Correlation between dermoscopy and direct microscopy in Tineabarbae.

Tineabarbae is a rare form of dermatophytosis that affects hair follicles of the beard and moustache. Dermoscopy could prove useful to identify parasitism of hair of the beard, just as it has proven useful in the diagnosis of Tineacapitis. We present the first fully documented case series of T. barbae with clinical, dermoscopic and mycological features.

Biopsia selectiva del ganglio centinela / Sentinel Lymph Node Biopsy

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Do Malassezia species play a role in exacerbation of scalp psoriasis?

INTRODUCTION: Clinical expression of psoriasis is in part dependent on external factors, such as drugs, microorganisms or stress. However convincing evidence of the role of Malassezia species in the pathogenesis of the psoriasis is still lacking. PATIENTS AND METHODS: Samples taken from scalp skin of 40 psoriatic patients and the same number of healthy individuals were observed under direct microsocopic examination and cultured on modified Dixon agar. RESULTS: Direct microscopy examination of psoriatic scalp scales was positive in 30 (75%) patients; while it was positive in only 12 (30%) healthy subjects (P=0.003). Half of the cultures from healthy subjects showed no growth of colonies, but only 8 (15%) of psoriatic patients were negative. When an exacerbation has occurred in the previous weeks, pseudohyphaes were observed in 12 (40%) patients, Malassezia globosa was isolated in 18 (45%) patients and Malassezia restricta was isolated in 12 (30%) patients. In the group of patients having stable lesion, without any exacerbation in the previous weeks, no pseudohypahes were observed, M. globosa was not isolated, M. restricta was isolated in 4 (10%), and cultures were negative in 6 of them (15%). CONCLUSIONS: Malassezia species form an integral part of normal cutaneous microflora in humans, however we found that during the episodes of exacerbation of the disease the presence of these yeasts, and particularly M. globosa, was increased.

[Impact of melanoma diagnosis on sun protection]. / Impacto del diagnóstico de melanoma sobre la fotoprotección.

INTRODUCTION: Knowledge of the dangers of sun exposure does not always lead to changes in behavior. Failure to make behavioral adjustments is of particular concern in high-risk patients. OBJECTIVES: a) To assess the impact of melanoma diagnosis on knowledge, attitudes, and behaviors relating to sun protection, and b) to identify factors that could influence sun protection behaviors. METHODS: A coded, anonymous questionnaire was given to 195 patients with a recent diagnosis of melanoma. Data were collected on clinical and demographic variables and on knowledge, attitudes, and behaviors relating to sun protection before and after diagnosis. The questionnaire also addressed patients' sense of distress and guilt following diagnosis. RESULTS: Sun protection behaviors improved following diagnosis in 66% of patients. Although 98% of patients reported having received advice on sun protection following diagnosis, 15% continued to take inadequate sun protection measures. The probability of behavioral improvement following diagnosis was 4 times greater in women than in men. The subgroup of patients whose behavior improved had worse behaviors prior to diagnosis than did those who showed no improvement. Patients who expressed distress and feelings of guilt following diagnosis were more likely to improve their sun protection behavior. Age, tumor site, intensiveness of treatment, and belief that a suntan is healthy had no significant influence on behavioral change. CONCLUSIONS: Melanoma diagnosis is associated with increased knowledge of sun protection measures and improvement in behaviors. Nevertheless, patients continue to use inadequate sun protection measures. Identification of barriers to optimal sun protection behavior may be instrumental in designing targeted educational campaigns.

Impacto del diagnóstico de melanoma sobre la fotoprotección / Impact of Melanoma Diagnosis on Sun Protection

Introducción: El conocimiento sobre los peligros de la exposición solar no siempre se traduce en cambios en el comportamiento. Esto es particularmente alarmante en pacientes de alto riesgo. Objetivos: a) Evaluar el impacto del diagnóstico de melanoma en los conocimientos, actitudes y hábitos sobre fotoprotección, y b) analizar qué factores pueden influir en el cambio de hábitos de fotoprotección. Métodos: Usando un cuestionario anónimo y codificado que recogía datos clinicodemográficos, 195 pacientes con reciente diagnóstico de melanoma fueron interrogados sobre los conocimientos, hábitos y actitudes sobre fotoprotección antes y después del diagnóstico y sobre los sentimientos de angustia y culpabilidad tras el mismo. Resultados: El 66% de los pacientes optimizó su conducta tras el diagnóstico. Un 15% mantuvo conductas deficientes, a pesar de que el 98% de los sujetos refería haber recibido consejos de fotoprotección tras el diagnóstico. Las mujeres optimizaron su conducta 4 veces más que los hombres. El subgrupo de pacientes que mejoró presentaba conductas más deficientes que el subgrupo que no mejoró. Aquellos que experimentaron sentimientos de angustia y culpa tras el diagnóstico presentaron mayor probabilidad de optimizar su conducta. La edad, la localización tumoral, la agresividad terapéutica y la creencia de que el bronceado es saludable no tuvieron influencia significativa en la modificación de la conducta. Conclusión: El diagnóstico de melanoma lleva consigo un aumento en los conocimientos y un cambio favorable en los hábitos de fotoprotección. A pesar de ello, las medidas de fotoprotección no son lo suficientemente adecuadas. La evaluación de las barreras hacia la fotoprotección óptima puede ser la clave para diseñar programas educacionales específicos (AU)

