Consenso multidisciplinar sobre prevención y tratamiento de la tuberculosis en pacientes candidatos a tratamiento biológico. Adaptación al paciente dermatológico

Patients with chronic inflammatory diseases being treated with immunosuppressive drugs, and with tumor necrosis factor inhibitors in particular, have an increased risk of infection by Mycobacterium tuberculosis. Screening for latent tuberculosis infection and preventive therapy to reduce the risk of progression to active tuberculosis are mandatory in this group of patients. This updated multidisciplinary consensus document presents the latest expert opinions on the treatment and prevention of tuberculosis in candidates for biologic therapy and establishes recommendations based on current knowledge relating to the use of biologic agents.     

Miasis forunculoide: descripción de dos casos con estudio histológico de las diferentes larvas

—Myasis means infestation of organs and tissues of vertebrates by larvae of dipterous. We report two cases of furuncular myiasis, uncommon disorders in Spain because the species of the flies responsible for the process do not live in our country. The first case was a myiasis due to Cordylobia anthropophaga, or tumbu fly, that usually resides in the countries of Africa at the Sounth of the Sahara. The second case was due to Dermatobia hominis, which usually resides in the countries of Central or South America.Cutaneous lesions consisted of nodular lesions with superficial ulcers and larvae emerging from the ulcers. These larvae were studied histopathologically, emphasizing the characteristics that allow a differential diagnosis between them.     

Contribución al estudio epidemiológico de las dermatofitosis en el área este de Valladolid

—We perform an epidemiological study of patients diagnosed of dermatophytosis confirmed by culture, which were observed in our Unit of Mycology at the Hospital Clínico Universitario in Valladolid for the period extended between January 2000 and May 2001. Data are analysed in relationship to different variables such as age, sex, time of occurrence, lesion localization or identified etiologic agent. We report 40 patients with positive dermatophyte culture. Fourteen were diagnosed as Tinea corporis, 10 Tinea pedis, 9 Tinea unguium, 6 Tinea cruris, 2 Tinea capitis, 2 Tinea manuum and 1 Tinea barbae. The most frequent isolated species was Trichophyton mentagrophytes (37%) followed by T. rubrum (32%), Microsporum canis (17%), T. tonsurans (8%), M. gypseum (3%) and M. audouinii (3%).M. canis predominated in Tinea corporis and accounted for two cases of Tinea capitis. In Tinea unguium, T. mentagrophytes and T. rubrum were mostly isolated. T. rubrum predominated in Tinea pedis.We present our results, which basically agree with those from other studies, in order to contribute to the epidemiological mapping of superficial mycoses in Spain.     

Actualización en dermatitis atópica. Propuesta de algoritmo de actuación

Atopic dermatitis is a chronic inflammatory disease that affects 20% of children and almost 3% of adults and is associated with considerable impairment of quality of life for both patients and their families. While the condition resolves spontaneously after puberty in over 75% of cases, it can persist into adulthood. Furthermore, in young children severe forms can have serious health consequences and affect social development. There are no appropriate guidelines on how to handle cases that do not respond to routine treatment. In this article, we review the current treatments for moderate to severe atopic dermatitis, describe our experience with this disease, and propose a management algorithm.     

Acropigmentación reticulada de Dohi

—Reticulate acropigmentation of Dohi is a dyschromic disorder characterized by hyperpigmented and hypopigmented macules with a reticulate pattern, localized on the dorsum of hands and feet, and appears predominantly in Japanese patients. We describe the case of a 20-year-old woman, with Japanese father and Spanish mother, that presented the typical lesions of reticulate acropigmentation of Dohi. This entity has an autosomal dominant inheritance, although recessive autosomal inheritance and sporadic cases have been described, as ours. Differential diagnosis must be made with other disorders that course with reticulate pigmentation as reticulate acropigmentation of Kitamura and Dowling-Degos disease.     

Actualización del tratamiento tópico en psoriasis: aportación de la combinación de calcipotriol y dipropionato de betametasona en espuma

Topical agents are the first-line treatment for mild and moderate psoriasis, but factors such as frequency of administration, organoleptic properties, and the limited short term results can reduce treatment adherence and effectiveness.Innovations in topical treatments are linked not only to the discovery of new molecules, but also to the reformulation of existing active ingredients based on improvements to administration, organoleptic properties, bioavailability, and ease of use. Calcipotriol and betamethasone dipropionate aerosol foam is a new formulation in which the active ingredients are dissolved in a mixture of volatile propellants that evaporate quickly, leaving a supersaturated solution of calcipotriol and betamethasone dipropionate that enhances penetration into the epidermis.In this article, we take a look at the new calcipotriol and betamethasone dipropionate aerosol formulation and briefly review the main evidence supporting the use of topical treatments for psoriasis.     

Hemangioendotelioma retiforme: descripción de dos casos y revisión de la literatura

Retiform hemangioendothelioma (RH) is a rare vascular neoplasm with distinctive morphological features that, provided a high rate of local recurrences an occasional metastases, was first described as an angiosarcoma of flow malignancy grade. Twenty three well-documented cases have been previously reported. We report two new cases of RH and review the literature. One patient was a 82 year old female with a slow growing, indurated, and ill-defined plaque in the dorsum of the right hand; the other patient was a 31-year-old female with a tumor in the sole. Histologically both tumors showed the characteristic features of RH with a dermohypodermal infiltrative proliferation of elongated, arborescent and thin-walled vascular channels lined with hobnail endothelial cells without atypia nor mitotic figures. The differential diagnosis has to be made with Dabska’ tumour, hobnail hemangioma and conventional angiosarcoma. The report of new cases of this infrequent vascular tumour can be of help in determining more precisely the clinical and morphologic spectrum of RH.     

Evaluación de la regresión en melanomas primarios sucesivos

Introduction and objectivesIt has been suggested that patients who have had a melanoma may develop increased immunity against certain antigens expressed by tumor-associated melanocytes. Thus our objective was to review the records of patients with successive primary melanomas to ascertain whether the pattern of regression might indicate the presence of an immunization effect arising from the first melanoma.Material and methodsA review of all the cases recorded in the melanoma database of our dermatology department between 2000 and 2012 identified 19 patients who had multiple asynchronous melanomas (2.56% of all the cases recorded). We studied the presence or absence of regression in these melanomas and other clinical and histological characteristics.ResultsThe presence of regression was significantly higher in successive melanomas than in the first tumors identified (42.10% vs 21.05%, P = .018). Regression of at least 1 melanoma was observed in 42.10% of the patients studied and regression of 2 melanomas was observed in 21.05%. In no case was regression observed in the first melanoma and not in the second; however, in 21.05% of the patients there was evidence of regression in the second tumor and none in the first.ConclusionsOur findings suggest the possibility that the first melanoma produces an immunization effect in some patients who develop multiple asynchronous melanomas.     

Fenómeno de Lucio. Comunicación de 14 casos

Introduction

The Lucius Phenomenon is a severe reaction, mainly observed in diffuse lepromatous leprosy, and characterised by necrotic lesions due to vasculitis.