Split-face study comparing conventional MAL photodynamic therapy in multiple actinic keratosis with complete time vs. half-time red light LED conventional illumination.

BACKGROUND: Conventional photodynamic therapy (PDT) with methylaminolevulinic acid (MAL) and daylight PDT have demonstrated similar efficacy in the treatment of actinic keratosis (AK). The reason for the use of daylight is to reduce pain during illumination but daylight has the limitation of the weather conditions. The difference in the doses of red light applied between these two methods suggests that an intermediate dose with red light conventional illumination could be effective in PDT of AK. OBJECTIVE: To compare the efficiency of conventional MAL-PDT with half-time conventional red light illumination in patients with multiple AK. MATERIAL AND METHODS: Adult patients with more than five symmetrically distributed AK were selected. After randomization, one area was treated with conventional PDT (Aktilite® , 630 nm, 37 J/cm2 , 8 min), while the contralateral was illuminated half time (Aktilite® , 630 nm, 37 J/cm2 , 4 min). Patients evaluated pain in each different side. Patients were evaluated at baseline, 3 and 6 months after PDT treatment by a blinded dermatologist. A questionnaire to be done at home 24 h after completing treatment was deliver to the patients to evaluate any side-effects. RESULTS: A total of 774 lesions were treated, 385 with conventional PDT and 389 with half-time PDT (P > 0.05). Conventional PDT was 85% of complete response of AK (327/385) at 3 months, and half-time PDT was 82% (319/389). At 6 months, conventional PDT was 70% (268/385) of complete response and half-time PDT was 65% (252/389). Pain during illumination was significantly lower in the VAS with the half-time protocol with a mean of 5.59 (SD 1.48) vs. 6.41 (SD 1.66) in conventional PDT. No difference in adverse effects was found between protocols. CONCLUSION: Conventional PDT with half-time illumination in multiple actinic keratosis is as effective as complete time illumination and decreased pain significantly.

[Extracorporeal photopheresis in dermatology]. / Fotoféresis extracorpórea en Dermatología.

Extracorporeal photochemotherapy or photopheresis is an immunomodulatory therapy that combines leukapheresis with phototherapy. Blood from the patient is processed to give a leukocyte-rich plasma, which is then treated ex vivo with a photosensitizer and ultraviolet A radiation before reinfusion back into the patient. The exact mechanism of action of photopheresis has not been fully elucidated although it is thought that induction of leukocyte apoptosis and formation of dendritic cells is essential for the development of an immune response to pathogenic cells. Extracorporeal photophoresis was initially used for treating cutaneous T-cell lymphoma. Since then, in view of its efficacy and safety, it has been used in a number of cutaneous and noncutaneous diseases with uneven results, which can in part be explained by the different patient selection criteria, therapy regimens, and follow-up protocols used in different hospitals.

Fotoféresis extracorpórea en Dermatología / Extracorporeal Photopheresis in Dermatology

La fotoquimioterapia extracorpórea o fotoféresis es una terapia inmunomoduladora que combina la leucoféresis con la fototerapia. Después de la separación de un plasma rico en leucocitos, se administra ex vivo un fotosensibilizante junto con radiación ultravioleta A y posteriormente se reinfunde en el paciente. El mecanismo de acción exacto de la fotoféresis no se conoce completamente, aunque se piensa que la inducción de apoptosis de linfocitos y la formación de células dendríticas desempeña un papel fundamental en el desarrollo de una respuesta inmunológica contra las células patógenas. Esta terapia se utilizó inicialmente para el tratamiento del linfoma cutáneo de células T. Desde entonces, basándose en su eficacia y seguridad, se ha empleado en múltiples patologías tanto cutáneas como no cutáneas, con resultados variables. Los distintos centros han utilizado diferentes criterios de selección de pacientes, pautas de tratamiento y protocolos de monitorización, lo que podría contribuir a la diferencia de resultados (AU)

