Genital Herpes Zoster: A Rare Location That Can Mimic Genital Herpes.

ABSTRACT: Herpes zoster is an acute, cutaneous viral infection caused by the reactivation of varicella-zoster virus. Genital dermatomes are involved in only up to 2% of cases and are probably underrecognized. We present a series of 7 genital herpes zoster cases diagnosed in our Unit of Sexually Transmitted Diseases. None of our patients were positive for HIV test, and only one was taking immunosuppressive medication. We recommend the use of molecular testings to confirm the diagnosis of varicella-zoster virus or herpes simplex virus infection in all cases of genital herpes-like lesions.

Prevalence of non-alcoholic fatty liver and liver fibrosis in patients with moderate-severe psoriasis: A cross-sectional cohort study.

BACKGROUND/OBJECTIVES: Several studies have reported that non-alcoholic fatty liver disease (NAFLD) is more frequent in patients with psoriasis, but few have reviewed the presence of liver fibrosis in those patients. METHODS: Cross-sectional cohort, single-centre study, continuously selecting all patients with moderate-severe psoriasis seen at the Psoriasis Unit of a Tertiary Hospital. The grade of liver steatosis was assessed using liver ultrasound, and the quantity of liver fibrosis was graded using a transitional vibration-controlled elastography (Fibroscan®). RESULTS: A total of 71 patients (66.2% male) were included, with an average age of 46.6 years old. The maximum historical PASI average was 14.4 while the baseline PASI average at the time of the study was 2. A third (36%) of patients met the criteria for metabolic syndrome 52% of patients had steatosis; being male, having metabolic syndrome comorbidities, elevated AST/ALT enzymes, dyslipidemia and high initial PASI were significantly related. 14% of patients had moderate liver fibrosis (≥7.6 KPa). In 30% of them, no ultrasound liver steatosis was observed. CONCLUSIONS: Elastography may be a useful tool along with ultrasound to evaluate liver disease in patients with psoriasis.

Primary Cutaneous Neuroendocrine Carcinoma with Diffuse Expression of Thyroid Transcription Factor-1: Report of Two Cases.

Primary cutaneous neuroendocrine carcinoma (PCNC), previously known as Merkel cell carcinoma (MCC), is a rare tumor of the skin with aggressive behavior and poor prognosis. Typically, PCNC is positive for Cytokeratin-20 (CK20) and negative for Thyroid Transcription Factor-1 (TTF-1). Rarely, CK-20 negative and TTF-1 positive PCNC have been described. We present the case of two patients with skin lesions histologically compatible with MCCs and a behavior characteristic of this disease, but with expression of TTF-1 instead of CK-20. In conclusion, there are increasing reports of TTF1+ CK20- skin lesions without signs of systemic disease which behave clinically and prognostically like a PCNC. The origin of these TTF1 tumors are, to date, unknown.

A prospective multicenter study assessing effectiveness and safety of secukinumab in a real-life setting in 158 patients.

BACKGROUND: Secukinumab is a first-in-class interleukin 17A monoclonal antibody that has demonstrated an excellent safety and efficacy profile in phase 3 studies. OBJECTIVE: To evaluate the effectiveness of secukinumab in daily clinical practice and to understand the clinical and epidemiologic characteristics of patients treated with secukinumab in clinical settings. METHODS: In this multicenter prospective observational study, we recruited adult patients with moderate-to-severe plaque psoriasis from 12 hospitals in Spain during January-December 2016. These patients were treated with secukinumab and prospectively followed at 12-week intervals for 52 weeks. RESULTS: In total, 158 patients were recruited to the study. A Psoriasis Area and Severity Index (PASI) score improvement ≥75% over baseline (PASI-75) was achieved by 57%, 83.5%, 89%, and 78.5% of patients at weeks 4, 12, 24, and 52, respectively. PASI-90 was achieved in 27.8%, 62%, 64.6%, and 63.2% of patients at weeks 4, 12, 24, and 52, respectively; PASI-75 and PASI-90 responders were significantly more common among patients with a body mass index <30 kg/cm2 and patients without previous biologic therapy failures. LIMITATIONS: Observational study. Time from onset of psoriasis was not evaluated. CONCLUSION: Secukinumab is a safe treatment with effectiveness rates similar to those found in its phase 3 studies. These rates endure up to a year from start of treatment.

Incidence of non-melanoma skin cancer in patients treated with psoralen and ultraviolet A therapy. / Incidencia de cáncer cutáneo distinto del melanoma en pacientes tratados con PUVA oral.

