RESUMEN
Cutaneous malakoplakia is a rare infection-related granulomatous disease frequently associated with immunocompromised states. Foamy macrophages containing basophilic granules, called the Michaelis-Gutman bodies, are pathognomonic. We report a case of cutaneous malakoplakia in a 77-year-old male with pyoderma gangrenosum and a 2-year history of a non-healing malleolar ulcer treated successfully with cotrimoxazole.
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Huésped Inmunocomprometido , Malacoplasia/tratamiento farmacológico , Malacoplasia/etiología , Piodermia Gangrenosa/complicaciones , Piodermia Gangrenosa/tratamiento farmacológico , Administración Cutánea , Anciano , Humanos , Masculino , Resultado del TratamientoRESUMEN
BACKGROUND: Actinic keratosis (AK) lesions have the potential to develop into invasive squamous cell carcinomas (SCCs), and approaches to treatment are evolving to try to reduce the burden of SCC. OBJECTIVE: To present the published clinical research surrounding the use of 0.5% 5-fluorouracil with 10% salicylic acid (low-dose 5-FU/SA) for the treatment of hyperkeratotic AKs. METHOD: A review of published clinical evidence for low-dose 5-FU/SA for the treatment of AKs. The articles were selected following a MEDLINE database search of the combined terms fluorouracil, salicylic acid and actinic keratosis which represent the peer review publications of clinical studies that primarily investigate the use of Actikerall in AK. RESULTS: Combining low-dose 5-FU with keratolytic SA is associated with high rates of histologic clearance, reduction in lesion number/area, and sustained clinical response in clinical study and the clinical practice setting. Low-dose 5-FU/SA has also been evaluated using imaging to detect the progression of subclinical AK lesions through a course of the field-directed treatment. CONCLUSION: Low-dose 5-FU/SA is an effective and well-tolerated treatment option licensed for the lesion-directed treatment of mild-to-moderate hyperkeratotic AK lesions.
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Antimetabolitos Antineoplásicos/administración & dosificación , Fluorouracilo/administración & dosificación , Queratolíticos/administración & dosificación , Queratosis Actínica/tratamiento farmacológico , Ácido Salicílico/administración & dosificación , Administración Cutánea , Combinación de Medicamentos , Humanos , SolucionesRESUMEN
Visual inspection may fail to accurately evaluate field cancerisation (subclinical actinic keratoses [AKs]). We aimed to describe field cancerisation by confocal reflectance microscopy and changes induced by the application of 3% diclofenac sodium gel in 2.5% hyaluronic acid. Fourteen male patients, > 50 years old, with AKs on the bald scalp were included. Clinical examination, confocal microscopy and histological study of clinically visible lesions and "normal appearing" adjacent skin before and after treatment was completed. Reflectance confocal microscopy showed a decrease in scaling (p = 0.001) and atypia of the honeycomb pattern (p = 0.001) at 2 weeks of treatment. Changes in parakeratosis, inflammation and dermal collagen remodelling were also observed. Histology correlated with confocal features in AK and subclinical AK. Reflectance confocal microscopy was useful in the evaluation of field cancerisation and monitoring of treatment response. A rapid improvement in epidermal atypia was observed.
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Antiinflamatorios no Esteroideos/administración & dosificación , Diclofenaco/administración & dosificación , Ácido Hialurónico/administración & dosificación , Queratosis Actínica/tratamiento farmacológico , Microscopía Confocal/métodos , Microscopía de Interferencia/métodos , Dermatosis del Cuero Cabelludo/tratamiento farmacológico , Cuero Cabelludo/efectos de los fármacos , Neoplasias Cutáneas/tratamiento farmacológico , Administración Cutánea , Biopsia , Quimioterapia Combinada , Humanos , Queratosis Actínica/patología , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Cuero Cabelludo/patología , Dermatosis del Cuero Cabelludo/patología , Neoplasias Cutáneas/patología , Factores de Tiempo , Resultado del TratamientoRESUMEN
All cases of MM diagnosed in 23 hospitals in Catalonia, from 2000 to 2007 were recorded and melanoma incidence calculated and adjusted for the European standard population via the direct method. The age standardised rate/100,000 inhabitants varied from 6.74 in 2000 to 8.64 in 2007 for all melanomas and from 4.79 to 5.80 for invasive MMs; the Breslow thickness was stable during the period. The increase in invasive melanoma incidence in the elderly was remarkable, the crude rate/100,000 inhabitants increasing from 11.04 (2000) to 15.49 (2007) in the 60-64 year population, while remaining more stable in the 30-34 year range, from 3.97 in 2000 to 4.55 in 2007, and with a tendency to decrease from 5.1 in 2000 to 2.5 in 2007 for the age range of 25-29 years. These lower age ranges are much more affected by immigration. Despite the large immigrant population (nearly one million immigrants arrived in Catalonia during the study period from countries with a low melanoma incidence), melanoma incidence in our region has risen considerably and this trend is likely to persist in the near future.
