C. de las Heras

Adult Blaschkitis (Lichen Striatus) in a Patient Treated with Adalimumab

Lichen striatus is an acquired inflammatory dermatosis that usually presents in children as papules arranged in a single band following the Baschko lines on an extremity. The disorder resolves slowly, leaving transient hypopigmentation, and rarely recurs. Histopathology findings indicate both lichenoid and spongiotic dermatitis. A variant of blaschkitis that occurs in adults is referred to as adult blaschkitis, acquired relapsing self-healing Blaschko dermatitis, or acquired Blaschko dermatitis. Characterized by papulovesicles grouped in multiple ipsilateral blaschkoid bands, adult blaschkitis typically affects the trunk. It resolves rapidly without sequelae, but relapses are frequent. Histopathology reveals a predominance of spongiotic dermatitis (Table 1).1-3 Disagreement has arisen in recent years, given that cases have been reported in which there have been marked clinical and histopathological similarities between blaschkitis and lichen striatus.3 This has led to the disorders being classified under the term Blaschko l inear acquired inf lammat ory skin erupt ion, with adult blaschkitis included under lichen striatus, or with both these considered as opposite poles of the same disease.2,4 The etiology of these dermatoses is unknown, although they have been associated with a personal or family history of atopy. Triggering factors have occasionally been identified, such as infections (eg, varicella), vaccines, pregnancy, stress, drugs (eg, metronidazole), skin trauma, and contact dermatitis.3,5 We describe the case of a 44-year old man with plaque psoriasis, who developed adult blaschkitis 2 months after commencing treatment with adalimumab. The patient, with a past history of gonarthrosis and tonsillectomy, had been diagnosed with plaque psoriasis 13 years earlier. The psoriasis had been treated with methotrexate and phototherapy (psoralen plus UV-A radiation and narrowband UV-B radiation). After an exacerbation of the psoriasis (a psoriasis area and severity index (PASI) score of 11.60), subcutaneous treatment was commenced with adalimumab in accordance with the standard protocol. Follow-up at 3 months showed an improvement in the psoriasis lesions (PASI score, 6.40). Several bands of slanted S-shaped erythematous papules were also observed in the right abdominal region, on the right flank and right buttock, and in the proximal area of the right thigh, following the Blaschko lines and sharply interrupted midline (Figure 1). The patient reported that the skin rash had appeared gradually over the previous 3 weeks and was pruritic. He had no personal or family history of atopic dermatitis. Biopsy revealed a predominantly lymphocytic inflammatory infiltrate in the dermis, affecting small patches in the papillary dermis and upper part of the mid dermis, and most concentrated around the follicles. The epidermis was normal except for discrete spongiosis (Figure 2). Adalimumab is a recombinant human monoclonal antibody for immunoglobulin G1 isotype which inhibits tumor necrosis factor (TNF) a. It is effective in the treatment of moderate to severe plaque psoriasis. Like other TNF-a inhibitors, it can, paradoxically, cause inflammatory skin disorders, particularly psoriasis or psoriasiform rash.6 Eruptions with lichenoid histopathology have also been described, but

Isolated Anterior Cervical Hypertrichosis

Anterior cervical hypertrichosis was described by Trattner and coworkers in 1991. It consists of a «tuft» of hair at the anterior cervical level just above the laryngeal prominence. To date, only 28 cases of anterior cervical hypertrichosis have been reported. Although it is normally an isolated finding, it may be associated with mental retardation, hallux valgus, retinal disorders, other hair disorders, facial dysmorphism, or sensory and motor peripheral neuropathy. We report the case of a 27-year-old woman who presented with this condition as an isolated finding.

