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Objectives To analyze trends in the prevalence of contact sensitization to p-phenylenediamine between 2004 and 2014, taking into consideration that the concentration of this product in cosmetics was regulated in 2009. To explore risk factors for contact allergy to p-phenylenediamine. Material and methods Retrospective observational study of patients suspected of having contact dermatitis from allergy to p-phenylenediamine during the years between 2004 and 2015 in 8 tertiary level hospitals. The patients underwent patch testing (TRUE-test) with the standard series of the Spanish Research Group on Contact Dermatitis and Skin Allergies. This series included p-phenylenediamine 1%. We followed international recommendations for the statistical analysis of data related to contact allergies. Results Three hundred eighty-six out of 9341 patients (4.1%) had positive reactions to p-phenylenediamine. The prevalence tended to decrease in the early years (2004-2007) and then leveled off at around 4%. Risk factors for developing contact dermatitis from p-phenylenediamine were sex, age over 40 years, multiple sensitivities, and profession, notably workers in hair salons and those who handle rubber and plastics. Conclusions The prevalence of p-phenylenediamine allergy remains high among patients with contact eczema. Risk factors for p-phenylenediamine contact allergy are consistent with previous reports.

Background: Fragrances constitute the second most frequent cause of allergic contact dermatitis in Spain. Objectives: To determine the rate of sensitization to the individual fragrances of fragrance mix (FM) I and FM II for each of the demographic and clinical factors included in the MOAHLFA (male, occupational dermatitis, atopic dermatitis, hand dermatitis, leg dermatitis, facial dermatitis, age) index. Methods: We conducted a 5-year retrospective study in 23 Spanish centres. We identified the patients who had undergone patch testing with a specific fragrance series after reacting positively to fragrance markers in a baseline series. We obtained the MOAHLFA index items in this population, then calculated for each demographic and clinical factor the frequencies of sensitization to the individual fragrances of FM I and FM II. Results: A specific fragrance series was patch tested in 1013 patients. The most frequent allergens in men, women, children, and retired people were Evernia prunastri (16%), geraniol (16.6%), isoeugenol (17.9%), and geraniol (22.4%), respectively. Citral (20.5%) and hydroxyisohexyl 3-cyclohexene carboxaldehyde (HICC) (14.5%) were the most common allergens in occupational eczemas and were also associated with a large proportion of hand and facial dermatitis. Conclusions: Frequency of sensitization to the individual fragrances of FM I and FM II varies with age, sex, affected body region, and history of occupational or atopic dermatitis.

Dermatofibroma (DF) represents one of the most common mesenchymal proliferations of the skin. Their recurrence rate, even when incompletely excised, is very low, whereas the atypical, aneurysmal, and cellular variants have recurrence rates of up to 20% each. Extraordinary rare malignant lesions with metastases to lymph nodes and/or lung have been described. We report a 64-year-old woman with a long history (years) of a skin lesion on her right arm that became painful during the last months. Histologically, it consisted of a conventional cellular DF in which perineural invasion was present. Subsequently, the lesion showed a clinically aggressive course with recurrences, sarcomatous transformation, and pulmonary metastases. Given that no predictive morphological features have been identified to separate classical benign DF from rare metastasizing forms, perineural invasion in an otherwise conventional DF could be a histopathologic clue for an adverse prognosis and should provoke a closer clinical follow-up., info:eu-repo/semantics/published

Background The cutaneous manifestations of COVID-19 disease are poorly characterized. Objectives To describe the cutaneous manifestations of COVID-19 disease and to relate them to other clinical findings. Methods We carried out a nationwide case collection survey of images and clinical data. Using a consensus we described five clinical patterns. We later described the association of these patterns with patient demographics, the timing in relation to symptoms of the disease, the severity and the prognosis. Results The lesions may be classified as acral areas of erythema with vesicles or pustules (pseudo-chilblain) (19%), other vesicular eruptions (9%), urticarial lesions (19%), maculopapular eruptions (47%) and livedo or necrosis (6%). Vesicular eruptions appear early in the course of the disease (15% before other symptoms). The pseudo-chilblain pattern frequently appears late in the evolution of the COVID-19 disease (59% after other symptoms), while the rest tend to appear with other symptoms of COVID-19. The severity of COVID-19 shows a gradient from less severe disease in acral lesions to more severe in the latter groups. The results are similar for confirmed and suspected cases, in terms of both clinical and epidemiological findings. Alternative diagnoses are discussed but seem unlikely for the most specific patterns (pseudo-chilblain and vesicular). Conclusions We provide a description of the cutaneous manifestations associated with COVID-19 infection. These may help clinicians approach patients with the disease and recognize cases presenting with few symptoms. What is already known about this topic? Previous descriptions of cutaneous manifestations of COVID-19 were case reports and mostly lacked illustrations. What does this study add? We describe a large, representative sample of patients with unexplained skin manifestations and a diagnosis of COVID-19, using a consensus method to define morphological patterns associated with COVID-19. We describe five clinical patterns associated with different patient demographics, timing and prognosis, and provide illustrations of these patterns to allow for easy recognition.

