Dermoscopic features of melanocytic nevi in seven different anatomical locations in patients with atypical nevi syndrome.

BACKGROUND: Dermoscopic screening facilitates early detection of melanoma and is recommended in patients with multiple or atypical nevi. OBJECTIVES: To investigate whether dermoscopic features of acquired melanocytic nevi differ between six body sites (neck, axilla, pectoral area, shoulders, buttocks, legs) and the trunk. METHODS AND MATERIALS: One hundred six patients with atypical nevi syndrome from a Digital Dermoscopy Unit were evaluated for the presence of nevi in each of seven body sites, and nevi representative of each region were selected as the predominant nevi. Dermoscopic features of 684 melanocytic nevi located in seven different body sites were analyzed. RESULTS: Globular and globular-homogeneous pattern nevi showed a cephalad distribution. Nevi at the neck, axilla, shoulders, and pectoral area showed a higher proportion of globular and globular-homogeneous patterns than other locations (p < .001). Comma vessels were also more frequent on the neck, axillary area, and shoulders (p < .001). A reticular pattern was more frequent on caudal areas (legs, buttocks and lower back, and abdomen; p < .001). CONCLUSIONS: Dermoscopic differences were found in different body areas. This information should be considered in the evaluation of lesions in patients with atypical nevus syndrome.

Úlcera gigante en la espalda / Giant ulcer on the back

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Eczema alérgico de contacto por resina epoxi / Allergic contact eczema from epoxy resin

Las resinas epoxi son plásticos muy empleados como aislantes eléctricos, en recubrimientos y como adhesivos y pinturas. Presentan un gran poder sensibilizante y son una de las principales causas de eczema alérgico de contacto, tanto en el medio laboral como fuera de éste. Presentamos el caso de un trabajador de una planta plastoquímica que manipulaba componentes de material aeronáutico en el proceso de fabricación de piezas de fuselaje. Consultó por lesiones eczematosas en los dedos, manos y antebrazos, de 2 años de evolución, en clara relación con su actividad laboral. Se realizaron pruebas epicutáneas con la batería estándar, la de plásticos y adhesivos y sus productos propios. Se objetivaron positividades a resinas epoxi (batería estándar) y a sus productos propios, entre los que se encontraban distintas láminas de fibras de vidrio y carbono impregnadas con resinas epoxi y adhesivos epoxi

Epoxy resins are plastics that are widely used as electrical insulation, in coatings, and as adhesives and paints. They have strong sensitizing power and are one of the main causes of allergic contact eczema, both in the workplace and elsewhere. We present the case of a worker at a plastics/ chemical plant, who handled aeronautical components in the process of manufacturing fuselage parts. He consulted his physician because of eczematous lesions on his fingers, hands and forearms which had developed over a two-year period and were clearly related to his work. The standard battery of skin tests was performed, along with the plastics and adhesives series and tests using the products from his workplace. Positivity was shown to epoxy resins (standard battery) and to the products from his workplace, which included different fiberglass and carbon fiber sheets impregnated with epoxy resins and epoxy adhesives

Xantomas en paciente con histiocitosis de células de Langerhans y cirrosis biliar / Xanthomas in a patient with Langerhans cell histiocytosis and liver cirrhosis

La afectación cutánea en las formas agudas de histiocitosis de células de Langerhans (HCL) es en forma de pápulas eritematosas, aunque se han descrito formas raras de lesiones xantomatosas. Presentamos el caso de un niño con HCL aguda diseminada, que comenzó a los 16 meses de edad con brotes de lesiones cutáneas tipo dermatitis seborreica y disfunción hepática progresiva. El cuadro se complicó con diabetes insípida central parcial e infiltración específica pulmonar por células de Langerhans, que desembocó en fibrosis. En su evolución, el paciente desarrolló cirrosis biliar, alteración del perfil lipídico y lesiones cutáneas xantomatosas diseminadas, concomitantes con aquéllas específicas de su HCL. A pesar de sucesivos ciclos de quimioterapia, el curso fue ominoso, y el paciente falleció al cabo de 5 años a causa de su enfermedad hepática. Las lesiones xantomatosas en los cuadros de HCL son típicas de fases tardías de formas crónicas progresivas, como la enfermedad de Hand-Schüller-Christian. Cuando aparecen en las formas agudas diseminadas existe controversia sobre si corresponden a una progresión de la enfermedad hacia formas más crónicas o si se trata de lesiones independientes asociadas, como en el presente caso

Skin involvement in acute forms of Langerhans cell histiocytosis (LCH) is in the form of erythematous papules, although rare forms of xanthomatous lesions have been described. We present the case of a boy with acute disseminated LCH who, at the age of 16 months, began to experience outbreaks of seborrheic dermatitis-like skin lesions and progressive hepatic dysfunction. The symptoms were complicated by partial central diabetes insipidus and specific pulmonary infiltration by Langerhans cells, which led to fibrosis. During the course of the disease, the patient developed liver cirrhosis, alterations in the lipid profile and disseminated xanthomatous skin lesions, concomitant with the lesions specific to the LCH. Despite successive cycles of chemotherapy, the outcome was the death of the patient after five years, due to his liver disease. Xanthomatous lesions in LCH are typical of the late stages of chronic progressive forms, such as Hand-Schüller-Christian disease. When they appear in acute disseminated forms, there is some controversy over whether they correspond to a progression of the disease towards more chronic forms, or whether they are associated independent lesions, such as in this case

Sarcoidosis subcutánea como primera manifestación de enfermedad sistémica / Subcutaneous sarcoidosis as the first manifestation of systemic disease

