[Utilidad del complejo soluble de ataque a membrana para determinar actividad clínica de la dermatomiositis y respuesta al tratamiento].

INTRODUCTION: Dermatomyositis is an autoimmune disease and the most common idiopathic inflammatory myopathy. During patient follow-up, determining biochemical parameters is required in order to assess for disease activity and treatment efficacy. OBJECTIVE: To determine the relationship between the degree of activation of the complement system through the soluble membrane attack complex (c5b-9), dermatomyositis clinical activity and its variations with conventional treatment. METHOD: Forty-five patients with active and inactive dermatomyositis were studied. Chemical parameters and clinical severity were established and correlated with ELISA-determined C5b-9 serum levels. RESULTS: There was positive correlation between dermatomyositis cutaneous and muscular activity and C5b-9 serum levels, which was lower than with traditional biochemical markers. In the case of treatment response, C5b-9 showed significant reduction, similar to clinical severity; with biochemical parameters, the reduction was not significant at one month of treatment with systemic steroids. CONCLUSIONS: Serum levels of C5b-9 levels of C5b-9 are higher in patients with dermatomyositis than in healthy subjects; dermatomyositis active and inactive cases were determined by means of their measurement. They can be a reliable parameter of therapeutic response, more accurate than muscle enzymes measurement, particularly creatine phosphokinase.

INTRODUCCIÓN: La dermatomiositis es una enfermedad autoinmune y es la más común de las miopatías inflamatorias idiopáticas. Durante el seguimiento de los pacientes se requiere determinar parámetros bioquímicos para precisar la actividad de la enfermedad y la eficacia de los tratamientos. OBJETIVO: Definir la relación entre el grado de activación del sistema del complemento a través del complejo soluble de ataque a membrana (C5b-9), la actividad clínica de la dermatomiositis y sus variaciones con el tratamiento convencional. MÉTODO: Se estudiaron 45 pacientes con dermatomiositis activa e inactiva. Se establecieron parámetros bioquímicos, severidad clínica y se correlacionaron con los niveles séricos de C5b-9, determinados mediante ELISA. RESULTADOS: Existió correlación positiva entre la actividad cutánea y muscular de la dermatomiositis y los niveles séricos de C5b-9, menor que con los marcadores bioquímicos tradicionales. En la respuesta al tratamiento, C5b-9 mostró reducción significativa, similar a la severidad clínica; con los parámetros bioquímicos, la reducción no fue significativa a un mes de tratamiento con esteroides sistémicos. CONCLUSIONES: Los niveles séricos de C5b-9 en pacientes con dermatomiositis están más elevados que en los sujetos sanos; con su medición se identificaron los casos activos e inactivos de dermatomiositis. Pueden ser un parámetro fiable de respuesta terapéutica, más precisos que la medición de enzimas musculares, particularmente creatinfosfosquinasa.

Dermatologists happiness and satisfaction / Estudio sobre la satisfacción laboral y la felicidad en médicos dermatólogos.

Objective: To assess the level of happiness and satisfaction in the life and medical practice of dermatologists in Mexico. Method: A descriptive study (online survey) was conducted focused on practicing dermatologists in our country. Questions included demographic characteristics, the Pemberton happiness index (with local validation) and questions that assessed the degree of personal satisfaction. Descriptive statistics were used to obtain the central tendency and dispersion. Measures of central tendency and dispersion were performed; to compare categorical variables, contingency tables for chi-square test were used and when comparing quantitative variables with normal distribution, Student's t t-test was used. Results: 219 surveys were included, 72.6% female and 27.4% male, with an average age of 45.6 and an average of 16 years of medical practice. Most of them (64.8%) graduate from Mexico City; 93% were very satisfied with the specialty and 98.6% of them would choose the same once again, the most important reason is to encompass medical and surgical areas. The level of happiness by using the Pemberton scale was "high" (mode: 9.11; standard deviation: 1.73). Conclusions: This first study in Latin America on this subject in dermatologists showed high levels of satisfaction and happiness in both professional and personal areas.

