Orientaciones para el manejo ambulatorio de adultos que viven con VIH en Chile / Guidelines for the primary care of adult people living with HIV in Chile

El enfrentamiento de las personas que viven con VIH es amplio y requiere dedicación en múltiples dimensiones, más allá de la terapia antirretroviral. Estas recomendaciones abordan el manejo desde el diagnóstico, primera visita, seguimiento, manejo de comorbilidades infecciosas y no infecciosas, tamizaje de neoplasias, profilaxis antimicrobiana y vacunas, entre otras.

Management of people living with HIV is broad and multiple dimensions must be considered, beyond antiretroviral therapy. These recommendations include management from diagnosis, first visit, patient follow-up, infectious and non-infectious comorbidities, malignancies screening, antimicrobial and immunizations prophylaxis, among others.

Validación de la versión en español de la escala de evaluación del trastorno por déficit de atención e hiperactividad (ADHD-RS-IV. es) en una muestra española / Validation of a Spanish-language version of the ADHD Rating Scale IV in a Spanish sample

OBJETIVOS: El objetivo de este estudio es validar la versión en castellano del ADHD-RS-IV (ADHD-RS-IV.es) en una muestra española. MÉTODOS: A partir de una muestra total de 652 niños y adolescentes (rango edad: 6-17 años; media [DE] = 11,14 [3,27] años), se incluyó a 518 pacientes con TDAH (criterios DSM-IV-TR) y a 134 controles sanos. Para la evaluación de la estructura factorial, la validez y la fiabilidad de la escala se realizó un análisis factorial confirmatorio (CFA) mediante structural equation modeling en una matriz de correlaciones policóricas, y usando el método de máxima verosimilitud para la estimación. Se calcularon la validez discriminante y su valor predictivo mediante curvas receiver operating characteristics. RESULTADOS: La escala en castellano mostró una consistencia interna elevada, tanto para la escala total como para sus subescalas. El coeficiente alfa de Cronbach era 0,94 para la escala total y ≥ 0,90 para las subescalas. Los valores alfa ordinales eran 0,95 para la escala total y ≥ 0,90 para las subescalas. El análisis CFA mostró un modelo de 2 factores (inatención e hiperactividad/impulsividad) intercorrelacionados. La escala ofrece buen poder discriminante (AUC = 0,97). CONCLUSIONES: La versión española del ADHD-RS-IV (ADHD-RS-IV.es) mostró una estructura bifactorial consistente con los modelos del DSM-IV-TR y DSM-5, y con el modelo propuesto por el autor de la escala original. Además, posee un alto poder discriminante, lo que lo convierte en un instrumento válido y fiable para medir la presencia y severidad de síntomas de TDAH en la población española

OBJECTIVES: The purpose of this study is to validate a Spanish-language version of the 18-item ADHD Rating Scale-IV (ADHD-RS-IV.es) in a Spanish sample. METHODS: From a total sample of 652 children and adolescents aged 6 to 17 years (mean age was 11.14 ± 3.27), we included 518 who met the DSM-IV-TR criteria for ADHD and 134 healthy controls. To evaluate the factorial structure, validity, and reliability of the scale, we performed a confirmatory factor analysis (CFA) using structural equation modelling on a polychoric correlation matrix and maximum likelihood estimation. The scale's discriminant validity and predictive value were estimated using ROC (receiver operating characteristics) curve analysis. RESULTS: Both the full scale and the subscales of the Spanish-language version of the ADHD-RS-IV showed good internal consistency. Cronbach's alpha was 0.94 for the full scale and ≥ 0.90 for the subscales, and ordinal alpha was 0.95 and ≥ 0.90, respectively. CFA showed that a two-factor model (inattention and hyperactivity/impulsivity) provided the best fit for the data. ADHD-RS-IV.es offered good discriminant ability to distinguish between patients with ADHD and controls (AUC = 0.97). CONCLUSIONS: The two-factor structure of the Spanish-language version of the ADHD-RS-IV (ADHD-RS-IV.es) is consistent with those of the DSM-IV-TR and DSM-5 as well as with the model proposed by the author of the original scale. Furthermore, it has good discriminant ability. ADHD-RS-IV.es is therefore a valid and reliable tool for determining presence and severity of ADHD symptoms in the Spanish population

Validation of a Spanish-language version of the ADHD Rating Scale IV in a Spanish sample. / Validación de la versión en español de la escala de evaluación del trastorno por déficit de atención e hiperactividad (ADHD-RS-IV.es) en una muestra española.

