RESUMEN
BACKGROUND: Patch or plaque stages in mycosis fungoides (MF) have different prognoses. The recent staging system proposed for MF discriminates between patches and plaques based upon clinical features. OBJECTIVE: To estimate interdermatologist agreement on the morphological evaluation of MF lesions. METHODS: Twenty-four patients with MF were enrolled. Two dermatologists evaluated every lesion face to face and independently with respect to the patch-plaque status. Cohen's κ was used to determine the rate of agreement. RESULTS: Agreement was 67% with respect to the patch or plaque status [95% confidence interval (CI) = 49-85%; p < 0.001]. Current systemic treatment (56%; p = 0.01) was associated with lower agreement. Younger age at diagnosis [odds ratio (OR) 1.03 (95% CI 1.02-1.05)], younger age at enrolment [OR 1.03 (95% CI 1.02-1.04)] and time on systemic treatment [OR 1.02 (95% CI 1.01-1.04)] were independent risk factors for disagreement (p < 0.001). CONCLUSION: The new system for MF staging carries a significant risk of disagreement regarding patch and plaque subsets.
Asunto(s)
Micosis Fungoide/patología , Estadificación de Neoplasias/métodos , Síndrome de Sézary/patología , Neoplasias Cutáneas/patología , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , PronósticoAsunto(s)
Antituberculosos/uso terapéutico , Axila , Pulgar , Tuberculosis Cutánea/diagnóstico , Tuberculosis Cutánea/tratamiento farmacológico , Biopsia con Aguja , Relación Dosis-Respuesta a Droga , Esquema de Medicación , Quimioterapia Combinada , Femenino , Estudios de Seguimiento , Humanos , Inmunohistoquímica , Persona de Mediana Edad , Recurrencia , Retratamiento , Medición de Riesgo , Índice de Severidad de la Enfermedad , Factores de Tiempo , Prueba de Tuberculina , Tuberculosis Cutánea/patologíaAsunto(s)
Calcinosis/tratamiento farmacológico , Dermatomiositis/tratamiento farmacológico , Inmunoglobulinas Intravenosas/uso terapéutico , Enfermedades de la Piel/tratamiento farmacológico , Calcinosis/complicaciones , Dermatomiositis/complicaciones , Femenino , Humanos , Persona de Mediana Edad , Enfermedades de la Piel/complicacionesRESUMEN
BACKGROUND: Mycosis fungoides (MF) is the most common form of primary cutaneous T cell lymphoma. Psoralen combined with ultraviolet A (PUVA) is a first-line treatment for early-stage disease. OBJECTIVES: This study was conducted to assess the clinical effectiveness of and tolerance to PUVA monotherapy in MF. METHODS: We retrospectively reviewed the files of patients who received PUVA for stage I disease. The study included 31 patients, of whom 32% presented with stage Ia and 67% with stage Ib disease, and 68% presented with patch and 32% with plaque disease. All patients received treatment three times per week. RESULTS: Complete response (CR) was achieved in 71% of patients. The median cumulative dose of UVA at CR was 211.7 J/cm(2) . There was a significant difference in median cumulative dose at CR between patients with plaque and patch disease, respectively, but not between patients with stage Ia and Ib disease. Median disease-free survival (DFS) was 230 weeks. Patients with patch disease achieved longer DFS than those with plaque disease (P = 0.004), although DFS was similar in stage Ia and Ib patients. Of the patients who received maintenance therapy, 58% relapsed. Univariate analysis showed patch disease to be a predictive factor for CR, but no predictors of relapse were identified. A total of 71% of patients developed clinical adverse reactions. CONCLUSIONS: Psoralen with UVA is a safe and effective treatment for early-stage MF. Patch disease responds more favorably than plaque disease and is associated with a longer period of DFS. Maintenance treatment does not appear to reduce recurrence. Current evidence suggests that the proposed revision to the classification of MF, which takes into account the extent and type of disease, more accurately predicts response to PUVA.
