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.

Preenchimento com ácido hialurônico e blefaroplastia transcutânea em esclerodermia sistêmica estável / Filling with hyaluronic acid and transcutaneous blepharoplasty in stable systemic sclerosis

A esclerose sistêmica é uma doença de causa desconhecida, que se caracteriza pelo espessamento da pele. Trata-se de uma patologia rara que, quando não é tratada a tempo, produz um dano grave na estética facial causando um grande impacto na qualidade de vida. Relatamos o caso de paciente feminina, 54 anos, com esclerose sistêmica há 25 anos, referindo estabilidade da doença há mais de quatro anos. A paciente se apresentou à consulta com queixa de deformidade facial. Foi submetida a procedimentos minimamente invasivos e de baixo risco - blefaroplastia transcutânea e preenchimento com ácido hialurônico - obtendo resultados esteticamente adequados.

Systemic sclerosis is a disease of unknown cause, is a rare pathology that, when not treated in time, produces severe damage to the facial aesthetic anatomy causing a significant impact on the quality of life. The case of a 54-year-old woman, with a history of systemic sclerosis of 25 years of evolution, and who was stable from her disease over four years ago. The patient consults for resolution of her facial deformity, which is why she proceeds to perform minimally invasive low-risk procedures such as transcutaneous blepharoplasty and fillings with hyaluronic acid obtaining aesthetically adequate results

Cutaneous inflammation as a marker of malignant transformation in a patient with linear unilateral basaloid follicular hamartoma

Basaloid follicular hamartoma is a rare, benign and superficial malformation of hair follicles, characterized histologically by epithelial proliferation of basaloid cells with radial disposition. It can be mistaken for basal cell carcinoma. Even though these hamartomas are considered benign lesions, malignant transformation has rarely been reported. We report the case of a 45-year-old healthy woman, with linear, unilateral basaloid follicular hamartoma which developed inflamed papules histologically suggestive of basal cell carcinoma. We believe that identification of local inflammation could be a clinical clue to guide us towards a malignant transformation of basaloid follicular hamartoma.

Tuberculosis en patrón esporotricoide: una presentación inusual de tuberculosis cutánea en un paciente inmunocompetente / Sporotrichoid-like tuberculosis: an unusual presentation of cutaneous tuberculosis in an immunocompetent patient

Tuberculosis remains a major global health problem. Cutaneous involvement is a rare manifestation of tuberculosis infection. Sporotrichoid clinical pattern consists of a linear arrangement of nodules along the lymphatic vessels. It is often seen in sporotrichosis. Few cases have been reported of cutaneous tuberculosis presenting as a sporotrichoid clinical pattern. We describe a 84-year-old female with ulcerative nodules on upper extremity caused by Mycobacterium tuberculosis, emphasizing the importance of considering cutaneous tuberculosis in the differential diagnosis of sporotrichoid lesions.

En la actualidad, la tuberculosis sigue siendo un problema de salud pública en el mundo. El compromiso cutáneo es una manifestación poco frecuente de la infección por Mycobacterium tuberculosis. El patrón esporotricoide se refiere a la disposición lineal de los nódulos cutáneos siguiendo el trayecto de los vasos linfáticos, forma de presentación característica de la esporotricosis, de ahí su nombre. Muy pocos casos han sido reportados sobre tuberculosis cutánea con patrón esporotricoide. Se presenta el caso clínico de una mujer de 84 años con nódulos ulcerativos de disposición lineal en miembro superior causados por Mycobacterium tuberculosis, destacando la importancia de incluir a la tuberculosis cutánea en el diagnóstico diferencial de lesiones con patrón esporotricoide.

Vasculitis séptica por Listeria monocytogenes / Septic vasculitis caused by Listeria monocytogenes

Septic vasculitis is a medium and small-vessel vasculitis caused by direct action of pathogens, associated with bacteremia. It is an uncommon condition; clinical manifestations include purpura, ulcers and vesicles-pustules. Most cases of septic vasculitis are related to meningococcemia. There are no cases reported in medical literature associated to Listeria spp. We report a case of a 71 year-old man who presented sepsis by Listeria monocytogenes, and then evolved with purpuric skin lesions. Skin biopsy revealed a septic vasculitis.

La vasculitis séptica es una inflamación de los vasos sanguíneos de pequeño y mediano calibre causada por la acción directa de agentes patógenos en el contexto de una sepsis. Es una condición infrecuente y se manifiesta clínicamente por lesiones cutáneas como púrpura, vesículo-pústulas e incluso úlceras. La mayoría de los casos de vasculitis séptica se asocian a una meningococcemia. No se han reportado casos en la literatura médica de vasculitis séptica secundaria a Listeria spp. Se presenta el caso de un hombre de 71 años, con cuadro de sepsis por Listeria monocytogenes y que presentó lesiones purpúricas con una biopsia compatible con una vasculitis séptica.