Emilio Sudy

Calcificación y osificación cutánea

Resumen —La calcificacion cutanea es un trastorno infrecuente caracterizado por el deposito de sales insolubles de calcio en la piel. Puede clasificarse en distrofica, metastasica e idiopatica. La calcificacion distrofica es el tipo mas comun y aparece en tejidos previamente danados, asociandose a una amplia variedad de trastornos inflamatorios neoplasicos, traumaticos o a enfermedades del tejido conectivo. La variedad metastasica aparece en pacientes con niveles plasmaticos elevados de calcio y/o fosforo. En la calcificacion idiopatica no existen evidencias de anomalias tisulares o de metabolismo fosfocalcico; son caracteristicos de este grupo el nodulo calcificado subepidermico, la calcificacion de los cartilagos auriculares, la calcificacion miliar asociada al sindrome de Down, la calcinosis tumoral y la calcificacion escrotal idiopatica. La osificacion cutanea puede ser primaria o secundaria. La primera es infrecuente y no existe lesion cutanea previa; incluye a la osteodistrofia hereditaria de Albright, la heteroplasia osea progresiva y distintas variedades de osteoma cutaneo: osteoma diseminado, osteoma en placa, osteoma solitario pequeno y osteoma miliar multiple de la cara. La osificacion secundaria aparece en lesiones preexistentes, comunmente asociada a cicatrices, tumores y diversos procesos inflamatorios.

Photolocalized purpura during ciprofloxacin therapy

Photosensitivity reactions reported with ciprofloxacin mimic those of sunburn, with erythema and edema in the milder forms, and painful blistering with subsequent peeling when severe. Purpuric eruptions during treatment with ciprofloxacin have been rarely reported. We describe a 30‐year‐old man who was given a 15‐day course with ciprofloxacin 500 mg twice a day for a prostatitis. Coinciding with sun exposure, he developed a purpuric, pruriginous eruption on his lower extremities, consisting of erythematous, petechial lesions located on the anterior aspect of his thighs and legs, clearly delimited by his bathing suit. The lesions cleared completely after the discontinuation of the drug and treatment with topical clobetasol. The acute reaction observed in our patient differed from a classical sunburn, consisting of confluent petechias, strictly limited to sunlight‐exposed areas, and accompanied by pruritus. Photoexposed purpuric eruptions should be considered as another side effect of ciprofloxacin therapy in addition to phosensitivity rashes.

Open comedones overlying granuloma annulare in a photoexposed area

A 57‐year‐old, fair‐skinned female patient with lesions of granuloma annulare located on her forearms – with signs of actinic damage – is described. No response was observed after successive treatments with topical corticosteroids and oral pentoxifylline. Four years later, the patient developed open comedones on the rim of granuloma annulare lesions. The loss of elastic fibers seen in both granuloma annulare and solar elastosis is presumed to have induced the appearance of open comedones, because of a loss of supporting properties of the dermis inducing a distension of the infundibular canal of the sebaceous follicle, as seen in the Favre–Racouchot disease and actinic comedonal plaque. Concomitantly, the patient developed insulin‐dependent diabetes mellitus. Treatment with insulin resulted in the disappearance of open comedones and notably regression of lesions of granuloma annulare. Response to insulin therapy in our case supports the hypothesis that insulinopenia could participate in the development of granuloma annulare in some cases.

Traction Folliculitis: 6 Cases Caused by Different Types of Hairstyles That Pull on the Hair

Excessive hair traction caused by hairstyles that pull the hair too tightly may cause noninfectious mechanical and irritant folliculitis known as traction folliculitis. We present a series of 6 cases of traction folliculitis caused by different hairstyles. All patients were women aged between 12 and 26 years old. Their hairstyles were braids, ponytails, pigtails, cornrows, and hair extensions in 2 patients. The lesions consisted of small, slightly painful, follicular pustules confined to the sites of maximum hair traction and surrounded by erythema. Only in 1 case were the lesions associated with traction alopecia. In 2 cases in which bacterial cultures were done, Staphylococcus aureus was isolated. All patients improved after undoing their hairstyle and treatment with oral flucloxacillin. We assume that the role of S aureus is secondary and opportunistic, given that only follicles subject to traction and not the adjacent ones were affected.

Unilateral acne after facial palsy

We describe a case of unilateral acne which appeared after an episode of facial nerve palsy. An 18-year-old female patient presented with papules and pustules predominantly located on the side where the facial paralysis occurred. The patient suffered right facial paralysis, which was treated with prednisone and kinesiotherapy with massages, electrostimulation, and infrared light. Two weeks later, acne lesions appeared in the area affected by the paralysis. As suggested in other cases of paralysis, including cases of Parkinsons disease and spinal cord injury, an increased sebum excretion rate and the immobility of the affected area are most likely what caused the unilateral acne lesions.We describe a case of unilateral acne which appeared after an episode of facial nerve palsy. An 18-year-old female patient presented with papules and pustules predominantly located on the side where the facial paralysis occurred. The patient suffered right facial paralysis, which was treated with prednisone and kinesiotherapy with massages, electrostimulation, and infrared light. Two weeks later, acne lesions appeared in the area affected by the paralysis. As suggested in other cases of paralysis, including cases of Parkinson’s disease and spinal cord injury, an increased sebum excretion rate and the immobility of the affected area are most likely what caused the unilateral acne lesions.

