Manuel Ángel Rodríguez-Prieto

Efficacy of intralesional photodynamic therapy for the treatment of hidradenitis suppurativa

prurituseif so, many patients who have suffered long and hard may receive a treatable diagnosis instead. The precise origin of BRP-triggered generalized pruritus remains unclear. Given that BRP is associated with cervical nerve impingement or damage, it is highly likely that other spinal nerves in the thoracic, lumbar, and sacral regions may be similarly affected. Generalization or expansion of itch in patients with BRP may also be very similar to chronic neuropathic pain, which can start localized and spread to become a more generalized phenomenon. Damage to spinal pain-transmitting neurons and central sensitization processes may be underlying mechanisms. Central sensitization may also be an important mechanism in the generalization of itch in BRP. Specifically, constant cervical nerve irritation and neuropathic damage may lead to spontaneous firing of damaged neurons. This increased signal could then amplify itch-specific messages in the spinal cord and brain and result in itch that generalizes outside of the affected dermatomal innervation pattern. Although the precise cause of BRP-triggered generalized pruritus is unknown, central nervous system mechanisms are probably involved. Thus, the use of neuroactive drugs, such as gabapentin and pregabalin, may be particularly helpful in the management of BRP-triggered generalized pruritus. In summary, our findings suggest that BRPtriggered generalized pruritus should be a diagnostic consideration in patients who present with generalized pruritus of otherwise undetermined origin.

Lymphomatoid dermatitis caused by contact with textile dyes

Lymphomatoid contact dermatitis, described by Gómez Orbaneja in 1976, is defined as a particular form of chronic, persistent contact dermatitis, with clinical and histological features resembling those of mycosis fungoides (1). There are localized forms, consisting of lesions in the areas of contact with the allergen, and generalized forms, characterized by generalized, spaced eczematous lesions, sometimes with evolution towards erythroderma, and often resistant to different treatments (2). There are descriptions of cases related to different allergens, such as phosphorus, p-tert-butylphenol-formaldehyde resin, p-phenylenediamine (PPD), ethylenediamine, nickel, cobalt, and gold (3). The hypothesis is that an antigenic stimulus produces an accumulation of activated lymphocytes. This stimulus, maintained over time, produces clonal selection and lymphoid proliferation, possibly leading to transformation into blast cells that may develop into a true cutaneous lymphoma (4). We present the first case of lymphomatoid dermatitis caused by contact with textile dyes.Lymphomatoid contact dermatitis, described by Gómez Orbaneja in 1976, is defined as a particular form of chronic, persistent contact dermatitis, with clinical and histological features resembling those of mycosis fungoides (1). There are localized forms, consisting of lesions in the areas of contact with the allergen, and generalized forms, characterized by generalized, spaced eczematous lesions, sometimes with evolution towards erythroderma, and often resistant to different treatments (2). There are descriptions of cases related to different allergens, such as phosphorus, p-tert-butylphenol-formaldehyde resin, p-phenylenediamine (PPD), ethylenediamine, nickel, cobalt, and gold (3). The hypothesis is that an antigenic stimulus produces an accumulation of activated lymphocytes. This stimulus, maintained over time, produces clonal selection and lymphoid proliferation, possibly leading to transformation into blast cells that may develop into a true cutaneous lymphoma (4). We present the first case of lymphomatoid dermatitis caused by contact with textile dyes.

Penetration of 630 nm laser and 5-aminolevulinic acid in tissue with intralesional photodynamic therapy

Photodynamic therapy is a common treatment in dermatology for several diseases, its main limitation is the penetration of topical photosensitizer and light in the tissue. However intralesional photodynamic therapy is a new technique where the photosensitizer and sometimes a 630nm laser beam are applied inside the lesión, so it allows achieve deeper penetration. It has been used to treat basal cell carcinoma, hidradenitis suppurativa or keloids.