OBJECTIVES: The purpose of this study is to validate a Spanish-language version of the 18-item ADHD Rating Scale-IV (ADHD-RS-IV.es) in a Spanish sample. METHODS: From a total sample of 652 children and adolescents aged 6 to 17 years (mean age was 11.14±3.27), we included 518 who met the DSM-IV-TR criteria for ADHD and 134 healthy controls. To evaluate the factorial structure, validity, and reliability of the scale, we performed a confirmatory factor analysis (CFA) using structural equation modelling on a polychoric correlation matrix and maximum likelihood estimation. The scale's discriminant validity and predictive value were estimated using ROC (receiver operating characteristics) curve analysis. RESULTS: Both the full scale and the subscales of the Spanish-language version of the ADHD-RS-IV showed good internal consistency. Cronbach's alpha was 0.94 for the full scale and ≥ 0.90 for the subscales, and ordinal alpha was 0.95 and ≥ 0.90, respectively. CFA showed that a two-factor model (inattention and hyperactivity/impulsivity) provided the best fit for the data. ADHD-RS-IV.es offered good discriminant ability to distinguish between patients with ADHD and controls (AUC=0.97). CONCLUSIONS: The two-factor structure of the Spanish-language version of the ADHD-RS-IV (ADHD-RS-IV.es) is consistent with those of the DSM-IV-TR and DSM-5 as well as with the model proposed by the author of the original scale. Furthermore, it has good discriminant ability. ADHD-RS-IV.es is therefore a valid and reliable tool for determining presence and severity of ADHD symptoms in the Spanish population.

[Attention deficit hyperactivity disorder in preschool age children. Its epidemiological prevalence in Navarra and La Rioja, Spain]. / Trastorno por deficit de atencion/hiperactividad en niños en edad preescolar. Prevalencia epidemiologica en Navarra y La Rioja, España.

INTRODUCTION: There are few studies about preschool attention deficit hyperactivity disorder (ADHD) prevalence. AIM: To study the prevalence of ADHD in preschoolers using an specific scale (ADHD-RS-IV-P-Es) developed for this age range. SUBJECTS AND METHODS: We evaluated the prevalence of possible ADHD in a representative sample of preschoolers in Navarra and La Rioja, Spain. RESULTS: We find a range of prevalence between 2.5-4.1% depending on the criteria that was used (more or less strict). CONCLUSIONS: There are specific tools that can be use in preschool ADHD study. The prevalence of preschool ADHD in Spain is similar than in other countries. The frequency of symptoms in this age range is similar to the found in school age children.

TITLE: Trastorno por deficit de atencion/hiperactividad en niños en edad preescolar. Prevalencia epidemiologica en Navarra y La Rioja, España.Introduccion. La prevalencia del trastorno por deficit de atencion/hiperactividad (TDAH) esta en constante estudio, y hay pocas publicaciones sobre la prevalencia en niños preescolares. Objetivo. Estudiar la prevalencia de sintomas de TDAH en niños preescolares usando una escala especifica (ADHD Rating Scale-IV, version preescolar, validada para España) desarrollada para esta franja de edad. Sujetos y metodos. Se evalua la prevalencia de posible TDAH en una muestra representativa de preescolares en Navarra y La Rioja usando diferentes puntos de corte. Resultados. Se encuentra un rango de prevalencia de sintomas de TDAH del 2,5-4,1% segun el criterio usado (mas o menos estricto). Conclusiones. Existen herramientas especificas que pueden usarse para evaluar el TDAH en preescolares. La prevalencia de posible TDAH en preescolares en España es similar a la encontrada en otros paises. La frecuencia de sintomas en esta franja de edad no es mas alta que en otras edades, por lo que no es cierto que los sintomas de TDAH sean muy prevalentes en la poblacion general de niños preescolares.

