Giant Cardiac Fibroma: An Unusual Cause of Failure to Thrive

Cardiac fibromas are extremely rare in the general pediatric population and may present with a wide spectrum of clinical signs, including life-threatening arrhythmias and sudden death. We report a 14-month-old boy who presented with failure to thrive as the only symptom. Echocardiography showed a large cardiac fibroma in the right ventricle. Cardiac magnetic resonance imaging confirmed the diagnosis. After complete surgical tumor resection, the boy showed normal catch-up growth. This case underlines the diversity of clinical features of cardiac tumors, which implies that they should be considered early in the differential diagnosis of infants with failure to thriv

A Report of Two Cases of Solid Facial Edema in Acne

Solid facial edema (SFE) is a rare complication of acne vulgaris. To examine the clinical features of acne patients with solid facial edema, and to give an overview on the outcome of previous topical and systemic treatments in the cases so far published.; We report two cases from Switzerland, both young men with initially papulopustular acne resistant to topical retinoids.; Both cases responded to oral isotretinoin, in one case combined with oral steroids. Our cases show a strikingly similar clinical appearance to the cases described by Connelly and Winkelmann in 1985 (Connelly MG, Winkelmann RK. Solid facial edema as a complication of acne vulgaris. Arch Dermatol. 1985;121(1):87), as well as to cases of Morbihan's disease that occurs as a rare complication of rosacea.; Even 30 years after, the cause of the edema remains unknown. In two of the original four cases, a potential triggering factor was identified such as facial trauma or insect bites; however, our two patients did not report such occurrencies. The rare cases of solid facial edema in both acne and rosacea might hold the key to understanding the specific inflammatory pattern that creates both persisting inflammation and disturbed fluid homeostasis which can occur as a slightly different presentation in dermatomyositis, angioedema, Heerfordt's syndrome and other conditions

Expression patterns of TNFα, MAdCAM1 and STAT3 in intestinal and skin manifestations of inflammatory bowel disease

Background: Pathogenesis of cutaneous extraintestinal manifestations (EIM) in inflammatory bowel disease (IBD) remains elusive. Efficacy of anti-TNF agents suggests TNF-dependent mechanisms. The role of other biologics such as anti-integrins or JAK-inhibitors is not yet clear. Methods: We performed immunohistochemistry for TNFα, NFκB, STAT1/STAT3, MAdCAM1, CD20/68, caspase 3/9, IFNγ, Hsp-27/70 on 240 intestinal (55 controls, 185 IBD) and 64 skin biopsies (11 controls, 18 Erythema nodosum (EN), 13 Pyoderma gangenosum (PG), 22 psoriasis). A semiquantitative score (0-100%) was used for evaluation. Results: TNFα was upregulated in intestinal biopsies from active Crohn`s disease (CD) vs. controls (36.2 vs. 12.1, p<0.001), but not ulcerative colitis (UC: 17.9). NFκB however was upregulated in intestinal biopsies from both active CD and UC (43.2 and 34.5 vs. 21.8, p<0.001 and p=0.017). TNFα and NFκB were overexpressed in skin biopsies from EN, PG and psoriasis. No MAdCAM1 overexpression was seen in skin tissues, while it was upregulated in active UC vs. controls (57.5 vs. 35.4, p=0.003). STAT3 was overexpressed in the intestinal mucosa of active and non-active IBD, while a similar upregulation was seen in skin biopsies from EN (84.7 vs. 22.3, p<0.001) and PG (60.5 vs. 22.3, p=0.011), but not in psoriasis. Caspase 3 and CD68 overexpression in skin biopsies distinguished EN/PG from psoriasis and controls. Conclusions: Upregulation of TNFα/NFκB in EN and PG is compatible with the efficacy of anti-TNF in EIM management. Data on overexpressed STAT3, but not MAdCAM1 support a rationale for JAK-inhibitors in EN and PG, while questioning the role of vedolizumab

Dermoscopy of Pitted Keratolysis

Irritated hyperhidrotic soles with multiple small pits are pathognomonic for pitted keratolysis (PK). Here we show the dermatoscopic view of typical pits that can ensure the diagnosis. PK is a plantar infection caused by Gram-positive bacteria, particularly Corynebacterium. Increases in skin surface pH, hyperhidrosis, and prolonged occlusion allow these bacteria to proliferate. The diagnosis is fundamentally clinical and treatment generally consists of a combination of hygienic measures, correcting plantar hyperhidrosis and topical antimicrobials

Active before passive tasks improve long-term visual learning in difficult-to-classify skin lesions

