Adverse Reactions Associated with Dermal Fillers in the Oral and Maxillofacial Region: A Venezuelan Experience.

BACKGROUND: Dermal facial fillers are increasingly popular. Published reports on the clinical and histopathologic characteristics related to adverse reactions to dermal fillers in the facial region have been relatively well documented. This study adds to the literature on adverse reactions to injected filler in the oral and maxillofacial region in a South American population. METHODS: A retrospective, descriptive cross-sectional study (2019-2020) was performed. The study population was a dermatology service in Venezuela. Clinical and histopathologic features of patients with adverse effects were documented. RESULTS: A total of 35 cases of adverse reactions associated with cosmetic filler procedures were diagnosed during the analyzed period; of these, six cases (17.1%) involved the oral and maxillofacial region. All cases occurred in women. The mean age at diagnosis was 59.3 years (58-73). In three cases, dermal fillers were used in different locations on the face, while three involved the lips. Five patients exhibited adverse reactions to lip filler. All six cases were histopathologically diagnosed as foreign body reactions to injected material. Four and two cases revealed microscopic features compatible with hyaluronic acid and polymethylmethacrylate, respectively. CONCLUSION: Reflecting the dramatic increase in cosmetic procedures with soft tissue fillers, this study contributed by reporting six cases of foreign body reaction involving the oral and maxillofacial region, confirmed with biopsy and histopathology.

Congenital Melanotic Macule of the Tongue: Report of Two Cases and Literature Review.

BACKGROUND: Congenital melanotic macule of the tongue (CMMT) has been described as a distinct entity, despite its unknown etiology. However, the diagnosis and management of affected newborns may challenge clinicians and pediatric dentists. METHODS: We document here the clinicopathological findings of two additional cases of CMMT. A literature review of CMMT reports identified across PubMed, Web of Science, Embase, and Scopus was also conducted. RESULTS: The patients, 2- and 4 month-old Venezuelan boys, respectively, presented at birth with a single or multiple dark-brown-pigmented macule exclusively on the dorsum of the tongue. Histopathological features revealed increased melanin pigmentation in the basal epithelial layer with overlying hyperkeratosis and pigment-laden subepithelial macrophages with normal morphological appearance. Nine studies comprising 17 cases of CMMT have been described hitherto. Most cases were from the USA and France (n = 6 each). Twelve (70.6%) patients were males, eight (50%) were white, and median age was 2.7 months. CMMT presented as brownish to black, solitary or multiple pigmentations located in the right or left region of the dorsum of the tongue, ranging in size from 3.0 to 30.0 mm. CONCLUSION: An important feature for the diagnosis of CMMT is the information about the manifestation at birth and consequent proportional growth. This report intends to draw the attention of pediatricians and dentists to this apparently underdiagnosed condition for decision-making and management of affected newborns.

International registry of dermatological manifestations secondary to COVID-19 infection in 347 Hispanic patients from 25 countries.

BACKGROUND: The infection by coronavirus disease 2019 (COVID-19) has been associated with multiple cutaneous manifestations, although characterization of them in Hispanic patients with darker skin phototypes is lacking. The objective of this study is to characterize the clinical dermatological manifestations associated with COVID-19 infection in cases with few or without general symptoms in patients from Latin America. METHODS: Cross-sectional study using a questionnaire that was made for health professionals (physicians with a specialty in dermatology) to investigate dermatological lesions associated with COVID-19 infection in patients from 25 countries of Latin America. The survey was active from June 9 to July 30, 2020. RESULTS: In this study, information was collected from a total of 347 patients. We found a female gender predominance: 179/347 (51.6%). The mean age at presentation was 40.87 years. The most frequent dermatological manifestations were maculopapular rash and urticarial lesions, followed by papulovesicular lesions, vesicular lesions, chilblain-like lesions, papular lesions, ecchymosis, petechial purpura, pityriasis rosea-like lesions, pruritus, palmoplantar dysesthesias, transient livedo, acral necrosis, palpable purpura, livedo racemosa, and retiform purpura. As far as we know, there are no previous reports of pruritus and palmoplantar dysesthesias. CONCLUSIONS: This registry emphasizes skin manifestations as an important criterion for establishing the diagnosis of COVID-19 infection in Latin American countries. This information will be useful for the early identification of suspected cases by health professionals (dermatologists and nondermatologists) and will allow contact tracing to mitigate the impact on health systems at different levels.

Oral manifestations associated with antimalarial therapy in patients with systemic lupus erythematosus.