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Melanoma/epidemiología , Neoplasias Cutáneas/epidemiología , Adulto , Distribución por Edad , Anciano , Emigración e Inmigración , Femenino , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Sistema de Registros , España/epidemiología , Adulto JovenRESUMEN
INTRODUCTION: The diagnosis of vitiligo is mainly based on clinical findings. However, dermoscopy or reflectance confocal microscopy (RCM) could be useful for assessing its progression (stability, pigmen-tation, or depigmentation). OBJECTIVES: To evaluate the correlation of dermatological findings by dermoscopy and RCM in pediatric vitiligo. METHODS: We conducted a cross-sectional, descriptive, and analytical clinical study. Pediatric patients with vitiligo of both sexes, aged > 1 year and < 18 years, with all spectrums of the disease were includ-ed. Vitiligo lesions were evaluated clinically, by dermoscopy, and microscopy. RESULTS: A total of 40 patients with vitiligo were included. Eight dermoscopic patterns were found: reduced/absent pigment network, perifollicular pigmentation, trichromic, tapioca sago, perifollicular depigmentation, starburst, leukotrichia, and erythema. Skin with a normal pigment network showed complete dermal papillary rings and half-rings. Skin with reduced/absent pigment network also had an absence of papillary rings or only showed half-rings and was more common in unstable vitiligo. The trichrome pattern only showed half-rings. The Tapioca sago pattern showed complete papillary rings and appeared in younger patients. Perifollicular pigmentation showed half-rings and complete rings and did not show associations. The diffuse borders did not present complete papillary structures. It was found that vitiligo duration time of fewer than 24 months (Odds Ratio 4.56, CI 1.09-18.99) and absent papillary rings (OR 2.75, CI 1.01-7.51) are associated with unstable prognosis. CONCLUSIONS: Certain dermatoscopic and microscopic findings, such as the reduction/absence of the pigment network, tapioca sago pattern, and absence of papillary rings, can be used to assess the stabil-ity of the disease and provide insight into the clinical behaviour of vitiligo.
RESUMEN
Vitiligo is a chronic, acquired autoimmune pigmentary skin disease, most times it can be diagnosed clinically. Dermoscopy can confirm vitiligo in a non-invasive way. It is a diagnostic technique that visualizes sub-macroscopic morphological structures which correspond with specific histological structures. It detects subtle changes in the pigment pattern, evaluates vitiligo activity, attempts of re-pigmentation, leucotrichia, and differentiates it from other hypo pigmentary disorders. Most dermatoscopic clues used to assess vitiligo activity are found at the perifollicular level in the center and edge of the lesion. Perifollicular pigmentation is present in both active lesions and treated pigmented lesions with treatment. However, perifollicular depigmentation represents poor response, in treated lesions, and poor prognosis in untreated ones. The center of the lesion has reduced and/or absent pigment network, in active and stable lesions. If on dermoscopy the center of the lesion shows islands of pigment, erythema, or telangiectasias, re-pigmentation is suggested. At the periphery of the lesion, unstable vitiligo usually shows up as a diffuse border, trichrome pattern, micro-Koebner/comet tail phenomenon, satellite lesions, or a tapioca sago pattern. In stable lesions it is more frequent to find well defined or trichromic border. Pigmented lesions commonly present sharp borders and marginal or perilesional hyperpigmentation.
