Acquired perforating dermatosis: clinicopathological study of 31 cases, emphasizing pathogenesis and treatment.

BACKGROUND: Acquired perforating dermatosis (APD) is a rare group of skin disorders of unknown aetiology and pathogenesis and is associated with several systemic diseases. OBJECTIVE: We review the clinicopathological features, associated systemic diseases and treatment response in a series of APD patients. METHODS: We conducted a retrospective observational study of all patients histologically diagnosed with APD in Hospital San Jorge (Huesca, Spain) between 2002 and 2014. Demographic and clinical features were collected from medical records. Statistical analyses were carried out using SPSS software (version 20.0; IBM Corp, Armonk, NY, USA). RESULTS: The study population consisted of 31 patients (19 women and 12 men), with a mean age of 54 years. Reactive perforating collagenosis (n = 15, 45%) was the most common histopathologic type. The most frequently affected area was the lower limbs (66.6%, n = 22), and pruritus was present in 19 patients (61.3%, P = 0.005). Arterial hypertension (30.3%) was the most common associated condition. Five patients were receiving treatment with infliximab when diagnosed with APD. Most patients responded to topical steroids and oral antihistamines (n = 15). LIMITATIONS: This study is retrospective, and the sample size is limited. CONCLUSION: Acquired perforating dermatosis is an underdiagnosed dermatosis frequently associated with systemic disorders. Its pathogenesis may involve vascular damage, not only in patients with diabetes, but also in those with arterial hypertension and chronic venous insufficiency. Control of pruritus and underlying extracutaneous disorders, as well as discontinuation of the treatment with biologics, are important aspects of the management of this dermatosis.

[Diffuse normolipemic xanthoma planum]. / Xantoma plano difuso normolipémico.

We comment on the case of a 75-year-old woman whose dermatologic process had started 15 years before with the onset of xanthelasma on the lower eyelids which were surgically removed, recurring on the scar areas two months later. At the same time new lesions involved the forehead as well as the periorbital and malar regions. Some months later new yellow papular lesions appeared involving the neck, thorax, pelvis and extremities which grew eccentrically covering large areas. Five years later the lesions localized on the face and showed a progressive tendency to atrophy in their centers while those localized on the trunk showed an evolution to sclerosis of their central area. There was no mucosal involvement or ulceration in any of the xanthomatous lesions. The microscopic study revealed the existence of a dermal infiltrate formed by histiocyte foamy frothy cells and Touton cells, among which there were some lymphocytes, which occasionally adopted a perianexial, perineural and perivascular pattern but there were no signs of thrombosis or degenerative changes in the perilesional connective tissue. The study by chromatography of the lipid composition of the pathologic skin revealed an increase in cholesterol esters. The laboratory exams as well as the general physical examination performed every six months for a period of 15 years' time were always normal except for a moderate elevation of ESR which persisted throughout the process.(ABSTRACT TRUNCATED AT 250 WORDS)

[Fixed cutaneous sporotrichosis localized on the face, with an infrequently seen clinical picture]. / Esporotricosis cutánea fija de localización facial, con morfología clínica poco frecuente.

A case of fixed cutaneous sporotrichosis in an urban patient in whom the contagious trauma could not be proved is commented on. Remarkable is the location of the lesions involving the face, which is extremely rare, as well as the morphology of the lesions, adopting the pattern of congestive erythema on which there were crusty-erythematous papules causing an intense itching which also preceded their onset.

[Toxic epidermal necrolysis (Lyell's syndrome) caused by piroxicam, with fatal outcome from disseminated aspergillosis]. / Necrolisis epidérmica tóxica (síndrome de Lyell) por piroxican, con evolución fatal por aspergilosis diseminada.

A case of Lyell Syndrome provoked by ingestion of an antirheumatic drug (Piroxicam) is commented. The evolution under treatment with steroids and broad spectrum antibiotics was excellent but once recovered from this, the patient died subsequently to a systemic infectious process caused by an Aspergillosis with pulmonary involvement and secondary affectation of the kidneys, brain liver, and heart. The hepatic involvement during the acute stage is discussed and evaluated (increase of transaminases), amylasemia, amylasuria, anemia and thrombopenia which persisted throughout the process and presumably conditioned the evolution of the disease.

Perforating folliculitis associated with tumour necrosis factor-alpha inhibitors administered for rheumatoid arthritis.

Perforating dermatoses are characterized by transepithelial elimination of dermal structures. We report a 61-year-old man with rheumatoid arthritis who developed a perforating folliculitis following the administration of two tumour necrosis factor (TNF)-alpha inhibitors, infliximab and etanercept. To our knowledge, no perforating disorders have been reported associated with these drugs. This report suggests, for the first time, a role for TNF-alpha in the pathogenesis of perforating folliculitis.

[Expression of galanin in melanocytic tumors]. / Estudio sobre la expresión de galanina en tumores melanocitarios.

