Dermatosis perineal y glútea en un paciente paliativo con rápida respuesta a tratamiento oral / Perineal and gluteal dermatosis in a palliative patient with rapid response to oral treatment

Los pacientes con enfermedades terminales presentan frecuentes y diversos problemas de la piel debido a sus enfermedades de base y complicaciones de su situación: encamamiento, inmovilidad, malnutrición, incontinencia, etc. Estas lesiones ocasionan importante sufrimiento por el dolor, prurito, incomodidad, alteración de la imagen corporal y falta de intimidad. Por lo tanto, su abordaje eficaz por los médicos de cuidados paliativos es prioritario. En algún caso es posible conseguir un tratamiento causal efectivo en el corto periodo de tiempo disponible como demuestra el paciente descrito

Patients with terminal disease frecuently present various skin problems due to their underlying disease and complications of their clinical situation: bed-ridden, immobility, malnutrition, incontinence, etc. These lesions commonly produce significant suffering because of pain, itching, discomfort, body image distortion and lack of intimacy. Thus, an effective management of these by palliative care is prioritary. Occasionally, a specific treatment efficacious in the short time avalilable is possible as the present case shows

[Infantile atypical hand-foot-mouth disease with features of eczema herpeticum and acrodermatitis]. / Enfermedad boca-mano-pie atípica infantil con rasgos de eczema herpetico y de acrodermatitis.

Hand-foot-mouth disease can present atypically, including forms with more numerous lesions and/or morphologically different from the classic presentation. It may even mimic other viral diseases. We present the case of a 2-year-old child previously diagnosed with atopic dermatitis, who presented with papules and umbilicated vesicles affecting the perioral area and limbs, predominantly in pressure areas, as well as in areas with previous atopic lesions. Although he was clinically diagnosed with herpetic eczema, tests results were negative for herpes virus. However, positive entorovirus polymerase chain reaction results were obtained from the content of a vesicle, a pharyngeal exudate and a stool sample.

La enfermedad boca-mano-pie puede presentarse con formas atípicas, con lesiones más generalizadas y morfología diferente a la forma clásica. A veces, incluso simula otras enfermedades víricas. En las formas atípicas, existe la tendencia a afectar a las zonas de traumatismo o inflamación. Se presenta el caso de un niño de 2 años con antecedente de atopia, que consultó por presentar lesiones papulosas y vesiculosas umbilicadas que afectaban a la zona perioral, los miembros superiores e inferiores, con predominio en las zonas de presión y de dermatitis atópica previa. Aunque clínicamente se diagnosticó eczema herpético, las pruebas complementarias fueron negativas para herpes virus. Sin embargo, la reacción en cadena de la polimerasa del contenido de una vesícula, del exudado faríngeo y de heces fue positiva para enterovirus.

Acroangiodermatitis of Mali (Pseudo-Kaposi Sarcoma) Associated with Chronic Venous Insufficiency and Obesity: A Case Report.

INTRODUCTION: Acroangiodermatitis, also known as psesudo-Kapsoi sarcoma, is a rare and benign angioproliferative malady. It presents clinically as purple-colored plaques, patches, or nodules resembling Kaposi sarcoma and is often related to chronic venous insufficiency, arteriovenous malformation of the legs, paralyzed limbs, and residual limbs. Obesity is a risk factor for venous insufficiency and could be related to acroangiodermatitis. CASE REPORT: The authors report a case of acroangiodermatitis of the bilateral legs that was misdiagnosed for 3 years. The diagnosis was confirmed using histopathological and immunohistochemical examinations such as hematoxylin and eosin staining and CD34 immunostaining. Multiple modalities were utilized to treat the wounds, including serial debridement, compression dressings, and silver antimicrobial dressings. CONCLUSIONS: It should be stressed that chronic, nonhealing wounds should be biopsied to obtain a proper diagnosis.

Acrodermatitis Enteropathica Presenting with Recurrent Diarrhea and Vomiting in an Infant Reluctant to Breastfeed, and a Peculiar Erythemato-Eczematous Eruption around the Oral and Anogenital Regions.

A 6-month-old, 4-kg, dehydrated girl, an Indian native, was admitted with recurrent episodes of diarrhea that had occurred since age 2 months. She had stopped breastfeeding. She had also had concomitant vomiting and loss of appetite. Later, the mother noticed progressively increasing erythematous eruptions around the anogenital and the oral region. The baby had been born to a short-stature mother and was delivered by lower segment cesarean section. Regular antenatal follow-up was normal.

Brief Report: HPV-17 Infection in Darier Disease With Acrokeratosis Verrucosis of Hopf.

