Coumarin/ß-Cyclodextrin Inclusion Complexes Promote Acceleration and Improvement of Wound Healing.

Coumarins have great pharmacotherapeutic potential, presenting several biological and pharmaceutical applications, like antibiotic, fungicidal, anti-inflammatory, anticancer, anti-HIV, and healing activities, among others. These molecules are practically insoluble in water, and for biological applications, it became necessary to complex them with cyclodextrins (CDs), which influence their bioavailability in the target organism. In this work, we studied two coumarins, and it was possible to conclude that there were structural differences between 4,7-dimethyl-2H-chromen-2-one (DMC) and 7-methoxy-4-methyl-2H-chromen-2-one (MMC)/ß-CD that were solubilized in ethanol, frozen, and lyophilized (FL) and the mechanical mixtures (MM). In addition, the inclusion complex formation improved the solubility of DMC and MMC in an aqueous medium. According to the data, the inclusion complexes were formed and are more stable at a molar ratio of 2:1 coumarin/ß-CD, and hydrogen bonds along with π-π stacking interactions are responsible for the better stability, especially for (MMC)2@ß-CD. In vivo wound healing studies in mice showed faster re-epithelialization and the best deposition of collagen with the (DMC)2@ß-CD (FL) and (MMC)2@ß-CD (FL) inclusion complexes, demonstrating clearly that they have potential in wound repair. Therefore, (DMC)2@ß-CD (FL) deserves great attention because it presented excellent results, reducing the granulation tissue and mast cell density and improving collagen remodeling. Finally, the protein binding studies suggested that the anti-inflammatory activities might exert their biological function through the inhibition of MEK, providing the possibility of development of new MEK inhibitors.

Allergic Dermatitis in Pêga Breed Donkeys (Equus asinus) Caused by Culicoides Bites in the Amazon Biome, Pará, Brazil.

An allergy to bites from Culicoides (Diptera: Ceratopogonidae) occurs because of a hypersensitivity reaction caused by the inoculation of insect salivary antigens during the bite, resulting in immune-mediated dermatitis. To the best of our knowledge, no previous studies have focused on allergic dermatitis in donkeys in Brazil. Therefore, this study aimed to describe the epidemiological, clinicopathological, and therapeutic aspects of allergic dermatitis in donkeys and to identify the insects involved in its epidemiology. This study reported the occurrence of dermatitis in 17 animals. The clinical signs were restlessness and severe itching. Skin lesions were found on the head, depigmented areas of the muzzle and cheeks, flanks, pelvic and thoracic limbs, and the scrotal sac. The lesions were characterized by areas of alopecia with crusts accompanied by serosanguineous exudates. Histologically, the lesions were characterized as moderate superficial dermatitis with irregular epidermal acanthosis and pronounced diffuse orthokeratotic hyperkeratosis. In total, 378 Culicoides specimens were collected, with Culicoides ocumarensis Ortiz being the most abundant species. The combined application of copaiba oil and a multivitamin emulsion exhibited potential for topical treatment of allergic dermatitis caused by insect bites in donkeys. Our study revealed an association between allergic dermatitis in donkeys and Culicoides.

Isolation and characterisation of Leishmania (Leishmania) infantum from cutaneous leishmaniasis patients in northeast Brazil

BACKGROUND In Brazil, Leishmania (Leishmania) infantum is a widely distributed protozoan parasite. The human leishmaniasis caused by this species is often associated with visceral form. Tegumentary leishmaniasis (TL) cases due to L. (L.) infantum in the country are considered rare but may be underestimated. Although probably uncommon, these cases represent a new challenge to the prevention and control of leishmaniasis. OBJECTIVES Here, we describe two distinct cases of TL with atypical clinical presentations caused by L. (L.) infantum. METHODS AND FINDINGS Parasites were isolated from cutaneous lesions of the two patients and typed as L. (L.) infantum after sequencing of the ribosomal DNA internal transcribed spacer. The dermotropic L. (L.) infantum isolates were compared in terms of growth culture patterns, metacyclogenesis and in vitro infectivity in macrophages. MAIN CONCLUSIONS This study addresses the emergence of L. (L.) infantum as a causative agent of cutaneous disease in a visceral leishmaniasis hotspot located in northeast Brazil. The data presented provides novel information about the presence of dermotropic L. (L.) infantum in the country and demonstrates the infectivity potential of theses isolates.

