Fernanda Teixeira

Topical isotretinoin vs. topical retinoic acid in the treatment of acne vulgaris

This is a clinical, prospective, and longitudinal study comparing the efficacy and incidence of averse effects of topical isotretinoin against those of topical retinoic acid in the treatment of acne vulgaris. The 30 participants were recruited from the patients attending the outpatient clinic of the Department of Dermatology of “Dr Manuel Gea González” General Hospital in Mexico City. They belonged to either sex and any race, their ages ranged between 13 and 30 years, and they presented with 15 to 100 facial inflammatory lesions (papulo‐pustules) and/or 15 to 100 noninflammatory lesions (comedones) and no more than three nodulo‐cystic lesions. The criteria of exclusion were as follows: pregnancy or lactation, systemic treatment with steroids, antibiotics, antiandrogens, or oral retinoids in the preceding 24 months, treatment with ultraviolet radiation, hypersensitivity to retinoids, or a severe systemic illness. From 44 interviewed patients, 14 were excluded. A detailed clinical history was obtained from the remaining individuals, the degree of seborrhea was recorded, and acne lesions were counted. Each patient received either isotretinoin gel 0.05% or retinoic acid cream 0.05%. The patients were instructed to wash their faces in the mornings and evenings with a neutral soap, and to apply the product after the evening cleansing.

Intraepidermal animal-type melanoma.

Animal‐type melanoma is a rare variant of melanoma in humans. 1 Its name is derived from its histological appearance, which is similar to that described in melanomas occurring in white or gray horses. 2 All tumors are dermally located, and characterized by a proliferation of deeply pigmented elongated or rounded cells, showing moderate atypia and a low mitotic rate. In some tumors, secondary infiltration of the epidermis has been noted. More than half of the patients are younger than 30 years, and prognosis seems to be much better than that expected for a superficial spreading or nodular melanoma of the same size. We report the first case of animal‐type melanoma in situ.

Adams-Oliver Syndrome with Widespread CMTC and Fatal Pulmonary Vascular Disease

Abstract:  We report a neonate with cutis marmorata telangiectatica congenita and clinical features of Adams–Oliver syndrome in association with severe pulmonary vascular disease. We provide an overview of cutis marmorata telangiectatica congenita, distinguishing it from cutis marmorata, a common and benign physiologic cutaneous disorder seen in neonates. We highlight the need for thorough medical evaluation in cutis marmorata telangiectatica congenita to exclude associated congenital anomalies.

A young woman with papules on the neck and axillae

1 to 14 days after exposure. Photoallergic reactions are clinically similar to allergic contact dermatitis but require light to chemically alter the medication or chemical to render it allergenic. They occur more frequently with topically applied agents, such as oxybenzone, than with systemic medications. The histopathologic changes of photoallergic reactions are identical to contact dermatitis with spongiosis in the epidermis and perivascular infiltrate of lymphocytes in the dermis. Many drugs induce photosensitivity. Examples include quinolones, tetracyclines, diuretics, nonsteroidal antiinflammatory drugs (NSAIDs), and others. The ability of a drug to act as a photosensitizer depends on its physical, chemical, pharmacokinetic, and pharmacodynamic properties. These include a low molecular weight (200-500 Daltons), planar, tricyclic, or polycyclic configurations, heteroatoms in their structure to enable resonance stabilization, and aromatic halogen substituents. The absorption maximum refers to the ability of the chemical to absorb light. The lipophilicity of a drug is an important factor in its ability to reach the skin. Doxycycline has a molecular weight of 444.4 Daltons, a tetracyclic configuration, and does not contain heteroatoms or aromatic halogen atoms. Its absorption maximum is 352 nm, which is in the UVA spectrum. The photosensitivity effect created by doxycycline is dependent on the medication dose, UVA intensity, and the skin phenotype. Demeclocycline is the strongest photosensitizer of the tetracycline group; however, it is rarely used. Tetracycline is also known to cause phototoxic reactions, but less so than doxycycline. Minocycline is minimally phototoxic. Like sunburn, phototoxic reactions usually subside within a week. Treatment is symptomatic. Avoiding the offending agent and excessive sunlight exposure is required. It is important to apply sunscreen 15 minutes before exposure and repeat at least every 2 hours. If excessive sun is difficult to avoid—as in a wintertime cruise to a high UV-light destination—discontinue the medication for several days and restart. Of note, window glass transmits sunlight above 330 nm, which is in the UVA range, and artificial room lighting contains wavelengths above 370 nm. For this series, the recommended choices are: 1, d; 2, c; 3, a.

Is there a role for myofibroblasts in hair regrowth in alopecia areata

In the normal human scalp, approximately 85% of the hair follicles are in anagen, < 1% in catagen, and about 15% in telogen. In the anagen phase, the hair follicle is located in the deep dermis or subcutaneous tissue, but when the hair enters catagen and telogen, the bulb migrates progressively upwards, until it is located just below the opening of the sebaceous gland. The follicular sheath acquires a shrunken appearance, likened to that of an empty sock, and contains a fibrous tract that links the telogen bulb, in the dermis, with the area previously occupied by the follicle when in anagen, in the deep dermis, or subcutaneous fat. After the telogen hair is lost, stem cells located at the region of the bulge proliferate, so that the follicle starts to descend again while a new hair is being formed. 1 The downward growth of the early anagen follicle occurs by direct pressure of the proliferating epithelial cells. To facilitate this movement and to loosen the fibrous tract inside the follicular sheath, the epithelial cells produce collagenases that degrade the extracellular matrix in a controlled manner. 2,3