological diagnosis of mycosis fungoides at early stage. All patients were treated with UVA1 for 22 sessions with two different protocols (3 times or 5 times per week) at the dose of 45 J/cm2. A punch biopsy was performed before and after the treatment, to evaluate the variation of histological features and of the proliferation index (Ki67/MIB1).

Results: At the end of the study, we found a marked clinical improvement in all patients, associated to a statistically significant reduction of the proliferation index Ki67/MIB1. Five patients achieved a complete clinical and histological response, while six a partial one and only one a minimal response.

Conclusions: Although in recent years the number of the therapeutic options available for all types of skin lymphoproliferative disorders, in particular mycosis fungoides, has increased considerably, there are few studies concerning UVA1 phototherapy. Our results represent a starting point for further studies, in order to investigate the role that these UV-rays can play either alone or in combination with other therapeutic regimens.
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http://dx.doi.org/10.23736/S0392-0488.18.05867-4DOI Listing
June 2020

Palpable migratory arciform erythema: hydroxychloroquine as a possible therapeutic option.

G Ital Dermatol Venereol 2019 Jun 16;154(3):357-360. Epub 2017 Nov 16.

Unit of Dermatology, Department of Medical, Surgical and Neurosciences, University of Siena, Siena, Italy.

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http://dx.doi.org/10.23736/S0392-0488.17.05694-2DOI Listing
June 2019

Middermal Elastolysis: Dermal Fibroblasts Cooperate with Inflammatory Cells to the Elastolytic Disorder.

Mediators Inflamm 2017 17;2017:9524594. Epub 2017 Sep 17.

Department of Molecular and Developmental Medicine, Section of General Pathology, University of Siena, Via Aldo Moro 6, 53100 Siena, Italy.

Little is known about the cause and pathophysiology of middermal elastolysis (MDE). In this condition, variable inflammatory infiltrate may be present or not together with loss of elastic fibres in the middermis that spares both papillary and lower reticular dermis. MDE may be a consequence of abnormal extracellular matrix degradation related to an imbalance between elastolytic enzymes released from inflammatory and resident cells and their naturally occurring inhibitors. However, the cause of this imbalance is still an object of investigation. In order to shed light on the role of fibroblasts in MDE, we used fibroblast cultures from MDE and control subjects to evaluate matrix metalloproteinases (MMPs) and their major inhibitor TIMP-1, which in combination with neutrophil or macrophage proteases released in inflamed areas may influence the elastolytic burden. We demonstrate that fibroblasts derived from MDE produce low levels of TIMP-1, the major inhibitor of MMPs. Elevated levels of MMP-2, MMP-14, and TIMP-2 capable to activate in a cooperative manner pro-MMP-2 are present in MDE tissue samples. Additionally, significant reaction for MMP-1 is present in the same MDE areas. These data all together suggest that ECM changes in MDE are due to cooperation of different cell populations (i.e., inflammatory cells and fibroblasts).
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http://dx.doi.org/10.1155/2017/9524594DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5623776PMC
June 2018

Bullous impetigo during interstitial pneumonitis.

G Ital Dermatol Venereol 2017 12;152(6):669-670

Division of Medical, Surgical and Neuro-Sciences, Department of Dermatology, University of Siena, Siena, Italy.

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http://dx.doi.org/10.23736/S0392-0488.16.05394-3DOI Listing
December 2017

Treatment of psoriasis with topical agents: Recommendations from a Tuscany Consensus.

Dermatol Ther 2017 Nov 20;30(6). Epub 2017 Sep 20.

Department of Surgery and Translational Medicine, Section of Dermatology and Venereology, University of Florence School of Medicine, Florence, Italy.

Psoriasis is a chronic and relapsing inflammatory skin disease, clinically characterized by erythematous and scaly plaques. Treatment approach is mainly driven by disease severity, though several factors should be considered in order to identify the optimal therapeutic choice. Mild psoriasis may be treated with a wide array of topical agents including corticosteroids, vitamin D analogs, keratolytics, and calcipotriol/betamethasone propionate compound. Because guidelines may not provide practical indications regarding the therapeutic approach, the use of topical agents in psoriasis is more individually tailored. In order to homogenize the standard of care, at least in a local setting, we collected the real-life-based recommendations for the use of topical therapies from an expert panel, the Tuscany Consensus Group on Psoriasis, representing all leading centers for psoriasis established in Tuscany. With this document, this consensus group sought to define principles guiding the selection of therapeutic agents with straightforward recommendations derived from a real-life setting.
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http://dx.doi.org/10.1111/dth.12549DOI Listing
November 2017

Dermoscopy of Biett's sign and differential diagnosis with annular maculo-papular rashes with scaling.

Indian J Dermatol Venereol Leprol 2017 Mar-Apr;83(2):270-273

Department of Dermatology, Division of Medical, Surgical and Neurosciences, University of Siena, Siena, Italy.

