Impact of the COVID-19 Pandemic on Dermatology Care in the Chilean Public Health Sector.

Due to the Coronavirus-19 (COVID-19) pandemic, most resources of the public health system were allocated to the increasing demand from respiratory patients. From this, it is expected that specialty consultations would decrease drastically. Access to dermatology care in the Chilean public health has been historically limited. To evaluate the impact of the pandemic on dermatology care, the total number of dermatological consultations (DCs) to the Chilean public sector in 2020 is analyzed according to sex and age range and compared with the available databases from 2017 to 2019. From this, 120,095 DCs were performed during 2020, with an incidence of 6.3 consultations per 1000 inhabitants. When compared to 2019 (n = 250,649), there was a 52.1% decrease. The regions most affected were located in the central part of Chile, which correlates with the regions most affected by the pandemic. Age and sex distributions remained similar to previous years but lower in amplitude. The month with the lowest number of consultations was April, with a gradual increase observed thereafter until December 2020. Although DCs decreased drastically in the Chilean public sector during 2020, sex and age range proportions were conserved, thus affecting all groups in a similar manner.

Comorbidities in Chilean patients with psoriasis: a Global Healthcare Study on Psoriasis.

BACKGROUND: Psoriasis is a chronic inflammatory skin disease associated with several important medical comorbidities. There are scant data available on the comorbidities of patients with psoriasis in South America. AIM: To examine the comorbidity profile of adult patients with psoriasis in Chile and its association with severity of psoriasis. METHODS: This was a multicentre, cross-sectional study involving 16 hospitals and clinics in Chile, which used a 48-item questionnaire to study clinician- and patient-reported outcomes and comorbidities. Inferential analyses were performed by psoriasis severity, using Fisher exact test, Student t-test and multivariable logistic regression. RESULTS: In total, 598 adult patients with psoriasis were included (51.1% male; mean age 49.2 ± 15.1 years); 48.5% mild and 51.4% moderate to severe; Psoriasis Area and Severity Index 11.6 ± 11.5; body surface area 14.7 ± 18.2%. Plaque psoriasis was the most common phenotype (90.2%), followed by guttate (13.4%). Psoriatic arthritis occurred in 27.3% of patients. Comorbidities were reported in 60.2% of all patients with psoriasis. Frequent concomitant diseases were obesity (25.3%), hypertension (24.3%), Type 2 diabetes mellitus (T2DM) (18.7%), dyslipidaemia (17.4%), metabolic syndrome (16.7%) and depression (14.4%). After adjustment, significant associations were found between moderate to severe psoriasis and obesity, T2DM and nonalcoholic fatty liver disease (NAFLD) compared with mild psoriasis. CONCLUSIONS: We report a large study of comorbidities, including depression, dyslipidaemia, T2DM and NAFLD, in people with psoriasis in Chile. The prevalence of comorbidities with psoriasis in Chile appears similar to that found in Western countries, and emphasizes the importance of assessing patients with psoriasis for risk factors for and presence of, comorbid disease in a multidisciplinary setting.

Autologous fibroblasts for the treatment of cutaneous loxoscelism: First experience.

Several treatments have been described for cutaneous loxoscelism (CL), but the quality of available evidence is insufficient for the elaboration of a therapeutic consensus. Dapsone has shown beneficial effects on stopping the inflammatory phenomenon and accelerating the recovery. It is recommended to start dapsone once the visceral involvement is ruled out if glucose-6-phosphate dehydrogenase levels are normal. Autologous fibroblast (AF) therapy is a novel therapy that has been successfully used in bioengineering as skin substitutes for surgical wounds and burns, diabetic and pressure ulcers, and other aesthetic purposes. Interestingly, there are no reports of AFs in CL. We present a case of CL in which the necrotic process was stabilised with dapsone, but the healing of the ulcer was not achieved. Three weekly applications of AFs 100 000/cm2 were performed on a biocompatible polymer matrix, with optimal response within 2 months. This represents the first report of AFs in CL, setting the stage for future studies.

Alopecic and Aseptic Nodules of the Scalp: First Report in South America and Second in America.

Alopecic and aseptic nodules of the scalp, also named pseudocysts of the scalp, are a relatively new, little-known, and for sure underdiagnosed disease. It affects mostly young men and is characterized by a solitary or a few dome-shaped nodules accompanied by nonscarring alopecia, deep inflammatory infiltration in the skin biopsy specimen, and, in most cases, granulomas. It has a good response to doxycycline, intralesional corticosteroids, or drainage/aspiration of the lesion. We present a case report and a summary of the published cases.

