Tricomicosis axilar: diagnóstico en imágenes, clínica, luz de Wood y dermatoscopia / Trichomycosis axillaris: clinical, Wood lamp, and dermoscopic diagnostic images

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Telangiectasias fotodistribuidas asociadas a amlodipino / Amlodipine-associated photodistributed telangiectasia

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Estudio retrospectivo de pilomatricomas: 261 tumores en 239 pacientes / Retrospective Study of Pilomatricoma: 261 Tumors in 239 Patients

INTRODUCCIÓN Y OBJETIVOS: El pilomatricoma es la segunda neoformación cutánea más frecuente en la infancia y la juventud, con un amplio diagnóstico diferencial. El objetivo principal del estudio fue determinar la incidencia de pilomatricomas en nuestro hospital y sus características en relación con: edad, sexo, localización, síntomas, traumatismo previo, diagnóstico clínico, enfermedades asociadas, casos múltiples, características ecográficas, tratamiento quirúrgico y técnica anestésica y complicaciones posteriores. MATERIAL Y MÉTODO: Se recogieron de forma retrospectiva los pilomatricomas extirpados quirúrgicamente en nuestro hospital de enero de 2004 a diciembre de 2012 a partir de la base de datos de anatomía patológica. RESULTADOS: Se estudiaron 261 pilomatricomas en 239 pacientes, 120 eran mujeres y 119 varones de edades comprendidas entre 1 y 83 años, con una media de 26,4 años. La forma de presentación más frecuente fue como un nódulo firme, subcutáneo, asintomático en el 82% de los casos. La localización más frecuente fue la cabeza y el cuello (49,81%). El diagnóstico clínico preoperatorio fue acertado en el 54,4%. Cincuenta y nueve pacientes tenían otras enfermedades y 7 recordaban traumatismo previo en la zona. Se registraron 17 casos múltiples, uno familiar, y 2 en pacientes con enfermedad de Steinert. En 57 lesiones se realizó ecografía de partes blandas, con imágenes compatibles con pilomatricoma en 48. Ciento ochenta y cinco pilomatricomas se extirparon con anestesia local y 76 con anestesia local y general. Como complicaciones posquirúrgicas hubo un caso de cicatriz hipertrófica y otro de dehiscencia. CONCLUSIONES: El nuestro es el estudio retrospectivo que recoge el mayor número de casos en nuestro país y uno de los que comunica mayor incidencia de casos. Además, se estudian variables no recogidas en otras series

BACKGROUND AND OBJECTIVES: Pilomatricoma is the second most common skin tumor in childhood and youth and it has a broad differential diagnosis. The main objective of the present study was to determine the incidence of pilomatricomas in our hospital and to analyze the following variables: patient age and sex, tumor site, symptoms, previous trauma, clinical diagnosis, associated diseases, number of cases of multiple tumors, ultrasound findings, anesthetic and surgical techniques, and postoperative complications. MATERIAL AND METHOD: This was a retrospective study of the pilomatricomas surgically excised between January 2004 and December 2012 and registered in the database of the pathology department of our hospital. RESULTS: We found 261 pilomatricomas in 239 patients (120 female and 119 male) between 1 and 83 years of age (mean age, 26.4 years). The most common presentation was as a firm subcutaneous nodule, which was asymptomatic in 82% of cases. Tumors most commonly affected the head and neck (49.81%). Preoperative diagnosis was correct in 54.4% of cases, concomitant diseases were present in 59 cases, and 7 patients reported a history of trauma in the area of the tumor. There were 17 cases of multiple tumors, 1 case in a patient with familial disease and 2 in patients with Steinert disease. Soft-tissue ultrasound was performed on 57 lesions; images were compatible with pilomatricoma in 48 cases. Tumor excision was performed under local anesthesia in 185 cases and under local and general anesthesia in 76. The postoperative complications were hypertrophic scarring and wound dehiscence (1 case each). CONCLUSIONS: This was a retrospective study with the largest series recorded in Spain and with one of the highest incidences. In addition, we report on variables not described in other studies

Fascitis eosinofílica: causa infrecuente de edemas / Eosinophilic Fasciitis: An Uncommon Cause of Edema

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Retrospective study of pilomatricoma: 261 tumors in 239 patients.

