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1.
J Am Acad Dermatol ; 2024 Jul 05.
Artículo en Inglés | MEDLINE | ID: mdl-38972480

RESUMEN

BACKGROUND: Patch testing to multiple cross reactive allergens for allergic contact dermatitis (ACD) may not be necessary due to copositivity. OBJECTIVE: We evaluated the formaldehyde group allergens to determine the optimal, most cost-effective allergens to test. METHODS: A retrospective analysis of Mayo Clinic (1997-2022) examined the well-established copositive formaldehyde group: Formaldehyde, Quaternium 15, Hexahydro-1,3,5-tris(2-hydroxyethyl)triazine, Diazolidinyl urea, Imidazolidinyl urea, Toluenesulphonamide formaldehyde resin, DMDM hydantoin, and Ethyleneurea melamine formaldehyde mix. Patch Optimization Platform (POP) identified which single formaldehyde-related allergen optimally captures patients with clinically relevant ACD. Next, POP determined the optimal additional 1, 2, 3, etc. allergens. Cost per patch test was $5.19 (Medicare 2022). RESULTS: 9832 patients were tested to all listed allergens, with 830 having positive patch tests. POP determined that Quaternium 15 alone captures 53% of patients with ACD to the formaldehyde group; adding the optimal second allergen (Formaldehyde 1%) captures 78%; the optimal five top allergens capture over 94% of patients. The incremental cost-per-additional-diagnosis increased up to 44-fold as the number of allergens tested increased. LIMITATIONS: Data is from a single institution, and the cost-per-test was fixed to Medicare Part B in 2022. CONCLUSIONS: For diagnosing ACD, we recommend considering an optimized allergen selection algorithm.

2.
J Cutan Pathol ; 2024 Jul 12.
Artículo en Inglés | MEDLINE | ID: mdl-38993097

RESUMEN

Histiocytoid Sweet syndrome (H-SS) is a histopathological variant of Sweet syndrome (SS) defined by cutaneous infiltration of immature myeloid cells morphologically resembling histiocytes. The association of H-SS with underlying malignancy, particularly myelodysplastic syndromes, is well-established. Myelodysplasia cutis (MDS-cutis) has been proposed to describe cases historically diagnosed as H-SS but characterized by shared clonality of the myeloid infiltrate in skin and bone marrow. Therefore, identifying patients who might have MDS-cutis is critical for the management of the associated hematologic malignancy. VEXAS syndrome, an adult-onset autoinflammatory disease, should also be included in the histopathologic differential diagnosis of H-SS, as it shares clinical and pathologic features with MDS-cutis. Through the presentation of two cases, we aim to highlight the defining features and key clinical implications of MDS-cutis and VEXAS syndrome.

3.
Exp Dermatol ; 32(9): 1498-1508, 2023 09.
Artículo en Inglés | MEDLINE | ID: mdl-37317627

RESUMEN

Vulvar lichen planus (VLP) is a chronic inflammatory disease which adversely affects patients' quality of life. The pathogenesis of VLP is unknown although Th1 immune response has been implicated. We aimed to discover specific tissue-based protein biomarkers in VLP compared to normal vulvar tissue (NVT), vulvar lichen sclerosus (VLS) and oral lichen planus (OLP). We used laser capture microdissection-liquid chromatography- tandem mass spectrometry to assess protein expression in fixed lesional mucosal specimens from patients with VLP (n = 5). We then compared proteomic profiles against those of NVT (n = 4), VLS (n = 5), OLP (n = 6) and normal oral mucosa (n = 5), previously published by our group. IL16, PTPRC, PTPRCAP, TAP1 and ITGB2 and were significantly overexpressed in VLP compared to NVT. Ingenuity pathway analysis identified antigen presentation and integrin signalling pathways. Proteins overexpressed in both VLP versus NVT and OLP versus NOM included IL16, PTPRC, PTPRCAP, TAP1, HLA-DPB1, HLA-B and HLA-DRA. This proteomic analysis revealed several overexpressed proteins in VLP that relate to Th1 autoimmunity, including IL16. Overlapping pathways, including those involving IFNγ and Th1 signalling, were observed between VLP, VLS, and OLP.


