[Epidemiology of pemphigus in the Hospital Universitario Virgen Macarena, Seville, Spain, 2005-2006]. / Epidemiología del pénfigo en el Hospital Universitario Virgen Macarena (2005-2006).

BACKGROUND: Pemphigus is a serious, potentially fatal chronic autoimmune bullous disease with cutaneous and mucosal manifestations. Early diagnosis and treatment are essential. MATERIAL AND METHODS: We performed a retrospective cohort study that included patients diagnosed with pemphigus in the dermatology department of Hospital Universitario Virgen Macarena, Seville, Spain, in 2005 and 2006. We reviewed demographic, clinical, and therapeutic data. RESULTS AND CONCLUSIONS: Twenty-three patients, the majority women, were included in the study. Clinical onset usually occurred between 30 and 60 years of age. The most common variant was pemphigus vulgaris (79 %), and the sites most frequently affected were the oral mucosa, trunk, and scalp. Oral corticosteroids were the initial treatment of choice in all patients, and azathioprine and mycophenolate mofetil were given as adjuvant therapy. Complete remission was induced in 8.68 % of patients and partial remission in 91.32 %. The main complications were infections, osteopenia and osteoporosis, and cataracts.

Localized Kaposi's sarcoma in a patient with pemphigus vulgaris.

We report the case of a patient with a 13-year history of pemphigus vulgaris (PV) treated with immunosuppressive agents, prednisone and mycophenolate mofetil who had developed lesions of Kaposi's sarcoma (KS) on a sole plaque of PV that had been previously treated with intralesional injections of steroids. The lesions were surgically removed and polymerase chain reaction (PCR) demonstrated human herpesvirus-8 (HHV-8) DNA. There were neither recurrences nor later dissemination of KS following gradual decrease of the immunosuppressive therapy. We suggest that the treatment with intralesional steroids may have influenced the local reactivation of a latent infection of the virus, determining the appearance of this localized KS.

A new case of semicircular lipoatrophy associated with repeated external microtraumas and review of the literature.

We present a new case of semicircular lipoatrophy whose lesions disappeared after 2 months of avoiding a repeated trauma in that area. It seems that this is the only associated aetiological factor, and this entity is perhaps a consequence of certain postural habits. The repeated microtraumas would damage the fatty tissue giving rise to the histopathological findings described, which are compatible with traumatic panniculitis. In conclusion, repeated microtraumas may be the aetiological factor in these cutaneous lesions. Other data in favour of this hypothesis are the disappearance of the lesions after avoiding the mechanical trauma, the fact that there were other affected people at work, and that this factor has also been identified in the majority of cases reported previously.

Lupus eritematoso discoide crónico en la infancia. Presentación de dos casos / Chronic discoid lupus erythematosus in childhood. Report of two cases

El lupus eritematoso discoide es un cuadro infrecuente en la infancia que presenta algunas características diferenciales con la forma de los adultos como el predominio masculino, la baja incidencia de fotosensibilidad y la frecuente progresión a lupus eritematoso sistémico. Describimos dos casos de lupus eritematoso discoide en niñas, de comienzo a los 4 y 9 años de edad, una con un lupus cutáneo generalizado y la otra localizado, que han mostrado respuesta favorable al tratamiento con antipalúdicos de síntesis (AU)

Pemphigus vulgaris and disseminated nocardiosis.

Infectious diseases, in particular septicaemia from Staphylococcus aureus, Proteus vulgaris and Pseudomonas aeruginosa, are the most severe and frequent complications for the immunosuppressive therapy of pemphigus. Infection by Nocardia asteroides in subjects with pemphigus vulgaris is rare. We report the sixth case found of such an association; the subject died of disseminated nocardiosis while receiving steroids and immunosuppressive drugs, 4 years after being diagnosed with chronic pemphigus vulgaris.

Management of facial hyperpigmentation.

Facial and neck pigmentations are the most cosmetically important. They are common in middle-aged women, and are related to endogenous (hormones) and exogenous factors (such as use of cosmetics and perfumes, and exposure to sun radiation). Melasma (chloasma) is the most common cause of facial pigmentation, but there are many other forms such as Riehl's melanosis, poikiloderma of Civatte, erythrose peribuccale pigmentaire of Brocq, erythromelanosis follicularis of the face and neck, linea fusca, and cosmetic hyperpigmentations. Treatment of melasma and other facial pigmentations has always been challenging and discouraging. It is important to avoid exposure to the sun or to ultraviolet lamps, and to use broad-spectrum sunscreens. Several hypopigmenting agents have been used with differing results. Topical hydroquinone 2 to 4% alone or in combination with tretinoin 0.05 to 0.1% is an established treatment. Topical azelaic acid 15 to 20% can be as efficacious as hydroquinone, but is less of an irritant. Tretinoin is especially useful in treating hyperpigmentation of photoaged skin. Kojic acid, alone or in combination with glycolic acid or hydroquinone, has shown good results, due to its inhibitory action on tyrosinase. Chemical peels are useful to treat melasma: trichloroacetic acid, Jessner's solution, Unna's paste, alpha-hydroxy acid preparations, kojic acid, and salicyclic acid, alone or in various combinations have shown good results. In contrast, laser therapies have not produced completely satisfactory results, because they can induce hyperpigmentation and recurrences can occur. New laser approaches could be successful at clearing facial hyperpigmentation in the future.

Distribution of HLA class II alleles among Spanish patients with pemphigus vulgaris.

