Micosis fungoide papular en las piernas, a propósito de un caso / Papular Mycosis Fungoides on the Legs: A Case Report

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Quistes miliares múltiples agrupados / Milia en Plaque

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Epidemiología de la dermatitis de contacto: prevalencia de sensibilización a diferentes alérgenos y factores asociados / Epidemiology of contact dermatitis: Prevalence of sensitization to different allergens and associated factors

Introducción: El eccema de contacto (EC) constituye una enfermedad cutánea relativamente frecuente en la práctica clínica, cuya prevalencia ha aumentado en los últimos años. El estudio mediante pruebas epicutáneas (PE) es fundamental e imprescindible en el diagnóstico de la sensibilización de contacto. Objetivos: Estudiar la prevalencia de sensibilización a diferentes alérgenos de la serie de pruebas estándar y observar la influencia de diferentes variables epidemiológicas y clínicas en la sensibilización de contacto. Introducimos un amplio número de alérgenos en nuestra serie de pruebas con la finalidad de detectar nuevas sensibilizaciones, cuya prevalencia justifique un estudio más detallado de éstos. Material y métodos: Se realizó un estudio epidemiológico, observacional y retrospectivo de 1.092 pacientes, llevado a cabo en nuestra unidad de alergia cutánea desde el 1 de enero de 2000 hasta el 31 de diciembre de 2005. Se estudió a todos los pacientes con una serie de pruebas compuesta por 51 alérgenos. Valoramos las siguientes variables: sexo, edad, procedencia, profesión, localización y evolución de las lesiones cutáneas, antecedentes personales y familiares de atopia, positividad de las PE, relevancia clínica, diagnóstico, origen de la sensibilización y su relación profesional. Resultados: El 55% de los pacientes estudiados tuvo alguna positividad y el 55,7% presentó EC en alguna de sus variedades clínicas: eccema alérgico de contacto (28,2%), eccema irritativo de contacto (20,1%), fotodermatitis alérgica de contacto (2,2%) y fotodermatitis tóxica de contacto (1,2%). Los alérgenos más prevalentes fueron sulfato de níquel (29,3%), cloruro de paladio (11,7%), cloruro de cobalto (10,8%), dicromato potásico (7,5%), mezcla de perfumes (6,3%) y parafenilendiamina (6,1%). El 41,1% de los pacientes con EC tuvo una relación profesional positiva y el 21,3% del total de los pacientes estudiados se diagnosticó de dermatitis de contacto profesional; los metalúrgicos, los trabajadores de la construcción y los peluqueros fueron los profesionales más representativos. El origen más frecuente de las sensibilizaciones fue el contacto con objetos metálicos, seguido de los medicamentos, los cosméticos y los objetos de goma. El sexo femenino fue la única variable independiente que influyó de forma significativa en la sensibilización de contacto en general. Conclusiones: Las mujeres se sensibilizaron más precozmente que los hombres, y la prevalencia de positividad de las PE aumentó con la edad, y alcanzó el máximo a los 60-69 años, intervalo en el que también se encontró el mayor índice de sensibilización. Al comparar nuestros resultados con los nacionales, observamos un aumento progresivo y constante de la sensibilización al sulfato de níquel, a la mezcla de perfumes, al bálsamo del Perú y a la colofonia y un descenso en la sensibilización al dicromato potásico. La introducción de nuevos alérgenos, como el cloruro de paladio, el dialil disulfuro y la resina de paratolueno sulfonamida formaldehído, mejoró la sensibilidad de la serie de pruebas estándar en la detección de la sensibilización de contacto. Por esto, aconsejamos más estudios sobre estos alérgenos (AU)

