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Resumen La aparicion de ulceras perianales en relacion con una pomada antihemorroidal es una condicion nunca antes reportada en la literatura. Presentamos una serie de 11 casos de 10 hospitales espanoles con diagnostico de ulceras perianales tras la aplicacion de una misma pomada antihemorroidal con acetonido de triamcinolona, lidocaina y pentosano polisulfato sodico como principios activos. No se ha podido identificar ninguna condicion previa o enfermedad concomitante que pudiera justificar un diagnostico etiologico alternativo y tras retirar la pomada antihemorroidal se ha evidenciado una resolucion completa de las ulceras en un periodo medio de 8 semanas. Esta serie de casos evidencia el potencial efecto danino de un producto farmaceutico no sujeto a prescripcion ni seguimiento medico y la necesidad de interrogar por el uso de agentes topicos ante la aparicion de ulceras perianales.

Resumen Los medicamentos industriales comercializados para uso topico oral son muy escasos y con vehiculos poco adecuados. En consecuencia, frecuentemente hay que recurrir a preparados magistrales que permitan aplicar principios activos en vehiculos disenados especialmente para su aplicacion en la mucosa oral. La formulacion magistral tambien permite incluir varios principios activos en un mismo vehiculo y prescribir farmacos actualmente en desabastecimiento, entre otras ventajas. Describimos las principales formulas magistrales para el tratamiento de la patologia de la mucosa oral mas frecuente.

Commercial topical medications for oral conditions are scarce and the vehicles used are not very suitable. Therefore, formulations containing active ingredients in vehicles specially designed for oral application must often be prepared. Drug compounding offers other advantages, including the possibility of combining several active ingredients in a single vehicle and prescribing drugs that are in short supply. In this article, we describe the main pharmaceutical formulations used to treat the most common diseases of the oral mucosa.

Summary Background Cutaneous reactions after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccines are poorly characterized. Objective To describe and classify cutaneous reactions after SARS-CoV-2 vaccination. Methods A nationwide Spanish cross-sectional study was conducted. We included patients with cutaneous reactions within 21 days of any dose of the approved vaccines at the time of the study. After a face-to-face visit with a dermatologist, information on cutaneous reactions was collected via an online professional survey and clinical photographs were sent by email. Investigators searched for consensus on clinical patterns and classification. Results From 16 February to 15 May 2021, we collected 405 reactions after vaccination with the BNT162b2 (Pfizer-BioNTech; 40·2%), mRNA-1273 (Moderna; 36·3%) and AZD1222 (AstraZeneca; 23·5%) vaccines. Mean patient age was 50·7 years and 80·2% were female. Cutaneous reactions were classified as injection site (‘COVID arm’, 32·1%), urticaria (14·6%), morbilliform (8·9%), papulovesicular (6·4%), pityriasis rosea-like (4·9%) and purpuric (4%) reactions. Varicella zoster and herpes simplex virus reactivations accounted for 13·8% of reactions. The COVID arm was almost exclusive to women (95·4%). The most reported reactions in each vaccine group were COVID arm (mRNA-1273, Moderna, 61·9%), varicella zoster virus reactivation (BNT162b2, Pfizer-BioNTech, 17·2%) and urticaria (AZD1222, AstraZeneca, 21·1%). Most reactions to the mRNA-1273 (Moderna) vaccine were described in women (90·5%). Eighty reactions (21%) were classified as severe/very severe and 81% required treatment. Conclusions Cutaneous reactions after SARS-CoV-2 vaccination are heterogeneous. Most are mild-to-moderate and self-limiting, although severe/very severe reactions are reported. Knowledge of these reactions during mass vaccination may help healthcare professionals and reassure patients.

Erythema annulare centrifugum (EAC) is a reactive phenomenon of the skin that has been reported to occur in association with numerous conditions, including infections.1 It commonly presents with annular, erythematous plaques with a fine desquamation in the inner portion of the advancing edge.2 In the last year, a wide spectrum of cutaneous manifestations has been associated with SARS-CoV-2 infection, including acral areas of erythema with vesicles or pustules, other vesicular eruptions, urticarial lesions, maculopapular eruptions and livedo or necrosis.3,4.

