Disseminated punctate keratoderma: a rare case report and review of the literature.

We report a rare case of a 53-year-old womanpresenting with diffuse, late-onset disseminatedhyperkeratotic papules. Biopsy showed massivehyperkeratosis overlying a crateriform epidermaldepression and hypergranulosis with mild epidermalhyperplasia. There was no parakeratosis, cornoidlamella, or dyskeratosis. Based on the clinical findingsand histopathological features, a diagnosis ofdisseminated punctate keratoderma was made. Thisis a rare subtype of palmoplantar keratoderma, whichhas a putative increased risk of malignancy. This casereport emphasizes the importance of identifyingthe clinical and histological presentation of this rarecondition; referral of the patient for age-appropriatemalignancy screening is appropriate. We also presenta concise review of treatment options.

The hand-foot-syndrome associated with medical tumor therapy - classification and management.

The hand-foot-syndrome (HFS, palmoplantar erythrodysesthesia, chemotherapy-associated acral erythema) is characterized by painful predominantly palmo-plantar lesions. The association with different chemotherapeutic agents has been known for over 20 years. More recently, HFS has been reported in association with regimens using targeted agents, in particular the multikinase inhibitors (MKI) sorafenib and sunitinib. The HFS associated with MKI has a different distribution and clinical appearance than the traditional disorder. In this review, similarities and differences between chemotherapy- and MKI-associated HFS are discussed and current recommendations for their prophylaxis and management are summarized.

Queratodermias palmoplantares adquiridas: revisión bibliográfica / Acquired palmoplantar keratoderma: bibliographic review

Las queratodermias palmo plantares son un grupo diverso de trastornos caracterizados por el engrosamiento anormal de la piel de las palmas y pantas, que puede ser hereditario o adquirido. Este últimos se define como una hiperqueratosis no hereditaria, no friccionar, de las palmas y/o las plantas que afecta al 50% o más de estas superficies ocrales. Es un trastorno de múltiples etiologías, entre las cuales destacan: el climaterio, asociada a malignidad, a otras dermatosis, acuagénica, causada por infecciones, asociada a medicamentos, a enfermedades sistémicas, y la hiperqueratosis palmo plantar filiforme (queratodemia espinosa). El tratamiento tiende a ser sintomático y puede variar desde medidas simples a queratoliticos tópicos, retinoides sistémicos o cirugía reconstructiva. En algunas queratodermias especificas, como la climatérica y aquellas asociadas a hipotiroidismo, el tratamiento indicado es el reemplazo hormonal, y en las asociadas a malignidad, la extirpación del tumor habitualmente produce la mejoría de to hiperqueratosis.

Palmoplantar keratodermas are a diverse group of disorders characterized by an abnormal thickening of the skin of the palms and soles, which can be hereditary or acquired. The last form above mentioned is defined as a non-hereditary, non-frictional hyperkeratosis of the palms and/or soles that involves 50 percent or more of the surface of these acral areas. This is a disorder produced by multiple causes, among which highlight climacteric, associated with malignancies, related with another dermatoses, aquagenic, infectious, drug-related, related with systemic disease and palmar/plantar filiform hyperkeratosis (spiny keratoderma). Treatment tends to be symptomatic and may vary from simple advices to topical keratolytics, systemic retinoids or reconstructive surgery. In some specific keratodermas like the climacteric one and in those associated with hypothyroidism the recommended treatment corresponds to hormonal replacement and in those associated with malignancies the removal of the tumor usually results in improvement of the hyperkeratosis.

Acroqueratodermia siríngea acuagénica. Presentación de dos casos / Aquagenic syringeal acrokeratoderma. Presentation of two cases

La acroqueratodermia siríngea acuagénica es una queratodermia adquirida y transitoria que se exacerba tras sumergir en agua las palmas y/o las plantas. Se manifiesta como pápulas y placas blanquecinas o amarillentas, translúcidas y aplanadas localizadas en las zonas de presión o traumatismo de palmas y/o plantas. La afectación suele ser bilateral. La histología es inespecífica, mostrando una ligera dilatación de la porción intraepidérmica del conducto excretor ecrino. El proceso tiende a la remisión espontánea. Presentamos el caso de 2 mujeres de 20 y 21 años que presentaban un cuadro de acroqueratodermia siríngea acuagénica de largo tiempo de evolución

Aquagenic syringeal acrokeratoderma is an infrequently described acquired, transitory keratoderma that is exacerbated when the palms and/or soles are immersed in water. It manifests as whitish or yellowish flattened, translucent papules and plaques, located in areas of pressure or trauma on the palms and/or soles. Involvement is usually bilateral. The histologic features are non-specific, showing a slight dilation of the intraepidermal portion of the eccrine sweat duct. The process tends to remit spontaneously. We present the case of two women, aged 20 and 21

[Pityriasis rubra pilaris]. / Pityriasis rubra pilaris.

Pityriasis rubra pilaris (PRP) is a rare papulosquamous disease with typical onset during the first and fifth decades. The skin disorder normally starts on the scalp and spreads caudally within a few weeks. It often results in a generalized erythroderma with sharply demarcated islands of sparing ("nappes claires"). A 65-year-old patient with severe PRP showed good clinial improvement after 8 months of treatment when treated with acitretin in combination with phototherapy and systemic gluocorticosteroids.

["Aqua-SUP" in chronic palmoplantar dermatoses]. / "Aqua-SUP" bei chronischen palmoplantaren Dermatosen.

In 11 of 15 patients suffering from chronic dermatoses of the palms and soles (psoriasis inversa, palmoplantar pustulosis, palmoplantar hyperkeratotic eczema and idiopathic pompholyx), an improvement was achieved with "aqua-SUP" therapy. Trials using this therapeutic modality, which is a combination of balneotherapy and selective UV phototherapy (SUP), have only rarely been reported so far. In addition, five patients received internal medication (mainly aromatic retinoid) that had previously not been effective enough, three of them in combination with local corticosteroids. Four more patients were administered local corticosteroids in addition to "aqua-SUP". Four patients experienced local pain in the treated area, especially in the initial phase of phototherapy, and a mild erythematobullous reaction occurred in three of them. No other side-effects were observed. The efficacy of "aqua-SUP" for the treatment of the above-mentioned dermatoses lies in the same range as that of local PUVA, which has been used up to now. However, as "aqua-SUP" is easily manageable, it is more convenient for the patient and does not involve the problems of photosensitization.