Corticoides sistémicos: uso racional en dermatología / Systemic glucocorticoids: rational use in dermatology

Los glucocorticoides (GC) son potentes agentes inmunosupresores y antiinflamatorios ampliamente utilizados en el tratamiento de enfermedades dermatológicas. Las complicaciones asociadas a la terapia esteroidal sistémica aumentan con dosis mayores, tratamientos prolongados y administración fraccionada. Para maximizar la eficacia de la terapia esteroidal minimizando el riesgo de efectos adversos, es necesario conocer su farmacocinética y función a nivel de distintos órganos blanco. En esta revisión damos una visión general del mecanismo de acción de los GC y sus efectos adversos, junto con algunas recomendaciones prácticas para su uso clínico efectivo y seguro, disminuyendo el riesgo de desarrollar complicaciones.

(GC) are potent immunosuppressive and anti-inflammatory agents widely used in the treatment of many dermatologic diseases. Complications associated with systemic GC increase with higher doses, prolonged therapies, and divided administration. In order to maximize the effectiveness of steroidal therapy, minimizing the risk of adverse effects, it is necessary to know their pharmacokinetics and function on different target organs. In this review, we take general look at the mechanism of action and side effects of GC, along with some practical recommendations for their safe and effective use in order to decrease the risk of complications.

Manifestaciones reumatológicas en pacientes con síndrome de inmunodeficiencia adquirida (VIH/SIDA) / Rheumatic manifestations in patient with human immunodeficiency virus infection

HIV infection produces a state of alteration in the immune system that not only increases the susceptibility to infections and tumors, but also leads to autoimmune conditions such as those found in rheumatology. These patients manifest a greater frequency of polyarthritis, pelvic spondylopathy, Sjõgren’s syndrome, myopias, and certain vasculitis. On the other hand, there is a great harboring and overexposure of symptoms among systemic autoimmune diseases (e.g. systemic lupus erythematosus, vasculitis), as well as HIV itself, which together with a greater frequency of autoantibodies in these patients, can frequently make differential diagnosis quite difficult. It is important to know about the existence of exclusive autoimmune manifestations, such as the diffuse infiltrative lymphocytosis syndrome, characterized by parotid hypertrophy, intestinal pneumonia and myopathy. However, new rheumatic conditions have appeared with the use of the highly successful antiretroviral therapy, whether caused by adverse reactions to drugs (myopathies, arthritis,neuropathologies) or within the context of the immune reconstitution syndrome, in which reactions such as sarcoidosis, the appearance or exacerbation of a preexisting rheumatoid arthritis and Graves disease, among others, have been described. Knowing the interrelation between autoimmune pathologies and HIV is important for the adequate diagnosis of both types of conditions and may provide information as to immunopathogenicity of both diseases.

Retinoides orales en niños y adolescentes / Oral retinoids in children and adolescent

Los retinoides son muy eficaces en el tratamiento de diversas enfermedades cutáneas que se presentan en niños, como psoriasis, acné e ictiosis. Sus efectos adversos potenciales limitan su uso, especialmente en la población pediátrica. Revisamos la eficacia y riesgos de la terapia con retinoides orales en niños y adolescentes. La toxicidad mucocutánea es el efecto adverso más frecuente, siendo generalmente bien tolerada, fácilmente tratable y reversible al discontinuar el tratamiento. Los efectos adversos sistémicos más graves incluyen la teratogenicidad y los efectos musculoesqueléticos, neurológicos y del sistema gastrointestinal. La educación y control de los pacientes pueden minimizar la ocurrencia de complicaciones.