Dermoscopy of topical steroid-dependent or damaged face: A cross-sectional study

Background: Topical corticosteroid (TCS) abuse is rampant and results in steroid addiction labeled as topical steroid-dependent or damaged face (TSDF). Indian market is replete with triple combination creams containing TCS sold as over-the-counter products at low cost, luring people to use them without prescription. The resultant damage if detected late is irreversible and difficult to treat. Dermoscopy can help in the early identification of features of TSDF at a preclinical stage resulting in better prognosis. However, the literature on the same is limited. Aims: This study is undertaken to characterize dermoscopic features of TSDF and to correlate them with potency and duration of application of the TCS. Methods: One hundred and thirty-two patients aged 18 years or above, with clinical symptoms and signs suggestive of TSDF and with history of application of TCS on the face for a period of more than one month, were enrolled in the study. Their demographic details, clinical features, and dermoscopy findings were recorded using a predesigned structured format. Comparison of dermoscopic findings with clinical examination, gender, potency of TCS, and duration of TCS use was done using Chi-square test, Fisher’s exact test, and one-tailed Z-test. Results: Mean age of the patients was 31.7 ± 8.1 years. Male to female ratio was 2:9. Sixty-nine (52.3%) patients abused TCS for more than one year. Clinical findings noted in the patients were erythema (81.1%), hyperpigmentation (80.3%), and hypertrichosis (68.2%). The most common dermoscopy findings seen were brown globules (96.2%), red diffuse areas (92.4%), vessels (87.1%), white structureless areas (86.4%), and hypertrichosis (80.3%). Red diffuse areas, vessels, brown globules, white structureless areas, and white hair were observed in a statistically higher proportion of cases dermoscopically. Y-shaped vessels and brown globules were seen in significantly higher number of patients, using TCS for more than three months and in those continuing it beyond six months, polygonal vessels were predominant. Limitations: Lack of histopathological correlation is the limitation of our study. Furthermore, brown globules seen in 96.2% patients of TSDF on dermoscopy may have been over-estimated and not always signify TSDF; instead, it could represent melasma for which patient applied TCS. Conclusion: Dermoscopy in TSDF can help dermatologists in a multitude of ways from confirming the diagnosis to differentiating from other causes of red face and predicting the approximate duration of TCS abuse.

Síndrome de Peutz-Jeghers, telangiectasias y prolapso de la válvula mitral. Presentación de caso y asesoramiento genético / Peutz-Jeghers syndrome, telangiectasias, and mitral valve prolapse. Case presentation and genetic counseling

Introducción: El síndrome de Peutz-Jeghers se caracteriza por hiperpigmentación mucocutánea y hamartomas gastrointestinales que pueden aparecer desde el estómago hasta el ano. Tiene un patrón de herencia autosómico dominante y expresividad variable. El diagnóstico se basa en los hallazgos clínicos y la apariencia histológica de los pólipos. No ha sido reportado hasta ahora asociación de esta entidad a telangiectasias y prolapso de la válvula mitral. Objetivo: Describir los hallazgos que permitieron establecer el diagnóstico de Síndrome de Peutz-Jeghers en un paciente y brindar asesoramiento genético. Presentación del caso: Paciente masculino de 36 años de edad con antecedentes de prolapso de la válvula mitral que acude a consulta de genética clínica con su esposa para solicitar asesoramiento genético, debido a que tienen una hija con diagnóstico de Síndrome de Peutz-Jeghers y desean conocer el riesgo de tener otro hijo afectado. Al examen físico se observa mácula hiperpigmentada en labio inferior y varias de estas en encías. Con tales hallazgos y el antecedente de tener la hija Síndrome de Peutz-Jeghers se emite el mismo diagnóstico en el padre. Como dato de interés se constatan en este individuo múltiples telangiectasias en tórax, cuello y espalda. Los estudios realizados en busca de la causa de estas fueron negativos. Conclusiones: Los antecedentes y los hallazgos encontrados en el paciente permitieron realizar el diagnóstico de Peutz-Jeghers y brindar asesoramiento genético. Se presenta el primer reporte de esta enfermedad asociada a telangiectasias y prolapso de la válvula mitral en la literatura científica(AU)