Objetivo: Conocer la felicidad y la satisfacción laboral de los dermatólogos en México. Método: Estudio descriptivo, mediante encuesta en línea dirigida a dermatólogos especialistas, graduados y con ejercicio en México. Se incluyeron elementos demográficos, el Índice de Felicidad de Pemberton (con validación local) y preguntas para evaluar la satisfacción personal. Se realizaron medidas de tendencia central y dispersión; para comparar las variables categóricas, se utilizaron tablas de contingencia para ji al cuadrado, y al comparar variables cuantitativas con distribución normal se utilizó la prueba t de Student. Resultados: Se incluyeron 219 encuestados, el 72.6% mujeres y el 27.4% hombres, con una media de edad de 45.6 años y un promedio de 16 años de ejercicio profesional. La mayoría (64.8%) eran egresados de la Ciudad de México y el 75.3% estaban muy satisfechos con su escuela de formación. Un 93% se manifestó muy satisfecho con su especialidad y el 98.6% volvería a escogerla; el mayor motivo sería abarcar ámbitos médicos y quirúrgicos. El grado de felicidad según el Índice de Pemberton fue «alto¼ (media: 9.11; desviación estándar: 1.73). Conclusión: Este primer estudio en América Latina sobre este aspecto en dermatólogos, muestra unos altos índices de satisfacción y felicidad, tanto en el área profesional como en la personal.

Congenital Malalignment of the Great Toenail.

Congenital malalignment of the great toenail (CMA) is a disorder of the anatomic orientation of the ungual apparatus, in which the longitudinal axis of the nail plate is not parallel with the axis of the distal phalanx but is deflected sideways. This disorder is understood to arise from multiple factors. Although many theories have been proposed about its origin, its pathogenesis is not fully known. Besides the cosmetic impact, this disorder causes such problems in the medium and long term as onychocryptosis and difficulty in motion. Some cases may regress spontaneously, although persistent cases may require a specialized surgical approach. Congenital malalignment of the great toenail is poorly understood and described medical condition that is often treated incorrectly; thus, reviewing the subject is important. A symptombased clinical classification system is proposed to guide diagnosis and treatment modality decisions.

The efficacy and safety of sertaconazole cream (2 %) in diaper dermatitis candidiasis.

AIM: Diaper dermatitis (DD) is an inflammatory irritating condition that is common in infants. Most cases are associated with the yeast colonization of Candida or diaper dermatitis candidiasis (DDC), and therefore, the signs and symptoms improve with antimycotic treatment. Sertaconazole is a broad-spectrum third-generation imidazole derivative that is effective and safe for the treatment for superficial mycoses, such as tineas, candidiasis, and pityriasis versicolor. Our goal was to assess the efficacy and safety of sertaconazole cream (2 %) in DDC. MATERIALS AND METHODS: Twenty-seven patients with clinical and mycological diagnosis of DDC were enrolled and treated with 2 daily applications for 14 days and were followed-up for 2 further weeks. RESULTS: Three etiologic agents were isolated: Candida albicans in 88.8 %, Candida parapsilosis in 7.3 %, and Candida glabrata in 3.2 %. There was an average symptom reduction from 7.1 to 3.2 in the middle of treatment and to 1.2 and 0.4 units at the end of treatment and follow-up, respectively. The treatment evaluation at the end of the follow-up period showed a total clinical and mycological cure in 88.8 %, improvement in 3.7 %, and failure in 7.4 %. There was side effect (3.7 %) of skin irritation, but the drug was not discontinued. CONCLUSIONS: Based on its safety and effectiveness, sertaconazole cream may be considered a new alternative for DDC treatment.

Th-17 and the lack of efficacy of ustekinumab in pemphigus vulgaris.

Systemic corticosteroids represent an effective treatment for pemphigus vulgaris (PV). However, this treatment is related to many adverse side effects. Herein, we report a case of PV treated with ustekinumab.

Preliminary study of the efficacy and tolerability of combination therapy with calcipotriene ointment 0.005% and tacrolimus ointment 0.1% in the treatment of stable plaque psoriasis.

