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Resumen Introduccion La enfermedad por coronavirus-19 (COVID-19) se ha relacionado con multiples sintomas: respiratorios, tromboticos, neurologicos, digestivos o cutaneos. Estos ultimos se han clasificado en 5 tipos: lesiones acroisquemicas, lesiones vesiculares, erupcion urticarial, exantema maculopapular o lesiones livedoides. Sin embargo, se han descrito mucho menos las alteraciones orales asociadas a la COVID-19. Pacientes y metodos Presentamos un estudio transversal realizado durante abril del 2020 en el Hospital de Campana de IFEMA examinando la mucosa oral de 666 pacientes con COVID-19. Resultados En total, 78 pacientes (11,7%) presentaron alteraciones en la mucosa oral. La mas frecuente fue papilitis lingual transitoria anterior en forma de U (11,5%) asociada o no a edema lingual (6,6%); estomatitis aftosa (6,9%), mucositis (3,9%) glositis con depapilacion en parches (3,9%), boca urente (5,3%), lengua saburral (1,6%) y enantema (0,5%). La mayoria referia disgeusia asociada. Conclusion La cavidad oral se puede alterar por la enfermedad COVID-19, el edema lingual con papilitis lingual transitoria en forma de U o la glositis con depapilacion en parches son los signos encontrados con mayor frecuencia, al igual que la sensacion de ardor en la cavidad oral o boca urente. Otras manifestaciones orales que se pueden asociar a la COVID-19 son mucositis con o sin aftas o el enantema. Todos pueden ser signos clave para un diagnostico de esta enfermedad.

Segmental stiff skin syndrome (SSSS) is a rare genetic connective tissue disease, which is often misdiagnosed. High-frequency ultrasonography can represent a useful clinical adjunct in the differential diagnosis of this condition, in conjunction with the clinical and histopathological findings. Treatment options are limited and evidence is scarce. We present the clinical, sonographic and histological features of 5 paediatric patients diagnosed at our institution and we discuss their response to treatment.

Background Coronavirus disease 19 (COVID-19) has many manifestations, including respiratory, thrombotic, neurologic, digestive, and cutaneous ones. Cutaneous manifestations have been classified into 5 clinical patterns: acro-ischemic (pseudo-chilblain), vesicular, urticarial, maculopapular, and livedoid. Oral manifestations have also been reported, but much less frequently. Patients and methods We performed a cross-sectional study in which we examined the oral mucosa of 666 patients with COVID-19 at the IFEMA field hospital in Madrid in April 2020. Results Seventy-eight patients (11.7%) had changes involving the oral mucosa. The most common were transient anterior U-shaped lingual papillitis (11.5%) accompanied or not by tongue swelling (6.6%), aphthous stomatitis (6.9%), a burning sensation in the mouth (5.3%), mucositis (3.9%), glossitis with patchy depapillation (3.9%), white tongue (1.6%), and enanthema (0.5%). Most of the patients also reported taste disturbances. Conclusions COVID-19 also manifests in the oral cavity. The most common manifestations are transient U-shaped lingual papillitis, glossitis with patchy depapillation, and burning mouth syndrome. Mucositis with or without aphthous ulcers or enanthema may also be observed. Any these findings may be key clues to a diagnosis of COVID-19.

Coronavirus disease 2019 (Covid-2019) has been associated with several cutaneous manifestations(1-3). A temporary field hospital was implemented during the pandemic peak in Madrid, Spain, to attend COVID-19 patients with mild to moderate pneumonia.

