Vemurafenib-associated neutrophilic panniculitis: An emergent adverse effect of variable severity.

Vemurafenib is a selective BRAF kinase inhibitor recently proven to improve rates of overall and progression-free survival in patients with BRAF-V600-mutant metastatic melanoma. The most common adverse effects of this targeted therapy are arthralgia, fatigue, and cutaneous lesions, including alopecia, photosensitivity, pruritus, hand-foot skin reactions, squamous cell carcinomas, keratoacanthomas, warty dyskeratomas and verrucous keratosis. Less frequently, cases of panniculitis of varying severity have been reported in patients receiving vemurafenib. In this report, we describe a patient who developed asymptomatic nodules on her legs, with complete, spontaneous resolution, while on vemurafenib therapy. A causal relationship was considered likely because of the timing of occurrence and the absence of other potential causes after extensive assessment. Vemurafenib therapy was continued at full dosage and no recurrences were observed. We believe that management of lobular panniculitis associated with selective BRAF inhibitors should vary according to the clinical presentation, degree of systemic involvement, and presence of joint inflammation. Physicians should be aware of this emergent side effect. Treatment discontinuation should be considered on a case-by-case basis because the condition may resolve spontaneously.

Cutaneous collagenous vasculopathy: description of two new cases in elderly women and review of the literature.

Cutaneous collagenous vasculopathy (CCV) is an idiopathic microangiopathy with characteristic histological findings. It was described in 2000, and 9 cases have since been described. Two women of 83 and 74 years consulted for long-standing telangiectasias. In case 1, they affected the limbs and trunk and in case 2 were located on the legs. Biopsies of these lesions showed dilated vascular structures whose walls were thickened due to deposition of eosinophilic hyaline material. The affected vessels were located in the superficial dermis in case 1, and in case 2 the reticular dermis was also affected. CCV is a microangiopathy of unknown etiology. Clinically it is indistinguishable from generalized essential telangiectasia and differs in its histology. CCV may be underdiagnosed, and some nonbiopsied cases of generalized essential telangiectasia may really be CCV. We contribute 2 new cases of this entity to help establish its clinical and epidemiological characteristics and make its etiology better known.

Progressive facial hemiatrophy with associated osseous lesionsd

No disponible

Progressive facial hemiatrophy (PFH) is a rare condition characterized by the slow, progressive appearance of a unilateral facial atrophy that affects the skin, subcutaneous tissue, muscle and bone. We report the case of a 60-year-old femalepatient whose cutaneous symptoms commenced in 1987 in the form of a purplish erythema on the left side of her face and neck, which subsequently remitted giving rise to an indurated region in the left maxillary region. Since 1995 until the present day, she has developed facial hemiatrophy on the left side accompanied by progressive osseous reabsorptionof the upper maxilla and left mandible with atrophy of soft tissue. The association of the onset of PFH with progressive osteolysis of the maxilla has not been previously reported in an adult patient (AU)

Recurrence rates of primary basal cell carcinoma in facial risk areas treated with curettage and electrodesiccation.

BACKGROUND: The incidence of basal cell carcinoma (BCC) is increasing. Curettage and electrodesiccation (CE) are not recommended for BCC treatment at medium- and high-risk facial sites. Surgical excision has been proposed as the treatment of choice. OBJECTIVE: We sought to evaluate the cumulative recurrence rate (RR) of primary BCC in facial areas of medium and high risk after CE. METHODS: This nonrandomized, clinical trial enrolled 257 patients with primary BCC located in medium- and high-risk facial areas, and treated with 4 or 5 cycles of CE by a single operator from a section specializing in BCC CE in a tertiary teaching hospital in Oviedo, Spain. Exclusion criteria for study entry included: recurrent BCC, fibrosing BCC, ill-defined BCC, and BCC larger than 10 mm in diameter (high-risk facial sites) or larger than 15 mm in diameter (medium-risk sites); BCC smaller than 4 mm; and nonbiopsy-proven BCC. BCCs included in the study were from the nose, and paranasal and nasal-labial fold (n = 105); eyelids and canthi (n = 48); perioral areas (n = 12); ears (n = 11); forehead and temples (n = 48); periauricular areas (n = 14); and malar areas and cheeks (n = 19). The primary outcome was recurrence of carcinoma, which was clinically evaluated by at least two observers in consensus. Data were analyzed using both a life table method and Kaplan-Meier analysis. The statistical analysis included best- and worst-case scenarios (which means that all cases lost to follow-up were considered as recurrences). RESULTS: The 5-year cumulative non-RR in the best-case scenario was 98.80% (SE 0.70, 95% confidence interval 97.40%-100%); thus, a 5-year cumulative RR of 1.20% was found after CE in our medium- and high-risk BCCs of the face (best case). The 5-year cumulative non-RR in the worst-case scenario was 79.40% (95% confidence interval 78.90%-79.90%); thus, a 5-year cumulative RR of 20.60%. LIMITATIONS: Retrospective design with a relatively small number of patients lost to follow-up is a study limitation. CONCLUSION: High 5-year cure rates can be obtained after CE of primary, nonfibrosing BCCs of medium- and high-risk areas of the face performed in a specialized section.

