Biopsy type does not affect the number of stages during Mohs micrographic surgery: a retrospective study.

Mohs micrographic surgery (MMS) is the treatment of choice for high-risk basal cell carcinoma (BCC). However, there are no evidence-based recommendations regarding which biopsy type is more appropriate to obtain tumour samples prior to MMS. Shave or punch biopsies are performed depending on the clinical characteristics of the tumour, surgeon experience and local protocols. However, biopsy type might result in difficult histopathological interpretation and influence the practical implementation of MMS. We performed a retrospective study on 208 consecutive BCCs treated with MMS. Of the 208 BCC biopsies, 42 (20.2%) were obtained by the shave method and 166 (79.8%) via punch. Those obtained with the shave technique had a mean of 1.64 stages vs. 1.69 stages with the punch technique (P = 0.130). These findings suggest biopsy type does not affect Mohs surgery performance. The biopsy type of choice is the one deemed adequate for each specific case to obtain a diagnosis and tumour subtyping.

[Scrofuloderma, cutaneous and pulmonary tuberculosis associated with COVID-19. Report of one case]. / Escrofuloderma: tuberculosis cutánea y pulmonar asociada a coinfección COVID-19. Reporte de caso.

Cutaneous tuberculosis represents 1-1.5% of extrapulmonary tuberculosis, including a variety of clinical conditions. Scrofuloderma and lupus vulgaris are the most common forms. We report a 49-year-old woman who sought medical attention through tele-dermatology concerning a cervical nodule associated with suppuration and cutaneous involvement. The diagnoses of scrofuloderma and pulmonary tuberculosis were confirmed, and during her evolution she presented a coinfection with SARS-CoV-2. The possible associations between tuberculosis and COVID-19 were reviewed.

Comparison of efficacy of aminolaevulinic acid photodynamic therapy vs. adapalene gel plus oral doxycycline for treatment of moderate acne vulgaris-A simple, blind, randomized, and controlled trial.

BACKGROUND: Although progress has been made in the study of photodynamic therapy for acne, studies using current recommended therapies as active comparators are lacking. METHODS: Randomized, controlled trial involving 46 patients with moderate inflammatory facial acne, 23 patients received two sessions of PDT separated by 2 weeks (ALA 20% incubated 1.5 hours before red light irradiation with 37 J/cm2 fluence) and 23 patients received doxycycline 100 mg/d plus adapalene gel 0.1%. In both groups, from the sixth week, we started adapalene gel 0.1% as maintenance therapy until 12 weeks of follow-up. Primary end point was the reduction of acne lesions at the 6-week follow-up, which was evaluated by 2 investigators blinded to the intervention. RESULTS: The median percent reductions in noninflammatory lesion count (P = 0.013) and total lesions (P = 0.038) at 6 weeks was found to be significantly higher in the group receiving PDT. At 12 weeks there was a greater reduction of inflammatory lesions in PDT group with 84% vs. 74% for group who received doxycycline plus adapalene (P = 0.020) as well as in reducing total lesions with 79% vs. 67% respectively (P = 0.026). No severe side-effects were observed for either therapy. CONCLUSIONS: ALA-PDT offers promise as an alternative treatment for moderately severe inflammatory acne that has a higher effectiveness than the combination of doxycycline and adapalene gel in reducing noninflammatory and total lesions at 6 weeks. There were significantly superior reductions at 12 weeks in the combination of PDT group followed by adapalene gel in total, inflammatory, and noninflammatory lesions.

[Cutaneous manifestations detected in human T cell lymphotropic virus type 1 infected Chilean blood donors]. / Manifestaciones cutáneas en donantes de sangre portadores de HTLV-1 en comparación con donantes de sangre no portadores de HTLV-1.

BACKGROUND: Most human T cell lymphotropic virus type 1 (HTLV-1) infected individuals are asymptomatic, but they commonly present cutaneous lesions that could be considered warning signs of the disease. AIM: To identify the main cutaneous manifestations present in HTLV-1 infected blood donors and compare them with healthy donors. MATERIALS AND METHODS: Two blood donor groups from the blood bank of an emergency hospital were matched according to gender and age. One group was formed by HTLV-1 (+) (cases) and the other by HTLV-1 (-) donors (controls). A blind examiner to the serologic condition, evaluated their cutaneous manifestations. RESULTS: Twenty five cases and 25 controls aged 18 to 60 years (24 females) were evaluated. One or more cutaneous manifestations were found in 24 (96%) cases and in 15 (60%) controls (p<0.01). Inflammatory cutaneous diseases were found in 19 (76%) cases and in 9 (36%) controls (p<0.01). Dermatophytosis was found in 18 (72%) cases and in 12 (48%) controls (NS). CONCLUSIONS: HTLV-1 infected Chilean subjects have a higher frequency of dermatoses than their healthy counterparts.