Background: In clinical practice, contact dermatitis is a relatively common skin complaint, whose prevalence has increased in recent years. Study by patch testing is essential for diagnosis of contact sensitization. Objectives: To study the prevalence of sensitization to different allergens in a standard battery and observe the influence of different epidemiological and clinical variables on contact sensitization. A large number of allergens were included in our battery in order to detect new sensitizations whose prevalence might justify further study. Material and methods: This was a retrospective, observational, epidemiological study of 1092 patients, conducted in our skin allergy unit between January 1, 2000, and December 31, 2005. All patients were studied with a battery of 51 allergens. We assessed the following variables: sex, age, type of referral, occupation, site and course of skin lesions, personal and family history of atopy, positive patch tests, clinical significance, diagnosis, source of sensitization, and occupational relationship. Results: At least 1 positive result was found in 55% of the patients, and 55.7% presented atopic dermatitis in one of its clinical variants: allergic contact dermatitis (28.2%), irritant contact dermatitis (20.1%), photoallergic contact dermatitis (2.2%), and phototoxic contact dermatitis (1.2%). The most prevalent allergens were nickel sulfate (29.3%), palladium chloride (11.7%), cobalt chloride (10.8%), potassium dichromate (7.5%), fragrance blends (6.3%), and p-phenylenediamine (6.1%). A positive occupational relationship was found in 41.1%, and 21.3% of the patients studied were diagnosed with occupational contact dermatitis. Metalworkers, construction workers, and professional hairdressers were the most strongly represented groups. The most common source of sensitization was contact with metallic objects, followed by drugs, cosmetics, and rubber items. Female sex was the only independent variable that had a significant influence on the risk of contact sensitization in general. Conclusion: Women became sensitized at a younger age than men, and the frequency of positive results in the patch tests increased with age, reaching a maximum at between 60 and 69 years of age, when the greatest rate of sensitization occurred. Comparison of our results with other Spanish data showed a progressive and constant increase in sensitization to nickel sulfate, fragrance blends, balsam of Peru, and Colophonium, and a decrease in sensitization to potassium dichromate. The inclusion of new allergens such as palladium chloride, diallyl disulfide, and p-toluene sulfonamide formaldehyde improved the sensitivity of the standard battery in the detection of contact sensitization. We therefore recommend further studies of these allergens (AU)

[Epidemiology of contact dermatitis: prevalence of sensitization to different allergens and associated factors]. / Epidemiología de la dermatitis de contacto: prevalencia de sensibilización a diferentes alérgenos y factores asociados.

BACKGROUND: In clinical practice, contact dermatitis is a relatively common skin complaint, whose prevalence has increased in recent years. Study by patch testing is essential for diagnosis of contact sensitization. OBJECTIVES: To study the prevalence of sensitization to different allergens in a standard battery and observe the influence of different epidemiological and clinical variables on contact sensitization. A large number of allergens were included in our battery in order to detect new sensitizations whose prevalence might justify further study. MATERIAL AND METHODS: This was a retrospective, observational, epidemiological study of 1092 patients, conducted in our skin allergy unit between January 1, 2000, and December 31, 2005. All patients were studied with a battery of 51 allergens. We assessed the following variables: sex, age, type of referral, occupation, site and course of skin lesions, personal and family history of atopy, positive patch tests, clinical significance, diagnosis, source of sensitization, and occupational relationship. RESULTS: At least 1 positive result was found in 55% of the patients, and 55.7% presented atopic dermatitis in one of its clinical variants: allergic contact dermatitis (28.2%), irritant contact dermatitis (20.1%), photoallergic contact dermatitis (2.2%), and phototoxic contact dermatitis (1.2%). The most prevalent allergens were nickel sulfate (29.3%), palladium chloride (11.7%), cobalt chloride (10.8%), potassium dichromate (7.5%), fragrance blends (6.3%), and p-phenylenediamine (6.1%). A positive occupational relationship was found in 41.1%, and 21.3% of the patients studied were diagnosed with occupational contact dermatitis. Metal workers, construction workers, and professional hairdressers were the most strongly represented groups. The most common source of sensitization was contact with metallic objects, followed by drugs, cosmetics, and rubber items. Female sex was the only independent variable that had a significant influence on the risk of contact sensitization in general. CONCLUSION: Women became sensitized at a younger age than men, and the frequency of positive results in the patch tests increased with age, reaching a maximum at between 60 and 69 years of age, when the greatest rate of sensitization occurred. Comparison of our results with other Spanish data showed a progressive and constant increase in sensitization to nickel sulfate, fragrance blends, balsam of Peru, and rosin, and a decrease in sensitization to potassium dichromate. The inclusion of new allergens such as palladium chloride, diallyl disulfide, and p-toluene sulfonamide formaldehyde improved the sensitivity of the standard battery in the detection of contact sensitization. We therefore recommend further studies of these allergens.

