Francisco M. Camacho-Martínez

Basal cell carcinoma with sarcomatoid features (sarcomatoid carcinoma): report of a case and review of the literature.

We report a new case of sarcomatoid carcinoma, which showed cellular features of basal cell carcinoma and malignant fibrous myxoid histiocytoma. For this new case and rare neoplasm, we propose the designation of sarcomatoid basal cell carcinoma, as both components were intimately intermingled, the spindle cells seemed to arise from epithelial cells, and both tumoral components showed the same immunohistochemistry expression, cytokeratin and P53 protein, suggesting a monoclonal origin. The epithelial component, a basal cell carcinoma, may have been the first component in the carcinogenesis process.

Trichoscopic features of frontal fibrosing alopecia: Results in 249 patients

To the Editor: Currently, dermoscopy constitutes an essential noninvasive tool for dermatologists. It helps discern between different types of alopecia, it provides a more precise follow-up, and it can be used to identify an adequate biopsy site. Frontal fibrosing alopecia (FFA) is a primary lymphocytic scarring alopecia with a distinctive clinical pattern of progressive frontotemporal hairline recession and eyebrow loss that mainly affects postmenopausal women. The main objective of our study was to describe the trichoscopic features of FFA in a large series of patients and to correlate these findings with several relevant parameters of FFA. We performed a descriptive, retrospective, observational, multicenter study of digital trichoscopic images, obtained between 1994 and 2013, of 238 women with FFA at 12 Spanish centers. Diagnostic criteria included typical clinical signs and/or histopathologic features consistent with FFA. Images were obtained with either a nonpolarizing or a polarizing dermoscope. Two dermatologists expert in dermoscopy evaluated the images if the registered trichoscopic features of FFA (cicatricial white patches, perifollicular erythema, follicular hyperkeratosis, lonely hairs, and hair diameter diversity) and yellow dots typical of androgenetic alopecia were present on the frontotemporal hairline. Both a descriptive and an analytic study to correlate these parameters with the degree of severity and other clinical variables were performed using SPSS 15.0 software. Clinical and severity variables included female pattern hair loss (FPHL), presence or absence of menopause, FFA severity (I: 1 cm, II: 1-2.99 cm, III: 3-4.99 cm, IV: 5-6.99 cm, and V: [7 cm), and years of evolution, pruritus, trichodynia, facial papules, occipital involvement, eyebrow and eyelash loss, pubis hair loss, and body hair involvement. A bivariate analysis including trichoscopic findings and the aforementioned variables was carried out, and those variables with statistical significance in X test were included in a multivariate logistic regression analysis adjusted for age and excluding lost cases. No new dermoscopic signs were found. Descriptive dermoscopic results are listed in Table I. Both the intraobserver and interobserver agreement for the assignment of a dermoscopic pattern for each lesion were excellent (! 1⁄4 0.82, P.001; ! 1⁄4 0.80, P.001, respectively). The trichoscopic features that were statistically significantly associated (P .05) with some clinical parameters in the bivariate and multivariate logistic regression analysis are listed in Table II. Dermoscopic features of FFA have previously been described in some isolated studies. Toledo-Pastrana et al retrospectively analyzed the dermoscopic images of 79 patients with FFA. They found that 100% of the patients showed no follicular openings, 72.1% showed follicular hyperkeratosis, 66.3% showed perifollicular erythema, and 44.8% showed follicular plugs. Interestingly, they also found that perifollicular erythema was statistically associated to the activity of FFA. In our study, we correlated the dermoscopic features with another outcome: the severity of the disease in terms of extension of the hairline. Remarkably, we found that the presence of cicatricial white patches was statistically associated with the severity of FFA. This dermoscopic feature correlates with the histopathologic findings of hair follicle destruction and severe tissue fibrosis. Therefore, it

Three Cases of Bullous Pemphigoid Associated with Dipeptidyl Peptidase-4 Inhibitors - One due to Linagliptin

