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As the largest organ in the body, skin can prove the most daunting to diagnose and manage due to the large number of conditions and their uncanny ability to have similar qualities visually. Skin can reflect current trauma or infections or can be a harbinger of an underlying systemic disorder. With knowledge of the most common pediatric skin conditions, it is possible for practitioners to start a child on a basic treatment regimen and then refer to an appropriate specialist for more complex or rare disorders. This article covers the most common skin conditions seen on the lower extremity in the pediatric population.

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Anamnese und klinischer Befund: Eine 53-jahrige Frau litt seit mehreren Jahrzehnten an braunlichen, gelegentlich ulzerierenden Plaques an beiden Unterschenkeln, zeitweise auch am linken Fusrucken. Zusatzlich bestand seit rund 15 Jahren eine progrediente flachige Verhartung am Rucken bei seit uber 40 Jahre bekanntem Typ-1-Diabetes. Untersuchungen und Diagnosen: Bioptisch wurde im Bereich der Unterschenkel eine Necrobiosis lipoidica und am Rucken ein Scleroedema adultorum Buschke gesichert, eine systemische Sklerodermie wurde somit ausgeschlossen. In Laboruntersuchungen zeigte sich kein erhohter ANA-Titer. Therapie und Verlauf: Nach diabetologischem Konsil und optimaler Einstellung der Stoffwechselstorung erfolgte die Behandlung der Necrobiosis lipoidica mit topischen Kortikosteroiden unter Kompression sowie einer Creme-PUVA-Therapie und einer Systemgabe von Pentoxifyllin. Die Ulzera wurden konservativ mit Kurettagen und einer Niederdruck-Wundtherapie (V.A.C.®, KCI) behandelt. Die Therapie des Scleroedema adultorum am Rucken umfasste zunachst eine UVA-1-Lichttherapie, die bei Unvertraglichkeit vorzeitig abgebrochen werden musste. Zusatzlich wurden Bindegewebsmassagen verordnet. Insgesamt zeigte sich ein therapieresistenter Verlauf. Folgerungen: Die Therapieoptionen zur Behandlung bei diabetesassoziierten Hauterkrankungen sind eingeschrankt. Insgesamt handelt es sich bei der Necrobiosis lipoidica und dem Scleroedema adultorum um oft therapierefraktare Leiden, bei denen die optimale Diabeteseinstellung entscheidend ist.

Resume Introduction Le xanthogranulome juvenile (XGJ) est une histiocytose non langerhansienne se presentant classiquement sous la forme de nodules cutanes jaunâtres isoles ou multiples. Des formes cutanees atypiques, lichenoides, reticulees, maculopapuleuses, en plaque ou encore lineaires ont ete decrites a partir d’observations isolees. Nous rapportons le cas d’un nourrisson ayant des XGJ eruptifs en plaque de la jambe gauche. Observation Une enfant de 13 mois avait depuis l’âge de 2 mois des lesions papuleuses rouge orange asymptomatiques evoluant par poussees sur la face anterieure de la jambe gauche, sans placard sous-jacent. La recherche d’un signe de Darier etait negative. L’examen histologique posait le diagnostic de XGJ. Discussion Notre cas se rapproche des XGJ en plaque plutot que d’une forme multiple, dont la topographie est diffuse. Seuls sept cas semblables ont ete rapportes dans la litterature, tous survenus avant cinq mois de vie. La lesion correspondait le plus souvent a une plaque erythemateuse asymptomatique surmontee de petites lesions jaunâtres, de topographie variable et d’apparition parfois progressive. La guerison spontanee etait la regle. Il n’y avait pas d’atteinte systemique. Nous presentons ici un cas unique de xanthogranulomes multiples localises, sans plaque infiltree sous-jacente evidente, evoluant par poussees.

der Haut, die mehrfach inzidiert und revidiert werden mussten. Im Verlauf zeigten die Hautveranderungen eine deutliche Progredienz, sodass zuletzt die Abszesse nur noch operativ exzidiert werden konnten. Fur einen Diabetes mellitus bestand kein Anhalt. Hautbefund Gluteal beidseits sowie im Bereich beider Oberschenkel zeigten sich purulente Papeln und frische Abszesse. Ferner bestanden Narben an vormaligen Inzisions- und Exzisionsstellen. (. Abb. 1 und 2) Das ubrige Integument zeigte disseminierte Erytheme und Plaques an Gesicht, Stamm und Extremitaten mit Betonung der Beugen bei bekanntem atopischem Ekzem.

