Annular Erythematous Plaques With Overlying Blisters in a Cluster of Jewels Pattern.

A woman in her 80s presented with erythematous, nondesquamative, annular plaques in a cluster of jewels pattern on her wrists and legs. What is your diagnosis?

Retrospective Case Series of Cocaine-Associated Plasma Cell Orificial Mucositis.

Importance: Plasma cell orificial mucositis (PCOM) associated with cocaine use is an emerging, rare condition that has become a concern in Spain in recent years. Limited knowledge exists regarding this novel condition. Objectives: To delineate the clinicopathologic characteristics of this emerging entity and establish a novel approach in the differential diagnosis of cocaine-associated lesions. Design, Setting, and Participants: A descriptive, retrospective, multicenter case series of 10 patients diagnosed with cocaine-associated PCOM was conducted in Spain from April 2020 to March 2023. Main Outcomes and Measures: Patient demographic, clinical, histopathologic, and treatment data were collected. Results: A total of 10 patients (6 [60%] male; median [range] age, 45.5 [36-66] years) presenting with exudative ulcerated plaques were identified for this study. The lesions had raised and erythematous edges over the nostril and a median (range) evolution time of 9 (2-24) months. Septal or palate perforations were observed in 4 (40%) of the patients. Biopsies revealed a dense inflammatory infiltrate of plasma cells in the dermis without atypia and with eosinophils. All patients reported recent cocaine use. Three urine tests detected cocaine but found no presence of amphetamines or opiates. Six patients improved with corticosteroid therapy. Up to 60% of patients were lost to follow-up. Conclusions and Relevance: This case series describes the clinicopathologic characteristics of PCOM, an emerging entity associated with cocaine use in Spain, and demonstrates a novel approach in the differential diagnosis of cocaine-associated lesions. To date, cocaine-associated skin lesions have been reported as neutrophilic dermatoses and vasculitis. The appearance of a plasma cell infiltrate changes what has been described in the medical literature so far. PCOM is a benign condition of unknown cause characterized by a proliferative polyclonal plasma cell infiltrate. A comprehensive differential diagnosis workup is required to reach this exclusionary diagnosis. Several irritants have been documented in cases of PCOM, and a hypersensitivity mechanism has been proposed. Since the initial report of cocaine-associated PCOM in Spain, its incidence has experienced a surge in the country. The cause of this phenomenon may be attributed to newly unidentified adulterants. The administration of corticosteroids and discontinuation of cocaine use are the sole treatments that have demonstrated efficacy. Clinicians should be vigilant regarding this emerging condition and conduct inquiries into cocaine use. Additional research is required to clarify the pathophysiology of this emerging condition.

Paquidermodactilia: la gran simuladora / Pachydermodactyly: the great mimicker

No disponible

Progressive macular hypomelanosis.

Progressive macular hypomelanosis (PMH) is a condition of unknown etiology characterized by asymptomatic, hypopigmented macules located predominantly on the trunk. We recorded 12 adolescents with PMH over a 6-month period. Ten were female, and the mean age was 16.6 years. The average time from the patients first noticing pigment change to diagnosis was 15 months. PMH is probably an underdiagnosed condition.

Dermatitis alérgica de contacto por corticoides / Allergic contact dermatitis to corticosteroids

La dermatitis alérgica de contacto por corticoides representa un importante problema de diagnóstico clínico dado el cuadro de dermatosis crónica y atípica que puede originar. Para el diagnóstico disponemos de pruebas epicutáneas, las cuales presentan peculiaridades ya que el alérgeno posee propiedades antiinflamatorias. Los corticoides se clasifican en diferentes grupos según su probabilidad de producir reacciones cruzadas. Este hecho nos permite elegir el tipo más adecuado en un determinado paciente alérgico. Presentamos una paciente con dermatitis alérgica de contacto aclobetasol 17 propio nato, que refleja la dificultad de diagnóstico por su presentación como dermatosisparadójica (AU)

Allergic contact dermatitis to corticosteroids is a serious problem in clinical practice because of its chronic, atypical skin manifestations. Specific patch testing is used in diagnostic investigation, but the interpretation of the reactions may be difficult because of the anti-inflammatory properties of the corticosteroids. Corticosteroids are classified into different groups depending on the probability of allergic cross-reactivity between molecules. This classification enables us to choose the most suitable type for each specific patient. We present a patient with allergic contact dermatitis to topical clobetasol 17 propionate, which reflects the difficulty in diagnosing this paradoxical dermatosis (AU)