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Introducción: la neurofibromatosis es un desorden genético, que afecta el crecimiento de tejidos neurales, con una incidencia de 1 en 4 000 personas, con impacto en la esperanza de vida por su asociación con neoplasias y enfermedad vascular. La neurofibromatosis segmentaria es una variante de la neurofibromatosis tipo 1, con una incidencia aproximada de 1 en 20 000 a 25,000 personas, se caracteriza por lesiones cutáneas que afectan un segmento corporal sin cruzar la línea media. Generalmente no tienen historia familiar ni compromiso sistémico. Caso clínico: paciente de sexo femenino de 63 años con dermatosis que afecta el tronco posterior de manera unilateral a nivel de los dermatomas T10-T11, caracterizada por múltiples neoformaciones exofíticas milimétricas en forma de domo, de consistencia blanda y depresibles a la palpación. El estudio histopatológico de una de ellas confirmó el diagnóstico de neurofibroma. La paciente no presentaba afectación neurológica ni ocular, además, sin afección en familiares, por lo que se establece diagnóstico de neurofibromatosis segmentaria. Conclusiones: la neurofibromatosis segmentaria es una patología poco frecuente, Aunque posiblemente sea subdiagnosticada por su carácter asintomático, lo que ocasiona una aparente baja incidencia. Los pacientes que la padecen pueden presentar penetrancia sistémica variable y un riesgo similar de neoplasias al descrito en pacientes con neurofibromatosis tipo 1. Pese al carácter benigno reportado en la literatura sugerimos un abordaje multidisciplinario de los pacientes.

Introduction: Spitz nevus is an uncommon, benign melanocytic proliferation that primarily appears on face, trunk or lower extremities of children. This lesion may share clinical and microscopical characteristics with melanoma, making it a diagnostic and management challenge. Case Report: A 13-year old male presented with an asymptomatic chronic dermatosis located on the third left-hand nail. Cutaneous examination revealed a homogeneous dark brown melanonychia which extended up to the cuticle. Upon dermoscopy, longitudinal bands measuring less than 3 mm wide of heterogeneous colors ranging from light to dark brown, and positive Hutchinson’s sign were observed. Discussion/Conclusion: We report the second case of a Spitz nevus ungually localized which strongly resembled an ungual melanoma with a positive Hutchinson’s sign upon dermoscopy. Describing the infrequent presentation and location of the Spitz nevus poses an opportunity to establish diagnostic and management criteria in the near future.

Members ofIn this article we comment on the most relevant aspects of nine patients with skin lesions caused byThe patients in the clinical cases presented a history of trauma, tattoos, and physical therapy techniques. The most common treatments were minocycline and clindamycin, doxycycline, ceftriaxone, cephalexin, moxifloxacin, rifampicin, and trimethoprim-sulfamethoxazole. The evolution of the treated patients was acceptable, except for one patient, who showed a partial improvement.Our series consisted of nine cases of skin biopsies recorded in different years; for this reason, we do not have all the data necessary for a complete description, in particular in four cases, causing limitations in the manuscript, especially in the therapy used and the evolution of patients due to lack of follow-up.

Pyoderma gangrenosum is a rare, neutrophil-mediated, auto-inflammatory dermatosis that wound care specialists must be prepared to recognise. This condition has clinical features analogous to infectious processes. There is no specific diagnostic test and the diagnosis is usually obtained from exclusion. Its early recognition and proper management with prompt initiation of immunosuppressive therapy are essential to improve the quality of life and the prognosis of patients.

Rothmund-Thomson syndrome, also known as congenital poikiloderma, is a rare autosomal recessive genodermatosis with onset in early childhood that affects at a multisystem level.Case 1. A 4-year-old male patient, consanguineous parents, 26-year-old brother with a probable diagnosis of Rothmund-Thompson syndrome. He presented with adactyly of the right thumb, hypoplasia of the left thumb, delayed growth and psychomotor development. At 3 months, he presented rough, dry, sparse hair and erythematous lesions on the face, leaving hyperpigmented and hypopigmented spots with a reticulated pattern. We detected hypoacusis, skeletal alterations, narrow chin, short stature, severe malnutrition, and chronic and asymptomatic hypodontia. Genetic sequencing showed a mutation for the RECQL4 gene, for which a multidisciplinary follow-up was provided by the genetics, gastroenterology, nutrition, endocrinology, stomatology, audiology, orthopedics, rehabilitation, ophthalmology and oncology services. Case 2. A 2-year-old female patient presented facial erythema that spread to the arms and legs at 3 months; skin biopsy showed poikiloderma. She was evaluated by the endocrinology service and followed up for short stature and hypogonadism. A genetic study was not performed.Rothmund-Thomson syndrome is characterized by atrophy. Only a few cases are reported in the literature. We present two cases of Rothmund-Thomson syndrome, emphasizing its clinical and dermatological characteristics.El síndrome de Rothmund-Thomson, también conocido como poiquilodermia congénita, es una rara genodermatosis autosómica recesiva de inicio en la infancia temprana y afectación multisistémica.Se describen dos casos de pacientes con síndrome de Rothmund-Thomson. Caso 1. Paciente de sexo masculino de 4 años de edad, padres consanguíneos, hermano de 26 años con diagnóstico probable de síndrome de Rothmund-Thompson. Presentó adactilia del pulgar derecho, hipoplasia de pulgar izquierdo, retraso en el crecimiento y retraso del desarrollo psicomotor. A los 3 meses de edad mostraba pelo áspero, seco y escaso, y lesiones eritematosas en la cara, las cuales dejaron manchas hiperpigmentadas e hipopigmentadas con patrón reticulado. Se detectaron hipoacusia, alteraciones esqueléticas, mentón estrecho, talla baja, desnutrición grave e hipodontia crónica y asintomática. La secuenciación genética resultó con mutación para el gen RECQL4, por lo que se dio seguimiento multidisciplinario por los servicios de genética, gastroenterología, nutrición, endocrinología, estomatología, audiología, ortopedia, rehabilitación, oftalmología y oncología. Caso 2. Paciente de sexo femenino de 2 años de edad que a los 3 meses de vida inició con eritema facial que se diseminó a los brazos y la piernas; la biopsia de piel reportó poiquilodermia. Se encuentra en seguimiento por el servicio de endocrinología por talla baja e hipogonadismo. No se realizó estudio genético.El síndrome de Rothmund-Thomson se caracteriza por atrofia. Existen pocos casos reportados en la literatura. Se presentan dos casos de síndrome de Rothmund-Thomson, enfatizando sus características clínicas y dermatológicas.

