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Lymphangioma is a known, but rare manifestation of Noonan syndrome. We present the case of disseminated and circumscribed cutaneous lymphangiomas in the context of Noonan syndrome. Oral rapamycin is a promising treatment in these extensive and morbidity-causing cases.

The development of perianal ulcers related to the use of a hemorrhoidal ointment has not been reported in the literature. We describe a series of 11 patients who were treated for perianal ulcers in 10 Spanish hospitals after they used the same ointment containing the active ingredients triamcinolone acetonide, lidocaine, and pentosan polysulfate sodium. No prior or concomitant conditions suggesting an alternative cause for the condition could be identified, and after the patients stopped using the ointment, their ulcers cleared completely in 8 weeks on average. This case series shows the damage that can be caused by an over-the-counter pharmaceutical product used without medical follow-up. It also illustrates the need to ask patients with perianal ulcers about any topical agents used before the lesions appeared.

A 14-year-old girl who reported generalized scaling and hyperkeratosis since age 1 year presented with severe pruritus of several months' duration. Scabies mites were detected, and molecular genetic analysis subsequently revealed a rare pathogenic variant in the keratin 2 (KRT2) gene, confirming a diagnosis of superficial epidermolytic ichthyosis. Treatment with oral ivermectin led to complete remission of symptoms. Disorders of keratinization can mimic clinical signs of scabies, leading to a delay in diagnosis.

Background: Methyldibromo glutaronitrile (MDBGN) was one of the most frequent and relevant allergens found in patch testing at the beginning of this century. In 2008, this preservative was banned from cosmetics in Europe and ever since the prevalence of contact allergy to MDBGN has progressively decreased. Despite that gradual decline, MDBGN is still patch-tested in most baseline series. This study assessed the frequency of MDBGN sensitization, epidemiological characteristics of allergic patients, and the relevance of positive patch tests in a nationwide Spanish registry (REIDAC). Patients and methods: We evaluated consecutively patch-tested patients in all participating centres. Using these data, we calculated the proportion of patients with positive patch tests to MDBGN from June 2018 to June 2020 and evaluated the relevance of the positive patch tests. Results: One hundred and fourteen out of 5072 (2.24 %) tested patients were sensitized to MDBGN. Clinical current relevance was confirmed in only one case. Conclusion: Although the frequency of contact allergy to MDBGN remains high, no clinical significance was found in most of these patients (5072 tests needed to obtain one relevant positive result). The clinical usefulness of this allergen seems weak and its continued inclusion in the European baseline series is questionable. Highlights: In 2008 methyldibromo glutaronitrile (MDBGN) was banned from cosmetics in Europe and since then, the prevalence of allergy to it has progressively decreased. Nevertheless, it is still being tested in European baseline series. This study assessed the frequency of MDBGN sensitization, epidemiological characteristics of allergic patients as well as the relevance of positive patch tests in a nationwide registry (REIDAC). The frequency of allergy to MDBGN remains high, but no clinical significance was found. Most of these patients are aged >40 years and probably represent historical sensitizations.

Sweet's syndrome is a neutrophilic dermatosis associated with many different underlying conditions but only rarely is it triggered by environmental factors such as ultraviolet (UV) exposure. We present two cases of photoinduced Sweet syndrome. Our first patient, who was taking hydrochlorothiazide, presented photodistributed lesions, pathological phototest and neutrophilic dermatosis histopathology. The phototest normalized after drug withdrawal, suggesting that both UV light and hydrochlorothiazide were necessary to cause the lesions. Our second case presented lesions clearly induced by UV light and histologically consistent with Sweet's syndrome. The MED was decreased and the lesions were reproduced with nbUVB, suggesting the diagnosis of photoinduced Sweet's syndrome. In conclusion, we report a case of neutrophilic dermatosis induced by hydrochlorothiazide and UV light and a case of photoinduced Sweet's syndrome with reproduction of the lesions after nbUVB. Both patients had a pathologic photobiological study. Our report emphasizes the need to perform phototests in patients with photodistributed Sweet's syndrome.

Resumen: Introducción: El ductus arterioso persistente (DAP) es frecuente en prematuros. Su cierre quirúrgico puede causar parálisis de cuerda vocal izquierda (PCVI) por lesión del recurrente. Material y métodos: Estudio retrospectivo de prematuros con DAP de nuestro centro entre 1999-2013. Revisamos sus características y complicaciones de tratamiento. En los pacientes intervenidos se realizó una encuesta sobre síntomas relacionados con PCVI y se ofertó realizar una laringoscopia. Resultados: Revisamos 88 pacientes diagnosticados de DAP en el período de estudio. Doce (13,64%) precisaron cirugía, los de menor edad gestacional y peso al nacer, teniendo mayor necesidad de ventilación mecánica e incidencia de parálisis diafragmática, displasia broncopulmonar y hemorragia intraventricular. El 33,3% (3/9) de los pacientes intervenidos tuvieron PCVI, presentando disfonía todos ellos (100 vs 16,7%, p = 0,05). Discusión: La PCVI es una complicación frecuente de la cirugía del DAP. Serían necesarios más estudios que aclaren sus factores de riesgo y consecuencias a corto y largo plazo. Abstract: Introduction: Patent ductus arteriosus (PDA) is a common problem in preterm newborns. Left vocal cord paralysis (LVCP) can complicate surgical closure if the recurrent nerve is damaged. Materials and Methods: A retrospective case series study was conducted on preterm babies diagnosed with PDA in our unit from 1999 to 2013. Their clinical features and treatment complications were reviewed. In those patients that received surgical treatment a telephone questionnaire on the symptoms of LVCP symptoms was completed, and laryncoscopy examination offered. Results: A total of 88 subjects diagnosed with PDA were found, of whom 13.64% (12/88) needed surgery. These patients had a lower gestational age and birth weight. They required mechanical ventilation more frequently, and they had more complications such as, diaphragmatic paralysis, bronchopulmonary dysplasia and intraventricular hemorrhage. One third (3/9) of the surgically treated patients had LVCP, and all of them had dysphonia (100% vs. 16.7%, p = .05). Discussion: LVCP is a common complication of PDA surgery. Further studies are needed to determine its risk factors and its short and long-term consequences.