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Introduction: Keratoacanthoma (KA) is a group of tumors of epidermal origin with controversial nature. Subungual keratoacanthoma (SUKA) is a rare and destructive variant with more aggressive behavior. SUKA appears as a rapidly growing, painful tumor beneath the nail plate that rapidly progresses to a mass that can measure up to 2 cm. The toe location is unusual. The diagnosis must be made based on the correlation of clinical, radiological, and histopathological findings. Case Presentation: We present two cases of patients diagnosed with SUKAs with different clinical presentations which ranged from very typical to uncommon one. Both cases were treated with simple excision without recurrences. Conclusion: SUKA is a rare subungual tumor. Nail bed location represents a more difficult diagnostic challenge. SUKA should be suspected in the context of persistent and progressive pain on a finger or toe, once more frequent painful tumors have been ruled out.

A cross-sectional pilot study was conducted in acute leukemia adult patients in order to characterize oral mucosal conditions in acute leukemia, and to analyze their association with certain clinical, nutritional and laboratory parameters. Oral evaluation was performed. Epidemiologic, clinical and laboratory data were considered. Statistical analysis included non-parametric tests and multivariate analysis. A total of 30 patients (60% males) were included; median age of 39 (range 17-62) years old. The median percentage of caloric intake adequacy was 96.8% (range 21.8-205.7%), and the median ideal weight was 117.9% (range 88.2-162.9%). The most common oral mucosal findings were pallor and furred tongue. Leukoedema was seen only in patients 30 years old. Exfoliative cheilitis was more frequent in females [OR=2.7 (CI=1.2-6.1); p=0.02] and in patients with high β-carotene concentrations [Md= 94.5 vs 57.0 µg/dl; (p=0.01)]. Higher rates of diffuse hyperpigmentation were seen (p

Introduction: Tuberous sclerosis complex (TSC) is a genetic multisystem disorder with prominent skin involvement. Multiple ungual fibromas, also known as Koenen tumors (KTs), are one of the major diagnostic criteria and occur approximately in 50% of patients with TSC. They are disfiguring, painful, and challenging to treat as they frequently recur. There are 2 previous cases in the literature of KTs as the only clinical sign of TSC. Case Presentation: A 56-year-old male patient with intellectual disability presented with a history of ungual growths that had gradually increased in size and number for 20 years. The diagnosis of KTs was established on clinical grounds, without the requirement of histological confirmation. No additional clinical evidence of TSC was found. Complete surgical excision of the tumors located in the proximal nail matrix, periungual folds, and nail bed of each toe was successfully performed. Discussion: The association between KTs and intellectual disability with TSC supported the clinical diagnosis. To date, there is no standard first-line treatment for KTs. Complete surgical excision up to the proximal base of the tumor offers satisfactory results in terms of functionally and esthetic appearance and could be considered the preferred therapeutic modality for patients with severe functional and cosmetic impairment. Prompt recognition of the many signs and symptoms associated with TSC is important to achieve early diagnosis, preventing further complications.

Because several nail disorders share similar clinical features, their diagnosis and management can be challenging to clinicians. The physical examination may disclose localized abnormalities or point to an underlying systemic disease, requiring additional workup. Furthermore, cosmetic distress and nail-related symptoms (e.g., tingling, stinging, numbness, and pain) are common factors that influence the patient's search for medical assistance. Nail pain (i.e., onychalgia) can accompany both localized and systemic pathology. Onychalgia can be acute or chronic according to the time of evolution; patients may describe it as intermittent or constant, and as a throbbing, burning, sharp, or shooting sensation denoting the nature of the pain. It may be exacerbated by colder temperatures, touch, and increased activity (e.g., manipulating objects, walking). We present four main groups of conditions that might cause nail pain: nail tumors, nail deformities, inflammatory or infectious diseases, and external or traumatic agents. Our article includes an overview of the clinical features, as well as diagnosis and management pearls for each entity. Physicians (dermatologists and nondermatologists) should be aware that abnormalities of the ungual and subungual space are not exclusive of dermatological disorders but may also be present in noncutaneous contexts.

Syphilis is an infectious disease caused by the spirochete Treponema pallidum, transmitted mainly by direct contact with the lesion. Primary syphilis usually presents with a chancre at the site of infection, which is highly contagious and resolves without treatment. The aim of this article is to illustrate an unusual location of a syphilitic chancre, in order to consider this diagnosis within the approach to patients with oral ulcers.a 30-year-old man who presented a dermatosis located in the left labial commissure, characterized by a painless ulcer of 1 cm in diameter of 20 days of evolution. The patient has a history of HIV/AIDS. A punch biopsy of the dermatosis was performed, with a histopathological report compatible with syphilitic chancre and a negative VDRL result. He was treated with penicillin G benzathine showing improvement.Primary syphilis is characterized by the development of the syphilitic chancre, which is the first manifestation of syphilis in up to 60% of cases. Extragenital presentation is rare, with only 12-14% of all cases, and of these between 40-70% occur in the mouth, being the lips the most frequent location. Oral manifestations can represent a diagnostic challenge due to its wide spectrum of clinical presentations.la sífilis es una enfermedad infecciosa causada por la espiroqueta Treponema pallidum, transmitida principalmente por contacto directo con la lesión. La sífilis primaria generalmente se presenta con un chancro en el sitio de la infección, el cual es altamente contagioso y se resuelve sin tratamiento. El objetivo de este trabajo es ilustrar una localización poco común de un chancro sifilítico, ya que conocer la existencia de presentaciones poco frecuentes permitirá favorecer su sospecha al abordar las causas de úlceras orales.hombre de 30 años de edad, el cual presenta una dermatosis localizada en la comisura labial izquierda, caracterizada por una úlcera no dolorosa de 1 cm de diámetro de 20 días de evolución. El paciente tiene antecedente de VIH/SIDA. Se realizó biopsia en sacabocados de la dermatosis, siendo el informe histopatológico compatible con chancro sifilítico y resultado de VDRL negativo. Fue tratado con penicilina G benzatínica, con lo que presentó mejoría.la sífilis primaria se caracteriza por la aparición del chancro sifilítico, el cual es la primera manifestación de la sífilis hasta en el 60% de los casos. La presentación extragenital es rara, con solo un 12-14% de todos los casos y, de estos, entre un 40-70 % se presentan en la boca, siendo los labios la localización más frecuente. Las manifestaciones orales pueden representar un desafío diagnóstico debido a su amplio espectro de presentaciones clínicas.

