Traumatic panniculitis.

Traumatic panniculitis refers to changes in the subcutaneous fat related to physical or chemical agents. The clinical picture of traumatic panniculitis is nonspecific. Cutaneous lesions are indurated, warm, red, subcutaneous plaques or nodules not necessary related to the intensity of the injury. The histologic picture includes fat microcysts surrounded by histiocytes, collections of foam cells, and inflammatory cells. Late lesions may show fibrosis, lipomembranous changes, or dystrophic calcic deposits. Traumatic panniculitis is usually a self-limiting disorder and requires only symptomatic treatment.

Subcutaneous sarcoidosis.

Subcutaneous sarcoidosis has been reported to occur in 1.4% to 6% of patients with systemic sarcoidosis. Most reported cases are in women, most often in their fifth and sixth decades, and appear as multiple, asymptomatic, hardly indurated subcutaneous nodules without changes in the overlying epidermis. The lesions are characteristically located in the upper extremities, mainly in the forearms, and usually are bilateral and asymmetric. In most cases the lesions appear at the beginning of systemic sarcoidosis and are not associated with chronic fibrotic disease. Histopathologically, sarcoidosis is characterized by noncaseating naked granulomas involving fat lobules, with minimal to no septal involvement.

Necrobiosis lipoidica.

Necrobiosis lipoidica (NL) is a granulomatous condition with a degenerative connective tissue of unknown etiology very often associated with diabetes. Histopathologically, NL involves all of the dermis and, often, the subcutaneous fat produces a septal panniculitis. There are some changes suggesting the diagnosis of NL, and systemic disease should be considered if there is the presence of necrotizing vasculitis in the skin biopsy. Many theories of pathogenesis have been proposed, and many types of drugs are available for use in its treatment.

Cutaneous infiltration by cancer.

BACKGROUND: Cutaneous infiltration by cancer has been reported to occur in 0.7% to 9% of all patients with malignant neoplasms and is usually considered a late event in the evolution of most visceral carcinomas. OBJECTIVE: To analyze the clinicopathological features of cutaneous infiltration by cancer. METHODS: All biopsy specimens codified as cutaneous infiltration by cancer between 1988 and 2005 were retrieved. Patients with hematologic malignancies were excluded. The clinical charts of the patients were reviewed to obtain additional information. RESULTS: In all, 381 patients (136 male and 245 female) were included in the study. The most frequent primary tumors were breast carcinoma (168 cases), malignant melanoma (59 cases), mucosal carcinoma of the head and neck (34 cases), lung carcinoma (25 cases), and large intestine carcinoma (22 cases). The most frequent clinical presentations were solitary nodule in 153 cases, multiple nodules in 82 cases, and infiltration of surgical scars in 50 cases. In 128 patients (33.6%) the cutaneous infiltrative lesions were present at diagnosis of the primary tumor. The number of yearly specimens of infiltration by breast carcinoma increased significantly from the first half to the second half of the period under examination. LIMITATIONS: This is an observational retrospective study. CONCLUSIONS: With the possibility of determining prognostic factors by analyzing tissue samples from malignant tumors, the role of cutaneous biopsy is expected to become increasingly important in the management of oncology patients, as is already the case with breast carcinoma.

Valor actual del test de Kveim en el diagnóstico de la sarcoidosis / Current value of the kveim test in the diagnosis of sarcoidosis

Introducción. La sarcoidosis es una enfermedad multisistémica para cuyo diagnóstico es preciso demostrar granulomas en uno o más órganos. El test de Kveim-Siltzbach puede ser útil para casos en los que no se puede demostrar inflamación granulomatosa en órganos afectados. En los últimos años su uso se ha restringido debido a la dificultad para obtenerlo y algunos autores lo han desaconsejado por el riesgo de transmisión de enfermedades infecciosas como la encefalopatía espongiforme bovina. Pretendemos analizar el valor actual del test Kveim-Siltzbach en los pacientes con especiales dificultades diagnósticas.Métodos. Se ha practicado el test de Kveim-Siltzbach a 20 pacientes remitidos al Servicio de Medicina Interna del Hospital de Bellvitge de Barcelona con sospecha de sarcoidosis en los que el diagnóstico no pudo ser confirmado mediante otros métodos. Las reacciones positivas se clasificaron en tres categorías según la cantidad de granulomas y la presencia de necrosis. Los pacientes fueron controlados durante un mínimo de 2 años.Resultados. El test de Kveim-Siltzbach fue positivo en 10 casos (ligeramente en 4 casos, moderadamente en cuatro e intensamente positivo en dos). En nueve de ellos el diagnóstico de sarcoidosis se confirmó mediante otros procedimientos. Únicamente en un paciente con test positivo el diagnóstico de sarcoidosis no pudo confirmarse por otros métodos.Conclusiones. El test de Kveim-Siltzbach sigue siendo útil como procedimiento diagnóstico en pacientes con especiales dificultades en la demostración histológica de granulomas (AU)

Pautas de tratamiento de los brotes en psoriasis vulgaris y pauta de mantenimiento / Therapeuitc and control régime of accute psoriasis vulgaris

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Crohn's disease presenting as prepuce and scrotal edema.

Metastatic cutaneous Crohn's disease, in which noncaseating granuloma infiltration of the skin occurs at sites separated from the gastrointestinal tract by normal tissue, is the least common dermatologic manifestation of Crohn's disease. We report a case of a 34-year-old man with metastatic Crohn's disease presenting as prepuce and scrotal edema with typical histopathologic features. We think that any unusual cutaneous lesion in patients with Crohn's disease should be biopsied.