A case series and a review of the literature on foreign modelling agent reaction: an emerging problem.

Foreign modelling agent reactions (FMAR) are the result of the injection of unapproved high-viscosity fluids with the purpose of cosmetic body modelling. Its consequences lead to ulceration, disfigurement and even death, and it has reached epidemic proportions in several regions of the world. We describe a series of patients treated for FMARs in a specialised wound care centre and a thorough review of the literature. A retrospective chart review was performed from January 1999 to September 2015 of patients who had been injected with non-medical foreign agents and who developed cutaneous ulceration needing treatment at the dermatology wound care centre. This study involved 23 patients whose ages ranged from 22 to 67 years with higher proportion of women and homosexual men. The most commonly injected sites were the buttocks (38·5%), legs (18%), thighs (15·4%) and breasts (11·8%). Mineral oil (39%) and other unknown substances (30·4%) were the most commonly injected. The latency period ranged from 1 week to 17 years. Complications included several skin changes such as sclerosis and ulceration as well as systemic complications. FMAR is a severe syndrome that may lead to deadly complications, and is still very common in Latin America.

BRAF Mutation (V600E) Prevalence in Mexican Patients Diagnosed with Melanoma.

BACKGROUND: B-Raf is a serine/threonine protein kinase activating the MAP kinase/ERK-signaling pathway. It has been shown that 50% of melanomas harbor activating BRAF mutations, with over 90% being the V600E mutation. OBJECTIVE: The goal of this research was to determine the prevalence of the BRAF V600E mutation in patients from Central Mexico diagnosed with primary melanoma. METHODS: Skin biopsies from 47 patients with melanoma were obtained from the dermatology department of the Hospital General 'Dr. Manuel Gea González' in Mexico City. For BRAF mutation determination, after DNA isolation, the gene region where the mutation occurs was amplified by PCR. Subsequently, the presence or absence of the V600E mutation was detected by Sanger sequencing performed at the private molecular diagnostic laboratory Vitagénesis in Monterrey, Mexico. RESULTS: Of the 47 patients sampled, 6.4% harbored the V600E mutation. No statistical significance was found between mutations and the type of tumor.

Best way to perform a punch biopsy.

Nail punch biopsy is used to obtain a tissue sample for the diagnosis and treatment of nail diseases. The best results will be possible if the surgeon is familiar with the anatomy and physiology of the nail apparatus. A punch biopsy can be used in all regions of the nail apparatus in the presence or absence of nail plate. When the procedure is performed with a careful handling of the anatomic site and specimen, in most cases a successful diagnosis can be achieved.

"Cotton nail cast": a simple solution for mild and painful lateral and distal nail embedding.

BACKGROUND: Onychocryptosis is one of the most common painful nail conditions. Conservative treatment may take a long time to obtain effective results. OBJECTIVE: The purpose of this study is to show the effectiveness of a conservative treatment of ingrown nails that shows rapid results. METHODS AND MATERIALS: Patients with painful Stage 1 to 2 onychocryptosis who were not candidates or refused surgery were treated with the cotton cast. The severity and cause of onychocryptosis was clinically evaluated during a 2-month period. A questionnaire was applied to all patients to evaluate pain, final treatment, and possible complications. RESULTS: All patients noticed results in less than 72 hours. Pain subsided in less than 24 hours in half of the patients and before 72 hours in 100% of the patients without the need of other treatments. The use of the cast prevented surgery and the accompanying morbidities in most of the patients (80%). CONCLUSION: The "cotton nail cast" is an effective conservative method for mild nail embedding. It is easy to apply, inexpensive, relieves pain rapidly, and avoids surgery in most patients.

Lack of IgG antibody seropositivity to Borrelia burgdorferi in patients with Parry-Romberg syndrome and linear morphea en coup de sabre in Mexico.

