Acne, one of the most common skin problems in dermatological practice, is a condition that affects not only adolescents but also adults. While approximately 80% of cases occurring in adulthood are persistent from teenage years, around 20% are described as 'late-onset' disease, appearing for the first time in adulthood. The disease can be triggered by hormonal changes (including a change from one contraceptive to another), or it can be induced by certain nonhormonal medications, emotional stress, and various underlying diseases such as polycystic ovary syndrome. In many cases acne becomes a chronic skin condition with undulating activity, including improvement and relapse phases, and is often experienced as a major psychological burden. It is, therefore, even more important to provide an effective as well as a safe and tolerable treatment. The spectrum of topical acne treatments has expanded substantially in recent years and various topical medications are available, ranging from azelaic acid, antibiotics, retinoids and benzoyl peroxide to several fixed combinations of these active compounds. The following case collection illustrates how 15% azelaic acid gel, as a well-established monotherapy, can be successfully employed to treat mild-to-moderate forms of adult female acne.

Ionizing radiation causes cell death through DNA damage and has a stronger effect on undifferentiated tumor cells with a high mitotic rate. The use of a fractionated radiotherapy regimen improves both efficacy and tolerance. In addition, greater fractionation, with lower doses per session, minimizes adverse effects. In the majority of tumors treated with radical radiotherapy, the tumor cells do not disappear immediately after treatment, and assessment of the final response to treatment before three months is premature. Radiotherapy is an important treatment modality in selected patients with skin cancer. Modern radiotherapy equipment and techniques achieve excellent rates of tumor control, associated with good cosmetic results, preserved function, and a low rate of complications. The choice of technique is determined by tumor size and site and the thickness. The techniques most widely used at the present time include external beam radiotherapy with linear accelerator sand high-dose-rate brachytherapy.

El mecanismo por el cual las radiaciones ionizantes producen muerte celular es el daño al ADN, que afecta más a las células tumorales de mayor actividad mitótica e indiferenciadas. La administración de radioterapia en dosis fraccionadas aumenta la eficacia y la tolerabilidad del tratamiento; esquemas más fraccionados en dosis bajas por sesión minimizan los efectos secundarios. La mayoría de los tumores irradiados en dosis radical no desaparecen de forma rápida al final del tratamiento. Una valoración de la respuesta definitiva antes de los tres meses es prematura. La radioterapia es un tratamiento importante en pacientes seleccionados con cáncer de piel. Se obtienen excelentes tasas de control tumoral, con buen resultado cosmético, preservación funcional e infrecuentes complicaciones con los modernos equipos y las técnicas de radioterapia. La elección de la técnica se determina por el tamaño, el espesor y la localización anatómica del tumor. Las técnicas actualmente más extendidas para el tratamiento del cáncer de piel son la radioterapia externa con electrones de acelerador lineal y la braquiterapia de alta tasa de dosis.

Journal Article Acute graft‐versus‐host disease (GVHD) overlapping chronic GVHD after reinduction chemotherapy Get access Y. Delgado‐Jimenez, Y. Delgado‐Jimenez Departments of Dermatology and Pathology, Hospital de La Princesa, Diego de Leon 62, 28006 Madrid, Spain E‐mail: ydelgado@aedv.es Search for other works by this author on: Oxford Academic Google Scholar R. Goiriz, R. Goiriz Departments of Dermatology and Pathology, Hospital de La Princesa, Diego de Leon 62, 28006 Madrid, Spain E‐mail: ydelgado@aedv.es Search for other works by this author on: Oxford Academic Google Scholar E. Vargas‐Diez, E. Vargas‐Diez Departments of Dermatology and Pathology, Hospital de La Princesa, Diego de Leon 62, 28006 Madrid, Spain E‐mail: ydelgado@aedv.es Search for other works by this author on: Oxford Academic Google Scholar J. Fraga, J. Fraga Departments of Dermatology and Pathology, Hospital de La Princesa, Diego de Leon 62, 28006 Madrid, Spain E‐mail: ydelgado@aedv.es Search for other works by this author on: Oxford Academic Google Scholar A. Garcia‐Diez, A. Garcia‐Diez Departments of Dermatology and Pathology, Hospital de La Princesa, Diego de Leon 62, 28006 Madrid, Spain E‐mail: ydelgado@aedv.es Search for other works by this author on: Oxford Academic Google Scholar J. Fernandez‐Herrera J. Fernandez‐Herrera Departments of Dermatology and Pathology, Hospital de La Princesa, Diego de Leon 62, 28006 Madrid, Spain E‐mail: ydelgado@aedv.es Search for other works by this author on: Oxford Academic Google Scholar British Journal of Dermatology, Volume 156, Issue 2, 1 February 2007, Pages 388–390, https://doi.org/10.1111/j.1365-2133.2006.07630.x Published: 01 February 2007

