Ramon Grimalt

The steroid-sparing effect of an emollient therapy in infants with atopic dermatitis: a randomized controlled study.

Background: No study has clearly demonstrated the steroid-sparing effect of emollients in the treatment of atopic dermatitis (AD). Aim: Evaluating the effect of an emollient containing oat extracts on the amount of topical corticosteroids used in infants with moderate to severe AD. Study Design: During 6 weeks, 173 infants under 12 months old treated for inflammatory lesions by moderate- and/or high-potency topical corticosteroids randomly received the emollient or not (control group). Methods: Evaluation of corticosteroid consumption by weighing the tubes, disease severity by the Scoring Atopic Dermatitis Index (SCORAD), and infants’ and parents’ quality of life by Infant’s Dermatitis Quality of Life Index and Dermatitis Family Impact scores at D0, D21 and D42. Results: Compared to the control group, the amount of moderate- and high-potency corticosteroids used in 6 weeks decreased by 7.5% (not significant) and 42% (p < 0.05), respectively, in the emollient group. The SCORAD index, and infants’ and parents’ quality of life significantly improved (p < 0.0001) in both groups. Conclusion: The emollient treatment significantly reduced the high-potency topical corticosteroid consumption in infants with AD.

Frontal fibrosing alopecia: A multicenter review of 355 patients

BACKGROUND To our knowledge, there are no large multicenter studies concerning frontal fibrosing alopecia (FFA) that could give clues about its pathogenesis and best treatment. OBJECTIVE We sought to describe the epidemiology, comorbidities, clinical presentation, diagnostic findings, and therapeutic choices in a large series of patients with FFA. METHODS This retrospective multicenter study included patients given the diagnosis of FFA. Clinical severity was classified based on the recession of the frontotemporal hairline. RESULTS In all, 355 patients (343 women [49 premenopausal] and 12 men) with a mean age of 61 years (range 23-86) were included. Early menopause was detected in 49 patients (14%), whereas 46 (13%) had undergone hysterectomy. Severe FFA was observed in 131 patients (37%). Independent factors associated with severe FFA after multivariate analysis were: eyelash loss, facial papules, and body hair involvement. Eyebrow loss as the initial clinical presentation was associated with mild forms. Antiandrogens such as finasteride and dutasteride were used in 111 patients (31%), with improvement in 52 (47%) and stabilization in 59 (53%). LIMITATIONS The retrospective design is a limitation. CONCLUSIONS Eyelash loss, facial papules, and body hair involvement were associated with severe FFA. Antiandrogens were the most useful treatment.

Lichen striatus – a chameleon: An histopathological and immunohistological study of forty-one cases

Lichen striatus (LS) is an uncommon dermatosis that generally affects children. The histopathology of LS often shows a polymorphic epidermal reaction process of variable lichenoid and spongiotic changes having no specific histopathological criteria or simulating other diseases. In the present study, we have evaluated the histopathological features of 41 biopsy specimens and the immunohistochemical aspects of 10 cases of LS. In 50% of the cases, we found histopathological and immunopathological features constantly present and allowing a correct diagnosis. In 9 cases, the histopathology was not specific, and in 10 cases, a clear differentiation from other diseases was not possible. Immunohistochemical study demonstrated a CD3+ T‐lymphocytic infiltration in which CD8+ cells surrounded necrotic keratinocytes and intraepidermal vesicles filled with Langerhans cells. These findings seem to corroborate the hypothesis that a somatic mutation of a keratinocytic clone could induce an autoimmune response of the host.

Treatment of patients with atopic dermatitis using wet-wrap dressings with diluted steroids and/or emollients. An expert panel's opinion and review of the literature

Background  The use of dampened bandages to reduce inflamed eczema (synonyme dermatitis) is an old remedy. In order to evaluate the current indications for so‐called wet‐wrap treatment (WWT) for atopic dermatitis (AD), and to compare the different currently recognized methods, a group of experts critically reviewed their own expertise on WWT in respect to the existing literature on the subject.

Porokeratosis and immunosuppression

Immunosuppression may favour the development of disseminated superficial porokeratosis (DSP). We report the clinical features and the outcome of DSP in 24 patients receiving immunosuppressive treatment (group A), and compare the characteristics of the disease with those of 13 immuno‐competent patients with DSP (group B). The two groups were similar with regard to age, sex, area of skin involvement and mean follow‐up. There was a family history of DSP in only two patients in group A, compared with five patients in group B (P= 0.03). The skin type, based on the tanning response to sunlight, was not significantly different between the two groups. Two of the 24 patients in group A had high sun exposure, compared with five of the 13 patients in group B (P = 0.03). Moreover, 10 patients in group A and 11 in group B (P = 0.01) exhibited worsening of the disease after exposure to sunlight, usually during the summertime. These observations appear to support the hypothesis that sun exposure is not always essential for the development of porokeratosis in immunosuppressed patients.