Background: Members of Micobacterium. abscessus complex comprises three subspecies (M. abscessus subsp. Abscessus, M. abscessus subsp. Bolletii, and M. abscessus subsp. Massiliense) and are a rapid-growing nontuberculous mycobacteria present in different aquatic habitats and soil. It often causes a wide spectrum of infections involving pulmonary infections, surgical wound infections, and infections related to mesotherapy, catheters, hemodialysis devices, endocarditis, and disseminated infections in immunocompromised individuals. Methods: In this article we comment on the most relevant aspects of nine patients with skin lesions caused by M. abscessus subsp. massiliense infection. Clinical characteristics, histopathology, and molecular identification were performed. Results: The patients in the clinical cases presented a history of trauma, tattoos, and physical therapy techniques. The most common treatments were minocycline and clindamycin, doxycycline, ceftriaxone, cephalexin, moxifloxacin, rifampicin, and trimethoprim-sulfamethoxazole. The evolution of the treated patients was acceptable, except for one patient, who showed a partial improvement. M. massiliense were identified in all clinical cases using a species-specific PCR. Conclusion: Our series consisted of nine cases of skin biopsies recorded in different years; for this reason, we do not have all the data necessary for a complete description, in particular in four cases, causing limitations in the manuscript, especially in the therapy used and the evolution of patients due to lack of follow-up.

Blastic plasmacytoid dendritic cell neoplasm (BPDCN) is a rare and aggressive malignancy of the skin and hematopoietic system. There are few pediatric cases reported in the literature. Management of primary cutaneous BPDCN is challenging because, despite an apparently indolent clinical presentation, rapid dissemination with high mortality can occur. We describe a child with isolated cutaneous involvement who had a good response to chemotherapy as first-line treatment of BPDCN.

Pityriasis versicolor (PV) is a superficial mycosis that it can occur at any age, even in newborns. In this review, we will describe epidemiological data, mycological characteristics of yeast, pathogenesis and clinical characteristics of the disease, different diagnostic resources, and the current recommendations for treatment. The typical morphology and topography of PV allow us to make a quick diagnosis, but atypical presentations have been described. Diagnostic tools, such as dermoscopy, can also reveal patterns that allow the evaluation of characteristics of scales and pigment in lesions. The discovery of new species and new mechanisms of interaction with the host has broadened the panorama of aetiological possibilities. Although PV is a common disorder, extensive research is necessary to better understand the pathophysiology of the disease, immunological characteristics of the pathogen-host relationship and resources needed to precisely diagnose the disease, treat the disease, and avoid its chronic and recurrent course.

We present the case of an HIV-positive patient who developed polymorphous lesions in which the evidence in the skin biopsy corresponds to the diagnosis of bacillary angiomatosis, and further tests proved the pathological agent involved in this case is not the usual Bartonella species, B. henselae and B. quintana, but B. elizabethae. As far as we know, this is the first case of bacillary angiomatosis secondary to this etiological agent.

INTRODUCCIÓN: El lupus eritematoso (LE) es una enfermedad autoinmune poco frecuente en el sexo masculino, que presenta manifestaciones clínicas múltiples relacionadas al pronóstico de la enfermedad. La etiología es desconocida, sin embargo, se relaciona a la exposición de radiación ultravioleta y alteración en la función linfocítica. El lupus eritematoso profundo (LEP) es una variante clínica de LE cutáneo que se presenta entre el 1% al 3% de los pacientes y únicamente el 10% de los casos reportados en la literatura pertenecen al sexo masculino. Hasta el 50% de los pacientes con LEP presentan progresión a lupus eritematoso sistémico (LES) durante su evolución.PRESENTACIÓN DEL CASO: Adolescente 16 años, previamente sano, que presentó una placa eritematosas, induradas y asintomáticas en mejilla izquierda de evolución crónica. Se realizó biopsia incisional con diagnóstico de LEP. El resto del abordaje para descartar lupus eritematoso sistémico resultó negativo. El paciente recibió tratamiento con corticosteroide tópico por 4 semanas en esquema de reducción así como fotoprotección estricta con mejoría del eritema y disminución del área indurada. Actualmente el paciente continúa en seguimiento con atención a signos y síntomas sugerentes de lupus eritematoso sistémico.CONCLUSIÓN: El LEP es una dermatosis multifactorial poco frecuente en el sexo masculino, por lo que la literatura actual podría no ser representativa en este sexo. Es necesario realizar un abordaje amplio al momento del diagnóstico con pruebas de laboratorio séricas y reumatológicas. Es de suma importancia ser capaces de identificar de manera temprana signos y síntomas que sugieran progresión a LES o linfoma.

