En IBderma nos preocupamos por su piel.
En los siguientes apartados encontrara informacion relevante sobre distintas enfermedades de la piel y de los tratamientos que le ofrecemos en IBDERMA.
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Noticias de actualidad de Dermatología en diversos medios de Comunicación.
- Displaying 20 most recent entries.
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A comparison of sunburn protection of high–sun protection factor (SPF) sunscreens: SPF 85 sunscreen is significantly more protective than SPF 50 |
1 Feb 2010
To the Editor: On August 27, 2007, the US Food and Drug Administration (FDA) released a proposed amendment to the 1999 sunscreen monograph. An important aspect of this amendment is that the FDA has proposed that manufacturers label their products with a specific sun protection factor (SPF) value up to 50; sunscreens with SPFs >50 would be labeled as 50+. We conducted a double-blind, randomized, split-face clinical study to evaluate whether a statistically significant difference exists between the sunburn protective effects of a SPF 50 sunscreen versus a SPF 85 formulation. -
Botox and Dysport: Is there a dose conversion ratio in dermatology and aesthetic medicine? |
1 Feb 2010
To the Editor: The use of botulinum neurotoxin A is the most frequent intervention in aesthetic medicine. Sales of the two main preparations—Botox (Allergan Inc, Irvine, CA) and Dysport (Ipsen Ltd, Slough, Berkshire, UK)—amounted to USD $1 billion in 2007, and the trend is still growing. -
Analysis of alterations adjacent to invasive squamous cell carcinoma of the penis and their relationship with associated carcinoma |
1 Feb 2010
Background: In contrast to vulvar squamous cell carcinoma (SCC), the etiologic factors and precancerous lesions associated with penile carcinoma remain uncertain.Objectives: To describe the morphologic features of lesions adjacent to invasive penile SCC and their relationship with the associated carcinoma and to compare these associations with vulvar carcinoma.Methods: This was a retrospective histologic analysis of 68 cases of penile SCC. Adjacent lesions were considered to be premalignant lesions. They were classified as penile intraepithelial neoplasia (PIN), squamous hyperplasia (SH), and lichen sclerosus (LS). PIN cases were divided into two subtypes depending on the extension of atypia throughout the epithelium and, by analogy, with the classification of the vulvar intraepithelial neoplasia (VIN). Thus they were designated as undifferentiated (or bowenoid) PIN, defined by full-thickness atypia throughout the epithelium, and differentiated PIN, characterized by atypia confined to the lower third of the epithelium. SCC subtypes were classified as usual, verrucous, warty (condylomatous), basaloid, and mixed.Results: Undifferentiated PIN was observed in 22 cases; LS was observed in 26 cases. Differentiated PIN and SH (except for two cases) were associated with underlying LS. Undifferentiated PIN was always associated with warty (condylomatous) (4 cases), basaloid (16 cases) or mixed SCC (2 cases), and LS with usual (19 cases) or verrucous SCC (7 cases).Limitations: This was a retrospective analysisConclusion: This study suggests that, similarly to vulvar carcinoma, penile SCC occurs in association with two types of penile lesions: undifferentiated (or bowenoid) PIN and LS-linked differentiated PIN and/or SH. It appears that the subtype of these carcinomas is related to these adjacent lesions. -
Congenital pigment synthesizing melanoma of the scalp |
1 Feb 2010
The pigment synthesizing melanoma, so-called animal type melanoma, is a rare variant of melanoma that is characterized by prominent melanin production and an unpredictable prognosis. Congenital onset of this melanoma is exceedingly rare. A 2-month-old Korean girl had a black nodule and a satellite black macule on the scalp which were noticed at birth. She received a surgical resection 3 months later because of rapidly growing lesions and the histopathologic features of a pigment synthesizing melanoma. Two months later, she returned with cervical area swelling, and the excised multiple lymph nodes showed metastatic malignant melanoma. The exact origin and pathogenesis of congenital pigment synthesizing melanoma is different from the more common forms of melanoma and remains poorly understood. -
Rapid improvement of nephrogenic systemic fibrosis with rapamycin therapy: Possible role of phospho-70-ribosomal-S6 kinase |
1 Feb 2010
