RESUMEN
Sonic hedgehog pathway inhibitor Vismodegib is the first systemic treatment to be approved for metastatic or locally advanced basal cell carcinoma non-subsidiary of surgical treatment, and appears to be a promising treatment option for patients with nevoid basal cell carcinoma syndrome. In these patients, where repeated or prolonged treatment may be necessary, the psychological exhaustion caused by the chronicity of less severe adverse effects appears as the main limiting factor in the persistence of the drug in the long term and in the willingness of patients to take the drug again after its suspension. We report our experience with three cases where a drug holiday approach was effective in decreasing the intensity of adverse effects or improving the patient's subjective tolerance to the drug while maintaining clinical response.
Asunto(s)
Antineoplásicos , Síndrome del Nevo Basocelular , Carcinoma Basocelular , Preparaciones Farmacéuticas , Neoplasias Cutáneas , Anilidas/efectos adversos , Antineoplásicos/efectos adversos , Síndrome del Nevo Basocelular/diagnóstico , Síndrome del Nevo Basocelular/tratamiento farmacológico , Carcinoma Basocelular/tratamiento farmacológico , Proteínas Hedgehog/uso terapéutico , Humanos , Piridinas , Neoplasias Cutáneas/tratamiento farmacológicoAsunto(s)
Erupciones Acneiformes/inducido químicamente , Inhibidores de la Angiogénesis/efectos adversos , Proteínas Recombinantes de Fusión/efectos adversos , Erupciones Acneiformes/patología , Adenocarcinoma/tratamiento farmacológico , Neoplasias Colorrectales/tratamiento farmacológico , Humanos , Masculino , Persona de Mediana Edad , Receptores de Factores de Crecimiento Endotelial VascularAsunto(s)
Melanoma/epidemiología , Enfermedades de la Uña/epidemiología , Neoplasias Cutáneas/epidemiología , Neoplasias de las Glándulas Sudoríparas/epidemiología , Glándulas Sudoríparas/patología , Anciano , Anciano de 80 o más Años , Femenino , Pie , Mano , Humanos , Masculino , Márgenes de Escisión , Melanoma/etiología , Melanoma/patología , Melanoma/cirugía , Persona de Mediana Edad , Enfermedades de la Uña/patología , Enfermedades de la Uña/cirugía , Uñas/patología , Uñas/cirugía , Piel/patología , Neoplasias Cutáneas/etiología , Neoplasias Cutáneas/patología , Neoplasias Cutáneas/cirugía , Neoplasias de las Glándulas Sudoríparas/etiología , Neoplasias de las Glándulas Sudoríparas/patología , Neoplasias de las Glándulas Sudoríparas/cirugía , Glándulas Sudoríparas/cirugíaAsunto(s)
Antígenos CD1/inmunología , Queratinocitos/patología , Leishmaniasis Cutánea/patología , Enfermedades Cutáneas Vesiculoampollosas/patología , Abuso de Sustancias por Vía Intravenosa , Biopsia con Aguja , Células Cultivadas , Diagnóstico Diferencial , Seropositividad para VIH/inmunología , Humanos , Inmunohistoquímica , Queratinocitos/inmunología , Leishmaniasis Cutánea/inmunología , Masculino , Persona de Mediana Edad , Medición de Riesgo , Enfermedades Cutáneas Vesiculoampollosas/diagnósticoRESUMEN
Programmed cell death receptor 1 inhibitors (anti-PD-1) constitute a form of immunotherapy for the treatment of several cancers. They are associated with cutaneous immune-related adverse events (irAE), occurring in up to 50% of patients. Lichenoid dermatitis is frequent and several presentations have been described. Although attempts have been made to study these reactions, they are yet to be fully characterized and the relationship with tumor response is unclear. We describe a case of digital ulcerative lichenoid dermatitis resembling ulcerative cutaneous lichen planus that occurred during pembrolizumab therapy for oral squamous cell carcinoma. The patient developed a painful ulcer on his index finger 18 months into therapy. Biopsy revealed epidermal ulceration with intense lichenoid dermatitis. Immunohistochemical study revealed intense CD8 positivity at the ulcer's edges and marked CD163 positivity at its base. Although idiopathic forms of this type of lichenoid dermatitis are particularly recalcitrant, our case was successfully managed with topical therapy and oncologic treatment did not require modification. One year after ending treatment the patient remains free of disease progression. It is unclear if this reaction is associated with his favorable oncologic response. This report adds an undescribed reaction to the increasing diversity of cutaneous irAE associated with anti-PD-1 therapy.
