C. de la Torre

Sarcoma de Kaposi asociado a corticoterapia sistémica

Resumen El sarcoma de Kaposi (SK) fue descrito por Moritz Kaposi en 1872. Las caracteristicas epidemiologicas del SK apuntan a una probable causa infecciosa. Se han identificado fragmentos de ADN que corresponden a un virus herpes no identificado previamente, el virus herpes humano tipo 8, en biopsias de SK asociado a sida. Se considera un factor necesario pero no suficiente, siendo conveniente tener en cuenta otros factores como la inmunosupresion. Los tratamientos inmunosupresores se asocian con un mayor riesgo de desarrollar SK. Describimos el caso de un paciente que desarrollo SK tras recibir tratamiento prolongado con prednisona con motivo de la arteritis de la temporal que padecia.

Lung Involvement in Pyoderma Gangrenosum: A Case Report and Review of the Literature

Pyoderma gangrenosum is a neutrophilic dermatosis that, in addition to its characteristic skin manifestations, can cause visceral alterations. Our patient was a 34-year-old woman with pyoderma gangrenosum that was exacerbated by iodine and that also affected the lungs. Other published cases of lung involvement in pyoderma gangrenosum are reviewed and we discuss the possible exacerbation of this disease by iodine. Lung involvement is the most common extracutaneous manifestation of pyoderma gangrenosum and the main differential diagnosis is then with Wegener granulomatosis. It is important to remember the possible presentation of extracutaneous manifestations of pyoderma gangrenosum, including particularly lung involvement, in order to avoid subjecting a patient to aggressive diagnostic tests, at least in the initial stages.

Primary Cutaneous Cryptococcosis Presenting With a Sporotrichoid Pattern in a Cancer Patient

Findings from endoscopic studies in patients with esophagitis caused by alendronate are associated with chemical esophagitis, similar to that caused by acetylsalicylic acid.7 The pathophysiological mechanism involved in these cases was direct irritation of the mucosa due to prolonged exposure to the drug. The same mechanism could apply to our patients who allowed tablets to dissolve in their mouths, causing erosion due to prolonged contact of the drug with the oral mucosa. In view of the increasing use of alendronate sodium we presume this must be quite a common complication despite the paucity of cases cited in the literature. As we are aware that alendronate sodium can cause erosions or ulcerations of the oral mucosa if not ingested properly, we must consider the drug as a possible causal agent in such cases and must question the patient carefully on how they ingested the tablets.8,9

Productos de higiene y antisepsia de manos: su empleo y relación con el eccema de manos en los profesionales sanitarios

Hand hygiene is the most important measure for the prevention of nosocomial infection. We describe the different products available for hygiene and antisepsis of the hands and the use of these products in daily practice. Hand hygiene products such as soaps and detergents are a cause of irritant dermatitis in health professionals. This irritation is one of the principal factors affecting their use in clinical practice. Alcohol-based products are better tolerated and less irritant than soap and water; irritation should not therefore be a limiting factor in the use of these products and they are to be recommended in place of soap and water. Informative and continued education programs could increase their use.

Kaposi Sarcoma Associated With Systemic Corticosteroid Therapy

Kaposi sarcoma (KS) was first described in 1872 by Moritz Kaposi. Its epidemiology is suggestive of an infectious disease and in 1994 Chang and coworkers identified DNA sequences corresponding to a previously unidentified herpes virus--human herpes virus 8 (HHV-8)--in AIDS-associated KS biopsies. It is now believed that the presence of HHV-8 is a necessary condition but not sufficient on its own to cause KS. Other factors such as immunosuppression should also be considered and it is known that immunosuppressive therapy increases the risk of KS. We describe a patient who developed KS after prolonged prednisone therapy for temporal arteritis.

[Value of palmar and plantar biopsies of hyperkeratotic and vesicular pustular lesions: a cross-sectional study].

Two patterns have been described. The most common pattern is formed of 1 or several large, clearly defined nodules; the other pattern, observed in 25 % of cases, is for small compact collections of melanocytes distributed diffusely through the dermis in the form of fascicles mixed in with the other nevus cells.5 The cells forming the nodules are large, with epithelioid or fusiform morphology and slightly larger nuclei than the adjacent nevus cells. Positive immunostaining for hMB-45 is associated with the presence of immature melanosomes (types I and II). normally, in a congenital or acquired nevus, immunostaining decreases from the superficial to deeper areas. The presence of immunostaining in the proliferative nodule can only suggest that these cells have immature melanosomes. The main differential diagnosis is with melanoma. The existence of marked pleomorphism, significant mitotic activity, necrosis, and the presence of a well-defined nodule suggest melanoma. Proliferative nodules, on the other hand, have uniform nuclei and no mitotic activity, necrosis, ulceration, hyperchromasia, patterns of destructive growth, or circumscription.2,5 Despite the fact that some cells may display a minimal degree of nuclear atypia, cell proliferation is low, as can be demonstrated by immunohistochemical analysis. In fact, the term ‘proliferative’ is used only descriptively, as the condition is not considered to be a true cell proliferation but rather a structural modification of the melanocytes that constitute the nodules as a result of their terminal differentiation.6 In conclusion, the presence of a nodular lesion and changes in color of a nevus should lead us to consider the possibility of a proliferative nodule, characterized by a benign nature. References

