ABSTRACT
Spironolactone is a drug, similar in structure to aldosterone and acts as an aldosterone receptor antagonist with an anti-androgenic effect. This drug has proven to be useful in several dermatological entities, however its use has not been well explored. Its use in diseases such as acne has opened the door to the possibility of new therapies depending on the clinical manifestations of the patients, as well as its possible to use it as a first line treatment. Other diseases associated with the use of spironolactone where its effects have been shown to be useful are hidradenitis suppurativa, hirsutism, and female pattern androgenetic alopecia. In this review, we discuss the use of spironolactone in different skin diseases that are common in our environment, dosage according to different studies, treatment recommendations and adverse effects; all of the above mentioned in order to use this drug in a daily clinical practice.
Subject(s)
Acne Vulgaris , Dermatology , Hidradenitis Suppurativa , Acne Vulgaris/drug therapy , Female , Hidradenitis Suppurativa/drug therapy , Hirsutism/drug therapy , Humans , Spironolactone/adverse effectsABSTRACT
Epidermolytic palmoplantar keratoderma (EPPK), an autosomal-dominant genodermatosis, is the most frequently occurring hereditary palmoplantar keratoderma. EPPK is characterized by hyperkeratosis of the palms and soles. Approximately 90% of patients present with mutations in the KRT9 gene, which encodes for keratin 9. Many of these mutations are located within the highly conserved coil 1A region of the alpha-helical rod domain of keratin 9, an important domain for keratin heterodimerization. The objective was to assess the clinical and molecular characteristics of a Mexican family with EPPK. The clinical characteristics of members of this family were analyzed. The KRT9 gene of affected members was polymerase chain reaction amplified from genomic DNA and sequenced. All affected members of the family had hyperkeratosis of the palms and soles with knuckle pads. The R163W mutation in the KRT9 gene was present in all affected individuals who were tested. Although R163W is the most frequent KRT9 mutation in patients with EPPK, only two families have been reported with knuckle pads associated with this mutation. Our findings indicate that knuckle pads can be associated with EPPK and the R163W mutation in a family with a genetic background different from that described here.
Subject(s)
Epidermis/pathology , Keratin-9/genetics , Keratoderma, Palmoplantar, Epidermolytic/genetics , Keratoderma, Palmoplantar, Epidermolytic/pathology , Adolescent , Adult , Child , Family Health , Female , Humans , Infant , Male , Mexico , Middle Aged , PedigreeABSTRACT
Gnathostomiasis is a systemic parasitic disease that is caused by the ingestion of contaminated raw fish, the intermediate host. Involvement of the skin is a common event, and when it does happen, it can produce a superficial or creeping eruption, pseudofurunculosis, and nodular migratory panniculitis. We carried out a retrospective study of 946 cases of gnathostomiasis; 66 of them had skin biopsies. The diagnosis was made based on clinical and epidemio-logic findings as well as the therapeutic response. The most common skin finding was nodular migratory panniculitis affecting the trunk. Most of the patients were males between 20 and 40 years of age. Histopathologically, we were able to see the larva and make a definitive diagnosis in 15 cases, and in 12 cases, the worm was retrieved during the surgical procedure. In remaining cases, despite of our inability to identify the larva, the histopathologic changes were quite characteristic and included: dermal and hypodermal edema with dense mixed infiltrates composed of eosinophils admixed with lymphocytes and neutrophils, eosinophilic vasculitis, flame figures, areas of necrosis, and hemorrhage. Thus, the presence of these histopathologic features in the context of a clinical picture suggestive of gnathostomiasis allows the pathologist to make the correct diagnosis.
Subject(s)
Gnathostoma/isolation & purification , Skin Diseases, Parasitic/pathology , Spirurida Infections/pathology , Adolescent , Adult , Aged , Albendazole/therapeutic use , Animals , Anthelmintics/therapeutic use , Antiparasitic Agents , Biopsy , Child , Child, Preschool , Female , Food Microbiology , Gnathostoma/pathogenicity , Humans , Male , Middle Aged , Panniculitis/drug therapy , Panniculitis/parasitology , Panniculitis/pathology , Retrospective Studies , Spirurida Infections/drug therapy , Spirurida Infections/parasitologyABSTRACT
Introducción. El prurigo solar o actínico es una de las enfermedades de la piel más frecuentes en la niñez, particularmente en la población indígena o mestiza de México y de otros países de América Latina. En su patogénesis participan diversos factores como el HDL-DR4, ambientales como la luz solar; la altitud y la nutrición (deficiente aporte proteico). Material y métodos. Se llevó a cabo un estudio de las características clínicas e histológicas de 50 niños con diagnóstico de prurigo solar durante el lapso de 1990-1995. El diagnóstico se basó en niños con diagnóstico de prurigo solar durante el lapso de 1990-1995. El diagnóstico se basó en criterios clínicos y se sustentó en la biopsia de piel. Se puso particular énfasis en los cambios labiales y conjuntivales. Analizándose antecedentes familiares, lugar de residencia, edad, sexo y características sociogeográficas, entre otros. Resultados. Todos los pacientes fueron residentes de la Ciudad de México (altitud de 2450 m sobre el nivel del mar); provenientes de bajo nivel sociocultural y con pobre aporte proteico en su dieta. Con edades de 2 a 14 años, e igual distribución por sexo. En 15 pacientes se demostró queilitis y en 26 conjuntivitis. La evolución de la enfermedad fue de 6 a 18 meses antes del diagnóstico. Conclusión. El prurigo solar es una enfermedad frecuente en nuestro medio debido a la influencia solar (altura), mala nutrición y factores sociogeográficos, de inicio en la niñez, con manifestaciones clínicas e histológicas suficientemente características. Las pápulas pruriginosas con distribución hacia las zonas expuesta son la característica sine qua non, e interesantemente las mucosas conjuntival y labial se ven afectadas hasta en 50 por ciento de los pacientes. La afección conjuntival parece ser característica de esta enfermedad y los cambios en la mucosa labial se correlacionan con lo descrito en la literatura
Subject(s)
Humans , Male , Female , Child, Preschool , Adolescent , Eye Manifestations , Oral Manifestations , Prurigo/diagnosis , Prurigo/etiology , Prurigo/physiopathology , Skin Manifestations , Ultraviolet Rays/adverse effectsABSTRACT
Se presenta un estudio clínico, longitudinal, predominantemente observacional, de 45 casos de hemangioma endotelioma de la infancia estudios durante cuatro años. Se encuentra que es dos veces más común en el sexo femenino. La mayoría de los pacientes consultaron dentro de los primeros dos años de vida, ya que habitualmente su presentación es al nacimiento, como una o más máculas que evolucionan a tumoración en los primeros tres meses. Usualmente se presenta como lesión única, involucra predominantemente la extremidad cefálica y tiende a la autoinvolución durante los primeros cinco años. La conducta expectante es lo más recomendable, excepto en casos de compromiso de funciones vitales como la alimentación, la respiración o la visión, el funcionamiento de algunas extremidades o descompensación cardiovascular. En estos casos el tratamiento deberá iniciarse cuanto antes con esteroides vía oral o cirugía
