Dermatosis específicas de la embarazada (DEE). Propuesta de nueva clasificación / Pregnant specific dermatoses (DEE). Proposal for a new classification

En el presente trabajo se realiza una breve descripción de las dermatosis específicas de la embarazada (DEE). Se considera que la afección específica más frecuente son las pápulas y placas urticarianas pruriginosas del embarazo (PPUPE), y en segundo lugar los prurigos vinculados del embarazo (PVE). Se aporta una propuesta de nueva clasificación de las dermatosis específicas de la embarazada (DEE). En la clasificación se consideran dos grupos de afecciones. Grupo A: dermatosis específicas de la embarazada (DEE), y dentro de él: a) como enfermedad más frecuente las pápulas y placas urticarianas pruriginosas del embarazo (PPUPE); b) seguidas de los prurigos, tanto sea el precoz como el tardío, a los cuales se los une bajo el término de prurigos vinculados del embarazo (PVE) como entidad también frecuente c) la foliculitis pruriginosa del embarazo (FPE). Como afecciones menos frecuentes dentro de este grupo: a) dermatitis papulosa de Spangler (DPS); b) erupción toxémica del embarazo (ETE); c) herpes gestationis (HG); d) impétigo herpetiforme (IH). Grupo B: afección específica de la embarazada sin lesiones en piel: colestasis intrahepática del embarazo (CIE). (AU)

In the present work, a brief description of the specific dermatoses of the pregnant woman (DEE) is made. The most common specific condition is considered to be pruritic urticarial papules and plaques of pregnancy (PPUPE), and secondly, prurigos associated with pregnancy (PVE). A proposal for a new classification of pregnant-specific dermatoses (DEE) is provided. Two groups of conditions are considered in the classification. Group A: pregnant-specific dermatosis (EED), and within it: a) as the most frequent disease, pruritic urticarial papules and plaques of pregnancy (PPUPE); b) followed by prurigos, both early and late, to which they are associated under the term of linked prurigos of pregnancy (PVE); as also frequent entity; c) the pruritic folliculitis of pregnancy (FPE). As less frequent conditions within this group: a) Spangler's papular dermatitis (DPS); b) toxic eruption of pregnancy (TEE); c) herpes gestationis (HG); d) impetigo herpetiformis (IH). Group B: specific condition of the pregnant woman without skin lesions: intrahepatic cholestasis of pregnancy (ICD). (AU)

Multiple whitish papules on the posterior neck of an elderly woman

Abstract White fibrous papulosis of the neck is a rare entity, with fewer than 50 cases described. It is a benign pathology whose main interest lies in its broad differential diagnosis, especially with pseudoxanthoma elasticum. The authors report the case of a 77-year-old woman with multiple yellow-white monomorphic papules on the posterior cervical region, with years of evolution. Cutaneous biopsy revealed a nodular area in the superficial and middle reticular dermis, with slight thickening of the collagen fibers and focally enlarged elastic fibers, aspects highlighted in the Verhoeff staining that additionally showed absence of elastic fibers in the papillary dermis.

Manifestaciones cutáneas en pacientes pediátricos infectados por el coronavirus SARS-CoV-2 / Cutaneous manifestations in pediatric patients infected with SARS-CoV-2 coronavirus

Introducción: El nuevo coronavirus SARS-CoV-2 ha causado un brote grave de la enfermedad denominado COVID-19. El virus fue identificado por primera vez en Wuhan, China, en diciembre del 2019. Recientemente se describieron las manifestaciones cutáneas, con similitud clínica entre niños y adultos. Se identificaron cinco patrones cutáneos: erupción máculo-papular, urticaria, lesiones acrales tipo perniciosas, erupción vesicular y livedo reticularis. Objetivo: Caracterizar a pacientes pediátricos con manifestaciones cutáneas en el curso de la COVID-19. Presentacion de casos: Se estudiaron 10 pacientes pediátricos con COVID-19 ingresados en el Hospital Militar de Villa Clara Comandante Manuel Piti Fajardo. Del total de pacientes, 8 presentaron rash eritemato-papuloso y 2 rash urticariforme. Las lesiones urticariformes se presentaron solamente en las féminas y las eritemato-papulosas, de forma similar en ambos sexos con ligero predominio en las adolescentes pacientes femeninas. Ambas lesiones predominaron en el tronco y acompañadas de un prurito ligero o ausente. Solo requirieron tratamiento médico las lesiones urticariformes. Conclusiones: La principal expresión clínica en la población pediátrica atendida en Villa Clara son las manifestaciones cutáneas. Las lesiones eritemato-papulosas son las más frecuentes, tienen. aparición tardía y evolución favorable sin necesidad de tratamiento y sin acompañarse de otra sintomatología(AU)