Spinulosis as a Manifestation of Demodicosis

1. Fetsch JF, Brinsko RW, Davis CJ Jr, Mostofi FK, Sesterhenn IA. A distinctive myointimal proliferation («myointimoma») involving the corpus spongiosum of the glans penis: a clinicopathologic and immunohistochemical analysis of 10 cases. Am J Surg Pathol. 2000; 24:1524-30. 2. McKenney JK, Collins MH, Carretero AP, Boyd TK, Redman JF, Parham DM. Penile myointimoma in children and adolescents: a clinicopathologic study of 5 cases supporting a distinct entity. Am J Surg Pathol. 2007;31:1622-36. 3. Katona TM, Lopez-Beltran A, MacLennan GT, Cheng L, Montironi R, Cheng L. Soft tissue tumors of the penis: a review. Anal Quant Cytol Histol. 2006;28:193-206. 4. Val-Bernal JF, Garijo MF. Solitary cutaneous myofibroma of the glans penis. Am J Dermatopathol. 1996;18:317-21. 5. Robbins JB, Kohler S. Penile nodule in a 54-year-old man: a case of a myointimoma. J Am Acad Dermatol. 2005;53: 1084-6. 6. Vardar E, Gunlusoy B, Arslan M, Kececi S. Myointimoma of the glans penis. Pathol Int. 2007;57;158-61. Figure 2. At higher magnification, the nodular structures are seen to be made up of spindle cells with a single nucleus, located between bundles of collagen (hematoxylineosin, ×20).

Escrofulodermia con tuberculosis osteoarticular en el área sanitaria de Ferrol

Resumen Introduccion La escrofulodermia se produce por la extension directa a la piel de un foco tuberculoso subyacente a nivel oseo, articular o incluso del epididimo, pero sucede con mayor frecuencia sobre un ganglio linfatico, sobre todo los cervicales. Metodos Analizamos todos los casos de escrofulodermia de origen oseo o articular vistos en el area sanitaria de Ferrol, poblacion actual de 220.000 habitantes, en un periodo de 15 anos. Describimos los datos clinicos, histopatologicos y microbiologicos de los pacientes. Resultados Encontramos 6 casos de escrofulodermia con tuberculosis osteoarticular. Esta serie incluye 5 varones y una mujer, de entre 37 y 80 anos de edad. Se encontro afectacion de organos internos en tres pacientes (50 %). Conclusion La tuberculosis osteoarticular constituye el 10 % de todas las infecciones tuberculosas extrapulmonares. Hay una alta probabilidad de afectacion interna en pacientes con escrofulodermia. Se debe descartar afectacion osea subyacente en todos los pacientes con escrofulodermia, sobre todo en los que muestran una respuesta incompleta al tratamiento medico.

Poroqueratosis en una paciente con dermatomiositis

There are several reports of porokeratosis in the context of immmunosuppressive diseases. These mainly include organ transplant, HIV infection, lymphomas and some inflammatory and autoimmune diseases commonly treated with immunosuppresive drugs or chemotherapy. Disseminated superficial actinic porokeratosis is the clinical variant of porokeratosis that most frequently develops in immunosuppressive states. We report a case of porokeratosis in a woman with dermatomyositis.

[Blaschkoid, zosteriform linear lichen sclerosus et atrophicus].

