Type IV hypersensitivity to subcutaneous heparin: a new case.

A 71-year-old woman was seen for cutaneous lesions that appeared on her abdomen 15 days after the beginning of subcutaneous injection of nadroparin calcium (Fraxiparina), a low molecular-weight heparin (LMWH). The lesions were very pruriginous, measured 0.5-3 cm, and appeared at and around the point of Fraxiparina injection. Fraxiparina treatment was stopped and the lesions subsided spontaneously in one week. The patient had been treated with intravenous heparin (H) one year before. A 6 mm punch biopsy showed spongiosis and a mild dermal superficial perivascular infiltrate composed of lymphocytes and eosinophils. A challenge test with a therapeutic dose of Fraxiparina produced a lesion similar to those described above. Epicutaneous, prick and intradermal tests with undiluted samples of different H (both preservative-containing and preservative-free) were performed. Patch tests produced a mild erythematous reaction to all H at 48 hours and a (++) reaction at 96 hours. These reactions persisted for one week. Prick tests showed neither an immediate nor a delayed reaction. Intradermal tests with H did not produce an immediate reaction, but induced an infiltrated erythematous reaction at 48 hours that enlarged during the next 2 days and was transformed into pruritic plaques with vesicles. The lesions cleared in two weeks. Our findings confirm a delayed-type hypersensitivity to H and cross-reactivity between unfractioned and LMWH.

[Lichen planus and hepatitis C virus infection. Study of 6 cases]. / Liquen plano e infección por el virus de la hepatitis C. Estudio de seis casos.

Lichen planus is an inflammatory dermatosis that has been associated to different chronic hepatopaties with a variable frequency. In recent years several case reports have been published dealing with lichen planus and its association to hepatitis C virus infection. We report six patients with lichen planus (four males, two females; aged 30-75) who also suffered a chronic hepatitis C virus infection. Lichen planus was confirmed by biopsy and viral infection was based on ELISA and RIBA-4 tests in all patients and also on PCR in five of them. A patient had also been diagnosed of porphyria cutanea tarda. Two patients were treated with alfa-Interferon. It did not modify the evolution of their lichen planus. We recommend to search for hepatitis C virus infection in lichen planus patients and also look for lichen planus patients suffering of chronic hepatopathies to improve our knowledge of the possible relation between both diseases.

[Familial pseudoxanthoma elasticum]. / Pseudoxantoma elástico familiar.

Pseudoxanthoma elasticum is a genodermatosis caused by a change in elastic fibers but with a non well defined biochemical correlate. Its prognosis depends upon the degree of visceral involvement. The appearance of cutaneous lesions allows an early diagnosis. We report here three sisters aged 23, 21, and 19 years with pseudoxanthoma elasticum who had typical cutaneous and retinal lesions. The clinical diagnosis was confirmed by a cutaneous biopsy. To note the high diagnostic yield and minimal morbidity of the cutaneous biopsy for diagnosing this disease.

[Perniosis and lupus anticoagulant]. / Perniosis y anticoagulante lúpico.

Five patients with acral chilblains and lupus anticoagulant activity revealed by coagulation analysis are reported. Three patients suffered a systemic lupus erythematosus, and two of them a completely developed antiphospholipid syndrome as well. Another case had chronic cutaneous lupus with only facial discoid lesions, and in the last one the lupus anticoagulant was likely related to a chronic liver infection of hepatitis B virus because she had not erythematous lupus. There are few dermatologic references about chilblain associated to lupus anticoagulant. Certain evidences suggest a pathogenic relation of this findings.

Allergic contact dermatitis due to Centella asiatica: a new case.

We report a new case of allergic contact dermatitis due to Centella asiatica, a weak sensitizer. Patch tests with Centella asiatica at different vehicles and in different concentrations were carried out. Regarding our results, we suggest as a routine procedure to start with 1% pet, and when the test remains negative 10% pet and 2% eth 70 degrees could be used.

Descriptive epidemiology of basal cell carcinoma and cutaneous squamous cell carcinoma in Soria (north-eastern Spain) 1998-2000: a hospital-based survey.

INTRODUCTION: Better knowledge of the epidemiology of basal cell carcinoma (BCC) and cutaneous squamous cell carcinoma (SCC) will allow the development of more effective diagnostic and preventive measures. MATERIAL AND METHODS: We have reviewed the clinical records of patients from the 'Hospital General de Soria' who were diagnosed with BCC and/or SCC (lower lip included) by histopathology between 1 January 1998 and 31 December 2000. Recurrences and diagnostic duplicities (tumours first biopsied and then excised) were excluded. RESULTS: The mean age was 71.4 years for BCC subjects and significantly older, 77.3 years, for SCC subjects. Photoexposed skin areas accounted for 92.6% and 93.8% of BCC and SCC tumours, respectively. The crude incidence rate for the population of 100 000 was 148.27 for BCC and 58.24 for SCC. The age-adjusted incidence rate (adjusted for world standard population) was 57.97 and 17.87 years, respectively. Subjects with superficial BCC were significantly younger than the rest of the BCC patients and their tumours were located on non-photoexposed skin. The ears and dorsum of the hands were the almost exclusive locations of SCC. CONCLUSIONS: Our results should be compared with those to be obtained in future years to determine trends in the descriptive epidemiology of BCC and SCC.

Cryoglobulinemic vasculitis associated with hepatitis C virus infection. A report of eight cases.

Cryoglobulinemia has an unknown etiology in many cases. In the last years, hepatitis C virus has been known to be involved as a causative agent of so called essential mixed cryoglobulinemia. We report 8 patients suffering from cutaneous vasculitis and chronic hepatitis C virus infection. Their sera showed cryoglobulinemia (6 cases mixed, 2 cases not typified), rheumatoid factor and complement consume. Their hepatitis C virus infection was confirmed by PCR. Hepatitis C virus RNA was found by PCR in 6/6 cryoprecipitates and 5/6 supernatants. The patients were followed for 0.5-12 years. Three of them developed renal affection (2 membranoproliferative glomerulonephritis, 1 not biopsied). Two patients were treated with alpha interferon. One patient noted a marked improvement in her cutaneous vasculitis with interferon treatment, lasting for 18 months after the end of treatment. We recommend the search of hepatitis C virus infection in every case of mixed cryoglobulinemia. Interferon therapy may be useful in some of these cases.