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.

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.     

Aplicación de membrana amniótica en el tratamiento de las úlceras crónicas de extremidades inferiores

IntroductionApproximately 1% of the general population have venous or arterial lower limb ulcers. These lesions can be treated with biological skin substitutes such as cadaver skin or tissue-engineered skin equivalents, but treatment fails in 25% of cases, resulting in pain and loss of patient autonomy, as well as increased morbidity and health care costs. In the treatment of corneal ulcers, amniotic membrane has been shown to have antimicrobial and bacteriostatic properties, and to protect the wound without eliciting an immune response. The same properties have been reported in the treatment of burns and postthrombotic ulcers.ObjectivesTo assess the effectiveness of amniotic membrane transplantation in the treatment of refractory chronic leg ulcers.Patients and methodsAmniotic membrane was grafted onto 4 refractory ulcers in 3 patients. The mean time required for partial and complete re-epithelialization was calculated by measuring the wound area at weeks 0, 4, 8, 12, and 16. Pain intensity was assessed at the same intervals using a visual analog scale.ResultsComplete wound re-epithelialization was achieved for 1 ulcer by week 8; in the other 3 cases, there was a 50% reduction in size compared to baseline. At week 16, the mean reduction in wound size for the 4 ulcers was 81.93%. The corresponding reduction in pain intensity was 86.6%. No adverse effects were observed.ConclusionsAmniotic membrane transplantation might be an effective alternative for the treatment of refractory chronic vascular ulcers on the lower limbs.     

Fibroepitelioma de Pinkus. Descripción dermatoscópica de 3 casos

Fibroepithelioma of Pinkus is considered to be a rare variant of basal cell carcinoma with well-defined histopathological features.Clinical diagnosis often requires differentiation from benign lesions such as acrochordon, intradermal melanocytic nevus, neurofibroma, seborrheic keratosis, and even malignant lesions such as amelanotic melanoma. Dermoscopy of this type of lesion is not extensively described in the literature, though it usually presents certain specific characteristics that suggest the diagnosis and, therefore, an appropriate therapeutic approach.We present 3 cases of fibroepithelioma of Pinkus, describing their clinical, dermoscopic, and histopathological features.     

Fenómeno isotópico de Wolf: serie de 9 casos

IntroductionThe term Wolf′s isotopic response refers to the appearance of a new skin disease at the site of an already healed, unrelated disease. In most cases, the initial disease is herpes zoster. Different diseases may subsequently develop on the same site. The most common isotopic responses are granulomatous and lichenoid reactions, infiltrations of hematologic diseases, skin tumors, and infections. The pathogenesis of these skin reactions is unknown. It has been suggested that viral infection may alter local skin immunity; this would favor hyperreactivity, leading to inflammatory processes, or local immunosuppression, leading to tumor infiltrations or infections.Materials and methodsWe performed a retrospective study of 9 patients diagnosed with Wolf's isotopic response in the dermatology department of Hospital Donostia in San Sebastian, Spain. Five patients had B-cell chronic lymphocytic leukemia, 2 had a non-Hodgkin lymphoma, and 1 had ovarian carcinoma.ResultsThe initial disease was herpes zoster in 7 cases, and chickenpox and herpes simplex in the other 2 cases. The second disease was granulomatous dermatitis in 4 cases, lichenoid dermatitis in 2 cases, infiltration by B-cell chronic lymphatic leukemia in 2 cases, and infiltration by systemic non-Hodgkin lymphoma in 1 case. In the last case, the skin lesions were the first sign of the lymphoma.ConclusionsWe highlight the need to biopsy these second lesions in order to rule out tumor infiltrations, which were more frequent than expected in our series     

Estudio epidemiológico de la tinea capitis en una población de Santiago de Chile. La aparición de Trichophyton tonsurans como agente etiológico

Introduction

Tinea capitis (TC) is a dermatophytosis that affects the hair and scalp. The epidemiology of TC depends on the different geographical areas and is variable over time. Direct microscopic examination and fungal culture are essential to confirm the diagnostic suspicion and to identify the germ involved.

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.     

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.     

Carcinoma basocelular de la vulva. Descripción de dos casos y revisión de la literatura

—Although basal cell carcinoma is the most common malignant tumor of the skin, vulvar basal cell carcinoma accounts for less than 5% of all vulvar neoplasms.We are reporting the cases of basal cell carcinoma of two women aged 43 and 66, that showed vulvar ulcer, itching and bleeding. Both patients had excisional biopsy; one developed local recurrence and was treated by wide local reexcision.Basal cell carcinoma is a rare but important consideration in the differential diagnosis of cutaneous vulvar lesions. Accurate diagnosis depends upon a high index of suspicion, biopsy and histopathologic examination. Complete local excision is curative, although the recurrence rate is high, and metastases have been reported.     

Uso de plasma rico en plaquetas para cicatrización de úlceras crónicas de miembros inferiores

Introduction and objectivesPlatelet-rich plasma (PRP) is used as an adjuvant in the treatment of chronic ulcers of the lower extremity and has shown particularly promising results in the case of neuropathic ulcers. There has been less research, however, into its use in venous and hypertensive ulcers. Our aim was to assess the safety and feasibility of using PRP in the treatment of chronic ulcers of the lower extremity and to evaluate its potential benefits in directed healing.Material and methodsWe prospectively selected 11 patients with nonischemic ulcers of the lower extremity that had been present for at least 6 weeks. PRP was injected subcutaneously into the perilesional tissue and applied topically in 4 sessions held at 1-week intervals. We assessed quality of life (SF-12 questionnaire), pain (visual analog scale), and the circumference of the ulcer before and after treatment.ResultsThere was a predominance of women (8/11, 73%), and venous ulcers (7/11, 64%) were more common than hypertensive ulcers (4/11, 36%). The median age of the patients was 79 years and the median time since onset of the ulcer was 17 months (range, 6-108 months). We observed a significant reduction in pain (P < .05) and a significant improvement in the physical and mental components of the SF-12 (P < .05). The mean reduction in ulcer size was 60%, and complete healing was achieved in 5 cases. No adverse effects were observed.ConclusionThe local application of PRP is a valuable and practical procedure that promotes the healing of chronic ulcers of the lower extremity; it can improve patient quality of life and is particularly effective in local pain relief.