[Dermatological emergencies: A descriptive study in a tertiary hospital]. / Urgencias dermatológicas: estudio descriptivo en un hospital terciario.

INTRODUCTION: Nowadays, there is an increasing number of patients who seek emergency treatment for their dermatology complaints. However, it is unknown to what extent a skin disease is urgent enough to require immediate specialised care. Our aims were to assess the type and prevalence of the dermatological diseases treated in the division of Dermatology of a tertiary hospital, as well as to determine the main features of the patients with these disorders and the means of access to the Dermatology Department. MATERIAL AND METHOD: A descriptive and prospective study was conducted on patients with dermatological conditions diagnosed in the Dermatology outpatient clinic of a hospital during a 5 month period. For this purpose, the information corresponding to health cover, basic epidemiological characteristics, origin, diagnosis, and destiny of each patient was entered into a database. RESULTS: The dermatologist attended 242 patients, of whom 49% were women and 51% men. The mean age was 49.2 years. The 78 different diagnoses made were grouped into 12 categories to facilitate analysis. According to this classification, most patients had eccemas (17.8%), followed by miscellaneous (17.4%), tumours and cysts (16.2%), and infectious dermatoses (15%). In 7 (2.9%) cases, the patient was admitted to hospital. CONCLUSIONS: Dermatological diseases attended to in the Dermatology Department were varied. The most common diagnoses were psoriasis, eccemas, and toxicoderma. The profile of the patient seeking emergency dermatological care is a person between the fourth and fifth decade of the life, who arrives directly to the Emergency Department without requesting previous assessment by a Primary Care physician. The most common reason for admission was erythrodermic psoriasis.

Trichoadenoma associated with an intradermal melanocytic nevus: a combined malformation.

Melanocytic nevi have been associated with epidermal hyperplasia, adnexal hyperplasia with follicular and sebaceous differentiation, cysts, and tumors of epidermal or adnexal origin. We report a combined cutaneous hamartoma in a 29-year-old woman that comprised a trichoadenoma within an intradermal melanocytic nevus. Clinical diagnosis was a malignant transformation of a melanocytic nevus. Histopathologically, multiple keratinous cysts together with solid islands or masses of eosinophilic epithelial cells were closely intermingled with the nevus cells. Occasional nests of basaloid cells were present. Although to our knowledge this association has not been previously reported, it is worth considering that trichoadenoma and desmoplastic trichoepithelioma are the two ends of a spectrum of lesions. This combined hamartoma reported herein is important because growth of these lesions could be clinically misinterpreted as malignant transformation of a preexisting lesion. Histologic study will reveal the correct diagnosis in such cases.

Nevus azul hipopigmentado: una variante poco frecuente del nevus azul / Hypopigmented blue nevus: an uncommon variant of blue nevus

Los nevus azules se manifiestan clínicamente por máculas o pápulas con una intensa y característica pigmentación melánica. El nevus azul amelanótico o hipopigmentado es una variante rara que tiene los mismos rasgos morfológicos que el nevus azul pero que es amelanótico o mínimamente pigmentado. Las lesiones se localizan en cualquier parte del cuerpo con predilección por la cara, la espalda y la zona dorsal de manos y pies. Ocurre en ambos sexos con una relación de mujer a varón de aproximadamente 2:1 y con una predilección por los jóvenes. Histológicamente se caracteriza por una proliferación dérmica de células fusiformes con poca o ninguna melanina. Presentamos dos casos de nevus azules amelanóticos (hipopigmentados). Reconocer el nevus azul amelanótico es importante ya que debido a la falta de pigmentación puede resultar difícil de diagnosticar tanto clínica como patológicamente. El diagnóstico diferencial histológico incluye el dermatofibroma, la cicatriz, los nevus intradérmicos, el neurofibroma y el melanoma desmoplásico

Blue nevi are typically heavily melanin-pigmented macules or papules. Amelanotic or hypopigmented blue nevus is a rare variant of blue nevus that has morphologic features similar to ordinary blue nevus but is either amelanotic or minimally pigmented. The lesions are located throughout the body with predilection for the face, the back and the dorso of the hands and feet. 80th sexes are affected with a female to ma/e rate of aproximately 2:7 and there is a predilection for young patients. Histologically is characterized by a dermal proliferation of spindle-shaped cells with little or no obvious melanín. We here report two cases of amelanotíc (hypomelanotic) blue nevus. Recognition of amelanotic blue nevus is important because of the lack of pigmentation may result in clinical and pathologíc díagnostíc difficulty The histological differential diagnosis includes dermatofíbroma, scar, intradermal nevus, neurofibroma and desmoplastic melanoma

Pure sclerotic neurofibroma: a neurofibroma mimicking sclerotic fibroma.

BACKGROUND: Neurofibroma (NF) is a benign tumor of the nerve sheath. Several variants of NF have been described. PURPOSE: We report a case of NF with sclerotic changes resembling sclerotic fibroma (SF). METHODS AND RESULTS: The patient was a 61-year-old man who had an asymptomatic cutaneous lesion on the right scapular region. Physical examination revealed a pedunculated, white-to-pinkish nodule that had a firm consistency, spherical morphology, and smooth surface. Microscopically, the nodule showed a well-circumscribed, nonencapsulated dermal tumor composed of scant cells and thick collagen bundles with prominent clefts. The tumor cells were immunoreactive for vimentin and S100 protein. The patient was diagnosed as having pure sclerotic NF. To our knowledge, only five cases of NF with SF-like pattern have been previously published, and in two this pattern was pure. CONCLUSION: It is important to recognize this exceptional type of NF because it may be easily confused with SF, as well as with a wide variety of neoplasms or hamartomatous conditions containing similar sclerotic pattern.

A clinic-based molecular epidemiologic study of tuberculosis in Monterrey, Mexico.

SETTING: A tuberculosis clinic associated with a university hospital in Monterrey, Mexico, an urban community with high tuberculosis incidence. OBJECTIVE: To determine the diversity of DNA fingerprint patterns and the extent of drug resistance of Mycobacterium tuberculosis isolates from patients who attended the clinic. DESIGN: Isolates of M. tuberculosis obtained from 186 patients during the period from 31 January 1996 to 31 March 1998 were tested for susceptibility to isoniazid, rifampicin, ethambutol and streptomycin. Demographic data and the social history of each patient were obtained prospectively by interview. The IS6110 DNA fingerprints were obtained for 166 of the 186 isolates. Secondary typing was carried out on isolates with fewer than six copies of IS6110. RESULTS: Thirty-two per cent of the tested isolates (60/ 186) were drug-resistant, and 18% (33/186) were multidrug-resistant. Approximately 55% of the resistant isolates (33/60) were attributed to acquired resistance. A total of 106 different IS6110 fingerprint patterns were observed among the 166 fingerprinted isolates. Based on both IS6110 and pTBN12 fingerprinting, 65 (39%) of the 166 isolates were part of 22 DNA fingerprint clusters. Various drug susceptibility patterns were seen in most clusters. CONCLUSION: Fingerprint clustering indicates extensive recent transmission of tuberculosis in patients attending the clinic. The prevalence of drug-resistant tuberculosis is high.