Un caso de liquen plano asociado a tratamiento con imatinib / A case of lichen planus associated to treatment with imatinib

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Multiple pilomatricomas in association with trisomy 9.

Multiple appearance of pilomatricoma is a rare phenomenon that has been associated with some diseases like Gardner syndrome, myotonic dystrophy, and Rubinstein-Taybi syndrome. We present a case of association of multiple pilomatricoma and trisomy 9, which represents the third published in literature. As a result of the small prevalence of these two entities, we believe they could be related.

Congenital hemangioma: a report of evolution from rapidly involuting to noninvoluting congenital hemangioma with aberrant Mongolian spots.

Congenital hemangiomas are unusual vascular tumors that are fully developed at the time of delivery. We report a case of an infant with an exophytic congenital hemangioma with features of a rapidly involuting hemangioma on the arm which over 3 years decreased in volume but continued to persist with features of a noninvoluting congenital hemangioma. He also had aberrant, persistent Mongolian spots on both legs. To our knowledge, this association has not been reported to date.

Cutaneous reactive angiomatosis associated with chronic lymphoid leukemia.

Cutaneous reactive angiomatosis is an unusual benign vascular disorder of the skin usually associated to systemic diseases. It is characterized by lobular or diffuse proliferation of small blood vessels with hyperplasia of endothelial cells, pericytes, and sometimes histiocytes. We report a 59-year-old man with asymptomatic erythematous-violaceous patches on back, palms, and elbows for 9 months. Laboratory examination revealed changes consistent with B-chronic lymphocytic leukemia. Cutaneous biopsy showed a predominantly lobular small blood vessel proliferation in dermis with pericytic hyperplasia and mild perivascular lymphoplasmacytic infiltrate. Spontaneous involution of lesions occurred after 6 months. A second biopsy performed at the beginning of clinical involution showed a less prominent vascular component with perivascular giant cells with coexpression of CD68 and CD 31. To our knowledge, this is the first case of cutaneous reactive angiomatosis with documented histopathological findings of clinical involution.

Complex signatures of selection for the melanogenic loci TYR, TYRP1 and DCT in humans.

BACKGROUND: The observed correlation between ultraviolet light incidence and skin color, together with the geographical apportionment of skin reflectance among human populations, suggests an adaptive value for the pigmentation of the human skin. We have used Affymetrix U133a v2.0 gene expression microarrays to investigate the expression profiles of a total of 9 melanocyte cell lines (5 from lightly pigmented donors and 4 from darkly pigmented donors) plus their respective unirradiated controls. In order to reveal signatures of selection in loci with a bearing on skin pigmentation in humans, we have resequenced between 4 to 5 kb of the proximal regulatory regions of three of the most differently expressed genes, in the expectation that variation at regulatory regions might account for intraespecific morphological diversity, as suggested elsewhere. RESULTS: Contrary to our expectations, expression profiles did not cluster the cells into unirradiated versus irradiated melanocytes, or into lightly pigmented versus darkly pigmented melanocytes. Instead, expression profiles correlated with the presence of Bovine Pituitary Extract (known to contain alpha-MSH) in the media. This allowed us to differentiate between melanocytes that are synthesizing melanin and those that are not. TYR, TYRP1 and DCT were among the five most differently expressed genes between these two groups. Population genetic analyses of sequence haplotypes of the proximal regulatory flanking-regions included Tajima's D, HEW and DHEW neutrality tests analysis. These were complemented with EHH tests (among others) in which the significance was obtained by a novel approach using extensive simulations under the coalescent model with recombination. We observe strong evidence for positive selection for TYRP1 alleles in Africans and for DCT and TYRP1 in Asians. However, the overall picture reflects a complex pattern of selection, which might include overdominance for DCT in Europeans. CONCLUSION: Diversity patterns clearly evidence adaptive selection in pigmentation genes in Africans and Asians. In Europeans, the evidence is more complex, and both directional and balancing selection may be involved in light skin. As a result, different non-African populations may have acquired light skin by alternative ways, and so light skin, and perhaps dark skin too, may be the result of convergent evolution.

Terfenadine-induced apoptosis in human melanoma cells is mediated through Ca2+ homeostasis modulation and tyrosine kinase activity, independently of H1 histamine receptors.