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Background Melanoma is an aggressive cutaneous cancer. Acral lentiginous melanoma is a melanoma subtype arising on palms, soles, and nail-units. The incidence, prevalence and prognosis differ among populations. The link between expression of major histocompatibility complex Class II alleles and melanoma progression is known. However, available studies report variable results regarding the association of melanoma with specific HLA Class II loci. Aims The aim of the study was to determine HLA Class II allele frequencies in acral lentiginous melanoma patients and healthy Mexican Mestizo individuals. Methods Eighteen patients with acral lentiginous melanoma and 99 healthy controls were recruited. HLA Class II typing was performed based on the sequence-specific oligonucleotide method. Results Three alleles were associated with increased susceptibility to develop acral lentiginous melanoma, namely: HLA-DRB1*13:01; pC = 0.02, odds ratio = 6.1, IC95% = 1.4-25.5, HLA-DQA1*01:03; pC = 0.001, odds ratio = 9.3, IC95% = 2.7-31.3 and HLA-DQB1*02:02; pC = 0.01, odds ratio = 3.7, IC95% = 1.4-10.3. Limitations The small sample size was a major limitation, although it included all acral lentiginous melanoma patients seen at the dermatology department of Dr. Manuel Gea González General Hospital during the study period. Conclusion HLA-DRB1*13:01, HLA-DQB1*02:02 and HLA-DQA*01:03 alleles are associated with increased susceptibility to develop acral lentiginous melanoma in Mexican Mestizo patients.
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Melanoma , Alelos , Estudios de Casos y Controles , Cadenas HLA-DRB1 , Haplotipos , Humanos , Melanoma/diagnóstico , Melanoma/epidemiología , Melanoma/genética , Neoplasias Cutáneas , Melanoma Cutáneo MalignoAsunto(s)
Carcinoma Basocelular/patología , Dermoscopía/métodos , Neoplasias Fibroepiteliales/patología , Neoplasias Primarias Múltiples/patología , Neoplasias Cutáneas/patología , Brazo , Biopsia con Aguja , Carcinoma Basocelular/diagnóstico , Humanos , Inmunohistoquímica , Masculino , Persona de Mediana Edad , Neoplasias Fibroepiteliales/diagnóstico , Neoplasias Primarias Múltiples/diagnóstico , Nevo Pigmentado/diagnóstico , Nevo Pigmentado/patología , Enfermedades Raras , Neoplasias Cutáneas/diagnósticoRESUMEN
Acral lentiginous melanoma is a histological subtype of cutaneous melanoma that occurs in the glabrous skin of the palms, soles and the nail unit. Although in some countries, particularly in Latin America, Africa and Asia, it represents the most frequently diagnosed subtype of the disease, it only represents a small proportion of melanoma cases in European-descent populations, which is partially why it has not been studied to the same extent as other forms of melanoma. As a result, its unique genomic drivers remain comparatively poorly explored, as well as its causes, with current evidence supporting a UV-independent path to tumorigenesis. In this review, we discuss current knowledge of the aetiology and diagnostic criteria of acral lentiginous melanoma, as well as its epidemiological and histopathological characteristics. We also describe what is known about the genomic landscape of this disease and review the available biological models to explore potential therapeutic targets.
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Enfermedades del Pie/patología , Melanocitos/patología , Melanoma/patología , Enfermedades de la Uña/patología , Neoplasias Cutáneas/patología , HumanosRESUMEN
Lidocaine/prilocaine cream is a topical anesthetic commonly used in pediatric and dermatologic practice to obtain local anesthesia. Common side effects include: transient skin blanching, erythema, urticaria, allergic contact dermatitis, irritant contact dermatitis, and hyperpigmentation. The authors report a petechial and purpuric reaction after the application of lidocaine/prilocaine cream. This is a rare side effect, since to our knowledge only few case reports have been documented in literature.
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Anestésicos Combinados/efectos adversos , Anestésicos Locales/efectos adversos , Erupciones por Medicamentos/etiología , Lidocaína/efectos adversos , Prilocaína/efectos adversos , Púrpura/inducido químicamente , Preescolar , Erupciones por Medicamentos/patología , Humanos , Combinación Lidocaína y Prilocaína , Masculino , Pomadas , Púrpura/patologíaRESUMEN
Chronic wounds are a major health care problem worldwide. Wound healing is a holistic endeavour that requires an accurate identification of the specific entities interfering with wound healing in a particular patient. We present a case of fixed sporotrichosis as the cause of a chronic ulcer in the knee. Although a culture of Sporothrix schenckii could not be obtained, a positive response to the sporotrichin skin test, a skin biopsy showed a suppurative granuloma and an adequate response to oral administration of potassium iodide confirmed the diagnosis. The identification and correction of the underlying aetiology of any chronic wound is the first and most important step to restore wound healing.
