Mycological profile of tinea capitis in schoolchildren in rural southern Ethiopia.

Tinea capitis is a known common infection among schoolchildren in developing countries that is still underreported in Ethiopia. The aim of this study was to examine the epidemiologic and etiologic profile of tinea capitis among school-aged children in a rural area in southern Ethiopia. We collected demographic and clinicodermatological data from school children aged 3-12 years with tinea infections. Pathologic specimens were taken for potassium hydroxide (KOH) mount and mycological culture. Dermatophyte species were identified by macroscopic examination of the colony and microscopic examination of fungal cultures. A total of 634 schoolchildren were screened in the study; 128 cases were suspected for tinea capitis based on clinical examination of which 99 patients (mean age 6.7 years within a range of 4-12 years), who were subsequently positive, either based on KOH examination or showed growth of dermatophytes on culture, were included in our study. The ratio of males to females was 3:1. A total of 88 patients (89.9%) had a culture positive for dermatophytes. The zoophilic species Trichophyton verrucosum was the most prevalent isolate (n = 29 cases), followed by the anthropophilic species T. tonsurans (n = 27). The other Trichophyton species implicated were T. mentagrophytes (n = 14), as well as T. schoenleinii, T. soudanense, and T. violaceum. Only 11 of the isolates belonged to the genus Microsporum: M. audouinii (n = 8), M. ferrugineum (n = 2), and M. gallinae (n = 1). T. verrucosum, followed by T. tonsurans were the most frequent causative agents in this study.

Reacciones de hipersensibilidad a corticoides / Hipersensitivity Reactions to Corticosteroids

Los corticoides son fármacos ampliamente utilizados en la práctica clínica, especialmente de forma tópica en dermatología. Estas sustancias pueden actuar como alérgenos y producir tanto reacciones de hipersensibilidad inmediata como retardada. La alergia en forma de dermatitis de contacto es la reacción más frecuente, y debe estudiarse mediante pruebas epicutáneas en unidades especializadas. Actualmente la batería estándar española tiene buenos marcadores para su detección, pero no ideales. Por ello, es rentable aplicar una batería específica de corticoides si dichos marcadores son positivos, así como los corticoides propios aportados por los pacientes. En cuanto a las reacciones de hipersensibilidad inmediata, son mucho menos habituales, pero potencialmente más graves. Debido a que estos fármacos son necesarios en múltiples enfermedades, es importante confirmar la sensibilización a estas sustancias, y orientar el uso de corticoides alternativos. En el presente artículo pretendemos revisar los principales conceptos respecto a estos 2 tipos de reacciones de hipersensibilidad en la alergia a corticoides, así como su abordaje en la práctica clínica

Corticosteroids are widely used drugs in the clinical practice, especially by topic application in dermatology. These substances may act as allergens and produce immediate and delayed hypersensitivity reactions. Allergic contact dermatitis is the most frequent presentation of corticosteroid allergy and it should be studied by patch testing in specific units. The corticosteroids included in the Spanish standard battery are good markers but not ideal. Therefore, if those makers are positive, it is useful to apply a specific battery of corticosteroids and the drugs provided by patients. Immediate reactions are relatively rare but potentially severe, and it is important to confirm the sensitization profile and to guide the use of alternative corticosteroids, because they are often necessary in several diseases. In this article we review the main concepts regarding these two types of hypersensitivity reactions in corticosteroid allergy, as well as their approach in the clinical practice

¿Tenemos algo más que aportar en el tratamiento de la tricotilomanía? / What else could we add to the treatment of trichotillomania?

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Hipersensitivity Reactions to Corticosteroids.

Corticosteroids are widely used drugs in the clinical practice, especially by topic application in dermatology. These substances may act as allergens and produce immediate and delayed hypersensitivity reactions. Allergic contact dermatitis is the most frequent presentation of corticosteroid allergy and it should be studied by patch testing in specific units. The corticosteroids included in the Spanish standard battery are good markers but not ideal. Therefore, if those makers are positive, it is useful to apply a specific battery of corticosteroids and the drugs provided by patients. Immediate reactions are relatively rare but potentially severe, and it is important to confirm the sensitization profile and to guide the use of alternative corticosteroids, because they are often necessary in several diseases. In this article we review the main concepts regarding these two types of hypersensitivity reactions in corticosteroid allergy, as well as their approach in the clinical practice.