Chitosan and chitosan/turmeric-based membranes for wound healing: Production, characterization and application.

In the present study, chitosan and chitosan/turmeric-based membranes were produced, characterized and applied in in vivo experiments showing the applicability for skin wound repair. Chitosan 1 % (w/v), chitosan + glycerol 30 % (w/w) and chitosan + glycerol 30 % + turmeric 1.5 % (w/w) membranes were produced through the casting technique. Self-sustainable, homogeneous, and flexible membranes were obtained from all materials tested. The FTIR spectra showed the main vibrational bands for materials used in the chemical groups. The membranes containing glycerol are more flexible than those formed with pure chitosan. Membranes formed with glycerol and glycerol/turmeric are more hydrophilic compared to the membranes formed by pure chitosan. The in vivo results showed that the group who received the chi/gly/turmeric membrane had a statistically greater reduction in the injured area, as well as a better healing process in the histological analysis compared to the other experimental groups. The material developed here is from a natural source, low cost and easy to apply and can accelerate the process of repairing skin lesions.

Carcinoma basocelular diagnosticado por dermatoscopia en consulta de dermatología del Hospital Universitario Miguel Enríquez

Fundamento: el carcinoma basocelular es un tumor maligno muy frecuente en el ser humano. Se considera invasivo de forma local, además de agresivo y destructivo. Objetivo: mostrar el comportamiento de los pacientes con carcinoma basocelular diagnosticados por dermatoscopia en consulta de dermatología del Hospital Universitario Miguel Enríquez, entre junio de 2020 y mayo de 2021. Método: se realizó un estudio descriptivo, de corte transversal, para mostrar el comportamiento de los pacientes con carcinoma basocelular que asistieron a la consulta de dermatología del Hospital Universitario Miguel Enríquez en el periodo de junio 2020 a mayo 2021. El universo de estudio se conformó por los pacientes mayores de 18 años que presentaron una o varias lesiones presuntivas de carcinoma basocelular menores de 3 cm de diámetro. Se utilizaron las variables: edad, sexo, fototipo de piel, formas clínicas, patrones dermatoscópicos, topografía de la lesión, ocupación relacionada o no con la exposición solar. Se trabajó con frecuencias absolutas, porcentaje, media, desviación estándar, valores máximos y mínimos, la razón, pruebas de ji-cuadrado y t de student, con significación p≤0,05. Resultados: predominó en ancianos (66,4±14,9 años), en hombres (54,1 %), con fototipo 2 (57,8 %), y en nariz el 33,9 %. La forma nodular fue más frecuente (41,3 %), ocupación expuesta al sol (66,9 %), tamaño promedio de la lesión 1,4 cm. La dermatoscopia mostró predominio de los vasos arborizantes (73,4 %). Por histología se confirmó el 90,8 % de los casos. Conclusiones: predominaron entre los pacientes los ancianos, con fototipo 2. La forma nodular fue más frecuente, el tamaño promedio de la lesión fue de 1,4 cm. La dermatoscopia mostró predominio de los vasos arborizantes. La dermatoscopía resultó ser una herramienta necesaria para el uso sistemático en dermatología.

Foundation: basal cell carcinoma is a very common malignant tumor in humans. It is considered locally invasive, also aggressive and destructive. Objective: to show the behavior of patients with basal cell carcinoma diagnosed by dermoscopy in dermatology clinic of the Miguel Enríquez University Hospital, between June 2020 and May 2021. Method: a descriptive, cross-sectional study was carried out to show the behavior of patients with basal cell carcinoma who attended the dermatology consultation at the Miguel Enríquez University Hospital from June 2020 to May 2021. The universe of study was made up of patients older than 18 years who presented one or more presumptive lesions of basal cell carcinoma less than 3 cm in diameter. The variables used were: age, sex, skin phototype, clinical forms, dermoscopic patterns, topography of the lesion, occupation related or not to sun exposure. We worked with absolute frequencies, percentage, mean, standard deviation, maximum and minimum values, the ratio, chi-square and student's t tests, with significance p≤0.05. Results: it prevailed in the elderly (66.4±14.9 years), in men (54.1 %), with phototype 2 (57.8 %), and in the nose 33.9 %. The nodular form was more frequent (41.3 %), occupation exposed to the sun (66.9 %), average size of the lesion 1.4 cm. Dermoscopy showed a predominance of arborizing vessels (73.4 %). By histology, 90.8 % of the cases were confirmed. Conclusions: the elderly prevailed among the patients, with phototype 2. The nodular form was more frequent, the average size of the lesion was 1.4 cm. Dermoscopy showed a predominance of arborizing vessels. Dermoscopy turned out to be a necessary tool for systematic use in dermatology.