To describe the pain management and clinical course of patients with severe Pemphigus Vulgaris (PV) admitted to a third-level Intensive Care Unit (ICU). This was a retrospective cohort study conducted in the Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran over the period 2013-2020. Study population comprised patients with severe PV admitted to the ICU. Eleven patients with severe PV were included. Mean age of presentation was 43.6 years. Percentage of the total body surface area affected ranged from 70 to 85% (mean: 80%). Visual Analogue Scale was used for pain assessment upon admission. Nine patients (72%) reported a 10/10 pain. The median Morphine Equivalent Daily Dose was 200 mg (range: 90-518 mg). Mortality was 27% during the ICU stay. One patient (9%) continued to experience severe pain and consume opioids after discharge. PV is a life-threatening disease characterized by painful, persistent erosions and ulcers. Integrated and multidisciplinary approach is often required. Opioids remain the mainstay for acute pain control in patients with severe PV. Biological, psychological, and social factors influence patients' daily opioid requirements and dose escalation. Successful pain management contributes to improving the quality of life, and the suppression and remission of PV.

espanolAntecedentes: El penfigo vulgar (PV) se caracteriza por la presencia de autoanticuerpos contra las desmogleinas 1 y 3 y da lugar a la formacion de ampollas epidermicas. El fundamento para usar la plasmaferesis terapeutica (PT) es retirar los autoanticuerpos patogenicos; este procedimiento se considera un tratamiento de tercera linea. Objetivo: Analizar el papel de la PT en pacientes con PV que no responden al tratamiento convencional y su efecto a largo plazo en la dosis de prednisona. Material y metodos: Analisis retrospectivo de una serie de casos de seis pacientes con PV sometidos a PT entre 2011 y 2015. Se registraron los datos demograficos, condiciones medicas, dosis de inmunosupresores iniciales y posteriores a la PT, numero de sesiones de PT y efectos adversos relacionados con la PT. Se comparo la dosis de prednisona antes de la PT y seis meses despues. Resultados: La media de superficie corporal afectada fue de 54%. Antes de la PT, todos los pacientes recibieron corticosteroides sistemicos (al menos 1 mg/kg/dia) e inmunosupresores sin adecuada respuesta. La media de sesiones de PT por paciente fue de tres y el tiempo medio para la reepitelizacion fue 10 dias. No se registraron efectos adversos graves relacionados con la PT. A los seis meses, todos los pacientes mostraron una reduccion significativa de la dosis de prednisona (p = 0.0413), con una media de reduccion de la dosis de 40 mg/dia. Conclusiones: La PT es un procedimiento seguro y efectivo en el tratamiento de casos resistentes, acelera la respuesta clinica y puede contribuir a la reduccion a largo plazo de la dosis de prednisona. EnglishBackground: Pemphigus vulgaris (PV) is characterized by the presence of autoantibodies against desmoglein 1 and 3 with resulting formation of epidermal blisters. The rationale for using therapeutic plasma exchange (TPE) is the removal of pathogenic autoantibodies, this procedure is considered a third-line treatment. Objective: The objective of the study was to analyze the role of plasmapheresis in PV patients that do not respond to conventional therapy and its long-term effect of prednisone dose. Materials and methods: We performed a retrospective analysis of a case series of six PV patients who underwent TPE from December 2011 to October 2015. We recorded demographic data, pre-existing medical conditions, immunosuppressant doses taken before and after TPE, number of TPE sessions, and adverse events related to TPE. We compared the prednisone dose before TPE and 6 months later. Results: The median affected body surface area at the time of admission was 54%. Before TPE, all the patients were receiving systemic corticosteroids (at least 1 mg/kg/day) and had received other immunosuppressants without adequate response. The median number of TPE sessions received by each patient was 3, and the median time to reepithelization after starting TPE was 10 days. No serious adverse events related to TPE were registered. At the 6-month follow-up, all the patients experienced significant reduction in the absolute prednisone dose (p = 0.0413), with a median reduction in prednisone dosage of 40 mg/days. Conclusion: TPE is a safe procedure that has been proved effective in the treatment of refractory cases of PV, it accelerates clinical response and it can contribute in the long-term dose reduction of prednisone.