We present the case of a 49-year-old man with an 18-month history of an intermittently pruritic red-brown reticulate eruption of the medial legs, with occasional blistering. There were areas of scale, crust and superficial erosions. The patient worked long overnight shifts standing in front of hot machinery wearing shorts, and spent time sitting in front of a heater at home. A clinical diagnosis of erythema ab igne (EAI) was made. This settled with heater avoidance and protection of the legs with long trousers, as well as a topical corticosteroid. Histology showed features of cutaneous reactive angiomatosis, a rare condition with various associations but only previously reported once in association with EAI.

Biopsy can cause or worsen ulceration at the incision site, increasing the risk of infection and sepsis.

The skin of the lower extremity can be a helpful diagnostic tool for systemic disease. Diabetes, renal disease, genetic disorders, and even cancer can have cutaneous manifestations in the legs and feet; moreover, proper diagnosis can facilitate earlier treatment of these diseases and not only clear up the skin symptoms but also bring about resolution of the systemic disease causing them. Although not comprehensive, this article discusses many of these disorders presenting with integumentary manifestations in the lower extremities. Where appropriate, it also enumerates the treatments involved, both systemic and localized.

Adverse drug reactions (ADRs) are a common cause of dermatologic consultation, involving 2 to 3 per 100 medical inpatients in the United States. Female patients are 1.3 to 1.5 times more likely to develop ADRs, except in children less than 3 years of age, among whom boys are more often affected. Certain drugs are more frequent causes, including aminopenicillins, trimethoprim-sulfamethoxazole, and nonsteroidal antiinflammatory drugs. Chemotherapeutic agents commonly cause adverse reactions to the skin and nails, with certain agents causing particular patterns of reactions. ADRs can involve any area of the skin; the appendages, including hair and nails; as well as mucosa.

A 27-year-old healthy woman presented to the medical centre with a one-month history of widespread skin lesions with slow clinical progression. The lesions appeared on her thighs, shins, lower abdomen and left arm three weeks after she had travelled to an area endemic for Leishmania major in

Antecedents: La dermatose erosive et pustuleuse est une entite clinique distinctive qui a ete decrite au niveau du cuir chevelu et du genou. Des erosions chroniques et superficielles, couvertes par une croute jaune, se developpent sur la peau atrophiee et fibreuse. Bien que le cuir chevelu soit le site le plus frequent, plusieurs cas de dermatose erosive et pustuleuse au niveau de la jambe ont ete notes. L'histopathologie est non specifique et la maladie est generalement consideree comme un diagnostic d'exclusion. Objectif et conclusion: Nous rapportons le cas de deux patients presentant une dermatose erosive et pustuleuse a la jambe. Le traitement aux agents antibacteriens et antifongiques n'a pas donne de resultats alors que les stetroides systemiques combines, dans un cas, au pimecrolimus topique et, dans l'autre, au clobetasol topique se sont averes efficaces. Nous pensons que cette affection n'a simplement pas recu l'attention necessaire d'ou les rares descriptions publiees a son sujet.

Moisturization of the skin is important for both medical and cosmetic purposes. The development of prescription device moisturizers, receiving 510K approval on the basis of the physical reduction in transepidermal water loss, provided a new dermatologic category. This investigator-blinded research utilized a split body model in 60 subjects to examine the effect of a traditional moisturizer as compared to a prescription device moisturizer in the treatment of mild to moderate symmetrical eczema of the arms or legs. This study demonstrated parity between the two moisturizers based on subject and investigator assessments.

