A case of lichen aureus successfully treated with 595 nm wavelength pulsed-dye laser.

BACKGROUND: Lichen aureus (LA) is a variant of pigmented purpuric dermatosis (PPDs) that typically presents with the acute onset of a solitary, unilateral, purple to rust-yellow colored lichenoid patch or plaque on lower extremities. Treatment remains challenging and is based on anecdotal case reports often with poor results. AIMS: Describe a case of LA successfully treated with 595 nm wavelength pulsed-dye laser (PDL). PATIENT/METHOD: A 46-year-old woman with segmental LA was treated using a 595 nm PDL at a uniform spot size of 10 mm, with pulse durations of 10 milliseconds and fluence of 6 J/cm2. The patient had received previous treatments with no improvement. RESULTS: Clearance was archived after three sessions with PDL. Sessions were performed at intervals of 4 weeks, with no serious adverse events nor recurrence. CONCLUSION: We hypothesize the favorable clinical outcome with PDL is due to the affinity of the wavelength for oxyhemoglobin (allowing uniform vessel penetration and energy delivery to fragile capillaries and intraluminal blood) and to its anti-inflammatory profile. PDL seems to be an alternative for patients with progressive LA that have failed other therapies.

Dermatosis purpúrica pigmentada. A propósito de un caso con localización atípica / Pigmented purpuric dermatosis. About a case with atypical location

RESUMEN Se presenta el caso de una paciente femenina de 29 años de edad, con antecedentes de salud referida que acude a consulta por la presencia de máculas hiperpigmentadas asintomáticas de 21 días de evolución, distribuidas de forma lineal en el miembro superior derecho. Los resultados de laboratorio fueron normales y la histopatología confirmó el diagnóstico de sospecha: dermatosis purpúrica pigmentada (variedad lineal unilateral). Hubo una disminución satisfactoria del número de lesiones durante los dos primeros meses de evolución. La púrpura pigmentada unilateral se presenta con mayor frecuencia en varones adolescentes o pacientes adultos jóvenes, y afecta por lo general las extremidades inferiores y tiene una resolución espontánea.

ABSTRACT The case of a 29 year-old female patient is presented, with a referred health history who came to the consultation due to the presence of asymptomatic hyper-pigmented macules of 21 days of progress, distributed linearly in the right upper limb. Laboratory exams were normal and it was histopathology confirmed the diagnosis of suspicion: pigmented purpuric dermatosis (unilateral linear variety). There was a satisfactory decrease in the number of lesions during the first two months. Unilateral pigmented purpura occurs most frequently in adolescent males or young adult patients, and usually affects the lower extremities and has a spontaneous resolution.

Clinical Profile of Levamisole-Adulterated Cocaine-Induced Vasculitis/Vasculopathy: A 30-Case Series.

OBJECTIVES: The aims of this study were to describe clinical and laboratory manifestations of patients with levamisole-adulterated cocaine-induced vasculitis/vasculopathy and to propose a skin classification according to the distribution and severity of lesions. METHODS: We report the characteristics of 30 patients admitted with levamisole-adulterated cocaine-induced vasculitis/vasculopathy in 4 high-complexity institutions in Colombia, from December 2010 to May 2017. We compare our findings with the main published series. RESULTS: Median age was 31 years (interquartile range, 27-38 years) with a male-to-female ratio of 5:1. Eighty-three percent of the patients had retiform purpura affecting the limbs, buttocks, face, or abdomen; 73% had ear necrosis, 50% cutaneous ulcers, 17% genital necrosis, 13% oral ulcers, and 10% digital necrosis. Cutaneous involvement was classified according to the frequency of the compromised corporal area, and purpuric lesions were stratified in 4 grades of severity. Anti-neutrophil cytoplasmic autoantibodies were positive in 85% of the cases, lupus anticoagulant in 73%, and antinuclear autoantibodies in 57%; rheumatoid factor was negative in all cases. We found nephritis in 17 cases (57%). Prednisolone was used in most of the patients (70%), with other immunosuppressive agents being used in a lower percentage. Improvement was observed in 93% of the patients, but symptoms recurred in 40%, attributed to relapses in consumption. End-stage chronic renal disease developed in 10% of the cases, and 1 patient died. CONCLUSIONS: Because of rising cocaine consumption and levamisole adulteration frequency, levamisole-adulterated cocaine-induced vasculitis/vasculopathy is becoming more common. Detailed characterization of skin involvement coupled with multiple antibody positivity is essential for a diagnosis. Renal involvement is frequent, clinically and histologically heterogeneous, and potentially serious.

