Rafael Jiménez-Puya

Tratamiento de las úlceras crónicas

Chronic ulcers are a challenge in dermatological therapy. It is essential to establish their etiology in order to treat them, but on many occasions local therapy is of great interest. Treatment of chronic ulcers is currently based on so-called moist wound healing, and it takes two aspects into consideration: the underlying pathology and local treatment. Local treatment is always necessary and includes: cleaning, debridement, the control of any infection, and the application of different topical agents, both medication and dressings. Recently, new therapeutic strategies are being established, some of which are still being assessed, and which include: skin replacement using biological skin substitutes, growth factors, laser, hyperbaric oxygen, electrical stimulation and negative pressure dressings. In this work, we review the therapeutic advances in this pathology, without neglecting the validity of classic treatments.

Complications in Dermatologic Surgery

Surgical complications are any deviation from the expected course of the surgical procedure. They occur as a consequence of one or more unexpected events, which can be avoided in the majority of cases through careful planning, a precise surgical technique, and correct postoperative care. Some complications, such as cardiac arrhythmias, anaphylaxis, and cardiorespiratory arrest, are life-threatening whereas others, occurring as a direct result of surgery, can affect the healing process and the final cosmetic appearance of the scar. We must therefore have not only the relevant training in dermatologic surgery, but also in basic and advanced cardiopulmonary resuscitation. In this review we discuss the perioperative measures necessary to avoid the onset of complications in dermatologic surgery and we define the various complications that can develop.

Etanercept: efficacy and safety.

Objective  To evaluate the efficacy and safety of etanercept in the treatment of patients with moderate to severe plaque psoriasis.

Granulomatous Slack Skin Disease in a Child : The Outcome

Abstract:  Granulomatous slack skin syndrome is a rare clinical and pathologic disorder. Only 42 patients have been reported, one of whom we described in 1997—the only child so far reported. We now describe the evolution of this patient and the transformation of the disease into a peripheral T‐cell lymphoma, and the complications resulting in the child’s death.

Capecitabine Induced Hyperpigmentation

Capecitabine is an antineoplastic agent used for the treatment of patients with metastatic solid tumors (breast and colon). Different adverse effects have been recognized, among which we find the muco-cutaneous ones and, specifically, hyperpigmentation. We report a case of localized cutaneous hyperpigmentation secondary to capecitabine in a woman that underwent surgery for breast cancer and was receiving this drug for a month. The start of therapy was associated with dysesthesias and hyperpigmentation of the hands and feet. The pathogenesis of such manifestations is unknown. Other reported cutaneous adverse effects associated with this drug involve the nails producing onycholysis, fragility, discoloration and dystrophy.

Angiosarcoma sobre linfedema crónico

Resumen El angiosarcoma que se desarrolla sobre una extremidad con linfedema cronico se denomina sindrome de Stewart-Treves. Este aparece tipicamente como una complicacion de un linfedema de larga evolucion localizado en el brazo, tras mastectomia y/o radioterapia por un cancer de mama. Existen casos de sindrome de Stewart-Treves sobre linfedema cronico en la extremidad superior contralateral al cancer de mama tratado y sobre linfedema cronico de pierna. Presentamos dos casos de este sindrome. El primero corresponde a un tipico sindrome de Stewart-Treves en una mujer de 83 anos, que fue diagnosticada de angiosarcoma en el territorio de un linfedema cronico secundario a mastectomia y radioterapia por un cancer de mama. El segundo caso es mucho mas raro, ya que se trata de un caso de angiosarcoma difuso de pierna, en un hombre de 42 anos e historia de linfedema. La naturaleza agresiva de este sindrome precisa de su conocimiento e investigacion de tratamientos para prevenirlo.

Reticulohistiocitosis cutánea difusa

The reticulohistiocytoses make up a heterogeneous group of diseases whose origin lies in an accumulation of cells of histiocytic lineage in different tissues and primarily in the skin. Three main clinical forms have been described (multicentric, solitary, diffuse cutaneous), which present with identical histological, ultrastructural and immunohistochemical characteristics. We present a case of diffuse cutaneous reticulohistiocytosis, which is the least common clinical pattern in the spectrum of this disease.

