Ingrid Aguayo-Leiva

Intralymphatic granulomas as a pathogenic factor in cheilitis granulomatosa/Melkersson-Rosenthal syndrome: report of a case with immunohistochemical and molecular studies.

Orofacial granulomatosis, an uncommon immunologically mediated disorder, includes cheilitis granulomatosa and Melkersson-Rosenthal syndrome. It is clinically characterized by recurrent or persistent swelling of the orofacial tissues with a spectrum of other orofacial features and sometimes with neurological symptoms. The pathological findings are varied but are often characterized by the presence of noncaseating granuloma. We present a new case of orofacial granulomatosis with unusual histopathological findings, namely, intralymphatic granulomas. These may be the cause of the tissue edema. We demonstrated, by immunohistochemical studies, the lymphatic nature of the vessels affected by the granulomatous process.

Surgical vs nonsurgical treatment of basal cell carcinoma

Numerous therapeutic options are now available for the treatment of basal cell carcinoma. However, few randomized controlled trials with 5-year follow-up have compared the effectiveness of the different treatments. Such a comparison is difficult, probably because efficacy depends on several factors: those related to the tumor, the patient, the technique, and the dermatologists experience. We first describe the available therapeutic options, including certain innovative treatments. We have divided them into 2 main groups-surgical and nonsurgical-and focus on the indications, advantages, and disadvantages of each one, as well as on the cure and recurrence rates. Then, based on the evidence reviewed, we attempt to provide an outline of the therapeutic strategies recommended in basal cell carcinoma, and the approach to be used in specific situations. We also describe our own experience.

Teledermatología diferida: análisis de validez en una serie de 2.000 observaciones

BACKGROUND AND OBJECTIVES The aim of this study was to assess the validity of store-and-forward teledermatology as a tool to support physicians in primary care and hospital emergency services and reduce the requirement for face-to-face appointments. Diagnostic validity and the approach chosen for patient management (face-to-face vs teledermatology) were compared according to patient origin and diagnostic group. MATERIAL AND METHODS Digital images from 100 patients were assessed by 20 different dermatologists and the diagnoses offered were compared with those provided in face-to-face appointments (gold standard). The proposed management of the different groups of patients was also compared. RESULTS The percentage complete agreement was 69.05% (95% confidence interval [CI], 66.9%-71.0%). The aggregate agreement was 87.80% (95% CI, 86.1%-89.0%). When questioned about appropriate management of the patients, observers elected face-to-face consultation in 60% of patients (95% CI, 58%-61%) and teledermatology in 40% (95% CI, 38%-41%). Diagnostic validity was higher in patients from primary care (76.1% complete agreement and 91.8% aggregate agreement) than those from hospital emergency services (61.8% complete agreement, 83.4% aggregate agreement) (p < 0.001) and teledermatology was also chosen more often in patients from primary care compared with those from emergency services (42% vs 38%; p=0.003). In terms of diagnostic group, higher validity was observed for patients with infectious diseases (73.3% complete agreement and 91.3% aggregate agreement) compared to those with inflammatory disease (70.8% complete agreement and 86.4% aggregate agreement) or tumors (63.0% complete agreement and 87.2% aggregate agreement) (p <0.001). Teledermatology was also chosen more often in patients with infectious diseases (52%) than in those with inflammatory disease (40%) or tumors (28%) (p <0.001). CONCLUSIONS Store-and-forward teledermatology has a high level of diagnostic validity, particularly in those cases referred from primary care and in infectious diseases. It can be considered useful for the diagnosis and management of patients at a distance and would reduce the requirement for face-to-face consultation by 40%.

The quadrivalent human papillomavirus vaccine: erythema multiforme and cutaneous side effects after administration.

The quadrivalent human papillomavirus (qHPV) vaccine, the first vaccine for use in the prevention of cervical cancer and condyloma acuminatum, was approved in June 2006. In 2008, the mass media reported suspected links between the qHPV vaccine and serious adverse events; however, several studies have found that the vaccine is safe and the main adverse events are mild local reactions. Erythema multiforme (EM) is an acute self-limited cutaneous or mucocutaneous syndrome characterized by the abrupt onset of symmetric target lesions. The clinical manifestations and histological features of EM, Stevens-Johnson syndrome and toxic epidermal necrolysis show considerable overlap, and they are classically considered to represent a spectrum of skin disorders. We present a case of EM following qHPV vaccination to review the cutaneous side effects of this vaccine and the possibility of more serious side effects with the administration of booster doses.