Background: Bullous pemphigoid (BP) is an acquired subepidermal autoimmune blistering disease in which there are humoral and cellular responses against the BP180 and BP230 antigens. Dipeptidyl peptidase (DPP)-4 inhibitors enhance endogenous glucagon peptide-1 and glucose-dependent insulinotropic polypeptide secretion with food intake, which leads to insulin secretion, as well as to the reduction of glucagon secretion. Recently, several cases of DPP-4 inhibitor-associated BP have been reported. Objectives: To report 3 cases of DPP-4 inhibitor-associated BP, one of which is due to linagliptin use, as well as to review all currently published cases of DPP-4 inhibitor-associated BP. Case Reports: Three patients diagnosed with BP at our department showed a clear temporal relationship between the introduction of DPP-4 for the treatment of diabetes and the onset of BP. One case was due to linagliptin use, while the other 2 cases were due to an association with vildagliptin-metformin use. Conclusions: This is the first report of linagliptin-associated BP. Furthermore, 2 other cases of vildagliptin-associated BP are reported.

Solid facial edema as a manifestation of acne

We report the histologic findings of solid facial edema in two male patients. The findings included edema, inflammation, and foreign bodies, is the dermis, which may eseplain the patients lack of response to antibiotics and their positive response to steroids

Beard involvement in a man with frontal fibrosing alopecia.

Indian Journal of Dermatology, Venereology, and Leprology | November-December 2014 | Vol 80 | Issue 6 542 Figure 2: Non-inflammatory bald patches in the beard 3. Paul TV, Spurgeon R, Jebasingh F. Visual vignette. Postherpetic neuralgia and galactorrhea. Endocr Pract 2008;14:392. 4. Bateganya MH, Muhwezi J, Mugyenyi P, Kityo C, Lynen L, Zolfo M, Colebenders R. Persistent galactorrhea in a post menopausal woman with Herpes zosterand HIV‐1 infection. Malawi Med J 2005;17:101‐3.

Epidemiology, clinical presentation and therapeutic approach in a multicentre series of dissecting cellulitis of the scalp.

Editor Dissecting cellulitis of the scalp (DCS) is a rare disorder in which inflammatory nodules, abscesses and sinuses may progress to scarring alopecia. Along with hidradenitis suppurativa (HS), acne conglobate (AC) and pilonidal cyst, DCS forms the follicular occlusion tetrad. These disorders share a similar aetiology, in relation to hyperkeratosis, follicular occlusion and subsequent inflammation. Although HS is a well-known entity, there are very few studies about the epidemiology, clinical profile and treatment of patients diagnosed with DCS. The objective of our study was to describe the epidemiology, clinical presentation and therapeutic options in a multicentre series of patients diagnosed with DCS. A retrospective multicentre study was designed in four Spanish hospitals. Patients diagnosed clinically and histologically with DCS were included. Epidemiological, clinical and therapeutic variables were recorded. In all, 21 patients diagnosed with DCS – 17 males (81%) and 4 females (19%) – with a mean age of 32.8 years (range 18–58 years) were included. The information about epidemiology and clinical presentation is shown in Table 1. Two patients (10%) were first cousins. Three patients (14%) associated the onset of the disease with the gym use of anabolic-androgenic steroids. Pruritus was present in 19 patients (90%) and pain in 14 patients (67%) (Fig. 1). Treatment response was assessed in 12 patients. Isotretinoin was administered in eight patients (67%) at a mean daily dose of 30 mg. Significant reduction in inflammatory activity was obtained in seven patients (88%). Doxicycline at a mean daily dose of 100 mg was prescribed in five patients (42%) with great reduction in disease activity in four patients (80%). Three patients (25%) were treated with azithromycin (500 mg daily three times a week) with significant improvement in all of them. Finasteride (1 mg daily) was administrated in three patients with significant improvement in two (67%). One patient was treated

Clinical and trichoscopic characteristics of temporal triangular alopecia: A multicenter study

(Table I). All portions of this study were conducted as a part of an institutional review board eapproved study at Washington University School of Medicine. We founda younger ageofHSonset in our patients with DS, and an overall increased prevalence of DS in our HS population. The mean age of HS symptom onset in those with DS was 14.9 years comparedwith 23.3 years (P1⁄4.018) for thosewithout DS. We were able to obtain age of HS symptom onset in only 8 of 16 of the patientswithDS.However, only 2 of 16 of patients with DS presented with HS after the age of 19 yearsethe median age of HS onset in general. The 2.4% prevalence of DS in our population of patients with HS was approximately 29 times higher than the 0.083% prevalence of DS in the general population. Although this relationship may be falsely exaggerated as a result of referral bias, we believe that bias alone could not account for such a massive increase in prevalence. These results support the notion that DS is associated with the development of HS, particularly at a younger age. Further investigation into the nature of the relationship between these 2 disease entities is warranted.

