Leishmaniasis mucocut nea con presentacion atipica: setenta anos posprimoinfeccion / Mucocutaneous leishmaniasis with atypical presentation: seventy years after primary infection

Las leishmaniasis son un grupo de enfermedades tropicales causadas por par sitos protozoarios del g‚nero Leishmania. Hayal menos 20 especies de Leishmania, cada una puede causar una enfermedad espec¡fica relacionada a la especie ya la respuesta inmunol gica del hu‚sped. Se presenta el caso de un paciente var¢n de 87 a¤os, con el diagn¢stico de leishmaniasis mucocut nea, setenta a¤os despu‚s de la primoinfecci n, cuya presentaci¢n se inicia en la zona cut nea y compromete la mucosa nasal por extensi¢n. Tiene antecedente de hace 70 a¤os de lesi¢n ulcerativa que se resolvi¢ espont neamente en un viaje a  rea end‚mica de leishmaniasis en Per£, desde entonces nunca viaj¢ fuera de Lima. El paciente fue diagnosticado de leishmaniasis por histopatologia y PCR de las lesiones. Fue tratado con estibogluconato de sodio, 20 mglkgld, intramuscular, cada 12 horas, por 28 d¡as, con per¡odos de descanso de 7 d¡as. Present¢ curaci¢n cl¡nica completa de las lesiones infiltradas y ulcerativas.

Leishmaniasis is a tropical disease witli a wide clinical spectrum caused by protoioan parasites of the genus Leishmania. There are at least 20 species of Leishmania, each may cause a disease specific to the species and the host immunological response. We present the case of a 87 year old male patient, We found he had an ulcerative lesion on his left arm 70 years prior, that spontaneously heal, while he traveled to an endemic area for leishmaniasis in Peru. Since then he had never traveled outside his city. The patient was diagnosed of leishmaniasis by histopathology and PCR from the lesions. He was treated with systemic sodium stibogluconate (20 mg/kg/d) for 28 days with complete clinical healing of the ulcerative lesions.

Vitiligo asociado a melanoma amelanótico metastásico / Metastatic amelanotic melanoma-associated vitiligo

La aparición de vitíligo en pacientes con melanoma maligno es un fenómeno pobremente comprendido. El melanoma es un tumor maligno de la piel que se desarrolla a partir de los melanocitos, con un comportamiento fatal si no es detectado y tratado a tiempo. El vitíligo es un desorden adquirido de la piel, de etiología desconocida, caracterizado por despigmentación secundaria a la perdida de melanocitos. La asociación entre melanoma maligno y vitíligo es rara. Se ha propuesto que la respuesta inmune contra antígenos del melanocito conlleva a la destrucción del melanoma además del propio melanocito, y probablemente influencia la evolución y pronóstico de la neoplasia. Presentamos el caso de un paciente de 84 años de edad, quien presentó melanoma amelanótico metastático un año después de un diagnóstico de vitíligo...

Development of vitiligo in patients with malignant is a poorly understood phenomenon. Melanoma, a skin cancer that arises from melanocytes, is fatal if not detected and treated early. Vitiligo, an acquired skin disorder of unknown etiology, is characterized by depigmentation due to melanocyte loss. Association between melanoma and vitiligo is rare. Immine response against melanocyte antigens leading to the destruction of both melanoma and melanocyte, has been proposed and will probably influence evolution and prognosis of the neoplasm. We report the case of an 84 years-old patient who developed amelanotic metastatic melanoma a year after the diagnosis of vitiligo...

Knowledge, attitudes and practices about sun exposure and photoprotection in outpatients attending dermatology clinics at four hospitals in Lima, Peru / Exposição solar e conhecimento, atitudes e práticas de fotoproteção em pacientes de unidades ambulatoriais de dermatologia em quatro hospitais de Lima, Peru

BACKGROUND: To establish the knowledge, about sun exposure and photoprotection in outpatients treated at the dermatology clinics in four hospitals in Lima, Peru. MATERIAL AND METHODS: A cross-sectional study was conducted involving a sample of 364 patients selected using a systematic random sampling process in the four participating hospitals. The selected patients were interviewed to determine their knowledge, behavior and practices in relation to sun exposure and photoprotection. The chi-square test was used to identify any significant differences between knowledge and practices. RESULTS: The mean age of the patients in this sample was 45.1 ± 21.4 years. Of the 364 patients, 55.9 percent were women and 54.8 percent had skin phototype IV. The principal risks related to sun exposure were skin cancer (80.5 percent) and sunburn (77.8 percent). Knowledge regarding sun protection was more evident in individuals with university/college education (p<0.001). In addition, 78.9 percent of the individuals reported that they knew about photo-protectors and 52.3 percent stated that they used them regularly. In general, women were more knowledgeable regarding sun protection (p=0.001). Of the total number of users of photoprotection, 38.4 percent used these products daily, while 61.6 percent used them only occasionally. The use of photo-protectors differed significantly in accordance with the individual's education level (p<0.001). In the majority of cases there was a statistically significant difference between knowledge and practice with respect to solar protection. CONCLUSIONS: The level of awareness of the outpatients treated at the dermatology clinics in these four hospitals in Lima, Peru about the risks of sun exposure is acceptable; however, a large proportion fail to incorporate regular solar protection as a practice in their daily life.