Exercise and Alzheimer's: the body as a whole / Ejercicio y enfermedad de Alzheimer: el cuerpo como un todo / Exercício e doença de Alzheimer: o corpo como um todo

Objective. Alzheimer's disease has been studied from various areas of knowledge (biomarkers, brain structure, behavior, cognitive impairment). Our aim was to examine the effects of an exercises protocol developed using complexity theory concepts. Method. Exercise improves neuroplasticity (neuronal ability to change and adapt as a result of experience) through mental and physical skills linked to cognitive-associative brain circuits. Introducing controlled physical and cognitive stimuli, self-organization and connectivity among brain systems enhance. We used tasks with non-linear outputs (several solutions) and learning as order parameter. Tasks were performed simultaneously, at the edge of the error seeking self-organized criticality. Results. Screening tests data showed a reduction in cognitive impairment, which suggests a reduction disease progression, in terms of executive function. There was a marked improvement in the physical tests: 30seconds chair stand test (PRE: 8.78±3.46; POST: 9.44±3.68 repetitions) and foot up and go test (PRE: 11.95±5.19; POST: 11.69±4.43seconds). Conclusion. Results showed that patient's self-organization was increased; behaviors atrophied or inhibited reappeared. Using these controlled perturbations, Alzheimer's Disease patients were able to manifest improvements in both their mental and physical abilities (AU)

Objetivo. La enfermedad de Alzheimer ha sido estudiada desde varias áreas del conocimiento (biomarcadores, estructura cerebral, conducta, discapacidad cognitiva). Nuestro objetivo ha sido examinar de un protocolo de ejercicio diseñado usando conceptos de la teoría de los sistemas complejos. Método. El ejercicio mejora la neuroplasticidad (habilidad neuronal para el cambio y adaptación como resultado de la experiencia) a través de las habilidades mentales y físicas vinculadas a los circuitos cerebrales cognitivo-asociativos. La inclusión de estímulos físicos y cognitivos controlados mejora la autoorganización y la conectividad entre los sistemas cerebrales. Hemos utilizado tareas con soluciones no lineales (varias soluciones) y hemos analizado el aprendizaje. Las tareas se realizaron simultáneamente en el límite del error buscando la autoorganización crítica. Resultados. El análisis de nuestros datos mostró una reducción del deterioro cognitivo, lo que sugiere un enlentecimiento de la progresión de la enfermedad, en términos de la función ejecutiva. Se constató una marcada mejoría en las pruebas físicas: Test de sentarse y levantarse durante 30′ (PRE: 8.78±3.46; POST: 9.44±3.68 repeticiones) y Test de levantarse y caminar (PRE: 11.95±5.19; POST: 11.69±4.43 segundos). Conclusión. Los resultados mostraron que la autoorganización del paciente mejoró y que reaparecieron conductas atrofiadas o inhibidas. Utilizando estos estímulos controlados, los pacientes con Alzheimer fueron capaces de manifestar mejoras en sus capacidades mentales y físicas (AU)

Objetivo. A doença de Alzheimer tem sido estudada por várias áreas do conhecimento (biomarcadores, estrutura cerebral, comportamento, déficit cognitivo). Nosso objetivo foi examinar os efeitos de um protocolo de exercícios desenvolvidos com os conceitos da teoria da complexidade. Método. O exercício melhora a neuroplasticidade (a capacidade neural para mudar e adaptar-se, como resultado de experiências) através de habilidades mentais e físicas ligadas a circuitos cerebrais cognitivo-associativos. Apresentando estímulos físicos e cognitivos controladas; auto-organização e aumento da conectividade entre os sistemas cerebrais. Usamos tarefas com saídas não-lineares (várias soluções) e de aprendizagem como parâmetro de ordem. As tarefas foram realizadas em simultâneo, no limite do erro em busca da criticalidade auto-organizada. Resultados. As triagens de dados testes mostraram uma redução no déficit cognitivo, o que sugere redução na progressão da doença, em termos de função executiva. Houve uma melhora acentuada nos testes físicos: 30 segundos no testes sentar e levantar da cadeira (PRE: 8.78±3.46; POST: 9.44±3.68 repetições) e no teste de levantar e caminhar (PRE: 11.95±5.19; POST: 11.69±4.43 segundos). Conclusões. Os resultados mostraram que a auto-organização do paciente foi aumentada; reapareceu comportamentos atrofiados ou inibidos. Usando estas perturbações controladas, os pacientes com doença de Alzheimer foram capazes de manifestar melhorias em suas capacidades físicas e mentais (AU)

Práctica de actividad física y actitudes en los adolescentes de canarias / Physical activity practice and attitudes in canarian teenagers

