Leonel Fierro-Arias

Mycetoma in Children: Experience With 15 Cases

Background: Mycetoma is a chronic infection caused by aerobic actinomycetes and filamentous fungi. It is an occupational disease frequent in tropical countries and is uncommon in children. Methods: A retrospective (25 years) report of mycetomas was conducted in children less than 15 years of age. Each of the cases was studied clinically and proven with microbiologic tests: direct examinations (to identify and classify the grains), cultures and identification based on morphology and biochemical tests. The therapeutic experience of the cases was also reviewed. Results: In a 25-year period, a total of 334 mycetomas were seen at our institution, 15 of which (4.5%) were in patients 15 years of age and younger (mean age: 11.2 years, age range: 6–15 years). Twelve cases were males and 3 females. The main clinical location was the foot in 10 of 15 (66.6%). Etiologies included 13 actinomycetomas and 2 eumycetomas. Etiologic agents were Nocardia brasiliensis in 12 cases, Nocardia asteroides in one and Madurella mycetomatis in 2. Eleven of the13 cases of actinomycetomas treated with trimethoprim–sulfamethoxazole plus diaminodiphenylsulfone were cured. The 2 failures were successfully treated with amoxicillin/clavulanate. One of the eumycetomas was cured with itraconazole therapy, whereas the other failed various treatments eventuating in surgical amputation. Conclusions: Mycetomas are exceptional in children; in our setting, actinomycetomas are more frequent than eumycetomas. The clinical and microbiologic diagnosis is simple. Overall, treatment response is better for actinomycetomas than for eumycetomas.

Periungual Eccrine Poroma

Background: Eccrine poroma is a rare, benign skin appendage tumor originating from the intraepidermal portion of the eccrine sweat duct, which typically occurs on the sides and soles of the feet. Nonetheless, eccrine poroma may be found in any skin area bearing sweat glands. Objective: Herein we report a case of an eccrine poroma in an unusual location, the surgical management of the condition, and follow-up processes.

Cutaneous disseminated sporotrichosis: clinical experience of 24 cases

Sporotrichosis is a subcutaneous mycosis, caused by complex Sporothrix schenckii, It is the most common implantation mycoses in worldwide. It is a polymorphic disease, cutaneous-lymphatic is the most frequent (75-90%).1-3 We report our 25 years’ experience (1990-2015) in cutaneous disseminated sporotrichosis (CDS). We conducted, an open, retrospective and observational study. This article is protected by copyright. All rights reserved.

Giant onychomatricoma in third toe: exceptional condition with surgical resolution

UVA-induced solar urticaria unresponsive to omalizumab. A 64-year-old Caucasian woman presented with a 28-year history of severe solar urticaria. Wheals developed within 3 min of exposure to sunlight, including through window glass. Sunlight exposure repeatedly provoked systemic symptoms with nausea and cardiovascular reactions. The relevant induction spectrum was found to lie between 340 and 400 nm (UVA1). The minimal dose was positive at 10 J/cm and a profound urticarial response was elicited in all test fields. Intradermal skin test with UVAirradiated autologous serum was positive implicating the presence of a serum factor. FBC, ANA, liver and renal profiles were normal. Serum IgE was 12,6 kU/L. Treatment with sunscreens, antihistamines, including high-dose desloratadine 20 mg/die in combination with ranitidine 300 mg/die was ineffective. Light hardening with narrow band UVB over 6 months resulted in marginal, short-lived reduction in symptoms. Two grams of Mycophenolate mofetil daily showed no effect and nine cycles of plasmapheresis resulted in only very transient improvement in the severity of symptoms. Omalizumab was commenced at a dose of 150 mg every 4 weeks. Following three treatment cycles, she reported no improvement, in contrast she felt symptoms had worsened. On repeat phototesting she developed urticae in all test fields, which spread to involve adjacent non-exposed skin within 2–3 min. Within 5 min, she developed generalized urticaria with associated dizziness and nausea. Vital signs remained stable and i.v. treatment with dimetindenmaleat (4 mg) resulted in resolution of her symptoms. Omalizumab was discontinued and treatment other than desloratadine and sunscreens was refused. In solar urticaria, a chromophore in the serum or skin of affected individuals is suggested to be altered as a result of exposure to an individual light spectrum and to act as mast cell activator in an IgE-dependent fashion. We report a case of UVA-induced solar urticaria unresponsive to omalizumab confirmed by a systemic response to phototesting with UVA light following three treatment cycles with omalizumab. Three cases of complete response of solar urticaria with omalizumab and one case with partial improvement have been reported. More recently, a case similar to ours was reported where solar urticaria failed to respond to omalizumab. As in our case, intradermal testing with UV-irradiated autologous serum confirmed the presence of a serum factor. Serum factor-positive solar urticaria patients generally have a poorer prognosis than those where no serum factor is identified. It is possible that these patients are more resistant to treatment with omalizumab. Dose finding studies regarding the treatment of chronic spontaneous urticaria with omalizumab have shown a dosage of 300 mg 4-weekly to be most effective. Thus, our patient may have responded better to higher dose omalizumab, however, on account of her subjective deterioration and systemic response to UVA phototesting she refused any further treatment with omalizumab. In conclusion, omalizumab may not always be effective in solar urticaria. Detailed characterization of patients with solar urticaria and central data collection may be required to establish biomarkers that allow us to predict treatment response to omalizumab in this exceedingly rare condition.

Estudio sobre la satisfacción laboral y la felicidad en médicos dermatólogos

Objective: To assess the level of happiness and satisfaction in the life and medical practice of dermatologists in Mexico. Method: A descriptive study (online survey) was conducted focused on practicing dermatologists in our country. Questions included demographic characteristics, the Pemberton happiness index (with local validation) and questions that assessed the degree of personal satisfaction. Descriptive statistics were used to obtain the central tendency and dispersion. Measures of central tendency and dispersion were performed; to compare categorical variables, contingency tables for chi-square test were used and when comparing quantitative variables with normal distribution, Student’s t t-test was used. Results: 219 surveys were included, 72.6% female and 27.4% male, with an average age of 45.6 and an average of 16 years of medical practice. Most of them (64.8%) graduate from Mexico City; 93% were very satisfied with the specialty and 98.6% of them would choose the same once again, the most important reason is to encompass medical and surgical areas. The level of happiness by using the Pemberton scale was “high” (mode: 9.11; standard deviation: 1.73). Conclusions: This first study in Latin America on this subject in dermatologists showed high levels of satisfaction and happiness in both professional and personal areas.

Fungal Leukonychia and Melanonychia: a Review

Fungal leukonychia is a common condition in immunosuppressed patients; the most common clinical forms are white superficial and proximal white superficial onychomycosis. It is frequently associated with Trichophyton mentagrophytes var. interdigitale and with Trichophyton rubrum. The diagnosis can be easily made by direct examination and culture. Fungal melanonychia is the nail plate pigmentation caused by fungal infections. The most frequently isolated fungi is T. rubrum and melanized molds like Neoscytalidium dimidiatum. The main differential diagnosis is malignant melanoma, although other causes include subungueal hematomas, exogenous pigmentation, and bacterial infection. If homogeneous pigmentation in lines or structureless discoloration, and the absence of melanin inclusions are seen by dermoscopy, diagnosis must be complemented with KOH preparations and cultures.