Teledermatología sincrónica en tiempos de Covid-19. Percepción del dermatólogo / Synchronous teledermatology in times of Covid-19. Dermatologist perception

Teledermatology (TD) is a remote medical care tool that experienced a great boom during the COVID19 pandemic, resulting in an increase in both, the number of remote consultations and the number of dermatologists who practice it. Several studies have reported a high degree of satisfaction among patients attended by this method. However, few studies have done so in dermatologists. We set out to investigate the experience of Chilean dermatologists with the tool by means of an online survey. Results. A total of 156 surveys were completed. The number of dermatologists using TD increased from 19.9% to 80.8% during the pandemic. They cited the absence of the physical examination-dermatoscopy as the main limitation to developing TD and reported feeling more comfortable with some pathologies. Dermatologists feel moderately comfortable and confident with the tool, however, they experienced varying degrees of stress and frustration. Only 40.8% plan to continue using TD in the future. Conclusion. Synchronous TD has clear limitations, however, these should emerge as an opportunity to consider in its development and its platforms, in order to generate a more comfortable tool for more dermatologists and thus extend its use, as an important tool for equal access to health care in Chile. (AU)

Coledococele: caso diagnosticado por resonancia magnética / Choledococele: case diagnosed by MRI

Resumen: El coledococele es una dilatación quística del segmento distal del conducto biliar común que sobresale en el lumen duodenal. Estos comprenden menos del 2% de todos los casos reportados de quistes de colédoco (2). Los hallazgos imagenológicos del coledococele y de los quistes de duplicación duodenal son muy similares, ambos presentan además clínica variada e inespecífica, por lo que el diagnóstico definitivo suele ser durante la cirugía. Presentamos un caso de una paciente de 10 años que consulta por dolor abdominal con elevación de transaminasas que, tras estudio con resonancia magnética con colangioresonancia y EDA se diagnostica coledococele.

Abstract: Choledochocele is a cystic dilation of the distal segment of the common bile duct protruding into the duodenal lumen. Is also known as type III choledochal cyst according to Todani's classification. It is usually misdiagnosed as duodenal duplication cyst. Multislice spiral computed tomography and magnetic resonance cholangiopancreatography may be comparable to endoscopic retrograde cholangiography for diagnosis of choledochocele. We present a case of a 10-years-old girl presented with abdominal pain, elevation of transaminases and a magnetic resonance cholangiopancreatography (MRCP) scan that revealed a choledochocele.

Hamartoma fibroso de la infancia: reporte de caso / Fibrous hamartoma of infancy: a case report

Resumen: El hamartoma fibroso de la infancia (FHI) es una lesión rara de tejidos blandos en niños con morfología trifásica característica. El principal problema con estas lesiones es el diagnóstico diferencial con otras masas de tejidos blandos, en particular sarcomas, que requieren un afrontamiento clínico y terapéutico diferente. Presentamos un caso de un infante de 10 meses con un crecimiento asintomático de una masa axilar que, tras realizarse angioresonancia magnética y biopsia se confirmó el diagnóstico de FHI.

Abstract: Fibrous hamartomas of childhood (FHC) are rare soft tissue lesions in infants and young children with characteristic three-phase morphology.The main problem with these lesions is differentiating it from other soft tissue masses, in particular sarcomas, which require a different clinical and therapeutic approach. We present a case of a 10-month-old infant with asymptomatic growth of a left axillary mass that, after magnetic resonance angiography and biopsy, the diagnosis of FHC was confirmed.

Manifestaciones cutáneas de enfermedades gastrointestinales / Cutaneous manifestations of gastrointestinal diseases

The gastrointestinal system is closely related to the skin. Multiple disorders of the gastrointestinal tract that manifest clinically on the skin surface are recognized, which can even occur before establishing the definitive diagnosis of the disease. For this reason, it is necessary that the dermatologist is internalized regarding the wide variety of clinical signs that can guide the etiological study, which requires in most cases, a multidisciplinary management. (AU)

Miasis cutánea por Cochliomyia hominivorax asociada a dermatitis seborreica: case report / Cutaneous myiasis due to Cochliomyia hominivorax associated with seborrheic dermatitis