Granuloma annulare on ultrasound: a diagnosis to consider in pediatric skin lesions.

BACKGROUND: Granuloma annulare (GA) is a rare, benign, inflammatory, self-limited, granulomatous dermatosis that affects children and young adults. The most frequent clinical form is localized GA. Deep GA generally presents as painless palpable subcutaneous nodules in the lower extremities, buttocks, hands and scalp. They may have a fast-growing firm subcutaneous mass presentation, mimicking a malignant lesion which requires an imaging evaluation. Diagnosis of deep GA can be more difficult and imaging evaluation is frequently performed, ultrasound being one of the techniques used. OBJECTIVE: To describe the US characteristics of GA in a pediatric series. MATERIALS AND METHOD: Descriptive, retrospective, 14-year study of all pediatrics GA cases. RESULTS: Twelve pediatric cases with GA. 66% females. The lesions were mainly distributed in the extremities: 50% in the lower extremities and 42% in the upper extremities, mostly with multiple lesions. A total of 45 lesions were analyzed, 8 superficial lesions and 37 deep lesions. On ultrasound, the superficial GA corresponded to hypoechoic poorly defined solid plaque like or nodular lesions, located in the dermal-epidermal plane. The deep GA presented as solid nodular, poorly defined hypoechoic lesions that compromised the deep subcutaneous-aponeurotic plane. CONCLUSION: GA is an inflammatory lesion that presents as a superficial or deep palpable nodule that predominantly affects children. Superficial and deep GA present characteristic findings on US that can guide the diagnosis. The radiologist needs to know its US appearance to be able to suggest the diagnosis, especially in multiples lesions.

Viruela símica grave en un paciente con infección por VIH, Ecuador / Severe mpox in a HIV patient, Ecuador. A case report

En mayo de 2022 se reportó un aumento de casos de viruela símica (mpox en inglés) en el mundo, cuyo comportamiento epidemiológico y clínico, particularmente en pacientes con infección por VIH, condujo a la declaración del brote de mpox 2022 como emergencia de salud pública internacional. Se presenta el caso de un paciente con infección por VIH que cursó con mpox grave y fulminante, con placas necróticas en párpado y membrana inflamatoria sobre la superficie ocular; mucosa oral con lesiones blanquecinas y úlceras en lengua; induración de tejidos blandos y lesiones necróticas en los pies. Tras múltiples complicaciones, se convirtió en la primera víctima fatal reportada en Ecuador en 2022. En pacientes con infección por VIH, mpox puede presentarse como un agente oportunista, causando lesiones cutáneas graves, con o sin manifestaciones sistémicas.

In May 2022 several cases of mpox were reported worldwide, whose epidemiological and clinical outcome, particularly in patients seropositive for HIV, led to declaring the 2022 mpox outbreak as a public health emergency. We describe a case of a patient with HIV infection and severe and fulminant mpox, with necrotic plaques on the eyelid and an inflammatory membrane on the ocular surface; oral mucosa with whitish lesions and ulcers on the tongue; soft tissues induration, and necrotic lesions on the feet. After multiple complications, he became the first fatality reported in Ecuador in 2022. In HIV-infected patients mpox can be considered an opportunistic agent, with severe skin lesions with or without systemic manifestations.

