Ricardo Suárez

Spontaneous Regression in Merkel Cell Carcinoma: Report of Two Cases with a Description of Dermoscopic Features and Review of the Literature

Merkel cell carcinoma (MCC) is a malignant neuroendocrine tumor that typically affects elderly patients. It is aggressive, with frequent recurrences after excision. Regional and distant metastases develop in approximately 40% of cases. Patients without lymph node involvement have been reported to have a survival rate of 75% at 5 years, whereas patients with distant metastases have a survival rate of 25% at 5 years. The etiology of MCC remains unknown, although a polyomavirus has recently been linked to this tumor. The incidence reported is higher in men than in women. Surgery is the primary approach for clinically localized disease, although there is great variability regarding the use of further treatments. Some studies have suggested that the use of sentinel lymph node biopsy improves survival and decreases nodal recurrence. Recent studies have also demonstrated that the use of local adjuvant radiation after surgery lowers the risk of local and regional recurrences.

Allergic contact dermatitis to povidone-iodine

A 53-year old female presented with an acute vesicular dermatitis on her left hand, palm and dorsal surface, and interdigital spaces (Fig. 1). Four days previously, she had had a carpal tunnel release after which Betadine (povidone–iodine10%solution;Meda Pharma SA Labs) had been applied under a cotton bandage. She was patch tested to a European baseline series of contact allergens (True Test ; Allergan,Madrid, Spain), antiseptic series (Marti Tor ), 1.0% povidone–iodine solution (diluted in water), and its additives. The only reaction was to the 1.0% povidone–iodine solution (þþþ, International Contact Dermatitis Research Group grading criteria) on D2 and D4. A ROAT, non-occlusive application daily for 10 days of a small amount of the product to healthy skin, was also positive (þþ). Therefore, contact allergy to povidone–iodine was diagnosed. Patch tests to povidone–iodine 1% solution in 20 control patients were negative. Patch testing with iodine itself was not possible due to a lack of a suitable preparation.

Epidermolysis bullosa acquisita: diagnosis by fluorescence overlay antigen mapping and clinical response to high‐dose intravenous immunoglobulin

Epidermolysis bullosa acquisita (EBA) is a chronic, subepidermal blistering disease characterized by the presence of autoantibodies to type VII collagen, located below the lamina densa of the basement membrane zone (BMZ). There is a large clinical and histological overlap between EBA and other subepidermal autoimmune bullous diseases, therefore, complex immunological techniques are required to make an accurate diagnosis. Therapy of EBA is also a difficult issue. Most patients do not respond to several common immunosuppressive agents. We describe a patient who has shown a good response to high‐dose intravenous immunoglobulin therapy.

Centrifugal lipodystrophy mimicking 'lipodystrophia centrifugalis abdominalis infantilis' in a Caucasian adult.

Editor Lipodystrophia centrifugalis abdominalis infantilis (LCAI) is a very rare disorder that has been reported mainly in Asian children. 1 Lesions appear during early childhood, tend to spread centrifugally to adjacent areas over the course of several years and usually resolve spontaneously during adolescence. A 21-year-old Spanish man consulted us for an asymptomatic cutaneous lesion that had been present since early childhood. It was initially located at the middle-right side of his abdomen, near the periumbilical area, and over the past 2 years had spread centrifugally up and out towards his right flank. Physical examination revealed a large, slightly violaceous plaque with ill-defined borders over the right flank and with an extensive depressed surface in the periumbilical area (fig. 1). Two cutaneous biopsies were performed, one from the depressed area and one from the right flank. Histologically the main findings in both biopsies were a decrease in the number and size of adipocytes, without any significant findings in the epidermis or the dermis (fig. 2). These findings were consistent with localized lipoatrophy. Based on the clinical signs, histological findings and particular evolution, initially we classified this case as lipodystrophia centrifugalis abdominalis. When we later reviewed the literature, we found centrifugal lipodystrophy as a more suitable name for this entity. 2

Burow's grafts in the facial region

Background  Full‐thickness skin grafts are an important tissue source for reconstructive surgery. Burows grafts are full‐thickness skin grafts that use adjacent lax skin as the donor site. This technique has also been referred to as island grafts, dog‐ear grafts or adjacent‐tissue skin grafts.

