Escabiasis costrosa imitando una acrodermatitis continua de Hallopeau / Crusted scabies mimicking an acrodermatitis continua of Hallopeau

Resumen Introducción: La escabiasis costrosa (EC) es una variante poco común de sarcoptiosis clásica, altamente contagiosa. Las lesiones poseen una elevada concentración del ácaro Sarcoptes scabiei var hominis, lo que conlleva a un cuadro clínico más extenso que en la escabiasis clásica. Se observa principalmente en pacientes con algún tipo de inmunocompromiso y se relaciona con el síndrome de Down. Caso clínico: Se describe una paciente pediátrica con síndrome de Down quien presentó placas escamosas que afectaron la porción distal de los dedos, asociadas con distrofia ungueal e hiperqueratosis subungueal, por lo que se consideró acrodermatitis continua de Hallopeau como diagnóstico diferencial. Se realizó una biopsia tipo punch con lo que se llegó al diagnóstico de EC. La paciente recibió tratamiento sistémico con ivermectina vía oral y tratamiento tópico con crema hidratante y desonida al 0.1%. Mostró mejoría clínica notoria dos semanas después de finalizar el tratamiento. Conclusiones: La EC es una variante prevalente en pacientes inmunocomprometidos y con síndrome de Down que fácilmente puede confundirse con patologías inflamatorias con alteración de la queratinización epidérmica. Este caso se considera una presentación atípica debido a la afección localizada en los dedos de las manos asociada con distrofia ungueal. El estudio histopatológico fue necesario para realizar el diagnóstico y descartar diagnósticos diferenciales.

Abstract Background: Crusted scabies (CS) is an uncommon, highly contagious, variant of classic scabies. Elevated concentrations of the mite Sarcoptes scabiei var. hominis are found in the skin lesions, which lead to a more exaggerated clinical picture than in classic scabies. This disease is mainly observed in patients with any kind of immunosuppression and relates to Down syndrome. Case report: A pediatric female patient with Down syndrome, who presented a crusty white plaque associated with nail dystrophy and subungual hyperkeratosis affecting the distal portion of the fingers is described. Because of these findings, the diagnosis of acrodermatitis continua of Hallopeau was considered. A punch biopsy was performed, attaining the diagnosis of CS. She received systemic treatment with oral ivermectin, topical treatment with emollient cream and desonide 0.1%. Notorious clinical improvement was observed two weeks after finalizing treatment. Conclusions: CS is variant of scabies prevalent in immunocompromised patients and Down syndrome that can be easily confused with inflammatory pathologies with abnormal epidermal keratinization. This case is considered as an atypical presentation of the disease because of local affection of the fingers and nail dystrophy. The histopathological study was necessary to obtain the diagnosis and rule out differential diagnosis.

Preventive Effects of Multi-Lamellar Emulsion on Low Potency Topical Steroid Induced Local Adverse Effect

BACKGROUND: Topical steroid treatment induces diverse local Wand systemic adverse effects. Several approaches have been tried to reduce the steroid-induced adverse effects. Simultaneous application of physiological lipid mixture is also suggested. OBJECTIVE: Novel vehicles for topical glucocorticoids formulation were evaluated for the efficacy of reducing side-effects and the drug delivery properties of desonide, a low potency topical steroid. METHODS: Transcutaneous permeation and skin residual amount of desonide were measured using Franz diffusion cells. The in vivo anti-inflammatory activity was evaluated using murine model. RESULTS: Topical steroids formulation containing desonide, in either cream or lotion form, were prepared using multi-lamellar emulsion (MLE), and conventional desonide formulations were employed for comparison. MLE formulations did not affect the anti-inflammatory activity of the desonide in phobol ester-induced skin inflammation model, compared with conventional formulations. While the penetrated amounts of desonide were similar for all the tested formulations at 24 hours after application, the increased lag time was observed for the MLE formulations. Interestingly, residual amount of desonide in epidermis was significantly higher in lotion type MLE formulation. Steroid-induced adverse effects, including permeability barrier function impairment, were partially prevented by MLE formulation. CONCLUSION: Topical desonide formulation using MLE as a vehicle showed a better drug delivery with increased epidermal retention. MLE also partially prevented the steroid-induced side effects, such as skin barrier impairment.

