[Controversial issues in congenital nevi]

Congenital melanocytic nevi are very common lesions that nevertheless pose many controversial questions. A systematic review of the literature suggests that the risk of developing melanoma on giant congenital melanocytic nevi (GCMN) is lower than previously thought given that, in the most recent series of GCMN, only 2 % of patients developed melanoma and most did so before the age of 5 years. Therefore,prophylactic surgery should be considered on an individual basis according to the degree of clinical suspicion of melanoma and the esthetic and functional consequences.In extensive reviews of series of biopsies of melanoma, small congenital melanocytic nevi have been associated with 7 % to 8 % of cases. Many authors believe that these might represent a significant risk of malignant conversion from 10 years onwards and so recommend regular control visits during infancy and prophylactic exeresis in puberty.

Multiple apocrine hidrocystomas: treatment with carbon dioxide laser vaporization

BACKGROUND

Apocrine hidrocystoma is a benign cystic tumour with apocrine differentiation. Although most cases are solitary tumours, multiple tumours may occur. Surgical removal is the usual treatment for apocrine hidrocystoma, but it may be troublesome and disfiguring in cases with multiple tumours.

OBJECTIVE

To determine the efficacy and cosmetic outcome of carbon dioxide laser vaporization in the treatment of multiple apocrine hidrocystomas.

PATIENTS AND METHODS

A total of 11 lesions in three adult patients were treated with carbon dioxide laser vaporization using a continuous and defocused mode, with a power density of 5 J/cm(2). The lesions were localized lateral to the outer canthus, on the free edge of the eyelids, and on the ear. Only a single session of treatment was performed for each lesion. Photographic controls were taken before and after treatment.

RESULTS

The lesions cleared after laser treatment without residual changes, and a successful cosmetic result was obtained.

CONCLUSION

Carbon dioxide laser is an efficient method of the treatment for multiple apocrine hidrocystomas.

[Allergic contact dermatitis to diethylthiourea in a neoprene wader]

Diethylthiourea, like other thioureas, is often used by the rubber industry and in the manufacture of neoprene. We present a patient who suffered allergic contact dermatitis to diethylthiourea in a neoprene wader and who required admission to hospital and systemic treatment. We review the literature on allergy to diethylthiourea. Thioureas are not included in the standard GEIDAC (Spanish Contact Dermatitis Research Group) battery of patch tests. In these cases, it is necessary to use a special battery of rubber allergens, which includes thiourea compounds, for diagnosis of the disease and to ensure that cases of contact allergic dermatitis to thioureas do not go undiagnosed.

Interface dermatitis in skin lesions of Kikuchi–Fujimoto’s disease: a histopathological marker of evolution into systemic lupus erythematosus?

Kikuchi’s disease (KD) is a self-limiting histiocytic necrotizing lymphadenitis (HNL). Cutaneous manifestations are frequent and usually show histopathological findings similar to those observed in the involved lymph nodes. HNL with superposed histological features to KD has been described in patients with lupus erythematosus (LE), and a group of healthy patients previously reported as having HNL may evolve into LE after several months. Up to date, features to predict which HNL patients will have a self-limiting disease and which could develop LE have been not identified. In order to clarify the characteristics of skin lesions associated with KD, we report a case of HNL with evolution into systemic lupus erythematosus (SLE) and a review of previous reports of KD with cutaneous manifestations. A 17-year-old woman presented with a 4-month history of fever and generalised lymphadenopathy. A diagnosis of HNL was established based on a lymph node biopsy. One month later, she developed an erythematoedematous rash on her upper body, with histopathological findings of interface dermatitis. After 8 months, anti-nuclear antibodies (ANA) at titre of 1/320, anti-DNA-ds antibodies and marked decrease of complement levels were detected. During the following 2 years, she developed diagnostic criteria for SLE, with arthralgias, pleuritis, aseptic meningitis, haemolytic anaemia and lupus nephritis. To our knowledge, 27 cases of nodal and cutaneous KD have been reported, 9 of which later developed LE. In all these patients, the skin biopsy revealed interface dermatitis. Skin biopsy revealed a pattern of interface dermatitis in all reviewed KD cases, which evolved into LE. Even this histopathological finding was not previously considered significant; it might be a marker of evolution into LE.

[Indications for lumbar puncture in patients with early active syphilis and human immunodeficiency virus coinfection: experience in a tertiary level hospital in La Coruña, Spain, 2003-2006]

INTRODUCTION

In the last years, the incidence of syphilis has incremented in Spain and coinfection with HIV occurs in a high percentage. In HIV-infected patients with syphilis, neurological complications, treatment failure and relapse appear to be slightly raised. Therefore, careful follow-up must be carried out because of the risk of developing neurosyphilis. According to the guidelines, lumbar puncture (LP) is indicated in HIV-infected patients with late latent syphilis or syphilis of unknown duration, but it is discussed in HIV-infected patients with early active syphilis. Recent research has been developed in order to determine clinical and analytical findings for identification of patients with high neurosyphilis risk. We review different opinions about this topic and report our experience.

METHODS

We have performed LP in all HIV-infected patients with early active syphilis during 2003-2006.

RESULTS

Of the eight studied patients, none met criteria for neurosyphilis. Three of eight (38 %) had a peripheral blood CD4 cell count CD4 + <or= 350 cells/microL. Seven of eight (875 %) had RPR >or= 1:32.

CONCLUSION

In these patients, performance of LP could be over indicated because of lack of well-established criterion. Our results are in agreement over to recent studies which restrict indication of LP to specific groups.

[Lichenoid drug eruption induced by olanzapine]

Lichenoid drug eruptions can mimic idiopathic lichen planus and other dermatoses. The list of drugs that can cause them is long and growing steadily. Although cutaneous side effects of antipsychotics are rare, various cutaneous manifestations have been reported in association with olanzapine. We present the case of a patient who developed an atypical lichenoid eruption due to olanzapine. A review of the literature in Medline from 1951 to 2007 and in the Indice Médico Español (Spanish Medical Index) revealed no previous cases of lichenoid eruptions associated with the use of this drug.