Víctor Alegre de Miquel

An immunohistochemical study of verrucous hemangiomas

According to the International Society for the study of vascular Anomalies, vascular anomalies are classified as vascular neoplasms and vascular malformations. In some vascular lesions, categorization as a neoplasm or malformation has not been established with confidence so far. In order to further clarify the nosology of verrucous hemangioma, we studied 13 cases.

Erythematous indurated plaque on the right upper limb

A 74-year-old woman with a history of hepatitis C presented with a painful rash on her right upper limb. The eruption had been present for approximately six weeks and had remained unchanged since onset. Two months previously, she had surgery on her shoulder due to a humerus fracture with placement of an orthopedic metal implant. The patient had no known history of rheumatoid arthritis. Physical examination revealed a poorly demarcated erythematous to brown indurated plaque overlying the surgical scar (Fig. 1). Figure 3 Intraluminal aggregates of mononuclear cells with eosinophilic cytoplasm and oval, uniform nuclei (hematoxylin-eosin; original magnification 9400)

Adult pityriasis lichenoides‐like mycosis fungoides: a clinical variant of mycosis fungoides

Mycosis fungoides (MF) is the most frequent type of cutaneous T cell lymphoma. Its clinicopathological spectrum is wide, and the resulting diversity makes it difficult to establish a differential diagnosis among pityriasis lichenoides (PL), lymphomatoid papulosis (LyP), and atypical MF.

Vulvar Epidermal Inclusion Cyst as a Long-term Complication of Female Genital Mutilation.

We present a case report of a patient with epidermal inclusion cyst as a late complication of female genital mutilation (FGM). We describe the management of the patient, and a review of the literature. We report the clinical and pathological findings in a 37-year-old female patient from Nigeria, with a clitoral mass of 1 year duration. She declared to have an FGM since she was 5 years. The lesion was excised successfully with good cosmetic results. Histological examination revealed epidermal cyst with the presence of granular layer. An epidermal inclusion cyst can develop as a long-term consequence of FGM.

Malignant syphilis with ocular involvement in an immunocompetent patient

matic amine hair dyes in products such as that sourced by our patient will greatly increase the risk for a reaction. The 2010 British Society of Cutaneous Allergy PPD information leaflet states that there is a significant risk for a reaction to PTD, para-aminodiphenylamine, 2,4-diaminoanisole, and m-, pand o-aminophenol in PPD-sensitized individuals. We support the view that the safest way to avoid potentially severe hair dye reactions in PPD-allergic patients is to recommend that they avoid all permanent and semi-permanent hair dyes. Our case reinforces the need to provide PPD-allergic patients with clear information to ensure that they do not unintentionally expose themselves to risk as a result of potentially misleading labeling on hair dye products. Non-reactive patch testing to PTD may allow a PPDsensitive individual to use a permanent hair dye, provided that PTD is the only hair colorant present. However, because most permanent hair dyes contain a number of potentially cross-reactive colorants, we recommend the use of only non-permanent hair dyes. In compliance with this advice, our patient has continued to use non-permanent hair dyes without problems.

Retiform Purpura Caused by the Use of Cocaine, That Was Probably Adulterated with Levamisole

Vol. 27, No. 1, 2015 117 Received June 24, 2013, Revised January 23, 2014, Accepted for publication April 27, 2014 Corresponding author: Jose Luis Torregrosa Calatayud, Department of Dermatology, General Hospital of Valencia, Avenida Tres Cruces No2, Valencia 46014, Spain. Tel: 34-665242548, Fax: 34-963-131-297, E-mail: joseluistorregrosa17@gmail.com This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http:// creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Online J 2011;17:25. 3. López-Cepeda LD, Domínguez-Gómez MA, Novales-Santa CJ, Guarneros-Campos A. Segmental neurofibromatosis of facial localization. Int J Dermatol 2005;44:583-586. 4. Agarwal A, Thappa DM, Jayanthi S, Shivaswamy KN. Segmental neurofibromatosis of face. Dermatol Online J 2005;11:33. 5. Jankovic I, Kovacevic P, Visnjic M, Jankovic D, Velickovic M. A unique case of hereditary bilateral segmental neurofibromatosis on the face. An Bras Dermatol 2012;87:895-898.

