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Parvovirus B19 infection can cause a wide range of cutaneous manifestations, including papular-purpuric gloves-and-socks syndrome (PPGSS) and petechial bathing trunk eruption. We report a case of an immunocompetent woman with a primary parvovirus B19 infection presenting as concurrent PPGSS and petechial bathing trunk eruption. Parvovirus B19 seroconversion was confirmed several days after the onset of the clinical manifestations. The coexistence of these two cutaneous manifestations of primary parvovirus B19 infection has rarely been reported in the literature. It is important to recognize parvovirus B19 infection early, based on the cutaneous manifestations, to avoid potentially serious systemic complications in susceptible individuals.

Clear cell acanthoma (CCA) is a benign epidermal lesion of epidermal keratinocytes which has a distinctive histopathology. Firstly described as a benign epidermal tumor, at the present, it is discussed if it is a true tumor or has an inflammatory reactive origin. Typical CCA is a red to brown, dome-shaped, solitary papule or nodule, often covered by a thin collarette of scale. The lesions usually present on the legs in middle-aged to elderly persons, without gender predilection. At the present, only nine cases of CCA on the areola or the nipple have been reported in the literature. On this location, women predilection is seen and typically presented as a chronic, erythematous, scaled, well-defined plaque, regarding chronic eczema. The preferred treatment is lesion removal, although anti-inflammatory treatment with potent corticosteroids should be previously done, based on reactive inflammatory dermatosis origin hypothesis.

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.

of other fingernails or toenails. Fungal cultures of the nail plate showed the presence of Fusarium species. Routine blood tests including full blood count, erythrocyte sedimentation rate, and biochemistry gave completely normal results, and the patient tested seronegative for HIV. Treatment with itraconazole (200 mg/d over 4 weeks) was prescribed, and a clear clinical improvement was seen. Fusarium species are nondermatophyte molds that tend to occur naturally as saprophytes in the soil and as pathogens in plants.1 Although infections can occur in humans, they are normally precipitated by local or general predisposing factors. Systemic infections are rare and only occur in immunodepressed patients.2 Onychomycosis caused by Fusarium species almost always affects the great toe, especially when accompanied by dystrophic and traumatic abnormalities or where nails were previously infected with dermatophytes.3 Wearing sandals or walking barefoot can encourage the condition.2 Most of the cases described in the literature are characterized by extensive paronychia, but this was not the case in our patient. Invasion of the toenail by Fusarium oxysporum is relatively uncommon despite the widespread distribution of the mold, implying that the toenail may be a portal of entry for systemic infections in immunodepressed patients,4-6 with the associated worse prognosis. The condition manifests itself clinically as the typical form of proximal subungual onychomycosis, occasionally with the presence of onycholysis or subungual hyperkeratosis. Treatment of Fusarium onychomycosis is not a straightforward matter.2 Better levels of response are reported with ungual avulsion followed by the application of topical antifungal agents, giving an improvement in most immunocompetent patients. Itraconazole (200 mg/d over 4 weeks or in pulse therapy) has also been used with some success.2 We would like to present the case of an immunocompetent patient who was diagnosed with proximal white subungual onychomycosis caused by Fusarium species. We also stress the value of microbiological cultures and the need to rule out immunosuppression—especially by HIV Letters to the Editor