Psoriasis is a multisystem disease associated with an increased prevalence of oral lesions. The aim of this study was to determine the prevalence of oral lesions in patients with psoriasis and examine associations with clinical and patient characteristics.We conducted a cross-sectional study of patients with psoriasis and healthy controls seen between December 2019 and February 2020. We recorded biometric data, comorbidities associated with psoriasis, oral examination findings, and clinical characteristics of psoriasis.We studied 100 patients with psoriasis and 100 controls. Oral lesions were more common in the psoriasis group (74% vs 46%, P.001). The most common lesions were fissured tongue (39% vs 16%, P.001) and periodontitis (28% vs 16%, P=.04). Geographic tongue was uncommon in both the study and the control group (4% vs 2%, P=.68). In the psoriasis group, patients with fissured tongue had a higher prevalence of cardiovascular disease (23.1% vs 4.9%), diabetes mellitus (28.2% vs 8.2%), and psoriatic arthritis (15.4% vs 1.6%) than those without this condition. Periodontitis was also associated with a higher prevalence of cardiovascular disease (28.6% vs 5.6%). Type of psoriasis, location, and time since onset were not significantly associated with oral lesions. Patients with oral lesions, however, had more severe disease (Psoriasis Area Severity Index [PASI], 3.9 vs 2.4; P=.05). Mean PASI was also higher in patients with fissured tongue (4.7 vs. 2.7, P=.03) and periodontitis (5.1 vs. 2.9, P=.04).The prevalence of oral lesions, especially fissured tongue and periodontitis, is higher in patients with psoriasis than in healthy controls. Oral lesions were associated with more severe psoriasis and a higher prevalence of associated comorbidities. We recommend examining the oral cavity of patients with psoriasis, especially those with more severe disease and comorbidities, irrespective of type of psoriasis, location, or time since onset.

The development of perianal ulcers related to the use of a hemorrhoidal ointment has not been reported in the literature. We describe a series of 11 patients who were treated for perianal ulcers in 10 Spanish hospitals after they used the same ointment containing the active ingredients triamcinolone acetonide, lidocaine, and pentosan polysulfate sodium. No prior or concomitant conditions suggesting an alternative cause for the condition could be identified, and after the patients stopped using the ointment, their ulcers cleared completely in 8 weeks on average. This case series shows the damage that can be caused by an over-the-counter pharmaceutical product used without medical follow-up. It also illustrates the need to ask patients with perianal ulcers about any topical agents used before the lesions appeared.

Compounding continues to play a key role in the treatment of skin conditions, despite the abundance of products made by the pharmaceutical industry. Right from the earliest days of dermatology, compounding proved very useful in the treatment of diseases for which no specific drugs were available. However, as new products came onto the market, this usefulness was called into question, and doubts over safety, stability, and effectiveness were raised. Today, compounding is regaining the place it once held in routine dermatological practice. We review the advantages and disadvantages of compounding, the most common indications, current legislation in our setting, and the latest developments in active ingredients and vehicles.

Resumen A pesar de la gran cantidad de productos disponibles producidos por la industria farmaceutica, hoy en dia la formulacion magistral sigue teniendo un papel muy importante en el tratamiento de las afecciones dermatologicas. Desde los inicios de la Dermatologia se ha usado, siendo muy util en el tratamiento de enfermedades para las que no se disponia de preparados farmaceuticos especificos; sin embargo, a medida que fueron apareciendo nuevos productos comercializados se puso en duda la utilidad de la formulacion, cuestionando su seguridad, estabilidad y efectividad. Esto contrasta con la tendencia actual de recuperar la formulacion, haciendo que vuelva a ocupar su lugar en la practica dermatologica habitual. En el presente articulo revisamos las patologias en las que se usa con mas frecuencia la formulacion, sus utilidades e inconvenientes, la legislacion actual al respecto en nuestro ambito, aportando las ultimas novedades descritas en cuanto a vehiculos y principios activos disponibles.

Multiple cutaneous and uterine leiomyomatosis (MCUL), or Reed syndrome, is characterized by the presence of cutaneous leiomyomas arising from the arrector pili muscles and, in women, by uterine leiomyomas. In some cases, MCUL is associated with renal cell carcinoma. This syndrome is an autosomal dominant disorder caused by a heterozygous germline mutation of the gene that encodes fumarate hydratase, a Krebs cycle enzyme that acts as a tumor suppressor.To review the cases of MCUL diagnosed at 2 university hospitals over a 5-year period (2008-2013).This was a retrospective study of 13 cases of MCUL that investigated demographic, clinical, and histologic characteristics, as well as possible associations with other diseases and treatments received.We identified 13 patients (10 women and 3 men) who had been diagnosed with MCUL. The mean age at diagnosis was 53 years. All the patients had multiple cutaneous leiomyomas; in 12 (92%) the distribution was clustered and 9 (69%) also had disseminated solitary lesions. In 1 patient (7.7%), the pattern of distribution was linear. Uterine fibroids requiring hysterectomy were present in 90% of the women. Nine patients were screened for renal lesions; no cases of renal cell carcinoma were detected but benign renal lesions were found in 4 patients.The clinical and histologic characteristics of the 13 cases of MCUL reviewed were similar to those reported in the literature. The most common cutaneous manifestation was a type 2 segmental pattern. It is important for dermatologists to identify cutaneous leiomyomas and be aware of the possible association with MCUL.