Twenty-six unrelated Spanish Caucasian individuals affected by pemphigus vulgaris (PV) were HLA typed and frequencies compared with those of 200 ethnically matched healthy controls. Twenty-three out of 26 patients were HLA-DR4. The frequency of HLA-DR14 was also increased (31%; controls: 4%). Of the 23 patients positive for HLA-DR4, 21 carried the DRB1*0402 allele. Therefore, the frequency of HLA-DRB1*0402 among patients was 81% (4% in controls; P=4.7x10(-27), OR=100.8). Interestingly, HLA-DR13, a frequent HLA-DR specificity in the Spanish general population (27%), was absent among the PV patients (P=0.009; Pc=0.1; OR=0.05). Taking together these data, we can conclude that, in the Spanish population, PV is preferentially and strongly associated with HLA-DRB1*0402, whereas DRB1*13 seems to confer a protective effect in our population.

M-plasty in the treatment of carcinomas located on the interglabellar region.

One of the main tasks of current cutaneous surgery is to completely eliminate the tumor while avoiding unnecessary normal tissue extirpation. This is especially important when removing facial tumors close to the external canthus, mouth angles and perialar regions. In all these areas we advise fusiform excision but with distal M-plasty in the nearest angle so as to avoid angle retraction. The same is true for mediofrontal tumors, as this often causes a drawing together of the eyebrows. We have reviewed all mediofrontal excisions carried out during the last six years. M-plasty following fusiform excision was always performed in the interglabellar area. The good results achieved allow us to recommend this technique in this location.

Lichenoid drug eruption following the Blaschko lines.

Eruptions similar to those of lichen planus (LP) are associated with systemic diseases or have been induced by many drugs. Linear lesions as a Koebner effect are frequently found in LP but isolated long, narrow, linear lesions, which may extend the whole length of the limb, are rare though rather more common in childhood. Some cases of zonal or zosteriform LP have been described in the literature. We describe a case of LP with a linear distribution following the Blaschko embryologic lines induced by nicergoline in a 65-year-old woman with a 6-month history of a pruritic eruption of erythematoviolaceous papules on the left breast, trunk and upper limb, with histological features of LP It would be the first case of linear LP associated with drugs.

Darier's disease associated with basal cell carcinomas.

BACKGROUND: Only three patients have been reported with basal cell carcinomas in skin involved with Darier's disease. OBJECTIVE: We report the fourth case and discuss the possible pathogenetic relationship between both diseases. RESULTS: In our case, oral retinoids made evident other basal cell carcinomas hidden in keratotic papules of the Darier's disease. CONCLUSION: Early excision of the tumor could be obtained.

[Acute neutrophilic febrile dermatosis (Sweet syndrome) associated with melanoma]. / Dermatosis aguda febril neutrofílica (síndrome de Sweet) asociada a melanoma.

A 45-years-old woman affected of Acute febrile neutrophilic syndrome is presented, with no reliable etiology. In a rutinary control, a pigmented ledion of one year of evolution was observed and a surgical excision was performed, with histological diagnosis of spreading superficial melanoma. In the next weeks of post-operatory, the Sweet's syndrome was decreased, disappearing completely two months later. No recurrences of Sweet's syndrome or malignant melanoma were observed after two years of follow-up. Association between Sweet's syndrome and neoplasias, in particular solid tumors, is commented, and the literature is reviewed.

[Treatment of condylomata acuminata using liquid nitrogen]. / Tratamiento de condilomas acuminados con nitrógeno líquido.

We treated 105 patients with anogenital warts with cotton swabs soaked in liquid nitrogen. 90.1% of the patients were cured, but recurrences were observed in 19.5%. With this method we obtained better clinical results than those obtained with the cryoprobes system. Good results were obtained when the lesions were accessible for treatment, but neither the time of evolution nor the size influenced the cure.

[Mucopurulent cervicitis at a clinic for sexually transmitted diseases]. / Cervicitis mucopurulenta en una clínica de ETS.

In a series of 1,011 women seen in the Diagnosis Center of Sexually Transmitted Diseases of the Faculty of Medicine of Seville, we study the prevalence of cervical infections caused by Neisseria gonorrhoeae and/or Chlamydia trachomatis and also mucopurulent cervicitis (CMP), these last diagnosed by the presence of more than 10 polymorphonuclear leukocytes x 1,000 magnification in Gram stain of secretion or endocervical mucopus. We calculate the predictive value that the diagnosis of the CMP had in detecting cervical infection by chlamydia and gonococcus. N. gonorrhoeae was isolated in 56 patients (5.5%), C. trachomatis in 83 (8.2%) and both in 15 (1.5%). In all, 154 women presented cervical infections, which correlates to a prevalence of 15.2%. CMP was diagnosed in 267 patients and, of these, 43.4% had cervical infection accused by N. gonorrhoeae and/or C. trachomatis. The diagnosis criteria of CMP used as predictors of cervical infection, had a sensibility of 0.75 and a specificity of 0.82, with a positive predictive value of 0.42.

Follow-up of vermilionectomies: evaluation of the technique.

Vermilionectomy is a straightforward technique that provides excellent results, not only in the treatment of solar cheilitis, but also as a prophylactic measure for squamous cell carcinoma (SCC) of the lower lip. Well-planned and well-executed, this operation is considered to have no postoperative complications. However, our 12-month follow-up of 52 postvermilionectomy patients revealed interesting features with regard to the contraction of the lip scar, sensitive, functional, and cosmetic disorders, and the prophylactic role of vermilionectomy on SCC of the lip.

[Nevus comedonicus]. / Nevus comedoniano.

Comedo naevus of which there are few cases in the literature are undoubtedly frequent, and pass unnoticed, as they are easily confused with furunculosis. A recent observation of a case in the Department of Medical-Surgical Dermatology and Venereology, in the Faculty of Medicine of Seville University has allowed us to review the genetic, clinical, histological and therapeutic aspects.