Introduction: Peutz-Jeghers syndrome is characterized by mucocutaneous hyperpigmentation and gastrointestinal hamartomas that can appear from the stomach to the anus. It has an autosomal dominant inheritance pattern and variable expressiveness. The diagnosis is based on clinical findings and histological appearance of the polyps. No association between this entity and telangiectasias and mitral valve prolapse has been reported so far. Objective: To describe the findings that made it possible to establish the diagnosis of Peutz-Jeghers syndrome in a patient and to provide genetic counseling. Case presentation: Thirty-six-year-old male patient with a history of mitral valve prolapse who attends a clinical genetics consultation with his wife to request genetic counseling due to the fact that their daughter was diagnosed with Peutz-Jeghers Syndrome and they want to know about the risk of having another affected child. On physical examination, a hyperpigmented macule on the lower lip and several of these on the gums were observed. With such findings and the antecedent of having a daughter with Peutz-Jeghers syndrome, the same diagnosis is made in the father. As data of interest, multiple telangiectasias on the thorax, neck and back were found in this individual. The studies carried out to identify the same cause were negative. Conclusions: The history and findings in this patient allowed us to make the diagnosis of Peutz-Jeghers syndrome as well as to provide genetic counselling. The first report of this disease associated with telangiectasias and mitral valve prolapse is presented in the scientific literature(AU)

Ophthalmologic alterations in cutis marmorata telangiectatica congenita: a series of cases / Alterações oftalmológicas na cutis marmorata telangiectásica congênita: uma série de casos

ABSTRACT Cutis marmorata telangiectasia congenita is a rare cutaneous vascular disorder that may be associated with different systemic manifestations like body asymmetry, cutaneous, ophthalmologic, vascular, and neurological manifestations. We describe ophthalmologic alterations found in three patients with cutis marmorata telangiectatica congenita highlighting the rare retinal manifestations.

RESUMO A Cutis marmorata telangiectasica congênita é uma desordem vascular cutânea rara que pode estar associada a diferentes manifestações sistêmicas, como assimetria corporal, alterações cutâneas, oftalmológicas, vasculares e neurológicas. Descrevemos alterações oftalmológicas encontradas em três pacientes com cutis marmorata telangiectasia congênita, destacando as raras manifestações retinianas.

Enfermedad de coats / Coats disease

RESUMEN Introducción: La enfermedad de Coats es una vasculopatía retiniana idiopática, poco frecuente, que puede progresar a desprendimiento de retina exudativo y glaucoma neovascular. Típicamente se presenta en la infancia, es la tercera causa más frecuente de leucocoria infantil. Presentación de caso: Paciente masculino de dos años de edad, procedente de zona rural. Asiste a consulta, porque la mama notó que el niño desvía el ojo derecho hacia fuera desde que nació. Conclusiones: La enfermedad de Coats simula otras vasculopatías retinianas y el retinoblastoma. La conducta a seguir dependerá de la, forma clínica de presentación y complicaciones asociadas.

ABSTRACT Introduction: Coats disease is a rare, idiopathic retinal vasculopathy that can progress to exudative retinal detachment and neovascular glaucoma. Typically occurring in childhood, it is the third most common cause of childhood leukocoria. Case report: Patient masculine of two years of age, coming from rural area. You attended consultation, because he/she suckles her he/she noticed that the boy deviates the right eye toward it was since he was born. Conclusions: Coats disease simulates other retinal vasculopathies and retinoblastoma. The behavior to be followed will depend on the clinical form of presentation and associated complications.

