Dermatosis autoinfligida: presentación de un caso y revisión / Self-inflicted dermatosis: presentation of a case and review

Las dermatosis autoinfligidas representan un motivo habitual de consulta, así como un desafío diagnóstico y terapéutico. Se caracterizan por la autoprovocación de lesiones cutáneas de manera consciente o inconsciente en el contexto de trastornos psiquiátricos complejos. Comunicamos el caso de una paciente que consultó al Servicio de Dermatología por úlceras irregulares y sobreinfectadas localizadas en rostro, de 2 meses de evolución. El caso representó una dificultad diagnóstica ya que solo a partir del interrogatorio exhaustivo y los exámenes complementarios, que descartaron otras patologías, se arribó al diagnóstico de úlceras autoprovocadas en contexto de patología psiquiátrica que requirió manejo interdisciplinario. (AU)

Self-inflicted dermatoses are a frequent cause for consultation and represent a diagnostic and therapeutic challenge. They are characterized by the conscious or unconscious self-generation of cutaneous lesions in the context of complex psychiatric disorders. We report the case of a patient who consulted at the dermatology department with two months history of irregular and superinfected ulcers located on the face. This case represented a diagnostic difficulty since only from an exhaustive interrogation and complementary examinations, which ruled out other pathologies, we arrived at the diagnosis of self-inflicted ulcers in the context of psychiatric pathology that required interdisciplinary management. (AU)

Mechanical evaluation of the resistance and elastance of post-burn scars after topical treatment with tretinoin

OBJECTIVE: After burn injuries, scarred skin lacks elasticity, especially in hypertrophic scars. Topical treatment with tretinoin can improve the appearance and quality of the skin (i.e., texture, distensibility, color, and hydration). The objective of this prospective study was to examine the effects of treatment with 0.05 percent tretinoin for one year on the biomechanical behavior and histological changes undergone by facial skin with post-burn scarring. Setting: Tertiary, Institutional. METHOD: Fifteen female patients who had suffered partial thickness burns with more than two years of evolution were selected. Skin biopsies were obtained initially and after one year of treatment. The resistance and elastance of these skin biopsies were measured using a mechanical oscillation analysis system. The density of collagen fibers, elastic fibers, and versican were determined using immunohistochemical analysis. RESULTS: Tretinoin treatment significantly lowered skin resistance and elastance, which is a result that indicates higher distensibility of the skin. However, tretinoin treatment did not significantly affect the density of collagen fibers, elastic fibers, or versican. CONCLUSION: Topical tretinoin treatment alters the mechanical behavior of post-burn scarred skin by improving its distensibility and thus leads to improved quality of life for patients.

Análise do lavado broncoalveolar em vítimas de queimaduras faciais graves / Bronchoalveolar lavage analysis in victims of severe facial burns

OBJETIVO: Analisar o lavado broncoalveolar (LBA) de vítimas de queimaduras que inalaram fumaça a fim de identificar alterações que possam estar associadas à morte ou à sobrevida. MÉTODOS: Dezoito vítimas de queimaduras faciais foram submetidas a LBA até 24 h após o evento, sendo realizadas a análise do conteúdo celular e proteico, incluindo TNF-α, HLA-DR, CD14, CD68 e iNOS. RESULTADOS: Dos 18 pacientes submetidos à broncoscopia, 8 (44,4 por cento) morreram durante o seguimento. A média de idade dos pacientes que morreram foi significativamente maior (44,7 vs. 31,5 anos). A superfície corporal queimada foi em média de 60,1 por cento nos pacientes que morreram e de 26,1 por cento nos sobreviventes (p < 0,0001). Entre os 18 pacientes submetidos à broncoscopia, 11 (61,1 por cento) apresentaram sinais endoscópicos de lesão por inalação de fumaça, e 4 (36,4 por cento) destes faleceram. Dos 7 pacientes sem sinais de lesão por inalação de fumaça, 4 (57,1 por cento) faleceram. A média do número de células epiteliais ciliadas no LBA dos pacientes que morreram foi significativamente maior daquela dos sobreviventes (6,6 por cento vs. 1,4 por cento; p = 0,03). Os demais parâmetros analisados não mostraram diferença entre os grupos. CONCLUSÕES: A superfície corporal queimada mostrou ser um fator preditivo de mortalidade. O aumento do número de células epiteliais ciliadas no LBA, denotando descamação epitelial brônquica, esteve associado à maior mortalidade de pacientes com queimaduras faciais.

OBJECTIVE: To analyze bronchoalveolar lavage (BAL) specimens of burn victims who inhaled smoke, in order to identify alterations associated with mortality or survival. METHODS: Eighteen victims of facial burns were submitted to BAL up to 24 h after the event. We investigated cell and protein content, including TNF-α, HLA-DR, CD14, CD68 and iNOS. RESULTS: Of the 18 patients submitted to bronchoscopy, 8 (44.4 percent) died during the follow-up period. The mean age of patients who died was significantly higher (44.7 vs. 31.5 years). On average, the patients who died had burns covering 60.1 percent of the total body surface area, compared with 26.1 percent in the survivors (p < 0.0001). Of the 18 patients submitted to bronchoscopy, 11 (61.1 percent) showed endoscopic signs of smoke inhalation injury, and 4 (36.4 percent) of those 11 died. Of the 7 patients with no signs of smoke inhalation injury, 4 (57.1 percent) died. The mean number of ciliated epithelial cells in the BAL fluid was significantly higher in the patients who died than in the survivors (6.6 percent vs. 1.4 percent; p = 0.03). There were no significant differences between the groups in terms of any of the other parameters evaluated. CONCLUSIONS: The total body surface area burned was a predictive factor for mortality. Increased numbers of ciliated epithelial cells in the BAL fluid, denoting bronchial epithelial desquamation, were associated with higher mortality in patients with facial burns.