In our previous works, we have demonstrated that terfenadine (TEF) induces DNA damage and apoptosis in human melanoma cell lines. In this present work, we have studied the effect of histamine on viability of A375 human melanoma cells and the cell-signalling pathways through which TEF may induce its apoptotic effect. We have found that exogenous histamine stimulates A375 melanoma cell proliferation in a dose- and time-dependent manner. Moreover, TEF-induced apoptosis seems to occur via other cellular pathways independent of the histamine-signalling system since co-treatment of histamine with TEF did not protect melanoma cells from the cytotoxic effect of TEF, and alpha fluoromethylhistidine did not induce the same cytotoxic effect of TEF. In addition, we have observed that knocking down the H1 histamine receptor (HRH1) by small interference RNA approach protects melanoma cells only slightly from TEF-induced apoptosis. To explore the molecular mechanisms responsible for histamine and TEF effect on the cell growth, we analysed intracellular cyclic nucleotides and Ca(2+) levels. TEF did not modify intracellular levels of cyclic adenosine 3',5'-monophosphate and cyclic guanine 3',5'-monophosphate; however, TEF induced a very sharp and sustained increase in cytosolic Ca(2+) levels in A375 melanoma cells. On the contrary, histamine did not modulate intracellular Ca(2+). TEF-induced Ca(2+) rise and apoptosis appear to be phospholipase C (PLC) dependent since neomycin and U73122, two inhibitors of PLC, abolished cytosolic Ca(2+) increase and protected the cells completely from cell death. Furthermore, inhibition of tyrosine kinase activity by genistein blocked cytosolic Ca(2+) rise and TEF-induced apoptosis. These results suggest that TEF modulates Ca(2+) homeostasis and induces apoptosis through other cellular pathways involving tyrosine kinase activity, independently of HRH1.

Dermatitis alérgica de contacto por propóleo / Allergic contact dermatitis from propolis

El propóleo es un producto elaborado por las abejas a partir de diferentes especies vegetales. Dadas sus propiedades antinflamatorias y antisépticas entre otras, es muy utilizada en productos naturales terapéuticos y cosméticos. A pesar de que inicialmente se considerara una dermatosis profesional, propia de apicultores, hoy en día la mayoría de casos de dermatitis alérgica por propóleo se dan precisamente en usuarios de productos naturistas que contienen propóleo. Presentamos un caso de dermatitis alérgica por una crema natural que contenía propóleo

Bees produce propolis from different vegetal species. As it is said to have anti-infl ammatory and antiseptic properties among many other, we can fi nd it in lots of natural therapeutic and cosmetic products. Although it was fi rst described like a professional dermatosis, nowadays most of the allergic contact dermatitis cases are reported in patients who use this kind of products. A case of allergic contact dermatitis due to a natural topical product is reported

H1 histamine receptor antagonists induce genotoxic and caspase-2-dependent apoptosis in human melanoma cells.

Previously, we found that the H1 histamine receptor antagonist diphenhydramine induces apoptosis in human acute T-lymphocytic leukemia cells. Since histamine has been shown to act as a growth factor in malignant melanoma cells, we decided to evaluate the in vitro effect of diphenhydramine and other H1 histamine receptor antagonists, such as terfenadine, astemizol and triprolidine on four malignant human melanoma cell lines. These antagonists were found to induce apoptotic cell death in all four melanoma cell lines. Apoptosis was determined by assessment of phosphatidylserine exposure on the surface of the cells and nuclear fragmentation. Importantly, H1 antagonist treatments did not adversely affect the viability of human melanocytes and murine fibroblasts at the same doses and duration of exposure. Treatment of melanoma cells with terfenadine induced DNA damage and caspases 2, 3, 6, 8 and 9 activation. Furthermore, the general caspase inhibitor (z-VAD-FMK) and a selective inhibitor of caspase-2 (z-VDVAD-FMK) protected melanoma cells from terfenadine-induced apoptosis. In contrast, the caspase-8 inhibitor (z-IETD-FMK) was ineffective. In addition, we found that mitochondria are involved in TEF-induced apoptosis, characterized by the dissipation of the mitochondrial transmembrane potential, the release of cytochrome c into the cytosolic compartment and caspase-9 activation. On the basis of these results we conclude that H1 histamine receptor antagonists induce apoptosis in human melanoma cells but not in normal melanocytes and embryonic murine fibroblasts; this apoptosis appears to be caspase-2-dependent and involves the mitochondrial pathway. The present results may contribute to the elaboration of novel therapeutic strategies for the treatment of malignant human melanoma.

