Manel Baradad

Dermatosis infantiles en la consulta de Dermatología de un hospital general universitario en España

Resumen Introduccion y objetivos La Dermatologia Pediatrica es una subespecialidad relativamente nueva sobre la que existen pocos estudios epidemiologicos. Nos proponemos determinar la carga de trabajo que representa en una consulta de Dermatologia general y cuales son los motivos de consulta mas frecuentes en nuestro centro en este grupo de edad. Metodos Estudio descriptivo del registro del Servicio de Dermatologia sobre las visitas realizadas a pacientes de ≤ 16 anos de edad en el ano 2005 y sus diagnosticos. Resultados La Dermatologia Pediatrica representa el 12,1 % de nuestra carga de trabajo (1.329/10.998 visitas fueron a ≤ 16 anos). Por grupos, los tumores y las infecciones fueron los diagnosticos mas frecuentes, ya que entre ambos representan el 55,4 % del total. A distancia les siguen los eczemas (15,0 %) y las enfermedades anexiales (8,8 %). El diagnostico individual mas frecuente fue nevo melanocitico (19,8 %), seguido de verruga virica (12,1 %), dermatitis atopica (8,9 %), molusco contagioso (8,4 %) y acne (7,0 %). Conclusiones En la mayoria de paises desarrollados la dermatitis atopica es el diagnostico mas frecuente en los ninos. En nuestro estudio los nevos melanociticos ocupan el primer lugar, lo que quiza refleje que existan mas ninos con multiples nevos porque se toma el sol en exceso, o por la melanofobia existente entre la poblacion. Tambien es posible que en nuestra area exista menos dermatitis atopica que en paises mas industrializados del norte de Europa. Se deberian impulsar conductas de fotoevitacion y fotoproteccion durante la epoca infantil. Ello podria contribuir a frenar, en nuestro medio, el incremento del melanoma en el adulto.

Expression of Somatostatin Receptors in Human Melanoma Cell Lines: Effect of Two Different Somatostatin Analogues, Octreotide and SOM230, on Cell Proliferation

Somatostatin analogues (SAs) are potential anticancer agents. This study was designed to investigate the expression of somatostatin receptors (SSTRs) in melanoma cells and the effect of two SAs on cell proliferation and viability. Eighteen primary and metastatic human cutaneous melanoma cell lines were treated with octreotide and SOM230. Expression of SSTR1, SSTR2, SSTR3 and SSTR5 was assessed by real-time polymerase chain reaction. Proliferation, viability and cell death were assessed using standard assays. Inhibition was modelled by mixed-effect regression. Melanoma cells expressed one or more SSTR. Both SAs inhibited proliferation of most melanoma cell lines, but inhibition was < 50%. Neither SA affected cell viability or induced cell death. The results suggest that melanoma cell lines express SSTRs. The SAs investigated, under the conditions used in this study, did not, however, significantly inhibit melanoma growth or induce cell death. Novel SAs, combination therapy with SAs and their anti-angiogenic properties should be further investigated.

Síndrome de Sweet con lesiones ampollosas

We present a case of Sweets syndrome with atypical lesions, characterized by erythematous plaques, vesicles and bullous lesions. Skin lesions in patients with an underlying malignancy are more frequently atypical and with vesicular, bullous or even ulcerative characteristics, in addition to the typical plaques and nodules. However, the case presented is not associated with malignancy, despite the fact that these processes, particularly hematologic ones, should be suspected.

Childhood Dermatosis in a Dermatology Clinic of a General University Hospital in Spain

BACKGROUND AND OBJECTIVES Pediatric dermatology is a relatively new subspecialty for which few epidemiological studies are available. We aimed to determine the work load associated with this subspecialty and the most common presenting complaints among pediatric patients in the general dermatology clinic of our hospital. METHODS A descriptive study was performed based on hospital records to analyze patients aged 16 years or under seen in our department in 2005 and their diagnoses. RESULTS Pediatric dermatology accounts for 12.1 % of the work load in our department (1,329/10,998 patients were <or= 16 years old). By disease groups, tumors and infections were the most common diagnoses and accounted for 55.4 % of all cases. A long way behind was eczema (15.0 %) and diseases affecting hair follicles, nails, and sweat and sebaceous glands (8.8 %). The most common individual diagnosis was melanocytic nevus (19.8 %), followed by viral warts (12.1 %), atopic dermatitis (8.9 %), molluscum contagiosum (8.4 %), and acne (7.0 %). CONCLUSIONS In most developed countries, atopic dermatitis is the most common dermatologic disease in children. In our study, however, melanocytic nevus was the most common presenting complaint, reflecting perhaps that there are more children in Spain with multiple nevi due to overexposure to sunlight or because of concern about melanoma among the population. Another possibility is that Spain has fewer cases of atopic dermatitis than more industrialized countries in northern Europe. Measures to avoid exposure to sunlight and use of sunscreen should be promoted during infancy. This could help slow the increase of melanoma in the adult population.