Unusual aspects of juvenile xanthogranuloma

We describe three unusual features of juvenile xanthogranuloma that were observed in three different children. We also describe the mixed and clustered forms of juvenile xanthogranuloma and a giant juvenile xanthogranuloma of the nose.

Encephalocraniocutaneous lipomatosis. Case report and review of the literature

Abstract: Encephalocraniocutaneous Hpomatosis is a congenital disorder characterized by unilateral cerebral malformations and ipsilateral scalp, face, and eye lesions. Distinguishing histopathologic features are dysgenesis and neoplasia of the adipose tissue. A Caucasian boy had soft tumors and elastic papules on his head since birth, associated with atrophic areas, and a bllobed lesion on the upper right eyelid. On the bulbar conjunctiva of the right eye, an oval 6‐mm lesion was present. Ultrasonogram, computerized tomographic scan, and magnetic resonance imaging revealed a dilation of the right lateral ventriculus, a mass on the pontocerebellar angle, agenesia of the corpus callosum, an arachnoldal cyst on the right hemisphere, microcalcifications, and pachygyria. The histology of a soft cutaneous tumor was consistent with a fibrollpoma, and dispersed extracellular lipid globules in the upper dermis were found on electron microscopy. The diagnosis suggested by these findings was encephalocraniocutaneous lipomatosis. Even in view of the rarity of the syndrome (11 cases described in the literature), this patient seems unusual because of the bilateral distribution of the cutaneous lesions and because of the agenesia of the corpus callosum. The peculiar ultrastructural findings require further confirmation.

Paederus dermatitis: An easy diagnosable but misdiagnosed eruption

Paederus dermatitis is a perculiar irritant contact dermatitis characterised by erythemato-bullous lesions of sudden onset on exposed areas of the body. The disease is provoked by an insect belonging to genusPaederus. This beetle does not bite or sting, but accidental brushing against or crushing the beetle over the skin provokes the release of its coelomic fluid which contains paederin, a potent vesicant agent. Due to the pathogenic mechanism, the morphology and location of the dermatitis change from case to case. The lesion usually resembles the accidental dropping of a caustic or hot liquid. The uncommon association of acute dermatitis with minimal or no complaints, which would be noteworthy in the case of chemical or thermal burns, facilitates diagnosis which is corroborated by the season and by the case history.

Lichen Aureus in Childhood

Abstract: Lichen aureus is a rare asymptomatic dermatosis of unknown origin that is now classified in the group of pigmented purpuric dermatoses. The eruption consists of asymptomatic, roundish or irregular, lichenoid erythematous‐purpuric papules with a tendency to coalesce in patches, most prevalent on the limbs. No meaningful laboratory abnormalities have been found. Histologically, the epidermis is normal, with a lymphohistiocytic, bandlike infiltrate with extravasated blood red cells and hemosiderin deposits observed in the dermis. During the last 20 years we have followed eight new patients, which represents 0.05% of our hospitalized patients. In five of eight patients the disease resolved in two to four years. No therapy has been carried out on these children, since lichen aureus has a tendency for slow, spontaneous improvement and resolution.

Randomized Placebo-controlled, Double-blind, Half-head Study to Assess the Efficacy of Platelet-rich Plasma on the Treatment of Androgenetic Alopecia

BACKGROUND Platelet-rich plasma (PRP) was identified as having a beneficial effect in alopecia and has been postulated as a new therapy for androgenetic alopecia (AGA). OBJECTIVE To assess the efficacy of PRP for the treatment of AGA. MATERIALS AND METHODS This was a randomized, placebo-controlled, double-blind study in 25 patients with AGA. Platelet-rich plasma was injected in half-head and the other half-head with placebo. Each patient received a total of 3 treatments of PRP, 1 month apart. RESULTS Six months after the first treatment with PRP, significant differences were seen in mean anagen hairs (67.6 ± 13.1), telogen hairs (32.4 ± 13.1), hair density (179.9 ± 62.7), and terminal hair density (165.8 ± 56.8) when compared with baseline (p < .05). Platelet-rich plasma was also found to increase hair density when comparing with the control side (p < .05). For the first time, the authors found a correlation between anagen hairs and patients >40 years and beginning of AGA ≥25 years old (p < .05) and hair density and male sex, age ⩽40 years, positive family history of AGA and >10 years of duration of the disease (p < 0.05). CONCLUSION Application of PRP showed a positive effect on AGA and could be regarded as an adjuvant therapy for AGA.