INTRODUCTION: Lupus erythematosus (LE) is an autoimmune disease often treated with antimalarial drugs. The prolonged use of chloroquine and hydroxychloroquine can cause hyperpigmentation in the skin, oral mucosa and retinal pigment epithelium, which in turn can trigger toxicity in this epithelium, which in some cases causes vision loss. The objective of the present work was to establish the association between the presence of oral pigmented macules by antimalarial and secondary retinal toxicity. METHODS: A total of 105 patients diagnosed with LE being treated with chloroquine/hydroxychloroquine were evaluated. All patients were ophthalmologically evaluated for retinopathy screening. When the patient showed oral hyperpigmented maculae, an incisional biopsy was performed with the corresponding histopathological study with informed consent. The variables were compared using the chi-square test for quantitative variables and the non-parametric Mann-Whitney U-test for categorical variables. The confidence level was established at 95%, and p-values of ≤0.005 were considered statistically significant. RESULTS: Only 9.5% of the patients showed oral brown spots. Histopathologically, 100% of the oral macules showed characteristics of oral pigmentation by drug and 100% ophthalmological parameters of normality. Two patients presented with a diagnosis of pre-retinopathy, but none showed oral lesions. CONCLUSION: Hyperpigmented macules in the buccal mucosa in lupus patients receiving antimalarial treatment are not frequent and do not represent a predictive finding of toxicity of the drug.

Odontogenic cutaneous sinus tracts due to infection with nontuberculous mycobacteria: a report of three cases.

BACKGROUND: Soft tissue or skin infections due to nontuberculous mycobacteria (NTM) have been reported frequently and are mostly associated with trauma or cosmetic interventions like plastic surgery. However, infection with NTM as a result of a dental procedure have rarely been described and the lack of clinical suspicion and a clear clinical manifestation makes diagnosis challenging. CASE PRESENTATION: We report on three patients with a facial cutaneous sinus tract of dental origin, due to an infection with respectively Mycobacterium fortuitum, M. abscessus and M. peregrinum. The infection source was the dental unit waterlines (DUWLs), which were colonized with NTM. CONCLUSIONS: Water of the DUWL can pose a health risk. This report emphasizes the need for quality control and certification of water flowing through DUWLs, including the absence of NTM. Our report also shows the need for a rapid recognition of NTM infections and accurate laboratory diagnosis in order to avoid long-term ineffective antibiotic treatment.

The CILAD, a model of an international dermatologic society, united by geographic, linguistic, and cultural nexus.

The Ibero Latin American College of Dermatology, CILAD, the largest dermatologic organization in the region, was established in 1948 during the course of the V International Congress of Leprosy held in Havana, Cuba. Constituted in its beginning with fewer than 100 dermatologists from nine countries, its growth has been exponential, reaching now around 4000 members spread throughout Latin America, the Iberian Peninsula, and other regions of the world. In recent years, academic activity has been intense, such as the development of several institutional programs, like its community health care program, designed for geographic areas lacking dermatologic care in the Latin American region. This contribution presents a review of its history, noting the dermatologists and personalities who ennoble the institution. The multiple areas of interest of this growing dermatologic organization are described, and the projections toward the future are discussed.

Psoriasis in Latin America.

During the last few decades, management of psoriasis has changed worldwide, owing to a better understanding of its pathophysiology and the introduction of new treatments. As experts in the field of dermatology, specialists from Latin America collaborated to develop this review and further provide an update on the current state of psoriasis management in Latin America. With the goal of summarizing the latest information on psoriasis in most countries in Latin America, we conducted a literature search to obtain relevant articles published in the medical/scientific literature in Latin American countries over the last 10 years; in addition, we completed a questionnaire comprised of 20 questions on important issues related to psoriasis. The aim of this final document isto help improve understanding and management of the disease and to help patients gain better access to new approaches and medical solutions.

The diagnosis of two cases of cutaneous ulcer caused by infection with Mycobacterium haemophilum: direct identification in a clinical sample by polymerase chain reaction-restriction endonuclease analysis.

