RESUMO
Currently, ulcerative sexually transmitted infections, including syphilis, herpes simplex virus (HSV), lymphogranuloma venereum (LGV), chancroid, donovanosis and, more recently, monkeypox (MPOX), represent a growing challenge for health care professionals. The incidence of syphilis and LGV has increased in recent years in Spain. Additionally, HSV, syphilis and chancroid can also increase the risk of HIV acquisition and transmission. The population groups most vulnerable to these infections are young people, men who have sex with men (MSM) and commercial sex workers. It is important to make a timely differential diagnosis since genital, anal, perianal, and oral ulcerative lesions may pose differential diagnosis with other infectious and non-infectious conditions such as candidiasis vulvovaginitis, traumatic lesions, carcinoma, aphthous ulcers, Behçet's disease, fixed drug eruption, or psoriasis. For this reason, the dermatologist plays a crucial role in the diagnosis and management of sexually transmitted infections. This chapter presents the main epidemiological, clinical and therapeutic features associated with these infections.
Assuntos
Síndrome de Hipersensibilidade a Medicamentos , Mieloma Múltiplo , Alopurinol/efeitos adversos , Síndrome de Hipersensibilidade a Medicamentos/diagnóstico , Síndrome de Hipersensibilidade a Medicamentos/etiologia , Humanos , Mieloma Múltiplo/diagnóstico , Mieloma Múltiplo/tratamento farmacológico , Talidomida/efeitos adversosRESUMO
BACKGROUND AND OBJECTIVE: Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is a complex multisystemic severe drug hypersensitivity reaction whose diagnosis and management are troublesome. DRESS syndrome requires management by various specialists. The correct identification of the culprit drug is essential to ensure safe future therapeutic options for the patient. There are no previous Spanish guidelines or consensus statements on DRESS syndrome. Objective: To draft a review and guidelines on the clinical diagnosis, allergy work-up, management, treatment, and prevention of DRESS syndrome in light of currently available scientific evidence and the experience of experts from multiple disciplines. METHODS: These guidelines were drafted by a panel of allergy specialists from the Drug Allergy Committee of the Spanish Society of Allergy and Clinical Immunology (SEAIC), together with other medical specialists involved in the management of DRESS syndrome and researchers from the PIELenRed consortium. A review was conducted of scientific papers on DRESS syndrome, and the expert panel evaluated the quality of the evidence of the literature and provided grades of recommendation. Whenever evidence was lacking, a consensus was reached among the experts. RESULTS: The first Spanish guidelines on DRESS syndrome are now being published. Important aspects have been addressed, including practical recommendations about clinical diagnosis, identification of the culprit drug through the Spanish pharmacovigilance system algorithm, and the allergy work-up. Recommendations are provided on management, treatment, and prevention. Algorithms for the management of DRESS in the acute and recovery phases have been drawn up. Expert consensus-based stepwise guidelines for the management and treatment of DRESS syndrome are provided.
Assuntos
Síndrome de Hipersensibilidade a Medicamentos/diagnóstico , Fígado/metabolismo , Pele/patologia , Algoritmos , Alopurinol/efeitos adversos , Antibacterianos/efeitos adversos , Anticonvulsivantes/efeitos adversos , Comorbidade , Consenso , Síndrome de Hipersensibilidade a Medicamentos/tratamento farmacológico , Síndrome de Hipersensibilidade a Medicamentos/epidemiologia , Eosinofilia , Prova Pericial , Humanos , Leucocitose , Fígado/patologia , Fatores de Risco , Espanha/epidemiologiaAssuntos
Síndromes Mielodisplásicas/complicações , Tratamento de Ferimentos com Pressão Negativa/instrumentação , Pioderma Gangrenoso/complicações , Ustekinumab/uso terapêutico , Anticorpos Monoclonais Humanizados/uso terapêutico , Fármacos Dermatológicos/uso terapêutico , Humanos , Masculino , Pessoa de Meia-Idade , Síndromes Mielodisplásicas/tratamento farmacológico , Síndromes Mielodisplásicas/patologia , Pioderma Gangrenoso/tratamento farmacológico , Pioderma Gangrenoso/patologia , Resultado do Tratamento , Ustekinumab/administração & dosagemAssuntos
Aminoquinolinas/administração & dosagem , Antineoplásicos/administração & dosagem , Doença de Paget Extramamária/tratamento farmacológico , Neoplasias Vulvares/tratamento farmacológico , Idoso , Idoso de 80 Anos ou mais , Formas de Dosagem , Feminino , Humanos , Imiquimode , Pessoa de Meia-Idade , Indução de RemissãoAssuntos
