Painful nodule on a young woman's cheek.

We present a 30-year-old woman with a solitary circumscribed neuroma (also known as palisaded encapsulated neuroma) diagnosed after surgical excision. We describe the histopathologic correlation and the dermoscopic features we found in this tumor, which have not been previously reported in the literature to our knowledge.

Microwave Treatment for Axillary Hyperhidrosis and Bromhidrosis. / Tratamiento con microondas en la hiperhidrosis y bromhidrosis axilar.

Axillary hyperhidrosis (AH) and bromhidrosis are common causes of consultation in dermatology. Currently, the most widely prescribed treatment for AH is botulinum toxin, a very effective but temporary option; it is totally ineffective in bromhidrosis. Sympathectomy is an increasingly infrequent choice of treatment due to the high incidence of compensatory hyperhidrosis. We describe the treatment of AH and bromhidrosis with a novel microwave device that can fibrose eccrine and apocrine glands, achieving possibly permanent results. The procedure should preferably be performed under tumescent anesthesia. Side effects, principally local inflammation, are transient. Clinical effectiveness and safety, supported by recently published studies, position this technique as a first-choice option both for hyperhidrosis and for bromhidrosis.

Ten Mistakes To Avoid When Injecting Botulinum Toxin.

Injection of botulinum toxin is currently the most common cosmetic procedure in the United States, and in recent years it has become-together with dermal fillers-the mainstay of therapy for the prevention and treatment of facial aging. However, in some cases the treatment may lead to a somewhat unnatural appearance, usually caused by loss of facial expression or other telltale signs. In the present article, we review the 10 mistakes that should be avoided when injecting botulinum toxin. We also reflect on how treatment with botulinum toxin influences us through our facial expressions, both in terms of how we feel and what others perceive.

[Propranolol in the treatment of infantile hemangioma: clinical effectiveness, risks, and recommendations]. / Propranolol en hemangiomas infantiles: eficacia clínica, riesgos y recomendaciones.

The therapeutic arsenal for hemangiomas in early childhood can now be considered to include oral ß-blockers, mainly propranolol. These drugs are thought to act as vasoconstrictors, regulating angiogenic pathways and inducing apoptosis of vascular endothelial cells. Although infantile hemangioma is not among the approved indications for ß-blockers, many specialized clinics will prescribe propranolol before resorting to corticosteroids. A dosage of 2 mg/kg/d, is usually employed with a dosing interval of 8 hours. Propranolol is safe, causing few side effects, although cases of hypoglycemia, hypotension, diarrhea, reflux, cold hands and feet, bronchospasm, and hyperkalemia have been described. Generally, these adverse effects have not had serious consequences. Prescription in PHACE syndrome is controversial. In all cases, a cardiologist should assess the patient before treatment begins, blood pressure should be monitored, and pediatric follow-up should be scheduled. This review covers our current understanding of the indications, clinical response, and adverse effects of propranolol, a drug has revolutionized our attitude toward infantile hemangioma and the way we approach therapy. Clinical trials under way are also reviewed.

[Metastatic Basal cell carcinoma in the axilla: reconstruction with a lateral pectoral island flap]. / Carcinoma basocelular metastásico en la axila: reconstrucción mediante un colgajo en isla pectoral lateral.

Although basal cell carcinoma (BCC) is one of the most common forms of cancer worldwide, it rarely occurs in the axilla. Only 31 cases have been reported in the literature. The incidence of metastatic BCC, particularly in areas not exposed to the sun, is very low. We present a new case of axillary BCC with lymph node metastases and the results of an extensive review of cases previously reported in the literature. BCC in the axilla is rare and metastasis is exceptional. Factors other than UV radiation probably contribute to its development. The lateral pectoral island flap was used for surgical closure. This method is useful for the reconstruction of axillary defects, obtaining excellent cosmetic and functional results. This flap should therefore be considered for the repair of large surgical defects in the axilla.

[Dermal fillers: types, indications, and complications]. / Materiales de relleno: tipos, indicaciones y complicaciones.

There are many types of dermal fillers currently used for cosmetic and medical indications in routine clinical practice. Fillers can be classified as temporary, semipermanent, or permanent depending on the length of time the substance remains in tissue. They can also be classified by the composition of the product. Materials can be based on collagen (bovine, porcine, and human), hyaluronic acid, poly-L-lactic acid, calcium hydroxylapatite, polymethal methacrylates, and polyacrylamide gels, among others. Temporary fillers are the products most often used for cosmetic purposes, in particular hyaluronic acid. This is due to the ease of application of fillers based on this substance, the good results obtained, and their safety profile. This review presents an overview of the techniques used for the correct placement of dermal fillers and the most common clinical indications for these procedures. It also covers the nature, properties, and mechanisms of action of the principal temporary, semipermanent, and permanent dermal fillers as well as the indications for each type of material. Finally, we describe the most common complications encountered and their treatment.

