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Sir, complications related to the use of depilation techniques have increased as a result of the ingrowing demand, the performance by unqualified personnel, and the development of new devices with ...

The presence of a subcutaneous foreign body may not be easily suspected after the initial history and exploration of the patient. The authors report a 54-year-old male who came to the Department of Dermatology, Hospital Universitario de Fuenlabrada, Madrid, Spain with a firm plaque, fixed to deep structures, which showed several draining orifices over the costal grid. After several tests, the authors performed an ultrasonography that revealed the presence of a fistula from a foreign body secondary to a previously untreated costal fracture that occurred several years before. The authors believe ultrasonography is a readily available and useful tool that may help dermatologists in daily clinical practice, with the advantage of being a noninvasive test.

Acral persistent papular mucinosis is a subtype of localized lichen myxedematosus. It presents as acrally located papules with a benign, but persistent course. It is a scarcely reported disease. We present a female with both the clinical and histopathological described criteria.

Histopatologia Se realizo una biopsia incisional, en la que se aprecio un infiltrado denso de celulas de habito linfoide, que presentaba en la periferia un patron perivascular y en la dermis reticular formaba una sabana difusa que respetaba la dermis superficial y la epidermis. Las celulas que componian el infiltrado eran linfoides, de tamano intermedio y habito centrocitico, con celulas aisladas centroblasticas/inmunoblasticas, con poblacion acompanante de celulas pequenas de habito linfoide maduro, algunas plasmaticas y eosinofilos (fig. 2). El estudio inmunohistoquimico evidencio una poblacion de linfocitos B (CD20 y CD79) y abundantes linfocitos T acompanantes (CD3, CD5 y CD43). La expresion de bcl-2 era negativa. Se comprobo policlonalidad para las cadenas y . Finalizado todo el estudio, una nueva valoracion del paciente mostro una evidente disminucion del tamano de la lesion (fig. 3). Decidimos realizar exeresis completa de la lesion, con un estudio histopatologico en el que se evidencio un infiltrado de caracteristicas histopatologicas e inmunohistoquimicas similares a las ya descritas. Con tecnicas de hibridacion in situ de fluorescencia de interfase (FISH) utilizando sondas break-apart sobre tejido parafinado, no se encontraron translocaciones cromosomicas que implicasen los genes bcl-2, malt-1, IgH, IgK e IgL. 435 CASOS PARA EL DIAGNOSTICO

Dermoscopy in acquired acral melanocytic nevi has been widely studied. This is in contrast with the little information about the dermoscopic characteristics in congenital acral melanocytic nevi. We report a 46-year-old man who was referred due to a lesion on his right sole present since childhood corresponding to an acral congenital nevus. Dermoscopy showed a homogeneous blue pattern not previously described in acral benign tumors. The homogeneous blue pattern has previously been associated with blue nevus and skin metastasis of melanoma. The recognition of this pattern in benign acral congenital nevi is relevant in the clinical decision making concerning acral tumors.

Depilation techniques have gain popularity in the last few decades. Nowadays there are available a wide variety of lasers as well as intense pulsed light for depilation. However, little is known about the long-term effects of these procedures when melanocytic nevi are affected by them. We report the cases of three patients where we observed clinical, dermoscopic and histopathological changes secondary to laser therapy and intense pulsed light depilation, respectively. We believe that it is necessary to perform further studies to prove the absence of malignant transformation so that we will be able to set up recommendations in those patients with a personal or family history of malignant melanoma and/or dysplastic nevi.

L ICHEN SCLEROSUS (LS) IS A CHRONIC INFLAMmatory dermatosis that is characterized by the presence of white papules and atrophic plaques. We describe 4 women with asymptomatic whitish papules and atrophic plaques at various locations on the body. Histopathologic examination of the lesions showed atrophy of the epidermis, follicular plugging, and a lymphocytic infiltrate. In all 4 cases, dermoscopy showed a whitish plaque with comedolike openings in the center of the lesion, and a diagnosis of extragenital LS was made. The lesions shown in Figures 1, 2, 3, and 4 are from the back of a 60-year-old woman, a 58-year-old woman, and a 46-year-old woman and from the dorsum of the left foot of a 54-year-old woman, respectively. The lesions that demonstrated an erythematous halo, which is a marker of activity in LS, had well-demarcated borders (Figure 4), whereas those without the halo had more diffuse and ill-defined margins. The comedolike openings and the whitish areas correlated with the histopathologic findings of follicular plugging and the atrophy of the epidermis, respectively. In our opinion, early lesions of LS are associated with dermoscopic features suggestive of follicular plugging (as noted in Figures 1, 2, and 4). With time, these features may become less prominent (Figure 3).

Rheumatoid nodulosis is considered a benign variant of rheumatoid arthritis. Several therapies have been used with variable results. We report a 63-year-old man who presented with nodular lesions on the metacarpophalangeal joints and knees which were diagnosed of rheumatoid nodulosis. Topical tacrolimus was started with good response on the following months.

Psychiatric and psychological morbidity is often associated with skin diseases. Recent research has focused on the epidemiological and clinical aspects of human papillomavirus infection, whereas the psychosocial and emotional factors related to the disease have not been well established. We describe the experience of a 22-year-old male who, after being diagnosed of condyloma acuminata, developed a major depressive disorder.