Background and Aims: The treatment of recalcitrant facial flat warts has always been challenging for dermatologists. The pain related to the application of the different treatments, side effects and costs are determining factors in the choice of therapy. To date, it is known that oral isotretinoin administered at a dose of 0.5 mg/kg/day is effective and safe; However, the different adverse effects reported have a dose-dependent behavior and they could limit their use. Our aim is to assess the effect of low-doses of oral isotretinoin to reducing side effects in the complete removal of recalcitrant facial flat warts and the current evidence in this regard. Methods: An extensive literature review was conducted to identify articles relating to low doses of oral isotretinoin for recalcitrant flat warts treatment, regardless of design up to May 2023. Results: The literature search yielded eight articles of 324 reviewed meeting criteria. Isotretinoin was administered in doses of 0.1-0.5 mg/kg/day. Complete elimination of the lesions occurred in 65.13% of the patients and a partial response in 19.26%. Four relapses were documented at the 4-month follow-up. The most frequent adverse effect was cheilitis. Conclusion: We might consider low doses of oral isotretinoin for the treatment of recalcitrant facial flat warts in which side effects need to be reduced. However, current published works have several limitations, including small sample sizes, lack of control group and follow-up periods. Larger, randomized, controlled studies are needed to verify the efficacy and safety of different doses of isotretinoin.
Scleromyxedema is an uncommon and progressive fibromucinous disorder characterized by disseminated papular eruption with histological features of dermal mucin deposition. The skin changes associated with this disease are highly visible and they tend to affect the patient's quality of life. We report a case of a 50-year-old male patient that presented a 3-year-old history of disseminated asymptomatic firm papules-associated systemic symptoms. Medical treatment with oral corticosteroid and thalidomide was indicated and surgical treatment on residual facial folds was performed, with an excellent outcome.
Introduction The human papillomavirus induces the formation of lesions in different epithelia. Several studies describe an association of class II human leukocyte antigen with genital lesions, implying that they could also be related to the presence of common warts. The goal of this work was to determine the frequency of human leukocyte antigens (HLA)-DQA1 and HLA-DQB1 in Mexicans with common warts. Methods Thirty-two patients with a diagnosis of common warts, without any other systemic disease, and 100 healthy subjects from the same geographic area were recruited. The second exon of the HLA-DQA1 and HLA-DQB1 loci was typed by dot-blot and chemiluminescence. Results Alleles DQA1*03:01:01 (P = 0.021) and DQB1*03:02 (P = 0.036) were associated with the presence of skin warts. DQA1*04:01-DQB1*04:02 (P = 0.009) and DQA1*03:01:01-DQB1*03:02 (P = 0.044) were the most frequent haplotypes in patients. Conclusion In conclusion, the results of our study showed that the alleles DQA1 *03:01:01, DQB1*03:02, DQA1 *04:01, and DQB1*04:02 were associated with susceptibility to common warts, while DQA1*05:01 was significantly diminished in them. Consequently, the haplotypes DQA1*04:01-DQB1*04: 02 and DQA1*03:01:01-DQB1*03:02 were found to be associated with susceptibility, and DQA1*05:01-DQB1*03:01 increased significantly in controls. Therefore, the alleles of the DQA1 and DQB1 genes that are associated with susceptibility could be presenting human papillomavirus (HPV) peptides to T lymphocytes that activate a Th2-type response (anti-inflammatory cytokines), which allows the development of skin warts in this population.
Resumen Comunicamos seis casos de mujeres quienes, tras la aplicación mediante mesoterapia con plasma rico en plaquetas, así como de un material de relleno intradérmico de origen desconocido, desarrollaron una infección en los sitios de inyección asociada a Mycobacterium massiliense, así como granulomas con reacción a cuerpo extraño. Aunque los cultivos fueron negativos, se logró la identificación del microorganismo por extracción de ADN de tejidos blandos obtenido por biopsia y posterior secuenciación del producto obtenido. Debido a la gran similitud en los cultivos de M. massiliense con la especie relacionada Mycobacterium abscessus, y a que tienen diferente respuesta terapéutica, las técnicas moleculares de diagnóstico son una opción real a considerar para administrar en forma precoz el tratamiento específico contra el patógeno y evitar la progresión de la infección.
