Teledermatología asincrónica a través de WhatsApp®: experiencia en la Pontificia Universidad Católica de Chile

Background: In Chile, there is little access to Dermatology outpatient consultations in the public health care system, which has favored the development of tele dermatology (TD). Aim: To assess satisfaction levels of primary care providers with a TD channel via the social networking app WhatsApp® and the concordance between the diagnosis of general practitioners and dermatologists at Pontificia Universidad Católica de Chile. Material and Methods: An electronic survey was answered by the general practitioners who participate in the TD channel. In 417 cases, the diagnostic concordance between general practitioners and specialists was assessed. Results: The survey was answered by 84 practitioners. General satisfaction levels with the platform were over 95%. Satisfaction levels with the response speed and the management suggested by the specialist were over 90%. Over 80% of the practitioners read the consultation sent by dermatologists and considered that their dermatological knowledge improved. Diagnostic concordance between practitioners and specialists was 41%. Conclusions: TD via a WhatsApp® group linked to a university is a low cost and easy to implement intervention, generating high levels of satisfaction among general practitioners.

[Assessment of an asyncronic tele dermatology system for primary care physicians via social networking app WhatsApp]. / Teledermatología asincrónica a través de WhatsApp®: experiencia en la Pontificia Universidad Católica de Chile.

BACKGROUND: In Chile, there is little access to Dermatology outpatient consultations in the public health care system, which has favored the development of tele dermatology (TD). AIM: To assess satisfaction levels of primary care providers with a TD channel via the social networking app WhatsApp® and the concordance between the diagnosis of general practitioners and dermatologists at Pontificia Universidad Católica de Chile. MATERIAL AND METHODS: An electronic survey was answered by the general practitioners who participate in the TD channel. In 417 cases, the diagnostic concordance between general practitioners and specialists was assessed. RESULTS: The survey was answered by 84 practitioners. General satisfaction levels with the platform were over 95%. Satisfaction levels with the response speed and the management suggested by the specialist were over 90%. Over 80% of the practitioners read the consultation sent by dermatologists and considered that their dermatological knowledge improved. Diagnostic concordance between practitioners and specialists was 41%. CONCLUSIONS: TD via a WhatsApp® group linked to a university is a low cost and easy to implement intervention, generating high levels of satisfaction among general practitioners.

[Aseptic techniques for minor surgical procedures]. / Actualización en técnica aséptica y uso de antibióticos profilácticos en procedimientos quirúrgicos ambulatorios que comprometan piel y mucosas: An update.

Aseptic techniques are those practices designed to reduce the risk of surgical site infection (SSI), defined as such, all those that occur within the first 30 days of the procedure. While the patient’s risk of developing an SSI in dermatologic surgery is low since many of the procedures are considered sterile, there are different factors associated with an increased or decreased risk of developing SSI. The characteristics of the surgical wound (such as involving infected or inflamed tissue or when breaks in the aseptic technique occur), patient characteristics (such as age, comorbidities, medication use and smoking) and procedure factors (such as setting, surgical technique, type of procedure, duration and body region involved). In this article we discuss the management of potential sources of infections such as personnel (hand washing, dressing), preparation of the patient, maintenance of a clean surgical environment, sterilization and the use of antiseptic solutions. Similarly, the current indications for prophylactic antibiotics for these procedures are considered.

Actualización en técnica aséptica y uso de antibióticos profilácticos en procedimientos quirúrgicos ambulatorios que comprometan piel y mucosas / Aseptic techniques for minor surgical procedures: an update

Aseptic techniques are those practices designed to reduce the risk of surgical site infection (SSI), defined as such, all those that occur within the first 30 days of the procedure. While the patient’s risk of developing an SSI in dermatologic surgery is low since many of the procedures are considered sterile, there are different factors associated with an increased or decreased risk of developing SSI. The characteristics of the surgical wound (such as involving infected or inflamed tissue or when breaks in the aseptic technique occur), patient characteristics (such as age, comorbidities, medication use and smoking) and procedure factors (such as setting, surgical technique, type of procedure, duration and body region involved). In this article we discuss the management of potential sources of infections such as personnel (hand washing, dressing), preparation of the patient, maintenance of a clean surgical environment, sterilization and the use of antiseptic solutions. Similarly, the current indications for prophylactic antibiotics for these procedures are considered.

[Acute generalized exanthematous pustulosis associated with Mycoplasma pneumoniae infection: a case report]. / Pustulosis exantemática generalizada aguda asociada a Mycoplasma pneumoniae: reporte de un caso.

