Mónica García-Arpa

Hiperplasia epitelial focal

Focal epithelial hyperplasia is a rare disease of the oral mucosa caused by the human papilloma virus (HPV). It appears as a benign epithelial growth, usually in the mucosa of the lower lip. It is mainly associated with HPV serotypes 13 and 32 and there is a clear racial predilection for the disease in Native Americans and Eskimos. We describe the case of a 17-year-old girl from Ecuador with multiple papular lesions in both lips that were clinically and histologically consistent with focal epithelial hyperplasia. Analysis by polymerase chain reaction detected HPV serotype 13.

Telemedicine and Teledermatology (I): Concepts and Applications

Telemedicine refers to the use of telecommunications technology to provide health care and medical information. The practice of medicine--and dermatology in particular--is undergoing a great upheaval due to advances in information technology. This article briefly reviews the origin, development, applications, benefits, methodology, and components of telemedicine. Specifically, we will analyze the types and applications of teledermatology, paying particular attention to technical, organizational, and legal aspects.

Metástasis digital acral

Cutaneous metastases are infrequent and in some cases represent the first manifestation of an unknown neoplasm. Acrally located metastases are particularly rare, and the prognosis is very poor, with a survival time of only a few months. Although the clinical presentation varies, they are generally confused with an infectious or inflammatory process, which delays diagnosis. When they are located on the fingers, the most frequent cause is lung carcinoma, while those located on the toes are usually due to tumors in the genitourinary tract. The histology of the metastasis is similar to that of the primary tumor, although less differentiated. In most acrometastases, first the bone and then the skin are affected. Treatment is palliative. We present the case of a patient with a metastasis on the big toe as an initial sign of a previously unknown lung tumor.

Focal epithelial hyperplasia

Focal epithelial hyperplasia is a rare disease of the oral mucosa caused by the human papilloma virus (HPV). It appears as a benign epithelial growth, usually in the mucosa of the lower lip. It is mainly associated with HPV serotypes 13 and 32 and there is a clear racial predilection for the disease in Native Americans and Eskimos. We describe the case of a 17-year-old girl from Ecuador with multiple papular lesions in both lips that were clinically and histologically consistent with focal epithelial hyperplasia. Analysis by polymerase chain reaction detected HPV serotype 13.

Tratamiento tópico con cantaridina de moluscos contagiosos

Resumen —Introduccion. El molusco contagioso es una infeccion viral comun para la que no se dispone de terapia antiviral especifica. Los tratamientos con curetaje o crioterapia resultan muy efectivos, pero el dolor y el trauma emocional que ocasionan limitan su uso. En 1998, la Food and Drug Administration (FDA) reincluyo la cantaridina entre las terapias aplicables por el dermatologo en consulta. No hay publicaciones relativas al uso de cantaridina en los paises europeos. Material y metodos En 2001 fueron tratados en nuestra unidad 28 pacientes con molusco contagioso aplicando cantaridina al 0,7 % en colodion flexible. Resultados Se incluyeron 28 pacientes, 15 mujeres y 13 varones, entre 3 y 43 anos de edad, con dos grupos bien diferenciados: 21 con menos de 12 anos (media: 6) y siete con mas de 20 (media: 29). El tiempo de evolucion oscilo entre 3 semanas y 2 anos, con una media de 5,7 meses. El numero total de lesiones oscilo entre 1 y 53, con una media de 16 lesiones. Las localizaciones mas frecuentes fueron el tronco (11 casos) y las extremidades (en ocho las superiores y en ocho las inferiores). Hubo 6 casos con lesiones en genitales- ingles, cuatro en las axilas y tres en la cara y el cuello. Dos pacientes se perdieron en el seguimiento, y los 26 restantes se curaron, para lo que precisaron entre uno y cinco tratamientos (media: 1,96). Doce pacientes (46 %) necesitaron una unica sesion de tratamiento con cantaridina; ocho (31 %), dos sesiones, y seis (23 %), tres o mas. El 89 % (26/29) presento como efecto secundario vesiculacion y el 73 % (19/26), inflamacion, que fue generalmente leve (14/19); tambien fueron comunes el prurito (9/29), el dolor leve (molestia en 10/29) y la hipopigmentacion (10/29) que aparecieron en el 33 % de los casos. El grado de satisfaccion fue alto o muy alto en el 88 % (23/26) para los pacientes, en el 87 % (20/23) para los padres y en el 81% (22/27) para el medico. En ningun caso fue bajo o muy bajo. Conclusiones La cantaridina constituye una alternativa eficaz y segura en el tratamiento del molusco contagioso, cuya principal ventaja frente a la crioterapia y el curetaje es la ausencia de molestias en el momento de la aplicacion.

Juvenile mycosis fungoides treated with bexarotene and PUVA

A 14‐year‐old Caucasian boy presented with a 4‐month history of a slightly pruritic eruption that began on the hips and later extended to the trunk and upper and lower limbs. The patient did not present fever, weight loss, or asthenia.

