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This study focused on detecting the reflections of healing and change in cortex activation in full-face transplantation and lesions patients on EEG activity. Face transplant patients have facial lesions before transplantation and, to identify pre-face transplant patients' brain activity in the absence of pre-transplant recordings, we used data obtained from pre-transplant facial lesion patients. Ten healthy, four facial lesion and three full-face transplant patients participated in this study. EEG data recorded for four different sensory stimuli (brush from the right face, right hand, left face, and left-hand regions) were analyzed using wavelet packet transform method. EEG waves were analyzed for standard bands. Our findings indicate significant change in the 2-4 Hz frequency range which may be a result of ongoing or previous cortical reorganization for face lesion and transplant patients. Alterations of the delta wave seen in patients with facial lesion and face transplant can also be explained by the intense central plasticity. Our findings show that the delta band differences might be used as a marker in the evaluation of post-transplant cortical plasticity in the future.

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Atypical pigmented facial lesions (aPFLs)-including lentigo maligna (LM) and lentigo maligna melanoma (LMM), solar lentigo (SL), pigmented actinic keratosis (PAK), atypical nevi (AN), seborrheic keratosis (SK) and lichen planus-like keratosis (LPLK)-can exhibit clinical and dermoscopic overlapping features. We aimed to investigate if and how 14 dermoscopic features suggestive for the aforementioned aPFLs vary according to six facial sites among 1197 aPFLs cases (excised to rule out malignancy) along with lesion and patients' metadata. According to distribution and association analysis, aPFLs on the forehead of a male patient aged > 69 years displaying the obliterated follicular openings pattern, appear to be more at risk of malignancy. Of converse, aPFLs of the orbital/cheek/nose area with evident and regular follicular openings with diameter < 10 mm in a female aged below 68 are probably benign. The obliterated follicular openings, keratin plugs, evident and regular follicular openings and target-like pattern features differed significantly among six facial areas in all aPFLs cases. Lesion of the nose may show both features suggestive of malignancy and benignity (e.g. many SL and PAK may display target-like pattern and some LM/LMM cases display keratin plugs and evident and follicular openings), making these features less specific.

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Background: Atypical pigmented facial lesions (aPFLs) often display clinical and dermoscopic equivocal and/or overlapping features, thus causing a challenging and delayed diagnosis and/or inappropriate excisions. No specific registry dedicated to aPFL paired with clinical data is available to date. Methods: The dataset is hosted on a specifically designed web platform. Each complete case was composed of the following data: (1) one dermoscopic picture; (2) one clinical picture; (3) two lesion data, that is, maximum diameter and facial location (e.g., orbital area/forehead/nose/cheek/chin/mouth); (4) patient's demographics: family history of melanoma, history of sunburns in childhood, phototype, pheomelanine, eyes/hair color, multiple nevi/dysplastic nevi on the body; and (5) acquisition device (videodermatoscope/camera-based/smartphone-based system). Results: A total of 11 dermatologic centers contributed to a final teledermoscopy database of 1,197 aPFL with a distribution of 353 lentigo maligna (LM), 146 lentigo maligna melanoma (LMM), 231 pigmented actinic keratoses, 266 solar lentigo, 125 atypical nevi, 48 seborrheic keratosis, and 28 seborrheic-lichenoid keratoses. The cheek site was involved in half of aPFL cases (50%). Compared with those with the other aPFL cases, patients with LM/LMM were predominantly men, older (69.32 ± 12.9 years on average vs. 62.69 ± 14.51), exhibited larger lesions (11.88 ± 7.74 mm average maximum diameter vs. 9.33 ± 6.46 mm), and reported a positive history of sunburn in childhood. Conclusions: The iDScore facial dataset currently represents a precious source of data suitable for the design of diagnostic support tools based on risk scoring classifiers to help dermatologists in recognizing LM/LMM among challenging aPFL in clinical practice.

