Search

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.

Background and objective Studies on the use of systemic therapy for psoriasis in pediatric patients are scarce. The main aim of this study was to describe the systemic treatments used for moderate to severe psoriasis in pediatric clinical settings. The second aim was to describe the effectiveness and safety of these treatments. Material and methods Descriptive, cross-sectional, multicenter study of patients under 18 years of age with moderate to severe psoriasis who were being treated or had been treated with a systemic drug (conventional or biologic) or phototherapy. We recorded demographic and clinical information, treatments received, tolerance, adverse effects, and response to treatment. Results Data were collected for 40 patients (60% female; mean age, 13 years) who had received 63 treatments in total. The most common first treatment (n = 40) was phototherapy (administered to 68% of patients), followed by acitretin (15%). The most common treatments overall (n = 63) were phototherapy (57%) and methotrexate (16%). At week 12 (evaluation of systemic treatment and phototherapy), 66% of the patients were classified as good responders and 22% as partial responders. The respective rates for week 24 (evaluation of systemic treatment only) were 36% and 32%. The treatments were well tolerated (97%) and adverse effects were reported in just 11% of cases. There were no treatment discontinuations because of adverse effects. Conclusions Phototherapy, followed by methotrexate, were the most common treatment for moderate to severe psoriasis in this series of patients under 18 years. The treatments showed a favorable safety profile and were associated with a good response rate of 66% at week 12 (systemic treatment and phototherapy) and 36% at week 24 (systemic treatment only).

Resumen Las metastasis cutaneas de cancer de prostata son extremadamente infrecuentes. Presentamos 2 casos de metastasis cutaneas a distancia de adenocarcinoma de prostata, con localizacion atipica y destacando 2 tinciones inmunohistoquimicas que pueden ayudar al diagnostico (fosfatasa acida prostatica y el antigeno prostatico especifico de membrana prostatica), fundamentalmente en aquellos casos en los que el antigeno prostatico especifico es negativo.

Cutaneous metastases of prostate cancer are extremely rare. We present 2 cases of distant cutaneous metastases at atypical locations of prostate adenocarcinoma, and highlight the value of 2 immunohistochemical stains—prostatic acid phosphatase and prostate-specific membrane antigen—that can aid diagnosis, particularly in cases with negative staining for prostate-specific antigen.

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.

El acantoma de la vaina pilosa es un tumor benignode piel muy poco frecuente. Suele presentarse comouna pápula asintomática, con un orificio central y lalocalización más frecuente es la cara. Presentamos unnuevo caso de acantoma de vaina pilosa, apoartandoimagen dermatoscópica del tumor.

Verrucous hemangioma (VH) is an uncommon, congenital, vascular anomaly that resembles angiokeratoma but it encompasses distinctive clinicopathological features. The differential diagnosis of this entity included all the hyperkeratotic vascular tumors and malformations and, especially in localized cases, pigmented lesions. VH lesions initially present at birth, and therefore, the diagnosis in the elderly may be difficult. We present a 77 year-old patient with a birth lesion on the back of his calf who came to the clinic with a two year history of enlargement of this lesion following trauma. We performed an excisional biopsy because clinical appearance simulated melanoma arising from a congenital nevus. Nevertheless, the histopathological examination revealed a verrucous hemangioma. A diagnosis of VH should be considered in erythematous papules, nodules, and plaques, especially those that are hyperkeratotic, present at birth, located on the lower extremities, and show growth after trauma or infection.

Background. Eosinophilic dermatosis of hematologic disorders is a reactive process that may cause a variety of clinical manifestations.Methods. We report a patient who had outbreaks of skin lesions since the onset of chronic lymphocytic leukaemia.Results. The cutaneous eruptions began as eosinophilic panniculitis and after changed to insect bite-like lesions.Conclusion. We think that eosinophilic panniculitis and insect bite-like lesions may be part of the spectrum of the same entity in patients with hematologic disorders.

Although still very rare, drug-related cases of Sweet’s syndrome have been reported. The more frequent associated medications with drug induced Sweet´s syndrome was: tetracyclines, trimethoprim-sulphamethaxazol, azatioprine, all trans retinoic acid, nitrofurantoin, granulocyte colony-stimulating factor, hydralazine, tripharil, lithium, oral contraceptives, furosemide, celecoxib and azathioprine. We only found one case of drug-induced Sweet´s syndrome secondary to pegylated interferon-alpha in combination with ribavirin reported in literature. To our knowledge, this one is the first reported case of Sweet’s syndrome in association with interferon beta 1-b therapy.Also, we would like to remark the atypical localization of the lesions in our patient, with a unilateral predominance on the left lower extremity and a very severe pain.

Alopecia and nail distrophy are rare signs of systemic amyloidosis. We present a case with both manifestations and give a brief review of the cutaneous signs of this disease. A biopsy of affected or unaffected skin may provide the diagnosis.