Clinical variants of pityriasis rosea

Pityriasis rosea (PR) is a common erythemato-squamous dermatosis which almost always, is easily diagnosed. Mostly the disease presents in its classical form. However, clinical dermatology is all about variations and PR is not an exception. Variants of the disease in some cases may be troublesome to diagnose and confuse clinicians. Prompt diagnosis and treatment of the condition becomes necessary to avoid unnecessary investigations. We hereby review and illustrate atypical presentations of the disease, including diverse forms of location and morphology of the lesions, the course of the eruption, and its differential diagnoses.

A case of localized, unilateral hyperkeratosis lenticularis perstans on a woman's breast

A 75-year-old woman presented with a 5-year history of asymptomatic lesions confined to the right breast, which caused her discomfort when wearing a bra. The patient denied any injury or trauma to the affected area. Clinical inspection showed three plaques, each of them formed by several yellowish keratotic adherent papules. The individual papules measured 1 to 2 mm in diameter, and consisted of isolated or contiguous monomorphic elements, ranging from 50 to 60 per plaque. Some of these elements were more elevated than others or showed a slight depression at their center (Figure 1). A biopsy taken from one of the plaques revealed a laminar orthokeratotic and hyperkeratotic lesion, strongly eosinophilic at its center, thus representing a contrast to the normal basket-weave stratum corneum on both sides. The epidermis below the lesion showed a loss of the rete ridges. Towards the edges of the lesion, the epidermis formed papillomatous elevations similar to a church spire. In the dermis, there was a slight perivascular lymphohistiocytic inflammatory infiltrate (Figure 2). Topical treatments including calcipotriene and urea were unsuccessful. Eventually, the lesions were removed using electrocautery and curettage. There was no recurrence. Also known by its eponym (Flegel’s disease), hyperkeratosis lenticularis perstans (HLP) is a rare disorder of keratinization described by Flegel in 1958. Most cases are sporadic in origin, although it is typically described as an autosomal dominant disorder. In some series, the minority of cases was familial [1, 2]. It characteristically affects middle-aged or older men, with bilateral lesions mainly found on the back of the feet and the anterior aspects of the legs. More rarely, the disorder has been described on the upper extremities and, as an exception, also in other locations. Clinically, it is characterized by multiple red-brown papules almost symmetrically located on the dorsum of the feet and legs. The typical HLP lesion is a well-defined red to yellow-brown papule, about 2 to 5 mm in diameter, with a keratotic adherent scale. Occasionally, it has been described involving the upper extremities [1], hands [3], back [4], ears [1], palms [5], and oral mucosa. More rarely, lesions in the axillary folds, antecubital and popliteal fossae, and on the eyelids have been reported, in addition to the more common involvement of legs and hands [6]. A case with unilateral lesions on the lower extremity – existing since puberty – has also been described [7]. Histopathologic findings characteristically show an orthokeratotic and hyperkeratotic epidermis of decreased thickness. The dermis exhibits a lymphocytic infiltrate of

Unilateral and distal subcorneal pustular dermatosis and persistent polyclonal immunoglobulin M hyperimmunoglobulinemia

Dear Editor, Subcorneal pustular dermatosis (SPD) is a rare disease of uncertain origin characterized by chronic relapsing episodes of sterile pustules mainly located on the trunk, especially on intertriginous areas such as the groin, axillae and submammary regions, or on the flexural aspect of proximal limbs. Uncommon variants have been reported with lesions on the soles, face and on the extensor aspects of the extremities, involving the dorsa of the hands and feet. Some cases have been associated with a monoclonal gammopathy, mainly of the immunoglobulin (Ig)A type (14 of 17 cases in one series), whereas among all the monoclonal gammopathies, the IgA type is only seen in 14% of cases. We describe a case of SPD with localized, distal, unilateral lesions and a persistent raised level of serum IgM for more than 15 years, without an associated monoclonal gammopathy. A 32-year-old woman was initially seen in 1993 for a 2-year history of a recurrent eruption strictly limited to the inner aspect of her left ankle. The lesions commenced with erythema and pruritus, followed by pustules. After 15–20 days, the eruption cleared completely with desquamation, reappearing soon afterward with the same characteristics. She was treated by diverse physicians with oral and topical antibiotics, antimycotics, corticosteroids, antihistamines and potassium iodide without any improvement. Cultures for bacteria and fungi were always negative. On examination she presented isolated and confluent pustules surrounded by erythema on the inner aspect of her left ankle (Fig. 1a). She had no other similar lesions on the rest of her body. A few days after, her lesions had cleared leaving erythema and desquamation (Fig. 1b). The histopathological study of a biopsy, taken during the first days of her next relapse, showed

Alopecia androgenética femenina de patrón masculino tras automedicación prolongada con suplemento hormonal

Resumen —Entre las diferentes causas de alopecia androgenetica femenina debe considerarse el empleo de suplementos hormonales con efecto androgenico. Describimos una mujer de 72 anos con una alopecia prominente de tipo masculino que se habia estado automedicando con un suplemento de alto contenido androgenico durante mas de 30 anos.