Transformation of a myelodysplastic syndrome to acute myeloid leukemia and concurrent necrotizing sweet syndrome.

The Sweet's syndrome, is an inflammatory skin disorder characterized by extensive infiltration of neutrophils in the dermis with extension to the subcutis, known as acute febrile neutrophilic dermatosis. It may occur as a paraneoplastic syndrome. To our knowledge, there are currently few reports about transformation of a myelodysplastic syndrome to acute myeloid leukemia and concurrent necrotizing Sweet syndrome in the literature. Herein we describe an unusual case in a young patient with these characteristics that evolved to a fatal outcome.

Circumscribed storiform collagenoma, an unusual tumor.

Circumscribed storiform collagenoma is a rare benign tumor. It appears as an isolated skin lesion or as part of the clinical spectrum of Cowden syndrome. The pathogenesis is still controversial. Although its clinical expression is heterogeneous, it has a characteristic histological pattern. We describe a case of a solitary circumscribed storiform collagenoma not associated with Cowden syndrome.

Langerhans Cell Histiocytosis with Isolated Cutaneous Involvement Refractory to Polychemotherapy: A Case Report.

BACKGROUND: Langerhans cell histiocytosis (LCH) is a neoplasm of the monocyte-macrophage lineage, characterized by clonal proliferation and dissemination of cells that express CD1a+ and CD207. It is a disorder that predominates in childhood. Although the skin is the second most frequently affected organ (30-60%), isolated cutaneous involvement is rare; its frequency does not exceed 4 to 12 percent of cases. Single system-LCH usually has a good prognosis. We describe a case of LCH with isolated cutaneous involvement that presented in an adult patient and was refractory to polychemotherapy.

Effective Treatment of Morbihan's Disease with Long-term Isotretinoin: A Report of Three Cases.

Morbihan's disease is characterized by the presence of chronic and persistent edema of the periorbital tissue, forehead, glabella, nose, and cheeks. In some cases, it is related to acne and rosacea, but its exact etiology remains unknown. A defined therapeutic approach has yet to be established for the treatment of Morbihan's disease. To date, the systemic and surgical options attempted have not been very successful and/or do not yield sustained results. Isotretinoin is a key systemic treatment used for the treatment of various skin conditions. However, there are few reports of isotretinoin being used to treat Morbihan's disease. Here, we present the details of three patients with Morbihan's disease who were successfully treated long-term with isotretinoin.

[Mexican consensus on the diagnosis and treatment of atopic dermatitis in adolescents and adults]. / Consenso mexicano para el diagnóstico y tratamiento de la dermatitis atópica en adolescentes y adultos.

BACKGROUND: The diagnostic approaches and therapeutic strategies of atopic dermatitis (AD) are generally inconsistent among physicians and health institutions. OBJECTIVE: To develop a consensus statement among experts to reduce the variations in practice regarding the diagnosis and treatment of patients ≥ 12 years with AD to improve their care. METHODS: Systematic literature search in PubMed and GREAT. With methodological support and using the Delphi method, a formal consensus was developed among 16 experts in Dermatology and Allergology, based on the current evidence and its applicability in the Mexican context. Apart from intense electronic communication, several issues of disagreement were discussed in two face-to-face meetings. RESULTS: The clinical experts reached consensus on 46 statements related to the definition, classification, diagnostic strategies and treatment of AD. For the diagnosis we suggest the Williams criteria and for severity scoring the SCORAD (by the doctor) and POEM (by the patient). In addition to general care and treatment education (workshops), we suggest four steps for treatment, depending on severity: 1. Topical treatment with anti-inflammatory agents (and systemic: antihistamines/antileukotrienes -low level evidence-) 2. Phototherapy, 3. Cyclosporin A and 4. Dupilumab, with the possibility of managing this biological earlier on if a fast effect is needed. In extrinsic AD we suggest evaluating the addition of allergen immunotherapy or an elimination diet, if there is an IgE-mediated respiratory or food allergy, respectively. CONCLUSION: The panel of experts reached consensus on relevant aspects of AD with a focus on the transcultural adaptation of recent evidence.

Antecedentes: Los abordajes diagnósticos y las estrategias terapéuticas de la dermatitis atópica generalmente son inconsistentes entre los médicos y entre las instituciones de salud. Objetivo: Consensar las opiniones de expertos para reducir las variaciones en la práctica respecto al diagnóstico y tratamiento de pacientes ≥ 12 años con dermatitis atópica para mejorar su cuidado. Métodos: Búsqueda sistemática de la literatura en PubMed y GREAT. Con apoyo metodológico y utilizando el método Delphi se desarrolló un consenso formal entre 16 expertos en dermatología y alergología, basándose en la evidencia actual y su aplicabilidad en el contexto mexicano. A parte de una comunicación electrónica intensa, se discutieron los puntos en desacuerdo en dos reuniones presenciales. Resultados: Los expertos clínicos alcanzaron consenso en 46 declaraciones relacionadas con la definición, clasificación, estrategias de diagnóstico y tratamiento de la dermatitis atópica. Para el diagnóstico sugerimos se usan los criterios de Williams y el SCORAD (por parte del médico) y POEM (por parte del paciente) para definir la gravedad. Aunado a cuidados generales y educación terapéutica, sugerimos cuatro pasos para tratamiento, según gravedad: 1. Manejo tópico con antiinflamatorio (y sistémico: antihistamínico/antileucotrieno ­evidencia reducida­) 2. Fototerapia, 3. Ciclosporina A y 4. Dupilumab, con la posibilidad de manejarlo antes si se necesita efecto rápido. En la dermatitis atópica extrínseca sugerimos agregar inmunoterapia con alérgenos o una dieta de eliminación si existe una alergia IgE-mediada, inhalatoria o alimentaria, respectivamente. Conclusión: El panel de expertos realizó consenso en aspectos relevantes de la dermatitis atópica con enfoque en la adaptación transcultural de evidencia reciente.

