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Llamas-Velasco M, Angulo J, Durán R, Fraitag S, Kutzner H, Requena L. Hemangioma with dabskoid features: a rare histopathologic variant of acquired hemangioma. J Cutan Pathol 2015; 43:258-62. [DOI: 10.1111/cup.12621] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2015] [Revised: 07/21/2015] [Accepted: 09/06/2015] [Indexed: 11/29/2022]
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Carrascosa R, Llamas-Velasco M, Montes-Torres A, Sánchez-Pérez J. Does boceprevir really increase the risk of skin eruptions during antihepatitis C treatment? Br J Dermatol 2015; 174:460-1. [PMID: 26369272 DOI: 10.1111/bjd.14169] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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153
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Llamas-Velasco M, Concha-Garzón M, García-Diez A, Daudén E. Liver Injury in Psoriasis Patients Receiving Ustekinumab: A Retrospective Study of 44 Patients Treated in the Clinical Practice Setting. ACTAS DERMO-SIFILIOGRAFICAS 2015. [DOI: 10.1016/j.adengl.2015.05.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Llamas-Velasco M, Concha-Garzón MJ, García-Diez A, Daudén E. Liver Injury in Psoriasis Patients Receiving Ustekinumab: A Retrospective Study of 44 Patients Treated in the Clinical Practice Setting. ACTAS DERMO-SIFILIOGRAFICAS 2015; 106:470-6. [PMID: 25912374 DOI: 10.1016/j.ad.2015.02.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2014] [Revised: 02/01/2015] [Accepted: 02/08/2015] [Indexed: 02/08/2023] Open
Abstract
INTRODUCTION The therapy of patients with psoriasis and liver disease can be a challenge due to the increased risk of adverse effects from traditional systemic treatments; in addition, although the anti-tumor necrosis factor agents are considered safer, they have also been associated with drug-induced liver injury and reactivation of viral hepatitis. Ustekinumab has a different mechanism of action and the little that is known of its effects on the liver comes from pivotal studies. The objectives of this study were to estimate the incidence of drug-induced liver injury in patients treated with ustekinumab in daily clinical practice and to analyze liver alterations in those patients with pre-existing liver disease. METHOD All patients treated with the standard regimen of ustekinumab were included in the study. Variables gathered included age, sex, type of psoriasis, nail involvement, arthritis, previous treatments, history of liver disease, viral serology, Psoriasis Area Severity Index (at baseline and at 12, 16, and 52 weeks), transaminase levels, manifestations of liver disease, liver ultrasound, and factors such as body mass index, alcohol consumption, and ferritin levels. RESULTS Grade 1 elevation of the transaminases was only observed in 6 patients; no cases of severe hypertransaminasemia were observed. None of the patients with elevation of the transaminases at baseline developed problems during treatment. CONCLUSIONS Ustekinumab-related liver injury is uncommon and mild. From a hepatic point of view, the drug appears safe, even in patients with pre-existing liver disease and those who have developed altered liver function previously with other drugs.
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Montes-Torres A, Llamas-Velasco M, Pérez-Plaza A, Solano-López G, Sánchez-Pérez J. Biological Treatments in Atopic Dermatitis. J Clin Med 2015; 4:593-613. [PMID: 26239349 PMCID: PMC4470158 DOI: 10.3390/jcm4040593] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2015] [Revised: 03/03/2015] [Accepted: 03/13/2015] [Indexed: 01/19/2023] Open
Abstract
Atopic dermatitis (AD) is one of the most common chronic inflammatory skin diseases that affect both children and adults with a prevalence of 30% and 10%, respectively. Even though most of patients respond satisfactory to topical anti-inflammatory drugs, about 10% require one or more systemic treatments to achieve good control of their illness. The progressive and increasingly detailed knowledge in the immunopathogenesis of AD has allowed research on new therapeutic targets with very promising results in the field of biological therapy. In this article, we will review the different biological treatments with a focus on novel drugs. Their mechanism of action, current status and results from clinical trials and observational studies will be specified.