Nephrogenic systemic fibrosis (NSF) is a fibrosing disorder that occurs in some patients with renal insufficiency. Exposure to gadolinium-based contrast agents (GdCA) has been associated with the development of NSF. No uniformly effective treatment options exist. We present immunohistochemical evidence to show that the proliferating fibrocytes of NSF express phospho-70-s6 kinase (PI-3-K), a protein downstream of PI-3-K, and the target of the drug rapamycin. In our patient, use of rapamycin resulted in rapid clinical improvement marked by reduced edema, reduced skin induration, and decreased pain. This suggests a possible role for PI-3-K and rapamycin (mTOR) pathways in the pathogenesis of NSF. Drugs that inhibit these pathways may be a target for future therapy. While our patient did attribute disease onset to GdCA exposure, used on a single occasion for abdominal imaging, he was also exposed to iron, calcium, and darbepoetin alpha at the time of imaging. -
Thyroid autoimmunity and pemphigus vulgaris: Is there a significant association? |
1 Feb 2010
To the Editor: The association of pemphigus with autoimmune thyroid diseases, namely Hashimoto thyroiditis and Graves disease, is well known. Nevertheless, controlled studies evaluating thyroidal autoimmunity in pemphigus patients are limited in the English-language literature. -
Perineural invasion progressing to leptomeningeal carcinomatosis: Is the absence of peripheral nerves an important sign? |
1 Feb 2010
Background: Leptomeningeal carcinomatosis (LMC) is a rare, frequently fatal complication of cranial nerve invasion by a primary cutaneous carcinoma.Objective: Complete absence of nerve tissue was observed in retrospect in a Mohs surgery case that had subsequently proceeded to LMC. We theorized that the cancer invaded the perineural space and spread contiguously until meeting a point of resistance, in this case the mental foramen. Pressure on the nerve resulted in Wallerian degeneration of the peripheral nerve, causing progressive anesthesia and obscuring the presence of perineural invasion (PNI). Our objective was to find out if this was an isolated phenomenon or an important sign of PNI progressing to LMC.Methods: We report and describe a case and review similar case reports in the literature.Results: Twenty-two case reports fit our criteria. In only two cases was carcinomatous PNI reported in initial surgical specimens.Limitations: There are relatively few similar case reports in the literature. In many reports, histopathologic findings are not detailed enough to be helpful. Absence of peripheral nerves, although inferred, is not specifically stated in any other case report.Conclusion: The absence of nerve tissue in a Mohs surgery specimen, coupled with signs of cranial nerve involvement, could be important early indicators of PNI progressing to LMC. -
Short-term isotretinoin treatment decreases insulin-like growth factor-1 and insulin-like growth factor binding protein-3 levels: does isotretinoin affect growth hormone physiology? |
31 Jan 2010
SummaryBackground Isotretinoin is an effective treatment for acne vulgaris. However, it has numerous side-effects. It was previously reported that serum growth hormone (GH) levels decreased with isotretinoin treament.Objectives To analyse whether isotretinoin has any effects on insulin-like growth factor-1 (IGF-1), insulin-like growth factor binding protein-3 (IGFBP3) and GH levels.Methods Forty-seven patients aged 21·5 ± 5·1 years (mean ± SD) with acne vulgaris were included in this study. Isotretinoin therapy was initiated at a dose of 0·5[ndash]0·75 mg kg[minus]1 daily and then adjusted to 0·88 mg kg[minus]1 daily as maintenance dosage after 1 month. Screening for biochemical and hormonal parameters was performed just before initiation and after 3 months of isotretinoin treatment.Results IGF-1 and IGFBP3 levels decreased significantly after treatment (P < 0·01), while GH levels did not change. Post-treatment, significant increases were seen in aspartate aminotransferase, total cholesterol, low-density lipoprotein cholesterol, triglycerides and low-density lipoprotein cholesterol/high-density lipoprotein cholesterol ratio (P < 0·0001) while high-density lipoprotein cholesterol levels were significantly decreased (P < 0·0001).Conclusions Isotretinoin therapy may have an effect on GH physiology, and further studies are needed to understand this association. -
Melanoma Associated With Long-term Voriconazole Therapy: A New Manifestation of Chronic Photosensitivity [Observation] |
18 Jan 2010
Background Voriconazole is a triazole antifungal agent approved by the US Food and Drug Administration for serious fungal infections, including with Aspergillus, Fusarium, Pseudallescheria, and Scedosporium species. In initial clinical trials, approximately 2% of patients developed cutaneous reactions, including photosensitivity, cheilitis, and xerosis. Subsequent reports have implicated voriconazole as a cause of severe photosensitivity and accelerated photoaging, pseudoporphyria cutanea tarda, and aggressive squamous cell carcinoma.
Observation We report 5 melanoma in situ lesions in the setting of extreme photosensitivity associated with long-term voriconazole therapy.
