María Teresa García-Romero
University of Toronto
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Featured researches published by María Teresa García-Romero.
Pediatrics | 2013
Erin F. Mathes; Vikash S. Oza; Ilona J. Frieden; Kelly M. Cordoro; Shigeo Yagi; Renee Howard; Leonard Kristal; Christine C. Ginocchio; Julie V. Schaffer; Sheilagh Maguiness; Susan J. Bayliss; Irene Lara-Corrales; María Teresa García-Romero; Daniel P. Kelly; Maria Salas; M. Steven Oberste; W. Allan Nix; Carol A. Glaser; Richard J. Antaya
OBJECTIVE: To characterize the atypical cutaneous presentations in the coxsackievirus A6 (CVA6)–associated North American enterovirus outbreak of 2011–2012. METHODS: We performed a retrospective case series of pediatric patients who presented with atypical cases of hand, foot, and mouth disease (HFMD) from July 2011 to June 2012 at 7 academic pediatric dermatology centers. Patients were included if they tested positive for CVA6 or if they met clinical criteria for atypical HFMD (an enanthem or exanthem characteristic of HFMD with unusual morphology or extent of cutaneous findings). We collected demographic, epidemiologic, and clinical data including history of skin conditions, morphology and extent of exanthem, systemic symptoms, and diagnostic test results. RESULTS: Eighty patients were included in this study (median age 1.5 years, range 4 months–16 years). Seventeen patients were CVA6-positive, and 63 met clinical inclusion criteria. Ninety-nine percent of patients exhibited a vesiculobullous and erosive eruption; 61% of patients had rash involving >10% body surface area. The exanthem had a perioral, extremity, and truncal distribution in addition to involving classic HFMD areas such as palms, soles, and buttocks. In 55% of patients, the eruption was accentuated in areas of eczematous dermatitis, termed “eczema coxsackium.” Other morphologies included Gianotti-Crosti–like (37%), petechial/purpuric (17%) eruptions, and delayed onychomadesis and palm and sole desquamation. There were no patients with serious systemic complications. CONCLUSIONS: The CVA6-associated enterovirus outbreak was responsible for an exanthem potentially more widespread, severe, and varied than classic HFMD that could be confused with bullous impetigo, eczema herpeticum, vasculitis, and primary immunobullous disease.
Pediatric Dermatology | 2016
María Teresa García-Romero; F.R.C.P. Patricia Parkin M.D.; Irene Lara-Corrales
Confusion is widespread regarding segmental or mosaic neurofibromatosis type 1 (MNF1). Physicians should use the same terms and be aware of its comorbidities and risks. The objective of the current study was to identify and synthesize data for cases of MNF1 published from 1977 to 2012 to better understand its significance and associations. After a literature search in PubMed, we reviewed all available relevant articles and abstracted and synthetized the relevant clinical data about manifestations, associated findings, family history and genetic testing. We identified 111 articles reporting 320 individuals. Most had pigmentary changes or neurofibromas only. Individuals with pigmentary changes alone were identified at a younger age. Seventy‐six percent had localized MNF1 restricted to one segment; the remainder had generalized MNF1. Of 157 case reports, 29% had complications associated with NF1. In one large case series, 6.5% had offspring with complete NF1. The terms “segmental” and “type V” neurofibromatosis should be abandoned, and the correct term, mosaic NF1 (MNF1), should be used. All individuals with suspected MNF1 should have a complete physical examination, genetic testing of blood and skin, counseling, and health surveillance.
