Introduction: Body surface area (BSA) affected by psoriasis is one of the most often used measures for assessing severity, but this method has shortcomings. Objective: To validate a new way to estimate BSA. Material and method: Prospective, multicenter study in 56 patients with psoriasis. Each patient was evaluated by 2 dermatologists in 2 visits to the same hospital. Each dermatologist used 2 methods for estimating BSA: the traditional visual estimation in which the area of the palm equals 1% of the total body surface and an optical pencil (OP) method in which the affected area is drawn on a touch screen. Software in the application then calculates the BSA. Results: Overall concordance between the 2 methods was acceptable according to an intra class correlation coefficient (ICC) of 0.87. However, the limits of agreement were unacceptably large and there was systematic bias: traditional estimates were consistently greater than OP calculations. Concordance between the methods was better (ICC > 0.8) on the trunk and lower extremities. Intraobserver reliability was excellent with both methods (ICCs, 0.97 and 0.98 for the traditional and OP estimates, respectively). Interobserver reliability was also high (ICCs, 0.91 and 0.94 for the traditional and OP methods), although the mean BSA differed significantly between observers. The ICCs were much lower for BSA estimates on the head. Conclusions: This study to validate the OP method for estimating the affected BSA in patients with psoriasis shows good agreement between the OP and traditional approaches. The OP calculations also showed less variance and better interobserver reliability. (C) 2019 AEDV. Published by Elsevier Espana, S.L.U.

Se trata de una mujer de 48 anos, ingresada en la Unidad de Cuidados Intensivos (UCI) por insuficiencia respiratoria, hemoptisis y fracaso renal agudo. Como antecedentes, destacaba un cuadro de dos meses de evolucion consistente en odinofagia, afonia, inyeccion conjuntival bilateral fluctuante, artromialgias y febricula, junto con un episodio de condritis del pabellon auricular izquierdo y aparicion de lesiones cutaneas asintomaticas.

We report a patient with multiple myeloma associated with primary systemic amyloidosis who had a rapid evolution and a very unusual form of presentation. The association of amyloidosis in patients with multiple myeloma is 15%, (1) and clinically evident mucocutaneous involvement occurs in up to 40% of patients.(2)

A 57year-old man presented with a 10-year-history of numerous small, asymptomatic, hypopigmented macules and papules, symmetrically distributed over the face, neck, upper chest and shoulders, which had remained stable in number and size. The lesions were 3–5 mm in diameter, and were irregular, well-defined hypopigmented macules and papules, with angulated shapes and tendency to confluence (Figs 1a,b).

Background Sweet's syndrome ( SS) has been reported in association with many conditions, including malignancy, infections, autoimmune disorders, pregnancy and drugs.Materials and methods We reviewed patients with SS-like lesions on the lymphoedema area seen in our department. Clinical manifestations, histopathologic characteristics, treatment and outcome data were recorded and analysed.Results We report seven women with a history of surgery for breast cancer with axillary lymphadenectomy. Six of them were on tamoxifen. All of them had various lesions consistent with SS localized predominantly on the limb affected by the postmastectomy lymphoedema, and on the ipsilateral chest, trunk and back. One of them presented bullous lesions. Three of the cases underwent spontaneous remission, two resolved with antibiotic therapy, one healed with corticosteroids, and one with corticosteroids plus antibiotic.Conclusions Erythematous tender plaques on the area of postmastectomy lymphoedema could be considered an unusual manifestation of Sweet's syndrome. We have found only three similar cases in the literature. Although it is difficult to elucidate the pathogenesis of this entity, it has been suggested that it could be due to immune surveillance impairment.