INTRODUCTION AND OBJECTIVES: Pilomatricoma is the second most common skin tumor in childhood and youth and it has a broad differential diagnosis. The main objective of the present study was to determine the incidence of pilomatricomas in our hospital and to analyze the following variables: patient age and sex, tumor site, symptoms, previous trauma, clinical diagnosis, associated diseases, number of cases of multiple tumors, ultrasound findings, anesthetic and surgical techniques, and postoperative complications. MATERIAL AND METHOD: This was a retrospective study of the pilomatricomas surgically excised between January 2004 and December 2012 and registered in the database of the pathology department of our hospital. RESULTS: We found 261 pilomatricomas in 239 patients (120 female and 119 male) between 1 and 83 years of age (mean age, 26.4 years). The most common presentation was as a firm subcutaneous nodule, which was asymptomatic in 82% of cases. Tumors most commonly affected the head and neck (49.81%). Preoperative diagnosis was correct in 54.4% of cases, concomitant diseases were present in 59 cases, and 7 patients reported a history of trauma in the area of the tumor. There were 17 cases of multiple tumors, 1 case in a patient with familial disease and 2 in patients with Steinert disease. Soft-tissue ultrasound was performed on 57 lesions; images were compatible with pilomatricoma in 48 cases. Tumor excision was performed under local anesthesia in 185 cases and under local and general anesthesia in 76. The postoperative complications were hypertrophic scarring and wound dehiscence (1 case each). CONCLUSIONS: This was a retrospective study with the largest series recorded in Spain and with one of the highest incidences. In addition, we report on variables not described in other studies.

Neonatos con necrosis cutánea por extravasación de gluconato cálcico / Neonates with skin necrosis due to extravasation of calcium gluconate

Las lesiones cutáneas por extravasación se producen por la salida o introducción directa de fármacos o líquidos al tejido celular subcutáneo en el transcurso de un tratamiento intravenoso. Los fármacos que con mayor frecuencia producen daño por extravasación son las soluciones hiperosmolares, los agentes vasopresores y los quimioterápicos. El gluconato cálcico es un ácido débil que se comporta como una solución hipertónica. Los neonatos, los ancianos y los pacientes ingresados en unidades de cuidados intensivos son la población que presenta este tipo de complicación con mayor frecuencia y gravedad, debido a su mala perfusión y delgadez de la piel y a la incapacidad para localizar el dolor. Los casos descritos en la bibliografía de necrosis cutánea por gluconato cálcico en neonatos son excepcionales. No hay una única forma de tratamiento de este tipo de patología. Se han empleado pautas conservadoras o tratamientos agresivos, con escisión amplia de los tejidos y cierre mediante injerto. Presentamos los casos de 2 recién nacidos con necrosis cutánea secundaria a la extravasación de gluconato cálcico, sin infección asociada, que evolucionaron favorablemente con tratamiento conservador, consistente en el empleo de apósitos de colágeno de origen porcino. Según nuestra experiencia, ésta podría ser una alternativa terapéutica útil en pacientes con esta infrecuente patología (AU)

Cutaneous injury due to extravasation is produced by leakage or direct introduction of drugs or fluids into the subcutaneous tissue during intravenous therapy. Hyperosmolar solutions, vasopressor agents and chemotherapy are the most frequently agents related to extravasation injury. Calcium gluconate is a weak acid that acts as a hypertonic solution. Infants, elderly patients and intensive care unit patients are prone to this type of complication and more serious effects can be observed in this population because of poor skin perfusion, thinning of cutaneous tissue and the inability to locate the pain. In the literature cases described of skin necrosis by calcium gluconate in neonates are exceptional. There is not standard treatment established for this pathology. Both conservative or aggressive management like wide excision of tissue and grafting has been used to treatment of this complication. We report two cases of neonatal skin necrosis secondary due to extravasation of calcium gluconate in which conservative treatment with dressings porcine collagen was successful. In our experience, this could be a useful therapeutic alternative in patients with this rare disease (AU)