Squamous Cell Carcinoma Developing in Jadassohn's Sebaceous Nevus: Case Report and Review of the Literature

Nevus sebaceous (or Jadassohn’s sebaceous nevus or organoid nevus) is a well-known congenital skin hamartoma involving ectodermand mesoderm-derived structures that usually appears in the head and face area. During childhood, the lesion remains static but, during puberty, grows and becomes more evident and verrucous. These changes reveal growth of pilosebaceous and apocrine elements, probably because of the influence of androgens.

Erythema Nodosum Associated With Inflammatory Tinea Capitis (Kerion Celsi)

Erythema nodosum is the most common form of panniculitis.1,2 The wide variety of processes with which it may be associated includes dermatophytoses, particularly inflammatory forms such as kerion celsi.3-7 The pathogenesis of erythema nodosum in such cases has not been fully elucidated. Traditionally, it has been considered, together with dyshidrotic reactions and follicular rashes, to be an id reaction, in other words, a hypersensitivity reaction to various fungal antigens at a site distant from the primary lesion. We describe the cases of 2 patients, aged 9 and 11 years, with inflammatory tinea of the scalp due to Trichophyton mentagrophytes, who developed erythema nodosum subsequent (16 and 26 days afterwards, respectively) to the initiation of treatment with griseofulvin (Figures 1 and 2). Relative rest was prescribed for both patients and the second patient also received ibuprofen (100 mg/5 mL) at a dose of 15 mL every 8 hours. In both patients the lesions resolved without sequelae in the following weeks. The pathogenetic mechanism underlying erythema nodosum has not been fully elucidated. It is considered a hypersensitivity reaction to a broad group of trigger factors. This wide variety of antigenic stimuli giving rise to a single process can be explained by the limited ways in which the skin can respond to different etiologic agents.1 One theory suggests that the mechanism is an antigen-antibody reaction, as immune complex deposits have been found around the venules of the septa of the hypodermis. This theory has been supported by the detection of circulating immune complexes and complement activation in patients with erythema nodosum. Direct immunofluorescence studies have also shown immunoglobulin deposits on the vascular walls of the septa. However, such findings are not constant, and other types of hypersensitivity, such as type IV hypersensitivity, may play an important role in the development of the condition.7 Llorente et al8 used semiquantitative reverse transcriptase-polymerase chain reaction (RT-PCR) to study the messenger RNA (mRNA) expression of T helper (TH) 1 (interleukin [IL] 2 and interferon γ [IFN-γ]) and TH2 (IL-4 and IL-10) cytokines in skin biopsies and peripheral blood of 11 patients with erythema nodosum and 9 healthy control subjects. They found increased TH1 cytokine expression in the skin lesions and peripheral blood of most of the patients with erythema nodosum, while no expression of either TH1 or TH2 cytokines was observed in the skin or peripheral blood of the control subjects. The number of cases of erythema nodosum associated with dermatophyte infections described in the literature is extremely limited. MEDLINE has only 8 indexed citations in Spanish or English, with a total of only 14 patients. Of these 14 cases, 9 were cases of inflammatory dermatophytosis caused by T mentagrophytes (Table).3-7,9-11 There have been immunologic studies of patients with skin infections due to T mentagrophytes that can explain this causal coincidence. These studies demonstrated the presence of a considerable cellular immune response both in vivo (showing the appearance of delayed hypersensitivity to the intradermal injection of trichophytin), and in vitro (using leukocyte migration inhibition and lymphocyte transformation tests.)12,13 In another study, Koga14 found increased IFN-γ synthesis by peripheral blood mononuclear cells in response to stimulation with trichophytin, and by RT-PCR detected IFN-γ mRNA in tinea lesions. All of these findings tend to support the hypothesis that skin lesions produced by dermatophytic infections of zoophilic origin, specifically those produced by T mentagrophytes, are caused by a TH1 response involved in the host defense against the dermatophytosis. This response may be responsible for both the associated erythema nodosum, as mentioned, and the spontaneous regression of most such infections. It has been observed, on the other hand, that anthropophilic species such as Trichophyton rubrum can more frequently trigger a low-intensity humoral immune response that is unable to destroy the fungus. For this reason, infections by such species resolve more LETTERS TO THE EDITOR

