Javier Labandeira

Hair Follicle Nevus: Case Report and Review

Hair follicle nevus has been variously defined as a specific type of neoplasm with follicular differentiation or as a synonym for trichofolliculoma; the latter view has predominated in recent years. We report a nodular lesion that was identified histopathologically as a hamartoma with follicular differentiation and that systematic serial sectioning showed not to be a trichofolliculoma. After reviewing previous descriptions of lesions diagnosed as hair follicle nevus, and in the light of our own observations, we believe that hair follicle nevus is a distinct type of adnexal hamartoma.

Prospective study of erythema toxicum neonatorum: epidemiology and predisposing factors.

Abstract:  We performed a prospective study of 1,000 neonates investigated in the first 72 hours of life in the health area of Ferrol (northwest of Spain) to assess the prevalence of erythema toxicum neonatorum, the anatomical sites most frequently involved, the influence of different maternal and neonatal parameters, day of life of medical examination, and type of delivery (vaginal or Cesarean). Overall prevalence of erythema toxicum neonatorum was 16.7%. Lesions most frequently involved the trunk, buttocks, and proximal areas of limbs. A higher prevalence of this dermatosis was found in Caucasian newborns (p = 0.01) and those with higher birthweight (p < 0.05), greater gestational age (p < 0.05), vaginal delivery (p < 0.05), maternal age of <30 years (p = 0.28), and fewer than two previous pregnancies (p = 0.12).

Prevalencia y características clínicas de los nevos melanocíticos congénitos en 1.000 recién nacidos españoles

BACKGROUND Congenital melanocytic nevus is a benign proliferation of melanocytes that is present at birth or develops in the first months of life. Although such lesions are common, few studies have analyzed their prevalence in Spain. OBJECTIVES The aim of this study was to define the prevalence and most frequent anatomical areas affected by congenital melanocytic nevi in our health service area. We also analyzed the influence of maternal and neonatal factors in the development of these lesions. PATIENTS AND METHODS We performed a prospective study of 1000 consecutive neonates seen in the first 72hours of life in the perinatology clinic of the Pediatrics Department of Hospital Arquitecto Marcide in Ferrol, Spain, recording specific maternal and neonatal variables and the size and site of congenital melanocytic nevi if present. RESULTS Fourteen infants (10 girls and 4 boys; 12 white European, 2 North African; 1.4% of the study population) presented at least 1 melanocytic nevus. None had more than 1 lesion. Eight of the nevi were located on the trunk, 2 on the face, 2 on the upper limbs, and 2 on the lower limbs. The diameter of the lesions was less than 1.5 cm in half of cases and between 1.5 and 3.5 cm in the remainder. CONCLUSIONS There was a higher prevalence of congenital melanocytic nevi in preterm infants, females, and nonwhite infants. Maternal age, number of previous pregnancies, and birth weight do not appear to influence the prevalence of these lesions.

Lichen amyloidosus without itching indicates that it is not secondary to chronic scratching.

Sir, The origin of lichen amyloidosus (LA) is controversial. It is a form of primary cutaneous amyloidosus in which fibrillar proteinaceous material is deposited solely in the skin, without associated systemic manifestations. LA is typically highly pruritic, and the deposition of fibrillar material has generally been considered to be secondary to the scratching induced by other subjacent pruritogenic processes. However, our literature search revealed one previous report of LA without pruritus and a small-series study in which pruritus preceded lesions in most but not all patients. Here we present a case of widespread lichen amyloidosus with lesions on the trunk and extremities first noted 7 years previously by a young man, who at no stage reported pruritus. We conclude that, contrary to the actual view, pruritus and scratching are merely possible symptoms of this dermatitis, not requisite causal factors.

Prevalence of Birthmarks and Transient Skin Lesions in 1000 Spanish Newborns

BACKGROUND AND OBJECTIVES: Almost all newborn children have some sort of birthmark or transient benign skin lesion. Few studies, however, have analyzed their frequency, particularly in Spain. The aims of this study were to determine their prevalence in 1000 newborn children in the health care area of Ferrol in northwest Spain and to compare the results with those of 9 other studies with similar characteristics. PATIENTS AND METHODS: We undertook a descriptive study of 1000 newborn infants seen in the first 3 days of life at the neonatal clinic in the Department of Pediatrics, Hospital Arquitecto Marcide, Ferrol, Spain. Each infant was examined for the presence of 19 different transient benign skin lesions and 11 birthmarks. RESULTS: Birthmarks or benign skin lesions were present in 994 neonates (99.4%). Transient skin lesions were present in 99.2% and birthmarks in 72%. The 5 most prevalent lesions were sebaceous hyperplasia (75%), salmon patch (64.2%), hypertrichosis (59%), sucking calluses (54%), and palatine cysts (53.7%). CONCLUSIONS: The results of this study show that most neonates have benign skin lesions. The findings of studies to assess their frequency are influenced not only by geographic location (affecting variables such as climate, social and health care conditions, and ethnic group) but also by the timing of examination, the inclusion criteria applied, and the terminology used.