Pediatrics | 2016
Sonal Shah; Eulalia Baselga; Catherine McCuaig; Elena Pope; Julien Coulie; Laurence M. Boon; Maria C. Garzon; Anita N. Haggstrom; Denise M. Adams; Beth A. Drolet; Brandon Newell; Julie Powell; María Teresa García-Romero; Carol Chute; Esther Roé; Dawn H. Siegel; Barbara Grimes; Ilona J. Frieden
BACKGROUND AND OBJECTIVES: Propranolol is first-line therapy for problematic infantile hemangiomas (IHs). Rebound growth after propranolol discontinuation is noted in 19% to 25% of patients. Predictive factors for rebound are not completely understood and may alter the management approach. The goal of the study was to describe a cohort of patients with IHs treated with propranolol and to identify predictors for rebound growth. METHODS: A multicenter retrospective cohort study was conducted in patients with IHs treated with propranolol. Patient demographic characteristics, IH characteristics, and specifics of propranolol therapy were obtained. Episodes of rebound growth were recorded. Patients’ responses to propranolol were evaluated through a visual analog scale. RESULTS: A total of 997 patients were enrolled. The incidence of rebound growth was 231 of 912 patients (25.3%). Mean age at initial rebound was 17.1 months. The odds of rebound among those who discontinued therapy at <9 months was 2.4 (odds ratio [OR]: 2.4; 95% confidence interval [CI]: 1.3 to 4.5; P = .004) compared with those who discontinued therapy between 12 to 15 months of life. Female gender, location on head and neck, segmental pattern, and deep or mixed skin involvement were associated with rebound on univariate analysis. With multivariate analysis, only deep IHs (OR: 3.3; 95% CI: 1.9 to 6.0; P < .001) and female gender (OR: 1.7; 95% CI: 1.1 to 2.6; P = .03) were associated. Of those with rebound growth, 83% required therapeutic modification including 62% of patients with modifications in their propranolol therapy. CONCLUSIONS: Rebound growth occurred in 25% of patients, requiring modification of systemic therapy in 15%. Predictive factors for rebound growth included age of discontinuation, deep IH component, and female gender. Patients with these predictive factors may require a prolonged course of therapy.
British Journal of Dermatology | 2016
María Teresa García-Romero; Ronald M. Laxer; Elena Pope
DEAR EDITOR, Localized scleroderma (LS) or morphea is a rare fibrosing disorder of the skin and underlying tissues, characterized by skin thickening and hardening owing to increased collagen density. Epidemiological studies have reported incidence rates ranging from 0 4 to 2 7 per 100 000 people, with a female predominance of 2 4 : 1. The onset of LS usually occurs in childhood between 2 and 14 years of age. The aetiology and pathogenesis are not completely understood. The natural progression of LS includes various stages (early inflammation, progressive sclerosis and an atrophic phase), occurring over several years. Typically, clinical activity persists for 3–4 years, but new lesions can develop after longer periods. Patients can have discrepancies in limb length, irreversible structural deformities, joint contractures and severe disabilities that can be functional, cosmetic or psychological. The management of severe LS is challenging, and the detection of disease activity remains a fundamental problem both for evaluating the need for treatment and assessing therapeutic efficacy over time. To date, neither clinical examination nor laboratory evaluations have been found to be consistently reliable indicators of disease activity. Therefore, investigators have been trying to develop clinical assessment tools to evaluate the state of disease activity in patients with LS more accurately. Several clinical scales have been developed to assess disease activity. The Localized Scleroderma Clinical and Ultrasound Study Group validated the LS Skin Severity Index (LoSSI) and more recently the LS Skin Damage Index (LoSDI), and recommended that both indexes be combined with the Physician’s Global Assessment to compose the LS Cutaneous Assessment Tool (LoSCAT) (Appendix 1). This appears to be a promising outcome measure for the disease, with very good interand intrarater reliability. The DIET scale is another proposed way of evaluating LS according to dyspigmentation (D), induration (I), erythema (E) and telangiectasias (T) (Appendix 2). Neither the interobserver variability nor the correlation with prognosis has been validated for this scale. Other methods of measuring disease activity have been reported, such as devices used to evaluate skin thickness (plicometer or durometer), infrared thermography and Doppler imaging. None of these methods are practical or reliable. A promising tool that has proved to be reliable is a computerized skin score (CSS) that measures induration and calculates the exact area affected and its relationship to the body surface area of each patient.
International Journal of Dermatology | 2015
María Teresa García-Romero; Nhung Ho
Sweet syndrome (SS) is a relatively rare pediatric diagnosis, with fewer than 80 pediatric cases reported in the literature, characterized by tender erythematous plaques and nodules associated with systemic inflammation.
International Journal of Dermatology | 2017
María Teresa García-Romero; Harkamal Kaur Randhawa; Ronald M. Laxer; Elena Pope
Determining the activity of localized scleroderma (LS) remains crucial for decision making, and reliable clinical indicators of activity are lacking. Our objective in this study was to analyze the utility of infrared thermography (IRT) in assessing the activity of LS according to existing clinical scales. A secondary objective was to study whether clinical characteristics of patients and/or IRT have any role in predicting the activity of LS.
