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We examined the sun-protection practices of 61 men attending a dermatology department in the west of Ireland. Most worked outdoors, either currently or in the past. Although most wore hats as a sun-protection measure, the majority wore baseball caps, with smaller numbers wearing other types of hats that do not offer protection to the head and neck. Use of SPF products was widespread, but often not used habitually.

Resumen La aparicion de ulceras perianales en relacion con una pomada antihemorroidal es una condicion nunca antes reportada en la literatura. Presentamos una serie de 11 casos de 10 hospitales espanoles con diagnostico de ulceras perianales tras la aplicacion de una misma pomada antihemorroidal con acetonido de triamcinolona, lidocaina y pentosano polisulfato sodico como principios activos. No se ha podido identificar ninguna condicion previa o enfermedad concomitante que pudiera justificar un diagnostico etiologico alternativo y tras retirar la pomada antihemorroidal se ha evidenciado una resolucion completa de las ulceras en un periodo medio de 8 semanas. Esta serie de casos evidencia el potencial efecto danino de un producto farmaceutico no sujeto a prescripcion ni seguimiento medico y la necesidad de interrogar por el uso de agentes topicos ante la aparicion de ulceras perianales.

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.

Lipedematous scalp is an uncommon entity of unknown etiology, rarely described in the pediatric age. It is characterized by boggy thickening of the scalp predominantly located at the vertex and occiput, which acquires a cotton-like consistency. This condition is palpable rather than visible. It is a casual finding because it is usually asymptomatic, although it may involve alopecia, pruritus, or dysesthesia. We report a 10-year-old girl with lipedematous scalp without alopecia. Sonographic and MRI findings confirmed the diagnosis of lipidematous scalp. El lipedema de cuero cabelludo o cuero cabelludo lipedematoso es una entidad infrecuente y de etiologia desconocida, rara vez descrita en la edad pediatrica. Se caracteriza por un engrosamiento difuso y de tacto esponjoso del tejido celular subcutaneo localizado principalmente en vertex y occipucio. Suele ser un hallazgo casual dado que habitualmente cursa de forma asintomatica, aunque puede asociar alopecia, prurito o disestesias. Presentamos el caso de una nina de 10 anos de edad con lipedema de cuero cabelludo sin alopecia asociada. Los hallazgos ecograficos y de resonancia magnetica confirmaron el diagnostico de lipedema de cuero cabelludo.

Blisters associated with PUVA treatments are an adverse effect of photochemotherapy that has been reported in the literature. Asymptomatic blisters appear spontaneously mainly on the lower limbs and resolve without treatment. The differential diagnoses to consider include a phototoxic reaction, pseudoporphyria, and PUVA-induced bullous pemphigoid. We describe the clinical and histologic features in 5 cases of blistering secondary to PUVA treatment. If this adverse effect is accurately diagnosed, photochemotherapy need not be interrupted, and unnecessary diagnostic procedures and additional treatments can be avoided.

Resumen Las ampollas secundarias al tratamiento con PUVA son un efecto secundario de la fotoquimioterapia poco descrito en la literatura cientifica. Se caracteriza por la aparicion espontanea de ampollas asintomaticas localizadas fundamentalmente en los miembros inferiores, que se resuelven sin necesidad de tratamiento. El diagnostico diferencial debe plantearse con una reaccion fototoxica, con la pseudoporfiria y con el penfigoide ampolloso inducido por PUVA. Presentamos 5 casos de ampollas secundarias a la terapia PUVA, con el objetivo de dar a conocer las caracteristicas clinicas e histologicas de dicha entidad. Su correcto diagnostico evitara la interrupcion del tratamiento, asi como la realizacion de procedimientos diagnosticos y terapeuticos innecesarios.

Background/Objectives Mosaic neurofibromatosis type 1 (MNF1) is a variant of neurofibromatosis type 1 (NF1) in which clinical manifestations are limited to one or several body segments. The objective was to characterize the cutaneous features and associated systemic findings in a cohort of children with MNF1. Methods We performed a retrospective study of 40 children diagnosed with MNF1 at the Department of Dermatology, Hospital Infantil Nino Jesus, Madrid, Spain, from January 1, 1986, to October 31, 2015. Results All patients had pigmentary changes, alone (n = 39) or in combination with neurofibromas (n = 1). Twenty-four cases fulfilling the definition of MNF1 had six or more cafe au lait spots with or without freckling within the affected segment. They all lacked any other National Institutes of Health criteria of NF1. No patient had juvenile xanthogranuloma (JXG) or nevus anemicus (NA). Two children with MNF1 had epilepsy and two others developed malignancy (Hodgkin's lymphoma and ganglioneuroblastoma). Conclusions Pigmentary changes are the most frequent presentation of MNF1 in children. MNF1 must be considered with segmentary distribution of freckling and cafe au lait spots. Other frequent cutaneous findings in NF1, such as JXG or NA, seem to be exceptional in MNF1. Although the possibility of systemic complications and cancer risk seem to be low, patients must be followed up.

Solitary morphea profunda is an unusual form of localized scleroderma in childhood. It is characterized by a single, poorly defined and indurate plaque often located on the upper trunk near the spine. Solitary morphea profunda is frequently asymptomatic and shows no associated systemic involvement. Histological examination reveals dense sclerosis of collagen and a marked lymphocytic infiltrate in the reticular dermis and subcutis. We report a 7-year-old girl with a solitary asymptomatic and sclerotic plaque on the back. Clinical, ultrasonographic and histological features were consistent with solitary morphea profunda.