Myiasis is an infestation of tissues and organs of humans and animals by Diptera larvae (flies, horseflies, mosquitoes). They are located at different body sites, and classified clinically as cutaneous, visceral and cavitary. We report a 26-year-old woman with a history of seborrheic dermatitis and recent trip to Brazil. She presented with a seven days history of suppurating wounds in the parieto-occipital area of the scalp. At physical examination we found three ulcers of approximately 1.5 cm each, with multiple mobile larvae inside. The obtained larvae were analyzed, identifying Cochliomyia hominivorax larvae at L2 and L3 stages. The patient was managed successfully with oral antimicrobials and local cleansing. The screwworm Cochliomyia hominivorax in our country is rare. Known risk factors are wounds, poor personal hygiene, extreme ages, psychiatric disorders, presence of specific dermatosis such as psoriasis and seborrheic dermatitis, among others.

Síndrome de Sweet: revisión de la literatura a propósito de un caso / Sweet syndrome: review of the literature about a case

Sweet (SS) syndrome is a neutrophilic dermatosis, characterized by a rapid onset of painful erythematous-purplish papules, nodules or plaques, accompanied by fever and associated with a dermal neutrophil infiltrate. CASE REPORT: Male, 69 years old, with a history of mild plaque psoriasis, arterial hypertension, gastroesophageal reflux and chronic sinusitis. He consulted for a 24-hour period characterized by headache and pain in the scalp. The examination highlights fever (38.5°), with slight erythema, sensitivity to palpation and some psoriasis plaques on the scalp. 48 hours later, it presents extensive painful erythematouspurplish plaques, present only on his right face and scalp. Biopsy was informed as Sweet Syndrome. He completed 14 days on prednisone, with excellent clinical evolution. DISCUSSION Sweet syndrome is classified into three categories: classic or idiopathic (most common), drug induced and associated with malignancy. In addition, other conditions have been described which may be related to: infections, autoimmune diseases, pregnancy. The management is focused on investigating an underlying cause and the use of corticosteroids, as a first line therapy. We report a case of idiopathic Sweet syndrome with atypical presentation, which was initially interpreted as facial cellulitis, with a rapid response to systemic corticosteroids. (AU)

Efecto del extracto purificado rico en antocianinas del fruto del maqui (Aristotelia chilensis) en un modelo experimental de hígado graso no alcohólico / Effect of a purified anthocyanin-rich extract of maqui (Aristotelia chilensis) on experimental model of nonalcoholic fatty liver disease

Background: Non-alcoholic fatty liver disease (NAFLD) is a spectrum of hepatic lesions, ranging from benign intrahepatic lipid accumulation (steatosis) to progressive non-alcoholic steatohepatitis, in absence of other known secondary causes. Both insulin resistance and oxidative stress have been involved in NAFLD development and progression and, therefore, insulin-sensitizers and/or antioxidants have been targets of different therapeutic agents. Some natural compounds such as Aristotelia chilensis have a high content of polyphenols, which are known for their antioxidant and anti-inflammatory properties. Objective: To assess the effect of a purified anthocyanin-rich extract of maqui (Aristotelia chilensis) on experimental model of NAFLD. Methods: C57BL6 mice were separated in four experimental groups (n = 4-10) and fed a control diet (chow) or a high fat diet (HFD) with or without a purified anthocyanin-rich extract of Aristotelia chilensis (ACnE) (400 mg/kg/day diluted in drinking water). The hepatic effects of HFD were assessed measuring serum levels of glucose and aminotransferases, hepatic histology and triglycerides. Results: HFD diet induced an increase in hepatic triglycerides and histological NAFLD. Administration of ACnE did not affect serum aminotransferases, hepatic triglycerides, liver weight or histological NAFLD. Conclusion: Administration of an ACnE showed no effects on NAFLD in the HFD experimental model.

