Yeray Peñate

Dermatologists in hospital wards: an 8-year study of dermatology consultations.

Background: The value of dermatologists as consultants is increasing. Objective: To evaluate the activity of dermatologists as inpatient consultants. Methods: Retrospective study of consultations to Dermatology of inpatients, visits per consultation, referral service, procedures performed, delay until visit and diagnoses based on ICD-9. Results: 3,144 requests generated 4,824 visits, 200 biopsies, 107 cultures and other procedures. The mean delay between request and visit was 0.75 days. The requesting service was recorded in 3,097 cases: 21.5% by Internal Medicine, 11.4% by Pediatrics, 8.3% by Neurology and 6.2% by the Infectious Diseases Unit. Follow-up was recommended in 12.4% by the Dermatology Service and in 8% by a dermatologist. Reliable diagnoses were recorded for 2,832 consultations. The most frequent diagnostic groups were diseases of the skin and subcutaneous tissue (ICD-9: 680–709) in 58%, infectious and parasitic diseases (ICD-9: 001–139) in 20%, and neoplasm (ICD-9: 140–239) in 5.7%. The most frequent diagnoses were contact dermatitis (ICD-9: 692.X) in 8.9%, drug reactions (ICD-9: 693.0) in 7.4%, candidiasis (ICD-9:112.X) in 7.1% and seborrheic dermatitis (ICD-9: 690) in 5.3%. Conclusions: Most diagnoses were of a specific cutaneous disease and the dermatologist would be in the best position to evaluate those that inpatients acquire.

Lupus eritematoso neonatal: 4 casos y revisión clínica

Resumen El lupus eritematoso neonatal (LEN) es una enfermedad poco frecuente del recien nacido debido al paso transplacentario de anticuerpos maternos anti-Ro/SSA, anti-La/SSB y/o anti-U 1 RNP en la que las afectaciones cutaneas y cardiacas son las mas destacadas. Realizamos un estudio retrospectivo de casos diagnosticados de LEN en los ultimos 10 anos en el Hospital Universitario Insular de Gran Canaria en el que se obtuvieron datos completes de 4 enfermos. En 3 casos se presentaron anticuerpos circulantes anti-Ro en la madre y en los neonatos, mientras que en el otro era anti-RNP. Dos madres estaban diagnosticadas de lupus sistemico, una de enfermedad mixta del tejido conjuntivo y otra de vasculitis leucocitoclastica. Las lesions cutaneas consistieron en lesiones urticariformes y descamativas. Un paciente presento ulceracion. El estudio histologico de las lesiones urticariformes mostro un infiltrado perivascular inespecifico; las lesiones descamativas fueron compatibles con lupus eritematoso subagudo.

Pediatric Dermatology Consultations: A Retrospective Analysis of Inpatient Consultations Referred to the Dermatology Service

Abstract:  To analyze the care provided by consultant dermatologists to hospitalized pediatric patients, we retrospectively studied the records of inpatient pediatric consultation requests received by a hospital dermatology department between 2000 and 2009. The diagnoses were recorded according to the International Classification of Diseases, Ninth Revision (ICD‐9). In a high percentage of cases, the problem was addressed in a single visit, and few additional tests were ordered. The most common diagnostic groups were diseases of the skin and subcutaneous tissue (ICD‐9: 680–709). The most frequent specific diagnosis was atopic dermatitis (ICD‐9: 691.8). Our series shows that the role of dermatologists as consultants for pediatric inpatients is similar to their role in outpatient consultations.

Bilateral areolar sebaceous hyperplasia in a female.

References 1 http://www.MedIndia.com/origin of yoga 2006. 2 Kahana M, Cohen M, Ronnen M, et al. Prayer nodules in Moslem men. Cutis 1986; 38: 281–282. 3 Roberts PJ, Katsimihas M, Wade RH. An interesting behavioural injury. Mecca Foot Foot Ankle Surg 2001; 7: 49–50. 4 Robertson JA. The hidden romance of the New Testament. http://www.katapi.org.uk/NTHiddenR/X.htm 2003. 5 Wollina U. Physikalisch und chemisch bedingte Erkrankungen [Physically and chemically induced diseases]. In: Braun-Falco O, Plewig G, Wolff HH, Burgdorf WHC, et al. eds. Dermatologie und Venerologie, 5th edn. Berlin, Heidelberg: Springer, 2005: 571–585.