Resumen La dermatitis anular liquenoide de la infancia es una entidad de etiologia desconocida que forma parte del grupo de las dermatosis liquenoides. Afecta sobre todo a ninos y adolescentes, mostrando unas caracteristicas clinicopatologicas definidas que permiten su diagnostico. Presentamos 2 nuevos casos de dermatitis liquenoide anular de la infancia en 2 ninas de 4 y 2 anos y medio, respectivamente, que presentan las caracteristicas clinicas clasicas de esta entidad. A diferencia del resto de casos publicados el examen histopatologico mostro un infiltrado inflamatorio liquenoide situado principalmente en el techo de las papilas dermicas, y no en la punta de las crestas epidermicas. En ambos casos las lesiones regresaron espontaneamente sin necesidad de tratamiento.

Annular lichenoid dermatitis of youth is a lichenoid dermatosis of unknown etiology. It mostly affects children and adolescents and has well-defined clinical and histological characteristics that permit a diagnosis. We present 2 new cases of annular lichenoid dermatitis of youth with classical clinical features in 2 girls, aged 2 and 4 years. The histologic findings, however, differed from those reported in the literature in that the lichenoid inflammatory infiltrate was located primarily at the top of the dermal papillae and not at the tips of the rete ridges. In both cases, the lesions regressed spontaneously without treatment.

La aplasia cutis congenita es una rara alteracion caracterizada por la ausencia de areas localizadas de piel en el momento del nacimiento. Suele manifestarse como una lesion solitaria localizada principalmente en el cuero cabelludo, que puede estar asociada con otras malformaciones congenitas. Las complicaciones pueden ser fatales, por lo que es necesario un tratamiento individualizado que vendra determinado por el tamano, localizacion y grado de afectacion de estructuras subyacentes. Presentamos un caso de aplasia cutis congenita del cuero cabelludo con multiples lesiones y defecto oseo subyacente de 3 × 1.5 cm de tamano, pero sin otras anomalias asociadas. El manejo conservador permitio una adecuada y completa epitelizacion cutanea con cierre del defecto oseo subyacente sin necesidad de procedimientos invasivos.

Solitary morphea profunda is an unusual form of localized scleroderma in childhood. It is characterized by a single, poorly defined and indurate plaque often located on the upper trunk near the spine. Solitary morphea profunda is frequently asymptomatic and shows no associated systemic involvement. Histological examination reveals dense sclerosis of collagen and a marked lymphocytic infiltrate in the reticular dermis and subcutis. We report a 7-year-old girl with a solitary asymptomatic and sclerotic plaque on the back. Clinical, ultrasonographic and histological features were consistent with solitary morphea profunda.La morfea profunda solitaria es una forma infrecuente de morfea localizada en la infancia. Se caracteriza clínicamente por la presencia de un área indurada, mal delimitada y asintomática, de localización paraespinal, que no tiende a la progresión ni se asocia con manifestaciones sistémicas. Histológicamente, muestra un engrasamiento e hialinización de las fibras de colágeno dérmico, junto con infiltrados de predominio linfohistiocitario en la dermis reticular y la hipodermis. Se presenta a una paciente de 7 años con una lesión solitaria en la región dorsal media izquierda, cuyos hallazgos clínicos, ecográficos e histológicos fueron compatibles con el diagnóstico de una morfea profunda solitaria.

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.

Pilomatricoma is a benign cutaneous tumor originatingfrom hair matrix cells. Anetodermic changes inthe skin overlying pilomatricomas are sometimesreported, although their precise mechanisms remainunknown. We present an unusual case of anetodermicpilomatricoma on the upper extremity of a 17-yearoldboy and report its clinical, histopathologic, andsonographic findings.

Subcutaneous granuloma annulare is a benign inflammatory disorder that primarily affects healthy children and manifests as a rapidly growing, painless, nonmobile mass, most commonly located in the leg. The current case highlights the sonographic appearance of subcutaneous granuloma annulare. Ultrasound color Doppler is a helpful noninvasive imaging test that may allow physicians to confirm the diagnosis of subcutaneous granuloma annulare and avoid unnecessary medical procedures.

La criptococosis cutanea es una micosis propia de pacientes inmunodeprimidos, sobre todo aquellos con infeccion por el virusde la inmunodeficiencia humana (VIH). Sin embargo, existen casos infrecuentes de criptococosis cutanea en pacientes inmunocompetentes, que suelen simular otras dermatosis, lo que retrasa su diagnostico y tratamiento. Presentamos el caso de un varon pluripatologico de 79 anos, con ulceras dolorosas en dorso de mano derecha que no respondian a tratamientos topicos. A traves del estudio histopatologico y micologico se alcanzo el diagnostico de criptococosis cutanea primaria, lograndose la remision de las lesiones tras 6 meses de tratamiento con fluconazol.

Vemurafenib has proved to be useful in the treatment of patients with unresectable or metastatic melanoma harboring the BRAF-V600E mutation, with better rates of overall and progression-free survival than previous treatments. Adverse cutaneous effects, such as alopecia, pruritus, photosensitivity reactions, verrucous keratosis, keratoacanthomas, or squamous cell carcinomas, have been described. Thirty cases of vemurafenib-associated panniculitis are available in the literature with variable clinical relevance. Only 9 of them exhibited definitive evidence of neutrophilic panniculitis. They all consist of multiple lesions, usually located in the lower limbs. Histopathologically, they have been described as predominantly neutrophilic, lymphocytic, or mixed, more commonly with lobular location. We report an additional case of neutrophilic panniculitis in a 45-year-old woman treated with vemurafenib for metastatic melanoma, presenting as a single lesion on his right leg. The lesion resolved spontaneously and did not need treatment reduction. The presentation of this condition with a single lesion is particularly challenging. Recognition of this association is important given the increasing use of vemurafenib and the potential implications of treatment withdrawal.