INTRODUCTION: Studies reporting incidences of non-melanoma skin cancer (NMSC) are heterogeneous, depend on the geographic area of the studied population and are often short-term. The aim of this study is to determine the incidence of NMSC in patients treated with oral PUVA therapy in the Mediterranean area. MATERIAL AND METHODS: A retrospective, observational study was carried out with a sample of 234 patients treated with systemic PUVA between 1982 and 1996, carrying out a historical follow-up until May 2017. The incidencedensity rate of CCNM (crude and adjusted) was calculated by direct standardisation. The incidence of CCNM was compared with that reported in the general population in a similar geographical area. RESULTS: 50 neoplasms were diagnosed in 22 patients. The prevalence of CCNM in patients treated with phototherapy was 10.3%. The mean follow-up time was 21 years. The crude-adjusted incidence density rate of CCNM was 554.4-183.9 cases/100,000 treated patients per year. The crude-adjusted incidence density rate of basal cell carcinoma was 352.3-111.2 cases/100.000 patients and of squamous cell carcinoma was 229-77.7 cases /100,000 patients. CONCLUSION: PUVA therapy is associated with an increased risk of CCNM inthe Mediterranean population.

Treponema Pallidum Epidermotropism in Nodular Secondary Syphilis.

Nodular secondary syphilis results from the hematogenous and lymphatic dissemination of spirochetes. Clinically, the lesions appear as partially infiltrated plaques or red-violaceous nodules, which can be solitary or multiple. Several hypotheses have been put forward to explain the formation of these infiltrated or granulomatous lesions. Among the most accepted are the specific hypersensitivity reactions to Treponema pallidum or the lenghty duration of the disease. We present a case of nodular syphilis where immunohistochemistry revealed the presence of multiple spirochetes invading the epidermis.

Eccema de manos en niños. Estudio clínico-epidemiológico de la población remitida a un hospital terciario / Hand eczema in children. Clinical and epidemiological study of the population referred to a tertiary hospital

INTRODUCCIÓN: El eccema de manos es una forma frecuente de eccema en adultos. Su diagnóstico en ocasiones es complejo debido a la existencia de diferentes clasificaciones diagnósticas. Existen pocos trabajos que estudien el eccema de manos y su clasificación en niños. MATERIAL Y MÉTODO: Se ha identificado a 389 niños entre 0 y 16 años remitidos a la Unidad de Alergia Cutánea de nuestro servicio para estudio con pruebas epicutáneas en el periodo 1996-2016. De entre todos los casos se han seleccionado 42 casos con dermatitis localizada exclusivamente en la mano (10,8% de todos los niños remitidos). En todos los casos se realizaron pruebas epicutáneas parchando la batería estándar, así como baterías adicionales en función de la sospecha clínica. Se recogieron datos epidemiológicos (edad, sexo, antecedentes de dermatitis atópica...), así como clínicos (localización de las lesiones). RESULTADOS: De los 42 niños remitidos con dermatitis de la mano, 25 (60,5%) eran niñas y 17 (40,5%) niños. La edad media de los pacientes con dermatitis de la mano fue de 10,6 ± 3,9 años. El diagnóstico definitivo tras la realización de pruebas epicutáneas fue dermatitis atópica en 15 casos, dermatitis alérgica de contacto en 14 pacientes, eccema endógeno vesiculoso en 6 casos, eccema endógeno hiperqueratósico en 5 casos y dermatitis irritativa de contacto en 2 casos. Los alérgenos detectados más frecuentes fueron tiomersal (9 casos), niquel (5 casos), mercurio (5 casos) y cobalto (4 casos). CONCLUSIÓN: El eccema de manos es una entidad frecuente en niños. La causa más frecuente es la dermatitis atópica, aunque no son infrecuentes los casos de dermatitis alérgica de contacto que se manifiestan como eccema de manos. Todo niño con eccema de manos en el que se sospeche una causa alérgica debe ser remitido para realización de pruebas epicutáneas