Calcipotriene ointment is widely used in the topical treatment of psoriasis, with tacrolimus ointment as an effective alternative in controlling stable plaque psoriasis. The efficacy of the combination of both products on stable plaque psoriasis has not been assessed in the literature consulted. We evaluated the efficacy of calcipotriene ointment 0.005% applied twice daily, tacrolimus ointment 0.1% applied twice daily, or a morning application of calcipotriene and an evening application of tacrolimus in 27 participants with stable plaque psoriasis over an 8-week treatment period. The mean reduction in the sum of the scores between baseline and week 8 was significant (P = .001) for calcipotriene alone (39.5%), tacrolimus alone (38.2%), and the combination of calcipotriene and tacrolimus (60.7%). Combination therapy was statistically more effective than tacrolimus alone (P = .043) but not statistically superior to calcipotriene alone (P=.056). Most adverse events (AEs) were related to skin irritation and pruritus; however, no AEs were evident in participants given the combination therapy.

Acetylcholine receptor antibodies in patients with pemphigus vulgaris: correlation with disease extent at the time of diagnosis and during follow-up.

Several studies have tried to determine the relationship between autoantibodies against the acetylcholine receptor and the development of pemphigus vulgaris. In this study, we observed that antibody levels against the acetylcholine receptor are mildly elevated in pemphigus vulgaris (PV), and significantly correlate with disease severity on the initial diagnosis and during follow up. However, it is not clear if these antibodies are just an epiphenomenon or a potential trigger of the known pathogenic process in PV.

[Skin cancer in adults younger than 40 years at the General Hospital of Mexico]. / Cáncer de piel en pacientes menores de 40 años. Experiencia de cuatro años en el Hospital General de México.

Skin cancer is the most common malignant neoplasm reported worldwide. Over the last 20 years, skin cancer has been recognized in a high proportion among young people not associated with genetic disorders or other diseases. In Mexico there is no epidemiological information about this topic, so we made a retrospective study from 2006 to 2009 in the Dermatology service of the General Hospital of Mexico. We included 730 patients with diagnosis of primary skin cancer; 51 cases occurred in people younger than 40 years with an average age of 38 years, and with an estimated accumulated incidence of 6.8% for the elapsed time. In this study, skin cancer in young people showed a predominance of women (67% of patients); basal cell carcinoma was the most common type. Most of the lesions were found in sun-exposed areas. Skin cancer in people younger than 40 years is increasing dramatically, so we recommend avoiding ultraviolet radiation exposure in childhood and adolescence, and implementing sun-protection campaigns in order to educate this sector of the population and make them more aware of the potential dangers.

Evidence-based treatment for gynoid lipodystrophy: A review of the recent literature.

Gynoid lipodystrophy (GLD) is a structural, inflammatory, and biochemical disorder of the subcutaneous tissue causing alterations in the topography of the skin. Commonly known as "cellulite," GLD affects up to 90% of women, practically in all stages of the life cycle, beginning in puberty. It is a clinical condition that considerably affects the patients' quality of life. It is a frequent reason for consultation, although the patients resort to empirical, improvised, nonevidence-based treatments which discourage and can be a source of frustration not only because of the lack of results but also due to the complications derived from those treatments. In this article, a panel of experts from different specialties involved in the management of this clinical skin disorder presents the results of a systematic literature search and of the consensus discussion of the evidence obtained from different treatments currently available. The analysis was divided into topical, systemic, noninvasive, and minimally invasive treatments.

[Crusted scabies in HIV/AIDS infected patients. Report of 15 cases]. / Escabiosis costrosa en pacientes con infección por VIH/SIDA. Reporte de 15 casos.

BACKGROUND: Crusted (Norwegian) scabies is a rare disease that occurs in patients with compromised immune system like patients with HIV/AIDS. We report 15 cases of crusted scabies in patients with HIV/AIDS successfully treated with oral ivermectin. CLINICAL CASES: The mean age of the patients was 43.7±8.06 and the diagnosis was made at a median of 5 months. All patients were diagnosed with HIV/AIDS treatment with antiretroviral therapy. Patients were treated with repeated doses of oral ivermectin with different schemes with good tolerance and efficacy with full resolution and without recurrence. CONCLUSIONS: Ivermectin is the treatment of choice for crusted scabies; it is tolerable and accessible to the patient. Immunosuppressed patients are those with the highest risk of acquiring that disease; we highlight the importance of lesion scraping to perform a correct and early diagnosis.

