Eosinophilic fasciitis in a pregnant woman with corticosteroid dependence and good response to infliximab.

Eosinophilic fasciitis (EF) is characterized by symmetrical thickening of subcutaneous muscular fascia, causing skin induration with wrinkles and prominent hair follicles: the classic peau d'orange. Eosinophilia is a characteristic-albeit not universal-finding. We present the case of a 43-year-old pregnant woman diagnosed with EF during pregnancy who had extensive cutaneous involvement and severe functional repercussions, including worsening of lung function and intrauterine growth restriction as a possible complication. Treatment with prednisone was initiated during gestation and it was necessary to increase the dose. After delivery, methotrexate treatment was initiated and the corticosteroid dose progressively decreased, with progressive worsening in the torso and abdomen and secondary dyspnea due to thoracic pressure. Treatment with infliximab was then initiated, with favorable progress, though residual ankle and tarsal joint stiffness and significant muscular atrophy in the limbs continued. The triggering factor of EF was not identified. In a systematic search of the medical literature, three cases of EF in pregnant woman without clear triggers were found. Interestingly, all three cases progressed favorably with steroid treatment. Apart from this case, there are only seven published cases of infliximab use in the literature, all with moderate or complete response. Infliximab could be an option for corticosteroid-dependent EF with no response to other options.

Metastatic Basal Cell Carcinoma: Case Report and Review of the Literature.

Basal cell carcinoma (BCC) is the most commonly occurring carcinoma among humans. However, despite their overall frequency, cases of BCC featuring metastases are extremely rare. We present the case of a male patient with BCC located in the chest, measuring 10 cm and with an evolution of 15 years. After several years, an axillary recurrence developed as a tumor mass affecting the lymph nodes. After 14 months, a further lymph node recurrence was observed and resected. Six months later, a pulmonary nodule was detected, which was resected with tumor-free margins. Histopathological report revealed infiltration by BCC. After 13 years of follow-up (after the removal of the primary tumor), the patient remained alive and received close clinicoradiological monitoring. Taking advantage of this opportunity, we also provide a brief review of the corresponding literature.

Preventing Skin Cancer Among Staff and Guests at Seaside Hotels.

Beach users and outdoor workers in resort areas are major risk groups for skin cancer, and therefore seaside hotels constitute a strategic area in which to conduct awareness-raising campaigns and interventions. The main aim of the present study is to describe habits, attitudes and knowledge related to sun exposure, the sunburn events experienced and potentially malignant skin lesions observed among hotel staff and guests recruited during a skin cancer prevention campaign at seaside hotels in the western Costa del Sol (southern Spain). This descriptive cross-sectional study was conducted at four seaside hotels in the western Costa del Sol. An 8-day awareness-raising campaign on skin cancer was conducted for hotel guests and staff, who were invited to complete a questionnaire about their habits, attitudes and knowledge regarding photoprotection, and to receive a comprehensive skin examination. The questionnaire on habits, attitudes and knowledge related to sun exposure was completed by 542 participants. The most common photoprotection practice was the use of sunglasses (79.3%). Potentially dangerous lesions were identified in 39 persons (14%). In addition, 94.0% reported having gained new knowledge, 89.6% had changed their attitudes towards sun tanning and 94.7% intended to improve their photoprotection practices in the future. Seaside hotels are an optimal scenario for conducting studies aimed at skin cancer prevention and reduction. Further studies should be carried out in other geographical areas to confirm our results, to evaluate the costs and benefits of such interventions and determine their long-term impact on health.

Necrosis cutánea tras shock séptico / Skin necrosis after septic shock

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Hyperbaric oxygen therapy: An alternative treatment for radiation-induced cutaneous ulcers.

Radiotherapy is a widely recognised treatment for non-melanoma skin cancer. We report three cases of radiation-induced skin ulcers in which hyperbaric oxygen therapy was administered in 90-min sessions, 5 days a week at 2.4 absolute atmospheres in a multiplace hyperbaric chamber. Hyperbaric oxygen therapy is an outpatient treatment that does not displace other classical treatments and may be used as an adjunct therapy.

