RESUMO
Currently, ulcerative sexually transmitted infections, including syphilis, herpes simplex virus (HSV), lymphogranuloma venereum (LGV), chancroid, donovanosis and, more recently, monkeypox (MPOX), represent a growing challenge for health care professionals. The incidence of syphilis and LGV has increased in recent years in Spain. Additionally, HSV, syphilis and chancroid can also increase the risk of HIV acquisition and transmission. The population groups most vulnerable to these infections are young people, men who have sex with men (MSM) and commercial sex workers. It is important to make a timely differential diagnosis since genital, anal, perianal, and oral ulcerative lesions may pose differential diagnosis with other infectious and non-infectious conditions such as candidiasis vulvovaginitis, traumatic lesions, carcinoma, aphthous ulcers, Behçet's disease, fixed drug eruption, or psoriasis. For this reason, the dermatologist plays a crucial role in the diagnosis and management of sexually transmitted infections. This chapter presents the main epidemiological, clinical and therapeutic features associated with these infections.
RESUMO
BACKGROUND AND OBJECTIVE: Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is a complex multisystemic severe drug hypersensitivity reaction whose diagnosis and management are troublesome. DRESS syndrome requires management by various specialists. The correct identification of the culprit drug is essential to ensure safe future therapeutic options for the patient. There are no previous Spanish guidelines or consensus statements on DRESS syndrome. Objective: To draft a review and guidelines on the clinical diagnosis, allergy work-up, management, treatment, and prevention of DRESS syndrome in light of currently available scientific evidence and the experience of experts from multiple disciplines. METHODS: These guidelines were drafted by a panel of allergy specialists from the Drug Allergy Committee of the Spanish Society of Allergy and Clinical Immunology (SEAIC), together with other medical specialists involved in the management of DRESS syndrome and researchers from the PIELenRed consortium. A review was conducted of scientific papers on DRESS syndrome, and the expert panel evaluated the quality of the evidence of the literature and provided grades of recommendation. Whenever evidence was lacking, a consensus was reached among the experts. RESULTS: The first Spanish guidelines on DRESS syndrome are now being published. Important aspects have been addressed, including practical recommendations about clinical diagnosis, identification of the culprit drug through the Spanish pharmacovigilance system algorithm, and the allergy work-up. Recommendations are provided on management, treatment, and prevention. Algorithms for the management of DRESS in the acute and recovery phases have been drawn up. Expert consensus-based stepwise guidelines for the management and treatment of DRESS syndrome are provided.
Assuntos
Síndrome de Hipersensibilidade a Medicamentos/diagnóstico , Fígado/metabolismo , Pele/patologia , Algoritmos , Alopurinol/efeitos adversos , Antibacterianos/efeitos adversos , Anticonvulsivantes/efeitos adversos , Comorbidade , Consenso , Síndrome de Hipersensibilidade a Medicamentos/tratamento farmacológico , Síndrome de Hipersensibilidade a Medicamentos/epidemiologia , Eosinofilia , Prova Pericial , Humanos , Leucocitose , Fígado/patologia , Fatores de Risco , Espanha/epidemiologiaAssuntos
Síndrome de Hipersensibilidade a Medicamentos , Mieloma Múltiplo , Alopurinol/efeitos adversos , Síndrome de Hipersensibilidade a Medicamentos/diagnóstico , Síndrome de Hipersensibilidade a Medicamentos/etiologia , Humanos , Mieloma Múltiplo/diagnóstico , Mieloma Múltiplo/tratamento farmacológico , Talidomida/efeitos adversosAssuntos
Síndromes Mielodisplásicas/complicações , Tratamento de Ferimentos com Pressão Negativa/instrumentação , Pioderma Gangrenoso/complicações , Ustekinumab/uso terapêutico , Anticorpos Monoclonais Humanizados/uso terapêutico , Fármacos Dermatológicos/uso terapêutico , Humanos , Masculino , Pessoa de Meia-Idade , Síndromes Mielodisplásicas/tratamento farmacológico , Síndromes Mielodisplásicas/patologia , Pioderma Gangrenoso/tratamento farmacológico , Pioderma Gangrenoso/patologia , Resultado do Tratamento , Ustekinumab/administração & dosagemRESUMO
The incidence of anal squamous cell carcinoma has increased alarmingly, particularly in high-risk groups such as men who have sex with men and immunosuppressed patients. Infection with an oncogenic strain of the human papillomavirus in the anal canal or perianal skin leads to anal intraepithelial neoplasias (AIN), progressive dysplastic intraepithelial lesions that are the precursors of anal squamous cell carcinoma. AIN can be diagnosed through cytological screening and biopsy guided by high-resolution anoscopy and can be treated using a range of procedures in an effort to prevent progression to invasive anal carcinoma. Given the recent advances in the understanding of this disease, and the increasing calls from experts for the establishment of screening programs to identify AIN, we review current knowledge on the condition, its diagnosis, and treatment from the point of view of dermatology.
