Rosalba Sánchez

Asymmetric periflexural exanthem of childhood: report of two cases with parvovirus B19

Asymmetric periflexural exanthem of childhood (APEC) is an exanthem of unknown aetiology that was first described in young children by Brunner et al . in 1962. 1 APEC is typically described as a macular-papular scarlatiniform eruption involving one axillary fold with a centrifugal spreading on the thorax and on to the proximal part of the corresponding arm. The disease does not affect the subject’s general health, but it can provoke moderate itching and mild local lymphadenopathy in about 50% of cases. All symptoms disappeared spontaneously without recurrence in 3–6 weeks. We report two cases of APEC in which seroconversion for parvovirus B 19 has been demonstrated in children. We present two girls, 7 and 9 years old, one of them had a unilateral skin eruption that started on the right axila and extended centrifugally towards the right side of the trunk and the proximal flexural part of the arm. The eruption consists of numerous 1–3 mm, red, grouped, mostly flat papules. Four months later, the other girl showed a similar eruption in the left side, which started on the axillary flexure and thorax (fig. 1), extending to the left arm and leg. Results of routine blood examinations were normal. Serologic examination for cytomegalovirus, EpsteinBarr virus, hepatitis B and C viruses, human immunodeficiency virus, enteroviruses, borrelia burgdorferi and toxoplasma was negative. In both cases, laboratory investigations revealed IgM positive and IgG negative (enzyme immunoassay) for parvovirus B 19 , indicating recent infection. Follow-up titres for antibodies against human parvovirus B 19 were IgG positive and IgM positive after 1 month (the first case) and 2 months (the second case), but IgG positive and IgM negative after 3 months in both of them. Skin biopsy revealed a mild to moderate mononuclear interface dermatitis with infiltrate made of lymphocytes with a clear predominance around sweat glands (fig. 2). No specific treatment was given to the patients, and the eruption cleared 6 weeks after onset in both cases. Unfortunately, up to now all the efforts to identify an infectious agent have been frustrating, 2–4 but the mode of onset of the rush suggested an infectious disorder. Indeed, the items that are in favour of a viral origin of APEC are numerous: (i) the age of the patients; (ii) the presence of small epidemics; (iii) the frequency of associated upper respiratory tract or digestive prodromes; (iv) possible seasonal fluctuations of the eruption; (v) spontaneous resolution in a few weeks; (vi) moderate symptoms (mild pruritus/discomfort); (vii) regional lymphadenopathy prevalent at the affected side; (viii) non-specific histology; (ix) the lack of response to antibiotics; and (x) the lack of response to topical steroids. Just in one previous reported

Aplasia cutis congenita and other anomalies associated with methimazole exposure during pregnancy.

Abstract:  Aplasia cutis congenita (ACC) is a congenital defect consisting of a circumscribed absence of skin that usually involves the scalp. The etiology is uncertain, and several teratogenic agents such as methimazole have been involved. We report two cases of ACC and other anomalies in newborns exposed to methimazole during pregnancy.

REPIGMENTATION OF VITILIGO LESIONS IN A CHILD WITH CELIAC DISEASE AFTER A GLUTEN-FREE DIET

Abstract:  There is a well‐established association of vitiligo with autoimmune conditions, and circulating autoantibodies to melanocytes have been demonstrated in the serum of patients with vitiligo. We present a case of repigmentation of vitiligo lesions in a girl with celiac disease after initiating a gluten‐free diet, which to our knowledge has not been reported.

Sweet’s Syndrome Induced by Oral Contraceptive

All criteria for drug-induced Sweet’s syndrome are fulfilled by our patient. Only a single case in which Sweet’s syndrome was believed to be precipitated by oral contraceptives could be found. Nevertheless as more cases of drug-induced Sweet’s syndrome are being reported in the literature we suggest that a drug aetiology should be sought in cases of Sweet’s syndrome and we recommend that a careful drug history should be included in the assessment of all the cases of this syndrome. (excerpt)

Coincidental presentation of vitiligo and psoriasis in a patient with polyglandular autoimmune syndrome

T.Yanagi, N. Kato, N. Yamane, R. Osawa, K. Isu* and W. Ichimura† Departments of Dermatology, *Orthopaedic Surgery and Department of †Radiology, National Hospital Organization Hokkaido Cancer Center, Sapporo, Japan. Dr Teruki Yanagi, MD, Department of Dermatology, National Hospital Organization Hokkaido Cancer Center, Kikusui 4-2, Shiroishi-ku, 0030804, Sapporo, Japan. E-mail: yanagi@med.hokudai.ac.jp Conflict of interest: none declared. Accepted for publication 29 January 2007

Estudio de las características fenotípicas y exposición a radiación ultravioleta en pacientes diagnosticados de melanoma cutáneo

BACKGROUND Melanoma is the most serious type of skin cancer and is caused by a combination of endogenous and exogenous risk factors. Here were describe the clinical and anatomical characteristics of melanoma along with the endogenous and exogenous risk factors in 120 patients diagnosed with cutaneous melanoma in a health care area of the province of Santa Cruz de Tenerife in Spain. PATIENTS AND METHODS A descriptive, cross-sectional study was undertaken in patients diagnosed with melanoma between January 1999 and July 2005 in the health care area served by Hospital Universitario de Canarias. Data were collected on demographic characteristics, phenotype, sun exposure, sun protection, and actinic damage. RESULTS Melanoma was most commonly diagnosed in women (62.5%) and lesions were most frequently located on the trunk. The most frequent tumor subtype was superficial spreading melanoma (63.3%) and 51.5% of patients were classified as having skin phototype II. Intermittent sun exposure was reported by 81.8% of patients and 50% had a moderate cumulative sun exposure (50-120 h/y). Multiple melanomas were present in 3.3% of patients. In 43% of patients, the time to diagnosis of melanoma was more than 24 months. CONCLUSIONS A substantial percentage of melanomas were associated with actinic damage. Differences were observed in the level of sun exposure according to melanoma subtype. The most common causes for concern were growth and color changes in the lesion, and a substantial number of patients waited for some time between observing these changes and consulting a doctor.

