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.

Nodular fasciitis, a forgotten entity.

BACKGROUND: Nodular fasciitis is a benign pseudosarcomatous, self-limited, and reactive process. Based on its clinical and histological features - a fast-growing, solitary tumor with high cellularity and mitotic count - nodular fasciitis is considered to be a benign mimic of sarcoma. METHODS: We present four cases of nodular fasciitis and a review of the literature. RESULTS: The cases we present were initially misdiagnosed as sarcoma; two as dermatofibrosarcoma protuberans, one as atypical fibroxanthoma, and one as leiomyosarcoma. CONCLUSION: Awareness of this entity among dermatologists is important as misdiagnosis may lead to unnecessary treatments associated with increased morbidity.

Cofilin-1 levels and intracellular localization are associated with melanoma prognosis in a cohort of patients.

Melanoma is an aggressive cancer with highly metastatic ability. We propose cofilin-1, a key protein in the regulation of actin dynamics and migration, as a prognostic marker. We determined cofilin-1 levels in a retrospective cohort of patients with melanomas and benign lesions of melanocytes (nevi) by immunohistochemistry. Higher cofilin-1 levels were found in malignant melanoma (MM) with Breslow Index (BI)>2 vs MM with BI<2, melanoma in situ (MIS) and nevi and also in MM with metastasis vs MM without detected metastasis. Kaplan-Meier survival curves were performed, clustering patients according to either the type of melanocytic lesions or cofilin-1 level. Survival curves demonstrated worse prognosis of patients with high vs low cofilin-1 levels. TCGA database analysis of melanoma also showed low survival in patients with upregulated cofilin-1 mRNA vs patients without alteration in CFL1 mRNA expression. As cofilin-1 has a dual function depending on its intracellular localization, we evaluated nuclear and cytoplasmic levels of cofilin-1 in melanoma and nevi samples by immunofluorescence. MM with high Breslow index and metastatic cells not only presented cytoplasmic cofilin-1, but also showed this protein at the nucleus. An increase in nuclear/cytoplasmic cofilin-1 mean fluorescence ratio was observed in MM with BI>2 vs MM with BI<2, MIS and nevi. In conclusion, an association of cofilin-1 levels with malignant features and an inverse correlation with survival were demonstrated. Moreover, this study suggests that not only the higher levels of cofilin-1, but also its nuclear localization can be proposed as marker of worse outcome of patients with melanoma.

Daylight Photodynamic Therapy Versus 5-Fluorouracil for the Treatment of Actinic Keratosis: A Case Series.

INTRODUCTION: The incidence of actinic keratosis (AK) continues to increase worldwide. Currently available options for the treatment of AK include topical 5-fluorouracil (5-FU) and daylight-mediated photodynamic therapy (DL-PDT). This split-face pilot study compared DL-PDT using 16% methyl aminolevulinate (MAL) cream versus 5-FU cream in patients with AK on the face/scalp. METHODS: Five male subjects (mean age 70 years) with grade I-III AK on the face/scalp were enrolled. Subjects received a single session of DL-PDT with 16% MAL on one side and topical 5% 5-FU for 21 days on the other side. Evaluations of efficacy, safety, and subject satisfaction were conducted 48 h, 7 days, 14 days, 1 month, and 3 months after treatment. RESULTS: At 3 months, the lesion complete response rate was 80% and 93% for DL-PDT and 5-FU, respectively. Lesion partial response was 20% and 7%, respectively. Fewer treatment-related adverse events (AEs) were reported with DL-PDT than with 5-FU, and they resolved spontaneously in 5-7 and 27-30 days, respectively. Subjects preferred DL-PDT because of the lower incidence of AEs and rapid recovery compared with 5-FU. CONCLUSION: DL-PDT is a convenient alternative to 5-FU with good efficacy and a favorable safety profile, allowing patients to effectively treat their AK without compromising their social life. FUNDING: Galderma.

