Beard alopecia areata: a multicentre review of 55 patients.

BACKGROUND: Alopecia areata on the beard area (BAA) is a common clinical manifestation, but there are no studies about its characteristics. OBJECTIVE: To describe the epidemiology, comorbidities, clinical presentation, evolution, diagnostic findings and therapeutic choices in a series of patients with BAA. METHODS: This retrospective multicentre review included patients diagnosed with BAA as the first and unique clinical manifestation with at least 12 months of follow-up. Diagnosis was performed based on the typical clinical features. Extra-beard involvement was monitored in all cases. RESULTS: Overall, 55 male patients with a mean age of 39.1 years (range 20-74) were included. Twenty-five patients (45.5%) developed alopecia of the scalp during follow-up and more than 80% of cases appeared in the first 12.4 months. Clinical presentation of AA on the scalp was patchy AA (less than 5 patches) (52%), multifocal AA (28%), AA totalis (12%) and AA universalis (8%). Multivariate analysis revealed a trend of association between scalp involvement and family history of AA without statistical significance. CONCLUSIONS: According to this study, BAA may progress to scalp AA in a significant number of patients (45.5% of the patients with a follow-up interval of at least 12 months). In the group of patients who developed scalp AA, 80% of them did it within the first 12 months, so follow-up of patients with BAA is highly encouraged.

Unusual forms of alopecia areata in a Trichology Unit.

BACKGROUND: Alopecia areata (AA) occurs with the apparition of asyntomatic non inflamatory alopecia plaques without scars. We distinguish several variants which are divided into two groups: typical forms (AA in single or multiple plaques) and atypical forms (by its presentation, evolution or paradoxical regrowth). OBJETIVES AND METHODS: We describe the cases of AA treated in our Trichology Unit between January 2000 and December 2011. RESULTS: We obtained 488 cases of AA. 114 (23.36%) were unusual form of AA or had paradoxical regrowth. The most common unusual form of AA was sisaipho type (7.37%), followed by AA for black and blonde hair (5.32%), atypical diffuse forms (4.30%), androgenetic alopecia type and (3.89%) and AA rectangular occipital (0.68%). Furthermore, we found nine cases of paradoxical regrowth (1.84%). CONCLUSIONS: Atypical variants of AA in our series are less than 25% of all cases, although it should be noted that since it is a specialized unit, we may be making a selection bias to be more difficult to diagnose cases or poor outcome.

Dermatitis artefacta: revisión / Dermatitis Artefacta: A Review

La dermatitis artefacta (DA) es un diagnóstico excepcional, que genera perplejidad y ansiedad al dermatólogo al encontrase ante una patología autoprovocada y de la que el paciente sabe más que el médico en cuanto a su etiología. Al contrario que otras dermatosis en las que existen pruebas histológicas o bioquímicas, en la DA el diagnóstico es de exclusión, lo que exige un gran consumo de recursos y de tiempo. En el presente trabajo repasamos las diversas formas clínicas, criterios diagnósticos y manejo de estos pacientes, y para ello nos basamos en la experiencia del estudio que realizamos de 201 casos de DA diagnosticados entre 1976 y 2006, de los cuales 152 eran mujeres y 49 varones, con una proporción de mujeres/varones de 3,1/1. La edad media fue de 31,2 años y estaba mayoritariamente constituida por personas con escasa o nula cualificación laboral, bajo nivel cultural y mayoritariamente solteros (AU)

Dermatitis artefacta is a rarely diagnosed disorder that is often a source of perplexity and anxiety for dermatologists because they know less about the cause of this self-inflicted condition than the patients themselves. It differs from other skin disorders in that diagnosis is made by exclusion rather than on the basis of histologic and biochemical findings and therefore involves a considerable investment of time and resources. Based on the findings of a study of 201 patients diagnosed with dermatitis artefacta between 1976 and 2006, we review the different clinical presentations of this skin disorder and discuss its diagnosis and treatment. The series analyzed comprised 152 women and 49 men (female to male ratio of 3.1:1) with a mean age of 31.2 years. The patients were mostly single and had a low educational level and few or no job qualifications or skills (AU)

Dermatitis artefacta: a review.

Dermatitis artefacta is a rarely diagnosed disorder that is often a source of perplexity and anxiety for dermatologists because they know less about the cause of this self-inflicted condition than the patients themselves. It differs from other skin disorders in that diagnosis is made by exclusion rather than on the basis of histologic and biochemical findings and therefore involves a considerable investment of time and resources. Based on the findings of a study of 201 patients diagnosed with dermatitis artefacta between 1976 and 2006, we review the different clinical presentations of this skin disorder and discuss its diagnosis and treatment. The series analyzed comprised 152 women and 49 men (female to male ratio of 3.1:1) with a mean age of 31.2 years. The patients were mostly single and had a low educational level and few or no job qualifications or skills.