We report six cases of female patients who, after the application by mesotherapy with platelet-rich plasma, as well as of an intradermal filler material of unknown origin, developed infection at the injection sites associated to Mycobacterium massiliense, as well as granuloma with reaction to foreign body. Although the cultures were negative, the identification of the microorganism was achieved by extraction of soft tissue DNA obtained by biopsy and sequencing the obtained product, with which the therapy was redirected against the particular species. Due to the great similarity in the culture between M. massiliense with the related species M. abscessus, to the required time for its growth, and to the different therapeutic response of each strain, molecular diagnostic techniques are a real option to consider to administer in an early way the appropriate treatment against the pathogen and prevent infection progression.
Humans , Beauty , Mycobacterium Infections, Nontuberculous/drug therapy , Injections, Intradermal , Molecular Diagnostic Techniques
We report six cases of female patients who, after the application by mesotherapy with platelet-rich plasma, as well as of an intradermal filler material of unknown origin, developed infection at the injection sites associated to Mycobacterium massiliense, as well as granuloma with reaction to foreign body. Although the cultures were negative, the identification of the microorganism was achieved by extraction of soft tissue DNA obtained by biopsy and sequencing the obtained product, with which the therapy was redirected against the particular species. Due to the great similarity in the culture between M. massiliense with the related species M. abscessus, to the required time for its growth, and to the different therapeutic response of each strain, molecular diagnostic techniques are a real option to consider to administer in an early way the appropriate treatment against the pathogen and prevent infection progression.
Beauty , Mycobacterium Infections, Nontuberculous , Female , Humans , Injections, Intradermal , Molecular Diagnostic Techniques , Mycobacterium Infections, Nontuberculous/drug therapy
A 35-year-old man presented with a 2-day history of a maculopapular pruritic eruption that had affected his general state of health and was accompanied by chills. The patient had been diagnosed with HIV in 2008, and was undergoing treatment with a combination of emcitrabine/tenofovir plus nevirapine. He had a current viral load of 1,558,160 copies/mL and a lymphocyte count CD4+ count of 230/mm3. Physical examination revealed an eruption involving the face, nape of the neck, chest, abdomen, extremities, palms, and soles. This was characterized by erythematous papules approximately 2 mm in diameter coalescing on the palms and soles, where they formed plaques (Figures 1 and 2).
HIV Infections/complications , Hidradenitis/complications , Hidradenitis/pathology , Adult , Humans , Male
BACKGROUND: B-Raf is a serine/threonine protein kinase activating the MAP kinase/ERK-signaling pathway. It has been shown that 50% of melanomas harbor activating BRAF mutations, with over 90% being the V600E mutation. OBJECTIVE: The goal of this research was to determine the prevalence of the BRAF V600E mutation in patients from Central Mexico diagnosed with primary melanoma. METHODS: Skin biopsies from 47 patients with melanoma were obtained from the dermatology department of the Hospital General 'Dr. Manuel Gea González' in Mexico City. For BRAF mutation determination, after DNA isolation, the gene region where the mutation occurs was amplified by PCR. Subsequently, the presence or absence of the V600E mutation was detected by Sanger sequencing performed at the private molecular diagnostic laboratory Vitagénesis in Monterrey, Mexico. RESULTS: Of the 47 patients sampled, 6.4% harbored the V600E mutation. No statistical significance was found between mutations and the type of tumor.
BACKGROUND: Progressive hemifacial atrophy or Parry-Romberg Syndrome (PRS) is a rare, acquired, progressive dysplasia of subcutaneous tissue and bone characterized by unilateral facial involvement. Its etiology is unknown, but theories about its pathogenesis include infectious, degenerative, autoimmune, and traumatic causes among others. The causal relationship of PRS and linear morphea en coup de sabre (LMCS) with Borrelia burgdorferi infection remains controversial. Our goal was to serologically determine anti-B. burgdorferi antibodies in patients diagnosed with PRS and LMCS to establish a possible association as a causative agent. METHODS: We conducted a serology study with patients belonging to a group of 21 individuals diagnosed with PRS, six with LMCS, and 21 matched controls. Anti-Borrelia IgG antibodies were determined by ELISA. A descriptive statistical analysis and Fischer's exact test were done. RESULTS: In serological tests, only two cases had borderline values and were further analyzed by Western blot with non-confirmatory results. For both the PRS and LMCS group, the association test was not significant, suggesting a lack of association between PRS or LMCS and the presence of anti-Borrelia antibodies. CONCLUSION: In Mexico there are no previous studies on Borrelia infection and its relationship between PRS or LMCS. Our result showed a lack of association of either clinical entities with anti-Borrelia-antibodies. Former reports of this association may suggest coincidental findings without causal relationship.
