Cristián Navarrete-Dechent

Atenolol versus propranolol for the treatment of infantile hemangiomas: A randomized controlled study

BACKGROUND Infantile hemangiomas have a dramatic response to propranolol, a nonselective beta-blocker. However, this treatment is not risk-free and many patients are excluded because of respiratory comorbidities. Atenolol is a cardioselective beta-blocker that may have fewer adverse events. OBJECTIVE We sought to evaluate the effectiveness of atenolol against propranolol in a noninferiority trial. METHODS In all, 23 patients met the inclusion criteria and were randomized to receive either atenolol or propranolol. Thirteen patients were treated with atenolol and 10 with propranolol. Follow-up was made at baseline, 2 weeks, 4 weeks, and then monthly for 6 months. RESULTS Patients treated with atenolol had a complete response of 53.8% and 60% with propranolol, respectively. These results were nonsignificant (P = .68). Relevant adverse events were not reported. LIMITATIONS The reduced number of patients could have influenced our results. CONCLUSION Atenolol appears to be as effective as propranolol. We did not find significant differences between these results or any adverse events.

High-risk cutaneous squamous cell carcinoma and the emerging role of sentinel lymph node biopsy: A literature review

Cutaneous squamous cell carcinoma (cSCC) is the second most common skin cancer in the world. A minority of patients will be given a diagnosis of a high-risk cSCC (HRcSCC) and a proportion of these will have a poor outcome. HRcSCC is characterized by an increase in aggressiveness manifested as locoregional recurrence, and occasionally death. The utility of sentinel lymph node biopsy in this group of patients is unclear without high-level evidence or clear-cut recommendations. If clinicians accept a cutoff threshold of 10% risk of harboring occult nodal metastasis, then a selected group of patients with HRcSCC may benefit from sentinel lymph node biopsy. We performed a review of the currently available evidence, in the form of systematic reviews, meta-analysis, trials, and case series and analyzed the features that define a HRcSCC and the feasibility of performing sentinel lymph node biopsy in this group of patients.

Oral Propranolol for Treating Infantile Hemangiomas: A Case Series of 57 Patients

INTRODUCTION AND OBJECTIVES Infantile hemangiomas (IH) are a frequent vascular tumor. In recent years, propranolol has emerged as an alternative in the treatment of IH. The objective of the present study was to evaluate the effectiveness of propranolol for the treatment of IH. MATERIALS AND METHODS Patients with IH requiring treatment were included. Cardiologic evaluation was made to every patient and electrocardiogram (ECG) and echocardiogram were done. Oral propranolol was started in an ambulatory way at a dose of 2mg/kg daily divided in two doses. At ten days all the patients were evaluated with a 24-h rhythm holter. Evaluation of effectiveness: In clinical controls and by images IH were formally analyzed, without blindness. Response was categorized as complete response (CR), partial response (PR) and no response (NR). Adverse events: Adverse events were registered in a special category of the formulary. RESULTS 57 patients were included. Mean age was 9.7 months. There were 80.8% females. Mean duration of treatment was 7.3 months (1-24 months). EFFICACY 50.6% had CR, 49.3% had PR. There were a 7% of adverse events. No differences in response rate exist according to age or location. No rhythm holter was altered at ten-day control. CONCLUSION Our study highlights the possibility of starting propranolol in an ambulatory way, establishes a dose of 2mg/kg/day and confirms the security profile of the drug. We consider propranolol as a first line treatment for IH.

Topical photodynamic therapy with methylaminolevulinate for the treatment of actinic keratosis and reduction of photodamage in organ transplant recipients: a case-series of 16 patients.

BACKGROUND Organ transplant recipients (OTR) are at high risk of developing cutaneous neoplasms. Topical photodynamic therapy (PDT) has been used for the treatment of actinic keratosis (AK) in OTR. AIMS The objective was to evaluate the efficacy of PDT with methylaminolevulinate (MAL) in the treatment of facial AK in OTR. As a secondary objective, we wanted to evaluate the usefulness of topical PDT in the reduction of photodamage in OTR. METHODS A prospective, single center, single arm study was made. 16 OTR were included. Topical PDT was applied for 1 or 2 cycles depending on the patients characteristics. An evaluation of AK was made at visits pre-treatment, at 12 weeks and at 24 weeks. Photodamage was measured with multispectral image technique (SkinCare). RESULTS A complete response rate of 100% was achieved for AK in all patients; it persisted without change at 12 and 24 weeks of follow-up. 62.5% of patients improved their photodamage as measured by SkinCare®, but this result was not statistically significant (P = 0.12). All patients had high level of satisfaction at the end of the therapy. CONCLUSIONS MAL-PDT is an effective therapy for the treatment of AK in OTRs. It can reduce photodamage in this group of patients, but these results were not statistically significant.

Manifestaciones dermatológicas asociadas a la infección por VIH/SIDA

The ongoing human immunodeficiency virus (HIV) infection epidemic coupled with more efficacious and available treatments has led to a larger number of patients living with HIV or AIDS. As a result, skin manifestations related to HIV/AIDS or its therapy have become increasingly more common and are reported to occur in as many as 95% of patients. Herein, we review the most common HIV/AIDS related cutaneous pathologies and classify them into inflammatory, HAART-associated, neoplastic, and infectious manifestations. Cutaneous manifestations should be promptly recognized and treated by physicians and health care personnel in order to provide optimal care.