Povidone‐iodine induced post‐surgical irritant contact dermatitis localized outside of the surgical incision area. Report of 27 cases and a literature review

Povidone–iodine solution is an antiseptic that is used worldwide as surgical paint and is considered to have a low irritant potential. Post‐surgical severe irritant dermatitis has been described after the misuse of this antiseptic in the surgical setting.

Generalized erythematous–violaceous plaques in a patient with a history of dyslipidemia

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Safety of Azathioprine Therapy Adjusted to Thiopurine Methyltransferase Activity in the Treatment of Infantile Atopic Dermatitis. Report on 7 Cases

BACKGROUND In a small number of cases of childhood atopic dermatitis, topical therapy is ineffective, necessitating prolonged use of systemic immunosuppressants. Over the last few years, a better understanding of the metabolic pathways involved in azathioprine breakdown has enabled us to use this drug more safely. In this study, we evaluated the toxicity of azathioprine treatment adjusted to thiopurine methyltransferase activity in children with severe atopic dermatitis. MATERIAL AND METHODS We performed a retrospective study of the side effects of azathioprine therapy adjusted to thiopurine methyltransferase activity in children aged under 14 years with atopic dermatitis who were treated in the dermatology department of Hospital Universitario Insular de Gran Canaria in Gran Canaria, Spain. Side effects were evaluated by analysis of leukocyte count and transaminase levels at baseline, after 1 month of treatment, and every 3 months thereafter. RESULTS During the last 4 years, 7 children (mean age, 10 years) with severe atopic dermatitis received azathioprine in our department. Mean duration of treatment was 12 months (range, 1 to 38 months). Only 2 patients presented mild transient leukopenia that did not require treatment to be suspended. DISCUSSION Our experience shows that, when adjusted to thiopurine methyltransferase activity, azathioprine is a safe drug for the treatment of children with severe atopic dermatitis. However, clinical trials should be performed to compare the risk-benefit ratios of the different immunosuppressants used to treat these patients.

Leflunomide in the Treatment of Palmoplantar Pustulosis

In 1995, a 30-year-old woman presented with a 6-day history of fever and pruritic pustules on her left hand. Physical examination revealed confluent pustules surrounded by erythema on the dorsal aspect of the left hand, palm, and wrist (Figure 1). There were no lesions in other locations. Her medical history was otherwise unremarkable. A complete laboratory blood cell count showed a slightly low white blood cell count (3600/μL [reference range, 4500-10 800/μL]; to convert to 10/L, multiply by 0.001). Findings from biochemical tests were within reference range. Cultures of the pustules were negative for organisms. Findings from skin biopsy specimens showed an intraepidermal pustule with mild acantholysis and moderate mononuclear infiltrate in dermis. A diagnosis of localized pustulosis was made. The patient was initially treated with topical and oral antibiotics with poor response. After a month, oral retinoids and topical steroids were added to her treatment, but the patient experienced new flares. Seven months after the onset of the process, she complained about arthralgias and chest and back pain. Imaging studies (radiography, computed axial tomography) revealed sacroileitis. A diagnosis of incomplete SAPHO syndrome (sacroileitis, acne, pustulosis, hyperostosis, osteitis) was made. Therapy was begun with methotrexate, 7.5 mg/wk, and the dosage was subsequently increased to 10 mg/wk. Two months later there was no improvement, so oral cyclosporine was added to her drug regimen but was poorly tolerated because of headache. During the following 4 years the patient subsequently failed treatment with sulfone, prednisone, colchicine, sulfasalazyn, and numerous nonsteroidal antiinflammatory drugs (NSAIDs).

Generalized erythematous-violaceous plaques in a patient with a history of dyslipidemia. Interstitial granulomatous drug reaction (IGDR).

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First-line treatment in lymphomatoid papulosis: a retrospective multicentre study

Data regarding response to treatment in lymphomatoid papulosis (LyP) are scarce.