Journal of the European Academy of Dermatology and VenereologyVolume 20, Issue 3 p. 344-345 Subcutaneous lepromas as leprosy-type presentation SB Álvarez-Ruiz, SB Álvarez-Ruiz Hospital Universitario La Princesa. Diego de León, Madrid, Spain.Search for more papers by this authorY Delgado-Jiménez, Y Delgado-Jiménez Hospital Universitario La Princesa. Diego de León, Madrid, Spain.Search for more papers by this authorM Aragüés, M Aragüés Hospital Universitario La Princesa. Diego de León, Madrid, Spain.Search for more papers by this authorJ Fraga, Corresponding Author J Fraga *Corresponding author, Departments of Dermatology and Pathology, Hospital Universitario La Princesa, Diego de León 62, 28006 Madrid, Spain, tel. +91 5202433; fax +91 5202435; E-mail: [email protected]Search for more papers by this authorA García-Díez, A García-Díez Hospital Universitario La Princesa. Diego de León, Madrid, Spain.Search for more papers by this author SB Álvarez-Ruiz, SB Álvarez-Ruiz Hospital Universitario La Princesa. Diego de León, Madrid, Spain.Search for more papers by this authorY Delgado-Jiménez, Y Delgado-Jiménez Hospital Universitario La Princesa. Diego de León, Madrid, Spain.Search for more papers by this authorM Aragüés, M Aragüés Hospital Universitario La Princesa. Diego de León, Madrid, Spain.Search for more papers by this authorJ Fraga, Corresponding Author J Fraga *Corresponding author, Departments of Dermatology and Pathology, Hospital Universitario La Princesa, Diego de León 62, 28006 Madrid, Spain, tel. +91 5202433; fax +91 5202435; E-mail: [email protected]Search for more papers by this authorA García-Díez, A García-Díez Hospital Universitario La Princesa. Diego de León, Madrid, Spain.Search for more papers by this author First published: 09 February 2006 https://doi.org/10.1111/j.1468-3083.2006.01402.xCitations: 6Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL No abstract is available for this article. References 1 Boletín epidemiológico. Centro Nacional de Epidemiología. Instituto Salud Carlos III 2002; 10: 06/49– 06/60. 2 Desai RG. An unusual case of Hansen's disease (lepromatous leprosy) with circulation anticoagulant and macroglobulinemia. Int J Lepr 1990; 58: 462– 465. 3 Meyers WM. Leprosy. Dermatol Clin 1992; 10: 73– 96. 4 Languillon J. Lésions cutanées. Précis de léprologie. 2a Ed. Paris, Masson, 1986: 71– 96. 5 Jopling WH, McDougall AC. The Disease. Handbook of leprosy. 4a Ed. Oxford, Heinemann Professional Publishing, 1988: 23– 37. 6 Modlin RL, Rea TH. Leprosy: new insight into an ancient disease. J Am Acad Dermatol 1987; 17: 1– 13. Citing Literature Volume20, Issue3March 2006Pages 344-345 ReferencesRelatedInformation

BACKGROUND:Nephrogenic fibrosing dermopathy (NFD) is a new skin-fibrosing disorder associated with renal dysfunction. It is marked by the acute onset of induration involving the upper and lower limbs, and it is characterized by distinctive histopathologic findings. METHODS:We report the case of a patient on hemodialysis who presented initially with the characteristic clinical and pathological features of NFD. The patient progressively developed painful hyperkeratotic spicules on both thighs and bone metaplasia was confirmed. RESULTS:Histological studies were performed at different stages of the disease showing an evolution from the well-known initial phase of NFD, characterized by thickening of the dermis, increased number of fibroblast-like cells, and mucin deposits, to an end stage characterized by the presence of dermal ossification. CONCLUSIONS:We report the exceptional finding of bone metaplasia in the setting of a case of NFD.

Journal Article Leucocytoclastic vasculitis, hepatitis C virus‐associated mixed cryoglobulinaemia with biclonal gammopathy and Waldenström macroglobulinaemia Get access S.B. Álvarez‐Ruiz, S.B. Álvarez‐Ruiz Departments of Dermatology, Pathology Search for other works by this author on: Oxford Academic Google Scholar I. García‐Río, I. García‐Río Departments of Dermatology, Pathology Search for other works by this author on: Oxford Academic Google Scholar M. Aragüés, M. Aragüés Departments of Dermatology, Pathology Search for other works by this author on: Oxford Academic Google Scholar J. Fraga, J. Fraga Departments of Dermatology, Pathology Search for other works by this author on: Oxford Academic Google Scholar J. Locertales Pueyo, J. Locertales Pueyo Haematology, Hospital Universitario de la Princesa, Diego de León 62, 28006 Madrid, Spain E‐mail: saralvarez@aedv.es Search for other works by this author on: Oxford Academic Google Scholar J. Fernández‐Herrera, J. Fernández‐Herrera Departments of Dermatology, Pathology Search for other works by this author on: Oxford Academic Google Scholar A. García‐Díez A. García‐Díez Departments of Dermatology, Pathology Search for other works by this author on: Oxford Academic Google Scholar British Journal of Dermatology, Volume 151, Issue 4, 1 October 2004, Pages 937–939, https://doi.org/10.1111/j.1365-2133.2004.06207.x Published: 01 October 2004

