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Background and objectives Psoriasis is an inflammatory skin disease of immunologic nature that is mediated by T-helper-1 cytokines. Clinical response to treatment with antitumor necrosis factor (TNF) a antibodies (infliximab) has been significant; however, the mechanisms for clearance of lesions have not been elucidated. The aim of the present study was to assess variations in the histology and expression of proliferation and apoptotic markers in sequential skin biopsies of patients with psoriasis treated with infliximab. Material and methods We studied skin biopsies (of lesioned and healthy skin) from 3 patients with extensive moderate-to-severe psoriasis (mean psoriasis area and severity index [PASI] score, 35) treated with intravenous infliximab infusions (5 mg/kg) at weeks 0, 2, and 6. Biopsies were taken on days 0, 14, and 28, and were processed for conventional histological and immunohistochemical study. The apoptotic markers used were TP53, B-cell lymphoma 2 protein, anticaspase 3, and anticaspase 8. The cell proliferation marker used was Ki67. Results Treatment with infliximab was associated with a significant clinical improvement in 3 patients (mean PASI score, 21.6 at 14 days and 13.9 at 6 weeks), which correlated with the progressive disappearance of histological lesions with a decrease in epidermal proliferation. However, apoptosis was not observed, and the samples tested negative for anticaspase antibodies. Expression of TP53 decreased 2 weeks after starting treatment, and was similar to that in normal skin at 28 days. Conclusions Clinical and histological response of psoriasis to infliximab was not associated with a significant increase in the apoptotic markers assessed.

Trichothiodystrophy comprises a heterogeneous group of autosomal recessive entities. This fact gives rise to different interrelated neuroectodermal disorders. From a structural point of view these features are the result of the low tissue sulfur content. We report a case of trichothiodystrophy initially classified as Tay syndrome that based on clinical features, complementary exams as well as on the disease evolution was labelled as PIBIDS syndrome.

Case report The Leishmania genus is formed by parasitic protozoa which are transmitted by the bite of infected female sand flies. Cases of sexual, vertical or transfusional transmission or via infected needles have also been described. In humans, 4 forms of this disease have been described: localised cutaneous (LC), diffuse cutaneous, mucocutaneous and visceral (1). LC counts for 50–75% of all cases (2), it is the mildest form of the disease and can be caused by any species of Leishmania. In Spain, the most frequent form is the oriental sore caused by L. infantum (2). Most cases resolve spontaneously within one year. In United States and Europe, the incidence is increasing due to tourism and co-infection with HIV. The morphological spectrum of LC is very wide; multiple forms of clinical presentation have been described, although the most characteristic one is the nodular ulcerative lesion, characterised by painless crater-like ulcers with a necrotic base and covered by an adhesive crust. The main complication of LC is its progression in some strains towards the other 3 forms of the disease (3). In patients with AIDS and other diseases associated with immunosuppression the risk of dissemination is much higher than in the immunocompetent. We present a case of LC with clinical and histopathological features similar to a pyogenic granuloma. Yes

We report a new case of sarcomatoid carcinoma, which showed cellular features of basal cell carcinoma and malignant fibrous myxoid histiocytoma. For this new case and rare neoplasm, we propose the designation of sarcomatoid basal cell carcinoma, as both components were intimately intermingled, the spindle cells seemed to arise from epithelial cells, and both tumoral components showed the same immunohistochemistry expression, cytokeratin and P53 protein, suggesting a monoclonal origin. The epithelial component, a basal cell carcinoma, may have been the first component in the carcinogenesis process.

ejd.2011.1451 Auteur(s) : Martina Ales-Fernandez malesfer@hotmail.com, Antonio Rodriguez-Pichardo, Francisco M Camacho-Martinez Department of Dermatology, Virgen Macarena University Hospital, Av/ Dr. Fedriani s/n, 41009 Seville, Spain Calcinosis cutis is an uncommon disorder characterized by deposition of insoluble calcium salts in cutaneous tissues. Depending on their pathophysiogenic mechanisms, they are classified into four types: dystrophic, metastatic, iatrogenic and idiopathic [1]. The [...]