Resume Introduction La variete dite sporotrichoide de la leishmaniose cutanee est definie par la presence de nodules dermo-hypodermiques etages le long d’un trajet lymphatique a distance de la ou des lesions primitives d’inoculation. Cette forme clinique est habituellement consideree comme rare. Le but de notre travail etait d’etudier les particularites epidemiologiques, cliniques, histologiques et evolutives de la forme sporotrichoide de leishmaniose cutanee du sud tunisien. Malades et methodes Au cours d’une etude systematique de tous les cas de leishmaniose cutanee originaires du sud tunisien diagnostiques dans notre centre hospitalier en 2002, les formes sporotrichoides ont ete isolees a partir de criteres cliniques. Pour toutes les leishmanioses cutanees sporotrichoides, les principaux caracteres cliniques etaient systematiquement precises. Des biopsies de nodules profonds ont ete realisees dans six cas. Resultats Dix-neuf malades avaient une forme sporotrichoide parmi 102 cas observes de leishmaniose cutanee, soit une frequence de 19 %. Les nodules sous-cutanes fermes et indolores, au nombre de deux a 20, etaient disposes en chapelet lineaire sur un membre superieur dans 79 % des cas. Ils etaient apparus dans un delai variable, de 12 jours a un an, apres les lesions primitives. Quatorze etaient apparus sans traitement prealable de leishmaniose et cinq apres infiltration d’antimoniate de meglumine (Glucantime ® ) dans les lesions primitives. Les biopsies des nodules ont montre un infiltrat inflammatoire polymorphe lymphohistiocytaire particulierement dense et riche en plasmocytes dans le derme profond, touchant les septa interlobulaires avec une discrete atteinte lobulaire dans le seul cas ou la biopsie atteignait l’hypoderme. Des corps de Leishman en petit nombre ont ete vus sur une seule biopsie profonde. Tous les cas ont evolue favorablement sous traitement. Conclusion La leishmaniose cutanee sporotrichoide semble frequente dans le sud tunisien, ou domine la leishmaniose cutanee due a Leishmania major. Cette forme ne parait pas associee a un pronostic pejoratif.

Introduccion: la amiloidosis cutanea primaria de tipo nodular es un subtipo de ami­loidosis de presentacion exclusivamente cutanea que afecta principalmente a mujeres, se presenta con nodulos amarillentos brillantes y firmes al tacto, generalmente asinto­maticos. Caso clinico : se presento el caso de una paciente de genero femenino de 46 anos con sintomatologia de cuatro anos de evolucion consistente en la aparicion de lesiones papulosas pequenas en miembros inferiores y en la region lumbosacra, pruriginosas, que no respondieron al tratamiento inicial por medicina general con loratadina. Sin antecedentes personales de importancia. Se sospecha la presencia de amiloidosis; la histologia con tincion Rojo Congo confirmo el diagnostico. No se encontraron hallazgos de enfermedad sistemica. Conclusion : la amiloidosis nodular, generalmente, es una enfermedad de etiologia diversa, inflamatoria, cronica, poco frecuente y de afectacion local en la piel con un pro­nostico bueno. En ocasiones su tratamiento se ve retardado por el diagnostico tardio. Rev.cienc.biomed. 2016;7(1):123-127. PALABRAS CLAVE Amiloidosis; Dermatosis de la pierna; Integumento comun. SUMMARY Introduction: nodular primary cutaneous amyloidosis is a subtype of amyloidosis that is only cutaneous it mainly affects women. It comes up with yellow and bright nodules, hard to the touch, usually asymptomatic. Case report: the case is presented in a 62-year-old female patient, who during four years presented pruritus, little papular lesions in lower limbs and in lumbosacral re­ gion that did not answered to the first medical treatment with loratadine. The patient did not present important clinical record. It is believed the presence of amyloidosis; the histology with Congo red staining confirmed the diagnosis. Systemic disease was not found. Conclusion: usually, nodular amyloidosis is a disease with chronic, inflammatory, di­verse and uncommon etiology; it only affects the skin with good prognosis. Sometimes, its treatment is delayed by late diagnosis. Rev.cienc.biomed. 2016;7(1):123-127. KEYWORDS Amyloidosis; Leg dermatoses; Integumentary system.

Stewart-Bluefarb syndrome (SBS) is a subtype of pseudo-Kaposi sarcoma (PKS), which is associated with congenital arteriovenous malformation. It is a rare syndrome, characterized by cutaneous lesions with onset in the second decade of life. We report a case of SBS in a 33-year-old man presenting with a 15-year history of unilateral, reddish-brown, raised lesions on his right lower leg and the dorsum of his foot. Diagnosis of PKS was confirmed by histopathology and radiology. We report the clinical features, aetiopathogenesis, differential diagnosis and treatment of this rare condition.

Localized bullous pemphigoid is a rare clinical variant of bullous pemphigoid. We report three cases of localized bullous pemphigoid in which the diagnosis was delayed because the presentation simulated other local vesicular or bullous diseases. Localized bullous pemphigoid differs from the generalized form by its more benign course. Early diagnosis will help avoid unnecessary and costly treatment for unrelated conditions.

