Mandibular melasma

Melasma is an acquired symmetrical brown hypermelanosis of the face. Three clinical patterns are recognized, namely centrofacial, malar and mandibular. This study addresses the clinical and histopathological features of ten women with mandibular melasma to determine its relation to other types of melasma. The mean age of the patients was 52 years and the onset of the disease occurred at an average age of 44 years. Sunlight aggravated the pigmentation in all cases. Only one patient was receiving hormonal therapy. Histopathologically, all patients demonstrated severe sundamage and hyperpigmentation of the epidermis. Nine of them had melanophages or melanin in the papillary dermis. We conclude than mandibular melasma may be a clinicopathologic entity different to other types of melasma.

Malignant melanoma in Puerto Rico: an update

A study about the incidence of malignant melanoma in Puerto Rico during the calendar year 1996 was carried out compiling the information submitted by pathological reports to the Puerto Rico Cancer Registry and identifying similar reports at other pathology laboratories. A total of 107 new cases were documented in 1996, resulting in an incidence of 3.03 (+/- 17.9) per 100,000 persons for that particular year. The age of the patients fluctuated between 19 and 88 years with a mean of 61.3 years, most of them being between 50 and 80 years. More than half of the cases (54.2 percent) were located in the head and neck, and the extremities. Thickness measurement of the neoplasm was reported in only 42 percent of the cases. In 60 percent of those cases in which the tumor thickness was reported, it was found to be less than 1.49 mm. Previous data in Puerto Rico from the years 1981 to 1986 had shown a tendency to an increase in the incidence of melanoma per 100,000 inhabitants rising 1.20 to 1.52 respectively. The present study reflects a continuation of the same pattern, with a two-fold increase in the last 10 years (from 1.52 to 3.03)

Acquired nevus flammeus

This is the case of a 55-year-old male with cirrhosis who required a LeVeen shunt for relief of refractory ascites. After eight months he developed recurrence of the ascites and a erythematous patch around the surgical scar. Skin biopsy revealed a proliferation of small and medium-sized vessels throughout the dermis. The acquired form of nevus flammeus is rare an is usually preceded by trauma. This is the report of a patient with an acquired nevus flammeus associated to an obstructed peritoneovenous shunt

The spectrum of cutaneous lesions in pediatric patients with leukemia

This is a clinical study that attempts to determine the incidence and patterns of cutaneous lesions in 109 pediatric patients with leukemia. Non-specific lesions, namely, adverse reactions to chemotherapy, complications of immunosuppression, and hemorrhagic diathesis were seen in 88.7 per cent of those patients with acute lymphocytic leukemia and in 88.9 per cent of patients with acute non-lymphocytic leukemia. Leukemia cutis was seen in three patients with acute non-lymphocytic leukemia, and in one patient with congenital leukemia. It seems that although skin complications are a frequent event in the course of childhood leukemia, leukemic infiltration of the skin a is rare event

Eccrine angiomatous hamartoma

This is the case of a 13 year-old female evaluated for a congenital skin lesion on the left buttock. Physical examination revealed a well-defined light brown patch with a 4mm papule on the center. A skin biopsy revealed an increased number of eccrine glands associated to a proliferation of vascular channels, particularly capillaries. These findings are consistent with a diagnosis of eccrine angiomatous hamartoma

Epidemiological study of tinea capitis in Puerto Rico

Two separate studies were carried out to determine the dermatophytes responsible for tinea capitis in Puerto Rico. A retrospective study to determine those agents during the period between 1979 and 1989 revealed a total of 36 mycologically positive cases. The causative organisms consisted of the following species: M. canis, 14 cases (38.9 per cent ); T. mentagrophytes, 7 cases (19.4 per cent ); T. rubrum, 7 cases (19.4 per cent ); M. gypseum, 5 cases (13.9 per cent ); and T. tonsurans, T. verrucosum, unclassified Microsporum species, 1 case each (2.8 per cent each). In a prospective study, fungal cultures were obtained from the scalps of 95 randomly selected children (45 males, 50 females) seen at the outpatient dermatology clinics of the Medical Sciences Campus of the University of Puerto Rico for a variety of skin problems but with no symptoms or signs of disease. One culture was positive for M. canis. All other cultures were negative. The significance of these findings is discussed as well as their relation to the incidence of T. tonsurans scalp infections in the Unites States

Response to treatment and recurrence of dermatomycosis in patients with diabetes

Thirteen diabetic and sixteen control patients with skin infections with dermatophytes and Candida albicans were evaluated for the response to treatment and the recurrence of the condition. Culture-proven infections of these organisms were treated with a topical antifungal cream (oxiconazole nitrate) for 30 days. There was no difference in response to treatment between the two groups. Nine diabetic and ten control patients were re-evaluated three months after finishing the treatment. Four of the nine diabetic patients (44 per cent ) and one of the ten control patients (10 per cent had evidence of recurrence. Dermatophytic skin infections in diabetic patients seem to respond adequately to topical treatment, however, recurrences appear to be frequent

Exogenous ochronosis

La ocronosis exógena es una condición que se caracteriza por tener hiperpigmentación de la cara secundario al uso crónico de cremas blanqueadores que contienen hidroquinona. Histopatológicamente se ve una colección de glóbulos amarillo-marrón (ocronóticos) en la dermis papilar. Se reportan dos casos de ocronosis exógena y se hace un repaso de la literatura

