Francisco Zúñiga Urbina

Circumscribed palmar hypokeratosis: clinical evolution and ultrastructural study after prolonged treatment with topical calcipotriol.

Circumscribed palmar hypokeratosis is a recently described condition that consists of a solitary area of depressed skin affecting the palm (or sole). Its histopathological features include a thinned horny layer, a slightly diminished granular cell layer, and intraepidermal vacuolated cells. Prolonged treatment with topical calcipotriol resulted in complete recovery of the affected zone in the case reported here. A second biopsy of the lesion taken at around the fourth year of therapy showed a normalization of the granular layer, a reduction in the intraepidermal vacuolated cells, and a somewhat thicker horny layer. An ultrastructural study carried out at the same time showed a reduction in keratin bundles and keratohyalin granules, and an increase in lipid droplets up to the horny layer. These findings and the therapeutic response to topical calcipotriol support the concept that circumscribed palmar hypokeratosis is a focalized abnormal keratinization defect morphologically expressed at the granular and horny layers.

Calcificación y osificación cutánea

Resumen —La calcificacion cutanea es un trastorno infrecuente caracterizado por el deposito de sales insolubles de calcio en la piel. Puede clasificarse en distrofica, metastasica e idiopatica. La calcificacion distrofica es el tipo mas comun y aparece en tejidos previamente danados, asociandose a una amplia variedad de trastornos inflamatorios neoplasicos, traumaticos o a enfermedades del tejido conectivo. La variedad metastasica aparece en pacientes con niveles plasmaticos elevados de calcio y/o fosforo. En la calcificacion idiopatica no existen evidencias de anomalias tisulares o de metabolismo fosfocalcico; son caracteristicos de este grupo el nodulo calcificado subepidermico, la calcificacion de los cartilagos auriculares, la calcificacion miliar asociada al sindrome de Down, la calcinosis tumoral y la calcificacion escrotal idiopatica. La osificacion cutanea puede ser primaria o secundaria. La primera es infrecuente y no existe lesion cutanea previa; incluye a la osteodistrofia hereditaria de Albright, la heteroplasia osea progresiva y distintas variedades de osteoma cutaneo: osteoma diseminado, osteoma en placa, osteoma solitario pequeno y osteoma miliar multiple de la cara. La osificacion secundaria aparece en lesiones preexistentes, comunmente asociada a cicatrices, tumores y diversos procesos inflamatorios.

CADASIL presenting with a movement disorder: A clinical study of a Chilean kindred

Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is a hereditary vascular disease that usually begins with migraine, followed by repeated strokes and progressive dementia. We describe an unusual clinical presentation of this condition in members of a Chilean family with an established NOTCH3 mutation. We report early clinical, neuropsychological, transcranial ultrasound, magnetic resonance imaging (MRI), cerebral blood flow, and skin biopsy findings on these patients. Of the patients, 2 presented with facial dystonia, 1 of whom had abnormal single photon emission computed tomography and transcranial ultrasound studies after normal brain MRI scans. Our report emphasizes that CADASIL must be considered in the study of patients with secondary dystonia.

Photolocalized purpura during ciprofloxacin therapy

Photosensitivity reactions reported with ciprofloxacin mimic those of sunburn, with erythema and edema in the milder forms, and painful blistering with subsequent peeling when severe. Purpuric eruptions during treatment with ciprofloxacin have been rarely reported. We describe a 30‐year‐old man who was given a 15‐day course with ciprofloxacin 500 mg twice a day for a prostatitis. Coinciding with sun exposure, he developed a purpuric, pruriginous eruption on his lower extremities, consisting of erythematous, petechial lesions located on the anterior aspect of his thighs and legs, clearly delimited by his bathing suit. The lesions cleared completely after the discontinuation of the drug and treatment with topical clobetasol. The acute reaction observed in our patient differed from a classical sunburn, consisting of confluent petechias, strictly limited to sunlight‐exposed areas, and accompanied by pruritus. Photoexposed purpuric eruptions should be considered as another side effect of ciprofloxacin therapy in addition to phosensitivity rashes.

Open comedones overlying granuloma annulare in a photoexposed area

A 57‐year‐old, fair‐skinned female patient with lesions of granuloma annulare located on her forearms – with signs of actinic damage – is described. No response was observed after successive treatments with topical corticosteroids and oral pentoxifylline. Four years later, the patient developed open comedones on the rim of granuloma annulare lesions. The loss of elastic fibers seen in both granuloma annulare and solar elastosis is presumed to have induced the appearance of open comedones, because of a loss of supporting properties of the dermis inducing a distension of the infundibular canal of the sebaceous follicle, as seen in the Favre–Racouchot disease and actinic comedonal plaque. Concomitantly, the patient developed insulin‐dependent diabetes mellitus. Treatment with insulin resulted in the disappearance of open comedones and notably regression of lesions of granuloma annulare. Response to insulin therapy in our case supports the hypothesis that insulinopenia could participate in the development of granuloma annulare in some cases.

EL PRINCIPIO DE RAZONABILIDAD EN LA JURISPRUDENCIA DEL TRIBUNAL CONSTITUCIONAL

Si bien el Derecho nos ofrece siempre varias soluciones posibles aplicables a un caso o situacion, la determinacion de cual de ellas es la mas adecuada es lo mismo que preguntarse cual de todas ellas es la mas razonable. En este trabajo se analizara el origen del principio de razonabilidad y la forma en que ha sido desarrollado en Estados Unidos. Asimismo, se senalara la forma en que este principio ha sido recogido en nuestra Constitucion, y como ha sido aplicado por la jurisprudencia de nuestro Tribunal Constitucional, para finalmente extraer un listado de criterios de razonabilidad emanados de dicha jurisprudencia.

Foliculitis por Demodex folliculorum: forma pigmentada

Resumen Se describe una variedad distintiva e infrecuente de foliculitis por Demodex folliculorum . Las lesiones clinicas consistian en maculas hiperpigmentadas asintomaticas, no descamativas, distribuidas bajo el menton. El estudio histopatologico mostro dilatacion folicular, inflamacion perifolicular linfohistiocitaria e infestacion folicular por Demodex folliculorum . Se observo una curacion completa de las lesiones tras tratamiento con metronidazol topico.

COMENTARIO A LA SENTENCIA DE LA CORTE INTERAMERICANA DE DERECHOS HUMANOS, CASO "ATALA RIFFO Y NIÑAS VS. CHILE", DE 24 DE FEBRERO DE 2012

El trabajo es un comentario a la sentencia dictada por la Corte Interamericana de Derechos Humanos, que decide acerca de la vulneracion a los derechos humanos, producida por la sentencia de la Corte Suprema de Chile, que priva a Karen Atalla Riffo de la tuicion de sus hijas por convivir, en una relacion homosexual, con otra mujer.

CONTROL DE CONSTITUCIONALIDAD DE AUTOS ACORDADOS

El autor analiza el problema de constitucionalidad de autos acordados de los tribunales superiores de justicia segun la doctrina jurisprudencial del Tribunal Constitucional, que somete a critica.

Constitución y ley interpretativa. Algunas notas sobre una paradoja y peligros relativos a este tipo de ley

El trabajo se aproxima al tema de la interpretacion de la Constitucion a traves de la “ley interpretativa”, nuevo tipo de ley incorporada a la taxonomia del articulo 66, y que posee, dada su naturaleza o contenido material, un caracter excepcional y limitado, no exenta de paradojas y peligros.