Hidradenitis suppurativa (HS) is a chronic disease with painful, inflamed lesions in the apocrine gland-bearing areas of the body and unsatisfactory treatment. TNFα blockers have been proposed as promising treatments, but only few randomized, short-term, small controlled trials have been conducted. The aim of this study was to evaluate long-term response of HS patients treated with infliximab (IFX).A long-term, prospective study of 10 patients with moderate-severe refractory HS treated with IFX was performed, including assessment of therapy safety, disease severity, and activity. Previous reports on IFX treatment for HS were reviewed.Lack of response was observed in 20% and relapse in 50% of patients, after a median period of 37 weeks. The median number of doses administered was 7.5 during 49 weeks. No life-threatening adverse events were detected. Systematic review of 61 previously published cases showed lack of response was associated with previous surgery, young age at diagnosis, and long time of evolution of the disease.Long-term IFX therapy might be an efficient, well-tolerated, safe option for patients with short-time evolution, severe HS. Relapse is common after 8 months of continuous treatment, especially in patients with more severe disease and in those treated with IFX in monotherapy.

The association of familial totalis leukonychia with multiple pilar cysts is a rare condition that could represent a separate syndromic entity. Since Bauer described a family with totalis leukonychia and sebaceous cysts in 1920, only four new affected families have been reported. We report a five-generation family with a total leukonychia and multiple pilar cysts on the scalp. The hypothesis of a deficiency of a gene regulating the structure of keratin has been postulated but the exact genetic mechanism has not been yet determined. In our family, no other keratinizing structures were involved.

Background: Keratosis pilaris atrophicans (KPA) is a group of disorders characterized by erythematous keratotic papules followed by atrophy on the face. The treatment is often unsatisfactory. Methods: Four white women, with ages ranging from 14 to 20 years, were treated with an intense pulsed light (IPL) system with a cut filter of 570 nm. The power density was between 40 and 47 J/cm2, divided into two pulses of 3 ms, with a delay between both of 20 ms. Patients received five to nine sessions. Results: Clinical improvement was noted in all patients, with a reduction of erythema in treated areas of between 75% and 100%. Treatment was well tolerated and no adverse reactions were observed. After a follow-up of 10 months no recurrence was observed. In addition, in parallel mode to erythema improvement, a reduction of roughness was observed. Conclusion: Our results suggest IPL should be considered as a safe treatment option in patients with KPA.

Arteriovenous haemangioma (AVH) is considered a rare, benign, acquired, cutaneous tumour of vascular origin. Recently, a variant associated with chronic hepatic disease has been described. The usual treatment is surgical resection but no other treatments have been reported.To evaluate the results obtained in the treatment of AVH with carbon dioxide laser vaporization.Every patient with AVH related to chronic hepatic disease treated in the laser unit was reviewed. Five patients were treated with carbon dioxide laser vaporization. The first pass of treatment was performed in defocused mode at 2 W/cm(2). After this, several passes were performed in order to clear the entire lesion. One session of treatment was necessary for three patients, and the other two patients needed two sessions.The tumoral mass as well as the pulse disappeared in all lesions; total clearance was obtained in four of the five cases. In the postoperative time, no bleeding or haemorrhage were observed. No significant secondary effects of treatment were present. The cosmetic outcome was excellent in all cases.Carbon dioxide laser vaporization may be an alternative treatment for cases of AVH in chronic hepatic disease: the procedure is easy and with good cosmetic outcome.

Interferon is used to treat hepatitis C virus infection and its cutaneous side effects are well known. Recently, interferon-induced sarcoidosis has been reported. We report a new case of sarcoidosis during pegylated interferon alfa and ribavirin treatment with an unusual presentation in a woman with previous episodes of erythema nodusum and nodular vasculitis related to HCV.

Actinic cheilitis (AC) is a precancerous lesion of the lip. Treatment of AC is indicated for prevention of squamous cell carcinoma (SCC), although the exact transition rate of AC to SCC is unknown. Carbon dioxide (CO(2)) laser vaporization seems to be an adequate therapy for AC, but there are no references about the evolution rate of AC to SCC after this treatment.To evaluate the results obtained after treatment of AC by CO(2) laser vaporization in comparison with other treatment modalities and the evolution rate of AC to SCC after CO(2) laser treatment.A retrospective review identified 43 patients with AC treated with CO(2) laser vaporization at our hospital from 2002 to 2006. Clinical and therapeutic information was evaluated. All patients were followed for more than 15 months after treatment.After a mean follow-up period of 29.4 months, 3/43 treated AC showed local recurrence. Another two patients developed SCC in the treated field. A residual scar was clinically evident in two patients.CO(2) laser vaporization with an adequate postoperative follow-up is an effective treatment for chronic AC. Nevertheless, some patients (4,6%) went on to develop lip SCC. The follow-up of these patients is mandatory.

ejd.2010.1251 Auteur(s) : Romina RODRIGUEZ-LOJO rodriguezlojo@hotmail.com, Beatriz FERNANDEZ-JORGE, Ana DE ANDRES, Carmen PENA, Jesus GARCIA-SILVA Servicio de Dermatologia, CHU A Coruna, Sir John Moore, s/n. 15001, A Coruna, Spain Surgical management of cutaneous squamous cell carcinomas (CSCC) in patients with severe generalised recessive dystrophic epidermolysis bullosa (SGRDEB) is hindered by the fragility of their skin. We present a patient with SGRDEB who underwent excision of multiple [...]