Three cases of Lipschutz vulval ulceration.

A Lipschütz ulcer or 'ulcus vulvae acutum' is an acute simple ulceration of the vulva or vagina of non-venereal origin which can be associated with lymphadenopathy. Three cases are described with accompanying clinical photographs. Two cases refer to adolescents, one an infant, all without any history of sexual contact. The cases serve to illustrate a little known but potentially important differential diagnosis of vulval ulceration.

Dermatitis artefacta of the breast: a retrospective analysis of 27 patients (1976-2006).

BACKGROUND: Dermatitis artefacta (DA) is defined as all dermatological, self-inflicted skin lesions, where the patient denies having produced the lesions. OBJECTIVES: The purpose of this study is to make a single-centre retrospective clinical review of patients diagnosed as DA of the breast. MATERIALS AND METHODS: During a 30-year period (1976-2006), patients diagnosed as DA of the breast, seen in the Department of Dermatology of the Virgen Macarena Hospital in Seville, were recorded. Clinical and epidemiological features are described. RESULTS: A total of 27 women with a mean age of 34.33 years were selected representing 13.43% of the total of DA patients recorded (n=201) in this period. The most frequent clinical forms were: excoriations (nine patients, 33.33%) and ulcers (nine patients, 33.33%), followed by burns (six patients, 22.22%), blisters (one patient, 3.70%), contact dermatitis (one patient, 3.70%) and haematomas (one patient, 3.70%). Ten of the cases were located exclusively on the breasts, whereas 17 had also other locations such as face in seven cases, arms in five cases, abdomen in five cases and the entire body in two cases. Cutaneous lesions were treated with occlusive bandages using zinc paste or plaster splint when necessary. CONCLUSION: To our knowledge, this is the major series of DA of the breast studied. This complicated psychodermatological condition requires a correct diagnosis, appropriate management and psychiatric assessment.

El lupus eritematoso en la consultade dermatología / Lupus erythematosus in dermatological practice

El lupus eritematoso (LE) es una enfermedad que presenta manifestaciones cutáneas en más del 80% de los pacientes. El propósito de este estudio esconocer la incidencia de las manifestaciones cutáneas de esta enfermedad en la mucosa oral y cuero cabelludo que, a menudo, pasan desapercibidaspara el clínico e incluso para el paciente. Además, se valoró la eficacia del tratamiento con inmunomoduladores tópicos en todos los tipos clínicos. Paraello, revisamos 63 pacientes diagnosticados de LE que asistieron a una consulta de Dermatología del Hospital Universitario Virgen Macarena entre septiembrey diciembre del 2005, incluyendo las formas sistémica, subaguda y discoide.Se analizaron datos demográficos, formas clínicas, localización de las lesiones, exposición solar, pruebas analíticas, histopatología y tratamiento.Observamos una alta frecuencia de lesiones en mucosa oral y cuero cabelludo y obtuvimos buenos resultados terapéuticos con el uso de inmunomoduladorestópicos en todos los tipos clínicos (AU)

Lupus erythematosus (LE) is a sistemic disease with cutaneous manifestations in more than 80% of the patients. The aim of the study is to know theincidence of manifestations at oral mucosa and scalp, which are frequently unnoticed to the physician and the patient. Moreover, we evaluated theefficacy of topical immunomodulators in all the types of LE. Sixty three patients diagnosed of LE who came to a consultation at the Department of Dermatologyat the Virgen Macarena Universitary Hospital from september to december of 2005 were reviewed. We included the systemic, subacute anddiscoid forms of LE. Demographic data, clinical types, location of the lesions, photoexposition, serology, histopathology and treatment followed bythe patients were considerated.We observed a high proportion of lesions at the oral mucosa and scalp. Finally, we obtained good therapeutical results using topical immunomodulatorsin all clinical types of lupus (AU)

Atrofia blanca con buena respuesta a estanozolol y ácido acetilsalicílico / Atrophic blanche with good response to stanozol. Case report and literature review