Assuntos
Neoplasias do Ânus/diagnóstico , Carcinoma in Situ/diagnóstico , Carcinoma de Células Escamosas/diagnóstico , Diagnóstico Precoce , Algoritmos , Alphapapillomavirus/patogenicidade , Terapia Antirretroviral de Alta Atividade , Neoplasias do Ânus/epidemiologia , Neoplasias do Ânus/patologia , Neoplasias do Ânus/virologia , Biópsia , Carcinoma in Situ/epidemiologia , Carcinoma in Situ/patologia , Carcinoma in Situ/virologia , Carcinoma de Células Escamosas/epidemiologia , Carcinoma de Células Escamosas/patologia , Carcinoma de Células Escamosas/prevenção & controle , Carcinoma de Células Escamosas/virologia , Comorbidade , Suscetibilidade a Doenças , Previsões , Infecções por HIV/tratamento farmacológico , Infecções por HIV/epidemiologia , Humanos , Hospedeiro Imunocomprometido , Incidência , Programas de Rastreamento , Infecções por Papillomavirus/diagnóstico , Infecções por Papillomavirus/epidemiologia , Lesões Pré-Cancerosas/diagnóstico , Proctoscopia , Risco , Comportamento SexualRESUMO
BACKGROUND: Dermatologic care was halted because of the coronavirus disease 2019 pandemic, prompting us to study the usefulness of direct-to-patient teledermatology via a mobile application. We aimed to evaluate the service as a tool for avoiding face-to-face consultations, describe the main conditions diagnosed, and assess levels of patient and physician satisfaction. MATERIAL AND METHOD: Prospective descriptive study of new patients who met the inclusion criteria. Descriptive statistics for all variables were analyzed with SPSS. RESULTS: Of the 1,497 patients who agreed to participate in the study, 25% (n=374) sent an image to a consultant dermatologist through the mobile application. Sixty-four patients (17%) were discharged directly and referred to primary care for follow-up. A face-to-face consultation was avoided for at least 3 months in 85% of patients (n=318); 87.1% (n=325) received a diagnosis and the dermatologist's level of confidence in this diagnosis was 7 or higher in 77.5% of cases (n=290). The quality of the images sent was considered sufficient in 52.1% of cases. Patients rated their satisfaction with a score of 4.5 out of 5. Eleven of the 16 dermatologists rated their satisfaction as good overall. The most common conditions were inflammatory and melanocytic lesions. The main diagnoses were nevi, acne, and eczema. DISCUSSION: Direct-to-patient store-and-forward teledermatology is an effective means of evaluating new patients. Both clinicians and patients expressed high levels of satisfaction with the service. Systems enabling the addition of digital images to patient records are necessary to ensure the efficiency of teledermatology.
