Dermatoses in Latin American Immigrant Children Seen in a Universitary Hospital of Spain.

Over the past 10 years Spain has become an important immigrant receiver country as the proximity with Africa and the cultural facilities with Latino-American countries have made of Spain a very attractive place to settle down for immigrants. From 1st January 2007 to 31st December 2007, all the pediatric patients visits (0-14 years old) seen in the units of the Dermatology Section of the University General Hospital of Alicante (Spain) were prospectively recorded. During the study period 3,108 visits were recorded. Of these, 447 (14.3 %) were generated by immigrant children, 243 (54.3 %) being episodes requested by 167 Latin American patients. Latin children consulted mainly in the outpatient clinic, like Spanish children. The most frequent type of dermatoses in these patients was eczema/atopic dermatitis. Infectious dermatitis showed no differences between them and Spaniards, but scabies was six times more frequent in the formers.

Congenital lower limb enlargement in a newborn.

A full-term newborn presented with swelling of his right leg soon after birth. There was no alteration in Doppler. The grandmother and other relatives were said to have shown a similar history at birth. Milroy's disease was then diagnosed and compressive massage was advised.

Fragrance contact allergy: a 4-year retrospective study.

BACKGROUND: Fragrance chemicals are the second most frequent cause of contact allergy. The mandatory labelling of 26 fragrance chemicals when present in cosmetics has facilitated management of patients allergic to fragrances. OBJECTIVES: The study was aimed to define the characteristics of the population allergic to perfumes detected in our hospital district, to determine the usefulness of markers of fragrance allergy in the baseline GEIDAC series, and to describe the contribution made by the fragrance series to the data obtained with the baseline series. MATERIAL AND METHODS: We performed a 4-year retrospective study of patients tested with the Spanish baseline series and/or fragrance series. There are four fragrance markers in the baseline series: fragrance mix I (FM I), Myroxylon pereirae, fragrance mix II (FM II), and hydroxyisohexyl 3-cyclohexene carboxaldehyde. RESULTS: A total of 1253 patients were patch tested, 117 (9.3%) of whom were positive to a fragrance marker. FM I and M. pereirae detected 92.5% of the cases of fragrance contact allergy. FM II and hydroxyisohexyl 3-cyclohexene carboxaldehyde detected 6 additional cases and provided further information in 8, enabling improved management. A fragrance series was tested in a selected group of 86 patients and positive results were obtained in 45.3%. Geraniol was the allergen most frequently found in the group of patients tested with the fragrance series. CONCLUSIONS: Classic markers detect the majority of cases of fragrance contact allergy. We recommend incorporating FM II in the Spanish baseline series, as in the European baseline series, and using a specific fragrance series to study patients allergic to a fragrance marker.

Mammary skin tag in a 2-year-old girl: a long-lasting adnexal polyp of neonatal skin?

We describe the case of a 2-year-old girl showing a pedunculated lesion on the areola of the nipple since birth. Clinical and histological features were consistent with an adnexal polyp of neonatal skin observed beyond the neonatal period.

Atypical presentation of an omphalomesenteric duct cyst.

We describe a clinical case of an omphalomesenteric duct (OMD) cyst that presented as an umbilical nodule with a late and atypical clinical presentation. This report illustrates the possibility of OMD cyst resembling a keloid or dermatofibroma.

Bullous congenital ichthyosiform erythroderma: a sporadic case produced by a new KRT10 gene mutation.

Bullous congenital ichthyosiform erythroderma is an unusual type of inherited ichthyosis by mutations in the genes that encode K1 and K10. We report the case of a girl with typical clinical and histopathologic findings of bullous congenital ichthyosiform erythroderma, who was found to have a new mutation in KRT10 gene, Glu445Lys at position 445, affecting the 2B region of the KRT10 protein, the end of the rod domain, where many other keratin mutations associated with hereditary skin disease have been reported. This new mutation contributes to add to the catalog of bullous congenital ichthyosiform erythroderma mutations known.

Extragenital bullous lichen sclerosus atrophicus.

Lichen sclerosus et atrophicus (LSA) is a rare, chronic, mucocutaneous disease of unknown etiology. Onset can occur in subjects of any age, but the condition is more prevalent in adult females around the time of menopause. In both sexes, the most common site of the lesions is the anogenital area. Bullous lichen sclerosus et atrophicus is an unusual form of the disease and the exact prevalence is not known. We describe a case of nongenital bullous LSA in a man.

