Multiple Perianal Ulcers Related to Use of a Hemorrhoidal Ointment With the Active Ingredients Triamcinolone Acetonide, Lidocaine, and Pentosan Polysulfate Sodium: A Series of 11 Spanish Patients. / Múltiples úlceras perianales en relación con el uso de una pomada antihemorroidal con acetónido de triamcinolona, lidocaína y pentosano polisulfato sódico como principios activos: una serie de 11 pacientes españoles.

The development of perianal ulcers related to the use of a hemorrhoidal ointment has not been reported in the literature. We describe a series of 11 patients who were treated for perianal ulcers in 10 Spanish hospitals after they used the same ointment containing the active ingredients triamcinolone acetonide, lidocaine, and pentosan polysulfate sodium. No prior or concomitant conditions suggesting an alternative cause for the condition could be identified, and after the patients stopped using the ointment, their ulcers cleared completely in 8 weeks on average. This case series shows the damage that can be caused by an over-the-counter pharmaceutical product used without medical follow-up. It also illustrates the need to ask patients with perianal ulcers about any topical agents used before the lesions appeared.

Penfigoide gestacional / Pemphigoid gestationis

El penfigoide gestacional (PG) o herpes gestationis es una rara enfermedad cutánea autoinmune, que generalmente aparece en el segundo y tercer trimestre, y durante el puerperio, y que puede afectar al curso de la gestación y producir afectación neonatal. Presentamos el caso de una secundigesta con gestación gemelar y pénfigo gestacional. Se describe el proceso de diagnóstico, tratamiento y evolución

The pemphigoid gestationis or herpes gestationis is a rare autoimmune skin disease that occurs during the second or third trimester of pregnancy or in the immediate postpartum and which may affect the course of the pregnancy and cause neonatal pemphigoid gestationis. We present the case of a 40-year-old secudigravida with a twin pregnancy and pemphigoid gestationis. We describe the diagnostic process, treatment, and outcome

Cinco casos de urticaria multiforme y revisión de la literatura / Urticaria multiforme: A report of 5 cases and a review of the literature

La urticaria multiforme es un cuadro cutáneo, propio de lactantes y niños pequeños, caracterizado por la aparición de grandes placas anulares urticariformes de centro violáceo frecuentemente asociado a un proceso febril. Tiene un curso benigno y autolimitado, pero el llamativo aspecto de las lesiones puede ser alarmante y generar gran ansiedad en los padres. Presentamos 5 casos de urticaria multiforme vistos en nuestro hospital a lo largo de 18 meses. El antecedente común a todos ellos fue una infección de vías respiratorias altas u otitis por la que fueron tratados empíricamente con amoxicilina. Es importante saber reconocer esta entidad para tranquilizar a los padres, ahorrar el ingreso hospitalario y evitar la realización de pruebas diagnósticas innecesarias

Urticaria multiforme is a cutaneous disorder that affects infants and small children. It is characterized by large, annular urticarial plaques with a violaceous center and is frequently accompanied by fever. Urticaria multiforme follows a benign, self-limiting course, but the striking appearance of the lesions can cause alarm and considerable anxiety among parents. We present 5 cases of urticaria multiforme seen in our hospital over a period of 18 months. All the cases were preceded by an infection of the upper airways or otitis, and they were all empirically with amoxicillin. It is important to be familiar with this condition to reassure parents and avoid unnecessary hospital admissions and tests

Urticaria multiforme: A report of 5 cases and a review of the literature.

Urticaria multiforme is a cutaneous disorder that affects infants and small children. It is characterized by large, annular urticarial plaques with a violaceous center and is frequently accompanied by fever. Urticaria multiforme follows a benign, self-limiting course, but the striking appearance of the lesions can cause alarm and considerable anxiety among parents. We present 5 cases of urticaria multiforme seen in our hospital over a period of 18 months. All the cases were preceded by an infection of the upper airways or otitis, and they were all empirically with amoxicillin. It is important to be familiar with this condition to reassure parents and avoid unnecessary hospital admissions and tests.

[Selectivity of photothermolysis in the treatment of port wine stains using multiple pulses with a pulsed dye laser]. / Selectividad de la fototermólisis en el tratamiento de las manchas en vino de Oporto mediante múltiples pulsos de láser de colorante pulsado.

BACKGROUND: In 25 % to 50 % of patients with port wine stains treated with pulsed dye laser (even in multiple sessions), only a partial improvement is obtained that is often unsatisfactory for the patient. Various factors have been proposed to explain the resistance to treatment, such as the presence of deep, small-caliber, or very thick vessels that cannot be coagulated with a single laser pulse. Certain mathematical models suggest that multiple pulses would be effective in coagulating those vessels without losing the selectivity of photothermolysis, since more energy could be delivered to the target structures without damaging the surrounding tissue. The aim of this study was to assess the efficacy and selectivity of photothermolysis with multiple laser pulses. METHODS: Twelve patients with port wine stains were included in the study. Various areas of each lesion were treated with pulsed dye laser (Candela V-beam, 595 nm) using different parameters. Immediately afterwards, the treated areas were biopsied. RESULTS: The risk of exceeding an appropriate dose was greater with small spot size, long pulse duration, short intervals between pulses, and high fluences. Heat damage was less with spots of 10 mm, short pulses, intervals of 1 minute between pulses, and low fluences. In selected cases, multiple pulses were effective and selective where single pulses did not successfully coagulate the vessels. CONCLUSIONS: Our results indicate the enormous possibilities of multiple laser pulses for the treatment of refractory vascular lesions. In addition, we have addressed the variables defining the complex thermodynamic interaction between the laser and the cutaneous tissue and indicated the safest parameters. We discuss the possible usefulness of this approach with other lasers and skin diseases.

