Angiosarcoma irresecable tratado con bevacizumab y paclitaxel / Unresectable Angiosarcoma Treated With Bevacizumab and Paclitaxel

No disponible

Fiebre por mordedura de rata. Un caso en España con lesiones cutáneas características / Rat-bite fever: A case in Spain with skin lesions

No disponible

No disponible

Complications of ambulatory major dermatological surgery in patients older than 85 years.

BACKGROUND: During the last decades, the progressive ageing of the population has resulted in a rising skin cancer incidence. Although previous studies detected no higher morbidity for dermatological surgery in senior patients, their exclusion from optimal surgical treatment remains as a common clinical practice. OBJECTIVE: The aim of this study was to determine the diseases treated with ambulatory major dermatological surgery, the surgical morbidity and the associated variables in ≥ 85 year-old patients. PATIENTS/METHODS: This is an observational study on 247 successive patients older than 85 years of age who underwent dermatological surgery in a single Ambulatory Mayor Surgery unit. Studied variables were age, gender, tobacco-alcohol exposure, co-morbid medical conditions, blood-thinning medication, antibiotic prophylaxis, number of lesions, location, histopathological diagnosis, area of skin removed, surgical technique, type of flap, length of surgery, entrance order, suture thread, surgical complications and need of post-operative admission. RESULTS: The most common site was head and neck (82.7%). The most frequent tumour was basal cell carcinoma (45.1%), followed by squamous cell carcinoma (38.7%) and melanoma (8.3%). Direct closure was the most frequent procedure (55.6%). Of the total number of patients, 7.9% of patients suffered complications; necrosis followed by cellulitis were the most frequent. Length of surgical procedure, area of skin removed and reconstruction with skin-graft were significantly related to higher risk of post-operative complications. CONCLUSIONS: No intra or post-surgical mortality or life-threatening local complications were detected. Most post-surgical local complications appeared after wide excisions and complex reconstruction techniques that prolonged the length of the surgery.

Significado etiopatogénico de una tuberculosis hiperqueratósica cutánea / Pathogenic significance of hyperkeratotic cutaneous tuberculosis

No disponible

No disponible

Hipoplasia dérmica focal unilateral / Unilateral focal dermal hypoplasia

No disponible

No disponible

[Flexural psoriasis induced by infliximab and adalimumab in a patient with Crohn's disease]. / Psoriasis secundaria al tratamiento con infliximab y adalimumab en la enfermedad de Crohn.

Anti-TNF drugs are used increasingly in several diseases with immune-mediated inflammation, not only in rheumatological conditions, but also in inflammatory bowel disease and psoriasis. Different side effects have been described over the last few years, including the development of psoriasis or psoriasiform exanthemas. These drugs began to be used in paediatrics during the 90's, therefore paediatricians need to be aware of the adverse effects that may occur. We describe here a flexural psoriasis induced by both infliximab and adalimumab in a paediatric patient with Crohn's Disease. To the best of our knowledge, this is the first reported paediatric case of psoriasis triggered by an anti-TNF drug, as well as the first case of psoriasis induced by adalimumab in patients with inflammatory bowel disease.

Psoriasis secundaria al tratamiento con infliximab y adalimumab en la enfermedad de Crohn / Flexural psoriasis induced by infliximab and adalimumab in a patient with Crohn & apos; s disease

Los fármacos inhibidores del factor de necrosis tumoral alfa se usan cada vez más frecuentemente en la práctica clínica diaria. Han mostrado su efectividad en el tratamiento de trastornos de base inflamatoria mediada por el sistema inmunitario, principalmente enfermedades reumáticas, pero también en la enfermedad inflamatoria intestinal y en la psoriasis. En los últimos años se han descrito diversos efectos secundarios, entre los cuales se encuentra el desarrollo, que resulta paradójico, de psoriasis o exantemas psoriasiformes. Desde finales de los noventa, la extensión de estos fármacos a la edad pediátrica es un hecho, y es necesario que los pediatras conozcamos los fenómenos adversos que pueden producir. Describimos aquí un caso de psoriasis invertida secundaria al tratamiento con infliximab y adalimumab en un paciente de 13 años con enfermedad de Crohn. Hasta donde llegamos a conocer, se trata del primer caso comunicado en edad pediátrica, así como el primer caso desencadenado por adalimumab en la enfermedad inflamatoria intestinal (AU)

