[Sclerosing acral skin perineurioma: clinicopathologic study of ten cases (eight classical and two with xanthomatous changes)]. / Perineuroma esclerosante de piel acral: estudio histopatológico de diez casos (ocho clásicos y dos con cambios xantomatosos).

INTRODUCTION: Perineurioma is an infrequent and benign cutaneous neoplasm characterized by proliferation of perineurial cells. It is classified into two main types: intraneural and the extraneural or soft tissue perineurioma, in which the sclerosing variant is included. Sclerosing perineurioma is more frequently found on acral skin. Clinically, they are well-circumscribed,skin colored, nodular tumors. OBJECTIVE: Describe and communicate clinicopathologic findings from a case series of sclerosing acral perineurioma. MATERIAL AND METHODS: This is a clinical, morphological and immunohistologic case study of eight patients with the diagnosis of sclerosing perineurioma. RESULTS: It included five men and five women, with ages ranging between nine and 66 years. All of them had lesion on acral skin. At microscopy study, the lesions showed a proliferation of epithelioid and spindle-shaped perineurial cells, arranged in small aggregates and short fascicles between thickened collagen bundles. Immunohistochemistry studies revealed that the proliferating cells expressed EMA, Claudin-1 and Glut-1, and were negative for S-100 protein. CONCLUSIONS: It is important to report these infrequent skin tumors, so they can be taken into account in the differential diagnoses of acral lesions.

Identification of Mycobacterium leprae and Mycobacterium lepromatosis in Formalin-Fixed and Paraffin-Embedded Skin Samples from Mexico.

BACKGROUND: The causative agents of leprosy are the well-known Mycobacterium leprae and the newly discovered Mycobacterium lepromatosis. This agent was found in 2008, and it was found to be the cause of diffuse lepromatous leprosy in two Mexican patients. OBJECTIVE: The objective of this work was to determine if M. leprae and M. lepromatosis were present in formalin-fixed and paraffin-embedded skin samples from cases from different regions in Mexico. METHODS: A total of 41 skin samples were obtained from 11 states of Mexico. All patients' samples were diagnosed by clinical and histopathological analyses. Total DNA was isolated using a Qiagen-DNeasy blood and tissue kit and molecular identification was achieved by two semi-nested polymerase chain reactions. RESULTS: The 41 patient included 33 samples from men and 8 samples from women; 29 samples were polymerase chain reaction (PCR)-positive to Mycobacterium and 12 samples were PCR-negative. From those 29 samples, 13 were PCR-positive to M. leprae, 8 to M. lepromatosis and 8 were positive to both species. The histopathological diagnosis included; Nodular lepromatous leprosy (NLL); Diffuse lepromatous leprosy (DLL); and Borderline leprosy (BL). The 29 PCR-positive samples were classified as follow: 14 NLL, 4 DLL, and 11 BL. In the 12 samples negative to Mycobacterium, 7 showed the NLL, 2 DLL and 3 BL. CONCLUSION: These findings add evidence to the M. leprae and M. lepromatous distribution, clinical forms and participation of dual infections in Mexico.

Leishmaniasis: a review.

Leishmaniasis is caused by an intracellular parasite transmitted to humans by the bite of a sand fly. It is endemic in Asia, Africa, the Americas, and the Mediterranean region. Worldwide, 1.5 to 2 million new cases occur each year, 350 million are at risk of acquiring the disease, and leishmaniasis causes 70,000 deaths per year. Clinical features depend on the species of Leishmania involved and the immune response of the host. Manifestations range from the localized cutaneous to the visceral form with potentially fatal outcomes. Many drugs are used in its treatment, but the only effective treatment is achieved with current pentavalent antimonials.

Actinomycetoma: an update on diagnosis and treatment.

Mycetoma is a chronic infection that develops after traumatic inoculation of the skin with either true fungi or aerobic actinomycetes. The resultant infections are known as eumycetoma or actinomycetoma, respectively. Although actinomycetoma is rare in developed countries, migration of patients from endemic areas makes knowledge of this condition crucial for dermatologists worldwide. We present a review of the current concepts in the epidemiology, clinical presentation, diagnosis, and treatment of actinomycetoma.