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http://dx.doi.org/10.4103/0378-6323.196318DOI Listing
June 2017

Superficial Acral Fibromyxoma of the Toe: Unusual Location of the Mixoid Variant.

Am J Dermatopathol 2017 Nov;39(11):849-852

*Department of Medicine, Surgery and Neurosciences, Dermatology Section, University of Siena, Italy; and †Department of Human Pathology and Oncology, Pathological Anatomy Section, University of Siena, Italy.

Superficial acral fibromyxoma (SAFM) is a rare soft tissue tumor that frequently involves the periungual and subungual regions of acral surfaces. Macroscopically, it appears as a flesh-colored dome-shaped solitary mass; microscopically, it consists of a moderately cellular proliferation of spindle-shaped fibroblast-like cells embedded in a myxocollagenous stroma and arranged in a loose storiform and focally fascicular pattern. The tumor cells are immunoreactive for CD34, epithelial membrane antigen, CD99, and CD10. In this study, we describe a case of SAFM on the fourth toe with predominantly myxoid stroma. Our case, in contrast of those reported in the literature, showed an unusual location for the myxoid variant. SAFM is often not recognized; it may resemble some benign and malignant mesenchymal neoplasm. The gold standard treatment is surgery. The tumor was completely excised, and no recurrence was evident at 1-year follow-up. Awareness of this entity facilitates its diagnosis and management, avoiding unwarranted concerns and additional procedures for the patient.
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http://dx.doi.org/10.1097/DAD.0000000000000767DOI Listing
November 2017

Dermatological emergency: post-emetic facial purpura.

G Ital Dermatol Venereol 2016 Oct;151(5):570-1

Section of Dermatology, Department of Clinical Medicine and Immunology,University of Siena, Siena, Italy -

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October 2016

Livedo racemosa and hemolytic uremic syndrome induced by gemcitabine.

Int J Dermatol 2016 Oct 28;55(10):e555-6. Epub 2016 Apr 28.

Division of Medical, Surgical and Neurological Sciences, Department of Dermatology, University of Siena, Siena, Italy.

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http://dx.doi.org/10.1111/ijd.13062DOI Listing
October 2016

Parallel-ridge pattern on dermatoscopy: observation in a case of purpura traumatica pedis.

Dermatol Pract Concept 2015 Oct 31;5(4):27-9. Epub 2015 Oct 31.

Dermatology Section, Department of Clinical Medicine and Immunological Sciences, Siena University, Italy.

Dermatologists are often referred urgent cases of acral hematoma by general practitioners and sports medicine specialists for the purpose of excluding warts, nevi or melanoma. Acral hematoma is often a cause of anxiety to patients and their families. Here, we report a case of purpura traumatica pedis, referred to us as suspected plantar melanoma because of the finding of parallel-ridge pattern on dermatoscopic examination. To avoid unnecessary and costly procedures, doctors should inquire about any episode of physical exertion before the onset of purpura, recording the lesion's anatomic site (e.g., unilateral vs. bilateral involvement) and clinical features.
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http://dx.doi.org/10.5826/dpc.0504a07DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4667598PMC
October 2015

Computer-assisted melanoma diagnosis: a new integrated system.

Melanoma Res 2015 Dec;25(6):537-42

aDepartment of Medical, Surgical and Neurological Science, Dermatology Section, Siena University Hospital bDepartment of Medicine, Surgery and Neurosurgery, Section of Pathological Anatomy, Policlinico Santa Maria alle Scotte cDepartment of Medical Biotechnologies, University of Siena, Siena, Italy.

In dermatology, attempts at synergy between man and machine have mainly been made to improve melanoma diagnosis. The aim of the present study was to test an 'integrated digital dermoscopy analysis' (i-DDA) system with a series of melanocytic lesions that were benign and malignant in nature, and to evaluate its discriminating power with respect to histological diagnosis. In a retrospective study we used an i-DDA system to evaluate a series of 856 excised, clinically atypical pigmented skin lesions (584 benign and 272 malignant). The system evaluated 48 parameters to be studied as possible discriminant variables, grouped into four categories (geometries, colours, textures and islands of colour) integrated with three personal metadata items (sex, age and site of lesion) and presence/absence of three dermoscopic patterns (regression structures, blue-white veil and polymorphic vascular structures). Stepwise multivariate logistic regression of i-DDA data selected nine variables with the highest possible discriminant power. At the end of the stepwise procedure the percentage of cases correctly classified by i-DDA was 89.2% (100% sensitivity and 40.8% specificity). The limitations of the study included those associated with a retrospective design and the 'a priori' exclusion of nonmelanocytic skin lesions. By incorporating numerical digital features with personal data and some dermoscopic patterns into the learning process, the proposed i-DDA improved the performance of assisted melanoma diagnosis, with the advantage that our results can be objectively repeated in any other clinical setting.
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http://dx.doi.org/10.1097/CMR.0000000000000209DOI Listing
December 2015

Influence of Ambient Stressors and Time Constraints on Diagnostic Accuracy of Borderline Pigmented Skin Lesions.