The aim of this study was to translate into Mexican Spanish, cross‐culturally adapt and validate the wound‐specific quality of life (QoL) instrument Cardiff wound impact schedule (CWIS) for Mexican patients. This instrument went through the full linguistic translation process based on the guidelines of Beaton et al (Beaton DE, Bombardier C, Guillemin F, Ferraz MB, Guidelines for the process of cross‐cultural adaptation of self‐report measures, Spine Phila Pa, 1976, 2000, 318‐391). We included a total of 500 patients with chronic leg ulcers. The expert committee evaluated the Face validity and they agreed unanimously that the instrument was adequate to assess the QoL of these patients, covering all relevant areas presented by them. The content validity index obtained was of 0.95. The construct validity demonstrated moderately significant correlations between related sub‐scales of CWIS and SF‐36 (P = .010 to P

Cutaneous drug-induced reactions are immune-mediated responses that can lead to life-threatening diseases such as drug reaction with eosinophilia and systemic symptoms (DRESS), Stevens-Johnson syndrome, and toxic epidermal necrolysis, collectively known as severe cutaneous adverse reactions (SCARs). Unfortunately, they cannot be predicted during drug development, and, at present, a prognostic biomarker is not available nor are validated in vitro assays for diagnosis. Thus, by using proteomic and microarray miRNA analysis, the cargo of extracellular vesicles obtained from SCARs patients was analyzed and correlated with the severity of the reaction. Confirmatory assays using Western blot and qRT-PCR were performed to validate findings, and bioinformatic tools were used to establish the correlation between protein and miRNAs expression between groups. The proteomic analysis showed an increase in the amount of pro-inflammatory proteins, von Willebrand factor, and C-reactive protein and a decrease in anti-inflammatory and protective proteins in the SCARs group compared with the control group. Additionally, histone protein H2A was enriched in DRESS patients. APO1 and SERPINA4 proteins, highly increased in the control group but absent in the SCARs group, are the target of several overexpressed miRNAs, suggesting that the regulation of these proteins might involve gene silencing and protein repressing mechanisms in the severe patients. According with previous reports showing its presence in plasma and T-cells, microRNA miR-18 was upregulated in extracellular vesicles obtained from the most severe patients. Determination of the unique cargo associated with different disease conditions will help to understand the pathophysiology of these complex reactions and might help to develop novel biomarkers for life-threatening iatrogenic cutaneous disease.

Lamotrigine is an antiepileptic drug that has been widely used for epilepsy, as a mood stabilizer (for type 1 bipolar disorder) and in the management of neuropathic pain, it is used both in monotherapy and in complementary therapy. Considered relatively new, approved by the Food and Drug Administration in 1994, its benefits include a greater margin of safety compared to other anticonvulsants. However, although in a lower percentage, it causes severe adverse skin reactions such as Stevens-Johnson syndrome and toxic epidermal necrolysis. A review is made about the probable pathways that trigger this delayed hypersensitivity immune response.La lamotrigina es un fármaco anticonvulsivo que ha sido utilizado ampliamente para tratar la epilepsia, como estabilizador del ánimo (en casos de trastorno bipolar tipo 1) y en el manejo del dolor neuropático; se usa tanto en monoterapia como en terapia complementaria. Considerado como un medicamento relativamente nuevo, aprobado por la Food and Drug Administration en 1994, dentro de sus beneficios se encuentra un mayor margen de seguridad en comparación con otros anticonvulsivos; sin embargo, aunque en menor porcentaje, es causa de reacciones cutáneas adversas graves, como el síndrome de Stevens-Johnson y la necrólisis epidérmica tóxica. En el presente estudio se realiza una revisión de las probables vías que desencadenan esta respuesta inmunitaria de hipersensibilidad tardía.

The onycholemmal horn is an exceedingly rare subungual tumor characterized by trichilemmal-like keratinization pattern. The only previous instance of onycholemmal horn dates back to 1983 when Haneke reported a keratotic subungual tumor clinically and histologically comparable to a trichilemmal horn. No other case of this condition has been reported so far. We present the case of a 72-year-old female patient, with a history of a slowly growing tumor originating from the nail bed epithelium of the left thumb. The lesion was surgically removed, and pathological examination was consistent with the diagnosis of an onycholemmal horn. Additionally, this study aims to elucidate the correlation between the onycholemmal and trichilemmal keratinization.

A man, age 45 years, was diagnosed with intermediate-risk stage IV clear cell renal carcinoma (lung and lymph node metastases). He was prescribed first-line systemic treatment with sunitinib (Sutent) 50 mg per day (each cycle: 4 weeks on, 2 weeks off). Upon day 22 of his second sunitinib cycle, he came to the oncology clinic complaining of difficulty walking due to bilateral sole pain. He described initial tingling sensations, which then became burning and painful, with symmetrical erythema and edema of the soles, without blisters. These turned into painful plaques with yellowish discoloration and hyperkeratosis on pressure-bearing areas. He denied fever or other symptoms. The pain limited his instrumental activities of daily living, but not his self-care activities of daily living. Total body skin examination disclosed hyperkeratotic plaques on the undersurface of the great toes and heels of both feet, predominantly at sites of pressure; no blisters, crusts, ulcers, or fissures were found. No relevant findings were found upon physical examination of his hands, mucosae, and scalp. A diagnosis of grade 2 hand-foot skin reaction (HFSR) was made.

Introduction Skin toxicity is a common, expected side effect of tyrosine kinase inhibitors (TKIs) and immune checkpoint inhibitors (ICIs) used for metastatic renal cell carcinoma (mRCC). We evaluated the association between skin toxicity and clinical efficacy outcomes of these agents in mRCC patients. Methods and materials Data were obtained from patients with mRCC treated with TKIs and/or ICIs from 2016-2019 at a referral hospital in Mexico City. Clinical outcomes were compared among patients who developed treatment-related cutaneous adverse events (AEs) and those without skin toxicity. Results Thirty-five patients with mRCC were identified who were treated with sunitinib (51.4%), nivolumab plus cabozantinib (28.6%), nivolumab monotherapy (17.1%), or ipilimumab plus nivolumab plus cabozantinib (2.9%). Any grade skin toxicity was seen in 65.7% of patients. With a median follow-up of 14 months, radiological responses were as follows: 48.6% stable disease, 25.7% partial response, and 2.8% complete response. Compared to subjects without skin toxicity, patients who developed cutaneous AEs had higher disease control rate 91.3% vs. 50.0% (P = 0.019) and superior 12-month overall survival rate 91% vs. 67% (P = 0.01), respectively. There was a trend toward improved median progression-free survival (16 months vs. 5 months, P = 0.13). Grade 1-2 cutaneous toxicity was found to be predictive for disease control, with HR 2.72 (95% CI 1.1-6.71, P = 0.030), and all grade cutaneous toxicity was prognostic of overall survival, with HR 0.18 (95% CI 0.04-0.91, P = 0.039). Conclusion Cutaneous AEs are associated with improved overall survival and response in patients with mRCC treated with immunotherapy and/or TKIs.