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Granuloma faciale (GF) is a rare benign chronic inflammatory dermatologic disease which is characterized by facial lesions. The diagnosis is mainly based on clinical and histopathology findings. It may be resistant to treatments and prone to relapse. Different treatment modalities include corticosteroid therapy, tacrolimus, cryotherapy and surgical methods. We report a case of GF in a patient with remitting seronegative symmetric synovitis with pitting edema (RS3PE). A male patient with RS3PE presented with reddish brown soft nodules on and over lateral aspects of his nose and adjacent areas on his face which were diagnosed histologically as GF. He was treated with prednisolone, methotrexate and clobetasol propionate cream successfully without recurrence. To the best of our knowledge this is the first case report of GF occurring in a patient with RS3PE.

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Introduction and importance: Pyogenic Granuloma (PG) commonly presents as a solitary, erythematous, non-tender, skin lesion, usually not exceeding 2.5 cm. Although Surgical excision is the first-line treatment, conservative treatments are recently developing. Solitary PG is well documented unlike multiple PGs, as the latter is rarely described in terms of its presentations and treatments. Case presentation: This interesting case report describes a 23-year-old male who developed multiple PGs on the nasal area (2cmx2cm) and mandibular area (10cmx2cm) after sutures removal secondary to a recent history of trauma. The lesions regressed after successfully treated with two months of timolol drops and topical corticosteroids. Subsequently, intralesional corticosteroids injections were given once-per-month for two months, with residual fibrosis of the regressed lesion. Clinical discussion: While the most common site for multiple PGs is the interscapular region, this case reports giant, facial, multiple PGs followed suture removal. Although ß-blockers were reported to successfully treat solitary PG, only a few cases were raised to discuss this treatment in terms of multiple PGs. This case completes the series and reports successfully-treated multiple PGs using a combination of topical timolol and steroid. Conclusion: This case supports the need to consider multiple PGs as a differential diagnosis following sutures removal even when it reaches rarely reported diameters. Also, it suggests topical timolol and steroids as an effective conservative treatment in similar cases of multiple giant PGs. Notably, the treatment failed to sidestep scar formation.

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H Syndrome is a rare genodermatosis. It may include facial involvement such as: facial telangiectasia, both hypo- and hyperpigmented lesions, hirsutism, swollen cheeks due to subcutaneous infiltration and eczematous lesions. We describe a new facial phenotype with dermoscopic and histological features in the spectrum of non-Langerhans cell histiocytosis.

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BACKGROUND: Skin metastases from colorectal adenocarcinoma are rare conditions that are metachronous in most of cases and may represent the first sign of a recurrence. These lesions are usually located to the abdominal wall on postoperative scars, perineum and chest due to direct spread from the tumor or to the lymphatic and venous dissemination. We describe a rare case of synchronous skin metastases in a patient affected by sigmoid adenocarcinoma with no sign of liver and lung repetitive lesions. CASE PRESENTATION: We admitted a 59 years old male, with no relevant medical history. He was evaluated by our tertiary center of colorectal surgery complaining diarrhoea and abdominal pain. The physical examination revealed a palpable mass in left flank of the abdomen. The colonoscopy showed a sub-stenosis of the sigmoid colon (G2 adenocarcinoma). No repetitive lesions were detected by the preoperative CT scan. The patient reported a rapid grow of a soft supralabial and chin nodules in the last 2 months, which he believed to be related to the use of the mask due to COVID-19 pandemic. A laparoscopic left hemicolectomy with complete mesocolic excision and a local excision of both facial nodules were performed. The histological examination revealed a poorly differentiated signet ring cell colorectal adenocarcinoma with metastases in seven pericolic lymphonodes. The excisional biopsy of the skin nodules revealed a subcutaneous metastases from primary colorectal tumour. CONCLUSIONS: As far as we know, synchronous facial metastases from colorectal cancer in the absence of any other metastases has never been described before. The onset of new skin nodules in patients affected by colorectal cancer should raise-up the clinical suspicion of metastatic lesions even when repetitive lesions are not detected in the liver or lungs.

