Cristina Galache

Acneiform lesions in Becker's nevus and breast hypoplasia

An 18‐year‐old woman was referred for the evaluation of a dull gray macule on the left breast. From the age of 13 years, the patient noted breast asymmetry beginning with the development of the left breast and the presence of a pigmented stain on its border. Physical exploration revealed hypoplasia of the left breast and a homogeneous, light brown macule on the side of the breast ( Fig. 1 ) without infiltration. Papules and pustules were located mainly around the Beckers nevus on the left anterior chest wall. Biopsy specimens with Fontanas stain disclosed a hyperpigmented acanthotic epidermis. A diagnosis of Beckers nevus, acne, and hypoplasia of the breast was made.

Merkel cell carcinoma and Merkel cell polyomavirus: a systematic review and meta-analysis

Several observational studies have assessed the correlation between Merkel cell carcinoma and Merkel cell polyomavirus with variable results. The objective of this systematic review was to determine whether there is a correlation between Merkel cell carcinoma and Merkel cell polyomavirus. Studies assessing the relationship between Merkel cell carcinoma and Merkel cell polyomavirus from January 2008 to August 2014 were pooled from Medline, Embase, PubMed, Cochrane Database of Systemic Reviews and Google Scholar. From each study we collected the first authors last name, publication year, country of origin, type of study design, characteristics of participants, possible variables incorporated into the multivariable analyses and the risk ratio (RR) for Merkel cell carcinoma associated with Merkel cell polyomavirus combined with the corresponding 95% confidence interval (CI). Methodological assessment of the study was evaluated using the Newcastle–Ottawa scale. Crude RR was calculated from the data provided in each article. Meta‐analyses for the global RR and for the proportion of positives in both case and control samples were performed. In addition, in order to explore the sources of heterogeneity among the studies, meta‐regression and sensitivity analyses are also provided. A total of 22 studies were identified for the analysis. The pooled RR from random‐effects analysis was determined to be 6·32 (95% CI, 4·02–9·93). Global proportions of positive samples were 0·79 (95% CI, 0·72–0·84) and 0·12 (95% CI, 0·08–0·19) in the case and control groups, respectively. The findings support the association between Merkel cell carcinoma and Merkel cell polyomavirus. However, a non‐negligible percentage of positive results have been identified in controls. Some caution must be taken in the interpretation of these results because heterogeneity between studies was found.

Multiple eruptive dermatofibromas in a patient receiving efalizumab.

Comment Although dermatofibromas (DFs) are very common, their pathogenesis is poorly understood. It has recently been proposed that this should be regarded as an immunoreactive process, mediated by dermal antigen-presenting cells that trigger an abortive immune response to as yet unidentified antigenic stimuli. According to this hypothesis, the development of MED in immunodeficient states could be facilitated by the inhibition of downregulatory T cells; alternatively, multiple DFs could develop as an exaggerated response to a putative pathogen that could not be cleared by the suppressed immune system [4–6] . Efalizumab (anti-CD11a) is a humanized monoclonal antibody, which blocks multiple T-cell-dependent functions involved in the pathogenesis of psoriasis, including T cell activation and migration to the skin provoking a partial immunosuppressed state [7] . We believe that this combination is not just coincidental and that the development of DF can be attributed to the medication. In a review of the literature we found only 1 patient with psoriasis receiving prednisolone and ultraviolet B phototherapy who developed MED, but the authors attributed the eruption of DF to the HIV infection which the patient suffered [8] . Moreover, the development of new DFs stopped after immunosuppressive therapy had been discontinued in our patient. As dermatologists prescribing new biological drug therapies we should be alert to the appearance of new side effects not found in clinical trials.

Q fever: a new cause of ‘doughnut’ granulomatous lobular panniculitis

Q fever is an uncommon zoonotic rickettsial disease with no exanthem or specific cutaneous lesions. Only nonspecific cutaneous involvement has been reported to date. A 69‐year‐old Spanish woman with chronic myelogenous leukaemia developed fever and two subcutaneous nodules. The patient complained of extreme pain. Biopsy revealed a granulomatous lobular panniculitis with a characteristic ‘fibrin ring’ or ‘doughnut’ appearance: fibrin and inflammatory cells arranged around a central clear space. Changes of membranous lipodystrophy were also found. Q fever serological studies were positive. Our patient had panniculitis with singular histopathological features. These histopathological changes have been described in liver and bone marrow of patients with Q fever. To the best of our knowledge, this cutaneous involvement due to Q fever has not previously been described in the literature.