Eritema anular centrífugo tipo profundo: reporte de un caso / Deep erythema annulare centrifugum: Acase report

El eritema anular centrífugo es una enfermedad poco común, habitualmente idiopática y con una gran variedad de diagnósticos diferenciales. Puede asociarse a diversas patologías de origen infeccioso, autoinmune y neoplásico, obligando al médico a considerarlas para su descarte. Tanto clínica como histopatológicamente se diferencia en dos tipos, el superficial y el profundo, siendo el de tipo profundo el menos frecuente. Actualmente, su fisiopatología es bastante desconocida, lo que dificulta la posibilidad de llegar a un consenso de cuál sería el mejor esquema de tratamiento para este cuadro. Se presenta el caso de una paciente de 62 años con eritema anular centrífugo de tipo profundo, con evolución progresiva e intermitente.

Erythema annulare centrifugum is an uncommon, usually idiopathic disease with a great variety of differential diagnoses. It may occur associated with infectious, auto-immune or neoplastic pathologies which the physician must consider in order to rule them out. There are two clinical and histopathological types, superficial and deep, deep being the less frequent. Its pathophysiology has not yet been well elucidated making it difficult to reach a consensus for its treatment. We present the case of a 52 year old with deep erythema annulare centrifugum with a progressive, intermittent clinical course.

Foliculitis decalvante: caso clínico y revisión de la literatura / Folliculitis decalvans: clinical case and review of the literature

La Foliculitis decalvante (FD) es un tipo de alopecia cicatricial poco frecuente, cuya presentación clínica se caracteriza por la presencia en el cuero cabelludo de pápulo-pústulas foliculares, habitualmente dolorosas, asociado a lesiones nodulares que evolucionan hacia áreas redondeadas de alopecia cicatricial, irregulares y atróficas. Su sospecha diagnóstica se basa en los hallazgos clínicos mencionados, siendo confirmada con biopsia de cuero cabelludo. A la fecha no existe un tratamiento estándar establecido, existiendo diversas alternativas terapéuticas con resultados variables. A continuación se presenta el caso clínico de una mujer de 42 años, que consultó en policlínico de Dermatología por cuadro de alopecia de larga data, sin controles previos. Al examen físico destacó la presencia de pústulas foliculares en cuero cabelludo y alopecia cicatricial irregular y atrófica. Marcadores inmunológicos negativos. Se realizó una biopsia del cuero cabelludo, obteniendo hallazgos que confirman diagnóstico de FD. Se inició manejo con corticoides intralesionales, con mala respuesta. Posteriormente se realizó tratamiento con terapia fotodinámica, doxiciclina e isotretinoína evolucionando con buena respuesta clínica.

Folliculitis decalvans is an infrequent scarring alopecia characterized by the appearance on the scalp of, usually painful, follicular pustules associated with nodular lesions which leave irregular, round, scarring, atrophic areas of alopecia. Diagnosis is based on clinical findings and is confirmed by biopsy of the scalp. There is no standard treatment and therapeutic alternatives have variable results. We present the case of a 42 year old woman seen in a dermatology outpatients clinic for long term alopecia for which she had not previously consulted. The physical examination revealed follicular pustules on her scalp and irregular scarring atrophic alopecia. Immunological markers were negative. A biopsy of her scalp confirmed the diagnosis of FD. She responded poorly to intra-lesion corticoids. She then responded well to photodynamic therapy, doxycycline and isotretinoin.

Osteoartropatía hipertrófica primaria y queratodermia palmoplantar: a propósito de un caso / Primary hypertrophic osteoarthropathy and palmoplantar keratoderma: a case report

La acropaquia es un trastorno que puede presentarse en forma aislada o formar parte del síndrome de osteoartropatía hipertrófica, entidad caracterizada por periostosis, dolor articular y acropaquia. Cuando este síndrome es causado por una mutación genética específica, se denomina osteoartropatía hipertrófica primaria. Este raro desorden hereditario se asocia, además, a alteraciones dermatológicas típicas, como hiperseborrea, acné, engrosamiento de pliegues faciales, entre otras. Una asociación rara vez descrita es la queratodermia palmoplantar. Se presenta el caso de una mujer de 46 años con osteoartropatía hipertrófica primaria asociada a queratodermia palmoplantar que asistió a la unidad de dermatología del Hospital Gustavo Fricke, Viña del Mar, Chile.

Clubbing is a disorder that can be an isolated finding or be part of the hypertrophic osteoarthropathy syndrome, an entity characterized by periostosis, joint pain and clubbing. When this syndrome is caused by a specific genetic mutation, it is called primary hypertrophic osteoarthropathy. This rare hereditary disorder is also associated with typical dermatological findings, such as hyperseborrhea, acne and facial feature coarsening. An association rarely described is palmoplantar keratoderma. We present the case of a 46-year-old woman with primary hypertrophic osteoarthropathy and palmoplantar keratoderma who came to the dermatology unit of Gustavo Fricke Hospital, Viña del Mar, Chile.

Lewandowsky's Rosaceiform Eruption: a Form of Cutaneous Tuberculosis Confirmed by PCR in Two Patients.