We present the case of a male infant diagnosed with IPEX (immune dysregulation, polyendocrinopathy, enteropathy, and X-linked) syndrome who presented a generalized rash with a BCG site reaction several months after vaccination. Erythema and induration at BCG site might be due to BCG which is a known complication of inborn errors of immunity with susceptibility to mycobacterial infection. However, in our patient this dermatological manifestation might be secondary to immune dysregulation, given the important role of Tregs and Th17 cells in mycobacterial immunity, similar to that observed in Kawasaki disease patients.

Introduction Hypohidrotic ectodermal dysplasia (HED) is a genetic condition typified by alterations in skin structures including sweat glands, hair, nails, and teeth. Hair findings in HED have been poorly characterized in larger series. Objective To characterize scalp and hair findings of patients with HED clinically and with trichoscopy and light microscopy. Methods A cross-sectional study in 21 pediatric HED patients was performed using available clinical and scalp dermatoscopic images, as well as pulled-hair samples for clinical evaluation, trichoscopic, and light microscopic analyses. Results Seventeen out of 21 patients (81%) were men. Twenty patients had straight hair. Sixteen patients had decreased hair density, 6 of whom had hair loss mainly in the temporal and occipital regions. Fourteen patients had hair whorls. On trichoscopy, we observed: single-hair follicular units (n = 19, 90%), scalp hyperpigmentation (n = 13, 62%), variable diameter of the hair shafts (n = 12, 57%), perifollicular scales (n = 8, 38%), scalp erythema (n = 8, 38%), and short curly pigtail hairs (n = 6, 29%). On light microscopy, findings included: hair shafts with irregular diameter (n = 7, 33%), heterogeneous hair color (n = 6, 29%), trichoptilosis (n = 2, 10%), and pili torti (n = 1, 5%). Conclusions In this series, hair findings in HED were similar to those described in previous studies. However, we describe two new clinical and two trichoscopic findings: decreased hair density mainly in the temporal and occipital regions, oblique upwards occipital hair follicles orientation, angled hairs, and short curly pigtail hairs. These heterogeneous findings may reflect the multiple factors and signaling pathways that can be affected in these syndromes.

Introduction: Onychomycosis is a frequent chronic nail infection, with a worldwide prevalence of 5.5% making it the most common nail disease, and its incidence increases with age. Clinically, it causes discoloration and thickening of the nail plate and may be accompanied by onycholysis. However, little is known of the subclinical infection. Methods: We studied adult male and female outpatients auto-referred as healthy and that had healthy appearing toenails. Nail distal clippings were obtained from the right first toenail. This sample was stained with PAS and observed by an expert dermatopathologist searching for fungal structures. Results: A total of 32 samples were included: 8 from men (25%) and 24 from women (75%), with ages ranging from 27 to 66 years (mean age of 43 years). Twenty-four patients did not present any histopathological finding suggestive of infection (75%), while 7 patients had a single finding (spores or hyphae) (21.8%), and 1 patient had both findings (3.12%). Discussion/Conclusion: We found 4 patients with yeasts, 3 with hyphae, and 1 patient with a combined infection with both yeasts and hyphae (3.1%). These add up to 25% of the clinically apparent healthy nails. Our results show that we still have much to learn from the initial stages of onychomycosis and that our population probably has higher incidence of this nail disease, so we must be alert to subtle nail changes. As our participants signed an informed consent, we will contact those that resulted positive for follow up consultations.

Griscelli syndrome type 2 (GS2) features silvery-grey hair, bronzed skin and immunodeficiency.1 The only curative treatment for GS2 is haematopoietic stem cell transplantation (HSCT) which corrects the immune and haematologic defects with persistence of oculocutaneous abnormalities.

Atopic dermatitis (AD) is a common chronic, inherited, relapsing, inflammatory skin condition. A multifactorial etiology has been postulated, including genetic and immunological factors, impaired skin barrier function and environmental triggers, all of them are relevant in the pathogenesis. Malassezia spp. is the most common fungi of the skin microbiome. Most of the studies comparing the skin colonization with Malassezia spp. in healthy people and AD patients did not show difference between both groups. This review aims to show the studies carried out in this regard and the reported evidence about the role of Malassezia spp. in the pathogenesis of AD. The rate of IgE-mediated sensitization Malassezia spp. is very high in AD patients, mainly in adult patients and in patients with involvement in the head and neck. Different mechanisms have been postulated to explain the interaction of Malassezia spp. with human skin cells and immune cells and how its interaction contributes to the inflammation process in AD. Systemic and topical azole antifungals have been used with doubtful results showing beneficial effects in some AD patients. There is no clear explanation for the high frequency of Malassezia spp. sensitization in AD patients in relation with healthy individuals. Further research is necessary to determine the specific role of Malassezia in AD and the indication for the use of antifungals in this disease.