Hiperplasia epitelial multifocal: un caso familiar / Multifocal epithelial hyperplasia: a familial case

La hiperplasia epitelial multifocal (HEM) o enfermedad de Heck es una patología de la mucosa oral poco frecuente en nuestro medio. Está producida por el virus del papiloma humano (VPH), asociándose fundamentalmente a los tipos 13 y 32. Se presenta en la infancia (3–18 años) y se describe mayor prevalencia en mujeres y en determinados grupos étnicos (indios americanos y esquimales). Consiste en una proliferación epitelial benigna, asintomática, en forma de múltiples pápulas de 3 a 10mm de color mucosa oral normal. Varón ecuatoriano de 14 años, con lesiones papulosas en mucosa oral de inicio a los 4 años de edad. Su madre, de 32 años, presenta idénticas lesiones. Conclusión: Presentamos dos miembros de una familia ecuatoriana con HEM. Aunque se trata de una patología rara en nuestro medio debemos pensar en esta enfermedad dado el aumento de población inmigrante en España (AU)

Multifocal epithelial hyperplasia (MEH), or Heck disease, is a disease of the oral mucosa rarely seen in Spain. It is caused by the human papillomavirus (HPV), and is mainly associated with types 13 and 32. It appears in childhood (3–18 years) and a higher prevalence is reported in women and certain ethnic groups (American Indians and Eskimos). It consists of a benign, asymptomatic epithelial proliferation in the form of multiple papules of 3–10mm with a normal oral mucosa colour. The case involves an Ecuadorian male of 14 years, with papulous lesions in the oral mucosa with onset at 4 years of age. His 32 year-old mother had identical lesions. Conclusion: We present two members of an ecuadorian family with MEH. Although it is a rare disease in Spain, we must take this disease into account, given the increase in the immigrant population in Spain (AU)

[Multifocal epithelial hyperplasia: a familial case]. / Hiperplasia epitelial multifocal: un caso familiar.

UNLABELLED: Multifocal epithelial hyperplasia (MEH), or Heck disease, is a disease of the oral mucosa rarely seen in Spain. It is caused by the human papillomavirus (HPV), and is mainly associated with types 13 and 32. It appears in childhood (3-18 years) and a higher prevalence is reported in women and certain ethnic groups (American Indians and Eskimos). It consists of a benign, asymptomatic epithelial proliferation in the form of multiple papules of 3-10mm with a normal oral mucosa colour. The case involves an Ecuadorian male of 14 years, with papulous lesions in the oral mucosa with onset at 4 years of age. His 32 year-old mother had identical lesions. CONCLUSION: We present two members of an ecuadorian family with MEH. Although it is a rare disease in Spain, we must take this disease into account, given the increase in the immigrant population in Spain.

Indicadores de consulta externa dermatológica / Indicators of dermatology out-patient clinic visit

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[Juvenile xanthogranuloma of the central nervous system]. / Xantogranuloma juvenil del sistema nervioso central.

