Efluvio en línea de aparición inmediata asociado a trasplante capilar de alta densidad: descripción de 28 casos / Immediate-Onset Linear Effluvium Associated With High-Density Hair Transplantation: A Series of 28 Cases

Describimos 28 pacientes que desarrollaron una forma de efluvio postrasplante capilar con características no descritas en la literatura: a) morfología lineal; b) aparición inmediata (1-3 días); c) asociación con ‘dense packing’ en entradas (‘signo de Mickey Mouse’); d) progresión del diámetro de la línea (patrón ‘wave-like’); e) posible adición posterior de efluvio lineal concéntrico a vértex (‘signo del Donut’), y f) además de otros efluvios tampoco publicados por su inmediatez de aparición. La morfología lineal podría ser el resultado de la alta densidad colocada en nuestros pacientes, provocando hipoxia perilesional y efluvio de las unidades foliculares miniaturizadas que rodean la zona receptora. Debido a que la línea alopécica provoca inseguridad a los pacientes sobre una posible no colocación de injertos, recomendamos iconografía postoperatoria inmediata demostrando unión de áreas trasplantada y no trasplantada, así como la explicación previa al paciente de este fenómeno transitorio y completamente reversible en 3 meses (AU)

We describe 28 patients who experienced effluvium with previously unreported features shortly after hair transplant surgery. Notable features were as follows: a) a linear morphology; b) immediate onset (1-3 days); c) association with dense-pack grafting in areas of receding hairline at the temples (Mickey Mouse pattern); d) a progressive increase in the diameter of the hair loss line (wave-like pattern); e) in some cases, subsequent concentric linear effluvium on the crown (donut pattern); and f) other forms of previously unreported immediate-onset effluvium. The linear morphology could be the result of dense packing, which can cause perilesional hypoxia and loss of miniaturized hairs around the recipient area. Since linear hair loss can cause patient concern about graft failure, we recommend taking images of transplanted and nontransplanted areas immediately after surgery and warning patients in advance about these transient effects, which are fully reversed in 3 months (AU)

[Translated article] Immediate-Onset Linear Effluvium Associated With High-Density Hair Transplantation: A Series of 28 Case / Efluvio en línea de aparición inmediata asociado a trasplante capilar de alta densidad: descripción de 28 casos

We describe 28 patients who experienced effluvium with previously unreported features shortly after hair transplant surgery. Notable features were as follows: a) a linear morphology; b) immediate onset (1-3 days); c) association with dense-pack grafting in areas of receding hairline at the temples (Mickey Mouse pattern); d) a progressive increase in the diameter of the hair loss line (wave-like pattern); e) in some cases, subsequent concentric linear effluvium on the crown (donut pattern); and f) other forms of previously unreported immediate-onset effluvium. The linear morphology could be the result of dense packing, which can cause perilesional hypoxia and loss of miniaturized hairs around the recipient area. Since linear hair loss can cause patient concern about graft failure, we recommend taking images of transplanted and nontransplanted areas immediately after surgery and warning patients in advance about these transient effects, which are fully reversed in 3 months (AU)

Describimos 28 pacientes que desarrollaron una forma de efluvio postrasplante capilar con características no descritas en la literatura: a) morfología lineal; b) aparición inmediata (1-3 días); c) asociación con ‘dense packing’ en entradas (‘signo de Mickey Mouse’); d) progresión del diámetro de la línea (patrón ‘wave-like’); e) posible adición posterior de efluvio lineal concéntrico a vértex (‘signo del Donut’), y f) además de otros efluvios tampoco publicados por su inmediatez de aparición. La morfología lineal podría ser el resultado de la alta densidad colocada en nuestros pacientes, provocando hipoxia perilesional y efluvio de las unidades foliculares miniaturizadas que rodean la zona receptora. Debido a que la línea alopécica provoca inseguridad a los pacientes sobre una posible no colocación de injertos, recomendamos iconografía postoperatoria inmediata demostrando unión de áreas trasplantada y no trasplantada, así como la explicación previa al paciente de este fenómeno transitorio y completamente reversible en 3 meses (AU)

Immediate-Onset Linear Effluvium Associated With High-Density Hair Transplantation: A Series of 28 Cases. / Efluvio en línea de aparición inmediata asociado a trasplante capilar de alta densidad: descripción de 28 casos.

We describe 28 patients who experienced effluvium with previously unreported features shortly after hair transplant surgery. Notable features were as follows: a) a linear morphology; b) immediate onset (1-3 days); c) association with dense-pack grafting in areas of receding hairline at the temples (Mickey Mouse pattern); d) a progressive increase in the diameter of the hair loss line (wave-like pattern); e) in some cases, subsequent concentric linear effluvium on the crown (donut pattern); and f) other forms of previously unreported immediate-onset effluvium. The linear morphology could be the result of dense packing, which can cause perilesional hypoxia and loss of miniaturized hairs around the recipient area. Since linear hair loss can cause patient concern about graft failure, we recommend taking images of transplanted and nontransplanted areas immediately after surgery and warning patients in advance about these transient effects, which are fully reversed in 3 months.