INTRODUCTION: Galanin is a neuropeptide with wide-ranging effects, especially within the endocrine and nervous systems. Galanin and its receptors are present in human skin. Galanin is expressed in different neural, endocrine and neuroendocrine tumors and, on the other hand, several neuropeptides, particularly alpha-MSH, seem to play a role in the pathogenesis of melanoma. OBJECTIVE: To investigate the expression of galanin in cutaneous melanomas and melanocytic nevi and correlate it with alpha-MSH expression and several prognostic factors for melanoma. MATERIAL AND METHODS: We performed an observational and retrospective study of the immunohistochemical expression of galanin and alpha-MSH in samples of cutaneous melanomas diagnosed in the last 5 years in the San Jorge Hospital, Huesca (Spain). Different types of melanocytic nevi were also analyzed. RESULTS: A total of 130 pigmented lesions were studied: 38 primary cutaneous melanomas, 6 cutaneous melanoma metastases and 86 melanocytic nevi. Immunostaining with galanin and alpha-MSH was significantly higher in melanomas than in melanocytic nevi (p < 0.001), although spindle cell and blue nevi showed significant expression of alpha-MSH. More than 50 % of nodular melanomas and 90 % of superficial spreading melanomas were positive for galanin and alpha-MSH, and the latter also showed the highest percentage of positive cells for galanin (mean 35.09 +/- 28.16) as well as for alpha-MSH (mean 67.64% +/- 35.38). A positive correlation of 71 % was found for immunostaining of both neuropeptides in melanomas. No significant correlation was observed between galanin expression and age, gender, location of the lesions, Breslow index, Clark level and mitotic index. CONCLUSION: Our study shows the expression of galanin in cutaneous melanoma and its significant correlation with alpha-MSH immunostaining.

Tinea capitis in infants in their first year of life.

BACKGROUND: Tinea capitis is the most common type of dermatophytosis in children, but is uncommon in the first year of life. OBJECTIVES: To review clinical, mycological and epidemiological data in a series of 10 infants aged under 1 year diagnosed as having tinea capitis in three Spanish hospitals between 1998 and 2002. METHODS: A retrospective case note study. RESULTS: There were six boys and four girls with a mean of age 7 months (range 1.5-12). All the children were born in Spain, but in five cases the parents were immigrants from Africa. In these cases the isolated dermatophytes were two Trichophyton tonsurans, one T. verrucosum and two Microsporum audouinii. Four autochthonous cases were caused by M. canis and one by M. audouinii (but this one was in contact with African immigrants). In two of the five cases produced by anthropophilic dermatophytes other family members were infected by the same fungus. Most cases were treated successfully with griseofulvin. CONCLUSIONS: Although tinea capitis is rare in infants in their first year of life, the condition should be investigated if scaling and/or alopecia are present. A thorough epidemiological study of other family members is mandatory.

Estudio sobre la expresión de galanina en tumores melanocitarios / Expression of galanin in melanocytic tumors

Introducción. La galanina es un neuropéptido que controla numerosas funciones en el sistema nervioso y endocrino y que está presente en la piel. Diferentes tumores neurales, endocrinos y neuroendocrinos expresan galanina y, por otro lado, varios neuropéptidos, especialmente la &apha;-MSH, se han involucrado en la patogénesis del melanoma. Objetivo. Estudiar la expresión de galanina en melanomas y nevi melanocíticos cutáneos, comparándola con la de α-MSH, y relacionándola con variables clínicas e histológicas con valor pronóstico en el melanoma. Material y métodos. Estudio observacional, retrospectivo de la expresión de galanina y αMSH mediante inmunohistoquímica en una muestra significativa de secciones histológicas de los melanomas cutáneos diagnosticados en el hospital San Jorge de Huesca en los últimos 5 años, y un número similar de distintos tipos de nevi melanocíticos. Resultados. Se estudiaron un total de 130 lesiones pigmentadas: 38 melanomas cutáneos primarios, 6 metástasis cutáneas de melanoma y 86 nevi melanocíticos. El inmunomarcaje con galanina y α-MSH fue significativamente mayor en melanomas que en nevi (p < 0,001), aunque dentro de los nevi destacan la expresión de α-MSH en los azules y fusocelulares. Más del 50 % de los melanomas nodulares y del 90 % de los de extensión superficial fueron positivos para galanina y α-MSH, y además estos últimos fueron los que mostraron un mayor porcentaje de células positivas tanto para galanina (media = 35,09 ± 28,16 %) como para α-MSH (media = 67,64% ± 35,38 %), siendo la correlación entre ambos en melanomas del 71%. No se encontró asociación estadísticamente significativa entre la expresión de galanina y las variables edad, sexo, localización, índice de Breslow, nivel de Clark y proliferación celular. Conclusión. Nuestro estudio demuestra la presencia de galanina en secciones histológicas de melanoma cutáneo, y esta inmunorreactividad se relaciona significativamente con la de α-MSH

Introduction. Galanin is a neuropeptide with wide-ranging effects, especially within the endocrine and nervous systems. Galanin and its receptors are present in human skin. Galanin is expressed in different neural, endocrine and neuroendocrine tumors and, on the other hand, several neuropeptides, particularly α-MSH, seem to play a role in the pathogenesis of melanoma. Objective. To investigate the expression of galanin in cutaneous melanomas and melanocytic nevi and correlate it with α-MSH expression and several prognostic factors for melanoma. Material and methods. We performed an observational and retrospective study of the immunohistochemical expression of galanin and α-MSH in samples of cutaneous melanomas diagnosed in the last 5 years in the San Jorge Hospital, Huesca (Spain). Different types of melanocytic nevi were also analyzed. Results. A total of 130 pigmented lesions were studied: 38 primary cutaneous melanomas, 6 cutaneous melanoma metastases and 86 melanocytic nevi. Immunostaining with galanin and α-MSH was significantly higher in melanomas than in melanocytic nevi (p < 0.001), although spindle cell and blue nevi showed significant expression of α-MSH. More than 50 % of nodular melanomas and 90 % of superficial spreading melanomas were positive for galanin and α-MSH, and the latter also showed the highest percentage of positive cells for galanin (mean 35.09 ± 28.16) as well as for α-MSH (mean 67.64% ± 35.38). A positive correlation of 71 % was found for immunostaining of both neuropeptides in melanomas. No significant correlation was observed between galanin expression and age, gender, location of the lesions, Breslow index, Clark level and mitotic index. Conclusion. Our study shows the expression of galanin in cutaneous melanoma and its significant correlation with α-MSH immunostaining