Introduction: The new coronavirus called SARS-Cov-2 has caused a severe outbreak of the disease called COVID-19. This virus was identified for the first time in Wuhan, China on December,2019. There were recently described its cutaneous manifestations, with clinical similarities among children and adults. There were identified five cutaneous patterns: macular-papular rash, hives, acral lesions pernicious type, vesicular rash and livedo reticularis. Objective: To characterize pediatric patients with cutaneous manifestations during COVID-19 disease. Cases presentation: There were studied 10 pediatric patients with COVID-19 admitted in ´´Comandante Manuel Piti Fajardo´´ Military Hospital of Villa Clara province. From the total of patients, eight presented eritemato-papular rash and two had urticariform rash. Urticariform lesions were present just in the girls, the eritomato-papulosa lesions presented similarly in both sexes with slight predominance in female adolescents. Both types of lesions appeared with predominance in the torso and accompanied of slight or absent pruritus. Just the urticariform lesions required medical treatment. Conclusions: The main clinical presentations in the pediatric population attended in the Military Hospital of Villa Clara province are the cutaneous manifestations. Eritemato-papular lesions are the most frequent; they have late onset and favorable evolution with no need of treatment and with no other symptomatology(AU)

A Case Series of Esophageal Lichen Planus: An Underdiagnosed Cause of Dysphagia

Lichen planus (LP) is a chronic mucocutaneous inflammatory condition that typically affects middle-aged adults. Esophageal involvement in LP is rare and underrecognized, often leading to delayed diagnosis and treatment of LP. Herein, we describe three cases of esophageal LP (ELP) in clinically symptomatic patients with endoscopic lesions in the upper to mid-esophagus. This case series suggests that ELP is be more common than was previously thought and emphasizes that clinicians should have a high index of suspicion for this diagnosis, particularly when evaluating proximal esophageal lesions in patients presenting with dysphagia. The series also highlights the successful treatment of our patients with budesonide-honey slurry.

Tratamiento del acné en la adolescencia / Treatment of acne in adolescents

El acné es la enfermedad dermatológica más común de la adolescencia. Aunque casi todos los casos remiten alrededor de la tercera década de la vida, cuando este problema conlleva una carga emocional para el paciente se requiere indicar tratamiento. En esta actualización, los autores revisan los distintos grados de compromiso de esta patología, el tratami-ento y los niveles de evidencia que tiene cada uno de ellos, con el objetivo de facilitar a los médicos de atención primaria el manejo de los pacientes que presentan esta enfermedad. (AU)

Acne is the most common dermatological condition in adolescents. Even though almost all cases will resolve around the third decade of life, treatment is indicated when this health problem carries an emotional burden for the patient. In this update, the authors review the grades of involvement of the disease and the available treatments according to levels of evidence, with the aim of helping primary care physicians to manage the patients presenting this illness. (AU)

Papulosis fibrosa blanca del cuello: a propósito de un caso / White fibrous papulosis of the neck: about a case

La papulosis fibrosa blanca del cuello es una patología benigna, que se presenta frecuentemente en personas mayores y que se caracteriza por pápulas blanquecinas ubicadas habitualmente en las regiones laterales del cuello. El hallazgo histopatológico distintivo es el incremento de las fibras de colágeno en la dermis papilar. Su etiopatogenia es, hasta ahora, desconocida y su tratamiento es difícil. Dado que corresponde a una patología infrecuente, probablemente subdiagnosticada, es que se decide reportar el caso de una mujer chilena de 77 años.

White fibrous papulosis of the neck is a benign pathology, which usually occurs in old people and is characterized by whitish papules that are frequently located in the lateral regions of the neck. The distinctive histopathological finding is the increase of collagen fibers in the papillary dermis. Its pathophysiology is not currently known and its treatment is difficult. Due to being a rare pathology, probably underdiagnosed, it was decided to report the case of a 77-yearold chilean woman.