BACKGROUND: Progressive hemifacial atrophy or Parry-Romberg Syndrome (PRS) is a rare, acquired, progressive dysplasia of subcutaneous tissue and bone characterized by unilateral facial involvement. Its etiology is unknown, but theories about its pathogenesis include infectious, degenerative, autoimmune, and traumatic causes among others. The causal relationship of PRS and linear morphea en coup de sabre (LMCS) with Borrelia burgdorferi infection remains controversial. Our goal was to serologically determine anti-B. burgdorferi antibodies in patients diagnosed with PRS and LMCS to establish a possible association as a causative agent. METHODS: We conducted a serology study with patients belonging to a group of 21 individuals diagnosed with PRS, six with LMCS, and 21 matched controls. Anti-Borrelia IgG antibodies were determined by ELISA. A descriptive statistical analysis and Fischer's exact test were done. RESULTS: In serological tests, only two cases had borderline values and were further analyzed by Western blot with non-confirmatory results. For both the PRS and LMCS group, the association test was not significant, suggesting a lack of association between PRS or LMCS and the presence of anti-Borrelia antibodies. CONCLUSION: In Mexico there are no previous studies on Borrelia infection and its relationship between PRS or LMCS. Our result showed a lack of association of either clinical entities with anti-Borrelia-antibodies. Former reports of this association may suggest coincidental findings without causal relationship.

[Trichoepithelioma: a retrospective study 1993-2012 - Dr Manuel Gea González General Hospital]. / Tricoepitelioma: estudio retrospectivo (1993-2012, Hospital General «Dr. Manuel Gea González¼).

BACKGROUND: Trichoepithelioma is a benign follicular tumor, affects young female adults, and has three clinical forms: solitary, multiple, or desmoplastic. Diagnosis represents a clinical challenge for the dermatologist. There are many differential diagnoses, and the most important is basal cell carcinoma because they share histological features. It has good prognosis and therefore treatment is usually for aesthetic purposes, even though it is associated with recurrence. METHODS: This is a retrospective study carried out from January 1993 to December 2012 of all the patients who were diagnosed by histopathology to have trichoepithelioma in the dermatology department of the Dr. Manuel Gea González General Hospital. RESULTS: There were 47 cases, of which 70.2% were female, with an average age of 43.6 years. Solitary trichoepithelioma was the most frequent clinical form (66%) and only three of 14 cases of multiple trichoepithelioma had a positive family history.

A case of oral mucosal melanoma. Clinical and dermoscopic correlation.

BACKGROUND: Most patients with oral mucosal melanoma have had a mucosal hyper pigmented area for months or even years before the diagnosis, it is important to consider the differential diagnosis of mucosal melanoma, which in many cases is a difficult diagnosis and because of the aggressive biological behavior of mucosal melanoma it is important to do a quick diagnosis. MAIN OBSERVATION: A 40-year-old Mexican male patient, presented with a lesion on the lower right half of the lip covering almost the entire vermillion border, 1 mm below the white roll. The lesion was a 1.5 x 4 cm pigmented macule with asymmetric and irregular borders and colors. Dermoscopy showed a multi component pattern. An incision biopsy was performed under the impression of mucosal melanoma. The pathologic report described a Clark I vermillion edge mucosal melanoma in situ. CONCLUSIONS: This case had confounding clinical signs that could have misguided the clinician. But dermoscopy proved to be useful when suspecting a malignant lesion, which prompted a biopsy and a correct diagnosis.

Dermoscopy Clues in Pigmented Bowen's Disease.

Pigmented tumors have similar clinical features that overlap and hamper diagnosis. Dermoscopy increases the diagnostic accuracy of doubtful melanocytic lesions and has been used as a noninvasive tool in the detection of pigmented lesions (PLs) like melanoma, basal cell carcinoma, and pigmented Bowen's disease (pBD). Our objective was to show the dermoscopic features of 2 cases of pBD and compare with the findings reported in the literature. Two dermoscopic images of biopsy proven pBD were retrospectively analyzed for dermoscopic patterns. Both cases showed brown regular globules, structureless brown and blue pigmentation, glomerular vessels, hypopigmented regression-like areas, and keratosis. These findings were similar to the cases reported previously. The dermoscopic diagnosis of pBD is based on the absence of criteria for a melanocytic lesion in the presence of glomerular vessels, regular brown globules and keratosis. Although pBD is rare, it should be included in the differential diagnosis of PLs, especially melanoma.

[Dermatology: science and art of sighting]. / Dermatología: ciencia y arte de mirar.

