Laura Cuesta

Fragrance contact allergy: a 4-year retrospective study.

Background: Fragrance chemicals are the second most frequent cause of contact allergy. The mandatory labelling of 26 fragrance chemicals when present in cosmetics has facilitated management of patients allergic to fragrances.

Correlation between lesion site and concentration of dimethyl fumarate in different parts of shoes in patients with contact dermatitis caused by dimethyl fumarate in footwear.

Background. Dimethyl fumarate (DMF) has been identified as being responsible for an outbreak of shoe contact dermatitis in Europe. All reported cases to date have involved the dorsa of the toes and the dorsa of the feet, sometimes in association with other areas.

Delayed hypersensitivity to methylchloroisothiazolinone/methylisothiazolinone not detected by the baseline series of the Spanish group

A mixture of methylcholoroisothiazolinone and methylisothiazolinone (MCI/MI), in a 3:1 ratio (1), has been used for over 20 years as a preservative in various products for personal, household, and industrial use. In most baseline series, MCI/MI has been included for years at a concentration of 100 ppm aq. (2), which has been considered to be the optimum concentration required to detect the greatest number of cases of contact allergy to the preservative with the fewest number of false negative and irritant reactions. We describe a series of cases of allergy to MCI/MI that were only diagnosed with MCI/MI at a concentration of 200 ppm aq. and accounted for 24% of

Contact allergy to beryllium chloride: report of 12 cases

Background. Isolated cases of allergic contact dermatitis, gingivitis and stomatitis caused by beryllium have been previously reported. We have been able to study a series of 12 patients with patch test reactions to beryllium chloride.

Cauliflower ear in a teenager: a possible sign of child abuse.

Abstract:  “Cauliflower ear” is a perichondritis of the auricular pavilion, usually caused by infection or repeated trauma. In children, this entity is considered infrequent. We present the case of a 10‐year‐old girl living in a child care institution with “cauliflower ear” that was interpreted as a possible sign of child abuse.

Photodynamic therapy of vulvar intraepithelial neoplasia using methyl aminolevulinate

Sir, Vulvar intraepithelial neoplasia is a pre-cancerous lesion that defines the grade of dysplasia of the vulvar squamous epithelium. According to the classification of the International Society for the Study of Vulva Diseases (ISSVD) 2004, the lesions may be low grade (VIN1) or high grade (VIN2 and VIN3) (1). Currently, there is little consensus regarding the optimal treatment method. Instead of vulvectomy, the tendency is to use more conservative forms of treatment such as laser ablation or local excision. Laser ablation is one of the most generally indicated methods, especially in young women with multicentric disease, in view of its good cosmetic and functional results. Various topical medical treatments including imiquimod, 5FU, dinitrochlorobenzene, bleomycin or interferon-a have also been tried, but they are sometimes very painful and have only limited success (2). No therapy is entirely satisfactory in all cases and the treatment chosen depends on the patient’s age and the site and extent of the lesions, together with the biopsy results. There are studies that have demonstrated the efficacy of photodynamic therapy (PDT) to treat VIN with 5-aminolevulinic acid (ALA). We present a case of VIN type III in an HIV-positive patient successfully treated with PDT and methyl aminolevulinate (MAL). A 38-year-old woman was referred for evaluation of vulvar lesions resistant to laser treatment. Her medical history included: ex-parenteral drug use, smoking 25 packet/year, chronic hepatitis C, hepatitis B viral infection, HIV infection with undetectable viral load and CD4 > 700, and urinary stress incontinence. The patient was undergoing treatment with lamivudin, nevirapin and tenofovir. Ten months previously she had been diagnosed as having grade III vulvar intraepithelial neoplasia and was treated by laser vaporization by the gynaecology service. Six months later, biopsies were performed again and the findings were reported as VIN II with koilocytotic changes suggesting viral infection (pathology not available for review). Because of the persistence of the lesions the patient was referred to the dermatology service. On physical examination, desquamative, pruriginous, erythematous plaques were seen involving the right labia majora, the root of the clitoris and perianal zone (Figure 1). In view of the lack of response to treatment, it was decided to use PDT. Topical MAL was applied to cutaneous and mucosal lesions. The area was then covered with an occlusive adhesive dressing. After 3 h of occlusion, any excess cream was removed using a 0.9% saline solution and the fluorescence of the lesions were evaluated using an ultraviolet lamp. To reduce discomfort, a spinal anesthesia was performed prior to the illumination. The area was exposed with 37 J/cm of red light from a lightemitting diode (LED) source (Aktilite CL128) for 10 minutes. Three months after the first session an improvement was seen, although clinically the lesions persisted. Since the first session was well tolerated it was decided to repeat the treatment. After the second session, the lesions disappeared completely and no signs of dysplasia were found in the biopsies repeated

Irritant contact dermatitis due to ammonium bifluoride in two infant twins.

Abstract:  Ammonium bifluoride is one of the most corrosive acids that may produce severe chemical burns when in contact with skin. This hazardous chemical is widely used in household products. We report two pediatric cases of irritant contact dermatitis after exposure to a rust remover, which contained ammonium bifluoride.

Angiomatous tumor on the back

A 29-year-old woman with no medical or family history of interest presented to the Department of Dermatology with a tumor on her back that had appeared four months previously and progressively increased in size. Physical examination revealed a 2.5–3 cm, nonulcerated, well demarcated, reddish tumor that was completely asymptomatic (Fig. 1). Dermoscopy showed multiple lobular red structures separated from each other by fissures with a radial distribution. A whitish veil was also observed (Fig. 2). A surgical excision was performed (Figs. 3 and 4).

Congenital Perianal and Abdominal Nodules

A female infant, born at term after a normal pregnancy and delivery, presented to our institution at 28 days of age with disseminated purplish skin lesions. No significant family history existed. According to the mother, the patient had a small perianal nodule and another nodule on the abdomen at birth. Subsequently, these lesions increased in size, and new lesions appeared on the scalp, trunk, arms, and inguinal area. The infant was in excellent general condition,with normal growth parameters. On examination at presentation to our institution at 28 days of age, a hard, painless erythematous nodulewas located in the perianal region (Fig. 1), and several slightly purplish nodules, measuring under 0.5 cm in diameter, were located on the scalp, trunk, and extremities (Fig. 2). No hepatosplenomegaly, adenopathy, or changes in the oral mucosa were found. A complete blood count showed neutropenia and lymphocytosis, with a normal hemoglobin and platelet count. TORCH serology, including syphilis serology, and chest radiograph, were normal. A skin biopsy was taken from the perianal lesion. The result is shown in Figs. 3 and 4.