La atrofia blanca es un proceso ulcerativo de los miembros inferiores que, en su evolución, da lugar a lesiones atróficas, rodeadas de pigmentación hemosiderótica y telangiectasias, La mayoría de los casos se asocian a insuficiencia venosa crónica, aunque en otras ocasiones se han relacionado con enfermedades sistémícas. Considerada anteriormente como un cuadro de origen vasculltico, actualmente se describe como una vasculopatía trombogénica, en la que se han descrito numerosos tratamientos para corregir las alteraciones de la microcirculación existentes en estos pacientes (AU)

Atrophie blanche is a lower leg ulcerative condition, which develops atrophic lesions, with hemosiderotic changes and telangiectasia. Most cases are associated with chronic venous insufficiency, although underlying systemic diseases have also been described. Although the process was previously considered to be of vasculitic origin, currently it is described as a thrombogenic vasculopathy, with a wide range of therapies aimed at correcting impaired microcirculation in these patients (AU)

Un nuevo caso de síndrome CHILD diagnosticado previamente como nevo epidérmico verrugoso inflamatorio lineal (NEVILl) / A new case of CHILD syndrome previously diagnosed as inflammatory linear verrucous epidermal nevus

Antecedentes: El síndrome CHILD, descrito en 1980 como una enfermedad hereditaria dominante ligada al sexo, se caracteriza por el nevo CHILD, un tipo de nevo epidérmico inflamatorio e ictiosiforme de disposición unilateral, marcada afinidad por los pliegues cutáneos (pticotropismo) y con frecuencia de distribución en bandas siguiendo las líneas de Blaschko, que se asocia con defectos de extremidades ipsilaterales. Objetivo: Demostrar que se trataba de un síndrome CHILD un caso observado en 1987 en una niña que presentaba un nevo ictiosiforme verrugoso que afectaba hemitronco y extremidades izquierdas, con pticotropismo axilar e inguinal y bandas verrugosas que seguían las líneas de Blaschko distribuidas por parte superior del tórax, cuello y extremidades, y que alcanzaban la mano afectándola en su totalidad en forma de escamas untuosas amarillentas. Métodos: Se obtuvieron varias biopsias del nevo epidérmico ictiosiforme. El examen de la mano izquierda comprobó una sindactilia entre los dedos índice y medio. Se realizaron mediciones radiográficas de extremidades cada 2 años. Una muestra de sangre fue enviada al Departamento de Dermatología de la Universidad de Marburg para análisis molecular. Resultados: El examen histopatológico evidenció epidermis paraqueratósica y acantósica reticular con microabscesos neutrofílicos subcorneales, y dermis papilar edematosa, inflamada, con vasodilatación y cúmulos de células grasas, recordando el xantoma verruciforme. Estos hallazgos eran incompatibles con nevo epidérmico verrugoso inflamatorio lineal (NEVIL) pero característicos del nevo CHILD. Aunque las mediciones óseas radiográficas fueron normales en los primeros años, a los 12 años pudo observarse un acortamiento de medio centímetro en la pierna izquierda. El análisis molecular demostró en Xq28 una mutación nonsense en gen NSDHL, exon 8 posición c.906C>A, con cambio de aminoácidos en Y302X. Conclusión: Las mujeres que presentan un cuadro clínico que recuerda un nevo epidérmico verrugoso inflamatorio lineal (NEVIL), y criterios dermatopatológicos de dermatosis psoriasiforme, y ocasionalmente de xantoma verruciforme, deben ser estudiadas genéticamente, especialmente si se asocian defectos de extremidades, para excluir un NEVIL y diagnosticar una entidad diferente, conocida como nevo CHILD, que es parte del síndrome CHILD. (AU)

Estudio de las uretritis masculinas mediante la tinción de Papanicolaou / Study of male urethritis with the Papanicolaou smear

Hemos investigado los patógenos sexuales, los tipos celulares y las alteraciones morfológicas de las células epiteliales uretrales mediante la tinción de Papanicolaou en 110 varones heterosexuales.Se incluyeron 75 pacientes con uretritis: 17 (22,6 por ciento) con uretritis gonocócica (UG) y 58 (77,3 por ciento) con uretritis no gonocócica (UNG). El grupo control lo formaron 35 varones sin síntomas ni signos de uretritis.En los pacientes con uretritis se observó un aumento de la disociación celular epitelial. Los cambios inflamatorios inespecíficos fueron estadísticamente más frecuentes en las uretritis que en los controles, siendo más intensos en la UG (65 por ciento) que en la UNG (15,5 por ciento). En las infecciones por C. trachomatis la atipia nuclear fue un hallazgo frecuente (43,5 por ciento). El moco se relacionó con la presencia de uretritis, aunque no se encontraron diferencias con respecto a su etiología.No se observaron neutrófilos en el exudado de tres pacientes (5 por ciento) con UNG. Hubo una presencia estadísticamente significativa de linfocitos en los pacientes con uretritis, sobre todo en la UG (45 por ciento), donde fueron más frecuentes que en la UNG (15,5 por ciento). Los hematies también fueron significativamente más frecuentes en las uretritis, con una mayor proporción en la UG (94 por ciento) que en la UNG (64 por ciento). Las células plasmáticas, los eosinófilos y los histiocitos sólo se visualizaron en pocos pacientes con uretritis. La tinción de Papanicolaou presentó una sensibilidad del 47 por ciento y una especificidad del 90 por ciento en la infección por C. trachomatis (AU)