Congenital malalignment of the great toenail, or ungual malalignment, is a rarely recognized disorder. It is characterized by lateral deviation of the longitudinal axis of the nail plate with respect to the distal phalanx, and if untreated, complications in the late teens and adulthood may arise. In this study, we have reviewed conservative and definitive treatments for this disorder.

Cutaneous involvement is often overlooked in rheumatoid arthritis (RA). We described cutaneous findings in outpatients attending a recent-onset cohort and identified factors associated with skin involvement and reduced (R) dermatological quality of life (DQoL).Skin and rheumatological examinations were performed in 122 patients. DQoL was assessed through the Dermatology Life Quality Index (DLQI). Skin findings were classified as RA-specific and RA-nonspecific. Multiple regression analysis identified factors associated to skin involvement and RDQoL (DLQI score1).Patients were middle-aged females (91%), with a 1-year mean disease activity score in 28 joints as 2.0 (interquartile range: 1.5-2.6). There were 94 (77%) patients in whom at least one cutaneous finding was observed: 17 (13.1%) had RA-specific findings (all were rheumatoid nodules) and 91 (96.8%) had at least one RA-nonspecific finding, further classified into skin diseases (35.2%), hair diseases (20.9%), and skin-related signs (76.9%, among whom 94.3% had xerosis). Age (odds ratio [OR]: 1.054, 95% confidence interval [CI]: 1.015-1.094) and skin-health concerns (OR: 5.657, 95% CI: 1.771-18.070) were associated with cutaneous involvement, whereas increased age and DLQI score were associated with a higher number of skin findings/patient. There were 29 patients (24.2%) with RDQoL, which were associated with the Short Form-36 emotional component (OR: 0.955, 95% CI: 0.923-0.988) and the number of skin findings/patient (OR 2.873, 95% CI 1.723-4.791). Pruritus and hair diseases were the individual categories associated with RDQoL.Cutaneous manifestations are frequent in RA patients and have the potential to impact the emotional component of health-related quality of life. Key Points • Up to 77% of the RA patients with substantial follow-up, from a recent-onset disease cohort, had cutaneous manifestations; these were primarily RA-nonspecific findings, whereas 13.1% had RA-specific findings. • Skin-health concerns and age were associated with cutaneous involvement; meanwhile, increased age and Dermatology Life Quality Index (DLQI) score were associated with a higher number of cutaneous findings/patient. • Reduced dermatological quality of life (RDQoL) was documented in one in four patients and was associated with the SF-36 emotional component and the number of cutaneous findings/patient.

Introduction. Systemic lupus erythematosus (SLE) is an autoimmune disease that includes a broad spectrum of mucocutaneous manifestations. Objectives. To characterize the clinical spectrum of oral mucosal lesions in patients with SLE and to analize their association with clinical and laboratory parameters. Methods. We performed a cross-sectional study with systematic oral evaluations in SLE adult patients. Systemic and cutaneous lupus activities were recorded. We collected epidemiologic, clinical, and laboratory data. Statistical analysis included the kappa coefficient, X2 test, Fisher’s exact test and Mann-Whitney U-test, adjusting for multiple comparisons according to Bonferroni’s method. Results. A total of 181 patients (92.8% females) were included, with a median age of 37 (range 16-76) years. Cutaneous, systemic, and oral manifestations of lupus erythematosus (LE) activity were found in 31.5%, 23.8% and 18.8% of patients, respectively. Higher titres of anti-double-stranded (ds) DNA antibodies were detected in patients with LE-related oral lesions (LEOL) when compared to those without LEOL [356 (82-1083) UI vs 45 (0-417) UI; p=0.02). LEOL did not correlate to cutaneous (k=0.380) nor systemic (k=0.228) LE-activity (p Conclusions. Oral manifestations related to SLE were significantly associated to anti double-ds DNA antibodies. LEOL were independent of cutaneous and systemic activity.

BACKGROUND: The infection by coronavirus disease 2019 (COVID-19) has been associated with multiple cutaneous manifestations, although characterization of them in Hispanic patients with darker skin phototypes is lacking. The objective of this study is to characterize the clinical dermatological manifestations associated with COVID-19 infection in cases with few or without general symptoms in patients from Latin America. METHODS: Cross-sectional study using a questionnaire that was made for health professionals (physicians with a specialty in dermatology) to investigate dermatological lesions associated with COVID-19 infection in patients from 25 countries of Latin America. The survey was active from June 9 to July 30, 2020. RESULTS: In this study, information was collected from a total of 347 patients. We found a female gender predominance: 179/347 (51.6%). The mean age at presentation was 40.87 years. The most frequent dermatological manifestations were maculopapular rash and urticarial lesions, followed by papulovesicular lesions, vesicular lesions, chilblain-like lesions, papular lesions, ecchymosis, petechial purpura, pityriasis rosea-like lesions, pruritus, palmoplantar dysesthesias, transient livedo, acral necrosis, palpable purpura, livedo racemosa, and retiform purpura. As far as we know, there are no previous reports of pruritus and palmoplantar dysesthesias. CONCLUSIONS: This registry emphasizes skin manifestations as an important criterion for establishing the diagnosis of COVID-19 infection in Latin American countries. This information will be useful for the early identification of suspected cases by health professionals (dermatologists and nondermatologists) and will allow contact tracing to mitigate the impact on health systems at different levels

