Terapia fotodinámica con metil aminolevulinato y ácido 5-aminolevulínico en acné inflamatorio leve y moderado: experiencia clínica / Photodynamic therapy with 5-aminolevulinic acid and methyl aminolevulinate for mild to moderate inflammatory acne: clinical experience

Introducción: La terapia fotodinámica (TFD) con ácido 5-aminolevulínico (ALA) y metil aminolevulinato (MAL) ha mostrado utilidad en el manejo del acné inflamatorio. Métodos: Dos grupos de cuatro pacientes cada uno, portadores de acné inflamatorio leve o moderado. Se realizaron dos sesiones de TFD separadas por dos semanas: un grupo fue tratado con MAL y luz roja y el otro, con ALA y luz azul. Se midió la severidad del acné con escala de 6 puntos y se consideró éxito clínico los grados 0 y 1. Resultados: En ambos grupos se observó éxito clínico a las 12 semanas post tratamiento, quedando con pigmentación residual, escasos comedones y menos de 10 pápulas. Se observaron efectos adversos tolerables, siendo los más importantes el eritema y la descamación. Conclusión: La TFD con ALA y MAL es una buena alternativa terapéutica para aquellos pacientes con acné inflamatorio leve y moderado que no responden o tienen contraindicación a los tratamientos convencionales.

Introduction: Photodynamic therapy with methyl aminolevulinate (MAL) and 5-aminolevulinic acid (ALA) has shown to be useful in the management of inflammatory acne. Methods: Two groups of 4 patients each with mild to moderate inflammatory acne. Two PDT sessions were performed within a 2 week interval; one group was treated with MAL and red light, and the other with ALA and blue light. Acne severity was measured with a 6-point scale and clinical success was considered between grades 0 and 1. Results: In both groups, clinical success was observed at 12 weeks post treatment, leaving residual pigmentation, scarce comedones and less than 10 papules. Tolerable side effects were observed, being the most important erythema and desquamation. Conclusion: PDT with ALA and MAL is a good therapeutic option for patients with mild to moderate inflammatory acne who do not respond or have contraindications to conventional treatments.

Queratosis folicular invertida pigmentada: a propósito de un caso: [revisión] / Inverted follicular keratosis: a case report: [review]

La queratosis folicular invertida (QFI) es una lesión benigna del infundíbulo folicular. Es poco frecuente y habitualmente el diagnostico es histopatológico. Clínicamente no presenta características propias ni patognomónicas, por lo que generalmente semeja otras lesiones proliferativas de la piel, como las verrugas, el carcinoma basocelular, las queratosis seborreicas y otros tumores benignos. La forma pigmentada es infrecuente y suele confundirse con melanoma. La queratosis folicular invertida es una entidad de histogénesis controvertida, proponiéndose como alternativas que sea una neoplasia benigna con diferenciación folicular, una variante de verruga vulgar o una queratosis seborreica irritada. El tratamiento de la queratosis folicular invertida es la extirpación completa de la lesión, con un excelente pronóstico, casi sin recurrencias.

Inverted follicular keratosis (IFK) is a benign lesion of follicular infundibulum. It is rare, and diagnosis is usually histopathological. Clinically, it is unique, with no pathognomonic characteristics and therefore often resembles other skin proliferative lesions such as warts, basal cell carcinoma, seborrheic keratoses and other benign tumors. The pigmented form is rare and often confused with melanoma. Inverted follicular keratosis is an entity of controversial histogenesis, alternatively considered as a benign neoplasm with follicular differentiation, a variant of vulgaris warts or irritated seborrheic keratoses. Treatment for inverted follicular keratosis is the complete removal of the lesion, with excellent prognosis, almost without recurrence.

Trastorno dismórfico corporal / Body dysmorphic disorder

Anteriormente llamado dismorfofobia, el trastorno dismórfico corporal (TDC) se define como la preocupación excesiva y desproporcionada por un defecto mínimo o imaginario en la apariencia física. El defecto generalmente se encuentra en la cara, aunque puede ser en cualquier parte del cuerpo. Es una enfermedad de mal pronóstico que remite raramente de forma completa y provoca un deterioro en la vida del paciente, el cual demanda constantemente soluciones médicas o quirúrgicas; sin embargo, si es oportunamente sospechada y tratada, tiene un curso más favorable. Estos pacientes frecuentemente consultan a dermatólogos y cirujanos plásticos, con la idea de mejorar sus defectos físicos. Su trastorno psiquiátrico habitualmente es subdiagnosticado, lo que puede desencadenar una acción iatrogénica e incluso consecuencias médico-legales.

Formerly called dysmorphophobia, body dysmorphic disorder (BDD) is defined as the exaggerated, out of proportion preoccupation with the slightest or imaginary defect of the body s appearance. The defect is normally found on the face, although it can also be present in any part of the body. The prognosis for this condition is poor, and rarely goes entirely into remission, deteriorating the patient s quality of life. Those who suffer from this syndrome demand medical or surgical solutions. However, if early diagnosis and treatment are made the course of the disease may improve. Patients frequently seek dermatologists and plastic surgeons consultation to overcome these defects. Psychiatric disorders are commonly under-diagnosed and may lead to atrogenic actions, and possible legal consequences.

[Systemic inflammatory response syndrome: is it comparable with severe sepsis?]. / Síndrome de respuesta inflamatoria sistémica severa: es comparable a la sepsis severa?

BACKGROUND: In 1992, a consensus conference defined the terms systemic inflammatory response syndrome (SIRS), sepsis, severe sepsis and septic shock. Since then, numerous reports have validated the prognostic usefulness of these operative definitions. AIM: To evaluate if sepsis severity criteria, as defined by the Consensus Conference, can be applied to noninfectious SIRS. PATIENTS AND METHODS: Five hundred eighteen patients admitted to 5 intensive care units (ICU) from 4 hospitals were prospectively evaluated during a 3 months period. Patients that met at least one severity criteria were included. SIRS etiology, organ dysfunction and evolution were recorded in each patient. RESULTS: One hundred two patients were included: 79 with sepsis (group I) and 23 with noninfectious SIRS (group II). ICU and hospital mortality were comparable (43 and 48% in sepsis compared to 43 and 51% in non infectious SIRS). The most common sources of sepsis were pneumonia and peritonitis. Group II patients had a wide variety of diseases. ICU stay, APACHE score and number of organs with dysfunction were not different among groups. Only the incidence of renal dysfunction was higher in the septic group. CONCLUSIONS: The Consensus sepsis severity criteria can be applied to noninfectious SIRS, defining a population subset with similar high mortality and organ dysfunction incidence, although with greatly heterogeneous etiologies.