Gastón Galimberti

Cutaneous necrosis by calcific uremic arteriolopathy.

Background  Calcific uremic arteriolopathy is a rare and serious disorder characterized by systemic medial calcification of the arteries and tissue ischemia. Most often it is found in patients with chronic renal failure on dialysis and in renal transplant recipients with secondary hyperparathyroidism.

Disseminated strongyloidiasis in immunocompromised patients – report of three cases

Background  Strongyloides stercoralis is an intestinal nematode of humans. The characteristic cutaneous manifestation of strongyloidiasis is larva currens. Patients with suppressed immunity can develop a severe disseminated strongyloidiasis involving wide spread of the larvae to extraintestinal organs, outside the usual migration pattern. Patients with cell‐mediated immunodeficiency and on corticosteroid therapy appear to be at highest risk for the development of this highly fatal entity.

Outcomes in 11 patients with dermatofibrosarcoma protuberans treated with Mohs micrographic surgery

Background  Dermatofibrosarcoma protuberans (DFSP) is an uncommon intermediate‐grade fibrohistiocytic sarcoma. It occurs most often in adults aged 20–50 years and is associated with local invasion and a high recurrence rate. Uncontrolled local disease or metastases may result in death. Treatment has involved wide excision, Mohs micrographic surgery (MMS) and other approaches. The purpose of the current study was to review our experience with MMS in the treatment of patients with DFSP over the past six years.

Síndrome de Sweet asociado a neoplasias

Sweets syndrome was described in 1964 by Robert Douglas Sweet, as an entity he named acute febrile neutrophilic dermatosis. It is characterized by five main features: 1) sudden appearance of erythematous and tender plaques on the face, neck and extremities; 2) fever; 3) polymorphonuclear leukocytes; 4) predominantly neutrophilic dense infiltrate in the dermis, and 5) rapid response to steroid therapy. Sweets syndrome can be classified into five groups: idiopathic, parainflammatory, paraneoplastic, drug-induced, and pregnancy-related. Twenty percent of cases are associated with malignancies; 85% out of them involve hematologic alignancies and the remaining 15%, solid tumors. A series of seven cases of Sweets syndrome associated with neoplasms which were diagnosed from 2002 to 2006 is presented. Six cases were related to oncohematologic diseases and one to solid tumors. These results highlight the importance of the diagnosis of the syndrome, since it may predict tumor relapse or underlying disease progression. The timely use of diagnostic and treatment methods may improve the quality of life of these patients. The fact that oncology patients take multiple medications (a colony-stimulating factor) which may be associated with the onset of this entity must also be considered in excluding possible causes.

Daylight-mediated photodynamic therapy for actinic damage in Latin America: consensus recommendations.

Although conventional photodynamic therapy (c‐PDT) using methyl aminolevulinate cream (MAL) is effective for the treatment of grade I‐II facial and scalp actinic keratosis (AK), it is associated with treatment‐related pain for some patients. Daylight‐mediated PDT (DL‐PDT) has shown similar efficacy to c‐PDT, was nearly painless, and was well tolerated. Overall, DL‐PDT effectively treats AK and offers a simpler and better tolerated treatment option than c‐PDT. This consensus panel provided recommendations on the use of DL‐PDT in Latin America (LATAM) for the treatment of actinic damage associated with few or multiple AKs. The panel was comprised of eight dermatologists from different LATAM countries who have experience using PDT for the treatment of actinic damage. The panel reviewed the relevant literature and provided personal expertise with regard to using DL‐PDT for the treatment of photodamage with or without AK. The recommendations formulated by the expert panel provide evidence‐based guidelines on all aspects of DL‐PDT for the treatment of actinic damage associated with AK in different regions of LATAM. These recommendations provide guidance for dermatologists to ensure maintenance of efficacy and safety of DL‐PDT when treating actinic damage, associated with few or multiple AKs in sun‐exposed skin.

Lymphocutaneous nocardiosis and cutaneous pheohyphomycosis in a liver transplant recipient.

Background  Infections are the leading cause of morbidity and mortality in transplanted patients. The increasing number of immunocompromised patients has not only augmented infections by specific pathogens, but also by opportunistic microbial agents.

