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Graphical abstract, Background and objectives Spain is in a situation of indefinite lockdown due to the ongoing coronavirus disease 2019 (COVID-19) pandemic. One of the consequences of this lockdown is delays in medical and surgical procedures for common diseases. The aim of this study was to model the impact on survival of tumor growth caused by such delays in patients with squamous cell carcinoma (SCC) and melanoma. Material and methods Multicenter, retrospective, observational cohort study. We constructed an exponential growth model for both SCC and melanoma to estimate tumor growth between patient-reported onset and surgical excision at different time points. Results Data from 200 patients with SCC of the head and neck and 1000 patients with cutaneous melanoma were included. An exponential growth curve was calculated for each tumor type and we estimated tumor size after 1, 2, and 3 months of potential surgical delay. The proportion of patients with T3 SCC (diameter > 4 cm or thickness > 6 mm) increased from 41.5% (83 patients) in the initial study group to an estimated 58.5%, 70.5%, and 72% after 1, 2, and 3 months of delay. Disease-specific survival at 2, 5, and 10 years in patients whose surgery was delayed by 3 months decreased by 6.2%, 8.2%, and 5.2%, respectively. The proportion of patients with ultrathick melanoma (> 6 mm) increased from 6.9% in the initial study group to 21.9%, 30.2%, and 30.2% at 1, 2, and 3 months. Five- and 10-year disease-specific survival both decreased by 14.4% in patients treated after a potential delay of 3 months. Conclusions In the absence of adequate diagnosis and treatment of SCC and melanoma in the current lockdown situation in Spain, we can expect to see to a considerable increase in large and thick SCCs and melanomas. Efforts must be taken to encourage self-examination and facilitate access to dermatologists in order to prevent further delays.

Scalp lesions are common in psoriasis and difficult to treat. Scientific evidence on the topic is scant and fragmentary, especially with respect to long-term treatment. This consensus statement is based on a critical assessment of the results of a MEDLINE search for clinical trials of the efficacy and safety of therapies used to treat scalp psoriasis. The recommendations were developed by an expert panel using the Delphi process to reach a consensus and then ratified by the members of the Psoriasis Group of the Spanish Academy of Dermatology and Venereology. The recommended induction therapy for scalp psoriasis is either a topical corticosteroid or a topical treatment combining calcipotriol and betamethasone. The choice of an appropriate vehicle is crucial in improving effectiveness and patient adherence to treatment. The only formulations that have been studied in the long-term treatment of scalp psoriasis are a combination of calcipotriol and betamethasone in gel and calcipotriol alone in solution.

Resumen Los anti-factor de necrosis tumoral (TNF) presentan un amplio espectro de lesiones cutaneas, entre las que se encuentra paradojicamente la psoriasis. Una mujer de 42 anos, con una historia de artritis reumatoidea desde los 19 anos, fue remitida al servicio de Dermatologia por presentar una psoriasis pustulosa en ambas plantas de los pies durante un tratamiento con etanercept. Ante la presencia de este cuadro se instauro tratamiento corticoideo topico oclusivo, con mejoria clinica a las 4 semanas y desaparicion total de las lesiones a las 6 semanas. Los anti-TNF son farmacos que actuan en enfermedades mediadas por celulas T. La aparicion de erupciones psoriasiformes es mas frecuente de lo comunicado en la literatura, ya que aparecen en todas las indicaciones y con todos los anti-TNF, con mayor frecuencia con adalimumab. Se producen tres tipos de reacciones, siendo la pustulosa la mas comun; predomina en mujeres y puede aparecer cronologicamente en cualquier momento durante el tratamiento. Respecto al tratamiento es aconsejable continuar con los anti-TNF.

Scalp lesions are common in psoriasis and difficult to treat. Scientific evidence on the topic is scant and fragmentary, especially with respect to long-term treatment. This consensus statement is based on a critical assessment of the results of a MEDLINE search for clinical trials of the efficacy and safety of therapies used to treat scalp psoriasis. The recommendations were developed by an expert panel using the Delphi process to reach a consensus and then ratified by the members of the Psoriasis Group of the Spanish Academy of Dermatology and Venereology. The recommended induction therapy for scalp psoriasis is either a topical corticosteroid or a topical treatment combining calcipotriol and betamethasone. The choice of an appropriate vehicle is crucial in improving effectiveness and patient adherence to treatment. The only formulations that have been studied in the long-term treatment of scalp psoriasis are a combination of calcipotriol and betamethasone in gel and calcipotriol alone in solution.