Dermatobia hominis is a fly endemic to and widely distributed throughout the Americas; it is found from the southern regions of Mexico to Argentina. However, because of widespread travel, myiasis has become common in countries where neither the disease nor the species that cause this infection are endemic. Central Mexico, for instance, is not a region where myiasis is endemic. We, thus, describe three cases of D. hominis myiasis: two autochthonous cases from the southern part of Mexico and one imported from Costa Rica. In addition, morphological and genetic identification was performed on the maggots extracted from the patients.

Resumen Antecedentes El carcinoma de piel no melanoma basocelular y el carcinoma epidermoide o espinocelular (CEC) son tumores frecuentes. El carcinoma basocelular es el cancer mas frecuente y el menos agresivo; en algunas ocasiones, a pesar del tratamiento quirurgico con margenes amplios, un porcentaje bajo tiene comportamiento agresivo, como invasion local extensa, recurrencias y metastasis. El CEC tiene un comportamiento mas agresivo, primero en piel, despues en ganglios linfaticos y, raramente, con metastasis a otros organos. Objetivo Identificar las caracteristicas de los CEC recurrentes y la frecuencia de aparicion de nuevos tumores, tras el tratamiento quirurgico con cirugia convencional y cierre diferido de herida hasta obtener el resultado histologico libre de tumor (transoperatorio tardio), esto con la finalidad de tener mejores opciones de tratamiento en la poblacion mexicana. Material y metodo Se revisaron los expedientes de 10 anos y se incluyeron aquellos que tenian diagnostico de CEC. Resultados Se incluyeron 114 tumores en 103 pacientes. Utilizando un analisis descriptivo, se encontro que la media de diagnostico de casos nuevos por ano fue 32.2. Pacientes masculinos 48 (46.6%) y 55 (53.4%) femeninos. La edad diagnostica fue entre 19 y 91 anos (media = 71.94; DE = 13.34) con un tiempo de evolucion de 1 a 112 meses (media = 12 meses; DE = 2.65). El mas frecuente es en la mejilla y la variedad histologica invasiva se da en el 54%. En 14 pacientes se encontro un segundo CEC. Solo tuvimos 4 recurrencias, que aparecieron entre el primer y el cuarto ano de seguimiento, y 3 de estos fueron tratados con cirugia con transoperatorio tardio. Conclusion Este estudio demostro que la tecnica de cirugia con transoperatorio tardio es adaptable para el tratamiento de CEC con buenos resultados y bajo porcentaje de recurrencia en un seguimiento a 10 anos.

Introduction Craniosynostosis and clavicular hypoplasia, delayed closure of the fontanelle, cranial defects, anal and genitourinary abnormalities, and skin (CDAGS), is an infrequent autosomal recessive entity with only 10 cases reported; no associated gene has been identified so far. Case Report The proband is a 2-year-old Mexican female with brachycephaly, cleft palate, anal malformation with rectovestibular fistula, and clinodactyly of the third toe overlapping the second. At 4 months of age, she developed a disseminated dermatosis with erythematous scaly nummular plaques, elevated keratotic sharp borders with thin to broad flaking, hematic crusts, and keratotic surface in others. The lesions were slightly pruritic and began at the lower limbs with posterior dissemination to the upper limbs, head, and trunk; palms and soles were unaffected. A skin biopsy showed hyperkeratosis, parakeratosis, acanthosis, and perivascular inflammatory infiltration in the upper reticular dermis among other alterations. She also presented mild bilateral neurosensory hypoacusia and enamel dysplasia. Her karyotype was normal. Treatment with topical hydrating creams partially improved the skin lesions at their center, while the sharply keratotic borders remained, giving a clinical resemblance to porokeratosis. Discussion The patient suffers from CDAGS syndrome but has normal development, and feet abnormality was described in only one other patient. The treatment with topical hydrating creams improved the skin lesions at their center, while porokeratotic characteristics persisted. CDAGS remains a diagnostic challenge; a comparison with previously reported cases is discussed. The timely detection of the syndrome will allow early treatment that may improve the condition of the patients.

Resumen Las mascotas exóticas, como el erizo de tierra, son capaces de transmitir al ser humano diferentes infecciones, como salmonelosis, micobacterias, protozoos como Cryptosporidium parvum, y dermatofitosis. Presentamos el caso de un paciente adulto masculino, que recientemente había adquirido un erizo de tierra, que presentó en la mano una lesión de tiña incógnita y un granuloma de Majocchi. Se identificó el agente etiológico como Trichophyton erinacei, por cultivo micológico y biología molecular. El paciente se trató con terbinafina por vía oral, por seis meses, con excelente respuesta.

