Uso del aprendizaje automático en el diagnóstico del melanoma. Limitaciones por superar

BackgroundAutomated image classification is a promising branch of machine learning (ML) useful for skin cancer diagnosis, but little has been determined about its limitations for general usability in current clinical practice.ObjectiveTo determine limitations in the selection of skin cancer images for ML analysis, particularly in melanoma.MethodsRetrospective cohort study design, including 2,849 consecutive high-quality dermoscopy images of skin tumors from 2010 to 2014, for evaluation by a ML system. Each dermoscopy image was assorted according to its eligibility for ML analysis.ResultsOf the 2,849 images chosen from our database, 968 (34%) met the inclusion criteria for analysis by the ML system. Only 64.7% of nevi and 36.6% of melanoma met the inclusion criteria. Of the 528 melanomas, 335 (63.4%) were excluded. An absence of normal surrounding skin (40.5% of all melanomas from our database) and absence of pigmentation (14.2%) were the most common reasons for exclusion from ML analysis.DiscussionOnly 36.6% of our melanomas were admissible for analysis by state-of-the-art ML systems. We conclude that future ML systems should be trained on larger datasets which include relevant non-ideal images from lesions evaluated in real clinical practice. Fortunately, many of these limitations are being overcome by the scientific community as recent works show.     

Asociación entre la infestación por el Demodex sp. y el acné vulgar grave. Estudio transversal de 168 pacientes

Background and objectivesInfestation with Demodex mites has been associated with acne vulgaris. The aim of this study was to explore the association between Demodex infestation and severe acne vulgaris in outpatients seen at Hospital Regional Lambayeque in Chiclayo, Peru.Material and methodsWe conducted a cross-sectional study of 46 patients with severe acne and 92 patients with nonsevere acne. Severe acne vulgaris was diagnosed if the score was 3 or more on the Spanish Acne Severity Scale (EGAE, in its Spanish acronym). Demodex infestation was diagnosed when a skin surface biopsy showed more than 5 mites/cm².ResultsThe patients had a median age of 18 years (interquartile range, 15-20 years), 60.9% were male, 81.9% lived in an urban area, and 29.7% were infested with Demodex mites. In the bivariate analysis, severe acne vulgaris was significantly associated with Demodex infestation (P = .001), sex (P = .003), residence (P = .015), a paternal history of acne (P = .045), a maternal history of acne (P = .045), and type of skin (P < .001). In the multivariate analysis, after adjustment for male sex, urban residence, previous treatment, maternal and paternal history of acne vulgaris, and an oily skin type, patients with Demodex infestation were 4.2 times more likely to have severe acne vulgaris (95% CI: 1.6-10.9, P = .003).ConclusionDemodex infestation was associated with severe acne vulgaris in outpatients at our hospital.     

Uso de la lipotransferencia en el tratamiento de cicatrices atróficas por secuelas de acné

BackgroundScars from acne sequelae represent a frequent complication, associated with great esthetic, social and psychological effects.ObjectiveTo evaluate the efficacy and safety of fat transfer in the treatment of atrophic scars due to acne sequelae.MethodAn observational, analytical and longitudinal study was carried out in 11 patients with atrophic scars due to acne sequelae of different anatomical locations, at the Hospital Clínico Quirúrgico «Hermanos Ameijeiras», in the period between January 1, 2017 and June 30, 2020. Lipotransference was performed using the Coleman method. The nanofat-type adipose tissue was processed and administered. The response to treatment was evaluated from the clinical point of view (3 months after having performed the procedure) using the Global Scale of Esthetic Improvement, the Qualitative Classification Scale of Acne Scars and the Acne Scars Clinical Assessment Scale (ECCA), with photographic evidence and microscope of surface.ResultsAfter treatment, there were significant changes in the Global Esthetic Improvement Scale (P = 0.0221), in the Qualitative Classification Scale of Acne Scars (P = 0.0017) and the Acne Scars Clinical Assessment Scale (P = 0,001). The adverse events found were pain, inflammation and ecchymosis; of mild or moderate intensity, without permanent consequences in individuals. The degree of satisfaction reported by the patients was good (36.4%) and very good (63.6%) (P = 0.0111).ConclusionsNanofat scar treatment is an available, simple and reproducible option that offers objective improvement of the scar with prompt surgical recovery.     

