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Resumen: Las complicaciones por hemorragia quirúrgica en la cirugía dermatológica son infrecuentes y poco relevantes en la mayoría de los casos. En algunas ocasiones la hemorragia quirúrgica puede conllevar infección de la herida quirúrgica, dehiscencia de sutura o necrosis del colgajo/injerto. En esta revisión se muestran los aspectos más importantes para prevenir, reconocer y tratar este tipo de complicaciones durante el acto quirúrgico y tras él. Abstract: Bleeding complications during dermatologic surgery are uncommon and usually minor, but bleeding occasionally leads to infection, wound dehiscence, or flap/graft necrosis. This review covers the keys to preventing, recognizing, and treating excessive bleeding during and after surgery.

Part 2 of this series on granulomatous diseases focuses on skin biopsy findings. Whereas the first part treated noninfectious conditions (metabolic disorders and tumors, among other conditions), this part mainly deals with various types of infectious disease along with other conditions seen fairly often by clinical dermatologists.

This series of 2 articles on dermatopathologic diagnoses reviews conditions in which granulomas form. Part 1 clarifies concepts, discusses the presentation of different types of granulomas and giant cells, and considers a large variety of noninfectious diseases. Some granulomatous diseases have a metabolic origin, as in necrobiosis lipoidica. Others, such as granulomatous mycosis fungoides, are related to lymphomas. Still others, such as rosacea, are so common that dermatologists see them nearly daily in clinical practice.

The aim of this study was to establish the diagnoses of patients with disseminated eczema and analyze the allergens involved in disseminated eczema due to allergic contact dermatitis. We analyzed the data from patients with a diagnosis of disseminated / generalized eczema who had undergone anamnesis, physical examination and patch tests in a Contact Dermatitis consultation from 2003 to 2019. Allergic contact dermatitis was the most frequent diagnosis, folowed by atopic dermatitis, asteatotic eczema, and gravitational eczema. The allergens most frequently involved in allergic contact dermatitis were isothiazolinones, topical medications, paraphenylenediamine, and fragrances. Allergic contact dermatitis caused almost half of the cases of disseminated eczema. It would be therefore advisable for patients with disseminated eczema to be assessed at a Contact Dermatitis unit and undergo patch tests.

Ophthalmological complications are uncommon in dermatologic surgery. Nonetheless, all surgeons should know the basics of recognizing, preventing, and treating the 4 complications addressed in this article from the series 'Safety in Dermatologic Procedures'. The first complication that surgeons should be familiar with is eye damage due to chemical irritants. This is a common complication in operating rooms given the presence of irritant substances and the performance of procedures in the eyebrow and eyelid region. The second complication is laser-induced eye damage. In this case, eye protection with safety glasses or eye caps is crucial. The third complication is accidental eyeball perforation, which can occur during certain surgical procedures. The fourth and final complication is retinal artery vasospasm or embolism due to drugs or filler materials. This complication is rare but important to recognize, as early treatment can prevent permanent blindness.

Resumen Fundamento Identificar los signos dermatoscópicos de los carcinomas basocelulares superficiales que se asocien a una peor respuesta completa al tratamiento con imiquimod. Método Se compararon de forma retrospectiva fotografías clínicas y dermatoscópicas de 56 carcinomas basocelulares superficiales de diferentes pacientes, valorados en consulta durante cinco años y tratados con imiquimod tópico al 5% cinco días a la semana durante seis semanas. Se identificaron los diferentes signos dermatoscópicos de las lesiones y se valoró la asociación de cada uno de ellos con la respuesta al tratamiento. Resultados Un 69,5% de los pacientes respondieron al tratamiento con imiquimod. La dermatoscopia de lesiones respondedoras mostró una frecuencia mayor de lesiones con puntos grises en foco (43,6%) y de erosiones múltiples menores de 2 mm (61,5%), sin observar diferencias estadísticamente significativas. El grupo sin respuesta mostró más telangiectasias arboriformes (58,8%), nidos ovoides (41,1%), ulceraciones (58,8%), áreas desestructuradas brillantes rojas-blancas (82,2%) y crisálidas (41,2%). Las áreas en velo azul-blanco (23,5%) y de patrón en arco iris (23,5%) solo se observaron en no respondedores. Ambos grupos fueron similares respecto a edad, sexo, diámetro de las lesiones y frecuencia de algunos signos dermatoscópicos: telangiectasias cortas finas, glóbulos azul-grises, áreas en hoja de arce y estructuras en rueda de carro. Conclusión Se identificaron criterios dermatoscópicos que se asocian de manera significativa a una peor respuesta al tratamiento con Imiquimod. En cambio, no se encontraron signos dermatoscópicos que se correlacionen de manera específica a una respuesta completa al tratamiento. Abstract Background To describe the dermoscopic features in superficial basal cell carcinoma that are associated with a poor therapeutic response to imiquimod treatment. Method Clinical and dermatoscopic photographs of 56 superficial basal cell carcinomas of different patients were compared retrospectively, assessed in our office for five years and treated with topic 5% imiquimod five days a week for six weeks. The different dermatoscopic signs of the lesions were identified and the association of each of them with the response to treatment was assessed. Results A total response to treatment was achieved by 69.5% of the lesions of patients treated with imiquimod. Dermatoscopy of responding lesions showed a higher frequency of lesions with in focus gray dots (43.6%) and multiple erosions of less than 2 mm (61.5%), without observing statistically significant differences. Within the group with poor response to treatment, a greater number of lesions were found with the presence of arborizing telangiectasias (58.8%), blue-gray ovoid nests (41.1%), ulceration (58.8%), shiny white-red structureless areas (82.2%) and chrysalis (41.2%). The areas in blue-white veil areas (23.5%) and rainbow pattern (23.5%) were only observed in non-responding lesions. Both groups were similar regarding age, sex, diameter of lesions and frequency of some dermatoscopic signs: fine short telangiectasias, gray blue globules, arc-leaf areas and cart-wheel structures. Conclusion The study identified dermatoscopic criteria that are significantly associated with a worse response to treatment with imiquimod. In contrast, we found no dermatoscopic signs that correlate specifically to a complete response to treatment.

Bleeding complications during dermatologic surgery are uncommon and usually minor, but bleeding occasionally leads to infection, wound dehiscence, or flap/graft necrosis. This review covers the keys to preventing, recognizing, and treating excessive bleeding during and after surgery.

This series of 2 articles on dermatopathologic diagnoses reviews conditions in which granulomas form. Part 1 clarifies concepts, discusses the presentation of different types of granulomas and giant cells, and considers a large variety of noninfectious diseases. Some granulomatous diseases have a metabolic origin, as in necrobiosis lipoidica. Others, such as granulomatous mycosis fungoides, are related to lymphomas. Still others, such as rosacea, are so common that dermatologists see them nearly daily in clinical practice.

Bleeding complications during dermatologic surgery are uncommon and usually minor, but bleeding occasionally leads to infection, wound dehiscence, or flap/graft necrosis. This review covers the keys to preventing, recognizing, and treating excessive bleeding during and after surgery.