Verónica Garza-Rodríguez

Acrodermatitis Enteropathica: A Novel SLC39A4 Gene Mutation in a Patient with Normal Zinc Levels.

Acrodermatitis enteropathica (AE) is a rare disease that results from a defective gene, SLC39A4, and is characterized by dermatitis, alopecia, and diarrhea. We report a case of AE presenting with only periorificial and acral dermatitis in which genetic testing revealed two novel compound heterozygous missense mutations for SLC39A4. This case demonstrates that not all AE mutations alter zinc transporters in the same manner and highlights the phenotypic variability of AE.

Pigmented purpura and cutaneous vascular occlusion syndromes

Purpura is defined as a visible hemorrhage in the skin or mucosa, which is not evanescent upon pressure. Proper classification allows a better patient approach due to its multiple diagnoses. Purpuras can be categorized by size, morphology, and other characteristics. The course varies according to the etiology, as do the diagnostic approach and treatment. This review discusses pigmented purpuras and some cutaneous vascular occlusion syndromes.Purpura is defined as a visible hemorrhage in the skin or mucosa, which is not evanescent upon pressure. Proper classification allows a better patient approach due to its multiple diagnoses. Purpuras can be categorized by size, morphology, and other characteristics. The course varies according to the etiology, as do the diagnostic approach and treatment. This review discusses pigmented purpuras and some cutaneous vascular occlusion syndromes.

Balloon Cell Melanoma and Its Metastasis, a Rare Entity

Balloon cell melanoma (BCM) with metastasis is a rarely occurring neoplasia. The incidence of BCM is low, and hence, the frequency of these lesions presenting metastasis is even less frequent. This review exposes the balloon cell metastasis cases that have been published and a new case. These cases share the histopathological features but the location of initial melanoma, age and sex vary. It is relevant for the dermatologist and dermatopathologist to keep in mind the diagnosis of BCM and consider the possibility of it metastasizing as nonpigmented skin lesions.

Basal cell carcinoma treated with Mohs micrographic surgery in young Ibero-American patients

The incidence of basal cell carcinoma (BCC) in younger individuals has increased in recent decades. However, the characteristics of BCCs in this population, especially in Ibero‐Latin American countries, have not been completely defined.

Dermoscopic features of acral melanocytic nevi in a case series from Mexico

Background Pigmented lesions on acral sites are common; clinical differentiation of nevi and early melanoma can be challenging. In these cases, dermoscopy can provide a more accurate diagnosis. Most dermoscopic patterns on acral skin have been described in Asian and European populations, while there are few studies in Latin American populations. Objectives To determine the frequency of pigmented lesions in volar skin and their dermoscopic patterns in a Mexican population. Methods: An observational, descriptive, cross-sectional study was performed in Hispanic patients with the presence of at least one pigmented lesion on acral skin. Clinical and dermoscopic images were obtained. These were subsequently evaluated independently by two dermatologists trained and experienced in dermoscopy. Results A total of 582 pigmented lesions on volar skin were diagnosed in 321 patients. Overall, prevalence of acral pigmented lesions on volar skin was 6.8%. For both observers, parallel furrows were the most frequent pattern described, but for observer 2, a lattice-like pattern was prevalent on the toes and a homogeneous pattern on the sides of the feet. There was lower inter-observer agreement, with a kappa index of 0.144. Study limitations The lesions were not biopsied, so clinical-histological correlation could not be performed. The study did not correlate dermoscopic patterns with age. Conclusions. As previously reported by other authors, parallel furrows were the most frequently found dermoscopic pattern on palmoplantar skin.BACKGROUND Pigmented lesions on acral sites are common; clinical differentiation of nevi and early melanoma can be challenging. In these cases, dermoscopy can provide a more accurate diagnosis. Most dermoscopic patterns on acral skin have been described in Asian and European populations, while there are few studies in Latin American populations. OBJECTIVES To determine the frequency of pigmented lesions in volar skin and their dermoscopic patterns in a Mexican population. METHODS An observational, descriptive, cross-sectional study was performed in Hispanic patients with the presence of at least one pigmented lesion on acral skin. Clinical and dermoscopic images were obtained. These were subsequently evaluated independently by two dermatologists trained and experienced in dermoscopy. RESULTS A total of 582 pigmented lesions on volar skin were diagnosed in 321 patients. Overall, prevalence of acral pigmented lesions on volar skin was 6.8%. For both observers, parallel furrows were the most frequent pattern described, but for observer 2, a lattice-like pattern was prevalent on the toes and a homogeneous pattern on the sides of the feet. There was lower inter-observer agreement, with a kappa index of 0.144. STUDY LIMITATIONS The lesions were not biopsied, so clinical-histological correlation could not be performed. The study did not correlate dermoscopic patterns with age. CONCLUSIONS As previously reported by other authors, parallel furrows were the most frequently found dermoscopic pattern on palmoplantar skin.

An Update on Calciphylaxis

Calciphylaxis, also known as calcific uremic arteriolopathy and uremic small artery disease with medial wall calcification and intimal hyperplasia, is a multifactorial cutaneous vascular disease characterized by chronic, painful, non-healing wounds that occur frequently in patients with chronic kidney disease, predominantly in those with end-stage renal disease. The pathogenesis remains unclear, and the development of calciphylaxis lesions depends on medial calcification, intimal fibrosis of arterioles and thrombotic occlusion. Despite an increase in reports of calciphylaxis in the literature and clinical recognition of demographic characteristics and risk factors associated with calciphylaxis, it remains a poorly understood disease with high morbidity and mortality. In this review, we analyze and summarize the clinical manifestations, pathogenesis and pathophysiology, histopathology, differential diagnosis, diagnostic workup and treatment modalities for calciphylaxis. Because of the lack of consensus regarding the optimal approach to and treatment of this disorder, a high degree of clinical suspicion, early diagnosis, and multimodal and multidisciplinary treatment in collaboration with dermatology, nephrology, wound care, nutrition and pain management specialties may improve survival in patients with calciphylaxis.

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?

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.