Extracorporeal photochemotherapy or photopheresis is an immunomodulatory therapy that combines leukapheresis with phototherapy. Blood from the patient is processed to give a leukocyte-rich plasma, which is then treated ex vivo with a photosensitizer and ultraviolet A radiation before reinfusion back into the patient. The exact mechanism of action of photopheresis has not been fully elucidated although it is thought that induction of leukocyte apoptosis and formation of dendritic cells is essential for the development of an immune response to pathogenic cells. Extracorporeal photophoresis was initially used for treating cutaneous T-cell lymphoma. Since then, in view of its efficacy and safety, it has been used in a number of cutaneous and noncutaneous diseases with uneven results, which can in part be explained by the different patient selection criteria, therapy regimens, and follow-up protocols used in different hospitals (AU)

Erupción cutánea tras toma de amoxicilina en paciente con fiebre y odinofagia / No disponible

No disponible

Prurito y erupción cutánea serpiginosa tras estancia en el Pirineo / Risk factor control in the hypertensive patients with chronic ischemic heart disease attended in cardiologic outpatient clinics. The CINHTIA study

No disponible

Síndrome CINCA: presentación de un caso con exacerbación febril de sus lesiones cutáneas / Exacerbation of skin lesions during fever in a patient with chronic infantile neurologic cutaneous articular syndrome

El síndrome CINCA (Chronic Infantile Neurologic Cutaneous Articular Syndrome) es una grave enfermedad inflamatoria sistémica crónica, de instauración temprana, que se caracteriza por afectación cutánea, articular y del sistema nervioso central (SNC). La clínica cutánea en forma de exantema urticariforme no pruriginoso es la primera en aparecer, siendo más o menos permanente con exacerbaciones que coinciden con brotes de fiebre, artritis y adenopatías. La biopsia de las lesiones cutáneas es muy variable, aunque destaca un infiltrado neutrofílico perivascular. El descubrimiento de mutaciones en el gen CIAS1, que codifica una proteína llamada criopirina, ha permitido añadir esta entidad al espectro de las enfermedades autoinflamatorias asociadas a criopirinas, junto con la urticaria familiar por frío y el síndrome de Muckle-Wells, implicando además nuevas opciones terapéuticas. Presentamos el caso de un varón diagnosticado de síndrome CINCA que presentó un brote de lesiones cutáneas dolorosas y fiebre, interpretándose éstas como una exacerbación de sus lesiones habituales durante un episodio febril (AU)

Chronic infantile neurologic cutaneous articular (CINCA) syndrome is a serious chronic systemic inflammatory disease that presents at a young age and that is characterized by skin, joint, and central nervous system disease. Skin symptoms are the first to appear, in the form of a longstanding non pruritic urticarial rash, with exacerbations coinciding with episodes of fever, arthritis, and enlarged lymph nodes. The findings of biopsy of skin lesions are extremely variable but characterized by perivascular neutrophilic infiltrate. With the discovery of mutations in the CIAS1 gene, which encodes a protein known as cryopyrin, this entity has been classified as one of the cryopyrin-associated autoinflammatory diseases, along with familial cold urticaria and Muckle-Wells syndrome. This discovery has also made available new therapeutic options. We present the case of a boy diagnosed with CINCA syndrome who presented with an outbreak of painful skin lesions and fever. These lesions were thought to be an exacerbation of underlying lesions during an episode of fever (AU)

[Exacerbation of skin lesions during fever in a patient with chronic infantile neurologic cutaneous articular (CINCA) syndrome]. / Síndrome CINCA: presentación de un caso con exacerbación febril de sus lesiones cutáneas.