International Journal of Dermatology | 2012
María Teresa García-Romero; Carola Durán-McKinster; Marimar Sáez-de Ocariz; Daniel Carrasco‐Daza; Carolina Palacios-López; Luz Orozco-Covarrubias; Ramón Ruiz-Maldonado
teenager Imatinib mesylate forms part of the mainstay therapy for chronic lymphocytic leukemia (CML). Cutaneous reactions to the drug are common and occur in 9.5–69% of patients, and a large clinical variety, from self-limiting skin rashes to erythroderma requiring drug withdrawal, has been described. We report the first case of neutrophilic folliculitis associated with the use of imatinib. A 16-year-old girl was diagnosed with CML, chronic phase (Philadelphia chromosome-positive). Treatment was started with imatinib mesylate 400 mg per day with good response. Twenty months later, the dose was raised to 600 mg per day and, three weeks after this, the girl presented with disseminated multiple millimetric erythematous perifollicular papules (Fig. 1), in some areas the papules conformed psoriasiform plaques. The skin biopsy was diagnosed as neutrophilic folliculitis (Fig. 2). Gram and PAS stains were negative for microorganisms. The skin alterations were attributed to the treatment with imatinib, and only regular skin care and emollients were prescribed. The dose of imatinib was not changed but, due to gastrointestinal intolerance, the patient did not take it regularly. Thus, it was involuntarily decreased, and the lesions disappeared in the next month. Imatinib mesylate (Gleevec) is a molecular antagonist of tyrosine kinase. It is an oral agent used as first-line treatment of Philadelphia chromosome-positive CML and gastrointestinal stromal tumors because of its specific inhibition of BCR-ABL. It also inhibits KIT, a product of c-kit and platelet-derived growth factor receptor,
International Journal of Dermatology | 2013
María Teresa García-Romero; Elena Pope
A 7-year-old healthy girl was followed in the dermatology clinic (Hospital for Sick Children, Toronto, Canada) for a giant congenital melanocytic nevus covering the left lower leg and multiple satellite lesions throughout her body and face. The nevus was covered with terminal hair, had very heterogeneous pigment with hypertrophic skin, and nodularity. She presented to our clinic ahead of her scheduled yearly visit because of multiple new nodules on the lower leg nevus that appeared over six weeks. On physical examination, we could see a giant melanocytic nevus on her left leg covered with terminal hair, with some of the nodular and papular growths already known to us but with multiple new, flesh-colored, and erythematous smaller papules (Fig. 1). Some of these papules were also present on other smaller melanocytic nevi on her arm but not on normal skin. On closer examination, we found these lesions resembled mollusca contagiosa and on questioning, the patient reported that her nevus was more pruritic than usual. She had also been taking swimming lessons for the past two months. Treatment was with topical cantharidine, with complete resolution of lesions.