Introducción: El hígado graso no alcohólico (HGNA) constituye un espectro de lesiones hepáticas, desde la acumulación lipídica intrahepática benigna (esteatosis) hasta la esteatohepatitis no-alcohólica progresiva, en ausencia de causas secundarias conocidas. En el desarrollo y la progresión del HGNA se ha involucrado la resistencia a insulina y el estrés oxidativo y, por lo tanto, insulino-sensibilizantes y antioxidantes han sido blancos de diferentes agentes terapéuticos. Algunos compuestos naturales como la Aristotelia chilensis (maqui) tienen un alto contenido de polifenoles, los que presentan propiedades antiinflamatorias y antioxidantes. Objetivo: Evaluar el efecto de un extracto purificado rico en antocianinas (EACn) del fruto del maqui (Aristotelia chilensis) sobre la esteatosis, en un modelo experimental de HGNA. Métodos: Los ratones fueron distribuidos en 4 grupos (n = 4-10). Dos alimentados con una dieta estándar (grupo control) y dos con una dieta alta en grasa- high fat diet (grupo HFD). Un grupo control y uno HFD recibieron además 400 mg/kg/día de EACn (grupo EACn). Se determinaron los niveles séricos de aminotransferasas y glucosa; se evaluó la histología hepática y el contenido hepático de triglicéridos. Resultados: HFD indujo aumento de triglicéridos hepáticos e HGNA histológico. La administración de EACn no modificó las transaminasas séricas, los triglicéridos hepáticos, el peso del hígado ni el HGNA histológico. Conclusiones: La administración de un EACn no mostró efectos en el modelo experimental de HGNA inducido por una dieta alta en grasa.

Actualización en psicodermatología / Update in psychodermatology

Psychodermatology is an area of dermatology dedicated to the connection between this medical discipline and psychiatry. Its importance is based in that emotional factors can exacerbate skin diseases and psychiatric disorders may manifest as skin lesions. This relationship can be described as an intricate network involving psychological, social, neuroendocrine, immune and skin factors, as reflected in the complexity of the management of these patients. Is important to increase research and interest in this important issue, as an integrative and multidisciplinary approach allows for interventions in the vicious circle between psychiatric dysfunction and skin symptoms, improving significantly the quality of life of patients...

Importancia actual de la vitamina D: déficit prevalente y asociación a diversas patologías / Current importance of vitamin D

En los últimos años se ha detectado una epidemia mundial de bajos niveles de vitamina D en la población general, la que ha alertado sobre su correlación con diversas enfermedades. Hay muchas razones que pueden ser las causales de este importante problema, siendo la baja exposición a luz solar uno de los principales. Nuestra especialidad juega un rol central en promover una foto exposición más saludable o suplementando a pacientes de alto riesgo para lograr niveles adecuados de esta vitamina. En nuestra revisión analizamos brevemente las causas de bajos niveles de vitamina D, sus funciones y las recientes correlaciones de su déficit con varias condiciones, entre ellas; el cáncer de piel, atopia y enfermedades autoinmunes. Finalmente recomendamos búsqueda activa y suplementación cuando sea necesario.

In the last few years, a worldwide epidemic of low levels of vitamin D in general population has been discovered, raising an alert about its correlation with health problems. Many reasons may be responsible for this important problem, and insufficient exposure to sunlight may be the main one. Our specialty has a key role in promoting a healthy sun exposure or supplementing high risk patients, to keep adequate levels of this vitamin. In our review, we analyze briefly the causes for low levels of vitamin D, its functions and newly discovered correlations with diseases, including skin cancer, atopy and autoimmune conditions. Finally we recommend screening and supplementation, when necessary.

Efeito da Lecitina de Soja sobre os Lipídeos e Proteína C reativa e na prevenção da Hipertrofia Ventricular Esquerda de Camundongos Hiperlipidêmicos / Effect of soy lecithin on lipids and C-reactive protein and the prevention of Left Ventricular Hypertrophy in hyperlipidemic mice

A regulação do metabolismo lipídico com drogas ou alimentos naturais é um alvo importante para diminuir o risco de doenças cardiovasculares. O objetivo deste estudo foi verificar o efeito da lecitina de soja na dislipidemia e na hipertrofia ventricular de camundongos hipercolesterolêmicos. Utilizaram-se quatro grupos de camundongos LDLr-/- com 3 meses de idade que receberam a seguintes dietas: Grupo S- ração padrão; Grupo S+Lec- ração padrão e lecitina de soja; Grupo HL- ração hiperlipídica; e Grupo HL+Lec- ração hiperlipídica e lecitina de soja. Após 15 dias, o sangue foi coletado para análise sérica dos lipídeos e da proteína C reativa. O ventrículo esquerdo foi separado, a proporção peso ventricular (mg) pelo peso do animal (g) foi calculada e, em seguida, processado histologicamente. Cortes histológicos foram corados com hematoxilina/eosina e picrosírius red para avaliar alterações morfológicas e morfométricas ventriculares. A lecitina de soja apresentou efeito antidislipidêmico e aumentou os níveis séricos de HDL nos camundongos do grupo S+Lec. Entretanto, nos camundongos do grupo HL+lec, a lecitina de soja não preveniu a dislipidemia, apenas aumentou o nível sérico do HDL. Este efeito nestes animais influenciou no processo inflamatório cardiovascular, reduzindo o nível sérico de proteína C reativa; e prevenindo a hipertrofia ventricular esquerda. A utilização da lecitina de soja representa um tratamento e/ou uma prevenção alternativa de baixo custo para as dislipidemias não associadas com dieta hiperlipídica. Contudo, a lecitina de soja aumenta os níveis séricos do HDL prevenindo o desenvolvimento da HVE mesmo em dislipidemias associadas com dieta hiperlipídica.