Acute generalized exanthematous pustulosis is an uncommon skin eruption, characterized by fever and the rapid onset of disseminated, non-follicular, sterile pustules, over an erythematous skin background. It is usually classified as a severe cutaneous adverse drug reaction, whose most relevant triggers are antibiotics and anticonvulsants. However, viral and bacterial infections have also rarely been associated with this dermatosis. We report the case of a patient, who developed lesions of acute generalized exanthematous pustulosis as an extrapulmonary manifestation of Mycoplasma pneumoniae infection.

Pustulosis exantemática generalizada aguda asociada a Mycoplasma pneumoniae: reporte de un caso / Acute generalized exanthematous pustulosis associated with Mycoplasma pneumoniae infection: a case report

Acute generalized exanthematous pustulosis is an uncommon skin eruption, characterized by fever and the rapid onset of disseminated, non-follicular, sterile pustules, over an erythematous skin background. It is usually classified as a severe cutaneous adverse drug reaction, whose most relevant triggers are antibiotics and anticonvulsants. However, viral and bacterial infections have also rarely been associated with this dermatosis. We report the case of a patient, who developed lesions of acute generalized exanthematous pustulosis as an extrapulmonary manifestation of Mycoplasma pneumoniae infection.

Vasculitis periflexual como manifestación de primoinfección por parvovirus B19: a propósito de un caso / Periplexual vasculitis as a manifestation of primary infection by parvovirus B19: about a case

La infección por parvovirus B19 es común, siendo más recurrente en la edad escolar, invierno y primavera, y su seroprevalencia alcanza hasta el 85% en adultos mayores. La presentación típica de la infección por este virus se conoce como eritema infeccioso (o "quinta enfermedad", destacando la afectación facial característica y la erupción reticulada), sin embargo, se han reportado múltiples manifestaciones dermatológicas de la infección por el virus. Paciente de 17 años, con antecedente de migraña, que desarrolló máculas y pápulas eritematoso-violáceas confluentes con petequias, predominando en pliegues antecubital, poplíteo e inguinal y cara lateral del tórax, con menor compromiso abdominal, espalda y muslos. La biopsia de la piel y los exámenes de laboratorio fueron compatibles con vasculitis leucocitoclástica secundaria a infección por parvovirus B19. Se han descrito diferentes patrones de la manifestación cutánea de la infección por parvovirus B19. La paciente del caso clínico expuesto desarrolló un rash cutáneo que constituyó una superposición entre el patrón vasculítico y el periflexural, presentación poco descrita en la literatura.

Parvovirus B19 infection is common, being more typical among school-age children, with seasonal changes. Infectious erythema (or 'fifth disease') is the classic manifestation of this viral infection; however, multiple dermatological manifestations of the virus infection have been reported. An otherwise healthy 17-year-old female patient, developed confluent erythematous-violaceous macules and papules with petechiae. They mainly involved the antecubital, popliteal and inguinal crease and lateral thorax. The lower abdomen, back and thighs were less involved. The skin biopsy and laboratory workup showed leukocytoclastic vasculitis and positive reaction for parvovirus B19, respectively. A variety of patterns have been described related to the cutaneous manifestation of parvovirus B19 infection. In the present case, the patient developed a cutaneous rash that constituted an overlap between the vasculitic and the periflexural patterns. This variant of parvovirus B19 infection has not been frequently described in literature.

Oral and written counseling is a useful instrument to improve short-term adherence to treatment in acne patients: a randomized controlled trial.

BACKGROUND: Therapeutic success in acne patients not only depends on the appropriate selection of drugs but also on the patient's treatment adherence or compliance. Lack of adherence is an important problem both in general medicine and in dermatologic practice. OBJECTIVE: To evaluate the impact of oral and written counseling on treatment adherence among acne patients. PATIENTS AND METHODS: Eighty patients were randomized into two groups of 40 patients each. The intervention group received a patient information leaflet (apart from oral counseling), and instructions were reinforced by a telephone call within 15 days of treatment onset. The second group (control group) received treatment indications as usual (oral counseling in-office only). Both groups were followed up with a phone call, evaluating adherence to treatment according to self-reporting of patients at 30, 60, 90 days, and 6 months. RESULTS: Better adherence to treatment was observed in the intervention group. This difference was significant only within the first month of treatment (80% versus 62%, p = 0.043). The beneficial effect of written counseling plus a phone call decreased in subsequent months. CONCLUSION: Written counseling significantly improves adherence within the first month of treatment. These results suggest that it is reasonable to spend time and resources in written counseling in order to optimize adherence to treatment.