Pediatric Dermatology | 2018
Carola Durán-McKinster; María del Mar Sáez-de-Ocariz; Luz Orozco-Covarrubias; Carolina Palacios-López; María Teresa García-Romero
Ram on Ruiz Maldonado was born on November 7, 1937, in the city of Puebla, Mexico, where he received his early education. Since childhood, he was inclined toward medicine, probably influenced by his godfather, Dr. Francisco Casas, a general doctor who Ram on and his parents loved and admired. In 1957 he entered the Faculty of Medicine of the Universidad Nacional Autonoma de Mexico. At the end of his studies he was selected for an internship at the Foch Hospital in Paris, where he worked in the Association of Medical Students and learned French. On his return to Mexico he specialized in dermatology with Professor Fernando Latap ı at the General Hospital of Mexico and at the Dr. Ladislao de la Pascua Dermatological Center. Later, he traveled to Europe and the United States for postgraduate studies in dermatology, mycology, and dermatopathology. He received awards from several governments, and well-recognized professors mentored him, including Robert Degos and Jean Civatte at the St. Louis Hospital in Paris; Franc ois Mariat, Gabriel Segretain, and Edouard Drouhet at the Pasteur Institute in Paris; Albert Wiedmann at the Vienna General Hospital; Jiri Trapl at Charles University in Prague; and Hermann Pinkus at Wayne State University in Detroit, Michigan. During his “academic exile,” his training was not only dermatologic. He learned French, English, German, and Italian. He wrote poetry and even a short novel entitled Saturday Afternoon, published in 1967, which was awarded in the X Literary Contest of “La Hora XXV.” Copies are still available! Upon returning from Europe, Ramon worked in the Pathology Department of the Pascua Dermatologic Center. A year later he was invited to the Children’s Hospital of Mexico as a dermatologist. In 1970, when the National Institute of Pediatrics was inaugurated, Dr. Lazaro Benavides invited Ram on to be head of the Department of Pediatric Dermatology, where he worked for 46 years. From the beginning, he and his colleague and closest collaborator, Dr. Lourdes Tamayo, worked together in a professional and friendly relationship. Three years later they created the specialty in pediatric dermatology at the Universidad Nacional Autonoma de Mexico. Dr. Maldonado and Dr. Tamayo were pioneers in pediatric dermatology in Mexico and in many countries of Latin America. From 1972 to 1995 the only formal course of specialization in pediatric dermatology in the world was that of their department. More than 120 general dermatologists and pediatricians were trained in pediatric dermatology, many of whom serve as heads of various Latin American pediatric dermatology departments. There was a consistency in his professional life of a love of teaching, helping students, and performing research. He was always a committed teacher, sharing his knowledge with anyone who asked. In 1992 the National Institutes of Health in Mexico recognized him as a senior researcher, and he was promoted to the rank of emeritus researcher in 2007. In 1983 Dr. Maldonado joined the National Academy of Medicine of Mexico and in 1989 the National System of Researchers, where he achieved the highest level. In 1989 Dr. Maldonado implemented the recognition of pediatric dermatology as an important branch of general dermatology at the Universidad Nacional Autonoma de Mexico. In 1996 the Mexican Board of Dermatology appointed him president of the Mexican Board of Pediatric Dermatology. He was a professor of dermatology and pediatric dermatology and an academic advisor for the masters and doctoral programs in medical, dental, and health sciences. He mentored 77 students in finishing their theses and in obtaining degrees in pediatrics and pediatric dermatology and masters degrees in medical sciences. From a personal point of view, to work with him and learn from him was a privilege and a pleasure. His contributions in class, from simple aspects such as the proper pronunciation of an author’s name DOI: 10.1111/pde.13319
Journal of Cutaneous Medicine and Surgery | 2017
Irene Lara-Corrales; Mitra Moazzami; María Teresa García-Romero; Elena Pope; Patricia C. Parkin; Andrea Shugar; Peter Kannu
Background: Neurofibromatosis type 1 (NF1) is a neurocutaneous disorder caused by loss-of-function mutation in the NF1 gene. Segmental or mosaic NF1 (MNF) is an uncommon presentation of the NF1 result of postzygotic mutations that present with subtle localised clinical findings. Objectives: Our study’s objectives were to describe the clinical characteristics of children with MNF. Methods: We conducted a cross-sectional study of children diagnosed with MNF at the Hospital for Sick Children in Toronto, Canada, from January 1992 to September 2012. Data were abstracted from health records and analysed using a standardised data collection form approved by our hospital Research Ethics Board. Results: We identified 60 patients with MNF; 32 of 60 (53.3%) were female. Mean ± SD age at first assessment was 10.6 ± 4.6 years. The most common initial physical manifestation in 39 of 60 (65.0%) patients was localised pigmentary changes only, followed by plexiform neurofibromas only in 10 of 60 (16.7%) and neurofibromas only in 9 of 60 (15.0%). Unilateral findings were seen in 46 of 60 (76.7%) patients. Most common associations identified included learning disabilities (7/60; 12%) and bony abnormalities (6/60; 10.0%). Conclusions: MNF is an underrecognised condition with potential implications for patients. Children mostly present with pigmentary anomalies only. Most patients do not develop associated findings or complications before adulthood, but long-term follow-up will help determine outcomes and possible associations. Recognition and confirmation of the diagnosis is important to provide follow-up and genetic counselling to patients.