[Crusted scabies in HIV/AIDS infected patients. Report of 15 cases]. / Escabiosis costrosa en pacientes con infección por VIH/SIDA. Reporte de 15 casos.

BACKGROUND: Crusted (Norwegian) scabies is a rare disease that occurs in patients with compromised immune system like patients with HIV/AIDS. We report 15 cases of crusted scabies in patients with HIV/AIDS successfully treated with oral ivermectin. CLINICAL CASES: The mean age of the patients was 43.7±8.06 and the diagnosis was made at a median of 5 months. All patients were diagnosed with HIV/AIDS treatment with antiretroviral therapy. Patients were treated with repeated doses of oral ivermectin with different schemes with good tolerance and efficacy with full resolution and without recurrence. CONCLUSIONS: Ivermectin is the treatment of choice for crusted scabies; it is tolerable and accessible to the patient. Immunosuppressed patients are those with the highest risk of acquiring that disease; we highlight the importance of lesion scraping to perform a correct and early diagnosis.

Introducción: la sarna costrosa (Noruega) es una enfermedad rara que se presenta en pacientes con un sistema inmunológico comprometido, como los pacientes con infección por VIH/SIDA. Reportamos 15 casos de sarna costrosa en pacientes con infección por VIH/SIDA tratados exitosamente con ivermectina oral. Casos clínicos: la media de edad de los pacientes fue de 43.7 ± 8.06 y el diagnóstico se hizo en una mediana de cinco meses. Todos los pacientes tenían diagnóstico de infección por VIH/SIDA en tratamiento con terapia antirretroviral. Los pacientes fueron tratados con dosis repetidas de ivermectina oral con diferentes esquemas; tuvieron una buena tolerancia y el tratamiento fue eficaz, pues hubo una resolución completa y sin recidiva. Conclusiones: la ivermectina es el tratamiento de elección de la sarna costrosa. Es un medicamento tolerable y accesible para el paciente. Los pacientes inmunosuprimidos son los que presentan más riesgo de contraerla; resaltamos la importancia del raspado de las lesiones para hacer un diagnóstico correcto y temprano.

Serum lactate is a useful predictor of death in severe sepsis in patients with pemphigus vulgaris.

BACKGROUND: Serum lactate is a useful prognostic marker in severe sepsis; high levels of serum lactate in critically ill patients are related to high mortality risk; assessing serum lactate levels in patients with pemphigus vulgaris is justified. The objective was to determine the role of serum lactate as a predictor of shock and its outcome in patients with pemphigus vulgaris and severe sepsis without acute organ dysfunction. METHODS: Thirty-seven patients with pemphigus vulgaris, 22 with severe sepsis and 15 without sepsis. Blood lactate levels were analyzed. The outcome was recorded as survival or non-survival. RESULTS: High serum lactate levels, compared with intermediate and low levels, were significantly associated with increased 28-day mortality in patients with severe sepsis. The 28-day mortality for the cohort was 27.3%. CONCLUSIONS: Initial serum lactate was associated with mortality in pemphigus vulgaris with severe sepsis. Patients with severe sepsis and with high serum lactate levels (≥ 4 mmol/L) constitute a potential risk group that may benefit from more aggressive treatment.

Annular atrophic lichen planus.

A 30-year-old woman presented with a 1-year history of a pruritic eruption on the extremities, characterized by several annular plaques. The patient had been treated unsuccessfully with medium-potency topical steroids. The lesions had an erythematous papular border with an atrophic center (width, 1-4 cm) (Fig. 1). No oral, genital, or nail lesions were observed. A skin biopsy from one of the plaques was performed. Histopathologic examination of the raised border showed hyperkeratosis of the stratum corneum, focal thickening of the granular layer, basal liquefaction degeneration of the epidermis, and a band-like subepidermal infiltration with numerous Civatte bodies. In the center of the lesion, the epidermis became thinner (Fig. 2). Elastic fibers were reduced or absent in the papillary dermis. The patient was treated with high-potency topical steroids for 2 months with clinical improvement.

Porokeratosis of Mibelli of the axillae: treatment with topical imiquimod.

Porokeratosis of Mibelli is a rare genodermatosis characterized by a disorder of keratinization. None of the currently available therapies is effective in all cases and this situation exposes the patient to multiple treatment cycles. We describe the successful use of topical imiquimod 5% cream in the management of porokeratosis of Mibelli of the axillae in a 12-year-old girl. Treatment with imiquimod was effective, probably due to the area of application, where large hydrated skin folds are found, which helps penetration of the drug on the stratum corneum.