Antibodies, Bacterial/blood , Borrelia burgdorferi/immunology , Facial Hemiatrophy/immunology , Immunoglobulin G/blood , Scleroderma, Localized/immunology , Adolescent , Adult , Aged , Case-Control Studies , Child , Facial Hemiatrophy/epidemiology , Facial Hemiatrophy/microbiology , Female , Humans , Lyme Disease/complications , Male , Mexico/epidemiology , Middle Aged , Scleroderma, Localized/epidemiology , Scleroderma, Localized/microbiology , Seroepidemiologic Studies , Young Adult
Los lipomas son tumores mesenquimales benignos compuestos por adipocitos maduros. Corresponden a casi el 50% de los tumores de tejidos blandos, presentes entre el 1 y 5% en cavidad oral, especialmente en mucosa yugal, piso de la boca y márgenes laterales de la lengua. Suelen ser asintomáticos y su color depende del espesor de la mucosa que lo cubre. Histológicamente están conformados por lóbulos de adipocitos maduros rodeados por una cápsula fibrosa. Las variedades histológicas están determinadas por el tejido adicional que contienen; los más frecuentes son el lipoma simple y el fibrolipoma. Su curso es benigno y el tratamiento consiste en la escisión quirúrgica. En el presente artículo se reportan dos casos de fibrolipoma, un tumor común en una localización poco frecuente.
Lipomas are benign mesenchymal tumors of mature adipocytes. They correspond to almost 50% of soft tissue tumors, 1 to 5% of them localized in the oral cavity, especially in the oral mucosa, floor of mouth and lateral edges of the tongue. Oral lipomas are usually asymptomatic and the color depends of the thickness of the overlying mucosa. Histologically there are lobules of mature adipocytes surrounded by a fibrous capsule, and there are several types according to the additional tissue, being the most frequent the single lipomas and fibrolipomas. The course is benign and the definitive treatment is surgical excision. This article reports two cases of fibrolipoma, a common tumor in an unusual presentation.
Humans , Female , Aged , Mouth Neoplasms/pathology , Lipoma/pathology , Adipocytes
BACKGROUND: A proliferating trichilemmal cyst (PTC) is an uncommon, rapidly-reproducing cutaneous epithelial cyst, differentiating from the isthmic portion of the outer hair root sheath. It is usually described as a benign tumor, but malignant transformation has been reported and is then denominated as a malignant proliferating trichilemmal tumor. Ki67 immunostaining has been used as a methodology for the evaluation of tumor grade in other tumors, due to its distinctive reaction patterns which exclusively involve proliferating cells. OBJECTIVES: (1) To report the incidence of cases of PTCs in a General Hospital during a 12 years period. (2) To determine the expression of ki67 using immunohistochemical staining. (3) To correlate ki67 reaction patterns with clinical prognosis. MATERIALS AND METHODS: The dermatology department's files during a period of 12 years were reviewed; cases with a diagnosis of PTC were selected, and ki67 immunostaining was done when enough biological material was available. RESULTS: A total of 15 cases with a diagnosis of PTC were identified. In 12 cases, ki67 immunostaining was carried out. In 9 of the 12 cases, ki67 was observed in the basal cells of the cystic epithelium, one case was moderately positive in palisading epithelial cells; in the other two cases ki67 immunostaining was negative. Clinical follow-up was done and revealed that no patient had local recurrence in 5 years after surgical removal of PTC. We therefore consider this immunostaining technique is probably correlated with low recurrence potential.
Objective: The aim of this study was to determine by immunohistochemistry the presence and significance of p53 and bcl-2 proteins in oral lichen planus (OLP) and oral squamous cell carcinoma (OSCC). Study Design: We used 21 cases diagnosed as OLP 16 diagnosed as OSCC and four normal gingival biopsies taken from healthy patients were used as controls. Slides were processed for immunohistochemistry using anti-p53 and anti-bcl-2 monoclonal antibodies. Results:: We found p53 immunoexpression in 71.4 We found p53 immunoexpression in 71.4 We found p53 immunoexpression in 71.4(..) (AU)
Humans , Tumor Suppressor Protein p53/isolation & purification , bcl-2 Homologous Antagonist-Killer Protein/isolation & purification , Carcinoma, Squamous Cell/pathology , Lichen Planus, Oral/pathology , Precancerous Conditions/pathology , DNA Repair-Deficiency Disorders/pathology
OBJECTIVE: The aim of this study was to determine by immunohistochemistry the presence and significance of p53 and bcl-2 proteins in oral lichen planus (OLP) and oral squamous cell carcinoma (OSCC). STUDY DESIGN: We used 21 cases diagnosed as OLP 16 diagnosed as OSCC and four normal gingival biopsies taken from healthy patients were used as controls. Slides were processed for immunohistochemistry using anti-p53 and anti-bcl-2 monoclonal antibodies. RESULTS: We found p53 immunoexpression in 71.4% OLP cases and 68.7% OSCC cases, with no immunoexpression in control cases. Bcl-2 was negative for all OLP and OSCC cases, and mild positivity was observed in normal tissue. We found significant correlation among p53 expression and OSCC malignancy. CONCLUSIONS: Our results suggest that TP53 system mainly promotes a hyperproliferative state by cell cycle arrest of the OLP epithelial cells for repairing damaged DNA nor apoptosis and that anti-apoptotic action of bcl-2 is not important in this disease.