Introduction Le syndrome trophique du trijumeau est une cause peu habituelle d’ulcere. Le diagnostique differentiel se pose avec les tumeurs cutanees, vascularites, maladies infectieuses, maladies granulomateuses et la dermatite factice. Nous rapportons le cas d’une jeune fille presentant des ulceres indolores dans la muqueuse orale avec une mauvaise evolution. Observations Une patiente, âgee de 6 ans, consultait pour la presence sur la langue, d’un ulcere indolore, evoluant depuis pres de deux mois et se propageant progressivement a la levre superieure droite et a l’aile de la narine droite. L’examen dermatologique montrait un ulcere de la langue avec le bord blanc et un autre sur les deux levres et sur l’aile de la narine droite avec la presence de croutes sans aucun signe d’infection, sur une peau saine sans autres lesions associees. Deux ans auparavant, la patiente avait presente un hematome spontane dans l’hemisphere droit du cervelet a cause d’une malformation arterio-veineuse qui avait entraine une admission a l’unite de soins intensifs pendant 9 jours. Pendant deux ans, 12 embolisations successives avaient ete realisees et en septembre 2013, une intervention chirurgicale etait pratiquee afin d’effectuer une resection de la malformation. A la suite de l’intervention, la patiente souffrait d’un syndrome de la fosse posterieure, avec hemiparesie discrete de l’hemicorps droit et paralysie faciale droite. Grâce a des seances de reeducation la patiente recuperait progressivement de la mobilite. Au fur et a mesure qu’elle recuperait la sensibilite du cote droit du visage l’ulcere apparaissait. Compte tenu des antecedents cliniques du patient et apres l’exclusion d’autres causes, le diagnostic envisage etait celui d’un syndrome trophique du trijumeau. Discussion Une des causes du developpement du syndrome trophique du trijumeau est l’insuffisance vertebro-basilaire apparue au decours de la chirurgie. La pathogenie n’est pas claire, mais elle est consideree comme etant due a un mecanisme physique d’automutilation faisant suite a l’anesthesie et a la paralysie par l’innervation sensitive faciale via le nerf trijumeau. Le traitement est difficile ; il repose sur la therapie basee sur le changement de comportement, sur un traitement medicamenteux (carbamazepine, gabapentine, amitriptyline), sur la stimulation nerveuse transcutanee de protection ou sur une reparation chirurgicale. Conclusion Un cas d’ulcere indolore de la muqueuse orale et du visage chez une fille de six ans en raison de syndrome trophique du trijumeau, apparu apres une operation chirurgicale du cervelet. Ce cas nous rappelle l’importance de l’histoire neurologique d’un patient dans l’apparition d’un ulcere du visage.

Dermanyssus gallinae is a mite that normally parasitizes small birds but may occasionally bite humans. We report an unusual case of an 82-year-old woman who presented with pruritus and bite-like lesions over her trunk. Other members of the household were also affected. On physical examination, mites1 mm in size were found on the patient's body. The family were residing in the city centre and had no pets, but there were pigeon nests in close proximity to the house. Most dermatologists have difficulties identifying ectoparasitosis. In the case of D. gallinae, the small size of the mites and the fact that they leave the host after feeding means that they may not be seen at presentation, thus such infestations are likely to be underdiagnosed. Physicians should be aware that infection with this mite is possible even in patients from urban areas, and it should be included in the differential diagnosis of conditions causing recurrent pruritus unresponsive to standard treatments.

Compounding continues to play a key role in the treatment of skin conditions, despite the abundance of products made by the pharmaceutical industry. Right from the earliest days of dermatology, compounding proved very useful in the treatment of diseases for which no specific drugs were available. However, as new products came onto the market, this usefulness was called into question, and doubts over safety, stability, and effectiveness were raised. Today, compounding is regaining the place it once held in routine dermatological practice. We review the advantages and disadvantages of compounding, the most common indications, current legislation in our setting, and the latest developments in active ingredients and vehicles.