Introduction: Knowledge of the dangers of sun exposure does not always lead to changes in behavior. Failure to make behavioral adjustments is of particular concern in high-risk patients. Objectives: a) To assess the impact of melanoma diagnosis on knowledge, attitudes, and behaviors relating to sun protection, and b) to identify factors that could influence sun protection behaviors. Methods: A coded, anonymous questionnaire was given to 195 patients with a recent diagnosis of melanoma. Data were collected on clinical and demographic variables and on knowledge, attitudes, and behaviors relating to sun protection before and after diagnosis. The questionnaire also addressed patients’ sense of distress and guilt following diagnosis. Results: Sun protection behaviors improved following diagnosis in 66% of patients. Although 98% of patients reported having received advice on sun protection following diagnosis, 15% continued to take inadequate sun protection measures. The probability of behavioral improvement following diagnosis was 4 times greater in women than in men. The subgroup of patients whose behavior improved had worse behaviors prior to diagnosis than did those who showed no improvement. Patients who expressed distress and feelings of guilt following diagnosis were more likely to improve their sun protection behavior. Age, tumor site, intensiveness of treatment, and belief that a suntan is healthy had no significant influence on behavioral change. Conclusions: Melanoma diagnosis is associated with increased knowledge of sun protection measures and improvement in behaviors. Nevertheless, patients continue to use inadequate sun protection measures. Identification of barriers to optimal sun protection behavior may be instrumental in designing targeted educational campaigns (AU)

Melanoma y retinoblastoma / Melanoma and Retinoblastoma

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Erupciones acneiformes en ocho pacientestratados con inhibidores del receptorde crecimiento epidérmico / Acneiform eruptions in eight patients treated with epidermal growth factor

En los últimos años, se están utilizando múltiples moléculas con actividad inhibidora del receptor del factor de crecimiento epidérmico (EGFR) para eltratamiento de tumores sólidos. Estos fármacos suelen tolerarse bien, predominando entre los efectos secundarios las reacciones adversas cutáneasentre las que destacan por su frecuencia las erupciones acneiformes.Presentamos ocho casos de erupciones acneiformes por inhibidores del EGFR mostrando su presentación clínica, los resultados de los cultivos bacterianosy micológicos de las lesiones, así como sus implicaciones pronósticas, tratamiento y respuesta al mismo (AU)

In the last few years many drugs which inhibit the epidermal growth factor receptor are being used in the treatment of solid tumors. These drugs areusually well tolerated, and cutaneous eruptions are the most frequent adverse effect associated with their use, especially acneiform eruptions.We present eight cases of acneiform eruptions associated with the use of epidermal growth factor receptor inhibitors showing their clinical features,the findings of the bacteriological and mycological cultures, their prognostic implications, management and response to treatment (AU)

Isolation of Toxoplasma gondii from animals in Durango, Mexico.

Little is known concerning the epidemiology of Toxoplasma gondii infection in people and animals in rural Mexico. Serum samples and tissues from 150 dogs (Canis familaris), 150 cats (Felis catus), 65 opossums (Didelphis virginianus), 249 rats (Rattus spp.), 127 mice (Mus musculus), and 69 squirrels (Spermophilus variegatus) from the Durango area were evaluated for T. gondii infection. Using a modified agglutination test and a serum dilution of 1:25, antibodies to this parasite were found in 68 (45.3%) of 150 dogs, 14 (9.3%) of 150 cats, 11 (16.6%) of 66 opossums, 2 (0.8%) of 249 rats, 4 (3.1%) of 127 mice, and 0 of 69 squirrels. Tissues (brain and heart) of dogs, cats, opossums, rats, mice, and squirrels were bioassayed in mice for the presence of T. gondii. Viable T. gondii was isolated in tissues from 3 of 28 seropositive dogs and 5 of 8 seropositive cats, but not from the other animals. The DNA obtained from the 3 T. gondii isolates from dogs, 6 isolates from 5 cats, and 4 isolates from free-range chickens from Mexico, previously isolated, were genotyped. The PCR-RFLP typing, which used 11 markers (B 1, SAGI, SAG2, SAG3, BTUB, GRA6, c22-8, c29-2, L358, PK1, and Apico), identified 5 genotypes. One genotype (the 4 chicken isolates) belongs to the clonal Type III lineage, three genotypes were reported in previous reports, and 1 genotype is unique.