Calcipotriol as pretreatment prior to daylight-mediated photodynamic therapy in patients with actinic keratosis: A case series.

This split-face design study evaluated the effect of pretreatment with calcipotriol prior to daylight-mediated photodynamic therapy (DL-PDT) in patients with actinic keratosis (AK). The study included 11 subjects with grade I-III AK (mean age: 55 years). Subjects used once-daily calcipotriol 50 mcg/g ointment on half the face/scalp for 15 days prior to DL-PDT. Evaluations of efficacy, safety and subject satisfaction were conducted 48 h and 7 days after treatment, and at 1- and 3-month follow-ups. Three months after treatment with calcipotriol/DL-PDT and DL-PDT alone, the complete response rate was 85% and 70%, respectively. The partial response rate was 12% and 25%, respectively. During calcipotriol pretreatment, 6 subjects reported erythema and moderate desquamation. In 7 subjects, calcipotriol/DL-PDT was associated with more marked erythema than that observed with DL-PDT alone. Eight subjects reported they preferred DL-PDT alone due to the inconvenience caused by the daily application of calcipotriol and the related erythema and desquamation. Although calcipotriol improved the efficacy of DL-PDT, it may not be applicable to all patients. DL-PDT is a simpler, safer and more convenient option than conventional-PDT. Therefore, the use of additional agents prolonging the course of treatment and increasing cost may diminish the advantages currently offered by DL-PDT.

Structured Expert Consensus on Actinic Keratosis: Treatment Algorithm Focusing on Daylight PDT.

BACKGROUND: A practical and up-to-date consensus among experts is paramount to further improve patient care in actinic keratosis (AK). OBJECTIVES: To develop a structured consensus statement on the diagnosis, classification, and practical management of AK based on up-to-date information. METHODS: A systematic review of AK clinical guidelines was conducted. This informed the preparation of a 3-round Delphi procedure followed by a consensus meeting, which combined the opinions of 16 clinical experts from 13 countries, to construct a structured consensus statement and a treatment algorithm positioning daylight photodynamic therapy (dl-PDT) among other AK treatment options. RESULTS: The systematic review found deficiencies in current guidelines with respect to new AK treatments such as ingenol mebutate and dl-PDT. The Delphi panel established consensus statements across definition, diagnosis, classification, and management of AK. While the diagnosis of AK essentially rests on the nature of lesions, treatment decisions are based on several clinical and nonclinical patient factors and diverse environmental attributes. Participants agreed on ranked treatment preferences for the management of AK and on classifying AK in 3 clinical situations: isolated AK lesions requiring lesion-directed treatment, multiple lesions within a small field, and multiple lesions within a large field, both requiring specific treatment approaches. Different AK treatment options were discussed for each clinical situation. CONCLUSIONS: The results provide practical recommendations for the treatment of AK, which are readily transferable to clinical practice, and incorporate the physician's clinical judgement. The structured consensus statement positioned dl-PDT as a valuable option for patients with multiple AKs in small or large fields.

Proposal for management and dermoscopy follow-up of nevi in patients affected by oculocutaneous albinism type Ia.

Albino patients are at great risk for developing cutaneous neoplasms, including melanomas. In this paper we describe the dermatoscopic findings of nevi in two patients with oculocutaneous albinism type Ia (OCA-Ia) highlighting that they manifest a vascular pattern similar to that described for amelanotic melanoma. We propose managing these patients with dermoscopy, using the comparative approach, digital follow up (DFU), and reflectance confocal microscopy as a complementary tool for difficult cases.