Dermatoses in Latin American immigrants seen in a tertiary hospital.

Europe, and in particular Spain, has become the destination of a considerable number of immigrants, 50% come from Latin America. The purpose of this study was to describe the cases of dermatoses seen in the immigrant Latin American population and compare them with those found in the control Spanish population. Over a year all the visits of economic immigrants seen in the Dermatology Section of the Hospital General Universitario de Alicante were prospectively recorded. During the study period 706 Latin American patients were seen. The most frequent dermatoses were eczema (18.2%), acne (6.5%) and non-genital viral warts (6.3%). The comparative study of dermatoses adjusted for age and sex, found a greater frequency of eczema, alopecia, melasma, herpes simplex, pilar keratosis, xerosis, and scabies (p < 0.01) in the Latin American population. On the other hand, melanocytic nevi and melanoma were less frequent in these patients (p < 0.05). We may say that the skin type and socio-sanitary conditions of the Latin American immigrant population lead to a greater frequency of eczema, melasma and scabies. In addition, the skin type and younger age favour a lower frequency of skin tumours.

Nail changes in Langerhans cell histiocytosis: a possible marker of multisystem disease.

We describe a child with a 6-month history of onycholysis, subungual hyperkeratosis, and hemorrhages in most of her fingernails and toenails. Nail involvement preceded the identification of osteolytic lesions at the mastoid on a cranial computed tomography scan, which was performed because of repeated episodes of acute otitis media. Some weeks later, a small number of erythematous papules developed over the trunk and face. The diagnosis of Langerhans cell histiocytosis was made by histopathologic examination of bone, skin, and bed and matrix nail biopsies. Response to treatment with vinblastine and prednisone was excellent. Nail changes in Langerhans cell histiocytosis are extremely uncommon, particularly as the presenting manifestation of the disease. The role of nail involvement as an unfavorable prognostic sign is unclear.

Multiple lentigines arising in resolving psoriatic plaques after treatment with etanercept.

Development of lentigines in zones previously affected by plaques of psoriasis has been described, and its frequency has probably been underestimated. Most cases have been described following the use of phototherapy, although other authors have observed the appearance of lentigines in patients with psoriasis treated only with topical products. It has been suggested that the mechanism involved could be an abnormal reaction to UV light or an unusual form of postinflammatory hyperpigmentation. We report the case of two patients in whom multiple lentigines appeared, confined to plaques of psoriasis after using etanercept. Development of lentigines after using biologic drugs is a phenomenon that does not appear to have been described previously. We consider that the mechanism of production of lentigines is related to psoriasis itself and not to the therapy used.

Non-melanocytic benign skin tumors in children.

BACKGROUND: Dermatologists often attend children with benign skin tumors and cysts. The decision to perform dermatologic surgery in children may be difficult to make, especially in cases of benign tumors. OBJECTIVE: The objective of this study was to determine the nature of non-melanocytic benign skin tumors amenable to dermatologic surgery in children. METHODS: Histopathologic studies of skin tumors in children treated by our department between January 2004 and December 2005 were studied. Malignant and melanocytic tumors were excluded. Age, sex, type of tumor, diagnostic category, site, size, reason for removal, type of anesthesia, and any other associated disorders were recorded. RESULTS: The records revealed that 121 patients presented 129 non-melanocytic benign skin tumors (73 in boys and 56 in girls). A total of 27 different anatomopathologic diagnoses were found. The most frequent was pilomatrixoma with 27 cases (20.9%), followed by infundibular cyst with 14 (10.9%), and molluscum contagiosum with 13 (10.1%). Tumors were located on the head and neck (45.7%), trunk (34.1%), and limbs (20.1%). The most frequently affected age group was children aged 11-14 years, which included 50 patients (38.8%). The main type of anesthesia used was local in 54.6% of the cases, sedation plus local anesthesia in 39.7%, and general anesthesia in 5.7%. The reasons that led to removal of the tumors were: increase in the size of the tumor (49%); various types of discomfort, such as severe itching or pain (30%); parental concern (4%); diagnostic uncertainty (16%); and esthetic reasons (1%). CONCLUSION: There is a wide diversity of non-melanocytic benign skin tumors in children, some of which require surgical treatment. Pilomatrixomas appear to be the most frequent benign tumors; there are also high frequencies of infundibular cysts, pyogenic granulomas, and viral tumors. Most can be removed under local anesthesia, with or without sedation.