Diagnóstico micológico de histoplasmosis en Uruguay, reporte de una serie de casos de la última década / Mycological diagnosis of histoplasmosis in Uruguay, report of a series of cases of the last decade

Introducción: La histoplasmosis es una micosis sistémica que afecta a humanos, su agente Histoplasma capsulatum, hongo dimorfo, es ubicuo en la naturaleza. Frecuentemente se presenta como reactivación en personas con infección por VIH/SIDA, con manifestaciones polimórficas y diseminadas. Las lesiones mucocutáneas son una importante llave diagnóstica. Objetivo: Contribuir al conocimiento de esta patología a través del reporte de los diagnósticos de laboratorio de histoplasmosis realizados en Uruguay en los últimos 10 años. Materiales y Métodos: Se realizó un estudio observacional, retrospectivo de las histoplasmosis diagnosticadas en el laboratorio de referencia de Micología de Facultad de Medicina y dos laboratorios clínicos. Se enrolaron los registros clínicos y analíticos asociados. Resultados: Fueron 69 los diagnósticos de histoplasmosis. Más de 80% correspondió a personas con infección por VIH/SIDA. El 62,3% del total presentó lesiones de piel y/o mucosas y en 58% el diagnóstico se realizó mediante el estudio de estas. El 62,3% de los diagnósticos se realizaron mediante la visualización al microscopio óptico de frotis coloreados. Conclusiones: La mayoría de las histoplasmosis se vinculan a la infección por VIH/SIDA. El estudio micológico de las lesiones de piel y/o de mucosas, es accesible, mínimamente invasivo, rápido y presenta una excelente performance diagnóstica.

Background: Histoplasmosis is a systemic mycosis that affects humans, its agent Histoplasma capsulatum, a dimorphic fungus, is ubiquitous in nature. It frequently presents as reactivation in people with HIV/AIDS infection, with polymorphic and disseminated manifestations. Mucocutaneous lesions are characteristic and an important diagnostic key. Aim: To contribute to the knowledge of this pathology through the report of histoplasmosis laboratory diagnosis made in Uruguay in the last 10 years. Methods: We conducted an observational, retrospective study of diagnosed histoplasmosis in the Mycology reference laboratory of the Faculty of Medicine and two clinical laboratories. Associated clinical and analytical records were obtained. Results: There were 69 histoplasmosis diagnoses. More than 80% corresponded to people with HIV/AIDS infection. 62.3% of the total presented skin and/or mucosal lesions and in 58% the diagnosis was made by studying them. 62.3% of the diagnoses were initially made by viewing colored smears under an optical microscope. Conclusions: Most histoplasmosis is linked to HIV/AIDS infection. Exposure to a high fungal load is a constant in cases of immunocompetent individuals. The mycological study of skin and/or mucosal lesions is accessible, minimally invasive, fast and has excellent diagnostic performance.

Immunomodulatory Effects of Cinnamaldehyde in Staphylococcus aureus-Infected Wounds.

Cinnamaldehyde (CNM) is an essential-oil component with reported anti-infective, anti-inflammatory, and healing effects, making it an interesting compound for the treatment of wound infection. Herein, we evaluated the effects of topical administration of CNM in experimental wounds infected by Staphylococcus aureus. Swiss mice (n = 12/group) were randomly allocated into three groups (CON: animals with uninfected lesions; Sa: animals with untreated infected lesions; Sa + CNM: animals with infected wounds and treated with CNM). Excisional lesions (64 mm2) were induced at the dorsal area followed by the addition of S. aureus (80 µL of a 1.5 × 108 CFU/mL bacterial suspension). The wounds were treated with CNM (200 µg/wound/day) or vehicle (2% DMSO) for 10 days. Skin samples were taken on the 3rd or 10th treatment day for quantification of inflammatory mediators, bacterial load, immunophenotyping, and histological analysis. The treatment with CNM improved the healing process and attenuated the severity of skin lesions infected by S. aureus. These effects were associated with significant decreases in bacterial loads in CNM-treated wounds. The levels of neutrophils, TNF-α, IL-6, NO, and VEGF were decreased in the lesions treated with CNM. Taken together, these data provide further evidence of the effectiveness of CNM for the treatment of skin infections.

Caracterización de lesiones cutáneas asociadas al uso de equipos de protección individual e infecciones por Staphylococcus aureus en personal sanitario en la lucha contra el Covid-19 / Characterization of skin lesions associated with the use of personal protective equipment and Staphylococcus aureus infections in health personnel in the fight against Covid-19

