M Sáez

Successful treatment of erosive pustular dermatosis of the scalp with topical tacrolimus

bined with topical or systemic anti-infective agents, dermabrasion, CO2 laser vaporization and Grenz ray therapy. Full-thickness excision of affected skin with repair by split-thickness grafting may reduce sweating and provide improvement. Dapsone, vitamin E, psoralen ultraviolet A, methotrexate, or thalidomide have been recommended. Infection is a common complication, and in disease exacerbation several infective causes (bacterial ⁄ fungal ⁄ viral) need to be excluded. Although our patient was treated with Fucibet ointment with no improvement, this did not exclude an underlying fungal infection. When he presented to us, apart from lesions consistent with Hailey–Hailey disease there was also evidence of tinea pedis and widespread fungal infection (tinea incognito). Our patient was commenced on oral lamisil and topical ketoconazole ointment with reduced usage of topical steroids in the infected areas, and improved after treatment.

Asymmetric periflexural exanthem of childhood: report of two cases with parvovirus B19

Asymmetric periflexural exanthem of childhood (APEC) is an exanthem of unknown aetiology that was first described in young children by Brunner et al . in 1962. 1 APEC is typically described as a macular-papular scarlatiniform eruption involving one axillary fold with a centrifugal spreading on the thorax and on to the proximal part of the corresponding arm. The disease does not affect the subject’s general health, but it can provoke moderate itching and mild local lymphadenopathy in about 50% of cases. All symptoms disappeared spontaneously without recurrence in 3–6 weeks. We report two cases of APEC in which seroconversion for parvovirus B 19 has been demonstrated in children. We present two girls, 7 and 9 years old, one of them had a unilateral skin eruption that started on the right axila and extended centrifugally towards the right side of the trunk and the proximal flexural part of the arm. The eruption consists of numerous 1–3 mm, red, grouped, mostly flat papules. Four months later, the other girl showed a similar eruption in the left side, which started on the axillary flexure and thorax (fig. 1), extending to the left arm and leg. Results of routine blood examinations were normal. Serologic examination for cytomegalovirus, EpsteinBarr virus, hepatitis B and C viruses, human immunodeficiency virus, enteroviruses, borrelia burgdorferi and toxoplasma was negative. In both cases, laboratory investigations revealed IgM positive and IgG negative (enzyme immunoassay) for parvovirus B 19 , indicating recent infection. Follow-up titres for antibodies against human parvovirus B 19 were IgG positive and IgM positive after 1 month (the first case) and 2 months (the second case), but IgG positive and IgM negative after 3 months in both of them. Skin biopsy revealed a mild to moderate mononuclear interface dermatitis with infiltrate made of lymphocytes with a clear predominance around sweat glands (fig. 2). No specific treatment was given to the patients, and the eruption cleared 6 weeks after onset in both cases. Unfortunately, up to now all the efforts to identify an infectious agent have been frustrating, 2–4 but the mode of onset of the rush suggested an infectious disorder. Indeed, the items that are in favour of a viral origin of APEC are numerous: (i) the age of the patients; (ii) the presence of small epidemics; (iii) the frequency of associated upper respiratory tract or digestive prodromes; (iv) possible seasonal fluctuations of the eruption; (v) spontaneous resolution in a few weeks; (vi) moderate symptoms (mild pruritus/discomfort); (vii) regional lymphadenopathy prevalent at the affected side; (viii) non-specific histology; (ix) the lack of response to antibiotics; and (x) the lack of response to topical steroids. Just in one previous reported

Cutaneous primary paracoccidioidomycosis.

Paracoccidioidomycosis is a common fungal infection in Latin America. Few cases have been described in non‐endemic countries and their diagnosis without the correct suspicion, bearing in mind that the latency period might be up to 60 years, may not be easy.

Multiple verrucae vulgaris in a young woman's tattoo.

356 JEADV 2006, 20, 341–362

Sweet’s Syndrome Induced by Oral Contraceptive

All criteria for drug-induced Sweet’s syndrome are fulfilled by our patient. Only a single case in which Sweet’s syndrome was believed to be precipitated by oral contraceptives could be found. Nevertheless as more cases of drug-induced Sweet’s syndrome are being reported in the literature we suggest that a drug aetiology should be sought in cases of Sweet’s syndrome and we recommend that a careful drug history should be included in the assessment of all the cases of this syndrome. (excerpt)

Safety of long-term treatment with cyclosporin A in resistant chronic plaque psoriasis: a retrospective case series.

Background  An intermittent short course of cyclosporin A (CyA) therapy is a good choice in the treatment of severe psoriasis. Nevertheless, some severe or resistant patients might benefit from long‐term treatment. Adverse effects of long‐term use of CyA are investigated and the results are compared with the literature.