Conclusions We recommend surveillance for skin cancer formation in all patients who require long-term voriconazole treatment, particularly those who manifest signs or symptoms of photosensitivity or chronic photodamage. Further study of the mechanism underlying voriconazole photosensitivity and oncogenesis is warranted.
Published online January 18, 2010 (doi:10.1001 /archdermatol.2009.362).
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Propranolol for complicated infantile haemangiomas: a case series of 30 infants |
6 Jan 2010
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Cheilitis glandularis: A clinicopathological study in 22 patients |
11 Dec 2009
Background: Cheilitis glandularis (CG) is a condition in which thick saliva is secreted by minor labial salivary glands and adheres to a swollen lip causing discomfort to the patient. Most publications refer to single case reports or small case series.Objective: We sought to report and to analyze clinical, pathological, and therapeutic data on 22 patients with CG seen at the department of dermatology at our university.Method: Retrospective data about 22 patients with CG are reviewed and presented.Results: Seventeen patients were male and 5 were female. All were fair skinned, including 6 albino individuals. Several of them presented significant signs of photodamage on the lips. Surgical treatment was performed in 10 severely affected patients and consisted of a vermilionectomy followed by minor salivary gland removal. Histopathological study revealed various degrees of chronic sialadenitis and vermilion epithelial changes. Superficially invasive and in situ squamous cell carcinoma of the vermilion was detected in 3 cases.Limitations: Biopsy and surgery were not performed in all patients.Conclusions: CG is strongly related to sun sensitivity and may be more severe in albino patients. The swollen, sun-exposed lip may become more susceptible to the occurrence of squamous cell carcinoma. -
Standards for genital protection in phototherapy units |
11 Dec 2009
Background: Phototherapy is a useful therapy for many dermatologic disorders and is known for its low side-effect profile. However, one potential notable side effect is genital skin cancer. Unfortunately, no standards for genital protection currently exist for this preventable complication. Patients treated with phototherapy may already have a decreased quality of life because of their primary dermatologic disorder. Development of squamous cell carcinoma of the genitalia may certainly further affect the quality of life.Objective: The objective was to determine which readily available materials afford the best photoprotection of the male genitalia.Methods: Seven common materials used in phototherapy units for genital protection were placed over ultraviolet (UV) B and UVA monitors and placed in broadband UVB, narrowband UVB, and UVA full-body units. The percentage of light blocked was then calculated.Results: Blue and white cotton underwear, blue surgical towels, an athletic supporter with or without a cup, and the psoralen plus UVA pouch provided acceptable means of genital protection; however, surgical masks did not.Limitations: Only the most commonly used materials were tested in the phototherapy units. The materials were not of a single material type or similar masses. In addition, only one of each type of full-body phototherapy unit was used to obtain the data.Conclusion: Although a polyester composition provides better UV protection, factors such as low porosity and higher mass are intrinsic to decreasing the amount of UV penetration of any fabric. Of the commonly used objects, surgical masks do not provide sufficient protection to the genital area. -
A child with coexistent juvenile xanthogranuloma and Langerhans cell histiocytosis |
7 Dec 2009
A 15-month-old boy was seen because of two distinct types of lesions, namely, yellowish papules on the scalp and face, and hemorrhagic macules and papules on the trunk. A biopsy specimen from one of the yellowish papules showed histopathologic and immunohistochemical changes of both juvenile xanthogranuloma and Langerhans cell histiocytosis. The section from the center of the biopsy specimen showed a proliferation of foamy histiocytes, among them Touton giant cells, which were positive for CD68, but negative for S-100 and CD1a. At the edges of the specimen was a predominantly histiocytic infiltration in the papillary dermis that was positive for S-100 and CD1a, but negative for CD68. The patient died 12 days after hospital admission consequent to disseminated intravascular coagulopathy. We did not biopsy the hemorrhagic lesions; however, this combination of findings suggests a possible relationship between juvenile xanthogranuloma and Langerhans cell histiocytosis, as previously reported. -
How informative are dermatopathology requisition forms completed by dermatologists? A review of the clinical information provided for 100 consecutive melanocytic lesions |
7 Dec 2009