Extensive Tinea in a Patient With Severe Combined Immunodeficiency

Abstract:  Severe combined immunodeficiency (SCID) is a heterogeneous group of disorders characterized by a defect of T and B cell immunity with a genetic origin in most cases. Although the X‐linked recessive form is most common (60–70%), there are autosomal recessive forms (20%) and spontaneous mutations. While SCID may present with many nosocomial infections, dermatophyte infections are not common. We reported a case of SCID which was associated with a widespread skin infection with Trichophyton mentagrophytes.

Proliferating Pilomatricoma treated Using a Bilateral Advancement Flap

Pilomatricoma is a benign neoplasm that is generally straightforward to diagnose clinically. It initially takes the form of a small tumor of nonspecific appearance but displays a characteristic firm consistency to palpation as it develops. We present the case of a giant pilomatricoma on the scalp, noting the abnormal morphology and rapid growth. We also describe a surgical solution in the form of a bilateral advancement flap or H-plasty. The clinical and pathological characteristics suggest that our case could be proliferating pilomatricoma. Pilomatricoma or calcifying epithelioma of Malherbe was first reported in 1880, when Malherbe and Chenantais described a tumor they initially denominated “calcified epithelioma of the sebaceous gland.” Just a year later, Malherbe published 18 cases stressing the fact that this tumor tended to affect young people. More than 50 years later, in 1933, Chin Luang-Yu identified calcification as another common characteristic of pilomatricoma, and this tumor became known as “calcifying epithelioma of the skin.” In 1942, Turhan and Kranier identified the site of tumor origin as the hair follicle and shortly afterwards, in 1949, Lever and Griesermer pinpointed it to the primary epithelial germ cells. The current name of pilomatricoma was proposed in 1961 by Forbis and Helwig after they presented a series of 240 examples of the tumor. Subsequent authors contributed further information on the neoplasm: an association with myotonic dystrophy was described by Cantwell and Reed in 1965, and a link with diabetes by Harper in 1971. We present the case of a 41-year-old man with no relevant medical history, who attended for the appearance of a tumor in the frontoparietal region. Rapid tumor or growth had prompted the patient to make a hasty appointment as the tumor reached the size seen in the photograph (Figure 1) within 4 to 6 weeks. The size of the lesion caused some discomfort and a continual sensation of tension in the area around the tumor that occasionally led to localized pain or a more widespread headache (possibly of a tension type). Examination revealed a multilobulated tumor measuring 4.2 cm in diameter. It was of an erythematous violaceous color and had a hard consistency without becoming stony (falling short of the expected hardness for classic pilomatricoma). Given the clinical appearance and rapid growth of the tumor, dermatofibrosarcoma, melanoma, and cutaneous metastasis were ruled out. Histology was conclusive and revealed tumor proliferation compatible with pilomatricoma, although there were some uncommon findings for this type of tumor, summarized as a high proliferation index (Figure 2), with: a) abundant matrix cells; b) fewer shadow cells than usual; c) a large number of mitotic cells; and d) elevated tumor proliferation (Ki-67 immunostaining). Histopathology confirmed the benign nature of the tumor and it was completely excised using a bilateral advancement flap H-plasty (Figure 3). Clinical forms of pilomatricoma include common nodules or small tumors of a hard consistency and are classified according to clinical-pathological features that some authors think correspond to early and late stages in tumor development.1-3 As a result, there is some controversy over whether the same tumor can present different forms or whether each clinical form is truly different even though all cases share a similar origin. To date, the following clinical forms of pilomatricoma have been described: Proliferating Pilomatricoma Treated Using a Bilateral Advancement Flap

Acute Acneiform Eruption Secondary to Cetuximab With Good Response to Metronidazole

hospital’s dermatology department from the gastroenterology department due to the rapid onset of an acneiform eruption after the initiation of immunosuppressant treatment. Notable in the patient’s history were surgery for colon cancer 3 years before, with subsequent metastases to the lung, and continuous headache which raised suspicion of intracranial hypertension (currently under study). The patient noticed the sudden appearance of multiple lesions reminiscent of juvenile acne after starting cytotoxic chemotherapy with C225 and irinotecan (CPT-11). The lesions first appeared 2 weeks after the first chemotherapy session, initially in the central region of the face with subsequent extension to the cheeks and scalp. Clinical examination revealed