Ana Pérez-Bernal

Management of facial hyperpigmentation.

Facial and neck pigmentations are the most cosmetically important. They are common in middle-aged women, and are related to endogenous (hormones) and exogenous factors (such as use of cosmetics and perfumes, and exposure to sun radiation). Melasma (chloasma) is the most common cause of facial pigmentation, but there are many other forms such as Riehl’s melanosis, poikiloderma of Civatte, erythrose peribuccale pigmentaire of Brocq, erythromelanosis follicularis of the face and neck, linea fusca, and cosmetic hyperpigmentations.Treatment of melasma and other facial pigmentations has always been challenging and discouraging. It is important to avoid exposure to the sun or to ultraviolet lamps, and to use broad-spectrum sunscreens. Several hypopigmenting agents have been used with differing results. Topical hydroquinone 2 to 4% alone or in combination with tretinoin 0.05 to 0.1 % is an established treatment. Topical azelaic acid 15 to 20% can be as efficacious as hydroquinone, but is less of an irritant. Tretinoin is especially useful in treating hyperpigmentation of photoaged skin. Kojic acid, alone or in combination with glycolic acid or hydroquinone, has shown good results, due to its inhibitory action on tyrosinase. Chemical peels are useful to treat melasma: trichloroacetic acid, Jessner’s solution, Unna’s paste, α-hydroxy acid preparations, kojic acid, and salicylic acid, alone or in various combinations have shown good results. In contrast, laser therapies have not produced completely satisfactory results, because they can induce hyperpigmentation and recurrences can occur. New laser approaches could be successful at clearing facial hyperpigmentation in the future.

Localized Kaposi's sarcoma in a patient with pemphigus vulgaris

We report the case of a patient with a 13‐year history of pemphigus vulgaris (PV) treated with immunosuppressive agents, prednisone and mycophenolate mofetil who had developed lesions of Kaposis sarcoma (KS) on a sole plaque of PV that had been previously treated with intralesional injections of steroids. The lesions were surgically removed and polymerase chain reaction (PCR) demonstrated human herpesvirus‐8 (HHV‐8) DNA. There were neither recurrences nor later dissemination of KS following gradual decrease of the immunosuppressive therapy. We suggest that the treatment with intralesional steroids may have influenced the local reactivation of a latent infection of the virus, determining the appearance of this localized KS.

Treatment of palmar hyperhidrosis with botulinum toxin type A: 44 months of experience

Background  Palmar hyperhidrosis (PH) can produce social and occupational difficulties and reduce the quality of life of those who suffer from this kind of problem. When dealing with focal hyperhidrosis, the patients’ attitudes and their subjective approaches regarding the process may influence the objective evaluation of the disorder.

Darier's Disease Associated with Basal Cell Carcinomas

BACKGROUND Only three patients have been reported with basal cell carcinomas in skin involved with Dariers disease. OBJECTIVE We report the fourth case and discuss the possible pathogenetic relationship between both diseases. RESULTS In our case, oral retinoids made evident other basal cell carcinomas hidden in keratotic papules of the Dariers disease. CONCLUSION Early excision of the tumor could be obtained.

Elephantiasis nostras verrucosa treated with surgical débridement.

© 2005 by the American Society for Dermatologic Surgery, Inc. • Published by BC Decker Inc ISSN: 1076–0512 • Dermatol Surg 2005;31:731. To the Editor: In June 2004, Iwao and colleagues reported in this journal a case of elephantiasis nostras verrucosa (ENV) that was successfully treated with surgical débridement.1 Management of this condition is challenging because few therapeutic options achieve good functional and cosmetic results. A 65-year-old woman with a 30-year history of ENV involving both lower legs was attended at our department. Examination of the left lower leg revealed a brown-colored edema entirely covered with multiple nodular and verrucous lesions, giving a cobblestone-like appearance to the skin from the maleolus to the knee (Figure 1A). Microbiologic studies ruled out a filarial infection. Under spinal anesthesia and sedation, we proceeded to shave (surgical blade no. 20) the nodules and verrucous lesions until an even surface was achieved (Figure 1B). Hemostasia of the bloody surface was obtained by means of conventional monopolar electrocoagulation. For postsurgical care, topical fusidic acid was applied under occlusion, and oral amoxicillin-clavulanic acid (500 mg/125 mg three times daily), subcutaneous heparin, and analgesic and anti-inflammatory drugs were also given. Dressings were changed on a daily basis, and the involved extremity was maintained elevated until complete reepithelialization of the wound could be observed 2 weeks after the patient was operated on (Figure 1C). After 1 year of follow-up, functional and subjective cosmetic results were acceptable. However, small nodules became apparent because the patient refused any sort of physiotherapy (Figure 1D). To the best of our knowledge, we report another example of ENV successfully treated by surgical débridement.

Epidemiología del pénfigo en el Hospital Universitario Virgen Macarena (2005-2006)

Resumen Introduccion El penfigo es una enfermedad ampollosa, autoinmune, cronica, con manifestaciones cutaneo-mucosas, grave y potencialmente mortal, que precisa un diagnostico y tratamiento precoces. Material y metodos Realizamos un estudio de cohortes retrospectivo incluyendo todos los casos de penfigo del Departamento de Dermatologia del Hospital Universitario Virgen Macarena durante 2005 y 2006. Revisamos los datos demograficos, clinicos y terapeuticos. Resultados y Conclusiones Se estudiaron 23 pacientes, con predominio del sexo femenino e inicio de la enfermedad entre la cuarta y sexta decadas de la vida. El penfigo vulgar fue la variante mas frecuente (el 79 % de los casos), la mucosa oral, el tronco y el cuero cabelludo las localizaciones predilectas; los corticoides orales, el tratamiento inicial de eleccion en todos los casos, y como adyuvantes utilizamos azatioprina y mofetil micofenolato. Se consiguio remision completa en el 8,68 % de los casos y una remision parcial en el 91,32 %. Las principales complicaciones fueron las infecciones, la osteopenia-osteoporosis y las cataratas.

Epidemiology of Pemphigus in Hospital Universitario Virgen Macarena, Seville, Spain, 2005-2006

BACKGROUND Pemphigus is a serious, potentially fatal chronic autoimmune bullous disease with cutaneous and mucosal manifestations. Early diagnosis and treatment are essential. MATERIAL AND METHODS We performed a retrospective cohort study that included patients diagnosed with pemphigus in the dermatology department of Hospital Universitario Virgen Macarena, Seville, Spain, in 2005 and 2006. We reviewed demographic, clinical, and therapeutic data. RESULTS AND CONCLUSIONS Twenty-three patients, the majority women, were included in the study. Clinical onset usually occurred between 30 and 60 years of age. The most common variant was pemphigus vulgaris (79 %), and the sites most frequently affected were the oral mucosa, trunk, and scalp. Oral corticosteroids were the initial treatment of choice in all patients, and azathioprine and mycophenolate mofetil were given as adjuvant therapy. Complete remission was induced in 8.68 % of patients and partial remission in 91.32 %. The main complications were infections, osteopenia and osteoporosis, and cataracts.

Skin bridge on a nail plate caused by distal onychocryptosis

The formation of a skin bridge on the nail plate is a rare finding which is sometimes observed in newborns and infants.We present the case of a 22 year-old-male who 2 years ago underwent surgical nail avulsion to treat bilateral onychocryptosis of the toenail on the right great toe. Following the procedure, the patient once again developed a painful lateral and distal ingrown nail. Owing to the elevation of the pulp hallux, the nail plate pierced through the distal nail groove, producing a painless [...]