P. Herranz-Pinto

Prepubertal hidradenitis suppurativa successfully treated with botulinum toxin A.

Hidradenitis suppurativa (HS) is a recurrent scarring suppurative disease of the apocrine gland-bearing areas of the body that usually affects the intertriginous areas. Prepubertal HS is a rare condition; fewer than 2% of patients have onset of the disease before the age of 11. Management of HS, in children and adults, may be difficult because of its chronic nature and lack of response to standard therapeutic options, and there is little evidence of the efficacy of the different treatments in randomized clinical trials or after long-term followup. Among all therapies, botulinum toxin A (BTX) has been regarded as effective for isolated case reports of adult-onset HS. Recently, we succeeded in treating a case of prepubertal HS with BTX, which to our knowledge has not previously been described.

Efficacy of botulinum toxin in pachyonychia congenita type 1: report of two new cases

Pachyonychia congenita (PC) is a rare genodermatosis caused by a mutation in keratin genes, which can lead to hypertrophic nail dystrophy and focal palmoplantar keratoderma (predominantly plantar), amongst other manifestations. Painful blisters and callosities, sometimes exacerbated by hyperhidrosis, are major issues that can have a significant impact on patient quality of life. Many alternative treatments for this condition have been applied with variable and partial clinical response, but a definitive cure for this disease has yet to be discovered. After obtaining informed consent, two patients with genetically confirmed PC type 1 were treated with plantar injections of botulinum toxin type A. Both patients showed a marked improvement in pain and blistering with an average response time of one week, a six‐month mean duration of effectiveness, and a lack of any side effects or tachyphylaxis.

Diffuse Reactive Angioendotheliomatosis Secondary to the Administration of Trabectedin and Pegfilgrastim.

Abstract:Diffuse dermal angiomatosis is a rare benign condition considered a variant of reactive angioendotheliomatosis, usually related to vascular disease such as arteriovenous fistula or severe peripheral vascular disease. The most frequent clinical manifestations range from a solitary erythematous patch to an indurated plaque that may ulcerate. A clinical case of a 60-year-old woman who developed generalized livedoid lesions 2 days after the administration of intravenous trabectedin and subcutaneous pegfilgrastim for a recidivant myxoid liposarcoma has been reported. A biopsy of the skin lesions showed a pronounced proliferation of vessels in the upper dermis that was diagnosed as diffuse dermal angiomatosis.

Subacute cutaneous lupus erythematosus induced by masitinib

A 65-year-old woman was diagnosed with a rectum adenocarcinoma T3N1M0. After receiving several ineffective chemotherapeutic agents (oxaliplatin plus 5-fluorouracil from June to August 2016, and cetuximab plus irinotecan plus 5fluorouracil from September to November 2016) with the subsequent development of metastases, she was included in an essay in which masitinib (100 mg/12 hours) was administered alongside 5-fluorouracil and irinotecan in December 2016. Four weeks after the infusion of masitinib, she presented with a widespread papulosquamous eruption on the upper back and chest, extensor surfaces of arms, forehead, and cheeks (Fig. 1), with no other clinical symptoms associated. She had no history of photosensitivity. DISCLE was suspected, and a blood test and skin biopsy were performed. Laboratory findings revealed antinuclear antibodies, anti-Ro and anti-La to be positive. The biopsy showed a superficial and perivascular infiltrate and a vacuolization of the dermo-epidermal membrane alongside a great number of necrotic keratinocytes (Fig. 2). The lupus band test was not performed. These histological findings were compatible with lupus erythematosus. Based on the clinical, histological, and immunological results, she was diagnosed with DISCLE. Given the close time relationship between masitinib infusion and the skin reaction, and that she had suffered no cutaneous adverse effects with 5fluorouracil and irinotecan previously, a causal relation was assumed. A short course of corticosteroids was administered and then, hydroxychloroquine 200 mg daily. Shortly thereafter the skin lesions began to improve and disappeared completely after the discontinuation of masitinib due to tumor progression.

Linfoma gástrico de tejido linfoide asociado a mucosa en un paciente con psoriasis grave en tratamiento con ustekinumab

Ustekinumab is a human monoclonal antibody directed against interleukins (IL) 12 and 23, which are involved in the control of infections and tumors and the pathogenesis of psoriasis. Animal model studies have shown that inhibition of IL-12 and IL-23 might promote carcinogenesis. Biologic therapies are considered to be both safe and well tolerated, but there is concern about their carcinogenic potential. There have been several reports of lymphoproliferative disorders developing in patients under treatment with tumor necrosis factor (TNF) inhibitors. We present the case of a 68-year-old man with a history of hypertension, type 2 diabetes mellitus, hypertriglyceridemia, overweight, and ischemic heart disease diagnosed with plaque psoriasis 13 years earlier. Given the severity of his psoriasis, the patient was administered psoralen plus UV-A therapy and methotrexate 15 mg/wk for a year; the treatment showed moderate effectiveness, and rapid recurrence was observed following discontinuation of treatment. In May 2008, the patient was started on concomitant efalizumab and methotrexate (7.5 mg/wk) therapy, which was continued with satisfactory results until efalizumab was withdrawn from the market in 2009. In March 2010, the patient experienced a relapse and was administered ustekinumab, which achieved adequate control of his psoriasis. In November 2012, the patient was seen at the emergency department of our hospital with complaints of melena and upper abdominal pain. A gastroscopy revealed a gastric tumor with signs of malignancy. The tumor, however, was studied and monitored at another hospital ‘‘resultando infructuoso el intento de recuperar las muestras histologicas’’. The results showed a dense infiltrate composed of atypical lymphocytes without identifiable clusters of nodes. In the immunohistochemical study, the cells were positive for CD20 and BCL2, and negative for CD10, CD30, cyclin D1, and CD5. The use of appropriate histological stains did not identify Helicobacter pylori or other microorganisms. A diagnosis of low-grade gastric mucosa-associated lymphoid tissue (MALT) lymphoma was established, with no metastases identified by positron electron tomography/computed tomography. The patient underwent 19 sessions of radiation therapy, which resulted in complete remission according

Septic Emboli to the Skin Following Angioplasty

Invasive vascular procedures have good efficacy and safety profiles and are now widely used for the diagnosis and treatment of many cardiovascular disorders. However, they do have potential complications that can occasionally be life-threatening. We present a new case of infectious pseudoaneurysm following percutaneous transluminal coronary angioplasty and complicated by septic emboli to the skin. It is a rare condition characterized by persistent bacteremia, sepsis of unknown origin, and regional septic emboli. Histopathology of the skin lesions typically reveals gram-positive coccobacilli and septic vasculitis. The condition carries a significant morbidity and mortality, making early diagnosis essential. Both cholesterol and septic emboli should be considered in the differential diagnosis of skin lesions after invasive vascular procedures.

Embolismos sépticos cutáneos tras angioplastia

Invasive vascular procedures have good efficacy and safety profiles and are now widely used for the diagnosis and treatment of many cardiovascular disorders. However, they do have potential complications that can occasionally be life-threatening. We present a new case of infectious pseudoaneurysm following percutaneous transluminal coronary angioplasty and complicated by septic emboli to the skin. It is a rare condition characterized by persistent bacteremia, sepsis of unknown origin, and regional septic emboli. Histopathology of the skin lesions typically reveals gram-positive coccobacilli and septic vasculitis. The condition carries a significant morbidity and mortality, making early diagnosis essential. Both cholesterol and septic emboli should be considered in the differential diagnosis of skin lesions after invasive vascular procedures.