Background: Accurate clinicopathologic correlation can be crucial to arriving at the correct microscopic diagnosis.Objective: We reviewed the clinical information provided on the dermatopathology requisition forms for melanocytic lesions submitted by community dermatologists.Methods: The clinical information provided and the microscopic diagnoses rendered were recorded in a retrospective, unblinded fashion for 100 consecutive melanocytic lesions submitted as wet tissue to our dermatopathology department.Results: Biopsy specimens were received from 60 community dermatologists and 5 nurse practitioners/physician assistants. Clinical morphology (ie, papule) was provided in 33% of cases. With respect to the ABCDE criteria, 55% of cases had none, 12% had one criterion, 21% had two criteria, 10% had 3 criteria, 2% had 4 criteria, and none had all 5 criteria. No forms stated whether the biopsy specimen was a partial or complete sampling of the lesion. Asymmetry was provided 4% of the time, border irregularity 8%, color 39%, diameter 22%, and evolution 10%. A family or personal history of melanoma was provided in 8% of cases. No requisition forms mentioned the “ugly duckling� sign. Dermatoscopy information and a clinical photograph were provided once each. In 19 cases, the only information on the requisition form was one of the phrases: “r/o atypia,� “r/o atypical nevus,� “r/o Clark's,� or “r/o dysplastic nevus.� In 10 cases, the only information was “r/o nevus.�Limitations: Only 100 consecutive melanocytic lesions were studied in a retrospective, unblinded fashion.Conclusion: Important clinical information regarding pigmented lesions is often not provided on the requisition form. Potential reasons for this deficit and suggestions for improvement are discussed. -
Clinical usefulness of variable-frequency ultrasound in localized lesions of the skin |
4 Dec 2009
Background: High variable-frequency ultrasound is a recently available technique capable of clearly defining skin layers and deeper structures that also provides local perfusion patterns obtained in real time.Objectives: The aim of the study was to assess the performance of variable-frequency ultrasound in the evaluation of skin lesions.Methods: We performed a retrospective study of 4338 skin ultrasound examinations in predominantly localized skin lesions, and in a group of 130 healthy controls. We determined ultrasound sensitivity, specificity, and statistical level of certainty, and compared ultrasound diagnoses with clinical diagnoses.Results: Referring diagnosis was correct in 73% of the lesions, and addition of ultrasound increased correctness to 97% (P < .001 for the difference). Ultrasound overall sensitivity was 99%, specificity was 100%, and statistical diagnostic certainty was 99%Limitations: Ultrasound in its current version cannot detect lesions that are epidermal only or that measure less than 0.1 mm in depth.Conclusions: Ultrasound is a reliable adjuvant for the accurate and precise diagnosis of skin lesions. -
Tissue gadolinium deposition and fibrosis mimicking nephrogenic systemic fibrosis (NSF)–subclinical nephrogenic systemic fibrosis? |
25 Nov 2009
Nephrogenic systemic fibrosis is a condition with significant and often debilitating cutaneous manifestations. Recent research on this disease has delineated an association between nephrogenic systemic fibrosis and exposure to magnetic resonance imaging studies using gadolinium-based contrast agents in patients with ongoing renal failure. This metal has been detected in cutaneous biopsy specimens taken from lesional skin suggesting that gadolinium provides an impetus for the deposition of circulating fibrocytes in the skin and subsequent fibrosis. We describe a hemodialysis-dependent liver transplant recipient who received a gadolinium-based contrast agent and demonstrated insoluble gadolinium deposition in a fibrotic dermis and subcutaneous septum using scanning electron microscopy/energy dispersive x-ray spectroscopy. He has yet to manifest symptoms and signs of nephrogenic systemic fibrosis 3 years after his magnetic resonance imaging study. -
Pulsed intravenous cyclophosphamide and methylprednisolone therapy in refractory pemphigus |
17 Nov 2009
Background Pemphigus is a rare autoimmune blistering disorder. The mainstay of current treatment is high-dose oral corticosteroid therapy in combination with a steroid-sparing agent. Adjuvant therapy is important for disease control and to reduce the iatrogenic effects of oral prednisolone. Pulsed therapy with intravenous methylprednisolone and cyclophosphamide (PPC) has been shown to be an effective treatment but there are currently few data on its use in patients who have failed to respond to conventional immunosuppression.Objectives To report the clinical and immunological responses of 21 patients with pemphigus refractory to prednisolone and azathioprine or mycophenolate mofetil treated in our department with a standard protocol of monthly PPC.Methods Patients with pemphigus were identified who had undergone PPC therapy during the period between 1997 and 2006. Initial clinical severity and response to treatment was assessed. In addition, change in intercellular antibody titres and desmoglein 1 and 3 antibodies to PPC therapy was also recorded.Results Of the 21 patients treated, seven had an excellent response, two a good response, five a moderate response, six a minimal response and one patient had no clinical response. Four patients achieved complete clinical remission and the number of pulses for these