En el presente estudio de la población adolescente de la Comunidad Autónoma de Canarias, se evidencia que aquellos adolescentes que cumplen con las recomendaciones de práctica de Actividad Física tanto de intensidad moderada como vigorosa frente a los que no las cumplen, muestran a su vez mejores valores en la percepción del conjunto de actitudes que influyen en los niveles de práctica; competencia motriz, disfrute y valor-utilidad otorgada a la misma. Lo cual nos permite afirmar que este conjunto de factores pueden determinar el tipo y grado de participación en actividades físico-deportivas en este sector de la población (AU)

In this actual study of the adolescent population of the Autonomous Region of the Canary Islands, is evident, that teens who comply with the recommendations of practice of physical activity both of moderate intensity as vigorous intensity, compared with those which do not comply, show the best values in the perception of the set of attitudes that influence the levels of practice; perceived competence, enjoyment, perceived value. Which allows us to affirm that this set of factors can determine the type and degree of participation in physical-sport activities in this sector of the population (AU)

Pitiriasis «rubra pilaris» localizada / Pityriasis rubra pilaris localized

Incluimos la pitiriasis rubra pilaris (PRP) dentro del grupo de las dermatosis papuloescamosas hiperqueratósicas de origen desconocido. Aunque poco frecuente, se han constatado dos picos de incidencia en la primera y en la quinta década de la vida, lo cual determina su clasificación en cinco grandes grupos, los dos primeros típicos en la edad adulta y los tres restantes en la edad juvenil. En los últimos años se ha incluido un sexto grupo, asociado al virus de la inmunodeficiencia humana (VIH), independientemente de la edad. No existe un tratamiento estandarizado para la PRP, pero por lo general en casos localizados suelen emplearse tratamientos tópicos, entre los que incluimos los corticoides, los derivados de la vitamina D o los retinoides; en casos más extensos podría recurrirse a tratamientos sistémicos, y como primera elección los retinoides orales(AU)

Pityriasis rubra pilaris (PRP) is an uncommon papulosquamous keratotic dermatosis of unknown origin. It has a bimodal distribution of age onset concentrating in the first and fifth decades. Classification of PRP includes 5 types: types I and II represent the forms of adult PRP, respectively, whereas types III, IV, and V are seen in juveniles. In recent years, a type VI PRP associated with HIV infection has been proposed. A universal standard treatment for PRP is lacking. Topical therapy is the treatment of choice for patients with mild type III and type IV PRP, including corticoids, vitamin D analogue ortopical retinoids. Systemic therapy is reserved for patients with severe type III and type V. Acitretin and isotretinoin are the treatment of choice(AU)

Telangiectasia nevoide unilateral / Unilateral nevoid telangiectasia

La telangiectasia nevoide unilateral se define por la aparición progresiva de telangiectacias localizadas de manera blaschkoide o unilateral en un dermatoma cutáneo, habitualmente en la cabeza, el cuello y los miembros superiores. Las lesiones suelen comenzar en torno a la pubertad y son más habituales en pacientes de sexo femenino. Es una patología benigna con repercusiones meramente estéticas, pero en ocasiones puede asociarse a hepatopatía o a enfermedades autoinmunes, como el lupus eritematoso sistémico. El tratamiento consiste en láser colorante pulsado(AU)

Unilateral nevoid telangiectasia is a disorder characterized by a progressive occurrence of telangiectases on the skin. They are usually arranged in an unilateral or Blaschkoid pattern on the head, the neck or the upper limb. The disease appears around puberty and has a female predilection. Unilateral nevoid telangiectasia is a benign disorder but it has also been described in association with hepatopathy or with a connective tissue disease like lupus erythematosus. The pulsed dye laser is the treatment of choice(AU)

Echocardiographic study of structure and functional cardiac profile of football referees.