Dermatoses do Pé/diagnóstico , Ceratose/etiologia , Melanose/etiologia , Tungíase/diagnóstico , Adulto , Animais , Antibioticoprofilaxia , Dermoscopia , Feminino , Dermatoses do Pé/parasitologia , Dermatoses do Pé/cirurgia , Humanos , Quênia/etnologia , Ceratose/diagnóstico , Ceratose/parasitologia , Masculino , Melanose/diagnóstico , Melanose/parasitologia , Óvulo , Tunga , Tungíase/complicações , Tungíase/cirurgiaRESUMO
The incidence of anal squamous cell carcinoma has increased alarmingly, particularly in high-risk groups such as men who have sex with men and immunosuppressed patients. Infection with an oncogenic strain of the human papillomavirus in the anal canal or perianal skin leads to anal intraepithelial neoplasias (AIN), progressive dysplastic intraepithelial lesions that are the precursors of anal squamous cell carcinoma. AIN can be diagnosed through cytological screening and biopsy guided by high-resolution anoscopy and can be treated using a range of procedures in an effort to prevent progression to invasive anal carcinoma. Given the recent advances in the understanding of this disease, and the increasing calls from experts for the establishment of screening programs to identify AIN, we review current knowledge on the condition, its diagnosis, and treatment from the point of view of dermatology.
Assuntos
Neoplasias do Ânus/diagnóstico , Carcinoma in Situ/diagnóstico , Carcinoma de Células Escamosas/diagnóstico , Diagnóstico Precoce , Algoritmos , Alphapapillomavirus/patogenicidade , Terapia Antirretroviral de Alta Atividade , Neoplasias do Ânus/epidemiologia , Neoplasias do Ânus/patologia , Neoplasias do Ânus/virologia , Biópsia , Carcinoma in Situ/epidemiologia , Carcinoma in Situ/patologia , Carcinoma in Situ/virologia , Carcinoma de Células Escamosas/epidemiologia , Carcinoma de Células Escamosas/patologia , Carcinoma de Células Escamosas/prevenção & controle , Carcinoma de Células Escamosas/virologia , Comorbidade , Suscetibilidade a Doenças , Previsões , Infecções por HIV/tratamento farmacológico , Infecções por HIV/epidemiologia , Humanos , Hospedeiro Imunocomprometido , Incidência , Programas de Rastreamento , Infecções por Papillomavirus/diagnóstico , Infecções por Papillomavirus/epidemiologia , Lesões Pré-Cancerosas/diagnóstico , Proctoscopia , Risco , Comportamento SexualRESUMO
BACKGROUND/AIM: Extramammary Paget's disease (EMPD) is an intraepidermal adenocarcinoma of apocrine gland-bearing skin. Although surgery remains the mainstay of treatment, loss of tissue function and high recurrence rates have been reported. Recently, topical Imiquimod has been shown as a safe and effective treatment option for extramammary Paget's disease. METHODS: Three patients diagnosed of EMPD of the vulva were treated with a daily application of 5% Imiquimod cream for three weeks, followed by an every other day application for an additional three weeks. RESULTS: Complete clinical and histological remission of the disease was achieved in the three patients. Mild irritation and tenderness were observed as the only side effects. CONCLUSION: Based on our results, we consider that Imiquimod cream is a safe and effective therapeutic option for the treatment of vulvar EMPD. These promising results warrant further studies to determine the real efficacy and safety of Imiquimod 5% cream for the treatment of this uncommon disease.
Assuntos
Aminoquinolinas/administração & dosagem , Antineoplásicos/administração & dosagem , Doença de Paget Extramamária/tratamento farmacológico , Neoplasias Cutâneas/tratamento farmacológico , Neoplasias Vulvares/tratamento farmacológico , Administração Tópica , Idoso , Idoso de 80 Anos ou mais , Aminoquinolinas/efeitos adversos , Antineoplásicos/efeitos adversos , Esquema de Medicação , Feminino , Humanos , Imiquimode , Pessoa de Meia-Idade , Indução de RemissãoAssuntos
Antimetabólitos Antineoplásicos/efeitos adversos , Desoxicitidina/análogos & derivados , Toxidermias/etiologia , Fluoruracila/análogos & derivados , Lúpus Eritematoso Cutâneo/induzido quimicamente , Idoso , Capecitabina , Neoplasias Colorretais/tratamento farmacológico , Desoxicitidina/efeitos adversos , Dermatoses Faciais/induzido quimicamente , Feminino , Fluoruracila/efeitos adversos , HumanosRESUMO
CASE REPORT: A six-year-old boy presented with proptosis of the right eye. Imaging studies detected a mass in the medial wall of the right orbit. This mass was biopsied revealing a histopathologic diagnosis of primitive neuroectodermal tumor, so chemotherapy treatment was given. After seven years in remission he presented with a recurrence of the orbital tumor and was found to also have systemic metastases. Treatment with chemotherapy, radiotherapy and orbital exenteration was unsuccessful. DISCUSSION: The orbital occurrence of these tumors is extremely rare. Differentiation from other small round cell tumors requires immunohistochemical and ultrastructural techniques.