Structured Expert Consensus on Actinic Keratosis: Treatment Algorithm Focusing on Daylight PDT

Background: A practical and up-to-date consensus among experts is paramount to further improve patient care in actinic keratosis (AK). Objectives: To develop a structured consensus statement on the diagnosis, classification, and practical management of AK based on up-to-date information. Methods: A systematic review of AK clinical guidelines was conducted. This informed the preparation of a 3-round Delphi procedure followed by a consensus meeting, which combined the opinions of 16 clinical experts from 13 countries, to construct a structured consensus statement and a treatment algorithm positioning daylight photodynamic therapy (dl-PDT) among other AK treatment options. Results: The systematic review found deficiencies in current guidelines with respect to new AK treatments such as ingenol mebutate and dl-PDT. The Delphi panel established consensus statements across definition, diagnosis, classification, and management of AK. While the diagnosis of AK essentially rests on the nature of lesions, treatment decisions are based on several clinical and nonclinical patient factors and diverse environmental attributes. Participants agreed on ranked treatment preferences for the management of AK and on classifying AK in 3 clinical situations: isolated AK lesions requiring lesion-directed treatment, multiple lesions within a small field, and multiple lesions within a large field, both requiring specific treatment approaches. Different AK treatment options were discussed for each clinical situation. Conclusions: The results provide practical recommendations for the treatment of AK, which are readily transferable to clinical practice, and incorporate the physician’s clinical judgement. The structured consensus statement positioned dl-PDT as a valuable option for patients with multiple AKs in small or large fields.

Mohs Micrographic Surgery for the Treatment of Basal Cell Carcinoma

INTRODUCTION Basal cell carcinoma accounts for 75% of all nonmelanoma skin cancer. Although various treatment modalities are available, the most frequently used option is surgical excision. Here, we evaluate the efficacy of Mohs micrographic surgery for the treatment of basal cell carcinoma. MATERIAL AND METHODS A retrospective review of cases of basal cell carcinoma treated with Mohs micrographic surgery between October 2003 and June 2009 was performed using patient records from Hospital Italiano in Buenos Aires, Argentina. RESULTS A total of 2412 basal cell carcinomas treated with Mohs micrographic surgery were identified; 50.5% were in women and 49.5% in men. The mean age of the patients was 70.7 years (range, 8-100 years). The histologic type of the tumor was solid in 65.3% of cases and in 89% of cases the tumor was located on the head or neck. Ten percent of the tumors were recurrent following previous treatment. A mean of 1.74 Mohs stages were used, with a mean of 3.81 sections. The mean size of the initial defect was 0.86 cm² and the mean final defect was 1.88 cm². The ratio of initial tumor size to final defect was estimated at 1.02. Over a mean follow-up of 32 months, there were 9 cases of tumor recurrence (0.37%). CONCLUSIONS In our experience, Mohs micrographic surgery is effective for the treatment of high-risk basal cell carcinoma.

Feasibility of daylight-mediated photodynamic therapy for actinic keratosis throughout the year in Central and South America: a meteorological study.

Daylight‐mediated photodynamic therapy (DL‐PDT) is an efficacious treatment option for thin actinic keratosis (AK) that offers advantages over conventional PDT in terms of tolerability, treatment duration, and cost. A clinical study conducted in Australia determined the mean irradiance during a 2‐hour exposure to be 305.8 W/m2 (range: 40–585 W/m2). The protoporphyrin IX light dose is influenced by latitude, weather conditions, and time of year. A recent study of meteorological data concluded that DL‐PDT can be performed effectively throughout the year in Australia.

Nephrogenic fibrosing dermopathy

We report a 19-year-old man with end-stage renal disease undergoing haemodialysis. He suffered from familial HUS and had been on haemodialysis since January 2004. After a corrective angioplastia of his left arm arteriovenous fistulae, he developed fever, oedema and limited mobility of extremities as well as myalgias. He had previously undergone magnetic resonance imaging with gadolinium containing contrast agents. An initial laboratory workup showed anaemia, hyperkalemia, hypercalcemia, hyperphosphatemia and increased ESR; bacterial, fungal and viral infections were ruled out. Due to severe and persistent hypercalcemia, pamidronate was administered. Calcium levels remained within normal limits. On physical examination, he presented global muscle atrophy with stiffness and flexion contractures in knees, hips and elbows. He had significant functional limitations and became unable to walk. The skin was thickened and indurate with brownish-grey, 4-mm-diameter, confluent, round papules with slightly desquamate area in lower extremities (fig. 1) and arms. A punch biopsy of the skin was done and showed dermal hyalinization and fibrosis with thickened collagen bundles (fig. 2). The immunohistochemical analysis showed the presence of numerous spindle CD 34 cells in dermis. All these findings were consistent with NFD. He was treated with methylprednisone 40 mg/day, anti–tumour necrosis factor monoclonal antibodies (etanercept) and 2 g/day mycophenolate mofetil. Muscle and joint pain disappeared, and flexion stiffness and skin lesions partially resolved. To our knowledge, this is the first case of familial HUS-associated NFD described in literature. The pathogenesis of NFD is still poorly understood. 1,3,4