Foreign modelling agent reactions (FMAR) are the result of the injection of unapproved high-viscosity fluids with the purpose of cosmetic body modelling. Its consequences lead to ulceration, disfigurement and even death, and it has reached epidemic proportions in several regions of the world. We describe a series of patients treated for FMARs in a specialised wound care centre and a thorough review of the literature. A retrospective chart review was performed from January 1999 to September 2015 of patients who had been injected with non-medical foreign agents and who developed cutaneous ulceration needing treatment at the dermatology wound care centre. This study involved 23 patients whose ages ranged from 22 to 67 years with higher proportion of women and homosexual men. The most commonly injected sites were the buttocks (38·5%), legs (18%), thighs (15·4%) and breasts (11·8%). Mineral oil (39%) and other unknown substances (30·4%) were the most commonly injected. The latency period ranged from 1 week to 17 years. Complications included several skin changes such as sclerosis and ulceration as well as systemic complications. FMAR is a severe syndrome that may lead to deadly complications, and is still very common in Latin America.

espanolIntroduccion: El linfoma anaplasico de celulas T grandes CD30+ es un linfoma primario cutaneo en el cual no hay evidencia de enfermedad sistemica; para su diagnostico es necesario el estudio histopatologico. Objetivo: Presentar los casos diagnosticados en el Departamento de Dermatologia del Hospital General “Dr. Manuel Gea Gonzalez” con linfomas anaplasicos de celulas T grandes primarios cutaneos CD30+ durante un periodo de 24 anos. Metodo: Estudio retrospectivo en el que realizo estadistica descriptiva. Se recopilo informacion de sexo, edad, caracteristicas clinicas, resultados de pruebas complementarias, tratamientos previos y actuales, reportes de los estudios histopatologicos y de inmunohistoquimica. Resultados: Entre 29 309 expedientes, se encontraron nueve casos (0.000034 %) con diagnostico de linfoma anaplasico de celulas T CD30+. Se hizo la confirmacion del diagnostico histopatologico e inmunohistoquimico por dos dermatopatologos certificados. La edad promedio fue de 61.2 anos, hubo predominio del sexo femenino y de lesion papular o nodular y topografia variada como presentacion clinica inicial. Conclusiones: El pronostico del linfoma anaplasico de celulas T grandes CD30+ en la poblacion estudiada fue dependiente del estadio clinico. El tratamiento en etapas tempranas tiene resultados favorables. EnglishIntroduction: CD30+ anaplastic large T cell lymphoma is a cutaneous primary lymphoma in which there is no evidence of systemic disease; histopathological study is required for its diagnosis. Objective: To present the cases diagnosed with primary cutaneous CD30+ anaplastic large T-cell lymphoma over a 24-year period in Hospital General “Dr. Manuel Gea Gonzalez” Department of Dermatology. Method: Retrospective study. Descriptive statistics was carried out. Information was collected on gender, age, clinical characteristics, complementary test results, previous and current treatments, histopathological studies reports and immunohistochemistry test results. Results: Of 29 309 records, nine patients (0.000034%) with a diagnosis of CD30+ anaplastic T cell lymphoma were found. Histopathological and immunohistochemical diagnosis was confirmed by two certified dermatopathologists. Average age was 61.2 years, and there was a predominance of the female gender, with initial clinical presentation as a papular or nodular lesion and varied topography. Conclusions: The prognosis of CD30+ anaplastic large T cell lymphoma in the studied population was dependent on clinical stage. The treatment at early stages has favorable results.

espanolIntroduccion: Las discrasias linfoides epiteliotropicas de celulas T son un grupo de dermatosis inflamatorias poco frecuentes que pueden progresar a linfomas cutaneos. El tratamiento con radiacion ultravioleta ha sido descrito como seguro y eficaz. Objetivo: Describir la respuesta al tratamiento, sus efectos secundarios y complicaciones. Metodo: Se administro radiacion ultravioleta A con psoralenos (PUVA) a dos pacientes y radiacion ultravioleta B de banda estrecha (NB-UVB) a nueve pacien- tes, con diferentes discrasias. Resultados: Conformaron la serie siete mujeres y cuatro hombres, con edades de 5 a 30 anos y con fototipos III y IV, con diagnostico de discrasia linfoide epiteliotropica hipopigmentada, pitiriasis liquenoide cronica, pa- rapsoriasis hipopigmentada y purpura pigmentada. Dos recibieron PUVA y nueve recibieron NB-UVB. Ocho alcanzaron res- puesta completa y tres respuesta parcial con 10 a 119 sesiones de tratamiento. Ningun paciente presento reactivacion de la enfermedad despues de 34 a 247 sesiones, y ninguno en tratamiento o seguimiento evoluciono a linfoma cutaneo. Los efectos secundarios fueron xerosis y prurito. Conclusion: El tratamiento de las discrasias linfoides con radiacion ultravioleta es eficaz y seguro, con efectos secundarios leves y con respuestas exitosas en la mayoria de los pacientes, en tiempo y numero de sesiones variables. EnglishIntroduction: T-cell lymphoid dyscrasia is a group of different, infrequent, epitheliotropic inflammatory dermatosis that prece- de cutaneous T-cell lymphomas. Treatment with ultraviolet radiation is safe and efficacious. Objective: To describe responses to treatment, secondary effects and complications. Method: Eleven patients with different T-cell lymphoid dyscrasias were treated. Two received psoralens plus ultraviolet A radiation (PUVA) and nine narrow band ultraviolet B radiation (NB-UVB). Results: Seven women and four men from 5 to 30 years-old and phototypes III and IV were included. They had hypopigmen- ted epitheliotropic lymphoid dyscrasia, chronic pityriasis lichenoides, hypopigmented parapsoriasis and pigmented purpuric dermatoses. Two received PUVA and 9 NB-UVB. Eight achieved complete response and three partial response with 10 to 119 sessions. Any patient presented neither relapse nor progression to cutaneous T-cell lymphoma during treatment or in the follow up period after 34 to 247 sessions. Secondary effects were xerosis and mild pruritus. Conclusions: The majority of patients with T-cell lymphoid dyscrasias can be successfully and safely treated with minimal secondary effects after a variable number of sessions and periods of time with ultraviolet radiation.