Contact DermatitisVolume 46, Issue 5 p. 302-302 Allergic contact dermatitis from benzoyl peroxide transferred by a loving son A. Hernández-Núñez, A. Hernández-Núñez Department of Dermatology. Hospital Universitario de la Princesa, C/Diego de León, 62, 28006 Madrid, SpainSearch for more papers by this authorJ. Sánchez-Pérez, J. Sánchez-Pérez Department of Dermatology. Hospital Universitario de la Princesa, C/Diego de León, 62, 28006 Madrid, SpainSearch for more papers by this authorM. Pascual-López, M. Pascual-López Department of Dermatology. Hospital Universitario de la Princesa, C/Diego de León, 62, 28006 Madrid, SpainSearch for more papers by this authorM. Aragüés, M. Aragüés Department of Dermatology. Hospital Universitario de la Princesa, C/Diego de León, 62, 28006 Madrid, SpainSearch for more papers by this authorA. García-Díez, A. García-Díez Department of Dermatology. Hospital Universitario de la Princesa, C/Diego de León, 62, 28006 Madrid, SpainSearch for more papers by this author A. Hernández-Núñez, A. Hernández-Núñez Department of Dermatology. Hospital Universitario de la Princesa, C/Diego de León, 62, 28006 Madrid, SpainSearch for more papers by this authorJ. Sánchez-Pérez, J. Sánchez-Pérez Department of Dermatology. Hospital Universitario de la Princesa, C/Diego de León, 62, 28006 Madrid, SpainSearch for more papers by this authorM. Pascual-López, M. Pascual-López Department of Dermatology. Hospital Universitario de la Princesa, C/Diego de León, 62, 28006 Madrid, SpainSearch for more papers by this authorM. Aragüés, M. Aragüés Department of Dermatology. Hospital Universitario de la Princesa, C/Diego de León, 62, 28006 Madrid, SpainSearch for more papers by this authorA. García-Díez, A. García-Díez Department of Dermatology. Hospital Universitario de la Princesa, C/Diego de León, 62, 28006 Madrid, SpainSearch for more papers by this author First published: 27 June 2002 https://doi.org/10.1034/j.1600-0536.2002.460512.xCitations: 12Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onEmailFacebookTwitterLinkedInRedditWechat No abstract is available for this article. References 1 Balato N, Lembo G, Cuccurullo FM, Patruno C, Nappa P, Ayala F. Acne and allergic contact dermatitis. Contact Dermatitis 1996: 34: 68–69. 2 Cronin E. In: Contact Dermatitis, 1st edn. Longman: Churchill Livingstone, 1980: 171–192. 3 Adams R M. Appendix: Job descriptions with their irritants and allergens. In: R M Adams (ed.) Occupational Skin Disease, 3rd edn. Philadelphia: W.B. Saunders/Harcourt Brace, 1999: 627–758. 4 Gebhardt M, Geier J. Evaluation of patch tests results with denture material series. Contact Dermatitis 1996: 34: 191–195. 5 Agathos M, Bandmann H J. Benzoyl peroxide contact allergy in leg ulcer patients. Contact Dermatitis 1984: 17: 316–317. 6 Greiner D, Weber J, Kaufmann R, Boehncke W H. Benzoyl peroxide as a contact allergen in adhesive tape. Contact Dermatitis 1999: 41: 233. 7 Mann R J, Peachey R D G. Allergen transfer between individuals as a cause of contact dermatitis. Contact Dermatitis 1981: 7: 164–165. 8 Fischer A A. Consort contact dermatitis. Cutis 1979: 24: 595–596. 668. 9 Caro I. Connubial contact dermatitis to benzoyl peroxide. Contact Dermatitis 1976: 2: 362. Citing Literature Volume46, Issue5May 2002Pages 302-302 ReferencesRelatedInformation

Atrial myxoma is the most common primary tumour of the heart. Skin manifestations in patients with a cardiac myxoma are frequent and may be due to cutaneous emboli, or may be specific findings as part of more complex syndromes. We present a 33-year-old-man with a history of episodes of pain in both legs and an ischaemic neurological event, who also had episodes of acral papular erythematous lesions on the legs and feet including the soles. The histological finding of dermal vessels occluded by a myxomatous material was the clue to the diagnosis of a cardiac myxoma. The diagnosis of this entity can be very difficult, because of the broad spectrum of clinical features; rarely the skin manifestations lead to the diagnosis of this tumour. The histological recognition of the myxomatous emboli is of vital importance for the diagnosis and treatment of this disease.

BACKGROUND:Scrotal calcinosis is a benign entity characterized by the appearance of calcific masses within the dermis of scrotal skin. Its pathogenesis has not been fully elucidated.OBJECTIVE:A 36-year-old man with massive scrotal calcinosis is described. Our aim was to perform a histologic examination of the surgical piece with subsequent closure of the defect achieving satisfactory cosmetic results.METHODS:Case report and literature review.RESULTS:Histologic studies of multiple nodules showed no epithelial lining and one calcified epidermal cyst. Subtotal excision of the scrotal wall was performed with excellent results.CONCLUSION:Even though the pathogenic mechanism of this entity is still unclear, our findings support the theory of dystrophic calcification of epidermoid cysts. Surgical treatment is the only definitive treatment. Subtotal excision of the scrotal wall in cases of massive calcinosis may be performed with good results.