Asunto(s)
Liquen Plano Oral , Liquen Plano , Liquen Escleroso Vulvar , Femenino , Humanos , Liquen Escleroso Vulvar/patología , Interleucina-16 , Proteómica , Calidad de Vida , Liquen Plano/patología , Mucosa Bucal
4.
Exp Dermatol ; 31(12): 1920-1926, 2022 12.
Artículo en Inglés | MEDLINE | ID: mdl-35960231

RESUMEN

Vulvar lichen sclerosus (VLS) confers approximately 3% risk of malignant transformation to vulvar squamous cell carcinoma (VSCC). We used unbiased proteomic methods to identify differentially expressed proteins in tissue of patients with VLS who developed VSCC compared to those who did not. We used laser capture microdissection- and nanoLC-tandem mass spectrometry to assess protein expression in individuals in normal vulvar tissue (NVT, n = 4), indolent VLS (no VSCC after at least 5 years follow-up, n = 5) or transforming VSCC (preceding VSCC, n = 5). Interferon-γ and antigen-presenting pathways are overexpressed in indolent and transforming VLS compared to NVT. There was differential expression of malignancy-related proteins in transforming VLS compared to indolent VLS (CAV1 overexpression, AKAP12 underexpression), particularly in the EIF2 translation pathway, which has been previously implicated in carcinogenesis. Results of this study provide additional molecular evidence supporting the concept that VLS is a risk factor for VSCC and highlights possible future biomarkers and/or therapeutic targets.


Asunto(s)
Carcinoma de Células Escamosas , Liquen Escleroso Vulvar , Neoplasias de la Vulva , Femenino , Humanos , Liquen Escleroso Vulvar/complicaciones , Liquen Escleroso Vulvar/metabolismo , Liquen Escleroso Vulvar/patología , Proteómica , Neoplasias de la Vulva/patología , Transformación Celular Neoplásica , Carcinoma de Células Escamosas/metabolismo
5.
J Am Acad Dermatol ; 87(6): 1352-1360, 2022 12.
Artículo en Inglés | MEDLINE | ID: mdl-32428608

RESUMEN

Because of a convergence of the availability of large data sets, graphics-specific computer hardware, and important theoretical advancements, artificial intelligence has recently contributed to dramatic progress in medicine. One type of artificial intelligence known as deep learning has been particularly impactful for medical image analysis. Deep learning applications have shown promising results in dermatology and other specialties, including radiology, cardiology, and ophthalmology. The modern clinician will benefit from an understanding of the basic features of deep learning to effectively use new applications and to better gauge their utility and limitations. In this second article of a 2-part series, we review the existing and emerging clinical applications of deep learning in dermatology and discuss future opportunities and limitations. Part 1 of this series offered an introduction to the basic concepts of deep learning to facilitate effective communication between clinicians and technical experts.


Asunto(s)
Aprendizaje Profundo , Radiología , Humanos , Inteligencia Artificial , Dermatólogos , Radiología/métodos , Radiografía
6.
J Am Acad Dermatol ; 87(6): 1343-1351, 2022 12.
Artículo en Inglés | MEDLINE | ID: mdl-32434009

RESUMEN

Artificial intelligence is generating substantial interest in the field of medicine. One form of artificial intelligence, deep learning, has led to rapid advances in automated image analysis. In 2017, an algorithm demonstrated the ability to diagnose certain skin cancers from clinical photographs with the accuracy of an expert dermatologist. Subsequently, deep learning has been applied to a range of dermatology applications. Although experts will never be replaced by artificial intelligence, it will certainly affect the specialty of dermatology. In this first article of a 2-part series, the basic concepts of deep learning will be reviewed with the goal of laying the groundwork for effective communication between clinicians and technical colleagues. In part 2 of the series, the clinical applications of deep learning in dermatology will be reviewed and limitations and opportunities will be considered.


