ABSTRACT
Vitiligo is a disease characterised by the autoimmune destruction of melanocytes, manifesting as depigmentation of the skin. We present the case of a female patient with a history of breast cancer who developed vitiligo in the area of the treatment field 12 months after the end of radiotherapy. It has been reported in the literature that vitiligo can occur in patients with a history of vitiligo after radiotherapy, attributable to the Koebner phenomenon, where some treatments can induce new vitiligo lesions in the patient.
ABSTRACT
Resumen: ANTECEDENTES: El liquen plano de vulva se manifiesta como una lesión erosiva, papuloeritematosa o hipertrófica aislada o con afectación extragenital concomitante. CASO CLÍNICO: Paciente de 41 años, sin antecedentes médicos de interés, que acudió a consulta por la aparición de lesiones cutáneas pruriginosas de dos meses de evolución. A la exploración se objetivaron múltiples pápulas eritematoescamosas, violáceas, hiperqueratósicas, concomitantes con fenómeno de Koebner y tendencia a la agrupación, ubicadas en la cara anterior de los antebrazos y las muñecas, el dorso del pie y el tronco; en los pliegues inguinales, región vulvar y perianal, y de forma asintomática en el surco interlabial izquierdo, una pápula no pruriginosa de 3 mm, de tonalidad violácea con reticulado blanquecino en la superficie (estrías de Wickham), y otras dos pápulas de 11 y 3 mm. Se estableció el diagnóstico de liquen plano pápulo-escamoso vulvar, variante hipertrófica cutánea. Puesto que la enfermedad aparece de forma espontánea, se decidió el tratamiento expectante y para el prurito se indicaron antihistamínicos por vía oral. Seis semanas después desaparecieron las lesiones cutáneas (sin cambios cicatriciales). CONCLUSIONES: En pacientes con procesos dermatológicos complejos se requiere la correcta anamnesis y exploración ginecológica, sobre todo cuando hay afectación de las mucosas, para evitar el infradiagnóstico. La biopsia de las lesiones es útil en caso de duda, sobre todo en las lesiones vulvares aisladas de tipo hipertrófico.
Abstract: BACKGROUND: Vulvar lichen planus is a subtype of dermatological pathology that is presented as erosive, papulo-erythematous, or hypertrophic lesions on the vulva. This lesion could appear in isolation or with concomitant extragenital involvement. CASE REPORT: A 41-year-old patient with no previous history of interest, who attended due to the onset of itchy skin lesions of two months of evolution. At medical examination, multiple erythematous squamous, violaceous, hyperkeratotic papules were observed, with Koebner phenomenon and a tendency to cluster at the forearms and wrists, dorsum of the feet and trunk. The same lesions were seen in inguinal folds, vulvar and perianal region. We also notice an asymptomatic non-itchy 3 mm papule with violet edge in left labia majora (it had a whitish reticulate on the surface called Wickham's striae) and other erosive papules 11 mm and 3 mm respectively, with violet edge. No vaginal or other mucosal lesions were seen. Diagnosis of vulvar papule-squamous lichen planus was established which coexists with a cutaneous hypertrophic form. Given the self-limited nature of this pathology, a wait-and-see approach and symptomatic treatment of pruritus with oral antihistamines was adopted. Six weeks later, disappearance of the cutaneous lesion without cicatricial areas was observed. CONCLUSIONS: It is essential to carry out an anamnesis and gynecological examination in dermatological preocedures, especially when mucosas are involvement to avoid under-diagnosis. The biopsy of the lesions will be useful when there are doubts in the diagnosis, and it is essential in isolated hypertrophic vulvar lesions.
ABSTRACT
Frontal fibrosing alopecia (FFA) represents a distinctive condition with a marginal scarring alopecia along the frontal and temporal hairline. Since its original description, the condition has been recognized to represent a more generalized than localized process, with extension beyond the frontotemporal hairline to include the parieto-occipital hairline and involve peculiar facial papules as evidence of facial vellus hair involvement and loss of peripheral body hair. Finally, the association of FFA with oral lichen planus, nail involvement, and concomitant lichen planopilaris (LPP) points to a close relationship to lichen planus. The Koebner phenomenon or isomorphic reaction has been described in lichen planus, LPP, and ultimately FFA, with face-lift procedures and hair restoration surgery having been implicated as the culprits in the latter. We report the first case of FFA in whom LPP developed at the sites of wig attachments, providing the evidence for Koebner phenomenon. Therefore, wigs are to be included to the list of procedures for hair restoration at risk of eliciting an isomorphic reaction in patients with FFA. Ultimately, the association of Koebner phenomenon with LPP-type lesions in FFA may provide further insight into the underlying pathology and nosology of the condition.
ABSTRACT
Las reticulohistiocitosis son un grupo de enfermedades muy poco frecuentes que se caracterizan por la acumulación de histiocitos en piel y articulaciones principalmente. Se suelen asociar a condiciones y patologías muy variadas, predominantemente neoplasias. Presentamos un caso de inicio súbito luego de quemadura solar (AU)
Reticulohisticytosis is a group of diseases characterized by the accumulation of cells of histiocytic lineage primarily in the skin and joints. They have been associated with many conditions and diseases, mainly malignant neoplasms. A case of multicentric reticulohitiocytosis of sudden onset after sunburn is reported (AU)