Metastatic Melanoma Negative for 5 Melanocytic Markers, Complete Regressed Primary Cutaneous Melanoma, and Melanoma-Associated Leukoderma in the Same Patient.

Melanomas with complete histological regression have been seen very infrequently. On the other hand, the diagnosis of metastatic melanoma is based on the histopathology and positivity of markers such as S100, Melan-A, and HMB-45 whose sensitivity is 99%, 82%, and 76%, respectively. It is very rare that metastatic melanomas and even more primary melanoma are negative for all of these markers. In these rare cases, there is usually a known primary. We present the case of a 82-year-old woman with a erythematous mass in the left groin and a 1-cm black-bluish irregular nodule on the skin of the ipsilateral foot. This lesion was clinical and dermoscopically compatible with primary melanoma. In the histological evaluation of the skin, a dermis full of melanophages and hemosiderophages were found in a background of fibrosis, scarce lymphocytic infiltrate, and neovascularization. Any cells expressing melanocytic markers were observed. It was diagnosed as tumoral melanosis. Lymph nodes showed a proliferation of atypical epithelioid cells with eosinophilic cytoplasm. Mitosis was conspicuous. Tumoral cells were vimentin and CD99 positive, and S100, CD34, HMB-45, Melan-A, SOX 10, tyrosinase, C-KIT, CD45, and CKAE1/AE3 negative, and BRAF-V600 mutated was detected. During follow-up, atypical vitiligo-like lesions were discovered, suggesting the diagnosis of metastatic melanoma totally regressed in our patient.

"Eruptive Lentiginosis" in a Patient With Vitiligo and Inflammatory Bowel Disease Treated With Azathioprine.

Multiple lentiginosis are seen in many multisystemic diseases and during the course of many treatment schemes in the area of application of topical substances, PUVA, or more disseminated reactions in the case of systemic drugs. We report a case of a 67-year-old man with multiple comorbidities including vitiligo, and a recent diagnosis of inflammatory bowel disease, who developed millimeter-size, circular, brown macules in photoexposed areas both affected and not affected by vitiligo while was taken azathioprine, which disappeared after drug withdrawal. Biopsy showed groups of apoptotic keratinocytes, basal hyperpigmentation, and slight dermal inflammation. The authors describe "eruptive lentiginosis" as an adverse event of azathioprine not previously described in the literature.

First Spanish study on the effectiveness of ultrasound-guided sacroiliac joint injection in patients with spondyloarthritis.

Objective: The aim was to assess clinical improvement after US-guided injection of CSs into the SI joint of patients with SpA. Methods: This was an observational, descriptive, retrospective study of patients with SpA and sacroiliitis who received an US-guided injection into the SI joint between 1 June 2020 and 31 May 2021. Means were compared using Student's paired t-test for the variables visual analog scale (VAS), BASDAI, ASDAS, CRP and ESR before and after the procedure. We evaluated the association between these variables and the clinical response using the odds ratio. Results: We analysed 32 patients with SpA [age 42.69 (8.19) years; female sex, 56.25%], with a VAS score of 7.88 (0.79), BASDAI of 5.43 (1.48) and ASDAS of 3.27 (0.86) before the procedure. At 2-3 months, 75% of patients had improved: VAS 3.81 (2.33) (-4.07, P < 0.0001) and BASDAI 3.24 (1.6) (-2.19, P < 0.0001). At 5-6 months, 59.37% had improved: VAS 4.63 (2.31) (-3.25, P < 0.0001), BASDAI 3.57 (1.67) (-1.86, P < 0.0001) and ASDAS 2.27 (0.71) (-1.0, P < 0.0001). Bone marrow oedema resolved in 87.5% of cases compared with the previous MRI scan. No significant association was identified with the clinical response to the injection. Conclusion: US-guided injection of CSs into the SI joint of patients with SpA and active sacroiliitis leads to an improvement in symptoms that is maintained at 5-6 months. The procedure is effective, safe, inexpensive and easy to apply.

Cutaneous lupus erythematosus, morphea profunda and psoriasis: A case report. / Lupus eritematoso cutáneo, morfea profunda y psoriasis en una paciente.