Store-and-Forward Teledermatology: Assessment of Validity in a Series of 2000 Observations

Background and objectives: the aim of this study was to assess the validity of store- and-forward teledermatology as a tool to support physicians in primary care and hospital emergency services and reduce the requirement for face-to-face appointments. Diagnostic validity and the approach chosen for patient management (face-to-face vs teledermatology) were compared according to patient origin and diagnostic group. Material and methods: Digital images from 100 patients were assessed by 20 different dermatologists and the diagnoses offered were compared with those provided in face-to- face appointments (gold standard). the proposed management of the different groups of patients was also compared. Results: the percentage complete agreement was 69.05% (95% confidence interval (ci), 66.9%-71.0%). the aggregate agreement was 87.80% (95% ci, 86.1%-89.0%). When questioned about appropriate management of the patients, observers elected face-to- face consultation in 60% of patients (95% ci, 58%-61%) and teledermatology in 40% (95% ci, 38%-41%). Diagnostic validity was higher in patients from primary care (76.1% complete agreement and 91.8% aggregate agreement) than those from hospital emergency services (61.8% complete agreement, 83.4% aggregate agreement) (P<.001) and teledermatology was also chosen more often in patients from primary care compared with those from emergency services (42% vs 38%; P =.003). in terms of diagnostic group, higher validity was observed for patients with infectious diseases (73.3% complete agreement and 91.3% aggregate agreement) compared to those with inflammatory disease (70.8% complete agreement and 86.4% aggregate agreement) or tumors (63.0% complete agreement and

Lichenoid red tatoo reaction and alopecia areata.

Lichenoid red tatoo reaction and alopecia areata Considering the ever increasing popularity of tattoos, significant adverse reactions remain unusual. The introduction of a foreign substance into the skin can promote a toxic or immunologic response. This reaction is more common with red ink, and the commonest histologic type shows a lichenoid pattern. The infiltrate may be indistinguishable from idiopathic lichen planus (LP), and classical lesions of LP distant to the site of the tattoo reaction have been described in some patients. Frequent associations between alopecia areata (AA) and immune-mediated cutaneous disorders have been reported. We report a case in which a lichenoid reaction to red ink in a tattoo developed in association with AA on the beard. A healthy 31-year-old man presented with a four-week history of indurated papules on the right arm. The affected area corresponded exactly to the red area of a tattoo, which he had acquired six months before. It was painful and intensely pruritic. Examination revealed erythema, swelling, and induration limited to the red areas of the tattoo (Fig. 1a); other colors were unaffected. At the same time, the patient developed a single patch of nonscarring hair loss over the beard, which was diagnosed as AA (Fig. 1b). Patch testing was negative to the standard battery. Biopsy of the affected area revealed a lichenoid reaction (Fig. 2a). The histologic features comprised a band-like inflammatory cell infiltrate with eosinophilic cytoid bodies, basal cell liquefactive degeneration, pigmentary incontinence, hyperqueratosis, wedge-shaped hypergranulosis, and irregular acanthosis (Fig. 2b). The patient was treated with intradermal triamcinolone in the tattoo affected areas with steady improvement after three sessions. Although no treatment was directly applied to the AA plaque, it showed complete hair restoration at the second treatment session. Any tattoo pigment can present allergic reactions. These reactions are more common with red ink, containing mercury-related compounds. 1 Various histologic tattoo reaction patterns are recognized, but the commonest shows a lichenoid pattern. Evidence exists that the lichenoid reaction in tattoos is an expression of delayed hypersensitivity to a lymphocytic T-cell infiltrate, which may simulate the graft-vs.-host response. Pinkus suggested that some of the pigmentary lichenoid reactions, which are similar to the contact LP produced by color developers, were attributable to an unknown environmental agent. The development of intense lichenoid reactions in these tattooed patients raises the possibility that mercury or some other foreign material may occasionally ‘‘trigger’’ a localized form of LP in tattoo areas. In this report, we describe, to our knowledge the first case of association between a lichenoid red tattoo reaction and AA. However, many cases of associations between AA and immune-mediated cutaneous disorders including LP have been described previously. The association of AA and LP is well known. Both diseases are autoimmune. Patients with AA were found to be at a (a)