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Resumen Introduccion Los tumores sebaceos son un grupo infrecuente de neoplasias. En algunos casos se han relacionado con neoplasias viscerales en pacientes con el sindrome de Muir-Torre; una variante clinica del sindrome de cancer de colon hereditario no poliposico. El objetivo de este trabajo es revisar el diagnostico y el seguimiento de una serie de pacientes con tumores sebaceos para comprobar cuantos de ellos cumplian criterios de sindrome de Muir-Torre. Pacientes y metodos Se realizo una busqueda en la base de datos del Servicio de Dermatologia del Consorcio Hospital General Universitario de Valencia entre 1990 y 2005, buscando pacientes con tumores sebaceos. Se revisaron las biopsias para confirmar el diagnostico. Tambien buscamos datos en las historias clinicas que sugiriesen un diagnostico de sindrome de Muir-Torre, cuando las historias estaban incompletas nos pusimos en contacto por telefono con los pacientes. Resultados Encontramos 20 pacientes diagnosticados de tumores sebaceos, pero despues de revisar la biopsia solo confirmamos este diagnostico en 12 pacientes. Dos pacientes pertenecian a una familia con antecedents de neoplasias viscerales, que cumplia los criterios clinicos de sindrome de cancer de colon hereditario no poliposico. No hubo un seguimiento uniforme de los pacientes ni se realizaron las mismas pruebas en todos ellos. Conclusiones Es fundamental descartar la presencia de un sindrome de Muir-Torre en pacientes con tumors sebaceos. El uso de nuevas tecnicas como la deteccion de la inestabilidad de microsatelites o la inmunohistoquimica pueden ayudar a detectar a las familias que tienen un mayor riesgo de padecer el sindrome de Muir-Torre.

Pemphigus vulgaris is a potentially fatal autoimmune bullous disease. High doses of immunosuppressive drugs are used in managing severe cases of pemphigus. Rituximab, an anti-CD20 monoclonal antibody, has proven to be effective in patients with refractory pemphigus vulgaris and pemphigus foliaceus. We review cases of pemphigus vulgaris and pemphigus foliaceus not associated with lymphoma that were treated with rituximab, and we report a new case of severe refractory pemphigus vulgaris successfully treated with rituximab.

El eberconazol es un compuesto imidazolico de aplicacion topica con actividad fungistatica y fungicida a altas dosis, de amplio espectro de accion, caracterizado por poseer una estructura molecular de tipo hidrofilo-lipofilo que favorece la penetrabilidad y la permanencia en la piel. Los componentes galenicos de este azol topico favorecen y optimizan la accion del farmaco en la piel. Los esteres de acidos grasos facilitan la penetracion en la piel y la extensibilidad de la crema, mientras que las poliacrilamidas producen un efecto filmogeno y facilitan la permanencia del principio activo en la piel. Estudios preclinicos han mostrado una alto grado de actividad in vitro frente a especies de Candida , incluyendo C. tropicalis , dermatofitos y Malassezia furfur . En un estudio reciente, el eberconazol mostro una actividad in vitro superior al clotrimazol, el ketoconazol y el miconazol frente a 200 cepas de dermatofitos. El eberconazol ha mostrado actividad en pruebas in vivo : dermatofitosis, candidiasis y pitiriasis experimentales del cobayo. No presenta hipersensibilidad retardada, y no produce fotosensibilidad, efecto fototoxico ni absorcion sistemica. Ha demostrado una eficacia superior que el clotrimazol en crema al 1% y equivalencia terapeutica con miconazol al 2% en el tratamiento de las micosis cutaneas producidas por dermatofitos, con una eficacia similar en el tratamiento de la candidiasis y la pitiriasis versicolor. Por todo ello, puede considerarse su uso en la practica clinica habitual.

Cutaneous fistulas and sinuses in the maxillofacial region secondary to osteomyelitis rarely appear in clinical practice. The most frequent cause of mandibular osteomyelitis is a dental infection, but it may also be hematogenic in origin. The diagnostic criteria for bacterial osteomyelitis are suppuration and osteolytic changes in the radiological study. The differential diagnosis of an ulcerative lesion in the mandibular area includes several pathologies, such as a fistula of dental origin, a reaction to a foreign body, a deep mycotic infection, a pyogenic granuloma or a congenital malformation.

Papillary dermal elastolysis similar to pseudoxanthoma elasticum is an elastolytic disorder characterized by cutaneous lesions on the neck and in the supraclavicular region that are clinically similar to pseudoxanthoma elasticum, with no systemic complications. The histological examination shows a loss of elastic fibers in the papillary dermis. We report a case in a 76-year-old woman with typical lesions on the neck.

We present the case of a 26-year-old Ecuadorian woman who presented with multiple hypertrophic scars along the lower left limb, secondary to a cutaneous process that she had had for 11 years, previously diagnosed and treated in her country as cutaneous leishmaniasis. It had been clinically worsening for 9 months with suppuration through the scars in the groin and thigh, associated with local pain and systemic symptoms. As we suspected cutaneous tuberculosis, we performed a number of complementary examinations to confirm the diagnosis and rule out bone involvement. Finally, a lymph node culture confirmed that it was scrofuloderma.

A 42-year-old woman presented with a 12-year history of extensive yellow and erythematous plaques, round and oblong with irregular configuration and glossy atrophic central areas on the pretibial aspects of both legs. Her 45-year-old sister presented with a 7-year history of a single plaque with erythematous margins, abundant telangiectases, and an atrophic center in the lower portion of the left leg. There was no family history of type-1 or type-2 diabetes mellitus. Both patients had normal fasting glucose concentration, oral glucose tolerance test, and glucose overload test. Different treatment options including topical corticosteroids were unsuccessful. Treatment with oral fumaric acid esters was attempted but the medication was discontinued because of intolerable side effects (flushing and gastrointestinal discomfort). At present, after a follow-up of 2 years, the plaques remain unchanged. These two cases should be added to the few cases of familial nondiabetic necrobiosis lipoidica previously reported.

A 62-year-old woman developed pruritus, oedema, erythema and vesiculation, well demarcated at the application sites of nitroglycerin TTS on the trunk and upper arms (Fig. 1). Lesions healed with post-inflammatory hyperpigmentation. Two weeks before, the patient had started treatment for coronary insufficiency with daily nitroglycerin transdermal patches (Dermatrans 5®, Recordati group, Madrid, Spain), and 6 days later she noted pruritus. The symptoms started 12 h after rechallenge. Although the patches were substituted with another brand, the pruritus and eczema did not decrease. Nitroglycerin TTS was withdrawn and the patient was treated with topical corticosteroids and oral antihistamines for a week. Later, patch tests were carried out with adhesives and nitroglycerin 1%, 0.5% and 0.1% in petrolatum (Fig. 2). All the nitroglycerin patch tests were positive at 48 h (stronger) and at 72 h, but the adhesive proved negative. The woman subsequently received sublingual nitroglycerin without adverse effects. Furthermore, the patient had been on isosorbide mononitrate orally for the last year because she had high blood pressure, but no cross-sensitivity allergic reaction occurred.