Allergic contact dermatitis from cyanamide.

Cyanamide (carbimide or calcium carbimide) has been used to treat chronic alcoholism for more than 45 years. The skin reactions provoked by this medication are very rare and are generally associated with systemic reactions after ingestion of the product. However, allergic contact dermatitis has also been detected on persons who prepare cyanamide for administration to patients. We present a case of work-related allergic contact dermatitis from cyanamide that was confirmed by patch testing.

Día del Euromelanoma. Resultados en España de las campañas de 2000, 2001 y 2002 / Euromelanoma day. Results of the 2000, 2001 and 2002 campaigns in Spain

Fundamento. La Academia Europea de Dermatología instauró en el año 2000 una campaña de detección precoz de melanoma denominada «Día del Euromelanoma». Objetivo. Exponer los resultados españoles del «Día del Euromelanoma », en las campañas realizadas en los años 2000, 2001 y 2002. Material y métodos. Los miembros de la Academia Española de Dermatología participantes realizaron una revisión gratuita de cuantas personas pidieran cita para la detección de lesiones sospechosas. A los 4 meses de la visita, se localizó telefónicamente a todos los pacientes que habían sido diagnosticado de sospecha de melanoma para preguntar si las lesiones habían sido extirpadas y, en su caso, el resultado del estudio histológico de la pieza. Resultados. Se recibieron 33.750 llamadas para concertar cita y fueron examinados 12.487 pacientes. La participación media de dermatólogos fue de 399 académicos por año. Se detectaron un total de 164 lesiones sospechosas de melanoma, sobre todo en Andalucía y Cataluña, confirmándose histológicamente en 31 casos. La correlación clinicopatológica fue del 23,3 %, cifra mayor que la de Estados Unidos y similar a la de países mediterráneos. El espesor tumoral medio fue de 0,93 mm. Conclusiones. Aunque estas campañas tienen los inconvenientes de posibles sesgos en sus hallazgos y producir cierta alarma social, el beneficio para la población ha sido incuestionable en términos de concienciación hacia un problema sanitario

Background. In the year 2000, the European Academy of Dermatology and Venereology initiated a campaign, called «Euromelanoma Day,» for the early detection of melanoma. Objective. To discuss the results of «Euromelanoma Day» in Spain for the campaigns carried out in 2000, 2001 and 2002. Material and methods. Participating members of the Spanish Academy of Dermatology examined everyone who requested an appointment, free of charge, in order to detect suspicious lesions. Four months after the visit, telephone contact was made with all patients who had been diagnosed with suspected melanoma to ask them whether the lesions had been excised, and if so, the result of the histological study of the specimen. Results. 33,750 calls to set up an appointment were received, and 12,487 patients were examined. The average participation by dermatologists was 399 academy members per year. A total of 164 lesions suspected of being melanoma were detected, above all in Andalusia and Catalonia, and the diagnosis was histologically confirmed in 31 cases. The clinicopathological correlation was 23.3 %, a higher figure than the one for the USA and similar to the one for Mediterranean countries. The average thickness of the tumors was 0.93 mm. Conclusions. Although these campaigns have the drawback of possible bias in the findings and may cause some degree of public alarm, the benefit to the population was unquestionable in terms of heightening awareness of a health problem

[Euromelanoma Day. Results of the 2000, 2001 and 2002 campaigns in Spain]. / Día del Euromelanoma. Resultados en España de las campañas de 2000, 2001 y 2002.

BACKGROUND: In the year 2000, the European Academy of Dermatology and Venereology initiated a campaign, called "Euromelanoma Day," for the early detection of melanoma. OBJECTIVE: To discuss the results of "Euromelanoma Day" in Spain for the campaigns carried out in 2000, 2001 and 2002. MATERIAL AND METHODS: Participating members of the Spanish Academy of Dermatology examined everyone who requested an appointment, free of charge, in order to detect suspicious lesions. Four months after the visit, telephone contact was made with all patients who had been diagnosed with suspected melanoma to ask them whether the lesions had been excised, and if so, the result of the histological study of the specimen. RESULTS: 33,750 calls to set up an appointment were received, and 12,487 patients were examined. The average participation by dermatologists was 399 academy members per year. A total of 164 lesions suspected of being melanoma were detected, above all in Andalusia and Catalonia, and the diagnosis was histologically confirmed in 31 cases. The clinicopathological correlation was 23.3 %, a higher figure than the one for the USA and similar to the one for Mediterranean countries. The average thickness of the tumors was 0.93 mm. CONCLUSIONS: Although these campaigns have the drawback of possible bias in the findings and may cause some degree of public alarm, the benefit to the population was unquestionable in terms of heightening awareness of a health problem.

