Noemi Guillermo

Dermatologists in hospital wards: an 8-year study of dermatology consultations.

Background: The value of dermatologists as consultants is increasing. Objective: To evaluate the activity of dermatologists as inpatient consultants. Methods: Retrospective study of consultations to Dermatology of inpatients, visits per consultation, referral service, procedures performed, delay until visit and diagnoses based on ICD-9. Results: 3,144 requests generated 4,824 visits, 200 biopsies, 107 cultures and other procedures. The mean delay between request and visit was 0.75 days. The requesting service was recorded in 3,097 cases: 21.5% by Internal Medicine, 11.4% by Pediatrics, 8.3% by Neurology and 6.2% by the Infectious Diseases Unit. Follow-up was recommended in 12.4% by the Dermatology Service and in 8% by a dermatologist. Reliable diagnoses were recorded for 2,832 consultations. The most frequent diagnostic groups were diseases of the skin and subcutaneous tissue (ICD-9: 680–709) in 58%, infectious and parasitic diseases (ICD-9: 001–139) in 20%, and neoplasm (ICD-9: 140–239) in 5.7%. The most frequent diagnoses were contact dermatitis (ICD-9: 692.X) in 8.9%, drug reactions (ICD-9: 693.0) in 7.4%, candidiasis (ICD-9:112.X) in 7.1% and seborrheic dermatitis (ICD-9: 690) in 5.3%. Conclusions: Most diagnoses were of a specific cutaneous disease and the dermatologist would be in the best position to evaluate those that inpatients acquire.

Bilateral areolar sebaceous hyperplasia in a female.

References 1 http://www.MedIndia.com/origin of yoga 2006. 2 Kahana M, Cohen M, Ronnen M, et al. Prayer nodules in Moslem men. Cutis 1986; 38: 281–282. 3 Roberts PJ, Katsimihas M, Wade RH. An interesting behavioural injury. Mecca Foot Foot Ankle Surg 2001; 7: 49–50. 4 Robertson JA. The hidden romance of the New Testament. http://www.katapi.org.uk/NTHiddenR/X.htm 2003. 5 Wollina U. Physikalisch und chemisch bedingte Erkrankungen [Physically and chemically induced diseases]. In: Braun-Falco O, Plewig G, Wolff HH, Burgdorf WHC, et al. eds. Dermatologie und Venerologie, 5th edn. Berlin, Heidelberg: Springer, 2005: 571–585.

Leflunomide in the Treatment of Palmoplantar Pustulosis

In 1995, a 30-year-old woman presented with a 6-day history of fever and pruritic pustules on her left hand. Physical examination revealed confluent pustules surrounded by erythema on the dorsal aspect of the left hand, palm, and wrist (Figure 1). There were no lesions in other locations. Her medical history was otherwise unremarkable. A complete laboratory blood cell count showed a slightly low white blood cell count (3600/μL [reference range, 4500-10 800/μL]; to convert to 10/L, multiply by 0.001). Findings from biochemical tests were within reference range. Cultures of the pustules were negative for organisms. Findings from skin biopsy specimens showed an intraepidermal pustule with mild acantholysis and moderate mononuclear infiltrate in dermis. A diagnosis of localized pustulosis was made. The patient was initially treated with topical and oral antibiotics with poor response. After a month, oral retinoids and topical steroids were added to her treatment, but the patient experienced new flares. Seven months after the onset of the process, she complained about arthralgias and chest and back pain. Imaging studies (radiography, computed axial tomography) revealed sacroileitis. A diagnosis of incomplete SAPHO syndrome (sacroileitis, acne, pustulosis, hyperostosis, osteitis) was made. Therapy was begun with methotrexate, 7.5 mg/wk, and the dosage was subsequently increased to 10 mg/wk. Two months later there was no improvement, so oral cyclosporine was added to her drug regimen but was poorly tolerated because of headache. During the following 4 years the patient subsequently failed treatment with sulfone, prednisone, colchicine, sulfasalazyn, and numerous nonsteroidal antiinflammatory drugs (NSAIDs).

Refractory Subacute Cutaneous Lupus Erythematosus With a Response to Efalizumab

Actas Dermosifiliogr. 2009;100:719-40 734 5. Gurrieri F, Franco B, Toriello H, Neri G. Oral-facial-digital syndromes: review and diagnostic guidelines. Am J Med Genet. 2007;143:3314-23. 6. Rimoin DL, Edgerton MT. Genetic and c linical heterogeneity in the oral-facial-digital syndrome. J Pediatr. 1967;71:94-102. 7. Anneren G, Arvidson B, Gustavson KH, Jorulf H, Carlsson G. Oral-facial-digital syndrome I and II: radiological methods for diagnosis and the clinical variations. Clin Genet.1984;26:178-86. 8. Sabato A, Fabris A, Oldrizzi L, Montemezzi S, Maschio G. Evaluation of a patient with hypertension and mild renal failure in whom facial and digital abnormalities are noted. Nephrol Dial Transplant. 1998;13:763-6.

Lupus eritematoso cutáneo subagudo refractario con respuesta a efalizumab

Actas Dermosifiliogr. 2009;100:719-40 734 5. Gurrieri F, Franco B, Toriello H, Neri G. Oral-facial-digital syndromes: review and diagnostic guidelines. Am J Med Genet. 2007;143:3314-23. 6. Rimoin DL, Edgerton MT. Genetic and clinical heterogeneity in the oral-facial-digital syndrome. J Pediatr. 1967;71:94-102. 7. Anneren G, Arvidson B, Gustavson KH, Jorulf H, Carlsson G. Oral-facial-digital syndrome I and II: radiological methods for diagnosis and the clinical variations. Clin Genet. 1984;26:178-86. 8. Sabato A, Fabris A, Oldrizzi L, Montemezzi S, Maschio G. Evaluation of a patient with hypertension and mild renal failure in whom facial and digital abnormalities are noted. Nephrol Dial Transplant. 1998;13:763-6. 9. Berk DR, Bayliss SJ. Milia: a review and classification. J Am Acad Dermatol. 2008;59:1050-63. 10. Larralde de Luna M, Raspa ML, Ibargoyen J. Oral-facial-digital type 1 syndrome of Papillon-Leage and Psaume. Pediatr Dermatol. 1992;9:52-6.

Disseminated Crusted Papules in a Newborn

The patient was a 1-month-old girl with a good general state, born after an uncomplicated pregnancy and delivery, and with no family or personal history of interest. The patient was referred to us for the presence of crusted lesions on the scalp since birth. These lesions had spread onto the trunk, axillas, and buttocks. The patient presented generalized, crusted, sometimes honey-colored, erythematous papules that were not infiltrated. The majority were situated on the scalp, axillas, upper part of the back, buttocks, and abdomen. There were also a number of residual lesions (Figure 1). Histopathology The pathologic study revealed parakeratosis in the epidermis and a band infiltrate that blurred the dermal-epidermal junction and that was formed of homogeneous, round, histiocytic cells, some with reniform nuclei, and with infrequent mitoses. There were occasional eosinophils (Figure 2). The histiocytic cells were positive for S100 protein and CD1a (Figure 3).

Pápulas costrosas generalizadas en una recién nacida

Nina de un mes de edad con buen estado general, fruto deun embarazo y parto sin complicaciones, y sin antecedentesfamiliares ni personales de interes. Nos fue remitida porpresentar desde el nacimiento lesiones costrosas en el cue-ro cabelludo que se habian ido extendiendo al tronco, lasaxilas y las nalgas.