Estudio de sensibilización a corticoides en una consulta de alergia cutánea / Corticosteroid hypersensitivity studies in a skin allergy clinic

INTRODUCCIÓN: Los corticoides pueden producir reacciones de hipersensibilidad, sobre todo retardadas. Se ha propuesto una nueva clasificación para el estudio de la alergia a corticoides que los divide en 3 grupos según su estructura molecular y establece 2 perfiles de pacientes según estén sensibilizados a uno o varios grupos. Los objetivos de este estudio son describir las características clínicas de nuestros pacientes alérgicos a corticoides, compararlas con las del resto de la población estudiada y analizar su distribución según la nueva clasificación. MATERIAL Y MÉTODOS: Estudio retrospectivo de 11 años que incluye los casos de pacientes con reacciones de hipersensibilidad retardada a corticoides en la Unidad de Alergia Cutánea del Servicio de Dermatología de un hospital terciario. RESULTADOS: Estudiamos a 2.857 pacientes, de los cuales 33 presentaron uno o más parches positivos a los corticoides. Estos pacientes presentaron menos dermatitis atópica y menor afectación de las manos. Todos fueron alérgicos a algún corticoide del grupo 1 y la budesonida fue el más frecuente (87,9%). Con la batería específica de corticoides observamos que 14 (42,4%) eran, además, alérgicos a corticoides del grupo 2 o 3. Ninguno fue alérgico solo a corticoides del grupo 2 o 3. El 61,9% (13/21) de los pacientes que fueron testados con cremas con un corticoide del grupo al cual era alérgicos no presentó reacción a aquellas. CONCLUSIONES: La batería estándar española tiene solo marcadores para la alergia a corticoides del grupo 1. Recomendamos aplicar una batería específica de corticoides y los fármacos propios si los marcadores son positivos para poder clasificarlos mejor y adecuar su manejo terapéutico

INTRODUCTION: Corticosteroids can cause hypersensitivity reactions, particularly delayed-type allergic reactions. A new classification system for testing hypersensitivity to corticosteroids distributes the drugs into 3 groups according to molecular structure; patients are classified according to whether they are allergic to agents in 1 or more of the groups. We aimed to describe the clinical characteristics of corticosteroid-allergic patients treated at our clinic and apply the new classification system to them; we also compared these patients' characteristics to those of others treated at our clinic. MATERIAL AND METHODS: Retrospective study of cases of delayed-type corticosteroid hypersensitivity treated in the skin allergy clinic of a tertiary level hospital over an 11-year period. RESULTS: We reviewed the records of 2857 patients, finding 33 with at least one positive patch test result showing corticosteroid hypersensitivity. Atopic dermatitis and hand involvement were less common in our corticosteroid-allergic patients. All were allergic to a group 1 corticosteroid (most often, budesonide, the culprit in 87.9%). Testing with a specific corticosteroid series revealed that 14 (42.4%) were also allergic to corticosteroids in group 2 and/or group 3. None were allergic exclusively to group 2 or group 3 agents. Twenty-one patients were exposed to a corticosteroid cream from a group their patch test results indicated allergy to; 13 of them (61.9%) did not develop a hypersensitivity reaction. CONCLUSIONS: The Spanish standard series only contains group 1 corticosteroids. In the interest of improving allergy management, we recommend testing with a specific corticosteroid series and a patient's own creams whenever patch testing with a standard series reveals a hypersensitivity reaction to corticosteroids

Alopecia e hirsutismo en una mujer posmenopáusica como forma de presentación de un tumor de células de Leydig hiliar del ovario / Alopecia and Hirsutism in a Postmenopausal Woman as the Presenting Complaint of Ovarian Hilus (Leydig) Cell Tumor

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Yellow and orange in cutaneous lesions: clinical and dermoscopic data.

Colour of the lesions is clue for the clinical and dermoscopic diagnosis. Nevertheless, we have detected in the literature an uneven relevance of the colours as a diagnostic criterion. Thus, while red, brown and blue have taken important role in dermoscopic descriptions, other like yellow and orange have been given much less importance. This article reviews those lesions in which the yellow and orange colours have been considered constitutive or essential for diagnosis, and on the other hand it emphasizes the entities in which may appear these colours and are not well reflected in the literature. We believe that organize all this information will help us in a better understanding of these pathologies.