Asunto(s)
Micosis Fungoide/tratamiento farmacológico , Micosis Fungoide/patología , Recurrencia Local de Neoplasia/patología , Terapia PUVA , Neoplasias Cutáneas/tratamiento farmacológico , Neoplasias Cutáneas/patología , Adulto , Anciano , Anciano de 80 o más Años , Supervivencia sin Enfermedad , Femenino , Humanos , Quimioterapia de Mantención , Masculino , Persona de Mediana Edad , Estadificación de Neoplasias , Terapia PUVA/efectos adversos , Estudios Retrospectivos , España , Centros de Atención Terciaria , Terapéutica , Adulto JovenAsunto(s)
Candidiasis Cutánea/congénito , Candidiasis Cutánea/diagnóstico , Adulto , Antifúngicos/uso terapéutico , Candidiasis Cutánea/tratamiento farmacológico , Candidiasis Cutánea/etiología , Femenino , Humanos , Recién Nacido , Masculino , Nistatina/uso terapéutico , Embarazo , Complicaciones Infecciosas del Embarazo , Vulvovaginitis/complicacionesAsunto(s)
Anestésicos Locales/efectos adversos , Dermatitis Alérgica por Contacto/diagnóstico , Dermatitis Alérgica por Contacto/etiología , Erupciones por Medicamentos/diagnóstico , Erupciones por Medicamentos/etiología , Tetracaína/efectos adversos , Anciano , Femenino , Humanos , Lubrificación , Pruebas del Parche , Estrechez Uretral/cirugíaRESUMEN
The occurrence of pruritus immediately after application of an aftershave product is usually due to irritant contact dermatitis. We report a case of contact urticaria in a male patient, produced by an aftershave product containing phenoxyethanol.
Asunto(s)
Cosméticos/efectos adversos , Dermatitis Alérgica por Contacto/etiología , Glicoles de Etileno/efectos adversos , Urticaria/etiología , Adulto , Cosméticos/administración & dosificación , Dermatitis Alérgica por Contacto/diagnóstico , Glicoles de Etileno/administración & dosificación , Humanos , Masculino , Pruebas Cutáneas , Urticaria/diagnósticoRESUMEN
Skin cancers are the most common malignancies and, historically, ionizing radiation has played an important role in their treatment. However, less experienced dermatologists generally consider radiation last in the line of therapeutic options. The authors sought to evaluate the effectiveness and safety of office-based elective radiation therapy for cutaneous carcinoma. A retrospective study of 604 basal cell carcinomas (BCCs) and 106 squamous cell carcinomas (SCCs) irradiated between 1971-96 was performed. The percentage of patients who developed tumor recurrence during the follow-up period was calculated using Kaplan-Meier survival curves. Cox's proportional model was used to assess the prognostic factors that might have influenced the recurrences. The recurrence rates for BCC and SCC were 11.5 and 16.5 per 1000 patient-years, respectively. The 5-year cure rates were 94.4% for BCC and 92.7% for SCC, and the 15-year cure rates were 84.8% and 78.6%, respectively. Tumor location on the nasolabial fold (OR 4.4; 95% IC, 1.3-14.7) and tumor size > or = 10 mm (OR 2.14; 95% IC, 1.03-4.45) were independent predictors of BCC recurrence. This study suggested that radiation therapy is an effective treatment for BCC and SCC and should be considered as a first option in many cases.
Asunto(s)
Carcinoma Basocelular/radioterapia , Carcinoma de Células Escamosas/radioterapia , Neoplasias Cutáneas/radioterapia , Anciano , Femenino , Estudios de Seguimiento , Humanos , Estimación de Kaplan-Meier , Masculino , Persona de Mediana Edad , Recurrencia Local de Neoplasia , Dosis de Radiación , Radioterapia/métodos , Radioterapia/estadística & datos numéricos , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
Primary cutaneous lymphomas are a heterogeneous group of lymphoproliferative disorders characterized by skin involvement with no evidence of systemic disease at the time of diagnosis. Their clinical behavior is generally indolent, and only occasionally is the development of extracutaneous disease observed. Since the 1980s, primary cutaneous B-cell lymphomas have been considered a specific group of lymphomas, differentiated from both T-cell lymphomas and from secondary cutaneous B-cell lymphomas. Both the EORTC and the WHO have proposed alternative classifications for these entities, with significant discrepancies that were finally resolved through the development of a new classification (WHO-EORTC classification for cutaneous lymphomas), which standardizes criteria that had previously been different. We present two new cases of primary cutaneous diffuse large B-cell lymphoma of the leg according to the new classification.
