Norberto López-Navarro

Erosive pustular dermatosis of the scalp: a successful treatment with photodynamic therapy.

Erosive pustular dermatosis of the scalp (EPDS) is a rare inflammatory disease of unknown aetiology that usually occurs in the elderly. It is characterized by sterile pustules, chronic crusted erosions, cicatricial alopecia, and skin atrophy. The histopathology is nonspecific, and its pathophysiology remains undetermined, with various types of local trauma possibly acting as the triggering factor. We describe a case of EPDS in a 75‐year‐old female in whom there was a marked response to photodynamic therapy with methyl 5‐aminolaevulinic acid.

Chronology of Metastasis in Cutaneous Melanoma: Growth Rate Model

In humans, it is not possible to obtain experimental evidence of when a cancer begins to metastasize. The purpose of this study was to estimate the time of onset of metastatic dissemination in cutaneous melanoma using a model based on its growth rate (GR). The critical time of onset of metastatic dissemination below which no cases of fatal melanomas were seen may be described with a potential function in which this time is inversely proportional to the GR. The critical time of development beyond which a melanoma may metastasize presents great variation. This time was just 1 month for those melanomas with a fast GR, whereas it was over 5 years for those with a very slow GR. Quantitatively, the fastest-growing melanomas began metastasizing with a greater thickness than the slowest-growing melanomas. A correlation exists between the critical time of onset of metastatic potential and the GR of the melanoma. These results may well have relevance to the understanding of mechanisms of tumor dissemination and for the design of future studies on melanomas, irrespective of whether they are basic studies on biomolecular mechamisms or clinical studies.

Subcutaneous sarcoidosis: a predictor of systemic disease?

Sarcoidosis is a multisystem granulomatous disorder of unclear origin [1]. The diagnosis is well established when clinical and radiological findings are supported by histological evidence of noncaseating granulomas in one or more tissues [2]. Skin lesions are heterogeneous and classified as specific and nonspecific on the basis of the presence or absence of sarcoidal granulomas, respectively [3]. The objective of the present study was to review our patients with subcutaneous sarcoidosis in order to evaluate their clinicopathological features and its correlation with a systemic involvement. Our study included the patients with subcutaneous sarcoidosis diagnosed from 2008 to 2010 at the University Hospital of Virgen de la Victoria (Málaga, Spain). The diagnosis of subcutaneous sarcoidosis was made on the basis of histological demonstration of noncaseating granulomas involving hypodermis. Other granulomatous diseases were excluded by special stains for microorganisms as PAS, Fite-Faraco, Gram, Ziehl-Neelsenandmethenaminesilver.Weexaminedat least six sections before declaring negative for mycobacterial infections. None of the cases studied showed evidence of micro-organism (bacterial, fungal or mycobacterial) on tissue culture. In addition, all the cases were negative for extraneous material on polarization microscopy of routine sections. Upon diagnosis of subcutaneous sarcoidosis was performed in all patients a chest radiograph and laboratory including complete blood count, calcium, angiotensin converting enzyme (ACE) and creatine kinase (CK). The patient follow-up was conducted by internal medicine and dermatology for 1 year. The diagnosis of systemic

Keratosis lichenoides chronica: response to photodynamic therapy.

Keratosis lichenoides chronica (KLC) is a rare, acquired disorder of keratinization of unknown aetiology. The disease has a chronic and progressive course and is characterized by a poor response to almost all topical treatments and most systemic regimens. We report the first case of KLC in which there was a marked response in localized areas to photodynamic therapy (PDT) with methyl 5‐aminolaevulinic acid (ALA).