¿Es frecuente la depresión mayor en la psoriasis? / Is major depression common in psoriasis?

Contexto: la psoriasis es una patología dermatológica con importantes consecuencias psicológicas derivadas del estigma que genera el llamativo aspecto de las lesiones, en especial el aislamiento, ansiedad, depresión mayor e incremento de ideas suicidas. Objetivo: determinar del grado de depresión en pacientes con diferentes grados de severidad de psoriasis. Sujetos y métodos: se efectuó un estudio descriptivo transversal con muestreo aleatorio en 82 pacientes con psoriasis, de ambos sexos, sin diagnóstico previo de depresión, con edades comprendidas entre 15 a 90 años que acuden a la consulta externa del servicio de Dermatología del hospital Carlos Andrade Marín, en el periodo julio-agosto 2015. Mediante el test de Beck se determinó el grado de depresión e índice PASI (Psoriasis Area Severity Index) se estimó el grado de psoriasis. Resultados: la prevalencia de depresión fue 24,4% y se encontró asociación estadística entre depresión y severidad de la psoriasis. El sexo femenino mostró 3,5 veces más riesgo para presentar depresión respecto al sexo masculino; sujetos con psoriasis severa tienen 35,7 veces más riesgo de depresión comparado con pacientes afectados de psoriasis leve. Conclusión: la prevalencia de depresión es elevada y aumenta con el grado de severidad de la psoriasis, se sugiere incluir en el manejo rutinario el seguimiento psicológico y psiquiátrico; se recomienda implementar estudios prospectivos para determinar la evolución de comorbilidades psiquiátricas en este grupo poblacional, a fin de diseñar protocolos de tratamiento ajustados a la población ecuatoriana.(AU)

Context: psoriasis is a dermatological pathology with important psychological consequences derived from the stigma generated by the striking appearance of the lesions, especially, isolation, anxiety, major depression and increase in suicidal ideas. Objective: to determine the degree of depression in patients with the degree of severity of psoriasis. Subjects and methods: a descriptive, cross-sectional study was conducted with random sampling in 82 patients with psoriasis, of both sexes, without previous diagnosis of depression, aged between 15 and 90 years, who attended the outpatient service of the Hospital's Dermatology service. Carlos Andrade Marín, in the period July-August 2015. By means of the Beck test, the degree of depression and PASI index (Psoriasis Area Severity Index) was determined, the degree of psoriasis was estimated. Results: the prevalence of depression was 24.4%; Statistical association was found between depression and severity of psoriasis. The female sex showed 3.5 times more risk to present depression with respect to the male sex; Subjects with severe psoriasis have a 35.7 times higher risk of depression compared with patients suffering from mild psoriasis. Conclusion: the prevalence of depression is high and increases with the degree of severity of psoriasis, it is suggested to include in the routine management the psychological and psychiatric follow-up; it is recommended to implement prospective studies to determine the evolution of psychiatric comorbidities in this population group, in order to design treatment protocols adjusted to the Ecuadorian population.(AU)

Factores asociados con el uso de medios sociales SoMe en pacientes con psoriasis / Factors associated with the use of SoMe social media in patients with psoriasis

Contexto: los medios de comunicación social (SoMe) son alternativas utilizadas por los pacientes para obtener información sobre psoriasis. Objetivo: describir la frecuencia de uso de SoMe y determinar su asociación con factores demográficos y clínicos. Sujetos y métodos: 200 pacientes con diagnóstico de psoriasis, atendidos en 6 unidades de salud localizados en las ciudades de Quito, Guayaquil y Portoviejo. Resultados: el 72% de los pacientes evaluados usaron internet y de estos, el 93% buscó información sobre psoriasis; las fuentes de información empleadas fueron Google (74,6%), Facebook (29,6%) y foros de salud (18,3%). Existe asociación estadística el mayor uso de SoMe con las variables sexo femenino, edad menor a 45 años, residencia urbana, nivel educativo alto y actividades profesionales (p<0,05). La afectación en la calidad de vida fue más alta en usuarios de SoMe (72,5% vs. 56,9%; p<0.05). El compromiso articular, lesiones en áreas expuestas, severidad de la psoriasis calificada de acuerdo a SAPASI, el tratamiento con inmunomoduladores o inmunosupresores, no se asociaron con e l uso de SoMe. Conclusión: el uso de SoMe en pacientes con psoriasis es usual y se asoció a factores demográficos. Se recomienda a la comunidad dematológica conocer fuentes de información en SoMe disponible para ofrecer a los pacientes. (AU)

