Dermatitis herpetiforme y enfermedad celíaca / Dermatitis herpetiformis and celiac disease

La dermatitis herpetiforme (DH) es una enfermedad crónica y ampollar caracterizada por la presencia de lesiones intensamente pruriginosas, de ubicación característica, y por asociarse en todos los casos a enfermedad celíaca (EC) (sintomática o no). Ambas entidades se consideran una expresión, en diferentes órganos, de hipersensibilidad al gluten. Se presenta una serie de cuatro pacientes de sexo femenino, con un promedio de 46 años, que consultaron por la aparición de pápulas, lesiones erosivocostrosas, excoriaciones y ampollas, pruriginosas, localizadas predominantemente en los codos, las rodillas y el dorso superior. Referían brotes intermitentes con un tiempo de evolución de entre 6 meses y 10 años. Se realizó una biopsia cutánea y estudio histopatológico que evidenció la presencia de una dermatosis ampollar subepidérmica con neutrófilos e IFD positiva en tres de las pacientes, y que confirmó el diagnóstico de dermatitis herpetiforme. Los hallazgos de laboratorio y la videoendoscopia digestiva alta con toma de biopsia fueron compatibles, en todos los casos, con enfermedad celíaca. Se les indicó dieta libre de gluten (DLG) a todas las pacientes; en una de ellas fue suficiente para lograr la remisión completa de las lesiones después de 3 meses; las tres restantes requirieron tratamiento con dapsona para controlar la enfermedad (AU)

Dermatitis herpetiformis (DH) is a chronic, bullous disease, which is characterized by intensely pruritic lesions, property location and diagnosis in all cases of celiac disease (CD) (symptomatic or not). Both entities are considered expression in different organs of hypersensitivity to gluten. A series of four female patients is presented with an average of 46 years who consulted by the appearance of papules, erosivocostrosas injuries, abrasions and blisters, itchy, localized predominantly on elbows, knees and upper back. Intermittent outbreaks concerned with evolution time between 6 months and 10 years. IFD positive skin biopsy and histopathological study showed subepidermal bullous dermatosis with neutrophils was performed, and in three of the patients confirmed the diagnosis of dermatitis herpetiformis. Laboratory findings and upper gastrointestinal video endoscopy with biopsy were compatible in every case with celiac disease. Gluten-free diet in all patients indicated, one of them was enough to achieve complete remission of lesions after three months; the remaining three required starting dapsone for disease control (AU)

Penfigoide bolhoso induzido por enalapril / Bullous pemphigoid induced by enalapril

O penfigoide bolhoso (PB) é uma dermatose bolhosa autoimune subepidérmica que comumente afeta indivíduos idosos. O desencadeamento da doença por medicamentos é conhecido, entretanto, pouco descrito na literatura, especialmente casos associados ao uso de enalapril. A interrupção do fármaco desencadeante constitui o pilar terapêutico, entretanto medicações podem ser necessárias. Descrevemos um caso de PB em um paciente com 45 anos associado ao uso do enalapril e discutimos sobre a variante de PB induzida por medicamentos.

Fish Pedicure-induced Aeromonas sobria Superficial Necrotic Bullous Dermatitis in a Previously Undiagnosed Diabetes Patient. What are the Risks of Fish Pedicure for Public Health?.

We describe a patient with previously undiagnosed diabetes who developed superficial necrotic bullous dermatitis due to Aeromonas sobria infection following a fish pedicure (also known as fish spa, fish therapy or Ichthyotherapy). A major concern regarding fish pedicure involves the transmission of viral and bacterial infections. It has been shown that fish tank water contains a wide variety of bacteria, including non-pathogenic as well as potentially pathogenic species. Commonly in fish spas the tank water is heated to a temperature of 25 to 30°C. Such temperatures favour overall bacterial growth and at the same time increase skin porosity upon immersion, hence indirectly promoting potential skin infections. The authors discuss three potential routes of transmission (from fish or tub surface to man, from water to man, and from man to man via the tub water) and analyse the potential risk of bacterial or viral transmission associated with fish pedicures. On the basis of the current case study and the consensus view of experts, the authors advise against fish pedicure, in particular for patients with diabetes or a compromised immune system.