Terapia fotodinámica con metil aminolevulinato y ácido 5-aminolevulínico en acné inflamatorio leve y moderado: experiencia clínica / Photodynamic therapy with 5-aminolevulinic acid and methyl aminolevulinate for mild to moderate inflammatory acne: clinical experience

Introducción: La terapia fotodinámica (TFD) con ácido 5-aminolevulínico (ALA) y metil aminolevulinato (MAL) ha mostrado utilidad en el manejo del acné inflamatorio. Métodos: Dos grupos de cuatro pacientes cada uno, portadores de acné inflamatorio leve o moderado. Se realizaron dos sesiones de TFD separadas por dos semanas: un grupo fue tratado con MAL y luz roja y el otro, con ALA y luz azul. Se midió la severidad del acné con escala de 6 puntos y se consideró éxito clínico los grados 0 y 1. Resultados: En ambos grupos se observó éxito clínico a las 12 semanas post tratamiento, quedando con pigmentación residual, escasos comedones y menos de 10 pápulas. Se observaron efectos adversos tolerables, siendo los más importantes el eritema y la descamación. Conclusión: La TFD con ALA y MAL es una buena alternativa terapéutica para aquellos pacientes con acné inflamatorio leve y moderado que no responden o tienen contraindicación a los tratamientos convencionales.

Introduction: Photodynamic therapy with methyl aminolevulinate (MAL) and 5-aminolevulinic acid (ALA) has shown to be useful in the management of inflammatory acne. Methods: Two groups of 4 patients each with mild to moderate inflammatory acne. Two PDT sessions were performed within a 2 week interval; one group was treated with MAL and red light, and the other with ALA and blue light. Acne severity was measured with a 6-point scale and clinical success was considered between grades 0 and 1. Results: In both groups, clinical success was observed at 12 weeks post treatment, leaving residual pigmentation, scarce comedones and less than 10 papules. Tolerable side effects were observed, being the most important erythema and desquamation. Conclusion: PDT with ALA and MAL is a good therapeutic option for patients with mild to moderate inflammatory acne who do not respond or have contraindications to conventional treatments.

Queratosis folicular invertida pigmentada: a propósito de un caso: [revisión] / Inverted follicular keratosis: a case report: [review]

La queratosis folicular invertida (QFI) es una lesión benigna del infundíbulo folicular. Es poco frecuente y habitualmente el diagnostico es histopatológico. Clínicamente no presenta características propias ni patognomónicas, por lo que generalmente semeja otras lesiones proliferativas de la piel, como las verrugas, el carcinoma basocelular, las queratosis seborreicas y otros tumores benignos. La forma pigmentada es infrecuente y suele confundirse con melanoma. La queratosis folicular invertida es una entidad de histogénesis controvertida, proponiéndose como alternativas que sea una neoplasia benigna con diferenciación folicular, una variante de verruga vulgar o una queratosis seborreica irritada. El tratamiento de la queratosis folicular invertida es la extirpación completa de la lesión, con un excelente pronóstico, casi sin recurrencias.

Inverted follicular keratosis (IFK) is a benign lesion of follicular infundibulum. It is rare, and diagnosis is usually histopathological. Clinically, it is unique, with no pathognomonic characteristics and therefore often resembles other skin proliferative lesions such as warts, basal cell carcinoma, seborrheic keratoses and other benign tumors. The pigmented form is rare and often confused with melanoma. Inverted follicular keratosis is an entity of controversial histogenesis, alternatively considered as a benign neoplasm with follicular differentiation, a variant of vulgaris warts or irritated seborrheic keratoses. Treatment for inverted follicular keratosis is the complete removal of the lesion, with excellent prognosis, almost without recurrence.

Trastorno dismórfico corporal / Body dysmorphic disorder

Anteriormente llamado dismorfofobia, el trastorno dismórfico corporal (TDC) se define como la preocupación excesiva y desproporcionada por un defecto mínimo o imaginario en la apariencia física. El defecto generalmente se encuentra en la cara, aunque puede ser en cualquier parte del cuerpo. Es una enfermedad de mal pronóstico que remite raramente de forma completa y provoca un deterioro en la vida del paciente, el cual demanda constantemente soluciones médicas o quirúrgicas; sin embargo, si es oportunamente sospechada y tratada, tiene un curso más favorable. Estos pacientes frecuentemente consultan a dermatólogos y cirujanos plásticos, con la idea de mejorar sus defectos físicos. Su trastorno psiquiátrico habitualmente es subdiagnosticado, lo que puede desencadenar una acción iatrogénica e incluso consecuencias médico-legales.

Formerly called dysmorphophobia, body dysmorphic disorder (BDD) is defined as the exaggerated, out of proportion preoccupation with the slightest or imaginary defect of the body s appearance. The defect is normally found on the face, although it can also be present in any part of the body. The prognosis for this condition is poor, and rarely goes entirely into remission, deteriorating the patient s quality of life. Those who suffer from this syndrome demand medical or surgical solutions. However, if early diagnosis and treatment are made the course of the disease may improve. Patients frequently seek dermatologists and plastic surgeons consultation to overcome these defects. Psychiatric disorders are commonly under-diagnosed and may lead to atrogenic actions, and possible legal consequences.

Has the mammary gland a protective mechanism against overexposure to triiodothyronine during the peripartum period? The prolactin pulse down-regulates mammary type I deiodinase responsiveness to norepinephrine.