Assuntos
COVID-19 , Dermatologia/tendências , Consulta Remota/tendências , Dermatopatias , Telemedicina/tendências , Controle de Doenças Transmissíveis , Humanos , Projetos Piloto , Estudos Prospectivos , Dermatopatias/diagnóstico , EspanhaRESUMO
BACKGROUND/AIM: Extramammary Paget's disease (EMPD) is an intraepidermal adenocarcinoma of apocrine gland-bearing skin. Although surgery remains the mainstay of treatment, loss of tissue function and high recurrence rates have been reported. Recently, topical Imiquimod has been shown as a safe and effective treatment option for extramammary Paget's disease. METHODS: Three patients diagnosed of EMPD of the vulva were treated with a daily application of 5% Imiquimod cream for three weeks, followed by an every other day application for an additional three weeks. RESULTS: Complete clinical and histological remission of the disease was achieved in the three patients. Mild irritation and tenderness were observed as the only side effects. CONCLUSION: Based on our results, we consider that Imiquimod cream is a safe and effective therapeutic option for the treatment of vulvar EMPD. These promising results warrant further studies to determine the real efficacy and safety of Imiquimod 5% cream for the treatment of this uncommon disease.
Assuntos
Aminoquinolinas/administração & dosagem , Antineoplásicos/administração & dosagem , Doença de Paget Extramamária/tratamento farmacológico , Neoplasias Cutâneas/tratamento farmacológico , Neoplasias Vulvares/tratamento farmacológico , Administração Tópica , Idoso , Idoso de 80 Anos ou mais , Aminoquinolinas/efeitos adversos , Antineoplásicos/efeitos adversos , Esquema de Medicação , Feminino , Humanos , Imiquimode , Pessoa de Meia-Idade , Indução de RemissãoRESUMO
PURPOSE: The purpose of this paper is to describe the frequency and characteristics of uveitis associated with juvenile idiopathic arthritis at a tertiary referral centre in Spain. METHODS: Review of clinical records. 205 children diagnosed with chronic juvenile arthritis over the last 15 years, of whom 26 presented anterior uveitis. Patients were classified according to their pattern of evolution, the time the uveitis was diagnosed with respect to the onset of arthritis, and the severity of uveitis at diagnosis. RESULTS: The prevalence of uveitis was 12.7%. Of the patients affected with uveitis 71% were girls. The average age at which the arthritis was diagnosed was significantly earlier in the group of patients who developed uveitis (4.06 years). No differences were observed in the incidence of uveitis in girls and boys, nor in pauci/polyarticular affectation. ANA positivity was found in 84.6% of the uveitis-affected patients, this being significantly different to the ANA- group. The average age at which uveitis was diagnosed is 5.87 years. 48.1% of uveitis patients develop uveitis within 12 months of the onset of arthritis. This group presented more complications during the evolution of the condition. A total of 84.7% of the uveitis-affected patients presented with a final visual acuity of >0.5 during the observation period. CONCLUSIONS: In our study, the development of uveitis was significantly associated with an earlier age of diagnosis of the arthritis and with the presence of ANA positivity. No differences were observed between boys and girls, or between pauci and polyarticular groups. A greater prevalence of complications was observed in cases presenting with a shorter time interval between the diagnosis of arthritis and uveitis and in those that presented with complications on diagnosis.
