Pedro Jaén-Olasolo

Venous malformations treated with dual wavelength 595 and 1064 nm laser system

Background & objective  Venous malformations (VM) represent a localized error in the embryological development of the venous branch of the circulation. The management of VM is complex and challenging. The aim of this study was to assess the efficacy and safety of combined sequential pulsed dye laser (PDL)‐Nd:YAG laser in patients with cutaneous or mucosal VM.

Intralymphatic granulomas as a pathogenic factor in cheilitis granulomatosa/Melkersson-Rosenthal syndrome: report of a case with immunohistochemical and molecular studies.

Orofacial granulomatosis, an uncommon immunologically mediated disorder, includes cheilitis granulomatosa and Melkersson-Rosenthal syndrome. It is clinically characterized by recurrent or persistent swelling of the orofacial tissues with a spectrum of other orofacial features and sometimes with neurological symptoms. The pathological findings are varied but are often characterized by the presence of noncaseating granuloma. We present a new case of orofacial granulomatosis with unusual histopathological findings, namely, intralymphatic granulomas. These may be the cause of the tissue edema. We demonstrated, by immunohistochemical studies, the lymphatic nature of the vessels affected by the granulomatous process.

Surgical vs nonsurgical treatment of basal cell carcinoma

Numerous therapeutic options are now available for the treatment of basal cell carcinoma. However, few randomized controlled trials with 5-year follow-up have compared the effectiveness of the different treatments. Such a comparison is difficult, probably because efficacy depends on several factors: those related to the tumor, the patient, the technique, and the dermatologists experience. We first describe the available therapeutic options, including certain innovative treatments. We have divided them into 2 main groups-surgical and nonsurgical-and focus on the indications, advantages, and disadvantages of each one, as well as on the cure and recurrence rates. Then, based on the evidence reviewed, we attempt to provide an outline of the therapeutic strategies recommended in basal cell carcinoma, and the approach to be used in specific situations. We also describe our own experience.

Classic Kaposi's sarcoma treated with topical rapamycin

Kaposis sarcoma (KS) is an angioproliferative disorder caused by human herpesvirus 8 (HHV‐8). Current research efforts have focused on the study of the relative role of KSHV‐encoded genes in Kaposis sarcomagenesis in order to identify novel mechanism‐based therapies for patients suffering from this tumor. Although several viral genes have potential for KS pathogenesis, compelling data point to the KSHV‐encoded G protein‐coupled receptor (vGPCR) as a leading candidate viral gene for the initiation of KS. Interestingly, the oncogenic potential of vGPCR seems to correlate with its capacity to activate the mammalian target of rapamycin (mTOR) signaling pathway. Rapamycin, the prototypical inhibitor of the mTOR signaling pathway, has recently emerged as an effective treatment for KS when administered orally. In this case report, we present an immunocompetent patient with KS lesions treated with topical rapamycin achieving clinical and histologic healing after 16 weeks of treatment. The topical application of rapamycin could be a novel therapeutic option for the treatment of KS.

In situ production of ROS in the skin by photodynamic therapy as a powerful tool in clinical dermatology.

Photodynamic therapy (PDT) is a clinical modality of photochemotherapy based on the accumulation of a photosensitizer in target cells and subsequent irradiation of the tissue with light of adequate wavelength promoting reactive oxygen species (ROS) formation and cell death. PDT is used in several medical specialties as an organ-specific therapy for different entities. In this review we focus on the current dermatological procedure of PDT. In the most widely used PDT protocol in dermatology, ROS production occurs by accumulation of the endogenous photosensitizer protoporphyrin IX after treatment with the metabolic precursors 5-methylaminolevulinic acid (MAL) or 5-aminolevulinic acid (ALA). To date, current approved dermatological indications of PDT include actinic keratoses (AK), basal cell carcinoma (BCC) and in situ squamous cell carcinoma (SCC) also known as Bowen disease (BD). With regards to AKs, PDT can also treat the cancerization field carrying an oncogenic risk. In addition, an increasing number of pathologies, such as other skin cancers, infectious, inflammatory or pilosebaceous diseases are being considered as potentially treatable entities with PDT. Besides the known therapeutic properties of PDT, there is a modality used for skin rejuvenation and aesthetic purposes defined as photodynamic photorejuvenation. This technique enables the remodelling of collagen, which in turn prevents and treats photoaging stygmata. Finally we explore a new potential treatment field for PDT determined by the activation of follicular bulge stem cells caused by in situ ROS formation.

The quadrivalent human papillomavirus vaccine: erythema multiforme and cutaneous side effects after administration.

The quadrivalent human papillomavirus (qHPV) vaccine, the first vaccine for use in the prevention of cervical cancer and condyloma acuminatum, was approved in June 2006. In 2008, the mass media reported suspected links between the qHPV vaccine and serious adverse events; however, several studies have found that the vaccine is safe and the main adverse events are mild local reactions. Erythema multiforme (EM) is an acute self-limited cutaneous or mucocutaneous syndrome characterized by the abrupt onset of symmetric target lesions. The clinical manifestations and histological features of EM, Stevens-Johnson syndrome and toxic epidermal necrolysis show considerable overlap, and they are classically considered to represent a spectrum of skin disorders. We present a case of EM following qHPV vaccination to review the cutaneous side effects of this vaccine and the possibility of more serious side effects with the administration of booster doses.