INTRODUCTION: Hand eczema is a frequent disease in adults. Diagnosing the cause of hand eczema is difficult due to different classifications. There is lack of evidence on hand eczema and its causes in children. MATERIAL AND METHOD: A total of 389 children between 0 and 16 years were identified between 1996 and 2016, from whom 42 (10.8%) with exclusively hand eczema were selected. In all cases a standard battery of epicutaneous patch tests was performed, as well as additional batteries depending on the clinical suspicion. The clinical and epidemiological features of these children were recorded and compared against children with eczema in other locations. RESULTS: The 42 children with hand eczema included 25 (60.5%) girls, and 17 (40.5%) boys, with a mean age of 10.6 +- 3.9 years, and did not differ from that of children with eczema in other locations. The definitive diagnosis after patch-testing was Atopic Dermatitis in 15 cases, Allergic Contact Dermatitis in 14 patients, Endogenous Vesiculous Eczema in 6 cases, Endogenous Hyperkeratotic Eczema in 5 cases, and Irritant Contact Dermatitis in 2 cases. The most frequent allergens detected were thiomersal (9 cases), nickel (5 cases), mercury (5 cases), and cobalt (4 cases). CONCLUSION: Hand eczema is a common condition in children. The most common cause is atopic dermatitis, although cases of allergic contact dermatitis manifesting as hand eczema are not uncommon. Any child with eczema of hands in whom an allergic cause is suspected should be referred for patch- testing

Sweet syndrome as the leading symptom in the diagnosis of gastric cancer.

Sweet syndrome is a neutrophilic infiltration of the papillary dermis, which may be associated with the presence of unknown malignancies, either haematological or solid tumours, in 1 out of 5 cases, being considered then as a paraneoplastic syndrome. We present the case of a male with a locally advanced gastric cancer whose final diagnosis was led by the prior debut of Sweet syndrome not explained by other causes.

[Hand eczema in children. Clinical and epidemiological study of the population referred to a tertiary hospital]. / Eccema de manos en niños. Estudio clínico-epidemiológico de la población remitida a un hospital terciario.

INTRODUCTION: Hand eczema is a frequent disease in adults. Diagnosing the cause of hand eczema is difficult due to different classifications. There is lack of evidence on hand eczema and its causes in children. MATERIAL AND METHOD: A total of 389 children between 0 and 16 years were identified between 1996 and 2016, from whom 42 (10.8%) with exclusively hand eczema were selected. In all cases a standard battery of epicutaneous patch tests was performed, as well as additional batteries depending on the clinical suspicion. The clinical and epidemiological features of these children were recorded and compared against children with eczema in other locations. RESULTS: The 42 children with hand eczema included 25 (60.5%) girls, and 17 (40.5%) boys, with a mean age of 10.6 +- 3.9 years, and did not differ from that of children with eczema in other locations. The definitive diagnosis after patch-testing was Atopic Dermatitis in 15 cases, Allergic Contact Dermatitis in 14 patients, Endogenous Vesiculous Eczema in 6 cases, Endogenous Hyperkeratotic Eczema in 5 cases, and Irritant Contact Dermatitis in 2 cases. The most frequent allergens detected were thiomersal (9 cases), nickel (5 cases), mercury (5 cases), and cobalt (4 cases). CONCLUSION: Hand eczema is a common condition in children. The most common cause is atopic dermatitis, although cases of allergic contact dermatitis manifesting as hand eczema are not uncommon. Any child with eczema of hands in whom an allergic cause is suspected should be referred for patch- testing.

Effective treatment of nail psoriasis with apremilast: report of two cases and review of the literature.

Nail psoriasis can cause great morbidity and a negative impact on the personal and work-related life of the patients. However, it responds more poorly to most drug therapies. Classically, the first line of treatment for nail psoriasis has been topical medication, but the new biological drugs seem to be the most effective treatment. Apremilast is another systemic oral drug that has shown a significant reduction of the severity in moderate-severe plaque psoriasis, as well as nail and scalp psoriasis. We present two cases of patients who exhibited a rapid response to treatment with apremilast.

Phototherapy in Atopic Dermatitis.

Atopic dermatitis (AD) is one of the most common chronic inflammatory skin diseases. Currently management of AD includes avoidance of triggering factors, skin care aiming to compensate the skin barrier defects, anti-inflammatory therapy (mostly topical corticosteroids and topical calcineurin inhibitors). When these first-line approaches are unsuccessful, systemic treatment or phototherapy ought to be carried out as next line of defence. Current phototherapy modalities for AD include broadband UVB (290-320 nm), narrowband UVB (311-313 nm), UVA-1 therapy (340-400 nm), UVA therapy plus 8-methoxypsoralens (PUVA), 308 nm excimer laser (EL) and Full spectrum light (FSL).

Dermatitis of the Foot: Epidemiologic and Clinical Features in 389 Children.

