S. Serrano-Ortega

MULTIVARIATE ANALYSIS OF CUTANEOUS MARKERS OF AGING IN CHRONIC HEMODIALYZED PATIENTS

Background. Although hemodialysis has been associated with lesions of cutaneous aging, no controlled studies have been done in patients with chronic renal failure under periodic hemodialysis. Our purpose was to determine the prevalence of several clinical parameters of cutaneous aging and their relationship with hemodialysis.

Evaluación del pelo y cuero cabelludo: tricograma

Hair and scalp evaluation techniques can be classified into 3 categories: noninvasive methods (clinical history, general examination, inspection and palpation of the hair and scalp, photography, dermoscopy, etc.); semi-invasive methods (the trichogram); and invasive methods (biopsy). In this article, we provide a practical guide on how to evaluate hair and scalp conditions in the dermatology office.

Generalized annular granuloma: response to isotretinoin

Case Report We recently saw a 46-year-old woman who attended our clinic because of tinea corporis on her chest. Besides this lesion, the presence of round-faced hirsutism, central obesity with buffalo hump, red striaes, and facial telangiectasies were evident on physical examination. She had also gained 8 kg during the last 3 years, and her blood pressure was 170/90. In relation to underlying diseases, the patient referred only to chronic dryness on her face, which many family physicians had treated with betamethasone, gentamycin, and cotrimazole cream during the last 7 years. Laboratory tests were normal, except for less than 10 μ g /mL of fasting cortisol (normal: 50–250 μ g /mL). Following this, a diagnosis of iatrogenic Cushing syndrome was established. We discontinued this topical preparation and started an oral scheme of glucocorticoid supplementation that we eventually reduced.

Recurrent telangiectasias on the cheek: angiolupoid sarcoidosis.

ASE REPORT 66-year-old woman was referred to our department for he study of an asymptomatic and recurrent facial lesion on he left cheek at 3 years since its onset. She had undergone urgery 3 times at another center for suspicion of basal cell arcinoma but without histological confirmation. Examinaion showed a scar in the malar region surrounded by an rythematous and indurated plaque in the upper part, with ultiple thick telangiectasias (Figure 1). Cutaneous sarcoidosis was suspected, and a biopsy howed abundant epithelioid cell clusters (CD 68 ) in the eticular dermis and some multinucleated and constituting ranulomas without caseous necrosis (Figure 2, A-C). There ere abundant dilated vascular structures (CD 34 ) on the urface (Figure 2D). Periodic acid-Schiff, Ziehl-Neelsen, nd polarized light studies were negative. Laboratory tests showed lymphopenia, angiotensin-conerting enzyme elevation (97 U/L, reference values 8-51 /L) with normal urine and blood calcium. Computed toography showed hiliar and supraclavicular adenopathies, nd respiratory function tests were normal. Scintigraphy ith gallium showed increased uptake in left parotid subandibular glands. The biopsy of one of the supraclavicular denopathies was compatible with sarcoidosis. Initial treatment with topical corticoids and oral hyroxychloroquine (200 mg/24 h) produced little response. he addition of oral prednisolone (30 mg/48 h) obtained nly a partial response. Then, the administration of allopu-

Sutura oblicua subcutánea

Please cite this article as: Serrano-Ortega S, Serrano-Falcón C, Fernández-Pugnaire M. Sutura oblicua subcutánea. Actas Dermosifiliogr. 2015;106:65--67. ∗ Corresponding author. E-mail addresses: salvio@ugr.es, consultadermatologia@gmail.com (S. Serrano-Ortega). removal is often delayed, but this frequently leaves suture marks along the borders of a scar in which dehiscence has occurred, giving rise to a typical ‘‘crab-like’’ appearance (Fig. 1). However, if the sutures are removed too early, wound dehiscence is possible. In 1992, Weber and Wulc described the vector-running suture for the closure of wounds situated in areas of tension

Scalp necrosis as a manifestation of temporal arteritis

Scalp necrosis as a manifestation of temporal arteritis An 85-year-old man with a history of hypertension and glaucoma was referred to us with a 2-month history of pain and skin necrosis on both temporoparietal regions (Fig. 1), which had been diagnosed as herpes zoster. The patient reported occasional fever below 38 C, asthenia, jaw claudication, pain on swallowing, weakness of scapular and pelvic waists, an unspecified weight loss, and general malaise. The physical examination showed extensive bilateral necrosis with serpiginous borders and a dirty and sphacelus appearance. The necrotic area was spontaneously highly painful and even more painful on palpation. The ophthalmologic examination was normal. The analytical study showed an elevated erythrocyte sedimentation rate (ESR) (70 mm in 1 h) and normochromic normocytic anemia. Temporal arteritis was suspected and a biopsy of the temporal artery confirmed the diagnosis (Fig. 2). Treatment was started with boluses of 6-methylprednisolone (500 mg · 3) and continued with oral steroids and oral methotrexate. The evolution was favorable. The areas of necrosis were debrided and were treated daily with antimicrobial cream to achieve granulation tissue and enable the area to be covered with skin grafts. The patient died soon after fromanacutemyocardial infarction. Temporal arteritis, giant cell arteritis, or Horton’s arteritis is characterized by a multisystem granulomatous vasculitis of the medium and large vessels, preferentially involving the external carotid area and, most frequently, the temporal artery. It is a rare disease, which appears in approximately 25 of every 100,000 individuals. It almost exclusively affects individualsagedover55years, females,andthewhitepopulation,althoughcaseshavebeenreportedinyoungpeople. It clinically manifests as cephalea, associated or not with a temporal artery of thickened, nodular appearance that is pulsatile and painful to palpation. It is usually accompanied by fever, general malaise, fatigue, anorexia, weight loss, jaw and tongue claudication, and musculoskeletal and ophthalmologic symptoms. It can also be associated with polymyalgia rheumatica syndrome. Cases of myocardial infarction, aorta dissection, strokes, and other infarctions of visceralorganshavebeenreportedinthesepatients. The diagnosis is simple in an elderly patient with the classic complex of fever, cephalea, and anemia with an increased ESR, and is confirmed by a biopsy of the temporal artery. Recent studieshaveproposedmagnetic resonanceangiography as a noninvasive method to aid in the clinical diagnosis and to select the optimal site for taking the biopsy, given that the involvementofthearteryisnotuniform. Pathology reveals a granulomatous arteritis that involves the inner layer with abundant multinucleated giant cells. It is associated with a proliferation of fibroblasts and muscle cells of the intima, with small changes in the middle layer, 466 Figure 1 Skin necrosis in both temporoparietal regions. The necrotic area shows serpiginous borders and a dirty and sphacelus appearance