Seventy-MHz Ultrasound Detection of Early Signs Linked to the Severity, Patterns of Keratin Fragmentation, and Mechanisms of Generation of Collections and Tunnels in Hidradenitis Suppurativa.

OBJECTIVES: To test the capability of 70-MHz ultrasound for detecting initial ultrasound signs of hidradenitis suppurativa (HS) linked to severity. METHODS: A cross-sectional study of the ultrasound images of patients with HS was conducted and compared with a healthy control group. Detection and identification of early subclinical ultrasound signs in the lesional and perilesional areas of the HS cases in comparison with the control group were performed. Statistical analyses included mean, dispersion measures, the Kruskal-Wallis test, and bivariate and multivariate ordered logistic regression studies. Significance was assessed at P < .05. RESULTS: A total of 139 patients with HS met the criteria and showed abnormalities of the hair follicles such as a curved shape, ballooning, and protrusion into pseudocysts, collections, or tunnels (donor of keratin sign). Significant increases in the sizes of the hair follicles and hair shafts were found in HS cases. The following ultrasound signs were significantly linked to severity: a connecting band between the base of adjacent hair follicles (bridge sign), a fragment of the hair shaft extruding through a dilated hair follicle (sword sign), and retained cylindrical fragments of keratin in the dermis. Two patterns of fragmentation of the keratin were detected: multifragment and cylindrical. CONCLUSIONS: Ultrasound can detect early HS signs that are significantly linked to severity and 2 types of fragmentation of the keratin, which could support the generation and perpetuation of the fluid collections and tunnels. These ultrasound signs can help prompt diagnosis and management, the development and testing of medications, and the measure of treatment outcomes in HS.

Ultrasound Characteristics of the Hair Follicles and Tracts, Sebaceous Glands, Montgomery Glands, Apocrine Glands, and Arrector Pili Muscles.

OBJECTIVES: To explore the capability of very high-frequency ultrasound (US; 50-71 MHz) to detect the normal morphologic characteristics of the hair follicles and tracts, sebaceous glands, Montgomery glands, apocrine glands, and arrector pili muscles. METHODS: A retrospective study, approved by the Institutional Review Board, evaluated the normal US morphologic characteristics of the hair and adnexal structures in a database of very high-frequency US images extracted from the perilesional or contralateral healthy skin of 1117 consecutive patients who underwent US examinations for localized lesions of the skin and 10 healthy individuals from December 2017 to June 2018. These images were matched with their counterparts from the database of normal histologic images according to the corporal region. The Cohen concordance test and regional mean diameters of the hair follicles and adnexal structures were analyzed. RESULTS: The normal hair follicles and tracts, sebaceous glands, Montgomery glands, apocrine glands, and arrector pili muscles were observed on US images and matched their histological counterparts in all the corporal regions. There was significant US concordance (κ = 0.82; P = .0001) among observers. Regional mean diameters (millimeters) of the hair follicles, sebaceous glands, and apocrine glands are provided. CONCLUSIONS: The hair follicles and tracts, sebaceous glands, Montgomery glands, apocrine glands, and arrector pili muscles are detectable with very high-frequency US, including some regional and anatomic variants. Knowledge of their normal US appearances is a requisite for detecting subclinical changes, understanding the physiopathologic characteristics, and supporting the early diagnosis and management of common dermatologic diseases.

Conductas de autoexamen cutáneo en dermatólogos chilenos / Cutaneous self-examination behaviors in Chilean dermatologistc

La incidencia de cáncer de piel ha aumentado, por lo que la detección precoz puede ser beneficiosa. Se ha sugerido que los dermatólogos son una población de alto riesgo para desarrollar cáncer de piel. El objetivo de este estudio es evaluar la frecuencia de autoexamen, consulta dermatológica y cáncer de piel en un grupo de dermatólogos chilenos. Pacientes y métodos: Se confeccionó una encuesta de 8 preguntas, hecha personalmente, durante 4 meses, a 143 dermatólogos de la Sociedad Chilena de Dermatología (46,7%). Las variables analizadas fueron: sexo, edad, fototipo de Fitzpatrick, frecuencia de autoexamen, consulta a otro dermatólogo, antecedente de melanoma maligno (MM), carcinoma basocelular (CBC), carcinoma espinocelular (CEC) y queratosis actínica (QA), y razones para no realizarse examen cutáneo en forma regular. Resultados: El 60% de encuestados se hacía autoexamen, pero 48% afirmó hacerlo sólo ocasionalmente. Con respecto a si solicitan ser evaluados por otro dermatólogo, el 81% no lo hace, del 19% que si lo hace, un 69% consultaba sólo ante una lesión llamativa. Finalmente, el 17% de encuestados refirió haber tenido neoplasias cutáneas. Entre ellas 12% para QA, 5% para CBC, 2% para CEC y ningún melanoma. Conclusión: La mayoría de los dermatólogos encuestados se realiza autoexamen, pero no regularmente, y raramente hacen consultas de chequeo a sus colegas, la mayoría solicita evaluación por otro dermatólogo ante una lesión sospechosa.