Topical photodynamic therapy with 5-aminolevulinate for the treatment of tumor-stage mycosis fungoides: a case report

A 70-year-old male patient with generalized tumor-stage mycosis fungoides (MF) presented to our office. He had been treated with psoralen + ultraviolet A, bexarotene, and total-skin electron beam radiation with poor response. He rejected systemic chemotherapy. The most uncomfortable lesions were those involving his face, fingers, buttocks, and calcaneus region (Fig. 1a). Skin biopsy confirmed the diagnosis (Fig. 2a). We offered him topical photodynamic therapy (PDT) with methyl-aminolevulinate (MAL). A 1-mm thick layer of 160 mg/g MAL cream (Metvix ; Photocure ASA, Oslo, Norway) with a 5 mm of margin was applied and covered with an occlusive dressing (Tegaderm ; 3M Health Care, St. Paul, MN, USA) for three hours on his fingers and buttocks, and in the calcaneus region. MAL was then cleaned with physiologic solution 0.9%. Irradiation was done with red light using a Waldmann lamp (PDT 1200 L, incoherent light source lamp) with a wavelength of 570–670 nm, 37 J/cm, and 70 mW/cm. Two to three sessions were done, depending on the lesion, each one separated by two weeks. Complete clinical and histological remission was achieved after treatment (Figs. 1b and 2b). No recurrences after five years of follow-up have been observed in the treated areas. New lesions have appeared in non-treated areas with excellent response to conventional therapies.

Intralesional methotrexate as an adjuvant treatment for pyoderma gangrenosum: A case report.

A 35‐year‐old man presented with an eighteen‐month history of painful ulcers on both calves. Three ulcers with erythematous‐violaceous undermined borders were noticed on his right leg and one on the left leg [Figure 1]. A detailed laboratory evaluation was done including complete blood counts, erythrocyte sedimentation rate, antinuclear antibodies, chest radiograph, quantiferon gold assay for tuberculosis and human immunodeficiency virus (HIV) serology all of which were unremarkable. Bacterial, fungal and mycobacterial cultures from the ulcer were negative. A skin biopsy showed ulceration surrounded by granulation tissue with a scant, diffuse infiltrate of lymphocytes, neutrophils and plasmacytes and fibrosis but without any signs of vasculitis [Figure 2] and a negative periodic acid‐Schiff stain, all suggestive of pyoderma gangrenosum. Associated systemic diseases were ruled out with normal blood and urine protein electrophoresis, sacroiliac radiography, rheumatoid factor and gastroenterology evaluation including colonoscopy.

Brimonidine gel for the treatment of persistent heliotrope rash in a patient with amyopathic dermatomyositis: a case report

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Vitamin D axis and its role in skin carcinogenesis: a comprehensive review

Vitamin D (VD) is a secosteroid hormone that is mainly synthesized in the skin upon exposure to UVB radiation. VD is widely known for its role in calcium metabolism; however, multiple endocrine, paracrine and autocrine functions of VD have been described, including a prominent role on carcinogenesis. In recent years, multiple associations between VD deficiency and different types of cancer have been described, supported by evidence of anti-proliferative, anti-angiogenic, pro-apoptotic, cell-differentiating and anti-invasive effects of this hormone. An immunomodulatory role of VD associated to cancer microenvironment has also been suggested. Regarding skin cancer, it has been shown that VD inhibits tumor development in basal cell carcinoma, squamous cell carcinoma, and melanoma in vitro. Some studies have suggested that lower VD levels may be a risk factor for skin cancer, while others have shown the opposite; there is also preliminary evidence on the role of VD supplementation for the prevention of melanoma in vivo. In this review, we explore the mechanisms of VD effects on carcinogenesis and the available scientific evidence of the interplay between VD and the genesis of both non-melanoma and melanoma skin cancer.

Oral and written counseling is a useful instrument to improve short-term adherence to treatment in acne patients: a randomized controlled trial.

Background: Therapeutic success in acne patients not only depends on the appropriate selection of drugs but also on the patient’s treatment adherence or compliance. Lack of adherence is an important problem both in general medicine and in dermatologic practice. Objective: To evaluate the impact of oral and written counseling on treatment adherence among acne patients. Patients and Methods: Eighty patients were randomized into two groups of 40 patients each. The intervention group received a patient information leaflet (apart from oral counseling), and instructions were reinforced by a telephone call within 15 days of treatment onset. The second group (control group) received treatment indications as usual (oral counseling in-office only). Both groups were followed up with a phone call, evaluating adherence to treatment according to self-reporting of patients at 30, 60, 90 days, and 6 months. Results: Better adherence to treatment was observed in the intervention group. This difference was significant only within the first month of treatment (80% versus 62%, p = 0.043). The beneficial effect of written counseling plus a phone call decreased in subsequent months. Conclusion: Written counseling significantly improves adherence within the first month of treatment. These results suggest that it is reasonable to spend time and resources in written counseling in order to optimize adherence to treatment.