Rosa María Ponce-Olivera

Efficacy of dioic acid compared with hydroquinone in the treatment of melasma

Background  Melasma is a common disorder of pigmentation characterized by relatively symmetric, brown or gray–brown patches on sun‐exposed facial areas. Hydroquinone, the most effective agent in melasma, is known to irritate the skin, and so new alternatives in the treatment of melasma are required. We sought to assess the clinical response of a new depigmenting agent in melasma.

Comparison of direct microscopy, culture and calcofluor white for the diagnosis of onychomycosis.

BACKGROUND Mycological diagnosis of onychomycosis can be performed by direct microcopy (KOH), cultures and calcofluor white. AIMS To compare the percentage of positivity and the degree of correlation of KOH, cultures and calcofluor white for the diagnosis of onychomycosis. METHODS Descriptive, transversal and comparative study. Samples of toenails with onychomycosis were used for KOH, cultures and calcofluor white under fluorescence. The percentage of positivity of the different techniques was calculated and the degree of correlation between them was determined (Epi Info v 3.4.3(©)). RESULTS KOH was positive in 66.67% of the cases, cultures in 33.33% and calcofluor white in 57.58%. KOH and calcofluor white had a higher percentage of positivity than culture (p<0.01 and p<0.05 respectively). The degree of correlation between KOH and calcofluor white was excellent (κ=0.8085; p<0.0001); however, the degree of correlation between KOH and culture and between calcofluor white and culture was poor. CONCLUSIONS The use of calcofluor white is not recommended in routine laboratories because it does not seem to bring any additional benefits when comparing with KOH. This is especially important when funding is a great problem.

Annular atrophic lichen planus

A 30‐year‐old woman presented with a 1‐year history of a pruritic eruption on the extremities, characterized by several annular plaques. The patient had been treated unsuccessfully with medium‐potency topical steroids. The lesions had an erythematous papular border with an atrophic center (width, 1–4 cm) ( Fig. 1 ). No oral, genital, or nail lesions were observed.

Efficacy and safety of adapalene gel 0.1% and 0.3% and tretinoin gel 0.05% for acne vulgaris: results of a single‐center, randomized, double‐blinded, placebo‐controlled clinical trial on Mexican patients (skin type III–IV)

The efficacy of topical retinoids is well known according to several clinical studies conducted predominantly among Caucasian patients. This study aimed to evaluate the efficacy and safety profile of adapalene and tretinoin among Mexican patients.

Serum gastrin‐releasing peptide levels correlate with disease severity and pruritus in patients with atopic dermatitis

DEAR EDITOR, Pruritus results from the activation of small nerve endings in the skin by noxious mediators. Gastrin-releasing peptide (GRP), substance P and glutamate have key roles in histamine-dependent itch transmission. GRP is present in primary afferent nerve fibres and was found to be increased in mice with chronic dermatitis and pruritus. Therefore, GRPexpressing nerves have an important role in mediating itch in animal models. Atopic dermatitis (AD) is a chronic, pruritic skin disease characterized by high serum IgE levels, positive immediate hypersensitivity to food or environmental allergens, and peripheral blood eosinophilia. The pathophysiology of itch in AD remains unclear; however, it can be explained by different mechanisms such as polarization of T helper 2 cells, proinflammatory cytokines (interleukins 31 and 33), abnormalities in the skin barrier (increased transepidermal water loss) and decreased skin hydration. Recently, Kagami et al. demonstrate that serum GRP levels were increased in patients with AD compared with healthy controls, and were significantly correlated with pruritus severity. Therefore, the potential role of GRP in the severity of AD was evaluated in the present study. Forty-seven adult patients with AD (32 men, 15 women; median age 28 years, range 18–52) were included in the

Myxoid neurofibroma: An unusual presentation

Myxoid neurofibroma (MN) is a benign tumor of perineural cell origin, which is demonstrated with a positive immunohistochemical staining for S-100 protein. The most common locations of the MN are the face, shoulders, arms, periungual and in the feet. To our knowledge, this is the first time that a trunk location is reported. MN should be included in the differential diagnosis of tumors on this location.

Efficacy and tolerance of superoxidized solution in the treatment of mild to moderate inflammatory acne. A double-blinded, placebo- controlled, parallel-group, randomized, clinical trial

Introduction: Superoxidized solution (SOS) is an electrochemically processed aqueous solution manufactured from pure water and sodium chloride. Inflammatory skin disorders have all improved their outcomes with the use of SOS. These indications suggest that SOS could be useful in acne. Methods: A total of 89 patients were enrolled in this double blinded, clinical trial. Patients presented with 10--50 inflammatory lesions (papules and pustules) and an absence of nodulocystic lesions. Results: Improvement was excellent in nine patients (23%) using SOS, compared with five patients (21%) using benzoyl peroxide (BP) (p = 0.378); good in 21 patients (54%) using SOS and 12 patients (50%) using BP (p = 0.794), compared with four patients (18%) taking placebo (p = 0.001); and fair in six patients (15%) using SOS and five patients (21%) using BP (p = 0.415), compared with 12 patients taking placebo (55%) (p = 0.014). In three patients using SOS (8%) the response was poor, compared with two patients (8%) using BP (p = 0.725) and six patients (27%) taking placebo (p = 0.075). We did not need to change a dose during the study period and no systemic effect was observed. Conclusions: We found that SOS is an important choice to treat inflammatory acne, comparable with benzoyl peroxide; however, a larger sample is needed.