BACKGROUND: Mycobacterium haemophilum was first recovered from subcutaneous lesions of a patient with Hodgkin's disease. Because of its special growth requirements (it grows at 30-32 degrees C and requires iron-supplemented medium), the organism cannot be isolated using routine culture techniques for other mycobacteria. Only a few developed countries have reported infection with this mycobacterium. We report the first two cases diagnosed in Venezuela. METHODS: The diagnosis of the first case was established using polymerase chain reaction (PCR)-restriction endonuclease analysis of the gene encoding the 65-kDa heat shock protein (hsp65) for the direct identification of M. haemophilum in a clinical specimen in which bacilli were observed on acid-fast smear, but growth was not detected by standard culture procedures. RESULTS: After recognizing this bacterium as a possible cause of infection in our setting, clinical samples of cutaneous lesions were routinely cultured on blood agar at 30 degrees C for at least 6 weeks, which resulted in the diagnosis of the second case. CONCLUSIONS: Dermatologists should consider this bacterium in immunocompromised patients with cutaneous ulcerating lesions. Material from the lesions can be screened for mycobacteria using an acid-fast stain and, if acid-fast bacilli are seen, PCR analysis of mycobacterial hsp65 can be an effective tool for early diagnosis. Appropriate culture methods are required for bacteriologic confirmation of infection with M. haemophilum.

[Soft-tissue infections due to non-tuberculous mycobacteria following mesotherapy. What is the price of beauty]. / Infecciones en tejidos blandos por micobacterias no tuberculosas secundarias a mesoterapia. 'Cuánto vale la belleza?

INTRODUCTION: Mesotherapy is widely used In Latin America for cosmetic purposes, particularly in obese individuals. We describe the clinical and epidemiological characteristics, microbiological diagnosis, treatment and follow-up of patients from Caracas (Venezuela) with soft tissue infection caused by non-tuberculous mycobacteria following mesotherapy. METHODS: Between March 2002 and December 2003, we evaluated 49 cases of skin and soft tissue infection following mesotherapy. Specimens obtained from the lesions and 15 products used in the mesotherapy procedure were cultured for the presence of non-tuberculous mycobacteria. Isolated mycobacteria were identified by PCR restriction fragment length polymorphism analysis of the hsp65 gene. RESULTS: Infection by non-tuberculous mycobacteria was confirmed in 81.6% of the 49 cases. Mycobacterium abscessus and M. fortuitum were the most common species, but M. chelonae, M. peregrinum, M. simiae and a new species that was designated "M. cosmeticum" were also isolated. Patients were treated with species-specific antibiotic agents for 3 to 18 months. Investigation into the source of the infection revealed that 21 patients were clustered within 3 different outbreaks and two products were found to be contaminated with M. fortuitum and M. abscessus, respectively. CONCLUSIONS: Physicians should be alerted to the possibility of infection by non-tuberculous mycobacteria in patients with a history of mesotherapy who develop late-onset skin and soft tissue infection, particularly if they do not respond to conventional antibiotic treatment.

Infecciones en tejidos blandos por micobacterias no tuberculosas secundarias a mesoterapia. ¿Cuánto vale la belleza? / Soft tissue infections due to non-tuberculous mycobacteria following mesotherapy. What is the price of beauty?

Introducción. La mesoterapia se utiliza mucho en Latinoamérica con fines cosméticos, especialmente en pacientes con obesidad. En este estudio se describen las características clínicas y epidemiológicas, el diagnóstico microbiológico, el tratamiento y el seguimiento de infecciones por micobacterias no tuberculosas en un grupo de pacientes en Caracas (Venezuela) con antecedentes de mesoterapia. Metodología. Entre marzo de 2002 y diciembre de 2003 se evaluaron 49 pacientes con infección en la piel y tejidos blandos secundaria a mesoterapia. Se tomaron muestras de las lesiones para el aislamiento de micobacterias y se elaboró una ficha clínica. Además, se analizaron 15 productos utilizados en mesoterapia. Las micobacterias aisladas fueron identificadas a través del polimorfismo de fragmentos de restricción del gen hsp65. Resultados. De los 49 pacientes evaluados, en el 81,6% se confirmó una infección por micobacterias no tuberculosas. Las especies más comunes fueron Mycobacterium abscessus y M. fortuitum pero también se aislaron M. chelonae, M. peregrinum, M. simiae y una nueva especie que fue designada M. cosmeticum. Los pacientes recibieron tratamiento específico para cada especie durante un período de 3 hasta 18 meses. La investigación de la fuente de infección reveló que 21 pacientes estaban agrupados en tres brotes y se encontraron dos productos contaminados, uno con M. fortuitum y otro con M. abscessus. Conclusiones. Los médicos deben estar atentos ante aquellos pacientes con antecedentes de mesoterapia que desarrollen tardíamente lesiones en piel y tejidos blandos, que no respondan al tratamiento antimicrobiano convencional, ya que éstas podrían ser causadas por micobacterias no tuberculosas (AU)

