International eDelphi Study to Reach Consensus on the Methotrexate Dosing Regimen in Patients With Psoriasis.

Importance: A clear dosing regimen for methotrexate in psoriasis is lacking, and this might lead to a suboptimal treatment. Because methotrexate is affordable and globally available, a uniform dosing regimen could potentially optimize the treatment of patients with psoriasis worldwide. Objective: To reach international consensus among psoriasis experts on a uniform dosing regimen for treatment with methotrexate in adult and pediatric patients with psoriasis and identify potential future research topics. Design, Setting, and Participants: Between September 2020 and March 2021, a survey study with a modified eDelphi procedure that was developed and distributed by the Amsterdam University Medical Center and completed by 180 participants worldwide (55 [30.6%] resided in non-Western countries) was conducted in 3 rounds. The proposals on which no consensus was reached were discussed in a conference meeting (June 2021). Participants voted on 21 proposals with a 9-point scale (1-3 disagree, 4-6 neither agree nor disagree, 7-9 agree) and were recruited through the Skin Inflammation and Psoriasis International Network and European Academy of Dermatology and Venereology in June 2020. Apart from being a dermatologist/dermatology resident, there were no specific criteria for participation in the survey. The participants worked mainly at a university hospital (97 [53.9%]) and were experienced in treating patients with psoriasis with methotrexate (163 [91.6%] had more than 10 years of experience). Main Outcomes and Measures: In a survey with eDelphi procedure, we tried to reach consensus on 21 proposals. Consensus was defined as less than 15% voting disagree (1-3). For the consensus meeting, consensus was defined as less than 30% voting disagree. Results: Of 251 participants, 180 (71.7%) completed all 3 survey rounds, and 58 participants (23.1%) joined the conference meeting. Consensus was achieved on 11 proposals in round 1, 3 proposals in round 2, and 2 proposals in round 3. In the consensus meeting, consensus was achieved on 4 proposals. More research is needed, especially for the proposals on folic acid and the dosing of methotrexate for treating subpopulations such as children and vulnerable patients. Conclusions and Relevance: In this eDelphi consensus study, consensus was reached on 20 of 21 proposals involving methotrexate dosing in patients with psoriasis. This consensus may potentially be used to harmonize the treatment with methotrexate in patients with psoriasis.

Real world prescription trends of methotrexate for psoriasis in Argentina: results of a national survey.

OBJECTIVE: To describe dermatologists' methotrexate (MTX) prescription trends for the treatment of psoriasis, and to identify variables associated with suboptimal MTX use. METHODS: Cross-sectional study of dermatologists from Argentina who completed a pre-designed survey focussed on MTX prescription characteristics. A multiple logistic regression model was used to identify variables independently associated with suboptimal MTX use (when less than 12 weeks and less than 15 mg/week were administrated in patients with monotherapy before discontinuing or adding a second drug). RESULTS: Two hundred and twenty-one dermatologists participated in the study. Median time of practice in dermatology: 10 (IQR 3-15) years. MTX initial dose: 2.5-7.5, 10-15 and 20-30 mg/week in 52%, 41% and 7% of the participants, respectively. Suboptimal MTX use was observed in 76% of the participants. Thirty per cent of the participants responded that they considered MTX to be an ineffective drug. The only variable that was independently associated with suboptimal MTX use was the prescriber's personal consideration of MTX to be an ineffective drug (OR 2.29; 95%CI 1.05-5.00). CONCLUSION: A wide heterogeneity in the prescribing profile of MTX for the treatment of psoriasis was observed among Argentinean dermatologists. Suboptimal MTX use was identified in the majority of the prescribers.

Histoplasmosis diseminada subaguda en el contexto de VIH y porfiria cutánea tarda. A Propósito de un caso / Subacute disseminated histoplasmosis in a patient with HIV and porphyria cutanea tarda. A case report

La histoplasmosis es una micosis sistémica endémica en la República Argentina.Es la infección micótica profunda más ampliamente extendida en el mundo. Se ha convertido en una infección oportunista cada vez más frecuente entre los pacientes con un sistema inmune deteriorado por agentes farmacológicos o por el virus de la inmunodeficiencia humana (VIH).Presentamos un caso de histoplasmosis diseminada subaguda en un paciente con antecedentes de Porfiria Cutánea Tarda(PCT) e infección por VIH que representó un desafío diagnóstico dado a la similitud de las lesiones de histoplasmosis con PCT.

Histoplasmosis is a deep fungal endemic infection in Argentina and world widely. It has become an opportunistic infectionincreasingly among patients with an impaired immune system due to pharmacological agents or HIV.A case of subacute disseminated histoplasmosis in a patient with a history of HIV and Porphyria Cutanea Tarda (PCT), representinga diagnostic challenge by the similar clinical appearance between histoplasmosis and PCT lesions is reported.

