Painful nodule on a young woman's cheek.

We present a 30-year-old woman with a solitary circumscribed neuroma (also known as palisaded encapsulated neuroma) diagnosed after surgical excision. We describe the histopathologic correlation and the dermoscopic features we found in this tumor, which have not been previously reported in the literature to our knowledge.

Tumor bicolor / A Two-Color Tumor

No disponible

Estudio prospectivo de la combinación de láser de alejandrita Q-Switched de 755nm y el láser V Beam de colorante pulsado de 595nm en dermatofibromas / Prospective Study of Q Switched Alexandrite Laser 755 nm and V Beam Pulsed Dye Laser 595 nm in Dermatofibroma

El uso de los láseres de colorante pulsado (pulse dye laser [PDL]) y de dióxido de carbono (CO2) para el tratamiento de los dermatofibromas (DF) ha demostrado tener buenos resultados clínicos. Un total de 23 DF fueron tratados en dos sesiones con el láser de alejandrita Q-Switched de 755 nm (7,5 J/cm2, 3 mm, 50 ms), dejando entre cada sesión un intervalo de 4semanas. Para el eritema residual se utilizó el láser V Beam PDL con una longitud de onda de 595nm (10-11 J/cm2, 7 mm, 1,5 ms). En 9 de las pacientes se observó una atenuación parcial de la coloración marrón y en 14 de ellas una desaparición completa de la misma. Las pacientes refirieron un grado elevado de satisfacción después de haber realizado el tratamiento. Así mismo, 15 de las pacientes notaron una disminución en el endurecimiento de los DF. En el examen dermatoscópico previo al tratamiento, en todos los DF se observó la presencia de una red de pigmento. Esta red de pigmento desapareció en todos los casos tras la aplicación del láser. La combinación del láser V Beam PDL y del láser de alejandrita Q-Switched en los DF constituye una alternativa terapéutica adecuada que, además de buenos resultados cosméticos, ha conseguido un elevado grado de satisfacción por parte de los pacientes

Pulsed dye and carbon dioxide lasers have been applied in dermatofibroma with clinical improvement. We treated 23 dermatofibromas two times at a 4-week interval with Q-Switched alexandrite laser 755 nm (7.5 J/cm2, 3 mm, 50 ms). V Beam pulsed dye laser with a wavelength of 595nm was used for the residual erythema (10-11 J/cm2, 7 mm, 1.5 ms). A partial attenuation of brown colour was observed in 9 patients and complete disappearance of brown colour in 14 patients. Patient satisfaction was very high. Fifteen patients felt a decrease in hardening of dermatofibroma after treatment. A pigment network in dermoscopy was observed in all patients before treatment and no one after treatment. A combined treatment using both V Beam pulsed dye laser and Q-Switched alexandrite laser may be a therapeutic option to reduce the aesthetic effect of dermatofibroma with a high patient satisfaction and good cosmetic outcomes

Prospective Study of Q Switched Alexandrite Laser 755 nm and V Beam Pulsed Dye Laser 595 nm in Dermatofibroma. / Estudio prospectivo de la combinación de láser de alejandrita Q-Switched de 755nm y el láser V Beam de colorante pulsado de 595nm en dermatofibromas.

Pulsed dye and carbon dioxide lasers have been applied in dermatofibroma with clinical improvement. We treated 23 dermatofibromas two times at a 4-week interval with Q-Switched alexandrite laser 755nm (7.5J/cm2, 3mm, 50ms). V Beam pulsed dye laser with a wavelength of 595nm was used for the residual erythema (10-11J/cm2, 7mm, 1.5ms). A partial attenuation of brown colour was observed in 9 patients and complete disappearance of brown colour in 14 patients. Patient satisfaction was very high. Fifteen patients felt a decrease in hardening of dermatofibroma after treatment. A pigment network in dermoscopy was observed in all patients before treatment and no one after treatment. A combined treatment using both V Beam pulsed dye laser and Q-Switched alexandrite laser may be a therapeutic option to reduce the aesthetic effect of dermatofibroma with a high patient satisfaction and good cosmetic outcomes.

Fibroma blando gigante infartado / Infarcted Giant Skin Tag

No disponible

Molusco contagioso palmar, una localización excepcional / Molluscum Contagiosum on the Palms: An Uncommon Location

No disponible

Hipertricosis cervical anterior aislada / Isolated anterior cervical hypertrichosis

No disponible

Infantile hemangiomas with minimal or arrested growth associated with soft tissue hypertrophy: a case series of 10 patients.