Assuntos
Artrite Juvenil , Uveíte , Fatores Etários , Artrite Juvenil/complicações , Artrite Juvenil/diagnóstico , Artrite Juvenil/epidemiologia , Catarata/diagnóstico , Criança , Pré-Escolar , Interpretação Estatística de Dados , Feminino , Glaucoma/diagnóstico , Humanos , Masculino , Prevalência , Fatores Sexuais , Espanha/epidemiologia , Fatores de Tempo , Uveíte/complicações , Uveíte/diagnóstico , Uveíte/epidemiologia , Acuidade VisualAssuntos
Dermatoses do Pé/diagnóstico , Ceratose/etiologia , Melanose/etiologia , Tungíase/diagnóstico , Adulto , Animais , Antibioticoprofilaxia , Dermoscopia , Feminino , Dermatoses do Pé/parasitologia , Dermatoses do Pé/cirurgia , Humanos , Quênia/etnologia , Ceratose/diagnóstico , Ceratose/parasitologia , Masculino , Melanose/diagnóstico , Melanose/parasitologia , Óvulo , Tunga , Tungíase/complicações , Tungíase/cirurgiaAssuntos
Aminoquinolinas/administração & dosagem , Antineoplásicos/administração & dosagem , Doença de Paget Extramamária/tratamento farmacológico , Neoplasias Vulvares/tratamento farmacológico , Idoso , Idoso de 80 Anos ou mais , Formas de Dosagem , Feminino , Humanos , Imiquimode , Pessoa de Meia-Idade , Indução de RemissãoRESUMO
CASE REPORT: A six-year-old boy presented with proptosis of the right eye. Imaging studies detected a mass in the medial wall of the right orbit. This mass was biopsied revealing a histopathologic diagnosis of primitive neuroectodermal tumor, so chemotherapy treatment was given. After seven years in remission he presented with a recurrence of the orbital tumor and was found to also have systemic metastases. Treatment with chemotherapy, radiotherapy and orbital exenteration was unsuccessful. DISCUSSION: The orbital occurrence of these tumors is extremely rare. Differentiation from other small round cell tumors requires immunohistochemical and ultrastructural techniques.
Assuntos
Recidiva Local de Neoplasia/diagnóstico , Tumores Neuroectodérmicos Primitivos Periféricos/diagnóstico , Tumores Neuroectodérmicos Primitivos Periféricos/secundário , Neoplasias Orbitárias/diagnóstico , Neoplasias Orbitárias/patologia , Criança , Humanos , MasculinoRESUMO
ANTECEDENTES: Como consecuencia de la pandemia por la COVID-19 cesó la actividad dermatológica asistencial, por lo que iniciamos un estudio para evaluar la utilidad de la teledermatología (TD) directa entre paciente y dermatólogo a través de una App. El objetivo fue evaluar el impacto de esta herramienta para evitar consultas presenciales, así como describir los principales diagnósticos y la satisfacción de pacientes y médicos. MATERIAL Y MÉTODO: Estudio descriptivo prospectivo. Se incluyen pacientes nuevos que cumplen criterios de inclusión. Se realizó un análisis descriptivo de todas las variables mediante el programa estadístico SPSS. RESULTADOS: De los 1.497 pacientes que aceptaron participar el 25% (n = 374) enviaron una consulta virtual con imagen. De entre ellos el 17% (n = 64) fueron dados de alta de forma directa para control por atención primaria. En un 85% (n=318) de los pacientes se logra evitar la consulta presencial durante al menos 3 meses. Se emitió un diagnóstico en el 87,1% (n = 325) de los pacientes, siendo la confianza en el diagnóstico ≥ 7/10 en el 77,5% (n = 290). La calidad de la imagen fue suficiente en el 52,1%. La satisfacción del paciente fue de 4,5/5. Once de 16 dermatólogos consideraron la TD útil globalmente. La afección más frecuente fue la inflamatoria y melanocítica, siendo los diagnósticos más habituales nevus, acné y eccema. DISCUSIÓN:La TD directa asíncrona es una herramienta eficaz para valorar pacientes nuevos, con un alto grado de satisfacción para médicos y pacientes. El desarrollo de un sistema de TD eficiente implica la integración de la imagen digital en los sistemas de información médicos