Background Hypopigmented dermatoses, more evident in dark-skinned people, are a frequent cause of consultation. Their etiology includes a wide range of dermatoses, from benign to malignant diseases. The clinical presentation appears very similar between them, making the correct diagnoses and management a challenge. Methodology Clinical records and histopathological biopsies were identified and compared in patients of the "Dr. Manuel Gea Gonzalez" General Hospital throughout a 16-year period with the presumptive diagnosis of hypopigmented epitheliotropic T-cell dyscrasia (HTCD) or hypopigmented mycosis fungoides (HMF). Immunostaining analysis was performed in each specimen, the panel of antibodies used was: CD3, CD4, CD7, CD8, CD20, and CD62L. Results Thirty cases of 81 patients found in the registries were included in this study. The main age group was formed by children younger than 15 years old. The main clinical differences between both entities were gender, presence of plaques, and neck lesions. The most significant histopathological parameters used to differentiate both diagnoses were: severity of lymphocytic infiltration, the extent of epidermotropism, folliculotropism, presence of Pautrier's microabscesses, lymphocytes with cerebriform nuclei, and dermal fibroplasia. No immunohistochemical differences were found between them. Conclusion The clinical distinction between HTCD and HMF continues to be a challenge, therefore an extensive clinicopathological correlation must be performed. AbCD7 and AbCD62L were not useful to differentiate both dermatoses. This paper suggests that HTCD and HMF should be considered as the beginning and the end of the same clinical spectrum.

Background: Onychomycosis is one of the most common nail diseases and constitutes up to 50% of all nail conditions. It is a chronic fungal nail infection common in the HIV-infected population. Few studies have found fungal organisms in the nail without clinical evidence, and thus, termed subclinical onychomycosis. Objectives: We analyzed the nails of the HIV population in our hospital, searching for subclinical onychomycosis. Method: A distal nail clipping was stained with PAS and observed by a trained dermatopathologist. Results: All of our samples (n = 48) turned out to be negative for fungal structures. Conclusions: The epidemiology of onychomycosis is changing, treatment options are much better now, and diagnosis and infection detection are being done earlier. Therefore, we will continue to further study this disease in other patient populations so that we can compare our results and see whether the incidence of onychomycosis in the HIV population is now similar to that in those without HIV infection of the same age.

Myopericytoma is a soft-tissue tumor of perivascular cells (pericytes). It is slow-growing, usually asymptomatic, and generally benign, although a malignant variant has been described. The etiology is unknown, but it has been associated with local trauma. The most common location is on the distal extremities. Histologically, it is characterized by a well-circumscribed, non-encapsulated proliferation of spindle shaped cells similar to myofibroblasts with oval nuclei and eosinophilic cytoplasm, arranged in perivascular concentric rings. There are few mitoses and no necrosis is reported. The immunohistochemical analysis is positive for smooth muscle actin and negative or weakly positive for desmin. A low Ki-67 proliferation index is typical. Treatment is surgical excision with free margins. Recurrences after adequate excision are uncommon. We describe a 48-year-old woman with a myopericytoma in an unusual location (next to the inner corner of her left eye) who was treated with surgical excision; there has been no recurrence after 5 years of follow up.

Exotic pets, such as the ground hedgehog, are capable of transmitting to the human being different zoonoses, such as salmonellosis, mycobacteria, protozoa such as Cryptosporidium parvum, and dermatophytosis. We present the case report of a male adult patient, who had recently acquired a ground hedgehog, who presented in his hand a ringworm lesion incognito and a Majocchi granuloma. The etiological agent was identified as Trichophyton erinacei by mycological culture and molecular biology. The patient was treated with terbinafine oral, with excellent response.

Transient reactive aquagenic pseudokeratoderma is characterized by transient whitish and translucent papules after water exposure in palms and soles. We report 5 additional cases and their histopathologic features. Patient 5 showed a topography that had not been reported before; this demonstrates that it is not an exclusive condition of palms and soles. Patient 2 presents very subtle clinical findings, making difficult the diagnosis. And the other 3 patients have a typical presentation. Transient reactive aquagenic pseudokeratoderma has heterogeneous clinical features; in some cases, histopathologic findings, although subtle, help to confirm the diagnosis.

