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Resumen Las reacciones granulomatosas «sarcoidosis-like» secundarias a ipilimumab afectaran simultaneamente a multiples organos y caracteristicamente se presentaran semanas o meses despues de haber iniciado el tratamiento. Paciente varon de 67 anos, quien consulta por reaccion cutanea granulomatosa a nivel de tronco, extremidades y rostro. Esta se presento 18 meses despues de haber iniciado tratamiento con ipilimumab, medicamento pautado por el diagnostico de un melanoma metastasico. Reportamos reaccion granulomatosa de presentacion exclusivamente cutanea, como efecto adverso medicamentoso tardio secundario al tratamiento con ipilimumab. Asi mismo resaltamos la necesidad de realizar en los pacientes tratados con ipilimumab un seguimiento prolongado.

Granulomatous sarcoidosis-like reactions affecting multiple organ systems at one time have infrequently been described within weeks to months after initiation of Ipilimumab. We present the first case of a 67-year-old man with isolated cutaneous granulomatous reaction involving the trunk, extremities, and face after eighteen months of treatment with ipilimumab for metastatic melanoma. This case documents the eruption of isolated cutaneous granulomatous reaction as a late treatment-related adverse effect of ipilimumab, highlighting the importance of adequate, prolonged follow-up.

This article provides an updated review on diagnosis and treatment of inflammatory nail disorders including psoriasis, lichen planus, trachyonychia, and autoimmune bullous disorders. Despite the significant negative repercussion of the nail psoriasis in the quality of life of patients, treatment is often not sufficiently effective. The efficacy of topical therapies is limited to nail bed psoriasis. Intralesional corticosteroid injections are extensively utilized in nail matrix psoriasis. Systemic immunosuppressant drugs such as methotrexate and cyclosporine have shown efficacy. Biologics, particularly infliximab and etanercept, have also demonstrated high efficacy in the treatment of severe nail disease. Nail matrix lichen planus can cause nail atrophy and irreversible nail scarring and requires prompt treatment with systemic steroids. There is not gold standard therapy for trachyonychia, but in most cases the nail signs improve spontaneously and treatment is not necessary. Nail changes in pemphigus and other autoimmune disorders respond promptly to systemic therapy with steroids and immunosuppressants.

Resumen Introduccion : La relacion del autor con los alimentos y las enfermedades relacionadas con ellos proceden de sus anos de estudiante preuniversitario y se hizo mas estrecha al estudiar Veterinaria, intensificandose a lo largo de su carrera profesional en el Ayuntamiento de Bilbao. A lo largo de la historia el binomio alimentos y salud ha tenido distinta consideracion hasta el momento actual en que ha adquirido gran importancia desde un punto de vista medico y sanitario. Otro tanto puede decirse de la tecnologia alimentaria que permite ofrecer a los consumidores productos seguros y de alta calidad. La aplicacion del calor para la conservacion de la leche supuso una autentica revolucion en la comercializacion de este producto de primera necesidad en las sociedades industriales. La pasterizacion, denominada asi por haber sido el cientifico frances Louis Pasteur el primero en describirla y aplicarla sistematicamente, fue defendida por numerosos medicos y veterinarios como el mejor metodo para evitar la transmision de enfermedades infecciosas por el consumo de leche, convirtiendose en obligatoria en la mayor parte de los paises occidentales a lo largo de la primera mitad del siglo XX. La elaboracion tradicional de quesos curados de oveja tipo Idiazabal sigue de una forma empirica criterios preventivos desde la perspectiva de los principios del denominado Sistema de Analisis de Peligros y Control de Puntos Criticos (HACCP).

Resumen Introduccion En los ultimos tiempos se ha detectado un aumento en los casos de sifilis, sobre todo en el colectivo de homosexuales masculinos. En nuestro Servicio hemos detectado 11 casos de sifilis precoz en 6 meses del 2006, constatando la presencia de un brote epidemico. Material y metodos Pacientes con sifilis temprana a los que se realizo una encuesta epidemiologica. Resultados Cinco casos eran de sifilis secundaria y 6 casos de primaria. Todos los pacientes eran varones, con un 70 % de homosexuales. La edad media era de 38,1 anos. Todos los pacientes tenian o habian tenido otras enfermedades de transmision sexual (ETS), 6 eran positivos para el virus de la inmunodeficiencia humana (VIH+). El 90 % reconocia haber tenido contactos sexuales promiscuos en el ultimo ano, y de ellos el 50% nunca utilizaba preservativo, no lo usaban en el sexo oral, y solo el 25 % lo empleaba en el sexo anal. Conclusiones Existe en el momento actual una relajacion excesiva en la proteccion como metodo de prevencion de ETS, lo que conlleva el incremento de casos. Nos parece importante insistir expresamente en la utilizacion de metodos de barrera en el sexo oral, dado que es una fuente importante de contagio.

Introduction. In the last times there has been an increased incidence of syphilis especially among homosexual men. In our department we have diagnosed 11 cases of early syphilis in 6 months during 2006, thus confirming an epidemic outbreak. Material and methods. We carried out an epidemiological survey of patients with early syphilis. Results. Syphilis was secondary in five cases and primary in six. All patients were men, 70 % homosexual with a mean age of 38.1 years. All patients had or have had other sexually transmitted diseases (STD), six were HIV positive. Ninety percent of the patients admitted having had promiscuous sexual contacts in the past year, and among these, 50 % never used protection, no protection was taken in cases of oral sex and only 25 % reported protection during anal sex. Conclusions. Currently, there is excessive slackening of protection practices as a method of STD prophylaxis, which leads to an increased number of cases. We consider relevant to insist in the use of barrier methods during oral sex as it is an important source of infection.

