Martha Elena García-Melendez

Protein tyrosine phosphatase PTPN22 +1858C/T polymorphism is associated with active vitiligo

Vitiligo is characterized by a skin depigmentation disorder resulting from an autoimmune response targeting melanocytes. Within the genetic factors involved in the development of the vitiligo immune response, various genes in the major histocompatibility complex (MHC) and non-MHC loci have been considered to be risk factors. The PTPN22 gene encodes for a lymphoid protein tyrosine phosphatase, a regulator of the activation and development of T-cells. The +1858C/T polymorphism has been associated to autoimmune disease susceptibility in different populations and could be implicated in the onset of vitiligo. To assess the possible association between the presence of PTPN22 +1858C/T and vitiligo, 187 patients with vitiligo and 223 control subjects were analyzed in the study. Genomic DNA was isolated using the salting-out method and samples were subjected to polymerase chain reaction-restriction fragment length polymorphism in order to detect the PTPN22 +1858C/T polymorphism. Causal associations were determined by χ2 test and their respective odds ratio (OR) was assessed in a 2×2 contingency table. The results showed an association between active vitiligo and the allele T load [P=0.0418; OR, 2.5706; 95% confidence interval (CI), 1.0040–6.5816], and active vitiligo-CT genotype (P=0.0389, OR, 2.6548; 95% CI, 1.0191–6.9156). In conclusion, the present data indicates a possible association between the PTPN22 +1858C/T genotype and a significant susceptibility of developing an active form of vitiligo.

Blastomycosis imported to Monterrey, Mexico: fifth case reported in Mexico.

Julio C. Salas-Alanis, Michel F. Martinez, Martha Garcia-Melendez, Brenda L. Gonzalez and Jorge Ocampo-Candiani Dermatology Service, Facultad de Medicina y Hospital Universitario Dr. Jose E. Gonzalez, Universidad Autonoma de Nuevo Leon, Monterrey, Mexico, Infectology Service, Facultad de Medicina y Hospital Universitario Dr. Jose E. Gonzalez, Universidad Autonoma de Nuevo Leon, Monterrey, Mexico and Hospital La Carlota, Montemorelos, Nuevo Leon, Mexico

Erythema elevatum diutinum: an atypical presentation.

Erythema elevatum diutinum (EED) is classified within the small vessel vasculitis. It is a rare, chronic and progressive disease affecting mostly extensor surfaces and skin overlying the joints.1 Clinically, it presents as multiple erythematous and violaceous papules with a symmetrical and bilateral distribution. Associations with underlying diseases are common, including autoimmune disease, malignancies and infections; although drug-induced cases have been reported. Treatment varies greatly among the literature, with dapsone being the most effective and most frequently used drug.2 EED is an important differential diagnosis of rheumatic disease, especially when treating patients with chronic arthralgias and nonspecific cutaneous lesions, in whom associated diseases must be ruled out.3 We describe a 45-year-old man with chronic joint pain and atypical hyperpigmented macules in palms, as well as euchromatic papules over the ears.

Pemphigus Foliaceus in an 11-Year-Old Mexican Girl with Response to Oral Dapsone

Pemphigus foliaceus (PF) is rarely described in the pediatric population with less than 40 cases reported in the literature. We report the case of an 11-year-old girl who was diagnosed with PF after 6 months of starting with symptoms and who responded well to therapy with oral dapsone. Although therapeutic guidelines for PF in children are lacking, oral corticosteroids in combination with dapsone have proven to be effective as first-line treatment in this setting.

Hyperpigmentation following Treatment of Frontal Fibrosing Alopecia

Introduction: Frontal fibrosing alopecia (FFA) is a scarring alopecia characterized by progressive recession of the frontotemporal hairline. Current treatment is aimed at stopping progression, and the combination of dutasteride and pimecrolimus is the most effective therapy. Side effects associated with dutasteride are erectile dysfunction as well as breast tenderness and enlargement, while pimecrolimus produces a burning sensation. Case Report: We present a 57-year-old postmenopausal female with a 3-year history of a scarring alopecic plaque in her frontotemporal region. Biopsy confirmed the diagnosis of FFA, and she was started on dutasteride 0.5 mg p.o. q.d., and later, topical pimecrolimus 1% b.i.d. was added. Eight months after initiating treatment, she showed hyperpigmentation on her metacarpophalangeal and interphalangeal joints, as well as on the cheeks and on the chin; dutasteride and pimecrolimus were discontinued. After 5 months of follow-up, her hyperpigmentation improved by 80% only by using photoprotection. Conclusion: Because of the variable clinical course of FFA, treatment is focused on halting its progression. Several therapeutic agents have been evaluated and the combination of dutasteride and pimecrolimus has shown a high response rate. There is no reported evidence of hyperpigmentation associated with this combination.

Neglected skin carcinomas: What should not be.

essential to identify the sinus tract, which facilitates continuity of the skin lesion with the underlying infected bony tissue. The therapy consists of removal of the dentogenic focus, sometimes combined with surgical embellishment of the remaining scar. Early correct diagnosis and treatment of an odontogenic fistula could help prevent unnecessary and ineffective antibiotic therapy, or surgical treatment.