BACKGROUND: Dermatologic care was halted because of the coronavirus disease 2019 pandemic, prompting us to study the usefulness of direct-to-patient teledermatology via a mobile application. We aimed to evaluate the service as a tool for avoiding face-to-face consultations, describe the main conditions diagnosed, and assess levels of patient and physician satisfaction. MATERIAL AND METHOD: Prospective descriptive study of new patients who met the inclusion criteria. Descriptive statistics for all variables were analyzed with SPSS. RESULTS: Of the 1,497 patients who agreed to participate in the study, 25% (n = 374) sent an image to a consultant dermatologist through the mobile application. Sixty-four patients (17%) were discharged directly and referred to primary care for follow-up. A face-to-face consultation was avoided for at least 3 months in 85% of patients (n = 318); 87.1% (n = 325) received a diagnosis and the dermatologist's level of confidence in this diagnosis was 7 or higher in 77.5% of cases (n = 290). The quality of the images sent was considered sufficient in 52.1% of cases. Patients rated their satisfaction with a score of 4.5 out of 5. Eleven of the 16 dermatologists rated their satisfaction as good overall. The most common conditions were inflammatory and melanocytic lesions. The main diagnoses were nevi, acne, and eczema. DISCUSSION: Direct-to-patient store-and-forward teledermatology is an effective means of evaluating new patients. Both clinicians and patients expressed high levels of satisfaction with the service. Systems enabling the addition of digital images to patient records are necessary to ensure the efficiency of teledermatology
Assuntos
Humanos , Teledermatologia , Dermatopatias/diagnóstico , Infecções por Coronavirus/prevenção & controle , Pneumonia Viral/prevenção & controle , Pandemias , Dermatopatias/classificação , Dermatopatias/terapia , Inquéritos e Questionários , Estudos Prospectivos , Epidemiologia Descritiva , Infecções por Coronavirus/epidemiologia , Pneumonia Viral/epidemiologia , Espanha/epidemiologiaRESUMO
BACKGROUND: Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is a complex multisystemic severe drug hypersensitivity reaction whose diagnosis and management are troublesome. DRESS syndrome requires management by various specialists. The correct identification of the culprit drug is essential to ensure safe future therapeutic options for the patient. There are no previous Spanish guidelines or consensus statements on DRESS syndrome. OBJECTIVE: To draft a review and guidelines on the clinical diagnosis, allergy work-up, management, treatment, and prevention of DRESS syndrome in light of currently available scientific evidence and the experience of experts from multiple disciplines. METHODS: These guidelines were drafted by a panel of allergy specialists from the Drug Allergy Committee of the Spanish Society of Allergy and Clinical Immunology (SEAIC), together with other medical specialists involved in the management of DRESS syndrome and researchers from the PIELenRed consortium. A review was conducted of scientific papers on DRESS syndrome, and the expert panel evaluated the quality of the evidence of the literature and provided grades of recommendation. Whenever evidence was lacking, a consensus was reached among the experts. RESULTS: The first Spanish guidelines on DRESS syndrome are now being published. Important aspects have been addressed, including practical recommendations about clinical diagnosis, identification of the culprit drug through the Spanish pharmacovigilance system algorithm, and the allergy work-up. Recommendations are provided on management, treatment, and prevention. Algorithms for the management of DRESS in the acute and recovery phases have been drawn up. Expert consensus-based stepwise guidelines for the management and treatment of DRESS syndrome are provided
ANTECEDENTES: El síndrome DRESS (Drug Reaction with Eosinophilia and Systemic Symptoms) es una reacción cutánea grave inducida por hipersensibilidad a fármacos, compleja y multisistémica. Su diagnóstico y manejo es difícil e implica a diferentes especialistas. Es muy importante una correcta identificación del fármaco responsable para que el paciente disponga de opciones terapéuticas seguras en el futuro. No hay guías ni documentos de consenso españoles previos sobre el síndrome DRESS. OBJETIVO: Realizar una revisión y guía sobre el diagnóstico clínico y alergológico, manejo, tratamiento y prevención del DRESS según la evidencia científica disponible y la experiencia de expertos de diferentes