[Linear lichen planopilaris of the face]. / Liquen Plano Pilar lineal de la cara.

Linear lichen planopilaris of the face is a rare variant of lichen plano- pilaris. Asymptomatic follicular papules in a linear configuration are the characteristic clinical features. The incidence is still unknown, but there are a few cases reported exclusively in male adults. We present the case of a fourteen-year-old girl with linear lichen planopilaris of the face. Improvement was obtained with the use of tacrolimus 0.03 percent ointment.

Paraqueratosis granular: descripción de un caso y revisión de la literatura / Granular parakeratosis, report of a case and review of the literatura

La paraqueratosis granular es una dermatosis de probable etiología reaccional descripta en la última década. Se presenta como pápulas hiperqueratósicas y eritematosas que confluyen formando placas de aspecto reticulado. Predomina en mujeres de entre 50 y 60 años, en zona de pliegues, particularmente axilares. Comunicamos un caso de paraqueratosis granular axilar, el primero dentro de la literatura médica argentina, y revisamos la bibliografía sobre el tema.

Granular parakeratosis is a cutaneous eruption probably due to a re-active mechanism described during the past decade. It has hyper-keratotic erythematous papules that coalesce into reticular plaques.Women are mostly affected, in their 5th to 6th decade, with a prefer-ence for axillary folds. This is the first report of a patient a with axillarygranular parakeratosis in Argentina, and review the medical literature on this condition.

Dermatomiositis paraneoplásica asociada a carcinoma de células pequeñas de pulmón: a propósito de un caso / Paraneoplastic dermatomysitis associated with small cell lung carcinoma: case report

La dermatomiositis es una rara enfermedad autoinmune que afecta principalmente músculos estriado y piel. Su causa es habitualmente desconocida pero en algunas oportunidades puede estar asociada a diversas neoplasias internas. Presentamos un paciente con dermatomiositis asociada a carcinoma de células pequeñas de pulmón.

Carcinoma de células de Merkel: estudio de 5 casos / Merkel cell carcinoma: study of five cases

El carcinoma de células de Merkel (CCM) es un tumor maligno infrecuente, localmente agresivo, con tendencia a dar metástasis ganglionares y a distancia, La ultraestructura y la inmunohistoquímica son similares al de las células neuroendocrinas. Su etiopatogenia se desconoce, pero se ha comunicado su asociación con otros tumores epiteliales, y recientemente se ha demostrado la replicación de un virus en su interior. Los factores de riesgo se caracterizan clínicamente con el acrónimo AEIOU. Se comunican 5 casos de pacientes con CCM, diagnosticados en los últimos 15 años en nuestro Servicio de Dermatología. Se realizó una revisión de la literatura, con análisis de las características clínicas, el tratamiento y la evolución. Nuestra experiencia coincide con lo publicado: observamos un aumento de la incidencia, la edad y la inmunosupresión como factores predisponentes, la asociación con carcinoma espinoso insitu, la involución tumoral en un caso y la mortalidad, que depende de la extensión tumoral en el momento del diagnóstico.

Merkel-cell carcinoma (MCC) is a rare malignant tumor, locally aggres-sive, that tends to metastasize to lymph nodes and distant sites, whosecells resemble neuroendocrine cells in both ultrastructure and immu-nohistochemistry. Its etiology is unknown, but an association with oth-er epithelial tumors, and recently, the presence of virus replication within the tumor has been reported. The risk factors are characterized clinically with the acronym: AEIOU. We communicate fi ve patients with MCC, diagnosed during the last 15 years in our Department of Dermatology. We reviewed the literature and analyzed the clinical features, treatments and outcome. Our findings agree with what has been published elsewhere: an incidence on the rise; age and immunosuppression as risk factors; its association within situ squamous-cell carcinoma; tumor regression in one patient, and a mortality rate that depends on the size of the tumor at the time of diagnosis.

Atypical leiomyoma: An unusual variant of cutaneous pilar leiomyoma.

Cutaneous atypical leiomyoma is an unusual benign tumor arising from arrector pili muscle that shares histological features with uterine atypical or symplastic leiomyoma: atypical cellularity with pleomorphic nuclei but minimal or no mitosis. Six other cases have been reported so far and, in spite of its name and of being a smooth muscle proliferation, no recurrences nor metastasis have been reported.

Síndrome trófico trigeminal: una causa infrecuente de úlceras faciales / Trigeminal trophic syndrome: a rare cause of facial ulceration

El síndrome trófico trigeminal (SST) es una rara causa de úlceras crónicas en cara. Se presenta con una tríada característica de úlceras faciales, parestesias y anestesia del área inervada por el nervio trigémino. Representa un doble desafío: diagnóstico, por la cantidad de diagnósticos diferenciales, y terapéuticos, por ser de muy difícil resolución. Se presenta un paciente de sexo masculino, con antecedentes de accidentes cerebrovascular con secula facial y ulceras correspondientes a este síndrome.