1. Sardella A. An up-to-date view on burning mouth syndrome. Minerva Stomatol. 2007;56:327-40. 2. Zakrzewska JM, Forssell H, Glenny M. Interventions for the treatment of burning mouth syndrome. Cochrane Database Syst Rev. 2005;25:CD002779. 3. Minguez Serra MP, Salort Llorca C, Silvestre Donat FJ. Pharmacological treatment of burning mouth syndrome: A review and update. Med Oral Patol Oral Cir Bucal. 2007;12:299-304. 4. Foster TS. Efficacy and safety of alpha-lipoic acid supplementation in the treatment of symptomatic diabetic neuropathy. Diabetes Educ. 2007;33:111-7. 5. Fermiano F, Gombos F, Scully C. Burning mouth syndrome: the efficacy of lipoic acid on subgroups. J Eur Acad Dermatol Venereol. 2004;18:676-8. 6. Fermiano F, Gombos F, Scully C. Burning Mouth Syndrome: open trial of psychotherapy alone, medication with alphalipoic acid (thioctic acid), and combination therapy. Med Oral.2004;9:8-13. 7. Fermiano F, Scully C, Gombos F. Idiopathic dysgeusia; an open trial of alpha lipoic acid (ALA) therapy. Int J Oral Maxillofac Surg. 2002;31:625-8. 8. Fermiano F. Burning mouth syndrome (BMS): an open trial of comparative efficacy of alpha-lipoic acid (thioctic acid) with other therapies. Minerva Stomatol. 2002;51:405-9. 9. Fermiano F, Scully C. Burning mouth syndrome (BMS): double blind controlled study of alpha-lipoic acid (thioctic acid) therapy. J Oral Pathol Med. 2002;31:267-9. 10. Fermiano F, Gombos F, Scully C, Busciolano M, De Luca P. Burning mouth syndrome (BMS): controlled open trial of the efficacy of alpha-lipoic acid (thioctic acid) on symptomatology. Oral Dis. 2000;6:274-7. without any improvement in symptoms. Two patients tested positive for antinuclear antibodies and 1 of these, diagnosed with systemic lupus, also tested positive for anti-Ro antibodies. Of all the patients treated, only 3 showed a mild improvement. The remaining patients showed no response to treatment. In the case series presented here, response was limited, as only 3 out of 10 patients reported a mild improvement in symptoms. Although this study cannot provide definitive conclusions, the results would seem to reject the hypothesis of the usefulness of a-lipoic acid in the treatment of BMS, as indicated in the systematic review published by the Cochrane library in 2005.2 Rigorous clinical trials would therefore be needed to demonstrate whether or not this treatment is effective.

Acantosis nigricans maligna, papilomatosis cutáneo-mucosa florida y paquidermatoglifia adquirida en paciente con adenocarcinoma gástrico

We describe the case of a 67-year-old man with a clinical history of smoking, hypertension, and hyperhomocysteinemia. The patient was referred for verrucous lesions on the face that had appeared more than 1 month earlier. A dermatological examination revealed several small, hyperkeratotic lesions on the cheeks and around the mouth (Figure 1A), as well as brownish plaques in the axillary and inguinal folds (Figure 1B). Both hands showed marked accentuation of the dermatoglyphics (Figure 1C). The patient reported that these symptoms had appeared abruptly within a period of less than 2 months. Based on clinical suspicion of a paraneoplastic dermatosis, additional tests were requested to identify the primary tumor. Analyses revealed a cholestatic pattern with elevated levels of alkaline phosphatase and -glutamyl transpeptidase. Tumor marker analysis revealed only a slight increase of -fetoprotein levels. A thoracoabdominopelvic computed tomography scan revealed a lytic lesion in the posterior third of the T12 vertebral body, with slight invasion of the medullary canal, minimal thickening of the antral wall (Figure 2A), and swelling of the periaortic lymph nodes and gastrohepatic ligament lymph nodes (Figure 2B). An upper endoscopy revealed a malignant-looking ulcerated lesion with irregular borders in the area of the gastric incisura, extending towards the gastric body. Biopsy of the

Acrochordons Caused by Friction From Crutch Use

Actas Dermosifiliogr. 2009;100:77-83 80 immunocompromised as a result of corticotherapy—the most common risk factor in developing cryptococcosis3,4— although he had no history of trauma. The skin lesions, although uncommon due to their sporotrichoid appearance, were confined to uncovered areas. Serotype D organisms were not identified in our case. Our patient showed no systemic symptoms other than those related to his cancer, and the physical examination and complementary studies did not reveal any extracutaneous diseases. This fact, combined with the rapid resolution of the condition following administration of fluconazole, makes us consider cutaneous cryptococcosis as a primary diagnosis. Treatment of the primary form is not well established at present.2 Initial management tends to be medical, or a combination of medical treatment and surgical excision. Fluconazole (200-400 mg/d) is the most common agent prescribed, on average, for 32 days. For maintenance treatment in immunocompromised patients it is recommended that this drug be replaced with a less toxic alternative.1 The effectiveness of the therapy was remarkable in our patient, with full healing obtained in less than a month despite immunodepression and the absence of surgical intervention. In conclusion, we present a new case of primary cutaneous cryptococcosis with an uncommon sporotrichoid presentation in a patient with metastasic cancer on high doses of corticosteroid treatment. We also stress the excellent response to fluconazole. Acknowledgments

