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Actinic cheilitis (AC) is a chronic condition that affects mainly the lower lip. To investigate the use of lip photopro-tection in patients with AC. A cross-sectional multicentre study of patients, =45 years of age, was performed in eight dermatology departments in the Galicia region over a period of one year. From 1,239 patients included in the study, 410 were diagnosed with AC and complete data were available for 408. An analysis of lip photopro-tection habits and possible associations in patients with AC is reported. Mean age of patients with AC was 71.9 years and 53.8% were women. More than 90% of AC patients (370/408) had never used lip photoprotection. In the group of patients who used it, 62.16% of them had only used a single stick within the previous year. The only variable significantly associated with the use of lip sun protection was low Fitzpatrick’s skin types I and II (p=0.039). Study limitations include the inclusion of patients 45 years or older and the use of a semiquantitative scale for measuring the frequency of application of lip photoprotection. To our knowledge, this is the first European study focused on lip photoprotection in patients suffering from AC. Only a minority of AC patients protect their lips from UV radiation. Specific lip sun protection recommendations should be promoted, especially in high-risk populations.

La queilitis actinica (QA) es una patologia que afecta principalmente al bermellon del labio inferior dando lugar a alteraciones clinicas y patologicas. La QA se considera mayoritariamente una forma superficial de carcinoma espinocelular y el principal factor de riesgo en su desarrollo es la exposicion solar cronica. La epidemiologia de la QA ha sido escasamente analizada en el pasado. Por este motivo, se diseno un estudio multicentrico transversal en la poblacion de la comunidad autonoma de Galicia con edad igual o superior a 45 anos para evaluar la prevalencia de QA, analizar sus factores de riesgo y manifestaciones clinicas e investigar el uso de fotoproteccion especifica en los labios. Se incluyeron 1250 pacientes en el estudio y de ellos, 410 presentaron QA. La prevalencia de QA en nuestro estudio fue 31,3%. Los sujetos con edad igual o superior a 60 anos, con fototipo II de Fitzpatrick, que habian trabajado en exteriores durante mas de 25 anos y con historia previa de cancer cutaneo no melanoma tuvieron un riesgo superior de desarrollar QA. La mayoria de pacientes con QA no realizaban fotoproteccion labial y, cuando lo hicieron, esta fue insuficiente; solo los pacientes con QA y fototipo I y II de Fitzpatrick mostraron tendencia al uso de fotoproteccion labial. La presencia de otros signos de dano actinico cronico, como queratosis actinicas y/o lentigos solares, fueron prevalentes en los pacientes con QA. En vista de los resultados, es necesario que se promuevan medidas educativas que insistan en la importancia de la fotoproteccion labial, especialmente en poblaciones de alto riesgo; ademas, la exploracion labial minuciosa deberia ser obligatoria en todos los pacientes con dano actinico cronico.

Actinic cheilitis (AC) is a common condition that mainly involves the lower lip, which is associated with chronic exposure to ultraviolet (UV) radiation. AC is considered a precursor of malignancy (1), but the rate of progression from AC to invasive squamous cell carcinoma (SCC) has not yet been established. An epidemiological study previously described the prevalence of AC and its associated variables in the Galicia region (north-western Spain); the prevalence of AC in a population aged 45 years and over was 31.3%, and multivariate analysis showed that significant and independent risk factors for AC were age ≥60 years, Fitzpatrick skin phototypes I and II, working outdoors for more than 25 years, and a history of non-melanoma skin cancer (NMSC) (2). We report here a subanalysis of the clinical manifestations of AC and the associations of AC with other markers of actinic damage SI

At birth, vernix caseosa can cover the whole body surface or accumulate only on the back and in the skin folds. Interest in its composition and function and its possible applications in adults has increased in recent years. The objective of this study was to determine the prevalence of vernix caseosa in newborn infants in the health care area of Ferrol, Spain, and to assess its relationship with neonatal and maternal factors. We performed a prospective study of 1000 newborns seen within the first 3 days of life in our hospital. Vernix caseosa was observed in 42.9% of cases. The clinical profile associated with the presence of vernix caseosa was the following: healthy newborn girl with a high birth weight, born at term by normal vaginal delivery to a multiparous mother who had received medication and dietary supplements during pregnancy. The absence of vernix caseosa was associated with the presence of physiological scaling of the newborn and erythema toxicum neonatorum.

