Maira Elizabeth Herz-Ruelas

Therapeutic evaluation of UVB-targeted phototherapy in vitiligo that affects less than 10% of the body surface area*

Background  Current treatments for vitiligo include different therapeutic modalities, such as corticosteroids, immunomodulators, pseudocatalase, skin grafts, diverse types of phototherapy [ultraviolet B (UVB), psoralen plus UVA (PUVA), narrow‐band UVB (NB‐UVB)], and, recently, targeted phototherapy. After a literature search, we found only two studies using different targeted broad‐band UVB units for the treatment of vitiligo.

Crusted Demodicosis in an Immunocompetent Pediatric Patient

Demodicosis refers to the infestation by Demodex spp., a saprophytic mite of the pilosebaceous unit. Demodex proliferation can result in a number of cutaneous disorders including pustular folliculitis, pityriasis folliculorum, papulopustular, and granulomatous rosacea, among others. We report the case of a 7-year-old female presenting with pruritic grayish crusted lesions over her nose and cheeks, along with facial erythema, papules, and pustules. The father referred chronic use of topical steroids. A potassium hydroxide mount of a pustule scraping revealed several D. folliculorum mites. Oral ivermectin (200 μg/kg, single dose) plus topical permethrin 5% lotion applied for 3 consecutive nights were administered. Oral ivermectin was repeated every week and oral erythromycin plus topical metronidazole cream was added. The facial lesions greatly improved within the following 3 months. While infestation of the pilosebaceous unit by Demodex folliculorum mites is common, only few individuals present symptoms. Demodicosis can present as pruritic papules, pustules, plaques, and granulomatous facial lesions. To our knowledge, this is the first reported case of facial crusted demodicosis in an immunocompetent child. The development of symptoms in this patient could be secondary to local immunosuppression caused by the chronic use of topical steroids.

Lichen planus pigmentosus and its variants: Review and update

Lichen planus pigmentosus (LPP) is considered a rare variant of lichen planus (LP). It is characterized by acquired dark brown to gray macular pigmentation located on sun‐exposed areas of the face, neck, and flexures, commonly found in dark‐skinned patients. In patients with LPP, an inflammatory lichenoid response results in marked pigmentary incontinence. It has been associated with hepatitis C virus, sun exposure, and contactants such as mustard oil and nickel. LPP‐inversus affects fair and dark skin, predominantly involving flexural and intertriginous areas, while sun‐exposed areas are spared; friction is an associated trigger. LPP along Blaschkos lines has been associated with susceptibility to genetic mosaicisms. LPP can present concomitantly with other variants of LP such as frontal fibrosing alopecia, as well as endocrinopathies, and autoimmune diseases. Treatment is difficult and consists of avoidance of triggers and topical and systemic medications in order to stop the inflammatory reaction and reduce pigmentation, improving aesthetic appearance and quality of life.

Ultraviolet A‐1 phototherapy as an alternative for resistant alopecia areata

association between tumor necrosis factor inhibitor therapy and hemoglobin A1C and fasting glucose among psoriasis, psoriatic arthritis, and rheumatoid arthritis patients. J Drugs Dermatol 2015; 14: 159–166. 7 Wu JJ, Rowan CG, Bebchuk JD, Anthony MS. Association between tumor necrosis factor inhibitor therapy and blood pressure, C-reactive protein, and alanine aminotransferase among psoriasis, psoriatic arthritis, or rheumatoid arthritis patients. J Am Acad Dermatol 2015; 72: 917–9.

Angioimmunoblastic T-Cell Lymphoma: A Diagnostic Challenge

Angioimmunoblastic T-cell lymphoma (AITL) accounts for 15-20% of all peripheral T-cell lymphomas. It is a rare subtype of CD4 T-cell peripheral lymphoma that affects aged individuals, causing B symptoms, generalized lymphadenopathy and hepatosplenomegaly. Its pathogenesis is still unclear, but in some cases it has been associated with infection, allergic reaction or drug exposure. The majority of patients are diagnosed in an advanced stage and anthracycline based regimen is considered the first-line therapy. Skin involvement is not well characterized, occurring in up to 50% of patients and presenting as nonspecific rash, macules, papules, petechiae, purpura, nodules and urticaria. We present the illustrative case of a 55-year-old woman with an AITL who presented prominent skin findings, arthritis, lymphadenopathy and hypereosinophilia. Skin biopsy reported a T-cell lymphoma and the diagnosis of AITL was confirmed by an axillary lymph node biopsy, which was also positive for Epstein-Barr virus. Chemotherapy with CHOP-21 and thalidomide was given, accomplishing complete remission after six cycles.