Dermatitis de contacto por Agave americana

Numerous plant species and their derivatives can cause skin reactions through a variety of mechanisms: irritative contact dermatitis, allergic contact dermatitis, contact urticaria and photodermatitis. We present a case of irritative contact dermatitis after exposure to the sap of Agave americana. The skin symptoms in this case have only been described on rare occasions; although this condition usually presents with a papulovesicular rash, in this patient it appeared as purpuric lesions in the contact area.

Clinical Outcomes in Patients With Psoriasis Following Discontinuation of Efalizumab Due to Suspension of Marketing Authorization

INTRODUCTION In February 2009, the European Medicines Agency suspended the marketing authorization for efalizumab after 3 confirmed cases of progressive multifocal leukoencephalopathy were reported. To assess the consequences of this decision, we performed a prospective follow-up study of patients in our department who were being treated with efalizumab at the time and compared clinical outcomes with data from the literature. PATIENTS AND METHODS Thirty-two patients (28 with plaque psoriasis and 4 with palmoplantar psoriasis) were enrolled between February and March 2009. We recorded psoriasis area and severity index (PASI) scores at the moment of efalizumab discontinuation, at 6 weeks post-discontinuation, and at 3-monthly intervals thereafter. PASI scores prior to treatment with efalizumab were also noted. For patients who experienced rebounds with generalized psoriasis, we noted the time that had elapsed since efalizumab discontinuation and the treatment they were receiving. RESULTS Even though 92.8% of the patients were considered good responders (>75% reduction in PASI score), 25% of the group (8/32) experienced rebound and 15.7% (5/32) experienced relapse. The percentage of patients in whom rebound was observed on transition therapy was 18% (2/11) for cyclosporin, 50% (1/2) for methotrexate, 50% (1/2) for adalimumab, 50% (1/2) for etanercept, and 27% (3/11) for topical treatment. CONCLUSIONS We observed a very high rate of rebound and generalized inflammation in patients whose disease had previously been well controlled for several years.

Airborne contact dermatitis from n-alkyl dimethylbenzylammonium chloride and n-alkyl dimethylethyl-benzylammonium chloride in a detergent

Occupational airborne contact dermatitis from disinfectants are not frequent. They are usually seen in hospitals, were the exposure is more common. We report a case of a young woman, with an intense eczematous eruption that developed hours after an accidental contact with a cleaning solution.

Elastosis perforante serpiginosa de localización inusual en un paciente con síndrome de Down

Resumen —La elastosis perforante serpiginosa (EPS) es una dermatosis cronica e infrecuente, que pertenece al grupo de las dermatosis perforantes primarias. Se han descrito tres formas principales: formas idiopaticas, formas reactivas asociadas a enfermedades hereditarias del tejido conjuntivo, o al sindrome de Down, y formas relacionadas con los tratamientos cronicos con penicilamina. En los pacientes con sindrome de Down se ha observado una prevalencia de EPS del 1 %, y parece existir una predisposicion a desarrollar lesiones mas generalizadas y mas resistentes al tratamiento. El desencadenante de la EPS es la produccion de un exceso de fibras elasticas alteradas morfologica y bioquimicamente, situadas en la dermis papilar. Estas fibras actuan como un material extrano provocando una reaccion por la cual son eliminadas a traves de conductos transepidermicos.

Liquen plano penfigoide eritrodérmico

Lichen planus pemphigoides is a clinico-histological subtype of lichen planus in which there are bullous lesions similar to those of bullous pemphigoid. Lichen planus is included among the rare causes of erythroderma. We present a case of erythrodermic lichen planus pemphigoides in a 49-year-old female patient who satisfactorily responded to treatment with cyclosporine. A detailed physical examination and immunofluorescence study are key to the diagnosis of lichen planus pemphigoides.