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Introduction: Body surface area (BSA) affected by psoriasis is one of the most often used measures for assessing severity, but this method has shortcomings., Objective: To validate a new way to estimate BSA., Material and Method: Prospective, multicenter study in 56 patients with psoriasis. Each patient was evaluated by 2 dermatologists in 2 visits to the same hospital. Each dermatologist used 2 methods for estimating BSA: the traditional visual estimation in which the area of the palm equals 1% of the total body surface and an optical pencil (OP) method in which the affected area is drawn on a touch screen. Software in the application then calculates the BSA., Results: Overall concordance between the 2 methods was acceptable according to an intraclass correlation coefficient (ICC) of 0.87. However, the limits of agreement were unacceptably large and there was systematic bias: traditional estimates were consistently greater than OP calculations. Concordance between the methods was better (ICC>0.8) on the trunk and lower extremities. Intraobserver reliability was excellent with both methods (ICCs, 0.97 and 0.98 for the traditional and OP estimates, respectively). Interobserver reliability was also high (ICCs, 0.91 and 0.94 for the traditional and OP methods), although the mean BSA differed significantly between observers. The ICCs were much lower for BSA estimates on the head., Conclusions: This study to validate the OP method for estimating the affected BSA in patients with psoriasis shows good agreement between the OP and traditional approaches. The OP calculations also showed less variance and better interobserver reliability., (Copyright © 2019 AEDV. Publicado por Elsevier España, S.L.U. All rights reserved.)

Present report is focused in our personal experience with the anti TNF-alpha infliximab. There is a short, four case series, but they are a very representative sample of the clinical conditions that we can solve with infliximab.

Recurrent vulvovaginitis is a common problem in clinical practice. Management is often complicated by a long history of inappropriate treatments based on tentative diagnoses after an incomplete diagnostic workup. We review the most common causes of recurrent vulvovaginitis; the appropriate steps with which to establish a diagnosis, from the medical history through to the additional tests needed; and, finally, the best therapeutic options. We will focus on infectious, irritant, allergic, and hormonal causes as the ones of most interest to the dermatologist. Given that infection is the most frequent cause of these processes and also a common reason for inopportune treatment, we will pay particular attention to infectious etiologies and their differential diagnosis.

Neutrophilic dermatoses constitute a clinically heterogeneous group of diseases that share a common histological substrate, consisting of a dense dermal inflammatory infiltrate of mature polymorphonuclear neutrophils and no evidence of vasculitis. We describe the case of a 56-year-old man with a 6-month history of painful generalized erythematous edematous plaques. Histopathology indicated neutrophilic dermatosis but the patient did not have fever, elevated white blood cell count, or systemic involvement. Tests to rule out possible inflammatory, neoplastic, or infectious processes were negative. We consider the term chronic recurrent annular neutrophilic dermatosis, first used by Christensen et al, to be the most appropriate to define this variant with clinical findings that differ from classic Sweet syndrome.

Granuloma annulare is a benign dermatosis of unknown etiology and chronic course, with different clinical variants. The disseminated form predominantly affects the extremities, sparing the trunk. We present the case of a 52-year-old woman with recurrent and autolimited outbreaks of disseminated granuloma annulare that began at summer time and involved the legs, arms and the dorsal area of hands. No pathological findings were observed in the laboratory studies performed. Histopathological examination confirmed our clinical suspicion. The development of granuloma annulare in photoexposed areas and sun exposure as a precipitating factor have been rarely reported in the literature.

Cryoglobulins are serum immunoglobulins that precipitate reversibly when the serum is cooled below 371 degrees C. In cryoglobulinemic syndrome, a multitude of organs can be involved, but many patients suffer from a moderate, chronic disease consisting of palpable purpura, arthralgia and fatigue. Skin involvement is especially useful in aiding early recognition of this entity. We present four patients with cryoglobulinemic syndrome and skin lesions, in whom it was not possible to find an etiological or associated factor. We discuss the etiopathogenesis, clinical and pathological findings, treatment and prognosis of this entity.

Dermatomyositis is a connective tissue disease which has several factors involved in its etiology. Recently, the existence of a sub-type called amyopathic dermatomyositis has been accepted, whose cutaneous manifestations are indistinguishable from the ones that appear in the classic form of the disease. However, it is different from the classic form in that clinical findings of muscular involvement are initially absent. The association of these two sets of symptoms with the possible presence of an underlying neoplastic process has been described on numerous occasions, and has been the subject of extensive debate. We present three patients with amyopathic dermatomyositis, two males aged 27 and 45 and a female aged 54, the latter associated with a malignant process, and we discuss and review the main differential features of the entity and its relationship with different types of neoplasms.