Usefulness of a "puzzle" flap; more than an advancement flap for surgical reconstruction of nasal ala defects: Review of 10 cases.

Reconstructive surgery in nasal pyramid can be a challenge for surgeons. Moreover this anatomic area is one the most common sites for non-melanoma skin cancer. The "puzzle" flap was described to repair surgical defects located just on the nasal ala affecting melolabial sulcus. We have seen this flap can be also very useful to repair defects located on nasal sidewall and cheek without dysfunctional effects and with a good cosmetic result.

Lesiones ampollosas en el dorso de las manos / Bullous lesions on the back of the hands

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Placas eritematosas parduzcas atróficas de 40 años de evolución / Rownish-erythematous atrophic plaques, developed over 40 years

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Signo de Leser-Trélat asociado a síndrome de Sézary / Sign de Leser-Trélat associated with Sézary syndrome

Se denomina signo de Leser-Trélat a la profusión de queratosis seborreicas secundaria a un proceso neoplásico. Aunque clásicamente el cuadro se ha incluido dentro de las dermatosis paraneoplásicas facultativas, durante las últimas décadas se ha debatido su carácter paraneoplásico. Se presenta el caso de un varón de 82 años en el que la aparición brusca de múltiples queratosis seborreicas llevó a sospechar la posibilidad de una neoplasia subyacente. Estudios posteriores nos llevaron al diagnóstico de un síndrome de Sézary asociado. La aparición simultánea de la dermatosis y el tumor y el curso evolutivo paralelo que se observa entre ambos procesos, hablan a favor de la existencia del signo de Leser-Trélat y de su importancia en la práctica clínica como marcador de neoplasia (AU)

Cromomicosis en paciente inmunodeprimido / Chromomycosis in an immunosuppresses patient

Las micosis cutáneas profundas son infecciones crónicas, provocadas por la inoculación traumática en dermis y tejido celular subcutáneo de diversas especies fúngicas. La incidencia es baja en nuestro medio y la mayor parte de los casos ocurren en regiones tropicales y subtropicales. La esporotricosis, el micetoma y la cromoblastomicosis constituyen las micosis subcutáneas más comunes. Presentamos el caso de una mujer de 73 años, en tratamiento inmunosupresor tras someterse a un trasplante cardíaco, que presentaba una úlcera traumática en tercio inferior de pierna izquierda de 9 meses de evolución. Los estudios histológicos y microbiológicos permitieron establecer el diagnóstico de cromomicosis. La respuesta a itraconazol oral fue favorable, obteniéndose una curación completa tras 3 meses de tratamiento (AU)

Leucemia cutánea aleucémica: presentación de un caso / Aleukemic leukemia cutis: a report of one case

Se denomina leucemia cutánea aleucémica a la invasión cutánea por células leucémicas en ausencia de afectación de sangre periférica y/o médula ósea. Aunque se desconocen los mecanismos patogénicos de esta enfermedad, está ampliamente aceptado su pronóstico grave. En la mayoría de los casos publicados se describe la expresión completa del proceso hematológico (con mayor frecuencia leucemias agudas monocíticas o granulocíticas) en los 10-14 meses posteriores al inicio del cuadro cutáneo, así como una supervivencia media de unos 22 meses. Presentamos el caso de un paciente varón de 77 años con leucemia cutánea aleucémica que inició la enfermedad en forma de múltiples lesiones papulonodulares eritematovioláceas en tronco y cabeza, con ausencia de afectación de sangre periférica y alteraciones incipientes en médula ósea. El estudio inmunohistoquímico, tanto de las lesiones cutáneas como de médula ósea, demostró la invasión de ambos tejidos por células tumorales pertenecientes a la estirpe monocitohistiocitaria. El paciente presentó una desaparición espontánea de las lesiones cutáneas, así como una ausencia de progresión del cuadro hematológico en los 9 meses posteriores al diagnóstico, a pesar de no haberse sometido a ningún tratamiento. Destacamos la baja incidencia de asociación entre síndromes mielodisplásicos y leucemias cutáneas aleucémicas, así como la sorprendente resolución espontánea de las lesiones cutáneas en nuestro caso (AU)