Corticosteroid hypersensitivity studies in a skin allergy clinic.

INTRODUCTION: Corticosteroids can cause hypersensitivity reactions, particularly delayed-type allergic reactions. A new classification system for testing hypersensitivity to corticosteroids distributes the drugs into 3 groups according to molecular structure; patients are classified according to whether they are allergic to agents in 1 or more of the groups. We aimed to describe the clinical characteristics of corticosteroid-allergic patients treated at our clinic and apply the new classification system to them; we also compared these patients' characteristics to those of others treated at our clinic. MATERIAL AND METHODS: Retrospective study of cases of delayed-type corticosteroid hypersensitivity treated in the skin allergy clinic of a tertiary level hospital over an 11-year period. RESULTS: We reviewed the records of 2857 patients, finding 33 with at least one positive patch test result showing corticosteroid hypersensitivity. Atopic dermatitis and hand involvement were less common in our corticosteroid-allergic patients. All were allergic to a group 1 corticosteroid (most often, budesonide, the culprit in 87.9%). Testing with a specific corticosteroid series revealed that 14 (42.4%) were also allergic to corticosteroids in group 2 and/or group 3. None were allergic exclusively to group 2 or group 3 agents. Twenty-one patients were exposed to a corticosteroid cream from a group their patch test results indicated allergy to; 13 of them (61.9%) did not develop a hypersensitivity reaction. CONCLUSIONS: The Spanish standard series only contains group 1 corticosteroids. In the interest of improving allergy management, we recommend testing with a specific corticosteroid series and a patient's own creams whenever patch testing with a standard series reveals a hypersensitivity reaction to corticosteroids.

Abordaje terapéutico en el eczema crónico de manos / Management of Chronic Hand Eczema

El manejo del eczema de manos es complejo, ya que engloba eczemas de etiopatogenia, curso y pronóstico muy diferentes; la mayoría de tratamientos disponibles no cuentan con niveles de eficacia establecidos, y en sus formas graves la calidad de vida se afecta de forma importante. La educación del paciente, las medidas de protección y el uso de emolientes constituyen un pilar fundamental en el abordaje de estos pacientes. Los corticoides tópicos de alta potencia son el tratamiento de elección, seguidos de los inhibidores de la calcineurina para el mantenimiento de la enfermedad. En los casos refractarios a estos tratamientos deberíamos utilizar la fototerapia o tratamientos sistémicos, los cuales no deberían demorarse para evitar sensibilizaciones, bajas laborales y alteración en la calidad de vida. La alitretinoína es el único tratamiento oral disponible que ha sido aprobado para su utilización en el eczema crónico de manos

Management of hand eczema is complex because of the broad range of different pathogeneses, courses, and prognoses. Furthermore, the efficacy of most available treatments is not well established and the more severe forms can have a major impact on the patient's quality of life. Patient education, preventive measures, and the use of emollients are the mainstays in the management of hand eczema. High-potency topical corticosteroids are the treatment of choice, with calcineurin inhibitors used for maintenance. Phototherapy or systemic treatments are indicated in patients who do not respond to topical treatments. Switching from topical treatments should not be delayed to avoid sensitizations, time off work, and a negative impact on quality of life. Alitretinoin is the only oral treatment approved for use in chronic hand eczema

Metástasis cutánea de hepatocarcinoma tras procedimientos percutáneos / Cutaneous Metastasis From Hepatocellular Carcinoma After a Percutaneous Interventional Procedure

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Management of Chronic Hand Eczema.

Management of hand eczema is complex because of the broad range of different pathogeneses, courses, and prognoses. Furthermore, the efficacy of most available treatments is not well established and the more severe forms can have a major impact on the patient's quality of life. Patient education, preventive measures, and the use of emollients are the mainstays in the management of hand eczema. High-potency topical corticosteroids are the treatment of choice, with calcineurin inhibitors used for maintenance. Phototherapy or systemic treatments are indicated in patients who do not respond to topical treatments. Switching from topical treatments should not be delayed to avoid sensitizations, time off work, and a negative impact on quality of life. Alitretinoin is the only oral treatment approved for use in chronic hand eczema.