Psoriasis pustulosa palmar unilateral: A propósito de un caso / Unilateral palmar pustular psoriasis: A clinical case

La psoriasis pustulosa palmoplantar (PPP) es una enfermedad inflamatoria crónica y recurrente, caracterizada por la presencia de pústulas estériles, sobre una base eritematosa en palmas y plantas. Es de gran importancia, debido a que ocasiona tanto limitación funcional como disminución en la calidad de vida, siendo en la mayoría de los casos refractaria al tratamiento. Se presenta un caso de PPP, donde fueron necesarias aplicar terapias combinadas: tópica y sistémica (esteroides de alta potencia y ciclosporina), con evolución satisfactoria en cuatro semanas de tratamiento. Se realizó una revisión exhaustiva en los motores de búsqueda como: Latindex.org, Scielo.org y Google académico, de las publicaciones más representativas hasta la actualidad y las palabras clave, a través de la web de Medical Subject Headings.

Palmoplantar Pustular Psoriasis (PPP) is a chronic and recurrent inflammatory disease, characterized by the presence of sterile pustules on an erythematous base in palms and soles. It is important because it causes both functional limitation decreasing quality of life. In most cases refractory to treatment. We present a case of PPP with topical and systemic combined therapy (high potency corticoids and cyclosporine) with satisfactory outcomes at four weeks of treatment. An exhaustive review in search engines as Scholar Google, Latindex and Scielo was made for the last 30 years and key words in Medical Subject Headings.

Comparative study of oral methotrexate and acitretin in the treatment of palmoplantar psoriasis.

Background: Psoriasis is chronic inflammatory skin condition. Palmoplantar psoriasis is a type where lesions are present on the palms and soles. This type affects patient’s quality of life and is difficult to treat. Topical modes of treatment are not so effective and produce inadequate response. Systemic drugs are necessary in the treatment of moderate to severe disease. The objective was to compare the efficacy of oral methotrexate and acitretin in treatment of moderate to severe palmoplantar psoriasis and there side effects. Methods: 50 patients with palmoplantar psoriasis were randomized into 2 groups. Patients in group I received oral methotrexate and patients in group II received acitretin for 3 months. Baseline grading was done with Modified Psoriasis Area Severity Index (MPASI) score. MPASI score was assessed monthly. Scores at the beginning and at the end of 3 months of treatment were compared. Quality of life was assessed using a questionnaire. Results: MPASI score in group I was 57.15 ± 17.17 at baseline and 14.50 ± 13.55 at the end of 3rd month. The difference in scores before and after treatment was statistically significant. MPASI score in group II was 57.76 ± 18.60 at baseline and 21.30 ± 8.168 at the end of 3rd month. Intragroup analysis showed statistically significant difference before and after treatment. There was significant improvement in the quality of life after treatment. Conclusion: Oral methotrexate reduces the lesions faster than acitretin. Both oral methotrexate and acitretin are highly effective in treating palmoplantar psoriasis and in improving patient’s quality of life.

Cardiac Myxoma Diagnosed by Signs of Purpuric Macules on Both Palms and Soles

Cardiac myxoma, the most prevalent primary cardiac tumor, is rare. The clinical features of this tumor are principally intracardiac obstruction, extracardiac embolism, and general symptoms including fever, myalgia, arthralgia. Although cutaneous manifestations in patients with cardiac myxoma are frequent, in rare cases, cutaneous signs have been clues to the correct diagnosis. We report a 42-year-old male who presented with recurrent multiple purpuric patches on both palms and soles for 4 months. Histopathological finding showed a myxomatous embolus in the arteriole in the lower dermis. Echocardiogram demonstrated the presence of a left atrial myxoma with a provisional diagnosis of left atrial myxoma. In our patient, skin examinations and histopathological finding led us to the diagnosis of cardiac myxoma.

Nevos melanocíticos palmoplantares: correlación dermatoscópica e histopatológica / Melanocytic nevi in palms and soles: dermatoscopy and histopathogic correlation