Assuntos
Recidiva Local de Neoplasia/diagnóstico , Tumores Neuroectodérmicos Primitivos Periféricos/diagnóstico , Tumores Neuroectodérmicos Primitivos Periféricos/secundário , Neoplasias Orbitárias/diagnóstico , Neoplasias Orbitárias/patologia , Criança , Humanos , MasculinoRESUMO
BACKGROUND: Retinoids have been shown to improve the manifestations of skin photodamage, including actinic keratoses. OBJECTIVE: The efficacy and tolerability of isotretinoin 0.1% cream in the treatment of actinic keratoses were evaluated in a randomized, double-blind, placebo-controlled, parallel-group study. METHODS: One hundred patients were randomly assigned to treatment with 0.1% cream or vehicle twice daily for 24 weeks to the face, the scalp, and the upper extremities. Patients were assessed every 4 weeks by the investigators, who counted and recorded the number of lesions in each treatment area. The 93 patients who had at least one postbaseline assessment were included for efficacy analysis. Local tolerability was evaluated at each study visit. RESULTS: On the face, the reduction in number of actinic keratoses (mean +/- SEM) at the end of treatment was greater for patients treated with isotretinoin (3.9 +/- 0.6, i.e., 66% of patients with a reduction > 30%) than with placebo (1.7 +/- 0.5, i.e., 45% of patients with a reduction > 30%); this difference was statistically significant (p = 0.001). No significant drug effect was seen for lesions on the scalp or upper extremities. Mild to moderate local reactions with isotretinoin abated with reduced treatment frequency. CONCLUSION: Our results suggest that isotretinoin 0.1% cream cannot compete with more rapid treatments of actinic keratoses. However, its effect on facial lesions may be beneficial during long-term treatment of associated sun-damaged skin.
Assuntos
Isotretinoína/administração & dosagem , Ceratose/tratamento farmacológico , Luz Solar/efeitos adversos , Administração Tópica , Braço , Método Duplo-Cego , Dermatoses Faciais/tratamento farmacológico , Dermatoses Faciais/etiologia , Dermatoses Faciais/patologia , Humanos , Isotretinoína/efeitos adversos , Ceratose/etiologia , Ceratose/patologia , Dermatoses do Couro Cabeludo/tratamento farmacológico , Dermatoses do Couro Cabeludo/etiologia , Dermatoses do Couro Cabeludo/patologiaRESUMO
Photodamaged skin is characterized clinically by coarseness, telangiectasia, wrinkling, discrete hyperpigmented and hypopigmented macules, atrophy, and ultimately the development of neoplasms. Studies on the UVB-irradiated hairless mouse indicate that topical application of tretinoin or isotretinoin induces structural modifications at the dermal level. Clinical trials indicate that tretinoin improves skin appearance in patients who have photodamage. This double-blind, vehicle-controlled clinical trial was conducted to determine whether 36 weeks of treatment with topical isotretinoin improves mildly to moderately photodamaged facial skin. After they gave written informed consent 776 patients were randomly assigned to 36 weeks of treatment with either vehicle cream or isotretinoin cream, applied once nightly. Efficacy was evaluated by means of physician and patient assessment and a blinded analysis of standardized photographs taken before and after treatment. When compared with vehicle, treatment with isotretinoin resulted in statistically significant improvement in overall appearance, fine wrinkling, discrete pigmentation, sallowness, and texture. Isotretinoin cream was well tolerated.