Rhabdomyomatous mesenchymal hamartoma clinical overview and report of a case with spontaneous regression / Hamartoma mesenquimal rhabdomiomatoso panorama clínico y reporte de un caso con regresión espontánea

A case of cutaneous rhabdomyomatous mesenchymal hamartoma in a 6-year old Afro-Caribbean girl is reported with review of the literature. The lesions were fine, located on the central face and became inapparent after six months. Spontaneous regression of these lesions has not been previously reported. Although rare, continued reporting will facilitate the elucidation of the clinical features and natural history of these lesions and the relationship to disordered embryogenesis.

Un caso de hamartoma mesenquimal rhabdomiomatoso cutáneo en una niña afrocaribeña de seis años de edad, se reporta junto con una revisión de la literatura. Las lesiones eran tenues, localizadas en la parte central de la cara, y se hicieron aparentes luego de seis meses. La regresión espontánea de estas lesiones no se ha reportado con anterioridad. Aunque sean raras, reportarlas de manera continuada facilitará la dilucidación de los rasgos clínicos y la historia natural de estas lesiones, así como su relación con una embriogénesis desordenada.

Avaliação comparativa da eficácia, tolerabilidade e segurança do furoato de mometasona a 0,1 por cento tópico comparado à desonida 0,05 por cento no tratamento da dermatite atópica em crianças / Comparative evaluation of efficacy, tolerability and safety of 0.1 por cento topical momethasone furoate and 0.05 por cento desonide in the treatment of childhood atopic dermatitis

O objetivo era avaliar comparativamente a eficácia e a segurança tópica do furoato de mometasona creme 0,1 por cento e da desonida creme 0,05 por cento aplicados uma vez ao dia, ambos corticosteróides de média potência, no tratamento da dermatite atópica em crianças entre 2 e 12 anos de idade. Foram estudados 25 doentes, com idades entre 2 e 12 anos, portadores de dermatite atópica, num ensaio clínico, duplo-cego, prospectivo e comparativo. Os doentes foram divididos em dois grupos, um de 13 crianças que utilizaram mometasona 0,1 por cento e outro de 12, que utilizaram desonida 0,05 por cento, com média de duração do tratamento de 26,8 e 25,7 dias, respectivamente. A eficácia e a tolerabilidade foram semelhantes para os dois fármacos. O evento adverso mais freqüentemente observado foi o ardor, em quatro pacientes, houve abandono do tratamento por parte de um paciente; verificaram-se sinais de atrofia leve em quatro doentes do grupo mometasona e em dois do grupo da desonida; foram encontrados na visita do quadragésimo segundo dia valores sem diferença significativa segundo testes de Friedman e Mann-Whitney. Os dois medicamentos mostraram-se igualmente seguros e bem tolerados, com eficácia estatisticamente significativa no tratamento da dermatite atópica

Avaliacao terapeutica da desonida, um novo corticosteroide topico, no tratamento da dermatite atopica. / Therapeutic evaluation of desonide a new topical corticosteroid in the treatment of atopic dermatitis

Um novo corticosteroide topico, nao-fluorado, 16 alfa hidroxiprednisolona, 16, 17 acetonida-desonida, foi avaliado no tratamento da dermatite atopica, em estudo nao-comparativo, 23 vinte e tres pacientes de ambos os sexos e com idades compreendidas entre 4 meses e 33 anos completaram o estudo. A avaliacao global ao termino do estudo mostrou resultados terapeuticos favoraveis em 92,6% dos casos tratados.A tolerabilidade foi considerada excelente com ausencia de efeitos colaterais