Introduction Allergic contact dermatitis (ACD) of the feet accounts for approximately 10% of all patch tested patients. Objective To study the clinical profile of patients with feet dermatitis and relevant contact allergens in Spain over a 10-year period. Methods Retrospective observational study of patients with suspected ACD from the GEIDAC (Spanish Research Group on Contact Dermatitis and Cutaneous Allergy) baseline series from eight hospitals in Spain between 2004 and 2014. The clinical data collected from each patient were age, sex, occupation, history of atopic dermatitis, and eczema location. Results A total of 450 cases clinically presented dermatitis affecting the feet; of these, 41% of were males and 5.6% were suspected to be of occupational origin. As much as 47% were diagnosed with ACD, 20% with atopic dermatitis/dyshidrotic eczema, and 5% with psoriasis. The "feet group" included statistically significantly more females in the age range of 21 to 60 years. The most frequent relevant contact allergens were potassium dichromate, cobalt(II) chloride, p-tert-butylphenol formaldehyde resin, mercapto mix, and mercaptobenzothiazole. Conclusions ACD is the most frequent clinical diagnosis of feet dermatitis in our series. The most frequent allergens are similar to those published in other series of foot ACD in Europe and the trend has not changed in the studied decade.

Background: Fragrance chemicals constitute the second most frequent cause of con in Spain. There are no data available concerning the individual fragrances that are frequently involved. Objectives: To describe the diagnostic contribution provided by specific fragrance series to the results obtained with baseline series fragrance markers by correlating the results of both series. Materials and methods: We performed a 5-year retrospective study of fragrance marker positive patients tested with specific fragrance series in 23 Spanish centres. We collected the demographic and clinical characteristics, and compared the results of patch tests obtained from different suppliers. Results: Of 19 588 patients patch tested with the Spanish baseline series, 1590 (8.1%) reacted positively to a fragrance marker. Of these, 1013 (63.7%) were patch tested with a fragrance series, and 664 patients reacted positively to at least one individual fragrance other than hydroxyisohexyl 3-cyclohexene carboxaldehyde. Geraniol was the most frequent allergen. Positive reactions to substances not included in fragrance mix (FM) I or FM II were found in 230 patients. Of the 436 FM I-positive patients and the 419 FM II-positive patients, 184 (42%) and 64 (39.1%), respectively, had no positive reactions to fragrance series. In the case of FM I, negative results were more common when individual fragrances were patch tested at low concentrations. Conclusions: We recommend patch testing all patients positive for any fragrance marker with a specific fragrance series. The correlation between the results of baseline series and fragrance series could be improved by increasing the concentrations of individual fragrances

Nail diseases are a diagnostic challenge and high-frequency ultrasound with colour Doppler is a simple and painless diagnostic test that can often be useful. Ultrasound allows real-time evaluation of the anatomical structures of the nail and its vascularisation. The present study reviews the literature on ultrasound findings in the normal nail and in inflammatory and tumoural disease.

Resumen La terapia fotodinamica (TFD) constituye una alternativa terapeutica para las queratosis actinicas, la enfermedad de Bowen y determinados carcinomas basocelulares. Se utiliza ademas para el tratamiento de otras enfermedades cutaneas de diversa naturaleza, incluyendo enfermedades inflamatorias e infecciosas. Los principales inconvenientes de la TDF convencional son el tiempo que consume su realizacion (al paciente y al personal sanitario) y el dolor que produce. Recientemente se ha descrito la TFD con luz de dia (TFDLD) como alternativa al procedimiento convencional. En diversos estudios se ha mostrado similar en eficacia y mejor tolerada que la TFD clasica en el tratamiento de queratosis actinicas leves-moderadas. No obstante, la mayoria de los estudios realizados proceden del norte de Europa, y no existen por ahora resultados en paises de la latitud de Espana. El presente articulo revisa los principales estudios publicados hasta el momento, expone el protocolo de utilizacion y resume nuestra experiencia en un grupo de pacientes tratados.