Context: social media (SoMe) are alternatives used by patients to obtain information about psoriasis. Objective: to describe the frequency of SoMe use and determine its association with demographic and clinical factors. Subjects and methods: 200 patients diagnosed with psoriasis, treated in 6 health units located in the cities of Quito, Guayaquil and Portoviejo. Results: 72% of the patients evaluated used the internet and of these, 93% looked for information on psoriasis; the sources of information used were Google (74.6%), Face-book (29.6%) and health forums (18.3%). There is a statistical association with the greater use of SoMe with the variables female sex, age younger than 45 years, urban residence, high educational level and professional activities (p <0.05). Affectation in the quality of life was higher in SoMe users (72.5% vs. 56.9%, p <0.05). Joint involvement, lesions in exposed areas, severity of psoriasis qualified according to SAPASI, treatment with immunomodulators or immunosuppressants, were not associated with the use of SoMe. Conclusion: the use of SoMe in patients with psoriasis is usual and associated with demographic factors. It is recommended to the dematological community to know sources of information in SoMe available to offer to patients. (AU)

Fototerapia UVB banda estrecha en el tratamiento de la enfermedad injerto contra huésped crónica cutánea: reporte de caso / Narrowband UVB phototherapy for the treatment of cutaneous chronic graft versus host disease: case report

Resumen La enfermedad injerto contra huésped crónica (EICHc) es una complicación frecuente en los pacientes que reciben trasplante de progenitores hematopoyéticos (TPH) alogénico, siendo la piel el órgano más frecuentemente afectado. La EICHc cutánea se presenta con lesiones esclerodermiformes y no esclerodermiformes y frecuentemente requiere tratamiento con inmunosupresores sistémicos, fotoféresis extracorpórea o fototerapia. Los inmunosupresores tienen el potencial de producir importantes efectos adversos, por lo que terapias con mejor perfil de seguridad son claramente necesarias. Presentamos el caso de una paciente de 11 años a quien se le realizó un TPH haploidéntico como tratamiento de una leucemia linfocítica aguda. En su evolución desarrolló EICHc cutánea esclerodermiforme. La paciente recibió tratamiento con luz ultravioleta B de banda estrecha (UVBbe), respondiendo satisfactoriamente en los 2 primeros meses. Existen múltiples reportes y series de casos exitosos sobre el tratamiento con fototerapia en distintas modalidades. En relación a la fototerapia con UVBbe, la literatura es escasa, sin embargo, muestran importantes resultados tanto en las formas esclerodermiformes y no esclerodermiformes de la EICHc cutánea y un buen perfil de seguridad. De todas formas, se requieren estudios prospectivos controlados a gran escala para determinar su efectividad como terapia adjuvante o incluso de primera línea y para definir los esquemas terapéuticos y dosis más efectivas.

Summary Chronic graft-vs-host disease (GVHD) is a frequent complication in patients who receive allogeneic hematopoietic cell transplants (HCTs), and the skin is the most common site of involvement. Chronic cutaneous GVHD can present with sclerotic or nonsclerotic changes and often requires treatment with systemic immunosuppressants, extracorporeal photopheresis, or phototherapy. Immunosuppressants carry the potential of causing important side effects, so additional modes of therapy with better security profiles are clearly needed. We report a case of an eleven year old girl, who received allogeneic HCTs to treat acute lymphocytic leukemia. She developed sclerotic chronic GVHD. The patient underwent treatment with narrowband UV-B phototherapy, and a significant improvement was seen over the first 2 months. There are a number of successful series and case reports on different forms of phototherapy. In relation to narrowband UV-B phototherapy, literature is scarce, although shows important results in sclerotic and nonsclerotic forms of chronic cutaneous GVHD and a good safety profile have been seen. Anyway, large-scale controlled prospective trials are needed to evaluate the effectiveness of phototherapy as adjuvant o even first-line therapy, and to establish the most effective therapy schemes and doses.