Fingertip calcinosis cutis in an incomplete limited-type systemic scleroderma

ejd.2011.1451 Auteur(s) : Martina Ales-Fernandez malesfer@hotmail.com, Antonio Rodriguez-Pichardo, Francisco M Camacho-Martinez Department of Dermatology, Virgen Macarena University Hospital, Av/ Dr. Fedriani s/n, 41009 Seville, Spain Calcinosis cutis is an uncommon disorder characterized by deposition of insoluble calcium salts in cutaneous tissues. Depending on their pathophysiogenic mechanisms, they are classified into four types: dystrophic, metastatic, iatrogenic and idiopathic [1]. The [...]

Dermatomyositis and malignant melanoma: a rare association that worsens prognosis?

calcium axis. Sodium thiosulphate was used with the aim of dissolving precipitated calcium, but did not help our patient. Cases 2 and 3 are atypical examples of calciphylaxis occurring in the absence of significant hyperparathyroidism or CKD. Predisposing factors may have been acute kidney injury (mediated by an immunemediated inflammatory response) and cardiac cirrhosis, respectively, both of which affect calcification inhibitors. In all of these cases, several possible mechanisms may have contributed to the arteriopathy, but despite this microscopic appearances were remarkably similar. Therefore, we suggest that a deep skin biopsy is very helpful in non-CKD patients (if only to exclude other more treatable ulcerative conditions) and to facilitate difficult discussions about the poor prognosis. Management involves treating the underlying medical condition as well as the skin and using multiple analgesics to control severe ischaemic pain.

Reply to: “Regarding trichoscopy of dissecting cellulitis of the scalp”

Fig 2. Dissecting cellulitis of the scalp. Trichoscopy showing exclamation mark hair (black arrow). To the Editor: We thank Drs Lacarrubba and Micali for their comments about our article. There are some points about trichoscopy of dissecting cellulitis of the scalp (DCS) that we would like to clarify. Regarding white dots (WDs), because the assessment of WDs in some cases may have a subjective component, we include here another trichoscopic image of the study where WDs may be appreciated (Fig 1). Concerning the image of the previous letter, the presence of growing hairs close to WDs in DCS does not exclude the possibility of WDs to be present, because DCS is characterized by the presence of scarring and nonscarring alopecia in the same patient. In our opinion, although the presence ofWDs is a characteristic feature of primary cicatricial folliculocentric alopecias (ie, lichen planopilaris and frontal fibrosing alopecia), they may be present in other alopecias in which perifollicular and interstitial fibrosis are present, such as folliculitis decalvans. In fact, WDs were previously described in 16% of folliculitis decalvans patients, while only 5.2% of frontal fibrosing alopecia patients had WDs on trichoscopy. Regarding exclamation mark hairs (EMHs), we agree with the authors that the marked hair should strictly be considered a tapered hair. However, because EMHs and tapered hairs are part of the same spectrum, we encompassed both as the same entity in order to simplify the analysis. Nevertheless, in the same picture another hair that fits the EMH criteria can be seen (Fig 2). Regarding the study design and instruments, they were notmentioned because of space limitations.We clarify that the study was developed in the authors’ centers listed at the end of the letter. Trichoscopywas performed using DermLite instruments (3Gen LLC, DanaPoint, CA) at 10-foldmagnification.Nopressure was applied to avoid collapse of the capillaries. In these patients who displayedmultiple alopecic areas, all were analyzed by trichoscopy. Concerning the title, it stated ‘‘EMHs and WDs as markers of disease chronicity,’’ not ‘‘EMHs and WDs as markers of chronic disease.’’ Chronicity may be shorter or longer, thus EMHs would be correlated with a shorter chronicity. Finally, we agree with the authors in the proposed methodology to improve the quality of trichoscopic studies.