BACKGROUND: Infantile hemangiomas with minimal or arrested growth (IH-MAGs) are characterized by a proliferative component of <25% of its surface area. The co-occurrence of IH-MAGs and soft tissue anomalies is rare, and case series of this association are lacking. OBJECTIVE: We present 10 cases of IH-MAGs associated with soft tissue hypertrophy and describe their clinical features. METHODS: We reviewed all infantile hemangiomas with minimal or arrested growth seen between 2009 and 2016 in the dermatology clinic department at Hospital Santa Creu i Sant Pau, Barcelona. To collect more patients, we also requested cases from the Hemangioma Investigator Group and members of the Spanish Society of Vascular Anomalies. RESULTS: Ten patients had IH-MAGs associated with soft tissue hypertrophy; seven involving the arm and three involving the leg. All displayed a segmental pattern, a doughy and puffy texture and prominent surface veins. No significant asymmetries in limbs and no other visceral anomalies were observed at follow-up (range 15 months to 7 years). One patient reported coldness in the limb with infantile hemangioma, but RMI-angiography did not disclose a vascular malformation underneath the lesion. Ulceration was observed in three patients. The proliferative component in all IH-MAGs had faded at 1-year follow-up, while soft tissue hypertrophy and prominent vessels remained unchanged. CONCLUSIONS: In this first case series of IH-MAGS associated with soft tissue hypertrophy, soft tissue hypertrophy was not progressive and remained unchanged over time, unlike the proliferative component of classic infantile hemangioma. The origin of the prominent vessels and the higher ulceration risk are unknown; however, these findings are probably related to a minor disruption of local vessels not detected in imaging tests.

Microwave Treatment for Axillary Hyperhidrosis and Bromhidrosis. / Tratamiento con microondas en la hiperhidrosis y bromhidrosis axilar.

Axillary hyperhidrosis (AH) and bromhidrosis are common causes of consultation in dermatology. Currently, the most widely prescribed treatment for AH is botulinum toxin, a very effective but temporary option; it is totally ineffective in bromhidrosis. Sympathectomy is an increasingly infrequent choice of treatment due to the high incidence of compensatory hyperhidrosis. We describe the treatment of AH and bromhidrosis with a novel microwave device that can fibrose eccrine and apocrine glands, achieving possibly permanent results. The procedure should preferably be performed under tumescent anesthesia. Side effects, principally local inflammation, are transient. Clinical effectiveness and safety, supported by recently published studies, position this technique as a first-choice option both for hyperhidrosis and for bromhidrosis.

Documento de consenso hispano-portugués para el uso de la terapia fotodinámica con metil aminolevulinato y luz de día en el tratamiento de las queratosis actínicas / Spanish-Portuguese Consensus Statement on Use of Daylight-Mediated Photodynamic Therapy With Methyl Aminolevulinate in the Treatment of Actinic Keratosis

INTRODUCCIÓN: La terapia fotodinámica con luz de día (TFDLD) es una nueva modalidad de terapia fotodinámica (TFD) que, manteniendo la misma eficacia en queratosis actínicas (QA) grado Iy II que la técnica convencional, disminuye sus efectos adversos y la hace más eficiente. Los condicionantes meteorológicos propios de la España y Portugal hacen necesario el establecimiento de un protocolo adecuado y consensuado por expertos adaptado a los mismos. OBJETIVO: Establecer un protocolo para la TFDLD con metil-aminolevulinato (MAL) para el tratamiento de las QA grado I y II adecuado y consensuado a las características epidemiológicas, meteorológicas y clínicas que se dan en España y Portugal. MÉTODO: Doce dermatólogos de diferentes áreas geográficas de ambos países, con experiencia en el tratamiento de las QA con TFD, se reunieron para elaborar un documento de consenso para la realización de TFDLD con MAL. De la revisión de la bibliografía y de su experiencia se elaboró el procedimiento recomendado para su realización. RESULTADOS: Las recomendaciones adoptadas establecen que los pacientes con QA grado I y II múltiples, especialmente en el contexto de campo de cancerización, son los candidatos a realizar este tratamiento. La TFDLD se puede realizar durante todo el año, siendo limitaciones las temperaturas menores de 10°C o las excesivamente elevadas, así como los días de lluvia, nieve o niebla. El procedimiento es sencillo y requiere la aplicación de un fotoprotector FPS>30 que solo contenga filtros orgánicos, la preparación adecuada de las lesiones, la aplicación del MAL sin oclusión y su activación con la luz del día durante 2h. CONCLUSIÓN: Este documento de consenso supone una guía práctica y detallada para la realización de la TFDLD con MAL en España y Portugal destinada a la consecución de la máxima efectividad con mínimos efectos adversos

