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Granuloma annulare may be caused by multiple triggers. Among these are vaccinations, which have been described as an infrequent cause of granuloma annulare. The authors report the first case of generalized granuloma annulare associated with pneumococcal vaccination in a 57-year-old woman, who presented cutaneous lesions 12 days after vaccination.

Background: The microbiological diagnosis of skin lesions related to COVID‐19 is not well known. Objective: Perform a microbiological diagnosis in COVID19‐related cutaneous manifestations. Methods: A cross‐sectional study was performed with 64 patients with cutaneous manifestations associated with COVID‐19 who underwent serological and nasopharyngeal reverse transcription polymerase chain reaction (RT‐PCR) for SARS‐CoV‐2. Results: Out of the 64 patients, 6 patients had positive RT‐PCR, with all of them developing SARS‐CoV‐2 IgG and 4 of them had positive IgM + IgA. Of the 58 patients with negative RT‐PCR, 8 cases had positive IgM + IgA and only one of them had IgG seroconversion. Therefore, the infection was demonstrated in 7 cases (10.9%) and was doubtful in 7 other cases (10.9%) who presented negative RT‐PCR and presence of IgA + IgM without subsequent seroconversion of IgG. Fifty patients (78.1%) had negative serological tests. The most frequent cutaneous pattern was pseudo‐chilblain (48.4%) followed by maculo‐papular pattern (26.6%), urticarial lesions (10.9%), vesicular eruptions (6.3%) and livedoid pattern (4.7%). The maculo‐papular pattern showed the highest positivity in RT‐PCR (3 cases; 17.6%) and serologies (4 cases; 23.5%). Skin lesions developed after the systemic symptoms in most patients (19 cases; 61.3%). Conclusions: Microbiological confirmation tests may not be an effective diagnostic technique for COVID‐related cutaneous manifestations or that attributed lesions are not related to COVID‐19. Confounding factors such as adverse drug reaction, serological cross‐reactions with other viruses, the low production of antibodies in asymptomatic or mild forms of COVID‐19 or its rapid disappearance, increase diagnostic uncertainty.

Pemetrexed is a multi-targeted folate antagonist drug approved for the treatment of advanced and metastatic non-small cell lung carcinoma (NSCLC), and malignant pleural mesothelioma, and is known to induce cutaneous adverse reactions in approximately 20% of patients. We report a case of an uncommon toxicity induced by pemetrexed: scleroderma-like condition of the lower extremities. This cutaneous adverse effect is often unrecognized, resulting in delayed diagnosis, which often leads to a worsening in the condition and increasing the risk of further fibrosing sequelae.

Since the beginning of the COVID‐19 pandemic, different types of cutaneous manifestations have been reported. In Spain, there were reports in the first weeks of April 2020 of an increase in purpuric acral lesions similar to perniosis on the hands and especially the feet of children and young adults. These patients do not normally present with clinical manifestations linked to COVID‐19, and their PCR and serological tests are usually negative for specific IgM and IgG.

Molluscum contagiosum (MC), a frequent viral infection, is generally easy to diagnose because of its characteristic clinical features. However, atypical presentations can be a diagnostic challenge for clinicians. Dermoscopy has helped in this cases by showing a characteristic dermoscopic pattern composed of a central pore or umbilication in conjunction with polylobular white to yellow amorphous structures, surrounded by linear or branched vessels (‘red crown”). However, additional dermoscopic patterns can be found. Herein we present two MC cases where rosettes were seen on dermoscopy

Acral purpura is generally a hallmark for severe internal disease. However, exogenous pigmentation related to contact with invertebrates, can induce acral purpura-like lesions. Data regarding the beetle's ability to cause skin hyperpigmentation or purpura-like lesions are scarce. We report a case of exogenous pigmentation caused by accidental contact with a darkling beetle, clinically simulating acral purpuric lesions. The history of recent drug inhalation and abnormal autoimmunity tests made this diagnosis difficult.

Exercise-induced vasculitis (EIV) is a benign cutaneous vasculitis that affects healthy individuals. We report a case of EIV in a 15-year-old male patient with a striking clinical appearance triggered by a combination of prolonged standing and disco dancing in a warm environment. Pediatric dermatologists should be aware of this activity as a possible trigger of EIV, especially in teenagers.