Background The cutaneous manifestations of COVID-19 disease are poorly characterized. Objectives To describe the cutaneous manifestations of COVID-19 disease and to relate them to other clinical findings. Methods We carried out a nationwide case collection survey of images and clinical data. Using a consensus we described five clinical patterns. We later described the association of these patterns with patient demographics, the timing in relation to symptoms of the disease, the severity and the prognosis. Results The lesions may be classified as acral areas of erythema with vesicles or pustules (pseudo-chilblain) (19%), other vesicular eruptions (9%), urticarial lesions (19%), maculopapular eruptions (47%) and livedo or necrosis (6%). Vesicular eruptions appear early in the course of the disease (15% before other symptoms). The pseudo-chilblain pattern frequently appears late in the evolution of the COVID-19 disease (59% after other symptoms), while the rest tend to appear with other symptoms of COVID-19. The severity of COVID-19 shows a gradient from less severe disease in acral lesions to more severe in the latter groups. The results are similar for confirmed and suspected cases, in terms of both clinical and epidemiological findings. Alternative diagnoses are discussed but seem unlikely for the most specific patterns (pseudo-chilblain and vesicular). Conclusions We provide a description of the cutaneous manifestations associated with COVID-19 infection. These may help clinicians approach patients with the disease and recognize cases presenting with few symptoms. What is already known about this topic? Previous descriptions of cutaneous manifestations of COVID-19 were case reports and mostly lacked illustrations. What does this study add? We describe a large, representative sample of patients with unexplained skin manifestations and a diagnosis of COVID-19, using a consensus method to define morphological patterns associated with COVID-19. We describe five clinical patterns associated with different patient demographics, timing and prognosis, and provide illustrations of these patterns to allow for easy recognition.

Wet wrap therapy (WWT) consists of topical steroids administered under a layer of wet cotton bandages or garments. Several trials with WWT have reported promising results in atopic dermatitis (AD). However, no systematic review and meta-analysis on its efficacy and safety has been published. Our objective was to conduct a systematic review of the literature on WWT in AD to assess its efficacy and safety. We included randomized controlled trials among patients of all ages with a diagnosis of AD based on predefined criteria or made by a dermatologist. Electronic searches were performed from 1970 to 30 March 2016 in the Cochrane Central Register of Controlled Trials, MEDLINE, Embase and the World Health Organization International Clinical Trials Registry. Selection of studies and data extraction were performed independently by two researchers, and discrepancies were resolved by consensus. Six trials comparing WWT with topical steroids in children or adults with AD were included. Sample sizes ranged from 19 to 51 patients. Results on clinical severity and quality of life were reported incompletely and proved heterogeneous across studies. A nonsignificant tendency to increased risk of mild skin infections was observed in those treated with WWT (pooled relative risk 6·35, 95% confidence interval 0·83-48·55). The overall grade of quality of evidence for the efficacy and safety outcomes was low. In conclusion, the evidence that WWT is more effective than conventional treatment with topical steroids in AD is of low quality. Further clinical trials should establish the efficacy of WWT in AD.

Idiopathic facial aseptic granuloma is a typical childhood disease characterized by the presence of one or more asymptomatic nodules on the cheek. Although pathogenesis remains unclear, the disease is thought to be a type of childhood rosacea. It resolves spontaneously, yet it could be confused with other lesions that require treatment. We present clinical and ultrasound findings and outcome from 3 new cases. In 2 cases, the lesion presented as childhood rosacea. Ultrasound revealed a characteristic pattern, with variations depending on the stage of development. High-frequency ultrasound can facilitate the differential diagnosis and thus obviate unnecessary biopsy or excision.

Amyloid is a proteinaceous material that is deposited in the tissues in a large variety of clinical contexts; in the skin it can be found with or without concomitant systemic disease. Primary localized cutaneous amyloidosis encompasses those amyloidoses restricted to the skin without involvement of other systems. The most common forms within this group are macular and lichen amyloidosis. Nodular amyloidosis is extremely rare, and there are notable differences in clinical presentation, prognosis, histology, and pathogenesis between this entity and the macular and lichenoid variants. We report a new case of nodular primary localized cutaneous amyloidosis with disseminated plaques and nodules in which no systemic disease developed in the 3 years following the appearance of the lesions.

Heparin use is associated with various cutaneous reactions, with the most common being immune-mediated skin lesions and bleeding complications. In this review, we compile the dermatological side-effects of heparin reported in the literature, and provide a clear approach to their adequate management.

Invasive vascular procedures have good efficacy and safety profiles and are now widely used for the diagnosis and treatment of many cardiovascular disorders. However, they do have potential complications that can occasionally be life-threatening. We present a new case of infectious pseudoaneurysm following percutaneous transluminal coronary angioplasty and complicated by septic emboli to the skin. It is a rare condition characterized by persistent bacteremia, sepsis of unknown origin, and regional septic emboli. Histopathology of the skin lesions typically reveals gram-positive coccobacilli and septic vasculitis. The condition carries a significant morbidity and mortality, making early diagnosis essential. Both cholesterol and septic emboli should be considered in the differential diagnosis of skin lesions after invasive vascular procedures.