Destructive squamous cell carcinoma of the penis.

A 38-year-old man presented with a 2-year history of a lesion on the penis. The patient referred the initial lesion as a chronic painless ulcer. Eventually there was necrosis of the glans and shaft with a subsequent development of a verrucous mass over the affected area. Physical examination of the genital area revealed a locally destructive ulcer of 18 × 12 cm with exophytic borders and absence of the penis and testicles (Figure ​(Figure1A).1A). There was no associated regional lymphadenopathy. The patients serology was positive for hepatitis C virus. Skin biopsy showed a moderately differentiated squamous cell carcinoma (Figure ​(Figure1B).1B). Contrast computed-tomography revealed complete destruction of the genital area with affection of the symphysis pubis and enlarged retroperitoneal lymph nodes (Figure ​(Figure1C).1C). The patient was treated with antibiotics for the concomitant infection of the area but denied any medical-oncological treatment and was lost to follow-up. FIGURE 1 Penile carcinoma is a rare malignancy with a global incidence of 0.1 to 0.7 cases per 100,000 males. The highest incidence is reported in Uganda and Brazil, whereas the lowest rates are seen in Israeli Jews.1 Associated risk factors are the presence of an intact foreskin, phimosis, human papillomavirus, smoking and chronic inflammation.2 Squamous cell carcinoma is the most frequent of penile neoplasms (95%). It is traditionally divided into 2 forms: endophytic or exophytic. Diagnosis is made with physical and histological examination, whereas staging is assessed by computed tomography or magnetic resonance imaging.3 The mainstay of treatment is surgical excision if diagnosed at an early stage; and in patients with advanced or metastatic disease, the aim is palliation. Mortality is secondary to sepsis and erosions of large vessels in the groin from local invasion.

SkIndia Quiz 18: Multiple erythematous nodules in a 30-year-old woman.

Department of Dermatology, University Hospital Jose Eleuterio Gonzalez UANL, Monterrey, Nuevo Leon, Mexico A 31-year-old Hispanic woman presented with two months history of multiple, nontender, red-brown, and violaceous nodules of 0.5-1 cm in diameter [Figures 1a-c]. The lesions were disseminated to the face, earlobes, chest, back, and upper extremities. She denied any history of fever, weight loss, and night sweats. Two nontender 2 cm lymph nodes over the left cervical region were noted during physical examination. She was SkIndia Quiz 18

Unvollständige Daten in randomisierten dermatologischen Studien: Auswirkungen und statistische Methoden

Randomisierte klinische Studien können den höchsten Evidenzgrad für die Wirksamkeit einer therapeutischen Maßnahme liefern. Wenn einzelne Teilnehmer vorzeitig aus einer Studie herausfallen, ist es häufig nicht möglich, die gewünschten Verlaufsparameter zu ermitteln; das führt zu unvollständigen Daten. Die vorliegende Arbeit gibt einen Überblick über verschiedene Mechanismen, die zu unvollständigen Daten führen können. Außerdem werden die Auswirkungen dieser Mechanismen diskutiert und Strategien für den Umgang mit unvollständigen Daten vorgestellt. Die genannten Aspekte werden im Kontext klinischer dermatologischer Studien besprochen. Weiterhin werden praktische Empfehlungen für die Planung von Studien und die Interpretation von Ergebnissen aus Studien mit möglicherweise unvollständigen Daten gegeben.Übersetzung aus Dermatology 2013;226:19-27 (DOI: 10.1159/000346247)

Körperkonzept von Patienten mit chronischem Pruritus in Bezug auf Kratzläsionen und psychische Symptome

Hintergrund: Zum Körperkonzept von Patienten mit chronischem Pruritus liegen nur wenige Studien vor. Wir untersuchten das Körperkonzept dieser Patientenpopulation unter Berücksichtigung untergruppenspezifischer Unterschiede und der beeinträchtigten Lebensqualität und verglichen diese Ergebnisse mit denen von Patienten mit Essstörungen und einer gesunden Kontrollgruppe.Methoden: 284 Teilnehmer mit chronischem Pruritus beantworteten die Fragebögen der Frankfurter Körperkonzeptskalen, der Hospital Anxiety and Depression Scale und des Dermatology Life Quality Index. Die statistische Auswertung erfolgte mittels t-Tests, Varianzanalyse und Pearson-Korrelationen.Ergebnisse: Das Körperkonzept der Patienten mit chronischem Pruritus war negativer als das der gesunden Probanden, jedoch weniger negativ als das der Patienten mit Essstörungen. Ein höheres Maß an Depression und Angst war mit einem negativeren Körperbild assoziiert.Schlussfolgerung: Das Körperkonzept von Patienten mit chronischem Pruritus sollte bei der Therapieplanung berücksichtigt werden. Ob sich das Körperkonzept nach erfolgreicher Behandlung verändert, muss in weiteren Studien untersucht werden.Übersetzung aus Dermatology 2013;227:263-269 (DOI: 10.1159/000354911)