Obesity and psoriasis: inflammatory nature of obesity, relationship between psoriasis and obesity, and therapeutic implications.

Obesity, particularly abdominal obesity, is currently considered a chronic low-grade inflammatory condition that plays an active role in the development of the pathophysiologic phenomena responsible for metabolic syndrome and cardiovascular disease through the secretion of proinflammatory adipokines and cytokines. In recent years clear genetic, pathogenic, and epidemiologic links have been established between psoriasis and obesity, with important implications for health. The relationship between the 2 conditions is probably bidirectional, with obesity predisposing to psoriasis and psoriasis favoring obesity. Obesity also has important implications in the treatment of psoriasis, such as a greater risk of adverse effects with conventional systemic drugs and reduced efficacy and/or increased cost with biologic agents, for which dosage should be adjusted to the patient's weight.

[Initial evaluation, diagnosis, staging, treatment, and follow-up of patients with primary cutaneous malignant melanoma. Consensus statement of the Network of Catalan and Balearic Melanoma Centers]. / Valoración inicial, diagnóstico, estadificación, tratamiento y seguimiento de los pacientes con melanoma maligno primario de la piel. Documento de consenso de la "Xarxa de Centres de Melanoma de Catalunya i Balears"

The consensus statement on the management of primary cutaneous melanoma that we present here was based on selection, discussion, review, and comparison of recent literature (including national and international guidelines). The protocols for the diagnosis, treatment, and follow-up used in the hospital centers throughout Catalonia and the Balearic Isles belonging to the Network of Catalan and Balearic Melanoma Centers were also considered. The main objective of this statement was to present the overall management of melanoma patients typically used in our region at the present time. As such, the statement was not designed to be an obligatory protocol for health professionals caring for this group of patients, and neither can it nor should it be used for this purpose. Professionals reading the statement should not therefore consider it binding on their practice, and in no case can this text be used to guarantee or seek responsibility for a given medical opinion. The group of dermatologists who have signed this statement was created 3 years ago with the aim of making our authorities aware of the importance of this complex tumor, which, in comparison with other types of cancer, we believe does not receive sufficient attention in Spain. In addition, the regular meetings of the group have produced interesting proposals for collaboration in various epidemiological, clinical, and basic applied research projects on the subject of malignant melanoma in our society.

Role of Leishmania spp. infestation in nondiagnostic cutaneous granulomatous lesions: report of a series of patients from a Western Mediterranean area.

BACKGROUND: Leishmaniasis is a parasitic disease prevalent in countries of the Mediterranean area. OBJECTIVES: The potential role of Leishmania as the aetiological factor for cutaneous granulomatous lesions in a series of patients from a Western Mediterranean area was evaluated. The practical usefulness of Leishmania-specific polymerase chain reaction (PCR) amplification and immunohistochemical techniques in skin biopsy specimens was assessed. METHODS: Twenty-five skin biopsies diagnosed as nonspecific granulomatous dermatoses were included in the study. A panel of histopathological features was blindly evaluated by two independent observers. Only those cases showing nondiagnostic clinicopathological features and lacking demonstrable microorganisms after bacteriological, mycological or mycobacteriological cultures and specific stains (Ziehl-Neelsen, Giemsa, Gram, periodic acid-Schiff stains) were finally selected. Quantitative real-time PCR was performed in all selected samples. In available samples, immunohistochemical detection of specific Leishmania spp. antigens was also performed. RESULTS: From the selected 25 biopsies, Leishmania spp. DNA was detected by real-time PCR in 13 cases. In seven of eight PCR-positive cases the presence of a varying density of amastigotes could also be demonstrated immunohistochemically. CONCLUSIONS: Leishmania infection seems to be an important aetiological factor in cutaneous granulomatous lesions showing nondiagnostic features in endemic areas. In such areas, Leishmania-specific PCR amplification and/or immunohistochemical studies may be useful diagnostic tools. These techniques may be specifically indicated in the evaluation of patients showing nonspecific granulomatous inflammatory infiltrates of unknown aetiology lacking the histopathological evidence of parasites.

Amelanotic lentigo maligna melanoma: report of a case and review of the literature.

Amelanotic lentigo maligna melanoma (ALMM) is an infrequent presentation of lentigo maligna melanoma, less than thirty cases having been reported to date. Hypopigmented or erythematous macules on the face of older women, resembling Bowen's disease or eczema, are the most common clinical presentation. We report a case of ALMM in a 73-year-old woman. Therapeutic trials with cryotherapy, 5-fluorouracil, and azelaic acid were unsuccessful, and the lesions were eventually cured by surgical excision. ALMM requires early clinical suspicion and histopathologic confirmation of diagnosis in every patient presenting with a slowly enlarging erythematous or hypopigmented macule, especially when located on the face of an older woman with a light complexion.

Persistent supravenous erythematous eruption: a rare local complication of intravenous 5-fluorouracil therapy.

We describe a 47-year-old man who developed a linear serpentine erythematous eruption, overlying the superficial veins on both arms, after treatment with intravenous 5-fluorouracil. No evidence of superficial phlebitis or extravasation were observed. Histologically, a prominent vacuolar alteration of basal cells, necrotic keratinocytes, pigment incontinence, and a perivascular lymphocytic infiltrate in the upper dermis were observed. In a review of the literature we encountered only 5 reports of a similar clinicopathologic picture. The term "persistent supravenous erythematous eruption" (PSEE) seems suitable to describe this rare and peculiar cutaneous eruption that develops after intravenous cytotoxic drug treatment.

Calcinosis cutis following calcium chloride electrode paste application for auditory-brainstem evoked potentials recording.

Circumscribed calcification in the dermis (calcinosis cutis) has been reported following electroencephalographic and electromyographic studies at sites of electrode placement following application of an electrode paste containing calcium chloride. Prolonged exposure and skin microabrasions seem to increase the risk of this rare complication of electrode placement, which has not been previously reported following auditory brainstem evoked potential recordings. We report the appearance of localized dermal calcifications at the sites of electrode placement (forehead and retroauricular areas) following auditory brainstem evoked potential recordings in two children, aged 3 and 2 years, respectively. In both cases the electrodes were applied after gentle scrubbing with an ethanol-impregnated gauze and interposition of a calcium chloride bentonite magma paste. The recording took about 1 hour. Erythematous macules and plaques ranging from 4 to 12 mm in diameter, studded with small stony excrescences, appeared at the areas of electrode application 1 and 5 days later, respectively. Histopathologic study of 4 mm punch biopsy specimens showed amorphous dermal deposits of calcium salts. There was superficial ulceration and transepidermal elimination of the calcium deposits, as well as a foreign body tissue reaction in the surrounding dermis. In both patients small stony pellets were extruded during the healing process, which took 11 and 9 weeks, respectively, and left no scars.

Bullous pemphigoid associated with acute glomerulonephritis.

We report an 82-year-old man who presented with bullous pemphigoid and who later developed an acute glomerulonephritis with the histopathological and immunofluorescence pattern of a postinfectious glomerulonephritis. Antibodies directed against 230 and 180 kDa bullous pemphigoid antigens were detected in the patient's serum by means of the immunoprecipitation technique. Staphylococcus aureus and methicillin-resistant S. aureus were isolated from the patient's skin. We consider that in this particular patient the cutaneous infection played a part in the development of the kidney complication.