[Tinea capitis. Dermoscopic findings in 37 patients]. / Tiña de la cabeza: descripción de los hallazgos dermatoscópicos en 37 pacientes.

BACKGROUND: Tinea capitis is a common fungal infection in children. Diagnosis is confirmed by mycological study, including direct examination of the samples with potassium hydroxide/chlorazol black and culture. Previous studies have reported the presence of "comma hairs" and "corkscrew hairs", as well as short hairs and black dots. AIMS: To describe the dermoscopic patterns in the trichoscopic examination in patients with tinea capitis. METHODS: A descriptive, observational and cross-sectional study was conducted on 37 patients with tinea capitis, studied during May, 2012, at Dr. Manuel Gea González General Hospital in Mexico, and the Instituto Dermatológico y Cirugía de Piel Dr. Huberto Bogaert Díaz, in the Dominican Republic. Clinical, mycological and dermoscopic evaluations were performed. RESULTS: Of the 37 patients included, 28 were of mixed race from Dominican Republic and 9 mixed race cases from Mexico. Seventy six percent were male and 24% female, and 94% were children. The following dermoscopic patterns were confirmed: "comma hairs" (41%), "corkscrew hairs" (22%), short hairs (49%), and black dots (33%). The presence of scales (89%), peripilar casts (46%), alopecia (65%), pustules (8%), and meliceric crusts (16%), were also observed. CONCLUSIONS: Dermoscopy in tinea capitis showed the presence of "comma hairs", and "corkscrew hairs". Scales, peripilar casts and alopecia were also found. It would be desirable to establish this diagnostic tool, particularly when an optical microscope or a mycology reference laboratory are not available.

Frequency of mixed onychomycosis with total nail dystrophy in patients attended in a Guatemalan Dermatology Center / Frecuencia de onicomicosis mixta con distrofia ungueal total en pacientes atendidos en un Centro de Dermatología de Guatemala

Introduction: Onychomycosis are fungal nail infections that can be caused by dermatophytes, non-dermatophytic molds and yeasts, which are capable of breaking down keratin. Mixed onychomycosis are a controversial subject and they are the outcome of the combination of two dermatophytes, dermatophytes/nondermatophytic molds or dermatophytes/yeast. Objetives: To determine the frequency of total dystrophic onychomycosis caused by more than one etiological agent (mixed onychomycosis) in outpatients from a Dermatologic Center in Guatemala and to establish the characteristics associated with this fungal infection. Methods: Prospective observational study from August to December of 2012. Nail samples were obtained from patients with total dystrophic onychomycosis to identify the causal agents by culture in Sabouraud dextrose and Mycosel® agar. Results: 32 of 130 patients had mixed onychomycosis. 68.5% were associated to tinea pedis. The most common association was between T. rubrum + Candida, T. rubrum + M. canis and T. rubrum + opportunist fungi. Conclusions: Mixed onychomycosis represent 25% of the total dystrophic onychomycosis in Guatemala. We observed an important relationship between diabetes and the main association was T. rubrum with Candida spp.

Introducción: Las onicomicosis son infecciones fúngicas de las uñas que pueden ser causadas por dermatofitos, mohos no dermatofitos y levaduras, que son capaces de degradar la queratina. Las onicomicosis mixtas son un tema polémico y es el resultado de la combinación de dos dermatofitos, dermatofitos / mohos no dermatofitos o dermatofitos / levadura. Objetivos: Determinar la frecuencia de la onicomicosis distrófica total causada por más de un agente etiológico (onicomicosis mixta) en pacientes ambulatorios de un Centro Dermatológico en Guatemala y establecer las características asociadas a esta infección fúngica. Métodos: Estudio observacional prospectivo de agosto a diciembre de 2012. Se obtuvieron muestras de uñas de pacientes con onicomicosis distrófica total para identificar los agentes causales en cultivo de agar dextrosa Sabouraud y Mycosel®. Resultados: 32 de 130 pacientes tenían onicomicosis mixta. 68.5% se asociaron a tinea pedis. La asociación más común fue entre T. rubrum + Candida, T. rubrum + M. canis y T. rubrum + hongos oportunistas. Conclusiones: La onicomicosis mixta representa el 25% de la onicomicosis distrófica total en Guatemala. Observamos una relación importante entre la diabetes y la asociación principal fue T. rubrum con Candida spp.