Epidemiología de los desórdenes venosos crónicos y factores asociados en amerindios nativos embera-chamí, Antioquia / Epidemiology of chronic venous disorders and associated factors in embera-chami native amerindians, Antioquia / Epidemiologia das doenças venosas crônicas e fatores associados em ameríndios nativos embera-chamí, Antioquia

Resumen Objetivo: Analizar la prevalencia de los desórdenes venosos crónicos (dvc) en los embera-chamí de Cristianía (Karmata Rua), en el suroeste de Antioquia, y conocer sus posibles factores asociados (fa). Metodología: Estudio de corte de una muestra aleatoria de 488 sujetos. El diagnóstico se realizó mediante ecoduplex venoso. Se recolectó información sobre fa sociodemográficos, comportamentales y antropométricos. Los fa más relevantes se seleccionaron por regresión logística binaria múltiple. Resultados: La prevalencia de várices fue del 27,5 % y la de insuficiencia venosa crónica (ivc) del 0,8 %. Hubo compromiso de segmentos anatómicos superficiales en el 34,8 % de los individuos. La edad fue el fa más importante, con Odds Ratio (or) entre 3,33 y 6,30 según el tipo de dvc (excepto C1). El sexo femenino, la paridad, la grasa en el muslo y pierna y la talla alta se asociaron a telangiectasias. La edad, la grasa abdominal y la forma de la pierna fueron fa de várices. A las venas superficiales, en ambos sexos, se asociaron la edad y la grasa abdominal y, en mujeres, también los antecedentes familiares de várices. A las profundas y perforantes se asociaron la edad y la depleción de grasa periférica. Conclusiones: El patrón de baja prevalencia de los dvc en embera-chamí puede ser consecuencia de los estilos de vida relacionados con la actividad física diaria y las diferencias genéticas compartidas con amerindios. En los programas de atención en salud diferencial deberían considerarse los desórdenes profundos y perforantes respecto a mestizos.

Abstract Objective: To analyze the prevalence of chronic venous disorders (CVD) in the embera-chamí from Cristianía (Karmata Rua), in the southwest of Antioquia, and to study possible associated factors (AF). Methodology: A cross sectional study of a random sample of 488 subjects. The diagnosis was performed through Doppler ultrasonography. Information about sociodemographic, behavioral and anthropometric AFs was collected. The most relevant AFs were selected through multiple binary logistic regression. Results: The prevalence of varicose veins was 27.5% and that of chronic venous insufficiency (cvi) was 0.8%. Superficial anatomical segments were compromised in 34.8% of individuals. Age was the most important AF, with an Odds Ratio (OR) between 3.33 and 6.30 according to the type of cvd. Being a female, parity, fat in the thigh/leg and large size were associated with telangiectasias. Age, abdominal fat and leg shape were AF of varicose veins. Superficial veins in both sexes were associated with age and abdominal fat and in women, also with a family background of varicose veins. Deep and perforator veins were associated with age and peripheral fat depletion. Conclusions: The low prevalence pattern of CVDs in embera-chamí may be a consequence of lifestyles involving daily physical activity and genetic differences shared with Amerindians. Deep and perforating disorders should be considered in differential health care programs in relation to mestizos.

Resumo Objetivo: Analisar a prevalência de doenças venosas crônicas (dvc) na Embera-Chami Christiania (KarmataRua), no sudoeste do estado de Antioquia, e conhecer seus fatores associados (AF). Metodologia: Um estudo de coorte de uma amostra aleatória de 488 indivíduos. O diagnóstico foi feito por ecoduplex venoso. Informações sobre FA sócio demográficas, comportamentais e antropométricas foram coletadas. Os FAs mais relevantes foram selecionados para múltipla regressão logística binária. Resultados: A prevalência de varizes foi de 27,5% e a de insuficiência venosa crônica (ivc) foi de 0,8%. Houve comprometimento dos segmentos anatômicos superficiais em 34,8% dos indivíduos. A idade foi a FA mais importante, com Odds Ratio (OR) entre 3,33 e 6,30 de acordo com o tipo de dvc. Sexo feminino, paridade, gordura na coxa e perna e altura foram associados a telangiectasias. Idade, gordura abdominal e formato de perna foram FA de varizes. Nas veias superficiais, em ambos os sexos, idade e gordura abdominal estavam associadas e, nas mulheres, também a história familiar de varizes. Às profundas e perfurantes foram associadas a idade e depleção de gordura periférica. Conclusões: O padrão de baixa prevalência de DVC em embera-chamí pode ser uma consequência de estilos de vida relacionados à atividade física diária e diferenças genéticas compartilhadas com ameríndios. Em programas diferenciais de atenção à saúde, distúrbios profundos e perfurantes devem ser considerados em relação aos mestiços.