Anti-TNF drugs are used increasingly in several diseases with immune-mediated inflammation, not only in rheumatological conditions, but also in inflammatory bowel disease and psoriasis. Different side effects have been described over the last few years, including the development of psoriasis or psoriasiform exanthemas. These drugs began to be used in paediatrics during the 90’s, therefore paediatricians need to be aware of the adverse effects that may occur.We describe here a flexural psoriasis induced by both infliximab and adalimumab in a paediatric patient with Crohn’s Disease. To the best of our knowledge, this is the first reported paediatric case of psoriasis triggered by an anti-TNF drug, as well as the first case of psoriasis induced by adalimumab in patients with inflammatory bowel disease (AU)

[Chronic graft-versus-host disease presenting as bullous lesions]. / Lesiones ampollosas como forma de presentación de una enfermedad de injerto contra huésped crónica.

Graft-vs-host disease is still the leading cause of morbidity and mortality in patients undergoing bone marrow transplantation. It is important to start treatment early to reduce the severity and consequences of this complication. Cutaneous lesions are often the presenting compliant of graft-vs-host disease and presage visceral involvement. We present the case of a 45-year-old woman with multiple myeloma who underwent autologous and subsequently allogeneic bone marrow transplantation with hematopoietic precursors. She developed bullous lesions with fluid elimination on the abdomen and legs. Biopsy findings were compatible with graft-vs-host disease and immunosuppressive therapy was increased. She subsequently presented oral lichenoid lesions and sicca syndrome. The bullous lesions progressed to painful ulcers that healed leaving highly sclerodermatous skin with substantial hyperpigmentation. Bullous lesions are a rare form of presentation of chronic graft-vs-host disease. In such cases, the diagnosis may not be suspected initially, particularly when the lesions are isolated and internal organs are not involved.

Lesiones ampollosas como forma de presentación de una enfermedad de injerto contra huésped crónica / Chronic graft-versus-host disease presenting as bullous lesions

La enfermedad de injerto contra huésped (EICH) continúa siendo la primera causa de morbilidad y mortalidad en los enfermos con trasplante de médula ósea, de modo que un tratamiento precoz es importante para reducir la gravedad y las consecuencias de esta complicación. Las lesiones cutáneas son en muchas ocasiones la forma de presentación de una EICH y anuncian la afectación visceral. Presentamos el caso de una paciente de 45 años con mieloma múltiple a la que se realizó primero un trasplante autólogo y posteriormente un trasplante alogénico de médula ósea con precursores hematopoyéticos. Desarrolló lesiones ampollosas con eliminación de líquido en el abdomen y los miembros inferiores. Se realizó una biopsia que fue compatible con una EICH y se aumentó el tratamiento inmunodepresor. La paciente posteriormente presentó lesiones liquenoides orales, síndrome seco y las lesiones ampollosas que evolucionaron a úlceras dolorosas, que cicatrizaron con un intenso aspecto esclerodermiforme e importante hiperpigmentación. Las lesiones ampollosas son una forma de presentación excepcional en la EICH crónica, y en estos casos la sospecha inicial del diagnóstico puede ser difícil, sobre todo cuando se presentan de forma aislada sin afectación de órganos internos (AU)

Graft-vs-host disease is still the leading cause of morbidity and mortality in patients undergoing bone marrow transplantation. It is important to start treatment early to reduce the severity and consequences of this complication. Cutaneous lesions are often the presenting compliant of graft-vs-host disease and presage visceral involvement. We present the case of a 45-year-old woman with multiple myeloma who underwent autologous and subsequently allogeneic bone marrow transplantation with hematopoietic precursors. She developed bullous lesions with fluid elimination on the abdomen and legs. Biopsy findings were compatible with graft-vs-host disease and immunosuppressive therapy was increased. She subsequently presented oral lichenoid lesions and sicca syndrome. The bullous lesions progressed to painful ulcers that healed leaving highly sclerodermatous skin with substantial hyperpigmentation. Bullous lesions are a rare form of presentation of chronic graft-vs-host disease. In such cases, the diagnosis may not be suspected initially, particularly when the lesions are isolated and internal organs are not involved (AU)

Outpatient dermatology major surgery: a 1-year experience in a Spanish tertiary hospital.