Peripartum is a crucial period for mammary gland final differentiation and the onset of lactation. Although the 'trigger' for lactogenesis depends on several hormones, a key factor is the peripartum prolactin (PRL) pulse whose deletion results in a failure to initiate milk production. Other hormones having a critical role during this period but exerting a contrary effect are the thyronines. A transitory hypothyroidism occurs at peripartum in serum and several other extrathyroidal tissues, whereas the induction of hyperthyroidism during late pregnancy is associated with the absence of lactation after delivery. We analyzed the mammary gland during pregnancy and lactation for: (a) the type and amount of thyroid receptors (TRs), (b) the local triiodothyronine (T3) generation catalyzed by type I deiodinase (Dio1), (c) the Dio1 response to norepinephrine (NE) and (d) the effect on Dio1 and TRs of blocking the PRL pulse at peripartum. Our data showed that during pregnancy the mammary gland contains Dio1 in low amounts associated with the highest expression of TRalpha1; whereas during lactation the gland shows high levels of both Dio1 and TRalpha1. However, at peripartum, both TRs and Dio1 decrease, and Dio1 becomes refractory to NE. This refractoriness disappears when the PRL pulse is blocked by the dopamine agonist bromocriptine. This blockade is also accompanied by a significant decrease in cyclin D1 expression. Our data suggested that the peripartum PRL pulse is part of a protective mechanism against precocious differentiation and/or premature involution of the alveolar epithelium due to T3 overexposure.

Liver 5'-deiodinase activity is modified in rats under restricted feeding schedules: evidence for post-translational regulation.

Restricted feeding schedules (RFSs) produce a behavioral activation known as anticipatory activity, which is a manifestation of a food-entrained oscillator (FEO). The liver could be playing a role in the physiology of FEO. Here we demonstrate that the activity of liver selenoenzyme deiodinase type 1 (D1), which transforms thyroxine into triiodothyronine (T3), decreases before food access and increases after food presentation in RFSs. These changes in D1 activity were not due to variations in D1 mRNA. In contrast, a 24 h fast promoted a decrease in both D1 activity and mRNA content. The adjustment in hepatic D1 activity was accompanied by a similar modification in T3-dependent malic enzyme, suggesting that the local generation of T3 has physiological implications in the liver. These results support the notion that the physiological state of rats under RFSs is unique and distinct from rats fed freely or fasted for 24 h. Data also suggest a possible role of hepatic D1 enzyme in coordinating the homeorhetic state of the liver when this organ participates in FEO expression.

Effect of suckling and adrenergic stimulation on peripheral deiodination in lactating rats: differential expression of type 1 deiodinase mRNA forms.

Previous works led us to propose that peripheral iodothyronine deiodination is mainly regulated by the reciprocal interaction between the thyroid and the sympathetic nervous system (SNS). In this study, we analyzed the role suckling exerts, through SNS activation, upon deiodination of thyronines in liver, heart, brown adipose tissue and mammary gland during lactation. Our results showed that resuckling causes a concurrent stimulatory response on deiodinase type 1 (D1) in heart and mammary gland, but not in liver and brown adipose tissue. The stimulatory response was mimicked by norepinephrine and by the beta-adrenergic agonist isoproterenol, through the overexpression of the large form of D1 mRNA. These results suggested that, during lactation, peripheral thyronine deiodination is co-ordinated by the SNS, and suckling is a major modulatory influence.

[Systemic inflammatory response syndrome: is it comparable with severe sepsis?]. / Síndrome de respuesta inflamatoria sistémica severa: es comparable a la sepsis severa?

BACKGROUND: In 1992, a consensus conference defined the terms systemic inflammatory response syndrome (SIRS), sepsis, severe sepsis and septic shock. Since then, numerous reports have validated the prognostic usefulness of these operative definitions. AIM: To evaluate if sepsis severity criteria, as defined by the Consensus Conference, can be applied to noninfectious SIRS. PATIENTS AND METHODS: Five hundred eighteen patients admitted to 5 intensive care units (ICU) from 4 hospitals were prospectively evaluated during a 3 months period. Patients that met at least one severity criteria were included. SIRS etiology, organ dysfunction and evolution were recorded in each patient. RESULTS: One hundred two patients were included: 79 with sepsis (group I) and 23 with noninfectious SIRS (group II). ICU and hospital mortality were comparable (43 and 48% in sepsis compared to 43 and 51% in non infectious SIRS). The most common sources of sepsis were pneumonia and peritonitis. Group II patients had a wide variety of diseases. ICU stay, APACHE score and number of organs with dysfunction were not different among groups. Only the incidence of renal dysfunction was higher in the septic group. CONCLUSIONS: The Consensus sepsis severity criteria can be applied to noninfectious SIRS, defining a population subset with similar high mortality and organ dysfunction incidence, although with greatly heterogeneous etiologies.

Mammary gland sympathetic innervation is a major component in type 1 deiodinase regulation.

Recent observations have shown that in lactating rats previously deprived of suckling, either suckling stimulus or ip injection of norepinephrine was capable of increasing mammary deiodinase type 1 (M-D1) mRNA content and enzyme activity. In the present work, we show that intact efferent sympathetic mammary innervation is required to restore both mammary D1 mRNA content and enzyme activity, whereas suckling-induced secretion of catecholamines from the adrenal glands does not seem to participate in M-D1 enzyme regulation. The data also indicate that the sympathetic reflex activation in response to suckling involves two complementary autonomic components: (1) activation, presumably through mammary segmental arrangement affecting neighboring mammary glands; and (2) an individual reflex regulatory mechanism capable of maintaining M-D1 activity within each mammary gland. In addition to these findings, we show that the suckling-induced sympathetic activation of M-D1 activity could be blocked by prior activation of ductal mechanoreceptors. This set of regulatory and counterregulatory mechanisms seems to ensure the optimal control of mammary energetic expenditure according to litter size.