Neurocristopatía / Neurocristopathy

Las neurocristopatías son las enfermedades secundarias al desarrollo embriológico anómalo de la cresta neural. Al contribuir en la formación de varios tipos de células, las manifestaciones clínicas pueden afectar a una gran variedad de estructuras, entre ellas la piel. Se presenta una niña con un trastorno pigmentario congénito y estudio anatomopatológico compatible con una neurocristopatía (AU)

Tuberculosis cutánea en cicatriz quirúrgica / Skin tuberculosis in a surgical scar

La afectación cutánea por M. tuberculosis supone el 1 % de todas las formas extrapulmonares. Se presenta el caso de un varón de 55 años con antecedente de probable tuberculosis pulmonar en la juventud que refería que le habían extirpado unas adenopatías cervicales 20 años antes. Consultó por la aparición de una placa eritematosa, lineal, de años de evolución, sobre la cicatriz quirúrgica del cuello. A la exploración física no presentaba adenopatías palpables, ni otras lesiones cutáneas. La biopsia cutánea mostró una inflamación granulomatosa de tipo tuberculoide y las tinciones de ácido peryódico de Schiff y Ziehl-Neelsen fueron negativas. En el cultivo del tejido creció M. tuberculosis y el resto de estudios analíticos y radiológicos fueron normales o negativos. Con el diagnóstico de lupus vulgar sobre cicatriz quirúrgica se realizó tratamiento tuberculostático, que condujo a la curación de la lesión. Nuestro paciente presentó un lupus vulgar limitado a la zona de la cicatriz de linfadenectomía que sugerimos ocurrió por diseminación durante el acto quirúrgico de extirpación de adenopatías tuberculosas, que no fueron diagnosticadas en su momento (AU)

Protoporfiria eritropoyética: estudio de cuatro casos y revisión de la literatura / Erythropoietic protoporphiria a studt of four cases and review of the literature

La protoporfiria eritropoyética (PPE) es una enfermedad de origen genético provocada por el déficit de la enzima ferroquelatasa. Es poco frecuente y las características clínicas más frecuentes son las manifestaciones derivadas de la fotosensibilidad. Sin embargo, muchas veces los pacientes con PPE únicamente refieren sensaciones de prurito y quemazón tras la exposición al sol sin lesiones clínicas objetivables, lo que dificulta el diagnóstico. Describimos cuatro casos de PPE que hemos estudiado en la Unidad de Fotobiología de nuestro servicio y repasamos los aspectos más importantes de esta enfermedad (AU)

Kaposi's sarcoma in renal transplant patients: experience at the Cruces Hospital in Bilbao.

BACKGROUND: Kaposi's sarcoma (KS) in renal transplant recipients (RTRs) probably arises from a complex interplay of multiple factors. OBJECTIVE: In order to analyze the prevalence of KS in patients transplanted at the Cruces Hospital in Bilbao, together with their clinical features, treatment, and etiologic factors, we performed a study using the registry of RTRs in our center. METHODS: The records of 1,230 kidney transplant patients at the Cruces Hospital between 1979 and 1998 were reviewed. Immunosuppressive therapy was reduced once a diagnosis of KS was made. A nested polymerase chain reaction was used to detect human herpesvirus 8 (HHV-8) DNA in the biopsy tissue. The DNA was extracted from fresh tissue (n = 2) or from formalin-fixed, paraffin-embedded specimens (n = 5). RESULTS: Six cases of KS were diagnosed. All patients with cutaneous KS improved with a reduction in immunosuppressive drugs. HHV-8 was detected in 100% (2/2) of the frozen biopsies and 20% (1/5) of the formalin-fixed samples investigated. CONCLUSIONS: Our experience indicates that a continuous state of immunodeficiency is important for the development of KS in RTRs. The association, previously described between HHV-8 and transplant-associated KS, also exists in the studied population.