Abstract: Skin cancer incidence has increased worldwide; early detection may be beneficial. Some evidence suggests dermatologists as a high-risk population for developing skin cancer. The aim of this study was to assess how often Chilean dermatologists consult with colleagues for check ups, to evaluate the frequency of self-skin examination and the frequency of skin cancer in this group. Patients and methods: A sample of 143 members (46,7%) of the Chilean Society of Dermatology responded an eight items questionnaire, in a face-to-face manner. Evaluated variables were: sex, age, Fitzpatrick phototype, self-skin examination frequency, frequency for consult s with another dermatologist, previous history of malignant melanoma, basal cell carcinoma, squamous cell carcinoma and actinic keratosis, and reasons to perform or not in themselves regular skin examination. Results: 60% performed regular self-skin examination, but only 48% did it regularly. Concerning whether they consulted another dermatologist, 81% didn´t, and between the 19% who do consult, 69% of them consulted only in case of a suspicious lesion. Finally, 17% of the surveyed people referred history of skin cancer. 12% were actinic keratosis, 5% basal cell carcinoma, 2% squamous cell carcinoma and no melanoma was declared. Conclusion: Most of surveyed dermatologists perform occasional self-skin examination, and rarely do regular check ups with colleagues, most of them consulted another dermatologist only if a suspicious lesion was found.

[Skin manifestations in adults with a liver allograft]. / Manifestaciones cutáneas en adultos con trasplante hepático del Hospital Clínico de la Universidad de Chile.

BACKGROUND: Skin manifestations after liver transplantation are increasing due to long term immunosuppressive therapy along with an increase in patient survival. Several studies have reported dermatologic complications following renal transplant, but few have studied dermatologic problems after liver transplantation. AIMS: To describe the different types of cutaneous lesions encountered in adults receiving a liver allograft. To evaluate the frequency of cutaneous manifestations of patients in the liver transplant waiting list. MATERIAL AND METHODS: Eighty patients submitted to a liver transplant and 70 patients in the liver transplant waiting list were evaluated with a complete dermatological physical examination. RESULTS: Sixty one percent of patients with a liver allograft had at least one skin manifestation. Of these, 34% had superficial fungal infections, 31% had viral infections, 20% had cutaneous side effects due to immunosuppressive treatment, 10% had malignant lesions, 2% had bacterial infections and one patient had a graft versus host disease. Only 28% of patients in the liver transplant waiting list had dermatologic problems, and the vast majority were lesions linked to liver cirrhosis. CONCLUSIONS: Cutaneous infections were the most common skin problems in liver transplant patients. Although neoplastic lesions are the most commonly mentioned lesions in the literature, only a 10% of our liver transplant patients presented these type of lesions.

Manifestaciones cutáneas en adultos con trasplante hepático del Hospital Clínico de la Universidad de Chile / Skin manifestations in adults with a liver allograft

Background: Skin manifestations after liver transplantation are increasing due to long term immunosuppressive therapy along with an increase in patient survival. Several studies have reported dermatologic complications following renal transplant, but few have studied dermatologic problems after liver transplantation. Aims: To describe the different types of cutaneous lesions encountered in adults receiving a liver allograft. To evaluate the frequency of cutaneous manifestations of patients in the liver transplant waiting list. Material and Methods: Eighty patients submitted to a liver transplant and 70 patients in the liver transplant waiting list were evaluated with a complete dermatological physical examination. Results: Sixty one percent of patients with a liver allograft had at least one skin manifestation. Of these, 34% had superficial fungal infections, 31% had viral infections, 20% had cutaneous side effects due to immunosuppressive treatment, 10% had malignant lesions, 2% had bacterial infections and one patient had a graft versus host disease. Only 28% of patients in the liver transplant waiting list had dermatologic problems, and the vast majority were lesions linked to liver cirrhosis. Conclusions: Cutaneous infections were the most common skin problems in liver transplant patients. Although neoplastic lesions are the most commonly mentioned lesions in the literature, only a 10% of our liver transplant patients presented these type of lesions.

