Josefa Novales

Polymorphous light eruption: Treatment with thalidomide.

Epidemiological, clinical, aetiological and therapeutic aspects of polymorphous light eruption, a very common disease in Mexico, are reviewed. Twenty‐five patients with this disease were treated with thalidomide over a period of 45 to 150 days with a dose depending on age: 100 to 200 mg a day. The results were satisfactory in 88% of the cases without any important side‐effect. The teratogenic action of the drug is stressed and the authors think that although the action mechanism of the drug remains unknown, it may shed new light on the understanding and treatment of this disease.

Cutaneous histoplasmosis associated with acquired immunodeficiency syndrome (AIDS).

A 30‐year‐old man, who had originally been admitted to the Centro Dermatológico Pascua for medical attention and was later transferred to the Hospital General de México, presented with a 2‐month history of progressive dermatosis affecting the head (face, ear lobes, oral cavity), trunk (all faces), upper and lower limbs (including the palms and soles), external genitalia, and the perianal region. The patient had no history of homosexuality, but did have a long history of sexual intercourse with prostitutes in the city of Ciudad del Carmen (island in southeastern Mexico), where he was born and lives. The dermatosis consisted of multiple nodules and ulcerative lesions, some of them isolated and others with junctions between them, forming verrucous plaques. He complained of mild pruritus and pain. The lesions had first appeared on the face and, over the course of 2 months, had increased in size and number and were accompanied by malaise, fever, and loss of 6 kg of body weight ( Fig. 1 ). The presumptive clinical diagnosis was leishmaniasis, an endemic disease in the area where he lives. Laboratory parameters at presentation included the following: hemoglobin 11.5 g/dL; hematocrit 34%; white blood cells (WBC) total 7900 cells/mm3 ; lymphocytes total 1414 cells/mm3 ; platelets 449,000/mm3 ; CD4+ lymphocytes 1.5% and CD8+ lymphocytes 81.0%, with a CD4/CD8 ratio of 0.18 cells/mm3. Blood chemistry, hepatic function tests, and serum electrolyte determinations were all within normal ranges. A chest roentgenogram was also normal. Human immunodeficiency virus (HIV) seropositivity was tested by enzyme‐linked immunosorbent assay (ELISA) and confirmed by Western blot.

Multiple myeloma and systemic amyloidosis.

A 66-year-old male patient, a resident of Villa Guerrero, Estado de México, México, was seen in the “Dr Ladislao de la Pascua” Dermatologic Center in Mexico City with a 10-year history of asymptomatic condylomatous tumors with gradual increase in size in the perianal region (Fig. 1). He also had a 4-year history of purpuric and pedunculated lesions on his upper eyelids treated twice with ocular surgery (Fig. 2). He gave a 10-year history of diabetes mellitus under treatment with glipizide and 1-year history of hypertension under treatment with enalapril. In the past months he had become increasingly tired, noticed hoarseness and difficulty in swallowing, experienced paresthesia of lower legs but denied weight loss. Physical examination revealed poor general condition and a mass on the anterior neck. With this information we provided a diagnosis of paraneoplastic dermatosis and requested laboratory tests and skin biopsies from both the perianal region and upper eyelids. Laboratory findings were as follows: hemoglobin, 10.2 g/dL; hematocrit, 32%; erythrocyte sedimentation rate, 40 mm/h; aspartate aminotransferase, 39 U/L; alanine aminotransferase, 75 U/L; alkaline phosphatase, 111 U/L; total protein, 8.1 g/dL; albumin, 3.2 g/dL; globulin, 5.21 g/dL; urea, 48 mg/dL; creatinine, 1.8 mg/dL; and blood urea nitrogen (BUN), 22.5 mg/dL. Thyroid profile with T 3 ,

Lucio’s leprosy: A clinical and therapeutic challenge

Leprosy has been a challenge in different areas of medicine; in underdeveloped countries it remains a public health problem, in which the social and economic problems facilitate the disease persistence. The diagnosis and consequently the treatment are delayed due to the clinical polymorphism of leprosy, which especially at the beginning the manifestations are not as evident, as is the case of diffuse lepromatous leprosy. This favors the disabilities and the development of the reaction episodes. Fortunately, reaction episodes have decreased with the use of multidrug therapy, and better control of the type 2 reactions has been managed with the use of thalidomide, as in Lucios phenomenon.