espanolLa vitamina D es una provitamina liposoluble de la hormona esteroidea 1,25- hidroxivitamina D3 sintetizada en los queratinocitos, producida por via endogena ante la exposicion a los rayos ultravioleta o por via exogena mediante suplementacion. La produccion de la vitamina D esta determinada por el fototipo de Fitzpatrick, el sexo, el indice de masa corporal y los polimorfismos en el receptor de vitamina D. En epocas anteriores, la vitamina D era considerada una hormona con funcion exclusivamente relacionada con el metabolismo y la homeostasis del calcio. En la actualidad, ha sido vinculada con diversas patologias de caracter neoplasico, autoinmune, cardiovascular y dermatologico. En el area de la Dermatologia, la alteracion de la vitamina D desempena un papel esencial en la etiopatogenia de diferentes dermatosis de caracter inflamatorio y neoplasicas, se encuentra relacionada con la gravedad de presentacion, pronostico a corto y largo plazo, asi como recurrencia de estas. Por lo tanto, conocer las principales dermatosis relacionadas con la alteracion en la regulacion inmunitaria de la vitamina D es de suma importancia para el manejo y posible suplementacion como tratamiento coadyuvante de la enfermedad. Consideramos que la suplementacion de vitamina D es util para mantener la homeostasis celular de la piel. EnglishVitamin D is a liposoluble provitamin of the steroid hormone 1,25-hydroxyvitamin D3 synthesized in keratinocytes, produced by the endogenous route when exposed to UV rays or exogenously by means of supplementation. The production of vitamin D is determined by Fitzpatrick’s phototype, gender, body mass index and polymorphisms in the vitamin D receptor. Previously, it was considered a hormone with function exclusively related to the calcium metabolism and homeostasis. Currently, the role of the hormone has been linked to an increasing number of neoplastic, autoimmune, cardiovascular and dermatological diseases. In Dermatology, altered vitamin D plays an essential role in pathogenesis of different inflammatory and neoplastic dermatoses, it is related to severity, short and long-term prognosis, as well as recurrence of the disease. Therefore, knowing the main dermatological diseases related to altered immune regulation of vitamin D is of utmost importance for the management and possible supplementation as an adjuvant treatment. We consider that Vitamin D supplementation is useful maintaining cell homeostasis of the skin.

Vitamin D has immunomodulatory effects both in the innate and adaptive immune systems, and there is growing scientific evidence demonstrating its relevance in inflammatory processes such as AD.If vitamin D3 promotes the skin immune system, then it should improve the response to treatment of patients with AD.A randomized, double-blind placebo-controlled clinical trial was conducted, which included 65 patients with AD according to Hanifin-Rajka criteria and the severity scale (SCORAD). The patients were divided into two groups to receive either vitamin D3 5000 IU/day (n = 33) or placebo (n = 32), plus baseline therapy (topical steroid, soap substitute, and emollient) during 3 months.Fifty-eight of the 65 enrolled subjects were included in the analysis. At the end of the intervention, the treated group achieved higher levels of 25(OH)D (P 0.001). At week 12, those patients who registered serum levels of 25(OH)D ≥20 ng/ml, regardless of whether or not they had received supplementation, showed a lower SCORAD compared to those with levels20 ng/ml (P 0.001). Eighty percent of the patients with serum levels20 ng/ml (n = 9) had moderate-severe AD despite standard treatment. Vitamin D levels ≥20 ng/ml associated with baseline therapy strongly favored remission of atopic dermatitis (P = 0.03). No significant differences were found between patients with serum levels of ≥20 ng/ml vs. ≥30 ng/ml.Reaching serum levels of 25(OH)D 20 ng/ml in conjunction with standard therapy is sufficient to achieve a reduction in severity (SCORAD) in patients with AD.

Resumen Antecedentes El carcinoma basocelular (CBC) es el cancer de piel no melanoma mas comun. Existen factores de riesgo asociados a un comportamiento clinico mas agresivo, siendo la invasion perineural (IPN) incidental (nervios Materiales y metodos Se revisaron los casos de CBC recidivantes y no recidivantes del Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran del 2000-2013. Se recabaron y analizaron sus caracteristicas clinicas e histopatologicas. Resultados Se estudiaron 45 casos de CBC, 32 no recidivantes, 12 recidivantes y 1 caso en el que no se corroboro el diagnostico de CBC. Veintiocho casos fueron hombres y 17 mujeres. El tamano de las neoplasias fue de 3-25 mm, la mayoria se encontraron en zonas de alto riesgo. El subtipo histologico predominante fue el nodular. La IPN incidental se encontro en 3 casos de los CBC no recidivantes y un caso de los CBC recidivantes, p = 0,806. Conclusiones Se requieren estudios prospectivos que evaluen el manejo de los CBC con IPN incidental, donde se defina el verdadero factor de riesgo que representa este hallazgo histologico. En nuestro estudio la IPN incidental no significo un factor de riesgo de mal pronostico.