Tiña del cuero cabelludo por Microsporum canis en una mujer adulta / Tinea capitis in the elderly: an unusual situation

La tiña del cuero cabelludo es una enfermedad muy rara en adultos. Presentamos una tinea capitis causada por Microsporum canis en una paciente sana postmenopáusica. Se discuten los factores predisponentes de la dermatofitosis en los pacientes adultos y se cuestiona el uso de terbinafina como tratamiento de primera elección en esta entidad, debido a la aparición de resistencias

Tinea capitis is very rare in adults. We report a new case of tinea capitis caused by Microsporum canis in a healthy postmenopausal woman. We argue the predisposing factors of the dermatophytoses in adult patients and discuss about the use of terbinafine like first line of treatment in this entity, because of the apparition of resistances

[Cutaneous semiology: a historical perspective of the evolution of basic terminology in Spain]. / Semiología cutánea: perspectiva histórica de la evolución de la terminología básica en España.

There are still numerous incompatibilities in the definitions of basic dermatological terms. In Spain, the problem is aggravated by the coexistence and conflict between two different semantic models, imported from other countries (France and the USA). These two models really have different "units": one model can be called "essentialist" and the other "nominalist". These models are not original to Spain; rather, each one shows the predominance or influence of an outside culture. Through a historical and evolutional study, we were able to verify that the origin of these semantic models goes back to Joseph Plenck and Robert Willan (essentialist model) and to Ferdinand Hebra (nominalist model), respectively. An analysis of these models from a historical perspective may help in understanding the origin of the current conflicts in the everyday use of Spanish dermatological semiology, and may therefore help resolve them.

Semiología cutánea: perspectiva histórica de la evolución de la terminología básica en España / Cutaneous semiology: a historical perspective of the evolution of basic terminology in Spain

En la actualidad persisten numerosas incompatibilidades en las definiciones de los términos básicos dermatológicos. En nuestro país el problema se agrava por la coexistencia y choque de dos modelos semánticos diferentes, importados de otros países (Francia, EE.UU.). Dos modelos que realmente tienen unidades diferentes: el modelo esencialista y el modelo nominalista. No son originales de nuestro país, sino que cada uno de ellos marca el predominio o influencia de una cultura exterior. Mediante un estudio histórico y evolutivo hemos podido comprobar que el origen de estos modelos semánticos de semiología se remonta a Joseph Plenck y Robert Willan (modelo esencialista) y a Ferdinand Hebra (modelo nominalista) respectivamente. Un análisis de estos modelos desde una perspectiva histórica puede ayudar a comprender el origen de los conflictos actuales en el uso cotidiano de la semiología dermatológica española y, por tanto, puede ayudar a resolverlos

There are still numerous incompatibilities in the definitions of basic dermatological terms. In Spain, the problem is aggravated by the coexistence and conflict between two different semantic models, imported from other countries (France and the USA). These two models really have different «units»: one model can be called «essentialist» and the other «nominalist.» These models are not original to Spain; rather, each one shows the predominance or influence of an outside culture. Through a historical and evolutional study, we were able to verify that the origin of these semantic models goes back to Joseph Plenck and Robert Willan (essentialist model) and to Ferdinand Hebra (nominalist model), respectively. An analysis of these models from a historical perspective may help in understanding the origin of the current conflicts in the everyday use of Spanish dermatological semiology, and may therefore help resolve them

[Acquired flat angiomas in the form of a port-wine stain]. / Angiomas planos adquiridos en mancha de vino de Oporto.

The development of flat angiomas in the form of a "port-wine stain" is an infrequent event in adults. We describe two cases of acquired flat angioma in the form of a "port-wine stain", which began in the second decade of life and grew slowly and steadily until reaching a large size. In the first case, it affected the front and back of the trunk, and in the second patient, the neck and left shoulder. Histopathology showed ectatic vessels in the papillary and reticular dermis, with no proliferation of endothelial cells.