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Llamas-Velasco M, Concha-Garzón MJ, Fraga J, Aragüés M. Histiocytoid sweet syndrome related to bortezomib: A mimicker of cutaneous infiltration by myeloma. Indian J Dermatol Venereol Leprol 2015; 81:305-6. [PMID: 25784226 DOI: 10.4103/0378-6323.152743] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Llamas-Velasco M, Requena L. Panniculitis with crystals induced by etanercept subcutaneous injection. J Cutan Pathol 2015; 42:413-5. [PMID: 25727404 DOI: 10.1111/cup.12478] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2014] [Revised: 01/18/2015] [Accepted: 01/25/2015] [Indexed: 11/30/2022]
Abstract
Panniculitis with lipid crystallization within adipocytes may be seen in several disorders, including crystal-storing histiocytosis, gouty panniculitis, subcutaneous fat necrosis of the newborn, post-steroid panniculitis, sclerema neonatorum, oxalosis and subcutaneous fungal infections by mucormycosis, zygomycosis or aspergillosis. Panniculitis at the sites of subcutaneous injection of drugs are frequent, but to our knowledge no crystals have been described in the drug-induced panniculitis at the sites of subcutaneous injections. We report on a patient who developed a panniculitis with lipid crystallization at the site of etanercept injection.
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Solano-López G, Llamas-Velasco M, Concha-Garzón MJ, Daudén E. Sweet syndrome and differentiation syndrome in a patient with acute promyelocytic leukemia. World J Clin Cases 2015; 3:196-198. [PMID: 25685768 PMCID: PMC4317615 DOI: 10.12998/wjcc.v3.i2.196] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2014] [Revised: 08/22/2014] [Accepted: 11/19/2014] [Indexed: 02/05/2023] Open
Abstract
The differentiation syndrome is an inflammatory reaction with increased capillary permeability that occurs in up to 25% of patients with acute promyelocytic leukemia treated with all-trans retinoic acid. A 50-year-old man with acute promyelocytic leukemia underwent chemotherapy with idarubicin and all-trans retinoic acid. On day +21 the patient developed pruritic prepatelar papules as well as several 10 mm subcutaneous nodules in both thighs accompanied by persistent fever. On the day +25 the patient presented with bilateral pulmonary crackles, infiltrates in the right lower lobe and severe hypotension which required dopamine infusion. Biopsy of one of the thighs nodules was performed. A Sweet syndrome associated to a differentiation syndrome was suspected. All-trans retinoic acid therapy was discontinued and dexamethasone was administered. In 48 h the patient showed remission of the fever and the infiltrates and the skin lesions acquired a residual aspect. It is debatable whether these two syndromes are distinct entities with common mechanisms or whether they are poles of the same spectrum. Dermatologists and hematologists must be aware of these two syndromes and its pathophysiologic association.
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Yuste V, Sierra E, Ruano D, Llamas-Velasco M, Conde E, Azorin D. Primary Cutaneous Ewing Sarcoma: Report of a Case. Fetal Pediatr Pathol 2015. [PMID: 26207391 DOI: 10.3109/15513815.2015.1068411] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Primary cutaneous Ewing's sarcoma is a rare entity. Although the diagnosis may be very difficult, it can be confirmed through molecular biology. We present the case of a 13-years old male with a lesion in the sole of the right foot, characterized by a monomorphous proliferation of small, round and blue cells. The histology and molecular biology allowed us to perform the diagnosis of cutaneous Ewing's sarcoma. This neoplasm must be distinguished from other round cell tumors with cutaneous involvement. The prognosis and treatment of this rare disease will also be discussed.
