Nail unit tumors: a study of 234 patients in the dermatology department of the "Dr Manuel Gea González" General Hospital in Mexico City.

BACKGROUND: The frequency of nail unit tumors is not well known because they are often misdiagnosed, and the clinical appearance of benign and malignant tumors is not characteristic. PATIENTS AND METHODS: A total of 234 patients from the dermatology department of a general hospital in Mexico City were included in this study, from January 1982 to November 2006. RESULTS: The tumors most frequently diagnosed were fibrous tumors (29.05%), osteocartilaginous tumors (21.79%), and myxoid pseudocysts (11.96%). Malignant melanoma occupied the fourth place (9.82%), and the second most frequent malignant tumor was squamous cell carcinoma (SCC; 4.70%). Among other tumors were glomus, neurofibromas, giant cell tumors of tendon sheath, and pyogenic granulomas. The nail plate was affected in 46.5% of the cases studied. CONCLUSION: This study in a Mexican population sheds light on the frequency and the alterations produced by nail unit tumors, which we must keep in mind for a more accurate diagnosis.

Chronic granulomatous disease: two members of a single family with different dermatologic manifestations.

Case 1: A 33-year-old man with a 14-year history of localized skin disease on the face and scalp was evaluated at the department of dermatology. The physical examination revealed plaques with papules, pustules, and a golden yellow crusting on the forehead, cheeks, upper lip, and chin (Figure 1). The scalp presented fine, whitish scales. At the beginning of his disease, the patient presented large red and painful purulent boils. The 14-year clinical course of these lesions was characterized by partial remissions and recurrences, but he did not specify any treatment related to improvement. The clinical diagnosis given for the scalp lesions was seborrheic dermatitis. For the facial lesions, many differential diagnoses were considered, among them: seborrheic dermatitis, acneiform dermatitis, impetigo, folliculitis, seborrheic pemphigus, and demodicidosis. The histopathologic study of a biopsy taken from the cheek (Figure 2) showed superficial spongiform dermatitis with neutrophils and folliculitis that are compatible with the diagnosis of seborrheic dermatitis. Both Gram and periodic acid-Schiff stains were negative. Follow-up of the patient was not possible since he did not come back. The disease in this patient initially manifested at age five by the presence of recurrent ganglionic abscesses. At age 15, he presented a pulmonary abscess of a left lobule that was surgically removed; at this point the diagnosis of chronic granulomatous disease was established. At age 28, an exploratory laparotomy was performed due to peritonitis and multiple hepatic abscesses. At that time, he was treated with antibiotics (mainly trimethoprim-sulfamethoxazole) and interferon-g. The patient had two brothers who died due to complications of chronic granulomatous disease. In addition, both his mother and sister presented a history of discoid lupus-like lesions. Case 2: Coincidentally, his 27-year-old sister was seen in our department of dermatology 5 years before, presenting infiltrated and erythematous plaques with fine scales (Figure 3) on the right side of the nose and the left annular finger. No other cutaneous or mucous lesions were seen. She referred onset in childhood with similar lesions on sun-exposed areas that disappeared without scarring. A biopsy was performed and the results were compatible with the diagnosis of discoid lupus erythematosus (Figure 4). Direct immunofluorescence was not available. At that time, she did not mention the family history of chronic granulomatous disease. Clinical follow-up was not possible, but his brother referred that she afforded complete remission only with sun protection.

Lichen planus in 24 children with review of the literature.

Lichen planus is a disease generally considered uncommon in children. Our objective was to obtain epidemiologic data retrospectively and determine the clinical characteristics of lichen planus in Mexican children seen in our dermatology department. We found 235 patients with the clinical and histologic diagnosis of lichen planus seen over a period of 22 years and 7 months. Twenty-four (10.2%) of these patients were children (15 years of age or younger). The ratio of male to female was 1:1.2. The main clinical pattern was classic lichen planus (43.5%). Mucous membrane and nail involvement were uncommon. No family history of lichen planus or systemic disease was noted. In the international literature, the frequency of lichen planus varied from 2.1% to 11.2% of the pediatric population. In the majority of studies no significant gender predominance was identified. Most patients had the classic variety of lichen planus. Reported mucosal involvement was rare, except in India and Kuwait. Frequency of nail involvement ranged from 0% to 16.6%. Little evidence of systemic disease or family history was found.

Evaluation of subcision as a treatment for cutaneous striae.

BACKGROUND: Treatment options for cutaneous striae are very limited. OBJECTIVE: To determine if subcision is an effective treatment for cutaneous striae and compare a combination with 0.1% tretinoin cream against a single treatment. METHODS: 14 patients were evaluated, each with 3 white striae. One stria received treatment with subcision, one with tretinoin cream in a 0.1% concentration, and one with subcision plus tretinoin. The length of follow-up was 3 months. Two blind investigators evaluated improvement by comparison of the initial and final digital photographs. RESULTS: Only 7 patients completed 3 months follow-up. A decrease of width and clinical improvement was observed with the 3 treatments. However, some striae showed no change at all and there was no statistically significant difference between treatments. Three patients presented necrosis in striae treated with subcision. CONCLUSIONS: There are no studies in the medical literature about subcision for the treatment of cutaneous striae. This is a preliminary study and considering the undesirable effects of necrosis in a high percentage of striae treated with subcision, the subjective way of evaluation, and the small study group, we can not recommend subcision as a treatment for cutaneous striae. Large studies are necessary to corroborate or to discard our findings.

[Lichen planus and hepatitis C virus. Is there an association?]. / Liquen plano e infección por virus de hepatitis C. Existe una asociación?

INTRODUCTION: The etiology of lichen planus (LP) is unknown. The possible role of hepatitis C virus (HCV) has been studied with controversial results. MATERIALS AND METHODS: The aim of this study was to determine the prevalence of HCV infection in 36 patients with lichen planus (LP) confirmed by histopathology, 12 in a retrospective way, and 24 in a prospective one. The controls were 60 consecutive blood donors from the Blood Bank of the hospital. Third generation enzyme immunoassay screening test was employed for determination of antibodies against HCV. RESULTS: A prevalence of HCV infection of 2.77% in LP patients, and 0% in control group (Fisher's exact test--p=0.375). CONCLUSIONS: We found in our patients with LP a lower prevalence of positive serology for HCV than that reported in the literature. Since all studies have found patients with LP without infection by HCV, we think that other factors in the pathogenesis of this dermatosis need to be studied.