Extensive oral telangiectasias in systemic sclerosis

The word telangiectasia is derived from tel- end, angos- vessels and ectasis- dilatation. Telangiectasia can be primary orsecondary. Connective tissue diseases like systemic sclerosis, dermatomyositis and systemic lupus erythematosus maybe associated with secondary telangiectasias. Systemic sclerosis presents with mat-like telangiectasias over face, handsand rarely oral mucosa. The present study discusses a case of extensive oral telangiectasias without significant sclerosisover face.

Enfermedad de Coats, presentación de un caso y revisión de la literatura / Coats Disease, case report and literatura review

La enfermedad de Coats, es una vasculopatía retiniana idiopática que sin tratamiento puede progresar a desprendimiento de retina exudativo y glaucoma neovascular. Se considera una patología de difícil diagnóstico, por su presentación clínica que simula otras vasculopatías retinianas ó retinoblastoma. Resulta indispensable contar con herramientas clínicas y paraclínicas para llegar a un diagnóstico acertado y poder realizar un manejo adecuado y oportuno. Presentamos el caso de un niño de 17 años, con enfermedad de Coats valorado y tratado en el Hospital Militar Central de Bogotá desde los 5 años de edad; Se realiza seguimiento clínico de 12 años de evolución y se discuten posibles diagnósticos diferenciales.

Coats disease is an idiopathic retinal vasculopathy that can progress to exudative retinal detachment and neovascular glaucoma if is not treated. It is considered a condition of difficult diagnosis due to clinical presentation, simulating retinoblastoma or other retinal vascular disease. It is essential to have clinical and paraclinical tools to have a correct diagnosis and to make adequate and timely handling. We report the case of a child of 17 years old with Coats disease assessed and treated at the Central Military Hospital in Bogota from 5 years of age during 12 years. Th e clinical evolution is described and a brief depiction of the disease is presented with its diff erential diagnoses.

Synthetic dural graft septoplasty in epistaxis from hereditary hemorrhagic telangiectasia / Septoplastia con injerto de dura sintética en epistaxis por telangiectasias hemorrágicas hereditarias

Abstract It is an autosomal dominant vascular disorder, which has a variety of clinical manifestations, with epistaxis being one of the most common. Many treatment options exist for epistaxis, but with no consensus on which is the method of choice. We describe the case of a patient with hereditary hemorrhagic telangiectasia (HHT) secondary epistaxis with septoplasty managed with synthetic hard graft, which improved intensity and frequency of bleeding episodes. This technique is a variant of the septodermoplasty described by several authors, but the use of synthetic dura can help in obtaining better results and avoid taking skin grafts from other sites different from the surgical site.

Resumen Esta condición es un trastorno vascular autosómico dominante, que tiene una variedad de manifestaciones clínicas; entre las más comunes, se encuentra epistaxis. Existen múltiples opciones terapéuticas para la epistaxis, pero no hay un consenso sobre cuál es el método de elección. Se describe el caso de un paciente con epistaxis secundaria a telangiectasias hemorrágicas hereditarias (THH) manejado con septoplastia con injerto de dura sintética, la cual obtuvo mejoría en la intensidad y frecuencia de los episodios de sangrados. Esta técnica es un variante de la septodermoplastia descrita por diversos autores, pero el uso de dura sintética puede ayudar a obtener mejores resultados y evita toma de injertos dérmicos de otros sitios diferentes al sitio quirúrgico.

