Acrodermatitis Enteropathica: A Novel SLC39A4 Gene Mutation in a Patient with Normal Zinc Levels.

Acrodermatitis enteropathica (AE) is a rare disease that results from a defective gene, SLC39A4, and is characterized by dermatitis, alopecia, and diarrhea. We report a case of AE presenting with only periorificial and acral dermatitis in which genetic testing revealed two novel compound heterozygous missense mutations for SLC39A4. This case demonstrates that not all AE mutations alter zinc transporters in the same manner and highlights the phenotypic variability of AE.

Safety and efficacy comparison of minocycline microgranules vs lymecycline in the treatment of mild to moderate acne: randomized, evaluator-blinded, parallel, and prospective clinical trial for 8 weeks.

BACKGROUND: Minocycline and lymecycline are used in the treatment of acne, but there is not enough evidence to support superior efficacy of one of them. METHODS: 170 participants from 14 to 34 years old with mild to moderate facial acne vulgaris were recruited. 84 had 100 mg of minocycline in a single daily dose for 8 weeks and 86 had 300 mg of lymecycline in a single daily dose for 8 weeks. Participants were evaluated at baseline, week 4 and week 8. RESULTS: 65 minocycline and 60 lymecycline patients were evaluable. The last observation carried forward for the count of non-inflammatory lesions changed from 37.5 ± 17.8 to 37.7 ± 17.8 in the minocycline group and from 36.9 ± 15.5 to 33.4 ± 19.3 in the lymecycline group (no significant changes); corresponding changes in inflammatory lesions were from 19.4 ± 12.4 to 12.2 ± 10.0 in the minocycline group and from 20.1 ± 11.3 to 12.6 ± 8.4 in lymecycline group (P< 0.05 comparing baseline vs. final in both groups). Porphyrin counts varied from 899.5 ± 613.9 to 233.5 ± 219.5 in the minocycline group and from 956.9 ± 661.8 to 411.8 ± 411.5 in the lymecycline group (P<0.05 between the groups at study end). 36 (42.9%) patients receiving minocycline suffered 55 adverse events (22 of them gastrointestinal), while 28 (33.3%) lymecycline patients had 37 adverse events (15 of them gastrointestinal). One patient in the lymecycline group withdrew the study due to gastritis, and one more patient in the same group experienced eosinophilia. CONCLUSIONS: There were no differences between the groups in non-inflammatory and inflammatory lesion counts, and in the safety profile. Treatment with minocycline induced statistically significant decrease in facial porphyrin counts compared to the group treated with lymecycline (ClinicalTrials.gov number, NCT00988026).

Role of the ACTH test and estimation of a safe dose for high potency steroids in vitiligo: A prospective randomized study.

BACKGROUND: Topical corticosteroids are used as first line of therapy for vitiligo, although side effects such as adrenal insufficiency are possible. OBJECTIVES: To establish the role of ACTH test before, during, and after treatment with high potency topical steroids; to determine if adrenal insufficiency occurs secondary to the use of high potency topical steroids in patients with vitiligo and intact cutaneous barrier; and also to determine response to treatment and side effects. MATERIALS AND METHODS: Forty-four adults with non-segmental vitiligo affecting 20% or less of the body surface area were included and randomized to receive topical clobetasol propionate 0.05% cream (group 1) or placebo (group 2) for 12 weeks, with a maximum dose of 50 g per week. The placebo group was crossed over after week 6 and started on clobetasol until completion of the study. Serum cortisol levels with the 1 µg ACTH test were determined at baseline and on weeks 6 and 12. RESULTS: No adrenal insufficiency was detected nor statistical significance was achieved when comparing cortisol levels between and within the groups at baseline and weeks 6 and 12. Group 1 had a better response to therapy but with more side effects. CONCLUSIONS: Doses of 50 g or less per week of clobetasol during a period of 12 weeks are safe on adult vitiligo patients, although local side effects are possible. Repigmentation rates were incomplete with single steroid therapy, making combined therapy a better option.

Could cryosurgery be an alternative treatment for basal cell carcinoma of the vulva?

Basal cell carcinomas (BCC) on the genital area account for less than 1% of all BCCs. Surgical management is indicated. Recurrence rate of vulvar BCC has been reported to be 10-20%. Mohs micrographic surgery (MMS) is a superior surgical option. Other treatments include radiation and topical immuntherapy. Cryosurgery for vulvar BCC has not been reported. We present the case of a 88-year-old Hispanic woman with a vulvar ulcer that was confirmed as BCC by histopathology and treated with liquid nitrogen cryosurgery. Control biopsy was performed on day 90 was negative for BCC. No clinical evidence of recurrence was detected after one year. Although, the vulva is considered to be a high-risk site with respect to BCC and MMS is the gold standard for treatment, the delicate nature of the area may preclude complete removal by a surgical technique without compromising vital anatomical function. Liquid nitrogen cryosurgery uses the effects of extreme cold to effect deep destruction of the tumor and surrounding tissues. This is the first report of a vulvar BCC successfully treated with liquid nitrogen cryosurgery. We suggest this technique could be of benefit as an alternative treatment in cases where excisional procedures cannot be performed.

[Cutaneous melanoma]. / Melanoma cutáneo.

Cutaneous melanoma is the most malignant skin tumor with great potential to develop metastases. For 50 years, its incidence has greatly increased worldwide, including Mexico. Although some risk factors are known, early diagnosis and treatment are still the only strategies that have shown to improve prognosis. Management of cutaneous melanoma is still a challenge. In this article we present a review and update of cutaneous melanoma, its epidemiology, etiology, risk factors, classification, diagnosis criteria, relevance of the sentinel node, management, treatment, and prevention.