Psoriasis is a common inflammatory dermatosis that may be associated with a number of diseases. Recent studies provide evidence that there is a greater frequency of autoimmune diseases, but association with autoimmune connective tissue diseases is uncommon. The coexistence of psoriasis and lupus erythematosus is rare. Besides, the occurrence of morphea has rarely been reported in patients with lupus or psoriasis. We report a woman with cutaneous lupus and morphea profunda associated with psoriasis, with an excellent response to methotrexate, and review the literature.

Frontal fibrosing alopecia and extrafacial lichen planus pigmentosum in a caucasian woman.

We present the case of a 72-year-old Caucasian woman with frontal fibrosing alopecia of one year's duration. Eighteen months later, she presented with sudden hyperpigmentation on the submental area, neck and upper chest. Histopathological examination was consistent with lichen planus pigmentosus. This is the report of a unique case of a FFA and extrafacial lichen planus pigmentosus.

Cutaneous Sarcoidosis: Preamble of a Paucisymptomatic Systemic Disease.

Sarcoidosis is a systemic granulomatous disease with a wide range of clinical manifestations. Skin involvement is an early, frequent and accessible location for a histopathological study. Several risk factors have been described to determine the likelihood of systemic involvement of an apparent cutaneous condition. Early diagnosis and systemic treatment could prevent future complications. A series of three cases is presented in which the initial diagnosis was cutaneous sarcoidosis, but it was actually the first manifestation of a systemic disease. A review of this topic is also presented.

What meralgia paresthetica can hide: renal tumor as an infrequent cause.

Meralgia paresthetica is a mononeuropathy of the femoral cutaneous nerve with characteristic findings, usually secondary to injury or compression, being most common in the inguinal area. Exceptional cases associated with compressions caused by abdominal or pelvic tumors have been published, so it is always advisable to extend the study with imaging tests. We present a case associated with a renal tumor.

Frontal fibrosing alopecia and extrafacial lichen planus pigmentosum in a caucasian woman

Abstract We present the case of a 72-year-old Caucasian woman with frontal fibrosing alopecia of one year's duration. Eighteen months later, she presented with sudden hyperpigmentation on the submental area, neck and upper chest. Histopathological examination was consistent with lichen planus pigmentosus. This is the report of a unique case of a FFA and extrafacial lichen planus pigmentosus.

Cryoglobulinemia with acronecrosis not associated with hepatitis C infection: a case report.

Cryoglobulinemia is a rare disease characterized by the production of monoclonal or polyclonal immunoglobulins that precipitate in cold temperature. While this phenomenon can be observed in a large number of disorders, it has been associated with hepatitis C virus infection in more than 90% of cases. The remaining 10%, called essential cryoglobulinemia, has been characterized by a more severe course and a failure to respond to conventional treatment. This article describes the case of a patient with essential cryoglobulinemia presenting with acronecrosis with a poor outcome, despite treatment, leading to amputation.

Relación médico paciente percibida por usuarios de consultorios externos de un hospital de Lima, Perú / Physician-patient relationship perceived by outpatients at a hospital in Lima, Peru

Describir la relación médico-paciente (RMP) y determinar los factores asociados a una buena percepción de está por los pacientes que acuden a consultorios externos del Hospital Carlos Lanfranco La Hoz (HCLLH) del Ministerio de Salud (MINSA), período mayo 2014. Material y Métodos: Estudio transversal-comparativo, realizado en pacientes que acuden a consulta externa de especialidades médicas. Se utilizó el cuestionario estructurado semicerrado, llamado PREMEPA. Los cálculos estadísticos fueron realizados con un nivel de confianza del 95%. Resultados: Un total de 179 pacientes completaron la encuesta, el 64,8%(116) fueron mujeres, el promedio de la edad fue de 42,1 ± 11,9 años. El 23% (41) de los usuarios percibieron una RMP buena, el 52% (93) regular y el 25% (45) mala. Las variables finalmente asociadas con una buena RMP fueron tener entre 18-35 años (OR = 8,1 [IC95%; 1,6-40,1), haber elegido a su médico (OR = 20,5 [IC95%; 5,1-82,5) y ser atendido por una médico mujer (OR = 3,1 [IC 95%; 1,01-9,3]). Conclusiones: Existe un bajo porcentaje (23%) de pacientes que perciben una buena relación médico paciente. El elegir a su médico, ser paciente joven y ser atendido por una médico mujer influyen en tener una buena RMP...