Seroepidemiology of Toxoplasma gondii infection in human adults from three rural communities in Durango State, Mexico.

There is scarce information concerning the epidemiology of Toxoplasma gondii infection in people of rural Mexico. Anti-T. gondii immunoglobulin (Ig)G and IgM antibodies were sought in 462 adult inhabitants from 3 rural communities of Durango, Mexico, using enzyme-linked immunoassays. In total, 110 (23.8%) of 463 persons had IgG anti-T. gondii antibodies. Ten (2.2%) of them also had IgM anti-T. gondii antibodies. Prevalences of T. gondii IgG antibodies in the 3 communities varied from 14.8 to 35.8%. The highest prevalence of infection was observed in participants older than 70 yr and in those with good housing conditions. Toxoplasma gondii infection was significantly associated with consumption of squirrel (adjusted odds ratio [OR] = 4.22; 95% confidence interval [CI] = 1.11-16.05) and turkey meat (adjusted OR = 4.58; 95% CI = 1.14-18.44). This is the first epidemiological study of T. gondii prevalence in rural Mexico.

Seroepidemiology of infection with Toxoplasma gondii in waste pickers and waste workers in Durango, Mexico.

Municipal waste is a potential source of infection for Toxoplasma gondii as it may contain contaminated meat with parasite tissue cysts and cat excrement with parasite oocysts. Therefore, we sought to determine the prevalence of T. gondii infection and associated characteristics in two populations exposed to municipal solid waste in Durango, Mexico. Ninety waste pickers and 83 waste workers of Durango City, Mexico were examined for T. gondii infection. They were tested for anti-T. gondii IgG and IgM antibodies using enzyme-linked immunoassays. In addition, socio-demographic and behavioural characteristics from each participant were obtained. Nineteen (21.1%) of the 90 waste pickers and seven (8.4%) of the 83 waste workers were positive for anti-T. gondii IgG antibodies. The difference in prevalence among the groups was statistically significant (P =0.03). Waste pickers aged 31-50 years showed a significantly higher prevalence (40.9%) than waste workers of the same age group (2.9%, P < 0.001). Anti-T. gondii IgM antibodies were found in two (2.2%) of the waste pickers but in none of the waste workers. The seroprevalence of T. gondii was significantly higher in workers of the waste transfer station (25.0%) than in drivers or helpers of waste vehicles (2.5%) (P =0.03). Multivariate analysis showed that T. gondii infection was associated with consuming food found in the garbage [adjusted odds ratio (OR) = 4.4; 95% confidence interval (CI) 1.6-11.8] and with lack of education (adjusted OR = 3.2; 95% CI 1.1-8.8). From this study, we conclude: (i) waste pickers may represent a risk group for T. gondii infection; (ii) lack of education might be a contributing factor for T. gondii infection; (iii) the higher the exposure to garbage, the higher the seroprevalence of T. gondii infection; (iv) Eating food products from the garbage may represent an important route for T. gondii infection.

[Teledermatology. Review of 917 teleconsults]. / Teledermatología. Revisión de 917 teleconsultas.

INTRODUCTION: Teledermatology is been currently introduced as a diagnostic tool in the daily practice of the dermatologist. Many published works regarding teleconsult show the high sensitivity and economic saving of this technique as a diagnostic method. MATERIAL AND METHODS: In this article we report our experience with nearly 1,000 teleconsults carried out in a period of two years, from October 2004 to October 2006. RESULTS: The majority of the 917 teleconsults performed were for benign lesions, notably seborrheic keratosis in 201 cases; among malignant lesions actinic keratosis appeared in 161 cases and melanoma was diagnosed in 5 cases. Fifty-eight percent of teleconsults have been arranged for a face-to-face consult in order to perform adequate treatment, in 90 % of cases, or to confirm diagnosis or carry out complementary exams, in 10 % of cases. CONCLUSION: The image is the gold standard for dermatological diagnosis. Currently, digital phototography gives us such a high image quality that, based on our experience, it can be stated that a neoplastic lesion that cannot be diagnosed by a high quality digital image with the available technology, rarely could be diagnosed in a face-to-face consult without the aid of complementary exams.