Patients with vitiligo present fewer cardiovascular risk factors: results from a case-control study.

Editor Vitiligo is a common dermatologic condition that affects 1% of the population worldwide, with no sexual predilection. Several co-morbidities have been described in association with this disorder: thyroidopathies, pernicious anaemia, diabetes, etc. However, no cardiovascular (CV) risk profile has been related so far. Several studies have analysed the relationship between other common dermatological conditions like psoriasis, lichen planus (LP) or androgenetic alopecia and CV disease or metabolic syndrome, showing a possible association based on a convergent mechanism of T-cell mediated chronic inflammation in cutaneous conditions, atherosclerosis or dyslipemia. In this study, we assessed the relationship between vitiligo and CV risk factors, and we suggest a molecular mechanism for this negative association. We performed a case–control study in the University Hospital of Canary Islands between January and August 2011. We included 200 patients, 105 with active non-segmental vitiligo and 95 healthy controls consecutively admitted to the outpatient clinic of Dermatology Department and Primary care respectively. We defined ‘cases’ as patients 14 years of age or older, diagnosed with active non-segmental vitiligo (with new lesions appearing in the last year) with no oral immunosuppressant medication, and ‘controls’ as those patients who are 14 years of age or older, with neither vitiligo nor oral immunosuppressant. Patients and controls were investigated for blood tests, including glycaemia, cholesterol HDL; LDL, triglycerides (TG), height, body weight, body mass index (BMI), abdominal perimeter (AP) and demographical data. Normal ranges for these values are recruited in Table 1. Written informed consent and the explicit approval of our Institutional Ethics Review Board were obtained. Data were analysed using the SPSS 17.0. Continuous variables were analysed using the t-test, chisquare, ANOVA or nonparametric test appropriately. P < 0.05 was considered statistically significant. Data for cases and controls are summarized in Table 2. A total of 105 patients were included in the study group (50 males and 55 females), age ranged from 14 to 85 years (average: 44.4 ± 17.4 years). Control group included 95 patients (32 males and 63 females), aged from 16 to 87 years (average: 49.1 ± 17 years). The analysis of metabolic syndrome parameters revealed a lower significant prevalence of altered AP, TG and low HDL in vitiligo patients (P < 0.05, Table 2). No significant differences could be observed in glucose levels, BMI or LDL. No significant differences could be observed between all these variables regarding gender in the study group.

Emergencies in dermatology outpatient clinics: our experience in Spain

ejd.2012.1724 Auteur(s) : Marina Rodriguez-Martin marinarm@gmail.com, Miguel Saez, Nayra Merino de Paz, Patricia Contreras Ferrer, Mar Pestana Eliche, Antonio Noda Cabrera Dermatology Department, Faculty of Medicine Ofra s/n, 38315 La Laguna, Spain It is generally believed that in dermatological practice, which takes place mainly in an outpatient setting, patients referred as “emergencies” are not usual. However, whether due to long waiting lists or to the poor level of health education among [...]

Successful Response to Topical Tacrolimus for a Granuloma Faciale in an Elderly Patient

plaques, papules or nodules over the dorsa of joints, and GF usually appears as one or a few plaques on the face. In addition, eosinophils and plasma cells are prominent in GF, whereas neutrophils are plentiful in erythema elevatum diutinum [1] . GF is often quite resistant to therapy [2–6] . Topical calcineurin inhibitors may represent a useful alternative to topical corticosteroids for the treatment of a number of other inflammatory skin diseases different from atopic dermatitis [7] . We report a 90-year-old male patient without remarkable medical history who presented to our department with an asymptomatic lesion on the nasal tip. This lesion had been present for 6 months, and gradual enlargement had been observed. Physical examination revealed an oval, well-delimited, reddish yellow plaque, 2.5 ! 1.5 cm in size, with a smooth and brilliant surface. Focal telangiectasia and follicular openings were also found ( fig. 1 ). A biopsy specimen was obtained which showed a dense dermal polymorphous inflammatory infiltrate with neutrophils, lymphocytes, plasma cells and numerous eosinophils. A narrow grenz zone and a mild fibrosis area were also found. With these histological findings, a diagnosis of GF was made. Therapy with topical 0.1% tacrolimus ointment twice daily was started after he had not responded to the application of topical corticosteroids. Treatment was stopped after 3 months with remission lasting for 1 year. Only slight reddish coloration at the edges of the lesion remained ( fig. 2 ). No burning sensation was noted.

Atypical molluscum contagiosum.

JEADV 2006, 20 , 461–488