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Resumen El ectropion o eversion del parpado, es la malposicion palpebral mas frecuente. Al alterar la funcion protectora palpebral puede causar epifora, lagoftalmos, queratinizacion, irritacion cronica, dolor o ulceracion. Se distinguen 5 tipos de ectropion en funcion de su mecanismo causal: congenito, paralitico, involutivo, cicatricial y mecanico. Lo mas habitual en dermatologia, es la presencia de ectropion de tipo mixto, con elementos involutivos y mecanico-traccionales. Existen varias tecnicas reparadoras de ectropion cuya indicacion dependera del componente patogenico principal. Revisamos la anatomia basica palpebral y exponemos la tecnica exploratoria que nos permitira analizar el riesgo de ectropion para prevenir su aparicion o determinar la patogenia del ectropion ya establecido para definir la tecnica reparadora mas apropiada.

Ectropion, or eyelid eversion, is the most common form of eyelid malposition. By impairing the eyelid's protective function, ectropion can cause epiphora, lagophthalmos, keratinization, chronic irritation, pain, and ulceration. There are 5 types of ectropion, each with a different cause: congenital, paralytic, involutional, cicatricial, and mechanical. The most common presentation in dermatology is involutional eversion with a mechanical or tractional element. Several options exist for the surgical repair of ectropion and choice of technique will depend on the main pathogenic component. We review the basic anatomy of the eyelid and describe examination techniques for assessing risk and preventing ectropion and for identifying the main pathogenic component in order to select the most suitable repair technique.

La neoplasia mas frecuente en los parpados es el carcinoma basocelular, siendo esta localizacion subsidiaria del empleo de cirugia de Mohs. La reconstruccion palpebral, tanto del parpado superior como del inferior, supone un desafio ante la complejidad de su estructura y la importante funcion que ambos desempenan. El parpado se divide de forma clasica en lamela anterior (compuesta por piel, tejido celular subcutaneo y musculo orbicular) y lamela posterior (compuesta por musculo tarsal y conjuntiva palpebral). En la lamela posterior el musculo tarsal dota al parpado de soporte fibroso y cartilaginoso al anclarse lateralmente a los ligamentos cantales, y estos a su vez al periostio de la orbita. Para una exitosa reconstruccion palpebral hemos de reparar ambas subunidades1. Actualmente las tecnicas mas empleadas para la reconstruccion de la lamela posterior en defectos totales de parpado inferior se pueden clasificar en: colgajos tarsoconjuntivales, injertos condromucosos e injertos condropericondricos. Todos ellos se combinan con colgajos o injertos cutaneos para la reconstruccion de la lamela anterior2. Entre los primeros cabe destacar el clasico colgajo de Hughes. Este colgajo de transposicion del parpado superior

Acute generalized exanthematous pustulosis (AGEP) is a rare, severe, pustular, cutaneous reaction. We report a case in which a patient developed AGEP after the intake of 3 different antitussive agents containing dextromethorphan as the only ingredient in common.

The case of a 39-year-old female with generalized eczema following sodium nadroparin administration was referred to us. Positive patch-tests for several low molecular weight heparins (LMWH), but negative for unfractionated heparins (UFH) and tinzaparin were obtained. Furthermore, intradermal tests gave positive results to sodium and calcium heparin, while only subcutaneous challenge showed tinzaparin sensitivity. In summary, in heparin type IV hypersensitivity diagnosis, the intradermal test seems to be an eligible tool, rather than patch-test.

Selective depletion of CD4+ T lymphocytes is common in both primary and secondary immunodeficiencies. Idiopathic CD4+ T lymphocytopenia (ICL) cases are defined as a persistent CD4+ T lymphocyte count of less than 300x10(6) cells/L and/or less than 20% of the total T-cell count.A 40-year-old woman, with a history of psoriasis and paracetamol allergy, presented with persistent warts of the hands and condylomas of the ano-genitalia. Histological and virological analysis was carried out on genital and cutaneous lesions and peripheral blood.Serology for HIV-1, HIV-2, Epstein-Barr virus and parvovirus B19 were negative. There was lymphopenia of 10% CD4+ cells, with normal numbers of total leukocytes; there were no other-abnormal immunological findings. DNA analysis of cutaneous lesions revealed HPV-49 and HPV-3 in the hands and HPV-6 in the genital region.The cause of the ICL in this patient is unknown. HPV is not known to be an immunosuppressive agent; it remains to be determined whether the HPV-associated lesions are the cause or the result of immunosuppression.

Las lesiones blanquecinas de la mucosa oral se suelen diagnosticar de candidiasis, liquen plano o displasias; sin embargo, hay que tener en cuenta otras entidades que aunque infrecuentes cursan con leucoplasia. Se comunica el caso de una niña de 7 años con lesiones blanquecinas en la mucosa oral, que tras estudios analíticos, micológicos e histopatológicos, fue diagnosticada de nevus blanco esponjoso oral : Whitish lesions in oral mucosa are usually diagnosed as candidosis, lichen planus or dysplasias. However, other infrequent entities associated with leukoplakia should be borne in mind. We present the case of a 7-year-old girl with whitish lesions in the oral mucosa. Laboratory, mycological and histopathological investigations were performed and the patient was diagnosed with oral white sponge nevus

A calculator program for the numerical optimization of physico-chemical parameters by the algorithm of Davies, Swann and Campey is described which includes estimation of the standard deviations of the optimized parameters.