Introduction. Mesotherapy is widely used In Latin America for cosmetic purposes, particularly in obese individuals. We describe the clinical and epidemiological characteristics, microbiological diagnosis, treatment and follow-up of patients from Caracas (Venezuela) with soft tissue infection caused by non-tuberculous mycobacteria following mesotherapy. Methods. Between March 2002 and December 2003, we evaluated 49 cases of skin and soft tissue infection following mesotherapy. Specimens obtained from the lesions and 15 products used in the mesotherapy procedure were cultured for the presence of non-tuberculous mycobacteria. Isolated mycobacteria were identified by PCR restriction fragment length polymorphism analysis of the hsp65 gene. Results. Infection by non-tuberculous mycobacteria was confirmed in 81.6% of the 49 cases. Mycobacterium abscessus and M. fortuitum were the most common species, but M. chelonae, M. peregrinum, M. simiae and a new species that was designated "M. cosmeticum" were also isolated. Patients were treated with species-specific antibiotic agents for 3 to 18 months. Investigation into the source of the infection revealed that 21 patients were clustered within 3 different outbreaks and two products were found to be contaminated with M. fortuitum and M. abscessus, respectively. Conclusions. Physicians should be alerted to the possibility of infection by non-tuberculous mycobacteria in patients with a history of mesotherapy who develop late-onset skin and soft tissue infection, particularly if they do not respond to conventional antibiotic treatment (AU)

Paracoccidioidomicosis: presentación inusual / Paracoccidioidomycosis: unusual presentation

La paracoccidioidomicosis es una micosis sistémica producida por un hongo multigemante, Paracoccidioides brasiliensis, endémica en muchos países de la región tropical y subtropical. Descrita por primera vez en Brasil en 1905 por Adolfo Lutz, el primer reporte en Venezuela fue hecho por O'Daly y Guerra en el año 1937. Se presenta el caso de un paciente masculino de 59 años de edad natural y procedente de la ciudad de Caracas, de profesión ingeniero petrolero, con antecedentes de enfermedad pulmonar obstructiva crónica y dislipidemia severa, quien refiere enfermedad actual de ocho meses de evolución caracterizada por lesiones bien cirscuncritas de apariencia verrugosa en cuello lateral izquierdo cara plantar de primer dedo de pie izquierdo. Recibió tratamiento de la lesión del dedo del pie con crioterapia y blenoxane intralesional en varias oportunidades sin resolución de la misma La biopsia excisional de la lesión del cuello reportó granuloma por agente vivo. El estudio directo con KOH, cultivo e histopatología de la lesión del pie y la serología fueron compatible con Paracoccidioidomicosis. Recibió tratamiento con itraconazol a dosis de 200mg diarios por cuatro meses con excelente respuesta clínica y ausencia de efectos adversos. Se presenta el caso por lo inusual de la presentación clínica, en un paciente con profesión y procedencia no frecuentemente relacionada con la infección por Paracoccidioides brasiliensis

Granuloma periungueal en los primeros dedos de los pies en pacientes bajo tratamiento antiretroviral / Periungueal granuloma in big toes of patients under treatment for AIDS

Presentamos tres casos de hombres con SIDA tratados con zidovudine, lamivudine e indinavir. Estos pacientes desarrollaron granulomas periungueales en los dedos gordos de ambos pies. No encontramos datos específicos de valor etiológico en la histopatología ni en los cultivos para bacterias usuales, microbacterias ni hongos. Consideramos que estos hallazgos pueden considerarse como efectos colaterales del tratamiento antiretroviral

Se deben considerar a los queratoacantomas carcinomas espinocelulares bien diferenciados: presentación de dos nuevos casos / They should be considered the queratoacantomas carcinomas well differentiated espinocelulares: presentation of two new cases

Los queratoacantomas son considerados como lesiones autolimitadas que, usualmente se presentan en personas mayores como pápulas o placas queratóticas en áreas expuestas al sol, con evidente daño actínico, incluyendo elastosis solar, queratosis o lentigo. En la mayoría de los casos presentan un curso indolente, describiéndose inclusive regresión espontánea sin tratamiento. Desde el punto de vista histológico, los queratoacantomas presentan en su mayoría, características similares a los carcinomas espinocelulares bien diferenciados, incluyendo la atipia celular figuras mitóticas atípicas, células disqueratóticas y perlas córneas. Razón por la cual la mayoría de los autores, coinciden en la estrecha relación que guardan con los carcinomas espinocelulares. A pesar de su comportamiento autolimitado, hay informes de casos en donde han ocurrido metástasis, por lo que algunos autores los han denominado "queratoacantomas metastizantes". En muchos de estos casos, los cortes histológicos de las lesiones primarias han sido revisadas y, retrospectivamente interpretadas como carcinomas espinocelulares. En este trabajo se presentan dos nuevos casos (en donde el diagnóstico inicial tanto clínico como histológicos fue el queratoacantoma), los cuales evolucionaron a carcinoma espinocelular, con desarrollo de metástasis en uno de ellos. Se plantean y discuten las, posibles hipótesis que pudiesen explicar esta controversia