Dysregulation in the expression of microRNAs (miRNAs), single-stranded RNAs which regulate gene expression, has been associated with diseases such as Stevens–Johnson syndrome (SJS)/toxic epidermal necrolysis (TEN), although their cellular origin has not been explored. Thus, the focus of this work was to study expression patterns of reported miRNAs involved in T-cell activation following drug-specific stimulation in peripheral blood mononuclear cells (PBMCs) and drug-specific CD4+ T-cell clones (TCC) from patients with different cutaneous manifestations of delayed-type drug hypersensitivity reactions. CD4+ T-cells from hypersensitive patients were stimulated to proliferate, secreted cytokines (IFN-γ and IL-22), cytolytic molecules (Granzyme B) and up-regulate miRNAs 24 to 48 h after drug exposure. Carbamazepine-specific CD4+ T-cells that proliferated to the greatest extent and secreted the highest levels of IFN-γ showed an up-regulation of miR-18a and miR-155. In contrast, piperacillin-specific CD4+ T-cell...

The cutaneous and oral lesions related to nutritional deficiencies are scarcely reported. Micronutrient deficiencies may significantly affect mouth mucosa and skin, causing great morbidity. We report an extraordinary case with detailed clinical and microscopic findings affecting the oral cavity and skin. Physicians must be familiar with these manifestations to suspect the diagnosis.

Acroangiodermatitis (AAD) is often seen in association with various vascular anomalies such as venous insufficiency, vascular syndromes, and conditions associated with thrombosis. This is the first case reported in the literature associated with arteriovenous fistula stenosis in a patient with chronic kidney disease on hemodialysis. This case is being described for its rarity and to familiarize the clinicians with this unusual complication, especially, to prevent them from thinking of this condition as an infectious complication. It is essential to recognize the uniqueness of the pathophysiology of this disease and to do a clear distinction with that of a venous ulcer. With this work we also aim to help health practitioners with proper management of the condition. As we've seen, surgical treatment in appropriately selected cases corrects the reflux of the venous system and successfully improves the appearance of the verrucous lesion. Our patient was successfully treated by correcting the arteriovenous fistula stenosis with near-complete subsidence of the verrucous lesion within days of the procedure. Acroangiodermatitis management must be conducted with a multidisciplinary approach (dermatology, vascular surgery, and internal medicine). It is essential the comprehensive management of these patients, to ensure prompt recovery and avoid chronic effects, as well as to guarantee the quality of life in the future.

Resumen Antecedentes El carcinoma de piel no melanoma basocelular y el carcinoma epidermoide o espinocelular (CEC) son tumores frecuentes. El carcinoma basocelular es el cancer mas frecuente y el menos agresivo; en algunas ocasiones, a pesar del tratamiento quirurgico con margenes amplios, un porcentaje bajo tiene comportamiento agresivo, como invasion local extensa, recurrencias y metastasis. El CEC tiene un comportamiento mas agresivo, primero en piel, despues en ganglios linfaticos y, raramente, con metastasis a otros organos. Objetivo Identificar las caracteristicas de los CEC recurrentes y la frecuencia de aparicion de nuevos tumores, tras el tratamiento quirurgico con cirugia convencional y cierre diferido de herida hasta obtener el resultado histologico libre de tumor (transoperatorio tardio), esto con la finalidad de tener mejores opciones de tratamiento en la poblacion mexicana. Material y metodo Se revisaron los expedientes de 10 anos y se incluyeron aquellos que tenian diagnostico de CEC. Resultados Se incluyeron 114 tumores en 103 pacientes. Utilizando un analisis descriptivo, se encontro que la media de diagnostico de casos nuevos por ano fue 32.2. Pacientes masculinos 48 (46.6%) y 55 (53.4%) femeninos. La edad diagnostica fue entre 19 y 91 anos (media = 71.94; DE = 13.34) con un tiempo de evolucion de 1 a 112 meses (media = 12 meses; DE = 2.65). El mas frecuente es en la mejilla y la variedad histologica invasiva se da en el 54%. En 14 pacientes se encontro un segundo CEC. Solo tuvimos 4 recurrencias, que aparecieron entre el primer y el cuarto ano de seguimiento, y 3 de estos fueron tratados con cirugia con transoperatorio tardio. Conclusion Este estudio demostro que la tecnica de cirugia con transoperatorio tardio es adaptable para el tratamiento de CEC con buenos resultados y bajo porcentaje de recurrencia en un seguimiento a 10 anos.

Fungal leukonychia is a common condition in immunosuppressed patients; the most common clinical forms are white superficial and proximal white superficial onychomycosis. It is frequently associated with Trichophyton mentagrophytes var. interdigitale and with Trichophyton rubrum. The diagnosis can be easily made by direct examination and culture. Fungal melanonychia is the nail plate pigmentation caused by fungal infections. The most frequently isolated fungi is T. rubrum and melanized molds like Neoscytalidium dimidiatum. The main differential diagnosis is malignant melanoma, although other causes include subungueal hematomas, exogenous pigmentation, and bacterial infection. If homogeneous pigmentation in lines or structureless discoloration, and the absence of melanin inclusions are seen by dermoscopy, diagnosis must be complemented with KOH preparations and cultures.

Squamous cell carcinoma of the nail unit (SCCnu) is the most common malignant tumor of the nail unit. It has a male predominance (sex ratio 2:1). Location is predominant in fingers, mainly the thumb and index. This could be due the more frequent exposure of the hands to trauma and oncogenic agents. It occurs most commonly in the fifth decade of life. They are usually single lesions, but polydactylous involvement has also been reported. Risk factors for SCCnu include trauma; immunosuppression; chronic paronychia; oral exposure to arsenic or pesticides; ionizing radiation exposure; dyskeratosis congenita; and infection with HPV subtypes 2, 11, 18, 26, 31, 34, 35, 52, 56, 58, 73, and especially type 16 (in 60%–80% of cases). Previous studies have shown that some Candida species produce carcinogenic nitrosamine compounds, thus chronic candida infection has also been proposed as a risk factor for SCCnu.