Amyloid is a proteinaceous material that is deposited in the tissues in a large variety of clinical contexts; in the skin it can be found with or without concomitant systemic disease. Primary localized cutaneous amyloidosis encompasses those amyloidoses restricted to the skin without involvement of other systems. The most common forms within this group are macular and lichen amyloidosis. Nodular amyloidosis is extremely rare, and there are notable differences in clinical presentation, prognosis, histology, and pathogenesis between this entity and the macular and lichenoid variants. We report a new case of nodular primary localized cutaneous amyloidosis with disseminated plaques and nodules in which no systemic disease developed in the 3 years following the appearance of the lesions.

Incontinentia pigmenti is a rare, dominantly X-linked genodermatosis characterized by multisystemic involvement that is lethal prenatally in the majority of affected males and shows great clinical variability when it is expressed in women. Recently it has been shown that mutations of the gene NEMO/IKK-g located in Xq28 cause the expression of the disease, being only one mutation responsible for approximately 80 % of the cases. The diagnosis of incontinentia pigmenti is performed based on clinical features and family history with the support of histological findings. Nevertheless, as the gene responsible for the phenotype of the disease has been identified, a genetic study may be employed for doubtful cases. We report three cases of this entity (two women and one man) in different clinical stages of development that show the broad clinical spectrum we may encounter in the clinic.

Acrocyanosis is an infrequent entity characterized by persistent and symmetrical erythrocyanotic discoloration of the hands, feet and face, which is not preceded by episodes of previous paleness. Acrocyanosis can be secondary to a variety of underlying causes, but is uncommon as a form of presentation of systemic sclerosis. We present a new clinical case of this disease and discuss its etiopathogenic, clinical, diagnostic and therapeutic characteristics; in addition to, we seek to distinguish this term from others that might be confused in the literature.

La acrocianosis es un cuadro clínico caracterizado por una coloración azul violácea persistente y simétrica de zonas acras, principalmente manos y pies, que no está precedida por episodios de palidez previos. Es una entidad que puede asociarse a diversas causas subyacentes, pero es infrecuente que lo haga como forma de debút de una esclerosis sistémica progresiva. Se presenta a continuación un nuevo caso de esta patología y se comentan sus características etiopatogénicas, clínicas y diagnósticas más relevantes además de un intento de diferenciar este término de otros con los que existe confusión en la literatura.

CASO CLINICO Paciente de 14 anos de edad que acude al Servicio de Urgencias por lesiones cutaneas de localizacion palpebral de 15 dias de evolucion, temperatura termometrada de 38 °C y malestar general, que se presentaron durante su estancia en un campamento de verano. Entre sus antecedentes figuraba una dermatitis atopica moderada de inicio en la infancia consistente en placas eritematodescamativas, excoriaciones y liquenificacion localizadas principalmente en parpados y flexuras, que habia requerido tratamiento con corticoides topicos de mediana y baja potencia en los brotes (aproximadamente uno al ano) e inhibidores de la calcineurina (tacrolimus y pimecrolimus) al inicio de los mismos y como parte del tratamiento de mantenimiento. En la exploracion fisica destacaba la presencia de eritema y edema palpebral bilateral, bastante simetrico, sobre el que se implantaban multiples ulceras monomorfas menores de 0,5 cm de diametro cubiertas de costras melicericas (fig. 1). Ademas, se observaron lesiones de similares caracteristicas salpicadas en escaso numero por region cervical (fig. 2) y adenopatias laterocervicales y retroauriculares mayores de 1 cm de diametro. Los estudios complementarios practicados, incluyendo hemograma, electrolitos, coagulacion, funcion hepatica, funcion renal, analisis de orina, velocidad de sedimentacion globular (VSG), radiografia de torax y hemocultivos fueron normales o no significativos, destacando unicamente una discreta leucocitosis con desviacion izquierda, asi como una leve elevacion de la VSG. En la exploracion oftalmologica se observaron pequenas ulceras dendriticas corneales sin otros hallazgos de interes. PREGUNTAS ?Cual es su diagnostico? ?Que actitud tomaria?