Satisfacción del paciente y el médico con la espuma en aerosol de calcipotriol y dipropionato de betametasona para el tratamiento de la psoriasis vulgar en el cuerpo

Background and objectiveCalcipotriol and betamethasone dipropionate (Cal/BD) aerosol foam is more effective in the treatment of plaque psoriasis than earlier formulations incorporating this combination of active ingredients. The aim of this study was to evaluate patient and physician satisfaction with Cal/BD aerosol foam in the treatment of plaque psoriasis on the body.Material and methodsRetrospective observational study of 446 patients with plaque psoriasis affecting no more than 30% of the body surface area who had received treatment with Cal/BD aerosol foam for 4 weeks. The patients rated their satisfaction with the treatment using the TSQM-9 (Treatment Satisfaction Questionnaire for Medication) and the physicians on a 5-point Likert scale.ResultsPatients were highly satisfied with Cal/BD aerosol in terms of its ability to treat their condition (84%), relieve their symptoms (84.4%), and act rapidly (82.8%). With respect to convenience, the patients gave high ratings to ease of use (91.8%), ease of planning (93.9%), and ease of following instructions (89.9%). Global satisfaction was also high, with 85% of patients expressing that they were satisfied, very satisfied, or extremely satisfied with the treatment. Of the physicians, 85.7% stated that they were quite or very satisfied with the treatment.ConclusionBoth patients and physicians expressed high satisfaction with the use of Cal/BD aerosol foam for the treatment of plaque psoriasis on the body.     

Reacciones cutáneas adversas a fármacos en los pacientes con infección por el VIH en la era TARGA

The introduction of highly active antiretroviral treatment (HAART) in 1996 radically changed the clinical course of human immunodeficiency virus (HIV) infection as it led to a dramatic reduction in mortality in these patients. However, these treatments have their limitations, including adverse effects, therapeutic failure, pharmacokinetic interactions, the development of resistance, and abnormal immune responses. In this article we review the current situation of cutaneous drug reactions in HIV-infected patients.     

Experiencia en el uso de fototerapia en pacientes pediátricos y comparación de esta técnica frente a pacientes adultos

IntroductionPhototherapy involves the use of UV radiation to treat different dermatologic diseases. Its efficacy and safety have been thoroughly established in adults and some publications indicate that it is also an effective and safe treatment in pediatric patients with refractory skin diseases.Material and methodsRetrospective study that included all patients under 17 years of age and 122 randomly selected adults who received phototherapy in our department between 2002 and 2017.ResultsNinety-eight pediatric patients (61% girls and 39% boys) with a mean age of 10.5 years received phototherapy. The 3 most frequently treated diseases were psoriasis (48% of patients), vitiligo (17%), and atopic dermatitis (16%). Eighty-six percent of the patients received phototherapy with narrowband UV-B, whereas 7% received phototherapy with psoralen and UV-A (PUVA). No statistically significant differences were found in terms of dosage, duration, or number of sessions compared to the adult population treated with narrowband UV-B therapy or PUVA. A complete response was achieved in 35% of the pediatric patients and no differences were found with respect to the adults. Only 16% of the children showed adverse effects, mostly in the form of mild erythema. We found greater adherence to treatment in the pediatric patients than in the adult patients (P < .05).ConclusionsNarrowband UV-B therapy and PUVA appear to be safe and effective in children and can be administered using the same treatment protocols as those used in adults. Adherence to treatment is greater in children than in adult patients.     

Efecto de los niveles séricos de vitamina D en el pronóstico del melanoma cutáneo

IntroductionVitamin D plays a fundamental role in many metabolic pathways, including those involved in cell proliferation and the immune response. Serum levels of this vitamin have been linked to melanoma risk and prognosis. This study aimed to assess the prognostic value of vitamin D serum level in melanoma.Material and methodsRetrospective, observational, longitudinal, and analytical study of 286 patients with a histologic diagnosis of melanoma in whom serum levels of vitamin D were measured at the time of diagnosis. We analyzed associations between serum level and epidemiologic and clinical variables and pathology findings; we also analyzed the influence of vitamin D on overall survival. An iterative loop was used to identify a vitamin D serum level to test for its an association with survival.ResultsA vitamin D level less than 9.25 ng/mL was associated with a histologic finding of ulceration. After a median follow-up period of 39.4 months, 24 patients (8.4%) had died. The cutoff of 9.25 ng/mL was associated with lower overall survival according to both the Kaplan-Meier curves and multivariate Cox regression analysis.ConclusionVitamin D levels less than 9.25 ng/mL are associated with ulceration in melanoma and serve as an independent prognostic factor for overall survival in this disease.     