[Cutaneous manifestations of leukemia]. / Manifestaciones cutáneas de las leucemias.

INTRODUCTION: To describe the type and frequency of cutaneous manifestations of leukemia. METHODS: Observational, descriptive study. We included patients over 16 years of age, with confirmed diagnosis of leukemia from the Hematology and Dermatology Departments of the outpatient clinic and from in-patients. Patients with bone marrow transplantation were excluded. A complete history and physical examination of the skin and appendages was performed, with biopsy and cultures if required. The cutaneous manifestations were classified as infection or drug-related, leukemic infiltration, associated dermatosis to leukemia and non-specific lesions. Descriptive statistics was employed. RESULTS: We included 142 patients (62 females, 80 males) with the following diagnoses: acute myeloid leukemia (n=36), acute lymphoblastic leukemia (n=52), chronic myeloid leukemia (n=21), chronic lymphocitic leukemia (n=30) and hairy cells leukemia (n=3). 42% of patients (n=60) presented some dermatoses. There were 36 non-specific dermatoses, 21 drug-related, 20 infectious, 3 infiltrative and none associated. CONCLUSIONS: Cutaneous manifestations directly related to leukemia are frequent, being the non-specific ones, the most commonly observed. However, a thorough dermatologic examination is important in these patients as part of an overall evaluation.

Introducción: el objetivo de este estudio es describir la frecuencia y tipo de manifestaciones cutáneas en pacientes con leucemia.Métodos: estudio observacional, descriptivo. Se incluyeron pacientes mayores de 16 años, con diagnóstico confirmado de leucemia, de los departamentos de Hematología y Dermatología procedentes de la consulta externa u hospitalizados. Se excluyeron los pacientes trasplantados de médula ósea. Se les efectuó historia clínica y revisión dermatológica completa de la piel y anexos, toma de biopsias y cultivos en caso de requerirlo. Las manifestaciones cutáneas se clasificaron en manifestaciones secundarias a procesos infecciosos o medicamentos, infiltración leucémica, dermatosis asociadas a la leucemia y lesiones inespecíficas. Se empleó estadística descriptiva.Resultados: Se incluyeron 142 pacientes con los siguientes diagnósticos: leucemia mieloide aguda (n = 36 pacientes), leucemia linfoblástica aguda (n = 52), leucemia mieloide crónica (n = 21), leucemia linfocítica crónica (n = 30), leucemia de células peludas (n = 3). El 42.25 % de los pacientes (n = 60) presentaron hallazgos positivos para alguna dermatosis. Se encontraron 36 dermatosis inespecíficas, 21 medicamentosas, 20 infecciosas, 3 infiltrativas y ninguna asociada.Conclusiones: las manifestaciones cutáneas directamente relacionadas a leucemia son frecuentes, siendo las inespecíficas las más comúnmente observadas. Sin embargo, el examen dermatológico completo es importante en estos pacientes como parte de su evaluación integral.

[Isotretinoin and depressive symptoms in patiens with severe and recurrent acne]. / Isotretinoína y síntomas de depresión en pacientes con acné severo y recurrente.

BACKGROUND: Since use of isotretinoin for acne management it has been published controversial results about its association with depression. The objective of this study was to know if use of isotretinoin in patients with severe and recurrent acne (SRA) is associated with depression. METHODS: 22 patients with diagnosis of SRA were included from the National Medical Center La Raza's Acne Clinic. They completed the Beck Depression inventory (IDB-II) before, during (2 months) and after treatment with isotretinoin (4 months), calculated at 0.5 mg/kg. RESULTS: The patients reported low depressive symptoms before treatment that reduced at the end (median=6 and 0, respectively, p<0.001). CONCLUSIONS: Treatment with isotretinoin in this sample of patients with severe and recurrent acne produced no increase in depressive symptoms, but improvement, due to the best corporal image self-perception.

Introducción: a partir del uso de isotretinoína para el manejo del acné, se han publicado resultados controversiales en torno a una probable asociación entre esta y depresión. El objetivo de este estudio fue conocer si el uso de isotretinoína en pacientes con acné severo y recurrente (ASR) se asocia a depresión.Métodos: se incluyeron 22 pacientes con diagnóstico de ASR pertenecientes a la clínica de acné del Centro Médico Nacional La Raza. Se les aplicó el inventario de depresión de Beck (IDB-II) antes, durante (2 meses) y después del tratamiento con isotretinoína (4 meses), calculada a 0.5 mg/kg.Resultados: en las primeras mediciones se reportaron puntuaciones bajas de síntomas depresivos que disminuyeron aún más al final del tratamiento (mediana = 6.5 antes del tratamiento, 3 a los dos meses y 0 al final, con una p < 0.001).Conclusiones: el tratamiento con isotretinoína en esta muestra de pacientes con acné severo y recurrente no produjo aumento de síntomas depresivos, por el contrario los redujo de manera indirecta al mejorar su imagen corporal.

[Toxic epidermal necrolysis treated with human gamma globulin]. / Gammaglobulina humana en necrólisis epidérmica tóxica.

Toxic epidermal necrolysis and Stevens Johnson syndrome are severe adverse cutaneous drug reactions that predominantly involve the skin and mucous membranes. We report a case of 43 year old female with 75 % body surface area affected, treated with intravenous immunoglobulin who presented favorable outcomes.