Management of periocular keratinocyte carcinomas with Mohs micrographic surgery and predictors of complex reconstruction: a retrospective study.

BACKGROUND: Skin cancer is the most frequent cancer worldwide and the most frequent periocular tumor. Keratinocyte Carcinomas (KC) located in periorificial areas, such as periocular tumors, are considered high-risk tumors. Mohs Micrographic Surgery (MMS) is considered the first line for the treatment of high-risk KC, providing a lower recurrence rate than conventional wide excision. OBJECTIVE: To describe the clinical-pathological features of periocular KC treated with MMS in a tertiary university center in Chile. METHODS: A single-center, retrospective study of patients with KC located on the periocular area, that underwent MMS between 2017‒2022. MMS details were recorded. RESULTS: One hundred thirteen patients with periocular carcinomas were included. The mean age was 59 ± 13 years; 52% were women. The most frequent location was the medial canthus (53%), followed by the lower eyelid (30.1%). The most frequent BCC histology was the nodular variant (59.3%). Regarding MMS, the average number of stages was 1.5 ± 0.7, and 54% of the cases required only 1 stage to achieve clear margins. To date, no recurrence has been reported. Tumors larger than 8.5 mm in largest diameter or 43.5 mm2 were more likely to require complex reconstruction. STUDY LIMITATIONS: Retrospective design and a relatively low number of patients in the SCC group. Possible selection bias, as larger or more complex cases, may have been referred to oculoplastic surgeons directly. CONCLUSION: The present study confirms the role of MMS for the treatment of periocular KCs. Periocular KCs larger than 8.5 mm might require complex reconstruction. These results can be used to counsel patients during pre-surgical visits.

[Bacillary angiomatosis]. / Angiomatosis bacilar por Bartonella quintana como primera manifestación de infección por VIH: Report of one case.

Bacillary angiomatosis is an unusual infectious disease, with angioproliferative lesions, typical of immunocompromised patients. It is caused by Bartonella quintana and Bartonella henselae, two infectious agents of the genus Bartonella, which trigger variable clinical manifestations, including cutaneous vascular and purpuric lesions, and regional lymphadenopathy, and even a systemic disease with visceral involvement. We report a 38-year-old HIV positive male presenting with a history of six months of cutaneous growing purple angiomatous lesions, located also in nasal fossae, rhi-nopharynx and larynx. The skin biopsy was compatible with bacillary angiomatosis. Polymerase chain reaction of a tissue sample showed homology with B. quintana strain Toulouse. The patient was treated with azithromycin and ciprofloxacin with a favorable evolution.

[Necrotizing herpes folliculitis. Report of one case]. / Foliculitis necrotizante herpética.

Herpes folliculitis is a rare manifestation of herpes virus infection. It usually represents a diagnostic challenge, due to the absence of characteristic skin manifestations such as vesicles or pustules. The reported cases are mainly associated with varicella zoster virus (VZV) and less commonly with herpes simplex viruses (HSV-1 y HSV-2). We report a 51-year-old male with a relapsing non-Hodgkin Lymphoma under chemotherapy, with history of extensive follicular lesions lasting one month. The pathologic study of the lesions was consistent with necrotizing herpes folliculitis. The patient was treated with Valacyclovir, achieving remission of the lesions. The appearance of folliculitis, especially in an immunocompromised patient, should raise the suspicion of herpes virus infection. Polymerase chain reaction may help to elucidate the diagnosis when pathologic findings are non-specific.

Cutaneous mastocytosis in twins: multiple mastocytomas and urticaria pigmentosa in two pairs of monozygotic twins.

We report two sets of monozygotic twins with cutaneous mastocytosis: one set with urticaria pigmentosa and the other set with multiple mastocytomas. This is the first report of multiple mastocytomas in twins to our knowledge.

Effectiveness of asthma education with and without a self-management plan in hospitalized children.