Niño de seis años de edad que presenta una lesión cutánea en mejilla izquierda de crecimiento progresivo de cuatro meses de evolución. Sus padres refieren el antecedente de una picadura de insecto en dicha localización durante un viaje a Marrakech (Marruecos) que realizaron hace cinco meses. A la exploración se aprecia una placa eritematosa de 1, 5 cm de diámetro con costra amarillenta central (fig. 1). La dermatoscopia de luz polarizada (DLP) reveló hallazgos compatibles con una infección cutánea por Leishmania spp. (fig. 2)...

Resumen: Introducción: La Hidradenitis palmoplantar ecrina idiopática (HPPI) es una dermatosis neutrofílica infrecuente, que cursa con nódulos eritematosos dolorosos de comienzo brusco en regiones plantares o palmoplantares, en niños que no tienen otra enfermedad subyacente. Objetivo: Presentar un caso que ilustra las principales características clínicas e histológicas de la HPPI. Caso Clínico: Niña de 11 años evaluada por nódulos eritematovioláceos dolorosos en planta de pie derecho de 48 horas de evo lución y fiebre de hasta 38,2 °C, sin antecedentes de interés salvo hiperhidrosis y práctica intensa de ejercicio en los días previos. Ante la sospecha clínica de HPPI se realizó biopsia cutánea, que mostró infiltrado inflamatorio neutrofílico alrededor de glándulas sudoríparas ecrinas y abscesos de neutrófilos, confirmando el diagnóstico. Se indicaron antiinflamatorios no esteroidales orales y reposo, con resolución de las lesiones en 7 días. Conclusiones: Este caso demuestra los aspectos más importantes de la HPPI. Esta entidad en muchos casos es infradiagnosticada, dado que puede confundirse con otras patologías que también cursan con nódulos acrales dolorosos, pero tienen distintas implicacio nes patogénicas y terapéuticas. Identificar apropiadamente la HPPI permite evitar la alarma innece saria, tanto en pacientes y sus padres, como en los propios dermatólogos y pediatras.

Lichen aureus is a rare pigmented purpuric dermatosis. We present an unusual case because of the pediatric age and the great number of lesions with zosteriform distribution. He is a 10-yearold boy, with a brownish, smaller than 1 cm, sharp edges, lichenified surface, asymptomatic macule, over the inner aspect of the left leg with a zosteriform distribution. The histology showed a band-like inflammatory infiltrate in the superficial dermis, composed of lymphocytes, histiocytes, erythrocytes and haemosiderin. He was diagnosed with zosteriform lichen aureus and was treated with topical mometasone furoate during 3 weeks resulting in partial lightening of the macules. Lesions have remained 2 years later, and new ones have appeared in the ipsilateral ankle. We must consider differential diagnosis with other pigmented purpuric dermatitis and pigmented purpuric mycosis fungoides. There are many therapeutic options and it tends to disappear spontaneously, so new studies are necessary.

Folliculitis caused by Pseudomonas aeruginosa is a rare, adverse effect of the therapeutic or recreational use of hot tubs, whirlpools, and occasionally swimming pools. The condition is characterized by follicular pustules and inflammatory papules that usually occur after an incubation period of two to four days and improve spontaneously in 7 to 10 days. We observed two cases of Pseudomonas aeruginosa folliculitis in two children which developed within two days after playing in a small vinyl pool. Since it is difficult to control the growth of Pseudomonas in hot tubs, whirlpools and swimming pools, attention to water conditions is the best way to prevent this folliculitis.

Mujer de 81 anos que presentaba placas y tumoraciones eritematoviolaceas e infiltradas, asintomaticas, de 8 meses de evolucion en la pierna derecha (fig. 1). La biopsia cutanea mostro un infiltrado denso y difuso de celulas linfoides centroblasticas (fig. 2A) e inmunoblasticas (fig. 2B), con estudio inmunohistoquimico confirmatorio de estirpe linfoide B: CD79a y CD20 positivos (fig. 2C y D). Tras descartar afectacion sistemica, se administro tratamiento quimioterapeutico con regimen CHOP (ciclofosfamida, doxorrubicina, vincristina y prednisona) mas rituximab, con remision clinica completa de las lesiones, que no han redicivado tras 6 meses de seguimiento (fig. 3).