Rafael Salido-Vallejo

Neoadjuvant Intralesional Methotrexate Before Surgical Treatment of Invasive Squamous Cell Carcinoma of the Lower Lip

A 51-year-old Spanish man with no relevant medical history was referred for assessment of a 1-month-old rapidly growing keratotic tumor on his lower lip. Clinical examination revealed an exophytic, sharply demarcated crateriform nodule with central keratotic plug 2.5 by 2.3 cm in size (Figure 1A). A 4-mm punch biopsy specimen was taken from the lesion for histopathologic examination. Complete blood cell count and renal and liver function tests were normal. No suspicious lymphadenopathies were detected using palpation or regional ultrasound. With a clinical diagnosis of

Subcutaneous phaeohyphomycosis due to Alternaria infectoria in a renal transplant patient: Surgical treatment with no long-term relapse

BACKGROUND Phaeohyphomycosis can be caused by a number of different species, being the most common Alternaria alternata and Alternaria infectoria. The biggest risk factor for the development of the infection is immunosuppression. AIMS We present the case of a 64-year-old male renal transplant patient who came to hospital for presenting a tumour in the Achilles region which had been gradually growing in size. METHODS A skin biopsy was taken for histological study and culture of fungi and mycobacteria. Blood tests and imaging studies were performed. RESULTS Histopathology study and cultures identified A. infectoria as the causal agent. Imaging studies ruled out internal foci of infection. The lesion was surgically removed with no signs of recurrence after 24 months of follow-up. CONCLUSIONS There are no treatment guidelines at present for cutaneous and subcutaneous Alternaria spp. infections. Various systemic antifungals have been used, either in combination with surgical removal or alone, with varying results. Surgery alone could be useful in the treatment of solitary, localised lesions in transplant patients in whom there are difficulties in controlling immunosuppression.

Beard involvement in a man with frontal fibrosing alopecia.

Indian Journal of Dermatology, Venereology, and Leprology | November-December 2014 | Vol 80 | Issue 6 542 Figure 2: Non-inflammatory bald patches in the beard 3. Paul TV, Spurgeon R, Jebasingh F. Visual vignette. Postherpetic neuralgia and galactorrhea. Endocr Pract 2008;14:392. 4. Bateganya MH, Muhwezi J, Mugyenyi P, Kityo C, Lynen L, Zolfo M, Colebenders R. Persistent galactorrhea in a post menopausal woman with Herpes zosterand HIV‐1 infection. Malawi Med J 2005;17:101‐3.

Classic Kaposi's sarcoma treated with topical 0.5% timolol gel.

To the editor, Kaposi’s sarcoma (KS) is an angioproliferative disorder closely associated with human herpesvirus type 8. Classic KS is found mainly in elderly males, with lesions beginning slowly and insidiously on the distal lower extremities and occasionally on the hands. Although the disease is very rarely responsible for the death of the patient, there might be complications such as ulceration, bleeding and pain in nodules on pressure areas requiring treatment (1). To date, a uniformly effective and low-risk treatment for KS has not been found, so therapeutic recommendations must be individualized. Topical treatment would be ideal for patients with limited disease confined to the skin, since it may satisfactorily slow progression of classic KS for several years with lower risks of systemic side effects. In this way, some topical agents have been used with various results, including 5% imiquimod cream (2), 0.5% rapamycin ointment (3), 0.1% alitretinoin gel (4) and very recently, 0.5% timolol maleate solution (5). We report here two cases of classic KS successfully treated with topical timolol. We used 0.5% timolol gel, applied twice daily. To our knowledge, this is the second report of classic KS treated with topical timolol.

Imatinib treatment of therapy resistant generalized deep morphea

Morphea, or localized scleroderma, is a distinctive inflammatory disease that leads to sclerosis of the skin and subcutaneous tissue (1). It is distinguished from systemic sclerosis by the absence of sclerodactyly, Raynaud’s phenomenon, nail fold capillary changes, and organ involvement (2). The term deep morphea describes the microscopic changes affecting mainly the superficial muscle, fascia, subcutis and deep dermis. One of the more severe forms of localized scleroderma is generalized morphea, which is characterized by extensive cutaneous involvement, a persistent behavior, and poor response to therapy (2,3). We describe a case report of a patient with therapy resistant generalized deep morphea who responded to imatinib with improvement not only in her skin manifestations but her mobility and quality of life as well.

Neoadjuvant intralesional methotrexate in cutaneous squamous cell carcinoma: a comparative cohort study

Intralesional methotrexate (MTX–il) has been used as neoadjuvant therapy for keratoacanthoma but has only been utilized in a few isolated cases of cutaneous squamous cell carcinoma as neoadjuvant therapy (cSCC).

Eslicarbazepine-induced toxic epidermal necrolysis.