Carcinoma, Squamous Cell/immunology , Lichen Planus, Oral/immunology , Mouth Neoplasms/immunology , Proto-Oncogene Proteins c-bcl-2/immunology , Tumor Suppressor Protein p53/immunology , Adult , Aged , Carcinoma, Squamous Cell/metabolism , Female , Humans , Lichen Planus, Oral/metabolism , Male , Middle Aged , Mouth Neoplasms/metabolism , Proto-Oncogene Proteins c-bcl-2/biosynthesis , Tumor Suppressor Protein p53/biosynthesis , Young Adult
El síndrome de la larva migrans abarca las parasitosis causadas por los nematodos de los géneros Uncinaria, Ancylostoma, Necator y Gnathostoma. Se ha descrito más comúnmente en lugares con climas calurosos. Se estima que 1.200 millones de personas alrededor del mundo han adquirido la infección en algún momento. La larva migrans cutánea causada por Ancylostoma caninum y A. Vrasiliense se caracteriza por trayectos eritematosos, ligeramente elevados, lineales o serpiginosos en patrones irregulares. El diagnóstico es eminentemente clínico. Es útil la biometría hemática y herramientas auxiliares como la entodermoscopia, la microscopia confocal y la biología molecular. El tratamiento más efectivo son los antiparasitarios por vía oral en especial la ivermectina.
Larva migrans syndrome includes parasitic diseases caused by nematodes of gender Uncinaria, Ancylostoma, Necator and Gnathostoma. It has been reported in tropical countries with an estimated incidence of 1.2 billon infected people around the world.Cutaneous larva migrans due to Ancylostoma caninum and A. brasiliense is characterized by erythematous linear or serpiginous sinuous tracts. Diagnosis is always done by its typical clinical features, and it can also be useful the hemathologic counts, dermoscopy, confocal microscopy and molecular biology. The most effective treatments are oral antiparasitic drugs especially ivermectin.
Humans , Larva Migrans/diagnosis , Larva Migrans/drug therapy , Ancylostoma , Antiparasitic Agents/therapeutic use , Diagnosis, Differential , Ivermectin/therapeutic use , Larva Migrans/etiology , Larva Migrans/pathology , Larva Migrans/prevention & control
BACKGROUND: The skin wart is a benign proliferation of the skin and mucous, secondary to human papillomavirus (HPV) infection. OBJECTIVES: The objective of this study is to determine gene frequencies of HLA-DR alleles in Mexican patients with skin warts and compare them with those present in ethnically matched healthy subjects. METHODS: Fifty-two patients with clinically and histologically confirmed skin warts from the Dermatology Outpatient Clinic, with results of high-resolution DNA typing for HLA-DR polymorphism. RESULTS: HLA-DR3 and DR9 were increased (P = 0.0029, OR: 2.5, 95% CI: 1.34.7 and P = 0.0062, OR: 5.4, 95% CI: 1.419.5, respectively), and HLA-DR6 allele was found decreased (P = 0.0002). LIMITATIONS: The major histocompatibility complex contribution in the infection and elimination of the virus is not clear and perhaps also contributes to a series of events not well established yet. CONCLUSIONS: This study follows the preponderant role of class II genes in the susceptibility or resistance to the development of skin warts caused by HPV infection.
