Osvaldo Vázquez-Martínez

Actinomycetoma of the scalp after a car accident

Background  Actinomycetoma is the most frequent type of mycetoma in Mexico. Localization on the scalp is very rare. Because of this topography and potential spread to the brain, the present case became a diagnostic and therapeutic challenge.

Complication of a Polyalkylimide Implant in a Patient with Facial Trauma

Filler materials have been used for contouring fine lines and wrinkles caused by aging, as well as to improve scars and congenital defects. A filler must be versatile in its usage, have a low possibility of adverse effects, and have a low potential for abuse. One of the main limitations of filler materials is the volume that can be injected, because there are diseases like facial lipoatrophy and congenital defects that require large amounts to repair them.

Dermoscopy of eccrine angiomatous hamartoma: The popcorn pattern

ources: None. f interest: None declared. dence to: Minerva G omez-Flores, MD, Hospital itario ‘‘Dr. Jos e Eleuterio Gonz alez,’’ Universidad ma de Nuevo Le on, Av. Francisco I. Madero Pte s/n y zalitos s/n, Col. Mitras Centro, Monterrey, Nuevo Le on, 64460. E-mail: minervagomezmx@yahoo.com.mx. JAAD Case Reports 2018;4:165-7. 2352-5126 a 2017 by the American Academy of Dermatology, Inc. Published by Elsevier, Inc. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-ncnd/4.0/). http://dx.doi.org/10.1016/j.jdcr.2017.08.014

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.

Nevus unius lateris: Electrofulguration as a therapeutic approach

detected adenocarcinoma, suggesting uterine malignancy. Upper and lower endoscopy did not show any abnormal finding. She was scheduled to undergo further examinations including enhanced computed tomography; however, she declined further examinations. She was eventually lost to follow up in our hospital, but had no relapse of skin symptoms at the last appointment while taking PSL 15 mg/day. The association of malignancy with pemphigoid disease is still controversial. Schulze et al. reported that bullous pemphigoid and mucous membrane pemphigoid are associated with hematological malignancies and non-melanoma skin cancers, respectively. Some single cohort studies indicated the possible association of bullous pemphigoid with kidney and laryngeal cancer, although meta-analysis did not show a significant association. Recently, two case reports described patients with advanced ovarian cancer and esophageal cancer, who eventually developed anti-p200/laminin-c1 pemphigoid, suggesting its neoplastic aspect. Because anti-p200 pemphigoid is a rare pemphigoid disease, there are no definitive data about the frequency of concomitant malignancies. Unfortunately, we were not able to conduct further examination for uterine malignancy, however, this case serves as a reminder that screening is useful to identify asymptomatic uterine malignancy in a patient with anti-p200 pemphigoid. Further studies are needed to evaluate whether patients with this rare autoimmune bullous disease may have an increased risk of malignancy.

Classic medical tools for the prevention of adverse technology-associated events: Tongue depressors and lasers

SURGICAL CHALLENGE Intense pulsed light, 810-nm diode, long pulsed 1064-nm neodymium-doped yttrium aluminium garnet, and Alexandrite are lasers that can be used for hair removal. The dermatologist should be cautious when treating patients with intense pulsed light or any laser that targets hairs or pigment in the eyebrows. Charring of hairs in eyebrows can lead to patient discomfort ranging from a few burned hairs that will eventually grow back to a thermal burn with visible consequences. A frequently encountered type of lawsuit in dermatology is related to cutaneous injuries resulting from laser application. In addition to being overly cautious, how can the dermatologist avoid applying intense pulsed light or any other laser treatment to the eyebrows or hairline?

SkIndia Quiz 38: Subcutaneous thumb tumor

A 58‐year‐old man presented with a 2‐year history of a painless subcutaneous mass on the right thumb [Figure 1a]. The tumor had gradually increased in size and there was no preceding history of trauma. Physical examination revealed a solitary tumor on the thumb tip underneath indurate, pink skin of 1 cm size. A radiograph of the affected part revealed no abnormality. Histological examination revealed a mass composed of spindle‐shaped cells [Figure 1b and c].

Cirugía micrográfica de Mohs: 27 años de experiencia en el Noreste de México

INTRODUCTION Skin cancer treatment includes surgical and non-surgical techniques. Among surgical techniques, Mohs micrographic surgery permits a complete evaluation of surgical margins with maximal tissue sparing. MATERIAL AND METHODS Retrospective review of dermatology database of skin cancer cases treated with Mohs surgery at University Hospital Dr. José Eleuterio González from 1988 to 2015. RESULTS A total of 546 cases were included, of these 289 (52.93%) corresponded to women and 257 (47.07%) to men. Mean age at presentation was 64.3. Most tumors (63.2%) corresponded to infiltrative basal cell carcinoma and the majority were located on the nose and cheek; 9.7% of cases corresponded to recurrent tumors. A mean of 1 Mohs stages was used in 56%, with a mean of 2 sections in 23.6%. Cutaneous flaps were used in 47.7%, representing the predominant reconstruction technique. CONCLUSION Mohs surgery has emerged in one of the dermatology reference centres in the North of the country as one of the surgical techniques for the treatment of aggressive carcinomas with high risk of recurrence.

A neglected giant metastatic melanoma.

tion after NIMFRF treatment. Improvement in pigmentary conditions has been previously reported with fractional lasers. No infectiozus complication was reported despite the absence of antibiotic and antiviral treatment. This aspect is another advantage over the CO2 fractional laser, which can have an infection rate of up to 9%, despite antiviral premedication. Nevertheless, NIMFRF could also be combined with CO2 fractional lasers to optimize results, as demonstrated in the treatment of stretch marks. The efficacy was similar for both indications (scar and photoaging), thus confirming the versatility of the technique and its efficacy in the main dermal remodelling indications. In conclusion, our study shows that the NIMFRF is efficacious in treating scars and photoaging, with the advantages of minimal post-treatment effects and very high patient satisfaction, in real-life clinical setting.

Human papillomavirus type 2 associated with pyogenic granuloma in patients without clinical evidence of warts

Pyogenic granuloma is a non‐neoplastic lesion that frequently occurs in the skin and mucous membranes of children and pregnant women. The anatomical sites of pyogenic granulomas overlap with those of wart infections caused by the human papillomavirus (HPV).