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Background Multiple or solitary facial lesions pose a unique challenge to the attending surgeon in terms of delivering the best cosmetic outcome. There are various methods in dealing with them and the preference of using them is based on the surgeon's experience, patient expectations, and availability of instruments. One such tool, skin-punch, primarily designed for a biopsy can play a very important therapeutic role in this era of keyhole surgery. In this paper, we assess the technique of punch incision with its combination of secondary healing for various facial lesion. Methods This observational study, a total of 307 patients with solitary or multiple benign facial lesions were treated with punch incision technique using 2 to 6 mm sterile, disposable skin biopsy punches. Subsequently, the wounds were managed with healing with secondary intention. Results In our series all superficial wounds epithelized by 7 to 14 days while the deeper lesions epithelized by 14 to 28 days. We had three recurrences which were managed by fusiform excision and one patient had surgical site infection which was managed conservatively. On application of our self-devised facial scar scoring system (SCAR or Scar Cosmesis Assessment and Rating) 3 on all the scars, the mean score was 6 at 1 year followup. Conclusion Punch incision with healing by secondary intention is a relatively easy, effective, single-stage office procedure. This method can be considered as an alternative method for the removal of various skin lesions, especially on face, thus providing a simple solution to complex problems.

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In order to support dermatologists' interest for the fascinating area of neonatal dermatology, we provide (1) an introduction to the specifics of skin barrier in premature and full-term neonates as well as their clinical implications and (2) an example of age-dependent differential diagnoses and approach to a facial vascular stain in a neonate.

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In 2017, approximately 40 out of 100 captive Cranwell's horned frogs Ceratophrys cranwelli from several facilities in Japan exhibited protruding facial lesions. Histopathological examination was performed on 6 specimens with such lesions randomly selected from 2 facilities. Lesions consisted of scattered stellate to spindle-shaped cells without atypia in an abundant myxoid matrix and occasional lymphocytic infiltrates. Maxillary bone was resorbed. No etiological organisms were detected using light microscopy or metagenomic analysis of the lesions. Macroscopic and histological assessments indicate that the lesions are associated with nodular facial myxomatous dermatitis, which has never been reported in amphibians.

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INTRODUCTION: Facial cutaneous lesions of dental origin are rare and hence the correct diagnosis is usually missed on the initial presentation to the surgeon. We present the largest series in the surgical literature to increase the awareness to this entity and emphasize that the wrong diagnosis may lead to medico-legal claims. PATIENTS AND METHODS: This is a retrospective study of 28 patients seen between 1994 and 2017. RESULTS: The series had one child and 27 adults. The presentation varied and included: a nodule, a subcutaneous soft mass, a sinus, an abscess, a cyst, a pigmented skin lesion and a scar. Thirteen cases had an initial wrong diagnosis and of these 4 had surgery to the lesion. Two out of the 4 surgically treated lesions ended with medico-legal claims. CONCLUSIONS: The surgeon should be aware of this rare entity and have a high index of suspicion. Dental treatment is curative and there is no need to operate the facial lesion. The wrong diagnosis and unnecessary surgery may lead to medico-legal claims.

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ABSTRACT Objective. We carried out this study to evaluate weight gain (WG), mortality, blood serum proteins (BP), facial lesions of littermates submitted to different teeth procedures. Material and Methods. The experiment was performed in a commercial breeding farm. Were used 15 sows, allotted into three groups: control, where piglets' teeth were kept intact (IT); teeth clipping (CT); and teeth grinding using an electric grinder (GT). We evaluated WG, BS (five males/litter), mortality, low viable piglets rates and facial lesions in piglets. Additionally, we evaluated sows' backfat thickness (P2) and teat lesion score. BP data, lesion score and WG were assessed individually. For WG, the initial weight and the litter size were used as covariates. Regarding other variables, we used the average of the litter. When there were differences, the means were compared using Duncan test (p<0.05). Results. In the first week, GT piglets presented higher WG. In the second week, CT presented worst WG. In the first two weeks as in the total period, CT piglets presented worse WG than the GT. Mortality and low viable piglets rates were not influenced. After the fourth day, CT and GT treatment reduced facial lesions. There was no effect on BP. Treatments did not influence P2 and teat lesion score. Conclusions. Treatments did not have influence on mortality, low viable rates, BP of the piglets and P2 and teat lesions score. CT treatment decreased weight gain and IT increased face lesions score.

