The diagnosis of pigmented basal cell carcinoma can bring significant distress to patients and physicians alike. However, astute clinicians that can employ correctly the clinical and dermatoscopical clues can reach a correct preoperative diagnosis, and as such can avoid unnecessary worry for the patient, additional work-up, or overtreatment. We present a case series of pigmented basal cell carcinomas and a comparative case with pigmented cutaneous melanoma, together with a literature review, that will highlight these aspects of the management of pigmented tumours of the skin.
Background and aim: Acne fulminans is a rare and severe form of acne which usually appears in young men with a personal history of mild to moderate acne. It is characterized by a sudden onset with nodules and ulcerative lesions mostly located on the thorax and extracutaneous manifestations (fever, weight loss, osteoarticular damage). The pathophysiologic mechanism is represented by a type III or IV hypersensitivity reaction to Propionibacterium acnes. Patient: We present the case of a 16-year old patient with acne fulminans. The lesions were accompanied by an impaired general condition with fever and weight loss. Paraclinically an inflammatory syndrome was revealed without osteoarticular changes. It was treated with prednisone 40 mg/day, erythromycin 2g/day and local antiseptic solutions. A gradual tapering of the prednisone dose (5 mg/week) and a dermatological revaluation after 3 weeks to introduce systemic treatment with retinoids were recommended at discharge. Conclusions: Acne fulminans is a severe form of acne with systemic manifestations and corticotherapy is the first line treatment.