Descripción de los pacientes intervenidos mediante cirugía de Mohs en España. Datos basales del registro español de cirugía de Mohs (REGESMOHS)

INTRODUCTION The Spanish registry of Mohs micrographic surgery started collecting data in July 2013. The aim of the registry is to report on the use of this technique in Spain and the outcomes achieved. In the present article, we describe the characteristics of patients and the tumors treated. MATERIAL AND METHODS This is a prospective cohort study of patients treated with Mohs micrographic surgery. The participating centers are hospitals where at least one intervention of this type is performed each week. All patients considered for Mohs micrographic surgery in participating centers are included in the registry except those who have been declared legally incompetent. RESULTS Between July 2013 and October 2014, data from 655 patients were included in the registry. The most common tumor involved was basal cell carcinoma, and the most common histological subtype was infiltrative basal cell carcinoma. Most of the tumors treated were located on the face or scalp, and the most common site was the nose. Almost 40% of the tumors treated were recurrent or persistent, and preoperative tumor size was similar to that reported in other European studies and in Australia. In total, 45.5% of patients had received previous surgical treatment. CONCLUSION The findings are similar to those reported in other studies, and the data collected are useful for assessing whether the results of studies carried out elsewhere are applicable in Spain.

Contact allergy to benzyl salicylate

Benzyl salicylate (benzyl-o-hydroxybenzoate; CAS no. 118-58-1) is a substance present in natural oils, including ylang ylang (Cananga odorata) and Dianthus caryophyllus Flower Oil (CAS no. 89958-29-2) (1, 2). It is a common ingredient in many perfumes for its fragrance and preservative properties, and is also found in numerous cosmetic and toiletry products, household cleaners, and detergents (2). According to current European regulations (EC No. 1223/2009), the presence of the substance must be indicated in the list of ingredients of the products that contain it (3).

Descripción de las intervenciones quirúrgicas recogidas en el registro español de cirugía de Mohs (REGESMOHS) (2013-2015)

INTRODUCTION The Spanish Mohs Surgery Registry is used to collect data on the use and outcomes of Mohs micrographic surgery (MMS) in Spain. The aim of this study was to describe perioperative and intraoperative data recorded for MMS procedures performed between July 2013 (when the registry started) and January 2016. MATERIAL AND METHODS Prospective cohort study of data from 18 hospitals. The data collected included type of anesthesia, surgical technique, hospital admission, number of Mohs stages, management of preoperative risk factors, additional treatments, previous treatments, type of tumor, operating time, and complications. RESULTS Data were available for 1796 operations. The most common tumor treated by MMS was basal cell carcinoma (85.96%), followed by squamous cell carcinoma (6.18%), lentigo maligna (2.81%), and dermatofibrosarcoma protuberans (1.97%). Primary tumors accounted for 66.9% of all tumors operated on; 19.2% of tumors were recurrent and 13.9% were persistent. The most common previous treatment was surgical. MMS was mostly performed under local anesthesia (86.7% of cases) and as an outpatient procedure (71.8%). The frozen section technique was used in 89.5% of cases. One stage was needed to achieve tumor-free margins in 56.45% of patients; 2 stages were required in 32.1% of patients, 3 in 7.1%%, 4 in 2.7%, and 5 or more in 1.8%. The defect was reconstructed by the dermatologist in 98% of patients and the most common technique was flap closure (47.2%). Intraoperative complications were recorded for just 1.62% of patients and the median (interquartile range) duration of surgery was 75 (60-100) minutes. CONCLUSION The characteristics of the patients and tumors treated by MMS are similar to those reported for similar studies in other geographic areas. Lentigo maligna and dermatofibrosarcoma protuberans accounted for a higher proportion of cases in our series, and repair of the surgical defect by a dermatologist was also more common. Operating times in MMS are not much longer than those reported for other procedures and the rate of intraoperative complications is very low.