The regulation of lipid metabolism with drugs or natural foods is an important target for reducing the risk of cardiovascular disease. The aim of this study was to investigate the effects of soy lecithin on left ventricular hypertrophy (LVH) and dyslipidemia in hypercholesterolemic mice. We used four experimental groups of LDLr-/- mice (aged 3 months), which received the following diets: Group S: standard diet, Group S+Lec: standard diet and soy lecithin; Group HL: hyperlipidic diet and Group HL+Lec: hyperlipidic diet and soy lecithin. After 15 days on these diets, blood was collected for analysis of serum lipids and C-reactive protein. The left ventricle was dissected out and weighed and the ratio of its weight to the body weight of the animal was calculated, after which it was processed histologically. Sections were stained with hematoxylin-eosin and picrosirius red, to assess morphological and morphometric changes in the ventricle. In Group S+Lec, the soy lecithin had an antidyslipidemic effect and enhanced the serum levels of HDL. However, in the mice in group HL+Lec, soy lecithin did not prevent dyslipidemia, only increasing the serum level of HDL. These effects in these animals influenced the cardiovascular inflammatory process, reducing the level of serum C-reactive protein and preventing LVH. Soy lecithin could thus be used as a treatment or a low-cost alternative preventative measure against dyslipidemia associated with a non-fat diet. However, soy lecithin increases the serum level of HDL, reducing the risk of LVH even in dyslipidemia associated with a high-fat diet.

Pioderma gangrenoso en paciente con colitis ulcerosa tratada con infliximab / Pyoderma gangrenosum in a patient with ulcerative colitits treated with infliximab

El pioderma gangrenoso (PG) es una dermatitis neutrofílica, que en algunos casos puede ser severa y de difícil manejo. Presentamos el caso de una paciente con múltiples lesiones de PG asociadas a colitis ulcerosa, en la cual, por severidad del cuadro, se optó por adicionar infliximab al tratamiento habitual. La respuesta clínica fue excelente y rápida tras la primera dosis de infliximab, pese a que recibió solo dos de las tres dosis recomendadas habitualmente. La mejoría cutánea y digestiva se ha mantenido un año después de este tratamiento. Infliximab ha demostrado ser, en este y otros reportes, una herramienta muy útil, especialmente en casos de compromiso severo como en nuestra paciente. Se requiere mas evidencia aún para comprobar en cuáles pacientes podría ser beneficioso. Se presenta este caso por su severidad y la rápida y sostenida respuesta obtenida con infliximab.

Pyoderma gangrenosum (PG) is a neutrophilic dermatosis and in some cases can be severe and difficult to manage. We report the case of a patient with multiple lesions of PG associated with ulcerative colitis. Due to the severity of the clinical presentation treatment with infliximab was added to standard therapy. Clinical response was excellent and fast after the first dose of infliximab, although ha received only two of the three doses usually recomended. Skin and digestive improvement has been maintained 1 year after treatment. Infliximab has proven, in this and other reports, as a very useful tool in the treatment of PG, especially in cases of severe involvement as in our patient. More evidence is required to prove in which patients with PG infliximab could beneficial. We present this clinical case because of its severity and the rapid and susteined response obtained with infliximab.