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Úlcera de la Pierna/microbiología , Úlcera de la Pierna/terapia , Sporothrix , Esporotricosis/diagnóstico , Esporotricosis/terapia , Enfermedad Crónica , Femenino , Humanos , Rodilla , Persona de Mediana EdadRESUMEN
Transepidermal elimination is a mechanism by which altered dermal extracellular material is discharged through the epidermis. Perforating elastosis is a rare disease characterized by the transepidermal elimination of abnormal elastic fibers. Clinically it manifests as skin-colored keratotic papules that may coalesce and form arcuate or serpiginous plaques. It affects mostly males, predominantly younger than 30-years-old. We present a case of a male patient with inflammatory bowel disease and sclerosing cholangitis associated with perforating elastosis. To our knowledge, this is the first description of inflammatory bowel disease associated with perforating elastosis.
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Colangitis Esclerosante/complicaciones , Colitis Ulcerosa/complicaciones , Enfermedades de la Piel/complicaciones , Adulto , Humanos , MasculinoRESUMEN
OBJECTIVE: Longitudinal melanonychia (LM) is a common dermatologic problem encountered in everyday practice. Its diagnostic approach is critical as it can be an early sign of nail melanoma. Racial melanonychia is the entity most frequently associated with LM. Because there are no clinical data regarding these associations in a Mexican population, we conducted a prospective study. METHODS: A total of 68 consecutive patients given the clinical diagnosis of LM were included and a nail biopsy was performed to determine its cause. RESULTS: Racial melanonychia was found in 48 cases (68%), 4 cases (5.7%) were associated with benign melanocytic hyperplasia, and 4 cases (5.7%) had a nail apparatus malignancy. LIMITATIONS: Dermatoscopy and immunohistochemical stains were not used. Incisional transverse nail matrix biopsies were performed when melanonychia affected the middle portion of the nail plate. CONCLUSION: LM is most commonly associated with racial melanonychia in the Mexican population, but in nearly 6% of cases it may be linked with nail apparatus malignancy. To our knowledge, this is the first time a study of this nature was performed in a mestizo Hispanic population.
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Melanocitos/patología , Melanoma/epidemiología , Enfermedades de la Uña/epidemiología , Trastornos de la Pigmentación/epidemiología , Neoplasias Cutáneas/epidemiología , Adolescente , Adulto , Anciano , Femenino , Humanos , Hiperplasia/epidemiología , Masculino , México/epidemiología , Persona de Mediana EdadRESUMEN
In the 1980s, the increasing incidence of skin cancers prompted the development of noninvasive medical devices to improve skin cancer diagnosis in daily dermatology practice. As a result of the development of these noninvasive techniques, diagnosis is now established earlier and with better accuracy. These advances are of great benefit to high-risk patients, who previously would have had to undergo several excisions. In this review, we focus on the classic technique of dermoscopy and the more recent digital version, as well as on advanced noninvasive imaging techniques, such as reflectance confocal microscopy and optical coherence tomography. On the basis of their specific features, these noninvasive medical devices can be used not only to diagnose and monitor melanoma and nonmelanoma skin cancers but also to choose the best therapy and follow the patient's response to treatment in vivo.
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Dermatología/métodos , Oncología Médica/métodos , Neoplasias Cutáneas/diagnóstico por imagen , Dermatología/instrumentación , Dermoscopía/instrumentación , Dermoscopía/métodos , Humanos , Oncología Médica/instrumentación , Microscopía Confocal/instrumentación , Microscopía Confocal/métodos , Fotoquimioterapia/métodos , Cuidados Preoperatorios/métodos , Pronóstico , Piel/diagnóstico por imagen , Neoplasias Cutáneas/terapia , Tomografía de Coherencia Óptica/instrumentación , Tomografía de Coherencia Óptica/métodos , Resultado del TratamientoRESUMEN
Most of our current knowledge of melanoma is derived from the study of patients from populations of European descent, for whom public health, sun protection initiatives and screening measures have appreciably decreased disease mortality. Notably, some melanoma subtypes that most commonly develop in other populations are not associated with exposure to ultraviolet (UV) light, suggesting a different disease aetiology. Further study of these subtypes is necessary to understand their risk factors and genomic architecture, and to tailor therapies and public health campaigns to benefit patients of all ethnic groups.
