Alejandra Abeldaño

Diagnosis and Treatment of Scabies

Scabies is a common, highly pruritic infestation of the skin caused by Sarcoptes scabiei var. Hominis. It is a very contagious parasitosis with specific lesions, such as burrows, and nonspecific lesions, such as papules, vesicles and excoriations. The typical areas of the body it affects are finger webs, wrists, axillary folds, abdomen, buttocks, inframammary folds and, in men, the genitalia. It is characterized by intense nocturnal pruritus. Scabies is spread through close personal contact (relatives, sexual partners, schoolchildren, chronically ill patients and crowded communities). Definitive diagnosis is made when the scabies mites or their eggs or fecal pellets can be identified on a light microscope. New techniques for diagnosis include the use of the epiluminiscence microscopy.The most common topical treatments for scabies include lindane and permethrin. Permethrin provides a greater margin of tolerability because of its low inherent toxicity and low percutaneous absorption. Oral ivermectin is the most recently developed treatment for scabies. A single oral dose of ivermectin 200 μg/kg of bodyweight is a well-tolerated and very effective treatment. It is especially indicated in crusted scabies, scabies in immunocompromised hosts and infestations in crowded communities. It is also useful as a simple treatment in the prophylaxis of close contacts.

Head louse infestations: epidemiologic survey and treatment evaluation in Argentinian schoolchildren.

Background Our aim was to demonstrate that the treatment of individual cases is effective, but not sufficient, to control endemic Pediculus capitis, and that eradication of the epidemiologic school focus may lower significantly the prevalence of infestation. Statistical data on the degree of infestation relating to socio‐economic and cultural variables were also updated. Therapeutic effects and educational impact were evaluated.

HEPATITIS C VIRUS ANTIBODY (ANTI‐HCV): PREVALENCE IN PSORIASIS

Background. In cases of psoriasis (PS), the etiology of the underlying liver disease is occasionally unknown. To investigate antibodies to hepatitis C virus (anti‐HCV), their prevalence and clinical significance, 118 unselected outpatients with PS were studied prospectively.

Development of cutaneous sarcoidosis in a patient with chronic hepatitis C treated with interferon alpha 2b

Background: Sarcoidosis is a multisystemic granulomatous disorder of unknown etiology that most commonly affects young adults. A probable induction of sarcoidosis by interferons (IFN) has been published. To this date, few cases of cutaneous sarcoidosis in patients with chronic hepatitis C under interferon treatment have been reported. Objective: We describe a 50-year-old woman with chronic hepatitis C who developed lesions of cutaneous sarcoidosis three months after IFN treatment. Conclusions: The possible role of INF therapy in the development of cutaneous sarcoidosis in a patient with chronic hepatitis C should be considered.

Paniculitis en paciente con dermatomiositis

Panniculitis is a rarely reported clinical finding in dermatomyositis. It may precede the other manifestations associated with dermatomyositis by as much as 14 months. In all cases, myositis and panniculitis improve simultaneously during treatment. The present report describes the case of a 30-year-old female patient with clinical and histopathological findings consistent with panniculitis two months after the onset of the muscle and cutaneous symptoms that permitted diagnosis of dermatomyositis. The skin lesions regressed following steroid treatment.

Primary cutaneous lymphoma in Argentina: a report of a nationwide study of 416 patients

The aim of this study was to determine the relative frequency of primary cutaneous lymphoma (PCL) in Argentina according to the new World Health Organization (WHO)‐European Organization for the Research and Treatment of Cancer (EORTC) classification system.

Levels of cyclosporine in breast milk and passage into the circulation of the infant of a mother with psoriasis.