Cellular neurothekeoma: case report and its (un) relation with nerve sheath myxoma.

Neurothekeoma is an uncommon, benign neoplasm presenting in young adults, primarily on the head and neck. It was initially related to nerve sheath myxoma but with the advent of immunohistochemistry, new insights into its cellular differentiation and origin have emerged, unlinking Neurothekeoma and nerve sheath myxoma. Herein we describe a 19-year-old male who had had a frontal, flesh-colored, asymptomatic papule for 2 years. Histology showed a dermal fusocellular-spindle cell tumor, including an eosinophilic cytoplasm with mild cellular pleomorphism and moderately dense fibrous stroma. IHQ was positive for CD10 and negative for S100 and Claudin-1. These findings were compatible with cellular Neurothekeoma. The lesion was completely extirpated and at the 6-month follow-up, the patient was asymptomatic and had experienced no recurrences.

Cellular neurothekeoma: case report and its (un) relation with nerve sheath myxoma

Neurothekeoma is an uncommon, benign neoplasm presenting in young adults, primarily on the head and neck. It was initially related to nerve sheath myxoma but with the advent of immunohistochemistry, new insights into its cellular differentiation and origin have emerged, unlinking Neurothekeoma and nerve sheath myxoma. Herein we describe a 19-year-old male who had had a frontal, fl esh-colored, asymptomatic papule for 2 years. Histology showed a dermal fusocellular-spindle cell tumor, including an eosinophilic cytoplasm with mild cellular pleomorphism and moderately dense fi brous stroma. IHQ was positive for CD10 and negative for S100 and Claudin-1. These fi ndings were compatible with cellular Neurothekeoma. The lesion was completely extirpated and at the 6-month follow-up, the patient was asymptomatic and had experienced no recurrences.

Eritema flagelado / Flagellate erythema

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Características de la piel del adulto mayor y condiciones dermatológicas asociadas a la edad: revisión de la literatura / Skin characteristics of the elderly and dermatological conditions associated with age: review

Consideramos adultos mayores a aquellas personas de 65 años o más. En el contexto de la transición demográfica experimentada durante los últimos años, tanto a nivel global como también en nuestro país, una cada vez más importante proporción de la población pertenece a este grupo etario. Al igual que en otros órganos, el proceso de envejecimiento tiene sus repercusiones a nivel cutáneo. Se experimentan cambios importantes en la estructura y en distintas funciones de la piel, como por ejemplo, en la permeabilidad, angiogénesis, la función de barrera, la lipogénesis, función inmune, cicatrización, la capacidad de producir vitamina D y la sudoración. El rol del daño acumulativo por radiación UV y otras noxas ambientales tiene especial relevancia en estas alteraciones. Lo anterior contribuye a que la población geriátrica presente con mayor frecuencia ciertas condiciones cutáneas o afecciones dermatológicas, como xerosis, dermatitis de contacto, úlceras por presión, alteraciones ungueales, alopecia, las reacciones adversas a medicamentos y las enfermedades ampollares. Considerando el aumento en número de estos pacientes, su mayor complejidad en términos globales y la alta prevalencia de patologías dermatológicas de este grupo etario, es relevante mantener actualizados nuestros conocimientos sobre los problemas dermatológicos más relevantes en el adulto mayor y su tratamiento, razón por la cual hemos realizado esta revisión de la literatura.

Geriatric population consider those individuals of 65 years or older. In the context of demographic transition in recent years, both globally and in our country, an increasingly large proportion of the population belong to this age group. As in other organs, the aging process has its effects on the skin. Important changes occur in the structure and various functions of the skin, such as the permeability, angiogenesis, barrier function, lipogenesis, immune function, wound healing, the ability to produce vitamin D, and sweating. The role of cumulative UV damage and other environmental noxas is particularly relevant in these alterations. This contributes to the fact that geriatric population present most frequently certain skin conditions such as xerosis, contact dermatitis, pressure ulcers, nail changes, alopecia, adverse drug reactions and bullous diseases. Considering the increasing number of these patients, the over complexity in global terms and the high prevalence of dermatological diseases in this age group, it is important to keep updated our knowledge about the most important dermatological problems in the elderly and its treatment; that is the reason why we conducted this review.