Background Congenital melanocytic nevus is a benign proliferation of melanocytes that is present at birth or develops in the first months of life. Although such lesions are common, few studies have analyzed their prevalence in Spain. Objectives The aim of this study was to define the prevalence and most frequent anatomical areas affected by congenital melanocytic nevi in our health service area. We also analyzed the influence of maternal and neonatal factors in the development of these lesions. Patients and methods We performed a prospective study of 1000 consecutive neonates seen in the first 72hours of life in the perinatology clinic of the Pediatrics Department of Hospital Arquitecto Marcide in Ferrol, Spain, recording specific maternal and neonatal variables and the size and site of congenital melanocytic nevi if present. Results Fourteen infants (10 girls and 4 boys; 12 white European, 2 North African; 1.4% of the study population) presented at least 1 melanocytic nevus. None had more than 1 lesion. Eight of the nevi were located on the trunk, 2 on the face, 2 on the upper limbs, and 2 on the lower limbs. The diameter of the lesions was less than 1.5cm in half of cases and between 1.5 and 3.5cm in the remainder. Conclusions There was a higher prevalence of congenital melanocytic nevi in preterm infants, females, and nonwhite infants. Maternal age, number of previous pregnancies, and birth weight do not appear to influence the prevalence of these lesions.

Background Folliculo-sebaceous cystic hamartoma (FSCH) is an uncommon skin condition presenting as a slow-growing papulo-nodular lesion, in or around the nose. Most cases are not clinically suspected and only histopathological examination allows the diagnosis. Pathological features include a dermal-located infundibulo-cystic structure with sebaceous glands radiating around, a stromal component encircling the epithelial structures, with clefts between the lesional epithelial and stromal parts, as well as between this and the adjacent dermis. Results We report eight patients with the diagnosis of FSCH (5 females and 3 males), with ages ranging from 35 to 77 years. Most cases (5 out of 8) were located in or around the nose and sizes were comprised between 0.6 and 1.2 cm. Lesions had grown for long periods of time, up to ten years in one case. Immunohistochemistry showed staining for p63 in the epithelial component of all lesions, while CD10 was only present in some sebocytes. CD34 and Factor XIIIa positive cells were present in the lesional stroma. Staining for androgen and alpha-estrogen receptors was also usually noticed. Conclusions FCSH is a hamartomatous skin lesion, clinically indistinct but with well-defined histopathological features. Immunohistochemistry shows a profile very close to normal sebaceous glands. © 2008 Blackwell Munksgaard.

Introduction. Porokeratosis is a rare disorder of keratinization. The presence of amyloid deposits has been observed in inflammatory and tumoral skin diseases. Objectives. The aim of this study was to determine the frequency of cutaneous amyloidosis in histology samples from various types of porokeratosis diagnosed in our department from 1988 to 2005. Material and methods. Thirty patients were selected and 34 biopsies of lesions clinically and histologically compatible with porokeratosis were performed. Sections were stained with hematoxylin-eosin and thioflavin T. Results. Amyloid deposits were observed in 11 biopsies from 9 patients. Most were women in their sixties, with disseminated superficial actinic porokeratosis that had begun at least 5 years earlier. No notable histologic differences were observed between porokeratosis specimens with and without amyloid deposits. Conclusions. The coexistence of porokeratosis and amyloidosis is a rare occurrence but may be underdiagnosed. In our opinion, the advanced age of the patients and the chronic nature of the lesions would have been predisposing factors for amyloid deposition. The possibility of racial or genetic influences, however, cannot be ruled out.

Introduction Porokeratosis is a rare disorder of keratinization. The presence of amyloid deposits has been observed in inflammatory and tumoral skin diseases. Objectives The aim of this study was to determine the frequency of cutaneous amyloidosis in histology samples from various types of porokeratosis diagnosed in our department from 1988 to 2005. Material and methods Thirty patients were selected and 34 biopsies of lesions clinically and histologically compatible with porokeratosis were performed. Sections were stained with hematoxylin-eosin and thioflavin T. Results Amyloid deposits were observed in 11 biopsies from 9 patients. Most were women in their sixties, with disseminated superficial actinic porokeratosis that had begun at least 5 years earlier. No notable histologic differences were observed between porokeratosis specimens with and without amyloid deposits. Conclusions The coexistence of porokeratosis and amyloidosis is a rare occurrence but may be underdiagnosed. In our opinion, the advanced age of the patients and the chronic nature of the lesions would have been predisposing factors for amyloid deposition. The possibility of racial or genetic influences, however, cannot be ruled out.

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.

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

La diseminacion cutanea de neoplasias internas se ha descrito con frecuencias variables en distintos tumores. En varones, los carcinomas broncogenicos, de colon y de cavidad oral tienen mayor tendencia a metastatizar en la piel, mientras que en mujeres son los de mama y ovario1,2; estos ultimos son los que originan la mayoria de las metastasis cutaneas abdominales en el sexo femenino3. El adenocarcinoma de endometrio es la segunda neoplasia ginecologica mas frecuente en las mujeres posmenopausicas en Europa occidental, despues de la de mama; sin embargo, las metastasis cutaneas son menos del 1%4,5 y se presentan casi siempre como lesiones nodulares unicas o multiples1,6. Otras formas mas raras de metastasis cutaneas uterinas son la erisipeloide, la telangiectasica y la esclerodermoide7,8. La mayor parte de ellas se localizan en el abdomen, proximas anatomicamente al tumor primario, aunque tambien se han descrito en zonas distantes como en el cuero cabelludo9, el talon10 y las extremidades4.

