Alexandra Irina Butacu

Special areas of involvement in psoriasis include the scalp region, the palms and soles, genital areas, as well as intertriginous sites. The involvement of these topographical regions is associated with important physical and emotional implications, resulting in reduced quality of life, social isolation, and work disability. Palms and soles can be affected as part of the generalized form of psoriasis or can be exclusively affected as palmo-plantar psoriasis. Nail involvement may be encountered in 10–55% of patients with psoriasis, while scalp involvement occurs in 45–56% of individuals with psoriasis. Genital involvement may be the only manifestation of cutaneous psoriasis in 2–5% of patients. Inverse or intertriginous psoriasis represents a special variant of psoriasis as it may mimic and be difficult to differentiate from other dermatological entities that involve the intertriginous skin, such as bacterial or fungal infections, eczema, or lichen planus. Treatment of psoriasis in special areas is challenging due to the facts that special areas are more resistant to standard therapies and are more sensitive to potent local treatments. Biological therapies, proven to be more efficient than standard therapies, are not widely available in the absence of extensive skin involvement. This manuscript aims to provide an up-to-date literature review on psoriasis in special areas, benefiting the everyday clinical practice of physicians in optimizing the evaluation and treatment of their patients.

Background: Despite recent advancements, medical technology has not yet reached its peak. Precision medicine is growing rapidly, thanks to machine learning breakthroughs powered by increased computational capabilities. This article explores a deep-learning application for computer-aided diagnosis in dermatology. Methods: Using a custom model based on EfficientNetB3 and deep learning, we propose an approach for skin lesion classification that offers superior results with smaller, cheaper, and faster inference times compared to other models. The skin images dataset used for this research includes 8,222 files selected from the authors' collection and the ISIC2019 archive, covering six dermatological conditions. Results: The model achieved 95.4% validation accuracy on four categories—melanoma, basal cell carcinoma, benign keratosis-like lesions, and melanocytic nevi—using an average of 1,600 images per category. Adding two categories with fewer images (about 700 each)—squamous cell carcinoma and actinic keratoses—reduced the validation accuracy to 88.8%. The model maintained accuracy on new clinical test images taken under the same conditions as the training dataset. Conclusions: The custom model demonstrated excellent performance on the diverse skin lesions dataset, with significant potential for further enhancements.

Zusammenfassung Gutartige Hauttumoren kommen bei einer großen Zahl von Hautveränderungen vor. Die Diagnose wird in der Regel durch das klinische Bild und die Anamnese gestellt. Eine histopathologische Untersuchung ist nicht in jedem Fall zwingend erforderlich. Die Therapie besteht meistens in der Entfernung der Hautveränderungen durch Kryotherapie, Elektrochirurgie oder Laserabtragung. Differenzierte Phänotypisierungen einschließlich genetischer und epigenetischer Befunde liefern die Grundlage für ein neues Verständnis der pathogenetischen Mechanismen. Einige gutartige Hauttumoren können Teil von Syndromen sein, daher sollten Zusammenhänge mit nichtdermatologischen Befunden bekannt sein, die diese seltenen Erkrankungen charakterisieren. Der epidermale Nävus kann mit Gefäßmalformationen in Beziehung stehen, der Naevus sebaceus sowie der Becker-Nävus mit Defekten zerebral, okulär und am Skelett, Pilomatrixome können kolorektalen Karzinomen beim Gardner-Syndrom vorangehen, tuberöse Sklerose kann assoziiert sein nicht nur mit Veränderungen im Zentralnervensystem, sondern auch an Lunge, Herz oder Nieren.

Objective: Acne scars carry a huge physical and psychological impact on people. This article aims to evaluate the role of fractional radiotherapy in treatment of atrophic acne scars. The main objective includes providing an up‐to‐date review of existing literature, presenting the most significant studies conducted in this field.Methods: In order to study the impact of fractional radiotherapy on the appearance of atrophic acne scars, we conducted a search on Pubmed using the keywords “fractional radiotherapy”, combined with/or “acne”, “atrophic acne scars” and “acne scars” and found 75 papers, from which we selected 39.Results: There are several therapeutic approaches for the improvement of acne scars with variable results and possible side effects. Fractional radiofrequency system has been used widely in the last years, as it turned out to be an effective treatment method, either in combination with other modalities, or alone.Conclusion: There are no generalized clinical guidelines adopted to standardize atrophic acne scar treatment. The multiple therapeutic options available create a dilemma in choosing the proper method in order to enhance its efficacy and to minimize its risks. The accumulated experience in nonablative collagen stimulating devices like fractional radiofrequency has proven that thickening of interstitial fibers in the dermis is possible with a controlled thermal injury, without epidermal damage and development of side effects.

Molluscum contagiosum is a benign viral epidermal infection associated with high risk of transmission. The guideline is focused on the sexually transmitted molluscum contagiosum. The diagnosis is clinical with characteristic individual lesions, termed ‘mollusca’, seen as dome‐shaped, smooth‐surfaced, pearly, firm, skin‐coloured, pink, yellow or white papules, 2 ‐ 5 mm in diameter with central umbilication. Dermoscopy may facilitate diagnosis. Therapeutic options are numerous, including physical treatments (cautery, curettage and cryotherapy), topical chemical treatments (e.g. podophyllotoxin and imiquimod) or waiting for spontaneous resolution in immunocompetent patients. In pregnancy, it is safe to use physical procedures (e.g. cryotherapy). Immunosuppressed patients develop severe and recalcitrant molluscum lesions that may require treatment with cidofovir, imiquimod or interferon. Patients with molluscum contagiosum infection should be offered to be screened for other sexually transmitted infections.

Background: Work‐related solar ultraviolet radiation (UVR) is an important factor in the pathogenesis of non‐melanoma skin cancer (NMSC). The World Health Organization, through the International Agency for Research on Cancer, has classified solar UVR as a group 1 carcinogen since 2012. The main problems encountered so far in the study of occupationally induced skin cancer include the lack of accurate occupational UVR dosimetry as well as insufficient distinction between occupational and leisure UVR exposure and underreporting of NMSC.Objectives: The aim of this study was to collect long‐term individual UVR measurements in outdoor workers across European countries.Methods: A prospective study was initiated through the European Academy of Dermatology and Venereology, Healthy Skin@Work Campaign, measuring UVR exposure doses at occupational settings of masons from five European countries. Measurements were performed for several consecutive months using the GENESIS‐UV measurement system.Results: The results identified alarming UVR exposure data. Average daily UVR doses ranged 148.40–680.48 J/m² in Romania, 342.4–640.8 J/m² in Italy, 165.5–466.2 J/m² in Croatia, 41.8–473.8 J/m² in Denmark and 88.15–400.22 J/m² in Germany. Results showed an expected latitude dependence with increasing UVR yearly dosage from the north to the south of Europe.Conclusions: This study shows that outdoor workers from EU countries included in this study are exposed to high levels of occupational solar UVR, vastly exceeding the occupational exposure limits for solar UVR exposure, considered to be 1–1.33 SED/day in the period from May to September. This finding may serve as an evidence‐based recommendation to authorities on implementing occupational skin cancer prevention strategies.