Generalized Familial Acanthosis Nigricans Associated With Hypochondroplasia

None of them reported any illness or habitual use of medication. We observed that all 3 patients examined presented small stature, with short limbs. The patient reported that all except 1 of her siblings were of small stature, as was 1 of her children. Radiological examinations of the patient revealed shortened long bones diagnostic of hypochondroplasia and similar results were seen in her son. Skin biopsy revealed hyperkeratosis and papillomatosis with moderate irregular acanthosis (Figure 2). In order to rule out any systemic disease associated with acanthosis nigricans, studies were requested for the patient, sister, and niece, including: blood tests, coagulation and general biochemistry, insulin and C-peptide, testosterone, dehydroepiandrosterone sulfate levels, and tumor markers. All the results were completely within normal ranges. Benign familial AN is characterized by presence at birth and progression in early infancy, with cutaneous changes becoming more prominent in puberty and then stabilizing or diminishing later. Lesions tend to be located in folds, although in some cases they reach an unusual extension and intensity— probably when onset occurs early with the ensuing long period of development. Prurutis is uncommon. 7 The condition is transmitted in autosomal dominant form with variable penetrance and it is not normally associated with any endocrine or congenital abnormality. We present a case of benign familial AN, with the classic clinical characteristics, associated with hypochondroplasia. Although we could not examine all the cases in this family, autosomal dominant inheritance appears to be present (Figure 3) as is normally the case. Benign familial AN is 1 of the usual classifications of the disease, although very few cases have been described. This could be due to the absence or minimal extent of associated symptoms and the hereditary nature of the disorder whereby patients do not consider the condition relevant or worthy of reporting to a physician. Even though there are generally no associated systemic alterations patients should be To the Editor: Acanthosis nigricans (AN) is a proliferative epidermal disorder expressed clinically in the form of velvety brown plaques in skin folds, although other parts of the skin and mucosa can occasionally be affected. New associations and peculiar clinical forms have been added to classifications of the disease since Pollitzer 1 and Janovsky 2 first reported cases of AN associated with neoplasia. There are currently 8 accepted types of AN, listed by Schwartz 3 as: benign, associated with obesity (pseudoacanthosis nigricans), syndromic, paraneoplastic, acral, unilateral, …

Linear Basal Cell Carcinoma. Report of Two Cases

and with no evidence of trauma or any previous trigger. The examination showed a violaceous lesion of linear morphology with a pearly, scarred appearance and measuring 4·0.5 cm (Figure 1). A skin biopsy was taken and found to be consistent with basal cell carcinoma, confirming the diagnosis of linear basal cell carcinoma. The lesion was removed by simple excision and the wound was closed directly, with the surgical margins found to be free of tumor cells. No recurrence had occurred after 1 year of follow-up. In the second case, a 69-year-old man came for consultation due to a linear lesion on the lower left eyelid, with an eroded, crusty surface, that measured 2.5·0.4 cm (Figure 2). The lesion was excised, with histology confirming the diagnosis of basal cell carcinoma. The linear form of basal cell carcinoma occurs equally in both sexes with an age ratio similar to that of other forms of basal cell carcinoma. 2 It is most commonly found in the periocular region. 3 These tumors are oriented along the tension lines of the skin and, therefore, some authors have speculated on the possibility that the Koebner phenomenon is related to its linear pattern. 4,5 However, as in our patients,

Widespread Idiopathic Comedones and Lichen Ruber Planus: Clinical and Histological Association

To the Editor: The presence of numerous acquired comedones on the trunk and limbs of an adult patient, with no other family member affected and with no triggering factors to explain their presence, requires us to rule out those conditions in which comedones are the predominant clinical feature. The fact that these lesions appear in association with areas of lichen ruber planus presents the dilemma of whether the lesions develop simultaneously by chance or whether there could be some pathogenic relationship. In the case we present below, we observed that, from a clinical point of view, the 2 types of lesion (comedones and lichen) were frequently closely related, with the comedones presenting a lichenoid halo, but they were sometimes separate. However, in all samples analyzed, histological study showed lichenoid infiltration of the comedones. A 72-year-old woman came to our outpatient clinic for mildly pruritic lesions that had been present on the trunk and limbs for approximately 2 years. The patient had a history of hypertension and dislipidemia, for which she had been on treatment with felodipine and pravastatin for at least 7 years. There was no family history of similar skin lesions. On physical examination, we observed small, shiny, erythematous-violaceous plaques and papules with a smooth surface, suggestive of lichen ruber planus (Figure 1). In addition, numerous comedones were identified on the trunk, arms, and thighs; some of these had an erythematous halo of lichenoid inflammatory appearance (Figure 2). A whitish, reticulated pattern was observed on the mucosa of both cheeks. There were no alterations of the hair or nails. The patient was unable to say whether the 2 types of lesion appeared simultaneously or in succession, and there was no history of the use of comedogenic products. We performed biopsies of the comedones, with the interesting finding of a lichenoid pattern around the infundibular microcysts of the comedones (Figure 3); this infiltrate was observed irrespective of whether there was a visible erythematous halo around the comedone or not. The biopsy from the violaceous plaques showed a linear lymphoid infiltrate in the superficial dermis and the presence of necrotic keratinocytes, also confirming the clinical impression of lichenoid lesions. There were no relevant pathological findings in the routine laboratory tests and serological tests for viral hepatitis were negative. The patient was treated with oral isotretinoin (0.5 mg/kg) for 4 months, with resolution of the lichenoid lesions and a marked reduction in the number of comedones. The presence of numerous comedones with a generalized distribution on the trunk and limbs, appearing in adult life, with no triggering factors and no family history of similar lesions is very rare. Recently, Zhang and Zhu 1 reported a similar case in a boy who, like our patient, presented disseminated idiopathic comedones. The histological

Angiomatous Rash in a Pregnant Woman

The patient was a 27-year-old woman of 5 months gestation who was seen for a rash on the trunk that had developed towards the end of the first trimester of pregnancy. The relevant findings in her past medical history were that she was a hepatitis C virus carrier and had had an uncomplicated previous pregnancy and a voluntary abortion. She had not received any treatment in the previous months except for vitamin supplements and did not report easy bleeding or a personal or family history of coagulation disorders.