Titanium mesh in reconstructive surgery of the nasal pyramid. Follow-up of our 11 initial cases

Titanium mesh has been employed in neurosurgery, plastic surgery, and maxillofacial surgery as a bone replacement in diverse conditions. We first reported on its use as a substitute for osteocartilaginous nasal structure with satisfactory functional and aesthetic results in 2009.

A morbilliform variant of linear IgA dermatosis: a new case

Linear IgA dermatosis (LAD) is a rare disease characterized by the presence on direct immunofluorescence of a linear band of IgA along the basement membrane zone. Although the cause is usually idiopathic, certain drugs have been known to induce LAD, most commonly vancomycin. The clinical presentation is variable, mimicking various autoimmune blistering diseases, erythema multiforme, or toxic epidermal necrolysis. Recently a new variant has been described as a morbilliform drug eruption that lacks blistering.

Tunnelized Preauricular Transposition Flap for Reconstruction of Anterior Auricular Defects

Actas Dermosifiliogr. 2008;99:157-69 161 To the Editor: Reconstruction of the anterior aspect of the auricle of the ear after oncologic surgery is often complicated and requires imagination when planning the surgical technique. The techniques usually used are direct suture, grafts, second-intention healing, and postauricular pedicle flaps, in particular the “revolving door” flap.1 We describe an ingenious preauricular transposition flap that is situated in the defect through an incision in the posterior aspect of the antihelix. The patient was an 81-year-old man with a history of chronic bronchitis who was seen for extensive lesions on the anterior and posterior aspects of the auricle of the ear that were clinically and histologically compatible with squamous cell carcinoma and had been present for more than 1 year. We performed excision of both lesions including the perichondrium and respecting the cartilage; the defects were repaired using 2 preauricular and postauricular transposition flaps. We first marked the flaps on the skin and then administered local anesthesia (bupivacaine with epinephrine) using the circumferential technique, infiltrating the whole circumference of the auricle starting at the lobule. For reconstruction of the defect of the antihelix, we designed a transposition flap using the preauricular region. The surface that was to be interposed in the auricular area was de-epithelialized (Figure 1). The flap was dissected above the superficial temporal vessels and passed through an incision on the posterior aspect of the antihelix to situate it over the defect (Figure 2). Finally, we used silk to suture the flap and preauricular region (Figure 3). For reconstruction of the posterior defect, we designed a rotational postauricular flap that was dissected and sutured to the defect. Surgery to the auricle of the ear is complex, particularly when the disorder affects the anterior aspect, which is more visible and therefore requires better esthetic results; this is even more complex if there is a second tumor on the same auricle. When the tumor is situated on the antihelix, reconstruction depends on the size of the resulting defect and on whether cartilage or perichondrium has been excised. Small defects can be sutured directly, sacrificing the helix, or if the perichondrium is intact, by secondintention healing or a graft. In defects of more than 1 cm that do not involve the perichondrium, we use these same techniques; if cartilage has been excised, postauricular flaps are used either as a revolving door island flap or as a transposition flap in 2 stages.2,3 In our case, we describe a novel flap that, in a single surgical procedure, provides skin with a similar color and texture to the defect. The flap is well vascularised and has a good consistency and can be used for defects with or without alterations of the cartilage and perichondrium, particularly when we cannot use postauricular flaps or grafts. Tunnelized Preauricular Transposition Flap for Reconstruction of Anterior Auricular Defects

Papilomatosis confluente y reticulada de Gougerot-Carteaud: respuesta al tratamiento con minociclina

Resumen —La papilomatosis confluente y reticulada es una enfermedad poco frecuente, de etiologia desconocida. Clinicamente se caracteriza por presentar multiples papulas confluentes, marrones, de localizacion intermamaria e interescapular, y que posteriormente se extienden perifericamente con un patron reticulado. Se presenta el caso clinico de un paciente afectado que se resolvio completamente tras el tratamiento con minociclina.