La pandemia por Covid-19 ha marcado cambio en paradigma de la atención médica, generando la necesidad del uso de equipo de protección individual (EPI), para salvaguardar la salud. Lo que ha originado manifestaciones cutáneas secundarias asociadas al uso de los mismos. Se realizó una investigación descriptiva de corte transversal con el objetivo de caracterizar las lesiones cutáneas asociadas al uso de EPI e infecciones por Staphylococcusaureus en 283 enfermeros, el diagnóstico dermatológico fue realizado por especialistas; el cultivo bacteriológico se realizó a partir de hisopados de algodón estériles o frotis de aposición sobre la lesión de piel. Para el aislamiento del género Staphylococcus, las muestras se sembraron en agar salino manitol rojo de fenol, incubándose de 24 a 48 horas a 37°C. La identificación de S. aureus se efectúo por la fermentación del manitol en el agar selectivo, la reacción positiva de la prueba de la coagulasa. El S. aureus se diferenció del Staphylococcus coagulasa negativo con el empleo de la prueba de la Dnasa. Se precisó LC-EPI en 75,618% de los enfermeros, de los cuales 92,523% presentaron síntomas sugestivos a infección bacteriana secundaria, ratificada en su totalidad por cultivo microbiológico, identificando a S. aureus. Se estimó que más del 60% de las LC-EPI eran de presentación única catalogada grado I, afectando mayormente las regiones: orbitaria, temporal, nasal, infraorbitaria y frontal, asociándose con el uso de lentes/protectores faciales, gorros y mascarillas como causantes de las lesiones. Se recomienda la definición de protocolos de prevención de LC-EPI(AU)

The Covid-19 pandemic has marked a paradigm shift in medical care, generating the need for the use of personal protective equipment (PPE) to safeguard health. This has caused secondary skin manifestations associated with their use. A descriptive cross-sectional investigation was carried out with the objective of characterizing the skin lesions associated with the use of PPE and Staphylococcus aureus infections in 283 nurses. The dermatological diagnosis was made by specialists; the bacteriological culture was performed using sterile cotton swabs or apposition smears on the skin lesion. For the isolation of the genus Staphylococcus, the samples were seeded in phenol red mannitol saline agar, incubating for 24 to 48 hours at 37°C. The identification of S. aureus was carried out by the fermentation of mannitol in the selective agar, the positive reaction of the coagulase test. S. aureus was differentiated from coagulase-negative Staphylococcus using the DNase test. LC-EPI was required in 75.618% of the nurses, of which 92.523% presented symptoms suggestive of secondary bacterial infection, fully confirmed by microbiological culture, identifying S. aureus. It was estimated that more than 60% of the LC-EPI were of a single presentation classified as grade I, mainly affecting the regions: orbital, temporal, nasal, infraorbital, and frontal, associated with the use of glasses/face protectors, hats, and masks as causes of the injuries. The definition of LC-EPI prevention protocols is recommended(AU)

In vitro porphyrin-based photodynamic therapy against mono and polyculture of multidrug-resistant bacteria isolated from integumentary infections in animals.

Multidrug-resistant (MDR) organisms have been frequently isolated from integumentary lesions of animals, and these lesions are usually infected by more than one pathogen. This study evaluated an in vitro antimicrobial photodynamic therapy (aPDT) using two water-soluble tetra-cationic porphyrins (3-H2TMeP and 4-H2TMeP) against mono and polyculture of MDR bacteria isolated from dogs, cats, and horses. Ten isolates of MDR bacteria (two of each species: Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, Serratia marcescens, and Staphylococcus pseudointermedius) were used to evaluate aPDT against the monoculture using a non-cytotoxic concentration of 3-H2TMeP and 4-H2TMeP porphyrins (40 µM), with 30 min of light irradiation in Gram-positive and 90 min for Gram-negative bacteria. The aPDT using the 4-H2TMeP porphyrin was also tested against five different polycultures (Coagulase positive Staphylococcus (CPS) and Pseudomonas sp.; E. coli and Proteus sp.; Pseudomonas sp. and Proteus sp.; CPS and E. coli; and CPS and Proteus sp.) for 90 min. The efficacy of both treatments was evaluated by plating the solution exposed to light or kept in the dark and counting the colonies forming units after 24 h of incubation at 37 °C. Atomic force microscope analysis was used to map bacteria morphological changes and extract adhesion force parameters from the bacteria membranes. Only the 4-H2TMeP porphyrin had antibacterial activity against MDR bacteria in monoculture, especially S. pseudointermedius and P. aeruginosa. In polyculture, the 4-H2TMeP porphyrin reduced bacterial concentrations (p < 0.05) in the associations of E. coli and S. pseudointermedius, P. aeruginosa and S. pseudointermedius, and P. aeruginosa and P. mirabilis. These results showed that aPDT using 4-H2TMeP is a good option for future associations of aPDT and other therapies or in vivo research.

