Fiebre botonosa mediterránea en niño de 3 años tratada con doxiciclina / Mediterranean spotted fever in a 3-year-old boy treated with doxycycline

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Allergic and photoallergic contact dermatitis to chlorpromazine.

Chlorpromazine is known to produce both systemic phototoxic and photoallergic reactions. However, it may also cause photoallergic contact dermatitis and, albeit exceptionally, allergic contact dermatitis (ACD). We present a series of photoallergic contact dermatitis and ACD to chlorpromazine diagnosed at a tertiary centre cutaneous allergy unit between 1980 and 2019.

Are patients in haemodialysis good candidates for immunotherapy treatment?

The effectiveness and safety of nivolumab, an anti-programmed cell death protein 1 mAbmonoclonal antibody, in patients with renal replacement therapy is unclear, with limited evidence supporting its usefulness in this context. Therefore, we report a case of recurrent metastatic melanoma in a patient on haemodialysis successfully treated with nivolumab. As seen in patients without renal impairment, significant regression of the lesions was observed after 8 weeks of treatment, reaching complete clinical response after 4 months. During follow-up, no dose adjustment, delay, or treatment suspension due to toxicity were required.

Juvenile melanocytic acral nevus: A comparative study between MANIAC and non-MANIAC nevus and its clinicopathological characteristics.

BACKGROUND: Melanocytic acral nevi have a series of distinguishing features, including their location, patient age at onset, clinical progression, and histological findings. In particular, histopathological analysis often reveals a melanocytic acral nevus with intraepidermal ascent of cells (MANIAC nevus), which in some cases can be mistaken for atypia or malignancy. AIM: This study describes the clinicopathological characteristics of acral nevi in patients under 18 years old and contrasts the clinical and histological features between MANIAC vs non-MANIAC nevi. METHODS: This was a retrospective observational study, performed in our department in the decade between January 2007 and January 2017. We included patients younger than 18 years of age who were subjected to the removal of melanocytic acral nevi. RESULTS: A total of 70 patients were studied. 54.2% (38/70) were females and 45.8% (32/70) were males. With regard to the type of nevus, 34 were compound, 27 were junctional, and 9 were predominantly intradermal lesions. We identified a total of 41 MANIAC nevi and 29 non-MANIAC nevi. Statistically significant differences between these two groups were identified in nevus size (larger in MANIAC) and the frequency of compound nevi (higher in the MANIAC group), but not in the remainder of the histological parameters studied.

Allergic contact dermatitis to chlorhexidine in pediatric patients.

Chlorhexidine is one of the most widely used antiseptics in our environment. Allergic contact dermatitis to chlorhexidine is common in adults, but is quite rare in the pediatric population. Its diagnosis is important because it can mimic other dermatoses common during childhood, and it can also lead to acute immediate hypersensitivity reactions following successive exposures.

Follicle and Sebaceous Gland Multinucleated Cells in Measles.

We report the case of a 32-year-old man with measles in which skin biopsy helped to establish a definitive diagnosis. Follicular involvement is a common histopathologic feature of measles. Multinucleated epidermal and follicular cells are distinctive findings.

Pirfenidone-induced photosensitivity confirmed by pathological phototest.

BACKGROUND: Idiopathic pulmonary fibrosis (IPF) is an idiopathic interstitial progressive fibrotic lung disease and the most lethal of all interstitial lung diseases. Pirfenidone is a novel antifibrotic and anti-inflammatory agent which reduces decline in lung function and prolonges progression-free survival. It has a favourable benefit-risk profile and is generally well tolerated. However gastrointestinal events, photosensitivity reactions and rash are the most common adverse events. OBJECTIVE: We report a 71-year-old man with 1 week history of erythematous partially pruritic lesions on both sides of the neck and the back of the hands limited to sun exposed areas. He had been diagnosed with IPF and was being treated with pirfenidone (Esbriet) for 8 months. We suspected a photosensitivity reaction caused by pirfenidone. METHODS: A phototest and a punch biopsy were performed. RESULTS: The phototest had a pathological result. The minimal erythema dose was decreased, presenting with erythema and edema starting from 7 mJ/cm2 of UVB and an aberrant response to UVA starting from 2 J/cm2. Histopathological examination revealed spongiotic acute dermatitis with focal presence of necrotic keratinocytes. The patient was diagnosed with pirfenidone-induced photosensitivity and treated with high potency topical steroid leading to the resolution of the lesions, without the need for discontinuation of the drug. CONCLUSION: To our Knowledge, this is the first pirfenidone-induced photosensitivity reported case confirmed by pathological phototest. Patient education and photoprotection advice are essential for prevention.

Ectopic intestinal mucosa implanted on the perianal skin of a patient with Crohn disease.

Intestinal mucosa implanted in skin is an exceedingly rare occurrence. Implantations are thought to occur during the creation of ostomy sites or other surgical procedures in which suture goes through bowel mucosa and then skin. Current ostomy literature reports this as a very uncommon complication. We present a 54-year-old man diagnosed with Crohn disease with severe perianal involvement who was referred to our outpatient clinic because of two persistent perianal cutaneous ulcerations. He previously underwent several interventions to drain complex perianal fistulas and abscesses, the last of them involved placing seton stitches to ensure continuous draining during the healing process. Physical examination revealed two painful ulcerations with bleeding on contact. A skin biopsy was performed, revealing ectopic intestinal mucosa with crypts, villi, and goblet cells. Perianal ulcerations characteristic of Crohn disease might be difficult to differentiate from ectopic implant of bowel mucosa secondary to a surgical procedure in the perianal area. Therefore, we believe a high degree of suspicion and skin biopsy are key to the diagnosis.

Whitish vulvar tumors associated with macular symmetrical rash.

We present a woman with an unusual case of secondary syphilis after an unnoticed primary infection. She initially presented with multiple grayish plaques and nodules on the vulva associated with an erythematous macular symmetrical rash affecting the trunk and extremities. Despite the increasing incidence of sexually transmitted diseases such as syphilis, presentation with unusual manifestations can lead to a delayed diagnosis.

Acneiform eruption induced by vedolizumab.

The development of new biological drugs for the treatment of advanced oncological processes or severe inflammatory diseases brings with it the appearance of new adverse effects. Vedolizumab, an α4ß7 integrin inhibitor antibody, is approved for induction and maintenance therapy in both Crohn disease and ulcerative colitis. We report a case of severe acneiform eruption induced by vedolizumab in a 17-year-old woman with ulcerative colitis.