INTRODUCTION: Daylight-mediated photodynamic therapy (PDT) is a new type of PDT that is as effective as conventional PDT in grade 1 and 2 actinic keratosis but with fewer adverse effects, resulting in greater efficiency. The climatic conditions in the Iberian Peninsula require an appropriately adapted consensus protocol. OBJECTIVE: We describe a protocol for the treatment of grade 1 and 2 actinic keratosis with daylight-mediated PDT and methyl aminolevulinate (MAL) adapted to the epidemiological and clinical characteristics of Spanish and Portuguese patients and the climatic conditions of both countries. METHODS: Twelve dermatologists from different parts of Spain and Portugal with experience in the treatment of actinic keratosis with PDT convened to draft a consensus statement for daylight-mediated PDT with MAL in these countries. Based on a literature review and their own clinical experience, the group developed a recommended protocol. RESULTS: According to the recommendations adopted, patients with multiple grade 1 and 2 lesions, particularly those at risk of developing cancer, are candidates for this type of therapy. Daylight-mediated PDT can be administered throughout the year, although it is not indicated at temperatures below 10°C or at excessively high temperatures. Likewise, therapy should not be administered when it is raining, snowing, or foggy. The procedure is simple, requiring application of a sunscreen with a protection factor of at least 30 based exclusively on organic filters, appropriate preparation of the lesions, application of MAL without occlusion, and activation in daylight for 2hours. CONCLUSION: This consensus statement represents a practical and detailed guideline to achieve maximum effectiveness of daylight-mediated PDT with MAL in Spain and Portugal with minimal adverse effects

Spanish-Portuguese consensus statement on use of daylight-mediated photodynamic therapy with methyl aminolevulinate in the treatment of actinic keratosis.

INTRODUCTION: Daylight-mediated photodynamic therapy (PDT) is a new type of PDT that is as effective as conventional PDT in grade 1 and 2 actinic keratosis but with fewer adverse effects, resulting in greater efficiency. The climatic conditions in the Iberian Peninsula require an appropriately adapted consensus protocol. OBJECTIVE: We describe a protocol for the treatment of grade 1 and 2 actinic keratosis with daylight-mediated PDT and methyl aminolevulinate (MAL) adapted to the epidemiological and clinical characteristics of Spanish and Portuguese patients and the climatic conditions of both countries. METHODS: Twelve dermatologists from different parts of Spain and Portugal with experience in the treatment of actinic keratosis with PDT convened to draft a consensus statement for daylight-mediated PDT with MAL in these countries. Based on a literature review and their own clinical experience, the group developed a recommended protocol. RESULTS: According to the recommendations adopted, patients with multiple grade 1 and 2 lesions, particularly those at risk of developing cancer, are candidates for this type of therapy. Daylight-mediated PDT can be administered throughout the year, although it is not indicated at temperatures below 10°C or at excessively high temperatures. Likewise, therapy should not be administered when it is raining, snowing, or foggy. The procedure is simple, requiring application of a sunscreen with a protection factor of at least 30 based exclusively on organic filters, appropriate preparation of the lesions, application of MAL without occlusion, and activation in daylight for 2hours. CONCLUSION: This consensus statement represents a practical and detailed guideline to achieve maximum effectiveness of daylight-mediated PDT with MAL in Spain and Portugal with minimal adverse effects.

Propranolol en hemangiomas infantiles: eficacia clínica, riesgos y recomendaciones / Propranolol in the treatment of infantile hemangioma: clinical effectiveness, risks, and recommendations

Los ß-bloqueantes orales –principalmente el propranolol– se consideran una opción más en el tratamiento de los hemangiomas infantiles. Se ha sugerido que pueden actuar a través del efecto vasoconstrictor, mediante la regulación de las vías implicadas en la angiogénesis y ocasionando apoptosis de las células endoteliales. Aunque su uso no está aprobado para esta indicación, en muchos centros se indican antes que los corticoides. La dosis más empleada es 2mg/kg/día repartida cada 8h. Es un fármaco seguro con escasos efectos secundarios. Se ha descrito hipoglucemia, hipotensión, diarrea, reflujo, frialdad de manos y pies, broncoespasmo e hiperpotasemia, generalmente sin repercusiones graves. Su indicación en el síndrome de PHACES es controvertida. Antes de iniciar el tratamiento se recomienda en todos los casos la realización de una evaluación cardiológica, la determinación de la presión arterial y el seguimiento pediátrico. En esta revisión se evalúan los conocimientos actuales sobre las indicaciones, la respuesta clínica, los efectos secundarios y los ensayos clínicos en curso de esta modalidad terapéutica que ha revolucionado la visión y el abordaje de los hemangiomas infantiles (AU)