Asunto(s)
Pierna , Linfoma de Células B/clasificación , Linfoma de Células B Grandes Difuso/clasificación , Neoplasias Cutáneas/clasificación , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Linfoma de Células B/patología , Linfoma de Células B Grandes Difuso/patología , Masculino , Persona de Mediana Edad , Neoplasias Cutáneas/patologíaRESUMEN
Neonatal lupus erythematosus (NLE) is an infrequent disease in newborns caused by the transplacental passage of maternal Anti-Ro/SSA, Anti-La/SSB and/or Anti-U1 RNP antibodies. The most common manifestations are cutaneous and cardiac. We carried out a retrospective study of cases of NLE diagnosed in the last 10 years at the Hospital Universitario Insular in Gran Canaria. Complete data was obtained for 4 patients. Three cases had circulating Anti-Ro antibodies in the mother and in the newborns, while in the fourth case they were Anti-RNP. Two mothers were diagnosed with systemic lupus, one with mixed connective tissue disease and the other with leucocytoclastic vasculitis. The skin lesions consisted of urticaria-like and desquamative lesions. One patient presented with ulceration. The histological study of the urticaria-like lesions showed a non-specific perivascular infiltrate; the desquamative lesions were consistent with subacute lupus erythematosus.
Asunto(s)
Lupus Eritematoso Cutáneo/patología , Femenino , Humanos , Lactante , Recién Nacido , Masculino , Estudios RetrospectivosAsunto(s)
Inmunosupresores/uso terapéutico , Isoxazoles/uso terapéutico , Psoriasis/tratamiento farmacológico , Adulto , Relación Dosis-Respuesta a Droga , Esquema de Medicación , Femenino , Estudios de Seguimiento , Dermatosis de la Mano/diagnóstico , Dermatosis de la Mano/tratamiento farmacológico , Humanos , Inmunosupresores/efectos adversos , Isoxazoles/efectos adversos , Leflunamida , Psoriasis/diagnóstico , Medición de Riesgo , Índice de Severidad de la Enfermedad , Resultado del TratamientoAsunto(s)
Alérgenos/efectos adversos , Dermatitis Alérgica por Contacto/diagnóstico , Nitrilos/efectos adversos , Conservadores Farmacéuticos/efectos adversos , Conducta Sexual , Adulto , Alérgenos/administración & dosificación , Dermatitis Alérgica por Contacto/etiología , Dermatitis Alérgica por Contacto/patología , Diagnóstico Diferencial , Femenino , Humanos , Masculino , Nitrilos/administración & dosificación , Pruebas del Parche , Conservadores Farmacéuticos/administración & dosificación , MusloAsunto(s)
Colchicina/uso terapéutico , Inmunoglobulina A , Enfermedades Cutáneas Vesiculoampollosas/tratamiento farmacológico , Adulto , Colchicina/administración & dosificación , Femenino , Humanos , Inmunoglobulina A/análisis , Piel/patología , Enfermedades Cutáneas Vesiculoampollosas/diagnóstico , Enfermedades Cutáneas Vesiculoampollosas/inmunología , Enfermedades Cutáneas Vesiculoampollosas/patología , Factores de Tiempo , Resultado del TratamientoAsunto(s)
Dermatitis Alérgica por Contacto/etiología , Dermatitis Profesional/etiología , Inmunización , Fenilendiaminas/efectos adversos , Tatuaje/efectos adversos , Adulto , Alérgenos/efectos adversos , Enfermedad Crónica , Colorantes/efectos adversos , Dermatitis Alérgica por Contacto/diagnóstico , Dermatitis Profesional/diagnóstico , Femenino , Estudios de Seguimiento , Dermatosis de la Mano/diagnóstico , Dermatosis de la Mano/etiología , Humanos , Exposición Profesional/efectos adversos , Pruebas del Parche , Medición de Riesgo , Índice de Severidad de la EnfermedadRESUMEN
No disponible
Asunto(s)
Femenino , Adulto , Humanos , Enfermedades de la Piel/diagnóstico , Enfermedades de la Piel/terapia , Epidermólisis Ampollosa Adquirida/diagnóstico , Epidermólisis Ampollosa Adquirida/tratamiento farmacológico , Colchicina/uso terapéutico , Técnica del Anticuerpo Fluorescente Directa/métodos , Dapsona/uso terapéutico , Sulfapiridina/uso terapéutico , Biopsia/métodosRESUMEN
Los linfomas primarios cutáneos son un grupo heterogéneo de procesos linfoproliferativos que se caracterizan por afectación cutánea sin evidencia de enfermedad sistémica en el momento del diagnóstico. Por lo general tienen un comportamiento clínico indolente, y sólo ocasionalmente suele observarse el desarrollo de enfermedad extracutánea. A partir de la década de 1980, se han considerado los linfomas primarios cutáneos de células B como un grupo específico de linfomas, diferenciándose tanto de los linfomas de células T como de los linfomas cutáneos secundarios de células B. Tanto la EORTC como la OMS han propuesto clasificaciones alternativas para estas entidades con discrepancias importantes que últimamente se han aclarado elaborando una nueva clasificación (clasificación de la OMS-EORTC de los linfomas cutáneos) que unifica criterios hasta ahora dispares. Se presentan dos nuevos casos de linfoma primario cutáneo B de célula grande difuso tipo piernas según esta nueva clasificación