Asunto(s)
Anticuerpos Monoclonales Humanizados/efectos adversos , Antineoplásicos Inmunológicos/efectos adversos , Erupciones Liquenoides/inducido químicamente , Receptor de Muerte Celular Programada 1/antagonistas & inhibidores , Úlcera Cutánea/inducido químicamente , Administración Cutánea , Anciano , Anticuerpos Monoclonales Humanizados/uso terapéutico , Antineoplásicos Inmunológicos/uso terapéutico , Betametasona/administración & dosificación , Betametasona/análogos & derivados , Carcinoma de Células Escamosas/tratamiento farmacológico , Combinación de Medicamentos , Gentamicinas/administración & dosificación , Humanos , Erupciones Liquenoides/tratamiento farmacológico , Erupciones Liquenoides/patología , Masculino , Neoplasias de la Boca/tratamiento farmacológico , Piel/patología , Úlcera Cutánea/tratamiento farmacológico , Úlcera Cutánea/patologíaRESUMEN
Apocrine hidrocystoma is a rare, benign, cystic tumor of the apocrine sweat glands. They are most commonly located around the eyes and may also be found on the scalp and neck. However, despite the fact that the nipple and areola contain numerous apocrine sweet glands, apocrine hydrocystomas have not been described previously in this area to the best of our knowledge. We report the first case of this cyst in this unsual location.
Asunto(s)
Glándulas Apocrinas/patología , Pezones/patología , Neoplasias de las Glándulas Sudoríparas/patología , Adulto , Femenino , Humanos , Pezones/diagnóstico por imagen , Neoplasias de las Glándulas Sudoríparas/diagnóstico por imagen , Ultrasonografía MamariaRESUMEN
Pemphigus foliaceus is an autoimmune bullous disease with autoantibodies against desmoglein 1. Case reports of pemphigus after surgery have also been described, which may simulate an infection of the surgical wound, a contact dermatitis, or even a tumor recurrence. Cytoimmunofluorescence can help to establish a rapid diagnosis.
Asunto(s)
Carcinoma Basocelular/cirugía , Neoplasias de los Párpados/cirugía , Técnica del Anticuerpo Fluorescente Directa , Inmunoglobulina G/análisis , Cirugía de Mohs/efectos adversos , Pénfigo/diagnóstico , Biomarcadores/análisis , Carcinoma Basocelular/patología , Neoplasias de los Párpados/patología , Femenino , Humanos , Persona de Mediana Edad , Pénfigo/tratamiento farmacológico , Pénfigo/inmunología , Pénfigo/patología , Valor Predictivo de las Pruebas , Esteroides/administración & dosificación , Resultado del TratamientoRESUMEN
The differential diagnosis of Grover disease (GD) includes pemphigus foliaceus. However, the focal nature of the histologic findings and negative direct immunofluorescent point to the diagnosis of GD. It has been associated with a variety of systemic and cutaneous diseases, but its association with other primary acantholytic disorders has been rarely documented. In this article, we describe the first case of GD in association with pemphigus foliaceus.