A 35-year-old man presented with a 2-day history of a maculopapular pruritic eruption that had affected his general state of health and was accompanied by chills. The patient had been diagnosed with HIV in 2008, and was undergoing treatment with a combination of emcitrabine/tenofovir plus nevirapine. He had a current viral load of 1,558,160 copies/mL and a lymphocyte count CD4+ count of 230/mm3. Physical examination revealed an eruption involving the face, nape of the neck, chest, abdomen, extremities, palms, and soles. This was characterized by erythematous papules approximately 2 mm in diameter coalescing on the palms and soles, where they formed plaques (Figures 1 and 2).

Background Progressive hemifacial atrophy or Parry–Romberg Syndrome (PRS) is a rare, acquired, progressive dysplasia of subcutaneous tissue and bone characterized by unilateral facial involvement. Its etiology is unknown, but theories about its pathogenesis include infectious, degenerative, autoimmune, and traumatic causes among others. The causal relationship of PRS and linear morphea en coup de sabre (LMCS) with Borrelia burgdorferi infection remains controversial. Our goal was to serologically determine anti-B. burgdorferi antibodies in patients diagnosed with PRS and LMCS to establish a possible association as a causative agent. Methods We conducted a serology study with patients belonging to a group of 21 individuals diagnosed with PRS, six with LMCS, and 21 matched controls. Anti-Borrelia IgG antibodies were determined by ELISA. A descriptive statistical analysis and Fischer's exact test were done. Results In serological tests, only two cases had borderline values and were further analyzed by Western blot with non-confirmatory results. For both the PRS and LMCS group, the association test was not significant, suggesting a lack of association between PRS or LMCS and the presence of anti-Borrelia antibodies. Conclusion In Mexico there are no previous studies on Borrelia infection and its relationship between PRS or LMCS. Our result showed a lack of association of either clinical entities with anti-Borrelia-antibodies. Former reports of this association may suggest coincidental findings without causal relationship.

Background Non-melanoma skin cancer includes basal cell carcinoma and squamous cell carcinoma (SCC). Basal cell carcinoma is the most common and least aggressive but in a low percentage of cases, despite appropriate wide surgical margins, it can be aggressive, producing local invasion, recurrences and distance metastasis. SCC has a more aggressive behaviour invading first the skin, the lymph nodes and less frequently produces distance metastasis. Objective To identify the characteristics of recurrent SCC and frequency of new SCC after conventional surgical and primary closure or closure delayed until a histological reporting of tumour-free surgical margins, in order to achieve a better surgical option, in our Mexican population. Materials and method We reviewed clinical records from the last 10 years, and included those with a diagnosis of SCC. Results One hundred and fourteen tumours in 103 patients were included. The mean new tumour diagnosis was 32.2 per year; there were 46.6% men and 53.4% women. Age range 19–91, with mean 71.94 years (SD = 13.34). The evolution time was from 1 to 112 months (mean = 12 months, SD = 2.65). The most affected site was the cheek. In addition, an invasive tumour was reported in 54% in the histopathological study. At 10-year follow-up we found a second SCC in 14 patients and only 4 recurrences, between the 1st and 4th year and 3 were treated with delayed closure until margins were tumour-free. Conclusion In this study we demonstrated that delayed closure technique is easy and adaptable in our population in the treatment of SCC, achieving good results with very low recurrences at 10-year follow-up.

Foreign modelling agent reactions (FMAR) are the result of the injection of unapproved high‐viscosity fluids with the purpose of cosmetic body modelling. Its consequences lead to ulceration, disfigurement and even death, and it has reached epidemic proportions in several regions of the world. We describe a series of patients treated for FMARs in a specialised wound care centre and a thorough review of the literature. A retrospective chart review was performed from January 1999 to September 2015 of patients who had been injected with non‐medical foreign agents and who developed cutaneous ulceration needing treatment at the dermatology wound care centre. This study involved 23 patients whose ages ranged from 22 to 67 years with higher proportion of women and homosexual men. The most commonly injected sites were the buttocks (38·5%), legs (18%), thighs (15·4%) and breasts (11·8%). Mineral oil (39%) and other unknown substances (30·4%) were the most commonly injected. The latency period ranged from 1 week to 17 years. Complications included several skin changes such as sclerosis and ulceration as well as systemic complications. FMAR is a severe syndrome that may lead to deadly complications, and is still very common in Latin America.

The porokeratoses are characterized by the formation of cornoid lamellae. Porokeratosis ptychotropica (PP), is a rare form first described by Lucker, where the dyskeratotic skin changes are mainly located around the gluteal cleft or genital area (1, 2). A 56-year-old man presented with mildly pruritic symmetrical hyperkeratotic brown plaques with subtle fine scaling, and smaller satellite plaques, affecting both buttocks, and partially the intergluteal cleft. (Figure 1 a) The plaque began a year before on the right buttock, and a second plaque followed on the left. Treatment with emollients, antifungals, and topical steroids was unsuccessful. He was otherwise healthy. This article is protected by copyright. All rights reserved.