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Llamas-Velasco M, Requena L, Podda M, Weidenthaler-Barth B, Rütten A. Apocrine intraductal carcinomain situin nevus sebaceus: two case reports. J Cutan Pathol 2014; 41:944-9. [DOI: 10.1111/cup.12394] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2014] [Revised: 07/03/2014] [Accepted: 09/07/2014] [Indexed: 11/26/2022]
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Llamas-Velasco M, Requena L, Kutzner H, Schärer L, Rütten A, Hantschke M, Paredes BE, Mentzel T. Fumarate hydratase immunohistochemical staining may help to identify patients with multiple cutaneous and uterine leiomyomatosis (MCUL) and hereditary leiomyomatosis and renal cell cancer (HLRCC) syndrome. J Cutan Pathol 2014; 41:859-65. [PMID: 25292446 DOI: 10.1111/cup.12396] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2014] [Revised: 06/10/2014] [Accepted: 10/05/2014] [Indexed: 01/14/2023]
Abstract
AIMS Multiple cutaneous and uterine leiomyomatosis (MCUL) also named as hereditary leiomyomatosis and renal cancer syndrome (HLRCC) is an autosomal dominant disorder caused by heterozygotic germline mutations in fumarate hydratase (FH) with incomplete penetrance and clinically challenging to diagnose. To test immunohistochemistry for FH as a potential marker for the detection of FH-deficiency. METHODS AND RESULTS We have tested 42 smooth muscle neoplasms, 13 lesions of patients with suspicious or confirmed HLRCC, 20 sporadic piloleiomyomas, two angioleiomyomas and 7 leiomyosarcomas. FH staining grades from 1 to 3. Ten of the 13 lesions from the patients with HLRCC syndrome showed negative FH staining. Most sporadic piloleiomyomas presented grade 3 FH staining although five cases presented grade 1 FH staining. Sensitivity of FH staining in our series is 83.3% but specificity is 75%. CONCLUSIONS This staining could indicate a high risk of HLRCC in most of the confirmed cases but it could also suggest the presence of a syndrome in up to 25% of sporadic cases. HLRCC syndrome should be rule out in FH negative piloleiomyomas after complete anamnesis if multiple lesions or positive familiar history is found.
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Llamas-Velasco M, Solano-López Morel GE, Gruber-Wackernagel A, Concha-Garzón MJ, Requena L, Cerroni L. Comedonal graft-vs-host disease: a distinct clinical expression of a lichenoid follicular GVHD. J Cutan Pathol 2014; 41:853-8. [DOI: 10.1111/cup.12391] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2014] [Revised: 07/06/2014] [Accepted: 07/20/2014] [Indexed: 11/29/2022]
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Llamas-Velasco M, Hilty N, Kempf W. Porokeratotic adnexal ostial naevus: review on the entity and therapeutic approach. J Eur Acad Dermatol Venereol 2014; 29:2032-7. [DOI: 10.1111/jdv.12732] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2014] [Accepted: 08/04/2014] [Indexed: 11/28/2022]
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García-Martín P, Llamas-Velasco M, Fraga J, García-Diez A. Tuberous Parietal Lesion Secondary to Sirsasana, the Yoga Headstand Posture. ACTAS DERMO-SIFILIOGRAFICAS 2014. [DOI: 10.1016/j.adengl.2014.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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García-Martín P, Llamas-Velasco M, Fraga J, García-Diez A. Tuberous parietal lesion secondary to Sirsasana, the yoga headstand posture. ACTAS DERMO-SIFILIOGRAFICAS 2014; 105:724-6. [PMID: 24656993 DOI: 10.1016/j.ad.2013.12.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2013] [Revised: 10/28/2013] [Accepted: 12/02/2013] [Indexed: 10/25/2022] Open
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Llamas-Velasco M, Sanchez-Perez J, Fraga J, Garcia-Diez A. Reply: Macular lymphocytic arteritis. J Cutan Pathol 2014; 41:481. [DOI: 10.1111/cup.12307] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2014] [Accepted: 01/28/2014] [Indexed: 11/30/2022]