Introduction Surgery is performed more frequently now at days, due to the increasing incidence of melanoma and no-melanoma skin cancer. There are different opinions among dermatologic surgeons between to continue or discontinue antithrombotic therapy prior to the procedure, which increases the risk of thromboembolic events. Prophylaxis with oral antibiotics in the postsurgical period is controversial. Objective To report the safety of surgery without suspending antithrombotic therapy and without oral antibiotic prophylaxis in dermatology surgery of patients with multiple comorbidities and polypharmacy. Method We designed a retrospective study. We included a total of 655 patients; 96.6% had at least one comorbidity; 27.7% used aspirin and 4.3% some type of antithrombotic therapy. The most common type of skin tumor was basal cell carcinoma with 69.8% . Results The complication rate was 4.2%; the most was wound dehiscence (1.1%), followed by partial necrosis (0.9%), infection (0.9%), reaction to foreign body (0.6%), complete necrosis (0.3%), bleeding (0.2%) and fistulae (0.2%). Conclusions Based on the literature and our experience, dermatologic surgery is safe without suspending antithrombotic therapy or antibiotic prophylaxis in patients with multiple comorbidity.

Background: Scalp involvement is not directly evaluated in patients with dermatomyositis (DM). Therefore, the exact frequency of scalp dermatomyositis (SDM) and its clinical and trichoscopic characteristics have been poorly described. Objective: The aim of this study was to determine the frequency and clinical and dermoscopic features of SDM in patients diagnosed with DM. Methods: We performed a descriptive prospective, cross-sectional observational study that included all patients diagnosed with DM at a Mexican academic institute over the course of a year. Results: Twenty-four out of 31 patients with DM had scalp involvement at clinical examination, with a prevalence of 77.4%. SDM was clinically characterized by erythema in all cases, scales in 20 (83.3%) patients, nonscarring alopecia in 21 (87.5%) patients, pruritus in 17 (70.8%) patients, and poikiloderma of the scalp in 16 (51.6%) patients. Twenty-eight patients were evaluated by trichoscopy. The most consistent finding was the presence of enlarged capillaries, found in 20 (71.4%) cases, followed by peripilar casts (57.1%) and tufting and interfollicular scales in 14 (50%) cases. Twenty-two patients also had positive nail fold capillaroscopic features similar to those observed by trichoscopy. Limitations: The simple size was limited. Conclusions: Scalp involvement and alopecia are common in patients with DM, and trichoscopy shows features similar to those found at capillaroscopy. Trichoscopy is a very important tool for diagnosis of scalp involvement in patients with DM.

Pemphigus is a group of autoimmune intraepidermal bullous diseases; being pemphigus foliaceus (PF) and pemphigus vulgaris (PV) the most common subtypes. Pustular variants are scarcely reported for both PV and PF. The purpose of this manuscript was to describe the clinical, microscopic and immunologic findings of an atypical case of PF presenting with pustules, including a review of the literature. PF is described as blisters and because this entity is rare, it is not known for the general medical community that they are other clinical features that can be seen as this one we present here with pustules.

Foreign modelling agent reactions (FMAR) are the result of the injection of unapproved high-viscosity fluids with the purpose of cosmetic body modelling. Its consequences lead to ulceration, disfigurement and even death, and it has reached epidemic proportions in several regions of the world. We describe a series of patients treated for FMARs in a specialised wound care centre and a thorough review of the literature. A retrospective chart review was performed from January 1999 to September 2015 of patients who had been injected with non-medical foreign agents and who developed cutaneous ulceration needing treatment at the dermatology wound care centre. This study involved 23 patients whose ages ranged from 22 to 67 years with higher proportion of women and homosexual men. The most commonly injected sites were the buttocks (38·5%), legs (18%), thighs (15·4%) and breasts (11·8%). Mineral oil (39%) and other unknown substances (30·4%) were the most commonly injected. The latency period ranged from 1 week to 17 years. Complications included several skin changes such as sclerosis and ulceration as well as systemic complications. FMAR is a severe syndrome that may lead to deadly complications, and is still very common in Latin America.

In situ squamous cell carcinoma of the skin (SCCis or Bowen's disease) is a common intraepidermal cutaneous malignancy with a low invasive potential. Acral Bowen's disease is usually solitary, but multiple acral SCCis have been reported. Pigmented Bowen's disease is typically unilesional and characterized by a hyperpigmented plaque with a velvety of keratotic surface, which can eventually simulate melanoma clinically. We describe two HIV-positive patients who presented with multiple pigmented SCCis involving the distal extremities. In patients with immunosuppression, the presence of multiple and hyperpigmented verrucae that clinically do not respond to adequate treatment should raise the differential diagnosis of SCC in situ.

