Antonio Aguilar

Proliferating trichilemmal cyst with focal invasion: report of a case and a review of the literature.

Proliferating trichilemmal cyst (PTC) is a rare but morphologically distinctive tumor that usually occurs in the scalp of elderly women. Furthermore, only 30 well-documented examples of so-called malignant PTC have been reported. Alternatively, some authors have recently proposed that PTC is squamous cell carcinoma. We describe a case of PTC with focal invasion that was indistinguishable from squamous cell carcinoma in areas, and we review the literature. This debate should be considered in PTCs to provide adequate treatment (wide local excision) and follow-up (long term), particularly in large and long-standing lesions.

Tripe Palms: A Cutaneous Marker of Internal Malignancy

Tripe palms is a distinctive paraneoplastic cutaneous sign which is frequently associated with internal malignancy, specially carcinomas of the lung and stomach. We describe a patient with ovary carcinoma who showed a curious rugose thickening of the palms with accentuation of the normal dermatoglyphic ridges. The lesions were a specially prominent on the fingertips. The patient also showed classical acanthosis nigricans in the axillae and groin. The soles were spared. Histopathologic findings in palmar lesions consisted of an undulant epidermis, with hyperkeratosis, acanthosis, and papillomatosis. Excision of the ovary carcinoma was followed by complete regression of the cutaneous lesions. We review the literature about tripe palms and discuss the relationship between this striking cutaneous manifestation and internal malignancy.

Fixed exanthema induced by ultraviolet radiation

An unusual cutaneous eruption of the feet and lower limbs induced by ultraviolet radiation in a 30-year-old caucasian man is presented. Previous reports in the literature and the present case indicate that sunlight and UV radiation may provoke fixed eruptions themselves without drug exposure.

Chronic venous ulcer treatment with topical sevoflurane.

Dear Editors, Vascular leg ulcers are a very common disease with a complicated management, a significant sanitary expense, as well as a significant repercussion in patient’s quality of life. An appropriate analgesic control is essential for the management of this condition. The most commonly used therapeutic options to treat the pain are oral analgesics (Non-Steroidal Anti-Inflammatory Drugs (NSAID), acetaminophen, metamizole, tramadol, pregabalin and gabapentin), opiates and topical anaesthetic creams, such as lidocaíne or prilocaine. These therapies may lead to several adverse effects and complications, depending on the drug used and the characteristics of the patient (1,2). Sevoflurane is an inhalable, halogenated anaesthetic agent with an adequate safety profile, used for induction and maintenance of general anaesthesia in hospital and ambulatory surgery, and its efficacy as a topical anaesthetic in vascular leg ulcers has already been reported (1–5). We present the case of a 73-year-old woman with a personal history of arterial hypertension, morbid obesity, type 2 mellitus diabetes, apnoea-hypoventilation syndrome, chronic renal failure and ischaemic cardiopathy. She suffered from a deep venous thrombosis on her right lower limb. The patient complained of disabling and highly painful vascular ulcers on her lower limbs. Daily cures and topical and multiple oral antibiotics were prescribed with an improvement and recovery of the ulcers on her left lower limb. Nevertheless, the ulcers on her right lower limb increased in number with severe pain and discomfort. A dermatological examination showed several deep ulcers with erythematous edges, seropurulent exudate and whitish and haemorrhagic scabs over the anterolateral surface of her right leg (Figure 1). X-ray image of her right leg did not show any significant alterations. The ankle-brachial index was normal. An ultrasound for deep venous thrombosis detection was normal. Histological study showed a chronic inflammatory infiltrate, with granulation tissue and skin calcification (Figure 2). The culture was positive for methicillin-resistant and clindamycin-mupirocin-sensitive Staphylococcus aureus. The patient was admitted to the Internal Medicine Service. Treatment was initiated with clindamycin, right leg immobilisation and strict control of glycaemia and arterial blood pressure. Written consent from the patient and permission from the Pharmacy Department were obtained for the off-label use of topical sevoflurane for her painful right leg ulcers. Daily treatment was initiated with a saline solution, followed by direct irrigation of 10 ml of liquid sevoflurane daily over the ulcers. An intense analgesic effect was reported in 10 minutes, lasting 8 hours without using other systemic analgesics, and it allowed cleaning with chlorhexidine gluconate solution, surgical debridement of the necrotic tissue, and occlusive dressings Figure 1 Several ulcers with erythematous edges and seropurulent exudate over the anterolateral surface of the patient’s right leg.

Achromic verrucous large cell acanthoma.

Large cell acanthoma (LCA) is an epidermal neoplasm whose nature has been variously explained. Though frequently hyper‐pigmented, we describe for the first time an achromic case located on the dorsum of the right hand of a 83‐year‐old woman. This observation is largely inconsistent with one of the theories about the nature of this condition: that it is merely a solar lentigo with large nuclei of keratinocytes.

INTRAVASCULAR PAPILLARY ENDOTHELIAL HYPERPLASIA: A REORGANIZING THROMBUS

A 31-year-old healthy woman consulted us for an asymptomatic nodule on the volar aspect of the third finger of the left hand (Fig, 1), This lesion had appeared spontaneously 3 months prior. It was somewhat masked by the shape of the finger, but the color and the discrete dome-shaped prominence revealed it clearly; a nonpainful, but tender, nodule 8 mm in size was evident on palpation. It was reddish-blue, blanching on pressure, thus suggesting vascular origin. It was shelled out easily from adjacent tissues by surgical excision, A 7-mm bloody mass was obtained, Histopathologic examination showed a mid-sized thinwalled dilated vein completely occupied by a large thrombus with two different areas (Fig, 2), The outer part was mainly solid and hypocellular, while the inner portion was markedly cellular (Fig, 3), Several small channels and transversely sectioned papillary structures could be observed. All these findings were consistent with an intravascular papillary endothelial hyperplasia. The lesion did not recur 15 months after excision.

Peripheral Ulcerative Keratitis with Pyoderma Gangrenosum.

Pyoderma gangrenosum is an unusual necrotizing noninfective and ulcerative skin disease whose cause is unknown. Ophthalmic involvement in pyoderma gangrenosum is an unusual event. Only a few cases have been reported, from which we can highlight scleral, corneal, and orbital cases. Peripheral ulcerative keratitis is a process which destroys the peripheral cornea. Its cause is still unknown although it is often associated with autoimmune conditions. Pyoderma gangrenosum should be included in the differential diagnosis of peripheral ulcerative keratitis. Early recognition of these manifestations can vary the prognosis by applying the appropriate treatment. We introduce a 70-year-old woman who suffered pyoderma gangrenosum associated with peripheral ulcerative keratitis in her left eye. The patients skin lesions and peripheral keratitis responded successfully to systemic steroids and cyclosporine A.