Electroquimioterapia en metástasis cutáneas de melanoma: experiencia en 31 casos / Electrochemotherapy in the treatment of melanoma skin metastases: a report on 31 cases

INTRODUCCIÓN Y OBJETIVOS: la electroquimioterapia (EQT) es una técnica terapéutica indicada en tumores cutáneos y subcutáneos no resecables quirúrgicamente. La EQT se fundamenta en la acción sinérgica de un fármaco antineoplásico junto con la electroporación de las membranas celulares para aumentar su citotoxicidad. El objetivo del presente estudio es objetivar la eficacia clínica, así como el perfil de seguridad de la EQT como tratamiento en pacientes con recidivas o metástasis cutáneas locorregionales de melanoma no abordables quirúrgicamente. MATERIAL Y MÉTODOS: Entre enero de 2007 y diciembre de 2012 se incluyeron 31 pacientes. Todos los tratamientos se realizaron siguiendo las guías de consenso European Standard Operating Procedures of Electrochemotherapy (ESOPE). La respuesta se calculó por paciente, obteniendo la media del conjunto de las lesiones. RESULTADOS: En el 49% de los casos se demostró una respuesta parcial y en el 23% se obtuvo una respuesta completa. Diecisiete pacientes mantuvieron la respuesta al año de seguimiento. En el 28% existió progresión de la enfermedad. Las complicaciones locales inmediatas (dolor, edema, eritema) fueron leves, y se resolvieron en las primeras 48 h en la mayoría de los casos. Ocho pacientes presentaron complicaciones locales posteriores, como ulceración y sobreinfección, secundarias a la necrosis de las lesiones y fueron controladas con tratamientos tópicos. CONCLUSIONES: La EQT presenta un excelente perfil de eficacia, eficiencia y seguridad, siendo de gran utilidad en el control de la enfermedad locorregional avanzada en el melanoma en lesiones no resecables quirúrgicamente

INTRODUCTION AND OBJECTIVES: electrochemotherapy is indicated for the treatment of unresectable cutaneous and subcutaneous tumors. The technique involves the synergistic use of electroporation of cell membranes to increase the cytotoxicity of anticancer drugs delivered to the tumor cells. The aim of this study was to analyze the clinical effectiveness and safety of electrochemotherapy in the treatment of unresectable locoregional recurrent or metastatic melanomas. MATERIAL AND METHODS: We studied 31 patients treated between January 2007 and December 2012. The European Standard Operating Procedures of Electrochemotherapy (ESOPE) were applied in all cases. Treatment response was analyzed as overall patient response (mean response based on results for all lesions treated in a given patient). RESULTS: Response was classified as partial in 49% of patients and complete in 23%. At 1 year, the level of response achieved had been maintained in 17 patients. Disease progression was observed in 28% of the series. Immediate local complications (pain, swelling, erythema) were mild and resolved within 48 hours in most cases. Eight patients developed subsequent local complications, such as ulcers and secondary infections associated with necrosis of the lesions. These complications were brought under control with topical treatments. CONCLUSIONS: Electrochemotherapy is a very effective, safe, and efficient treatment for advanced locoregional disease in patients with unresectable melanoma lesions

Electrochemotherapy in the treatment of melanoma skin metastases: a report on 31 cases.

INTRODUCTION AND OBJECTIVES: Electrochemotherapy is indicated for the treatment of unresectable cutaneous and subcutaneous tumors. The technique involves the synergistic use of electroporation of cell membranes to increase the cytotoxicity of anticancer drugs delivered to the tumor cells. The aim of this study was to analyze the clinical effectiveness and safety of electrochemotherapy in the treatment of unresectable locoregional recurrent or metastatic melanomas. MATERIAL AND METHODS: We studied 31 patients treated between January 2007 and December 2012. The European Standard Operating Procedures of Electrochemotherapy (ESOPE) were applied in all cases. Treatment response was analyzed as overall patient response (mean response based on results for all lesions treated in a given patient). RESULTS: Response was classified as partial in 49% of patients and complete in 23%. At 1 year, the level of response achieved had been maintained in 17 patients. Disease progression was observed in 28% of the series. Immediate local complications (pain, swelling, erythema) were mild and resolved within 48hours in most cases. Eight patients developed subsequent local complications, such as ulcers and secondary infections associated with necrosis of the lesions. These complications were brought under control with topical treatments. CONCLUSIONS: Electrochemotherapy is a very effective, safe, and efficient treatment for advanced locoregional disease in patients with unresectable melanoma lesions.

Eczema herpeticum with herpetic folliculitis after bone marrow transplant under prophylactic acyclovir: are patients with underlying dermatologic disorders at higher risk?

We present an unreported coexistence: eczema herpeticum (EH) with histopathological findings of herpetic folliculitis (HF) after allogeneic bone marrow transplantation (BMT). A patient with atopic dermatitis (AD) underwent allogeneic BMT for idiopathic acquired aplastic anemia. She had been receiving cyclosporine (150 mg/12 h) and acyclovir (400 mg/12 h) for 6 months. A facial rash was observed, composed of monotonous erythematous, umbilicated papulo-vesicles and papulo-crusts <4 mm in size. The histopathological study showed herpetic cytopathic changes within the epidermis that extended into the hair follicle epithelium. Interestingly, microscopic HF has not previously been associated with post-transplant patients or EH. However, it is reasonable to hypothesize that the coexistence of these herpes simplex virus-related events may be underreported in the literature. Although further studies are necessary, we suggest that the prophylactic antiviral dose after BMT be enhanced in patients with underlying dermatologic diseases, especially in those with AD.