J.L. Santiago Sánchez-Mateos

Lesión purpúrica recurrente en el dorso de la mano

Varon de 51 anos que acude a Urgencias por aparicion de quemazon y lesion cutanea en el dorso de la mano derecha desde hacia 48 horas. Referia haber presentado al menos tres episodios similares, con afectacion de la misma zona, en relacion con procesos respiratorios de vias altas acompanados de fi ebre. En esta ocasion tambien habia sido diagnosticado de gripe y tratado con ibuprofeno oral hacia tres dias. El paciente negaba haber tomado otros farmacos y, al ser interrogado sobre el cuadro respiratorio, afi rmaba que siempre habia recibido la misma medicacion (ibuprofeno) para tratar la odinofagia y la fi ebre. En la exploracion estaba afebril, con una placa purpurica bien delimitada, con una ampolla central situada en el dorso de la mano derecha (fi g. 1). El resto de la exploracion fisica estaba dentro de la normalidad. El hemograma, la bioquimica y la coagulacion no mostraban alteraciones signifi cativas. Se procedio a la realizacion de una biopsia cutanea de la lesion y se pauto un tratamiento con corticoides topicos, suspendiendo el ibuprofeno y sustituyendolo por paracetamol.

Management of superficial lymphangiectasias with laser: report of five patients

Editor Lymphangiectasias are lymph vessels secondary to lymphatic malformations (LM) or chronic lymphoedema. LM does not tend to autoresolution, and they are rarely symptomatic. Treatment of LM is often requested for cosmetic reasons. Nevertheless, in some cases, this condition can affect the functionality of certain organs, such as the lesions located in the cervical area where there is the risk of collapsing the airways. Multidisciplinary management is needed in order to achieve optimal cosmetic results when treating the associated complications, such as recurrent cellulitis and lymph exudation. Five patients (2 female and 3 male) who presented lymphangiectasias where treated with laser (Table 1). One of them had a vulvae lymphedema with superficial lymphangiectasias secondary to a gynecological surgery. The other four patients had congenital malformations (Klippel-Trénaunay syndrome, thoracic haemangiolymphangiomas, eyelid microcystic LM and penis microcystic LM). Mepivacaine 2% local anaesthetic was used before the laser treatment. Postoperative care consisted of antibiotic prophylaxis with fusidic acid cream twice a day during 7 days. Improvement was detected in all patients after the therapy. Figure 1 shows a patient before the treatment, and Fig. 2 shows the patient after laser treatment. No complications were observed in any of the patients, and all of them showed resolution of the lymphangiectasias. In addition, patients 1 and 2, with a history of recurrent celullitis, did not show new infectious episodes. Surgery, percutaneous sclerotherapy and laser have been shown to be effective therapies for LM. The most appropriate therapeutical possibility should be selected according to the size and anatomical location of lesion. Surgery is the only curative treatment,1 but the anatomical zone and the extension of the lesion usually limit this treatment. Sclerotherapy2 is an adequate alternative in cystic LM, but not for diffuse ones. However, in LM which are too large for using sclertherapy or those in which a surgical approach is difficult, alternative treatments are needed. Argon laser or CO2 laser are good options 3–6 for superficial or microcystic LM. The cosmetic results are good since the laser removes the superficial vesicles and exudation and also reduces the risk of cellulitis. In mixed lesions (capillary, venous and lymphatic), an adequate laser device should be used in order to cause minimal epidermal damage. Pulse dye Laser (PDL) is elective for the capillary component,7–9 reducing the erythema of the lesion. Diode laser and Nd:YAG laser are also useful for the treatment of more hypertrophic vascular component.7 Ta b le 1

Lesiones purpúricas y edema faciales en adolescente tras exposición solar intensa

Presentamos el caso de una mujer de 15 anos que consulta por edema facial acompanado de lesiones cutaneas dolorosas y pruriginosas en la misma localizacion de 48 horas de evolucion. Interrogada por organos y aparatos no referia otra sintomatologia, a excepcion de aftas orales de reciente aparicion. El cuadro clinico se inicio tras una exposicion solar importante en un jardin publico. A la exploracion estaba afebril y sin afectacion del estado general, presentando marcado edema facial y lesiones purpuricas, infiltradas, distribuidas de modo simetrico en la zona malar, dorso nasal y tercio inferior de pabellones auriculares (figs. 1 y 2). Negaba la aplicacion de productos topicos, toma de farmacos o clinica infecciosa en las semanas previas. No habia antecedentes familiares ni personales de enfermedades reumatologicas. La analitica mostraba una velocidad de sedimentacion globular (VSG) de 27 mm en la primera hora y anemia normocitica y normocromica, sin otras anomalias en el hemograma, bioquimica, coagulacion, basico de orina y sedimento urinario.