Especies del género malassezia aisladas en pacientes con psoriasis y sujetos controles sanos / Species of the genus Malassezia isolated in patients with psoriasis and healthy control subjects

La Psoriasis es una enfermedad crónica de la piel, de etiología y patogenia aún desconocida. Se ha propuesto una posible asociación entre la levadura Malassezia y la exacerbación de lesiones cutáneas en pacientes con psoriasis. OBJETIVO: Determinar frecuencia y distribución de especies de Malassezia en pacientes con psoriasis y en un grupo control sano. MATERIAL Y MÉTODO: Se evaluaron 25 pacientes con psoriasis y 55 sanos como grupo control. Se recolectó muestras de piel de 4 sitios anatómicos y se realizó un examen microscópico directo (EMD) con recuento de levaduras y cultivo en medio de Dixon modificado. Las levaduras aisladas se identificaron según características macro y micromorfológicas y pruebas bioquímicas. RESULTADOS: Un total de 396 muestras de escamas de piel de 4 sitios anatómicos obtenidas de 80 pacientes (55 sanos y 25 con psoriasis). Un 67,5% (54/80) de los pacientes presentaron un EMD positivo y la tasa de recuperación por cultivo fue 58,7% (47/80). De las 396 muestras analizadas, un 28 % (111/396) fueron positivas al EMD y un 25,2% (100/396) al cultivo. Las especies aisladas fueron: M. furfur, M. globosa, M. slooffiae y M. sympodialis. CONCLUSIONES: La presencia de Malassezia en la muestra global fue 77,5 %. El sitio anatómico más afectado fue espalda y pecho y las especies identificadas corresponden a las descritas en la literatura internacional, en sujetos sanos y con psoriasis, pero con diferente frecuencia. Se requerirán estudios adicionales para ayudar a dilucidar el posible rol de Malassezia en la exacerbación de lesiones en los pacientes con psoriasis.

Psoriasis is a chronic skin disease of unknown etiology. A possible association between psoriasis exacerbation and Malassezia species has been proposed. AIM: To determine the frequency and distribution of Malassezia species in psoriasis patients and a healthy control group. MATERIAL AND METHODS: 25 psoriatic patients and 55 healthy controls were studied. In each one of them skin scrapings samples were collected, from 4 anatomical sites. KOH yeast count and culture in modified Dixon agar were done. The isolated yeasts were identified according to macroscopic, microscopic and physiologic features. RESULTS: In 80 patients (55 healthy and 25 psoriatic), a total of 396 skin scrapings samples from 4 different anatomical sites were obtained. A total of 67.5% of the patients presented a positive KOH, and the recovery rate per culture was 58.7%. Out of the 396 analyzed samples, 28% (111/396) resulted positive to microscopic examination and 25,2% (100/396) positive on culture. The isolated species were: M. furfur, M globosa, M. slooffiae y M. sympodialis. CONCLUSIONS: The global frequency of Malassezia in the studied sample was 77.5%. It was more frequently detected on the posterior trunk and chest. We found the same species reported worldwide, in healthy and psoriatic patients, but in different frequency. Further research will be needed to clarify a possible role of this yeast on the exacerbation of skin lesions in psoriatic patients.

High-resolution color Doppler ultrasound of a caliber-persistent artery of the lip, a simulator variant of dermatologic disease: case report and sonographic findings.

BACKGROUND: Caliber-persistent labial artery (CPLA) is a vascular anomaly in which a primary artery penetrates the submucosa without caliber loss. It presents as an asymptomatic papular lesion, usually on the lower lip, which may be misdiagnosed as a malignant skin tumor and can cause severe bleeding during biopsy or surgery. Development of new high-resolution ultrasound equipment has improved its observation. AIM: This study was undertaken to assess the scope of ultrasound for the diagnosis of CPLA. METHODS: We report a case of a 65-year-old woman with a nodule involving the lower lip, initially misdiagnosed as a malignant skin tumor. Diagnosis was confirmed by high-resolution color Doppler ultrasound using a compact linear probe that generates frequencies of 7-15 MHz. RESULTS: The clinical presentation of the lesion, ultrasound technique, and sonographic findings are described. A current literature review of CPLA diagnosis was performed. Clinical and sonographic images are given as examples. CONCLUSIONS: High-resolution color Doppler ultrasound is a reliable noninvasive technique for CPLA diagnosis. It allows direct visualization of this vascular variant in real time without the use of an intravenous contrast agent. It may avoid surgical complications and help in the differential diagnosis. Newer high-resolution equipment allows a clear definition of the cutaneous and muscular layers, as well as the vascularity of the lips.

Campaña de educación y detección del cáncer a la piel / Campaign of education and detection of skin cancer

En Octubre de 2002, nuestro Servicio lanzó una campaña de tres días de duración, denominada Exposol, dirigida a educar sobre los riesgos de la exposición solar y a la detección precoz del cáncer de piel en Santiago. Un total de 2.378 personas asistieron a la campaña. Ochocientas noventa y cinco personas fueron evaluadas por dermatólogos al referir lesiones sospechosas de ellos, un 9 por ciento presentaban, clínicamente, lesiones cutáneas de aspecto maligno. Nuestros resultados son similares a publicaciones internacionales. Campañas de este tipo pueden ayudar a disminuir las cifras de incidencia de cáncer de piel, pero deben realizarse esfuerzos adicionales y continuos para llegar con este mensaje a la mayor cantidad de la población.