Displaying 20 most recent entries.
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Revised U.K. guidelines for the management of cutaneous melanoma 2010 |
30 Jun 2010
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Carcinoma de células de Merkel: aportación de 10 casos (Original) |
21 Jun 2010
Introduction
Merkel cell carcinoma (MCC) is an aggressive cutaneous tumour with high mortality. Although the incidence is increasing, it is still a rare neoplasm. Existing data to determine the optimal treatment for this disease are still limited. We report our experience in the management of MCC over ten years.
Piel. 2010;25:295-9.
Introducción
El carcinoma de células de Merkel (CCM) es un tumor cutáneo agresivo que presenta una elevada mortalidad. Aunque su incidencia está aumentando, sigue siendo un tumor raro. Los conocimientos actuales sobre el tratamiento más adecuado de esta enfermedad son todavía limitados. Aportamos nuestra experiencia en la actitud diagnóstico-terapéutica del CCM durante 10 años.
Piel. 2010;25:295-9.
Patients and method
A descriptive and retrospective analysis of 10 patients with MCC diagnosed at our hospital during the period 1998–2008 was performed.
Piel. 2010;25:295-9.
Pacientes y método
Se realizó un estudio descriptivo y retrospectivo de 10 pacientes diagnosticados de CCM en nuestro hospital en el período comprendido entre 1998–2008.
Piel. 2010;25:295-9.
Results
MCC most commonly occurred in elderly women in sun-exposed areas. Eight of the 10 patients were treated by surgery and radiotherapy was applied after excision of the primary tumour in 2 cases. Four of the 10 patients had a relapse, three patients had local recurrence and one had regional lymph node recurrence. One patient developed systemic metastases. Three patients died due to MCC. Disease stage at the time of presentation was the best predictor of survival.
Piel. 2010;25:295-9.
Resultados
El CCM afectó principalmente a mujeres de edad avanzada en áreas fotoexpuestas. Se trató a 8 de los 10 pacientes mediante cirugía y 2 recibieron radioterapia tras la extirpación de la lesión primaria. Se observó recidiva en 4 de los 10 pacientes, en 3 la recidiva fue local y en uno en los ganglios linfáticos regionales. Un paciente presentó metástasis a distancia. En 3 de los pacientes el CCM fue la causa de muerte. El estadio en el momento del diagnóstico fue el factor pronóstico más importante para la supervivencia.
Piel. 2010;25:295-9.
Conclusiones
El CCM es un tumor cutáneo con alta mortalidad y tendencia a la recurrencia a pesar del tratamiento. Actualmente, el diagnóstico precoz temprano es el mejor método para prolongar la supervivencia de los pacientes.
Piel. 2010;25:295-9.
Conclusions
MCC is a cutaneous tumour with high mortality and tendency towards recurrence despite treatment. Currently, early diagnose is the best method to ensure long-term survival.
Piel. 2010;25:295-9.
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Tratamiento del pénfigo (Terapéutica dermatológica) |
21 Jun 2010
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Dermatosis potencialmente fatales (La piel en el contexto de la medicina y sus especialidades) |
21 Jun 2010
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La formulación magistral en dermatología, hoy en día (Editorial) |
21 Jun 2010
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Acute Diffuse and Total Alopecia: A New Subtype Of Alopecia Areata With A Favorable Prognosis. F1000: "Changes Clinical Practice" |
21 Jun 2010
This article illustrates a subtype of alopecia areata characterized by acute diffuse hair loss and favorable outcome, as well as potential clues as to why someone may become grey in one night.
Faculty of 1000 Medicine -
The Hazards of Moist Toilet Paper: Allergy to the Preservative Methylchloroisothiazolinone/Methylisothiazolinone [Observation] |
21 Jun 2010
Background Methylchloroisothiazolinone/methylisothiazolinone (MCI/MI), a common preservative in some brands of moist toilet paper (baby wipes and moist towelettes), has been reported to be a cause of allergic contact dermatitis. However, few cases have been reported in the United States.
Observations We report the cases of 4 adult patients with severe perianal and perineal allergic contact dermatitis seen at our institution during a 6-month period. With patch testing, we identified allergy to MCI/MI, and we determined that all 4 patients were using moist toilet paper. The dermatitis resolved after use of the moist toilet paper was discontinued.
Conclusion This study highlights that the MCI/MI in moist toilet paper can be a cause of perianal and perineal allergic contact dermatitis.
