Rápida implementación de teledermatología durante la pandemia por COVID-19: lecciones aprendidas de un departamento académico de Dermatología

Background: The day after COVID-19 quarantine started, we initiated patient care through Tele-dermatology. Aim: To report the experience of the implementation of Telemedicine in dermatology and to assess its impact on the number of dermatological visits compared with the pre-pandemic period. Material and methods: The study was conducted between March 27th, 2020, and April 30th, 2020. All patients submitted clinical images of their skin condition via secure email before the telemedicine visit. All telemedicine visits were conducted using the Zoom video conferencing platform. Patient demographics and medical history were recorded. If the dermatologist was unable to reach a diagnosis, the patient was sent for an in-person visit, skin biopsy, or additional laboratory workup. Results: We recorded 1,357 Tele dermatology visits from 1,222 patients aged 29 ± 18 years (38% males). Visits increased from 104 to 298 from the first to the last week, corresponding to 17% of the patient volume seen before the pandemic (1,709 in-person patients/week). A preliminary diagnosis was made in 95% of cases. Ninety percent of patients sent photos. Fifty eight percent of cases were chronic diseases, and were classified as inflammatory in 68%, infectious in 15%, neoplastic/tumoral in 7%, or other conditions in 11%. Less than 1% of these visits were COVID-19 related. Conclusions: In this prospective study of Tele-dermatology lasting five weeks, a preliminary diagnosis could be made in approximately 95% of cases and in the first five weeks of implementation, a volume of consultations equivalent to 17% of those made in the pre-pandemic period was carried out. Therefore, Tele-dermatology can be implemented quickly and successfully in practices when healthcare access is limited.

Use of tumor necrosis factor alpha (TNF α) antagonists in a patient with psoriasis and Chagas disease

There are several studies on the benefits of using TNFα antagonists in the treatment of psoriasis, but few studies addressing the interaction of these drugs with chronic infections. We report the case of a 52-year-old patient diagnosed with psoriasis refractory to traditional systemic agents, who was treated with biologic therapies. After one year of treatment with biologic agents, the patient was diagnosed with Chagas Disease.

Carcinoma basocelular vulvar: revisión de la literatura a propósito de un caso / Vulvar basal cell carcinoma: review of the literature

El carcinoma basocelular (CBC) corresponde al 70 por ciento-80 por ciento de los cánceres cutáneos. Los factores de riesgo son: exposición solar, fototipos I-II y edad avanzada, entre otros. El 85 por ciento se ubican en áreas fotoexpuestas y menos del 1 por ciento se encuentran en la región vulvar. Algunos factores predisponentes son irritación, infección crónica, e inmunosupresión. Clinicamente se manifiestan como placas, a veces pigmantadas y el síntoma más frecuente es el prúrito. Dada su ubicación, suelen pasar indvertidas en el examen físico. E patrón histopatológico más frecuente es el nodular. Es localmente invasivo y tiene una baja tasa de metástasis (0,1 por ciento). El tratamiento es la resección quirúrgica con márgenes (1-3 cm), así como también la cirugía de Mohs. La recidiva registrada es alta (9 por ciento - 20 por ciento) y se relaciona a márgenes positivos postquirúrgicos, por lo que es importante el seguimiento estrecho y prolongado.

Basal cell carcinoma (BCC) is responsible for 70 percent-80 percent of all cutaneous cancers. Some risk factors are sun exposure, fair skin and advanced age. 85 percent of BCC are located in sun exposed areas and less than 1 per cent can be found in the vulvar region. Some risk factors are chronic irritation, infection and inmunosuppression. Clinically they present as plaques with or without pigmentation and the most frequent symptom is pruritus. Due to the location, they tend to be unnoticed at physical examination. The most frequent histopathologic pattern is the nodular type. It behaves as a locally invasive cancer and metastasis are extremely rare (0,1 percent). The treatment should include surgical resection with margins (1-3 cm). In larger lesions, Mohs technique has been successfully used. The recurrence is high (9 percent-20 percent) due to positive margins, therefore it is important to keep a close and prolonged follow-up.