Dermatology 2015 14;231(3):269-73. Epub 2015 Aug 14.

Dermatology Section, Department of Medical, Surgical and Neurological Science, Siena University Hospital, Siena, Italy.

Background: Health professionals are required to make complex decisions in dynamic contexts involving many variables and factors. Decisions are more difficult in the presence of uncertainty, urgency and high risk.

Objective: To evaluate the effect of ambient stressors and time constraints on decision making by expert dermatologists faced with borderline pigmented skin lesions (PSL) (early melanoma vs. atypical nevi).

Methods: We performed a retrospective chart review of PSL from the image databases of our department. A total of 321 PSL (219 nevi and 102 melanomas) were randomly assigned to three groups: control group, ambient stress group and time stress group. The diagnostic accuracy of each group was evaluated as sensitivity and specificity.

Results: Mean sensitivity and specificity of diagnosis were 69.2 and 90.5% in the control group, 62 and 81.2% in the ambient stress group and 59.6 and 82.5% in the time stress group, respectively.

Conclusion: Time constraints and stressors negatively influenced the performance of dermatologists in the diagnosis of atypical PSL.
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http://dx.doi.org/10.1159/000435951DOI Listing
June 2016

Infantile perianal pyramidal protrusion: a case report with dermoscopy and ultrasound findings.

Dermatol Pract Concept 2015 Apr 30;5(2):125-8. Epub 2015 Apr 30.

Department of Medicine, Surgery and Neurosciences, Dermatology Section, University of Siena, Italy.

Infantile perianal pyramidal protrusion, it is a rare benign cutaneous condition described in relatively recent times. It is considered to be under-reported in the pediatric literature because it is often mistaken for other conditions. The unawareness of this lesion may be responsible for an excessive concern both in physician and in parents, which leads to overly aggressive and unnecessary treatments. Thus its recognition has many implications regarding proper management and treatment. We report a typical presentation of IPPP in which the diagnosis was based on the use of non-invasive diagnostic tools and in particular of dermoscopy and ultrasonography.
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http://dx.doi.org/10.5826/dpc.0502a25DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4462916PMC
April 2015

Benign dermoscopic parallel ridge pattern in plantar hyperpigmentation due to capecitabine.

Dermatol Pract Concept 2015 Apr 30;5(2):79-81. Epub 2015 Apr 30.

Department of Clinical Medicine and Immunological Sciences, Dermatology Section, University of Siena, Siena, Italy.

We report the case of a 37-year-old woman (phototype II) who presented at our outpatient clinic with a two-month history of hyperpigmented plantar macules. Medical history revealed that the patient had taken capecitabine in the past three months as adjuvant chemotherapy for recurrent breast cancer. Dermoscopic examination of the plantar macules showed parallel ridge pattern with pigmentation in the furrows without obliteration of eccrine gland apertures. Besides in acral melanoma, parallel ridge pattern can also be observed in benign plantar lesions, such as congenital or acquired acral nevi, subcorneal hemorrhage, dye-related pigmentation and drug-induced hyperpigmentation, especially in patients with phototypes III-VI. The few reported cases of capecitabine-induced hyperpigmentation have been associated with hand and foot syndrome in patients with phototypes IV-V and palmar as well as plantar involvement.
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http://dx.doi.org/10.5826/dpc.0502a14DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4462905PMC
April 2015

Crosstalk between platelets and PBMC: New evidence in wound healing.

Platelets 2016 1;27(2):143-8. Epub 2015 Jun 1.

a Department of Medical , Surgical and Neuro Sciences, Dermatology Section, University of Siena , Siena , Italy .

Platelet-derived products have proven useful in accelerating healing processes and tissue regeneration. However, despite their widespread use in clinical practice, the cellular and molecular mechanisms involved have not yet been completely clarified. Recent studies show that interaction between platelet gel (PG) and peripheral blood mononuclear cells (PBMC) can result in activation of PBMC and production of several cytokines involved in wound healing and tissue repair. The aim of our study was to analyze whether crosstalk between platelets and PBMC can influence wound healing by modulating release of VEGF, bFGF and IL-10 by PBMC. Cultures of PBMC alone and co-cultures with autologous PG of 24 healthy volunteers were incubated under normoxia for 24 h. VEGF, bFGF and IL-10 concentration and expression were then analyzed in supernatants by ELISA and by real-time RT-PCR. We observed a down-regulation of VEGF and bFGF release and an up-regulation of IL-10 release in co-cultures of PBMC and PG. Platelets are not only important in the early stages of the healing process (clot formation, direct release of growth factors), but also can influence the whole process of tissue regeneration by modulating synthesis and release of VEGF, bFGF and IL-10 by PBMC. These effects could give platelets a new key role in the control of healing processes and provide insights into the clinical success of platelet-derived products in many medical fields.
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http://dx.doi.org/10.3109/09537104.2015.1048216DOI Listing
November 2016