Haemorrhagic cellulitis caused by Salmonella enteritidis

Soft tissue infections are rare manifestations of extra-intestinal salmonellosis and occur more frequently in immunocompromized patients [1–4]. We report haemorrhagic cellulitis in an immunosuppressed patient with sepsis caused by a non-typhoid Salmonella.

Multiple lentigines confined to resolving psoriatic plaques in a patient treated with adalimumab.

drug induced, (b) the result of the immunosuppressive action of adalimumab, because systemic immunosuppressants are reported to cause an increase in melanocyte activity, or (c) might simply be a postinflammatory hyperpigmentation. On the other hand, melanocytes may be involved in the psoriatic process in several ways: there have been several reports suggesting an association between chronic plaque psoriasis and vitiligo, and the absence of lentigines in psoriatic plaques has been presumed to be the result of selectively destroyed melanocytes by the psoriatic process [6] . The clinical implication of our finding is uncertain. Overall, careful surveillance will be required in those patients receiving biological treatments.

The adverse prognostic effect of tumor budding on the evolution of cutaneous head and neck squamous cell carcinoma

Background Tumor budding is a readily detectable histopathologic feature that has been recognized as an adverse prognostic factor in several human cancers. Objective We sought to assess the correlation of tumor budding with the clinicopathologic features and the prognostic value of tumor budding in cutaneous squamous cell carcinoma (cSCC). Methods Forty‐nine primary nonmetastatic and 49 primary metastatic cSCCs to regional lymph nodes were retrospectively studied. Statistical analyses were carried out to assess the relationship between tumor budding, clinicopathologic parameters, and patient survival. Results Tumor budding was observed in 45 cases of 98 (46%). High‐intensity budding (≥5 tumor buds) was observed in 20 tumors. Presence of tumor buds was a significant risk factor for nodal metastasis with crude and adjusted hazard ratios (HRs) of 8.92 (95% CI, 4.39‐18.1) and 6.93 (95% CI, 3.30‐14.5), respectively, and for reduced overall survival time (crude and adjusted HRs of 2.03 [95% CI, 1.26‐3.28] and 1.72 [95% CI, 1.05‐2.83], respectively). Limitations This was a retrospective study limited to cSCCs of the head and neck. Examined tumors were >2 mm thick, and all were from a primary excision. Conclusion These results indicate an increased frequency of nodal metastasis and risk of death in patients with tumor buds.

Development of familial benign chronic pemphigus in a patient undergoing treatment with efalizumab for psoriasis.

© 2008 The Authors JEADV 2009, 23, 570–620 Journal compilation

Síndrome de Kindler : Aportación de un caso

Kindler syndrome is a very rare disease caused by mutations resulting in defects in the extracellular matrix-actin link. It usually presents with acral blistering from birth in trauma-prone areas, pronounced photosensitivity that improves with age and the development of poikiloderma and cutaneous atrophy. Mucosal involvement and degeneration have been described with relative frequency.Kindler syndrome is a very rare disease caused by mutations resulting in defects in the extracellular matrix-actin link. It usually presents with acral blistering from birth in trauma-prone areas, pronounced photosensitivity that improves with age and the development of poikiloderma and cutaneous atrophy. Mucosal involvement and degeneration have been described with relative frequency.

Nódulo subcutáneo doloroso

The patient was a 57-year-old woman who practiced hiking, and had no history of disease. She presented with a subcutaneous lesion measuring 5 mm in the fifth toe of her left foot that she had detected 12 weeks earlier. The lesion was intensely painful and had undergone no changes. Plain radiography of the foot revealed the presence of a small calcification on the lateral border of the distal phalanx of the fifth toe on left foot (Fig. 1). Analyses included inflammatory markers, calcium, phosphorus and uric acid, which were all normal. The pain disappeared after extirpation (Fig. 2). In 20 months of follow-up, it has not reappeared. The diagnosis was tenosynovitis with psammomatous calcification. Although it can be considered part of the spectrum of tumor lesions with calcification, its clinical and histological features indicate that it is a distinct entity. It is very seldom observed, and rarely reported in the medical literature.1–4 It can be described clinically as a single subcutaneous nodule or mass that is most frequently located in the acral regions of the extremities, predominantly in adult women. The patients mentioned a history of repeated injuries associated with their occupation or related to sports.2 The lesions were situated in tendon or in peritendinous soft tissue. From the histological point of view, they were found to be a proliferation composed of histiocytes and (myo) fibroblasts, and the presence of numerous psammoma bodies. The differential diagnosis should include a variety of neoplastic and nonneoplastic processes of the distal extremities accompanied by calcifications: gout, pseudogout, calcifying aponeurotic