Sarcoma de Kaposi clásico localizadoen pene / Penile classic Kaposi’s sarcoma

El Sarcoma de Kaposi es un tumor vascular de origen multifocal que se relaciona con el virus herpes humano tipo 8. La afectación genital en el sarcomade Kaposi es rara sobretodo en pacientes VIH negativo. Las lesiones en este área muestran rasgos clínicos e histológicos similares a otras localizaciones,sin embargo, es interesante el diagnóstico diferencial con otras enfermedades que presentan lesiones genitales. Presentamos un caso de sarcoma deKaposi clásico localizado exclusivamente en pene (AU)

Kaposi’s sarcoma is a multifocal vascular tumor which is related to human herpes virus type 8. The genital involvement in Kaposi’s sarcoma is infrequentmostly in HIV - patients. Lesions in this area show similar clinical and histological features as Kaposi’s sarcoma lesions in other locations. However,the differential diagnosis is interesting taking into account other dermatological conditions than present with genital lesions. We report a case ofclassic Kaposi’s sarcoma located in the penis (AU)

[Post-traumatic basal cell carcinoma associated with patch testing]. / Carcinoma basocelular postraumático relacionado con pruebas epicutáneas.

Basal cell carcinoma is the most common epithelial skin cancer in humans and usually effects elderly individuals. Although the pathogenesis is directly related to exposure to ultraviolet sunlight, other factors,particularly trauma, may be involved. We present the case of a woman with contact dermatitis due to sensitization to metals. She developed superficial basal cell carcinoma at the same site as a patch test-performed 30 months earlier-that was strongly positive to 1 % gold chloride. In the histologic study with a scanning electron microscope, we detected electron-dense particles in the dermis which were subsequently identified as gold.

Carcinoma basocelular postraumático relacionado con pruebas epicutáneas / Post-Traumatic Basal Cell Carcinoma Associated with Patch Testing

El carcinoma basocelular (CBC) es la neoplasia cutánea epitelial más frecuente de la raza humana, que afecta generalmente a personas de edad avanzada. Aunque su patogénesis está directamente relacionada con la exposición a las radiaciones ultravioletas solares, también pueden involucrarse otros factores, entre los que destacamos los traumatismos. Aportamos el caso de una mujer con dermatitis de contacto por sensibilización a metales, que desarrolló un CBC superficial en la misma localización en la que tuvo una prueba epicutánea fuertemente positiva al cloruro de oro 1%, realizada 30 meses antes del desarrollo del tumor. Realizamos un estudio del corte histológico con el microscopio electrónico de barrido, que nos demostró la presencia de partículas electrón-densas en la dermis, que fueron identificadas definitivamente como oro (AU)

Basal cell carcinoma is the most common epithelial skin cancer in humans and usually effects elderly individuals. Although the pathogenesis is directly related to exposure to ultraviolet sunlight, other factors, particularly trauma, may be involved. We present the case of a woman with contact dermatitis due to sensitization to metals. She developed superficial basal cell carcinoma at the same site as a patch test-performed 30 months earlier-that was strongly positive to 1% gold chloride. In the histologic study with ascanning electron microscope, we detected electron-dense particles in the dermis which were subsequently identified as gold (AU)

Angiolymphoid hyperplasia with eosinophilia on the tongue.

Angiolymphoid hyperplasia with eosinophilia (AHE) is a benign reactive vascular lesion characterized by a proliferation of small to medium sized vascular structures lined by epithelioid endothelial cells. We report a 75-year-old woman with a 1-month history of a painful ulcer on the tongue. Histopathological findings confirmed a diagnosis of angiolymphoid hyperplasia with eosinophilia. The tongue is an unusual site for this lesion. The treatment of choice for AHE is surgical excision.

Mondor's disease.

Mondor's disease (MD) is a rare condition, which is considered a thrombophlebitis of the subcutaneous veins. It commonly occurs on the anterolateral thoracoabdominal wall, but it can also occur on the penis, groin, antecubital fossa and posterior cervical region. The clinical features are a sudden and typically asymptomatic onset of a cord-like induration, although some patients report a feeling of 'strain'. It is a self-limiting process that lasts a short period of time, which may be the reason why there are few reports about its diagnosis and treatment. Its pathogenesis has remained unclear, because of the lack of methods to reliably differentiate between veins and lymphatic vessels. Immunohistochemical staining for CD31 and D240 has been identified recently as the best method to distinguish small veins from lymphatic vessels, making it a valuable technique in diagnosing not only MD, but also many other diseases in which veins or lymphatic vessels are affected. MD has been associated with several systemic diseases such as breast cancer and hypercoagulability states, thus laboratory studies are recommended to exclude any possible systemic disorders. As this condition is usually a benign and self-limiting process, vigorous treatment is only recommended when the process is symptomatic or recurrent.