Asunto(s)
Aprendizaje Profundo , Neoplasias Cutáneas , Humanos , Inteligencia Artificial , Dermatólogos , Algoritmos , Neoplasias Cutáneas/diagnóstico
7.
J Am Acad Dermatol ; 82(3): 634-641, 2020 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-31344376

RESUMEN

BACKGROUND: Focal or total skin radiation therapy can be used to treat mild to refractory cutaneous T-cell lymphoma. OBJECTIVE: To report the broad therapeutic benefit of radiation therapy for cutaneous T-cell lymphoma. METHODS: Retrospective, single-institution review of outcomes for skin-directed radiation therapy. RESULTS: Skin-directed radiation therapy showed a 99% response rate and 80% complete response rate after treatment regardless of involvement, severity, histopathologic subtype, dose, or fractionation. The overall in-field recurrence rate was 15%, and median time to recurrence was 296 days (range, 1-1884 days). Focal and hypofractionated regimens were similarly associated with disease response and rare toxicity. Short-term rates of secondary skin cancer after treatment were comparable to expected incidence in a patient population without radiation. LIMITATIONS: Large total number of treatments courses compared with overall number of patients. Heterogenous mix of treatment regimens (no standardization of dose or fraction number). CONCLUSIONS: Radiation therapy is a well-tolerated treatment option for properly selected patients with cutaneous T-cell lymphoma.


Asunto(s)
Linfoma Cutáneo de Células T/radioterapia , Neoplasias Cutáneas/radioterapia , Anciano , Femenino , Humanos , Masculino , Radioterapia/métodos , Estudios Retrospectivos , Piel , Resultado del Tratamiento
8.
J Am Acad Dermatol ; 82(6): 1553-1567, 2020 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-32151629

RESUMEN

Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are life-threatening conditions with high morbidity and mortality. Supportive care management of SJS/TEN is highly variable. A systematic review of the literature was performed by dermatologists, ophthalmologists, intensivists, and gynecologists with expertise in SJS/TEN to generate statements for supportive care guideline development. Members of the Society of Dermatology Hospitalists with expertise in SJS/TEN were invited to participate in a modified, online Delphi-consensus. Participants were administered 9-point Likert scale questionnaires regarding 135 statements. The RAND/UCLA Appropriateness Method was used to evaluate and select proposed statements for guideline inclusion; statements with median ratings of 6.5 to 9 and a disagreement index of ≤1 were included in the guideline. For the final round, the guidelines were appraised by all of the participants. Included are an evidence-based discussion and recommendations for hospital setting and care team, wound care, ocular care, oral care, urogenital care, pain management, infection surveillance, fluid and electrolyte management, nutrition and stress ulcer prophylaxis, airway management, and anticoagulation in adult patients with SJS/TEN.


Asunto(s)
Síndrome de Stevens-Johnson/terapia , Adulto , Humanos
9.
Dermatol Surg ; 45(4): 519-526, 2019 04.
Artículo en Inglés | MEDLINE | ID: mdl-30608295

RESUMEN

BACKGROUND: Few reports describe squamous cell carcinoma (SCC) arising in hidradenitis suppurativa (HS). OBJECTIVE: The 2 objectives were (1) to describe the clinical characteristics, pathologic findings, and postoperative outcomes of SCC in HS and (2) to assess whether human papillomavirus (HPV) is involved in the pathogenesis. MATERIALS AND METHODS: Cases of SCC in HS were identified through institutional medical records (1976-2013) and the Rochester Epidemiology Project. Tumor specimens were assessed for HPV DNA/RNA with in situ hybridization. RESULTS: Twelve patients were identified (11 Caucasians and 9 men). All SCCs involved gluteal, perianal, or perineal skin; 1 patient had, in addition, involvement of the vagina. Surgical excision was performed on all 12 patients, 4 of whom had a colostomy. Mean duration of HS before SCC development was 28.5 years (range, 15-53 years). Mean follow-up was 4.3 years after surgical excision. Seven of 12 patients followed had postoperative SCC recurrence. Squamous cell carcinoma caused death despite wide surgical excision in these 7 patients. Of the remaining 5 patients, 4 are unknown and 1 who did not recur had an in situ SCC (Bowen disease carcinoma). Squamous cell carcinoma was not associated with high-risk or low-risk HPV. CONCLUSION: Invasive SCC arising in HS carries a high risk of death.