Gene Frequency , Genes, MHC Class II , HLA-DR Antigens/genetics , Papillomavirus Infections/genetics , Warts/genetics , Adolescent , Adult , Alleles , Child , Child, Preschool , DNA Probes, HLA , Female , Genetic Predisposition to Disease , Humans , Male , Mexico , Middle Aged , Papillomaviridae , Polymorphism, Genetic , Warts/virology , Young Adult
BACKGROUND: The frequency of nail unit tumors is not well known because they are often misdiagnosed, and the clinical appearance of benign and malignant tumors is not characteristic. PATIENTS AND METHODS: A total of 234 patients from the dermatology department of a general hospital in Mexico City were included in this study, from January 1982 to November 2006. RESULTS: The tumors most frequently diagnosed were fibrous tumors (29.05%), osteocartilaginous tumors (21.79%), and myxoid pseudocysts (11.96%). Malignant melanoma occupied the fourth place (9.82%), and the second most frequent malignant tumor was squamous cell carcinoma (SCC; 4.70%). Among other tumors were glomus, neurofibromas, giant cell tumors of tendon sheath, and pyogenic granulomas. The nail plate was affected in 46.5% of the cases studied. CONCLUSION: This study in a Mexican population sheds light on the frequency and the alterations produced by nail unit tumors, which we must keep in mind for a more accurate diagnosis.
Nail Diseases/diagnosis , Skin Neoplasms/diagnosis , Adolescent , Adult , Aged , Aged, 80 and over , Child , Child, Preschool , Female , Humans , Male , Mexico , Middle Aged , Nail Diseases/epidemiology , Retrospective Studies , Skin Neoplasms/epidemiology , Young Adult
OBJECTIVE: To report a case of simultaneous erythema nodosum and erythema multiforme after local lidocaine injection. CASE SUMMARY: A 33-year-old female experienced coexisting erythema nodosum and erythema multiforme after lidocaine spray was used for upper gastrointestinal endoscopy. The reaction was exacerbated after localized injection of 2% lidocaine for a skin biopsy. An objective causality assessment revealed that an adverse drug reaction was highly probable. DISCUSSION: Lidocaine is the most frequently used local anesthetic agent. The coexistence of erythema nodosum and erythema multiforme has been reported in lepromatous leprosy, Yersinia enterocolítica and Yersinia pseudotuberculosis gastrointestinal infection (both with diarrhea), histoplasmosis, hepatitis C, and milkers nodule, but not with lidocaine. CONCLUSIONS: If clinicians observe similar lesions after lidocaine exposure, they should suspect an adverse drug reaction and exercise caution in the administration of amide anesthetics to patients with a documented history of adverse reaction to lidocaine.
Anesthetics, Local/adverse effects , Erythema Multiforme/chemically induced , Erythema Nodosum/chemically induced , Lidocaine/adverse effects , Administration, Topical , Adult , Biopsy , Endoscopy, Gastrointestinal , Female , Humans
Paget's disease of the nipple is a superficial manifestation of an underlying breast malignancy. It has been reported in 1-3% of all breast carcinomas. The peak incidence is between 50 and 60 years. Its clinical presentation includes an unilateral, erythematous, slightly infiltrated scaly plaque and nipple retraction. Sero-sanguineous discharge may be observed. We here report a 51 year old woman who had an eight month history of an eritematous-squamous plaque with hematic scabs in the left nipple, with mild pruritus. A biopsy was taken and the diagnosis confirmed Paget's disease and intraductal breast carcinoma.
Breast Neoplasms/diagnosis , Paget's Disease, Mammary/diagnosis , Female , Humans , Middle Aged
La enfermedad de Paget mamaria (EP) es una manifestación superficial de enfermedad maligna de la mama. Suele presentarse entre 1 y 3% de todos los cánceres de mama y afecta principalmente mujeres entre los 50 y 60 años de edad. La forma clínica clásica se manifiesta con una placa infiltrada unilateral con eritema, escamas y en etapas avanzadas secreción del pezón o retracción del mismo. Presentamos el caso de una paciente de 51 años quién presentó dermatosis localizada a pezón izquierdo constituida por una placa eritemato-escamosa con costras hemáticas, de ocho meses de evolución, con prurito leve. Se le realizó biopsia y se diagnosticó enfermedad de Paget con carcinoma intraductal.
Paget's disease of the nipple is a superficial manifestation of an underlying breast malignancy. It has been reported in 1-3% of all breast carcinomas. The peak incidence is between 50 and 60 years. Its clinical presentation includes an unilateral, erythematous, slightly infiltrated scaly plaque and nipple retraction. Sero-sanguineous discharge may be observed. We here report a 51 year old woman who had an eight month history of an eritematous-squamous plaque with hematic scabs in the left nipple, with mild pruritus. A biopsy was taken and the diagnosis confirmed Paget's disease and intraductal breast carcinoma.
Humans , Female , Middle Aged , Paget's Disease, Mammary/diagnosis , Breast Neoplasms/diagnosis