Fungal leuconychia defines the clinical manifestations of white changes in onychomycosis. This uncommon clinical aspect is mostly seen, although not exclusively, in immunosuppressed patients. The principal isolated organism is Trichophyton spp. but the entity can also be caused by non-dermatophyte moulds. The mechanism of infection is unclear; it could be acquired through the proximal nail fold, or, as more recently proposed, may be secondary to lymphatic or vascular dissemination. To analyse the clinical, mycological and histopathological features of fungal leuconychia, we included 10 patients with the clinical diagnosis of fungal leuconychia. Direct examination of culture and nail plate biopsy were performed. Nine patients had confirmed fungal leuconychia. Four had a positive culture and all had positive haematoxylin-eosin (H&E) and Periodic Acid Schiff (PAS) stains for fungal elements with varying degrees of nail plate invasion. Seven of our patients were immunosuppressed and the isolated aetiological agents are the same as previously reported. The direct examination is reliable, fast and inexpensive to establish the diagnosis. The correlation of onychomycosis with histology, stained with H&E and PAS was 100%. We think that the site of nail plate invasion provides more information to support the theory that the infection reaches the ungual apparatus through systemic dissemination.

Renal cell carcinoma (RCC) accounts for 2-3% of adult solid malignancies. About 25-30% develop metastasis at the time of diagnosis and 60% corresponds to clear cell type.A 66-year-old man, with a personal history of left radical nephrectomy, presents with an asymptomatic skin tumor he noticed one month earlier. Histopathologic study reported metastatic cutaneous infiltration of clear cell carcinoma, suggestive of a primary renal carcinoma.Cutaneous metastasis of RCC represents 6.0-6.8% of all cutaneous metastases. These patients have poor prognosis and, therefore, their treatment is palliative. It is essential to perform a complete periodic dermatologic examination for proper restaging and treatment.

Perineurioma is an infrequent and benign cutaneous neoplasm characterized by proliferation of perineurial cells. It is classified into two main types: intraneural and the extraneural or soft tissue perineurioma, in which the sclerosing variant is included. Sclerosing perineurioma is more frequently found on acral skin. Clinically, they are well-circumscribed,skin colored, nodular tumors.Describe and communicate clinicopathologic findings from a case series of sclerosing acral perineurioma.This is a clinical, morphological and immunohistologic case study of eight patients with the diagnosis of sclerosing perineurioma.It included five men and five women, with ages ranging between nine and 66 years. All of them had lesion on acral skin. At microscopy study, the lesions showed a proliferation of epithelioid and spindle-shaped perineurial cells, arranged in small aggregates and short fascicles between thickened collagen bundles. Immunohistochemistry studies revealed that the proliferating cells expressed EMA, Claudin-1 and Glut-1, and were negative for S-100 protein.It is important to report these infrequent skin tumors, so they can be taken into account in the differential diagnoses of acral lesions.

Acral melanoma is the most frequent subtype in the Asian and Mexican mestizo populations. Dermoscopy is a noninvasive diagnostic technique that helps the differential diagnosis of pigmented skin lesions on acral volar skin. We, herein, present a case of acral congenital melanocytic nevus with a parallel ridge dermoscopic pattern. Since the parallel ridge pattern in a melanocytic lesion of the acral skin is classically ascribed to melanoma, the present case can be definitely labeled as "atypical" and worth of being elucidated in its histopathological correlates.

Summary Human histoplasmosis is caused by the dimorphic fungus Histoplasma capsulatum. This infection can run asymptomatic or be life-threatening, depending fundamentally on the host's immune status. Immunocompromised patients can present disseminated disease to the skin, making the biopsy an accessible approach. The current diagnosis gold standard is fungal culture which takes several days or weeks to grow and must be handled in a biosafe laboratory which is avoided if we use the technique here described. We propose the use of molecular biology for diagnosis confirmation, considering it can shorten diagnosis lapse, has good specificity and sensitivity and reduces the risk of infection for the medical and laboratory personnel. Seven paraffin-embedded skin biopsy samples were included from patients with confirmed HIV and histoplasmosis diagnosis. Total DNA was isolated and molecular typing of H. capsulatum var. capsulatum. All samples were positive. This is a safe and accurate method for skin histoplasmosis diagnosis.

The vasculities are complex diseases. Their cutaneous manifestations are very important and often mirror several pathologies. Cocaine use has been related to both, vasculitis and thrombotic vasculopathy and pseudovasculitis. A new syndrome has been described in association with its adulteration with levamisole. It can be very serious, leading patients to death. This is relevant as levamisole-adultered cocaine seems to be increasingly offered to consumers. Our goal is to report the first two cases in Mexico, which faces an important raise in cocaine use, emphasizing that a high suspicion based on certain characteristics allows for early recognition and adequate treatment.Las vasculitis son enfermedades complejas con manifestaciones cutáneas importantes que pueden traducir diversas patologías. El uso de cocaína está relacionado con casos tanto de vasculitis y vasculopatía trombótica, como de pseudovasculitis. Recientemente se ha descrito una condición peculiar asociada a su forma adulterada con levamisol, la cual puede ser incluso mortal, y cuya frecuencia va en aumento. Nuestro objetivo es reportar los primeros dos casos de alta sospecha en México, que enfrenta un incremento en el consumo de cocaína, enfatizando en que ciertas características y la realización de determinados estudios permiten la identificación temprana y el tratamiento adecuado de esta condición.

Patients with a first primary melanoma are known to have an increased risk of being diagnosed with another primary melanoma. We present the case of a 42-year-old male patient with multiple primary melanoma who was admitted to the dermatology department at the general hospital "Dr Manuel Gea González" in Mexico City. Incidence, risk factors and prognosis are discussed in this review.