Background. Keratoacanthoma centrifugum marginatum is a rare variety of keratoacanthoma, usually presented and classified as solitary keratoacanthoma. Reported cases of multiple keratoacanthoma centrifugum marginatum are exceptional in the literature. Observations. A 21-year-old man presented for evaluation of erythematous papules and plaques on both legs that had had a peripheral growth over the past year. Clinical and histologic examination showed typical features of keratoacanthoma centrifugum marginatum. Owing to the multiplicity and size of the lesions, treatment with oral isotretinoin was started. It was ineffective. Subsequent treatment with methotrexate combined with oral prednisone led to the regression of all lesions. Conclusions. The exceptional case of a man with multiple keratoacanthoma centrifugum marginatum is reported. Treatment with methotrexate combined with oral prednisone was effective. This case illustrates how some variants of keratoacanthomas do not really fit into the current classification and how complex the treatment of these tumors is.

Keywords: allergic contact dermatitis; CAS no. 458-37-7; case report; curcumin; turmeric

Se presentan fragmentos de diez columnas de opinion que fueron publicadas por el doctor Carlos Cruz Echeverria en las penultimas decadas del siglo XX en periodicos de circulacion regional en el Caribe colombiano. Se han hallado columnas de prensa desde 1982 hasta 1993. En muchas de sus columnas de opinion, el doctor Carlos Cruz Echeverria dejo su impronta de neurologo y explico a la comunidad el impacto y las consecuencias de diversas enfermedades desarrolladas en el tejido cerebral. Alerto tempranamente sobre la magnitud de la cisticercosis. Fue de los primeros en la Universidad de Cartagena que escribio sobre temas que hoy hacen parte de lo que se conoce como medicina del deporte. Certeramente expuso sus consideraciones sobre el desempeno del deportista y los riesgos del doping sin poseer el adecuado condicionamiento fisico, nutricional y mental. Dedico varias columnas al boxeo, del cual fue apasionado dirigente internacional y aficionado. Escribio sobre politica, educacion, sensibilidad social y atencion primaria en salud, al abordar el tema de la obesidad. Su vida y obra esta siendo estudiada por el Semillero de Investigacion HISTORI-MED de la Facultad de Medicina de la Universidad de Cartagena. Las fotografias que ilustran este documento hacen parte de la Fototeca Historica de la Medicina cartagenera. Rev.cienc. biomed. 2016;7(1):164-176. PALABRAS CLAVE Neurociencias; Ciencias de la nutricion y el deporte; Educacion; Historia de la Medicina. SUMMARY There are fragments of ten columns of opinion that were published by Dr. Carlos Cruz Echeverria in the penultimate decades of the twentieth century in newspapers of regional circulation in the Colombian Caribbean. Press columns have been found from 1982 to 1993. Dr. Carlos Cruz Echeverria left his imprint of neurologist and explained to the community the impact and consequences of various diseases developed in the brain tissue in many of his opinion columns. He warned early about the magnitude of cysticercosis. He was one of the first at Universidad de Cartagena who wrote about topics that today are part of what is known as sports medicine. He certainly exposed his considerations about the athlete’s performance and the risks of doping without adequate physical, nutritional and mental condition. He dedicated several columns to boxing, of which he was passionate international leader and amateur. He wrote about politics, education, social sensitivity and primary health care, addressing the issue of obesity. His life and work is being studied by the HISTORI-MED seminar of Medicine Department at Universidad de Cartagena. The photographs that pictures this document are part of the Historical Photo Library of Cartagena Medicine. Rev.cienc. biomed. 2016;7(1):164-176. KEYWORDS Neurosciences; Sports nutritional sciences; Education; History of medicine. family:Verdana;color:black;mso-ansi-language: EN-US'> Conclusion: usually, nodular amyloidosis is a disease with chronic, inflammatory, di­verse and uncommon etiology; it only affects the skin with good prognosis. Sometimes, its treatment is delayed by late diagnosis. Rev.cienc.biomed. 2016;7(1):123-127. KEYWORDS Amyloidosis; Leg dermatoses; Integumentary system.

Nevo epidérmico verrucoso inflamatório linear (Nevil) é uma variante do nevo epidérmico verrucoso que acomete mais comumente o sexo feminino. Clinicamente, é caracterizado por fenômenos inflamatórios recorrentes, conferindo aspecto de dermatite eczematosa crônica ou psoriasiforme, frequentemente unilateral, com prurido intenso, de aparecimento desde o nascimento e de difícil tratamento.