Urticaria: A comprehensive review: Epidemiology, diagnosis, and work-up.

Urticaria is a common clinical condition presenting with wheals (hives), angioedema, or both. Urticaria has a complex pathogenesis, along with a high disease burden, a significant impact on quality of life, and high health care costs. The first article in this continuing medical education series covers the definition, classification, epidemiology, diagnosis, and work-up of urticaria, taking into account the recent literature and the best available evidence.

Urticaria: A comprehensive review: Treatment of chronic urticaria, special populations, and disease outcomes.

Second-generation antihistamines are considered first-line agents in the treatment of chronic urticaria because of their safety and efficacy profile. Some patients require higher doses of H1 antihistamines alone or in combination with other classes of medications, including H2 antihistamines, leukotriene receptor antagonists, or first-generation H1 antihistamines. One major therapeutic advance has been omalizumab, a humanized monoclonal anti-immunoglobulin E that was recently approved by the US Food and Drug Administration for the treatment of chronic urticaria that is unresponsive to H1 antagonists. In addition, the second article in this continuing medical education series outlines several evidence-based alternative treatments for urticaria and the differences in recommendations between 2 major consensus groups (the European Academy of Allergy and Clinical Immunology/World Allergy Organization and the American Academy of Allergy, Asthma and Immunology/American College of Allergy, Asthma and Immunology Joint Task Force).

Patients' prediction of their wound healing time.

Understanding and managing patients' expectations can help improve their adherence to treatment for chronic wounds; however, little is known concerning about their expectations regarding healing time. Recruited subjects were asked to predict how long their wounds would take to heal and their charts were reviewed to retrieve real time of healing. We recruited 100 subjects from which 77% have healed. Fifty-three subjects (68.8%) had a longer healing time than they predicted (underestimated), and 17 (22.1%) had a shorter healing time than they predicted (overestimated). Subjects with shorter wound duration history tended to predict shorter healing time than subjects with longer wound duration (p < 0.01). However, wound duration did not affect prediction accuracy (p = 0.65). Subjects with chronic wounds seem more often to underestimate their time of healing. Wound duration significantly influenced patients' prediction time, although it did not make their prediction more accurate. Patient education about expectations may be important as patients often expect their wounds to heal faster than they actually do.

The effect of ankle range of motion on venous ulcer healing rates.

Limitation of ankle movement may contribute to calf muscle pump failure, which is thought to contribute to venous leg ulcer formation, which affects nearly 1 million Americans. We therefore wished to study ankle movement in patients with venous leg ulcers and its effect on healing. Using goniometry, we measured baseline ankle range of motion in venous leg ulcer patients from a Phase 2 dose-finding study of an allogeneic living cell bioformulation. Two hundred twenty-seven patients were enrolled in four active treatment groups and one standard-care control group, all receiving compression therapy. Goniometry data from a control group of 49 patients without venous disease, from a previous study, was used for comparison. We found patients with active venous leg ulcers had significantly reduced ankle range of motion compared with the control group (p = 0.001). After 12 weeks of therapy, baseline ankle range of motion was not associated with healing, as there was no significant difference between healed and nonhealed groups, suggesting that ankle range of motion is not important in venous leg ulcer healing or, more likely, is overcome by compression. However, patients with venous ulcers located on the leg (as opposed to the ankle) had significantly higher ankle range of motion for plantar flexion and inversion (p = 0.021 and p = 0.034, respectively) and improved healing with both cell bioformulation and standard care (p = 0.011), suggesting that wound location is an important variable for ankle range of motion as well as for healing outcomes.

Atypical form of transient reactive papulotranslucent acrokeratoderma in a cystic fibrosis carrier.

We report the first documented case of an atypical form of transient reactive papulotranslucent acrokeratoderma (TRPA) in a patient heterozygous for the ΔF508 CFTR(cystic fibrosis transmembrane conductance regulator) mutation. TRPA represents a condition that classically presents with translucent to white plaques that become evident after water exposure. An atypical form with persistent lesions has also been described. Our patient is a 16-year-old girl with small, white papules coalescing into pebbly plaques on the palms. This condition is exacerbated after 5-10 min of water exposure and is associated with discomfort. The skin biopsy showed expanded stratum corneum, orthohyperkeratosis and dilation of eccrine ducts consisting with TRPA. A cystic fibrosis carrier state, barrier function defect, hyperhidrosis and the intake of cyclooxygenase inhibitors may have been pathogenic factors in our patient.