Asunto(s)
Acantólisis/complicaciones , Carcinoma Basocelular/complicaciones , Ictiosis/complicaciones , Pénfigo/complicaciones , Neoplasias Cutáneas/complicaciones , Carcinoma Basocelular/cirugía , Femenino , Humanos , Persona de Mediana Edad , Neoplasias Cutáneas/cirugíaAsunto(s)
Antineoplásicos/efectos adversos , Vasculitis por IgA/inducido químicamente , Inhibidores de Proteínas Quinasas/efectos adversos , Sunitinib/efectos adversos , Adulto , Biopsia , Carcinoma de Células Renales/tratamiento farmacológico , Carcinoma de Células Renales/patología , Dermoscopía , Femenino , Humanos , Vasculitis por IgA/diagnóstico , Vasculitis por IgA/patología , Neoplasias Renales/tratamiento farmacológico , Neoplasias Renales/patología , Piel/diagnóstico por imagen , Piel/patologíaRESUMEN
We report the case of a 32-year-old man with measles in which skin biopsy helped to establish a definitive diagnosis. Follicular involvement is a common histopathologic feature of measles. Multinucleated epidermal and follicular cells are distinctive findings.
Asunto(s)
Células Gigantes/patología , Folículo Piloso/patología , Queratinocitos/patología , Sarampión/patología , Glándulas Sebáceas/patología , Adulto , Biopsia , Humanos , Masculino , Sarampión/diagnósticoRESUMEN
BACKGROUND: Idiopathic pulmonary fibrosis (IPF) is an idiopathic interstitial progressive fibrotic lung disease and the most lethal of all interstitial lung diseases. Pirfenidone is a novel antifibrotic and anti-inflammatory agent which reduces decline in lung function and prolonges progression-free survival. It has a favourable benefit-risk profile and is generally well tolerated. However gastrointestinal events, photosensitivity reactions and rash are the most common adverse events. OBJECTIVE: We report a 71-year-old man with 1 week history of erythematous partially pruritic lesions on both sides of the neck and the back of the hands limited to sun exposed areas. He had been diagnosed with IPF and was being treated with pirfenidone (Esbriet) for 8 months. We suspected a photosensitivity reaction caused by pirfenidone. METHODS: A phototest and a punch biopsy were performed. RESULTS: The phototest had a pathological result. The minimal erythema dose was decreased, presenting with erythema and edema starting from 7 mJ/cm2 of UVB and an aberrant response to UVA starting from 2 J/cm2. Histopathological examination revealed spongiotic acute dermatitis with focal presence of necrotic keratinocytes. The patient was diagnosed with pirfenidone-induced photosensitivity and treated with high potency topical steroid leading to the resolution of the lesions, without the need for discontinuation of the drug. CONCLUSION: To our Knowledge, this is the first pirfenidone-induced photosensitivity reported case confirmed by pathological phototest. Patient education and photoprotection advice are essential for prevention.
Asunto(s)
Fotoquimioterapia/métodos , Trastornos por Fotosensibilidad/inducido químicamente , Fármacos Fotosensibilizantes/efectos adversos , Piridonas/efectos adversos , Corticoesteroides/uso terapéutico , Anciano , Humanos , Fibrosis Pulmonar Idiopática/tratamiento farmacológico , Masculino , Fotoquimioterapia/efectos adversos , Trastornos por Fotosensibilidad/tratamiento farmacológico , Fármacos Fotosensibilizantes/uso terapéutico , Piridonas/uso terapéuticoAsunto(s)
Anticuerpos Antinucleares/análisis , Técnica del Anticuerpo Fluorescente Directa/métodos , Esclerodermia Limitada/inmunología , Esclerodermia Limitada/patología , Biomarcadores/análisis , Biopsia con Aguja , Humanos , Inmunohistoquímica , Masculino , Persona de Mediana Edad , Pronóstico , Esclerodermia Limitada/diagnóstico , Sensibilidad y Especificidad , Índice de Severidad de la EnfermedadRESUMEN
Nodular secondary syphilis results from the hematogenous and lymphatic dissemination of spirochetes. Clinically, the lesions appear as partially infiltrated plaques or red-violaceous nodules, which can be solitary or multiple. Several hypotheses have been put forward to explain the formation of these infiltrated or granulomatous lesions. Among the most accepted are the specific hypersensitivity reactions to Treponema pallidum or the lenghty duration of the disease. We present a case of nodular syphilis where immunohistochemistry revealed the presence of multiple spirochetes invading the epidermis.