RESUMEN Objetivo. Este estudio fue realizado para evaluar la ganancia de peso, mortalidad, proteínas plasmáticas (BP), lesiones faciales en los lechones y en las cerdas, grasa dorsal (P2) y lesiones en los pezones en lechigadas sometidas a diferentes manejos dentales. Materiales y métodos. La investigación fue conducida en una granja comercial de cría. Fueron utilizadas quince cerdas, divididas en tres grupos: control, en el cual los dientes de los lechones permanecieron intactos; descolmille con alicate; descolmille con limadora eléctrica. Nosotros evaluamos WG, BP (cinco machos/lechigada), mortalidad, lechones de baja viabilidad y lesiones faciales en los lechones. En las cerdas, nosotros evaluamos P2 y la escala de lesiones en los pezones. Los datos de BP, escala de lesiones y WG fueron evaluados individualmente. Para el WG, el peso inicial y el tamaño de la lechigada fueron considerados. Acerca de las otras variables, nosotros usamos el peso promedio de la lechigada. Cuando hubo diferencias, las medias fueron comparadas usando la prueba de Duncan (p<0.05). Resultados. En la primera semana, los lechones del GT presentaron mayor WG. En la segunda semana el CT presentó la peor WG. En las dos primeras semanas así como en el período total, los lechones del CT presentaron peor WG de que los del GT. La mortalidad y los lechones de baja viabilidad no fueron influenciados. Después del cuarto día, el CT y el GT redujeron las lesiones faciales. No hubo efectos en BP. Los tratamientos no influenciaron P2 y las lesiones en los pezones. Conclusiones. Los tratamientos no influenciaron en la mortalidad, lechones de baja viabilidad, BP de los lechones y en la escala de lesiones en los pezones de las cerdas. CT redujo la ganancia de peso y IT aumentó las lesiones faciales.

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PURPOSE: Benign masses of the eyebrow and forehead are common in pediatric patients and can result in facial asymmetry, discomfort, or super-infection. Excision is classically conducted via an incision directly over the mass, which can produce sub-optimal cosmesis. Recently, an endoscopic approach using pediatric brow-lift equipment has been adopted. We reviewed our center's experience with endoscopic removal of benign facial lesions and compared these cases with an equivalent series of open cases. MATERIALS AND METHODS: A retrospective chart review was conducted to identify pediatric cases of endoscopic and open removal of benign eyebrow or forehead lesions at our institution from 2009 to 2016. Clinical and cosmetic outcomes were reviewed. RESULTS: A total of 40 endoscopic and 25 open cases of excision of benign facial lesions in children were identified. For the patients who underwent endoscopic excision, the majority (85%) presented with a cyst located at the eyebrow. Histologic examination revealed 36 dermoid cysts (90%), 2 epidermal cysts, and 2 pilomatrixomas. Of the 36 cases with post-operative follow-up, 32 patients (89%) had an uncomplicated recovery with good cosmesis. Two patients had an eyebrow droop that resolved without intervention. One patient had localized numbness overlying the site, but no motor deficits. One patient presented with a recurrent dermoid cyst that required open resection. For the patients who underwent open excision, the majority (52%) had dermoid cysts located at the eyebrow. Of the 22 cases with follow-up, 20 of the patients had an uncomplicated recovery (90%). Comparing the rate of complications, there was no statistically significant difference between the two groups (P = 1.0). CONCLUSION: Endoscopic excision of benign forehead and eyebrow lesions in pediatric patients is feasible and yields excellent cosmetic results. When compared with open excision, complication rates are similar between both approaches and a facial scar can be avoided with an endoscopic approach.

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OBJECTIVE: The aim of this study was to empirically generate a responder definition for the treatment of papulopustular rosacea. METHODS: A total of 8 multicenter clinical studies on patients with papulopustular facial rosacea were analyzed. All patients were treated with azelaic acid and/or comparator treatments. The severity of rosacea was described by the Investigator Global Assessment (IGA) and the number of lesions. Patients with the IGA score of "clear/minimal" were considered as responders, and those staying in the range of IGA "mild to severe" as nonresponders. The respective number of lesions was determined. RESULTS: A total of 2,748 patients providing 12,410 measurements were included. After treatment, responders showed 2.23±2.48 lesions (median 2 lesions [0-3]), and nonresponders showed 13.74±10.40 lesions (median 12 lesions [6-18]). The optimal cutoff point between both groups was 5.69 lesions. CONCLUSION: The calculated cutoff point of 5.69 lesions allows discrimination of responders (5 or less remaining lesions) and nonresponders (6 or more remaining lesions) of therapeutic interventions in rosacea.