BACKGROUND/OBJECTIVES: Footwear dermatitis is a form of contact dermatitis resulting from exposure to shoes. There have been only small studies regarding foot contact dermatitis in children. The present study was undertaken to define the prevalence and epidemiologic and clinical features of shoe dermatitis in children. METHODS: A retrospective study was undertaken of all children referred for patch testing between 1996 and 2015. Children with dermatitis limited to the feet were selected. RESULTS: We collected data from 389 children younger than 16 years, 52 of whom (13.4%) were referred with dermatitis exclusively on the feet. Diagnosis after patch testing was allergic contact dermatitis in 23 children (44.2%), atopic eczema in 12 (23.1%), juvenile plantar dermatosis in 8 (15.4%), dyshidrotic eczema in 6 (11.5%), irritant contact dermatitis in 2 (3.8%), and tinea pedis in 1 (1.9%). The most frequent allergens were potassium dichromate, thimerosal, cobalt chloride, mercapto mix, colophonium, mercury, and nickel(II) sulfate. CONCLUSION: Allergic contact dermatitis caused by footwear is a common cause of foot dermatitis in children. Children with foot dermatitis should be referred for patch testing when an allergic origin is suspected.

Dermatitis alérgica de contacto a parafenilendiamina por tatuajes con henna en población pediátrica / Para-phenylenediamine allergic contact dermatitis due to henna tattoos in a child and adolescent population

INTRODUCCIÓN: Los tatuajes con henna son una práctica común en la población adolescente. En la mayoría de las ocasiones, la henna se mezcla con parafenilendiamina (PPDA) para mejorar las características del tatuaje. La PPDA es un potente alérgeno que causa con frecuencia dermatitis alérgica de contacto. MATERIAL Y MÉTODO: Se recogió a 726 niños parcheados en la Unidad de Alergia del Hospital General Universitario de Valencia entre 1980 y 2015, identificándose los casos y revisando los resultados de las pruebas, así como datos clínicos y epidemiológicos. RESULTADOS: Trescientos sesenta y un niños (49,7%) demostraron sensibilización a al menos un alérgeno y 34 fueron alérgicos a la PPDA (4,68%). La edad media de los pacientes alérgicos a PPDA fue de 12,4 años. El 44,2% de los niños alérgicos eran varones. Dos pacientes (5,9%) presentaron antecedentes personales de atopia. El 73,5% de reacciones positivas a PPDA se consideraron de relevancia presente. El origen de la sensibilización fue la realización de un tatuaje con henna en el 50% de los pacientes. CONCLUSIÓN: La sensibilización a PPDA es relativamente frecuente en la población pediátrica. El origen más frecuente es la realización de tatuajes con henna adulterada. Los adolescentes son la población con mayor riesgo de presentar este tipo de reacciones. Se debe desaconsejar activamente la práctica de tatuajes con henna negra en la población pediátrica

INTRODUCTION: Henna tattoos are a very common practice in the adolescent population. Henna is very often admixed with para-phenylenediamine (PPDA) to improve the appearance of the tattoo. PPDA is a potent allergen, and is a frequent cause of allergic contact dermatitis (ACD). Material and method. A study was conducted on the results of 726 consecutive children who had been patch tested in the University General Hospital Consortium of Valencia between 1980 and 2015. RESULTS: Almost half (49.7%; (361 cases) of the children had one or more positive patch test findings, with 4.7% (34) being allergic to PPDA. Mean age of patients allergic to PPDA was 12.4 years, and 44.2% were male. There were 2 cases (5.9%) of atopic dermatitis. Of the positive reactions, 73.5% were considered to be current clinically relevant. The sensitisation origin was a Henna tattoo in 50% of cases. CONCLUSION: PPDA sensitisation is relatively common in the child and adolescent population. The most frequent origin is the performing of Henna tattoos adulterated with PPDA. Adolescents are at the higher risk of developing ACD due to Henna tattoos. Henna tattooing should be strongly discouraged in children

[Para-phenylenediamine allergic contact dermatitis due to henna tattoos in a child and adolescent population]. / Dermatitis alérgica de contacto a parafenilendiamina por tatuajes con henna en población pediátrica.