Surgery is performed more frequently now at days, due to the increasing incidence of melanoma and no-melanoma skin cancer. There are different opinions among dermatologic surgeons between to continue or discontinue antithrombotic therapy prior to the procedure, which increases the risk of thromboembolic events. Prophylaxis with oral antibiotics in the postsurgical period is controversial.To report the safety of surgery without suspending antithrombotic therapy and without oral antibiotic prophylaxis in dermatology surgery of patients with multiple comorbidities and polypharmacy.We designed a retrospective study. We included a total of 655 patients; 96.6% had at least one comorbidity; 27.7% used aspirin and 4.3% some type of antithrombotic therapy. The most common type of skin tumor was basal cell carcinoma with 69.8% .The complication rate was 4.2%; the most was wound dehiscence (1.1%), followed by partial necrosis (0.9%), infection (0.9%), reaction to foreign body (0.6%), complete necrosis (0.3%), bleeding (0.2%) and fistulae (0.2%).Based on the literature and our experience, dermatologic surgery is safe without suspending antithrombotic therapy or antibiotic prophylaxis in patients with multiple comorbidity.La cirugía es uno de los procedimientos que se realizan con mayor frecuencia en dermatología debido a la mayor incidencia de cáncer de piel melanoma y no melanoma. Se han encontrado distintas posturas entre los cirujanos dermatólogos sobre continuar o suspender antiagregantes y anticoagulantes antes del procedimiento, lo cual incrementa el riesgo de eventos tromboembólicos, además de la preferencia de utilizar profilaxis antibiótica de forma posquirúrgica por algunos dermatólogos.Reportar nuestra experiencia en cuanto a la seguridad de la cirugía dermatológica sin la suspensión de anticoagulantes/antiagregantes y sin profilaxis antibiótica en pacientes con múltiple comorbilidad y polifarmacia.Se revisaron 655 pacientes. El 96.6% tenían al menos otra enfermedad. El 27.7% utilizaba ácido acetilsalicílico y el 4.3% algún tipo de anticoagulante. El tipo de neoplasia más frecuente fue el carcinoma basocelular con 69.8%.La tasa total de complicaciones fue del 4.2%. La complicación más frecuente fue la dehiscencia de la herida (1.1%), seguida de la necrosis parcial (0.9%), la infección (0.9%), la reacción a cuerpo extraño (0.6%), la necrosis total (0.3%), la hemorragia (0.2%) y la fístula cutánea (0.2%).Basándonos en la literatura y nuestra experiencia, la cirugía dermatológica es segura sin suspender antitrombóticos ni indicar profilaxis antibiótica en pacientes con múltiple comorbilidad.

Dysregulation in the expression of microRNAs (miRNAs), single-stranded RNAs which regulate gene expression, has been associated with diseases such as Stevens-Johnson syndrome (SJS)/toxic epidermal necrolysis (TEN), although their cellular origin has not been explored. Thus, the focus of this work was to study expression patterns of reported miRNAs involved in T-cell activation following drug-specific stimulation in peripheral blood mononuclear cells (PBMCs) and drug-specific CD4

Nail punch biopsy is used to obtain a tissue sample for the diagnosis and treatment of nail diseases. The best results will be possible if the surgeon is familiar with the anatomy and physiology of the nail apparatus. A punch biopsy can be used in all regions of the nail apparatus in the presence or absence of nail plate. When the procedure is performed with a careful handling of the anatomic site and specimen, in most cases a successful diagnosis can be achieved.

Background Onychocryptosis is one of the most common painful nail conditions. Conservative treatment may take a long time to obtain effective results. Objective The purpose of this study is to show the effectiveness of a conservative treatment of ingrown nails that shows rapid results. Methods and materials Patients with painful Stage 1 to 2 onychocryptosis who were not candidates or refused surgery were treated with the cotton cast. The severity and cause of onychocryptosis was clinically evaluated during a 2-month period. A questionnaire was applied to all patients to evaluate pain, final treatment, and possible complications. Results All patients noticed results in less than 72 hours. Pain subsided in less than 24 hours in half of the patients and before 72 hours in 100% of the patients without the need of other treatments. The use of the cast prevented surgery and the accompanying morbidities in most of the patients (80%). Conclusion The "cotton nail cast" is an effective conservative method for mild nail embedding. It is easy to apply, inexpensive, relieves pain rapidly, and avoids surgery in most patients.

Subungual melanoma represents 20% of all melanomas in Hispanic population. Here, we report the outcome of 15 patients with in situ subungual melanoma treated with resection of the nail unit with a 5-mm margin without amputation, followed up for 55.93 ± 43.08 months. The most common complications included inclusion cysts and nail spicules. We found no evidence of local or distant recurrences at the last visit of our follow up. Functional outcome was good, with only one patient reporting persistent mild pain. These results support functional, non-amputative surgical management of in situ subungual melanomas.

Cutaneous metastasis is a rare event occurring most frequently in patients previously diagnosed with cancer. However, subungual metastases are even less frequent. The most common neoplasms associated with the latter are lung, kidney, and breast neoplasms. Lung cancer is the main cause of subungual metastases in the fingers, and genitourinary tract tumors are the main cause of subungual metastases in the toes. This is the first case report of an adenocarcinoma of the prostate with subungual metastasis.

BACKGROUND The mucocutaneous clinical profile of patients with amyloidosis in Latin America has been scarcely reported. OBJECTIVE To describe clinical characteristics of skin and mucosal manifestations in systemic amyloidosis in a tertiary care center in Mexico City. METHODS A cross sectional, retrospective analytical study was performed in patients with systemic amyloidosis over a 15-year period. Statistical analysis was done. RESULTS A total of 98 patients were included (53 [54%] men; overall median age = 49 years old). Acquired systemic immunoglobulin light chain amyloidosis (AL) was the most common (49%) type, followed by (24.5%) wild-type transthyretin amyloidosis (H-TTR) (24.5%), undetermined cases (21%), and reactive systemic amyloidosis (AA) (6.1%). There were mucocutaneous manifestations in 34.7% of cases, mostly multiple myeloma-related AL (ALMM). Head and neck was the most often affected site (38.2%), and purpuric macules were the most common morphology (44.1%). Mucocutaneous affectation was predominantly observed in AL (50.0%) compared to other types (20.0%) of amyloidosis (P = 0.01). Likewise, involvement of organs was also significantly different among the diverse amyloidosis types (P