Serie parasitosis en dermatología. Miasis: diferentes formas de presentación clínica / Parasitic series in dermatology. Myiasis: different forms of clinical presentation

La miasis es una infestación por larvas en desarrollo de una gran variedad de moscas del orden Díptera. Según el sitio de invasión, se clasifica en miasis cavitarias, que pueden deberse a invasión de cavidades naturales o de heridas, y miasis forunculoide, cuando atraviesa piel indemne. Esta infestación presenta una distribución mundial, con variaciones estacionales en relación con la latitud geográfica y el ciclo de vida de distintas especies de moscas. Presentamos una serie de tres casos de pacientes con distintas formas clínicas de manifestación de miasis. (AU)

Myiasis is the tissue infestation by a variety of Diptera order larvae flies. According to the invasion site, they are classified in myiasis of cavities, which can be because of an invasion of natural cavities or wounds, and furuncular myiasis, when they invade through intact skin. This infestation has a worldwide distribution, with seasonal variations in relation to the geographic latitude and the life cycle of different species of flies. We present three cases of patients with different clinical forms of presentation of myiasis. (AU)

Nuevas posibilidades terapéuticas en melanoma metastásico / Novel therapeutics possibilities for metastatic melanoma

El melanoma ha experimentado un aumento constante en su tasa de incidencia en las últimas cinco décadas a nivel mundial. El pronóstico del paciente con melanoma se relaciona con el estadio de la enfermedad al momento del diagnóstico, con una sobrevida global media de 6,2 meses en pacientes con melanoma metastásico. El avance en las investigaciones sobre la biología y el comportamiento tumoral permitió el desarrollo de nuevas terapias con distintos mecanismos de acción y mayor eficacia. En esta revisión se abordan las terapias biológicas en melanoma metastásico, su mecanismo de acción y principales resultados en ensayos clínicos. (AU)

Melanoma has experienced a consistent increase in incidence over the past five decades worldwide. The prognosis of patients with melanoma is related to the stage of disease at diagnosis, with a median overall survival of 6.2 months in metastatic melanoma. Progress in research on tumor biology allowed the development of new therapies with different mechanisms of action and greater efficiency. In this review, biologic therapies in metastatic melanoma, its mechanism of action and main results in clinical trials are discussed. (AU)

Feasibility of daylight-mediated photodynamic therapy for actinic keratosis throughout the year in Central and South America: a meteorological study.

BACKGROUND: Daylight-mediated photodynamic therapy (DL-PDT) is an efficacious treatment option for thin actinic keratosis (AK) that offers advantages over conventional PDT in terms of tolerability, treatment duration, and cost. A clinical study conducted in Australia determined the mean irradiance during a 2-hour exposure to be 305.8 W/m(2) (range: 40-585 W/m(2) ). The protoporphyrin IX light dose is influenced by latitude, weather conditions, and time of year. A recent study of meteorological data concluded that DL-PDT can be performed effectively throughout the year in Australia. OBJECTIVES: Based on the same hypothesis and applying the same methodology, the present study investigated the suitability of daylight to perform DL-PDT in Central and South America. METHODS: Solar radiation and weather data were gathered and analyzed to assess daylight irradiance (light intensity) throughout a full year across 32 geographical locations in Central and South America. RESULTS: The minimum average daily solar irradiance reported was above 305.8 W/m(2) in all locations investigated throughout the year. Annual averages of daily irradiance ranged from 578 W/m(2) in Chihuahua, Mexico, to 321 W/m(2) in Puerto Montt, Chile. CONCLUSIONS: Daylight-mediated PDT for AK can be performed effectively throughout the year in Central and South America given that weather conditions permit a comfortable 2-hour direct exposure to daylight.

Daylight-mediated photodynamic therapy for actinic damage in Latin America: consensus recommendations.