Introduction: Notalgia paresthetica is a sensory mononeuropathy that affects dorsal segments T2 to T6. It can have a significant effect on quality of life. Numerous treatments have been used with variable results. Material and methods: Five patients diagnosed with notalgia paresthetica were treated with intradermal botulinum toxin A. None had achieved relief of the pruritus with previous treatments. Results: Variable results were observed after the administration of intradermal botulinum toxin. Complete resolution of the pruritus was not achieved in any of the patients.

Scleroderma-like cutaneous changes have been reported in association with several drugs, but not with hydroxyurea (HU), to our knowledge. We report the case of a 67-year-old man who was treated with HU (hydroxycarbamide) for 12 years for a myeloproliferative disorder, and presented a progressive pruritic woody induration, symmetrically affecting both legs. He also had Gottron-like papules on the back of the metacarpophalangeal joints, and a retroauricular undifferentiated squamous cell carcinoma. On histological examination of a skin biopsy taken from the leg, massive dermal fibrosis was seen, with thickening of collagen bundles throughout the entire dermis. Six months after HU withdrawal, the skin induration resolved without scarring. Scleroderma-like syndrome has not been previously considered one of the secondary effects of HU. The evolution of our patient's condition supports a causal relationship between the HU treatment and the sclerodermiform changes of the skin. © The Author(s). CED © 2012 British Association of Dermatologists.

Resumen Introduccion el estudio epidemiologico del eczema de contacto puede realizarse mediante el analisis de los datos obtenidos a partir de la experiencia clinica de las unidades de alergia cutanea. Objetivo determinar el perfil de los pacientes que acuden a una unidad de alergia cutanea y determinar la prevalencia de sensibilizaciones mas frecuente en esta poblacion. Material y metodos estudio observacional retrospectivo de los 5 hospitales pertenecientes a la Red Espanola de Vigilancia de Alergia de Contacto (REVAC) durante el ano 2008. Todos los pacientes fueron estudiados mediante pruebas epicutaneas con la serie estandar espanola. Las frecuencias de sensibilizacion se han estandarizado por sexo y edad. Resultados se recogieron datos de 1.161 pacientes. Los 5 alergenos que presentaron positividades mas frecuentemente fueron sulfato de niquel (25,88%), dicromato potasico (5,31%), cloruro de cobalto (5,10%), mezcla de fragancias (4,64%) y balsamo del Peru (4,44%). Los alergenos menos frecuentes fueron la mezcla de quinoleinas/clioquinol y la mezcla de lactonas sesquiterpenicas. En las mujeres la prevalencia de sensibilizacion al niquel fue del 35%. Conclusiones el perfil de sensibilizaciones de Espana es el esperado para un pais del Sur de Europa. El sulfato de niquel sigue siendo el alergeno mas prevalente, siendo especialmente importante en mujeres. La mezcla de quinoleinas/clioquinol y la mezcla de lactonas sesquiterpenicas no han mostrado rentabilidad suficiente para su permanencia en la serie espanola.

Background: The epidemiology of contact dermatitis can be analyzed using clinical data from skin allergy units. Objectives: The aims of this study were to define the profile of patients attending a skin allergy unit and to determine the prevalence of the most common sensitizations in this population. Material and methods: Throughout 2008, a retrospective observational study was carried out in the 5 hospitals of the Spanish Surveillance System on Contact Allergies. All patients underwent skin patch tests with the Spanish standard series. The frequencies of sensitization were normalized for age and gender. Results: Data were gathered on 1161 patients. The 5 allergens that gave the most frequent positive reactions were nickel sulfate (25.88%), potassium dichromate (5.31%), cobalt chloride (5.10%), fragrance blends (4.64%), and balsam of Peru (4.44%). The least frequently detected reactions were to quinolone-clioquinol mix and sesquiterpene lactone mix. There was a 35% prevalence of sensitization to nickel among women. Conclusions: The profile of sensitizations in Spain is similar to that of other Southern European countries. Nickel sulfate continues to be the most prevalent allergen, particularly in women. The low prevalence of sensitization to quinolone-clioquinol mix and sesquiterpene lactone mix supports their exclusion of the Spanish series. © 2010 Elsevier Espana, S.L. y AEDV. Todos los derechos reservados.