Dowling-Degos disease: a therapeutic challenge: report of a family with no response to laser treatments

La enfermedad de Dowling-Degos (DDD), conocida también como 'anomalía reticulada y pigmentada de las flexuras' es una rara genodermatosis autosómica dominante. Se caracteriza por la aparición de máculas hiperpigmentadas de configuración reticulada; afectando principalmente los grandes pliegues como las axilas e ingles. Pudiendo, además, comprometer otros pliegues como cervicales, antecubitales, submamarios e interglúteos. Otras características asociadas son las lesiones tipo comedones y los pits palmo-plantares. Presentamos el caso de una familia con enfermedad de Dowling-Degos sin respuesta al tratamiento con laser Nd:YAG y CO2. Se realiza una revisión de la literatura de los tratamientos disponibles.

Dowling-Degos disease (DDD), also known as "reticulate pigmented anomaly of the flexures", is a rare autosomal dominant genodermatosis. DDD is characterized by an acquired reticular skin hyperpigmentation which begins in the axillae and groin. It later involves other body folds, including neck, inner aspects of the arms and thighs, inframammary, and intergluteal folds. Associated features include comedolike lesions on the neck or back, pitted facial or perioral scars, and epidermoid cysts. Herein we present a family (proband, mother, grandmother) with DDD that were treated with Q-switched Nd:YAG laser and CO2 laser without response. Treatment options are discussed and the available literature is reviewed.

Novel Mutations inGene in Two Chinese Acne Inversa Families Manifested as Familial Multiple Comedones and Dowling-Degos Disease / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Acne inversa (AI), also called hidradenitis suppurativa, is a chronic, inflammatory, recurrent skin disease of the hair follicle. Familial AI shows autosomal-dominant inheritance caused by mutations in the γ-secretase genes. This study was aimed to identify the specific mutations in the γ-secretase genes in two Chinese families with AI.</p><p><b>METHODS</b>In this study, two Chinese families with AI were investigated. All the affected individuals in the two families mainly manifested with multiple comedones, pitted scars, and a few inflammatory nodules on their face, neck, trunk, axilla, buttocks, upper arms, and thighs. Reticulate pigmentation in the flexures areas resembled Dowling-Degos disease clinically and pathologically. In addition, one of the affected individuals developed anal canal squamous cell carcinoma. Molecular mutation analysis of γ-secretase genes including PSENEN, PSEN1, and NCSTN was performed by polymerase chain reaction and direct DNA sequencing.</p><p><b>RESULTS</b>Two novel mutations of PSENEN gene were identified, including a heterozygous missense mutation c.194T>G (p.L65R) and a splice site mutation c.167-2A>G.</p><p><b>CONCLUSIONS</b>The identification of the two mutations could expand the spectrum of mutations in the γ-secretase genes underlying AI and provide valuable information for further study of genotype-phenotype correlations.</p>

The utility of dermoscopy in the diagnosis of evolving lesions of vitiligo.

Background: Early lesions of vitiligo can be confused with various other causes of hypopigmentation and depigmentation. Few workers have utilized dermoscopy for the diagnosis of evolving lesions of vitiligo. Aim: To analyze the dermoscopic findings of evolving lesions in diagnosed cases of vitiligo and to correlate them histopathologically. Methods: Dermoscopy of evolving lesions in 30 diagnosed cases of vitiligo was performed using both polarized light and ultraviolet light. Result: On polarized light examination, the pigmentary network was found to be reduced in 12 (40%) of 30 patients, absent in 9 (30%), and reversed in 6 (20%) patients; 2 patients (6.7%) showed perifollicular hyperpigmentation and 1 (3.3%) had perilesional hyperpigmentation. A diffuse white glow was demonstrable in 27 (90%) of 30 patients on ultraviolet light examination. Melanocytes were either reduced in number or absent in 12 (40%) of 30 patients on histopathology. Conclusion: Pigmentary network changes, and perifollicular and perilesional hyperpigmentation on polarized light examination, and a diffuse white glow on ultraviolet light examination were noted in evolving vitiligo lesions. Histopathological examination was comparatively less reliable. Dermoscopy appears to be better than routine histopathology in the diagnosis of evolving lesions of vitiligo and can obviate the need for a skin biopsy.

