Estudio clínico-histopatológico de las eritrodermias en un hospital universitario: 14 años de experiencia / Clinical-histopathological study of erythroderma in a university hospital: 14 years of experience

INTRODUCCIÓN: La eritrodermia es un síndrome inflamatorio cutáneo infrecuente caracterizado por compromiso eritematoso generalizado y descamación, de más del 90% de superficie cutánea total. OBJETIVO: Caracterizar clínica e histopatológicamente a los pacientes con eritrodermia en un hospital universitario chileno. METODOLOGÍA: Estudio retrospectivo, realizado en el Hospital Clínico Universidad de Chile, basado en revisión de fichas clínicas e informes histopatológicos de pacientes con eritrodermia, entre 2005 y 2018. Se evaluó edad, sexo y variables clínicas (co-morbilidades, síntomas, días de evolución, ingreso hospitalario, informe histopatológico, diagnóstico y evolución). RESULTADOS: Total de 28 pacientes, 18 hombres (64%), edad promedio 59 años. Causa más frecuente de eritrodermia fue dermatosis pre-exis-tentes, con 15 casos (54%), que incluyen: psoriasis 9 (32%), dermatitis de contacto 3 (11%), PRP 2 (7%), dermatitis atópica 1 (4%). A estas le siguen: reacción adversa medicamentosa 6 (21%), idiopática 6 (21%) y Síndrome de Sezary 1 (4%). CONCLUSIÓN: El presente estudio corresponde a la primera serie de eritrodermias realizada en Chile. Destacan las dermatosis preexistentes como la principal causa, lo que se correlaciona con la literatura.

INTRODUCTION: Erythroderma is an infrequent cutaneous inflammatory disorder characterized by generalized erythematous compromise and desquamation, of more than 90% of total cutaneous surface. OBJECTIVE: Clinical and histopathological cha-racterization of patients with erythroderma in a Chilean university hospital. METHODOLOGY: Retrospective study, performed at the University of Chile Clinical Hospital, based on review of clinical records and histopatho-logical reports of patients with erythroderma, between 2005 and 2018. Age, sex and clinical variables were evaluated (co-morbidities, symp-toms, days of evolution, hospital admission, histopathological report, diagnosis and evolu-tion). RESULTS: A total of 28 patients, 18 were men (64%), average age 59 years. Most frequent cause of erythroderma was pre-existing dermatosis, with 13 cases (52%), which included: psoriasis 9 (32%), contact dermatitis 3 (11%), PRP 2 (7%), atopic dermatitis 1 (4%). These are followed by adverse drug eruption 6 (21%), idiopathic 6 (21%) and Sezary syndrome 1 (4%). CONCLUSION: The present study corresponds to the first series of erythrodermas performed in Chile. The pre-existing dermatoses were the main cause of erythroderma, which coincides with other reports.

Automédication et toxidermies bulleuse à Abidjan : aspects épidémiologiques, cliniques et évolutifs

Objectif : Cette étude a été réalisée pour décrire les caractéristiques épidémiologiques, cliniques et évolutives des toxidermies bulleuses chez les patients suite à une automédication.Matériel et méthodes : Il s'agissait d'une étude transversale rétrospective à visée descriptive. Elle s'est déroulée du 01 septembre 2004 au 31 Août 2014 au centre de dermatologie du CHU de Treichville (Côte d'ivoire). Ont été inclus tous les patients ayant eu une toxidermie bulleuse suite à une automédication et hospitalisés pendant la période d'étude. Résultats : Pendant 10 ans nous avons recensé 191 cas de toxidermies bulleuses hospitalisés en dermatologie du CHU de Treichville. Quatre-vingt-quatre patients ont eu recours à une automédication soit 44,0%. La moyenne d'âge de ces patients était de 29,22 ans avec des extrêmes de 2 et 69 ans. Il y avait une prédominance féminine avec 56 patientes (66,7%). Le syndrome de Stevens Johnson avec 58 cas représentait 69,0 % des toxidermies suivi du syndrome de Lyell avec 23 cas (27,4%). La sulfadoxine pyrimethamine a été le médicament le plus incriminé avec 16 cas (19,1%) suivi du cotrimoxazole avec 15 cas (17,9%). Le taux de décès était de 22,6% (19 patients) dont 13 cas (68,42%) de syndrome de Lyell et 6 cas (31,58%) de syndrome Stevens Johnson. Conclusion : L'automédication est une pratique qui augmente l'incidence des toxidermies à Abidjan

Inflamação de queratoses seborreicas múltiplas induzida por quimioterapia com gencitabina: [relato de caso] / Inflammation of multiple seborrheic keratoses induced by chemotherapy with gemcitabine: [case report]

São diversos e comuns os efeitos mucocutâneos dos quimioterápicos, alguns por ação citotóxica, outros por hipersensibilidade ao fármaco. Os autores relatam a ocorrência de inflamação em múltiplas queratoses seborreicas pré-existentes, após terapia citorredutora com gencitabina, em paciente sob tratamento para neoplasia de pâncreas. Discutem, ainda, a benignidade do evento e alertam para a necessidade de adequada identificação dos efeitos cutâneos decorrentes da quimioterapia sistêmica.

There are several common mucocutaneous adverse effects related to chemotherapy, either by direct cytotoxic action or by hypersensitivity to the drugs. The authors report inflammation in multiple seborrheic keratoses after chemotherapy with gemcitabine in a patient under treatment for pancreatic cancer. Moreover, they discuss the relative benignity of this event and warn about the need to correctly identify systemic chemotherapy-induced skin adverse effects.