Réplica a «Hemangioma verrugoso frente a malformación linfática microquística» / Response to «Verrucous Hemangioma Versus Microcystic Lymphatic Malformation»

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Immunohistochemical clues to the diagnosis of Mondor's disease of the penis.

Mondor's disease of the penis is usually a benign, self-limiting process of acute onset. To date, there have been few studies about its diagnosis and treatment. It is difficult to differentiate MD of the penis from sclerosing lymphangitis of the penis, because the symptoms, epidemiology and aetiology are similar, and because veins are histologically very similar to lymphatics. We report a case of MD in which immunochemical markers such as CD31 and D240 allowed us to specifically discriminate between the small vein and lymphatic vessels. This is important not only for the recognition of MD at any site, but for many other diseases in which veins or lymphatic vessels are affected.

[Contact sensitization to Euxyl K-400]. / Sensibilización de contacto al Euxyl K-400.

INTRODUCTION: Euxyl K400 is a widely used preservative in cosmetics, topical drugs, cutting fluids, etc. This antimicrobial product has two active components: methyldibromoglutaronitrile (MDGN), also known as 1,2-dibromo-2,4-dicyanobutane, and 2-phenoxyethanol, in a proportion of 1 to 4. The aim of this study was to assess the prevalence of sensitization to this preservative in cases in our dermatology department over a 5-year period. We also assessed the prevalence of sensitization to the two active components of Euxyl K400 and calculated the agreement with sensitization to Euxyl K400. MATERIAL AND METHODS: In this retrospective study, we analyzed the medical records of 1,092 patients attended in our skin allergy unit between January 2000 and December 2005. We undertook testing with a standard battery that included, in addition to the allergens recommended by the Spanish Group for Research Into Dermatitis and Skin Allergies (GEIDAC), 0.3 % MDGN and 1 % 2-phenoxyethanol in Vaseline (Trolab). RESULTS: Only 15 patients developed a positive reaction to Euxyl K400. Of these, 11 were positive to MDGN and 2 to phenoxyethanol. Sensitization to Euxyl K400 was significantly more common in men. The agreement between sensitization to Euxyl K400 and MDGN was good (Kp = 0.68), whereas agreement between Euxyl K400 and phenoxyethanol was poor (Kp = 0.23). CONCLUSIONS: The prevalence of Euxyl K400 sensitization in this study was 1.4 %. Most cases of Euxyl K400 sensitization were associated with the MDGN component, as indicated by the good agreement between the two substances.

Sensibilización de contacto al Euxyl K-400 / Contact Sensititazion to Euxil K400

Introducción. El Euxyl K-400 es un conservante muy utilizado en cosméticos, medicamentos de uso tópico, fluidos de corte, etc. Este producto antimicrobiano consta de dos componentes activos: metildibromoglutaronitrilo (MDGN), también llamado 1,2-dibromo-2,4-dicianobutano, y 2-fenoxietanol, en una proporción 1:4. El objetivo de este estudio fue evaluar la prevalencia de sensibilización a este conservante en nuestro departamento de Dermatología, en un período de 5 años. Evaluamos también la prevalencia de sensibilización de los dos componentes del Euxyl K-400 y calculamos la concordancia entre dichas sensibilizaciones. Material y métodos. Hemos realizado un estudio retrospectivo analizando las historias clínicas de 1.092 pacientes estudiados en nuestra unidad de Alergia Cutánea desde enero de 2000 hasta diciembre de 2005. Realizamos pruebas con una batería estándar que contenía, además de todos los alérgenos recomendados por el Grupo Español de Investigación en Dermatitis y Alergia Cutánea (GEIDAC), el MDGN al 0,3 % y el 2-fenoxietanol al 1 % en vaselina (Trolab®).Resultados. Solo 15 pacientes presentaron positividad al Euxyl K-400, de los que 11 fueron positivos al MDGN y 2 al fenoxietanol. La sensibilización al Euxyl K-400 fue significativamente superior en los hombres. La concordancia entre la sensibilización al Euxyl K-400 y el MDGN fue buena (Kp = 0,68), mientras que la concordancia entre el Euxyl K-400 y el fenoxietanol solo fue regular (Kp = 0,23). Conclusiones. La prevalencia de sensibilización al Euxyl K-400 en nuestro estudio fue de 1,4 %. La mayoría de las sensibilizaciones al Euxyl K-400 se debe al componente MDGN, hecho corroborado en nuestro trabajo, en el que se observa una buena concordancia entre ambos alérgenos (AU)