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Carcinoma epidermoide de pene. Estudiomediante hibridación in situ / Epidermoid carcinoma of the penis. An in situ hibridisation study

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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)

[Study of urethritis in males using Papanicolaou smear]. / Estudio de las uretritis masculinas mediante la tinción de Papanicolaou.

Sexual pathogens, cell types and morphologic alterations of urethral epithelial cells were investigated by means of the Papanicolaou smear in 110 heterosexual men. Seventy-five patients with urethritis were included: 17 (22.6%) with gonococcal urethritis (GU) and 58 (77.3%) with non-gonococcal urethritis (NGU). Thirty-five males without symptoms or signs of urethritis comprised the control group. An increase in epithelial cell dissociation was observed in patients with urethritis. Non-specific inflammatory changes were statistically more common in patients with urethritis than in controls, and more severe in GU (65%) than in NGU (15.5%). Nuclear atypia was a common finding (43.5%) in infections due to C. trachomatis. Mucus was associated with the presence of urethritis although no differences regarding etiology were found. No polimorphonuclear neutrophils were observed in the exudate of three patients (5%) with NGU. There was a statistically significant presence of lymphocytes in patients with urethritis, particularly in GU (45%), more frequent than in NGU (15.5%). Erythrocytes were also significantly more frequent in urethritis, with a greater proportion in GU (94%) than in NGU (64%). Plasma cells, eosinophils, and histiocytes were only observed in a few patients with urethritis. The Papanicolaou smear had a sensitivity of 47% and a specificity of 90% in Chlamydia trachomatis infections.

Extensive and deep dermatophytosis caused by Trichophyton mentagrophytes var. interdigitalis in an HIV-1 positive patient.

BACKGROUND: Cutaneous infections are common in HIV-1 positive patients and are usually severe, recurrent, and caused by microorganisms that are unusual in immunocompetent patients. OBJECTIVE: We report a case of an HIV-1-positive 23-year-old male, with a history of intravenous drug use, in stage C-II (CDC '86), with a CD4 lymphocyte count of 335 cells/mm3. He had multiple, large erythematous, circinate and pustular plaques on his abdomen, back, arms and legs. RESULTS: We isolated Trichophyton mentagrophytes var. interdigitalis from the lesions. The biopsy showed suppurative deep dermatophytosis and folliculitis. The patient satisfactorily responded to itraconazole (100 mg/d for 14 days). CONCLUSION: This is the first reported case of deep dermatophytosis caused by T. mentagrophytes in an HIV-positive patient.

Alopecia areata, stress and psychiatric disorders: a review.

Although the results of some studies have proven negative, the influence of psychological factors in the development, evolution and therapeutic management of alopecia areata is, in general, well documented. Life events and intrapsychically generated stress can play an important role in triggering of some episodes. The comorbidity of psychiatric disorders, mainly generalized anxiety disorder, depression, and phobic states, is high. The role of treatment of concomitant psychopathological disorders is a vital one. Indeed this treatment can positively affect how the patient adapts to his/her alopecia and social setting and perhaps can even lead to a better dermatological evolution of the alopecia. Therefore, controlled studies analyzing the possible links between psychiatric symptoms, treatment with antidepressants or benzodiacepines, evolution of alopecia, medium term prognosis, and immune function are necessary. Basic psychotherapeutic support may prove to be of use in many cases and can be carried out by the dermatologist, although a subgroup of patients may need psychopharmacological or psychotherapeutic specialized treatments. Studies using operative diagnostic criteria and structured interviews are still scarce. Therefore, it seems necessary to design studies using modern psychiatric methodology. Controlled clinical trials to test the efficiency of psychoactive drugs and psychotherapy in the disease are also needed. By studying in depth these and other related aspects, we may improve the clinical management of our patients.