Although conventional photodynamic therapy (c-PDT) using methyl aminolevulinate cream (MAL) is effective for the treatment of grade I-II facial and scalp actinic keratosis (AK), it is associated with treatment-related pain for some patients. Daylight-mediated PDT (DL-PDT) has shown similar efficacy to c-PDT, was nearly painless, and was well tolerated. Overall, DL-PDT effectively treats AK and offers a simpler and better tolerated treatment option than c-PDT. This consensus panel provided recommendations on the use of DL-PDT in Latin America (LATAM) for the treatment of actinic damage associated with few or multiple AKs. The panel was comprised of eight dermatologists from different LATAM countries who have experience using PDT for the treatment of actinic damage. The panel reviewed the relevant literature and provided personal expertise with regard to using DL-PDT for the treatment of photodamage with or without AK. The recommendations formulated by the expert panel provide evidence-based guidelines on all aspects of DL-PDT for the treatment of actinic damage associated with AK in different regions of LATAM. These recommendations provide guidance for dermatologists to ensure maintenance of efficacy and safety of DL-PDT when treating actinic damage, associated with few or multiple AKs in sun-exposed skin.

Técnica simple para extracción de quiste triquilemal en consultorio / Simple technique for the extraction of trichilemmal cyst in the private

Los quistes triquilemales o pilares, se presentan en segundo orden de frecuencia, luego de los epidérmicos o epidermoides. Suelen ser esporádicos o familiares de herencia autosómica dominante, múltiples y de inicio en edades tempranas. Se trata de lesiones usualmente localizadas en cuero cabelludo.La extracción de quistes triquilemales constituye el 15% de las intervenciones quirúrgicas en dermatología. Los pacientes solicitan su extirpación por motivos estéticos o por molestias locales cuando los mismos alcanzan cierto tamaño. En este trabajo se describe una técnica simple y práctica para extracción de estas lesiones en el consultorio dermatológico. La misma simplifica los cuidados posteriores y evita la extracción engorrosa de puntos de sutura en área pilosa...

Utilidade do retalho de avanço e rotação para fechamento de defeitos cutâneos na região malar / Usefulness of rotation and advancement flap for the closure of skin defects in the malar region

Apresenta-se retalho de avanço e rotação que pode ser utilizado para a reconstrução de defeitos cirúrgicos localizados na região malar. O desenho se resume num triângulo contendo o defeito em que uma linha desce paralela à lateral do nariz, acompanhando o sulco nasogeniano; outra se inicia no mesmo ponto e segue as linhas dinâmicas da região malar. Para finalizar, executa-se um triângulo de Burow no final do sulco. A força de tensão final se dá sobre a parede nasal evitando o ectrópio, e o reposicionamento da gordura malar devolve o contorno da região.

The present study introduces an advancement and rotation flap that can be used for the reconstruction of surgical defects located in the malar region. The design is essentially a triangle containing the defect, where one line runs parallel to the lateral part of the nose along the nasolabial fold, while another starts at the same point and follows the dynamic lines of the malar region. In order to complete the geometrical shape of the flap, a Burow's triangle is performed at the end of the fold. The final tension force occurs on the nasal wall, preventing ectropion. The repositioning of the malar fat restores the contour of the region.

Colgajo de avance: doble triángulo de Burow. Una opción para cierres de defectos faciales / BurowÆs triangle: on the options on facial defects

La dermatología quirúrgica requiere conocimientos anatómicos y técnicos por parte del dermatólogo, el cual dispone de diversas herramientas para el cierre de defectos posquirúrgicos. Dentro de éstas se encuentran los cierres primarios, colgajos, injertos y cierres por segunda intención. Nos referiremos en el presente trabajo al doble triángulo de Burow y sus indicaciones faciales, como parte de los colgajos de avance que resuelven de forma sencilla defectos posquirúrgicos. (AU)

Dermatologic surgery requires anatomical and technical knowledge from thedermatologist, having several options for post surgical closure. Among whichare: flaps, grafts, primary and secondary closure.In this paper we discuss Burow´s double triangle and its facial indications as partof the advancement flaps, which solves easily post-surgical defects.(AU)

Colgajo de avance: doble triángulo de Burow. Una opción para cierres de defectos faciales / Burow’s triangle: on the options on facial defects

La dermatología quirúrgica requiere conocimientos anatómicos y técnicos por parte del dermatólogo, el cual dispone de diversas herramientas para el cierre de defectos posquirúrgicos. Dentro de éstas se encuentran los cierres primarios, colgajos, injertos y cierres por segunda intención. Nos referiremos en el presente trabajo al doble triángulo de Burow y sus indicaciones faciales, como parte de los colgajos de avance que resuelven de forma sencilla defectos posquirúrgicos.