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Llamas-Velasco M, Fraga J, Kutzner H, Steegmann JL, García-Diez A, Requena L. Hypopigmented macules secondary to imatinib for the treatment of chronic myeloid leukemia: a histopathologic and immunohistochemical study. J Cutan Pathol 2014; 41:417-26. [PMID: 24467724 DOI: 10.1111/cup.12298] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2013] [Revised: 11/24/2013] [Accepted: 12/16/2013] [Indexed: 12/12/2022]
Abstract
BACKGROUND A few series addressing the cutaneous side effects related to imatinib in the skin have been published, but only one described scarce histopathologic information in seven patients. OBJECTIVE To characterize these lesions and compare the number of melanocytes between hypopigmented lesions and normal appearing skin. METHODS We retrieved clinical data of the patients and performed 24 skin biopsies (13 from hypopigmented skin and 11 from normal-appearing skin) within a cohort of 41 patients with chronic myeloid leukemia treated with imatinib. We classified the biopsies into three patterns. RESULTS About 45% of patients presented with periocular hypopigmentation. Perifollicular fibrosis was observed in hypopigmented skin biopsies (76.9%) and in normal-appearing skin (45.5%). Epidermal melanin, as determined with Masson-Fontana staining, and melanocyte number, as evaluated with MiTF, Melan A and c-kit immunostains, were lower in hypopigmented skin. CONCLUSIONS Histopathologic study of hypopigmented macules demonstrates the presence of melanin with a statistically significant decrease in the number of melanocytes. Therefore, these findings differ from vitiligo, as melanocytes are present. Three histopathological patterns may be found, namely (a) perifollicular fibrosis, (b) lichen planopilaris-like and (c) apparently normal skin. One of the most striking histopathologic finding consisted of the presence of perifollicular fibrosis in both hypopigmented lesions and apparently normal skin.
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Llamas-Velasco M, Pérez-Gónzalez YC, Requena L, Kutzner H. Histopathologic clues for the diagnosis of Wiesner nevus. J Am Acad Dermatol 2013; 70:549-54. [PMID: 24373783 DOI: 10.1016/j.jaad.2013.10.032] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2013] [Revised: 10/12/2013] [Accepted: 10/14/2013] [Indexed: 11/20/2022]
Abstract
The dermatologic hallmark of a recently described BAP1-associated cancer susceptibility syndrome is a dome-shaped nevus with distinct clinicopathological features, first delineated by Wiesner and colleagues. Here we describe the leading histopathological criteria of Wiesner nevus. Wiesner nevus is composed of various nevomelanocytic populations all showing different degrees of atypia ranging from hyperchromatic nevus cell-like to large atypical epithelioid cells. Immunohistochemically, Wiesner nevus is BAP1 negative and VE1 positive.
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Llamas-Velasco M, Fraga J, Solano-López GE, Steegmann JL, García Diez A, Requena L. Multiple eruptive dermatofibromas related to imatinib treatment. J Eur Acad Dermatol Venereol 2013; 28:979-81. [PMID: 24321053 DOI: 10.1111/jdv.12328] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2013] [Accepted: 11/05/2013] [Indexed: 11/29/2022]
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Llamas-Velasco M, Vargas E, Delgado Y, García-Diez A. Extensive Bowenoid Papulosis of the Vulva Treated by Carbon Dioxide Laser in a Patient With AIDS. ACTAS DERMO-SIFILIOGRAFICAS 2013. [DOI: 10.1016/j.adengl.2012.11.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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Llamas-Velasco M, Daudén E, Martínez-Peñas G, García-Diez A. Response to Comments on “Late-Onset Acquired Generalized Lipodystrophy With Muscle Involvement”. ACTAS DERMO-SIFILIOGRAFICAS 2013; 104:734. [DOI: 10.1016/j.adengl.2013.02.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2013] [Accepted: 02/24/2013] [Indexed: 10/26/2022] Open
