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Resumen En el presente articulo de la serie «Seguridad en procedimientos dermatologicos» se aborda el diagnostico, prevencion, manejo y tratamiento de tres situaciones. Primeramente, se aborda la anafilaxia: una situacion infrecuente, grave y potencialmente mortal, que requiere una identificacion agil para un manejo urgente coordinado por parte de medicos especialistas en anestesiologia. En segundo lugar, la reaccion vasovagal, que es la complicacion medica mas frecuente durante la cirugia dermatologica (una de cada 160 intervenciones), con una evolucion habitualmente benigna autorresolutiva, pero que, en individuos muy sensibles, puede provocar una parada cardiaca por asistolia. En tercer y ultimo lugar, el sindrome de hiperventilacion aguda, que es una respuesta anomala de determinados individuos a un evento estresante, con un incremento de la ventilacion que excede la demanda metabolica. En los tres casos se incluyen recomendaciones que se plasman de forma practica y somera.

This article, part of a the series on safety in dermatologic procedures, covers the diagnosis, prevention, management, and treatment of 3 situations or conditions. The first condition we address is anaphylaxis, an uncommon but severe and potentially fatal reaction that must be recognized quickly so that urgent management coordinated with an anesthesiologist can commence. The second is fainting due to a vasovagal reaction, which is the most common complication in dermatologic surgery. This event, which occurs in 1 out of every 160 procedures, usually follows a benign course and resolves on its own. However, in patients susceptible to vasovagal reactions, syncope may lead to asystole and cardiac arrest. The third is acute hyperventilation syndrome, which is an anomalous anxiety-related increase in breathing rate beyond metabolic requirements. Brief practical recommendations for managing all 3 events are included.

Acquired hypertrichosis lanuginosa, an infrequent, paraneoplastic process, consists of the rapid development of lanugo-type hair, primarily on the face. We describe a 50-year-old woman with a 4-month case of hypertrichosis on the face and upper body, and weight loss over the last 6 months, in whom an inoperable squamous cell carcinoma of the cervix was discovered. Hypertrichosis lanuginosa is an indicator of a poor prognosis. It is associated with tumors in any location, but most often with lung and colorectal tumors. This is the first case associated with squamous cell carcinoma of the cervix.

Pemphigus vulgaris (PV) is a rare autoimmune bullous disease that affects the skin and mucosae, characterized by the presence of antibodies against desmoglein 3, that causes acantholisis and formation of intraepidermal blisters. Observation of PV cases in several members of the same family suggests the existence of genetic factors that contribute to susceptibility to suffer the disease. However, very few cases of familial PV have been described. Based on its autoimmune nature, many studies have found an association between PV and the HLA class II allele, specifically with the HLA-DRB1*0402 DQB1*0302 and HLA-DRB1*1401 DQB1*0503 haplotypes that bestows a significant risk of disease.Study of three families with PV.In this study, we present three families, with a total of 7 patients, diagnosed of familial PV. HLA antigens were determined with the PCR (polymerase chain reaction) technique in several members of these families.All the subjects affected were positive for HLA DR4 and HLA DR14. The fact that different families with PV are associated with identical haplotypes and that healthy siblings of the patients have the same haplotype is of special interest.These results support the concept of genetic predisposition in this rare disease.

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.

Acquired hypertrichosis lanuginosa, an infrequent, paraneoplastic process, consists of the rapid development of lanugo-type hair, primarily on the face. We describe a 50-year-old woman with a 4-month case of hypertrichosis on the face and upper body, and weight loss over the last 6 months, in whom an inoperable squamous cell carcinoma of the cervix was discovered. Hypertrichosis lanuginosa is an indicator of a poor prognosis. It is associated with tumors in any location, but most often with lung and colorectal tumors. This is the first case associated with squamous cell carcinoma of the cervix.