Disseminated Lobular Capillary Angioma Induced by Erythropoietin

Actas Dermosifiliogr. 2009;100:437-40 439 5. Tennant LB, Mulliken JB, Pérez-Atayde AR, Kozakewich HP. Verrucous hemangioma revisited. Pediatric Dermatology. 2006;23:208-15. 6. Mentzel T, Kutzner H. Tumours of lymphatic vessels of the skin and soft tissues. Pathologe. 2002;23:118-27. 7. Requena L, Sangueza OP. Cutaneous vascular anomalies. Part I. Hamartomas, malformations and dilation of preexisting vessels. J Am Acad Dermatol. 1997;37:523-49. 8. Costa da Cunha Castro E, Galambos C. Prox-1 and VEGFR3 antibodies are superior to D2-40 in identifying endotelial cells of lymphatic malformationsa proposal of a new immunohistochemical panel to differentiate lymphatic from other vascular malformation. Pediatr Dev Pathol. 2008;20:1. 9. Fordham LA, Chung CJ, Donnelly LF. Imaging of congenital vascular and lymphatic anomalies of the head and neck. Neuroimaging Clin N Am. 2000;10:117-36. 10. Garrido-Ríos AA, Sánchez-Velicia L, Marino-Harrison JM, Torrero-Antón MV, Miranda-Romero A. Hemangioma verrugoso: estudio histopatológico y radiológico. Actas Dermosifiliogr. 2008;99:723-6.

Solitary Congenital Plaque-Like Telangiectatic Glomangioma

Glomus tumors comprise a group of relatively rare neoplasms. They may be either solitary or multiple. The latter constitute less than 10% of all cases, and in the traditional classification they were divided into disseminated and localized forms.1,2 In 1990, another form, called congenital multiple plaquelike glomus tumors, was described by Landthaler et al.3 Subsequently, in 1998, Requena et al4 described a rare variety cellular migration) in epidermal keratinocytes following treatment with C225. This is related to a change in the in vivo regulation of follicular and epidermal homeostasis mediated by EGFR, leading to the appearance of the acneiform eruption.5,12,13 Cultures fail to show an infectious agent as the cause of the eruption, a factor which supports the diagnosis.35,8,9 The histopathologic study of the lesions shows a follicular reaction consisting of an intense neutrophilic inflammatory infiltrate surrounding the infundibuli,5,12 which sometimes appear hyperkeratotic.6 A differential diagnosis should be established with rapid-onset follicular eruptions, whether they are established entities or drug reactions; among the most common drug reactions are those produced by vitamin B12, corticosteroids, androgens, lithium, tuberculostatic drugs, halogens, some tricyclic antidepressants, anticonvulsive drugs, and immunosuppressors. The eruption usually responds to tetracyclines such as minocycline at 100 mg/d, or doxycycline at the same dose. Currently no consensus exists as to the duration of treatment.3,9,10,14 Recurrence is relatively frequent, although less intense than the initial episode. In view of the increased use of biological therapy in a variety of specialties, we can expect to see this entity with increased frequency in everyday dermatological practice. Dermatologists should therefore consider it as soon as the patient’s history is taken, thus avoiding invasive tests such as biopsy in many cases. Tetracyclines are currently the treatment of choice and there have been few reports of therapeutic success with alternatives such as metronidazole, used in the present case, or other systemic antibiotics.