Viruela del mono (MPOX) en paciente varón heterosexual VIH negativo

Se presenta el caso de un paciente varón de 28 años, heterosexual, con VIH negativo que desarrolló erupción cutánea intensa caracterizada por la presencia de vesículas, pústulas y pápulas umbilicadas confluentes en el pene y región púbica con escasa diseminación en el resto del cuerpo, sin adenopatía ni manifestaciones sistémicas, cuatro días después de haber tenido relaciones sexuales con una prostituta aparentemente sana. El hisopado de las lesiones dérmicas revelaron la presencia de ADN del virus MPOX por PCR en tiempo real. Las pruebas inmunológicas fueron las siguientes: ELISA cuarta generación para VIH y Western Blot negativas, anticuerpos IgM para herpes simplex1=1.2 U/ml, anticuerpos IgM para herpes simplex2=1.9 U/ml, anticuerpos IgM para varicela zóster=0.5 S/CO, FTA-ABS (IgM)=negativo. Se resalta la intensidad de las lesiones cutáneas en el pene y la necesidad de realizar pruebas para descarte de MPOX en prostitutas.

We present the case of a 28-year-old male patient, heterosexual, with negative HIV who developed an intense skin rash characterized by the presence of confluent vesicles, pustules, and umbilicated papules on the penis and pubic region with little spread to the rest of the body, without lymphadenopathy or systemic manifestations, four days after having sexual relations with an apparently healthy prostitute. The swabbing of the dermal lesions revealed the presence of MPOX virus DNA by real-time PCR. The immunological tests were the following: negative fourth-generation ELISA and Western Blot for HIV, IgM antibodies to herpes simplex1=1.2 U/ ml, IgM antibodies to herpes simplex2=1.9 U/ml, IgM antibodies to varicella zoster=0.5 S/CO and negative FTA-ABS (IgM) for syphilis. The intensity of skin lesions on the penis and the need to perform tests to rule out MPOX in prostitutes are highlighted.

Leucemia linfocítica aguda con infiltración en la piel. Presentación de un caso y revisión de la literatura

RESUMEN La leucemia cutánea es una patología muy poco frecuente y se puede presentar en diferentes tipos de leucemias asociadas o no a síndromes genéticos. Es una forma muy poco común de presentación inicial de malignidad. Por sus lesiones inespecíficas en la piel y la similitud con diversas patologías cutáneas representa un gran desafío diagnóstico para el dermatólogo pediátrico. Se presenta el caso de un niño de 5 años con antecedentes de leucemia linfocítica aguda con lesiones papulosas descamativas de aspecto liquenoide diseminadas en tegumento cutáneo. Se realizó una biopsia bajo la sospecha de infiltración a piel o leucemia cutis. Se discutió el caso para llegar a la confirmación diagnóstica de leucemia cutánea. Se inició el tratamiento en el Servicio de Hematología. Esta enfermedad hematológica se manifiesta ocasionalmente en la piel y cuando lo hace es necesario reconocerla para completar su diagnóstico y tratamiento y salvar la vida del paciente afectado como en este caso. El interés de esta presentación radica en que la aparición de lesiones cutáneas, aunque sean inespecíficas, en un paciente con leucemia, debe alertar al equipo médico tratante para su rápido estudio y así orientar la conducta terapéutica y por su baja incidencia de presentación.

ABSTRACT Cutaneous leukemia is a very rare pathology and can occur in different types of leukemia associated or not with genetic syndromes. It is a very uncommon form of initial presentation of malignancy. Due to its non-specific skin lesions and the similarity with various skin pathologies, it represents a great diagnostic challenge for the pediatric dermatologist. We present the case of a 5-year-old boy with a history of acute lymphocytic leukemia with scaly papular lesions of a lichenoid appearance disseminated in the cutaneous integument. A skin biopsy was performed on suspicion of skin infiltration or leukemia cutis. The case was discussed to reach diagnostic confirmation of cutaneous leukemia. Treatment was started in the Hematology Service. This hematological disease occasionally manifests itself on the skin and when it does, it is necessary to recognize it to complete its diagnosis and treatment and save the life of the affected patient, as in this case. The interest of this presentation lies in the fact that the appearance of skin lesions, even if they are non-specific, in a patient with leukemia, should alert the treating medical team for their rapid study and thus guide therapeutic behavior and due to their low incidence of presentation.