Asunto(s)
Carcinoma de Células Escamosas/patología , Hidradenitis Supurativa/patología , Neoplasias Cutáneas/patología , Canal Anal/patología , Nalgas/patología , Carcinoma de Células Escamosas/etiología , Carcinoma de Células Escamosas/mortalidad , Carcinoma de Células Escamosas/virología , Femenino , Hidradenitis Supurativa/complicaciones , Hidradenitis Supurativa/mortalidad , Hidradenitis Supurativa/virología , Humanos , Masculino , Papillomaviridae/aislamiento & purificación , Infecciones por Papillomavirus/complicaciones , Infecciones por Papillomavirus/virología , Perineo/patología , Piel/patología , Neoplasias Cutáneas/etiología , Neoplasias Cutáneas/mortalidad , Neoplasias Cutáneas/virología
10.
Am J Dermatopathol ; 41(9): 644-648, 2019 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-31433793

RESUMEN

The recently published 2016 revision of the WHO classification of lymphoid neoplasms includes primary cutaneous acral CD8-positive T-cell lymphoma (PCATCL) as a provisional entity. This is a rare indolent lymphoma characterized by papules or nodules on the ear and a dermal infiltrate of CD8-positive T-lymphocytes with cytotoxic marker expression. A retrospective review of a single institutional experience with PCATCL identified 3 patients (mean age 54; range 49-62) with papules or nodules on the ear. Lesional biopsies demonstrated a dense diffuse dermal infiltrate of atypical lymphocytes with a Grenz zone in 2 cases and focal epidermotropism in 1 case. The atypical lymphocytes were predominantly CD3 and CD8 positive with expression of cytotoxic marker TIA1. Staging evaluation failed to reveal systemic disease. Two patients underwent local excision, and the third received local radiation therapy all with complete response and no disease recurrence at last follow-up 3 months (range 2-5 months). Our cases add to the existing limited literature on the clinical and histopathological features of PCATCL. We also performed an updated systematic literature view of the entity.


Asunto(s)
Linfocitos T CD8-positivos/patología , Linfoma Cutáneo de Células T/patología , Linfoma Cutáneo de Células T/terapia , Neoplasias Cutáneas/patología , Neoplasias Cutáneas/terapia , Biopsia con Aguja , Procedimientos Quirúrgicos Dermatologicos/métodos , Humanos , Inmunohistoquímica , Linfoma Cutáneo de Células T/diagnóstico por imagen , Masculino , Persona de Mediana Edad , Tomografía Computarizada por Tomografía de Emisión de Positrones/métodos , Pronóstico , Radioterapia/métodos , Estudios Retrospectivos , Muestreo , Neoplasias Cutáneas/diagnóstico por imagen , Resultado del Tratamiento
12.
J Am Acad Dermatol ; 78(6): 1097-1101.e1, 2018 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-29288097

RESUMEN

BACKGROUND: Graft-versus-host-disease (GVHD) after solid organ transplantation (SOT) is extremely rare. OBJECTIVE: To investigate the dermatologic manifestations and clinical outcomes of SOT GVHD. METHODS: Systematic literature review of SOT GVHD. RESULTS: After full-text article review, we included 61 articles, representing 115 patients and 126 transplanted organs. The most commonly transplanted organ was the liver (n = 81). Among 115 patients, 101 (87.8%) developed skin involvement. The eruption appeared an average of 48.3 days (range, 3-243 days) posttransplant and was pruritic in 5 of 101 (4.9%) cases. The eruption was described as morbilliform in 2 patients (1.9%), confluent in 6 (5.9%), and desquamative in 4 (3.9%) cases. In many cases, specific dermatologic descriptions were lacking. The mortality rate was 72.2%. Relative time of death was reported in 23 patients who died during the follow-up period. These patients died an average of 99.2 days (range, 22-270 days) posttransplant, or 50.9 days after the appearance of dermatologic symptoms. Frequent causes of death were sepsis and multiorgan failure. LIMITATIONS: Incomplete descriptions of skin findings and potential publication bias resulting in publication of only the most severe cases. CONCLUSIONS: GVHD is a potentially fatal condition that can occur after SOT and often presents with a skin rash. We recommend that dermatologists have a low threshold to consider and pursue this diagnosis in the setting of post-SOT skin eruption.


