Journal Information
Vol. 111. Issue 7.
Pages 611 (September 2020)
Vol. 111. Issue 7.
Pages 611 (September 2020)
Images in Dermatology
DOI: 10.1016/j.adengl.2020.08.009
Open Access
«Before applying the next dose, peel the white film off the lesion»
«Antes de la siguiente aplicación, retira la película blanca»
A. López Gómez
Corresponding author

Corresponding author.
, Z. Ezsol Lendvai, M.I. de la Hera Matute
Servicio de Dermatología, Hospital de la Vega Lorenzo Guirao, Cieza, Murcia, Spain
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An 84-year-old woman visited our department with a lesion on the right side of the forehead that had been growing progressively. The patient presented a yellow-whiteish, compact, stony material on the skin with agglutinated hair and strongly adhered to the surface of the skin (Fig. 1). After carefully removing the material, the underlying skin revealed an erythematous plaque with a hyperkeratotic central area.

Fig. 1.

Appearance of patient's forehead on entering the consulting room.


When taking the patient’s history, the patient’s family member stated that they had been applying Actikerall® solution (fluorouracil + salicylic acid) daily to the lesion since it had appeared, prescribed by her primary-care physician, but without removing the film that forms on the skin when the solution dries before each application. This led to the accumulation of material in layers with the appearance of puff pastry.

The lesion was finally excised with a histopathology diagnosis of squamous cell carcinoma in situ.

This case illustrates the importance of dedicating the necessary time in the consultation so that patients or their family members understand clearly the treatments we prescribe, as well as the utility of providing them with information leaflets that clearly describe the instructions for correct application.

Please cite this article as: López Gómez A, Ezsol Lendvai Z, de la Hera Matute MI. «Antes de la siguiente aplicación, retira la película blanca». Actas Dermosifiliogr. 2020;111:611.

Actas Dermo-Sifiliográficas (English Edition)

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