Background: A few cases on primary sensitization by, and occupational contact dermatitis from, methylisothiazolinone in paints and glues have been published. In cosmetics, methylisothiazoline (MI) is permitted in a concentration of 100 p.p.m., while 15 p.p.m. for the mixture of methylchloroisothiazolinone and methylisothiazoline (MCI/MI). Objectives: To present cases of sensitization to, and allergic contact dermatitis from, cosmetic products containing methylisothiazolinone only. Patients, Materials, and Methods: Seven patients with suspected contact dermatitis – six of them with (peri-)anal lesions and one with facial dermatitis – were patch tested with the baseline series, the own products exposed to, cosmetic ingredients, as well as with methylisothiazolinone 1000 p.p.m. and MCI/MI 200 p.p.m. Results: The patients with anal lesions had become sensitized by wipes for intimate hygiene, and one patient with facial dermatitis by a make-up remover, all containing methylisothiazolinone only. Three out of seven cases would have been missed if only MCI/MI 100 p.p.m., as present in the baseline series, had been tested. Conclusion: The inclusion of methylisothiazolinone as a preservative in cosmetics might not represent the solution to the problem of allergic contact dermatitis from isothiazolinones, since it leads to primary sensitization.

Background. Erysipelas and cellulitis are relatively common cutaneous infections that can sometimes be the cause of a prolonged hospital admission. The objective of this study was to determine the most relevant epidemiologic factors and their influence on the length of hospital stay, comparing our results with those of previous studies. Material and methods. We performed a retrospective, observational, cross-sectional study of 122 patients admitted over a 5-year period to the dermatology department of our hospital with a diagnosis of erysipelas or cellulitis. Results. Patients with a diagnosis of erysipelas or cellulitis represented 8.6 % of all admissions during the study period. The mean age was 58.93 years and the female to male ratio was 1.06:1. The most common site of involvement was on the legs (76.22 %). Overweight or obesity was present in 42.6 % of patients and tinea pedis was detected in 33.6 % of cases. A skin abscess developed in 7.4 % of cases. The mean length of admission was 10.20 days; length of stay increased with age and with the erythrocyte sedimentation rate (ESR) on admission (P < .01 for both differences). Conclusions. We confirm general epidemiologic factors such as sex and age distributions, predominant site, past history, and length of hospital stay. In view of their predictive value for the length of hospital stay, we propose that age and the ESR on admission should be considered to be indirect indicators of disease severity.

Background. Erysipelas and cellulitis are relatively common cutaneous infections that can sometimes be the cause of a prolonged hospital admission. The objective of this study was to determine the most relevant epidemiologic factors and their influence on the length of hospital stay, comparing our results with those of previous studies. Material and methods. We performed a retrospective, observational, cross-sectional study of 122 patients admitted over a 5-year period to the dermatology department of our hospital with a diagnosis of erysipelas or cellulitis. Results. Patients with a diagnosis of erysipelas or cellulitis represented 8.6 % of all admissions during the study period. The mean age was 58.93 years and the female to male ratio was 1.06:1. The most common site of involvement was on the legs (76.22 %). Overweight or obesity was present in 42.6 % of patients and tinea pedis was detected in 33.6 % of cases. A skin abscess developed in 7.4 % of cases. The mean length of admission was 10.20 days; length of stay increased with age and with the erythrocyte sedimentation rate (ESR) on admission (P

Background: Ulceration and osteoclast-like giant cells are two pathological features uncommonly seen in dermatofibromas. To our knowledge, the presence of these features has not been previously described within the same lesion. Methods: We report the clinical, histopathological and immunohistochemical findings of a 38-year-old man with an ulcerated dermatofibroma (DF) on the sole containing OLGC. Comments: DF, or cutaneous fibrous histiocytoma, is a frequent dermatological lesion with many clinicopathological variants. Therefore, a correct diagnosis is not always straightforward, especially when two rare features co-exist in the same lesion. Differential diagnosis was performed with cutaneous and even non-cutaneous lesions. An explanation for the clinicopathological findings is also described.

Elastolytic giant cell granuloma (EGCG) is an infrequent granulomatous skin disorder with variable response to different therapeutic regimens. Information on the benefit of phototherapy is very scarce as this therapy has seldom been tried in the affected patients. We present the results achieved in two female patients after undergoing psoralen-ultraviolet A (PUVA). Two 54-year-old otherwise healthy female patients received a course of PUVA after trying other alternatives. Complete clearance was achieved in the two patients with excellent tolerance and no adverse effects. We consider PUVA is a well-tolerated, safe, and effective treatment for patients with EGCG.