Introducción: la sarna costrosa (Noruega) es una enfermedad rara que se presenta en pacientes con un sistema inmunológico comprometido, como los pacientes con infección por VIH/SIDA. Reportamos 15 casos de sarna costrosa en pacientes con infección por VIH/SIDA tratados exitosamente con ivermectina oral. Casos clínicos: la media de edad de los pacientes fue de 43.7 ± 8.06 y el diagnóstico se hizo en una mediana de cinco meses. Todos los pacientes tenían diagnóstico de infección por VIH/SIDA en tratamiento con terapia antirretroviral. Los pacientes fueron tratados con dosis repetidas de ivermectina oral con diferentes esquemas; tuvieron una buena tolerancia y el tratamiento fue eficaz, pues hubo una resolución completa y sin recidiva. Conclusiones: la ivermectina es el tratamiento de elección de la sarna costrosa. Es un medicamento tolerable y accesible para el paciente. Los pacientes inmunosuprimidos son los que presentan más riesgo de contraerla; resaltamos la importancia del raspado de las lesiones para hacer un diagnóstico correcto y temprano.

[Bacterial resistance in acne? A meta-analysis of the controversy]. / ¿Resistencia en el acné? Un metaanálisis a propósito de la controversia.

BACKGROUND: Acne is one of the dermatological pathologies with the highest incidence around the world. It is a multifactorial disease and its treatment can be complex. Propionibacterium acnes play a key role in the inflammation of this dermatosis. Topical antibiotics, including mainly erythromycin and clindamycin, have been used, but there is controversy over their use due to the widely documented bacterial resistance. For this reason a meta-analysis of the publications over the past 10 years is presented in order to confirm this hypothesis. MATERIAL AND METHODS: A search was made of the publications over the past 10 years that included the results of antibiogams of patients with acne. MeSH type searches were performed with the terms "acne vulgaris", "Propionibacterium acnes", "topical administration", "treatment", "erythromycin", "clindamycin", "nadifloxacin", "antibacterial agent", "bacterial drug resistance" in PubMed, Ovid, EBSCO, Cochrane, ScienceDirect and ClinicalKey meta-searches. RESULTS: A total of 13 articles were found that met the inclusion criteria. The mean odds ratio (OR 1.24, 95% CI) of the articles showed a slight tendency toward resistance of Propionibacterium acnes. CONCLUSIONS: An increase in bacterial resistance to topical erythromycin and clindamycin can be confirmed, thus the use of these antibiotics is recommended in selective cases for short periods, and in combination with benzoyl peroxide for the best clinical outcome in patients with acne vulgaris.

Efficacy and safety of adapalene gel 0.1% and 0.3% and tretinoin gel 0.05% for acne vulgaris: results of a single-center, randomized, double-blinded, placebo-controlled clinical trial on Mexican patients (skin type III-IV).

BACKGROUND: The efficacy of topical retinoids is well known according to several clinical studies conducted predominantly among Caucasian patients. This study aimed to evaluate the efficacy and safety profile of adapalene and tretinoin among Mexican patients. AIMS: To compare adapalene 0.1 and 0.3% and tretinoin 0.05% in Mexican subjects with acne vulgaris. METHODS: We enrolled 171 patients in this single-center, randomized, double-blinded, placebo-controlled clinical trial. The patients applied on the face either adapalene 0.1%, adapalene 0.3%, tretinoin 0.05%, or placebo for 90 days and were evaluated for the reduction in total lesion counts and for the level of irritation. RESULTS: Tretinoin 0.05% and adapalene 0.3% were more effective than adapalene 0.1% and placebo in the reduction of both inflammatory and noninflammatory lesions. Most of adverse events to adapalene and many on tretinoin group were related to skin irritation, dry skin, scaling, pruritus, burning, and postinflammatory hyperpigmentation. CONCLUSION: Adapalene 0.3% and tretinoin 0.05% are comparable in efficacy, and adapalene 0.1% offers a better safety profile in Mexican patients.

Comparison of direct microscopy, culture and calcofluor white for the diagnosis of onychomycosis.