Chromoblastomycosis.

Chromoblastomycosis is a chronic, subcutaneous mycosis, characterized by verrucous nodular lesions, usually involving the legs and mainly caused by Fonsecaea, Phialophora, and Cladophialophora spp. The characteristic finding on direct examination or biopsy specimen is the presence of fumagoid cells or Medlar bodies. Chromoblastomycosis can be refractory to medical treatment. Therapeutic options include oral itraconazole, terbinafine, or 5-fluocytosine, alone or combined with surgery or cryosurgery.

Tiña de la cabeza: descripción de los hallazgos dermatoscópicos en 37 pacientes / Tinea capitis. Dermoscopic findings in 37 patients

Antecedentes. La tiña de la cabeza (tinea capitis) es la tiña más común en niños. El diagnóstico clínico se confirma con el estudio micológico, que incluye examen directo con hidróxido de potasio o negro de clorazol, así como el cultivo. Mediante dermatoscopia se ha descrito la presencia de pelos «en coma», «en sacacorchos» («tirabuzón»), además de pelos cortos y puntos negros. Objetivos. Describir los patrones dermatoscópicos que se encuentran en la exploración tricoscópica en pacientes con diagnóstico de tiña de la cabeza. Métodos. Estudio descriptivo, observacional y transversal. Se incluyeron 37 pacientes con diagnóstico de tiña de la cabeza, atendidos en el mes de mayo de 2012 en el Departamento de Dermatología del Hospital General Dr. Manuel Gea González, de México, y el Instituto Dermatológico y Cirugía de Piel Dr. Huberto Bogaert Díaz, de República Dominicana. Se llevó a cabo la evaluación clínica, micológica y dermatoscópica. Resultados. Se evaluaron 37 pacientes, 28 mulatos de República Dominicana y 9 mestizos de México, con un 76% de varones y un 24% de mujeres. El 94% de los casos fueron niños. Se corroboró la presencia de los patrones dermatoscópicos ya descritos: pelos «en coma» (41%), «en sacacorchos» (22%), cortos (49%) y puntos negros (33%); además, se constató la presencia de escamas (89%), vainas peripilares (46%), alopecia (65%), pústulas (8%) y costras melicéricas (16%). Conclusiones. El estudio dermatoscópico puede confirmar el diagnóstico de tiña de la cabeza, y complementa el estudio micológico, al encontrar pelos «en coma» y «en sacacorchos»; además, se observó la presencia de escamas, vainas peripilares y alopecia. Es deseable instaurar este método diagnóstico en lugares en los que no se cuente con un microscopio óptico o un laboratorio de micología de referencia (AU)

Background. Tinea capitis is a common fungal infection in children. Diagnosis is confirmed by mycological study, including direct examination of the samples with potassium hydroxide/chlorazol black and culture. Previous studies have reported the presence of 'comma hairs' and 'corkscrew hairs', as well as short hairs and black dots. Aims. To describe the dermoscopic patterns in the trichoscopic examination in patients with tinea capitis. Methods. A descriptive, observational and cross-sectional study was conducted on 37 patients with tinea capitis, studied during May, 2012, at Dr. Manuel Gea González General Hospital in Mexico, and the Instituto Dermatológico y Cirugía de Piel Dr. Huberto Bogaert Díaz, in the Dominican Republic. Clinical, mycological and dermoscopic evaluations were performed. Results. Of the 37 patients included, 28 were of mixed race from Dominican Republic and 9 mixed race cases from Mexico. Seventy six percent were male and 24% female, and 94% were children. The following dermoscopic patterns were confirmed: 'comma hairs' (41%), 'corkscrew hairs' (22%), short hairs (49%), and black dots (33%). The presence of scales (89%), peripilar casts (46%), alopecia (65%), pustules (8%), and meliceric crusts (16%), were also observed. Conclusions. Dermoscopy in tinea capitis showed the presence of 'comma hairs', and 'corkscrew hairs'. Scales, peripilar casts and alopecia were also found. It would be desirable to establish this diagnostic tool, particularly when an optical microscope or a mycology reference laboratory are not available (AU)