To the Editor: We present the case of a 31-year-old woman with no relevant medical history, who consulted because of lesions on the backs of the hands related to minor traumas; the lesions worsened in the summer leaving residual hyperpigmentation (Figure). The patient had phototype III skin and displayed discrete hypertrichosis in the zygomatic areas. Photosensitive dermatosis was suspected and a battery of tests was requested to measure liver function, serum iron, transferrin and ferritin levels, blood and urine porphyrins, and photosensitivity. High levels of porphyrins were found in the 24-hour urine collection: 2104 µg/L (normal values

Introduction: Notalgia paresthetica is a sensory mononeuropathy that affects dorsal segments T2 to T6. It can have a significant effect on quality of life. Numerous treatments have been used with variable results. Material and methods: Five patients diagnosed with notalgia paresthetica were treated with intradermal botulinum toxin A. None had achieved relief of the pruritus with previous treatments. Results: Variable results were observed after the administration of intradermal botulinum toxin. Complete resolution of the pruritus was not achieved in any of the patients. Conclusions: Botulinum toxin A appears to be a safe therapeutic option for patients with notalgia paresthetica. However, data currently available come from small patient series, making it difficult to draw definitive conclusions regarding the true efficacy and long-term effects of this treatment.

BACKGROUND: The pattern of contact sensitization to the supposedly most important allergens assembled in the baseline series differs between countries, presumably at least partly because of exposure differences. Objectives. To describe the prevalence of contact sensitization to allergens tested in consecutive patients in the years 2007 and 2008, and to discuss possible differences.METHODS: Data from the 39 departments in 11 European countries comprising the European Surveillance System on Contact Allergy network (www.essca-dc.org) in this period have been pooled and analysed according to common standards.RESULTS: Patch test results with the European baseline series, and country-specific or department-specific additions to it, obtained in 25 181 patients, showed marked international variation. Metals and fragrances are still the most frequent allergens across Europe. Some allergens tested nationally may be useful future additions to the European baseline series, for example methylisothiazolinone, whereas a few long-term components of the European baseline series, namely primin and clioquinol, no longer warrant routine testing.CONCLUSIONS: The present analysis points to 'excess' prevalences of specific contact sensitization in some countries, although interpretation must be cautious if only few, and possibly specialized, centres are representing one country. A comparison as presented may help to target in-depth research into possible causes of 'excess' exposure, and/or consideration of methodological issues, including modifications to the baseline series.

Smooth muscle hamartoma (SMH) is a cutaneous malformation mainly composed of a disorganized proliferation of normal muscle fibers that arise from arrector pili. It usually presents as a single congenital lesion that frequently involves the back and the lower limbs. Unusual clinical presentations, such as atypical localizations, multiple disseminated lesions, and generalized forms have been rarely described. In 2001, Gualandri et al. reported the presence of multiple SMH in three members of the same family, namely two brothers and their mother. This is, as far as we know, the only familial case reported in the English literature. We herein describe a similar case affecting two siblings who presented with identical congenital lesions in the same location.

Clear cell acanthoma (CCA) is a benign epidermal lesion with distinctive clinicopathological features. Multiple disseminated eruptive CCA is an infrequent clinical variant that has been rarely reported. It is characterized by the presence of more than 30 lesions from 1 to 10 mm in diameter that appear progressively over the years. We report the case of a 65-year-old woman with multiple disseminated eruptive CCA affecting her lower extremities. In contrast to previous reports, most of the lesions appeared in a short period of time (less than a month) and, what is more interesting is that some of them have regressed spontaneously leaving residual hyperpigmentation. At present, the histogenesis and etiology of CCA remain unknown. Accumulating data suggest a reactive origin associated with a variety of different inflammatory conditions. The case presented in this report further substantiates that CCA is indeed a reactive epidermal reaction pattern with an inflammatory etiology.

Verrucous Carcinoma (VC) of the foot often affects deep structures such as tendons, muscles or bone. The complete removal of the tumor is essential to avoid recurrences. Radiological studies should be performed before surgical planning in order to determine the extent of the tumor. A 54-year-old man presented with a VC of the foot. Magnetic resonance imaging (MRI) demonstrated a soft-tissue mass affecting the plantar aponeurosis and the sole muscles, without evidence of bone invasion. Computed tomography (CT) showed a lytic area with cortical disruption in the fourth metatarsal neck. A transmetatarsal amputation was performed. Histopathological examination confirmed the bone invasion. MRI is considered the imaging technique of choice in studying VC of the foot. Computed tomography is superior to MRI in determining minimum changes in the cortical bone related to tumor invasion. We conclude that when MRI images are not conclusive, CT scan is a good alternative to determine incipient bone invasion.