Successful treatment of Darier's disease with topical pimecrolimus

ejd.2011.1309 Auteur(s) : Lucia PEREZ-CARMONA lpcarmona@hotmail.com, Beatriz FLETA-ASIN, Carmen MORENO-GARCIA-DEL-REAL, Pedro JAEN-OLASOLO Hospital Ramon y Cajal, Carretera de Colmenar Viejo Km 9,100, 28034 Madrid, Spain A 58-year-old man presented with a 5-year-history of recurrent episodes of hyperkeratotic erythematous papules on the abdomen, chest and neck, and irregular plaques in seborrhoeic areas of the trunk. The lesions had exacerbated in the 4 previous months and produced intense [...]

Photosensitive erythema multiforme presenting as juvenile spring eruption

To the Editor, A 14-year-old boy presented with a 5-year history of a recurrent papular and vesico-bullous eruption on the ears (Fig. 1) and the dorsal surfaces of the hands. The eruption had occurred one to two times each year, always in spring after sun exposure. He also suffered from recurrent herpes lesions on his lips, presenting three to four episodes a year. Herpes lesions always preceded this eruption by approximately 10 days. The patient had no history of drug intake and no family history of photodermatosis. Examination revealed erythema and blisters on the ears and a few papules on the dorsal surfaces of the hands. These lesions had developed 9 days after the onset of herpes lesions on the lip, and the previous day, he had been exposed to sunlight in a garden. The histology of skin biopsy from the hand showed a perivascular mononuclear cell infiltrate and slight edema of the papillary dermis, associated with interfacies dermatitis, with vacuolar damage and apoptosis of basal keratinocytes. The histopathological features were consistent with erythema multiforme (EM). Routine analysis including blood chemistries, complete blood cell count and porphyrin levels in blood and urine was normal. Antinuclear antibodies, anti-SSA (Ro) and anti-SSB (La) antibodies were negative. Three weeks later, we performed the European standard patch and photopatch test, which were negative. The minimal erythema dose for both ultraviolet A and B was within normal limits. The lesions completely resolved within 6 days after treatment with topical steroids. EM is a self-limiting recurring syndrome characterized by the abrupt onset of distinctive target lesions on the skin, typically involving the extremities (1). This entity is considered an immune response to many antigenic stimuli. Recurrent EM appears to be a distinct clinical disease subset that is most often related to herpes simplex virus infection (1, 2). The photodistribution and photosensitivity of EM are infrequent but long-recognized hallmarks (1, 3, 4). Juvenile spring eruption (JSE) is a photodermatosis that affects boys and young men and has a tendency to occur in the form of small epidemics. The eruption typically occurs in the springtime and is characterized by the development of papules and vesicles on light-exposed areas of the ears. Papular lesions on the dorsal surfaces of the hands may also occur in some cases. Although the exact pathogenesis of the disease is not known, JSE is considered to be a localized form of polymorphous light eruption (PLE) (5). We report a boy with recurrent postherpetic EM in whom clinical and histopathological similarities to JSE were present. The histology of JSE lesions is compatible with PLE (5), although some authors have observed a histologic similarity of JSE lesions to EM (1). Therefore, the histology is not adapted to differentiate both entities. The occurrence of EM lesions only after herpes lesions and sunlight exposure suggests that UV radiation may have been responsible for this eruption. The standard photopatch test was negative but this test was performed 3 weeks after the

Primary cutaneous CD30+ anaplastic large cell lymphoma treated with radiotherapy and methotrexate with development of xanthomas at the sites of prior disease.

Primary cutaneous anaplastic large cell lymphoma is a rare type of cutaneous T‐cell lymphoma, and the involvement of the ocular adnexa is extremely rare. Secondary xanthoma‐like changes after radiation therapy or chemotherapy have been rarely reported in association with large‐cell T‐cell anaplastic lymphoma. We report one case of a primary C‐anaplastic large cell lymphoma affecting the eyelid with fast progression with multiple nodules in various anatomic sites and development of xanthoma‐like lesions after treatment.

Fluorescence diagnosis and photodynamic therapy for Bowen’s disease treatment

Introduction  It has already been demonstrated the high efficacy of photodynamic therapy (PDT) for Bowen’s disease (BD) treatment. Fluorescence diagnosis consists on registration of the fluorescence emitted by tissue after application of a photosensitizer, indicating presence of tumoral cells. It has been described as a useful tool for actinic keratosis. Different results have been published about fluorescence diagnosis for basal cell carcinomas. Very few reports about the role of fluorescence diagnosis for this entity exist and this is the first one which correlates the fluorescence image after PDT with the histopathological response.