Fenómeno de Lucio. Comunicación de 14 casos

Introduction

The Lucius Phenomenon is a severe reaction, mainly observed in diffuse lepromatous leprosy, and characterised by necrotic lesions due to vasculitis.

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.     

Aplicación de membrana amniótica en el tratamiento de las úlceras crónicas de extremidades inferiores

IntroductionApproximately 1% of the general population have venous or arterial lower limb ulcers. These lesions can be treated with biological skin substitutes such as cadaver skin or tissue-engineered skin equivalents, but treatment fails in 25% of cases, resulting in pain and loss of patient autonomy, as well as increased morbidity and health care costs. In the treatment of corneal ulcers, amniotic membrane has been shown to have antimicrobial and bacteriostatic properties, and to protect the wound without eliciting an immune response. The same properties have been reported in the treatment of burns and postthrombotic ulcers.ObjectivesTo assess the effectiveness of amniotic membrane transplantation in the treatment of refractory chronic leg ulcers.Patients and methodsAmniotic membrane was grafted onto 4 refractory ulcers in 3 patients. The mean time required for partial and complete re-epithelialization was calculated by measuring the wound area at weeks 0, 4, 8, 12, and 16. Pain intensity was assessed at the same intervals using a visual analog scale.ResultsComplete wound re-epithelialization was achieved for 1 ulcer by week 8; in the other 3 cases, there was a 50% reduction in size compared to baseline. At week 16, the mean reduction in wound size for the 4 ulcers was 81.93%. The corresponding reduction in pain intensity was 86.6%. No adverse effects were observed.ConclusionsAmniotic membrane transplantation might be an effective alternative for the treatment of refractory chronic vascular ulcers on the lower limbs.     

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.     

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