Tratamiento de aa proctitis actinica con argon plasma: primera experiencia en Cuba / Actinic Proctitis treatment with Argon Plasma Coagulation

Se presenta reporte preliminar de una investigación prospectiva con la aplicación de la endoscopia terapéutica en pacientes con Proctitis radiógena procedentes de la consulta externa del Instituto Nacional de Oncología y Radiobiología, en los que se aplica Argón Plasma Coagulación (APC) para ablación de las lesiones vasculares, como consecuencia del efecto de las radiaciones en el recto. Se detalla la aplicación del método terapéutico en 20 pacientes, todos del sexo femenino, el síntoma cardinal en todos los casos fue el sangrado rectal, el promedio de sesiones de tratamiento fue de 3 y todos los casos refirieron mejoría evidente por disminución del sangrado desde la primera sesión, con disminución importante o eliminación de las telangiectasias durante el seguimiento y no se presentaron complicaciones mayores con el procedimiento. Se considera que el tratamiento endoscópico constituye un método valioso y una opción factible, segura y eficaz para el tratamiento de la proctitis actínica.

We performed a prospective research applying therapeutic endoscopy in patients suffering of Actinic Proctitis, after radiation for pelvic cancer. We used Argon Plasma Coagulation to remove vascular lesions in these patients. We described the application of this therapeutic in 20 patients, all of them female, with rectal bleeding. Patients received as average, 3 sessions of treatment, and all of the them get better since the first session, with importantreduction of the bleeding and the number of telangiectasias. There were no complications with this technique. We consider that therapeutic endoscopic treatment with APC is a valuable and safe treatment for patients, suffering with Actinic Proctitis.

A Case of Successful Laser Photocoagulation in Gastric Telangiectasias / 대한소화기내시경학회지

The routine of endoscopy in the evaluatien of gastrointestinal bleeding demonatratd that telangiectasia in the upper gastrointestinal tract may be responsible for the chronic recurrent bleeding. If the bleeding lesion within the reach of the endoscaiye, it is amenahle to endoscopic therapy, One of the several treatment modalities that has been employed is laser photocoagulation. We report a case of ef fective laser therapy in a 63-years old woman presented with a about 3 years history of recurrent upper gastrointestinal bleeding and persistent iron deficieney anemia in gaatic multiple telangeictasias. An upper gastrointestinal endoscopy demonstrated variable sized multiple bleeding telangectatic lesions in the entire stomach. Nd-YAG laser photocoagulation was appligd in 0.5 seconds pulse of 60-70W power(2300 joules and total 7 sessions). All legions in the stomach were treated. Local epinephrine injection prior to laser treatment was carried out in the telangiectatie lesions greater than 1 cm. Follow-up endoscopy 5 months after laser treatment demonstrated no telangiectatic lesions in the stomach and no episodes of upper gastrointestinal bleeding were noted and the other symptoms improved.

A Case of Successful Laser Photocoagulation in Gastric Telangiectasias / 대한소화기내시경학회지

The routine of endoscopy in the evaluatien of gastrointestinal bleeding demonatratd that telangiectasia in the upper gastrointestinal tract may be responsible for the chronic recurrent bleeding. If the bleeding lesion within the reach of the endoscaiye, it is amenahle to endoscopic therapy, One of the several treatment modalities that has been employed is laser photocoagulation. We report a case of ef fective laser therapy in a 63-years old woman presented with a about 3 years history of recurrent upper gastrointestinal bleeding and persistent iron deficieney anemia in gaatic multiple telangeictasias. An upper gastrointestinal endoscopy demonstrated variable sized multiple bleeding telangectatic lesions in the entire stomach. Nd-YAG laser photocoagulation was appligd in 0.5 seconds pulse of 60-70W power(2300 joules and total 7 sessions). All legions in the stomach were treated. Local epinephrine injection prior to laser treatment was carried out in the telangiectatie lesions greater than 1 cm. Follow-up endoscopy 5 months after laser treatment demonstrated no telangiectatic lesions in the stomach and no episodes of upper gastrointestinal bleeding were noted and the other symptoms improved.