Generalized papular-purpuric eruption due to Solenopsis fugax bites.

A 59-year-old atopic man referred to for the onset of a diffused itching papular-purpuric eruption involving his trunk and legs but without systemic symptoms. History revealed that he started feeling itching after spending few hours in his basement. Direct examination of the environmental dust (www.edpa.it) showed high level of infestation of Solenopsis fugax, a small Myrmicinae ant. The skin eruption completely healed without scarring in 2 weeks. Specific disinfestation measures were performed and the patient did not comply of any recurrence during a 6-months follow-up.

Generalized papular-purpuric eruption due to Solenopsis fugax bites

Abstract: A 59-year-old atopic man referred to for the onset of a diffused itching papular-purpuric eruption involving his trunk and legs but without systemic symptoms. History revealed that he started feeling itching after spending few hours in his basement. Direct examination of the environmental dust (www.edpa.it) showed high level of infestation of Solenopsis fugax, a small Myrmicinae ant. The skin eruption completely healed without scarring in 2 weeks. Specific disinfestation measures were performed and the patient did not comply of any recurrence during a 6-months follow-up.

Pigmented purpura and cutaneous vascular occlusion syndromes.

Purpura is defined as a visible hemorrhage in the skin or mucosa, which is not evanescent upon pressure. Proper classification allows a better patient approach due to its multiple diagnoses. Purpuras can be categorized by size, morphology, and other characteristics. The course varies according to the etiology, as do the diagnostic approach and treatment. This review discusses pigmented purpuras and some cutaneous vascular occlusion syndromes.

Pigmented purpura and cutaneous vascular occlusion syndromes

Abstract: Purpura is defined as a visible hemorrhage in the skin or mucosa, which is not evanescent upon pressure. Proper classification allows a better patient approach due to its multiple diagnoses. Purpuras can be categorized by size, morphology, and other characteristics. The course varies according to the etiology, as do the diagnostic approach and treatment. This review discusses pigmented purpuras and some cutaneous vascular occlusion syndromes.

Púrpura de Schönlein-Henoch Buloso. Caso clínico / Bullous Henoch-Schönlein purpura. Case report

Resumen: Introducción: El púrpura de Schonlein-Henoch (PSH) O Vasculitis IgA es la vasculitis sistémica más frecuente de la edad pediátrica. Se manifiesta clínicamente como púrpura palpable, artralgias, dolor abdominal y compromiso renal. El púrpura palpable buloso a diferencia de lo que ocurre en la edad adulta, es muy infrecuente en la infancia. Objetivo: Reportar una forma infrecuente de presentación cutánea del PSH en niños. Caso clínico: Niña de 14 años con historia de 2 semanas con ampollas dolorosas múltiples y confluentes en ambas extremidades inferiores asociado a artralgias. A la histo-patología destacan vesículas intracórneas, epidermis con acantosis y espongiosis e infiltrado dérmico perivascular. Inmunofluorescencia directa (+) para IgA. Se plantea el diagnóstico de PSH ampollar y se realiza tratamiento inicial con corticoides intravenosos. A los tres días del traslape a corticoides orales aparecen nuevas lesiones equimóticas en ambas piernas. Se decide asociar azatriopina e iniciar descenso de corticoides, obteniéndose buena respuesta. Conclusión: Si bien la formación de bulas en el PSH no agrega morbilidad, suele ser un fenómeno alarmante que requiere realizar diagnóstico di ferencial con otras patologías. El uso de corticoides estaría indicado en estos casos ya que disminuiría la producción de las metaloproteinsas responsables de la formación de las bulas.