Actas Dermosifiliogr. 2007;98:372-6 373 To the Editor: We describe a 57-year-old man with multiple basal cell carcinomas on the scalp, where he had undergone radiation therapy in childhood. He consulted for a pearly mass adjacent to a violaceous mass of 5 cm that was poorly defined, indurated, asymptomatic, and with several peripheral nodules (Figure 1), but no local or regional lymph node enlargement. The biopsy showed a basal cell carcinoma and a highly malignant angiosarcoma, with mixed epithelioid and fusiform cell type, high mitotic index, and considerable vascular invasion (Figure 2). Immunohistochemistry showed strong positivity for CD31 (Figure 3), partial for cytokeratins, and low for CD34 and VIII antigen. The computed tomography scans and magnetic resonance imaging revealed infiltration of the subcutaneous cellular tissue and a lesion in the left frontoparietal lobe, the nature of which could not be determined, as the patient declined angiography. Biopsies of the underlying bone and cerebral parenchyma showed no evidence of infiltration. Surgery and local radiation therapy were performed. However, at 2 months, new nodules appeared on the scalp as well as enlarged retroauricular lymph nodes; these were treated by local radiation therapy. Pulmonary metastases have appeared recently, and the patient is undergoing systemic chemotherapy at the time of writing. Angiosarcoma is a rare malignant tumor. A third of these tumors occur in the skin, with a predisposition for superficial soft tissues.1 The condition is more common in older white men. Lymphedema, chronic radiodermatitis, and immunosuppression are related factors. The pathogenesis is unknown, although it appears to have a multifocal origin in the lymphatic vessels. As occurs with basal cell carcinomas, gene mutations have been found in the gene for p53, which would induce overexpression of vascular endothelial growth factor.2,3 Angiosarcoma can display 4 clinical presentations: idiopathic angiosarcoma of the scalp and face, angiosarcoma associated with chronic lymphedema, angiosarcoma secondary to radiation therapy, and primary angiosarcoma of the breast. Initially, all of these types Radiotherapy-Induced Scalp Angiosarcoma

Journal Article; INTRODUCTION Frontal fibrosing alopecia (FFA) in an entity characterized by the recession of the frontotemporal hairline (FTHL) with alopecic scarring change. In recent years there are numerous articles discussing the usefulness of dermoscopy for the clinical diagnosis of different types of scarring alopecia. MATERIALS AND METHODS We value 79 patients diagnosed with FFA, evaluating some trichoscopical findings described as typical for FFA: Absence of follicular opening, follicular hyperkeratosis, follicular plugs and erythema. RESULTS In a population of 79 women, 100% showed no follicular opening, 72.1% follicular hyperkeratosis, 66.3% perifollicular erythema and 44.8% follicular plugs. Thus, 100% of patients had at least one of the dermoscopic elements described as suggestive of FFA, 53% two of them, 45% three and 27%, all those elements. Perifollicular erythema was present in 95% of cases in which the disease was active. CONCLUSIONS We consider that the presence of perifollicular erythema will be a direct marker of FFA activity. Yes

We report the histologic findings of solid facial edema in two male patients. The findings included edema, inflammation, and foreign bodies, is the dermis, which may eseplain the patients lack of response to antibiotics and their positive response to steroids

To the Editor.— I read with great interest the article by Santhosh-Kumar et al on "Unusual Skin Tumors in Langerhans Cell Histiocytosis." 1 I was particularly interested in the statement "the large skin tumors have not been previously described as appearing with LHC." In 1988,I and a number of my colleagues from First October Hospital of Madrid (Spain) published in Actas Dermo-Sifiliograficas 2 the results of a case study on pure cutaneous histiocytosis X in which the symptoms, dermatopathologic, immunochemical, and electronic microscopic studies were the same: swelling growing to a cylindrical mass across the axillary and inguinal region; dermal histiocytic infiltrates and granulomas; these cells stained with immunoperoxidase S100 and showed numerous Birbeck granules. I recently received slides of a young male patient that, when reviewed, convinced me that this was the same case. The patient was sent to me and subsequent clinical examination and histopathologic, immunohistochemical, and electronic microscopic studies bore this out.