AIM: The aim of this study was to analyze, through echocardiography, the structure and functional cardiac profile of national category Spanish soccer referees. METHODS: The sample consisted of 54 licensed referees, who belonged to the Football Inter-Insular Federation of Las Palmas. The sample presented a mean age of 28.52 ± 6.39 years, a height of 1.76 ± 0.07 m, a body mass of 77.26 ± 10.74 kg and a Body Mass Index of 24.90 ± 2-73 kg/m2. The diastolic and systolic dimensions of the left ventricle were 50.03 ± 4.79 mm and 33.74 ± 5.23 mm, respectively. The thicknesses of the interventricular septum and the posterior wall of the left ventricle were 9.77 ± 1.53 mm and 9.47 ± 1.54 mm, respectively. The left ventricular mass was 112.80 ± 26.53 g/m2, the diastolic volume of the left ventricle 135.09 ± 39.63 mL and the ejected volume 47.34 ± 12.44 mL/m2. RESULTS: This study shows that the echocardiographic profile of football referees is characterized by presenting an increase in the left ventricular mass caused by an increase of the cardiac chambers and a normal systolic and diastolic function. The values obtained by football referees were higher than those found in sedentary people and lower than in professional football players. CONCLUSION: These differences may be due to the different physical training workloads employed by football players and referees.

Enfermedad mano-pie-boca / Hand, foot and mouth disease

La enfermedad mano-pie-boca es una entidad nosológica de causa viral, que se caracteriza por la presencia de lesiones cutáneas en la mucosa oral y las regiones acrales. En la mayoría de las ocasiones el agente causal son los virus Coxsackie, miembros de la familia picornavirus. La infección se presenta habitualmente de forma esporádica, si bien pueden existir epidemias. El tratamiento es sintomático y el pronóstico es excelente, aunque se han descrito complicaciones neurológicas y casos mortales (AU)

Hand, foot and mouth disease is a nosological entity of viralorig in characterised by cutaneous lesions of the oral mucosa and acral regions. In most cases the causal agent is the Coxsackie virus, a member of the Picornavirus family. The infection usually occurs sporadically, even though epidemics may occur. Its treatment is symptomatic and the prognosis is excellent, although there have been reports of neurological complications and fatal cases (AU)

Hipomelanosis macular progresiva / Progressive macular hypomelanosis

La hipomelanosis macular progresiva es una entidad poco conocida y, sin embargo, relativamente frecuente. Cursa con la aparición de máculas hipocrómicas asintomáticas en el tronco de adolescentes y adultos jóvenes, sin inflamación previa. La etiología de esta enfermedad es desconocida, pero se postula la posible intervención de cepas de Propionibacterium acnes. No tiene tratamiento eficaz, pero hay casos que responden a la fototerapia y la antibioterapia tópica (AU)

Progressive macular hypomelanosis is a little-known and yet relatively common condition. It presents with the appearance of asymptomatic hypochromic macules on the trunk of adolescents and young adults, without prior inflammation. This disease if of unknown a etiology, but is thought to involve the possible intervention of strains of Propionibacterium acnes. There is no efficient treatment for this disease, although certain cases respond to phototherapy and topical antibiotherapy (AU)

Hemangiomatosis difusa neonatal / Diffuse neonatal hemangiomatosis

El hemangioma es el tumor benigno más frecuente de la infancia. La mayoría de las veces se manifiesta como un tumor solitario(o, a lo sumo, aparecen dos o tres lesiones), y remite de forma espontánea antes de los 10 años de vida. Cuando el número de hemangiomas es de cinco o más, el proceso de denomina hemangiomatosis cutánea múltiple. En estos casos pueden aparecer hemangiomas viscerales, sobre todo hepáticos; hablamos entonces de hemangiomatosis difusa neonatal, siendo necesario efectuar una monitorización estrecha para descartar posibles complicaciones (AU)

The hemangioma is the most common benign tumor in childhood. In most cases, it is a solitary tumor or, at most, there maybe two or three, which remits spontaneously before the childreaches the age of 10 years. When there are five or more hemangiomas, the process is referred to as multiple cutaneous hemangiomatosis. In these cases, visceral hemangiomas can develop, mainly in the liver, thus resulting in the disease referred to as diffuse neonatal hemangiomatosis. This process requires close monitoring in order to rule out possible complications (AU)

Talón negro (hematoma subcórneo) / Black heel (subcorneal hematoma)

El talón negro es un proceso relativamente frecuente, caracterizado por la aparición de una lesión negra en la zona de apoyo del talón, que aparece en jóvenes deportistas. Está provocado por pequeños traumatismos que pueden dar lugar a hemorragias superficiales. Su interés patológico radica en la posible confusión con lesiones pigmentarias de estirpe melanocítica, lo que puede originar cierto grado de alarma. El diagnóstico es fácil de realizar y puede llevarse a cabo por el simple raspado de la lesión o mediante el examen con dermatoscopio(AU)

Black heel, or talon noir, is a relatively common condition, especially in young athletes, that is characterized by the development of a black lesion on the part of the heel that is subjected to pressure. It is caused by the rupture of tiny blood vessels and can lead to bruising. It is of interest because of the possible confusion with pigmented melanocytic lesions, a circumstance that can give rise to a certain degree of alarm. The diagnosis is easy to perform and can consist of simple scraping of the lesion or a dermoscopic examination(AU)

[Effects of HIV status and other variables on the outcome of tuberculosis treatment in Spain]. / Efectos del VIH y otras variables sobre el resultado del tratamiento antituberculoso en España.