BACKGROUND: Mycological diagnosis of onychomycosis can be performed by direct microcopy (KOH), cultures and calcofluor white. AIMS: To compare the percentage of positivity and the degree of correlation of KOH, cultures and calcofluor white for the diagnosis of onychomycosis. METHODS: Descriptive, transversal and comparative study. Samples of toenails with onychomycosis were used for KOH, cultures and calcofluor white under fluorescence. The percentage of positivity of the different techniques was calculated and the degree of correlation between them was determined (Epi Info v 3.4.3(©)). RESULTS: KOH was positive in 66.67% of the cases, cultures in 33.33% and calcofluor white in 57.58%. KOH and calcofluor white had a higher percentage of positivity than culture (p<0.01 and p<0.05 respectively). The degree of correlation between KOH and calcofluor white was excellent (κ=0.8085; p<0.0001); however, the degree of correlation between KOH and culture and between calcofluor white and culture was poor. CONCLUSIONS: The use of calcofluor white is not recommended in routine laboratories because it does not seem to bring any additional benefits when comparing with KOH. This is especially important when funding is a great problem.

Cutaneous zygomycosis.

Cutaneous zygomycosis is a fungal infection caused by zygomycetes that affects the skin. It occurs in uncontrolled diabetic patients and immunosuppressed individuals. It has 2 clinical forms: primary cutaneous zygomycosis and secondary cutaneous zygomycosis. The first is characterized by necrotic lesions and the fungus is usually inoculated by trauma. If diagnosed early, it generally has a good prognosis. Secondary zygomycosis is usually a complication and extension of the rhinocerebral variety that starts as a palpebral fistula and progresses to a necrotic lesion with a poor prognosis. The diagnosis is made by identification of the fungus by direct KOH examination, culture, and biopsy. Treatment for the primary disease is surgical debridement plus amphotericin B. The secondary type is treated with amphotericin B and/or posaconazole.

Serum lactate is a useful predictor of death in severe sepsis in patients with pemphigus vulgaris.

BACKGROUND: Serum lactate is a useful prognostic marker in severe sepsis; high levels of serum lactate in critically ill patients are related to high mortality risk; assessing serum lactate levels in patients with pemphigus vulgaris is justified. The objective was to determine the role of serum lactate as a predictor of shock and its outcome in patients with pemphigus vulgaris and severe sepsis without acute organ dysfunction. METHODS: Thirty-seven patients with pemphigus vulgaris, 22 with severe sepsis and 15 without sepsis. Blood lactate levels were analyzed. The outcome was recorded as survival or non-survival. RESULTS: High serum lactate levels, compared with intermediate and low levels, were significantly associated with increased 28-day mortality in patients with severe sepsis. The 28-day mortality for the cohort was 27.3%. CONCLUSIONS: Initial serum lactate was associated with mortality in pemphigus vulgaris with severe sepsis. Patients with severe sepsis and with high serum lactate levels (≥ 4 mmol/L) constitute a potential risk group that may benefit from more aggressive treatment.

Efficacy and tolerance of superoxidized solution in the treatment of mild to moderate inflammatory acne. A double-blinded, placebo-controlled, parallel-group, randomized, clinical trial.

INTRODUCTION: Superoxidized solution (SOS) is an electrochemically processed aqueous solution manufactured from pure water and sodium chloride. Inflammatory skin disorders have all improved their outcomes with the use of SOS. These indications suggest that SOS could be useful in acne. METHODS: A total of 89 patients were enrolled in this double blinded, clinical trial. Patients presented with 10-50 inflammatory lesions (papules and pustules) and an absence of nodulocystic lesions. RESULTS: Improvement was excellent in nine patients (23%) using SOS, compared with five patients (21%) using benzoyl peroxide (BP) (p = 0.378); good in 21 patients (54%) using SOS and 12 patients (50%) using BP (p = 0.794), compared with four patients (18%) taking placebo (p = 0.001); and fair in six patients (15%) using SOS and five patients (21%) using BP (p = 0.415), compared with 12 patients taking placebo (55%) (p = 0.014). In three patients using SOS (8%) the response was poor, compared with two patients (8%) using BP (p = 0.725) and six patients (27%) taking placebo (p = 0.075). We did not need to change a dose during the study period and no systemic effect was observed. CONCLUSIONS: We found that SOS is an important choice to treat inflammatory acne, comparable with benzoyl peroxide; however, a larger sample is needed.