Introduction. Euxyl K400 is a widely used preservative in cosmetics, topical drugs, cutting fluids, etc. This antimicrobial product has two active components—methyldibromo glutaronitrile (MDGN), also known as 1,2-dibromo-2,4-dicyanobutane, and 2-phenoxyethanol, in a proportion of 1 to 4. The aim of this study was to assess the prevalence of sensitization to this preservative in cases in our dermatology department over a5-year period. We also assessed the prevalence of sensitization to the two active components of Euxyl K400 and calculated the agreement with sensitization to Euxyl K400. Material and methods. In this retrospective study, we analyzed the medical records of 1,092 patients attended in our skin allergy unit between January 2000 and December 2005. We undertook testing with a standard battery that included, in addition to the allergens recommended by the Spanish Group for Research In to Dermatitis and Skin Allergies (GEIDAC), 0.3 % MDGN and 1 % 2-phenoxyethanol in Vaseline (Trolab®). Results. Only 15 patients developed a positive reaction to Euxyl K400. Of these, 11 were positive to MDGN and 2 to phenoxyethanol. Sensitization to Euxyl K400 was significantly more common in men. The agreement between sensitization to Euxyl K400 and MDGN was good (Kp = 0.68), whereas agreement between EuxylK400 and phenoxyethanol was poor (Kp = 0.23). Conclusions. The prevalence of Euxyl K400 sensitization in this study was 1.4 %. Most cases of Euxyl K400 sensitization were associated with the MDGN component, as indicated by the good agreement between the two substances (AU)

Réplica: ¿Tienen ustedes una definición de nevo melanocítico típico? / Response: Do You Have a Definition for Typical Melanocytic Nevus?

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[Lipedematous scalp]. / Cuero cabelludo lipedematoso.

Lipedematous scalp is a rare condition first described by Cornbleet in 1935. An increased thickness of subcutaneous tissue in the scalp gives rise to a soft spongy appearance of the surface and occasionally causes pruritus and pain in the affected area. When hair loss is also associated with the condition, it is described as lipedematous alopecia. To date, 10 cases of lipedematous scalp and 13 of lipedematous alopecia have been reported. We present the case of a 77-year-old white woman who developed dysesthesia on her scalp 5 months after the death of her husband. Biopsy revealed subcutaneous tissue thickening that even extended to the dermis. Computed tomography showed thickening of subcutaneous tissue at the vertex and in the occipital region. We diagnosed a new case of lipedematous scalp in a white woman. This case highlights the importance of differential diagnosis in cases of dysesthetic syndrome of the scalp.

Cuero cabelludo lipedematoso / Lipedematous Scalp

El cuero cabelludo lipedematoso es una rara entidad que fue descrita por Cornbleet en 1935, en la que un aumento del tejido subcutáneo del cuero cabelludo produce un aspecto suave y esponjoso de la superficie del mismo y ocasionalmente prurito y dolor de la zona afectada. Cuando además esta condición produce alopecia se denomina alopecia lipedematosa. Hasta la fecha se han descrito 10 casos de cuero cabelludo lipedematoso y 13 de alopecia lipedematosa. Presentamos el caso de una mujer de 77 años de raza caucásica con sensación disestésica en el cuero cabelludo 5 meses después de la muerte de su esposo. Realizamos una biopsia donde se observaba un engrosamiento del tejido graso subcutáneo que incluso se extendía a la dermis. Una tomografía computarizada mostraba este engrosamiento de los tejidos subcutáneos en el vértex y el área occipital. Diagnosticamos un nuevo caso de cuero cabelludo lipedematoso en una mujer caucásica, destacando la importancia del diagnóstico diferencial con el síndrome disestésico del cuero cabelludo (AU)

Lipedematous scalp is a rare condition first described by Cornbleet in 1935. An increased thickness of subcutaneous tissue in the scalp gives rise to a soft spongy appearance of the surface and occasionally causes pruritus and pain in the affected area. When hair loss is also associated with the condition, it is described as lipedematous alopecia. To date, 10 cases of lipedematous scalp and 13 of lipedematous alopecia have been reported. We present the case of a 77-year-old white women who developed dysesthesia on her scalp 5 months after the death of her husband. Biopsy revealed subcutaneous tissue thickening that even extended to the dermis. Computed tomography showed thickening of subcutaneous tissue at the vertex and in the occipital region. We diagnosed a new case of lipedematous scalp in a white women. This case highlights the importance of differential diagnosis in cases of dysesthetic syndrome of the scalp (AU)