The co-existence of Darier disease (DD) and acrokeratosis verruciformis of Hopf (AKV) has been noted for decades and the relationship between the 2 entities remains controversial. Although, it has been shown that both diseases are associated with mutations in ATPA2 gene, it is yet to be determined if they are the same disease, or separate but allelic, or interlinked in some other fashion. Herein, the authors report the case of a 13-year-old girl presenting with shiny flat-topped verruca plana-like papules, on the dorsal hands and feet and red-brown crusted papules on her forehead and along the sides of her neck. Histological evaluation of a wart-like lesion shows features of AKV, a verruca plana-like histopathology and focal acantholytic dyskeratosis. Forehead biopsy also demonstrated focal acantholytic dyskeratosis supporting the diagnosis of DD. Polymerase chain reaction for human papillomavirus (HPV) DNA detected HPV-17, a human betapapillomavirus in the verruca plana-like papule. Cytoplasmic expression of the L1 capsid expression was seen in areas of hypergranulosis. The presence of productive betaPV infection in the setting of DD and AKV suggests a susceptibility to HPV infection.

Itch Management in Childhood.

Itch in children is a very common symptom and is mainly related to a skin disease rather than an underlying systemic disorder. The most common dermatoses include atopic dermatitis, contact dermatitis, insect bites, scabies, and pediculosis capitis. There are specific diagnostic patterns which require the evaluation of a careful history and dermatological examination. For dermatological treatment, we have to consider that children, especially infants, show differences in physiology and pathophysiology, and also in pharmacokinetics and pharmacodynamics compared with adults.

Gianotti-Crosti syndrome associated with Ebstein-Barr virus and Parvovirus B-19 coinfection in a male adult: case report and review of the literature.

Gianotti-Crosti syndrome (GCS) is a self-limiting, mostly childhood-appearing, cutaneous eruption with characteristic symmetric areal distribution. The original cases, described by Gianotti in 1955, were associated with hepatitis B virus infection, but other viral and bacterial infections, as well as immunizations, have been implied in etiology of this condition. Adult cases are rare and have been reported almost exclusively in women. We present the case of a 20-year-old Caucasian man who had typical clinical presentation: monomorphic pale, pink-to-flesh - colored or erythematous papules and papulovesicles localized symmetrically over the extensor surfaces of the extremities, buttocks and the face; some lesions were detected on knees, elbows and palms, as well. Laboratory tests revealed slight bilirubin and alanine aminotransaminase elevation. Serology tests demonstrated antibodies against Epstein-Barr virus and parvovirus B-19. Histology of skin biopsy specimens revealed a vesicular dermatitis with perivascular lymphocytic infiltrate. Oral and topical corticosteroids and oral antihistamines led to complete resolution of lesions in 3 weeks. GCS is rare in adults, especially men. To the best of our knowledge, this is the fifth male adult case and the first with Parvovirus B-19 and EBV coinfection.

Unusual Eruptions Associated with Mycoplasma pneumoniae Respiratory Infections: Review of the Literature.

BACKGROUND: Maculopapular or urticarial eruptions and erythema multiforme sometimes occur in patients affected with Mycoplasma pneumoniae respiratory infections. Further eruptions have also been reported. OBJECTIVE: To review the literature addressing M. pneumoniae respiratory infection and rather unusual eruptions. METHODS: Computer-based search in the U.S. National Library of Medicine database as well as in the search engine Google. RESULTS: We found a possible relationship between M. pneumoniae infection and Fuchs' syndrome (n = 37), varicella-like eruptions (n = 8), Henoch-Schönlein syndrome and further leukocytoclastic vasculitides (n = 21) and erythema nodosum (n = 11). A temporal relationship was also observed with 2 cases of Gianotti-Crosti syndrome. Finally, there exists reasonable evidence that pityriasis rosea Gibert and pityriasis lichenoides et varioliformis acuta Mucha-Habermann are not associated with Mycoplasma infections. CONCLUSION: This review implies that M. pneumoniae may cause, in addition to erythematous maculopapular (or urticarial) eruptions and erythema multiforme, Fuchs' syndrome and varicella-like eruptions. Furthermore, there is an intriguing link with leukocytoclastic vasculitides or erythema nodosum that deserves further investigation.

Stewart-Bluefarb syndrome: review of the literature and case report of chronic ulcer treatment with heparan sulphate (Cacipliq20®).

Stewart-Bluefarb syndrome (SBS), also known as acroangiodermatitis or pseudo-Kaposi, is a condition rarely encountered. It involves skin lesions that are clinically similar to Kaposi sarcoma but are histologically different, and are usually secondary to an underlying arteriovenous fistula. Treatment of this disease usually involves the correction of the underlying vascular abnormality, with the mainstay of therapy ranging from compression devices for venous stasis, limited oral medications (dapsone and erythromycin) and local wound care including topical steroids. Different methods of treatment showed varied success but none is ideal. We report a case of a lower extremity ulcer in a 22-year-old male recently diagnosed with SBS successfully treated with heparan sulphate (Cacipliq20®).