Multiple Perianal Ulcers Related to Use of a Hemorrhoidal Ointment With the Active Ingredients Triamcinolone Acetonide, Lidocaine, and Pentosan Polysulfate Sodium: A Series of 11 Spanish Patients. / Múltiples úlceras perianales en relación con el uso de una pomada antihemorroidal con acetónido de triamcinolona, lidocaína y pentosano polisulfato sódico como principios activos: una serie de 11 pacientes españoles.

The development of perianal ulcers related to the use of a hemorrhoidal ointment has not been reported in the literature. We describe a series of 11 patients who were treated for perianal ulcers in 10 Spanish hospitals after they used the same ointment containing the active ingredients triamcinolone acetonide, lidocaine, and pentosan polysulfate sodium. No prior or concomitant conditions suggesting an alternative cause for the condition could be identified, and after the patients stopped using the ointment, their ulcers cleared completely in 8 weeks on average. This case series shows the damage that can be caused by an over-the-counter pharmaceutical product used without medical follow-up. It also illustrates the need to ask patients with perianal ulcers about any topical agents used before the lesions appeared.

[Clinical-pathological features of cutaneous melanomas diagnosed in a Mediterranean tertiary hospital between 1990 and 2004: a comparison between sexes and age groups and analysis of longterm outcomes]. / Características clínicopatológicas de los melanomas cutáneos diagnosticados en un hospital terciario mediterráneo entre 1990 y 2004: comparación entre sexos, por grupos de edad y evolución a lo largo del tiempo.

BACKGROUND: The incidence of malignant melanoma has increased over recent decades. Early diagnosis continues to be essential for effective treatment. Our objective was to analyze cutaneous malignant melanomas diagnosed over a 15-year period in a tertiary hospital for trends towards earlier diagnosis and to identify subgroups with poorer prognosis. MATERIAL AND METHODS: Retrospective analysis of primary cutaneous melanomas analyzed in the pathology department of Hospital La Paz, Madrid, Spain, between 1990 and 2004. RESULTS: In total, 526 melanomas were diagnosed. The mean (SD) Breslow thickness was 2.63 (4.84) mm and the median thickness was 0.98 mm (range, 0-65 mm). The mean size (widest point) was 16.59 (12.11) mm. The most common histological type was surface-spreading melanoma and the most common site was the trunk. Melanomas detected in men were generally larger and thicker than in women (P=0.05). Individuals aged over 60 years consulted for significantly thicker and larger tumors than younger individuals. The incidence of malignant melanomas has increased steadily over the years whereas the mean Breslow thickness and size have decreased. CONCLUSIONS: Diagnosis of melanoma in Spain is made increasingly earlier, although locally advanced tumors are still sometimes seen in men and in individuals aged over 60 years.

Tinea corporis extensa en paciente inmunocompetente / Extensive tinea corporis in immunocompetent patient

Tinea corporis es producida por la infección por dermatofitos de la piel lampiña. Habitualmente son lesiones poco extensas en pacientes inmunocompetentes. Un varón de 40 años, de origen rumano, consultó por lesiones cutáneas pruriginosas anulares de hasta 30 cm, de borde papuloso eritemato escamoso, afectando hasta un 60% de la superficie corporal total. Se realizó una visión con hidróxido de potasio (KOH) y cultivo de las lesiones, que resultaron positivos para Trichophyton rubrum, estableciéndose el diagnóstico de tinea corporis. Las condiciones sociosanitarias desempeñan un papel de gran importancia en las infecciones por dermatofitos, siendo un grupo de riesgo la población inmigrante. En el caso presentado, pensamos que es la situación sociosanitaria del paciente la que ha debido determinar la presentación clínica peculiar de una tinea corporis de tan gran extensión

Tinea corporis is caused by infection of glabrous skin from dermatophytes. They are generally fairly localized lesions in immunocompetent patients. A 40 year old male, of Romanian origin, consulted about itchy cutaneous lesions with the shape of large rings up to 30 cm in diameter, with a scaly erythematous border containing papules. It affected up to 60% of the total body surface. A KOH test and culture of the lesions were done, and were positive for trichophyton rubrum, the diagnosis of tinea corporis being established. Socio-health care conditions play a very important role in infections due to dermatophytes, the immigrant population being a risk group. In the case presented, we think that the socio-health care situation of the patient is that which must determine the distinctive clinical presentation of such a widespread tinea corporis

[Risks of black henna tattoos]. / Riesgos de los tatuajes de henna negra.

Temporary henna tattoos have become increasingly popular in the last few years, because of their apparent harmlessness and disappearance in few weeks. Black henna contains paraphenylenediamine (PPD), a synthetic colorant which is used in hair dyes and can cause sensitization. Many cases of allergic contact dermatitis occurring after tattooing have been reported, especially in children and teenagers during the summer time, since there are many tattoo-painters at holiday places and the parents are unaware of the risks of these tattoos. Clinicians, particularly pediatricians, primary care physicians and dermatologists should seek to remedy this misinformation. We can be the first person to be consulted before the tattoo painting and we will treat patients with lesions. We present our experience of eight cases of allergic contact dermatitis after tattooing and briefly review the literature on the risks of black henna tattoos.

Vasculitis leucocitoclástica cutánea debida a infección por Micoplasma pneumoniae / Cutaneous leukocytoclastic vasculitis due to Mycoplasma pneumoniae infection

El Micoplasma pneumoniae (MP) es un germen frecuentemente implicado en cuadros de infecciones respiratorias en niños y adultos jóvenes. Se han descrito múltiples afectaciones extrapulmonares asociadas con la enfermedad, fundamentalmente a nivel del sistema nervioso central, como mielitis trasversa, meningoencefalitis y meningitis aséptica. Sin embargo, sólo hemos encontrado, en la literatura, tres casos descritos previamente en los que coexisten infección por MP (confirmada serológicamente) y vasculitis leucocitoclástica (confirmada por biopsia). Creemos que esto se debería a la realización de tratamiento empírico sin confirmación histológica y serológica, lo que conllevaría un infradiagnóstico de esta patología. Presentamos un caso de infección aguda por MP con lesiones cutáneas de vasculitis leucocitoclástica.

Larva migrans cutánea / Cutaneous larva migrans

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Eccema crónico de las manos en relación con la aplicación de un antihemorroidal / Chronic hand eczema related to haemorrhoid drugs

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