Reconstrucción facial con colgajos locales / Facial reconstruction with local flaps

Este trabajo tiene como objetivo conocer la evolución clínica de pacientes sometidos a reconstrucciones faciales con empleo de colgajos locales. Estudio prospectivo, descriptivo y observacional, diseño no experimental. Se presentan cuatro (4) casos clínicos, pacientes masculinos, a dos (2), se les diagnóstica mediante biopsia Carcinoma Basocelular, a uno (1) Carcinoma Espinocelular y al otro Carcinoma Epidermoide, se les practica excéresis de las lesiones que presentan y posteriormente en el mismo acto quirúrgico, se realiza colocación de colgajos, utilizando para ésto piel y en un caso músculo, de diferentes regiones de la cara. Evolución funcional y estética satisfactoria.

Sudoriferous cyst of the orbit of adult origin after trauma.

A rare case of sudoriferous cyst of the orbit occurring in an adult, who had facial trauma, is reported. Several factors suggest its adult onset. The only other case reported in an adult is of presumed childhood origin. Very few congenital cases have been reported. A 65-year-old lady presented with recent onset of left-sided ptosis and a painless mass below the left supraorbital margin. The patient had traumatic ptosis after a road traffic accident 13 years ago. The ptosis was surgically repaired, which resulted in symmetrical palpebral apertures. Computed tomographic scan revealed a well-defined cystic mass in the anterior orbit. The mass was removed in toto by anterior orbitotomy. Histopathological examination revealed a single cyst lined by double-layered cuboidal epithelium in some areas and transitional epithelium at others. A periodic acid Schiff (PAS) positive, diastase-resistant glycocalyx lined the inner epithelium. Apical snouting suggested an apocrine nature. This confirmed a diagnosis of sudoriferous cyst.

Facial and craniofacial trauma: epidemiology, experience and treatment / Trauma facial e craniofacial: epidemiologia, experiência e tratamento

Various factors related to living in today's society, make facial trauma an unavoidable subject for the otorhinolaryngologist and head and neck surgeon, due to its increasing frequency and the medical and legal importnace of its management. This paper gives a view in perspective of the authors' experience through 200 cases of facial and craniofacial trauma. Nasal trauma, by far the most frequent among facial lesions of traumatic origin, as well as mandibular fractures, are not included in this presentation. All the cases are from the authors'private in a city. San Miguel de Tucumán, located at the Northwest of Argentina. It is a city of about 600 thousand inhabitants; main city of a state fairly industrialized. It most important resources come from agriculture, commerce and some industrial activities, especially those linked with the derivates of the sugar cane. Violent sports, such as rugby, and the increasing violence characteristic of a society with socio-economic troubles, are all factors that contribute to depict an image in which trauma, in all its forms, is a common occurence. The authors' experience is considered taking into account epidemiologic, etiologic and the pathologic concers. Treatment modalities employed, results, complications, and sequelae are discussed

Leishmaniasis mucosa y otras lesiones destructivas centrofaciales / Mucocutaneous leishmaniasis and other midfacial area destructive lesions

Varias enfermedades producen lesiones del área centrofacial. Una de las más frecuentes en nuestro medio es la leishmaniasis destructivas mucosa. Como el INS es un centro de estudio de leishmaniasis, se atendieron pacientes o sus biopsias con afecciones del macizo centrofacial, primariamente remitidas con el diagnóstico clínico de leishmaniasis mucosa. En un período de 7 años (1987-1993), se estudiaron 134 biopsias de estos pacientes. El diagnóstico de leishmaniasis mucosa fue definitivo en 26 casos, por demostración del amastigote con la coloración de hematoxilina eosina y el mismo diagnóstico se estableció por patrón histopatológico solamente, en 27 casos. Una técnica inmunoenzimática para demostrar los amastigotes no fue satisfactoria. La perforación banal del tabique nasal (52 biopsias) es la entidad que el clínico y el patólogo confunden con mayor frecuencia con la leishmaniasis mucosa. Otras entidades demostradas fueron la paracoccidioidomicosis (3), histoplasmosis (2), rinosporidiosis (2), esporotricosis (1), tuberculosis bucal (3), lepra lepromatosa(1), escleroma nasal (2), granulomatosis de Wegener (2), linfomas angiocéntricos (4), aspiración crónica de cocaína (1), y carcinoma escamocelular palatino (1). La biopsia, luego de la historia clínica, es el pilar esencial para identificar y manejar adecuadamente estas lesiones, que pueden originar destrucción facial grave, a veces letal, si no se dispone del diagnóstico preciso y del tratamiento oportuno