Incidencia y características clínico patológicas del carcinoma espinocelular cutáneo. Hospital Nacional Alberto Sabogal Sologuren, 2004-2006 / Squamous cell carcinoma incidence and clinico-pathological paterns. Hospital Nacional Alberto Sabogal Sologuren, 2004-2006

El carcinoma espinocelular cutáneo (CEC) es una proliferación maligna del queratinocito con capacidad metastásica; son escasos los estudios sobre la epidemiología de este tumor en el Perú y Latinoamérica, de ahí la inquietud de estudiar el tema.Objetivo: Determinar la incidencia del CEC en el Hospital Nacional Alberto Sabogal Sologuren en el periodo 2004-2006 y las características epidemiológicas, clínicas y patológicas del mismo. Métodos: Estudio transversal. Se incluyeron en el estudio todos los pacientes con diagnóstico histopatológico CEC in situ, invasor y queratoacantoma, en el Hospital Nacional Alberto Sabogal Sologuren durante el periodo 2004-2006. Se revisaron las historias clínicas y las láminas histopatológicas. Resultados: Se halló un total de 116 casos, con incidencias calculadas de 4.94, 4.04, y 3.82 por 100 000 habitantes para los años 2004, 2005 y 2006 respectivamente. Predominó el sexo masculino (66.4%) y la edad promedio fue 73.2±11.2 años. El 69% de casos correspondió a CECinvasor, el 21% a CEC in situ y el 10% a queratoacantomas. Las localizaciones más frecuentes fueron cabeza (49%), miembros superiores (20%) y región perineal (16%). El tiempo promedio de enfermedad fue de 24±12 meses para CEC in situ, de 12±12 meses para CEC invasor y de 6±6meses para queratoacantoma (p<0.01). Con respecto al CEC invasor, las variantes histológicas más frecuentes fueron la clásica (66.7%) y laverrucosa (10.1%). La mayoría de lesiones correspondió a estadio T1 (72.5%), N0 (95.7%), M0 (100%) y estadio I (71.0%). Conclusiones: Se evidencia una incidencia de CEC menor a la reportada en otras series de países desarrollados, con una tendencia a la disminución en el periodo de estudio. Las características clínico-patológicas, en general, son similares a lo reportado en la literatura.

Squamous cell carcinoma (SCC) is a keratinocites malignant proliferation, with metastatic capacity; its epidemiology is poorly studied in Peruand Latin America, from there the interest to study this topic. Objective: To determine SCC incidence at Hospital Nacional Alberto Sabogal Sologuren from 2004 to 2006, and its epidemiological, clinical and pathological patterns. Methods: Cross-sectional study. All the patients with diagnosis of insitu SCC, invasive SCC and keratocanthoma were included. The clinical files and histopathological smears were reviewed. Results: We studied 116 clinical cases, with a calculated incidence of 4.94, 4.04 and 3.82 per 100 000 inhabitants for years 2004, 2005 and2006 respectively. Male patients predominated (66.4%), with an average age of 73.2±11.2. 69% of the cases were invasive SCC, 21% in situ SCCand 10% keratoacanthomas. They were more likely to be found in the head (49%), upper extremities (20%) and perineal region (16%). The average time of disease was 24±12 months for in situ SCC, 12±12 months for in situ SCC and 6±6 months for keratoachantomas (p<0.01). The most frequent histological types for invasive SCC were classical (66.7%) and verrucosum (10.1%). Most lesions were T1 (72.5%), N0 (95.7%), M0 (100%) and stage I (71.0%).Conclusions: The incidence of SCC is lower than the incidence reported in other series from developed countries, with a decreasing trend in the period of study. The clinical-pathological characteristics, in general, are similar to the reported in the literature.