Resumen El hamartoma o nevus oligemicus es una entidad infrecuente, de etiopatogenia poco aclarada, en la que se produce una vasoconstriccion selectiva del plexo vascular profundo dermico con relacion al superficial. Estas alteraciones funcionales dan lugar a lesiones fijas, adquiridas y asintomaticas a modo de maculas lividas, eritematosas, tipicamente frias al tacto si se compara con la piel sana adyacente. Comunicamos los casos de 6 varones jovenes con lesiones en el abdomen y en los flancos, compatibles clinicamente con nevus oligemicus . La medicion de la temperatura superficial de la lesion, constatando un descenso de hasta 2,5 °C respecto de la piel sana adyacente, permitio realizar el diagnostico definitivo. Se describen los estudios complementarios realizados, los diagnosticos diferenciales, los posibles agentes etiologicos responsables y se comentan los casos referidos en la literatura hasta el momento. Consideramos que el nevus oligemicus es una entidad infradiagnosticada y mucho mas frecuente de lo referido en la literatura.

Hamartoma or nevus oligemicus is an uncommon lesion that is characterized by selective vasoconstriction of the deep dermal vascular plexus with respect to the superficial one and whose cause has not been clearly established. This selective vasoconstriction gives rise to fixed, acquired, and asymptomatic lesions in the form of livid, erythematous macules that are typically cold to touch compared with surrounding skin. We report the cases of 6 young men with lesions clinically compatible with nevus oligemicus on the abdomen and flanks. Measurement of the surface temperature of the lesion revealed a decrease of up to 2.5°C with respect to healthy surrounding skin and allowed a definitive diagnosis to be made. We describe the additional studies undertaken, the differential diagnosis, and the possible etiologic agents, and discuss the cases reported in the literature to date. In our opinion, nevus oligemicus is an underdiagnosed lesion that is much more common than has been reported in the literature.

Resumen —Una paciente de 63 anos afecta de leucemia aguda mieloblastica, tras 5 dias de infeccion de las vias respiratorias altas, presento una placa necrotica en ala nasal derecha; posteriormente, una lesion satelite en la pierna derecha y empeoramiento del estado general. Se aislo Mucor spp. En el cultivo de una de las dos biopsias efectuadas. En ambas habia trombos formados por hifas no septadas. A pesar de un tratamiento precoz con anfotericina B intravenosa y desbridamiento quirurgico la paciente fallecio. La mucormicosis es una infeccion por hongos saprofitos de la clase de los zigomicetos que afecta a pacientes inmunodeprimidos. Las manifestaciones cutaneas en la mucormicosis diseminada son raras; sus formas de presentacion varian: nodulos con centros equimoticos, placas eritematosas con centro purpurico y lesiones similares al ectima gangrenoso. Dada su ubicuidad, para su diagnostico se necesitan criterios microbiologicos e histopatologicos estrictos. El tratamiento mas eficaz es el empleo de anfotericina B intravenosa a dosis altas y el desbridamiento quirurgico, a pesar de lo cual la mortalidad es elevada.

Schonlein-Henoch purpura is a small vessel disease that affects mainly skin and kidney, although several gastrointestinal symptoms may occur including abdominal pain, intussusception, perforation or bleeding. Massive lower gastrointestinal haemorrhage is rare and even more as the main symptom of the disease. We present a case of a 2-year-old boy with Schonlein-Henoch purpura who developed a massive lower gastrointestinal bleeding requiring blood transfusion. In this patient both Schonlein-Henoch purpura and gastrointestinal haemorrhage were successfully treated with intravenous methylprednisolone, avoiding surgical intervention. Physicians need to have a high index of suspicion when evaluating these patients, even more when dermatologic signs are scarce. Glucocorticosteroid therapy may be effective when treating severe gastrointestinal symptoms.

En los estudios complementarios destacaba: unos linfocitos CD4 17 celulas/mm3, carga viral 2.600 copias/ml y antigenemia de citomegalovirus negativa. La tomografia axial computarizada de cuello mostraba pequenas adenopatias laterocervicales bilaterales, sin observarse masas en los espacios parafaringeos. Un esofagograma realizado tras un intento fallido de endoscopia demostro la presencia de una ulcera en el tercio distal del esofago (fig. 2).

The patient was a 41-year-old man who was admitted for a 3-week history of fever, dysphagia, odynophagia, and painful ulcers in the oropharynx. The patient reported that 3 years earlier he suffered a similar condition that was less severe and resolved spontaneously. He had been diagnosed with human immunodeficiency virus (HIV) infection, category B3, and hepatitis C infection, and was on treatment with cotrimoxazole.

in the service list not to be eligible for referral. Despite the limited scope of the study in terms of data collection and with no prior study that could be used as a reference, the results suggest that consensus and subsequent distribution of the service list in the referral area would have some impact on referrals of trivial, extremely widespread lesions that account for almost 1 of 3 consultations. The factors that lead to a high prevalence of consultations for trivial lesions in the public health care system and their medium-term and long-term consequences on dermatologists’ activity are unquestionably complex and deserve lengthy and careful discussion. However, this situation not only requires funding, as MacayaPascual et al 1 pointed, but could largely