Comparación de 2 técnicas de bloqueo anestésico en el tratamiento quirúrgico de onicocriptosis del primer dedo del pie

Background and objectiveSurgery for an ingrown toenail of the great toe is a common procedure that requires an anesthetic neuromuscular blockade of the entire digit. Various digital block techniques have been described, but no evidence-based recommendations on the best choice have emerged. We aimed to compare the V block to the H block in this type of surgery.Material and methodsMulticenter randomized clinical trial in patients undergoing onychocryptosis surgery between February 2018 and February 2020. We recorded sex, age, foot intervened, type of blockade used (H block or V block), efficacy 10 and 20 minutes after injection of the anesthetic, and number of attempts.ResultsA total of 140 surgeries to treat ingrown toenails were assigned to 2 groups (H block or V block) of 70 patients each. The same anesthetic, dose, and volume were used in all cases. The V technique produced a better neuromuscular block in 7.2% more cases at 10 minutes and in 12.8% more at 20 minutes.ConclusionsBoth block techniques are safe and effective. The V block is a good alternative to the H block in patients undergoing surgery to treat an ingrown toenail.     

La efectividad del tratamiento con omalizumab en la vida real es menor en pacientes con urticaria crónica de más de 18 meses de evolución y tratamiento inmunosupresor previo

BackgroundThe efficacy of omalizumab in the treatment of chronic spontaneous urticaria has been demonstrated in phase iii clinical trials, but limited information is available regarding real-life effectiveness using the weekly Urticarial Activity Score (UAS7). The aim of the study was to assess clinical response (UAS7 ≤ 6) and complete response (UAS7 = 0) rates at weeks 12 and 24 in a real-life cohort and to identify possible predictors of response to omalizumab.MethodsClinical records of consecutive patients with moderate-to-severe chronic spontaneous urticaria (UAS ≥ 16) treated with omalizumab at a university-affiliated reference dermatology department in Barcelona, Spain, from February 2014 to September 2017 were retrospectively reviewed. UAS7 values and patients’ evolution were assessed according to a predefined protocol. Statistical analysis of data was done using SPSS 18 statistical package (SPSS 18 Inc., Chicago, IL, USA) software.ResultsForty-eight patients were included in the study. All of them completed at least 24-weeks of treatment and follow-up. At week 12, clinical response rates (UAS7 < 6) were 70.8% and complete response rates (UAS7 = 0) were 47.9%. At week 24, clinical response rates were 64.6% and complete response rates were 52.1%.Patientswith long-term urticaria (≥ 18 months’ duration) were less likely to achieve a clinical response at week 12 (odds ratio: 0.25; 95% confidence interval 0.06-0.96). Previous immunosuppressive treatment tended to be associated with a lower probability of complete response at week 12 (odds ratio: 0.27 95% confidence interval: 0.07-1.02). H1-antihistamine treatment was associated with lower probability of response at week 24 (odds ratio: 0.1 95% 95% confidence interval: 0.01-0.88)ConclusionsThe effectiveness and safety of omalizumab in real life are similar to efficacy and safety in clinical trials. Duration of disease, previous immunosuppressive therapy and requirement for concomitant H1-antihistamine treatment may be helpful in predicting response to omalizumab treatment.     

Manifestaciones dermatológicas en los profesionales de la salud asociadas al uso de equipo de protección personal para la atención de los pacientes con infección por COVID-19 en los hospitales del área metropolitana de la ciudad de México

BackgroundSince the outbreak of the coronavirus disease-2019 (SARS-CoV-2) in December 2019, thousands of healthcare workers have faced this highly contagious disease; For its handling, the use of personal protective equipment (PPE) consisting of masks, goggles and protective clothing is needed for long periods of time, generating the appearance of various skin manifestations (pressure injuries, contact dermatitis, urticaria and exacerbation of pre-existing skin diseases).ObjectiveTo describe the frequency of cutaneous manifestations caused by the use of PPE in healthcare workers and the risk factors for developing them.MethodologyFrom June 4 to 14, 2020; 1,000 surveys were distributed online to health workers from 12 hospitals in the metropolitan area of Mexico City. Results. 78% showed dermatological alterations associated with PPE, mainly xerosis, scaling and erythema, with greater involvement in the hands, the nasal bridge and the cheeks, usually accompanied by itching and pain. There was a relationship between the use of PPE and the exacerbation of dermatological diseases, mainly rosacea (OR 2.96). It was shown that the alcohol gel increased 1.8 and 2 times the risk of presenting xerosis and fissures respectively, with an association (OR 2.3) between constant hand washing and xerosis.ConclusionThe exacerbation and increase of dermatosis associated with the use of PPE and the associated factors for its appearance were observed.