Hidradenitis supurativa prepuberal: presentación de 2 casos clínicos / Prepubertal Hidradenitis suppurativa: Report of 2 clinical cases

La hidradenitis supurativa (HS) es una enfermedad inflamatoria de la piel, caracterizada por la aparición de nódulos profundos en zonas que poseen glándulas apocrinas. Aparece más frecuentemente en mujeres entre la segunda y la tercera década de la vida. Objetivo Reportar 2 pacientes portadoras de HS a edad prepuberal. Caso 1 Paciente de sexo femenino, 10 años de edad, Tanner I-II, con antecedentes de obesidad. Consultó por un cuadro de 4 meses de evolución caracterizado por lesiones recurrentes en región inguinal bilateral que ocasionalmente drenan material purulento. Se diagnosticó HS Hurley I, se trató con antibióticos tópicos y manejo nutricional, con buena respuesta. Caso 2 Paciente de sexo femenino, 10 años de edad, Tanner I-II, con antecedentes de obesidad. Consultó desde los 6 años por cuadros recurrentes de lesiones en cara interna de muslo izquierdo. Fue tratada con múltiples cursos de antibióticos con escasa respuesta. Se diagnosticó HS Hurley I y se decidió manejo con terapia fotodinámica y apoyo nutricional, con buena respuesta. Conclusiones La etiología de la HS no es clara. La presentación a edades tempranas se asocia a antecedentes familiares y compromiso más extenso a futuro. El tratamiento de la enfermedad depende de cada caso, no existiendo un protocolo establecido.

Hidradenitis suppurativa (HS) is an inflammatory follicular skin disease. It usually presents as recurrent, deep nodules in flexural apocrine gland bearing areas. It appears mainly in women, in the second and third decade of life. Objective To present 2 cases of patients with prepuberal HS. Case 1 A 10-year old female, Tanner stage I-II and obesity. History of 4 months of evolution with bilateral recurrent groin lesions that occasionally drain pus; HS Hurley stage I was diagnosed, and topical antibiotics and nutritional management were prescribed, with a good response. Case 2 A 10 years old female, Tanner stage I-II and obesity. Since the age of 6 years, recurrent episodes of lesions in the inner side of the left thigh were observed, and multiple antibiotics with poor response were prescribed. HS Hurley stage I was diagnosed, and photodynamic therapy and nutritional management were used, with good response. Conclusions The etiology of HS is unclear. Usually the presentation at early age is associated with a family history and more extensive compromise in the future. Treatment is difficult and depends on each case and severity.

[Prepubertal Hidradenitis suppurativa: Report of 2 clinical cases]. / Hidradenitis supurativa prepuberal: presentación de 2 casos clínicos.

UNLABELLED: Hidradenitis suppurativa (HS) is an inflammatory follicular skin disease. It usually presents as recurrent, deep nodules in flexural apocrine gland bearing areas. It appears mainly in women, in the second and third decade of life. OBJECTIVE: To present 2 cases of patients with prepuberal HS. CASE 1: A 10-year old female, Tanner stage I-II and obesity. History of 4 months of evolution with bilateral recurrent groin lesions that occasionally drain pus; HS Hurley stage i was diagnosed, and topical antibiotics and nutritional management were prescribed, with a good response. CASE 2: A 10 years old female, Tanner stage I-II and obesity. Since the age of 6 years, recurrent episodes of lesions in the inner side of the left thigh were observed, and multiple antibiotics with poor response were prescribed. HS Hurley stage i was diagnosed, and photodynamic therapy and nutritional management were used, with good response. CONCLUSIONS: The etiology of HS is unclear. Usually the presentation at early age is associated with a family history and more extensive compromise in the future. Treatment is difficult and depends on each case and severity.

Oral and written counseling is a useful instrument to improve short-term adherence to treatment in acne patients: a randomized controlled trial.

BACKGROUND: Therapeutic success in acne patients not only depends on the appropriate selection of drugs but also on the patient's treatment adherence or compliance. Lack of adherence is an important problem both in general medicine and in dermatologic practice. OBJECTIVE: To evaluate the impact of oral and written counseling on treatment adherence among acne patients. PATIENTS AND METHODS: Eighty patients were randomized into two groups of 40 patients each. The intervention group received a patient information leaflet (apart from oral counseling), and instructions were reinforced by a telephone call within 15 days of treatment onset. The second group (control group) received treatment indications as usual (oral counseling in-office only). Both groups were followed up with a phone call, evaluating adherence to treatment according to self-reporting of patients at 30, 60, 90 days, and 6 months. RESULTS: Better adherence to treatment was observed in the intervention group. This difference was significant only within the first month of treatment (80% versus 62%, p = 0.043). The beneficial effect of written counseling plus a phone call decreased in subsequent months. CONCLUSION: Written counseling significantly improves adherence within the first month of treatment. These results suggest that it is reasonable to spend time and resources in written counseling in order to optimize adherence to treatment.

[Skin necrosis: report of eleven cases]. / Necrosis cutánea: un desafío para el médico.

Skin necrosis must be considered as a syndrome, because it is a clinical manifestation of different diseases. An early diagnosis is very important to choose the appropriate treatment. Therefore, its causes should be suspected and confirmed quickly. We report eleven patients with skin necrosis seen at our Department, caused by different etiologies: Warfarin-induced skin necrosis, loxoscelism, diabetic microangiopathy, ecthyma gangrenosum, disseminated intravascular coagulation, necrotizing vasculitis, paraneoplastic extensive necrotizing vasculitis, livedoid vasculopathy, necrotizing fasciitis, necrosis secondary to the use of vasoactive drugs and necrosis secondary to the use of cocaine. We also report the results of our literature review on the subject.