Background. Formal education in primary care can reduce asthma exacerbations. However, there are few studies in hospitalized children, with none originating in Latin America. Methods. A prospective randomized study was designed to evaluate whether a full education with self-management plan (ESM) was more effective than an education without self-management plan (E) in reducing asthma hospitalization. Children (5 to 15 years of age) who were hospitalized for an asthma attack were divided in two groups. Children in the E group received general instructions based on a booklet. Those in the ESM group received the same booklet plus a self-management guide and a puzzle game that reinforces the lessons learned in the booklet. Patients were interviewed every 3 months, by telephone, for one year. Interviewers recording the number of hospitalizations, exacerbations, and emergency visits for asthma and oral steroid burst uses. Results. From 88 children who met the inclusion criteria, 77 (86%) completed one year of follow-up (41 from E and 36 from ESM group). Overall, after one year, the hospitalization decreased by 66% and the inhaled corticosteroids therapy increased from 36% to 79%. At the end of the study, there was no difference in exacerbations, emergency visits, oral steroid burst uses, or hospitalizations between the two groups. Conclusions. Asthma education with or without a self-management plan during asthma hospitalization were effective in reducing exacerbations, emergency visits, oral steroid burst uses, and future rehospitalizations. This evidence supports the importance of providing a complete asthma education plan in any patient who is admitted for asthma exacerbation.

Management of periocular keratinocyte carcinomas with Mohs micrographic surgery and predictors of complex reconstruction: a retrospective study

Abstract Background Skin cancer is the most frequent cancer worldwide and the most frequent periocular tumor. Keratinocyte Carcinomas (KC) located in periorificial areas, such as periocular tumors, are considered high-risk tumors. Mohs Micrographic Surgery (MMS) is considered the first line for the treatment of high-risk KC, providing a lower recurrence rate than conventional wide excision. Objective To describe the clinical-pathological features of periocular KC treated with MMS in a tertiary university center in Chile. Methods A single-center, retrospective study of patients with KC located on the periocular area, that underwent MMS between 2017‒2022. MMS details were recorded. Results One hundred thirteen patients with periocular carcinomas were included. The mean age was 59 ± 13 years; 52% were women. The most frequent location was the medial canthus (53%), followed by the lower eyelid (30.1%). The most frequent BCC histology was the nodular variant (59.3%). Regarding MMS, the average number of stages was 1.5 ± 0.7, and 54% of the cases required only 1 stage to achieve clear margins. To date, no recurrence has been reported. Tumors larger than 8.5 mm in largest diameter or 43.5 mm2 were more likely to require complex reconstruction. Study limitations Retrospective design and a relatively low number of patients in the SCC group. Possible selection bias, as larger or more complex cases, may have been referred to oculoplastic surgeons directly. Conclusion The present study confirms the role of MMS for the treatment of periocular KCs. Periocular KCs larger than 8.5 mm might require complex reconstruction. These results can be used to counsel patients during pre-surgical visits.

Escrofuloderma: tuberculosis cutánea y pulmonar asociada a coinfección COVID-19: reporte de caso / Scrofuloderma, cutaneous and pulmonary tuberculosis associated with COVID-19: report of one case

Cutaneous tuberculosis represents 1-1.5% of extrapulmonary tuberculosis, including a variety of clinical conditions. Scrofuloderma and lupus vulgaris are the most common forms. We report a 49-year-old woman who sought medical attention through tele-dermatology concerning a cervical nodule associated with suppuration and cutaneous involvement. The diagnoses of scrofuloderma and pulmonary tuberculosis were confirmed, and during her evolution she presented a coinfection with SARS-CoV-2. The possible associations between tuberculosis and COVID-19 were reviewed.

Oral and written counseling is a useful instrument to improve short-term adherence to treatment in acne patients: a randomized controlled trial.

BACKGROUND: Therapeutic success in acne patients not only depends on the appropriate selection of drugs but also on the patient's treatment adherence or compliance. Lack of adherence is an important problem both in general medicine and in dermatologic practice. OBJECTIVE: To evaluate the impact of oral and written counseling on treatment adherence among acne patients. PATIENTS AND METHODS: Eighty patients were randomized into two groups of 40 patients each. The intervention group received a patient information leaflet (apart from oral counseling), and instructions were reinforced by a telephone call within 15 days of treatment onset. The second group (control group) received treatment indications as usual (oral counseling in-office only). Both groups were followed up with a phone call, evaluating adherence to treatment according to self-reporting of patients at 30, 60, 90 days, and 6 months. RESULTS: Better adherence to treatment was observed in the intervention group. This difference was significant only within the first month of treatment (80% versus 62%, p = 0.043). The beneficial effect of written counseling plus a phone call decreased in subsequent months. CONCLUSION: Written counseling significantly improves adherence within the first month of treatment. These results suggest that it is reasonable to spend time and resources in written counseling in order to optimize adherence to treatment.