We report three new cases of allergic contact dermatitis due to vitamins in cosmetic creams. The first patient was diagnosed with worsening rosacea but had allergic contact dermatitis from alpha-tocopherol in a moisturizing cream. The second and third cases presented as acute eyelid dermatitis due to vitamin K in eyelid lifter creams. Repeated open application testing and patch tests with the actual products and individual components of the creams were useful in establishing the diagnosis.

To the Editor: In recent years, an association has been described between the use of protease inhibitors for antiretroviral therapy and the appearance of angiolipomas and lipomas, as well as with an increase in the number and size of those already present.1-3 A 40-year-old man consulted in 2005 for lesions that first appeared in 1998, and that had increased in number and size since then. Some were tender to pressure or spontaneously painful, while others were asymptomatic. The patient, a former intravenous drug user, tested positive for hepatitis B, C, and D, and for the human immunodeficiency virus (HIV). He had started antiretroviral treatment with lamivudine, zidovudine, and indinavir in 1998, and in 2001 indinavir was substituted with nelfinavir; however, the lesions continued to appear. He reported no family or personal history of similar lesions. Physical examination revealed numerous subcutaneous tumors on the upper limbs and, to a lesser extent, on the trunk and lower limbs. These were clearly circumscribed, firm, and, in some instances, painful to the touch (Figure 1). distributed over the entire skin surface6,7; (2) localized multiple glomangiomas, in which glomus tumors are grouped together and limited to 1 region, for example a limb8; and (3) plaque-like congenital glomangioma, the rarest type of glomus tumor.3,9,10 The term congenital plaque-like glomangioma was coined in 1990 by Landthaler et al3 in their description of poorly demarcated multiple plaques similar to hematomas located on the shoulders of 2 children. Subsequently, other cases were reported consisting of multiple bluish or reddish nodules grouped into 1 or several plaques, or in clusters of discrete nodules in a particular region of the body, which in some cases presented clinically with a morphology of venous malformation.9,10 Plaque-like glomangioma is present from birth and may be painful. The lesions are generally flat at birth, pink or bluish in color, and increase in size as the child grows. During puberty, satellite lesions may appear at a distance from the initial lesion. There are descriptions of familial cases of autosomal dominant inheritance with incomplete penetrance and variable expressivity, in which family members have minor lesions. This should be differentiated from tufted angioma, venous malformations, or congenital plaque-like blue nevus9,10. In 1998, Requena et al4 described a solitary plaque-like telangiectatic glomangioma, an entity distinct from congenital plaque-like glomangioma since it was solitary and acquired, with a telangiectatic surface. Our case substantially resembles this one (the patient’s female sex and the localization, telangiectatic surface, and slight depression of the lesion), but differs from it in its congenital nature, and for this reason we consider it to be a solitary congenital plaque-like telangiectatic glomangioma.

A 48-year-old woman developed drug-induced subacute lupus erythematosus while taking lamotrigine. The eruption resolved after discontinuance of lamotrigine, suggesting this drug as the cause.

We report a 7-year-old boy with a past medical history of B-cell leukemia with dysmorphic features, including cleft palate, hypotrichosis with trichorrhexis nodosa, hypohidrosis, oligodontia, and ridging of nails. A heterozygous germline mutation, Ala111Thr, in the p63 gene was detected in the boy and in his mother, who had no clinical expression. This case emphasizes the spectrum of different phenotypical manifestations of mutations in the p63 gene and underlines the possible role of this gene as a tumor suppressor.

Cutaneous collagenous vasculopathy is an idiopathic microangiopathy first described in 2000 by Salama and Rosenthal.It must not be confused with generalized essential telangiectasia. To date, all patients have been white men over the age of 50 years, most of whom had multiple pathologies, were taking multiple drugs, and had no family history of similar conditions or hemorrhagic disorders. The disease is characterized by the development of various numbers of telangiectases on the limbs, lower abdomen, chest, or back, with no involvement of the mucosas or nail bed. Histopathology shows dilated superficial cutaneous vessels with perivascular deposits of periodic acid-Schiff diastase-positive, eosinophilic hyaline material that exhibits positive immunoreactivity to collagen IV. We report a new case in a 68-year-old man with symmetrically distributed telangiectases on his forearms, lower abdomen, posterior thighs, lower legs, and dorsum of the feet.

Epidermal nevus syndrome is a rare congenital sporadic neurocutaneous disorder characterized by an epidermal nevus and various developmental abnormalities of the skin, eyes, nervous, cardiovascular and urogenital systems. We describe a patient with an extensive epidermal nevus associated with various organ abnormalities, particularly polyostotic fibrous dysplasia, central nervous system lipoma, and aplasia cutis. Our patient demonstrates the polymorphic spectrum of involvement in epidermal nevus syndrome.