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Países Desarrollados , Países en Desarrollo , Promoción de la Salud , Melanoma/genética , Neoplasias Cutáneas/genética , Salud Global , Humanos , Melanoma/epidemiología , Melanoma/patología , Melanoma/prevención & control , Grupos Raciales , Neoplasias Cutáneas/epidemiología , Neoplasias Cutáneas/patología , Neoplasias Cutáneas/prevención & controlRESUMEN
OBJECTIVE: To describe the results of an intervention program to reduce the rate of surgical site infection (SSI) in the breast tumor department of a referral teaching hospital for patients with cancer. METHODS: Preventive measures introduced in the Breast Tumor Department of the study hospital included the following: starting in July 2000, use of sterile technique for wound care; starting in 2001, use of closed antireflux silicone evacuation systems, use of perioperative antimicrobial prophylaxis, provision of feedback to surgeons, and remodeling of the ambulatory wound care clinic. We conducted surveillance of all patients who underwent mastectomy between February 1 and December 31, 2001, and the SSI rate was calculated. A case-control analysis was performed for risk factors known to be associated with SSI. Results were compared with the data from 2000. RESULTS: The study included data on 385 surgeries. SSIs were registered in 52 (13.7%) of these 385, which was a rate 58.6% less than the 2000 infection rate (33.1%). Risk factors associated with SSI included concomitant chemotherapy and radiation therapy (OR, 3.6 [95% confidence interval {CI}, 1.9-7.1]), surgery performed during an evening shift (OR, 1.9 [95% CI, 1.1-3.6]), and insertion of a second drainage tube during the late postoperative period (OR, 2.8 [95% CI, 1.4-5.7]). The mean number (+/- SD) of postoperative visits to the outpatient wound care clinic was reduced from 11.6+/-7.1 in 2000 to 9.2+/-4.4 in 2001 (P<.001, Student's t test). The mean number of days that the evacuation systems were used was reduced from 19.0 to 16.0 days (P=.001, Student's t test). CONCLUSIONS: Continuous wound surveillance, along with feedback to surgeons, use of closed antireflux evacuation systems, and standardized practices in wound and drainage-tube care, decreased by 58.6% the rate of SSI in a breast surgical department with high rates of infection.
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Control de Infecciones/normas , Mastectomía/efectos adversos , Vigilancia de la Población , Infección de la Herida Quirúrgica/epidemiología , Infección de la Herida Quirúrgica/prevención & control , Femenino , Estudios de Seguimiento , Humanos , Control de Infecciones/métodos , Mastectomía/métodos , Persona de Mediana Edad , Estudios Prospectivos , Infección de la Herida Quirúrgica/etiologíaRESUMEN
Lobular capillary hemangioma (pyogenic granuloma) has been reported more frequently in the skin (88%) than in the mucous membranes (12%). Granuloma gravidarum is a pyogenic granuloma that develops during pregnancy, often in the oral mucosa. Estrogens apparently increase the inflammatory response of mucous membranes. In this article, we describe the first case of a granuloma gravidarum of the scalp.
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Granuloma Piogénico/patología , Enfermedades de la Piel/patología , Adulto , Femenino , Granuloma Piogénico/cirugía , Humanos , Embarazo , Cuero Cabelludo/patología , Cuero Cabelludo/cirugía , Enfermedades de la Piel/cirugía , Resultado del TratamientoRESUMEN
INTRODUCTION: A relatively novel application for dermoscopy is its use in the monitoring of topical treatment response for non-melanoma skin cancer. Basal cell carcinoma (BCC) is the most frequent type of skin cancer in humans. Surgical excision is still considered the "gold-standard" of treatment. However, a number of topical therapies are now available for the treatment of different types of basal cell carcinoma. CASE REPORT: This case report exemplifies the usefulness of dermoscopy in the monitoring of residual disease after incomplete surgical excision and also in the monitoring of topical treatment response. Imiquimod 5% cream acts as a topical immune response modifier promoting a Th-1 immune response enhancing the removal of neoplastic cells and has proven to reduce deregulated Hedgehog (HH)/GLI signal strength independent of Toll-like receptor signaling, which makes it a valuable adjuvant topical therapy for the treatment of basal cell carcinoma. CONCLUSION: Imiquimod 5% cream is a valuable adjuvant therapy for the treatment of incompletely excised BCC. This case report adds further evidence to the usefulness of dermoscopy in the assessment and monitoring of treatment outcome.