Published online June 21, 2010 (doi:10.1001/archdermatol.2010.114).
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Comentarios a las directrices europeas y británicas sobre el tratamiento de la psoriasis (Artículo de opinión) |
5 Jun 2010
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Materiales de relleno: tipos, indicaciones y complicaciones (Revisión) |
5 Jun 2010
Abstract
There are many types of dermal fillers currently used for cosmetic and medical indications in routine clinical practice. Fillers can be classified as temporary, semipermanent, or permanent depending on the length of time the substance remains in tissue. They can also be classified by the composition of the product. Materials can be based on collagen (bovine, porcine, and human), hyaluronic acid, poly-L-lactic acid, calcium hydroxylapatite, polymethal methacrylates, and polyacrylamide gels, among others. Temporary fillers are the products most often used for cosmetic purposes, in particular hyaluronic acid. This is due to the ease of application of fillers based on this substance, the good results obtained, and their safety profile. This review presents an overview of the techniques used for the correct placement of dermal fillers and the most common clinical indications for these procedures. It also covers the nature, properties, and mechanisms of action of the principal temporary, semipermanent, and permanent dermal fillers as well as the indications for each type of material. Finally, we describe the most common complications encountered and their treatment.
Actas Dermosifiliogr. 2010;101:381-93.
Resumen
Existen numerosos materiales de relleno utilizados en la práctica clínica diaria con fines cosméticos y médicos. Se pueden clasificar, en función de su duración en el tejido, en temporales, semipermanentes y permanentes. También pueden clasificarse de acuerdo con la composición del relleno: colágeno (bovino, porcino y humano), ácido hialurónico, ácido poliláctico, hidroxiapatita de calcio, polimetilmetacrilatos y geles de poliacrilamida, entre otros. Los rellenos temporales son los más empleados con fines estéticos, especialmente el ácido hialurónico. Este hecho se debe al perfil de seguridad que tienen, a la facilidad en su aplicación y a los buenos resultados encontrados. En esta revisión se exponen las diferentes técnicas descritas para su colocación correcta y las indicaciones clínicas más frecuentes. También se describe la naturaleza, las propiedades, los mecanismos de acción y las indicaciones de los principales materiales de relleno, tanto temporales como semipermanentes o permanentes. Finalmente se describen las complicaciones más comunes y su tratamiento.
Actas Dermosifiliogr. 2010;101:381-93.
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Skin photodynamic therapy in severe localized atopic dermatitis: a case report |
23 Apr 2010
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Undifferentiated pleomorphic sarcoma in a child with type 1 neurofibromatosis |
23 Apr 2010
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Tinea of vellus hair: an indication for systemic antifungal therapy |
15 Apr 2010
Background Topical antifungal treatment is indicated in tinea of glabrous skin, except in cases of extensive, multiple or recurrent lesions, or immunocompromised patients. However, in daily practice there are cases resistant to topical treatment despite these indications. Parasitism of the hair could be the cause behind the majority of isolated lesions of ringworm of hairless skin with a poor outcome with topical antifungal treatment.Objectives To present a prospective observational study of 13 cases of tinea of glabrous skin with topical antifungal resistance during the period 2007[ndash]2009.Methods Cases were analysed from a clinical, mycological and therapeutic standpoint.Results The mean age was 7 years. Eight (62%) patients reported prior contact with an animal and 10 (77%) patients had received topical corticosteroids before visiting the dermatologist. Excoriation was observed in eight (62%) patients, and follicular micropustules were seen in 11 (85%). In all patients, some short thin hairs fell easily on to the slide during the skin scraping. In all patients all the few vellus hairs identified in direct examination were affected. All identified species were zoophilic or geophilic. All cases resolved after oral antifungal treatment.Conclusions In tinea of glabrous skin with low response to topical antifungal treatment we must rule out tinea of the vellus hair. Infection by nonanthropophilic dermatophytes, previous corticosteroid therapy and excoriation might be predisposing factors. Parasitism of the vellus hair, observed by direct microscopy, should be another criterion for establishing systemic treatment from the onset, as is the case in tinea capitis. -
High-resolution cutaneous ultrasonography to differentiate lipoedema from lymphoedema |
15 Apr 2010