Erysipelas in a stranded common bottlenose dolphin: first report in a South American odontocete.

Erysipelas is a zoonotic disease caused by Erysipelothrix rhusiopathiae. In cetaceans, this disease has two main clinical forms: a cutaneous one, grossly characterized by rhomboid lesions, and a septicemic and often fatal form. Erysipelas is considered an important cause of morbidity and mortality in captive cetaceans; however, information in free-ranging cetaceans is limited. An adult common bottlenose dolphin (Tursiops truncatus) was found dead and in advanced autolysis in Paraíba state, northeastern Brazil, on July 19th, 2020. Upon gross examination, 80% of the body surface presented disseminated rhomboid cutaneous lesions ranging from 4 to 6 cm-width, characterized by well-defined edges and occasional ulceration, consistent with erysipelas. Additionally, anthropic-made postmortem linear cuts and partial mechanical removal of the flank musculature were noted. Skin samples were collected for histopathologic and molecular analyses. Microscopically, it was possible to observe multifocal dermatitis with vasculitis. Erysipelothrix sp. was detected by PCR. Despite previous reports of human consumption of cetacean meat in northeastern Brazil, the observed marks and advanced carcass autolysis suggested that the animal was most likely used as bait for fishing instead of human intake. This case highlights the value of postmortem examination and PCR even in poorly preserved cadavers and contributes to the understanding of the epidemiology of cutaneous erysipelas in free-ranging cetaceans (first report in an odontocete from the Southern Hemisphere). Due to the zoonotic potential of certain Erysipelothrix species (i.e., E. rhusiopathiae), active public health policies are required to inform field professionals and the general public about the health threats associated with marine mammal manipulation and consumption.

Dermatosis relacionadas indirectamente con la COVID-19 / Dermatoses indirectly related to COVID-19

RESUMEN Introducción: el nuevo coronavirus SARS-CoV-2, agente causal de la COVID-19, fue hallado en Wuhan, China, en diciembre de 2019. Desde entonces, la pandemia generada ha puesto en vilo al mundo, dada su alta contagiosidad y capacidad para dañar los órganos y sus sistemas, incluyendo la piel. Esta se ha visto afectada tanto por la acción directa del virus como por los nuevos estilos de vida que han sido adoptados para evitar el contagio. Objetivo: caracterizar las lesiones cutáneas originadas por los nuevos estilos de vida durante la COVID-19. Materiales y métodos: se realizó un estudio observacional, descriptivo y prospectivo de los pacientes que acudieron a consulta de Dermatología en el Hospital Universitario Clínico Quirúrgico Comandante Faustino Pérez Hernández, de Matanzas, con lesiones cutáneas de reciente aparición sin causa aparente conocida, entre septiembre de 2020 y febrero de 2021, y que dieron su consentimiento informado para participar en la investigación. El universo estuvo integrado por 14 pacientes portadores de lesiones sin etiología precisada. Todas las lesiones fueron sometidas a examen clínico y algunas, además, fueron tributarias de examen microbiológico. Resultados: predominaron las féminas con un 78,6 %, una media de edad de 34 años y la piel blanca, para un 71,4 %. Las pápulas y pústulas fueron las lesiones de mayor incidencia, siendo más afectados los que usan la mascarilla más de cuatro horas. Los sitios anatómicos más vulnerables fueron el mentón, las mejillas y la zona peribucal. Conclusiones: el maskné y las discromías postinflamatorias son enfermedades que se atribuyen en la actualidad al uso continuo del nasobuco.