Asunto(s)
Enfermedad Injerto contra Huésped/etiología , Trasplante de Órganos/efectos adversos , Enfermedades de la Piel/etiología , Femenino , Rechazo de Injerto , Supervivencia de Injerto , Enfermedad Injerto contra Huésped/fisiopatología , Humanos , Trasplante de Riñón/efectos adversos , Trasplante de Riñón/métodos , Trasplante de Hígado/efectos adversos , Trasplante de Hígado/métodos , Trasplante de Pulmón/efectos adversos , Trasplante de Pulmón/métodos , Masculino , Trasplante de Órganos/métodos , Pronóstico , Medición de Riesgo , Índice de Severidad de la Enfermedad , Enfermedades de la Piel/fisiopatología , Análisis de Supervivencia
13.
J Drugs Dermatol ; 17(10): 1131-1133, 2018 Oct 01.
Artículo en Inglés | MEDLINE | ID: mdl-30365596

RESUMEN

Crusted scabies (CS) is a highly infectious hyperinfestation variant of scabies with up to millions of Sarcoptes scabiei mites present on the skin surface. Diagnostic clues include intense itching and thick crusting especially on the face, groin, and buttocks, although variable presentations may mimic other dermatoses. CS has been associated with immunosuppression including the human immunodeficiency virus (HIV) and lymphoreticular malignancies.1-3 A long latency period from symptom onset to diagnosis and appropriate treatment is often reported. Clinical suspicion is required to obtain a mineral oil preparation or biopsy. We report a patient treated for eczema with 9 months of progressive immunosuppression who was found to have crusted scabies. J Drugs Dermatol. 2018;17(10):1131-1133.


Asunto(s)
Huésped Inmunocomprometido , Enfermedad Pulmonar Obstructiva Crónica , Escabiosis/diagnóstico , Anciano de 80 o más Años , Diagnóstico Diferencial , Eccema/diagnóstico , Cara , Femenino , Ingle , Humanos , Escabiosis/tratamiento farmacológico , Escabiosis/patología , Índice de Severidad de la Enfermedad
14.
J Am Acad Dermatol ; 77(6): 1053-1059, 2017 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-29031660

RESUMEN

BACKGROUND: Genital or vulval lichen planus (VLP) may have a disabling effect on a patient's quality of life. Evidence-based management guidelines are lacking for VLP. OBJECTIVE: We sought to review clinical presentation and treatment of patients who received a diagnosis of VLP. METHODS: The 100 consecutive patients who received a diagnosis of VLP at Mayo Clinic between January 1, 1997, and December 31, 2015, were reviewed retrospectively. Descriptive statistics were used for data analysis. Fisher's exact test and the Wilcoxon rank sum test were used for analysis of categorical and continuous variables, respectively. All statistical tests were 2 sided, with the α level set at .05 for statistical significance. RESULTS: The time to diagnosis for 49% of patients was more than 1 year. Three patients (3%) had vulval dysplasia, including invasive squamous cell carcinoma. Sixty-eight patients (68%) had multisite lichen planus disease. Eleven patients (11%) had disease remission. Dermatology was the lead specialty for 9 of these cases of remission. LIMITATIONS: This was a retrospective, small-cohort study. CONCLUSION: A low frequency of disease remission was seen in patients with VLP. Patients with lichen planus benefit considerably from dermatology consultation. Further research is warranted to establish high-quality, evidence-based guidelines for multidisciplinary management of this challenging disease.


