Fotoprotección

—Sun protection is aimed at preventing damage to our skin as the result of its exposure to solar ultraviolet radiation. The skin has some mechanisms to protect itself from this harm, whose efficacy varies from one person to the next and is clearly insufficient in fair-skinned people.Current approaches to photoprotection focus on reducing overall exposure to sunlight, especially during peak sun hours; this includes wearing protective clothing, hats and sunglasses and regular use of broad-spectrum high SPF sunscreen (SPF 15 or higher). Using sunscreen is the most common practice for protecting the skin from the sun, although it is the most controversial.This review summarizes the different approaches to sun protection, with special reference to sunscreens, either oral or topical: their types, main characteristics, side effects, controversies and mechanisms of failure.Moreover, Public Health Guidelines and Recommendations from the International Agency for Research on Cancer are presented. Public education on sun protection must be aimed at multiple and diverse target populations and activities. Childhood interventions are very important, not only because behavioural changes are easier in children than adults, but also because ultraviolet damage is cumulative and sun protection strategies should start early in life.     

Regresión en el melanoma: problemas en su definición e implicación pronóstica

Between 10 % and 35 % of all melanomas show histological regression. That is, there is an area within the melanoma where the tumor retreats or disappears to be progressively replaced by fibrosis with presence of melanophages and variable degrees of inflammation, and neovascularization. Such regression is generally considered an indicator of poor prognosis in melanoma, although a number of studies contradict this affirmation.In this review, we summarize the leading articles about the influence of regression on melanoma prognosis. The results of these studies are very inconsistent, and so the prognostic significance of regression is somewhat controversial. We believe that some of these differences can be explained by differing criteria for regression and so we propose clear histological criteria to define early and sustained regression.     

Calcificación distrófica localizada

—Calcinosis cutis is due to deposition of calcium phosphate into the skin. The calcium deposit in localized or widespread tissue injury in the absence of detectable abnormalities of calcium and phosphate metabolism is called dystrophic calcification.We report the case of a 43-year-old black male, kidney transplanted, with localized dystrophic calcification in the wrist due to arterial puntion without alteration in calcium metabolism.     

Siringometaplasia escamosa ecrina como expresión del fenómeno de evocación

—We report a case of 3 years old girl with a diagnosis of Wilms tumor stage IIIb who presented, in association with combined therapy with chemotherapy and radiotherapy, erythemato-violaceous plaques affecting the skin treated with radiotherapy. Histological examination identified the lesions as eccrine squamous syringometaplasias (ESS). The recall phenomenon is a drug-induced dermatitis that occurs in a zone previously treated with radiotherapy. Radiotherapy induces a subclinical cellular damage favoring a toxic effect, usually caused by chemotherapeutic agents. ESS is an uncommon pattern of the recal phenomenon.     

Evaluación de la regresión en melanomas primarios sucesivos

Introduction and objectivesIt has been suggested that patients who have had a melanoma may develop increased immunity against certain antigens expressed by tumor-associated melanocytes. Thus our objective was to review the records of patients with successive primary melanomas to ascertain whether the pattern of regression might indicate the presence of an immunization effect arising from the first melanoma.Material and methodsA review of all the cases recorded in the melanoma database of our dermatology department between 2000 and 2012 identified 19 patients who had multiple asynchronous melanomas (2.56% of all the cases recorded). We studied the presence or absence of regression in these melanomas and other clinical and histological characteristics.ResultsThe presence of regression was significantly higher in successive melanomas than in the first tumors identified (42.10% vs 21.05%, P = .018). Regression of at least 1 melanoma was observed in 42.10% of the patients studied and regression of 2 melanomas was observed in 21.05%. In no case was regression observed in the first melanoma and not in the second; however, in 21.05% of the patients there was evidence of regression in the second tumor and none in the first.ConclusionsOur findings suggest the possibility that the first melanoma produces an immunization effect in some patients who develop multiple asynchronous melanomas.     

Prurigo crónico: actualización

Chronic prurigo is itself a common condition, but it can also occur secondary to a large number of diseases. Management is challenging as historically chronic prurigo has been poorly defined and very few treatments are available. Clinically, it presents as excoriated, hyperkeratotic lesions. When chronic prurigo is suspected, a comprehensive differential diagnosis is essential. New diagnostic criteria have appeared in recent years and new drugs have been developed. Although no truly effective treatment is yet available, patients will benefit from a greater understanding of this condition.     

Actualización en dermatitis atópica. Propuesta de algoritmo de actuación

Atopic dermatitis is a chronic inflammatory disease that affects 20% of children and almost 3% of adults and is associated with considerable impairment of quality of life for both patients and their families. While the condition resolves spontaneously after puberty in over 75% of cases, it can persist into adulthood. Furthermore, in young children severe forms can have serious health consequences and affect social development. There are no appropriate guidelines on how to handle cases that do not respond to routine treatment. In this article, we review the current treatments for moderate to severe atopic dermatitis, describe our experience with this disease, and propose a management algorithm.     

Pterigión ungueal invertido

—Pterygium inversum unguis is an uncommon anomaly of the distal part of the nail bed. It remains adherent to the ventral surface of the nail plate resulting in the extension of the hyponichium outside the usual limits and producing the obliteration of the distal cleft. This nail disorder may be congenital or acquired. The acquired secondary forms are the most common, usually related to conective tissue diseases.We report a 22 year-old girl with slight mental retardation who consulted complaining of a nail deformity on the first fingers of her hands. This deformity consisted of adherence of the distal part of the nail bed to the ventral surface of the nail plate showing the distal groove obliterated. It had arisen in the last five years. Patient denied trauma or use nail polish. Analysis performed to rule out associated systemic diseases were negative.     

Actualización en tricoscopia

Trichoscopy is a simple, noninvasive office procedure that can be performed using a handheld or digital dermatoscope. This tool has gained popularity in recent years, because it provides useful diagnostic information for hair loss and scalp disorders by enabling the visualization and identification of distinctive signs and structures. We present an updated review of the trichoscopic features described for some of the most common hair loss disorders seen in clinical practice. Dermatologists should be familiar with these helpful features, as they can significantly aid the diagnosis and follow-up of numerous conditions, such as alopecia areata, trichotillomania, and frontal fibrosing alopecia.