Elena Vera

Telemedicina y teledermatología (II): estado actual de la investigación en teleconsulta dermatológica

Resumen El rapido incremento en el desarrollo de los servicios en telemedicina hace crucial su evaluacion critica. Este articulo revisa la evidencia actual en articulos de investigacion en teledermatologia con la suficiente calidad metodologica como para alcanzar conclusiones razonables. La revision se organiza analizando las areas de investigacion en teledermatologia: fiabilidad en el diagnostico y el manejo, validez, resultados, costes y satisfaccion. Las conclusiones de la misma indican que la teledermatologia ha demostrado ser factible y fiable pero que esta lejos de alcanzar su madurez como tecnologia medica para su practica habitual. El cuerpo de evidencia con mayor desarrollo es el area de fiabilidad en el diagnostico y el manejo, donde existen un gran numero de estudios, aunque muchos de ellos adolecen de importantes defectos metodologicos. Existen estudios de validez en oncologia cutanea con metodologia correcta que muestran unos resultados comparables con la consulta presencial. Se hace preciso el diseno de estudios en resultados de salud que permitan un analisis fidedigno de resultados finales, costes y satisfaccion de los sistemas de teledermatologia.

Telemedicine and Teledermatology (II): Current State of Research on Dermatology Teleconsultations

The rapid increase in the use of telemedicine makes a critical appraisal of these services essential. This article reviews the current evidence from studies of teledermatology with sufficiently rigorous methodology to allow reasonable conclusions to be drawn. The review is organized according to areas of research in teledermatology: reliability of diagnosis and management, accuracy, outcomes, costs, and satisfaction. The conclusion of this review is that teledermatology has been shown to be feasible and reliable but that it has a long way to go before maturing as a medical technology in daily practice. The largest body of evidence relates to the reliability of diagnosis and management, but although numerous studies have been performed, many have marked methodological shortcomings. Accuracy studies have been conducted in skin oncology with appropriate methodology that show an accuracy comparable to that of face-to-face consultations. Studies of health outcomes should be designed such that a faithful assessment of the final outcomes, costs, and satisfaction with teledermatology systems can be carried out.

Metástasis digital acral

Cutaneous metastases are infrequent and in some cases represent the first manifestation of an unknown neoplasm. Acrally located metastases are particularly rare, and the prognosis is very poor, with a survival time of only a few months. Although the clinical presentation varies, they are generally confused with an infectious or inflammatory process, which delays diagnosis. When they are located on the fingers, the most frequent cause is lung carcinoma, while those located on the toes are usually due to tumors in the genitourinary tract. The histology of the metastasis is similar to that of the primary tumor, although less differentiated. In most acrometastases, first the bone and then the skin are affected. Treatment is palliative. We present the case of a patient with a metastasis on the big toe as an initial sign of a previously unknown lung tumor.

Dermatitis alérgica de contacto en pacientes con dermatitis atópica

Introduccion . La incidencia de dermatitis alergica de contacto en sujetos atopicos es una cuestion ampliamente debatida, con estudios que apoyan la necesidad de realizar pruebas epicutaneas a estos pacientes y otros que no encuentran beneficios clinicos con esta tecnica diagnostica. Material y metodos . En nuestro estudio parcheamos un total de 594 enfermos, de los cuales 164 presentaban dermatitis atopica. Presentaban pruebas positivas 98 pacientes con dermatitis atopica (59 %). A la hora de interpretar los resultados, prestamos especial atencion a la relevancia presente, pasada o desconocida de las pruebas. Resultados . En los pacientes con dermatitis atopica y pruebas positivas; 47 pacientes (28,6 %) tenian pruebas con relevancia presente, 25 (15 %) con relevancia pasada y 26 (15,8 %) relevancia desconocida. Estos resultados indican que el 43% de los enfermos con dermatitis atopica tuvieron en algun momento de su vida, dermatitis alergica de contacto. La prueba positiva mas frecuente fue el niquel, aunque su relevancia presente fue minima. De las pruebas positivas con relevancia presente, la mas frecuente fue el cromo, le siguieron kathon, fragancias mixtas, parafenilendiamina, grupo mercapto y carbas. En cuanto a localizacion de las lesiones, el porcentaje mayor de sensibilizaciones aparece en enfermos con lesiones en el dorso de los pies, siendo la causa el cromo del calzado. En enfermos con lesiones en dorso de manos los alergenos implicados fueron el kathon, fragancias mixtas presentes en cosmeticos y el grupo mercapto en los guantes de goma. Los pacientes con eczema en cara y parpados presentaron pruebas alergicas de contacto positivas de forma excepcional. Conclusion . Nuestro estudio apoya la necesidad de parchear a los pacientes atopicos con lesiones en dorso de pies y dorso de manos por el alto grado de sensibilizaciones encontradas.

Casos clínicosAngiomixoma superficialSuperficial angiomyxoma

Superficial angiomyxomas are clinically variable, infrequent, benign skin lesions. They are usually located on the trunk, but can also appear on the lower limbs, head and neck. They are diagnosed histologically, and are characterized by the fact that they are poorly delimited, multinodular tumors, and by the presence of interstitial myxoid material with scanty cellularity. Treatment is through surgery, and local recurrence is possible. An associated Carneys complex must always be ruled out with superficial angiomyxoma. We present the case of a woman with a solitary, fast-growing superficial angiomyxoma.

Xantomas planos normolipémicos y micosis fungoide

Diffuse normolipemic plane xanthomas are characterized by the presence of yellowish plaques on the eyelids, neck, upper trunk, buttocks and flexures. Histology shows foamy histiocytes in the dermis. Approximately half of all cases are associated with hematological disorders. On rare occasions, they have been described in the context of cutaneous T-cell lymphomas. We present the case of a female patient with tumor-stage mycosis fungoides who developed normolipemic plane xanthomas coinciding with the appearance of new lymphoma lesions. We review English-language literature regarding the rare association of xanthomas and cutaneous T-cell lymphomas.

Forma cutánea difusa de erisipeloide

Resumen —El erisipeloide es una infeccion ocupacional causada por Erysipelothrix rhusiopathiae. El organismo es ubicuo, pero el reservorio mas comun es el cerdo. Existen tres formas clinicas principales descritas en humanos: el erisipeloide, la forma cutanea difusa y la sistemica. Es importante considerar la posible existencia de endocarditis asociada. Presentamos el caso de una forma cutanea difusa de erisipeloide en un varon de 63 anos, ganadero, que presentaba lesiones cutaneas anulares en dorso de mano derecha y region dorsolumbar.

Granuloma de las piscinas

Mycobacterium marinum is a causative pathogen of skin and soft tissue infections that have been called «swimming pool granulomas». Infection occurs when that microorganism is inoculated in erosive skin by exposure to contaminated water of aquariums and swimming-pools. A case of M. marinum infection of the hand is reported with successful therapeutic response to minocycline.

Hemangioendotelioma epitelioide cutáneo

Epithelioid hemangioendothelioma is a rare vascular tumor of intermediate aggressiveness, which usually appears in adults. It generally affects soft tissues and, less frequently, the lungs and liver. Diagnosis is by histological evaluation, and the epithelioid appearance of the neoplastic endothelial cells is typical, as is the tendency to form vascular channels. Treatment is surgical excision, with broad margins. This tumor may in exceptional cases affect the skin, with few cases having been described in literature. We describe the case of a male patient with plantar epithelioid hemangioendothelioma, and we review the literature.