Background Lipoedema is an accumulation of fat abnormally distributed in the lower limbs, and lymphoedema is oedema caused by a deficiency of the lymphatic system. High-resolution ultrasound operating at 20 MHz makes it possible to characterize dermal oedema.Objectives The purpose of our study was to demonstrate that high-resolution ultrasound imaging of the skin can differentiate lipoedema from lymphoedema.Methods Sixteen patients with lymphoedema (22 legs), eight patients with lipoedema (16 legs) and eight controls (16 legs) were included. Patients with lipolymphoedema were excluded. Ultrasound examinations were carried out with a real-time high-resolution ultrasound device on three different sites for each lower limb. The images were then anonymized and examined by an independent dermatologist who was blind to the clinical diagnosis. A new series of images was examined by three dermatologists to check interobserver agreement.Results A significant difference in dermal thickness was observed between patients with lymphoedema and those with lipoedema and between patients with lymphoedema and controls. No significant difference in dermal thickness was shown between patients with lipoedema and controls at the thigh or ankle. Dermal hypo-echogenicity was found in at least one of the three sites in 100% of patients with lymphoedema, 12·5% of cases with lipoedema and 6·25% of the controls. Hypoechogenicity affected the entire dermis in all cases of lymphoedema except one. In cases of lipoedema and controls, hypoechogenicity was localized at the ankle and prevailed in the upper dermis. The expert correctly diagnosed all lower limbs with lymphoedema. No cases of lipoedema were diagnosed as lymphoedema. Exact interobserver agreement was excellent (0·98).Conclusions High-resolution cutaneous ultrasonography makes it possible to differentiate lymphoedema from lipoedema. Obtaining a reliable diagnosis through high-resolution cutaneous ultrasonography might be valuable for improving the treatment of lipoedema and lymphoedema. -
Acute hair loss on the limbs in frontal fibrosing alopecia: a clinicopathological study of two cases |
14 Apr 2010
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Epstein–Barr virus involvement in the pathogenesis of hydroa vacciniforme: an assessment of seven adult patients with long-term follow-up |
28 Mar 2010
Background Hydroa vacciniforme (HV) is a chronic papulovesicular photodermatosis of childhood, with some cases persisting through adulthood. In children, the Epstein[ndash]Barr virus (EBV) has been detected in typical HV and in HV evolving into natural killer/T-cell lymphoma. No exploration of EBV infection has been performed in adult patients with HV with long-term follow-up.Objectives To assess EBV infection systematically in blood and in experimentally photoinduced lesions in adult patients with HV.Methods Repeated tests for EBV DNA blood load using real-time polymerase chain reaction (PCR) and serological EBV tests were performed in seven adult patients with long-term follow-up. Skin samples from phototest-induced lesions and surrounding normal skin were studied using PCR, in situ hybridization and electron microscopy. ZEBRA protein was detected using immunostaining. Thirty-five patients with other photosensitive disorders were included as controls.Results The EBV DNA blood load was strongly positive in the seven patients with HV and negative in 34 of 35 of the patients with other photosensitive disorders (P < 0·001). The levels were higher in photosensitive patients with HV than in patients with HV in clinical remission. Ultrastructurally, viral particles were detected in lymphocytes and also in keratinocytes in three experimentally phototest-induced lesions; they were not found in the surrounding normal skin. ZEBRA protein was also detected in phototest-induced lesions, but not in the surrounding normal skin.Conclusion EBV is involved in HV pathogenesis and persists in adult patients with HV. A positive EBV DNA load, specific to HV in the spectrum of photosensitive disorders, might be a useful biomarker in HV. -
Peripheral nerve blockade for biopsy of plantar skin |
24 Mar 2010
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Androgenetic alopecia in the paediatric population: a retrospective review of 57 patients |
22 Mar 2010
Background Hair loss is an unwelcome event at any age, but it can be particularly distressing for adolescents and their families. While androgenetic alopecia (AGA) is the most common form of hair loss in adults, little is known about its prevalence, clinical features and response to treatments in the paediatric population.Objectives To better characterize the causes of alopecia in a paediatric population.Methods We performed a retrospective chart review to identify all patients with hair loss seen in an academic paediatric dermatology practice at New York University over a 12-year period to better characterize the causes of alopecia in this population. We review the clinical and histological features, natural progression and associated laboratory abnormalities of AGA in 57 paediatric patients.Results AGA was identified as the most frequent cause of hair loss in adolescents and the second most common diagnosis overall. The male to female ratio was 2 : 1 and the average age at initial presentation with AGA was 14·8 years. Adolescent girls had diffuse thinning or thinning at the crown, and boys frequently presented with female pattern hair loss. When biopsies were performed, perifollicular inflammation was a common finding. A family history of AGA was reported in 83% of patients. Laboratory evaluation for androgens revealed polycystic ovarian syndrome in three girls and late-onset congenital adrenal hyperplasia in one boy.Conclusions AGA is the most common form of hair loss in adolescents, and can be the presenting sign of an underlying endocrine disorder. An accurate and timely diagnosis is essential for appropriate medical and psychosocial intervention when warranted. -