Mastocitos en dermatofibromas de pacientes con lupus eritematoso sistémico / Mast cells in dermatofibroma in patients with lupus systemic erythematosus

Los dermatofibromas múltiples (DFM) han sido descritos en varios desórdenes autoinmunes, especialmente en pacientes con Lupus eritematoso sistémico (LES) o bajo terapia inmunosupresora. Para investigar el papel de los mastocitos en la formación de los DFM asociados a enfermedades autoinmunes, se cuantificó su número en diez lesiones procedentes de cuatro pacientes con LES. Se concluye que el número de mastocitos en los deramtofibromas (DF) se correlacionan con el tiempo de evolución, estando aumentado en los DF recientes y disminuidos en los antiguos. En DFM el número de mastocitos es mayor que los DF solitarios, lo que sugiere que la proliferación reactiva en los casos múltiples es mayor

Terapéutica dermatológica 1995-1996: parte 1 / The therapeutics dermatological 1995-1996: aprt 1

Se revisa la literatura Internacional de Terapéutica Dermatológica correspondiente a los años 1995-1996, seleccionando un grupo de bibliografía que consideramos de interés

Terapéutica dermatológica 1995-1996: parte II / Therapeutics dermatological 1995-1996: part II

Se revisa la literatura internacional de Terapéutica Dermátologica correspondiente a los años 1995-1996, seleccionando un grupo de bibliografía que consideramos de interéz

Epidemiología de la tunga penetrans en Venezuela / Epidemiology of the tunga penetrants in Venezuela

La tungiasis es una condición inflamatoria de la piel producida por la infestación parasitaria cutánea de la pulga Tunga penetrans. Se considera la pulga más pequeña conocida (1 mm.) y se describe ampliamente distribuida en los trópicos. El objetivo de esta presentación fue determinar su presencia en el territorio nacional y determinar la importancia así como las consecuencias que tiene su presencia tanto a nivel de los servicios de salud como en la comunidad. En los resultados la encontramos ampliamente distribuida en todo el territorio a predominio de zonas de abundante arena y en cochineras. Las comunidades que sufren los mayores estragos son las poblaciones indígenas del Amazonas quienes como única medida de librarse de su presencia, en ocasiones (cuando se ven masivamente infectada por la pulga), se han visto obligadas a abandonar el chabono. Se discute el ciclo de vida, la distribución mundial, hábitat, así como el tratamiento y las medidas profilácticas

Inmunofenotipos leucocitarios en el vitiligo / Leukocitaries immunophenotipes at the vitiligo

El vitiligo es una enfermedad pigmentaria, que afecta al sistema melanocítico y acarrea como consecuencia la no producción de melanina, definido clínicamente como máculas acrómicas. En el presente se evaluaron los distintos inmunofenotipos que participan en esta patología. Para ello se emplearon diversos anticuerpos monoclonales utilizando la técnica de inmunoperoxidasa. En este contexto, se estudiaron 10 pacientes con vitiligo, excluyendo otras enfermedades hipomelanocíticas. Las biopsias fueron congeladas en nitrógeno líquido y cortadas en un criomicrotomo (3-4) micromicras de espesor) y posteriormente cuantificados los siguientes anticuerpos monoclonales: CD4, CD8, CD1, ICAM-1, alfa-beta y gamma-delta. Los resultados obtenidos muestran una elevada densidad de células mononucleares que expresan en fenotipo CD4+, CD8+, CD1+, y alfa-beta en comparación con otros trabajos previos realizados en piel normal. El incremento de células de Langerhans (mayor o igual 1433 cel/mm2), como células presentadoras de antígeno y accesorias de la piel, podría jugar un papel importante en el control de la generación de la respuesta inmune cutánea. Por otro lado, los linfocitos T que expresan fenotípicamente CD4+ y CD8+, mostraron una acumulación selectiva hacia la zona basal y la relación CD4/CD8 en los infiltrados fue de 1,38 considerado dentro de los valores normales. Por otro lado la expresión del ICAM-1 por los queratinocitos en la epidermis (n=8 de un total de 10), sugiere un estado pro-inflamatorio que puede contribuir con la patología de la enfermeda