Assuntos
Dermatoses Faciais/tratamento farmacológico , Isotretinoína/uso terapêutico , Envelhecimento da Pele/efeitos dos fármacos , Administração Cutânea , Adulto , Idoso , Método Duplo-Cego , Tolerância a Medicamentos , Estética , Dermatoses Faciais/patologia , Feminino , Humanos , Isotretinoína/administração & dosagem , Masculino , Pessoa de Meia-Idade , Satisfação do Paciente , Veículos Farmacêuticos , Pele/patologia , Pigmentação da Pele/efeitos dos fármacosRESUMO
In a double-blind, randomized, within-patient comparative study, the efficacy and tolerability of Ro 14-9706 (an arotinoid methyl sulfone) in the treatment of actinic keratoses was compared with that of tretinoin (all-trans-retinoic acid). A total of 25 patients with more than three lesions on each side of the face completed the study. All patients applied each agent twice daily for 16 weeks as a 0.05% cream to opposite sides of the face. The number of actinic keratoses in each treatment area was counted before treatment and at weekly intervals. The mean percent decrease in the number of actinic keratoses was 37.8% for areas treated with Ro 14-9706 and 30.3% for areas treated with tretinoin. Each of these decreases was significantly different from baseline (p less than 0.01), but not from each other. Ro 14-9706 was better tolerated; local inflammation was slight or absent in most patients, whereas tretinoin caused severe erythema in 50% and severe scaling in 23% of patients.
Assuntos
Dermatoses Faciais/tratamento farmacológico , Ceratose/tratamento farmacológico , Naftalenos , Retinoides/administração & dosagem , Sulfonas/administração & dosagem , Tretinoína/administração & dosagem , Administração Cutânea , Idoso , Idoso de 80 Anos ou mais , Método Duplo-Cego , Dermatoses Faciais/patologia , Feminino , Humanos , Ceratose/patologia , Masculino , Pessoa de Meia-Idade , Pomadas , Retinoides/efeitos adversos , Sulfonas/efeitos adversos , Tretinoína/efeitos adversosRESUMO
Two cases of pre-Sézary erythroderma of several years of evolution that evolved into Sézary syndrome are presented. The role of persistent antigenic stimulation in the development of T-cell lymphoproliferative disease in discussed. We also review the different therapeutic approach to Sézary syndrome.
Assuntos
Dermatite Esfoliativa/patologia , Síndrome de Sézary/patologia , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Síndrome de Sézary/tratamento farmacológico , Síndrome de Sézary/etiologiaRESUMO
Since our preliminary report of psoralen plus long-wave ultraviolet A (PUVA) therapy in ten patients with erythroderma-type or plaque-type mycosis fungoides (MF), we have treated 38 patients with biopsy-proved MF. Approximately one third, mostly patients with erythroderma, received PUVA as primary therapy; the remainder had recurrent disease following electron beam irradiation or topical mechlorethamine (Mustargen) hydrochloride. Follow-up data are presented in 29 patients who completed an initial course of PUVA given two to three times weekly. A complete clinical response was observed in ten patients with plaque-type MF and seven with erythroderma without Sézary syndrome. The PUVA therapy was palliative for patients with advanced disease, in combination with other therapies. The mean observation period was approximately five years. Despite maintenance PUVA, most patients relapsed between ten and twenty months and were treated with another intensive course. Long-term maintenance therapy with PUVA was necessary to control the disease.
Assuntos
Dermatomicoses/tratamento farmacológico , Terapia PUVA , Adulto , Idoso , Dermatomicoses/patologia , Feminino , Seguimentos , Humanos , Masculino , Mecloretamina/uso terapêutico , Pessoa de Meia-Idade , Terapia PUVA/efeitos adversos , RecidivaRESUMO
Specific treatments for mycosis fungoides, including electron beam irradiation, topical mechlorethamine, and psoralen plus ultraviolet A (PUVA) may be associated with the development of skin cancers after a variable latency period. Because these treatments are often not curative, topical therapies for mycosis fungoides, administered sequentially or concomitantly, are being used increasingly in order to control recurrent disease. This report documents the development of multiple cutaneous tumors, including squamous cell carcinoma, basal cell carcinoma, actinic keratoses, keratoacanthomas, and one case of lentigo maligna, in seven patients who received topical therapies for mycosis fungoides. In contrast to the usual latency period between ionizing radiation therapy and the development of skin cancer, two of our patients who had received prior PUVA therapy developed multiple skin tumors upon completion of electron beam irradiation. The development of metastatic squamous cell carcinoma in two of the other seven patients with multiple cutaneous neoplasms suggests that this potential hazard must be considered in the evaluation and treatment of patients with mycosis fungoides.