Prospective Study of Q Switched Alexandrite Laser 755 nm and V Beam Pulsed Dye Laser 595 nm in Dermatofibroma. / Estudio prospectivo de la combinación de láser de alejandrita Q-Switched de 755nm y el láser V Beam de colorante pulsado de 595nm en dermatofibromas.

Pulsed dye and carbon dioxide lasers have been applied in dermatofibroma with clinical improvement. We treated 23 dermatofibromas two times at a 4-week interval with Q-Switched alexandrite laser 755nm (7.5J/cm2, 3mm, 50ms). V Beam pulsed dye laser with a wavelength of 595nm was used for the residual erythema (10-11J/cm2, 7mm, 1.5ms). A partial attenuation of brown colour was observed in 9 patients and complete disappearance of brown colour in 14 patients. Patient satisfaction was very high. Fifteen patients felt a decrease in hardening of dermatofibroma after treatment. A pigment network in dermoscopy was observed in all patients before treatment and no one after treatment. A combined treatment using both V Beam pulsed dye laser and Q-Switched alexandrite laser may be a therapeutic option to reduce the aesthetic effect of dermatofibroma with a high patient satisfaction and good cosmetic outcomes.

Integral Facial Management of the Aesthetic Patient: The Skin Age Management Protocol. / Abordaje facial global del paciente estético: protocolo Skin Age Management.

Aesthetic dermatology includes many minimally invasive therapies that can help our patients age gracefully and discreetly. Because it is hard to systematize these treatments to make patients aware of the options they have for the area of the face they want to improve, at Clínica Dermatológica Internacional, we have developed the Skin Age Management (SAM) protocol. In this article, we describe the protocol, which is aimed at helping doctors and patients to better understand and plan available treatments, underlining the advisability of combining techniques with the goal of achieving discreet changes to obtain what we consider to be optimum results, based on our experience at our center.

Bacillary angiomatosis: a treatable cause of acute psychiatric symptoms in human immunodeficiency virus infection.

BACKGROUND: Bacillary angiomatosis is a systemic infection that has been most commonly reported in the setting of immunosuppression, especially human immunodeficiency virus (HIV) disease. METHOD: We report two patients who had bacillary angiomatosis who presented with psychiatric symptoms. RESULTS: The first patient presented with marked exacerbation of previous depressive disease. The second patient presented with new psychotic symptoms. In both cases psychiatric symptoms did not resolve until antibiotic treatment was given. CONCLUSION: Our report expands the clinical spectrum of bacillary angiomatosis and identifies a new cause of treatable psychiatric disease in HIV-infected persons.

Anetoderma and human immunodeficiency virus infection.

BACKGROUND: Autoimmune disorders such as vitiligo and alopecia areata have been reported in persons infected with the human immunodeficiency virus (HIV). OBSERVATIONS: Three HIV-infected men had anetoderma develop early in the course of their HIV infection. In two patients this preceded other features of HIV disease, and in the third it occurred while the helper T-cell count exceeded 200/mm3. CONCLUSIONS: These findings suggest that anetoderma may be an early manifestation of HIV disease, perhaps autoimmune in its pathogenesis.

[Hyponatremia upon admission in patients over 65 years of age. Relation with medium length of stay and hospital mortality]. / Hiponatremia al ingreso en pacientes mayores de 65 años. Relación con la estancia media y la mortalidad hospitalaria.

OBJECTIVE: To determine the relation between natremia levels equal to or lower than 130 mEq/l upon admission, and average length of stay and hospital mortality in patients with more than 65 years of age. DESIGN: Prospective case-control study lasting one year. LOCATION: Complejo Hospitalario San Millán-San Pedro (second-level hospital) in Logroño (La Rioja). CASES: patients with more than 65 years of age and natremia levels equal to or lower than 130 mEq/l upon admission. CONTROL: normonatremic patients matched by age and sex. VARIABLES: average length of stay and hospital mortality. Comparative tests: Z-test comparing two mean values and Yate's chi-square continuity correction. RESULTS: With a 95% confidence, we have verified that the average length of stay of hyponatremic patients is between 1.44 and 9.2 days longer than in the case of normonatremic patients and the mortality rate is between 2.1 and 28.1% greater. CONCLUSION: Patients with hyponatremia upon admission have a longer average length of stay and a greater mortality. Plasmatic sodium levels equal to or lower than 130 mEq/l upon admission are associated to a poor prognosis in the latter evolution of the patient.