Introducción. El nevo se define como malformación circuscripta de los tegumentos, disembrioplásicos o hereditarios, transitorios o permanentes. Su importancia radica en su conocida relación casual con el melanoma. Un porcentaje de los melanomas proviene de nevos melanocíticos preexistentes. Por este motivo es importante distinguir aquellos que tienen alto riesgo de modificarse. La dermatoscopía es una técnica no invasiva, especialmente útil en la distinción de lesiones pigmentadas melanocíticas y no melanocíticas y, dentro de las primeras, entre nevos y melanoma. La piel volar presenta características especiales que producen imágenes dermatoscópicas peculiares. Objetivos, Descripción de los patrones dermatoscópicos acrales y frecuencia de presentación, correlación dermatoscópica e histopatológica de los nevos palmoplantares. Evaluar la concordancia dermatoscópica entre el investigador y un observador independiente. Material y métodos. Estudio observacional, prospectivo, transversal y analítico de pacientes con diagnóstico clínico de nevos melanocíticos palmoplantares. Se realizó en el hospital Privado de Córdoba entre mayo 2006 y abril 2007. Variables a estudiar: edad, sexo, antecedentes personales, fototipo, localización, patrón dermatoscópico y patrón histológico. Todos los pacientes fueron observados por el investigador y un observador independiente. Se realizó dermatoscopía y cirugía de todos los nevos. Resultados. En 74 pacientes, promedio de edad 32 años, con fototipo principal el II, se detectaron 83 nevos melanocíticos acrales. El patrón dermatoscópico más frecuente fue el paralelo del surco, y el patrón histológico fue el compuesto. La concordancia dermatoscópica fue excelente, calculada con el valor Kappa. Conclusión. Los patrones dermatoscópicos hallados en nuestro estudio coinciden con la literatura consultada.

Introduction.Nevus is defi ned as a circumscribed malformation, whichcan be dysembryoplastic or hereditary, temporary or permanent, of the teguments. Nevi are important given their well-known causal relationship with melanoma, a percentage of which results from preexisting melanocytic nevi. The refore, it is important to distinguish nevi which run the risk of undergoing a change. Dermoscopy is a non-invasive technique particularly useful to distinguish pigmented melanocytic lesions, which can be nevior melanomas, and pigmented non-melanocytic lesions. Volar skin exhib-its special dermoscopic features which produce particular images. Objectives. To describe the acral dermoscopic patterns, the frequency with which they occur and the dermoscopic and histopathologic correlation of nevi of the palms and soles, and to assess the dermatoscopic agreement between the investigator and an independent observer.Material and Methods. Observational, prospective, transverse and analytical study of patients with the clinical diagnosis of melanocytic nevi of the palms and soles. The study was conducted at Hospital Privado, in Córdoba, from May 2006 through April 2007. The variables to be studied were age, sex, personal history, phototype, location and dermoscopic and histologic patterns. All the patients were observed by the investigator as well as an independent observer, and dermoscopy and surgery were performed in all nevi. Results. 83 acral melanocytic nevi were detected in 74 patients with amean age of 32 and phototype II. The most frequent dermoscopic pat-tern was the parallel furrow pattern and the most frequent histologic pattern was the compound one. The dermoscopic agreement, calculated with Kappa values, was excellent. Conclusion.The dermoscopic patterns found in our study is consistedwith the literature reviewed.

A Case of Basal Cell Nevus Syndrome with Symmetric Basal Cell Carcinomas on Neck

Basal cell nevus syndrome is an autosomal dominant disorder characterized by developmental and skeletal anomalies, palmo-plantar pits, odontogenic keratocysts, ectopic calcification, and occurrence of various types of tumors including basal cell carcinoma. Within our country, 9 cases at dentistry and 3 cases at dermatology were reported. The patient was a 66-year-old woman. Chief complaint was multiple dark brownish colored papules which were symmetrically distributed around the neck. Excision and biopsy were done under general anesthesia and the wound was healed without complication. Histological examination of the lesion revealed 'basal cell carcinoma'. During the evaluation of metastasis of basal cell carcinoma, at PNS CT we found odontogenic keratocyst on the left alveolar process of maxilla by accident. Physical examination revealed pits of the palm and sole. These are consistent with the major diagnostic criteria for basal cell nevus syndrome. Hereby we report one case of basal cell nevus syndrome.

A Case of Nevoid Basal Cell Carcinoma Syndrome with Multiple, Symmetrically Distributed Basal Cell Carcinomas / 대한피부과학회지

Nevoid basal cell carcinoma syndrome is a rare inherited disorder characterized by multiple cutaneous basal cell carcinoma, pits of the palms and soles, cysts of the jaws, and ectopic calcification of cranial membranes. The patient was a 66 year old female. She complained of multiple, symmetrically distributed black-colored papules on the both sides of the neck. On physical examination, multiple pits were detected in the palms and soles. The histopathologic findings of the papules showed variable shaped and sized tumor nests composed of basaloma cells. On PNS CT for search of metastasis of the cancer, odontogenic keratocyst was detected at the Lt. alveolar process of maxilla by accident. We diagnosed her nevoid basal cell carcinoma syndrome and the lesions on both sides of the neck were removed completely.