Background The reactivation of a latent tuberculosis infection is one of the possible major events that may occur during biologic therapies for inflammatory chronic diseases such as psoriasis. Although its main screening test is regularly used in clinical practice, there are few studies about the prevalence of this silent mycobacterial infection and the rate of positive convertors during treatment. Objective To assess the prevalence of latent tuberculosis infection (LTBI) in patients with moderate to severe psoriasis receiving biologic therapy by using tuberculin skin test as a screening method and to evaluate the rate of conversion of tuberculin skin test (TST) during the treatment with biologics. Methods A total of 445 patients were included in our retrospective study, conducted from January 2006 to September 2012. Tuberculin skin test was performed in all patients prior to treatment and once a year during the follow-up. PPD was considered positive with an induration above 5 mm, following the recommendations of Centers for Disease Control and Prevention/ America Thoracic Society. Data analysis was obtained with SPSS 20.0. Results The prevalence of LTBI in our population before initiating the treatment was 4.5% by using TST screening method. During the treatment, 10 cases that were initially TST-negative became positive. Only one of the patients developed active tuberculosis infection. The other 9 TST-positive patients were detected during the regular annual screening, and no symptoms or findings on chest x-ray were seen. All the patients were treated with isoniazid (INH) for nine months, and biologic therapy was restarted after one month of treatment with INH without development of overt TB infection in any of them during the follow-up period of the study. The mean time to becoming TST positive from start date was 26.7 months (range from 8 months to 5 years). As the PPD was done annually, it is unknown exactly when the patients became TST positive. Prior to initiating treatment, 20 patients were found to be TST positive. All patients had clear chest x-rays and were treated with nine months of INH prior to initiating biologic therapy at least month later. Conclusions The use of a screening tool for LTBI is mandatory in patients taking biologic therapies to avoid severe infectious complications. Periodic follow-up is also crucial as positive results may be seen after prolonged use of these agents.

Etanercept has been used to treat chronic plaque psoriasis. Previously reported data demonstrated that some patients experienced secondary failure and frequently rotational-switch therapy is used. The re-treatment with etanercept as part of the rotational therapy could be considered as another safe and efficient therapeutic approach.To evaluate the efficacy of the re-treatment with etanercept in patients with a history of etanercept use with good response and secondary loss of efficacy.This is an open label prospective study involving 20 patients with moderate to severe plaque psoriasis, who had been initially treated with etanercept and were re-treated after a variable interval with 50 mg BIW for 12 weeks.At week 12 of etanercept re-treatment, 13 of 20 patients (65%) achieved a PGA score of 2 or less and 40% (8 of 20), achieved a PGA score of 0 to 1. Etanercept was well tolerated and no serious adverse events were reported.Our study involved a small number of patients. Failure of etanercept was establish by patient's history. However we were able to correlate such failure from our medical records in 17 patients.Re-treatment with etanercept, after secondary loss of efficacy should be considered in patients with psoriasis if satisfactory therapy cannot be achieved with other therapeutic regimens.

Cyclosporine is an immunosuppressive drug that acts selectively on T-cells by inhibiting calcineurin phosphorylase. It has been used in dermatology since its approval for US Food and Drug Administration in 1997 for the use in psoriasis. While indicated only for the treatment of moderate to severe psoriasis, cyclosporine has also been used as an off-label drug for the treatment of various inflammatory skin conditions, including atopic dermatitis, blistering disorders, and connective tissue diseases. In this article, we review the use of cyclosporine in dermatology.

Systemic sclerosis is a connective tissue disorder that affects multiple organs. Although the initial symptoms of the disease are vascular, skin involvement is almost universally present in patients with systemic sclerosis. The presence of Raynaud's phenomenon, progressive thickening of the skin, digital ulcers, and calcinosis all correlate proportionally with disease severity. Since no treatment is available to completely prevent the natural course of the disease, emphasis is often placed on managing symptoms and complications. In this review, the authors focus on the management of each one of the skin manifestations seen in systemic sclerosis, as the dermatologist may facilitate the early recognition and treatment of these complications.

Auteur(s) : Luis Dehesa1, Jesus Bastida1, Rafael Camacho-Galan2, Conrado Campos-Adsuar3, Javier Gomez-Duaso1, Jaime Vilar-Alejo1 1Service of Dermatology, University Hospital Doctor Negrin, Barranco de la Ballena s.n., 35010 Las Palmas de Gran canaria, Spain 2Department of Pathology, University Hospital Doctor Negrin, Barranco de la Ballena s.n., 35010 Las Palmas de Gran canaria, Spain 3Service of Hematology, University Hospital Doctor Negrin, Barranco de la Ballena s.n., 35010 [...]

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A 77-year-old woman presented with a trauma to the scalp caused from the blade of a windmill. The condition was persistent from the past 50 years. At the initial examination, a deep, foul-smelling and well-circumscribed ulcer was apparent on the head region, involving the majority of the cranium. Skin biopsy specimens of the lesion were nonspecific. The bone biopsy showed extensive necrotic areas of bone and soft tissues, with lymphocytic exudate foci. A computed tomography scan of the head revealed bone destruction principally involving both the parietal bones, and parts of the frontal and occipital bones. Streptococcus parasanguis was isolated from the skin culture, and Proteus mirabilis and Peptostreptococcus sp. were identified in the cultures from the bone. A long-term treatment with amoxicillin-clavulanic acid (1 g/12 h) and levofloxacin (500 mg/day) was prescribed, but even after 6 months, the lesion remained unchanged. The frequency of occurrence of scalp ulcers in dermatological patients is less, principally because of the rich blood supply to this area. We have not found any similar case report of a scalp ulcer secondary to chronic osteomyelitis discovered more than 50 years after the causal trauma. We want to highlight the importance of complete cutaneous evaluation including skin and bone biopsies, when scalp osteomyelitis is suspected.