Fenómeno isotópico de Wolf: serie de 9 casos

IntroductionThe term Wolf′s isotopic response refers to the appearance of a new skin disease at the site of an already healed, unrelated disease. In most cases, the initial disease is herpes zoster. Different diseases may subsequently develop on the same site. The most common isotopic responses are granulomatous and lichenoid reactions, infiltrations of hematologic diseases, skin tumors, and infections. The pathogenesis of these skin reactions is unknown. It has been suggested that viral infection may alter local skin immunity; this would favor hyperreactivity, leading to inflammatory processes, or local immunosuppression, leading to tumor infiltrations or infections.Materials and methodsWe performed a retrospective study of 9 patients diagnosed with Wolf's isotopic response in the dermatology department of Hospital Donostia in San Sebastian, Spain. Five patients had B-cell chronic lymphocytic leukemia, 2 had a non-Hodgkin lymphoma, and 1 had ovarian carcinoma.ResultsThe initial disease was herpes zoster in 7 cases, and chickenpox and herpes simplex in the other 2 cases. The second disease was granulomatous dermatitis in 4 cases, lichenoid dermatitis in 2 cases, infiltration by B-cell chronic lymphatic leukemia in 2 cases, and infiltration by systemic non-Hodgkin lymphoma in 1 case. In the last case, the skin lesions were the first sign of the lymphoma.ConclusionsWe highlight the need to biopsy these second lesions in order to rule out tumor infiltrations, which were more frequent than expected in our series     

Fibroepitelioma de Pinkus. Descripción dermatoscópica de 3 casos

Fibroepithelioma of Pinkus is considered to be a rare variant of basal cell carcinoma with well-defined histopathological features.Clinical diagnosis often requires differentiation from benign lesions such as acrochordon, intradermal melanocytic nevus, neurofibroma, seborrheic keratosis, and even malignant lesions such as amelanotic melanoma. Dermoscopy of this type of lesion is not extensively described in the literature, though it usually presents certain specific characteristics that suggest the diagnosis and, therefore, an appropriate therapeutic approach.We present 3 cases of fibroepithelioma of Pinkus, describing their clinical, dermoscopic, and histopathological features.     

Leiomioma de la areola mamaria. Presentación de dos casos

—Cutaneous genital or dartoic leiomyomas are rare benign tumors originating in the smooth muscle fibers of the skin of the scrotum, vulva, nipple and areola. The latter are the less frequently observed.We report two cases of leiomyoma of the areola. Both presented as a solitary, small, nonulcerated nodule. Histopathological features shared similar characteristics: a non-encapsulated, ill-defined tumor in superficial and mid-dermis composed of spindle cells with elongated nuclei and eosinophilic cytoplasm, arranged in interdigitating fascicles. There were no atypia or mitoses. It was remarkable a reactive epidermal hyperplasia overlying the surface of the tumor, as is typically seen in the histiocytomas. Areolar leiomyoma is a benign lesion that is not known to undergo malignant transformation, although it may be confused clinically with carcinoma of the breast.     

Carcinoma basocelular de la vulva. Descripción de dos casos y revisión de la literatura

—Although basal cell carcinoma is the most common malignant tumor of the skin, vulvar basal cell carcinoma accounts for less than 5% of all vulvar neoplasms.We are reporting the cases of basal cell carcinoma of two women aged 43 and 66, that showed vulvar ulcer, itching and bleeding. Both patients had excisional biopsy; one developed local recurrence and was treated by wide local reexcision.Basal cell carcinoma is a rare but important consideration in the differential diagnosis of cutaneous vulvar lesions. Accurate diagnosis depends upon a high index of suspicion, biopsy and histopathologic examination. Complete local excision is curative, although the recurrence rate is high, and metastases have been reported.     

Carcinoma de células de Merkel. Presentación de seis casos

—Merkel cell carcinoma is a biologically aggressive primary cutaneous neoplasm that is especially localized to the head and neck in persons of advanced age. It generally presents as a localized skin disease, although on certain occasions, there is evidence of regional lymphatic disease or distant metastasis at the time of the initial diagnosis. We performed a retrospective analysis of the six Merkel cell carcinoma cases diagnosed at the Hospital Clínico San Cecilio in Granada during the period from 1997-2001.     

