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Background and Objective: The treatment of psoriasis should not only focus on skin affectations but also weigh the parameters for health-related quality of life (HRQoL), thereby tackling the concept of cumulative life course impairment (CLCI) and treating the patient from a holistic perspective. The CRYSTAL study aimed to characterize psoriasis with real-word data from Spanish clinical practice in patients with moderate to severe disease who received continuous systemic treatment for at least 24 weeks by using the absolute Psoriasis Area and Severity Index (PASI) score and its correlation to HRQoL., Material and Methods: This was a non-interventional, cross-sectional study conducted in 30 centers in Spain, with 301 patients between the ages of 18 and 75 years. The study collected data regarding current treatment and absolute PASI and their relationship to HRQoL using the Dermatology Life Quality Index (DLQI), to activity impairment using the Work Productivity and Activity Impairment (WPAI) questionnaire, and to treatment satisfaction., Results: The mean (SD) age was 50.5 (12.5) years, with a duration of disease of 14 (14.1) years. The mean (SD) absolute PASI reported was 2.3 (3.5), with 28.7% of patients presenting with PASI from >1 to ≤3 and 22.6% with PASI>3. Higher PASI scores were associated with higher DLQI (p<0.001) and WPAI scores and lower levels of treatment satisfaction (p<0.001)., Conclusions: These data indicate that achieving lower absolute PASI values may correlate not only with better HRQoL but also with better work productivity and treatment satisfaction., (Copyright © 2023 AEDV. Publicado por Elsevier España, S.L.U. All rights reserved.)

Diastematomyelia is a rare form of occult spinal dysraphism (less than 3 % of cases) that is more frequent in children and mainly affects females. Clinically, there are three groups of manifestations: cutaneous, neurological and orthopedic deformities. We present the case of an 11-year-old girl with a recent, incidental diagnosis of diastematomyelia. Although this entity is unusual, it should be considered together with other forms of spinal dysraphism in children with congenital cutaneous markers of spinal dysraphism, even when these are vague and the patient is asymptomatic. Due to the frequency with which cutaneous manifestations appear, the intervention of a dermatologist is desirable in the diagnosis of this entity. A high index of suspicion is important when evaluating neonates and infants, given that an early diagnosis can alter neurologic prognosis, improving the quality of life of these patients.

Trichoepithelioma is a benign neoformation with hair follicle differentiation that may clinically present in solitary, multiple or desmoplastic form. From a histopathological standpoint, it poses some diagnostic difficulties with basal cell carcinoma. We present two cases of desmoplastic trichoepithelioma, a rare adnexal tumor whose incidence is estimated at 2 per 10,000. Desmoplastic trichoepithelioma is a benign lesion, clinically and histologically similar to other dermatoses, and presents a true diagnostic challenge.

Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are part of the same disease spectrum, but are differentiated by the degree of skin detachment. In TEN, more than 30 % of the body's surface area is affected; thus, it is a serious process, whose frequency is estimated at 1.2-6 cases per million population/year. We describe the case of a 75-year-old male who suffered from SJS which evolved into TEN, probably because of the ingestion of ginkgo biloba extract. He was treated with intravenous immunoglobulins (Ig IV) at a dose of 0.5 g/kg/day for five consecutive days, with favorable progress and no significant side effects. It is evident that isolated cases do not justify the systematic use of this treatment, but they may help build up experience.

Eccrine squamous syringometaplasia is a rare entity that occurs in patients who have received chemotherapy treatment. It also occurs in association with chronic ulcers, skin tumors, and after the ingestion of drugs, exposure to toxic agents and inflammatory processes. We present the case of a 47-year-old male diagnosed with microcytic lung carcinoma and superior vena cava syndrome. After receiving the third cycle of chemotherapy, and after accidental extravasation, he presented with an erythematous plaque. The histopathological study revealed eccrine squamous syringometaplasia together with interphase dermatitis and epidermal changes that may be responsible for the epidermal necrosis.

Cholesterol crystal embolism (CCE) is an infrequent entity that primarily appears in males over the age of 60 with generalized arteriosclerosis after angiographic procedures, vascular surgery or, more rarely, with oral anticoagulant treatment with heparin or with fibrinolytics. We present the case of a patient with several risk factors for CCE, who presented with the pathognomonic triad of leg and foot pain, livedo reticularis and palpable pedal pulses. The diagnosis was based on the fact that cholesterol crystals were seen in the arterioles in the skin biopsy. Due to the frequency with which the skin manifestations appear and the importance of early diagnosis and treatment, an awareness of these crystals is fundamental in diagnosing these processes.

We present two patients with subcutaneous nodular lesions of several years' duration. These lesions were well defined and painless and were located next to bony surfaces or in the pulps of fingers and elbows. No other symptoms were observed except for frequent attacks of palindromic rheumatism with no evidence of arthritis or systemic manifestations suggestive of rheumatoid arthritis. Other studies performed were normal with negative results for rheumatoid factor and antinuclear antibodies. Radiographs of affected sites showed no signs of arthritis while the histopathologic study revealed some findings compatible with rheumatoid nodule. One of the patients also presented desquamate papular lesions at the level of elbows while histologically a process of transepidermal elimination of fibrinoid could be observed. Our patients fulfil all the diagnostic criteria for rheumatoid nodulosis as they present multiple rheumatoid nodules confirmed on biopsy, symptoms of palindromic rheumatism, no evidence of arthritis or radiological alterations and negative rheumatoid factor.