Factores de riesgo en epilepsia. Estudio epidemiológico de casos y controles

La prevalencia de la epilepsia es tres veces más elevada en los paises en desarrollo que en los industrializados. En Colombia es de 20 por mil habitantes. Se estudiaron los factores de riesgo responsables de la alta prevalencia de la enfermedad con el propósito de proponer los medios para rebajarla. Se investigaron 1.131 casos de epilepsia y 1.137 controles sanos equiparados por edad, sexo y condicion socioeconomica, con el fin de determinar la frecuencia de los siguientes factores de riesgo: presencia de epilepsia en los antecesores del paciente, riesgo obstétrico, infecciones del SNC, enfermedades virales de la infancia y trauma encefalocraneano. La información obtenida se analizó por dos métodos estadísticos y los resultados indican que de los factores de riesgo analizados solamente muestran significación estadística como productores de epilepsia los siguientes: el factor heredofamiliar fue el más importante de todos por su elevada significancia estadística, p<0.0005; el parto no institucional, el parto prolognado y la anoxia perinatal fueron los únicos factores obstétricos significativos; las meningitis o encefalitis y el trauma encefalocraneano fueron también importantes en la producción de epilepsia. Se discuten las implicaciones de estos resultados y se proponen las medidas conducentes a rebajar la elevada prevalencia de la epilepsia en nuestro país.

Efficacy of 1, alpha 25-dihidroxyvitamin D (calcitriol) in the treatment of psoriasis vulgaris: an open study

Several reports have appeared in the literature suggesting that Vitamin D metabolites and analogues may be useful for the treatment of psoriasis. This is a report of an open study in which the efficacy of 1, Alpha-25-dihydroxyvitamin D (Calcitriol) is evaluated in cases of moderate to severe psoriasis. Study of ten cases showed moderate improvement in four when using calcitriol at a daily dose of 0.5 ug for a period of three months. All Vitamin D metabolites were within normal limits during and after the trial. Further trials with calcitriol as an adjuvant therapy to topical steroids or photochemotherapy, as well as the development of topical Vitamin D analogues may be the future of this novel therapeutic alternative for psoriasis

Melanoma maligno en Puerto Rico / Malignant melanoma in Puerto Rico

Se efectuó un estudio epidemiológico de melanoma maligno mediante la revisión de todos los casos de melanomas reportados al Registro de Cáncer de Puerto Rico entre los años 1981 al 1987. Se documentaron un total de 367 casos nuevos con una incidencia anual que fluctuó entre 1.20 y 2.12 por 100,000 habitantes y un promedio de 1.59. La mayoría de los pacientes tenín entre los 40 y 80 años de edad, con una mayoría en los 60. Casi la mitad de los tumores ocurrieron en las extremidades, sobre todo en los pies, compartiendo esta tendencia con otras razas como los negros y japoneses. El tipo clínico-histológico más frecuente lo fue el melanoma superficial expansivo seguido del acral lentiginoso , el nodular y el melanoma lentigo maligna. Cerca de un tercio del total de casos no fue clasificado de acuerdo al tipo histológico, mientras que los niveles de Clark y el grosor de Breslow no fueron reportados en 44 y 84% de los casos respectivamente. Cuando comparamos nuestra data a la de un estudio previo en Puerto Rico entre los años de 1977 al 1980, la incidencia anual promedio de casos nuevos aumentó de 0.92 a 1.59 por 100,000 habitantes, documentándose un aumento de incidencia en nuestra población, pero no tan significativo como el aumento registrado en los Estados Unidos

Bullous pemphigoid and malignancy

Bullous pemphigoid has been reported in multiple publications to be associated with malignant neoplasms of different internal organ systems. This relationship was studied among forty patients seen at the Dermatology Clinics of the Puerto Rico Medical Center. The study demonstrated that Puerto Rican patients with bullous pemphigoid do not show an increased incidence of internal malignancy when compared with the general population matched for age, sex and study period. We conclude that extensive diagnostic studies for malignant neoplasms should not be the standard of care in patients with bullous pemphigoid. Additional studies should be guided by the clinical history and physical findings

Acral PUVA: induced pigmented macules

This report describes four patients with chronic psoriasiform dermatitis of the palms and soles who developed pigmented macular lesions after localized photochemotherapy (PUVA) to these areas. These lesions had varied histopathologic presentations including lentigines, atypical melanocytic proliferation and a junction nevus suggesting a wide clinico pathologic spectrum in the PUVA-induced pigmented macules

Clinicopathologic study on pityriasis alba

Pityriasis alba (PA) is a relatively common skin disorder usually seen in children and young adults characterized by the presence of superficial hypopigmented macules. A clinicopathologic study on pityriasis alba was undertaken which showed an increased ocurrence of the disease in preadolescent children with

Phaeohyphomycosis: first case in Puerto Rico

A 24 year-old woman with systemic lupus erythematosus developed a subcutaneous nodule on the back wich upon histopathological examination was found to be a case of phaeohyphomycosis. To our knowledge, this is the first case of the condition to be reported in Puerto Rico