The therapeutic arsenal for hemangiomas in early childhood can now be considered to include oral ß-blockers, mainly propranolol. These drugs are thought to act as vasoconstrictors, regulating angiogenic pathways and inducing apoptosis of vascular endothelial cells. Although infantile hemangioma is not among the approved indications for ß-blockers, many specialized clinics will prescribe propranolol before resorting to corticosteroids. A dosage of 2mg/kg/d, is usually employed with a dosing interval of 8hours. Propranolol is safe, causing few side effects, although cases of hypoglycemia, hypotension, diarrhea, reflux, cold hands and feet, bronchospasm, and hyperkalemia have been described. Generally, these adverse effects have not had serious consequences. Prescription in PHACE syndrome is controversial. In all cases, a cardiologist should assess the patient before treatment begins, blood pressure should be monitored, and pediatric follow-up should be scheduled. This review covers our current understanding of the indications, clinical response, and adverse effects of propranolol, a drug has revolutionized our attitude toward infantile hemangioma and the way we approach therapy. Clinical trials under way are also reviewed (AU)

[Propranolol in the treatment of infantile hemangioma: clinical effectiveness, risks, and recommendations]. / Propranolol en hemangiomas infantiles: eficacia clínica, riesgos y recomendaciones.

The therapeutic arsenal for hemangiomas in early childhood can now be considered to include oral ß-blockers, mainly propranolol. These drugs are thought to act as vasoconstrictors, regulating angiogenic pathways and inducing apoptosis of vascular endothelial cells. Although infantile hemangioma is not among the approved indications for ß-blockers, many specialized clinics will prescribe propranolol before resorting to corticosteroids. A dosage of 2 mg/kg/d, is usually employed with a dosing interval of 8 hours. Propranolol is safe, causing few side effects, although cases of hypoglycemia, hypotension, diarrhea, reflux, cold hands and feet, bronchospasm, and hyperkalemia have been described. Generally, these adverse effects have not had serious consequences. Prescription in PHACE syndrome is controversial. In all cases, a cardiologist should assess the patient before treatment begins, blood pressure should be monitored, and pediatric follow-up should be scheduled. This review covers our current understanding of the indications, clinical response, and adverse effects of propranolol, a drug has revolutionized our attitude toward infantile hemangioma and the way we approach therapy. Clinical trials under way are also reviewed.

[Metastatic Basal cell carcinoma in the axilla: reconstruction with a lateral pectoral island flap]. / Carcinoma basocelular metastásico en la axila: reconstrucción mediante un colgajo en isla pectoral lateral.

Although basal cell carcinoma (BCC) is one of the most common forms of cancer worldwide, it rarely occurs in the axilla. Only 31 cases have been reported in the literature. The incidence of metastatic BCC, particularly in areas not exposed to the sun, is very low. We present a new case of axillary BCC with lymph node metastases and the results of an extensive review of cases previously reported in the literature. BCC in the axilla is rare and metastasis is exceptional. Factors other than UV radiation probably contribute to its development. The lateral pectoral island flap was used for surgical closure. This method is useful for the reconstruction of axillary defects, obtaining excellent cosmetic and functional results. This flap should therefore be considered for the repair of large surgical defects in the axilla.

Carcinoma basocelular metastásico en la axila: reconstrucción mediante un colgajo en isla pectoral lateral / Metastatic Basal Cell Carcinoma in the Axilla: Reconstruction with a Lateral Pectoral Island Flap

A pesar de que el carcinoma basocelular (CBC) es una de las formas más comunes de cáncer, esta neoplasia cutánea raramente ocurre en la axila, con sólo 31 casos recogidos en la literatura. La incidencia del CBC metastásico es excepcional, siendo aún más infrecuente en áreas no fotoexpuestas. Se presenta un nuevo caso de CBC axilar con metástasis nodal y se realiza una revisión extensa de la literatura de aquellos casos publicados previamente. El CBC localizado en la axila es un raro evento, pero el desarrollo de metástasis es excepcional. Otros factores diferentes a la radiación ultravioleta probablemente contribuyan a su desarrollo. El colgajo en la isla pectoral lateral fue la técnica aplicada en el cierre quirúrgico. Este resulta útil en la reconstrucción de defectos quirúrgicos axilares y obtiene excelentes resultados tanto estéticos como funcionales. Por estas razones, la realización de este colgajo debería considerarse ante importantes defectos quirúrgicos en la región axilar (AU)

Although basal cell carcinoma (BCC) is one of the most common forms of cancer worldwide, it rarely occurs in the axilla. Only 31 cases have been reported in the literature. The incidence of metastatic BCC, particularly in areas not exposed to the sun, is very low. We present a new case of axillary BCC with lymph node metastases and the results of an extensive review of cases previously reported in the literature.BCC in the axilla is rare and metastasis is exceptional. Factors other than UV radiation probably contribute to its development. The lateral pectoral island flap was used for surgical closure. This method is useful for the reconstruction of axillary defects, obtaining excellent cosmetic and functional results. This flap should therefore be considered for the repair of large surgical defects in the axilla (AU)