INTRODUCTION: Henna tattoos are a very common practice in the adolescent population. Henna is very often admixed with para-phenylenediamine (PPDA) to improve the appearance of the tattoo. PPDA is a potent allergen, and is a frequent cause of allergic contact dermatitis (ACD). MATERIAL AND METHOD: A study was conducted on the results of 726 consecutive children who had been patch tested in the University General Hospital Consortium of Valencia between 1980 and 2015. RESULTS: Almost half (49.7%; (361 cases) of the children had one or more positive patch test findings, with 4.7% (34) being allergic to PPDA. Mean age of patients allergic to PPDA was 12.4 years, and 44.2% were male. There were 2 cases (5.9%) of atopic dermatitis. Of the positive reactions, 73.5% were considered to be current clinically relevant. The sensitisation origin was a Henna tattoo in 50% of cases. CONCLUSION: PPDA sensitisation is relatively common in the child and adolescent population. The most frequent origin is the performing of Henna tattoos adulterated with PPDA. Adolescents are at the higher risk of developing ACD due to Henna tattoos. Henna tattooing should be strongly discouraged in children.

Pustulosis palmoplantar por adalimumab en un paciente con enfermedad de Crohn / Palmoplantar pustulosis by adalimumab in a patient with Crohn disease

No disponible

Dermatitis de contacto profesional, estudio clínico-epidemiológico entre los años 2011 y 2015 / Professional contact dermatitis, clinical-epidemiologic study 2011-2015

INTRODUCCIÓN: Las dermatitis de contacto son una de las formas más frecuentes de enfermedades profesionales en Europa, representado una importante carga económica para el empleador y el Estado. OBJETIVOS: El objetivo de nuestro trabajo es describir las características clínico-epidemiológicas de los pacientes con dermatitis de contacto profesional (DCP), con el fin de identificar las diferentes poblaciones afectas, los productos mayormente relacionados y su evolución en el tiempo. MATERIAL Y MÉTODO: Se realizó un estudio clínico-epidemiológico retrospectivo en el que se analizaron 1213 pacientes estudiados con pruebas epicutáneas en la unidad de alergia cutánea del servicio de Dermatología del Hospital General Universitario de Valencia, entre los años 2011 y 2015. Todos los pacientes fueron estudiados con la serie estándar española del GEIDAC, con el que se realizaron lecturas en los días D2 y D4. Las respuestas se valoraron de acuerdo con la escala internacional de ICDRG. RESULTADOS: Se observó una incidencia media de DCP del 10,1%. El 73,2% de los pacientes presentaban una Dermatitis alérgica de contacto (DAC). El 100% presentaron clínica de eccema, con un 91,9% en manos. El 60,2% de los pacientes eran trabajadores de los servicios de restauración y comercio, servicio de salud y cuidados. Los conservantes fueron los alérgenos más frecuentes (37,8%), entre los que destacan las isotiazolinonas (91,2%). Los principales agentes irritantes han sido el agua y los detergentes, así como guantes y antisépticos. DISCUSIÓN: Se ha observado un predominio femenino y en población joven. Las profesiones afectadas más frecuentemente son las esteticistas, peluqueras, personal de hostelería y limpieza, en las que el diagnóstico más corriente es el de DAC. En los profesionales sanitarios predomina la dermatitis de contacto irritativa y la manipulación de alimentos es el principal factor de riesgo de la dermatitis de contacto proteínic

INTRODUCTION: Contact dermatitis disorders are one of the most common forms of occupational diseases in Europe, representing a significant economic burden on employers and even the State. OBJECTIVES: The aim of our study is to describe the clinical and epidemiological characteristics of patients who suffer from occupational contact dermatitis (OCD) in order to identify not only the affected populations, but the most related products and its evolution over time. MATERIAL AND METHODS: A retrospective clinical and epidemiological study was carried out. 1213 patients were studied with patch tests on the Skin Allergy Unit of the Department of Dermatology at the University General Hospital of Valencia between 2011 and 2015. All patients were studied with the Spanish contact dermatitis and Skin Allergy Research Group (Spanish standard patch test serie GEIDAC), performing readings on days D2 and D4. Results were assessed according to the International Contact Dermatitis Research Group ICDRG. RESULTS: OCD average incidence of 10.1% was observed. 73.2% of patients had an allergic contact dermatitis (ACD). 100% of patients had clinically eczema, 91.9% suffered from hand dermatitis. 60.2% of patients were workers of catering services and commerce, people health care services. Preservatives were the most common allergens (37.8%), highlighting the isothiazolinone (91.2%). Water and detergents, gloves and antiseptics were the main irritants. DISCUSSION: A female predominance and younger ages were observed. The most frequently affected professions are beauticians, hairdressers, catering and cleaning staff, where ACD is the most frequent diagnosis. In health professionals predominates irritant contact dermatitis whereas food handling is the main risk factor of protein contact dermatitis