patients varied between 11 and 22. We observed significant reductions in indirect immunofluorescence titres for normal human skin substrate (P = 0·0078) and antidesmoglein 1 and 3 autoantibody levels (P = 0·007 and P = 0·0085, respectively) from pre-PPC therapy to 1 year after the last pulse. All patients were able to reduce their prednisolone dose from a pre-pulsing median dose of 40[ndash]10 mg at the last pulse with a median dose reduction of 66% (P < 0·001). The most common adverse effect was transient lymphopenia (12 patients); nonlife-threatening sepsis (seven patients) and premature ovarian failure (two patients) also occurred.Conclusions PPC can be an effective treatment for refractory pemphigus but its adverse effects should be considered prior to therapy and closely monitored in patients on treatment. -
Juvenile temporal arteritis |
14 Sep 2009
Juvenile temporal arteritis (JTA) is a nongranulomatous inflammation of the temporal artery with fragmentation of the internal elastic lamina and no concurrent systemic manifestations. It is a rare clinicopathologic entity with fewer than 20 reported cases, most of which represent localized disease with no recurrence or systemic symptoms at follow-up of up to 2 years. Histopathologic features can include lymphoeosinophilic infiltrate and endothelial proliferation. As the histology may resemble angiolymphoid hyperplasia with eosinophilia or Kimura disease, whether JTA is a discrete localized disease or a manifestation of these systemic conditions has been debated. We present a case of a 36-year-old Jamaican woman with a painful forehead nodule that showed histologic features of JTA, including intimal hyperplasia, lymphoeosinophilic inflammation of the vessel wall, and disruption of the internal elastic lamina; distinctive signet ringlike cytomorphologic alterations of the endothelial cells were noted as well. The lesion also showed extensive subcutaneous lymphoeosinophilic infiltrates and neovascularization with extension into the underlying muscle consistent with angiolymphoid hyperplasia with eosinophilia or Kimura disease. As the connection between JTA and angiolymphoid hyperplasia with eosinophilia and Kimura disease is currently debated and most reported cases of JTA have had only brief follow-up, the long-term sequelae of JTA are not known and careful patient monitoring may be necessary. -
Minocycline-induced drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome with persistent myocarditis |
10 Aug 2009
Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is a rare serious adverse effect associated with a variety of medications. We present a case of minocycline-induced DRESS syndrome, which resulted in acute renal failure, transient thyroiditis, and transaminitis, and a persistent lymphocytic myocarditis resulting in congestive heart failure. To our knowledge, this is the third reported case of minocycline-induced myocarditis. Additionally, we report successful plasmapheresis and rituximab treatment for minocycline-induced myocarditis associated with the DRESS syndrome. -
Psoriasis in patients with HIV infection: From the Medical Board of the National Psoriasis Foundation |
3 Aug 2009
Background: Patients with psoriasis and HIV infection often present with more severe and treatment-refractory cutaneous disease. In addition, many of these patients have significant psoriatic arthritis. Many effective drugs for psoriasis and psoriatic arthritis are immunosuppressive. Therefore, therapy for the HIV-infected patient is more challenging, requiring both careful consideration of the potential risks and benefits of treatment and more fastidious monitoring for potential adverse events.Objective: A task force of the National Psoriasis Foundation Medical Board was convened to evaluate treatment options. Our aim was to arrive at a consensus on therapy for psoriasis in patients with HIV.Methods: A MEDLINE search of the terms “psoriasis,� “psoriatic arthritis,� “human immunodeficiency virus (HIV),� and “HIV skin diseases� was performed and literature relevant to HIV-associated psoriasis and the treatment of HIV-associated psoriasis were reviewed.Results: Based on a review of the literature, 29 reports were included as evidence in this review. Topical therapy is the first-line recommended treatment for mild to moderate disease. For moderate to severe disease, phototherapy and antiretrovirals are the recommended first-line therapeutic agents. Oral retinoids may be used as second-line treatment. For more refractory, severe disease, cautious use of cyclosporine, methotrexate, hydroxyurea, and tumor necrosis factor-α inhibitors may also be considered.Limitations: There are no randomized, placebo-controlled trials evaluating the therapeutic efficacy or safety of treatments for patients with HIV-associated psoriasis; consequently, the evidence supporting this review consists mainly of case reports or case series.Conclusions: HIV-associated psoriasis is often refractory to traditional treatments. Treatment is challenging and requires careful consideration and should be tailored to patients based on disease severity and the input from an infectious disease specialist. Close monitoring for potential adverse events is necessary. - Read more of my shared items...