Tumourlike Lesions of Skin - A Clinicopathological Analysis of 175 Cases.

As the skin is the largest and complex organ, a wide variety of tumourlike lesions are encountered in the clinical practice. The ability to properly diagnose & treat these common lesions & to distinguish them from malignant tumours is the vital skills for all clinicians. Objective: To analyse retrospectively tumourlike lesions of skin with respect to age, sex, clinical features and histopathological features in a tertiary referral centre in Maharashtra, India. Methods : The present study consisted of analysis of tumourlike lesions of skin received in the histopathology section of department of pathology over a period of 5 years that is from August 2005 to July 2010 .The material comprised of biopsies and excision specimens. The clinical and histopathological details were noted. The findings were compared with those reported by other authors. Results : One hundred and seventy five (175) cases of tumourlike lesions of skin were seen .These lesions presented as skin swellings or tumours. Maximum cases (34.8%) of tumourlike lesions occurred in fourth & fifth decades with male preponderance (1.35:1). The maximum number of cases was encountered in the head & neck region (63.4%). Their size ranged from 0.4 to 9 cms. Epidermal cyst was the commonest tumourlike lesion (59.4%) followed by dermoid cyst (13.1%).Other lesions were trichilemmal cyst, fibroepithelial polyp, keloid, hypertrophic scar and epidermal nevus. Conclusion : Tumourlike lesions are clinically diagnosed by their presentation. However, the histopathological examination confirms the clinical diagnosis. The pathologic evaluation of all tumourlike lesions is mandatory to avoid patient’s and family’s anxiety.

Psoriasis, una enfermedad sistemica con un tratamiento limitado / Psoriasis, a systemic disease with a limited treatment

La psoriasis es una enfermedad inflamatoria sistémica, mediada inmunológicamente que afecta piel, uñas y articulaciones en 2 al 3% de la población mundial. Anteriormente se consideraba como enfermedad limitada a la piel con pocas implicaciones en la salud general del que la sufría, sin embargo a través de los estudios epidemiológicos se ha demostrado que los pacientes con psoriasis tienen una incidencia aumentada de padecer otras condiciones crónicas inflamatorias como artritis reumatoide, enfermedad inflamatoria intestinal, de igual manera obesidad, diabetes mellitus tipo 2, enfermedad cardiovascular e ictus; sin olvidar la vinculación de la psoriasis a trastornos psicológicos que conllevan a altas tasas de depresión y ansiedad. Por lo cual, el enfoque de la psoriasis como enfermedad limitada a piel ha sido sustituido por el de enfermedad sistémica, que debe ser tratada con fármacos que además de controlar las lesiones cutáneas, sean capaces de prevenir el desarrollo de patologías asociadas con la morbimortalidad que estas representan....

Follicular Dowling Degos disease: A rare variant of an evolving dermatosis.

Dowling Degos disease is a rare, reticulate pigmentary disorder with variable phenotypic expression that manifests as hyperpigmented macules and reticulate pigmentary anomaly of the fl exures. Many variants of this condition and its overlap with other reticulate pigmentary disorders have been reported in the literature. We present here two cases of DDD with follicular localization, both clinically and histologically. It was associated with ichthyosis vulgaris in one case. Follicular DDD is an uncommon variant of this evolving dermatosis. Our report supports the possible role for disordered follicular keratinisation in its pathogenesis.

Quistes vellosos eruptivos: un caso / Eruptive vellus cyst: a case

Los quistes vellosos eruptivos son pápulas foliculares bien delimitadas, de color piel normal, rojizas o amarillentas, que miden de 1 a 4 milímetros de diámetro y se localizan preferentemente en el tórax anterior o las extremidades. Constituyen una entidad benigna, de herencia autosómica dominante o adquirida. Se presentan habitualmente sin síntomas, aunque en ocasiones generan prurito. Se describe una niña de 7 años de edad con quistes vellosos eruptivos de presentación esporádica...

Eruptive vellus hair cysts are follicular, well-defined papules, measuring from 1 to 4 mm in diameter, normal skin color, reddish or yellowish that are preferentially located on the anterior chest or limbs. It is a benign condition, sporadic or inherited as an autosomal trait. They are clinically asymptomatic, although sometimes they may itch. We describe a 7-year-old girl that presents sporadic eruptive vellus hair cysts...