Asunto(s)
Liquen Plano , Adulto , Anciano , Anciano de 80 o más Años , Estudios de Cohortes , Femenino , Humanos , Liquen Plano/diagnóstico , Liquen Plano/terapia , Persona de Mediana Edad , Estudios Retrospectivos , Enfermedades de la Vulva/diagnóstico , Enfermedades de la Vulva/terapia
15.
J Am Acad Dermatol ; 76(4): 683-688, 2017 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-28012574

RESUMEN

BACKGROUND: Sézary syndrome (SS) is characterized by erythroderma with leukemic involvement. In atypical SS, leukemic involvement is present without erythroderma. Little is known about the presentation, prognosis, and outcome in these patients. OBJECTIVE: We sought to describe our experience with patients with SS without erythroderma. METHODS: We retrospectively identified patients with SS, but without erythroderma, at Mayo Clinic from 1976 to 2010. Patients all met criteria for high blood tumor burden. Their clinical characteristics, disease course, and prognosis were reviewed and compared with a previously described cohort of 176 patients with SS from this institution. RESULTS: Among 16 patients identified, all had cutaneous findings consistent with cutaneous T-cell lymphoma, most commonly erythematous patches (n = 6) and plaques (n = 12). All 16 patients were deceased at the time of the study. Median time from diagnosis of SS without erythroderma to the date of death was 3.6 years (range, 0.5-8.7 years). Survival was not different between patients with SS with and without erythroderma (hazard ratio 1.58; 95% confidence interval 0.94-2.66; P = .08). LIMITATIONS: This was a single-institution retrospective study. CONCLUSION: Leukemic involvement may confer shortened survival in patients with SS, because the presence of erythroderma did not affect survival. These atypical cases could potentially be more accurately described using the TNMB classification.


Asunto(s)
Dermatitis Exfoliativa , Síndrome de Sézary/patología , Neoplasias Cutáneas/patología , Anciano , Biopsia , Progresión de la Enfermedad , Femenino , Humanos , Estimación de Kaplan-Meier , Infiltración Leucémica , Ganglios Linfáticos/patología , Masculino , Persona de Mediana Edad , Células Neoplásicas Circulantes , Especificidad de Órganos , Pronóstico , Estudios Retrospectivos , Síndrome de Sézary/sangre , Síndrome de Sézary/clasificación , Síndrome de Sézary/diagnóstico , Piel/patología , Neoplasias Cutáneas/sangre , Neoplasias Cutáneas/clasificación , Neoplasias Cutáneas/diagnóstico , Evaluación de Síntomas , Carga Tumoral
16.
Dermatol Surg ; 43(1): 125-133, 2017 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-28027202

RESUMEN

BACKGROUND: Hidradenitis suppurativa (HS) is a progressive, recurrent inflammatory disorder. OBJECTIVE: To assess long-term satisfaction and postoperative perceptions among patients who underwent surgical management of HS. MATERIALS AND METHODS: A questionnaire was mailed to 499 HS surgical patients to assess surgical outcome, satisfaction, and quality of life. RESULTS: Of the 499 questionnaires mailed, 113 were returned (22.6% response rate) and 2 were excluded for redundancy. Of the 111 respondents, 65 (58.6%) were female, 91 (82.0%) had Hurley Stage III disease, 88 (79.3%) were treated with excision and 23 (20.7%) with unroofing, 45 (40.5%) had perianal or perineal disease, and 41 (36.9%) had axillary disease. Most patients were satisfied or very satisfied with their surgical results (84.7%; 94 of 111), were glad they underwent surgery (96.3%; 105 of 109), and would recommend surgery to a friend or relative (82.6%; 90 of 109). Most patients were satisfied or very satisfied with the appearance of their healed wound (62.4%; 68 of 109). Retrospective mean quality of life increased significantly from 5 preoperatively to 8.4 postoperatively (p < .001). CONCLUSION: Hidradenitis suppurativa surgical management was well regarded by patients and should be considered by future patients to limit the morbidity of HS.