OBJECTIVE: To analyze the effect of human immunodeficiency virus (HIV) status and other variables on the outcome of tuberculosis treatment in Spain. PATIENTS AND METHODS: Multicenter retrospective cohort study in 6 autonomous communities of Spain (from May 1996 to April 1997). Data on treatment outcome were collected for new cases of tuberculosis in accordance with European guidelines. Follow up of patients continued for 3 months after scheduled end of treatment. RESULTS: Of the 4899 patients included, 3417 (69.7%) had a satisfactory outcome, 438 (8.9%) died before or during treatment, and 1044 (21.4%) had a potentially unsatisfactory outcome. On stratification by HIV status, satisfactory outcome, mortality, and potentially unsatisfactory outcome were reported for 43.4%, 21.5%, and 35.1%, respectively, of HIV-positive patients; 71%, 6.2%, and 22.8%, respectively, of HIV-negative patients; and 74.3%, 7.5%, and 18.2%, respectively, of patients with no HIV status available. HIV modified the effect of several variables on the outcome of treatment, and so separate logistic regression models for each HIV category were constructed. Among HIV-positive patients, mortality increased in patients with neoplastic disease and in users of drugs by nonintravenous routes of administration, whereas potentially unsatisfactory outcomes increased in intravenous drug users and in women. CONCLUSIONS: In Spain, the outcome of tuberculosis treatment is much worse in HIV-positive patients. Drug use and presence of neoplastic disease substantially affect mortality.

Acrokeratosis paraneoplastica: Bazex syndrome.

Bazex syndrome is a paraneoplastic dermatosis characterized by acral psoriasiform lesions associated with an underlying neoplasm. We present the case of a 64-year-old patient that was diagnosed with squamous cell lung carcinoma after being evaluated for lesions compatible with paraneoplastic acrokeratosis. With a high frequency Bazex syndrome is the earliest marker of an underlying subclinical neoplasm. An early suspicion is of the outmost importance in order to perform a prompt diagnosis of an underlying malignancy. We propose a diagnostic algorithm upon suspicion of acrokeratosis paraneoplastica and review the pathogenesis of this entity.

Cutaneous necrosis induced by acenocoumarol.

Cutaneous necrosis is an infrequent but well-documented complication of oral anticoagulants. In the pathogenesis of cutaneous necrosis induced by oral anticoagulants recent hypotheses favour the combined role of local factors and a transient unbalance of coagulation mechanisms leading to an hypercoagulable state. There exists a genetic factor that determines a decreased level of two vitamin-K dependent glycoproteins, namely protein C and protein S. We present the case of an obese woman that developed an extensive cutaneous necrosis while receiving acenocoumarol for a deep venous thrombosis. She had an heterozygous deficit for protein C. The histopathologic findings of vessel thrombi and red blood cell extravasation were consistent with the clinical picture. A biopsy specimen taken from an initial lesion disclosed images of leucocytoclastic vasculitis. We reviewed the literature focusing on the pathogenesis and the histopathology of the disease.

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Liquen escleroatrófico vulvar / Vulvar lichen sclerosus et atrophicus

El liquen escleroatrófico vulvar (LEV) infantil es una enfermedad inflamatoria de etiología desconocida que se acompaña de prurito y escozor en la vulva junto con lesiones erosivas vulvares. Debe diferenciarse de otras enfermedades, como la vulvitis irritativa consecutiva al rascado que puede acompañar a otros procesos como la dermatitis atópica o psoriasis, y también deben descartarse enfermedades infecciosas. El diagnóstico se basa en la clínica y se apoya en la histopatología del proceso. El pronóstico es excelente y el cuadro suele remitir en la pubertad. El tratamiento de elección es la aplicación de cremas de corticoides potentes con lo que se consigue la resolución de las lesiones (AU)