Epidemiología del melanoma en la región de O'Higgins durante los años 2012 y 2015 / Epidemiology of melanoma in the O'Higgins region during the years 2012 and 2015

Introducción: La incidencia y mortalidad del melanoma maligno (MM) ha aumentado a nivel internacional durante las últimas décadas. En Chile existen escasos registros locales y regionales de cáncer de piel. El objetivo de este trabajo es describir los casos de MM en el Hospital Regional de Rancagua (HRR). Métodos: Se evaluaron todas las biopsias con diagnóstico de MM del HRR entre los años 2012-2015. Se registraron variables demográficas, clínicas e histológicas. Se excluyeron segundas biopsias y metástasis. Resultados: Se identificaron 48 biopsias de MM, 54% fueron hombres. la mediana de edad al diagnóstico fue de 61,5 años. La distribución de la localización fue: 34% extremidades inferiores (EEII), 25% dorso, 25% cara-cuello y 15% extremidades superiores (EESS). La localización más frecuente en hombres fue caracuello (35%) y en las mujeres EEII (38%). El subtipo histológico más frecuente fue: extensión superficial (48%), seguido de nodular (30%), in-situ (20%) y acral lentiginoso (2%). En hombres predominó extensión superficial y nodular (42%) mientras que in-situ sólo se observó en el 16%. En mujeres el 55% fue extensión superficial, seguido de in-situ con 23%. El Breslow de los MM infiltrantes fue: 34% <1mm, 26% 1- 2mm, 17% 2-4mm y 23% >4mm. En hombres 26% fue <1mm mientras que en las mujeres el 44%. Conclusión: Esta es una primera aproximación para evaluar la epidemiología del MM en la sexta región. Los pocos casos encontrados hacen suponer un subdiagnóstico. Se debe continuar trabajando para mejorar el registro y generar estrategias para prevención y diagnóstico precoz.

Introduction: The incidence and mortality of malignant melanoma (MM) has increased over the last decades worldwide. In Chile there are few local and regional registries of skin cancer. In the O'Higgins region, the epidemiology of MM is unknown. The aim of this study is to describe the cases of MM in Rancagua Regional Hospital (RRH). Methods: All MM biopsies from RRH were evaluated between 2012-2015. Demographic, clinical and histological characteristics were recorded. Second biopsies and metastases were excluded. Results: Forty-eight biopsies were evaluated, 54% were from male patients. The mean age at diagnosis was 62.1 years. The most frequent location of MM was 34% in lower extremities, 25% in the back, 25% in face and neck and 15% upper extremities. The most frequent site in men was face and neck (35%) and in women lower extremities (38%). The most frequent histological subtype was superficial extension (48%), followed by nodular (30%), in-situ (20%) and acral lentiginous (2%). In men, superficial extension and nodular (42%) were the most frequent and In-situ was present only in 16%, in women predominated superficial extension(55%) followed by in-situ (23%). The Breslow of the invasive MM was: 34% <1mm, 26% 1-2mm, 17% 2-4mm and 23% >4mm. In men 26% was <1mm and in women 44%. Conclusion: This is a first approximation to describe the epidemiology of MM in the O'Higgins region. The few cases found make us suspect underdiagnosis. An improvement in MM registry will serve to generate strategies for prevention and early diagnosis.

Manifestaciones cutáneas en donantes de sangre portadores de HTLV-1 en comparación con donantes de sangre no portadores de HTLV-1 / Cutaneous manifestations detected in human T cell lymphotropic virus type 1 infected Chilean blood donors

Background: Most human T cell lymphotropic virus type 1 (HTLV-1) infected individuals are asymptomatic, but they commonly present cutaneous lesions that could be considered warning signs of the disease. Aim: To identify the main cutaneous manifestations present in HTLV-1 infected blood donors and compare them with healthy donors. Materials and Methods: Two blood donor groups from the blood bank of an emergency hospital were matched according to gender and age. One group was formed by HTLV-1 (+) (cases) and the other by HTLV-1 (-) donors (controls). A blind examiner to the serologic condition, evaluated their cutaneous manifestations. Results: Twenty five cases and 25 controls aged 18 to 60 years (24 females) were evaluated. One or more cutaneous manifestations were found in 24 (96%) cases and in 15 (60%) controls (p < 0.01). Inflammatory cutaneous diseases were found in 19 (76%) cases and in 9 (36%) controls (p < 0.01). Dermatophytosis was found in 18 (72%) cases and in 12 (48%) controls (NS). Conclusions: HTLV-1 infected Chilean subjects have a higher frequency of dermatoses than their healthy counterparts.