Asunto(s)
Hidradenitis Supurativa/cirugía , Satisfacción del Paciente , Calidad de Vida , Adolescente , Adulto , Axila , Nalgas , Niño , Preescolar , Femenino , Hidradenitis Supurativa/diagnóstico , Humanos , Masculino , Persona de Mediana Edad , Perineo , Complicaciones Posoperatorias/etiología , Recurrencia , Reoperación , Estudios Retrospectivos , Encuestas y Cuestionarios , Factores de Tiempo , Adulto Joven
17.
Pediatr Dermatol ; 34(5): e279-e280, 2017 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-28884911

RESUMEN

Pediatric genital mucocutaneous diseases are rare. A retrospective review was performed of children presenting with symptomatology of genital dermatoses to a hospital-based dermatology service. This study highlights that the range of genital diseases in children is not as broad as in adults. The diagnosis of genital mucocutaneous disease in children is usually genital lichen sclerosus, but other diagnoses should be considered.


Asunto(s)
Enfermedades de los Genitales Femeninos/epidemiología , Adolescente , Niño , Preescolar , Femenino , Enfermedades de los Genitales Femeninos/diagnóstico , Genitales/patología , Humanos , Prevalencia , Estudios Retrospectivos
18.
J Am Acad Dermatol ; 75(5): 931-939, 2016 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-27473454

RESUMEN

BACKGROUND: There are limited large case series of peristomal pyoderma gangrenosum (PPG), an uncommon cause of recalcitrant peristomal ulceration. OBJECTIVE: We sought to further characterize the clinical features, causes, treatments, and outcomes of PPG. METHODS: We conducted a retrospective chart review of patients with PPG seen at Mayo Clinic from January 1996 to July 2013. RESULTS: A total of 44 patients had PPG (mean age, 46 years; 32 women [73%]); 41 (93%) had inflammatory bowel disease. Mean time to PPG onset after stoma surgery was 5.2 months (excluding 1 outlier). Systemic therapies included corticosteroids (66%), immunosuppressants (41%), biologics (36%), and a combination of systemic treatments (36%). Mean time to reach a complete response was 10.7 weeks. Stoma closure had the greatest complete response (4 of 4 patients, no recurrences). Recurrence after any treatment was documented in 23 of 38 (61%) patients. Stoma relocation/revision recurred in 10 of 15 (67%) patients. Remission occurred in 29 of 31 (94%) patients. LIMITATIONS: Small sample size and retrospective study design are limitations. CONCLUSION: PPG is strongly associated with inflammatory bowel disease, is predominant in women, and has a prolonged time to onset and high recurrence rate. Systemic corticosteroid or combination therapies and surgical closure can be effective treatments. Timely recognition and management are paramount to achieving early remission.


Asunto(s)
Complicaciones Posoperatorias/etiología , Piodermia Gangrenosa/etiología , Estomas Quirúrgicos/efectos adversos , Adolescente , Corticoesteroides/uso terapéutico , Adulto , Anciano , Anciano de 80 o más Años , Antibacterianos/uso terapéutico , Productos Biológicos/efectos adversos , Productos Biológicos/uso terapéutico , Errores Diagnósticos , Susceptibilidad a Enfermedades , Quimioterapia Combinada , Femenino , Humanos , Huésped Inmunocomprometido , Inmunoglobulinas Intravenosas/uso terapéutico , Inmunosupresores/efectos adversos , Enfermedades Inflamatorias del Intestino/cirugía , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/tratamiento farmacológico , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/cirugía , Piodermia Gangrenosa/diagnóstico , Piodermia Gangrenosa/tratamiento farmacológico , Piodermia Gangrenosa/epidemiología , Piodermia Gangrenosa/cirugía , Recurrencia , Reoperación , Estudios Retrospectivos , Factores de Riesgo , Úlcera Cutánea/tratamiento farmacológico , Úlcera Cutánea/epidemiología , Úlcera Cutánea/etiología , Adulto Joven
19.
Dermatology ; 232(3): 344-52, 2016.
Artículo en Inglés | MEDLINE | ID: mdl-27011206