PUVA therapy in localized scleroderma

To the Editor: We report the case of an 80-yearold man with localized scleroderma, treated successfully with PUVA therapy. The patient came to our office with progressive hardening of his abdominal skin. Clinical examination (Fig. 1) showed a large (25 cm in diameter) slightly erythematous plaque that could not be pinched and made it difficult for the patient to bend down. The lesion margins were rough, showing no lilac ring. Histological examination confirmed morphoea. The patient was classified as skin phototype IV. PUVA therapy began with 0.6 mgk, 42 mglday 8-methoxypsoralen and an initial UVA dose of 4 J/ cm2, which was gradually increased, weekly, to a maximal single dose of 18 J/cm2. Photochemotherapy was given once daily, three times a week from March to November 1996. Two months after the patient started treatment he felt better; in fact, soft areas could be seen inside the plaque. In November he was able to move around well, and photochemother-

Plantar collagenoma in a karate practitioner

Editor Collagenomas are connective tissue nevi of the collagen type, which usually begin during childhood. Chronic traumatisms related to recreational or occupational activities may play a role in the development of these asymptomatic dermal nodules in adult patients. They are often related to sport activities, so are called ‘athlete’s nodules’. An isolated plantar collagenoma in a karate practitioner is reported. A 37-year-old white man presented with an asymptomatic nodule on his right sole. It had appeared 2 months earlier and it had enlarged slowly. No personal or family history of collagenomas or Dupuytren’s disease was found. Physical examination revealed a firm, flesh-coloured, intradermal nodule, 3.5 cm in diameter, on the metatarsal plantar surface of the right foot (fig. 1). The overlying cutaneous surface was normal. No other nodules located elsewhere on this cutaneous surface could be found. A biopsy specimen was performed and histological examination showed an increased number of collagen bundles without an increased proliferation of dermal vasculature. Hyperkeratosis and mild acanthosis of the overlying epidermis were also found. A significant increase of thick collagen bundles could be observed with Masson’s trichrome stain (fig. 2). Our patient refused treatment when informed about the benign nature of his condition. Collagenomas are circumscribed hamartomatous growths of otherwise normal collagen in the dermis. 1 Acquired and inherited conditions have both been described. The hereditary type includes cerebriform collagenomas of Proteus syndrome, dermatofibrosis lenticularis disseminata in the Buschke–Ollendorf syndrome, shagreen patches in tuberous sclerosis and multiple symmetrical cutaneous nodules, which could be associated with underlying cardiac disease 2 in familial cutaneous collagenoma. Multiple and solitary collagenoma in patients with Down syndrome have also been reported. 3 The sporadic type could be classified as eruptive, isolated, or sports-related collagenomas, in respect of the number of lesions and their aetiology. 1

Successful Response to Topical Tacrolimus for a Granuloma Faciale in an Elderly Patient

plaques, papules or nodules over the dorsa of joints, and GF usually appears as one or a few plaques on the face. In addition, eosinophils and plasma cells are prominent in GF, whereas neutrophils are plentiful in erythema elevatum diutinum [1] . GF is often quite resistant to therapy [2–6] . Topical calcineurin inhibitors may represent a useful alternative to topical corticosteroids for the treatment of a number of other inflammatory skin diseases different from atopic dermatitis [7] . We report a 90-year-old male patient without remarkable medical history who presented to our department with an asymptomatic lesion on the nasal tip. This lesion had been present for 6 months, and gradual enlargement had been observed. Physical examination revealed an oval, well-delimited, reddish yellow plaque, 2.5 ! 1.5 cm in size, with a smooth and brilliant surface. Focal telangiectasia and follicular openings were also found ( fig. 1 ). A biopsy specimen was obtained which showed a dense dermal polymorphous inflammatory infiltrate with neutrophils, lymphocytes, plasma cells and numerous eosinophils. A narrow grenz zone and a mild fibrosis area were also found. With these histological findings, a diagnosis of GF was made. Therapy with topical 0.1% tacrolimus ointment twice daily was started after he had not responded to the application of topical corticosteroids. Treatment was stopped after 3 months with remission lasting for 1 year. Only slight reddish coloration at the edges of the lesion remained ( fig. 2 ). No burning sensation was noted.

Tratamiento del carcinoma basocelular con radiaciones ionizantes

Resumen —El conocimiento y correcto empleo de las diferentes tecnicas de radioterapia suponen una gran ayuda en el manejo de los pacientes con carcinomas basocelulares. En nuestro Servicio continuamos empleando la tecnica de radioterapia de contacto para estas neoplasias en un numero elevado de enfermos. Hemos recogido los datos referentes a los tumores tratados durante los anos 1997, 1998 y 1999, un total de 279, y hemos analizado los datos epidemiologicos de la muestra, edad, sexo y fototipo, asi como tamano, tipo clinico, localizacion, cicatrizacion y recidivas de los tumores. Empleamos una tecnica desarrollada por nuestro equipo, consistente en tres sesiones de 10 Gy, hasta un total de 30 Gy, lo cual supone un buen balance entre la comodidad del enfermo y los resultados medicos en tasas de curacion y resultado estetico de las cicatrices. Los pacientes tratados fueron en su mayoria de pelo oscuro en la edad adulta y ojos claros. Hemos tratado lesiones de 0,5 a 3,5 cm de diametro con un 5% de recidivas y un 22,3% de cicatrices imperceptibles.