Background: Visual perceptual learning is essential in many domains, including medicine. Prior research has shown that combining active and passive tasks improves learning efficiency. However, previous studies have only implemented passive before active tasks, contradicting findings on productive failure learning designs. Aims: We aimed to replicate and extend earlier results by comparing 1) combined versus uniform active and passive tasks and 2) active before passive versus passive before active tasks in visual learning. The to-be-learned skill was the detection of pigmented skin cancer. Sample: The sample consisted of 161 university students without professional knowledge about skin lesion classification. Methods: We randomly assigned the participants to four groups: 1) active before passive, 2) passive before active, 3) uniform active, and 4) uniform passive tasks. The students completed the learning intervention, an intermediate and three post-tests (immediate, two days delayed and two weeks delayed) online. Results: In line with our hypotheses, we found that learning with combined active and passive tasks led to higher diagnostic accuracy in difficult skin lesion classification tasks in the two weeks delayed post-test than learning with only one of the two task types. Furthermore, we found that active before passive tasks resulted in higher diagnostic accuracy than passive before active tasks. Conclusion: Our findings suggest that initial active tasks improve long-term visual learning outcomes in difficult melanoma detection tasks, but future research needs to confirm this result and explore the underlying learning mechanisms further

Skin Detachment and Regrowth in Toxic Epidermal Necrolysis

Toxic epidermal necrolysis is a rare but clinically well-described dermatological pathology. However, clinical pictures of this disorder in text books do not reflect its dynamic evolution. Usually, the desquamative post-bullous stage is represented, neglecting the initial bullous stage as well as the skin healing. With one clinical case, we provide a day-after-day illustration of the evolution of a patient suffering from toxic epidermal necrolysis. During one month, a skin area of a limb was regularly photo-documented

Augmented and virtual reality in dermatology : where do we stand and what comes next?

As the skin is an accessible organ and many dermatological diagnostics still rely on the visual examination and palpation of the lesions, dermatology could be dramatically impacted by augmented and virtual reality technologies. If the emergence of such tools raised enormous interest in the dermatological community, we must admit that augmented and virtual reality have not experienced the same breakthrough in dermatology as they have in surgery. In this article, we investigate the status of such technologies in dermatology and review their current use in education, diagnostics, and dermatologic surgery; additionally, we try to predict how it might evolve in the near future

Robust T-Loss for Medical Image Segmentation

This paper presents a new robust loss function, the T-Loss, for medical image segmentation. The proposed loss is based on the negative log-likelihood of the Student-t distribution and can effectively handle outliers in the data by controlling its sensitivity with a single parameter. This parameter is updated during the backpropagation process, eliminating the need for additional computation or prior information about the level and spread of noisy labels. Our experiments show that the T-Loss outperforms traditional loss functions in terms of dice scores on two public medical datasets for skin lesion and lung segmentation. We also demonstrate the ability of T-Loss to handle different types of simulated label noise, resembling human error. Our results provide strong evidence that the T-Loss is a promising alternative for medical image segmentation where high levels of noise or outliers in the dataset are a typical phenomenon in practice. The project website can be found at https://robust-tloss.github.ioComment: Early accepted to MICCAI 202

Artificial Intelligence-Driven Skin Aging Simulation as a Novel Skin Cancer Prevention

Introduction: Skin cancer, a prevalent cancer type among fair-skinned patients globally, poses a relevant public health concern due to rising incidence rates. Ultraviolet (UV) radiation poses a major risk factor for skin cancer. However, intentional tanning associated with sunburns remains a common practice, notably among female adults. Appropriate prevention campaigns targeting children and adolescents are needed to improve sun protection behavior particularly in these age groups. The aim of our study was to investigate if an AI-based simulation of facial skin aging can enhance sun protection behavior in female adults. Methods: In this single-center, prospective, observational pilot study at Department of Dermatology at the University Hospital of Basel, we took photographs of healthy young females’ faces with a VISIA-CR camera (Version 8.2; Canfield Scientific Inc., Parsippany, NJ, USA) between February and March 2021. Digital images were performed in three angles (straight, left 45°, and right 45°). All participants received an AI-based simulation of their facial skin with continuous aging to 80 years. A newly created anonymous questionnaire capturing participants’ sociodemographic data and also tanning and sun protection behavior was completed in pre- and post-aging simulation. To observe long-term effects, a 2-year follow-up was conducted between March and April 2023. Results: The 60 participants (mean age 23.6 ± 2.5 years) evaluated the importance of sun protection significantly higher after skin aging simulation with VISIA-CR camera (p &lt; 0.0001; 95% CI: 8.2–8.8). Post-intervention, 91.7% (55/60) of the females were motivated to reduce UV exposure and to intensify UV protection in the future since the individual UV-dependent risk was perceived significantly higher (p &lt; 0.001; 95% CI: 5.9–6.7). At 2-year follow-up, 96% (24/25) indicated persistent effort reducing UV exposure. The preference for SPF 50+ sunscreen increased to 46.7% (28/65) directly after the skin aging simulation and continued to rise up to 60.0% (15/25) after 2 years. Conclusions: Our data emphasize the potential of AI-assisted photoaging interventions to enhance motivation for UV protection in the short and the long term. We encourage that different age and gender groups are addressed in a personalized, generation-specific manner with the appropriate media and by considering the Hawthorne effect. Campaigns with visual AI support can improve the intent of cancer-preventative behavior