Primary cutaneous lymphomas are a heterogeneous group of lymphoproliferative disorders characterized by skin involvement with no evidence of systemic disease at the time of diagnosis. Their clinical behavior is generally indolent, and only occasionally is the development of extracutaneous disease observed. Since the 1980s, primary cutaneous B-cell lymphomas have been considered a specific group of lymphomas, differentiated from both T-cell lymphomas and from secondary cutaneous B-cell lymphomas. Both the EORTC and the WHO have proposed alternative classifications for these entities, with significant discrepancies that were finally resolved through the development of a new classification (WHO-EORTC classification for cutaneous lymphomas), which standardizes criteria that had previously been different. We present two new cases of primary cutaneous diffuse large B-cell lymphoma of the leg according to the new classification
Asunto(s)
Masculino , Femenino , Anciano , Persona de Mediana Edad , Humanos , Linfoma Cutáneo de Células T/complicaciones , Linfoma Cutáneo de Células T/diagnóstico , Linfoma Cutáneo de Células T/terapia , Linfoma de Células B Grandes Difuso/complicaciones , Linfoma de Células B Grandes Difuso/diagnóstico , Linfoma de Células B Grandes Difuso/clasificación , Inmunohistoquímica/métodos , Inmunoglobulinas/uso terapéutico , Linfoma de Células B Grandes Difuso/terapia , Complejo I de Transporte de Electrón/uso terapéutico , Recurrencia Local de Neoplasia/complicacionesRESUMEN
El lupus eritematoso neonatal (LEN) es una enfermedad poco frecuente del recién nacido debido al paso transplacentario de anticuerpos maternos anti-Ro/SSA, anti-La/ SSB y/o anti-U1RNP en la que las afectaciones cutáneas y cardiacas son las más destacadas. Realizamos un estudio retrospectivo de casos diagnosticados de LEN en los últimos 10 años en el Hospital Universitario Insular de Gran Canaria en el que se obtuvieron datos completos de 4 enfermos. En 3 casos se presentaron anticuerpos circulantes anti-Ro en la madre y en los neonatos, mientras que en el otro era anti-RNP. Dos madres estaban diagnosticadas de lupus sistémico, una de enfermedad mixta del tejido conjuntivo y otra de vasculitis leucocitoclástica. Las lesiones cutáneas consistieron en lesiones urticariformes y descamativas. Un paciente presentó ulceración. El estudio histológico de las lesiones urticariformes mostró un infiltrado perivascular inespecífico; las lesiones descamativas fueron compatibles con lupus eritematoso subagudo
Neonatal lupus erythematosus (NLE) is an infrequent disease in newborns caused by the transplacental passage of maternal Anti-Ro/SSA, Anti-La/SSB and/or Anti-U1 RNP antibodies. The most common manifestations are cutaneous and cardiac. We carried out a retrospective study of cases of NLE diagnosed in the last 10 years at the Hospital Universitario Insular in Gran Canaria. Complete data was obtained for 4 patients. Three cases had circulating Anti-Ro antibodies in the mother and in the newborns, while in the fourth case they were Anti-RNP. Two mothers were diagnosed with systemic lupus, one with mixed connective tissue disease and the other with leucocytoclastic vasculitis. The skin lesions consisted of urticaria-like and desquamative lesions. One patient presented with ulceration. The histological study of the urticaria-like lesions showed a non-specific perivascular infiltrate; the desquamative lesions were consistent with subacute lupus erythematosus
Asunto(s)
Masculino , Femenino , Recién Nacido , Adulto , Humanos , Lupus Eritematoso Cutáneo/diagnóstico , Lupus Eritematoso Cutáneo/terapia , Cardiopatías Congénitas/diagnóstico , Lupus Eritematoso Sistémico/complicaciones , Urticaria/diagnóstico , Corticoesteroides/uso terapéutico , Hidrocortisona/uso terapéutico , Dexametasona/uso terapéutico , Teofilina/uso terapéutico , Úlcera Cutánea/terapia , Estudios Retrospectivos , Vasculitis/complicaciones , Vasculitis/diagnóstico , Piel/lesiones , Sepsis/complicaciones , Hepatomegalia/complicaciones , Eritema/complicaciones , Biopsia/métodos , Complicaciones Hematológicas del Embarazo , Tejido Conectivo/patologíaRESUMEN
No disponible