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The diagnosis of pigmented actinic keratosis (PAK) is often challenging because of overlapping features with lentigo maligna. OBJECTIVE: To investigate dermoscopic patterns of PAK according to their different evolutionary stages, and to correlate the pattern with clinical characteristics of the patients. METHODS: Descriptive and analytical study of 232 PAK. Dermoscopic patterns were divided into two categories: the follicule surroundings' abnormalities (FSA) and follicular keratosis' abnormalities (FKA). RESULTS: FSA and FKA dermoscopic patterns were related to male gender, except for star-like appearance, double white clods and dermoscopic horn (p≤0.04). Rhomboidal, annular granular pattern, gray halo, white circle and double clods were dermoscopic pattern significantly related to xeroderma pigmentosum's type of skin. Based on the evolutionary stages of PAK, the jelly sign was significantly related to thin patches of PAK. Central crusts and scales were related to thick plaques and the star-like appearance to hypertrophic PAK. The presence of 2 or more dermoscopic signs in both FSA and FKA was noticed in 99.1% of lesions. CONCLUSIONS: The dermoscopic diagnosis of PAK vary according to the evolutionary stages of the disease, this will increase the diagnosis accuracy, with therapeutic implications.

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BACKGROUND/OBJECTIVES: The clinical and dermoscopic differential diagnosis of flat pigmented facial lesions represents a great challenge for the clinicians. Our aim was to report a quantitative method based on dermoscopic features to better classify pigmented facial lesions. METHODS: This is a retrospective case-series study that analysed the dermoscopic features of 582 pigmented facial lesions. RESULTS: The individual patient probability of lentigo maligna (LM) was predicted by a multivariate model, with an accuracy of 0.72. According to the odds ratio at the multivariate analysis, an individual scoring index was assigned to each criterion, and a value of 4.56 was identified as optimal cut-off point. Up to a score of 2.5, the probability that a lesion is an LM is 0. The probability increases from 10 to 50% for a score ranging between 4.5 and 6. It is about 90% for a score of 7. CONCLUSION: The optimal cut-off point obtained and the curve that identifies the probability of a patient having a LM could improve the classification and the management strategies of equivocal pigmented facial lesions.

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Porokeratoses are a group of hereditary or acquired disorders characterized by annular lesions with an atrophic center and a prominent peripheral ridge. Pathologically, porokeratosis is characterized by the presence of abnormal clones of keratinocytes that form a column of parakeratotic cells, called the cornoid lamella. Fifteen percent of patients of disseminated superficial actinic porokeratosis (DSAP) have facial lesions; other regions like the extensor surface of extremities constitute the majority of reported cases. Exclusively facial lesions are probably less frequent. Rarely, actinic porokeratosis is confined to the nose only. Of reported porokeratosis cases, 7.5% have revealed a malignancy arising within the lesion. We present a case of facial sporadic DSAP that was treated with imiquimod 5% cream in conjunction with a regular sunscreen. Follow-up of this case is important to rule out the possibility of malignant transformation of the lesions.

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BACKGROUND: Since child abuse and neglect are serious conditions which can potentially lead to inappropriate dental health, we conducted this qualitative study to define the factors influencing child abuse and neglect, which lead to oro-facial lesions. MATERIALS AND METHODS: Qualitative semi-structured interviews were conducted by social services employees. Purposive sampling was used to recruit participants to capture a range of experiences such as the physical abuse, sexual abuse, role of family in child abuse, age, and gender. RESULTS: Participants demonstrated a range of perceptions which lead to child abuse including hitting on the head and slapping. Often subsidiary to this view, several factors were mentioned that occasionally influenced child abuse. These factors appeared to be idiosyncratic but could be drawn together into three categories: Cultural lacks which includes poverty, cruelty of parents and addiction, psychological disorders, and separation in the family which was seen in most of the children. CONCLUSION: This study has identified a variety of factors influencing the incidence of child abuse. Therefore, dentists should meticulously pay attention to children who have these risk factors in order to discover child abuse events. Quantitative research would reveal the extent of these factors. Dentists' knowledge of their roles in managing cases suffering from abuse might need to be assessed to see if dentists need further education in this important area.