Dermatofibrosarcoma protuberans: comunicación de un caso y revisión de la literatura / Dermatofibrosarcoma protuberans: case report and literature review

El dermatofibrosarcoma protuberans (DFSP) es un tumor raro, de origen fibrohistiocítico y malignidad intermedia, caracterizado por su crecimiento local progresivo y su alta tasa de recidivas locales con bajo potencial metastásico. Afecta principalmente a adultos entres los 20 y 50 años, pero también se presentan casos en la niñez. Se localiza más frecuentemente en el tronco y raíz de miembros y menos del 5% de los casos afecta cuero cabelludo. Se presenta el caso de un varón de 20 años con un dermatofibrosarcoma protuberans en región frontoparietal izquierda con compromiso del cuero cabelludo, al que se le realizó tratamiento cirugía micrográfica de Mohs y se realiza una revisión de la literatura.

Psoriasis: comorbilidades en nuestra población / Psoriasis: comorbidities in our community

Introducción. La psoriasis es una enfermedad inmunológica e inflamatoria crónica que afecta la piel, uñas y articulaciones. Su incidencia varía del 2 al 4%. Los avances en el conocimiento han llevado a comprender su carácter inflamatorio sistémico. Diversos estudios demostraron una mayor asociación con algunas comorbilidades como insulinorresistencia, obesidad, hipertensión arterial y dislipidemias, así como mayor incidencia de neoplasias y enfermedades autoinmunes. Objetivo. Analizar si las comorbilidades descriptas están presentes en los pacientes del consultorio de la Sección de Psoriasis de nuestro hospital. Materiales y métodos. Se revisaron retrospectivamente las historias clínicas de 120 pacientes en seguimiento por la Sección de Psoriasis del Hospital Churruca. Se tomaron en cuenta sexo, edad, tiempo de evolución de la enfermedad, antecedentes familiares y personales, tratamientos realizados y estudios de laboratorio. Resultados. De los 120 pacientes, 44 fueron mujeres y 76 varones, con edades entre 6 y 87 años y una media de 46,5. De estos, el 54,5% de las mujeres y el 48,6% de los hombres presentaron artralgias. Con respecto a los valores de laboratorio, 71 pacientes presentaron algún tipo de alteración en el metabolismo de los carbohidratos y, de estos, sólo 12 tenían diagnóstico previo de diabetes. Noventa y dos pacientes presentaron alguna alteración lipídica (colesterol total aumentado: 56 pacientes; HDL disminuido: 58 pacientes; LDL aumentado: 45 pacientes; triglicéridos aumentados: 40 pacientes) y 12 pacientes presentaron alteraciones en todas las fracciones del lipidograma. Conclusiones. Resulta fundamental un enfoque integrador del paciente con psoriasis por lo que el dermatólogo debe conocer sus potenciales comorbilidades lo que permitirá la detección temprana y eventual derivación al especialista para el tratamiento apropiado.

Introduction. Psoriasis is a chronic, immunologic and inflammatory disea- se that aff ects the skin, the nails an the joints. Its incidence varies between 2 to 4%. Advances in the knowledge have allowed us to understand the sys- temic infl ammatory behavior of this disease. Many diff erent studies havde- monstrated that psoriasis has an ncreased association with some comorbi- dities such as insulin resistance, obesity, hypertension and dyslipidemias as well as a higher incidence of immune mediated disorders and malignancies. Aim. To analyze if the comorbidities previously described as associated psoriasis are present in the patients of our Hospital.Materials and methods. We reviewed the clinical records of 120 patients whose disease was controlled at the psoriasis clinic in our hospital. We took into account gender, age, personal and family history of psoria- sis, duration of the disease and previous treatments. Evaluation of gluco- se, insulin, lipids and thyroid functionbwere also performed. Results. Out of 120 patients, 44 were women and 76 males, whose ages ranged between 6 and 87 years (mean: 46,5 ys). Of these, 54,5% of the women and 48,6% of men presented articular pain. Seventy one patients presented some type of alteration in the carbohydrate metabolism, with only 12 patients with a history of diabetes. Ninety two patients presen- ted at least one type of alteration in their lipid metabolism. Fifty six pa- tients presented an increase in total cholesterol, 58 presented decreased HDL while 45 had increased LDL, and 40 presented hypertriglyceridemia. Twelve patients showed alterations in all types of lipids. Conclusions. Dermatologists must keep in mind that he will likely be the only physician these patients consult, giving them a fundamental role in the early detection of the potential comorbidities and the likely consul- tation to the pertinent specialist (Dermatol Argent 2009;15(5):340-343).