Neutrophilic Eccrine Hidradenitis in an HIV-Infected Patient.

A 35-year-old man presented with a 2-day history of a maculopapular pruritic eruption that had affected his general state of health and was accompanied by chills. The patient had been diagnosed with HIV in 2008, and was undergoing treatment with a combination of emcitrabine/tenofovir plus nevirapine. He had a current viral load of 1,558,160 copies/mL and a lymphocyte count CD4+ count of 230/mm3. Physical examination revealed an eruption involving the face, nape of the neck, chest, abdomen, extremities, palms, and soles. This was characterized by erythematous papules approximately 2 mm in diameter coalescing on the palms and soles, where they formed plaques (Figures 1 and 2).

[Comparative study of the efficacy of larva therapy for debridement and control of bacterial burden compared to surgical debridement and topical application of an antimicrobial]. / Estudio comparativo de la eficacia de la larvaterapia (LT) para desbridar y controlar la carga bacteriana en úlceras venosas comparado con desbridamiento quirúrgico y aplicación de un antimicrobiano tópico.

Maggot debridement therapy (MDT) is the use of medical grade maggots of the fly Lucilia sericata for wound debridement. Recent observations show that MDT decreases bacterial burden as well. Venous ulcers are the most commonly seen in wound clinics and require, besides adequate treatment of venous hypertension, proper wound bed preparation with debri dement of necrotic tissue and control of potential infections. To evaluate the efficacy of MDT in venous ulcers a randomized controlled trial was designed to compare MDT to surgical debridement and topical application of silver sulfadiazine (SSD) in 19 patients for 4 weeks. The study variables were area reduction, wound bed characteristics, pain, odor, anxiety and bacterial burden using quantitative tissue biopsies. MDT was effective as surgical debridement associated with topical SDD in the debridement of the wound and in reducing its size. A significant difference was observed in the reduction of bacterial burden in favor of the MDT group. Odor and anxiety increased in the MDT group without any difference in the pain intensity between groups. In conclusion, this study suggests that MDT is as effective as surgical debridement for the debridement of necrotic tissue and promote wound healing in venous ulcers and better at reducing bacterial burden.

[Cutaneous metastasis of renal cell carcinoma: A case report and review of the literature]. / Metástasis cutánea de carcinoma de células renales (MCCCR): reporte de caso y revisión de la literatura.

INTRODUCTION: Renal cell carcinoma (RCC) accounts for 2-3% of adult solid malignancies. About 25-30% develop metastasis at the time of diagnosis and 60% corresponds to clear cell type. CASE PRESENTATION: A 66-year-old man, with a personal history of left radical nephrectomy, presents with an asymptomatic skin tumor he noticed one month earlier. Histopathologic study reported metastatic cutaneous infiltration of clear cell carcinoma, suggestive of a primary renal carcinoma. DISCUSSION: Cutaneous metastasis of RCC represents 6.0-6.8% of all cutaneous metastases. These patients have poor prognosis and, therefore, their treatment is palliative. It is essential to perform a complete periodic dermatologic examination for proper restaging and treatment.

[Underestimation of dermatology based on ignorance and its impact on patient's health]. / El menosprecio hacia la dermatología basado en la ignorancia y su repercusión en la salud del paciente.

With the emergence of medical specialties in different areas of medicine, assessment of patients became narrow and specialized. There is also the perception that some specialties are more difficult than others. Dermatology has long been seen by most physicians non dermatologists as a relaxed area, without real emergencies or requirement of great intellectual effort. Some specialists, erroneously think that everything can be cured with topical steroids and/or antifungal creams. Although several skin diseases are common complains seen by the general practitioner, very few time and credits are granted to cover these diseases during the years of undergraduate training. Thus, the primary care physicians and others medical specialists believe that skin diseases are not life threatening and hence irrelevant. Nonetheless, they feel competent enough to prescribe a variety of treatments for skin diseases that may lead to iatrogenesis.

Con la aparición de las especialidades en las diferentes áreas de la medicina se comenzó a notar una "fragmentación" en la forma de evaluar al paciente; también surgió la percepción de que existen algunas más difíciles que otras. La Dermatología ha sido vista durante mucho tiempo por la mayor parte de los médicos no dermatólogos como una área relajada, sin guardias, sin urgencias y que no requiere gran ejercicio intelectual. Algunos especialistas piensan que todo se "cura" con esteroides tópicos y/o antimicóticos. A pesar de que varias dermatosis son motivo frecuente de consulta para el médico general, durante los años de pregrado se concede poco tiempo y, consecuentemente, escasos créditos a esta materia, dando como resultado que los médicos y otros especialistas no den la importancia debida a las enfermedades de la piel, al no ser estas riesgosas para la salud del paciente. Sin embargo sí se atreven a tratar dichas enfermedades con tal displicencia que terminan por generar iatrogenia de todo tipo.