Hasta en el 25 % de los pacientes con sarcoidosis existe sintomatología dermatológica y es rara la aparición de nódulos subcutáneos específicos como manifestación de esta entidad. Éstos pueden, incluso, anteceder a otras manifestaciones de sarcoidosis. Se presenta el caso de una mujer de 38 años de edad, con nódulos subcutáneos asintomáticos en miembros que correspondían a granulomas sarcoideos profundos en el estudio histológico. No presentaba otros datos extracutáneos. En las pruebas de imagen realizadas se encontraron adenopatías paratraqueales derechas. Con todo ello se llegó al diagnóstico de sarcoidosis, en su doble vertiente subcutánea y pulmonar (estadio I). La sarcoidosis subcutánea es probablemente una entidad infradiagnosticada, ya que existen menos de 40 casos recogidos en la literatura médica. Su valor estriba en que puede ser la primera manifestación de una sarcoidosis extracutánea o sistémica, por lo que se hace necesario considerar esta forma de sarcoidosis en el diagnóstico diferencial de las lesiones nodulares subcutáneas así como el seguimiento estrecho de estos pacientes

There are dermatological symptoms in up to 25 % of patients with sarcoidosis, and the appearance of specific subcutaneous nodules as a manifestation of this entity is rare. They may even predate other manifestations of sarcoidosis. We present the case of a 38-year-old woman with asymptomatic subcutaneous nodules in the limbs, which corresponded to deep sarcoid granulomas in the histological study. She did not present with any extracutaneous indications. The imaging tests performed revealed right paratracheal adenopathies. This led to the diagnosis of sarcoidosis, in both its subcutaneous and pulmonary forms (stage I). Subcutaneous sarcoidosis is probably an underdiagnosed entity, as fewer than 40 cases are reflected in literature. Its value lies in the fact that it may be the first manifestation of extracutaneous or systemic sarcoidosis, which means that this form of sarcoidosis must be considered in the differential diagnosis of subcutaneous nodular lesions; close follow-up of these patients is also necessary

[Subcutaneous sarcoidosis as the first manifestation of systemic disease]. / Sarcoidosis subcutánea como primera manifestación de enfermedad sistémica.

There are dermatological symptoms in up to 25% of patients with sarcoidosis, and the appearance of specific subcutaneous nodules as a manifestation of this entity is rare. They may even predate other manifestations of sarcoidosis. We present the case of a 38-year-old woman with asymptomatic subcutaneous nodules in the limbs, which corresponded to deep sarcoid granulomas in the histological study. She did not present with any extracutaneous indications. The imaging tests performed revealed right paratracheal adenopathies. This led to the diagnosis of sarcoidosis, in both its subcutaneous and pulmonary forms (stage I). Subcutaneous sarcoidosis is probably an underdiagnosed entity, as fewer than 40 cases are reflected in literature. Its value lies in the fact that it may be the first manifestation of extracutaneous or systemic sarcoidosis, which means that this form of sarcoidosis must be considered in the differential diagnosis of subcutaneous nodular lesions; close follow-up of these patients is also necessary.

[Xanthomas in a patient with Langerhans cell histiocytosis and liver cirrhosis]. / Xantomas en paciente con histiocitosis de células de Langerhans y cirrosis biliar.

Skin involvement in acute forms of Langerhans cell histiocytosis (LCH) is in the form of erythematous papules, although rare forms of xanthomatous lesions have been described. We present the case of a boy with acute disseminated LCH who, at the age of 16 months, began to experience outbreaks of seborrheic dermatitis-like skin lesions and progressive hepatic dysfunction. The symptoms were complicated by partial central diabetes insipidus and specific pulmonary infiltration by Langerhans cells, which led to fibrosis. During the course of the disease, the patient developed liver cirrhosis, alterations in the lipid profile and disseminated xanthomatous skin lesions, concomitant with the lesions specific to the LCH. Despite successive cycles of chemotherapy, the outcome was the death of the patient after five years, due to his liver disease. Xanthomatous lesions in LCH are typical of the late stages of chronic progressive forms, such as Hand-Schüller-Christian disease. When they appear in acute disseminated forms, there is some controversy over whether they correspond to a progression of the disease towards more chronic forms, or whether they are associated independent lesions, such as in this case.

[Allergic contact eczema from epoxy resin]. / Eczema alérgico de contacto por resina epoxi.

Epoxy resins are plastics that are widely used as electrical insulation, in coatings, and as adhesives and paints. They have strong sensitizing power and are one of the main causes of allergic contact eczema, both in the workplace and elsewhere. We present the case of a worker at a plastics/chemical plant, who handled aeronautical components in the process of manufacturing fuselage parts. He consulted his physician because of eczematous lesions on his fingers, hands and forearms which had developed over a two-year period and were clearly related to his work. The standard battery of skin tests was performed, along with the plastics and adhesives series and tests using the products from his workplace. Positivity was shown to epoxy resins (standard battery) and to the products from his workplace, which included different fiberglass and carbon fiber sheets impregnated with epoxy resins and epoxy adhesives.

Dermatitis perioral granulomatosa infantil / Childhood granulomatous perioral dermatitis

La dermatitis perioral granulomatosa infantil es una variante clinicopatológica de la dermatitis perioral clásica, de la que se han referido menos de 100 casos, la mayoría en pacientes pediátricos de raza negra. Se caracteriza por la presencia de granulomas tuberculoides sin necrosis central de localización perifolicular o parafolicular en el estudio histológico. Generalmente se trata de un proceso autoinvolutivo, con escasa respuesta a los tratamientos convencionales. Se presenta el caso de una niña de 7 años, de raza blanca, con lesiones peribucales, perinasales y oculares asintomáticas de varios meses de evolución. La anatomía patológica de una de estas lesiones revelaba la presencia de granulomas tuberculoides parafoliculares. El curso fue oscilante, con remisiones parciales y empeoramientos espontáneos sin aparente relación con el tratamiento (AU)