Clinical Characteristics and Outcomes in a Population With Disseminated Herpes Zoster: A Retrospective Cohort Study. / Características clínicas y evolutivas de una población con herpes zoster diseminado: un estudio de cohorte retrospectiva.

INTRODUCTION: Shingles is the cutaneous expression of the reactivation of latent varicella zoster virus infection in sensory ganglia. It presents as vesicles in the corresponding dermatome. The condition is called disseminated herpes zoster (DHZ) when more than 2 contiguous dermatomes are affected, more than 20 vesicles are observed outside the initial dermatome, or involvement is systemic. DHZ is rare and most frequently occurs in immunocompromised patients. OBJECTIVES: To describe the epidemiology, predisposing factors, clinical presentation, laboratory findings, and clinical course of patients with DHZ, and to compare the findings in immunocompromised and immunocompetent patients. METHODOLOGY: We analyzed a retrospective case series of adults hospitalized between February 2010 and October 2015. RESULTS: Forty-one patients with virologically confirmed manifestations of DHZ were included. Stress as a trigger factor was detected in 39% and immunodepression in 58.5%. Immunocompromised patients were younger than the immunocompetent patients (mean ages, 60.5 vs 82 years, P<.01). The 8 immunocompetent patients with no detectable trigger factors were older (mean age, 85 years). In 95% of cases, DHZ was initially limited to a single dermatome and then spread to other dermatomes or became disseminated. Thrombocytopenia was detected in 56% of cases. Complication rates were similar in immunocompromised and immunocompetent patients (54% vs 59%, P>.01). Six patients died; there was no difference in mortality between the 2 groups. CONCLUSION: This study provides evidence on the relationship between DHZ, the presence of underlying immunodepression, and complications. Immunosenescence may play an important role in the onset of this disease in older immunocompetent patients.

Lentigo Maligna: Keys to Dermoscopic Diagnosis. / Lentigo maligno. Claves en el diagnóstico dermatoscópico.

Dermoscopy is a noninvasive technique that improves accuracy in the diagnosis of cutaneous lesions. The recognition and differential diagnosis of lentigo maligna (LM) and lentigo maligna melanoma (LMM) is challenging, especially in the early stages when there are no distinctive clinical features. Early diagnosis and appropriate treatment can improve prognosis. Several dermoscopic features have been described for LM and LMM. The following 4 criteria in combination have achieved a diagnostic sensitivity of 89% and a specificity of 96%: asymmetric pigmented follicular openings, dark rhomboidal structures, slate gray dots, and slate gray globules. A biopsy is warranted when dermoscopic examination reveals a grayish coloring. For a flat pigmented lesion acquired in adulthood, a histopathological diagnosis of "atypical junctional nevus" is not to be accepted uncritically. LM and LMM can also appear in sites other than the face, and dermoscopy can facilitate their recognition. Dermoscopy is an essential tool for physical examination.