BACKGROUND:Water-induced pruritus is characterized by the development of intense and widespread itching after contact with water at any temperature and without observable skin lesions. Around 40-52% of patients with polycythaemia vera (PV) have water-induced pruritus, and more than 20% of the patients continue with symptoms despite an adequate control of the underlying disease. The aetiology is unknown and treatment is often unsuccessful. We report a patient with a haematologically controlled polycythaemia vera and water-induced pruritus that responded to phototherapy.METHODS:An 83-year-old woman with haematologically controlled PV referred with intense water-induced pruritus without cutaneous lesions. Topical emollients and oral antihistamines were unsatisfactory and so phototherapy treatment (90% UVA/10% UVB) three times a week was commenced.RESULTS:Improvement was visible after 1 month and at the end of 3 months the pruritus had disappeared and treatment was stopped.CONCLUSION:It is considered that the successful treatment in this patient is due to the UVB radiation.

We report a patient who presented with an intensely pruritic rash, with hyperpigmentation of the whole back and multiple hyperpigmented and hyperkeratotic papules over his forearms and lower extremities. Histologically, he showed deposits of amyloid that reacted positively with monoclonal antibodies against cytokeratins. The lesions were resistant to antihistamines and corticosteroids. Treatment with oral acitretin was started and great improvement of the lesion was noted: the patient became asymptomatic. We review the literature on the effect of retinoids in cutaneous amyloidosis.

In May 1994, a 40‐year‐old woman with chronic myeloid leukemia received an allogeneic bone marrow transplant (BMT) from her human leukocyte antigen (HLA) identical sister, after a conditioning regimen with cyclophosphamide and busulfan. Graft‐versus‐host disease (GVHD) prophylaxis consisted of cyclosporine (CsA) and methotrexate. Facial and palmoplantar erythema and moderate cholestasis developed on day 14 after the BMT. A diagnosis of acute GVHD was made and she was successfully treated with low doses of corticosteroids. On day 150 after the BMT, despite the prophylactic treatment of GVHD with CsA (150 mg/12 h), she developed several burning white plaque‐like striae over the buccal mucosa and numerous itching violaceous lichenoid papules on the fingertips. Biopsy specimens obtained from both the skin of the fingertips and the oral mucosa (Fig. 1) revealed patchy to diffuse subepithelial lymphocytic inflammation and necrosis of individual squamous cells, consistent with a diagnosis of chronic lichenoid GVHD. Despite therapy with CsA, topical and systemic corticosteroids (prednisone 60 mg/24 h), the oral lichenoid lesions persisted. On day 750 after the BMT, 2 months after withdrawal of immunosuppressive therapy, she developed several erythematous, pruriginous, and slight indurated lesions over the neck. These lesions coalesced into plaques, adopting a white atrophic‐like appearance with follicular plugs similar to lichen sclerosus et atrophicus (Fig. 2). Histopathologic examination showed hyperkeratosis with follicular plugging, atrophy of the stratum Malpighii with hydropic degeneration of the basal cells, homogenization of the collagen, incontinence of the pigment, and a discrete lymphoplasmocytic inflammatory infiltrate in the upper dermis (Fig. 3). Systemic corticosteroid therapy was re‐introduced. On day 850 after the BMT, physical examination revealed patchy hyperpigmentation affecting the back and limbs, and diffuse thickening and hardening of the skin of the legs, forearms, and dorsa of the hands, resulting inDiffuse subepithelial lymphocytic inflammation and satellite cell necrosis of squamous cells in oral mucosa (hematoxylin and eosin, ×25)imageAtrophic and confluent plaques with follicular plugs on the neckimageFollicular plugging, atrophy of the stratum Malpighii, hydropic degeneration of basal cells with a split visible at the dermoepidermal junction, and homogenization of the collagen in the upper dermis (hematoxylin and eosin, ×25)imagea slight limitation of movements. Various smooth, shiny, and indurated plaques, characteristic of morphea, were present on the flexural areas of the arms (at vein puncture sites). Lichenoid lesions over the oral mucosa and the atrophic plaques on the neck were still present. No dysphagia was observed. Liver function tests revealed a pattern of cholestasis. Antinuclear antibodies were detected (1 : 80); no antibodies against centromere antigens and DNA topoisomerase I (SCL70) were found. Reduced lacrimal secretion (Schirmer test <10 mm in 5 min) and a reduced forced expiratory volume in 1 s (FEV1) were documented. A biopsy specimen from a sclerodermatous area showed a thickened reticular and papillary dermis with closely packed collagen bundles and abundant melanophages in the dermis (Fig. 4). Azathioprine was added to the corticosteroid therapy in an attempt to arrest the progression of the disease. Six months after starting treatment, cutaneous lesions still persist, but the patient has not developed any other systemic symptoms.Thick collagen bundles in reticular and papillary dermis (hematoxylin and eosin, ×10)image