FUNDAMENTOS: O objetivo deste estudo foi determinar o conhecimento, sobre a exposição solar e fotoproteção em pacientes ambulatoriais tratados nas unidades de dermatologia de quatro hospitais em Lima, Peru. MATERIAIS E MÉTODOS: Estudo de corte transversal. A amostra foi formada por 364 pacientes originários dos quatro hospitais participantes. Os pacientes foram selecionados através de um processo de amostragem aleatória sistemática. Uma vez selecionados, os pacientes foram entrevistados para determinação do conhecimento, atitudes e práticas em relação à exposição ao sol e à fotoproteção. O teste do qui-quadrado foi usado para determinar diferenças significativas entre conhecimento e práticas. RESULTADOS: Os pacientes tinham em média 45,1±21,4 anos de idade, 55,9 por cento eram mulheres e 54,8 por cento tinham pele fototipo IV. Os principais riscos relacionados à exposição solar foram câncer de pele (80,5 por cento) e queimaduras solares (77,8 por cento). Participantes com nível universitário apresentaram maior conhecimento sobre proteção solar (p <0,001). O conhecimento de fotoprotetores foi relatado por 78,9 por cento dos participantes enquanto o uso periódico dos fotoprotetores foi relatado por 52,3 por cento. As mulheres tinham conhecimento amplamente maior sobre proteção solar (p = 0,001). Do total de usuários de fotoprotetores, 38,4 por cento usavam o produto diariamente e 61,6 por cento usavam somente ocasionalmente. O uso de fotoprotetores variou significantemente com o nível de escolaridade (p <0,001). Na maioria dos casos se encontrou diferença estatisticamente significante entre o conhecimento sobre fotoproteção e práticas de fotoproteção. CONCLUSÕES: Os pacientes ambulatoriais tratados nas unidades de dermatologia desses quatro hospitais em Lima têm um nível aceitável de conhecimento mas um grande número deles não haviam incorporado práticas de fotoproteção nas rotinas pessoais.

Enfermedad de Bowen gigante de larga evolución: presentación de un caso y revisión de la literatura / Giant BowenÆs disease of long duration: report of a case and review of literature

La enfermedad de Bowen es un carcinoma in situ de lento crecimiento y, la mayoría de veces, de presentación única y localizada frecuentemente en extremidades inferiores, cabeza y cuello. Tiene bajo potencial invasivo y se reporta que puede presentar remisión espontanea parcial o total. Se presenta el caso de un paciente varón de 73 años de edad con un tiempo de enfermedad de 30 años, con una lesión principal de crecimiento lento y de gran tamaño.

Bowen's disease is a carcinoma in situ of slow growth, and most of the time, the presentation only, often localized in the lower limbs, head and neck. It has low potential invasive and reports that you can present spontaneous remission, partial or total. The case of a male patient of 73-year-old with a time of disease of 30 years, with a slow-growing and large main injury occurs.

Acroqueratoelastoidosis, patología infrecuente o diagnóstico por hallazgo con subregistro: reporte de dos casos y revisión de la literatura / Acrokeratoelastoidosis: infrequent pathology or underreported diagnostic finding: report of two cases and review of the literature

La acroqueratoelastoidosis es una genodermatosis de curso crónico que se caracteriza por la presencia de múltiples pápulas pequeñas e hiperqueratosicas, o placas firmes sobre márgenes laterales de manos y pies, así como dorso de palmas y plantas. Describimos dos casos clínicos evaluados en dos instituciones de salud, el primero de un paciente varón de 73 anos que consulta por tina de la mano, con el hallazgo casual de lesiones papulares traslúcidas, algunas umbilicadas, en bordes y dorso de dedos de las manos, sin antecedentes familiares de cuadros similares; el segundo caso el de una paciente de 16 anos que consulta por acné y que al examen general se describe como hallazgo lesiones queratósicas papulares, pequeñas, agrupadas, traslucidas y de color amarillento que se ubicaban en el borde cubital del quinto dedo y pliegue interdigital del primer y segundo dedo en ambas manos. El estudio histopatológico concluyo en acroqueratoelastoidosis. Reportamos estos casos por ser cuadros de poca frecuencia y se realiza una revisión de la literatura.

Acrokeratoelastoidosis is a genodermatosis of chronic condition, characterized by multiple small hyperkeratotic papules or by firm plaques on the sides of the hands and feet, as well as the back of palms and soles. We describe two cases who attended to two healthcare facilities, the first of a 73-year-old male who consulted for ringworm of the hand, with the incidental finding of translucent papular lesions, some with umbilicated center, along the sides and backs of fingers, with no previous family history of such symptoms. The second one of a 16-year-old female patient who consulted for acne but presented, on physical examination, a small group of translucent yellowish papular keratotic lesions on the cubital side of the ulnar finger and interdigital fold of the first and second fingers on both hands. Histopathology study concluded acrokeratoelastoidosis. We report these cases because of their low frequency, and reviewed the literature.

Angioqueratoma Nevoide Circunscrito / Circumscribed Nevoid Angiokeratoma

Los angioqueratomas son un grupo de malformaciones vasculares caracterizadas histológicamente por la presencia de dilatación de capilares superficiales con hiperqueratosis suprayacente, existen cinco tipos clínicamente reconocibles. El angioqueratoma nevoide circunscrito (ANC) es un tipo inusual de angioqueratoma localizado en glúteos o muslos mostrando una distribución unilateral. Presentamos el caso de un angioqueratoma nevoide circunscrito en una adolescente cuyo tratamiento resultó insatisfactorio, siendo pocos los aportes de la literatura en el manejo exitoso de esta patología.

The angiokeratomas are a group of vascular malformations histologically characterized by the presence of dilated surface capillaries with overlying hyperkeratosis, there are five types clinically recognizable. The nevoid circumscriptum angiokeratoma is an unusual type of angiokeratoma located in buttocks or thighs showing a unilateral distribution. We present a nevoid circumscribed angiokeratoma in a teenager, whose treatment was unsatisfactory, with little input from the literature on the successful management of this condition.