RESUMO
Background: There is controversy on the efficacy and safety of chemical peels used to treat Hispanic women with melasma. Studies evaluating superficial peels for melasma are limited due to lack of controls, blinding or objective assessment tools, poor inclusion of darker phototypes, and small sample number. Objectives: We sought to evaluate the safety and efficacy of trichloroacetic acid (TCA) peels when added to hydroquinone and tretinoin in the treatment of melasma in Hispanic women. Methods: A single blinded, prospective, split-face trial of superficial TCA peels was performed on Hispanic women with melasma. Topical hydroquinone and tretinoin were used on both sides. A total of four monthly peels were performed on one side. The relative reduction of melasma severity was evaluated using narrowband reflectance spectrophotometry (NRS), Modified Melasma Area and Severity Index (mMASI), and Global Melasma Severity Assessment (GMSA). Adverse events were monitored. Results: Thirty-three patients completed the study. Pigment intensity was reduced on both sides based on all measures. A greater improvement of mMASI and GMSA was achieved on the peeled side. Limitations: Limitations include the single-center study design with one blinded investigator. Conclusion: Based on our results, TCA peels appear to be safe and effective in augmenting treatment response on melasma patients with phototypes III and IV treated with hydroquinone and tretinoin.
RESUMO
Renal cell carcinoma (RCC) is a common genitourinary malignancy of increasing incidence and significant mortality rate. Skin metastases of RCC are considered a rare phenomenon of unfavorable outcomes. We present a 75-year-old male patient who developed a rapidly evolving lesion on his left cheek four years after undergoing a right radical nephrectomy for non-metastatic RCC. Immunohistochemistry of the skin lesion was diagnostic for cutaneous metastasis of renal clear cell carcinoma, which eventually led to the detection of internal malignancy recurrence by positron emission tomography. A new facial skin lesion may unmask the underlying recurrence of RCC.
RESUMO
BACKGROUND: The anecdotic evidence of the benefits from biologic agents for psoriasis is extensive. However, data on the efficacy of biologic agents for pustular psoriasis are limited. METHODS: To update the data on the efficacy and safety of biologic agents for the management of pustular psoriasis. A systematic review of published data regarding biologic therapies on PubMED database, used in the management of pustular psoriasis from 2012 was undertaken. RESULTS: A total of 209 articles were identified, and 43 articles were selected for inclusion. TNF-α inhibitors were used in 205 patients, and 86 patients received ustekinumab, secukinumab, brodalumab, ixekizumab and IL-1 inhibitors. Overall response was favorable for most modalities. No serious adverse events were reported. Inconsistent measures of treatment response and study variability limited the overall evaluation of data. CONCLUSIONS: Infliximab and ustekinumab have the most evidence of efficacy and safety for the treatment of pustular psoriasis. Recent evidence supports the use of IL-17 antagonists. Prospective controlled and comparative trials are needed to further explore the efficacy and safety of biologic agents in order to establish objective recommendations for the management of this challenging condition.