[POEMS syndrome with an isolated lytic lesion and glomeruloid hemangiomas: report of one case]. / Síndrome de POEMS con lesión lítica aislada y hemangiomas glomeruloides: Caso clínico.

POEMS syndrome (polyneuropathy, organomegaly, endocrine abnormality, M-protein, plasma cell dyscrasia, and skin lesions) is a rare atypical plasma cell dyscrasia with characteristic para neoplastic manifestations. Glomeruloid hemangioma is a typical skin change pathogenetically related with elevated levels of Vascular Endothelial Growth Factor (VEGF). We report a 69 year-old woman that presented cachexia associated with diabetes, hypothyroidism and severe sensitive motor polyneuropathy. Her skin changes included hyper pigmentation, acrocyanosis and glomeruloid hemangioma. The subsequent study revealed a monoclonal gammopathy lambda type; a unique lytic vertebral lesion and a clonal plasma cell proliferation. Treatment with prednisone 0.5 mg/kg and melphalan 0,25 mg/kg in cycles of 4 days every 4 weeks was started, but the patient was lost from follow up.

[Cutaneous histiocytic sarcoma: report of one case]. / Sarcoma histiocítico cutáneo: reporte de un caso.

Histiocytic sarcoma (HS) is a rare hematologic malignancy with morphologic and immunophenotypic evidence of histiocytic differentiation. Previously known as "true histiocytic lymphoma", the tumor follows an aggressive clinical course. Involvement of lymph nodes, skin, and extranodal sites has been described. Among the latter, approximately 29 cases involving the skin have been reported. On pathology, the lesion shows a diffuse proliferation of large epitheloid histiocytes with marked pleomorphism. We report a 78 year-old male who presented with a nodular lesion in the forehead, involving the skin and son tissue. The pathological diagnosis was a HS. The patient was lost from follow up.

Síndrome de POEMS con lesión lítica aislada y hemangiomas glomeruloides: caso clínico / POEMS syndrome with an isolated lytic lesion and glomeruloid hemangiomas: report of one case

POEMS syndrome (polyneuropathy, organomegaly, endocrine abnormality, M-protein, plasma cell dyscrasia, and skin lesions) is a rare atypical plasma cell dyscrasia with characteristic para neoplastic manifestations. Glomeruloid hemangioma is a typical skin change pathogenetically related with elevated levels of Vascular Endothelial Growth Factor (VEGF). We report a 69 year-old woman that presented cachexia associated with diabetes, hypothyroidism and severe sensitive motor polyneuropathy. Her skin changes included hyper pigmentation, acrocyanosis and glomeruloid hemangioma. The subsequent study revealed a monoclonal gammopathy lambda type; a unique lytic vertebral lesion and a clonal plasma cell proliferation. Treatment with prednisone 0.5 mg/kg and melphalan 0,25 mg/kg in cycles of 4 days every 4 weeks was started, but the patient was lost from follow up.

Sarcoma histiocítico cutáneo: Reporte de un caso / Cutaneous histiocytic sarcoma: Report of one case

Histiocytic sarcoma (HS) is a rare hematologic malignancy with morphologic and immunophenotypic evidence of histiocytic differentiation. Previously known as "true histiocytic lymphoma", the tumor follows an aggressive clinical course. Involvement of lymph nodes, skin, and extranodal sites has been described. Among the latter, approximately 29 cases involving the skin have been reported. On pathology, the lesion shows a diffuse proliferation of large epitheloid histiocytes with marked pleomorphism. We report a 78 year-old male who presented with a nodular lesion in the forehead, involving the skin and son tissue. The pathological diagnosis was a HS. The patient waslost from follow up.

Tanning salons in Santiago, Chile: the knowledge of the staff in charge and the quality of information provided to potential clients before and after a new regulatory law.

INTRODUCTION: In recent years, the use of artificial tanning devices has become very popular in Chile. In April, 2007, a new law was established to regulate the non-medical use of tanning beds and tanning booths. The aim of this study was to evaluate the level and quality of information provided by tanning salon staff to clients before deciding on using the services. This information was collected before and 6 months after the law was enacted by researchers visiting tanning salons posing as potential clients. METHODS: Using a previously designed questionnaire, 24 tanning salons in Santiago, Chile, were evaluated by researchers acting as potential customers without experience with artificial tanning devices. Employees were questioned using a hidden questionnaire before and 6 months after enactment of the law. RESULTS: Before the law, 25% of the establishments gave spontaneous information about the risks of using tanning beds, which increased to 45.8% after enactment of the law. Clients never received written information, either before or after enactment of the law. On both evaluations, more than 1/3 of the employees affirmed that there were no risks in using tanning beds. Before enactment of the law, only 12.5% of the tanning salons required the use of goggles, while after the law, this increased to 25% (P=NS). Only two establishments required that clients sign an informed consent form after enactment of the law. DISCUSSION: The level of knowledge among employees in tanning salons was very low and the quality of the information they provided to the clients was very poor. It was important to legislate on ultraviolet tanning services, but at present, the impact of the law has been very limited.