Casos clínicosAngiomixoma superficialSuperficial angiomyxoma

Superficial angiomyxomas are clinically variable, infrequent, benign skin lesions. They are usually located on the trunk, but can also appear on the lower limbs, head and neck. They are diagnosed histologically, and are characterized by the fact that they are poorly delimited, multinodular tumors, and by the presence of interstitial myxoid material with scanty cellularity. Treatment is through surgery, and local recurrence is possible. An associated Carneys complex must always be ruled out with superficial angiomyxoma. We present the case of a woman with a solitary, fast-growing superficial angiomyxoma.

Xantomas planos normolipémicos y micosis fungoide

Diffuse normolipemic plane xanthomas are characterized by the presence of yellowish plaques on the eyelids, neck, upper trunk, buttocks and flexures. Histology shows foamy histiocytes in the dermis. Approximately half of all cases are associated with hematological disorders. On rare occasions, they have been described in the context of cutaneous T-cell lymphomas. We present the case of a female patient with tumor-stage mycosis fungoides who developed normolipemic plane xanthomas coinciding with the appearance of new lymphoma lesions. We review English-language literature regarding the rare association of xanthomas and cutaneous T-cell lymphomas.

Celulitis atípica asociada a bacteriemia por Campylobacter jejuni en un paciente con hipogammaglobulinemia ligada al cromosoma X

Resumen —Un paciente varon de 18 anos de edad, con antecedentes de agammaglobulinemia ligada al cromosoma X o de Bruton, presento simultaneamente lesiones atipicas de celulitis, en ambas piernas y brazo izquierdo, y bacteriemia por Campylobacter jejuni, sin sintomatologia intestinal previa. Tanto C. jejuni como los bacilos del genero Helicobacter o Flexispira deben ser considerados causa de septicemias/bacteriemias, celulitis, abscesos, uveitis, artritis y osteomielitis en pacientes con cualquier tipo de inmunodeficiencia, incluida la agammaglobulinemia ligada al X.

Atypical linear toxicodermia by sorafenib

Atypical linear toxicodermia by sorafenib Dear Sir, Sorafenib (Nevaxar ) is an oral drug approved for use in advanced renal cell carcinoma and hepatocellular carcinoma. It is a multikinase inhibitor as well as imatinib, desatinib, nilotinib, and sunitinib. This drug shows anti-mitotic and anti-angiogenic properties. Moderate to severe adverse drug reactions to sorafenib occur particularly with cardiovascular (hypertension) and gastrointestinal systems (diarrhea, anorexia, weight loss, and abdominal pain), and skin is frequently affected. We report the case of a patient with atypical cutaneous reaction to sorafenib. A 37-year-old woman was diagnosed with Wilson disease and multiple hepatocellular carcinomas five years ago. She received treatment with D-penicilamide and chemoembolotherapy, and recently, sorafenib 400 mg bid (twice daily) for the last 2 weeks. Suddenly, she developed an itchy eruption on her right arm. Physical examination revealed a linear plaque constituted by erythematoviolaceous lichenoid papules, 0.5 cm in diameter. Both porcelain-like center lesions and necrotic papules were noticed (Fig. 1). We obtained two cutaneous biopsies (one from a lichenoid papule and other from a white papule) with similar findings. Histologic images showed extensive epidermic parakeratosis, and interphase dermatitis with necrotic queratinocites, apoptotic bodies, with lymphoid infiltrate in dermoepidermal junction, and scattered eosinophils. It was compatible with toxicodermia (Fig. 2). Furthermore, the patient presented intense bilateral palpebral edema and severe gastrointestinal symptoms (diarrhea, nausea, and vomiting) attributable to sorafenib, so the drug was discontinued. Two weeks later, the skin lesions had disappeared without treatment, but left a residual pigmentary linear macule or plaque. Sorafenib inhibits the kinasa activities of both c-RAF and b-RAF. Several side effects have been reported such as hypertension, diarrhea, fatigue and cutaneous lesions. The inhibition of tyrosine-kinase receptors widely expressed in the skin structures results in a wide range of cutaneous side effects. These skin reactions are usually taken as a positive indicator of drug efficacy. There are several well-known cutaneous adverse effects, normally light to moderate reactions, and only 17% are severe. The largest prospective study of cutaneous adverse effects of sorafenib is reported by Autier et al., with 43 patients receiving sorafenib and 42 placebos. The most frequent skin adverse effects are: subungueal splinter hemorrhages (70%), hand-foot skin reaction (60%) (erythrodysesthesia, erythema, hyperkeratosis, and scars), facial and scalp reaction (63%) (erythema facial, palpebral edema, and seborreic dermatitis), scalp dysesthesia (49%) and alopecia (44%). Later, Robert et al present a 1214 Figure 1 Linear lesion with erythematous and violaceous lichenoid papules on her right arm Figure 2 Histological section shows an extensive epidemic parakeratosis, and interphase dermatitis with apoptotic bodies (hematoxylin-eosin 40·)