Abstract: Henoch-Schönlein purpura (HSP) or IgA Vasculitis is the most common childhood vasculitis. The classic tetrad of signs and symptoms include palpable purpura, arthralgia, abdominal pain and renal disease. The occurrence of hemorrhagic bullae in children with HSP is rarely encountered. Objec tive: To report an unusual cutaneous manifestation of HSP in children. Case report: A 14-year-old girl complained about a 2-week painful bullous rash in both lower extremities and multiple arthral gias. There was no history of abdominal pain or urinary symptoms. In both lower extremities, there were numerous palpable purpura and hemmorrhagic bullae. In light of clinical findings, laboratory tests and skin biopsy are requested. The histopathology described intraepidermal blisters, acanthosis, spongiosis and perivascular dermal infiltrate. Direct immunofluorescence (IFD) (+) for IgA. The diagnosis of bullous HSP was made and treatment with endovenous corticosteroids was initiated. Three days after overlapping to oral corticosteroids, new ecchymotic lesions appeared in both legs. Due to the persistence of cutaneous involvement and negative control tests, azathioprine was associa ted obtaining a good response. Conclusion: Although bullous lesions in HSP does not add morbidity, it is often an alarming phenomenon with multiple differential diagnoses. The anti-inflamatory effect of corticoids is likely to be beneficial in the treatment of patients with severe cutaneous involvement through inhibition of proinflammatory transcription factors and decreasing the production of the metalloproteinases.

Evolución de un cuadro de hemorragia intracraneal en lactante con trombocitopenia inmune primaria / Evolution of a case of intracraneal hemorrhage in infant with primary immune trombocytopenia

La trombocitopenia inmune primaria (TIP) es una enfermedad hematológica de causa inmunológica que presenta una plaquetopenia inferior a 100 000 plaquetas/mm3 y tiene una incidencia de 4 casos por cada 100 000 habitantes, siendo más prevalente entre los 2 a 6 años de edad. Esta entidad continúa siendo un desafío con respecto a la terapéutica y puede conllevar a complicaciones graves muy difíciles de resolver una vez establecidas.Se presenta el caso de un lactante menor de sexo masculino que curso con por un cuadro de palidez generalizada con aparición súbita de hematoma en mucosa oral, máculas equimóticas y hemorragias puntiformes en toda la superficie corporal. En los exámenes realizados se evidenciaron trombocitopenia y anemia grave, llegando al diagnóstico de trombocitopenia inmune primaria inicialmente manejada con transfusiones y posteriormente con corticoides. A pesar del manejo, el cuadro evolucionó con complicaciones de hemorragia intraparenquimatosa y declino neurológico.

Primary immune thrombocytopenia (PIT) is a hematological disease of immunological cause that has platelet count less than 100 000 platelets / mm3 and has an incidence of 4 cases per 100 000 inhabitants, being more prevalent between 2 and 6 years of age. This entity remains a challenge with regard to therapeutics and can lead to serious complications that are difficult to resolve once established. We report the case of a young male infant who has a generalized pallor with sudden onset of hematoma in the oral mucosa, equimotic macules and punctate hemorrhages throughout the body surface. In the examinations performed thrombocytopenia and severe anemia were evident, arriving at the diagnoses of idiopathic thrombocytopenic purpura initially managed with transfusions and later with corticoids. despite the treatment the case progress whith complications of intraparenchymal hemorrhage accompanied by neurological decline

What is the cause of palate lesions? A case report.

OBJECTIVES: Trauma to the oral tissues can be caused by fellatio. Few cases are reported in the literature. METHODS: A case of oral palate lesions is presented and discussed. RESULTS: The patient developed a large band of petechial haemorrhage extending across the soft palate following the practice of fellatio. The diagnosis was made through an interview with the patient, which disclosed a probable case for fellatio as the cause of the palatal spots. At the follow-up visit 14 days later, the lesions disappeared. CONCLUSIONS: Oral sex activity has increased over the last decades. The dental care professional should be aware that lesions of the palate may result from sexual behaviour. With this possibility in mind, those working in the area of head and neck medicine should consider fellatio as an addition to the differential aetiology of intraoral petechiae.

Case for diagnosis. Papular-purpuric gloves and socks syndrome.

Papular-purpuric gloves and socks syndrome is a rare, highly contagious dermatosis caused by parvovirus B19, which may result in the abrupt cessation of red blood cell production in patients with preexisting hematological diseases. It affects predominantly children and young adults and has an unusual presentation.

Case for diagnosis / Caso para diagnóstico

Papular-purpuric gloves and socks syndrome is a rare, highly contagious dermatosis caused by parvovirus B19, which may result in the abrupt cessation of red blood cell production in patients with preexisting hematological diseases. It affects predominantly children and young adults and has an unusual presentation.

A síndrome "gloves and socks" pápulo-purpúrica é uma dermatose incomum, altamente contagiosa, causada pelo parvovírus B19, que pode provocar interrupção aguda da produção de glóbulos vermelhos em pacientes com doenças hematológicas preexistentes. Acomete, principalmente, crianças e jovens, e tem uma apresentaçao nao-usual.