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Background Chronic spontaneous urticaria (CSU) may occasionally exhibit long‐lasting lesions with bruising, usually considered a hallmark of urticarial vasculitis (UV). Histopathology of these chronic urticarial lesions has not been extensively studied. Methods Skin biopsies from patients with anti‐H1 resistant CSU were evaluated for several parameters (edema, location, intensity, and cell composition of the inflammatory infiltrate, and abnormalities in the blood vessels). Results We studied 45 patients (37 female/8 male, mean age 49.3 years) with CSU, 60% of whom with occasional bruising lesions and 3 patients with hypocomplementemic UV. Histopathology in CSU showed mainly perivascular and interstitial inflammatory infiltrate (91.1%), including eosinophils (80%), neutrophils (77.8%), and lymphocytes (71.1%), vasodilatation (88.9%), intravascular neutrophils (95.6%), dermal edema (51.1%), swelling of endothelial cells (51.1%), and minor and rare fibrinoid necrosis and karyorrhexis (6.7%). Significant karyorrhexis and frank fibrinoid necrosis were observed, respectively, in two and three cases of UV. In patients with occasional bruising, mast cells occurred in fewer cases whereas eosinophils were more frequent, but no statistically significant difference was found for other parameters. Conclusions Histopathological findings were not significantly different between CSU with or without bruising lesions. Bruising may be associated with more severe forms of CSU with no histopathological signature, although UV cannot be completely excluded based on histopathology.

Endometriosis is a chronic disorder characterized by the presence of ectopic functional endometrial tissue outside the uterine cavity and which affects about 10% of all women of reproductive age. Cutaneous endometriosis, usually localized in the abdominal wall, is a rare entity. We report the case of a nulliparous woman with an acute painful umbilical nodule that slowly increased in size during the days prior to observation. The lesion was surrounded by a painful periumbilical subcutaneous plaque. The patient denied associated constitutional symptoms and reported two similar episodes in the previous two years. A skin biopsy was performed, and histopathologic examination was consistent with the diagnosis of endometriosis. This article reviews this disease particularly rare in nulliparous and highlights the importance of recognizing this clinical presentation of endometriosis due to its frequent association with pelvic disease that can lead to reduced fertility.

DISCUSSIONThis relatively low reactivity to IPBC, and the higher prevalence in males and those aged >40 years, are consistent with results from another European centre, 7 but are distinct from results from the last 10 years in North America. They showed higher reactivity to IPBC (between 3.1% and 4.7%), possibly because of the inclusion of doubtful results and the higher patch test concentration (0.5% pet). 8 Low IPBC reactivity contrasts with high reactivity to isothiazolinones (>14%), 9 which is still found among our patients in many household and professional products and occasional

We present a 6-year-old girl with skin hyperpigmentation, leukoplakia, and onychodystrophy, the classic mucocutaneous triad usually associated with dyskeratosis congenita. The patient also had premature graying of the hair, bone marrow failure, hepatitis, exudative retinopathy, osteopenia with multiple long bone fractures, and intracranial calcifications and brain cysts. Coats plus syndrome is a rare disease with a clinical and genetic overlap with dyskeratosis congenita. This disease is reviewed, with a focus on the pathogenesis of the genetic anomalies and its background as a telomere biology disorder.

K E Y W O R D S : allergic contact dermatitis: occupational, glove protection, (meth)acrylates, 30-minute patch test Allergic contact dermatitis (ACD) caused by (meth)acrylates in nail aesthetics is a rising concern in the occupational setting 1,2 Some technicians may have to abandon the job, as allergen avoidance is difficult. 3Aiming to evaluate the capacity of gloves to protect against occupational ACD, we performed patch tests with glove fragments placed between the allergens and patients' skin for different time periods, in patients with occupational ACD and positive patch test reactions to the (meth)acrylates and negative patch test results with gloves. METHODS Finn Chambers loaded with 2-hydroxyethylmethacrylate (HEMA) 2%pet. (Chemotechnique Diagnostics, Vellinge, Sweden) or patients' own products "as is" were applied on 3 × 3-cm fragments of different types of gloves used by the patients at work (thin nitrile gloves, thicker nitrile gloves, "medical" latex gloves, and domestic rubber gloves), and fixed on patients' backs or arms with tissue-type tape. Contact with the skin was maintained for different time intervals (30 minutes to 24 hours) in order to allow the allergen to permeate through the glove and reach the skin. A test chamber with HEMA 2% pet. was also applied directly on the skin for the same time period for comparison ( Figure 1A). After the respective time period, test chambers and glove fragments were removed, and the application areas were marked with a colour skin pen.Readings were performed on day (D) 3 and D5-D7, according to ESCD recommendations. All patients gave their written informed consent. RESULTSCase 1 was a 38-year-old nail aesthetician with hand eczema of 6 months' duration, and with a doubtful reaction to HEMA and positive patch test reaction to the nail gel "as is" (+++). Case 2 was a 56-year-old nail aesthetician with eyelid and hand eczema of 4 months' duration, and with positive patch test reactions to HEMA (++), hydroxypropyl methacrylate (HPMA) 2% pet. (++), hydroxyethyl acrylate 0.1% pet. (++), ethylene glycol dimethacrylate (EGDMA) 2% pet. (+), and triethylene glycol diacrylate (TREGDA) 0.1% pet. (+). Case 3 was a 50-year-old nail aesthetician with persistent pulpitis of 7 months' duration despite using nitrile gloves, and positive patch test reactions to HEMA (++), HPMA 2% pet. (++), EGDMA 2% pet. (++), TREGDA 0.1% FIGURE 1 Illustration of the technique. (A), 2-Hydroxyethylmethacrylate (HEMA) on Finn Chambers applied directly on the skin (squares above) and over blue nitrile glove fragments (squares below), with occlusion for 30 minutes (left) and 60 minutes (right), with reactions on day 3. (B), Strong positive reactions after 30 and 60 minutes of contact with no protection (above), a negative result with protection for 30 minutes (right), but a positive reaction after 60 minutes of exposure over nitrile gloves (left) 62 MORGADO ET AL.

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