Ampollas inducidas por PUVA. Presentación de 5 casos

Blisters associated with PUVA treatments are an adverse effect of photochemotherapy that has been reported in the literature. Asymptomatic blisters appear spontaneously mainly on the lower limbs and resolve without treatment. The differential diagnoses to consider include a phototoxic reaction, pseudoporphyria, and PUVA-induced bullous pemphigoid. We describe the clinical and histologic features in 5 cases of blistering secondary to PUVA treatment. If this adverse effect is accurately diagnosed, photochemotherapy need not be interrupted, and unnecessary diagnostic procedures and additional treatments can be avoided.     

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.     

Infección cutánea por Mycobacterium chelonae. Revisión de seis casos

—Mycobacterium chelonae (M. chelonae) is a rapid-growth atypical mycobacteria, which belongs to Runyon group IV. Infection often develops either in patients with immunosuppresion or in immunocompetent hosts associated with penetrating trauma or injury.We present six female immunocompetent patients, who presented nodules, plaques or ulcers, with abscess formation and clear fluid drainage that followed a protracted course in spite of cloxaciline therapy. Although one patient referred a previous history of liposuction, the others did not recall an inoculation size. Treatment of M. chelonae infection required oral clarithromicina for at least 3 months, in addition to other drugs. The histopathologic analysis showed an inflammatory infiltrate, and abscess and granuloma formation. M. chelonae was cultured from skin biopsy specimens.Although M. chelonae infection usually occurs in immunologically compromised patients or may follow puncture wound or trauma, our series shows that chronic suppurative lesions in otherwise healthy women with no previous trauma might be due to M. chelonae.     

Infección cutánea por Mycobacterium marinum. Descripción de tres casos y revisión de la literatura

—Mycobacterium marinum is a causative pathogen of skin and soft tissue infections. Infection often occurs when the microorganism is inoculated by exposure to contaminated water of aquariums and swimming-pools. Mycobacterium marinum is only infectious in erosive skin; therefore, the most common locations are the body areas exposed to traumatism.Three cases of cutaneous infection caused by Mycobacterium marinum are described. Cultures from skin biopsy specimens revealed this organism in all cases. Patients received antibiotic treatment with different response in all of them.We discuss the characteristics of cutaneous infection caused by this mycobacteria, as well as the need of an adequate diferential diagnosis to carry out an appropriate diagnosis and treatment, in order to avoid the appearance of complications.     

Dermatosis erosivopustulosa del cuero cabelludo. Descripción de siete casos

—Seven patients with erosive pustular dermatosis of the scalp are reported. They developed chronic, extensive, eroded, crusted and occasionally pustular lesions on the scalp which produced scarring alopecia. Microbiological investigations were essentially negative and skin biopsies showed only non-specific changes. The use of mid-strength or potent local glucocorticoids produced a marked improvement. All the patients gave a history of previous local trauma in the same area where the dermatosis started, mainly shingles in the opthalmic division of the trigeminal nerve extending onto the frontal scalp and topical treatment of solar keratoses with retinoic cream or cryotherapy. As other authors, we consider that scalp injury is an important precipitating factor for this condition.     

Tratamiento de larga duración con retinoides orales de la psoriasis pustulosa generalizada infantil. Presentación de tres casos

—We report 3 children with severe generalized pustular psoriasis (GPP) which begun within the first months of life. They have been treated with oral retinoids for long periods of time, ranging from 46 months to 14 years. This treatment was effective and devoid of severe adverse effects. Treatment of severe GPP of infancy with etretinate or acitretin is a good therapeutic alternative, potentially less toxic than other drugs such as methotrexate or cyclosporin.     

Acroqueratoelastoidosis: presentación de dos nuevos casos

—Acrokeratoelastoidosis is a rare genodermatosis characterized by the presence of translucent keratotic papules in lateral margins of hands and feet. The most important histological finding is elastorrhexis (an alteration in the secretion of elastic material by the fibroblasts). We present two new non-familial cases and review the clinical and histological manifestations, the etiology, and the differential diagnosis of this rare condition.