Disseminated fusariosis with endophthalmitis after skin trauma in acute lymphoblastic leukaemia

PETT schedule, to successfully control both, metastatic growth in cutaneous and uveal melanoma by simultaneously targeting multiple hallmarks of melanoma: Communicative reprogramming may overcome (molecular-)genetic heterogeneity among melanomas of quite different origin as well as at different metastatic sites. PETT schedule provides a modest toxicity profile and omits maximal tolerable dosages of single drugs by concertedly modulating melanoma plus adjacent stroma cell functions. These promising data with PETT combination therapy are currently studied in a randomized phase II trial in second-line. A.R., C.H. designed the research, analysed the data and wrote the paper; C.H., M.V., Ch.H., M.L., M.B., S.H. and A.R. treated the patients; W.H. critically reviewed the manuscript.

Escalating dosimetry of UVA-1 in the treatment of alopecia areata

Phototherapy can be an option in unresponsive alopecia areata (AA); however, variable results have been reported with its use. We could not find literature of treatment with UVA‐1 in AA. A study was designed to evaluate progressive dosimetry to determine the initial dose and its increments.

Ulcerated Radiodermatitis Induced after Fluoroscopically Guided Stent Implantation Angioplasty

Cases of radiation-induced skin injury after fluoroscopically guided procedures have been reported since 1996, though the majority of them have been published in Radiology and Cardiology literature, less frequently in Dermatology journals. Chronic radiation dermatitis induced by fluoroscopy can be difficult to diagnose; a high grade of suspicion is required. We report a case of an obese 46-year-old man with hypertension, dyslipidemia, and severe coronary artery disease. He developed a pruritic and painful atrophic ulcerated skin plaque over his left scapula, six months after fluoroscopically guided stent implantation angioplasty. The diagnosis of radiodermatitis was confirmed histologically. We report this case to emphasize the importance of recognizing fluoroscopy as a cause of radiation dermatitis. A good clinical follow-up at regular intervals is important after long and complicated procedures, since the most prevalent factor for injury is long exposure time.

Hair That Is Difficult to Manage in a Hispanic Girl

physical examination, her hair was light brown, with discrete glistening in some areas, along with a dry and unruly appearance ( Fig. 1 ). No other morphological defects were found upon physical examination. Dermoscopy did not reveal any relevant features, nor did examination under a light microscope. Scanning electron microscopy was not available; therefore, we decided to send some hair strands for pathology examination ( Fig. 2 ). What is your diagnosis? Question

Efficacy of phototherapy in pityriasis lichenoides chronica of dark skin: A retrospective study from a tertiary center in Mexico

Dear Editor, Pityriasis lichenoides chronica (PLC) is a chronic inflammatory skin disorder of unknown etiology (Maranda et al., 2016). It is considered a therapeutic challenge because of its frequently relapsing course (Zang et al., 2018). Clinical and therapeutic information of cutaneous inflammatory disorders in dark skin, including PLC, is scarce (Charrow et al., 2017). Hereby we present our experience with this subpopulation. A retrospective and observational analysis of PLC patients treated at Hospital Universitario “Dr. José E. González” in Monterrey, Mexico from 2011 to 2017 was performed. Demographic, clinical and therapeutic data was obtained from clinical charts. Only patients with clinical and histopathological diagnosis consistent with PLC were included. In subjects with clinical suspicion of early mycosis fungoides, immunohistochemical analysis was done to discard this diagnosis. Patients without biopsy or photographic follow-up were excluded. Narrowband ultraviolet B phototherapy (NB-UVB) data was gathered, including number of sessions and maximum dose. We considered complete response as clearance of >90% of affected body surface area (BSA), partial response as 50–90% BSA clearance, and no response <50% BSA clearance (Fernández-Guarino et al., 2017). Relapse was defined as a flare of lesions after initial improvement. The phototherapy booth used was Spectra 311/35 (Daavlin, Ohio) equipped with Philips TL-01/100 W 311 nm lamps (Philips, Netherlands). Initial dose was determined by skin phototype and increased 20% at each subsequent visit if no erythema was present, with twice or thrice weekly sessions (Mohammad et al., 2017). In patients who achieved complete remission, phototherapy was gradually tapered in 6 months reducing the frequency of sessions, while maintaining the last highest dose. Patients younger than 10 years old were considered eligible for phototherapy when able to stand in the booth wearing goggles and adequately follow instructions (Mohammad et al., 2017). Nineteen Hispanic patients with PLC were included. Clinical and demographic characteristics are shown in Table 1. All patients had Fitzpatricks skin phototypes III or IV. The most common clinical distribution was diffuse in 18 (94.7%) subjects. The most frequent pigmentary alterations were hypopigmented macules and patches in 14 (73.7%) subjects (Figure 1a,b). Three patients received a combination of oral erythromycin (3–4 cycles of 30–50 mg/kg/day) along with Class I topical corticosteroids, all of them had partial response. Five patients received only Class I topical steroids for a mean time of 4 months (one had complete response and four had partial response). Eleven patients who had not received any treatment within the previous 2 months were treated