Art is beauty, reasoning, science and profession. Medicine is an art because it combines all these skills. But in the practice of medicine, experience is required and it can only be obtained through practice. Dermatology is also an art; it is learned through looking. To look is the act of perceiving the color and form of things through the eyes. The dermatologist utilizes art to learn, he uses observation, knowledge, reasoning to observe artwork. And through these acts he starts to observe figures, colors, and finally forms a pattern. After repeating this act, he establishes experience, and that is when the dermatologist learns the true art of dermatology, the art of seeing.

[Confluent and reticulated Gougerot-Carteaud papillomatosis: a case report of an excellent response to minocycline]. / Papilomatosis reticulada y confluente de Gougerot-Carteaud. Un caso con excelente respuesta a minociclina.

Confluent and reticulated Gougerot-Carteaud papillomatosis is an uncommon dermatological condition that affects adolescents, especially young women with dark skin types. It presents itself as asymptomatic pigmented patches with a papillomatous texture that coalesce to form reticular plaques localized in the neck and intertriginous areas. The cause of this disease is unknown, although an abnormal keratinization has been implicated and sometimes has been associated with Malassezia sp. It has a chronic course with remissions and exacerbations. Several therapies have been used unsuccessfully to eradicate it but nowadays there is no specific treatment. We report a case treated efficiently with minocycline without recurrence at 6 months follow-up.

Dermatología: ciencia y arte de mirar / Dermatology: science and art of sighting

El arte es belleza, razonamiento, ciencia y oficio. La medicina es un arte porque combina todas estas destrezas. Pero en la práctica de la medicina se requiere experiencia y esta se obtiene sólo por la práctica. La dermatología es un arte; se aprende viendo. Ver es el acto de percibir con los ojos el color y la forma de las cosas. El dermatólogo utiliza el arte para aprender; usa la observación, el conocimiento y el razonamiento para observar obras de arte. A través de la este acto ve figuras, colores y, finalmente, establece patrones. Después de repetir este acto se forma la experiencia, y es cuando el dermatólogo aprende el verdadero arte de la dermatología: el arte de mirar.

Art is beauty, reasoning, science and profession. Medicine is an art because it combines all these skills. But in the practice of medicine, experience is required and it can only be obtained through practice. Dermatology is also an art; it is learned through looking. To look is the act of perceiving the color and form of things through the eyes. The dermatologist utilizes art to learn, he uses observation, knowledge, reasoning to observe artwork. And through these acts he starts to observe figures, colors, and finally forms a pattern. After repeating this act, he establishes experience, and that is when the dermatologist learns the true art of dermatology, the art of seeing.

Papilomatosis reticulada y confluente de Gougerot-Carteaud: un caso con excelente respuesta a minociclina / Confluent and reticulated Gougerot-Carteaud papillomatosis: a case report of an excellent response to minocycline

La papilomatosis reticulada y confluente de Gougerot-Carteaud es una dermatosis poco frecuente que por lo general afecta a individuos jóvenes, especialmente a mujeres de fototipos oscuros. Es asintomática y se presenta como placas pigmentadas con textura papilomatosa que confluyen formando placas reticuladas de mayor tamaño en el cuello y zonas intertriginosas. La causa es desconocida, aunque se ha implicado una queratinización anormal, y en ocasiones se puede asociar a Malassezia sp. Su evolución es crónica con remisiones y exacerbaciones. Por el momento no se dispone de un tratamiento específico. Se presenta un caso tratado de manera efectiva con minociclina que no presentó recidiva tras seis meses de seguimiento.

Confluent and reticulated Gougerot-Carteaud papillomatosis is an uncommon dermatological condition that affects adolescents, especially young women with dark skin types. It presents itself as asymptomatic pigmented patches with a papillomatous texture that coalesce to form reticular plaques localized in the neck and intertriginous areas. The cause of this disease is unknown, although an abnormal keratinization has been implicated and sometimes has been associated with Malassezia sp. It has a chronic course with remissions and exacerbations. Several therapies have been used unsuccessfully to eradicate it but nowadays there is no specific treatment. We report a case treated efficiently with minocycline without recurrence at 6 months follow-up.