Nicolau syndrome following intramuscular benzathine penicillin.

Nicolau syndrome (NS) is a rare complication of an intramuscular injection characterized by severe pain, skin discoloration, and varying levels of tissue necrosis. The case outcomes vary from atrophic ulcers and severe pain to sepsis and limb amputation. We describe a case of a seven-year-old boy with diagnosis of NS after intramuscular benzathine penicillin injection to the ventrolateral aspect of the left thigh. Characteristic violaceous discoloration of skin and immediate injection site pain identified it as a case of NS. The case was complicated by rapid progression of compartment syndrome of the lower limb, proceeding to acute renal failure and death. Associated compartment syndrome can be postulated as a poor prognostic factor for NS.

Spectrum of cutaneous adverse drug reactions seen in the emergency department [ED]: a prospective study from Kuwait

To study cutaneous adverse drug reactions [ADR] seen in the Emergency Department of AlFarwaniva hospital. All patients consulting for drug eruptions between 1st Jan 2004 to 31st Dec 2004 were included in the study. In every case, a detailed history was elicited and a thorough clinical examination was done. The total number of cases in this series was 208, the most common types of adverse drug eruptions seen in the ED were exanthematous eruptions, urticaria and fixed drug eruptions. The most common groups of causative drugs were antimicrobial agents, antipyretic/anti-inflammatory analgesics and drugs acting on the central nervous system. The clinical patterns and the drugs causing adverse drug eruptions are remarkably similar to those observed in other countries except for minor variations

Farmacodermias. Frecuencia en un hospital general / Adverse drug eruptions. Frequency in a general hospital

Se comunican los resultados de un estudio efectuado para determinar la frecuencia de farmacodermias en pacientes dermatológicos en un hospital general. La incidencia fue del 2.16 por ciento. Los cuadros clínicos más frecuentes fueron exantemas y eritema pigmentado fijo tanto en adultos como en niños. Los antiinflamatorios no esterioides causaron 37 por ciento de las reacciones en adultos, y metamizol y sulfas fueron los medicamentos más frecuentemente implicados en niños

Necrose tecidual após injeçäo intramuscular de diclofenaco de sódio: relato de 4 casos / Tissue necrosis following intramuscular sodium diaclofenac injection: report of 4 cases

Säo relatados quatro casos de necrose tecidual após injeçäo intramuscular do antiinflamatório diclofenaco de sódio (Voltarem). A primeira paciente desenvolveu pequena lesäo necrótica na nádega esquerda, que acometia pele, tecido subcutâneo e pequena porçäo do músculo glúteo máximo. A evoluçäo foi benigna. A 2ª paciente desenvolveu necrose da regiäo deltóidea direita, que também acometia pele, tecido subcutâneo e pequena porçäo do músculo deltóide. A evoluçäo também foi benigna, mas a cicatriz resultante do processo era extensa e inestética. O 3ª pacientes desenvolveu extensa necrose da regiäo deltóidea direita, com acometimento da pele, tecido subcutâneo e músculo, resultando em déficit motor (abduçäo, retro e anteversäo) permanente do membro superior direito. A 4ª paciente desenvolveu necrose musculocutânea na regiäo deltóidea D (com predomínio cutâneo e subcutâneo), que resultou em cicatriz inestética e discreto déficit motor (abduçäo). O mecanismo etiopatogênico da necrose parece estar relacionado a processo embólico, angioespasmo e trombose ou, mais provavelmente, a uma interaçäo destes mecanismos. Alguns autores acreditam num mecanismo imunoalérgico. Säo discutidos cuidados a serem tomados para evitar este tipo de acidente, assim como medidas terapêuticas a serem adotadas caso o acidente venha a ocorrer

Farmacodermia: aspectos epidemiologicos, tipos clínicos e agentes causais / Cutaneous reactions to drugs: epidemiologic aspects, clinical types and etiology

Neste trabalho levantou-se 14,561 prontuários dos pacientes do Serviço de Dermatologia do Centro Médico da Faculdade de Medicina de Santo Amaro, no período de janeiro de 1980 a maio de 1989. Realizou-se levantamento epidemiológico, apresentaçöes clínicas mais freqüentes e as principais drogas envolvidas. Foram diagnósticados 166 casos de farmacodermias

A study of dermatological conditions in leprosy in-patients.

Three hundred and sixty six in-patients in a leprosy hospital were examined for other dermatological conditions. Eighty eight of them displayed ichthyosiform changes. A peculiar condition of a verrucous hyperkeratotic growth on the anterior aspect of ankle, not described previously, was observed in four patients. It was noted that 11 out of 12 patients with scabies did not have the classical lesions in web spaces of the hands.

Cuidados intensivos en necrolisis epidérmica tóxica (Brocq-Lyell) / Intensive care of toxic epidermal necrolysis Brocq-Lyell syndrome

La mortalidad de la necrosis epidérmica tóxica es sumamente alta en la forma grave; en el presete trabajo se informa de once casos que fueron corroborados por cuadro clínico y biopsia de piel, cuya etiología en el 91 por ciento fueron medicamentos, y que categorizando al paciente con esta enfermedad, fueron tratados en la unidad de cuidados intensivos con heparina y dipiridamol y tuvieron una sobrevida del 100 por ciento.