Tamoxifen-loaded liposomal topical formulation arrests hair growth in mice |
17 Mar 2010
Background For several decades, androgens have dominated endocrine research in the domain of hair growth control. However, it has long been known that oestrogens also tend to alter hair follicle (HF) growth and cycling significantly by binding to locally expressed high-affinity oestrogen receptors (ORs). Tamoxifen (TAM) is a selective OR modulator.Objectives The current work aims to investigate the effect of topically applied TAM on the hair growth of mice.Methods Test formulations were applied once daily on the shaved back area of the mice for a period of 5 weeks. The effect of these formulations was studied by visual and histological examinations.Results Animals treated with saline and placebo gel formulation showed significant hair growth on the 20th day. The number and length of follicles were also found to be normal. In contrast, no hair growth was observed in the animals treated with TAM gel, even after the termination of treatment. The HFs were found to be arrested in telogen phase with clear signs of follicle dystrophy.Conclusions The hair growth-retarding effect of TAM observed in the current study clearly demonstrates its OR agonistic effect on hair growth. This work also provides a distinct lead towards the possible potential of TAM liposomal gel in the treatment of hirsutism. -
Mechanisms of the sensory effects of tacrolimus on the skin |
10 Mar 2010
Background Tacrolimus is an immunosuppressant drug currently used for the treatment of atopic dermatitis and pruritus. This topical therapy is effective and safe, but transient burning, stinging and itch are frequently reported.Objectives To understand the mechanisms underlying these burning sensations.Methods We examined the impact of tacrolimus on substance P (SP) release in an in vitro model of cutaneous neurogenic inflammation. Because phosphorylation of TRPV1 (transient receptor potential subtype vanilloid 1) plays a role in the induction of pain, we investigated whether tacrolimus regulates the phosphorylation state of TRPV1. Finally, we used a macropatch to evaluate the impact of tacrolimus on voltage-gated calcium currents of sensory neurons.Results Tacrolimus was able to induce initial SP release by extracellular calcium influx and inhibited SP release induced by capsaicin after 1, 24 and 72 h of pretreatment. Analysis of TRPV1 phosphorylation by Western blot confirmed the capacity of tacrolimus to favour phosphorylation. An electrophysiological study showed inhibitory effects on calcium currents.Conclusions The efficacy of tacrolimus in pruritus, as well as the sensory side-effects, could be explained by a direct effect on neurons through an effect on calcineurin, possibly by a desensitization of TRPV1 and calcium currents through the PIP2 regulation pathway. -
Systematic mutation screening of KRT5 supports the hypothesis that Galli–Galli disease is a variant of Dowling–Degos disease |
5 Mar 2010
Background Galli[ndash]Galli disease (GGD) is a rare genodermatosis. Its clinical presentation is identical to that of Dowling[ndash]Degos disease (DDD), but the presence of the histopathological feature of acantholysis in GGD is thought to distinguish the two disorders. Mutations in the keratin 5 gene (KRT5) have been identified in the majority of patients with DDD and in a small number of patients with GGD.Objectives To provide further support for the hypothesis that GGD is merely a variant of DDD, and to examine whether acantholysis is genuinely rare in DDD or rather a common but under-reported histological feature of DDD.Methods We conducted the first systematic mutational investigation of patients with GGD and re-examined the histopathology of patients previously assigned a diagnosis of DDD. For the mutational investigation, KRT5 was sequenced in seven unrelated patients with clinically and histopathologically confirmed GGD. In addition, the histopathological findings of six patients with DDD were re-evaluated.Results The mutation c.418dupA was found in five patients with GGD. The typical histopathological features of GGD were identified in six patients who had previously been assigned a diagnosis of DDD.Conclusions We found further evidence to suggest that GGD is indeed a variant of DDD and not a distinct disease entity. Two facts in particular support this conclusion: the same KRT5 mutation was found in patients with GGD and in patients with DDD, and acantholysis seems to be present in a large number of patients who had previously been assigned a diagnosis of DDD.
