Pyoderma gangrenosum (PG) is a rare, chronic neutrophilic dermatosis of unknown aetiology that usually presents with necrotising ulcers, although the evolution of the disease can be variable and is not always progressive. Its pathogenesis is poorly understood but an underlying immunological abnormality seems to be implicated in the genesis of the lesions. This hypothesis is supported by its frequent association with inflammatory bowel disease, malignancies, and rheumatological disorders. The diagnosis is challenging even for dermatologists as there are no specific tests or histological features. There are no clinical trials evaluating the efficacy of the different drugs used to treat the disease due to its rarity, and therefore there is no ’gold standard’ therapy. In this mini-review we describe the main clinical aspects of PG, its pathophysiology, association with underlying diseases, diagnosis, treatment options, and prognosis.

Calcinosis cutis is a rare syndrome characterized by the deposition of insoluble calcium salts in the skin and subcutaneous tissue. It can be classified as: dystrophic, metastatic, iatrogenic and idiopathic. 1 Dystrophic calcinosis cutis (DCC) is the most common type and is characterized by the abnormal deposition of calcium salts in degenerated tissues with serum calcium and phosphate levels within normal range. DCC occurs in association with connective tissue diseases, cutaneous neoplasms, infections, trauma and inherited disorders, such as pseudoxanthoma elasticum. 2It has been rarely reported as a late complication of burn scars. A 57-year-old man presented for evaluation of a 6-monthold non-healing ulcer on his right leg. His medical history was only remarkable for a previous thermal burn on the same site that spontaneously healed with scaring at the age of 15. We was no under any medication. On physical examination within a burn scar a 3 X 1 cm well-defined ulcer with erythematous indurated borders filled with a hard yellowish-brown material was observed (Fig. 1). Some hard material was removed from the ulcers bed and a skin biopsy was performed. Histopathology revealed the particles to be calcium and showed the presence of amorphous dystrophic calcium deposits in the subcutaneous tissue (Fig. 2). The analytical study showed no abnormalities with serum calcium and phosphate levels within normal range. The diagnosis of DCC was made. Six months after surgical excision of the lesion there was no evidence of recurrence.A review of the literature shows that DCC is a rare event as a late complication of burn scars. Latency periods of 15-54 years have been reported. 2,3 In our case, a latency period of 42 years was observed. DCC with squamous cell carcinoma in a postburn scar has also been documented. 4 The pathophysiology of the disorder is still not clear. High levels of intracellular calcium resulting from damaged cell membranes may form hydroxyapatite crystals and the precipitation of calcium phosphate caused by the increased alkalinity of the necrotic tissue are suggested hypothesis.

Brachioradial pruritus is a chronic sensory neuropathy of unknown etiology which affects the skin of the shoulders, arms and forearms on the insertion of the brachioradialis muscle. We describe the case of a 60-yearold woman recently diagnosed with multiple myeloma who refers paresis, severe pruritus and itching lesions on the right arm with 6 months of evolution. Investigation led to a diagnosis of Brachioradial pruritus consequent to the presence of cervical disc herniation and Parsonage-Turner syndrome. The patient started gabapentin 900mg/day with good control of itching. Corticosteroids and antihistamines are often ineffective in the treatment of BP. Gabapentin has been used with encouraging results. All patients with Brachioradial pruritus should be evaluated for cervical spine injuries.

Adenofibroma is an extremely uncommon benign tumor composed of glandular and fibrous tissues. It occurs more often in the endometrium but it can also occur in the cervix and extrauterine sites. We report a case of a 32-year-old asymptomatic woman with cervical adenofibroma, first detected in a routine endovaginal ultrasound, as a cervical mass containing multiple cystic components. Histopathologic findings diagnosed its nature. As adenofibromas are very rare, we present this case with a brief review of the literature.

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