Improvement of alopecia areata with apremilast

nodules on her buttocks (Fig. 1a). Ultrasonography revealed multiple 6–10 mm low-echo subcutaneous nodules with a cyst wall-like structure (Fig. 1b). Punched biopsy showed whitish fluid in the subcutaneous nodules (Fig. 1c). A punched biopsy specimen revealed subcutaneous cysts and the infiltration of focal inflammatory cells into the subcutaneous tissue (Fig. 1d). The cyst wall consisted of fibrotic tissue, lymphocytes, and the infiltration of histiocytes around necrotic adipocytes (Fig. 1e). Focal inflammatory cell infiltration involved histiocytes, multinucleated giant cells, and plasma cells around necrotic adipocytes (Fig. 1f). Since there were no subcutaneous nodules at other locations except the buttocks, we diagnosed the patient with subcutaneous fat necrosis caused by progesterone injections. Fat necrosis is a rare cutaneous complication at injection sites. There are no published data on fat necrosis after progesterone injections. Several drugs, including glucocorticoids, interferon, and insulin, have reportedly been associated with localised lipoatrophy. Glucocorticoids and interferon may have negative effects on the microcirculation by attenuating the formation of micro blood vessels, thereby inducing capillary thrombosis and vasculitis. In this case, histopathological findings showed no thrombosis or vasculitis, but revealed histiocyte infiltration and multinucleated giant cells around necrotic adipocytes, which may reflect a foreign body response to injected progesterone. Progesterone induces the growth of the uterine membrane to promote embryo implantation and increases body temperature. The effects of progesterone injections are confirmed using a basal body temperature graph. At the first progesterone injection, her body temperature was maintained at higher levels for the luteal phase for 2 weeks. However, it was not maintained at higher levels for the luteal phase by progesterone injections 7 months later. Although we did not analyse the whitish fluid for its content, we considered that injected progesterone might have been capsulised as subcutaneous nodules due to foreign body granulation and fat necrosis. We herein report a case of fat necrosis that resulted in subcutaneous nodules after progesterone injections. In the case of the fertility treatment, subcutaneous nodules need to be considered if the basal body temperature graph is not maintained at higher levels.

Eccema de manos en niños. Estudio clínico-epidemiológico de la población remitida a un hospital terciario

INTRODUCTION Hand eczema is a frequent disease in adults. Diagnosing the cause of hand eczema is difficult due to different classifications. There is lack of evidence on hand eczema and its causes in children. MATERIAL AND METHOD A total of 389 children between 0 and 16 years were identified between 1996 and 2016, from whom 42 (10.8%) with exclusively hand eczema were selected. In all cases a standard battery of epicutaneous patch tests was performed, as well as additional batteries depending on the clinical suspicion. The clinical and epidemiological features of these children were recorded and compared against children with eczema in other locations. RESULTS The 42 children with hand eczema included 25 (60.5%) girls, and 17 (40.5%) boys, with a mean age of 10.6 +- 3.9 years, and did not differ from that of children with eczema in other locations. The definitive diagnosis after patch-testing was Atopic Dermatitis in 15 cases, Allergic Contact Dermatitis in 14 patients, Endogenous Vesiculous Eczema in 6 cases, Endogenous Hyperkeratotic Eczema in 5 cases, and Irritant Contact Dermatitis in 2 cases. The most frequent allergens detected were thiomersal (9 cases), nickel (5 cases), mercury (5 cases), and cobalt (4 cases). CONCLUSION Hand eczema is a common condition in children. The most common cause is atopic dermatitis, although cases of allergic contact dermatitis manifesting as hand eczema are not uncommon. Any child with eczema of hands in whom an allergic cause is suspected should be referred for patch- testing.

Interferon alfa–induced sarcoidosis resolving without drug withdrawal

Sarcoidosis is an uncommon systemic granulomatous disease of unknown origin affecting lung, skin, liver, and other tissues. Noncaseating granulomas in the involved organs are the hallmark of this disease. An exaggerated immune response to an unknown antigenic stimulus could play a role in sarcoidosis development. Lung is one of the most frequently involved organs.1 Manifestations range from alveolitis to granulomatous infiltration of alveoli, bronchi, and blood vessels. The end stage of lung sarcoidosis is development of interstitial fibrosis with “honeycombing” of lung parenchyma. Interferon alfa in association with ribavirin is the treatment of choice for hepatitis C. Early treatment of acute hepatitis C with interferon alfa-2b will prevent the development of hepatic cirrhosis, but adverse effects are frequent and often can result in discontinuation of treatment.2 Most frequent adverse effects related to interferon are malaise, fever, arthralgia, and cough. Pulmonary events such as bronchial asthma, bronchiolitis obliterans, and interstitial pneumonitis have been reported. Interferon alfa is also used in the treatment of malignant melanoma, multiple myeloma, hairy-cell leukemia and HIV-associated Kaposis sarcoma.3 Some cases of sarcoidosis after treatment with interferon alfa have been reported in the literature.4, 5, 6 Improvement of sarcoidosis has been reported with discontinuation of treatment, but in other cases an independent course of disease has been proposed, raising the belief that interferon discontinuation is unnecessary in mild-to-moderate cases of interferon-related sarcoidosis.7 We present the case of a patient with hepatitis C treated with interferon in whom pulmonary sarcoidosis developed. The sarcoidosis was initially believed to be a pulmonary neoplasm, but skin lesions developed that indicated the diagnosis of systemic sarcoidosis. The sarcoidosis finally resolved without discontinuation of interferon alfa.

Intensification therapy with golimumab: a new treatment strategy for moderate–severe refractory psoriasis

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