To describe the Physician-patient relationship and to determine the factors associated with a good perception of it by the patients that attend ambulatory care in the Carlos Lanfranco La Hoz Hospital (CLLHH) of the Health Ministry (MINSA), during May 2014. Material and Methods: Transversal-comparative study performed with patients that attend ambulatory care of medical specialties. In this study, a structured semi closed questionnaire called PREMEPA was used and statistical calculations were made with 95% confidence level.Results: A total of 179 patients completed the questionnaire. Of those, 64.8% (116) were women, the average age was 42,1 ± 11,9 years old. 23% (41) of the patients perceived a good physician-patient relationship, 52% (93) regular and 25% (45) a bad relationship. The variables finally associated with a good physician -patient relationship were having between 18-35 years old (OR = 8,1 [IC95%; 1,6-40,1), personally choosing their physicians (OR = 20,5 [IC95%; 5,1-82,5), and be attended by a female physician (OR = 3,1 [IC 95%; 1,01-9,3]). Conclusions: There is a low percentage (23%) of patients that perceive a good physician -patient relationship. Choosing their physician, being a young patient and be attended by a female physician influenced in having a good physician-patient relationship...

Factores de riesgo para la ocurrencia de melasma en pacientes de un hospital de referencia / Factors associated with the occurrence of melasma in patients at a referral hospital

Objetivo. Determinar los factores de riesgo para la ocurrencia de melasma en pacientes adultos del servicio de Dermatolog¡a del Hospital Nacional Daniel A. Carri¢n durante el a¤o 2011. Methodolog¡a. Estudio de casos y controles. La poblacion de estudio estuvo conformada por pacientes atendidos en el Servicio de Dermatolog¡a del Hospital Nacional Daniel A. Carri¢n en el Callao. Per£. Se evalu¢ la presencia de factores de riesgo para la ocurrencia de meelasma tales como edad, sexo fototipo cut neo, lugar de procedencia, lugar de nacimiento del paciente, antecedentes de fotoexposici¢n, gestaciones previas y uso de hormonas sexuales femeninas. Se calcularon odds ratios (OR) crudos y ajustados con un nivel de confianza de 95%, mediante el uso del programa estad¡stico Stata12. Resultados. Se evalu¢ 78 casos y 76 controles. El an lisi bivariado mostr¢ que tanto el sexo femenino (OR, 10,2; IC95% 3,3-30,9), el haber nacido en Lima a Callao (OR, 2,7; IC95%, 1,2-160,4) asi como la procedencia de los padres de Lima o Callao (OR padre, 16; IC95%. 1.9-136; OR madre, 18,7; IC95%, 2,2-160,4) estuvieron asociados a la presencia de melasma. el uso de fotoprotector fue mayor entre los casos (p<0,01). el uso de hormonas sexuales femeninas estuvo fuertemente asociado al aumento de melasma (OR, 43,3; IC95%, 3,7 a 505). El an lisis multivariado encontr¢ que el sexo femenino(OR, 10,9; IC95%, 3,3-30,9) y el uso de anticonceptivos orales (OR, 44,9; IC95%, 3,35-603,9) constituyeron factores de riesgo para la presencia de melasma, con ajuste para variables potencialmente confusoras como el sexo del producto de la £¤tima gestaci¢n, lugar de nacimiento as¡ como de la procedencia del padre y la madre. Conclusion. El sexo femenino y el uso de anticonceptivos orales contituyen factores de riesgo para melasma en pacientes del Hospital Daniel A. Carri¢n.