Dermatologic surgery requires anatomical and technical knowledge from thedermatologist, having several options for post surgical closure. Among whichare: flaps, grafts, primary and secondary closure.In this paper we discuss Burow´s double triangle and its facial indications as partof the advancement flaps, which solves easily post-surgical defects.

Outcomes in 11 patients with dermatofibrosarcoma protuberans treated with Mohs micrographic surgery.

BACKGROUND: Dermatofibrosarcoma protuberans (DFSP) is an uncommon intermediate-grade fibrohistiocytic sarcoma. It occurs most often in adults aged 20-50 years and is associated with local invasion and a high recurrence rate. Uncontrolled local disease or metastases may result in death. Treatment has involved wide excision, Mohs micrographic surgery (MMS) and other approaches. The purpose of the current study was to review our experience with MMS in the treatment of patients with DFSP over the past six years. METHODS: We carried out a retrospective chart review for all patients treated with MMS at the Hospital Italiano de Buenos Aires during a six-year period to October 2009. Patient data included age and sex, site, and prior surgical treatment (if any) of the tumor and details of the Mohs procedure. RESULTS: Eleven patients were treated for DFSP. Four (36.4%) patients had been previously treated with a standard wide excision. Three (27.3%) of the 11 tumors were located on the back, four (36.4%) on the upper extremity, one (9.1%) on the lower extremity, and three (27.3%) on the trunk. Mean lesion size at presentation was 5.16 cm(2), and mean defect size was 12.65 cm(2), yielding a difference of 7.49 cm(2) and a ratio (defect size/lesion size) of 2.45. No tumors recurred after MMS. CONCLUSIONS: The recurrence potential of DFSP is directly related to the extent of resection. Mohs micrographic surgery with continuous histological margin control allows for maximum tissue preservation and low recurrence rates and is rapidly emerging as a first-line treatment modality for this condition.

Valor de la tomografía por emisión de positrones en la estadificación de melanoma / Value positron emission tomography in Staging of melanoma

El melanoma es una neoplasia con curso natural agresivo, lo que resalta la importancia del diagnóstico temprano y de una estadificación adecuada como herramientas para alterar la evolución natural de esta enfermedad. Se realizó un estudio retrospectivo con el objetivo de establecer la sensibilidad y la especificidad de la tomografía por emisión de positrones fusionada con tomografía computada (FDG PET/TC) en la estadificación de melanoma. Material y métodos. El estudio incluyó a todos los pacientes con diagnóstico de melanoma evaluados por medio de FDG PET /TC, en el Hospital Italiano de Buenos Aires entre los años 2003 y 2008. Resultados. La FDG PET/TC mostró una sensibilidad del 66% y una especificidad del 54% para la detección de lesiones subclínicas de melanoma. En el melanoma avanzado (estadio IV) se observó una sensibilidad del 85%.Comentario. Se concluye que el estudio con FDG PET/TC es útil para la estadificación y el monitoreo de pacientes en fases avanzadas de la enfermedad...

Melanoma is a highly metastatizising neoplasm of increasing incidencein the last decades. It´s aggressiveness highlights the importance of earlydiagnosis and adequate staging as tools that may alter the natural course of sucha devastating disease. A study was performed in order to establish the sensitivityand specificity of the positron emission tomography/computed tomography(PET/TC) in melanoma.Material and methods: We have undertaken a retrospective analysis of all patientswith diagnosis of melanoma that underwent PET/TC carried out at HospitalItaliano de Buenos Aires since 2003 to 2008.Results: FDG PET/TC shows a sensitivity of 66% with a specificity of 54%. Instage IV melanoma, the sensitivity raises to 85%.Conclusion: We conclude that FDG PET/TC...