Fiebre, hematoquecia y úlceras cutáneas en un adulto joven / Fever, hematochezia and skin ulcers in a young adult

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[Efficacy of dapsone in disseminated granuloma annulare: a case report and review of the literature\]. / Eficacia de la dapsona en el granuloma anular diseminado: presentación de un caso y revisión de la literatura.

Granuloma annulare is a dermatosis of unknown cause that is generally self-limiting and has several clinical forms of presentation. It may be associated with pruritus or present asymptomatically. The disseminated variant of the disease accounts for 15 % of all cases. Most authors consider that the duration of this form is longer and that treatment response is worse than for localized forms. A range of therapeutic options have been tried for this disease with a wide range of outcomes. We present a patient with disseminated granuloma annulare who started treatment with dapsone after several therapeutic failures. With dapsone therapy, her cutaneous symptoms showed a clear improvement without any relevant side effects. We then review reports in the literature of cases of disseminated granuloma annulare treated with dapsone.

Eficacia de la dapsona en el granuloma anular diseminado: presentación de un caso y revisión de la literatura / Efficacy of dapsone in disseminated granuloma annulare: a case report and review of the literature

El granuloma anular es una dermatosis de causa desconocida, habitualmente autorresolutiva, con varias formas clínicas de presentación. Puede asociar prurito o manifestarse de forma asintomática. La variante diseminada de la enfermedad supone el 15 % de los casos, y para la mayoría de los autores su duración es mayor y la respuesta al tratamiento peor que en las formas localizadas. Se han propuesto múltiples opciones terapéuticas para esta patología, con resultados muy variables. Presentamos el caso de una paciente con granuloma anular generalizado que tras varios fracasos terapéuticos inició tratamiento con dapsona, obteniéndose una clara mejoría de la clínica cutánea hasta su total resolución, sin efectos secundarios significativos. Aportamos una revisión de los casos de granuloma anular diseminado tratados con dapsona hallados en la literatura

Granuloma annulare is a dermatosis of unknown cause that is generally self-limiting and has several clinical forms of presentation. It may be associated with pruritus or present asymptomatically. The disseminated variant of the disease accounts for 15 % of all cases. Most authors consider that the duration of this form is longer and that treatment response is worse than for localized forms. A range of therapeutic options have been tried for this disease with a wide range of outcomes. We present a patient with disseminated granuloma annulare who started treatment with dapsone after several therapeutic failures. With dapsone therapy, her cutaneous symptoms showed a clear improvement without any relevant side effects. We then review reports in the literature of cases of disseminated granuloma annulare treated with dapsone

[Palmoplantar hyperkeratosis associated with losartan]. / Hiperqueratosis palmoplantar asociada a losartán.

Losartan belongs to the group of angiotensin II receptor antagonists and is used for the treatment of hypertension and heart failure. It acts in the renin angiotensin system (RAS) by blocking the angiotensin II receptor. There have been several reports on cutaneous side events by angiotensin antagonists due to their effect on the local cutaneous RAS. We review the case of palmoplantar lesions that developed in a patient taking losartan and the subsequent remission after treatment withdrawal. Since these reactions are being increasingly reported and as they can mimic a broad variety of classical skin disorders, they should be considered as the cause of sudden, inexplicable skin eruptions in patients taking angiotensin receptor antagonists.

Hiperqueratosis palmoplantar asociada a losartán / Palmo-plantar hyperkeratosis associated with losartan

El losartán pertenece al grupo de los inhibidores de los receptores de angiotensina II, fármacos muy utilizados en el momento actual para el tratamiento de la hipertensión arterial (HTA) y el fallo cardiaco. Actúan a nivel del sistema renina-angiotensina (SRA), impidiendo la acción de la angiotensina II, al bloquear su receptor. Han sido publicados distintos casos de lesiones cutáneas en relación con la toma de dichos fármacos, que parecen estar provocados por una interacción de los mismos, con el SRA local de la piel. Presentamos el caso de una paciente con lesiones cutáneas palmoplantares, que aparecen tras la toma de losartán, cediendo con la retirada del mismo. Ante la creciente declaración de este tipo de lesiones, que pueden imitar cualquier dermatosis clásica, los dermatólogos deberían considerarlo siempre como causa de una erupción cutánea brusca e inexplicable en pacientes con dichos tratamientos

Losartan belongs to the group of angiotensin II receptor antagonists and is used for the treatment of hypertension and heart failure. It acts in the renin angiotensin system (RAS) by blocking the angiotensin II receptor. There have been several reports on cutaneous side events by angiotensin antagonists due to their effect on the local cutaneous RAS. We review the case of palmoplantar lesions that developed in a patient taking losartan and the subsequent remission after treatment withdrawal. Since these reactions are being increasingly reported and as they can mimic a broad variety of classical skin disorders, they should be considered as the cause of sudden, inexplicable skin eruptions in patients taking angiotensin receptor antagonists