INTRODUCTION: The constant increase in the incidence of skin cancer together with the requirement for maximum exploitation of available medical resources has meant that dermatological major surgery on an outpatient basis has greatly increased in recent years. OBJECTIVE: This article reviews the practice of dermatological surgery in an outpatient setting over a 1-year period. Its purpose is to analyse the number of surgical procedures, the type of cutaneous processes treated and the kind of surgical intervention and anaesthesia used. We also assessed the percentage of cancellations, postsurgical hospital admission and postsurgical complications. Clinicopathological correlation and complete tumour removal were also evaluated. MATERIAL AND METHODS: Our clinical experience of major surgery of outpatients at the dermatology department of the Hospital Juan Canalejo in A Coruña (Spain), analysing 565 patients in a non-randomized pilot study running from January to December 2003, is presented. RESULTS: Six hundred and forty-four surgical procedures were performed on a total of 565 patients. The three main cutaneous processes treated were basal cell carcinoma (240), squamous cell carcinoma (117) and melanoma (77). The most frequent type of procedure was direct closure (346), followed by exeresis and flap (133) and partial- or full-thickness skin graft (29), nail apparatus surgery (56) and lip surgery (33). Twelve patients were admitted to hospital after surgery owing to the complexity of their operations or to complications arising during surgery. Five hundred and fifty-three patients were discharged after being kept under observation for a few hours. Seventeen patients (3%) suffered complications following surgery, which consisted of partial implant failure (six cases), infection of the surgical wound (six cases), intense pain (four cases) and haemorrhage (one case). There was a good clinicopathological correlation in 90.78% of non-melanoma skin cancers, of which 92.03% were completely removed. CONCLUSIONS: Medium and high complexity operations for dermatological processes, traditionally performed on hospitalized patients, can be conducted on an outpatient basis. This allows hospitalization costs and waiting lists to be reduced and affords the possibility of achieving better morbidity rates and medical care than in the standard hospital setting.

Paciente con VIH, fiebre y lesiones cutáneas / HIV patient, fever and skin lesions

No disponible

Acne is not a stigma of HIV infection: a review of 36 patients.

INTRODUCTION: Several diseases with follicular occlusion have been described in HIV-infected patients and can appear isolated or associated with each other in an independent disease named 'HIV-associated follicular syndrome'. Worsening of cutaneous lesions during the course of infection in patients with previous acne vulgaris, late onset or severe forms of acne have been reported in HIV-infected patients. PATIENTS AND METHODS: A prospective study of 335 HIV-infected patients was performed in our hospital. A meticulous dermatological exploration in all patients was made, and multiple data were stored into a Microsoft Access 97 program. Patients diagnosed as having acne were considered separately, and we studied their characteristics. A statistical analysis with SPSS 9.0 (Statistical Package for the Social Sciences) was performed. RESULTS: Thirty-six patients (10.8%) were diagnosed as having acne. Papulopustular lesions were the most frequent clinical presentation. Most lesions were localized on the face or on the back, and 80% of patients had mild to moderate acne; 40% of them required no treatment and the remainder was treated with topical measures, oral antibiotics and isotretinoin. 85% of cases reported the onset of acne during adolescence or before HIV infection and without any relationship with this disease. No relation between acne intensity and stage of HIV infection was observed. A multivariate analysis showed that the most important variable was age. DISCUSSION: In contrast to previous reports, no greater intensity or modifications in acne lesions were observed in our HIV-infected patients during the course of the disease. In the majority of cases, cutaneous lesions started before HIV infection, during adolescence, and the most important factor for suffering from acne was young age. In contrast to data reported in the literature, no relation of acne lesions to CD4 lymphocyte count or AIDS case criteria was found in our patients. CONCLUSIONS: Acne in HIV-infected patients has characteristics similar to those in non-HIV-infected patients. The age is the most important factor for the appearance of lesions that usually develop during adolescence. Acne lesions are not modified by HIV infection, and no relationship with the severity of HIV infection has been observed.

Fixed drug eruption from piroxicam.

The pathogenetic mechanism of fixed drug eruption (FDE) is still unknown. One of the most common causes of FDE is the use of nonsteroidal antiinflammatory drugs (NSAIDs). Oxicams are in the NSAID group and piroxicam is one of the most used of these drugs. FDE caused by piroxicam is rare but a few cases have been reported. Patch tests are useful for diagnosing some cases of FDE; they give variable results on previously affected skin while no reaction appears on unaffected skin. Some cases of cross-sensitivity among piroxicam and other substances have been reported. We report two new cases of FDE due to piroxicam with negative patch test on normal skin and positive results on affected skin.