Objective. Evaluated the factors associated with the ocurrence of melasma in adult patients of the Dermatology Department of the Hospital Nacional Daniel A. Carrion in 2011. Methods. We conducted a case-control study. The study population consisted of patients attending the Dermatology Department of the Hospital Nacional Daniel A. Carri¢n in Callao, Per£. We evaluated the presence of factors associated with the ocurrence of melasma such as age, sex, skin phototype, place of origin and birth of the patient, history of photo exposure, previous pregnancies, and use of sesual hormones. We calculated crude and adjusted ORs with a confidence level of 95% using the statistical software stata 12. Results. We evaluated 78 cases and 76 controls. The bivariate analysis showed that female sex (OR, 10,2; 95%CI, 3,3-30,9), being born in Lima and Callao (OR, 2,7;95%CI, 1,2-6,2) and parents origin of Lima and Callao (father OR, 16; 95% CI, 2,2-160,4) were associated with the presence of melasma. The use of sunscreen was higher among cases (p<0,01). The use of secual hormones was strongly associated with melasma (OR, 43,3; 95%CI, 3,35-603,9) as the only factor associated with the occurrence of melasma, adjusted by the sex of the baby, place of birth and origin of the father and the mother. Role of female gender was not evaluated because of dependency among variables. conclusion. Melasma is a highly prevalent entity in our environment female gender and the uso of hormonal medication were identified as only factors associated to this condition in our population.

Percepción de las relaciones médico-paciente, por parte de los usuarios externos de un departamento de medicina / Perception of doctor-patient relationship by external users of a medicine department

Introducción: La relación médico paciente, la mayor potencia recuperadora de la salud, está hoy amenazada por los cambios que afectan la práctica médica. Objetivos: Determinar la percepción, por parte de los usuarios de consulta externa, de la calidad de su relación médico-paciente y su asociación con las características del médico y el paciente. Diseño: Estudio observacional, tipo encuesta. Lugar: Departamento de Medicina, Hospital Nacional Daniel Alcides Carrión, Callao, Perú, hospital docente. Participantes: Pacientes de consulta externa de medicina. Intervenciones: Un cuestionario semiabierto fue aplicado a los pacientes seleccionados por muestreo sistemático, al salir del consultorio. Principales medidas de resultados: Calidad de la relación médico-paciente. Resultados: De 168 pacientes, 39,9 por ciento ya había acudido a otro lugar por su problema de salud, 51,2 por ciento fue atendido por primera vez por determinado médico, 92,3 por ciento tuvo una adecuada relación médico-paciente y 89,3 por ciento afirmó estar muy satisfecho. Se observó que mayor es el grado de satisfacción de la consulta a mejor percepción de la calidad de relación médico-paciente (p <0,001, OR 61,2); ambas se asociaron a la intención de recomendación del médico (OR 298 y OR 48, respectivamente). Conclusiones: Se encontró una adecuada relación médico-paciente en 92,3 por ciento de los pacientes encuestados, y 89,3 por ciento afirmó estar muy satisfecho con la atención médica.

Introduction: Physician-patient relationship is the most important power for health recovery. Nevertheless it appears threatened by the many changes affecting todayÆs medical practice. Objectives: To determine patientÆs perception on the quality of the doctorûpatient relationship and its association with physicianÆs and patientÆs characteristics. Design: Observational study, inquiry type. Setting: Department of Medicine, Hospital Nacional Daniel Alcides Carrion, Callao, Peru, a teaching hospital. Participants: Medicine outpatient patients. Interventions: A semi-opened questionnaire with 21 questions was applied to systematically selected patients when leaving the doctorsÆ office. Main outcome measures: Quality of doctor-patient relationship. Results: One hundred and sixty-eight patients were inquired, 39,9 per cent had been previously attended in other place for the same health problem, 51,2 per cent were attended for the first time. An adequate doctor-patient relationship was found in 92,3 per cent and 89,3 per cent were very satisfied. The quality of doctorpatient relationship perceived was strongly associated to medical attention satisfaction (p <0,001, OR 61,2). Both were associated with recommending the doctor (OR 298 and OR 48 respectively). Conclusions: We found an adequate doctor-patient relationship in 92,3 per cent, and 89,3 per cent said they were very satisfied with the medical attention.