Chronic infantile neurologic cutaneous articular (CINCA) syndrome is a serious chronic systemic inflammatory disease that presents at a young age and that is characterized by skin, joint, and central nervous system disease. Skin symptoms are the first to appear, in the form of a longstanding nonpruritic urticarial rash, with exacerbations coinciding with episodes of fever, arthritis, and enlarged lymph nodes. The findings of biopsy of skin lesions are extremely variable but characterized by perivascular neutrophilic infiltrate. With the discovery of mutations in the CIAS1 gene, which encodes a protein known as cryopyrin, this entity has been classified as one of the cryopyrin-associated autoinflammatory diseases, along with familial cold urticaria and Muckle-Wells syndrome. This discovery has also made available new therapeutic options. We present the case of a boy diagnosed with CINCA syndrome who presented with an outbreak of painful skin lesions and fever. These lesions were thought to be an exacerbation of underlying lesions during an episode of fever.

Pápula negruzca subungueal en viajero / Blackish subungual papule in a traveler

No disponible

Púrpura cérvico-facial / Facial-cervical purpura

No disponible

Tumoración indurada y asintomática de tres semanas de evolución en paciente con leucemia mieloide aguda / Indurated and asymptomatic tumor having 3 week course in patient with acute myeloid leukemia

No disponible

[Adult Still's disease with atypical skin manifestations]. / Enfermedad de Still del adulto con manifestaciones cutáneas atípicas.

Adult Still's disease (ASD) is an uncommon inflammatory disease of unknown etiology. It is characterized by the triad of intermittent high fever, evanescent rash and polyarthralgia or polyarthritis. We present the case of a 29-year-old woman with ASD and persistent erythematous papule on neck and upper part of the trunk. The presence of fixed lesions is not characteristic of ASD, but its appearance during development of the disease suggests that they are a manifestation of it. Recently, other skin manifestations of ASD have been published, but they are not well-known.

Enfermedad de Still del adulto con manifestaciones cutáneas atípicas / Adult still’s disease with atypical skin manifestations

La enfermedad de Still del adulto (ESA) es una enfermedad inflamatoria sistémica poco frecuente de etiología desconocida. Se caracteriza por la tríada de fiebre alta intermitente, rash evanescente y poliartralgia o poliartritis. Presentamos el caso de una mujer de 29 años con ESA y pápulas eritematosas persistentes en el cuello y la parte superior del tronco. La presencia de lesiones fijas no es característico de la ESA, pero su aparición durante el desarrollo de la enfermedad sugiere que son una manifestación de la misma. Recientemente otras manifestaciones cutáneas de la ESA han sido publicadas, pero no son bien conocidas

Adult Still's disease (ASD) is an uncommon inflammatory disease of unknown etiology. It is characterized by the triad of intermittent high fever, evanescent rash and polyarthralgia or polyarthritis. We present the case of a 29-year-old woman with ASD and persistent erythematous papule on neck and upper part of the trunk. The presence of fixed lesions is not characteristic of ASD, but its appearance during development of the disease suggests that they are a manifestation of it. Recently, other skin manifestations of ASD have been published, but they are not well-known

[Malignant syphilis in patients with human immunodeficiency virus (HIV)]. / Sífilis maligna en paciente infectado por el virus de la inmunodeficiencia humana (VIH).

Malignant or noduloulcerative syphilis is an infrequent variant of secondary syphilis which appears in HIV+ patients. It is associated with fever, general malaise and skin lesions in the form of pustules or ulcerative scabs. Histology studies on the lesions show a perivascular infiltration of plasma cells and a formation of granuloma of giant and epitheloid cells. Most patients test positive for syphilis. We discuss the case of a 37-yar-old man who attended our service complaining of fever and scabby nodular lesions all over his skin. Blood testing confirmed that he had syphilis and HIV. The patient responded rapidly to penicillin treatment, with remittance of his fever. The skin lesions disappeared after 8 weeks. The rareness of malignant syphilis and its unusual clinical manifestation is a challenge to medical personnel. This diagnosis ought to be considered in HIV+ patients with fever and ulcerative skin lesions. Penicillin is the treatment of choice.