Hematopoietic stem cell transplant (SCT) is considered standard therapy for a variety of malignant and nonmalignant diseases. Graft-versus-host disease (GVHD) still represents today a major complication of hematopoietic SCT. Two types of GVHD have traditionally been recognized on the basis of the time of onset following transplantation, distinct pathobiological pathways, and different clinical presentations. The acute form commonly breaks out 2 to 6 weeks after transplantation, affecting up to 60% of patients receiving allogeneic transplants from HLA identical donors. Transfer of immunocompetent donor T cells contained in the graft may undergo alloreactivity against recipient cells because of major or minor histocompatibility antigens disparities between the donor and the immunosuppressed host. Target specificity in acute GVHD involves preferential injury to epithelial surfaces of the skin and mucous membranes, biliary ducts of the liver, and crypts of the intestinal tract. Chronic GVHD affects approximately 30% to 80% of patients surviving 6 months or longer after stem cell transplantation and is the leading cause of nonrelapse deaths occurring more than 2 years after transplantation. Chronic GVHD is a multiorgan syndrome with clinical features suggesting some autoimmune diseases, and possibly both alloreactive and autoreactive T cell clones are involved in its pathophysiology. Although GVHD may convey beneficial graft-versus-leukemia/lymphoma effects, it also entails a significant risk of morbidity and mortality. Patients with mild GVHD need only minimal, if any, immunosuppressive treatment, whereas prognosis of patients with extensive disease or resistant to standard immunosuppressive treatment may be dismal. Early recognition of GVHD followed by prompt therapeutic intervention may prevent the progression to higher-grade disease and improve the outcome for patients receiving hematopoietic SCT.

Background Although skin is typically the first site of involvement of acute graft-versus-host disease (GVHD), most standard recommended staging and grading criteria allow enrolment of patients with involvement of GVHD target organs other than the skin in studies analysing risk factors for acute GVHM after stem cell transplantation (SCT).Objectives To determine the risk factors for developing histologically confirmed acute cutaneous GVHD in patients who underwent allogeneic SCT for different haematological disorders.Methods This retrospective study was based on review of clinical files and databases from 300 consecutive patients with several haematological disorders who received allogeneic SCT between I January 1984 and 31 December 1999 at Hospital Universitario de la Princesa, Madrid, Spain. Variables evaluated included diagnosis of haematological disorder, age and gender (donor and recipient), FILA matching, female donor to male recipient, donor and recipient viral serology (cytomegalovirus), conditioning regimen, GVHD prophylaxis, blood counts at day of engraftment, mortality, cause of death, and survival at 100 days, 5 years and 10 years following SCT.Results In multivariate analysis, risk factors for acute cutaneous GVHD were type of haematological disease (P = 0.006), HLA disparity (P = 0.006), number of transplants per patient (P = 0.017), conditioning regimen (P = 0.001), and GVHD prophylaxis (P = 0.025). Survival rates did not differ significantly for cases and controls.Conclusions Risk factors for acute cutaneous GVHD were a diagnosis of chronic myeloid leukaemia, HLA disparity, receipt of more than one SCT, conditioning regimens including total body irradiation, and GVHD prophylaxis regimens other than ciclosporin plus methotrexate. Other common risk factors for acute GVHD without specific target organ involvement showed no significant association with the risk for developing acute GVHD affecting the skin as primary target organ.

Angiokeratoma corporis diffusum (ACD), initially considered to be synonymous with Fabry's disease, represents a well-known cutaneous marker of some other lysosomal enzyme disorders. Aspartylglucosaminuria (AGU) is a rare hereditary disorder mostly affecting the Finnish population, with only a few sporadic patients of non-Finnish origin. To date, only three patients with AGU have been reported with cutaneous lesions of ACD. A 19-year-old Spanish woman presented with a 10-year history of progressive ACD affecting the limbs, buttocks and trunk. After the age of 6 years she had developed progressive mental deterioration, coarse facies and macroglossia with a scrotal appearance. Peripheral blood smears showed many vacuolated lymphocytes. Enzyme analysis in cultured fibroblasts revealed a decreased activity of aspartylglucosaminidase. By the age of 31 years the patient had developed a bipolar psychosis, polycystic ovarian disease and severe impairment of cognitive skills. This is the first case of AGU detected in a Spanish patient presenting with cutaneous lesions of ACD. To our knowledge, macroglossia with a scrotal appearance and polycystic ovarian disease have not been reported in previous cases of AGU.

Madelung's disease or benign symmetric lipomatosis is rare. Symmetric lipomatosis of the tongue as an association of Madelung's disease is very rare; up to now only two cases of this association have been reported. We report the third case of Madelung's disease with involvement of the tongue in the form of macroglossia.

We report a 73-year-old woman presenting with recurrent eruptions of generalized follicular pustules. Histological examination revealed, several palisading necrobiotic granulomas with mucin deposits, with a perifollicular distribution. A dense neutrophilic infiltrate in the upper portion of affected follicular structures gave rise to pustulous lesions, Scaly papules and pseudovesiculous lesions over the palms with deeper necrobiotic granulomas involving sweat glands and epidermal perforation coexisted in some of the eruptions with generalized pustules, We propose the term follicular pustulous granuloma annulare for this peculiar form of granuloma annulare, which widens the clinicopathological spectrum of presentation of this disease.

Pseudoxanthoma elasticum-like papillary dermal elastolysis is a peculiar idiopathic elastolytic disorder with cutaneous lesions clinically resembling pseudoxanthoma elasticum with partial or total band-like elastolysis of the papillary dermis histopathologically, and without systemic complications. We here report 2 new cases and review the clinicopathological features of patients with this diagnosis in the literature. The possible pathogenesis of this recently described entity is discussed.

Background and Objective. Papular‐purpuric gloves‐and‐socks syndrome (PPGSS) is a recently described dermatosis in which human parvovirus B19 (HPV B19) has been implicated as etiologic agent; however, it is suspected that PPGSS may be caused by various agents. This study was designed to survey the general characteristics of PPGSS and to determine the role of HPV B19 in its etiology.