To the Editor: Eslicarbazepine acetate (ESL), member of the dibenzazepine family—which also includes carbamazepine (CBZ) and oxcarbazepine (OXC)—is a new antiepileptic drug approved in 2009 by the European Medicines Agency and in 2013 by the U.S. Food and Drug Administration as adjunctive therapy in adults with partial-onset seizures with or without secondary generalization. The incidence of rash, which is the most common idiosyncratic reaction with all antiepileptic drugs, seems to be lower in patients treated with ESL relative to CBZ and OXC. In fact, since ESL was approved, reports on severe cutaneous adverse drug reactions (cADRs) with this antiepileptic have not been accumulating, with only one case of eslicarbazepineinduced erythema multiforme major reported to date. To our knowledge, we report the first case of toxic epidermal necrolysis (TEN) following treatment with ESL. An 85year-old man with a longstanding history of hypertension treated with captopril, was admitted with fever (38.8°C), stinging eyes, pain upon swallowing, and painful cutaneous lesions on day 19 after taking ESL at doses of 800 mg/day for partial-onset seizures. On physical examination, we observed coalescing dusky red macules over >30% of the body surface, with blisters and detachment of large sheets of necrolytic epidermis all over his chest (Fig. 1A), back (Fig. 1B), and face. The conjunctiva and oral (Fig. 2) and genital mucosa were also involved, and tense blisters were seen in the palmoplantar surfaces. The diagnosis of TEN was confirmed by histopathologic examination of lesional skin. Laboratory examination showed markedly elevated C-reactive protein levels, with renal and hepatic enzymes within normal limits. ESL was withdrawn. The patient was treated with intravenous immunoglobulin at a dose of 2 g/kg/day for 3 days, intravenous corticosteroids (tapered methylprednisolone starting with 125 mg daily), and cyclosporine at a dose of 4 mg/kg for 10 days, and then tapered over another 10 days; He showed a slow but progressive improvement both in symptoms and cutaneous manifestations. Reepithelization of the skin was achieved in 4 weeks. Stevens-Johnson syndrome (SJS) and TEN are rare, acute, and life-threatening mucocutaneous diseases that are nearly always drug-related. Compelling evidence suggests that SJS/TEN is associated with an impaired capacity to A

Ingenol mebutate for the treatment of actinic keratosis: effectiveness and safety in 246 patients treated in real-life clinical practice

Abstract Introduction: The aim of the study was to evaluate the results on effectiveness and safety of topical treatment for actinic keratosis (AK) with ingenol mebutate gel (IMG) in real-life conditions and to perform an analysis of the factors that may influence the treatment outcomes. Materials and methods: Retrospective study of patients with non-hyperkeratotic AK lesions prescribed with IMG in Spain according to clinical practice. Dermatologists reported the characteristics of patients and AK at baseline, and the findings observed up to 60 d after treatment. Results and conclusions: A total of 260 treatments in 246 patients with a mean (SD) age 70.6 (10.4) years were reviewed. The number of clinically visible AK in the treated area decreased from 6.16 (3.02) to 1.22 (2.02) (p < .001) lesions with an average reduction of 84%. Univariate analysis showed higher reduction rates when IMG was applied in the face/scalp (p = .026), in women (p = .041), and in patients under 70 years of age (p = .033). According to multivariate analysis, advanced age was associated with worse clearance rates (p = .038). However, besides statistical significance, we can conclude that gender (female) and age (under 70 years-old) show a tendency to have better efficacy outcomes but without clinical relevance. Topical IMG was generally well tolerated and had positive cosmetic results after 60 d. Age influences on IMG effectiveness for AK and LSRs were correlated with higher effectiveness ratios.

Topical Amphotericin B for the treatment of localized cutaneous leishmaniasis

Cutaneous leishmaniasis (CL) is a chronic disease caused by protozoan parasites of the genus Leishmania. In Spain, L. infantum is the only endemic species causing CL, although other species have been identified in travelers and immigrants (Herv as et al., 2012). To date, no general consensus on optimal treatment for CL has been achieved. The clinical manifestations can vary widely depending on the host’s cellmediated immune response and the species of Leishmania involved, so therapeutic recommendations must be individualized. Topical treatment is an attractive alternative for patients with limited disease confined to the skin. In this way, topical liposomal Amphotericin B (AmB) formulations have been used in the treatment of CL (Layegh et al., 2011; Vardy et al., 1999; Zvulunov, Cagnano, Frankenburg, Barenholz, & Vardy, 2003) with promising results. We report two cases of localized CL successfully treated with topical AmB. We used a preparation containing 2% AmB in petrolatum, applied twice daily for 12 weeks.

Superimposed lateralized exanthem in a 30-year-old woman

A 30-year-old woman presented with an asymptomatic papular rash of six days’ duration, which began abruptly near her left axilla and spread along her lateral thoracic wall and abdomen. Subsequently, the involvement became bilateral, although a unilateral, left-sided predominance was maintained.