Community study of fixed-combination adapalene 0.1% and benzoyl peroxide 2.5% in acne.

A new fixed-dose combination formulation of adapalene 0.1% and benzoyl peroxide (BPO) 2.5% has shown excellent efficacy and safety in registration studies; however, it can be difficult to judge the real-world performance of a product using only the results from controlled clinical trials. This 12-week, open-label, community-based study evaluated adapalene/BPO in 91 patients with mild to moderate acne (20-50 inflammatory lesions and 30-100 noninflammatory lesions) who were treated at dermatology centers throughout Argentina. The study evaluated efficacy, described the most common side effects, determined tolerability, and assessed the level of patient satisfaction with treatment. By week 12, there were statistically significant reductions in both inflammatory and noninflammatory lesions (80.6% and 69.3% from baseline, respectively; P < .001); there were also significant improvements in the Investigator's Global Assessment scores (median score, 2.9 at baseline and 1.0 at week 12; P < .001). By week 12, 67% of patients were rated clear or almost clear by investigators. Local tolerability was good overall. When cutaneous irritation was present, it typically occurred in the first 2 weeks of treatment and improved or resolved with continuing therapy. Patients were highly satisfied with the results of treatment, and 74% of patients felt that they had marked or total improvement by week 12. Patient survey also revealed that 94% rated the efficacy as good or very good and 87.5% rated tolerability as good or very good. A significant majority (81%) felt that the treatment met expectations, and 62% perceived that improvement had been rapid during adapalene/BPO therapy. These results demonstrate that adapalene/BPO has good efficacy and tolerability in routine practice, resulting in continuous reductions in lesion counts throughout the study. Adapalene/BPO therapy is also associated with high patient satisfaction, which is important for therapeutic adherence and satisfaction with the physician's care.

Inmunosupresores y cáncer de piel / Inmunosuppressive drugs and skin cancer

El trasplante de órganos, uno de los avances más sorprendentes de la medicina junto con el desarrollo de agentes inmunosupresores cada vez más eficaces, modificó el curso de enfermedades terminales devastadoras. Sin embargo, esta práctica médica nos enfrenta a una población cada vez más longeva que padece las complicaciones secundarias de la inmunosupresión crónica, necesaria para asegurar la supervivencia del injerto. La elevada incidencia de neoplasias interna y, en particular, cutáneas plantea la necesidad de un manejo interdisciplinario. En este sentido, el médico dermatólogo desempeña un papel protagónico en la prevención, el diagnóstico y el tratamiento de estos procesos malignos.

Disseminated strongyloidiasis in immunocompromised patients--report of three cases.

BACKGROUND: Strongyloides stercoralis is an intestinal nematode of humans. The characteristic cutaneous manifestation of strongyloidiasis is larva currens. Patients with suppressed immunity can develop a severe disseminated strongyloidiasis involving wide spread of the larvae to extraintestinal organs, outside the usual migration pattern. Patients with cell-mediated immunodeficiency and on corticosteroid therapy appear to be at highest risk for the development of this highly fatal entity. METHODS: We present three patients with disseminated strongyloidiasis. All patients were immunocompromised and were undergoing corticosteroid therapy. Physical examination revealed a rapidly progressive purpuric petechial eruption with a reticulated pattern, mainly over the abdomen. RESULTS: The histopathologic findings of the skin biopsies revealed a purpuric lymphomonocytic vasculitis that compromised the superficial dermis. In one skin biopsy, a larva was identified. None of our patients had eosinophilia. Strongyloides stercoralis was isolated in the fluid of the three patients, either before or after they died. CONCLUSION: The risk of disseminated strongyloidiasis in patients with impaired cell-mediated immunity is unknown; however, given the poor prognosis of disseminated strongyloidiasis, consideration should be given to the screening of patients at increased risk of infection.