especialidades médicas. MÉTODOS: Esta guía ha sido elaborada por un grupo de alergólogos del Comité de Alergia a Fármacos de la SEAIC, junto a otros especialistas involucrados en el manejo del DRESS e investigadores del Consorcio PIELenRed. Se realizó una búsqueda de publicaciones científicas sobre DRESS y el grupo de expertos evaluó la evidencia científica de la literatura y aportaron grados de recomendación. Cuando no existía evidencia se alcanzó un consenso entre expertos. RESULTADOS: Se publica la guía española sobre DRESS. Incluye aspectos prácticos importantes sobre el diagnóstico clínico, la identificación de fármacos causales a través del algoritmo del Sistema Español de Farmacovigilancia y guía para el diagnóstico alergológico. Se realizan recomendaciones sobre el manejo, tratamiento y prevención del DRESS. Se aportan algoritmos sobre el manejo en la fase aguda y en la de recuperación. Se ha elaborado una guía terapéutica escalonada consensuada por expertos especialistas implicados en el tratamiento del DRESS
Assuntos
Humanos , Síndrome de Hipersensibilidade a Medicamentos , Síndrome de Hipersensibilidade a Medicamentos/diagnóstico , Síndrome de Hipersensibilidade a Medicamentos/prevenção & controle , Síndrome de Hipersensibilidade a Medicamentos/terapia , EspanhaRESUMO
Since our preliminary report of psoralen plus long-wave ultraviolet A (PUVA) therapy in ten patients with erythroderma-type or plaque-type mycosis fungoides (MF), we have treated 38 patients with biopsy-proved MF. Approximately one third, mostly patients with erythroderma, received PUVA as primary therapy; the remainder had recurrent disease following electron beam irradiation or topical mechlorethamine (Mustargen) hydrochloride. Follow-up data are presented in 29 patients who completed an initial course of PUVA given two to three times weekly. A complete clinical response was observed in ten patients with plaque-type MF and seven with erythroderma without Sézary syndrome. The PUVA therapy was palliative for patients with advanced disease, in combination with other therapies. The mean observation period was approximately five years. Despite maintenance PUVA, most patients relapsed between ten and twenty months and were treated with another intensive course. Long-term maintenance therapy with PUVA was necessary to control the disease.
Assuntos
Dermatomicoses/tratamento farmacológico , Terapia PUVA , Adulto , Idoso , Dermatomicoses/patologia , Feminino , Seguimentos , Humanos , Masculino , Mecloretamina/uso terapêutico , Pessoa de Meia-Idade , Terapia PUVA/efeitos adversos , RecidivaAssuntos
Antimetabólitos Antineoplásicos/efeitos adversos , Desoxicitidina/análogos & derivados , Toxidermias/etiologia , Fluoruracila/análogos & derivados , Lúpus Eritematoso Cutâneo/induzido quimicamente , Idoso , Capecitabina , Neoplasias Colorretais/tratamento farmacológico , Desoxicitidina/efeitos adversos , Dermatoses Faciais/induzido quimicamente , Feminino , Fluoruracila/efeitos adversos , HumanosRESUMO
Streptococci are responsible for a diverse spectrum of cutaneous infections like erysipelas, impetigo, and cellulitis. Blistering distal dactylitis is an infrequent, superficial infection of the anterior fat pad of the distal portion of the finger described classically in children. We report a case of blistering distal dactylitis in an adult caused by group A beta-hemolytic streptococci that was cured with oral phenoxymethyl penicillin. Familiarity with blistering distal dactylitis should permit the dermatologist and internist to diagnose this new entity in adults.
Assuntos
Dedos/patologia , Dermatoses da Mão/microbiologia , Dermatopatias Infecciosas/microbiologia , Dermatopatias Vesiculobolhosas/microbiologia , Infecções Estreptocócicas/patologia , Adulto , Feminino , Dermatoses da Mão/patologia , Humanos , Dermatopatias Infecciosas/patologia , Dermatopatias Vesiculobolhosas/patologiaRESUMO
Two cases of pre-Sézary erythroderma of several years of evolution that evolved into Sézary syndrome are presented. The role of persistent antigenic stimulation in the development of T-cell lymphoproliferative disease in discussed. We also review the different therapeutic approach to Sézary syndrome.