INTRODUCTION: Juvenile xanthogranuloma (JXG) is a benign histiocytosis affecting mostly skin, although it may also be extracutaneous. Lesions tend to regress spontaneously, but there are cases of bad prognosis. CASE REPORT: We report the case of a girl aged 3 months with JXG involving skin and, asymptomatically, central nervous system (CNS) and lungs. At age 4 months, the bigger CNS lesion, placed in the right cavernous sinus and whose growth might have had important neurologic repercussions, was excised. After surgery she presented seizures with initial response to antiepileptic drugs. At age 8 and 10 months surgery was again necessary for appearance of a tension pseudoyst in postsurgical bed; a cystoperitoneal shunt was instaured and seizures were controlled. When the patient was 12 months old, the diagnosis of hypothyroidism was established, with a favourable response to levothyroxine. At present, the patient is 2 years 8 months and has a slightly slow neurologic development, with occasional short seizures. Skin lesion is smaller, lung nodules have regressed and, regarding CNS lesions, the bigger has not recurred and the other one remains stable. CONCLUSIONS: Some authors propose doing JXG s extension study only when suggested by clinical findings, so long as an effective therapy and the advantage to presymptomatic treatment are not well established. We wonder whether early diagnostic and therapeutic approach to silent deep lesions might lead to a better outcome of patients with JXG, particularly those with CNS involvement.

Xantogranuloma juvenil del sistema nervioso central / Juvenile xanthogranuloma of the central nervous system

Introducción. El xantogranuloma juvenil (XGJ) es una histiocitosis benigna que afecta fundamentalmente a la piel, aunque puede ser también extracutáneo. Las lesiones tienden a regresar espontáneamente, pero hay casos de mal pronóstico. Caso clínico. Presentamos el caso de una niña de 3 meses con XGJ que afectaba a la piel y, asintomáticamente, al sistema nervioso central (SNC) y a los pulmones. A los 4 meses se le extirpó la lesión mayor del SNC, situada en el seno cavernoso derecho y cuyo crecimiento podría haber tenido graves consecuencias neurológicas. Tras la cirugía presentó crisis, sólo inicialmente controladas con anticomiciales. A los 8 y 10 meses fue reintervenida por aparición de un pseudoquiste a tensión en el lecho posquirúrgico; se le colocó una derivación quistoperitoneal que permitió la remisión de las crisis. A los 12 meses se le diagnosticó hipotiroidismo, y respondió favorablemente al tratamiento con levotiroxina. Actualmente la paciente tiene 2 años y 8 meses y presenta un leve retraso psicomotor, con convulsiones breves aisladas. La lesión cutánea es de menor tamaño, los nódulos pulmonares han regresado, y de las lesiones del SNC, la mayor no ha recurrido y la otra permanece estable. Conclusiones. Algunos autores proponen hacer el estudio de extensión del XGJ sólo cuando lo sugiere la clínica, mientras no esté bien establecido un tratamiento efectivo ni la ventaja de instaurarlo en fase presintomática. Nos preguntamos si la aproximación diagnóstica y terapéutica precoces a lesiones profundas silentes conduciría a un mejor pronóstico de los pacientes con XGJ, en especial los que tienen afectación del SNC (AU)

[Syringomas. Presentation of 7 cases]. / Siringomas. Presentación de siete casos.

OBJECTIVE: To further knowledge of syringoma and its importance within the overall condition of the patient, with a view to making it relevant in the differential diagnosis of other conditions such as xanthomata or milium cysts. DESIGN: A descriptive study of a crossover type. SETTING: Primary care and the dermatology clinic of a health centre in the metropolitan area of Madrid. PATIENTS AND OTHER PARTICIPANTS: The records of patients with syringomas confirmed by histological tests during 1990-1993 were examined. Patients with only a clinical diagnosis were discarded. The different diagnoses on referral by the primary care doctor were also studied. MEASUREMENTS AND MAIN RESULTS: Seven patients (5 women, two men) were confirmed by histological tests as suffering Syringomas. They were between 16 and 52 years old. Four had lesions only on the eyelids; in the other three they were widespread. All of them were asymptomatic, had been over three years without lesions and had no special previous history. None of them wanted to undergo treatment. The referral diagnoses cited xanthomata in five cases and milium cysts in the others. CONCLUSIONS: The primary care doctor must become better informed about syringoma, given its frequent confusion with other conditions (xanthomata and milium cysts). This confusion gives rise to unnecessary additional examinations and discomfort for the patients. These lesions should be verified histologically, as it is an nonaggressive method.