ABSTRACT Introduction: the new SARS-CoV-2 virus, causal agent of COVID-19, was found in Wuhan, China, in December 2019. Since then, the pandemics generated has put the world in suspense, given its high contagiousness and capability to damage the organs and their systems, including the skin. The skin has been affected both by the direct action of the virus and by the new life styles that have been adopted to avoid contagion. Objective: to characterize the lesion skins originated by the new life styles adopted during the COVID-19 pandemics. Materials and methods: an observational, descriptive and prospective study was carried out with the patients who assisted the consultation of Dermatology in the Clinical-surgical Teaching Hospital Faustino Perez Hernandez, from Matanzas, with skin lesions recently appeared with apparently unknown cause, between September 2020 and February 2021, and who gave their informed consent to participate in the research. The universe was formed by 14 patients bearing lesions without precise etiology. All lesions undergone clinical examination and some of them also underwent microbiological examination. Results: females predominated with 78.6 %, aged an average 34 years and white skin with for 71.4 %. Papules and pustules were the lesions of higher incidence, being the most affected those who wear masks for more than four hours. The most vulnerable anatomic sites were the chin, cheeks and peribuccal area. Conclusions: maskne and post-inflammatory dyscromies are diseases that are currently attributed to the continued use of face masks.

Occurrence of sarcoptic mange in free-ranging vicuñas (Vicugna vicugna) of the Andean high plateau region of Argentina.

Free-ranging vicuñas (Vicugna vicugna) are handled in some areas of the Andean high plateau region following an ancestral practice known as chaku, which consists in their transient capture and shearing of their fiber for commercialization. In this study, 807 vicuñas captured during 12 chaku events that took place in 2019 in the province of Jujuy, Argentina, were examined for typical mange skin lesions. Twenty-eight of the examined vicuñas presented alopecia with erythema, exudation, hyperkeratosis, and/or bleeding scarred lesions, mostly in the chest, rear and front legs, and inguinal zone. Most of the cases (82%) appeared in Laguna Cucho at 4900 masl, where 23% of the animals presented these skin reactions. Microscopic evaluation of skin scrapings revealed the presence of a great number of 0.1- to 0.4-mm-long mites of different life cycle stages, morphologically compatible with the species Sarcoptes scabiei. This etiological agent was confirmed by PCR amplification and sequencing of a cox-1 species-specific segment. Histopathological examination of skin biopsies showed extensive infiltration of the dermis with lymphocytes, neutrophils and eosinophils, hyperplasia at different stages, epidermis degeneration, and hyperkeratosis. This is the first characterization of sarcoptic mange in free-ranging vicuñas by clinical examination, mite morphology, histopathological studies, and molecular confirmation in the region. Mange hampers the welfare of vicuñas and the economy of the local communities that organize chaku events since infested vicuñas cannot be sheared. Its long-term effects are unknown but it might affect the fitness and survival of this iconic South American camelid.

Reimagining leprosy elimination with AI analysis of a combination of skin lesion images with demographic and clinical data.

Background: Leprosy is an infectious disease that mostly affects underserved populations. Although it has been largely eliminated, still about 200'000 new patients are diagnosed annually. In the absence of a diagnostic test, clinical diagnosis is often delayed, potentially leading to irreversible neurological damage and its resulting stigma, as well as continued transmission. Accelerating diagnosis could significantly contribute to advancing global leprosy elimination. Digital and Artificial Intelligence (AI) driven technology has shown potential to augment health workers abilities in making faster and more accurate diagnosis, especially when using images such as in the fields of dermatology or ophthalmology. That made us start the quest for an AI-driven diagnosis assistant for leprosy, based on skin images. Methods: Here we describe the accuracy of an AI-enabled image-based diagnosis assistant for leprosy, called AI4Leprosy, based on a combination of skin images and clinical data, collected following a standardized process. In a Brazilian leprosy national referral center, 222 patients with leprosy or other dermatological conditions were included, and the 1229 collected skin images and 585 sets of metadata are stored in an open-source dataset for other researchers to exploit. Findings: We used this dataset to test whether a CNN-based AI algorithm could contribute to leprosy diagnosis and employed three AI models, testing images and metadata both independently and in combination. AI modeling indicated that the most important clinical signs are thermal sensitivity loss, nodules and papules, feet paresthesia, number of lesions and gender, but also scaling surface and pruritus that were negatively associated with leprosy. Using elastic-net logistic regression provided a high classification accuracy (90%) and an area under curve (AUC) of 96.46% for leprosy diagnosis. Interpretation: Future validation of these models is underway, gathering larger datasets from populations of different skin types and collecting images with smartphone cameras to mimic real world settings. We hope that the results of our research will lead to clinical solutions that help accelerate global leprosy elimination. Funding: This study was partially funded by Novartis Foundation and Microsoft (in-kind contribution).