Lipschütz ulcer (ulcus vulvae acutum): a rare cause of genital lesion.

Lipschütz Ulcer, or ulcus vulvae acutum, is a rare and probably underdiagnosed entity that usually presents as an acute painful vulvar ulcer in young women. The etiology is unknown, although recent reports have associated it with the Epstein-Barr virus. The diagnosis is made by exclusion after ruling out sexually transmitted diseases, autoimmune causes, trauma, and other etiologies of genital ulcerations. We report a case of a young woman who developed flu-like symptoms and painful vulvar ulcers. Complementary examinations ruled out sexually transmitted diseases and the other usual causes of genital ulcers; lesions healed with no sequelae or recurrences. This case represents a rare important differential diagnosis of genital ulceration.

Lipschütz ulcer (ulcus vulvae acutum): a rare cause of genital lesion / Úlcera de Lipschütz (ulcus vulvae acutum): uma causa rara de lesão genital

Lipschütz Ulcer, or ulcus vulvae acutum, is a rare and probably underdiagnosed entity that usually presents as an acute painful vulvar ulcer in young women. The etiology is unknown, although recent reports have associated it with the Epstein-Barr virus. The diagnosis is made by exclusion after ruling out sexually transmitted diseases, autoimmune causes, trauma, and other etiologies of genital ulcerations. We report a case of a young woman who developed flu-like symptoms and painful vulvar ulcers. Complementary examinations ruled out sexually transmitted diseases and the other usual causes of genital ulcers; lesions healed with no sequelae or recurrences. This case represents a rare important differential diagnosis of genital ulceration.

A Úlcera de Lipschütz, ou ulcus vulvae acutum, é uma entidade rara mas provavelmente subdiagnosticada, que se apresenta como úlcera vulvar aguda dolorosa numa mulher jovem. A etiologia é desconhecida embora relatos recentes a tenham associado à primo-infecção pelo vírus Epstein-Barr. O diagnóstico é estabelecido após exclusão de doenças sexualmente transmissíveis, causas autoimunes, traumáticas e outras etiologias de úlceras genitais. Relatamos o caso de uma jovem que desenvolveu quadro gripal e dolorosas úlceras genitais. Os exames complementares excluiram doenças sexualmente transmissíveis e as outras causas habituais de ulceração genital. As lesões cicatrizaram sem sequelas e sem recorrências. Este caso representa um diagnóstico diferencial importante e raro de ulceração genital.

Value of patch tests in clindamycin-related drug eruptions.

BACKGROUND: Patch tests help to confirm the aetiology of the cutaneous adverse drug reactions involving delayed hypersensitivity mechanisms, but the results vary with the pattern of skin reaction and the culprit drug. OBJECTIVES: To analyse the results of patch tests in patients with cutaneous adverse drug reactions imputable to clindamycin and assess their contribution to the diagnosis. PATIENTS AND METHODS: Between 2005 and 2009, we studied patients with delayed cutaneous adverse drug reactions following administration of clindamycin, usually associated with other drugs. After resolution of the cutaneous adverse drug reaction, patch tests were performed with a series of antibiotics, including pure clindamycin 10% in petrolatum. RESULTS: We studied 30 patients (23 females and 7 males) aged 33-86 years (mean 59.97 years) with generalized maculopapular exanthema where clindamycin was among the highly suspected drugs. Two patients had a previous positive involuntary rechallenge. Patch tests with clindamycin were positive in 9 of 30 patients (30%). More than 50 control patients patch tested with clindamycin were negative. DISCUSSION: We considered the positive patch tests results with clindamycin, in the 9 patients with maculopapular exantema, to be specific, versus the negative results observed in the control group. Although the sensitivity is low (30%), they confirmed the responsibility of this antibiotic in cutaneous adverse drug reactions in which, with only chronological criteria, it was not possible to conclude on the culprit drug.

Fibrous histiocytomas: histopathologic review of 95 cases.

Fibrous histiocytoma (FH) is a heterogeneous tumor composed of fibroblasts, histiocytes, and blood vessels. We conducted a retrospective histopathologic analysis of 95 biopsies, performed over the last 3.5 years, of fibrous histiocytomas to analyze the location, delimitation, epithelial changes, induction of folliculo-sebaceous structures, cellularity, vascularity, collagen pattern, and types of composite cells of the FH. In the majority of the biopsies, we confirmed the classical histopathologic features of fibrous histiocytomas. The presence of lymphoid nodules, mast cells, and sparse infiltrate of inflammatory cells was an interesting finding observed in our study.