A 19-year-old pregnant woman presented with a 10-day history of large plaque psoriasis, for the last three days of which she had experienced mild fever and malaise. She had a three-year history of mild plaque psoriasis without psoriatic arthritis that responded well to topical steroid therapy. No psoriatic lesions had developed until gestational week 33, when she had a severe flare. There was no recent history of medication or infection. Large and small erythematous infiltrated and scaly plaques covered about 80% of the trunk, extremities, face, and scalp. The patient was started on cyclosporine at 300 mg administered in two equal doses (equivalent to 4.8 mg/kg/d). Very significant lesion regression was seen after one week of treatment with cyclosporine. The treatment was well tolerated with no adverse reactions. The subject’s blood pressure remained normal during the course of treatment. The subject gave birth to a healthy, full-term, female infant (birthweight: 3800 g) at week 40 and started breastfeeding while she was receiving cyclosporine 200 mg/d. Cyclosporine levels were measured in the mother’s blood and milk and in the baby’s blood. Multiple maternal and infant blood and milk samples were collected, and cyclosporine levels were measured by fluorescent polarization immune assay. Cyclosporine concentrations in the breast milk were 128 lg/l at day 10, 200 lg/l at day 30, 207 lg/l at day 40, and 364 lg/l at day 50. Breast milk was collected by the mother using hand compression. Maternal blood concentrations of cyclosporine were 352 lg/l at day 10, 458 lg/l at day 30, and 462 lg/l at day 50, in samples taken two hours after the patient had taken her morning dose (C2). On day 40, cyclosporine concentration was measured prior to the morning dose for a result of 62 lg/l. To examine the differences in cyclosporine concentrations at different times of day, we tested milk collected before and two hours after doses of cyclosporine. Predose (C0) levels of cyclosporine were 207 and 128 lg/l. Cyclosporine concentrations in breast milk samples obtained two hours after the morning dose of cyclosporine (C2) were 200 and 364 lg/l (Table 1). All blood cyclosporine concentrations in the infant were below the detectable range (25 lg/l) except the first, on day 10 after birth, which was 30 lg/l. The infant was exclusively breastfed for six months. 355

Simultaneous diagnosis of mycosis fungoides and dermatofibrosarcoma protuberans in a young patient: is it just a coincidence?

of OTC amounts of several antipruritic agents. Specifically, the product contained 0.25% (0.15 gm) of menthol, 0.25% of camphor (0.15 gm), 1% hydrocortisone (0.6 gm), lidocaine 2% (1.2 gm), diphenhydramine 2% (1.2 gm), 25% poloxamer, preserved purified water QS up to 60 ml, and 6 to 10 drops of 95% ethanol. The product was formulated by weighing out 15 gm poloxamer and placing it in a 100 ml graduated cylinder QS up to 60 ml using preserved purified water, stirring with glass stirring rod and placing in refrigerator until liquefied. Menthol (0.15 gm) and 0.15 gm camphor were weighed out and placed in mortar. Menthol and camphor were triturated together until eutectic mixture formed. Hydrocortisone was weighed out to 0.6 gm and triturated with the menthol and camphor in mortar. Lidocaine was then weighed out to 1.2 gm and added to the mixture. Between three and five drops of 95% ethanol was then added to wet and mix the lidocaine to make a smooth paste. Diphenhydramine 1.2 gm was then added to the triturate with 3–5 drops of 95% ethanol again added until a smooth paste for formulated. At this point, poloxamer was added to the mortar, and the compound was mixed well until an even liquid mixture was at hand. The finished product was then placed in squeeze bottles and labeled and kept under refrigeration until ready for external use. The ability to retain coolness when applied to the skin after refrigeration and to be thermoreversible, makes poloxamers most beneficial in delivery of dermatologic skin products. Certainly studies need to be initiated to assess patient satisfaction and therapeutic benefits. In short, by using a poloxamer as the base, the product is in a liquid state while cold, and can be applied directly to the skin from refrigerated storage. When so applied to the skin, the poloxamer becomes a gel at body temperature with great skin adherent features. Poloxamer may prove to be an excellent method of drug delivery for skin products designed for reducing pruritus.