Prevalence and Clinical Features of Congenital Melanocytic Nevi in 1,000 Spanish Newborns

Abstract Background Congenital melanocytic nevus is a benign proliferation of melanocytes that is present at birth or develops in the first months of life. Although such lesions are common, few studies have analyzed their prevalence in Spain. Objectives The aim of this study was to define the prevalence and most frequent anatomical areas affected by congenital melanocytic nevi in our health service area. We also analyzed the influence of maternal and neonatal factors in the development of these lesions. Patients and methods We performed a prospective study of 1000 consecutive neonates seen in the first 72hours of life in the perinatology clinic of the Pediatrics Department of Hospital Arquitecto Marcide in Ferrol, Spain, recording specific maternal and neonatal variables and the size and site of congenital melanocytic nevi if present. Results Fourteen infants (10 girls and 4 boys; 12 white European, 2 North African; 1.4% of the study population) presented at least 1 melanocytic nevus. None had more than 1 lesion. Eight of the nevi were located on the trunk, 2 on the face, 2 on the upper limbs, and 2 on the lower limbs. The diameter of the lesions was less than 1.5cm in half of cases and between 1.5 and 3.5cm in the remainder. Conclusions There was a higher prevalence of congenital melanocytic nevi in preterm infants, females, and nonwhite infants. Maternal age, number of previous pregnancies, and birth weight do not appear to influence the prevalence of these lesions.

Prevalence of Milia and Palatal and Gingival Cysts in Spanish Newborns

Abstract:  We performed a descriptive survey of 1,000 consecutive newborns cared for in the first 3 days of life in the health area of Ferrol (in northwest Spain) to assess the prevalence and most‐frequent locations of oral cysts and milia and to study the influence of different maternal and neonatal parameters in the development of these lesions. Prevalence of palatal, gingival, and cutaneous cysts was 53.7%, 13.4%, and 16.6%, respectively. Milia were predominantly located on the cheeks, chin, and forehead. We found a frequent association between palatal and gingival cysts but not between oral cysts and milia. Neonatal factors such as sex, weight at birth, and gestational age can significantly influence the development of palatal and gingival cysts.

Efficacy of topical calcipotriol in the treatment of a giant viral wart.

To the Editor: Viral warts occur most often in children and no treatment has been uniformly effective. Topical vitamin D3 derivatives have shown effectiveness for HPV-related diseases (1) and recently, using an occlusive dressing, also for recalcitrant warts in immunocompromised patients (2). We report a patient with a giant viral wart that healed after simple application of calcipotriol cream, without recurrence during 6 years of follow-up. A 14-year-old boy with no relevant personal or familial medical history consulted in 1998 because of an asymptomatic verrucous lesion that had been present for 2 years and never been treated. Dermatologic examination showed a reddish, hyperkeratotic plaque, 3 cm wide and 9 cm long, on the back of the right hand and wrist and a few keratotic papules on the back of the same hand and fingers (Fig. 1). A presumptive diagnosis of ILVEN was made, a biopsy of the plaque performed, and calcipotriol cream (Daivonex, 50 μ g per g) twice daily prescribed as the initial treatment. The patient did not return for 2 months and had been applying the cream once daily and only to the giant plaque. He reported no irritation and examination showed complete healing, with only residual pigmentation and the satellite keratotic papules remaining (Fig. 2). Histologic examination showed orthokeratotic hyperkeratosis, acanthosis, some papillomatosis, and large vacuolated cells in the upper regions of the malpighian and granular layer (Fig. 3). Immunostaining with antiserum against HPV (Dako, Monoclonal mouse, clone K1H8) was performed at a dilution 1 : 10 and positivity was detected in some nuclei of the granular layer and in parakeratotic cells of the stratum corneum (Fig. 4). The definitive diagnosis was viral wart and the remaining satellite papules were

Salmon Patch: a Descriptive Study

Abstract Background and objectives Salmon patch is a congenital venous malformation that usually affects the midline. Although it is very common, few studies have analyzed its prevalence or predisposing factors. The aim of this study was to determine the prevalence and clinical characteristics of salmon patch in a group of newborn infants from a health care area in northwest Spain and to assess its association with neonatal and maternal variables. Patients and methods A descriptive study was undertaken of live newborn children seen in the neonatal unit of the Department of Pediatrics at Hospital Arquitecto Marcide, Ferrol, Spain between May 1, 2008 and January 31, 2009. The study protocol included collection of data on neonatal variables (including gestational age, sex, ethnic origin, weight, and presence and anatomical site of salmon patch) and maternal variables (including age and number of previous pregnancies). Results Of the 600 newborn infants included in the study, 59% had salmon patches. The most commonly affected sites were the nape of the neck (226 infants, 37.6%) and eyelids (211 infants, 35.1%). In a number of cases, more than one part of the body was affected. There was a higher prevalence of salmon patch in full-term or post-term births, in girls, white children, heavier children, and infants born to mothers aged between 30 and 34 years or who had not been pregnant previously. Conclusions Salmon patch occurred most frequently on the nape of the neck, the eyelids, and the glabella. Its prevalence was associated with certain neonatal and maternal factors.

Tolerability and effectiveness of liquid nitrogen spray cryotherapy with very short freeze times in the treatment of xanthelasma palpebrarum.

Xanthelasma are cholesterol‐filled, soft, yellow plaques that usually appear on the medial aspects of the eyelids bilaterally. They are always benign lesions so therapy is usually undertaken only for cosmetic reasons. Surgical excision, chemical peeling with tricholoroacetic acid, and laser ablation are commonly used treatments. Liquid nitrogen cryotherapy is a potentially effective but rarely used treatment due to the risk of intense eyelid swelling. We report on our experience with four of our patients, and propose an explanation for the effectiveness of gentle liquid nitrogen spray cryotherapy in xanthelasma. We consider that gentle liquid nitrogen cryotherapy should be used in the treatment of xanthelasma due to the ease of application and low risk of adverse effects.