Local cryosurgery and imiquimod: A successful combination for the treatment of locoregional cutaneous metastasis of melanoma: A case series

Locoregional cutaneous metastases of melanoma (LCMM) represent a therapeutic challenge. Many treatment options are available with varying results. The combination of cryotherapy and imiquimod, two treatments with a possible synergistic effect, has not yet been described for treating this disease. In this paper, we aimed to show the response of LCMM to cryotherapy combined with topical imiquimod 5%. A retrospective review of 20 patients diagnosed with LCMM and treated with cryotherapy combined with topical imiquimod 5% between November 2000 and May 2014 at three institutions was performed. The locoregional cutaneous response was evaluated. After a mean of five sessions, 13 patients (65%) responded to treatment, eight (40%) of these completely and five (25%) partially. Systemic disease progressed in 16 (80%) patients. Cryotherapy followed by topical imiquimod 5% is simple to apply, has minimal adverse effects and provides response rates similar to other, more complex treatment options.

www.dermatoweb.net. Una web docente para el aprendizaje de la Dermatología en el pregrado

Resumen Dermatoweb es una web de ayuda para el aprendizaje de la Dermatologia durante el pregrado. Contiene el programa de la asignatura de la Facultad de Medicina de Lleida, basado principalmente en presentaciones clinicas, unas tablas con el diagnostico diferencial de los 20 motivos de consulta mas frecuentes en Dermatologia, unos 200 casos clinicos problema, para estimular el autoaprendizaje, y un temario con los 32 temas que conforman el programa de Dermatologia de muchas de las facultades de Medicina. Gracias a la web algunos de nuestros estudiantes superan la asignatura de forma notable sin apenas haber venido a clase. Contiene ademas unas guias terapeuticas de las dermatosis comunes, un atlas con mas de 5.300 fotografias y cerca de 100 videos referentes a los procedimientos dermatologicos mas empleados que pueden servir de ayuda para el medico de familia, los residentes de Dermatologia de los primeros anos y el dermatologo practico.

Tratamiento neoadyuvante con acitretino oral e imiquimod tópico en el carcinoma basocelular gigante

Giant basal cell carcinoma (BCC) is defined as a tumor with a diameter of 5 cm or more. Surgery, the treatment of choice for any type of BCC, can cause considerable anatomical damage in large tumors. In 2 patients with giant BCC we therefore provided neoadjuvant treatment with a combination of oral acitretin and topical 5% imiquimod. Acitretin is a systemic retinoid used for primary prevention of nonmelanoma skin cancer. Imiquimod is an immunomodulator whose approved indications include treatment of nonfacial superficial BCC less than 2 cm in diameter. Previous studies have demonstrated a synergic anticancer effect of both drugs in vitro and in vivo. This combination produced a marked reduction in tumor mass in our patients. Later we were able to provide definitive treatment, which achieved complete remission of the tumors.

Bowen's Disease Associated with Human Papillomavirus Infection of the Nail Bed

A 54-year-old right-handed woman presented with a few-month history of progressive right thumbnail dystrophy. She had an asymptomatic hyperkeratotic plaque under her nail that had caused onycholysis and had extended to the nail folds. No other digits were involved, and no signs of lymphadenopathy were detected. The lesion had been biopsied twice and diagnosed as a viral wart. There was no previous history of trauma or exposure to arsenic. Past medical history included ischemic heart disease, arterial hypertension, diabetes mellitus, and a hysterectomy 13 years earlier because of a disease whose diagnosis the patient did not remember. A complete excision of the finger lesion was performed. The histopathological analysis showed a papillomatous and highly hyperkeratotic lesion with an epithelial architectural disorder, numerous dyskeratotic keratinocytes, and large atypical cells with large nuclei in the upper layers of the epidermis (Figure 1). No signs of koilocytosis or any other histopathological changes associated with human papilloma virus (HPV) infection were observed. A diagnosis of digital Bowen’s disease was made.