Tacrolimus in confluent and reticulated papillomatosis of Gougerot Carteaud.

357–360. 2 Hamadah IR, Banka N. Autosomal recessive plasma cell panniculitis with morphea-like clinical manifestation. J Am Acad Dermatol 2006; 54(Suppl): 189–191. 3 Tomb R, Soutou B, Chehadi S. Plasma cell panniculitis: a histopathological variant of morphea profunda. Ann Dermatol Venereol 2009; 136: 256–259. 4 Falanga V, Lilloran CE. Morphea. In: Wolff K, Goldsmith LA, Katz SI, et al., eds. Fitzpatrick’s Dermatology in General Medicine, 7th edn. New York, NY: McGraw-Hill, 2008: 543–546. 5 Azad J, Dawn G, Shaffrali FC, et al. Does solitary morphea profunda progress? Clin Exp Dermatol 2004; 29: 25–27.

Majocchi’s Granuloma (Dermatophytic Granuloma): Updated Therapeutic Options

Majocchi’s granuloma (MG) is a rare, well-recognized, deep skin infection caused by dermatophyte, which can be seen in immunosuppressed as well as immunocompetent individuals. It is primarily caused by dermatophytes, most commonly Trichophyton rubrum; however, occasionally other Trichophyton sp., Trichosporon sp., Aspergillus sp., and Phoma sp. are involved. Diagnosis is based on clinical, mycological, and histological characteristics. This review focuses on clinical characteristics of MG and diagnosis and therapeutic options of MG.

Elevated interleukin-33 and soluble ST2 levels in the sera of patients with pemphigus vulgaris: correlation with clinical and immunological parameters during follow-up

DEAR EDITOR, Pemphigus vulgaris (PV), an autoimmune-mediated blistering disease of the skin and mucous membranes, is mediated by antidesmoglein (Dsg) 1 and/or 3 autoantibodies, leading to loss of cohesion between the keratinocytes in the epidermis. The exact molecular pathogenesis of the disease remains unclear; however, it seems that dysregulation of cytokine signalling may contribute to PV. Interleukin (IL)-33 and soluble ST2 (sST2), members of the IL-1 family, are predominantly found in the skin, lung, adipocytes and synovial fibroblasts. Both cytokines seem to have a considerable role in the regulation of inflammation, whereas excessive production contributes to the pathogenesis of autoimmune diseases. The aim of the present study was to assess the potential role of IL-33 and sST2 in PV, and to explore their possible relation with clinical features and immunological parameters. Sixty new and consecutive patients with active PV who were treatment-na€ıve or experiencing relapse, and 30 healthy ageand sex-matched, unrelated individuals entered the study. All patients gave written informed consent to the procedures. All patients underwent blood sampling, and IL-33 and sST2 serum levels were measured by the enzyme-linked immunosorbent assay (www.antibodies-online.com, Atlanta, GA, U.S.A.). Disease severity was determined according to the Pemphigus Vulgaris Activity Score (PVAS). The patients were arbitrarily categorized into two groups: (i) patients with mild disease (with a PVAS score of six out of 18 points) and (ii) patients with severe disease (with a PVAS score of ≥ 13 out of 18 points). To arrive at a reliable conclusion on the relationship between the severity of the disease and the serum levels of cytokines, patients with disease of a moderate severity (a PVAS score of 7–12 out of 18 points) were excluded. The levels of IL-33 and sST2 in patients with PV were significantly higher than healthy controls (P < 0 01 for both cytokines; Table 1). After 1 month of therapy, IL-33 and sST2 levels significantly decreased in all patients (Fig. 1); furthermore, 45 patients had decreased disease activity and 15 patients had moderate change compared with the first assessment. Significant changes in sST2 and IL-33 levels at the first and second evaluations among the 15 patients with moderate changes in disease severity were observed [sST2: 79 61 ;15 79 vs. 49 69 3 87 pg mL 1 (P < 0 01); IL-33: 625 42 94 54 vs. 429 07 42 95 pg mL 1 (P < 0 01)]. Similar results were seen in patients with marked changes in disease severity [IL-33: 462 49 116 3 vs. 264 7 102 23 pg mL 1 (P < 0 01); sST2: 71 08 16 32 vs. 39 79 6 21 pg mL 1 (P < 0 01)]. IL-33 and sST2 levels correlated with daily prednisone dose [r = 0 31 (P < 0 01) and r = 0 43 (P < 0 01), respectively]. Patients receiving prednisone 1 mg kg 1 daily had higher IL-33 and sST2 levels (585 32 92 3 and 84 56 12 14 pg mL , respectively) compared with those receiving < 1 mg kg 1 daily (433 21 87 6 and 53 21 12 15 pg mL , respectively). Patients with elevated anti-Dsg3 antibodies (> 150 IU mL ) had higher sST2 (75 98 15 35 pg mL ) and IL-33 levels (533 73 118 55 pg mL ) than those with lower anti-Dsg3 antibody levels [sST2: 62 14 16 84 pg mL 1 (P = 0 02); IL-33: 381 2 110 82 pg mL 1 (P < 0 01)]. Regression analysis using disease severity (a PVAS score > 13 or severe disease) as the dependent variable and sST2 and IL-33 as independent variables, after controlling for age, Table 1 Clinical, demographic and laboratory data