Corticoides sistémicos: uso racional en dermatología / Systemic glucocorticoids: rational use in dermatology

Los glucocorticoides (GC) son potentes agentes inmunosupresores y antiinflamatorios ampliamente utilizados en el tratamiento de enfermedades dermatológicas. Las complicaciones asociadas a la terapia esteroidal sistémica aumentan con dosis mayores, tratamientos prolongados y administración fraccionada. Para maximizar la eficacia de la terapia esteroidal minimizando el riesgo de efectos adversos, es necesario conocer su farmacocinética y función a nivel de distintos órganos blanco. En esta revisión damos una visión general del mecanismo de acción de los GC y sus efectos adversos, junto con algunas recomendaciones prácticas para su uso clínico efectivo y seguro, disminuyendo el riesgo de desarrollar complicaciones.

(GC) are potent immunosuppressive and anti-inflammatory agents widely used in the treatment of many dermatologic diseases. Complications associated with systemic GC increase with higher doses, prolonged therapies, and divided administration. In order to maximize the effectiveness of steroidal therapy, minimizing the risk of adverse effects, it is necessary to know their pharmacokinetics and function on different target organs. In this review, we take general look at the mechanism of action and side effects of GC, along with some practical recommendations for their safe and effective use in order to decrease the risk of complications.

Estudio de pacientes hospitalizados por erisipela y celulitis en el Servicio de Dermatología del Hospital Clínico de la Universidad de Chile / Study of erysipelas and cellulitis in the Clinical Hospital of Universidad de Chile

Erisipela y celulitis son causa frecuente de morbilidad y hospitalización; sin embargo, no existen estudios nacionales que caractericen a este grupo de pacientes. El objetivo del trabajo fue describir aspectos epidemiológicos y clínicos de pacientes hospitalizados por erisipela o celulitis en el Servicio de Dermatología del Hospital Clínico de la Universidad de Chile, en el período de mayo del año 2006 hasta abril del 2007. Se hospitalizó un total de 32 pacientes, 31 con diagnóstico de celulitis y uno de erisipela. Al ingreso 36 por ciento presentó fiebre. La localización más frecuente fue en extremidades inferiores. En relación a factores de riesgo, 72 por ciento presentó tiña pedis, 53 por ciento, tabaquismo y 34 por ciento, obesidad. El 65 por ciento recibió tratamiento antibiótico con cefazolina endovenosa. El promedio de estadía hospitalaria fue 5,3 días. Los resultados encontrados son concordantes con estudios internacionales. Los pacientes tuvieron una evolución satisfactoria; sin embargo, es importante no olvidar que a estas piodermias pueden asociarse graves complicaciones locales y sistémicas si no son diagnosticadas y tratadas oportunamente.

Erysipelas and cellulitis are common causes of morbidity and hospitalization. However there are no national studies that describe this group of patients.The aim of this study was to describe epidemiological and clinical features of patients admitted in our service with diagnosis of erysipelas and cellulitis in the period between May 2006 and April 2007. From a total of 32 patients, 31 presented cellulitis and 1 erysipelas. At the moment of admission 36 percent of the patients presented fever. The most frequent localization was the lower limbs. Within risk factors, 72 percent presented tinea pedis, 53 percent were smokers and 34 percent obese. Within treatment, 65 percent received endovenous cefazolin. Average hospitalization period was 5.3 days.In conclusion, this study showed no significant differences from those internationally published. Patients had a satisfactory evolution. It is, however, important not to forget the serious local and systemic complications that this infections may lead to if they are overlooked.

Estudio de enfermedad celíaca en pacientes con psoriasis / Frequency of celiac disease among patients with psoriasis

Background: A possible relationship has been reported between psoriasis and celiac disease, with common pathogenic mechanisms that may need further investigation. Aim: To investigate the presence of clinical and serological markers for celiac disease in a group of Chilean psoriatic patients. Material and methods: We included 80 psoriatic patients (42 males) aged 16 to 79 years, whose serum was tested for antitransglutaminase antibodies (ATGA) and antiendomysial antibodies (AEMA). Patients with weakly positive AEMA tests were also tested for antigliadin antibodies (AGA). Results: In six patients (7.5 percent), AEMA and AGA were positive and one patient was positive for ATGA. An upper gastrointestinal endoscopy and duodenal biopsy was offered to these six patients and five accepted the procedure. Only one had a pathological diagnosis of celiac disease. Conclusions: Only one of 80 patients with psoriasis had celiac disease (1.2 percent). Other four patients with positive serologic markers had a normal duodenal biopsy. This group of patients may have latent celiac disease and they should be followed up.