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Llamas-Velasco M, Mentzel T, Requena L, Palmedo G, Kasten R, Kutzner H. Cutaneous PEComa does not harbour TFE3 gene fusions: immunohistochemical and molecular study of 17 cases. Histopathology 2013; 63:122-9. [PMID: 23711163 DOI: 10.1111/his.12145] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2012] [Accepted: 03/20/2013] [Indexed: 12/19/2022]
Abstract
AIMS The family of perivascular epithelioid cell tumours (PEComas) comprises a related group of mesenchymal tumours of uncertain origin that show both smooth muscle and melanocytic differentiation markers. TFE3 nuclear immunoreactivity may be viewed as a supporting marker, as it has been found in a subset of visceral PEComas. We immunohistochemically analysed 17 cases of primary cutaneous PEComas for TFE3, and five of them also for SOX-10, and also analysed them by FISH for TFE3 rearrangement. METHODS AND RESULTS PEComas presented as skin-coloured tumours, in 12 women and five men, with a median age of 49.5 years. Tumours showed either a mixed clear cell-epithelioid cell pattern or a monomorphous clear cell pattern. None of the primary cutaneous PEComas showed detectable TFE3 or SOX-10 positivity. FISH assay for TFE3 rearrangement yielded negative results in all of the tested tumours. CONCLUSIONS Cutaneous PEComas are mostly composed of clear cells, and, unlike a subset of visceral and deep-seated PEComas, cutaneous PEComas consistently lack TFE3 expression. Owing to the lack of SOX-10 expression, a neural crest origin could not be shown.
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Concha Garzón M, Llamas-Velasco M, Sánchez-Pérez J, Fraga J. Radiodermatitis with Signs of Eccrine Squamous Syringometaplasia Following a Diagnostic Procedure. ACTAS DERMO-SIFILIOGRAFICAS 2013. [DOI: 10.1016/j.adengl.2012.04.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Llamas-Velasco M, García-Martín P, Sánchez-Pérez J, Sotomayor E, Fraga J, García-Diez A. Macular lymphocytic arteritis: first clinical presentation with ulcers. J Cutan Pathol 2013; 40:424-7. [PMID: 23384039 DOI: 10.1111/cup.12094] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2012] [Revised: 07/18/2012] [Accepted: 08/19/2012] [Indexed: 11/29/2022]
Abstract
Macular lymphocytic arteritis describes a recently reported entity, clinically characterized by asymptomatic hyperpigmented macules on the lower limbs, without association of systemic diseases. Histopathologically it is characterized by a lymphocytic arteritis with a hyalinized fibrin ring. We report a new case presenting with ulceration, a finding not previously described. A 25-year-old Hispanic woman was evaluated for a 1-year history of a gradually progressive, asymptomatic eruption that begins at level of both knees and progressively affects both legs and feet. She also referred recently appeared ulcers on inner right ankle without previous traumatism. Physical examination revealed multiple fairly well-defined light brown and faint pink patches with petechiae on as well as retiform crusts and livedoid lesions on inner right ankle. Both types of lesions were biopsied showing lymphocytic arteritis with fibrinoid necrosis and thrombus. There were no relevant laboratory alterations. The clinical peculiarity of our case is the clinical image of the lesions mimicking a pigmented purpuric dermatosis and the presence of a non-traumatic ulcer which could be explained because chronic lymphocytic damage may cause ischemic damage. Ulceration in our case supports consideration of macular arteritis as a latent form of cutaneous polyarteritis nodosa.
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Llamas-Velasco M, Vargas E, Delgado Y, García-Diez A. Extensive bowenoid papulosis of the vulva treated by carbon dioxide laser in a patient with AIDS. ACTAS DERMO-SIFILIOGRAFICAS 2013; 104:934-6. [PMID: 23347880 DOI: 10.1016/j.ad.2012.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2012] [Revised: 11/07/2012] [Accepted: 11/26/2012] [Indexed: 11/29/2022] Open
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