Photoallergic contact dermatitis from benzydamine presenting mainly as lip dermatitis.

BACKGROUND: Benzydamine, a non-steroidal anti-inflammatory drug (NSAID) in use for more than four decades, has been reported to cause photosensitivity. OBJECTIVES: To study the results of photopatch testing to benzydamine and the clinical features of the dermatitis during a 3-year period (2006-2008). PATIENTS AND METHODS: During this period, 74 patients with photodermatoses were photopatch tested with an extended baseline series of allergens including benzydamine and in suspicious cases, with drugs that contain it. Test sites were irradiated on D2 with 5 J/cm(2) and readings were performed on D2 and D4. RESULTS: Ten patients (six females/four males), aged 21-84 years (mean 64.9) had a positive photopatch test to benzydamine [1-5% petrolatum (pet.) from Bial-Aristegui] and to drugs that contain it (Tantum verde oral solution and Momen gel). Nine patients had lower lip cheilitis and one lichenified eczema on photo-exposed sites. CONCLUSION: Photosensitivity from both topical and systemic benzydamine has been occasionally described, mainly in southern Spain. Despite its widespread use and its known photosensitizing capacity, photoallergic contact dermatitis from benzydamine is probably underdiagnosed as the clinical presentation of mainly the lip and chin is not typical of photoallergic contact dermatitis and benzydamine is not part of most photoallergen series.

Histiocitomas fibrosos: revisão histopatológica de 95 casos / Fibrous histiocytomas: histopathologic review of 95 cases

O histiocitoma fibroso é tumor heterogéneo composto por fibroblastos, histiócitos e vasos sanguíneos. Efectuamos uma revisão histopatológica retrospectiva de 95 biopsias de histiocitomas fibrosos do nosso arquivo dos últimos 3,5 anos, com o objectivo de avaliar a localização, delimitação, alteração da epiderme, indução folículo-sebácea, celularidade, vascularização, padrão do colagénio e tipo de células constituintes. Na maioria das biopsias, confirmamos as características histopatológicas clássicas dos histiocitomas fibrosos. Achados interessantes observados no nosso estudo foram presença de células nódulos linfoides, mastócitos e infiltrado de células inflamatórias.

Fibrous histiocytoma (FH) is a heterogeneous tumor composed of fibroblasts, histiocytes, and blood vessels. We conducted a retrospective histopathologic analysis of 95 biopsies, performed over the last 3.5 years, of fibrous histiocytomas to analyze the location, delimitation, epithelial changes, induction of folliculo-sebaceous structures, cellularity, vascularity, collagen pattern, and types of composite cells of the FH. In the majority of the biopsies, we confirmed the classical histopathologic features of fibrous histiocytomas. The presence of lymphoid nodules, mast cells, and sparse infiltrate of inflammatory cells was an interesting finding observed in our study.

Photopatch testing with an extended series of photoallergens: a 5-year study.

OBJECTIVE: We conducted a retrospective study (2003-07) evaluating the results of photopatch tests (PPTs) performed with an extended series with the objective of determining the main photoallergens in our region and whether they would be detected by a recently recommended baseline PPT series. MATERIALS AND METHODS: 83 patients (58 females/25 males, mean age 54.8 years) were tested with a photoallergen series, and among these, 30 were also tested with a non-steroidal anti-inflammatory drug (NSAID) series, irradiated at D2 with 5 J/cm(2) ultraviolet A (UVA). RESULTS: Thirty-six of 83 patients (43.3%) had at least one positive reaction, with 21 (25.3%) reacting in the photoallergen series. The main relevant reactions were as follows: 10 to ultraviolet filters (benzophenone-3 and benzophenone-4, 3 patients each), 7 to promethazine, and 2 to chlorpromazine. Twenty of 30 patients tested (70%) had a relevant positive PPT to an NSAID, 9 to piroxicam because of systemic photosensitivity, 8 to benzydamine from a topical gel or oral solution, and 2 to ketoprofen. CONCLUSIONS: Our results are discordant with most recently published studies because of the particularities of the population studied and to regional prescribing habits. Therefore, apart from the recommended baseline series of photoallergens, other substances must be tested according to regional peculiarities.