RESUMEN

In Olmsted County, Minn., USA, reliable, population-based epidemiologic research studies can be performed because of a unique medical records linkage system, the Rochester Epidemiology Project (REP). Our objective was to summarize the epidemiologic data describing the prevalence of skin and skin-related diseases derived from the REP and to compare the findings with those from other studies worldwide. Retrospectively, we reviewed the results of population-based REP studies reporting the prevalence of skin and skin-related diseases over more than 4 decades and compared them to other published prevalences globally. Prevalences from the REP reported per 100,000 persons were as follows: hidradenitis suppurativa, 130.0; psoriasis, 700.0; psoriatic arthritis in 1992, 100.0, and in 2000, 160.0; Behçet disease, 5.2; scleroderma, 13.8; dermatomyositis, 21.42; systemic lupus erythematosus (SLE), from 30.5 to 122.0 suspected SLE, 32.8; combined SLE, 41.8; discoid lupus erythematosus, 27.6, and cutaneous lupus erythematosus, 70.4 and 73.2 (from 2 studies). Many of the population-based prevalences of specific skin and skin-related diseases derived from the REP are different from those estimated globally. Suggested reasons for disparity in the prevalences globally may include differences in the type of reported prevalence, study methodology, geographic areas, ethnic groups, age distribution, and socioeconomic status.


Asunto(s)
Publicaciones Periódicas como Asunto , Enfermedades de la Piel/epidemiología , Humanos , Prevalencia , Estados Unidos/epidemiología
20.
Dermatol Surg ; 42(9): 1030-40, 2016 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-27340739

RESUMEN

BACKGROUND: Hidradenitis suppurativa is a progressive, recurrent inflammatory disease. Surgical management is potentially curative with limited efficacy data. OBJECTIVE: To evaluate hidradenitis surgical patients. METHODS: Retrospective review of outcomes of 590 consecutive surgically treated patients. RESULTS: Most patients were white (91.0% [435/478]), men (337 [57.1%]), smokers (57.7% [297/515]) with Hurley Stage III disease (476 [80.7%]). Procedure types were excision (405 [68.6%]), unroofing (168 [28.5%]), and drainage (17 [2.9%]) treating disease of perianal/perineum (294 [49.8%]), axilla (124 [21.0%]), gluteal cleft (76 [12.9%]), inframammary (12 [2.0%]), and multiple surgical sites (84 [14.2%]). Postoperative complications occurred in 15 patients (2.5%) and one-fourth (144 [24.4%]) suffered postoperative recurrence, which necessitated reoperation in one-tenth (69 [11.7%]) of patients. Recurrence risk was increased by younger age (hazard ratio [HR], 0.8; 95% confidence interval [CI], 0.7-0.9), multiple surgical sites (HR, 1.6; 95% CI, 1.1-2.5), and drainage-type procedures (HR, 3.5; 95% CI, 1.2-10.7). Operative location, disease severity, gender, and operative extent did not influence recurrence rate. CONCLUSION: Excision and unroofing procedures were effective treatments with infrequent complications and low recurrence rates. Well-planned surgical treatment aiming to remove or unroof the area of intractable hidradenitis suppurativa was highly effective in the management of this challenging disease.


Asunto(s)
Hidradenitis Supurativa/cirugía , Adolescente , Adulto , Factores de Edad , Anciano , Anciano de 80 o más Años , Axila/cirugía , Mama/cirugía , Nalgas/cirugía , Drenaje , Femenino , Humanos , Masculino , Persona de Mediana Edad , Perineo/cirugía , Complicaciones Posoperatorias/etiología , Recurrencia , Reoperación , Estudios Retrospectivos , Factores de Riesgo , Índice de Severidad de la Enfermedad , Adulto Joven
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