INTRODUCTION: Cutaneous tuberculosis (TBC) is a chronic disease caused by Mycobacterium tuberculosis, and is present in less than 1-2% of all TBC cases. The current problem with diagnosis is the demonstration of bacillus in the skin, especially paucibacillar forms, where sources like polymerase chain reaction (PCR) have improved diagnostic capacity. CASE PRESENTATION: Two cases of cutaneous TBC are reported. The first patient was 52-year-old woman with facial erythematous papulo-nodular lesions which had been developing for 4 months, and had previously been treated as acne rosacea, with partial response. Histopathological studies showed chronic granulomatous inflammation. TBC was suspected, so PCR was performed, which showed positive for M. tuberculosis. The second case was a 43-year-old woman with a facial rosaceiform plaque which began 6 months previously, and was treated as rosacea without any change for 5 months. Skin biopsy and PCR were positive for TBC. Both cases were treated using primary schedule for TBC, and both presented a favorable response. DISCUSSION: A clinical profile called Lewandowsky's rosacea-like eruption has been previously described. The condition has been questioned for years and was later removed from the spectrum of tuberculids and cutaneous TBC for not being able to isolate microorganisms in skin samples, a situation that might now change. In paucibacillar forms, when culture and staining are negative and TBC is still suspected, it is recommended to use DNA amplification by PCR for an accurate diagnosis. Both cases bring up the concern about once again bringing Lewandowsky's rosaceiform eruption into the spectrum of cutaneous TBC, and the discussion about the current definition of tuberculid.

Inverse psoriasis involving genital skin folds: successful therapy with dapsone.

INTRODUCTION: Inverse psoriasis is a rare form of psoriasis that affects between 3% and 7% of the patients with psoriasis. It can comprise genital skin folds as part of genital psoriasis, and it is one of the most commonly seen dermatoses of this area. There are few evidence-based studies about the treatment of intertriginous psoriasis involving genital skin folds. CASE PRESENTATION: The authors present a 42-year-old female patient with erythematous plaques in the vulva, groin, and perianal region. The patient had previously received a broad range of topical and systemic therapies that had to be discontinued due to ineffectiveness or side effects. She was treated with 100 mg dapsone daily for 10 months, showing a significant improvement of her cutaneous and mucous lesions. Complete clearance of psoriatic lesions was observed after 4 weeks of treatment. She has remained in remission for up to 2 years, using only topical therapy with tacrolimus 0.1% and calcipotriol. DISCUSSION: Genital psoriasis is a skin disease that causes great discomfort. It is important to include examination of the genital region and to adopt this conduct in daily clinical practice. Research in this field is still poor, making no discrimination between flexural and genital psoriasis, and is based on case series and expert opinion; therefore, empirical recommendations for the treatment of genital psoriasis remain. Dapsone has been shown to be an effective and convenient alternative for the treatment of inverse psoriasis in genital skin folds, which can provide effective control of the disease. Further studies are required to determine the efficacy and safety of current therapies, and to decide whether dapsone therapy should be considered in the management of this form of psoriasis when topical and other systemic agents are not effective.

Hirsutismo / Hirsutism

El hirsutismo representa para el médico una posible enfermedad sistemática, sin embargo para la paciente connotaciones emocionales. De una buena comprensión fisiopatológica del problema, resultará un buen diagnóstico y un manejo racional de este importante problema. Se realiza una actualización del tema, enfatizando el rol de la piel como órgano blanco de la acción hormonal

Tratamiento de la hepatitis crónica viral / Treatment of chronic viral hepatitis

Gracias a los actuales conocimientos sobre la patogénesis de la hepatitis crónica viral y a la contemporánea disponibilidad de un amplio espectro de fármacos capaces de modular el sistema inmunitario y de interferir en la replicación viral, es hoy posible plantear una estrategia terapéutica más eficaz con respecto al esquema empírico y desilusionante del pasado. Se destaca la importancia del diagnóstico etiológico de la infección viral y del daño hepático para la elección del tratamiento más apropiado para cada uno de los pacientes, considerando los factores que favorecen o desfavorecen una buena respuesta terapéutica. Entre los fármacos disponibles el Interferon ha demostrado la mayor eficacia, pero su empleo es limitado a un grupo particular de pacientes. Tratamientos combinados han dado resultados interesantes en este último tiempo en pacientes refractarios al Interferon Alfa

Brote epidémico de fascioliasis hepática humana en Valparaíso / Human hepatic fascioliasis outbreak in Valparaiso

Se analiza un brote epidémico de fascioliasis hepática humana ocurrido en la provincia de Valparaíso, durante 1983. A partir de 47 pacientes índices se sospechó la infección en un total de 128 personas. Se logró estudiar a 86 sujetos, demostrandose la parasitosis en 20 casos. Se describe el fenómeno epidemiológico observado y se discuten los factores que pudieron incidir en el hecho. Se propone un esquema de acción para enfrentarlo en el futuro