Teledermatología. Revisión de 917 teleconsultas / Teledermatology. Review of 917 teleconsults

Introducción. Actualmente el uso de la teledermatología como herramienta diagnóstica está introduciéndose en la práctica diaria del dermatólogo, ya son muchos los trabajos publicados sobre la teleconsulta, donde se demuestra la alta sensibilidad y el alto ahorro económico de esta técnica como método diagnóstico. Material y métodos. Presentamos en este artículo nuestra experiencia con cerca de 1.000 teleconsultas realizadas en un periodo de 2 años, desde octubre de 2004 a octubre de 2006. Resultados. De las 917 teleconsultas realizadas, la mayoría de las lesiones han sido de patología benigna, destacando las queratosis seborreicas en 201 ocasiones, entre la patología maligna destacan las queratosis actínicas en 161 de los casos y se han diagnosticado 5 melanomas. El 58 % de las teleconsultas han sido citados para la consulta de presencia física, ya sea para realizar el tratamiento adecuado, en el 90 % de los casos, como para confirmar el diagnóstico o realizar pruebas complementarias, en un 10%. Conclusión. La imagen es el gold standard para el diagnóstico dermatológico. Actualmente la fotografía digital nos da tal calidad de imagen que, a la luz de nuestra experiencia, cabría afirmar que la patología tumoral que no pueda diagnosticarse con una imagen fotográfica digital de alta calidad, como las que proporcionan los instrumentos y medios que manejamos, raramente pueden llegar a diagnosticarse en presencia física sin la ayuda de pruebas complementarias

Introduction. Teledermatology is been currently introduced as a diagnostic tool in the daily practice of the dermatologist. Many published works regarding teleconsult show the high sensitivity and economic saving of this technique as a diagnostic method. Material and methods. In this article we report our experience with nearly 1,000 teleconsults carried out in a period of two years, from October 2004 to October 2006. Results. The majority of the 917 teleconsults performed were for benign lesions, notably seborrheic keratosis in 201 cases; among malignant lesions actinic keratosis appeared in 161 cases and melanoma was diagnosed in 5 cases. Fifty-eight percent of teleconsults have been arranged for a face-to-face consult in order to perform adequate treatment, in 90 % of cases, or to confirm diagnosis or carry out complementary exams, in 10 % of cases. Conclusion. The image is the gold standard for dermatological diagnosis. Currently, digital phototography gives us such a high image quality that, based on our experience, it can be stated that a neoplastic lesion that cannot be diagnosed by a high quality digital image with the available technology, rarely could be diagnosed in a face-to-face consult without the aid of complementary exams

Neospora caninum and Toxoplasma gondii antibodies in dogs from Durango City, Mexico.

Toxoplasma gondii and Neospora caninum are structurally similar parasites, with many hosts in common. The prevalence of antibodies to T. gondii and N. caninum was determined in sera from dogs from Durango City, Mexico. Using a modified agglutination test, antibodies to T. gondii were found in 52 (51.5%) of the 101 dogs with titers of 1:25 in 27, 1:50 in 11, 1:100 in 5, 1:200 in 4, 1:400 in 2, 1:800 in 2, and 1:3,200 or higher in 1. Antibodies to N. caninum were determined by the indirect immunofluorescent antibody test (IFAT) and the Neospora sp. agglutination test (NAT). Two of the 101 dogs had N. caninum antibodies; these dogs did not have T. gondii antibodies, supporting the specificity of the tests used. The N. caninum antibody titers of the 2 dogs were: 1:400 by IFAT and 1:200 by NAT in 1, and 1:25 by NAT and IFAT in the other. Results indicate that these 2 structurally similar protozoans are antigenically different.

Seroprevalence of Toxoplasma gondii antibodies in cats from Durango City, Mexico.

The prevalence of antibodies to Toxoplasma gondii was determined in sera from 105 domestic cats from Durango City, Mexico. Using a modified agglutination test, antibodies to this parasite were found in 21% of the 105 cats, with titers of 1:25 in 3 cats, 1:50 in 4 cats, 1:200 in 5 cats, 1:400 in 2 cats, 1:800 in 2 cats, 1:1,600 in 4 cats, and 1:3,200 or higher in 2 cats. Cats older than 1 yr had a significantly higher frequency of infection than that found in cats younger than 0.5 yr (41 vs. 13.2%, respectively; odds ratio = 4.55; 95% CI = 1.24-17.18; P = 0.01). Overall, the seroprevalence of T. gondii antibodies in cats in Durango, Mexico, is much lower compared with those reported in other countries.