Gemcitabine therapy-associated cutaneous vasculitis with a polyarteritis nodosa-like pattern

1 Cohen PR, Grossman ME, Silvers DN, Kurzrock R. Tripe palms and cancer. Clin Dermatol 1993; 11: 165–173. 2 Moore RL, Devere TS. Epidermal manifestations of internal malignancy. Dermatol Clin 2008; 26: 17–29. 3 Cohen PR, Kurzrock R. Malignancy-associated tripe palms. J Am Acad Dermatol 1992; 27: 271–272. 4 Mullans EA, Cohen PR. Tripe palms: a cutaneous paraneoplastic syndrome. South Med J 1996; 89: 626–627. 5 Khaled A, Abdallah MB, Tekaya R, et al. Tripe palms with oligoarthritis, two rare paraneoplastic syndromes heralding a small cell lung cancer. J Eur Acad Dermatol Venereol 2009; 23: 579–580.

Successful treatment of perforating granuloma annulare with 0.1% tacrolimus ointment

Perforating granuloma annulare (PGA) is a rare subtype of granuloma annulare (GA) named in 1971 by Owens and Freeman. It is characterized by necrobiotic areas surrounded by histiocytes and lymphocytes with transepidermal elimination. Many treatments for PGA have been used, often with unsatisfactory results. Tacrolimus in its topical formulation has been established as a safe and effective alternative to topical corticosteroids because of its mild side effects and its minimal systemic absorption. Topical tacrolimus has been approved for the treatment of atopic dermatitis; moreover, ample data exist which demonstrate the usefulness of tacrolimus for the specific treatment of other inflammatory diseases. We report a 70‐year‐old diabetic woman with PGA, in whom the ulceration due to PGA responded to 0.1% topical tacrolimus.

Human immunodeficiency virus (HIV)-associated eosinophilic folliculitis and follicular mucinosis in a black woman.

Our patient is a 35-year-old woman from Nigeria but living in Spain for a year, HIV diagnosed for 5 months, and had a 4-month history of a pruritic papular recurrent eruption, distributed mainly on the face and thorax. The eruption first appeared on the head as pruritic pustules and gradually progressed to involve the neck, upper chest, and back (Fig. 1a–b). At the time of consultation she was receiving emtricitrabina, tenofovir, lopinavir, and ritonavir; her CD4 count was 300 cells/mm and plasma HIV RNA of 48145 copies/ml. There was no history of previous medication. Hematological, biochemical, immunological, and urine analysis were within normal limits. Histopathologic examination of two biopsies obtained from the back and from the forehead showed similar findings. There was a prominent superficial and deep mixed inflammatory infiltrate with numerous eosinophils and follicular eosinophilic spongiosis. Pustulosis involving the infundibular region of the hair follicle was observed. The infiltrate extends into the sebaceous glands (Fig. 2a). The epidermis was eroded and covered by a scale crust. Striking feature was the follicular deposit of mucinous material stained positive with alcian blue at pH 2.5 and colloidal iron (Fig. 2b). A Gram and PAS stain showed no microorganisms. Microbiological examination and culture of swabs from pustules revealed no bacteria or fungi. Based on the clinical and histological findings, a diagnosis of HIV-associated eosinophilic folliculitis (HIV-EF) with follicular mucinosis (FM) was made. The patient was treated with oral antihistamines, minociclina (100 mg/d) and topical corticosteroid. All lesions had resolved by the time of her 3-month follow-up evaluation; the patient is now under narrow band UVB therapy for mild pruritus just on the trunk. Eosinophilic folliculitis as a clinical entity is a heterogeneous group of disorders that broadly fall into three main forms, namely, Ofuji’s disease, HIV-EF and eosinophilic folliculitis of infancy. HIV-EF is a pruritic, follicular eruption that typically develops in the setting of abnormal 1308

Treatment of actinic cheilitis with methyl aminolevulinate photodynamic therapy and light fractionation: a prospective study of 10 patients

Actinic cheilitis (AC) is a common disorder of the lower lip caused by chronic ultraviolet radiation exposure and smoking. Numerous studies have reported good clinical and histologic response in patients with AC treated with photodynamic therapy (PDT) with 5-aminolevulinic acid and its methyl ester, methyl aminolevulinate (MAL) [1-4]. Described treatment schemes require several sessions held on different days but fractionated illumination, with 2 light doses delivered in the same day, which is described [...]