Our study brings evidence of a higher thrombophilic risk among the patients with early onset of the CVU as they had significantly higher prevalence of multiple (≥3) thrombophilias (P=0.03), homozygous mutations (P=0.03) and family history of leg ulcer (P=0.02) when compared with patients with later onset. Thrombophilia screening is important in patients with CVU before the age of 50 in order to stratify the thrombotic risk and to allow an appropriate prophylactic and therapeutic management.

No abstract

Recognition of facial lentigo maligna (LM) is often difficult, particularly at early stages. Algorithms and multivariate diagnostic models have recently been elaborated on the attempt to improve the diagnostic accuracy. We conducted a cross-sectional and retrospective study to evaluate dermatoscopic criteria aiding in diagnosis of flat pigmented facial lesions (FPFL). We examined 46 FPFL in 42 Caucasian patients and found that 4 of 20 dermatoscopic criteria reached the significance level required for features indicating malignancy namely, hyperpigmented follicular openings, obliterated follicular opening, annular-granular structures, and pigment rhomboids. Concomitant presence of at least 2 or 3 of the 4 mentioned criteria was significantly more frequent in LM than in pigmented actinic keratosis (PAK). However, despite more frequently seen in LM, these features were also displayed in some of the PAK and other FPFL, so we found them not specific for LM. Although dermatoscopy enhances the diagnostic accuracy in evaluating FPFL, histopathology remains the gold standard for correct diagnosis, making evident the need for improvements in early noninvasive diagnosis of LM.

No abstract

Riga-Fede disease is a rare, benign disorder characterized by reactive ulceration of the oral mucosa associated with repetitive dental traumatism. It was first described in children with neurologic disorders and is very rare in adults. This case report describes the occurrence of a large ulcer of the tongue, resembling squamous cell carcinoma, in an adult with hemiparesis. The lesion cleared after neurologic recovery. This case highlights the importance of considering this disorder in the differential diagnosis of oral mucosal ulcerations.

We report the case of a 22-year-old male patient with 2 episodes, 4 months apart, of acute generalized exanthematous pustulosis (AGEP) associated with oral intake of amoxicillin and simultaneous reactivation of parvovirus B19 infection proven by positive polymerase chain reaction test in the skin fragment and blood sample and elevation of the IgG antibodies titer. To our knowledge, this is the first report of AGEP resulting from the interaction between drug hypersensitivity and the reactivation of parvovirus B19. A combination of an immunological reaction to the drug and virus infection could be responsible for the clinical picture.

Fixed drug eruption (FDE) is most commonly associated with antibiotics, anticonvulsants, and nonnarcotic analgens, including nonsteroidal anti-inflammatory drugs (NSAIDs). However, the newer cyclooxygenase 2 (COX-2) inhibitors have been rarely reported to cause FDE. We report the case of a 52-year-old Caucasian woman with erythematous pruritic plaques on the neck, left forearm, and second finger of the right hand, healing with hyperpigmentation and recurring in the same locations. The patient was sporadically taking oral etoricoxib 90 mg for her back pain and noticed the relation between administration of the drug and skin lesions, the time interval decreasing progressively from 1 week to 30 minutes. No other signs, symptoms, or drug intake was mentioned. The patch tests with etoricoxib 1% and 5% in petrolatum were positive at the location of the lesions and negative on the back (nonlesional skin). Standard European and NSAID series were negative. Patch tests of 10 healthy controls with etoricoxib 1% and 5% in petrolatum were negative. After the avoidance of the drug, no relapse was mentioned. The patch test was reliable for the diagnosis of FDE, avoiding the need for subsequent oral provocation testing and therefore preventing the possible adverse effects. Despite being regarded as a safe drug, the occurrence of cutaneous adverse reactions to etoricoxib should be considered, especially in the setting of its increasing use in pain control.

Introdução: A pele e as mucosas são alvos comuns das reacções aos medicamentos, com uma grande variabilidade de formas clínicas e fármacos envolvidos. Objectivo: O nosso estudo pretende caracterizar as toxidermias que necessitaram de internamento. Métodos: Foram analisados os dados clínicos e laboratoriais dos doentes com o diagnóstico de toxidermia internados no nosso Serviço durante 11 anos (2000-2010). Resultados: O estudo incluiu 168 doentes (110 do sexo feminino e 58 do sexo masculino). As formas clínicas foram: exantema máculo-papular (n=85, 50.6%), síndrome Stevens-Johnson (SSJ: n=14, 8.3%), necrólise epidérmica tóxica (NET: n=10, 5.9 %), overlap SSJ/NET (n=3), síndrome de hipersensibilidade (n=12), reacção de fotossensibilidade (n=10), eritrodermia (n=9), pustulose exantemática aguda (n=6), eritema pigmentado fixo (n=6), vasculite (n=5), eritema multiforme (n=3), urticária/angioedema (n=2), síndrome de Sweet (n=1), exantema flexural simétrico re- lacionado com fármacos (n=1), erupção liquenóide (n=1). Os fármacos mais frequentemente envolvidos foram: antibióticos (39,8%, sobretudo amoxicilina/ácido clavulânico e cotrimoxazol), anticonvulsivantes (15,5%), antinflama- tórios não-esteróides (13,5%) e alopurinol (12,5%). Em 4 pacientes foi encontrada infecção vírica concomitante (vírus Epstein Barr, citomegalovírus, herpes vírus humano 6 e parvovírus B19). O intervalo mediano entre a toma do fármaco e o aparecimento da dermatose foi de 8 dias (variando entre 6 horas e 90 dias). Dezanove doentes continuaram o medicamento por mais de 10 dias após o início da erupção; 6 deles desenvolveram eritrodermia mas nenhum evoluiu para SJS/NET. Corticoterapia foi utilizada na maioria dos doentes e imunoglobulina endovenosa em 15 casos. A mortalidade global foi de 5,3%, sendo de 26% na SSJ/NET. Além do elevado valor do SCORTEN, a presença da infecção e a hipoalbuminémia foram relacionadas com a mortalidade na SJS/NET.PALAVRAS-CHAVE – Toxidermias; Fármacos; Internamento.